Influence of cryopreservation on the pulpal tissue of immature third molars in vitro

In Vitro Investigation into the Effect of Cryopreservation on the Mechanical Characteristics of Dental Hard Tissues

Previous research has reported on hidden damage within the dentin introduced by cryopreservation, but the effect on the mechanical properties of the hard tissues at tooth level remains unclear. The main objective of this study is to investigate the effect of cryopreservation on the mechanical properties of teeth. A matched sample of 234 premolars of 117 children (9 ≤ age ≤ 16 years), bilaterally extracted for orthodontic reasons, were included. For each child, one tooth was randomly allocated to the cryopreservation group and the contralateral tooth was assigned to the control group. Static compression tests were performed to determine load to failure, stiffness, and toughness. In a subgroup of 20 teeth, a cyclic preloading or chewing simulation was performed. Additionally, the fracture mode was determined, and the microstructure of the fractured surfaces was examined using a scanning electron microscope (SEM). Linear mixed model analyses could not detect a statistical difference in the mean load to failure (p = 0.549), mean toughness (p = 0.968), or mean stiffness (p = 0.150) between cryopreserved and non-cryopreserved teeth. No significant difference in load to failure after cyclic preloading was detected between groups (p = 0.734). SEM analysis revealed comparable fracture characteristics between groups. It is concluded that cryopreservation does not affect the mean load to failure, stiffness, or toughness of teeth, indicating that hidden damage in the dentin is not critical at tooth level.

Application of cryopreservation to tooth germ transplantation for root development and tooth eruption

We cryopreserved mouse tooth germs with widely open cervical margins of the enamel organ to overcome difficulties in cryoprotectant permeation and tested their efficacy by transplanting them into recipient mice. The upper right first molar germs of 8-day-old donor mice were extracted and categorized into the following four groups according to cryopreservation time: no cryopreservation, 1 week, 1 month, and 3 months. The donor tooth germs were transplanted into the upper right first molar germ sockets of the 8-day-old recipient mice. The upper left first molars of the recipient mice were used as controls. The outcome of the transplantation was assessed at 1, 2, and 3 weeks after transplantation. Stereomicroscopic evaluation revealed that most of the transplanted teeth erupted by 3 weeks after transplantation. Micro-computed tomography analysis revealed root elongation in the transplanted groups as well as in the controls. There was no significant difference between the cryopreserved and non-cryopreserved transplanted teeth, but the roots of the cryopreserved teeth were significantly shorter than those of the control teeth. Histological examination revealed root and periodontal ligament formations in all the transplanted groups. These results suggest that the transplantation of cryopreserved tooth germs facilitates subsequent root elongation and tooth eruption.

Cryopreservation of mesenchymal stem cells derived from dental pulp: a systematic review

Objectives

The aim of the present systematic review was to investigate the cryopreservation process of dental pulp mesenchymal stromal cells and whether cryopreservation is effective in promoting cell viability and recovery.

Materials and Methods

This systematic review was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the research question was determined using the population, exposure, comparison, and outcomes strategy. Electronic searches were conducted in the PubMed, Cochrane Library, Science Direct, LILACS, and SciELO databases and in the gray literature (dissertations and thesis databases and Google Scholar) for relevant articles published up to March 2019. Clinical trial studies performed with dental pulp of human permanent or primary teeth, containing concrete information regarding the cryopreservation stages, and with cryopreservation performed for a period of at least 1 week were included in this study.

Results

The search strategy resulted in the retrieval of 185 publications. After the application of the eligibility criteria, 21 articles were selected for a qualitative analysis.

Conclusions

The cryopreservation process must be carried out in 6 stages: tooth disinfection, pulp extraction, cell isolation, cell proliferation, cryopreservation, and thawing. In addition, it can be inferred that the use of dimethyl sulfoxide, programmable freezing, and storage in liquid nitrogen are associated with a high rate of cell viability after thawing and a high rate of cell proliferation in both primary and permanent teeth.

The orthodontic bonding properties of human enamel after cryopreservation

The aim was to investigate the effect of cryopreservation on the enamel bonding properties of orthodontic brackets. Sixty-six human premolars were randomly allocated to a control group or a cryopreserved group. Conventional stainless-steel orthodontic brackets were bonded with a light cure adhesive on the buccal side of the premolars. The shear bond strength (SBS) was determined at a crosshead speed of 1 mm/min. The SBS and adhesive remnant index (ARI) were evaluated respectively by an independent samples t test and Fisher's exact test (α≤0.05). The mean failure load was lower in the cryopreserved group. However, this difference in SBS was not significant (p=0.443). In both groups, the ARI mostly indicated a failure at the enamel-adhesive interface. The mean ARI scores for both groups were not significantly different (p=0.099). Within the limitations of this macro bond strength testing, it can be concluded that cryopreservation does not significantly affect the bonding properties of enamel.

The establishment of a chemically defined serum-free culture system for human dental pulp stem cells

Background

The concept of establishing a dental stem cell (DSC) bank for oral and maxillofacial regeneration has become of great interest but it remains at a primitive stage. The routine application of serum-containing conditions for human DSC (hDSC) culture is in great controversy considering that the animal-originated serum can cause serious ethical concerns and lead to increasingly irrelevant variables, errors, and poor repeatability of experiment results. Thus, this study aimed to establish a safe, stable and efficient hDSC serum-free culturing system for future DSC bank usage.

Methods

Dental pulp stem cells (DPSCs) from human permanent tooth pulp were isolated, expanded, passaged, and divided into two groups according to their culture conditions: group 1 was the serum-containing medium (SCM) group; and group 2 was the serum-free Essential 8 medium (E8) group. DPSCs were characterized first, followed by cell proliferation, pluripotency, and migration study in SCM and E8 medium.

Results

Human DPSCs (hDPSCs) in E8 medium demonstrated greater proliferation, pluripotency, migration ability and less apoptosis. hDPSCs could be successfully induced to the adipogenic, osteogenic, neurogenic, and chondrogenic lineages in E8 group. Real-time polymerase chain reaction indicated that the expression of PPAR-γ, RUNX2, OCN and MAP-2 was higher in E8 group. 

Conclusions

Compared with serum-containing medium, E8 medium exhitibed higher ability in maintaining the cell proliferation, pluripotency, migration, and stability. This new serum-free culture environment might be applicable for hDSC culture in the future.

The evaluation of the transport medium for extracted premolars prior to cryopreservation: a systematic literature review

Prior to cryopreservation, a tooth is transported from a contaminated oral environment to the tooth bank. Our objective was to identify all studies reporting or investigating a transport protocol prior to the cryopreservation of teeth, in terms of decontamination of the subjects. The systematic literature search (1970-2017) was based on MEDLINE via PubMed, Web of Science and the Cochrane Library. The reference lists of the included studies and the Science Citation Index were used for hand searching (snowballing). Only studies reporting the transport conditions of the transplant were included. Language restrictions for English, Dutch or French were applied. The search led to 14 eligible studies. Almost all studies were laboratory studies, so the methodological quality of evidence was low. The majority of the included studies was performed by only five different research groups and the number of subjects varied between 1 and 120 teeth. In general, the teeth were stored in a tissue culture medium supplemented with fetal calf serum and/or different combinations of antibiotics and/or antimycotics. The teeth were transported cooled (4 °C) or at room temperature, for a period of time not exceeding 24 h. Only three studies reported the irrigation of the teeth with phosphate buffered saline prior to the transport. The optimisation of the decontamination during transport was investigated in three studies (from 1971, 1980 and 1982). It was concluded that the literature on this topic is scarce, and the decontamination protocol for teeth, prior to cryopreservation has not been validated recently.

Does Cryopreservation Affect the Biological Properties of Stem Cells from Dental Tissues? A Systematic Review

This systematic review evaluated if different cryopreservation protocols could affect biological properties (Cell survival rate (CSR), proliferation, differentiation, maintenance of stem cell markers) of stem cells obtained from dental tissues (DSC) post-thaw. An electronic search was carried out within PubMed and ISI Web Science by using specific keyword. Two independent reviewers read the titles and abstracts of all reports respecting predetermined inclusion/exclusion criteria. Data were extracted considering the biological properties of previously cryopreserved DSCs and previously cryopreserved dental tissues. DSCs cryopreserved as soon as possible after their isolation presents a CSR quite similar to the non-cryopreserved DSC. Dimethyl sulfoxide (DMSO) [10%] showed good results related to cell recovery post-thaw to cryopreserve cells and tissues for periods of up to 2 years. The cryopreservation of DSC in a mechanical freezer (-80°C) allows the recovery of stem cells post-thaw. The facilities producing magnetic field (MF), demand a lower concentration of cryoprotectant, but their use is not dispensable. It is possible to isolate and cryopreserve dental pulp stem cell (DPSC) from healthy and diseased vital teeth. Cryopreservation of dental tissues for late DSC isolation, combined with MF dispensability, could be valuable to reduce costs and improve the logistics to develop teeth banks.

Effect of a cryopreservation protocol on the proliferation of stem cells from human exfoliated deciduous teeth

OBJECTIVE

The aim of the present study was to evaluate the influence of a cryopreservation protocol on the proliferation and viability of stem cells from human exfoliated deciduous teeth (SHEDs).

MATERIALS AND METHODS

Cells from the pulp of three deciduous teeth were isolated and characterized to confirm their stem cell nature. In second passage, part of the cells were submitted to normal conditions of cell culture (Control group), while part of the cells were maintained in 10% DMSO diluted in foetal bovine serum and submitted to the following cryopreservation protocol: 2 h at 4 °C, 18 h at -20 °C and then at -80 °C for two intervals (30 days - Cryopreservation I; and 180 days Cryopreservation II). Cell proliferation and cell cycle were evaluated at intervals of 24, 48 and 72 h after plating, and apoptosis-related events were analyzed at 72 h.

RESULTS

All groups exhibited an increase in the number of cells, and no significant differences between the cryopreserved and control groups were observed (p > .05). The distribution of cells in the cell cycle phases was consistent with cell proliferation, and the percentage of viable cells was higher than 99% in all groups, indicating that cell viability was not affected by the cryopreservation protocol throughout the experiment.

CONCLUSION

The proposed cryopreservation protocol is adequate for the storage of SHED, permitting their use in future experimental studies.

Characteristics of stem cells from human exfoliated deciduous teeth (SHED) from intact cryopreserved deciduous teeth

The aim of this study is to compare the characteristics of stem cells derived from human exfoliated deciduous teeth (SHED) from cryopreserved intact deciduous teeth with those of fresh SHED. In total, 20 exfoliated deciduous teeth were randomly divided into a fresh group (f-SHED; n = 11) and cryopreserved group (c-SHED; n = 9; stored for 1-8 months). Following thawing and separation of the pulp, the SHED cells were cultured, and the characteristics as mesenchymal stem cells were investigated using proliferation assays, cell-cycle analysis, colony-forming unit-fibroblast (CFU-F) assays, and flow cytometry analyses. Furthermore, differentiation into adipogenic and osteogenic lineages was investigated in vitro as well as in vivo via transplantation in mice. We found no significant differences between the two groups in the proliferation analyses, in the expression of mesenchymal stem cell markers, or in the adipogenic and osteogenic differentiation in vitro (p < 0.05). Furthermore, the in vivo transplantation results showed no significant differences in the quantity of bone tissue that formed or in histochemistry performance (p < 0.05). In conclusion, cryopreservation of intact exfoliated deciduous teeth appears to be a useful method for preserving SHED.

Dental Stem Cells in Pulp Regeneration: Near Future or Long Road Ahead?

Although regenerative endodontic procedures have yielded an impressive body of favorable outcomes, the treatment of necrotic immature permanent teeth in particular remains to be a challenge. Recent advances in dental stem cell (DSC) research have gained increasing insight in their regenerative potential and prospective use in the formation of viable dental tissues. Numerous studies have already reported successful dental pulp regeneration following application of dental pulp stem cells, stem cells from the apical papilla, or dental follicle precursor cells in different in vivo models. Next to responsive cells, dental tissue engineering also requires the support of an appropriate scaffold material, ranging from naturally occurring polymers to treated dentin matrix components. However, the routine use and banking of DSCs still holds some major challenges, such as culture-associated differences, patient-related variability, and the effects of culture medium additives. Only in-depth evaluation of these problems and the implementation of standardized models and protocols will effectively lead to better alternatives for patients who no longer benefit from current treatment protocols.

Today prospects for tissue engineering therapeutic approach in dentistry

In dental practice there is an increasing need for predictable therapeutic protocols able to regenerate tissues that, due to inflammatory or traumatic events, may suffer from loss of their function. One of the topics arising major interest in the research applied to regenerative medicine is represented by tissue engineering and, in particular, by stem cells. The study of stem cells in dentistry over the years has shown an exponential increase in literature. Adult mesenchymal stem cells have recently been isolated and characterized from tooth-related tissues and they might represent, in the near future, a new gold standard in the regeneration of all oral tissues. The aim of our review is to provide an overview on the topic reporting the current knowledge for each class of dental stem cells and to identify their potential clinical applications as therapeutic tool in various branches of dentistry.

Numerical simulation of the effect of superparamagnetic nanoparticles on microwave rewarming of cryopreserved tissues

In this study, the microwave rewarming process of cryopreserved samples with embedded superparamagnetic (SPM) nanoparticles was numerically simulated. The Finite Element Method (FEM) was used to calculate the coupling of the electromagnetic field and the temperature field in a microwave rewarming system composed of a cylindrical resonant cavity, an antenna source, and a frozen sample phantom with temperature-dependent properties. The heat generated by the sample and the nanoparticles inside the electromagnetic field of the microwave cavity was calculated. The dielectric properties of the biological tissues were approximated using the Debye model, which is applicable at different temperatures. The numerical results showed that, during the rewarming process of the sample phantom without nanoparticles, the rewarming rate was 29.45°C/min and the maximum temperature gradient in the sample was 3.58°C/mm. If nanoparticles were embedded in the sample, and the cavity power was unchanged, the rewarming rate was 47.76°C/min and the maximum temperature gradient in the sample was 1.64°C/mm. In the presence of SPM nanoparticles, the rewarming rate and the maximum temperature gradient were able to reach 20.73°C/min and 0.68°C/mm at the end of the rewarming under the optimized cavity power setting, respectively. The ability to change these temperature behaviors may prevent devitrification and would greatly diminish thermal stress during the rewarming process. The results indicate that the rewarming rate and the uniformity of temperature distribution are increased by nanoparticles. This could be because nanoparticles generated heat in the sample homogeneously and the time-dependent parameters of the sample improved after nanoparticles were homogeneously embedded within it. We were thus able to estimate the positive effect of SPM nanoparticles on microwave rewarming of cryopreserved samples.

Viability of pulp stromal cells in cryopreserved deciduous teeth

The cryopreservation of exfoliated deciduous teeth and harvesting of stem cells from them as required would reduce the costs and efforts associated with banking stem cells from primary teeth. The aim of this study was determine whether the viability of pulp stromal cells from deciduous teeth was influenced by the cryopreservation process itself or the period of cryopreservation. In total, 126 deciduous teeth were divided into three groups: (1) fresh, (2) cryopreserved for <3 months (cryo<3), and (3) cryopreserved for 3-9 months (cryo3-9). The viability of the pulp tissues was compared among the three groups by evaluating the outgrowth from pulp tissues and cell activity within those pulp tissues. In addition, the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay was performed to compare cell apoptosis within fresh pulp tissue and pulp tissue that had been cryopreserved for 4 months. The outgrowth from and cell activity within the pulp tissues did not differ significantly between the fresh and cryo<3 pulp tissues. However, these parameters were significantly reduced in the cryo3-9 pulp tissue. In TUNEL assay, 4-month cryopreserved pulp tissues has more apoptotic cells than fresh group. In conclusion, it is possible to acquire pulp stromal cells from cryopreserved deciduous teeth. However, as the period of cryopreservation becomes longer, it is difficult to get pulp cells due to reduced cell viability.

The critical apical diameter to obtain regeneration of the pulp tissue after tooth transplantation, replantation, or regenerative endodontic treatment

INTRODUCTION

Regeneration of pulp-like tissue in the pulp chamber after tooth transplantation, replantation, or in regenerative endodontic treatment is only possible if the apical foramen is open. According to the literature, the success of regeneration decreases considerably if the foramen is smaller than 1 mm when measured on radiographs. The aim of this study was to study histologically the relation between the width of the apical foramen and regeneration of tissue in the pulp chamber after autotransplantation.

METHODS

Fifteen single-rooted mature teeth of 3 adult beagle dogs were used. All experimental teeth were extracted and underwent apicoectomy. The teeth were photographed from the apical side, and the width of the foramen was calculated. The foramen width ranged from 0.24-1.09 mm. All teeth were replanted in infraocclusion. The observation period was 90 days after transplantation.

RESULTS

The 10 teeth with the smallest apical diameter, ranging between 0.24 and 0.53 mm, showed vital tissue in at least one third of the pulp chamber. The 6 most successful teeth showing vital tissue in the entire pulp chamber had an apical diameter between 0.32 and 0.65 mm, and 80% of the experimental teeth with a diameter varying between 1.09 and 0.31 mm showed vital tissue in at least one third of the pulp chamber 90 days after transplantation.

CONCLUSIONS

The size of the apical foramen seems not to be the all decisive factor for successful revascularization and ingrowth of new tissue after transplantation. The minimum width of the apical foramen has not been determined, but a size smaller than 1 mm does not prevent revascularization and ingrowth of vital tissue. In this animal study an apical foramen of 0.32 mm did not prevent ingrowth of new tissue in two-thirds of the pulp chamber 90 days after transplantation.

Er:YAG laser-roughened enamel promotes osteoblastic differentiation

OBJECTIVE

The aim of this study was to test whether Er:YAG laser-etched enamel of human teeth could act as a biologically active scaffold for tissue regeneration.

BACKGROUND DATA

Hydroxylapatite (HA) with rough surface created by acid etching treatment has been used as a scaffold for tissue engineering. However, whether tooth HA can be a scaffold for osteoblastic cell seeding is still unclear.

MATERIALS AND METHODS

Enamel samples from human teeth were pretreated with an Er:YAG laser to create a rough surface. Then the surface of the laser-treated enamel was examined using a surface roughness profilometer and a scanning electron microscope. In addition, static water contact angles of the Er:YAG laser-treated enamel samples were measured using goniometry. To observe the effects of cell behavior on an Er:YAG laser-roughened enamel surface, we cultured MG63 osteoblast-like cells on the surface-modified enamel samples. Alkaline phosphatase activity, a marker of cell proliferation and differentiation, was monitored and compared with that in untreated control and acid-etched enamel samples.

RESULTS

Er:YAG laser treatment significantly improved the surface roughness of the enamel samples. Furthermore, MG63 osteoblast-like cells cultured on the Er:YAG laser-roughened enamel surface expressed more alkaline phosphatase activity and exhibited greater degrees of cellular differentiation than did cells that had been cultured on untreated enamel samples.

CONCLUSIONS

These results demonstrate that Er:YAG laser-roughened enamel promotes osteoblastic differentiation. This finding suggests that Er:YAG laser-roughened enamel surfaces can potentially serve as a scaffold for tissue engineering.

In vitro comparative analysis of cryopreservation of undifferentiated mesenchymal cells derived from human periodontal ligament

Cryopreservation aims to cease all biological functions of living tissues in a reversible and controlled manner, i.e., to permit the recovery of cells by maintaining a high degree of their viability and functional integrity. The objective of this study was to evaluate in vitro the influence of cryopreservation on undifferentiated mesenchymal cells derived from the periodontal ligament of human third molars. Mesenchymal cells were isolated from six healthy teeth and cultured in α-MEM medium supplemented with antibiotics and 15% FBS in a humid atmosphere with 5% CO(2) at 37°C. The cells isolated from each tooth were divided into two groups: group I (fresh, non-cryopreserved cells) was immediately cultured, and group II was submitted to cryopreservation for 30 days. The rates of cell adhesion and proliferation were analyzed in the two groups by counting the cells adhered to the wells at 24, 48 and 72 h after plating. The number of cells per well was obtained by counting viable cells in a hemocytometer using the Trypan blue exclusion method. Differences between groups at each time point were evaluated by the Wilcoxon test. The Friedman test was used to determine differences between time points and, if detected, the Wilcoxon test with Bonferroni correction was applied. The results showed no significant difference in the in vitro growth capacity of undifferentiated mesenchymal cells between the two groups. In conclusion, cryopreservation for 30 days had no influence on periodontal ligament mesenchymal cells.

Human dental pulp stem cells derived from different cryopreservation methods of human dental pulp tissues of diseased teeth

BACKGROUND

Successful isolation of human dental pulp stem cells (hDPSCs) has been documented at least 120h after tooth extraction. Viable hDPSCs have been isolated chiefly from cryopreserved healthy molar teeth and their undigested dental pulp tissue. Isolation of hDPSCs from diseased but vital teeth after cryopreservation has not been reported. This study aimed to isolate hDPSCs from cryopreserved diseased but vital teeth of various tooth types.

MATERIALS

Fifty tooth samples were divided into group A (n = 20) - freshly derived dental pulp tissues, group B (n = 20) - liquid nitrogen (liq N(2) )-stored dental pulp tissues and group C (n = 10) - liq N(2) -stored intact teeth.

METHODS AND RESULTS

The success rate for hDPSCs isolation was 100% for groups A and B and only 20% for group C. hDPSCs from all groups demonstrated self-renewal properties and similar multipotent potential characteristics of adipogenic, chondrogenic and osteogenic differentiation. In addition, hDPSCs showed high expression of bone-marrow mesenchymal stem-cell markers (CD29, CD90 and CD105) and very low expression of specific hematopoietic cells markers (CD14, CD34 and CD45).

CONCLUSION

Our results indicate that hDPSCs isolated from diseased but vital teeth of various tooth types can be stored in liq N(2) for future usage.