An in vitro model of human dental pulp repair

Construction of dentin-on-a-chip based on microfluidic technology and tissue engineering

AIM

Three-dimensional (3D) cell culture systems perform better in resembling tissue or organism structures compared with traditional 2D models. Organs-on-chips (OoCs) are becoming more efficient 3D models. This study aimed to create a novel simplified dentin-on-a-chip using microfluidic chip technology and tissue engineering for screening dental materials.

METHODOLOGY

A microfluidic device with three channels was designed for creating 3D dental tissue constructs using stem cells from the apical papilla (SCAP) and gelatin methacrylate (GelMA). The study investigated the effect of varying cell densities and GelMA concentrations on the layer features formed within the microfluidic chip. Cell viability and distribution were evaluated through live/dead staining and nuclei/F-actin staining. The osteo/odontogenic potential was assessed through ALP staining and Alizarin red staining. The impact of GelMA concentrations (5 %, 10 %) on the osteo/odontogenic differentiation trajectory of SCAP was also studied.

RESULTS

The 3D tissue constructs maintained high viability and favorable spreading within the microfluidic chip for 3-7 days. A cell seeding density of 2 × 104 cells/μL was found to be the most optimal choice, ensuring favorable cell proliferation and even distribution. GelMA concentrations of 5 % and 10 % proved to be most effective for promoting cell growth and uniform distribution. Within the 5 % GelMA group, SCAP demonstrated higher osteo/odontogenic differentiation than that in the 10 % GelMA group.

CONCLUSION

In 3D culture, GelMA concentration was found to regulate the osteo/odontogenic differentiation of SCAP. The study recommends a seeding density of 2 × 104 cells/μL of SCAP within 5 % GelMA for constructing simplified dentin-on-a-chip.

CLINICAL SIGNIFICANCE

This study built up the 3D culture protocol, and induced odontogenic differentiation of SCAP, thus forming the simplified dentin-on-a-chip and paving the way to be used as a well-defined biological model for regenerative endodontics. It may serve as a potential testing platform for cell differentiation.

Early diagnosis of aortic calcification through dental X-ray examination for dental pulp stones

Vascular calcification, an ectopic calcification exacerbated by aging and renal dysfunction, is closely associated with cardiovascular disease. However, early detection indicators are limited. This study focused on dental pulp stones, ectopic calcifications found in oral tissues that are easily identifiable on dental radiographs. Our investigation explored the frequency and timing of these calcifications in different locations and their relationship to aortic calcification. In cadavers, we examined the association between the frequency of dental pulp stones and aortic calcification, revealing a significant association. Notably, dental pulp stones appeared prior to aortic calcification. Using a rat model of hyperphosphatemia, we confirmed that dental pulp stones formed earlier than calcification in the aortic arch. Interestingly, there were very few instances of aortic calcification without dental pulp stones. Additionally, we conducted cell culture experiments with vascular smooth muscle cells (SMCs) and dental pulp cells (DPCs) to explore the regulatory mechanism underlying high phosphate-mediated calcification. We found that DPCs produced calcification deposits more rapidly and exhibited a stronger augmentation of osteoblast differentiation markers compared with SMCs. In conclusion, the observation of dental pulp stones through X-ray examination during dental checkups could be a valuable method for early diagnosis of aortic calcification risk.

In vitro, ex vivo, and in vivo models for dental pulp regeneration

Based on the concept of tissue engineering (Cells-Scaffold-Bioactive molecules), regenerative endodontics appeared as a new notion for dental endodontic treatment. Its approaches aim to preserve dental pulp vitality (pulp capping) or to regenerate a vascularized pulp-like tissue inside necrotic root canals by cell homing. To improve the methods of tissue engineering for pulp regeneration, numerous studies using in vitro, ex vivo, and in vivo models have been performed. This review explores the evolution of laboratory models used in such studies and classifies them according to different criteria. It starts from the initial two-dimensional in vitro models that allowed characterization of stem cell behavior, through 3D culture matrices combined with dental tissue and finally arrives at the more challenging ex vivo and in vivo models. The travel which follows the elaboration of such models reveals the difficulty in establishing reproducible laboratory models for dental pulp regeneration. The development of well-established protocols and new laboratory ex vivo and in vivo models in the field of pulp regeneration would lead to consistent results, reduction of animal experimentation, and facilitation of the translation to clinical practice.

BACH1 regulates the proliferation and odontoblastic differentiation of human dental pulp stem cells

Background

The preservation of biological and physiological vitality as well as the formation of dentin are among the main tasks of human dental pulp for a life time. Odontoblastic differentiation of human dental pulp stem cells (hDPSCs) exhibits the capacity of dental pulp regeneration and dentin complex rebuilding. Exploration of the mechanisms regulating differentiation and proliferation of hDPSCs may help to investigate potential clinical applications. BTB and CNC homology 1 (BACH1) is a transcription repressor engaged in the regulation of multiple cellular functions. This study aimed to investigate the effects of BACH1 on the proliferation and odontoblastic differentiation of hDPSCs in vitro.

Methods

hDPSCs and pulpal tissues were obtained from extracted human premolars or third molars. The distribution of BACH1 was detected by immunohistochemistry. The mRNA and protein expression of BACH1 were examined by qRT-PCR and Western blot analysis. BACH1 expression was regulated by stable lentivirus-mediated transfection. Cell proliferation and cell cycle were assessed by cell counting kit-8 assay, 5-Ethynyl-2'-deoxyuridine assay and flow cytometry. The expression of mineralization markers, alkaline phosphatase (ALP) activity and alizarin red S staining were conducted to assess the odontoblastic differentiation ability.

Results

BACH1 expression was stronger in the odontoblast layer than in the cell rich zone. The total and nuclear protein level of BACH1 during odontoblastic differentiation was downregulated initially and then upregulated gradually. Knockdown of BACH1 greatly inhibited cell proliferation, arrested cell cycle, upregulated the heme oxygenase-1 (HO-1) expression and attenuated ALP activity, decreased calcium deposits and downregulated the expression of mineralization markers. Treatment of Tin-protoporphyrin IX, an HO-1 inhibitor, failed to rescue the impaired odonto/osteogenic differentiation capacity. Overexpression of BACH1 increased cell proliferation, ALP activity and the expression of mineralization markers.

Conclusions

Our findings suggest that BACH1 is an important regulator of the proliferation and odontoblastic differentiation of hDPSCs in vitro. Manipulation of BACH1 expression may provide an opportunity to promote the regenerative capacity of hDPSCs.

In-vitro models of biocompatibility testing for restorative dental materials: From 2D cultures to organs on-a-chip

Dental caries is a biofilm-mediated, diet-modulated, multifactorial and dynamic disease that affects more than 90% of adults in Western countries. The current treatment for decayed tissue is based on using materials to replace the lost enamel or dentin. More than 500 million dental restorations are placed annually worldwide, and materials used for these purposes either directly or indirectly interact with dentin and pulp tissues. The development and understanding of the effects of restorative dental materials are based on different in-vitro and in-vivo tests, which have been evolving with time. In this review, we first discuss the characteristics of the tooth and the dentin-pulp interface that are unique for materials testing. Subsequently, we discuss frequently used in-vitro tests to evaluate the biocompatibility of dental materials commonly used for restorative procedures. Finally, we present our perspective on the future directions for biological research on dental materials using tissue engineering and organs on-a-chip approaches. STATEMENT OF SIGNIFICANCE: Dental caries is still the most prevalent infectious disease globally, requiring more than 500 million restorations to be placed every year. Regrettably, the failure rates of such restorations are still high. Those rates are partially based on the fact that current platforms to test dental materials are somewhat inaccurate in reproducing critical components of the complex oral microenvironment. Thus, there is a collective effort to develop new materials while evolving the platforms to test them. In this context, the present review critically discusses in-vitro models used to evaluate the biocompatibility of restorative dental materials and brings a perspective on future directions for tissue-engineered and organs-on-a-chip platforms for testing new dental materials.

Secreted Frizzled-Related Protein 1 Promotes Odontoblastic Differentiation and Reparative Dentin Formation in Dental Pulp Cells

Direct pulp capping is an effective treatment for preserving dental pulp against carious or traumatic pulp exposure via the formation of protective reparative dentin by odontoblast-like cells. Reparative dentin formation can be stimulated by several signaling molecules; therefore, we investigated the effects of secreted frizzled-related protein (SFRP) 1 that was reported to be strongly expressed in odontoblasts of newborn molar tooth germs on odontoblastic differentiation and reparative dentin formation. In developing rat incisors, cells in the dental pulp, cervical loop, and inner enamel epithelium, as well as ameloblasts and preodontoblasts, weakly expressed Sfrp1; however, Sfrp1 was strongly expressed in mature odontoblasts. Human dental pulp cells (hDPCs) showed stronger expression of SFRP1 compared with periodontal ligament cells and gingival cells. SFRP1 knockdown in hDPCs abolished calcium chloride-induced mineralized nodule formation and odontoblast-related gene expression and decreased BMP-2 gene expression. Conversely, SFRP1 stimulation enhanced nodule formation and expression of BMP-2. Direct pulp capping treatment with SFRP1 induced the formation of a considerable amount of reparative dentin that has a structure similar to primary dentin. Our results indicate that SFRP1 is crucial for dentinogenesis and is important in promoting reparative dentin formation in response to injury.

Nerve growth factor signalling in pathology and regeneration of human teeth

Nerve growth factor (NGF) is a key regulator of the development and differentiation of neuronal and non-neuronal cells. In the present study we examined the distribution of NGF and its low and high-affinity receptors, p75^NTR and TrkA respectively, in permanent human teeth under normal and pathological conditions. In intact functional teeth, NGF, p75^NTR and TrkA are weakly expressed in dental pulp fibroblasts and odontoblasts that are responsible for dentine formation, while the NGF and p75^NTR molecules are strongly expressed in nerve fibres innervating the dental pulp. In carious and injured teeth NGF and TrkA expression is upregulated in a selective manner in odontoblasts surrounding the injury sites, indicating a link between NGF signalling and dental tissue repair events. Accordingly, NGF and TrkA expression is strongly upregulated in cultured primary human dental mesenchymal cells during their differentiation into odontoblasts. Targeted release of NGF in cultured human tooth slices induced extensive axonal growth and migration of Schwann cells towards the NGF administration site. These results show that NGF signalling is strongly linked to pathological and regenerative processes in human teeth and suggest a potential role for this neurotrophic molecule in pulp regeneration.

Effects of neurotrophin receptor-mediated MAGE homology on proliferation and odontoblastic differentiation of mouse dental pulp cells

OBJECTIVES

This study aimed to investigate effects of neurotrophin receptor-mediated melanoma antigen-encoding gene homology (NRAGE) on proliferation and odontoblastic differentiation of mouse dental pulp cells (mDPCs).

MATERIALS AND METHODS

Mouse dental pulp cells were infected with recombinant lentivirus to stably knockdown expression of NRAGE, and biological effects of NRAGE on the cells were detected. Proliferation and odontoblastic differentiation of mDPCs were observed. Simultaneously, mRNA and protein levels of NRAGE and nuclear factor-κB (NF-κB) protein expression were detected. Immunofluorescence assay was used to detect expression and location of NRAGE and NF-κB.

RESULTS

NRAGE mRNA and protein levels reduced significantly after mDPC odontoblastic induction. Knockdown of NRAGE inhibited the proliferation of mDPCs. However, knockdown of NRAGE enhanced their odontoblastic differentiation with up-regulated ALPase activity. It also promoted mineral nodule formation as well as mRNA and protein expressions of ALP, DSPP and DMP1. Protein levels of NF-κB/p50 significantly increased, whereas NF-κB/p105 protein expression decreased in the mDPC/shNRG group. Immunofluorescence revealed that relocation of NF-κB was similar to that of NRAGE during odontoblastic induction, in which NF-κB translocated from the cytoplasm to the nucleus.

CONCLUSION

NRAGE is a potent regulator of proliferation and odontoblastic differentiation of mDPCs, which might be via the NF-κB signalling pathway.

Correlation between Fibrillin-1 Degradation and mRNA Downregulation and Myofibroblast Differentiation in Cultured Human Dental Pulp Tissue

Myofibroblasts and extracellular matrix are important components in wound healing. Alpha-smooth muscle actin (α-SMA) is a marker of myofibroblasts. Fibrillin-1 is a major constituent of microfibrils and an extracellular-regulator of TGF-β1, an important cytokine in the transdifferentiation of resident fibroblasts into myofibroblasts. To study the correlation between changes in fibrillin-1 expression and myofibroblast differentiation, we examined alterations in fibrillin-1 and α-SMA expression in organotypic cultures of dental pulp in vitro. Extracted healthy human teeth were cut to 1-mm-thick slices and cultured for 7 days. In intact dental pulp, fibrillin-1 was broadly distributed, and α-SMA was observed in pericytes and vascular smooth muscle cells. After 7 days of culture, immunostaining for fibrillin-1 became faint concomitant with a downregulation in its mRNA levels. Furthermore, fibroblasts, odontoblasts and Schwann cells were immunoreactive for α-SMA with a significant increase in α-SMA mRNA expression. Double immunofluorescence staining was positive for pSmad2/3, central mediators of TGF-β signaling, and α-SMA. The administration of inhibitors for extracellular matrix proteases recovered fibrillin-1 immunostaining; moreover, fibroblasts lost their immunoreactivity for α-SMA along with a downregulation in α-SMA mRNA. These findings suggest that the expression of α-SMA is TGF-β1 dependent, and fibrillin-1 degradation and downregulation might be implicated in the differentiation of myofibroblasts in dental pulp wound healing.

Regeneration of dentin–pulp-like tissue using an injectable tissue engineering technique

An injectable tissue engineering technique to regenerate dentin–pulp complex.

Iloprost up-regulates vascular endothelial growth factor expression in human dental pulp cells in vitro and enhances pulpal blood flow in vivo

INTRODUCTION

Prostacyclin (PGI2) is a biomolecule capable of enhancing angiogenesis and cellular proliferation.

METHODS

We investigated the influence of a PGI2 analogue (iloprost) on dental pulp revascularization in vitro and in vivo by using human dental pulp cells (HDPCs) and a rat tooth injury model, respectively. Iloprost stimulated the human dental pulp cell mRNA expression of vascular endothelial growth factor (VEGF), fibroblast growth factor-2 (FGF-2), and platelet-derived growth factor (PDGF) in a significant dose-dependent manner. This mRNA up-regulation was significantly inhibited by pretreatment with a PGI2 receptor antagonist and forskolin (a protein kinase A activator). In contrast, a protein kinase A inhibitor significantly enhanced the iloprost-induced mRNA expression of VEGF, FGF-2, and PDGF. Pretreatment with a fibroblast growth factor receptor inhibitor attenuated the VEGF, FGF-2, and PDGF mRNA expression, indicating opposing regulatory mechanisms.

RESULTS

The effect of iloprost on the dental pulp was investigated in vivo by using a rat molar pulp injury model. The iloprost-treated group exhibited a significant increase in pulpal blood flow at 72 hours compared with control.

CONCLUSIONS

The present study indicates that iloprost may be a candidate agent to promote neovascularization in dental pulp tissue, suggesting the potential clinical use of iloprost in vital pulp therapy.

Short-term effect of low-intensity pulsed ultrasound on an ex-vivo 3-d tooth culture

We investigated the short-term effect of LIPUS on human dentin-pulp complex in vitro. We collected sixty-three premolars from patients who needed the extraction. The premolars were sectioned transversely into 600-μm-thick slices, and then divided into five groups according to LIPUS application time (control, 5, 10, 15 and 20 min). LIPUS transducer produced an incident intensity of 30 mW/cm(2). After 24 h, tissue was harvested for histomorphometrical analysis and RT-PCR (Genes of interest: Collagen I, DMP1, DSPP, TGF β1, RANKL and OPG). Histomorphometric analysis showed no significant difference among the five groups in the odontoblast count and predentin thickness. RT-PCR demonstrated no expression of TGF β1, low amounts of DSPP, a twofold increase in collagen I expression in the 5- and 10-minute LIPUS groups and a threefold increase in DMP1 expression in the 10-minute LIPUS group. LIPUS application was stimulatory to the dentin-pulp complex in vitro and increased the expression of collagen I and DMP1.

Dental tissue repair: novel models for tissue regeneration strategies

Studies have shown that dentin matrices contain reservoirs of bioactive molecules capable of directing tissue repair. Elucidating the release mechanisms of such endogenous growth factors will enhance our understanding of dentinpulp regeneration and support the development of novel treatment modalities to enhance dentin repair following trauma and disease. Current clinical practice using new materials which are perceived to maintain pulpal viability require biological evidence to assess their therapeutic benefit and there is a need for better effective methods of assessing therapeutic approaches to improving dentin regeneration at the cellular and tissue level. Experimental modelling of dentin regeneration is hampered by the lack of suitable models. In vivo and in vitro studies have yielded considerable information on the processes taking place, but are limited, due to the cost, ethics and lack of cell/matrix interactions. Novel organotypic models, whereby cells and tissues are cultured in situ may provide a more suitable model system to facilitate dental tissue engineering and regeneration.

Expression and purification recombinant human dentin sialoprotein in Escherichia coli and its effects on human dental pulp cells

Dentin sialoprotein (DSP) is cleaved from dentin sialophosphoprotein (DSPP) and most abundant dentinal non-collagenous proteins in dentin. DSP is believed to participate in differentiation and mineralization of cells. In this study, we first constructed recombinant human DSP (rhDSP) in Escherichia coli (E. coli) and investigated its odontoblastic differentiation effects on human dental pulp cells (hDPCs). Cell adhesion activity was measured by crystal violet assay and cell proliferation activity was measured by MTT assay. To assess mineralization activity of rhDSP, Alizarin Red S staining was performed. In addition, the mRNA levels of collagen type І (Col І), alkaline phosphatase (ALP), and osteocalcin (OCN) were measured due to their use as mineralization markers for odontoblast-/osteoblast-like differentiation of hDPCs. The obtained rhDSP in E. coli was approximately identified by SDS-PAGE and Western blot. Initially, rhDSP significantly enhanced hDPCs adhesion activity and proliferation (p<0.05). In Alizarin Red S staining, stained hDPCs increased in a time-dependent manner. This odontoblastic differentiation activity was also verified through mRNA levels of odontoblast-related markers. Here, we first demonstrated that rhDSP may be an important regulatory ECM in determining the hDPCs fate including cell adhesion, proliferation, and odontoblastic differentiation activity. These findings indicate that rhDSP can induce growth and differentiation on hDPCs, leading to improve tooth repair and regeneration.

Effects of recombinant dentin sialoprotein in dental pulp cells

Dentin sialophosphoprotein (DSPP) is critical for dentin mineralization. However, the function of dentin sialoprotein (DSP), the cleaved product of DSPP, remains unclear. This study aimed to investigate the signal transduction pathways and effects of recombinant human DSP (rh-DSP) on proliferation, migration, and odontoblastic differentiation in human dental pulp cells (HDPCs). The exogenous addition of rh-DSP enhanced the proliferation and migration of HDPCs in dose- and time-dependent manners. rh-DSP markedly increased ALP activity, calcium nodule formation, and levels of odontoblastic marker mRNA. rh-DSP increased BMP-2 expression and Smad1/5/8 phosphorylation, which was blocked by the BMP antagonist, noggin. Furthermore, rh-DSP phosphorylated extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), Akt, and IκB-α, and induced the nuclear translocation of the NF-κB p65 subunit. Analysis of these data demonstrates a novel signaling function of rh-DSP for the promotion of growth, migration, and differentiation in HDPCS via the BMP/Smad, JNK, ERK, MAPK, and NF-κB signaling pathways, suggesting that rh-DSP may have therapeutic utility in dentin regeneration or dental pulp tissue engineering.

Long term effect of low intensity pulsed ultrasound on a human tooth slice organ culture

OBJECTIVE

Investigate the effect of therapeutic Low Intensity Pulsed Ultrasound (LIPUS) on human dentine-pulp complex in an in vitro model.

DESIGN

92 premolars were extracted from 23 adolescent orthodontic patients. The premolars were sectioned transversely into 600 μm thick slices. The slices were divided into two main groups according to how often the LIPUS was applied (single or daily application), and then subdivided into five subgroups each (5, 10, 15 and 20 min and one control group). The tooth slices were cultured at (37 °C/5% CO(2)) in a humidified incubator where medium was changed every 48 h. LIPUS was applied using a 3.9 cm(2) transducer that produces an incident intensity of 30 mW/cm(2). After five days, tissue was harvested for histomorphometrical analysis and real time PCR to investigate expression of genes of interest (Collagen I, DMP1, DSPP, TGF-β1, RANKL and OPG).

RESULTS

Histomorphometric analyses revealed that odontoblast cell count was higher in the single application groups (5, 10 and 15 min, respectively) than in the control and other treatment groups. Predentin thickness was higher in the single application group (10, 5 and 15 min) respectively than in the daily application group and the control groups, however they were not significantly different from each other. Real time PCR demonstrated no statistically significant difference between the groups in the expression of Collagen I, DMP1, TGF-β1, DSPP, RANKL and OPG.

CONCLUSION

Reproducible responses from cultured dentine-pulp complex were observed in groups with single application of LIPUS for 5, 10 and 15 min.

The effect of low intensity pulsed ultrasound in a 3D ex vivo orthodontic model

OBJECTIVES

This study investigated the effects of low intensity pulsed ultrasound (LIPUS) on dentoalveolar structures during orthodontic force application using a novel organ culture system.

METHODS

Mandibles were dissected from 28-day-old male Sprague Dawley rats, sliced into 1.5mm and cultured at 37°C and 5% CO(2), prior to application of a 50g force to each mandible slice. Slices were randomly divided into three groups of control, 5 and 10min LIPUS application and cultured for five days before histological and histomorphometrical analysis.

RESULTS

Cementum and predentine thickness and subodontoblast and periodontal ligament cell counts were increased in the ultrasound groups, with increases statistically significant in the 10min treated groups. Odontoblasts remained viable during LIPUS exposure and osteoclast activity was increased by LIPUS.

CONCLUSIONS

LIPUS may influence remodelling of the dentine-pulp complex and associated tissues during orthodontic force application ex vivo.

An ex vivo rodent mandible culture model for bone repair

To understand fully cellular mechanisms during bone tissue repair and engineering, there is a need to develop reproducible three-dimensional organotypic culture models, whereby cells in their natural extracellular matrix can be manipulated. Limitations in current model systems do not allow for this integrated approach. This study aimed to develop and validate an ex vivo fractured rat mandible model, to investigate specific molecular and cellular processes involved in bone repair. Slices of mandible from 28-day-old male Wistar rats were cultured in Trowel-type cultures at the liquid-gas interface for up to 21 days. Maintenance of cell and tissue architecture and viability was shown within fractured mandible slices during all culture periods. Autoradiographic studies demonstrated that resident cells were actively synthesizing and secreting proteins, and cells of the osteoblast lineage were shown to survive throughout the culture periods. The model was responsive to exogenously added transforming growth factor-β1, with observed increases in cellular migration/proliferation and expression of bone matrix proteins. The ex vivo mandible model developed within this study may represent an ideal system for investigating specific processes of bone repair, as well as a promising alternative to in vivo testing of novel clinical therapeutics.

Differentiation potential of dental papilla, dental pulp, and apical papilla progenitor cells

INTRODUCTION

Regenerative endodontic procedures use the differentiation potential of embryonic and adult pulp progenitor cell populations to reconstitute dental structures.

METHODS

An in-depth search of the literature was accomplished to review biologic knowledge from basic research on tooth morphogenesis and differentiation, root development, dentin-pulp regeneration, pulp revascularization and apexification, experimental and clinical studies on the dentinogenic differentiation potential of progenitor cells in the embryonic dental papilla, dental pulp, and associated mesenchymal tissues of the developing root.

RESULTS

Odontogenic potential is determined during early tooth morphogenesis in the odontogenic mesenchyme. Progenitor cells from the odontogenic mesenchyme give rise to primary dentin-forming cells (odontoblasts) in the presence of stage-specific enamel epithelium and/or basement membrane and tertiary dentin-forming cells (odontoblast-like cells) in experimental conditions. The specificity of odontogenic mesenchymal cells to form tertiary dentin might be related to the repertoire of signaling pathways operated by the temporospatial pattern of epithelial-mesenchymal interactions during tooth formation. Dental papilla cells isolated from tooth germs before the onset of odontoblast differentiation have not shown any competence to become odontoblasts in the absence of enamel epithelium. On the other hand, the specificity of progenitor cells in the mesenchymal cell populations of the developing root apex remains to be determined.

CONCLUSIONS

It seems evident that the dental pulp might be only used as a source of progenitor cells with dentinogenic competence for the regeneration of the dentin-pulp complex. The nature of dental or apical papilla progenitor cells in terms of their specificity for dentin regeneration has to be first characterized.

Equine idiopathic cheek teeth fractures. Part 1: Pathological studies on 35 fractured cheek teeth

REASONS FOR PERFORMING STUDY

There is little published information on the pathology of idiopathic fractures of cheek teeth (CT).

OBJECTIVES

To perform pathological examinations on equine CT with idiopathic fractures in order to establish fracture patterns and to gain information on their aetiopathogenesis.

HYPOTHESIS

Gross and histological examination of CT with idiopathic fractures, including measurements of dentinal thickness, will provide information on fracture patterns, and on the duration and aetiopathogenesis of these fractures.

METHODS

Of 35 CT with idiopathic fractures that were examined to determine their fracture patterns, 20 underwent gross, histological and ultrastructural examinations, including dentinal thickness measurements, with the latter compared to dentinal measurements of dental age and Triadan position matched control CT, to help determine the duration of any pre-existing endodontic disease.

RESULTS

The fracture planes involved the pulp chambers in 30 out of 35 CT examined, and ran through coalesced, carious infundibula in the other 5 (maxillary) CT. The maxillary CT, particularly the Triadan 09 position were preferentially affected. The most common fracture plane, which was termed a maxillary buccal slab fracture, occurred through the 2 lateral (1st and 2nd) pulp chambers of maxillary CT and usually involved only the clinical crown. Buccal slab fractures of mandibular CT (through 4th and 5th pulp chambers) and midline sagittal fractures through the infundibula (of maxillary CT) were the next most common fracture patterns. Reduced dentinal thickness (probably indicating prior pathological changes in the fractured CT) was present in 25% of fractured CT.

CONCLUSIONS

Most idiopathic equine CT fractures involve the pulp chambers, especially those on the buccal aspect of both upper and lower CT. No predisposition to fracture was found in the majority of affected CT that appeared to have a normal endodontic appearance prior to development of fractures through their pulp chambers. The remaining idiopathic CT fractures were caused by advanced infundibular caries.

POTENTIAL RELEVANCE

All CT with idiopathic fractures are all at risk of pulpar or even apical infection.

Mechanical stress promotes odontoblastic differentiation via the heme oxygenase-1 pathway in human dental pulp cell line

AIMS

Although heme oxygenase-1 (HO-1) is involved in osteoblastic differentiation, the HO-1- and odontoblastic differentiation-inducing effects of mechanical stress (MS) have not been clarified in human dental pulp cells (HDPCs). In this study, we examined the effects of MS on the odontoblastic differentiation of immortalized HDPCs and on the primary intracellular signaling pathways, including the HO-1 pathway, implicated in this differentiation.

MAIN METHODS

A Flexercell strain unit was used to generate cyclic tensile strain in HDPCs. Expressions of mRNAs encoding HO-1 and HDPC differentiation markers, such as osteopontin (OPN), bone sialoprotein (BSP), dentin sialophosphoprotein (DSPP), and dentin matrix-protein-1 (DMP-1), were evaluated using the reverse transcription-polymerase chain reaction. Expression of the NF-E2-related transcription factor 2 (Nrf2) protein was analyzed by Western blotting.

KEY FINDINGS

MS significantly increased the expression of HO-1, OPN, BSP, DSPP, and DMP-1 mRNAs in HDPCs. HO-1 silencing and inhibitors of HO-1, p38 MAPK, ERK, phosphoinositide 3-kinase, and nuclear factor-kappaB (NF-kappaB) all attenuated MS-stimulated differentiation. The MS-induced nuclear translocation of Nrf2 was suppressed by inhibitors of PI3K and NF-kappaB.

SIGNIFICANCE

Collectively, these results provide the first evidence that MS stimulates odontoblastic differentiation of HDPCs via modulation of the Nrf2-mediated HO-1 pathway.

Self-etching Increases Matrix Metalloproteinase Expression in the Dentin-Pulp Complex

In adhesive restorations, one major problem is hybrid layer degradation. At present, this deterioration is explained by the activation of the endogenous matrix metalloproteinases (MMPs) present in dentin due to the acidic property of adhesive systems. We hypothesized that self-etching adhesive should also stimulate the expression of MMPs in odontoblasts. In cultured tooth slices, we evaluated the changes in MMP-2 and proMMP-9 expression in the dentin-pulp complex after self-etching adhesive treatment on dentin cavities in immunochemistry and by zymography. The treatment resulted in increased MMP-2 expression in odontoblasts, as shown by immunohistochemistry. Zymography showed increased proMMP-9 and MMP-2 in dentin under self-etching treatment when pulp was present. These results showed that self-etching adhesive stimulates the secretion of MMPs from the dentin-pulp complex and, more precisely, by odontoblasts, suggesting that odontoblasts participate in hybrid layer degradation.

Regeneration of dentine/pulp-like tissue using a dental pulp stem cell/poly(lactic-co-glycolic) acid scaffold construct in New Zealand white rabbits

With the expanding knowledge of tooth regeneration and biological mechanisms of functional dental tissue repair, current treatment strategies are beginning to give way to evolving fields such as tissue engineering and biomimetics. Dental pulp stem cells were isolated from rabbit teeth and seeded onto scaffolds prepared from 50/50 poly(lactic-co-glycolic acid) polymers using two different porogen particle sizes. These cell/scaffold constructs were then transplanted subcutaneously in the rabbits. The expanded rabbit dental pulp stem cells showed high proliferative and clonogenic capacities as well as the ability to give rise to mineralised-like tissues in vitro in culture flasks and after seeding them onto the scaffolds for 12 days. Histological evaluation of transplanted samples revealed the formation of osteodentine-like structures as well as tubular bilayered structures of vertically aligned parallel tubules resembling tubular-like dentine. Using a tissue engineering approach yielded tissues quite similar to normal dentine/pulp-like tissues that can perhaps be used later on for regenerative endodontic or operative procedures.

Comparison of operative procedure variables on pulpal viability in an ex vivo model

AIM

To measure and compare the responses of pulp tissue to cavity preparation and restoration variables using a novel tooth slice culture model.

METHODOLOGY

Experimental cavities (265) were continuously cut, under carefully controlled conditions, into the dentine of the labial aspect of 28-day-old Wistar rat incisors, and slices of these teeth maintained in organ culture for up to 2 weeks. The experimental variables examined were: the preparation method, remaining dentine thickness, coolant, drill speed, conditioning with EDTA and filling materials. The reactions of the dentine-pulp complex to the experimental variables were measured using pathohistometric analysis and the correlations between variables were determined using analysis of variance statistical tests.

RESULTS

In rank order of surgically induced restorative pulpal injury, from the most to the least injurious were: remaining dentine thickness, absence of coolant during cavity preparation, bur speed, cavity conditioning treatments and the filling material.

CONCLUSIONS

To reduce pulp injury and to promote pulpal repair activity, the correct use of appropriate materials are important. However, of relatively greater importance is the operative technique adopted, the need to avoid the excess removal of dentine and to minimize trauma during preparation.

Human tooth culture: A study model for reparative dentinogenesis and direct pulp capping materials biocompatibility

In a previous work, based on an in vitro entire tooth culture model of human immature third molars, we demonstrated that perivascular progenitor cells can proliferate and migrate to the injury site after pulp exposure. In this work, we investigated the differentiation of cells after direct capping with biomaterials classically used in restorative dentistry. Histological staining after direct pulp capping with Calcium Hydroxide XR(R) or MTA revealed early and progressive mineralized foci formation containing BrdU-labeled sequestered cells. The molecular characterization of the matrix and the sequestered cells by immunohistochemistry (Collagene type I, Dentin sialoprotein, and Nestin) clearly demonstrates that these areas share common characteristics of the mineralized matrix of reparative dentin formed by odontoblast-like cells. This reproduces some features of the pulp responses after applying these materials in vivo and demonstrates that the entire tooth culture model reproduces a part of the early steps of dentin regeneration in vivo. Its future development may be useful in studying the effects of biomaterials on this process.

Immunohistochemical localization of metallothionein in dental pulp after cavity preparation of rat molars

OBJECTIVE

Metallothionein (MT) is an intracellular cysteine-rich protein associated with cell proliferation and differentiation. Our objective was to examine immunohistochemically the localization of MT in the rat dental pulp after cavity preparation.

STUDY DESIGN

Cavities were prepared on the upper first molars of 9 rats. Specimens were collected at 1, 3, and 5 days after cavity preparation, and paraffin sections were made. For double-immunohistochemical staining, anti-MT monoclonal antibody (E9) and anti-proliferating cell nuclear antigen (PCNA) monoclonal antibody (PC10) were applied.

RESULTS

At 3 days after cavity preparation, some odontoblasts corresponding to the cavity, many pulp cells, and some endothelial cells in the pulp under the cavity showed both MT- and PCNA-positive immunostainings.

CONCLUSION

Metallothionein was detected in the dental pulp after pulp injury, and it is likely that MT is closely related to the proliferation of newly differentiating odontoblasts and angiogenesis during the healing process.

Pulpal cellular reactions to experimental tooth movement in rats

OBJECTIVE

The objective was to study the early cellular reactions of the dental pulp during experimental tooth movement.

STUDY DESIGN

A total number of 98 male rats were used. Tooth movement was induced for 1 to 168 hours by inserting elastic bands between maxillary first and second molars of animals, which were labeled with tritiated thymidine. Pathologic signs, macrophage content, and proliferation of fibroblasts and endothelial cells were assessed histologically on autoradiographs of second molar pulps. Data were analyzed using ANOVA with Tukey's test as post hoc pairwise comparison.

RESULTS

Pathologic signs and macrophage content generally increased with time after the induction of tooth movement. The proliferation of pulpal connective tissue progenitor cells and endothelial cells increased as a reaction to the force application.

CONCLUSIONS

Force-induced tooth movement may lead to extensive, however temporary, trauma of the pulpal tissues, which react with early wound-healing events, such as macrophage invasion, cell proliferation, and angiogenesis.

Influence of extended operation time and of occlusal force on determination of pulpal healing pattern in replanted mouse molars

The mechanism regulating the divergent healing processes following tooth replantation is unclear. This study clarifies the relationship between the healing pattern, the time taken for tooth replantation, and the influence of occlusal force. We investigated the pulpal healing process after tooth replantation by immunohistochemistry for 5-bromo-2'-deoxyuridine and nestin and by histochemistry for tartrate-resistant acid phosphatase. The upper right first molar of 3-week-old mice was extracted and repositioned in the original socket immediately or 30 min to 6 h after the operation. We divided the animals into a non-occluded group in which the lower right first molar was extracted and an occluded group without extraction of the counterpart tooth. In control teeth (upper left first molar), the periphery of the coronal dental pulp showed intense nestin-positive reaction. Tooth replantation weakened the nestin-positive reaction in the pulp tissue. On postoperative days 5-7, tubular dentin formation commenced next to preexisting dentin in which nestin-positive odontoblast-like cells were arranged in successful cases. In other cases, bone-like tissue formation occurred in the pulp chamber until day 14. The ratio of tertiary dentin formation was significantly higher in the non-occluded group. The intentionally prolonged time for the completion of tooth replantation induced bone-like tissue formation, expanded inflammatory reaction, or fibrous tissue formation in pulp tissue. Thus, the lack of a proper oxygenated medium is probably decisive for the survival of odontoblast-lineage cells, and occlusal force during and/or after operation worsens the fate of these cells.

Maturogenesis of a cariously exposed immature permanent tooth using MTA for direct pulp capping: a case report

Successful direct pulp capping of cariously exposed permanent teeth with reversible pulpitis and incomplete apex formation can prevent the need for root canal treatment. A case report is presented which demonstrates the use of mineral trioxide aggregate (MTA) as a direct pulp capping material for the purpose of continued maturogenesis of the root. Clinical and radiographic follow-up demonstrated a vital pulp and physiologic root development in comparison with the contralateral tooth. MTA can be considered as an effective material for vital pulp therapy, with the goal of maturogenesis.

Ultrastructural and immunocytochemical characterization of immortalized odontoblast MO6-G3

AIM

To investigate an immortalized murine odontoblast cell line as a potential alternative for experimental studies on dentinogenesis.

METHODOLOGY

The MO6-G3 cell line was investigated morphologically over 3, 7, 11 and 42 days of culture, using histochemical localization of dentine sialoprotein (DSP), alkaline phosphatase (AP), type I collagen and actin filaments, histoenzymatic staining and biochemical investigation of AP and finally, transmission and scanning electron microscopy.

RESULTS

Scanning electron micrographs showed elongated cells. Accordingly, a polarized organization of odontoblasts was observed by transmission electron microscopy, identifying distinct subcellular compartments as described in vivo. The secretion apparatus, which includes cisternae of rough endoplasmic reticulum, Golgi apparatus saccules and secretion vesicles and granules, was longitudinally organized in the supranuclear compartment ending distally in the secretory pole. A cellular process was observed. The investigation of the cytoskeleton network revealed that actin microfilaments were organized in parallel stress fibre oriented depending on the longitudinal axis of the cytoplasm. Immunofluorescent labelling showed a continuous expression of type I collagen, DSP and AP. A unipolar distribution characterized intracellular DSP immunoreactivity. Histoenzymology revealed AP active sites increasing from 3 to 11 days albeit with a moderate level of activity comparatively to the in vivo situation in dental cells.

CONCLUSION

This cell line MO6-G3 not only showed the criteria of odontoblast phenotype as previously reported but also the characteristic morphodifferentiation pattern of polarized odontoblasts at the cellular level but with an apparent random distribution.

Tooth slice organ culture and established cell line culture models for cytotoxicity assessment of dental materials

The aim was to compare the use of different cell-material contact test methods with two different biological systems (cell line and tooth slice cultures) for cytotoxicity assessment of dental materials. Cytotoxicity of composites polymerized with two halogen-based and two light-emitting diode (LED) light-curing units (LCUs) served as the basis for comparison. Disk shaped specimens (7 x 2 mm) were fabricated using the four light sources. Composites were tested using L-929 cell line using direct/indirect/extract tests in accordance to standard protocols. Cytotoxicity was assessed using neutral red uptake. Tooth slice organ cultures were also employed to test the dental materials using direct/indirect test methods. Histomorphometric cell counting of intact odontoblasts and pulp fibroblasts and the use of tetrazolium salt 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays were applied for cytotoxicity evaluation. Discrepancy in result presentation was observed in the different tests used with L-929. Sensitivity levels of the L-929 tests ranked as follows: extract test < direct contact test < indirect contact test. Tooth slice tests confirmed that L-929 direct contact test proved to be the most reliable test among the three. In conclusion, this study highlights the risk involved when relying on a single test method for cytotoxicity assessment. It would be advisable to test different culture models and then proceed using more clinically relevant biological system that stimulate the in vivo situation for confirmation.

Expression of Insulin-Like Growth Factor-1 Receptor in Human Pulp Tissue

Insulin-like growth factor-1 (IGF-1) plays an important role in cell proliferation and differentiation. The purpose of this study was to use a radioreceptor assay to evaluate whether IGF-1 receptors are present in human pulp and to determine whether differences in its expression are found in the pulp tissue of teeth having incomplete or complete root development. Twenty pulps were obtained from freshly extracted human third molars; they were then processed and labeled with I-IGF-1. The results showed IGF-1 receptor expression in all human pulp samples. t test revealed statistically significant higher expression in the pulps from teeth having incomplete root development (P <0.005). Given the functions of this growth factor system in other tissues, the present findings are consistent with the hypothesis that IGF-1 contributes toward forming and mineralizing dental tissues as well as in pulp-repairing processes.

Fluoride-induced changes to proteoglycan structure synthesised within the dentine–pulp complex in vitro

Fluoride is known to influence mineralisation patterns within dentine, where alterations in the post-translational modification of proteoglycans (PG) have been proposed as an implicating factor. In light of recent studies elucidating changing PG profiles in the transition of predentine to mineralised dentine, this study investigates the influence of fluoride on the major PG populations (decorin, biglycan and versican) within the pulp, predentine and dentine. Tooth sections from rat incisors were cultured for 14 days in the presence 0, 1 and 6 mM sodium fluoride and the PG extracted from the pulp, predentine and dentine matrices. PG species and corresponding metabolites were identified by their immuno-reactivity to antibodies against decorin, biglycan and versican. Component glycosaminoglycan chains were characterised with respect to their nature, chain length and disaccharide composition. Levels of PG extracted from pulp and predentine were reduced, particularly for biglycan. Fluoride did not influence levels of decorin or versican within predentine or dentine, although the processing of these macromolecules within pulp and predentine was affected, particularly at higher fluoride concentrations. Levels of dermatan sulfate were reduced within pulp and predentine, although the effect was less pronounced for predentine. Fluoride reduced sulfation of glycosaminoglycan chains within pulp and predentine tissues, with a notable reduction in Deltadi6S evident. In all three tissues, glycosaminoglycan chain length was reduced. Considering the various roles for PG in the dentine-pulp complex, either directly or indirectly in the mineralisation process, changes in the synthesis, structure and processing of the different PG species within the pulp, predentine and dentine matrices provides a further molecular explanation for the altered mineralisation patterns witnessed during fluorosis.

Future directions in bonding resins to the dentine-pulp complex

Resin-based materials are rapidly becoming the primary restorative material to replace tooth structure and the low percentage of biological problems reported for resin-based restorations is testimony to their relative biocompatibility. Despite considerable advances in the understanding of the mechanisms, which govern the integration of resin composite materials with the dentine-pulp complex, considerable potential for improvement remains. Most of these improvements centre around a better understanding of the biological and microbiological risks of resin materials and will only be possible with improved in vitro and in vivo models. There are also a number of possible future developments in materials, clinical techniques and diagnostic methods that may improve the long-term success and reliability of resin-based restorations. The remainder of this paper describes the most likely avenues for future improvements.

In vitro study of a neodynium:yttrium aluminum perovskite laser on human nonexposed pulp after cavity preparation

PURPOSE

The aim of this study was to investigate dental pulp reactions after a neodynium:yttrium aluminum perovskite laser pulse on the dentinal floor of occlusal cavities in an in vitro model.

METHODS

A Lokki dt laser was used at 30 Hz, 5 W, and 160 mJ for 0.5 s. The pulp reactions were analyzed in a previously described human tooth slice cultured model. The following markers were identified by immunohistochemistry: collagens I, III, and IV and HLA-DR-positive cells.

RESULTS

After 4 days of culture, under laser pulse, a concentration of type III collagen beneath the odontoblast layer, a higher level of vessels and an accumulation of HLA-DR-positive cells were routinely observed subjacent to the cavity.

CONCLUSION

This laser treatment leads to the first step of rapid pulp repair under culture conditions.

Two- versus three-dimensional in vitro differentiation of human pulp cells into odontoblastic cells

The spatial organization of the pulp cells may modify the cytodifferentiation process. The purpose of this study was to compare the two- versus three-dimensional cell culture systems for differentiation of human odontoblastic cells in vitro. Pulpal cores from freshly extracted human third molars were cultured in vitro in a perfusion device on two types of membranes: polyester membrane (two-dimensional [2D] cell culture) and nylon mesh (three-dimensional [3D] cell culture). The cells were incubated with minimum essential medium containing (a) substitute serum, (b) 10% fetal calf serum (FCS), (c) 10% fetal calf serum + 2 mM beta-glycerophosphate (beta GP), and (d) 10% fetal calf serum + transforming growth factor (TGF) beta 1. Immunohistochemistry was used to evaluate the expression of collagen I, osteonectin, and nestin. Small differences were observed between 2D and 3D cell culture systems. This was particularly evident in the 10% FCS group. beta-Glycerophosphate in the 3D system seems to stimulate the osteogenic cell phenotype, as a considerable induction of osteonectin is observed.

Molecular regulation of odontoblast activity under dentin injury

Pulp tissue responds to dentin damage by laying down a tertiary dentin matrix (reactionary or reparative) beneath the site of injury. Reactionary dentin is secreted by surviving odontoblasts in response to environmental stimuli, leading to an increase in metabolic activities of the cells. The inductive molecules that determine the success of the pulp healing may be released from the damaged dentin as well as from the pulp tissue subjacent to the injury. This paper will schematically consider two major growth factors probably implicated in the control of odontoblast activity: TGF beta-1 released from demineralized dentin and NGF from pulp. To analyze their role with an in vitro system that mimics the in vivo situation, we have used thick-sliced teeth cultured as described previously. The supply of factors was accomplished by means of a small tube glued onto the dentin. The tube was filled with TGF beta-1 (20 ng/mL) or NGF (50 ng/mL), and slices were cultured for 4 or 7 days. Results showed that TGF beta-1 binding sites are strongly detected on odontoblasts in the factor-rich zone. A strong expression of alpha 1(I) collagen transcripts was also detected. In the NGF-rich environment, p75NTR was re-expressed on odontoblasts and the transcription factor NF-kappa B activated. Modifications in the odontoblast morphology were observed with an atypical extension of the cell processes filled with actin filaments. These results suggest that odontoblasts respond to influences from both dentin and pulp tissue during pulp repair.

Characterization of alpha-smooth muscle actin positive cells in mineralized human dental pulp cultures

In response to injury, pulp precursor cells can differentiate into odontoblast-like cells that produce reparative dentine. In culture, pulp cells form mineralizing nodules, but the characteristics of the cells involved in this process are still not fully known. Human pulp cells for culture were obtained from coronal pulp isolated from non-erupted molars, and were maintained in RPMI 1640 medium supplemented with fetal calf serum. Nodules were forming in all human pulp primary cultures (HPPc) and human pulp subcultures observed until their fifth passage (HPSc<5). Mineralization of the nodules was confirmed by the presence of calcium and phosphate that were quantified by X-ray microanalysis. Specific immunolabeling revealed alpha-smooth muscle actin and vimentin in both HPPc and HPSc<5 cells. Cells positive for alpha-smooth muscle actin were either isolated or gathered together in the nodules. Under transmission electron microscopy, some cells in primary pulp cultures exhibited features typical of myofibroblasts or pericytes, such as stress fibers, fibronexus, indented nuclei and gap-junctions. These cells were frequently in close contact with mineral deposits. This work demonstrates for the first time the presence of pericytes or myofibroblasts in mineralized human pulp cultures, but further investigation is required to determine their origin, role and degree of differentiation.

Wet and dry deep cavity preparations compared by a novel odontoblast culture technique

The human odontoblast's unique cellular extension within dentin does not easily allow culturing by traditional methods. This study leaves these cells in their natural position in the dentin. Deep preparations were made through the occlusal surfaces of extracted human third molars. The crowns were separated from the roots and the pulps gently teased from the chambers, leaving the odontoblast layer intact. These inverted pulp chambers were then incubated in cell culture medium for 2 to 4 days. Trypan blue staining was used to detect non-vital odontoblasts, and the differentiation between vital and nonvital cells was verified by SEM and toluidine vital staining. Control teeth and areas not adjacent to the preparation showed no blue staining, indicating intact cells. Areas of nonvital cells were greatest with wider preparation. Irrigation decreased odontoblast death with wide preparations. No difference due to irrigation was detected in narrow preps. A comparison of wet preparations to which heat was applied versus dry preparations showed statistically similar results. This study provides a simple in vitro method for the study of odontoblasts with their processes intact within dentin.