[Effects of surface potentials of tooth hard tissue on bone remodeling in rabbit tibiae]

OBJECTIVE

To investigate the influence of surface potentials of tooth hard tissue on bone remodeling.

METHODS

After insured the surface potentials of human extracted teeth with electrochemical methods, teeth sections and artificial hydroxyapatite were implanted into 25 rabbits' tibiae. The rabbits were sacrificed at 1, 2, 4, 6 and 8 weeks after implantation, respectively. The bone regeneration was compared between opposite two sides (cathode side and anode side) of tooth sections using hematoxylin-eosin (HE) staining, tartrate-resistant acid phosphatase (TRAP) activity detecting and tetracycline tracing method.

RESULTS

Resorption lacunae was seen in the tibiae facing to the enamel anode and new bone density in the implant bed near the cathode of tooth samples was much higher than that near the anode, while the number of TRAP positive cells near the cathode was smaller than that near the anode (P < 0.01). The fluorescent area of tetracycline tracing near the cathode was larger than that near the anode (P < 0.05).

CONCLUSIONS

The cathode of tooth hard tissue (cementum) could improve or trigger new bone formation, while the other side, anode (enamel), could improve the bone resorption. This study suggests that tooth hard tissue's electrochemical characteristic might affect the remodeling of alveolar bone, and tooth supraeruption and the alveolar bone loss after tooth extraction might result from the redundant or lack of root electrochemical stimulation to bone.

Marker of cemento-periodontal ligament junction associated with periodontal regeneration

OBJECTIVE

The purpose of this study was to identify factors promoting formation of the cemento-periodontal ligament junction.

BACKGROUND

Regeneration of the cemento-periodontal ligament junction is an important factor in recovery of the connective tissue attachment to the cementum and it is important to identify all specific substances that promote its formation. To clarify the substances involved in cemento-periodontal ligament junction formation, we produced a monoclonal antibody (mAb) to human cemento-periodontal ligament junction (designated as the anti-TAP mAb) and examined its immunostaining properties and reactive antigen.

METHODS

Hybridomas producing monoclonal antibody against human cemento-periodontal ligament junction antigens were established by fusing P3U1 mouse myeloma cells with spleen cells from BALB/c mice immunized with homogenized human cemento-periodontal ligament junction. The mAb, the anti-TAP mAb for cemento-periodontal ligament junction, was then isolated. The immunoglobulin class and light chain of the mAb were examined using an isotyping kit. Before immunostaining, antigen determination using an enzymatic method or heating was conducted. Human teeth, hard tissue-forming lesions, and animal tissues were immunostained by the anti-TAP mAb.

RESULTS

The anti-TAP mAb was positive in human cemento-periodontal ligament junction and predentin but negative in all other human and animal tissues examined. In the cemento-osseous lesions, the anti-TAP mAb was positive in the peripheral area of the cementum and cementum-like hard tissues and not in the bone and bone-like tissues. The anti-TAP mAb showed IgM (kappa) and recognized phosphoprotein.

CONCLUSION

The anti-TAP mAb is potentially useful for developing new agents promoting cementogenesis and periodontal regeneration.

Effect of Cyclosporin A on the Mineral Apposition Rate of Cementum and Dentin in Growing Rats

BACKGROUND

Since there is no direct information to verify whether cyclosporin A (CsA) can affect the mineralization of dental hard tissue, the formation of dentin and cementum in growing rats was recorded by labeling the mineral phase of these tissues with fluorochrome marker in this study.

METHODS

After the extraction of the right maxillary molars, 30 male 3-week-old Sprague-Dawley rats were assigned to two groups. Following a 2-week healing period, the experimental rats received 30 mg/kg CsA daily for 7 weeks, while the control rats received only mineral oil. The fluorescent markers, calcein and alizarin red, were given on alternate weeks for 7 weeks. At the end of study, the mandibles were obtained and undemineralized sections were processed. Serial sections, 8 microm thick, were cut for the entire distal roots of the first molars. Five central sections were selected to determine the mineral apposition of cellular cementum and dentin at the apex and middle of root, respectively.

RESULTS

The apposition rates of apical cellular cementum were significantly influenced by CsA therapy, occlusal function, and observation duration. However, the dentin apposition rates were significantly influenced by the observation intervals only.

CONCLUSIONS

In this study, CsA therapy and occlusal function significantly influenced the apposition rates of apical cementum, but not the rates of mid-root dentin. Our hypothesis that CsA can induce oral hard tissue alterations, as well as gingival overgrowth, is demonstrated.

Periapical Tissue Responses and Cementum Regeneration with Amalgam, SuperEBA, and MTA as Root-End Filling Materials

The purpose of this study was to compare the periapical tissue responses and cementum regeneration in response to three widely used root-end filling materials, amalgam, SuperEBA, and Mineral Trioxide Aggregate (MTA). These materials were placed using modern microsurgical techniques on endodontically treated dog premolars and molars. After 5 months, the cell and tissue reactions of surface-stained un-decalcified ground sections were evaluated by light microscopy and statistically analyzed. The major difference in the tissue responses to the three retrofilling materials were the degree of inflammation and types of inflammatory cells, number of fibrous capsule formations, cementum neoformation over these materials, osseous healing and resulting periodontal ligament thickness. MTA showed the most favorable periapical tissue response, with neoformation of cemental coverage over MTA. SuperEBA was superior to amalgam as a root-end filling material.

Cyclosporin A promotes mineralization by human cementoblastoma-derived cells in culture

OBJECTIVE

The immunosuppressive drug cyclosporin A has been shown to induce cementum deposition in vivo in experimental animals. Using cementoblastoma-derived cells, we have studied whether this drug will be useful to study cementum mineralization and differentiation in vitro.

METHODS

Human cementoblastoma cells and gingival fibroblasts (controls) were cultured and treated with 0.5, 1.0 and 5.0 microg/ml of cyclosporin A. Cell proliferation was evaluated by MTT (tetrazolium) assay and cell number, and cell viability was assessed by trypan blue dye exclusion. Induction of mineralization was evaluated by alizarin red S staining to detect mineralized nodules and by reverse transcription-polymerase chain reaction (RT-PCR) to assess the expression of bone differentiation markers alkaline phosphatase, osteocalcin, bone sialoprotein and core-binding factor a1 (Cbfa1).

RESULTS

Cyclosporin A at 5.0 microg/ml concentration reduced significantly the increase in the number of cementoblastoma cells. A dose-dependent increase in the number of mineralized nodules occurred in cultures of cementoblastoma-derived cells treated with cyclosporin A, and RT-PCR analyses showed significantly higher levels of expression of alkaline phosphatase, bone sialoprotein, type I collagen, matrix metalloproteinase-1, osteocalcin, osteopontin, and Cbfa1. Human gingival fibroblast proliferation and cell number were not affected. Mineralized nodules were not detected in gingival fibroblasts and bone specific proteins were not expressed.

CONCLUSIONS

Presence of cyclosporin A during 14-day culture period appears to suppress the proliferation of cementoblastoma cells and induce the formation mineralized-like tissue by these cells.

Clinical and histologic evaluation of an enamel matrix protein derivative combined with a bioactive glass for the treatment of intrabony periodontal defects in humans

The present study clinically and histologically evaluated healing of human intrabony defects following treatment with a combination of enamel matrix derivative (EMD) and bioactive glass (BG) or BG alone. Six patients displaying either combined one- and two-walled (five patients) or three-walled (one patient) intrabony defects around teeth scheduled for extraction were included. A notch was placed at the most apical extent of the calculus on the root surface to serve as a reference. Six months after surgery, the teeth or roots were extracted, together with some of their surrounding soft and hard tissues, and processed for histologic evaluation; a gain of clinical attachment was found in all cases. Healing in all three defects treated with EMD + BG was mainly characterized by new cementum with inserting collagen fibers and new periodontal ligament; most graft particles were surrounded by bone-like tissue, indicating ongoing mineralization. Treatment with BG resulted in epithelial down-growth and connective tissue encapsulation of the graft material in all three specimens. Reformation of cementum and periodontal ligament was observed in one of the specimens, limited to the most apical part of the defect. Formation of bone-like tissue around the graft particles was observed in only one of the three specimens treated with BG. Direct contact between the BG particles and root surface (cementum or dentin) was not observed in any of the six specimens. BG alone has low potential to facilitate periodontal regeneration. However, EMD + BG resulted in formation of new cementum with an associated periodontal ligament, as well as enhanced mineralization around the BG particles.

Physical properties of root cementum: Part 3. Hardness and elastic modulus after application of light and heavy forces

BACKGROUND

The aims of this investigation were to evaluate the hardness and elastic modulus of untreated human premolar cementum and to investigate the changes after application of light and heavy orthodontic forces.

METHODS

Thirty-six maxillary and mandibular first premolars were collected from 16 prospective orthodontic patients. The patients were assigned to 1 of 2 groups. Group I (light force) consisted of 8 subjects (4 male, 4 female, mean age 14.8 years) who had 25 g of buccally directed orthodontic force applied to the first premolars on 1 side. Group II (heavy force) consisted of 9 subjects (7 male, 2 female, mean age 13.8 years) who had 225 g of buccally directed orthodontic force applied to first premolars on 1 side. Contralateral premolars served as the control in both groups. The force was applied for 4 weeks; then each first premolar was extracted and stored in deionized water. Physical properties were tested on unprepared cementum on buccal and lingual surfaces at the cervical, middle, and apical thirds with an ultra-micro-indentation system.

RESULTS

Mean (+/- standard deviation) hardness of the untreated cementum at the cervical, middle, and apical thirds, respectively, was 0.25 +/- 0.09 GPa, 0.24 +/- 0.07 GPa, and 0.18 +/- 0.06 GPa on the buccal surface and 0.24 +/- 0.08 GPa, 0.24 +/- 0.06 GPa, and 0.21 +/- 0.06 GPa on the lingual surface. Mean elastic modulus at the cervical, middle, and apical thirds, respectively, was 4.4 +/- 2.4 GPa, 3.4 +/- 2.0 GPa, and 2.4 +/- 1.8GPa on the buccal surface and 3.8 +/- 2.1 GPa, 3.2 +/- 1.4 GPa, and 2.4 +/- 1.5 GPa on the lingual surface.

CONCLUSIONS

The mean hardness and elastic modulus of untreated human premolar cementum gradually decreased from cervical to apical regions of the buccal and lingual surfaces. A similar decrease was observed in the experimental teeth of light-force and heavy-force groups. There were no statistically significant differences between the control and experimental teeth; this is probably due to large intraindividual variation.

Bones, teeth, and genes: a genomic homage to Harry Sicher's "Axial Movement of Teeth"

AIM

The model of the unopposed rodent molar was used to study the morphologic and genetic mechanisms of tooth eruption.

METHODS

Left maxillary molar teeth of 12-day-old Swiss-Webster mice were extracted under anesthesia, and mandibular molars were allowed to supererupt. To trace areas of tissue remodeling and to determine areas of new tissue formation, mice were injected with fluorescent dyes, tetracycline, alizarin red, and calcein blue. Subsequent to sacrifice, mandibular tissue blocks were prepared for ultrathin ground sections, fluorescent microscopy, and von Kossa's mineral detection procedure. A second set of specimens was prepared for RNA extraction and microarray analysis.

RESULTS

The data established significant eruption of first and second mandibular mouse molars 12 days after complete extraction of antagonists, exceeding the control side by 0.13 mm. Labeled tissue sections revealed significant amounts of new bone and cementum apposition on the unopposed side compared to the control side, as revealed by fluorescent markers and ultrathin ground sections. Microarray transcript level comparisons between the experimental and the control groups demonstrated significant (more than twofold) increase in gene expression of elastin and tenascin C extracellular matrix proteins; brevican, lumican, and biglycan proteoglycans; as well as fibroblast growth factor 9.

CONCLUSION

In this study, the authors have established the unopposed mouse molar as a model to study tissue dynamics during the axial movement of teeth. The data indicated significant new formation of bone and cementum in tandem with increased expression of extracellular matrix-related genes.

Role of Hertwig's epithelial root sheath cells in tooth root development

During tooth development, after the completion of crown formation, the apical mesenchyme forms the developing periodontium while the inner and outer enamel epithelia fuse below the level of the crown cervical margin to produce a bilayered epithelial sheath termed Hertwig's epithelial root sheath (HERS). The role of HERS cells in root formation is widely accepted; however, the precise function of these cells remains controversial. Functions suggested have ranged from structural (subdivide the dental ectomesenchymal tissues into dental papilla and dental follicle), regulators of timing of root development, inducers of mesenchymal cell differentiation into odontoblasts and cementoblasts, to cementoblast cell precursors. The characterization of the HERS phenotype has been hindered by the small amount of tissue present at a given time during root formation. In this study, we report the establishment of an immortal HERS-derived cell line that can be maintained in culture and then induced to differentiate in vitro. Characterization of the HERS phenotype using reverse transcriptase-polymerase chain reaction and Western blot immunostaining suggests that HERS cells initially synthesize and secrete some enamel-related proteins such as ameloblastin, and then these cells appear to change their morphology and produce a mineralized extracellular matrix resembling acellular cementum. These studies suggest that the acellular and cellular cementum are synthesized by two different types of cells, the first one by HERS-derived cementoblasts and the later by neural crest-derived cementoblasts.

The effect of sample preparation technique on determination of structure and nanomechanical properties of human cementum hard tissue

The mechanical properties of a tissue can be evaluated by determining the response of the structure to mechanical loading. This can be accomplished only when the tissue has been prepared with minimum to no artifacts, thus preserving its structure. In this study it was hypothesized that the structure of cementum is inhomogeneous, contributing to a significant variation in mechanical properties of cementum. Therefore, the goals of the study were to identify potential artifacts generated by conventional sample preparation techniques such as polishing and ultrasectioning and subsequently characterize the prepared specimens using an atomic force microscope (AFM) and an AFM-nanoindenter. Comparisons between cryofractured, ultrasectioned and polished specimens concluded that ultrasectioned surfaces have significantly lower average surface roughness 'R(a)' (p<0.05). Microstructure of ultrasectioned specimens characterized using an AFM illustrated Sharpey's fibers (SF) and intrinsic fibers (IF) running perpendicular and parallel to the root surface similar to the observed microstructure of cryofractured cementum. In addition, a 10-50 microm wide cementum dentin junction (CDJ) was distinctly observed in the ultrasectioned specimens but not in polished specimens. The SF and CDJ illustrated relatively higher levels of hydrophilicity under wet conditions. The observed inhomogeneous microstructure of the ultrasectioned specimens led to a broader range of nanomechanical properties (modulus: 14.2-25.9 GPa; hardness: 0.48-1.09 GPa). However, masking of the same regions such as SF and CDJ due to smeared cementum in polished specimens resulted in a narrower range of nanomechanical properties (modulus: 18.2-20.8 GPa; hardness: 0.79-0.89 GPa). This effect is most noticeable under wet conditions for ultrasectioned specimens (modulus 2.6-10.9 GPa; hardness 0.05-0.30 GPa) compared to the polished specimens (modulus 12.2-14.5 GPa; hardness 0.33-0.45 GPa). Cementum also was shown to be highly viscoelastic, especially when hydrated. The results suggest ultrasectioning of cementum was superior to polishing preparation technique since it allowed visualization of cementum structures similar to cryofractured specimens while providing a flat surface necessary for AFM-based nanoindentation techniques. Additionally, the structural inhomogeneity observed within ultrasectioned cementum contributed to a broader range of mechanical properties.

Histologic evaluation of demineralized freeze-dried bone allografts in barrier membrane covered periodontal fenestration wounds and ectopic sites in dogs

BACKGROUND/AIM

The aim of this study was to investigate healing responses to demineralized freeze-dried bone powder allografts in standardized periodontal fenestration defects, compared with subcutaneous wounds in a dog model.

METHODS

Circular periodontal fenestration defects were created buccally at all four canines in 14 mongrel dogs. Each site received one of the following underneath a barrier membrane: (a) ethylene oxide (EO)-sterilized demineralized freeze-dried bone allografts (DFDBA), (b) heat-treated DFDBA, (c) non-sterilized DFDBA and (d) ungrafted control. Twelve of the 14 dogs had three subcutaneous chest wall pouches created and one of the three DFDBA materials placed in each. The animals were necropsied at 4 weeks. Histologic sections were prepared through the center of the fenestration sites in an apico-coronal direction. Quantitative analysis using computer-assisted imaging technique was performed. Subcutaneous implants were evaluated histologically and quantified for associated inflammatory cell infiltrate.

RESULTS

Fenestration defects healed by partial osseous fill and cementum regeneration with formation of a periodontal ligament. The graft particles generally appeared isolated from the site of osteogenesis and covered by cementum-like substance. Graft particles incorporated into newly formed bone at a distance from the root surface was the exception. No statistically significant differences in new bone formation were observed between treatment groups within animals, but significant inter-animal variation was found (p<0.01). Quantities of retained graft particles were limited, and without cellular resorption. A bone augmentation effect was associated with the barrier in the majority of sites. No bone formation was evident at the subcutaneous sites where graft particles displayed distinctly modified surface zones and multinucleated giant cell resorption. Significantly more inflammatory infiltrate was associated with EO-sterilized grafts compared with heat-treated grafts (p=0.05).

CONCLUSION

Implantation of DFDBA neither enhanced osseous healing in periodontal fenestration defects, nor resulted in ectopic bone induction. DFDBA particles implanted in either periodontal fenestration or subcutaneous wounds evoked distinctly different healing responses.

Cementum engineering with three-dimensional polymer scaffolds

Cloned cementoblasts (OCCMs), periodontal ligament fibroblasts (SV-PDLs), and dental follicle (SV-F) cells obtained from mice were used as a tool to study periodontal tissue engineering. OCCM, SV-PDL, and SV-F cells were seeded onto three-dimensional poly lactic-co-glycolic acid (PLGA) scaffolds and cultured with the use of bioreactors or implanted subcutaneously in severe combined immune deficiency (SCID) mice for up to 6 weeks. We explored the behavior of these cells in porous PLGA sponges by cell growth, expression of mineral-associated genes using reverse transcriptase polymerase chain reaction, and mineralization by histologic analysis in vitro and in vivo. Results indicated that cells attached to PLGA scaffolds under either static or dynamic conditions in vitro. Only OCCM implants, retrieved from both in vitro bioreactors and SCID mice at 3-and 6-weeks post-cell implantation exhibited mineral formation. Types I and XII collagens, osteocalcin, and bone sialoprotein genes were detected in all implants retrieved from SCID mice. These results suggest that delivery of selected cells via PLGA scaffolds may serve as a viable approach for promoting periodontal tissue regeneration.

Mechanical stress generated by orthodontic forces on apical root cementum: a finite element model

OBJECTIVES

1) To determine the mechanical stress generated at the root apex during different types of tooth movement using a finite element model of an ideal, human maxillary central incisor. 2) To determine the relationship of thickness of cementum and the magnitude of mechanical stress at the root apex.

DESIGN

Computer simulation.

SETTING AND SAMPLE POPULATION

Not applicable, computer simulation.

EXPERIMENTAL VARIABLES

Tooth and investing tissue layers (enamel, dentin, cementum, pulp, periodontal ligament, and alveolar bone).

OUTCOME MEASURE

Von Mises and maximum principal stresses.

RESULTS

Increasing the apical thickness of cementum increases the amount of mechanical stress.

CONCLUSION

A finite element model incorporating all layers of a human maxillary central incisor has been developed. This model was used to determine the location and magnitude of mechanical stress generated for all regions of the tooth, PDL, and enclosed alveolar bone, when orthodontic forces are applied to the tooth. Mechanical stresses were found to increase at the root apex with increasing thickness of apical cementum.

Periodontal regeneration of transplanted rat molars after cryopreservation

The effects of cryopreservation on periodontal regeneration of transplanted rat molars were investigated histologically and histochemically in rats. Bilateral first and second maxillary molars of 4-week-old Wistar rats were gently extracted and transplanted into the abdominal subcutaneous connective tissue immediately or after cryopreservation in liquid nitrogen overnight. Donor teeth were slowly frozen by a rate-controlling freezer (program freezer) using 5% dimethylsulfoxide (DMSO) and 6% hydroxyethyl starch (HES) as cryoprotectants. One-four weeks after transplantation, they were carefully excised with the surrounding tissues. Regeneration of acellular cementum, periodontal ligament, and alveolar bone were observed 2 weeks after immediate transplantation. The pulp was repaired by the ingrowth of granulation tissue from the root apex followed by the formation of calcified tissue. The regenerated periodontal ligament was positive for alkaline phosphatase (ALP). Small or mononuclear tartrate resistant acid phosphatase (TRAP) positive cells were scattered on the newly formed alveolar bone and on the hard tissue in the pulp, but there was no external or internal progressive root resorption at 4 weeks. Cryopreserved teeth had acellular cementum with a rough surface at 1 week, but with the increase of cementoblasts and the appearance of periodontal ligament and alveolar bone, the surface became smooth at 3 weeks. Epithelial rests of Malassez (ERM) also revived. After regeneration of the periodontal tissues at 4 weeks, there was no evidence of root resorption. Although the process proceeded slowly, the cryopreserved teeth showed the periodontal regeneration substantially similar to that of the immediately transplanted teeth without progressive root resorption, indicating that they could be applicable for clinical use.

Clinical and histologic evaluation of anorganic bovine bone collagen with or without a collagen barrier

This study evaluated an anorganic bovine-derived xenograft (Bio-Oss Collagen) in the treatment of human periodontal defects. Four patients with intrabony defects on teeth that were treatment planned for extraction were enrolled in the study. Presurgical measurements of probing depth, attachment level, and recession were recorded. The surgical procedure consisted of flap reflection, debridement of the osseous defects and root surface, placement of a notch through calculus into the root surface, topical application of a tetracycline paste to the root surface, grafting with Bio-Oss Collagen, and flap closure. Three of the eight defects examined received a resorbable collagen barrier (Bio-Gide) in addition to the bone graft. Patients were seen every 2 weeks for plaque control and review of oral hygiene measures. Six months postsurgery, clinical parameters were rerecorded prior to en bloc resection of teeth and adjacent graft sites. The majority of sites showed a favorable clinical response with respect to probing depth reduction and clinical attachment gain. Histologic analysis demonstrated new bone, cementum, and periodontal ligament coronal to the reference notch in two of the eight specimens. Two sites demonstrated new attachment, and four showed a long junctional epithelium. Periodontal regeneration is possible following a bone-replacement graft of Bio-Oss Collagen.

Favorable healing following space creation in rhBMP-2-induced periodontal regeneration of horizontal circumferential defects in dogs with experimental periodontitis

BACKGROUND

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is believed to be capable of inducing periodontal regeneration. However, the risk of aberrant healing events, such as root resorption and ankylosis, has been reported. We hypothesized that implantation of BMP-containing carriers directly on the root planed surface may be the cause of unfavorable healing. The purpose of this study was to evaluate the influence of a 1 mm spacer membrane, which separated the rhBMP-2 in polymer-coated gelatin sponge (PGS) and the root surface, on periodontal regeneration of experimentally induced horizontal defects in dogs.

METHODS

Horizontal circumferential periodontal defects were surgically created, and experimental periodontitis was induced in 72 maxillary and mandibular premolars of four male beagle dogs. The recipient sites of each quadrant received: 1) rhBMP-2/PGS (B group) (rhBMP-2 at 1.0 mg/ml, total implant volume/ site approximately 7.2 microl) (n = 24); 2) rhBMP-2/PGS with a spacer membrane (PB group) (n = 24); and 3) physiological saline (PS)/PGS as a control (P group) (n = 24). One quadrant was left untreated. Dogs were sacrificed at 12 weeks post-surgery, and healing was evaluated histologically.

RESULTS

Both groups treated with rhBMP-2/PGS demonstrated enhanced new bone formation and connective tissue attachment with cementum regeneration when compared to the control group. Sites treated with rhBMP-2/PGS showed a greater degree of bone formation than sites treated with rhBMP-2/PGS and spacer membrane, although the latter sites showed no ankylosis.

CONCLUSIONS

Implantation of rhBMP-2/PGS enhances bone formation and connective tissue attachment in horizontal circumferential defects. In addition, the use of a spacer membrane reduces the degree of bone formation, but minimizes ankylosis.

Hertwig's epithelial root sheath, enamel matrix proteins, and initiation of cementogenesis in porcine teeth

OBJECTIVES

The aim of this study was to analyze the association between Hertwig's epithelial root sheath (HERS) cells, enamel matrix proteins (EMPs), and cementogenesis.

MATERIAL AND METHODS

Porcine teeth were examined at the beginning of root formation by light and transmission electron microscopy. Colloidal gold immunocytochemistry was used to analyze the protein expression of amelogenin and ameloblastin.

RESULTS

Before and during disintegration of HERS, its cells displayed the cytologic features of protein synthesis and secretion. While some cells assumed an ameloblast-like phenotype, others extended their territory away from the root surface. A collagenous matrix filled the widening intercellular spaces, and tonofilaments and desmosomes were still present in cells featuring the morphologic characteristics of cementoblasts. Labeling for amelogenin was observed but ameloblastin was not immunodetected. Labeling was associated with organic matrix deposits that were sporadically and randomly distributed both along the root surface and away from it among the dissipated epithelial cells.

CONCLUSIONS

These findings suggest that HERS' cells occasionally assume a lingering ameloblastic activity at the beginning of root formation in the pig. While the results do not support the hypothesis of a causal relationship between EMPs and cementogenesis, they lend support to the concept of an epithelial origin of cementoblasts.

Periodontal Ligament: Structural and Clinical Correlates

This paper reviews certain structural aspects of the periodontal ligament. These include collagen (type, crimping and fibril diameters), ground substance (functions), cells (fibroblast morphology, cell heterogenicity and distinguishing of cell phenotypes, cell kinetics, 'foetal' characteristics), nerves (presence of neuropeptides) and blood vessels (presence of fenestrations). Attention is drawn to recent advances in our understanding of the development of the periodontal ligament, especially cementum formation, and in the presence of bioactive molecules such as growth factors and cytokines.

The Effect of Calcium Sulfate on Hard-Tissue Healing After Periradicular Surgery

The purpose of this study was to determine the effect of calcium sulfate (CS) on cementum deposition and osseous healing after periradicular surgery. The root canals of 24 mandibular premolars in four 2-yr-old beagle dogs were endodontically treated, followed 2 weeks later by periradicular surgery. Mineral trioxide aggregate (MTA) was used as root-end-filling material. The right or left side was assigned at random to receive CS alpha-hemihydrate or no material in the osteotomy sites before closure. The animals were killed after 4 months. Hard-tissue healing was analyzed histomorphometrically. All samples displayed evidence of cementum deposition adjacent to the root-end fillings and bone regeneration in the osteotomy sites. The data was analyzed using the Mann-Whitney U test, comparing the scores for cementum and osseous healing of the two groups at significance level of alpha = 0.05. The results indicated that placement of CS in osteotomy sites after periradicular surgery does not significantly affect periradicular healing.

Noggin gene delivery inhibits cementoblast-induced mineralization

Bone morphogenetic proteins (BMPs) are known to promote periodontal tissue regeneration, while noggin inhibits the biological activities of BMP-2, -4, and -7. To investigate the effect of BMPs and noggin gene transfer on cementogenesis, we used cloned murine cementoblasts (OCCM). Cells were transduced using adenoviruses encoding BMP-7 (Ad-BMP-7), noggin devoid of the heparin binding site (Ad-NOGDeltaB2), or a control adenovirus encoding green fluorescent protein (Ad-GFP). Cells were seeded into 3D polymer scaffolds and implanted into SCID mice to determine the in vivo mineral-inducing ability of the cells. Cells transduced with Ad-NOGDeltaB2 at 3 and 6 weeks postimplantation exhibited reduced mineral formation compared with all other groups. Although gene expression of osteocalcin and bone sialoprotein increased after Ad-BMP-7 transduction in vitro, following BMP-7 gene transfer in vivo, transcripts for OCN and BSP were not significantly different from controls, and mineral density was not significantly increased compared with Ad-GFP and NT groups. These results indicate that in mature cementoblast populations, gene transfer of noggin inhibits biomineralization induced by cementoblasts, whereas exogenous BMP has minimal effects on mineralization.

Effect of enamel matrix proteins (Emdogain® ) on healing after re-implantation of “periodontally compromised” roots

OBJECTIVE

The present experiment was performed to assess whether Emdogain applied on the root surface of extracted teeth or teeth previously exposed to root planning can protect the tooth from ankylosis following re-implantation.

MATERIAL AND METHODS

The experiment included two groups of dogs, including five animals each. The root canals of all mandibular third premolars (3 P 3) were reamed and filled with gutta-percha. A crestal incision was placed from the area of the second to the fourth premolar. Buccal and lingual full thickness flaps were elevated. With the use of a fissure bur, the crown and furcation area of 3 P 3 were severed in an apico-coronal cut. The distal and mesial tooth segments were luxated with an elevator and extracted with forceps. Group A: The mesial and distal segments of 3 P 3 were air dried on a glass surface for 60 min. The roots from the right side were conditioned and exposed to Emdogain application. The roots from the left side received the same treatment with the exception of Emdogain application. The mesial and distal tooth segments were re-implanted and the crown portions were severed with a horizontal cut and removed. The buccal and lingual flaps were mobilized and sutured to obtain complete coverage of the submerged roots. Group B: A notch was prepared in each root, 4-5 mm apical of the cemento-enamel junction. The area of the root that was located coronal to the notch was scaled and planned. The roots in the right side of the mandible were treated with Emdogain, while the roots in the left side served as controls. After 6 months of healing, the dogs were killed and blocks containing one root with surrounding tissues were harvested, and prepared for histological examination, which also included morphometric assessments. Thus, the proportions of the roots that exhibited signs of (i) replacement (ii) inflammatory and (iii) surface resorption were calculated.

RESULTS AND CONCLUSION

It was demonstrated that healing of a re-implanted root that had been extracted and deprived of vital cementoblasts was characterized by processes that included root resorption, ankylosis and new attachment formation. It was also demonstrated that Emdogain treatment, i.e. conditioning with EDTA and placement of enamel matrix proteins on the detached root surface, failed to interfere with the healing process.

Dental root resorption and repair: histology and histometry during physiological drift of rat molars

OBJECTIVE

The process of dental root resorption and subsequent cementum regeneration has not been sufficiently elucidated. This study aimed to examine the process of the root resorption and cementum regeneration during physiological tooth drift using a rat model, and to evaluate this experimental model.

METHODS

Distal roots in mandibular first molars and the surrounding periodontal tissues were investigated with light and electron microscopy. The light microscopic approach included histochemical and histometric analyses utilizing the tartrate-resistant acid phosphatase (TRAP) reaction.

RESULTS

Root resorption was observed in the distal side of the roots and was most active in 5- to 6-week-old rats, and gradually decreased hereafter. An increase in the number of TRAP-positive mononuclear cells, which seemed to be odontoclast precursor cells, preceded the increase in the number of odontoclasts. Root resorption was transient, and was followed by the new formation of acellular extrinsic fiber cementum accompanied with only a slight inflammation, and therefore classified as external surface resorption. Preparation for new cementum started adjacent to the resorption areas when root resorption was most active.

CONCLUSIONS

The root resorption during drift in rats is transient and followed by acellular extrinsic fiber cementum regeneration. Cellular kinetics suggested that odontoclast precursor cells are supplied as mononuclear cells from vascular spaces.

Periodontal repair in dogs: gingival tissue occlusion, a critical requirement for GTR?

BACKGROUND

Design criteria for guided tissue regeneration (GTR) devices include biocompatibility, cell occlusion, space maintenance, tissue integration, and ease of use. Previous studies have established the importance of wound stabilization and space provision during the early healing sequel for successful GTR outcomes as well as evaluated biocompatibility, tissue integration, and clinical manageability of various biomaterials. The importance of cell or tissue occlusion has yet to be established. The objective of this study was to evaluate the role of tissue occlusion as a critical determinant for GTR outcomes.

METHODS

Routine, critical size, 5-6 mm, supra-alveolar, periodontal defects were created around the mandibular premolar teeth in six young adult Beagle dogs. Space-providing expanded polytetrafluoroethylene (ePTFE) membranes, with (macroporous) or without (occlusive) 300- microm laser-drilled pores, 0.8 mm apart, were implanted to provide for GTR. Treatments were randomly assigned to left and right jaw quadrants in subsequent animals. The gingival flaps were advanced to cover the membranes and sutured. The animals were euthanized at 8 weeks postsurgery for histologic and histometric analysis.

RESULTS

Three animals experienced wound failure within 2-3 weeks postsurgery resulting in exposure and removal of the occlusive ePTFE membranes. All defect sites, irrespective of membrane configuration or history of membrane exposure and removal, exhibited substantial evidence of periodontal regeneration including a functionally oriented periodontal ligament. To evaluate the biologic potential of GTR devices, only animals without wound failure and membrane removal were included. Alveolar bone regeneration for animals receiving occlusive and macroporous ePTFE membranes averaged (+/-sd) 3.2+/-1.1 versus 2.0+/-0.4 mm (p=0.3113). Cementum regeneration was enhanced in defect sites receiving the occlusive ePTFE membrane compared to the macroporous membrane (4.7+/-0.4 versus 2.3+/-0.2 mm; p=0.0167). Ankylosis was observed in one animal. Limited root resorption was observed in a second animal.

CONCLUSION

Tissue occlusion does not appear to be a critical determinant for GTR. However, tissue occlusion may be a requirement for optimal GTR. Moreover, macroporous space-providing devices may increase the predictability of clinical GTR therapy.

Progenitor cells from dental follicle are able to form cementum matrix in vivo

To address the molecular mechanisms of cementogenesis, we have isolated dental follicle cells and examined them to see if they contain cementoblast progenitors. Dental follicle tissue was dissected from the root surface of bovine tooth germ and cells were released by digestion with bacterial collagenase. The released cells were maintained as a bovine dental follicle cells (BDFC). To elucidate the differentiation capacity of BDFC, they were transplanted into severe combined immunodeficiency (SCID) mice for 4 weeks. Transplanted BDFC formed cementumlike matrix; in contrast, bovine alveolar osteoblast (BAOB) transplants formed bonelike matrix, and bovine periodontal ligament cells (BPDL) formed a small amount of the cementumlike matrix. Immunohistochemical analysis showed that cementumlike matrix was positive for anti-cementum attachment protein monoclonal antibody, whereas bone-like matrix was negative. These results indicated that the BDFC contained cementoblast progenitors that were able to differentiate to cementoblasts in vivo. They also indicated that the BDFC are phenotypically distinct from BAOB and BPDL, and provide a useful model for investigating molecular mechanisms of cementogenesis.

Cementum and periodontal wound healing and regeneration

The extracellular matrix (ECM) of cementum resembles other mineralized tissues in composition; however, its physiology is unique, and it contains molecules that have not been detected in other tissues. Cementum components influence the activities of periodontal cells, and they manifest selectivity toward some periodontal cell types over others. In light of emerging evidence that the ECM determines how cells respond to environmental stimuli, we hypothesize that the local environment of the cementum matrix plays a pivotal role in maintaining the homeostasis of cementum under healthy conditions. The structural integrity and biochemical composition of the cementum matrix are severely compromised in periodontal disease, and the provisional matrix generated during periodontal healing is different from that of cementum. We propose that, for new cementum and attachment formation during periodontal regeneration, the local environment must be conducive for the recruitment and function of cementum-forming cells, and that the wound matrix is favorable for repair rather than regeneration. How cementum components may regulate and participate in cementum regeneration, possible new regenerative therapies using these principles, and models of cementoblastic cells are discussed.