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Kollmuss M, Edelhoff D, Schwendicke F, Wuersching SN. In Vitro Cytotoxic and Inflammatory Response of Gingival Fibroblasts and Oral Mucosal Keratinocytes to 3D Printed Oral Devices. Polymers (Basel) 2024; 16:1336. [PMID: 38794529 PMCID: PMC11125196 DOI: 10.3390/polym16101336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
The purpose of this study was to examine the biocompatibility of 3D printed materials used for additive manufacturing of rigid and flexible oral devices. Oral splints were produced and finished from six printable resins (pairs of rigid/flexible materials: KeySplint Hard [KR], KeySplint Soft [KF], V-Print Splint [VR], V-Print Splint Comfort [VF], NextDent Ortho Rigid [NR], NextDent Ortho Flex [NF]), and two types of PMMA blocks for subtractive manufacturing (Tizian Blank PMMA [TR], Tizian Flex Splint Comfort [TF]) as controls. The specimens were eluted in a cell culture medium for 7d. Human gingival fibroblasts (hGF-1) and human oral mucosal keratinocytes (hOK) were exposed to the eluates for 24 h. Cell viability, glutathione levels, apoptosis, necrosis, the cellular inflammatory response (IL-6 and PGE2 secretion), and cell morphology were assessed. All eluates led to a slight reduction of hGF-1 viability and intracellular glutathione levels. The strongest cytotoxic response of hGF-1 was observed with KF, NF, and NR eluates (p < 0.05 compared to unexposed cells). Viability, caspase-3/7 activity, necrosis levels, and IL-6/PGE2 secretion of hOK were barely affected by the materials. All materials showed an overall acceptable biocompatibility. hOK appeared to be more resilient to noxious agents than hGF-1 in vitro. There is insufficient evidence to generalize that flexible materials are more cytotoxic than rigid materials. From a biological point of view, 3D printing seems to be a viable alternative to milling for producing oral devices.
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Affiliation(s)
- Maximilian Kollmuss
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany; (F.S.); (S.N.W.)
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany;
| | - Falk Schwendicke
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany; (F.S.); (S.N.W.)
| | - Sabina Noreen Wuersching
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany; (F.S.); (S.N.W.)
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Chachartchi T, Itai Y, Tzach-Nahman R, Sculean A, Shapira L, Polak D. Mechanical force application and inflammation induce osteoclastogenesis by independent pathways. Clin Oral Investig 2023; 27:5853-5863. [PMID: 37775586 DOI: 10.1007/s00784-023-05196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/28/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To investigate the functional changes of PDL fibroblasts in the presence of mechanical force, inflammation, or a combination of force and inflammation. MATERIALS AND METHODS Inflammatory supernatants were prepared by inoculating human neutrophils with Porphyromonas gingivalis. Primary human PDL fibroblasts (PDLF), gingival fibroblasts (GFs), and osteoblasts (Saos2) were then exposed to the inflammatory supernatants. Orthodontic force on the PDLFs was simulated by centrifugation. Analyses included cell proliferation, cell viability, cell cycle, and collagen expression, as well as osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-Β ligand (RANKL) expression. RESULTS Mechanical force did not affect PDLF viability, but it increased the metabolic rate compared to resting cells. Force application shifted the PDLF cell cycle to the G0/G1 phase, arresting cell proliferation and leading to elevated collagen production, mild OPG level elevation, and robust RANKL level elevation. Including an inflammatory supernatant in the presence of force did not affect PDLF viability, proliferation, or cytokine expression. By contrast, the inflammatory supernatant increased RANKL expression in GFs, but not in Saos2 cells. CONCLUSION Applying mechanical force significantly affects PDLF function. Although inflammation had no effect on PDLF or Saos2 cells, it promoted RANKL expression in GF cells. Within the limitations of the in vitro model, the results suggest that periodontal inflammation and mechanical forces could affect bone catabolism through effects on different cell types, which may culminate in synergistic bone resorption.
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Affiliation(s)
- Tali Chachartchi
- Department of Periodontology, Hadassah Faculty of Dental Medicine, Hebrew University, P.O. Box 12272, 91120, Jerusalem, Israel
| | - Yifat Itai
- Department of Orthodontics, Hadassah Faculty of Dental Medicine, Hebrew University, Jerusalem, Israel
- The Institute of Dental Sciences, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Rinat Tzach-Nahman
- Department of Periodontology, Hadassah Faculty of Dental Medicine, Hebrew University, P.O. Box 12272, 91120, Jerusalem, Israel
- The Institute of Dental Sciences, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Lior Shapira
- Department of Periodontology, Hadassah Faculty of Dental Medicine, Hebrew University, P.O. Box 12272, 91120, Jerusalem, Israel
| | - David Polak
- Department of Periodontology, Hadassah Faculty of Dental Medicine, Hebrew University, P.O. Box 12272, 91120, Jerusalem, Israel.
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Chen LW, Jin SH, Lu Q, Zhou JG, Liu JG, Guan XY, Xia HB, He H. Identification of immunological bioprocesses involved in peri-implantitis using weighted gene co-expression network analysis. J Periodontol 2023; 94:1078-1089. [PMID: 37032448 DOI: 10.1002/jper.22-0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 01/04/2023] [Accepted: 03/18/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Peri-implantitis is an irreversible infectious disease that occurs with high incidence. Exploring the immune responses of peri-implantitis is key to developing targeted treatment strategies. However, there is limited research on the immune response of peri-implantitis. METHODS This study performed a weighted gene co-expression network analysis to identify the peri-implantitis related gene network and conducted a functional enrichment analysis of the gene network. Thereafter, the candidate hub genes were selected by constructing a protein-protein interaction network and drawing an upset plot. The hub genes were identified through their significant associations with disease condition and validated using quantitative reverse transcription-polymerase chain reaction (qRT-PCR) analysis. Using the gene set variation analysis, the hub genes were further used to explore infiltrating immunocytes and immune factors in peri-implantitis. Finally, the immunocytes and immune factor related hub genes were intersected to obtain the therapeutic target, which was validated using histological staining. RESULTS The peri-implantitis related gene network was enriched in innate and adaptive immune response. Subsequently, interleukin (IL)1B, IL10, ITGAM, ITGB1, STAT3, and TLR4 were identified as hub genes. Plasmacytoid dendritic cells, macrophages, myeloid-derived suppressor cells, natural killer T cells, and immature B cells were positively and significantly related to the hub genes IL1B, TLR4, ITGAM, and ITGB1 (correlation coefficient > 0.80). While immune factors CXCL10, IL6, and CXCL12 and hub genes IL10 and IL1B held the highest degree in the immune factors network. IL1B may be a promising therapeutic target. CONCLUSION This study provides new insights into the hub genes, immunocytes, and immune factors underlying peri-implantitis immunological bioprocess.
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Affiliation(s)
- Liang-Wen Chen
- Hubei-MOST KLOS & KLOBM, Department of Oral Implantology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Su-Han Jin
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
| | - Qian Lu
- Hubei-MOST KLOS & KLOBM, Department of Oral Implantology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jian-Guo Zhou
- Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jian-Guo Liu
- School of Stomatology, Special Key Laboratory of Oral Diseases Research, Higher Education Institution, Zunyi Medical University, Zunyi, China
| | - Xiao-Yan Guan
- Department of Orthodontics, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
| | - Hai-Bin Xia
- Hubei-MOST KLOS & KLOBM, Department of Oral Implantology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hong He
- Department of Orthodontics, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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Alkakhan W, Farrar N, Sikora V, Emecen-Huja P, Huja SS, Yilmaz Ö, Pandruvada SN. Statins Modulate Microenvironmental Cues Driving Macrophage Polarization in Simulated Periodontal Inflammation. Cells 2023; 12:1961. [PMID: 37566040 PMCID: PMC10417531 DOI: 10.3390/cells12151961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023] Open
Abstract
Periodontal disease (PD) is a chronic inflammatory disorder characterized by the destruction of connective tissue, tooth loss, and systemic infections. Clinically, treatment of PD includes control of the etiologic factors via several modalities: initial therapy including scaling and root planing (SRP), corrective phase of surgical treatment, both with and without adjunct antimicrobial/pharmacological agents, followed by a maintenance/supportive periodontal therapy phase. Each treatment phase aims to control oral biofilm by addressing risk factors and etiology. Monotherapy of systemic antibiotics is insufficient compared to their use as an adjunct to SRP. The critical issue of systemic antimicrobial usage includes adverse patient outcomes and increased bacterial resistance. Therefore, alternative adjuncts to periodontal therapy have been sought. Statins are widely prescribed for the treatment of hypercholesterolemia and cardiovascular disease. Statins have demonstrated anti-inflammatory properties and immunomodulatory effects, and a few retrospective studies showed that statin patients exhibit fewer signs of periodontal inflammation than subjects without the medication. Despite the available clinical studies on the local administration of statins for PD, no studies have reported the macrophage polarization response. We have developed a gingival fibroblast-macrophage co-culture model to track macrophage response when exposed to a battery of microenvironmental cues mimicking macrophage polarization/depolarization observed in vivo. Using our model, we demonstrate that simvastatin suppresses macrophage inflammatory response and upregulates tissue homeostasis and M2 macrophage markers. Our findings support the usage of statins to mitigate periodontal inflammation as a valid strategy.
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Affiliation(s)
- Waleed Alkakhan
- Department of Oral Health Sciences, James B. Edwards College of Dental Medicine, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA (Ö.Y.)
- Division of Periodontics, James B. Edwards College of Dental Medicine, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA;
| | - Nico Farrar
- Department of Oral Health Sciences, James B. Edwards College of Dental Medicine, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA (Ö.Y.)
| | - Vanessa Sikora
- Department of Oral Health Sciences, James B. Edwards College of Dental Medicine, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA (Ö.Y.)
| | - Pinar Emecen-Huja
- Division of Periodontics, James B. Edwards College of Dental Medicine, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA;
| | - Sarandeep S. Huja
- Division of Orthodontics, James B. Edwards College of Dental Medicine, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA;
| | - Özlem Yilmaz
- Department of Oral Health Sciences, James B. Edwards College of Dental Medicine, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA (Ö.Y.)
| | - Subramanya N. Pandruvada
- Department of Oral Health Sciences, James B. Edwards College of Dental Medicine, Medical University of South Carolina, 173 Ashley Avenue, Charleston, SC 29425, USA (Ö.Y.)
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Serrano-Lopez R, Morandini AC. Fibroblasts at the curtain call: from ensemble to principal dancers in immunometabolism and inflammaging. J Appl Oral Sci 2023; 31:e20230050. [PMID: 37377310 PMCID: PMC10392869 DOI: 10.1590/1678-7757-2023-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/08/2023] [Indexed: 06/29/2023] Open
Abstract
Inflammation is a necessary step in response to injuries, being vital in restoring homeostasis and facilitating tissue healing. Among the cells that play a crucial role in inflammatory responses, stromal cells, including fibroblasts, have an undeniable significance in fine-tuning the magnitude of mediators that directly affect hyper-inflammatory responses and tissue destruction. Fibroblasts, the dominant cells in the gingival connective tissue, are a very heterogeneous population of cells, and more recently they have been receiving well deserved attention as central players and often the 'principal dancers' of many pathological processes ranging from inflammation and fibrosis to altered immunity and cancer. The goal of the current investigation is to dive into the exact role of the stromal fibroblast and the responsible mechanistic factors involved in both regulation and dysregulation of the inflammatory responses. This article reviews the most recent literature on how fibroblasts, in their different activation states or subtypes, play a crucial role in contributing to inflammatory outcomes. We will focus on recent findings on inflammatory diseases. We will also provide connections regarding the stromal-immune relationship, which supports the idea of fibroblast coming out from the 'ensemble' of cell types to the protagonist role in immunometabolism and inflammaging. Additionally, we discuss the current advances in variation of fibroblast nomenclature and division into clusters with their own suggested function and particularities in gene expression. Here, we provide a perspective for the periodontal implications, discussing the fibroblast role in the infection-driven and inflammatory mediated diseases such as periodontitis.
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Affiliation(s)
- Rogelio Serrano-Lopez
- Augusta University, Dental College of Georgia, Department of Oral Biology and Diagnostic Sciences, Augusta, GA, USA
- Augusta University, Honors Program, College of Science and Mathematics, Augusta, GA, USA
| | - Ana Carolina Morandini
- Augusta University, Dental College of Georgia, Department of Oral Biology and Diagnostic Sciences, Augusta, GA, USA
- Augusta University, Dental College of Georgia, Department of Periodontics, Augusta, GA, USA
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Chmielewski M, Pilloni A. Current Molecular, Cellular and Genetic Aspects of Peri-Implantitis Disease: A Narrative Review. Dent J (Basel) 2023; 11:dj11050134. [PMID: 37232785 DOI: 10.3390/dj11050134] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
(1) Background: Peri-implantitis is a multi-factorial disease with an inflammatory background that occurs in both soft and hard tissues surrounding implants. In recent years, the understanding of the cellular, molecular and genetic background of peri-implantitis has broadened. This study aims to summarize the currently available articles on the subject and highlight the most recent advances over the last 20 years. (2) Methods: For this study, the Embase and PubMed libraries were searched using the keywords: ("peri-implantitis" AND "cytokine" OR "genetics" OR "cellular") and ("peri-implantitis" AND "cytokine" OR "genetics" OR "cellular" AND "risk factors"). The search revealed a total of 3013 articles (992 from PubMed, 2021 from Embase). Following screening of the titles and abstracts and full-text reads, 55 articles were included. (3) Results: In peri-implantitis IL-6, IL-1β, TNF-α, MMP-8 and their genetic variations appear to be the most important cytokines in relation to not only pathogenesis, but also their potential diagnostic capabilities. Epithelial and inflammatory cells, along with those of the bone lineage, are prime cellular elements found in peri-implantitis. (4) Conclusions: A wide array of cells stand behind peri-implantitis, as well as cytokines and their genetic variations that take part in the process. However, the growing interest in this topic has led to the introduction of specific new diagnostic tools to enable a better understanding of patients' responses to treatment and, in turn, to even enable prediction of the risk of developing peri-implant disease.
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Affiliation(s)
| | - Andrea Pilloni
- Section of Periodontics, Department of Oral and Maxillo-Facial Sciences, Sapienza Unviersity of Rome, 00185 Rome, Italy
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Wielento A, Lagosz-Cwik K, Potempa J, Grabiec A. The Role of Gingival Fibroblasts in the Pathogenesis of Periodontitis. J Dent Res 2023; 102:489-496. [PMID: 36883660 PMCID: PMC10249005 DOI: 10.1177/00220345231151921] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Gingival fibroblasts (GFs) are essential components of the periodontium, which are responsible for the maintenance of tissue structure and integrity. However, the physiological role of GFs is not restricted to the production and remodeling of the extracellular matrix. GFs also act as sentinel cells that modulate the immune response to oral pathogens invading the gingival tissue. As an important "nonclassical" component of the innate immune system, GFs respond to bacteria and damage-related signals by producing cytokines, chemokines, and other inflammatory mediators. Although the activation of GFs supports the elimination of invading bacteria and the resolution of inflammation, their uncontrolled or excessive activation may promote inflammation and bone destruction. This occurs in periodontitis, a chronic inflammatory disease of the periodontium initiated and sustained by dysbiosis. In the inflamed gingival tissue, GFs acquire imprinted proinflammatory phenotypes that promote the growth of inflammophilic pathogens, stimulate osteoclastogenesis, and contribute to the chronicity of inflammation. In this review, we discuss the biological functions of GFs in healthy and inflamed gingival tissue, highlighting recent studies that provide insight into their role in the pathogenesis of periodontal diseases. We also draw parallels with the recently discovered fibroblast populations identified in other tissues and their roles in health and disease. This knowledge should be used in future studies to discover more about the role of GFs in periodontal diseases, especially chronic periodontitis, and to identify therapeutic strategies targeting their pathological interactions with oral pathogens and the immune system.
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Affiliation(s)
- A. Wielento
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - K.B. Lagosz-Cwik
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - J. Potempa
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
- Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, USA
| | - A.M. Grabiec
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
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Wuersching SN, Högg C, Kohl L, Reichl FX, Hickel R, Kollmuss M. Leaching components and initial biocompatibility of novel bioactive restorative materials. Dent Mater 2023; 39:293-304. [PMID: 36754734 DOI: 10.1016/j.dental.2023.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Bioactive restorative materials were developed on the premise that direct restorations should not only serve the purpose of reconstructing dental hard tissue defects but also exhibit biological features that prevent secondary caries development, without having adverse effects on the host cells. This study focuses on assessing the in vitro biocompatibility of two novel bioactive restorative materials. METHODS Specimens of the bioactive restorative materials, Cention Forte (CF) and ACTIVA BioACTIVE RESTORATIVE (AB), a glass ionomer cement/glass hybrid (EQUIA Forte HT, EF) and an established nanohybrid composite (Venus Diamond, VD) were produced and finished. The specimens were eluted in water and methanol and the resulting eluates were analyzed via gas chromatography-mass spectrometry. hGF-1 cells were exposed to eluates prepared in cell culture medium. Cellular ATP levels, oxidized glutathione concentration, caspase-3/7 activity and the inflammatory response (IL-6 and PGE2 levels) were determined. Microscopic images were taken to examine the cell morphology. RESULTS Methyl methacrylate and 2-Hydroxyethyl methacrylate were the main monomers detected in CF and AB eluates. All materials inhibited cell proliferation and led to significantly reduced ATP-levels. The cells exhibited a healthy morphology in the presence of CF and AB. Cells exposed to VD showed increased oxidized glutathione levels. Only EF led to enhanced caspase-3/7 activity. CF and AB caused IL-6 levels to increase, while EF and AB led to enhanced PGE2 levels. SIGNIFICANCE CF and AB are promising materials from a biological point of view and seem to have improved bioactive properties compared to glass ionomer cements.
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Affiliation(s)
- Sabina Noreen Wuersching
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany. .-muenchen.de
| | - Christof Högg
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany; Walther Straub Institute of Pharmacology and Toxicology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Lisa Kohl
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
| | - Franz-Xaver Reichl
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany; Walther Straub Institute of Pharmacology and Toxicology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
| | - Maximilian Kollmuss
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
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Su W, Li J, Jiang L, Lei L, Li H. Hexokinase 2-mediated glycolysis supports inflammatory responses to Porphyromonas gingivalis in gingival fibroblasts. BMC Oral Health 2023; 23:103. [PMID: 36793034 PMCID: PMC9933269 DOI: 10.1186/s12903-023-02807-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND When infected with Porphyromonas gingivalis, gingival fibroblasts undergo metabolic reprogramming, and rely on aerobic glycolysis rather than oxidative phosphorylation for rapid energy replenishment. Hexokinases (HKs) are catalysts for glucose metabolism, and HK2 constitutes the major HK inducible isoform. The objective of this study is to determine whether HK2-mediated glycolysis promotes inflammatory responses in inflamed gingiva. METHODS Levels of glycolysis-related genes were assessed in normal and inflamed gingiva. Human gingival fibroblasts were harvested and infected with Porphyromonas gingivalis in order to mimic periodontal inflammation. 2-deoxy-d-glucose, an analogue of glucose, was used to block HK2-mediated glycolysis, while small interfering RNA was used to knock down HK2 expression. The mRNA and protein levels of genes were analyzed by real-time quantitative PCR and western blotting, respectively. HK2 activity and lactate production were assessed by ELISA. Cell proliferation was assessed by confocal microscopy. The generation of reactive oxygen species was assessed by flow cytometry. RESULTS Elevated expression of HK2 and 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 was observed in the inflamed gingiva. P. gingivalis infection was shown to promote glycolysis in human gingival fibroblasts, as evidenced by increased gene transcription of HK2 and 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3, cell glucose consumption, and HK2 activity. Inhibition and knockdown of HK2 resulted in reduced cytokine production, cell proliferation, and reactive oxygen species generation. Furthermore, P. gingivalis infection activated the hypoxia-inducible factor-1α signaling pathway, thus promoting HK2-mediated glycolysis and proinflammatory responses. CONCLUSIONS HK2-mediated glycolysis promotes inflammatory responses in gingival tissues, and therefore glycolysis can be targeted in order to inhibit the progression of periodontal inflammation.
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Affiliation(s)
- Wenqi Su
- grid.41156.370000 0001 2314 964XDepartment of Periodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, #30 Zhongyang Road, Nanjing, 210008 Jiangsu China ,grid.41156.370000 0001 2314 964XCentral Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jingwen Li
- grid.41156.370000 0001 2314 964XDepartment of Periodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, #30 Zhongyang Road, Nanjing, 210008 Jiangsu China ,grid.41156.370000 0001 2314 964XCentral Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lishan Jiang
- grid.41156.370000 0001 2314 964XDepartment of Periodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, #30 Zhongyang Road, Nanjing, 210008 Jiangsu China ,grid.41156.370000 0001 2314 964XCentral Laboratory of Stomatology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lang Lei
- grid.41156.370000 0001 2314 964XDepartment of Orthodontics, Medical School of Nanjing University, Nanjing Stomatological Hospital, Nanjing, China
| | - Houxuan Li
- Department of Periodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, #30 Zhongyang Road, Nanjing, 210008, Jiangsu, China.
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Substrate stiffness controls proinflammatory responses in human gingival fibroblasts. Sci Rep 2023; 13:1358. [PMID: 36693942 PMCID: PMC9873657 DOI: 10.1038/s41598-023-28541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Soft gingiva is often compromised in gingival health; however, the underlying biological mechanisms remain unknown. Extracellular matrix (ECM) stiffness is involved in the progression of various fibroblast-related inflammatory disorders via cellular mechanotransduction. Gingival stiffness might regulate cellular mechanotransduction-mediated proinflammatory responses in gingival fibroblasts. This in vitro study aims to investigate the effects of substrate stiffness on proinflammatory responses in human gingival fibroblasts (hGFs). The hGFs isolated from two healthy donors cultured on type I collagen-coated polydimethylsiloxane substrates with different stiffnesses, representing soft (5 kPa) or hard (25 kPa) gingiva. Expression levels of proinflammatory mediators, prostaglandin E2 or interleukin-1β, in hGFs were significantly higher with the soft substrate than with the hard substrate, even without and with lipopolysaccharide (LPS) to induce inflammation. Expression levels of gingival ECM and collagen cross-linking agents in hGFs were downregulated more with the soft substrate than with the hard substrate through 14 days of culture. The soft substrate suppressed the expression of mechanotransduction-related transcriptional factors and activated the expression of inflammation-related factors, whereas the hard substrate demonstrated the opposite effects. Soft substrate induced proinflammatory responses and inhibition of ECM synthesis in hGFs by inactivating cellular mechanotransduction. This supports the importance of ECM stiffness in gingival health.
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Wuersching SN, Hickel R, Edelhoff D, Kollmuss M. Initial biocompatibility of novel resins for 3D printed fixed dental prostheses. Dent Mater 2022; 38:1587-1597. [PMID: 36008188 DOI: 10.1016/j.dental.2022.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/27/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Several materials for 3D printing of fixed dental prostheses (FDP) have been recently introduced. This study aims to evaluate the initial biocompatibility of novel printable resins for manufacturing temporary and permanent FDP. METHODS Specimens of five printable resins (VarseoSmile Crown plus, NextDent C&B MFH, VarseoSmile Temp, Temp PRINT, P Pro Crown & Bridge), two types of resins for subtractive manufacturing (Tetric CAD, Telio CAD) and two types of resins with conventional curing processes (Tetric EvoCeram, Protemp 4) were produced and finished. Post-processing was strictly performed according to the manufacturer's protocol. Biocompatibility was evaluated by eluting specimens with cell culture medium and treating human gingival fibroblast cells with the eluates. A 72-hour continuous read cell viability assay measuring the reducing potential of the cells was performed. The cellular inflammatory response in terms of IL-6 and PGE2 levels was determined with specific ELISAs. Oxidative stress was determined by measuring oxidized glutathione concentrations after exposure to the resin eluates. A luminescence-based apoptosis assay was used to detect apoptosis. RESULTS Tetric CAD and Telio CAD were slightly toxic. All other resins were moderately to severely cytotoxic. VarseoSmile Crown plus and P Pro Crown & Bridge significantly enhanced PGE2 levels. Higher concentrations of oxidized gluthatione were determined in the presence of Telio CAD, VarseoSmile Temp and P Pro Crown & Bridge. Tetric EvoCeram and Protemp 4 reduced intracellular gluthatione levels. All printable resins slightly induced apoptosis. SIGNIFICANCE Further post-processing steps such as additional curing and washing may improve the biocompatibility of printable materials.
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Affiliation(s)
- Sabina Noreen Wuersching
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany.
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
| | - Maximilian Kollmuss
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
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Behm C, Zhao Z, Andrukhov O. Immunomodulatory Activities of Periodontal Ligament Stem Cells in Orthodontic Forces-Induced Inflammatory Processes: Current Views and Future Perspectives. FRONTIERS IN ORAL HEALTH 2022; 3:877348. [PMID: 35601817 PMCID: PMC9114308 DOI: 10.3389/froh.2022.877348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/13/2022] [Indexed: 12/25/2022] Open
Abstract
Orthodontic tooth movement (OTM) is induced by applying active mechanical forces, causing a local non-infectious inflammatory response in the periodontal ligament (PDL). As a prerequisite for OTM, the inflammation status is associated with increased levels of various cytokines and involves the interaction between immune cells and periodontal ligament stem cells (hPDLSCs). It is well established that hPDLSCs respond to orthodontic forces in several ways, such as by secreting multiple inflammatory factors. Another essential feature of hPDLSCs is their immunomodulatory activities, which are executed through cytokine (e.g., TNF-α and IL-1β)-induced production of various soluble immunomediators (e.g., indoleamine-2,3-dioxygenase-1, tumor necrosis factor-inducible gene 6 protein, prostaglandin E2) and direct cell-to-cell contact (e.g., programmed cell death ligand 1, programmed cell death ligand 2). It is well known that these immunomodulatory abilities are essential for local periodontal tissue homeostasis and regeneration. So far, only a handful of studies provides first hints that hPDLSCs change immunological processes during OTM via their immunomodulatory activities. These studies demonstrate the pro-inflammatory aspect of immunomodulation by hPDLSCs. However, no studies exist which investigate cytokine and cell-to-cell contact mediated immunomodulatory activities of hPDLSCs. In this perspective article, we will discuss the potential role of the immunomodulatory potential of hPDLSCs in establishing and resolving the OTM-associated non-infectious inflammation and hence its potential impact on periodontal tissue homeostasis during OTM.
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Andrukhov O, Blufstein A, Behm C. A Review of Antimicrobial Activity of Dental Mesenchymal Stromal Cells: Is There Any Potential? FRONTIERS IN ORAL HEALTH 2022; 2:832976. [PMID: 35098213 PMCID: PMC8795861 DOI: 10.3389/froh.2021.832976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 12/19/2022] Open
Abstract
Antimicrobial defense is an essential component of host-microbial homeostasis and contributes substantially to oral health maintenance. Dental mesenchymal stromal cells (MSCs) possess multilineage differentiation potential, immunomodulatory properties and play an important role in various processes like regeneration and disease progression. Recent studies show that dental MSCs might also be involved in antibacterial defense. This occurs by producing antimicrobial peptides or attracting professional phagocytic immune cells and modulating their activity. The production of antimicrobial peptides and immunomodulatory abilities of dental MSCs are enhanced by an inflammatory environment and influenced by vitamin D3. Antimicrobial peptides also have anti-inflammatory effects in dental MSCs and improve their differentiation potential. Augmentation of antibacterial efficiency of dental MSCs could broaden their clinical application in dentistry.
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Affiliation(s)
- Oleh Andrukhov
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Alice Blufstein
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Christian Behm
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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Onyedibe KI, Elmanfi S, Aryal UK, Könönen E, Gürsoy UK, Sintim HO. Global proteomics of fibroblast cells treated with bacterial cyclic dinucleotides, c-di-GMP and c-di-AMP. J Oral Microbiol 2021; 14:2003617. [PMID: 34992733 PMCID: PMC8725719 DOI: 10.1080/20002297.2021.2003617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Constant exposure of human gingival fibroblasts (HGFs) to oral pathogens trigger selective immune responses. Recently, the activation of immune response to cyclic dinucleotides (CDNs) via STING has come to the forefront. Reports show that other proteins outside the STING-TBK1-IRF3 axis respond to CDNs but a global view of impacted proteome in diverse cells is lacking. HGFs are constantly exposed to bacterial-derived cyclic-di-adenosine monophosphate (c-di-AMP) and cyclic-di-guanosine monophosphate (c-di-GMP). AIM To understand the response of HGFs to bacterial-derived CDNs, we carried out a global proteomics analysis of HGFs treated with c-di-AMP or c-di-GMP. METHODS The expression levels of several proteins modulated by CDNs were examined. RESULTS Interferon signaling proteins such as Ubiquitin-like protein ISG15 (ISG15), Interferon-induced GTP-binding protein Mx1 (MX1), Interferon-induced protein with tetratricopeptide repeats (IFIT) 1 (IFIT1), and (IFIT3) were significantly upregulated. Interestingly, other pathways not fully characterized to be regulated by CDNs, such as necroptosis signaling, iron homeostasis signaling, protein ubiquitination, EIF2 signaling, sumoylation and nucleotide excision repair pathways were also modulated by the bacterial-derived CDNs. CONCLUSION This study has added to the increasing appreciation that beyond the regulation of cytokine production via STING, cyclic dinucleotides also broadly affect many critical processes in human cells.
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Affiliation(s)
- Kenneth I. Onyedibe
- Department of Chemistry, Purdue University, West Lafayette, USA
- Immunology and Infectious Disease, Purdue Institute for Drug Discovery and Purdue Institute of Inflammation, Purdue University, West Lafayette, USA
| | - Samira Elmanfi
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Uma K. Aryal
- Purdue Proteomics Facility, Bindley Bioscience Center, Purdue University, West Lafayette, USA
- Department of Comparative Pathobiology, Purdue University, West Lafayette, USA
| | - Eija Könönen
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Ulvi Kahraman Gürsoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Herman O. Sintim
- Department of Chemistry, Purdue University, West Lafayette, USA
- Immunology and Infectious Disease, Purdue Institute for Drug Discovery and Purdue Institute of Inflammation, Purdue University, West Lafayette, USA
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15
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Hussein H, Kishen A. Engineered Chitosan-based Nanoparticles Modulate Macrophage-Periodontal Ligament Fibroblast Interactions in Biofilm-mediated Inflammation. J Endod 2021; 47:1435-1444. [PMID: 34214497 DOI: 10.1016/j.joen.2021.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/20/2021] [Accepted: 06/21/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Crosstalk between immune cells and tissue-resident cells regulates the pathophysiology and posttreatment healing of apical periodontitis. This investigation aimed to understand the influence of residual root canal biofilm on macrophage (MQ)-periodontal ligament fibroblast (PdLF) interaction and evaluate the effect of engineered chitosan-based nanoparticles (CSnp) on MQ-PdLF interactions in residual biofilm-mediated inflammation. METHODS Six-week-old Enterococcus faecalis biofilms in root canal models were disinfected conventionally using sodium hypochlorite alone or followed by calcium hydroxide medication or CSnp dispersed in carboxymethylated chitosan (CMCS). The effect of the treated biofilms (n = 25/group) on the inflammatory response of THP-1-differentiated MQ monoculture versus coculture with PdLF was evaluated for cell viability, MQ morphometric characterization, inflammatory mediators (nitric oxide, tumor necrosis factor alpha, interleukin [IL]-1 beta, IL-1RA, IL-6, transforming growth factor beta 1 [TGF-β1], and IL-10), and the expression of transcription factors (pSTAT1/pSTAT6)/cluster of differentiation markers (CD80/206) after 24, 48, and 72 hours of interaction. PdLF transwell migration was evaluated after 8 and 24 hours. Unstimulated cells served as the negative control, whereas untreated biofilm was the positive control. RESULTS Biofilm increased nitric oxide and IL-1β but suppressed IL-10, IL-1RA, and PdLF migration with significant cytotoxic effects. CSnp/CMCS reduced nitric oxide and IL-1β (P < .01) while maintaining ≥90% cell survival up to 72 hours with evident M2-like MQ phenotypic changes in coculture. CSnp/CMCS also increased the IL-1RA/IL-1β ratio and enhanced TGF-β1 production over time (P < .05, 72 hours). In coculture, CSnp/CMCS showed the highest IL-10 level at 72 hours (P < .01), reduced the pSTAT1/pSTAT6 ratio, and enhanced PdLF migration (P < .01, 24 hours). CONCLUSIONS CSnp/CMCS medication facilitated MQ switch toward M2 (regulatory/anti-inflammatory) phenotype and PdLF migration via paracrine signaling.
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Affiliation(s)
- Hebatullah Hussein
- The Kishen Lab, Dental Research Institute, University of Toronto, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada; Faculty of Dentistry, Endodontics Department, Ain Shams University, Cairo, Egypt
| | - Anil Kishen
- The Kishen Lab, Dental Research Institute, University of Toronto, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada; Department of Dentistry, Mount Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Kantarci A, Tognoni CM, Yaghmoor W, Marghalani A, Stephens D, Ahn JY, Carreras I, Dedeoglu A. Microglial response to experimental periodontitis in a murine model of Alzheimer's disease. Sci Rep 2020; 10:18561. [PMID: 33122702 PMCID: PMC7596239 DOI: 10.1038/s41598-020-75517-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
Periodontal disease (PD) has been suggested to be a risk factor for Alzheimer's disease (AD). We tested the impact of ligature-induced PD on 5xFAD mice and WT littermates. At baseline, 5xFAD mice presented significant alveolar bone loss compared to WT mice. After the induction of PD, both WT and 5xFAD mice experienced alveolar bone loss. PD increased the level of Iba1-immunostained microglia in WT mice. In 5xFAD mice, PD increased the level of insoluble Aβ42. The increased level in Iba1 immunostaining that parallels the accumulation of Aβ in 5xFAD mice was not affected by PD except for a decrease in the dentate gyrus. Analysis of double-label fluorescent images showed a decline in Iba1 in the proximity of Aβ plaques in 5xFAD mice with PD compared to those without PD suggesting a PD-induced decrease in plaque-associated microglia (PAM). PD reduced IL-6, MCP-1, GM-CSF, and IFN-γ in brains of WT mice and reduced IL-10 in 5xFAD mice. The data demonstrated that PD increases neuroinflammation in WT mice and disrupts the neuroinflammatory response in 5xFAD mice and suggest that microglia is central to the association between PD and AD.
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Affiliation(s)
| | - Christina M Tognoni
- Department of Veterans Affairs, VA Boston Healthcare System, Research and Development Service, Building 1A-(151), 150 S. Huntington Avenue, Boston, MA, 02130, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Wael Yaghmoor
- Forsyth Institute, 245 First Street, Cambridge, MA, 02142, USA
| | - Amin Marghalani
- Forsyth Institute, 245 First Street, Cambridge, MA, 02142, USA
| | | | - Jae-Yong Ahn
- Department of Veterans Affairs, VA Boston Healthcare System, Research and Development Service, Building 1A-(151), 150 S. Huntington Avenue, Boston, MA, 02130, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Isabel Carreras
- Department of Veterans Affairs, VA Boston Healthcare System, Research and Development Service, Building 1A-(151), 150 S. Huntington Avenue, Boston, MA, 02130, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, 02118, USA.,Department of Biochemistry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Alpaslan Dedeoglu
- Department of Veterans Affairs, VA Boston Healthcare System, Research and Development Service, Building 1A-(151), 150 S. Huntington Avenue, Boston, MA, 02130, USA. .,Department of Neurology, Boston University School of Medicine, Boston, MA, 02118, USA. .,Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA.
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Ohtani M, Nishimura T. Sulfur-containing amino acids in aged garlic extract inhibit inflammation in human gingival epithelial cells by suppressing intercellular adhesion molecule-1 expression and IL-6 secretion. Biomed Rep 2019; 12:99-108. [PMID: 32042418 DOI: 10.3892/br.2019.1269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/06/2019] [Indexed: 12/13/2022] Open
Abstract
Aged garlic extract (AGE) contains various biologically active sulfur-containing amino acids, such as S-allylcysteine (SAC), S-1-propenylcysteine (S1PC) and S-allylmercaptocysteine (SAMC). These amino acids have been demonstrated to lower hypertension, improve atherosclerosis and enhance immunity through their anti-inflammatory and antioxidant activities. It was recently reported that the administration of AGE alleviated gingivitis in a clinical trial. In this study, to gain insight into this effect of AGE, the authors examined whether AGE and the three above-mentioned sulfur compounds influence the effects of tumor necrosis factor-α (TNF-α) in inducing intercellular adhesion molecule-1 (ICAM-1) expression and interleukin-6 (IL-6) secretion in Ca9-22 human gingival epithelial cells. It was found that S1PC reduced the level of ICAM-1 protein induced by TNF-α possibly through post-translational levels without affecting the TNF-α-induced mRNA expression. However, SAC and SAMC had no effect. It was also confirmed the inhibitory effect of an antimicrobial peptide [human-β defensin-3 (hβD3)] and found that the inhibitory effects of hbD3 and S1PC were synergistic. On the other hand, the TNF-α-induced IL-6 secretion was attenuated by SAC and SAMC in a dose-dependent manner, whereas S1PC was ineffective. In addition, SAC and SAMC, but not S1PC inhibited the phosphorylation of the transcription factor nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB), which is involved in the expression of inflammatory molecules, suggesting that the anti-inflammatory effects of SAC and SAMC are mediated, at least partly, by NF-κB. On the whole, the findings of this study suggest that the three sulfur amino acids in AGE function synergistically in alleviating inflammation in human gingival epithelial cells.
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Affiliation(s)
- Masahiro Ohtani
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., Akitakata, Hiroshima 739-1195, Japan
| | - Tsubasa Nishimura
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., Akitakata, Hiroshima 739-1195, Japan
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18
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Higuchi K, Sm Z, Yamashita Y, Ozaki Y, Yoshimura A. Initial periodontal treatment affects nucleotide-binding domain leucine-rich repeat-containing protein 3 inflammasome priming in peripheral blood mononuclear cells. Arch Oral Biol 2019; 110:104625. [PMID: 31830640 DOI: 10.1016/j.archoralbio.2019.104625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/27/2019] [Accepted: 11/26/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Accumulating evidence suggests an association between periodontitis and several systemic diseases, such as atherosclerosis. In the lesions of these diseases, nucleotide-binding domain leucine-rich repeat-containing protein 3 (NLRP3), apoptosis-associated speck-like protein containing a caspase activation and recruitment domain (ASC) and caspase-1 form inflammasome complex, which leads to the functional maturation of interleukin (IL)-1β via cleavage of caspase-1 in macrophages. IL-1β plays a critical role in the etiology of these diseases; however, inflammasome priming-specifically, IL-1β and NLRP3 upregulation-is necessary for effective IL-1β production. We investigated the effect of initial periodontal treatment on the inflammasome priming of peripheral blood mononuclear cells (PBMCs). METHODS Twenty-two patients with chronic periodontitis were enrolled in this study and given initial periodontal treatment. Peripheral blood samples were collected at baseline and re-evaluation (41.1 ± 29.1 d after the treatment), and the relative expression of IL-1β, and three inflammasome components, ASC, NLRP3 and Caspase-1, mRNA was determined using quantitative reverse transcription PCR. PBMCs were stimulated with silica crystals, and the IL-1β secretion was measured via enzyme-linked immunosorbent assay. RESULTS Probing pocket depth and bleeding on probing (BOP) were significantly improved after the treatment. Expression of IL-1β and ASC in the PBMCs decreased after the treatment. PBMCs stimulated with silica crystals secreted IL-1β. The treatment attenuated IL-1β secretion by PBMCs in low BOP percentages group whereas IL-1β secretion was increased in high BOP percentages group. CONCLUSION Periodontal treatment altered the inflammasome priming status of the PBMCs, however, the effects on systemic diseases need to be further investigated.
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Affiliation(s)
- Kanako Higuchi
- Department of Periodontology and Endodontology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Ziauddin Sm
- Department of Periodontology and Endodontology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yasunori Yamashita
- Department of Periodontology and Endodontology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yukio Ozaki
- Department of Periodontology and Endodontology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Atsutoshi Yoshimura
- Department of Periodontology and Endodontology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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de Souza VZ, Manfro R, Joly JC, Elias CN, Peruzzo DC, Napimoga MH, Martinez EF. Viability and collagen secretion by fibroblasts on titanium surfaces with different acid-etching protocols. Int J Implant Dent 2019; 5:41. [PMID: 31749041 PMCID: PMC6868076 DOI: 10.1186/s40729-019-0192-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND From the consolidation of surface treatments of dental implants and knowledge on the cellular mechanisms of osseointegration, studies have highlighted the importance of a connective tissue seal against the implant to prevent contamination from the oral environment and consequent biofilm formation. OBJECTIVE This in vitro study aimed to evaluate whether different titanium surface treatments using acid solutions promoted an increase in collagen secretion, proliferation, and viability of fibroblasts. MATERIAL AND METHODS Commercially pure grade-4 titanium disks (6 × 2 mm) were treated with different acid solutions (hydrochloric, nitric, and sulfuric) for 20 and 60 min, respectively, obtaining mean surface roughness of 0.1 to 0.15 μm and 0.5 to 0.7 μm. Human fibroblasts were seeded onto different surfaces and assessed after 24 h, 48 h, and 72 h for cell proliferation and viability using Trypan blue staining and MTT, respectively, as well as the secretion of type I collagen on to such surfaces using ELISA. Machined titanium surfaces were used as controls. Data were statistically analyzed using one-way ANOVA and Fisher's LSD test for multiple comparisons, adopting a significance level of 5%. RESULTS No significant difference was observed in cell proliferation for the different surfaces analyzed. Cell viability was significantly lower on the machined surface, after 48 h, when compared to the groups treated with acid for 20 or 60 min, which did not differ from each other. The expression of type I collagen was lowest on the acid-treated surfaces. CONCLUSION The results showed that the acid treatment proposed did not promote fibroblast proliferation and viability nor favor type I collagen synthesis.
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Affiliation(s)
| | - Rafael Manfro
- Division of Implantology, SOEBRÁS, Passo Fundo, RS, Brazil
| | - Júlio César Joly
- Division of Implantology, Faculdade São Leopoldo Mandic, Campinas, SP, Brazil
| | - Carlos Nelson Elias
- Materials Science Department, Instituto Militar de Engenharia, Rio de Janeiro, RJ, Brazil
| | | | | | - Elizabeth Ferreira Martinez
- Division of Oral Biology and Cell Biology, Faculdade São Leopoldo Mandic, Rua José Rocha Junqueira, 13, Campinas, SP, 13045-755, Brazil.
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Andrukhov O, Behm C, Blufstein A, Rausch-Fan X. Immunomodulatory properties of dental tissue-derived mesenchymal stem cells: Implication in disease and tissue regeneration. World J Stem Cells 2019; 11:604-617. [PMID: 31616538 PMCID: PMC6789188 DOI: 10.4252/wjsc.v11.i9.604] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/24/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023] Open
Abstract
Mesenchymal stem cells (MSCs) are considered as an attractive tool for tissue regeneration and possess a strong immunomodulatory ability. Dental tissue-derived MSCs can be isolated from different sources, such as the dental pulp, periodontal ligament, deciduous teeth, apical papilla, dental follicles and gingiva. According to numerous in vitro studies, the effect of dental MSCs on immune cells might depend on several factors, such as the experimental setting, MSC tissue source and type of immune cell preparation. Most studies have shown that the immunomodulatory activity of dental MSCs is strongly upregulated by activated immune cells. MSCs exert mostly immunosuppressive effects, leading to the dampening of immune cell activation. Thus, the reciprocal interaction between dental MSCs and immune cells represents an elegant mechanism that potentially contributes to tissue homeostasis and inflammatory disease progression. Although the immunomodulatory potential of dental MSCs has been extensively investigated in vitro, its role in vivo remains obscure. A few studies have reported that the MSCs isolated from inflamed dental tissues have a compromised immunomodulatory ability. Moreover, the expression of some immunomodulatory proteins is enhanced in periodontal disease and even shows some correlation with disease severity. MSC-based immunomodulation may play an essential role in the regeneration of different dental tissues. Therefore, immunomodulation-based strategies may be a very promising tool in regenerative dentistry.
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Affiliation(s)
- Oleh Andrukhov
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna 1090, Austria
| | - Christian Behm
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna 1090, Austria
| | - Alice Blufstein
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna 1090, Austria
| | - Xiaohui Rausch-Fan
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna 1090, Austria
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21
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Ren X, van der Mei HC, Ren Y, Busscher HJ. Keratinocytes protect soft-tissue integration of dental implant materials against bacterial challenges in a 3D-tissue infection model. Acta Biomater 2019; 96:237-246. [PMID: 31302293 DOI: 10.1016/j.actbio.2019.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022]
Abstract
The soft-tissue seal around dental implants protects the osseo-integrated screw against bacterial challenges. Surface properties of the implant material are crucial for implant survival against bacterial challenges, but there is no adequate in vitro model mimicking the soft-tissue seal around dental implants. Here, we set up a 3D-tissue model of the soft-tissue seal, in order to establish the roles of oral keratinocytes, gingival fibroblasts and materials surface properties in the protective seal. To this end, keratinocytes were grown on membrane filters in a transwell system, while fibroblasts were adhering to TiO2 surfaces underneath the membrane. In absence of keratinocytes on the membrane, fibroblasts growing on the TiO2 surface could not withstand challenges by commensal streptococci or pathogenic staphylococci. Keratinocytes growing on the membrane filters could withstand bacterial challenges, but tight junctions widened to allow invasion of bacteria to the underlying fibroblast layer in lower numbers than in absence of keratinocytes. The challenge of this bacterial invasion to the fibroblast layer on the TiO2 surface negatively affected tissue integration of the surface, demonstrating the protective barrier role of keratinocytes. Streptococci caused less damage to fibroblasts than staphylococci. Importantly, the protection offered by the soft-tissue seal appeared sensitive to surface properties of the implant material. Integration by fibroblasts of a hydrophobic silicone rubber surface was affected more upon bacterial challenges than integration of more hydrophilic hydroxyapatite or TiO2 surfaces. This differential response to different surface-chemistries makes the 3D-tissue infection model presented a useful tool in the development of new infection-resistant dental implant materials. STATEMENT OF SIGNIFICANCE: Failure rates of dental implants due to infection are surprisingly low, considering their functioning in the highly un-sterile oral cavity. This is attributed to the soft-tissue seal, protecting the osseo-integrated implant part against bacterial invasion. The seal consists of a layer of keratinocytes covering gingival fibroblasts, integrating the implant. Implant failure involves high patient discomfort and costs of replacing an infected implant, which necessitates development of improved, infection-resistant dental implant materials. New materials are often evaluated in mono-culture, examining bacterial adhesion or tissue interactions separately and neglecting the 3D-structure of the tissue seal. A 3D-tissue model allows to study new materials in a more relevant way, in which interactions between keratinocytes, gingival fibroblast, bacteria and materials surfaces are accounted for.
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Affiliation(s)
- Xiaoxiang Ren
- University of Groningen and University Medical Center of Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Henny C van der Mei
- University of Groningen and University Medical Center of Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Yijin Ren
- University of Groningen and University Medical Center of Groningen, Department of Orthodontics, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Henk J Busscher
- University of Groningen and University Medical Center of Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Ingendoh-Tsakmakidis A, Nolte L, Winkel A, Meyer H, Koroleva A, Shpichka A, Ripken T, Heisterkamp A, Stiesch M. Time resolved 3D live-cell imaging on implants. PLoS One 2018; 13:e0205411. [PMID: 30304039 PMCID: PMC6179276 DOI: 10.1371/journal.pone.0205411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/25/2018] [Indexed: 11/18/2022] Open
Abstract
It is estimated that two million new dental implants are inserted worldwide each year. Innovative implant materials are developed in order to minimize the risk of peri-implant inflammations. The broad range of material testing is conducted using standard 2D, terminal, and invasive methods. The methods that have been applied are not sufficient to monitor the whole implant surface and temporal progress. Therefore, we built a 3D peri-implant model using a cylindrical implant colonized by human gingival fibroblasts. In order to monitor the cell response over time, a non-toxic LIVE/DEAD staining was established and applied to the new 3D model. Our LIVE/DEAD staining method in combination with the time resolved 3D visualization using Scanning Laser Optical Tomography (SLOT), allowed us to monitor the cell death path along the implant in the 3D peri-implant model. The differentiation of living and dead gingival fibroblasts in response to toxicity was effectively supported by the LIVE/DEAD staining. Furthermore, it was possible to visualize the whole cell-colonized implant in 3D and up to 63 hours. This new methodology offers the opportunity to record the long-term cell response on external stress factors, along the dental implant and thus to evaluate the performance of novel materials/surfaces.
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Affiliation(s)
- Alexandra Ingendoh-Tsakmakidis
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hannover, Germany
- * E-mail:
| | - Lena Nolte
- Industrial and Biomedical Optics Department, Laser Zentrum Hannover e.V., Hannover, Germany
| | - Andreas Winkel
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hannover, Germany
| | - Heiko Meyer
- Industrial and Biomedical Optics Department, Laser Zentrum Hannover e.V., Hannover, Germany
| | - Anastasia Koroleva
- Nanotechnology Department, Laser Zentrum Hannover e.V., Hannover, Germany
| | - Anastasia Shpichka
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Tammo Ripken
- Industrial and Biomedical Optics Department, Laser Zentrum Hannover e.V., Hannover, Germany
| | | | - Meike Stiesch
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hannover, Germany
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23
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Yu S, Ding L, Liang D, Luo L. Porphyromonas gingivalisinhibits M2 activation of macrophages by suppressing α-ketoglutarate production in mice. Mol Oral Microbiol 2018; 33:388-395. [PMID: 30007055 DOI: 10.1111/omi.12241] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 12/26/2022]
Affiliation(s)
- S. Yu
- School of Stomatology; Weifang Medical University; Weifang China
- Clinical Research Center; Shanghai Jiading Central Hospital; Shanghai China
| | - L. Ding
- School of Stomatology; Weifang Medical University; Weifang China
- Clinical Research Center; Shanghai Jiading Central Hospital; Shanghai China
| | - D. Liang
- Clinical Research Center; Shanghai Jiading Central Hospital; Shanghai China
| | - L. Luo
- Department of Periodontics; The Affiliated Stomatology Hospital; Tongji University; Shanghai China
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24
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Kriebel K, Hieke C, Müller-Hilke B, Nakata M, Kreikemeyer B. Oral Biofilms from Symbiotic to Pathogenic Interactions and Associated Disease -Connection of Periodontitis and Rheumatic Arthritis by Peptidylarginine Deiminase. Front Microbiol 2018; 9:53. [PMID: 29441048 PMCID: PMC5797574 DOI: 10.3389/fmicb.2018.00053] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/10/2018] [Indexed: 12/15/2022] Open
Abstract
A wide range of bacterial species are harbored in the oral cavity, with the resulting complex network of interactions between the microbiome and host contributing to physiological as well as pathological conditions at both local and systemic levels. Bacterial communities inhabit the oral cavity as primary niches in a symbiotic manner and form dental biofilm in a stepwise process. However, excessive formation of biofilm in combination with a corresponding deregulated immune response leads to intra-oral diseases, such as dental caries, gingivitis, and periodontitis. Moreover, oral commensal bacteria, which are classified as so-called “pathobionts” according to a now widely accepted terminology, were recently shown to be present in extra-oral lesions with distinct bacterial species found to be involved in the onset of various pathophysiological conditions, including cancer, atherosclerosis, chronic infective endocarditis, and rheumatoid arthritis. The present review focuses on oral pathobionts as commensal and healthy members of oral biofilms that can turn into initiators of disease. We will shed light on the processes involved in dental biofilm formation and also provide an overview of the interactions of P. gingivalis, as one of the most prominent oral pathobionts, with host cells, including epithelial cells, phagocytes, and dental stem cells present in dental tissues. Notably, a previously unknown interaction of P. gingivalis bacteria with human stem cells that has impact on human immune response is discussed. In addition to this very specific interaction, the present review summarizes current knowledge regarding the immunomodulatory effect of P. gingivalis and other oral pathobionts, members of the oral microbiome, that pave the way for systemic and chronic diseases, thereby showing a link between periodontitis and rheumatoid arthritis.
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Affiliation(s)
- Katja Kriebel
- Institute of Medical Microbiology, Virology and Hygiene, University of Rostock, Rostock, Germany
| | - Cathleen Hieke
- Institute of Medical Microbiology, Virology and Hygiene, University of Rostock, Rostock, Germany
| | | | - Masanobu Nakata
- Department of Oral and Molecular Microbiology, Osaka University Graduate School of Dentistry, Suita-Osaka, Japan
| | - Bernd Kreikemeyer
- Institute of Medical Microbiology, Virology and Hygiene, University of Rostock, Rostock, Germany
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25
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Wheelis SE, Wilson TG, Valderrama P, Rodrigues DC. Surface characterization of titanium implant healing abutments before and after placement. Clin Implant Dent Relat Res 2017; 20:180-190. [PMID: 29214721 DOI: 10.1111/cid.12566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Implant healing abutments (IHA) have a vital role in soft tissue healing after implant placement. Although there is thorough investigation on the implant surface, little is known about the effects potentially damaging oral conditions impose on healing abutments. PURPOSE To characterize the surface of titanium healing abutments before and after clinical placement to understand the effects of the oral environment and time on the device surface. MATERIALS AND METHODS Ten regular Straumann IHA were subjected to characterization pre and postplacement to elucidate the effects of the oral environment on device surfaces. Changes in surface crystallinity, morphology, and elemental composition were monitored with Raman spectroscopy, scanning electron microscopy, optical microscopy, and x-ray photoelectron spectroscopy, respectively. In addition, corrosion rate and polarization resistance were obtained to assess electrochemical device stability after placement. RESULTS Control analysis indicated the titanium oxide of IHAs was thicker than natural commercially pure titanium and had the structure of crystalline anatase. After removal, the abutments possessed large amounts of biological debris, visible scratches, and discoloration sparsely on the surface. Spectroscopic analysis revealed the titanium oxide on the surface of IHAs was structurally unchanged, with crystalline titanium dioxide still present on the surface. Electrochemical results revealed that implanted healing abutments possessed a significantly higher corrosion rate than controls (change in corrosion rate = 2.34 ± 0.58 nm/year). CONCLUSIONS Healing abutments were stable in the oral environment due to the chemical stability of the oxide, and were likely subjected to abrasions from unintentional loading and oral hygiene techniques.
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Affiliation(s)
- Sutton E Wheelis
- Deparment of Bioengineering, The University of Texas at Dallas, Richardson, Texas, USA
| | - Thomas G Wilson
- Deparment of Periodontics and Dental Implants, North Dallas Dental Health, Dallas, Texas, USA
| | - Pilar Valderrama
- Deparment of Periodontics and Dental Implants, North Dallas Dental Health, Dallas, Texas, USA
| | - Danieli C Rodrigues
- Deparment of Bioengineering, The University of Texas at Dallas, Richardson, Texas, USA
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26
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Isola G, Williams RC, Lo Gullo A, Ramaglia L, Matarese M, Iorio-Siciliano V, Cosio C, Matarese G. Risk association between scleroderma disease characteristics, periodontitis, and tooth loss. Clin Rheumatol 2017; 36:2733-2741. [PMID: 28988297 DOI: 10.1007/s10067-017-3861-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 02/07/2023]
Abstract
Systemic sclerosis (SSc) is a multi-system disorder that can have significant adverse effects on the health of the mouth. The aim of this study was to investigate the associations between the disease characteristics of SSc, periodontal disease (PD), and tooth loss. Fifty-four patients affected by SSc and 55 non-diseased controls were matched for age and gender. SSc was characterized in subtypes and with the mean duration of disease and the Modified Rodnan Skin Score [mRSS]. Patients were surveyed and examined through the evaluation of the periodontal parameters and the number of teeth. A logistic regression analysis showed that patients with SSc presented a higher number of missing teeth (p = 0.001) and a significant median increased odds 2.95 (95% CI 1.26 to 6.84) of PD (defined as clinical attachment loss, CAL) compared to nondiseased controls (6.83, 95% CI 1.94 to 24.36). Moreover, the fewer values of PD was correlated with mRSS in the total SSc group and with the mean duration of disease in patients with limited SSc (p = 0.007), even after adjusting this correlation with the presence of the major organ involvement. This study showed that patients with SSc presented increased odds of PD and tooth loss compared to non-diseased controls. In SSc patients, the magnitude of PD was strongly associated with the mRSS and with the mean duration of the disease. The clinicians should be aware of the potential systemic health problems related to PD.
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Affiliation(s)
- Gaetano Isola
- Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, AOU Policlinico "G. Martino", via C. Valeria, 98125, Messina, Italy
| | - Ray C Williams
- Department of Periodontology, UNC School of Dentistry, Campus Box #7450, Chapel Hill, NC, 27599-7450, USA
| | - Alberto Lo Gullo
- Department of Clinical and Experimental Medicine, Section of internal medicine and rheumatology, University of Messina, AOU Policlinico "G. Martino", via C. Valeria, 98125, Messina, Italy
| | - Luca Ramaglia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, University of Naples "Federico II", Via C. Pansini 5, 80100, Naples, Naples, Italy
| | - Marco Matarese
- Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, AOU Policlinico "G. Martino", via C. Valeria, 98125, Messina, Italy.
| | - Vincenzo Iorio-Siciliano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine, University of Naples "Federico II", Via C. Pansini 5, 80100, Naples, Naples, Italy
| | - Claudio Cosio
- Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, AOU Policlinico "G. Martino", via C. Valeria, 98125, Messina, Italy
| | - Giovanni Matarese
- Department of Biomedical, Odontostomatological Sciences and of Morphological and Functional Images, School of Dentistry, University of Messina, AOU Policlinico "G. Martino", via C. Valeria, 98125, Messina, Italy
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