The crucial role of periodontal ligament's Poisson's ratio and tension-compression asymmetric moduli on the evaluation of tooth displacement and stress state of periodontal ligament

The hydrostatic stress in the periodontal ligament (PDL) evaluated by finite element analysis is considered an important indicator for determining an appropriate orthodontic force. The computed result of the hydrostatic stress strongly depends on the PDL material model used in the orthodontic simulation. This study aims to investigate the effects of PDL Poisson's ratio and tension-compression asymmetric moduli on both the simulated tooth displacement and the PDL hydrostatic stress. Three tension-compression symmetric and two asymmetric PDL constitutive models were selected to simulate the tensile and compressive behavior of a PDL specimen under uniaxial loading, and the resulting numerical results were compared with the in-vitro PDL experimental results reported in the literature. Subsequently, a tooth model was established, and the selected constitutive models and parameters were employed to assess the hydrostatic stress state in the PDL under two distinct loading conditions. The simulated results indicate that PDL Poisson's ratio and tension-compression asymmetry exert substantial influences on the simulated PDL hydrostatic stress. Conversely, the elastic modulus exhibits minimal impact on the PDL stress state under the identical loading conditions. Furthermore, the PDL models with tension-compression asymmetric moduli and appropriate Poisson's ratio yield more realistic hydrostatic stress. Hence, it is imperative to employ suitable Poisson's ratio and tension-compression asymmetric moduli for the purpose of characterizing the biomechanical response of the PDL in orthodontic simulations.

Cyclic Stretching Triggers Cell Orientation and Extracellular Matrix Remodeling in a Periodontal Ligament 3D In Vitro Model

During orthodontic tooth movement (OTM), the periodontal ligament (PDL) plays a crucial role in regulating the tissue remodeling process. To decipher the cellular and molecular mechanisms underlying this process in vitro, suitable 3D models are needed that more closely approximate the situation in vivo. Here, a customized bioreactor is developed that allows dynamic loading of PDL-derived fibroblasts (PDLF). A collagen-based hydrogel mixture is optimized to maintain structural integrity and constant cell growth during stretching. Numerical simulations show a uniform stress distribution in the hydrogel construct under stretching. Compared to static conditions, controlled cyclic stretching results in directional alignment of collagen fibers and enhances proliferation and spreading ability of the embedded PDLF cells. Effective force transmission to the embedded cells is demonstrated by a more than threefold increase in Periostin protein expression. The cyclic stretch conditions also promote extensive remodeling of the extracellular matrix, as confirmed by increased glycosaminoglycan production. These results highlight the importance of dynamic loading over an extended period of time to determine the behavior of PDLF and to identify in vitro mechanobiological cues triggered during OTM-like stimulus. The introduced dynamic bioreactor is therefore a useful in vitro tool to study these mechanisms.

Effects of aligner activation and power arm length and material on canine displacement and periodontal ligament stress: a finite element analysis

BACKGROUND

This study aimed to assess the impact of aligner activation and power arm length and material on canine and aligner displacement, von Mises stress in the power arm, and principal stress in the periodontal ligament (PDL) during canine tooth distalization using finite element analysis (FEA). The effects of aligner activation and power arm length were primary outcomes, while the effect of the power arm material was a secondary outcome.

METHODS

Aligner activation (0.1 mm or 0.2 mm) was applied without using a power arm in two models. The effects of aligner activation, power arm length (12, 13, or 14 mm) and power arm material (stainless steel [SS] or fiber-reinforced composite [FRC]) on canine distalization were investigated in 12 models by evaluating displacement and stress via ALTAIR OptiStruct analysis.

RESULTS

Greater canine displacement was observed in all models with 0.2 mm than 0.1 mm of aligner activation. When models with the same aligner activation were compared, reduced mesiodistal tipping, increased palatal tipping, and increased extrusion of the canine cusp were observed with increasing power arm length. Moreover, the von Mises stress increased as the power arm length increased. Increasing the aligner activation and power arm length increased the maximum principal stress in the PDL. Power arms of the same length in both materials showed the same results in terms of canine displacement, clear aligner displacement, and maximum principal stress in the PDL. However, under conditions of equal length and aligner activation, the von Mises stress of the SS power arm was higher than that of the FRC power arm.

CONCLUSION

Using a power arm in canine distalization reduced mesiodistal tipping but increased palatal tipping and extrusion of the canine cusp. Aligner activation and additional force increased tooth movement and principal stress in the canine PDL. FRC power arms exhibited less von Mises stress than SS power arms.

[Study on quantitative analysis of bracket-induced nonlinear response of labio-cheek soft tissue during the orthodontic process]

In the orthodontics process, intervention and sliding of an orthodontic bracket during the orthodontic process can arise large response of the labio-cheek soft tissue. Soft tissue damage and ulcers frequently happen at the early stage of orthodontic treatment. In the field of orthodontic medicine, qualitative analysis is always carried out through statistics of clinical cases, while quantitative explanation of bio-mechanical mechanism is lacking. For this purpose, finite element analysis of a three-dimensional labio-cheek-bracket-tooth model is conducted to quantify the bracket-induced mechanical response of the labio-cheek soft tissue, which involves complex coupling of contact nonlinearity, material nonlinearity and geometric nonlinearity. Firstly, based on the biological composition characteristics of labio-cheek, a second-order Ogden model is optimally selected to describe the adipose-like material of the labio-cheek soft tissue. Secondly, according to the characteristics of oral activity, a two-stage simulation model of bracket intervention and orthogonal sliding is established, and the key contact parameters are optimally set. Finally, the two-level analysis method of overall model and submodel is used to achieve efficient solution of high-precision strains in submodels based on the displacement boundary obtained from the overall model calculation. Calculation results with four typical tooth morphologies during orthodontic treatment show that: ① the maximum strain of soft tissue is distributed along the sharp edges of the bracket, consistent with the clinically observed profile of soft tissue deformation; ② the maximum strain of soft tissue is reduced as the teeth align, consistent with the clinical manifestation of common damage and ulcers at the beginning of orthodontic treatment and reduced patient discomfort at the end of treatment. The method in this paper can provide reference for relevant quantitative analysis studies in the field of orthodontic medical treatment at home and abroad, and further benefit to the product development analysis of new orthodontic devices.

Immunomodulatory nanotherapeutic approaches for periodontal tissue regeneration

Periodontitis is an infection-induced inflammatory disease characterized by progressive destruction of tooth supporting tissues, which, if left untreated, can result in tooth loss. The destruction of periodontal tissues is primarily caused by an imbalance between the host immune protection and immune destruction mechanisms. The ultimate goal of periodontal therapy is to eliminate inflammation and promote the repair and regeneration of both hard and soft tissues, so as to restore the physiological structure and function of periodontium. Advancement in nanotechnologies has enabled the development of nanomaterials with immunomodulatory properties for regenerative dentistry. This review discusses the immune mechanisms of the major effector cells in the innate and adaptive immune systems, the physicochemical and biological properties of nanomaterials, and the research advancements in immunomodulatory nanotherapeutic approaches for the management of periodontitis and the regeneration of periodontal tissues. The current challenges, and prospects for future applications of nanomaterials are then discussed so that researchers at the intersections of osteoimmunology, regenerative dentistry and materiobiology will continue to advance the development of nanomaterials for improved periodontal tissue regeneration.

Assessment of the Maximum Amount of Orthodontic Force for PDL in Intact and Reduced Periodontium (Part I)

This study examines 0.6 N and 1.2 N as the maximum orthodontic force for periodontal ligament (PDL) at multiple levels of periodontal breakdown, and the relationships with the ischemic, necrotic, and resorptive risks. Additionally, this study evaluates if Tresca failure criteria is more adequate for the PDL study. Eighty-one 3D models (from nine patients; nine models/patients) with the 2nd lower premolar and different degrees of bone loss (0-8 mm) where subjected to intrusion, extrusion, rotation, translation, and tipping movements. Tresca shear stress was assessed individually for each movement and bone loss level. Rotation and translation produced the highest PDL stresses, while intrusion and extrusion determined the lowest. Apical and middle third PDL stresses were lower than the cervical stress. In intact periodontium, the amount of shear stress produced by the two investigated forces was lower than the 16 KPa of the maximum physiological hydrostatic pressure (MHP). In reduced periodontium (1-8 mm tissue loss), the apical amount of PDL shear stress was lower than MHP for both applied forces, while cervically for rotation, translation and tipping movements exceeded 16 KPa. Additionally, 1.2 N could be used in intact periodontium (i.e., without risks) and for the reduced periodontium only in the apical and middle third of PDL up to 8 mm of bone loss. However, for avoiding any resorptive risks, in the cervical third of PDL, the rotation, translation, and tipping movements require less than 0.2-0.4 N of force after 4 mm of loss. Tresca seems to be more adequate for the study of PDL than other criteria.

Assessment of the Best FEA Failure Criteria (Part I): Investigation of the Biomechanical Behavior of PDL in Intact and Reduced Periodontium

The accuracy of five failure criterions employed in the study of periodontal ligaments (PDL) during periodontal breakdown under orthodontic movements was assessed. Based on cone-beam computed tomography (CBCT) examinations, nine 3D models of the second lower premolar with intact periodontium were created and individually subjected to various levels of horizontal bone loss. 0.5 N of intrusion, extrusion, rotation, tipping, and translation was applied. A finite Elements Analysis (FEA) was performed, and stresses were quantitatively and qualitatively analyzed. In intact periodontium, Tresca and Von Mises (VM) stresses were lower than maximum physiological hydrostatic pressure (MHP), while maximum principal stress S1, minimum principal stress S3, and pressure were higher. In reduced periodontium, Tresca and VM stresses were lower than MHP for intrusion, extrusion, and the apical third of the periodontal ligament for the other movements. 0.5 N of rotation, translation and tipping induced cervical third stress exceeding MHP. Only Tresca (quantitatively more accurate) and VM are adequate for the study of PDL (resemblance to ductile), being qualitatively similar. A 0.5 N force seems safe in the intact periodontium, and for intrusion and extrusion up to 8 mm bone loss. The amount of force should be reduced to 0.1-0.2 N for rotation, 0.15-0.3 N for translation and 0.2-0.4 N for tipping in 4-8 mm periodontal breakdown. S1, S3, and pressure criteria provided only qualitative results.

The Bone Sialoprotein RGD Domain Modulates and Maintains Periodontal Development

Bone sialoprotein (gene: Ibsp; protein: BSP) is a multifunctional extracellular matrix protein present in bone, cementum, and dentin. Accumulating evidence supports BSP as a key regulator of mineralized tissue formation via evolutionarily conserved functional domains, including a C-terminal integrin-binding Arg-Gly-Asp (RGD) domain implicated in extracellular matrix-cell signaling. Ablation of Ibsp in mice (Ibsp-/-) results in impaired bone growth and mineralization and defective osteoclastogenesis, with effects in the craniofacial region including reduced acellular cementum formation, detachment of the periodontal ligament (PDL), alveolar bone hypomineralization, and severe periodontal breakdown. We hypothesized that BSP-RGD plays an important role in cementum and alveolar bone formation and mineralization, as well as periodontal function. This hypothesis was tested by replacing the RGD motif with a nonfunctional Lys-Ala-Glu (KAE) sequence in (IbspKAE/KAE) mice and OCCM.30 murine (IbspKAE) cementoblasts. The RGD domain was not critical for acellular or cellular cementum formation in IbspKAE/KAE mice. However, PDL volume and thickness were increased, and significantly more tartrate-resistant acid phosphatase-positive osteoclasts were found on alveolar bone surfaces of IbspKAE/KAE mice versus wild type mice. PDL organization was disrupted as indicated by picrosirius red stain, second harmonic generation imaging, dynamic mechanical analysis, and decreased asporin proteoglycan localization. In vitro studies implicated RGD functions in cell migration, adhesion, and mineralization, and this was confirmed by an ossicle implant model where cells lacking BSP-RGD showed substantial defects as compared with controls. In total, the BSP-RGD domain is implicated in periodontal development, though the scale and scope of changes indicated by in vitro studies indicate that other factors may partially compensate for and reduce the phenotypic severity of mice lacking BSP-RGD in vivo.

Gold Nanoparticles Promote the Bone Regeneration of Periodontal Ligament Stem Cell Sheets Through Activation of Autophagy

OBJECTIVE

Cell sheet technology (CST) is advantageous for repairing alveolar bone defects in clinical situations, and osteogenic induction before implantation may result in enhanced bone regeneration. Herein, we observed the effect of gold nanoparticles (AuNPs) on osteogenic differentiation of periodontal ligament stem cell (PDLSC) sheets and explored their potential mechanism of action.

METHODS

PDLSCs were cultured in cell sheet induction medium to obtain cell sheets. PDLSC sheets were treated with or without AuNPs. Alkaline phosphatase, alizarin red S, von Kossa, and immunofluorescence staining were used to observe the effects of AuNPs on the osteogenic differentiation of PDLSC sheets. Western blotting was performed to evaluate the osteogenic effects and autophagy activity. The cell sheets were transplanted into the dorsa of nude mice, and bone regeneration was analyzed by micro-CT and histological staining.

RESULTS

AuNPs could promote the osteogenic differentiation of PDLSC sheets by upregulating bone-related protein expression and mineralization. The 45-nm AuNPs were more effective than 13-nm AuNPs. Additional analysis demonstrated that their ability to promote differentiation could depend on activation of the autophagy pathway through upregulation of microtubule-associated protein light chain 3 and downregulation of sequestosome 1/p62. Furthermore, AuNPs significantly promoted the bone regeneration of PDLSC sheets in ectopic models.

CONCLUSION

AuNPs enhance the osteogenesis of PDLSC sheets by activating autophagy, and 45-nm AuNPs were more effective than 13-nm AuNPs. This study may provide an AuNP-based pretreatment strategy for improving the application of CST in bone repair and regeneration.

Effects of histamine on human periodontal ligament fibroblasts under simulated orthodontic pressure

As type-I-allergies show an increasing prevalence in the general populace, orthodontic patients may also be affected by histamine release during treatment. Human periodontal ligament fibroblasts (PDLF) are regulators of orthodontic tooth movement. However, the impact of histamine on PDLF in this regard is unknown. Therefore PDLF were incubated without or with an orthodontic compressive force of 2g/cm² with and without additional histamine. To assess the role of histamine-1-receptor (H1R) H1R-antagonist cetirizine was used. Expression of histamine receptors and important mediators of orthodontic tooth movement were investigated. PDLF expressed histamine receptors H1R, H2R and H4R, but not H3R. Histamine increased the expression of H1R, H2R and H4R as well as of interleukin-6, cyclooxygenase-2, and prostaglandin-E2 secretion even without pressure application and induced receptor activator of NF-kB ligand (RANKL) protein expression with unchanged osteoprotegerin secretion. These effects were not observed in presence of H1R antagonist cetirizine. By expressing histamine receptors, PDLF seem to be able to respond to fluctuating histamine levels in the periodontal tissue. Increased histamine concentration was associated with enhanced expression of proinflammatory mediators and RANKL, suggesting an inductive effect of histamine on PDLF-mediated osteoclastogenesis and orthodontic tooth movement. Since cetirizine inhibited these effects, they seem to be mainly mediated via histamine receptor H1R.

Frequency-related viscoelastic properties of the human incisor periodontal ligament under dynamic compressive loading

Studies concerning the mechanical properties of the human periodontal ligament under dynamic compression are rare. This study aimed to determine the viscoelastic properties of the human periodontal ligament under dynamic compressive loading. Ten human incisor specimens containing 5 maxillary central incisors and 5 maxillary lateral incisors were used in a dynamic mechanical analysis. Frequency sweep tests were performed under the selected frequencies between 0.05 Hz and 5 Hz with a compression amplitude that was 2% of the PDL's initial width. The compressive strain varied over a range of 4%-8% of the PDL's initial width. The storage modulus, ranging from 28.61 MPa to 250.21 MPa, increased with the increase in frequency. The loss modulus (from 6.00 MPa to 49.28 MPa) also increased with frequency from 0.05 Hz- 0.5 Hz but remained constant when the frequency was higher than 0.5 Hz. The tanδ showed a negative logarithmic correlation with frequency. The dynamic moduli and the loss tangent of the central incisor were higher than those of the lateral incisor. This study concluded that the human PDL exhibits viscoelastic behavior under compressive loadings within the range of the used frequency, 0.05 Hz- 5 Hz. The tooth position and testing frequency may have effects on the viscoelastic properties of PDL.

GLP-1 inhibits PKCβ2 phosphorylation to improve the osteogenic differentiation potential of hPDLSCs in the AGE microenvironment

BACKGROUND AND OBJECTIVE

Advanced glycation end products (AGEs) have been hypothesized as the etiologic factors of diabetic periodontitis. The discovery of incretins (including GLP-1 and GIP) provides a novel therapy for the treatment of diabetes. Recent reports have shown that glucagon-like peptide-1 (GLP-1) is an important modulator of bone growth and remodeling. The aim of this study was to clarify the mechanism of how GLP-1 weakens/inhibits the effect of AGEs in hPDLSCs (human periodontal ligament stem cells).

MATERIALS AND METHODS

The hPDLSCs were cultured under simulated conditions of osteogenic culture, AGEs, AGEs + GLP-1, AGEs + GLP-1 + PMA and AGEs + GLP-1 + LY333531. The phenomenon and related mechanism of cell osteogenesis under different microenvironments were evaluated by Alizarin red staining, ALP staining and quantitative activity measurement, RT-qPCR, western blotting and immunofluorescence staining.

RESULTS

RT-qPCR showed that AGEs negatively regulated the expression of osteogenic differentiation markers (ALP, BSP, OPN, and Runx2); in contrast, GLP-1 increased the expression of these markers. Furthermore, the expression of RAGE and pPKCβ (PKC phosphorylation) in the AGE group was upregulated, while the expression of RAGE and pPKCβ was decreased in the GLP-1 group compared with the AGE group.

CONCLUSIONS

AGEs impaired the osteogenic potential of hPDLSCs via PKCβ2. Our phenomenon showed that GLP-1 could reverse the function of AGEs on osteogenic potential. In addition, the mechanism of GLP-1 weakens/inhibits the effect of AGEs in hPDLSCs, possibly by inhibiting PKCβ2 phosphorylation.

Monitoring Biochemical and Structural Changes in Human Periodontal Ligaments during Orthodontic Treatment by Means of Micro-Raman Spectroscopy

The aim of the study was to examine the biochemical and structural changes occurring in the periodontal ligament (PDL) during orthodontic-force application using micro-Raman spectroscopy ( μ -RS). Adolescent and young patients who needed orthodontic treatment with first premolar extractions were recruited. Before extractions, orthodontic forces were applied using a closed-coil spring that was positioned between the molar and premolar. Patients were randomly divided into three groups, whose extractions were performed after 2, 7, and 14 days of force application. From the extracted premolars, PDL samples were obtained, and a fixation procedure with paraformaldehyde was adopted. Raman spectra were acquired for each PDL sample in the range of 1000-3200 cm - 1 and the more relevant vibrational modes of proteins (Amide I and Amide III bands) and CH 2 and CH 3 modes were shown. Analysis indicated that the protein structure in the PDL samples after different time points of orthodontic-force application was modified. In addition, changes were observed in the CH 2 and CH 3 high wavenumber region due to local hypoxia and mechanical force transduction. The reported results indicated that μ -RS provides a valuable tool for investigating molecular interchain interactions and conformational modifications in periodontal fibers after orthodontic tooth movement, providing quantitative insight of time occurring for PDL molecular readjustment.

Extracellular Matrix Induces Periodontal Ligament Reconstruction In Vivo

One of the problems in dental implant treatment is the lack of periodontal ligament (PDL), which supports teeth, prevents infection, and transduces sensations such as chewiness. The objective of the present study was to develop a decellularized PDL for supporting an artificial tooth. To this end, we prepared mouse decellularized mandible bone with a PDL matrix by high hydrostatic pressure and DNase and detergent treatments and evaluated its reconstruction in vivo. After tooth extraction, the decellularized mandible bone with PDL matrix was implanted under the subrenal capsule in rat and observed that host cells migrated into the matrix and oriented along the PDL collagen fibers. The extracted decellularized tooth and de- and re-calcified teeth, which was used as an artificial tooth model, were re-inserted into the decellularized mandible bone and implanted under the subrenal capsule in rat. The reconstructed PDL matrix for the extracted decellularized tooth resembled the decellularized mandible bone without tooth extraction. This demonstrates that decellularized PDL matrix can reconstruct PDL tissue by controlling host cell migration, which could serve as a novel periodontal treatment approach.

Periodontal Bone-Ligament-Cementum Regeneration via Scaffolds and Stem Cells

Periodontitis is a prevalent infectious disease worldwide, causing the damage of periodontal support tissues, which can eventually lead to tooth loss. The goal of periodontal treatment is to control the infections and reconstruct the structure and function of periodontal tissues including cementum, periodontal ligament (PDL) fibers, and bone. The regeneration of these three types of tissues, including the re-formation of the oriented PDL fibers to be attached firmly to the new cementum and alveolar bone, remains a major challenge. This article represents the first systematic review on the cutting-edge researches on the regeneration of all three types of periodontal tissues and the simultaneous regeneration of the entire bone-PDL-cementum complex, via stem cells, bio-printing, gene therapy, and layered bio-mimetic technologies. This article primarily includes bone regeneration; PDL regeneration; cementum regeneration; endogenous cell-homing and host-mobilized stem cells; 3D bio-printing and generation of the oriented PDL fibers; gene therapy-based approaches for periodontal regeneration; regenerating the bone-PDL-cementum complex via layered materials and cells. These novel developments in stem cell technology and bioactive and bio-mimetic scaffolds are highly promising to substantially enhance the periodontal regeneration including both hard and soft tissues, with applicability to other therapies in the oral and maxillofacial region.

Effects of ethanol on human periodontal ligament fibroblasts subjected to static compressive force

Consumption of toxic substances such as alcohol is widespread in the general population and thus also in patients receiving orthodontic treatment. Since human periodontal ligament (hPDL) fibroblasts play a key role in orthodontic tooth movement (OTM) by expressing cytokines and chemokines, we wanted to clarify whether ethanol modulates the physiological activity and expression pattern of hPDL fibroblasts during static compressive force application. We pre-incubated hPDL fibroblasts for 24 h with different ethanol concentrations, corresponding to casual (0.041% blood alcohol concentration [BAC], % by volume) and excessive (0.179%) alcohol consumption. At each ethanol concentration, we incubated the cells for another 48 h with and without an additional physiological compressive force of 2 g/cm² occurring during orthodontic tooth movement in compression areas of the periodontal ligament. Thereafter, we analyzed expression and secretion of genes and proteins involved in OTM regulation by RT-qPCR and ELISA. We also performed co-culture experiments to observe hPDL-fibroblast-mediated osteoclastogenesis. We observed no effects of ethanol on cytotoxicity or cell viability of hPDL fibroblasts in the applied concentrations. Ethanol showed an enhancing effect on angiogenesis and activity of alkaline phosphatase. Simultaneously, ethanol reduced the induction of IL-6 and increased prostaglandin E₂ synthesis as well as hPDL-fibroblast-mediated osteoclastogenesis without affecting the RANK-L/OPG-system. hPDL fibroblasts thus seem to be a cell type quite resistant to ethanol, as no cytotoxic effects or influence on cell viability were detected. High ethanol concentrations, however, seem to promote bone formation and angiogenesis. Ethanol at 0.179% also enhanced hPDL-induced osteoclastogenesis, indicating increased bone resorption and thus tooth movement velocity to be expected during orthodontic therapy.

Building capacity for macrophage modulation and stem cell recruitment in high-stiffness hydrogels for complex periodontal regeneration: Experimental studies in vitro and in rats

Recently, we found that although high-stiffness matrices stimulated osteogenic differentiation of bone marrow-derived stromal cells (BMSCs), the macrophages (Mφs) in high-stiffness transglutaminase crosslinked gelatins (TG-gels) tended to undergo M1 polarization and hence compromised cell osteogenesis. In this study, we hypothesized that the copresentation of interleukin (IL)-4 and stromal cell-derived factor (SDF)-1α in high-stiffness TG-gels may enhance periodontal regeneration by modulating Mφ polarization and promoting endogenous stem cell recruitment. We found that Mφs were more likely to polarize toward an immunomodulatory M2 state in the presence of IL-4 and hence positively influence the osteogenic differentiation of BMSCs when these cells coexisted in either indirect or direct co-culture systems. In cell migration assays, BMSCs exhibited an enhanced capability to move toward gels containing SDF-1α, and more cells could be recruited into the three-dimensional matrix of TG-gels. When TG-gels containing IL-4 and/or SDF-1α were used to repair periodontal defects, more new bone (MicroCT) was formed in animals that received the dual cytokine-loaded transplants at 4 weeks postsurgery. Mφs were recruited to all the transplanted gels, and after one week, more M1-phenotype cells were found in the groups without IL-4, while the presence of IL-4 was more likely to result in M2 polarization (immunofluorescence staining). When the tissue biopsies were histologically examined, the TG-gels containing both IL-4 and SDF-1α led to a generally satisfactory regeneration with respect to attachment recovery (epithelial and connective tissue) and hybrid tissue regeneration (bone, periodontal ligament and cementum). Our data suggest that the incorporation of IL-4 into high-stiffness TG-gels may promote the M2 polarization of Mφs and that SDF-1α can be applied to guide endogenous cell homing. Overall, building capacity for Mφ modulation and cell recruitment in high-stiffness hydrogels represents a simple and effective strategy that can support high levels of periodontal tissue regeneration. STATEMENT OF SIGNIFICANCE: The development of hydrogel-based regenerative therapies centered on the mobilization and stimulation of native cells for therapeutics opens a window toward realizing periodontal endogenous regeneration. In the present study, the parallel use of immunomodulatory and homing factors in high-stiffness hydrogel materials is shown to induce stem cell homing, modulate cell differentiation and indeed induce regrowth of the periodontium. We found that incorporation of interleukin (IL)-4 in high-stiffness TG-gels coaxed macrophages to polarize into M2 phenotypes, and stromal cell-derived factor (SDF)-1α could be applied to direct endogenous cell homing. Hence, we present for the first time a clinically relevant strategy based on macrophage modulation and host cell recruitment that can support high levels of periodontal tissue regeneration.

Concise Review: Periodontal Tissue Regeneration Using Stem Cells: Strategies and Translational Considerations

Periodontitis is a widespread disease characterized by inflammation-induced progressive damage to the tooth-supporting structures until tooth loss occurs. The regeneration of lost/damaged support tissue in the periodontium, including the alveolar bone, periodontal ligament, and cementum, is an ambitious purpose of periodontal regenerative therapy and might effectively reduce periodontitis-caused tooth loss. The use of stem cells for periodontal regeneration is a hot field in translational research and an emerging potential treatment for periodontitis. This concise review summarizes the regenerative approaches using either culture-expanded or host-mobilized stem cells that are currently being investigated in the laboratory and with preclinical models for periodontal tissue regeneration and highlights the most recent evidence supporting their translational potential toward a widespread use in the clinic for combating highly prevalent periodontal disease. We conclude that in addition to in vitro cell-biomaterial design and transplantation, the engineering of biomaterial devices to encourage the innate regenerative capabilities of the periodontium warrants further investigation. In comparison to cell-based therapies, the use of biomaterials is comparatively simple and sufficiently reliable to support high levels of endogenous tissue regeneration. Thus, endogenous regenerative technology is a more economical and effective as well as safer method for the treatment of clinical patients. Stem Cells Translational Medicine 2019;8:392-403.

Can interfaces at bracket-wire and between teeth in multi-teeth finite element model be simplified?

OBJECTIVE

Finite element (FE) method's correctness depends heavily on modeling method. This study aimed at determining whether the interfaces at bracket-wire and between teeth can be simplified for multi-teeth FE analysis.

METHOD

A three-dimensional FE model of a mandible was created from cone-beam computed tomography scan. Due to symmetry, only a half of the mandible was modeled, which consisted of five teeth (first premolar extraction and only first molar), brackets and archwire, periodontal ligament (PDL), cortical bone, and cancellous bone. All the bone, teeth, and PDL were considered to be isotropic and linear. The En-masse retraction case was simulated. A detailed model, which has contact elements between the bracket and archwire and between teeth, was developed to allow relative motion at the interfaces. A model with simplified interfacial conditions, which does not allow the relative motion, was also created. The stresses and displacements as results of the treatment on these two models were calculated and compared.

RESULTS

The stress and displacement distributions from the detailed model were more close to reality based on the expected displacement pattern of the clinical case than from the simplified model. The maximum stresses from the two methods were also different. The highest stress from the detailed model is twice as high as from the simplified model.

CONCLUSIONS

The detailed model provides much more reasonable results than the simplified model. Thus, the simplified model should not be used to replace the detailed model if the stress magnitude and highest stress location are the expected outcomes.

Viscoelastic properties of human periodontal ligament: Effects of the loading frequency and location

OBJECTIVES

To determine the viscoelastic properties of the human periodontal ligament (PDL) using dynamic mechanical analysis (DMA).

MATERIALS AND METHODS

This study was carried out on three human maxillary jaw segments containing six upper central incisors and four lateral incisors. DMA was used to investigate the mechanical response of the human PDL. Dynamic sinusoidal loading was carried out with an amplitude of 3 N and frequencies between 0.5 Hz and 10 Hz. All samples were grouped by tooth positions and longitudinal locations.

RESULTS

An increase of oscillation frequency resulted in marked changes in the storage and loss moduli of the PDL. The storage modulus ranged from 0.808 MPa to 7.274 MPa, and the loss modulus varied from 0.087 MPa to 0.891 MPa. The tanδ, representing the ratio between viscosity and elasticity, remained constant with frequency. The trends for storage and loss moduli were described by exponential fits. The dynamic moduli of the central incisor were higher than those of the lateral incisor. The PDL samples from the gingival third of the root showed lower storage and loss moduli than those from the middle third of the root.

CONCLUSIONS

Human PDL is viscoelastic through the range of frequencies tested: 0.5-10 Hz. The viscoelastic relationship changed with respect to frequency, tooth position, and root level.

[p38 MAPK pathway mediated BMP9-induced osteogenetic differentiation of hPDLSCs]

PURPOSE

To determine the effect of p38 MAPK signaling pathway on BMP9-induced osteogenetic differentiation of human periodontal ligament stem cells( hPDLSCs)． METHODS： hPDLSCs were collected in vitro, and adenovirus vectors were used to infect hPDLSCs; then the activity and staining of alkaline phosphatase(ALP) were detected ,the expression of osteopontin (OPN) and osteocalcin(OCN) were detected by qPCR ，and the calcium nodule deposition was used to analyse the ability of BMP9-induced hPDLSCs osteogenetic differentiation. Phosphorylation of p38 and MKK3/6 was detected after hPDLSCs was intervened with Ad-BMP9 and SB203580 ( inhibitor of p38 MAPK signaling pathway) for 36 h respectively for the effect of the signaling pathway on osteogenic differentiation． SPSS16.0 software package was used for statistical analysis.

RESULTS

Under the action of Ad-BMP9, the activity of ALP, the levels of osteopontin and osteocalcin genes were significantly higher than the control group (P<0.01). Staining of ALP and the calcium nodule deposition were consistent with the activity of ALP, the levels of osteopontin and osteocalcin. Western blot demonstrated that the expression of p-p38 and p-MKK3/6 was increased significantly. After adding SB203580, the expression of ALP, OPN and OCN was decreased significantly (P<0.01),and the calcium mineral deposits were also decreased.

CONCLUSIONS

During hPDLSCs differentiation, BMP9 can induce osteogenesis, and MKK3/6-p38-MAPK pathway was involved in the osteogenesis and had positive regulation for osteogenesis of hPDLSCs.

Necrostatin-1 promotes ectopic periodontal tissue like structure regeneration in LPS-treated PDLSCs

Necroptosis is a programmed necrosis, regulated by receptor interacting protein kinase 1(RIP1) and receptor interacting protein kinase 3(RIP3), and could be inhibited by necrostatin-1(Nec-1) specifically. This study aims to evaluate the effect of Nec-1 on LPS-treated periodontal ligament stem cells (PDLSCs). In the research, three groups were established: normal cultured PDLSCs, Porphyromonas gingivalis (Pg)-LPS stimulated PDLSCs and Pg-LPS+Nec-1 treated PDLSCs. The expression of RIP1 and RIP3 and osteogenic differentiation of PDLSCs in three groups were analyzed. Then, we constructed cell aggregates (CA) using PDLSCs, then PDLSCs-CA were combined with Bio-Oss in three groups were transplanted subcutaneously in nude mice to assess their potentials of periodontal tissue regeneration. The results showed that RIP1 and RIP3 were fully expressed in Pg-LPS stimulated PDLSCs and the level increased significantly. Nec-1 inhibited RIP1-RIP3 interaction, and further inhibited necroptosis of PDLSCs in inflammatory state. Moreover, Nec-1 pretreatment ameliorates the osteogenic differentiation of LPS-treated PDLSCs and can effectively promote the cementum like structure ectopic regenerative ability of PDLSCs in nude mice. These findings show RIP1/RIP3-mediated necroptosis is an important mechanism of cell death in PDLSCs. Nec-1 has a protective effect in reducing cell death and promotes ectopic periodontal tissue like structure regeneration by inhibiting necroptosis. Nec-1 is a hopeful therapeutic agent which protects cells from necroptosis and ameliorates functional outcome.

A Graded Multifunctional Hybrid Scaffold with Superparamagnetic Ability for Periodontal Regeneration

The regeneration of dental tissues is a still an unmet clinical need; in fact, no therapies have been completely successful in regenerating dental tissue complexes such as periodontium, which is also due to the lack of scaffolds that are able to guide and direct cell fate towards the reconstruction of different mineralized and non-mineralized dental tissues. In this respect, the present work develops a novel multifunctional hybrid scaffold recapitulating the different features of alveolar bone, periodontal ligament, and cementum by integrating the biomineralization process, and tape casting and electrospinning techniques. The scaffold is endowed with a superparamagnetic ability, thanks to the use of a biocompatible, bioactive superparamagnetic apatite phase, as a mineral component that is able to promote osteogenesis and to be activated by remote magnetic signals. The periodontal scaffold was obtained by engineering three different layers, recapitulating the relevant compositional and microstructural features of the target tissues, into a monolithic multifunctional graded device. Physico-chemical, morphological, and ultrastructural analyses, in association with preliminary in vitro investigations carried out with mesenchymal stem cells, confirm that the final scaffold exhibits a good mimicry of the periodontal tissue complex, with excellent cytocompatibility and cell viability, making it very promising for regenerative applications in dentistry.

Micropatterned Scaffolds with Immobilized Growth Factor Genes Regenerate Bone and Periodontal Ligament-Like Tissues

Periodontal disease destroys supporting structures of teeth. However, tissue engineering strategies offer potential to enhance regeneration. Here, the strategies of patterned topography, spatiotemporally controlled growth factor gene delivery, and cell-based therapy to repair bone-periodontal ligament (PDL) interfaces are combined. Micropatterned scaffolds are fabricated for the ligament regions using polycaprolactone (PCL)/polylactic-co-glycolic acid and combined with amorphous PCL scaffolds for the bone region. Scaffolds are modified using chemical vapor deposition, followed by spatially controlled immobilization of vectors encoding either platelet-derived growth factor-BB or bone morphogenetic protein-7, respectively. The scaffolds are seeded with human cells and delivered to large alveolar bone defects in athymic rats. The effects of dual and single gene delivery with and without micropatterning are assessed after 3, 6, and 9 weeks. Gene delivery results in greater bone formation at three weeks. Micropatterning results in regenerated ligamentous tissues similar to native PDL. The combination results in more mature expression of collagen III and periostin, and with elastic moduli of regenerated tissues that are statistically indistinguishable from those of native tissue, while controls are less stiff than native tissues. Thus, controlled scaffold microtopography combined with localized growth factor gene delivery improves the regeneration of periodontal bone-PDL interfaces.

Anti-inflammatory character of Phelligridin D modulates periodontal regeneration in lipopolysaccharide-induced human periodontal ligament cells

BACKGROUND AND OBJECTIVE

Phelligridin D is a hispidin analogue from the mushroom Phellinus baumii that is widely used as a food source in East Asia. This study tested phelligridin D for the anti-inflammatory effect and mechanism in lipopolysaccharide (LPS)-induced human periodontal ligament cells (HPDLCs). The objective of this study was to clarify whether the anti-inflammatory function of phelligridin D affects periodontal regeneration for supporting the HPDLCs of teeth.

MATERIAL AND METHODS

Primary HPDLCs were isolated from healthy teeth and then cultured. The anti-inflammatory function, mechanism and differentiation molecules were verified with reactive oxygen species generation and western blot analysis in LPS-induced HPDLCs.

RESULTS

HPDLCs showed increased inflammatory molecules (intracellular adhesion molecule-1 and vascular cell adhesion molecule-1) and decreased osteogenic proteins (bone morphogenetic protein-7, Osterix and runt-related transcription factor 2) by LPS treatment. Phelligridin D decreased inflammatory molecules and increased osteogenic molecules via downregulation of the extracellular signal-regulated kinase and c-jun N-terminal kinases pathway among the mitogen-activated protein kinase, followed by blocking of nuclear factor kappa-B translocation from cytosol to nucleus. In addition, phelligridin D showed antioxidant properties by reducing reactive oxygen species activity. Finally, the anti-inflammatory and antioxidant function of phelligridin D promoted the periodontal differentiation of HPDLCs.

CONCLUSION

These results suggest that phelligridin D supports teeth on the alveolar bone against outside stress, and may be used as an anti-inflammatory compound for the prevention of periodontitis or periodontal regenerative related disease.

Human Periodontal Ligament-Derived Stem Cells Promote Retinal Ganglion Cell Survival and Axon Regeneration After Optic Nerve Injury

Optic neuropathies are the leading cause of irreversible blindness and visual impairment in the developed countries, affecting more than 80 million people worldwide. While most optic neuropathies have no effective treatment, there is intensive research on retinal ganglion cell (RGC) protection and axon regeneration. We previously demonstrated potential of human periodontal ligament-derived stem cells (PDLSCs) for retinal cell replacement. Here, we report the neuroprotective effect of human PDLSCs to ameliorate RGC degeneration and promote axonal regeneration after optic nerve crush (ONC) injury. Human PDLSCs were intravitreally injected into the vitreous chamber of adult Fischer rats after ONC in vivo as well as cocultured with retinal explants in vitro. Human PDLSCs survived in the vitreous chamber and were maintained on the RGC layer even at 3 weeks after ONC. Immunofluorescence analysis of βIII-tubulin and Gap43 showed that the numbers of surviving RGCs and regenerating axons were significantly increased in the rats with human PDLSC transplantation. In vitro coculture experiments confirmed that PDLSCs enhanced RGC survival and neurite regeneration in retinal explants without inducing inflammatory responses. Direct cell-cell interaction and elevated brain-derived neurotrophic factor secretion, but not promoting endogenous progenitor cell regeneration, were the RGC protective mechanisms of human PDLSCs. In summary, our results revealed the neuroprotective role of human PDLSCs by strongly promoting RGC survival and axonal regeneration both in vivo and in vitro, indicating a therapeutic potential for RGC protection against optic neuropathies. Stem Cells 2018;36:844-855.

Vibration paradox in orthodontics: Anabolic and catabolic effects

Vibration in the form of High Frequency Acceleration (HFA) is anabolic on the craniofacial skeleton in the absence of inflammation. Orthodontic forces trigger an inflammation-dependent catabolic cascade that is crucial for tooth movement. It is unknown what effect HFA has on alveolar bone if applied during orthodontic treatment. The objectives of this study are to examine the effect of HFA on the rate of tooth movement and alveolar bone, and determine the mechanism by which HFA affects tooth movement. Adult Sprague Dawley rats were divided to control, orthodontic force alone (OTM), and different experimental groups that received the same orthodontic forces and different HFA regimens. Orthodontic tooth movement was assessed when HFA parameters, frequency, acceleration, duration of exposure, and direct or indirect application were varied. We found that HFA treatment significantly enhanced the inflammation-dependent catabolic cascade during orthodontic tooth movement. HFA treatment increased inflammatory mediators and osteoclastogenesis, and decreased alveolar bone density during orthodontic tooth movement. Each of the HFA variables produced significant changes in the rate of tooth movement and the effect was PDL-dependent. This is the first report that HFA enhances inflammation-dependent catabolic cascades in bone. The clinical implications of our study are highly significant, as HFA can be utilized to enhance the rate of orthodontic tooth movement during the catabolic phase of treatment and subsequently be utilized to enhance retention during the anabolic remodeling phase after orthodontic forces are removed.

[MicroRNA-125b regulates osteogenic differentiation of human periodontal ligament stem cells]

PURPOSE

To investigate the effect of microRNA-125b (miR-125b) on osteogenic differentiation of periodontal ligament stem cell (PDLSCs).

METHODS

The surface factor of isolated PDLSCs was detected by flow cytometry. After transfected with miR-125b or anti-miR125b in PDLSCs, MTT and LDH were used to detect cell viability and cytotoxicity; ALP activity and calcium level were detected by ALP assay kit and calcium colorimetric assay kit. Western blot and RT-qPCR were used to determine the expression of osteogenesis-related genes. The interaction between miR-125b and connexin 43 (Cx43) was detected by dual luciferase gene reporter assay. The data were analyzed with SPSS 17.0 software.

RESULTS

The cultured PDLSCs showed the characteristics of mesenchymal stem cells. After transfected with miR-125b in PDLSCs, the cell viability was decreased, cytotoxicity was increased; ALP activity, calcium level and the expression of osteogenesis-related genes were significantly decreased. On the contrary, cell viability, ALP activity, calcium level and the expression of osteogenesis-related genes in PDLSCs were increased after anti-miR-125b transfection. Dual luciferase gene reporter assay showed that miR-125b could target Cx43. In addition, the effect of miR-125b on osteogenic differentiation of PDLSCs was reversed after Cx43 overexpression.

CONCLUSIONS

miR-125b may inhibit osteogenic differentiation of PDLSCs by targeting Cx43.

Osteopontin regulates dentin and alveolar bone development and mineralization

The periodontal complex is essential for tooth attachment and function and includes the mineralized tissues, cementum and alveolar bone, separated by the unmineralized periodontal ligament (PDL). To gain insights into factors regulating cementum-PDL and bone-PDL borders and protecting against ectopic calcification within the PDL, we employed a proteomic approach to analyze PDL tissue from progressive ankylosis knock-out (Ank^-/-) mice, featuring reduced PP_i, rapid cementogenesis, and excessive acellular cementum. Using this approach, we identified the matrix protein osteopontin (Spp1/OPN) as an elevated factor of interest in Ank^-/- mouse molar PDL. We studied the role of OPN in dental and periodontal development and function. During tooth development in wild-type (WT) mice, Spp1 mRNA was transiently expressed by cementoblasts and strongly by alveolar bone osteoblasts. Developmental analysis from 14 to 240days postnatal (dpn) indicated normal histological structures in Spp1^-/- comparable to WT control mice. Microcomputed tomography (micro-CT) analysis at 30 and 90dpn revealed significantly increased volumes and tissue mineral densities of Spp1^-/- mouse dentin and alveolar bone, while pulp and PDL volumes were decreased and tissue densities were increased. However, acellular cementum growth was unaltered in Spp1^-/- mice. Quantitative PCR of periodontal-derived mRNA failed to identify potential local compensators influencing cementum in Spp1^-/- vs. WT mice at 26dpn. We genetically deleted Spp1 on the Ank^-/- mouse background to determine whether increased Spp1/OPN was regulating periodontal tissues when the PDL space is challenged by hypercementosis in Ank^-/- mice. Ank^-/-; Spp1^-/- double deficient mice did not exhibit greater hypercementosis than that in Ank^-/- mice. Based on these data, we conclude that OPN has a non-redundant role regulating formation and mineralization of dentin and bone, influences tissue properties of PDL and pulp, but does not control acellular cementum apposition. These findings may inform therapies targeted at controlling soft tissue calcification.

A novel approach for early evaluation of orthodontic process by a numerical thermomechanical analysis

The main objective of this paper is to propose a novel method that provides an opportunity to evaluate an orthodontic process at early phase of the treatment. This was accomplished by finding out a correlation between the applied orthodontic force and thermal variations in the tooth structure. To this end, geometry of the human tooth surrounded by the connective soft tissue called the periodontal ligament and the bone was constructed by employing dental CT scan images of a specific case. The periodontal ligament was modeled by finite strain viscoelastic model through a nonlinear stress-strain relation (hyperelasticity) and nonlinear stress-time relation (viscoelasticity). The tooth structure was loaded by a lateral force with 15 different quantities applied to 20 different locations, along the midedge of the tooth crown. The resultant compressive stress in the periodontal ligament was considered as the cause of elevated cell activity that was modeled by a transient heat flux in the thermal analysis. The heat flux value was estimated by conducting an experiment on a pair of rats. The numerical results showed that by applying an orthodontic force to the tooth structure, a significant temperature rise was observed. By measuring the temperature rise, the orthodontic process can be evaluated.

[CCN3 regulates the proliferation and apoptosis in periodontal ligament fibroblasts]

PURPOSE

To investigate the effect of CCN3 on proliferation and apoptosis in periodontal ligament fibroblasts (PDLFs) and related mechanism.

METHODS

Recombinant vector pcDNA.3.1-CCN3 was constructed and transfected into human PDLFs to overexpress CCN3. CCN3 siRNA was transfected to inhibit CCN3. Fra-1 siRNA was transfected into the PDLFs with CCN3 inhibition to realize the inhibition of CCN3 and Fra-1 in the meantime. mRNA expressions of CCN3 and Fra-1 were measured by quantitative real-time PCR (qRT-PCR). The protein expressions of CCN3, Fra-1and Bcl-2 were detected by Western blot. Cell growth and viability and proliferation of PDLFs were measured by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and bromodeoxyuridine (BrdU) assays; Caspase-3 activity was tested by using the available kit. The data were analyzed with SPSS20.0 software package.

RESULTS

The results showed that the mRNA (P<0.05) and protein (P<0.05) expressions of CCN3 were significantly up-regulated in the experimental group of pcDNA.3.1-CCN3 transfection. In addition, the mRNA (P<0.05) and protein (P<0.05) expressions of CCN3 were significantly decreased in the experimental group of CCN3 siRNA transfection. Cell growth (P<0.05) and viability, proliferation (P<0.05) and Bcl-2 (P<0.05) protein expression were increased, while caspase-3 activity (P<0.05) decreased in the PDLFs with CCN3 inhibition. However, CCN3 overexpression exhibited reversed effect. CCN3 overexpression or inhibition could remarkably constrain (P<0.05) or promote (P<0.01) the expression of Fra-1, respectively. Moreover, co-inhibition of CCN3 and Fra-1 could promote apoptosis (P<0.01) and inhibit proliferation (P<0.05) in PDLFs.

CONCLUSIONS

The results suggest that inhibition of CCN3 could accelerate proliferation and constrain apoptosis via up-regulating expression of Fra-1 in PDLFs.

Alginate/hyaluronic acid hydrogel delivery system characteristics regulate the differentiation of periodontal ligament stem cells toward chondrogenic lineage

Cartilage tissue regeneration often presents a challenging clinical situation. Recently, it has been shown that Periodontal Ligament Stem Cells (PDLSCs) possess high chondrogenic differentiation capacity. In this study, we developed a stem cell delivery system based on alginate/hyaluronic acid (HA) loaded with TGF-β1 ligand, encapsulating PDLSCs; and investigated the chondrogenic differentiation of encapsulated cells in alginate/HA hydrogel microspheres in vitro and in vivo. The results showed that PDLSCs, as well as human bone marrow mesenchymal stem cells (hBMMSCs), as the positive control, were stained positive for both toluidine blue and alcian blue staining, while exhibiting high levels of gene expression related to chondrogenesis (Col II, Aggrecan and Sox-9), as assessed via qPCR. The quantitative PCR analyses exhibited that the chondrogenic differentiation of encapsulated MSCs can be regulated by the modulus of elasticity of hydrogel delivery system, confirming the vital role of the microenvironment, and the presence of inductive signals for viability and differentiation of MSCs. In vivo, histological and immunofluorescence staining for chondrogenic specific protein markers confirmed ectopic cartilage-like tissue regeneration inside transplanted hydrogels. PDLSCs presented significantly greater capability for chondrogenic differentiation than hBMMSCs (P < 0.05). Altogether, our findings confirmed that alginate/HA hydrogels encapsulating PDLSCs are a promising candidate for cartilage regeneration.

[Effect of NaF on proliferation and mineralization of human periodontal ligament cells]

PURPOSE

To investigate the effect of NaF on proliferation and mineralization of human periodontal ligament cells (hPDLCs).

METHODS

hPDLCs were isolated and characterized. The proliferation of hPDLCs treated with different concentration of NaF was tested by CCK-8. Four moderate concentrations were chosen for subsequent experiments. The mineralization was investigated using ALP activity assay, Alizarin red S staining and quantitative real-time polymerase chain reaction(RT-PCR). The data were statistically analyzed with SPSS20.0 software package.

RESULTS

Immunohistochemistry showed that the isolated cells were hPDLCs. 5×10^-5, 1×10^-4 and 5×10^-4 mol/L NaF had pro-proliferation effects while 5×10^-4 mol/L resulted in the best effect (P<0.05). ALP activity and calcium content was significantly enhanced by 1×10^-5 mol/L NaF with osteogenic inductive medium (P<0.05). Quantitative RT-PCR data varied in genes as a result of different NaF concentrations and treatment periods.

CONCLUSIONS

5×10^-5, 1×10^-4, 5×10^-4 mol/L NaF can stimulate proliferation in hPDLCs, 1×10^-5 mol/L NaF can enhance ALP activity and calcium content formation of hPDLCs.

A Step-by-Step Description of PDL-Mediated Ridge Preservation for Immediate Implant Rehabilitation in the Esthetic Region

The aim of this study was to present in detail the clinical steps of the root-membrane technique. This technique combines the benefits of conventional root submergence via intentional maintenance of a root fragment for ridge preservation with those of immediate implant placement for functional rehabilitation of the treated site. A case study of a tooth diagnosed with a horizontal root fracture is used to illustrate this technique step by step. The clinical application of the root-membrane technique not only allowed for immediate placement in a site with compromised buccal plate but also facilitated excellent clinical stability of soft tissue contours during the 3 years of follow-up.

Transient Pain Following Orthodontic Fixed Appliances Induces Sensitization of Gingival and Periodontal Tissues

AIMS

To evaluate the transient effects of orthodontic treatment on the mechanical detection threshold (MDT) and mechanical pain threshold (MPT) of the buccal attached gingiva and the pressure pain threshold (PPT) of the buccal attached gingiva and of the teeth in two directions (perpendicular and parallel).

METHODS

A total of 20 patients (15 females and 5 males) aged 18 to 30 years participated in the study. Perceived pain on a 0- to 10-cm visual analog scale (VAS) and MDT, MPT, and PPT scores were evaluated at two time points at the masseter muscle, gingiva, teeth, and hand (control) prior to orthodontic treatment (T₀) and 24 hours after the first archwire placement (T₁). Mean values and SEMs were calculated for all continuous variables. The differences between T₀ and T₁ of MDT, MPT, and PPT were analyzed by means of a paired Student t test.

RESULTS

The pain intensity as assessed on the VAS was 4.2 ± 1.8 cm. No significant changes in MDT or MPT were found at the hand and buccal attached gingiva (P > .06). The PPTs at the buccal attached gingiva of teeth 21, 23, 24, and 34, at teeth 21, 23, 24, and 34 (perpendicular) and at teeth 21 and 23 (parallel) were lower (ie, more sensitive) at T₁ compared with T₀ (P < .04).

CONCLUSION

This study indicates for the first time that pain following insertion of an archwire causes sensitization to blunt-pressure stimuli both in the attached gingiva and in the periodontal ligament. Quantitative assessment of mechanical sensitivity may provide more insights into procedural pain and allow for better monitoring and evaluation of the effects of orthodontic treatment in the future.

Enhanced periodontal regeneration using collagen, stem cells or growth factors

The regeneration of periodontal tissues still remains a challenge in periodontology. The aim of the present study was to examine the regenerative potential of a) different collagen support versus blank, b) different collagen support +/- a growth factor cocktail (GF) and c) a collagen powder versus collagen powder + periodontal ligament stem cells (PDLSCs) comparatively in a large animal model. The stem cells (SC) were isolated from extracted teeth of 15 adult miniature pigs. A total of 60 class II furcation defects were treated with the materials named above. Concluding, a histological evaluation followed. A significant increase in regeneration was observed in all treatment groups. The new attachment formation reached a maximum of 77 percent. In the control group a new attachment formation of 13 percent was observed. The study shows that all implanted materials improved periodontal regeneration, though there were no significant differences between the experimental groups. Within the limitations of this study, it can be assumed that the lack of significant differences is due to the complexity of the clinical setting.

Additive Biomanufacturing: An Advanced Approach for Periodontal Tissue Regeneration

Periodontitis is defined as a chronic inflammatory condition, characterized by destruction of the periodontium, composed of hard (i.e. alveolar bone and cementum) and soft tissues (i.e. gingiva and periodontal ligament) surrounding and supporting the teeth. In severe cases, reduced periodontal support can lead to tooth loss, which requires tissue augmentation or procedures that initiate a repair, yet ideally a regenerative response. However, mimicking the three-dimensional complexity and functional integration of the different tissue components via scaffold- and/or matrix-based guided tissue engineering represents a great challenge. Additive biomanufacturing, a manufacturing method in which objects are designed and fabricated in a layer-by-layer manner, has allowed a paradigm shift in the current manufacturing of medical devices and implants. This shift from design-to-manufacture to manufacture-to-design, seen from a translational research point of view, provides the biomedical engineering and periodontology communities a technology with the potential to achieve tissue regeneration instead of repair. In this review, the focus is put on additively biomanufactured scaffolds for periodontal applications. Besides a general overview of the concept of additive biomanufacturing within this field, different developed scaffold designs are described. To conclude, future directions regarding advanced biomaterials and additive biomanufacturing technologies for applications in regenerative periodontology are highlighted.

The in vivo Levels of Matrix Metalloproteinase-1 and -8 in Gingival Crevicular Fluid during Initial Orthodontic Tooth Movement

Orthodontic force induces biochemical responses in the periodontal ligament (PDL), but the matrix metalloproteinase (MMP)-dependent molecular mechanisms in orthodontically induced periodontal remodeling have remained unclear. Previous studies indicate that mechanical stress induces MMP-1 production in human PDL cells in vitro. We tested the hypothesis whether the in vivo levels, molecular forms, and degree of activation of MMP-1 and MMP-8 in gingival crevicular fluid (GCF) reflect an early stage of orthodontic tooth movement. Molecular forms of MMP-1 and MMP-8 were analyzed by Western blot, and MMP-8 levels by quantitative immunofluoro-metric assay (IFMA). The results showed that GCF MMP-8 levels for orthodontically treated teeth were significantly higher at 4-8 hrs after force application than before activation, and when compared with the control teeth (p < 0.05). Analysis of our data indicates that the cells within the periodontium are up-regulated to produce MMP-8, and the increased expression and activation of GCF MMP-8 reflect enhanced periodontal remodeling induced by orthodontic force.

[MiR-142-3p inhibits lipopolysaccharide-induced inflammatory response in human periodontal ligament cells through targeting IRAK1]

PURPOSE

To investigate the effects of miR-142-3p overexpression on secretion of inflammatory factors in human periodontal ligament cells (hPDLCs) induced by lipopolysaccharide (LPS) and its underlying mechanism.

METHODS

hPDLCs were cultured by tissue cultivation in vitro and treated with various concentrations of LPS for 6, 12, 24 and 48 h. hPDLCs were treated with miR-142-3p mimics for 24 h in the presence of 2.0 μg/mL LPS and the expression levels of inflammatory factors (TNF-α, IL-6 and IL-1β) were detected by ELISA assay. The target relationship between miR-142-3p and interleukin-1 receptor- associated kinase 1 (IRAK1) was detected by dual-luciferase reporter assay. The miR-142-3p and IRAK1 mRNA expression was measured by qRT-PCR. The protein expression levels of IRAK1, TLR4 and NF-κB were detected by Western blotting. Statistical analysis was performed using SPSS 16.0 software package.

RESULTS

The miR-142-3p expression level was decreased significantly at 24 h in 2.0 μg/mL LPS-treated hPDLCs (P<0.01). Transfection of miR-142-3p mimics remarkably increased miR-142-3p expression (P<0.01). The secretion of inflammatory factors (TNF-α, IL-6 and IL-1β) in LPS-treated hPDLCs was significantly decreased by miR-142-3p overexpression (P<0.05). Dual-luciferase reporter assay showed a directly targeting relationship between miR-142-3p and IRAK1. Overexpression of miR-142-3p significantly reduced the IRAK1 protein expression in LPS-treated hPDLCs (P<0.05), whereas no obvious effect on IRAK1 mRNA expression was noted (P>0.05). Moreover, miR-142-3p overexpression markedly diminished the protein expression of TLR4 and phosphorylated NF-κB in LPS-treated hPDLCs (P<0.05).

CONCLUSIONS

Overexpression of miR-142-3p can alleviate the inflammatory response induced by LPS in hPDLCs and the underlying mechanism may be associated with targeting and inhibiting IRAK1 expression leading to suppression of TLR4/NF-κB inflammatory signaling pathway through which miR-142-3p overexpression protects peridentium against inflammation.

Bone Response of Loaded Periodontal Ligament

The tooth-periodontal ligament-alveolar bone complex acts symbiotically to dissipate the mechanical loads incurred during mastication and/or orthodontic tooth movement. The periodontal ligament functions both in the tension and compression. At the molecular and celleular levels, the loads in the periodontal ligament trigger mechanobiological events in the alveolar bone, which leads to bone modeling and remodeling. The current review focuses on the bone response to mechanical loading of the periodontal ligament on the tension and pressure sides. Understanding the bone response has major implications for dentistry, including a better understanding of the different types of orthodontic tooth movement.

Increase of Galanin in Trigeminal Ganglion during Tooth Movement

It is known that nerve fibers containing neuropeptides such as galanin increase in the periodontal ligament during experimental tooth movement. However, the origin of galanin-containing nerve fibers in the periodontal ligament remains unclear. This study was conducted to examine our hypothesis that the increased galanin nerve fibers have a sensory neuronal origin, and that the peptide is associated with pain transmission and/or periodontal ligament remodeling during experimental tooth movement. In control rats, galanin-immunoreactive trigeminal ganglion cells were very rare and were observed predominantly in small ganglion cells. After 3 days of experimental tooth movement, galanin-immunoreactive trigeminal ganglion cells significantly increased, and the most marked increase was observed at 5 days after experimental tooth movement. Furthermore, their cell size spectrum also significantly changed after 3 and 5 days of movement: Medium-sized and large trigeminal ganglion cells began expressing, and continued to express, galanin until 14 days after experimental tooth movement. These findings suggest that the increase of galanin in the periodontal ligament during experimental tooth movement at least partially originates from trigeminal ganglion neurons and may play a role in pain transmission and/or periodontal remodeling.

From restoration to regeneration: periodontal aging and opportunities for therapeutic intervention

With the march of time our bodies start to wear out: eyesight fades, skin loses its elasticity, teeth and bones become more brittle and injuries heal more slowly. These universal features of aging can be traced back to our stem cells. Aging has a profound effect on stem cells: DNA mutations naturally accumulate over time and our bodies have evolved highly specialized mechanisms to remove these damaged cells. Whilst obviously beneficial, this repair mechanism also reduces the pool of available stem cells and this, in turn, has a dramatic effect on tissue homeostasis and on our rate of healing. Simply put: fewer stem cells means a decline in tissue function and slower healing. Despite this seemingly intractable situation, research over the past decade now demonstrates that some of the effects of aging are reversible. Nobel prize-winning research demonstrates that old cells can become young again, and lessons learned from these experiments-in-a-dish are now being translated into human therapies. Scientists and clinicians around the world are identifying and characterizing methods to activate stem cells to reinvigorate the body's natural regenerative process. If this research in dental regenerative medicine pans out, the end result will be tissue homeostasis and healing back to the levels we appreciated when we were young.

[Effects and mechanisms of Egr-1 on inflammatory responses induced by mechanical stress in human periodontal ligament cells]

PURPOSE

To investigate the effects and mechanisms of silencing Egr-1 on MS-mediated secretion and expression of inflammatory cytokines in hPDLs.

METHODS

The secretion and expression of IL-1β, IL-6, IL-8 and IL-11 were detected using ELISA and RT-PCR when cells were cultured with or without various duration (6, 12, 24 and 48 h) and force (3%, 6%, 12%, 15%) of mechanica stress (MS). RT-PCR and Western blotting were used to evaluate the expression of Egr-1 under a 12% MS for 24 h. The roles of silencing Egr-1 in MS-mediated expression of inflammatory cytokines were determined using ELISA and RT-PCR. The protein levels of PTEN/PI3K/Akt signaling pathway were determined using Western blotting. Moreover, cells were pretreated with 20 μmol/L LY294002 for 30 min, in order to study the mechanisms of Egr-1 in MS-mediated secretion and expression of inflammatory cytokines. Statistical analysis was performed using SPSS 11.0 software package.

RESULTS

The secretion and expression of IL-1β, IL-6, IL-8 and IL-11 were increased gradually with the time under a MS force of 12% in hPDLs, and peaked in cells after exposure to MS for 24 h. The mRNA and protein levels of Egr-1 were elevated in hPDLs after exposure to 12% MS for 24 h. Moreover, depletion of Egr-1 inhibited MS-mediated secretion and expression of inflammatory cytokines. Knockdown of Egr-1 reduced the protein level of PTEN, and increased the protein expression of p-PI3K and p-Akt in hPDLs. LY294002 blocked partially the inhibitory roles of Egr-1 in the secretion and expression of inflammatory cytokines.

CONCLUSIONS

Depletion of Egr-1 suppressed the secretion and expression of inflammatory cytokines induced by MS through PTEN/PI3K/Akt pathway.

Fabrication of gelatin methacrylate/nanohydroxyapatite microgel arrays for periodontal tissue regeneration

INTRODUCTION

Periodontitis is a chronic infectious disease and is the major cause of tooth loss and other oral health issues around the world. Periodontal tissue regeneration has therefore always been the ultimate goal of dentists and researchers. Existing fabrication methods mainly focused on a top-down tissue engineering strategy in which several drawbacks remain, including low throughput and limited diffusion properties resulting from a large sample size. Gelatin methacrylate (GelMA) is a kind of photocrosslinkable and biocompatible hydrogel, with the capacities of enabling cell encapsulation and regeneration of functional tissues. Here, we developed a novel method to fabricate GelMA/nanohydroxylapatite (nHA) microgel arrays using a photocrosslinkable strategy. The viability, proliferation, and osteogenic differentiation and in vivo osteogenesis of human periodontal ligament stem cells (hPDLSCs) encapsulated in microgels were evaluated. The results suggested that such microgels provide great potential for periodontal tissue repair and regeneration.

METHODS

Microgel arrays were fabricated by blending different weight ratios of GelMA and nHA. hPDLSCs were encapsulated in GelMA/nHA microgels of various ratios for a systematic evaluation of cell viability, proliferation, and osteogenic differentiation. In vivo osteogenesis in nude mice was also studied.

RESULTS

The GelMA/nHA microgels exhibited appropriate microarchitecture, mechanical strength, and surface roughness, thus enabling cell adhesion and proliferation. Additionally, the GelMA/nHA microgels (10%/2% w/v) enhanced the osteogenic differentiation of hPDLSCs by elevating the expression levels of osteogenic biomarker genes, such as ALP, BSP, OCN, and RUNX2. In vivo ectopic transplantation results showed that GelMA/nHA microgels (10%/2% w/v) increased mineralized tissue formation with abundant vascularization, compared with the 1%, 3%, and the pure GelMA group.

CONCLUSION

The GelMA/nHA microgels (10%/2% w/v) facilitated hPDLSCs viability, proliferation, and osteogenic differentiation in vitro and further promoted new bone formation in vivo, suggesting that the GelMA/nHA microgels (10%/2% w/v) provide great potential for periodontal tissue regeneration.

Biomechanical characterization of the periodontal ligament: Orthodontic tooth movement

OBJECTIVE

To quantify the biomechanical properties of the bovine periodontal ligament (PDL) in postmortem sections and to apply these properties to study orthodontic tooth intrusion using finite element analysis (FEA). We hypothesized that PDL's property inherited heterogeneous (anatomical dependency) and nonlinear stress-strain behavior that could aid FEA to delineate force vectors with various rectangular archwires.

MATERIALS AND METHODS

A dynamic mechanical analyzer was used to quantify the stress-strain behavior of bovine PDL. Uniaxial tension tests using three force levels (0.5, 1, and 3 N) and samples from two anatomical locations (circumferential and longitudinal) were performed to calculate modulus. The Mooney-Rivlin hyperelastic (MRH) model was applied to the experimental data and used in an FEA of orthodontic intrusion rebounded via a 0.45-mm step bend with three archwire configurations of two materials (stainless steel and TMA).

RESULTS

Force levels and anatomical location were statistically significant in their effects on modulus (P < .05). The apical part had a greater stiffness than did the middle part. The MRH model was found to approximate the experimental data well (r = 0.99), and it demonstrated a reasonable stress-strain outcome within the PDL and bone for FEA intrusion simulation. The force acting on the tooth increased five times from the 0.016 × 0.022-inch TMA to the 0.019 × 0.025-inch stainless steel.

CONCLUSIONS

The PDL is a nonhomogeneous tissue in which the modulus changed in relation to location. PDL nonlinear constitutive model estimated quantitative force vectors for the first time to compare intrusive tooth movement in 3-D space in response to various rectangular archwires.

Orthodontic force simulation of Tooth-PDL-Bone Complex under archwire loading

Orthodontic force simulation is very important for the guidance of clinical orthodontic treatment. Previous works were mainly conducted by directly loading the force on a single or a few teeth. However, in clinic, the orthodontic force is provided by loading orthodontic appliances, and there currently is no appropriate way to measure the force on the teeth provided by the loaded appliances. This study presents a method to simulate the orthodontic force of a whole Tooth-Periodontal Ligament-Bone Complex (TPBC) by directly loading the archwire to the dentition applying the finite element method. A 3D TPBC model was reconstructed from CT images, and models of brackets and the archwire were also built. The loading procedure of the archwire was implemented by simulating the deformation and displacement of the archwire before and after the loading, and the stress of the archwire induced by the deformation and displacement was obtained. Then, the stress was applied to the brackets, and the corresponding orthodontic force of the TPBC was simulated. By applying the method, archwire designed according to the planned dentition shape was loaded successfully to the original dentition, and the orthodontic force of the TPBC was obtained.

Characterization and cytocompatibility of thermosensitive hydrogel embedded with chitosan nanoparticles for delivery of bone morphogenetic protein-2 plasmid DNA

A novel injectable chitosan thermosensitive hydrogel was designed as a target multi-effect scaffold for endogenous repair of the periodontium. The hydrogel complex was designed by embedding chitosan nanoparticles (CSn) loaded with bone morphogenetic protein-2 plasmid DNA (pDNA-BMP2) into a chitosan (CS)-based hydrogel with α,β-glycerophosphate (α,β-GP), termed CS/CSn(pDNA-BMP2)-GP. Characterization, the in vitro release profile for pDNA-BMP2, and cytocompatibility to human periodontal ligament cells (HPDLCs), were then conducted. The average diameter of the CSn(pDNA-BMP2) was 270.1 nm with a polydispersity index (PDI) of 0.486 and zeta potential of +27.0 mv. A DNase I protection assay showed that CSn could protect the pDNA-BMP2 from nuclease degradation. Encapsulation efficiency and loading capacity of CSn(pDNA-BMP2) were more than 80 and 30 %, respectively. The sol-gel transition time was only 3 min when CSn(pDNA-BMP2) was added into the CS/α,β-GP system. Scanning electron microscopy showed that CSn(pDNA-BMP2) was randomly dispersed in a network with regular holes and a porous structure. Weighting method showed the swelling ratio and degradation was faster in medium of pH 4.0 than pH 6.8. An in vitro pDNA-BMP2 release test showed that the cumulative release rate of pDNA-BMP2 was much slower from CS/CSn-GP than from CSn in identical release media. In release media with different pH, pDNA-BMP2 release was much slower at pH 6.8 than at pH 4.0. Three-dimensional culture with HPDLCs showed good cell proliferation and the Cell-Counting Kit-8 assay indicated improved cell growth with the addition of CSn(pDNA-BMP2) to CS/α,β-GP. In summary, the CS/CSn(pDNA-BMP2)-GP complex system exhibited excellent biological properties and cytocompatibility, indicating great potential as a gene delivery carrier and tissue regeneration scaffold for endogenous repair of the periodontium.

Biomaterials in Periodontal Regenerative Surgery: Effects of Cryopreserved Bone, Commercially Available Coral, Demineralized Freeze-dried Dentin, and Cementum on Periodontal Ligament Fibroblasts and Osteoblasts

The ultimate goal of periodontal therapy is to achieve successful periodontal regeneration. The effects of different biomaterials, allogenic and alloplastic, used in periodontal surgeries to achieve regeneration have been studied in vitro on periodontal ligament (PDL) cells and MC3T3-E1 cells. The materials tested included cryopreserved bone allograft (CBA), coralline hydroxyapatite (CH), demineralized freeze-dried dentin (DFDD), and cementum. CBA and CH revealed an increase in initial PDL cell attachment, whereas CH resulted in an increase in long-term PDL cell attachment. Mineral-like nodule formation was observed significantly higher in DFDD compared to other materials tested for osteoblasts. Based on the results of this in vitro study, we conclude that the materials used are all biocompatible with human PDL cells and osteoblasts, which have pivotal importance in periodontal regeneration.

Multiscale biomechanical responses of adapted bone-periodontal ligament-tooth fibrous joints

Reduced functional loads cause adaptations in organs. In this study, temporal adaptations of bone-ligament-tooth fibrous joints to reduced functional loads were mapped using a holistic approach. Systematic studies were performed to evaluate organ-level and tissue-level adaptations in specimens harvested periodically from rats (N=60) given powder food for 6 months over 8,12,16,20, and 24 weeks. Bone-periodontal ligament (PDL)-tooth fibrous joint adaptation was evaluated by comparing changes in joint stiffness with changes in functional space between the tooth and alveolar bony socket. Adaptations in tissues included mapping changes in the PDL and bone architecture as observed from collagen birefringence, bone hardness and volume fraction in rats fed soft foods (soft diet, SD) compared to those fed hard pellets as a routine diet (hard diet, HD). In situ biomechanical testing on harvested fibrous joints revealed increased stiffness in SD groups (SD:239-605 N/mm) (p<0.05) at 8 and 12 weeks. Increased joint stiffness in early development phase was due to decreased functional space (at 8 weeks change in functional space was -33 μm, at 12 weeks change in functional space was -30 μm) and shifts in tissue quality as highlighted by birefringence, architecture and hardness. These physical changes were not observed in joints that were well into function, that is, in rodents older than 12 weeks of age. Significant adaptations in older groups were highlighted by shifts in bone growth (bone volume fraction 24 weeks: Δ-0.06) and bone hardness (8 weeks: Δ-0.04 GPa, 16 weeks: Δ-0.07 GPa, 24 weeks: Δ-0.06 GPa). The response rate (N/s) of joints to mechanical loads decreased in SD groups. Results from the study showed that joint adaptation depended on age. The initial form-related adaptation (observed change in functional space) can challenge strain-adaptive nature of tissues to meet functional demands with increasing age into adulthood. The coupled effect between functional space in the bone-PDL-tooth complex and strain-adaptive nature of tissues is necessary to accommodate functional demands, and is temporally sensitive despite joint malfunction. From an applied science perspective, we propose that adaptations are registered as functional history in tissues and joints.

Periodontal Ligament and Alveolar Bone in Health and Adaptation: Tooth Movement

The periodontal ligament (PDL) and alveolar bone are two critical tissues for understanding orthodontic tooth movement. The current literature is replete with descriptive studies of multiple cell types and their matrices in the PDL and alveolar bone, but is deficient with how stem/progenitor cells differentiate into PDL and alveolar bone cells. Can one type of orthodontic force with a specific magnitude and frequency activate osteoblasts, whereas another force type activates osteoclasts? This chapter will discuss the biology of not only mature cells and their matrices in the periodontal ligament and alveolar bone, but also stem/progenitor cells that differentiate into fibroblasts, osteoblasts and osteoclasts. Key advances in tooth movement rely on further understanding of osteoblast and fibroblast differentiation from mesenchymal stem/progenitor cells, and osteoclastogenesis from the hematopoietic/monocyte lineage.