Biomechanics of a bone-periodontal ligament-tooth fibrous joint

Evaluation of stress patterns in teeth with endodontic treatment and periapical lesions as abutments for fixed prosthesis: a finite element analysis study

BACKGROUND

Examining stress distributions in abutment teeth with periapical lesions is essential for understanding their biomechanical impact on dental structures and tissues. This study uses finite element analysis (FEA) to evaluate these stress patterns under occlusal forces, aiming to enhance treatment strategies and prosthetic designs.

METHODS

Three FEA models were created: a healthy mandibular premolar (Model 1), a premolar with a single crown and a lesion repaired using a fiber-post (Model 2), and 3) a premolar with a lesion repaired using fiber-post to support a four-member bridge (Model 3). A 300 N occlusal static stress was given to each model at a 45° angle to the long axis of the tooth, namely at the lingual inclination of the buccal-cusp. Deformation behaviour and maximum equivalent stress distributions were simulated on the all components, including the bony structure for each model.

RESULTS

The study showed a reduction in equivalent stress levels in trabecular and cortical bone, crown, cementum, and PDL under occlusal force, from Model 1 to Model 3. The Von Mises yield criteria values of the tooth models differed depending on the prosthetic restorations, with the highest value seen in Model 2 (133.87 MPa). Similar locations in all models showed concentrated equivalent stresses for all components. The periapical lesion area exhibited relatively low stress values for Models 2 and 3, at 0.061 MPa and 0.039 MPa, respectively. The largest level of stress was seen in the cervicobuccal areas of the tooth in all models.

CONCLUSION

Prosthetic restorations on teeth with periapical lesions resulted in varying stress and biomechanical responses in the tooth and surrounding bone tissue. These teeth can serve as abutments in a four-unit bridge when subjected to optimal occlusal stresses, based on the findings.

Biomechanical analysis of teeth movement during the repair of mandibular defects using transport disk distraction osteogenesis

INTRODUCTION

Teeth movement or rotation is one of the complications of mandibular defect repair using transport disk distraction osteogenesis (TDDO). However, the mechanical reasons are not clearly understood.

MATERIAL AND METHODS

To evaluate the biomechanical factors associated with teeth movements during mandibular defect repair with TDDO, a finite element model created from computed tomographic images of the human mandible was adopted to evaluate teeth displacement and the Von Mises stress distribution on the periodontal ligament resulting from the transport disk for teeth subjected to TDDO loading.

RESULTS

Under a displacement of 0.5 mm to the fixed arm of the transport disk, the teeth on the disk moved away from the distraction. The stress on the periodontal ligament was highest (60 KPa) around the distal neck. Upon the application of 150 g of resistance, the entire tooth moved in the same direction and the isoline gradient was almost parallel to the long axis of the tooth. Although the stress was distributed similarly; it decreased to 0.117 KPa geometrically.

DISCUSSION

When mandibular defects are repaired with TDDO, the transport disk and anti-distraction forces contribute to the reversal movement or rotation of the teeth, which may become immobility when antagonistic forces are applied in the same direction.

In vivo measurement of strain in the periodontal space of pig (Sus scrofa) incisors using in-fiber Bragg sensors

The incisor teeth in pigs, Sus scrofa, function in association with a disc-shaped snout to explore the environment for potential food. Understanding how mechanical loading applied to the tooth deforms the periodontal ligament (PDL) is important to determining the role of periodontal mechanoreceptors during food exploration and feeding. The objective of this study was to use fiber Bragg (FBG) sensors to measure strain in vivo within the PDL space of pig incisors. The central mandibular incisors of pigs underwent spring loaded lingual tipping during FBG strain recording within the labial periodontal space. FBG sensors were placed within the periodontal space of the central mandibular incisors of ~2-3-month-old farm pigs. The magnitude and orientation of spring loads are expected to mimic incisor contact with food. During incisor tipping with load calibrated springs, FBG strains in vitro (N = 6) and in vivo (N = 6) recorded at comparable load levels overlapped in range (-10-20 με). Linear regressions between peak FBG strains, that is, the highest recorded strain value, and baseline strains, that is, strain without applied spring load, were significant across all in vivo experiments (peak strain at 200 g vs. baseline, p = .04; peak strain at 2000 g vs. baseline p = .03; peak strain at 2000 g vs. 200 g, p = .004). These linear relationships indicate that on a per experiment basis, the maximum measured strain at different spring loads showed predictable differences. A Friedman test of the absolute value of peak strain confirmed the significant increase in strain between baseline, 200 g, and 2000 g spring activation (p = .02). Mainly compressive strains were recorded in the labial PDL space and increases in spring load applied in vivo generated increases in FBG strain measurements. These results demonstrate the capacity for FBG sensors to be used in vivo to assess transmission of occlusal loads through the periodontium. PDL strain is associated with mechanoreceptor stimulation and is expected to affect the functional morphology of the incisors. The overall low levels of strain observed may correspond with the robust functional morphology of pig incisors and the tendency for pigs to encounter diverse foods and substrates during food exploration.

Functional non-uniformity of periodontal ligaments tunes mechanobiological stimuli across soft- and hard-tissue interfaces

The bone-periodontal ligament-tooth (BPT) complex is a unique mechanosensing soft-/hard-tissue interface, which governs the most rapid bony homeostasis in the body responding to external loadings. While the correlation between such loading and alveolar bone remodelling has been widely recognised, it has remained challenging to investigate the transmitted mechanobiological stimuli across such embedded soft-/hard-tissue interfaces of the BPT complex. Here, we propose a framework combining three distinct bioengineering techniques (i, ii, and iii below) to elucidate the innate functional non-uniformity of the PDL in tuning mechanical stimuli to the surrounding alveolar bone. The biphasic PDL mechanical properties measured via nanoindentation, namely the elastic moduli of fibres and ground substance at the sub-tissue level (i), were used as the input parameters in an image-based constitutive modelling framework for finite element simulation (ii). In tandem with U-net deep learning, the Gaussian mixture method enabled the comparison of 5195 possible pseudo-microstructures versus the innate non-uniformity of the PDL (iii). We found that the balance between hydrostatic pressure in PDL and the strain energy in the alveolar bone was maintained within a specific physiological range. The innate PDL microstructure ensures the transduction of favourable mechanobiological stimuli, thereby governing alveolar bone homeostasis. Our outcomes expand current knowledge of the PDL's mechanobiological roles and the proposed framework can be adopted to a broad range of similar soft-/hard- tissue interfaces, which may impact future tissue engineering, regenerative medicine, and evaluating therapeutic strategies. STATEMENT OF SIGNIFICANCE: A combination of cutting-edge technologies, including dynamic nanomechanical testing, high-resolution image-based modelling and machine learning facilitated computing, was used to elucidate the association between the microstructural non-uniformity and biomechanical competence of periodontal ligaments (PDLs). The innate PDL fibre network regulates mechanobiological stimuli, which govern alveolar bone remodelling, in different tissues across the bone-PDL-tooth (BPT) interfaces. These mechanobiological stimuli within the BPT are tuned within a physiological range by the non-uniform microstructure of PDLs, ensuring functional tissue homeostasis. The proposed framework in this study is also applicable for investigating the structure-function relationship in broader types of fibrous soft-/hard- tissue interfaces.

In-fiber Bragg sensor measurements assess fluid effects on strain in the periodontal space of an ex-vivo swine incisor complex under mechanical loading

The purpose of this study is to determine whether in-fiber Bragg grating (FBG) sensors detect changes within the periodontal ligament (PDL) of ex-vivo swine tooth-PDL-bone complex (TPBC) when manipulating fluid content. Recording strain will allow for a better understanding of the biomechanics of viscoelastic load transfer from the tooth to the PDL during chewing and/or orthodontic tooth movement, as well as replication of these dynamics in regenerated PDL tissues. FBG sensors placed within the PDL of swine incisor teeth were used to measure strain resulting from an intrusive load. Specimens were mounted in a custom platform within an MTS machine and a compressive load was applied at 0.3 mm/s to a depth of 0.5 mm and held for 10 s. Median peak strain and load and median absolute deviation (MAD) were compared: dry vs. saline (n = 19) with bias-corrected bootstrap 95% CI. Dry vs. saline conditions did not statistically differ (median peaks of 5με, 103-105 N) and recorded strains showed high repeatability (MAD of 0.82με, 0.72με, respectively). FBG sensors did not detect the fluid changes in this study, suggesting that the deformation of tissues in the PDL space collectively determine FBG strain in response to tooth loading. The repeatability of measurements demonstrates the potential for FBG sensors to assess the strain in the PDL space of an in vivo swine model.

A practical guide for in situ mechanical testing of musculoskeletal tissues using synchrotron tomography

Musculoskeletal tissues are complex hierarchical materials where mechanical response is linked to structural and material properties at different dimensional levels. Therefore, high-resolution three-dimensional tomography is very useful for assessing tissue properties at different scales. In particular, Synchrotron Radiation micro-Computed Tomography (SR-microCT) has been used in several applications to analyze the structure of bone and biomaterials. In the past decade the development of digital volume correlation (DVC) algorithms applied to SR-microCT images and its combination with in situ mechanical testing (four-dimensional imaging) have allowed researchers to visualise, for the first time, the deformation of musculoskeletal tissues and their interaction with biomaterials under different loading scenarios. However, there are several experimental challenges that make these measurements difficult and at high risk of failure. Challenges relate to sample preparation, imaging parameters, loading setup, accumulated tissue damage for multiple tomographic acquisitions, reconstruction methods and data processing. Considering that access to SR-microCT facilities is usually associated with bidding processes and long waiting times, the failure of these experiments could notably slow down the advancement of this research area and reduce its impact. Many of the experimental failures can be avoided with increased experience in performing the tests and better guidelines for preparation and execution of these complex experiments; publication of negative results could help interested researchers to avoid recurring mistakes. Therefore, the goal of this article is to highlight the potential and pitfalls in the design and execution of in situ SR-microCT experiments, involving multiple scans, of musculoskeletal tissues for the assessment of their structural and/or mechanical properties. The advice and guidelines that follow should improve the success rate of this type of experiment, allowing the community to reach higher impact more efficiently.

Microstructural heterogeneity of the collagenous network in the loaded and unloaded periodontal ligament and its biomechanical implications

The periodontal ligament (PDL) is a highly heterogeneous fibrous connective tissue and plays a critical role in distributing occlusal forces and regulating tissue remodeling. Its mechanical properties are largely determined by the extracellular matrix, comprising a collagenous fiber network interacting with the capillary system as well as interstitial fluid containing proteoglycans. While the phase-contrast micro-CT technique has portrayed the 3D microscopic heterogeneity of PDL, the topological parameters of its network, which is crucial to understanding the multiscale constitutive behavior of this tissue, has not been characterized quantitatively. This study aimed to provide new understanding of such microscopic heterogeneity of the PDL with quantifications at both tissue and collagen network levels in a spatial manner, by combining phase-contrast micro-CT imaging and a purpose-built image processing algorithm for fiber analysis. Both variations within a PDL and among the PDL with different shapes, i.e. round-shaped and kidney-shaped PDLs, are described in terms of tissue thickness, fiber distribution, local fiber densities, and fiber orientation (namely azimuthal and elevation angles). Furthermore, the tissue and collagen fiber network responses to mechanical loading were evaluated in a similar manner. A 3D helical alignment pattern was observed in the fiber network, which appears to regulate and adapt a screw-like tooth motion under occlusion. The microstructural heterogeneity quantified here allows development of sample-specific constitutive models to characterize the PDL's functional and pathological loading responses, thereby providing a new multiscale framework for advancing our knowledge of this complex limited mobility soft-hard tissue interface.

Orthodontic Tooth Movement Studied by Finite Element Analysis: an Update. What Can We Learn from These Simulations?

PURPOSE OF REVIEW

To produce an updated overview of the use of finite element (FE) analysis for analyzing orthodontic tooth movement (OTM). Different levels of simulation complexity, including material properties and level of morphological representation of the alveolar complex, will be presented and evaluated, and the limitations will be discussed.

RECENT FINDINGS

Complex formulations of the PDL have been proposed, which might be able to correctly predict the behavior of the PDL both when chewing forces and orthodontic forces are simulated in FE models. The recent findings do not corroborate the simplified view of the classical OTM theories. The use of complex and biologically coherent FE models can help understanding the mechanisms leading to OTM as well as predicting the risk of root resorption related to specific force systems and magnitudes.

Tissue Engineering for Periodontal Ligament Regeneration: Biomechanical Specifications

The periodontal biomechanical environment is very difficult to investigate. By the complex geometry and composition of the periodontal ligament (PDL), its mechanical behavior is very dependent on the type of loading (compressive versus tensile loading; static versus cyclic loading; uniaxial versus multiaxial) and the location around the root (cervical, middle, or apical). These different aspects of the PDL make it difficult to develop a functional biomaterial to treat periodontal attachment due to periodontal diseases. This review aims to describe the structural and biomechanical properties of the PDL. Particular importance is placed in the close interrelationship that exists between structure and biomechanics: the PDL structural organization is specific to its biomechanical environment, and its biomechanical properties are specific to its structural arrangement. This balance between structure and biomechanics can be explained by a mechanosensitive periodontal cellular activity. These specifications have to be considered in the further tissue engineering strategies for the development of an efficient biomaterial for periodontal tissues regeneration.

Functional adaptation of interradicular alveolar bone to reduced chewing loads on dentoalveolar joints in rats

OBJECTIVES

The effects of reduced chewing loads on load bearing integrity of interradicular bone (IB) within dentoalveolar joints (DAJ) in rats were investigated.

METHODS

Four-week-old Sprague Dawley rats (N = 60) were divided into two groups; rats were either fed normal food, which is hard-pellet food (HF) (N = 30), or soft-powdered chow (SF) (N = 30). Biomechanical testing of intact DAJs and mapping of the resulting mechanical strains within IBs from 8- through 24-week-old rats fed HF or SF were performed. Tension- and compression-based mechanical strain profiles were mapped by correlating digital volumes of IBs at no load with the same IBs under load. Heterogeneity within IB was identified by mapping cement lines and TRAP-positive multinucleated cells using histology, and mechanical properties using nanoindentation technique.

RESULTS

Significantly decreased interradicular functional space, IB volume fraction, and elastic modulus of IB in the SF group compared with the HF group were observed, and these trends varied with an increase in age. The elastic modulus values illustrated significant heterogeneity within IB from HF or SF groups. Both compression- and tension-based strains were localized at the coronal portion of the IB and the variation in strain profiles complemented the observed material heterogeneity using histology and nanoindentation.

SIGNIFICANCE

Interradicular space and IB material-related mechanoadaptations in a DAJ are optimized to meet soft food related chewing demands. Results provided insights into age-specific regulation of chewing loads as a plausible "therapeutic dose" to reverse adaptations within the periodontal complex as an attempt to regain functional competence of a dynamic DAJ.

High resolution imaging in bone tissue research-review

This review article focuses on imaging of bone tissue to understand skeletal health with regards to bone quality. Skeletal fragility fractures are due to bone diseases such as osteoporosis which result in low bone mass and bone mineral density (BMD) leading to high risk of fragility fractures. Recent advances in imaging and analysis technologies have highly benefitted the field of biological sciences. In particular, their application in skeletal health has been of significant importance in understanding bone mechanical behavior (structure and properties) at the tissue level. While synchrotron based microCT technique has remained the gold standard for non-destructive evaluation of structure in material and biological sciences, several lab based microCT systems have been developed to provide high resolution imaging of specimens with greater access, and ease of use in laboratory settings. Lab based microCT scanners are widely used in the bone field as a standard tool to evaluate three-dimensional (3D) morphologies of bone structure at image resolutions appropriate for bone samples from small animals to bone biopsy specimens from humans. Both synchrotron and standard lab based microCT systems provide high resolution imaging ex vivo for a small sized specimen. A few X-ray based systems are also commercially available for in vivo scanning at relatively low image resolutions. Synchrotron-based CT microscopy is being used for various ultra-high-resolution image analyses using complex 3D software. However, the synchrotron-based CT technology is in high demand, allows only limited numbers of specimens, expensive, requires complex additional instrumentation, and is not easily available to researchers as it requires access to a synchrotron source which is always limited. Therefore, desktop laboratory scanners (microXCT, Zeiss/Xradia, Scanco, SkyScan. etc.), mimicking the synchrotron based CT technology or image resolution, have been developed to solve the accessibility issues. These lab based scanners have helped both material science, and the bone field to investigate bone tissue morphologies at submicron mage resolutions. Considerable progress has been made in both in vivo and ex vivo imaging towards providing high resolution images of bone tissue. Both clinical and research imaging technologies will continue to improve and help understand osteoporosis and other related skeletal issues in order to develop targeted treatments for bone fragility. This review summarizes the high resolution imaging work in bone research.

Movement analysis of primate molar teeth under load using synchrotron X-ray microtomography

Mammalian teeth have to sustain repetitive and high chewing loads without failure. Key to this capability is the periodontal ligament (PDL), a connective tissue containing a collagenous fibre network which connects the tooth roots to the alveolar bone socket and which allows the teeth to move when loaded. It has been suggested that rodent molars under load experience a screw-like downward motion but it remains unclear whether this movement also occurs in primates. Here we use synchroton micro-computed tomography paired with an axial loading setup to investigate the form-function relationship between tooth movement and the morphology of the PDL space in a non-human primate, the mouse lemur (Microcebus murinus). The loading behavior of both mandibular and maxillary molars showed a three-dimensional movement with translational and rotational components, which pushes the tooth into the alveolar socket. Moreover, we found a non-uniform PDL thickness distribution and a gradual increase in volumetric proportion of the periodontal vasculature from cervical to apical. Our results suggest that the PDL morphology may optimize the three-dimensional tooth movement to avoid high stresses under loading.

rhBMP-2 Pre-Treated Human Periodontal Ligament Stem Cell Sheets Regenerate a Mineralized Layer Mimicking Dental Cementum

The periodontal complex consisting of alveolar bone, cementum, and periodontal ligaments (PDL) supports human teeth through the systematic orchestration of mineralized tissues and fibrous tissues. Importantly, cementum, the outermost mineralized layer of dental roots, plays an essential role by bridging the inner ligaments from the dental root to the alveolar bone. When the periodontal complex is damaged, the regeneration of each component of the periodontal complex is necessary; however, it is still challenging to achieve complete functional regeneration. In this study, we tried to control the regeneration of cementum and PDL by using a human PDL stem cell (hPDLSC) sheet engineering technology with the pretreatment of recombinant human BMP-2 (rhBMP-2). Isolated hPDLSCs obtained from extracted human teeth were pretreated with rhBMP-2 for in vitro osteogenic differentiation and grafted on the micro/macro-porous biphasic calcium phosphate (MBCP) blocks, which represent dental roots. The MBCPs with hPDLSC sheets were implanted in the subcutaneous layer of immune-compromised mice, and rhBMP-2 pretreated hPDLSC sheets showed higher mineralization and collagen ligament deposition than the no-pretreatment group. Therefore, the rhBMP-2-hPDLSC sheet technique could be an effective strategy for the synchronized regeneration of two different tissues: mineralized tissue and fibrous tissues in periodontal complexes.

Confirmation of a wear-compensation mechanism in dental roots of ruminants

Diet affects many factors of an animal's anatomy, but teeth are a specific focus of dietary research, as their durability lends them to record information on a large variety of scales. Abrasive diets like those of grazing herbivores are known to wear down teeth, but how that wear affects tooth growth and the relations between its different morphological components is rarely investigated. Seven pelleted diets varying in abrasive size and concentration were fed over a 17-month period to 49 sheep (Ovis aries), of which n = 39 qualified for morphology measurements. Using computed tomography, scans of the skulls were made over the course of the experiment, and the impact of diet-related wear was observed on tooth volume and morphology, including the position of dental burr marks, over time. Digital caliper measurements were applied to 3D renderings of the teeth, and the volume of crown and root segments were investigated separately. We aimed to detect a signal of root growth compensating for wear, and test if this mechanism would be affected by dietary abrasives. Crown-segment volume loss was correlated to root-segment volume gain. Height and burr mark measurements indicated a much higher experimental tooth wear than that previously reported for free-ranging animals. The reason for this is unclear. There was no relationship between tooth height and dentine basin depth. For all parameters, there was no effect of diet; hence, while the measurements corroborate general understanding of tooth wear and compensatory processes, these methods appear not suitable to assess subtle differences between feeding regimes.

Biomechanical pathways of dentoalveolar fibrous joints in health and disease

Spatial and temporal adaptations within periodontal tissues and their interfaces result from functional loads. Functional loads can be physiologic and/or pathologic in nature. The prolonged effect of these loads can alter the overall biomechanics of a dentoalveolar fibrous joint (dentoalveolar joint) by changing the form of the tooth root and its socket. This "sculpting" of the tooth root and alveolar bony socket is a consequence of several mechano-biological changes that occur within the periodontal complex of a load-bearing dentoalveolar joint. These include changes in biochemical expressions, structure, elemental composition, and mechanical properties of alveolar bone, the underlying tissues of the roots of teeth, and their interfaces. These physicochemical changes in tissues continue to prompt mechano-responsive biochemical activities at the attachment sites of periodontal ligament (soft) with bone (hard), and ligament with cementum (hard), which are the entheses of a load-bearing dentoalveolar joint. Forces at soft-hard tissue attachment sites between disparate materials with different stiffness values theoretically generate strain singularities or discontinuities. These discontinuities under prolonged functional loading increase the probability for failure to occur specifically at the enthesial zones. However, in a normal dentoalveolar joint, gradual stiffness gradients exist from ligament to bone, and from ligament to cementum. The gradual transitions in stiffness from softer ligament (lower stiffness) to harder bone or cementum (higher stiffness) or vice versa optimize tissue and interfacial strains. Optimization of tissue and ligament-enthesial physical and chemical properties facilitates transmission of cyclic forces of varying magnitudes and frequencies that collectively maintain the overall biomechanics of a dentoalveolar joint. The objectives of this review are 3-fold: (i) to illustrate physicochemical adaptations at the periodontal ligament entheses of a human periodontal complex affected by subgingival calculus; (ii) to demonstrate how to "program" the hallmarks of periodontitis in small-scale vertebrates in vivo to generate spatiotemporal maps of physicochemical adaptations in a diseased dentoalveolar joint; and (iii) to correlate dentoalveolar joint biomechanics in healthy and diseased states to spatiotemporal maps of physicochemical adaptations within respective periodontal tissues. This interdisciplinary approach demonstrates that physicochemical adaptations within periodontal tissues using the mechanics of materials (tissue mechanics), materials science (tissue composition), and mechano-biology (matrix molecules) can help explain the mechano-adaptation of dentoalveolar joints in normal and diseased functional states. Multiscale biomechanics and mechano-biology approaches can provide insights into the functional competence of a diseased relative to a normal dentoalveolar joint. Insights gathered from interdisciplinary and multiscale biomechanics approaches include the following: (i) physiologic loads related to chewing maintain a balance between mineral-forming and-resorbing biochemical cellular events, resulting in gradual stiffness gradients at the periodontal ligament entheses, and, in turn, sustain the overall biomechanics of a normal "healthy" dentoalveolar joint; (ii) pathologic loads resulting from tissue degradation and physical changes to the periodontal complex promote an abrupt stiffness gradient at the periodontal ligament entheses. The shift from gradual to an abrupt stiffness gradient could prompt a shift in the biochemical cascades, exacerbate mechano-responsive biochemical expressions at periodontal ligament entheses farther away from the site of insult, and culminate in joint degradation; (iii) sustained pathologic function on periodontally diseased joints exacerbates degradation of periodontal ligament entheses providing insights into "rescue therapy", such as the use of an adequate "mechanocal dose" to regain joint function; and (iv) spatiotemporal maps of changes in biochemical expressions, and physicochemical properties of strain-dominated affected sites, including the periodontal ligament entheses, can guide anatomy-specific therapeutics for tissue regeneration and/or disease control with the purpose of regaining dentoalveolar joint function. Modulation of occlusal loads could minimize disease progression and potentially assist in regaining functional attachment of ligament to bone and/or ligament to cementum of the dentoalveolar joint. Elucidating mechanisms that drive the breakdown of the functionally active periodontal complex burdened with microbes will provide the required critical insights into regenerative medicine and/or biomimetic approaches that would facilitate rescue/regain of dentoalveolar joint function.

In silico study of cuspid' periodontal ligament damage under parafunctional and traumatic conditions of whole-mouth occlusions. A patient-specific evaluation

BACKGROUND AND OBJECTIVE

Although traumatic loading has been associated with periodontal ligament (PDL) damage and therefore with several oral disorders, the damage phenomena and the traumatic loads involved are still unclear. The complex composition and extremely thin size of the PDL make experimentation difficult, requiring computational studies that consider the macroscopic loading conditions, the microscopic composition and fine detailed geometry of the tissue. In this study, a new methodology to analyse the damage phenomena in the collagen network and the extracellular matrix of the PDL caused by parafunctional and traumatic occlusal forces was proposed.

METHODS

The entire human mandible and a portion thereof containing a full cuspid tooth were separately modelled using finite element analysis based on computed tomography and micro-computed tomography images, respectively. The first model was experimentally validated by occlusion analysis and subjected to the muscle loads produced during hard and soft chewing, traumatic cuspid occlusion, grinding, clenching, and simultaneous grinding and clenching. The occlusal forces computed by the first model were subsequently applied to the single tooth model to evaluate damage to the collagen network and the extracellular matrix of the PDL.

RESULTS

Early occlusal contact on the left cuspid tooth guided the mandible to the more occluded side (16.5% greater in the right side) and absorbed most of the lateral load. The intrusive occlusal loads on the posterior teeth were 0.77-13.3% greater than those on the cuspid. According to our findings, damage to the collagen network and the extracellular matrix of the PDL could occur in traumatic and grinding conditions, mainly due to fibre overstretching (>60%) and interstitial fluid overpressure (>4.7 kPa), respectively.

CONCLUSIONS

Our findings provide important biomechanical insights into the determination of damage mechanisms which are caused by mechanical loading and the key role of the porous-fibrous behaviour of the PDL in parafunctional and traumatic loading scenarios. Besides, the 3D loading conditions computed from occlusal contacts will help future studies in the design of new orthodontics appliances and encourage the application of computing methods in medical practice.

Molecular Basis for Periodontal Ligament Adaptation to In Vivo Loading

A soft food diet leads to changes in the periodontal ligament (PDL). These changes, which have been recognized for more than a century, are ascribed to alterations in mechanical loading. While these adaptive responses have been well characterized, the molecular, cellular, and mechanical mechanisms underlying the changes have not. Here, we implicate Wnt signaling in the pathoetiology of PDL responses to underloading. We show that Wnt-responsive cells and their progeny in the PDL space exhibit a burst in proliferation in response to mastication. If an animal is fed a soft diet from the time of weaning, then this burst in Wnt-responsive cell proliferation is quelled; as a consequence, both the PDL and the surrounding alveolar bone undergo atrophy. Returning these animals to a hard food diet restores the Wnt signaling in PDL. These data provide, for the first time, a molecular mechanism underlying the adaptive response of the PDL to loading.

Whole-field macro- and micro-deformation characteristic of unbound water-loss in dentin hard tissue

High-resolution deformation measurements in a functionally graded hard tissue such as human dentin are essential to understand the unbound water-loss mediated changes and their role in its mechanical integrity. Yet a whole-field, 3-dimensional (3D) measurement and characterization of fully hydrated dentin in both macro- and micro-scales remain to be a challenge. This study was conducted in 2 stages. In stage-1, a stereo-digital image correlation approach was utilized to determine the water-loss and load-induced 3D deformations of teeth in a sagittal section over consecutively acquired frames, from a fully hydrated state to nonhydrated conditions for a period up to 2 hours. The macroscale analysis revealed concentrated residual deformations at the dentin-enamel-junction and the apical regions of root in the direction perpendicular to the dentinal tubules. Significant difference in the localized deformation characteristics was observed between the inner and outer aspects of the root dentin. During quasi-static loadings, further increase in the residual deformation was observed in the dentin. In stage-2, dentin microstructural variations induced by dynamic water-loss were assessed with environmental scanning electron microscopy and atomic force microscopy (AFM), showing that the dynamic water-loss induced distention of dentinal tubules with concave tubular edges, and concurrent contraction of intertubular dentin with convex profile. The findings from the current macro- and micro-scale analysis provided insight on the free-water-loss induced regional deformations and ultrastructural changes in human dentin.

Synthesis, characterization & cytocompatibility of poly (diol-co-tricarballylate) based thermally crosslinked elastomers for drug delivery & tissue engineering applications

The aim of this study was to investigate the synthesis and in vitro characterization of thermoset biodegradable poly (diol-co-tricarballylate) (PDT) elastomeric polymers for the purpose of their use in implantable drug delivery and tissue engineering applications. The synthesis was based on thermal crosslinking technique via a polycondensation reaction of tricarballylic acid with aliphatic diols of varying chain lengths (C6-C12). PDT prepolymers were synthesized at 140 °C for 20 min. After purification, the prepolymers were molded and kept at 120 °C for 18 h under vacuum to complete the crosslinking process. PDT prepolymers were characterized by DSC, FT-IR, ¹H NMR and GPC. The PDT elastomers were also subjected to thermal and structural analysis, as well as sol content, mechanical testing, in vitro degradation and cytocompatibility studies. The mechanical properties and sol content were found to be dependent on synthesis conditions and can be controlled by manipulating the crosslinking density and number of methylene groups in the chain of precursor aliphatic diol. The family of thermally crosslinked PDT biodegradable polyesters were successfully prepared and characterized; besides they have promising use in drug delivery and other biomedical tissue engineering applications.

A Force on the Crown and Tug of War in the Periodontal Complex

The load-bearing dentoalveolar fibrous joint is composed of biomechanically active periodontal ligament (PDL), bone, cementum, and the synergistic entheses of PDL-bone and PDL-cementum. Physiologic and pathologic loads on the dentoalveolar fibrous joint prompt natural shifts in strain gradients within mineralized and fibrous tissues and trigger a cascade of biochemical events within the widened and narrowed sites of the periodontal complex. This review highlights data from in situ biomechanical simulations that provide tooth movements relative to the alveolar socket. The methods and subsequent results provide a reasonable approximation of strain-regulated biochemical events resulting in mesial mineral formation and distal resorption events within microanatomical regions at the ligament-tethered/enthesial ends. These biochemical events, including expressions of biglycan, decorin, chondroitin sulfated neuroglial 2, osteopontin, and bone sialoprotein and localization of various hypertrophic progenitors, are observed at the alkaline phosphatase-positive widened site, resulting in mineral formation and osteoid/cementoid layers. On the narrowed side, tartrate-resistant acid phosphatase regions can lead to a sequence of clastic activities resulting in resorption pits in bone and cementum. These strain-regulated biochemical and subsequently biomineralization events in the load-bearing periodontal complex are critical for maintenance of the periodontal space and overall macroscale joint biomechanics.

Periodontal ligament entheses and their adaptive role in the context of dentoalveolar joint function

OBJECTIVE

The dynamic bone-periodontal ligament (PDL)-tooth fibrous joint consists of two adaptive functionally graded interfaces (FGI), the PDL-bone and PDL-cementum that respond to mechanical strain transmitted during mastication. In general, from a materials and mechanics perspective, FGI prevent catastrophic failure during prolonged cyclic loading. This review is a discourse of results gathered from literature to illustrate the dynamic adaptive nature of the fibrous joint in response to physiologic and pathologic simulated functions, and experimental tooth movement.

METHODS

Historically, studies have investigated soft to hard tissue transitions through analytical techniques that provided insights into structural, biochemical, and mechanical characterization methods. Experimental approaches included two dimensional to three dimensional advanced in situ imaging and analytical techniques. These techniques allowed mapping and correlation of deformations to physicochemical and mechanobiological changes within volumes of the complex subjected to concentric and eccentric loading regimes respectively.

RESULTS

Tooth movement is facilitated by mechanobiological activity at the interfaces of the fibrous joint and generates elastic discontinuities at these interfaces in response to eccentric loading. Both concentric and eccentric loads mediated cellular responses to strains, and prompted self-regulating mineral forming and resorbing zones that in turn altered the functional space of the joint.

SIGNIFICANCE

A multiscale biomechanics and mechanobiology approach is important for correlating joint function to tissue-level strain-adaptive properties with overall effects on joint form as related to physiologic and pathologic functions. Elucidating the shift in localization of biomolecules specifically at interfaces during development, function, and therapeutic loading of the joint is critical for developing "functional regeneration and adaptation" strategies with an emphasis on restoring physiologic joint function.

Strain mapping and correlative microscopy of the alveolar bone in a bone-periodontal ligament-tooth fibrous joint

This study details a method to calculate strains within interradicular alveolar bone using digital volume correlation on X-ray tomograms of intact bone-periodontal ligament-tooth fibrous joints. The effects of loading schemes (concentric and eccentric) and optical magnification on the resulting strain in alveolar bone will be investigated with an intent to correlate deformation gradients with data sets from other complementary techniques. Strain maps will be correlated with structural and site-specific mechanical properties obtained on the same specimen using atomic force microscopy and atomic force microscopy-based nanoindentation technique. Specimens include polydimethylsiloxane as a standard material and intact hemi-mandibles harvested from rats. X-ray tomograms were taken at no-load and loaded conditions using an in situ load cell coupled to a micro X-ray computed tomography unit. Digital volume correlation was used to calculate deformations within alveolar bone. Comparison of strain maps was made as a result of different loading schemes (concentric vs eccentric) and at different magnifications (4× vs 10×). Virtual sections and strain maps from digital volume correlation solutions were aligned with structure and reduced elastic modulus to correlate datasets of the same region within a specimen. Strain distribution between concentrically and eccentrically loaded complexes was different but illustrated a similar range. Strain maps of homogeneous materials (polydimethylsiloxane) resulting from digital volume correlation at different magnifications were similar. However, strain maps of heterogeneous materials at lower and higher magnification differed. The digital volume correlation technique illustrated a dependence on optical magnification specifically for heterogeneous materials such as bone. The results at a higher optical magnification highlight the potential for extracting deformation at higher resolutions. Correlation of data spaces from different complementary techniques is plausible and could provide insights into biological and physicochemical processes that lead to functional adaptation of tissues and joints.

Effect of proteoglycans at interfaces as related to location, architecture, and mechanical cues

INTRODUCTION

Covalently bound functional GAGs orchestrate tissue mechanics through time-dependent characteristics.

OBJECTIVE

The role of specific glycosaminoglycans (GAGs) at the ligament-cementum and cementum-dentin interfaces within a human periodontal complex were examined. Matrix swelling and resistance to compression under health and modeled diseased states was investigated.

MATERIALS AND METHODS

The presence of keratin sulfate (KS) and chondroitin sulfate (CS) GAGs at the ligament-cementum and cementum-dentin interfaces in human molars (N=5) was illustrated by using enzymes, atomic force microscopy (AFM), and AFM-based nanoindentation. The change in physical characteristics of modeled diseased states through sequential digestion of keratin sulfate (KS) and chondroitin sulfate (CS) GAGs was investigated. One-way ANOVA tests with P<0.05 were performed to determine significant differences between groups. Additionally, the presence of mineral within the seemingly hygroscopic interfaces was investigated using transmission electron microscopy.

RESULTS

Immunohistochemistry (N=3) indicated presence of biglycan and fibromodulin small leucine rich proteoglycans at the interfaces. Digestion of matrices with enzymes confirmed the presence of KS and CS GAGs at the interfaces by illustrating a change in tissue architecture and mechanics. A significant increase in height (nm), decrease in elastic modulus (GPa), and tissue deformation rate (nm/s) of the PDL-C attachment site (215±63-424±94nm; 1.5±0.7-0.4±0.2GPa; 21±7-48±22nm/s), and cementum-dentin interface (122±69-360±159nm; 2.9±1.3-0.7±0.3GPa; 18±4-30±6nm/s) was observed.

CONCLUSIONS

The sequential removal of GAGs indicated loss in intricate structural hierarchy of hygroscopic interfaces. From a mechanics perspective, GAGs provide tissue recovery/resilience. The results of this study provide insights into the role of GAGs toward conserved tooth movement in the socket in response to mechanical loads, and modulation of potentially deleterious strain at tissue interfaces.

Strain-guided mineralization in the bone-PDL-cementum complex of a rat periodontium

Objective

The objective of this study was to investigate the effect of mechanical strain by mapping physicochemical properties at periodontal ligament (PDL)–bone and PDL–cementum attachment sites and within the tissues per se.

Design

Accentuated mechanical strain was induced by applying a unidirectional force of 0.06 N for 14 days on molars in a rat model. The associated changes in functional space between the tooth and bone, mineral forming and resorbing events at the PDL–bone and PDL–cementum attachment sites were identified by using micro-X-ray computed tomography (micro-XCT), atomic force microscopy (AFM), dynamic histomorphometry, Raman microspectroscopy, and AFM-based nanoindentation technique. Results from these analytical techniques were correlated with histochemical strains specific to low and high molecular weight GAGs, including biglycan, and osteoclast distribution through tartrate resistant acid phosphatase (TRAP) staining.

Results

Unique chemical and mechanical qualities including heterogeneous bony fingers with hygroscopic Sharpey's fibers contributing to a higher organic (amide III — 1240 cm^− 1) to inorganic (phosphate — 960 cm^− 1) ratio, with lower average elastic modulus of 8 GPa versus 12 GPa in unadapted regions were identified. Furthermore, an increased presence of elemental Zn in cement lines and mineralizing fronts of PDL–bone was observed. Adapted regions containing bony fingers exhibited woven bone-like architecture and these regions rich in biglycan (BGN) and bone sialoprotein (BSP) also contained high-molecular weight polysaccharides predominantly at the site of polarized bone growth.

Conclusions

From a fundamental science perspective the shift in local properties due to strain amplification at the soft–hard tissue attachment sites is governed by semiautonomous cellular events at the PDL–bone and PDL–cementum sites. Over time, these strain-mediated events can alter the physicochemical properties of tissues per se, and consequently the overall biomechanics of the bone–PDL–tooth complex. From a clinical perspective, the shifts in magnitude and duration of forces on the periodontal ligament can prompt a shift in physiologic mineral apposition in cementum and alveolar bone albeit of an adapted quality owing to the rapid mechanical translation of the tooth.

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Load-mediated shifts in mechanical strains will prompt self-governing zones at PDL-cementum and PDL-bone entheses.

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The intensity of strain amplification is predominantly felt at the entheses as it is a region where disparate materials attach.

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Physicochemical observations at the PDL-bone enthesial zone are not directly correlated to the events at PDL-cementum zone.

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Rapid shifts in PDL strain can prompt a shift in mineral apposition at respective entheses albeit of an adapted quality.

Multiscale biomechanical responses of adapted bone-periodontal ligament-tooth fibrous joints

Reduced functional loads cause adaptations in organs. In this study, temporal adaptations of bone-ligament-tooth fibrous joints to reduced functional loads were mapped using a holistic approach. Systematic studies were performed to evaluate organ-level and tissue-level adaptations in specimens harvested periodically from rats (N=60) given powder food for 6 months over 8,12,16,20, and 24 weeks. Bone-periodontal ligament (PDL)-tooth fibrous joint adaptation was evaluated by comparing changes in joint stiffness with changes in functional space between the tooth and alveolar bony socket. Adaptations in tissues included mapping changes in the PDL and bone architecture as observed from collagen birefringence, bone hardness and volume fraction in rats fed soft foods (soft diet, SD) compared to those fed hard pellets as a routine diet (hard diet, HD). In situ biomechanical testing on harvested fibrous joints revealed increased stiffness in SD groups (SD:239-605 N/mm) (p<0.05) at 8 and 12 weeks. Increased joint stiffness in early development phase was due to decreased functional space (at 8 weeks change in functional space was -33 μm, at 12 weeks change in functional space was -30 μm) and shifts in tissue quality as highlighted by birefringence, architecture and hardness. These physical changes were not observed in joints that were well into function, that is, in rodents older than 12 weeks of age. Significant adaptations in older groups were highlighted by shifts in bone growth (bone volume fraction 24 weeks: Δ-0.06) and bone hardness (8 weeks: Δ-0.04 GPa, 16 weeks: Δ-0.07 GPa, 24 weeks: Δ-0.06 GPa). The response rate (N/s) of joints to mechanical loads decreased in SD groups. Results from the study showed that joint adaptation depended on age. The initial form-related adaptation (observed change in functional space) can challenge strain-adaptive nature of tissues to meet functional demands with increasing age into adulthood. The coupled effect between functional space in the bone-PDL-tooth complex and strain-adaptive nature of tissues is necessary to accommodate functional demands, and is temporally sensitive despite joint malfunction. From an applied science perspective, we propose that adaptations are registered as functional history in tissues and joints.

In vivo measurements and numerical analysis of the biomechanical characteristics of the human periodontal ligament

The periodontal ligament is a complex tissue with respect to its biomechanical behaviour. It is important to understand the mechanical behaviour of the periodontal ligament during physiological loading in healthy patients as well as during the movement of the tooth in orthodontic treatment or in patients with periodontal disease, as these might affect the mechanical properties of the periodontal ligament (PDL). Up to now, only a limited amount of in vivo data is available concerning this issue. The aim of this study has been to determine the time dependent material properties of the PDL in an experimental in vivo study, using a novel device that is able to measure tooth displacement intraorally. Using the intraoral loading device, tooth deflections at various velocities were realised in vivo on human teeth. The in vivo investigations were performed on the upper left central incisors of five volunteers aged 21-33 years with healthy periodontal tissue. A deflection, applied at the centre of the crown, was linearly increased from 0 to 0.15mm in a loading period of between 0.1 and 5.0s. Individual numerical models were developed based on the experimental results to simulate the relationship between the applied force and tooth displacement. The numerical force/displacement curves were fitted to the experimental ones to obtain the material properties of the human PDL. For the shortest loading time of 0.1s, the experimentally determined forces were between 7.0 and 16.2N. The numerically calculated Young's modulus varied between 0.9MPa (5.0s) and 1.2MPa (0.1s). By considering the experimentally and numerically obtained force curves, forces decreased with increasing loading time. The experimental data gained in this study can be used for the further development and verification of a multiphasic constitutive law of the PDL.

Predicting the holistic force-displacement relation of the periodontal ligament: in-vitro experiments and finite element analysis

BACKGROUND

The biomechanical property of the periodontal ligament (PDL) is important in orthodontics and prosthodontics. The objective of this study was to evaluate the feasibility of measuring the biomechanical behavior of the periodontal ligament using micro-computed tomography (micro-CT).

METHODS

A custom-made apparatus measured the force and displacement of a porcine PDL specimen within the micro-CT environment. Synchronized computed tomography (CT) images were used to obtain the deformation and displacement of the entire specimen and to reconstruct the three-dimensional mesh model. To match the experimental results, finite element analysis was then applied to simulate the biomechanical response of the PDL. The mechanical model of the PDL was assumed as the hyperelastic material in this study.

RESULTS

The volume variations of the tooth and the alveolar bone were less than 1%, which implies that tooth displacement was caused mostly by displacement of the PDL. Only translational displacement was observed with each load step because the transformation matrix acquired from the CT image registration was identical. The force-displacement curve revealed the nonlinear behavior of the PDL. There was a high correlation between the experimental displacement results and the simulation displacement results. The numerical results (based on the assumption that the PDL is the hyperelastic material) showed good agreement with the experimental results.

CONCLUSIONS

Nondestructive measurements by micro-CT obtained the biomechanical behavior of the PDL. Using the hyperelastic characteristic as the constitutive model can properly predict the force-displacement relation of the PDL after loading. This study provided a feasible approach for measuring the biomechanical behavior of the PDL for further dental application.

Adaptive properties of human cementum and cementum dentin junction with age

OBJECTIVES

The objective of this study was to evaluate age related changes in physical (structure/mechanical properties) and chemical (elemental/inorganic mineral content) properties of cementum layers interfacing dentin.

METHODS

Human mandibular molars (N=43) were collected and sorted by age (younger=19-39, middle=40-60, older=61-81 years). The structures of primary and secondary cementum (PC, SC) types were evaluated using light and atomic force microscopy (AFM) techniques. Chemical composition of cementum layers were characterized through gravimetric analysis by estimating ash weight and concentrations of Ca, Mn, and Zn trace elements in the analytes through inductively coupled plasma mass spectroscopy. The hardness of PC and SC was determined using microindentation and site-specific reduced elastic modulus properties were determined using nanoindentation techniques.

RESULTS

PC contained fibrous 1-3 µm wide hygroscopic radial PDL-inserts. SC illustrated PC-like structure adjacent to a multilayered architecture composing of regions that contained mineral dominant lamellae. The width of the cementum dentin junction (CDJ) decreased as measured from the cementum enamel junction (CEJ) to the tooth apex (49-21 µm), and significantly decreased with age (44-23 µm; p<0.05). The inorganic ratio defined as the ratio of post-burn to pre-burn weight increased with age within primary cementum (PC) and secondary cementum (SC). Cementum showed an increase in hardness with age (PC (0.40-0.46 GPa), SC (0.37-0.43 GPa)), while dentin showed a decreasing trend (coronal dentin (0.70-0.72 GPa); apical dentin (0.63-0.73 GPa)).

SIGNIFICANCE

The observed physicochemical changes are indicative of increased mineralization of cementum and CDJ over time. Changes in tissue properties of teeth can alter overall tooth biomechanics and in turn the entire bone-tooth complex including the periodontal ligament. This study provides baseline information about the changes in physicochemical properties of cementum with age, which can be identified as adaptive in nature.

The plastic nature of the human bone-periodontal ligament-tooth fibrous joint

This study investigates bony protrusions within a narrowed periodontal ligament space (PDL-space) of a human bone-PDL-tooth fibrous joint by mapping structural, biochemical, and mechanical heterogeneity. Higher resolution structural characterization was achieved via complementary atomic force microscopy (AFM), nano-transmission X-ray microscopy (nano-TXM), and microtomography (MicroXCT™). Structural heterogeneity was correlated to biochemical and elemental composition, illustrated via histochemistry and microprobe X-ray fluorescence analysis (μ-XRF), and mechanical heterogeneity evaluated by AFM-based nanoindentation. Results demonstrated that the narrowed PDL-space was due to invasion of bundle bone (BB) into PDL-space. Protruded BB had a wider range with higher elastic modulus values (2-8GPa) compared to lamellar bone (0.8-6GPa), and increased quantities of Ca, P and Zn as revealed by μ-XRF. Interestingly, the hygroscopic 10-30μm interface between protruded BB and lamellar bone exhibited higher X-ray attenuation similar to cement lines and lamellae within bone. Localization of the small leucine rich proteoglycan biglycan (BGN) responsible for mineralization was observed at the PDL-bone interface and around the osteocyte lacunae. Based on these results, it can be argued that the LB-BB interface was the original site of PDL attachment, and that the genesis of protruded BB identified as protrusions occurred as a result of shift in strain. We emphasize the importance of bony protrusions within the context of organ function and that additional study is warranted.

Biomechanical adaptation of the bone-periodontal ligament (PDL)-tooth fibrous joint as a consequence of disease

In this study, an in vivo ligature-induced periodontitis rat model was used to investigate temporal changes to the solid and fluid phases of the joint by correlating shifts in joint biomechanics to adaptive changes in soft and hard tissue morphology and functional space. After 6 and 12 weeks of ligation, coronal regions showed a significant decrease in alveolar crest height, increased expression of TNF-α, and degradation of attachment fibers as indicated by decreased collagen birefringence. Cyclical compression to peak loads of 5-15N at speeds of 0.2-2.0mm/min followed by load relaxation tests showed decreased stiffness and reactionary load rate values, load relaxation, and load recoverability, of ligated joints. Shifts in joint stiffness and reactionary load rate increased with time while shifts in joint relaxation and recoverability decreased between control and ligated groups, complementing measurements of increased tooth displacement as evaluated through digital image correlation. Shifts in functional space between control and ligated joints were significantly increased at the interradicular (Δ10-25μm) and distal coronal (Δ20-45μm) regions. Histology revealed time-dependent increases in nuclei elongation within PDL cells and collagen fiber alignment, uncrimping, and directionality, in 12-week ligated joints compared to random orientation in 6-week ligated joints and to controls. We propose that altered strains from tooth hypermobility could cause varying degrees of solid-to-fluid compaction, alter dampening characteristics of the joint, and potentiate increased adaptation at the risk of joint failure.

The adaptive nature of the bone-periodontal ligament-cementum complex in a ligature-induced periodontitis rat model

The novel aspect of this study involves illustrating significant adaptation of a functionally loaded bone-PDL-cementum complex in a ligature-induced periodontitis rat model. Following 4, 8, and 15 days of ligation, proinflammatory cytokines (TNF-α and RANKL), a mineral resorption indicator (TRAP), and a cell migration and adhesion molecule for tissue regeneration (fibronectin) within the complex were localized and correlated with changes in PDL-space (functional space). At 4 days of ligation, the functional space of the distal complex was widened compared to controls and was positively correlated with an increased expression of TNF-α. At 8 and 15 days, the number of RANKL(+) cells decreased near the mesial alveolar bone crest (ABC) but increased at the distal ABC. TRAP(+) cells on both sides of the complex significantly increased at 8 days. A gradual change in fibronectin expression from the distal PDL-secondary cementum interfaces through precementum layers was observed when compared to increased and abrupt changes at the mesial PDL-cementum and PDL-bone interfaces in ligated and control groups. Based on our results, we hypothesize that compromised strain fields can be created in a diseased periodontium, which in response to prolonged function can significantly alter the original bone and apical cementum formations.