Biocompatibility and immunohistochemical evaluation of a new calcium silicate-based cement, Bio-C Pulpo.

AIM: To evaluate the inflammatory response and ability to induce mineral deposition through histological and immunohistochemical analysis for osteocalcin (OCN), osteopontin (OPN) and bone sialoprotein (BSP) of a new calcium silicate-based cement, Bio-C Pulpo (Angelus), compared to white mineral trioxide aggregate (White MTA-Ang) (Angelus). METHODOLOGY: Polyethylene tubes containing Bio-C Pulpo and White MTA-Ang as well as empty tubes were implanted into the dorsal connective tissue of 30 Wistar rats, which were arranged in five groups according to the period of analysis: 7, 15, 30, 60 and 90 days. After each experimental period, the tubes with surrounding tissue were removed and histologically processed to be analysed using haematoxylin-eosin and immunohistochemistry for the detection of OCN, OPN and BSP. The data were statistically analysed (Friedman's test) at a 5% significance level. RESULTS: The inflammatory response observed with Bio-C Pulpo and White MTA-Ang was greater after 7 and 15 days and decreased from 30 days onwards. No significant difference was found between the control, Bio-C Pulpo and White MTA-Ang at the different periods of analysis (P > 0.05). The immunolabelling for OCN, OPN and BSP was more intense for Bio-C Pulpo and White MTA-Ang after 60 and 90 days, but there was no difference between Bio-C Pulpo and White MTA-Ang at the different periods of analysis (P > 0.05). CONCLUSION: Bio-C Pulpo is biocompatible and induces immunolabelling of osteogenic markers such as OCN, OPN and BSP similar to White MTA-Ang.

Inflammatory follicular cysts associated to necrotic primary teeth.

BACKGROUND: Cysts are pathological cavities lined by epithelium and supported by connective tissue, containing fluid or semi-fluid substances and presenting developmental or inflammatory origins. CASE REPORT: This study aimed to evaluate a case series of inflammatory follicular cysts in children to clarify their nomenclature, diagnosis, clinical implications and treatment outcomes. Prevalence, aetio-pathogenesis, clinical, radiographic and microscopic findings, treatments and sequelae of this condition were assessed by using the records of patients treated between 2000 and 2015. Data were analysed and presented descriptively. FOLLOW-UP: This was performed periodically for 2 years to monitor lesion regression and complete eruption of impacted permanent teeth. All of the involved permanent teeth erupted naturally. Twelve cases of asymptomatic lesions with volumetric bone expansion were identified through radiographic findings or delayed tooth eruption in patients aged between 8 and 14 years. After establishing the diagnosis of inflammatory follicular cyst, necrotic primary teeth extraction was followed by decompression of the cystic lesions. CONCLUSIONS: The investigated cases were consistent with inflammatory follicular cyst diagnoses. The proposed treatment was considered to be appropriate, that was revealed by the maintenance of the permanent teeth involved during the patients follow-up.

Clinical, radiographic and histologic analysis of the effects of pulp capping materials used in pulpotomies of human primary teeth.

AIM: To compare the clinical, radiographic and histological responses of the pulp to mineral trioxide aggregate (MTA), calcium hydroxide (CH) and Portland cement (PC) when used as a pulpotomy agent in human primary teeth. STUDY DESIGN: Forty-five mandibular primary molar teeth were randomly assigned to CH, MTA or PC groups and treated by pulpotomy technique. METHODS: The teeth were treated by conventional pulpotomy technique, differing only in the capping material for each group. Clinical and radiographic evaluations were recorded at 6-, 12- and 24-month follow-up. Teeth in the regular exfoliation period were further processed for histologic analysis. STATISTICS: Data were tested using parametric tests at a significance level of 5 %. The histological results were expressed descriptively. RESULTS: Clinically and radiographically, the MTA and PC groups showed 100 % success rates at 6, 12 and 24 months. In CH group, several teeth presented clinical and radiographic failures detected throughout the follow-up period, and internal resorption was a frequent radiographic finding. Histologic analysis revealed the presence of dentine-like mineralised material deposition obliterating the root canal in the PC and MTA groups. CH group presented, in most of the sections, necrotic areas in the root canals. CONCLUSIONS: MTA and PC may serve as effective materials for pulpotomies of primary teeth as compared to CH. Although our results are very encouraging, further studies and longer follow-up assessments are needed in order to determine the safe clinical indication of Portland cement.

Tooth slice/scaffold model of dental pulp tissue engineering.

Multipotency is a defining characteristic of post-natal stem cells. The human dental pulp contains a small subpopulation of stem cells that exhibit multipotency, as demonstrated by their ability to differentiate into odontoblasts, neural cells, and vascular endothelial cells. These discoveries highlight the fundamental role of stem cells in the biology of the dental pulp and suggest that these cells are uniquely suited for dental pulp tissue-engineering purposes. The availability of experimental approaches specifically designed for studies of the differentiation potential of dental pulp stem cells has played an important role in these discoveries. The objective of this review is to describe the development and characterization of the Tooth Slice/Scaffold Model of Dental Pulp Tissue Engineering. In addition, we discuss the multipotency of dental pulp stem cells, focusing on the differentiation of these cells into functional odontoblasts and into vascular endothelial cells.

SHED differentiate into functional odontoblasts and endothelium.

Studies on mechanisms underlying the differentiation of dental pulp stem cells are critical for the understanding of the biology of odontogenesis and for dental tissue engineering. Here, we tested the hypothesis that stem cells from exfoliated deciduous teeth (SHED) differentiate into functional odontoblasts and endothelial cells. SHED were seeded in tooth slice/scaffolds and implanted subcutaneously into immunodeficient mice. SHED differentiated into functional odontoblasts that generated tubular dentin, as determined by tetracycline staining and confocal microscopy. These cells also differentiated into vascular endothelial cells, as determined by beta-galactosidase staining of LacZ-tagged SHED. In vitro, vascular endothelial growth factor (VEGF) induced SHED to express VEGFR2, CD31, and VE-Cadherin (markers of endothelium) and to organize into capillary-like sprouts. VEGF induced ERK and AKT phosphorylation (indicative of differentiation), while inhibiting phosphorylation of STAT3 (indicative of 'stemness'). Collectively, this work demonstrates that SHED can differentiate into angiogenic endothelial cells and odontoblasts capable of generating tubular dentin.

The effectiveness of mineral trioxide aggregate, calcium hydroxide and formocresol for pulpotomies in primary teeth.

AIM: To compare the effectiveness of mineral trioxide aggregate (MTA), calcium hydroxide (CH) and formocresol (FC) as pulp dressing agents in carious primary teeth. METHODOLOGY: Forty-five primary mandibular molars with dental caries in 23 children [AUTHOR QUERY: How many children?] between 5 and 9 years old were treated by a conventional pulpotomy technique. The teeth were randomly assigned to the experimental (CH or MTA) or control (FC) groups. After coronal pulp removal and haemostasis, remaining pulp tissue was covered with MTA paste or CH powder in the experimental groups. In the control group, diluted FC was placed with a cotton pellet over the pulp tissue for 5 min and removed; the pulp tissue was then covered with zinc oxide-eugenol (ZOE) paste. All teeth were restored with reinforced ZOE base and resin modified glass-ionomer cement. Clinical and radiographic successes and failures were recorded at 3, 6, 12, 18 and 24 month follow-up. RESULTS: Forty-three teeth were available for follow-up. In the FC and MTA groups, 100% of the available teeth were clinically and radiographically successful at all follow-up appointments; dentine bridge formation could be detected in 29% of the teeth treated with MTA. In the CH group, 64% of the teeth presented clinical and radiographic failures detected throughout the follow-up period, and internal resorption was a frequent radiographic finding. CONCLUSIONS: Mineral trioxide aggregate was superior to CH and equally as effective as FC as a pulpotomy dressing in primary mandibular molars. Internal resorption was the most common radiographic finding up to 24 month after pulpotomies performed with CH.

The selective and non-selective cyclooxygenase inhibitors valdecoxib and piroxicam induce the same postoperative analgesia and control of trismus and swelling after lower third molar removal.

We compared the clinical efficacy of orally administered valdecoxib and piroxicam for the prevention of pain, trismus and swelling after removal of horizontally and totally intrabony impacted lower third molars. Twenty-five patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Valdecoxib (40 mg) or piroxicam (20 mg) was administered in a double-blind, randomized and crossed manner for 4 days after the surgical procedures. Objective and subjective parameters were recorded for comparison of postoperative courses. Both agents were effective for postoperative pain relief (N = 19). There was a similar mouth opening at suture removal compared with the preoperative values (86.14 +/- 4.36 and 93.12 +/- 3.70% of the initial measure for valdecoxib and piroxicam, respectively; ANOVA). There was no significant difference regarding the total amount of rescue medication taken by the patients treated with valdecoxib or piroxicam (173.08 +/- 91.21 and 461.54 +/- 199.85 mg, respectively; Wilcoxon test). There were no significant differences concerning the swelling observed on the second postoperative day compared to baseline measures (6.15 +/- 1.84 and 8.46 +/- 2.04 mm for valdecoxib and piroxicam, respectively; ANOVA) or on the seventh postoperative day (1.69 +/- 1.61 and 2.23 +/- 2.09 mm for valdecoxib and piroxicam, respectively; ANOVA). The cyclooxygenase-2 selective inhibitor valdecoxib is as effective as the non-selective cyclooxygenase inhibitor piroxicam for pain, trismus and swelling control after removal of horizontally and totally intrabony impacted lower third molars.

The selective and non-selective cyclooxygenase inhibitors valdecoxib and piroxicam induce the same postoperative analgesia and control of trismus and swelling after lower third molar removal

We compared the clinical efficacy of orally administered valdecoxib and piroxicam for the prevention of pain, trismus and swelling after removal of horizontally and totally intrabony impacted lower third molars. Twenty-five patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Valdecoxib (40 mg) or piroxicam (20 mg) was administered in a double-blind, randomized and crossed manner for 4 days after the surgical procedures. Objective and subjective parameters were recorded for comparison of postoperative courses. Both agents were effective for postoperative pain relief (N = 19). There was a similar mouth opening at suture removal compared with the preoperative values (86.14 ± 4.36 and 93.12 ± 3.70 percent of the initial measure for valdecoxib and piroxicam, respectively; ANOVA). There was no significant difference regarding the total amount of rescue medication taken by the patients treated with valdecoxib or piroxicam (173.08 ± 91.21 and 461.54 ± 199.85 mg, respectively; Wilcoxon test). There were no significant differences concerning the swelling observed on the second postoperative day compared to baseline measures (6.15 ± 1.84 and 8.46 ± 2.04 mm for valdecoxib and piroxicam, respectively; ANOVA) or on the seventh postoperative day (1.69 ± 1.61 and 2.23 ± 2.09 mm for valdecoxib and piroxicam, respectively; ANOVA). The cyclooxygenase-2 selective inhibitor valdecoxib is as effective as the non-selective cyclooxygenase inhibitor piroxicam for pain, trismus and swelling control after removal of horizontally and totally intrabony impacted lower third molars.

Mineral trioxide aggregate pulpotomy of a primary second molar in a patient with agenesis of the permanent successor.

AIM: To describe a pulpotomy with mineral trioxide aggregate in a primary second molar with no permanent successor. SUMMARY: Coronal pulpotomy was performed on a carious primary molar with no permanent successor in a 7-year-old child. Follow-up examinations 24 months later revealed that the treatment was successful in preserving the tooth and the vitality of its pulp. KEY LEARNING POINT: Mineral trioxide aggregate might be considered as an alternative wound dressing for pulpotomy in primary molars, preserving pulp vitality and prolonging the useful life of the tooth.

Analgesic and anti-inflammatory dose-response relationship of 7.5 and 15 mg meloxicam after lower third molar removal: a double-blind, randomized, crossover study.

Fifty patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Meloxicam 7.5 or 15 mg was once daily administered in a double-blind, randomized and crossover manner after the surgery for 4 days. Objective and subjective parameters were recorded for comparison of postoperative courses. Patients treated with 7.5mg meloxicam who underwent osteotomy reported higher pain scores at 1.5, 3, 4, 10, 12 and 16 h (P<0.05) and ingested a greater amount of rescue analgesic medication (P<0.05) than those who did not require osteotomy. A higher percentage of patients who underwent osteotomy medicated with 7.5mg meloxicam needed rescue medication as compared to those who did not require osteotomy (P<0.05). There was a similar mouth opening at suture removal compared with preoperative values for both doses (P>0.05). There were no significant differences concerning swelling observed on the 2nd or 7th postoperative days in comparison with baseline (P>0.05) between the two doses. Pain, trismus and swelling after lower third molar removal not requiring osteotomy can be successfully controlled by a dose regimen of 7.5mg meloxicam once daily. For more aggressive extractions 15 mg meloxicam is advisable.

Effect of adhesive systems associated with resin-modified glass ionomer cements.

The bonding of resin-modified glass ionomer cements to dentin remains a challenge in clinical routine. In an attempt to improve this property, different materials and techniques have been proposed. This study investigated the shear bond strength of resin-modified glass ionomer cements (Vitremer, 3M/ESPE and Fuji II LC Improved, GC) to human dentin using two one-bottle adhesive systems (Prime & Bond 2.1, Dentsply and Single Bond, 3M/ESPE). The restored specimens were stored in deionized water for 24 h at 37 +/- 1 degrees C, and then the bonded surfaces were tested in shear strength using a Universal testing machine at a crosshead speed of 0.5 mm min(-1). Bond strength means were recorded and failure modes were assessed with a stereomicroscope at 40x magnification. Data were submitted to two-way anova and multiple comparisons were performed using a Tukey statistical test (P < 0.05). Fuji II LC Improved yielded higher bond strength (P < 0.05) than Vitremer in all experimental conditions. No statistically significant differences (P > 0.05) were observed among the proposed dentin surface treatments, although a slight decrease in bond strength was observed when phosphoric acid was used alone. Bond strengths of the resin-modified glass ionomer cements to dentin seemed to be more material-dependent than surface treatment-dependent. It may be concluded that the one-bottle adhesive systems tested in this study did not improve the bond strength of the resin-modified glass ionomer cements to dentin.