Nonuniformity in ligaments is a structural strategy for optimizing functionality.

Ligaments serve as compliant connectors between hard tissues. In that role, they function under various load regimes and directions. The 3D structure of ligaments is considered to form as a uniform entity that changes due to function. The periodontal ligament (PDL) connects the tooth to the bone and sustains different types of loads in various directions. Using the PDL as a model, employing a fabricated motorized setup in a microCT, we demonstrate that the fibrous network structure within the PDL is not uniform, even before the tooth becomes functional. Utilizing morphological automated segmentation methods, directionality analysis, as well as second harmonic generation imaging, we find high correlation between blood vessel distribution and fiber density. We also show a structural feature in a form of a dense collar around the neck of the tooth as well as a preferred direction of the fibrous network. Finally, we show that the PDL develops as a nonuniform structure, with an architecture designed to sustain specific types of load in designated areas. Based on these findings, we propose that ligaments in general should be regarded as nonuniform entities, structured already at developmental stages for optimal functioning under variable load regimes.

Effects of age, sex, and blood pressure on the blood flow velocity in dental pulp measured by Doppler ultrasound technique.

OBJECTIVE: To examine the effects of age, sex, and BP on the PBFV in human maxillary anterior teeth. METHODS: A total of 332 maxillary anterior teeth from 95 participants were included. The age and sex of each subject were recorded. The systolic and diastolic BPs were measured by a digital sphygmomanometer. The PBFV of each tooth was measured by a Doppler ultrasound system with a 20 MHz transducer. RESULTS: Among the variables, only systolic BP demonstrated a significant association with the PBFV. There were significant decreases in the PBFV with the groups of lower BP (P<.05). Age, sex, and tooth type were not significantly associated with the PBFV. CONCLUSIONS: Within the limitations of this study, it is considered that the PBFV increases with an increase in systolic BP. Age, sex, and tooth type had no significant effect on the PBFV of maxillary anterior teeth.

Pulp revascularization of immature permanent teeth: a review of the literature and a proposal of a new clinical protocol.

Tissue engineering is a growing field. In the near future, it will probably be possible to generate a complete vital tooth from a single stem cell. Pulp revascularization is dependent on the ability of residual pulp and apical and periodontal stem cells to differentiate. These cells have the ability to generate a highly vascularized and a conjunctive rich living tissue. This one is able to colonize the available pulp space. Revascularization is a new treatment method for immature necrotic permanent teeth. Up to now, apexification procedures were applied for these teeth, using calcium dihydroxide or MTA to produce an artificial apical barrier. However, the pulp revascularization allows the stimulation of the apical development and the root maturation of immature teeth. Two pulp revascularization techniques are used in the literature, one using calcium dihydroxide and the second using a triple antibiotic paste. Based on these two different pulp revascularization protocols, which obtain the desired therapeutic success, the literature will be reviewed and analyzed according to the relevance of their choice of materials. Based on the literature, we propose a new relevant protocol and a new mixture of antibiotics.

Outcomes of revascularization treatment in immature dog's teeth.

AIM: The purpose of the current study was to examine the success rate of a revascularization treatment protocol involving canal space disinfection using copious irrigation, a triantibiotic dressing, and induction of a blood clot matrix in immature dog's teeth. MATERIALS AND METHODS: Thirty-six immature mongrel dog's teeth were divided into two experimental and two control groups. The experimental groups included a necrotic-infected group (n = 20) and a vital group (n = 10). In the group with the necrotic-infected teeth, periapical lesions were induced, and disinfection of the canals was carried out using copious irrigation and a triple antibiotic medication (metronidazole, ciprofloxacin, and tetracycline). Subsequently, the periapical tissues were irritated to initiate bleeding, producing a blood clot. A double seal of the coronal access was then placed. In the vital group, the pulp was aseptically removed before the canal was irrigated and periapical tissues irritated to induce bleeding. The same protocol as that used for the necrotic-infected group was used to seal the coronal access. In the positive control group (n = 3), after pulp removal, sterile sponges soaked in plaque suspension were placed in the pulp chambers of the teeth, after which the chambers were sealed. In the negative control group (n = 3), one untouched 1st premolar tooth in each dog was assigned and left to develop naturally. Radiographic and histological findings were evaluated at 3 and 6 months. Data analysis was performed using Fisher's exact test. RESULTS: The necrotic-infected group radiographically demonstrated apical healing and apical closure in 70% of the cases and thickening of the walls in 40% after 6 months. The vital group showed apical closure in 77% and thickened walls in 44% of the cases after 3 months. Histological findings confirmed the radiographic findings. No significant difference was observed between the two groups (P > 0.05). CONCLUSIONS: If necrotic-infected canals are effectively disinfected and treated according to the protocol, the ensuing revascularization response is similar to that of vital immature teeth.

Unravelling the blood supply to the zebrafish pharyngeal jaws and teeth.

We describe the vascular supply to the pharyngeal jaws and teeth in zebrafish, from larval stages to juveniles, using serial high quality semithin sections and 3D reconstructions. We have identified that the arterial blood supply to the last pair of branchial arches, which carries the teeth, issues from the hypobranchial artery. Surprisingly, the arteries supplying the pharyngeal jaws show an asymmetric branching pattern that is modified over ontogeny. Moreover, the blood vessel pattern that serves each jaw can best be described as a sinusoidal cavity encircling the bases of both the functional and replacement teeth. Capillaries branching from this sinusoidal cavity enter the pulp and constitute the intrinsic blood supply to the attached teeth. The role of these blood vessels during tooth development (whether instructive or nutritive) remains to be determined and requires further study. However, we have provided a firm morphological basis that will aid in the interpretation of experiments addressing this question.

Expression patterns of Sema3F, PlexinA4, -A3, Neuropilin1 and -2 in the postnatal mouse molar suggest roles in tooth innervation and organogenesis.

OBJECTIVE: Semaphorins form a family of axon wiring molecules but still little is known about their role in tooth formation. A class 3 semaphorin, Semaphorin3F (Sema3F), besides acting as a chemorepellant for different types of axons, controls a variety of non-neuronal developmental processes. MATERIALS AND METHODS: Cellular mRNA expression patterns of Sema3F as well as neuropilin 1 (Npn1), neuropilin 2 (Npn2), plexinA3 and plexinA4 receptors were analyzed by sectional in situ hybridization in the mouse molar tooth during postnatal days 0-7. The expression of the receptors was studied in PN5 trigeminal ganglia. RESULTS: Sema3F, Npn1, -2 and plexinA4 exhibited distinct, spatiotemporally changing expression patterns, whereas plexinA3 was not observed in the tooth germs. Besides being expressed in the base of the dental mesenchyme Sema3F, like plexinA4, Npn1 and -2, was present in the ameloblast cell lineage. Npn1 and Npn2 were additionally seen in the pulp horns and endothelial cells and like PlexinA4 in the developing alveolar bone. Npn1, plexinA3 and -A4 were observed in trigeminal ganglion neurons. CONCLUSIONS: Sema3F may act as a tooth target-derived axonal chemorepellant controlling establishment of the tooth nerve supply. Furthermore, Sema3F, like Npn1, -2 and plexinA4 may serve non-neuronal functions by controlling the development of the ameloblast cell lineage. Moreover, Npn1 and Npn2 may regulate dental vasculogenesis and, together with PlexinA4, alveolar bone formation. Further analyses such as investigation of transgenic mouse models will be required to elucidate in vivo signaling functions of Sema3F and the receptors in odontogenesis.

Limited Evidence Suggests Benefits of Single Visit Revascularization Endodontic Procedures - A Systematic Review.

Revascularization endodontic procedures commonly require multiple treatment sessions. However, single visit procedures may be advantageous from the clinical and patient management standpoints. The purpose of this review was to evaluate the outcomes of single-visit revascularization endodontic procedures for the management of immature permanent teeth with non-vital pulp. Two electronic databases (Scopus and PubMed) were searched, from their inception to July 2018, for studies that assessed clinical and/or radiographic and/or histologic outcomes of single-visit revascularization endodontic procedures performed in immature permanent teeth with non-vital pulp. Case reports, animal studies and clinical trials were included. The quality of case reports was appraised by Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. The quality of randomized clinical trials was assessed by the revised Cochrane risk of bias tool for randomized trials. The risk of bias for animal studies was assessed using SYRCLE's risk of bias tool. Tabulation followed by narrative synthesis was used to draw conclusions. Seven studies satisfied the selection criteria. Five were classified as case reports, one as a randomized clinical trial and one as animal study. The latter presented with a high risk of bias, whilst the remaining showed a low risk. The evidence supporting the potential use of single-visit revascularization endodontic procedures is scarce. Successful single-visit revascularization endodontic procedures commonly include the use of high concentrations of sodium hypochlorite and EDTA combined with the use of agitation systems. Further clinical trials with long term follow up are needed to confirm the results of the current review.

Odontology or philologic: medical disputation about the teeth.

The dissertation, here rendered, was published at the gymnasium of Hof in 1669. It is remarkable that the respondent, who was probably also its author, declared in the title page that he intends to do his task "following the custom of the blessed Hebrews and any other conventions of true Israelites" and cites in the following text repeated proverbs of Rabbis. Therefore, we suppose him to have been a Jew converted to the Christian faith. His Odontology is a large collection of knowledge about the teeth, the etymology of this term, the question of them belonging to the bones, their anatomy and fixation in the jaws, and their tasks in the crushing of foods and helping in pronunciation, and in animals for self-protection. With respect to their removal, he emphasizes that one read Sennert's Institutiones Medicae. The points of view discussed by the author depended more heavily on philological than on medical authors. Nevertheless, there are mentioned also "paramedical" opinions of the general population. The monograph seems to us important for the history of dentistry.

Pulp Vascularization during Tooth Development, Regeneration, and Therapy.

The pulp is a highly vascularized tissue situated in an inextensible environment surrounded by rigid dentin walls, with the apical foramina being the only access. The pulp vascular system is not only responsible for nutrient supply and waste removal but also contributes actively to the pulp inflammatory response and subsequent regeneration. This review discusses the underlying mechanisms of pulp vascularization during tooth development, regeneration, and therapeutic procedures, such as tissue engineering and tooth transplantation. Whereas the pulp vascular system is established by vasculogenesis during embryonic development, sprouting angiogenesis is the predominant process during regeneration and therapeutic processes. Hypoxia can be considered a common driving force. Dental pulp cells under hypoxic stress release proangiogenic factors, with vascular endothelial growth factor being one of the most potent. The benefit of exogenous vascular endothelial growth factor application in tissue engineering has been well demonstrated. Interestingly, dental pulp stem cells have an important role in pulp revascularization. Indeed, recent studies show that dental pulp stem cell secretome possesses angiogenic potential that actively contributes to the angiogenic process by guiding endothelial cells and even by differentiating themselves into the endothelial lineage. Although considerable insight has been obtained in the processes underlying pulp vascularization, many questions remain relating to the signaling pathways, timing, and influence of various stress conditions.

Current challenges in human tooth revitalization.

Tooth vitality and health are related to the presence of a living connective tissue, the dental pulp (DP), in the center of the dental organ. The DP contains the tooth immune defence system that is activated against invading oral cariogenic bacteria during the caries process and the tissue repair/regeneration machinery involved following microorganisms' eradication. However, penetration of oral bacteria into the DP often leads to complete tissue destruction and colonization of the endodontic space by microorganisms. Classical endodontic therapies consist of disinfecting then sealing the endodontic space with a gutta percha-based material. However, re-infections of the endodontic space by oral bacteria can occur, owing to the lack of tightness of the material. Recent findings suggest that regenerating a fully functional pulp tissue may be an ideal therapeutic solution to maintain a tooth defence system that will detect and help manage future injuries. The objective of this paper was to explain the different revascularization and regeneration strategies that have been proposed to reconstitute a living DP tissue and to discuss the main challenges that have to be resolved to improve these therapeutic strategies.

Morphological variations in a tooth family through ontogeny in Pleurodeles waltl (Lissamphibia, Caudata).

Most nonmammalian species replace their teeth continuously (so-called polyphyodonty), which allows morphological and structural modifications to occur during ontogeny. We have chosen Pleurodeles waltl, a salamander easy to rear in the laboratory, as a model species to establish the morphological foundations necessary for future molecular approaches aiming to understand not only molecular processes involved in tooth development and replacement, but also their changes, notably during metamorphosis, that might usefully inform studies of modifications of tooth morphology during evolution. In order to determine when (in which developmental stage) and how (progressively or suddenly) tooth modifications take place during ontogeny, we concentrated our observations on a single tooth family, located at position I, closest to the symphysis on the left lower jaw. We monitored the development and replacement of the six first teeth in a large growth series ranging from 10-day-old embryos (tooth I1) to adult specimens (tooth I6), using light (LM), scanning (SEM), and transmission electron (TEM) microscopy. A timetable of the developmental and functional period is provided for the six teeth, and tooth development is compared in larvae and young adults. In P. waltl the first functional tooth is not replaced when the second generation tooth forms, in contrast to what occurs for the later generation teeth, leading to the presence of two functional teeth in a single position during the first 2 months of life. Larval tooth I1 shows dramatically different features when compared to adult tooth I6: a dividing zone has appeared between the dentin cone and the pedicel; the pulp cavity has enlarged, allowing accommodation of large blood vessels; the odontoblasts are well organized along the dentin surface; tubules have appeared in the dentin; and teeth have become bicuspidate. Most of these modifications take place progressively from one tooth generation to the next, but the change from monocuspid to bicuspid tooth occurs during the tooth I3 to tooth I4 transition at metamorphosis.

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.

Tissue characterization following revascularization of immature dog teeth using different disinfection pastes.

Revascularization of immature teeth with necrotic pulps traditionally involves the use of triple antibiotic paste, which may sometimes lead to undesirable complications. The objective of this study was to assess tissue repair in immature dog teeth with apical periodontitis subjected to revascularization, comparing two different pastes used for root canal disinfection. Apical periodontitis was induced in 30 dog premolars. Teeth were randomly divided into three experimental groups: root canals filled with triple antibiotic paste (n = 10); root canals filled with 1% propolis paste (n = 10); and no medication (n = 10). An additional group (n = 10, no intervention) was used as control. After 7 months, the jaws were histologically evaluated for the following variables: newly formed mineralized tissue (present/absent); vital tissue in the canal space (absent/periodontal ligament-like/pulp-like); apical extension of root (present/absent); and severity of inflammatory process (absent/mild/moderate/severe). There were no statistically significant differences among the experimental groups in new mineralized tissue formation and apical root development. The formation of vital tissue in the canal space, in turn, was statistically different between the triple paste and propolis groups: vital tissues were present in all revascularized teeth disinfected with propolis paste (100%), compared to 71% of those disinfected with the triple paste. Severity of inflammatory process was different between the triple paste and no medication groups. The new tissues formed onto canal walls and in the root canal space showed characteristics of cementum and periodontal ligament, respectively. Propolis may have some advantages over the triple paste for the revascularization of immature teeth.

Blocking VEGF signaling delays development of replacement teeth in zebrafish.

The dentition in zebrafish is extremely and richly vascularized, but the function of the vasculature, in view of the continuous replacement of the teeth, remains elusive. Through application of SU5416, a vascular endothelial growth factor receptor inhibitor, we studied the role of the blood vessels in the dentition of the zebrafish. We were unable to show an effect on the development of first-generation teeth as well as first tooth replacement. However, in juvenile fish, a delay was observed in the developmental state of the replacement tooth compared with what was expected based on the maturation state of the functional tooth. Furthermore, we observed a difference between treated and nontreated fish in the distance between blood vessels and developing replacement teeth. In conclusion, our results provide support for a nutritive, rather than an inductive, function of the vasculature in the process of tooth development and replacement.

NPY/sympathetic and NPY/VIP innervation of the blood vessels supplying rat tooth-related structures: effects of sympathectomy.

In order to better understand the regulation of blood flow to tooth-related structures, the patterns of VIP- and NPY-ergic innervations in the rat were examined. Nerve fibers showing NPY-like immunoreactivity (NPY-LI) frequently occurred in the walls of the large main arteries, as well as in association with the arterioles, to a high degree co-existing with tyrosine hydroxylase (TH), whereas VIP-LI was mainly restricted to the walls of the large arteries. After sympathectomy, no NPY/TH-LI nerve fibers were seen in blood vessel walls. However, a NPY-immunoreactive nerve population remained in the walls of the large arteries, NPY- and VIP-LI co-existing in this nerve population. Both immunoreactions were intense. The present study suggests that a NPY/sympathetic innervation as well as a VIP innervation (large arteries) are likely to have substantial roles in the balance and maintenance of vasoregulation in tooth-related structures and that a NPY/VIP innervation becomes of particular importance when the NPY/sympathetic innervation is destroyed.

Influence of Caldwell-Luc operation on developing permanent teeth.

The influence of Caldwell-Luc operation on the permanent teeth of school children was studied in a material of 21 six to 14-year-old children, who had undergone, altogether, 30 Caldwell-Luc operations. Ten of the children had also undergone 23 endonasal antrostomies. The control material consisted of a class of 27 healthy school children, their mean age being 10.2 years. Total anesthesia was found in five teeth on the operated side and in one tooth on the non-operated side. Additionally, the operation had caused slight hypesthesia in part of the teeth, mostly in the first incisors. All sensory disturbances were caused by nerve lesion only, and no tooth had died as a result of the operation. The operation could not be shown to be conducive to caries. Correctly performed, Caldwell-Luc operation does not cause serious dental injuries in school children, and is indicated especially in chronic sinobronchitis when conservative methods of treatment fail.

Immunohistochemical and electron microscopic demonstration of nerve fibres in relation to gingiva, tooth germs and functional teeth in the lower jaw of the cichlid Tilapia mariae.

Immunohistochemistry revealed the presence of numerous neurofilament (NF)-like immunoreactive axons in relation to gingiva and dental follicles surrounding mineralizing tooth germs. The gingival nerve fibres frequently approached the prospective papilla of early tooth primordia. Electron microscopic (EM) analysis revealed the presence of bundles of unmyelinated axons immediately below the epithelial-proprial junction of the gingiva. Bundles of nerve fibres were also present in the border zone between the prospective papilla of bud-stage tooth germs and surrounding mesenchyme and in close proximity to blood vessels of the follicles surrounding older tooth germs, but no axons were observed within the emerging dental papilla. In the individual functional tooth, a bundle of NF-like immunoreactive nerve fibres entered the apical part of the pulp forming a subodontoblastic plexus at mid-pulpal levels. EM analysis showed that the apical bundle consisted of many unmyelinated and a few myelinated axons invested by Schwann cell processes. The subodontoblastic plexus contained unmyelinated axons only. Thin, axon-like profiles were also seen in predentinal tubules. Nerve fibres were not observed at pulpal horn levels and in the ligamentous attachment. It is concluded that both immature and mature parts of the lower-jaw dentition of the cichlid T. mariae are innervated and that the microscopic anatomy of this innervation is partly similar to the pattern seen in developing and adult mammals.

The blood-vessel thrust theory of tooth eruption and migration.

The Blood-Vessel Thrust Theory is a new hypothesis regarding the forces which produce the normal eruption of teeth, and the movement of 'nonerupted' teeth through bone away from their normal position in the jaws. It points out that the flow of blood through the vessels of the dental pulp, and of the tissues surrounding the tooth, must produce hydrodynamic and hydrostatic forces within the blood vessels, and that these forces have a resultant towards the tooth crown, thus causing the tooth to move, crown first, through the bone during normal eruption or abnormal tooth migration.

Vascular changes after experimentally-induced inflammation in the mandible.

In this study, the vascular supply of an experimentally-induced inflammatory reaction in 5 monkey mandibles is examined. A barium sulfate injection method, combined with contact microradiography was used. In all monkeys, marked vascular changes were seen within the areas of inflammation. Vertical nutrient branches were interrupted shortly after leaving the inferior alveolar artery, and a conglomerate of thin irregular vessels were seen interspersed through newly formed bone trabeculae. The vascular supply to the neighbouring teeth seemed to be unaltered; neither was there any evidence of vascular thrombosis or vasculitis.

Effect of probe design and bandwidth on laser Doppler readings from vital and root-filled teeth.

Laser Doppler flowmetry has been shown to be useful in assessing blood flow in teeth. This study investigated the effect of probe design and bandwidth on laser Doppler readings from vital and root-filled teeth using an 810 nm light source, and established the sensitivity and specificity of each probe/bandwidth combination. Readings were taken from 20 human subjects with a root-filled tooth and a vital contralateral tooth using each of the probes with 0.125 mm, 0.375 mm and 0.5 mm fibre separations and three bandwidths (3.1 kHz, 14.9 kHz and 20 kHz). Ten pairs of traces from each group were examined by 10 trained observers who indicated whether the traces had come from a vital or root-filled tooth. The sensitivity and specificity of each combination were calculated from the accuracy of their replies. This was repeated for five observers but with additional information from Fourier analysis. Median readings from vital teeth were higher than those from root-filled teeth for all combinations. This difference was only significant at the 95% confidence level for the 0.5 mm probe with the two lower bandwidths. The 0.125 mm fibre separation probe showed good specificity. The other two probes had better sensitivity but poor specificity. The best specificity and sensitivity was shown by the 0.5 mm probe/3.1 kHz bandwidth combination. All sensitivities and specificities increased when additional information from Fourier analysis was available, but the 0.5 mm probe/3.1 kHz combination still had the best sensitivity and specificity.