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Journal of Dental Research Feb 2015Dentin can be described as a biological composite with collagen matrix embedded with nanosized hydroxyapatite mineral crystallites. Matrix metalloproteinases (MMPs) and... (Review)
Review
Dentin can be described as a biological composite with collagen matrix embedded with nanosized hydroxyapatite mineral crystallites. Matrix metalloproteinases (MMPs) and cysteine cathepsins are families of endopeptidases. Enzymes of both families are present in dentin and collectively capable of degrading virtually all extracellular matrix components. This review describes these enzymes and their presence in dentin, mainly focusing on their role in dentin caries pathogenesis and loss of collagen in the adhesive hybrid layer under composite restorations. MMPs and cysteine cathepsins present in saliva, mineralized dentin, and/or dentinal fluid may affect the dentin caries process at the early phases of demineralization. Changes in collagen and noncollagenous protein structure may participate in observed decreases in mechanical properties of caries-affected dentin and reduce the ability of caries-affected dentin to remineralize. These endogenous enzymes also remain entrapped within the hybrid layer during the resin infiltration process, and the acidic bonding agents themselves (irrespective of whether they are etch-and-rinse or self-etch) can activate these endogenous protease proforms. Since resin impregnation is frequently incomplete, denuded collagen matrices associated with free water (which serves as a collagen cleavage reagent for these endogenous hydrolase enzymes) can be enzymatically disrupted, finally contributing to the degradation of the hybrid layer. There are multiple in vitro and in vivo reports showing that the longevity of the adhesive interface is increased when nonspecific enzyme-inhibiting strategies are used. Different chemicals (i.e., chlorhexidine, galardin, and benzalkonium chloride) or collagen cross-linker agents have been successfully employed as therapeutic primers in the bonding procedure. In addition, the incorporation of enzyme inhibitors (i.e., quaternary ammonium methacrylates) into the resin blends has been recently promoted. This review will describe MMP functions in caries and hybrid layer degradation and explore the potential therapeutic role of MMP inhibitors for the development of improved intervention strategies for MMP-related oral diseases.
Topics: Cathepsins; Collagen; Dental Bonding; Dental Caries; Dental Materials; Dentin; Disease Progression; Humans; Matrix Metalloproteinase Inhibitors; Matrix Metalloproteinases
PubMed: 25535202
DOI: 10.1177/0022034514562833 -
Monographs in Oral Science 2018Carious lesion dynamics are dependent predominantly on the availability of fermentable sugars, other environmental conditions, bacteria, and host factors. Our current...
Carious lesion dynamics are dependent predominantly on the availability of fermentable sugars, other environmental conditions, bacteria, and host factors. Our current understanding of the microorganisms involved in the initiation and progression of caries is still rather incomplete. The most relevant acidogenic-aciduric bacterial species known to date are Streptococcus mutans, bifidobacteria, and lactobacilli. Whereas mutans streptococci are initiators, bifidobacteria and lactobacilli are more enhancers for progression. Boosters for microbial activity are specific environmental conditions, such as the presence of fermentable dietary sugars and the absence of oxygen. Based on these conditions, the necrotic and/or contaminated zone fulfils all criteria for disease progression and has to be removed. For those deep lesions where the pulp vitality is not affected, a selective removal of the contaminated leathery dentine should take place as this approach lowers the risk of regrowth of the few embedded microbial cells here. In repelling the microbial attack and repairing damage, the host has developed several ingenious strategies. A major resistance to carious lesion progression is mounted by the dentine-pulp tissues. The signalling molecules and growth factors released upon dentine demineralisation upregulate the odontoblast activity and act as sensor cells. After carious stimulation, odontoblasts initiate an inflammatory reaction by producing chemokines and synthesise a protective tertiary dentine. After the destruction of these cells, the pulp still has a high capacity to synthesise this tertiary dentine thanks to the presence of adult stem cells within the pulp. Also, in addition to the systemic regulation, the pulp which is located within inextensible the confines of the dentine walls has a well-developed local regulation of its inflammation, regeneration, and vascularisation. This local regulation is due to the activity of different pulp cell types, mainly the fibroblasts, which secrete soluble molecules that regulate all these processes.
Topics: Dental Caries; Dental Pulp; Dentin; Humans
PubMed: 29794423
DOI: 10.1159/000487826 -
Clinical Oral Investigations Oct 2019To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or...
OBJECTIVES
To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions.
METHODS
Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference.
RESULTS
Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.
CONCLUSIONS
Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions.
CLINICAL RELEVANCE
Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.
Topics: Consensus; Delphi Technique; Dental Caries; Dental Enamel; Dentin; Esthetics, Dental; Humans
PubMed: 31444695
DOI: 10.1007/s00784-019-03058-w -
Folia Morphologica 2018Endodontium, otherwise referred to as pulp-dentin complex or endodont. This term includes two tooth tissues: dentin and pulp, which constitute a structural and... (Review)
Review
Endodontium, otherwise referred to as pulp-dentin complex or endodont. This term includes two tooth tissues: dentin and pulp, which constitute a structural and functional unity. These tissues have a huge, inseparable influence on each other - the pulp (inter alia) nourishes the dentine, while the dentin forms a protective barrier for the pulp. They develop from the papillary tissue (Latin: papilladentis) from mesenchymal tissue. Nevertheless, in clinical practice this structural-functional complex is often treated as two separate tissues, and not as a whole. Adequate knowledge of the structure, function and protective mechanisms of the endodontium produces successful results in the treatment. The appropriate choice and application of the therapeutic methods and materials to the dentin secures vitality of both tissues of this complex.
Topics: Animals; Dental Pulp; Dentin; Humans
PubMed: 29345716
DOI: 10.5603/FM.a2018.0008 -
Biomedical Physics & Engineering Express Aug 2021This study aimed to demonstrate the feasibility of using optical coherence tomography (OCT) for locating the sectioning site of a specimen before characterizing the...
This study aimed to demonstrate the feasibility of using optical coherence tomography (OCT) for locating the sectioning site of a specimen before characterizing the ultrastructural features of dentin surfaces as well as the inner wall of the dentinal tubules (DT) using a field emission scanning electron microscope (FESEM). Eight sound human molar teeth were extracted, examined via cross-polarization optical coherence tomography (CP-OCT), embedded, and hemisectioned using a low-speed diamond sawing machine. Next, each sectioned surface was further trimmed, polished, and examined under a confocal laser scanning microscope (CLSM) to locate the target area on the superficial dentin. Subsequently, each section was gold-coated and examined using FESEM. Backscattered reflection from the dentin layer was less than that from the enamel under CP-OCT. Distinct reflections from certain enamel and dentin microstructures were observed before sectioning the specimens. Areas with enamel cracks and dentin defects were identified and avoided during sectioning. At the micron level, the CLSM images exhibited a homogenous distribution of the DT orifices. Low magnification FESEM images showed intertubular dentin as a loosely condensed globular layer with shallow grooves in between, whereas peritubular dentin exhibited more organized condensation of apatite crystals surrounding the DT orifices. High magnification of the DT revealed a cross-linking layer of mineralized collagen network extending in the peri-intratubular lumen, with scattered globules of matrix vesicles. CP-OCT enabled the realization of rapid initial scanning and image acquisition with high contrast at the micron scale before profound insights into dentin ultrastructures at the nano scale were provided by FESEM. The variations in structural densities of the dental tissues significantly affected the image contrast and helped identify underlying structures.
Topics: Dentin; Humans; Microscopy, Confocal; Molar; Tomography, Optical Coherence
PubMed: 34340215
DOI: 10.1088/2057-1976/ac19cf -
The Chinese Journal of Dental Research Dec 2023Dentine is a major component of teeth and is responsible for many of their functions, such as mastication and neural sensation/transduction. Over the past decades,... (Review)
Review
Dentine is a major component of teeth and is responsible for many of their functions, such as mastication and neural sensation/transduction. Over the past decades, numerous studies have focused on dentine development and regeneration using a variety of research models, including in vivo, ex vivo and in vitro models. In vivo animal models play a crucial role in the exploration of biochemical factors that are involved in dentine development, whereas ex vivo and in vitro models contribute mainly to the identification of biophysical factors in dentine regeneration, of which mechanical force is most critical. In the present review, research models involved in studies related to dentine development and regeneration were screened from publications released in recent years and summarised comprehensively, particularly in vivo animal models including prokaryotic microinjection, Cre/LoxP, CRISPR/Cas9, ZFN and TALEN, and scaffold-based in vitro and ex vivo models. The latter were further divided by the interactive forces. Summarising these research models will not only benefit the development of future dentine-related studies but also provide hints regarding the evolution of novel dentine regeneration strategies.
Topics: Animals; Dentin; Tooth; Regeneration
PubMed: 38126366
DOI: 10.3290/j.cjdr.b4784033 -
Medical Hypotheses Dec 2015Despite the many hypotheses trying to explain how the physiologic sclerotic dentin is formed, there has been so far no convincing explanation for all of its... (Review)
Review
Despite the many hypotheses trying to explain how the physiologic sclerotic dentin is formed, there has been so far no convincing explanation for all of its observations. In this review, we tried to make a hypothesis based on the facts published to date. We found that the apoptosis of odontoblasts, which takes place after the formation of the apical constriction, may be the key-factor for the development of physiologic sclerotic dentin, because the resulting apoptotic bodies cannot be eliminated through phagocytosis and become trapped within the dentinal tubules due to the continuous formation of secondary dentin. The apoptotic bodies suffer later from a secondary or apoptotic necrosis leading to the release of the internal contents of pyrophosphate and hydrogen phosphate. Pyrophosphate can dehydrate the dentin and hydrogen phosphate can demineralize it, leading to the release of Ca(2+) ions which then contribute to the intratubular mineralization.
Topics: Apoptosis; Calcium; Cell Survival; Dental Pulp; Dentin; Humans; Hydrogen; Ions; Macrophages; Microscopy, Electron, Transmission; Necrosis; Odontoblasts; Phagocytosis; Phosphates; Pressure; Sclerosis
PubMed: 26404871
DOI: 10.1016/j.mehy.2015.09.016 -
Journal of the Mechanical Behavior of... Dec 2022Human dentin is a hierarchical material with multi-level micro-/nano-structures, consisting of tubule, perti-tubular dentin (PTD) and intertubular dentin (ITD) as the...
Human dentin is a hierarchical material with multi-level micro-/nano-structures, consisting of tubule, perti-tubular dentin (PTD) and intertubular dentin (ITD) as the major constituents at microscale; and the PTD and ITD are further composed of collagen and hydroxyapatite (HAp) crystals with different volume fractions at nanoscale. In most cases, the HAp is considered as elastic while the collagen as viscoelastic material. It is of great significance to study the hierarchical structure and viscoelasticity of human dentin to understand the mechanical properties of dentin for further development of restorative materials. Based on this, this paper focuses on multiscale modeling of the elastic properties and dynamic viscoelastic response of dentin and establishes a bottom-up micromechanics model from nano-to macro-scale. In order to study the nanostructural effect on the viscoelastic behavior of hierarchical structures, the homogenization theories of random platelets composites (HTRPC) and the locally-exact homogenization theory (LEHT) are introduced for the homogenization of heterogeneous materials of microstructures at different levels. The HTRPC, based on Eshelby Inclusion theory, is used to predict the effective modulus of PTD and ITD. The LEHT is a method for homogenizing multiphase dentin characterized by repeated unit cells (RUCs). The resulting predictions are in very good agreement with several experimental data from the literature. In addition, the results of nanostructrual effect on dentin show that the viscoelasticity of dentin is majorly contributed by collagen and the HAp greatly provide the strength and hardness of dentin. Furthermore, the ageing effect on dentin's viscoelasticity is considered from the proposed multiscale micromechanics model. It is demonstrated that the ageing effect is much more influential in affecting the loss moduli of dentin than the storage.
Topics: Humans; Dentin; Hardness; Collagen
PubMed: 36302275
DOI: 10.1016/j.jmbbm.2022.105525 -
Journal of Tissue Engineering and... Sep 2015Dentine remineralization is important for the treatment of dentine caries and the bonding durability of dentine and resin materials in clinical practice. Early studies... (Review)
Review
Dentine remineralization is important for the treatment of dentine caries and the bonding durability of dentine and resin materials in clinical practice. Early studies of dentine remineralization were mostly based on the classical pathway of crystallization, which involves large-scale deposition of calcium phosphate crystals on collagen and is achieved in a liquid environment containing mineral ions. Results from these studies were unsatisfactory and not suitable for clinical application because they did not simulate the ordering of hydroxyapatite in the collagen fibres of natural teeth. As studies on collagen type I and non-collagenous proteins have advanced, dentine biomimetic remineralization has become a popular research topic and has shifted to processes involving intrafibrillar remineralization, which is more similar to natural tooth formation. The objective of this review was to summarize current theory and research progress as it relates to dentine remineralization.
Topics: Dental Research; Dentin; Tooth Remineralization
PubMed: 23955967
DOI: 10.1002/term.1814 -
Journal of Dentistry Mar 2023The present review discussed the biomechanical properties of cracks and fractures in crown and root dentine and attempted to explain why cracked teeth and vertical root... (Review)
Review
OBJECTIVES
The present review discussed the biomechanical properties of cracks and fractures in crown and root dentine and attempted to explain why cracked teeth and vertical root fractures are so frequent despite the existence of multiple crack toughening mechanisms in dentine. The implications of this knowledge were used to justify how these defects are managed clinically.
DATA, SOURCES AND STUDY SELECTION
Literature search was conducted on PubMed, Web of Science, and Scopus for a narrative review on fracture mechanics of crown and root dentine as well as the clinical management of cracked teeth and teeth with vertical root fracture.
CONCLUSIONS
Although dentine is tougher and less brittle than enamel, it's facture toughness is considerably lower than most ductile metals. Because the initiation toughness of dentine is very low, cracks initiate from incipient damage under low stress While crack toughening mechanisms exist that enable dentine to resist crack extension, these mechanisms are often inadequate for protecting dentine from crack propagation that ultimately leads to catastrophic failure. Additional factors such as ageing also reduces the resistance of dentine to crack growth. Because dentine cracks are eventually filled with bacteria biofilms upon exposure to oral fluids, they enable rapid bacteria ingress into the dental pulp via open dentinal tubules. To date, treatment options for cracked teeth are limited. While most teeth with vertical root fracture are recommended for extraction, new strategies have been reported that appeared to achieve short-term success in preserving these teeth.
CLINICAL SIGNIFICANCE
Current strategies for the management for dentine cracks and fractures are limited and their long-term effectiveness remain uncertain. Understanding the characteristics, toughening mechanism and weakening factors of tooth cracks is helpful in designing better treatment.
Topics: Humans; Tooth; Dental Enamel; Tooth Fractures; Cracked Tooth Syndrome; Dentin
PubMed: 36657703
DOI: 10.1016/j.jdent.2023.104424