Root Surfaces Of Teeth Research Articles

SEM evaluation of the apical external root surface of teeth with chronic periapical lesion

The aim is to verify, under scanning electron microscopy, the occurrence of apical root resorption in anterior and posterior teeth with chronic and radiographically visible periapical lesions. Thirty-two teeth were extracted, the apical thirds (n = 39) were removed, and prepared to analyse the external apical root surface. All specimens presented irregular areas of root resorption with different depths, located mainly around the apical foramen. Teeth with chronic periapical lesions present areas of external apical root resorption with irregular surface and different depths located mainly around the apical foramen. Root resorptions may show different configurations and destroy the apical root structure more or less extensively.

In VitroDifferentiation and Attachment of Human Embryonic Stem Cells on Periodontal Tooth Root Surfaces

Periodontal tissue engineering based on cell replacement therapies is a promising field for improved regeneration of tooth supporting structures lost as a result of destructive periodontal diseases. Human embryonic stem cells (hESCs) could become adequate cell source for tissue engineering because of their unlimited proliferative potential and ability to differentiate to all somatic cell types. The aim of this study was to analyze the differentiation capacity of hESCs toward periodontal compartment cells and their relationship with tooth root surfaces in vitro. Periodontal ligament fibroblastic cell (PDLF) cultures were established and characterized; hESCs (HUES-9 line) were expanded in undifferentiated state and characterized for pluripotency morphologically and immunohistochemically. Extracted tooth root slices (RS) of 300 microm thickness, prepared with both periodontal and endodontic instrumentation, were used. Three different experimental groups were established: (i) undifferentiated hESC colonies cultured on and around the RS; (ii) undifferentiated hESC colonies cultured on and around RS with PDLF coculture, and (iii) undifferentiated hESC colonies cultured on and around RS with PDLF coculture in osteoinductive medium for 3 weeks. The fibrogenic and osteogenic marker expression was assessed with immunohistochemistry; histological staining and scanning electron microscopy were utilized to determine the relationship between differentiating hESCs and mineralized tooth root structures. Results demonstrate that hESC differentiation is influenced by tooth structures, PDLFs, and osteogenic medium, resulting with increased propensity toward mesenchymal lineage commitment, and formation of soft-hard tissue relationship in close contact areas. The proposed experimental system may facilitate further understanding in development of periodontal structures and contribute to realization of hESCs as a cell source in periodontal tissue engineering applications.

Alendronate Binds to Tooth Root Surfaces and Inhibits Progression of Feline Tooth Resorption: A Pilot Proof-of-Concept Study

Tissue distribution, bioavailability, and efficacy of alendronate in preventing progression of resorption of teeth were evaluated in cats. [Butyl-4-14C-]-alendronate accumulates on subgingival tooth and alveolar bone surfaces adjacent to vascularized tissue resulting in concentration of the drug around tooth roots. Three cats were treated with a 0.03 mg/kg i.v. bolus of [butyl-4-14C-]-alendronate followed by blood, urine, and feces collection and euthanasia 24-hours later. Drug tissue distribution was accessed by autoradiography and sample combustion. To assess bioavailability, 12 cats were administered alendronate orally (3.0 or 9.0 mg/kg in water or 9.0 mg/kg in tuna water) and urine was collected for 24-hours. In these formulations, alendronate oral bioavailability in cats was approximately 3%. In addition, 10 cats with radiographic evidence of pre-existing tooth resorption (14 affected teeth) were treated with vehicle or 3.0 mg/kg alendronate per os once weekly for 22-weeks and, then, 9.0 mg/kg per os twice weekly for 27-weeks in a random, masked study. Radiographic area of resorption was measured and progression scored every 3 to 4-months. In placebo-treated cats, resorption progressed in five of six teeth (+ 97% average increase in area of resorption), whereas progression of resorption was seen in only three of eight affected teeth in alendronate-treated cats with a -22% average change (decrease) in area (P < 0.01 difference in number of teeth showing progression; P < 0.001 difference in area of resorption). Alendronate accumulated preferentially on subgingival tooth surfaces and adjacent alveolar bone and, at a dose of 9 mg/kg twice weekly, effectively slowed or arrested the progression of resorption.

Effects of root planing procedures with hand instrument or erbium, chromium:yttrium–scandium–gallium–garnet laser irradiation on the root surfaces: a comparative scanning electron microscopy study

The purpose of this study was to investigate the efficiency of hand instrumentation and laser irradiation on calculus removal from the root surfaces, in vitro. Thirty-two human teeth, extracted for periodontal reasons, were used in this study. Root surfaces of single-rooted teeth were treated by different methods including (1) conventional hand instruments; (2) hand instruments and tetracycline-hydrochloride (Tet-HCl); (3) erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser irradiation, setting I (short pulse); (4) Er,Cr:YSGG laser irradiation, setting II (long pulse). Three premolar teeth, extracted for orthodontic reasons, served as control. The morphology of the root surfaces was evaluated by light and scanning electron microscopy. Energy dispersive X-ray (EDX) analysis was performed to compare the mineral content of root surfaces treated with hand instrumentation and lasing procedures. The results of this study demonstrated that all treatments were efficient in calculus removal from the root surfaces. Thermal changes, including melting and carbonization, were not observed in either lasing procedure. The surface was rougher in the laser groups than in the groups treated with hand instruments. Moreover, roughness was greater in the long-pulse laser setting than in the short-pulse setting. While increased calcium (Ca) and decreased phosphate (P) (weight concentration percent) were observed in all treatments when compared with the control, laser procedures resulted in a more similar mineral content than in the groups treated with hand instruments. Based on these findings, laser procedures, when used in appropriate settings, are capable of performing scaling and root planing in the treatment of periodontitis. It may be concluded that short pulse laser may be more suitable for the micro-morphology of the root surface. However, additional in vitro and clinical studies are necessary to clarify the success of laser in periodontal therapy.

Diversity of Acellular and Cellular Cementum Distribution in Human Permanent Teeth

Cementum is divided into acellular cementum and cellular cementum based on the absence and presence of cementocytes in the cementum matrix. Since the distribution of acellular and cellular cementum is affected by physical conditions such as aging and pathological conditions like inflammation and hyper occlusal pressure causing hypercementosis. Moreover, it has been reported in many text books that acellular and cellular cementum distribute irregularly. However, it is generally known that acellular cementum is located from the cervical margin to the cervical half or one-third and cellular cementum is observed from the apical half or two-thirds to the apical portion. In the present study, we have observed labio-lingual grinding sections of extracted human permanent teeth used for student practice (50 incisors and 78 molars) and classified the distribution pattern of acellular and cellular cementum into five types as following: 1) Typical distribution type of the acellular and cellular cementum as explained above, 2) Type with thick acellular cementum at the cervical portion. In this type, thick acellular cementum is observed at the cervical portion, although the acellular and cellular cementum is distributed as same as type 1 except in the cervical portion, 3) Type with thick cellular cementum at the cervical portion. This type showed that thick cellular cementum is distributed at the cervical portion instead of acellular cementum in type 2, 4) Type with acellular cementum from the cervical area to apical portion. This type showed acellular cementum covering from the cervical to apical portion of the tooth root surface, although the cellular cementum was located near the dentino-cement junction, 5) Type with cellular cementum from the cervical to apical portion. Cellular cementum distributed from the cervical to apical portion of the tooth root surface, although the acellular cementum is located inside the surface cellular cementum. In type 5, we found holes of various sizes and shapes in the hypertrophied cementum. Since these holes were large and cement canaliculus surrounding the holes extended toward the holes, it is suggested that the hypertrophied cementum enfolded a part of the periodontal ligament.

Comparative Effect of the Ionic Products from Bioactive Glass Dissolution on the Behavior of Cementoblasts, Osteoblasts, and Fibroblasts

The cementum, a mineralized tissue lining the tooth root surface, is required for development of a functional periodontal ligament. The presence of healthy cementum is considered to be an important criterion for predictable restoration of periodontal tissues lost as a consequence of disease. Despite the importance of cementum to general oral health, very little is known about the cells responsible for the formation of cementum, cementoblasts. The aim of this study was to examine the effect of the ionic products from the dissolution of bioactive glass with 60% of silica ( BG60S ) on the behavior of cementoblasts, osteoblasts and fibroblasts. The cell viability was tested by MTT assay based on mitochondria activity of the cell and Trypan Blue assay based on membrane cell viability. The membrane cell viability measured by Trypan Blue assay showed the beneficial effect on all the cell types tested. It was observed a higher proliferation in the presence of ionic products from dissolution of BG60S when compared to control. In the MTT assay we also observed increased cell viability on all the cell types, but proliferation of cementoblasts was higher (107%) than observed for the other cells (104%) compared to control. The results from this study suggest that Cementoblasts, osteoblasts and fibroblasts are important cells on events that control the development of mineralizing and not mineralizing tissues and the investigation of the comparative behavior of these cells can be a useful experimental model. The observed effect of the bioactive glass particles on cementoblasts shows that this material is an interesting alternative to be used in composite membranes for cementum tissue engineering.

Histological analysis of orthodontic root resorption in rats treated with the cyclooxygenase‐2 (COX‐2) inhibitor celecoxib

It has been reported that anti-inflammatory drugs used for treatment of pain and discomfort related to orthodontic treatment could slow down tooth movement. However, the effect of these drugs on orthodontic root resorption is not well understood. The aim of this study was to investigate whether the COX-2 inhibitor celecoxib offers some protection against orthodontically induced root resorption. Male Wistar rats were divided into four groups: Groups I and II were treated with saline and celecoxib (10 mg / kg), respectively for 3 days. Groups III and IV were treated with saline and celecoxib for 14 days. The upper left first molars of all rats were moved mesially for 14 days with 50 g of force. An area including the disto-apical aspect of the mesial root of the first molar was processed for histological and histochemical techniques with tartarate-resistant acid phosphatase (TRAP). The degree of root resorption was measured using an image analysis system with a grid-sheet superimposed in the root were resorption lacunae were counted. The number of TRAP-positive cells on the tooth root surface defined as odontoclasts were also evaluated. The results revealed that there were no significant differences in the degree of root resorption and in the number of odontoclasts on the root between the four groups studied. The short and long-term celecoxib administration did not suppress the root resorption in case of experimental orthodontic force application.

Reasons for persistent and emerging post‐treatment endodontic disease

This article is a critical review of the reasons for persistent and emerging post‐treatment endodontic disease (PTED). While there is a strong consensus that micro‐organisms, mainly bacteria, are practically the only cause of primary apical periodontitis, the reasons for persistent apical periodontitis lesions have been more a matter of debate. The authors of this review focus on the role of micro‐organisms in PTED, and while secondary developments such as cholesterol crystals or foreign material in the periapical area of a tooth with apical periodontitis may contribute to additional irritation and/or an inflammatory reaction, a detailed analysis of the available data suggests that evidence supporting a primary role for such secondary factors without the continued presence of bacteria is lacking. Therefore, even in PTED, elimination of micro‐organisms residing within the tooth structure, root surface, or periapical tissues remains the goal of treatment and the key to long‐term success.

Comprehensive Analysis of Tissue-specific Markers Involved in Periodontal Ligament Development

The periodontal ligament (PDL) is a tendon/ligament-like fibrous tissue that connects the tooth root surface and the alveolar bone. General interest has been expressed in PDL development as a model for connective tissue formation because of its ability to adapt to mechanical loading. PDL cell has its origin in the dental follicle (DF) cell, and it begins to differentiate during tooth root development. During apical development of the tooth root, PDL progenitors in DF differentiate into PDL cells to form the PDL ; however, the molecular mechanisms of PDL development have not yet been clarified, as PDL lineage-specific markers are not available. We recently established a transcriptome database for the human PDL (KK-Periome database), and screened the genes specifically expressed during PDL development. Initial screening of the database allowed us to identify F-spondin and tenascin-N, which are restricted to DF and PDL cells, respectively. Thus, these could serve as PDL lineage-specific markers that would be useful for investigating the molecular mechanisms of PDL development.

Root Surface Characteristics of Children Teeth with Periodontal Diseases

The present study examined the root surfaces of teeth from children with or without periodontal diseases and with or without systemic diseases. Light microscopy revealed that when compared to control teeth: teeth with chronic periodontitis had similar radicular histology; teeth from children with leukocyte adhesion deficiency, Down syndrome and aggressive periodontitis had narrower cementum areas; teeth from children with hypophosphatasia showed cementum aplasia. Cementum anomalies may facilitate the establishment and progress of periodontitis in children.

Comparative observations on the tooth root morphology of Gigantopithecus blacki

The extinct great ape Gigantopithecus blacki from the middle Pleistocene of China and Vietnam is known only from dental and mandibular remains, and its dietary specializations remain contentious. Here, for the first time, we describe the root morphology in G. blacki using computed tomography and three-dimensional image processing. We quantify the tooth root lengths and surface areas of the female G. blacki mandible No. 1 from the Liucheng Cave and compare it to a sample of extant great apes and humans, as well as the giant panda ( Ailuropoda melanoleuca) and the American black bear ( Ursus americanus). The results show that, in G. blacki, the pattern of mandibular root numbers—particularly that of the premolars—corresponds with that of Gorilla gorilla, Pan troglodytes, and Pongo pygmaeus. However, G. blacki can be distinguished from the extant hominids by having relatively higher values for postcanine root length and surface area, both absolutely and relative to mandibular size (except for premolar root lengths of humans). The relatively large postcanine root surface areas, which are most similar to A. melanoleuca, suggest that the dentition of G. blacki was adapted to sustaining relatively large occlusal forces needed to fracture mechanically resistant foods such as bamboo.

OPN deficiency suppresses appearance of odontoclastic cells and resorption of the tooth root induced by experimental force application

Osteopontin (OPN) is a major non-collagenous bone matrix protein implicated in the regulation of cell function. Although OPN is rich in the cementum of the tooth, the significance of OPN in this tissue is not understood. Tooth root resorption is the most frequent complication of orthodontic tooth movement (TM). The objective of this study was to examine the pathophysiological role of OPN in cementum of the tooth root. For this purpose, the upper right first molar (M1) in OPN-deficient and wild-type (WT) mice was subjected to mechanical force via 10 gf NiTi coil spring while the left side molar was kept intact to serve as an internal control. Micro-CT section and the level of tartrate resistant acid phosphatase (TRAP)-positive cells on the tooth root surface defined as odontoclasts were quantified at the end of the force application. In WT mice, force application to the tooth caused appearance of odontoclasts around the mesial surface of the tooth root resulting in tooth root resorption. In contrast, OPN deficiency significantly suppressed the force-induced increase in the number of odontoclasts and suppressed root resorption. This force application also induced increase in the number of TRAP-positive cells in the alveolar bone on the pressure side defined as osteoclasts, while the levels of the increase in osteoclastic cell number in such alveolar bone were similar between the OPN-deficient and WT mice. These observations indicate that OPN deficiency suppresses specifically tooth root resorption in case of experimental force application.

Study of Tooth Root Surface Treated with Various Techniques Using Variable Pressure SEM.

Extended abstract of a paper presented at MC 2007, 33rd DGE Conference in Saarbrücken, Germany, September 2 – September 7, 2007

The expression of estrogen receptors and the effects of estrogen on human periodontal ligament cells

Osteoporotic women exhibit high frequency of alveolar bone loss and low bone density. Estrogen deficiency, which is vital in the pathogenesis of postmenopausal osteoporosis, has received increasing attention in the studies related to the periodontal diseases. Similar to most hormones, estrogen exerts its influence by binding to specific receptors, estrogen receptor (ER)-alpha and -beta. The periodontal ligament cells (PDLcs) are very important in maintaining the integrity of the periodontal tissue, which is the connective tissue located between the alveolar bone and the root surface of tooth. In this study, we evaluated the effects of estrogen deficiency on the alveolar bone in ovariectomized rats by histometric measurement of attachment level in vivo. Using the reverse transcriptase polymerase chain reaction (RT-PCR) and Western-blot procedure, we also detected mRNA and protein products of ERs and investigated the effects of estrogen on bone-forming capability by monitoring alkaline phosphatase (ALP) activity and osteocalcin production in cultured human PDLcs. Our results demonstrated that both ER-alpha and -beta were expressed in PDLcs. Moreover, when exposed to 17-beta estradiol, PDLcs exhibited positive modulation on ALP activity and osteocalcin production. The study suggests that estrogen and ERs may play an important role in periodontal diseases.

Comparative in vitro study of root roughness after instrumentation with ultrasonic and diamond tip sonic scaler

Objective:The purpose of this study was to evaluate the root surface roughness after instrumentation with hand curette and diamond-coated sonic and universal ultrasonic tips.Materials and Methods:Forty root surfaces of human teeth were randomly assigned to four treatment groups: control group (without instrumentation), curette instrumentation, ultrasonic instrumentation with universal tip and sonic instrumentation with diamond-coated tip. Each sample was instrumented with fifteen strokes. Before and after instrumentation, surface roughness was measured. In addition, the root surface topography was examined after treatment under the scanning electron microscope.Results:Significant statistical differences (p<0.05) were observed when comparing the control group (0.48±0.07mm) to the treated groups (hand - 1.246±0.279mm, ultrasonic - 1.468±0.177mm and sonic instrumentation - 1.576±0.20mm). The highest roughness was produced by diamond-coated sonic tip and by ultrasonic universal tip (p>0.05).Conclusion:The diamond-coated tip with sonic scaler instrumentation and ultrasonic instrumentation produce similar root surface roughness, higher than curette instrumentation.

Porphyromonas gingivalis lipopolysaccharide lipid A heterogeneity: differential activities of tetra- and penta-acylated lipid A structures on E-selectin expression and TLR4 recognition

Porphyromonas gingivalis is a gram-negative bacterium strongly associated with periodontitis, a chronic inflammatory disease of the tissue surrounding the tooth root surface. Lipopolysaccharide (LPS) obtained from P. gingivalis is unusual in that it has been shown to display an unusual amount of lipid A heterogeneity containing both tetra- and penta-acylated lipid A structures. In this report, it is shown that penta-acylated lipid A structures facilitate E-selectin expression whereas tetra-acylated lipid A structures do not. Furthermore, it is shown that tetra-acylated lipid A structures are potent antagonists for E-selectin expression. Both tetra- and penta-acylated lipid A structures interact with TLR4 although experiments utilizing human, mouse and human/mouse chimeric TLR4 proteins demonstrated that they interact differentially with the TLR4 signalling complexes. The presence of two different structural types of lipid A in P. gingivalis LPS, with opposing effects on the E-selectin response suggests that this organism is able to modulate innate host responses by alterations in the relative amount of these lipid A structures.

The potential for dental plaque to protect against erosion using an in vivo‐in vitro model — A pilot study

Tooth erosion is a problem for professional wine tasters (exogenous erosion from frequent exposure to wine acids) and for people with gastro oesophageal reflux disease (GORD) and bulimia who experience frequent reflux of gastric contents into the mouth (endogenous erosion from mainly HCl). The objective in this study was to determine whether plaque/pellicle could provide teeth with any protection from two common erosive acids, using an in vivo-in vitro technique. Tiles of human tooth enamel and root surfaces were prepared from six extracted, unerupted third molar teeth and sterilized. Mandibular stents were prepared for six volunteer subjects and the tiles bonded to the buccal flanges of these stents. They were worn initially for three days to permit a layer of pellicle and plaque to form over the tile surfaces, and for a further 10 days of experimentation. Following cleaning of the plaque/ pellicle layer from the tiles on the right side flange, all the tiles were submerged in either 0.06M HCl or white wine for an accumulated time of 600 and 1500 minutes, respectively. Depths of erosion were determined using light microscopy of sections of the enamel and root tiles. SEM of the lesion surfaces was carried out to investigate the nature of erosive damage and of plaque/pellicle remnants. Retained plaque was found to significantly inhibit dental erosion on enamel, from contact with both HCl and wine, compared with that resulting following its removal. However, it was found to provide no significant protection on root surfaces. SEM analysis of the tile surfaces revealed marked etching of enamel on the cleaned surfaces, and considerable alteration to the appearance of remaining plaque and pellicle on most surfaces. Within the limitations of numbers of specimens, dental plaque/pellicle provided a significant level of protection to tooth enamel against dental erosion from simulated gastric acids and from white wine, using an in vivo-in vitro model. It was unable to provide any significant protection to root surfaces from these erosive agents. Possible reasons for this difference are explored.

The use of enamel matrix derivative (Emdogain®) for improvement of probing attachment level of the autotransplanted teeth

The enamel matrix derivative (EMD, Emdogain) was used for the purpose to obtain the periodontal regeneration on the denuded root-surfaces of the donor teeth in two cases of the immediate tooth-transplantation. The root-surfaces at the cervical portion of the teeth were denuded because of extrusion. The healthy periodontium of each tooth remained at the apical portion of the roots. The denuded root-surfaces were cleansed before extraction. Then, the donor teeth were gently extracted with forceps, administered EMD, and transplanted so that the denuded surfaces were covered by gingival flaps. After the transplantation, the mean probing attachment level (PAL) improved 3.2 mm and 1.5 mm, respectively. The mean probing pocket depth was within normal level. The actual supporting areas of the roots of the transplanted teeth increased and the teeth worked as the abutments of prosthetic bridges.

Protective effects of etoricoxib, a selective inhibitor of cyclooxygenase‐2, in experimental periodontitis in rats

The purpose of the present study was to evaluate the effect of a potent selective cyclooxygenase-2 (COX-2) inhibitor, etoricoxib, on the prevention of alveolar bone loss in experimental periodontitis induced in rats. Ninety Wistar rats were separated into three experimental groups. Cotton ligatures were placed at the gingival margin level of lower right first molars. The rats were randomly assigned to one of the following groups: control received a daily oral dose of 1 ml/kg of saline solution; Eto1 received 6 mg/kg of etoricoxib; Eto2 received 12 mg/kg of etoricoxib. Serum levels of etoricoxib and white blood cells were determined. Standardized digital radiographs were taken after death at 3, 5, 10, 18 and 30 days to measure the amount of bone loss at the mesial root surface of the first molar tooth in each rat. One-way analysis of variance (anova) indicated that groups treated with both doses of etoricoxib had significantly (p < 0.05) less alveolar bone loss when compared to controls. Furthermore, etoricoxib treatment significantly inhibited the leukocytosis observed 3 days after the induction of periodontitis. These data provide evidence that systemic therapy with etoricoxib can retard alveolar bone loss in a ligature-induced periodontitis model in rats.

Calculus‐like deposit on the apical external root surface of teeth with post‐treatment apical periodontitis: report of two cases

To report two cases in which calculus-like material was found on external root surfaces of (i) an extracted root and (ii) an apicected part of a root, both of which were removed due to post-treatment refractory apical periodontitis. In each case, there was a fistulous tract, which did not heal after conventional root canal treatment. The first case did not heal even after apical surgery, and subsequent tooth extraction revealed calculus-like material on a root surface of complex anatomy. The second case showed radiographic signs of healing after apicectomy. Histology of the apical biopsy revealed a calculus-like material on the external surface of the root apex. It is suggested that the presence of calculus on the root surfaces of teeth with periapical lesions may contribute towards the aetiology of failure. Biofilm on the external root surface has been implicated in the failure of apical periodontitis to heal, despite adequate root canal treatment. Calculus-like material was found, in two cases, on the root surface of teeth with post-treatment apical periodontitis, where the only communication externally was a sinus tract.