Comportamiento clínico, radiográfico e histomorfométrico del diente autólogo como biomaterial en elevación de seno maxilar de acceso lateral. Caso clínico con seis mese de seguimiento post-carga protésica / Clinical, radiographic and histomorphometric behaviour of the autologous tooth as a biomaterial in lateral access maxillary sinus elevation. Case report with six months of post-prosthetic loading follow-up

Introducción: la pérdida ósea tras las extracciones puede requerir en el maxilar posterior la realización de una elevación de seno para la correcta colocación de implantes. El hueso autólogo se considera el gold estándar, pero tiene una alta tasa de reabsorción y morbilidad, haciendo que haya otras alternativas como el diente autólogo, con buenos resultados en procedimientos regenerativos. Este caso clínico evalúa a nivel clínico, radiográfico e histomorfométrico el empleo del diente autólogo en elevación de seno maxilar y el comportamiento de dos implantes colocados de manera diferida. Caso clínico: se presenta el caso de una mujer de 48 años, que acudió a consulta para reponer el sector posterior derecho. Se realizó la exodoncia del 4.8 como diente donante para utilizarlo como biomaterial en una elevación de seno de acceso lateral, colocando dos implantes seis meses tras la intervención, y evaluándolos seis meses tras su carga protésica. Discusión: el diente autólogo en el presente caso clínico presentó un 30,56% de hueso neoformado tras seis meses de espera, con mejores resultados que al emplear aloinjertos y xenoinjertos. Además, diferentes aspectos culturales y étnicos respaldan la aceptación del diente autólogo por parte de los pacientes, aunque se necesitan más estudios a largo plazo para evaluar la estabilidad de este tipo de injerto en elevación de seno maxilar. Conclusiones: el diente autólogo en la elevación de seno ofrece biocompatibilidad, baja incidencia de complicaciones y buena aceptación por parte del paciente, con un buen comportamiento clínico y radiográfico de los implantes, a pesar del poco tiempo transcurrido en este caso tras la carga. (AU)

Introduction: Bone loss after extractions may require a sinus elevation to be performed in the posterior maxilla for the correct placement of implants. Autologous bone is considered the gold standard, but has a high rate of resorption and morbidity, leading to other alternatives such as autologous tooth, with good results in regenerative procedures. This case report evaluates at the clinical, radiographic and histomorphometric level the use of the autologous tooth in maxillary sinus elevation and the behaviour of two implants placed in a delayed manner. Case report: The case is presented of a 48-year-old woman who came for consultation to replace the right posterior sector. The extraction of 4.8 as a donor tooth was performed to use it as a biomaterial in a lateral access sinus elevation, placing two implants six months after the intervention, and evaluating them six months after their prosthetic loading. Discussion: The autologous tooth in this case report showed 30.56% of newly formed bone following a six-month wait, with better results than when allografts and xenografts were used. In addition, different cultural and ethnic aspects support the acceptance of the autologous tooth by patients. However, more longterm studies are needed to evaluate the stability of this type of graft in maxillary sinus elevation. Conclusions: The autologous tooth in the sinus elevation offers biocompatibility, low incidence of complications and good patient acceptance, with good clinical and radiographic behaviour of the implants, despite the short time elapsed in this case after loading.(AU)

Utilización de dentina autógena para relleno del gap en el implante inmediato postextracción: a propósito de un caso clínico con seis meses de seguimiento / Autogenous dentin graft in the immediate post-extractive implant gap: six-month follow up of a clinical report

Introducción: las extracciones dentarias producen una reabsorción horizontal y vertical de la cresta alveolar, que se puede minimizar con algunas técnicas quirúrgicas, como la colocación de implantes inmediatos post-extracción, asociados al empleo de biomateriales. Caso clínico: se presenta el caso clínico de una mujer de 48 años, que acudió a consulta presentando dolor intenso en la zona del incisivo lateral superior izquierdo, asociado a una profundidad de sondaje de 12 mm. Se realizó la exodoncia del 2.2, y la colocación de un implante inmediato post-extracción, utilizando la dentina de la raíz extraída, para rellenar el gap entre el implante y la cortical vestibular, mostrando buenos resultados clínicos y radiográficos a los 6 meses tras la intervención. Discusión: aunque en la actualidad se utilizan multitud de biomateriales para reducir la reabsorción ósea en los implantes inmediatos post-extracción, ninguno de ellos parece tener mejores resultados que el resto, suponiendo en este sentido la dentina autógena una alternativa útil al tratarse de un material autólogo, con buenas tasas de aceptación por parte de los pacientes, y teniendo unas propiedades adecuadas de osteoconducción y osteoinducción.Conclusiones: la dentina autógena presenta buenos resultados clínicos y radiográficos para rellenar el gap en implantes inmediatos post-extracción (AU)

Introduction: Tooth extraction produces an horizontal and vertical resorption of the alveolar ridge, which can be reduced by many surgical techniques, such as immediate post-extractive implants, in combination with bone substitutes. Clinical case: A clinical case of a 48-year-old woman is presented, who went to dental clinic referring pain in her upper lateral incisor, associated to high probing depth. An immediate post extractive implant was placed, employing autogenous dentin from the root extracted, to fill the gap between the implant and the buccal plate, showing good clinical and radiographic evolution 6 months after surgery. Discussion: Although nowadays there are different bone substitutes to reduce bone resorption when immediate implants are placed, they have similar results, becoming autogenous dentin an useful alternative, which is an autologous material, with good patient acceptation rates and osteoconductive and osteoinductive properties.Conclusion: Autogenous dentin shows promising clinical and radiographical results when it is used to fill the gap in the post-extractive immediate implant (AU)

Influence of root width and dentin wall thickness evaluatedby endoscopy upon the outcome of periapical surgery. A cohort study

Background: An analysis was made of the correlation between root width, the thickness of the remaining dentinalwall as determined by endoscopy, and the outcome of periapical surgery.Material and Methods: A retrospective cohort study was carried out involving patients subjected to periapicalsurgery between 2017 and 2019 at the University of Valencia (Valencia, Spain).One year after surgery, cone-beam computed tomography (CBCT) was used to evaluate healing against the preoperative volumes. The maximum root width was measured on the postoperative CBCT scan at the apical section ofthe treated root. This measurement was transferred to the intraoperative endoscopic image, where the minimumroot width, peripheral dentin thickness, and minimum dentin thickness were recorded. Root measurements, andthe position (maxillary or mandibular) and type of tooth (roots of incisors, canines, premolars or molars) werefurther correlated to periapical surgery outcome.Results: A total of 51 patients, comprising 52 teeth and 62 roots, were included in the study. The mean measurements were: maximum root width (4.13±0.84 mm), minimum root width (2.46±0.72 mm), peripheral dentin thickness (0.77±0.2 mm) and minimum dentin thickness (0.4±0.2 mm). The success rate was 82.2%. Premolar roots showed a greater minimum dentin thickness (0.58±0.25 mm) (p<0.003) than incisor roots. No significant association was found between the different measurements and the healing rate at one year, though the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly. The position and type oftooth did not influence healing outcome.Conclusions: The root width and thickness of the remaining dentin wall did not significantly influence healing.However, the roots that failed to heal showed smaller minimum dentin thickness values than the roots that healed correctly. (AU)

Regeneración ósea guiada con dentina autógena tras la exodoncia de un premolar retenido en posición invertida: evaluación a 4 meses de un caso clínico / Guided bone regeneration with autogenous dentin after extraction of an impacted bicuspidin inverse position: 4-month evaluation of a clinical case

Introducción: el empleo de técnicas regenerativas tras la extracción de dientes retenidos ha mostrado su eficacia con diversos materiales de regeneración, al asociarse al empleo de membranas, pero en los últimos años se ha descrito el empleo de dentina autógena en procedimientos de regeneración ósea, mostrando unos resultados favorables. Caso clínico: se presenta un caso clínico de una mujer de 20 años, sin antecedentes médico-quirúrgicos de interés, que acudió a consulta remitida por su ortodoncista, para la extracción de un premolar maxilar retenido, en posición invertida. Tras la extracción del premolar y del tercer molar inferior retenidos, se obtuvo dentina procedente de ambos, para la regeneración ósea guiada del defecto resultante de la extracción del premolar, realizando revisiones a la semana y a los 4 meses de la intervención. Conclusiones: la dentina autógena demuestra ser un biomaterial biocompatible, adecuado para procedimientos de regeneración ósea guiada, tras la extracción de dientes retenidos, como alternativa a otros biomateriales. (AU)

Introduction: regenerative bone techniques after impacted teeth extraction have shown to be effective with different materials, when used in conjunction with membranes, but in the last few years, autogenous dentin has been used in bone regeneration procedures, having promising results. Clinical case: a clinical case of a 20-year-old woman is presented, with no interesting medical record, who went to dental clinic for removal of an inverse maxillary bicuspid retained. After maxillary bicuspid and lower third molar extractions, autogenous dentin was obtained from both teeth, to perform a guided bone regeneration of the bicuspid defect. A week and 4-month check-up were carried out. Conclusion: autogenous dentin has shown to be a biocompatible material, adequate for guided bone regeneration procedures, after extraction of impacted teeth, as an alternative to other biomaterials. (AU)

Utilización de dentina autóloga como material de regeneración. Rehabilitación de un paciente mediante tratamiento quirúrgico y prostodóncico con flujo digital / Utilization of autologous dentin as regeneration material. A patients’ rehabilitation by surgical and prosthodontic treatment with digital workflow

Introducción: Existen numerosos procedimientos para conseguir un lecho óseo adecuado para colocar implantes tras la pérdida de dientes naturales. En los últimos años se han propuesto técnicas para la preservación del lecho tras la extracción dental. Los injertos de dentina autóloga ofrecen un sustrato conveniente con propiedades osteoinductivas y osteogénicas óptimas para la regeneración alveolar. Objetivo: Se presenta un caso clínico de un paciente rehabilitado mediante un tratamiento quirúrgico y prostodóntico, y una actualización de la bibliografía en relación con los injertos de dentina autóloga. Caso clínico: Varón de 64 años sin antecedentes médicos ni hábitos patológicos, que presenta desgastes severos, inestabilidad oclusal y problemas estéticos. Se realiza una rehabilitación integral del paciente combinando una técnica quirúrgica de preservación alveolar con injerto de dentina autóloga, tras la cual se procede a la colocación de implantes, con un tratamiento protésico de coronas de zirconio, incrustaciones de disilicato de litio y reconstrucciones de composite. El tratamiento protésico se realiza en dos fases, pasando por una fase de provisionalización previa a la colocación de las restauraciones definitivas, empleando el flujo digital. A los 6 meses el paciente se encuentra satisfecho y con una función y estética óptima. Conclusiones: El injerto de dentina autóloga parece una alternativa eficaz y predecible como material de regeneración alveolar. Combinando esta técnica de preservación con una planificación digital, se puede maximizar el resultado del tratamiento rehabilitador, consiguiendo una mayor satisfacción del paciente. (AU)

Introduction: There are multiple procedures to achieve an adequate bone site for implant placement after teeth loss. In the last years, numerous techniques have been proposed for alveolar preservation. Dentin autologous grafts offer a convenient substrate with osteoinductive and osteogenic properties, which are optimum for alveolar regeneration. Objective: In this article, a clinical case of a patient rehabilitated by surgical and prosthodontic treatment, and a review of the literature regarding autologous dentin grafts is presented. Case report: 64 years old male, with no medical records or parafunctional habits, presents severe wear, occlusal instability and aesthetic problems. An integral rehabilitation is performed combining a surgical preservation technique with autologous dentin graft, after which the placement of the implants takes place, and a prosthodontic treatment with zirconium crowns, lithium disilicate inlays and composite restorations. The prosthodontic treatment is accomplished in two phases, going through a provisionalization phase previous to the placement of the definitive restorations, and digital workflow is used. 6 months later, the patient is satisfied, and function and aesthetic are optimum. Conclusions: Dentin autologous graft offers a predictable and effective alternative as a material for alveolar regeneration. Combining this preservation technique, with a good digital planification, results can be maximized and satisfaction for the patient can be increased. (AU)

Uso de dentina particulada en procedimientos de preservación alveolar / Use of particulate dentin in alveolar preservation procedures: systematic review of the literature

Introducción: Los procesos biológicos que acontecen tras las exodoncias dentales provocan defectos en los tejidos blandos y duros de los maxilares, lo que dificulta las técnicas rehabilitadoras con implantes. Los procedimientos de preservación alveolar han sido propuestos para disminuir estos cambios dimensionales. A pesar de que el hueso autógeno se presenta como el material con mejores propiedades, también conlleva un aumento de la morbilidad en el paciente. Por ello, el propio diente se presenta como alternativa. Los objetivos de esta revisión fueron analizar los cambios dimensionales en la altura/anchura de la cresta alveolar tras los procedimientos de preservación alveolar con dentina particulada, además de las posibles complicaciones intra y postoperatorias, formación de hueso nuevo y tiempo de reentrada en la zona injertada. Material y método: Se realizó una revisión de la literatura relevante a través de PubMed en la base de datos MEDLINE, identificando los estudios en los que se evaluaran los procedimientos de preservación alveolar con dentina particulada en pacientes humanos y se registrara su seguimiento. Resultados: Un total de 12 estudios se incluyeron en el análisis sistemático. Los cambios dimensionales, tras el injerto con dentina particulada, fue comparable al de otros biomateriales y menor que en los grupos control. La aparición de complicaciones fue baja. La formación de hueso nuevo y el tiempo de reentrada fue similar al de otros biomateriales. Conclusiones: El uso de dentina particulada en procedimientos de preservación alveolar se presenta como una opción prometedora respecto a otros materiales de relleno y superior a la ausencia de preservación alveolar. (AU)

Introduction: The biological processes that take place following dental extractions cause defects in the soft and hard tissues of the jaw, which hinders rehabilitation techniques with implants. Alveolar preservation procedures have been proposed to decrease these dimensional changes. Although autogenous bone is presented as the material with the best properties, it also leads to an increase in morbidity in the patient. Therefore, the tooth itself is presented as an alternative. The objectives of this review were to analyse the dimensional changes in alveolar ridge height/width after alveolar preservation procedures using particulate dentin, as well as possible intraoperative and postoperative complications, new bone formation and re-entry time in the grafted area. Material and method: A review of the relevant literature in the PubMed and MEDLINE databases was carried out, identifying studies evaluating alveolar preservation procedures with particulate dentin in human patients with recorded follow-up. Results: A total of 12 studies were included in the systematic analysis. The dimensional changes, after grafting with particulate dentin, were comparable to those of other biomaterials and lower than in the control groups. The occurrence of complications was low. New bone formation and re-entry time was similar to that of other biomaterials. Conclusions: The use of particulate dentin in alveolar preservation procedures is presented as a promising option compared with other filling materials and superior to the absence of alveolar preservation. (AU)

Propiedades osteoinductivas de la dentina en regeneración ósea. Estudio preliminar / Osteoinductive properties of the dentin in bone regeneration. Preliminary study

Introducción: El concepto de preservación alveolar está relacionado con los procedimientos llevados a cabo tras realizar una exodoncia dentaria con el fin de reducir la reabsorción dentro del alvéolo. La dentina ha sido propuesta como un biomaterial para este fin. Este artículo tiene como propósito evaluar la efectividad de la dentina en la preservación alveolar y contrastar sus propiedades. Material y Método: Se presentan como parte de un estudio en desarrollo los primeros casos tras realizar exodoncias múltiples. Determinamos un alveolo de estudio preservado con dentina y un alveolo control en el que estabilizamos el coagulo. La estabilidad dimensional de ambos alveolos se valoró mediante CBCT pasadas 8 y 16 semanas. Tras este periodo colocamos dos implantes experimentales de superficie Bioecth®. A las 16 semanas fueron explantados con trefina y sustituidos por implantes convencionales. Estas muestras fueron analizadas histológica e histomorfomètricamente. Resultados: En el análisis tomográfico apreciamos mayor estabilidad dimensional en el lado estudio. Histológicamente observamos ausencia de células inflamatorias, o signos de reacción a cuerpo extraño, además de partículas de dentina completamente rodeadas de hueso neoformado, y frentes osteogènicos partiendo de partículas de dentina. Discusión: Los resultados obtenidos a partir de este estudio en humanos están en consonancia con lo que ha sido descrito en la literatura. Observamos a nivel tomográfico menor variación dimensional en los alveolos donde se llevó a cabo la preservación con dentina particulada, estos resultados sumados al análisis histológico contrastan las propiedades descritas para injertos particulados de dentina no desmineralizada, biocompatibilidad, osteoconducción y osteoinducción. (AU)

Introduction: The concept of alveolar preservation is related to the procedures carried out after performing a tooth extraction in order to reduce resorption within the alveolus. Dentin has been proposed as a biomaterial for this purpose. The aim of this article is to evaluate the effectiveness of dentin in alveolar preservation and to contrast its properties. Material and Method: The first cases are presented as part of a work in progress study after multiple extractions. It is determined a study socket preserved with dentin and a control socket in which the clot is stabilized.The dimensional stability of both sockets was assessed by CBCT after 8 and 16 weeks. After this period, two experimental Bioecth® surface implants were placed. After 16 weeks these were explanted with trephine and replaced with conventional implants. The samples were analyzed histologically and histomorphometrically. Results: In the tomographic analysis it was observed greater dimensional stability on the study side. It was noted the absence of inflammatory cells, or signs of foreign body reaction in the histology. In addition, dentin particles were completely surrounded by newly formed bone, and appeared osteogenic fronts associated with these particles. Discusion: The results obtained from this study in humans are in line with what has been described in scientific papers. At the tomographic level, it was observed less dimensional variation in sockets where the preservation with particulate dentin was carried out. These results added to the histological análisis, contrast the properties described for particulate grafts of non-demineralized dentin, biocompatibility, osteoconduction and osteoinduction. (AU)

Use of particulate dentin in alveolar preservation procedures: a systematic review

Introduction: The biological processes that take place following dental extractions cause defects in the soft and hard tissues of the jaw, which hinder rehabilitation techniques with implants. Alveolar preservation procedures have been proposed to decrease these dimensional changes. Although autogenous bone is considered the material with the best properties, it also leads to an increase in patient morbidity. Therefore, the tooth itself is considered as an alternative. The objectives of this review were to analyse the dimensional changes in alveolar ridge height/width after alveolar preservation procedures using particulate dentin, as well as possible intraoperative and postoperative complications, new bone formation and re-entry time in the grafted area. Materials and method: A review of the relevant literature in the PubMed and MEDLINE databases was carried out, identifying studies evaluating alveolar preservation procedures with particulate dentin in human patients with recorded follow-up. Results: A total of 12 studies were included in the systematic analysis. The dimensional changes, after grafting with particulate dentin, were comparable to those of other biomaterials and fewer than in the control groups. The occurrence of complications was low. New bone formation and re-entry time were similar to other biomaterials. (AU)

Efecto de distintos sistemas de instrumentación con rotación continua o alternante en la conformación y limpieza de los conductos radiculares de raíces mesiales de primeros molares mandibulares / Effect of different rotary and reciprocation instrument systems in the shaping and cleaning of mesial root canals in first mandibular molars

OBJETIVO: Comparar en raíces mesiales de primeros molares mandibulares ex vivo, la acción de distintos sistemas de instrumentación en la conformación y limpieza de los conductos radiculares. Material y MÉTODOS: Se emplearon 25 raíces, cuyos conductos radiculares fueron instrumentados con los sistemas: WaveOne Gold, Reciproc, Mtwo, ProTaper Next y ProTaper Gold. Las raíces fueron seccionadas transversalmente a nivel de los tercios cervi-cal, medio y apical, y las muestras se analizaron con microscopía Confocal. En cada tercio se evaluó: a) Acción de los instrumentos sobre las paredes del conducto radicular, b) Presencia de istmos y su relación con la preparación quirúrgica y c) Medición en micrómetros cuadradas de las zonas no instrumentadas. Para la evaluación estadística se utilizó el análisis de varianza de dos factores con medidas repetidas en el factor tercio. El nivel de significación fue establecido en P < 0,05.RESULTADOS: Todos los sistemas mostraron una preparación regular de la superficie dentinaria excepto el Reciproc R25 que produjo zonas de desgarramiento de dentina. Con todos ellos se generaron fisuras dentinarias, dispuestas perpendiculares, oblicuas o paralelas a la pared del conducto radicular. Los istmos presentaban restos impactados en su interior. En ocasiones, ambos conductos mesiales se encontraban unidos por un istmo determinando a veces un conducto mediomesial. Se observó entre un 19.4% y 42.2% de la superficie de los conductos radiculares no instrumentada, sin diferencias significativas entre grupos ni entre tercios

OBJECTIVE: To compare ex vivo, the action of different systems in cleaning and shaping the mesial root canals of mandibular first molars. Material and METHODS: 25 roots were instrumented with the following systems: WaveOne Gold, Reciproc, Mtwo, ProTaper Next, and ProTaper Gold. The roots were cross-sectioned at the level of the cervical, middle, and apical thirds, and the samples were analyzed with Confocal microscopy. In each third, the following aspects were evaluated: a) Action of the instruments on the walls of the root canal, b) Presence of isthmus and their relationship with the surgical preparation, and c) Measurement in square micrometers of the non-instrumented areas. For the statistical evaluation, the two-factor analysis of varianza with repeated measures in the third factor was used. The level of significance was established at P < 0,05. RESULTS: All systems showed a regular preparation of the dentin surface except Reciproc R25 which produced areas of dentinal tears. With every system, dentin cracks were generated, arranged perpendicular, oblique, or parallel to the wall of the root canal. The isthmus showed the presence of debris packed inside. On occasions, both mesial canals were unified by an isthmus, sometimes conforming a middle mesial canal. Between 19.4% and 42.2% non-instrumented root canal surface was observed, without significant differences between groups or between thirds. CONCLUSIONS: None of the system used completely cleaned and shaped the root canals, leaving a significant porcentage of the dentinal walls non-instrumented

Prevención de defectos periodontales tras la exodoncia de terceros molares inferiores con injerto de dentina autógena: evaluación a 6 meses de un caso clínico / Prevention of periodontal defects after lower third molar surgery with autogenous dentin graft: 6 month evaluation of a clinical case

INTRODUCCIÓN: El defecto periodontal localizado en la cara distal del segundo molar inferior es una complicación asociada al tercer molar inferior en posición horizontal o mesioangular. El tratamiento quirúrgico de estos terceros molares inferiores retenidos se acompaña del desbridamiento de la cara distal del segundo molar, no siendo esto suficiente para devolver la salud periodontal en esta zona. Por tanto, son muchos los autores que recomiendan la regeneración ósea guiada para conseguir una recuperación periodontal completa. CASO CLÍNICO: Se presenta un caso clínico de una mujer de 27 años de edad, sin antecedentes médico-quirúrgicos de interés, que acudió al Servicio de Cirugía Bucal e Implantología de la Facultad de Odontología de la Universidad Complutense de Madrid para la exodoncia de los terceros molares inferiores. Una vez realizada la Historia Clínica, se le realizó la exodoncia del tercer molar inferior izquierdo en posición horizontal con regeneración con dentina autógena, y el tercer molar inferior derecho de manera convencional, haciendo un seguimiento de 6 meses para comparar la evolución de ambos lados. CONCLUSIONES: la dentina autógena puede ayudar a la reducción de los defectos periodontales post exodoncia sobre el segundo molar tras la extracción de terceros molares inferiores mal posicionados

INTRODUCTION: periodontal defect localized in the distal surface of lower second molar is a complication associated to lower third molars in a horizontal or mesioangular position. Surgical treatment of these third molars is helped with debridement of second molar distal surface, not being this option enough to restore periodontal health. So, many authors suggest guided bone regeneration to achieve a complete recovery in this area. CLINICAL CASE: a clinical case of a 27-year-old woman is presented, with no previous registered medical records. This woman attended to the Oral Surgery and Implantology Service of the Dentistry faculty of the Complutense University of Madrid for removal of lower third molars. After the clinical and radiological examination, left lower third molar was removed, with regeneration with autogenous dentin, and right lower third molar in a conventional approach, with a 6 month follow up to check and compare the evolution. CONCLUSION: autogenous dentin as graft material in periodontal defects in the distal side of the lower second molar could be an effective treatment for surgical lower third molar removal

Effect of different solutions in reversing the damage caused by radiotherapy in dentin structure

BACKGROUND: Previous studies have shown that radiotherapy of the head and neck region can cause direct changes in dental structure. This study evaluated the effect of different solutions on the dentin chemical composition and collagen structure of irradiated dentin. MATERIAL AND METHODS: Sixty maxillary canines were distributed in 2 groups (n = 30): non-irradiated and irradiated (radiotherapy: X-rays of 6 MV in 30 cycles of 2 Gy to 60 Gy). The teeth were sectioned, sanded, and polished to obtain 3x3x2 mm fragments, which were redistributed in 3 subgroups (n = 10) according to the treatment employed: chlorhexidine 2% (CL), chitosan 0.2% (QT), and 0.5 M carbodiimide (EDC). The samples were analyzed in FTIR at time zero (T0-control) and after 1 (T1), 3 (T3), and 5 (T5) minutes of immersion in the tested solutions. The data for the areas of the carbonate (C), amide I (AI) bands, and the ratio between the areas of the amide III/proline and hydroxyproline (AIII/PH) bands were analyzed using ANOVA and Tukey test (alpha = 5%).RESULTS: QT showed lower C values at T1, T3, and T5 (P < 0.0001), presenting lower values when compared to CL and EDC subgroups (P < 0.05). AI values at T3 and T5 were higher than T0-control and T1, independently of the radiotherapy and dentin treatment factors (P < 0.05). At T0-control, the AIII/PH ratio was lower in the irradiated group (P < 0.05), whereas the EDC treatment at T1, T3, and T5 and QT at T3 and T5 increased these values (P < 0.05), making them similar to non-irradiated subgroups (P>0.05). CONCLUSIONS: Radiotherapy changes the secondary structure of collagen, and EDC was able to restore collagen integrity after 1 minute of immersion, without changing dentin inorganic composition

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The impact of head and neck radiotherapy on the dentine-enamel junction: a systematic review

BACKGROUND: Radiotherapy is widely used in contemporary head and neck cancer treatment protocols. The abil-ity of head and neck radiotherapy (HNRT) to cause direct radiogenic destruction to the teeth is one of the most controversial topics in the field of oral oncology. Therefore, this systematic review aimed to investigate ionising radiation as an independent factor for physical and chemical changes on the dentine-enamel junction (DEJ), a piv-otal dental topography for the onset and progression of radiation-related caries (RRC) and enamel delamination. MATERIAL AND METHODS: Systematic searches were conducted on three databases: Scopus, MEDLINE (Via PubMed) and Embase (Elsevier). Laboratory studies evaluating the effects of simulated or in vivo HNRT on the DEJ were included. The GRADE tool adapted for in vitro studies was used to assess the methodological quality. RESULTS: Of the 154 initially selected studies, eight met the inclusion criteria, from which five studies were graded as high quality of evidence, two studies were graded as moderate quality and one as low quality. Two studies did not demonstrate DEJ alterations following HNRT while the other six articles described several organic and inorganic changes in the DEJ of irradiated teeth samples. These radiogenic events were mostly detected through micro and na-noindentation, Raman micro-spectroscopy, confocal microscopy, Western blotting and optical coherence tomography. CONCLUSIONS: HNRT may have a negative impact on the physical and chemical aspects of the DEJ, predisposing can-cer patients to RRC and enamel delamination

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Empleo de diente autógeno como material de regeneración ósea: revisión de la literatura a propósito de un caso clínico / Use Of Autogenous Teeth As Bone Regeneration Material: Case Report And Review

Introducción: El empleo de dientes autógenos, como material de injerto, es una opción terapéutica actual en casos de regeneración ósea. Su obtención se ha facilitado con la introducción de dispositivos capaces de procesar los dientes. El objetivo de este trabajo es realizar, a propósito de un caso clínico, una revisión de la literatura sobre el uso de dientes autólogos como material de injerto óseo y los dispositivos para su procesamiento. Caso clínico: Paciente varón de 18 años que acude a consulta presentando un cordal inferior retenido. El diagnóstico determinó la necesidad de extraer el diente y se informó al paciente de la posibilidad de utilizarlo como material de regeneración ósea. Tras la exodoncia, el diente procesado con el dispositivo Tooth Transformer(R) (Imbiodent), fue utilizado como material de injerto autólogo. El postoperatorio no presentó ninguna complicación y la evaluación radiográfica, tras 8 días y tras 10 semanas, mostró una evolución favorable del tratamiento. Discusión: La dentina desmineralizada es un material orgánico cuyo potencial reside en los factores de crecimiento que contiene para estimular la formación y reparación ósea. No obstante, no existe consenso sobre el grado de desmineralización o tamaño de partícula ideal. La reciente introducción de dispositivos, capaces de procesar dientes, facilita la obtención de un material de injerto dental para su uso en terapias de regeneración ósea. Conclusión: El uso de dientes autólogos constituye una alternativa prometedora en el campo de los injertos óseos. La técnica de transformación del diente es sencilla con el empleo de los dispositivos actuales

Introduction: The use of autogenous teeth, as graft material, is a current therapeutic option in cases of bone regeneration. Its obtention has been facilitated by the introduction of devices capable of processing teeth. The aim of this article is to perform, based on a clinical case, a review of the literature about the use of autologous teeth as bone graft material and the devices for its processing. Clinical case: Male patient, 18 years of age, who comes to the dental office presenting a lower wisdom retained. Extraction of the tooth was determined by diagnosis and the patient was informed about the possibility of using it as bone regeneration material. After the extraction, the tooth was processed by the Tooth Transformer(R) (Imbiodent) device and was used as autologous graft material. No postoperative complications were presented and the radiographic evaluation, at 8 days and 10 weeks, showed a favorable evolution of the treatment. Discusion: Demineralized dentin is a organic material whose potential relies in the growth factors it contains to stimulate bone formation and repair. However, there is no consensus on the degree of demineralization or the ideal particle size. The recent introduction of devices, capable of processing teeth, enables the obtention of a dental graft material for bone regeneration therapies. Conclusion: The use of autologous teeth is a promising alternative in the bonev grafts field. The technique of tooth transformation is simple with the use of the current devices

Utilización de dentina autógena como material de injerto en Cirugía Bucal / Autogenous dentine as graft material in Oral Surgery

Las extracciones dentarias producen una pérdida ósea en sentido horizontal y vertical, que conllevan alteraciones funcionales para los pacientes, y dificultan la colocación de implantes dentales para los profesionales. Para minimizar esta pérdida ósea, se utilizan diferentes materiales de injerto, entre los cuales destaca el injerto autógeno, por cumplir las características de osteogénesis, osteoconducción y osteoinducción. En el año 2010 se describe por primera vez la utilización de dentina como material de injerto autógeno, demostrando que este material puede ser una alternativa terapéutica al resto de materiales de injerto, al permitir la osteoconducción y la osteoinducción, y mostrar la formación de hueso nuevo en un 46-87% del área con injerto de dentina autógena, 3 meses después de su utilización. La última revisión sistemática publicada en el año 2018, concluyó que los implantes colocados en áreas regeneradas en zonas en las que se empleó dentina como material de injerto, presentaron tasas de supervivencia del 97,7% después de 1 año de seguimiento, sugiriendo este nuevo material como una alternativa con resultados prometedores, aunque son necesarios más estudios al respecto

Subsequent to tooth extraction, a reduction of the length and width of alveolar ridge can be observed. It causes functional alterations to patiens, and problems to proper insertion of dental implants. In order to prevent this bone atrophy, different graft materials can be used, being considered autogenous graft the best because allows osteogenesis, osteoconduction and osteoinduction. In 2010 it was first published the use of autogenous dentine as a graft material, showing it could be an ideal graft material, as a material with excellent osteoconduction and osteoinduction. Besides, this graft material is slowly absorbed and replaced by new bone, in 46-87% of the áreas grafted with dentine, 3 months after regeneration. Last systematic review published in 2018 concluded dental implants inserted in regenerated areas with autogenous dentine had survival rates of 97,7% for over a year follow-up, so this new material is considered an alternative with good results, but there are necessary more studies with long term follow-up

Silver-loaded nanoparticles affect ex-vivo mechanical behavior and mineralization of dentin

Background: The aim was to evaluate the effect of silver loaded nanoparticles (NPs) application on the triboscopic, crystallographic and viscoelastic properties of demineralized dentin. Polymethylmetacrylate-based NPs and Ag loaded NPs were applied on demineralized dentin. Material and Methods: Treated and untreated surfaces were probed by a nanoindenter to test viscoelasticity, and by atomic force microscopy to test nanoroughness and collagen fibril diameter. X-ray diffraction and transmission electron microscopy through selected area diffraction and bright-field imaging were also used. Results: Dentin treated with Ag-NPs attained the lowest complex modulus, and the highest tan delta values after 7 days of storage. Dentin treated with undoped-NPs achieved the lowest nanoroughness and the greatest collagen bandwidths among groups. Crystals were identified as hydroxyapatite with the highest crystallographic maturity and crystallite size in dentin treated with undoped-NPs. Texture increased in all samples from 24 h to 7 d, except in dentin surfaces treated with Ag-NPs at 310 plane. Polyhedral, block-like, hexagonal or plate-like shaped apatite crystals constituted the bulk of minerals in dentin treated with Ag-NPs, after 7 d. Polyhedral or rounded/drop-like, and polymorphic in strata crystal apatite characterized the minerals when undoped-NPs were used, with more crystalline characteristics after 7 d than that found when Ag-NPs were applied. Ag-NPs application did not improve the mechanical performance of dentin and did not produce dentin remineralization. However, energy was dissipated through the dentin without showing stress concentration; contrary was occurring at dentin treated with undoped- NPs, that provoked bridge-like mineral deposits at the dentin surface. Conclusions: Ag-NPs application did not enhance the mechanical properties of cervical dentin, though the energy dissipation did not damage the dentin structure. Remineralization at dentin was not produced after Ag-NPs appli-cation, though improved crystallinity may lead to increase stability of the apatite that was generated at the dentin surface

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Use of autologous tooth-derived graft material in the post-extraction dental socket. Pilot study

Background: The objectives of the present pilot study are to compare via CBCT the alveolar contraction suffered both vertically and horizontally between the control group and the group using autologous dental material (ADM), as well as to study the densitometric differences between both post-extraction sockets. Material and Methods: A split-mouth study was performed in n = 9 patients who required two extraction of single-rooted teeth deemed suitable for deferred rehabilitation with osseointegrated implants. Two groups were formed - a control group, in which the post-extraction socket was not filled, and an ADM group, in which the alveolar defect was filled with freshly processed autogenous dental material. Both dimensional and densitometric analyses of the alveoli were performed in both groups immediately after surgery (baseline), as well as 8 weeks and 16 weeks later. Results: The mean height of alveolar bone loss was: VL (Control 1.77 mm, loss of 16.87% of initial alveolar height; ADM 0.42 mm, loss of 4.2% of initial alveolar height), HL-BCB (Control 2.22 mm, ADM 0.16 mm, p= 0.067 at 16 weeks). The mean bone loss of the vestibular width (VL-BCB) was much higher in the control group (1.91 mm at 1 mm, 1.3 mm at 3 mm, and 0.89 mm at 5 mm) than in the ADM group (0.46 mm at 1 mm, 0.21 mm at 3 mm, 0.01 at 5 mm, p=0.098 at 16 weeks). At 16 weeks, densitometric analysis of the coronal alveolar area revealed a bone density of 564.35 ± 288.73 HU in the control group and 922.68 ± 250.82 HU in the ADM group (p=0.045 ). Conclusions: In light of these preliminary results, autologous dentine may be considered a promising material for use in socket preservation techniques

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Evaluación de microfracturas dentinarias después de la preparación con sistemas rotatorios y recíprocos. Estudio ex vivo / Evaluation of dentin microfractures after preparation with rotary and reciprocal endodontic instrumentation. An ex vivo study

El objetivo de este estudio fue comparar la frecuencia de microfracturas dentinarias después de la instrumentación con sistemas rotatorios y recíprocos. Se seleccionaron 50 incisivos inferiores, con un solo conducto. Se prepararon las cavidades de acceso y sellaron con Cavit(R). Cada raíz fue envuelta con una lámina de papel de aluminio, e incluida en resina acrílica autopolimerizable. Luego, se retiró la pieza de la resina, la hoja de aluminio e impresionó con silicona. La misma ocupó el espacio simulando el ligamento periodontal. Las muestras se dividieron al azar en cinco grupos de 10 piezas cada uno (n=10). Grupo 1: Control; Grupo 2: Sistema Mtwo(R); Grupo 3: Sistema RaCe(R); Grupo 4: Sistema Reciproc(R) y Grupo 5: Sistema WaveOne(R). Después de la preparación, las raíces fueron seccionadas horizontalmente a 3, 6 y 9 mm desde el ápice y observadas con microscopio estereoscópico a una magnificación de 30X. Se determinó la presencia de microfractura cuando la misma fue encontrada en 1 o más niveles. Se usó el Test Exacto con un nivel de significancia a=0,05. No se observaron defectos en el grupo 1. Todos los sistemas causaron microfracturas dentinarias, sin diferencias entre los grupos a los 3 mm, 6mm y 9mm. Las piezas preparadas por el sistema Reciproc fueron los que presentaron mayor frecuencia de microfracturas (30%), seguido por el sistema Mtwo y Race, cada uno con el 23% y finalmente, el sistema WaveOne con el 20%. Con excepción del grupo control, todos los grupos experimentales mostraron microfracturas. Aunque Reciproc mostró más grietas, no hubo diferencias entre los sistemas

The aim of this study was to compare the frequency of dentin microfractures after instrumentation with rotary and reciprocating systems. Fifty mandibular incisors with single canals were selected. Access cavities were prepared and sealed. Each root was wrapped with a single layer of aluminium foil and embedded in auto polymerizing resin. Aluminium foil was then peeled off. All roots were covered with a fine layer of silicon impression material simulating the periodontal ligament. Samples were randomly divided into five groups of 10 pieces each (n = 10). Group 1: Control; Group 2: Mtwo(R) System; Group 3: RaCe(R) System; Group 4: Reciproc (R) System and Group 5: WaveOne(R) System. After preparation, the roots were sectioned horizontally at 3, 6 and 9 mm from the apex. Samples were viewed under stereomicroscope at 30X magnification. The presence of microfracture was determined when it was found in 1 or more levels. The Exact Test was used with a level of significance a=0,05. No defects were observed in group 1. All systems caused dentinal microfractures, with no differences between groups at 3 mm, 6 mm and 9 mm. The pieces prepared with the Reciproc system were the ones with the highest microfracture frequency (30%), followed by the Mtwo and Race systems, each with 23% and finally the Waveone system with 20%. With the exception of the control group, all experimental groups showed microfractures. Although Reciproc showed more cracks, there were no differences between the systems

A zinc-doped endodontic cement facilitates functional mineralization and stress dissipation at the dentin surface

BACKGROUND: The purpose of this study was to evaluate nanohardness and viscoelastic behavior of dentin surfaces treated with two canal sealer cements for dentin remineralization. MATERIAL AND METHODS: Dentin surfaces were subjected to: I) 37% phosphoric acid (PA) or II) 0.5 M ethylenediaminetetraacetic acid (EDTA) conditioning prior to the application of two experimental hydroxyapatite-based cements, containing sodium hydroxide (calcypatite) or zinc oxide (oxipatite), respectively. Samples were stored in simulated body fluid during 24 h or 21 d. The intertubular and peritubular dentin were evaluated using a nanoindenter to assess nanohardness (Hi). The load/displacement responses were used for the nano-dynamic mechanical analysis to estimate complex modulus (E*) and tan delta (δ). The modulus mapping was obtained by imposing a quasistatic force setpoint to which a sinusoidal force was superimposed. AFM imaging and FESEM analysis were performed. RESULTS: After 21 d of storage, dentin surfaces treated with EDTA+calcypatite, PA+calcypatite and EDTA+oxipatite showed viscoelastic discrepancies between peritubular and intertubular dentin, meaning a risk for cracking and breakdown of the surface. At both 24 h and 21 d, tan δ values at intertubular dentin treated with the four treatments performed similar. At 21 d time point, intertubular dentin treated with PA+oxipatite achieved the highest complex modulus and nanohardness, i.e., highest resistance to deformation and functional mineralization, among groups. CONCLUSIONS: Intertubular and peritubular dentin treated with PA+oxipatite showed similar values of tan δ after 21 d of storage. This produced a favorable dissipation of energy with minimal energy concentration, preserving the structural integrity at the dentin surface

Influencia de la presencia de barrillo en la profundidad de penetración dentinaria del agente fotosensible empleado en la terapia fotodinámica / Influence of the presence of semar layer in the depth of dentinal penetration of the phosotensitizing agent used in photodynamic therapy

La efectividad antimicrobiana de la terapia fotodinámica (TFD), como complemento a la preparación biomecánica, depende del íntimo contacto entre un agente fotosensible, una fuente de energía (LED) y los microorganismos presentes en el conducto. Objetivo. Evaluar si la eliminación del barrillo dentinario influye en la penetración del agente fotosensibilizante dentro de los túbulos dentinarios en la TFD. Metodología. 20 premolares con conductos tipo I fueron decoronados a 12 mm del ápicy preparados biomecánicamente con MTwo y NaOCL al 5,25%. La muestra se dividió aleatoriamente en dos grupos (ni = 10): I, se irrigó con EDTA 17% seguido de suero fisiológico; II, se irrigó sólo con suero fisiológico. Tras la aplicación de la TFD, los especímenes fueron seccionados, obteniéndose discos correspondientes a los tercios coronal, medio y apical. Las muestras fueron visualizadas con un microscopio óptico de reflexión y el software Canvas X16. Se evaluaron el porcentaje de área teñida (PAT) y la penetración intratubular media (PIM). Análisis estadístico: Tests U de Mann-Whitney y Wilcoxon con un nivel de significación de p<0,05. Resultados. Los resultados de PAT y PIM fueron mayores en el grupo I (11,1 ± 5,1/0,45 ± 0,18) que en el II (4,93 ± 4,1/0,26 ± 0,16). No hubo diferencias significativas de PIM en los tercios coronales de I vs. II. Ambos grupos presentaron diferencias de PAT y PIM entre sus tercios. Conclusión. La remoción del barrillo dentinario previa a la aplicación de la TFD mejora significativamente la penetración del agente fotosensible en los tres tercios de la raíz

Antimicrobial efectiveness of the photodynamic therapy (PDT), in addition to chemicomechanical preparation, depends on the contact between a photosensitizer, a light source (LED) and root canal microorganisms. Aim. To evaluate if the removal of smear layer influences the penetration of the photosensitizer into dentinal tubules in the PDT. Methodology. 20 premolars with Type I canals were sectioned at 12 mm from apex and conformed with MTwo and 5.25% NaOCl. Were randomized divided in two groups (ni = 10): group I was irrigated with 17% EDTA and 0.9% NaCl; group II was irrigated with 0.9% NaOCl. For the PDT 0.01% of TBO (Fotosan® ,CMS) as photosensitizer was applied into the canal and activated for 30 sec with a LED red light source (Foto-san630®, CMS). After this, all specimens were sectioned in order to obtain dentin discs of coronal, medium and apical third. Samples were evaluated with an optical microscope at 20x and the software Canvas X16, measuring the percentage of stained area (PAT) and Intratubular media penetration (PIM). Statistical analysis: Test U de Mann-Whitney y Wilcoxon with a significance level of p < 0.05. Results. The results of PAT and PIM were higher in Group I (11,1 ± 5,1/0,45 ± 0,18) than Group II (4,93 ± 4,1/0,26 ± 0,16). No significant differences of PIM were founded between coronal thirds of I vs II. Both groups presented differences of PAT and PIM between their thirds. Conclusion. The removal of smear layer before the TFD application improves the penetration of the photosensitizer in the three root thirds

Caries enfermedad versus caries lesión: implicaciones diagnósticas y terapéuticas según el International Caries Consensus Collaboration Group / Caries disease versus caries lesion: diagnostic and therapeutic implications according to the International Caries Consensus Collaboration Group

La caries dental es la principal etiología de la pulpitis y la periodontitis apical. Ante un diente afectado por caries, el diagnóstico correcto de la extensión de la lesión cariosa y del grado de afectación pulpar es esencial para decidir entre el tratamiento endodóncico invasivo o un procedimiento operatorio preventivo y conservador. En la actualidad, el tratamiento de la lesión de caries debe basarse en los principios y las técnicas de la odontología mínimamente invasiva. Sin embargo, un problema importante que se aprecia cuando se lee literatura científica sobre la caries es que la terminología utilizada para referirse a la dentina cariada y a los procedimientos que se emplean para eliminar el tejido cariado no es uniforme. En este trabajo se abordan y se revisan los cambios propuestos por el grupo International Caries Consensus Collaboration (ICCC) en su reunión de Leuven (Bélgica) en 2015, en lo relativo a terminología, manejo de la caries y a las técnicas operatorias indicadas para el tratamiento de los diferentes tipos de lesiones de caries dentinaria

Dental caries is the main etiologic factor of pulpitis and apical periodontitis. When a tooth affected by caries must be treated, the correct diagnosis of the extent of carious lesion and the degree of pulp involvement is essential to decide between invasive endodontic treatment or preventive and conservative operative procedure. At present, the treatment of carious lesion should be based on the principles and techniques of minimally invasive dentistry. However, an important problem when reading scientific literature about dental caries is that the terminology used to refer to carious lesions and to the procedures used to remove the carious tissue is not uniform. The aim of this paper is to address and review the changes proposed by the International Caries Consensus Collaboration Group (ICCC), in its convention in Leuven (Belgium) in 2015, with regard to the terminology, management of caries, and operative techniques indicated for the treatment of the different types of dentine carious lesions