Pivotal Role of Tenascin-W (-N) in Postnatal Incisor Growth and Periodontal Ligament Remodeling

The continuously growing mouse incisor provides a fascinating model for studying stem cell regulation and organ renewal. In the incisor, epithelial and mesenchymal stem cells assure lifelong tooth growth. The epithelial stem cells reside in a niche known as the cervical loop. Mesenchymal stem cells are located in the nearby apical neurovascular bundle and in the neural plexus. So far, little is known about extracellular cues that are controlling incisor stem cell renewal and guidance. The extracellular matrix protein tenascin-W, also known as tenascin-N (TNN), is expressed in the mesenchyme of the pulp and of the periodontal ligament of the incisor, and is closely associated with collagen 3 fibers. Here, we report for the first time the phenotype of tenascin-W/TNN deficient mice, which in a C57BL/6N background exhibit a reduced body weight and lifespan. We found major defects in the alveolar bone and periodontal ligament of the growing rodent incisors, whereas molars were not affected. The alveolar bone around the incisor was replaced by a dense scar-like connective tissue, enriched with newly formed nerve fibers likely leading to periodontal pain, less food intake and reduced body weight. Using soft food to reduce mechanical load on the incisor partially rescued the phenotype. In situ hybridization and Gli1 reporter mouse experiments revealed decreased hedgehog signaling in the incisor mesenchymal stem cell compartment, which coordinates the development of mesenchymal stem cell niche. These results indicate that TNN deficiency in mice affects periodontal remodeling and increases nerve fiber branching. Through periodontal pain the food intake is reduced and the incisor renewal and the neurovascular sonic hedgehog secretion rate are reduced. In conclusion, tenascin-W/TNN seems to have a primary function in rapid periodontal tissue remodeling and a secondary function in mechanosensation.

Contribution of capsaicin-sensitive innervation to the continuous eruption of the rat mandibular incisors

A major component of tooth innervation is made of capsaicin-sensitive primary afferents (CSPA). These fibers play a key role in tooth pain and inflammation; little is known, however, about the role of CSPA in tooth eruption. The aim of this study was to examine the role of the capsaicin-sensitive afferents in the process of eruption of intact rat incisors. CSPA fibers in several rat groups, were subjected to one of the following experimental procedures: systemic chemical ablation, systemic ablation followed by chemical sympathectomy and localized activation. The observed effects on incisor eruption were compared to those made on controls. The total amount of eruption in control/naïve rats, measured over a total period of 144 h, was 3.18 ± 0.07 mm and decreased to 2.43 ± 0.08 mm (n = 7; p < 0.001) following systemic ablation of CSPA. Further decrease to 2.24 ± 0.08 mm (n = 7; p < 0.001) was noticed when chemical sympathectomy was added to CSPA ablation. The average rate of eruption was 1.7 ± 0.25 mm following CSPA activation, compared to an average of 0.8 ± 0.07 mm for controls (n = 7; p < 0.001). Capsaicin sensitive fibers play an important role in tooth homeostasis, and intact neural supply is required for tooth growth under normal conditions.

Effect of Three Different Injection Sites on the Success of Anterior Middle Superior Alveolar Nerve Block with 3% Mepivacaine: A Randomized Controlled Trial

AIM

Anterior middle superior alveolar (AMSA) nerve block injection targets the anterior superior alveolar nerve and the middle superior alveolar nerve branches of the infraorbital nerve through nutrient canals. Therefore, the central incisor to the second premolar teeth of one quadrant can be anesthetized. The aim of the present study was to evaluate the efficacy of AMSA nerve block injection with 3% mepivacaine solution at three different injection sites.

MATERIALS AND METHODS

In a double-blind crossover study, 47 volunteers participated and three AMSA nerve block injections of 3% mepivacaine solution without epinephrine were administered at the anterior, posterior, and the most common injection sites with a 1-week interval between injections. Anesthesia of the central incisor to the second premolar of the injected side was evaluated by using an electric pulp tester. The success of the injection was considered as lack of response to two consecutive 80 readings. The generalized estimating equation analytic tests were administered (α = 0.05).

RESULTS

The success rate of the AMSA nerve block injection ranged from 27.5-47.5% for the most common injection site and 22.5-42.5% for both the anterior and posterior injection sites.

CONCLUSION

Changing the injection site did not result in statistically significant improvements (p > 0.05).

CLINICAL SIGNIFICANCE

Changing the injection site anteropos-teriorly did not influence the success rate of the AMSA nerve block injection.

Secretion of shh by a neurovascular bundle niche supports mesenchymal stem cell homeostasis in the adult mouse incisor

Mesenchymal stem cells (MSCs) are typically defined by their in vitro characteristics, and as a consequence the in vivo identity of MSCs and their niches are poorly understood. To address this issue, we used lineage tracing in a mouse incisor model and identified the neurovascular bundle (NVB) as an MSC niche. We found that NVB sensory nerves secrete Shh protein, which activates Gli1 expression in periarterial cells that contribute to all mesenchymal derivatives. These periarterial cells do not express classical MSC markers used to define MSCs in vitro. In contrast, NG2(+) pericytes represent an MSC subpopulation derived from Gli1+ cells; they express classical MSC markers and contribute little to homeostasis but are actively involved in injury repair. Likewise, incisor Gli1(+) cells, but not NG2(+) cells, exhibit typical MSC characteristics in vitro. Collectively, we demonstrate that MSCs originate from periarterial cells and are regulated by Shh secretion from an NVB.

[Anatomical and radiological studies on additional mandible teeth anesthesia considering innervation variability]

The paper presents studies on nutritional foramina of the mandible. Some nutritional foramina located in the frontal mandibular region on the lingual surface and containing significant blood vessels and nerves are found to be more typical for teeth-bearing mandible. In retromolar area in case of third molars presence intraosseous canals were revealed leading to inferior alveolar nerve canal. One should consider intraligamental and lingual anesthesia by lower incisors extraction. Intraosseous anesthesia and retromolar area infiltration significantly increase anesthesia efficiency by third molar extraction.

A prospective, randomized comparison of the anesthetic efficacy of the greater palatine and high tuberosity second division nerve blocks

INTRODUCTION

Few clinical studies have evaluated the efficacy of the maxillary second division nerve block. The purpose of this prospective, randomized study was to compare the anesthetic efficacy of the greater palatine second division nerve block and the high tuberosity second division nerve block technique by using 3.6 mL of 2% lidocaine with 1:100,000 epinephrine.

METHODS

Forty subjects randomly received greater palatine nerve blocks and high tuberosity nerve blocks of 3.6 mL of 2% lidocaine with 1:100,000 epinephrine at 2 separate appointments spaced at least 1 week apart. The anterior, premolar, and molar teeth were pulp tested in 4-minute cycles for a total of 60 minutes.

RESULTS AND CONCLUSIONS

Both techniques resulted in a high success rate of pulpal anesthesia (95%-100%) for first and second molars. Around 70%-80% of the second premolars were anesthetized with both techniques. Both techniques were ineffective for profound pulpal anesthesia of the anterior teeth and first premolars.

Neurotrophin-4/5-depletion induces a delay in maturation of the periodontal Ruffini endings in mice

Neurotrophin-4/5 (NT-4/5) - a member of the neurotrophic factors - is a ligand for TrkB, which has been reported to be expressed in the mechanoreceptive Ruffini endings of the periodontal ligament. The present study examined developmental changes in the terminal morphology and neural density in homozygous mice with a targeted disruption of the nt-4/5 gene and wild-type mice by immunohistochemistry for protein gene product 9.5 (PGP 9.5), a general neuronal marker, and by quantitative analysis using an image analyzer. Postnatal development of terminal Schwann cells was also investigated by enzymatic histochemistry for non-specific cholinesterase activity (ChE). Furthermore, the immuno-expression of TrkB and low affinity nerve growth factor receptor (p75-NGFR) was surveyed in the periodontal Ruffini endings as well as trigeminal ganglion. At postnatal 1 week, the lingual periodontal ligament of both types of mice contained PGP 9.5-positive nerve fibers showing a tree-like ramification with axonal swellings in their course. In both types of mice at 2 weeks of age, comparatively thick nerve fibers with a smooth outline increased in number, and frequently ramified to form nerve terminals with dendritic profiles. However, no typical Ruffini endings with irregular outlines observed in the adult wild-type mice were found in the periodontal ligament at this stage. At postnatal 3 weeks, typical Ruffini endings with irregular outlines were discernable in the periodontal ligament of the wild-type mice while the dendritic endings showing smooth outlines were restricted to the homozygous mice. After postnatal 8 weeks, both types of mice showed an increase in the number of Ruffini endings, but the morphology differed between the wild-type and NT-4/5 homozygous mice. In the wild-type mice, a major population of the Ruffini endings expanded their axonal branches and developed many microprojections, resulting in a reduction of endings with smooth outlines. In contrast, we failed to find such typical Ruffini endings in the periodontal ligament of the homozygous mice: A majority of the periodontal Ruffini endings continued to show smooth outlines at postnatal 12 weeks. Quantitative analysis on neural density demonstrated a reduction in the homozygous mice with a significant difference by postnatal 8 weeks. Enzymatic histochemistry for non-specific ChE did not exhibit a distinct difference in the distribution and density of terminal Schwann cells between wild-type and homozygous mice. Furthermore, TrkB and p75-NGFR mRNA and proteins did not differ in the trigeminal ganglion between the two types. The periodontal Ruffini endings also displayed immunoreactivities for TrkB and p75- NGFR in both phenotypes. These findings suggest that the nt-4/5 gene depletion caused a delay in the formation and maturation of the periodontal Ruffini endings in the mice by inhibiting the growth of the periodontal nerves at an early stage, and indicate that multiple neurotrophins such as NT- 4/5 and BDNF might play roles in the development and/or maturation of the periodontal Ruffini endings.

Effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve block technique

The purpose of this study was to assess the effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve (ASAN) block technique. Secondarily, the possible innervation of the maxillary central incisors by the nasopalatine nerve was also investigated. Twenty-seven healthy, young adult volunteers (age: 17-26 years; gender: 9 males and 18 females) were enrolled in this study. All participants were undergraduate dental students of the University of Vale do Rio Verde de Três Corações. The volunteers had the anterior superior alveolar nerves anesthetized and a thermal sensitivity test (cold) was performed on the maxillary central incisors. The volunteers that responded positively to cold stimulus received a nasopalatine nerve block and the thermal sensitivity test was repeated. All participants were anesthetized by a single operator. Three patients presented sensitivity after both types of bilateral blocks and were excluded from the percentage calculations. In the remaining 24 patients, 16 had their maxillary central incisors anesthetized by the anterior superior alveolar block and 8 remained with sensitivity after the ASAN block. All these 8 patients had their maxillary central incisors successfully anesthetized by the nasopalatine block. In this study, 33.3% of the subjects had the innervation of one or both maxillary central incisors derived from the nasopalatine nerve, whilst most subjects (66.7%) had such teeth innervated by the anterior superior alveolar nerve. The nasopalatine nerve block was effective in anesthetizing the maxillary central incisors when the anterior superior alveolar nerve block failed.

Influence of Injection Speed on the Effectiveness of Incisive/Mental Nerve Block: A Randomized, Controlled, Double-blind Study in Adult Volunteers

This randomized, double-blind trial tested the null hypothesis that speed of deposition has no influence on the injection discomfort, efficacy, distribution, and duration of pulp anesthesia after incisive/mental nerve block in adult volunteers. Thirty-eight subjects received incisive/mental nerve blocks of 2.0 mL lidocaine with 1:80,000 epinephrine slowly over 60 seconds or rapidly over 15 seconds at least 1 week apart. Pulp anesthesia was assessed electronically to 45 minutes after injection. Injection discomfort was self-recorded on visual analogue scales. Overall, 48.7% of volunteers developed pulp anesthesia in first molars, 81.8% in bicuspids, and 38.5% in lateral incisors. The mean duration of pulp anesthesia was 19.1 minutes for first molars, 28.5 minutes for bicuspids, and 19.0 minutes for lateral incisors. Speed of injection had no significant influence on anesthetic success or duration of anesthesia for individual teeth. Slow injection was significantly more comfortable than rapid injection (P < .001). The null hypothesis was supported, although slow injection was more comfortable.

Immunolocalization of aquaporin-1 in the mechanoreceptive Ruffini endings in the periodontal ligament

Previous ultrastructural studies have suggested an axon-Schwann cell interaction in the periodontal Ruffini ending, a primary mechanoreceptor. However, no information is available on the transport mechanism between them. The present study examined the immunolocalization of aquaporin-1 (AQP1) and -4 (AQP4), a member of the water-selective channel, in the periodontal Ruffini endings of the rat incisors and trigeminal ganglion. In addition, the expression of mRNA for AQP1 and 4 was detected in the trigeminal ganglion by a RT-PCR technique. A single PCR product of the sizes anticipated for AQP1 and 4 was detectable in a reverse transcripted cDNA sample from the trigeminal ganglion, whose neurons innervate the periodontal Ruffini endings. An AQP1 immunoreaction was recognizable in the axon terminals of the periodontal Ruffini endings as well as their associated terminal Schwann cells, as confirmed with a double staining with AQP1 and either PGP9.5 or S-100 protein. However, no immunoreaction for AQP4 was found in periodontal Ruffini endings. Although the AQP4 immunoreaction was localized in some satellite cells - but never in neurons - of the trigeminal ganglion, 16.1% trigeminal neurons showed the AQP1 immunoreaction. Furthermore, the AQP1 immunoreaction was found in certain satellite cells which surrounded AQP1-positive or -negative neurons. An analysis of a cross-sectional area of these positive neurons demonstrated that approximately 66.9% of the positive neurons were 400-1000 microm2 (671.4+/-172.4 microm2), indicating that they could be categorized as medium-sized neurons which mediate mechanotransduction. These findings suggest that AQP1 controls water transport in the periodontal Ruffini endings.

Forces applied by anterior and posterior teeth and roles of periodontal afferents during hold-and-split tasks in human subjects

Hold-and-split tasks were performed by 20 subjects (12 females and 8 males) using the right central incisors, canines, 2nd premolars, and 1st molars, respectively. Half a peanut was positioned on a transducer-equipped plate and the subject was instructed to hold the plate with the peanut between two antagonistic teeth, and not using more force than necessary. After ca. 3 s the subject was instructed to split the peanut in a natural manner. Each session consisted of a series of three in which the subject performed the hold-and-split task five times for each tooth. Thus, in total, data were obtained from 60 trials for each subject. The magnitude of the forces and the force rates used to split the peanut increased distally along the dental arch. However, the duration of the split phase was similar for the various teeth examined. During anesthesia of the periodontal ligament (four subjects), no significant changes were seen in the split phase. The forces used to hold the peanut between the teeth also increased distally along the dental arch: 0.60 N for the incisor, 0.77 N for the canine, 1.15 N for the 2nd premolar, and 1.74 N for the 1st molar. The difference in hold forces for the various teeth can be explained by the different sensitivity characteristics of the periodontal afferents innervating anterior and posterior teeth. During periodontal anesthesia, the magnitude and variability of the hold forces increased for all types of teeth, thus supporting the suggestion that periodontal afferent information is used in the regulation of the level of forces used to hold and manipulate morsels between the teeth.

Speed of Injection Influences Efficacy of Inferior Alveolar Nerve Blocks: A Double-Blind Randomized Controlled Trial in Volunteers

This randomized double-blind crossover trial investigated the efficacy and discomfort associated with slow (60 seconds) and rapid (15 seconds) inferior alveolar nerve blocks (IANB) using 2.0 ml of 2% lidocaine with 1:80,000 epinephrine in securing mandibular first molar, premolar and lateral incisor pulp anesthesia in 38 healthy adult volunteers. Episodes of maximal stimulation (80 microA) without sensation on electronic pulp testing were recorded. Injection discomfort was self-recorded by volunteers on 100 mm visual analogue scales. Data were analyzed by McNemar, Friedman, Wilcoxon Signed Ranks, and paired t tests. Slow IANB produced more episodes of no response to maximal pulp stimulation than rapid IANB in molars (220 episodes versus 159, p < 0.001), premolars (253 episodes versus 216, p = 0.003) and lateral incisors (119 episodes versus 99, p = 0.049). Slow IANB was more comfortable than rapid IANB (p = 0.021).

Cortical, callosal, and thalamic connections from primary somatosensory cortex in the naked mole-rat (Heterocephalus glaber), with special emphasis on the connectivity of the incisor representation

We investigated the distribution of cortical, callosal, and thalamic connections from the primary somatosensory area (S1) in naked mole-rats, concentrating on lower incisor and forelimb representations. A neuronal tracer (WGA-HRP) was injected into the center of each respective representation under guidance from microelectrode recordings of neuronal activity. The locations of cells and terminals were determined by aligning plots of labeled cells with flattened cortical sections reacted for cytochrome oxidase. The S1 lower incisor area was found to have locally confined intrahemispheric connections and longer connections to a small cluster of cells in the presumptive secondary somatosensory (S2) and parietal ventral (PV) incisor fields. The S1 incisor area also had sparse connections with anterior cortex, in presumptive primary motor cortex. Homotopic callosal projections were identified between the S1 lower incisor areas in each hemisphere. Thalamocortical connections related to the incisor were confined to ventromedial portions of the ventral posterior medial subnucleus (VPM) and posterior medial nucleus (Po). Injections into the S1 forelimb area revealed reciprocal intrahemispheric connections to S2 and PV, to two areas in frontal cortex, and to two areas posterior to S1 that appear homologous to posterior lateral area and posterior medial area in rats. The S1 forelimb representation also had callosal projections to the contralateral S1 limb area and to contralateral S2 and PV. Thalamic distribution of label from forelimb injections included ventral portions of the ventral posterior lateral subnucleus (VPL), dorsolateral Po, the ventral lateral nucleus, and the ventral medial nucleus and neighboring intralaminar nuclei.

Jaw movement alters the reaction of human jaw muscles to incisor stimulation

The changes in the minimum time to consciously react (reaction time) and the order of jaw muscle recruitment to precisely controlled axial stimulation of the incisors during controlled jaw movements are not known. To this end, ten subjects were recruited to investigate the reaction time of bilateral temporalis and masseter muscles and bite force. Stimuli were delivered axially to the upper central incisors during active jaw closing and opening, and under static conditions. The results showed that the reaction time was increased an average of 35% during both jaw opening and closing movements when compared with static jaw conditions. The left temporalis was recruited approximately 10 ms before the right temporalis, whereas no significant side differences were found between the masseter muscles. The masseter muscles were recruited an average of 20 ms before the temporalis muscles during jaw closing, but no difference existed during opening. Under static conditions the reaction time in the bite force was approximately 16 ms longer than the left temporalis, but was not significantly different from the reaction time of any of the other muscles, indicating that, under the static conditions tested, the left temporalis was more often responsible for initiation of the mechanical reactions in the jaw. Because of active compensation, no force measurements were made during jaw movement. This study is a prerequisite for investigations into the modulation of reflexes during jaw movement, because a response to a stimulus commencing after the minimum reaction time may not be entirely reflex in origin.

Requirement of occlusal force for maintenance of the terminal morphology of the periodontal Ruffini endings

The present study examined whether mechanical stimulation is required for morphological maintenance of the Ruffini endings--primary mechanoreceptors in the periodontal ligament of the rat incisors, using a hypofunctional model by immunohistochemistry for protein gene product 9.5. The periodontal Ruffini endings of adult rats were observed to be restricted to the alveolar half of the lingual ligament where they displayed a dendritic arborization of expanded axon terminals with threadlike microprojections. In the experimental group, the tips of the upper and lower incisors were unilaterally ground to reduce mechanical stimulation of the ligament, i.e. occlusal force. A reduction in the occlusal force induced morphological changes in the terminal morphology of the periodontal Ruffini endings: they became smooth, unlike the irregular profiles exclusively observed in the control group. Quantitative analysis demonstrated significantly lower percentages of immunoreactive areas in the restricted portion on the ground sides than in normal animals. When incisor occlusion was re-established, the terminal portions of the Ruffini endings returned to their normal appearance, and the percentages of immunoreactive areas also recovered. The present results confirm the reduced size and number of axon terminals of periodontal Ruffini endings following reduced occlusal force and restoration of the morphological alteration after the re-establishment of incisor occlusion, indicating that proper mechanical stimulation is an important factor for maintaining the morphology of mechanoreceptors.

EMG, force and discharge rate analysis of human jaw reflexes in response to axial stimulation of the incisor

Reflex studies utilising controlled stimulation along the long axis of human incisors are relatively new, and the effects that various stimulus parameters have on the elicited reflexes are not fully understood. Twelve subjects were recruited to determine the effects that contraction level, stimulus force and amount of constant force applied between stimuli have on the reflex response of the masseter muscle. Multi-unit intramuscular electromyogram (EMG) was recorded alongside surface EMG to determine whether any differences existed between the two. Furthermore, cumulative peri-stimulus "dischargegrams" were constructed to determine whether events seen in the EMG corresponded to changes in the discharge rates of the underlying motor units. Axial stimulation of the incisor induced a response in the EMG comprising of peak-trough-peak, with the trough being the most dominant. The bite force record showed only a reduction (relaxation) in response to the stimulation. The most significant experimental factor affecting the reflex occurrence and strength was the stimulus force. Although the latency, duration and occurrence rates were not significantly different, the strength of the responses was greater in intramuscular recordings compared with the surface recordings. Discharge rate analysis showed that approximately two-thirds of the late peaks detected in the EMG did not correspond to an increase in the discharge rates of the underlying units; hence they were due to the clustering of action potentials following the trough and not to a change in the membrane potential of the motoneurone. It was also found that the duration of the trough, as seen by the reduced cumulative discharge rate of the underlying units, was longer than indicated by the EMG.

Injection pain and postinjection pain of the palatal-anterior superior alveolar injection, administered with the Wand Plus® system, comparing 2% lidocaine with 1:100,000 epinephrine to 3% mepivacaine

PURPOSE

The purpose of this prospective, randomized, double-blind study was to compare injection pain and postinjection pain of 2% lidocaine with 1:100,000 epinephrine and 3% mepivacaine using the computer-assisted Wand Plus injection system to administer the palatal-anterior superior alveolar (P-ASA) injection. Additionally study was done to determine if the use of topical anesthetic decreased the pain of needle insertion with the P-ASA injection.

STUDY DESIGN

Using a crossover design, 40 subjects randomly received, in a double-blind manner, P-ASA injections of 1.4 mL of 2% lidocaine with 1:100,000 epinephrine and 1.4 mL of 3% mepivacaine, at 2 separate appointments. The P-ASA injection was administered, utilizing the Wand Plus system, 6 to 10 mm into the incisive canal located lingual to the central incisors. The pain of needle insertion, needle placement, solution deposition and postinjection pain were recorded on a Heft-Parker visual analog scale for the 2 P-ASA injections. Eighty injections were randomly administered in the study, 40 using topical anesthetic gel and 40 using a placebo gel.

RESULTS

For needle insertion, 30% of the subjects reported moderate/severe pain with the lidocaine solution and 43% reported moderate/severe pain with the mepivacaine solution. There was no significant difference (P > .05) between the topical and placebo groups. For needle placement into the incisive canal, 54% of the subjects reported moderate/severe pain with the lidocaine solution and 58% reported moderate/severe pain with the mepivacaine solution. For anesthetic solution deposition, 8% of the subjects reported moderate pain with the lidocaine solution and 12% reported moderate pain with the mepivacaine solution. There were no significant differences (P > .05) between the lidocaine and mepivacaine solutions. Regarding postinjection pain, when anesthesia wore off on the day of the injection, 20% of the subjects reported moderate/severe pain with the lidocaine solution and 14% reported moderate/severe pain with the mepivacaine solution. Pain ratings decreased over the next 3 days. There were no significant differences (P > .05) between the lidocaine and mepivacaine solutions. Postinjection, 12% and 18% of the subjects experienced temporary numbness/paresthesia of the incisive papilla with the lidocaine and mepivacaine solutions, respectively. Twenty percent and 28% of the subjects had incisive papilla swelling or soreness with the lidocaine and mepivacaine solutions, respectively. There were no significant differences (P > .05) between the lidocaine and mepivacaine solutions.

CONCLUSIONS

The P-ASA injection of 1.4 mL of 2% lidocaine with 1:100,000 epinephrine or 3% mepivacaine, administered with the Wand Plus, has the potential to be a painful injection. The use of topical anesthetic did not significantly reduce pain of needle insertion when compared to a placebo. The incidence of postinjection pain, temporary numbness/paresthesia, and incisive papilla swelling or soreness would indicate that some pain and problems occur with the P-ASA technique, regardless of whether 2% lidocaine with 1:100,000 epinephrine or 3% mepivacaine is used.

Minimal tonic firing rates of human lateral pterygoid single motor units

OBJECTIVE

The minimal tonic firing rates (the lowest firing rates at which motor units fire regularly; MTFR) of single motor units (SMUs) within the lateral pterygoid muscle have not been widely investigated. The aims of this study were (a) to identify MTFR of SMUs within the inferior head (IHLP) and superior head (SHLP) of the lateral pterygoid muscle during horizontal jaw movements, and (b) to determine whether these MTFR vary with movement direction.

METHODS

Twenty subjects moved the jaw to maintain SMU firing at the lowest continuous firing rate. SMU activity was recorded from computer-tomography-verified sites within the IHLP or SHLP.

RESULTS

In the IHLP, the mean (+/-SD) MTFR for contralateral movement (15.6+/-2.3 imp/s; n=22 SMUs) were not significantly different from those during protrusion (16.3+/-3.4 imp/s; n=19). In the SHLP, the mean (+/-SD) MTFR for contralateral, ipsilateral movement, and protrusion were 14.7+/-2.5 imp/s (n=10), 13.2+/-2.1 imp/s (n=8), and 16.2+/-3.7 imp/s (n=2), respectively.

CONCLUSIONS

Lateral pterygoid SMUs have greater MTFR than previously reported in the masseter and IHLP, namely 5-8 and 8-10 imp/s, respectively. The MTFR did not vary with the task within each muscle head.

SIGNIFICANCE

Some physiological properties of lateral pterygoid SMUs may be different from those in other jaw muscles.

Blood-flow and neurosensory changes in the maxillary dental pulp after differing Le Fort I osteotomies

PURPOSE

The objective of this study was to examine changes in blood flow and the recovery of sensibility in the maxillary dental pulp after two different types of maxillary osteotomies. Study design Nine patients (C-group) who underwent a combined of Le Fort I and horseshoe osteotomy and 14 patients (NC-group) who underwent a single-segment Le Fort I osteotomy were compared. Thirty-two (C-group) and 54 (NC-group) maxillary incisors were examined preoperatively and at 1-7 days, 14 days, and 3, 6, and 12 months postoperatively. The pulpal blood flow (PBF) was measured by laser Doppler flowmetry, and the pulpal sensibility (PS) was investigated by electrodiagnostics.

RESULTS

In both groups, the PBF dropped to its lowest value at 1 day after surgery and increased thereafter. Though a temporary drop of the PBF was observed in the NC-group on day 4, the PS recovered earlier in the NC-group than in the C-group.

CONCLUSION

These results suggest that the method of maxillary osteotomy influences the postoperative change of the PBF and recovery of the PS in the maxillary teeth.

Regeneration of periodontal Ruffini endings of rat lower incisors following nerve cross-anastomosis with mental nerve

The present study utilized protein gene product 9.5 (PGP 9.5) and S-100 protein immunohistochemistry to examine if Ruffini endings, the primary mechanoreceptors in periodontal ligaments, can regenerate following nerve cross-anastomosis with an inappropriate nerve. Normally, axon terminals of periodontal Ruffini endings are extensively ramified, and terminal Schwann cells, identified by their S-100 immunoreactivity, are associated with axon terminals. Schwann cells are restricted to the alveolus-related part (ARP), but not tooth-related part (TRP) or the shear zone at the border between the ARP and the TRP of the lingual periodontal ligament of the lower incisor. When the central portion of the mental nerve (MN) was connected with the peripheral portion of the inferior alveolar nerve (IAN), regenerating MN fibers invaded the IAN around postoperative day 5 (PO 5). During the postoperative period, numerous S-100-immunoreactive (IR) cells, presumably terminal Schwann cells, began to migrate to the shear zone and the TRP. PGP 9.5-IR elements reappeared at PO 7 and gradually increased in number. Around PO 28, the terminal portion of the regenerating Ruffini endings appeared dendritic, but less expanded, and the rearrangement of terminal Schwann cells was noted. Regenerated periodontal Ruffini endings were slightly smaller in number. The number of trigeminal ganglion neurons sending peripheral processes beyond the site of injury was smaller compared to those of normal MN, but their cross-sectional areas were almost comparable. Expressions of calbindin D28k and calretinin, normally localized in axonal elements in Ruffini endings, were first detected around PO 56. The present results show that parts of periodontal Ruffini endings can regenerate following nerve cross-anastomosis with mental nerve.

Development of innervation in primary incisors in the foetal period

Sections from the frontal part of the mandible of 43 human foetuses from 9 to 39 weeks of prenatal age, which contained two, three and sometimes four lower incisors were immunohistochemically examined using protein gene product and neuron specific enolase (NSE) antibodies in order to establish the time of appearance of nerve fibres in the developing tooth germ and to define their topography. Nerve fibres were first detected in the dental follicle in the 11th week of intrauterine life. Their presence in the dental papilla was confirmed in the 18th week when the first layers of dentine and enamel were deposited. In the 24th week of intrauterine life, the nerve fibres first reached the subodontoblastic region. In the subsequent weeks, an increase in the number of nerve fibres accompanying blood vessels in the central portion of the dental papilla resulted in the formation of neuro-vascular bundles. Moreover, the progressive deposition of enamel and dentine was accompanied by branching of papillary nerves, which thereby formed a fan-pattern. In the foetal period, no evidence was found for the formation of a subodontoblastic plexus. However, we did observe single nerve fibres in close proximity to the odontoblast layer at the end of intrauterine life. Nerve fibres were not detected in either predentine or dentine throughout foetal life.

Efficacy of anterior and middle superior alveolar (AMSA) anesthesia using a new injection system: the Wand

OBJECTIVE

This study examined the effect of anterior and middle superior alveolar (AMSA) field block of maxillary nerves using a new local anesthetic system--the Wand.

METHOD AND MATERIALS

Twenty healthy volunteers aged 23 to 44 years were used in the study. Either side of the maxillary teeth was randomly selected for AMSA injection; the other side was left as a control. For each side, 1.8 mL of 2% lidocaine solution with 1/80,000 epinephrine was injected by the Wand on a point that bisects the maxillary first and second premolars and is midway between the crest of the free gingival margin and the midpalatine suture. Pain rating score (PRS) and visual analogue scale (VAS) were applied for measurement of puncture, insertion, and injection pain. Electric pulp stimulation was given to each maxillary tooth every 10 minutes for 1 hour after the injection in order to find out the specific tooth on which AMSA injection was effective.

RESULTS

During needle insertion, 14 out of 20 subjects answered moderate pain and VAS showed 27.3 mm (mean). During injection, 11 of 20 revealed no pain and the mean of VAS was 14.5 mm. No one claimed severe pain by PRS. Electric pulp stimulation indicated that lateral incisors, canines, and first and second premolars were more anesthetized than central incisors and first molars.

CONCLUSION

AMSA injection using the Wand method seems to avoid severe injection pain and seems to be very effective for pulpal anesthesia at lateral incisors, canines, and premolars.

Centrally mediated reflex vasodilation in the gingiva induced by painful tooth-pulp stimulation in sympathectomized human subjects

This study was designed to determine whether painful electrical stimulation of the tooth pulp induces centrally mediated reflex vasomotor changes in human gingiva and whether the sympathetic nervous system is involved in the vasomotor responses. Dynamic changes in maxillary gingival blood flow (GBF) following painful electrical stimulation of the mandibular lateral incisor were investigated, by means of laser-Doppler flowmetry, in both healthy volunteers and patients undergoing sympathetic blockade for hyperhidrosis. Increases in GBF were observed in both healthy volunteers and patients on the ipsilateral side without an increase in systemic blood pressure, but the evoked GBF increase disappeared when pain sensation was abolished by local anesthetization with 2% xylocaine solution. The vasodilator responses did not differ in amplitude between before and after the sympathectomy. These results suggest that painful tooth stimulation evokes centrally mediated reflex vasodilation, presumably via parasympathetic efferent fibers, in the human gingiva and that sympathetic vasomotor mechanisms are not involved in these responses.

Regeneration of periodontal Ruffini endings in adults and neonates

We reviewed the regeneration of periodontal Ruffini endings, primary mechanoreceptors in the periodontal ligament, following injury to the inferior alveolar nerve (IAN) in adult and neonatal rats. Morphologically, mature Ruffini endings are characterized by an extensive arborization of axonal terminals and association with specialized Schwann cells, called lamellar or terminal Schwann cells. Following injury to IAN in the adult, the periodontal Ruffini endings of the rat lower incisor ligament regenerate more rapidly than Ruffini endings in other tissues. During regeneration, terminal Schwann cells migrate into regions where they are never found under normal conditions. The development of periodontal Ruffini endings of the rat incisor is closely associated with the eruption of the teeth; the morphology and distribution of the terminal Schwann cells became almost identical to those in adults during postnatal days 15-18 (PN 15-18d) when the first molars appear in the oral cavity, while the axonal elements showed extensive ramification around PN 28d when the functional occlusion commences. When the IAN was injured in neonates, the regeneration of periodontal Ruffini endings was delayed compared with the adults. The migration of terminal Schwann cells is also observed following IAN injury, after which the distribution of terminal Schwann cells became almost identical to that of the adults, i.e., PN 14d. Since the interaction between axon and Schwann cell is important during regeneration and development, further studies are required to elucidate its molecular mechanism during the regeneration as well as the development of the periodontal Ruffini endings.

The periodontal Ruffini endings in brain derived neurotrophic factor (BDNF) deficient mice

Innervation and terminal morphology in the lingual periodontal ligament of the incisor were investigated in brain derived neurotrophic factor (BDNF) heterozygous mice and littermate wild-type mice (aged two months) using immunohistochemistry for protein gene product 9.5 (PGP 9.5), a general neuronal marker. In addition, computer-assisted quantitative analysis was performed for a comparison of neuronal density in the periodontal ligament between heterozygous and wild-type mice. In wild-type mice, the periodontal ligament was found to be richly innervated by the mechanoreceptive Ruffini endings and nociceptive free nerve endings in the alveolus-related part of the periodontal ligament. The periodontal Ruffini endings in the wild-type mice incisor ligament were classified into two types: type I with ruffled outlines, and type II with a smooth outline. BDNF heterozygous mice showed malformations of the type I Ruffini endings which included fewer nerve fibers and fewer ramifications than those in wild-type mice as well as smooth outlines of the axon terminals. Quantitative analysis under a confocal microscope showed a roughly 18% reduction in neuronal density in the periodontal ligament of the heterozygous mice. These findings suggest that the development and maturation of the periodontal Ruffini endings require BDNF.

Response of human jaw muscles to axial stimulation of the incisor

The role of periodontal mechanoreceptors (PMRs) in the reflex control of the jaw muscles has thus far been mainly derived from animal studies. To date, the work that has been done on humans has been limited and confined to orthogonal stimulation of the labial surface of the tooth. The purpose of this study was to investigate the response of the masseter and digastric muscles in humans to controlled axial stimulation of the upper left central incisor, both before and during a local anaesthetic block of the PMRs. Ten neurologically normal young adult females were tested, each on two separate occasions to confirm the reproducibility of the results. It was found that the reflex response in the masseter was modulated by the rate of rise of the stimulus used and, to a lesser degree, the level of background muscle activity. There was little detectable change in the activity of the digastric muscle under the tested conditions and what was found could be attributed to cross-talk with the masseter. The reflex responses obtained were significantly different between subjects; however retesting the same subject on a different occasion yielded similar results. The results indicate that the most common response of the masseter muscle to brisk axial stimulation of the incisor is a reflex inhibition at 20 ms, followed by a late excitation at 44 ms. However, it is possible that this late excitation could be due to delayed action potentials and hence be artefactual. As the application of a local anaesthetic block removed or significantly reduced both of these responses, it was concluded that they originated from the PMRs. Unlike during orthogonal stimulation, slowly rising stimuli did not produce any excitatory reflex activity. This indicated a difference in jaw reflexes to forces applied in different directions, possibly due to the activation of different receptor types when stimulating the tooth in either the orthogonal or axial directions.

Response properties of periodontal mechanoreceptors in rats, in vitro

Single unit activities of the inferior alveolar nerve evoked by calibrated von Frey stimuli (1.1, 2.9, 7.8, 11.8, and 17.2mN) on the periodontal ligaments of the mandibular molars or incisors were recorded in an in vitro jaw-nerve preparation of Wistar albino rats. The data of 55 (lower incisor) and 100 (lower molars) units were collected in the present study. Both rapidly (RA) and slowly adapting (SA) type units were found in the incisors, and most of these units were innervated by Abeta fibers. While all the units of the molars were of RA types, the innervated fibers of two-thirds (67/100) of the units have been identified as Adelta fibers. The response patterns of the RA type were subdivided into three types (ON, OFF or ON-OFF type) both in the incisors and the molars. While von Frey thresholds of all incisor units were 11.8 mN except one unit that was 7.8 mN, those of the molars varied from 2.9 to 11.8 mN. In the molars, a majority of afferents innervated the periodontal ligaments of more than one tooth. This study suggests that response properties of periodontal mechanoreceptors are different between the incisors and the molars in rats, suggesting that these receptors have different functions in the regulation of mastication.

A unique localization of mechanoreceptors in the periodontal tissue of guinea pig teeth

This study describes the unique distribution of Ruffini endings (RE) in the periodontal tissues of the guinea pig teeth with special references to their presence in the enamel-related aspects of the continuously growing incisors and molars. In guinea pig incisors, immunohistochemistry for PGP 9.5 and glia specific S-100 protein revealed a condensed distribution of well-developed RE in the bone-related part of the lingual periodontal ligament as has been reported in many other rodents. In most cases, some RE-like nerve elements characterized by dendritic ramification and rounded terminal Schwann cells were found to be located in the labial, enamel-related regions, where no periodontal ligament-like fiber arrangement was established. In the molar periodontal ligament, well-developed RE-like nerve elements were also distributed in the enamel-related part, but in intimate relation to thick periodontal fiber bundles inserted in the cementum pearls grown on the enamel surface. In some cases, few RE were located in the apical region of the alveolar socket, where no periodontal fiber bundles could be identified. Our data provide the first morphological evidence of the presence of RE-like nerve elements in the enamel-related, fibrous connective tissue of continuously erupting rodent incisors. These data indicate that RE in guinea pig periodontal tissues have variable spatial correlation to the surrounding fibers, implicating their diverse mechanoreceptive properties depending on the anatomical location.

Biological interpretation of the correlation of emergence times of permanent teeth

The eruption mechanism is not fully understood. It is known that the dental follicle is essential and that experimentally provoked denervation influence the process of eruption. Accordingly, the purpose of this study was to elucidate the eruption pattern in a human population and relate this pattern to the pattern of jaw innervation. The eruption pattern was evaluated from the correlation between the emergence times of different teeth in the permanent dentition based on longitudinal data from a large national registry (12,642 boys and 12,095 girls). Correlations coefficients were generally high (>0.5) and higher between teeth within the same tooth groups (i.e. incisors, canines and premolars, and molars) than between teeth from different tooth groups. It was shown that the correlation in emergence of teeth closely followed the pattern of innervation of the jaws. Thus the study supported the hypothesis concerning a possible association between eruption and innervation.

Anesthetic efficacy of different volumes of lidocaine with epinephrine for inferior alveolar nerve blocks

Volumes of 1.8 mL and 3.6 mL of 2% lidocaine with 1:100,000 epinephrine were compared in inferior alveolar nerve blocks. The first molars, first premolars, and lateral incisors of 462 subjects were pulp tested for 55-60 minutes following administration of inferior alveolar nerve blocks. Results showed no significant difference between the two volumes of anesthetic in achieving successful pulpal anesthesia.

Correlations between response properties of periodontal mechanosensitive neurones in the primary somatosensory cortex of the rabbit and cortically induced rhythmical jaw movements

The response properties of incisor- and molar-sensitive periodontal mechanosensitive (PM) neurones in the primary somatosensory (SI) cortex of rabbits were examined and rhythmical jaw movements induced by repetitive electrical stimulation of the recording sites of cortical PM neurones were observed. PM units were recorded from the rostromedial (RM) and rostrolateral (RL) areas of the SI cortex. In the RM area, most PMs (85%) were lower incisor-sensitive. Electrical stimulation of the RM area produced chopping-type rhythmical jaw movements. In the RL area, both incisor- and molar-sensitive PM units were recorded, and molar-sensitive units were located more rostromedially than incisor-sensitive units. More than half (66%) of the incisor-sensitive PM units were upper incisor-sensitive. The incidences of sustained-response type units were 8 and 10% for upper incisor- and lower incisor-sensitive units and 28 and 34% for upper molar- and lower molar-sensitive units, respectively. The optimal stimulus directions for the upper molar-sensitive units were predominantly labial or lingual, whereas those for most of the lower molar-sensitive units were lingual. Electrical stimulation of the PM unit-recording sites in the RL area induced grinding-type rhythmical jaw movements. Based on these findings, the lower incisor-sensitive neurones in the RM area of the SI cortex might mainly contribute to a neural network that controls jaw movements during ingestion. Furthermore, the response properties of molar-sensitive cortical neurones might be useful for discriminating the magnitude and direction of the biting force during grinding. Further studies are needed to clarify the role of upper incisor-sensitive neurones in the RL area in triggering grinding-type rhythmical jaw movements.

Distribution of periodontal afferent input to motoneurons of human masseter

The distribution of the synaptic input from the periodontal mechanoreceptors onto the motoneurons of the human masseter is studied. Periodontal mechanoreceptors were activated using slowly rising force profiles of 2.5 N, which are known to induce predominantly excitatory reflex responses in the surface electromyogram (EMG) of the masseter. The reflex responses of single motor units (SMUs) were recorded to quantify the distribution of the periodontal input onto the masseter motoneurons. The relative sizes of motoneurons were estimated by comparing the peak-to-peak amplitude of the MacroRep (i.e. the representation of the SMU in the Macro EMG record). It was found that the larger SMUs had more excitatory and less inhibitory reflex responses than those of smaller size. This study demonstrates that the inputs from the periodontal mechanoreceptors, activated by slowly rising force profiles, are not distributed equally to the masseteric motoneurons. This may cause recruitment of motoneurons contrary to the size principle under some circumstances.

Effect of unilateral superior cervical ganglionectomy on mandibular incisor eruption rate in rats

To assess the effect of sympathectomy on rat tooth eruption, the effect of a unilateral superior cervical ganglionectomy (SCGx) on eruption rate of ipsi- and contralateral lower incisors was examined. Two experiments were performed. In a first experiment, the eruption rate of ipsilaterally denervated incisors was similar to that of contralaterally innervated incisors, when assessed for up to 28 days after surgery. In a second experiment, under conditions of unilateral unimpeded eruption of incisors performed ipsilaterally or contralaterally to a unilateral SCGx, a significantly lower eruption rate of denervated incisors at the impeded eruption side, and a significantly higher eruption rate of denervated incisors at the unimpeded side were observed, when computed every 2 days. Significant differences in individual Student's t tests at every time interval occurred mainly during the first and the last week of examination. When average daily eruption rate was computed in weekly intervals, a significant interaction between SCGx and the side of impeded or unimpeded eruption was found in a factorial ANOVA, that is, for each of the 4 weeks of examination, sympathetically denervated incisors showed lower eruption rates at the impeded eruption side, and higher eruption rates at the unimpeded side. These results indicate that incisor eruption is not modified by a local sympathetic denervation unless the contralateral lower rat incisor is cut out of occlusion.

Using AMSA and P-ASA nerve blocks for esthetic restorative dentistry

Esthetic restorative dentistry procedures represent an increasing segment of the services provided by the general practitioner. One important assessment criterion for a successful anterior esthetic restoration is how well it harmonizes with the lips to create a pleasing smile line. Unfortunately, traditional local anesthetic techniques interfere with this assessment by distorting the lips and face during anesthesia. The anterior, middle superior alveolar block and the palatal approach anterior superior alveolar block injections represent two recently defined techniques to anesthetize maxillary teeth effectively without numbness of the face, lips, or muscles of expression. Although safety and efficacy studies are only beginning to emerge, these injections appear to be useful additions to local anesthetic techniques, especially when anterior esthetic restorative procedures are being performed.

Anesthetic efficacy of unilateral and bilateral inferior alveolar nerve blocks to determine cross innervation in anterior teeth

OBJECTIVE

The purpose of this prospective randomized study was to measure the degree of anesthesia obtained with unilateral and bilateral inferior alveolar nerve blocks to determine whether cross innervation occurs in anterior teeth.

STUDY DESIGN

Through use of a repeated-measures design, 38 subjects randomly received unilateral or bilateral inferior alveolar nerve blocks at two separate appointments. Each inferior alveolar nerve block used 3.6 mL of 2% lidocaine with 1:100,000 epinephrine. Mandibular anterior teeth were blindly pulp-tested at 4-minute cycles for 60 minutes' postinjection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Anesthesia was considered successful when 2 consecutive 80 readings were obtained.

RESULTS

One hundred percent of the subjects had lip numbness with each of the inferior alveolar nerve block techniques. Anesthetic success rates of the unilateral inferior alveolar nerve block were 39% for the central incisor, 50% for the lateral incisor, and 68% for the canine. For the bilateral inferior alveolar nerve blocks, success rates were 66% for the central incisor, 74% for the lateral incisor, and 76% for the canine. The bilateral inferior alveolar nerve block success rates were significantly (P <.05) higher for the central and lateral incisors when compared with the success rates of the unilateral inferior alveolar nerve block.

CONCLUSIONS

Cross innervation does seem to occur in mandibular central and lateral incisors. However, the success rates in these teeth with bilateral inferior alveolar nerve blocks were below 75%. The failure of the inferior alveolar nerve blocks to anesthetize the anterior teeth was the overriding reason for failure. Clinically, bilateral inferior alveolar nerve blocks to provide profound pulpal anesthesia in mandibular anterior teeth are not recommended on the basis of the results of this study.

Immunocytochemical detection of superoxide dismutases (SODs) in the periodontal Ruffini endings of the rat incisor

The expression of immunoreactivities for superoxide dismutases (SODs), Mn-SOD and Cu/Zn-SOD, was immunohistochemically investigated in the lingual periodontal ligament and toe pads of adult rats. Immunocytochemistry for SODs revealed that the axon terminals of both the periodontal Ruffini endings and cutaneous Meissner's corpuscles showed mitochondrial Mn-SOD immunoreactivity, but not cytosolic Cu/Zn-SOD immunoreactivity, indicating Mn-SOD is a useful marker for identifying the mechanoreceptors. It is likely that Mn-SOD in the axon terminals of mechanoreceptors exerts protective action against nerve injury and neuronal death under severe conditions, serving to scavenge free radicals from the axon terminals.

Anterior loop of the mental canal: an anatomical-radiologic study

This study sought to characterize the anatomical dimensions of the anterior mental loop and to determine the accuracy of conventional radiographs in identifying its presence and dimensions. The study group consisted of 46 hemimandibles fixed in formalin. Radiographs of the area between the mental foramen and the midline were obtained and evaluated for each hemimandible, followed by dissection and physical examination of the same area. Anatomically, an anterior loop of the mental nerve was observed in only 13 hemimandibles (28%). The anterior extension of the loop ranged from 0.4 to 2.19 mm. No correlation was found between the radiographic image and the anatomical shape of the loop. Of the radiographically diagnosed loops, 40% were not seen in anatomical examination. In cases with a false radiologic loop, a correlation was found between the diameter of the origin of the incisive canal and the radiologic interpretation of the loop. The radiologic appearance or diagnosis of the anterior mental loop in cadaver mandibles does not disclose the true ramification of the inferior alveolar nerve to the mental and incisive nerve.

Accessory innervation of the mandible: identification and anesthesia options

The nerves commonly associated with accessory innervation of the mandible are identified and alternative techniques to gain their anesthesia are recommended, based on sound anesthetic principles and the current understanding of nerve anatomy.

Reflex responses induced by tooth unloading

The reflex response of the masseter muscle to the rapid unloading of a single maxillary incisor tooth was studied. Unloading of a static force of 2 N in the horizontal direction resulted in a short-latency excitation, inhibition, and long-latency excitation of masseter muscle activity occurring at latencies of approximately 13, 20, and 40 ms, respectively, with a corresponding change in bite force occurring slightly later in each case. Following the blocking of periodontal input by the injection of local anesthetic around the stimulated tooth, inhibitory responses were abolished. Therefore, it is concluded that the observed masseteric inhibition was caused by the unloading of periodontal mechanoreceptors and thus that these receptors may contribute to the jaw unloading reflex.

Effects of neonatal injury of the inferior alveolar nerve on the development and regeneration of periodontal nerve fibers in the rat incisor

Our previous study showed that the migration of terminal Schwann cells occurred in the periodontal ligament of the rat lower incisor following transection of the inferior alveolar nerve (IAN) in the adult animals [Y. Atsumi, K. Matsumoto, M. Sakuda, T. Maeda, K. Kurisu, S. Wakisaka, Altered distribution of Schwann cells in the periodontal ligament of the rat incisor following resection of the inferior alveolar nerve: An immunohistochemical study on S-100 proteins, Brain Res. 849 (1999) 187-195]. The aim of the present study was to investigate the effects of neonatal transection of the IAN on the regeneration of axon elements and Schwann cells in the periodontal ligament of the rat lower incisor. Following transection of IAN at post-natal day 5 (PN 5d), when the numbers of both axon elements and the terminal Schwann cells were very small, regenerating nerve fibers appeared between post-injured days 7 (PO 7d) and PO 14d, and increased in number thereafter gradually. Although the terminal morphologies of regenerated Ruffini endings became identical to those of the adult animals by PO 54d, the number of regenerated PGP 9.5-IR nerve fibers did not recover the adult levels even by PO 56d. A small number of Schwann cells migrated into the shear zone, the border between the alveolus-related part (ARP) and the tooth-related part (TRP), but did not enter into the TRP. Following transection of the IAN at PN 14d or PN 28d, when clusters of apparent terminal Schwann cells could be recognized, axon regeneration started around PO 5d. Individual axon terminals of the regenerating Ruffini endings ramified and became identical to those of the adult animals around PO 28d, but the number of regenerated Ruffini endings was smaller than that of the adult animals. Similar to the adult animals, the migration of Schwann cells into the shear zone and TRP occurred, and disappeared prior to the completion of the axonal regeneration. The present results indicate that the migration of the Schwann cells into TRP during the regeneration of the periodontal nerve fibers following nerve injury to the IAN depends on the maturation of the terminal Schwann cells of the periodontal Ruffini endings, not on post-operative time.

Morphological variability of the human inferior alveolar nerve

The aims of this study were: to compare the radiographic appearance of the neurovascular bundle and its surrounding bone with the actual situation revealed on dissection; to reveal the morphology of the neurovascular bundle in dentate and edentulous subjects; and to note any changes occurring following the removal of the teeth and the consequent resorption of alveolar bone. Twenty-nine human mandibles were examined; 20 were dry skeletal specimens that were examined radiographically and the remaining nine were radiographed then dissected after decalcification and the branches of the inferior alveolar nerve were identified, sketched, and photographed. Different patterns of identifying characteristics of the mandibular canal were noted on the radiographs, ranging from alternating bands of radiopacity and radiolucency to continuous radiopaque lines. Dissections indicated that the radiographic appearance related to the number, distribution, and pattern of trabeculae around the canal. The dissections revealed that in all cases, the main nerve divided into its incisive and mental branches in the molar area well before reaching the mental foramen. A branch to the molar teeth, and in two instances to the second premolar as well, was given off from the main trunk before it divided into incisive and mental branches. In the dentate specimens, the neurovascular bundle formed two distinct curvatures, one between the mandibular and mental foraminae and the other between the mental foramen and the incisor teeth apices. In the edentulous specimens, the neurovascular bundle was reduced in size and although some small nerve branches, notably to the molar areas, were distinguishable, the blood vessels seemed to have atrophied beyond macroscopic identification. This project confirmed the inaccuracy of descriptions repeated in many anatomical textbooks suggesting that the inferior alveolar branch of the trigeminal nerve divides at the mental foramen into its incisive and mental branches and that during their path through the body of the mandible they give off fibers to the individual teeth. It further confirmed that the neurovascular bundle reduces in size quite markedly after removal of teeth and that the vascular component cannot be clearly identified.

Heterogeneous localizations of Trk B among individual periodontal Ruffini endings in the rat incisor

The present immunocytochemical study examined the localization of Trk B, a high affinity neurotrophin receptor, in the neural elements of the periodontal ligament of the rat incisor. In light microscopy, the immunoreactivity was demonstrated in dendritic profiles in the alveolar half of the periodontal ligament. Their location and morphological features indicated that they were periodontal Ruffini endings. Occasional rounded cells associated with periodontal Ruffini endings, which had immunonegative kidney-shaped nuclei, were immunoreactive; these were judged to be terminal Schwann cells. Immunoelectron microscopy revealed the heterogeneous localization of Trk B among individual Ruffini endings. Some terminal Schwann cells contained immunoreactive products for Trk B in the cytoplasm, while others did not. Similarly, a part of the Schwann sheaths covering the axon terminals showed Trk B immunoreactivity. Most axon terminals associated with periodontal Ruffini endings were immunopositive for Trk B, though a few of them were immunonegative. The ordinary Schwann cells did not contain Trk B immunoreactive products. These findings imply that Trk B is required for the maintenance of periodontal Ruffini endings. The different expression pattern of Trk B suggests that neuronal and glial elements comprising individual periodontal Ruffini endings are subject to heterogeneous conditions with regard to the requirement of Trk B.

Augmentation of the sinus floor with mandibular bone block and simultaneous implantation: a 6-year clinical investigation

Between 1991 and 1995, 216 sinus-lift procedures were accomplished as part of a clinical study. The study involved placing 467 implants in the atrophic posterior maxillae of 142 female and 74 male patients. The initial bone height at the implant site was between 1 and 5 mm. The implants were supported subantrally with bone block grafts harvested from the retromolar or symphysis areas of the mandible. Perforations of the maxillary sinus membrane were observed in 51 patients; these were repaired with fibrin adhesive. The spaces remaining above the bone graft were filled with various materials. A total of 28 implants failed. All the remaining implants were deemed successfully osseointegrated, based on radiographic and clinical (including periodontal health) criteria. No patients experienced maxillary sinus complications. Clinically and radiographically, the best bone regeneration was observed in those patients in whom the surgically created space was completely grafted with autogenous bone that included a high percentage of resorption-resistant cortical bone. In those patients having bone grafts harvested from the mandibular symphysis, none of their facial profiles were adversely affected; however, some patients experienced neurosensory deficits involving the mandibular anterior incisors and adjacent alveolar mucosa. Occasionally, these symptoms persisted for up to 1 year following the procedure.

Morphological changes in periodontal mechanoreceptors of mouse maxillary incisors after the experimental induction of anterior crossbite: a light and electron microscopic observation using immunohistochemistry for PGP 9.5

Ruffini nerve endings (mechanoreceptors) in the periodontal ligament (PDL) of mouse incisors were examined to elucidate whether experimentally-induced crossbites cause any changes or abnormalities in their morphology and distribution. Anterior guiding planes were attached to the mandibular incisors of 3-week-old C3H/HeSlc mice. At 3 days and 1, 2, 4, 6, and 8 weeks post-attachment of the appliance, the mice were sacrificed by perfusion fixation. Frozen sagittal cryostat sections of the decalcified maxillary incisors were processed for immunohistochemistry of protein gene product 9.5, followed by histochemical determination of tartrate-resistant acid phosphatase activity to reveal sites of alveolar bone resorption. Despite the absence of bone resorption within the lingual PDL of control mice, distinct resorption sites were seen in the respective regions of the experimental animals. Unlike the controls, many Ruffini endings showing vague and swollen contours, with unusually long and pedunculated micro-projections were observed in the affected lingual PDL of the incisors in the experimental animals with short-term anterior crossbite induction. Club-shaped nerve terminations with few, if any, micro-projections were observed in the lingual PDL of experimental animals with long-term induction, as well as in aged control mouse incisors. Differences in the distribution of Ruffini endings were also observed. These results indicate that changing the direction of the force applied to the PDL results in rapid and prolonged changes in the morphology of Ruffini-like mechanoreceptors.

Differentiating condition-induced facilitation, inhibition and disinhibition in a complex series of reflexes in an electromyogram

In man, the principal exteroceptive reflexes evoked by intra-oral stimulation involve the jaw-closing muscles and include inhibitory and excitatory responses [H.W. van der Glas, A. De Laat, D. van Steenberghe, Oral pressure receptors mediate a series of inhibitory and excitatory periods in the masseteric post-stimulus EMG complex following tapping of a tooth in man, Brain Res. 337 (1985) 117-125.]. These reflexes can be observed in electromyograms (EMGs) recorded with bipolar surface electrodes. The likelihood that these reflexes play important roles in the integrative actions of the jaw has led to interest in the physiological control mechanisms by which they may be modulated. It has been reported recently that the complex series of jaw reflexes evoked by non-painful tapping on human teeth can be modulated by the application of noxious stimulation to the hand [S.W. Cadden, H.W. van der Glas, F. Lobbezoo, A. van der Bilt, Effects of remote noxious stimulation on exteroceptive reflexes in human jaw closing muscles, Brain Res. 726 (1996) 189-197.] or by exercises which produce a change in mental state [S.W. Cadden, H.W. van der Glas, F. Lobbezoo, A. van der Bilt, The influence of attentional factors on short- and long-latency jaw reflexes in man, Arch. Oral Biol. 41 (1996) 995-998.]. The effects of remote noxious stimuli and mental exercises usually involved transient increases in electromyographic (EMG) activity around the interfaces between the successive inhibitory and excitatory reflexes. As the mechanisms underlying the tap-induced inhibitory and excitatory reflexes may show some temporal overlap [H.W. van der Glas, A. De Laat, D. van Steenberghe, Oral pressure receptors mediate a series of inhibitory and excitatory periods in the masseteric post-stimulus EMG complex following tapping of a tooth in man, Brain Res. 337 (1985) 117-125.], these condition-induced increases in EMG activity could, in the simplest hypothesis, have been due to either (i) a condition-induced inhibition of the tap-induced inhibitory influences on the motoneurones (i.e., disinhibition) and/or (ii) a condition-induced facilitation of the tap-induced excitatory influences underlying the subsequent excitatory reflexes. In the present protocol, we describe how it is possible to differentiate between these different underlying mechanisms. The method includes a regression analysis of the relationship between condition-induced changes in amplitude of a reflex and the reflex amplitude under control conditions after taking account of the effect of chance. The analysis is applied on reflex data pooled from various subjects. Although this method of data analysis is illustrated with trigeminal reflexes, it is potentially of use for other complex extracellular recordings including those in other fields of motor control (e.g., EMGs from muscles other than jaw ones).

Calretinin-like immunoreactivity in the regenerating periodontal ruffini endings of the rat incisor following injury to the inferior alveolar nerve

Regeneration of calretinin (CR)-like immunoreactive (IR) nerve fibers was investigated in the periodontal ligament of the rat lower incisor following resection of the inferior alveolar nerve (IAN). In addition, the degeneration and regeneration processes of periodontal nerve fibers were examined by immunohistochemistry for protein gene product 9.5 (PGP 9.5), a general neuronal marker. In normal animals, the periodontal nerve fibers showing PGP 9.5-like immunoreactivity (LI) formed either periodontal Ruffini endings with expanded arborization and thin free nerve endings in the alveolar half of the ligament. Thick CR-IR nerve fibers also appeared in a dendritic fashion in the same region, but thin CR-IR nerve fibers were rarely observed. Five days following resection of the IAN, a major population of PGP 9.5-IR and all CR-IR nerve fibers disappeared except for some thin PGP 9.5-IR nerves in the periodontal ligament. Regenerated PGP 9.5-IR nerve fibers appeared around 7 days following resection, in contrast to a very small number of regenerated CR-IR nerve fibers. Around 14-21 days following resection, the number and terminal morphology of regenerated PGP 9.5-IR nerve fibers were comparable to those observed in normal animals, but the number of regenerated CR-IR nerve fibers was still smaller than that of normal animals. The number of regenerated CR-IR nerve fibers increased to return to normal by 56 days following injury. The delay of expression of CR-LI in the regenerated periodontal Ruffini endings suggests that functional recovery of periodontal Ruffini endings occurred after the completion of the regeneration of periodontal nerve fibers.

Nerve fibers immunoreactive to calcitonin gene-related peptide, substance P, neuropeptide Y, and dopamine beta-hydroxylase in innervated and denervated oral tissues in ferrets

The effect of sensory and sympathetic denervation on the localization and distribution of nerve fibers immunoreactive (IR) to calcitonin gene-related peptide (CGRP), substance P (SP), neuropeptide Y (NPY), and dopamine beta-hydroxylase (DBH) was studied in the dental pulp, periodontal ligament (PDL), and gingiva in ferrets. Unilateral axotomy was performed by resection of the inferior alveolar nerve (IAN) 10 days before the experiment (Group 1); sympathectomy, by unilateral removal of the cervical ganglion 5 days before the experiments (Group 2). Immunohistochemistry was performed on free-floating sections by the avidin-biotin-peroxidase technique. A considerably higher density of sensory fibers IR to CGRP and SP was found in the dental pulp than in PDL and gingiva. The majority of pulpal fibers were located in the walls of blood vessels. A subodontoblastic network of fibers IR to CGRP and SP was lacking in incisors and canines and was found only in the coronal pulp in premolars and molars. Sympathetic fibers were sparsely distributed in the pulp, and they were mainly confined to large vessels running centrally in the root pulp as well as the larger vessels in apical PDL and alveolar bone. Gingiva was well supplied with CGRP- and SP-IR nerves, and some NPY and DBH fibers were located in association with larger vessels. Round cell-like structures within the basal part of the epithelium were CGRP-IR. Axotomy induced a complete loss of CGRP- and SP-IR fibers in the anterior part of the jaws, whereas sympathectomy caused a reduction, but not a total loss, of NPY- and DBH-IR nerves. It is concluded that, except for some distributional differences, the oral tissues in the ferret have an abundant sensory innervation similar to that found in other species.