Eventual Tooth Loss Research Articles

Inhibition of transglutaminase activity in periodontitis rescues periodontal ligament collagen content and architecture.

Periodontal disease (PD) afflicts approximately 50% of the population in the United States and is characterized by chronic inflammation of the periodontium that can lead to loss of the periodontal ligament through collagen degradation, loss of alveolar bone, and to eventual tooth loss. Previous studies have implicated transglutaminase (TG) activity in promoting thin collagen I fiber morphology and decreased mechanical strength in homeostatic PDL. The aim of this study was to determine whether TG activity influenced collagen assembly in PDL in the setting of periodontal disease. A ligature model was used to induce clinically relevant PD in mice. Mice with ligature were assessed at 5 and 14days to determine PDL collagen morphology, transglutaminase (TG) activity, and bone loss. The effects of inhibition of TG on PDL were assessed by immunohistochemistry and second-harmonic generation (SHG) to visualize collagen fibers in native tissue. Ligature placement around the 2nd molar resulted in significant bone loss and a decrease in total collagen content after 5days of ligature placement. A significant increase in thin over thick fibers was also demonstrated in mice with ligature at 5days associated with apparent increases in immunoreactivity for TG2 and for TG-mediated N-ε-γ-glutamyl cross-links in PDL. Inhibition of TG activity increased total collagen and thick collagen fiber content over vehicle control in mice with ligature for 5days. SHG of PDL was used to visualize and quantify the effects of TG inhibition on enhanced collagen fiber organization in unfixed control and diseased PDL. These studies support a role of TG in regulating collagen fiber assembly and suggest that strategies to inhibit TG activity in disease might contribute to restoration of PDL tissue integrity.

Prosthetic rehabilitation of a patient with X-linked hypophosphatemia using dental implants: a case report and review of the literature

BackgroundX-linked hypophosphatemia is associated with a range of dental problems, many of which may result in early loss of the dentition. Most patients, but especially young adults, are likely to desire fixed prosthodontic replacements, and dental implants may be the preferred solution in many cases. The use of dental implants to rehabilitate this patient group has not been widely studied with the literature limited to a small number of case reports with limited follow-up.Case presentationThis case report describes the dental journey of a young adult with X-linked hypophosphatemia, his eventual tooth loss and rehabilitation with multiple dental implants. Over 10 years’ follow-up of three of the fixtures is presented.ConclusionsThis case report shows a common presentation and progression of a patient with X-linked hypophosphatemia and will hopefully provide further positive evidence for the clinician to rely on when considering dental implant based treatments for such patients.

WITHDRAWN: Ozone therapy for the treatment of dental caries.

Dental caries is a bacterially mediated disease characterised by demineralisation of the tooth surface, which may lead to cavitation, discomfort, pain and eventual tooth loss. Ozone is toxic to certain bacteria in vitro and it has been suggested that delivering ozone into a carious lesion might reduce the number of cariogenic bacteria. This possibly could arrest the progress of the lesion and may, in the presence of fluoride, perhaps allow remineralisation to occur. This may in turn delay or prevent the need for traditional dental conservation by 'drilling and filling'. To assess whether ozone is effective in arresting or reversing the progression of dental caries. We searched the Cochrane Oral Health Group's Trials Register (to 7 November 2003); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2003, Issue 3); MEDLINE and PREMEDLINE (OVID) (1966 to November 2003); EMBASE (OVID) (1980 to November 2003); CINAHL (OVID) (1982 to November 2003); AMED (OVID) (1985 to November 2003). Quintessence was handsearched through 2002 and KaVo were contacted as manufacturers of the HealOzone apparatus for any additional published or unpublished trials. Inclusion was assessed independently by at least two reviewers. Trials were only included if they met the following criteria: randomisation in a controlled trial; single surface in vivo carious lesion accessible to ozone application; clear allocation concealment; ozone application to the lesions in the intervention group; no such application of ozone in the control group; outcomes measured after at least 6 months. Reviewers independently extracted information in duplicate. A paucity of comparable data did not allow meta-analytic pooling of the included studies. Three trials were included, with a combined total of 432 randomised lesions (137 participants). Forty-two conference papers, abstracts and posters were excluded (from an unknown number of studies). The risk of bias in all studies appeared high. The analyses of all three studies were conducted at the level of the lesion, which is not independent of the person, for this reason pooling of data was not appropriate or attempted. Individual studies showed inconsistent effects of ozone on caries, across different measures of caries progression or regression. Few secondary outcomes were reported, but one trial reported an absence of adverse events. Given the high risk of bias in the available studies and lack of consistency between different outcome measures, there is no reliable evidence that application of ozone gas to the surface of decayed teeth stops or reverses the decay process. There is a fundamental need for more evidence of appropriate rigour and quality before the use of ozone can be accepted into mainstream primary dental care or can be considered a viable alternative to current methods for the management and treatment of dental caries.

Processing of Biopolymers-based, Efficiently Integrated Bilayer Membranes for Use in Guided Tissue Regeneration Procedures

Periodontitis is a chronic inflammatory disease affecting the tooth supporting structures - the alveolar bone in particular, to extent of eventual tooth loss. Among others, the guided tissue regeneration (GTR) procedure including placement of occlusive barrier membrane is very promising approach. Herein we develop chitosan (CHT) / gelatin (GEL) bilayer membranes via successive solvent– and freeze-casting procedures and genipin (GEN)-mediated cross-linking chemistry. By utilizing the auto-fluorescence signal from GEN cross-linking products (i.e. the secondary CHT (GEL) amines and GEN esters), the Confocal Fluorescent Microscopy (CFM) identifies the chemical as well as physical integration between layers´ interfaces, supported also by Scanning Electron Microscopy (SEM) data. The presence of non- and highly μ-porous and pore-interconnecting regions is demonstrated within cross-sections of GEL-prevalent membranes in contrast to the sheet-like organization in membrane with equal components presence. The constant processing conditions onto variable compositions did not significantly affect the pore size distributions (in 1-230 μm range), while pore wall thickness increases up to 220 μm with GEL increase, which also improves the yield stress at compression from 10 to 19 kPa and elastic modulus from 26 to 34 kPa. The further applied rapid mineralization resulted in deposition of non-regular to spherical minerals, containing nonstoichiometric carbonated apatite with Ca/P ration in 1.7-2 range, which demonstrates formation of osseointegrative interface. The intensive, composition-dependent swelling (up to 580%), as well as 67% to 100% weigh loss in 4 weeks in vitro degradation experiment imply on bilayer membranes GTR relevance.

Correlation of interleukin-6-174 GC and interleukin-6-572 GC gene polymorphisms with periodontal disease in an Iranian population.

Periodontal disease has a multifactorial etiology. A combination of microbial agents and environmental, habitual, systemic, and genetic risk factors is responsible for the development of periodontal disease. Host immune response causes the destruction of tooth-supporting structure and eventual tooth loss. This study aimed to assess the correlation of interleukin 6 (IL-6) -174-GC and IL-6-572-GC gene polymorphisms with periodontal disease in an Iranian population. This case-control analytical study was conducted on 129 subjects presenting to the laboratory of Taleghani Hospital. Subjects underwent clinical and periodontal examinations and divided into five groups of healthy, gingivitis and mild, moderate and severe periodontitis. Blood samples (2 ml) were obtained. Genomic DNA was extracted manually using the salting-out method. IL-6 sequence amplification was performed using polymerase chain reaction with three thermal protocols. Digested products were analyzed by electrophoresis through 2% agarose gel using Gel Red staining. Data were analyzed using Chi-square, Kruskal-Wallis, and Mann-Whitney tests, and P < 0.05 was considered significant. The frequency of GG polymorphism at IL-6-174 and IL-6-572 genomic regions was 51.2% and 71.3%, respectively. The frequency of IL-6-572-GG polymorphism was significantly greater than that of IL-6-572-GC polymorphism (P < 0.001). Comparison of the mean and maximum pocket depth and clinical attachment level, as well as bleeding on probing percentage, revealed significant differences between the healthy controls and periodontitis patients (P < 0.001). The frequency percentages of GC and GG polymorphisms were almost equal in the healthy, gingivitis, and periodontitis groups. In other words, the frequency of the two polymorphisms was not significantly different between the health and disease states (P = 0.065 for IL-6-572 and P = 0.63 for IL-6-174). This study found no association between IL-6-174 and IL-6-572 gene polymorphisms and periodontitis in the studied population.

Peptidylarginine deiminase from Porphyromonas gingivalis contributes to infection of gingival fibroblasts and induction of prostaglandin E2 -signaling pathway.

Porphyromonas gingivalis (P. gingivalis) expres-ses the enzyme peptidylarginine deiminase (PPAD), which has a strong preference for C-terminal arginines. Due to the combined activity of PPAD and Arg-specific gingipains, P. gingivalis on the cell surface is highly citrullinated. To investigate the contribution of PPAD to the interaction of P. gingivalis with primary human gingival fibroblasts (PHGF) and P. gingivalis-induced synthesis of prostaglandin E2 (PGE2 ), PHGF were infected with wild-type P. gingivalis ATCC 33277, an isogenic PPAD-knockout strain (∆ppad) or a mutated strain (C351A) expressing an inactive enzyme in which the catalytic cysteine has been mutated to alanine (PPAD(C351A) ). Cells were infected in medium containing the mutants alone or in medium supplemented with purified, active PPAD. PHGF infection was assessed by colony-forming assay, microscopic analysis and flow cytometry. Expression of cyclo-oxygenase 2 (COX-2) and microsomal PGE synthase-1 (mPGES-1), key factors in the prostaglandin synthesis pathway, was examined by quantitative reverse transcription polymerase chain reaction (qRT-PCR), while PGE2 synthesis was evaluated by enzyme immunoassay. PHGF were infected more efficiently by wild-type P. gingivalis than by the ∆ppad strain, which correlated with strong induction of COX-2 and mPGES-1 expression by wild-type P. gingivalis, but not by the PPAD activity-null mutant strains (Δppad and C351A). The impaired ability of the Δppad strain to adhere to and/or invade PHGF and both Δppad and C351A to stimulate the PGE2 -synthesis pathway was fully restored by the addition of purified PPAD. The latter effect was strongly inhibited by aspirin. Collectively, our results implicate PPAD activity, but not PPAD itself, as an important factor for gingival fibroblast infection and activation of PGE2 synthesis, the latter of which may strongly contribute to bone resorption and eventual tooth loss.

Comparison of Destructive Periodontal Disease in Blue Iris Mink to PCB 126–induced Mandibular and Maxillary Squamous Epithelial Proliferation in Natural Dark Mink

Mink (Mustela vison) exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-like chemicals have been reported to develop mandibular and maxillary squamous cell proliferation that results in the destruction of alveolar bone and eventual tooth loss. This jaw lesion has been reported in wild mink collected from areas contaminated with TCDD-like compounds and is a potential biomarker for exposure to these chemicals. The blue iris strain of domestic mink is prone to develop severe periodontal disease, which results in destruction of bone and tooth loss that is grossly similar to the lesion induced by exposure to TCDD-like chemicals. A histological assessment of jaws from blue iris mink and natural dark mink exposed to 3,3',4,4',5-pentachlorobiphenyl (PCB 126) was done to determine whether the oral lesions are similar. The jaw tissue from the blue iris mink had lesions indicative of lymphoplasmacytic gingivitis and osteomyelitis, caused by inflammation entering the dental sulcus, while the jaw tissue from the mink exposed to PCB 126 exhibited squamous epithelial proliferation. Therefore, it was determined that the tooth loss and bone destruction seen in these mink are of different origin despite the similarity of the gross clinical signs.

Contemporary management of tooth replacement in the traumatized dentition

Dental trauma can result in tooth loss despite best efforts at retaining and maintaining compromised teeth (Dent Traumatol, 24, 2008, 379). Upper anterior teeth are more likely to suffer from trauma, and their loss can result in significant aesthetic and functional problems that can be difficult to manage (Endod Dent Traumatol, 9, 1993, 61; Int Dent J 59, 2009, 127). Indeed, teeth of poor prognosis may not only present with compromised structure but trauma may also result in damage to the support tissues. Injury to the periodontium and alveolus can have repercussions on subsequent restorative procedures (Fig. 19). Where teeth are identified as having a hopeless prognosis either soon after the incident or at delayed presentation; planning for eventual tooth loss and replacement can begin at the early stages. With advances in both adhesive and osseointegration technologies, there are now a variety of options for the restoration of edentate spaces subsequent to dental trauma. This review aims to identify key challenges in the provision of tooth replacement in the traumatized dentition and outline contemporary methods in treatment delivery.

Synchrotron radiation analysis of possible correlations between metal status in human cementum and periodontal disease

Periodontitis is a serious disease that affects up to 50% of an adult population. It is a chronic condition involving inflammation of the periodontal ligament and associated tissues leading to eventual tooth loss. Some evidence suggests that trace metals, especially zinc and copper, may be involved in the onset and severity of periodontitis. Thus we have used synchrotron X-ray fluorescence imaging on cross sections of diseased and healthy teeth using a microbeam to explore the distribution of trace metals in cementum and adhering plaque. The comparison between diseased and healthy teeth indicates that there are elevated levels of zinc, copper and nickel in diseased teeth as opposed to healthy teeth. This preliminary correlation between elevated levels of trace metals in the cementum and plaque of diseased teeth suggests that metals may play a role in the progress of periodontitis.

The 15-Deoxy-Δ 12,14-prostaglandin J 2 inhibits LPS-stimulated AKT and NF-κB activation and suppresses interleukin-6 in osteoblast-like cells MC3T3E-1

Aims Periodontitis is a chronic inflammatory disease that results in gingival inflammation and periodontal tissue destruction and is accompanied by alveolar bone resorption and eventual tooth loss. We examined the effect of 15-deoxy-Δ 12,14-prostaglandin J 2 (15d-PGJ 2) on periodontitis by inhibiting the production of interleukin-6 (IL-6). Main methods Osteoblast-like cells MC3T3E-1 were pretreated with 15d-PGJ 2 before being incubated with lipopolysaccharide (LPS), the effect of 15d-PGJ 2 on IL-6 production, expression and its regulatory mechanisms were studied by reverse transcription-polymerase chain reaction (RT-PCR), Western blot, electrophoretic mobility shift assay (EMSA), and confocal laser scanning microscopy study. Key findings 15d-PGJ 2 inhibits LPS-stimulated IL-6 production in a concentration-dependent manner in osteoblast-like cells MC3T3E-1, without appreciable cytotoxicity. To further examine the mechanism responsible for the inhibition of IL-6 production by 15d-PGJ 2, we examined the effect of 15d-PGJ 2 on nuclear factor-κB (NF-κB) activation and the phosphorylation of protein kinase B (Akt). 15d-PGJ 2 treatment clearly reduced the DNA binding activity of NF-κB in LPS-stimulated osteoblast-like cells MC3T3E-1, an effect that was mediated by inhibiting the degradation of inhibitor κB (IκB) and nuclear translocation of NF-κB p65 subunit. In addition, 15d-PGJ 2 attenuated the LPS-mediated Akt pathway. These effects of 15d-PGJ 2 were not abrogated by the PPARγ antagonist, GW9662, indicating that they are PPARγ-independent actions. Significance These results suggest that 15d-PGJ 2 possess a potent suppressive effect on inflammatory responses of osteoblast-like cells MC3T3E-1 via the Akt and NF-κB pathways independent of PPARγ and suggest that this compound may offer some insight into the development of a new therapeutic approach to the prevention and treatment of periodontal diseases.

B Cell IgD Deletion Prevents Alveolar Bone Loss Following Murine Oral Infection

Periodontal disease is one of the most common infectious diseases of humans. Immune responses to infection trigger loss of alveolar bone from the jaw and eventual tooth loss. We investigated the contribution of B cell IgD to alveolar bone loss by comparing the response of B cell normal BALB/cJ mice and IgD deficient BALB/c-Igh-5−/−J mice to oral infection with Porphyromonas gingivalis, a gram-negative periodontopathic bacterium from humans. P. gingivalis-infected normal mice lost bone. Specific antibody to P. gingivalis was lower and oral colonization was higher in IgD deficient mice; yet bone loss was completely absent. Infection increased the proportion of CD69+ activated B cells and CD4+ T cells in immune normal mice compared to IgD deficient mice. These data suggest that IgD is an important mediator of alveolar bone resorption, possibly through antigen-specific coactivation of B cells and CD4+ T cells.

Auto-transplantation in the Restorative Management of Traumatized Anterior Teeth: A Case Report

Auto-transplantation can be used to replace missing anterior teeth following traumatic injuries. This technique has the advantage (over other forms of treatment) of maintaining alveolar bone height which allows orthodontic and further restorative intervention by way of implants later in life. Careful restorative management of transplanted teeth is vital to their long-term survival as inadequate maintenance post transplant may result in root resorption and eventual tooth loss. This paper describes the restorative management of two cases following transplantation. Dental practitioners should be aware of the option to auto-transplant teeth as part of an overall treatment plan and the subsequent interventions often required.

Ozone therapy for the treatment of dental caries.

Dental caries is a bacterially mediated disease characterised by demineralisation of the tooth surface, which may lead to cavitation, discomfort, pain and eventual tooth loss. Ozone is toxic to certain bacteria in vitro and it has been suggested that delivering ozone into a carious lesion might reduce the number of cariogenic bacteria. This possibly could arrest the progress of the lesion and may, in the presence of fluoride, perhaps allow remineralisation to occur. This may in turn delay or prevent the need for traditional dental conservation by 'drilling and filling'. To assess whether ozone is effective in arresting or reversing the progression of dental caries. We searched the Cochrane Oral Health Group's Trials Register (to 7 November 2003); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2003); MEDLINE and PREMEDLINE (OVID, 1966 to November 2003); EMBASE (OVID, 1980 to November 2003); CINAHL (OVID, 1982 to November 2003); AMED (OVID, 1985 to November 2003). Quintessence was handsearched through 2002 and KaVo were contacted as manufacturers of the HealOzone apparatus for any additional published or unpublished trials. Inclusion was assessed independently by at least two reviewers. Trials were only included if they met the following criteria: randomisation in a controlled trial; single surface in vivo carious lesion accessible to ozone application; clear allocation concealment; ozone application to the lesions in the intervention group; no such application of ozone in the control group; outcomes measured after at least 6 months. Reviewers independently extracted information in duplicate. A paucity of comparable data did not allow meta-analytic pooling of the included studies. Three trials were included, with a combined total of 432 randomised lesions (137 participants). Forty-two conference papers, abstracts and posters were excluded (from an unknown number of studies). The risk of bias in all studies appeared high. The analyses of all three studies were conducted at the level of the lesion, which is not independent of the person, for this reason pooling of data was not appropriate or attempted. Individual studies showed inconsistent effects of ozone on caries, across different measures of caries progression or regression. Few secondary outcomes were reported, but one trial reported an absence of adverse events. Given the high risk of bias in the available studies and lack of consistency between different outcome measures, there is no reliable evidence that application of ozone gas to the surface of decayed teeth stops or reverses the decay process. There is a fundamental need for more evidence of appropriate rigour and quality before the use of ozone can be accepted into mainstream primary dental care or can be considered a viable alternative to current methods for the management and treatment of dental caries.

Parameter on "Refractory" Periodontitis.

The American Academy of Periodontology has developed the following parameter on the treatment of "refractory" periodontitis. Patients should be informed of the disease process, therapeutic alternatives, potential complications, expected results, and their responsibility in treatment. Consequences of no treatment should be explained. No treatment is very likely to result in further progression of the disease and eventual tooth loss. Given this information, patients should then be able to make informed decisions regarding their periodontal therapy. J Periodontol 2000;71:859-860.

Dental Paleopathologies in the Sanders Site ( 41LR2) Population from Lamar County, Texas

Dental health, like skeletal health, reflects the natural and social environment, as well as genetics. This paper focuses on the results of stress on the teeth once they have erupted; stresses include chemical, mechanical, and pathogenic forces. These forces are primarily the result of dietary factors. The specific aspects of dental health examined in this paper are cariogenesis, dental attrition, antemortem tooth loss, and abscessing. These dental paleopathologies primarily reflect diet and food processing strategies. Throughout the Americas, dental disorders have increased with the adoption of maize agriculture. Reliance on maize provides a sticky, carbohydraterich dietary staple that is favorable to microbial attack. Maize cultivation has been ... correlated with an increase in caries and abscess frequency. Poor dental health also may directly impact general physical health. Periodontal disease often results in gingival inflammation, abscessing, and tooth loss. Lesions in the mouth can be the port of entry for pathogens, such as staphylococci and streptococci, that may then travel to other parts of the body. Dental attrition is not considered a disorder in this paper, but the natural result of a diet high in unprocessed vegetal materials and grit. Grit is introduced into the diet from a variety of means, but I will focus on the introduction of grit through stone grinding implements. Sand particles can also result in a considerable amount of attrition. Dental attrition can, however, lead to pathologies if the pulp cavity is exposed. In this case, the pulp cavity may serve as the focus of infection, resulting in abscessing and eventual tooth loss. Dental health is thus largely dependent on dietary factors. The examination of dental health is useful in reconstructing nutritional behaviors. It will be seen in this examination of the teeth that the maize agriculturalists at the Sanders site were primarily affected by a high frequency of caries. Other factors examined (moderate dental enamel attrition, slight antemortem tooth loss, and slight abscessing) suggest that dietary behaviors were not as detrimental to the Sanders population as has been noted for other maize-dependent agricultural groups. If nutrition was related to status among Caddoan groups, this may be the result of the assumed high status of the individuals interred at the Sanders site, since all the individuals were interred in a mound context.

Periodontal changes following coronal/root perforation and formocresol pulpotomy

A clinical case report is presented which describes the sequelae of an iatrogenic lateral crown/root perforation and a formocresol pulpotomy. The post-operative course of the initial therapy included significant hard and soft tissue destruction and eventual tooth loss. The possible implication of the role of formocresol is discussed.

An overview of periodontal surgical procedures.

It is obvious from the foregoing that there are many technical approaches to periodontal surgery. The mere presence of a periodontal pocket of a cerain depth as the major indicator for surgery is not as steadfast as once believed. Other criteria such as hemorrhage and exudate must also be used in evaluating the need for surgery. The decision on which approach to use remains with the therapist and the individual situation which he/she is faced. However, in the past decade it has become increasingly clear that the need for so-called more advanced surgical procedures is not as important to the control of periodontal diseases as was once thought. Regardless, it is also clear that some form of surgical intervention, as defined by this paper, is still necessary to interrupt the sequence of events that make up the pathogenesis of periodontal disease that leads to eventual tooth loss. This paper has reviewed and evaluated some of the current procedures available to the therapist in the surgical approach to therapy.

Dental Care and the Health Maintenance Organization Concept

The principal dental diseases, caries and periodontal disease, affect almost the entire population and result in considerable pain and discomfort, with eventual tooth loss, if untreated. These disorders can either be prevented or their effects minimized through dental intervention so that intact functioning dentitions can be maintained. Despite the fact that enough practicing dentists probably exist in the United States to achieve these results, the majority of the population lose all of their natural teeth if they live out their normal life spans. The solo-practice fee-for-service system, even with third-party payment, may reduce the difficulties somewhat but cannot solve the problem. Prepaid dental group practice, either independently or as part of a general health care system, has the potential of virtually eliminating edentulism in populations for which it has responsibility. At present, it is possible to project costs and resource needs with sufficient accuracy to start viable entities. The "health maintenance organization" concept, therefore, applies to dental care.