Needle-free anesthetic polymeric device for dental anesthesia in children: A randomized clinical trial.

PURPOSE: To evaluate efficacy of an anesthetic mucoadhesive film with a polymeric device (PD) in promoting anesthesia compared to conventional local infiltration (LA) in children. METHODS: 50 children aged 6-10 years (both genders) needing similar procedures on homologous teeth on the maxilla were included. The parents and children were asked about perception of dental treatment. The child's heart rate per minute (bpm) and blood pressure were evaluated before and after each anesthetic technique (AT) procedure. Anesthesia efficacy was measured by reporting pain using Wong-Baker Faces Scale. Children's behavior and AT preferences were also evaluated. Paired T-test, chi-square and Wilcoxon test were used for statistical comparisons. RESULTS: Fear of anesthesia was reported by 50% of caregivers and by 66% of children. No difference was observed in systolic (P= 0.282) and diastolic (P= 0.251) blood pressure, comparing both AT. Difference was observed regarding the child's behavior when the PD was used (P= 0.0028). Evaluating the face scale, 74% of the children selected the "no pain" (face 0) (P< 0.0001) for PD, and 26% for LA. PD was preferred by 86% of children. Only 20% of the PD anesthesia needed to be complemented by LA. CLINICAL SIGNIFICANCE: The polymeric device presented promising results since most children did not report pain and dental procedures could be performed without local infiltration.

Ovariectomy Exacerbates Apical Periodontitis in Rats with an Increase in Expression of Proinflammatory Cytokines and Matrix Metalloproteinases.

INTRODUCTION: The aim of this study was to evaluate the gene expression of proinflammatory cytokines, matrix metalloproteinases (MMPs), and cathepsin K in apical periodontitis (AP) and the volume of lesions in ovariectomized and sham-operated rats. METHODS: Twenty 12-week-old female Wistar rats were subjected to ovariectomy (OVX) or sham surgery. After 9 weeks, access cavities were prepared in the maxillary and mandibular first molars, pulp tissue was removed, and canals were exposed to the oral environment during 21 days for the induction of AP. The groups were as follows: sham, OVX, sham+AP, and OVX+AP. Animals were euthanized, and blocks containing the maxillary first molar and the surrounding bone were removed for quantification of proinflammatory cytokines cathepsin K and MMP genes by real-time polymerase chain reaction. The hemimandibles containing the mandibular first molars were used for analysis of the AP lesion volume by micro-computed tomographic imaging. RESULTS: AP in OVX rats showed an increased expression of interleukin 1 beta, tumor necrosis factor alpha, interleukin 6, MMP-8, and MMP-13 (P < .05). OVX alone, without AP induction, did not affect the expression of the evaluated genes. Additionally, AP induced an increase in cathepsin K expression, without significant differences between AP in the sham and OVX groups (P > .05). Micro-computed tomographic imaging showed a significantly greater AP lesion mean volume in OVX compared with sham animals (P < .05). CONCLUSIONS: AP lesions in ovariectomized rats are larger and have an increased expression of proinflammatory cytokines and MMPs, indicating that the infection combined with ovariectomy has an important role in the regulation of these signaling molecules and enzymes during the development of AP. Based on that, it may be assumed that the hypoestrogenic condition aggravates inflammation and degradation of extracellular matrix components in AP, which may provide insight into understanding the development of AP in female postmenopausal patients.

Expression of Mineralization Markers during Pulp Response to Biodentine and Mineral Trioxide Aggregate.

INTRODUCTION: The purpose of this study was to compare the cell viability of dental pulp cells treated with Biodentine (Septodont, Saint-Maur, France) and mineral trioxide aggregate (MTA) and the in vitro and in vivo expression of mineralization markers induced by the 2 materials. METHODS: Human dental pulp cells isolated from 6 permanent teeth were stimulated with Biodentine and MTA extracts. Cell viability was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay, and quantitative reverse-transcriptase polymerase chain reaction was used to determine the expression of mineralization markers. Specimens of teeth from dogs treated with Biodentine and MTA after pulpotomy were used to determine the presence of osteopontin and alkaline phosphatase by immunohistochemistry and runt-related transcription factor 2 by immunofluorescence. RESULTS: No significant differences in cell viability were found between MTA and Biodentine extracts and controls after 24 and 48 hours (P > .05). After 48 hours, osteopontin (SPP1), alkaline phosphatase (ALP), and runt-related transcription factor 2 (RUNX2) expression was higher in MTA and Biodentine than in controls (P < .05). Osteopontin staining was more intense and spread over a greater number of areas in Biodentine than in MTA samples (P < .0001). Alkaline phosphatase staining of a mineralized tissue bridge was significantly different between materials (P < .0001), but no difference in alkaline phosphatase staining of pulp tissue was found between MTA and Biodentine (P = .2). Also, no significant difference in the number of cells labeled for runt-related transcription factor 2 by immunofluorescence was observed between materials (P > .05). CONCLUSIONS: Biodentine stimulated similar markers as MTA, but staining was more intense and spread over a larger area of the pulp tissue.