Ageing Well, Ageing Productively
Oral Pathology /Oral Medicine
This department is primarily located at the Westmead Hospital Centre for Oral Health. Research work in cancer, wound healing, and cell biology is directed towards improving both the understanding of basic pathological processes and the management of disease. The departmental laboratories are very well equipped, allowing employment of a wide range of experimental methodologies to these varying projects including: tissue culture; light, con-focal, and electron microscopy; small and large animal experimentation; protein chemistry; molecular biology; and cell biology. A wide collaborative network provides access to further resources and expertise including mass spectrometry and micro-array technology.
Current projects include:
Work continues across the areas of: the anti-apoptotic activity of serum albumin; the inflammatory response of endothelium; the interaction of malignant cells with normal stromal cells, especially via 'cellular sipping'; and bony remodelling in tooth eruption and pathological processes. Related to Prof Zoellner's service as Association for the Promotion of Oral Health (APOH) chairman, collaborative research in areas of public health dentistry and the funding of dental services is also ongoing.
This Research Unit is located at Sydney Dental Hospital and is involved in studies of Dental Restorative Materials, Biomaterials and Biomechanics as well as normal and diseased teeth. As caries still affect the majority of the population these materials and their properties are of critical importance for effective dental restorative treatment.
The research unit has a number of major focuses which include the following:
Quantifying the spatial dependence of the micro-mechanical properties of teeth and the role of remnant proteins and peptides on their properties. This work also extends to hypoplastic enamel.
Evaluating the influence of caries on the micromechanical properties of enamel and dentine. This also includes quantifying mineral densities through natural and caries lesions plus exploring options for remineralisation of carious teeth.
Investigating the residual stresses associated with curing of composite resins and associated marginal failure.
Advanced dental ceramics for restorative applications.
Bone remodeling associated with dental restorative treatments including implants (with Engineering University of Sydney).
Characterisation of adhesion of dental materials.
Current projects include:
Quantification of adhesion and bonding of materials using classical fracture mechanics based concepts. This is being applied to a range of systems from porcelain bonded to zirconia to composites bonding to enamel and dentine.
Remineralisation of enamel and dentine. A range of strategies are being investigated with colleagues and students to effectively and verifiably repair carious lesions in enamel and dentine. This also relates to what restorative materials are most appropriate for minimal intervention dentistry.
Modeling of prosthodontic structures as well as bone remodeling. This is taking place with colleagues in Engineering (Prof Qing Li) and attempting to understand the basis for the loading of soft tissues has on the underlying hard tissue response.
Cell surface interactions. This research commenced during a visiting professorial appointment at the University of Freiburg.
This Research Unit is located at the Westmead Hospital Centre for Oral Health and is involved in the following studies:
(a) Temporomandibular disorders (TMDs) that are a painful, life-changing disorder severely affecting 5% of the population. Onset for TMD is generally in early adult life, the formation years for lifestyle stability. Symptoms vary in intensity from pain and clicking noises with jaw movement to an inability to chew or speak without intense, continuing pain.
The research unit is modelling normal jaw function through refined recordings of muscle activity and jaw movement in 3 dimensions as well as computer tomography and magnetic resonance imaging for studying the detailed structure of the jaw muscles. The same methodologies are being now applied to the study of jaw function in TMD patients to identify differences between TMD patients. This unique methodology will allow an assessment of the effectiveness of various commonly used treatments that have a variable success rate in the management of these debilitating disorders. The information should lead to a reduction of the burden that TMD causes on the health-care system.
Current projects include:
Predictors for the development of persistent musculoskeletalpain. A proportion of patients undergoing dental treatment develop persistent pain and this project aims to understand variables responsible for this transition.
Brain changes with chronic orofacial pain. This projects aims to understand better the nervous system activity for different forms of orofacial pain. This will provide a better understanding of underlying mechanisms of different pain conditions and may lead to the development of treatments targeting specific areas of the nervous system.
Muscle retraining in the jaw system. Pain typically results in different muscle activity. The aim is to better understand the interaction between pain and muscle activity and to determine possible ways to retrain muscle activity to reduce pain and/or improve jaw function.
Biopsychosocial impact of acute and chronic jaw muscle pain. Several projects are investigating the afferent and efferent mechanisms involved in the perception of pain under various psychological constructs. The current projects are providing information to determine how acute pain, known to be a survival cue, has different psychophysiological properties to the perception of chronic pain. Areas of study include models of homeostatis and diathesis, pain catastrophizing, QST, stressand mood disorders.
Translational clinical research. Projects involving patients attending the Orofacial Pain Clinic at WCOH are providing patient-specific data through clinical assessments and psychosocial profiling with the aim of improving diagnosis and management at the individual level.
Key researchers in this area are:
Professor Iven Klineberg - Head of Unit - AM RFD, BSc MDS, PhD, FRACDS, FDSRCS
Professor Greg Murray PhD, BDS, MDS, FRACDS
Professor Chris Peck PhD, BDS, MScDent, GradDipScMed(Pain)
(b) Oral rehabilitation with implants in adult cases
(i) As a component of restoration of oral and cerebral functionas well as quality of life and psychosocial wellbeing. Brain imaging in association with oral rehabilitation with implant application to transform functional and aesthetic parameters is providing insights into adaptation and management of change. Collaboration has ben developed with the Brain DynamicsCenter, Wesmead Hospital and The University of Sydney and MRI Unit, Wesmead Hospital.
(ii) Ectodermal Dysplasia (oligodontia, hypodontia and anodontia) and in particular in younger patients with this condition. This syndrome affects a small population but has a severe influence causing suffering and psychosocial impairment with its greatest impact in cases of anodontia.
The research has developed an international consensus co-ordinated by the Sydney team with 10 teams from the USA, UH, HK, France, Sweden, on optimising the clinical protocol for case management of young patients with this condition as a forerunner of a multicentre clinical study.
Interdisciplinary studies have included animal studies, undertaken as a component of clinical case management on use of blood derived PRF to enhance implant integration both for general implant purposes and for management of ED cases; and application of bioscaffold augmentation of bone at potential oral implant sites for volumetric expansion to accommodate implants in augumented bone in ED to address bone limitations and the implications for aesthetics.
As part of a long term follow-up of implant cases microstructural, histochemical and immunochemical analyses have commenced on bone trefined at oral implant sites as a correlate of implant outcomes.
Key researchers in this area are:
Professor Iven Klineberg - Project co-ordinator
Dr Lavier Gomes - Head MRI Unit, Westmead Hospital
Dr Mayuresh Korgaonkar - Brain Dynamics Centre
Research in the discipline in recent years has been multi-facetted. Efficient mechanics of tooth movement are being examined to improve our understanding of the processes of tooth movement. The effects of orthodontic therapy on biological tissues are being analysed to gain a greater understanding of the physiological and pathological processes that occur in orthodontic treatment. High-precision indentation and scanning methods have been developed to analyse the spatial variation of the mechanical properties of teeth. This work has now been extended to relate the change of physical and chemical as well as structural properties of cementum in different areas of the root surface when different amounts of orthodontic forces are applied. Target genes and receptors involved in the control of tooth movement and resorption are being studied. In the area of the management of obstructive sleep apnoea using oral appliances the discipline is one of the leading institutions. A series of studies has been undertaken on the effects of the mandibular advancement splints on the management of obstructive sleep apnoea. The discipline is also active in studies that have shown that magnetic and electromagnetic fields can accelerate bone repair as well as soft tissue healing. The discipline is also improving appliance design and is analyzing the effectiveness and efficacy of appliances. Clinical studies on newly designed mandibular growth modification appliances are being trialed.
Key Researcher is:
Professor Ali Darendeliler - Head of Unit - BDS, PhD, MDSc (Ortho)
Environmental Oral Health
Current projects in this department include determining the relationship between metal concentrations in teeth and other biological media and environmental samples. Health outcomes previously linked with metals of interest will also be measured to assess whether the tooth biomarker is able to predict a well-established exposure-disease relationship.
Exposure to metal toxicants remains a major public health issue in Australia and globally with a substantial body of evidence supporting their role in a range of disorders, including cardiovascular disease, neurodevelopmental deficits and cancer. Many metals, including arsenic, lead and manganese, readily cross the placental barrier which is concerning as developing foetal organs, particularly the brain, are much more susceptible to injury caused by toxic agents than an adult brain. The major barrier in studying adverse intrauterine effects of toxicants and the exact time period of highest vulnerability in humans is the inability to directly measure foetal exposure at different stages of development.
In human primary teeth mineralization begins prenatally between the 14th and 18th gestational weeks and occurs in a rhythmic manner creating incremental lines, like growth rings in a tree. In addition, a histological landmark known as the neonatal line is formed at the time of birth. This allows us to demarcate pre- and postnatally formed parts of the tooth. Many metal toxicants accumulate in teeth and using a spatial elemental analysis tool like LA-ICP-MS we can assess exposure based on magnitude and timing and therefore identify critical periods of susceptibility.