High-plasticity mineral trioxide aggregate and its effects on M1 and M2 macrophage viability and adherence, phagocyte activity, production of reactive oxygen species, and cytokines.

Objectives: This study evaluated the effects of high-plasticity mineral trioxide aggregate (MTA-HP) on the activity of M1 and M2 macrophages, compared to white MTA (Angelus). Materials and Methods: Peritoneal inflammatory M1 (from C57BL/6 mice) and M2 (from BALB/c mice) macrophages were cultured in the presence of the tested materials. Cell viability (MTT and trypan blue assays), adhesion, phagocytosis, reactive oxygen species (ROS) production, and tumor necrosis factor (TNF)-α and transforming growth factor (TGF)-ß production were evaluated. Parametric analysis of variance and the non-parametric Kruskal-Wallis test were used. Results were considered significant when p < 0.05. Results: The MTT assay revealed a significant decrease in M1 metabolism with MTA-HP at 24 hours, and with MTA and MTA-HP later. The trypan blue assay showed significantly fewer live M1 at 48 hours and live M2 at 48 and 72 hours with MTA-HP, compared to MTA. M1 and M2 adherence and phagocytosis showed no significant differences compared to control for both materials. Zymosan A stimulated ROS production by macrophages. In the absence of interferon-γ, TNF-α production by M1 did not significantly differ between groups. For M2, both materials showed higher TNF-α production in the presence of the stimulus, but without significant between-group differences. Likewise, TGF-ß production by M1 and M2 macrophages was not significantly different between the groups. Conclusions: M1 and M2 macrophages presented different viability in response to MTA and MTA-HP at different time points. Introducing a plasticizer into the MTA vehicle did not interfere with the activity of M1 and M2 macrophages.

Análise imunológica dos efeitos dos cimentos MTA, Bio-C Repair e Bio-C Repair Íon+ nas respostas de macrófagos inflamatórios de murino / Effects of cements MTA, Bio-C Repair and Bio-C Repair Ion+ on inflammatory murine macrophage responses, an immunological analysis

As melhorias alcançadas nas propriedades físico-químicas dos materiais endodônticos permitiram a utilização de materiais de reparo em situações clínicas que eram consideradas críticas. Os chamados biocerâmicos, derivados do MTA, apresentando boa biocompatibilidade e bioatividade, se tornaram uma solução eficaz. Estes materiais apresentam propriedades clínicas melhoradas, com excelente consistência e manuseabilidade, além de adequado tempo de trabalho e presa. Estes cimentos seguem em evolução e as empresas vêm investindo em melhorias em suas composições com o intuito de potencializar suas propriedades biotivas. Este trabalho teve como objetivo avaliar o cimento biocerâmico Bio-C Repair (Angelus, Londrina, Paraná, Brasil) e o seu potencial sucessor, o cimento Bio-C Repair Íon+ (Angelus, Londrina, Paraná, Brasil), bem como o MTA (Angelus, Londrina, Paraná, Brasil). Foi aprovado pelo Comitê de Ética no Uso de Animal (CEUA-UFMG 350/2019). Tais biocerâmicos foram avaliados quanto às respostas de macrófagos. Os experimentos foram realizados no laboratório de Gnotobiologia e Imunologia do Instituto de Ciências Biológicas (ICB) da Universidade Federal de Minas Gerais. Utilizou-se macrófagos murinos obtidos de camundongos C57BL/6 quando se avaliou a viabilidade celular (pelo método MTT), a aderência celular, a capacidade de fagocitose (na presença da levedura S. boulardii) e a detecção da produção de Espécies Reativas de Oxigênio (ROS), na ausência e na presença de Zymosan A (de Saccharomyces cerevisiae), bem como, na presença e na ausência dos cimentos. Os macrófagos inflamatórios foram obtidos do peritônio dos animais após a injeção de caldo Tioglicolato estéril a 3%. Após aspirados, os macrófagos foram centrifugados e a concentração celular final foi ajustada de acordo com cada ensaio proposto: viabilidade e aderência (1x106 cel/mL); ensaio de fagocitose e ROS (5x105 cel/mL). Fez-se a manipulação dos materiais sob fluxo laminar, quando foram inseridos em capilares estéreis. Os resultados de viabilidade celular demonstraram que houve diferença significativa na cultura de 24 horas, tratada com o Bio-C Repair Íon+, em relação ao grupo controle. Os ensaios de fagocitose e aderência celular não apresentaram diferença estatisticamente significante entre os grupos. As análises demonstraram expressivos níveis de ROS quando as células foram tratadas na presença de Zymozan A. Na presença desse estímulo, o Bio-C Repair Íon+ apresentou diferença significativa em relação a todos os demais biocerâmicos e ao grupo controle. Os resultados foram analisados pelo teste ANOVA (P<0,05), comparando-se os grupos experimentais entre si e o grupo controle. Conclui-se que o novo material reparador Bio-C Repair Íon+ apresenta ações de biocompatibilidade quase semelhantes ao Bio-C Repair e MTA. As diferenças observadas em relação ao Bio-C Repair Ion+ quanto à viabilidade celular e a produção de ROS podem estar relacionadas ao íon metálico presente em sua composição.

The improvements achieved in the physicochemical properties of endodontic materials allowed the use of repair materials in clinical situations considered critical. The so-called bioceramics, derived from MTA, showing good biocompatibility and bioactivity, have become an effective solution. These materials have improved clinical properties, exhibiting excellent consistency and handling, as well as good working and setting time. These types of cement are still evolving, and companies have been investing in improvements in their compositions to enhance their bioactive properties. This study aimed to evaluate the Bio-C Repair bioceramic cement (Angelus, Londrina, Paraná, Brazil) and its potential successor, the Bio-C Repair Íon+ (Angelus, Londrina, Paraná, Brazil), as well as the MTA (Angelus, Londrina, Paraná, Brazil). The Animal Use Ethics Committee (CEUA) of the Federal University of Minas Gerais (UFMG) approved the study (350/2019). Such bioceramics were evaluated in macrophage responses. The experiments were carried out in the Gnotobiology and Immunology laboratory of the Institute of Biological Sciences (ICB) of the UFMG. Murine macrophages obtained from C57BL/6 mice were used to evaluate cell viability (by the MTT method), cell adhesion, phagocytosis capacity (in the presence of the yeast S. boulardii), and in the detection of the production of Reactive Oxygen Species (ROS) in the absence and presence of Zymosan A (from Saccharomyces cerevisiae), as well as in the presence and absence of types of cement. Inflammatory macrophages were obtained by injecting sterile 3% thioglycolate broth into the animals' peritoneum. After aspirating, the macrophages were centrifuged, and the final cell concentration was adjusted according to each proposed assay: viability and adherence (1x106 cells/mL), phagocytosis, and ROS assay (5x105 cells/mL). The materials were manipulated under laminar flow when inserted into sterile capillaries. The cell viability results showed a significant difference in the 24-hour culture, treated with Bio-C Repair Ion+, to the control group. The phagocytosis and cell adhesion assays showed no statistically significant difference between the groups. The analyses showed expressive ROS levels when the cells were treated in the presence of Zymosan A. In the presence of this stimulus, the Bio-C Repair Ion+ showed a significant difference between all other bioceramics and the control group. The results were analyzed by the ANOVA test (P<0.05), comparing the experimental groups and the control group. It is concluded that the new repair material Bio-C Repair Ion+ has biocompatibility actions almost similar to Bio-C Repair and MTA. The differences observed with Bio-C Repair Ion+ regarding cell viability and ROS production may be related to the metallic ion's composition.

3D Apicoectomy Guidance: Optimizing Access for Apicoectomies.

When conventional endodontic treatment resources are depleted, endodontic surgery becomes an alternative treatment for apical periodontitis to remove unreachable infected areas and seal the root canal. Digital workflows have been used more frequently in many dental applications in recent years. In endodontics, virtual 3-dimensional (3D) planning and endodontic guidance are new aspects important for the treatment of complex cases. This report aimed to present 3D Apicoectomy Guidance, a novel method of performing guided ultraconservative endodontic surgery with conventional implant-guided drills, and to describe its application in a case with a complex anatomic scenario and intimate contact with the maxillary sinus. Implantology computer software, as well as cone-beam computed tomography images and a digital scanning 3D impression, enabled virtual planning of the surgical procedure. Subsequently, a 3D template was produced to guide the instruments used in the osteotomy and root resection. The patient was completely asymptomatic at the 1-week follow-up visit. Cone-beam computed tomography scans were performed at 1 and 6 months after surgery and showed that resection of the apex of the root was performed accurately and that a thin dentin slice remained distally, preventing the rupture of the sinus membrane. The patient remained asymptomatic, and the tissue healed normally. The method used was shown to be very straightforward and reliable. This method allowed the patient to be treated expeditiously with very precise tissue removal.