Characterization of a rapidly responding animal model for fluoride-stimulated bone formation

Histomorphometric and Histopathologic Evaluation of the Effects of Systemic Fluoride Intake on Orthodontic Tooth Movement

Objectives  The aim of this study was to determine the effects of systemic fluoride intake on orthodontic tooth movement with histomorphometric and histopathologic methods.

Materials and Methods  Forty-eight Wistar albino rats were randomly divided into four groups of 12 rats each. Group I received fluoridated water and underwent orthodontic tooth movement. Group II received fluoridated water and did not undergo orthodontic tooth movement. Group III received nonfluoridated water and underwent orthodontic tooth movement. Group IV received nonfluoridated water and did not undergo orthodontic tooth movement. At the beginning of the experiment (T1), impressions were taken from the maxilla of the rats in groups I and III under general anesthesia, and a NiTi closed coil spring appliance was ligated between the left maxillary central incisors and maxillary first molar. The orthodontic force applied was approximately 75 g, and the duration of the experimental period was 18 days. During the experimental period, appliances were controlled daily. At the end of the experimental period (T2), the rats were sacrificed with an overdose of a ketamine/xylasine combination, and their impressions were obtained. The upper first molars were subsequently dissected for histological examination. Incisor–molar distance, number of osteoblasts, number of osteoclasts and periodontal ligament (PDL) space widths on the compression and tension sides were measured.

Statistical Analysis  All measurements were statistically analyzed with SPSS for Windows version 18.0 (SPSS Inc., Chicago, IL, USA). Repeated measures ANOVA and posthoc Tukey tests were used to compare the groups.

Results  No statistically significant difference was found with respect to the amount of tooth movement between the fluoridated and nonfluoridated groups ( p > 0.05). Orthodontic force application increased the number of osteoblasts at the tension sides and reduced it at the compression sides ( p < 0.001). An increased number of osteoclasts was observed in the nonfluoridated group relative to the fluoridated group ( p < 0.01).

Conclusions  No difference was observed with respect to the amount of tooth movement between the fluoridated and nonfluoridated groups. Fluoride significantly reduced the number of osteoclasts in the experimental groups.

Inorganics and hormesis

The article is a comprehensive review of the occurrence of hormetic dose-response relationships induced by inorganic agents, including toxic agents, of significant environmental and public health interest (e.g., arsenic, cadmium, lead, mercury, selenium, and zinc). Hormetic responses occurred in a wide range of biological models (i.e., plants, invertebrate and vertebrate animals) for a large and diverse array of endpoints. Particular attention was given to providing an assessment of the quantitative features of the dose-response relationships and underlying mechanisms that could account for the biphasic nature of the hormetic response. These findings indicate that hormetic responses commonly occur in appropriately designed experiments and are highly generalizeable with respect to biological model responses. The hormetic dose response should be seen as a reliable feature of the dose response for inorganic agents and will have an important impact on the estimated effects of such agents on environmental and human receptors.

Fluoride and the skeleton

Fluoride has the potential to increase skeletal mass to a greater extent than any other pharmacologic agent, yet it has proven difficult to translate this into therapeutic benefit for patients with low bone mass in diseases such as osteoporosis. This apparent paradox can be explained in part by toxic actions of the ion on skeletal mineralization, impairment of the normal processes of bone resorption, and fluoride-induced decreases in strength per unit of bone (mass or volume). In part, the paradox can be explained by the late stage of osteoporosis in most patients enrolled in controlled clinical trials of fluoride, with alterations in skeletal microarchitecture beyond which restoration of mechanical integrity is not likely. Exposure of calcified tissues to environmental fluoride (water supply, dentifrices) also offers paradoxes. The anticaries effects are well documented as are the deleterious skeletal effects of endemic fluorosis when environmental exposure is too high. More controversial is the effect of seemingly nontoxic levels of exposure on the prevalence of osteoporotic fractures of the hip. This review attempts to provide a balanced overview of the conflicting literature concerning therapeutic and environmental effects of fluoride on the skeleton.

Phenytoin and fluoride act in concert to stimulate bone formation and to increase bone volume in adult male rats

We have recently demonstrated that phenytoin is an osteogenic agent at low doses. The present paper describes observations that a mitogenic dose (i.e., 20 microM in BGJb medium) of fluoride significantly augments the phenytoin-dependent stimulation of normal human bone cell proliferation and alkaline phosphatase (ALP) activity in cell culture. Additionally, the present study was designed to investigate whether fluoride and phenytoin would interact to increase bone formation in rats in vivo. Four groups of weight-matched adult male rats received daily I.P. injection of (1) vehicle (10% DMSO), (2) 5 mg/kg/day phenytoin, (3) 5 mg/kg/day phenytoin and 50 ppm NaF, and (4) 50 ppm NaF and vehicle, respectively, for 36 days. Sodium fluoride (NaF) was delivered in drinking water. Blood samples were drawn weekly and analyzed for serum osteocalcin, ALP, calcium, phosphorus, and 25(OH)D3. Rats were labeled with tetracycline at day 21 and 30 and histomorphometric analysis was carried out on the tibia at the end of the experiment. Neither agent by itself or together affected the serum calcium, phosphorus, or 25(OH)D3 levels. All measures of bone formation, i.e., serum osteocalcin level and ALP activity, bone ALP specific activity, mineral apposition rate, bone formation rate, and % bone formation surface, were increased by each agent. Fluoride and phenytoin together produced bigger increases in each parameter than did each agent alone. Trabecular bone volume was increased in the tibial metaphysis by fluoride or phenytoin alone; and when administered together, the two agents produced a greater increase.(ABSTRACT TRUNCATED AT 250 WORDS)

Differential effects of fluoride during initiation and progression of mineralization of osteoid nodules formed in vitro

Osteoid nodules form in cultures of fetal rat calvarial (RC) cells grown in medium containing 10% FBS and 50 micrograms/ml of ascorbic acid. When 10 mM beta-glycerophosphate (beta-GP) is added, osteoid nodules mineralize in two phases: an initiation phase, which is dependent upon alkaline phosphatase activity for conversion of beta-GP to P(i), and a progression phase that proceeds independently of alkaline phosphatase activity and does not require exogenous phosphate. We have now used this system to investigate the effects of fluoride (F-) on mineralization. In cultures in which osteoid was formed and mineralization initiated in the presence of F-, a dose-dependent inhibition of the initiation of mineralization occurred over a concentration range of 25-500 microM F- (p < 0.001 in all cases). The initiation of mineralization was not inhibited if F- was removed from the cultures at the time when mineralization was initiated with beta-GP. In osteoid nodules grown in the absence of F-, addition of F- resulted in a dose-dependent inhibition of the initiation of mineralization, with significant decreases in 45Ca uptake occurring at F- concentrations of 3 microM (p < 0.01) and higher. However, if F- was added to cultures after mineralization was initiated in the absence of F-, a stimulation of 45Ca uptake was observed at F- concentrations of 250 microM and above (p < 0.001). F- (1-1000 microM) did not affect the conversion of beta-GP to P(i) or alkaline phosphatase activity in the cultures.(ABSTRACT TRUNCATED AT 250 WORDS)

Biocompatibility of glass ionomer cements

Glass ionomer cements (GICs) are widely used in the dental field and are increasingly being considered as materials with potentially good osteogenic properties. This paper details a comprehensive biocompatibility evaluation of a number of GICs. These include conventional, commercially available materials, novel formulations and a new light cured material. The experimental programme entailed in vitro cell culture studies using direct contact and extraction tests and an in vitro rat model in which the GICs were in intimate contact with bone for periods up to 8 wk. The results demonstrate clear differences between the materials and in particular highlight the poor cellular response to the light cured material. Methylthiazolyldiphenyl tetrazolium assay demonstrates stimulation of cell growth by some GIC formulations and indicates that cytotoxic leachable agents can be removed from others. The results obtained following implantation into bone are comprehensively presented using photomicrographs. New bone formation with time is demonstrated with a number of formulations.

Effect of sodium fluoride on bone density in chickens

In addition to increasing bone volume, fluoride has been demonstrated to increase ash weight and mineral density. To determine whether newly formed or older bone is most affected by fluoride treatment, bone from chickens receiving fluoridated water was fractionated into lower density (recently formed) and higher density (more mature) specific gravity fractions. Fluoride was administered to the chickens for different lengths of time (4 or 13 weeks) or at varying doses for a 4-week period (0, 4.2, 16.8 mmol/liter drinking water). Fluoride treatment caused a shift in the mineral density profile, showing an increased proportion of mineral distribution in the more mature, higher density fractions. To determine whether this density gradient shift was due to increased maturation rate of bone or decreased resorption and mineralization rates, [3H]proline and 45Ca were injected 5 days and 24 hours prior to sacrifice, respectively. The distributions of both 3H or 45Ca, as percentages of total counts incorporated, were shifted by fluoride treatment into more mature, higher density fractions. Expressing the number of counts as a percent of the bone in each fraction (total hydroxyproline or Ca) revealed an increased incorporation of both 3H and 45Ca into the higher specific gravity fractions 2.0-2.2. These results suggest that fluoride treatment increases bone maturation and the rate of secondary mineralization in the cortical bone. Such changes in the quality of more mature, well-mineralized bone, in humans as well as animals, may have a significant influence on brittleness and strength.

Bone mass increase and glucose tolerance in rats chronically treated with sodium fluoride

Female rats were treated with fluoride for 100 days (between 21 and 121 days of age) replacing the water supply with a 5 mM NaF solution. Bone mass was assessed by destructive physical and chemical measurements on the whole skeleton, that gave an overall view not reported previously. Bone mass (dry, fat-free weight of the skeleton/100 g of body weight) increased 7% (P less than 0.001) with respect to control animals. This phenomenon was equally evident in the head, the axial and the appendicular skeleton. Fluoride treatment did not affect the ratio ashes/organic matrix. Treated animals showed a subtle disturbance of glucose tolerance as shown by glucose tolerance tests. The disturbance was manifest as high plasma and soft tissue levels of fluoride during the period of bone mass increase. Glucose tolerance was normalized when the maximum bone mass was achieved and plasma and soft tissue fluoride returned to control levels.

Stimulation of bone formation in osteoporosis patients treated with fluoride associated with increased DNA synthesis by osteoblastic cells in vitro

In this study we evaluated whether the fluoride-induced increased bone formation in osteoporosis is mediated by stimulation of bone cell proliferation and/or differentiation. We analyzed the kinetics of DNA synthesis and the phenotypic features of osteoblastic cells isolated from the trabecular bone surface in relationship to histomorphometric indices of bone formation evaluated on the same bone biopsy in 12 osteoporotic patients treated with fluoride. Osteoblastic cells isolated from patients with a higher than normal bone formation rate, increased mean wall thickness of trabecular bone packets, and high trabecular bone volume after fluoride therapy displayed a higher than normal rate of DNA synthesis in vitro. The peak of [3H]thymidine incorporation into DNA, the maximal DNA synthesis, and the area under the growth curve of osteoblastic cells isolated from these patients were higher than the values in normal bone cells obtained from age-matched controls. By contrast, in vitro parameters of osteoblastic cell proliferation were not different from normal in fluoride-treated osteoporosis patients in whom bone formation was not increased, although the duration of treatment and bone fluoride content were not different. Parameters of bone cell proliferation in vitro were increased in correlation with the mean wall thickness, and the latter correlated with the trabecular bone volume, indicating that the augmentation of bone formation and bone volume induced by fluoride was paralleled by an increased proliferation of osteoblastic cells. Basal osteocalcin production (corrected for cell protein) and alkaline phosphatase activity in vitro were comparable, and the response to 1,25-dihydroxyvitamin D3 (10 nmol/liter, 48 h) was not different in normal osteoblastic cells and in cells from fluoride-treated osteoporosis patients whether they had high or normal bone formation. The results show that the fluoride-induced increased bone formation in osteoporotic patients is associated with an increased in vitro proliferative capacity of osteoblastic cells lining the trabecular bone surface, whereas parameters of osteoblast differentiation are not affected. The data also suggest that induction of a higher than normal bone cell proliferation is prerequisite for the stimulation of bone formation by fluoride.

Response of cortical bone to local controlled release of sodium fluoride: the effect of implant insertion site

In a previous experiment, sodium fluoride in a biodegradable polymer matrix was introduced into the femoral canal of the rabbit and bone formation was compared with contralateral controls. We noted significant bone formation, but only in the distal third of the periosteal surface of the femur. This experiment was performed to distinguish fluoride-induced periosteal bone formation from that due to the reactive osteogenic changes associated with local injury caused by the process of implantation. A proximal approach on the right leg and a distal approach on the left were used for the insertion of the implants in rabbits. Femurs were removed after 30 days and tested for stiffness and load to failure. The cross-sectional area of mineralized bone was determined at proximal, midshaft, and distal locations. Fluorescent bone tissue growth labels were injected at weekly intervals to measure the rate of new periosteal bone formation. The results were compared with a control group that received sham implants. Results showed no difference between measured properties in right and left femurs in the control group or in those exposed to fluoride. A significant increase was found in the fluoride group in load to failure, along with cross-sectional area of mineralized bone, and periosteal growth rates compared with the control group, but no difference was seen in stiffness. No difference was detected between the response proximally and distally in the fluoride group regardless of the location of insertion. There were no detectable changes in serum fluoride level after implantation of the poly L-lactic acid/sodium fluoride matrix. These results show that fluoride exerts its osteogenic effects equally at proximal, midshaft, and distal regions of diaphyseal bone and is uninfluenced by the site of local injury due to insertion of the implant.

Local effects of impaired mechanical properties of collagen on bone formation and resorption

To study the relationship between the mechanical properties of collagen and the bone turnover, 2-week-old Balb/C mice were fed on a diet containing 0.25% Beta aminopropionitrile (B-APN), a potent inhibitor of collagen crosslink formation, for 3 weeks. Mandibular incisor socket was selected for the analysis of bone formation and resorption parameters. Plastic embedded sections stained with toluidine blue and cut at 4 microns were used to analyze the average area of bone lamellae, bone-forming surface, and the number of osteoblasts/mm of forming surface. Similar sections were used to localize acid phosphatase on resorbing surfaces and within the osteoclasts, while bone alkaline phosphatase was determined by a colorimetric method. Morphometric analyses showed that the area of newly formed bone lamellae, total forming surface, number of osteoblasts and the Alk. Pase activity were significantly lower in B-APN-fed mice as compared to the controls. There was a concomitant smaller, but significant, reduction in total resorption surface, active resorption surface and the number of osteoclasts. These results suggest that the regulation of bone formation and resorption at this site, which is independent of systemic regulation, is influenced by the mechanical properties of the collagenous matrix, which in turn may have a significant effect on the existing pool of bone-forming cells, but may not influence the recruitment of new cells.

Initial in-vivo evaluation of glass-ionomer cements for use as alveolar bone substitutes

The response of rat femora to implantation of four glass-ionomer (polyalkenoic) cements (GIC) compared to that seen following implantation of densely sintered hydroxyapatite (Ha) ceramic was evaluated for periods up to 12 weeks. Light and transmission electron microscopic analysis of the GIC/bone interface revealed direct bonding of the GIC G338 and Ketac Cem (both based on fluoro-alumino-silicate) glasses to bone, with a mineralized collagen-containing extra-cellular matrix deposited on the surface of the GIC. AquaCem and the fluoride-free GIC based on MP4 glass showed incomplete osseointegration.

Effects of fluoride on rat cancellous bone

Female Wistar rats were divided into four groups each fed ad libitum regular rodent chow and fluoridated water at four levels (0, 2, 4, 6 mmol/l) for 3 months. There were significant differences in ash weights between control and fluoridated vertebrae (P less than 0.01). Intact bone fluoride (F) values observed were: 0.04 +/- 0.01% fat-free dry weight (ffdw) for control vertebrae and 0.22-0.34 +/- 0.03% ffdw for fluoridated vertebrae. Deproteinized fluoridated vertebral bone had significantly lower specific surface area (SSA) (from 100 +/- 19 m2/g, P less than 0.01, down to 80 +/- 20 m2/g, P less than 0.001) than the control group (120 +/- 10 m2/g); a finding in support of our hypothesis that more of the bone mineral units in fluoridated bone are older (hence denser) than in normal bone. Static morphometric analysis of toluidine blue-stained sections of the femoral metaphyses showed that both cancellous bone volume/tissue volume (Cn-BV/TV) and trabecular thickness (Tb.Th) increased linearly with NaF dosage (R = 0.99 and 0.97, respectively); with Cn-BV/TV increasing from 21 +/- 7 to 33 +/- 6% (P less than 0.01) and Tb.Th from 76 +/- 8 to 98 +/- 9 microns (P less than 0.01). Similar Cn-BV/TV results were also obtained from von Kossa-stained sections.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of the influence of NaF or 1,25-(OH)2 vitamin D3 on the proliferative bone effect of an avian osteopetrosis virus, MAV-2(O)

1,25-(OH)2 vitamin D3 (D3) and sodium fluoride (NaF) were given to chicken embryos and newly hatched chickens infected with a slow onset strain of avian osteopetrosis-inducing virus [MAV-2(O)] to determine if either agent influenced MAV-2(O)-induced proliferation of bone. Embryos were administered MAV-2(O) and treated with: 1) up to 240 micrograms NaF or up to 100 ng D3 as embryos; 2) up to 1.8 g NaF/kg or up to 9.5 micrograms D3/kg after hatching: or 3) 240 micrograms NaF as embryos and up to 1.8 g NaF/kg after hatching. Administration of MAV-2(O) alone resulted in expansion of the cortical diameter of bone. Coadministration of NaF or D3 with MAV-2(O) did not influence the change in cortical diameter seen with MAV-2(O) alone at 18 days of incubation, and 3 and 6 weeks after hatching. Increased osteoid relative to bone (hyperosteoidosis), with NaF and MAV-2(O) compared to MAV-2(O) alone, and NaF compared to untreated controls reflected delayed mineralization of osteoid, a known fluoride effect. We conclude that the administration of NaF or D3 did not influence the incidence, severity or time of onset of the MAV-2(O)-induced proliferative changes of bone.

The effects of fluoride on osteoblast progenitors in vitro

The number of discrete, three-dimensional bone nodules formed in vitro from a class of osteoprogenitor cells present in fetal rat calvaria cell populations (RC cells) is linearly related to the number of cells plated, implying that this system functions as a colony assay for the expression of osteoprogenitor cells. To determine the effect of fluoride on the expression of these cells, primary RC cells were grown for periods of up to 21 days in alpha-MEM (minimal essential medium) containing 5-15% heat-inactivated fetal bovine serum (FBS), 50 micrograms/ml ascorbic acid, 10 mM Na beta-glycerophosphate, and NaF at concentrations from 10 microM to 5 mM. The continuous presence of NaF resulted in an increase in the number of bone nodules with maximal response occurring at 500 microM (p less than 0.001). A similar response at 500 microM NaF was observed also with regard to alkaline phosphatase activity. NaF levels up to 500 microM did not affect the growth of the mixed RC cell population, however, higher concentrations (1 mM) significantly reduced cell numbers (p less than 0.001) suggestive of cytotoxicity. Plating efficiency tests for colony formation in the presence of 0.5 to 2 mM NaF showed that the decreases in nodule formation observed at concentrations above 500 microM correlated with cytotoxicity. NaC1 at 1 mM had no effect on nodule formation, alkaline phosphatase activity, or cell growth. The results show that NaF stimulates osteoprogenitor cell number in vitro and that the maximal effect occurs at concentrations close to toxic levels.

The effects of fluoride on bone and implant histomorphometry in growing rats

The effects of fluoride at concentrations of 2.0 and 4.5 mM in drinking water on growth rate, vitamin D, water and mineral metabolism, bone histomorphometry, and osteoinduction of demineralized allogenic bone matrix (DABM) were compared in the rat. Whereas fluoride did not influence fluid intake or growth rate at the lower concentration, it increased fluid intake and inhibited growth rate at the higher concentration. Fluoride produced dose-related increases in serum fluoride and alkaline phosphatase but did not alter serum 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D. Serum calcium and phosphate were reduced by fluoride at concentrations of 2.0 mM but not 4.5 mM. Cancellous bone fractional area was increased by fluoride at 2.0 mM and was reduced by fluoride at 4.5 mM. Fluoride had no effect on cancellous bone surface length or the percentage surface lined by osteoblasts and osteoclasts. Fluoride increased medullary area and decreased the endosteal bone formation rate. Fluoride increased periosteal bone formation and apposition rates at concentrations of 2.0 mM but not 4.5 mM. Fluoride inhibited mineralization in DABM implants, and at the higher concentration, fluoride increased the formation of new bone matrix. These results indicate that in the rat, fluoride increases cortical and trabecular bone at therapeutic doses and reduces trabecular bone at toxic doses. The serum concentration of fluoride at therapeutic doses in the rat is similar to that in patients with osteoporosis who are on treatment with fluoride. In the rat, there is a narrow range between toxic and therapeutic doses.

Evidence that fluoride-stimulated 3[H]-thymidine incorporation in embryonic chick calvarial cell cultures is dependent on the presence of a bone cell mitogen, sensitive to changes in the phosphate concentration, and modulated by systemic skeletal effectors

In previous studies we have shown that clinically effective concentrations of fluoride (5 to 30 mumol/L) could also have direct effects in vitro on skeletal tissues to increase embryonic chick bone formation and bone cell proliferation (3[H]-thymidine incorporation into DNA). From these observations, we hypothesized that fluoride-stimulated bone formation might be mediated by a direct effect of fluoride to increase bone cell proliferation. The current studies were intended to investigate the mechanism of fluoride-stimulated 3[H]-thymidine incorporation, in chick calvarial cell cultures, by assessing mitogenic interactions between fluoride and inorganic phosphate, bone-derived growth factors, and systemic skeletal effectors. With respect to fluoride-phosphate interactions, the results of our studies indicate that the effect of fluoride was dependent on the phosphate concentration in the medium. Fluoride did not increase 3[H]-thymidine incorporation in BGJb medium containing 1 mmol/L (total) phosphate; but, in 1.6 mmol/L phosphate medium, fluoride caused a dose-dependent increase in 3[H]-thymidine incorporation, between 1 and 20 mumol/L (P less than .001). The action of fluoride was also dependent on the presence of a bone cell mitogen. Fluoride increased 3[H]-thymidine incorporation when added to calvarial cell cultures in the cell-conditioned medium, but had no effect in unconditioned (ie, fresh) medium. The action of fluoride could be restored by adding an exogenous growth factor (ie, concentrated cell-conditioned medium, bone-derived growth factors, or a systemic bone cell mitogen) to the unconditioned culture medium, P less than .05 for each effector.(ABSTRACT TRUNCATED AT 250 WORDS)