Randomized Clinical Study of the Use of MTA and Biodentine™ for Pulpotomy in Primary Teeth

ABSTRACT Objective: To verify, through clinical and radiographic evaluations, the in vivo response of the dentin-pulpal complex of human primary teeth after pulpotomy with MTA and Biodentine™ in a follow-up period of 3, 6, and 12 months. Material and Methods: Thirty teeth were divided into MTA pulpotomy (n = 15) and Biodentine™ pulpotomy (n = 15) from children between 5 and 9 years of age, a randomized clinical trial with simple random sampling. The materials were inserted into the cavity after opening and removing the coronary pulp tissue. The cavity base consisted of glass ionomer cement and light-cured composite resin restoration. Clinical and radiographic analyses were performed after 3, 6, and 12 months. Statistical analysis by Fisher's exact test for dichotomous data at a 5% significance level was utilized. Results: Both materials caused color change after 12 months. However, MTA showed a higher percentage than Biodentine™ (p<0.0001). Pain was detected only with Biodentine™ at six months and mobility at 12 months (p=0.0013). Radiographically, after 12 months, periapical lesions, interradicular lesions, and internal resorption were evidenced in 13% of the cases for Biodentine™-treated teeth (p<0.0013). MTA induced pulp calcification in 13% of cases, unlike Biodentine™ (p<0.0013). Conclusion: BiodentineTM and MTA are suitable for clinical use in pulpotomy treatment, yet both materials lead to tooth discoloration.

Metaloproteinases da matriz: papel no desenvolvimento das lesões periapicais e modulação após tratamento endodôntico / Matrix metalloproteinases: role in the development of apical periodontitis and modulation after endodontic treatment

Introduction: Apical periodontitis represents a local immune response directed against the progression of microorganisms from the dental pulp to the apical foramen and periapical tissues, which results in bone and dental resorption. The aim of this review is to describe the expression of this group of proteases in apical periodontitis and its modulation during the periapical healing phase following root canal treatment. Literature review: The pathogenesis of apical periodontitis involves degradation of several extracellular matrix components. Matrix metalloproteinases (MMPs) are expressed in response to specific stimuli by resident cells of connective tissue during tissue remodeling and by inflammatory cells that arrive into the surrounding tissues during inflammatory events. MMPs have been reported in apical periodontitis, either experimentally induced or obtained from humans and there is evidence that these enzymes show diff erent expression patterns in granulomas and periapical cysts. Root canal therapy is important for the reduction of periapical inflammation as well as the synthesis of MMPs, especially when using a calcium hydroxide-based dressing. Conclusion: Apical periodontitis show high expression of matrix metalloproteinases and root canal treatment results in less expression of MMPs when compared to untreated apical periodontitis.

Introdução: A lesão periapical representa a resposta imunoinflamatória devido ao aumento do número e progressão de micro-organismos advindos dos canais radiculares contaminados em direção aos tecidos apicais e periapicais, resultando em reabsorção óssea. O objetivo desta revisão será abordar a importância das metaloproteinases da matriz no desenvolvimento das lesões periapicais e sua modulação durante a fase de reparação tecidual depois de instituído o tratamento endodôntico. Revisão da literatura: A patogênese da lesão periapical envolve a degradação progressiva de diversos componentes da matriz extracelular. Dentre as proteases responsáveis pela degradação destes componentes estão as metaloproteinases da matriz (MMPs). Estas proteinases são expressas em resposta a estímulos específicos pelas células residentes do tecido conjuntivo durante o processo de remodelação tecidual e por células inflamatórias que invadem os tecidos durante eventos inflamatórios. As MMPs foram descritas em lesões periapicais experimentais e em humanos e existem evidências de que estas enzimas apresentam padrões de expressões diferentes em granulomas e cistos periapicais. A terapia endodôntica é importante para a redução da inflamação periapical assim como da síntese das MMPs, principalmente quando utilizado um curativo de demora à base de hidróxido de cálcio. Conclusão: As lesões periapicais apresentam alta expressão de metaloproteinases da matriz e o tratamento endodôntico em dentes com lesão periapical resulta em menor expressão de MMPs quando comparado às lesões periapicais não tratadas.

Root canal contamination or exposure to lipopolysaccharide differentially modulate prostaglandin E 2 and leukotriene B 4 signaling in apical periodontitis

Abstract Purpose To evaluate the kinetics of apical periodontitis development in vivo , induced either by contamination of the root canals by microorganisms from the oral cavity or by inoculation of bacterial lipopolysaccharide (LPS) and the regulation of major enzymes and receptors involved in the arachidonic acid metabolism. Methodology Apical periodontitis was induced in C57BL6 mice (n=96), by root canal exposure to oral cavity (n=48 teeth) or inoculation of LPS (10 µL of a suspension of 0.1 µg/µL) from E. coli into the root canals (n= 48 teeth). Healthy teeth were used as control (n=48 teeth). After 7, 14, 21 and 28 days the animals were euthanized and tissues removed for histopathological and qRT-PCR analyses. Histological analysis data were analyzed using two-way ANOVA followed by Sidak's test, and qRT-PCR data using two-way ANOVA followed by Tukey's test (α=0.05). Results Contamination by microorganisms led to the development of apical periodontitis, characterized by the recruitment of inflammatory cells and bone tissue resorption, whereas inoculation of LPS induced inflammatory cells recruitment without bone resorption. Both stimuli induced mRNA expression for cyclooxygenase-2 and 5-lipoxygenase enzymes. Expression of prostaglandin E 2 and leukotriene B 4 cell surface receptors were more stimulated by LPS. Regarding nuclear peroxisome proliferator-activated receptors (PPAR), oral contamination induced the synthesis of mRNA for PPARδ, differently from inoculation of LPS, that induced PPARα and PPARγ expression. Conclusions Contamination of the root canals by microorganisms from oral cavity induced the development of apical periodontitis differently than by inoculation with LPS, characterized by less bone loss than the first model. Regardless of the model used, it was found a local increase in the synthesis of mRNA for the enzymes 5-lipoxygenase and cyclooxygenase-2 of the arachidonic acid metabolism, as well as in the surface and nuclear receptors for the lipid mediators prostaglandin E2 and leukotriene B4.

Visão farmacoterapêutica em odontologia, frequência e classes de medicamentos prescritos em uma clínica odontológica de um município do sul de Minas Gerais-MG / Pharmacotherapeutic view in dentistry, frequency and therapeutic classes of prescribed drugs at a dental clinic in a city of southern Minas Gerais state

Este trabalho visou avaliar a frequência e classes de medicamentos mais prescritos em uma clínica odontológica, bem como o conhecimento em farmacologia dos entrevistados. Para isto, foi conduzido um estudo observacional com uma amostragem composta por cirurgiões-dentistas (professores) e alunos da clínica integrada de odontologia de uma Universidade do Sul de Minas Gerais. Os dados foram coletados pela aplicação de um questionário individual. A partir disto, a frequência e classes de medicamentos mais prescritos, bem como o conhecimento em farmacologia dos entrevistados foram avaliadas. Entre as 66 pessoas entrevistadas (9 professores e 57 alunos), a maior porcentagem classificaram suas prescrições como de baixa frequência e optam em sua maioria por prescrições utilizando o nome genérico do medicamento, sendo 96,96% destas prescrições realizados por escrito. Na classe dos antibióticos, o mais utilizado pelos profissionais foram Amoxicilina e Clindamicina, na classe dos analgésicos Dipirona Sódica e Paracetamol, na classe dos antiinflamatorios a Nimesulida, os ansiolíticos igualmente distribuídos entre Diazepan, Lorazepan e Midazolan, na classe dos antissépticos a Clorexidina e como protetor gástrico a Ranitidina. Um pequeno percentual (1,52%) dos entrevistados consideraram seu conhecimento farmacológico insuficiente para a prática clínica, 21,21% regular, 63,64% suficiente e 13,63% ótimo. Estes dados indicam que são necessárias novas abordagens para melhorar o conhecimento em farmacologia de dentistas e futuros dentistas, com intuito de promover o uso racional de medicamentos.

In this work was evaluated the frequency and therapeutic classes of prescribed drugs at a dental clinic as well as knowledge in pharmacology of the interviewed. An observational study was conducted from a sample composed by dentists (professors) and undergraduate dental students from a dental clinic of a University of Southern Minas Gerais. The data were collected by applying an individual questionnaire, accordingly, frequency and therapeutic classes of commonly prescribed drugs as well as the knowledge in pharmacology of the interviewed were assessed. Among the 66 people interviewed (9 professors and 57 students), the highest percentage of them rated their prescriptions as low frequency and opted mostly for prescriptions using generic drug names, being writing prescriptions in 96.96% of the cases. In the class of antibiotics, the most used by professionals were Amoxicillin and Clindamycin, in the class of painkillers Sodium Dipyrone and Paracetamol, in the class of anti-inflammatory Nimesulide, anxiolytics class was equally distributed between Diazepam, Lorazepam, and Midazolam, in the class of antiseptics the Chlorhexidine, and how a gastric protector Ranitidine was most prescribed. 1.52% of the interviewed considered their pharmacological knowledge as poor, 21.21% fair, 63.64% good, and 13.63% excellent. These data indicate that new approaches are needed to improve the knowledge in pharmacology of dentists and future dentists, aiming to encourage the rational use of drugs.