Evaluation of dentinogenesis inducer biomaterials: an in vivo study

Abstract When exposure of the pulp to external environment occurs, reparative dentinogenesis can be induced by direct pulp capping to maintain pulp tissue vitality and function. These clinical situations require the use of materials that induce dentin repair and, subsequently, formation of a mineralized tissue. Objective: This work aims to assess the effect of tricalcium silicate cements and mineral trioxide aggregate cements, including repairing dentin formation and inflammatory reactions over time after pulp exposure in Wistar rats. Methodology: These two biomaterials were compared with positive control groups (open cavity with pulp tissue exposure) and negative control groups (no intervention). The evaluations were performed in three stages; three, seven and twenty-one days, and consisted of an imaging (nuclear medicine) and histological evaluation (H&E staining, immunohistochemistry and Alizarin Red S). Results: The therapeutic effect of these biomaterials was confirmed. Nuclear medicine evaluation demonstrated that the uptake of 99mTc-Hydroxymethylene diphosphonate (HMDP) showed no significant differences between the different experimental groups and the control, revealing the non-occurrence of differences in the phosphocalcium metabolism. The histological study demonstrated that in mineral trioxide aggregate therapies, the presence of moderate inflammatory infiltration was found after three days, decreasing during follow-ups. The formation of mineralized tissue was only verified at 21 days of follow-up. The tricalcium silicate therapies demonstrated the presence of a slight inflammatory infiltration on the third day, increasing throughout the follow-up. The formation of mineralized tissue was observed in the seventh follow-up day, increasing over time. Conclusions: The mineral trioxide aggregate (WhiteProRoot®MTA) and tricalcium silicate (Biodentine™) present slight and reversible inflammatory signs in the pulp tissue, with the formation of mineralized tissue. However, the exacerbated induction of mineralized tissue formation with the tricalcium silicate biomaterial may lead to the formation of pulp calcifications

Experimental gel containing bioactive glass-ceramic to minimize the pulp damage caused by dental bleaching in rats

Abstract Objectives This study evaluated if the use of a bioactive glass-ceramic-based gel, named Biosilicate (BS), before, after or mixed with bleaching gel, could influence the inflammation of the dental pulp tissue of rats' molars undergoing dental bleaching with hydrogen peroxide (H2O2). Methodology The upper molars of Wistar rats (Rattus norvegicus, albinus) were divided into Ble: bleached (35% H2O2, 30-min); Ble-BS: bleached and followed by BS-based gel application (20 min); BS-Ble: BS-based gel application and then bleaching; BS/7d-Ble: BS-based gel applications for 7 days and then bleaching; Ble+BS: blend of H2O2 with BS-based gel (1:1, 30-min); and control: placebo gel. After 2 and 30 days (n=10), the rats were euthanized for histological evaluation. The Kruskal-Wallis and Dunn statistical tests were performed (P<0.05). Results At 2 days, the Ble and Ble-BS groups had significant alterations in the pulp tissue, with an area of necrosis. The groups with the application of BS-based gel before H2O2 had moderate inflammation and partial disorganization in the occlusal third of the coronary pulp and were significantly different from the Ble in the middle and cervical thirds (P<0.05). The most favorable results were observed in the Ble+BS, which was similar to the control in all thirds of the coronary pulp (P>0.05). At 30 days, the pulp tissue was organized and the bleached groups presented tertiary dentin deposition. The Ble group had the highest deposition of tertiary dentin, followed by the Ble-BS, and both were different from control (P<0.05). Conclusion A single BS-based gel application beforehand or BS-based gel blended with a bleaching gel minimize the pulp damage induced by dental bleaching.

Expression of calcitonin gene-related peptide and pulp sensitivity tests in irreversible pulpitis

Abstract The aim of the present study was to identify the relationship between the expression of calcitonin gene-related peptide (CGRP) and the responses of pulp sensitivity tests in healthy pulps and irreversible pulps by performing a cross-sectional study on patients. Two hundred subjects were evaluated. A total of 75 subjects complied with the criteria. The participants were divided into two groups: a) Healthy pulp (subjects [n = 35] having posterior teeth with clinically normal pulp tissue), and b) Irreversible pulpitis (subjects [n = 40] having posterior teeth with irreversible pulpitis). All participants were evaluated using the following variables: a) medical and dental history, b) pulp sensitivity tests, c) expression of CGRP by the enzyme-linked immunosorbent assay (ELISA), and d) expression levels of mRNA CGRP and mRNA CGRP receptor genes. We determined that the responses of the cold test between 4 and ≥12 s presented a higher average of the expression of CGRP in the group having irreversible pulpitis (p = 0.0001). When we compared the groups with the value of the electrical impulse, we found statistically significant differences (p = 0.0001), observing positive responses to the test with electrical impulses of 7 to 10, with an average of 72.15 ng/mL of CGRP in the irreversible pulpitis group. High values of CGRP expression were observed in that group in the responses of pulp sensitivity.

In-office tooth bleaching with 38% hydrogen peroxide promotes moderate/severe pulp inflammation and production of ll-1ß, TNF-ß, GPX, FGF-2 and osteocalcin in rats

Abstract Objectives: To study the intensity of inflammatory infiltrate and production of interleukin-1β (ll-1β), tumor necrosis factor-β (TNF-β), fibroblast growth factor-2 (FGF-2), glutathione peroxidase (GPX), and osteocalcin in response to in-office tooth bleaching in rats. Material and Methods: Twenty male Wistar rats were randomized into four groups (n=5) according to the received treatment (tooth bleaching or no treatment - control) and the period of euthanasia after treatment (24 h or 10 days). We performed tooth bleaching using a 38% hydrogen peroxide gel on maxillary and mandibular incisors. After euthanasia, incisors (20 per group) were processed for histological analysis, immunohistochemistry staining of ll-1β, TNF-β, FGF-2 and GPX and osteocalcin by immunofluorescence. We analyzed data using the Mann-Whitney and Kruskal-Wallis/Dunn tests (p<0.05). Results: The bleached groups presented statistically significant differences regarding the pulp inflammation stage compared with the control groups. Bleached teeth showed moderate/severe inflammatory infiltrate and control groups presented absent inflammatory cells or a negligible number of mononuclear cells (p<0.001) at two times (24 h and 10 days). There was strong staining for ll-1β, TNF-β, and GPX in bleached groups at 24 h and strong staining for ll-1β, TNF-β, GPX and FGF-2 at 10 days. After 10 days of tooth bleaching, the bleached group showed a statistically superior amount of osteocalcin than the other groups (p<0.01). Conclusions: Tooth bleaching with 38% hydrogen peroxide causes severe pulp inflammation, but characteristics of tissue repair after 10 days.

Frecuencia de patologías pulpares atendidas en una clínica docente de Ecuador / Frequency of pulpal pathologies attended in a teaching clinic

Objetivos: Determinar la frecuencia de patologías pulpares en pacientes de 18 a 45 años de edad que acudieron a la clínica de odontología de la Unidad Académica de Ciencia Odontológica de la Universidad Católica de Cuenca en el año lectivo 2013 ­ 2014. Material y métodos: Se realizó un estudio descriptivo transversal en 320 pacientes con un rango de edad entre 18 y 45 años mediante un formulario en el que se recogió nombre, edad, sexo, historia clínica, diente afectado y la patología pulpar presentada por el paciente. Resultados: La patología pulpar más frecuente fue pulpitis irreversible (62 %), seguido de necrosis (38%). Los pacientes de entre 26 a 30 y 40 a 45 años presentaron una frecuencia de pulpitis irreversible de 70 y 75 % respectivamente. Mientras que la frecuencia de necrosis no superó el 50 % de los casos en ningún grupo etario, siendo mayor en los grupos de 36 a 40 años y 18 a 25 años. Conclusiones: No existe diferencia significativa entre ambos sexos. (AU)

Objectives: To determinate pulpal pathologies frequency in patients from 18 to 45 years who were attended in dental clinic of Unidad Académica de Ciencia Odontológica de la Universidad Católica de Cuenca among 2013 ­ 2014 academic year. Material and methods: A cross-sectional descriptive study was performed in 320 patients between 18 and 45 years through a form in which name, age, sex, medical history, affected tooth and the pulp pathology presented by the patient were collected. RESULTS: irreversible pulpitis was the most frequent pulp pathology (62%), followed by necrosis (38%). Patients between 26-30 and 40-45 years had an irreversible pulpitis frequency of 70 and 75%, respectively. While the frequency of necrosis did not exceed 50% of the cases in any age group, being greater in the groups from 36 to 40 years and 18 to 25 years. Conclusions: There is no significant difference between the sex. (AU)

Inflammatory response of human dental pulp to at-home and in-office tooth bleaching

ABSTRACT Tooth bleaching is a technique of choice to obtain a harmonious smile, but bleaching agents may damage the dental pulp. Objective: This study evaluated the inflammatory responses of human dental pulp after the use of two bleaching techniques. Material and Methods: Pulp samples were collected from human third molars extracted for orthodontic reasons and divided into three groups: control - no tooth bleaching (CG) (n=7); at-home bleaching with 15% carbamide peroxide (AH) (n = 10), and in-office bleaching with 38% hydrogen peroxide (IO) (n=12). Pulps were removed and stained with hematoxylin-eosin for microscopic analysis of inflammation intensity, collagen degradation, and pulp tissue organization. Immunohistochemistry was used to detect mast cells (tryptase+), blood vessels (CD31+), and macrophages (CD68+). Chi-square, Kruskal-Wallis, and Mann Whitney tests were used for statistical analysis. The level of significance was set at p<.05. Results: The inflammation intensity and the number of macrophages were significantly greater in IO than in AH and CG (p<0.05). The results of CD31+ (blood vessels per mm2) were similar in CG (61.39±20.03), AH (52.29±27.62), and IO (57.43±8.69) groups (p>0.05). No mast cells were found in the pulp samples analyzed. Conclusion: In-office bleaching with 38% hydrogen peroxide resulted in more intense inflammation, higher macrophages migration, and greater pulp damage then at-home bleaching with 15% carbamide peroxide, however, these bleaching techniques did not induce migration of mast cells and increased the number of blood vessels.

Pulpa dentaria sana vs. pulpitis reversible: caracterización estereológica de fibroblastos / Healthy normal dental pulp vs. reversible pulpitis: stereological characterization of fibroblasts

La reacción y reparación de la dentina depende del número de células presentes en la pulpa, dentro de éstas fibroblastos. Los métodos diseñados para obtener una estimación fiable de la cantidad de elementos celulares de la pulpa han sido subjetivos y sesgados, sobre todo al evaluar los cambios cuantitativos y potencial capacidad reparadora en presencia de caries. El objetivo fue estimar y comparar cuantitativamente las densidades de número, volumen y superficie de fibroblastos en pulpas sanas y con diagnóstico de pulpitis reversible producto de caries en dientes humanos jóvenes. Se utilizaron dientes premolares humanos obtenidos de exodoncias, divididos en un grupo sano y cariado, los cuales fueron fijados y posteriormente descalcificados con ácido nítrico al 5 %. Siguiendo el protocolo del orientator se obtuvieron 5 secciones de 5 µm teñidas por H-E de cada diente. Se aplicó el recuento estereológico de los fibroblastos pulpares (FP) con el test multipropósito M42. Se estimaron las densidades de número (Nv), volumen (Vv) y superficie (Sv), y calcularon las Medias (±DE) por diente, y Medias (±EE) por grupo. Las diferencias entre grupos se analizaron mediante la prueba T, con un valor p 0,05 de significación estadística. En dientes sanos, la Media (±EE) para Nv de FP fue 0,393 x 105/mm3 (±0,020x105/mm3), para Vv 15,467 % (±1,334 %) y para Sv 16,330 mm2/mm3 (±1,274 mm2/mm3). En dientes cariados, la Nv fue 0,447 x 105/mm3 (±0,019x105/mm3), la Vv 20,171 % (±1,213 %) y la Sv 20,150 mm2/mm3 (±1,447 mm2/mm3). Al comparar las Nv, los FP del grupo con caries aumentaron significativamente (p= 0,047), al igual que la Vv (p= 0,0105) y Sv (p= 0,013). Existe un aumento del número de FP en los dientes con pulpitis reversible, lo que condicionaría su capacidad de respuesta. La metodología empleada puede ser aplicable para determinar el comportamiento pulpar y cuantificar variables de respuesta odontoblástica en tratamientos restauradores atraumáticos de manera imparcial y reproducible.

Dentine reaction and repair depends on the number of cells present in the pulp, within these fibroblasts. The methods designed to obtain a reliable estimate of the amount of cellular elements of the dental pulp have been subjective and biased, especially when evaluating quantitative changes and potential reparative capacity in the presence of caries. The aim of this study was to estimate and quantitatively compare with stereological tools, number, density, volume and surface of fibroblasts in healthy teeth and reversible pulpitis diagnosis due to caries. We obtained premolar teeth from human tooth extractions, divided into healthy and carious groups, which were fixed and decalcified with 5 % nitric. Following the orientator protocol we obtained 5 sections of 5 µm from each tooth which were stained by H-E. The stereological counting of pulp fibroblasts (FP) with M42 multipurpose test was applied. Number densities (Nv), volume (Vv) and surface (Sv) were estimated, and calculated the means (±SD) for a tooth, and Mean (±SE) per group. Differences between groups were analyzed by t-test, p 0.05 a statistically significant value. In healthy teeth, the mean (±SE) for Nv FP was 0.393x105/mm3 (±0.020x105/mm3), Vv 15.467 % (±1.334 %) and Sv 16.330 mm2/mm3 (±1.274 mm2/mm3). In decayed teeth, it was 0.447x105 Nv/mm3 (±0.019x105/mm3), the Vv 20.171 % (±1.213 %) and Sv 20.150 mm2/mm3 (± 1.447 mm2/mm3). Comparing Nv, the FP carious group increased significantly (p =0.047), as Vv (p =0.0105) and Sv (p =0.013). There is an increased number of FP teeth with reversible pulpitis, which would determine their responsiveness. The methodology can be applied to determine the pulp behavior and odontoblast quantify response variables in impartially and reproducible atraumatic restorative treatments.

Efecto de la inducción de enfermedad endodóntica sobre el sistema nervioso central (SNC): estudio en ratones / Effect of endodontic disease induction on the central nervous system (CNS): a study in mice

El objetivo de este estudio fue comprender el efecto de la infección periapical asociada a un modelo de estrés sobre los parámetros de evaluación del sistema nervioso central. Para este experimento se seleccionaron 20 ratones machos de la especie Rattus Novergicus en dos grupos, respectivamente, de estrés y apertura (GEA) y apertura (GA). Los procedimientos de inducción de la enfermedad endodóntica se realizaron por medio de una apertura coronaria del 1º molar inferior derecho. Después de la institución del modelo de estrés fue realizada la evaluación motora y psicológica de los animales por medio de pruebas de comportamiento del tipo laberinto elevado en forma de cruz y campo abierto. En relación a la evaluación en el campo abierto no existieron diferencias estadísticas (p>0,05) entre los grupos. Para la evaluación del laberinto en cruz, fueron observadas dos variables. En relación al tiempo de permanencia en el brazo cerrado el GA demostró un mayor tiempo de permanencia comparado al GEA (p<0,05). En relación al brazo abierto, el GEA tuvo un tiempo mayor de permanencia en la región en comparación al GA, inclusive con diferentes estadísticas (p<0,05). Dentro de las limitaciones del estudio, se puede notar que el estrés asociado a la inflamación de los tejidos periapicales llevaron a la modificación del comportamiento del animal.

The aim of this study was to understand the effect of periapical infection associated with a model of stress on the parameters of the central nervous system evaluation. For this experiment we selected 20 male rats divided into two groups: stress and opening group (SOG) and opening group (OG). In the first group, rats were tested for induction of stress associated with endodontic disease through coronary opening of the first lower right molar, the second group, the same procedure was carried out but without the stress partner. After 30 days of the imposition of the stress model was evaluated for motor and mental development of animals through field testing of high-maze behavior in a cross and open. Regarding the open-field assessment there was no statistically significant differences (p> 0.05) for the evaluation of the maze, there are two variables. In terms of time spent in closed arm OG showed a longer hospital stay compared to SOG (p <0.05). Regarding the open design industry, the SOG had a longer hospital stay in the region against the OG, including statistically significant differences (p <0.05). It was seen that the stress associated with inflammation of periapical tissues led to the modification of animal behavior.

Interleukin-1 beta and interleukin-8 in healthy and inflamed dental pulps

After aggression to the dental pulp, some cells produce cytokines in order to start and control the inflammatory process. Among these cytokines, interleukin-1 beta (IL-1β) and interleukin-8 (IL-8) emerge as important ones. OBJECTIVE: The purpose of this study was to analyze the location, distribution and concentration of these cytokines in healthy and inflamed dental pulps. MATERIAL AND METHODS: Twenty pulps, obtained from healthy third molars (n=10) and from pulpectomies (n=10) were used for the study, with half of each group used for immunohistochemistry and half for protein extraction and ELISA assays. Fibroblasts obtained from healthy dental pulps, stimulated or not by Escherichia coli lipopolysaccharide (LPS), in order to simulate aggression on the cell cultures, were also used and analyzed by ELISA for IL-1β and IL-8 as complementary information. Data obtained from immunohistochemistry were qualitatively analyzed. Data obtained from ELISA assays (tissue and cells) were statistically treated by the t-test (p<0.05). RESULTS: Immunohistochemically, it was observed that inflamed pulps were strongly stained for both cytokines in inflammatory cells, while healthy pulps were not immunolabeled. ELISA from tissues quantitatively confirmed the higher presence of both cytokines. Additionally, cultured pulp fibroblasts stimulated by LPS also produce more cytokines than the control cells. CONCLUSIONS: It may be concluded that inflamed pulps present higher amounts of IL-1β and IL-8 than healthy pulps and that pulp fibroblasts stimulated by bacterial LPS produce higher levels of IL-1β and IL-8 than the control group.

Análise do padrão de expressão de MMP-2, -9 e -8 em tecido humano pulpar normal e inflamado / Analysis of the expression perfile of MMP-2, -9 and -8 in normal and inflamed human pulp tissue

As metaloproteinases da matriz (MMPs) foram relacionadas a diversas doenças inflamatórias como artrite e também ao câncer. O presente trabalho tem por objetivo estabelecer o papel da MMP-2, MMP-9 e MMP-8 no processo de inflamação pulpar. Foram adotadas as seguintes hipóteses nulas: (1) o padrão de expressão das MMP-2, MMP-9 e MMP-8 não sofre alteração nos diferentes estágios da polpa humana: normal, reversível, transição, irreversível ou necrose; (2) não há diferença de expressão das MMP-2, -9 e MMP-8, considerando-se um mesmo estágio de inflamação tecidual pulpar. Os métodos utilizados foram: (I) Obtenção dos espécimes, que foram divididos em grupos de acordo com critérios adotados de semiologia subjetiva e objetiva. Obtiveram-se os seguintes grupos: GI (Controle) dentes hígidos (n=7); GII (Pulpite Reversível n=4); GIII (Pulpite Transição n=4); GIV (Pulpite Irreversível/Necrose n=8). Logo após exodontia, os dentes obtidos foram cortados ligeiramente abaixo da junção amelodentinária e fixados em formol a 10% por 48h. Foram lavados em água corrente (24h) para então serem processados histologicamente. Foram obtidas secções de 4m, aderidas em lâminas silanizadas e submetidas à imunomarcação (Técnica da Peroxidase), utilizando os anticorpos anti MMP-2, MMP-9 e MMP-8 humanos. A presença de imunomarcação foi realizada através da análise semi-quantitativa por escores, sendo que a quantificação de marcação por corte seguiu o seguinte escore: 0= ausente; 1= leve; 2= moderada; 3= intensa. Realizou-se teste estatístico não paramétrico Kruskal-Wallis, p<0,05. As comparações intergrupos revelaram, para CO: (1)MMP-2 - GI=GII=GIII, GIII=GIV, GI>GIV (p<0,01) e GII>GIV (p<0,05); (2)MMP-9 GI=GII=GIV, GII=GIII e GIII>GI (p<0,01); (3)MMP-8 GI=GII=GIII=GIV. Na região central da polpa, obteve-se: (1)MMP-2 GI=GII=GIII, GIII=GIV, GI>GIV (p<0,001) e GII>GIV (p<0,01); (2)MMP-9 GI=GII=GIII, GIII=GIV, GIV>GI (p<0,001) e GIV>GII (p<0,01); (3)MMP-8 GI=GII, GIII=GIV, GIII>GI (p<0,05),...

The matrix metalloproteinases (MMPs) have been related to various inflammatory diseases, such as arthritis, as well as to cancer. The aim of the present study was to establish the role of MMP-2, MMP-9 and MMP-8 in the process of dental pulp inflammation. The following null hypotheses were adopted: (1) the pattern of MMP-2, MMP-9 and MMP-8 expression does not undergo alteration in the following different stages of human pulp: normal, reversible, transition, irreversible or necrosis; (2) there is no difference in the expression of MMP-2, -9 and MMP-8, when considering the same stage of pulp tissue inflammation. The methods used were: (I) Obtainment of specimens, which were divided into groups according to the subjective and objective criteria of semiology adopted. The following groups were obtained: GI (Control) healthy teeth (n=7); GII (Reversible Pulpitis n=4); GIII (Transition Pulpitis n=4); GIV (Irreversible Pulpitis/Necrosis n=8). Soon after extraction the teeth obtained were cut slightly below the amelodentinal junction and fixed in 10% formol for 48h. They were washed under running water (24h) and were histologically processed afterwards. Sections of 4m were obtained, adhered to silanized slides, and submitted to immunomarking (Peroxidase Technique), using human anti MMP-2, MMP-9 and MMP- 8 antibodies. The presence of immunomarking was determined through semi-quantitative analysis by scores, and marking by cut was quantified using the following score: 0= absent; 1= slight; 2= moderate; 3= intense. The Kruskal-Wallis non-parametric statistical test was performed, p<0.05. Intergroup comparisons revealed the following: for CO: (1)MMP-2 - GI=GII=GIII, GIII=GIV, GI>GIV (p<0.01) and GII>GIV (p<0.05); (2)MMP-9 GI=GII=GIV, GII=GIII and GIII>GI (p<0,01); (3)MMP-8 GI=GII=GIII=GIV. In the central region of the pulp, the following results were obtained: (1)MMP-2 GI=GII=GIII, GIII=GIV, GI>GIV (p<0.001) and GII>GIV (p<0.01); (2)MMP-9 GI=GII=GIII, GIII=GIV, GIV>GI...

Distribuiçäo de bactérias planctônicas, colônias bacterianas e biofilmes microbianos em dentes decíduos com pulpite e ou necrose pulpar / Distribution of bacterial plankton, bacterial colonies and microbial biofilm on deciduous teeth with pulpitis and pulp necrosis

As bactérias constituem fatores primordiais da contaminaçäo da polpa dentária de dentes decíduos resultando em implicaçöes clínicas e terapêuticas. Com a finalidade de analisar a presença de bactérias planctônicas, colônias e biofilmes microbianos nas estruturas de dentes decíduos portadores de pulpite e necrose pulpar, utilizaram-se 32 dentes decíduos com cárie profunda. Dezesseis dentes foram seccionados no sentido longitudinal e o restante no sentido transversal. Os espécimes foram corados pela hematoxilina-eosina de Harris e Brown e Brenn para análise pela microscopia óptica. A partir da metodologia empregada pôde-se verificar que: 1) Em dentes decíduos com pulpite decorrente de cárie dentária, as bactérias podem ser encontradas nos túbulos dentinários e especialmente no interior do tecido pulpar na área inflamada. Colônias bacterianas e biofilmes microbianos säo visualisados na superfície cariosa e nos focos de liquefaçäo dentinária; 2) As bactérias plactônicas, colônias bacterianas e biofilmes microbianos estäo abundantemente presentes nas câmaras pulpares e canais radiculares de dentes decíduos com necrose pulpar, localizando-se nas superfícies do teto, do soalho da câmara pulpar, nas paredes laterais do canal radicular e, por extensäo, nas paredes externas apicais...

Estudio al microscopio electronico de la pulpitis / Study of electron microscopic of the pulpitis

La pulpa humana ha sido objeto de muchos estudios a microscopia óptica y bajo diferentes aspectos, histológicos, morfológicos, histoquímicos, etc. otros pocos estudios han sido llevados por los demás reconocidos autores, al microscopio electrónico. Los resultados de la microscopia de luz han determinado las diferentes capas que estructuran la pulpa. Inspirados en saber las posibles implicaciones de la pulpitis en la zona rica de células y las sintomatogía clínica denominada reversible e irreversible, evaluamos los diversos cambios ultraestructurales, a nivel citoplasmático y nuclear de acuerdo al grado de dolor presentado o provocado por el frío y calor. Los primeros cambios son evidenciados en el citoplasma con alteraciones en la mayoría de sus organelos y luego suceden en el núcleo manteniendo cierta polaridad donde posiblemente están implicados los cambios de presión del fluido pulpar durante los diferentes estudios del dolor. Se concluye que no se puede hablar de pulpitis reversible o irreversible, mejor decir tratables y no tratables, tratando de constituir cierto límite poco definido como es la sensibilidad al frío que debe ser clínicamente bien evaluado con los otros elementos del diagnóstico tradicional

Estudo histopatológico do envolvimento endo-periodontal em molares humanos / Histopathological study of endodontic-periodontal involvement in human molars

Os autores analisaram, valendo-se de quatorze pacientes, dos quais foram selecionados setenta e quatro molares com doença periodontal avançada, aspectos histopatológicos do envolvimento endo-periodontal. Os resultados foram obtidos examinando-se os tecidos gengivais, periodontais e pulpares de dentes antes e durante o tratamento periodontal, o que confirmou a tríade que caracteriza a síndrome do envolvimento endo-periodontal, a presença da bolsa periodontal, mobilidade dental e pulpopatias