Periodontal Ligament Remnants Research Articles

Knowledge and Attitude of Pediatricians with Regard to Emergency Management of Dental Avulsion- A Survey

Dental trauma is a very significant problem encountered in both primary and the permanent dentition.Inpreschool children the trauma rate is as high as 18% of all injuries. Among all facial injuries, dental injuries arethe most common of which avulsions occur in 1–16% of all dental injuries. Among dental traumatic injuries,avulsion results in major functional and esthetic disturbances for patients. Epidemiological studies revealedthat children from 8 to 12 years often suffer a dental injury.The teeth most commonly avulsed in both theprimary and the permanent dentition are the maxillary central and lateral incisors. The longer the avulsedtooth is out of its socket, the less likely it will remain in a healthy functional state after replantation. Theprognosis of replanted permanent teeth depends primarily on (i) prompt and appropriate first care, commonlyprovided by non-health professionals at the site of the accident, (ii) the storage media of the avulsed toothprior to replantation, and (iii) the viability of periodontal ligament remnants on the root surface. Researchhas shown that immediate replantation is the best and most appropriate treatment for the traumaticallyavulsed permanent teeth.The aim of this study is to assess the basic knowledge of dental trauma and its management amongpediatricians

The sequestration of florid cemento-osseous dysplasia – a case report

Background: Florid cement-osseous dysplasia (FCOD) is a fibro-osseous lesion characterized by the replacement of normal bone by fibrous connective tissue with deposition of immature bone that gradually becomes sclerotic. Occurs more commonly in black women between the 5th and 6th decades. Its etiology is still unknown but its pathogenesis is believed to be related to remnants of periodontal ligament as seen in its histopathological similarity.

Biomechanics of Immediate Postextraction Implant Osseointegration

The aim of this study was to gain insights into the biology and mechanics of immediate postextraction implant osseointegration. To mimic clinical practice, murine first molar extraction was followed by osteotomy site preparation, specifically in the palatal root socket. The osteotomy was positioned such that it removed periodontal ligament (PDL) only on the palatal aspect of the socket, leaving the buccal aspect undisturbed. This strategy created 2 distinct peri-implant environments: on the palatal aspect, the implant was in direct contact with bone, while on the buccal aspect, a PDL-filled gap existed between the implant and bone. Finite element modeling showed high strains on the palatal aspect, where bone was compressed by the implant. Osteocyte death and bone resorption predominated on the palatal aspect, leading to the loss of peri-implant bone. On the buccal aspect, where finite element modeling revealed low strains, there was minimal osteocyte death and robust peri-implant bone formation. Initially, the buccal aspect was filled with PDL remnants, which we found directly provided Wnt-responsive cells that were responsible for new bone formation and osseointegration. On the palatal aspect, which was devoid of PDL and Wnt-responsive cells, adding exogenous liposomal WNT3A created an osteogenic environment for rapid peri-implant bone formation. Thus, we conclude that low strain and high Wnt signaling favor osseointegration of immediate postextraction implants. The PDL harbors Wnt-responsive cells that are inherently osteogenic, and if the PDL tissue is healthy, it is reasonable to preserve this tissue during immediate implant placement.

A Wnt-Responsive PDL Population Effectuates Extraction Socket Healing

Stem cells residing in the periodontal ligament (PDL) support the homeostasis of the periodontium, but their in vivo identity, source(s), and function(s) remain poorly understood. Here, using a lineage-tracing mouse strain, we identified a quiescent Wnt-responsive population in the PDL that became activated in response to tooth extraction. The Wnt-responsive population expanded by proliferation, then migrated from the PDL remnants that remained attached to bundle bone, into the socket. Once there, the Wnt-responsive progeny upregulated osteogenic protein expression, differentiated into osteoblasts, and generated the new bone that healed the socket. Using a liposomal WNT3A protein therapeutic, we showed that a single application at the time of extraction was sufficient to accelerate extraction socket healing 2-fold. Collectively, these data identify a new stem cell population in the intact periodontium that is directly responsible for alveolar bone healing after tooth removal.

Contribution of the PDL to Osteotomy Repair and Implant Osseointegration

Our objective was to clarify the fate of the periodontal ligament (PDL) retained in the socket after tooth extraction, then determine if this tissue contributed to the osseointegration of “immediate” implants placed in these fresh extraction sockets. Mice underwent maxillary first molar extraction, the residual PDL was removed by an osteotomy, and titanium implants were placed. The osteotomy was created in such a way that the palatal surface was devoid of PDL remnants while the buccal, mesial, and distal surfaces retained PDL fibers. At multiple time points after surgery, tissues were analyzed using a battery of molecular, cellular, and histomorphometrical assays. We found that PDL remnants mineralized and directly contributed to new bone formation in the extraction site. Compared with regions of an extraction site where the PDL was removed by osteotomy, regions that retained PDL fibers had produced significantly more new bone. Around immediate implants, the retained PDL remnants directly contributed to new bone formation and osseointegration. Thus, we conclude that PDL remnants are inherently osteogenic, and if the tissue is healthy, it is reasonable to conclude that curetting out an extraction socket prior to immediate implant placement should be avoided. This recommendation aligns with contemporary trends toward minimally invasive surgical manipulations of the extraction socket prior to immediate implant placement.

Guided Bone Regeneration Using Nanocrystalline Calcium Sulfate Bone Graft in an Extraction Socket: A Case Report

Introduction: The use of bone grafts to replace the lost bone in extraction sockets is commonplace today. This helps to maintain the height and width of the bone for eventual placement of dental implants.Case Presentation: A 41‐year‐old female patient presented to a private clinic with a hopeless tooth #31. Atraumatic extraction was performed. The socket was cleaned. Infected, inflamed tissue, as well as remnants of periodontal ligament, were removed. The site was thoroughly irrigated and decorticated. Particles of nanocrystalline calcium sulfate (nCS) were mixed with saline to form a putty. nCS putty was then lightly condensed in the extraction socket with a plastic instrument and a plugger. The site was closed with a barrier membrane. Radiographs were taken before and after the surgery. The patient was followed regularly. Four months after grafting the socket, two dental implants were placed in the healed socket. A small core of the bone from the grafted socket was obtained before implant placement and was analyzed histologically and histomorphometrically. Socket healing was uneventful. Histologic analysis demonstrated robust bone regeneration in the socket, and histomorphometric analysis showed 52% bone and 48% soft tissue. One hundred percent of the bone was vital. Implants were restored 4 months after placement.Conclusion: This case demonstrates the effective use of nCS for guided bone regeneration in a molar extraction socket.

A morphological survey of root grooves and their influence on periodontal attachment loss

Periodontal health reflects a balance between harmful and protective elements in the gingival marginal area. The total plaque mass, specific periodontopathogens, the tooth morphology, and local environmental factors may challenge this balance. The periodontal ligament attachment loss shifts this balance adversely toward the periodontal disease. The aim of this retrospective study was to determine the significance of proximal root grooves as a risk factor in the periodontal attachment loss; the effect of their dimensions and locations has been evaluated. One hundred (100) extracted formalin stored single rooted permanent anterior teeth were studied by staining with 0.1% toludine blue to visualize attached periodontal ligament remnants. On each tooth, the loss of attachment was measured from the cemento-enamel junction to the most coronal level of the stained periodontal ligament remnants. The prevalence of proximal root grooves was found to be 81% and a statistically significant greater loss of attachment was present on grooved than on non-grooved surfaces (p<0.01). Generally, there was direct relationship between groove location, its dimensions, and maximum loss of attachment. The results suggest that proximal root grooves should be considered in periodontal diagnosis, prognosis, and treatment planning.

Delayed replantation of rat teeth after use of reconstituted powdered milk as a storage medium

Minimal extraoral dry storage period and moist storage for the avulsed tooth are identified as key steps for the treatment protocol of tooth replantation. Among the possible moist storage media, bovine milk has stood out because of its capacity of preserving the integrity of the periodontal ligament (PDL) fibers. This condition has attracted the attention to investigate the use of powdered milk, which is one of the presentation forms of bovine milk, as a feasible storage medium in cases of delayed tooth replantation. The aim of this study was to evaluate the healing process after delayed replantation of rat teeth stored in reconstituted powdered milk and long shelf-life (ultra high temperature) whole milk. Forty maxillary right rat incisors were assigned to four groups (n = 10): group I--the teeth were extracted and immediately replanted into theirs sockets; group II--the teeth were stored for 60 min in 200 ml of freshly reconstituted powdered milk; group III--the teeth were stored for 60 min in 200 ml of long shelf-life whole milk; group IV--the teeth were kept dry for the same time. All procedures were performed at room temperature. Next, the root canals of teeth in groups II, III, and IV were instrumented, filled with a calcium hydroxide-based paste, and replanted into their sockets. All animals received systemic antibiotic therapy and were killed by anesthetic overdose 60 days after replantation. The pieces containing the replanted teeth were removed, fixed, decalcified, and paraffin-embedded. Semi-serial 6-microm-thick sections were obtained and stained with hematoxylin and eosin for histomorphological analysis. There was statistically significant difference (P < 0.05) between groups I and IV regarding the presence of replacement resorption and PDL remnants on root surface. The powdered milk and long shelf-life whole milk presented similar results to each other and may be indicated as storage media for avulsed teeth.

Analysis of the healing process in delayed tooth replantation after root canal filling with calcium hydroxide, Sealapex and Endofill: a microscopic study in rats

The major concern in the therapeutics of tooth replantation refers to the occurrence of root resorption and different approaches have been proposed to prevent or treat these complications. The purpose of this study was to evaluate tissue response to delayed replantation of anterior rat teeth treated endodontically using calcium hydroxide, Sealapex, and Endofill without the placement of gutta-percha cones. Thirty rats had their right upper incisor extracted and maintained in dry storage for 60 min. After removal of the dental papilla, enamel organ, pulp tissue, and periodontal ligament remnants, the teeth were immersed in 2% sodium fluoride phosphate acidulated, pH 5.5, for 10 min. The root canals were dried with absorbent paper points and the teeth were assigned to three groups (n = 10) according to the filling material. Group I - calcium hydroxide and propyleneglycol paste, Group II - Sealapex, and Group III - Endofill. The sockets were irrigated with saline and the teeth were replanted. Replacement resorption, inflammatory resorption and ankylosis were observed in all groups. Although the occurrence of inflammatory resorption was less frequent in Group I, there were no statistically significant differences among the groups. It may be concluded that compared to the paste, filling the root canals with Sealapex and Endofill sealers without the placement of gutta-percha cones did not provide better results.

Treatment of root surface in delayed tooth replantation: a review of literature

The time elapsed between a trauma and tooth replantation usually ranges from 1 to 4 h. The chances of root surface damage are higher when tooth replantation is not performed immediately or if the avulsed tooth is not stored in an adequate medium. This invariably leads to necrosis of pulp tissue, periodontal ligament cells and cementum, thus increasing the possibility of root resorption, which is the main cause of loss of replanted teeth. This paper presents a comprehensive review of literature on root surface treatments performed in cases of delayed tooth replantation with necrotic cemental periodontal ligament. Journal articles retrieved from PubMed/MedLine, Bireme and Scielo databases were reviewed. It was observed that, when there are no periodontal ligament remnants and contamination is under control, replacement resorption and ankylosis are the best results and that, although these events will end up leading to tooth loss, this will happen slowly with no loss of the alveolar ridge height, which is important for future prosthesis planning.

Mechanical removal of necrotic periodontal ligament by either Robinson bristle brush with pumice or scalpel blade. Histomorphometric analysis and scanning electron microscopy

One of the important factors accounting for successful delayed replantation of avulsed teeth is seemingly the type of root surface treatment. Removal of necrotic cemental periodontal ligament remnants may prevent the occurrence of external root resorption, which is the major cause of loss of teeth replanted in such conditions. The purpose of this study was to compare the efficacy of two mechanical techniques for removal of root-adhered periodontal ligament. Preservation or removal of the cementum layer concomitantly with these procedures was also assessed. Forty-five roots of healthy premolars extracted for orthodontic purposes were selected. After extraction, the teeth were kept dry at room temperature for 1 h and then immersed in saline for rehydration for an additional 10 min. Thereafter, the roots were assigned to three groups, as follows: group 1 (control)--the cemental periodontal ligament was preserved; group 2--removal of the periodontal ligament by scraping root surface with a scalpel blade (SBS); group 3--periodontal ligament remnants were removed using a Robinson bristle brush at low-speed with pumice/water slurry (RBP). The specimens were analysed histomorphometrically and examined by scanning electron microscopy. The quantitative and qualitative analyses of the results showed that the RBP technique was significantly more effective than the SBS technique for removal of the periodontal ligament remnants adhered to root surface. Both techniques preserved the cementum layer.

Delayed tooth replantation after root surface treatment with sodium hypochlorite and sodium fluoride: histomorphometric analysis in rats

In cases of delayed tooth replantation, non-vital periodontal ligament remnants have been removed with sodium hypochlorite in an attempt to control root resorption. Nevertheless, reports of its irritating potential in contact with the alveolar connective tissue have been described. Therefore, this study evaluated the healing process on delayed replantation of rat teeth, after periodontal ligament removal by different treatment modalities. Twenty-four rats, assigned to 3 groups (n=8), had their upper right incisor extracted and left on the workbench for desiccation during 60 min. Afterwards, the teeth in group I were immersed in saline for 2 min. In group II, root surfaces were scrubbed with gauze soaked in saline for 2 min; and in group III, scrubbing was done with gauze soaked in 1% sodium hypochlorite solution. Thereafter, root surfaces were etched with 37% phosphoric acid and immersed in 2% acidulate-phosphate sodium fluoride solution, at pH 5.5. Root canals were filled with a calcium hydroxide-based paste and the teeth were replanted. The animals were sacrificed 60 days postoperatively and the pieces containing the replanted teeth were processed and paraffin-embedded. Semi-serial transversally sections were obtained from the middle third of the root and stained with hematoxylin and eosin for histomorphometric analysis. Data were analyzed statistically using Kruskal-Wallis and Dunn's tests. The results showed that root structure and cementum extension were more affected by resorption in group III (p<0.05). All groups were affected by root resorption but the treatment performed in group III was the least effective for its control. The treatment accomplished in groups I and II yielded similar results to each other.

Cemental tear: a risk factor in periodontal attachment loss.

The objective of this retrospective study was to evaluate the influence of cemental tear as a risk factor in periodontal attachment loss. Seventeen extracted, single-rooted teeth showing loss of attachment and having one cemental tear surface and one opposite intact surface were examined. The teeth were stained in 0.1% toluidine blue to visualize attached periodontal ligament remnants and examined in a light microscope under incident light. On each tooth, loss of attachment was measured along the long axis of the root from the cemento-enamel junction to the most coronal level of the periodontal ligament on intact as well as on defect surfaces. Cemental tear surfaces demonstrated a significantly greater loss of attachment than opposite intact surfaces (P < 0.0001). In one specimen, the cemental tear fragment was partially attached to the root after the extraction procedure. This specimen was processed for light microscopy to determine the location of the cemental tear fracture. Histological examination clearly revealed that the split between the root and the fragment had occurred along the cemento-dentinal border. The results indicate that cemental tear should be considered as a possible etiologic entity in localized rapid periodontal breakdown.

Root grooves: a risk factor in periodontal attachment loss.

Periodontal health reflects a balance between harmful and protective elements in the gingival margin area. The total plaque mass, specific periodontopathogens, and local environmental factors may challenge this balance. The aim of this retrospective study was to evaluate the effect of proximal root grooves as a risk factor in periodontal attachment loss. One-hundred and three (103) extracted, formalin-stored, single-rooted teeth showing loss of attachment and having one non-grooved and one grooved proximal root surface were selected for the study. Following staining in 0.1% toluidine blue to visualize attached periodontal ligament remnants, the teeth were examined in a light microscope under incident light. On each tooth, loss of attachment was measured along the long axis of the root from the cemento-enamel junction to the most coronal level of the stained periodontal ligament remnants on mesial as well as on distal surfaces. Incisors and premolars were grouped separately. For both groups, a statistically significant greater loss of attachment was present on grooved than on non-grooved surfaces (P < 0.0001). Generally, there was a direct relationship between groove location and maximum loss of attachment. The results indicate that proximal root grooves should be considered in periodontal diagnosis, prognosis, and treatment planning.

Bone reactions around transplanted roots.

Abstract The aim of this experiment was to study endosteal bone reactions around roots transplanted into an edentulous crest, and the role, if any, of periodontal ligament (PDL) remnants preservation. After extraction of pre-molars and healing of the crests, 20 roots in 5 dogs were transplanted into bone cavities prepared in the edentulous areas. Roots implanted in the lower and upper right cavities had their PDL remnants preserved while those grafted in the left cavities had their surface planed and dried. After 5 months, the roots with surrounding bone were removed. 2 bone areas were delineated at the mesial aspect of each root, one immediately adjacent to the alveolar wall and the other distal to it. Results demonstrated that bone volume was higher in the proximal versus distal area in the maxilla and mandible preserved groups. The adipocyte content of the marrow spaces, an index of bone maturation, was less pronounced in the proximal versus distal area in the preserved groups. The number of osteoclasts was higher in the proximal zone in the preserved groups as were the extents of the different bone remodeling activities. The results indicate that the organization of PDL around transplanted roots is associated with rearrangement of the bone tissue surrounding the grafts. This process of long duration might be an adaptation to the likely low mechanical strains applied on bone through the root. Transplantation of PDL-damaged roots did not induce such events in the surrounding bone which had acquired the structure of an edentulous crest.

A Quantitative Study of Cementum Removal With Hand Curettes

An in vitro study was conducted to quantitatively measure the depth of root surface removal using curettes of standardized sharpness and with definite stroke number. Extracted periodontally healthy teeth from patients 10 to 15, 16 to 25, and 26 to 40 years old had periodontal ligament remnants removed with dry gauze before being secured in a vertical position during root planing. The force applied to the root surface was measured with a tension load cell. The "bright line" test was used to assess curette sharpness. After histologic processing, the thickness of cementum adjacent to the root defect, the cementum (if any) in the root defect, total amount of cementum removed, and depth of root defect were measured by a microscopic ocular grid. Teeth from each age range were evenly distributed into 6 groups of 10 teeth each. In the majority of teeth from the 20 stroke group through the 70 stroke group, complete cementum removal was observed at the site of planing. However, in some sections from each group, fragments of cementum remained on the root surface. A positive relationship (r/s = 1) was found between the number of strokes and the force applied to the root surface and the mean depth of defect (P less than 0.05). However, an inverse relationship existed between mean force per stroke and mean defect depth (r/s = -.99) such that as mean force per stroke increased, the mean defect depth decreased. As the root surface became smoother with an increasing number of strokes, the forces increased and were more consistent.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone reactions around transplanted roots

The aim of this experiment was to study endosteal bone reactions around roots transplanted into an edentulous crest, and the role, if any, of periodontal ligament (PDL) remnants preservation. After extraction of premolars and healing of the crests, 20 roots in 5 dogs were transplanted into bone cavities prepared in the edentulous areas. Roots implanted in the lower and upper right cavities had their PDL remnants preserved while those grafted in the left cavities had their surface planed and dried. After 5 months, the roots with surrounding bone were removed. 2 bone areas were delineated at the mesial aspect of each root, one immediately adjacent to the alveolar wall and the other distal to it. Results demonstrated that bone volume was higher in the proximal versus distal area in the maxilla and mandible preserved groups. The adipocyte content of the marrow spaces, an index of bone maturation, was less pronounced in the proximal versus distal areas in the preserved groups. The number of osteoclasts was higher in the proximal zone in the preserved groups as were the extents of the different bone remodeling activities. The results indicate that the organization of PDL around transplanted roots is associated with rearrangement of the bone tissue surrounding the grafts. This process of long duration might be an adaptation to the likely low mechanical strains applied on bone through the root. Transplantation of PDL-damaged roots did not induce such events in the surrounding bone which had acquired the structure of an edentulous crest.