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Resorption of permanent teeth.
The varying extent of permanent tooth resorption attributable to different types of orthodontic appliances is a continuing cause for concern. This paper reviews recent researches which contribute to an improved understanding of the origin and behaviour of osteoclasts; and considers the structure and behaviour of the periodontal ligament and its relationship to the cementum and bundle bone of the tooth socket. Permanent tooth resorption is identified as a normal phenomenon. A simple explanation is offered as to why under normal circumstances the bone of the tooth socket is more likely to be resorbed than the tooth itself. With this knowledge treatment procedures can be selected which will reduce tooth resorption risks to a minimum.
Tissue response to a haemostatic alginate wound dressing in tooth extraction sockets.
Kaltostat is a new haemostatic wound dressing composed of non-woven sodium calcium alginate fibres, and was originally developed to cover exposed wounds of the skin. A histopathological study was undertaken to determine the tissue response to Kaltostat in healing tooth sockets, to obtain a comparison with oxidised regenerated cellulose (Surgicel). Tooth sockets filled with blood clot acted as controls. The results showed that both biomaterials delayed wound healing in the early phase (1-4 weeks), giving rise to foreign body reactions. At 12 weeks there was little difference between the control sockets and the sockets containing the test materials, although remnants of retained dressing materials were identified. Healing of the tooth sockets was complete at 24 weeks.
[Osteopontin mRNA expression in remodeling alveolar bone incident to tooth movement--visualized by in situ hybridization].
The purpose of this study was to investigate the osteopontin mRNA expression in the alveolar bone incident to the physiologic and experimental tooth movement. The upper jaws of female rats (7 weeks old) which were submitted to experimental molar tooth movement and control specimens were decalcified and sliced into paraffin sections. Osteopontin mRNA expression and tartrate-resistant acid phosphatase (TRACPase) activity were examined in the alveolar bone by use of in situ hybridization techniques and enzyme histochemistry, respectively. In the control specimens high levels of osteopontin mRNA expression was observed in the osteocytes and lining cells close to the osteoclasts which were detected by TRACPase staining in the distal areas of the tooth sockets. In the mesial tooth socket areas however, low levels of osteopontin mRNA expression was observed. In the experimental specimens high levels of osteopontin mRNA expression of both the osteoblasts and osteocytes was observed in the mesial areas of tooth sockets in response to the experimental tooth movement. These results indicated that osteopontin gene expression is related to the alveolar bone remodeling as far as the bone resorption incident to the physiologic tooth movement and that this expression level significantly increased in response to a certain mechanical stress incident to the experimental tooth movement.
Expression of cartilage-derived retinoic acid-sensitive protein during healing of the rat tooth-extraction socket.
Cartilage-derived retinoic acid sensitive protein (CD-RAP) is a recently described, cartilage-specific protein. During early healing of the tooth-extraction socket, cells express both chondrogenic and osteogenic cell markers, but no cartilage is formed. Cartilaginous collagen type II protein, a major constituent of hyaline cartilage, has not been detected in the healing socket, although type IX collagen, which coats these fibres, has been detected transiently in early socket healing. This study investigated the spatial and temporal expression of CD-RAP and various osteoblast cell markers, i.e., alkaline phosphatase, osteopontin, osteonectin and osteocalcin, during healing. Immunolocalization of these proteins was determined in the rat tooth socket at 3, 4, 5, 6, 7, 8, 10 and 14 days after extraction. CD-RAP was expressed by preosteoblast cells maximally at 6, 7, and 8 days after extraction. Fully differentiated osteoblasts expressed osteocalcin, a specific osteoblast marker. Preosteoblasts and fibroblasts did not express osteocalcin. On double immunofluorescent staining, some preosteoblasts coexpressed CD-RAP (indicative of chondrogenic differentiation), and either alkaline phosphatase or osteopontin (markers of osteogenic stem-cell maturation). There was no colocalization between osteopontin and osteonectin. CD-RAP was unique amongst the cell markers used in that it was expressed by preosteoblasts, but not by osteoblasts lining the newly formed trabeculae. CD-RAP may have an important role in osteoblast cell differentiation during bone healing.
Healing of tooth extraction sockets in experimental diabetes mellitus.
PURPOSE: This study was undertaken to examine the healing of molar tooth extraction sockets in the streptozotocin-treated, diabetic rat. MATERIALS AND METHODS: Insulin-dependent diabetes mellitus was induced in a group of mature Sprague-Dawley rats by injecting streptozotocin. Control animals were injected with citrate buffer only. A third group of rats were also injected with streptozotocin, but the diabetes was controlled by daily injections of insulin. After 2 weeks, all of the rats underwent extraction of the right maxillary molar teeth under general anesthesia. The rats were killed at varying intervals and the maxilla and calvaria recovered in continuity. Tissue sections were stained with hematoxylin-eosin and periodic acid-Schiff (PAS), the latter to identify diabetic microangiopathy. RESULTS: At 10 days after tooth extraction in the control and insulin-streptozotocin-treated rats, thick collagen fibers formed a pretrabecular scaffold that dictated the direction of the forming trabeculae. The collagen fibers in the diabetic socket were thin and scanty, and formed a narrow layer in the apical part. There was no evidence of diabetic microangiopathy in the extraction sockets of diabetic, insulin-treated diabetic, or normal rats. CONCLUSION: These histologic observations suggest that in uncontrolled, insulin-dependent diabetes, the formation of the collagenous framework in the tooth extraction socket is inhibited, resulting in delayed healing and increased alveolar destruction.
Scanning electron microscope study of the healing molar tooth extraction socket in the rat.
Healing molar tooth extraction wounds in rats were examined by scanning electron microscopy from 15 minutes to 40 days following tooth removal. The wound epithelium, which was derived mainly from the gingiva but also from the cheek and hard palate, migrated beneath the superficial socket contents. The contents were lost between 5 to 11 days, thus leaving a central epithelial-lined depression. This decreased in width with time as the level of the wound epithelium approached that of the hard palate but was still present at 40 days. Between 5 and 7 days, the wound epithelium became more regular. However, from 11 days on, it became more irregular with increasing numbers of saucer-shaped depressions, circular defects and circular whorls of epithelial cells. The surface structure of the epithelial cells changed as it migrated and matured. The initially plump, then flattened cells mostly had smooth areas along with variable numbers of irregular microridges and microvilli, although cells derived from the cheek had only smooth surfaces. With further maturation, all cells developed a regular honeycomb surface pattern of interconnecting microridges similar to that on the hard palate. Why the wound epithelium became more uneven after 11 days is not known.
[Roentgenographic study on the healing processes of the deciduous tooth extraction sockets].
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Trabecular bone formation in the healing of the rodent molar tooth extraction socket.
The aim of this study was to investigate the nature of the template structure on which trabecular bone formation occurs during healing of the rodent tooth extraction socket, a well studied bone healing system. The presence of collagen type II mRNA has previously been described in the healing socket, although the formation of the protein or cartilage has not been observed. However, recent evidence from developmental and other bone healing studies indicates that collagen type III may be important in forming the preliminary scaffold on which bone trabeculae are formed. The maxillary right molar teeth were removed from rats under general anaesthesia and the animals killed at various times afterward. The tissues were examined using histological, in situ hybridization, and immunohistochemical staining techniques. It was concluded that collagen type IIA mRNA was produced by osteoblast cells of the socket, but that collagen type II, if present, would account for less than 0.01% of the total proteins extracted. During bone formation, Sharpey's fibers were seen radiating from the peripheral bone toward the center of the socket. These optically active collagen fibers were inserted into the forming bone trabeculae and were recognized by antibodies raised against collagen type III. The arrangement and composition of these fibers therefore suggest that they form a preliminary framework on which deposition of woven bone trabeculae occurs.
[Histochemical study on healing process of tooth extraction socket].
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Discontinuity of life conditions at the transition from the Roman imperial age to the early middle ages: Example from central Italy evaluated by pathological dento-alveolar lesions.
Teeth are highly informative in the study of past human populations. In particular, the occurrence of lesions in the masticatory apparatus relates diseases, diet, and living conditions. The dental pathology of three skeletal samples from the north-central part of Latium (central Italy) is reported. Two of them belong to the Roman Imperial Age (1st-3rd century AD): the first (including 942 permanent teeth and 1,085 tooth sockets) represents the rural town of Lucus Feroniae and is mainly composed of slaves and/or war veterans, whereas the second (872 permanent teeth and 1,325 tooth sockets) comes from the Isola Sacra necropolis at Portus Romae and represents the "middle class" segment of an urban population. The medieval sample (912 teeth and 1,097 tooth sockets), dated to the 7th century AD, belongs to the Lombard necropolis of La Selvicciola. All of the samples were examined for caries, abscesses, antemortem tooth loss, calculus, alveolar resorption, attrition, and enamel hypoplasia; standard methods were used to identify, classify, and quantify these conditions. The results reveal different patterns of dental and alveolar lesions for the three populations, indicating a different combination of dietary factors and hygienic conditions in the Roman samples compared to the Lombard series. As evidenced by multivariate correspondece analysis, the Romans show afffinites between each other, whereas the Medieval sample appears associated with the incidence of caries and the pathological conditions related to them, thus indicating increase of these lesions and deterioration of the quality of life in the transition to the early Middle Ages. These data agree with the respective archeological characterizations of the necropolises and the hypothetical social composition of each population. Am. J. Hum. Biol. 11:327-341. Copyright 1999 Wiley-Liss, Inc.
Painful, nonhealing, tooth extraction socket.
The oral signs and symptoms of acute leukemia include gingival hypertrophy, gingival hemorrhage, petechiae and ecchymoses, mucosal ulceration, paresthesia, tooth pain, and oral infections. This case was unusual in that the diagnosis of acute leukemia was made only after a biopsy specimen of tissue protruding from the socket of a recently extracted tooth disclosed malignant cells suggestive of leukemia or lymphoma. The diagnosis of epulis granulomatosa should be made only after clinical, radiographic, and microscopic studies have been performed to rule out a malignant process.
Sympathetic activity-mediated neuropathic facial pain following simple tooth extraction: a case report.
This is a report of a case of sympathetic activity-mediated neuropathic facial pain induced by a traumatic trigeminal nerve injury and by varicella zoster virus infection, following a simple tooth extraction. The patient had undergone extraction of the right lower third molar at a local dental clinic, and soon after the tooth extraction, she became aware of spontaneous pain in the right ear, right temporal region, and in the tooth socket. At our initial examination 30 days after the tooth extraction, the healing of the tooth socket was normal; however, the patient had a tingling and burning sensation (dysesthesia) and spontaneous pain of the right lower lip and the right temporal region, both of which were exacerbated by non-noxious stimuli (allodynia). The patient also showed paralysis of the marginal mandibular branch of the facial nerve, taste dysfunction, and increased varicella zoster serum titers. A diagnostic stellate ganglion block (SGB) 45 days after the tooth extraction using one percent lidocaine markedly alleviated the dysesthesia and allodynia. These symptoms are characteristic of neuropathic pain with sympathetic interaction. The patient was successfully treated with SGB and a tricyclic antidepressant.
Early bone healing events in the human extraction socket.
The tooth extraction socket is unique in terms of a bone-healing defect in that it contains the remnants of periodontal ligament fibroblasts attached to the socket wall. Although these cells have an osteogenic potential in vitro, the origin of cells populating the human extraction socket is unknown and may include bone marrow, periosteum and pericytic cells. Recently, monoclonal antibodies (AML-3, SB-10 and SB-20) have become available which can identify cells undergoing osteogenic differentiation. The aim of this work was to investigate the pattern of osteoblast differentiation in the human extraction socket using these markers. Immunolocalization was used to identify the osteoprogenitor cell population in the extraction sockets of three patients. Runx2 was most strongly expressed by the osteoblasts at the socket margin and in the surrounding marrow spaces. Osteoprogenitor, pre-osteoblast and osteoblast cells surrounded the newly formed trabeculae, and expressed on their cell surface antigens which reacted with the SB-10 and SB-20 antibodies. In a specimen with the tooth and periodontium present, both osteo-blasts and periodontal ligament fibroblasts were immunoreactive with SB-10, and SB-20 and also expressed Runx2. There was heterogeneity of expression of these osteogenic markers e.g. not all osteoblasts expressed Runx2. We have shown that osteoprogenitor cells in the residual periodontal ligament and bone marrow may contribute to bone regeneration following tooth extraction.
[Effect of PC powder on the healing of the socket after tooth extraction].
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Histometric study of socket healing after tooth extraction in rats treated with diclofenac.
The purpose of the present study was to investigate if diclofenac administration interferes with the time course of alveolar wound healing in rats. Forty-two Wistar rats were used, 21 rats received 10 mg/kg/day of diclofenac one day before and 4 days after extraction of the right maxillary incisors and 21 rats received saline. The animals were sacrificed 7, 14 and 21 days after tooth extraction. Progressive new bone formation and a decrease in the volume fraction of blood clot and connective tissue from 1 to 3 weeks after tooth extraction was quantified using the histometric point-counting method. Diclofenac treatment caused a significant delay in new bone formation in association with an impairment of blood clot remission/organization.
Reactivated herpes simplex virus infection as a possible cause of dry socket after tooth extraction.
This study was designed to evaluate a possible association between reactivated herpes simplex virus type 1 (HSV-1) infection after lower third molar extraction and development of dry socket (DS). The HSV-1 antibody response was analyzed before and after tooth removal by enzyme-linked immunosorbent assay and immunoblotting in 208 patients. History of previous possible oral herpes reactivation was evaluated by a questionnaire that was based on self-rated frequency of oral cold sores. Tobacco users were identified. The anatomic proximity of the root apex to the mandibular nerve canal was classified radiographically before extraction. Fifteen patients (7%) developed DS after tooth extraction. Eleven of the 15 DS patients (73%) were HSV seropositive as compared with 7 of 15 (47%) in the matched control group. Seven of the 11 seropositive DS patients have shown HSV-1 reactivation by an increase of specific polypeptides, predominantly gB, gC, gD and ICP 4 and 6, in the immunoblot test. No change in HSV-1 reactivity was observed in control sera. DS patients reported a high frequency of oral cold sores (64%) compared with the controls (33%). Tobacco use was not found to influence the frequency of cold sores or the development of DS. A close radiographic proximity between the mandibular canal and root apex was more common (P < .05) in DS patients. The results indicate that extraction of a mandibular third molar could be a possible cause of reactivation and recurrence of an HSV-1 infection.(ABSTRACT TRUNCATED AT 250 WORDS)
Dental implant fixation by electrically mediated process. II. Tissue ingrowth.
The effect of electrical stimulation on the interfacial strength of the porous polymethylmethacrylate implant/oral tissue union and the amount of tissue growth was investigated in the fourth premolars of dogs. The study indicates the interfacial strength peaks at about three weeks and decreases thereafter for both control and the stimulated specimens. The stimulated side showed consistently higher strength than its paired control. There was a positive relationship between implant period and amount of tissue in the pores although the latter was not correlated with the interfacial strength. Microradiographs showed a different pattern of new bone formation on the stimulated side when compared to the control. On both sides, bone formation occurred upward from the bottom of the tooth socket while on the stimulated side, new bone also developed from the sides of the tooth socket which was minimal in the controls. It is proposed that the direction of oral tissue formation is responsible for the different results obtained in this study compared with a similar study on long bones.