Melatonin regulation and the function of the periodontal ligament: Future perspective and challenges

The present article reviews the emerging role of melatonin(MT)and the Hippo-Yes-associated protein signaling pathway in periodontal regeneration,high-lighting their potential to delay the aging process of periodontal ligament stem cells(PDLSCs).Oxidative stress and cellular senescence are major obstacles in regenerative therapies,especially in an aging population.MT,a potent antioxidant,restores the morphology,proliferation,and osteogenic differentiation potential of PDLSCs under oxidative stress conditions.Recent research highlights how MT enhances PDLSC stemness by upregulating Yes-associated protein ex-pression,offering a promising therapeutic strategy to antagonize tissue dege-neration.In addition,the article discusses the growing interest in probiotics as a complementary approach to improve oral microbiota and support tissue regeneration.The integration of MT with traditional and novel therapeutic approaches may pave the way for innovative preventive or active treatments in periodontology,aimed at reducing oxidative stress.Future research needs to focus on translating these findings into clinical applications and promoting a deeper understanding of periodontal regeneration and cellular aging.

Elastic modulus determination at different levels of periodontal ligament in nanoindentation

In order to investigate the material properties ofperiodontal ligament （ PDL） in different locations, the nanoindentation method is used to survey the elastic modulus of the PDL at different levels. Cadaveric specimens of human mandibular canine were obtained from 4 adult donors, 16 transverse specimens were made from the sections of cervical margin, midroot and apex using the slow cutting machine. The prepared specimens were tested in different sections （along the longitudinal direction） and different areas （in the circumferential direction）. According to the Oliver-Phair theory, the mean values of elastic modulus were calculated foreach area and the differences among them were compared. In the midroot section, the average elastic modulus is ranging from 0. 11 to 0. 23 MPa, the changing range of the cervical margin and apex are from 0. 21 to 0. 53 MPa and 0. 44 to0.62 MPa, respectively. Experimental results indicate that the average elastic modulus in the midroot is lower than that in the cervical margin and apex, and relatively small changes occur among them. However, there is a large change to the elastic modulus value in the cicumferential direction for the PDL.

Characterization of the osteogenic potential of mesenchymal stem cells from human periodontal ligament based on cell surface markers

Mesenchymal stem cell （MSC）-mediated therapy has been shown to be clinically effective in regenerating tissue defects. For improved regenerative therapy, it is critical to isolate homogenous populations of MSCs with high capacity to differentiate into appropriate tissues. The utilization of stem cell surface antigens provides a means to identify MSCs from various tissues. However, few surface markers that consistently isolate highly regenerative MSCs have been validated, making it challenging for routine clinical applications and making it all the more imperative to identify reliable surface markers. In this study, we used three surface marker combinations： CD51/CD140a, CD271, and STRO-1/CD146 for the isolation of homogenous populations of dental mesenchymal stem cells （DMSCs） from heterogeneous periodontal ligament cells （PDLCs）. Fluorescence-activated cell sorting analysis revealed that 24% of PDLCs were CD51＋/CD140a＋, 0.8% were CD271＋, and 2.4% were STRO-1＋/CD146＋. Sorted cell populations were further assessed for their multipotent properties by inducing osteogenic and chondrogenic differentiation. All three subsets of isolated DMSCs exhibited differentiation capacity into osteogenic and chondrogenic lineages but with varying degrees. CD271＋ DMSCs demonstrated the greatest osteogenic potential with strong induction of osteogenic markers such as DLX5, RUNX2, and BGLAP. Our study provides evidence that surface marker combinations used in this study are sufficient markers for the isolation of DMSCs from PDLCs. These results provide important insight into using specific surface markers for identifying homogenous populations of DMSCs for their improved utilization in regenerative medicine.

Overview of noncoding RNAs involved in the osteogenic differentiation of periodontal ligament stem cells

Periodontal diseases are infectious diseases that are characterized by progressive damage to dental support tissue.The major goal of periodontal therapy is to regenerate the periodontium destroyed by periodontal diseases.Human periodontal ligament(PDL)tissue possesses periodontal regenerative properties,and periodontal ligament stem cells(PDLSCs)with the capacity for osteogenic differentiation show strong potential in clinical application for periodontium repair and regeneration.Noncoding RNAs(ncRNAs),which include a substantial portion of poly-A tail mature RNAs,are considered“transcriptional noise.”Recent studies show that ncRNAs play a major role in PDLSC differentiation;therefore,exploring how ncRNAs participate in the osteogenic differentiation of PDLSCs may help to elucidate the underlying mechanism of the osteogenic differentiation of PDLSCs and further shed light on the potential of stem cell transplantation for periodontium regeneration.In this review paper,we discuss the history of PDLSC research and highlight the regulatory mechanism of ncRNAs in the osteogenic differentiation of PDLSCs.

Expression analysis of a-smooth muscle actin and tenascin-C in the periodontal ligament under orthodontic loading or in vitro culture

α-smooth muscle actin （α-SMA） and tenascin-C are stress-induced phenotypic features of myofibroblasts. The expression levels of these two proteins closely correlate with the extracellular mechanical microenvironment. We investigated how the expression of α-SMA and tenascin-C was altered in the periodontal ligament （PDL） under orthodontic loading to indirectly reveal the intrinsic mechanical microenvironment in the PDL. In this study, we demonstrated the synergistic effects of transforming growth factor-β1 （TGF-β1） and mechanical tensile or compressive stress on myofibroblast differentiation from human periodontal ligament cells （hPDLCs）. The hPDLCs under higher tensile or compressive stress significantly increased their levels of α-SMA and tenascin-C compared with those under lower tensile or compressive stress. A similar trend was observed in the tension and compression areas of the PDL under continuous light or heavy orthodontic load in rats. During the time-course analysis of expression, we observed that an increase in α-SMA levels was matched by an increase in tenascin-C levels in the PDL under orthodontic load in vivo. The time-dependent variation of α-SMA and tenascin-C expression in the PDL may indicate the time-dependent variation of intrinsic stress under constant extrinsic loading.

Low-power laser irradiation promotes the proliferation and osteogenic differentiation of human periodontal ligament cells via cyclic adenosine monophosphate

Retaining or improving periodontal ligament （PDL） function is crucial for restoring periodontal defects. The aim of this study was to evaluate the physiological effects of low-power laser irradiation （LPLI） on the proliferation and osteogenic differentiation of human PDL （hPDL） cells. Cultured hPDL cel Is were irradiated （660 nm） daily with doses of O, 1, 2 or 4 J .cm-2. Cell proliferation was evaluated by the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide （MTT） assay, and the effect of LPLI on osteogenic differentiation was assessed by Alizarin Red S staining and alkaline phosphatase （ALP） activity. Additionally, osteogenic marker gene expression was confirmed by real-time reverse transcription-polymerase chain reaction （RT-PCR）. Our data showed that LPLI at a dose of 2 J.cm-2 significantly promoted hPDL cell proliferation at days 3 and 5. In addition, LPLI at energy doses of 2 and 4 J.cm-2 showed potential osteogenic capacity, as it stimulated ALP activity, calcium deposition, and osteogenic gene expression. We also showed that cyclic adenosine monophosphate （cAMP） is a critical regulator of the LPLI-mediated effects on hPDL cells. This study shows that LPLI can promote the proliferation and osteogenic differentiation of hPDL cells. These results suggest the potential use of LPLI in clinical applications for periodontal tissue regeneration.

Human β-defensin 3 gene modification promotes the osteogenic differentiation of human periodontal ligament cells and bone repair in periodontitis

Efforts to control inflammation and achieve better tissue repair in the treatment of periodontitis have been ongoing for years.Humanβ-defensin 3,a broad-spectrum antimicrobial peptide has been proven to have a variety of biological functions in periodontitis;however,relatively few reports have addressed the effects of human periodontal ligament cells(h PDLCs)on osteogenic differentiation.In this study,we evaluated the osteogenic effects of h PDLCs with an adenoviral vector encoding humanβ-defensin 3 in an inflammatory microenvironment.Then humanβ-defensin 3 gene-modified rat periodontal ligament cells were transplanted into rats with experimental periodontitis to observe their effects on periodontal bone repair.We found that the humanβ-defensin 3 gene-modified h PDLCs presented with high levels of osteogenesis-related gene expression and calcium deposition.Furthermore,the p38 MAPK pathway was activated in this process.In vivo,humanβ-defensin 3 gene-transfected rat PDLCs promoted bone repair in SD rats with periodontitis,and the p38 mitogen-activated protein kinase(MAPK)pathway might also have been involved.These findings demonstrate that humanβ-defensin 3 accelerates osteogenesis and that humanβ-defensin 3 gene modification may offer a potential approach to promote bone repair in patients with periodontitis.

Effects of lysophosphatidic acid on human periodontal ligament stem cells from teeth extracted from dental patients

Despite their potential applications in future regenerative medicine, periodontal ligament stem cells(PDLSCs) are difficult to obtain in large amounts from patients. Therefore, maintaining sternness while expanding the cell numbers for medical use is the key to transitioning PDLSCs from the bench to the clinic. Lysophosphatidic acid(LPA), which is present in the human body and saliva, is a signaling molecule derived from phospholipids. In this study, we examined the effects of LPA on sternness maintenance in human PDLSCs. Several spindle-shaped and fibroblast-like periodontal ligament stem-like cell lines were established from PDLSC isolation. Among these cell lines, the most morphologically appropriate cell line was characterized. The expression levels of OCT4, NANOG(a stem cell marker), and CD90(a mesenchymal stem cell marker) were high. However, CD73(a negative marker of mesenchymal stem cells) expression was not observed. Notably, immunofluorescence analysis identified the expression of STRO-1, CD146(a mesenchymal stem cell marker), and sex determining region Y-box 2 at the protein level. In addition, lipid droplets were stained by Oil red O after the induction of adipogenesis for 21 days, and mineralized nodules were stained by Alizarin Red S after the induction of osteogenesis for 14 days. Alkaline phosphate staining also demonstrated the occurrence of osteogenesis. In summary, we established a human PDLSC line, which could be applied as a cell source for tissue regeneration in dental patients. However, further studies are needed to determine the detailed effects of LPA on PDLSCs.

Therapeutic potential of periodontal ligament stem cells

Inflammatory periodontal disease known as periodontitis is one of the most common conditions that affect human teeth and often leads to tooth loss.Due to the complexity of the periodontium,which is composed of several tissues,its regeneration and subsequent return to a homeostatic state is challenging with the therapies currently available.Cellular therapy is increasingly becoming an alternative in regenerative medicine/dentistry,especially therapies using mesenchymal stem cells,as they can be isolated from a myriad of tissues.Periodontal ligament stem cells(PDLSCs)are probably the most adequate to be used as a cell source with the aim of regenerating the periodontium.Biological insights have also highlighted PDLSCs as promising immunomodulator agents.In this review,we explore the state of knowledge regarding the properties of PDLSCs,as well as their therapeutic potential,describing current and future clinical applications based on tissue engineering techniques.

Mass acquisition of human periodontal ligament stem cells

The periodontal ligament(PDL)is an essential fibrous tissue for tooth retention in the alveolar bone socket.PDL tissue further functions to cushion occlusal force,maintain alveolar bone height,allow orthodontic tooth movement,and connect tooth roots with bone.Severe periodontitis,deep caries,and trauma cause irreversible damage to this tissue,eventually leading to tooth loss through the destruction of tooth retention.Many patients suffer from these diseases worldwide,and its prevalence increases with age.To address this issue,regenerative medicine for damaged PDL tissue as well as the surrounding tissues has been extensively investigated regarding the potential and effectiveness of stem cells,scaffolds,and cytokines as well as their combined applications.In particular,PDL stem cells(PDLSCs)have been well studied.In this review,I discuss comprehensive studies on PDLSCs performed in vivo and contemporary reports focusing on the acquisition of large numbers of PDLSCs for therapeutic applications because of the very small number of PDLSCs available in vivo.

Human periodontal ligament stem cells repair mental nerve injury

Human periodontal ligament stem cells are easily accessible and can differentiate into Schwann cells. We hypothesized that human periodontal ligament stem cells can be used as an alternative source for the autologous Schwann cells in promoting the regeneration of injured peripheral nerve. To validate this hypothesis, human periodontal ligament stem cells （1 × 106） were injected into the crush-injured left mental nerve in rats. Simultaneously, autologous Schwann cells （1 × 106） and PBS were also injected as controls. Real-time reverse transcriptase polymerase chain reaction showed that at 5 days after injection, mRNA expression of low affinity nerve growth factor receptor was sig-nificantaly increased in the left trigeminal ganglion of rats with mental nerve injury. Sensory tests, histomorphometric evaluation and retrograde labeling demonstrated that at 2 and 4 weeks after in-jection, sensory function was significantly improved, the numbers of retrograde labeled sensory neurons and myelinated axons were significantly increased, and human periodontal ligament stem cells and autologous Schwann cells exhibited similar therapeutic effects. These findings suggest that transplantation of human periodontal ligament stem cells show a potential value in repair of mental nerve injury.

Effects of Aging on the Proliferation and Differentiation Capacity of Human Periodontal Ligament Stem Cells

periodontal ligament stem cells; aging; proliferation; osteogenic differentiation Objective The aim of this study is to investigate the proliferation, differentiation and apoptosis of periodontal ligament stem cells （PDLSC） derived from different aged donors, and to evaluate the effects of aging on the biological characteristics of PDLSC. Methods Periodontal ligament tissues were obtained from 24 surgically extracted human premolars during orthodontics therapy. The specimens were divided into three groups according to the donor’s age. Group A： 18-20 years, group B： 30-35 years, group C： 45-50 years. PDLSC were isolated and cultured using a tissue-block-based enzymolytic method by limiting dilution assay. The colony forming efficiency of PDLSC for three experimental groups was determined. Senescence-Associated β-Galactosidase （SA-β-G） expression in the three groups was examined using β-galactosidase staining working solution. Cell cycle and apoptosis of the PDLSC were examined by the flow cytometry. Alkaline phosphatase （ALP） activity was evaluated by ALP staining. The expression of osteoplastic differentiation related genes Runt-related transcription factor-2 （Runx-2）, Collagen Type 1 （col-1）, and ALP of PDLSC were examined by quantitative real-time RT-PCR. Results The colony forming efficiency of PDLSC in Group A, B and C was 36.67%, 22.67% and 9.33%, respectively, which decreased with donors’ age （P〈0.05）. SA-β-G expression of the senescent PDLSC in group A, B and C were 4.14%, 16.39%, 50.38%, respectively （P〈0.05）. Cells in G2/S phase was 38.73%, 29.88%, 18.25% （P〈0.05）, and the apoptosis rate was 1.57%, 4.56%, 5.84% （P〈0.05）, in group A, B and C respectively. The ALP staining in the three groups decreased with the increase of donors’ ages, and the expression of Runx-2, col-1 and ALP decreased gradually from group A to group C （all P〈0.05）, which indicated the osteogenic differentiation capacity of PDLSC decreased while donor aging. Conclusion Human PDLSC could be successfully isolated from periodontal ligament tissues of different aged donors. However, the proliferation and osteogenic differentiation capacity of PDLSC decreased while donor aging.

Effectiveness and Safety of Computer-controlled Periodontal Ligament Injection System in Endodontic Access to the Mandibular Posterior Teeth

Objective To evaluate the effectiveness and safety of a computer-controlled periodontal ligament （PDL） injection system to the local soft tissues as the primary technique in endodontic access to mandibular posterior teeth in patients with irreversible pulpitis. Methods A total of 162 Chinese patients who had been diagnosed with irreversible pulpitis in their mandibular posterior teeth without acute infection or inflammation in the periodontal tissues were enrolled in this clinical study. The patients were divided into 3 groups according to the position of the involved tooth： the premolar group （PM, z2=38）, first molar group （FM, n=66）, and second molar group （SM, n=58）. All the patients received computer-controlled PDL injection with 4% articaine and 1 ＇ 100 000 epinephrine. Immediately after the injection, endodontic access was performed, and the degree of pain during the treatment was evaluated by the patients using Visual Analogue Scale for pain. The success rates were compared among the 3 groups. The responses of local soft tissues were evaluated 3-8 days and 3 weeks after the procedure. Results The overall success rate was 76.5%. There was a significant difference in success rates among the PM, FM, and SM groups （92.1%, 53.0%, 93.1%, respectively; 2 X =34.3, P〈0.01）. Both the PM and SM groups showed higher success rates than that of the FM group （v=l, f=16.73, P〈0.01, v=l, Z = 4.5, X2 2 P〈0.01）. No irreversible adverse effects on the periodontal soft tissues at the injection sites were observed in the follow-up visits in any of the groups. Conclusion The computer-controlled PDL injection system demonstrates both satisfactory anesthetic effects and safety in local soft tissues as primary anesthetic technique in endodontic access to the mandibular posterior teeth in patients with irreversible pulpitis.

Exosomes Derived from Human Umbilical Cord Mesenchymal Stem Cells Enhance the Osteoblastic Differentiation of Periodontal Ligament Stem Cells Under High Glucose Conditions Through the PI3K/AKT Signaling Pathway

Objective High glucose(HG)can influence the osteogenic differentiation ability of periodontal ligament stem cells(PDLSCs).Human umbilical cord mesenchymal stem cell-derived exosomes(hUCMSC-exo)have broad application prospects in tissue healing.The current study aimed to explore whether hUCMSC-exo could promote the osteogenic differentiation of hPDLSCs under HG conditions and the underlying mechanism.Methods We used a 30 mmol/L glucose concentration to simulate HG conditions.CCK-8 assay was performed to evaluate the effect of hUCMSC-exo on the proliferation of hPDLSCs.Alkaline phosphatase(ALP)staining,ALP activity,and qRT-PCR were performed to evaluate the pro-osteogenic effect of hUCMSC-exo on hPDLSCs.Western blot analysis was conducted to evaluate the underlying mechanism.Results The results of the CCK-8 assay,ALP staining,ALP activity,and qRT-PCR assay showed that hUCMSC-exo significantly promoted cell proliferation and osteogenic differentiation in a dosedependent manner.The Western blot results revealed that hUCMSC-exo significantly increased the levels of p-PI3K and p-AKT in cells,and the effect was inhibited by LY294002(PI3K inhibitor)or MK2206(AKT inhibitor),respectively.Moreover,the increases in osteogenic indicators induced by hUCMSC-exo were significantly suppressed by LY294002 and MK2206.Conclusion hUCMSC-exo promote the osteogenic differentiation of hPDLSCs under HG conditions through the PI3K/AKT signaling pathway.

Triclosan inhibits the activation of human periodontal ligament fibroblasts induced by lipopolysaccharide from Porphyromonas gingivalis

Periodontitis is a highly prevalent,chronic,non-specific,and immunologically devastating disease of periodontal tissues,caused by microbial infection.This study aims to examine the efficacy and protective mechanism of triclosan(TCS),a bisphenolic,non-cationic component of oral care products,against periodontal inflammation induced by lipopolysaccharide purified from Porphyromonas gingivalis(LPS-PG).TCS markedly downregulated interleukin-6(IL-6),IL-8,and IL-15 in human periodontal ligament fibroblasts(HPDLFs)treated with LPS-PG.By using a liquid chromatography-tandem mass spectrometry(LC-MS/MS)approach,318 differentially expressed proteins(161 upregulated and 157 downregulated)were identified in TCS-pretreated HPDLFs.TCS upregulated HSPA5 and HSP90B1 but downregulated HSPA2.Besides,TCS upregulated miR-548i in HPDLFs,which downregulated IL-15.These results indicate that TCS attenuates the activation of HPDLFs and downregulates the inflammatory cytokines through various mechanisms,thus highlighting its protective role in periodontal inflammation.

The biomechanical role of periodontal ligament in bonded and replanted vertically fractured teeth under cyclic biting forces

After teeth are replanted,there are two possible healing responses：periodontal ligament healing or ankylosis with subsequent replacement resorption.The purpose of this study was to compare the fatigue resistance of vertically fractured teeth after bonding the fragments under conditions simulating both healing modes.Thirty-two human premolars were vertically fractured and the fragments were bonded together with Super-Bond C＆B.They were then randomly distributed into four groups（BP,CP,CA,BA）.The BP and CP groups were used to investigate the periodontal ligament healing mode whilst the BA and CA groups simulated ankylosis.All teeth had root canal treatment performed.Metal crowns were constructed for the CP and CA groups.The BP and BA groups only had composite resin restorations in the access cavities.All specimens were subjected to a 260 N load at 4 Hz until failure of the bond or until 2 x 106 cycles had been reached if no fracture occurred.Cracks were detected by stereomicroscope imaging and also assessed via dye penetration tests.Finally,interfaces of the resin luting agent were examined by scanning electron microscope.The results confirmed that the fatigue resistance was higher in the groups with simulated periodontal ligament healing.Periodontal reattachment showed important biomechanical role in bonded and replanted vertically fractured teeth.

Effects of Apatite Nanocrystals on Proliferation, Subcellular Structure, Protein Synthesis Activity of Human Periodontal Ligament Cells

To determine the cellular events occurring in the presence of yttrtum/ hyclroxyapatite（Y / HA ） or HA nanocrystals, human periodontal ligament （HPDL） cells were isolated and maintained in culture. The specificity of the cells was evidenced by their proliferation, subcellular structure, and deposition of extracellular matrix components. The presence of nanocrystals was significantly related to an increase in the proliferation. Moreover, the presence of Y/HA nanocrystals was significantly related to an increase in the proliferation with HA nanocrystals. Transmission electron microscopy （TEM） demonstrated the phagocytotic process of HPDL cells toward Y/ HA or HA nanocrystuls . The presence of Y/ HA or HA nanocrystuls was significantly related to an increase in the protein synthesis activity of HPDL cells.

The Effects of Dense/Nanometer Hydroxyapatite on Proliferation and Osteogenetic Differentiation of Periodontal Ligament Cells

The objective of this study is to investigate possible effects of nanometer powder of hydroxyapatite on proliferation of periodontal ligament cells. With sol-gel method, the nanometer hydroxyapatite powder were fabricated. The primary periodontal ligcament cells were caltured on dense particle hydroxyapatite and nanometer particle hydroxyapatite. The effects on proliferation of periodontal ligament cell were examined in vitro with MTT （ methyl thiazolil tetracolium） test. The intercellalar effects were observed with scanning electron microscopy and energy dispersive X-ray analyzer. In addition, the influence of two materials on osteogenetic differentiation was determined with measurement of ALP （ alkaline phosphatase ） activity. It is concluded that nanometer hydroxyapatite can promote proliferation and osteogenetic differeraiation of periodontal ligament cells and it may become absorbable agent in osseous restoration.

Cell Attachment of Periodontal Ligament Cells on Commercially Pure Titanium at the Early Stage

Summary: In order to study the character of periodontal ligament cells (PDLCs) attaching on commercially pure titanium (cpTi) by morphology and metrology on the early stage (24 h), 1×105/ml PDLCs in 2 ml culture medium were seeded on cpTi discs fixed in 24-well culture plates. Morphology of cell attachment was observed by contrast phase microscope, scanning electron microscope (SEM) and fluroscence microscopy. Cell adhesion was analyzed by MTT at 0.5, 1, 2, 4 h respectively. PDLCs could attach and spread on cpTi discs. SEM showed that PDLCs had pseudopod-like protuberance. PDLCs showed different attaching phases and reached saturation in cell number at 2 h. It was concluded that PDLCs had good biocompatibility with cpTi, and showed a regular and dynamic pattern in the process of attaching to cpTi.

Effects of Tension Force on Proliferation and Differentiation of Human Periodontal Ligament Cells Induced by Lipopolysaccharides

Human periodontal ligament cells (hPDLCs), with the potential for multi-directional differentiation and reproduction, are the target cells of orthodontic tooth movement. The aim of this study was to examine the effect of mechanical tension force and lipopolysaccharides (LPS) on hPDLCs and whether they induce proliferative and differentiated characters in vitro. Tension force was applied to hPDLCs stimulated with and without LPS for 24 hrs. Real-time polymerase chain reaction (qPCR) was carried out to analyze the mRNA expression of Cyclin 2 (CCND2), WNT1 inducible signaling pathway protein 1 (WISP1), runt-related transcription factor 2 (RUNX2) and alkaline phosphatase (ALP). Analysis of variance (ANOVA) was used for statistical analysis. Significant differences were indicated by P < 0.05. The results showed that tension force promoted the mRNA expression of both the proliferation-related genes (CCND2 and WISP1) and differentiation-related genes (RUNX2 and ALP), and that both were enhanced by the simulation of LPS. In addition, the relative expression ratios CCND2/RUNX2 and CCND2/ALP both increased significantly after the application of tension, and this effect was further enhanced by LPS. All results indicated that with the assessed level of mechanical force loading, tension could promote both the proliferation and differentiation of hPDLCs, which could be enhanced by LPS, and that proliferation is promoted to a greater extent than differentiation. These findings may be valuable for understanding the importance of the application of suitable mechanical force in periodontal remodeling, especially in the process of orthodontic tooth movement with inflammation.