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Iatrogenic pulpal reactions to orthodontic extrusion.

A careful review of the literature reveals an absence of studies about the reactions of dental pulp to orthodontic extrusion. The purpose of the present research investigation is to study the pulpal reactions and the sequence of histologic events in human dental pulp after orthodontic extrusion. The sample consisted of 36 intact maxillary first premolars of young adult orthodontic subjects. The mean age of the subjects was 18 years. Eighteen maxillary first premolars were extruded, under controlled conditions with the aid of fixed edgewise orthodontic appliances, for either 1, 2, or 4 weeks. The contralateral maxillary first premolars were not extruded and were used as controls. Immediately after removal of the appliances, all the maxillary first premolars were extracted. The pulps were histologically examined in a double-blind experiment. The results obtained from this study indicate that certain characteristic pulpal reactions arise from orthodontic extrusion. These reactions involve circulatory disturbances with congested and dilated blood vessels, odontoblastic degeneration, vacuolization and edema of the pulp tissues, and (by the fourth week) manifestation of fibrotic changes. It is speculated that the vacuolization of the pulp tissues (which occurred after the application of extrusive orthodontic forces in young adult subjects) resulted from a prolapse of the pulp, made possible by the relatively wide apical foramina. However, the odontoblastic degeneration is most probably the result of a compromised blood supply. The authors believe that this study constitutes a building block for establishing a more complete biologic foundation for orthodontic tooth movement. Further studies are suggested to reach more definitive conclusions.

Adolescent↗

Cell-specific patterns of Cbfa1 mRNA and protein expression in postnatal murine dental tissues.

Cbfa1 (core binding factor alpha 1) is a transcription factor that is a key determinant of the osteoblastic lineage. Recent data showed that Cbfa1 is also highly expressed in early stages of tooth development and is involved in crown morphogenesis and cytodifferentiation of odontoblasts. Here we report the mRNA expression and protein localization of Cbfa1 in the mouse dentition in (later) stages of crown and root development. In addition to osteoblasts, osteocytes, chondrocytes, odontoblasts, dental follicle cells, cementoblasts and periodontal ligament cells, we report also Cbfa1 expression in dental epithelial cells (secretory and maturation ameloblasts) and several non-mineralizing cell types (hair follicles, ducts of salivary glands, and junctional epithelium of the gingiva).

Age Factors↗

Immunolocalization of cathepsin D in dental tissues.

Cathepsin D antigenicity was localized at the light and electron microscopic levels within dental cells, but not in extracellular matrix. Different intracellular sites for cathepsin D were found depending on the cell type: the enzyme was detected in secretory vesicles of the odontoblasts and in the lysosome-like structures of the ameloblasts. Otherwise, these results suggest that the secretory vesicles of the odontoblasts may contain both cathepsin D and type I collagen. These data might implicate cathepsin D in the enamel and the dentin formations.

Animals↗

Tooth development in Ambystoma mexicanum: phosphatase activities, calcium accumulation and cell proliferation in the tooth-forming tissues.

Prerequisites of tooth formation, cell proliferation in the tooth-forming tissues, calcium accumulation and the enzymatic activities of alkaline (ALP) and acid phosphatases (ACP) were investigated by immunohistochemical and histochemical methods in various developmental stages of the Mexican Axolotl, Ambystoma mexicanum. During the growth of replacement teeth, the tooth-forming tissues continually recruit cells from the surrounding regions. The basal layer of the oral epithelium, the dental lamina and sometimes even the outer enamel epithelium provide cells for the differentiated inner enamel epithelium, in which the active ameloblasts are localized. The differentiating odontoblasts are derived from proliferating cells situated basally to the replacement teeth in the mesenchymal tissue. When differentiation has started and the cells have become functional, proliferative activity can no longer be observed. Calcium is accumulated close to the site of mineralization in the inner enamel epithelium and in the odontoblasts as it is in mammals, elasmobranchii and teleostei. The activities of ACP and ALP related to the mineralization of the replacement teeth are separated spatially and not sequentially as they are in mammals. However, the results indicate a similar function of these enzymatic components in relation to tooth formation and maturation of mineral deposition. Most of the substantial processes related to tooth formation reported from other vertebrates occur in a manner similar to that in Ambystoma mexicanum, but there also seem to be basic mechanisms present that are realised in a unique way in this urodele.

Acid Phosphatase↗

Stromelysin-1 (MMP-3) in forming enamel and predentine in rat incisor-coordinated distribution with proteoglycans suggests a functional role.

Stromelysin-1 (matrix metalloproteinase-3) or proteoglycanase was visualized by light and electron microscopy immunolabelling in the forming zone of rat incisors. In predentine, labelling was more dense at the transition zone between the inner proximal third and the two outer thirds. Odontoblast processes were also positively stained, mostly in predentine and to a lesser degree in dentine. The dentine-enamel junction was intensely labelled, whereas dentine and forming enamel were only faintly stained. Gold-antibodies complexes were seen inside secretory ameloblasts and odontoblasts in cytosolic locations. The distribution of stromelysin-1 was compared with the distribution of 2-B-6 epitope, an antibody recognizing chondroitin-4-sulphate/dermatan sulphate and which showed a decreasing gradient from the proximal zone to the distal part of predentine. In contrast, both 5-D-4, an anti-keratan sulphate antibody and an anti-lumican antibody displayed a reversed distribution, with an increase seen from the proximal and central thirds to the distal part of predentine. This coordinated distribution suggests that stromelysin-1 may have a functional role, being implicated in predentine in the degradation of chondroitin-4-sulphate/dermatan sulphate-containing proteoglycans, and consequently allowing keratan sulphate proteoglycan concentration to increase near the border where mineralization is initiated.

Ameloblasts↗

Immunohistochemical study on pulpal response in rat molars after cavity preparation by Er:YAG laser.

While Er:YAG laser systems are in extensive use for caries removal and cavity preparation, the effects of such treatment on pulp tissue remain unclear. This study evaluates these systems using immunohistochemical methods and compares the results with information gained from treatment using conventional burs. Cervical cavities were prepared in the upper first molars of rats, using either an Er:YAG laser or a conventional tungsten-carbide bur. At intervals of 5 min, 6 h, 12 h, 1 d, 3 d and 7 d after cavity preparation, the teeth were processed for immunohistochemical analyses of tissue non-specific alkaline phosphatase, OX6-positive major histocompatibility complex class II antigen-expressing cells and PGP 9.5-immunoreactive nerve fibers. DNA fragmentation was detected by the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method. Tissue non-specific alkaline phosphatase was observed mainly in the subodontoblastic layer under the cavity lesion, from 5 min, in both groups. The immunoreactivity was more pronounced in the laser group, but by 7 d no significant differences were recognizable. At 12 h, TUNEL-positive cells were detected around the odontoblastic layer in both groups. From 3 d to 7 d, a limited number of positive cells were still visible in the group that underwent standard treatment. Clear similarities in the distribution patterns of OX6-immunopositive cells and PGP 9.5-immunoreactive nerve fibers were also noted. From 12 h to 1 d, OX6-positive cells accumulated along the pulp-dentin border, extending their processes into the dentinal tubules. Numerous bead-like PGP 9.5-immunoreactive nerve fibers were observed under the odontoblastic layer at 7 d. These results demonstrated that there was no appreciable difference in the manner in which pulp tissue responded to treatment with either Er:YAG laser or a conventional drill. This would seem to indicate the usefulness of the Er:YAG laser system in the removal of caries and cavity preparation.

Alkaline Phosphatase↗

Identification, distribution and expression of osteoadherin during tooth formation.

Osteoadherin (OSAD) is a keratan sulfate-containing proteoglycan, belonging to the small leucine-rich proteoglycan (SLRP) family. In bone OSAD has been localized in primary spongiosa within the bovine fetal rib growth plate. Moreover, in situ hybridization has shown expression of OSAD in osteoblasts close to the cartilage and bone border in the growth plate of rat femur. mRNA expression has also detected OSAD in mature osteoblasts on the surface of bone trabeculae. We have identified OSAD in extracts of bovine dentin, and the identity was verified by N-terminal sequencing. Western blot analysis detected two bands in bovine bone and dentin at 85 kDa and 60 kDa. Northern blot analysis of RNA samples from 5-d-old-rat tooth and femur showed a 1.9-kb transcript for OSAD in both tissues. OSAD was located to the mineralized dentin matrix, cementum and surrounding alveolar bone by immunohistochemistry, and in situ hybridization showed OSAD to be highly expressed during early crown formation in the entire odontoblast cell layer, in the area of Hertwig's epithelial root sheath, in the cells of the newly formed mantle dentin, and in the odontoblasts at the fissures. Ultrastructural studies indicated that OSAD might be associated with collagen fibrils. Thus, OSAD may play an important role during tooth development and biomineralization of dentin.

Alveolar Process↗

Effect of lipopolysaccharides on vascular endothelial growth factor expression in mouse pulp cells and macrophages.

Vascular endothelial growth factor (VEGF), a potent pro-angiogenic factor, might regulate the neovascularization observed in the pulp of teeth with deep caries. The purpose of this in vitro study was to evaluate the effect of bacterial lipopolysaccharides (LPS) on VEGF expression in dental pulp cells. Mouse odontoblast-like cells (MDPC-23) or undifferentiated pulp cells (OD-21) were exposed to 0-20 microg ml-1Escherichia coli LPS or 0-80 microg ml-1Prevotella intermedia LPS. As controls, mouse macrophages or gingival fibroblasts were exposed to LPS, since these cells are known to secrete VEGF. The VEGF expression was evaluated by reverse transcriptase polymerase chain reaction or enzyme-linked immunosorbent assay. The baseline expression levels of VEGF protein were higher in MDPC-23 and OD-21 than in fibroblasts or macrophages. Vascular endothelial growth factor protein expression was upregulated in MDPC-23 and macrophages exposed to E. coli LPS, but not in OD-21 cells or fibroblasts. Higher concentrations of P. intermedia LPS were required to induce VEGF expression in MDPC-23 cells. Treatment with LPS did not affect VEGF expression at the mRNA level in any of the cells evaluated. These results demonstrate that bacterial LPS upregulates VEGF expression in odontoblast-like cells and macrophages, and suggest that the regulation of VEGF expression occurs primarily at a post-transcriptional level.

Analysis of Variance↗

Studies of osteocalcin function in dentin formation in rodent teeth.

Osteocalcin (OC) is a major non-collagenous protein synthesized by osteoblasts, odontoblasts and cementoblasts. We examined the function of OC in dentinogenesis by exposing rat and hamster tooth organ cultures to 1,25(OH)2vit D3 or to bovine OC added to the culture medium. We furthermore examined dentinogenesis in tooth explants cultured in the presence of warfarin (an inhibitor of gamma-carboxylation of OC). Finally, we analyzed dentin from osteocalcin null mutant mice. Exposure to 1,25(OH)2vit D3 increased OC synthesis by odontoblasts in vitro at the transcriptional and protein levels but had no apparent effect on matrix formation or 45Ca uptake. High levels of bovine OC temporarily suppressed the initial formation of dentin and enamel and uptake of 45Ca. This effect was not seen when tooth explants were exposed to thermally decarboxylated OC. Exposure of tooth explants to warfarin had no significant effect on dentinogenesis. Dentin obtained from two-month-old OC null mutants looked structurally normal and did not show marked differences in dentin matrix thickness and mineral content compared to wild type. We concluded that, although OC at supraphysiological levels has the potential to affect dentin mineralization probably through its Gla-residues, the locally produced levels of OC are not sufficient to markedly influence dentinogenesis.

Amelogenesis↗

Timp-1, -2 and -3 show coexpression with gelatinases A and B during mouse tooth morphogenesis.

Matrix metalloproteinases (MMPs) have been implicated in tissue remodelling and in regulation of cell-matrix interactions during organ development. The activity of MMPs is regulated by members of the TIMP (tissue inhibitors of metalloproteinase) family. We analyzed by in situ hybridization the expression of gelatinase A (MMP-2) and gelatinase B (MMP-9) as well as Timp-1, -2 and -3 during different stages of mouse tooth development. Gene expression was generally found in mesenchymal tissues except for Timp-3, which also was found in dental epithelial cells. During early tooth development, gelatinase A and Timp-2 were widely expressed in the branchial arch, while gelatinase B and Timp-1 and Timp-3 expression showed clear association with epithelial morphogenesis and was restricted to the mesenchyme at the tip of the growing tooth bud. Gelatinase A and Timp-1 showed transient expression in secretory odontoblasts at the time of basement membrane degradation, while Timp-2 expression continued throughout the dental papilla. At the time of tooth eruption, Timp-3 was expressed in most dental epithelial cells except secretory ameloblasts, and gelatinase B was intensely expressed in osteoclasts in the jaw bone. The exact co-localization of gelatinase A and Timp-1 in secretory odontoblasts, and the correlation between gelatinase B and Timp-3 during bone resorption may indicate interaction of the proteins during degradation of the basement membrane and in the control of ECM turnover in connection with tooth eruption.

Animals↗

Immunolocalization of bone extracellular matrix proteins (type I collagen, osteonectin and bone sialoprotein) in human dental pulp and cultured pulp cells.

AIM: To simultaneously analyse the expression of type I collagen, osteonectin and bone sialoprotein (BSP) in human dental pulp of different ages. METHODOLOGY: Cultured dental pulp fibroblasts (FP1 cell line), pulps from dental germs with incomplete root formation (n = 4) and pulps of erupted teeth with total root formation (n = 4) were used. Bone proteins were searched by immunohistochemistry and immunofluorescence using polyclonal antibodies and compared among the three groups assessed. RESULTS: Immunohistochemistry detected the three proteins in dental pulp tissue, as it labelled extracellular matrix, predentine and odontoblasts. The BSP label was weaker, when compared to both type I collagen and osteonectin. The presence of type I collagen was more evident in pulps from erupted teeth, when compared to germ dental pulps. On the other hand, a strong expression of osteonectin in germ dental pulps was observed. CONCLUSIONS: Regardless of the degree of maturation, dental pulps present type I collagen, osteonectin and BSP in the extracellular matrix (ECM) and in the odontoblastic layer. Thus, the results suggest that these proteins are related to the production and mineralization of dentine.

Cell Line↗

Development of larval and transformed teeth in Ambystoma mexicanum (Urodela, Amphibia): an ultrastructural study.

Odontogenesis of early larval non-pedicellate teeth, late larval teeth with a more or less distinct dividing zone and fully transformed pedicellate teeth in Ambystoma mexicanum (Urodela) was studied to obtain insights into the development of differently structured teeth in lower vertebrates. Using transmission electron microscopy we investigated five developmental stages: (1) papilla; (2) bell stage (secretion of the matrix begins); (3) primordium (mineralization and activity of ameloblasts starts); (4) replacement tooth (young, old); and (5) established, functional tooth. Development of the differently structured teeth is largely identical in the first three stages. Mineralization takes place in apico-basal direction up to the (prospective) pedicel (early and some late larvae) or up to the zone that divides the late larval and transformed tooth in pedicel and dentine shaft (pedicellate condition). Mineralization starts directly at the collagen and by means of matrix vesicles. First odontoblasts develop small processes that extend to the basal lamina of the inner epithelial layer of the enamel organ. The processes are small and lack organelles in early larval teeth, but become larger, arborescent, and contain some organelles in late larval and transformed teeth. The processes are surrounded by unmineralized matrix (predentine). Odontoblasts at the basis of the teeth, at the pedicel, and in the zone of division do not develop significant cytoplasmic processes that extend into the matrix. Cells of the inner enamel epithelium differentiate to ameloblasts that secrete the enamel. In the early larval tooth they show an extensive basal labyrinth that becomes regressive when the enamel layer is completed. In late larval and transformed teeth, however, a large cavity arises between the basal ruffled border of ameloblasts and their basal lamina. This cavity appears to mediate amelogenesis. A small apical zone in early, but not in late larval teeth directly below the thin enamel layer consists of enameloid and is free of dentine channels.

Ambystoma mexicanum↗

Estrogen receptors in human pulp tissue.

OBJECTIVE: The aim of this study was to evaluate the expression of estrogen receptor (ER)-alpha in human pulp tissue. STUDY DESIGN: Tissue samples were collected from 51 teeth extracted for orthodontic reasons or from endodontically treated teeth. Immunohistochemical staining was performed with mouse antihuman ER-alpha 1D5 by using the alkaline phosphatase antialkaline phosphatase technique. Immunohistochemical reactivity was semiquantitatively assessed and graded on an intensity scale of 0 to 3. RESULTS: ERs were found in odontoblasts, endothelial cells, and Schwann cells. By means of statistical analysis, ERs were found to be common in odontoblasts (1.3-1.6) and in endothelial cells (1.0-1.4), whereas in Schwann cells they were somewhat rare (0.7-1.1). Difference in expression of ERs was not found among patients in different age groups. With respect to sex, a difference in reactivity was observed in Schwann cells, which showed higher reactivity in female pulps. CONCLUSION: The results of this study confirm the expression of ER-alpha in the human dental pulp.

Adult↗

A histochemical study of the regeneration process after injury by pulsed Nd:YAG laser irradiation of root canals.

Histological changes of rat dental pulp cells were followed after injury. The regeneration process after 3, 6 and 10 days was monitored. Mandibular incisors were irradiated with a pulsed Nd:YAG laser at 2 W and 20 pulses per sec (pps) for 5 sec and the pulp was examined histologically and immunohistochemically for TGF-beta1. Eruption of the developing tooth was disturbed for a short period only. Rapid formation of osteodentin was observed. After 3 days, a zone of fibrodentin matrix as well as newly formed vessels were found. Afterwards, regenerative dentin formation was observed accompanied by the formation of a layer of odontoblast-like cells in the damaged area. Immunohistochemical staining of TGF-beta1 showed that positivity was present in small tissue areas beneath the mantle dentin, the zone of fibrodentin matrix and odontoblast-like cells. These results indicate that pulsed Nd:YAG laser irradiation of rat incisor pulp induces formation of osteodentin, and TGF-beta1 plays a role during regeneration.

Animals↗

Effects of alginate hydrogels and TGF-beta 1 on human dental pulp repair in vitro.

The objective of this study was to investigate the use of alginate hydrogels to present either exogenous or endogenous transforming growth factor (TGF)-beta 1 to the dentin-pulp complex to signal reparative processes. Hydrogels were prepared, applied to cultured human tooth slices and the effects on tertiary dentinogenesis examined histologically. Both TGF-beta 1-containing and acid-treated alginate hydrogels, but not untreated hydrogels, upregulated dentin matrix secretion and induced odontoblast-like cell differentiation with subsequent secretion of regular tubular dentin matrix on cut pulpal surfaces. It is concluded that TGF-beta 1 can signal both induction of odontoblast-like cell differentiation and upregulation of their matrix secretion in the human dentin-pulp complex. Alginate hydrogels provide an appropriate matrix in which dental regeneration can take place and may also be useful for delivery of growth factors, including TGF-beta s, to enhance the natural regenerative capacity of the dental pulp.

Acids↗

Immunohistochemical localization of MMP-2, MMP-9, TIMP-1, and TIMP-2 in the forming rat incisor.

Western blots analyses and gelatin zymography established the presence of matrix metalloproteinase (MMP)-2 and -9 in the forming zone of rat incisor. Light microscope immunohistochemistry carried out on undemineralized material provided evidence for strong MMP-2 staining in the secretory ameloblasts, odontoblasts, in the enamel organ, and in the pulp. A weaker staining was observed in predentin and in the outer part of the forming enamel. Using MMP-9 antibodies, the staining was generally weak, except for the secretory ameloblasts that were positively stained. Electron microscopic immunohistochemistry of undemineralized sections revealed a close association between gold-antibodies complexes and cytoskeletal microfilaments in the cytosol of secretory ameloblasts and odontoblasts, within the rough endoplasmic reticulum and along the plasma membrane. The striking feature of MMP-2 and -9 electron immunostaining was the particularly high labeling in the mantle dentin. By contrast, staining of tissue inhibitors of metalloproteinases (TIMP-1 and -2) was lowest in this region. We suggest that this uneven distribution may have some functional implications.

Actin Cytoskeleton↗

Stimulation of reparative dentin formation by ex vivo gene therapy using dental pulp stem cells electrotransfected with growth/differentiation factor 11 (Gdf11).

Dental pulp progenitor/stem cells have the capacity to differentiate into odontoblasts and they provide a potential for dentin repair and regeneration by gene therapy. To develop a successful ex vivo gene therapy to induce reparative dentin formation rapidly and effectively after treatment of caries, we developed a three-dimensional pellet culture system of pulp cells electrotransfected with growth/differentiation factor 11 (Gdf11). The viability after electrotransfection was more than 85%, and the efficiency was about 70% as determined by flow cytometry. After 10 days of culture, the total amount of type I and type III collagen was 3-fold higher in the pEGFP-Gdf11-transfected pellet than in the control. Real-time RT-PCR analysis demonstrated that the expression of markers of odontoblast differentiation (alkaline phosphatase, dentin matrix protein 1 [Dmp1], dentin sialophosphoprotein [Dspp], enamelysin, and phosphate-regulating gene with homologies to endopeptidases on X-chromosome [Phex]) was increased in the pEGFP-Gdf11-transfected pellet compared with the control on day 14. On the basis of this in vitro evaluation, an in vivo investigation in the dog was performed. Autogenous transplantation of Gdf11-transfected cells cultured as a pellet on amputated pulp stimulated reparative dentin formation. Thus, Gdf11 gene therapy may be potentially used in endodontic treatment in dentistry.

Alkaline Phosphatase↗

The application of tissue engineering to regeneration of pulp and dentin in endodontics.

Caries, pulpitis, and apical periodontitis increase health care costs and attendant loss of economic productivity. They ultimately result in premature tooth loss and therefore diminishing the quality of life. Advances in vital pulp therapy with pulp stem/progenitor cells might give impetus to regenerate dentin-pulp complex without the removal of the whole pulp. Tissue engineering is the science of design and manufacture of new tissues to replace lost parts because of diseases including cancer and trauma. The three key ingredients for tissue engineering are signals for morphogenesis, stem cells for responding to morphogens and the scaffold of extracellular matrix. In preclinical studies cell therapy and gene therapy have been developed for many tissues and organs such as bone, heart, liver, and kidney as a means of delivering growth factors, cytokines, or morphogens with stem/progenitor cells in a scaffold to the sites of tissue injury to accelerate and/or induce a natural biological regeneration. The pulp tissue contains stem/progenitor cells that potentially differentiate into odontoblasts in response to bone morphogenetic proteins (BMPs). There are two strategies to regenerate dentin. First, is in vivo therapy, where BMP proteins or BMP genes are directly applied to the exposed or amputated pulp. Second is ex vivo therapy and consists of isolation of stem/progenitor cells from pulp tissue, differentiation into odontoblasts with recombinant BMPs or BMP genes and finally transplanted autogenously to regenerate dentin. This review is focused on the recent progress in this area and discusses the barriers and challenges for clinical utility in endodontics.

Animals↗