Use of the Tooth Coronal Pulp Index for Recognition of the Pubertal Growth Period

AIM

The present study aimed to investigate the association between the tooth coronal index (TCI) and the pubertal growth stages (PGS) for children and adolescents.

MATERIALS AND METHODS

A cross-sectional study was performed using retrospectively collected panoramic and hand-wrist radiographs of 262 individuals (125 males, 137 females). The coronal height (CH) and the coronal pulp cavity height (CPCH) of the left mandibular teeth were measured. Then the TCI for which was calculated according to Ikeda et al (1985). The estimated TCI for individuals with the following PGS after Fishman (1987) are: SMI 4 (S), SMI 5 (DP3 cap), SMI 6 (MP3 cap) and SMI 7 (Mp5 cap). The associations between the TCI and the PGS were investigated by correlation coefficient of Spearman's rho, and the validity values for the PGS were computed.

RESULTS

Significant correlations were noted between the simple TCI values for premolars and molars and the PGS, and the highest correlation was for the summed TCI for both first and second molars. Utilizing the validity values of the summed TCI for both first and second mandibular molars, the PGS can be predicted as follows: S stage when TCI is 49.17 or lesser, DP3cap stage when TCI is 43.52 or lesser, MP3cap stage when TCI is 36.73 or lesser, and Mp5cap stage when TCI is 26.84 or lesser.

CONCLUSION

The TCI values declined along with the maturational process in children and adolescents. The TCI for both first and second molars was the best predictor of the PGS.

CLINICAL SIGNIFICANCE

Panoramic photographs can be beneficial for prediction of the skeletal maturity and treatment planning without resorting to hand-wrist radiographs.

Structural and recovery mechanisms of 3D dental pulp cell microtissues challenged with Streptococcusmutans in extracellular matrix environment

Cariopathogen Streptococcus mutans exists in infected dental pulp of deciduous teeth and is frequently linked with heart diseases. Organotypic (3D) dental pulp stem cell (DPSC) cultures/microtissues, developed to mimic the physiological conditions in vivo, were utilized to assess the bacterial impact on their (i) 3D structural configuration and (ii) recovery mechanisms. The cultures, developed in extracellular matrix (ECM) bio-scaffold (Matrigel™), interacted with WT and GFP-tagged bacterial biofilms by permitting their infiltration through the ECM. Challenged cell constructs were visualized by F-actin/nuclei staining. Their pluripotency (Sox2) and differentiation (osteocalcin) markers were assessed by immunocytochemistry. Secreted mineral was detected by alizarin red, and 3D structural arrangements were analysed by epi-fluorescence and confocal scanning microscopy. Bacterial biofilm/ECM-embedded DPSC interactions appeared in distinct areas of the microtissues. Bacterial attachment to the cell surface occurred without evidence of invasion. Surface architecture of the challenged versus unchallenged microtissues was apparently unaltered. However, significant increases in thickness (138.42 vs 106.51 µm) and bacterial penetration were detected in challenged structures causing canal-like microstructures with various diameters (12.94 -42.88 µm) and average diameter of 20.66 to 33.42 µm per microtissue. Challenged constructs expressed pluripotency and differentiation markers and secreted the mineral. Presented model shows strong potential for assessing pulp-pathogen interactions in vivo. S. mutans infiltrated and penetrated the microtissues but did not invade the cells or compromise major cell repair mechanisms. These findings would suggest reexamining the role of S. mutans as an endodontic pathogen and investigating DPSC resistance to its pathogenicity.

Infected Dentine Revisited

Dentine becomes infected as a result of caries lesion formation on root surfaces and when lesions progress following cavitation of enamel lesions. However, this infection is unimportant because the driving force for lesion formation and progression is the overlying biofilm. This explains why root surface caries can be controlled by mechanical plaque control and fluoride, and restorations are not needed to arrest these lesions. Similarly, the infected dentine in cavitated coronal lesions does not have to be removed to arrest the lesion. If the lesion is either accessible or opened for cleaning by the patient or parent, the lesion can be arrested. Sealing of infected dentine within the tooth, either by a Hall crown in the primary dentition or by partial caries removal prior to placing a well-sealed filling, will also arrest the lesion. When restoring deep lesions in symptomless, vital teeth, vigorous excavation of infected dentine is likely to expose the pulp and make root canal treatment necessary. Thus complete excavation'is not needed and should be avoided. CPD/CLINICAL RELEVANCE: Root surface caries can be arrested by cleaning and fluoride application. Restorations are not essential. Vigorous excavation of softened dentine in deep cavities of symptomless, vital teeth is contra-indicated. It is not needed and increases the risk of pulp exposure.

Morphological aspects and physical properties of enamel and dentine of Sus domesticus: A tooth model in laboratory research

This study aims to describe and analyze morphological and physical properties of deciduous teeth of Sus domesticus. Ultrastructural analysis, mineral composition and microhardness of enamel and dentine tissues were performed on 10 skulls of S. domesticus. External anatomic characteristics and the internal anatomy of the teeth were also described. Data regarding microhardness and ultrastructural analysis were subjected to statistical tests. For ultrastructural analysis, we used the analysis of variance (ANOVA) with Tukey's post hoc (p≤0.05) test. In the analysis of microhardness, the difference between the enamel and dentine tissues was analyzed by a Student's t test. Values were expressed as mean with standard error. The results of ultrastructural analysis showed the presence of an enamel prism pattern. A dentinal tubule pattern was also observed, with a larger diameter in the pulp chamber and the cervical third, in comparison to middle and apical thirds. We observed an average microhardness of 259.2kgf/mm(2) for enamel and 55.17kgf/mm(2) for dentine. In porcine enamel and dentine, the chemical elements Ca and P showed the highest concentration. The analysis of internal anatomy revealed the presence of a simple root canal system and the occurrence of main canals in the roots. The observed features are compatible with the functional demand of these animals, following a pattern very similar to that seen in other groups of mammals, which can encourage the development of research using dental elements from the pig as a substitute for human teeth in laboratory research.

Diffusion of HEMA from resin cements through different dentin thicknesses in vitro

PURPOSE

To evaluate the in vitro diffusion of 2-hydroxyethyl methacrylate (HEMA) from the resin cements through different thicknesses of dentin using high-performance liquid chromatography (HPLC) at two time intervals.

METHODS

60 freshly extracted caries- and restoration-free human third molar teeth were used in this study. Standardized box-shaped Class I inlay cavities (6 mm long, 3 mm wide and 2 mm deep) were prepared in all teeth with a high-speed handpiece mounted on a standard cavity machine. The remaining dentin thickness (RDT) between the pulpal wall of the cavity and the roof of the pulp chamber was measured at multiple points for each tooth so that two main groups of 30 teeth each were prepared with an RDT range 0.5-1.9 and 2.0-3.5 mm, respectively. Each of these main groups was divided into three subgroups (n = 10), according to the resin cements tested (RelyX ARC, Panavia F 2.0, Multilink Automix). Lithium disilicate-based ceramic inlays (IPS Empress 2) were manufactured to restore the prepared cavities. A polypropylene chamber containing 1 ml distilled water was attached to the cemento-enamel junction of each tooth. Then, ceramic inlays were cemented with resin cements according to the manufacturers' instructions. Water elutes were analyzed by HPLC at 4.32 minutes and 24 hours. HEMA diffusion amounts were analyzed using three-way ANOVA and Tukey's HSD tests (P < 0.05).

RESULTS

HEMA was detected in the pulp chamber elutes of all the teeth. The amounts of released HEMA did not significantly differ between time periods. The diffused HEMA amounts were significantly different between the RDT of 0.5-1.9 and 2.0-3.5 mm (P < 0.05) and between resin cements tested (P < 0.05). Decreasing RDT substantially increased the amount of HEMA that diffused through the dentin to the pulp space.

Evaluation of four different optimized magnetic-resonance-imaging sequences for visualization of dental and maxillo-mandibular structures at 3 T

OBJECTIVES

The purpose of this study was to evaluate four in-house optimized, non-contrast enhanced sequences for MRI-investigation of maxillo-mandibular and dental structures by use of 3 T.

METHODS

12 volunteers with different dental status were examined by using a 3 T MRI with a 20-channel standard head-and-neck coil. All images performed were evaluated by using 3D-techniques, with different slice-thicknesses, in 3D T1- and T2-weighted sequences, as well as by using new techniques of image depictions. In addition phantom measurements were performed to estimate the extent of image artefacts caused by retainers and metal implants.

RESULTS

Mean age of the participants was 33 years (range, 25.5-62.75 years), and the sex ratio was 5 females to 7 males. We identified different techniques to improve osseous and dental structures, despite problems caused by dental implants, tooth crowns or braces.

CONCLUSION

The sequences evaluated offered excellent visualization in 2D and 3D of osseous and dental structures. Anatomical, osseous and dental structures were described at their ROI, in relation to patients with dental and head and neck pathologies. The ability to detect and distinguish pathological processes as soon as possible in 3D with excellent image quality avoiding ionizing radiation remains a challenging domain.

Age estimation in archaeological skeletal remains: evaluation of four non-destructive age calculation methods

Estimation of age at death is an essential part of reconstructing information from skeletal material. The aim of the investigation was to reconstruct the chronological age of an archaeological sample from Croatia using cranial skeletal remains as well as to make an evaluation of the methods used for age estimation. For this purpose, four age calculation methods were used: palatal suture closure, occlusal tooth wear, tooth root translucency and pulp/tooth area ratio. Cramer's V test was used to test the association between the age calculation methods. Cramer's V test showed high association (0.677) between age determination results using palatal suture closure and occlusal tooth wear, and low association (0.177) between age determination results using palatal suture closure and pulp/tooth area ratio. Simple methods like palatal suture closure can provide data about age at death for large number of individuals, but with less accuracy. More complex methods which require qualified and trained personnel can provide data about age for a smaller number of individuals, but with more accuracy. Using different (both simple and complex) age calculation methods in archaeological samples can raise the level of confidence and percentage of success in determining age.

Endodontic diagnostic terminology update

Determination of the etiology of the patient's chief complaint and a correct diagnosis are paramount prior to a recommendation of endodontic therapy. Reproduction of the patient's chief complaint is critical. If the chief complaint cannot be reproduced, consider consultation with or referral to an endodontist or orofacial pain specialist. The diagnostic terminology presented in this update provides for a more accurate description and communication of the health or pathological conditions of both pulpal and apical tissues. This information is summarized in Table I.

Age estimation in an Indian population using pulp/tooth volume ratio of mandibular canines obtained from cone beam computed tomography

The present study assessed the suitability of pulp/tooth volume ratio of mandibular canines for age prediction in an Indian population. Volumetric reconstruction of scanned images of mandibular canines from 140 individuals (aged ten - 70 years), using computed tomography was used to measure pulp and tooth volumes. Age calculated using a formula reported earlier for a Belgian sample, resulted in errors > ten years in almost 86% of the study population. The regression equation obtained for the Indian population: Age = 57.18 + (- 413.41 x pulp/tooth volume ratio), was applied to an independent control group (n = 48), and this resulted in mean absolute errors of 8.54 years which was significantly (p < 0.05) lower than those derived with the Belgian formula. The pulp/tooth volume ratio is a useful indicator of age, although correlations may vary in different populations and hence, specific formulae should be applied for the estimates.

Expression of clock proteins in developing tooth

Morphological and functional changes during ameloblast and odontoblast differentiation suggest that enamel and dentin formation is under circadian control. Circadian rhythms are endogenous self-sustained oscillations with periods of 24h that control diverse physiological and metabolic processes. Mammalian clock genes play a key role in synchronizing circadian functions in many organs. However, close to nothing is known on clock genes expression during tooth development. In this work, we investigated the expression of four clock genes during tooth development. Our results showed that circadian clock genes Bmal1, clock, per1, and per2 mRNAs were detected in teeth by RT-PCR. Immunohistochemistry showed that clock protein expression was first detected in teeth at the bell stage (E17), being expressed in EOE and dental papilla cells. At post-natal day four (PN4), all four clock proteins continued to be expressed in teeth but with different intensities, being strongly expressed within the nucleus of ameloblasts and odontoblasts and down-regulated in dental pulp cells. Interestingly, at PN21 incisor, expression of clock proteins was down-regulated in odontoblasts of the crown-analogue side but expression was persisting in root-analogue side odontoblasts. In contrast, both crown and root odontoblasts were strongly stained for all four clock proteins in first molars at PN21. Within the periodontal ligament (PDL) space, epithelial rests of Malassez (ERM) showed the strongest expression among other PDL cells. Our data suggests that clock genes might be involved in the regulation of ameloblast and odontoblast functions, such as enamel and dentin protein secretion and matrix mineralization.

Development of a visio-haptic integrated dental training simulation system

The use of haptic devices in the medical field has become widespread in the last decade. In this study, a visio-haptic dental training system is developed using haptic and stereoscopic devices. Several advantages are offered by such a simulation system, including effective learning without any fear of making mistakes on a patient, possibility of repeating various dental operations, ease of evaluating student performance, and low-cost dental training even without an instructor. In this study, the biomechanical properties of enamel, dentin, pulp, and caries were modeled, and the parameters were fine-tuned to provide more realistic haptic sensations. Maxillary and mandibular dental arches and various dental instruments such as mouth mirror, probe, and dental drills were modeled in a 3D virtual environment. Probing and cavity preparation on teeth were implemented in the training system. Various graphical rendering methods (Surface Rendering in CPU, Iso-Surface Rendering, and Ray-Casting in GPU) were implemented and compared in performance. The implementation details and the software structure used are described. Finally, detailed performance tests by a group of dentists are conducted, and the results of these tests are presented. The performance tests found that dentists have a strong motivation to use the system and that in the aspects of usability, clarity, effectiveness, help/support provided, and satisfaction, the users' responses were above average.

[A structural mechanics study with human maxillary premolar]

OBJECTIVE

To evaluate the stress distribution and offset of dental and periodontal tissues imposed by changes in inner diameter of pulp cavity.

METHODS

Six models of maxillary second bicuspid tooth with different inner diameter of pulp cavity were established, including: (1) calcificated pulp without pulp chamberi (2) mostly calcificated pulp chamber with inward reduction of 0. 5 mm in normal pulp cavity; (3) initially calcificated pulp chamber with inward reduction of 0.25 mm in normal pulp cavity; (4) normal pulp cavity; (5) initially absorbed pulp chamber with outward expansion of 0.25 mm in normal pulp cavity; (6) mostly absorbed pulp chamber with outward expansion of 0.5 mm in normal pulp cavity. Vertical and oblique forces with 160 N were loaded on the central fossa, respectively, in order to calculate the stress distribution of dental and periodontal tissues and the maximum incipient offset of the teeth.

RESULTS

With loaded vertical and oblique forces on central fossa, increased stress distribution of periodontal tissues and maximum incipient offset of teeth were found in all of the models, which increased with the increase of pulp cavity.

CONCLUSION

The change in inner diameter of pulp cavity has an impact on the stress distribution of periodontal tissues and maximum incipient offset of the second upper bicuspid teeth.

Coronal pulp dimensions in noncarious and restored deciduous second molars: a radiovisiographic study

PURPOSE

The purpose of this study was to measure the coronal pulp dimensions in primary maxillary and mandibular second molars and to evaluate the influence on restorative procedures on them.

METHODS

Included in this study were 80 4-7 year-old male and female patients with occlusal or proximal restorations on primary maxillary or mandibular second molars and with noncarious antimeres. Radiovisiographic images were captured utilizing standard bitewing radiographs via the parallel cone technique. Morphometric analysis was performed using Dexis and AutoCAD 2000 software, and data was analyzed using student's t test (unpaired).

RESULTS

A significant difference was found in crown and coronal pulp dimensions in noncarious (sound) primary maxillary and mandibular second molars, even though no significant reductions were found in restored primary second molars.

CONCLUSIONS

Crown and coronal pulp dimensions were significantly greater in noncarious primary mandibular second molars than in maxillary second molars. The mesiodistal crown width of maxillary molars was greater in males than in females. Nonsignificant reductions were observed in amalgam restored primary maxillary and mandibular second molars over a period of six months. No significant difference in pulpal dimensions was observed when Class I restorations were compared with Class II restorations in either arch.

A novel instrument to determine pulp proximity

The aim was to determine whether extracted teeth could be used to test the Prepometer instrument, which indicates pulp proximity with green/amber/red light emitting diodes. Third molars were reduced to a plane in dentine and Prepometer readings made. Dentine was removed in 0.5 mm increments and readings made until only lights 9 or 10 (red) showed. The teeth were sectioned and the dentine thickness measured. Analysis permitted construction of a highly significant predictor-model (p < 0.01), the red/amber light boundary coinciding with a dentine thickness of 2.4 mm. The Prepometer was consistent in predicting pulp proximity but was more sensitive than specified.

On the applicability of secondary dentin formation to radiological age estimation in young adults

The literature provides linear regression formulas for dental age estimation that is based on radiological two-dimensional measurements of the pulp size. The aim of the present study was to explore whether the previously presented regression formulas could lead to statistically sound results and to appropriate repeatability when applied to young individuals. Orthopantomograms (OPGs) of 44 Austrian individuals, aged between 13 and 24 years, were selected at random. In accordance with the reported method, six teeth on each OPG were chosen to carry out the measurements. Statistical analysis was performed in order to assess the difference between the estimated and the true chronological age. The regression formulas reported by Kvaal et al. (1995) led to a consistent underestimation; the regression formulas reported by Paewinsky et al. (2005) resulted in a constant overestimation of age. The statistical analysis of intraobserver and interobserver variation revealed a variation width below 2%, respectively.

Comparative evaluation for microleakage between Fuji-VII glass ionomer cement and light-cured unfilled resin: a combined in vivo in vitro study

Glass ionomer cement, besides being used as restorative material, can also be used as pit and fissure sealant. The use of glass ionomer cement as pit and fissure sealant has added benefit by its fluoride-releasing property that results in increased resistance of the fissures to demineralize. The capacity of a sealant to prevent microleakage into the fissure is important, since microleakage may initiate and support a carious lesion beneath the sealant. The study was carried out to compare marginal microleakage between Fuji-VII glass ionomer cement (G C Corporation, Tokyo, Japan) and the conventional light-cured unfilled resin as pit and fissure sealants (3M Concise, 3M Dental Products, St. Paul, USA). The dye used was 2% methylene blue (Qualigens Fine Chemicals, Mumbai, India). The teeth were sectioned and studied under the stereomicroscope. The result revealed that there was no difference in microleakage (P > 0.05) between the two materials.

Color in natural teeth and direct resin composite restorations: essential aspects

This article presents the essential aspects for understanding and reproducing the color of natural teeth with the use of direct resin composite. Fluorescence and opalescence are discussed, with special emphasis on counter-opalescence, which is primarily responsible for the appearance of an orange discoloration at the mamelon dentin tips and incisal edges of anterior teeth. The dynamics of color in natural teeth in relation to age is also discussed, focusing on the age-related changes that occur in enamel, dentin, and pulp. Further, it is demonstrated how to reproduce the esthetic features of natural teeth using latest-generation direct resin composites.

Age estimation methods using anthropological parameters on human teeth–(A0736)

The research was conducted on the 160 intact extracted human teeth with one and two roots of the known age and sex. The teeth were disinfected, dried and X-rayed. After that the section of the longitudinal cut through the teeth was performed in order to facilitate monitoring of all tissues and morphological characteristics of the teeth. The age was determined in three ways: Method 1 [G.Bang, E. Ramm, Determination of age in humans from root dentin transparency, Acta Odontol. Scand. 28 (1970) 3-35]--analysis of the translucency of the root dentine, Method 2 [S. Kvaal, T. Solheim, A non-destructive dental method for age estimation, J. Forensic Odonto-stomatol. 12 (1994) 6-11]--analysis of the root and the root canal from the X-ray, Method 3 [G. Johanson, Age determination from human teeth, Odontol. Revy. 22 (1971) 1-126]--analysis of six parameters on each teeth. All data were subject to the correlation and regression analysis which showed the following: all of the three applied methods were in the significant correlation with the real age, and the best of them proved to be Method 3 where the coefficient of correlation was 0.85, p<0.001. The teeth of the maxilla are more convenient for the age determination than the teeth of mandible. They are in the significant strong correlation with the known real age, and in Method 3, the coefficient of correlation is 0.78, p<0.001. Age determination of the teeth with two roots is in significant correlation with the known real age p<0.001 in relation to the determined age on the teeth with one root. The results show that sex too, is in significant correlation with the real age, p<0.001. In practice, the methods used and the results achieved in this research have been enabling the dental age estimation of human remains from mass graves after the 1991 war in Croatia.

Find canals faster through basic research

Achieving access and finding canals are the key first steps in the endodontic procedure. This has always been a time-consuming, qualitative procedure that relies on the dentist's experience and feel. Recent basic research has been published that shows that the anatomic morphological measurements concerning the pulp chamber are very consistent in every tooth. This research points the way to a quantitative, predictable and quick technique for making endodontic access preparations without risk. The research and clinical technique are described in this article.

Reliability in Age Determination by Pulp/Tooth Ratio in Upper Canines in Skeletal Remains

Estimation of age of skeletal remains is one of the most complex questions for anthropologists. The most common macroscopic methods are based on dental wear and histological evaluation of bone remodeling. These methods are often qualitative, require great technical expertise, and have proved inexact in the estimation of ages over 50 years. Certain dental methods investigate the apposition of secondary dentine, in the study of tooth cross-sections, and X-rays to study width, height, and pulp area. The primary author previously proposed a method of estimating the age of a living person based on the pulp/tooth ratio (PTR) method in the upper canines. The aim of the present study is to verify whether the PTR method can also be used to estimate the age at death of skeletal remains. This paper investigates the study of historical samples of known age as a means to validate the proposed method.

British Orthodontic Society, Chapman Prize Winner 2003. A novel in vitro culture model to investigate the reaction of the dentine-pulp complex to orthodontic force

OBJECTIVE

To develop a novel mandible slice organ culture model to investigate the effects of externally applied force on the dentine-pulp complex.

DESIGN

In vitro organ culture.

SETTING

School of Dentistry, Birmingham, UK.

MATERIALS AND METHODS

Transverse 2 mm thick sections were cut from the mandibles of five 28-day-old male Wistar rats. Serial sections were used for control and test pairs. Springs made from 0.016-inch and 0.019 x 0.025-inch stainless steel wires were used to apply a 50 g tensile or compressive force, respectively, to test specimens. Control and test specimens were cultured for 5 days in a humidified incubator with 5% CO(2) at 37 degrees C and processed for routine histological investigation. Nine more rats were used to provide control and compression test pairs where the pulps were extirpated after 3 days culture and total RNA isolated for gene expression analysis by reverse transcriptase polymerase chain reaction (RT-PCR).

RESULTS

Histology showed the dental and supporting tissues maintained a healthy appearance in the control cultures after culture. Histomorphometric analysis revealed a 20-27% increase in pulp fibroblast density in test specimens compared with controls. Gene expression analyses revealed up-regulation in the test groups of PCNA, c-Myc, Collagen 1alpha, TGF-beta1 and alkaline phosphatase, whilst expression of osteocalcin was reduced.

CONCLUSIONS

The results demonstrated that the present organ culture technique provides a valuable in vitro experimental model for studying the effects of externally applied forces. These forces stimulated a cellular response in the pulp chamber characterized by altered gene expression and proliferation of fibroblasts; the latter being unaffected by the nature of the force in terms of compression or tension.

Structure and innervation of the tusk pulp in the African elephant (Loxodonta africana)

African elephants (Loxodonta africana) use their tusks for digging, carrying and behavioural display. Their healing ability following traumatic injury is enormous. Pain experience caused by dentin or pulp damage of tusks seems to be negligible in elephants. In this study we examined the pulp tissue and the nerve distribution using histology, electron microscopy and immunhistochemistry. The results demonstrate that the pulp comprises two differently structured regions. Randomly orientated collagen fibres characterize a cone-like part lying rostral to the foramen apicis dentis. Numerous nerve fibres and Ruffini endings are found within this cone. Rostral to the cone, delicate collagen fibres and large vessels are orientated longitudinally. The rostral two-thirds of the pulp are highly vascularized, whereas nerve fibres are sparse. Vessel and nerve fibre distribution and the structure of connective tissue possibly play important roles in healing and in the obviously limited pain experience after tusk injuries and pulp alteration. The presence of Ruffini endings is most likely related to the use of tusks as tools.

Morphological changes in dental pulp after the teeth preparation procedure

The aim of this study was to evaluate the immediate changes in the pulp-dentin complex that result from crown preparation, and their correlation with the thickness of remaining dentin and the preparation technique (with or without water spray cooling). Thirty upper intact premolars scheduled for extraction for orthodontic reasons were high speed prepared, extracted immediately after preparation and divided in 5 groups. The analysis of the pulp morphology demonstrated that there are several differences according with the preparation technique. The most severe changes appear after the profound preparation without water-cooling, the odontoblastic layer being extremely affected. Also, vascular reactions and inflammatory infiltrate (in the absence of bacteria) were present. Our study revealed that the histologic changes in the pulp and dentin following complete crown preparation occur anyway and they are considered difficult to avoid, even if an adequate technique of preparation is used.

Precision and reliability of pulp/tooth area ratio (RA) of second molar as indicator of adult age

This paper discusses a method for assessing adult age based on the relationship between age and measurement of the pulp/tooth area ratio (RA) of the second molar teeth. The sample consisted of 312 Italian white Caucasian patients (135 men, 177 women) aged between 14 and 24 years. Orthopantomograph samples (OPGs) were analyzed by the same observer and calibrated by kappa statistics. Probabilities of an individual being older than 18 years of age (adult age) were derived using measurements of the ratio pulp/tooth area (RA) of the second molar teeth and the dichotomized stages of third molar development (Tm) as explanatory variables. These results were exploited to establish a threshold value to assign an individual to juvenile or adult age. A cut-off value of RA* = 0.088 was applied if Tm = 0 and RA* = 0.097 if Tm = 1. The sensitivity of this test was 91% and its specificity 94.5%. The proportion of individuals with correct classifications was 92%.

Variations in pulp/tooth area ratio as an indicator of age: a preliminary study

This paper details a method for age determination of adults from single rooted teeth. The sample consisted of 100 Italian white Caucasian patients (46 men, 54 women) aged between 18 and 72 years. The single rooted maxillary right canine was utilized in this preliminary study. Pulp/root ration, tooth length, pulp/tooth length ratio, pulp/tooth area and pulp/root width ratios at three different levels were computed. Pearson's correlation coefficients between age and these variables showed that the ratio between pulp and tooth area correlated best with age (r2 = 0.85). Stepwise multiple regression models yielded a linear relationship between pulp/root width at mid-root level and chronological age and a linear relationship when pulp/tooth area was compared to age. Statistical analysis indicated that these two variables explain 84.9% of variations in estimated chronological age. The median of the absolute value of residual errors between actual and estimated ages was less than four years.

Lymphangiogenesis in human dental pulp

AIM

To investigate the impact of inflammation on lymphangiogenesis in human dental pulp.

METHODOLOGY

Eleven samples of dental pulp without inflammation and 11 dental pulps with moderate to intense mononuclear cell inflammatory infiltrate associated with dentine caries were selected. The streptavidin-biotin complex stain was used to detect CD31, vascular endothelial growth factor receptor-3 (VEGFR-3) and alpha-smooth muscle actin. The number of lymphatic vessels was obtained by counting the number of vessels positive for CD31 and VEGFR-3 and negative for alpha-smooth muscle actin.

RESULTS

The results demonstrated that the mean number (+/-SD) of vessels positive for CD31 and VEGFR-3 (lymphatic vessels) in the group with inflammation (6.09 +/- 1.81) was statistically higher (P = 0.0123) than the mean number in the group without inflammation (3.73 +/- 2.20).

CONCLUSION

Increased co-immunostaining of CD31 and VEGF-3 in vessels associated with human dental pulp inflammation occurred, which suggests lymphangiogenesis.

Lymph drainage in the human dental pulp

We investigated which structural components are responsible for maintaining interstitial fluid equilibrium in the pulpal tissue, for which the existence of an effective lymph drainage is postulated. There have been only a small number of investigations on pulpal lymph tissue. Therefore, we decided to perform a detailed structural analysis. Twenty vital, healthy teeth that had to be extracted for orthodontic reasons were immersed in Patent Blue for 10 to 15 minutes after opening the pulpal cavity. They were then extracted and the dental pulps were opened by cleavage of the surrounding hard tooth structure. Subsequently, the specimens were prepared for light and electron microscopic investigation. A clear blue ring of stain was detected by light microscopy in Weil's zone in the coronal region of the pulp, the cell-rarefied layer surrounded by the odontoblasts. No dye deposition was observed in the apical part. However, using transmission electron microscopy, capillary structures with typical morphological characteristics of lymphatic vessels were found apically. The coronal part of the pulp did not reveal any such vascular structures. It may be concluded from these findings that the lymph in the coronal region is collected in interstitial tissue clefts and drained towards the apex, whence it is further transported via lymph capillaries.

Coronal pulp size in molars: a study of bitewing radiographs

AIM

To: (i) study coronal pulp dimensions in human first molar teeth; (ii) investigate the effects of restorations on pulp size; (iii) determine differences in dimensions between teeth of Mongoloid patients and teeth of other ethnic groups; and (iv) record the presence of pulp stones.

METHODOLOGY

Bitewing radiographs of 121 subjects (mean age, 20.9 years) were taken under standardized conditions. The films were digitally scanned and nine measurements were made from the image of each first molar. The data were analysed in terms of presence or absence of restorations and in terms of racial group. Differences were examined using Student's t-test, Pearson correlations and Levene's test.

RESULTS

A total of 445 teeth were analysed. Large crowns were correlated to large pulps. Teeth restored with occlusal and proximal restorations had significantly smaller pulps (P = 0.044 and 0.004, respectively), but no difference was found in pulp area in the clinical crown between the restoration types. Mongoloid crowns were shorter and more bulbous. Pulp areas of maxillary molars and pulp widths at the cervix of mandibular molars were significantly larger in Mongoloids. The pulp area in the clinical crown correlated to pulp horn height for Mongoloids and others and for maxillary and mandibular teeth. No differences were found between the heights of pulp horns in the Mongoloid and other teeth. Four of the pulp measurements demonstrated sexual dimorphism. Stones were present in almost 10% of the subjects, representing 4% of the tooth pulps examined.

CONCLUSION

Even teeth with shallow occlusal restorations had reduced pulp spaces. There were significant differences in pulp and crown dimensions between the teeth of Mongoloid patients and those of other patients.

Ultimate tensile strength of dentin: Evidence for a damage mechanics approach to dentin failure

Dentin structure and properties are known to vary with orientation and location. The present study explored the variation in the ultimate tensile strength (UTS) of dentin with location in the tooth. Hourglass specimens were prepared from dentin located in the center, under cusps, and in the cervical regions of human molar teeth. These were tested in tension at various distances from the pulp. Median tensile strengths ranged from 44.4 MPa in the inner dentin near the pulp, to 97.8 MPa near the dentino-enamel junction (DEJ). This increase in the median UTS with distance from the pulp to the DEJ was statistically significant (P <.001). Of particular importance was the observation that the UTS measurements followed a Weibull probability distribution, with a Weibull modulus of about 4.5. The Weibull behavior of the UTS data strongly suggests that the large variances in fracture strength data result from a distribution of preexisting defects in the dentin. These findings justify a damage-mechanics approach to studies of dentin failure.

Induction of reparative dentin formation by ultrasound-mediated gene delivery of growth/differentiation factor 11

Bone morphogenetic proteins (BMPs) are morphogens implicated in embryonic and regenerative odontogenic differentiation. Gene therapy has the potential to induce reparative dentin formation for potential pulp capping. We have optimized the gene transfer of Growth/differentiation factor 11 (Gdf11)/Bmp11 plasmid DNA into dental pulp stem cells by sonoporation in vivo. Dental pulp tissue treated with plasmid pEGFP or CMV-LacZ in 5-10% Optison (Molecular Biosystems Inc., San Diego, CA) and stimulated by ultrasound (1 MHz, 0.5 W/cm(2), 30 sec) showed significant efficiency of gene transfer and high level of protein production selectively in the local region, within 500 microm of the amputated site of the pulp tissue. The Gdf11 cDNA plasmid transferred into dental pulp tissue by sonoporation in vitro, induced the expression of dentin sialoprotein (Dsp), a differentiation marker for odontoblasts. The transfection of Gdf11 by sonoporation stimulated a large amount of reparative dentin formation on the amputated dental pulp in canine teeth in vivo. These results suggest the possible use of BMPs using ultrasound-mediated gene therapy for endodontic dental treatment.

Immunocytochemical investigation of neurovascular relationships in human tooth pulp

This study sought to explore the anatomical relationships between peptidergic nerves and blood vessels within human primary and permanent teeth. Extracted primary and permanent molars (n = 120) were split longitudinally, placed in Zamboni's fixative and the coronal pulps were processed for indirect immunofluorescence. Ten-micrometre-thick serial frozen pulp sections were triple-labelled using combinations of the following antisera: (1) protein gene-product 9.5 (PGP 9.5), a general neuronal marker; (2) one of the neuropeptides, calcitonin gene-related peptide (CGRP), substance P (SP), vasoactive intestinal polypeptide (VIP) or neuropeptide Y (NPY); and (iii) the lectin Ulex europeus, a label for vascular endothelium. The mid-coronal pulp region was examined, using fluorescence microscopy, to determine the proportion of blood vessels showing a positive innervation (recorded when PGP 9.5-labelled nerves appeared to intersect the vessel wall). In addition, the percentage of these vascular-related nerves expressing each of the above neuropeptides was recorded. Overall, 20% of pulpal blood vessels appeared to have a positive innervation. In the main these were thick-walled arterioles. Capillaries, venules and lymphatics were mostly devoid of an associated innervation. Ninety-two per cent of vascular-related nerves expressed CGRP, 87% expressed SP, 15% expressed VIP and 80% expressed NPY. There were no significant differences in overall innervation or peptide-related innervation between primary and permanent teeth (P < 0.05, ANOVA), indicating that pulpal blood flow is likely to be subject to similar neurological control mechanisms in both dentitions.

An immunohistochemical study on hard tissue formation in a subcutaneously transplanted rat molar

While dental pulp undergoes calcification following tooth replantation or transplantation, we actually know little about these mechanisms. We therefore conducted histological and immunohistochemical evaluations of mineralized tissue that formed in the pulp of rat maxillary molar transplanted into abdominal subcutaneous tissue. One, 2, 3, and 4 weeks post-transplantation, the teeth were investigated immunohistochemically using antibodies to osteocalcin (OCN), osteopontin (OPN), bone sialoprotein (BSP), dentin sialoprotein (DSP), and tissue non-specific alkaline phosphatase (TNAP). In the 1st week after transplantation, cell-rich hard tissue was formed at the root apex. At 2 weeks, formations of hard tissue, with few cells in the root canals and bone-like tissue in the coronal pulp chamber, were noted. After 3 and 4 weeks, the amounts of these hard tissues were increased. The immunolocalization of OCN, OPN, and BSP was seen strongly in coronal and apical hard tissues, but weakly in the root hard tissue. Conversely, DSP localized in the root hard tissue, but not in other newly formed hard tissues. At 1 week, TNAP localized along the periphery of the apical hard tissue and the lower surfaces of root predentin. These results demonstrate that the newly formed hard tissues in the pulp cavity of subcutaneously transplanted molars could be classified into three types, suggesting that these might be formed by type-specific cells.

Dentin shear strength: effect of distance from the pulp

OBJECTIVE

Dentin structure varies with orientation and location. Ultimate shear strength (USS) has also been found in previous studies to vary with location. The present study further explores this relationship between USS and various locations in coronal dentin as well as distance from the pulp.

METHODS

Stick specimens were prepared from coronal dentin located in the center or under cusps of human molar teeth. These were tested in the shear mode at various distances from the pulp.

RESULTS

Median values ranged from 52.7 (range 29.0-73.1) MPa near the pulp to 76.7 (range 53.9-104.0) MPa near the dentino-enamel junction. No differences were found among the buccal, central or lingual locations, however, the USS near the pulp was found to be significantly lower.

SIGNIFICANCE

The properties of coronal dentin vary with distance from the pulp, which may affect adhesion and other aspects of restorative dentistry.

Solid-state nuclear magnetic resonance microscopy demonstrating human dental anatomy

OBJECTIVE

Magnetic resonance imaging has become a common diagnostic tool in medical practice. It is a common view that solid-state material lacking a sufficient amount of unpaired nuclear spins, in particular proton spins, is impossible to depict with clinically used magnetic resonance devices. Characteristically rapid dephasing, caused by relatively short spin-spin relaxation (T(2) time) also leads to broad resonance lines. A newly introduced technique, constant-time imaging, uses 3 phase-encoding gradients for the acquisition of only one complex data point per phase-encoding step, resulting in detection times of only a few microseconds and extremely sharp resonance lines.

STUDY DESIGN

Using a Bruker spectrometer AMX 300 WB (300 MHz, 7.1 T) with a microimaging attachment, we performed solid-state magnetic resonance imaging of whole teeth. Data processing was carried out by means of 3-dimensional Fourier analysis, and reconstructions were performed by the ParaVision (Bruker) software system.

RESULTS

Dental hard tissues (enamel, dentin, and root cementum) and pulpal soft tissue could be depicted in 2-dimensional and 3-dimensional images. The voxel resolution isotropically reached 195 microm.

CONCLUSION

The constant-time imaging technique enabled a naturalistic and nondestructive visualization of the teeth without application of ionizing radiation. This technique bears the potential to help us overcome the limitations of clinically used standard magnetic resonance tomography devices and offers new perspectives for dental imaging.

Observation of depth and incidence of the mesial groove between the mesiobuccal and mesiolingual orifices in mandibular molars

The purpose of this study was to analyze the mesiolingual-mesiobuccal groove indentations at the pulpal floor in mandibular first and second molars. The depth and incidence of occurrence were assessed. Sixty freshly extracted, mature teeth were kept in a 2.5% sodium hypochlorite for 5 to 7 days. The teeth were accessed without touching the floor of the chamber. The dental debris was washed thoroughly and then the patency and the presence of two mesial canals were established with a #10 file. The teeth were placed in 2.5% sodium hypochlorite for 3 to 5 days and later rinsed and air-dried before placement in centrifuge tubes. A vinyl polysiloxane impression material was injected into the chambers, and the teeth were centrifuged. The impressions were carefully removed and then measured by using a dissecting microscope and a transparent millimeter ruler. The ruler, at zero, placed at the mid-floor area of the impression and viewed from the mesial, measured (to the nearest 0.5 mm) the depth of the mesial groove between the mesiolingual and mesiobuccal canals. Due to imperfect impressions, 50 teeth were included in the study. The recorded average in depth was 1.0 mm. Some of the impressions had depths measuring 3.5 mm. This could be a significant space when considering the limitations of instrumentation techniques. There is the question of whether this area may remain untouched, thereby effecting the prognosis of treatment in both vital and nonvital teeth. Modifications in access preparation and/or an increased emphasis on irrigation and intracanal medication may be needed.

Age-related and site-specific changes in the pulpodentinal morphology of rat molars

The rat molars are frequently used as experimental models in endodontic research, but there is little systematic information available on the influence of age on the pulpodentinal organ in Wistar rat molars and it is often difficult to evaluate more subtle changes following experimental interventions. The aim here was to describe changes with age in first upper Wistar rat molars with specific reference to the pulpodentinal organ. Animals were perfused with glutaraldehyde at 19 days, 1, 3, 6, 8, 12, 16, or 24 months of age. First upper molars from 56 animals were demineralized in EDTA, embedded in Epon, and processed for light and transmission electron microscopy. Substantial variation in the structure of the dentine and odontoblasts was observed within the root canals and the coronal pulp chamber. In general, odontoblasts changed from a tall, columnar morphology in the coronal pulp chamber to a more cuboidal or flattened shape near the apex, particularly towards the interradicular space. Secondary dentine formation was more pronounced along the mesial aspect of the root chamber and corresponding to the bottom of fissures. Local tertiary dentine formation was layered in the upper pulp chamber, corresponding to occlusal attrition of the cusp. In several molars a local formation of irregular tertiary dentine was observed cervically in the mesial pulp chamber. After 1 year, a distinct protrusion of irregular dentine extended into the mesiocervical pulp, apparently corresponding to a denudation of cervical root dentine. Experimental pulp-capping studies frequently use first upper rat molars with perforations made through the mesial aspect of the crown; such perforations might be close to the irregular dentine in the mesiocervical region. In conclusion, this study identifies age-associated and regional changes of pulpodentinal morphology in first upper rat molars. Therefore, evaluation of morphological alterations following vital-pulp experiments should be done in specific age groups and at specific sites in the pulp.

Age-related odontometric changes of human teeth

OBJECTIVE

The number of older patients requiring restorative treatment are likely to increase due to improvements in oral health and increased longevity. However, aging odontometric data are lacking. The aim of this study was to determine possible changes in pulp cell density, pulp area, and dentinal thickness with age.

STUDY DESIGN

Incisors (50), canines (39), premolars (51), and molars (7) extracted from 60 patients aged between 10 and 59 years, were analyzed histomorphometrically for cell density (odontoblasts, subodontoblasts, and pulp core fibroblasts) and dentinal thickness.

RESULTS

With increasing patient age, in both crown and root aspects of teeth, dentinal thickness increased (P <.001), while the density of odontoblasts (P <.001), subodontoblasts (P = 0.001), and pulp fibroblasts (crown, P <.011; root, P =.0015) decreased. The degree of age-related changes in teeth appeared to be asymmetrical, with decreases in the root being greater than in the crown. At all ages pulp cell densities, including odontoblasts, within the crown were greater than in the root (P <.001), even though the calculated rate of dentinal deposition was greatest in the root.

CONCLUSION

Decreases in pulp cell density may reduce pulp repair activity after restorative treatments, although increases in dentinal thickness may aid pulp protection. An understanding of these age-related changes will influence the provision of restorative and endodontic care and benefit older patients.

Replacement of resin-based composite: evaluation of cavity design, cavity depth, and shade matching

OBJECTIVE

The aim of this study was to evaluate the effect of different cavity designs, cavity depths, and shade matching on the dimensions of Class I resin-based composite preparations during replacement of the restoration.

METHOD AND MATERIALS

Forty Class I cavity preparations were prepared in extracted premolars. The occlusal depths varied from 1.5 to 2.5 mm. In 20 teeth, the buccal and lingual walls were perpendicular to the pulpal floor; in another 20, they were divergent to the pulpal floor. Impressions were made of all preparations. The cavities were restored with resin-based composite. All subgroups were further divided into another two subgroups (n = 5), in which half of the teeth were restored with shade that matched the tooth and the other half were restored with a resin composite that was three shades different from the tooth. After 168 hours in distilled water, the restorations were removed. New impressions were made, and a total of 80 stone casts were fabricated. The perimeter and area of the restorations were recorded with a video-based imaging system. The dimensions of the postoperative cavity preparations were compared to the initial cavity sizes.

RESULTS

The depth of the original cavity preparation had a statistically significant effect on the change in cavity dimension, as measured by area and perimeter. The 2.5-mm-deep cavities showed greater loss of tooth structure. No statistically significant difference was found for different cavity designs or shade matching.

CONCLUSION

Replacement of Class I resin-based composite restorations results in loss of tooth structure. The deeper the original cavity preparation, the greater the loss of tooth structure at the occlusal cavosurface margin during replacement.

A comparison of the supra-alveolar pulp size of impeded and unimpeded mandibular rat incisors using micro-computed tomography

The pulp space is almost totally obliterated in the incisal end of a mandibular rat incisor. Repeated shortening of the incisor has been shown to increase the pulp space below the alveolar bone level; however, little is known about that above the alveolar bone level. This study investigated the changes in the pulp space superior to the bone level after rendering the incisor unimpeded for a period of three weeks. A desktop micro-computed tomography scanning unit, which is non-invasive, non-destructive, accurate, less technique sensitive and less time consuming than conventional methods, was used to calculate the volume of the pulp space. The results showed that the pulp size increased 140% at a level 3 mm below the alveolar bone margin and more than 700% at a level 2.5 mm above the alveolar bone. Moreover, the bone level of the unimpeded incisor was found to move incisally 0.4-0.5 mm; while deposition of dentine on the mesial and distal aspects of the pulp space were affected differently to that on the buccal and lingual sides.

Multifactorial analysis of an MOD restored human premolar using auto-mesh finite element approach

The use of an mesial-occlusal-distal (MOD) restoration in repairing a large carious lesion depends on many factors. Biomechanical performance is one of the most important. It has been recognized that resistance to restoration failure is not solely a biological concern (e.g. toxicity), but that the cavity shape, dimensions, and the state of stress must all be taken into account. In the present study, a newly developed auto-mesh program was used to generate 30 three-dimensional (3D) finite element (FE) models simulating the biomechanics for multiple factorial design of the MOD gold restoration in a maxillary second premolar. Stress levels were related to individual design factors (e.g. pulpal wall depth [P], isthmus width [W] and interaxial thickness [T]) and to their interactions under the worst physiological scenario: a concentrated bite force acting on lingual cusp with debonded interfaces between cavity walls and restorations. The results showed that enlarging the volume of the MOD cavity significantly increased stresses in enamel but did not intentionally affect stresses in dentin. The alternation of individual design parameters significantly changed the peak stresses (P < 0.05). For all three parameters, except for the width, the peak stress increased as the cavity dimension increased. Stress elevation rate (termed as 'volumetric stress rate'--stress elevation by increasing one unit volume of the restored materials) was different among three design factors. Depth was the most critical factor governing the stress elevation in enamel (1.76 MPa mm(-3)) while length (interaxial thickness) was the most important parameter in dentin (0.49 MPa mm(-3)). Width was the least compromising factor to the remaining tooth, 0.32 MPa mm(-3) for enamel and -0.23 MPa mm(-3) for dentin. The findings, at its core, did not fully agree with the traditional concept that the preservation of tooth substances will reduce risk of tooth fracture. This study leaves open possibility for the structural optimization of the MOD restoration.

Numerical investigation of the factors affecting interfacial stresses in an MOD restored tooth by auto-meshed finite element method

Many researches have addressed the high correlation between the fracture of restored teeth and the prepared cavity geometry. In addition, concerns about bonding versus debonding dental materials from cavity walls and different occlusal force conditions could also alter the mechanical responses in a restored tooth. This study employed an automatic mesh procedure to investigate the mechanical interactions between different interfacial conditions and cavity parameters such as pulpal wall depth under different chewing functions. The results indicated that when occlusal force was applied directly on the tooth, it could increase unfavourable stress dramatically. When interfacial fixation was simulated as the contact condition between the tooth tissue and restorative material, it might increase the fracture potential exponentially compared with the bonded interface. For pulpal wall depth analyses, greater risks of fracture for the remaining tooth were observed in deeper cavity of mesio-occlusal-distal (MOD) restorations and the existence of a pulpal wall is essential even it is only 1 mm above the gingival wall.

Pulp-dentin biology in restorative dentistry. Part 1: normal structure and physiology

Considerable knowledge has accumulated over the years on the structure and function of the dental pulp and dentin. Some of this knowledge has important clinical implications. This review, which is the first of seven articles, will be limited to those parts of the normal structure and physiology of the pulp and dentin that have been shown to result in, or are likely lead to, tissue reactions associated with the clinical treatment of these tissues. Although certain normal structures will be highlighted in some detail, a basic knowledge of pulpal and dentinal development and structure is a prerequisite for an understanding of this text.