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Rampant caries and periodontal diseases occur in patients treated with antidepressants such as serotonin reuptake inhibitors (SRIs; e.g., Prozac) which target the serotonin transporter (SERT). As the serotonin 2B receptor (5HT2BR) regulates SERT functionality and capacity to recognize SRIs, we investigated the potential role of 5HT2BR on dental tissues by exploiting 5HT2BR knockout (KO) mice. Compared to wild-type (WT) mice, several structural differences were identified in the teeth of KO mice. In the molar of KO mice, rod curvatures and twisting were altered compared to WT mice, suggesting involvement of 5HT2BR at early stages of enamel formation. The volume of the KO enamel layer was also reduced, and larger porosities were observed in the prismatic enamel, with smaller crystallite thickness. Crystallite pattern disorganization and occlusal abrasion were enhanced in female KO mice, indicating a sexual dimorphism. In the incisor, no difference was detected in the width of the enamel layer between KO and WT mice; however, enamel maturation differed in absence of 5HT2BR. Specifically, the outer aprismatic enamel border was 1.5- to 2-fold larger in KO compared to WT mice, together with a decreased etching pattern. Finally, although no noticeable difference was observed in dentin, the micro-CT three-dimensional pulp reconstruction evidenced a decrease in both length and width of dentin formation in the root canals of the KO versus WT mice. These data provide evidence that 5HT2BR-mediated signaling pathways are involved in enamel formation and dentinogenesis.

We review firstly the specificities of the different types of dentin present in mammalian teeth. The outer layers include the mantle dentin, the Tomes' granular and the hyaline Hopewell-Smith's layers. Circumpulpal dentin forming the bulk of the tooth, comprises intertubular and peritubular dentin. In addition to physiological primary and secondary dentin formation, reactionary dentin is produced in response to pathological events. Secondly, we evaluate the role of odontoblasts in dentin formation, their implication in the synthesis and secretion of type I collagen fibrils and non-collagenous molecules. Thirdly, we study the composition and functions of dentin extracellular matrix (ECM) molecules implicated in dentinogenesis. As structural proteins they are mineralization promoters or inhibitors. They are also signaling molecules. Three different forms of dentinogenesis are identified: i) matrix vesicles are implicated in early dentin formation, ii) collagen and some proteoglycans are involved in the formation of predentin, further transformed into intertubular dentin, iii) the distal secretion of some non-collagenous ECM molecules and some serum proteins contribute to the formation of peritubular dentin.

Dentin sialophosphoprotein (DSPP), a major non-collagenous matrix protein of odontoblasts, is proteolytically cleaved into dentin sialoprotein (DSP) and dentin phosphoprotein (DPP). Our previous studies revealed that DSPP null mice display a phenotype similar to human autosomal dominant dentinogenesis imperfecta, in which teeth have widened predentin and irregular dentin mineralization resulting in sporadic unmineralized areas in dentin and frequent pulp exposure. Earlier in vitro studies suggested that DPP, but not DSP, plays a significant role in initiation and maturation of dentin mineralization. However, the precise in vivo roles of DSP and DPP are far from clear. Here we report the generation of DPPcKO mice, in which only DSP is expressed in a DSPP null background, resulting in a conditional DPP knockout. DPPcKO teeth show a partial rescue of the DSPP null phenotype with the restored predentin width, an absence of irregular unmineralized areas in dentin, and less frequent pulp exposure. Micro-computed tomography (micro-CT) analysis of DPPcKO molars further confirmed this partial rescue with a significant recovery in the dentin volume, but not in the dentin mineral density. These results indicate distinct roles of DSP and DPP in dentin mineralization, with DSP regulating initiation of dentin mineralization, and DPP being involved in the maturation of mineralized dentin.

Familial hypophosphatemic rickets is transmitted in most cases as an X-linked dominant trait and results from the mutation of the PHEX gene predominantly expressed in osteoblast and odontoblast. Patients with rickets have been reported to display important dentin defects. Our purpose was to explore the structure, composition and distribution of noncollagenous proteins (NCPs) of hypophosphatemic dentin. We collected teeth from 10 hypophosphatemic patients whose mineralization occurred either in a hypophosphatemic environment or in a corrected phosphate and vitamin environment. Teeth were examined by scanning electron microscopy, immunohistochemistry and Western blot analysis. An abnormal distribution (accumulation in interglobular spaces) and cleavage of the NCPs and particularly of matrix extracellular phosphoglycoprotein were observed in deciduous dentin. In contrast, it was close to normal in permanent dentin mineralized under corrected conditions. In conclusion, dentin mineralization in a corrected phosphate and vitamin D environment compensates the adverse effect of PHEX mutation., (Copyright 2008 S. Karger AG, Basel.)

Dentin non-collagenous matrix components (NCPs) are structural proteins involved in the formation, the architecture and the mineralization of the extracellular matrix (ECM). We investigated here how recombinant metalloproteinase stromelysin-1, also termed MMP-3, initiates the release of ECM molecules from artificially demineralized human dentin. Analysis of the supernatants by Western blotting reveals that MMP-3 extracts PGs (decorin, biglycan), and also a series of phosphorylated proteins: dentin sialoprotein (DSP), osteopontin (OPN), bone sialoprotein (BSP) and MEPE, but neither dentin matrix protein-1 (DMP1), another member of the SIBLING family, nor osteocalcin (OC), a non-phosphorylated matrix molecule. After treatment of dentin surfaces by MMP-3, scanning electron microscope (SEM) examination of resin replica shows an increased penetration of the resin into the dentin tubules when compared to surfaces only treated by demineralizing solutions. This preclinical investigation suggests that MMP-3 may be used to improve the adhesive properties of restorative materials.

This review summarizes the in vivo experiments carried out by our group after implantation of bioactive molecules (matricellular molecules) into the exposed pulp of the first maxillary molar of the rat or the mandibular incisor of rats and mice. We describe the cascade of recruitment, proliferation and terminal differentiation of cells involved in the formation of reparative dentin. Cloned immortalized odontoblast progenitors were also implanted in the incisors and in vitro studies aimed at revealing the signaling pathways leading from undifferentiated progenitors to fully differentiated polarized cells. Together, these experimental approaches pave the way for controlled dentin regenerative processes and repair.

Objective: To evaluate the outcome of 1-(OH) vitamin D and oral phosphate treatment on dentin structure in patients with familial hypophosphatemic rickets, and expression of SIBLINGs (a family of non-collagenous proteins involved in dentinogenesis) and osteocalcin., Patients and Methods: Seven patients with familial hypophosphatemic rickets (age 3-16 years) were studied before or during treatment. Deciduous and permanent teeth were prepared for scanning electron microscopy (SEM) analysis and immunohistochemistry., Results: Untreated or inadequately treated patients had necrotic teeth with impaired dentin mineralization including unmerged calcospherites and accumulation of non-collagenous proteins in wide interglobular spaces. Most of the primary incisors analyzed displayed fissures linking enamel subsurface to pulp horn. These elements may explain the bacterial penetration and dental abscesses despite the absence of carious lesions. Well-treated patients had healthy teeth with good dentin mineralization and little evidence of calcospherites., Conclusion: Treatment of hypophosphatemic children with 1-(OH) vitamin D and oral phosphate insures good dentin development and mineralization, and prevents clinical anomalies such as the dental necrosis classically associated with the disease. Starting treatment during early childhood and good adherence to the therapy are mandatory to observe these beneficial effects.

Familial hypophosphatemic rickets is in most cases transmitted as an X-linked dominant trait and results from mutation of the PHEX gene, predominantly expressed in osteoblast and odontoblast. Patients have been reported to display important dentin defects, and therefore, we explored the dentin structure, composition, and distribution of extracellular matrix (ECM) molecules in hypophosphatemic human deciduous teeth. Compared to age-matched controls, the dentin from hypophosphatemic patients exhibited major differences: presence of large interglobular spaces resulting from the lack of fusion of calcospherites in the circumpulpal dentin; defective mineralization in the interglobular spaces contrasting with normal Ca-P levels in the calcospherites on X-ray microanalysis; abnormal presence of low-molecular weight protein complexes recognized on Western blots by antibodies against matrix extracellular phosphoglycoprotein (MEPE), dentin sialoprotein, osteopontin, and reduced osteocalcin (OC) level; and accumulation in the interglobular spaces of immunolabeling with antibodies against DSP, dentin matrix protein, bone sialoprotein, MEPE and OC, while chondroitin/dermatan sulfate glycosaminoglycans were exclusively located inside calcospherites. Alterations of the post-translational processing or partial degradation of some ECM appear as key factors in the formation of the defective hypophosphatemic dentin.

To determine the functions of fibromodulin (Fmod), a small leucine-rich keratan sulfate proteoglycan in tooth formation, we investigated the distribution of Fmod in dental tissues by immunohistochemistry and characterized the dental phenotype of 1-day-old Fmod-deficient mice using light and transmission electron microscopy. Immunohistochemistry was also used to compare the relative protein expression of dentin sialoprotein (DSP), dentin matrix protein-1 (DMP 1), bone sialoprotein (BSP), and osteopontin (OPN) between Fmod-deficient mice and wild-type mice. In normal mice and rats, Fmod immunostaining was mostly detected in the distal cell bodies of odontoblasts and in the stratum intermedium and was weaker in odontoblast processes and predentin. The absence of Fmod impaired dentin mineralization, increased the diameter of the collagen fibrils throughout the whole predentin, and delayed enamel formation. Immunohistochemistry provides evidence for compensatory mechanisms in Fmod-deficient mice. Staining for DSP and OPN was decreased in molars, whereas DMP 1 and BSP were enhanced. In the incisors, labeling for DSP, DMP 1, and BSP was strongly increased in the pulp and odontoblasts, whereas OPN staining was decreased. Positive staining was also seen for DMP 1 and BSP in secretory ameloblasts. Together these studies indicate that Fmod restricts collagen fibrillogenesis in predentin while promoting dentin mineralization and the early stages of enamel formation.

After implantation in the exposed pulp, some molecules of the den-tin extracellular matrix induce the formation of a reparative dentinal bridge in the coronal pulp. In some cases, total occlusion of the root canal also is observed. This is the case for bone sialoprotein, bone morphogenetic protein-7, Dentonin (a fragment from matrix extracellular phosphoglycoprotein), and two small amelogenin gene splice products (A+4 and A-4). Cells implicated in the reparative process are recruited, proliferate, and differentiate into osteoblast-like and odontoblast-like cells. The same results may be obtained by direct implantation of odontoblast progenitor cell into the pulp.

Small leucine-rich proteoglycans have been suggested to affect mineralization of dental hard tissues. To determine the functions of two of these small proteoglycans during the early stages of tooth formation, we characterized the dental phenotypes of biglycan (BGN KO) and decorin deficient (DCN KO) mice and compared them to that of wild type mice. Each targeted gene disruption resulted in specific effects on dentin and enamel formation. Dentin was hypomineralized in both knock out mice, although the effect was more prominent in the absence of decorin. Enamel formation was dramatically increased in newborn biglycan knockout mice but delayed in absence of decorin. Increased enamel formation in the former case resulted from an upregulation of amelogenin synthesis whereas delayed enamel formation in the later case was most probably an indirect consequence of the high porosity of the underlying dentin. Enamelin expression was unchanged in BGN KO, and reduced in DCN KO. Dentin sialoprotein (DSP), a member of the family of phosphorylated extracellular matrix proteins that play a role in dentinogenesis, was overexpressed in BGN-KO odontoblasts and in the sub-odontoblastic layer. In contrast, a decreased expression of DSP was detected in DCN KO. Dentin matrix protein-1 (DMP-1), bone sialoprotein (BSP) and osteopontin (OPN) were upregulated in BGN KO and downregulated in the DCN KO. Despite the strong effects induced by these deficiencies in newborn mice, no significant difference was detected between the three genotypes in adult mice, suggesting that the effects reported here in newborn mice are transient and subjected to self-repair.

In order to study the involvement of matrix metalloproteinases (MMPs) on dentin formation and mineralization, day 18 embryonic mouse tooth germs were cultured for 10 d in the presence or absence of Marimastat, a general MMP inhibitor, or CT(1166), a more selective inhibitor of gelatinases (MMP-2 and MMP-9) and stromelysin-1 (MMP-3). With Marimastat a dose-dependent increase in thickness of the predentin layer and a decreased mineralization of dentin were observed. At the highest concentration of the inhibitor used, enamel formation had ceased. With CT(1166), these effects were already apparent at the lowest concentration used. Western blot analyses demonstrated that the two inhibitors inhibited the expression of enamelysin (MMP-20). These observations indicate that MMPs (possibly MMP-2, -3, -9 and/or -20) play a role in the onset of dentin mineralization. The lack of enamel formation was possibly due to diffusion of amelogenin from its normal site of apposition. The protein clearly was not retained at the surface of the non-mineralized dentin layer, and immunopositive amelogenin accumulated in the odontoblast compartment. The diffusion of enamel proteins and the accumulation revealed by immunolabeling of two small leucine-rich proteoglycans, decorin and biglycan, in the predentin may have contributed to impaired dentin mineralization.

Small leucine-rich proteoglycans (SLRPs) regulate extracellular matrix organization. In order to investigate the distribution and potential functions of decorin, biglycan (BGN), and fibromodulin (3 SLRPs, potentially related to dentinogenesis), we performed light and electron immunochemistry on teeth from rats, and on wild-type and biglycan knockout mice (BGN KO). Immunohistochemical data demonstrate that chondroitin sulfate/dermatan sulfate (CS/DS) and keratan sulfate (KS) distributions displayed reverse gradients in predentin. The decrease of CS/DS labeling from the proximal to the distal predentin contrasted with the sharp decorin increase observed in the distal predentin near the predentin/dentin transition, an effect possibly attributable to the deglycosylation action of stromelysin-1. In contrast, BGN concentration was apparently constant throughout the whole predentin. Additional immunolabelings showed, for the first time, the presence of fibromodulin in predentin. Compared with the wild-type mouse, the mean diameter of collagen fibrils in the BGN KO was smaller in the proximal predentin but larger in the central and distal predentin, the metadentin was broader, and the dentin mineralization appeared altered and heterogeneous. Altogether, our data suggest an important role for BGN in dentin formation and mineralization.

The dentino-enamel junction is not an simple inert interface between two mineralized structures. A less simplistic view suggests that the dentino-enamel junctional complex should also include the inner aprismatic enamel and the mantle dentin. At early stages of enamel formation, fibroblast growth factor (FGF)-2 is stored in and released from the inner aprismatic enamel, possibly under the control of matrix metalloproteinase (MMP)-3. The concentration peak for MMP-2 and -9 observed in the mantle dentin coincided with a very low labeling for TIMP-1 and -2, favoring the cross-talk between mineralizing epithelial and connective structures, and as a consequence the translocation of enamel proteins toward odontoblasts and pulp cells, and vice versa, the translocation of dentin proteins toward secretory ameloblasts and cells of the enamel organ. Finally, in X-linked hypophosphatemic rickets, large interglobular spaces in the circumpulpal dentin were the major defect induced by the gene alteration, whereas the mantle dentin was constantly unaffected. Altogether, these data plead for the recognition of the dentino-enamel junctional complex as a specific entity bearing its own biological characteristics.

Using antibodies raised against the proform and fully processed (secreted) forms of the proteoglycans decorin and biglycan, combined with gold electron immunohistochemistry, we observed in the incisors of five Sprague-Dawley rats that the proforms were mostly located in the cell bodies of odontoblasts, with a presence reduced to one-third or one-fourth in the processes. Proforms, also present in the extracellular matrix, were uniformly distributed throughout predentin, with higher labeling for probiglycan than pro-decorin. Both were present in lesser amounts in metadentin and dentin. With respect to the secreted form, grain density was at a constant level for biglycan in predentin and dentin, whereas a gradient was detected for decorin, the grain density being increased three times in the distal predentin. Although decorin labeling was diminished in metadentin, staining in circumpulpal dentin was similar to that found in distal predentin. We have previously reported a reverse gradient for chondroitin sulfate/dermatan sulfate distribution. To reconcile these diverging data, our hypothesis is that enzymatic proteolytic cleavage may remove the glycosylated N-terminal-containing region, resulting in a non- proteoglycan form of the molecule. Although substantial differences in distribution were apparent between the two proteoglycans, increasing interactions between proteoglycans and collagen, facilitated by the cleavage and loss of the N-terminal glycosaminoglycan chain region in the distal predentin, may be a prerequisite for dentin mineralization.

The predominant proteoglycans present in predentin and dentin are the chondroitin-sulphate-rich decorin and biglycan and the keratan-sulphate-rich lumican and fibromodulin. These are small, interstitial, leucine-rich proteoglycans which have recently been shown to exist in gradients across the predentin. Antibodies recognizing chondroitin sulphate show a decreasing gradient from the pulpal aspect toward the mineralizing front, the converse being true for keratan sulphate. Antidecorin shows an increase toward the mineralization front. Evidence from biochemical, autoradiographic, and immunohistochemical studies implies that such changes may be brought about by gradients of metalloproteinases. This offers the possibility that the proteoglycans organize the collagen network for receipt of phosphoproteins and phospholipids, the former being evident only at the onset of dentin formation. The suggestion is raised that glycosaminoglycan-depleted leucine-rich protein cores act as sequester points for receipt of phosphoproteins in particular. The rigid, spatially oriented glycosaminoglycan chains on decorin and biglycan are known to bind calcium and may feature directly in mineral initiation.

Stromelysin-1 (matrix metalloproteinase-3) or proteoglycanase was visualized by light and electron microscopy immunolabelling in the forming zone of rat incisors. In predentine, labelling was more dense at the transition zone between the inner proximal third and the two outer thirds. Odontoblast processes were also positively stained, mostly in predentine and to a lesser degree in dentine. The dentine-enamel junction was intensely labelled, whereas dentine and forming enamel were only faintly stained. Gold-antibodies complexes were seen inside secretory ameloblasts and odontoblasts in cytosolic locations. The distribution of stromelysin-1 was compared with the distribution of 2-B-6 epitope, an antibody recognizing chondroitin-4-sulphate/dermatan sulphate and which showed a decreasing gradient from the proximal zone to the distal part of predentine. In contrast, both 5-D-4, an anti-keratan sulphate antibody and an anti-lumican antibody displayed a reversed distribution, with an increase seen from the proximal and central thirds to the distal part of predentine. This coordinated distribution suggests that stromelysin-1 may have a functional role, being implicated in predentine in the degradation of chondroitin-4-sulphate/dermatan sulphate-containing proteoglycans, and consequently allowing keratan sulphate proteoglycan concentration to increase near the border where mineralization is initiated.

In order to study the uptake and fate of [3H]choline into cellular and extracellular phospholipids in the forming part of mandibular rat incisors, radioautography was carried out after treatment with the iodoplatinate reaction which retains phospholipids. Thirty minutes and 1 hour after the intravenous injection of the radiolabeled precursor, grain density in secretory odontoblasts and ameloblasts was not significantly above background labeling whereas dentin was actually labeled. Therefore, at this early period, odontoblasts cannot be responsible for the secretion of phospholipids incorporated into dentin, and intercellular diffusion of components originating from blood could explain this early dentin labeling. After 2 hours, odontoblasts and ameloblasts were labeled. In cells, grain density reached a maximum at 4 hours, reduced at 24 hours, and strongly decreased at 4 days. In predentin and enamel, grain density peaked at 24 hours and diminished at 4 days. However, in the forming enamel 4 days after the injection, labeling was twice as high as in any other compartment. Altogether, the results highlighted two distinct pathways for phospholipids in dental mineralized dental tissues: a first one shows evidence of early incorporation of [3H]choline into dentin resulting from intercellular diffusion independently from odontoblasts secretion, whereas inside the forming enamel, higher labeling and longer retention of choline-containing membrane components were detected between 4 hours and 4 days. This suggests an accumulation of membranes that are not subjected to rapid turnover in contrast with other dental compartments.

Lanthanum nitrate was either perfused intravascularly or segments of mouse tooth were immersed in a fixative solution containing the tracer. The tracer deposits were examined in young (8-day-old) and older (8-week-old) mouse incisors and molars, demineralized or undemineralized. Lanthanum passed the distal junctional complex of odontoblasts and appeared in the predentine of incisors as large electron-dense stellate aggregates, 40-70 nm in diameter, and in molars as round, 20-40 nm dots. In dentine, tracer deposits were detected at three locations. Near the predentine dentine junction, the tracer densely stained a band 0.5-2.5 microm in width, also termed metadentine; in the inner circumpulpal dentine, the staining was weaker or lacking in an area extending 5-7 microm from the predentine-dentine junction; in outer circumpulpal dentine, lateral diffusion had occurred in porosities of intertubular dentine. Lanthanum impregnated the walls of dentine tubules and a peritubular-like dentine. In contrast, the mantle dentine was never stained. These differences in the pattern of diffusion prove that lanthanum staining is age-dependent and varies between mouse incisors and molars, independently of tissue processing. Architectural properties and driving flux are involved in the transport and localization of lanthanum in predentine and dentine.

Cyclosporin A (CsA), a widely used immunosuppressive drug, induces gingival overgrowth and modifications of bone remodelling. The scope of this study was to investigate the possible effect of CsA on dentin. Thirty mg/kg/day of CsA were administered orally to male Sprague-Dawley rats for nineteen weeks. The same number of control rats received oil-based vehicle solution. Rats were anesthetized, and tissues were fixed by an intracardiac perfusion of fixative solution. Mandibles were dissected, demineralized, and processed for Epon embedding. Semi-thin sections of the first molars revealed alterations at the secondary dentin-pulp interface in four out of six experimental animals. The changes consisted of the formation of: 1) osteodentin spurs, in which the volume and interface with the secondary dentin varied from about 25,000 to 75,000 microns 3 and from 1400 to 3530 microns 2, respectively; 2) abnormally shaped and irregularly spaced incremental lines; and 3) numerous globular formations embedded in dentin or free in the pulp. These results indicate that CsA induces abnormal mineralized matrix formation in dentin and in the peripheral part of the pulp in rat molars.

The appearance of the junction between predentin and dentin of rat incisors was investigated after chemical fixation (aldehyde), physical fixation (high pressure freezing and freeze substitution) and by histochemistry. Physical fixation revealed a 1-2 micron wide intermediary zone, in which only the collagen fibers were mineralized. In dentin, which looked denser and more homogeneous, both collagen fibers and intercollagenous spaces were mineralized. The intermediary layer could not been seen after aldehyde fixation. When cationic dyes were used during fixation in order to retain proteoglycans, a 0.5-5 micron border zone located at the junction between predentin and dentin was densely stained on the dentin side, whereas in dentin only the interglobular network displayed electron density. The periodic acid-thiocarbohydrazide-silver proteinate reaction, visualizing glycoproteins, and the phosphotungstic acid/chromic acid mixture, which reveals glycoproteins and phosphorylated proteins, produced extensive staining of the transitional zone located at the dentin edge, whereas staining was weaker in dentin. These morphological and histochemical investigations support the existence of an intermediary zone in which mineralization occurs. This transitional zone between predentin and dentin has specific properties; therefore we propose it be termed metadentin.

Autoradiographic investigations were carried out 0.5, 1, 2, 4, 24, 48, 72, and 120 hours after the injection of a single dose of [35S]-sulfate on undemineralized molars of 7-15-day-old rats. In predentin, labeling was detected at 0.5 hours. Silver grain density reached a plateau value between 1 and 24 hours, then decreased and disappeared 120 hours after injection. In dentin, the mineralization front started to be labeled as early as 0.5 hours after injection. Labeling increased at the dentin edge between 1 and 2 hours, reached a maxima at 4 hours, then started to decrease, the labeled band seen 24 hours after injection being further incorporated into dentin. This band stood at constant distance from the dentin-enamel junction with stable grain density, even at 120 hours. This investigation proves the existence of two distinct groups of [35S]-labeled proteoglycans, one exclusively related to predentin and disappearing with time, and the second one located in dentin behaves as a stable component. The fact that an early labeling appeared at the mineralization front which was further incorporated into dentin, confirms that dentin proteoglycans constitute an individual group of molecules that are not derived from predentin proteoglycans, and act as mineralization promotors.

At neutral pH, poly-L-lysine-gold complexes labelled the predentine extensively, whereas in dentine the number of gold complexes was reduced by half. Hyaluronidase pretreatment of the section at pH 6.8, prior to labelling, suppressed most of the staining in predentine and did not affect dentine. In contrast, alkaline phosphatase pretreatment at pH 9 enhanced the gold complex labelling in predentine and removed most of the labelling in dentine. This proves that at pH 7.2, the polyanions which are stained include a heterogeneous population of glycosaminoglycans, located in predentine, and phosphoproteins, visualized in dentine. At acidic pH levels (2.9 and 1.1), the number of scored gold complexes decreased, but the ratio between predentine and dentine labelling remained constant. Hyaluronidase pretreatment removed or firmly reduced the gold complex labelling both in predentine and dentine, whereas alkaline phosphatase pretreatment of the sections at pH 9 prior to labelling did not induce any change. This argues in favour of an increased specificity of polylysine-gold complex staining for glycosaminoglycans, stained at low pH in both predentine and dentine. Differential staining of glycosaminoglycans and phosphoproteins according to the pH provides a useful tool for studying the role played respectively by the two matrix components in dentine mineralization.

Objectives and Methods: The value of the concept of a pulpo-dentinal complex was assessed on human teeth treated according to the ISO test on biological evaluation. The teeth were extracted after 1 or 3 months and examined histologically. Biochemical and biological data available from the dental literature were also re-examined., Results: During the early development of the tooth, pulp and dentine establish close links and form an undivided organ. However, examination of the tissues at later stages of development casts doubt on the validity of such a concept. Major differences are reviewed in this report between the cells (odontoblasts and heterogeneous pulpal cells) and extracellular matrix (collagens, non-collagenic proteins and phospholipids) located either in the odontoblast-dentine area or in the pulp. It seems also that clear-cut differences are detected during inflammatory and repair processes., Conclusion: It is concluded that, although the existence of a dentino-pulpal reaction cannot be denied, the concept of a pulpo-dentinal complex is an oversimplification and should be revisited. This may have implications in the evaluation of restorative treatments and in the design of a tissue repair strategy.

The present investigation studies the effects of persistently cutting one lower rat incisor out of occlusion. Within four days, the rate of eruption of the cut (unimpeded) incisor increased to 216% and that of the uncut (impeded) contralateral to 136% of the baseline rate. While the former remained high, the latter decreased gradually to about 90% within three weeks. The rate of attrition of the impeded incisor increased to 233% of the baseline rate within two days, then fell abruptly, and remained at a slightly lower level than the rate of eruption. Accordingly, the length of the erupted part of the impeded incisor decreased initially, but increased gradually after about four days. Measurements made on SEM micrographs of the series of transverse tooth segments obtained when cutting the incisor out of occlusion, showed that growth-related increase in mesiodistal tooth width was arrested from the 10th segment, dentin thickness decreased gradually to about 50% in the 12th segment, and enamel thickness, after an initial increase, decreased to about 80% in the 11th segment. The present study provides experimental evidence that accelerated eruption affects morphogenesis and histogenesis of the rat lower incisor. An impeded incisor, especially the contralateral, may not serve as an ideal control.

In order to determine the differential effects of the thyroid hormones and the parathyroid hormone upon dentinogenesis in the rat incisor one control group (C) and four groups of surgically treated rats were studied: parathyroid autotransplanted (PTT), thyroidectomized (TX), parathyroidectomized (PTX), and thyro-parathyroidectomized group. One month after surgery the incisors were dissected and the tissues were prepared for light microscopy and morphometric measurements. This study revealed modifications in the TPTX rats as well as in the PTX rats: an enlargement of the predentin, alterations in the predentin appearance and the presence of mineralization defects. These results confirm that the effects observed are probably due to a PTH deficiency and/or hypocalcemia and suggest that their occurrence is associated with a determined stage of dentinogenesis in the rat.

Using two histochemical methods, malachite green-aldehyde and iodoplatinate, phospholipids were visualized in the predentine of rat incisors in the spaces located between collagen fibers and in dentine as needle-like structures located along individual or groups of mineralizing collagen fibers. The same staining pattern was seen with phospholipase A2-gold. Autoradiographic investigation using 3H choline as labelled precursor, visualized the incorporation of membrane-associated and extracellular choline-containing phosphatidyl choline and sphingomyelin. The cell and membrane-associated labelling decreased gradually between 24 and 4 days, whereas incorporation of the labelled precursor as stable extracellular matrix component was seen in dentine. In addition to these investigations, pharmacologically induced (suramine) and genetically (Krabbe's disease) lysosomal storage pathology was investigated. Defects due to lipid metabolism alterations were seen in predentine and/or in dentine. The major differences visualized here between the non-mineralized and mineralized compartments and interactions between phospholipids and proteoglycans, support the view that phospholipids as matrix components play an important role in the mechanisms of dentine formation and mineralization.

An ultrastructural study was carried out in order to better characterize the findings observed in the first part of our study. The materials and methods are the same as those used in the preceding paper. This study reveals the occurrence of structures which display a symmetrical cross-banded pattern within the predentin and dentin of thyro-parathyroidectomized (TPTX) and parathyroidectomized (PTX) rats. A difference in the distribution of the symmetrical banded structures as dentinogenesis advances, as well as differences in the amount of the symmetrical banded structures between TPTX and PTX rats were observed. The symmetrical banded structures correspond with the so-called symmetrical SLS previously described in the incisor of normal and pathologic rats. The occurrence of these structures at a given stage of the incisor development suggests that the odontoblast is sensitive to the parathyroid hormone deficiency and/or hypocalcemia in a precise stage of its maturation.

In order to assess the biocompatibility of dental materials, clinical studies, as well as in vitro studies, are needed. Although no bacteria were detected inside tubules, pulp reactions were observed when either adhesives of the last generation aiming to create an hybrid layer were used or restorative materials controlling the interface between the biomaterial and dental tissues. However, the reactions were feeble to moderate. Reparative dentine seldom appeared after such treatments. Differences between odontoblast and pulp cells, the nature of the lesion (necrosis or apoptosis), and differences between sound experimental and carious teeth seen in the real clinical situation are discussed in the context of in vivo human studies.

The iodoplatinate (IP) reaction, a selective method for visualization of phospholipids, was applied to the predentine and dentine of rat incisors and compared with malachite green aldehyde (MG) fixation/staining. Spot tests indicated (1) that IP specifically stains phospholipids, but not amino acids, displaying as do phospholipids, quaternary ammonium groups; and (2) phosphatidylserine and sphingomyelin were also stained by MGA. Although this reagent is known to interact with phosphorus, phosphoproteins remained unstained. In the rat incisor, an IP-positive network including granules and thin filaments was seen in predentine in the inter-collagen spaces, in many cases closely associated with collagen fibres and their periodic striations. In dentine, positively stained needle-like structures were located along individual collagen fibres, or at the surface of groups of collagen fibres. This staining pattern was unchanged on sections of material pretreated with acetone, whereas the staining was abolished or markedly reduced when the samples were treated either with chloroform/methanol or phospholipase C prior to the IP reaction. Pretreatment of the samples with hyaluronidase promoted subsequent diffusion of the staining. A very similar staining pattern was observed with MGA, in accordance with earlier reports. The present findings validate the histochemical results reported previously on the distribution and potential role(s) of phospholipids in dentine biomineralization.

Proteoglycans (PGs) have been visualized in the predentine and dentine with cationic dyes by staining thin sections with Alcian Blue, bismuth nitrate, or using Spicer's high-iron diamine (HID) method. The precise location may be obtained by adding cationic dyes such as Cuprolinic Blue, ruthenium hexamine trichloride or cationic detergent (cetylpyridinium chloride) to the fixative. These methods induced the formation of aggregates which varied in shape and number according to the method used. Rapid freezing followed by freeze-substitution revealed an amorphous ground substance, homogeneously stained with Alcian Blue, located in the predentine between the collagen fibres. These PGs may be involved in transport and diffusion in predentine. In dentine, small granules and needle-like structures were observed along the collagen fibres. This second group of PGs differs in composition, distribution and functions from the predentine PGs. The same distribution was seen when hyaluronidase-gold labelling was used. Labelling with antibodies and autoradiography also gave evidence of two distinct groups of PGs. In predentine, as an hydrated gel, PGs seems to act as mineral inhibitors, whereas immobilized on a surface, as seen at the dentine edge, they act as nucleating agents. The interaction between PGs and phospholipids seems also to play a role in the mineralization process.

Electron-histochemical visualization of proteoglycans was carried out in the predentine and dentine of rat incisors. Using various techniques proteoglycans were seen to be located between the collagen fibres in predentine, whereas they were observed at the surface of groups of collagen fibres in dentine. The same distribution was found when electron histochemical techniques aiming to visualize phospholipids were used. This co-distribution may play role in the mineralization processes.

In vivo studies were carried out on dental tissues of rat incisor after a single injection of suramin, a drug which induces mucopolysaccharidosis-like disease. Accumulation of lysosome-like structures was seen in secretory ameloblasts and odontoblasts. In vitro studies on embryonic tooth germ buds showed similar changes when they were cultured in presence of suramin. Anti-phospholipid immunolabelling revealed a developmentally regulated temporo-spatial pattern. Radiolabeling with 3H-suramin indicated cytosolic and nuclear incorporation. The drug acting as polyanion interacted directly with predentine. 35S sulphate incorporation was impaired by the drug. Another lysosomal storage disease, the sphingolipidosis, Krabbe's disease was also investigated in human. Changes were observed in pulp cells and as a consequence in dentin. Enamel also displayed many changes. Pharmacological or genetically acquired diseases constitute models providing insights on the role played by glycosaminoglycans and phospholipids in biomineralization.

Rat incisors were fixed with a solution of 0.05% Cuprolinic Blue and 2.5% glutaraldehyde in the presence of various concentrations of MgCl2 according to the critical electrolyte concentration (CEC) principle. This method allows glycosaminoglycans (GAG) to be properly preserved and visualized. Small granules were stained by the cationic dye in the predentine in the absence of MgCl2. These granules grew in size and became more electron-dense when the concentration of the electrolyte was increased. Larger ribbon-like structures and granules were seen when 0.3 M MgCl2 was used. In the dentine, tiny dots in close association with the surface of the collagen fibres, or their periodic striations, were positively stained. A thick electron-dense band located on the dentine side at the predentine-dentine junction was seen both with and without 0.05 M MgCl2. With higher concentrations of the electrolyte (0.1-0.3 M), this band was reduced to a very thin line located at the border of the dentine, along with mineralizing collagen fibres. This demonstrated the presence of GAG at the dentine surface and therefore indicated that GAG may play a role as nucleator agent.

This paper review the effects of orthophosphoric acid and other acidic agents on dental enamel. The effects of other treatments such as proteolytic agents or of mixture able to remove the lipids are also described. Specific problems are related to the dentine treatment. Acids and chelators should be avoided, because of the dentine tubules, the odontoblasts and pulp. We review also the problem of the smear layer, the surface of the carious dentine and the consequences for dental treatment. Researches which are still in progress are reported including the use of enzymes and alcali gels submitted to feeble electrolysis, this latter being able to prepare dentine, cementum and bone surfaces in order to increase the adhesion of biomaterials.

3H proline and 3H serine were injected intraperitoneally to rats which were killed 4 and 24 hours later. The incorporation of the labelled precursors was studied in the odontoblasts, predentine and dentine of the first lower molars. After radioautography, statistically significant differences in grain density appeared between the furcation, occlusal and lateral areas of the pulp chamber. The incorporation of predentine components into dentine was faster in the lateral than in the occlusal area, the slowest being detected in the furcation area. These differences may be related to the distribution of occlusal forces in the rat molar.

The enzyme-gold technique was used on dental tissues. Hyaluronidase was complexed with gold, and ultrathin sections of rat incisors were incubated with the hyaluronidase-gold complex to localize chondroitin-sulphate and hyaluronic acid at the ultrastructural level. The hyaluronidase-gold complex was found in predentine and dentine, especially at the mineralization front, in interglobular spaces and around dentinal canaliculi. The very young enamel was labelled, but not the later stages of formation. This method allowed a very precise localization of hyaluronic acid and/or chondroitin sulphate in rat incisors extracellular matrices. These findings support the important role of glycosaminoglycans in dentine mineralization.

Using cetylpyridinium chloride (CPC) in glutaraldehyde as fixative, we observed sinuous fiber-like structures 300-500 nm long and 7-14 nm thick in the spaces between the collagen fibers of rat incisor predentin. Small granules and fibrils were also detected. Electron-dense vesicles were seen inside the odontoblast processes. The plasma membrane was irregularly stained with material that adhered to its surface. In demineralized dentin, needle-like structures were seen at the periphery of globular structures which were not stained. Staining the sections with Alcian blue did not greatly improve the visualization of CPC-precipitated glycosaminoglycans. The specificity of staining was assessed on serial sections by selective dissociation of glycosaminoglycan aggregates with 2 M calcium chloride and their digestion by bovine testicular hyaluronidase. The glycosaminoglycans were probably combined with lipids, because treatment of the sections with a chloroform/methanol mixture removed the CPC-induced precipitates from both predentin and dentin.

Cuprolinic blue in a MgCl2-critical electrolyte concentration solution allows a larger surface representation of proteoglycans than other methods. Glycoaminoglycans in predentine were ribbon-like structures 14 nm thick and 60 nm long, with radiating filaments (3-4 nm) located in spaces between collagen fibres. Glycoaminoglycans and collagen together displayed longitudinal and orthogonal relationships. The ground substance was slightly electron dense. In dentine, the precipitate was less in quantity and consisted of rounded granules (15 nm in diameter, and filaments/3 nm in width) closely associated with the surfaces of collagen fibres.

Morphological and autoradiographic data give evidence that secretion take place at the odontoblast process level according to a lateral axis, perpendicular to the maturation axis of the predentine. Induced modifications with vinblastine sulphate emphasize the importance of the pericellular space (150--200 nm) while the disorganization of the collagen fiber arrangement suggests the presence of flows. We propose an hypothesis which connects all these facts.

The appearance of proteoglycans visualized on thin sections with alcian blue was compared in rat incisor predentine fixed either in aqueous aldehyde solutions or by anhydrous methods (acrolein vapours or rapid freezing-freeze substitution). The granular or branched chain-like structures detected after aqueous fixation probably resulted from precipitation or shrinkage of an expanded amorphous gel observed only after anhydrous fixation. In predentine, morphological interactions between proteoglycans and collagen fibres may be also artefactual.

Ruthenium hexammine trichloride (RHT) used as a probe to visualize anion groups in the predentine and dentine of rat incisors, showed a complex distribution pattern including: intercellular proteoglycans (Pg), detected in the predentine as granules 10-15 nm in diameter and as filaments. Non-aggregating Pg was observed in the spaces between collagen fibres as an amorphous group substance. The dentine included smaller RHT-positive granules, observed after thin-section demineralization; pericellular aggregates, 30-50 nm in diameter, which were absent at the onset of the cell coat along the plasma-membrane of the odontoblast process and of the membrane itself. All these RHT-positive components might be Pg and/or sialoglyconjugates and glyco- or phospholipids present on the plasma membrane.