Deferoxamine Reduces Inflammation and Osteoclastogenesis in Avulsed Teeth.

Replacement and inflammatory resorption are serious complications associated with the delayed replantation of avulsed teeth. In this study, we aimed to assess whether deferoxamine (DFO) can suppress inflammation and osteoclastogenesis in vitro and attenuate inflammation and bone resorption in a replanted rat tooth model. Cell viability and inflammation were evaluated in RAW264.7 cells. Osteoclastogenesis was confirmed by tartrate-resistant acid phosphatase staining, reactive oxygen species (ROS) measurement, and quantitative reverse transcriptase-polymerase chain reaction in teeth exposed to different concentrations of DFO. In vivo, molars of 31 six-week-old male Sprague-Dawley rats were extracted and stored in saline (n = 10) or DFO solution (n = 21) before replantation. Micro-computed tomography (micro-CT) imaging and histological analysis were performed to evaluate inflammation and root and alveolar bone resorption. DFO downregulated the genes related to inflammation and osteoclastogenesis. DFO also reduced ROS production and regulated specific pathways. Furthermore, the results of the micro-CT and histological analyses provided evidence of the decrease in inflammation and hard tissue resorption in the DFO group. Overall, these results suggest that DFO reduces inflammation and osteoclastogenesis in a tooth replantation model, and thus, it has to be further investigated as a root surface treatment option for an avulsed tooth.

Revascularización con pasta tri-antibiótica. Revisión bibliográfica / Revascularization with tri-antibiotic paste. Literature review

Se presenta una revisión bibliográfica sobra la revascularización con pasta tri-antibiótica. Se analizan los diferentes protocolos y los resultados obtenidos en la literatura, comparándolos y eligiendo los materiales y protocolos más actuales. Definimos un protocolo de actuación frente al tratamiento de dientes inmaduros no vitales. Se comparan la apexificación con la revascularización, definiendo las ventajas y las desventajas de ambos tratamientos (AU)

We are presenting a bibliografic review about tri-antibiotic revascularization. We have analized different protocols and results in the literature, comparing them and chosing the best and the newest tecniques, and finally we defined an ultimate treatment of necrotic immature teeth. We compared apexification and revascularization, stating their advantages and disadvantages of both treatments (AU)

Dynamic assessment of Capparis spinosa buds on survival of periodontal ligament cells using a real-time cell analysis method.

BACKGROUND: Tooth avulsion is the most severe type of traumatic dental injuries and it results in the complete displacement of the tooth out of its socket in alveolar bone. Reimplantation of the tooth is considered to be a best treatment modality due to its biological and psychological advantages. Its prognosis depends on the extra alveolar time, the storage medium, and the patient's general health. OBJECTIVE: The aim of this study was to evaluate the effect of Capparis spinosa (C. spinosa) in maintaining the viability of human periodontal ligament (PDL) cells using a real-time cell analysis method. MATERIALS AND METHODS: Periodontal ligament cells were obtained from healthy human third molars extracted for orthodontic purposes. The storage media tested were: Dulbecco's Modified Eagle Medium (DMEM), C. spinosa, Hank's Balanced Salt Solution (HBSS), and light milk. A real-time cell analyzer system was used to evaluate cell viability. After seeding cell suspensions into the wells of the E-plate 96, PDL cells were treated with each of tested media and monitored for every 5 min for 26 h. Statistical analysis of the data was accomplished using one-way analysis of variance complemented by the Tukey test. The level of significance was set at P < 0.05. RESULTS: Dulbecco's Modified Eagle Medium (control) and C. spinosa groups had significantly higher cell index values compared with the HBSS and light milk (P < 0.05). Although, C. spinosa showed better results than DMEM (control), but this difference was not found statistically significant. CONCLUSION: Capparis spinosa can be a suitable, alternative storage medium for avulsed teeth.

Effects of the bisphosphonate alendronate on molars of young rats after lateral luxation.

BACKGROUND AND AIM: The bisphosphonate alendronate (ALN) was employed with the aim of investigating its effects on dental and periodontal tissues after lateral luxation of developing molars. MATERIAL AND METHODS: Twenty-one-day-old Wistar rats had their second upper molars laterally luxated. Daily 2.5 mg kg(-1) ALN injections started at the day of the luxation; controls received sterile saline solution. The teeth were analyzed 7, 14, and 21 days after the procedure. On the days cited, the maxillae were fixed, decalcified, and embedded in paraffin or Spurr resin. The paraffin sections were stained with H&E, incubated for TRAP histochemistry or immunolabeled for osteopontin (OPN). Spurr ultrathin sections were examined in a transmission electron microscope. RESULTS: After 21 days, the root apex of luxated molars without ALN was wide open and disorganized and also covered by an irregular layer of cellular cementum, which was not observed in ALN-treated animals. Ankylosis sites were observed in ALN rats in both luxated and non-luxated teeth. The TRAP-positive osteoclasts were more numerous in ALN group, despite their latent ultrastructural appearance without the presence of resorption apparatus compared to controls. OPN immunolabeling revealed a thick immunopositive line in the dentin that must be resultant from the moment of the luxation, while ALN-treated specimens did not present alterations in dentin. CONCLUSION: The present findings indicate that alendronate inhibits some alterations in dentin and cementum formation induced by dental trauma.

Tetracycline: a cure all?

Tetracyclines are used to treat a range of oral conditions. Their efficacy in the treatment of periodontitis is well established, and they are authoritatively recommended in the management of avulsed teeth. There is a growing evidence base to support the use of tetracycline to treat recurrent aphthous stomatitis, but its use in white spongy naevus is limited to a handful of case reports. The mechanism of action in these conditions is either unknown or indicated to be through the inhibition of matrix metalloproteinases (MMP). The use of a single agent to treat diverse oral conditions has important implications for oral medicine.

A national survey of pediatric dentists on antibiotic use in children.

PURPOSE: The purposes of this study were to: (1) examine the antibiotic prescribing practices of pediatric dentists and adherence to professional guidelines; and (2) assess their knowledge of and attitudes toward antibiotic resistance. METHODS: A cross-sectional survey regarding antibiotic use, resistance, and knowledge of antibiotic stewardship programs was emailed to 4,636 members of the American Academy of Pediatric Dentistry (AAPD). RESULTS: 987 surveys (21 percent) were completed; 984 were analyzed. Lack of adherence to AAPD antibiotic guidelines was noted. There was a trend toward overuse of antibiotics for the following conditions: irreversible pulpitis with (32 percent) and without vital pulp (42 percent); localized dentoalveolar abscess with (68 percent) and without draining fistula (39 percent); mitral valve relapse with regurgitation (43 percent); intrusion (15 percent); extrusion (13 percent); and rheumatoid arthritis (12 percent). Determinants of antibiotic use were: facial swelling (88 percent); pain relief (15 percent); unavailable appointment for several weeks (six percent); and parental satisfaction (four percent). Although 98 percent of respondents believed that antibiotic resistance is of growing concern, only 15 percent were aware of antibiotic stewardship programs. CONCLUSION: AAPD members overprescribe antibiotics. Educational programs to increase knowledge of antibiotic resistance and stewardship programs should be implemented to increase adherence to professional guidelines.

Effect of intracanal corticosteroids on healing of replanted dog teeth after extended dry times.

This study investigated the effect of potent intracanal corticosteroids on periodontal healing of replanted avulsed teeth and evaluated the systemic absorption of these corticosteroids. Sixty-seven extracted dog premolar roots were randomly assigned to one of the following groups: groups 1-3 filled with gutta-percha and replanted immediately and after 40 and 60 minutes, respectively; groups 4 and 5 filled with 0.05% clobetasol; and groups 6 and 7 filled with 0.05 % fluocinonide. Groups 4 and 6 were replanted after 40 minutes and groups 5 and 7 after 60 minutes. After 4 months, roots were evaluated histologically for signs of periodontal healing. Roots treated with clobetasol and fluocinonide healed more favorably than roots filled with gutta-percha and were different from each other at 60 minutes. No change in the systemic corticosteroid blood concentration was observed in any group. Corticosteroids were efficacious in the beagle model as intracanal medicaments for promoting favorable postavulsion periodontal healing.

Calcium hydroxide: a review.

Calcium hydroxide is a multipurpose agent, and there have been an increasing number of indications for its use. Some of its indications include direct and indirect pulp capping, apexogenesis, apexification, treatment of; root resorption, iatrogenic root perforations, root fractures, replanted teeth and interappointment intracanal dressing. The purpose of this paper is to review the properties and various indications for the use of calcium hydroxide.

RhBMP-7 improves survival and eruption in a growing tooth avulsion trauma model.

Long-term loss of avulsed and replanted teeth is a frequent clinical problem. Bone morphogenetic protein-7 (BMP 7) induces cementogenesis in periodontitis-associated periodontal ligament (PDL) defects. This study's aim was to assess the utility of rhBMP 7 in a tooth avulsion trauma model in growing individuals. Immature primary incisors of 12 minipigs were extracted. PDL and cementum were removed either partially (group 1: 4 mm2 [n=28 teeth]; group 2: 16 mm2 [n=26 teeth]) or totally (group 3 [n=26 teeth]). 500 microg rhBMP 7/g collagen matrix was applied to the teeth from one side while the corresponding teeth on the contralateral side served as controls (split mouth model). After an experimental period of 4 months, microradiography, fluorescence and light microscopy of nondecalcified sections were performed. All teeth of group 1 survived and all teeth of group 3 were lost, whether rhBMP-7 was applied or not. In group 2, nine out of ten teeth survived when rhBMP-7 was applied and four out of ten teeth were lost when rhBMP-7 was not applied. In the presence of rhBMP-7, eruption of teeth in group 2 was significantly improved (difference [median]: 5 mm, P<0.05, n=6). Even though there was a tendency towards increased deposition rates of cementum under rhBMP-7, this difference was not significant (Wilcoxon: P>0.05, ANOVA: P=0.002; n=6/group). In conclusion, rhBMP-7 improved survival rates and eruption of replanted teeth in growing individuals. No adverse effects were seen. Based on the present results, future clinical trials appear to be warranted.

Estudo microscópico do efeito do tratamento da superfície radicular com acetazolamida em dentes de ratos avulsionados e reimplantados / Microscopic study of the effect of root surface treatment with acetazolamida in avulsed and re-implanted rat teeth

Um dos procedimentos indicados para dentes avulsionados e que seräo reimplantados após trinta minutos fora do alvéolo é o tratamento da superfície radicular. Mesmo com a eliminaçäo do ligamento periodontal ressecado ou danificado e limpeza do canal radicular, os casos de insucessos säo enormes. Frente a isso, este trabalho tem como objetivo tratar a superfície radicular de dentes de ratos avulsionados e reimplantados tardiamente. Para isso, foram utilizados 54 dentes incisivos centrais superiores direitos de ratos, divididos em três grupos. No grupo I, a superfície radicular foi tratada com soluçäo de hipoclorito de sódio a 1 por cento; no grupo II, com soluçäo de hipoclorito de sódio a 1 por cento seguido da aplicaçäo de fluoreto de sódio a 2 por cento; no grupo III, após o uso do hipoclorito de sódio a 1 por cento , foi utilizada a soluçäo de acetazolamida a 5 por cento. Todos os grupos tiveram seus canais preenchidos com pasta de hidróxido de cálcio e, em seguida, os dentes foram reimplantados em seus alvéolos. Passados 15, 60 e 90 dias do reimplante, os animais foram mortos e as peças obtidas, processadas em laboratório para análise em microscópio de luz. Os resultados mostraram que todos os tratamentos testados näo impediram a ocorrência da anquilose e da reabsorçäo radicular