[Advances in tooth root resection].
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Periodontal disease is marked by inflammation and subsequent loss and/or damage to tooth-supporting tissues including bone, cementum, and periodontal ligament. A key tissue in the initial process of periodontal development as well as regeneration following periodontal disease is cementum. Research efforts aimed toward understanding mechanisms involved in periodontal development and regeneration, and in particular the formation of root cementum, have been hampered by an inability to isolate and culture cells involved in cementum production (i.e., cementoblasts). Much has been learned regarding the processes and mechanisms involved in bone formation and function from experiments using bone cell cultures. Therefore, the purpose of this study was to develop a strategy whereby cementoblasts could be isolated, cultured, and characterized. As a first step, using in situ hybridization, we determined the timed and spatial expression of mineral-associated proteins during first molar root development in CD-1 mice. These proteins included dentin sialoprotein (DSP), osteopontin (OPN), bone sialoprotein (BSP), osteocalcin (OCN), and type I collagen. During root development in mice BSP, OPN, and OCN mRNAs were expressed selectively by cells lining the tooth root surface--cementoblasts--with high levels of expression at day 41. Importantly, at this time point BSP, OPN, and OCN mRNAs were not expressed throughout the periodontal ligament. These findings provided us with markers selective to root-lining cells, or cementoblasts, in situ, and established the time (day 41) for isolating cells for in vitro studies. To isolate cells from tissues adherent to the root surface, enzymatic digestion was used, similar to what are now considered classical techniques for isolation of osteoblasts. To determine whether cells in vitro contained root-lining cells and cementoblasts, cultured cells were analyzed for expression of mineral-associated proteins. Cells within this heterogeneous primary population expressed type I collagen, BSP, OPN, and OCN as determined by in situ hybridization. In contrast, cells within this population did not express dentin sialoprotein, an odontoblast-specific protein. These procedures have provided a means to obtain root-lining cells in vitro that can now be cloned and used for studies directed at determining the properties of root-lining cells, or cementoblasts, in vitro.
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The efficiency of extremely small particles of hydroxylapatite on a therapy with hypersensitive tooth-necks was approved in a double-blind-study. 90% of the test persons stated an improvement of their complaints after 3-5 days, and 50% became complaintless within the time of study. The manner of working was proved with the help of x-ray inclination and by polarisation-optical studies.
BACKGROUND: Alveolar bone changes following tooth extraction have been well documented and have given rise to a number of treatment approaches. Included in these approaches are placement of various grafting materials, immediate implant placement, and a combination of both. METHODS: A review of all pertinent literature discussing regenerative therapy at the time of tooth extraction or immediate implant placement with or without concomitant regenerative therapy was carried out. RESULTS: A clinically-based hierarchy of treatment selection following extraction of single rooted teeth is proposed, based upon the available literature and clinical experience. The role of patient phenotype is considered. CONCLUSION: Utilization of the proposed hierarchy of treatment selection affords a logical framework within which to predictably treat a variety of patients.
BACKGROUND: Endogenous dental erosion is that produced by contact of gastric acids with tooth structure. It may affect exposed root cementum/dentine as well as coronal enamel, causing marked loss of mineral. The aim of this study was to determine whether 1.23 per cent acidulated phosphate fluoride gel, if applied to the surface cementum at certain intervals during an erosive acid challenge, could provide any protection against demineralization. MATERIALS AND METHODS: Roots of preserved extracted human teeth were painted with a water and acid resistant varnish, leaving two windows (3x1mm) of exposed dentine. These were placed in a solution containing 0.06MHCl and 2.2mMCaHPO4, which has been shown to simulate gastric acid when it meets the tooth surface. The roots were placed in the erosive solution unprotected (controls), or subject to APF application for four minutes prior to and every 10, 30 or 120 minutes during the erosive challenge. Roots were removed at either 6 or 12 hours, washed thoroughly and cut into 120microm thick sections. Depths of demineralization were measured using an optical graticule under polarized light microscopy. RESULTS: A high level of protection was provided when the roots were coated with APF gel every 10 or 30 minutes. CONCLUSIONS: APF gel will partially inhibit endogenous erosion of roots for up to 30 minutes if applied, for example, the night before a morning reflux episode. This should be considered along with other erosion control or reduction procedures for patients suffering from the effects of endogenous erosion.
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