Healing in transplanted teeth with periodontal ligament cultured in vitro

In Situ Tooth Replica Custom Implant: A 3-Dimensional Finite Element Stress and Strain Analysis

This study is a phase of a biomechanical study, a part of a research program concerned with the new concept of in situ tooth replication. The purpose of the study was to evaluate tooth replica under each of two possible circumstances: (1) attachment via periodontal ligament and (2) osseointegration. Replicas were made of Cortoss, a bioactive glass, bone substitute. Three-dimensional finite element analysis was used to assess the stresses and strains resulting from each of 2 types of loads: off-vertical pressure and vertical point force acting on natural mandibular second premolar and corresponding replicas. Natural tooth tolerated 19 MPa pressure or 85 N vertical force, periodontally attached replica tolerated 15 MPa pressure or 80 N force, and osseointegrated replica tolerated 23 MPa pressure or 217 N force.

In Situ Tooth Replica Custom Implant: Rationale, Material, and Technique

This study introduced a new concept of an in situ, custom-made, tooth replica dental implant. It was obtained by injecting a self-set, nonresorbable polymer type bone graft substitute into the tooth socket after extraction. Based on its cited properties, new composite bone cement Cortoss was suggested. The properties were reviewed and evaluated. The technique of application was described with a simulation model presented that appeared simple. Apparently, immediate duplication of tooth anatomy was achieved; thus, the concept might have the potentials of spontaneous adaptation and stabilization, preservation of alveolar bone, increasing implant-bone surface area, better load distribution, and bone stimulation. Modifications were also described to manage cases of resorbed alveolar bone as well as long-standing extracted teeth. Investigations were still required to assess the performance of the material and if modifications would be needed.

Modulation of osteogenic potential by recombinant human bone morphogenic protein-2 in human periodontal ligament cells: effect of serum, culture medium, and osteoinductive medium

BACKGROUND AND OBJECTIVE

Bone morphogenic proteins are known, in animal models, to promote many developmental processes, including osteogenesis. Clinical trials are currently underway to evaluate the potential of bone morphogenic proteins to promote bone and periodontal regeneration in humans. The aim of this study was to establish an optimal cell culture condition for using to study the biological effects of recombinant human bone morphogenic protein-2 on periodontal ligament cells.

MATERIAL AND METHODS

The roles of serum concentration, types of culture medium (alpha-modified essential medium or Dulbecco's modified Eagle's medium), the presence of osteoinductive medium (including dexamethasone, ascorbic acid and beta-glycerophosphate), and timing of addition of the osteoinductive medium and recombinant human bone morphogenic protein-2, on the expression of alkaline phosphatase were investigated in cultured periodontal ligament cells. Cytochemical stainings and biological assay of alkaline phosphatase were also demonstrated.

RESULTS

Our results suggested that an increased concentration of serum might mask the effect of recombinant human bone morphogenic protein-2 on the expression of alkaline phosphatase in periodontal ligament cells. alpha-Modified essential medium was found to induce a stronger cytochemical staining of the alkaline phosphatase than Dulbecco's modified Eagle's medium under similar culture conditions. Pre-incubation of cells with osteoinductive medium before the addition of various concentrations of recombinant human bone morphogenic protein-2 enhanced greater alkaline phosphatase expression than the simultaneous presence of both osteoinductive medium and recombinant human bone morphogenic protein-2.

CONCLUSION

The findings of this study suggest that the effect of recombinant human bone morphogenic protein-2 on periodontal ligament cells could be efficiently investigated after the proper selection of culture variables and temporal sequence of adding bioactive factors. The optimal culture condition identified in this study might be useful in further studies to elucidate the regulatory mechanism of periodontal ligament cells in periodontal regeneration after stimulation with recombinant human bone morphogenic protein-2.

Favorable healing following space creation in rhBMP-2-induced periodontal regeneration of horizontal circumferential defects in dogs with experimental periodontitis

BACKGROUND

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is believed to be capable of inducing periodontal regeneration. However, the risk of aberrant healing events, such as root resorption and ankylosis, has been reported. We hypothesized that implantation of BMP-containing carriers directly on the root planed surface may be the cause of unfavorable healing. The purpose of this study was to evaluate the influence of a 1 mm spacer membrane, which separated the rhBMP-2 in polymer-coated gelatin sponge (PGS) and the root surface, on periodontal regeneration of experimentally induced horizontal defects in dogs.

METHODS

Horizontal circumferential periodontal defects were surgically created, and experimental periodontitis was induced in 72 maxillary and mandibular premolars of four male beagle dogs. The recipient sites of each quadrant received: 1) rhBMP-2/PGS (B group) (rhBMP-2 at 1.0 mg/ml, total implant volume/ site approximately 7.2 microl) (n = 24); 2) rhBMP-2/PGS with a spacer membrane (PB group) (n = 24); and 3) physiological saline (PS)/PGS as a control (P group) (n = 24). One quadrant was left untreated. Dogs were sacrificed at 12 weeks post-surgery, and healing was evaluated histologically.

RESULTS

Both groups treated with rhBMP-2/PGS demonstrated enhanced new bone formation and connective tissue attachment with cementum regeneration when compared to the control group. Sites treated with rhBMP-2/PGS showed a greater degree of bone formation than sites treated with rhBMP-2/PGS and spacer membrane, although the latter sites showed no ankylosis.

CONCLUSIONS

Implantation of rhBMP-2/PGS enhances bone formation and connective tissue attachment in horizontal circumferential defects. In addition, the use of a spacer membrane reduces the degree of bone formation, but minimizes ankylosis.