Effect of EGCG-based paste as intracanal dressing, in MMPs 2 and 9 expression in dog's periapical lesions

Abstract High expression of MMP-2 and MMP-9 in periapical lesions plays an important role in the degradation of the extracellular matrix. This study aimed to investigate the effect of epigallocatechin-3-gallate (EGCG)-based endodontic paste as an intracanal dressing on the expression of MMP-2 and MMP-9 in periapical lesions. Periapical lesions were experimentally induced in 35 mature beagle dog premolars randomly divided into healthy teeth, untreated periapical lesions, periapical lesions treated in a single session (control groups), and periapical lesions treated in two sessions with EGCG or calcium hydroxide-based pastes (experimental groups). After 120 days, specimens were obtained for histopathologic and immunofluorescence analyses to assess the expression of MMP-2 and MMP-9. The statistical analysis was performed using a p-value of 0.05. Endodontic treatment in two sessions using medication with EGCG and calcium hydroxide-based pastes provided similar repair of the apical and periapical tissues and neoformation of periodontal ligament fibers, cementum, and alveolar bone (p>0.05). The experimental groups treated in two sessions with both medications presented expression of MMP-2 and MMP-9 similar to that in healthy teeth (p>0.05), and significantly lower than teeth treated in a single session or untreated periapical lesions (p <0.001). Expression of MMP-2 and MMP-9 was observed in the cytoplasm of fibroblasts, osteoblasts, cementoblasts, cementocytes, and vascular endothelium. The use of EGCG-based endodontic paste reduced the expression of MMP-2 and MMP-9 and allowed repair of periapical lesions, similar to calcium hydroxide-based paste, and superior to treatment performed in a single session.

Resumo A alta expressão de MMP-2 e MMP-9 em lesões periapicais desempenha um papel importante na degradação da matriz extracelular. Este estudo teve como objetivo investigar o efeito de uma pasta à base de epigalocatequina-3-galato (EGCG) como curativo intracanal na expressão de MMP-2 e MMP-9 em lesões periapicais. Lesões periapicais foram induzidas experimentalmente em 35 pré-molares de cães da raça beagle, maduros, divididos aleatoriamente em dentes saudáveis, lesões periapicais não tratadas, lesões periapicais tratadas em uma única sessão e lesões periapicais tratadas em duas sessões com a pasta de EGCG ou pasta à base de hidróxido de cálcio. O operador monitorou os animais e realizou a eutanásia após 120 dias para análises histopatológicas e de imunofluorescência para avaliar a expressão de MMP-2 e MMP-9. A análise estatística foi realizada utilizando p=0,05. O tratamento endodôntico em duas sessões com pasta à base de EGCG e pasta à base de hidróxido de cálcio proporcionou níveis semelhantes de reparação dos tecidos apicais e periapicais e neoformação de fibras do ligamento periodontal, cemento e osso alveolar. Em ambos os grupos, a expressão de MMP-2 e MMP-9 foi mínima, sendo observada no citoplasma de fibroblastos, osteoblastos, cementoblastos, cementócitos e endotélio vascular. Em ambos os grupos tratados em duas sessões, a expressão de MMP-2 e MMP-9 foi semelhante à dos dentes hígidos e significativamente menor do que nas lesões periapicais tratadas em sessão única ou não tratadas (p < 0,001). O uso da pasta à base de EGCG reduziu a expressão de MMP-2 e MMP-9 e permitiu o reparo de lesões periapicais, semelhante à pasta à base de hidróxido de cálcio, e foi superior ao tratamento realizado em sessão única.

Prevalence of apical periodontitis in people living with HIV in Southern Brazil / Prevalência de periodontite apical em pessoas vivendo com HIV no Sul do Brasil

Objective: This cross-sectional study aimed to describe the prevalence of apical periodontitis (AP) in people living with HIV (PLHIV) over 50 years old and explore its association with sociodemographic, medical, and oral characteristics. Methods: Data from 59 PLHIV were collected, and the periapical area of 1018 teeth was evaluated through periapical radiographs (Rx) using the periapical index (PAI). The presence and quality of root fillings and restorations (coronal fillings and crowns) were assessed with Rx, and caries presence was based on Rx and clinical data. Viral load (VL) and T CD4 counts were also analyzed. Results: AP prevailed in 71% of individuals and 8% of teeth. Family income of >5 Brazilian minimum wages (OR=0.06, 95% CI=0.005-0.62) and having at least one root-filled tooth (OR=14.55, 95% CI=1.45-145.72) were associated with AP prevalence, whereas VL and T CD4 were not. Caries, root filling, and restorations were associated with AP occurrence. Conclusion: PLHIV presented a high AP prevalence, but intrinsic factors related to HIV infection were not associated with AP in the studied subjects. PLHIV would benefit from oral health policies to prevent AP, as the results indicate that the endodontic disease in the present sub-population might be related to social problems.(AU)

Objetivo: este estudo transversal teve como objetivo descrever a prevalência de periodontite apical (PA) em pessoas vivendo com HIV (PVHIV) acima de 50 anos de idade, e explorar sua associação com características sociodemográficas, médicas e bucais. Métodos: os dados de 59 PVHIV foram coletados e a região periapical de 1018 dentes foi avaliada através de radiografias periapicais (Rx) usando o Índice Periapical (PAI). A presença e qualidade das obturações radiculares e restaurações (restaurações diretas e coroas) também foram avaliadas no Rx; a presença de cárie foi baseada em dados clínicos e radiográficos. Carga Viral (CV) e contagem de linfócitos T CD4 também foram avaliados. Resultados: a prevalência de PA nos indivíduos foi de 71%, e 8% dos dentes apresentaram PA. Renda familiar >5 salários mínimos (OR=0.06, 95% CI=0.005-0.62) e ter pelo menos um dente com obturação endodôntica (OR=14.55, 95% CI=1.45-145.72) foram associados com a prevalência de PA, enquanto que CV e T-CD4 não foram. A presença de cárie, obturação endodôntica e restaurações foram associadas com a presença de PA no dente. Conclusão: PVHIV apresentaram uma alta prevalência de PA, mas fatores intrínsecos relacionados à infecção pelo HIV não foram associados com PA nos sujeitos avaliados. PVHIV se beneficiariam de políticas públicas de saúde para prevenir a PA, uma vez que os resultados indicam que a doença endodôntica na presente subpopulação pode ser relacionada a problemas sociais.(AU)

Diagnóstico clínico, radiográfico e histológico de un caso de fibrosis periapical posendodóntica / Clinical, radiographic, and histologic diagnosis of a postendodontic periapical fibrosis case

Objetivo: La fibrosis periapical posendodóntica es un proceso reparativo asintomático, radiolúcido y no progresivo que se interpreta con frecuencia como una lesión patológica persistente. El diagnóstico de esta entidad suele ser dudoso y sólo puede definirse mediante la correlación de las obser- vaciones clínicas, radiográficas e histológicas. El objetivo de este informe es describir el caso de un paciente que presenta un área radiolúcida periapical persistente y asintomática en un incisivo lateral superior. Caso clínico: Luego de cuatro años y dos meses de ha- ber recibido un tratamiento endodóntico el paciente concurre a la consulta para un examen de rutina. El examen radiográfico del diente revela un área radiolúcida persistente y bien defini- da. A causa de una fractura radicular irreparable, se indicó la extracción de la pieza dentaria. Esto permitió realizar el estu- dio histológico del tejido blando que permanecía adherido en el ápice de la raíz, lo que confirmó y completó el diagnóstico de fibrosis periapical posendodóntica.(AU)

Aim: The postendodontic periapical fibrosis is an asymp- tomatic radiolucent and non-progressive healing process that is often interpreted as a persistent pathological lesion. The diagnosis of this entity is usually uncertain, and it is only de- fined by the correlation of clinical, radiographic and histo- logical observations.The aim of this report is to describe the case of a patient with a long-term persisting asymptomatic and radiolucent area in a upper lateral incisor. Clinical case: Four years and two months after receiv- ing an endodontic treatment the patient comes to our office for a routine control. Radiographic examination revealed the presence of a persistent well defined radiolucent area. Sur- gical tooth extraction was required due to the presence of a complicated root fracture.This allowed to perform a histolog- ical study of the soft tissue attached to the apex of the ex- tracted root, which confirmed and completed the diagnosis of postendodontic periapical fibrosis (AU)

Early Dental Implant Failure in Patient with Active Implant Periapical Lesions: Lesson Learnt from Two Case Reports

ABSTRACT@#Implant periapical lesion (IPL) is also known as retrograde peri-implantitis and as the name suggests, it involves inflammation surrounding the apical part of the dental implants. Previously, many studies have reported the event of IPL that further delays osseointegration, and some reported failure of implant placement due to this disease. In this article, we described two cases of early dental implant failure that was associated with active IPL and correlated the clinical and radiographical findings with the histopathological findings.

Protocolo estandarizado para la observación de la imagen tomográfica en endodoncia / Standardized protocol of observation of the tomographic image in endodontics

Objetivo: establecer un protocolo estandarizado de observación de la tomografía computarizada de haz cónico (CBCT) en endodoncia, para determinar de manera sistemática las dimensiones de las lesiones apicales crónicas. Métodos: análisis y aplicación de las herramientas de los software tomográficos de haz cónico usados para la exploración de tejidos dentales y periapicales, con previa revisión bibliográfica del tema. Posteriormente, se diseñaron los pasos sistemáticos estandarizados de observación y medición de la imagen tomográfica dental en endodoncia, con lo cual se estableció el protocolo. Finalmente, se entrenaron dos endodoncistas en la aplicación del protocolo para medir sistemáticamente las dimensiones de lesiones apicales crónicas (altura, profundidad y ancho) Resultados: se generó un documento con material gráfico sobre los pasos a seguir del protocolo estandarizado y se realizó una prueba estadística de concordancia, que evidenció un alto grado de coincidencia entre las mediciones hechas por las endodoncistas entrenadas (observadoras 2 y 3) frente a las de una radióloga experta (observadora 1). El mayor grado de acuerdo se encontró entre las observadoras 1 y 2 en la vista sagital al evaluar la altura de la lesión (ICC: 0.9997545), mientras que, las observadoras 1 y 3 lograron el mayor grado de acuerdo en la vista axial (ICC 0.9996737, IC 95%) al evaluar la profundidad de la lesión. Conclusión: la aplicación de este protocolo sencillo, sistemático y estandarizado de observación de tomografía dental permite evaluar de manera confiable, reproducible y precisa la imagen de la periodontitis apical y, a su vez, alcanzar un alto grado de concordancia cuando se miden lesiones apicales.

Objective: Establish a standardized protocol for the observation of Cone Beam Computed Tomography (CBCT) in endodontics, to systematically determine the dimensions of chronic apical lesions. Methods: Analysis and application of the tools of the specific Cone Beam Computed Tomography software for the exploration of dental and periapical tissues, prior literature review of the subject. Subsequently, the design of standardized systematic steps of observation and measurement of the dental tomographic image in Endodontics, thus establishing the Protocol. Finally, training of 2 Endodontists in the application of the Protocol by an expert Radiologist, measuring the dimensions of chronic apical lesions (height, depth and width) in 45 high-resolution conical beam dental tomographs and checking its usefulness, through a concordance test using the Intraclass Correlation Index (ICC). Results: A written document was generated with explanatory graphic material on the steps to follow by the Standardized Protocol and a statistical concordance test was carried out that evidenced a high degree of agreement between the measurements of the trained endodontists (observers 2 and 3) against the expert radiologist (observer 1). The highest degree of agreement was found among observers 1 and 2 in the sagittal view when assessing the height of the lesion (ICC: 0.9997545), while observers 1 and 3 achieved the highest degree of agreement in axial vision (ICC 0.9996737, 95% CI) when assessing the depth of the lesion. Conclusion: The application of this simple, systematic and standardized protocol for the observation of dental tomography in clinical practice makes it possible to reliably, reproducibly and accurately assess the image of apical periodontitis, prior observer training, allowing a high degree of concordance to be achieved when apical lesions are measured.

Negative pressure irrigation presents mineralizing potential in dogs' immature teeth with periapical lesion

Abstract The objective of this in vivo study was to assess the effect of the root canal irrigation by negative and positive apical pressure on the expression of molecules that are an indicative of cell differentiation with mineralizing phenotype in teeth of dogs with incomplete rhizogenesis and induced periapical lesion. A total of 30 teeth (60 roots) were distributed into 3 groups (n=20): EndoVac®, Conventional and Control. After 90 days, the routine histotechnical procedures were performed and the sections were submitted to immunohistochemical technique for the staining of osteopontin (OPN), alkaline phosphatase (ALP) and the RUNX2 transcription factor in the apical and periapical regions of the roots. A semi-quantitative analysis of the positive immunostaining was performed and the intensity of the expression was classified in absent (0), mild (1), moderate (2), or intense (3). Scores data were statistically analyzed by the Kruskal-Wallis non-parametric test and Dunn post-test, and the significance level was set at 5%. RUNX2 immunostaining revealed that in the negative pressure group there was a significantly stronger (p<0.05) immunostaining in comparison to the control group. Regarding the OPN expression, it was not possible to detect a statistically significant difference between the groups (p>0.05). After analyzing ALP immunostaining, a statistically significant difference was observed between the groups (p<0.05), and the negative pressure group showed a markedly stronger mark immunostaining than the control group. The results of the present in vivo study allowed concluding that negative apical pressure irrigation presents mineralizing potential in immature teeth with apical periodontitis.

Resumo O objetivo do presente estudo in vivo foi avaliar o efeito da irrigação do canal radicular por pressão apical negativa e por pressão positiva na expressão de moléculas que são indicativas de diferenciação celular com fenótipo mineralizador em dentes de cães com rizogênese incompleta e lesão periapical. Um total de 30 dentes (60 raízes) foi distribuído em 3 grupos (n=20): EndoVac, Convencional e Controle. Após 30 dias, foram realizados os procedimentos histotécnicos de rotina e os cortes foram submetidos à técnica de imunohistoquímica para marcação de Osteopontina (OPN), Fosfatase Alcalina (ALP) e para o fator de transcrição RUNX2 nas regiões apical e periapical das raízes. Foi realizada uma análise semi-quantitativa da imunomarcação positiva e a intensidade da expressão foi classificada em ausente (0), leve (1), moderada (2) ou intensa (3). Os dados por escores foram analisados estatisticamente pelo teste não-paramétrico de Kruskal-Wallis e pelo pós-teste de Dunn, e o nível de significância adotado foi de 5%. A imunumarcação para RUNX2 revelou que no grupo pessão negativa houve marcação significativamente mais intensa (p<0,05), em comparação ao grupo controle. Com relação à expressão de OPN, não foi possível observer diferença estatisticamente significante entre os grupos (p>0,05). Após análise da imunomarcação para ALP, foi observado diferença estatisticamente significante entre os grupos (p<0,05), e o grupo pressão negativa demonstrou uma marcação siginificativamente mais intensa do que o grupo controle. Os resultados do presente estudo in vivo permitiram concluir que a irrigação por pressão apical negativa apresenta potencial mineralizador em dentes com ápice aberto e lesão periapical.

Oral metastasis intraosseous mimicking periapical lesion: a case report / Metástase oral intraóssea mimetizando lesão periapical: um relato de caso

ABSTRACT Jaw metastasis can be mistaken for inflammatory or infectious diseases. Then, they should be considered in the differential diagnosis of unknown jaw lesions. Study reported here involved metastasis of breast cancer in the mandible of a 45-year-old woman. The most important differential diagnostic was a reactive lesion in an unusual periapical location associated with a nonvital tooth. However, given patient's medical history and because paresthesia and pain were observed a few days after pulpectomy, metastasis of breast cancer could not be ruled out. When bone scintigraphy suggested the metastasis of a malignant bone tumor, incisional biopsy was performed. Histopathologic examination and immunohistochemical reaction confirmed the diagnosis of metastasis of breastcancer, and chemotherapy was thus performed as well. Unfortunately, patient died 2 years after diagnosis. Dentists as well as general physicians should therefore consider presence of oral metastasis in cases involving atypical symptoms, especially in patients with known malignant disease.

RESUMO As metástases mandibulares podem ser confundidas com doenças inflamatórias ou infecciosas. Sendo assim, elas devem ser consideradas no diagnóstico diferencial de lesões desconhecidas na mandíbula. Esse relato de caso envolveu metástase de câncer de mama na mandíbula de uma mulher de 45 anos. O diagnóstico diferencial mais importante foi uma lesão reacional, em uma localização periapical incomum, associada a um dente não vital. No entanto, dado o histórico médico da paciente e uma vez que parestesia e dor foram observadas alguns dias após a realização da pulpectomia, a metástase de câncer de mama não foi descartada. Quando a cintilografia óssea sugeriu a metástase de um tumor ósseo maligno, uma biópsia incisional foi realizada. O exame histopatológico e a reação imunohistoquímica confirmaram o diagnóstico de metástase do câncer de mama, e a quimioterapia foi então realizada. Infelizmente, a paciente morreu 2 anos após o diagnóstico. Portanto, dentistas e médicos generalistas devem considerar a presença demetástases oral em casos que envolvam sintomas atípicos, principalmente em pacientes com doença maligna conhecida.

Retrospective Assessment of Apicectomy Performed in a Known Population: An Institutional Based Study

Background: Apical surgery or Apicectomy is often a lastresort to surgically maintain a tooth with a periapical lesion thatcannot be managed with conventional endodontic treatment.The present study was conducted to assess retrospectivelycases of apicectomy performed in a known population.Materials and Methods: This retrospective study wasconducted to assess the patients treated with apicectomy overthe time of 6 months. Preoperative periapical radiograph wastaken using a parallel technique. Local anesthesia wasadministered and followed by flap elevation.Surgical curette was used to enucleate the pathologic tissueand identify the root apex with/without prior osteotomy. Theapical 3 mm of the root was resected perpendicularly to thelong axis of the tooth with no or minimal bevel. Flaps wererepositioned and sutured. Periapical radiograph was takenafter surgery using the parallel technique. Antibioticsand analgesics medication were prescribed. Follow-upappointments were arranged. The data was included whichcomprises of demographic data, preoperative clinicalexamination type. Statistical analysis was performed using theSPSS software version 21.0 (SPSS Inc., Chicago, IL, USA).Results: In this retrospective study total 87 cases ofapicectomy was recorded over the period of 6 months in which23(26.43%) were male while remaining 64(73.56%) werefemales. Apicectomy cases were prevalent in age group 31-40years (36.78%). Apicectomy cases were prevalent in maxillarytooth(73.56%).Conclusion: Our study concluded that apicectomy cases wereprevalent in females, in age group of 31-40 years and inposterior tooth.

A periodontite apical como fator de risco às manifestações sistêmicas: uma perspectiva histórica atualizada / Apical periodontitisas a risk factor to systemic manifestations: a updated historical perspective

Objetivo: O objetivo deste trabalho foi revisar a literatura científica pertinente, dando enfoque ao tratamento endodôntico e dentes portadores de necrose pulpar associados à periodontite apical como fator de risco às manifestações sistêmicas, desde a teoria da infecção focal até os dias atuais. Metodologia: Empregou-se fontes de catalogação bibliográfica identificadas eletronicamente pelo MEDLINE, até setembro de 2018. Os artigos relacionados pela busca eletrônica foram selecionados, por três revisores independentes, avaliando os critérios de inclusão e exclusão. Resultados: A busca apresentou 107 artigos, sendo que destes, 17 estudos satisfizeram os critérios de inclusão, o que possibilitou a análise dos dados. Conclusão: Muitos dos preceitos da teoria da infecção focal estão sendo reerguidos por pesquisas que mostram cada vez mais a existência de associações entre patologias endodônticas e sistêmicas.

Objective: The aim of this work was to review the pertinent scientific literature, focusing on endodontic treatment and teeth with pulp necrosis associated with apical periodontitis as a risk factor for systemic manifestations, from the focal infection theory to the present day. Methodology: The sources of bibliographic cataloging electronically identified by MEDLINE were used until September 2018. Articles related to the electronic search were selected by three independent reviewers, evaluating the inclusion and exclusion criteria. Results: The search presented 107 articles, of which, 17 studies met the inclusion criteria, which made it possible to analyze the data. Conclusion: Many of the precepts of the focal infection theory are being reinstated by research that increasingly shows the existence of associations between endodontic and systemic pathologies.

Análise epidemiológica e imunológica em indígenas das etnias Sateré Mawé e Tikuna portadores de infecções endodônticas / Epidemiological and immunological analysis in indigenous people of the Sateré Mawé and Tikuna ethnic groups with endodontic infections

Os povos indígenas compõem 305 etnias, distribuídas por todas as unidades federativas do Brasil. Esta diversidade cultural consiste em uma das maiores riquezas do país, mas, ao mesmo tempo, é também um grande desafio para a elaboração e implementação de políticas públicas específicas e diferenciadas. O objetivo deste estudo foi analisar o perfil epidemiológico de saúde bucal e a necessidade de tratamento endodôntico de indígenas das etnias SATERÉ MAWÉ, que vivem em Barreirinha-AM, e TIKUNA, residentes na zona urbana de MANAUS-AM. Após determinar a necessidade de tratamento endodôntico, este estudo comparou as respostas perirradiculares de infecções endodônticas entre membros de uma civilização ocidental, residentes em Belo Horizonte MG, e indígenas não miscigenados da etnia TIKUNA. Para a análise epidemiológica participaram do estudo 138 indivíduos, sendo 98 pertencentes à etnia TIKUNA e 40 SATERÉ-MAWE; distribuídos nos grupos etários de 7 a 50 anos ou mais. Para a analise imunológica das alterações perirradiculares das populações selecionas, coletaram-se as amostras clínicas em dentes portadores de necrose pulpar. Os indígenas da etnia Tikuna foram atendidos na Clínica de Endodontia da UNIP (Universidade Paulista), campus Manaus. Os membros da população ocidental foram atendidos nas clínicas da Faculdade de Odontologia da UFMG. As amostras foram coletadas imediatamente após a instrumentação do SCR, introduzindo-se cones absorventes nos SCR, 1 mm além do ápice radicular. Subsequentemente, as amostras foram transferidas para um tubo estéril, e mantidas na temperatura de - 70 º C até a sua análise. Utilizando-se o PCR em tempo real, avaliou-se a expressão das citocinas e quimiocinas TNF-, IL-1-, IL-9, INF-, IL-17, IL-10, CXCR-4, CCL-2/MCP-1 e CCR-6. Os resultados demonstram que, em relação à etnia SATERÉ-MAWÉ, na faixa etária de 7 a 12 anos, o CPO-d apresentou valor médio de 3.17. Comparando-se o índice CPO-d e a necessidade de tratamento endodôntico em cada uma das etnias, verificou-se que estas variáveis estão correlacionadas, uma vez que, à medida que o CPO-d aumentou, verificou-se um aumento na necessidade de tratamento endodôntico. Os molares prevaleceram dentre os os dentes mais acometidos por cárie e com necessidade de tratamento endodôntico. Quanto à análise imunológica, observou-se um aumento significativo na expressão gênica de TNF, CCL-2/MCP-1, CXCR4, e CCR6, após os procedimentos de limpeza e formatação dos SCR apenas na população ocidental. Os níveis de INF- aumentaram na 2a coleta na população indigena, enquanto, em ambas as populações, houve um aumento significativo na expressão de IL-10 e IL-17 após os procedimentos de limpeza e formataçao. Não observaram-se diferenças significativas entre as expressões de IL-1 , IL-9, e CCL4, entre a 1ª e 2ª coleta, em ambas as populações. Conclui-se que as populações indígenas encontram-se desasistidas, visto que o CPO-d de ambas as etnias se encontram acima dos padrões recomendados pela OMS, principalmente na faixa etária de 07 a 12anos. Ademais, o nível de escolaridade ainda é muito baixo nas populações indígenas analisadas, mesmo na comunidade Tikuna, situada na zona urbana de Manaus/AM. Finalmente, observaram-se padrões imunes distintos quando se comparou as respostas das comunidades ocidentais e Tikuna, sugerindo que os determinantes genéticos e ambientais devem ser mais bem avaliados no futuro.

The indigenous peoples comprise 305 ethnic groups, distributed by all the federative units of Brazil. This cultural diversity is one of the most significant assets of the country, but at the same time, it is also a great challenge for the elaboration and implementation of specific and differentiated public policies. The objective of this study was to analyse the epidemiological profile of oral health and the need for endodontic treatment of SATERÉ MAWÉ indigenous people living in Barreirinha-AM, and TIKUNA, living in the urban area of MANAUS-AM. After determining the need for endodontic treatment, this study compared the perirradicular responses of endodontic infections among members of western civilisation, living in Belo Horizonte - MG, and no - mixed indigenous TIKUNA. For the epidemiological analysis, the study consisted of 138 individuals, of whom 98 were TIKUNA ethnicity, and 40 were SATERÉ-MAWE ethnics; aged between 7 and 50 years or more. For the immunological analysis of the perirradicular alterations of the selected populations, the clinical samples were collected in teeth with pulp necrosis. The Tikuna Indians were treated at the Endodontics Clinic of UNIP (Universidade Paulista), Manaus campus. The members of the western population were attended in the clinics of the Faculty of Dentistry of UFMG. Samples were collected immediately after SCR instrumentation, introducing absorbent cones in the SCR, 1 mm beyond the root apex. Subsequently, the samples were transferred to a sterile tube and maintained at -70 ° C until analysed. Using the real-time PCR, the expression of cytokines and chemokines TNF-, IL-1-, IL-9, INF-, IL-17, IL-10, CXCR- 2 / MCP-1 and CCR-6. The results show that, concerning the ethnicity SATERÉ-MAWÉ, in the age group of 7 to 12 years, the CPO-d presented a mean value of 3.17. Comparing the CPO-d index and the need for endodontic treatment in each of the ethnicities, these variables were correlated, since, as CPO-d increased, there was an increase in the demand for endodontic treatment. The molars prevailed among the teeth most affected by caries and in need of endodontic treatment. As for the immunological analysis, a significant increase in the gene expression of TNF, CCL-2 / MCP-1, CXCR4, and CCR6 was observed after the SCR cleaning and formatting procedures only in the western population. INF- levels increased in the second collection in the Indian community, while in both people, there was a significant increase in the expression of IL-10 and IL-17 after the cleaning and shaping procedures. There were no significant differences between IL-1, IL-9, and CCL4, between the 1st and 2nd collection, in both populations. It is concluded that the indigenous people are disassociated, since the CPO-d of both ethnic groups is above the standards recommended by the WHO, especially in the age group from 07 to 12 years. Besides, the educational level is still shallow in the indigenous populations analysed, even in the Tikuna community, located in the urban area of Manaus / AM. Finally, distinct immune patterns were observed when comparing Western societies and Tikuna responses, suggesting that genetic and environmental determinants should be better evaluated in the future. Keywords: endodontic treatment, epidemiology, indigenous, cytokines, chemokines, periapical lesion.

Non-surgical Management Of A Large Periapical Lesion: A Case Report

Aim - To report the non-surgical management of a large periapical lesion. This paper presents the successful management of periapical lesion with successful resolution of signs and symptoms both clinically and radiographically. With dawn of era of minimal intervention in dentistry, surgical management of periapical lesions become controversial. Nonsurgical or conservative management of periapical lesions not only cause less trauma to the tissues, but also promote faster and less eventful healing. This article highlights the healing potential of non surgical endodontic treatment in the management of large periapical lesions.

Correlación en el diagnóstico clínico, radiográfico e histológico de lesiones apicales dentales / Correlation of clinical, radiographic and histological diagnoses of apical dental lesions

Objetivo: Establecer la correlación entre las características clínicas, radiográficas e histológicas de lesiones apicales dentales al momento de su diagnóstico. Material y métodos: Estudio descriptivo en el que se realizó la comparación de las características clínico-radiográficas con el estudio histopatológico de las lesiones. Se incluyeron muestras de individuos que fueron diagnosticados con procesos de patología periapical, obtenidas a través de apicectomías y extracciones dentales. Los cortes fueron procesados rutinariamente y evaluados por patólogo para su diagnóstico histológico. Resultados: El 50% de las muestras fue diagnosticado como periodontitis apical, seguido por quistes periapicales (28.5%). Al correlacionar entre sí características clínicas como sensibilidad a la percusión y dolor espontáneo hubo asociación (p = 0.01). Igualmente, al relacionar la pérdida ósea vertical con movilidad dental (p = 0.023) y ésta con el órgano dentario afectado (p = 0.036). Sin embargo, no mostró asociación, la correlación entre el estado sintomático del paciente como dolor espontáneo y el tipo de infiltrado inflamatorio predominante en las lesiones (p = 1.4); pero sí la hubo, con el tipo de infiltrado secundario que existía en ellas (p = 0.057). La movilidad dental se mostró como un marcador diagnóstico para granuloma y quiste periapical (p = 0.025). Conclusiones: Se hallaron ciertos marcadores clínicos capaces de predecir la presentación histológica de las lesiones, como la movilidad dental para granuloma y quiste periapical. Sin embargo, la predicción exacta de cada una de las patologías aún se hace difícil, debido a la misma dinámica de las lesiones y a la poca correlación que existe entre las características clínico-radiográficas con la descripción histológica de las lesiones.

Objective: To establish a correlation amongst clinical, radiographic and histological characteristics of dental apical lesions at the time of diagnosis. Material and methods: A descriptive study which undertook to establish comparison of clinical and radiographic characteristics with histopathological study of lesions. Included in the study were samples of individuals which had been previously diagnosed with periapical disease processes; samples were harvested from apicoectomies and dental extractions. In order to achieve histological diagnosis, a pathologist routinely processed and assessed all specimens. Results: 50% of all samples were diagnosed as apical periodontitis, followed by periapical cysts (28.5%). An association of (p = 0.01) was found when correlating clinical characteristics such as sensitivity to percussion and spontaneous pain. The same situation arose when relating vertical bone loss to dental mobility (p = 0.023), and dental mobility with affected tooth (p = 0.036), nevertheless, no association was found with correlation of patient's symptomatic status, such as spontaneous pain, and type of predominant inflammatory infiltrate in the lesions (p = 1.4), nevertheless, association was found with the secondary infiltrate type existing in them (p = 0.057). Dental mobility was taken as diagnostic marker for granuloma and periapical cyst (p = 0.025). Conclusions: Certain clinical markers were found with the ability to predict histological manifestation of the lesions, such as dental mobility for granuloma and periapical cyst cases. Nevertheless, exact prediction of each one of the diseases is still dificult to obtain, this is due to the lesion's dynamics and the scarce correlation existing among clinical and radiographic characteristics with the histological description of the lesions.

Murine Experimental Root Canal Infection: Cytokine Expression in Response to F. nucleatum and E. faecalis

Abstract The aim of this study was to evaluate the gene expression of proinflammatory (RANKL, TNF-a and IFN-g) and regulatory (TGF-b and IL-10) cytokines as reaction to experimental infection by mono or bi-association of Fusobacterium nucleatum (ATCC 10953) and Enterococcus faecalis (ATCC 19433). F. nucleatum and E. faecalis, either in mono- or bi-association were inoculated into the root canal system (RCS) of Balb/c mice. Animals were sacrificed at 10 and 20 days after infection and periapical tissues surrounding the root were collected. The mRNA expression of the cytokines RANKL, TNF-a, IFN- g, TGF-b and IL-10 was assessed using real-time PCR. The Kruskal-Wallis test was used for statistical analysis. F. nucleatum mono-infection induced high expression of RANKL and TNF-a, while its modulation was due to IL-10. High expression of IFN-g at day 20 was up-regulated by E. faecalis and RANKL; TNF-a was up-regulated by an independent mechanism via IL-10 and TGF-b. Bi-association (F. nucleatum and E. faecalis) stimulated high expression of RANKL, TNF-a and IFN-g, which seemed to be modulated by TGF-b 20 days later. The gene expression of proinflammatory cytokines was more prominent in the earlier periods of the experimental periapical infection, which concomitantly decreased in the later period. This expression may be regulated by IL-10 and TGF-b in an infection-specific condition

Resumo O objetivo deste trabalho foi avaliar a expressão gênica de citocinas pró-inflamatórias (RANKL, TNF-a e IFN-g) e regulatórias (TGF-b e IL-10) em resposta à infecção experimental por Fusobacterium nucleatum (ATCC 10953) e Enterococcus faecalis (ATCC 19433) como mono-infecção ou em bi-associação. F. nucleatum e E. faecalis foram inoculados no sistema de canais radiculares de camundongos Balb/c, tanto isoladas como em bi-associação. Os animais foram sacrificados em 10 e 20 dias após a infecção, e os tecidos periapicais foram coletados. As expressões do mRNA das citocinas RANKL, TNF-a, IFN-g, TGF-b e IL-10 foram analisadas por meio do real-time PCR. O teste de Kruskal-Wallis foi utilizado para análise estatística. A mono-infecção com F. nucleatum induziu alta expressão de RANKL e TNF-a, enquanto sua modulação ocorreu devido à IL-10. A alta expressão de IFN-g no dia 20 foi regulada positivamente por E. faecalis e RANKL; TNF-a foi regulada positivamente por um mecanismo independente via IL-10 e TGF-b. A bi-associação (F. nucleatum e E. faecalis) estimulou uma alta expressão de RANKL, TNF-a e IFN-g, que parece ser modulada por TGF-b após 20 dias. A expressão gênica de citocinas pró-inflamatórias foi mais proeminente nos estágios iniciais da infecção periapical experimental, com concomitante redução no período tardio. Este fenômeno pode ser regulado por IL-10 e TGF-b em uma condição de infecção específica.

Study of Anatomical Relationship between Posterior Teeth and Maxillary Sinus Floor in a Subpopulation of the Brazilian Central Region Using Cone-Beam Computed Tomography - Part 2

Abstract This study evaluated the anatomical relationship between posterior teeth root apices and maxillary sinus floor (MSF) on 202 cone beam computed tomography (CBCT) exams. The distance between the root apices and the MSF, as well as the MSF thickness of the cortical bone closest to root apices and furcation regions were measured. The vertical and horizontal relationships of the MSF with the molar roots were classified into categories adapted from the criteria proposed by Kwak et al. (14). The shortest distances between MSF and the root apices were observed in the mesiobuccal root of the second molar (0.36±1.17 mm) and the palatal root of the first molar (0.45±1.10 mm) and the widest in buccal roots of the first premolars (5.47±4.43 mm). Significant differences were observed between the distance of MSF to the root apices of single-rooted first and second premolars. The cortical thickness ranged from 0.65±0.41 mm over the mesiobuccal root of the second molar to 1.28±0.42 mm over the buccal root of the first premolar. The most observed vertical and horizontal relationships were type II and 2H, respectively. The maxillary molar roots showed greater proximity to the MSF. The thickness of the MSF cortical bone closest to the apices and furcation regions was found to be similar only for premolars.

Resumo Avaliou-se a relação anatômica entre dentes posteriores e o soalho do seio maxilar (SSM) por meio da tomografia computadorizada de feixe cônico (TCFC) em 202 exames. A distância entre os ápices radiculares e o SSM, bem como a espessura do osso cortical do SSM próximo dos ápices radiculares e áreas de bifurcação foram medidas. As relações verticais e horizontais do SSM com as raízes dos molares foram classificados em categorias adaptadas a partir dos critérios propostos pelo Kwak et al. (14). A menor distância entre o SSM e os ápices dentários foi observada na raiz mesiovestibular do segundo molar (0,36±1,17 mm) e na raiz palatina do primeiro molar (0,45±1,10 mm), e a maior na raiz vestibular do primeiro pré-molar (5,47±4.43 mm). Diferenças significantes foram observadas entre a distância do SSM e os ápices dentários de primeiros e segundos pré-molares unirradiculares. A espessura da cortical óssea variou de 0,65±0,41 mm na região da raiz mesiovestibular do segundo molar a 1,28±0,42 na raiz vestibular do primeiro pré-molar. As relações vertical e horizontal mais prevalentes foram do tipo II e 2H, respectivamente. As raízes dos molares superiores apresentaram maior proximidade com o SSM. A espessura da cortical óssea do SSM nas regiões mais próximas dos ápices e área de furca foi similar apenas para os pré-molares.

Diagnóstico diferencial de imagem sugestiva de lesão periapical / Diagnóstico diferencial de imagen sugestiva de lesión periapical / Differential diagnosis of periapical lesion suggestive image

Introdução: o conhecimento da anatomia radiográfica na área odontológica é muito importante para ajudar a estabelecer um diagnóstico correto, na diferenciação entre lesões ósseas e estruturas anatômicas. Objetivo: apresentar uma situação que demonstra confusão no diagnóstico entre o forame mental e lesões periapicais. Dados principais do caso: paciente que se queixava de dente escurecido, assintomático dois anos após um tratamento endodôntico. Na radiografia foi observada radioluscência no ápice do primeiro dente bicúspide inferior esquerdo, o que levou à suspeita de lesão periapical. Foram realizadas mais duas radiografias (mesializando e distalizando da região) observando-se o desligamento da área radiolúcida e um ligamento periodontal sem espaços. Principais comentários: a importância da compreensão da localização forame mentual está relacionada com o diagnóstico diferencial de lesões periapicais(AU)

Introducción: el conocimiento de la anatomía radiográfica en el área odontológica es muy importante para ayudar a establecer un diagnóstico correcto, y poder diferenciar las lesiones óseas de las estructuras anatómicas. Objetivo: presentar una situación que demuestra confusión en el diagnóstico entre el foramen mentoniano y lesiones periapicales. Datos principales del caso: paciente que se quejaba de diente que se oscureció, asintomático, dos años después de un tratamiento endodóntico. En la radiografía se observó radiotransparencia en el ápice de la primera bicúspide inferior izquierda, lo que llevó a la sospecha de lesión periapical. Se indicaron dos radiografías (mesializando y distalizando la región) y se observó la eliminación de la imagen radiolúcida y un ligamento periodontal sin espacios. Principales comentarios: Hay que tener en cuenta la ubicación del agujero mentoniano al realizar el diagnóstico diferencial con lesiones periapicales(AU)

Introduction: the knowledge of radiographic anatomy in the dental field is very important to subsidiary to establish of a correct diagnosis, in differentiation between bone lesions and anatomical structures. Objective: to present a situation that demonstrates confusion at diagnosis between the mental foramen and periapical lesions. Main data of the case: patient who complained of tooth darkened, asymptomatic two years after an endodontic treatment. Radiography was observed radiolucency at the apex of the first bicuspid tooth left lower, which led to suspicion of periapical lesion. There were over two radiographs (mesialing and distalizing the region) and observed the separation of radiolucent and a periodontal ligament without spacing. Main comments: The importance of understanding the location of the mental foramen is related to the differential diagnosis of periapical lesions(AU)

Non surgical management of large periapical lesion using mta: report of 2 cases

In the past, cases with open apices were often treated over several appointments, using calcium hydroxide, with the hope of creating a ''calcific'' barrier against which gutta percha could eventually be placed. The treatment could be as long and the prognosis is questionable. These roots were often thinner and, therefore, more brittle; extending treatment over a long period of time without providing a permanent restoration increased the chances of losing these teeth due to fracture. With the favorable histologic response of MTA, this material is the best current choice for this procedure. Completion of these cases in an effective and efficient way allows for permanent restorations to be done in a timelier manner, prolonging the longevity of these teeth. The following case report demonstrates the use of MTA as an obturating material to promote periapical healing with an open apex.

Use of second-generation platelet concentrate (platelet-rich fibrin) and hydroxyapatite in the management of large periapical inflammatory lesion: A computed tomography scan analysis.

Periapical surgery is required when periradicular pathosis associated with endodontically treated teeth cannot be resolved by nonsurgical root canal therapy (retreatment), or when retreatment was unsuccessful, not feasible or contraindicated. Endodontic failures can occur when irritants remain within the confines of the root canal, or when an extraradicular infection cannot be eradicated by orthograde root canal treatment. Foreign‑body responses toward filling materials, toward cholesterol crystals or radicular cysts, might prevent complete periapical healing. We present here a case report wherein, combination of platelet‑rich fibrin (PRF) and the hydroxyapatite graft was used to achieve faster healing of the large periapical lesion. Healing was observed within 8 months, which were confirmed by computed tomography, following improved bone density. PRF has many advantages over platelet‑rich plasma. It provides a physiologic architecture that is very favorable to the healing process, which is obtained due to the slow polymerization process.

Management of Large Periapical Lesion of Teeth via Conservative Approach (Report of two cases).

Infection of the dental pulp occurs as a consequence of caries, operative dental procedures and trauma. These infections often cause total pulpal necrosis and subsequently stimulate an immune response in the periapical region. The latter is commonly referred to as a periapical lesion. The ultimate goal of endodontic therapy should be to return the involved teeth to a state of health and function without surgical intervention. All inflammatory periapical lesions should be initially treated with conservative nonsurgical procedures. Surgical intervention is recommended only after nonsurgical techniques have failed. Besides, surgery has many drawbacks, which limit its use in the management of periapical lesions. A nonsurgical approach should always be adopted before resorting to surgery. Periodic follow-up examinations are essential. Irrespective of the size of the lesion every attempt should be made to treat the periapical lesions with non-surgical endodontic therapy. The aim of this paper is to present two case reports of periapical radiolucent lesions, which were treated, non-surgically.

Lesiones pulpares y periapicales en la consulta de Urgencia Estomatológica. Clínica "Felipe Soto". 2010-2011 / Periapical and pulp lesions in the stomatological emergency consultation at Felipe Soto dental clinic. 2010-2011

Introducción: la mayoría de las urgencias estomatológicas se debe a enfermedades pulpares y periapicales. En nuestro país son pocos los estudios realizados en relación con la prevalencia de estas lesiones en la población, lo que motivó la realización de este trabajo. Objetivo: determinar el comportamiento de las lesiones pulpares y periapicales en pacientes de 19 a 59 años. Material y Método: se realizó un estudio descriptivo y transversal a pacientes comprendidos entre 19 y 59 años de edad quienes asistieron a la consulta de Urgencia Estomatológica de la clínica "Felipe Soto", del municipio Boyeros, de febrero del 2010 a junio del 2011. El universo fue de 250 pacientes a los que se realizó un examen clínico-estomatológico, de los cuales solo 154 presentaron este tipo de lesiones; se analizaron variables como edad, sexo, grupo dentario y causa de la enfermedad. Resultados: el grupo dentario más afectado fue el de los molares, la caries dental fue la principal causa relacionada con la aparición de dichas patologías. Conclusiones: el sexo femenino fue el predominante y el grupo de edad más afectado fue el de 19-34 años, el grupo dentario más afectado por lesiones pulpares y periapicales fue el de los molares, seguido de las bicúspides y las principales causas relacionadas con la aparición de estas enfermedades fueron la caries dental y las obturaciones defectuosas.

Introduction: most of emergency in the Cuban stomatological clinics are due to dental pulp diseases. In our country, there are only a few studies performed on this topic in relation to the prevalence of these injuries in the population. That's why we were motivated to work on this matter. Objective: to determine pulp and periapical lesions conduct in patients from 19 to 59 years old. Material and Methods: a descriptive and cross-sectional study was done in patients between 19 and 59 years old who attended to stomatological emergency services at "Felipe Soto" clinic from Boyeros Municipality, from February 2010 to June 2011. A stomatological clinical exam was done to a population of 250 patients and the sample was of 154 patients who presented dental pulp injuries, some variables were analyzed such as age, sex, dental group and causes of the disease. Results: the more affected teeth groups were the molars. As identified causes, the dental caries were the main related to the appearance of these pathologies. Conclusions: female sex predominant and the most affected age group was the one between 19 and 34 years old. The most affected dental group due to pulp and periapical lesions was that of molars fallowed by bicuspids and the main causes related to the appearing of these sicknesses were dental caries and faulty obturations.

Cone beam computed tomography: A tool for the diagnosis of confusing periapical lesions in conventional radiographs.

We report two cases in which cone beam computed tomography (CBCT) was essential for the establishment of the diagnosis of periapical lesions. CBCT allows a three-dimensional assessment of a specific region with no superimposition of structures. Therefore, its use is recommended when radiographic images are not sufficient for the diagnosis.