Research progress on fluoride-releasing restorative materials for caries control / 口腔疾病防治

@#Restorative materials such as conventional glass ionomer cement (CGIC), resin-modified glass ionomer cement (RMGIC), polyacid-modified composite resin (compomer), and giomer have the properties of fluoride release and refill, which may prevent or slow down the progression of caries. The caries resistance of these materials was evaluated according to the following criteria: fluorine-releasing ability, antibacterial activity, mechanical properties and anti-aging properties. The anti-caries effect of these materials mainly depends on the effect of fluoride ions on mineralization. However, materials with strong fluorine release ability, such as CGIC, are mainly used in pediatric dentistry and temporary restoration due to their poor mechanical properties. It is difficult to achieve both fluoride ion release potential and mechanical strength, and there are few materials that can provide ideal mechanical strength while maintaining a high standard of fluoride release. The fluoride releasing and recharging capacity of CGIC, RMGIC, compomer and giomer decrease successively. The trend of material modification, to a certain extent, tends to sacrifice the fluoride release capacity of materials to maintain the ideal mechanical strength. In recent years, scholars have tried to add a variety of fillers to further enhance the anti-cracking ability of materials and add antibacterial agents to compensate for the anti-caries effect to reduce the loss of fluoride release.

¿Cómo Intervenir el Proceso de Caries en Niños? Adaptación del Consenso de ORCA/EFCD/DGZ

RESUMEN: La caries dental afecta alrededor del 70% de los niños y en Latinoamérica este problema es aún más complejo, dadas las barreras socioeconómicas y culturales que dificultan el acceso a la salud bucal, con grandes inequidades. Durante el año 2019, un panel de expertos de la Organización Europea para la Investigación en Caries (ORCA), la Federación Europea de Odontología Conservadora (EFCD) y la Federación Alemana de Odontología Conservadora (DGZ) elaboraron revisiones sistemáticas de la literatura y consensuaron recomendaciones basadas en evidencia destinadas a dentistas, mediante un taller en Berlín, Alemania, seguido de un trabajo de consenso mediante metodología e-Delphi. El propósito de este artículo es presentar las principales conclusiones del consenso adaptadas idiomáticamente al español y al contexto de Latinoamérica para permitir una mejor difusión del conocimiento generado y su aplicación en la práctica clínica. El artículo proporciona evidencia y recomendaciones clínicas para las intervenciones preventivas, no invasivas, microinvasivas, mínimamente invasivas e invasivas mejor sustentadas por la ciencia para el manejo de la enfermedad de caries y de las lesiones de caries en niños, con énfasis en la caries de la infancia temprana (CIT), dientes primarios y superficies oclusales de dientes permanentes.

ABSTRACT: Dental caries remains the most prevalent chronic disease in the world, affecting around 70% of children and posing a challenge for public health. Given the socioeconomic, cultural barriers and great inequalities that hinder access to oral health, in Latin America this problem is even more complex. During 2019, a panel of experts from the European Organization for Caries Research (ORCA), the European Federation for Conservative Dentistry (EFCD) and the German Federation for Conservative Dentistry (DGZ) prepared systematic reviews of the literature to reach consensus and generate evidence-based recommendations for dentists on how to manage caries in children. In a workshop in Berlin, Germany, followed by an e-Delphi methodology the experts published the consensus. The purpose of this article is to present the main conclusions of the consensus adapted idiomatically to Spanish and to the Latin American context to allow a better dissemination of the knowledge generated and facilitate its application in clinical practice. The article provides evidence and clinical recommendations for the best science-supported preventive, non-invasive, micro-invasive, minimally invasive, and invasive interventions for the management of caries disease and caries lesions in children, with an emphasis on early childhood caries (ECC), primary teeth and occlusal surfaces of permanent teeth.

A biocomplex to repair experimental critical size defects associated with photobiomodulation therapy

The association of scaffolds to repair extensive bone defects can contribute to their evolution and morphophysiological recomposition. The incorporation of particulate biomaterials into three-dimensional fibrin bioproducts together with photobiomodulation therapy (PBM) has potential and can improve regenerative medicine procedures. The objective of this experiment was to evaluate the effects of PBM therapy on critical size defects filled with xenogenic bone substitute associated with fibrin biopolymer. Methods: A critical defect of 8 mm was performed in 36 Wistar male adult rats that were divided into four groups. Groups BC and BC-PBM were defined as controls with defects filled by a clot (without or with PBM, respectively) and groups XS and XS-PBM that comprised those filled with biocomplex Bio-OssTM in association with fibrin biopolymer. PBM was applied immediately after the surgery and three times a week every other day, with the parameters: wavelength of 830 nm, energy density 6.2 J/cm2, output power 30 mW, beam area of 0.116 cm2, irradiance 0.258,62 W/cm2, energy/point 0.72 J, total energy 2.88 J. Fourteen and 42 days after the surgery, animals were euthanatized and subjected to microtomography, qualitative and quantitative histological analysis. Results: The BC-PBM and XS-PBM groups had a similar evolution in the tissue repair process, with a higher density of the volume of new formed bone in relation to the groups without PBM (p = 0.04086; p = 0.07093, respectively). Intense vascular proliferation and bone deposition around the biomaterial particles were observed in the animals of the groups in which biocomplex was applied (XS and XS-PBM). Conclusion: PBM therapy allowed an improvement in the formation of new bone, with a more organized deposition of collagen fibers in the defect area. Biocomplex favored the insertion and permanence of the particulate material in bone defects, creating a favorable microenvironment for accelerate repair process.(AU)

Effect of fluoride varnish, glass ionomer and resin sealant on the prevention of pit and fissure caries in young children / 口腔疾病防治

Objective @# To study the effect of fluoride varnish, glass ionomer and resin sealant on the prevention of pit and fissure caries in young children, and to identify an a method to reduce the sensitivity of operation technique to prevent pit and fissure caries in young children with limited moisture isolation.@*Methods@# A self-control design was used to select 370 young children aged 3 to 5. Eight molars in the mouth were distributed in four quadrants, and each quadrant was randomly allocated to the blank group, fluoride varnish Duraphat group, glass ionomer GC FujiⅦ group, and resin ClinproTM Sealant group. The retention rate of pit and fissure sealant and the incidence of primary molar caries were observed in the 6th, 12th, 24th and 36th months respectively.@* Results @# In the 6th month, 12th month and 24th month, there were no significant differences in the material retention rate between the GC Fuji Ⅶ group and ClinproTM Sealant group. In the 36th month, the retention rate of the ClinproTM sealant group was better than that of the GC Fuji Ⅶ group (P < 0.05). In the 6th month, the caries incidence in the Duraphat group, GC Fuji Ⅶ group and ClinproTM sealant group was significantly lower than that in the blank group (P < 0.001). There was no significant difference between the Duraphat group, GC Fuji Ⅶ group and ClinproTM sealant group. In the 12th month, 24th month and 36th month, the incidence of caries in the GC Fuji Ⅶ group and ClinproTM sealant group was lower than that in the Duraphat group and blank group (P < 0.001), but there was no significant difference between the blank group and Duraphat group, and there was no significant difference in caries incidence between the GC Fuji Ⅶ group and ClinproTM sealant group.@*Conclusion @#The GC Fuji Ⅶ and ClinproTM sealant treatments continuously and effectively prevented pit and fissure caries compared with simple fluoride application. However, in cases of limited cooperation and poor moisture isolation in young children, the preventive measures of glass ionomer pits and fissure sealants (GC Fuji Ⅶ) are simpler and more feasible.

A biocomplex to repair experimental critical size defects associated with photobiomodulation therapy

Abstract Background: The association of scaffolds to repair extensive bone defects can contribute to their evolution and morphophysiological recomposition. The incorporation of particulate biomaterials into three-dimensional fibrin bioproducts together with photobiomodulation therapy (PBM) has potential and can improve regenerative medicine procedures. The objective of this experiment was to evaluate the effects of PBM therapy on critical size defects filled with xenogenic bone substitute associated with fibrin biopolymer. Methods: A critical defect of 8 mm was performed in 36 Wistar male adult rats that were divided into four groups. Groups BC and BC-PBM were defined as controls with defects filled by a clot (without or with PBM, respectively) and groups XS and XS-PBM that comprised those filled with biocomplex Bio-OssTM in association with fibrin biopolymer. PBM was applied immediately after the surgery and three times a week every other day, with the parameters: wavelength of 830 nm, energy density 6.2 J/cm2, output power 30 mW, beam area of 0.116 cm2, irradiance 0.258,62 W/cm2, energy/point 0.72 J, total energy 2.88 J. Fourteen and 42 days after the surgery, animals were euthanatized and subjected to microtomography, qualitative and quantitative histological analysis. Results: The BC-PBM and XS-PBM groups had a similar evolution in the tissue repair process, with a higher density of the volume of new formed bone in relation to the groups without PBM (p = 0.04086; p = 0.07093, respectively). Intense vascular proliferation and bone deposition around the biomaterial particles were observed in the animals of the groups in which biocomplex was applied (XS and XS-PBM). Conclusion: PBM therapy allowed an improvement in the formation of new bone, with a more organized deposition of collagen fibers in the defect area. Biocomplex favored the insertion and permanence of the particulate material in bone defects, creating a favorable microenvironment for accelerate repair process.

Experimental study on rabbit lamellar corneal transplantation with double-layer corneal stromal lens attactched by fibrin sealant / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the biocompatibility of double-layer corneal stromal lens attactched by fibrin sealant(FS)<i>in vivo</i>, and to explore the feasibility of using this material for corneal transplantation.<p>METHODS: Fifteen healthy and clean New Zealand white rabbits were selected for a self-control study. The right eye of the rabbit was used as the experimental eye and the left eye was used as the control eye. The experimental eyes used FS adhesived double-layer corneal stromal lens as the material for lamellar keratoplasty, and the control eyes did not undergo manual intervention. At 7,14, and 28d after surgery, a hand-held slit lamp was used to observe the cornea of the rabbits and then score the biocompatibility. The corneas of both eyes were taken for histopathological examination by HE staining to observe the corneal recovery at the same time.<p>RESULTS: Slit lamp observation results showed that by 28d after the operation, the corneal epithelium of the experimental eyes grew well, the degree of corneal transparency was basically restored, the degree of edema was reduced, the growth of neovascularization to the corneal edge was not aggravated, and no rejection reaction such as epithelial and endothelial rejection lines were seen; The control eyes had clear corneas and smooth corneal epithelium. The results of biocompatibility score showed that the degree of corneal implant edema gradually decreased, the transparency gradually recovered, the rejection reaction was less, and the biocompatibility of corneal implants was better in the experimental eyes after corneal transplantation. There were no differences in the degree of corneal transparency, edema and neovascularization growth between the experimental and control eyes at 28d after surgery(<i>P</i>>0.01). The results of histopathological examination showed that by 28d after corneal transplantation, there were 4-5 layers of corneal epithelial cells covering the surface of the implant in the experimental eyes, the corneal collagen was neatly and regularly arranged, no obvious inflammatory cell infiltration was seen in the implant, the boundary between the two lenses disappeared, the interlayer FS was completely absorbed by the organism, the implant was fused with the implant bed, and no obvious demarcation was seen.<p>CONCLUSION:Using FS pasted double-layer corneal stroma lens as a graft for lamellar keratoplasty has better recovery, less rejection and better biocompatibility, and can be used for lamellar keratoplasty.

Research progress on nano-calcium phosphate modified dental materials for the prevention and treatment of dental pulp diseases / 口腔疾病防治

@#Nanomaterials usually refer to tiny particles with a diameter of 1-100 nm, which often have unique physicochemical properties and are one of the main areas of research interest for development of dental biomaterials. Nano-calcium phosphate modified dental materials have been widely used in pit and fissure sealing, dental resin restoration, tooth adhesion, and root canal sealing. The current research shows that the dental material modified by nano-calcium phosphate has stronger mechanical properties and shows long-term calcium and phosphorus ion release and excellent ion recharging ability, which can promote the remineralization of tooth hard tissue and has good prospects for application. However, it is difficult to accurately simulate the complex environment of the oral cavity. Therefore, the biocompatibility, cytotoxicity and effect of clinical application of nano-calcium phosphate modified dental materials still needs further study. This review summarizes and discusses the recent research progress regarding nano-calcium phosphate modified dental materials in the prevention and treatment of dental pulp diseases.

Efficacy of homologous fibrin sealant in the surgery for pneumothorax

Background: Prolonged air leakage following pneumothorax surgery is a significant issue causing increased hospital stay and morbidity. This study aimed to investigate the cost and efficacy of homologous fibrin sealant in preventing the air leakages.Methods: Among the patients who had undergone bullectomy and subtotal parietal pleurectomy for recurrent primary spontaneous pneumothorax via transaxillary mini thoracotomy between 2010 and 2018, two groups each including 35 cases were conducted as to whether fibrin sealent had been applied. These two patient groups were compared in terms of age, gender, duration of air leakage and cost.Results: Mean age of whole group of patients including 59 males and 11 females was 21.5 years. Mean values of air leakage duration and cost of hospital stay was calculated as 1.94 days and 2777 TL for sealant applied group and 2.97 days and 1200 TL for sealent unapplied group, respectively. The patient groups did not indicate a statistically difference in terms of age and gender whereas duration of air leakage was shorter but cost was higher in the group for whom fibrin sealant had been administered (p<0.001). None of the patients developed mortality but recurrence was present in 4 (5.7%) patients.Conclusions: Although homologous fibrin sealant applied in pneumothorax surgery results in cost increase, it contributes to surgical outcomes by preventing possible additional complications in consideration of shortened duration of air leakage.

Neuroprotection and immunomodulation by dimethyl fumarate and a heterologous fibrin biopolymer after ventral root avulsion and reimplantation

Ventral root avulsion (VRA) is an experimental approach in which there is an abrupt separation of the motor roots from the surface of the spinal cord. As a result, most of the axotomized motoneurons degenerate by the second week after injury, and the significant loss of synapses and increased glial reaction triggers a chronic inflammatory state. Pharmacological treatment associated with root reimplantation is thought to overcome the degenerative effects of VRA. Therefore, treatment with dimethyl fumarate (DMF), a drug with neuroprotective and immunomodulatory effects, in combination with a heterologous fibrin sealant/biopolymer (FS), a biological glue, may improve the regenerative response. Methods: Adult female Lewis rats were subjected to VRA of L4-L6 roots followed by reimplantation and daily treatment with DMF for four weeks. Survival times were evaluated 1, 4 or 12 weeks after surgery. Neuronal survival assessed by Nissl staining, glial reactivity (anti-GFAP for astrocytes and anti-Iba-1 for microglia) and synapse preservation (anti-VGLUT1 for glutamatergic inputs and anti-GAD65 for GABAergic inputs) evaluated by immunofluorescence, gene expression (pro- and anti-inflammatory molecules) and motor function recovery were measured. Results: Treatment with DMF at a dose of 15 mg/kg was found to be neuroprotective and immunomodulatory because it preserved motoneurons and synapses and decreased astrogliosis and microglial reactions, as well as downregulated the expression of pro-inflammatory gene transcripts. Conclusion: The pharmacological benefit was further enhanced when associated with root reimplantation with FS, in which animals recovered at least 50% of motor function, showing the efficacy of employing multiple regenerative approaches following spinal cord root injury.(AU)

Fluoride Release of Giomer and Resin Based Fissure Sealants / Liberación de flúor de sellantes de fosas y fisuras a base de resina y/o ionómero

ABSTRACT Fissure sealants are applied to teeth to prevent caries development. The presence of the fissure sealant creates a protective barrier, which prevents plaque accumulation to the pits and fissure. They have a significant role in preventing pit and fissure caries. The aim of this study was to evaluate the time-dependent fluoride ion release of giomer- and resin-based fissure sealants. Fissure sealants were divided into 4 groups: BeautiSealant (Shofu, Japan), Clinpro Sealant (3M ESPE, USA), Helioseal F (Ivoclar Vivadent, Liechtenstein), Fissurit F (Voco, Germany). Disk shaped samples were prepared for each sealant material tested, and they were transferred into polyethylene vials containing 5 ml of deionized water. Fluoride ion diffusion was determined on days 1,2,3,7,14,21, and 28 (n=7). The fluoride concentration in these samples was analyzed using a pre-calibrated spectrophotometer in parts per million (ppm). These experiments were performed in triplicates at room temperature. ANOVA and Tukey's HSD test were used for statistical analysis. BeautiSealant was released the highest amount of fluoride on day 1 (5.33 ppm), followed by a sudden decrease on the day 2 (2.17ppm). The burst effect was observed only in this group. Clinpro Sealant, Fissurit F and HelioSeal F groups presented fluoride release of 2.69, 2.94 and 2.91 ppm on the first day, respectively, without a significant difference (p>0.05). After the first week, a constant fluoride release level has been reached. The fluoride release for the three resin-based fissure sealants was slightly lower than that for the giomer-based. After the first week, materials exhibited no significant difference and reached a plateau. The usage of a high and prolonged fluoride-releasing fissure sealant material should be considered by clinicians, particularly in patients with caries risk.

RESUMEN Los sellantes de fosas y fisuras se utilizan con el objetivo de prevenir el desarrollo de caries. La presencia del sellante crea una barrera protectora, que evita la acumulación de placa en las fosas y fisuras. Tienen un papel importante en la prevención de la caries. El objetivo de este estudio fue evaluar la liberación de iones fluoruro de los sellantes de fosas y fisuras a base de Ionómeros y resinas. Los sellantes de fosas y fisuras se dividieron en 4 grupos: BeautiSealant (Shofu, Japón), Clinpro Sealant (3M ESPE, EE. UU.), Helioseal F (Ivoclar Vivadent, Liechtenstein), Fissurit F (Voco, Alemania). Se prepararon muestras en forma de disco para cada material, y se transfirieron a viales de polietileno que contenían 5 ml de agua desionizada. La difusión de iones fluoruro se determinó en los días 1,2,3,7,14,21 y 28 (n=7). La concentración de fluoruro en estas muestras se analizó utilizando un espectrofotómetro precalibrado en partes por millón (ppm). Estos experimentos se realizaron por triplicado a temperatura ambiente. ANOVA y la prueba de HSD de Tukey se utilizaron para el análisis estadístico. BeautiSealant liberó la mayor cantidad de fluoruro en el día 1 (5.33 ppm), seguido por una disminución repentina en el día 2 (2.17ppm). Los grupos Clinpro Sealant, Fissurit F y HelioSeal F presentaron una liberación de fluoruro de 2.69, 2.94 y 2.91 ppm el primer día, respectivamente, sin una diferencia significativa (p> 0.05). Posterior a la primera semana, fue alcanzado un nivel constante de liberación de fluoruro. La liberación de flúor para los tres sellantes de fosas y fisuras a base de resina fue ligeramente inferior a la de los Ionómeros. Después de la primera semana, los materiales no mostraron diferencias significativas. Los odontólogos deben considerar el uso de un material sellante de fosas y fisuras que promueva la liberación de flúor a lo largo del tiempo, especialmente en pacientes con riesgo de caries.

Prospective Study on the Impact of the Use of Human Fibrin Sealant free of Clot-Stabilizing Agents in Total Knee Arthroplasty / Estudo prospectivo sobre o impacto do uso do selante de fibrina humano livre de agentes estabilizadores de coágulo na artroplastia total de joelho

Abstract Objective The present study aimed to evaluate the results of the intraoperative topical use of a human fibrin sealant free of clot-stabilizing agents in total knee arthroplasties (TKAs), looking for differences between groups regarding blood loss, transfusion requirement, length of hospital stay, pain perception, range of motion (ROM), and incidence of complications. Methods We have analyzed prospectively an intervention group with 32 patients (Sealant) and a control group with 31 patients (Control) with symptomatic knee osteoarthritis who underwent TKA. Results The results were similar between the groups regarding visible blood loss in the drain in 24 hours (Control, 276.5 mL ± 46.24 versus Sealant, 365.9 mL ± 45.73), total blood loss in 24 hours (Control, 930 mL ± 78 versus Sealant, 890 mL ± 67) and in 60 hours after surgery (Control, 1,250 mL ± 120 versus Sealant, 1,190 mL ± 96), blood transfusion requirement (which occurred only in 1 control patient), length of hospital days stay (Control, 5.61 ± 0.50 versus Sealant, 4.81 ± 0.36), postoperative pain, and ROM. Sealant use was not related to wound healing complications, to infection, or to deep venous thrombosis. Conclusion We have concluded that the hemostatic agent composed of human fibrin was not effective in reducing bleeding volume and blood transfusion requirement, nor it interfered with hospital length of stay, pain perception, and ROM. Its use was not related to any complications.

Resumo Objetivo O objetivo do presente estudo foi avaliar os resultados do uso tópico intraoperatório do selante de fibrina humano livre de agentes estabilizadores de coágulo em pacientes com osteoartrite (OA) submetidos a artroplastia total de joelho (ATJ), buscando diferenças entre os grupos em relação à perda sanguínea, à necessidade transfusional, ao tempo de internação hospitalar, à percepção de dor, à amplitude de movimento e à incidência de complicações. Métodos Foram analisados prospectivamente um grupo de intervenção (Selante) com 32 pacientes e um grupo controle (Controle) com 31 pacientes, com OA sintomática dos joelhos, submetidos a ATJ. Resultados Os resultados foram semelhantes entre os grupos, em relação à perda sanguínea visível no dreno em 24 horas (Controle 276,5 mL ± 46,24 versus Selante 365,9mL ± 45,73), à perda sanguínea total em24 horas (Controle 930 mL ± 78 versus Selante 890 mL ± 67) e em 60 horas de pós-operatório (Controle 1.250 mL ± 120 versus Selante 1.190 mL ± 96), à necessidade de hemotransfusão (ocorreu em apenas 1 controle), ao tempo de dias na permanência hospitalar (Controle 5,61 ± 0,50 [n = 31] versus Selante 4,81 ± 0,36), dor pós-operatória e amplitude de movimento. O uso do agente selante de fibrina não se relacionou à ocorrência de complicações da cicatrização de ferida, de infecção ou de trombose venosa profunda. Conclusão Concluímos que o agente hemostático de fibrina humana não foi eficaz em reduzir o volume de sangramento e a necessidade de hemotransfusão ou em interferir no tempo de internação hospitalar, na percepção de dor e na amplitude de movimento. Seu uso não se relacionou a nenhuma complicação.

Evaluation of High-power Light Emitting Diode Curing Light on Sealant Polymerization / 대한소아치과학회지

This study aimed to determine whether the curing times of Xtra Power and High Power modes of high-power light emitting diode (LED) curing light are sufficient for polymerization of resin sealants. The specimens were prepared and their microhardness values were measured and compared with those of specimens polymerized under conventional LED curing light.The filled sealant polymerized for 8 seconds in the High Power mode and for 3 seconds in the Xtra Power mode showed significantly lower microhardness than the control specimen (p = 0.000). The unfilled sealant polymerized for 8, 12 seconds in the High Power mode and for 6 seconds in the Xtra Power mode showed significantly lower microhardness than the control specimen (p = 0.000).The results of this study suggest that the short curing time with the Xtra Power and High Power modes of highpower LED curing light are not sufficient for adequate polymerization of sealants under specific conditions, taking into account the curing times and the type of sealant.

Fibrin biopolymer as scaffold candidate to treat bone defects in rats

Bone tissue repair remains a challenge in tissue engineering. Currently, new materials are being applied and often integrated with live cells and biological scaffolds. The fibrin biopolymer (FBP) proposed in this study has hemostatic, sealant, adhesive, scaffolding and drug-delivery properties. The regenerative potential of an association of FBP, biphasic calcium phosphate (BCP) and mesenchymal stem cells (MSCs) was evaluated in defects of rat femurs. Methods: Adult male Wistar rats were submitted to a 5-mm defect in the femur. This was filled with the following materials and/or associations: BPC; FBP and BCP; FBP and MSCs; and BCP, FBP and MSCs. Bone defect without filling was defined as the control group. Thirty and sixty days after the procedure, animals were euthanatized and subjected to computed tomography, scanning electron microscopy and qualitative and quantitative histological analysis. Results: It was shown that FBP is a suitable scaffold for bone defects due to the formation of a stable clot that facilitates the handling and optimizes the surgical procedures, allowing also cell adhesion and proliferation. The association between the materials was biocompatible. Progressive deposition of bone matrix was higher in the group treated with FBP and MSCs. Differentiation of mesenchymal stem cells into osteogenic lineage was not necessary to stimulate bone formation. Conclusions: FBP proved to be an excellent scaffold candidate for bone repair therapies due to application ease and biocompatibility with synthetic calcium-based materials. The satisfactory results obtained by the association of FBP with MSCs may provide a more effective and less costly new approach for bone tissue engineering.(AU)

Unique heterologous fibrin biopolymer with hemostatic, adhesive, sealant, scaffold and drug delivery properties: a systematic review

Fibrin biopolymers, previously referred as "fibrin glue" or "fibrin sealants", are natural biomaterials with diverse applications on health. They have hemostatic, adhesive, sealant, scaffold and drug delivery properties and have become widely used in medical and dental procedures. Historically, these biomaterials are produced from human fibrinogen and human or animal thrombin, and the possibility of transmission of infectious diseases by human blood is not ruled out. In the 1990s, to overcome this problem, a new heterologous biomaterial composed of a thrombin-like enzyme purified from Crotalus durissus terrificus venom and a cryoprecipitate rich in fibrinogen extracted from buffaloes Bubalus bubalis blood has been proposed. Therefore, a systematic review of studies on exclusively heterologous fibrin sealants published between 1989 and 2018 was carried out using the following databases: PubMed, SciELO and Google Scholar. The keyword used was "heterologous fibrin sealant". The search resulted in 35 scientific papers in PubMed, four in SciELO and 674 in Google Scholar. After applying the inclusion/exclusion criteria and complete reading of the articles, 30 studies were selected, which formed the basis of this systematic review. It has been observed that the only completely heterologous sealant is the one produced by CEVAP/UNESP. This heterologous biopolymer is proven effective by several studies published in refereed scientific journals. In addition, clinical trials phase I/II for the treatment of chronic venous ulcers authorized by the Brazilian Health Regulatory Agency (ANVISA) were completed. Preliminary results have indicated a safe and promising effective product. Phase III clinical trials will be proposed and required to validate these preliminary findings.(AU)

Review and suggestion on the evaluation of the effect and the benefit of a pit and fissure sealant project / 口腔疾病防治

@#As a professional method to prevent decayed teeth and an oral public health project, pit and fissure sealant is widely used domestically. How to evaluate the effect and benefit of the community pit and fissure closure project, especially the community full coverage pit and fissure closure project, requires investigation. The Guangzhou Children′s Pit and Fissure Sealing Project was carried out in an orderly manner and was administered normatively. A retrospective cohort study with use of a sample survey was used in this program. According to cavity occurrence and reservations of sealant in the first permanent molar, the samples were divided into the following two groups: the sealing group with indication and the sealing group without indication. Reservations of sealant, cavity incidence, reduced incidence, net profit, cost-effectiveness and cost-benefits of the program were evaluated. Some promotable experiences were summarized during this project. Various relevant theories and reports of the pit and fissure sealant project evaluation were reviewed and previous studies were discussed in this article. By analyzing the methods and results of the pit and fissure sealant project in Guangzhou, suggestions are made for project evaluation, especially sample grouping and evaluation indicators, which was refer to a further study for the pit and fissure sealing project.

Histopathological Analysis of Sealant Infiltration in White Spot Enamel Lesions (WSEL) / Análisis Histopatológico de Infiltración de Sellante en Lesiones de Mancha Blanca en Esmalte (LMBE)

ABSTRACT: The use of resin sealants has shown partial infiltration of White-Spot Enamel Lesions in vitro (WSEL). The aim of the present study was to perform a morphological evaluation of natural WSEL when infiltrated using a commercially available sealant (Concise, 3M- ESPE). 20 bicuspids extracted for orthodontic reasons from patients ranging 18 to 30 years old, which had WSEL, were used in this study. The patients agreed to donate their teeth by signing a written consent. Every WSEL was assessed microscopically (Stereo Zeiss Axiscop) and then photographed (ProScope HR microscope). Prior to applying the sealant the lesion was etched using phosphoric acid at 37 % (3M-ESPE, St Paul, MN, USA.) for 30 seconds, washed for 40 seconds and then air-dried. The sealant was marked with rhodamine B (1mg/ml) and was applied according to the manufacturer directions. A specimen of approximately 100 mm was obtained for every WSEL by cutting perpendicularly through the lesion (Isomet 1000, Buehler Co.) and grinding (600 grit). The specimens were evaluated using: clear camp, polarized light, and epifluorescence microscopy. Images were taken of each specimen for every microscopic evaluation using a slide film (Kodak Ektachrome film 400 ASA). The images were digitalized by scanning at 1200 dpi resolution (Epson Filmscan 200) and then saved as JPEG and TIFF files. The sealant infiltration into The WSEL was assessed by means of analysis, processing and digital superimposing using Adobe Photoshop 7.0 and Matrox Inspector 1.07. It was concluded that the sealant infiltrated the whole body zone of the lesion. The depth of penetration of sealants into White Spot Enamel Lesion plays an important role in the control of caries lesion progression.

RESUMEN: El uso de sellantes de resina ha demostrado lograr la infiltración parcial de lesiones de mancha blanca en esmalte in vitro (LMBE). El objetivo del presente estudio fue realizar una evaluación morfológica de la infiltración a LMBE naturales utilizando un sellante disponible comercialmente (Concise, 3M-ESPE). Se utilizaron en este estudio, 30 bicúspides extraídos por razones de ortodoncia en pacientes que tenían entre 18 a 30 años de edad, y presentaban LMBE. Los pacientes aceptaron donar sus dientes firmando un consentimiento informado. Cada LMBE se evaluó microscópicamente (Stereo Zeiss Axiscop) y luego se fotografió (microscopio ProScope HR). Antes de aplicar el sellante, la lesión se grabó usando ácido fosfórico al 37 % (3M-ESPE, St Paul, MN, EE. UU.) durante 20 segundos, luego se lavó durante 40 segundos y finalmente se secó con aire de jeringa triple. El sellante se marcó con rodamina B (1 mg / ml) y se aplicó siguiendo las instrucciones del fabricante. Se obtuvo una muestra de aproximadamente 100 mm para cada LMBE cortando perpendicularmente a través de la lesión (Isomet 1000, Buehler Co.) y trituración (grano 600). Las muestras se evaluaron usando: campo claro, luz polarizada y microscopía de epifluorescencia. Se tomaron imágenes de cada espécimen para la evaluación microscópica usando una película deslizante (Kodak Ektachrome film 400 ASA). Las imágenes se digitalizaron escaneando a una resolución de 1200 ppp (Epson Filmscan 200) y luego se guardaron como archivos JPEG y TIFF. La infiltración del sellante en las LMBE se evaluaron mediante análisis, procesamiento y superposición digital utilizando Adobe Photoshop 7.0 y Matrox Inspector 1.07. Se concluyó que el sellante infiltró toda la zona del cuerpo de la lesión. La capacidad de penetración en profundidad de los sellantes en Lesiones de Mancha Blanca del Esmalte desempeñan un rol importante en el control de la progresión de las lesiones de caries.

La Mínima Incisión en la cirugía de catarata pediátrica / Minor Incision pediatric cataract surgery

Introducción: las cataratas congénitas e infantiles constituyen una amenaza para el desarrollo visual en los niños, pues inhiben o detienen potencialmente su maduración, unido a la complejidad de su tratamiento. Objetivo: evaluar los resultados visuales y anatómicos de la cirugía de catarata infantil con el uso de la incisión corneal pequeña autosellante. Método: se realizó un estudio transversal, cuyo universo estuvo constituido por 19 niños (24 ojos) con catarata congénita e infantil, intervenidos quirúrgicamente en el Hospital Pediátrico de Holguín en 2016 y 2017. Se evaluaron las variables: edad, sexo, etiología, agudeza visual pre y postoperatoria a los 3 meses, técnica quirúrgica empleada, astigmatismo inducido, conservación de la transparencia y curvatura corneal, así como complicaciones. Resultados: predominó el grupo de edad de 3 a 8 años con el 47,4%, y el sexo masculino, con el 79%, y la etiología congénita ascendió hasta el 50%. La agudeza visual preoperatoria entre percepción luminosa a 0,1 se presentó en el 50%. En la postoperatoria del 62,5% de los casos se obtuvo entre 0,7 a 1,0. La técnica quirúrgica empleada fue la incisión corneal pequeña autosellante, en el 75%, y el astigmatismo inducido fue bajo, menor de 1 D. La transparencia corneal se conservó en el 100%, y en el 62,5% la curvatura corneal tuvo variaciones mínimas (≤0,50 D). Las complicaciones más frecuentes fueron opacidad de la cápsula posterior con 50% y uveítis anterior con el 37,5%. Conclusiones: el uso de la incisión corneal pequeña autosellante en la cirugía de catarata infantil garantiza buenos resultados visuales y anatómicos.

Introduction: congenital and infant cataracts are a threat for children visual development because this can mainly be inhibited or stopped and it also requires a complicated treatment. Objective: to evaluate anatomic and visual results of infant cataracts surgeries by self-sealant corneal incision. Method: a transversal study which universe was composed by 19 children (24 eyes) suffering from congenital or infants cataracts, who were operated at the Pediatric Hospital of Holguín, during 2016 to 2017, was carried out. Some variables like: age, sex, etiology, pre and postsurgical visual sharpness in the first 3 months, surgical techniques, induced astigmatism, transparency preservation corneal curve and possible complications, were evaluated. Results: ages from 3 to 8 years prevailed up to 47.4%, as well as males with 79% and congenital etiology with a 50%. Pre-surgical visual sharpness was in the range of PL- 0.1 representing the 50%, while post- surgical was between 0.7- 1.0 in 62.5% of the cases. Surgical technique was the self-sealant small incision in 75%. Induced astigmatism was low, less than 1D. Corneal transparency was obtained 100%, and the corneal curvature had minor variations (≤0.50D) in 62.5% of the cases. Most frequent complications were posterior capsule dullness (50%) and the anterior uveitis (37.5%). Conclusions: the use of the small self-sealant corneal incision in the infant cataracts surgery guarantees good anatomic and visual outcomes.

Transcleral approach for closing retinal tears using DuraSeal� hydrogel sealant

Purpose: The aim of this study was to evaluate an innovative approach for closing retinal tears using DuraSeal� (DS) hydrogel sealant in a rabbit model. Methods: Retinal detachment with a small tear was performed on 20 New Zealand rabbits. Thereafter, rabbits were divided into two groups; the experimental group received a transscleral injection of 0.1 ml DS into the subretinal space whereas the control group received sham injection of saline. Eyes were clinically evaluated using indirect ophthalmoscopy, retinal function was recorded in ten rabbits by electroretinography and the sealant's toxicity was evaluated histopathologically. Results: We found that the DS hydrogel was easily injected transsclerally into the subretinal space of the detached retinas with no major complications. Retinal reattachment was seen in both groups within 2 weeks with no toxicity to the sensory retina. There were no significant differences in retinal function between groups. Conclusion: Subretinal injection of hydrogel through a transscleral route is easy to perform and may open a new avenue in the treatment of retinal detachment. However, the efficacy of the DS as a tamponade for sealing retinal tear is yet to be definite. Long-term clinical, functional, and toxicological studies are needed to evaluate its full potential for clinical applications.

Combination of heterologous fibrin sealant and bioengineered human embryonic stem cells to improve regeneration following autogenous sciatic nerve grafting repair

Peripheral nerve injury is a worldwide clinical problem, and the preferred surgical method for treating it is the end-to-end neurorrhaphy. When it is not possible due to a large nerve gap, autologous nerve grafting is used. However, these surgical techniques result in nerve regeneration at highly variable degrees. It is thus very important to seek complementary techniques to improve motor and sensory recovery. One promising approach could be cell therapy. Transplantation therapy with human embryonic stem cells (hESCs) is appealing because these cells are pluripotent and can differentiate into specialized cell types and have self-renewal ability. Therefore, the main objective of this study was to find conditions under which functional recovery is improved after sciatic nerve neurorrhaphy. We assumed that hESC, either alone or in combination with heterologous fibrin sealant scaffold, could be used to support regeneration in a mouse model of sciatic nerve injury and repair via autografting with end-to-end neurorrhaphy. Methods Five millimeters of the sciatic nerve of C57BL/6 J mice were transected off and rotated 180 degrees to simulate an injury, and then stumps were sutured. Next, we applied heterologous fibrin sealant and/or human embryonic stem cells genetically altered to overexpress fibroblast growth factor 2 (FGF2) at the site of the injury. The study was designed to include six experimental groups comprising neurorrhaphy (N), neurorrhaphy + heterologous fibrin sealant (N + F), neurorrhaphy + heterologous fibrin sealant + doxycycline (N + F + D), neurorrhaphy + heterologous fibrin sealant + wild-type hESC (N + F + W), neurorrhaphy + heterologous fibrin sealant + hESC off (N + F +T), and neurorrhaphy + heterologous fibrin sealant + hESC on via doxycycline (N + F + D + T). We evaluated the recovery rate using Catwalk and von Frey functional recovery tests, as well as immunohistochemistry analysis. Results The experiments indicated that sensory function improved when transgenic hESCs were used. The regeneration of sensory fibers indeed led to increased reflexes, upon stimulation of the paw ipsilateral to the lesion, as seen by von-Frey evaluation, which was supported by immunohistochemistry. Conclusions Overall, the present data demonstrated that transgenic embryonic stem cells, engineered to overexpress FGF-2 in an inducible fashion, could be employed to support regeneration aiming at the recovery of both motor and sensory functions.(AU)

Penetration and Microleakage Assessment of Flowable Resin Applied on Carious Fissure Following Various Fissurotomy Techniques / 대한소아치과학회지

The purpose of this study was to evaluate the effect of fissurotomy on the penetration and microleakage of flowable resins for carious fissures. A total of 250 extracted premolars with early fissure caries were selected and divided into five groups according to the fissurotomy; no fissurotomy (n = 50), fissurotomy with Fissurotomy® original bur (n = 50), fissurotomy with Fissurotomy® Miro NTF bur (n = 50), fissurotomy with SF104R tapered diamond bur (n = 50), fissurotomy with 1/2 round carbide bur (n = 50). Two types of flowable resins (UniFil®Flow, Filtek®Flow) were used as sealing materials. All samples were sectioned and observed using a stereoscopic microscope after thermocycling and immersing in methylene blue solution. The adaptation of flowable resin to the fissure wall was observed using scanning electron microscopy. The penetration of flowable resin into the carious fissure was significantly increased by fissurotomy, which also decreased microleakage. Fissure preparation using different burs showed a significantly different in penetration, but did not show any difference in microleakage. Unifil®Flow showed better penetration than Filtek®Flow, but there was no significant difference in microleakage. Fissurotomy can be used to increase the penetration of flowable resin into carious fissures and decrease microleakage.