Human biological reactions at the interface between bone tissue and polymethylmethacrylate cement.

This study investigated cytotoxicity of cement fragments harvested from two prosthesis revisions by the MTT test using L929 fibroblasts and human osteoblasts. The results did not show any toxicity of the extracts prepared after 48 and 78 months implantation. We consider that no MMA monomer has been released from the cement fragments. Histological studies on undecalcified samples harvested around revising prosthesis from 11 patients were used to evaluate tissue reactions at the bone-cement interface after 2-168 months implantation. Cement and prosthesis particles (5-35 microm) either dispersed or forming a layer were observed. A fibrous tissue layer, osteolysis, and osteonecrosis areas were observed at the interface. Besides, fibroblasts, macrophages, and multinucleated giant cells were also observed. New bone formation with osteoid, osteoblasts, and endochondral ossification with fibrocartilaginous tissue has been observed. The tissue reactions seemed to decrease with time. However, osseous trabeculae fractures were observed in the samples after 19 months. Although we consider that monomer toxicity, exothermic reaction, and particles formation may cause short-term prosthesis loosening; the trabeculae fractures may be due to prosthesis and bone cement micromovements. This fractures and particles formation may cause long-term prosthesis loosening.

Pulpal inflammatory responses following non-carious class V restorations.

The effects of inflammatory activity following surgical intervention can injure pulp tissues; in severe cases it can lead to pulpal complications. With this article, the authors report on the effects of cavity preparation and restoration events and how they can interact together to reduce or increase the severity of pulpal inflammatory activity in 202 restored Class V cavities. Although some inflammatory activity was observed in the absence of bacteria, the severity of pulpal inflammatory activity was increased when cavity restorations became infected. Zinc oxide eugenol and resin-modified glass ionomer cement prevented bacterial microleakage in cavity restorations, with no severe inflammatory activity observed with these materials. Bacteria were observed in cavities restored with enamel bonding resin and adhesive bonded composites and were associated with severe grades of inflammatory activity. The cavity remaining dentin thickness influenced the grade of inflammatory activity. In the absence of infection, the grade of inflammatory activity decreased after 20 weeks post-operatively. In the presence of infection, the grade of pulpal inflammation remained stable until a minimum of 30 weeks had elapsed.

Restorative pulpal and repair responses.

BACKGROUND: Each year, about 90 million new restorations are placed in the United States and 200 million are replaced. Controversy surrounds the pulpal reactions and frequency of bacterial microleakage associated with common restorative materials. The authors investigated and compared pulpal reactions to different types of restorative materials. METHODS: Two hundred seventy-two teeth with standardized rectangular Class V unexposed cavities were restored with resin-based composite bonded to dentin; resin-based composite bonded to enamel; resin-modified glass ionomers, or RMGI; amalgam lined with zinc polycarboxylate, or ZnPC; amalgam lined with calcium hydroxide, or Ca(OH)2; or zinc oxide-eugenol, or ZnOE. Teeth were extracted for orthodontic reasons between 20 and 381 days later. The authors categorized pulpal responses according to standards set by the Federation Dentaire Internationale and the International Organization for Standardization. Bacteria were detected using Brown-Brenn-stained sections. Pulpal responses were evaluated using histomorphometric analysis and analysis of variance statistics. RESULTS: The results showed that RMGI was the best material for preventing bacterial microleakage, and resin-based composite bonded to enamel was the worst. In regard to minimizing pulpal inflammatory activity, ZnOE was the best material and resin-based composite bonded to enamel was the worst. In terms of maximizing odontoblast survival beneath deep cavity preparations, Ca(OH)2, was the best material and RMGI was the worst. CONCLUSIONS: The results show that bacterial microleakage, pulpal injury and repair responses varied widely with different restorative materials. CLINICAL IMPLICATIONS: The authors recommend that RMGI be used to restore teeth with cavities that are shallow to moderate in depth, with the floor of deep cavities being lined with Ca(OH)2 before the teeth are restored with RMGI.

The effect of cavity restoration variables on odontoblast cell numbers and dental repair.

OBJECTIVES: Dentinal repair following cavity restoration is dependent on several parameters including the numbers of surviving odontoblasts. The purpose of this study was to examine the effects of cavity cutting and restoration treatments on post-operative odontoblast numbers. METHODS: 353 Standardised non-exposed rectangular Class V cavities, were cut into the buccal dentin of intact 1st or 2nd premolar teeth of 165 patients, aged between nine and 25 years of age. Composite cavity restorations with various etching treatments were compared with resin-modified glass ionomer cements, enamel bonding resins, as well as polycarboxylate, calcium hydroxide, and zinc oxide eugenol materials. Following tooth extraction (20-381 days) for orthodontic reasons, the area of the reactionary dentine and the area of the odontoblasts was measured histomorphometrically. RESULTS: Odontoblast numbers and dentine repair activity were found to be influenced more by cavity restoration variables, than the choice of cavity filling materials or patient factors. The most important cavity preparation variable was the cavity remaining dentine thickness (RDT); below 0.25mm the numbers of odontoblasts decreased by 23%, and minimal reactionary dentine repair was observed. CONCLUSIONS: Odontoblast injury increased as the cavity RDT decreased. In rank order of maintaining odontoblast numbers beneath restored cavities with a RDT below 0.5mm, and using calcium hydroxide for comparison; calcium hydroxide (100%), polycarboxylate (82.4%), zinc oxide eugenol (81.3%), composite (75.5%), enamel bonding resin (49.5%) and RMGIC (42.8%). The vitality and dentine repair capacity of the pulp is dependent on odontoblast survival. Variations in the extent of odontoblast injury caused during operative procedures, may be the major underlying reason for the success or failure of restorative treatments.

Factors influencing pulpal response to cavity restorations.

OBJECTIVES: The purposes of this retrospective work were: (1) to determine the relative importance of bacteria on cavity walls, remaining dentin thickness and post-operative time on pulpal inflammation after cavity restoration; (2) to compare the respective influences of bacterial microleakage and the restorative material itself on pulp reaction severity. METHODS: 317 class V cavities, in human bicuspids scheduled for extraction for orthodontic reasons were used for this study. Nine different materials were included. The severity of the pulpal reaction was ranked on hematoxylin/eosin stained sections according to FDI standards. The further parameters recorded were: (1) the presence or absence of bacteria on the cavity walls was noted on Brown and Brenn stained sections; (2) the remaining dentin thickness was measured and the teeth classified into three groups (< 500, 500-1000, > 1000 microns); and (3) the post-operative delay before extraction was recorded and classified as short time (< 5 weeks) or long time (> 5 weeks). Three two-way analyses of variance (ANOVA) followed by Kruskall and Wallis tests evaluated the influence of the three parameters on pulpal reaction severity. The third ANOVA also compared pulpal reactions under the different materials when the teeth were pooled, on bacteria free teeth and on bacteria contaminated teeth. RESULTS: The first ANOVA ranked by decreasing order of importance: the presence of bacteria (p < 0.0001), the remaining dentin thickness (p = 0.02) and the post-operative delay (p = 0.04). The second ANOVA showed no difference among the restorative materials when bacteria were present on the cavity walls. SIGNIFICANCE: The presence of bacteria on the cavity walls is the main factor influencing pulpal reaction under restorative materials, but does not account for 100% of the cases.

Human odontoblast cell numbers after dental injury.

OBJECTIVES: The purpose of this study was to measure the changes in odontoblast cell numbers in response to cavity restoration variables and patient factors, and the effect these factors have on dental repair by tertiary dentinogenesis. The number of vital odontoblasts is a critical factor for pulpal repair following restorative surgery, and yet little information is available on these cell numbers. METHODS: Class V non-exposed cavities were prepared in the buccal surface of intact first or second premolar teeth of 27 patients, between 9 and 17 years of age. Following tooth extraction (28-163 days) the area of reactionary dentine and the area of the odontoblasts were measured histomorphometrically. RESULTS: Patient factors, as well as cavity preparation and restoration variables, had little effect on the numbers of odontoblasts per pulpal unit area. However, the age of the patient did appear to have an effect on the reactionary dentine secretory capacity of odontoblasts per unit area, and on the relative number of odontoblasts beneath cut dentinal tubules. CONCLUSIONS: Odontoblast cell numbers were maintained following the preparation of cavities cut into dentine with a 0.5mm residual dentine thickness. The repair capacity of the pulp-dentine complex would appear to be age dependent, this may explain differences in the success of various restorative treatments between patients.

Immunocytochemical detection of apoptosis in human odontoblasts.

Pulpal chamber size decreases on ageing due to primary and secondary dentin deposition. This work was designed to find out the consequences of this pulp chamber reduction on odontoblast number and distribution. Twenty-one healthy human premolars were equally divided into three groups from 11-, 12.5- and 14-yr-old adolescents, respectively). The external and the internal perimeters of dentin were recorded on vestibulo-lingual sections, from buccal to lingual cemento-enamel junction using an image analysis system. Nuclei of the odontoblasts were recorded on 12 automatically selected fields. On nine erupted premolars (3 teeth from each 11-, 12.5- and 14-yr-old patients), apoptosis was detected by confocal microscopy using a modification of the original TUNEL method. Apoptotic cells were labeled in central pulp fibroblasts, perivascular endothelial cells, and in odontoblasts. When the pulp volume decreases due to primary dentin production, the decrease of the surface available for odontoblasts is compensated for by a multilayer distribution of cells. Secondary dentin deposition, associated with odontoblasts reorganization in a single layer, results in a hyperbolic decrease of the odontoblasts number. This decrease seems to result from a programmed cell death, which eliminates half of the odontoblasts over a 4-yr period.

Comparison of the intraosseous biocompatibility of Vitremer and super EBA by implantation into the mandible of rabbits.

OBJECTIVES: This study compared the intraosseous biocompatibility of Vitremer, a new hydrophilic glass-ionomer cement, to that of Super EBA. STUDY DESIGN: Twenty-two New Zealand rabbits were anesthetized, the mandibular bone exposed, and two holes were drilled through the cortical plate. The materials were loaded into silicone carriers and inserted into the mandibles. Eleven rabbits were killed 4 weeks after implantation, 11 animals after 12 weeks. The mandibles were prepared with standard histologic procedures; the tissue reactions were graded from none to very severe. RESULTS: At 4 weeks Vitremer implants showed very slight to slight reactions, and the Super EBA implants showed slight reactions and one moderate reaction with no significant difference between the two materials. At 12 weeks, bone healing had occurred, despite the persistence of some fibrous tissue interposition. The reactions were classified as none to very slight for Vitremer and very slight to slight for EBA. Statistical analysis showed better results for Vitremer at 12 weeks. CONCLUSION: The intraosseous biocompatibility of Vitremer was similar at 4 weeks and superior at 12 weeks to that of Super EBA. Its other properties should be evaluated before considering its use in clinical practice.

Medial elastic structure alterations in atherosclerotic arteries in minipigs: plaque proximity and arterial site specificity.

Using a model of atherosclerosis in minipigs, we analyzed changes in elastic structure within the medial sections of the abdominal aorta and left interventricular coronary artery both in the vicinity of and distal to atheromatous plaques. Twenty-four animals, divided into three groups, were fed either a control diet or a hypercholesterolemic and hyperhomocysteinic atherogenic diet, alone or in association with an antihypertensor, namely isosorbide dinitrate (Risordan). The atherogenic diet, administered for a period of four months, induced in the minipig advanced noncalcified atherosclerotic lesions that were histologically similar to those found in humans. A morphodensitometric analysis of the medial elastic structures was carried out on images obtained from specifically stained transverse arterial sections examined under a light microscope. The volume density of the elastic structures was diminished in the arterial media of the atherosclerotic animals due to opening and widening of the fenestrae in the elastic laminate and increased communication between the interlamellar spaces. Whereas this elastolytic process was uniform and independent of the proximity of atheromatous plaques in the left interventricular coronary artery, it was intensified in the vicinity of the plaques in the abdominal aorta. Overall elastolytic activity was increased in the walls of atheromatous artery in both arterial sites, and metalloproteinases were implied in this increase of activity. We previously reported that treatment with isosorbide dinitrate significantly reduced the moderate systolic hypertension and the increase in transparietal stress observed in the abdominal aorta of atheromatous animals. We report here that isosorbide dinitrate prevented the atherogenic-diet-induced deterioration of the elastic structure in these arteries; complete inhibition of changes to the elastic laminae was evident in areas remote from plaque formation, but only partial inhibition in the vicinity of such plaques. It did not, however, prevent structural damage in the left interventricular coronary artery or modify the increase in parietal elastolytic activity in either of the two arteries. This suggests that damage to the elastic structure in atheromatous arteries is dependent not only on overall elastolytic activity but also on localized factors, possibly related to parietal stresses, affected by the presence of atheromatous plaques.

Study of behaviour and endurance of Bioapatite implanted in the periodontium of the dog (closed model).

The principle purpose of this study was to quantify endurance of the biomaterial Bioapatite implanted in periodontal structures of the dog (closed model), such quantification being established by means of indices (Endurance Index and Transformed Endurance Index) obtained as a result of data-processed analysis of histologic images. The investigation further aimed at studying the development of new cementum and the reconstruction of an attachment system. The study was conducted on eight dogs and 222 sections. New cementogenesis and the reconstruction of an attachment system are observed both in the test sites and the reference sites. Endurance of the biomaterial is statistically linked with time: the most substantial decrease in the endurance is observed between two and six months. Traces of the material subsist at month 9. The structure of material masses always remains lacunal on a microscopic scale (highest average Endurance Index observed during the investigation: 30.35%). An osteoid deposit can be continually detected as of the second month around crystalline deposits. Further, this type of deposit was noted on the periphery of the deposits implanted in ectopic position in the supracrestal connective tissue.

Biocompatibility testing of restorative materials influencing dentin and pulp.

A comparative study was carried out using 27 healthy human bicuspids that had been extracted for orthodontic reasons from adolescents 11-14 years old. A microphotometrical analysis of buccal and lingual odontoblast layer thickness was performed using the SAMBA 2000 system and the results were submitted to statistical comparison. The buccal odontoblast layer (BOL) was found to be thicker than the lingual odontoblast layer (LOL). These results were independent of age, sex, and tooth position in the dental arch. Moreover, a strong relationship existed between the layer thicknesses as linear function on a logarithmic scale. Standards for the evaluation of pulp-dentin biocompatibility are based essentially upon qualitative or semiquantitative histological criteria. A method of quantitative evaluation based upon microphotometrical measurements of the thickness of the buccal odontoblast layer, considered variable, and the lingual odontoblast layer, considered stable, was applied to coronal filling materials that had previously been tested by a classic method. Seventy bicuspids extracted from adolescents 11-14 years of age whose class-V cavities had been filled in situ with one of four restorative materials, and whole residual dentin thickness was less than 750 microns, were divided into two groups: an intermediate-term group (A) and a long-term group (B); both groups were subdivided into four experimental series as a function of test materials. A microphotometrical analysis was carried out using an automatic scanning system (SAMBA 2000) for the quantification of buccal and lingual odontoblast layer thicknesses. The results confirmed that due to the stability of the LOL thickness it may legitimately be used as reference in the study of the analogous BOL thickness.(ABSTRACT TRUNCATED AT 250 WORDS)

Biocompatibility of an enamel-dentin adhesive.

To assess the biocompatibility of a third-generation dentinal adhesive that uses a smear layer conditioner (Scotchbond 2), Class V cavities were prepared and restored in vivo, following a standardized protocol, in 32 human premolars to be extracted for orthodontic reasons. Histologic observation showed seven slight, five moderate, and one severe reaction short term, while 11 slight and three moderate reactions were observed long term. It appeared that the intensity of the reactions decreased with time. Bacteria were observed on only five teeth, and no correlation could be established between the presence of bacteria and the intensity of the reactions. It seemed that the conditioning of the smear layer, although it might have rendered the residual dentin more permeable, limited percolation phenomena by increasing adhesion. Although only one severe reaction was observed, it is mandatory in a clinical setting to place a protective lining near the pulp.

In vivo comparison of the biocompatibility of two root canal sealers implanted into the mandibular bone of rabbits.

The purpose of this study was to evaluate the in vivo biocompatibility of two zinc oxide-eugenol-based sealers, Sealite and Pulp Canal Sealer, after implantation into the mandibular bone of rabbits. Thirty female New-Zealand rabbits were randomly divided into three groups on the basis of the material to be implanted in each side of the mandible: six rabbits received a positive control implant (silicone tubes filled with asbestos) in both sides of the mandible; 12 rabbits received a Sealite implant in the left side and a negative control implant (silicone tubes filled with silicone adhesive) in the right side of the mandible; and 12 rabbits received a silicone tube filled with Pulp Canal Sealer in the left side and a negative control implant in the right side of the mandible. The sealers were implanted in a freshly mixed, unset state. The rabbits were killed 4 or 12 weeks after implantation and the implants and surrounding bone were sectioned and treated in accord with standard histologic procedures. The tissue reactions were scored and rated as none, very slight, slight, moderate, severe, and very severe. The statistical analysis of the data showed that the two sealers had similar, good biocompatibility, and that the reactions observed at the 12-week period were better than those observed at the 4-week period. Both sealers may be used indifferently in routine endodontic practice.

[Dye penetration of 3 temporary ready-to-use cements]. / Pénétration d'un colorant au niveau de trois ciments temporaires prêts à l'emploi.

Dye penetration following obturation of standardized access cavities with three different ready to use temporary cements was compared (Cavit G, Dentorit and Ciprospad). Leakage and dye penetration of the materials were simultaneously evaluated. Ciprospad appears to be the most adapted material.

[Osseous biocompatibility of Endomethasone(R)]. / Biocompatibilité osseuse de l'Endométhasone(R).

The root canal filling paste "Endométhasone" was tested, following the F.D.I. criterions by bone implants on rabbits. The tissue reaction after four weeks can be appreciated as moderate and as mild after twelve weeks. Taking in count the criterions selected and the experimental conditions of this study, the "Endométhasone" can be considered as a root canal cement with acceptable in vivo tolerance.

[Guided tissue regeneration: clinical and microscopic study]. / Régénération tissulaire guidée: étude clinique et microscopique.

A case of furcation involvement of a maxillary molar is reported. The treatment consisted in applying the concept of Controlled Tissue Regeneration using a Goretex membrane. After removal of the membrane the result is satisfactory. The membrane is then examined under transmission electronic microscope. The lateral aspect of the membrane (in contact with the proliferating epithelial tissue) show a marked bacterial proliferation.