Remodeling of Mineralized Tissues, Part II: Control and Pathophysiology

Food texture and vitamin D influence mouse mandible form and molar roots

Industrialization influenced several facets of lifestyle, including softer nutrient-poor diets that contributed to vitamin D deficiency in post-industrzialized populations, with concomitantly increased dental problems. Here we simulated a post-industrialized diet in a mouse model to test the effects of diet texture and vitamin D level on mandible and third molar (M3) forms. Mice were raised on a soft diet with vitamin D (VitD) or without it (NoD), or on a hard diet with vitamin D. We hypothesized that a VitD/hard diet is optimal for normal mandible and tooth root form, as well as for timely M3 initiation. Subsets of adult NoD/soft and VitD/soft groups were bred to produce embryos that were micro-computed tomography (μCT) scanned to stage M3 development. M3 stage did not differ between embryos from mothers fed VitD and NoD diets, indicating that vitamin D does not affect timing of M3 onset. Sacrificed adult mice were μCT-scanned, their mandibles 3D-landmarked and M3 roots were measured. Principal component (PC) analysis described the largest proportion of mandible shape variance (PC1, 30.1%) related to diet texture, and nominal shape variance (PC2, 13.8%) related to vitamin D. Mice fed a soft diet had shorter, relatively narrower, and somewhat differently shaped mandibles that recapitulated findings in human populations. ANOVA and other multivariate tests found significantly wider M3 roots and larger root canals in mice fed a soft diet, with vitamin D having little effect. Altogether our experiments using a mouse model contribute new insights about how a post-industrial diet may influence human craniodental variation.

Understanding basic multicellular unit activity in cortical bone through 3D morphological analysis: New methods to define zones of the remodeling space

The activity of basic multicellular units (BMU) in cortical bone is classically described as a sequential order of events- resorption, reversal and formation. This simplified portrayal of the remodeling process is pervasive despite the reported variability in remodeling space morphology. These variations may reflect meaningful nuances in BMU activity but methods to quantify 3D remodeling space morphology within the context of the cellular activity are currently lacking. This study developed new techniques to define zones of BMU activity based on the 3D morphology of remodeling spaces in rabbit cortical bone and integrated morphological data with the BMU longitudinal erosion rate (LER) to elucidate the spatial-temporal coordination of BMUs and estimate mineral apposition rate (MAR). The tibiae of New Zealand white rabbits (n = 5) were imaged in vivo using synchrotron radiation and two weeks later ex vivo with desktop microCT. The in vivo and ex vivo datasets were co-registered, and 27 remodeling spaces were identified at both timepoints. A radial profile representing the 3D morphology was the platform for partitioning the remodeling spaces into resorption, reversal and formation zones. Manual, automated and semi-automated partitioning approaches were compared, and the zone-segmentations were used to calculate the length, change in radius and slope of each zone. The manual approach most accurately defined the zones of idealized remodeling spaces with known dimensions (relative error = 0.9-9.2 %) while the semi-automated method reliably defined the zones in rabbit remodeling spaces (ICC = 0.85-1.00). Combining LER and the manually derived zone dimensions indicated that a BMU passes through a cross-section in approximately 18.8 days with resorption, reversal and formation taking 4.1, 2.2, and 12.5 days, respectively. MAR estimated by the 3D analysis was not significantly different than that determined with classic histomorphometry (p = 0.48). These techniques have the potential to assess dynamic parameters of bone resorption and formation, eliminate the need for fluorochrome labeling and provide a more comprehensive perspective of the remodeling process.

Biomechanical evaluation of customized root implants in alveolar bone: A comparative study with traditional implants and natural teeth

PURPOSE

To compare and evaluate density changes in alveolar bones and biomechanical responses including stress/strain distributions around customized root implants (CRIs), traditional implants, and natural teeth.

MATERIALS AND METHODS

A three-dimensional finite element model of the maxillary dentition defect, CRI models, traditional restored implant models, and natural teeth with periodontal tissue models were established. The chewing load of the central incisor, the traditional implant, and the CRI was 100N, and the load direction was inclined by 11° in the sagittal plane. According to the bone remodeling numerical algorithm, the bone mineral density and distribution were calculated and predicted. In addition, animal experiments were performed to verify the feasibility of the implant design. The results of the simulation calculations were compared with animal experimental data in vivo to verify their validity.

RESULTS

No significant differences in bone mineral density and stress/strain distribution were found between the CRI and traditional implant models. The animal experimental results (X-ray images and histological staining) were consistent with the numerical simulated results.

CONCLUSIONS

CRIs were more similar to traditional implants than to natural teeth in terms of biomechanical and biological evaluation. Considering the convenience of clinical application, this biomechanical evaluation provides basic theoretical support for further applications of CRI.

Contact ratio and adaptations in the maxillary and mandibular dentoalveolar joints in rats and human clinical analogs

Spatial maps of function-based contact areas and resulting mechanical strains in bones of intact fibrous joints in preclinical small-scale animal models are limited. Functional imaging in situ on intact dentoalveolar fibrous joints (DAJs) in hemimandibles and hemimaxillae harvested from 10 male Sprague-Dawley rats (N = 5 at 12 weeks, N = 5 at 20 weeks) was performed in this study. Physical features including bone volume fraction (BVF), bone pore diameter and pore density, and cementum fraction (CF) of the molars in the maxillary and mandibular joints were evaluated. Biomechanical testing in situ provided estimates of joint stiffness, changes in periodontal ligament spaces (PDL-space) between the molar and bony socket, and thereby localization of contact area in the respective joints. Contact area localization revealed mechanically stressed interradicular and apical regions in the joints. These anatomy-specific contact stresses in maxillary and mandibular joints were correlated with the physical features and resulting strains in interradicular and bony socket compartments. The mandibular joint spaces, in general, were higher than maxillary, and this trend was consistent with age (younger loaded: Mn - 134 ± 55 μm, Mx - 110 ± 47 μm; older loaded: Mn - 122 ± 49 μm, Mx - 105 ± 48 μm). However, a significant decrease (P < 0.05) in mandibular and maxillary joint spaces with age (younger unloaded: Mn - 147 ± 51 μm; Mx - 125 ± 42 μm; older unloaded: Mn - 134 ± 46 μm; Mx - 116 ± 44 μm) was observed. The bone volume fraction (BVF) of mandibular interradicular bone (IR bone) increased significantly with age (P < 0.05) with the percent porosity of coronal mandibular bone lower than its maxillary counterpart. The contact ratio (contact area to total surface area) of maxillary teeth was significantly greater (P < 0.05) than mandibular teeth; both maxillary interradicular and apical contact ratios (IR bone: 41%, 56%; Apical bone: 4%, 12%) increased with age, and were higher than the mandibular (IR bone: 19%, 44%; Apical bone: 1%, 4%) counterpart. Resulting higher but uniform strains in maxillary bone contrasted with lower but higher variance in mandibular strains at a younger age. Anatomy-specific colocalization of physical properties and functional strains in bone provided insights into form-guided adaptive dominance of the maxilla compared to material property-guided adaptive dominance of the mandible. These age-related trends from the preclinical animal model paralleled with age- and tooth position-specific variabilities in mandibular craniofacial bones of adolescent and adult patients following orthodontic treatment.

Pathophysiology of Demineralization, Part I: Attrition, Erosion, Abfraction, and Noncarious Cervical Lesions

PURPOSE OF THE REVIEW

Compare pathophysiology for infectious and noninfectious demineralization disease relative to mineral maintenance, physiologic fluoride levels, and mechanical degradation.

RECENT FINDINGS

Environmental acidity, biomechanics, and intercrystalline percolation of endemic fluoride regulate resistance to demineralization relative to osteopenia, noncarious cervical lesions, and dental caries. Demineralization is the most prevalent chronic disease in the world: osteoporosis (OP) >10%, dental caries ~100%. OP is severely debilitating while caries is potentially fatal. Mineralized tissues have a common physiology: cell-mediated apposition, protein matrix, fluid logistics (blood, saliva), intercrystalline ion percolation, cyclic demineralization/remineralization, and acid-based degradation (microbes, clastic cells). Etiology of demineralization involves fluid percolation, metabolism, homeostasis, biomechanics, mechanical wear (attrition or abrasion), and biofilm-related infections. Bone mineral density measurement assesses skeletal mass. Attrition, abrasion, erosion, and abfraction are diagnosed visually, but invisible subsurface caries <400μm cannot be detected. Controlling demineralization at all levels is an important horizon for cost-effective wellness worldwide.

Pathophysiology of Demineralization, Part II: Enamel White Spots, Cavitated Caries, and Bone Infection

PURPOSE OF REVIEW

Compare noninfectious (part I) to infectious (part II) demineralization of bones and teeth. Evaluate similarities and differences in the expression of hard tissue degradation for the two most common chronic demineralization diseases: osteoporosis and dental caries.

RECENT FINDINGS

The physiology of demineralization is similar for the sterile skeleton compared to the septic dentition. Superimposing the pathologic variable of infection reveals a unique pathophysiology for dental caries. Mineralized tissues are compromised by microdamage, demineralization, and infection. Osseous tissues remodel (turnover) to maintain structural integrity, but the heavily loaded dentition does not turnover so it is ultimately at risk of collapse. A carious tooth is a potential vector for periapical infection that may be life-threatening. Insipient caries is initiated as a subsurface decalcification in enamel that is not detectable until a depth of ~400μm when it becomes visible as a white spot. Reliable detection and remineralization of invisible caries would advance cost-effective wellness worldwide.

Functional adaptation of interradicular alveolar bone to reduced chewing loads on dentoalveolar joints in rats

OBJECTIVES

The effects of reduced chewing loads on load bearing integrity of interradicular bone (IB) within dentoalveolar joints (DAJ) in rats were investigated.

METHODS

Four-week-old Sprague Dawley rats (N = 60) were divided into two groups; rats were either fed normal food, which is hard-pellet food (HF) (N = 30), or soft-powdered chow (SF) (N = 30). Biomechanical testing of intact DAJs and mapping of the resulting mechanical strains within IBs from 8- through 24-week-old rats fed HF or SF were performed. Tension- and compression-based mechanical strain profiles were mapped by correlating digital volumes of IBs at no load with the same IBs under load. Heterogeneity within IB was identified by mapping cement lines and TRAP-positive multinucleated cells using histology, and mechanical properties using nanoindentation technique.

RESULTS

Significantly decreased interradicular functional space, IB volume fraction, and elastic modulus of IB in the SF group compared with the HF group were observed, and these trends varied with an increase in age. The elastic modulus values illustrated significant heterogeneity within IB from HF or SF groups. Both compression- and tension-based strains were localized at the coronal portion of the IB and the variation in strain profiles complemented the observed material heterogeneity using histology and nanoindentation.

SIGNIFICANCE

Interradicular space and IB material-related mechanoadaptations in a DAJ are optimized to meet soft food related chewing demands. Results provided insights into age-specific regulation of chewing loads as a plausible "therapeutic dose" to reverse adaptations within the periodontal complex as an attempt to regain functional competence of a dynamic DAJ.

Mechanoadaptive strain and functional osseointegration of dental implants in rats

Spatiotemporal implant-bone biomechanics and mechanoadaptive strains in peri-implant tissue are poorly understood. Physical and chemical characteristics of an implant-bone complex (IBC) were correlated in three-dimensional space (along the length and around a dental implant) to gather insights into time related integration of the implant with the cortical portion of a jaw bone in a rat. Rats (N = 9) were divided into three experimental groups with three rats per time point; 3-, 11-, and 24-day. All rats were fed crumbled hard pellets mixed with water (soft-food diet) for the first 3 days followed by a hard-food diet with intact hard-food pellets (groups of 11- and 24-day only). Biomechanics of the IBCs harvested from rats at each time point was evaluated by performing mechanical testing in situ in tandem with X-ray imaging. The effect of physical association (contact area) of a loaded implant with adapting peri-implant tissue, and resulting strain within was mapped by using digital volume correlation (DVC) technique. The IBC stiffness at respective time points was correlated with mechanical strain in peri-implant tissue. Results illustrated that IBC stiffness at 11-day was lower than that observed at 3-day. However, at 24-day, IBC stiffness recovered to that which was observed at 3-day. Correlative microscopy and spectroscopy illustrated that the lower IBC stiffness was constituted by softer and less mineralized peri-implant tissue that contained varying expressions of osteoconductive elements. Lower IBC stiffness observed at 11-day was constituted by less mineralized peri-implant tissue with osteoconductive elements that included phosphorus (P) which was co-localized with higher expression of zinc (Zn), and lower expression of calcium (Ca). Higher IBC stiffness at 24-day was constituted by mineralized peri-implant tissue with higher expressions of osteoconductive elements including Ca and P, and lower expressions of Zn. These spatiotemporal correlative maps of peri-implant tissue architecture, heterogeneous distribution of mineral density, and elemental colocalization underscore mechanoadaptive physicochemical properties of peri-implant tissue that facilitate functional osseointegration of an implant. These results provided insights into 1) plausible "prescription" of mechanical loads as an osteoinductive "therapeutic dose" to encourage osteoconductive elements in the peri-implant tissue that would facilitate functional osseointegration of the implant; 2) a "critical temporal window" between 3 and 11 days, and perhaps it is this acute phase during which key candidate regenerative molecules can be harnessed to accelerate osseointegration of an implant under load.

Effects of Twin-block vs sagittal-guidance Twin-block appliance on alveolar bone around mandibular incisors in growing patients with Class II Division 1 malocclusion

INTRODUCTION

The purpose of this study was to comparatively evaluate the effects of Twin-block (TB) appliance and sagittal-guidance Twin-block (SGTB) appliance on alveolar bone around mandibular incisors in growing patients with Class II Division 1 malocclusion, using cone-beam computed tomography.

METHODS

The sample consisted of 25 growing patients with Class II Division 1 malocclusion (14 boys and 11 girls, mean age 11.92 ± 1.62 years) and was randomly distributed into the TB group (n = 13) and the SGTB group (n = 12). The treatment duration was 11.56 ± 1.73 months. Pretreatment (T1) and posttreatment (T2) cone-beam computed tomography scans were taken in both groups. Height, thickness at apex level, and volume of the alveolar bone around mandibular left central incisors were measured respectively on labial and lingual side, using Mimics software (version 19.0; Materialise, Leuven, Belgium). Based on the stable structures, 3-dimensional (3D) registrations of T1 and T2 models were taken to measure the sagittal displacement of incisors. Intragroup comparisons were evaluated by paired-samples t tests and Wilcoxon tests. Independent-samples t tests and Mann-Whitney U tests were used for intergroup comparisons.

RESULTS

In both groups, alveolar bone height and volume on the labial side of the incisors significantly decreased after treatment (P <0.05). Lingual alveolar bone height, lingual and total alveolar bone volume, labial, lingual and total alveolar bone thickness showed no significant difference between T1 and T2 (P >0.05). In both groups the incisors tipped labially and drifted to the labial side. Compared with the TB group, less labial alveolar bone loss, less incisor proclination and crown edge drift were found in the SGTB group (P <0.05).

CONCLUSIONS

Labial alveolar bone loss around mandibular incisors was observed after both types of appliances treatment in growing patients with Class II Division 1 malocclusion. Less labial alveolar bone loss, less incisor proclination, and crown edge drift were found in the SGTB group than in the TB group during treatment.

Periodontal ligament entheses and their adaptive role in the context of dentoalveolar joint function

OBJECTIVE

The dynamic bone-periodontal ligament (PDL)-tooth fibrous joint consists of two adaptive functionally graded interfaces (FGI), the PDL-bone and PDL-cementum that respond to mechanical strain transmitted during mastication. In general, from a materials and mechanics perspective, FGI prevent catastrophic failure during prolonged cyclic loading. This review is a discourse of results gathered from literature to illustrate the dynamic adaptive nature of the fibrous joint in response to physiologic and pathologic simulated functions, and experimental tooth movement.

METHODS

Historically, studies have investigated soft to hard tissue transitions through analytical techniques that provided insights into structural, biochemical, and mechanical characterization methods. Experimental approaches included two dimensional to three dimensional advanced in situ imaging and analytical techniques. These techniques allowed mapping and correlation of deformations to physicochemical and mechanobiological changes within volumes of the complex subjected to concentric and eccentric loading regimes respectively.

RESULTS

Tooth movement is facilitated by mechanobiological activity at the interfaces of the fibrous joint and generates elastic discontinuities at these interfaces in response to eccentric loading. Both concentric and eccentric loads mediated cellular responses to strains, and prompted self-regulating mineral forming and resorbing zones that in turn altered the functional space of the joint.

SIGNIFICANCE

A multiscale biomechanics and mechanobiology approach is important for correlating joint function to tissue-level strain-adaptive properties with overall effects on joint form as related to physiologic and pathologic functions. Elucidating the shift in localization of biomolecules specifically at interfaces during development, function, and therapeutic loading of the joint is critical for developing "functional regeneration and adaptation" strategies with an emphasis on restoring physiologic joint function.

Bone Density and Dental External Apical Root Resorption

When orthodontic patients desire shorter treatment times with aesthetic results and long-term stability, it is important for the orthodontist to understand the potential limitations and problems that may arise during standard and/or technology-assisted accelerated treatment. Bone density plays an important role in facilitating orthodontic tooth movement (OTM), such that reductions in bone density can significantly increase movement velocity. Lifestyle, genetic background, environmental factors, and disease status all can influence a patients' overall health and bone density. In some individuals, these factors may create specific conditions that influence systemic-wide bone metabolism. Both genetic variation and the onset of a bone-related disease can influence systemic bone density and local bone density, such as observed in the mandible and maxilla. These types of localized density changes can affect the rate of OTM and may also influence the risk of unwanted outcomes, i.e., the occurrence of dental external apical root resorption (EARR).

Bone density changes around teeth during orthodontic treatment

The objective of this study was to evaluate bone density changes around the teeth during orthodontic treatment by using cone beam computed tomography (CBCT). CBCT was used to measure the bone densities around six teeth (both maxilla central incisors, lateral incisors, and canines) before and after 7 months of orthodontic treatment in eight patients. In addition, each root was divided into three portions (cervical, intermediate, and apical) to determine whether the bone density change varied with tooth level. The mean reduction in bone density around the measured teeth was 24% after orthodontic treatment. The bone density reduction around teeth was largest for the upper-right and upper-left central incisor (29% and 26%, respectively) and ranged from 20% to 23% for the other four teeth. The mean bone density reduction did not differ significantly between the cervical, portion, and apical portions of the teeth (26%, 22%, and 24%, respectively). CBCT is useful for evaluating bone density changes around teeth during orthodontic treatment. The bone density around the teeth reduced significantly after the application of orthodontic forces for 7 months.

Effects of orthodontic tooth movement on alveolar bone density

The object of this study was to evaluate the relationship between changes in the alveolar bone density around the teeth and the direction of tooth movement by using cone-beam computed tomography (CBCT). CBCT was used to measure the bone densities around six maxilla anterior teeth before and after 7 months of orthodontic treatment in eight patients. Each root was divided into three levels (cervical, intermediate, and apical) to determine whether the bone density change varied with the tooth level. Moreover, each level was divided into four regions (palatal, distal, mesial, and buccal sides). Three-dimensional computer models of the maxilla before and after orthodontic treatment were created to detect the direction of tooth movement. The percentage for all 144 samples [8 (patients) × 6 (teeth) × 3 (levels)] in which the side (palatal, distal, mesial, or buccal sides) of maximum bone density reduction (before and after orthodontic treatment) coincided with the direction of tooth movement was calculated; this was referred to as the "coincidence percentage". The bone density around the teeth reduced by 24.3 ± 9.5%. The average coincidence percentage for the eight patients was 59.0%. The coincidence percentages for the eight patients were 62.5%, 62.5%, and 52.1% at the cervical, intermediate, and apical levels, respectively. The obtained results demonstrate that the direction of tooth movement is associated with the side of maximum bone density reduction, and that CBCT is a useful approach for evaluating bone density changes around teeth induced by orthodontic treatment.