Establishment of acellular extrinsic fiber cementum on human teeth. A light- and electron-microscopic study

Tooth acellular extrinsic fibre cementum incremental lines in humans are formed by parallel branched Sharpey's fibres and not by its mineral phase

In humans, the growth pattern of the acellular extrinsic fibre cementum (AEFC) has been useful to estimate the age-at-death. However, the structural organization behind such a pattern remains poorly understood. In this study tooth cementum from seven individuals from a Mexican modern skeletal series were analyzed with the aim of unveiling the AEFC collagenous and mineral structure using multimodal imaging approaches. The organization of collagen fibres was first determined using: light microscopy, transmission electron microscopy (TEM), electron tomography, and plasma FIB scanning electron microscopy (PFIB-SEM) tomography. The mineral properties were then investigated using: synchrotron small-angle X-ray scattering (SAXS) for T-parameter (correlation length between mineral particles); synchrotron X-ray diffraction (XRD) for L-parameter (mineral crystalline domain size estimation), alignment parameter (crystals preferred orientation) and lattice parameters a and c; as well as synchrotron X-ray fluorescence for spatial distribution of calcium, phosphorus and zinc. Results show that Sharpey's fibres branched out fibres that cover and uncover other collagen bundles forming aligned arched structures that are joined by these same fibres but in a parallel fashion. The parallel fibres are not set as a continuum on the same plane and when they are superimposed project the AEFC incremental lines due to the collagen birefringence. The orientation of the apatite crystallites is subject to the arrangement of the collagen fibres, and the obtained parameter values along with the elemental distribution maps, revealed this mineral tissue as relatively homogeneous. Therefore, no intrinsic characteristics of the mineral phase could be associated with the alternating AEFC incremental pattern.

Cementum is key to periodontal tissue regeneration: A review on apatite microstructures for creation of novel cementum-based dental implants

The cementum is the outermost layer of hard tissue covering the dentin within the root portion of the teeth. It is the only hard tissue with a specialized structure and function that forms a part of both the teeth and periodontal tissue. As such, cementum is believed to be critical for periodontal tissue regeneration. In this review, we discuss the function and histological structure of the cementum to promote crystal engineering with a biochemical approach in cementum regenerative medicine. We review the microstructure of enamel and bone while discussing the mechanism underlying apatite crystal formation to infer the morphology of cementum apatite crystals and their complex structure with collagen fibers. Finally, the limitations of the current dental implant treatments in clinical practice are explored from the perspective of periodontal tissue regeneration. We anticipate the possibility of advancing periodontal tissue regenerative medicine via cementum regeneration using a combination of material science and biochemical methods.

Titanium Nanosurface with a Biomimetic Physical Microenvironment to Induce Endogenous Regeneration of the Periodontium

The periodontium supports the teeth by dentoalveolar fibrous joints that serve unique oral functions. Endogenous regeneration of the periodontium around artificial teeth (dental implants) provides a cost-effective solution for the extension of healthy life expectancy but remains a challenge in regenerative medicine. Biomimetics can create smart biomaterials that tune endogenous cells at a tissue-material interface. Here, we created a smart titanium nanosurface mimicking the surface nanotopography and micromechanical properties of the tooth root cementum (TRC), which is essential for the induction of dentoalveolar fibrous joints to regenerate the periodontium. After transplantation into the rat renal capsule, only the titanium artificial tooth with the TRC-mimetic nanosurface formed a complex dentoalveolar fibrous joint structure, with bone tissue, periodontal ligament (PDL), and TRC, in the decellularized jawbone matrix. TRC-mimetic titanium implants induce the formation of functional periodontium, even in a jawbone implantation model, which generally causes osseointegration (ankyloses). In human PDL cells, TRC analogousness in the surface mechanical microenvironment regulates matrix mineralization through bone sialoprotein expression and phosphorus metabolism, which are critical for cementogenesis. Therefore, the titanium nanosurfaces with nanotopographical and mechanical microenvironments mimicking the TRC surface induce dentoalveolar fibrous joints for periodontal regeneration by interfacial tuning of endogenous cells.

On the discovery of cementum

Though cementum of the tooth root is critical for periodontal structure and tooth attachment and function, this tissue was not discovered and characterized on human teeth until a full century later than enamel and dentin. Early observations from the seventeenth to the nineteenth centuries by Marcello Malpighi, Antonie van Leeuwenhoek, Robert Blake, Jacques Tenon and Georges Cuvier founded a confusing and conflicting nomenclature that obscured the nature of cementum, often conflating it with bone. Advances in microscopy and histological procedures yielded the first detailed descriptions of human cementum in the 1830s by Jan Purkinje and Anders Retzius, who identified for the first time acellular and cellular types of cementum, and the resident cementocytes embedded in the latter. Comparative anatomy studies by Richard Owen and others over the latter half of the nineteenth century identified coronal and radicular cementum varieties across the Reptilia and Mammalia. The functional importance of cementum was not appreciated until detailed anatomical studies of the periodontium were performed by G.V. Black and others in the late nineteenth and early twentieth centuries. These early studies on cementum laid the foundation for more advanced understanding of cementum ultrastructure, composition, development, physiology, disease, genetics, repair and regeneration throughout the twentieth and into the twenty-first century.

Are Cementoblasts a Subpopulation of Osteoblasts or a Unique Phenotype?

Experimental studies have shown a great potential for periodontal regeneration. The limitations of periodontal regeneration largely depend on the regenerative potential at the root surface. Cellular intrinsic fiber cementum (CIFC), so-called bone-like tissue, may form instead of the desired acellular extrinsic fiber cementum (AEFC), and the interfacial tissue bonding may be weak. The periodontal ligament harbors progenitor cells that can differentiate into periodontal ligament fibroblasts, osteoblasts, and cementoblasts, but their precise location is unknown. It is also not known whether osteoblasts and cementoblasts arise from a common precursor cell line, or whether distinct precursor cell lines exist. Thus, there is limited knowledge about how cell diversity evolves in the space between the developing root and the alveolar bone. This review supports the hypothesis that AEFC is a unique tissue, while CIFC and bone share some similarities. Morphologically, functionally, and biochemically, however, CIFC is distinctly different from any bone type. There are several lines of evidence to propose that cementoblasts that produce both AEFC and CIFC are unique phenotypes that are unrelated to osteoblasts. Cementum attachment protein appears to be cementum-specific, and the expression of two proteoglycans, fibromodulin and lumican, appears to be stronger in CIFC than in bone. A theory is presented that may help explain how cell diversity evolves in the periodontal ligament. It proposes that Hertwig’s epithelial root sheath and cells derived from it play an essential role in the development and maintenance of the periodontium. The role of enamel matrix proteins in cementoblast and osteoblast differentiation and their potential use for tissue engineering are discussed.

Fibrous architecture of cementodentinal junction in disease: A scanning electron microscopic study

Background:

The cementodentinal junction (CDJ) forms a biological and structural link between cementum and dentin. This biological link is regarded as a distinct tissue in its own right. Certain important proteins responsible for periodontal regeneration are said to be present in this tissue. Few studies have described the structure and composition of this layer by light and electron microscopy. Scanning electron microscopic studies pertaining to CDJ in health and disease are few and documentation of periodontal pathological changes of CDJ is unclear. In the first phase of our study, the collagenous architecture of CDJ of healthy teeth has been reported.

Aim:

The objective of this study is to observe and report periodontal pathological changes in the fibrous or collagenous architecture of CDJ of periodontitis-affected teeth and discuss the probable clinical implications of CDJ in disease.

Materials and Methods:

Twenty periodontitis-affected teeth were collected and processed for observing under a scanning electron microscope.

Results:

The results are as follows: Increased width of interface at CDJ in periodontitis samples (7.1 μ) compared to that of healthy samples; fewer areas of fiber intermingling at CDJ in periodontitis samples as compared to healthy samples; frequent detachment of cementum from dentin during sodium hydroxide maceration of samples.

Conclusion:

It may be inferred from results that there is a possibility of a definite weakening of CDJ in periodontally affected root surfaces and we believe that clinical procedures such as scaling and root planning may have a detrimental effect on the cementodentinal attachment of periodontally involved root surfaces.

Mineralization defects in cementum and craniofacial bone from loss of bone sialoprotein

Bone sialoprotein (BSP) is a multifunctional extracellular matrix protein found in mineralized tissues, including bone, cartilage, tooth root cementum (both acellular and cellular types), and dentin. In order to define the role BSP plays in the process of biomineralization of these tissues, we analyzed cementogenesis, dentinogenesis, and osteogenesis (intramembranous and endochondral) in craniofacial bone in Bsp null mice and wild-type (WT) controls over a developmental period (1-60 days post natal; dpn) by histology, immunohistochemistry, undecalcified histochemistry, microcomputed tomography (microCT), scanning electron microscopy (SEM), transmission electron microscopy (TEM), and quantitative PCR (qPCR). Regions of intramembranous ossification in the alveolus, mandible, and calvaria presented delayed mineralization and osteoid accumulation, assessed by von Kossa and Goldner's trichrome stains at 1 and 14 dpn. Moreover, Bsp(-/-) mice featured increased cranial suture size at the early time point, 1 dpn. Immunostaining and PCR demonstrated that osteoblast markers, osterix, alkaline phosphatase, and osteopontin were unchanged in Bsp null mandibles compared to WT. Bsp(-/-) mouse molars featured a lack of functional acellular cementum formation by histology, SEM, and TEM, and subsequent loss of Sharpey's collagen fiber insertion into the tooth root structure. Bsp(-/-) mouse alveolar and mandibular bone featured equivalent or fewer osteoclasts at early ages (1 and 14 dpn), however, increased RANKL immunostaining and mRNA, and significantly increased number of osteoclast-like cells (2-5 fold) were found at later ages (26 and 60 dpn), corresponding to periodontal breakdown and severe alveolar bone resorption observed following molar teeth entering occlusion. Dentin formation was unperturbed in Bsp(-/-) mouse molars, with no delay in mineralization, no alteration in dentin dimensions, and no differences in odontoblast markers analyzed. No defects were identified in endochondral ossification in the cranial base, and craniofacial morphology was unaffected in Bsp(-/-) mice. These analyses confirm a critical role for BSP in processes of cementogenesis and intramembranous ossification of craniofacial bone, whereas endochondral ossification in the cranial base was minimally affected and dentinogenesis was normal in Bsp(-/-) molar teeth. Dissimilar effects of loss of BSP on mineralization of dental and craniofacial tissues suggest local differences in the role of BSP and/or yet to be defined interactions with site-specific factors.

Cell-to-cell communication--periodontal regeneration

BACKGROUND

Although regenerative treatment options are available, periodontal regeneration is still regarded as insufficient and unpredictable.

AIM

This review article provides scientific background information on the animated 3D film Cell-to-Cell Communication - Periodontal Regeneration.

RESULTS

Periodontal regeneration is understood as a recapitulation of embryonic mechanisms. Therefore, a thorough understanding of cellular and molecular mechanisms regulating normal tooth root development is imperative to improve existing and develop new periodontal regenerative therapies. However, compared to tooth crown and earlier stages of tooth development, much less is known about the development of the tooth root. The formation of root cementum is considered the critical element in periodontal regeneration. Therefore, much research in recent years has focused on the origin and differentiation of cementoblasts. Evidence is accumulating that the Hertwig's epithelial root sheath (HERS) has a pivotal role in root formation and cementogenesis. Traditionally, ectomesenchymal cells in the dental follicle were thought to differentiate into cementoblasts. According to an alternative theory, however, cementoblasts originate from the HERS. What happens when the periodontal attachment system is traumatically compromised? Minor mechanical insults to the periodontium may spontaneously heal, and the tissues can structurally and functionally be restored. But what happens to the periodontium in case of periodontitis, an infectious disease, after periodontal treatment? A non-regenerative treatment of periodontitis normally results in periodontal repair (i.e., the formation of a long junctional epithelium) rather than regeneration. Thus, a regenerative treatment is indicated to restore the original architecture and function of the periodontium. Guided tissue regeneration or enamel matrix proteins are such regenerative therapies, but further improvement is required. As remnants of HERS persist as epithelial cell rests of Malassez in the periodontal ligament, these epithelial cells are regarded as a stem cell niche that can give rise to new cementoblasts. Enamel matrix proteins and members of the transforming growth factor beta (TGF-ß) superfamily have been implicated in cementoblast differentiation.

CONCLUSION

A better knowledge of cell-to-cell communication leading to cementoblast differentiation may be used to develop improved regenerative therapies to reconstitute periodontal tissues that were lost due to periodontitis.

Evaluation of the nanostructure of cervical third cementum in health and chronic periodontitis: An in vitro study

Background:

During the progression of periodontal disease, the cementum undergoes alterations in its structure and composition. Understanding the nanostructure of cementum, in terms of its mechanical properties, will provide an insight into the milieu that periodontal ligament cells encounter in health and chronic periodontitis. This study aims to analyze the nanomechanical properties of the cervical third of the cementum (transverse section) in health and chronic periodontitis.

Materials and Methods:

Twenty teeth (10 healthy and 10 periodontally diseased) were collected and the nanomechanical properties of the transverse section of the cervical third cementum were evaluated with depth-sensing nanoindentation technique under dry conditions. A total of 100 nanoindentations were performed to analyze the modulus of elasticity and hardness of cervical third of the cementum.

Results:

The nanomechanical properties of the healthy cervical third cementum sections were significantly higher (P < 0.05) (hardness: 0.720 ± 0.305 GPa; modulus: 15.420 ± 3.902 GPa) than the diseased cementum section (hardness: 0.422 ± 0.157 GPa; modulus: 11.056 ± 3.434 GPa).

Conclusion:

The results of our study indicate that the hardness and modulus of elasticity of the cervical third cementum decreases significantly in chronic periodontitis.

An immunohistochemical study of the attachment mechanisms in different kinds of adhesive interfaces in teeth and alveolar bone of the rat

BACKGROUND AND OBJECTIVE

This study was designed to examine the histological and immunohistochemical nature of different kinds of adhesive interfaces in the rat molar region under identical experimental conditions and to discuss the structural and functional similarities between these adhesive interfaces.

MATERIAL AND METHODS

Four kinds of adhesive interfaces - an initial attachment layer for principal fibers on the developing alveolar bone surface, a reattachment layer for principal fibers on resorbed alveolar bone surface, cement lines on the alveolar bone surface unrelated to the principal fibers, and the cemento-dentinal junction - were examined in 25-d-old male Wistar rats. Routine histological staining, immunohistochemical staining for bone sialoprotein and osteopontin, and digestion tests with trypsin were conducted.

RESULTS

The adhesive interfaces showed very similar histological and immunohistochemical features: they were intensely hematoxylin-stainable, deficient in collagen fibrils, and rich in bone sialoprotein and osteopontin. After trypsin treatment the four adhesive interfaces had lost immunoreactivity to bone sialoprotein and osteopontin, and the two adjacent tissue parts held together finally separated at the adhesive interfaces.

CONCLUSION

The above findings suggest that (i) the different types of adhesive interfaces in the rat molar region have a common structure in that they are filled with highly accumulated bone sialoprotein and osteopontin and deficient in collagen fibrils; (ii) accumulated bone sialoprotein and osteopontin are closely associated with the adhesion at the interfaces; and (iii) the adhesive interfaces have a similar developmental process.

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.

Evidence for an extensive collagen type III/VI proximal domain in the rat femur. I. Diminution with ovariectomy

Collagenous proteins other than Type I have received little attention in hypogonadal bone loss. Using femora from 25 young (2.5 months) and older (11 months) control and ovariectomized adult rats killed 1-4 months postoperation, cancellous atrophy was histologically confirmed, and the immunolocalization of collagen Type III was examined. This occurred as numerous immunofluorescent Sharpey-like fibers, 5-25 microm thick, regularly associated with collagen Type VI, which ramified the femoral cortex. Sequential transverse cryosections enabled the mapping of the fibers in three-dimensions, demonstrating that they constituted an extensive subperiosteal domain which may be a lasting legacy of early skeletal development. Fiber density was greatest in the trochanters and femoral neck. The domain tapered distally and was apparently anchored into the mid-shaft by intracortical cartilaginous islands, staining for collagen Type VI (as well as Type II and fibronectin). Ovariectomy caused disconnection of the fibers and reduced the proximal domain of both young and older animals, previously positive areas of the cortex becoming negative. It is concluded that collagen Type III/VI occupies a substantial, discrete domain in the rat proximal femur as a complex extension of the periosteum. Diminution of this cortical domain with trabecular atrophy suggests that it has a proactive or reactive role in determining bone mass and strength by facilitating musculoskeletal exchange in a form that is disengaged by ovariectomy.

A light microscopic study of the attachment mechanism in different kinds of adhesive lines in rat molars

This study was designed to observe drifting molars of 70-day-old rats by light microscopy, and to elucidate whether there are similar attachment mechanisms at different kinds of adhesive lines in periodontal mineralized tissue of the rat molar region. Three kinds of adhesive lines--cement lines on resorbed alveolar bone, cement lines on resorbed roots, and cemento-dentinal junctions were examined. The two kinds of cement lines showed similar histological and histochemical features, they were proteoglycan-rich and fiber-poor. They appeared to form on the resorbed tissue before principal fiber reattachment. After covering by new bone or by reparative cementum, the cement lines retained the original features. The cemento-dentinal junction showed features very similar to those of the cement lines. Previous studies have suggested that the cemento-dentinal junctions bind the cementum and dentine by adhesion of proteoglycans. Structural similarities suggest that cement lines provide similar links between new bone and resorbed bone and between resorbed root and reparative cementum. In conclusion, this study suggests that there is one attachment mechanism for the different kinds of collagen based hard tissue in the rat molar region.

The initial attachment of cemental fibrils to the root dentin surface in acellular and cellular cementogenesis in rat molars

To elucidate the initial attachment mechanism of cemental fibrils to the root dentin surface in acellular and cellular cementogenesis, developing rat molars were observed by light microscopy and scanning electron microscopy combined with NaOH maceration. The NaOH maceration was used to observe details of the positional association of cemental and dentinal fibrils during cementogenesis. An initial hematoxylin stained, cementum layer began to form on the root dentin surface with the first dentin mineralization in both acellular and cellular cementogenesis. The initial attachment of cemental fibrils to the dentin surface also began at this point. At the initial attachment the intermingling of cemental and dentinal fibrils occurred only in places. With advanced cementogenesis the initial cementum layer became the fibril-poor cemento-dentinal junction. This suggests that cemental fibrils attach on the initial cementum layer, and not directly on dentinal fibrils, so that the layer results in the fibril-poor cemento-dentinal junction. The present study suggests that an intervening adhesive is necessary for the cemento-dentinal attachment at any stage of cementogenesis in rat molars.

The fibrillar structure of cementum and dentin at the cemento-dentinal junction in rat molars

The cemento-dentinal junction was examined in demineralized rat molars with complete roots by scanning electron microscopy combined with NaOH maceration. It is established that the NaOH maceration removes interfibrillar substances and cells from connective tissues selectively without structural damage to collagen fibrils. The cementum was detached from the dentin by the maceration. The inner cementum surface facing the dentin and the outer dentin surface facing the cementum were observed. In acellular cementum, both the outer dentin surface and the inner cementum surface had a smooth appearance. There was little indication of fibrils intermingling between dentin and cementum. In contrast, both the inner cementum surface and outer dentin surface in cellular cementum had an uneven appearance due to the irregular arrangement of collagen fibrils. Point-like protrusions of fibril bundles were observed on both surfaces. Some (not all) of these point-like protrusions appeared to correspond to places of fibrillar intermingling between dentin and cementum.

A histological and electron-microscopic study of the architecture and ultrastructure of human periodontal tissues

The structure of periodontal tissues is still far less understood than their clinical relevance would demand. Here the periodontal ligament and radicular cementum in healthy human teeth were studied by light microscopy, transmission and scanning electron microscopy. These observations showed that the extracellular matrix of periodontal ligament is composed of a loose plexus of wavy collagen fibrils immersed in a highly hydrated interfibrillar matrix. Only close to their cemental insertion do these fibrils gather in thick, parallel fascicles (Sharpey's fibres). As these cross the mineralization front, they become infiltrated by the mineral phase and continue directly with the cementum matrix. Sharpey's fibres, "extrinsic" and "intrinsic" fibres all appear to be the same fibres, which bend and branch repeatedly during their course within the thickness of the cementum. Because of its physical continuity with the cementum, a limited portion of the periodontal ligament approximately corresponding to the length of Sharpey's fibres remains unaffected by enzymatic digestion of the interfibrillar matrix while the rest of the ligament is completely dissolved. The findings here indicate that the periodontal ligament and dental cementum join by a continuity rather than a contiguity of structures; that the collagen-mineral relation in cementum has distinctive features in comparison to other hard tissues; that extrinsic and intrinsic fibres of cementum and the adjoining portion of periodontal ligament form a structural, mechanical and metabolic unit distinct from the central, more metabolically active portion of the periodontal ligament.

The structure of the cemento-dentinal junction in rat molars

The cemento-dentinal junction was observed in the acellular and cellular cementum of rat molars by light and scanning electron microscopy. Scanning electron microscopy, combined with NaOH maceration, was used to observe the fibrous architecture directly in this region. Light microscopy revealed that the cemento-dentinal junction contains fewer collagen fibrils and more proteoglycans than the cementum and dentin. Scanning electron microscopy also showed that fibril intermingling is found only in some regions of the fibril-poor junction in macerated specimens. Prolonged maceration breaks down the cemento-dentinal junction in spite of the fibril intermingling. Only macerated specimens showed detachment here. It was established that NaOH maceration removes interfibrillar substances effectively, and does not damage the fibril structure or architecture. This suggests that the adhesion of proteoglycans is more important than fibril intermingling for preserving the cemento-dentinal attachment in the rat molar.

The structure and function of the cemento-dentinal junction in human teeth

The structure and function of the cemento-dentinal junction were studied in human molars by light and electron microscopy. The cemento-dentinal junction was an approximately 1-3-micron-thick layer full of proteoglycans with mucopolysaccharides but containing fewer collagen fibrils than the root dentin and cementum. In places, cemental fibrils crossed the cemento-dentinal junction. These fibrils appeared to intermingle with dentinal fibrils. By enzymatic treatment of decalcified specimen with hyaluronidase and trypsin, the cemento-dentinal junction decreased or lost staining affinity to toluidine blue. Prolonged treatment caused the separation of cementum from the root dentin during routine histological processes. These data suggest that the adhesion of proteoglycans is more important than the intermingling of dentinal and cemental fibrils for the cemento-dentinal attachment.

Nature and attachment of cementum formed under guided conditions in human teeth. An electron microscopic study

In an attempt at characterizing the nature and attachment of cementum formed under conditions of guided tissue regeneration (GTR) in humans, front teeth from 4 patients aged 42 to 72 years were examined at the electron microscopic level. All teeth were affected by complex periodontitis associated with advanced loss of periodontal support. Roots were surgically planed and notched, but not chemically conditioned. Either the mesial or distal surface of each tooth represented the experimental site and was covered with a biodegradable polyglactin 910 barrier, while the opposite approximal surface served as control. Following 3 months of healing, teeth were removed together with surrounding periodontal tissues including some alveolar bone. These blocks were fixed histologically, decalcified, embedded in epoxy, and sectioned for examination in the scanning (backscatter mode) and transmission electron microscope. Both experimental and control sites disclosed 2 types of regenerative cementum that seemed to be formed by cells resembling cementoblasts. The first type was characterized by a thin fringe of collagen fibrils which were arranged perpendicular to the root surface and appeared mineralized in a zone extending about 1 to 3 microm from the dentin. The second type occurred as thick patches which revealed scattered cementocytes and sheets of collagen fibrils oriented mainly parallel to the root surface, running both circularly and axially. In both situations, a continuous, thin, electrondense layer was interposed between newly formed cementum and preexisting radicular hard tissues. Interdigitation of collagen fibrils from cementum and dentin, such as observed along the natural cemento-dentinal junction, did not occur. Thus, regenerative cementum laid down in humans under guided conditions on previously diseased and planed, but not otherwise treated root surfaces shares some morphologic features with cementum formed during spontaneous repair of root resorptions. However, unlike in the course of such repair, a fibrous attachment of new cementum resembling the natural cemento-dentinal junction does not seem to be regenerated under guided conditions.

Developmental appearance and distribution of bone sialoprotein and osteopontin in human and rat cementum

BACKGROUND

Bone sialoprotein (BSP) and osteopontin (OPN), two major noncollagenous proteins (NCPs) in collagen-based mineralized tissues, have been implicated in mineral deposition and cell- and matrix-matrix interactions during root development. However, their role in cementogenesis is still a subject of debate. Since distribution of proteins is indicative of function, we have analyzed their temporo-spatial appearance in relation to that of cementum collagen.

METHODS

Human premolars and rat molars at various stages of root development characterized by differing rates of formation were fixed in aldehyde and embedded in epoxy and LR White resin. Sections were processed for ultrastructural analysis and postembedding colloidal gold (immuno)cytochemistry.

RESULTS

Incubations with antibodies against BSP and OPN and with lectins recognizing prominent sugars in these proteins generally revealed similar labeling patterns in both human and rat teeth, with gold particles accumulating mainly in the interfibrillar spaces. The lectin Helix pomatia, specific for N-acetyl-D-galactosamine, was distinctive in that it consistently reacted with human cementum, but only sporadically labeled rat cementum. Regardless of both the species and the stage of root development, mineralization initiated in mantle predentin in association with distinct foci immunoreactive for BSP and OPN. In human teeth, the deposition of cementum collagen began before the start of dentin mineralization and thus prior to any detectable labeling for BSP and OPN. However, at early stages of root formation in the rat, cementum collagen appeared after BSP and OPN accumulated on the root surface, whereas at advanced stages the deposition of cementum collagen, BSP and OPN coincided.

CONCLUSIONS

The temporo-spatial differences in the appearance of BSP and OPN relative to cementum collagen correlate well with known differences in the speed of root elongation and explain the variable appearance of the dentino-cemental junction. The data reveal no causal relationship between BSP and OPN and the differentiation of cementoprogenitor cells and indicate that the distribution of collagen fibrils ultimately determines the amount and pattern of accumulation of these NCPs. There also is no consistent planar accumulation of BSP and OPN between dentin and cementum such as the cement lines found between "old" and "new" bone. It is concluded that the interlacement of collagen fibrils at the dentino-cemental junction, across which mineralization spreads, represents the primary attachment mechanism between cementum and dentin.

New cementum formation induced by cyclosporin A: a histological, ultrastructural and histomorphometric study in the rat

Cyclosporin A (CsA), a widely used immunosuppressive agent, is known to induce gingival overgrowth; 30 mg/kg/d of CsA were administrated orally in young and adult male Sprague-Dawley rats. The same number of rats received oil-based vehicle solution. After 4, 9, 14 and 19 wk of CsA or vehicle administration 3 control and 3 experimental rats were anaesthetized and tissues fixed by an intracardiac perfusion of fixative solution. Upper and lower jaws were dissected, demineralized and processed for Epon inclusion. Histological examination revealed the presence of large amounts of new cementum (NC) covering extensive areas of the acellular extrinsic fibre cementum (AEFC) in all the root surfaces. NC was particularly abundant at the cervical third of the roots facing the gingival connective tissue, where it occurred as layers, spurs or in both configurations. NC was characterized by its irregular outline, globular body content and infrequent presence of incremental lines. Histomorphometric evaluation by semi-automatic image analysis indicated that the volume and the external surface of NC spurs were 2.86-6.49 and 1.29-1.97-fold increased comparative to those of the AEFC covering the same root areas. Electron microscopy revealed that NC was a functional tissue with insertion of collagen fibres perpendicularly to the long axis of the root. It can be concluded that under some experimental conditions formation of abundant amounts of NC can be achieved and that these results must be taken into account for a new approach in the treatment of periodontal disease.

Extracellular matrix in tooth cementum and mantle dentin: localization of osteopontin and other noncollagenous proteins, plasma proteins, and glycoconjugates by electron microscopy

BACKGROUND

Noncollagenous proteins (NCPs) are considered to have multiple functions related to the formation, turnover, and repair of the collagen-based mineralized tissues. Collectively, they comprise a class of generally acidic, mineral-binding proteins showing extensive posttranslational modifications, including glycosylation, phosphorylation, and sulfation. METHODS. We have used colloidal-gold immunocytochemistry and lectin-gold cytochemistry, together with transmission electron microscopy, to examine the organic matrix composition of tooth cementum and the subjacent mantle dentin in rodent molar teeth. Molars were processed for immunocytochemistry using antibodies against osteopontin (OPN), osteocalcin (OC), bone sialoprotein (BSP), bone acidic glycoprotein-75 (BAG-75), albumin (ALB), and alpha 2HS-glycoprotein (alpha 2HS-GP), or for glycoconjugate cytochemistry using lectin-gold complexes.

RESULTS

Ultrastructurally, at the advancing root edge in developing molars, OPN and BSP initially were associated with small calcification foci in the mantle dentin. With progressing mineralization, OC and alpha 2HS-GP appeared diffusely distributed throughout the calcified mantle dentin, and diminished as a gradient toward the circumpulpal dentin. Immediately following disruption of Hertwig's epithelial root sheath, cementum deposition commenced at the root surface occasionally with the appearance of a cement line rich in OPN. Cementum matrix proper contained abundant OPN, BSP, OC, and alpha 2HS-GP, but no or little BAG-75 or ALB. Protein immunolabeling, as well as lectin labeling for beta-D-galactose and N-acetyl-neuraminic acid and/or N-glycolyl-neuraminic acid, both being prominent sugars of certain NCPs, was primarily concentrated between, and at the surface of, collagen fibrils in acellular extrinsic fiber cementum. OPN, BSP, OC, and alpha 2HS-GP were also prominent components of cellular cementum and of Sharpey's fibers. In cellular cementum, laminae limitantes sometimes present delimiting cementocyte lacunae and cell process-containing canaliculi were also rich in OPN. Along the root surface, occasional cementoblasts exhibited intracellular labeling for OPN over the Golgi apparatus and secretory granules.

CONCLUSIONS

We have identified OPN, BSP, OC, and alpha 2HS-GP as being prominent organic constituents of both mantle dentin and acellular and cellular cementum, and, have elucidated the details of their distribution at the ultrastructural level. The temporal appearance and spatial distribution of these organic moieties in the teeth root are similar to those seen during bone formation and are consistent with proposals that certain NCPs may be involved in regulating calcification and/or participating in cell-matrix and matrix-matrix/mineral adhesion events.

Cementogenesis reviewed: a comparison between human premolars and rodent molars

BACKGROUND

Cementum continues to be the least-known mineralized tissue. Although recent advances in the field of molecular biology have contributed to an understanding of the involvement of molecular factors in cementum formation during development and regeneration, cementogenesis on a cell biological basis is still poorly understood. Virtually nothing is known about cementoblast origin, differentiation, and the cell dynamics during normal development, repair, and regeneration. This review describes the recent findings of cementogenesis on roots of human premolars and opposes them to those of teeth from other mammals, particularly the rodent molar.

METHODS

Using light and electron microscopy, light microscopic radioautography, and various measurements, a comprehensive insight into the development and repair of cementum during and after root formation and tooth eruption has been achieved for human premolars.

RESULTS

Cementum is a highly responsive mineralized tissue. This biological activity is necessary for root integrity and for bringing and maintaining the tooth in its proper position. With regard to cementum formation and periodontal fiber attachment, considerable species-particularities exist that are mainly based on differences in growth rates and tooth sizes. Since root development and initial cementogenesis last on the average 5-7 years in human premolars, cementum formation in these teeth is characterized by along-lasting phase of prefunctional development, with occurs independent of principal periodontal fiber attachment to the root and which may take 5 years or more. The first molar of the rat, however, is in functional occlusion 3 1/2 weeks after the onset of root formation. Since initial cementum formation and periodontal fiber attachment to the root occur almost at the same time in this tooth, the distinction between cells associated with one or the other process is very difficult to achieve, and cementogenesis cannot be described independent of periodontal fiber attachment to the root. Therefore, the determination of cementoblast origin in the rodent molar may be intricate.

CONCLUSIONS

Taking into account these species differences, the current description on the origin and differentiation of cementoblasts is inconsistent and the description of cementogenesis is still incomplete. This review calls into question the currently held concept of cementogenesis and offers a possible alternative.

The role of epithelium in the development, structure and function of the tissues of tooth support

The roles of epithelium in the development, structure and function of the tissues of tooth support are reviewed. Epithelium is involved in initiating odontogenesis which includes the tissues of tooth support and this role is discussed. Particular attention is paid to Hertwig's epithelial root sheath and its participation in the formation of the hyaline layer on the root surface as well as its possible role in initiating the differentiation of cementoblasts. The possible functions of the epithelial cell rests are reviewed and it is concluded that as yet no function can be ascribed to them. Evidence for an increasing role for dental epithelium in tooth eruption is presented and the role of dental epithelium in establishing the dentogingival junction is discussed, with the conclusion drawn that this role temporary.

Osteopontin at mineralized tissue interfaces in bone, teeth, and osseointegrated implants: ultrastructural distribution and implications for mineralized tissue formation, turnover, and repair

Currently available data describing the gene expression and regulation, secretion, distribution, and protein chemistry of osteopontin (OPN) all are consistent with the notions of this protein functioning as an inhibitor of mineralization and/or as a mediator of cell-matrix and matrix-matrix/mineral adhesion (cohesion) during the formation, turnover, and repair of normal and pathological mineralized tissues. The properties and overall integrity of mineralized tissues are in part dictated by the nature of their interfaces--sites where organic and inorganic components of the extracellular matrix interact to provide biomechanical strength, regulate mineral ion homeostasis, and influence cellular events involved in mineralized tissue modeling, remodeling, and repair. High-resolution, colloidal-gold immunocytochemistry has been used to characterize the proteinaceous composition of these interfaces and to establish that the phosphorylated sialoprotein, OPN, is a major component found at these sites where it accumulates as a dense, planar "coating" of organic material termed either a cement line or a lamina limitans. Structural/functional features of OPN predict an ability of this protein to regulate calcification in the matrix proper of mineralized tissues and to participate, more specifically, in cell-matrix and matrix-matrix/mineral adhesion in laminae limitantes and cement lines, respectively. From the ultrastructural immunocytochemical data presented herein for OPN illustrating the cellular expression and extracellular matrix distribution of this protein, it is demonstrated that the production of OPN is one of the earliest, and latest, secretory activities of the osteoblast lineage and that this activity manifests itself morphologically as a cement line or a lamina limitans, respectively, at bone matrix interfaces. In laminae limitantes at bone surfaces, OPN appears to be involved in osteoclast adhesion and possibly haptotaxis. An OPN-containing cement line is also present at hard tissue interfaces in rat tooth, against osseointegrated titanium and hydroxyapatite implants and at the margins of surgically created bone defects--and there may influence biological adhesion in a manner similar to that proposed for normal bone. It is suggested, therefore, that in addition to its potential for influencing cell adhesion/dynamics in bones and teeth, OPN in cement lines may act as an interfacial adhesion promoter between apposing substrates, therein maintaining the overall integrity of bone during the bone remodeling sequence and "bonding" dissimilar tissues (or biocompatible materials) together in biological composites such as teeth and osseointegrated implants.

Attempts to label matrix synthesis of human root cementum in vitro

The present study describes the dynamic process of both acellular extrinsic (AEFC) and acellular/cellular intrinsic fiber cementum (AIFC/CIFC) matrix production on growing human teeth. Selected erupting maxillary and mandibular premolars with roots grown to about 70%-95% of their final length were placed in organ culture immediately following extraction. Twelve teeth for short-time labeling were pulse-incubated for 15 min in medium containing 3H-proline and chased for various times in order to follow the migration and secretion of the tracer. Eight teeth for long-time incubation were labeled continuously for 5 h before being chased for 1-8 days in order to label cementum matrix accumulation. After decalcification in ethylene diaminetetraacetic acid (EDTA), their roots were subdivided into about 20 slices each. Epon-embedded sections were prepared for light- and electron-microscopic as well as autoradiographic examination. During CIFC-formation, cementoblasts revealed high intracytoplasmic silver grain concentrations within the first hour after 3H-proline administration. The release of the tracer occurred between 60 to 120 min after administration. After 2 h, cementoblasts and the cementum matrix appeared to be labeled about equally. After 5 h, most of the labeled proteins appeared to be localized in the cementoid. Silver grains increased in number over the cementum matrix from 5-24 h. Very high intracellular grain concentrations within very large cementoblasts corresponded to regions of rapid cementum formation. Tracer-halos around entrapped cells lend support to a multipolar mode of matrix production during CIFC-initiation. The fate of the tracer during the development of early AEFC-matrix was less clear. However, fibroblasts revealed dense intracytoplasmic grain accumulations within the first hour after 3H-proline administration. Thereafter, the tracer localization was vague. This indistinct grain localization reflected the particular mode of AEFC-matrix production characterized by addition of new fibril segments to pre-existing fibers of a collagenous fringe.

Growth of acellular extrinsic fiber cementum (AEFC) and density of inserting fibers in human premolars of adolescents

The present study describes for the first time the changes of both AEFC thickness and the numerical density of collagen fibers inserting into AEFC at specified levels and sites of human premolars at different stages of development. The investigation was based on 45 premolars (25 maxillary, 20 mandibular; 25 first and 20 second), extracted from adolescents and young adults. All teeth were free of disease and presented with roots developed from 30-100% of their final length. They were prefixed in Karnovsky's fixative, decalcified in EDTA and subdivided into about 14 slices each, cut from mesial and distal root surfaces, vertical to and along the root axis. The slices were postfixed in OsO4, embedded in Epon and cut for light-microscopic study. AEFC thickness (4086 measurements) and the density of the collagenous fiber fringe (454 counts) inserting in AEFC were measured at 1, 3, 5 and 7 mm apical to the cementoenamel junction. The data obtained showed: AEFC thickness increased with age and varied between 0 and 57.5 microns. Between 9 and 17 years, cervical AEFC thickness increased in maxillary first premolars from an average of 5 to 30 microns, and in mandibular second premolars from 6 to 20 microns, i.e., AEFC grew at approximately the same rate as later in life. Depending on the differences in tooth development, AEFC on maxillary first premolars became thicker than that on mandibular second premolars. Due to the corono-apically decreasing gradient of AEFC development, its increase in mid-root regions lagged behind that in cervical regions of all teeth in people younger than about 14 yr.(ABSTRACT TRUNCATED AT 250 WORDS)

Initial formation of cellular intrinsic fiber cementum in developing human teeth. A light- and electron-microscopic study

The present study describes the formative process of the initiation of cellular intrinsic fiber cementum (CIFC) in still growing human teeth. From 29 premolars and molars with incomplete roots developed to 60-90% of their final length, 8 premolars (with roots formed to three quarters of their final length) were selected for electron-microscopic investigation. All teeth were clinically intact and prefixed in Karnovsky's fixative immediately after extraction. Most of them were decalcified in ethylene diaminetetraacetic acid (EDTA), and the apical part of the roots was divided axially into mesial and distal portions that were subdivided in about 5 slices each. Following osmication and embedding in Epon, these blocks were cut for light- and electron-microscopic examination. In addition, 5 teeth with incomplete roots were freed from organic material and processed for scanning electron microscopy. It was found that CIFC-initiation commenced very close to the advancing root edge and resulted in a rapid cementum thickening. Thereafter, appositional growth continued on the already established cementum surface. Large, basophilic and rough endoplasmic reticulum-rich cementoblasts, some of which became cementocytes, were responsible for both fast and slow CIFC-formation. The CIFC-matrix was free of Sharpey's fibers and composed of more or less organized intrinsic collagen fibrils, in part fibril bundles, that ran roughly parallel to the root surface. Initially, the cementum fibrils intermingled with those of the dentinal collagen fibrils, which were not yet mineralized. This boundary subsequently underwent calcification. The development of collagen fibril bundles and their extracellular arrangement were associated with cytoplasmic processes probably involved in fibril formation and fibril assembly. Many cementoblasts contained intracytoplasmic, membrane-bounded collagen fibrils, which probably were related to fibril formation rather than degradation.