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

Bone formation ability of Gli1+ cells in the periodontal ligament after tooth extraction

During the process of socket healing after tooth extraction, osteoblasts appear in the tooth socket and form alveolar bone; however, the source of these osteoblasts is still uncertain. Recently, it has been demonstrated that cells expressing Gli1, a downstream factor of sonic hedgehog signaling, exhibit stem cell properties in the periodontal ligament (PDL). Therefore, in the present study, the differentiation ability of Gli1⁺-PDL cells after tooth extraction was analyzed using Gli1-Cre^ERT2/ROSA26-loxP-stop-loxP-tdTomato (iGli1/Tomato) mice. After the final administration of tamoxifen to iGli1/Tomato mice, Gli1/Tomato⁺ cells were rarely detected in the PDL. One day after the tooth extraction, although inflammatory cells appeared in the tooth socket, Periostin⁺ PDL-like tissues having a few Gli1/Tomato⁺ cells remained near the alveolar bone. Three days after the extraction, the number of Gli1/Tomato⁺ cells increased as evidenced by numerous PCNA⁺ cells in the socket. Some of these Gli1/Tomato⁺ cells expressed BMP4 and Phosphorylated (P)-Smad1/5/8. After seven days, the Osteopontin⁺ bone matrix was formed in the tooth socket apart from the alveolar bone. Many Gli1/Tomato⁺ osteoblasts that were positive for Runx2⁺ were arranged on the surface of the newly formed bone matrix. In the absence of Gli1⁺-PDL cells in Gli1-Cre^ERT2/Rosa26-loxP-stop-loxP-tdDTA (iGli1/DTA) mice, the amount of newly formed bone matrix was significantly reduced in the tooth socket. Therefore, these results collectively suggest that Gli1⁺-PDL cells differentiate into osteoblasts to form the bone matrix in the tooth socket; thus, this differentiation might be regulated, at least in part, by bone morphogenetic protein (BMP) signaling.

The mechanical effect of geometric design of attachments in invisible orthodontics

INTRODUCTION

In invisible orthodontics, attachments are used with aligners to better control tooth movement. However, to what extent the geometry of the attachment can affect the biomechanical properties of the aligner is unknown. This study aimed to determine the biomechanical effect of attachment geometry on orthodontic force and moment using 3-dimensional finite element analysis.

METHODS

A 3-dimensional model of mandibular teeth, periodontal ligaments, and the bone complex was employed. Rectangular attachments with systematic size variations were applied to the model with corresponding aligners. Fifteen pairs were created to move the lateral incisor, canine, first premolar, and second molar mesially for 0.15 mm, respectively. The resulting orthodontic forces and moments were analyzed to compare the effect of attachment size.

RESULTS

Expansion in the attachment size showed a continuous increase in force and moment. Considering the attachment size, the moment increased more than the force, resulting in a slightly higher moment-to-force ratio. Expanding the length, width, or thickness of the rectangular attachment by 0.50 mm increases the force and moment up to 23 cN and 244 cN-mm, respectively. The force direction was closer to the desired movement direction with larger attachment sizes.

CONCLUSIONS

Based on the experimental results, the constructed model successfully simulates the effect of the size of attachments. The larger the size of the attachment, the greater the force and moment, and the better the force direction. The appropriate force and moment for a particular clinical patient can be obtained by choosing the right attachment size.

Gli1+-PDL Cells Contribute to Alveolar Bone Homeostasis and Regeneration

The periodontal ligament (PDL) contains mesenchymal stem cells (MSCs) that can differentiate into osteoblasts, cementoblasts, and fibroblasts. Nevertheless, the distribution and characteristics of these cells remain uncertain. Gli1, an essential hedgehog signaling transcription factor, functions in undifferentiated cells during embryogenesis. Therefore, in the present study, the differentiation ability of Gli1⁺ cells was examined using Gli1-CreERT2/ROSA26-loxP-stop-loxP-tdTomato (iGli1/Tomato) mice. In 4-wk-old iGli1/Tomato mice, Gli1/Tomato⁺ cells were only slightly detected in the PDL, around endomucin-expressing blood vessels. These cells had proliferated over time, localizing in the PDL as well as on the bone and cementum surfaces at day 28. However, in 8-wk-old iGli1/Tomato mice, Gli1/Tomato⁺ cells were quiescent, as most cells were not immunoreactive for Ki-67. These cells in 8-wk-old mice exhibited high colony-forming unit fibroblast activity and were capable of osteogenic, chondrogenic, and adipogenic differentiation in vitro. In addition, after transplantation of teeth of iGli1/Tomato mice into the hypodermis of wild-type mice, Tomato fluorescence indicating the progeny of Gli1⁺ cells was detected in the osteoblasts and osteocytes of the regenerated bone. These results demonstrate that Gli1⁺ cells in the PDL were MSCs and could contribute to the alveolar bone regeneration.

Food hardness can regulate orthodontic tooth movement in mice

BACKGROUND AND OBJECTIVES

Orthodontic treatment is often accompanied with prescription of softer foods to patients. The question to ask is, is this prescribed load regimen congruent with Wolff's law, and does it provide an adequate mechanical stimulus to maintain the functional health of periodontal complex? This question was answered by studying the effects of mice chewing on soft food (SF) and hard food (HF) while undergoing experimental tooth movement (ETM).

METHODS

Three-week-old C57BL/6 mice (n = 18) were fed either hard pellet (HF; n = 9) or soft-chow food (SF; n = 9). ETM was performed on mice at 8 weeks of age, and mice were euthanized at 1 min, 2 weeks, and 4 weeks (8, 10, and 12 weeks old, respectively). A logistic regression model was applied to the experimental data to extrapolate the prolonged effects of ETM on the physical features of the dentoalveolar joint (DAJ).

RESULTS

By 12 weeks, mice that chewed on SF expressed wider periodontal ligament space than those that chewed on HF. Mice that chewed on SF demonstrated increased alveolar socket roughness with larger alveoli and decreased bone volume fraction but with significantly lower bone mineral density and reduced overall tooth movement.

CONCLUSIONS

These altered physical features when contextualized within the DAJ illustrated that (a) the regions farther away from the "site of insult" also undergo significant adaptation, and (b) these adaptations vary between mesial and distal sides of the periodontal complex and topographically differentiate in the direction of the ETM. These insights underpin the main conclusion, in that there is a need to "regulate chewing loads" as a therapeutic dose following ETM to encourage regeneration of periodontal complex as an effective clinical outcome. The discussed multiscale image analyses also can be used on patient cone beam computed tomography data to identify the effectiveness of orthodontic treatment within the realm of masticatory function.

An in-silico approach to modeling orthodontic tooth movement using stimulus-induced external bone adaptation

Bone remodeling process has been used in orthodontics to treat malposition of teeth in patients by applying stimuli outside of usual everyday loads to promote tooth movement by affecting equilibrium state of the surrounding bone tissue. Accurate modeling of long term orthodontic tooth movement (OTM) is crucial in the field of dental biomechanical research since it allows to predict the behavior and interaction of bone-tooth environment in a non-destructive way, and helps to gain more insight on how exactly tooth motion progresses over time. Existence of such predictive tools might help to avoid the adverse effects of OTM on teeth and the surrounding tissues during this clinical procedure. In this study a new numerical approach to simulating long-term OTM is proposed, that involves external bone adaptation with strain energy density of the bone taken as the stimulus parameter and bone adaptation modeled by nodal movements at the bone-tooth interface using Abaqus UMESHMOTION subroutine. Contrary to conventional re-meshing algorithms, where the mesh of resorbed-apposed bone region is constantly updated and element deletion/creation is performed for each increment, the proposed method only moves nodes without changing the initial mesh topology. For this study, a 3D model of right central maxillary incisor tooth and its surrounding maxillary bone was used for the modeling of OTM for a duration of 1 week. Two test cases were performed and the results from induced tooth motion were investigated. Results indicate tooth movement values that were quite close to clinical values provided in the literature and this method is easily applicable to validate various postulates of OTM via adapting the stimulus-adaption rate relation and patient-specific planning of orthodontic patients as well.

Treponema denticola-Induced RASA4 Upregulation Mediates Cytoskeletal Dysfunction and MMP-2 Activity in Periodontal Fibroblasts

The periodontal complex consists of the periodontal ligament (PDL), alveolar bone, and cementum, which work together to turn mechanical load into biological responses that are responsible for maintaining a homeostatic environment. However oral microbes, under conditions of dysbiosis, may challenge the actin dynamic properties of the PDL in the context of periodontal disease. To study this process, we examined host-microbial interactions in the context of the periodontium via molecular and functional cell assays and showed that human PDL cell interactions with Treponema denticola induce actin depolymerization through a novel actin reorganization signaling mechanism. This actin reorganization mechanism and loss of cell adhesion is a pathological response characterized by an initial upregulation of RASA4 mRNA expression resulting in an increase in matrix metalloproteinase-2 activity. This mechanism is specific to the T. denticola effector protein, dentilisin, thereby uncovering a novel effect for Treponema denticola-mediated RASA4 transcriptional activation and actin depolymerization in primary human PDL cells.

Role of Mechanotransduction in Periodontal Homeostasis and Disease

Novel findings broaden the concept of mechanotransduction (MT) in biophysically stimulated tissues such as the periodontium by considering nuclear MT, convergence of intracellular MT pathways, and mechanoresponsive cotranscription factors such as Yes-associated protein 1 (YAP1). Regarding periodontal disease, recent studies have elucidated the role of bacterial gingipain proteases in disturbing the barrier function of cadherins, thereby promoting periodontal inflammation. This leads to dysregulation of extracellular matrix homeostasis via proteases and changes the cell's biophysical environment, which leads to alterations in MT-induced cell behavior and loss of periodontal integrity. Newest experimental evidence from periodontal ligament cells suggests that the Hippo signaling protein YAP1, in addition to integrin-FAK (focal adhesion kinase) mechanosignaling, also regulates cell stemness. By addressing mechanosignaling-dependent transcription factors, YAP1 is involved in osteogenic and myofibroblast differentiation and influences core steps of autophagy. Recent in vivo evidence elucidates the decisive role of YAP1 in epithelial homeostasis and underlines its impact on oral pathologies, such as periodontitis-linked oral squamous cell carcinogenesis. Here, new insights reveal that YAP1 contributes to carcinogenesis via overexpression rather than mutation; promotes processes such as apoptosis resistance, epithelial-mesenchymal transition, or metastasis; and correlates with poor prognosis in oral squamous cell carcinoma. Furthermore, YAP1 has been shown to contribute to periodontitis-induced bone loss. Mechanistically, molecules identified to regulate YAP1-related periodontal homeostasis and disease include cellular key players such as MAPK (mitogen-activated protein kinase), JNK (c-Jun N-terminal kinase), Rho (Ras homologue) and ROCK (Rho kinase), Bcl-2 (B-cell lymphoma 2), AP-1 (activator protein 1), and c-myc (cellular myelocytomatosis). These findings qualify YAP1 as a master regulator of mechanobiology and cell behavior in human periodontal tissues. This review summarizes the most recent developments in MT-related periodontal research, thereby offering insights into outstanding research questions and potential applications of molecular or biophysical strategies aiming at periodontal disease mitigation or prevention.

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.

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.

Osteoprotegerin is sensitive to actomyosin tension in human periodontal ligament fibroblasts

Periodontal ligament fibroblasts (PdLFs) are an elongated cell type in the periodontium with matrix and bone regulatory functions which become abnormal in periodontal disease (PD). Here we found that the normally elongated and oriented PdLF nucleus becomes rounded and loses orientation in a mouse model of PD. Using in vitro micropatterning of cultured primary PdLF cell shape, we show that PdLF elongation correlates with nuclear elongation and the presence of thicker, contractile F-actin fibers. The rounded nuclei in mouse PD models in vivo are, therefore, indicative of reduced actomyosin tension. Inhibiting actomyosin contractility by inhibiting myosin light chain kinase, Rho kinase or myosin ATPase activity, in cultured PdLFs each consistently reduced messenger RNA levels of bone regulatory protein osteoprotegerin (OPG). Infection of cultured PdLFs with two different types of periodontal bacteria (Porphyromonas gingivalis and Fusobacterium nucleatum) failed to recapitulate the observed nuclear rounding in vivo, upregulated nonmuscle myosin II phosphorylation and downregulated OPG. Collectively, our results add support to the hypothesis that PdLF contractility becomes decreased and contributes to disease progression in PD.

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.

Biglycan in the Skeleton

Small leucine rich proteoglycans (SLRPs), including Biglycan, have key roles in many organ and tissue systems. The goal of this article is to review the function of Biglycan and other related SLRPs in mineralizing tissues of the skeleton. The review is divided into sections that include Biglycan's role in structural biology, signaling, craniofacial and long bone homeostasis, remodeled skeletal tissues, and in human genetics. While many cell types in the skeleton are now known to be affected by Biglycan, there are still unanswered questions about its mechanism of action(s).

Periodontal cell mechanotransduction

The periodontium is a structurally and functionally complex tissue that facilitates the anchorage of teeth in jaws. The periodontium consists of various cell types including stem cells, fibroblasts and epithelial cells. Cells of the periodontium are constantly exposed to mechanical stresses generated by biological processes such as the chewing motions of teeth, by flows generated by tongue motions and by forces generated by implants. Mechanical stresses modulate the function of cells in the periodontium, and may play a significant role in the development of periodontal disease. Here, we review the literature on the effect of mechanical forces on periodontal cells in health and disease with an emphasis on molecular and cellular mechanisms.