Comprehensive study of root surface treatment and regeneration in periodontal disease

本研究旨在发展一种获得结缔组织附着的根面处理新方法，并探讨其在牙周手术后的临床应用。在本项目中，通过各种方法阐明了牙周膜细胞动力学与新根表面处理之间的关系。结果如下：(1)牙周韧带细胞增殖和分化的机制（Takata）。(2)牙周组织再生过程中神经的参与（Maeda）。(3)牙周组织再生和动态平衡的机制（Shimono）。(4)上皮附着与结缔组织附着的相关性（Hashimoto）。(5)应用生长因子对牙周组织的再生改变（Sugaya）。(6)釉质底物蛋白（Yamada）获得结缔组织附着。(7)微循环在牙周组织再附着过程中的作用（Sekiguchi）。在靠近PDL表面的浅层亚群中，增殖活性较高。碱性磷酸酶（ALP）活性和钙化活性在靠近根表面的深层亚群中较高。有趣的是，根表面的PDL亚群在ALP和增殖方面都表现出较高的活性。这里建立的实验模型可以成为讨论使用生长因子的新再生疗法的一个很好的工具。在退变过程中，末端雪旺细胞迁移到牙齿相关部位，在完整韧带中很少观察到鲁菲尼末梢。在牙周Ruffini末梢再生之前，它们向牙槽相关部位移动。这些数据表明，末端雪旺细胞在牙周鲁菲尼末梢再生中起重要作用。指出马拉塞兹上皮休息或残余在牙周韧带维持中的重要性。在长结上皮的内层，显示了整合素和层粘连蛋白-5，表明它对上皮附着很重要。rhPDGF-BB组蛋白浓度和细胞数量显著升高，rhBMP-2组ALP活性显著升高。因此，将rhPDGF-BB和rhBMP-2应用于EDTA脱矿牙本质表面，分别促进牙周膜细胞的反应，最终促进牙周再生。柠檬酸在牙本质上的应用可以作为牙骨质形成的积极因素。柠檬酸处理表面脱钙的牙本质基质具有诱导牙骨质形成的能力。少

The aim of this comprehensive study is development of new root surface treatment method to acquire the connective tissue attachment, and it's clinical application in which after periodontal surgery. In this project, relationship between the dynamics of periodontal ligament cells and the new root surface treatment was clarified by various methods. Followings results were obtained.(1) The mechanism of cell proliferation and differentiation in the periodontal ligament (Takata).(2) The involvement of the nerve in the regeneration process of the periodontal tissue (Maeda).(3) The mechanism of regeneration and homeostasis of the periodontal tissue (Shimono).(4) The correlation between epithelial attachment and connective tissue attachment (Hashimoto).(5) The regenerative change of the periodontal tissue by Growth factor application (Sugaya).(6) The acquisition of connective tissue attachment by the enamel substrate protein (Yamada).(7) The involvement of the microcirculation in the reattachm … More ent of the periodontal tissue (Sekiguchi).Proliferation activities were higher in the shallower subpopulations near the PDL surface. On the other hand, activities of alkaline phosphatase (ALP) and calcification were higher in the deeper subpopulations close to the root surface. Interestingly, the PDL subpopulation on the root surface showed the high activities both in ALP and proliferation. The experimental model established here could be an excellent tool for the discussion of new regenerative therapies using growth factors. The terminal Schwann cells migrated into tooth-related part, where the Ruffini endings were rarely observed in intact ligament, during degeneration process. Prior to regeneration of periodontal Ruffini endings, they moved to alveolus-related part. These data suggested that terminal Schwann cells play important roles in regeneration of periodontal Ruffini endings. The importance of Malassez epithelial rest or remnant in the maintenance of the periodontal ligament was indicated. In the internal lamina of the long-junctional epithelium, Integrin and Laminin-5 were indicated, and it suggested to be important for epithelial attachment. A significant increase of protein concentration and cell number in rhPDGF-BB groups and a significant increase of ALP activity in rhBMP-2 groups was observed. Thus, rhPDGF-BB and rhBMP-2 application to EDTA demineralized dentin surfaces promote the periodontal ligament cell responses respectively which ulimately would enhance periodontal regeneration. The application of the citric acid on the dentin can act as positive factor for cementum formation. The superficially decalcified dentin matrix treated with citric acid has the ability toinduce cementogenesis. Less