Raloxifene modulates regulators of osteoclastogenesis and angiogenesis in an oestrogen deficiency periapical lesion model.

AIM: To analyse the local regulatory mechanisms of osteoclastogenesis and angiogenesis during the progression of periapical lesions in female rats with oestrogen deficiency and treatment with raloxifene (RLX). METHODOLOGY: Female Wistar rats were distributed into groups: SHAM-veh, subjected to sham surgery and treated with a vehicle; OVX-veh, subjected to ovary removal and treated with a vehicle; and OVX-RLX, subjected to ovary removal and treated with RLX. Vehicle or RLX was administered orally for 90 days. During treatment, the dental pulp of mandibular first molars was exposed to the oral environment for induction of periapical lesions, which were analysed after 7 and 30 days. After the experimental periods, blood samples were collected for measurement of oestradiol, calcium, phosphorus and alkaline phosphatase. The rats were euthanized and the mandibles removed and processed for immunohistochemical detection of receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG), hypoxia-inducible factor-1 alpha (HIF-1α) and bone-specific alkaline phosphatase (BALP). Data were compared using Kruskal-Wallis followed by Dunn test (nonparametric values) and anova followed by the Tukey's test (parametric values). RESULTS: The plasma concentration of oestradiol showed hypo-oestrogenism in the rats subjected to ovary removal. On day 7, alkaline phosphatase activity, calcium and phosphorus were higher in the OVX-RLX group than in the OVX-veh group (P < 0.001), but immunolabelling for RANKL and HIF-1α was lower in OVX-RLX group (P < 0.001). On day 30, the OVX-veh group had higher immunolabelling for RANKL than the OVX-RLX group (P < 0.05). There were no significant differences in the immunoreactivity of OPG and BALP between any groups at either time-point (P > 0.05). CONCLUSION: RLX therapy reversed the increased levels of the local regulators of both osteoclastogenesis and angiogenesis induced by oestrogen deficiency.

The role of IL-6 on apical periodontitis: a systematic review.

The aim of this review was to examine current knowledge of the role of interleukin-6 (IL-6) in apical periodontitis (AP) pathogenesis as an inflammatory or pro-inflammatory cytokine. It also looked at whether IL-6 could serve as a measure for differential diagnosis or as a biomarker that can further predict the progression of bone resorption. A systematic review relating to AP and IL-6 was made via PubMed, BIOSIS, Cochrane, EMBASE and Web of Science databases using keywords and controlled vocabulary. Two independent reviewers first screened titles and abstracts and then the full texts. The reference lists of the identified publications were examined for additional titles. Eighteen papers were studied in total. In vitro studies (n = 6) revealed that IL-6 is present in AP, and its levels are proportional to the size of the periapical lesions. Neutrophils and macrophages resident in these lesions can produce IL-6 in vitro after a bacterial stimulus. Animal studies (n = 5) showed that IL-6 is present in AP and that osteoblasts can produce IL-6 in vivo. On the other hand, two studies using IL-6 knockout mice revealed larger periapical lesions when compared with control groups, demonstrating IL-6's role as an anti-inflammatory cytokine. In human studies (n = 7), IL-6 was identified in AP, and its levels were higher in symptomatic, epithelialized and large lesions than in asymptomatic and small lesions. These data lead to the conclusion that IL-6 may play a pro-inflammatory role, increasing its levels and reabsorbing bone in the presence of infections. When IL-6 is not present, other cytokines such as IL-1 and TNF-α induce bone resorption. Further studies about the relationship between AP development and the cytokine network must be performed to establish the exact role of each cytokine in the inflammatory process.

Relationships between oral infections and blood glucose concentrations or HbA1c levels in normal and diabetic rats.

AIM: To measure glycosylated haemoglobin (HbA1c) in a diabetic model as a means of investigating apical periodontitis and periodontal disease for their effects on both blood glucose concentrations and long-term glycaemic control. METHODOLOGY: Wistar rats (n = 80) were assigned to one of eight groups (10 animals/group): control (G1), apical periodontitis (G2), periodontal disease (G3), apical periodontitis and periodontal disease (G4), diabetic (G5), diabetic with apical periodontitis (G6), diabetic with periodontal disease (G7) and diabetic with apical periodontitis and periodontal disease (G8). A diabetic state was induced with streptozotocin. Apical periodontitis was induced by dental exposure to the oral environment. Periodontal disease was induced by periodontal ligature. Blood glucose concentrations were measured at 0, 6, 30 and 60 days. After euthanization, rat maxillae were excised and processed for histopathology and for measurement of HbA1c levels by ion exchange chromatography. Data were tabulated and subject to statistical analysis (P < 0.05). RESULTS: The inflammatory infiltrate and alveolar bone resorption were more severe in diabetic rats (P < 0.05). Diabetic rats exhibited higher levels of HbA1c independent of apical periodontitis or periodontal disease (P < 0.05). However, the presence of oral infections in diabetic rats was associated with increased blood glucose concentrations (P < 0.05). CONCLUSIONS: Oral infections affect glycaemic conditions in diabetic rats and increase HbA1c levels in normoglycaemic or diabetic rats.

Histological evaluation of MTA as a root-end filling material.

AIM: To assess the histological response associated with grey mineral trioxide aggregate (GMTA) and zinc oxide eugenol (ZOE) as root-end filling materials in teeth where the root canals were not filled and the coronal access cavities were not restored. METHODOLOGY: Periapical lesions were developed in 24 premolar teeth in three dogs. The root canals were prepared and half of them were dried, filled and the coronal access restored (closed). The remaining teeth were not root filled and no coronal restoration was placed (open). Apical root-end resections were performed 3 mm from the apex, and root-end cavities were prepared with ultrasonic tips. These were randomly filled with either ZOE or GMTA in the same number of specimens using MAPSYSTEM device. After 180 days the animals were killed and blocks of tissues removed and processed for histological examination. Periradicular tissue reaction was evaluated, including severity of inflammation and cementum formation. Statistical analysis was performed using anova analysis and Tukey's test. RESULTS: A significant difference was found between the levels of inflammation in the periradicular tissues of the GMTA/closed group, compared with the ZOE/open and ZOE/closed groups (P < 0.05) but not between GMTA/closed and GMTA/open groups. Cementum formation was not found over any ZOE specimens but over MTA in all specimens. No microorganisms were found in the interface between the material and the dentinal walls. CONCLUSIONS: GMTA was associated with less periapical inflammation and tissue response when used as a root-end filling material, even when no root filling or coronal restoration was present.

Filtración marginal tras la obturación de perforaciones radiculares laterales con distintos materiales / Marginal leakage after obturation of root perforations with different materials

En este estudio se emplearon 30 dientes humanos uniradiculares recientemente extraídos. Se partieron los dientes en dos mitades y cada mitad recibió 2 perforaciones. Las perforaciones fueron rellenadas con los siguientes materiales: 1- Sealapex con óxido de zinc y óxido de calcio, 2- Sealapex con óxido de zinc, 3- Sealapex, 4- ionómero de vidrio, 5- MTA Ângelus, 6- Amalgama, 7- Cemento Portland, 8- Pro Root MTA. Después de 48 horas en cámara húmeda, los especímenes fueron inmersos en azul de metileno al 2% al vacío y las filtraciones marginales evaluadas linealmente. Los mejores resultados fueron obtenidos con los materiales 1, 2 y 3 (p=0,05)

Thirty human single rooted tooth recently extracted were employed in this study. The tooth were seccioned longitudinally in the middle and each half received two perforations. The perforations were filled with the following materials: 1- Sealapex with zinc oxide and calcium oxide, 2- Sealapex with zinc oxide, 3- Sealapex, 4- Glass ionomer, 5- Angelus MTA., 6-Amalgam, 7-Porland cement, 8-Pro Root MTA. The teeth remained in a damp camera for 48 hours and then were placed into a 2% methylene blue dye solution under vacuum, and leakage was linearly evaluated. The results showed better results with the sealers 1,2 and 3 (p=0.05)

Healing process of dog dental pulp after pulpotomy and pulp covering with mineral trioxide aggregate or Portland cement.

Considering several reports about the similarity between the chemical compositions of the mineral trioxide aggregate (MTA) and Portland cement (PC), the subject of this investigation was to analyze the behavior of dog dental pulp after pulpotomy and direct pulp protection with these materials. After pulpotomy, the pulp stumps of 26 roots of dog teeth were protected with MTA or PC. Sixty days after treatment, the animal was sacrificed and the specimens removed and prepared for histomorphological analysis. There was a complete tubular hard tissue bridge in almost all specimens. In conclusion, MTA and PC show similar comparative results when used in direct pulp protection after pulpotomy.

Reaction of rat connective tissue to implanted dentin tube filled with mineral trioxide aggregate, Portland cement or calcium hydroxide.

The subject of this study was to observe the rat subcutaneous connective tissue reaction to implanted dentin tubes filled with mineral trioxide aggregate, Portland cement or calcium hydroxide. The animals were sacrificed after 7 or 30 days and the undecalcified specimens were prepared for histological analysis with polarized light and Von Kossa technique for mineralized tissues. The results were similar for the studied materials. At the tube openings, there were Von Kossa-positive granules that were birefringent to polarized light. Next to these granulations, there was an irregular tissue like a bridge that was Von Kossa-positive. The dentin walls of the tubes exhibited in the tubules a structure highly birefringent to polarized light, usually like a layer and at different depths. The mechanism of action of the studied materials has some similarity.

Reaction of rat connective tissue to implanted dentin tubes filled with mineral trioxide aggregate or calcium hydroxide.

This study was conducted to observe the rat subcutaneous connective tissue reaction to the implanted dentin tubes filled with calcium hydroxide or mineral trioxide aggregate. The animals were sacrificed after 7 and 30 days, and the specimens were prepared for morphological study. Some undecalcified specimens were prepared for histological analysis with polarized light and Von Kossa technique for calcium. The results were similar for both studied materials. At the tube openings, there were Von Kossa-positive granules that were birefringent to polarized light. Next to these granulations, there was an irregular tissue like a bridge that was Von Kossa-positive. The dentin walls of the tubes exhibited in the tubules a structure highly birefringent to polarized light, usually like a layer and at different depths. It is possible that the mechanism of action of both materials has some similarity.

Reaction of dogs' teeth to root canal filling with mineral trioxide aggregate or a glass ionomer sealer.

This study was conducted to observe the reaction of apical tissues of dogs' teeth after root canal filling with gutta-percha and mineral trioxide aggregate (MTA) or a glass ionomer (Ketac-Endo) as a sealer. The root canals were instrumented and filled by the lateral condensation technique with the sealers studied. Animals were killed 6 months later, and the specimens were removed and prepared for histological analysis. Results showed no inflammatory reaction of apical tissue and total closure of the apical foramen of all the teeth sealed with MTA. The teeth sealed with Ketac-Endo showed two cases of partial closure and different degrees of chronic inflammatory reaction. In conclusion, MTA exhibited better biological properties than Ketac-Endo.

Effect of root canal filling material and level of surgical injury on periodontal healing in dogs.

Some divergencies in the literature about periodontal healing after surgical injury stimulated the development of this experiment. The root canals of dogs' teeth were negotiated and filled by the lateral condensation technique with two kinds of sealers: Sealapex and zinc oxide-eugenol cement. In the second session, the bone tissue was exposed and one cavity was made at the apical third of the root and another at the border between the coronal and middle thirds, both penetrating into the root canal. Six months later the animals were sacrificed and the specimens prepared for histopathologic analysis. The results showed that the kind of filling material and the level of the periodontal wound exposing the root canal can influence the healing process.

Calcium hydroxide and a corticosteroid-antibiotic association as dressings in cases of biopulpectomy. A comparative study in dogs' teeth.

The subject of this paper was to study the behavior of the periapical tissues of dogs' teeth after biopulpectomy and dressing with calcium hydroxide or a corticosteroid-antibiotic association, before root canal filling with zinc oxide eugenol (ZOE) or Sealapex sealers. The teeth were overinstrumented and dressed for 7 days before the root canal filling. The animals were sacrificed 180 days after treatment and the specimens were prepared for morphological analysis. Specimens treated with Sealapex presented a higher number of cases with biological closure than ZOE. When the root canals were filled with ZOE, better results were observed with the use of the Ca(OH)2 dressing.

Apical leakage following root canal dressing with calcium hydroxide.

The purpose of this study was to analyse the apical leakage in teeth filled by the lateral condensation technique following medication with calcium hydroxide. One hundred and twenty extracted human teeth were biomechanically prepared by using exclusively reaming motion with files up to #40. Half of the teeth received a calcium hydroxide dressing for 3 days. The medication was removed by irrigation and reaming motion with files #40 up to #70. The teeth were divided in 6 experimental groups, according to the dimension of the utilized instrument. The root canals were filled and posteriorly the teeth were placed into a 2% methylene blue dye solution inside a flask, which was attached to a vacuum pump. Leakage was measured linearly, and the results showed significantly (p<0.01) less leakage in the experimental groups that received calcium hydroxide dressings than in the control groups. The results persisted even after the removal of 300 micrometers of dentin from the root canal dentinal walls.