Application of neoadventitia technique in root repair of acute type A aortic dissection / 中华胸心血管外科杂志

Objective:To evaluate the safety and efficacy of the neoadventitia technique for root repair in acute type A aortic dissection(ATAAD).Methods:From January 2019 to February 2022, a total of 94 patients with ATAAD who underwent surgical treatment in Beijing Anzhen Hospital were retrospectively analyzed. According to the different treatment methods for the aortic root, the patients were divided into the neoadventitia technique group(58 cases) and the Bentall group(36 cases). The perioperative data and postoperative follow-up results of the two groups were compared, and the efficacy of the new adventitia technique in acute type A aortic dissection was analyzed.Results:There were no intraoperative deaths. The 30-day mortality was 3.4% and 5.6% in the neoadventitia group and Bentall group, respectively ( P=0.636). The cardiopulmonary bypass time[(154.3±29.8)min, P<0.001] and aortic clamp time[(94.7±20.6)min, P<0.001)]were significantly shorter in the neoadventitia group, compared with the Bentall group. Aortic regurgitation was significantly improved after the operation (0.33±0.50 vs. 1.02±0.80, P<0.001). No aortic root-related secondary intervention occurred during follow-up. There was no significant difference in mortality between the two groups( P=0.248). Conclusion:Neoadventitia root repair is a safe and feasible method for the treatment of ATAAD, which has good short-term and mid-term efficacy.

Comparative Evaluation of the Apical Leakage of Different Bioceramic Retrofilling Materials with and without Smear Layer: A Stereomicroscopic Study

Objective: Present in?vitro study aimed to evaluate the apical leakage of different bioceramic retrofilling materials with and without smear layer. Materials and Methods: Sixty human single?rooted teeth were decoronated at a standardized root length of 13 mm, chemo?mechanically prepared and obturated. After obturation, root?end resection was done and root?end cavities were prepared using ultrasonic tips. The specimens with prepared retro cavities were randomly assigned into 2 groups (n = 30) based on the smear layer removal protocol used. Each group was further subdivided into 3 subgroups (n = 10) based on the bioceramic retrofilling material MTA (Mineral Trioxide Aggregate; Proroot Dentsply/Tulsa), CEM (Calcium?Enriched Mixture; Bionique Dent, Tehran) and ERRM (EndoSequence® Root Repair Material; Brasseler USA, Savannah, GA). The extension of dye (2% Rhodamine B) penetration was measured in millimetre using a stereomicroscope at 10× zoom. Results were statistically analysed using one?way ANOVA (analysis of variance) test and unpaired Student’s t test. Results: In the presence of smear layer, MTA demonstrated maximum mean apical leakage value (1.70 ± 0.30), followed by CEM (1.40 ± 0.37) and ERRM (1.40 ± 0.23), which was statistically not significant. Without the smear layer, ERRM demonstrated the least mean apical leakage value, which was statistically significant as compared with CEM (P <.05) and MTA ( P <.01). Conclusion(s): All bioceramic retrofilling materials demonstrated apical leakage irrespective of the presence or absence of the smear layer. The presence of a smear layer is beneficial for the sealing ab

Short-and mid-term results after adventitial inversion technique for root repair in acute type A aortic dissection / 中华胸心血管外科杂志

Objective:To evaluate the safety and effectiveness of adventitial inversion technique for root repair in patients with acute type A aortic dissection(ATAAD).Methods:Between 2015 and 2018, ATAAD patients with dissected root and underwent open surgery were included. The exclusion criteria were as follows: previous root intervention, traumatic dissection and patient underwent root replacement(Bentall or David procedure). 490 ATAAD patients were included, 366(74.69%) male and 124(25.31%) female, aged(51.28±10.99) years(range 24-77 years). The clinical data were retrospectively analyzed with ANOVA/ nonparametric test and Chi- square test. Follow-up mortality and reoperation were displayed with Kaplan- Meier curve. Results:All patients were technically divided into three groups: adventitial inversion(A), direct suture(B) and Cabrol-shunt(C). The mean age in group A was(53.05±11.09) years, whereas worse cardiac and renal function occurred in group C. The mean duration of HCA, CPB and ACC were shortest, with a highest average of minimum rectal temperature during surgical interval in group A. Postoperative complications and early mortality were similar among groups. There were no significant differences of mid-term mortality and reoperation among these three techniques. Though no late reintervention for aortic root was found in both group A and B, the root diameter was more stable in group A during follow-up period[(33.14±3.74)mm vs.(34.51±3.83)mm vs.(33.89±3.89)mm, P=0.008]. Conclusion:Adventitial inversion technique is safe and effective for root repair in patients with ATAAD, achieving satisfactory short- and mid-term effects.

Application of aortic root repair in acute type A aortic dissection with aortic sinus involvement / 中华胸心血管外科杂志

Objective:To evaluate the outcomes of aortic root repair in acute type A aortic dissection (ATAAD) with aortic sinus involvement.Methods:The clinical data of patients with ATAAD involving the aortic sinus and an aortic root diameter of ≤45 mm who were treated from January 1, 2015, to December 31, 2016, were collected. Patients were divided into group A (involvement of one aortic sinus or part of one aortic sinus) and group B (involvement of more than one aortic sinus). The effectiveness of aortic root repair in ATAAD with sinus involvement was analyzed by comparing the preoperative imaging characteristics and postoperative results between the two groups.Results:The study cohort comprised 155 patients, including 100 patients in group A and 55 in group B. There were no differences between the two groups in baseline characteristics, aortic root diameter, 30-day mortality, and complication rates. During an average follow-up of(49.1±14.6) months, there was no difference between the two groups in the survival rate (92.0% vs. 89.5%, P=0.61). The aortic root diameter at follow-up showed no progressive expansion compared with preoperatively in either of the two groups[(38.1±3.6) mm vs. (37.9±3.5)mm, P=0.92, A; (38.4±4.1) mm vs. (38.3±3.6) mm, P=0.74, B]; furthermore, there was no difference between the two groups in aggravation of aortic regurgitation. Conclusion:Aortic root repair achieves satisfactory medium-term outcomes in ATAAD with more than one aortic sinus involved, but the long-term outcomes need to be evaluated.

" Watching without dealing" aortic root repair in the treatment of acute Stanford type A aortic dissection: a prospective observational study / 中华胸心血管外科杂志

Objective:To evaluate the clinical effects of " watching without dealing" aortic root repair technique in acute Stanford type A aortic dissection(ATAAD).Methods:From October 2017 to October 2018, " watching without dealing" technique was performed in ATAAD patients with mild aortic root involvement. The proximal aortic anastomosis was at the level of the sinotubular junction, without " pursuing" complete excision of the intra-sinus dissections. The perioperative clinical data and follow-up imaging results of the patients were collected and analyzed to evaluate early and mid-term efficacy of the technique.Results:A total of 20 patients received " watching without dealing" technique in our hospital, including 15 males and 5 females with a mean age of(48.0±12.1) years old(34-73 years old). The preoperative aortic sinus diameter was(41.3±3.6)mm and the aortic sinotubular junction diameter was(43.9±6.6) mm. All patients underwent ascending aortic replacement and total arch replacement plus frozen elephant trunk surgery. The cardiopulmonary bypass time was(179.5±41.5)min(132~255 min), the cross-clamp time was(120.3±23.7) min(95~180 min), and the circulatory arrest time was(8.8±7.6) min(2~22 min). During perioperative period, no adverse events such as death, secondary opening, renal failure, cerebral infarction, and paraplegia occurred. The CTA examination of the aorta before the patients were discharged showed that all residual false lumen in the sinus disappeared, the diameter of the aortic sinus was(30.8±2.6) mm, and the diameter of the aortic sinotubular junction was(27.2±2.5) mm. The patients were followed up for mean(28.5±7.8) months(3~35 months). No surgical re-intervention of the aortic root occurred. The aortic CTA during follow-up period showed no residual or new dissection in the aortic sinus, the diameters of the aortic sinus and aortic sinotubular junction were(30.9±2.4) mm and(27.5±2.7) mm respectively; the ultrasonic cardiogram showed normal aortic valve structure and function. No statistically significant differences were found when comparing the aortic sinus diameter and aortic sinotubular junction diameter between two time points of at discharge and follow-up.Conclusion:The " watching without dealing" aortic root repair technique for ATAAD is relatively simple to learn and safe in the perioperative period. Early and mid-term follow-up imaging showed normalization of the aortic sinus structure. Further follow-up and observation were necessary to figure out the long-term clinical outcome of this modified aortic root repair.

Experimental nano calcium aluminate/tri calcium silicate root repair: Synthesis, physical and mechanical properties compared to mineral trioxide aggregate and Biodentine / Reparo radicular experimental de nano aluminato de cálcio/silicato de tri cálcio: Síntese, propriedades físicas e mecânicas em comparação com agregado de trióxido mineral e Biodentine

Objective: Endodontic perforation is a challenging mishap that should be repaired with a biocompatible material, Mineral trioxide aggregate (MTA) and Biodentine are the most commonly used repair materials. However, these materials are expensive, (MTA) has prolonged setting time and difficult manipulation. The purpose of this study is to prepare the experimental nano calcium-aluminate/tri-calcium-silicate (CA/C3S) material and comparing its physical properties with biodentine and MTA, to evaluate the experimental material eligibility to compete the commercial repair materials. And to perform part two (animal study) that will evaluate the cytotoxicity, the biocompatibility and the efficacy of (CA/C3S) in furcal perforation repair compared to diode laser. Material and Methods: A mixture of calcium carbonate and aluminum oxide was used to formulate calcium aluminate phase (CA), tri-calcium-Silicate phase (C3S) was formulated by firing of calcium carbonate and quartz. The produced powders were investigated by X-ray diffraction, then (CA) and (C3S) mixed with water.(CA/ C3S) compared with MTA and biodentine for setting-time, micro-hardness, dimensional-stability and solubility. Results: Mean setting time of (CA/C3S) was (32.70±0.75min) which is significantly higher than MTA and Biodentine. The Mean microhardness of (CA/C3S) was (56.50±7.41VHN) which has no statical difference with MTA and Biodentine. Solubility results showed weight increase for (CA/C3S) as following (6.29±3.05)and loss of weight for MTA and Biodentine. The percentage of change in dimensions for(CA/C3S) increased as following (0.64±0.78) while decreased for MTA and Biodentine. Conclusion: The experimental (CA/C3S) material showed good microhardness, dimensional stability and acceptable setting time that could be improved in further work (AU)

Objetivo: A perfuração endodôntica é um percalço desafiador que deve ser reparado com um material biocompatível, Agregado de trióxido mineral (MTA) e Biodentina são os materiais de reparo mais comumente usados. No entanto, esses materiais são caros, (MTA) tem tempo de presa prolongado e difícil manipulação. O objetivo deste estudo é preparar o material experimental de nano aluminato de cálcio/silicato tricálcico (CA/C3S) e comparar suas propriedades físicas com biodentina e MTA, para avaliar a elegibilidade do material experimental para competir com os materiais de reparo comerciais. E realizar a segunda parte (estudo animal) que avaliará a citotoxicidade, a biocompatibilidade e a eficácia do (CA/C3S) no reparo de perfuração de furca em comparação ao laser de diodo.Material e Métodos: Uma mistura de carbonato de cálcio e óxido de alumínio foi usada para formular a fase de aluminato de cálcio (CA), a fase tri-cálcio-silicato (C3S) foi formulada por queima de carbonato de cálcio e quartzo. Os pós produzidos foram investigados por difração de raios X, em seguida (CA) e (C3S) misturados com água. (CA/ C3S) comparados com MTA e biodentina para tempo de presa, microdureza, estabilidade dimensional e solubilidade. Resultados: O tempo médio de presa de (CA/C3S) foi (32,70±0,75min) que é significativamente maior que MTA e Biodentine. A microdureza média de (CA/C3S) foi (56,50±7,41VHN) que não tem diferença estática com MTA e Biodentine. Os resultados de solubilidade mostraram aumento de peso para (CA/C3S) conforme a seguir (6,29±3,05) e perda de peso para MTA e Biodentine. A porcentagem de mudança nas dimensões para (CA/C3S) aumentou como segue (0,64±0,78), enquanto diminuiu para MTA e Biodentine. Conclusão: O material experimental (CA/C3S) apresentou boa microdureza, estabilidade dimensional e aceitável tempo de presa, que pode ser melhorado em trabalhos futuros (AU)

The short-term effect of aortic sinoplasty on repairing aortic roots of patients with acute type A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To investigate the feasibility, effectiveness and durability of aortic sinoplasty in repairing aortic roots of patients with acute type A aortic dissection. Methods    From January 2014 to July 2017, 43 consecutive patients with acute type A aortic dissection underwent aortic sinoplasty to repair aortic root in our institution, including 34 males and 9 females, aged 32-65 (50.1±8.1) years. The perioperative and follow-up data were retrospectively analyzed, and statistical analysis on the preoperative, postoperative and follow-up ultrasound indicators was performed. Results    Thirty-day mortality was 4.7%. Preoperative aortic regurgitation was corrected and false lumen was eliminated immediately after operation in all patients. There was no late death, or aortic root or valve re-intervention and two patients were lost during a follow-up of 18-45 (27.9±6.7) months. There was no residual dissection found. No patients had significant dilation of aortic root. No statistically significant difference was found when comparing the maximum of root diameter and aortic regurgitation grade between at discharge and follow-up. Conclusion    Aortic sinoplasty for aortic root repair in acute type A aortic dissection is a simple and reliable technique and demonstrates excellent early outcomes.

Influence of Powder-to-Gel Ratio on Physicochemical Properties of a Calcium Silicate Sealer / Influencia de la relación polvo-gel sobre las propiedades fisicoquímicas de un sellador de silicato de calcio

Abstract Differences in liquid-to-powder ratio can affect the properties of calcium silicate-based materials. This study assessed the influence of powder-to-gel ratio on physicochemical properties of NeoMTA Plus. Setting time (minutes), flow (mm and mm²), pH (at different periods), radiopacity (mm Al) and solubility (% mass loss) were evaluated using the consistencies for root repair material (NMTAP-RP; 3 scoops of powder to 2 drops of gel) and root canal sealer (NMTAP-SE; 3 scoops of powder to 3 drops of gel), in comparison to Biodentine cement (BIO) and TotalFill BC sealer (TFBC). Statistical analysis was performed using one-way ANOVA and Tukey tests (α=0.05). BIO had the shortest setting time, followed by NMTAP-RP and NMTAP-SE. TFBC showed the highest setting time and radiopacity. BIO, NMTAP-RP, and NMTAP-SE had similar radiopacity. All materials promoted an alkaline pH. NMTAP-RP/SE presented lower solubility than BIO and TFBC. Regarding the flow, TFBC had the highest values, followed by NMTAP-SE, and NMTAP-RP. BIO had the lowest flow. In conclusion, NMTAP in both powder-to-gel ratios showed high pH and low solubility. The increase in the powder ratio decreased the setting time and flow. These findings are important regarding the proper consistency and work time to clinical application.

Resumen Las diferencias en la proporción líquido/polvo pueden afectar las propiedades de los materiales a base de silicato de calcio. Este estudio evaluó la influencia de la proporción polvo/gel en las propiedades fisicoquímicas del cemento NeoMTA Plus. El tiempo de fraguado (minutos), la fluidez (mm y mm²), el pH (en diferentes períodos), la radiopacidad (mmAl) y la solubilidad (% de pérdida de masa) fueron evaluados utilizando las consistencias para el material de reparación radicular (NMTAP-RP; 3 cucharadas de polvo/2 gotas de gel) y para cemento sellador del conducto radicular (NMTAP-SE; 3 cucharadas de polvo/3 gotas de gel), en comparación con el cemento Biodentine (BIO) y el cemento TotalFill BC (TFBC). El análisis estadístico se realizó utilizando las pruebas ANOVA y Tukey unidireccionales (α=0.05). BIO tuvo el tiempo de fraguado más corto, seguido de NMTAP-RP y NMTAP-SE. TFBC mostró el mayor tiempo de fraguado y radiopacidad. BIO, NMTAP-RP y NMTAP-SE tuvieron una radiopacidad similar. Todos los materiales promovieron un pH alcalino. NMTAP-RP/ SE tuvieron una solubilidad menor que BIO y TFBC. Con respecto a la fluidez, TFBC tuvo los valores más altos, seguido de NMTAP-SE y NMTAP-RP. BIO tuvo la fluidez más baja. En conclusión, NMTAP en la relación polvo/gel mostró un pH alto y una baja solubilidad. El aumento en la proporción de polvo disminuyó el tiempo de fraguado y la fluidez. Estos hallazgos son importantes con respecto a su consistencia y tiempo de trabajo durante la aplicación clínica.

The push-out bond strength of BIOfactor mineral trioxide aggregate, a novel root repair material

OBJECTIVES: The aim of this in vitro study was to evaluate the push-out bond strength of a novel calcium silicate-based root repair material-BIOfactor MTA to root canal dentin in comparison with white MTA-Angelus (Angelus) and Biodentine (Septodont). MATERIALS AND METHODS: The coronal parts of 12 central incisors were removed and the roots were embedded in acrylic resin blocks. Midroot dentin of each sample was horizontally sectioned into 1.1 mm slices and 3 slices were obtained from each root. Three canal-like standardized holes having 1 mm in diameter were created parallel to the root canal on each dentin slice with a diamond bur. The holes were filled with MTA-Angelus, Biodentine, or BIOfactor MTA. Wet gauze was placed over the specimens and samples were stored in an incubator at 37°C for 7 days to allow complete setting. Then samples were subjected to the push-out test method using a universal test machine with the loading speed of 1 mm/min. Data was statistically analyzed using Friedman test and post hoc Wilcoxon signed rank test with Bonferroni correction. RESULTS: There were no significant differences among the push-out bond strength values of MTA-Angelus, Biodentine, and BIOfactor MTA (p > 0.017). Most of the specimens exhibited cohesive failure in all groups, with the highest rate found in Biodentine group. CONCLUSIONS: Based on the results of this study, MTA-Angelus, Biodentine, and BIOfactor MTA showed similar resistances to the push-out testing.

In Vitro Cytotoxicity Evaluation of Three Root-End Filling Materials in Human Periodontal Ligament Fibroblasts

Abstract The aim of this study was to evaluate in vitro the cytotoxicity on human periodontal ligament fibroblasts of three root-end filling materials: MTA Angelus(r), EndoSequence Root Repair Material Putty(r) and Super EBA(r). A primary culture of human periodontal ligament fibroblasts was previously obtained in order to evaluate the cytotoxicity of the three extracts from the root-end filling materials after 2 and 7 days of setting. Serial dilutions of these extracts (1:1, 1:2, 1:4 and 1:8) were evaluated at 1, 3 and 7 days using the methyl-thiazol-tetrazolium (MTT) colorimetric assay. Cell viability was evaluated as percentage of the negative control group, which represented 100% cell viability. Statistical analyses were done with t-test, ANOVA and Kruskal-Wallis test at a significance level of 5%. It was found that the main difference among root-end filling materials was in the higher dilutions (p<0.05), but there was a similar behavior in lower dilutions (p>0.05). Cell viability of MTA Angelus(r) was superior for 2-day setting (p<0.05), compared with the other two root-end fillings. There were no statistically significant differences between 7-day set MTA Angelus(r) and EndoSequence Root Repair Material Putty(r). Super EBA(r) showed the lowest percentage of cell viability at higher dilutions (p<0.05). Therefore, MTA Angelus(r) and EndoSequence Root Repair Material Putty(r) were less cytotoxic in the highest dilution (1:1) compared with Super EBA(r).

Resumo O objetivo deste trabalho foi avaliar in vitro a citotoxicidade em fibroblastos do ligamento periodontal humano de três cimentos de retrobturação: MTA Angelus(r), EndoSequence Root Repair Material Putty(r) e Super EBA(r). Uma cultura de fibroblastos primários do ligamento periodontal humano foi obtida anteriormente a fim de avaliar a citotoxicidade dos três extratos dos cimentos de retrobturação após 2 e 7 dias de endurecimento. As diluições em série destes extratos (1:1, 1:2, 1:4 e 1:8) foram avaliados em 1, 3 e 7 dias empregando o ensaio colorimétrico metil-tiazol-tetrazólio (MTT). A viabilidade celular foi calculada em base da porcentagem do grupo de controle negativo, que representou 100% de viabilidade de células. As análises estatísticas foram realizadas com o teste t, ANOVA e teste de Kruskal-Wallis a um nível de significância de 5%. Verificou-se que a principal diferença entre os cimentos de retrobturação estava nas diluições mais elevadas (p<0,05) e houve um comportamento semelhante nas diluições mais baixas (p>0,05). A viabilidade celular dos fibroblastos do ligamento periodontal humano foi superior para MTA Angelus(r) de 2 dias de endurecimento (p<0,05), em comparação com os outros materiais de retrobturação. Não houve diferença significante entre MTA Angelus(r) e EndoSequence Root Repair Material Putty(r) de 7 dias de endurecimento. Super EBA(r) mostrou a menor percentagem da viabilidade celular nas diluições mais altas (p<0,05). Portanto, os cimentos de retrobturação MTA Angelus(r) e EndoSequence Root Repair Material Putty(r) foram menos citotóxicos na diluição mais alta (1:1) em comparação com Super EBA(r).

The influence of osteoclasts during the repairs of tooth root in rats model of tooth resorption by intermittent injection of parathyroid hormone (PTH) / 重庆医学

Objective To investigate the role of PT H (1-34 ) on the expression of receptor activator factor of NF-κB ligand (RANKL) in the induction of osteoclasts and its effect to osteoclasts on compression side during the repairs of tooth root in rats model of tooth resorption by intermittent injection of small dose of PTH (1-34) .Methods After the model of tooth resorption was established in rats 6-8 weeks in age ,63 male SD rats were divided in three groups .Rats in the control group were not given injec-tions for any drugs ;The negative control group were given injections for normal saline 6μg/kg subcutaneously every other day ;The experimental group were given injections for PTH (1-34) 6 μg/kg(PTH :1 μg/mL) subcutaneously every other day ;then rats in every group were killed on the day 0 ,7 ,10 ,14 ,17 ,21 ,25 .TRAP staining for counting TRAP-positive stained osteoclasts ,calculat-ing the mean ;Ligand RANKL immunohistochemistry and using image-pro-plus image analysis system to measure the average opti-cal density value of compression side .Results On the day of discontinuation ,the tooth resorption continued in each group ;the num-ber of osteoclasts between every two arrays there were no significant statistic differences (P>0 .05);RANKL immunohistochemis-try :Compared with control group and the negative control group ,the experimental group significantly increased in early stage ,and reduced in latest stage(P<0 .05) .Conclusion It indicated that intermittent injection of small dose PTH (1-34) did not cease the rats tooth resorption which occured during the period of tooth repair .