Development of the periodontium: an electron microscopic study

Hierarchically patterned triple-layered gelatin-based electrospun membrane functionalized by cell-specific extracellular matrix for periodontal regeneration

OBJECTIVES

Regenerating the periodontium poses a critical challenge in oral medicine. To repair various periodontal defects, it is necessary to adopt a bio-scaffold that provides both the architecture and bioactive cues for local stem cells to migrate, reside, proliferate, and differentiate. The objective of this study is to combine a cell-specific decellularized extracellular matrix (ECM) and a biomimetic electrospinning scaffold to regenerate severely destructed periodontium.

METHODS

SEM, water contact angle (WCA), live/dead staining, swelling ratio, tensile test and immune-fluorescent staining were used to define the suitable topography for certain dental stem cells seeding and culturing. Transwell assay, CCK-8, Alizarin Red staining and PCR immune-fluorescent staining were used to determine ideal cell-specific ECM for PDLSCs/BMSCs migration, viability, and oriented differentiation. A biodegradable triple-layered electrospun scaffold (TLS) was fabricated by electrospinning with aligned fibers on both surfaces and a polyporous structure in the middle. The morphology and inter-porous structure of the TLS were characterized by SEM and mercury intrusion porosimetry (MIP). The surface of the TLS was functionalized with cell-specific ECM (Bi-ECM-TLS) through decellularization of the cell sheets cultured on the scaffold. The regenerative outcome of Bi-ECM-TLS was assessed by an in-situ rat periodontal defect model. Micro-CT, HE-staining, Masson's trichome staining, Sirius Red staining and Immunofluorescent staining were used for histological analysis.

RESULTS

Aligned Gelatin/PCL fibrous membrane (GPA) was most effective for both PDLSCs and BMSCs in culture with WCA around 50 degrees and better mechanical strength than the rest. MSCs favored the same type of ECM (cell-specific ECM), and their regenerative properties were effectively induced with better chemotaxis, proliferative and differentiating behaviors. TLS characterization showed that TLS possessed aligned-random-aligned structure and inter-porous structure. In a rat model of periodontal defects, the TLS functionalized by BMSC-specific ECM for bone regeneration and PDLSC-specific ECM demonstrated highest BV/TV ratio, best bone structure and ligament fiber orientation and blood vessel formation, suggesting optimal performance in regenerating both alveolar bone and periodontal ligaments over TLS, single-ECM loaded TLS and r-Bi-ECM-TLS.

SIGNIFICANCE

This study highlights the importance of combining a cell-specific decellularized ECM and a biomimetic electrospinning scaffold for targeted periodontal tissue regeneration, with potential implications for periodontal tissue engineering and improved patient outcomes.

Novel approaches for periodontal tissue engineering

The periodontal complex involves the hard and soft tissues which support dentition, comprised of cementum, bone, and the periodontal ligament (PDL). Periodontitis, a prevalent infectious disease of the periodontium, threatens the integrity of these tissues and causes irreversible damage. Periodontal therapy aims to repair and ultimately regenerate these tissues toward preserving native dentition and improving the physiologic integration of dental implants. The PDL contains multipotent stem cells, which have a robust capacity to differentiate into various types of cells to form the PDL, cementum, and alveolar bone. Selection of appropriate growth factors and biomaterial matrices to facilitate periodontal regeneration are critical to recapitulate the physiologic organization and function of the periodontal complex. Herein, we discuss the current state of clinical periodontal regeneration including a review of FDA-approved growth factors. We will highlight advances in preclinical research toward identifying additional growth factors capable of robust repair and biomaterial matrices to augment regeneration similarly and synergistically, ultimately improving periodontal regeneration's predictability and long-term efficacy. This review should improve the readers' understanding of the molecular and cellular processes involving periodontal regeneration essential for designing comprehensive therapeutic approaches.

The Roles of SIBLING Proteins in Dental, Periodontal and Craniofacial Development

The majority of dental, periodontal, and craniofacial tissues are derived from the neural crest cells and ectoderm. Neural crest stem cells are pluripotent, capable of differentiating into a variety of cells. These cells can include osteoblasts, odontoblasts, cementoblasts, chondroblasts, and fibroblasts which are responsible for forming some of the tissues of the oral and craniofacial complex. The hard tissue forming cells deposit a matrix composed of collagen and non-collagenous proteins (NCPs) that later undergoes mineralization. The NCPs play a role in the mineralization of collagen. One such category of NCPs is the small integrin-binding ligand, N-linked glycoprotein (SIBLING) family of proteins. This family is composed of dentin sialophosphosprotein (DSPP), osteopontin (OPN), dentin matrix protein 1 (DMP1), bone sialoprotein (BSP), and matrix extracellular phosphoglycoprotein (MEPE). The SIBLING family is known to have regulatory effects in the mineralization process of collagen fibers and the maturation of hydroxyapatite crystals. It is well established that SIBLING proteins have critical roles in tooth development. Recent literature has described the expression and role of SIBLING proteins in other areas of the oral and craniofacial complex as well. The objective of the present literature review is to summarize and discuss the different roles the SIBLING proteins play in the development of dental, periodontal, and craniofacial tissues.

C-Graft in regeneration of periodontal tissue in intrabony periodontal defect in dog

The aim of this study was to investigate the effect of C-Graft particles on formation of new cementum and bone in periodontal bone defects in dog. Healing and tissue change were histologically determined at 2, 4, 8, and 16 weeks. Little bone or cementum formation was observed in the control group. A statistically significant increase in bone and cementum formation was seen in the C-Graft group compared to the control group (75.4% vs. 44.9%, p < 50.01, 80.4% vs. 46.7%, p < 50.05, respectively). These findings suggest that C-Graft particles provide a scaffold for the regeneration of new bone and cementum.

Development and cell fate in interspecific (Mus musculus/Mus caroli) orthotopic transplants of mouse molar tooth germs detected by in situ hybridization

Interpretation of results from previous tooth germ transplantation studies is limited by the inability to distinguish between donor and host cells unequivocally. Furthermore, ectopic transplantation sites have generally been used and the relevance of this to tooth development in situ is uncertain. The aim here was to determine cell fate in orthotopic tooth germ transplants using an interspecific mouse marker system. Mandibular first molar tooth germs were dissected from Mus musculus (CD1) and Mus caroli mice (age range 15-19 day embryo) and transplanted interspecifically into the alveolar crypt of extirpated first mandibular molars in neonatal M. musculus (CD1) and M. caroli hosts. Grafts were recovered at intervals up to 4 weeks postoperatively. Paraffin wax-embedded sections were examined using routine histological techniques and in situ hybridization with a biotinylated DNA probe (pmSat5) specific for M. musculus, to distinguish between donor and host cells. Development of M. musculus tooth germs in M. caroli mandibles and vice versa was similar and transplants progressed to incipient root formation. Vascularization of transplants was chimaeric, being donor-derived in the pulp and host-derived more peripherally. The investing soft tissues comprised a mixture of donor and host cells, predominantly donor. Donor cells were also found in the soft tissue of intertrabecular spaces in the surrounding bone, but alveolar osteocytes were almost entirely host-derived. Long-term survival of grafts was limited and few donor cells were present after 2 weeks. This study provides an unequivocal demonstration of the origin of all cells present in transplanted tooth germs.

Periodontal regeneration in a buccal dehiscence model in monkeys after application of enamel matrix proteins

There is increasing evidence that cells of the epithelial root sheath synthesize enamel matrix proteins and that these proteins play a fundamental role in the formation of acellular cementum, the key tissue in the development of a functional periodontium. The purpose of the present study was to explore the effect of locally applied enamel matrix and different protein fractions of the matrix on periodontal regeneration in a buccal dehiscence model in monkeys. Buccal, mucoperiosteal flaps were raised from the canine to the 1st molar on each side of the maxilla. The buccal alveolar bone plate, the exposed periodontal ligament and cementum were removed. Various preparations of porcine enamel matrix with or without vehicles were applied before the flaps were repositioned and sutured. After 8 weeks, the healing was evaluated in the light microscope, and morphometric comparisons were made. Application of homogenized enamel matrix or an acidic extract of the matrix containing the hydrophobic, low molecular weight proteins, amelogenins, resulted in an almost complete regeneration of acellular cementum, firmly attached to the dentin and with collagenous fibers extending over to newly formed alveolar bone. After application of fractions obtained by neutral EDTA extraction containing the acidic, high molecular weight proteins of the enamel matrix, very little new cementum was formed and hardly any new bone. The results of the controls in which no test substance was applied before the repositioning of the flap, were very similar to those obtained with the EDTA extracted material. Propylene glycol alginate (PGA), hydroxyethyl cellulose and dextran were tried as vehicles for the enamel matrix preparations. Only PGA in combination with the amelogenin fraction resulted in significant regeneration of the periodontal tissues.

The role of enamel matrix proteins in the development of cementum and periodontal tissues

The role of Hertwig's epithelial root sheath (HERS) and of the enamel-related proteins in the development of acellular cementum are reviewed. The inner layer of HERS is an apical extension of the ameloblastic layer in the crown. A number of studies now indicate that the cells of HERS have a secretory stage similar to the ameloblasts. In rats and mice the secretory product of the HERS cells does not seem to be amelogenin, which is the main protein of the enamel matrix. In humans, however, amelogenin has been demonstrated at the apical ends of the roots of developing teeth. The development and distribution of coronal cementum in various species are discussed. The amelogenins have been remarkably well conserved between species. Experiments in monkeys have shown that it is possible to induce formation of acellular cementum by application of porcine enamel matrix on a denuded root surface, which thereby promotes periodontal regeneration. These results further support the idea that enamel-related proteins are involved in cementum formation.

Cementogenesis reviewed: a comparison between human premolars and rodent molars

BACKGROUND

Cementum continues to be the least-known mineralized tissue. Although recent advances in the field of molecular biology have contributed to an understanding of the involvement of molecular factors in cementum formation during development and regeneration, cementogenesis on a cell biological basis is still poorly understood. Virtually nothing is known about cementoblast origin, differentiation, and the cell dynamics during normal development, repair, and regeneration. This review describes the recent findings of cementogenesis on roots of human premolars and opposes them to those of teeth from other mammals, particularly the rodent molar.

METHODS

Using light and electron microscopy, light microscopic radioautography, and various measurements, a comprehensive insight into the development and repair of cementum during and after root formation and tooth eruption has been achieved for human premolars.

RESULTS

Cementum is a highly responsive mineralized tissue. This biological activity is necessary for root integrity and for bringing and maintaining the tooth in its proper position. With regard to cementum formation and periodontal fiber attachment, considerable species-particularities exist that are mainly based on differences in growth rates and tooth sizes. Since root development and initial cementogenesis last on the average 5-7 years in human premolars, cementum formation in these teeth is characterized by along-lasting phase of prefunctional development, with occurs independent of principal periodontal fiber attachment to the root and which may take 5 years or more. The first molar of the rat, however, is in functional occlusion 3 1/2 weeks after the onset of root formation. Since initial cementum formation and periodontal fiber attachment to the root occur almost at the same time in this tooth, the distinction between cells associated with one or the other process is very difficult to achieve, and cementogenesis cannot be described independent of periodontal fiber attachment to the root. Therefore, the determination of cementoblast origin in the rodent molar may be intricate.

CONCLUSIONS

Taking into account these species differences, the current description on the origin and differentiation of cementoblasts is inconsistent and the description of cementogenesis is still incomplete. This review calls into question the currently held concept of cementogenesis and offers a possible alternative.

Origins of cementum

There are diverging opinions about the role of Hertwig's epithelial root sheath in the formation of cementum. In the present review this role is discussed. There is increasing evidence that Hertwig's epithelial root sheath is actively involved in the formation of both acellular and cellular cementum. The development of acellular cementum seems to be associated with secretion of enamel-related proteins by cells of the epithelial root sheath. Formation of the matrix for cellular cementum appears to be induced by exposure of the inner layer of the epithelial root sheath to the mesenchymal cells in the dental follicle. Experimental studies with 1-hydroxyethylidene-1, 1-bisphosphonate (HEBP) indicate that the formation of acellular cementum must be preceded by mineralization of the mantle dentin. If the mineralization is inhibited by means of HEBP, there is precocious separation of the two layers of the epithelial root sheath after which matrix for a cellular type of cementum is formed.

Development and cell fate in interspecific (Mus musculus/Mus caroli) intraocular transplants of mouse molar tooth-germ tissues detected by in situ hybridization

Mandibular first molar tooth germs were dissected from Mus musculus (CDI) and Mus caroli (age range: 14-day embryo to 1-day postnatal). Most of the tooth germs were separated enzymically into epithelial and mesenchymal components. Interspecific tissue recombinations and intact M. caroli tooth germs were grown in the anterior chamber of the eye of adult CDI mice for 24 weeks. Recombinations of M. caroli enamel-organ epithelium with M. musculus, dental papilla and follicle mesenchyme developed into normal teeth with advanced root, periodontal ligament and bone formation, thereby confirming extensive epithelial-mesenchymal interactions across the species barrier. Labelling sections by in situ hybridization with a M. musculus-specific DNA probe (pMSat5) showed that almost all cells in the pulp, periodontal ligament and bone were M. musculus, including cementoblasts. Reduced enamel epithelium and epithelial cell rests derived from donor M. caroli enamel organ were unlabelled. This indicates that any cementogenic role of Hertwig's epithelial root sheath must be short-lived. The immunological privilege of the intraocular transplantation site in M. musculus CDI mice did not extend to grafts including xenogeneic M. caroli dental mesenchyme. Thus, intact M. caroli tooth germs and recombinations of M. musculus enamel organ with M. caroli dental papilla and follicle showed limited development, with no root formation, and were populated almost exclusively with labelled host M. musculus lymphocytes.

The soft connective tissues of the gingiva and periodontal ligament: are they unique?

The connective tissues of the gingiva and periodontal ligament share a common embryonic development from cells of the cranial neural crest. This review paper describes the relationship of these tissues in tooth germ initiation, development and eruption.

Bone sialoprotein is localized to the root surface during cementogenesis

Bone sialoprotein (BSP), an RGD-containing protein with cell attachment properties, is believed to play a regulatory role in the biomineralization of various connective tissues. To determine its possible role in tooth root formation, murine dentoalveolar tissues at sequential phases of development were analyzed immunohistochemically for the presence of BSP. BSP was localized to alveolar bone and cementum at time points associated with initial mineralization of these tissues. In addition, northern blot analyses of dental follicle tissue at day 27 of tooth development indicated that BSP mRNA is expressed by dental follicle cells at a time point coincident with the initiation of cementogenesis on the peripheral tooth root surface. Collectively, these findings indicate that BSP may play an important role in the formation and mineralization of cementum.

Disturbances of cementum formation induced by single injection of 1-hydroxyethylidene-1,1-bisphosphonate (HEBP) in rats: light and scanning electron microscopic studies

With the rat molar as a model, evidence is presented that dentin mineralization influences formation of acellular cementum. Formation of acellular cementum did not occur on the surface of experimentally induced unmineralized dentin. Instead, an atypical hyperplastic cementum was formed. The disturbance in acellular cementum formation was permanent.

Cellular origins and differentiation control mechanisms during periodontal development and wound healing

In the context of cellular origins, odontogenic epithelium and oral epithelium are the sources for junctional epithelium during development and during wound healing respectively. In contrast, both odontogenic and non-odontogenic mesenchyme contain the progenitors for gingival fibroblasts in developing tissues while in wounded tissues, gingival fibroblasts are derived from gingival connective tissues and comprise a heterogeneous population of cells with diverse properties and functions. Periodontal ligament, bone and cementum cell populations apparently originate from dental follicle progenitor cells during development, but during wound healing derive from ancestral cells in periodontal ligament and bone. Cellular differentiation in developing periodontium is governed in part by epithelial-mesenchymal interactions that generate specific signals which regulate selective cell populations in time and space. On the other hand, differentiation during wound healing and regeneration is regulated by a vast array of extracellular matrix informational molecules and by cytokines that induce both selective and non-selective responses in the different cell lineages and their precursors. Further, several important signalling systems are irretrievably lost after development is complete. Thus, in the context of cellular origins and differentiation, developing and wounded periodontal tissues exhibit fundamental differences. Future prospects for improved healing and regeneration of periodontal tissues may derive from identification and isolation of informational molecules that are stored in connective tissue matrices. These molecules and elucidation of their functions may open new perspectives in our understanding of the biology of periodontal wound healing and may provide novel approaches to periodontal regeneration.

Development of the murine periodontium. II. Role of the epithelial root sheath in formation of the periodontal attachment

Experimental manipulation of the developing murine tooth germ has provided evidence that basement membrane components on the forming root surface are involved in early periodontal attachment formation. The purpose of this investigation was to determine the role of epithelial root sheath (ERS) cells in murine cementogenesis and periodontal ligament formation using tissue separation and recombination techniques. Root dentin specimens, with and without root-associated basement membrane components (D + RBM or D - RBM), were recombined with dental sac in the presence or absence of ERS. Recombinations were cultured for 2 weeks, harvested, and examined by light, electron, and immunofluorescence microscopy. Mineralized tissue formed in all tissue recombinations. However, when ERS was included in recombinations between D + RBM and dental sac, 25% of recombinations formed a periodontal ligament with fibrous attachment of the root specimen to adjacent bone. These results support the hypothesis that root and periodontal ligament formation is influenced by epithelio-mesenchymal interactions and further support a key role for ERS in these processes.

Occurrence of epidermal growth factor-binding sites during differentiation of cementoblasts and periodontal ligament fibroblasts of the young rat: a light and electron microscopic radioautographic study

Occurrence of epidermal growth factor (EGF)-binding sites during differentiation of cementoblasts and periodontal ligament (PDL) fibroblasts was investigated using radioautography after I. V. injection of 125I-EGF to 14-day-old rats. During differentiation of cementoblasts, a very low level of EGF-binding sites was present on the mesenchymal cells in dental follicle proper, precementoblasts, and cementoblasts. On the other hand, during differentiation of PDL fibroblasts, numerous EGF-binding sites were observed on the undifferentiated paravascular cells and on the perifollicular mesenchymes representing the major source of PDL fibroblast precursor cells. Also heavy labeling was observed throughout their differentiation to PDL fibroblasts, as well as during full synthetic activity as mature cells. Quantitative analysis of the light microscopic radioautographs revealed that these cells demonstrated approximately 4 grains per 100 microns 2 of cell area. These results suggest that EGF plays an important role in differentiation of PDL fibroblasts, but not in that of cementoblasts. Furthermore, the well-known in vivo effect of EGF in producing precocious eruption of teeth may be a consequence of a more extensive effect of EGF throughout differentiation of PDL fibroblasts as well as during full synthetic activity as mature cells.

Initiation of acellular extrinsic fiber cementum on human teeth. A light- and electron-microscopic study

The development of acellular extrinsic fiber cementum (AEFC) has never before been studied in human teeth. We have therefore examined the initiation of AEFC in the form of a collagenous fiber fringe and its attachment to the underlying dentinal matrix, in precisely selected, erupting human premolars with roots developed to 50%-60% of their final length. Freshly extracted teeth were prefixed in Karnovsky's fixative, decalcified in EDTA and subdivided into about 10 blocks each, cut from the mesial and distal root surfaces, vertical to and along the root axis. The blocks were postfixed in osmium tetroxide, embedded in Epon and cut for light- and electron-microscopic investigation. Starting at the advancing edge of the root, within a region extending about 1 mm coronal to this edge, fibroblast-like cells were seen closely covering the external root surface. Along the first 100 microns from the root edge, these cells extended cytoplasmic processes and contacted the dentinal collagen fibrils. Between these cells and the dentinal matrix, new collagen fibrils and very short collagen fibers gradually developed. Within the second 100 microns from the root edge, this resulted in the formation of a cell-fiber fringe network. Newly formed fibers of the fringe were directly attached to the non-mineralized matrix containing dentinal collagen fibrils and could be distinguished from the latter by differences in fibril orientation. During the process of dentin mineralization, the transitional zone between the fiber-fringe base and the dentinal matrix, i.e., the future dentino-cemental junction, also mineralized. It is suggested that this fiber fringe is the base of AEFC, which later increases in thickness by fiber extension and subsequent mineralization.

Creation of a chimaeric periodontium in the rat by isotopic tooth germ transplantation

The purpose of this work was to develop and test a chimaeric periodontium in which it would be possible to distinguish between connective tissue cells of odontogenic and oral mucosal origin. The recombinant periodontium was created by transplanting first maxillary molar tooth germs with their follicles from 1-3-day-old hooded Lister rats into the corresponding evacuated crypts of 6-9-day-old histocompatible recipients of the same strain. Of 71 transplants, 22 had formed erupted teeth 3 weeks later, with dentogingival junctions and periodontal ligaments histologically similar to those of control teeth. The recombinant nature of the graft periodontium was confirmed by incubating tooth germs in vitro with tritiated thymidine before grafting them, and then demonstrating radiolabelled nuclei in the dentogingival junctions formed by the transplants. Labelled cells were randomly distributed within the periodontal ligament and predominantly near to the basement membrane of junctional epithelium.

Radioautographic study of [3H]mannose utilization during cementoblast differentiation, formation of acellular cementum, and development of periodontal ligament principal fibers

The formation of acellular cementum and the deposition of [3H]mannose-labeled extracellular matrix were studied in 14-day-old Sprague-Dawley rats. The sequential events of cementogenesis and periodontal ligament formation observed by light and electron microscopy were described from the stage of an intact root sheath to postcementogenesis. Ultrastructural examination of cementoblasts and periodontal ligament fibroblasts revealed [3H]mannose labeling of the Golgi apparatus at 10 minutes, collagen secretion granules at 30 minutes, and the extracellular matrix beginning at 30 minutes. The extracellular matrix between cementoblasts and dentin was heavily labeled at 1 and 4 hours. Newly formed principal fibers of the periodontal ligament were also heavily labeled at 4 hours. Fully differentiated cementoblasts exhibited the largest sectional profiles and the highest number of silver grains per unit area of cytoplasm. The morphologic and radioautographic data suggest that during the formation of acellular cementum, the cementoblast phenotype is expressed for a short period of time, after which cementoblasts appear to mix with the fibroblasts of the periodontal ligament.

Development of periodontal ligament and alveolar bone in homografted recombinations of enamel organs and papillary, pulpal and follicular mesenchyme in the mouse

Mandibular first-molar tooth germs were dissected from 16-day-embryo and new-born CD1 mice. By incubation in collagenase they were separated into enamel organ, papilla and follicle. Dental pulp was obtained from mandibular first molars of 3-, 7- and 10-day-old mice. Various combinations of epithelial and mesenchymal tissues were grown for periods up to four weeks in the anterior chamber of the eye of homologous adult male mice. Recombinations of enamel organ and papilla formed teeth with regeneration of the investing layer of follicle and a root-related periodontal ligament, but no formation of alveolar bone. Bone only formed in those grafts which also included follicle. Recombinations of enamel organ and pulp produced dysplastic dentine with no enamel formation or proper tooth development. It was impossible, therefore, to assess whether the potential to regenerate an investing layer extends to the pulp later in development. At an earlier stage, however, the papillary mesenchyme has the ability to regenerate investing-layer cells which lack the capacity to form bone.

Equine bone marrow: a quantitative analysis of erythroid maturation

The equine bone marrow responds to blood loss by increased erythropoiesis, only releasing reticulocytes into the peripheral circulation in severe chronic anemia. We have used morphometric analysis based on electron microscopy of the equine marrow to examine the maturation and release of reticulocytes. Developing red cells in the bone marrows of normal and chronically anemic horses were divided into four stages: early, intermediate, late-stage erythroblasts, and reticulocytes. Morphometric analysis of each stage included volume density of mitochondria per micron3 of cytoplasm, surface area of the outer mitochondrial membrane per unit volume of mitochondria, and the number of ribosomes per unit volume of cytoplasm (total, clustered, single). Matched t tests between normal and anemic animals showed significant differences (P less than or equal to .001) for volume density of mitochondria and numbers of ribosomes only at the reticulocyte stage. The large reticulocyte produced and released in chronic anemia may be best explained by a skipped mitotic division.

Epithelial root-sheath changes during molar formation in the mouse

The ultrastructure of the epithelial root-sheath was examined in the first mandibular molar teeth of 11, 16 and 21-day-old mice. The changing morphology of the sheath was related to root maturity. An initial, predominantly bicellular layer progressively shortened in an apical direction, the outer layer more so than the inner. The changing morphology appeared to involve maintenance of the inner layer largely at the expense of the outer. Some inner-layer cells persisted at spaced intervals adjacent to forming acellular cementum. Some epithelial rests, distant from the root surface, appeared to be formed early in root development at the time of initial root-sheath severance from the cervical loop of the enamel organ. Epithelial rests located along the acellular cementum appeared to arise from inner, rather than outer, epithelial root-sheath cells and at later stages in root development.

A periodontal attachment mechanism without alveolar bone. Case report

A 22-year-old black male was referred for periodontal therapy because of radiographic evidence of advanced bone loss associated with the posterior teeth. Clinical examination revealed gingivitis, normal sulcus depths, and minimal loss of clinical attachment. Complete blood counts, serum chemistry, and neutrophil function were within normal limits. Histological, histochemical and ultrastructural analysis of an extracted tooth revealed no loss of attachment; large areas of the cementum were collagen-poor and, ultrastructurally, resembled afibrillar cementum. It is proposed that the periodontal attachment mechanism present in this case was associated with a localized failure in normal periodontal development.

Root surface--soft tissue interface. Part I: A review

A review of the literature is presented with regards to the soft tissue-root surface interface. The basic biological aspects are discussed followed by reports on healing after periodontal surgery. The effect of citric acid, to enhance new attachment, is reviewed in detail. Articles reporting on clinical findings, ultrastructural observation (TEM and SEM), and light microscopic studies have been selected to present the reader with a logical overview of what has been reported in the literature.

The surface structure of the completely and incompletely orthokeratinized oral epithelium in the rat: a light, scanning and transmission electron microscope study

Mucosa from the hard and soft palates, molar gingiva, cheek and dorsal surface of the tongue of the rat was examined in the light microscope, following Mallory's triple connective tissue stain, and in the scanning and transmission electron microscopes. The epithelium covering the hard palate, gingiva, the smooth band of mucosa at the junction of the hard and soft palates, intermediate zones of the soft palate, fungiform papilla-like structures in the central zone of the soft palate, the fungiform papillae, and the more superficial part and posterior surfaces of the filiform papillae of the tongue all exhibited complete orthokeratinization. The oral surfaces of the epithelial cells in all these areas had a honeycomb pattern of interconnecting ridges surrounding depressions. Imprints of the overlying cells that had been desquamated were apparent, and the lateral boundaries between the cells were formed by two raised ridges separated by a gap. The epithelium covering the cheek, central zone of the soft palate apart from the fungiform papilla-like structures, lateral zones of the soft palate, gingival crevice, and the mucosa between the fungiform and filiform papillae of the tongue all exhibited incomplete orthokeratinization. The oral surfaces of the epithelial cells in all these areas were relatively smooth and did not exhibit a honeycomb pattern of interconnecting ridges. Imprints of the overlying cells that had been desquamated and the lateral boundaries between the cells were only very occasionally found. In the transmission electron microscope the outlines of the cells were compatible with the surface patterns seen in the scanning electron microscope. The possible relationships between the degree of orthokeratinization and ultrastructure of the various epithelia are discussed.

Healing following simulated fiber retention procedures in rats

Healing responses of a simulated fiber retention procedure in rats has been presented. In the area of attached, but severed supracrestal fibers, a loss of cells was observed in the initial stages of repair. Subsequently, connective tissue cells migrated into this area as did blood vessels. A very distinct interface was seen at about 1 week after surgery between the advancing soft tissues from the flap wound surface and the attached, but severed supracrestal fibers. By 4 weeks after surgery, such distinction was absent and supragingival fiber bundles appeared continuous from their cemental attachment over to the adjacent alveolar crest. However, no evidence of cementogenesis was seen at this site which suggests that these attached fibers were attached prior to surgery. The position of the new junctional epithelium appeared to be limited to the level of the retained supracrestal fiber fragments. However, in areas where cementum, and thereby attached fibers, had been removed during surgery, an altered epithelial adherence was usually seen. This altered adherence was in the form of a long junctional epithelium or a short junctional epithelium on top of parallel oriented collagen fibers. The latter also appeared to adhere to the tooth surfaces.