Observations of root surfaces from patients with early-onset periodontitis and leukocyte adhesion deficiency

Root resorptions induced by genetic disorders: A systematic review

OBJECTIVES

Root resorption in permanent teeth is a common pathological process that often follows dental trauma or orthodontic treatment. More rarely, root resorption is a feature of genetic disorders and can help with diagnosis. Thus, the present review aims to determine which genetic disorders could induce pathological root resorptions and thus which mutated genes could be associated with them.

METHODS

We conducted a systematic review following the PRISMA guidelines. Articles describing root resorptions in patients with genetic disorders were included from PubMed, Embase, Web of Science, and Google Scholar. We synthesized the genetic disorder, the type, severity, and extent of the resorptions, as well as the other systemic and oral symptoms and histological features.

RESULTS

The synthetic analysis included 25 studies among 937 identified records. We analyzed 21 case reports, three case series, and one cohort study. Overall, we highlighted 14 different pathologies with described root resorptions. Depending on the pathology, the sites of resorption, their extent, and their severity showed differences.

CONCLUSION

With 14 genetic pathologies suspected to induce root resorptions, our findings are significant and enrich a previous classification. Among them, three metabolic disorders, three calcium-phosphorus metabolism disorders, and osteolysis disorders were identified.

Cemental and alveolar bone defects after chronic exposure to amoxicillin in rats (histopathologic and radiographic study)

OBJECTIVES

This study aimed to shed new light on the potential detrimental effects on cementum and adjacent alveolar bone after chronic exposure to amoxicillin.

METHODS

Six pregnant adult Albino rats were equally divided into two groups. Saline solution and amoxicillin (100 mg/Kg) were given to rats of control and amoxicillin group, respectively from the 13th to the 21st day of pregnancy. The same treatment was given to the pups till the 42nd day. The cementum of the first molar teeth and the surrounding alveolar bone were examined qualitatively by histopathological and scanning electron microscope, and quantitatively by energy dispersive X-ray spectroscopy and cone beam computed tomography.

RESULTS

Amoxicillin group depicted cemental and alveolar bone defects along with resorption lacunae. Statistically significant decreases in calcium and calcium/phosphorus ratio in cementum and in calcium only in alveolar bone were evident (p ≤ 0.05). Overall cementum and alveolar bone densities also showed statistically significant decreases (p ≤ 0.05).

CONCLUSION

Chronic amoxicillin administration displayed destructive effects on cementum and the surrounding alveolar bone which may disturb tooth attachment integrity. Therefore, it is recommended to minimize its haphazard usage during pregnancy and early childhood.

"Oral Manifestations of Patients with Inherited Defect in Phagocyte Number or Function" a systematic review

INTRODUCTION

Inherited phagocyte defects are one of the subgroups of primary immunodeficiency diseases (PIDs) with various clinical manifestations. As oral manifestations are common at the early ages, oral practitioners can have a special role in the early diagnosis.

MATERIALS AND METHODS

A comprehensive search was conducted in this systematic review study and data of included studies were categorized into four subgroups of phagocyte defects, including congenital neutropenia, defects of motility, defects of respiratory burst, and other non-lymphoid defects.

RESULTS

Among all phagocyte defects, 12 disorders had reported data for oral manifestations in published articles. A total of 987 cases were included in this study. Periodontitis is one of the most common oral manifestations.

CONCLUSION

There is a need to organize better collaboration between medical doctors and dentists to diagnose and treat patients with phagocyte defects. Regular dental visits and professional oral health care are recommended from the time of the first primary teeth eruption in newborns.

Radiographic morphology of intrabony defects in the first molars of patients with localized aggressive periodontitis: Comparison with health and chronic periodontitis

BACKGROUND AND OBJECTIVE

The aim of this study was to describe the radiographic features of the first molars of patients with localized aggressive periodontitis (LAgP) and of their associated intrabony defects and to compare them with a control sample of chronic periodontitis cases and healthy subjects.

METHODS

Data from a total of 93 patients were included in this analysis. First, dental panoramic tomograms of 34 patients with LAgP (131 first molars) and 30 periodontally healthy patients (110 first molars) were compared. Then, periapical radiographs of the first molars of the same patients with LAgP and of 29 patients with chronic periodontitis affected by intrabony defects were analysed.

RESULTS

Shorter root trunks were associated with the presence of intrabony defects in patients with LAgP (P = .002 at multilevel logistic regression), also when LAgP molars were compared with healthy subjects (P = .036). Although no difference in defect depth and angle was noted between LAgP and chronic periodontitis intrabony defects, LAgP intrabony defects appeared to be more frequently symmetrical and arch-shaped than in chronic periodontitis (P = .008), with positive predictive value and negative predictive value of for 'wide arch' defect of 87.3% (95% CI = 77.2%-93.3%) and 32.3% (95% CI = 27.7%-37.2%) respectively.

CONCLUSION

First molars of patients with LAgP affected by intrabony defects may have some distinct radiographic anatomical characteristics to those of healthy subjects. The shape of intrabony defects seems to differ between LAgP and chronic periodontitis cases. Further studies need to confirm these features and investigate if they are related to the initiation and progression of periodontitis.

[Skin and teeth]

Skin and teeth not only share several characteristics in their development but also have a similar ontogenetic origin from the ectoderm. Thus, numerous congenital diseases, such as genetic, infectious, inflammatory, and immune disorders affect both skin and teeth. Particularly skin diseases are often identified by the synopsis of systemic symptoms. The understanding and appreciation of dental abnormalities guides dermatologists in the diagnosis and identification of syndromes as well as in finding an optimal therapy.

Dental trauma associated with anaesthesia

Damage to teeth is the most common complaint against anaesthetists. A dental history and oral examination are important before anaesthesia. Pre-existing dental pathology or the presence of prostheses makes damage more likely but sound teeth may be affected. The maxillary central incisors are most at risk. Certain diseases and drugs should alert anaesthetists to increased likelihood of dental pathology. The flange of the Macintosh blade appears responsible for much damage and alternative equipment or techniques of endotracheal intubation should be considered, particularly when risk factors are present. Manoeuvres to protect teeth must not impact adversely on airway management. Custom mouthguards can be useful. A management plan can help control losses if damage does occur. Patients should be warned about the possibility of dental trauma.

Morphological study of root surfaces in teeth with adult periodontitis

BACKGROUND

Our study correlates the histological alterations in the cementum (especially resorption areas) of teeth with the different stages of adult periodontitis.

METHODS

Sixty-seven teeth affected by adult periodontitis and 7 healthy teeth extracted from patients over 40 years old were used. The teeth were divided into 3 groups according to radiographic data: group 1: five teeth with bone loss less than one-third of the normal alveolar height; group 2: thirty-one teeth with bone loss between one and two thirds; and group 3: thirty-one teeth with bone loss greater than two thirds. The samples were prepared for light and scanning electron microscopy, considering the gingival, middle, and apical thirds in each root.

RESULTS

Two control teeth, 4 teeth in group 1, and all teeth in groups 2 and 3 showed resorption areas. Regarding the gingival third, the control teeth did not show any resorption, while 25% of affected teeth in group 1, 38.7% of teeth in group 2, and 35.5% of teeth in group 3 exhibited resorption. Regarding the middle third, 50% of affected teeth belonging to the control group and group 1; 67.7% of teeth in group 2; and 87.1% of teeth in group 3 showed resorption. Regarding the apical third, all teeth belonging to the control group and group 1 showed resorption, while 93.5% and 87.1% of teeth in groups 2 and 3, respectively, exhibited resorption. Most of the resorptions did not extend beyond the cementum. However, in 29.0% of teeth in group 2 and 38.7% of teeth in group 3, resorption had spread as far as the dentin. All the lesions in the control group and group 1 were practically repaired, while only 71.0% of teeth in group 2 and 61.3% of teeth in group 3 showed some sign of reparation. However, in groups 2 and 3, practically all lesions affecting dentin were repaired.

CONCLUSIONS

These data suggest that the spread of root resorption is associated with inflammation. This study also suggests that the capacity for repair of root resorption is diminished with greater severity of periodontitis.

Root surface characteristics of primary teeth from children with prepubertal periodontitis

This study describes the histologic characteristics of root surfaces of primary teeth from children with prepubertal periodontitis (PP). Fifteen primary teeth from 4 children with PP, and 2 control primary teeth from 2 healthy children were examined. Light microscopy revealed normal root surfaces in the control teeth. In contrast, the PP specimens revealed bacteria inside dentin tubules or covering cementum, a cuticle, or resorbed dentin; normal, wider than normal, or hypoplastic cementum; resorption lacunae with various depths; aplastic root resorption; alternate resorption and repair; and active repair. No cementoclasts were found in the resorption lacunae. Scanning electron microscopy revealed intrabony and suprabony root areas, and a "plaque free zone" (PFZ). Colonies of filaments were evident at the cemento-enamel junction (CEJ). The suprabony root surfaces had resorption lacunae, isolated short rods, calculus, colonies of filaments, or colonies composed by an heterogeneous bacterial population. The coronal boundary of the PFZ was the border of a sheet-like structure, which included isolated rods or filaments. At the PFZ, isolated filaments and rods, and a fibril matrix were evident. The apical boundary of the PFZ consisted of bundles of soft tissue remnants or the insertion of the periodontal fibers. The intrabony surfaces were mostly covered by soft tissue, which included isolated filaments and short rods. Resorption lacunae with or without soft tissue were also evident in this area. Crystals of calcium oxalate dihydrate and erythrocytes in distinct forms were found at various root areas. The present findings are different from those previously reported for hypophosphatasia specimens.

Loss of deciduous teeth and germs of permanent incisors in a 4-year-old child. An atypic prepubertal periodontitis? A clinical, microbiological, immunological and ultrastructural study

A 4-year-old child was referred, in April 1988, to Rennes Dental School (France) for deciduous tooth mobility with premature loss of 4 deciduous teeth and germs of 2 permanent incisors. Microbiological examinations by culture revealed the presence of the periodontal pathogen Actinobacillus actinomycetemcomitans. Immunofluorescence of plaque samples revealed the presence of Porphyromonas gingivalis that had not been isolated by culture. Neutrophil functions were within normal ranges. Transmission electron microscopy of gingiva showed a disorganised epithelium. The connective tissue was infiltrated by inflammatory cells. The basement membranes were normal, but the connective tissue-epithelium interface was mainly composed of short rete pegs. Scanning electron microscopy of extracted deciduous teeth revealed lack of cementum, lacunae in the cementum and lack of fibrillar insertion on the middle part of the root. Skin lesions, mainly situated on face, were observed. Treatment was by extraction of mobile deciduous teeth combined with 3-week courses of metronidazole. Clinical and microbiological follow-up was continued over a 7-year period. No periodontal lesions have been detected since eruption of the permanent teeth. The present subgingival and lingual microflora (December 1995) is composed of bacteria associated with periodontal health. However, the future appearance of a hitherto undetected systemic disease is still possible.

Expression of bone associated markers by tooth root lining cells, in situ and in vitro

Periodontal disease is marked by inflammation and subsequent loss and/or damage to tooth-supporting tissues including bone, cementum, and periodontal ligament. A key tissue in the initial process of periodontal development as well as regeneration following periodontal disease is cementum. Research efforts aimed toward understanding mechanisms involved in periodontal development and regeneration, and in particular the formation of root cementum, have been hampered by an inability to isolate and culture cells involved in cementum production (i.e., cementoblasts). Much has been learned regarding the processes and mechanisms involved in bone formation and function from experiments using bone cell cultures. Therefore, the purpose of this study was to develop a strategy whereby cementoblasts could be isolated, cultured, and characterized. As a first step, using in situ hybridization, we determined the timed and spatial expression of mineral-associated proteins during first molar root development in CD-1 mice. These proteins included dentin sialoprotein (DSP), osteopontin (OPN), bone sialoprotein (BSP), osteocalcin (OCN), and type I collagen. During root development in mice BSP, OPN, and OCN mRNAs were expressed selectively by cells lining the tooth root surface--cementoblasts--with high levels of expression at day 41. Importantly, at this time point BSP, OPN, and OCN mRNAs were not expressed throughout the periodontal ligament. These findings provided us with markers selective to root-lining cells, or cementoblasts, in situ, and established the time (day 41) for isolating cells for in vitro studies. To isolate cells from tissues adherent to the root surface, enzymatic digestion was used, similar to what are now considered classical techniques for isolation of osteoblasts. To determine whether cells in vitro contained root-lining cells and cementoblasts, cultured cells were analyzed for expression of mineral-associated proteins. Cells within this heterogeneous primary population expressed type I collagen, BSP, OPN, and OCN as determined by in situ hybridization. In contrast, cells within this population did not express dentin sialoprotein, an odontoblast-specific protein. These procedures have provided a means to obtain root-lining cells in vitro that can now be cloned and used for studies directed at determining the properties of root-lining cells, or cementoblasts, in vitro.

Periodontal implications: medically compromised patients

The presence of systemic disease in patients requiring periodontal therapy creates challenges for management. Alteration of treatment plans, with emphasis on physician consultation and preventive periodontal care, is frequently needed to minimize the impact of periodontal disease on the systemic condition. Conversely, detection and treatment of systemic disorders may impact upon the status of the periodontium and the success of periodontal therapy. The goal of holistic patient management is facilitated by a free flow of information between the patients and their medical and dental health care providers.