Mechanobiology of the tooth movement during the orthodontic treatment: a literature review

Orthodontic tooth movement differs significantly from the physiological tooth movement, as it determines a biological response of the surrounding tissues of the teeth, resulting in a remodelling of the periodontal ligament and the alveolar bone. The result is a biochemical adaptive response to the application of the orthodontic force with the reorganization of the intracellular and the extracellular matrix, in addition to a change of the local vascularization. This in turn leads to the synthesis and the release of arachidonic acid, growth factors, metabolites, cytokines and various enzymes. Biologically, not only the intensity of the force, but also its duration and the tissue response to the application of the same are important for tooth movement. Having these insights it will possible to examine the concept of optimal orthodontic force, a determining factor for the success of orthodontic treatment. The purpose of this revision was to describe the biological processes and future perspective of the application of orthodontic force, by providing relevant information to understand the changes at the molecular and cellular level occurring when the tissues are subjected to such forces. Knowledge on the subject of mechanics and biology in orthodontics is constantly growing, producing an increasingly strong basis for clinical success.

Action Mechanism of Fibroblast Growth Factor-2 (FGF-2) in the Promotion of Periodontal Regeneration in Beagle Dogs

Fibroblast growth factor-2 (FGF-2) enhances the formation of new alveolar bone, cementum, and periodontal ligament (PDL) in periodontal defect models. However, the mechanism through which FGF-2 acts in periodontal regeneration in vivo has not been fully clarified yet. To reveal the action mechanism, the formation of regenerated tissue and gene expression at the early phase were analyzed in a beagle dog 3-wall periodontal defect model. FGF-2 (0.3%) or the vehicle (hydroxypropyl cellulose) only were topically applied to the defect in FGF-2 and control groups, respectively. Then, the amount of regenerated tissues and the number of proliferating cells at 3, 7, 14, and 28 days and the number of blood vessels at 7 days were quantitated histologically. Additionally, the expression of osteogenic genes in the regenerated tissue was evaluated by real-time PCR at 7 and 14 days. Compared with the control, cell proliferation around the existing bone and PDL, connective tissue formation on the root surface, and new bone formation in the defect at 7 days were significantly promoted by FGF-2. Additionally, the number of blood vessels at 7 days was increased by FGF-2 treatment. At 28 days, new cementum and PDL were extended by FGF-2. Moreover, FGF-2 increased the expression of bone morphogenetic protein 2 (BMP-2) and osteoblast differentiation markers (osterix, alkaline phosphatase, and osteocalcin) in the regenerated tissue. We revealed the facilitatory mechanisms of FGF-2 in periodontal regeneration in vivo. First, the proliferation of fibroblastic cells derived from bone marrow and PDL was accelerated and enhanced by FGF-2. Second, angiogenesis was enhanced by FGF-2 treatment. Finally, osteoblastic differentiation and bone formation, at least in part due to BMP-2 production, were rapidly induced by FGF-2. Therefore, these multifaceted effects of FGF-2 promote new tissue formation at the early regeneration phase, leading to enhanced formation of new bone, cementum, and PDL.

A qualitative investigation of RANKL, RANK and OPG in a rat model of transient ankylosis

INTRODUCTION

Previous studies have found ankylosis occurs as a part of the inflammatory process of aseptic root resorption initiated in a rat model. The physiologic mechanisms behind the development of dentoalveolar ankylosis and healing response are still unclear. While receptor activator of nuclear factor-κβ ligand (RANKL), receptor activator of nuclear factor-κβ (RANK) and osteoprotegerin (OPG) have gained momentum in the understanding of resorption, no study to date has investigated their role in dentoalveolar ankylosis.

AIMS

The aims of this study were to investigate if, and when, ankylosis occurred in the rat PDL, whether the resolution of ankylosis occurred with time and, finally, to observe the expression of RANKL, RANK and OPG during the ankylotic process.

MATERIALS AND METHODS

Dry ice was applied for 20 minutes to the upper right first molar crown of 15 eight-week-old, male Sprague-Dawley rats. An additional three rats served as untreated external controls. Groups of three rats were sacrificed after the thermal insult on day 0, 4, 7, 14 and 28 respectively. Each maxilla was dissected out and processed for histological examination and RANKL, OPG and RANK immunohistochemistry.

RESULTS

By the use of light microscopy and H&E staining, no ankylosis was detected in the external control group and the experimental groups at days 0 and 4. On day 7, disruption within the periodontal ligament was observed in the interradicular region and the initial signs of ankylosis were seen in the form of finger-like projections extending from the alveolar bone towards the cementum. Fourteen days after the thermal insult, all animals exhibited extensive ankylosis that spanned the entire interradicular periodontal space. At 28 days, the development of ankylosis appeared to have ceased and repair was observed, together with an intact periodontal ligament in all but one rat. Positive staining results were obtained with RANKL, RANK and OPG antibodies. The expressions of RANKL, RANK and OPG were similar in the external control group, 0-, 4-, and 28-day experimental groups. In the 7- and 14-day experimental groups, RANKL, RANK and OPG were expressed in the blood vessels within the ankylotic regions.

CONCLUSIONS

During the development of ankylosis and its resolution, it was concluded from their simultaneous presence that there is a complex interaction between RANKL, RANK and OPG that requires further investigation.

In vivo identification of periodontal progenitor cells

The periodontal ligament contains progenitor cells; however, their identity and differentiation potential in vivo remain poorly characterized. Previous results have suggested that periodontal tissue progenitors reside in perivascular areas. Therefore, we utilized a lineage-tracing approach to identify and track periodontal progenitor cells from the perivascular region in vivo. We used an alpha-smooth muscle actin (αSMA) promoter-driven and tamoxifen-inducible Cre system (αSMACreERT2) that, in combination with a reporter mouse line (Ai9), permanently labels a cell population, termed 'SMA9'. To trace the differentiation of SMA9-labeled cells into osteoblasts/cementoblasts, we utilized a Col2.3GFP transgene, while expression of Scleraxis-GFP was used to follow differentiation into periodontal ligament fibroblasts during normal tissue formation and remodeling following injury. In uninjured three-week-old SMA9 mice, tamoxifen labeled a small population of cells in the periodontal ligament that expanded over time, particularly in the apical region of the root. By 17 days and 7 weeks after labeling, some SMA9-labeled cells expressed markers indicating differentiation into mature lineages, including cementocytes. Following injury, SMA9 cells expanded, and differentiated into cementoblasts, osteoblasts, and periodontal ligament fibroblasts. SMA9-labeled cells represent a source of progenitors that can give rise to mature osteoblasts, cementoblasts, and fibroblasts within the periodontium.

The inter-relation between epithelial cells of Malassez and vessels studied immunohistochemically in the periodontal membrane of human primary and permanent teeth

BACKGROUND

Only few immunohistochemical studies have focused on the periodontal membrane in human primary teeth. Recently, studies on epithelial cells of Malassez and innervation have been published. Studies on the inter-relation between vessels and the epithelial cells of Malassez are seemingly lacking.

AIM

he aim of this immunohistochemical study is to describe the histological inter-relation between epithelial cells of Malassez and vessels in the periodontal membrane close to the root surface of human primary and permanent teeth.

METHODS

Twenty-nine human primary teeth and 15 permanent teeth were extracted in connection with dental treatment. The teeth were fixated, embedded in paraffin, cut in serial sections and examined immunohistochemically for epithelial cells of Malassez using wide spectrum screening and vessels using Von Willebrand Factor VIII.

RESULTS

The study showed that vessels and epithelial cells of Malassez are seen parallel to the root surface. The vessels are seen on that side of the epithelial cells of Malassez, which are not facing the root surface.

CONCLUSION

The vascularization appeared similar in primary and permanent teeth.

[Orthodontic tooth movement and expression of calcium regulating hormone]

Nociception by orthodontic tooth movement stimulate Trigeminal nerve free endings in periodontal ligament (PDL) , and neuropeptides such as substance P and CGRP are synthesized in Trigeminal ganglion sensory cells and released both centrally and peripherally around blood vessels in PDL and pulp. Neuropeptides such as CGRP and substance P are the signal transmitter of pain and might modulate vascular enlargement, blood flow or vascular permeability. CGRP receptor for its subunit, receptor activity modifying protein 1 (RAMP 1) distributed on osteoclasts and osteoblasts in PDL. CGRP may have effects on bone remodeling due to not only inhibiting bone resorption like calcitonin but also directly stimulating bone formation in the luxated PDL and during experimental tooth movement.

An extraction socket classification developed using analysis of bone type and blood supply to the buccal bone in monkeys

Bone modeling and remodeling following tooth extraction has been studied extensively. The reason for bone loss during the remodeling process is multifactorial, and the primary reason for this loss is still yet to be determined. The aim of this study was to examine the type of bone and the blood supply to the buccal bone in monkeys. Six maxillary arches from six monkeys were used. The arches were divided into three sections: right posterior, anterior from canine to canine, and left posterior. Blocks were decalcified and prepared for histologic processing and examination. Modified Masson trichrome and retic staining were used. Histologic sectioning demonstrated that the blood supply to the buccal bone came from the inner (socket) side of the alveolus, the periodontal ligament, the adjacent interdental bone, and the supraperiosteal vessels emanating from the covering gingiva or mucosa. Histologic examination showed that the buccal bone was composed of bundle and cortical bone. The thickness of the buccal bone was not uniform coronoapically, and the thinnest area of buccal bone was the coronal portion.

Correspondences of hydrostatic pressure in periodontal ligament with regions of root resorption: a clinical and a finite element study of the same human teeth

INTRODUCTION

The main objectives of this study were to generate individual finite element models of extracted human upper first premolars, and to simulate the distribution of the hydrostatic pressure in the periodontal ligament (PDL) of these models for evaluation of the risk of root resorption.

METHODS

The individual extracted teeth were from a previous in vivo study that investigated root resorption after application of continuous intrusive forces. The results of experimental examination and simulations were compared on these identical tooth roots. The applied force system was 0.5N and 1.0N of intrusive force.

RESULTS

The simulated results during intrusion of 0.5N showed regions near the apical thirds of the roots with hydrostatic pressure over the human capillary blood pressure. These regions correlated with the electron microscopies of previous studies performed in Brazil with the identical teeth. An increased force of 1.0N resulted in increased areas and magnitudes of the hydrostatic pressure.

CONCLUSIONS

The key parameter indicating beginning root resorption used in this study was an increased value for hydrostatic pressure in the PDL.

[The study on the cushioning function of PDL's microvasculature by vascular cast technique in dogs]

PURPOSE

To investigate the cushioning function of periodontal ligament (PDL)'s microvasculature by studying the microvascular architecture of PDL and its surrounding alveolar bone in dogs.

METHODS

Vascular cast technique was used on the mandibles from four adult hybrid dogs. Liquid synthetic resin was perfused through bilateral inferior alveolar arteries. Decalcification was performed with 10% hydrochloric acid. The soft tissues were dissolved in 20% potassium hydroxide solution. The specimens were examined under a scanning electron microscope after being dried and coated with gold.

RESULTS

The venules derived from the PDL drained to the surrounding alveolar bone via Volkmann's canals. Venules draining to the interradicular septum (IRS) were more in quantity and larger in diameter than those to the buccal or lingual alveolar bone. Enlarged sinusoid venules in the IRS were observed. Marrow cavities were significantly larger in volume and much more in quantity in the IRS than in the buccal or lingual alveolar bone.

CONCLUSIONS

The venules derived from the vasculature of PDL mainly drain to the venules of IRS. Like a reservoir, the sinusoid vessels in the IRS are presumably related to the cushioning function of the PDL during mastication.

Hypoxia and Reoxygenation Augment Bone-Resorbing Factor Production From Human Periodontal Ligament Cells

BACKGROUND

Oxygen deficiency caused by occlusal trauma and smoking may be associated with bone resorption in periodontitis. In the present study, the effects of hypoxia and reoxygenation on the production of bone-resorbing factors by cultured human periodontal ligament (PDL) cells were examined.

METHODS

Human PDL cells were cultured in 1% O(2) (hypoxia), 20% O(2) (normal oxygen tension [normoxia]), or an oxygen concentration that went from 1% to 20% (reoxygenation). The concentrations of bone-resorbing factors, i.e., vascular endothelial growth factor (VEGF), interleukin (IL)-6 and -1beta, tumor necrosis factor-alpha (TNF-alpha), and prostaglandin E(2) (PGE(2)), in the cell culture supernatants were determined by enzyme-linked immunosorbent assay. Expression of the corresponding mRNAs was detected by reverse transcription-polymerase chain reaction.

RESULTS

Significantly higher extracellular concentrations of VEGF and IL-6 were detected along with greater corresponding mRNA expression in the hypoxia group compared to the normoxia group. The protein production and mRNA expression of IL-1beta were observed only in the hypoxia group. Neither TNF-alpha nor PGE(2) was detectable in samples from either group, whereas cyclooxygenase-2 mRNA was detected. However, PGE(2) was detected after reoxygenation. Furthermore, VEGF and IL-6 and -1beta production also tended to increase in extracellular concentration and mRNA level after reoxygenation.

CONCLUSION

Hypoxia and reoxygenation may stimulate the PDL to produce VEGF, IL-6 and -1beta, and PGE2, which could result in the resorption of alveolar bone in periodontitis.

Periodontal Ligament Hydrostatic Pressure with Areas of Root Resorption after Application of a Continuous Torque Moment

Objective: To evaluate the risk of root resorption, individual finite element models (FEMs) of extracted human maxillary first premolars were created, and the distribution of the hydrostatic pressure in the periodontal ligament (PDL) of these models was simulated.

Materials and Methods: A continuous lingual torque of 3 Nmm and 6 Nmm respectively was applied in vivo to the aforementioned teeth. After extraction, FEMs of these double-rooted teeth were created based on high-resolution microcomputed tomographics (micro CT, voxel size: 35 microns). This high volumetric resolution made the recognition of very small resorption lacunae possible. Scanning electron micrographs of the root surfaces were created as well. This enabled the investigation of advantages and disadvantages of the different imaging techniques from the viewpoint of the examination of root resorption. Using the FEMs, the same loading conditions as applied in vivo were simulated.

Results: The results of clinical examination and simulations were compared using the identical roots of the teeth. The regions that showed increased hydrostatic pressure (>0.0047 MPa) correlated well with the locations of root resorption for each tooth. Increased torque resulted in increased high-pressure areas and increased magnitudes of hydrostatic pressure, correlating with the experiments.

Conclusion: If hydrostatic pressure exceeds typical human capillary blood pressure in the PDL, the risk of root resorption increases.

Histological and immunohistochemical analysis of initial and early subepithelial connective tissue attachment at chemically modified and conventional SLA®titanium implants. A pilot study in dogs

The aim of the present pilot study was to histologically/immunohistochemically investigate initial and early subepithelial connective tissue attachment at transmucosal parts of modified (mod) and conventional sandblasted, large grit and acid-etched (SLA) titanium implants. Implantation of modSLA and SLA implants was performed bilaterally in both the mandible and maxilla of four beagle dogs. The implants were submerged to prevent bacterial contamination. The animals were killed after 1, 4, 7 and 14 days. Peri-implant tissue reactions were assessed histologically (Masson Goldner Trichrome stain-MG) and immunohistochemically (IH) using monoclonal antibodies to fibronectin (FN) and proliferating cell nuclear antigen (PCNA). The surgical procedure of implant submerging resulted in the formation of an artificial gap in the transmucosal area of both types of implants. After 14 days of healing, MG stain revealed the formation of well-organized collagen fibres and numerous blood vessels in a newly formed loose connective tissue zone adjacent to modSLA. While some fibres were oriented in a parallel direction, others have started to extend and attach partially perpendicular to the implant surface. In contrast, SLA implants appeared to be clearly separated by a dense connective tissue zone with parallel-running collagen fibres and rare blood vessel formation. First signs of a positive FN and PCNA staining adjacent to both implant surfaces were observed at day 4. Within the limits of a pilot study, it might be concluded that modSLA titanium surfaces might possess the potential to promote subepithelial connective tissue attachment at the transmucosal part of the implant.

The blood vessel system in the periodontal ligament of the equine cheek teeth--part I: The spatial arrangement in layers

Corrosion casts of blood vessels in the periodontium of cheek teeth from eight horses were observed three-dimensionally with a dissection microscope. Selected specimens were examined in a scanning electron microscope. Periodontal blood vessels communicated with those from the gingiva, the alveolar bone, and the apical region. In the upper jaw, there were anastomoses with the blood vessels of the mucosa of the maxillary sinus. The periodontal vascular system was organized in two or three layers. The peripheral layer was mainly composed of large venules, the inner one consisted of capillaries. In the intermediate layer, blood vessels were post-capillary venules. This layer was developed only in horses under 10 years of age. In all layers the vascular orientation was mainly occluso-apical, this was defined as the standard pattern. There were many variations displayed in different courses of certain blood vessels. The vascular organization is discussed with regard to the specialized functions of the periodontal ligament (PDL). The wide vessels of the outer layer are thought to play a mechanical role as part of a shock absorbing system. The capillaries of the inner layer meet nutritional requirements. The disappearance of the intermediate layer in horses older than 10 years is taken as an adaptation to the remodelling of the PDL. Modifications in the standard pattern of vascular arrangements are also interpreted as adaptations to life-long changes in the periodontal space. Anastomoses between the periodontal vasculature and the blood vessels of the maxillary sinus indicate that periodontal disease may be transferred into the sinus.

The blood vessel system in the periodontal ligament of the equine cheek teeth – Part II: The micro-architecture and its functional implications in a constantly remodelling system

The micro-vasculature of the equine periodontal ligament (PDL) was investigated using corrosion casts for scanning electron microscopy. Specimens from eight healthy warm-blooded horses were examined. Specific vascular features such as large ampullae with a diameter of up to 300 microm and blind vascular casts were found in the specimens of the equine PDL. The ampullae-shaped venules occurred only in the peripheral layer, where they were formed at the confluence of several vessels. Two types of blind stumps were identified. The first was developed in all three layers, while the second was found only in the peripheral layer. Blood-flow-regulating structures were not present in the equine PDL. As vascular valves are absent, the blood can flow in all directions. This polydirectional shift exists in all vascular layers. The vascular ampullae, present exclusively in the peripheral layer, are discussed here as specific features of a mechanism that can receive masticatory forces. Apart from its mechanical role, the vasculature must constantly adapt to the spatial changes resulting from the life-long eruption of the equine cheek tooth. This is facilitated by vascular sprouting and intussusceptive vascular remodelling. The blind ending stumps of the corrosion casts are typical equivalents of vascular sprouting. The large ampullae are interpreted as the first step in an intussusceptive process.

Effects of essential fatty acid deficiency on periodontal tissue adaptation to spontaneous tooth migration

Essential fatty acids (EFAs) play a significant role in bone metabolism. Herein we studied the adaptation of alveolar bone to physiologic tooth drift in young rats deprived of essential fatty acids from birth. Reductions in femur size and trabecular bone volume reflected body growth impairment. Along the alveolar wall, osteoclastic resorption and bone formation were depressed, disrupting the adaptive deformation of the tooth socket to ongoing migration. As a result, the periodontal ligament narrowed considerably, and further adaptation was achieved through root resorption. Essential fatty acid deficiency (EFAD), did not affect precursor recruitment or differentiation in the periodontal ligament (PDL), but caused redistribution of nonspecific-esterase (NSE)-positive osteoclast precursors and tartrate-resistant acid phosphatase (TRAP)-positive pre-osteoclasts between the bone compartment (which was depleted) and the root compartment (which was enriched). EFAD had also a marked effect on the PDL vasculature; the number of vessels was reduced, whereas their size was markedly increased. As a whole, our results show that EFAD disturbs alveolar bone adaptation to drift, but that a reaction (detrimental to root integrity) prevents root collision with the bone surface, thereby preserving the PDL as a source of precursor cells for bone and cementum homeostasis. Moreover, our results confirm that although alveolar bone resorption is arachidonic acid-dependent, the factors activating root resorption are different.

Distinct fibro-vascular arrangements in the periodontal ligament of the horse

OBJECTIVE

The periodontal ligament (PDL) of the hypsodont cheek teeth of the horse meets specific requirements of tooth support: (1) to fix the tooth; (2) to withstand pressure and tension during the laterolateral mastication movement; (3) to restore the original tooth position. These requirements are assumed to be met by the periodontal collagen fiber apparatus and by the vascular system. Distinct fibro-vascular arrangements are described here in order to reveal the structural prerequisites for these distinct functions.

DESIGN

Specimens from nine horses were processed for (1) collagen labeling with fluorescein, (2) oxytalan fiber staining, (3) immunostaining of smooth muscle actin, and (4) TEM examinations.

RESULTS

Blood vessels were found to be integrated in the PDL in three distinct ways:

CONCLUSIONS

The sheaths formed by veil cells (type-I arrangement) isolate distinct groups of blood vessels from deformations of the surrounding tissue. In contrast, the distinct fibro-vascular arrangements of anchored blood vessels (type-II arrangement) and ballooned venules (type-III arrangement) are assumed to accept the forces generated by masticatory tooth movements. The anchored blood vessels sustain tractive forces by means of what is called a lateral compression mechanism, whereas the ballooned venules act as a hemodynamic cushion.

Influence of occlusal height for an implant prosthesis on the periodontal tissues of the antagonist

The purpose of this study was to investigate a suitable occlusal height for an implant prosthesis by examining the responses of the periodontal tissues around a natural antagonist. The subjects were three Japanese females with two posterior missing teeth restored by ITI system implants (Straumann). Two kinds of experimental implant prostheses were adjusted as follows; one was adjusted in heavy clenching (HC), and the other was adjusted in light clenching (LC). The periodontal pulsation, displacement during biting an occlusal force meter and the mobility of the antagonist were measured before and one week after temporary cementing HC and LC, and one week after removal. In each prosthesis, there was no significant difference in the amounts of the pulsation and mobility of the antagonist before and one week after cementing, and one week after removal (p>0.05). The displacement of the antagonist during biting the occlusal force meter did not change much during the conditions. The results of this study suggested that an implant prosthesis adjusted not only under heavy clenching but light clenching like crown restorations for natural teeth did not affect the periodontal tissues of the antagonist in a harmful manner.

Histopathologic changes in dental and oral soft tissues in 2-butoxyethanol-induced hemolysis and thrombosis in rats*

BACKGROUND

2-Butoxyethanol (2-BE; ethylene glycol monobutyl ether) is extensively used as a solvent in surface coatings, such as lacquers, enamels, and varnishes in industrial and household cleaning products. Its major toxicity is manifested in the circulation, as it induces hemolytic anemia and thrombosis in various organs. While 2-BE has been implicated in the induction of anemia in different species, the rat has proven most sensitive, especially the female of this species. The purpose of this study was to document the effects of 2-BE on dentition, the periodontal ligament, the tongue, the salivary glands, and the oral mucosa in male and female Fischer 344 rats.

METHODS

The experiment included 40 rats divided into five groups. Four groups were exposed to 2, 3, or 4 daily doses of 2-BE, and a fifth group served as control. The rats were killed on days 2, 3, 4, and 29. The teeth and soft oral tissues were prepared for histopathologic observation.

RESULTS

The histopathologic analysis showed that the major effect of 2-BE was exerted on the odontoblasts of the incisors and on molars, with greater effect on the incisors. Foci of damaged muscle cells in the tongue were also observed. The blood vessels were dilated and congested, and a primary thrombosis was seen in the dental pulp.

CONCLUSIONS

The results of this study revealed a resemblance between the dental injuries in this rat model and those seen in sickle cell anemia in humans. This 2-BE animal model holds potential to assist in the discovery of preventive measures and/or treatment for dental injuries that occur in human diseases with hemolytic anemia.

Nitric oxide synthase expression is increased by occlusal force in rat periodontal ligament

OBJECTIVES

The goal of this study was to investigate the role of nitric oxide synthase (NOS) in occlusal force-induced signal transduction in rat periodontal ligament (PDL).

DESIGN

Rats were fitted with a bite plate and a metal cap to the maxillary and mandibular incisors, respectively, to eliminate the occlusal forces on rat molars. One group was sacrificed at 7 days (exclusion group), while the remaining rats had their appliances removed to reestablish molar occlusal contact (reload group) and were sacrificed 7 days thereafter. Another group of rats (normal group) were left completely untreated. Frozen cross sections of the upper first molars were stained with NADPH-diaphorase to quantify NOS activity. The distal sides of the disto-palatal roots of the upper first molars were examined, and the number and the area of stained cells in the PDL were measured.

RESULTS

In the normal group, NOS expression was detected in blood vessels, monocyte-macrophages, fibroblastic cells and osteoclastic cells. NOS expression was lower in the exclusion group when compared with the normal group or the reload group (p < 0.05), and the exclusion group exhibited occluded blood vessels and a narrowing of PDL. In contrast, in the reload group the PDL and blood vessel structure had recovered and NOS expression was increased to the level of the controls.

CONCLUSION

Occlusal force resulted in increased NOS expression. NO may mediate changes in PDL structure in response to occlusal force.

Effect of nitric oxide on the recovery of the hypofunctional periodontal ligament

The relationship between occlusal stimuli and a hypofunctional periodontal ligament (PDL) structure has been reported, though changes in occlusal recovery conditions were still unclear. Nitric oxide (NO) produced by NO synthase (NOS) is considered a factor for vascular and immune system control, and it increases according to mechanical stimuli. The objective of this study was to examine the relationship between NOS and occlusal stimuli in PDL by comparing hypofunction with occlusal recovery. The study focused on the expression of endothelial NOS (eNOS) and inducible NOS (iNOS). Their expression significantly decreased in occlusal hypofunction compared with the control group and increased close to normal in an occlusal recovery group. The change in the immunopositive area was more dramatic than the immunopositive cell number. Moreover, the rate of iNOS increase was higher than that of eNOS. This study suggests that NO plays an important role in the recovery of the hypofunctional PDL.

Distribution of the epithelial rests of Malassez and their relationship to blood vessels of the periodontal ligament during rat tooth development

BACKGROUND

There is some evidence that the epithelial cell rests of Malassez partition the root surface from the periodontal ligament blood vessels, and may protect the root from resorption.

OBJECTIVE

The aim of the present study was to determine the distributions of the epithelial rests of Malassez (ERM) and blood vessels in the periodontal ligament (PDL) of the developing rat first molar before, during and after emergence.

METHODS

Four Sprague-Dawley rats were sacrificed at two days, one week, two weeks, three weeks, four weeks and six weeks of age. After processing, the maxillae were embedded in paraffin, and sectioned longitudinally and transversely. The sections were stained with a double immuno-histochemical technique which utilised a keratin antibody AE1-AE3 (1:2,000) and an endothelial antibody Factor VIII (1:10,000) to enable simultaneous labelling of ERM and blood vessels. ERM and blood vessel counts were obtained from the mesio-buccal roots of three week, four week and six week-old rats, whilst qualitative observations were made for the earlier developmental stages.

RESULTS

ERM cells and cell clusters were found in the tooth third of the PDL width at the three, four and six week stages. Cells and cell clusters increased in number with age, especially in the upper third of the mesio-buccal root. The largest numbers of cells and clusters were found on the distal surfaces of the roots in all age groups. Cells and clusters in all root surfaces increased from three to four weeks, but decreased from four to six weeks. The greatest number of blood vessels was found in the bone-side third of the PDL. The distal surface had the highest proportion of blood vessels, and the palatal surface the least proportion. The number of blood vessels in all surface quadrants did not vary much from three to four weeks of age, but increased from four to six weeks of age, possibly as a reaction to tooth emergence and occlusal function. Physiological root resorption was only observed after tooth emergence, and appeared to be related to loss of continuity of the ERM network and the incursion of blood vessels.

CONCLUSIONS

Orthodontic root resorption can be regarded as an exaggerated response to loss of PDL homeostatic control, possibly mediated by the epithelial rests of Malassez.

Upregulation of immunoreactivity of endothelin-1 and alpha-SMA in PDL microvasculature following acute tooth loading: an immunohistochemical study in the marmoset

OBJECTIVES

To test the hypothesis that a continuous mechanical tooth load would elevate immunoreactivity of endothelin-1 (ET-1) and alpha-smooth muscle actin (alpha-SMA) in the periodontal ligament (PDL) microvasculature.

DESIGN

A randomized control study employing 1.5 h of loading to first molars.

SETTING AND SAMPLE POPULATION

Orthodontic Research Laboratory, Dental School, Adelaide University. Four young adult, male marmoset monkeys were consecutively anaesthetized and treated.

EXPERIMENTAL VARIABLE

An external telescoping frame applied a jaw closing load (120-200 g) transmitted occlusally, via a rubber pad, to randomly assigned mandibular left or right first molars. Contralateral molars were used as controls.

OUTCOME MEASURE

Undemineralized, midsagittal, mandibular molar slices, approximately 150 microm thick were immunolabelled with ET-1 and alpha-SMA antibodies and examined in a confocal laser scanning microscope (CLSM) for vascular endothelium and smooth muscle immunolabelling.

RESULTS

Three categories of post-capillary-sized venule endothelial cell immunolabelling occurred: endothelium labelled solely with ET-1; endothelium labelled solely with alpha-SMA; endothelium labelled with both ET-1 and alpha-SMA. In endothelial cells, the alpha-SMA showed a moderate cytoplasmic distribution with dense peripheral concentration. Loading increased arteriole alpha-SMA actin labelling.

CONCLUSION

Scattered expression of ET-1 is the default state in primate PDL endothelial cells. Increased antigenicity of endothelial cells to both ET-1 and alpha-SMA, and of arteriolar smooth muscle to alpha-SMA, is a response to shear and compression loads.

Microvascular response in the periodontal ligament following mucoperiosteal flap surgery

BACKGROUND

When the mucoperiosteal flap is elevated, the gingivo-periosteal vascular plexus and periodontal ligament (PDL) vascular plexus sever their connection with the circulatory tracts that pass through alveolar bone. We studied the effect exerted on the PDL vascular plexus during restoration of the circulatory tract.

METHODS

We performed experimental mucoperiosteal flap surgery in adult beagle dogs. Histological specimens, prepared after injecting India ink into the blood vessels on postoperative days 5, 7, 14, 21, 28, and 42, were examined under a light microscope. In addition, vascular corrosion cast specimens of the PDL, into which acrylic resin was injected, were observed using a scanning electron microscope.

RESULTS

On postoperative day 5, the PDL vascular plexus had formed new blood vessels toward the bone side and root side, and bone resorption of the alveolar bone proper had initiated primarily around the opening of the Volkmann's canal. From postoperative day 7 to 14, the PDL vascular plexus formed new vessels on the bone side and root side accompanied by bone resorption of the alveolus, and demonstrated a complicated vascular architecture, which gradually organized and transformed into a mesh structure from postoperative day 21. Osteogenesis was initiated and encircled the newly formed vessels, and the alveolar bone proper recovered to a flat morphology. Judging from the quantity of new vessels and bone resorption, the width of the PDL space seemed to be the greatest on postoperative day 14.

CONCLUSIONS

When the mucoperiosteal flap was elevated, active wound healing was activated because of angiogenesis from the PDL, which possesses a microcirculatory system. Moreover, it was suggested that angiogenesis of the PDL vascular plexus and subsequent bone resorption of alveolar bone might temporarily reduce the tooth-supporting function and cause postoperative mobility.

Development of oxytalan fibers in the rat molar periodontal ligament

Although oxytalan fibers are known to be a ubiquitous component of the periodontal ligament, little information has been available concerning their organization in the developing periodontal ligament. In the present study, growth and distribution of oxytalan fibers were examined in the developing periodontal ligament of rat molars aged 11, 14, 19, 21 and 28 days. A quantitative analysis of the fibers was made and the spatial relationship between the fibers and blood vessels was studied by means of a three-dimensional reconstruction of serial sections. At the beginning of root formation, oxytalan fibers appeared at first as dot-like structures around the root sheath as well as in areas very close to blood vessels. These structures were resolved in the electron microscope to be made up of 12-nm-wide microfibrils in the vicinity of the surface of the cells of the root sheath. In the process of development, these dot-like structures elongated into entities with helical appearances. As the development further proceeded, longer oxytalan fibers were produced in the apico-occlusal direction along with blood vessels. Quantitative analysis showed that an increase in oxytalan fibers coincided with an increase in the density of the vascular network in the developing periodontal ligament. Based on the results of the present study, the role of oxytalan fibers in the developing periodontal ligament may be in the maintenance of the integrity of the vascular system as previously suggested.

Changes in periodontal pulsation in relation to increasing loads on rat molars and to blood pressure

Pulsation originating from the vascular system of the periodontal ligament (PDL) is apparently synchronized with the heartbeat. As periodontal pulsation causes pulsatile tooth vibration, it might be possible to evaluate it indirectly by measuring tooth vibration. Periodontal pulsation has been found to be dependent on blood flow and blood pressure in the PDL. Heavy orthodontic force is known to reduce blood flow and decrease the amplitude of the pulsation. The purpose now was to examine (1). the magnitude of the experimental orthodontic force that will impair PDL blood flow; and (2). the differences in the amplitude of pulsation between normal and hypertensive animals. The experiments were performed on 10 Wistar, 10 Dahl S and 10 Dahl R rats. Hypertension was induced in Dahl S rats. The head and maxilla of anaesthetized animals were immobilized. Mesial tipping forces of different loads (0.098-0.882 N) were applied to a molar and periodontal pulsation was measured with a highly sensitive laser displacement meter. The periodontal pulsation at each load resembled a blood-volume pulse wave. Its amplitude began to decrease at a load of 0.588 N in Wistar and Dahl R rats, and at 0.784 N in Dahl S rats. The group with induced hypertension had a significantly larger amplitude than the other two groups when 0.588 N was applied. These results suggest that: (1). periodontal pulsation can indicate a PDL overload; and (2). that systemic blood pressure affects the amplitude of periodontal pulsation during loading.

Changes in tooth position in humans in relation to arterial blood pressure

The three-dimensional physiological tooth movement synchronized with the heartbeat is called periodontal pulsation. This study utilized a computer-assisted amorphous sensor to evaluate the relation between tooth position and arterial blood pressure, and also between the amplitude of periodontal pulsation and arterial blood pressure. The measuring device consisted of a small magnet attached to the tooth and an amorphous sensor that was used to detect displacement of the tooth without actually contacting it. The sample consisted of the upper left central incisors of six healthy Japanese volunteers. The three measuring points for each tooth were on the labial surface. The cold-pressor test was used as an autonomic nerve stimulus that induces an increase in blood pressure and heart rate. Periodontal pulsation, electrocardiogram, blood pressure and heart rate were recorded simultaneously during a 1 min pre-test relaxation, a 2 min cold-pressor test and a 1 min recovery. The results showed significant correlations between tooth position and mean blood pressure in five of the six volunteers and between tooth position and pulse pressure in four. Moreover, it was confirmed that tooth position shifted in the labial direction in conjunction with an increase of the mean blood pressure induced by cold stimulation. Significant correlations were found between the amplitude of periodontal pulsation and pulse pressure in four of the volunteers. These findings suggest that in humans tooth position might be affected by the force of blood pressure transmitted through periodontal vessels and that the amplitude of periodontal pulsation tends to reflect changes of pulse pressure rather than changes in mean blood pressure.

Scanning electron microscopic observation of microvasculature in periodontium

In this study, vascular resin cast models in the periodontium of beagle dogs were prepared and three-dimensional observation of the relationship between the gingiva and periodontal ligament (PDL) vascular network was performed. After the perfusion of Ringer's solution and fixative, synthetic resin was injected from the inferior alveolar arteries. Soft tissue was digested by proteinase solution and specimens were examined under scanning electron microscope (SEM). The gingival vascular network (GVN) in the region facing the teeth consisted of sulcular and junctional epithelium. The vascular network of the sulcular epithelium (SE) had a renal glomerulus-like form and the junctional epithelium (JE) consisted of squamous mesh. The gingival sulcular fluid exudated from the vascular network directly beneath the JE, and leukocytes permeated from the vascular network beneath the epithelium. Thus, we considered that the GVN performs an important function in the protection against the inflammation. Periodontal ligament had a polygonal mesh vascular network that was anastomosed to the venous plexus of alveolar bone through Volkmann's canals (VC). When occlusal force was applied, the blood in the periodontal vessels flowed out through VC into the bone marrow, and when the force was removed, it flowed backward into the PDL. This blood transfer acted as an absorber against occlusal force. Our findings suggest that the blood vessels of the gingiva perform an important function in defending against inflammation, while the blood vessels of the PDL play a key role in absorbing occlusal force.

Endothelin-1 expression in the microvasculature of normal and 3-hour continuously loaded rat molar periodontal ligament

Endothelin-1 (ET-1) distribution is described in the microvascular bed (MVB) of normal rat molar periodontal ligament (PDL). Five male Sprague-Dawley rats, aged 90 days, were anaesthetized and an external pressure of 100 +/- 20 g, maintained for 3 hours, was transmitted occlusally to randomly allocated left or right molars. The controls were the contralateral molars. Rats were perfused for 5 minutes with 5 per cent paraformaldehyde, and the mandibles post-fixed and stored in 30 per cent sucrose. Sagittal, undemineralized, mandibular jaw sections, approximately 150 microns thick, were immunolabelled with ET-1 and alpha-smooth muscle actin (alpha-SMA) primary antibodies, and IgG/CY5 and IgG/CY3 secondary antibodies, respectively. Serial images were captured with a Bio-Rad MRC-1000 UV confocal laser scanning microscope (CLSM). In the control PDL, the ET-1 immunolabelling occurred sporadically in all categories of PDL blood vessels. ET-1 showed a punctate distribution within endothelial cells, producing longitudinal and circumferential pan-endothelial labelling. Immunoreactivity to the ET-1 antibody occurred at or adjacent to vessel branching sites, and affected blood vessels with and lacking alpha-SMA immunolabelling. Treatment effects on ET-1 immunofluorescence were analysed for vascular endothelium, socket bone surface cells, cementum surface cells and PDL background in the cervical, inter-radicular and apical regions. Significant (P < 0.05) region by treatment interactions occurred for the endothelium and bone. Cementum showed a significant (P < 0.05) region effect and a significant (P < 0.05) treatment effect. However, the region by treatment interaction was not significant. Background immunofluorescence showed significant (P < 0.05) region by treatment effects for the endothelium and bone. ET-1 activity is the default state for normal PDL vascular endothelium.

The distribution of retinaldehyde dehydrogenase-2 in rat and human orodental tissues

Retinoic acid is an important signalling molecule in embryological development and continues to be important in the adult animal because it modulates growth and differentiation in many epithelial tissues. The distribution of the enzyme retinaldehyde dehydrogenase-2 (RALDH 2), which is involved in the synthesis of retinoic acid, was studied using immunocytochemical techniques in: (1) the developing orodental region of rats aged between 15 days in utero and 6 months; and (2) in archival human autopsy material consisting of abdominal skin and mucosa from various regions of the mouth. In developing tooth germs, RALDH 2 was absent in the enamel organ and dental papilla, its presence only being noted at the periphery of the dental follicle adjacent to parts of the developing alveolar crypt. In adult teeth, the presence of RALDH 2 was limited to blood vessels in the periodontal ligament. In embryos, the connective tissue beneath the nasal epithelium and the meninges stained strongly positively for RALDH 2, as did the connective tissue beneath nasal epithelium in an adult rat. Both keratinized and non-keratinized human oral epithelia and abdominal skin stained positively for RALDH 2. Staining was present throughout the stratified epithelium, except in the keratinized layer and in the basal layer associated with the dorsal surface of the tongue. In addition, the adnexia as well as the ductal lining of mucous glands stained positively for RALDH 2.

Histomorphometric study of the periodontal vasculature during and after experimental tipping of the rat incisor

The periodontal vasculature encircling the entire length of the rat lower incisor was studied at the time of tipping movement and 3 months later. In 12 rats (212+/-4 g b.w.), loads (0.19+/-0.016 N) were applied to the lower left incisor in a linguointrusive direction. After 2 weeks of loading, six experimental animals were killed with the loading springs in place. The springs were removed in the six remaining rats, which were killed 12 weeks later. Six additional rats with intact teeth served as control. All incisors were fixed, demineralized, embedded in glycol methacrylate and cross-sectioned perpendicular to the long axis of the tooth. The distance of each section (2 microm) from the apex was calculated. A computerized image-analysis program was used to measure the width and area of the labial and lingual periodontal ligament to establish whether the measured segments corresponded to the compressed or expanded zones. In each cross-section, the various types of blood vessels were counted and the cross-sectional area of all venous vessels was measured. The results showed that after 2 weeks of loading (1) the general trend of vascular changes was similar under pressure and tension; (2) the large-diameter vessels were unaffected by loading; (3) the mean number of terminal arterioles had decreased significantly, while the number of capillaries and postcapillary venules had increased significantly in the apical tooth part; (4) the venous blood vessel area had decreased significantly in the apical tooth part; (5) the intensity of the vascular reaction was dependent on the degree of tissue distortion; and (6) after 12 weeks' recovery the vascular changes were still present, demonstrating a rebound effect. The findings suggest that microvascular alterations following tooth loading are not directly related to the spatial effect of loading itself and are of a much longer duration than expected.

[Immediate microcirculation reaction of periodontal ligaments to experimental intrusion of dog teeth]

OBJECTIVE

The purpose of this study is to investigate the immediate microcirculation reaction of periodontal ligaments to experimental intrusion of dog teeth.

METHODS

The forth premolar was chosen as the anchor tooth to intrude the second premolar using an intrusion circle loop. All tissue sections were observed and analyzed using the ink perfusion technique and an image analysis apparatus.

RESULTS

The microvascular pattern of periodontal ligaments was changed after the maxillary second premolar had been intruded for 2 hours with 100 g of force. The vascular diameter and volume density diminished, but the vascular number and some parts of the microvasculature, especially capillaries were compressed due to the blood escaping from the periodontal ligament. It showed that the initial effect of 100 g of intrusive force caused adaptable changes in the microcirculation of periodontal ligaments, but no significant impediment of blood flow occurred.

CONCLUSION

During the tooth intrusion with 100 g of force, a suitable microenvironment was established for the benefit of the survival of periodontal ligaments, which could avoid overloads imposed on the periodontal ligament and decreased the injury of periodontal tissue. It elucidates that the microcirculation of periodontal ligaments plays an important role in the protection of the periodontal tissue, in terms of biological function.

Ultrastructural changes in postcapillary-sized venule morphology in aged mouse periodontal ligament

The aim of this study was to compare the postcapillary-sized venule (PCV) morphology of four young ALCA mice (35 days) and four colony-related aged mice (365 days) using the transmission electron microscope (TEM). Right and left mandibular first molar mesial roots with associated periodontal ligament (PDL) and bony socket, were used for TEM assessment. Five PCV profiles were selected at each 160 microm interval, from the alveolar crest to the tooth apex. PCV profile dimensions were measured on standardised micrographs magnified x2900. Age affects were tested using multiple regression analysis. The number of PCV profiles in the tooth third of the PDL was higher in aged mice (p < 0.01) and comprised predominantly apericytic vessels (p < 0.001). The number of PCV profiles increased significantly (p < 0.001) in aged mice in the PDL middle circumferential third halfway down the molar root. Age had no significant affect on PCV diameter. Aged PDL permeability studies are needed to investigate whether the changes in aged PCV profile number are associated with functional modification of the PDL microvasculature.

Ultrastructure of cementum and periodontal ligament after continuous intrusion in humans: a transmission electron microscopy study

An ultrastructural study of the cementum and periodontal ligament (PDL) changes after continuous intrusion with two different and controlled forces in humans was carried out. Twelve first upper premolars, at stage 10 of Nolla, orthodontically indicated for extraction from six patients (mean age 15.3) were used. They were divided into three experimental groups, distributed intra-individually as follows: control (not moved), continuously intruded for 4 weeks with 50 or 100 cN force, utilizing a precise biomechanical model with nickel titanium super-elastic wires (NiTi-SE), which were developed and calibrated individually. The teeth were extracted, fixed, decalcified, and conventionally processed for examination in a Jeol 100 CX II transmission electron microscope. Evident signs of degeneration of cell structures, vascular components, and extracellular matrix (EM) of cementum and PDL were observed in all the intruded teeth, with more severe changes towards an apical direction and in proportion to the magnitude of force applied. Resorptive areas and an irregular root surface of the intruded teeth were noticed, according to the same pattern described above. Concomitant, areas of repair were also revealed in the cementum and PDL although the magnitude of forces remained the same throughout the experimental period. Thus, a reduction of continuous force magnitude should be considered to preserve the integrity of tissues.

Developmental changes of the vasculature in the periodontal ligament of rat molars: a scanning electron microscopic study of microcorrosion casts

Vascularization of the periodontal ligament was examined in developing upper first molars of rats from 5 to 30 d after birth with light and scanning electron microscopy. Formation of the vascular network in the periodontal ligament (PDL) started with the beginning of root formation. The PDL vessels derived from the basal region of the tooth germ ran parallel to the long axis of the root and connected with the vascular network of the enamel organ at the cervical end. The boundary of these 2 networks was initially indistinct but became clearer with the progress of root formation. The PDL vessels further elongated longitudinally and connected with each other by lateral branches to form a coarse mesh. Other vessels derived from the alveolar bone via Volkman's canals also contributed to the vascular construction of the PDL. The vessels from the alveolar bone provided branches to the existing mesh of the PDL. Consequently, the vascular network of the PDL consisted of vessels from 2 sources: 1 derived from the basal region of the tooth germ, and the other from the alveolar bone. The density of the vascular network reduced with the progress of root formation, especially at the middle part of the root, but the mesh at the apical region maintained a basket-like structure.

The immunohistochemical response of the rat periodontal ligament endothelium to an inflammatory stimulus

Recently, inflammation has been recognised as an important co-requisite to orthodontic tooth movement. When such a reaction is initiated, the process of up-regulation of certain adhesion molecules may occur, resulting in the extravasation of leukocytes. This may stimulate progenitor/precursor pathways and signals that regulate the biological responses resulting in tooth movement. We propose that up-regulation of leukocyte adhesion molecules occurs in response to orthodontic forces, resulting in circulating monocyte attraction, extravasation and differentiation into osteoclasts, which are responsible for bone resorption that results in orthodontic tooth movement. To investigate this hypothesis, it is necessary to determine whether periodontal ligament (PDL) endothelium responds to inflammatory stimuli as other organs do. We studied the normal distribution of endothelial adhesion molecule ICAM-1 within PDL vessels, and then the following exposure to an inflammatory endotoxin. The rat PDL blood vessels expressed ICAM-1 in response to the inflammatory stimulus, similar to other organs, suggesting that the inflammatory responses are similar. Whether and where in the PDL microvascular bed orthodontic forces cause up-regulation of ICAM-1 needs to be established.

Brackets, epitopes and flash memory cards: a futuristic view of clinical orthodontics

Orthodontics continues to be a profession anchored in traditional technology using appliances that cause inflammatory periodontal ligament (PDL) responses. Existing concepts of biological tooth movement based largely on histological tissue observations and the application of physical principles require major reassessment. In the next millennium, the genome revolution and knowledge of protein production and control could lead to the genetic correction of dentofacial anomalies and pain-free, biomolecular methods of malocclusion correction and long-term stability. A fundamental change is likely to be the abolition of bracket systems and their replacement with preprogrammed microchips driven by computers, and the control of PDL blood vessels and cells by pharmacological targeting. Future survival of the profession will depend on a radically different specialist who will be educated with a postgraduate curriculum based on molecular biology and computer engineering.

Blood vessel response to pan-endothelium (RECA-1) antibody in normal and tooth loaded rat periodontal ligament

Immunolabelling of the normal rat molar periodontal ligament (PDL) with RECA-1 antibody, an endothelial cell surface marker, demonstrated the endothelium in the different categories of blood vessels. The intensity of immunolabelling was similar for venous capillaries (VC), post-capillary-sized venules (PCV), and collecting venules (CV). Arterial capillaries (AC) and terminal arterioles (TA) showed a different response, both having a high intensity of endothelium and smooth muscle cell labelling, whether they were located in the PDL or alveolar bone. An experimental, continuous loading of approximately 100 g was applied unilaterally to the mandibular molars for 10 minutes. In the PDL apical compression zone this load resulted in a loss of RECA-1 immunolabelling of the VC, PCV, and CV. Adjacent to the alveolar crest, where shear and tension loads were judged to have occurred, there was enhanced immunoreactivity of VC, PCV, and CV. In the loaded PDL, the AC and TA, irrespective of their location in the ligament or bone, showed strong immunofluorescence of their endothelium and the enveloping smooth muscle layer. Vessel and PDL immunofluorescence were analysed with standardized grey scale densitometry, and the data subjected to ANOVA. Comparison between individual vessel means showed significant differences (P < 0.05). Control teeth showed no immunostaining difference between the coronal and apical region vessels, whereas in the loaded teeth the overall cervical vessel endothelium had a significantly higher value than the apical vessel endothelium (P < 0.001). These findings demonstrate that the endothelium of this microvascular bed can undergo significant immunoreactivity changes when exposed to short-term, continuous, tooth loading.

Blood volume in human bicuspid periodontal ligament determined by electron microscopy

The microvascular volume of periodontal ligament is reported to range from 1.63 to 3.5% in man, whereas that of animals varies from 7.5 to 11.5%. This transmission electron-microscopic investigation was undertaken to determine stereologically the volume in human periodontal ligament. The hypothesis tested was that the ligament blood volume in man is similar to that in animals. Left and right segments of mandible containing first and second premolars came from an adult burns' victim who underwent jaw reconstruction. The segments were immersion-fixed in 2.5% glutaraldehyde, demineralized at 4 degrees C in 0.1 M EDTA and processed for microscopy. Segments of distal periodontal ligament were sectioned at 150-micron intervals from the alveolar crest to the root apex and random tissue quadrats recorded for point counting and data analysis using a generalized linear-regression statistical model. Mean adjusted microvascular luminal volume was 9.52 +/- 2.28% (SEM) and the abluminal volume 12.91 +/- 2.76%; the wall volume was 3.39%. Significant differences existed between the luminal and abluminal volumes of the different vessel type (p < 0.05) and their distribution across the circumferential thirds of the ligament (p < 0.05). Total length density of the blood vessels was 149.84 x 10(3) cm/cm3 and the surface density 330.19 cm2/cm3. Postcapillary-sized venules held 69.1% of the total blood volume and provided 49.3% of the luminal surface area. Venous capillaries were the most common vessel, comprising 48.5%, and they contributed 71.5% of the overall length density. This study confirmed the hypothesis for the blood volume in the periodontal ligament in man. Blood volumes do not reflect the configurations of microvascular beds.

Effects of aging on oxytalan fibre in mouse periodontal ligament

The reactions of periodontal tissues to the mechanical stimulation of teeth seem to be different in patients of different ages. Although the effects of aging on other structures of the periodontal tissues, i.e., collagen fibre, bone, and cementum, have been reported, there is very little information available concerning the effects of aging on periodontal oxytalan fibre, which is reportedly the only elastic element in the human periodontal ligament. The purpose of this research was to clarify the aging related changes in the distribution of oxytalan fibres in the periodontal ligament of mice. Histological sections of the periodontal ligament of the lower first molar of 10-week-old (control group) and 1-year-old (aged group) ICR mice were specifically stained for oxytalan fibres with aldehyde fuchsin after preoxidization, and observed by light microscopy and confocal laser scanning microscopy (CLSM). In the aged group, oxytalan fibres seemed to be more prevalent around blood vessels in comparison with the control group. Furthermore, CLSM clearly showed that oxytalan fibres in the aged group were relatively more tortuous and complex than those in the control group. This tortuosity and complexity might imply that the oxytalan fibres in aged mice have lost a considerable amount of their original elasticity. While further study of these changes is required, these results may help orthodontists to establish better treatment strategies and methods for adult orthodontic patients.

Histologic evaluation of the periodontium of abutment teeth in combination implant/tooth fixed partial denture

The histologic response of the periodontal tissues of teeth rigidly joined to implants with a fixed partial denture was evaluated using light microscopy. The fourth premolar of a dog was connected to implants placed in the first and second premolar position with a fixed partial denture. The restored teeth were under function for periods of 6, 12, 18, and 24 months, with unrestored fourth premolars as controls. The histology of the periodontal ligament on the fourth premolar was found to be similar in the control and the restored teeth. The periodontal tissues contained a minimal amount of inflammatory cell infiltrate. The crestal bone was cortical in nature, showing no periodontal breakdown. The orientation of the periodontal fibers was easily determined, indicating that minimal remodeling had taken place. The number and morphology of the blood vessels were also similar in the control and the treated teeth. The lack of inflammation and stability of the periodontal tissue suggested that the use of combination implant-to-natural-teeth restorations with rigid joints in this animal model does not result in deleterious effects on the periodontal tissues and that the forces placed on the tissues are within the remodeling capabilities of the teeth.

Microvascular system of the rat incisor enamel organ. A scanning electron microscopic study of vascular corrosion casts

The rat incisor is a commonly used model in studies of tooth eruption, amelogenesis and effects of mechanical loading on the dental and periodontal tissues. The purpose of this study was to assess the three-dimensional architecture of the microvascular bed of the rat incisor enamel organ, to describe the direction of blood flow, and to provide a histometric assessment of the vascular categories that can be statistically analyzed. Vascular corrosion casts were prepared and examined by scanning electron microscopy. The microvasculature of the labial periodontal space was arranged in three distinct layers. The inner layer in direct relation to the enamel organ consisted of a capillary network which was drained by short venules at the cemento-enamel junction. The intermediate layer consisted of arterioles oriented parallel to the long axis of the incisor mainly mid-labially, branching off smaller arterioles to the capillary network. The outer layer was formed by flattened sinusoid vessels of larger caliber. Blood supply was from the anterior superior alveolar artery branches through the arterioles into the capillary network. Drainage was postero-laterally along the cemento-enamel junction via short venules which emptied into the sinusoid vessels, finally to flow through Volkmann's canals into the alveolar bone via small venules. The findings demonstrate that the microvasculature of the rat incisor enamel organ has an exceptionally high level of physiologically-adapted structural organization.

Confocal laser scanning-microscopic observations on the three-dimensional distribution of oxytalan fibres in mouse periodontal ligament

The purpose was to improve confocal laser scanning-microscopic (CLSM) techniques to observe the three-dimensional (3-D) distribution of oxytalan fibres in mouse periodontal ligament and to clarify the 3-D relation between those fibres and blood vessels. As aldehyde fuchsin is a contrast agent and the specific wavelength affects the depth of penetration, CLSM reflectance imaging of oxytalan stained with aldehyde fuchsin after oxidization provides strong contrast. Oxytalan fibres, whose precise roles have not yet been clarified, are connective tissue fibres present in human periodontal ligament in addition to collagen fibres. Despite many studies on their arrangement and biomechanical characteristics, their 3-D distribution in relation to other structures has never been reported. Mandibular first molars of mice were sectioned mesiodistally, pre-oxidized by monopersulphate compound (Oxone), stained with aldehyde fuchsin and examined by CLSM. CLSM images clearly revealed the 3-D distribution, and relation of oxytalan fibres to blood vessels and other structures, as well as their branching patterns in the periodontal ligament. The marked anatomical correlations between the direction, distribution and branching patterns of oxytalan fibres and blood vessels suggest that they interact to perform a specialized physiological role in the periodontal ligament.

[The responses of the microvasculature of the periodontal ligament to horizontal force]

OBJECTIVE

The purpose of this study is to examine the responses of the microvasculature in periodontal ligament(PDL) to horizontal force.

METHODS

Using ink injections and celloidin embed, serial sections were cut, then observed by light micrascope, quantitative analysis was conducted by the picture-analysis instrument. Vascular corrosion casts were prepared and examined by scanning electron microscopy. The forth premolars of dogs were pulled by 200 g force in a mesial direction for two hours, and the pressure effects in different positions were demonstrated.

RESULTS

The section area of the microvasculature per unit PDL area is obvious larger on the tension sides than on the pressure sides. There is not an obvious distinction on the pressure sides between the experiment groups and control groups. However, there are clear distinctions in the one-third of cervical, and apical segment on the tension sides between the experiment groups and control groups.

CONCLUSION

The microvascular changes in PDL had importance to the cushioning effect of PDL when a teeth received a kind of force in a short-time.

Effect of inferior alveolar nerve axotomy on periodontal and pulpal blood flow subsequent to experimental tooth movement in rats

The aims of this study were to evaluate the effect of inferior alveolar nerve (IAN) axotomy on periodontal (PDL) and pulpal blood flow incident to experimental tooth movement and to investigate whether nerve fiber regeneration coincides with blood flow changes. The first right mandibular molar was moved mesially for 3, 7, and 14 days after ipsilateral IAN axotomy in 29 rats. Four rats served as unoperated controls. At the end of each experimental period fluorescent microspheres (FM) were injected into the left ventricle and thereafter counted in serial sections in the PDL and pulp of the right and left first mandibular molars. The number of FM per tissue volume was taken as a measure of blood flow. Re-innervation of nerve fibers was mapped immunohistochemically 7, 14, and 21 days after IAN axotomy in 9 rats that had no orthodontic appliance. The statistical analysis showed no significant differences in the number of FM/mm3 PDL between the denervated and the contralateral side at 3 and 7 days. At 14 days the PDL on the denervated side showed a significant increase in the number of FM/mm3, coinciding with the initial periodontal nerve fiber re-innervation. In the pulp no significant differences were found between the denervated and the contralateral, innervated side in any experimental period. It can be concluded that IAN axotomy postpones an increase in periodontal blood flow until a sensory tissue re-innervation is established, thus indicating that neurogenic mechanisms play an important role in the development of the inflammatory reaction induced by experimental tooth movement.

[Microvasculature of the dog's periodontal ligament and its immediate response to orthodontic forces]

The purpose of this study was to examine the microvascular architecture of dog's periodontal ligament (PDL) and its immediate response to horizontal orthodontic force. A force of 200 g was applied mesially to the mandibular premolar of a dog for 2 hours, the distal side served as the contrast side. Formalin ink was perfused into the carotid arteries bilaterally through the cannulas. After perfusion the mandible was decalcified, celloidin embedded, serially sectioned and stained with eosin. The sections were then observed by light microscope and analyzed by image analyzer. Vascular corrosion casts were prepared by the similar way with the formalin ink perfusion and examined by scanning electron microscope. The results showed: there were extensive interconnections among the PDL, dental pulp, gingiva, alveolus and the neighbour tooth PDL, which would benefit the maintenance of health and functions of the dental pulp and the periodontal tissues. Arterioles and venulae could be confirmed by the presence of characteristic differences of nuclear impressions in endothelial cell under the scanning electron microscope. The quantitative analysis showed that the tensioned PDL sites in the experimental group had a higher microvascular volume density than the corresponding sites in the contrast group, while the pressed PDL sites in the experimental group had a lower microvascular volume density than the corresponding sites in the contrast group. This should result from the hydraulic mechanism in the PDL.

Effect of experimental tooth movement on nerve fibres immunoreactive to calcitonin gene-related peptide, protein gene product 9.5, and blood vessel density and distribution in rats

The effect of experimental tooth movement on nerve fibers immunoreactive to calcitonin gene-related peptide (CGRP) and to protein gene product (PGP) 9.5 were studied, as well as the coincidence of these responses with changes in blood vessel density and distribution in the periodontal ligament (PDL) and pulp of young Wistar rats. The first right maxillary molar was moved mesially by an orthodontic appliance for 3, 7, 14 and 21 days. Sagittal and horizontal serial sections were incubated alternately with antibodies to CGRP, PGP 9.5 and laminin. Nerve and blood vessel density and distribution between the experimental and control sides were compared in the apical and cervical PDL, and in root and coronal pulp. The most pronounced changes occurred in the 7 day group. CGRP and PGP 9.5 immunoreactive nerves in the apical PDL showed increased density, being distributed towards the alveolar bone and frequently found in bone resorption lacunae. Numerous nerve fibres were often present adjacent to hyalinized tissue, but were never found near or within root resorption lacunae. Nerve sprouting was also present both in the root and coronal pulp. Increased nerve and blood vessel density generally coincided with each other. At day 14, periodontal nerves and blood vessels were still disorganized compared with the controls. Tissues near cellular cementum and root resorption lacunae were consistently devoid of nerve fibres. After 21 days, PDL nerve and blood vessel density and distribution were nearly at control level. However, nerve fibres were regularly found inside root resorption areas. In conclusion, experimental tooth movement induces dynamic changes in density and distribution of periodontal and pulpal nerve fibres, indicating their involvement in both early stages of periodontal remodelling and later in the regenerative processes of the PDL, generally occurring in concerted action with modulation of blood vessels.

Dental innervation: functions and plasticity after peripheral injury

Oral tissues including the periodontal ligament, gingiva, and tooth pulp have a relatively dense sensory innervation and a rich vascular supply. Teeth and supporting tissues are susceptible to tissue injury and inflammation, partly due to lack of collateral blood and nerve supply and to their low compliance. This review focuses on dental nerve functions and adaptive changes in the trigeminal ganglion and tooth pulp after peripheral injuries. An overview of the peptidergic innervation of oral tissues is presented, followed by a discussion of plasticity in neuropeptide expression in trigeminal peripheral neurons after local insults to teeth and peripheral nerve injuries. The functional implications of these adaptive changes are considered, with special reference to nerve regeneration, inflammation, and hemodynamic regulation.

Direct evidence of parasympathetic vasodilatation in cat periodontal ligament

Sympathetic regulation of periodontal ligament blood flow (PLBF) is well-attested; however, vasodilator responses mediated by parasympathetic nerve fibers have yet to be conclusively demonstrated in the periodontal ligament (PL). The present study was designed to determine whether parasympathetic vasodilator mechanisms do or do not exist in the cat PL. In our cats, the cervical sympathetic trunks were sectioned bilaterally prior to any stimulation in order to eliminate sympathetic effects on the vascular beds under study. Dynamic changes in PLBF, with mandibular lip blood flow (LBF) recorded for comparison, were investigated in cat mandibular canine teeth using laser Doppler flowmetry. The peripheral cut ends of the facial and glossopharyngeal nerve roots, which have been reported to contain parasympathetic nerve fibers to the oral tissues, were electrically stimulated intracranially. Such stimulation caused blood flow to increase in the ipsilateral PL and lip, without an increase in systemic blood pressure. These vasodilator responses in the PL and lip were sensitive to ganglion blockade (with hexamethonium), indicating vasodilation via activation of parasympathetic vasodilator fibers. In contrast, although intracranial stimulation of the trigeminal nerve root also induced increases in both PLBF and LBF, these were unaffected by hexamethonium, but reduced by tripelennamine, indicating antidromic vasodilatation via the trigeminal sensory nerve. These results suggest that parasympathetic vasodilator mechanisms do exist in feline PL.

Healing of the root surface-associated periodontium: an immunohistochemical study of orthodontic root resorption in man

The purpose of the present investigation was to study resorption and regeneration of periodontal tissues incident to orthodontic tooth movement, in particular cells resorbing the root surface and the subsequent regeneration of the periodontal epithelial network and forming reparative cementum. The study was carried out using a select number of immunohistochemical markers on extracted human teeth which had been treated orthodontically. The most striking finding in the resorbing areas was the presence of what appeared to be two populations of KP 1+ mononuclear cells located at a distance of 50-100 microns from the root surface and multinucleated cells in resorption lacunae in close contact with the root surface. KP 1+ has previously not been reported for odontoclasts. The mononuclear KP 1+ cells in the periodontal ligament may represent either precursors to odontoclasts or phagocytic scavenger cells of the macrophage lineage. The subsequent healing of the resorption lacunae was characterized by re-establishment of nervous, vascular and epithelial tissues as evidenced by S-100+ filamentous delicate structures, factor VIII+ vessels and cytokeratin+ clusters of cells, respectively. However, cytokeratin+ single cells in close contact with the unresorbed cementum did not re-appear within the healing period. Although the present results are not quantitative in nature, cementoblasts located in the vicinity of resorption lacunae, especially healing ones, appeared to show an up-regulation of epidermal growth factor (EGF) receptors. It may be suggested the intense positive staining for EGF receptors may be an expression of an auto- or paracrine stimulatory pathway increasing the rate of reparative cementum formation.