Research progress on in vivo models for stem cell-based pulp regeneration / 口腔疾病防治

@#Basic research on pulp regeneration requires in vivo experiments. The PubMed database was searched for in vivo models of stem cell-based pulp regeneration using the following keywords: "pulp regeneration", "stem cell" and "animal model". The retrieved models were classified into ectopic, semiorthotopic and orthotopic regeneration models and their characteristics and clinical values were reviewed. This literature review indicated that the ectopic regeneration model is the most widely used model for the simple steps. However, this model does not accurately capture clinical situations. The semiorthotopic regeneration model, which is an improvement of the ectopic regeneration model, can create a more realistic regeneration environment. The orthotopic regeneration model can simulate clinical procedures that more closely resemble application, but it is less commonly used for difficult operations and long experimental periods. The applicability of the above three animal models depend on the stage of the animal experiment: the ectopic regeneration model is suitable to test the regenerative effect and biocompatibility of the implant complex; the semiorthotopic regeneration model is suitable to more persuasively evaluate the regeneration effect of the implant complex; and the orthotopic regeneration model is suitable to confirm the regeneration effect and practicability of the regenerative implant complex prior to clinical study.

Effects of different degrees of root canal filling therapy on pain severity, stress response and masticatory function in patients with dental diseases / 中国基层医药

Objective:To investigate the effects of different degrees of root canal filling therapy on pain severity, stress response and masticatory function in patients with dental diseases.Methods:A total of 120 patients with dental disease who received treatment in Department of Oral Surgery, Zhoushan Hospital between December 2019 and December 2020 were included in this study. They were randomly divided into study and control groups ( n = 60/group). Patients in the control group were given excessive root canal filling and those in the study group were given approximate root canal filling. Cortisol, adrenocorticotropic hormone, interleukin-1β and interleukin-10 levels, bite force, gingival index and masticatory efficiency were determined before and after treatment. Visual Analog Scale (VAS) was used to evaluate the severity of pain in each group. Clinical efficacy was compared between the two groups. Results:After treatment, interleukin-1β, cortisol and adrenocorticotropic hormone levels in the study group were (23.66 ± 6.94) μg/L, (129.61 ± 27.18) μg/L, (14.58 ± 4.11) ng/L, respectively, which were significantly lower than those in the control group [(31.31 ± 10.13) μg/L, (147.93 ± 30.26) μg/L, (17.16 ± 5.04) ng/L, t = 4.82, 3.45, 3.07, all P < 0.05]. Interleukin-10 level in the study group was significantly higher than that in the control group [(65.19 ± 16.06) ng/L vs. (56.61 ± 15.52) ng/L, t = 2.97, P < 0.05). Bite force and masticatory efficiency in the study group were (127.53 ± 33.20) 1bs and (84.73 ± 20.65)%, respectively, which were significantly higher than those in the control group [(115.25 ± 30.12) 1bs, (75.49 ± 18.14)%, t = 2.12, 2.60, both P < 0.05]. Gingival index and Visual Analog Scale score in the study group were (0.44 ± 0.12) and (2.73 ± 0.81) points, respectively, which were significantly lower than those in the control group [(0.44 ± 0.12), (2.73 ± 0.81) points, t = 7.92, 2.66, both P < 0.05]. Total response rate in the study group was significantly higher than that in the control group (96.67% vs. 81.67%, χ2 = 5.52, P < 0.05). Conclusion:Appropriate root canal filling therapy is highly effect on dental diseases. It can decrease stress response, inhibit inflammation, alleviate pain, and improve masticatory function.

Estado de la enseñanza del diagnóstico de afecciones pulpares y periapicales centrada en el método clínico / Status of the pulp and periapical disorders diagnosis teaching focused on the clinical method

RESUMEN Fundamento: la enseñanza del diagnóstico de las afecciones pulpares y periapicales se enmarca como un contenido esencial del proceso de enseñanza-aprendizaje en la asignatura de Operatoria Clínica, para cumplir las funciones principales declaradas en el perfil profesional del modelo de formación del estomatólogo general en Cuba. Objetivo: determinar el estado actual de la enseñanza del diagnóstico de afecciones pulpares y periapicales en la asignatura de Operatoria Clínica de la carrera de Estomatología. Métodos: investigación observacional, descriptiva y de corte transversal realizada en la Universidad de Ciencias Médicas de Cienfuegos sobre una población conformada por 8 docentes y los 37 estudiantes de tercer año del curso 2017-2018. Se utilizó una guía para observar de forma directa cómo se realiza la enseñanza del diagnóstico de las afecciones pulpares y periapicales y se aplicó una encuesta a profesores y estudiantes con preguntas cerradas. Resultados: se evidenció como fortaleza que predomina la educación en el trabajo como forma organizativa y existen referencias de la enseñanza del método clínico en la carrera de medicina. Se constataron limitaciones en el claustro respecto a las categorías docentes, científicas y años de experiencia; limitado aprovechamiento de la caracterización de los estudiantes y sus resultados así como deficiente aplicación de las acciones esenciales correspondientes a la etapa diagnóstica del método clínico y prevalencia del papel autoritario del docente. Conclusiones: aún existen limitaciones en la enseñanza actual del diagnóstico de las afecciones pulpares y periapicales en la población objeto de estudio.

ABSTRACT Background: the teaching of the pulp and periapical diseases diagnosis is defined as an essential content of the teaching-learning process in the Clinical Operative subject, to fulfill the main functions declared in the professional profile of the general stomatologist training model in Cuba. Objective: to determine the current state of pulp and periapical disorders teaching diagnosis in the Stomatology career Clinical Operative subject. Methods: observational, descriptive and cross-sectional research carried out at the Cienfuegos University of Medical Sciences on a population of 8 teachers and 37 third-year students of the 2017-2018 academic year. A guide was used to directly observe how the teaching of the diagnosis of pulp and periapical diseases is carried out and a survey was applied to teachers and students with closed questions. Results: it was evidenced as a strength that education at work predominates as an organizational form and there are references to the clinical method teaching in the medical career. Limitations were found in the faculty with respect to the teaching and scientific categories and years of experience; limited use of the students characterization and their results as well as deficient application of the essential actions corresponding to the diagnostic stage of the clinical method and prevalence of the teacher authoritarian role. Conclusions: still limitations in the diagnosis of pulp and periapical diseases current teaching of the population under study.

Endo-perio lesions prevalence in non-molar and molar teeth: a pilot study / Prevalência de lesões endo-perio em dentes não-molares e molares: um estudo piloto

Introduction Pulp and periodontal tissues may communicate and, in pathological situations, combined endodontic-periodontal lesions may be established. Objective The aim of this study was to evaluate the prevalence of endo-perio lesions in non-molar and molar teeth referred for endodontic treatment. Material and method The sample consisted of 104 teeth evaluated in 79 consecutive patients in a cross-sectional design. Visible plaque, probing depth, and bleeding on probing were evaluated. Endodontic evaluation included the presence or absence of caries, fistulas, pain, and pulp sensitivity. The presence/absence of periapical lesion, bone loss in the furcation region, and proximal area were evaluated. Result The results showed that pain was the main reason for seeking dental care in 63.3% of patients. The molar teeth demonstrated higher presence of probing depth (PD) ≥ 7 mm (38.3%) and higher PD mean (6.17 mm) than non-molar teeth (P<0.05). It was verified that 65.4% of the teeth were diagnosed with a primary endodontic lesion and that the periodontal component was present in 34.6% of the teeth, either in a primary (10.6%), secondary (11.5%), or combined form (12.5%). True combined endodontic-periodontal lesion occurred significantly in molar teeth compared to non-molar teeth (p<0.05). Conclusion The primary endodontic lesion was found in a greater proportion in teeth referred for endodontic treatment; however, approximately 1/3 of the sample had periodontal involvement, which demonstrates the importance of the periodontal examination together with the general clinical examination.

Introdução Os tecidos pulpar e periodontal podem se comunicar e, em situações patológicas, podem-se estabelecer lesões endodônticas-periodontais combinadas. Objetivo O objetivo deste estudo foi avaliar a prevalência de lesões endo-perio em dentes não molares e molares encaminhados para tratamento endodôntico. Material e método A amostra consistiu de 104 dentes avaliados em 79 pacientes consecutivos em um desenho transversal. Placa visível, profundidade de sondagem e sangramento à sondagem foram avaliados. A avaliação endodôntica incluiu a presença ou ausência de cáries, fístulas, dor e sensibilidade pulpar. Foram avaliados a presença / ausência de lesão periapical, perda óssea em região de furca e área proximal. Resultado Os resultados mostraram que a dor foi o principal motivo de procura de atendimento odontológico em 63,3% dos pacientes. Os dentes molares demonstraram maior presença de profundidade de sondagem (PS) ≥ 7 mm (38,3%) e maior média de PS (6,17 mm) do que os dentes não molares (P <0,05). Verificou-se que 65,4% dos dentes tinham diagnóstico de lesão endodôntica primária e que o componente periodontal estava presente em 34,6% dos dentes, seja na forma primária (10,6%), secundária (11,5%) ou combinada (12,5%). Lesão endodôntica-periodontal combinada verdadeira ocorreu significativamente em dentes molares em comparação com os dentes não molares (p <0,05). Conclusão A lesão endodôntica primária foi encontrada em maior proporção nos dentes encaminhados para tratamento endodôntico; entretanto, aproximadamente 1/3 da amostra apresentava acometimento periodontal, o que demonstra a importância do exame periodontal em conjunto com o exame clínico geral.

The clinical application of ultrasonic root canal intermittent irrigation in endodontic vascular reconstruction / 中国医师杂志

Objective:To investigate the clinical effect of ultrasonic root canal intermittent irrigation in endodontic vascular reconstruction.Methods:32 young permanent teeth with pulp and periapical lesions were randomly divided into two groups ( n=32): experimental group was treated with ultrasonic root canal intermittent irrigation and the control group was rinsed with sodium hypochlorite root canal. The changes of periapical lesions and root development were evaluated by preoperative and postoperative clinical symptom observation and radiograph examination, and the clinical effect of endodontic vascular reconstruction was discussed. The time of inflammation control was discussed by analyzing the starting point from the first diagnosis to the date of mineral trioxide aggregate (MTA) coverage. Results:The clinical symptoms of the 16 affected teeth in the experimental group and the control group disappeared, the periapical lesions were eliminated, and the root continued to develop. In the experimental group, root formation was observed in 13 of the affected teeth, with a success rate of 81.25% and a reduction rate of 18.75%. In the control group, root formation was observed in 10 of the affected teeth, with a success rate of 62.5% and a reduction rate of 37.5%. There was no difference in the effective rate between the experimental group and the control group ( P>0.05). The control time of inflammation was (28.44±5.98)days in the experimental group and (34.13±7.17)days in the control group, with statistically significant differences ( P<0.05). Conclusions:Ultrasonic root canal intermittent swabbing applied to pulp revascularization can achieve good clinical effect and shorten the time of inflammation control.

Factores asociados a la evolución clínica de los procesos pulpares reversibles / Factors associated with clinical evolution of reversible pulp processes

RESUMEN La mayoría de los pacientes que acuden a consulta de urgencias de Estomatología refieren una sintomatología dolorosa causada por las enfermedades pulpares. Se realizó un estudio observacional-analítico; la población estuvo conformada por los 252 pacientes que acudieron al Servicio Estomatológico del Policlínico Chiqui Gómez Lubián, Santa Clara, y que fueron diagnosticados con una afección pulpar reversible transitoria, en el período enero-diciembre 2016. La muestra (167 pacientes) fue elegida de forma intencional. El principal objetivo fue describir los agentes causales, relacionar la evolución clínica y las variables clínico-epidemiológicas, e identificar los factores asociados a la evolución clínica en los procesos pulpares reversibles. El rango de edad más afectado fue de 22 a 52 años y predominó el sexo masculino. El agente causal que afectó a la mayor cantidad de pacientes fue el bacteriano; se relacionaron todas las variables con el resultado de la evolución clínica.

ABSTRACT Most of the patients who come to the Dental Emergency Consultation report painful symptomatology caused by pulp diseases. An observational analytical study was performed; the population consisted of 252 patients who were seen at the Dental Service of "Chiqui Gómez Lubián" Polyclinic, Santa Clara, and were diagnosed with a transient reversible pulp condition from January to December 2016. The sample (167 patients) was chosen intentionally. The main objective was to describe the causal agents, relate clinical evolution and clinical-epidemiological variables, and identify factors associated with clinical evolution in reversible pulp processes. The most affected age range was 22 - 52 years old and male gender predominated. The causal agent that affected the greatest number of patients was the bacterial one; all variables were related to the result of clinical evolution.

Efficacy of Lasers Treatment of Exposed Pulps to Stimulate Healing: A Systematic Review and Meta-Analysis

Abstract Objective: The present systematic review and meta-analysis aimed at evaluating the efficacy of laser's treatment of exposed pulps to stimulate healing. Material and Methods: MEDLINE, PubMed, Cochrane Library, Embase, ISI, Google Scholar have been searched as the electronic databases for performing systematic literature between 2005 to 2019. Searches were performed with MESH terms. The quality of the studies included was assessed using the Critical Appraisal Skills Program checklist. For Data extraction, two reviewers blind and independently extracted data from the abstract and full text of the studies included. Moreover, the fixed-effect model's odds ratio for a 95% confidence interval (CI) was calculated. Random effects were used to deal with potential heterogeneity, and I2 showed heterogeneity. The meta-analysis and forest plots have been evaluated using the Comprehensive Meta-Analysis Stata. Results: Five studies (3 RCTs and 2 animal studies) were included in this study. The Odds Ratio was 1.90 (95% CI 1.39-2.42; p=0.00); there was a statistically significant difference between the laser and the control groups (p=0.00). Conclusion: The success rate of laser treatment for exposed pulps is higher than mineral trioxide aggregate, resin, calcium hydroxide and resin-modified glass-ionomer cement. The exact mechanism of this effect has not yet been determined; further research on lasers' impact on exposed pulps treatment is required.

Caracterización de las enfermedades pulpares en pacientes pertenecientes al Área II del municipio Cienfuegos / Characterizacion of pulpal diseases in patients from area II of the Cienfuegos Municipality

Fundamento: Las enfermedades pulpares adquieren cada día más importancia debido a su sintomatología dolorosa y a que frecuentemente son el motivo de consulta de urgencia estomatológica.Objetivo: caracterizar las enfermedades pulpares en pacientes pertenecientes al área II del municipio Cienfuegos.Métodos: se realizó un estudio observacional descriptivo, transversal, en el periodo comprendido de abril a diciembre de 2015. Se trabajó con 329 pacientes que cumplieron con los criterios de inclusión y exclusión. El registro primario de datos se obtuvo mediante la observación y la recolección de la información a través de historia clínica individual, previo consentimiento informado. Las principales variables fueron: edad, sexo, enfermedades pulpares, tratamiento realizado y grupo dentario.Resultados: se observó un predominio del sexo masculino y del grupo de edad de 35 a 59 años. La necrosis pulpar fue la enfermedad más frecuente, con un 40,73 % de pacientes afectados. La exodoncia fue el tratamiento que se aplicó en mayor cantidad de casos, sobre todo en el grupo de 20 a 34 años. Los primeros molares inferiores fueron los más afectados por enfermedades pulpares.Conclusión: se concluye que la necrosis pulpar fue la que predominó entre todas las enfermedades pulpares, lo cual se corresponde con que es uno de los motivos de consulta más frecuentes en las clínicas estomatológicas. Por ello, se debe seguir encaminando el trabajo a prevenir estas afecciones estomatológicas.

Foundation: Pulpal diseases acquire a great importance due to their painful manifestations and they frequently the chief complain in dental emergency consultation. Objectives: To characterize pulpal diseases in patients from Area II of the Cienfuegos Municipality. Methods: A descriptive observational cross study was carried out from April to December 2015. A number of 329 patients was included in the study who complied with the requirements of inclusion and exclusion. Data primary registration was obtained through observation and information collection from the individual clinical record, previous informed consent. The main variables were: Age, sex pulpal diseases, treatment and dental group.Results: It was observed male sex predominance and the 35 to 59 age group. Pulpar necrosis was the most frequent disease, with 40.73% affected patients. Exodontic treatment was applied to most of the patients mainly in the 20 to 34 year old group. Inferior first molars were the most affected by pulpal disease. Conclusion: It is concluded that necrosis was predominant among all pulpal diseases, which corresponds to that it is one of the most frequent chief complains in dental clinics. That is the reason why it is necessary to continue working on preventing these dental conditions.

Antimicrobial Activity and Biocompatibility of the Psidium cattleianum Extracts for Endodontic Purposes

Abstract Psidium cattleianum (PC) has been displaying inhibitory effect against a variety of microorganisms, but this effect has not yet been tested against endodontic pathogens. The aim of this study was to evaluate the antimicrobial activity and biocompatibility of the aqueous (PCAE) and hydroethanolic (PCHE) extracts from Psidium cattleianum (PC) leaves. Minimum inhibitory concentration (MIC) and minimum lethal concentration (MLC) were determined using the microdilution broth method in order to analyze the antimicrobial effect against Enterococcus faecalis, Pseudomonas aeruginosa, Actinomyces israelii and Candida albicans in planktonic conditions. Biofilm assays were conducted only with the extracts that were able to determine the MLC for microorganisms in planktonic conditions. Immediate and late tissue reactions against PC extracts were evaluated using edemogenic test and histological analysis of subcutaneous implants in Wistar rats. The results showed that the MIC and MLC values ranged between 0.25 and 4 mg/mL. The MLC obtained for PCHE inhibited 100% growth of all the tested strains, except for C. albicans. PCAE had the same effect for E. faecalis and P. aeruginosa. Both PC extracts were able to eliminate E. faecalis biofilms and only the PCHE eliminated P. aeruginosa biofilms. The positive controls inhibited the growth of all tested strains in MIC and MLC essays, but no CHX tested concentrations were able to eliminate A. israelii biofilm. PCAE caused a discrete increase in the edema over time, while PCHE caused a higher initial edema, which decreased progressively. Both PCAE and PCHE extracts were biocompatible, but PCHE showed better results with slight levels of inflammation at 28 days. In conclusion, PCHE was biocompatible and presented better antimicrobial effect against important pathogens associated with persistent endodontic infections

Resumo Psidium cattleianum (PC) tem apresentado atividade inibitória frente diversos microrganismos, entretanto esse efeito ainda não foi testado contra microrganismos de interesse endodôntico. O objetivo desse estudo foi avaliar a atividade antimicrobiana e a biocompatibilidade dos extratos aquoso (EAPC) e hidroetanólico (EHPC) das folhas de Psidium cattleianum. As concentrações inibitória mínima (CIM) e letal mínima (CLM) foram determinadas pelo método de microdiluição em caldo, com o objetivo de analisar o efeito antimicrobiano frente Enterococcus faecalis, Pseudomonas aeruginosa, Actinomyces israelii e Candida albicans em condições planctônicas. Os ensaios de biofilme foram realizados somente com os extratos em que se determinou a CLM frente os microrganismos em condições planctônicas. Respostas teciduais imediata e tardia frente aos extratos de Psidium cattleianum foram avaliadas por teste edemogênico e análise histológica de implantes subcutâneos em ratos Wistar. Os resultados mostraram que CIM e CLM variaram entre 0,25 e 4 mg/mL. As CLMs determinadas pelo EHPC inibiram 100% do crescimento de todas as cepas testadas, exceto Candida albicans. EAPC apresentou o mesmo efeito para E. faecalis e P. aeruginosa. Ambos os extratos de PC conseguiram eliminar o biofilme de E. faecalis, e somente o EHPC eliminou o biofilme de P. aeruginosa. Os controles positivos inibiram o crescimento de todos os microrganismos testados nos ensaios de CIM e CLM, mas nenhuma das concentrações de clorexidina testadas foi capaz de eliminar o biofilme de A. israelii. O EAPC provocou um discreto aumento de edema com o tempo, enquanto EHPC provocou um edema inicial severo, que diminuiu progressivamente. Ambos os extratos EAPC e EHPC foram biocompatíveis, entretanto, EHPC apresentou melhores resultados com baixos níveis de inflamação em 28 dias. Pode-se concluir que EHPC foi biocompatível e apresentou melhor efeito antimicrobiano frente importantes patógenos associados a infecções endodônticas persistentes.

Ex vivo model for studying polymicrobial biofilm formation in root canals / Modelo ex vivo para el estudio de la formación de biopelícula polimicrobiana en conductos / Efeitos sobre a pesca nos elasmobrânquios no Pacífico colombiano

Abstract Endodontic disease has mainly a microbial origin. It is caused by biofilms capable of attaching and surviving in the root canal. Therefore, it is important to study the conditions in which those biofilms grow, develop and colonize the root canal system. However, few studies have used natural teeth as models, which would take into account the root canal anatomical complexity and simulate the clinical reality. In this study, we used human premolar root canals to standardize in vitro biofilm optimal formation conditions for microorganisms such as Enterococcus faecalis, Staphylococcus aureus and Candida albicans. 128 lower premolars underwent canal preparation using K-type files, and were treated with 5.25% sodium hypochlorite and EDTA. Samples were inoculated with microorganisms and incubated for 15, 30, 45, and 60 days under anaerobiosis (CO2 atmosphere) and aerobiosis. Microorganism presence was confirmed by Gram staining, cell culture, and electron microscopy. Exopolysaccharide matrix and microorganism aggregation were observed following 15 days of incubation. Bacterial growth towards the apical third of the root canal and biofilm maturation was detected after 30 days. CO2 atmosphere favored microbial growth the most. In vitro biofilm maturation was confirmed after 30 days of incubation under a CO2 atmosphere for both bacteria and yeast.

Resumen La enfermedad endodóntica tiene principalmente un origen microbiano. Es causada por biopelículas capaces de adherirse y sobrevivir en el conducto dental. Por ello es importante estudiar las condiciones en las que estas biopelículas crecen, se desarrollan y colonizan el conducto. Sin embargo, pocos trabajos han utilizado como modelos dientes naturales, que tengan en cuenta la complejidad anatómica de los conductos y simular la realidad clínica. En este estudio se utilizaron conductos de premolares para estandarizar las condiciones óptimas de formación in vitro de la biopelícula de microorganismos como Enterococcus faecalis, Staphylococcus aureus and Candida albicans. Se prepararon los conductos de 128 premolares inferiores usando limas para endodoncia tipo-K, y fueron tratados con 5.25 % hipodorito de sodio y EDTA. Las muestras se inocularon con microrganismos y fueron incubadas por 15, 30, 45 y 60 días en anaerobiosis (atmósfera de CO2) y aerobiosis. La presencia de microorganismos fue confirmada por tinción de Gram, cultivo celular y microscopia electrónica. Se observó una matriz de exopolisacáridos y agregación de microorganismos a los 15 días de incubación. Después de 30 días se detectó crecimiento bacteriano hacia el tercio apical del conducto, así como maduración de la biopelícula. La atmósfera de CO2 fue la que más favoreció el crecimiento microbiano. La maduración in vitro de la biopelícula se confirmó después de 30 días de incubación en atmósfera de CO2 tanto para la bacteria como para el hongo.

Resumo A doença endodôntica tem principalmente uma origem microbiana. É causada por biofilmes capazes de se fixar e sobreviver no canal radicular. Portanto, é importante estudar as condições em que esses biofilmes crescem, se desenvolvem e colonizam o sistema de canais radiculares. No entanto, poucos estudos utilizaram dentes naturais como modelo, os quais consideram a complexa anatomia dos canais radiculares e simulam a realidade clínica. Neste estudo, utilizamos canais radiculares pré- molares para padronizar as condições de formação ótima in vitro de biofilme para microrganismos como Enterococcus faecalis, Staphylococcus aureus e Candida abicans. Foram preparados os canais de 128 pré-molares inferiores usando limas odontológicas tipo K, e foram tratados com hipoclorito de sódio 5,25 % e EDTA. As amostras foram inoculadas com microrganismos e incubadas por 15, 30, 45 e 60 dias em anaerobiose (atmosfera de CO2) e aerobiose. A presença de microrganismos foi confirmada por coloração de Gram, cultura celular e microscopia eletrônica. Observou-se uma matriz de exopolisacáridos e um agregado de microrganismos depois de 15 dias de incubação. Após 30 dias de incubação foram detectados crescimento bacteriano no terço apical do canal radicular e maduração do biofilme. A atmosfera de CO2 foi a que mais favoreceu o crescimento microbiano. A maduração in vitro do biofilme foi confirmada depois de 30 dias de incubação em atmosfera de CO2 tanto para bactérias como para fungos.

Analysis of microbial infection and the related factors in patients with periodontal -endodontic combined lesions / 中国基层医药

Objective To explore the microbial infection and the related factors in patients with periodontal-endodontic combined lesions(PECL),in order to provide reference for the control and prevention of clinical infec-tion.Methods 36 patients with PECL were selected as observation group;36 cases(36 teeth)were selected as con-trol group.Samples of periodontal pockets and root canal samples were collected to detect the infection of microorgan-ism,and the risk factor of the occurrence of PECL was analyzed.Results 23 teeth in the observation group were detected microorganisms,the detection rate was 63.9%,such as Neisseria,Corynebacterium,actinomyces,Campy-lobacter,Fusobacterium were the main microorganisms,including 23 teeth for periodontal pockets were detected in the microorganism,the detection rate was 100.0%,and 14 cases of root canal detection of microbial,the detection rate was 60.9%;7 teeth in the control group was found in microbes,and the detection rate was 19.4%,the detection rate in the observation group was significantly higher than that of control group(χ2 =14.63,P <0.05).The tooth week source PECL dependent variable y multi factors logistic regression analysis showed that Neisseria,Corynebacterium, actinomyces,Fusobacterium infection were periodontal source PECL risk factors(OR =1.462,1.379,1.467,1.665, all P <0.05).Conclusion The occurrence of periodontal source PECL is closely related to the microbial infection, and the clinical treatment can improve the cure rate.

Comparative evaluation of somatosensory mechanisms involved in orofacial somatic, visceral and neuropathic pain / Avaliação comparativa dos mecanismos somatossensoriais envolvidos na gênese das dores orofaciais de origem somática, visceral e neuropática

Orofacial pain conditions can be classified into somatic, visceral or neuropathic pain. Somatic pain is triggered by a noxious stimulus generally inducted by peripheral traumas, such as dental implants surgeries (IMP). Visceral pain initiates within internal body tissues and is normally triggered by inflammation, as in inflammatory toothaches (IT). The third condition is neuropathic pain, which results from persistent injury to the peripheral nerve as in Atypical Odontalgia (AO). The aims of this study were: 1- to investigate somatosensory abnormalities, using mechanical, painful, and electrical quantitative sensory testing (QST), in somatic (IMP patients), visceral (IT) and neuropathic pain (AO); 2- to quantify how accurately QST discriminates an IT or AO diagnosis; and 3- to investigate the influence implant surgeries or pulpectomy may have on somatosensory system and sensory nerve fibers. Sixty subjects were divided in three groups: IMP (n = 20), IT (n = 20) and AO group (n = 20). A sequence of five QSTs and the Conditioned Pain Modulation Test (CPM) were performed one month and three months after dental implant surgery (IMP group) or pulpectomy (IT group). AO group was evaluated only at baseline. QST comprehended Mechanical Detection Threshold (MDT), Mechanical Pain Threshold (MPT), Dynamical Mechanical Allodynia (DMA), Current Perception Threshold (CPT) for A-beta (frequency of 2000Hz), A-delta (250Hz) and C fibers (5Hz) and Temporal Summation Test (TS). "Z" score transformation were applied to the data, and within and between groups were statistically analyzed using two-way ANOVA. In addition, the receiver operating characteristic curve analysis, diagnostic accuracy, sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of QSTs were calculated (α = 5%). The findings of this study proved that: 1- loss of function for touch threshold and electrical threshold of C fibers is present in inflammatory toothache; 2- allodynia, hyperalgesia, gain of function for touch and pain thresholds and impaired pain modulation is detected in atypical odontalgia; 3- some QSTs may be used as complementary tests in the differential diagnosis of atypical odontalgia and inflammatory toothache with strong accuracy; 4- the most accurate QSTs for differential diagnosis between subjects with AO and IT were MDT, MPT and DMA where touch threshold forces > 1 g/mm2 and pain threshold forces > 10g/mm2 can be used to accurately discriminate AO from IT; and 5- no somatosensory modification is found after implant surgery and reduced electrical threshold in C fiber is found for patients with inflammatory toothache after 3 months of pulpectomy.(AU)

As dores orofaciais podem ser classificadas em dores somáticas, viscerais ou neuropáticas. A dor somática está relacionada a um estímulo nocivo evidente, geralmente associada a um trauma periférico, como por exemplo, nas cirurgias de implantes (IMP). As dores viscerais têm origem dentro dos órgãos e cavidades internas do corpo e são ativadas pela inflamação, como no exemplo da dor de dente do tipo Pulpite Aguda (PA). A terceira condição é a dor neuropática, que resulta de uma lesão persistente ao nervo periférico, como ocorre na Odontalgia Atípica (OA). Os objetivos deste estudo foram: 1- avaliar as alterações somatossensoriais, por meio do uso de Testes Sensoriais Quantitativos (TSQ) mecânicos, dolorosos e elétricos em dores somáticas (pacientes IMP), viscerais (PA) e neuropáticas (OA); 2- quantificar a acurácia dos TSQs na descriminação diagnóstica de uma PA ou OA; e 3- investigar alterações somatossensoriais e nas fibras nervosas sensoriais após cirurgia de instalação de implantes dentários ou pulpectomia. Sessenta sujeitos foram divididos em três grupos: IMP (n = 20), PA (n = 20) e OA (n = 20). Uma sequência de cinco TSQs e o teste de Controle da Modulação da Dor (CMD) foram realizados um mês e três meses após cirurgia de implantes (grupo IMP) ou pulpectomia (grupo PA). No grupo OA, os testes foram realizados somente uma vez no início do estudo. Os TSQs englobaram o Limiar de Detecção Mecânica (LDM), Limiar de Dor Mecânica (LDoM), Alodinia Mecânica Dinâmica (AMD), Limiar de Percepção de Corrente (LPC) para fibras A-beta (frequência de 2000Hz), A-delta (250Hz) e C (5 Hz), e o teste de Somação Temporal (ST). A transformação em escores de "Z" foi aplicada aos dados, e diferenças intra e inter-grupos foram analisadas usando ANOVA de medidas repetidas. Ainda, a acurácia diagnóstica dos TSQs foi medida por meio da sensibilidade, especificidade, razão de verossimilhança e razão de chances para diagnóstico (α = 5%). Os resultados deste estudo mostraram que: 1- perda da função em limiar táctil e limiar elétrico de fibras C está presente na Pulpite Aguda; 2- alodinia, hiperalgesia, ganho de função nos limiares de tato e de dor, e modulação da dor prejudicada são encontrados em pacientes com odontalgia atípica; 3- alguns TSQs podem ser usados como testes diagnósticos complementares ao diagnóstico diferencial entre PA e OA; 4- os TSQs com maior acurácia para o diagnóstico diferencial entre indivíduos com PA e OA foram LDM LDoM e AMD, onde uma força maior que 1 g/mm2 para limiar de tato e maior que 10 g/mm2 para limiar de dor podem ser usados com precisão; e 5- nenhuma alteração somatossensorial é encontrada após cirurgia de implantes e uma redução no limiar elétrico em fibras C é encontrado em pacientes com PA após 3 meses da pulpectomia.(AU)

Guía de diagnóstico clínico para patologías pulpares y periapicales. Versión adaptada y actualizada del "Consensus conferencere commended diagnostic terminology", publicado por la asociación americana de endodoncia (2009) / Guidelines for clinical diagnosis of pulp and periapical pathologies. Adapted and updated from the "Consensus Conference Recommended Diagnostic Terminology" published by the American Association of Endodontists (2009)

Introducción: el correcto diagnóstico en endodoncia permite la selección de un tratamiento endodóntico adecuado. Los términos utilizados para la nominación de cada patología, deben asociarse a las condiciones clínicas particulares. La unificación de la terminología diagnóstica en endodoncia ha sido un tema ampliamente discutido en el ámbito clínico y académico. El objetivo de esta investigación fue desarrollar la adaptación y actualización de la Guía de diagnóstico clínico, para patologías pulpares y periapicales bajo los parámetros de la metodología ADAPTE, para la difusión y socialización dentro de la comunidad académica y profesional. Métodos: para la búsqueda de las guías, organismos recopiladores como National Guideline Clearinghouse (NGC), el Centro Nacional de Guías de EEUU y la Agency for Health Research and Quality (AHRQ). Para la selección de la guía se utilizó la herramienta AGREE II, donde se reconoció el documento "Consensus Conference Recommended Diagnostic Terminology" de la (AAE) (2009), como "recomendable", iniciando el proceso de adaptación con ADAPTE. Las bases de datos utilizadas, Cochrane, PubMed, Tripdatabase, las palabras claves verificables en DeCS y MeSH. La valoración de la literatura se hizo con los lineamientos del Scottish Intercollegiate Guidelines Network (SIGN) y del National Institute for Clinical Excellence (NICE). Resultados: adaptación y actualización de la Guía de diagnóstico clínico para patologías pulpares y periapicales. Conclusiones: la unificación de la terminología permitirá identificar las condiciones del tejido pulpar y periapical. La elaboración de guías de práctica clínica debe soportarse en la evidencia científica y en metodologías consensuadas.

IIntroduction: accurate diagnosis in endodontics leads to the selection of adequate endodontic treatment. The terms used to name each pathology must be associated to particular clinical conditions. The standardization of diagnostic terminology in endodontics has been widely discussed in the academic and clinical fields. The objective of this study was to adapt and update the Guidelines for clinical diagnosis of pulp and periapical pathologies under the parameters of the ADAPTE methodology for circulation and socialization within the academic and professional communities. Methods: guidelines search was conducted in compiling agencies such as the National Guideline Clearinghouse (NGC), USA National Center of Guidelines, and the Agency for Healthcare Research and Quality (AHRQ). Guidelines were selected with the AGREE II tool, considering AAE's document "Consensus Conference Recommended Diagnostic Terminology" (2009) as "recommendable", and initiating the adaptation process with ADAPTE. The source databases include Cochrane, PubMed, Tripdatabase, with verifiable key words in DeCS and MeSH. Literature assessment followed the parameters of the Scottish Intercollegiate Guidelines Network (SIGN) and the method of the National Institute for Clinical Excellence (NICE). Results: adaptation and update of the Guidelines for clinical diagnosis of pulp and periapical disease. Conclusions: terminology standardization will allow identifying pulp tissue and periapical conditions. The development of guidelines for clinical practice must be supported on scientific evidence and on agreed methodologies.

Development of Intracanal Formulation Containing Silver Nanoparticles

This study aimed to synthetize, characterize and evaluate the antimicrobial properties of silver nanoparticles to be used in the development of a root intracanal formulation. Silver nanoparticles (AgNPs) were obtained by reduction of silver nitrate with sodium borohydride and characterized by UV-Visible spectrophotometry, scanning electron microscopy (SEM) and dynamic light scattering (DLS). The antimicrobial activity of nanoparticle formulation was evaluated by determinations of the minimum inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) against different bacterial species by the microdilution method, according to recommendations of the Clinical and Laboratory Standards Institute (CLSI). Three potential vehicles, hydroxyethylcellulose, Carbomer and polyethylene glycol were tested as carriers for formulations containing AgNPs. The efficiency of the synthesis method chosen to produce AgNPs was demonstrated by four characterization techniques. The nanoparticles showed antibacterial activity against all species tested. Incorporation of AgNPs into all experimental vehicles produced stable formulations but the one in hydroxyethylcellulose presented better physical proprieties. The results indicate that silver nanoparticles are potential antiseptic agents to be used in root canals and incorporation in adequate vehicles may favor a broader application.

O presente estudo teve como objetivo sintetizar, caracterizar e avaliar as propriedades antimicrobianas de nanopartículas de prata visando o desenvolvimento de uma formulação intracanal. As nanopartículas de prata (AGNPS) foram obtidas pela redução de nitrato de prata com borohidreto de sódio e caracterizados por espectrofotometria UV-Visível, microscopia eletrônica de varredura (MEV) e espalhamento de dinâmico de luz (DLS). A atividade antimicrobiana da formulação de nanopartículas foi avaliada por meio das determinações da concentração inibitória mínima (CIM) e a concentração bactericida mínima (CBM) contra diferentes espécies de bactérias pelo método de microdiluição, de acordo com recomendações do Clinical and Laboratory standards Institute (CLSI). Três potenciais veículos, hidroxietilcelulose, carbómero e polietileno glicol foram testados como veículos para as formulações de AGNPS. A eficiência do método de síntese escolhido para produzir AGNPS foi demonstrada por quatro técnicas de caracterização. As nanopartículas apresentaram atividade antibacteriana contra todas as espécies bacterianas testadas. A incorporação de AGNPS em todos os veículos experimentais produziram formulações estáveis, porém, quando utilizado a hidroxietilcelulose foram obtidos melhores propriedades físicas. Os resultados indicam que as nanopartículas de prata são potenciais agentes anti-sépticos para serem usados na terapia endodôntica e a incorporação em veículos adequados pode favorecer uma aplicação mais ampla.

Internal root resorption in the maxillary centralincisor

Introduction: Internal root resorption is a chronic inflammatoryprocess initiated within the pulp space with the loss of dentin. Theclastic cells present in the pulp tissue trigger a progressive resorptionphenomenon. Case report and conclusion: This paper reports aclinical case of an internal root resorption in the permanent centralincisor, at the middle third of the root canal. Because it is asymptomatic,internal root resorption needs an early diagnosis in order to institutethe endodontic treatment before the process compromises themineralized structures of the tooth.

Diagnosis and root canal treatment in a mandibular premolar with three canals

This paper presents a case report of a left mandibular second premolar with three canals and three different apical foramina. A 39-year-old male patient presented to our clinic with pain in the mandibular left second premolar. Initially, pain was caused by cold stimulus and later was spontaneously. The intraoral clinical examination revealed a fractured amalgam restoration with occlusal caries. Percussion and cold (Endo-Frost) tests were positive. The radiographic examination showed the presence of two roots. The probable diagnosis was an acute pulpitis. After access cavity, it was observed remaining roof of the pulp chamber and mild bleeding in the tooth lingual area, indicating the possible presence of a third canal. The endodontic treatment was completed in a single session using Root ZX apex locator and K3 NiTi rotary system with surgical diameter corresponding to a .02/45 file in the three canals and irrigation with 1 percent sodium hypochlorite. The canals were obtured with gutta-percha cones and Sealer 26 using the lateral condensation technique. After 1 year of follow-up, the tooth was asymptomatic and periapical repair was observed radiographically. Internal alterations should be considered during the endodontic treatment of mandibular second premolars. The correct diagnosis of these alterations by the analysis of preoperative radiographs can help the location of two or more canals, thereby avoiding root therapy failure.

O presente artigo teve como objetivo a apresentação de um caso clínico de um segundo pré-molar inferior esquerdo com três canais com três forames distintos. Paciente de 39 anos de idade, leucoderma, relatava dor inicialmente estimulada ao frio e posteriormente dor espontânea no referido dente. No exame intraoral foi constatada restauração de amálgama fraturada e cárie oclusal. Os testes de sensibilidade à percussão e ao frio (Endo-Frost) foram positivos. O exame radiográfico evidenciou a presença de duas raízes. O diagnóstico provável foi de pulpite aguda. Após o preparo de acesso à câmara pulpar notou-se a presença de teto remanescente e um leve sangramento, sendo possível localizar um terceiro canal na região lingual. O tratamento endodôntico foi realizado em uma única sessão, com auxílio do localizador apical Root ZX, e o preparo biomecânico com sistema rotatório com limas de NiTi K3 com diâmetro cirúrgico correspondente ao instrumento .02/45 nos três canais, e a solução química auxiliar hipoclorito de sódio 1 por cento. A obturação foi realizada por condensação lateral de guta-percha e cimento Sealer26. Durante o período de proservação de 1 ano, o dente apresentou-se clinicamente assintomático com reparação dos tecidos periapicais observada radiograficamente. Alterações internas devem ser consideradas durante tratamento endodôntico em segundos pré-molares inferiores. O correto diagnóstico destas alterações por meio da análise de radiografias pré-operatórias podem auxiliar na localização de dois ou mais canais, evitando dessa maneira o insucesso do tratamento a ser realizado.

Effects of endodontic treatment on heart rate, blood pressure and electrocardiogram of elderly patients with cardiovascular diseases / 中华老年医学杂志

Objective To study the safety of opening pulp chamber therapy for elderly patients with cardiovascular diseases. Methods Blood pressure, heart rate and electrocardiography were examined during the treatment by opening of pulp chamber for patients with acute and chronic pulpititis and cardiovascular diseases. Patients without cardiovascular disease were used as controls. Results Both blood pressure and heart rates were increased during local anesthetic injection(14/6 mm Hg, 14 4/6 6 mmHg; 4 8, 4 1 times/min) and during the opening of pulp chamber(16/9 mm Hg, 19/12 mm Hg; 6 4, 5 9 times/min) for both patients and control groups with statistically significant differences compared with that before operation. But there was no statistically significant differences between the patients with cardiovascular diseases and the controls during the local anesthetic injection and the opening of pulp chamber. Electrocardiogram showed myocardial ischemia deteriorated in some patients with cardiovascular diseases. Conclusions Endodontic treatment under monitoring by electrocardiography is safe and can be recommended to the elderly patients with cardiovascular diseases

Patologías pulpares y periapicales más frecuentes en urgencias en 2 clínicas estomatológicas

Las patologías pulpares y periapicales son unas de las enfermedades que más llevan a los pacientes a acudir a una consulta de urgencia estomatológica debido a su sintomatología. Es de gran importancia realizar un correcto diagnóstico en este momento para brindar la terapeútica adecuada.La frecuencia de estas patologías en consulta de urgencia fue lo que nos motivó a la realización de este trabajo, el cual tuvo entre sus objetivo contribuir al conocimiento de las patologías pulpares y periapicales más frecuentes en urgencias, determinar la patología pulpar aguda más frecuente según grupos de edad, así como la patología periapical aguda. Para realizar el trabajo se examinaron 70 pacientes de las Clínicas Estomatológicas "Dr. Mario Pozo Ochoa" y "Manuel Angulo Farrán". Se observó que las patologías agudas fueron las que más se presentaron, entre ellas, la hiperemia y el absceso alveolar agudo.

Pulpar and periapical pathologies are some of the diseases that make the patients attend the dental emergency department due to their symptomatology. It is very important to make a right diagnosis at this moment in order to give the adequate therapy. The frequency of these pathologies at the dental emergency department led us to write this paper. One of its objectives was to contribute to the knowledge of the most frequent pulpar and periapical pathologies in emergencies and to determine the most common acute pulpar pathology according to age groups and the acute periapical pathology. 70 patients from the ?Dr. Mario Pozo Ochoa? and ?Manuel Angulo Farrán? Dental Clinics were examined. It was observed that the acute pathologies were the most frequent and, among them, hyperemia and acute alveolar abscess.