Células madre en odontología: nuevas perspectivas / Stem cells in dentistry: new perspectives

En el campo de la odontología, prevalecen actualmente alternativas terapéuticas con una filosofía conservadora. Sin embargo, con el advenimiento de los tratamientos con células madre (CM), se amplían las posibilidades terapéuticas, que buscan la combinación y el equilibrio entre la intervención tradicional y las posibilidades de reposición de estructuras anatómicas dañadas, a través de la regeneración de tejidos utilizando células madre o sus derivados (AU)

In the dentistry field, therapeutic alternatives with a conservative philosophy currently prevail. However, with the advent of stem cell (SC) treatments, therapeutic possibilities are expanding, seeking a combination and balance between traditional intervention and the pos- sibility of replacing damaged anatomical structures through tissue regeneration, using stem cells or their derivatives (AU)

The role of complement C5a receptor in DPSC odontoblastic differentiation and in vivo reparative dentin formation / 国际口腔科学杂志·英文版

Therapeutic dentin regeneration remains difficult to achieve, and a majority of the attention has been given to anabolic strategies to promote dentinogenesis directly, whereas, the available literature is insufficient to understand the role of inflammation and inflammatory complement system on dentinogenesis. The aim of this study is to determine the role of complement C5a receptor (C5aR) in regulating dental pulp stem cells (DPSCs) differentiation and in vivo dentin regeneration. Human DPSCs were subjected to odontogenic differentiation in osteogenic media treated with the C5aR agonist and C5aR antagonist. In vivo dentin formation was evaluated using the dentin injury/pulp-capping model of the C5a-deficient and wild-type mice. In vitro results demonstrate that C5aR inhibition caused a substantial reduction in odontogenic DPSCs differentiation markers such as DMP-1 and DSPP, while the C5aR activation increased these key odontogenic genes compared to control. A reparative dentin formation using the C5a-deficient mice shows that dentin regeneration is significantly reduced in the C5a-deficient mice. These data suggest a positive role of C5aR in the odontogenic DPSCs differentiation and tertiary/reparative dentin formation. This study addresses a novel regulatory pathway and a therapeutic approach for improving the efficiency of dentin regeneration in affected teeth.

Urgência em Endodontia: diagnóstico e tratamento em casos de pulpite irreversível sintomática / Urgency in Endodontics: Diagnosis and Treatment in Cases of Symptomatic Irreversible Pulpitis

Objetivo: discutir sobre o diagnóstico e a conduta terapêutica em casos de urgência endodôntica em dentes que apresentam pulpite irreversível sintomática. Material e Métodos: realizou-se uma revisão bibliográfica de estudos publicados nos últimos 5 anos (2015- 2020) por meio de busca nas bases de dados: PubMED, BVS (Biblioteca Virtual em Saúde) e Scielo (Scientific Eletronic Library). Para a pesquisa, foram utilizados os seguintes descritores: Pulpite Irreversível (Irreversible Pulpitis), Tratamento (Treatment), Dor (Pain) e Endodontia (Endodontics). Resultados: O diagnóstico é um passo fundamental no tratamento das urgências e emergências de origem endodôntica, pois é a partir do correto diagnóstico que será instituído o tratamento correto, reestabelecendo o conforto do paciente. Quando o profissional dispõe de tempo suficiente para realizar a remoção do tecido pulpar e o preparo do canal radicular, esse é o tratamento de escolha para os casos de pulpite irreversível sintomática, o qual pode ser realizado em sessão única ou em múltiplas sessões. Quando o profissional não dispõe de tempo suficiente para realizar o tratamento endodôntico convencional, a opção de tratamento é realizar apenas o atendimento de urgência para retirar o paciente do quadro de dor aguda presente, e em um momento futuro realizar o tratamento endodôntico completo. Conclusão: As urgências endodônticas sempre estão presentes nos consultórios odontológicos, os profissionais devem estar sempre preparados para realizar um correto diagnóstico e tratamento para cada caso, trazendo assim conforto ao paciente.

Objective: to discuss the diagnosis and therapeutic management in cases of endodontic urgency in teeth with symptomatic irreversible pulpitis. Material and Methods: a bibliographic review of studies published in the last 5 years (2015-2020) was carried out by searching the databases: PubMED, BVS (Virtual Health Library) and Scielo (Scientific Electronic Library). For the research, the following descriptors were used: Irreversible Pulpitis, Treatment, Pain and Endodontics. Results: The diagnosis is a fundamental step in the treatment of urgencies and emergencies of endodontic origin, as it is from the correct diagnosis that the correct treatment will be instituted, reestablishing the patient's comfort. When the professional has enough time to remove the pulp tissue and prepare the root canal, this is the treatment of choice for cases of symptomatic irreversible pulpitis, which can be performed in a single session or in multiple sessions. When the professional does not have enough time to carry out the conventional endodontic treatment, the treatment option is to perform only emergency care to remove the patient from the present acute pain condition, and at a future time to carry out the complete endodontic treatment. Conclusion: Endodontic emergencies are always present in dental offices, professionals must always be prepared to carry out a correct diagnosis and treatment for each case, thus bringing comfort to the patient.

TNF-alpha increases angiogenic potential in a co-culture system of dental pulp cells and endothelial cells

Abstract We recently demonstrated that a co-culture system of human umbilical vein endothelial cells (HUVECs) and human dental pulp stem cells (hDPSCs) could enhance angiogenesis ability in vitro. However, whether tumor necrosis factor α (TNF-α) could promote blood vessel formation during pulp regeneration remained unknown. The aim of this study was to investigate the effects of TNF-α on the formation of endothelial tubules and vascular networks in a co-culture system of hDPSCs and HUVECs. hDPSCs were co-cultured with HUVECs at a ratio of 1:5. The Matrigel assay was performed to detect the total tubule branching lengths and numbers of branches, and the Cell-Counting Kit 8 assay was performed to examine the effect of TNF-α on cell proliferation. Real-time polymerase chain reactions and western blot were used to detect vascular endothelial growth factor (VEGF) mRNA and protein expression. The Matrigel assay showed significantly greater total branching lengths and numbers of branches formed in the experimental groups treated with different concentrations of TNF-α compared with the control group. The decomposition times of the tubule structures were also significantly prolonged (P < 0.05). Treatment with 50 ng/ml TNF-α did not significantly change the proliferation of co-cultured cells, but it significantly increased the VEGF mRNA and protein expression levels (p < 0.05). In addition, the migration abilities of HUVECs and hDPSCs increased after co-culture with TNF-α (p < 0.05). TNF-α enhanced angiogenic ability in vitro in the co-culture system of hDPSCs and HUVECs.

There is no pulp necrosis or calcific metamorphosis of pulp induced by orthodontic treatment: biological basis

ABSTRACT To biologically explain why the orthodontic treatment does not induce pulp necrosis and calcific metamorphosis of the pulp, this paper presents explanations based on pulp physiology, microscopy and pathology, and especially the cell and tissue phenomena that characterize the induced tooth movement. The final reflections are as follows: 1) the orthodontic movement does not induce pulp necrosis or calcific metamorphosis of the pulp; 2) there is no literature or experimental and clinical models to demonstrate or minimally evidence pulp alterations induced by orthodontic movement; 3) when pulp necrosis or calcific metamorphosis of the pulp is diagnosed during orthodontic treatment or soon after removal of orthodontic appliances, its etiology should be assigned to concussion dental trauma, rather than to orthodontic treatment; 4) the two pulp disorders that cause tooth discoloration in apparently healthy teeth are the aseptic pulp necrosis and calcific metamorphosis of the pulp, both only induced by dental trauma; 5) the concussion dental trauma still requires many clinical and laboratory studies with pertinent experimental models, to increasingly explain its effects on the periodontal and pulp tissues.

RESUMO Para fundamentar biologicamente por que o tratamento ortodôntico não induz necrose pulpar e metamorfose cálcica da polpa, apresentou-se explicações com base na fisiologia, microscopia e patologia pulpar, bem como, e principalmente, nos fenômenos celulares e teciduais que caracterizam a movimentação dentária induzida. As reflexões finais foram: 1) o movimento ortodôntico não induz necrose pulpar ou metamorfose cálcica da polpa; 2) não há literatura e modelos experimentais e clínicos que comprovem ou minimamente evidenciem alterações pulpares induzidas pelo movimento ortodôntico; 3) quando a necrose pulpar ou metamorfose cálcica da polpa for diagnosticada durante o tratamento ortodôntico ou logo após a remoção dos aparelhos ortodônticos, a sua etiologia deve ser atribuída ao traumatismo dentário do tipo concussão, e não ao tratamento ortodôntico; 4) as duas doenças pulpares que levam ao escurecimento coronário em dentes aparentemente hígidos são a necrose pulpar asséptica e a metamorfose cálcica da polpa, ambas induzidas exclusivamente pelo traumatismo dentário; 5) o traumatismo dentário do tipo concussão requer, ainda, muitos estudos clínicos e laboratoriais, com modelos experimentais pertinentes, para fundamentar cada vez mais os seus efeitos sobre os tecidos periodontais e pulpares.

Efficacy of removal of cariogenic bacteria and carious dentin by ablation using different modes of Er: YAG lasers

The primary objective of this in vitro study was to evaluate the efficiency of removal of cariogenic bacteria and carious dentin by ablation using two lasers: fluorescence-feedback controlled (FFC) Er:YAG laser and different pulses of Er:YAG laser based on variable square pulse technology (VSPt). The secondary objective was to measure the temperature during laser ablation of carious tissue. Seventy-two extracted human molars were used in this study. Sixty teeth with carious dentin were randomly divided into four experimental groups according to the treatment for caries removal: group 1: 400 µs (FFC group); group 2: super short pulse (SSP group, 50 µs pulse); group 3: medium short pulse (MSP group, 100 µs pulse); group 4: short pulse (SP group, 300 µs pulse) and one positive control group with no treatment. Twelve teeth without carious lesion were used as a negative control group. After caries removal, swabs were taken with cotton pellets and real-time PCR analysis was performed. During caries ablation, a thermal infrared camera was used to measure the temperature changes. In all experimental groups, specimens were free of bacterial contamination after the treatment. In the SSP, MSP and SP groups, temperatures measured during caries ablation were significantly higher compared to temperatures in the FFC group (P<0.001). In this in vitro study, laser treatment for removal of carious dentin and cariogenic bacteria was an efficient treatment modality without causing excessive temperatures that might adversely affect pulp vitality.

Actualización sobre la evidencia histológica de los tejidos formados mediante terapia de regeneración pulpar guiada / Update on histological evidence of tissue formed by guided pulp tissue regeneration

La finalidad de la endodoncia regenerativa es restablecer la función de la pulpa normal endientes traumatizados, necróticos o infectados, convirtiendo a un diente no vital en uno vital nuevamente. Sin embargo, aún los resultados son imprevisibles. El objetivo de esta revisión fue recopilar y sintetizar la información disponible sobre la evidencia histológicas de los tejidos del complejo pulpo dentinario formados a través de la terapia de regeneración de tejido guiada. Se realizó una investigación basada en la búsqueda en MEDLINE utilizando filtros de tiempo (2011-2016) y palabras clave "Pulp", "Dentin", "Regeneration", "Tissue" and"Histologic". La búsqueda arrojó alrededor de 140 artículos; los de interés fueron seleccionados y descargados a texto completo. Los estudios más alentadores respecto a la regeneración de tejido guiada han sido descritos en reportes de caso de dientes inmaduros con diagnóstico de pulpitis irreversible en el cual al estudio histológico se observaron células tipo odontoblastos. Sin embargo, no existen estudios con seguimiento a largo plazo sobre este tipo de terapia. Algunos protocolos de tratamiento pueden dar lugar a resultados no deseados e impredecibles. Se requieren esfuerzos para mejorar y actualizar las estrategias de endodoncia regenerativa para que sea aplicada de un modo biológicamente eficaz y seguro para salvar los dientes.

The goal of regenerative endodontics is to reinstate normal pulp function in traumatized, necrotic and infected teeth that would result in reestablishment of their functions, but still fail to re-establish real pulp tissue and give unpredictable results. The aim of this review was to compile and synthesize available information on the histological evidence of tissue pulp-dentinal complex formed through guided tissue regeneration. A web-based research on MEDLINE was done using filter terms Review, published in the last 10 years and Dental journals. Keywords used for research were “Pulp", "Dentin", "Regeneratión", "Tissue” and "Histologic". The search yielded about 140 articles; the interest were selected and downloaded in full text. The most encouraging studies regarding guided tissue regeneration have been described in case reports of immature teeth diagnosed with irreversible pulpitis in which the histology odontoblasts type cells were observed. However, there are no studies with long-term follow up on this type of therapy. Some treatment protocols might result in undesired and unpredictable outcomes. Efforts are required to improve and update existing regenerative endodontic strategies to make it an effective, safe, and biological mode to save teeth.

Células madre e ingeniería de tejidos: los avances y desafíos de la odontología del futuro / Stem cells and tissue engineering: the advances and challenges of the future dentistry

En los días actuales, con los avances de la ingeniería de tejidos, el principal objetivo de los investigadores es desarrollar una tercera dentición, utilizando células madre. Nuestro trabajo tuvo como objetivo un levantamiento bibliográfico acerca de la utilización de células madre en odontología para la regeneración de los tejidos bucales. Para este trabajo, llevamos en consideración la información de artículos nacionales e internacionales de 2006 hasta 2014, construyendo una tabla. Sabemos que las células madre son muy especiales y prometen revolucionar la historia de la odontología mundialmente, solucionando grandes problemas clínicos.

Effects of glucose and glutamine concentrations in human dental pulp stem cells viability. An approach for cell transplantation

PURPOSE: To evaluate microscopic behavior and viability of dental pulp stem cells under glucose and glutamine deprivation. METHODS: Human tooth tissues were minced in isolated pieces and cultured until the desired cellular proliferation for experimental phases. Cells were cultured under variations of glucose and glutamine in both serum presence and absence, and then those cells were evaluated according to number and viability by MTT assay. The confocal microscopy analyzed cytoskeleton, nucleus, and mitochondria integrity. RESULTS: A low concentration of glucose favored cellular viability and microscopic behavior; the presence of glutamine in culture medium was favorable only when associated with glucose. The cellular biological potential in culture could be preserved in serum absence if nutritional requirements are adequate. CONCLUSION: Cell microscopic behavior and viability have demonstrated better patterns on serum-free low glucose culture medium with glutamine deprivation. .

Análise do efeito de substâncias liberadas por adesivos dentinários sobre a atividade e a expressão gênica de proteases da matriz extracelular (MMPs e CTs) em células-tronco da polpa dentária humana / Analysis of the effects of substances leached from adhesive systems on the activity and gene expression of extracellular matrix proteases (MMPs e CTs) in human dental pulp stem cells

Adesivos dentinários aplicados diretamente sobre dentina aumentam a atividade de enzimas endógenas deste tecido que degradam colágeno, colocando em risco a integridade da camada híbrida de restaurações estéticas. Estes adesivos podem também alcançar a polpa dentária indiretamente através do fluído dos túbulos dentinários por substâncias liberadas pelos mesmos. Desta forma, a polpa dentária poderia responder a estas substâncias por meio de síntese e/ou aumento da atividade de colagenases, o que poderia colaborar na degradação da camada híbrida. Sendo assim, o objetivo desse trabalho foi avaliar o efeito das substâncias liberadas por sistemas adesivos dos tipos autocondicionante e condicione e lave sobre a atividade e a expressão gênica de metaloproteinases (MMPs) e cisteíno-catepsinas (CTs) em células-tronco da polpa dentária humana. Foram aplicados meios de cultura condicionados por adesivos do tipo autocondicionante e condicione e lave polimerizados e não polimerizados sobre culturas celulares por 24 horas. O meio de cultivo fresco foi usado como controle. Depois de 24, 48, 72 e 96 horas, as atividades gelatinolíticas de MMP-2 e de MMP-9 foram avaliadas por meio da técnica de zimografia em gel de gelatina. Nos mesmos tempos experimentais, a modulação da expressão gênica das MMPs (1, 2, 3, 7, 9, 13 e 14) e das CTs (B e K) foi analisada por meio de reação de transcriptase reversa quantitativa em tempo real (qRT-PCR). Os resultados obtidos dos dois experimentos foram avaliados por meio do teste estatístico ANOVA, complementado pelo teste de Tukey (p<0.05)...

Adhesive systems directly applied to dentin increase the activity of endogenous collagen degrading proteinases of the dentin, which jeopardizes the integrity of the hybrid layer of aesthetic restorations. These adhesives can also reach the dental pulp through the dentinal fluid indirectly by substances leached from them. Then, the dental pulp tissue could respond by synthetizing and/or increasing the activity of collagen proteases, which in turn could collaborate to the hybrid layer degradation. Then, the aim of this study was to evaluate the effect of substances leached from self-etch and etch-and-rinse adhesive systems on the expression and activities of matrix metalloproteinases (MMPs) and cysteine cathepsins (CT-B and CT-K) in human dental pulp stem cells. Culture media conditioned by polymerized or non-polymerized self-etch and etch-and-rinse adhesive systems were applied to the cultures for 24 hours. Fresh medium was used as control. After 24, 48, 72 and 96 hours, the gelatinolytic activities of MMP-2 and MMP-9 were assessed by zymography technique. At the same experimental time gene expression of MMPs (1, 2, 3, 7, 9, 13 e 14) and CTs (B e K) were analyzed with quantitative reverse transcription polymerase chain reaction (qRT-PCR). Data was compared by ANOVA complemented by the Tukey´s test (p<0.05). All experimental groups showed increased gelatinolytic activity for MMP-2 and MMP-9. Until 72 hours, the activities were similar regardless the group...

Avaliação dos efeitos tradios da radioterapia na microcirculação pulpar: Taxa de (% SpO2) pulpar de pacientes irradiados para tumores malignos intraorais e de orofaringe / Late effects evaluation of radiotherapy on dental pulp microcirculation: (% SpO2) pulpal rate in patients given radiation therapy for malignant intraoral and oropharyngeal tumors

O objetivos deste estudo foi avaliar a influência da radiação ionizante na vitalidade do tecido pulpar mensurada através dos níveis de saturação de oxigênio (%SpO2) em pacientes com tumores malígnos intraoral ou de orofaringe, passado de 4-6 anos da radioterapia (RT). Noventa pacientes com tumores malígnos intraoral ou de orofaringe, submetidos de 4-6 anos anteriores a RT foram selecionados para este estudo. Os níveis de oxigenação e sensibilidade pulpar, avaliados através do oxímetro de pulso e do spray refrigerante TFE (tetrafluoretano), foram analisados nos dentes anteriores (superior e inferior) de cada paciente selecionado (n=693),, indiferente do quadrante e da área irradiada. Como grupo controle foram selecionados noventa pacientes saudáveis (nunca submetidos a RT) e os mesmos testes foram empregados (n=693). Todos os dentes foram considerados vitais. 100% mostraram resposta positva ao teste térmico e as médias de (%SpO2) foram de 92.7% no grupo dos pacientes irradiados (SD ± 1.83) e 92.6% no grupo dos não-irradiados (SD ± 1.80), sem diferença estatística observada. Houve uma tendência de valores de (%SpO2) menores em dentes caninos comparados aos incisivos, entretanto sem diferença estatística significante. Passados de 4-6 anos da RT, as (%SpO2) da polpa dental estão dentro dos padrões considerados normais para uma polpa vital e podese assumir que a RT não têm influência danosa a longo prazo sobre a vitalidade do tecido pulpar, assim sugerindo que este tecido pode ser apto a retornar o fluxo sanguíneo normal após a RT. As mudanças observadas na microcirculação pulpar devido a RT parecem ser temporárias, então o tratamento endodôntico preventivo ou a extração dental em pacientes que receberam radiação ionizante são desnecessários...

The aim of this study was to evaluate the influence of radioation on pulp vitality through the measurement of pulpal oxigenation levels (%SpO2) in patients with malignant intraoral and oropharyngeal tumors at 4-6 years after radiotherapy (RT). Ninety patients with malignant tumors in the oral cavity or oropharynx, submitted to RT 4-6 years prior to the study were selected. Pulp oxygenation levels and pulp sensitivity, measured by pulse oximetry and by cold refrigerant spray TFE (tetrafluoroethane), were analyzed in the anterior teeth (upper and lower) of each patient selected (n=693), regardless of the quadrant and the irradiated area. As a control group were selected ninety healthy patients (never submitted to RT) and the same tests were performed (n=693). All teeth were considered vital. 100% showed a positive response to the thermal test and the (%SpO2) rates were 92.7% in irradiated group (SD ± 1.83) and 92.6% in non-irradiated group (SD ± 1.80), without statistical difference. There was a trend for lower (%SpO2) values in canine teeth compared to incisors, however it was not statistically significant. After 4-6 years of RT the dental pulp (%SpO2) are within the normal range considered for a vital pulp and it can be assumed that RT did not have a long term influence on the pulp vitality, therefore suggesting that the pulp tissue may be able to recover normal blood flow after RT. The changes observed in the pulp microcirculation due to RT seems to be temporary, so preventive endodontic treatment or tooth extraction in patients who will receive RT may not be necessary...

Dentina / Dentin

Si bien la dentina y la pulpa tienen marcadas diferencias en su composición y estructura, ambas están tan íntimamente ligadas por su origen embriológico, que cualquier cosa que afecte a la dentina lo hará sobre la pulpa y viceversa. El ejemplo más claro en ese sentido está dado por el líquido intersticial. Este líquido, semejante al plasma, pero con menos proteínas, constituye una continuidad entre ambos tejidos y sus efectos hidrodinámicos son muy importantes tanto en los estados fisiológicos como en los patológicos.

Dentina / Dentin

Si bien la dentina y la pulpa tienen marcadas diferencias en su composición y estructura, ambas están tan íntimamente ligadas por su origen embriológico, que cualquier cosa que afecte a la dentina lo hará sobre la pulpa y viceversa. El ejemplo más claro en ese sentido está dado por el líquido intersticial. Este líquido, semejante al plasma, pero con menos proteínas, constituye una continuidad entre ambos tejidos y sus efectos hidrodinámicos son muy importantes tanto en los estados fisiológicos como en los patológicos.

Endodoncia regenerativa en el primer molar inferior de la rata con ápices incompletamente calcificados: un modelo experimental / Regenerative endodontics in the mandibular first molar of the rat: an experimental model

Objetivo: luego de la extirpación de la pulpa, el procedimiento de regeneración pulpar, inducido por un coágulo sanguíneo apical dentro de los conductos radicualres con ápices incompletamente formados, ha sido experimentado. El objetivo de este estudio piloto fue investigar si este mismo proceso se produce al utilizar el conducto distal del primer molar inferior de la rata como modelo experimental. Materiales y métodos: se realizaron biopulpectomías totales en el conducto distal del primer molar inferior derecho en diez ratas Wistar macho que presentaban sus ápices incompletamente calcificados. El primer molar inferior izquierdo no fue intervenido y se utilizó como control negativo. Se provocó una hemorragia apical con el objeto de inducir la formación de un coágulo sanguíneo. El acceso coronario se obturó con resina compuesta y se obtuvieron radiografías posoperatorias inmediatas. Las mandíbulas fueron resecadas y posteriormente radiografiadas. Los primeros molares, junto con las estructuras periodontales y óseas que los rodean, fueron removidos, fijados y procesados para estudio histológico. A las 96 horas, los ápices de los dientes experimentales permanecían aún incompletamente calcificados y se observó dentro de los conductos la invaginación de un tejido de aspecto similar al periodontal, muy celular y con gran cantidad de vasos sanguíneos. Los controles revelaron un desarrollo radicular más extenso, donde se podía apreciar la presencia de la pulpa, la papila dental y numerosos odontoblastos jóvenes. A los treinta días, se observó en los dientes experimentales un desarrollo radicular casi completo y que el conducto se encontraba ocupado por tejido fibroso maduro con vasos sanguíneos. Los dientes de control presentaron un desarrollo radicular completo, con tejido pulpar normal muy vascularizado y paredes dentinarias más espesas. Conclusión: los resultados sugieren que el primer molar inferior de la rata podría constituir un modelo adecuado.

Comparação da dinâmica da resposta celular utilizando dois diferentes biomateriais: Nanopartículas de Hidroxiapatita e Agregado Trióxido Mineral (MTA) / Comparison of dynamic cellular response using to different biomaterials: Nanobeads of Hidroxyapatite and Mineral Trioxide Aggregate (MTA)

As células da polpa dental têm o potencial de responder a estímulos externos e reparar o tecido dentário lesionado. Nos dentes, as lesões cariosas profundas e as lesões traumáticas são frequentes e resultam em alterações pulpares. Com o desenvolvimento da ciência e a busca de formas inovadoras de tratamento utilizando biomateriais de tamanho cada vez menor, verificar a biocompatibilidade desses materiais antes da aplicação clínica se mostra necessário e promissor. Assim, a finalidade deste estudo foi avaliar a biocompatibilidade de uma nova nanopartícula de hidroxiapatita utilizando células pulpares humanas em cultura. As Nanopartículas de Hidroxiapatita (HAp) utilizadas em nosso estudo são um material novo e ainda não disponível para a prática clínica. Como parâmetro comparativo, foi utilizado o material já consagrado na Odontologia para tratamentos endodônticos, o Agregado Trióxido Mineral (MTA). Para tanto, foram realizados testes de biocompatibilidade (MTS (3-(4,5-dimetiltiazol-2-y)5-(3-carboximetoxifenil)-2-(4-sulfofenil-2H-tetrazolio)). Foi preparada uma solução de material na concentração de 0,1g/ml diluído em meio de cultura, proporção preconizada pela norma ISO 10.993-12 (ISO, 1996). Esta solução foi diluída em 3 diferentes concentrações (1/10, 1/100 e 1/1000). Também foram realizados testes de migração celular e testes de capacidade de diferenciação, na concentração de 1/100

Como resultados pudemos verificar que as células da polpa foram viáveis quando expostas a diferentes concentrações de HAp, proliferaram mais quando tratadas com HAp na concentração de 1/100, migraram em direção aos materiais estudados e diferenciaram-se em tecido mineralizado quando em contato direto com ambos materiais estudados. Concluímos que o novo material testado é biocompatível e capaz de induzir mineralização em células de polpa dental sugerindo que as HAp podem ter aplicações clínicas futuras em tecidos mineralizados como osso e dente

The dental pulp cells have the potential to respond to external stimuli and repair the dental tissue injury. On teeth, deep carious lesions and traumatic injuries are common and result in pulp changes. With the development of science and the search for innovative treatment forms using reduced size biomaterials, to verify the biocompatibility of these materials before clinical application has become necessary and promising. Thus, the purpose of this study was to evaluate the biocompatibility of a new hydroxyapatite nanoparticle using human pulp cells in culture. The nanoparticles of hydroxyapatite (HAp) used in our study are new material and not yet available for clinical practice. As a comparator, we used the material already used in dentistry to root canal treatment, the Mineral Trioxide Aggregate (MTA). To do so, biocompatibility (MTS (3-(4,5-dimetiltiazol-2-y)5-(3-carboximetoxifenil)-2-(4-sulfofenil-2H-tetrazolio)). A solution of the material in a concentration of 0.1 g / ml diluted in culture medium recommended by ISO 10993-12 (ISO 1996) standard was prepared. This solution was diluted in three different concentrations (1/10, 1/100 and 1/1000). Were also performed cell migration and differentiation capacity assays at a concentration of 1/100

As results, we found that the pulp cells were viable when exposed to different concentrations of HAp, they proliferated more when treated with 1/100 HAp concentration, migrated toward the studied materials and differed into mineralized tissue when there was direct contact with both materials studied. We conclude that the new material tested is biocompatible and able to induce mineralization of dental pulp cells suggesting that the HAp may have future clinical applications in mineralized tissues such as bone and tooth

Ex-vivo evaluation of the intrapulpal temperature variation and fracture strength in teeth subjected to different external bleaching protocols

This study evaluated the influence of bleaching protocols on intrapulpal temperature and fracture strength of the bleached teeth. Ninety maxillary incisors were assigned to 9 groups (n=10): G1: 35 percent carbamide peroxide (35 percent CP), G2: 38 percent hydrogen peroxide (38 percent HP), G3: halogen light, G4: LED-laser, G5: 35 percent CP + halogen light, G6: 38 percent HP + halogen light, G7: 35 percent CP + LED-laser, G8: 38 percent HP + LED-laser, and G9: no treatment (control). Pulp space was widened, a thermocouple was introduced through the apex up to the pulp chamber and the temperature was recorded (°C). The fracture strength (kN) was determined using an Instron machine. Data were analyzed by ANOVA and Tukey's test (p<0.05). The halogen light alone (1.10 ± 0.24) (G3) and associated with 38 percent HP (1.15 ± 0.30) (G6) produced the highest temperature increase, statistically different (p<0.05) from the other groups. G1 (0.15 ± 0.06) and G6 (0.19 ± 0.07) produced the lowest values, statistically different (p<0.05) from G5 (0.65 ± 0.49). The bleaching protocols increased the temperature, but no increment exceeded the critical value of 5.6°C. Neither 35 percent CP nor 38 percent HP or the light sources alone altered the fracture strength of the teeth.

Este estudo avaliou a influência de protocolos de clareamento na temperatura intrapulpar e resistência à fratura de dentes clareados. Noventa incisivos superiores foram divididos em 9 grupos (n=10): G1: peróxido de carbamida a 35 por cento (PC 35 por cento), G2: peróxido de hidrogênio a 38 por cento (PH 38 por cento), G3: luz halógena, G4: LED-laser, G5: PC 35 por cento + luz halógena, G6: PH 38 por cento + luz halógena, G7: PC 35 por cento + LED-laser, G8: PH 38 por cento + LED-laser e G9: sem tratamento (controle). O canal radicular foi alargado, um termopar foi introduzido no ápice até a câmara pulpar e a temperatura foi calculada (°C). A resistência à fratura (kN) foi determinada em máquina Instron. Os dados foram analisados por análise de variância e teste de Tukey (p>0,05). A luz halógena utilizada isoladamente (1,10 ± 0,24) (G3) e associada ao PH 38 por cento (1,15 ± 0,30) (G6) proporcionaram os maiores valores de temperatura, sendo estatisticamente diferentes dos demais grupos (p<0,05). O G1 (0,15 ± 0,06) e o G6 (0,19 ± 0,07) produziram os menores valores de resistência à fratura, sendo estatisticamente diferentes (p<0,05) do G5 (0,65 ± 0,49). Os protocolos de clareamento aumentaram a temperatura, mas nenhum incremento excedeu o valor crítico de 5,6oC. O PC 35 por cento, PH 38 por cento e as fontes de luz utilizadas isoladamente não alteraram a resistência à fratura dos dentes.

Transient thermal and stress analysis of maxillary second premolar tooth using an exact three-dimensional model.

Aim : In this paper, the temperature and stress distributions in an exact 3D-model of a restored maxillary second premolar tooth are obtained with finite element approach. Objective : The carious teeth need to restore with appropriate restorative materials. There are too many restorative materials which can be used instead of tooth structures; since tooth structures are being replaced, the restorative materials should be similar to original structure as could as possible . Materials and Methods : In the present study, a Mesial Occlusal Distal (MOD) type of restoration is chosen and applied to a sound tooth model. Four cases of restoration are investigated: two cases in which base are used under restorative materials and two cases in which base is deleted. The restorative materials are amalgam and composite and glass-inomer is used as a base material. Modeling is done in the solid works ambient by means of an exact measuring of a typical human tooth dimensions. Tooth behavior under thermal load due to consuming hot liquids is analyzed by means of a three dimensional finite element method using ANSYS software. The highest values of tensile and compressive stresses are compared with tensile and compressive strength of the tooth and restorative materials and the value of shear stress on the tooth and restoration junctions is compared with the bond strength. Also, sound tooth under the same thermal load is analyzed and the results are compared with those obtained for restored models. Results : Temperature and stress distributions in the tooth are calculated for each case, with a special consideration in the vicinity of pulp and restoration region. Numerical results show that in two cases with amalgam, using the base material (Glass-ionomer) under the restorative material causes to decrease the maximum temperature in the restorative teeth . In the stress analysis, it is seen that the principal stress has its maximum values in composite restorations. Conclusion : The maximum temperatures are found in the restoration case of amalgam without base. Besides, it is found that restoration has not any influence on the stress values at DEJ, such that for all cases, these values are close to sound tooth results.

Apoptosis in pulp elimination during physiological root resorption in human primary teeth

Pulp samples of 50 healthy human teeth with indication for extraction were examined to evaluate the role of apoptosis in pulp elimination during physiological root resorption. Two groups were formed: a test group (n=30) composed of pulp samples of primary teeth with physiological root resorption and a control group (n=20) composed of pulp samples of permanent maxillary third molars. Morphological evidence of apoptosis as well as in situ detection of cellular DNA fragmentation by TUNEL assay and detection of internucleosomal pattern of fragmentation of the genomic DNA by electrophoresis were observed. The apoptotic index of the primary tooth group was significantly higher than that of the permanent tooth group (51.01 ± 0.52 versus 25.32 ± 0.68) (p<0.001). TUNEL reaction showed intense and diffuse labeling in the pulp samples of primary teeth, which were discrete in the controls. Intense DNA internucleosomal fragmentation, a specific pattern for apoptosis, was observed in primary tooth pulps DNA by electrophoresis, in the permanent tooth pulps this pattern fragmentation of the genomic DNA for apoptosis were not present. These results seem to indicate a role of apoptosis in pulp elimination during the physiological root resorption of human primary teeth.

Cinqüenta amostras de polpas de dentes humanos hígidos com indicação para extração foram estudadas a fim de verificar a participação da apoptose na eliminação pulpar durante a reabsorção radicular fisiológica. As amostras foram divididas em 2 grupos: um grupo de estudo composto por 30 polpas de dentes decíduos hígidos com reabsorção radicular fisiológica, e um grupo controle composto por 20 polpas de terceiros molares superiores hígidos. Evidências morfológicas de apoptose, bem como detecção in situ da fragmentação do DNA genômico via reação de TUNEL e também a detecção do padrão internucleossômico de fragmentação do DNA genômico via eletroforese foram observados. O índice apoptótico foi maior no grupo de dentes decíduos (51,01 ± 0,52) quando comparado ao grupo de dentes permanentes (25,32 ± 0,68) (p<0,001). Quanto à reação de TUNEL, houve intensa marcação positiva para fragmentação do genoma no grupo de estudo, o que ocorreu de maneira discreta nos controle. A eletroforese do DNA genômico mostrou fragmentação internucleossômica, em um padrão específico de apoptose nas amostras de dentes decíduos o que não ocorreu no grupo de dentes permanentes. Estes achados parecem indicar a apoptose como um mecanismo importante na eliminação do tecido pulpar durante a reabsorção radicular fisiológica de dentes decíduos humanos.

Dentin permeability: the basis for understanding pulp reactions and adhesive technology

Permeability involves the passage of fluids, ions, molecules, particulate matter and bacteria into and through a substance or tissue under different and varying conditions. The permeability of the dentin is essential to support the physiology and reaction patterns of the pulp-dentin organ. Nutrients and impulses are transported from the pulp via the odontoblast process and the contents of its tubules maintain the dentin as a vital tissue. However, the main interest of this paper focuses on penetration from the outside towards the pulp rather than from the pulp towards the outside. The present overview centers on the dentinal tubules; how they are formed and how they change as a result of normal and abnormal function, age, and pathological processes and the effect of these processes on the permeability of dentin. Particular attention is focused on the patency of the dentinal tubules.This overview is largely based on the author’s own research, clinical insights and active participation in continuing dental education over the last 50 years. It is not a review of the literature related to the permeability of dentin. Rather it presents interpretation of results related to the permeability of dentin based on experience and opinions acquired over a lifetime in dental research.

A permeabilidade envolve a passagem de fluidos, íons, moléculas, material particulado e bactérias para o interior e através de uma substância ou tecido sob diferentes e variáveis condições. A permeabilidade da dentina é essencial para a fisiologia e para os padrões de reação do órgão dentino-pulpar. Nutrientes e impulsos são transportados a partir da polpa por meio dos processos odontoblásticos e o conteúdo dos seus túbulos mantém a vitalidade da dentina. Entretanto, o principal interesse deste artigo concentra-se na penetração do exterior para a polpa e não da polpa para o exterior. O presente artigo centra-se essencialmente nos túbulos dentinários; como eles são formados e como eles mudam em razão da função normal e anormal, idade e processos patológicos, e o efeito destes processos na permeabilidade da dentina. Especial atenção é dada à patência dos túbulos dentinários. Este artigo apresenta uma visão geral do assunto e baseia-se amplamente nas pesquisas e percepções clinicas do próprio autor e em sua ativa participação na educação odontológica continuada ao longo dos últimos 50 anos. Não se trata de uma revisão da literatura relacionada à permeabilidade dentinária, mas sim da interpretação de resultados relacionados à permeabilidade dentinária com base na experiência e opiniões formadas ao longo de toda uma vida dedicada à pesquisa odontológica.

In vitro study of the pulp chamber temperature rise during light-activated bleaching

This study evaluated in vitro the pulp chamber temperature rise induced by the light-activated dental bleaching technique using different light sources. The root portions of 78 extracted sound human mandibular incisors were sectioned approximately 2 mm below the cementoenamel junction. The root cavities of the crowns were enlarged to facilitate the correct placing of the sensor into the pulp chamber. Half of specimens (n=39) was assigned to receive a 35 percent hydrogen peroxide gel on the buccal surface and the other halt (n=39) not to receive the bleaching agent. Three groups (n=13) were formed for each condition (bleach or no bleach) according to the use of 3 light sources recommended for dental bleaching: a light-emitting diode (LED)laser system, a LED unit and a conventional halogen light. The light sources were positioned perpendicular to the buccal surface at a distance of 5 mm and activated during 30 s. The differences between the initial and the highest temperature readings for each specimen were obtained, and, from the temperature changes, the means for each specimen and each group were calculated. The values of temperature rise were compared using Kruskal-Wallis test at 1 percent significance level. Temperature rise varied significantly depending on the light-curing unit, with statistically significant differences (p<0.01) among the groups. When the bleaching agent was not applied, the halogen light induced the highest temperature rise (2.38±0.66ºC). The LED unit produced the lowest temperature increase (0.29±0.13ºC); but there was no significant difference between LED unit and LED-laser system (0.35±0.15ºC) (p>0.01). When the bleaching agent was applied, there were significant differences among groups (p<0.01): halogen light induced the highest temperature rise (1.41±0.64ºC), and LED-laser system the lowest (0.33±0.12ºC); however, there was no difference between LED-laser system and LED unit (0.44±0.11ºC). LED and LED-laser ...