Molhabilidade de um cimento endodôntico à base de resina epóxi na dentina tratada com diferentes protocolos de quelação / Wettability of an epoxy resin-based root canal sealer on dentin treated with different chelating protocols

Objetivo: Avaliar a molhabilidade do cimento AH Plus em contato com a dentina radicular após diferentes protocolos quelantes envolvendo ácido etidrônico (HEBP) e o EDTA. Métodos: Cinquenta e seis fatias de dentina radicular foram utilizadas e irrigadas com 5.25% de hipoclorito de sódio (NaOCl) ou com uma mistura de 5.25%NaOCl/18%HEBP para simular a irrigação durante o preparo químico-mecânico. As amostras irrigadas com NaOCl foram divididas em 5 grupos, de acordo com o agente quelante: G1- água destilada (AD); G2-17%EDTA; G3-17%EDTA+2.5%NaOCl; G4-18%HEBP; e G5-18%HEBP+2.5%NaOCl. As amostras irrigadas com a mistura de NaOCl/HEBP foram dividias em 2 grupos: G6-AD; G7-NaOCl/HEBP+2.5%- NaOCl. Todos os protocolos receberam irrigação de AD entre as substâncias irrigadoras e como lavagem final. O goniômetro Rame-Hart foi utilizado para mesurar o ângulo de contato entre a superfície da dentina radicular e o cimento. O teste estatístico Kruskal-Wallis e Dunn foram aplicados (p<0.05). Resultados: Os grupos onde a smear layer foi removida apresentaram menor ângulo de contato (p<0.05), com exceção do G7. O G6 apresentou o menor ângulo de contato do AH Plus, entretanto, a irrigação final com NaOCl (G7) aumentou significativamente o ângulo de contato. G2 e G4 apresentaram comportamento similar e a irrigação final com NaOCL (G3 e G4) não modificou a molhabilidade da dentina. Conclusão: O tratamento da dentina radicular com a mistura NaOCl/HEBP, quando usada como irrigante, conferiu boa molhabilidade desta superfície ao cimento AH Plus(AU).

Evaluate the wettability of AH Plus in contact with root dentin after different chelating protocols involving etidronic acid (HEBP) and EDTA. Material and Methods: Fifty six human polished root dentin slices were used. They were irrigated with 5.25% sodium hypochlorite (NaOCl) or a mixture of 5.25%NaOCl/18%HEBP to simulate irrigation during chemomechanical preparation. The specimens irrigated with NaOCl were divided into 5 groups regarding chelating agents: G1-destiled water (DW); G2- 17%EDTA; G3-17%EDTA+2.5%NaOCl; G4-18%HEBP; and G5-18%HEBP+2.5%NaOCl. The specimens irrigated with the mixture NaOCl/HEBP were divided into 2 groups: G6-DW; G7-NaOCl/HEBP+2.5%NaOCl. All protocols received irrigation with DW between irrigants and as final rinse. Rame-Hart goniometer was used to measure the contact angle between the dentin surfaces and the sealer. Kruskal-Wallis and Dunn tests were applied (p<0.05). Results: Groups in which the smear layer was removed showed a lower contact angle (p<0.05), except for G7. The G6 showed the lowest contact angle of AH Plus, but the NaOCl final irrigation (G7) increased the angle. G2 and G4 have similar behaviour and final irrigation with NaOCl (G3 and G5) did not change wettability when these chelators were used. Conclusions: The mixture NaOCl/HEBP showed good effect on the wettability of sealer on to the root canal dentine, when used as main irrigant (AU).

Eficácia do etidronato na remoção da smear layer dos canais radiculares: um estudo com microscopia eletrônica de varredura / Effectiveness of etidronate in root canal smear layer removal: A study with scanning electron microscopy

Avaliar, por microscopia eletrônica de varredura (MEV), o efeito do uso individual e combinado do etidronato 18% (HEBP) na remoção da smear layer do canal radicular. Métodos: Trinta dentes humanos unirradiculares foram utilizados. As raízes foram preparadas com instrumentos rotatórios do Sistema ProTaper Universal e divididas aleatoriamente em três grupos, de acordo com o protocolo de irrigação empregado: G1 = hipoclorito de sódio 2,5% (NaOCl) e ácido etilenodiaminotetracético 17% (EDTA); G2 = NaOCl 2,5% e HEBP 18%; e G3 = NaOCl 2,5% + HEBP 18%, misturados em partes iguais. As raízes foram seccionadas longitudinalmente e metalizadas, para análise em MEV. As fotomicrografias obtidas dos terços cervical, médio e apical foram avaliadas por três examinadores calibrados, que atribuíram escores de 1 a 5 às imagens. Os grupos experimentais foram comparados usando o teste de Kruskal-Wallis e o teste de Student-New- man-Keuls. Os terços radiculares foram comparados pelo teste de Friedman. O nível de significância foi estabelecido em 5%. Resultados: A capacidade de remoção da smear layer com NaOCl 2,5% e 18% HEBP (G2) foi semelhante à obtida com NaOCl 2,5% e EDTA 17% (G1) no terço médio e cervical da raiz; o nível de limpeza do terço apical foi semelhante, independentemente do protocolo de irrigação utilizado. Conclusão: HEBP é uma solução promissora para uso em tratamentos endodônticos (AU).

Introduction: We evaluated the effect of individual and combined use of 18% etidronate (HEBP) in root canal smear layer removal using scanning electron microscopy (SEM). Methods: Thirty human single-rooted teeth were used. The roots were prepared with ProTaper Universal System rotary files and randomly divided into three groups according to the irrigation protocol used. G1: 2.5% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA); G2: 2.5% NaOCl and 18% HEBP; and G3: 2.5% NaOCl + HEBP 18%, mixed in equal parts. The roots were sectioned longitudinally and metallized for SEM analysis. The photomicrographs obtained from the cervical, middle, and apical thirds were evaluated by three calibrated examiners, who assigned scores from 1 to 5 to the images. The experimental groups were compared using the Kruskal-Wallis test and the Student-Newman-Keuls test. Root thirds were compared by the Friedman test. The level of significance was set at 5%. Results: The capacity for removal of the smear layer by 2.5% NaOCl and 18% HEBP (G2) was similar to that achieved with 2.5% NaOCl and 17% EDTA (G1) in the cervical and middle thirds of the root; the cleansing level of the apical third was similar, regardless of the irrigation protocol used. Conclusion: HEBP is a promising solution for use in endodontic treatments (AU).

Osteonecrosis of the jaw associated to biphosponates in Cali - Colombia / Osteonecrosis Maxilar asociada a bifosfonatos en Cali, Colombia

Antecedentes: Después de más de 15 años del primer reporte de osteonecrosis asociada a bifosfonato (BP), siguen reportándose casos relacionados con este y con otros medicamentos, dándose el aumento en el número de prescripciones. Objetivo: Caracterizar pacientes con osteonecrosis de maxilar asociada a bifosfonatos (BRONJ), atendidos en la ciudad de Cali, Colombia. Materiales y Métodos: Se realizó una encuesta estructurada a 32 cirujanos maxilofaciales de la ciudad de Cali, Colombia, donde se preguntó sobre diferentes tópicos relacionados con pacientes afectados y desarrollo de la patología como edad y genero de los pacientes, tipo de medicamento, tiempo de administración, hueso expuesto, etc. Resultados: Treinta y dos cirujanos maxilofaciales respondieron la encuesta con un total de 8 casos. Se encontró 6 casos correspondieron a mujeres y 2 a hombres, la edad fue superior a 44 años; 4 de los tratamientos con bifosfonatos fueron de prescripción oral y 4 intravenoso. La mayor parte de los casos de osteonecrósis se presentaron en mandíbula (88%) y 6 casos (75%) presentaron exposición de hueso. Conclusiones: La osteonecrosis asociada a bifosfonatos es una situación que todavía se presenta, es necesario que la comunidad de pacientes y el personal de salud conozcan más sobre esta situación.

Background: After more than 15 years of the first report of osteonecrosis associated with bisphosphonate (BP), still cases related to BP and other medications continue to be reported and there is an alert about the increase in the number of prescriptions. The need for both patients and students and health professionals to be familiar with medications, pathology, prevention and treatment measures has been highlighted. Aim: To characterize patients with osteonecrosis in the maxilla associated to bisphosphonate (BRONJ), from Cali, Colombia. Materials and Methods: A structured survey was conducted of 32 maxillofacial surgeons from the city of Cali, Colombia, where different topics related to affected patients and the development of the pathology such as age and gender of patients, type of medication, time of study were asked. administration, exposed bone, etc. Results: Thirty-two maxillofacial surgeons answered the survey with a total of 8 cases, it was found that 6 corresponded to women and 2 to men and the age was over 44 years; 4 of the treatments were oral prescription and 4 intravenous; the majority of cases were presented in the jaw (88%) and 6 cases (75%) presented bone exposure. Conclusions: Osteonecrosis associated with bisphosphonates is a situation that still occurs and could increase its incidence due to the increase in the number of prescriptions for osteoporosis medications, it is necessary that the patient community and health staff know More about this situation.

Effect of Final Irrigating Solutions on Smear Layer Removal and Penetrability of an Epoxy Resin based Sealer into Dentinal Tubules

Introduction: During instrumentation smear layer formationoccurs on dentinal wall and for a successful root canal itsremoval is necessary. Aim of the study was to compare effectof 17% EDTA, MTAD & 18%Etidronic acid (HEBP) + 5%NaOCl, irrigating solutions on smear layer removal andpenetrability of AH Plus sealer into dentinal tubules usingscanning electron microscopy (SEM).Material and methods: Sixty single rooted mandibularpremolars, were divided into three groups (n=20).Group -I17% EDTA, Group -II MTAD, Group -III 18%Etidronic acid+5% NaOCl. The final rinse was done by 5ml of solution for2 minutes. Ten samples from each group were evaluated atmiddle and apical thirds for smear layer removal using SEM.Remaining ten samples of each group were obturated withgutta-percha & AH PLUS sealer and evaluated at 5mm abovefrom the root apex for sealer penetration using SEM.Results: At middle 3rd no difference in smear layer removalwas seen between Group –I and Group -II For apical 3rdGroup- II showed better smear layer removal than Group–I and Group- III. Thus both in middle and apical thirdsMTAD showed better smear layer removal. For mean sealerpenetration Group -II showed a highest depth of sealerpenetration i.e, 231.37±18.12µm followed by Group -I154.95±22.53µm and Group –III 125.99±17.39µmConclusion: MTAD is effective in smear layer removal fromboth middle and apical thirds. Maximum depth of sealerpenetration was seen in MTAD group followed by EDTAgroup and least in Etidronic acid group

Avaliação da expressão de citocinas pró e anti-inflamatórias após estímulo celular com diferentes agentes irrigantes / Evaluation of the expression of pro and anti-inflammatory cytokines after cellular stimulation with different irrigating agents

O objetivo do trabalho foi investigar o efeito de diferentes soluções químicas auxiliares, em concentrações subcitotóxicas, na expressão de citocinas pró e anti-inflamatórias, quando em contato com células da linhagem de linfoma humano, diferenciadas em macrófagos, human macrophage-like (U937), através da adição de 125ng/mL de PMA. As concentrações, citotóxica e subcitotóxica, de cada solução, foram determinadas de acordo com padrão ISO, utilizando-se fibroblastos de camundongos (L929). As células L929 foram cultivadas em meio MEM completo e mantidas em placas de 96 poços. As células foram então colocadas em contato com as diluições das soluções químicas auxiliares (a partir das concentrações recomendadas para uso, NaOCL 5,25%; CHX 2%; Quitosana 0,2%; HEBP 18%; GSE de Vitis vinífera, 6,5%), por 24 horas a 37ºC em estufa de CO2. Em seguida, o meio de cultivo contendo 1mg/mL de MTT foi adicionado aos poços em triplicata, para avaliação da viabilidade celular e determinação das concentrações citotóxicas (30% de morte das células L929) e subcitotóxicas (15% de morte) por regressão linear por meio do programa GraphPad Prism versão 6.0. As concentrações subcitotóxicas foram colocadas em contato com as células human macrophage-like (U937) por 60 min. Os sobrenadantes da pré-incubação (controles sem substâncias químicas auxiliares), e incubação com as soluções químicas auxiliares em meio DMEM completo foram congelados em freezer ultrafrio (­ 80ºC) e avaliados para as concentrações de dezessete citocinas através do kit Bio-Plex Pro Human Th17 Cytokine Panel® pelo método Luminex®. Foi possível obter valores de expressão de 7 citocinas pró-inflamatórias: IL-1ß, TNFα, IL-6, IL-17A, IL-17F, IL-22 e IL-23. As substâncias com maior atividade citotóxica (padrão ISO para morte celular) foram em ordem de grandeza, a quitosana, a CHX, o NaOCl, o HEBP e o GSE de Vitis vinifera. As concentrações subcitotóxicas das soluções químicas auxiliares, CHX e NaOCl, induziram ao aumento da maioria das citocinas pró-inflamatórias, exceto para a IL-6. Quanto a IL-1ß, a quitosana e a CHX, estas foram as que mais induziram a expressão pelas células U937 (P<0,05),enquanto o NaOCl induziu maior expressão de TNFα (P>0,05). Dentre as citocinas relacionadas ao fenótipo Th17, a CHX foi a que mais induziu a expressão de IL-17A (P<0,05), IL-17F e IL-23, seguido do NaOCl(P<0,05). O NaOCl induziu maior expressão de IL22 seguido da CHX (p<0,05). Quanto a IL-6, todas as substâncias modularam a sua expressão pelas células U937(p>0.05). O HEBP atuou como um excelente modulador da expressão de citocinas pró-inflamatórias, induzindo a redução da expressão de todas as citocinas testadas (P<0,05). O GSE de Vitis vinifera, apesar de ser o menos citotóxico não apresentou diferença estatística para o controle em nenhuma das situações avaliadas, exceto para a redução da IL-6 (assim como o HEBP e a quitosana) (p<0,05). A quitosana comportou-se de forma similar ao GSE de Vitis vinífera (p>0,05) exceto para a IL-1ß. Conforme observado, as substâncias químicas auxiliares são capazes de induzir a expressão de citocinas pró-inflamatórias diversas. O HEBP foi o agente químico que melhor modulou a expressão de citocinas pró-inflamatórias.

The aim of this investigation was to analyze the effect of different chemical endodontic solutions, in subcytotoxic concentrations, on the expression of pro and anti-inflammatory cytokines when in contact with human lymphoma lineage differentiated into human macrophages, human macrophage-like (U937), by the addition of 125ng/ml PMA. The cytotoxic and subcytotoxic concentrations of each solution were determined according to ISO standard using mouse fibroblasts (L929). L929 cells were cultured in complete MEM medium and maintained in 96-well plates. Dilutions of the auxiliary chemical solutions, from the recommended concentrations for use: NaOCL 5,25%; CHX 2%; Chitosan 0.2%; Etidronic acid 18% and Grape seed extract, Vitis vinifera, 6.5%, were carried out in complete MEM medium, and placed in contact with the cells for 24 hours at 37ºC in CO2 cell incubator, in triplicate. Thereafter, the culture medium containing 1 mg/mL MTT was added to the wells. Cytotoxic concentrations (30% death of L929 cells) and subcytotoxic (15% death) were determined by linear regression using GraphPad Prism version 6.0. Subcytotoxic concentrations were obtained in complete DMEM medium and maintained in contact for 60 min. with U937 cells. Controls without chemical substances were also performed. Supernatants from the pre-incubation, incubation with the chemical solutions and complete DMEM were removed, frozen in ultra-cold freezer (-80ºC) and evaluated for the concentrations of 17 cytokines through the Bio-Plex Pro Human Th17 Cytokine Panel® kit by Luminex®. The substances with higher cytotoxic activity were in order of magnitude: chitosan, CHX, NaOCl, etidronic acid and Vitis vinifera extract. The values of 7 pro-inflammatory cytokines: IL-1ß, TNFα, IL-6, IL-17A, IL-17F, IL-22 and IL-23 were obtained. Subcytotoxic concentrations of the irrigant agents (chlorhexidine and NaOCl) generally induced the increase of most pro-inflammatory cytokines, except for IL-6. Chitosan and CHX were the agents that most induced the expression of IL-1ß by U937 cells, whereas NaOCl induced higher TNFα expression (P> 0,05). Among the cytokines related to the Th17 phenotype, CHX was the agent that induced the highest expression of IL-17A (P <0,05), IL-17F and IL-23, followed by NaOCl (P<0,05). NaOCl induced the highest expression of IL22 followed by CHX. All of the substances modulated the expression of IL-6 by U937 cells (P >0,05). HEBP was an excellent modulator of the expression of pro-inflammatory cytokines, inducing the reduction of the expression of all cytokines tested. Vitis vinifera extract, despite being the least cytotoxic agent, did not present statistical differences compared to the control for any of the evaluated cytokines, except for the reduction of IL-6 (as well as etidronic acid and chitosan) (P<0,05). Chitosan, except for IL-1 ß, was very similar to the Vitis vinifera (P>0,05) extract. As observed, the auxiliary substances (especially the irrigants) are capable of inducing the expression of various pro-inflammatory cytokines. Etidronic acid was the chemical that modulated the expression of pro-inflammatory cytokines.

Etidronate from Medicine to Endodontics: effects of different irrigation regimes on root dentin roughness

An increase in dentin roughness, associated with surface composition, contributes to bacterial adherence in recontaminations. Surface roughness is also important for micromechanical interlocking of dental materials to dentin, and understanding the characteristics of the surface is essential to obtain the adhesion of root canal sealers that have different physico-chemical characteristics. OBJECTIVES: To evaluate the effects of sodium hypochlorite (NaOCl), ethylenediaminetetraacetic (EDTA), etidronic (HEBP), and citric acid (CA) associated with different irrigation regimens on root dentin roughness. MATERIAL AND METHODS: Forty-five root halves of anterior teeth were used. The root parts were sectioned in thirds, embedded in acrylic resin and polished to a standard surface roughness. Initially, the samples of each third were randomly assigned into 3 groups and treated as follows: G1 - saline solution (control); G2 - 5% NaOCl+18% HEBP mixed in equal parts; and G3 - 2.5% NaOCl. After initial measuments, the G3 samples were distributed into subgroups G4, G5 and G6, which were subjected to 17% EDTA, 10% CA and 9% HEBP, respectively. Following the new measuments, these groups received a final flush with 2.5% NaOCl, producing G7, G8 and G9. The dentin surface roughness (Ra) was determined before and after treatments using a profilometer. The Wilcoxon test (α<0.05) was used to compare the values before and after treatments, and the Friedman test (α<0.05) to detect any differences among root thirds. RESULTS: (i) NaOCl did not affect the surface roughness; (ii) there was a significant increase in roughness after the use of chelating agents (P<0.01); and (iii) only the G3 group showed a difference in surface roughness between apical third and other thirds of the teeth (P<0.0043). CONCLUSION: Only the irrigation regimens that used chelating agents altered the roughness of root dentin. .

Nivel de satisfacción con pamidronato disódico en el tratamiento de osteogénesis imperfecta: trabajo realizado en el Hospital Ortopédico Infantil Caracas Venezuela / Level of satisfaction with pamidronate disodium in the treatment of osteogenesis imperfecta: work Hospital Ortopédico Infantil Caracas Venezuela

Se realizó un estudio descriptivo, prospectivo, de tipo transversal para determinar el nivel de satisfacción en 101 pacientes con Osteogénesis Imperfecta en el tratamiento con Pamidronato. Se contactaron por encuesta vía telefónica a 52 pacientes quienes contaban con al menos dos ciclos de tratamiento.De 505 fracturas reportadas, el 71% se produjeron previas al tratamiento, evidenciándose disminución del 42% de fracturas. 69 % de los pacientes no refieren dolor posterior al tratamiento en comparación con el 27% que no refieren dolor previo al tratamiento. El porcentaje de pacientes capaces de caminar de manera independiente aumentó 21%, disminuyendo 31% de paciente confinados al lecho o silla de ruedas. El porcentaje de mejoría, conformidad y recomendación del tratamiento es favorable en casi 100% de los entrevistados. El tratamiento con Pamidronato mejora la calidad de vida de los pacientes con Osteogénesis Imperfecta.

We present a descriptive study to evaluate the level of satisfaction in 101 patients with Osteogenesis Imperfecta in treatment with Pamidronato. We contact 52 patient for an enquire by telephone, who have 2 or more ciclos of treatment. From 505 fractures report, the 71% was until treatment, we found disminution of 42% of fractures. 69% of patients don’t refer pain after treatment in comparison with the 27% that do not refer pain until treatment. The porcent of patients capables of walk independent increase 21%, decrease 31% of patients that can not walk. The porcent of improvement, conformity and recomendation of treatment is good in also 100% of interview. The treatment with Pamidronato improve the life quality in the patients with Osteogenesis Imperfecta.