Efeito de diferentes irrigantes finais na resistência união de um cimento de silicato de cálcio: estudo in vitro / Effect of different final irrigants on the bond strength of a calcium silicate cement : in vitro study

Objetivo: Este estudo teve como objetivo avaliar a resistência de união do cimento Biodentine® à dentina radicular após a utilização de diferentes irrigantes finais. Método: Vinte dentes humanos extraídos tiveram seu terço médio radicular cortado em fatias que foram submersas em hipoclorito de sódio 2,5% e posteriormente divididas aleatoriamente em 4 grupos experimentais (n=15) conforme o irrigante final utilizado (1) água destilada (controle), (2) QMixTM, (3) ácido cítrico 10%, (4) EDTA 17%. Após a imersão na substância teste as amostras foram preenchidas com o cimento Biodentine e imersas em solução salina tamponada com fosfato (PBS) por um período de 7 dias. O teste de push out foi realizado e os valores de resistência de união em Mpa foram obtidos. Os dados foram analisados pelos testes de Kruskal Wallis e Studend- Newman-Keuls. Resultados: Os piores valores de união foram obtidos após a utilização do EDTA enquanto a água destilada, o QMix e o ácido cítrico apresentaram resultados estatisticamente semelhantes entre si. Conclusão: A remoção da smear layer não resultou em melhora nos resultados de união do cimento Biodentine.(AU)

Objective: This study aimed to evaluate the bond strength of Biodentine® cement to root dentin after the use of different final irrigants. Method: Twenty extracted human teeth had their middle root third cut into slices that were submerged in 2.5% sodium hypochlorite and then randomly divided into 4 experimental groups (n=15) according to the final irrigant used (1) distilled water (control), (2) QMixTM, (3) 10% citric acid, (4) 17% EDTA. After immersion in the test substance the samples were filled with Biodentine cement and immersed in phosphate buffered saline (PBS) for a period of 7 days. The push out test was performed and the bond strength values in MPa were obtained. The data were analyzed by Kruskal Wallis and Studend- Newman-Keuls tests. Results: The worst bond values were obtained after using EDTA while distilled water, QMix and citric acid showed statistically similar results to each other. Conclusion: Removal of the smear layer did not result in improved bonding results of Biodentine cement.(AU)

Root filling quality and bond strength of endodontic sealers to human and bovine dentin / Qualidade da obturação e resistência de união de cimentos endodônticos à dentina humana e bovina

Objetivo: Este estudo teve como objetivo comparar a qualidade da obturação e a resistência de união de dois cimentos endodônticos, AH Plus e Bio-C Sealer, em dentes humanos e bovinos. Métodos: Os canais radiculares de 60 dentes unirradiculares [30 humanos (H) e 30 bovinos (B)] foram preparados e obturados por condensação lateral da guta-percha e AH Plus (grupos AP-H e AP-B) ou Bio-C Sealer (grupos BC-H e BC-B). Seis fatias de 1,5 mm de espessura foram obtidas de cada raiz. Os espécimes foram observados em estereomicroscópio para avaliar a qualidade da obturação, considerando possíveis espaços vazios no material obturador. Posteriormente, as fatias radiculares foram avaliadas em termos de resistência de união por push-out e modo de falha. Os dados foram analisados pelos testes de Mann-Whitney e coeficientes de correlação de Spearman (α=5%). Resultados: A qualidade de obturação fornecida por AP e BC foi semelhante em ambos os substratos de dentina. No entanto, ao comparar dentes humanos e bovinos, os escores de espaços vazios foram maiores nas amostras bovinas, para ambos os cimentos. AP teve maior resistência de união à dentina humana e bovina do que BC. No entanto, não houve diferença significativa na resistência de união entre os substratos dentinários, para ambos os cimentos testados. Além disso, houve uma correlação positiva e moderada entre os valores de resistência de união de dentes humanos e bovinos. O modo de falha misto foi o mais prevalente. Conclusão: AP e BC fornecem qualidade de obturação semelhante, mas o primeiro apresenta maiores valores de resistência de união à dentina humana e bovina. A utilização de dentes bovinos como substitutos de amostras humanas parece ser adequada em estudos relacionados à resistência de união, mas não naqueles que testam a qualidade da obturação endodôntica.(AU)

Objective: This study aimed to compare the filling quality and bond strength of two endodontic sealers, AH Plus and Bio-C Sealer, in human and bovine teeth. Methods: The root canals of 60 [30 human (H) and 30 bovine (B)] single-rooted teeth were prepared and filled by lateral condensation of gutta-percha and AH Plus (groups AP-H and AP-B) or Bio-C Sealer (groups BC-H and BC-B). Six 1.5-mm-thick slices were obtained from each root. The specimens were observed under a stereomicroscope to assess filling quality, considering possible voids within the filling material. Subsequently, root slices were evaluated in terms of push-out bond strength and failure mode. Data were analyzed by Mann-Whitney tests and Spearman correlation coefficients (α=5%). Results: The filling quality provided by AP and BC was similar in both dentin substrates. However, when comparing human and bovine teeth, void scores were greater in the bovine samples, for both sealers. AP had higher bond strength to human and bovine dentin than BC. However, there was no significant difference in bond strength between dentin substrates, for both sealers tested. Also, there was a positive and moderate correlation between the bond strength values of human and bovine teeth. The mixed failure mode was the most prevalent. Conclusion: AP and BC provide similar filling quality, but the first presents higher bond strength values to human and bovine dentin. The use of bovine teeth as substitutes for human samples seems adequate in studies related to bond strength, but not in those testing root canal filling quality.(AU)

Investigation of the effect of indirect pulp capping materials on dentin mineral density

Aim: To evaluate the potential of inducing mineral density changes of indirect pulp capping materials applied to demineralized dentin. Methods: A total of 50 cavities were prepared, 5 in each tooth, in extracted ten molars without caries, impacted or semi-embedded. The cavities were scanned by microcomputed tomography (µ-CT) after creating artificial caries by microcosm method (pre-treatment). Each cavity was subjected to one of 5 different experimental conditions: control (dental wax), conventional glass ionomer cement (Fuji IX GP Extra), resin-modified calcium silicate (TheraCal LC), resin-modified calcium hydroxide (Ultra-Blend Plus), MTA (MM-MTA) and the samples were kept under intrapulpal pressure using simulated body fluid for 45 days. Then, the second µ-CT scan was performed (post-treatment), and the change in dentin mineral density was calculated. Afterward, elemental mapping was performed on the dentinal surfaces adjacent to the pulp capping agents of 5 randomly selected samples using energy dispersive X-ray spectroscopy (EDS) apparatus attached to a scanning electron microscope (SEM). The Ca/P ratio by weight was calculated. Friedman test and Wilcoxon Signed Ranks test were used to analyze the data. Results: There was a significant increase in mineral density values of demineralized dentin after treatment for all material groups (p<0.05). Resin-modified calcium silicate had similar efficacy to MTA and conventional glass ionomer cement, but was superior to resin-modified calcium hydroxide in increasing the mineral density values of demineralized dentin. Conclusions: Demineralized dentin tissue that is still repairable can be effectively preserved using materials with remineralization capability

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.

A case of poisoning by oral lime sulfur / 中华劳动卫生职业病杂志

Lime sulfur is a common bactericide with strong alkalinity, and is highly corrosive to humans and animals. It is rare for lime sulfur poisoning clinically. This article discusses the clinical manifestations of a patient who was poisoned by oral lime sulfur. After the poisoning, the mucosa of the lips and pharynx broke, fever, and pulmonary inflammation quickly appeared. The pulmonary CT showed slight interstitial changes in both lungs. Through high flow oxygen inhalation, fluid infusion, drainage, maintenance of water and electrolyte balance, protection of important organ functions, and other symptomatic support and treatment, as well as control of blood pressure, blood sugar, maintenance of circulatory function and other targeted measures, the patient's condition gradually improved.

Response of dental pulp capped with calcium-silicate based material, calcium hydroxide and adhesive resin in rabbit teeth

Direct pulp capping induces a local inflammatory process. Several biomaterials have been used for this procedure. The aim of this study was to compare the dentinal bridge thickness using three different pulp capping biomaterials with the conventional technique (high speed diamond bur) or Er-Yag laser, 1 month after pulp effraction. Materials and Methods: Forty two Class V cavities were prepared on the buccal surface of 4 maxillary incisors and 2 mandibular incisors of New Zealand rabbits. Specimens were divided into 6 treatment groups. Teeth were treated with: In Group 1: Er-Yag laser and Biodentine® (Septodont), in Group 2: Er: Yag laser and calcium hydroxide (Dycal® Dentsply), in Group 3: Er: Yag laser and adhesive system (Prime& Bond® NT Dentsply), in Group 4: high speed diamond bur and Biodentine® (Septodont), in Group 5: high speed diamond bur and calcium hydroxide (Dycal® Dentsply), and in Group 6: high speed diamond bur and adhesive system (Prime& Bond® NT Dentsply). The preparation was done with copious irrigation. The animals were sacrificed at 30 days and the teeth were extracted and prepared for histological analysis. Results: In the group of « laser Er-Yag ¼, iatrogenic pulpal wounds treated with Biodentine® were covered with a thick hard tissue barrier after 1 month. The difference was not significant with the groups of Dycal® used with Er: Yag laser and high speed diamond bur. Prime& Bond® NT Dentsply specimens showed a thin dentinal bridge layer. Conclusion: At 1 month, Er-Yag laser proved to be useful with Biodentine® for direct pulp capping procedures

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.

Research progress in vital pulp therapy in mature permanent teeth with carious pulp exposure / 中华口腔医学杂志

Vital pulp therapy(VPT)is an important pathway to preserve and maintain pulp tissue in a healthy state. VPT has been improved recently as the new progress achieved in pathobiology, bioactive materials and clinical research. The present review summarizes the clinical outcomes and prognostic factors of VPT, including direct pulp capping, partial pulpotomy and full pulpotomy in mature permanent teeth with carious pulp exposure, and briefly introduces the new progress in this field.

A death case of oral lime sulfur mixture poisoning / 中华劳动卫生职业病杂志

The Second Affiliated Hospital of Shandong First Medical University treated a patient with oral sulfur mixture poisoning on January 14, 2020. The patient presented with cyanosis and disturbance of consciousness as the first manifestations, accompanied by metabolic acidosis, shock, hypercalcemia and severe liver function and myocardial damage. The patient was given active treatment, including gastric lavage, blood purification, methylene blue application, correction of shock, organ support and other therapies. However the treatment was poor. Finally, the patient's family chose to give up and requested to be discharged from the hospital, and the patient died on the same day after follow-up.

A comparative evaluation of the sealing ability of two calcium silicate based sealers and a resin epoxy-based sealer through scanning electron microscopy and bond strength: an in vitro study

Aim: this study aimed to compare the sealing ability of two types of commercially available calcium silicate bioceramic based root canal sealers and a resin based root canal sealer. Methods: Twenty one single-rooted teeth were used, samples (n= 21) were randomly divided into three groups according to the sealer used (group A; ADSEAL, group B; Wellroot, group C; Ceraseal). Roots were then cleaved longitudinally in the labiolingual direction; all samples were then sectioned at three, six, and nine mm from the root tip. The penetration of sealers into the dentinal tubules was examined at 1000x with a scanning electron microscope. Data were tested for normality using Shapiro Wilk test. ANOVA test was used for analyzing normally distributed data followed by Bonferroni post hoc test for pair-wise comparison. Significance level p≤0.001. Results: groups B and C showed better sealing ability than group A in all the three sections. The coronal section showed higher sealing ability than the middle section followed by the apical section in the three tested groups. Conclusion: it can be concluded that both calcium silicate-based sealers had better sealing ability and higher bond strength than the resin epoxy- based sealer

Marginal gaps and internal voids after root-end filling using three calcium silicate-based materials: A Micro-CT analysis

Abstract This study evaluated the 3D quality of root-end filling, assessing the presence (volume and percentage) of marginal gaps and internal voids formed after retro-filling with three calcium silicate-based materials: MTA Angelus (Angelus Soluçoes Odontologicas, Londrina, PR, Brazil), Biodentine (Septodont Ltd., Saint Maur-des-Faussés, France) and Neo MTA Plus (Avalon Biomed Inc., Bradenton, Florida, US). Thirty human, extracted, single rooted teeth were used. Orthograde root canal treatment, root resection (3mm shorter than the apex) and retrograde cavity preparation with ultrasonic tips were performed. Teeth were divided into 3 groups (n =10 each) following a stratified randomization according to the initial volume of the root-end cavity. After retrofilling, samples were stored for 7 days. Then, two rounds of micro-CT scans were performed: soon after root-end preparation (with the cavity still empty) and 7 days after root-end filling. Marginal gaps, internal voids volume (mm3 and %), as well as, the overall defects (sum of gaps and voids) were evaluated. Statistics compared the three groups in relation to those defects. There was not statistical difference between groups regarding the marginal gaps (P≥ 0.05), the internal voids (P≥ 0.05), and the overall defects (P≥ 0.05). Median (mm3) and % of overall air-entrapment defects (gaps and/or voids) was: 0.004mm3 and 1.749% for MTA Angelus, 0.018mm3 and 6.660% for Biodentine, and 0.012mm3 and 4.079% for Neo MTA Plus. All materials had gaps and/or voids. No differences were found between MTA Angelus, Biodentine and Neo MTA Plus.

Resumo Este estudo avaliou a qualidade 3D de retro-obturações, avaliando a presença (volume e percentagem) de "gaps" marginais e "voids" internos formados a partir da retro-obturação com três materiais à base de silicato de cálcio: MTA Angelus (Angelus Soluções Odontológicas, Londrina, PR, Brasil), Biodentine (Septodont Ltd., Saint Maur-des-Faussés, França) and Neo MTA Plus (Avalon Biomed Inc., Bradenton, Flórida, US). Trinta dentes humanos unirradiculares extraídos foram usados. Após tratamento de canal ortrógrado, resecção radicular (3 mm apicais), o prepare da cavidade retrógrada com pontas ultrassônicas foi realizado. Os dentes foram divididos em três grupos (n= 10 cada) seguindo uma randomização estratificada, de acordo com o volume inicial da cavidade retrógrada. Depois da retro-obturação as amostras foram armazenadas por 7 dias. Duas rodadas de escaneamento de micro-CT foram realizadas: logo após o preparo retrógrado (com a cavidade ainda vazia) e 7 dias após a retro-obturação. O volume de "gaps" marginais e de "voids" internos (mm3 e %), bem como, os defeitos totais (soma de "gaps" e "voids") foram avaliados. Não houve diferença estatística entre os grupos em relação aos "gaps" marginais (P≥ 0,05), "voids" internos (P≥ 0,05), e aos defeitos totais (P≥ 0,05). A mediana (mm3) e porcentagem dos defeitos totais de aprisionamento de ar foi 0,004mm3 e 1,749% para o MTA Angelus, 0,018mm3 e 6,660% para o Biodentine, e 0,012mm3 e 4,079% para o Neo MTA Plus. Todos os materiais tiveram defeitos ("gaps"e/ou "voids"). Não houve diferença entre MTA Angelus, Biodentine e Neo MTA Plus.

Physicochemical properties, cytocompatibility and antibiofilm activity of a new calcium silicate sealer

Abstract The aim of this study was to evaluate the physicochemical properties, cytocompatibility and antibiofilm activity of a new calcium silicate-based endodontic sealer, Sealer Plus BC (MK Life, Brazil), in comparison with TotalFill BC Sealer (FKG Dentaire SA, Switzerland) and AH Plus (Dentsply, Germany). Setting time and flow were evaluated based on ISO 6876 standard. The pH was evaluated after different periods, and radiopacity by radiographic analysis (mmAl). Solubility (% mass loss) and volumetric change (by micro-CT) were assessed after 30 days of immersion in distilled water. Cytocompatibility was assessed by methyltetrazolium (MTT) and neutral red (NR) assays, after exposure of Saos-2 cells to the sealer extract for 24 h. An additional analysis was performed by using MTT assay after 1, 3 and 7 days of exposure of Saos-2 to the sealers 1:8 dilution extracts. Antibiofilm activity against Enterococcus faecalis and/or Candida albicans was evaluated by crystal violet assay and modified direct contact test. The physicochemical properties were analyzed using ANOVA/Tukey tests; MTT and NR data were analyzed by ANOVA and Bonferroni tests; the antimicrobial tests were analyzed by Kruskal-Wallis and Dunn tests (α=0.05). Sealer Plus BC had proper setting time, radiopacity, flow and alkalization capacity. Sealer Plus BC was significantly more soluble than AH Plus (p<0.05) and presented volumetric change similar to AH Plus and TotalFill BC (p>0.05). Sealer Plus BC presented antibiofilm activity and no cytotoxic effect. In conclusion, although Sealer Plus BC had higher solubility, this sealer showed proper physicochemical properties, cytocompatibility, and antibiofilm activity.

Resumo O objetivo deste estudo foi avaliar as propriedades físico-químicas, a citocompatibilidade e a atividade antibiofilme de um novo cimento endodôntico à base de silicato de cálcio, Sealer Plus BC (MK Life, Brasil), em comparação com TotalFill BC Sealer (FKG Dentaire SA, Suíça) e AH Plus (Dentsply, Alemanha). O tempo de presa e o escoamento foram avaliados com base nas normas ISO 6876. O pH foi avaliado após diferentes períodos, e a radiopacidade por análise radiográfica (mmAl). A solubilidade (% de perda de massa) e alteração volumétrica (por micro-CT) foram avaliadas após 30 dias de imersão em água destilada. Citocompatibilidade foi avaliada pelos ensaios metiltetrazólio (MTT) e vermelho neutro (NR), após exposição das células Saos-2 ao extrato de cimento por 24 horas. Análise adicional foi realizada através do ensaio MTT após 1, 3 e 7 dias de exposição das células Saos-2 aos extratos dos cimentos na diluição de 1:8. Atividade antibiofilme contra Enterococcus faecalis e/ou Candida albicans foi avaliada pelos ensaios cristal violeta e contato direto modificado. As propriedades físico-químicas foram analisadas utilizando os testes ANOVA e Tukey; MTT e NR foram analisados pelos testes ANOVA e Bonferroni; os ensaios antimicrobianos foram analisados pelos testes Kruskal-Wallis e Dunn (α=0.05). Sealer Plus BC apresentou tempo de presa, radiopacidade e escoamento adequados, além de capacidade de alcalinização. Sealer Plus BC foi significantemente mais solúvel que AH Plus (p<0.05) e apresentou alteração volumétrica similar à de AH Plus e TotalFill BC (p>0.05). Sealer Plus BC apresentou atividade antibiofilme, sem efeito citotóxico. Como conclusão, embora Sealer Plus BC apresente maior solubilidade, este cimento apresentou propriedades físico-químicas adequadas, citocompatibilidade e atividade antibiofilme.

Cytotoxicity and cytokine production by calcium silicate-based materials on periodontal ligament stem cells

Abstract This study investigated the effect of three commercial calcium silicate-based materials (CSBM) on cytotoxicity and pro-and anti-inflammatory cytokines production in cultured human periodontal ligament stem cells (hPDLSCs). Culture of hPDLSCs was established and characterized. Extracts of Bio-C Sealer (Angelus, Londrina, PR, Brazil), MTA Fillapex (Angelus, Londrina, PR, Brazil) and PBS Cimmo HP (Cimmo Soluções em Saúde, Pouso Alegre, MG, Brazil) were prepared by placing cement specimens (5 x 3 mm) in culture medium. Then, the extracts were serially two-fold diluted (1, 1:2, 1:4, 1:8, 1:16) and inserted into the cell-seeded wells for 24, 48 and 72 h for MTT assays. TNF-α and IL-10 cytokines were quantified by ELISA at 24h-cell supernatants. Data were analyzed by ANOVA and Tukey's test (α = 0.05). All CSBM exhibited some cytotoxicity that varied according to extract concentration and time of evaluation. MTA Fillapex presented the highest cytotoxic effects with significant reduction of metabolic activity/cell viability when compared to Bio-C Sealer and Cimmo HP®. TNF-α was significantly upregulated by the three tested cements (p < 0.05) while only MTA Fillapex significantly upregulated IL-10 in comparison to control. Taken collectively, the results showed that PBS Cimmo HP®, Bio-C Sealer and MTA Fillapex present mild and transient cytotoxicity and slightly induced TNF-α production. MTA Fillapex upregulated IL-10 release by hPDLSCs.

Resumo Este estudo investigou o efeito de três materiais comerciais à base de silicato de cálcio (CSBM) na citotoxicidade e na produção de citocinas pró e antiinflamatórias em células-tronco do ligamento periodontal humano (hPDLSCs). Cultura de hPDLSCs foi estabelecida e caracterizada. Extratos de Bio-C Sealer (Angelus, Londrina, PR, Brasil), MTA Fillapex (Angelus, Londrina, PR, Brasil) e PBS Cimmo HP® (Cimmo Soluções em Saúde, Pouso Alegre, MG, Brasil) foram preparados com a colocação de espécimes dos cimentos (5 x 3 mm) em meio de cultura. Em seguida, os extratos foram diluídos (1, 1: 2, 1: 4, 1: 8, 1:16) e inseridos nos poços semeados de células para ensaio de citotoxicidade por meio de MTT por 24, 48 e 72 h. As citocinas TNF-α e IL-10 foram quantificadas por ELISA em sobrenadantes de células de 24 h. Os dados foram analisados por ANOVA e teste de Tukey (α = 0,05). Todos os CSBM exibiram alguma citotoxicidade que variou de acordo com a concentração do extrato e o tempo de avaliação. O MTA Fillapex apresentou os maiores efeitos citotóxicos com redução significativa da atividade metabólica / viabilidade celular quando comparado ao Bio-C Sealer e Cimmo HP®. O TNF-α foi regulado positivamente pelos três cimentos testados (p <0,05), enquanto apenas o MTA Fillapex regulou positivamente a liberação de IL-10 em comparação com o controle. Tomados em conjunto, os resultados mostraram que PBS Cimmo HP®, Bio-C Sealer e MTA Fillapex apresentam citotoxicidade leve e transitória e induziram a produção de TNF-α. O MTA Fillapex regulou positivamente a liberação de IL-10 por hPDLSCs.

Fracture resistance of simulated immature teeth reinforced with different mineral aggregate-based materials

Abstract This study assessed the fracture resistance of simulated immature teeth reinforced with calcium aluminate cement (CAC) or mineral trioxide aggregate (MTA) containing calcium carbonate nanoparticles (nano-CaCO3). The microstructural arrangement of the cements and their chemical constitution were also evaluated. Forty-eight canines simulating immature teeth were distributed into 6 groups (n=8): Negative control - no apical plug or root canal filling; CAC - apical plug with CAC; CAC/nano-CaCO3 - apical plug with CAC+5% nano-CaCO3; MTA - apical plug with MTA; MTA/nano-CaCO3 - apical plug with MTA+5% nano-CaCO3; and Positive control - root canal filling with MTA. The fracture resistance was evaluated in a universal testing machine. Samples of the cements were analyzed under Scanning Electron Microscope (SEM) to determine their microstructural arrangement. Chemical analysis of the cements was performed by Energy Dispersive X-ray Spectroscopy (EDS). The fracture resistance of CAC/nano-CaCO3 was significantly higher than the negative control (p<0.05). There was no significant difference among the other groups (p>0.05). Both cements had a more regular microstructure with the addition of nano-CaCO3. MTA samples had more calcium available in soluble forms than CAC. The addition of nano-CaCO3 to CAC increased the fracture resistance of teeth in comparison with the non-reinforced teeth. The microstructure of both cements containing nano-CaCO3 was similar, with a more homogeneous distribution of lamellar- and prismatic-shaped crystals. MTA had more calcium available in soluble forms than CAC.

Resumo Este estudo avaliou a resistência à fratura de dentes imaturos simulados reforçados com cimento de aluminato de cálcio (CAC) ou trióxido agregado mineral (MTA) contendo nanopartículas de carbonato de cálcio (nano-CaCO3). O arranjo microestrutural dos cimentos e sua constituição química também foram avaliados. Quarenta e oito caninos simulando dentes imaturos foram distribuídos em 6 grupos (n=8): Controle negativo - sem plug apical ou obturação do canal radicular; CAC - plug apical com CAC; CAC/nano-CaCO3 - plug apical com CAC + 5% nano-CaCO3; MTA - plug apical com MTA; MTA/nano-CaCO3 - plug apical com MTA + 5% nano-CaCO3; e Controle positivo - obturação dos canais radiculares com MTA. A resistência à fratura foi avaliada em máquina universal de ensaios. Amostras dos cimentos foram analisadas em Microscópio Eletrônico de Varredura (MEV) para determinar seu arranjo microestrutural. A análise química dos cimentos foi realizada por Espectroscopia de Energia Dispersiva de Raio-X (EDS). A resistência à fratura de CAC/nano-CaCO3 foi significativamente maior do que o controle negativo (p<0,05). Não houve diferença significativa entre os outros grupos (p>0,05). Ambos os cimentos apresentaram microestrutura mais regular com a adição de nano-CaCO3. As amostras de MTA apresentaram mais cálcio disponível em formas solúveis do que CAC. A adição de nano-CaCO3 ao CAC aumentou a resistência à fratura dos dentes em comparação aos dentes não reforçados. A microestrutura de ambos os cimentos contendo nano-CaCO3 foi semelhante, com uma distribuição mais homogênea de cristais de formato lamelar e prismático. MTA apresentou mais cálcio disponível nas formas solúveis do que CAC.

Tooth discoloration using calcium silicate-based cements for simulated revascularization in vitro

Abstract The endodontic revascularization may be an alternative treatment for necrotic immature teeth, however, several treatment steps may cause tooth discoloration. This study evaluated the use of three calcium silicate-based cements with different radiopacifying agents on the color alteration (∆E) of extracted premolars after simulation of revascularization. Forty single rooted extracted premolars were shaped with #1-6 gates Glidden drills, rinsed with sodium hypochlorite, and filled with fresh human blood. Three calcium silicate-based cements with different radiopacifying agents (bismuth oxide - CSBi, calcium tungstate - CSW, and zirconium oxide - CSZr) were applied over the blood clot (n=10). The control group received the application of a temporary zinc oxide-based cement (TFZn) (n=10). ∆E was measured with a spectrophotometer, using the L*a*b* color system of the International Commission on Illumination (CIELab), in different times: prior to the preparation of the access cavity (t0); right after treatment (t1); and after one (t2), two (t3), three (t4) and four (t5) months. The tooth site for color evaluation was standardized by silicon matrix, the color reading was performed 3 times per tooth, and the teeth were stored in 37º water between evaluations. ∆E, whiteness (WID index) and yellowness (b*) were evaluated. Data were subjected to one-way ANOVA and repeated measures ANOVA, followed by Tukey's post hoc test (α=0.05). All groups were similar in ∆E1 (t0-t1). The ∆E was the lowest and constant in the control group. In all evaluation times, CSBi presented the highest ∆E (p<0.01). CSW and CSZr were similar in all evaluated times and presented intermediate ∆E values. WID index from CSBi and CSW presented more distancing from 'white' reference. CSBi presented the greatest decrease in yellowness (b* value). The cement containing bismuth oxide presented the highest color alteration values. All tested calcium silicate-based cements presented clinically perceptible discoloration. Calcium tungstate and zirconium oxide may be used as alternative radiopacifiers to decrease tooth discoloration after endodontic tooth revascularization.

Resumo A revascularização endodôntica pode ser um tratamento alternativo para dentes imaturos necrosados, porém, várias etapas do tratamento podem causar alteração de cor dental. Este estudo avaliou o uso de três cimentos a base de silicato de cálcio com diferentes agentes radiopacificadores na alteração de cor (∆E) de pré-molares extraídos após a simulação de revascularização. Quarenta pré-molares unirradiculares extraídos foram conformados com brocas gates glidden #1-6, irrigados com hipoclorito de sódio, e preenchidos com sangue humano fresco. Três cimentos a base de silicato de cálcio com diferentes agentes radiopacificadores (óxido de bismuto - CSBi, tungstato de cálcio - CSW, e óxido de zircônio - CSZr) foram aplicados sobre o coágulo sanguíneo (n=10). O grupo controle recebeu a aplicação de um cimento temporário a base de óxido de zinco (TFZn) (n=10). ∆E foi medida com um espectrofotômetro, utilizando o sistema de cor L*a*b* da International Commission on Illumination (CIELab), em tempos diferentes: previamente ao preparo da cavidade de acesso (t0); logo após o tratamento (t1); e após um (t2), dois (t3), três (t4) e quatro (t5) meses. O local do dente para a avaliação de cor foi padronizado por uma matriz de silicone, a leitura da cor foi realizada 3 vezes por dente, e os dentes foram armazenados em água a 37ºC entre as avaliações. ∆E, 'clareamento' (índice WID) e tom amarelado (b*) foram avaliados. Os dados foram submetidos ao teste de ANOVA um fator e teste ANOVA de medidas repetidas, seguidos pelo teste post hoc de Tukey (α=0,05). Todos os grupos foram semelhantes em ∆E1 (t0-t1). A ∆E foi menor e constante no grupo controle. Em todos os tempos de avaliação, CSBi apresentou os maiores valores de ∆E (p<0.01). CSW e CSZr foram semelhantes em todos os tempos avaliados e apresentaram valores intermediários de ∆E. O índice WID de CSBi e CSW se distanciaram mais da referência 'branco'. CSBi apresentou maior diminuição no tom amarelado (valor de b*) os outros grupos. O cimento contendo óxido de bismuto apresentou os maiores valores de alteração de cor. Todos os cimentos testados apresentaram alteração de cor clinicamente perceptível. O tungstato de cálcio e óxido de zircônio podem ser usados como radiopacificares alternativos para a diminuição da alteração de cor dental após o processo de revascularização endodontica.

Effect of different dimensions of test samples on the volumetric change assessment of endodontic materials

Abstract New methodologies using micro-CT to evaluate solubility besides dimensional and morphological changes of endodontic materials are proposed. However, there is no standardization in the methods. The aim of this study was to assess the effect of different dimensions of test samples on volumetric change evaluation of different endodontic materials. AH Plus, FillCanal and Sealapex root canal sealers, Biodentine, IRM and MTA root-end filling cements were used in the tests. Samples of each material with a thickness of 1.5 mm and different diameters were manufactured: 6.3, 7.75, and 9.0 mm. The samples were scanned in micro-computed tomography (micro-CT) after setting and after 7 days of immersion in distilled water. The volumetric change was evaluated by means of the difference in the total volume of the specimens before and after immersion. Data were submitted to ANOVA and Tukey tests (p<0.05). The size of the samples did not affect the percentage of volumetric change of the materials (p>0.05). All sample sizes had greater volume loss for Sealapex among the sealers and Biodentine for the cements (p<0.05). In conclusion, Biodentine and Sealapex had the highest volume loss after immersion. Samples with 1.5 mm thickness, and diameters ranging between 6.3 and 9.0 mm can be used to assess the stability of endodontic materials using micro-CT without affecting the percentage of volumetric change.

Resumo Novas metodologias utilizando micro-CT são propostas para avaliar a solubilidade além de alterações dimensionais e morfológicas em materiais endodônticos. No entanto, não há padronização nos métodos. O objetivo deste estudo foi avaliar o efeito de diferentes dimensões de corpos de prova na avaliação da alteração volumétrica de diferentes materiais endodônticos. Os cimentos obturadores AH Plus, FillCanal e Sealapex e os cimentos retrobturadores Biodentine, IRM e MTA foram utilizados nos testes. Foram confeccionadas amostras de cada material com espessura de 1.5 mm e diâmetros diferentes: 6.3, 7.75 e 9.0 mm. As amostras foram escaneadas em microtomografia computadorizada (micro-CT) após a presa e após 7 dias de imersão em água destilada. A alteração volumétrica foi avaliada por meio da diferença no volume total dos corpos de prova antes e após a imersão. Os dados foram submetidos aos testes ANOVA e Tukey (p<0,05). A dimensão das amostras não afetou o percentual de alteração volumétrica dos materiais (p>0,05). Todos os diâmetros de amostra mostraram maior perda de volume para Sealapex entre os cimentos obturadores e Biodentine entre os cimentos retrobturadores (p<0,05). Como conclusão, Biodentine e Sealapex mostraram a maior perda volumétrica após a imersão. Amostras com 1.5 mm de espessura e diâmetros variando entre 6.3 e 9.0 mm podem ser usadas para avaliação da estabilidade de materiais endodônticos utilizando micro-CT, sem influenciar no percentual de alteração volumétrica.

Tratamiento de lesiones apicoperirradiculares con un biomaterial de tercera generación (Licon-D) / Treatment of apicoperiradicular lesions with a third-generation biomaterial (Licon-D)

Biomaterial de tercera generación con una tasa de degradabilidad en la zona perirradicular y del foramen apical, con una velocidad similar a la que emplea el organismo para formar tejido calcificado y sellar biológicamente el extremo apical del diente. Mediante el recurso tecnológico de la microencapsulación se produce la liberación lenta y controlada de Ca2+ retenido en la superficie y en el interior de las microesferas de alginato de calcio, sin que se modifique de manera significativa las propiedades reológicas básicas del biomaterial de obturación de conductos, tales como la compresibilidad, plasticidad, extensibilidad, fluidez, viscosidad cinemática, viscosidad de compresión y endurecimiento por trabajo (AU)

Third-generation biomaterial with a degradability rate in the periradicular area and the apical foramen, with a speed similar to that used by the body to form calcified tissue and biologically seal the apical end of the tooth. Through the technological resource of microencapsulation, the slow and controlled release of Ca2+ retained on the surface and inside the calcium alginate microspheres is produced, without significantly modifying the basic rheological properties of the duct sealing biomaterial, such as compressibility, plasticity, extensibility, flowability, kinematic viscosity, compression viscosity, and work hardening (AU)

Cytotoxicity, and antimicrobial and physicochemical properties of sealers incorporated with Uncaria tomentosa

Abstract This study evaluated the cytotoxicity, the antimicrobial and physicochemical properties of root canal sealers incorporated with phytotherapic Uncaria tomentosa (UT). Unmodified AH Plus (Dentsply, DeTrey, Germany) and MTA Fillapex (Angelus, Londrina, Brazil) were used as controls. UT was incorporated into AH Plus and MTA Fillapex, at concentrations of 2% and 5% of the total weight of these sealers (w/w). Flowability, setting time, and solubility were evaluated following ISO requirements. The pH values were measured at periods of 12, 24, 48 hours, and 7 days. The antimicrobial activity of the sealers against Enterococcus faecalis was analyzed by both direct contact tests in freshly prepared sealers, and after 7 days. The cytotoxicity of the samples was evaluated by the MTT assay, to check Balb/c 3T3 cell viability. The statistical analysis was performed by one-way ANOVA and Tukey's test (p < 0.05). The incorporation of UT was associated with a decrease in flow, for both sealers, an increase in AH Plus setting time, increase in MTA Fillapex pH values, and solubility (after 14 days), for both sealers (p < 0.05). Regarding the antibacterial evaluation, bacterial reduction was reported after incorporation of UT into both AH Plus and MTA Fillapex, up to 7 days after handling of the material (P<0.05). UT incorporation decreased the cytotoxic effects of both AH Plus and MTA Fillapex sealers in a way directly proportional to their respective concentrations (p < 0.05). In conclusion, UT can be added to both sealers to reduce their cytotoxicity, and improve their antibacterial effects, without compromising their original physicochemical properties.

Calcium supplementation and cardiovascular disease in postmenopausal women: a study in South Brazil / Suplementação de cálcio e doença cardiovascular em mulheres na pós-menopausa: um estudo no Sul do Brasil

Objective: To evaluate the link between calcium supplementa- tion and cardiovascular disease in postmenopausal women (aged 55 years or older). Methods: A standardized questionnaire was employed to collect data about calcium supplements, eart di- sease, and demographic of women attended at Primary Care in the South Region of Brazil. Generalized linear regression models were performed to evaluate the association and adjust for poten- tial confounders. Results: Overall, 1,057 women completed the questionnaire. Information about calcium supplementation was present in 1,035 questionnaires. The mean ± standard deviation of the age of participants was 67.2±7.6 years. The frequency of calcium supplementation was 18.6%. There was no association between heart failure, stroke, and ischemic heart disease and cal- cium supplementation (prevalence ratio; 95% confidence interval of 0.3; -0.9-0.4, -0.2; -0.8-0.4 and -0.5; -1.0-0.02, respectively. Con- clusions: Our study did not find an association of higher risk of cardiovascular disease in women using calcium supplementation at Primary Care in South Brazil.

Objetivo: Avaliar a ligação entre a suplementação de cálcio e doença cardiovascular em mulheres na pós-menopausa (com 55 anos ou mais). Métodos: Um questionário padronizado foi em- pregado para coletar dados sobre suplementos de cálcio, doenças cardíacas e demográficos de mulheres que frequentavam a Aten- ção Primária na Região Sul do Brasil. Modelos de regressão linear generalizada foram realizados para avaliar a associação e ajustar os potenciais fatores de confusão. Resultados: No total, 1.057 mulheres responderam ao questionário. As informações sobre su- plementação de cálcio estavam presentes em 1.035 questionários. A média ± desvio-padrão da idade dos participantes foi de 67,2 ± 7,6 anos. A frequência de suplementação de cálcio foi de 18,6%. Não houve associação entre insuficiência cardíaca, acidente vas- cular cerebral e doença cardíaca isquêmica e suplementação de cálcio (razão de prevalência; intervalo de confiança de 95% de -0,3; -0,9-0,4, -0,2; -0,8-0,4 e -0,5; -1,0-0,02, respectivamente). Con- clusão: Nosso estudo não encontrou associação de maior risco de doença cardiovascular em mulheres em uso de suplementação de cálcio na Atenção Primária no Sul do Brasil.

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.