X-ray evaluation of pulp calcification in adult permanent teeth after pulpotomy / 北京大学学报(医学版)

OBJECTIVE@#To compare the clinical effects of pulpotomy with two kinds of calcium silicate materials, and to evaluate the formation of dentin bridge and pulp calcification after pulpotomy of adult permanent teeth.@*METHODS@#Patients who visited the General Department of Peking University School and Hospital of Stomatology from November 2017 to September 2019 and planned for pulpotomy on permanent premolars and molars with carious exposed pulp were selected. They were randomly divided into two groups. Bioceramic putty material iRoot BP (iRoot group, n=22) and mineral trioxide aggregate MTA (MTA group, n=21) were used as pulp capping agents, respectively. The patients were recalled after one year and two years. The clinical efficacy, dentin bridge index (DBI) and pulp calcification index (PCI) were recorded. Blinding method was used for the patients and evaluators.@*RESULTS@#There was no significant difference in gender, mean age, dentition and tooth position between the two groups (P>0.05). Seven cases were lost during the first year (4 cases in iRoot group and 3 cases in MTA group). In the iRoot group, 1 case had transient sensitivity at the time of 1-year follow-up. The cure rate of the two groups was 100% at the time of 2-year follow-up. The proportion of dentin bridge formation was 38.9% one year after operation, 55.6% two years after operation. The proportion of partial or even complete disappearance of root canal image was 5.6% before operation, 38.9% and 55.6% one and two years after operation, respectively. The difference was statistically significant by rank sum test (P < 0.05). There was no significant difference in dentin bridge formation and pulp calcification between the two groups (P < 0.05). DBI and PCI after operation was as the same as those before operation (44.4% cases of DBI and 25% cases of PCI) or gradually increased (55.6% cases of DBI and 75% cases of PCI). Spearman's nonparametric correlation analysis showed that age was positively correlated with preoperative pulp calcification index (PCI0, P < 0.05), but not with the dentin bridge index (DBI1, DBI2), pulp calcification index (PCI1, PCI2) and the degree of change (DBI2 vs. DBI1, PCI1 vs. PCI0, PCI2 vs. PCI0) 1-year and 2-year after operation (P>0.05).@*CONCLUSION@#According to this study, good clinical effects were obtained within 2-year after pulpotomy of adult permanent teeth with MTA and iRoot. In some cases, the root canal system had a tendency of calcification aggravation, and there was no statistical difference in the development of this trend between the two groups.

Evaluation of bioceramic putty repairmen iRoot and mineral trioxide aggregate in mature permanent teeth pulpotomy / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the clinical characteristics and effectiveness of pulpotomy in mature permanent teeth with bioceramic putty repairmen iRoot and mineral trioxide aggregate (MTA).@*METHODS@#Pulpotomy was performed on mature permanent premolars and molars with carious exposures at the Department of General Dentistry of Peking University School and Hospital of Stomatology, from November 2017 to September 2019. The patients were randomly divided into 2 groups, Group iRoot (n=22) and Group MTA (n=21). In Group iRoot, bioceramic putty repairmen iRoot was used as pulp capping agent, while in Group MTA, mineral trioxide aggregate was used as pulp capping agent. All the patients had signed informed consent forms. The clinical efficacy was evaluated by clinical examinations (temperature and electrical activity test) and imaging examinations 3, 6, and 12 months after surgery. Blinding was used for the patients and evaluators, but due to the obvious differences in the properties of the two pulp capping agents, the blinding method was not used for the treatment provider (the attending physician).@*RESULTS@#There was no significant difference in gender, average age, dentition and tooth position distribution between the two groups (P>0.05). In the study, 7 cases were lost to follow-up 12 months after operation (4 cases in Group iRoot, and 3 cases in Group MTA). One case in each of the two groups had transient sensitivity at the end of the 3-month follow-up, and the pulp vitality was normal at the end of the 6-month follow-up. One case in Group iRoot showed sensitivity at the end of the 12-month follow-up. The success rates of the two groups at the end of 12-month follow-up were 100%, and the cure rates were 94.4% (Group iRoot) and 100% (Group MTA), respectively, and the difference was not statistically significant (P>0.05). No cases in Group iRoot had obvious crown discoloration, while 3 cases in Group MTA had.@*CONCLUSION@#The clinical characteristics and effectiveness of pulpotomy in mature permanent teeth with bioceramic putty repairmen iRoot were similar with MTA. Bioceramic putty repairmen iRoot is an acceptable material when used in pulpotomy of mature permanent teeth. Because it is not easy to cause tooth discoloration after treatment and is convenient to operate, bioceramic putty repairmen iRoot has a better clinical application prospect.

Eficacia clínica del MTA en Pulpotomías de pacientes pediátricos: Una Revisión Sistemática / Eficácia Clínica da MTA em Pulpotomias Pediátricas de Pacientes: Uma Revisão Sistemática / Clinical Efficacy of MTA in Pediatric Patient Pulpotomies: A Systematic Review

Objetivo: Analizar la eficacia clínica del Agregado Trióxido Mineral (MTA) en pulpotomías a través de estudios comparativos con el formocresol, sulfato férrico e hidróxido de calcio; en pacientes pediátricos con edad de tres a nueve años. Materiales y Métodos: El artículo se basa en una revisión sistemática de la literatura, por ello, se utilizaron como fuentes de información las bases de datos: PubMed, Scielo, y Biblioteca Virtual de Salud. Asimismo, como criterios de inclusión se establecieron publicaciones del año 2008 al 2019, cuya procedencia se derivó de journalsy revistas académicas arbitradas; los cuales permitieron obtener dieciséis ensayos que evaluaban la eficacia clínica a través de los signos y síntomas de las patologías pulpares más comunes: absceso, inflamación gingival, movilidad patológica, dolor a la percusión y dolor espontáneo. Resultados: El MTA obtuvo una eficacia de 97,9% en contraposición al 86,9% del Sulfato Férrico. En relación al Formocresol, el MTA logró el 99% contra un 98,3% de eficacia. Además, en la comparación del MTA con el Hidróxido de Calcio el primero logró un 98,2% y el segundo 74,5%. Conclusiones: El MTA obtuvo una mayor eficacia clínica debido a su biocompatibilidad, pH básico y su elevada facultad al sellar la cámara pulpar. Por lo tanto, puede emplearse como un material seguro para las pulpotomías de pacientes pediátricos.

Objetivo: Analisar a eficácia clínica do Agregado de Trióxido Mineral (MTA) em pulpotomias através de estudos comparativos com formocresol, sulfato férrico e hidróxido de cálcio; em pacientes pediátricos de três a nove anos de idade. Materiais e Métodos: O artigo é baseado em uma revisão sistemática da literatura, portanto, bases de dados foram utilizadas como fontes de informação: PubMed, Scielo, e Biblioteca Virtual. Da mesma forma, como critério de inclusão, foram estabelecidas publicações de 2008 a 2019, cuja origem foi derivada de periódicos e revistas acadêmicas de referência; o que nos permitiu obter dezesseis ensaios que avaliaram a eficácia clínica através dos sinais e sintomas das doenças mais comuns da polpa: abscesso, inflamação gengival, mobilidade patológica, dor na percussão e dor espontânea. Resultados: A MTA obteve uma eficácia de 97,9% contra 86,9% para o sulfato férrico. Em relação ao Formocresol, o MTA alcançou 99% contra 98,3% de eficácia. Além disso, na comparação do MTA com o hidróxido de cálcio, o primeiro atingiu 98,2% e o segundo 74,5%. Conclusões: A MTA obteve uma maior eficácia clínica devido a sua biocompatibilidade, pH básico e sua alta faculdade ao selar a câmara de celulose. Portanto, pode ser usado como material segura para pulpotomias de pacientes pediátricos.

Objective: To analyze the clinical efficacy of the Mineral Trioxide Aggregate (MTA) in pulpotomies through comparative studies with formocresol, ferric sulfate and calcium hydroxide; in pediatric patients aged three to nine years. Materials and Methods: The article is based on a systematic review of the literature, therefore, databases were used as sources of information: PubMed, Scielo, and Virtual Health Library. Likewise, as inclusion criteria, publications from 2008 to 2019 were established, whose origin was derived from journals and refereed academic journals; which allowed us to obtain sixteen trials that evaluated clinical efficacy through the signs and symptoms of the most common pulp diseases: abscess, gingival inflammation, pathological mobility, pain on percussion and spontaneous pain. Results: MTA obtained an efficacy of 97.9% as opposed to 86.9% for ferric sulfate. Concerning to Formocresol, MTA achieved 99% versus 98.3% efficacy. Also, in the comparison of MTA with Calcium Hydroxide, the former achieved 98.2% and the latter 74.5%. Conclusions: MTA obtained a higher clinical efficacy due to its biocompatibility, basic pH and its high faculty when sealing the pulp chamber. Therefore, it can be used as a safe material for pediatric patient pulpotomies.

Tratamento com MTA Repair HP de extensa perfuração radicular após iatrogenia: relato de caso / Treatment with MTA Repair HP of extensive root perforation after iatrogeny: case report

Objetivo: relatar um caso clínico de perfuração radicular causada por iatrogenia, em terço cervical e médio de um incisivo central superior, dente 21, com presença de lesão óssea periapical. Relato de caso: clinicamente, pôde-se constatar ausência de edema e fístula. Na avaliação da condição pulpar e dos tecidos perirradiculares, o dente apresentou dor na palpação, ausência de mobilidade e de dor em percussão vertical e horizontal. Após os exames de imagem obtidos por meio de tomografia computadorizada de feixe cônico (TCFC; Prexion 3D), constatou-se lesão perirradicular extensa, canal radicular obliterado e perfuração radicular em face vestibular após tentativa de acesso cirúrgico. Como escolha de tratamento, optou-se por recuperar o trajeto original do canal de maneira a obter acesso intracanal, realização do preparo químico-mecânico e obturação pela técnica do cone único, para posteriormente promover o selamento adequado da perfuração com MTA Repair HP (Angelus, Londrina, PR, Brasil). Após seis meses, o dente apresentava-se assintomático e, radiograficamente, observou-se o reparo da lesão periapical. Considerações finais: o correto planejamento, o conhecimento dos materiais utilizados e a abordagem terapêutica foram de suma importância para o manejo adequado do caso. (AU)

Objective: to report a clinical case of root perforation, caused by iatrogeny in the cervical and middle third of an upper central incisor, tooth 21, with presence of periapical bone lesion. Case report: clinically, there was no edema and fistula. Facing the evaluation of the pulp condition and the periradicular tissues, the tooth presented pain on palpation, absence of mobility and pain on vertical and horizontal percussion. After the imaging exams, obtained by cone-beam computed tomography (CBCT; Prexion 3D), extensive periradicular lesion, obliterated root canal and root perforation were observed in the buccal face after attempted surgical access. As a choice of treatment, we chose to recover the original path of the canal in order to obtain intracanal access, chemicomechanical preparation and obturation by the single-cone technique to later promote proper sealing of the perforation with MTA Repair HP (Angelus, Londrina, PR, Brazil). After six months, the tooth was asymptomatic and, radiographically, the repair of the periapical lesion was observed. Final considerations: the correct planning, knowledge of the materials used and therapeutic approach were of paramount importance for the proper management of the case. (AU)

Comparison between calcium hydroxide mixtures and mineral trioxide aggregate in primary teeth pulpotomy: a randomized controlled trial

Abstract Objectives: To evaluate the effect of calcium hydroxide (CH) associated with two different vehicles as a capping material for pulp tissue in primary molars, compared with mineral trioxide aggregate (MTA). Methodology: Forty-five primary mandibular molars with dental caries were treated by conventional pulpotomy using one of the following materials: MTA only (MTA group), CH with saline (CH+saline group) and CH with polyethylene glycol (CH+PEG group) (15 teeth/group). Clinical and periapical radiographic examinations of the pulpotomized teeth were performed 3, 6, and 12 months after treatment. Data were tested by chi-squared analysis and a multiple comparison post-test. Results: The MTA group showed both clinical and radiographic treatment success in 14/14 teeth (100%), at all follow-up appointments. By clinical evaluation, no teeth in the CH+saline and CH+PEG groups had signs of mobility, fistula, swelling or inflammation of the surrounding gingival tissue. However, in the CH+saline group, radiographic analysis detected internal resorption in up to 9/15 teeth (67%), and inter-radicular bone resorption and furcation radiolucency in up to 5/15 teeth (36%), from 3 to 12 months of follow-up. In the CH+PEG group, 2/11 teeth (18%) had internal resorption and 1/11 teeth (9%) presented bone resorption and furcation radiolucency at all follow-up appointments. Conclusion: CH with PEG performed better than CH with saline as capping material for pulpotomy of primary teeth. However, both combinations yielded clinical and radiographic results inferior to those of MTA alone.

A randomized clinical trial of cavity liners after selective caries removal: one-year follow-up

Abstract Alternatives for the treatment of caries disease, such as minimally invasive approaches, have been developed in recent years. Objective: To carry out clinical and radiographic evaluations of three cavity liners after selective caries removal. Methodology: Thirty-six primary molars with deep occlusal caries lesions without pulp involvement (from children of both genders, aged between 5 and 8 years) were randomly divided into the following groups: calcium hydroxide cement (CHC) group; mineral trioxide aggregate (MTA) group and Portland cement with added zirconium oxide (PCZ) group. The following-up period was 6- and 12-month. The clinical and radiographic success rates were evaluated through chi-square test. The radiographic measurements were compared by ANOVA followed by Tukey's test (p<0.05). Results: Thirty-six patients were included, but thirty-four returned for 12-month follow-up. The overall success rate of the therapy for the three groups was 94.11% and no statistically significant differences occurred in the comparison among groups (p>0.05). Nineteen radiographs were selected to measure the dentin barrier thickness. The intragroup comparison presented a statistically significant increase of the dentin barrier for all groups, at 12-month follow-up. However, the MTA group showed increase of the dentin barrier, over time, 6- to 12-month follow-up. The intergroup comparison revealed no statistically significant differences (p>0.05). Conclusion: The clinical and radiographic data showed that all cavity liners provided effective treatment of primary teeth after selective caries removal.

Influence of photobiomodulation therapy on root development of rat molars with open apex and pulp necrosis

Abstract This study aimed to evaluate the role of photobiomodulation (PBM) in apexification and apexogenesis of necrotic rat molars with an open apex. Rat molars were exposed to the oral environment for 3 weeks. Canals were rinsed with 2.5% NaOCl and 17% EDTA, filled with antibiotic paste and sealed. After 7 days, canals were rinsed and divided into six groups (n=6): mineral trioxide aggregate (MTA); blood clot (BC); human dental pulp stem cells (hDPSC); MTA+PBM; BC+PBM; and hDPSC+PBM. In hDPSC groups, a 1% agarose gel scaffold was used. Two groups were not exposed: healthy tooth+PBM (n = 6), healthy tooth (n = 3); and one was exposed throughout the experiment: necrotic tooth (n = 3). In PBM groups, irradiation was performed with aluminum gallium indium phosphide (InGaAlP) diode laser for 30 days within 24-h intervals. After that, the specimens were processed for histological and immunohistochemical analyses. Necrotic tooth showed greater neutrophil infiltrate (p < 0.05). Necrotic tooth, healthy tooth, and healthy tooth+PBM groups showed absence of a thin layer of fibrous condensation in the periapical area. All the other groups stimulated the formation of a thicker layer of fibers (p < 0.05). All groups formed more mineralized tissue than necrotic tooth (p < 0.05). PBM associated with MTA, BC, or hDPSC formed more mineralized tissue (p < 0.05). MTA+PBM induced apexification (p < 0.05). Rabbit polyclonal anti-bone sialoprotein (BSP) antibody confirmed the histological findings of mineralized tissue formation, and hDPSC groups exhibited higher percentage of BSP-positive cells. It can be concluded that PBM improved apexification and favored apexogenesis in necrotic rat molars with an open apex.

Root perforations: a review of diagnosis, prognosis and materials

Abstract: Root perforation results in the communication between root canal walls and periodontal space (external tooth surface). It is commonly caused by an operative procedural accident or pathological alteration (such as extensive dental caries, and external or internal inflammatory root resorption). Different factors may predispose to this communication, such as the presence of pulp stones, calcification, resorptions, tooth malposition (unusual inclination in the arch, tipping or rotation), an extra-coronal restoration or intracanal posts. The diagnosis of dental pulp and/or periapical tissue previous to root perforation is an important predictor of prognosis (including such issues as clinically healthy pulp, inflamed or infected pulp, primary or secondary infection, and presence or absence of intracanal post). Clinical and imaging exams are necessary to identify root perforation. Cone-beam computed tomography constitutes an important resource for the diagnosis and prognosis of this clinical condition. Clinical factors influencing the prognosis and healing of root perforations include its treatment timeline, extent and location. A small root perforation, sealed immediately and apical to the crest bone and epithelial attachment, presents with a better prognosis. The three most widely recommended materials to seal root perforations have been calcium hydroxide, mineral trioxide aggregate and calcium silicate cements. This review aimed to discuss contemporary therapeutic alternatives to treat root canal perforations. Accordingly, the essential aspects for repairing this deleterious tissue injury will be addressed, including its diagnosis, prognosis, and a discussion about the materials actually suggested to seal root canal perforation.

Two-year outcomes of pulpotomy in primary molars using mineral trioxide aggregate: a retrospective study / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the two-year outcomes of primary molars pulpotomy using mineral trioxided aggregate (MTA) and to find out the potential influence factor, with the help of electronic medical record database.@*METHODS@#Children who received primary molars pulpotomy in the Department of Pediatric Dentistry in Peking University School and Hospital of Stomatology from May, 2014 to November, 2015 were searched in the Electronic Medical Record Database of Peking University School and Hospital of Stomatology, via the database for scientific research provided by the corporation of Kaientai. The children who were healthy, no more than 8 years old and followed up over 1.5 years were selected as the subjects of this study. At the same time, those children who didn't have complete medical records and X-rays before and after treatment were removed. Basic information, the relevant medical records and radiographic records of those children were collected. All molars were examined clinically and radiographically, and classified into 1 of 5 outcomes: N, H, P0, PX, PY. Molars classified into P0, PX and PY were regarded as failed. Survival analysis was applied. The survival rate and survival time of the deciduous teeth were calculated.Multivariate analysis was performed by using Cox proportional hazard model.@*RESULTS@#One hundred and fifteen children were finally included,aged from 2.6 to 8.2 years, with the mean age of (4.5±1.1) years. 211 primary molars were included, and the average follow up time was (880±154) days. A good level of agreement between the raters was found for molars with five outcomes(κ=0.913). Intrarater reliability was good for molars with five outcomes (κ=0.916). Forty-nine molars failed by September, 2017. Forty-three molars had abnormal radiographic manifestation. Six molars suffered premature loss. Only fourteen molars had an associated gingival swelling or parulis, or pathologic mobility upon clinical examination. The cumulative survival probability of half a year, one year, one year and a half, two years, two year and a half for the pulpotomy was 100%, 98.5%, 92.9%, 90.5%,73.8% through the Kaplan-Meier method, respectively. Through the analysis of Cox proportional hazard model, the survival probability was significantly higher when the age was younger. When sodium hypochlorite and the saline were used as the irrigation at the same time, the survival probability was not improved for those teeth with more bleeding in the operation compared with that used saline only. The teeth with preformed metal crown (PMC) gained longer median survival time than those restored with resin composite and others, but the difference was not significant, either. What's more, gender, the restoration time of PMC, the restoration of the opposite teeth were not found to be associated with the success of the treatment.@*CONCLUSION@#The cumulative survival probability of two years after the primary pulpotomy was 90.5%, complying the current instructions in our department. The survival probability of the molars after the treatment was significantly affected by the age.

Manejo médico de la hiperhidrosis / Medical management of hyperhidrosis

La hiperhidrosis es un aumento patológico de la sudoración, que puede asociarse a patologías médicas y fármacos, afectando en forma significativa la calidad de vida. La hiperhidrosis focal primaria es una patología común, cuyo manejo es un desafío. Están disponibles múltiples terapias para el tratamiento de hiperhidrosis, incluyendo productos tópicos, iontoforesis, toxina botulínica, fármacos sistémicos, cirugía y nuevos equipos para destrucción selectiva de las glándulas sudoríparas. El propósito de este artículo es revisar la literatura, enfocándose en las terapias no quirúrgicas y opciones de tratamiento emergentes.

Hyperhidrosis is a pathological excessive sweating. It can be associated with medical conditions or drugs and affect significantly the quality of life. Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. Multiple therapies are available for the treatment of hyperhidrosis, including topical products, iontophoresis, botulinum toxin, systemic medications, surgery and new devices aimed at the destruction of ecrine glands. The purpose of this article is to review the literature, with a focus on non-surgical therapies and emerging treatment options.

The use of a biocompatible cement in endodontic surgery. A randomized clinical trial 1

ABSTRACT PURPOSE: To evaluate the clinical applicability of Pozzolana Biologic Silva cement (PBS(r)) in endodontic surgery. METHODS: Persistent apical periodontitis was diagnosed in 30 teeth of 12 patients by cone-beam computed tomography (CT). All patients had 2 or 4 affected teeth and underwent endodontic surgery with root-end filling. Patients with 2 affected teeth had one tooth (control) treated with mineral trioxide aggregate (MTA-Angelus(r)) as a root-end filling material, and the other tooth treated with PBS (experiment). When the patient had four affected teeth, two of them were treated with MTA and two with PBS. Six months after surgery, all patients were assessed by CT scan. Between-group comparisons of measurements were performed using the Wilcoxon test. RESULTS: Periradicular tissue regeneration was observed in all cases. Significant within-group differences in long axes of the lesion were found in the bucco-palatal direction (PBS group, p=0.0012; MTA group, p=0.024) and coronal-apical direction (PBS group, p=0.0007; MTA group, p=0.0015) between pre- and postoperative measurements. CONCLUSIONS: Pozzolana Biologic Silva cement can be used in the treatment of persistent periradicular lesions. The clinical use of PBS as a root-end filling material may be an alternative to MTA. PBS has additives, which provide enhanced strength.

Portland cement versus MTA as a root-end filling material. A pilot study

PURPOSE: To assess periradicular lesions clinically and by computed tomography (CT) after endodontic surgery using either Portland cement or mineral trioxide aggregate (MTA) as a root-end filling material. METHODS: Three patients diagnosed with periradicular lesions by cone-beam CT underwent endodontic surgery with root-end filling. Patient A was treated with MTA as the root-end filling material, patient B was treated with Portland cement and patient C had two teeth treated, one with MTA and the other with Portland cement. Six months after surgery, the patients were assessed clinically and by CT scan and the obtained results were compared. RESULTS: Periradicular tissue regeneration was observed in all cases, with no significant differences in bone formation when comparing the use of MTA and Portland cement as root-end filling materials. CONCLUSION: Both mineral trioxide aggregate and Portland cement were successful in the treatment of periradicular lesions. .

O efeito do uso de fitoterápicos e da própolis nas propriedades físico-químicas, antimicrobiana e biocompatibilidade do MTA / The effect of the use of phytotherapics and propolis in physicochemical properties, antimicrobial and biocompatibility of MTA

O objetivo deste estudo foi avaliar as propriedades físico-químicas, antimicrobianas e biocompatibilidade do MTA branco manipulado com extratos aquoso e/ou em propilenoglicol da Arctium lappa L., Casearia sylvestris Sw. e própolis. Dentre os testes físico-químicos foram avaliados o tempo de presa, escoamento, pH, liberação de íons cálcio e alteração volumétrica. Para verificar o efeito antimicrobiano foram aplicadas as metodologias do contato direto (Enterococcus faecalis e a Cândida albicans) e da descontaminação dentinária, empregando a microscopia confocal de varredura laser para verificar a viabilidade de Enterococcus faecalis. Para a avaliação da biocompatibilidade, 162 ratos Wistar foram utilizados, onde cada animal recebeu dois implantes subcutâneos e um alveolar. Após os períodos experimentais de 15, 30 e 60 dias foram realizadas análises microtomográfica, histológica descritiva e histomorfométrica. Adicionalmente amostras do tecido alveolar foram processadas para dosagem das citocinas TNF-α e IL-10 por meio do ensaio imunoenzimático (ELISA). Os dados obtidos foram analisados estatisticamente com os testes ANOVA e Tukey ou Kruskal-Wallis e Dunn. Os resultados revelaram que a variação do veículo associado ao MTA aumentou significativamente o tempo de presa, no entanto, não houve influência na alteração volumétrica (P>0,05) e na capacidade do cimento em manter o meio alcalino e liberar íons cálcio. Os cimentos manipulados com extratos em propilenoglicol apresentaram maior escoamento (P<0,05). Apenas o extrato da própolis agregou ao MTA efeito contra o Enterococcus faecalis após 24 e 48 horas (descontaminação dentinária e contato direto respectivamente) e contra a Cândida albicans após 10 horas (P<0,05). De acordo com as avaliações histológica e histomorfométrica dos implantes em tecidos subcutâneo e alveolar não foi constatada diferença significativa entre os grupos experimentais quando comparados com o grupo no qual o MTA foi manipulado...

The aim of this study was to evaluate the physicochemical, antimicrobial properties and biocompatibility of white MTA mixed with aqueous or propylene glycol extracts of Arctium lappa L., Casearia sylvestris Sw. and propolis. Among physicochemical tests were evaluated the setting time, flowability, pH, ion calcium release and volumetric change. To verify the antimicrobial effects were applied the methods of direct contact (Enterococcus faecalis and Candida albicans) and dentin decontamination by using the confocal laser scanning microscopy to verify the Enterococcus faecalis viability. To evaluate the biocompatibility were used 162 Wistar rats. Each animal received one alveolar and two subcutaneous implants. After the experimental periods of 15, 30 and 60 days were performed the microtomography, histological description and histomorphometric analyses. Additionally alveolar tissue samples were processed for the measurement of TNF-α e IL-10 cytokines by enzyme-linked immunosorbent assay (ELISA). The data were statistically analyzed by the ANOVA and Tukey or KruskalWallis and Dunns tests. The results revealed that the variation of the vehicle associated to MTA significantly increased its setting time, however did not influence the volumetric change (P>0,05) and the cement's ability to maintain the alkaline medium and ion calcium release. Cements mixed with propylene glycol extracts showed higher flowability (P<0,05). Only propolis extract added to MTA the effect against E. faecalis after 24 and 48 hours (dentin decontamination and direct contact respectively) and against Candida albicans after 10 hours (P<0,05). According to the histological and histomorphometric evaluation of the implants in subcutaneous and alveolar tissue was not observed significant differences between the experimental groups in comparison to the reference group (MTA was mixed with distilled water). The microtomography analysis and expression of TNF-α and IL-10 showed...

Técnica de revascularização para o tratamento de reabsorção inflamatória externa radicular / Revascularization technique for the treatment of external inflammatory root resorption

O protocolo atual para o tratamento das reabsorções inflamatórias externas radiculares utiliza o hidróxido de cálcio como agente de desinfecção, como curativo de demora, em várias trocas sucessivas e por longo período de tempo. Além da necessidade de várias consultas para a substituição do hidróxido de cálcio, a sua permanência nos canais por longo período de tempo, provoca o enfraquecimento das estruturas dentárias. Portanto, modificação desta terapia seria aconselhável. Nesta investigação clínica, três pacientes portadores de reabsorção inflamatória externa radicular foram tratados com a terapia de revascularização, usualmente utilizada em dentes com necrose pulpar e ápices abertos. Os dentes foram tratados com o protocolo da terapia de revascularização que consiste na desinfecção do sistema de canais radiculares com pasta tri-antibiótica, com posterior preenchimento do canal com coagulo sanguíneo e selamento do canal com agregado trióxido mineral e resina adesiva. Foi observado durante a proservação a paralização do processo patológico com neoformação tecidual nas áreas radiolúcidas preexistentes. Foi detectada a redução da mobilidade dos elementos dentários tratados. Os três casos foram acompanhados por 30, 18 e 15 meses, respectivamente. Todos os elementos dentários permaneceram assintomáticos, mantidos com função e mobilidade fisiológica. A terapia utilizada no procedimento de revascularização mostrou-se eficiente no tratamento da reabsorção inflamatória externa radicular, reduzindo o número de consultas e aumentando a adesão dos pacientes.

The current external inflammatory root resorption treatment protocol, which uses calcium hydroxide dressing, usually comprises multiple and long-term applications. In addition to the need for multiple appointments for calcium hydroxide replacement, the long-term maintenance of this compound in the root canal weakens dental structures. A modification of this therapy would be advisable. In this clinical investigation, three patients with external inflammatory root resorption were submitted to revascularization therapy protocol usually used in teeth with necrotic pulp and open apices. The teeth were treated with revascularization therapy protocol, which consisted of disinfecting the root canal system with tri-antibiotic paste, filling it with blood clot, and sealing of the root canal with mineral trioxide aggregate and bonded resin restoration. During the follow up, the pathological process was arrested with tissue repair in preexisting radiolucent areas. Reduced mobility was observed in the treated teeth. The three cases were followed up for 30, 18, and 15 months, respectively. All teeth remained asymptomatic and retained function and physiological mobility. The therapy used in the revascularization procedure was efficient in the treatment of external inflammatory root resorption, reducing the number of appointments and increasing patient compliance.

O efeito do uso de fitoterápicos e da própolis nas propriedades físico-químicas, antimicrobiana e biocompatibilidade do MTA / The effect of the use of phytotherapics and propolis in physicochemical properties, antimicrobial and biocompatibility of MTA

O objetivo deste estudo foi avaliar as propriedades físico-químicas, antimicrobianas e biocompatibilidade do MTA branco manipulado com extratos aquoso e/ou em propilenoglicol da Arctium lappa L., Casearia sylvestris Sw. e própolis. Dentre os testes físico-químicos foram avaliados o tempo de presa, escoamento, pH, liberação de íons cálcio e alteração volumétrica. Para verificar o efeito antimicrobiano foram aplicadas as metodologias do contato direto (Enterococcus faecalis e a Cândida albicans) e da descontaminação dentinária, empregando a microscopia confocal de varredura laser para verificar a viabilidade de Enterococcus faecalis. Para a avaliação da biocompatibilidade, 162 ratos Wistar foram utilizados, onde cada animal recebeu dois implantes subcutâneos e um alveolar. Após os períodos experimentais de 15, 30 e 60 dias foram realizadas análises microtomográfica, histológica descritiva e histomorfométrica. Adicionalmente amostras do tecido alveolar foram processadas para dosagem das citocinas TNF-α e IL-10 por meio do ensaio imunoenzimático (ELISA). Os dados obtidos foram analisados estatisticamente com os testes ANOVA e Tukey ou Kruskal-Wallis e Dunn. Os resultados revelaram que a variação do veículo associado ao MTA aumentou significativamente o tempo de presa, no entanto, não houve influência na alteração volumétrica (P>0,05) e na capacidade do cimento em manter o meio alcalino e liberar íons cálcio. Os cimentos manipulados com extratos em propilenoglicol apresentaram maior escoamento (P<0,05). Apenas o extrato da própolis agregou ao MTA efeito contra o Enterococcus faecalis após 24 e 48 horas (descontaminação dentinária e contato direto respectivamente) e contra a Cândida albicans após 10 horas (P<0,05). De acordo com as avaliações histológica e histomorfométrica dos implantes em tecidos subcutâneo e alveolar não foi constatada diferença significativa entre os grupos experimentais quando comparados com o grupo no qual o MTA foi manipulado...

The aim of this study was to evaluate the physicochemical, antimicrobial properties and biocompatibility of white MTA mixed with aqueous or propylene glycol extracts of Arctium lappa L., Casearia sylvestris Sw. and propolis. Among physicochemical tests were evaluated the setting time, flowability, pH, ion calcium release and volumetric change. To verify the antimicrobial effects were applied the methods of direct contact (Enterococcus faecalis and Candida albicans) and dentin decontamination by using the confocal laser scanning microscopy to verify the Enterococcus faecalis viability. To evaluate the biocompatibility were used 162 Wistar rats. Each animal received one alveolar and two subcutaneous implants. After the experimental periods of 15, 30 and 60 days were performed the microtomography, histological description and histomorphometric analyses. Additionally alveolar tissue samples were processed for the measurement of TNF-α e IL-10 cytokines by enzyme-linked immunosorbent assay (ELISA). The data were statistically analyzed by the ANOVA and Tukey or KruskalWallis and Dunns tests. The results revealed that the variation of the vehicle associated to MTA significantly increased its setting time, however did not influence the volumetric change (P>0,05) and the cement's ability to maintain the alkaline medium and ion calcium release. Cements mixed with propylene glycol extracts showed higher flowability (P<0,05). Only propolis extract added to MTA the effect against E. faecalis after 24 and 48 hours (dentin decontamination and direct contact respectively) and against Candida albicans after 10 hours (P<0,05). According to the histological and histomorphometric evaluation of the implants in subcutaneous and alveolar tissue was not observed significant differences between the experimental groups in comparison to the reference group (MTA was mixed with distilled water). The microtomography analysis and expression of TNF-α and IL-10 showed...

Effect of MTA-based sealer on the healing of periapical lesions

Some manufacturers have recently added specific components to improve the ease of handling and insertion material properties of MTA in order to create MTA-based sealers. Objective The aim of this study was to evaluate the healing of periapical lesions in canine teeth after a single session of endodontic treatment with MTA Fillapex® compared with Sealapex® or Endo-CPM-Sealer®. Material and Methods Sixty-two root canals were performed on two 1-year-old male dogs. After coronal access and pulp extirpation, the canals were exposed to the oral cavity for 6 months in order to induce periapical lesions. The root canals were prepared, irrigated with a solution of 2.5% sodium hypochlorite and filled with gutta-percha and different sealers, according to the following groups: 1) Sealapex®; 2) Endo-CPM-Sealer®; and 3) MTA Fillapex®. Some teeth with periapical lesions were left untreated for use as positive controls. Healthy teeth were used as negative controls. After 6 months, the animals were sacrificed and serial sections from the roots were prepared for histomorphologic analysis and stained with hematoxylin and eosin and the Brown and Brenn technique. The lesions were scored according to pre-established histomorphologic parameters and the scores statistically analyzed using the Kruskal-Wallis test. Results All 3 materials produced similar patterns of healing (p>0.05); in particular, persistent inflammation and absence of complete periapical tissue healing were consistently noted. Conclusions Preparation of the infected root canals followed by filling with the materials studied was insufficient to provide complete healing of the periapical tissues. .

Apical Barrier Formation After Incomplete Orthograde MTA Apical Plug Placement in Teeth with Open Apex - Report of Two Cases

Two cases are reported in which incomplete placement of 4 mm mineral trioxide aggregate (MTA) plug was performed unintentionally at the apical third of permanent immature teeth with open apex and apical periodontitis. As confirmed radiographically, there were gaps between MTA and dentinal walls along the MTA-dentin interface. After setting of MTA was confirmed, endodontic treatment was completed and access was sealed with composite resin. At 6 to 16 months follow-up examinations, formation of dentin in contact with the MTA surface, as well as apical closure and periapical healing were ideied radiographically for both cases. The results of these cases showed that apical barrier formation and complete periapical healing is possible despite the incomplete apical placement of the MTA plug. This might be due to the biological properties of the MTA. Even so, an incomplete three-dimensional placement of the filling material is not advocated.

Sealing Ability of MTA Used as a Root End Filling Material: Effect of the Sonic and Ultrasonic Condensation

Despite the excellent properties of mineral trioxide aggregate (MTA), the condensation technique may have some influence in its sealing ability. The purpose of this study was to compare the sealing ability of sonic and ultrasonic setting of MTA. Thirty-four extracted human teeth had their canals prepared and filled with Sealapex sealer and gutta-percha using the active lateral condensation technique. The teeth were rendered waterproof and apicoectomy performed at 3 mm from the apex. Root-end cavities (3.0 mm deep and 1.4 mm diameter) were prepared with diamond ultrasonic tips. The root-end cavities were filled with Pro-Root MTA® with ultrasonic vibration, sonic vibration or no vibration. The positive control group did not receive any material while the negative control group was totally rendered waterproof. After material set, the specimens were immersed in Rodhamine B for 24 h, under vacuum in the first 15 min, then washed, dried and split longitudinally for evaluating the infiltration at the dentin/material interface. Data were analyzed using ANOVA and Tukey's tests at 5% significance level. Sonic vibration promoted the lowest infiltration values (p<0.05). It was concluded that sonic vibration could be considered an efficient aid to improve the sealing ability of MTA when used as root-end filling material.

Resumo O objetivo deste estudo foi avaliar in vitro, a influência da vibração sônica e ultrassônica no selamento marginal proporcionado pelo MTA. Trinta e quatro dentes humanos tiveram seus canais radiculares instrumentados e obturados com cimento Sealapex® pela técnica da condensação lateral ativa. Os dentes foram impermeabilizados e seccionados os 3 mm apicais. Retrocavidades (3 mm de profundidade e 1,4 mm de diâmetro) foram preparadas com pontas ultrassônicas diamantadas. As retrocavidades foram preenchidas com Pro-Root MTA® com auxílio da vibração ultrassônica, com auxílio da vibração sônica e sem vibração alguma. O grupo controle positivo não recebeu material retrobturador, enquanto que o negativo foi totalmente impermeabilizado. Após a presa do material, os espécimes foram mergulhados em Rodamina B por 15 min em vácuo, permanecendo nesta solução por mais 24 h. Em seguida, foram lavados, secados e clivados longitudinalmente para avaliação da infiltração do corante na interface dentina/material retrobturador. Os dados foram analisados utilizando a análise de variância e o teste de Tukey (p<0,05). Observou-se que apenas a vibração sônica foi diferente apresentando os menores índices de infiltração. Pode-se concluir que vibração sônica contribui com a melhora da capacidade de selamento marginal proporcionado pelo MTA quando empregado como material retrobturador. .

Portland cement with additives in the repair of furcation perforations in dogs / Cimento Portland com aditivos na reparação de perfurações radiculares em cães

PURPOSE: To evaluate the use of Portland cements with additives as furcation perforation repair materials and assess their biocompatibility. METHODS: The four maxillary and mandibular premolars of ten male mongrel dogs (1-1.5 years old, weighing 10-15 kg) received endodontic treatment (n=80 teeth). The furcations were perforated with a round diamond bur (1016 HL). The perforations involved the dentin, cementum, periodontal ligament, and alveolar bone. A calcium sulfate barrier was placed into the perforated bone to prevent extrusion of obturation material into the periradicular space. The obturation materials MTA (control), white, Type II, and Type V Portland cements were randomly allocated to the teeth. Treated teeth were restored with composite resin. After 120 days, the animals were sacrificed and samples containing the teeth were collected and prepared for histological analysis. RESULTS: There were no significant differences in the amount of newly formed bone between teeth treated with the different obturation materials (p=0.879). CONCLUSION: Biomineralization occurred for all obturation materials tested, suggesting that these materials have similar biocompatibility.

OBJETIVO: Avaliar o uso de cimentos Portland aditivados na reparação de perfurações radiculares e a biocompatibilidade destes materiais. MÉTODOS: Oitenta pré-molares, quatro da arcada dentária superior e quatro da arcada inferior de 10 cães machos, sem raça definida, com idade em torno de um a um ano e meio, pesando entre 10 e 15 kg foram submetidos a tratamento endodôntico, sendo realizadas perfurações nas furcas com broca de diamante 1016 HL. A cavidade envolveu dentina e cemento, como também periodonto e o osso alveolar. Na porção óssea da obturação, barreira de sulfato de cálcio foi utilizada evitando extravasamento do cimento para o espaço periodontal. Foi realizada a distribuição randomizada dos cimentos MTA (controle), Portland tipo II, Portland tipo V e Portland branco estrutural nas obturações. Os dentes foram restaurados com resina composta. Após 120 dias realizou-se eutanásia, retirada dos dentes, preparação e análise histológica. RESULTADOS: Entre os cimentos não houve diferença estatística significante quanto à neoformação óssea (p=0,879). CONCLUSÃO: Ocorreu biomineralização com os diferentes cimentos usados no estudo, sugerindo que estes são similares em termos de biocompatibilidade.

Furcal-perforation repair with mineral trioxide aggregate: Two years follow-up.

Furcal perforations are significant iatrogenic complications of endodontic treatment and could lead to endodontic failure. Mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair, retrograde filling, pulp capping, and apexification. This case report describes a furcal perforation in a maxillary first molar, which was repaired using MTA. The tooth was endodontically treated and coronally restored with resin composite. After 2 years, the absence of periradicular radiolucent lesions, pain, and swelling along with functional tooth stability indicated a successful outcome of sealing the perforation using MTA.