The human jaw, like all other articulated body parts, exhibits small oscillatory movements during isometric holding tasks. These movements, known as physiological tremor, arise as a consequence of the interaction of various factors. One of these factors is reflex feedback from peripheral receptors. In the human jaw, receptors that innervate the periodontium are able to transduce minute changes in force. This thesis examines the contribution of these periodontal mechanoreceptors (PMRs) to the genesis of physiological tremor of the human jaw. By using frequency domain analysis of time series recorded during isometric biting tasks, the character of physiological jaw tremor can be revealed. Physiological jaw tremor was observed in force recorded from between the teeth as well as from electromyograms recorded from the principal muscles of mastication. These recordings have shown us that jaw physiological tremor consists of a frequency invariant component between 6 and 10Hz. This frequency remains unaltered under various load conditions where the mechanical resonance of the jaw would be expected to vary greatly (Chapter 2). Such findings indicate a ‘neurogenic’ origin for this tremor. A possible candidate for this neurogenic component of physiological tremor in the jaw is the reflex feedback arising from the PMRs. Using local anaesthetisation, it has been shown in this thesis, that by blocking outflow from the PMRs, the amplitude of neurogenic physiological jaw tremor can be reduced dramatically. This procedure caused a dramatic reduction in not only the mechanical recordings of tremor but also in the coupling between masseteric muscles bilaterally (Chapter 3) and between single motor units recorded from within a homonymous muscle (Chapter 4). The obvious mechanism by which periodontal mechanoreceptor anaesthetisation could reduce the amplitude of physiological tremor in the jaw would be by reducing the amplitude of the oscillatory input to the motoneurones driving the tremor. This interpretation remains controversial however as physiological tremor in the jaw can be observed at force levels above which the PMRs are supposedly saturated in their response. In light of this knowledge, the saturating characteristics of these receptors in terms of reflex output were examined. To do this, a novel stimulation paradigm was devised whereby the incisal teeth were mechanically stimulated with identical stimulus waveforms superimposed upon increasing tooth preloads. This necessitated the use of a frequency response method to quantify the reflexes. An optimal frequency for stimulation was identified and used to confirm that the hyperbolic saturating response of PMRs observed previously, translated to a similar phenomenon in masticatory reflexes (Chapter 5). These data reinforced the idea that physiological tremor in the jaw was not just a consequence of rhythmic reflex input from PMRs, as the dynamic reflex response uncoupled from the input as the receptor-mediated reflex response saturated. An alternative hypothesis was then developed that suggested the effect of PMR suppression in physiological tremor was via tonic rather than rhythmic effects on the masseteric motoneurone pool. By utilising a novel contraction strategy to manipulate the mean firing rate of the motor neuron pool at a given level of force production, data contained in Chapter 6 shows that population motor unit firing statistics influence the expression of physiological tremor, and such manipulations mimic, to an extent, the changes in firing statistics and tremor amplitude seen during anaesthetisation of the PMRs. This thesis therefore posits a mechanism whereby periodontal input influences the firing rate of motoneurones in such a way as to promote tremulous activity (Chapter 5). However, as this proposed mechanism did not explain the full extent of tremor suppression seen during PMR anaesthetisation it can therefore only be considered a contributing factor in a multifactor process. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297555 / Thesis (Ph.D.) -- University of Adelaide, School of Molecular and Biomedical Science, 2007

Made available in DSpace on 2014-08-20T14:30:13Z (GMT). No. of bitstreams: 1 Tese_Silvia_Terra_Fontes.pdf: 622962 bytes, checksum: 7bf1877d5a2267c9c8ee6f9619480978 (MD5) Previous issue date: 2011-12-16 / During restorative procedures, different isolation methods of the operative field can be used to promote moisture control and retraction of the gingival tissues. The aim of the present clinical trial was to evaluate the effects of two isolation techniques on the clinical performance of Class V restorations, as well on the periodontal conditions of restored sites. Patients presenting at least two noncarious cervical lesions (NCLs) were enrolled in this study. The NCLs were randomized into the following groups: (1) isolation performed with rubber dam and gingival retraction clamp and (2) isolation provided with cotton rolls and gingival retraction cord. Both techniques were used with a saliva suction device. All restorative procedures were performed using a selfetching adhesive system and a nanofilled composite resin according to the manufacturer s instructions. The clinical performance of restorations was recorded in terms of fracture and retention of restoration, marginal adaptation, marginal staining, postoperative hypersensitivity, and preservation of tooth vitality at 1 week and 6 months after placement.The periodontal condition of restored sites was evaluated based on the presence of supragingival plaque, gingival marginal bleeding, probing depth, and relative gingival recession. Thirty patients were enrolled in the study, yielding a total of 136 restorations (68 restorations per group). At the 6-month followup, one restoration from the rubber dam group and three restorations from the cotton roll group lost retention. In this period, the highest incidence of small marginal defects was observed in the group isolated with cotton rolls (p= 0.01). Both groups showed a statistically significant increase in supragingival plaque at six months after restoration placement (p< 0.05). However, no significant differences were detected among the two groups tested with respect to any of the criteria used to evaluate the restorations or the periodontal condition (p> 0.05). Within the limits of this study, it can be concluded that both isolation techniques resulted in equally clinically acceptable restorations without producing negative effects on periodontal tissues / Durante os procedimentos restauradores, diferentes métodos de isolamento do campo operatório podem ser utilizados a fim de promover controle de umidade e retração de tecidos gengivais. O objetivo do presente ensaio clinico foi avaliar os efeitos de duas técnicas de isolamento no desempenho clínico de restaurações Classe V, bem como na condição periodontal dos sítios restaurados. Pacientes apresentando, no mínimo, duas lesões cervicais não cariosas (LCNCs) foram selecionados para este estudo. As LCNCs foram randomizadas nos seguintes grupos: (1) isolamento com lençol de borracha e grampo retrator de gengiva e (2) isolamento com rolos de algodão e fio retrator de gengiva. Um sugador de saliva foi utilizado em ambas as técnicas. Todos os procedimentos restauradores foram executados com sistema adesivo autocondicionante e compósito restaurador nanoparticulado, seguindo as instruções dos fabricantes. O desempenho clinico das restaurações foi avaliado em termos de fratura e retenção da restauração, adaptação marginal, manchamento marginal, sensibilidade pós-operatória e preservação da vitalidade pulpar após 1 semana e 6 meses da inserção das restaurações.A condição periodontal dos sítios restaurados foi avaliada com base na presença de placa supragengival, sangramento gengival marginal, profundidade de sondagem e recessão gengival relativa. Trinta pacientes foram incluídos no estudo, resultando num total de 136 restaurações (68 restaurações por grupo). Após seis meses de acompanhamento, uma restauração do grupo isolado com lençol de borracha e três restaurações do grupo isolado com rolos de algodão perderam a retenção. Neste período, uma maior incidência de pequenos defeitos marginais foi observada no grupo que recebeu isolamento com rolos de algodão (p= 0.01). Ambos os grupos apresentaram um aumento significativo do acúmulo de placa supragengival após 6 meses da inserção das restaurações (p< 0.05). Porém, não foram detectadas diferenças estatisticamente significativas entre os dois grupos testados considerando os critérios utilizados para avaliação das restaurações e da condição periodontal (p> 0.05). Dentro das limitações deste estudo, foi possível concluir que ambas as técnicas de isolamento resultaram em restaurações clinicamente aceitáveis, sem produzir efeitos negativos nos tecidos periodontais

This study deals with the mechanical aspects of human mandible in physiological state during the occlusion. The work is focused on evaluation of stress-strain conditions of bone tissue. The emphasis is paid to the interaction of teeth with the bone. In addition, contact pres-sures in temporomandibular joints during various loading conditions were determined. The analysis of material model of some parts of the system regarding their modelling-level is pre-sented as well. The problem concerning the evaluation of stress-strain states is solved by computational simulation using the finite element method. The presented work is a detailed analysis of the parts of the masticatory system and a thorough description of their modelling is presented. Special focus is paid to modelling of cancellous bone as well as of periodontal tissue which mediates the interaction between a tooth and the alveolar bone. Three-dimensional geometry of the mandible and all its teeth has been obtained by using the digitizing of real objects, namely by using of three-dimensional optical scanner. Three various modelling levels of the material of periodontium are assessed: Linear iso-tropic model, bilinear isotropic model and linear orthotropic model. Characteristics of these models are analyzed and especially nine new constants describing orthotropic model (which is almost absent in the literature) are proposed. Two-dimensional models are used for analysis of differencies in mechanical response of cancellous bone to the tooth loading. Two cases are considered: Cancellous bone as a ho-mogenous continuous model on one hand and with detailed trabeculous architecture model on the other. Computational model is divided into four basic cases varying in level of masticatory appa-ratus geometry: A – 2D geometry of bone; B – 3D geometry of bone segment with one tooth through three teeth; C – 3D geometry of whole mandible with the only tooth; D – 3D geome-try of whole mandible with all teeth. All basic cases are further researched in different varia-tions for different material models etc.

No description available.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A projeção de incisivos e expansão dos arcos dentários são uma alternativa valiosa à extração dentária, especialmente quando se considera a estética facial em pacientes adultos. O efeito da projeção ortodôntica dos incisivos inferiores sobre o periodonto é controverso devido às avaliações em exames bidimensionais e os aspectos multi-fatoriais que envolvem as recessões gengivais. O objetivo deste estudo foi comparar as modificações na altura da borda alveolar dos dentes ântero-inferiores de pacientes, que foram submetidos à projeção ortodôntica, com pacientes tratados sem projeção; e correlacionar estas modificações com o grau de inclinação dentária, com as alterações da distância bicanina e com o biotipo gengival. Pacientes adultos com mais de 3 mm de falta de espaço no arco inferior e curva de Spee moderada ou acentuada compuseram o grupo experimental (n=15). O grupo controle (n=7) consistiu de pacientes com bons arcos inferiores, que não necessitavam de grandes movimentos dentários. Estes pacientes foram submetidos a alinhamento e nivelamento dentário até o fio de aço .020". Tomografias computadorizadas de feixe cônico (TCFC) foram obtidas antes do tratamento e ao final da fase de alinhamento e nivelamento. As alturas das bordas alveolares (BA) de incisivos e caninos inferiores foram medidas nas TCFC em reconstruções 3D e comparadas entre os grupos e entre os tempos pelos testes-t de Student não pareado e pareado, respectivamente. As BA foram correlacionadas com o grau de inclinação dentária (IMPA), com a distância intercaninos (DIC) e com o biotipo gengival (BG) pelo teste de correlação de Pearson. Os resultados demonstraram que os caninos inferiores do grupo experimental apresentaram perda óssea significativa (p<0,005), quando comparados com o grupo controle, em média 2,5 mm. As BA dos dentes 43, 33 e 32 ao final do alinhamento e nivelamento eram significativamente maiores do que ao início do tratamento no grupo experimental (p<0,001). Não foram encontradas diferenças significativas entre as medidas iniciais e finais das BA de todos os dentes do grupo controle. Apesar destes resultados, não foram encontradas correlações entre a remodelação da BA e o IMPA, a DIC e o BG. Pode-se concluir que o aumento no comprimento do arco inferior com arcos ortodônticos contínuos aumenta a inclinação dos incisivos inferiores e a DIC. O aumento da DIC parece exercer maior efeito sobre a BA dos caninos inferiores do que a inclinação de incisivos sobre a BA dos incisivos inferiores. No entanto, as modificações da BA não estão associadas ao grau de inclinação dos incisivos, a quantidade de expansão do arco inferior e ao biotipo gengival. / Incisor proclination and dental arch expansion are a valuable choice of treatment instead of extraction, especially when considering facial aesthetics in adult patients. The effect of orthodontic projection of the lower incisors on the periodontium is controversial because of evaluation in two-dimensional exams and the multi factorial aspects of gingival recessions. The aim of this study was to compare alveolar height modifications in the lower arch of patients that were treated with orthodontic proclination, with patients treated without proclination, and correlate these modifications with the degree of dental projection, with the changes in the lower intercanine width and with gingival biotype. Adult patients with lower arch discrepancy of more than 3 mm and moderate or pronounced curve of Spee composed the experimental group (n=15). The control group (n=7) consisted of patients with good lower arches, that did not need large dental movements. These patients had their dental arches aligned and leveled up to a .020 wire. Cone beam computed tomography (CBCT) was taken before treatment and after leveling and alignment. The height of the alveolar border (AB) of the lower incisors and canines were measured on CBCT with 3D reconstruction, and compared between groups, and between times, by paired and independent Students t-test, respectively. The AB were correlated with the degree of dental inclination (IMPA), intercanine width (ICW) and gingival biotype (GB) by the Pearson correlation test. Results showed that the lower canines of the experimental group presented significant bone loss (p<0,005) when compared with the control group, with a mean of 2.5 mm. The AB of teeth 43, 33 and 32 at the end of alignment were significantly greater than at beginning of treatment for the experimental group (p<0,001). No significant differences were found between initial and final AB measurements for all control group teeth. Despite these results, no correlation was found between remodeling of AB and IMPA, ICW and GB. It can be concluded that the increase of lower arch length with continuous orthodontic archwires increases lower incisor inclination and ICW. The increase of the ICW seems to exert more effect over the AB of lower canines, than the incisor inclination over the AB of the incisors. However, AB modifications are not associated with the degree of incisors inclination, neither the amount of lower arch expansion, nor to the gingival biotype.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A projeção de incisivos e expansão dos arcos dentários são uma alternativa valiosa à extração dentária, especialmente quando se considera a estética facial em pacientes adultos. O efeito da projeção ortodôntica dos incisivos inferiores sobre o periodonto é controverso devido às avaliações em exames bidimensionais e os aspectos multi-fatoriais que envolvem as recessões gengivais. O objetivo deste estudo foi comparar as modificações na altura da borda alveolar dos dentes ântero-inferiores de pacientes, que foram submetidos à projeção ortodôntica, com pacientes tratados sem projeção; e correlacionar estas modificações com o grau de inclinação dentária, com as alterações da distância bicanina e com o biotipo gengival. Pacientes adultos com mais de 3 mm de falta de espaço no arco inferior e curva de Spee moderada ou acentuada compuseram o grupo experimental (n=15). O grupo controle (n=7) consistiu de pacientes com bons arcos inferiores, que não necessitavam de grandes movimentos dentários. Estes pacientes foram submetidos a alinhamento e nivelamento dentário até o fio de aço .020". Tomografias computadorizadas de feixe cônico (TCFC) foram obtidas antes do tratamento e ao final da fase de alinhamento e nivelamento. As alturas das bordas alveolares (BA) de incisivos e caninos inferiores foram medidas nas TCFC em reconstruções 3D e comparadas entre os grupos e entre os tempos pelos testes-t de Student não pareado e pareado, respectivamente. As BA foram correlacionadas com o grau de inclinação dentária (IMPA), com a distância intercaninos (DIC) e com o biotipo gengival (BG) pelo teste de correlação de Pearson. Os resultados demonstraram que os caninos inferiores do grupo experimental apresentaram perda óssea significativa (p<0,005), quando comparados com o grupo controle, em média 2,5 mm. As BA dos dentes 43, 33 e 32 ao final do alinhamento e nivelamento eram significativamente maiores do que ao início do tratamento no grupo experimental (p<0,001). Não foram encontradas diferenças significativas entre as medidas iniciais e finais das BA de todos os dentes do grupo controle. Apesar destes resultados, não foram encontradas correlações entre a remodelação da BA e o IMPA, a DIC e o BG. Pode-se concluir que o aumento no comprimento do arco inferior com arcos ortodônticos contínuos aumenta a inclinação dos incisivos inferiores e a DIC. O aumento da DIC parece exercer maior efeito sobre a BA dos caninos inferiores do que a inclinação de incisivos sobre a BA dos incisivos inferiores. No entanto, as modificações da BA não estão associadas ao grau de inclinação dos incisivos, a quantidade de expansão do arco inferior e ao biotipo gengival. / Incisor proclination and dental arch expansion are a valuable choice of treatment instead of extraction, especially when considering facial aesthetics in adult patients. The effect of orthodontic projection of the lower incisors on the periodontium is controversial because of evaluation in two-dimensional exams and the multi factorial aspects of gingival recessions. The aim of this study was to compare alveolar height modifications in the lower arch of patients that were treated with orthodontic proclination, with patients treated without proclination, and correlate these modifications with the degree of dental projection, with the changes in the lower intercanine width and with gingival biotype. Adult patients with lower arch discrepancy of more than 3 mm and moderate or pronounced curve of Spee composed the experimental group (n=15). The control group (n=7) consisted of patients with good lower arches, that did not need large dental movements. These patients had their dental arches aligned and leveled up to a .020 wire. Cone beam computed tomography (CBCT) was taken before treatment and after leveling and alignment. The height of the alveolar border (AB) of the lower incisors and canines were measured on CBCT with 3D reconstruction, and compared between groups, and between times, by paired and independent Students t-test, respectively. The AB were correlated with the degree of dental inclination (IMPA), intercanine width (ICW) and gingival biotype (GB) by the Pearson correlation test. Results showed that the lower canines of the experimental group presented significant bone loss (p<0,005) when compared with the control group, with a mean of 2.5 mm. The AB of teeth 43, 33 and 32 at the end of alignment were significantly greater than at beginning of treatment for the experimental group (p<0,001). No significant differences were found between initial and final AB measurements for all control group teeth. Despite these results, no correlation was found between remodeling of AB and IMPA, ICW and GB. It can be concluded that the increase of lower arch length with continuous orthodontic archwires increases lower incisor inclination and ICW. The increase of the ICW seems to exert more effect over the AB of lower canines, than the incisor inclination over the AB of the incisors. However, AB modifications are not associated with the degree of incisors inclination, neither the amount of lower arch expansion, nor to the gingival biotype.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Imagens de tomografia computadorizada (TC) permitem a visualização, sem distorções ou sobreposições, do complexo maxilo-facial, principalmente do osso alveolar. Estudos demonstraram boa reprodutibilidade e precisão da mensuração da altura da borda alveolar, todavia a influência da espessura óssea ainda é pouco descrita. Através da comparação com a mensuração direta, o objetivo deste estudo foi avaliar a precisão, reprodutibilidade e a influência da espessura óssea, na mensuração da altura da borda alveolar em imagens volumétricas e imagens bidimensionais multiplanares em TC de feixe cônico (TCFC) e em TC espiral (TCE). Utilizando 10 mandíbulas secas de humanos, 57 dentes anteriores foram tomografados em equipamentos iCAT (Imaging Science International, Hatfield, PA, EUA) e Brilliance 64 canais (Philips Eletronics, Eindhoven, Holanda), ambos utilizando voxels de 0,25 mm. Através de imagens volumétricas (3D) e imagens bidimensionais (2D) de cortes multiplanares, foi comparada a mensuração da altura da borda alveolar dessas imagens com a mensuração direta nas mandíbulas, feita por vestibular e lingual, por três avaliadores, com o auxílio de um paquímetro, totalizando 114 bordas alveolares medidas. Alta reprodutibilidade intra-avaliador (0,999 a 0,902) e interavaliador (0,998 e 0,868) foi observada através do índice de correlação intraclasse (ICC). Observou-se alta correlação entre a mensuração direta e indireta da altura da borda alveolar em imagens 2D, sendo r=0,923** e 0,916**, e em imagens 3D, com r=0,929** e 0,954*, em TCFC e TCE, respectivamente. Imagens 2D superestimam a altura da borda alveolar em 0,32 e 0,49 mm e imagens 3D em 0,34 e 0,30 mm, em TCFC e TCE respectivamente. Quando o osso alveolar apresenta espessura de no mínimo 0,6 mm a média da diferença entre medidas diretas e indiretas é de 0,16 e 0,28 mm em imagens 2D e de 0,12 e 0,03 mm em imagens 3D para TCFC e TCE respectivamente, sendo que 95% do limite de concordância varia de -0,46 a 0,79 mm e -0,32 a 0,88 mm em imagens 2D, e de -0,64 a 0,67 mm e -0,57 a 0,62 mm em imagens 3D, para TCFC e TCE respectivamente. Quando o osso alveolar é mais fino do que 0,6 mm a TC é imprecisa, pois 95% do limite de concordância variou de -1,74 a 5,42 mm e -1,64 a 5,42 mm em imagens 2D, e de -3,70 a 4,28 mm e -3,49 a 4,25 mm em imagens 3D, para TCFC e TCE respectivamente. Conclui-se que a mensuração da altura da borda alveolar através de imagens tomográficas apresenta alta reprodutibilidade, sendo que quando a borda alveolar apresenta pelo menos 0,6 mm, a precisão da mensuração é alta, todavia quando esta espessura é menor do que 0,6 mm a técnica é imprecisa. / Computerized tomogoraphy (CT) images allow for visualization, with no distortions or superimpostions, of the maxillo-facial complex, especially of the alveolar margins. Studies have demonstrated good reproducibility and precision of the alveolar bone height, however the influence of bone thickness is still scarcely described. The purpose of this study was, by comparing the direct measurement of alveolar bone height, to evaluate the precision, reproducibility and the influence of bone thickness on the same measurement in cone beam CT (CBCT) and spiral CT (SCT) volumetric and biplane images. Ten dry human mandibles, with a total of 57 anterior teeth were tomographed with an iCAT (Imaging Science International, Hatfield, PA, EUA) and a 64 channels Brilliance 64 tomograph (Philips Eletronics, Eindhoven, Holland), both using voxels of 0.25 mm. Alveolar bone height was measured on volumetric (3D) and bidimensional (2D) images of tomograms and compared with direct caliper measurements performed on the dry mandibles, on the buccal and lingual sides, by three raters in a total of 114 measurements. High intra-rater (0.999 a 0.902) and inter-rater (0.998 e 0.868) reproducibility was observed using the intraclass correlation coefficient (ICC). A high correlation was also observed between the direct and indirect measurements of alveolar bone height in 2D (r=0.923** e 0.916**), and 3D images (r=0.929** e 0.954*), for CBCT and SCT, respectively. Two-dimensional images overestimate alveolar bone height in 0.32 and 0.49 mm and 3D images in 0.34 and 0.30 mm, for CBCT and SCT, respectively. When alveolar bone thickness is at least 0.6 mm the mean difference is of 0.16 and 0.28 mm in 2D images and of 0.12 and 0.03 mm in 3D images for CBCT and SCT, respectively, with 95% limits of agreement ranging from -0.46 to 0.79 mm and -0.32 to 0.88 mm in 2D images, and of -0.64 to 0.67 mm and -0.57 to 0.62 mm in 3D images, for CBCT and SCT, respectively. When alveolar bone thickness is smaller than 0.6 mm CT evaluation is inaccurate, since 95% limits of agreement vary from -1.74 to 5.42 mm and -1.64 to 5.42 mm in 2D images, and from -3.70 to 4.28 mm and -3.49 to 4.25 mm on 3D images, for CBCT and SCT, respectively. It can be concluded that measurement of alveolar bone height on CT images presents high reproducibility. When alveolar bone thickness is greater than 0.6 mm measurement precision is high, and when this thickness is less than 0.6 mm the technique is inaccurate

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Imagens de tomografia computadorizada (TC) permitem a visualização, sem distorções ou sobreposições, do complexo maxilo-facial, principalmente do osso alveolar. Estudos demonstraram boa reprodutibilidade e precisão da mensuração da altura da borda alveolar, todavia a influência da espessura óssea ainda é pouco descrita. Através da comparação com a mensuração direta, o objetivo deste estudo foi avaliar a precisão, reprodutibilidade e a influência da espessura óssea, na mensuração da altura da borda alveolar em imagens volumétricas e imagens bidimensionais multiplanares em TC de feixe cônico (TCFC) e em TC espiral (TCE). Utilizando 10 mandíbulas secas de humanos, 57 dentes anteriores foram tomografados em equipamentos iCAT (Imaging Science International, Hatfield, PA, EUA) e Brilliance 64 canais (Philips Eletronics, Eindhoven, Holanda), ambos utilizando voxels de 0,25 mm. Através de imagens volumétricas (3D) e imagens bidimensionais (2D) de cortes multiplanares, foi comparada a mensuração da altura da borda alveolar dessas imagens com a mensuração direta nas mandíbulas, feita por vestibular e lingual, por três avaliadores, com o auxílio de um paquímetro, totalizando 114 bordas alveolares medidas. Alta reprodutibilidade intra-avaliador (0,999 a 0,902) e interavaliador (0,998 e 0,868) foi observada através do índice de correlação intraclasse (ICC). Observou-se alta correlação entre a mensuração direta e indireta da altura da borda alveolar em imagens 2D, sendo r=0,923** e 0,916**, e em imagens 3D, com r=0,929** e 0,954*, em TCFC e TCE, respectivamente. Imagens 2D superestimam a altura da borda alveolar em 0,32 e 0,49 mm e imagens 3D em 0,34 e 0,30 mm, em TCFC e TCE respectivamente. Quando o osso alveolar apresenta espessura de no mínimo 0,6 mm a média da diferença entre medidas diretas e indiretas é de 0,16 e 0,28 mm em imagens 2D e de 0,12 e 0,03 mm em imagens 3D para TCFC e TCE respectivamente, sendo que 95% do limite de concordância varia de -0,46 a 0,79 mm e -0,32 a 0,88 mm em imagens 2D, e de -0,64 a 0,67 mm e -0,57 a 0,62 mm em imagens 3D, para TCFC e TCE respectivamente. Quando o osso alveolar é mais fino do que 0,6 mm a TC é imprecisa, pois 95% do limite de concordância variou de -1,74 a 5,42 mm e -1,64 a 5,42 mm em imagens 2D, e de -3,70 a 4,28 mm e -3,49 a 4,25 mm em imagens 3D, para TCFC e TCE respectivamente. Conclui-se que a mensuração da altura da borda alveolar através de imagens tomográficas apresenta alta reprodutibilidade, sendo que quando a borda alveolar apresenta pelo menos 0,6 mm, a precisão da mensuração é alta, todavia quando esta espessura é menor do que 0,6 mm a técnica é imprecisa. / Computerized tomogoraphy (CT) images allow for visualization, with no distortions or superimpostions, of the maxillo-facial complex, especially of the alveolar margins. Studies have demonstrated good reproducibility and precision of the alveolar bone height, however the influence of bone thickness is still scarcely described. The purpose of this study was, by comparing the direct measurement of alveolar bone height, to evaluate the precision, reproducibility and the influence of bone thickness on the same measurement in cone beam CT (CBCT) and spiral CT (SCT) volumetric and biplane images. Ten dry human mandibles, with a total of 57 anterior teeth were tomographed with an iCAT (Imaging Science International, Hatfield, PA, EUA) and a 64 channels Brilliance 64 tomograph (Philips Eletronics, Eindhoven, Holland), both using voxels of 0.25 mm. Alveolar bone height was measured on volumetric (3D) and bidimensional (2D) images of tomograms and compared with direct caliper measurements performed on the dry mandibles, on the buccal and lingual sides, by three raters in a total of 114 measurements. High intra-rater (0.999 a 0.902) and inter-rater (0.998 e 0.868) reproducibility was observed using the intraclass correlation coefficient (ICC). A high correlation was also observed between the direct and indirect measurements of alveolar bone height in 2D (r=0.923** e 0.916**), and 3D images (r=0.929** e 0.954*), for CBCT and SCT, respectively. Two-dimensional images overestimate alveolar bone height in 0.32 and 0.49 mm and 3D images in 0.34 and 0.30 mm, for CBCT and SCT, respectively. When alveolar bone thickness is at least 0.6 mm the mean difference is of 0.16 and 0.28 mm in 2D images and of 0.12 and 0.03 mm in 3D images for CBCT and SCT, respectively, with 95% limits of agreement ranging from -0.46 to 0.79 mm and -0.32 to 0.88 mm in 2D images, and of -0.64 to 0.67 mm and -0.57 to 0.62 mm in 3D images, for CBCT and SCT, respectively. When alveolar bone thickness is smaller than 0.6 mm CT evaluation is inaccurate, since 95% limits of agreement vary from -1.74 to 5.42 mm and -1.64 to 5.42 mm in 2D images, and from -3.70 to 4.28 mm and -3.49 to 4.25 mm on 3D images, for CBCT and SCT, respectively. It can be concluded that measurement of alveolar bone height on CT images presents high reproducibility. When alveolar bone thickness is greater than 0.6 mm measurement precision is high, and when this thickness is less than 0.6 mm the technique is inaccurate

Le rachitisme vitamino-résistant hypophosphatémique (RVRH) est une maladie génétique rare causée par des mutations du gène PHEX. La perte de fonction de la protéine PHEX conduit à l’augmentation du FGF23, une hormone circulante qui agit sur le rein et entraîne une perte systémique de phosphate. Le squelette rachitique des patients atteints de RVRH présente des déformations osseuses et une ostéomalacie. La dentine hypominéralisée des patients est à l’origine d’abcès dentaires fréquents, mais le statut parodontal des patients RVRH est mal connu, de même que leur risque de développer une parodontite pouvant aboutir à la perte des dents. La fonction et le substrat de la protéine PHEX ne sont pas identifiés avec exactitude. Il a été montré in vitro que PHEX avait la capacité d’interagir et de dégrader des protéines membres de la famille des SIBLINGs comme MEPE ou OPN, toutes les deux impliquées dans la régulation de la minéralisation des tissus osseux et dentinaires, mais on ne sait pas si in vivo les défauts de minéralisation observés résultent principalement de l’hypophosphatémie systémique ou bien également des effets directs de l’absence de PHEX sur les protéines régulatrices de la minéralisation. L’objectif de cette thèse a consisté à s’intéresser à la physiopathologie du parodonte dans le RVRH ainsi qu’à déterminer quel était l’impact de la mutation de PHEX dans un modèle de biominéralisation humaine où les conditions de concentration en phosphate pouvaient être ajustées et normalisées. Nous avons d’abord analysé le statut parodontal de 34 patients RVRH dans une étude clinique cas-témoins et ainsi montré que les malades dont la supplémentation en phosphate et vitamine D était tardive ou incomplète présentaient une fréquence et une sévérité accrues de maladie parodontale. Le phénotype parodontal du RVRH a alors été étudié sur des échantillons humains et sur le modèle murin du RVRH, la souris HYP. Nous avons réalisé un modèle d’égression dentaire de façon à permettre une apposition du cément cellulaire, ainsi qu’un modèle de résorption et de réparation osseuses parodontales afin de caractériser l’impact du RVRH sur la physiopathologie parodontale. Nos résultats ont montré que le phénotype parodontal et sa physiopathologie étaient très perturbés dans le rachitisme vitamino-résistant hypophosphatémique et chez la souris HYP, nous avons aussi pu mettre en évidence que le rôle pathologique majeur joué par l’ostéopontine dans le tissu osseux au cours du RVRH ne pouvait pas être généralisé aux autres tissus minéralisés du parodonte. De façon à identifier le rôle de PHEX dans la minéralisation matricielle locale indépendamment de la phosphatémie systémique, nous avons ensemencé des matrices de collagène dense avec des cellules primaires humaines issues de patients RVRH comparés à des contrôles que nous avons cultivés pendant 24 jours en conditions ostéogéniques avec des concentrations en phosphate identiques. Nos résultats ont montré que malgré une concentration normale en phosphate, la perte de fonction de la protéine PHEX entraînait une diminution de la quantité et de la qualité de la phase minérale et une accumulation et une dégradation pathologiques de la protéine OPN. Les contributions originales de ce travail de thèse doctorale ont consisté à démontrer sur le plan clinique et biologique la susceptibilité accrue du rachitisme hypophosphatémique lié à l’X quant au risque de développer une maladie parodontale, ainsi qu’à apporter la preuve d’un rôle pathologique de l’absence de PHEX indépendant de la phosphatémie sur des cultures primaires humaines. / X-linked hypophosphatemia (XLH) is a rare X-linked dominant disorder caused by inactivating mutations in the PHEX gene. The impairment of PHEX protein leads to an increase in FGF23, a circulating factor that causes systemic loss of phosphate. The rachitic skeleton of patients with XLH displays short stature and osteomalacia. Dental defects include poorly mineralized dentin and spontaneous dental abscesses. Little is known about the periodontal condition of XLH and if patients are more prone to develop periodontitis, eventually leading to tooth loss. Although the exact function and substrate of PHEX are not known, it has been shown in vitro that PHEX could interact with SIBLING proteins such as MEPE or OPN, both involved in the regulation of bone and dentin mineralization, but it is not yet clear if the defects in the calcified extracellular matrices of XLH are caused by systemic hypophosphatemia only, or also by local consequences of the absence of PHEX. The aim of this doctoral dissertation was to explore the pathobiology of the XLH periodontium and to determine the impact of PHEX deficiency at the local level in a model of human biomineralization where phosphate supply could be adjusted and normalized. We first examined 34 adults with XLH in a case-control study and observed that periodontitis frequency and severity were increased in individuals with late or incomplete supplementation in phosphate and vitamin D analogs. The periodontium was then analyzed in XLH dental roots and further characterized in the Hyp mouse, the murine model of XLH. We performed a model of tooth movement adaptation leading to the formation of cellular cementum and a model of periodontal breakdown and repair to investigate the impact of XLH on the pathobiology of periodontal tissues. Our results showed strongly affected XLH/Hyp periodontal phenotype and impaired pathobiology and suggested that the key role played by OPN in bone could not be generalized to other periodontal mineralized tissues. In order to determine the role of PHEX in local human mineralization, dense collagen gels were seeded with primary human dental pulp cells harvested from XLH patients displaying PHEX mutations and age-matched healthy individuals. Cell-seeded gels were cultured up to 24 days under osteogenic conditions and controlled phosphate medium concentrations. Our results showed that despite normal phosphate concentrations, PHEX deficiency led to decreased quantity and quality of the mineral phase and a pathologic accumulation and processing of OPN. Overall the original contributions of this doctoral dissertation consist in the demonstration of a higher susceptibility of XLH patients to periodontitis and in the evidence of a local effect of PHEX deficiency in the pathologic intrinsic mineralization from XLH osteogenic cells.