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Bumm CV, Ern C, Folwaczny J, Wölfle UC, Heck K, Werner N, Folwaczny M. Periodontal grading-estimation of responsiveness to therapy and progression of disease. Clin Oral Investig 2024; 28:289. [PMID: 38691197 PMCID: PMC11062956 DOI: 10.1007/s00784-024-05678-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To investigate the capability of periodontal grading to estimate the progression of periodontal disease and the responsiveness to therapy. MATERIALS AND METHODS Eighty-four patients who underwent non-surgical therapy (NST) were included. Direct and indirect evidence of progression were determined according to the current classification. Responsiveness to therapy was examined using mean pocket probing depths reduction (PPDRed), reduction of bleeding on probing (BOPRed), and the rate of pocket closure (%PC) after six months. RESULTS Statistical analysis revealed no agreement between direct and indirect evidence in grading periodontitis (κ = 0.070). The actual rate of progression as determined by longitudinal data was underestimated in 13% (n = 11), overestimated in 51% (n = 43) and correctly estimated in 30% (n = 36) by indirect evidence. No significant differences in responsiveness to therapy were observed in patients graded according to direct evidence. Using indirect evidence, patients assigned grade C showed more PPDRed but less BOPRed and lower %PC compared to grade B. CONCLUSION The present data indicate that indirect evidence may lead to inaccuracies compared to direct evidence regarding the estimation of periodontal progression. However, indirect evidence seems to be more suitable in the estimation of responsiveness to therapy than direct evidence, helping to identify cases that are more likely to require additional therapies such as re-instrumentation or periodontal surgery. CLINICAL RELEVANCE Regarding the estimation of disease progression and responsiveness to periodontal therapy, accuracy and reliability of both direct and indirect evidence are limited when grading periodontitis.
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Affiliation(s)
- Caspar Victor Bumm
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich Goethestraße 70, 80336, Munich, Germany.
- Private Practice, Munich, Germany.
| | - Christina Ern
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich Goethestraße 70, 80336, Munich, Germany
- Private Practice, Munich, Germany
| | - Julia Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich Goethestraße 70, 80336, Munich, Germany
| | - Uta Christine Wölfle
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich Goethestraße 70, 80336, Munich, Germany
| | - Katrin Heck
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich Goethestraße 70, 80336, Munich, Germany
| | - Nils Werner
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich Goethestraße 70, 80336, Munich, Germany
| | - Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich Goethestraße 70, 80336, Munich, Germany
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Werner N, Heck K, Walter E, Ern C, Bumm CV, Folwaczny M. Probing pocket depth reduction after non-surgical periodontal therapy: Tooth-related factors. J Periodontol 2024; 95:29-39. [PMID: 37436696 DOI: 10.1002/jper.23-0285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND To investigate tooth-related factors that influence the reduction of probing pocket depths (PPD) after non-surgical periodontal therapy (NST). METHODS Seven hundred forty-six patients with a total of 16,825 teeth were included and retrospectively analyzed. PPD reduction after NST was correlated with the tooth-related factors; tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration; using logistic multilevel regression for statistical analysis. RESULTS NST was able to reduce probing depth overall stratified probing depths (1.20 ± 1.51 mm, p ≤ 0.001). The reduction was significantly higher at teeth with higher probing depths at baseline. At pockets with PPD ≥ 6 mm, PPD remains high after NST. Tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration are significantly and independently associated with the rate of pocket closure. CONCLUSIONS The tooth-related factors: tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration had a significant and clinically relevant influence on phase I and II therapy. Considering these factors in advance may enhance the prediction of sites not responding adequately and the potential need for additional treatment, such as re-instrumentation or periodontal surgery, to ultimately achieve the therapy end points.
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Affiliation(s)
- Nils Werner
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
| | - Katrin Heck
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
| | - Elias Walter
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
| | | | - Caspar Victor Bumm
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
- Private practice, Munich, Germany
| | - Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU, Munich, Germany
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Folwaczny M, Ahantab R, Kessler A, Ern C, Frasheri I. Cytotoxicity of 3D printed resin materials for temporary restorations on human periodontal ligament (PDL-hTERT) cells. Dent Mater 2023; 39:529-537. [PMID: 37055304 DOI: 10.1016/j.dental.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES Various dental resin materials are available for the fabrication of temporary restorations using modern additive printing methods. Albeit these materials are placed for several months in intimate contact with dental hard and soft tissues, including the gingival crevice, there exists only insufficient evidence on the biocompatibility of these materials. This in vitro study aimed to delineate the biocompatibility of 3D printable materials on periodontal ligament cells (PDL-hTERTs). METHODS Samples of four dental resin materials for additive fabrication of temporary restorations using 3D printing (MFH, Nextdent; GC Temp, GC; Freeprint temp, Detax; 3Delta temp, Deltamed), one material for subtractive fabrication (Grandio disc, Voco) and one conventional temporary material (Luxatemp, DMG) were prepared with a standardized size according to the manufacturer's instructions. Human PDL-hTERTs were exposed to resin specimens or eluates of the material for 1, 2, 3, 6 and 9 days. For determination of cell viability, XTT assays were performed. In addition, the expression of the proinflammatory cytokines interleukin 6 and 8 (IL-6 and 8) was assessed in the supernatants with ELISA. Cell viability and the expression of IL-6 and 8 in presence of the resin material or their eluates was compared with untreated controls. Immunofluorescence staining for IL-6 and IL-8, as well as scanning electron microscopy of the discs after culturing, were performed. Differences between groups were analyzed with Student´s t-test for unpaired samples. RESULTS Compared to untreated control samples, the exposure against the resin specimen induced strong reduction of cell viability in case of the conventional material Luxatemp (p < 0.001) and the additive material 3Delta temp (p < 0.001) irrespective of the observation period. On the contrary, the presence of eluates of the various materials induced only minor changes in cell viability. Considering IL-6 (day 2: p = 0.001; day 6 and 9: p < 0.001) and IL-8 (day 1: p = 0.001; day 2, 3, 6, 9: p < 0.001) their expression was strongly reduced in presence of the eluate of Luxatemp. Except for IL-6 at day 1 and 6 also the material 3Delta temp caused significant reduction of both proinflammatory mediators at any time point. SIGNIFICANCE The conventional material Luxatemp and the additive material 3Delta temp appear to severely affect cell viability when in direct contact with PDL-hTERTs. The other tested materials of this new category of additive materials and the subtractive material Grandio seem to induce only minor changes in direct contact with these cells. Therefore, they could serve as a viable alternative in the fabrication of temporary restorations.
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Affiliation(s)
- Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany.
| | - Roya Ahantab
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
| | - Andreas Kessler
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
| | - Christina Ern
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
| | - Iris Frasheri
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
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Frasheri I, Grimm A, Ern C, Hickel R, Folwaczny M. In-vitro cytocompatibility of self-adhesive dual-curing resin cements on human mesenchymal stem cells (hMSC) and periodontal ligament cells (PDL-hTERT). Dent Mater 2022; 38:376-383. [PMID: 34996633 DOI: 10.1016/j.dental.2021.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/17/2021] [Accepted: 12/15/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Self-adhesive dual cured resin cements provide easier clinical application than conventional resin cements but release higher amounts of unreacted monomers, potentially affecting their biocompatibility. This study aimed to compare the cytotoxic effects of self-adhesive dual cured resin cements with two conventional resin cements. METHODS Samples of four resin cements, two self-adhesive dual cured cements (group A: RelyX Unicem, group B: SmartCem), and two conventional resin cements (group C: Panavia 2.0, group D: Variolink Esthetic DC) were prepared with a similar dimension under standardized polymerization conditions and stored in water. For each material 18 samples were used and cell cultures of human mesenchymal stem cells (hMSCs) or periodontal ligament cells (PDL-hTERT) were added under appropriate conditions. One experimental group (group E) was left untreated as control. A cell viability WST test, was performed in each experimental group at day 1, 7, 14 and 21. Moreover, microscopic examination of cells was performed using cell viability staining. RESULTS Viability of both cell types as determined by WST test was significantly impaired at all time periods by the four different cement materials compared to the untreated control. Comparison between the four materials revealed different inhibition of the viability of both, PDL-hTERT and hMSC cells (group C > group B > group A > group D; p < 0.0001). SIGNIFICANCE All resin-based cements caused significant impairment of cell viability, reflecting considerable cytotoxicity. Variolink caused significantly smaller changes of viability than the other tested materials.
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Affiliation(s)
- Iris Frasheri
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
| | - Alexandra Grimm
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
| | - Christina Ern
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
| | - Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany.
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Frasheri I, Heym R, Ern C, Summer B, Hennessen TG, Högg C, Reichl FX, Folwaczny M. Salivary and gingival CXCL8 correlation with periodontal status, periodontal pathogens and smoking. Oral Dis 2021; 28:2267-2276. [PMID: 34388304 DOI: 10.1111/odi.13994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Neutrophil granulocytes have been proposed to play a major role in the mediation of periodontitis-associated tissue destruction. Their recruitment and activation are regulated by the chemokine CXCL8. This study aimed to delineate the dependency of CXCL8-expression in gingival crevicular fluid (GCF) and saliva on periodontal status, bacterial infection and smoking, in patients with periodontitis. METHODS The study cohort comprised 279 subjects with untreated periodontitis. Probing pocket depth (PPD), gingival recession, bleeding on probing (BOP), plaque index, and bone loss were evaluated. CXCL8 was determined in saliva and GCF using flow cytometry. RESULTS Considering the entire study sample, CXCL8 levels were correlated with the mean PPD (ρ=0.131; p=0.029), severity of periodontitis (ρ=0.121; p=0.043), BOP (ρ=0.204; p=0.001) and smoking (ρ=-0.219; p<0.0001) in GCF; and, in whole saliva, with mean PPD (ρ=0.154; p=0.010) severity of periodontitis (ρ=0.140; p=0.020), gender (ρ=0.178; p=0.003) and smoking (ρ=-0.156; p=0.010). Subgroup analysis among non-smokers revealed significantly higher amounts of CXCL8 in GCF (p=0.012) and saliva (p=0.026) comparing subjects with mean PPD ≤3mm and >3mm. CONCLUSION The current study revealed a strong dependency of CXCL8-expression in GCF on the severity and activity of periodontal disease. Smoking causes a significant reduction of CXCL8-expression in saliva and GCF.
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Affiliation(s)
- Iris Frasheri
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Germany
| | - Richard Heym
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Germany
| | - Christina Ern
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Germany
| | - Burkhard Summer
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Germany
| | - Till G Hennessen
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Germany
| | - Christof Högg
- Walther Straub Institute of Pharmacology and Toxicology, University Hospital, LMU Munich, Germany
| | - Franz-Xaver Reichl
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Germany.,Walther Straub Institute of Pharmacology and Toxicology, University Hospital, LMU Munich, Germany
| | - Matthias Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Germany
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Ern C, Frasheri I, Berger T, Kirchner HG, Heym R, Hickel R, Folwaczny M. Effects of prostaglandin E 2 and D 2 on cell proliferation and osteogenic capacity of human mesenchymal stem cells. Prostaglandins Leukot Essent Fatty Acids 2019; 151:1-7. [PMID: 31589940 DOI: 10.1016/j.plefa.2019.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 12/19/2022]
Abstract
The manifestation of periodontitis-related inflammatory reaction is inevitably bound to the production of prostaglandins E2 and D2 which have been suggested to mediate osteoclastic and osteogenic effects within the affected tissue. We demonstrated the presence of PGE2 and PGD2 receptors on hMSCs on RNA level and with immunofluorescence. For each Prostaglandin, three concentrations were studied: 0.1; 0.5 or 1.0 µg/ml. A lower expression of EP1 and EP4 (PGE2 receptors 1 and 4) after stimulation with PGE2 was shown, thus a tendency to compromise osteogenic differentiation and metabolism. PGE2 induced a higher growth-rate during the first week, while a continuous inflammatory challenge determined a decrease of the proliferation of hMSCs. PGD2 inhibited cell growth irrespective of the duration of the stimulation. PGE2 and PGD2 have also negative effects on calcium deposition osteogenic, thus on differentiation of hMSCs. PGE2 and PGD2 seem to induce bone resorption also having indirectly a negative impact on the osteogenic differentiation of hMSCs. Thus, inhibitors of PGE2 and PGD2 can be used as adjunct to mechanical periodontal treatment.
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Affiliation(s)
- C Ern
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, Munich D-80336, Germany
| | - I Frasheri
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, Munich D-80336, Germany
| | - T Berger
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, Munich D-80336, Germany
| | - H G Kirchner
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, Munich D-80336, Germany
| | - R Heym
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, Munich D-80336, Germany
| | - R Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, Munich D-80336, Germany
| | - M Folwaczny
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, Munich D-80336, Germany.
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Heym R, Krause S, Hennessen T, Pitchika V, Ern C, Hickel R. A Computer-Assisted Training Approach for Performing and Charting Periodontal Examinations: A Retrospective Study. J Dent Educ 2018; 82:76-83. [PMID: 29292329 DOI: 10.21815/jde.018.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/11/2017] [Indexed: 11/20/2022]
Abstract
The aim of this study was to retrospectively investigate the development of a model-based, computer-assisted training approach for performing and charting periodontal examinations in a dental clinic in Germany. The study was initiated in summer semester 2013 and repeated in two consecutive semesters (S1: 44 students, S2: 48 students, and S3: 61 students) because technical features were introduced (S2: feedback and time control; S3: input control). In each semester, new dental students who had never performed periodontal examinations participated. Students were divided into two groups and received intense training at different time points. Agreement levels were calculated at baseline, after the first group received training, and after the second group received training. Comparisons were also made among the semesters. All 153 enrolled students in the three semesters participated. The results showed that probing depth accuracy significantly decreased in S1 from baseline to training completion (79.9% to 74.5%), and the probing depth accuracy significantly increased in S2 (76.1% to 78.9%) and S3 (77.2% to 82.3%). The students who received intense training at a late stage of the tutorial showed greater improvement, especially in the case of S3. Small changes in accuracy were observed for recession (S1: 94.5% to 96.1%; S2: 93.8% to 93.9%; S3: 95.4% to 96.6%). Accuracy for furcation involvement improved significantly in S1 (46.1% to 52.0%), S2 (46.8% to 59.7%), and S3 (44.2% to 58.3%); the improvements occurred when the students received intense training. The time taken for periodontal examination decreased significantly for S2 (23.6 to 14.2 min) and S3 (25.7 to 13.9 min). This study found that when feedback was provided, the students' periodontal examinations improved in accuracy and duration.
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Affiliation(s)
- Richard Heym
- Dr. Heym is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University, Munich, Germany; Dr. Pitchika is a dentist, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Ern is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany.
| | - Sebastian Krause
- Dr. Heym is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University, Munich, Germany; Dr. Pitchika is a dentist, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Ern is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany
| | - Till Hennessen
- Dr. Heym is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University, Munich, Germany; Dr. Pitchika is a dentist, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Ern is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany
| | - Vinay Pitchika
- Dr. Heym is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University, Munich, Germany; Dr. Pitchika is a dentist, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Ern is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany
| | - Christina Ern
- Dr. Heym is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University, Munich, Germany; Dr. Pitchika is a dentist, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Ern is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany
| | - Reinhard Hickel
- Dr. Heym is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University, Munich, Germany; Dr. Pitchika is a dentist, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; Dr. Ern is Associate Professor in Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Germany
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Ern C, Berger T, Frasheri I, Heym R, Hickel R, Folwaczny M. Differentiation of hMSC and hPDLSC induced by PGE2 or BMP-7 in 3D models. Prostaglandins Leukot Essent Fatty Acids 2017; 122:30-37. [PMID: 28735626 DOI: 10.1016/j.plefa.2017.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/06/2017] [Accepted: 06/12/2017] [Indexed: 01/14/2023]
Abstract
Regenerative therapies of pathogenic tissue defects are gaining increasing importance in periodontology. Among others, the osteogenic effect of BMP-7 seems to play a major role in the development of teeth and alveolar bone. Human periodontal ligament stem cells (hPDLSC), as well as human mesenchymal stem cells (hMSC), show the ability to differentiate into various types of tissues. Regarding prostaglandin E2, many studies have confirmed that it is involved in the inflammation associated to periodontitis stimulating osteoclasts, which ultimately leads to resorption of tooth supporting bone. Herein, we aimed to investigate how PGE2 influences regenerative processes. The influence of PGE2 and BMP-7 on the osteogenic differentiation of hMSC and hPDLSC was determined in a 3D cell culture model using qRT-PCR, immunocytochemistry and REM. BMP-7 enhanced the expression of osteogenic markers in hMSC and lowered it in hPDLSC-TERT. BMP-7 had a lower osteogenic effect on hPDLSC-hTERT than on hMSC, while PGE2 decreases the osteogenic differentiation in both cell types, thus, inhibiting anabolic processes. Both cell types presented good proliferation and adhesion onto the scaffolds. The well-developed structural morphology and the support of osteogenic differentiation suggest that the scaffolds are potential candidate materials for bone regeneration. The positivity for Cap in hPDLSC and more in hMSC immunostaining samples indicates the initiation of neocementogenesis as part of periodontal regeneration. In conclusion, BMP7, in particular combined with MSC, seems to have a favourable application also in periodontal regeneration. Our results show that inflammation plays an important role in periodontal regeneration. PGE2 is a key mediator, which stimulates bone resorption also via a mechanism involving the inhibition of osteogenic differentiation of MSC as well as PDLSC. Therefore, regenerative approaches should always be conducted in combination with anti-inflammatory measures oriented to control inflammation.
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Affiliation(s)
- Christina Ern
- Department of Operative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Germany.
| | - Tamara Berger
- Department of Operative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Germany; Max Planck Institute of Psychiatry, Munich, Germany.
| | - Iris Frasheri
- Department of Operative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Germany.
| | - Richard Heym
- Department of Operative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Germany.
| | - Reinhard Hickel
- Department of Operative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Germany.
| | - Matthias Folwaczny
- Department of Operative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-Universität München, Germany.
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Affiliation(s)
- Richard Heym
- Department of Conservative Dentistry and Periodontology; Ludwig Maximilian University of Munich; Germany
| | | | | | | | - Christina Ern
- Department of Conservative Dentistry and Periodontology; Ludwig Maximilian University of Munich; Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology; Ludwig Maximilian University of Munich; Germany
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Heym R, Krause S, Hennessen T, Pitchika V, Ern C, Hickel R. A New Model for Training in Periodontal Examinations Using Manikins. J Dent Educ 2016; 80:1422-1429. [PMID: 27934667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 05/24/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to develop and test models for training dental students in periodontal examinations using manikins that had distinct anatomical designs but were indistinguishable in external appearance. After four models were tested for inter- and intra-examiner reliability by two experienced dentists, 26 additional models were produced. The models were tested by 35 dental students at a dental school in Germany in 2014. The testing involved completing a periodontal examination that included probing depths, gingival recessions, and furcation involvements. The primary purpose of the study was to determine whether the models could be used as a tool for periodontal examination training by the students. Levels of agreement (students and dentists) and Kappa statistics (dentists) were calculated using absolute (±0 mm) and tolerable difference (±1 mm). Over the span of two weeks, the dentists' reliability with preset values for probing depths, gingival recessions, and furcation involvements ranged from 0.29 to 0.38, 0.52 to 0.61, and 0.54 to 0.57, respectively, under absolute difference and from 0.86 to 0.90, 0.96 to 0.99, and 0.62 to 0.73, respectively, under tolerable difference. The students' proportions of agreement for probing depths and gingival recessions under absolute vs. tolerable difference were 34.8% vs. 79.9% and 71.9% vs. 94.4%, respectively. The students frequently scored values higher than the preset values, overestimated furcation involvements, and failed to differentiate the levels of furcations. The models used did not pose any systematic or technical difficulties in the pilot study. Students were unable to measure furcation involvements with acceptable agreement. Thus, these models could be used for student periodontal examination training.
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Affiliation(s)
- Richard Heym
- Dr. Heym is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University of Munich, Germany; Mr. Pitchika is a dentist and statistician; Dr. Ern is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany.
| | - Sebastian Krause
- Dr. Heym is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University of Munich, Germany; Mr. Pitchika is a dentist and statistician; Dr. Ern is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany
| | - Till Hennessen
- Dr. Heym is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University of Munich, Germany; Mr. Pitchika is a dentist and statistician; Dr. Ern is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany
| | - Vinay Pitchika
- Dr. Heym is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University of Munich, Germany; Mr. Pitchika is a dentist and statistician; Dr. Ern is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany
| | - Christina Ern
- Dr. Heym is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University of Munich, Germany; Mr. Pitchika is a dentist and statistician; Dr. Ern is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany
| | - Reinhard Hickel
- Dr. Heym is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; Dr. Krause is a dentist in private practice; Mr. Hennessen is a dental student, Ludwig Maximilian University of Munich, Germany; Mr. Pitchika is a dentist and statistician; Dr. Ern is Associate Professor of Periodontology, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany; and Dr. Hickel is Head, Department of Conservative Dentistry and Periodontology, Ludwig Maximilian University of Munich, Germany
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Lenze U, Pohlig F, Seitz S, Ern C, Milz S, Docheva D, Schieker M. Influence of osteogenic stimulation and VEGF treatment on in vivo bone formation in hMSC-seeded cancellous bone scaffolds. BMC Musculoskelet Disord 2014; 15:350. [PMID: 25323565 PMCID: PMC4216837 DOI: 10.1186/1471-2474-15-350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 09/23/2014] [Indexed: 01/24/2023] Open
Abstract
Background Tissue engineering approaches for reconstruction of large bone defects are still technically immature, especially in regard to sufficient blood supply. Therefore, the aim of the present study was to investigate the influence of osteogenic stimulation and treatment with VEGF on new bone formation and neovascularization in hMSC-loaded cancellous bone scaffolds in vivo. Methods Cubic scaffolds were seeded with hMSC and either cultured in stem cell medium or osteogenic stimulation medium. One osteogenically stimulated group was additionally treated with 0.8 μg VEGF prior to subcutaneous implantation in athymic mice. After 2 and 12 weeks in vivo, constructs and selected organs were harvested for histological and molecular analysis. Results Histological analysis revealed similar vascularization of the constructs with and without VEGF treatment and absence of new bone formation in any group. Human DNA was detected in all inoculated scaffolds, but a significant decrease in cells was observed after 2 weeks with no further decrease after 12 weeks in vivo. Conclusion Under the chosen conditions, osteogenic stimulation and treatment with VEGF does not have any influence on the new bone formation and neovascularization in hMSC-seeded cancellous bone scaffolds. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-350) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Denitsa Docheva
- Laboratory of Experimental Surgery and Regenerative Medicine, Department of Surgery, University of Munich (LMU), Munich, Germany.
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Ern C, Krump-Konvalinkova V, Docheva D, Schindler S, Rossmann O, Böcker W, Mutschler W, Schieker M. Interactions of human endothelial and multipotent mesenchymal stem cells in cocultures. Open Biomed Eng J 2010; 4:190-8. [PMID: 21625373 PMCID: PMC3102321 DOI: 10.2174/1874120701004010190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 07/27/2010] [Accepted: 07/29/2010] [Indexed: 01/16/2023] Open
Abstract
Current strategies for tissue engineering of bone rely on the implantation of scaffolds, colonized with human mesenchymal stem cells (hMSC), into a recipient. A major limitation is the lack of blood vessels. One approach to enhance the scaffold vascularisation is to supply the scaffolds with endothelial cells (EC). The main goal of this study was to establish a coculture system of hMSC and EC for the purposes of bone tissue engineering. Therefore, the cell behaviour, proliferation and differentiation capacity in various cell culture media as well as cell interactions in the cocultures were evaluated. The differentiation capacity of hMSC along osteogenic, chondrogenic, and adipogenic lineage was impaired in EC medium while in a mixed EC and hMSC media, hMSC maintained osteogenic differentiation. In order to identify and trace EC in the cocultures, EC were transduced with eGFP. Using time-lapse imaging, we observed that hMSC and EC actively migrated towards cells of their own type and formed separate clusters in long term cocultures. The scarcity of hMSC and EC contacts in the cocultures suggest the influence of growth factor-mediated cell interactions and points to the necessity of further optimization of the coculture conditions.
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Affiliation(s)
- Christina Ern
- Experimental Surgery and Regenerative Medicine, Department of Surgery, University of Munich (LMU), Munich, Germany
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Abstract
Objective of this study is the novel application of Fourier transform infrared (FTIR) microscopic imaging to identify the differentiation state of individual human mesenchymal stem cells with or without osteogenic stimulation. IR spectra of several hundred single cells with lateral resolution of 5-10 microm were recorded using a FTIR imaging spectrometer coupled to a microscope with a focal plane array detector. A classification model based on linear discriminant analysis was trained to distinguish four cell types by their IR spectroscopic fingerprint. Without stimulation two cell types dominated, showing low or high levels of glycogen accumulation at the cell periphery. After stimulation, the protein composition in the cells changed and some cells started expressing calcium phosphate salts such as octacalciumphosphate, a precursor of the bone constituent hydroxyapatite. Few cells were identified which remained in their non-stimulated state. This study demonstrated for the first time that FTIR microscopic imaging can probe stem cell differentiation at the single cell level rapidly, non-destructively and with minimal preparation.
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Affiliation(s)
- Christoph Krafft
- Institute for Analytical Chemistry, Dresden University of Technology, D-01062 Dresden, Germany.
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Ern C, Donner W, Dosch H, Adams B, Nowikow D. Temperature-dependent interfacial stiffness of the disorder layer in a thin Cu3Au alloy film. Phys Rev Lett 2000; 85:1926-1929. [PMID: 10970649 DOI: 10.1103/physrevlett.85.1926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2000] [Indexed: 05/23/2023]
Abstract
The order-disorder transition in a 170 A thick Cu3Au(111) epitaxial alloy film is examined using x-ray diffraction techniques. Below the transition temperature T0, a disordered surface layer of thickness l is detected. This layer exhibits wetting behavior, i.e., l increases, obeying a logarithmic growth law on approach to T0. We show by a detailed analysis of the order parameter profiles that the stiffness of the order-disorder interface is temperature dependent, resulting in a nonuniversality of the wetting transition.
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Affiliation(s)
- C Ern
- Max-Planck-Institut fur Metallforschung, D-70569 Stuttgart, Germany and Universitat Stuttgart, Institut fur Theoretische und Angewandte Physik, D-70569 Stuttgart, Germany
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