Cellular and molecular mechanisms of tooth root development.

The tooth root is an integral, functionally important part of our dentition. The formation of a functional root depends on epithelial-mesenchymal interactions and integration of the root with the jaw bone, blood supply and nerve innervations. The root development process therefore offers an attractive model for investigating organogenesis. Understanding how roots develop and how they can be bioengineered is also of great interest in the field of regenerative medicine. Here, we discuss recent advances in understanding the cellular and molecular mechanisms underlying tooth root formation. We review the function of cellular structure and components such as Hertwig's epithelial root sheath, cranial neural crest cells and stem cells residing in developing and adult teeth. We also highlight how complex signaling networks together with multiple transcription factors mediate tissue-tissue interactions that guide root development. Finally, we discuss the possible role of stem cells in establishing the crown-to-root transition, and provide an overview of root malformations and diseases in humans.

Incisor inclination and perceived tooth colour changes.

INTRODUCTION: Social attractiveness is influenced by a variety of different smile-related factors. We evaluated whether the degree of upper central incisor proclination can result in tooth colour change. METHODS: Forty young adult subjects (20-25 years) in good health with a complete sound dentition were selected. The subjects were seated in standardized light conditions with an above-directed light source. Their natural head position was stated as 0 degrees. To mimic the range of possible anterior torque movements they were asked to tilt their heads upward +15 degrees (upward tilting) and downward -15 degrees (downward tilting). Frontal macro photographs, parallel to the Frankfort plane of the patient's natural head position were taken at the three head angulations (+15, 0, and -15 degrees ). Photographs were analysed for colour differences at the centre of the incisor clinical crowns with a CIE L*a*b* colour model based software. A paired t-test was used to test for significance between each value for each inclination. RESULTS: Differences were found between the CIE L*a*b* colour values for: upward tilting, downward tilting, and -15 to +15 degrees (total tilting) except for b* values for downward tilting. As the inclination of the subject's head changed downward, the upper incisors were retroclined and the CIE L*a*b* values indicated a darker and less green but redder colour component. As the inclination of the subject's head changed upwards the upper incisors were proclined and the L*a*b* values indicated a lighter and less green and yellow but redder and bluer colour component. CONCLUSIONS: Proclination of upper incisors caused lighter tooth colour parameters compared to retroclined incisors and colour changes. Orthodontic change of upper incisor inclination may induce alterations on how tooth colour is perceived.

Modifying the biomechanical response of mouthguards with hard inserts: A finite element study.

PURPOSE: To investigate the influence of a high elastic modulus material insert on the stress, shock absorption and displacement of mouthguards. METHODS: Finite element models of a human maxillary central incisor with and without mouthguard were created based on cross-sectional CT-tomography. The mouthguard models had four designs: without insert, and middle, external, or palatal hard insert. The hard inserts had a relatively high elastic modulus when compared to the elastic modulus of ethylene vinyl acetate (EVA): 15 GPa versus 18 MPa. A non-linear dynamic impact analysis was performed in which a heavy rigid object hit the model at 1 m/s. Strain and stress (von Mises and critical modified von Mises) distributions and shock absorption during impact were calculated as well as the mouthguard displacement. RESULTS: The model without mouthguard had the highest stress values at the enamel and dentin structures in the tooth crown during the impact. It was concluded that the use of a mouthguard promoted lower stress and strain values in the teeth during impact. Hard insertion in the middle and palatal side of the mouthguard improved biomechanical response by lowering stress and strain on the teeth and lowering mouthguard displacement.

Biomechanical effects of corticotomy approaches on dentoalveolar structures during canine retraction: A 3-dimensional finite element analysis.

INTRODUCTION: Corticotomy has proven to be effective in facilitating orthodontic tooth movement. There is, however, no relevant study to compare the biomechanical effects of different corticotomy approaches on tooth movement. In this study, a series of corticotomy approaches was designed, and their impacts on dentoalveolar structures were evaluated during maxillary canine retraction with a 3-dimensional finite element method. METHODS: A basic 3-dimensional finite element model was constructed to simulate orthodontic retraction of the maxillary canines after extraction of the first premolars. Twenty-four corticotomy approach designs were simulated for variations of position and width of the corticotomy. Displacement of the canine, von Mises stresses in the canine root and trabecular bone, and strain in the canine periodontal ligament were calculated and compared under a distal retraction force directed to the miniscrew implants. RESULTS: A distal corticotomy cut and its combinations showed the most approximated biomechanical effects on dentoalveolar structures with a continuous circumscribing cut around the root of the canine. Mesiolabial and distopalatal cuts had a slight influence on dentoalveolar structures. Also, the effects decreased with the increase of distance between the corticotomy and the canine. No obvious alteration of displacement, von Mises stress, or strain could be observed among the models with different corticotomy widths. CONCLUSIONS: Corticotomies enable orthodontists to affect biomechanical responses of dentoalveolar structures during maxillary canine retraction. A distal corticotomy closer to the canine may be a better option in corticotomy-facilitated canine retraction.

Finite element method analysis of the periodontal ligament in mandibular canine movement with transparent tooth correction treatment.

BACKGROUND: This study used the 3D finite element method to investigate canine's displacements and stresses in the canine's periodontal ligament (PDL) during canine's translation, inclination, and rotation with transparent tooth correction treatment. METHODS: Finite element models were developed to simulate dynamic orthodontic treatments of the translation, inclination, and rotation of the left mandibular canine with transparent tooth correction system. Piecewise static simulations were performed to replicate the dynamic process of orthodontic treatments. The distribution and change trends of canine's displacements and stresses in the canine's PDL during the three types of tooth movements were obtained. RESULTS: Maximum displacements were observed at the crown and middle part in the translation case, at the crown in the inclination case, and at the crown and root part in the rotation case. The relative maximum von Mises and principal stresses were mainly found at the cervix of the PDL in the translation and inclination cases. In the translation case, tensile stress was mainly observed on the mesial and distal surfaces near the lingual side and compressive stress was located at the bottom of the labial surface. In the inclination case, tensile stress was mainly observed at the labial cervix and lingual apex and compressive stress was located at the lingual cervix and labial apex. In the rotation case, von Mises stress was mainly located at the cervix and inside the lingual surface, tensile stress was located on the distal surface, and compressive stress was detected on the mesial surface. The stress and displacement value rapidly decreased in the first few steps and then reached a plateau. CONCLUSIONS: Canine's movement type significantly influences the distribution of canine's displacement and stresses in the canine's PDL. Changes in canine's displacement and stresses in the canine's PDL were exponential in transparent tooth correction treatment.

Eruptive and functional changes in periodontal ligament fibroblast orientation in CD44 wild-type vs. knockout mice.

BACKGROUND AND OBJECTIVE: Periodontal ligament (PDL) fibroblasts establish principal fibers of the ligament during tooth eruption, and maintain these fibers during occlusion. PDL development and occlusal adaptation includes changes in the orientation of PDL fibroblasts; however, the mechanism for these changes in orientation is unclear. The objective of this study was to compare PDL fibroblast orientation in different stages corresponding with first molar eruption and occlusion in CD44 wild-type (WT) and knockout (KO) mice. MATERIAL AND METHODS: CD44 WT and KO mice were raised to six postnatal stages corresponding with first molar (M1 ) eruption (postnatal day 8, 11, 14 and 18) and occlusion (postnatal day 26 and 41). Coronal sections of the first mandibular molar (M1 ) were prepared and the orientation of fibroblasts in the cervical root region was measured. Angle measurements were compared across developmental stages and between strains using Watson-Williams F-test (oriana software) and ANCOVA. RESULTS: PDL fibroblast orientation increased significantly in CD44 WT (9-87°) and KO mice (14-93°; p ≤ 0.05) between intraosseous eruption (day 11), mucosal penetration (day 14) and preocclusal eruption (day 18); however, the PDL fibroblast orientation did not change significantly with the onset of occlusion (day 26) or continued function (day 41). Within each strain, the variance in fibroblast orientation during preocclusal eruption (day 18) was significantly higher than the variance of all other time points (p < 0.0005). CD44 WT and KO mice showed a similar pattern of PDL development and eruption with a significant difference in CD44 WT vs. KO fibroblast orientations only during early function (day 26, 92° vs 116°; p = 0.05). CONCLUSIONS: The development of PDL fibroblast orientation is highly similar between CD44 WT and KO mice. Between early (day 11) and late (day 18) eruptive stages PDL fibroblast orientation increases, corresponding with the upward movement of M1 . The PDL fibroblast orientation established in preocclusal eruption (day 18) is maintained during early (day 26) and late (day 41) stages of occlusal function, suggesting that PDL cells adapt to mechanical loads in the oral cavity before M1 occlusion.

The time-dependent biomechanical behaviour of the periodontal ligament--an in vitro experimental study in minipig mandibular two-rooted premolars.

The aim of the present work was to evaluate the biomechanical behaviour of the periodontal ligament (PDL) with respect to force development with different controlled loading velocities. For this purpose, an in vitro experimental study was performed on 18 minipig jaw segments. Displacements with variable increasing loading time were applied to one premolar crown of each jaw segment into the linguobuccal direction through a force sensor provided by a specialized biomechanical set-up. The predefined displacement values to be achieved were 0.1 and 0.2 mm. Each of the given displacement increments was applied on the specimens with a linear displacement increase employing the following time spans: 5, 10, 20, 30, 60, 120, 300, 450, and 600 seconds. Force values were measured during load application to register force/displacement diagrams and after the maximum displacement was reached force decay was monitored for a period of 600 seconds. Force/time curves for each tooth were plotted according to the data obtained. Diagrams of the maximum force values obtained from these plots and the force at the end of each measurement were extracted for all teeth. Forces at the point when maximum displacement was reached ranged from 0.5 to 2.5 N for the 0.1 mm activation and showed extreme variation with the specimens. The factor of volume and surface area of the individual roots were evaluated and found not to be responsible for these deviations. A comparable behaviour was recorded for the 0.2 mm deflection, however, on a higher force level. The results show that the force development at different displacement velocities is complex and dominated by the PDL biomechanical characteristics.

Biomechanical impact of labiolingual diameter on endodontically treated anterior teeth with crown restoration under occlusal loading.

OBJECTIVE: To evaluate the effect of the labiolingual diameter and construction of an endodontically treated (ET) anterior tooth with crown restoration on stress distribution and biomechanical safety under occlusal loading. METHODOLOGY: Three-dimensional finite element models were generated for maxillary central incisors with all-ceramic crown restorations. The labiolingual diameters of the tooth, defined as the horizontal distance between the protrusion of the labial and lingual surfaces, were changed as follows: (D1) 6.85 mm, (D2) 6.35 mm, and (D3) 5.85 mm. The model was constructed as follows: (S0) vital pulp tooth; (S1) ET tooth; (S2) ET tooth with a 2 mm ferrule, restored with a fiber post and composite resin core; (S3) ET tooth without a ferrule, restored with a fiber post and composite resin core. A total of 12 models were developed. In total, two force loads (100 N) were applied to the crown's incisal edge and palatal surface at a 45° oblique angle to the longitudinal axis of the teeth. The Von Mises stress distribution and maximum stress of the models were analyzed. RESULTS: Regardless of the loading location, stress concentration and maximum stress (34.07~66.78MPa) in all models occurred in the labial cervical 1/3 of each root. Both labiolingual diameter and construction influenced the maximum stress of the residual tooth tissue, with the impact of the labiolingual diameter being greater. A reduction in labiolingual diameter led to increased maximum stress throughout the tooth. The ferrule reduced the maximum stress of the core of S2 models (7.15~10.69 MPa), which is lower compared with that of S3 models (19.45~43.67 MPa). CONCLUSION: The labiolingual diameter exerts a greater impact on the biomechanical characteristics of ET anterior teeth with crown restoration, surpassing the influence of the construction. The ferrule can reduce the maximum stress of the core and maintain the uniformity of stress distribution.

Effect of cavity design on tooth surface strain.

STATEMENT OF PROBLEM: The loss of tooth structure can increase cuspal flexure, thereby reducing the fracture resistance of the tooth, or open the tooth-restoration interface, leading to microleakage. PURPOSE: The purpose of this study was to evaluate tooth strain in teeth with different cavity preparations after loading and unloading. MATERIAL AND METHODS: Ten intact human maxillary premolars were selected and embedded in epoxy resin molds. Constantan strain gauges were used and tested as an intact tooth (group I), occlusal cavity (group O), mesio-occlusal cavity (group MO), and finally mesio-occluso-distal cavity (group MOD). All teeth were subjected to gradual nondestructive occlusal loading and unloading (50 N, 70 N, 90 N, 110 N, 130 N, 50 N, 0 N) in a servohydraulic testing machine. All data were analyzed statistically by performing a repeated measures ANOVA with load and cavity as factors to compare the relevant mean strains, and a Bonferroni post hoc test was performed for multiple comparisons (α=.05). RESULTS: The repeated measures ANOVA did not provide any evidence of an interaction between load and cavity but indicated a significant difference in the mean strains both between the loads (P<.001) and between the cavity groups (P<.001). CONCLUSIONS: MOD cavities presented statistically significantly higher values of strain than MO, O, or intact teeth, and a significant increase in the values of mean strain for all cavities was observed, even with intact teeth, when nondestructive occlusal loading was increased.

Estimation of periodontal ligament's equivalent mechanical parameters for finite element modeling.

INTRODUCTION: Young's modulus (E) and Poisson's ratio (v) of the periodontal ligament are needed in a finite element analysis for investigating the biomechanical behavior of a tooth, periodontal ligament, and bone complex. However, large discrepancies in E (0.01-1,750 MPa) and v (0.28-0.49) were reported previously. The objective of this study was to narrow the ranges and to provide equivalent E and v pairs suitable for finite element modeling of a tooth, periodontal ligament, and bone complex by using a reported crown load-displacement relationship as the criterion. METHODS: A 3-dimensional finite element model of a 3-tooth, periodontal ligament, and bone complex, consisting of a maxillary central incisor with 2 adjacent teeth, from a cone-beam computed tomography scan was created. The dimensions, constraints, and loading condition were kept similar to those reported in the human study. With the load applied to the crown, both v and E were adjusted independently, and the corresponding crown displacements were calculated. The resulting load-displacement curves were compared with those reported in the human study. The mean absolute displacement difference method was used to find the best fit. The E and v pairs that generated the minimum mean absolute displacement difference were identified. RESULTS: The finite element model with 1 of the 3 E and v pairs (v = 0.35, E = 0.87 MPa; v = 0.4, E = 0.71 MPa; and v = 0.45, E = 0.47 MPa) simulated the tooth, periodontal ligament, and bone complex well. The mean absolute displacement differences were 0.0135, 0.0138, and 0.0138 mm, respectively; these are less than 8% of 0.175 mm, which was the crown displacement of the tooth, periodontal ligament, and bone complex under the load of 500 cN. CONCLUSIONS: The E and v values close to the 3 pairs might be used for finite element modeling of the tooth, periodontal ligament, and bone complex.

Numerical simulations of canine retraction with T-loop springs based on the updated moment-to-force ratio.

The purpose of this study was to develop a new finite element method for simulating long-term tooth movements and to compare the movement process occurring in canine retraction using a T-loop spring having large bends and with that having small bends. Orthodontic tooth movement was assumed to occur in the same manner as the initial tooth movement, which was controlled by the moment-to-force (M/F) ratios acting on the tooth. The M/F ratios were calculated as the reaction forces from the spring ends. For these M/F ratios, the teeth were moved based on the initial tooth movements, which were calculated by using the bilinear elastic model of the periodontal ligament. Repeating these calculations, the teeth were moved step by step while updating the M/F ratio. In the spring with large bends, the canine at first moved bodily, followed by root distal tipping. The bodily movement was quickly achieved, but over a short distance. In the spring with small bends, the canine at first rotated and root mesial tipping occurred, subsequently the canine uprighted and the rotation decreased. After a long time elapsed, the canine moved bodily over a long distance. It was found that the long-term tooth movement produced by the T-loop springs could be simulated by the method proposed in this study. The force system acting on the teeth and the movement type remarkably changed during the long-term tooth movement. The spring with large bends could move the canine bodily faster than that with small bends.

Influence of crown ferrule heights and dowel material selection on the mechanical behavior of root-filled teeth: a finite element analysis.

PURPOSE: This study used the 3D finite element (FE) method to evaluate the mechanical behavior of a maxillary central incisor with three types of dowels with variable heights of the remaining crown structure, namely 0, 1, and 2 mm. MATERIALS AND METHODS: Based on computed microtomography, nine models of a maxillary central incisor restored with complete ceramic crowns were obtained, with three ferrule heights (0, 1, and 2 mm) and three types of dowels (glass fiber = GFD; nickel-chromium = NiCr; gold alloy = Au), as follows: GFD0--restored with GFD with absence (0 mm) of ferrule; GFD1--similar, with 1 mm ferrule; GFD2--glass fiber with 2 mm ferrule; NiCr0--restored with NiCr alloy dowel with absence (0 mm) of ferrule; NiCr1--similar, with 1 mm ferrule; NiCr2--similar, with 2 mm ferrule; Au0--restored with Au alloy dowel with absence (0 mm) of ferrule; Au1--similar, with 1 mm ferrule; Au2--similar, with 2 mm ferrule. A 180 N distributed load was applied to the lingual aspect of the tooth, at 45° to the tooth long axis. The surface of the periodontal ligament was fixed in the three axes (x = y = z = 0). The maximum principal stress (σ(max)), minimum principal stress (σ(min)), equivalent von Mises (σ(vM)) stress, and shear stress (σ(shear)) were calculated for the remaining crown dentin, root dentin, and dowels using the FE software. RESULTS: The σ(max) (MPa) in the crown dentin were: GFD0 = 117; NiCr0 = 30; Au0 = 64; GFD1 = 113; NiCr1 = 102; Au1 = 84; GFD2 = 102; NiCr2 = 260; Au2 = 266. The σ(max) (MPa) in the root dentin were: GFD0 = 159; NiCr0 = 151; Au0 = 158; GFD1 = 92; NiCr1 = 60; Au1 = 67; GFD2 = 97; NiCr2 = 87; Au2 = 109. CONCLUSION: The maximum stress was found for the NiCr dowel, followed by the Au dowel and GFD; teeth without ferrule are more susceptible to the occurrence of fractures in the apical root third.

Nature of occlusion during eccentric mandibular movements in young adults.

AIM: The aim of this study was to find out the nature of occlusion and tooth contact during various eccentric mandibular movements in young adults with class I occlusion. MATERIALS AND METHODS: The sample consisted of 100 young adults with class I occlusion with full complement of teeth. Anterior disclusion in centric occlusion was demonstrated using a shim stock interposed between the upper and lower anteriors. Disclusion of posteriors was ascertained during 1.5 mm straight protusion and in edge-to-edge protrusion, visually as well as using a silk floss method. Posterior disclusion was also verified during lateroprotrusion and crossover. Besides these occlusal wear of teeth also were observed. RESULTS: The results of this study showed that the anterior disclusion is seen only in one-fourth of the subjects compared to almost three-fourth showing posterior disclusion. Mutually protected occlusion was also seen only in one-fourth of the subjects. Canine protective mechanism is seen in a relatively large number of subjects, but it was not overwhelmingly predominant. No correlation could be established between cuspid wear and the type of occlusion. A relatively high percentage of subjects showed wear on posterior teeth when there was no posterior disclusion. CONCLUSION: From the above study it is seen that posterior disclusion is acknowledged as a common factor except when a bilateral balance is present. Since bilateral balance is harmful, the ideal occlusal relationship in eccentric movements is in favor of posterior disclusion. Posterior disclusion is easily obtainable when restorations are planned. CLINICAL SIGNIFICANCE: From the findings and results it has been possible to make some contributions on the nature of tooth contacts and disclusion during various eccentric movements and compare it with the requirements of ideal occlusion.

Adhesive restoration of endodontically treated premolars: influence of posts on cuspal deflection.

PURPOSE: To determine, by means of a non-destructive experimental procedure, the effectiveness of adhesive restorations in reducing the cuspal deflection of endodontically treated premolars, with or without root canal fiber posts. MATERIALS AND METHODS: The cuspal deflection of ten sound, intact maxillary premolars was evaluated. A loading device induced deformation by axial force (ranging from 98 to 294 N) applied on the occlusal surface of teeth while laser sensors registered the amount of deflection. Once tested, teeth were endodontically treated and the marginal ridges were removed. The teeth were randomly divided into two groups and restored with: group 1) dual curing adhesive, flowable composite, and microhybrid composite; group 2) the same materials associated with root canal glass fiber post and composite cement. The cuspal deflection test was repeated with the same protocol after restorative procedures, allowing a direct comparison of the same samples. Statistical analysis was performed using ANOVA at a significance level of 0.05. RESULTS: Different average cuspal deflection was detected in the two groups: composite resin with post insertion resulted in lower deformation compared with composite alone. Mean deflection ranged from 3.43 to 12.17 µm in intact teeth, from 14.42 to 26.93 µm in group 1, and from 15.35 to 20.39 µm in group 2. ANOVA found significant differences (p = 0.02). CONCLUSION: Bonded composite restorations with fiber posts may be more effective than composite alone in reducing the cuspal deflection in endodontically treated premolars in which the marginal ridges have been lost.

Exploring the use of pulsed erbium lasers to retrieve a zirconia crown from a zirconia implant abutment.

BACKGROUND: Removal of cement-retained implant fixed restorations when needed, can be challenging. Conventional methods of crown removal are time consuming and costly for patients and practitioners. This research explored the use of two different types of pulsed erbium lasers as a non-invasive tool to retrieve cemented zirconia crowns from zirconia implant abutments. MATERIALS AND METHODS: Twenty identical zirconia crowns were cemented onto 20 identical zirconia prefabricated abutments using self-adhesive resin cement. The specimens were divided into two groups for laser assisted crown removal; G1 for erbium-doped yttrium aluminum garnet laser (Er:YAG), and G2 for erbium, chromium-doped yttrium, scandium, gallium and garnet (Er,Cr:YSGG). For the G1, after the first crown removal, the specimens were re-cemented and removed again using the Er:YAG laser. Times needed to remove the crowns were recorded and analyzed using ANOVA (α = 0.05). The surfaces of the crown and the abutment were further examined using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) analyses. RESULTS: The average times of zirconia crown removal from zirconia abutments were 5 min 20 sec and 5 min 15 sec for the Er:YAG laser of first and second experiments (G1), and 5 min 55 sec for the Er,Cr:YSGG laser experiment (G2). No statistical differences were observed among the groups. SEM and EDS examinations of the materials showed no visual surface damaging or material alteration from the two pulsed erbium lasers. CONCLUSIONS: Both types of pulsed erbium lasers can be viable alternatives for retrieving a zirconia crown from a zirconia implant abutment. Despite operating at different wavelengths, the Er:YAG and Er,Cr:YSGG lasers, perform similarly in removing a zirconia crown from a zirconia implant abutment with similar parameters. There are no visual and elemental composition damages as a result of irradiation with pulsed erbium lasers.

Reduction of Egf signaling decides transition from crown to root in the development of mouse molars.

Mouse, rat, and human molars begin to form their roots after the completion of crown morphogenesis. Though several signaling pathways and transcription factors have been implicated in the regulation of molar crown development, relatively little is known about the regulatory mechanisms involved in the transition from crown to root development. Tooth root formation is initiated by the development of Hertwig's epithelial root sheath (HERS) from the cervical loop in the enamel organ. In this study we examined the change in epidermal growth factor (Egf) signaling during this transition process. Immunohistochemical studies showed that the expression of Egf receptors in the enamel organ disappear gradually in the process and are not observed in HERS. Here, to examine the effect of Egf on the transition, we used the organ culture method to examine the root development. In the presence of Egf, stellate reticulum (SR) cells between the inner and outer epithelial layers in the enamel organ actively proliferated and maintained the enamel organ, and the formation of HERS was not observed. On the other hand, in either the absence of Egf or the presence of the inhibitor of Egf receptors, the SR cells disappeared and HERS formation started. Subsequently, root formation proceeded in the culture period. Therefore, disappearance of SR area may be a key event that controls the timing of onset of HERS formation, and Egf may be one of regulatory factors involved in the change from cervical loop epithelium to HERS during root development.

Crown formation during tooth development and tissue engineering.

Considering tooth crown engineering, three main parameters have to be taken into account: (1) the relationship between crown morphology and tooth functionality, (2) the growth of the organ, which is hardly compatible with the use of preformed scaffolds, and (3) the need for easily available nondental competent cell sources. In vitro reassociation experiments using either dental tissues or bone marrow-derived cells (BMDC) have been designed to get information about the mechanisms to be preserved in order to allow crown engineering. As the primary enamel knot (PEK) is involved in signaling crown morphogenesis, the formation and fate of this structure was investigated (1) in heterotopic reassociations between embryonic day 14 (ED14) incisor and molar enamel organs and mesenchymes, and (2) in reassociations between ED14 molar enamel organs and BMDC. A PEK formed in cultured heterotopic dental tissue reassociations. The mesenchyme controls the fate of the EK cells, incisor or molar-specific using apoptosis as criterion, and functionality to drive single/multiple cusps tooth development. Although previous investigations showed that they might differentiate as odontoblast- or ameloblast-like cells, BMDC reassociated to an enamel organ could not support the development of multicusp teeth. These cells apparently could neither maintain nor stimulate the formation of a PEK.

An engineering analysis of dental occlusion principles.

INTRODUCTION: The purpose of this study was to develop an analytical model of contacting teeth, based on principles of basic engineering statics. The model would be used to demonstrate the interactions between occlusal contacts and tooth loading (forces and moments) and to critique occlusion-related dogma. METHODS: Free-body diagrams were drawn to depict 2 teeth in occlusal contact. In combination with the concept of the center of resistance, the governing equilibrium equations were derived and used to solve for the forces and moments on the teeth and to investigate the influences of tripod and cusp-fossa occlusal schemes. RESULTS: With a specific load on a tooth, it was demonstrated that the load on the opposing tooth and the concomitant occlusal scheme dictated crown-crown contact forces that can be computed. CONCLUSIONS: This engineering analysis suggests flaws in widely held notions about the mechanics of occlusion. Loading that is generally considered clinically desirable is certain to produce undesirable loading on the opposing tooth. The complex relationships between the loads on teeth and crown-crown occlusal contacts make it virtually impossible to control tooth loading with occlusal equilibration. For computational and conceptual reasons, it is essential to consider the center of resistance.

Torque control of the maxillary incisors in lingual and labial orthodontics: a 3-dimensional finite element analysis.

INTRODUCTION: Lingual orthodontics has developed rapidly in recent years; however, research on torque control variance of the maxillary incisors in both lingual and labial orthodontics is still limited, especially studies with 3-dimensional finite element methods. Thorough understanding of the biomechanical differences of incisor torque control during lingual and labial orthodontic treatment is critical for the best results. METHODS: A 3-dimensional finite element model of the maxilla and the maxillary incisors was made with 98,106 nodes, 71,944 10-node solid elements, and 5236 triangle shell units. Horizontal retraction force, vertical intrusive force, and lingual root torque were applied to simulate labial and lingual orthodontic treatment. Then the distribution of the stress-strain (maximum and minimum principal stresses; maximum and minimum principal strains) in the periodontal ligament, the total displacement, and the vector graph of displacement of the nodes of the maxillary central incisor were analyzed and compared between labial and lingual orthodontics. RESULTS: Loads of the same magnitude produced translation of the maxillary incisor in labial orthodontics but lingual crown tipping of the same tooth in lingual orthodontics. This suggests that loss of torque control of the maxillary incisors during retraction in extraction patients is more likely in lingual orthodontic treatment. CONCLUSIONS: Lingual orthodontics should not simply follow the clinical experience of the labial techniques but should increase lingual root torque, increase vertical intrusive force, and decrease horizontal retraction force properly to achieve the best orthodontic results.

Mechanical responses to orthodontic loading: a 3-dimensional finite element multi-tooth model.

INTRODUCTION: The initial mechanical response to orthodontic loading comprises biologic reactions that remain unclear, despite their clinical significance. We used a 3-dimensional finite element analysis to investigate the stress-strain responses of teeth to orthodontic loading. METHODS: The model was derived from computed tomography data, with adequate boundary conditions and tissue characterization, with orthodontic hardware to provide a more accurate reflection of events during orthodontic therapy. This study also incorporated the adjacent dentition. Two cases were analyzed: a single-tooth system with a mandibular canine, and a multi-tooth system consisting of the mandibular incisor, the canine, and the first premolar, subjected to orthodontic tipping forces. RESULTS AND CONCLUSIONS: The systems experienced elevated distortion strain energies in the alveolar crest, whereas the tensile and compressive stresses coincided with the apical sites clinically associated with root resorption. Stress levels were considerably greater in the multi-tooth system than in the single-tooth system. The results for the single-tooth model agree with those previously reported. The numeric studies show how orthodontic tooth movement develops different stress fields and how root resorption might occur as a result of hydrostatic compressive stress-induced tissue necrosis.