Prevalencia de osteopenia del prematuro antes y después de la implementación de una estrategia temprana de manejo fosfocálcico / Prevalence of osteopenia of prematurity before and after implementing an early strategy with the use of calcium and phosphate

Introducción. Con el uso de la nutrición parenteral agresiva en recién nacidos de muy bajo peso, se detectaron alteraciones del metabolismo fosfocálcico. En 2016 se implementó una estrategia de prevención a través del monitoreo fosfocálcico y su suplementación temprana. El objetivo fue estudiar si esta estrategia disminuye la prevalencia de osteopenia e identificar factores de riesgo asociados. Población y métodos. Estudio cuasiexperimental que comparó la prevalencia de osteopenia entre dos grupos: uno después de implementar la estrategia de monitoreo y suplementación fosfocálcica (01/01/2017-31/12/2019), y otro previo a dicha intervención (01/01/2013-31/12/2015). Resultados. Se incluyeron 226 pacientes: 133 pertenecen al período preintervención y 93 al posintervención. La prevalencia de osteopenia global fue del 26,1 % (IC95% 20,5-32,3) y disminuyó del 29,3 % (IC95% 21,7-37,8) en el período preintervención al 21,5 % (IC95% 13,6-31,2) en el posintervención, sin significancia estadística (p = 0,19). En el análisis multivariado, el puntaje NEOCOSUR de riesgo de muerte al nacer, recibir corticoides posnatales y el período de intervención se asociaron de manera independiente a osteopenia. Haber nacido luego de la intervención disminuyó un 71 % la probabilidad de presentar fosfatasa alcalina >500 UI/L independientemente de las restantes variables incluidas en el modelo. Conclusión. La monitorización y suplementación fosfocálcica precoz constituye un factor protector para el desarrollo de osteopenia en recién nacidos con muy bajo peso al nacer.

Introduction. With the use of aggressive parenteral nutrition in very low birth weight infants, alterations in calcium and phosphate metabolism were detected. In 2016, a prevention strategy was implemented through calcium phosphate monitoring and early supplementation. Our objective was to study whether this strategy reduces the prevalence of osteopenia and to identify associated risk factors. Population and methods. Quasi-experiment comparing the prevalence of osteopenia between two groups: one after implementing the calcium phosphate monitoring and supplementation strategy (01/01/2017­12/31/2019) and another prior to such intervention (01/01/2013­12/31/2015). Results. A total of 226 patients were included: 133 in the pre-intervention period and 93 in the post-intervention period. The overall prevalence of osteopenia was 26.1% (95% CI: 20.5­32.3) and it was reduced from 29.3% (95% CI: 21.7­37.8) in the pre-intervention period to 21.5% (95% CI: 13.6­31.2) in the post-intervention period, with no statistical significance (p = 0.19). In the multivariate analysis, the NEOCOSUR score for risk of death at birth, use of postnatal corticosteroids, and the intervention period were independently associated with osteopenia. Being born after the intervention reduced the probability of alkaline phosphatase > 500 IU/L by 71%, regardless of the other variables included in the model. Conclusion. Calcium phosphate monitoring and early supplementation is a protective factor against the development of osteopenia in very low birth weight infants.

The impact of synthetic bone grafting for tissue regeneration: an in vivo study

Aims: This study aimed to examine the biological response of synthetic nanocomposite material on canine mandibular bone. Methods: Nine healthy adult male local breed dogs aged 12 to 18 months and weighing 10.2 to 15.2 kg were used in the study. Based on healing intervals of 1 and 2 months, the dogs were divided into 2 groups. Each group had 3 subgroups with 3 dogs each. The division was based on the grafting material used to fill the created defect: an empty defect (Control-ve), Beta-Tricalcium Phosphate, and nanocomposite (Beta-Tricalcium Phosphate and nanosilver 1%) . Surgery started after the dogs were anaesthetized. The surgical procedure began with a 5 cm parallel incision along the mandible's lower posterior border. After exposing the periosteum, a three 5mm-diameter, 5-mmdeep critical-size holes were made, 5mm between each one. Each group's grafting material had independent 3 holes. The defects were covered with resorbable collagen membranes followed by suturing of the mucoperiosteal flap. Results: Total densitometric analysis showed no significant differences between groups at 1-month intervals, with the nanocomposite group having a higher mean rank (165.66± 31.21) in comparison to other groups while at 2 months intervals that there was a highly significant difference between three groups as the P-value was (0.000) with the nanocomposite group having a higher mean rank (460.66± 26.40). Conclusions: In the current study, the use of nanocomposites improved osteoconductivity by accelerating new bone formation. Moreover, the encorporation of nanosilver enhanced growth factor activity. These attributes make nanocomposites a promising material for enhancing the bone healing process

Biological properties of experimental methacrylate-based sealers containing calcium phosphates

Abstract This study aimed to evaluate, in vitro and in vivo, the biocompatibility of experimental methacrylate-based endodontic sealers containing α-tricalcium phosphate (α-TCP) or nanostructured hydroxyapatite (HAp). Experimental methacrylate-based dual-cure sealers with the addition of α-TCP or HAp, at 10%wt were formulated and compared to AH Plus (AHP). Cell viability was assessed by 3-(4,5-dimethyl-thiazoyl)-2,5-diphenyl-tetrazolium bromide (MTT), and sulforhodamine B (SRB). Sealers were implanted in rats' subcutaneous tissue and histologically evaluated. Bioactivity was assessed by alkaline phosphatase enzyme activity (ALP) and Alizarin Red (AR), using apical papillary cells (SCAPs), and by the bone deposition measured in surgical cavities on rats' femur filled with AH Plus or α-TCP. In both viability assays, HAp and AHP sealers were similar, and α-TCP presented lower viability compared to the others at MTT assay (p<0.05). A gradual decrease of the inflammatory response according to the periods was observed and AHP was the only that presented giant cells (7-day period). Collagen fibers condensation increased according to the periods, with no differences among sealers. There was an increase at ALP activity and mineralized nodules deposition according to periods. HAp and α-TCP presented higher values for ALP activity at 5 days and at 5, 10, and 15 days for AR and were different from AHP (p<0.05). α-TCP presented superior values at 10 and 15 days compared to HAp and AHP for AR (p<0.05). At 90 days, α-TCP and control (empty cavity) showed high bone deposition compared to AHP (p<0.05). α-TCP and HAp, in a methacrylate-based sealer, presented biocompatibility and bioactivity, with the potential to be used as endodontic sealers in clinical practice. Further investigations are required to gain information on the physicochemical properties of these sealers formulation before its clinical implementation.

Resumo O objetivo deste estudo foi avaliar a biocompatibilidade de cimentos endodônticos experimentais à base de metacrilato contendo fosfato α-tricálcico ou hidroxiapatita nanoestruturada in vitro e in vivo. Cimentos experimentais de cura dual à base de metacrilato com a adição de fosfato de α-tricálcico (α-TCP) ou hidroxiapatita (HAp), a 10% em peso, foram formulados e comparados com AH Plus (AHP). Viabilidade celular foi avaliada por brometo de 3- (4,5-dimetil-tiazoil) -2,5-difenil-tetrazólio (MTT) e sulforodamina B (SRB). Cimentos foram implantados no tecido subcutâneo dos ratos e avaliados histologicamente. Bioatividade foi avaliada pela atividade da enzima fosfatase alcalina (ALP) e Alizarin Red (AR) utilizando células da papila apical (SCAPs) e pela deposição óssea, medida em cavidades cirúrgicas no fêmur de ratos preenchidos com AH Plus e α-TCP. Nos dois ensaios de viabilidade, HAp e AHP não apresentaram diferenças estatísticas, α-TCP apresentou menores resultados de viabilidade para o ensaio MTT (p <0,05). Resultados histológicos mostraram que houve uma diminuição do conteúdo inflamatório de acordo com os períodos, e o AHP foi o único grupo que apresentou células gigantes (período de 7 dias). A condensação das fibras colágenas aumentou conforme os períodos, sem diferenças entre os grupos. Houve aumento da atividade da ALP e deposição de nódulos mineralizados de acordo com os períodos. HAp e α-TCP apresentaram maiores valores para a atividade de ALP em 5 dias e em 5, 10 e 15 dias para AR, com diferença para o AHP (p <0,05). O α-TCP apresentou valores superiores aos 10 e 15 dias quando comparado ao HAp e AHP para AR (p <0,05). Aos 90 dias, α-TCP e controle (cavidade vazia) apresentaram maior deposição de tecido ósseo quando comparado ao AHP (p <0,05). α-TCP e HAp, presentes nos cimentos à base de metacrilato, apresentaram biocompatibilidade e potencial para serem utilizados como seladores endodônticos na prática clínica. Investigações adicionais são necessárias para obter informações sobre as propriedades físico-químicas dessas formulações de cimentos antes de sua implementação clínica.

Histological comparison between biphasic calcium phosphate and deproteinized bovine bone on critical-size bone defects

Abstract The limited options for bone repair have led to an extensive research of the field and the development of alloplastic and xenogeneic grafts. The purpose of this study was to evaluate bone repair with two bone substitutes: deproteinized bovine bone (DBB) and biphasic calcium phosphate ceramic (BCP) in critical-size defect. A total of 8-mm defects were made in the parietal bones of rabbits (n=12). The animals were divided into three experimental groups: sham (defect filled with a blood clot), DBB (defect filled with DBB), and BCP (defect filled with BCP). After the experimental periods of 15 and 45 days, the animals were euthanized and submitted to histomorphometric analysis. The total defect area, mineralized tissue area, biomaterial area, and soft tissue area were evaluated. A greater amount of immature bone tissue and biomaterial particles were observed in the BCP group compared to DBB and sham at 45 days (p<0.05). There was no difference in the qualitative pattern of bone deposition between DBB and BCP. However, the sham group did not show osteoid islands along with the defect, presenting a greater amount of collagen fibers as well in relation to the DBB and BCP groups. There was a greater number of inflammatory cells in the DBB at 45 days compared to BCP and sham groups. In conclusion, BCP and DBB are options for optimizing the use of bone grafts for maxillofacial rehabilitation. Bone defects treated with BCP showed greater deposition of bone tissue at 45 days.

Resumo As opções limitadas para reparo ósseo levaram ao desenvolvimento de abrangente pesquisa na área de enxertos aloplásticos e xenogênicos. O objetivo deste estudo foi avaliar o reparo ósseo com dois substitutos ósseos: osso bovino desproteinizado (DBB) e cerâmica fosfática de cálcio bifásica (BCP) em defeito de tamanho crítico. Material e métodos: defeitos críticos de 8 mm foram feitos nos ossos parietais de coelhos (n=12). Os animais foram divididos em três grupos experimentais: sham (defeito preenchido com coágulo sanguíneo), DBB (defeito preenchido com DBB) e BCP (defeito preenchido com BCP). Após os períodos experimentais de 15 e 45 dias, os animais foram sacrificados e submetidos à análise histomorfométrica. Foram avaliadas a área total de defeitos, área de tecidos mineralizados, área de biomateriais e área de tecidos moles. Resultados: maior quantidade de tecido ósseo imaturo e de partículas de biomaterial foram observados no grupo BCP em comparação aos grupos DBB e sham aos 45 dias (p<0,05). Não houve diferença no padrão qualitativo de deposição óssea entre DBB e BCP. Ainda, o grupo sham não apresentou ilhas osteóides ao longo do defeito, apresentando maior quantidade de fibras colágenas em relação aos grupos DBB e BCP. Houve maior quantidade de células inflamatórias no DBB aos 45 dias em comparação aos grupos BCP e sham. Conclusões: BCP e DBB são opções para otimizar o uso de enxertos ósseos na reabilitação de pacientes. Defeitos ósseos tratados com BCP mostraram maior deposição de tecido ósseo aos 45 dias.

Calcium phosphate carrying simvastatin enhances bone regeneration: a systematic review

Abstract Several studies have aimed to develop alternative therapeutic biomaterials for bone repair. The purpose of this systematic review was to evaluate how statins carried by calcium phosphate affect the formation and regeneration of bone tissue in animal models when compared to other biomaterials or spontaneous healing. This systematic review followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, the PRISMA guidelines, and the Preclinical Systematic Review & Meta-analysis Facility (SyRF). The protocol of this systematic review was registered in PROSPERO (CRD42018091112) and in CAMARADES. In addition, ARRIVE checklists were followed in order to increase the quality and transparency of the search. An electronic search was performed using the MEDLINE/PubMed, Scopus, SciELO, and PROSPERO library databases. The authors used a specific search strategy for each database, and they also conducted a search in the grey literature and cross-references. The eligibility criteria were animal studies, which evaluated bone repair treated with calcium phosphate as a simvastatin carrier. The selection process yielded 8 studies from the 657 retrieved. All manuscripts concluded that locally applied simvastatin carried by calcium phosphate is biocompatible, enhanced bone repair and induced statistically greater bone formation than cloth or calcium phosphate alone. In conclusion, the pertinent pre-clinical studies evidenced the calcium phosphate biocompatibility and its effectiveness in delivering SIM to improve the repair of bone defects. So, clinical trials are encouraged to investigate the impact of SIM associated with calcium phosphate bone graft in repairing bone defect in humans.

Resumo Muitos estudos objetivaram desenvolver biomateriais terapêuticos alternativos para o reparo ósseo. O objetivo desta revisão sistemática foi avaliar o efeito da estatina carreada por fosfato de cálcio na formação e regeneração de tecido ósseo em modelos animais quando comparado com outros biomateriais ou coágulo. Esta revisão sistemática seguiu as recomendações do Cochrane Handbook for Systematic Reviews of Interventions, PRISMA guidelines, e o Preclinical Systematic Review & Meta-analysis Facility (SyRF). O protocolo desta revisão sistemática foi registrado no PROSPERO (CRD42018091112) e no CAMARADES. Além disso, o guia ARRIVE foi utilizado com o objetivo de aumentar a qualidade e transparência do estudo. Uma pesquisa eletrônica foi realizada através do MEDLINE/PubMed, Scopus, SciELO, e biblioteca do PROSPERO. Os autores utilizaram uma estratégia de busca específica para cada base de dados, e uma busca foi conduzida na literatura cinza e nas referências dos artigos selecionados. Os critérios de elegibilidade foram estudos em animais, os quais avaliaram o repara do ósseo tratado com fosfato de cálcio como carreador de estatina. O processo de seleção obteve 8 estudos dos 657 encontrados. Todos os estudos concluíram que a aplicação local da sinvastatina carreada pelo fosfato de cálcio é biocompatível, melhora o reparo ósseo e induz uma formação óssea significantemente maior que coágulo ou fosfato de cálcio sozinho. Em conclusão, os estudos pré-clínicos pertinentes evidenciaram a biocompatibilidade do fosfato de cálcio e sua eficácia na entrega do SIM para melhorar o reparo de defeitos ósseos. Assim, estudos clínicos são encorajados a investigar o impacto do SIM associado ao enxerto ósseo de fosfato de cálcio na reparação de defeito ósseo em humanos.

Upper urinary tract stone compositions: the role of age and gender

ABSTRACT Objective: To analyze the compositions of upper urinary tract stones and investigate their distributions in different gender and age groups. Materials and Methods: Patients diagnosed with upper urinary tract stone disease between December 2014 and March 2018 were retrospectively reviewed. Patient's age, gender, BMI, comorbidities, stone event characteristics, and compositions were collected, and proportions of stone components in different gender and age groups were analyzed. Results: A total of 1532 stone analyses were performed (992 from males and 540 from females). The mean age was younger in males (p <0.001). Males included more cases with larger BMI, hyperuricemia, and obesity, while females had more urinary tract infections. Multiple components were present in 61.8% of stones. Calcium oxalate (CaOx) (67.0%) was the most common component, followed by uric acid (UA) (11.8%), infection stone (11.4%), calcium phosphate (CaP) (8.0%), cystine (1.1%), brushite (0.4%), and 2, 8-dihydroxyadenine (0.2%). Men contributed with more CaOx stones than women at age 30-49 years (all p <0.01) and more UA stones at 30-59 years (all p <0.05). Women contributed with more infection stones than men in age groups 30-49 and 60-69 years (all p <0.05), and more CaP stones at 30-49 years. The prevalence peak was 50-59 years in men and 60-69 years in women. Both genders had the lowest prevalence in adolescence. Prevalence of UA stones increased while that of infection stones decreased with aging in both genders. Conclusions: Age and sex had a strong association with distribution of stone compositions in this Chinese cohort.

Surface and mechanical properties of adhesives with calcium phosphates challenged to different storage media

Aim: To evaluate the behavior of experimental dental adhesives with hydroxyapatite (HAp), alpha-tricalcium phosphate (α-TCP) or octacalcium phosphate (OCP) after storing them in three different media: dry storage, distilled water, or lactic acid. Methods: An experimental adhesive resin was formulated with bisphenol A glycol dimethacrylate, 2-hydroxyethyl methacrylate, and photoiniciator/co-initiator system. HAp(GHAp), α-TCP (Gα-TCP), or OCP (GOCP) were added to the adhesive resin at 2 wt.%, and one group remained without calcium phosphates to be used as a control (GCtrl). The adhesives were evaluated for surface roughness, scanning electron microscopy (SEM), and ultimate tensile strength (UTS) after storing in distilled water (pH=5.8), lactic acid (pH=4) or dry medium. Results: The initial surface roughness was not different among groups (p>0.05). GHAp showed increased values after immersion in water (p<0.05) or lactic acid (p<0.05). SEM analysis showed a surface variation of the filled adhesives, mainly for Gα-TCP and GHAp. GHApshowed the highest UTS in dry medium (p<0.05), and its value decreased after lactic acid storage (p<0.05). Conclusions: The findings of this study showed that HAp, OCP, and α-TCP affected the physical behavior of the experimental adhesive resins in different ways. HAp was the calcium phosphate that most adversely affected the surface roughness and the mechanical property of the material, mainly when exposed to an acid medium

Estudo clínico prospectivo, randomizado do tipo "Split mouth" do aumento ósseo em enxertos sinusais realizados com o fosfato de cálcio bifásicozado do tipo "Split mouth" do aumento ósseo em enxertos sinusais realizados com o fosfato de cálcio bifásico / Prospective, randomized "split mouth" clinical study of bone augmentation in sinus grafts performed with biphasic calcium phosphate

Objetivos: Avaliar e comparar o comportamento do Fosfato de Cálcio Bifásico (FCB) na forma granulada e em pasta enxertados em seios maxilares de humanos, através da análise histomorfometrica e imunoistoquímica. Metodologia: Este estudo é do tipo Split mouth com radomização controlada, em que 10 pacientes participaram do estudo, 10 seios maxilares foram enxertados com FCB na forma de pasta e 10 com FCB na forma de grânulos. Aos 6 meses após a enxertia, foi colhida a biópsia para as análises histomorfometrica e imunoistoquímica. O teste de normalidade mostrou resultados paramétricos para todas as análises, portanto foi aplicado o teste t. Resultados: A média de quantidade de tecido ósseo foi de 1923705,9 ± 364393 µm2 para o grupo Grânulos e 1532468,7 ± 334892 µm2 para o grupo Pasta (p=0,0223), a média da quantidade de biomaterial foi de 1468571 ± 230879 µm2 para o grupo Grânulos e 1658428 ± 122324 µm2 (38,60%) para o grupo Pasta (p=0,0338) e a média da quantidade de tecido mole foi de 897786 ± 270137,9 µm2 para o grupo Grânulos e 1099166,5 ± 221947,3 µm2 para o grupo Pasta (p=0,0852), as marcações para a osteocalcina foi intenso para ambos os grupos. Conclusão: O FCB em forma de pasta, assim como o FCB em grânulos, pode ser utilizado adequadamente como substituto ósseo para enxerto em seio maxilar de humanos(AU)

Objectives: To evaluate and compare the behavior of Biphasic Calcium Phosphate (BCP) in granulated and paste form grafted on maxillary sinuses of humans, through histometric and immunohistochemical analysis. Metodology: This study is of the Split mouth type with controlled radomization, in which 10 patients participated in the study, 10 maxillary sinuses were grafted with BCP in the form of paste and 10 with BCP in the form of granules. At 6 months after grafting, a biopsy was taken for histometric and immunohistochemical analysis. The normality test showed parametric results for all analyzes, so the t test was applied. Results: The mean amount of bone tissue was 1923705.9 ± 364393 µm2 for the Granules group and 1532468.7 ± 334892 µm2 for the Pasta group (P = 0.0223), the average biomaterial amount was 1468571 ± 230879 µm2 for the Granules group and 1658428 ± 122324 µm2 (38.60%) for the Pasta group (P = 0.0338) and the average amount of soft tissue was 897786 ± 270137.9 µm2 for the Granules group and 1099166.5 ± 221947.3 µm2 for the Pasta group (P = 0.0852), the markings for osteocalcin were intense for both groups. Conclusion: BCP in paste form, like BCP in granules, can be used properly as a bone substitute for grafting in the maxillary sinus of humans(AU)

Effects of bleaching using 10% carbamide peroxide with calcium or amorphous calcium phosphate on enamel mineral content and hardness / Asociación entre la severidad de Hipomineralización Incisivo-Molar (HIM) y lesiones cavitadas de caries en escolares

ABSTRACT This study evaluated enamel mineral content and surface microhardness before and after bleaching treatment using 10% carbamide peroxide (CP) containing calcium (Ca) or amorphous calcium phosphate (ACP). Thirty-six bovine slabs were randomly allocated into 3 groups (n = 12) according to bleaching treatment: G1 - Opalescence PF 10% (CP), G2 -NiteWhite ACP (CP+ACP), and G3 - Opalescence PF (10%) with calcium (CP+CA). The bleaching agent was applied on enamel surface for 6 h/day over a period of 21 days. Enamel surface was evaluated by Knoop microhardness (KNH) and micro energy-dispersive X-ray fluorescence spectrometry (p-EDXRF) at baseline and at after bleaching treatment. Data were statistically analyzed by repeated measures ANOVA and Tukey's test (a = 0.05). There was a significant decrease in microhardness after bleaching treatments for all study groups, but no difference between bleaching gels. There was no difference in the Ca/P ratio measured by p-EDXRF for all groups at the study times, but the mean value was lower in group CP+CA than in group CP+ACP. Group CP was similar to both CP+ACP and CP+CA. It can be concluded that enamel microhardness decreased after the bleaching process, regardless of the presence of calcium or ACP, but there was no significant change in the Ca/P ratio of enamel after bleaching for each tested gel. This indicates that the bleaching gels have erosive potential, causing softening of enamel without promoting surface loss, regardless of the presence of calcium of ACP ions.

RESUMO Este estudo avaliou o conteúdo mineral do esmalte e a microdureza superficial antes e após o tratamento clareador, utilizando peróxido de carbamida 10% (PC) contendo cálcio (Ca) ou fosfato de cálcio amorfo (ACP) em sua composigao. Trinta e seis espécimes de esmalte bovino foram alocados aleatoriamente em 3 grupos (n = 12) de acordo com os tratamentos clareadores: G1 - Opalescence PF 10% (CP), G2 -NiteWhite (CP+ACP); e G3 - Opalescence PF (10%) com cálcio (CP + CA). O agente clareador foi aplicado na superficie do esmalte por 6 h/dia por um periodo de 21 dias. A superficie do esmalte foi avaliada por microdureza Knoop (KNH) e espectrometria de fluorescencia de raios X micro-dispersiva (p-EDXRF) no inicio e após o tratamento clareador. Os dados foram analisados estatisticamente pelo teste ANOVA de medidas repetidas e Tukey (a = 0,05). Houve uma diminuigao significativa da microdureza após os tratamentos clareadores para todos os grupos estudados, mas nao houve diferenga entre os diferentes géis. Nao houve diferenga da relagao Ca/P mensurada por p-EDXRF para todos os grupos nos tempos estudados; no entanto, o grupo CP+CA apresentou menor valor comparado ao grupo CP+ACP. O grupo CP foi similar aos grupos CP+ACP e CP+CA. Portanto, pode-se concluir que houve redugao significativa da microdureza do esmalte após o clareamento, independente da presenga de cálcio ou APC na composigao dos géis, embora nao tenha havido alteragao significando na relagao Ca/P do esmalte após o clareamento. Isto indica um potencial erosivo dos géis clareadores, causando o amolecimento sem perda da estrutura do esmalte, independente da presenga dos íons cálcio e ACP.

A comparative study of the biocompatibility of two root-end filling materials in rat connective tissue / Estudio comparativo de la biocompatibilidad de dos materiales de retro-obturación en tejido conectivo de rata

The aim of the present study was to examine the short-term biocompatibility of Endosequence Root Repair Material (ERRM) paste and white Mineral Trioxide Aggregate MTA by implanting them into polyethylene tubes in the subcutaneous connective tissue of rats. twenty five male Wistar rats, 3-4 months old, weighing 300-350 g, were used. The tubes were implanted dorsally into the subcutaneous connective tissues of the rats. Five animals were sacrificed at five examination time points: 1, 3, 5, 7 and 15 days. The connective tissues containing the implants were excised. These sections were studied qualitatively and quantitatively using a light microscope. An average value for each group was obtained by averaging the sum of all inflammatory cells counted in 10 randomly selected, separate areas. For the ERRM group: There was a significant increase in the number of inflammatory cells on days 1-3 and on days 5-7 (P ≤ 0.003 and P ≤ 0.024). In the WHITE MTA group, the mean values of the sum of the inflammatory cells during the periods 1-3 days and 5-7 days were statistically significant (P ≤ 0.001 and P ≤ 0.044, respectively) and the XILOPERCHA group: Difference was observed significant in the value of the sum of inflammatory cells during the period of 3-5 days (P ≤ 0.05). According to the results it can be concluded that both, ERRM as MTA, caused an inflammatory reaction, which decreased over time; suggesting that both materials are biocompatible; showing however the presence of a higher organization of collagen fibers around the implants of ERRM.

El objetivo del presente estudio fue evaluar la biocompatibilidad a corto plazo de Material de Reparación de la Raíz Endodóntica (MRRE) y el agregado de trióxido mineral (AgTM), implantándolos dentro de tubos de polietileno en el tejido conectivo subcutáneo de ratas. Se usaron 25 ratas Wistar macho, de 3-4 meses de edad, con peso de 300 a 350 g. Los tubos fueron implantados en el tejido conectivo subcutáneo del dorso de las ratas. Cinco animales fueron sacrificados en cada uno de los siguientes períodos de tiempo: 1, 3, 5, 7, y 15 días. El tejido conectivo con los implantes fue escindido y seccionado. Los cortes se evaluaron cualitativa y cuantitativamente mediante microscopio óptico. Se obtuvo un valor para cada grupo resultado al promediar la suma de las células inflamatorias contadas en 10 áreas separadas seleccionadas aleatoriamente. Para el grupo de MRRE; hubo un incremento significativo en la cantidad de células inflamatorias entre los días 1-3 y 5-7 (p ≤ 0,003 y p ≤ 0,024). En el grupo de AgTM blanco, los valores promedio de la suma de células inflamatorias entre los períodos 1-3 días, y 5-7 días mostraron ser estadísticamente significativos (p≤ 0,001 y p ≤ 0,044 respectivamente) y en el grupo control de Xilopercha se observó diferencia significativa entre los valores de la suma de células inflamatorias entre los períodos de 3-5 días (P ≤ 0,05). De acuerdo a los resultados, puede concluirse que ambos materiales, AgTM y MRRE causaron una reacción inflamatoria que disminuyó a través del tiempo, sugiriendo que ambos materiales son biocompatibles; mostrando sin embargo una mayor organización de fibras colágenas alrededor de los implantes de MRRE.

An in Vitro Evaluation of Remineralizing Capacity of Self-Assembling Peptide (SAP) P11-4 and Casein Phosphopeptides-Amorphous Calcium Phosphate (CPP-ACP) on Artificial Enamel

Objective: To determine and compare the remineralizing capacity of self-assembling peptide (SAP) P11-4 and casein phosphopeptides­amorphous calcium phosphate (CPP-ACP) on enamel. Material and Methods: Enamel samples were divided into 2 groups. Group I was treated with Self­assembling peptide (SAP) P11-4 and group II with casein phosphopeptides-amorphous calcium phosphate (CPP-ACP). In both groups, remineralizing capacity was assessed at baseline, 2 weeks, 6 weeks and 12 weeks. Student's t- test and ANOVA were applied, with the significance level set at 5%. Results: The mean calcium weight % was evaluated at baseline, 2 weeks, 6 weeks and 12 weeks. In Group I, there was increase in mean value (62.12 ± 1.24) from baseline to 12 weeks (67.36 ± 2.14). However, there was decrease in phosphate weight % from 37.16 ± 2.52 at baseline to 35.72 ± 2.11 at 12 weeks. In Group II, mean calcium weight % was 64.18 ± 1.52 at baseline, which ultimately increased to 66.01 ± 2.03 at 12 weeks. Phosphate weight % showed reduction from 37.34 ± 2.23 at baseline to 35.04 ± 2.02 at 12 weeks. Ca/P ratio showed significant improvement. There was significant difference in Ca/P ratio at 2 weeks, 6 weeks and 12 weeks in both groups (p<0.05). Conclusion: Self-assembling peptide (SAP) P11-4 found to be more effective and efficient as compared to casein phosphopeptides­amorphous calcium phosphate (CPP-ACP).

Comparative Evaluation of Remineralizing Potential of a Paste Containing Bioactive Glass and a Topical Cream Containing Casein Phosphopeptide-Amorphous Calcium Phosphate: An in Vitro Study

Objective: To evaluate and compare the remineralization potential of a dentifrice containing bioactive glass and a topical cream containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) in remineralizing artificial carious lesion on enamel. Material and Methods: Forty-five freshly extracted human permanent premolar teeth were selected. Samples were divided into three groups: GI - regular tooth paste without specific remineralizing agent; GII - tooth paste containing calcium sodium-phosphosilicate (novamin) and GIII - topical cream containing casein phosphopeptide-amorphous calcium phosphate. All the sound enamel samples were viewed under scanning electron microscope (SEM) to assess the topographical pictures of enamel surface and energy dispersing x-ray analysis (EDAX) was done to estimate quantitatively the amounts of mineral (calcium and phosphorous). The mineral content of calcium and phosphorus after demineralization in each group was noted. The samples were then subjected to SEM and EDAX. Results: GI does not show any increase in the calcium and phosphorus after applying toothpaste without any remineralizing agent but GII and GIII showed a net increase in calcium and phosphorous values after applying concern-remineralizing agents. Inter group comparison showed GIII yield higher net calcium and phosphorous values than GII. Conclusion: Two remineralizing agents showed remineralization potential on enamel surfaces. Casein phosphopeptide-amorphous calcium phosphate showed better remineralizing potential than calcium sodium phosphosilicate. Hence CPP-ACP can be considered as the material of choice in remineralizing early enamel carious lesions.

The Ability of Biodentine™ of Guided Tissue Remineralization (GTR): Analysis Using SEM, EDX and TEM

Objective: To analyze the Biodentine™ capability in guided tissue remineralization. Material and Methods: Four premolar with two cavities per tooth of 3 mm depth were demineralized with EDTA 17% in shaking incubator at 37°C temperature. After 7 days, the sample were washed with aquabidest then were soaked in 20 ml NaCl 1 M (pH 7.0) at 25°C temperature for 8 hours. The samples were divided into two groups: G1: The control group (cavity directly restored with composite resin); G2: Biodentine™ group (cavity with Biodentine™ as a base then restored with composite resin). All samples were stored in shaking incubator under PBS solution at 37°C temperature. SEM, EDX and TEM analysis were performed on the 7th and 14th day. Results: The 14th day Biodentine group had the best SEM remineralization feature with irregular dentine tubular features covered by density of mass. In the EDX analysis, the concentration of calcium ion of the Biodentine group was higher than the control group on the 7th day analysis (Biodentin™ 10.2167 and control 1.9667) and on the 14th day analysis (Biodentine™ 29.833 and Control 22.080). The Biodentine™ group and control group of the 7th and 14th day experienced significant increases in calcium ion concentration while the concentration of phosphate ion in the Biodentine™ and control group had a much lower value of calcium either on the 7th or 14th day. The TEM analysis of Biodentine™ group showed more intrafibrillar remineralization than the control group. The feature of intrafibrillar dentin remineralization is analyzed by looking at the density of black dots in collagen. Conclusion: Biodentine™ is able to trigger the process of remineralization by guided tissue remineralization.

Penetration of bioceramic and epoxy-resin endodontic cements into lateral canals

Abstract: The aim of the present study was to assess the penetration capacity of two endodontic cements, Endosequence BC Sealer and AH Plus, in artificial lateral canals. Twenty-six two-rooted, maxillary first premolars were instrumented to size 40.06 using K3 files. In each root, six lateral canals of two diameters (0.06 and 0.10 mm) were created with a working length of 2, 4, and 6 mm. The specimens were randomly divided into two groups according to the endodontic cement to be used (Endosequence BC Sealer and AH Plus) and obturated by the single-cone technique. The specimens were imaged by digital periapical radiography and scores from 0 to 4 were attributed according to the degree of penetration by sealers into the lateral canals. Data were analyzed statistically by Kruskal-Wallis and Student-Newman-Keuls tests, and a significance level of p < 0.05 was adopted. No significant difference was observed between the two endodontic cements used to fill the simulated lateral canals (p > 0.05). The diameter of lateral canals only influenced the capacity of the Endosequence BC Sealer in filling the canals, and presented greater penetration in the lateral canals of diameter 0.10 mm (p < 0.05). We concluded that the bioceramic endodontic cement Endosequence BC Sealer presented similar ability as AH Plus to fill simulated lateral canals.

Characterization of bone substitute beta946; -TCP block for maxillofacial reconstruction / Caracterización del bloque beta946; -TCP de sustitución ósea para la reconstrucción maxilofacial

SUMMARY: The aim of this study was to characterize a commercial beta tricalcium phosphate (β-TCP) block allograft for use in maxillofacial reconstruction, evaluating its homogeneity, porosity and mineralization. Two commercial 5 x 5 x10 mm chronOS Vivify β-TCP blocks were used, which were evaluated by a STEM SU-3500 variable pressure scanning electron microscope (SEM-STEM) (Hitachi, Japan). For the semi-quantitative microanalysis of elements, the QUANTAX 100 energy dispersive x-ray spectrometer detector (EDX) (Bruker, Germany) was used. The homogeneity of the structural morphology, macropore and micropore size and component homogeneity were evaluated. The microscopic analysis showed micropores of 164.92 mm (± 35.032 mm) in diameter in the outer area and micropores in the inner area of 54.44 mm (± 17.676 mm). The formation of porosities and irregularities present in the block was heterogeneous between the outer and inner surfaces. The mineral content of the blocks presented homogeneity with the presence of carbon (2.02 %), oxygen (44.33 %), phosphate (16.62 %) and calcium (37.87 %). The β-TCP block can be used in bone reconstruction but the presence of reduced macropore and micropore sizes could limit efficiency in the substitution and bone regeneration phase.

RESUMEN: El objetivo de este estudio fue caracterizar un aloinjerto de bloqueo de fosfato tricálcico (β-TCP) comercial para su uso en la reconstrucción maxilofacial, evaluando su homogeneidad, porosidad y mineralización. Se utilizaron dos bloques comerciales de 5 x 5 x 10 mm de vivify β-TCP de chronOS, que se evaluaron mediante un microscopio electrónico de barrido de presión variable STEM SU-3500 (SEM-STEM) (Hitachi, Japón). Para el microanálisis de elementos semicuantitativo, se utilizó el detector de espectrómetro de rayos X de dispersión de energía QUANTAX 100 (EDX) (Bruker, Alemania). Se evaluó la homogeneidad de la morfología estructural, el tamaño del macroporo y microporo y la homogeneidad de los componentes. El análisis microscópico mostró microporos de 164,92 mm (± 35,032 mm) de diámetro en el área externa y microporos en el área interna de 54,44 mm (± 17,676 mm). La formación de porosidades e irregularidades presentes en el bloque fue heterogénea entre las superficies externas e internas. El contenido mineral de los bloques presentó homogeneidad con la presencia de carbono (2,02 %), oxígeno (44,33 %), fosfato (16,62 %) y calcio (37,87 %). El bloque β-TCP se puede utilizar en la reconstrucción ósea, pero la presencia de macroporos y tamaños de microporos reducidos podría limitar la eficacia en la fase de sustitución y regeneración ósea.

Effects of in-office bleaching agent combined with different desensitizing agents on enamel

Abstract Objective: To analyze color change, microhardness and chemical composition of enamel bleached with in-office bleaching agent with different desensitizing application protocols. Materials and Methods: One hundred and seventeen polished anterior human enamel surfaces were obtained and randomly divided into nine groups (n = 13). After recording initial color, microhardness and chemical composition, the bleaching treatments were performed as G1: Signal Professional White Now POWDER&LIQUID FAST 38% Hydrogen peroxide(S); G2: S+Flor Opal/0.5% fluoride ion(F); G3: S+GC Tooth Mousse/Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) paste(TM); G4: S+UltraEZ/3% potassium nitrate&0.11% fluoride(U); G5: S+Signal Professional SENSITIVE PHASE 1/30% Nano-Hydroxyapatite (n-HAP) suspension(SP); G6: S-F mixture; G7: S-TM mixture; G8: S-U mixture; G9: S-SP mixture. Color, microhardness and chemical composition measurements were repeated after 1 and 14 days. The percentage of microhardness loss (PML) was calculated 1 and 14 days after bleaching. Data were analyzed with ANOVA, Welch ANOVA, Tukey and Dunnett T3 tests (p<0.05). Results: Color change was observed in all groups. The highest ΔE was observed at G7 after 1 day, and ΔE at G8 was the highest after 14 days (p<0.05). A decrease in microhardness was observed in all groups except G6 and G7 after 1 day. The microhardness of all groups increased after 14 days in comparison with 1 day after bleaching (p>0.05). PML was observed in all groups except G6 and G7 after bleaching and none of the groups showed PML after 14 days. No significant changes were observed after bleaching at Ca and P levels and Ca/P ratios at 1 or 14 days after bleaching (p>0.05). F mass increased only in G2 and G6, 1 day after bleaching (p<0.05). Conclusions: The use of desensitizing agents containing fluoride, CPP-ACP, potassium nitrate or n-HAP after in-office bleaching or mixed in bleaching agent did not inhibit the bleaching effect. However, they all recovered microhardness of enamel 14 days after in-office bleaching.

Microlitiasis alveolar pulmonar. Reporte de caso / Pulmonary Alveolar microlithiasis, Case Report

Antecedentes: La microlitiasis es una afección pulmonar poco frecuente, caracterizada por acumulo de fosfatos de calcio en el interior de los alveolos pulmonares, originando cuerpos nodulares conocidos como microlitos, siendo esta su principal caracterís-tica. Destacando la poca relación Clínico Radiológica, dada su escasa documentación y relativamente poco estudio, es difícil su diag-nóstico y frecuentemente es confundida con otras entidades patológicas. Caso Clínico: Femenina de 38 años, hipertensa controlada con atenolol 100 mg vía oral día, exposición al humo de leña, con 6 meses de tos intermitente, seca, disnea y sibilancias nocturnas, se le practicó una tomografía que en la ventana mediastial se aprecia corazón de tamaño normal con algunas adenomegalias de pocos milímetros para órticos y peri traqueales no sospechosos y en la ventana pulmonar hay llenado alveolar homogéneo difuso bilateral, con engrosamiento nodular centro lobular y septal con calciicaciones inas de la pleura. La biopsia trasbronquial reporta espacios al-veolares con presencia de concentraciones laminares en piel de cebolla basóilos intra alveolares compatible con microlitiasis alveolar. Discusión: Identiicar estas particularidades nos permitiría realizar un abordaje temprano para evitar complicaciones iniciales de esta enfermedad, aunque no se conoce un tratamiento curativo...(AU)

Caracterização de biocerâmica de fosfatos de cálcio microestruturada em diferentes composições em ovinos / Bioceramic characterization of calcium phosphates microstructured in different composition in sheep

RESUMO: As biocerâmicas microporosas de fosfatos de cálcio e bifásicas de hidroxiapatita e fosfato tricálcico beta (HA/TCP-β) na forma de biomateriais granulados microporosos, são temas de pesquisas e se destacam como substitutos ósseos em aplicações biomédicas. As biocerâmicas bifásicas são biocompatíveis, bioativas, osteoindutoras e promovem a osteointegração, quando aplicados in vivo ou em meio simulado. Outro ponto diferencial dessas biocerâmicas está associado à capacidade de solubilidade que esses biomateriais apresentam quando aplicados em meio biológico, permitindo a liberação gradual de íons cálcio e fosfatos para o meio biológico, estes são absorvíeis e promovem a neoformação de um novo tecido ósseo. As biocerâmicas bifásicas de fosfatos de cálcio também se apresentam promissores em aplicações traumatológicas na reparação do tecido ósseo traumatizado e na liberação controlada de medicamentos, em tratamentos da estrutura óssea. O desempenho desses biomateriais como substitutos ósseos e na liberação controlada de medicamentos, estão associados, as suas características físicas, químicas, morfológicas e de superfície. O objetivo desse estudo foi realizar a caracterização morfológica, microestrutural dos biomateriais pela técnica de microscopia eletrônica de varredura (MEV), física com difratometria de raios X (DRX) e método de Arthur para determinação da porosidade aberta. A densidade teórica dos biomateriais bifásicos foi determinada pelo método teórico das concentrações bifásicas. Por fim, se realizou avaliação do comportamento da neoformação óssea e osteointegração dos diferentes biomateriais de fosfatos de cálcio em testes in vivo em ovinos. Os testes in vivo foram realizados em tíbias de ovinos com tempo de implantação de 03 meses. Os biomateriais implantados foram hidroxiapatita (HA), fosfato tricálcico-β (TCP-β) e composições bifásicas HA/TCP-β nas proporções: 80/20, 20/80, 70/30 e 30/70. Foram utilizadas 08 ovelhas mestiças Texel, com 12 meses de idade e peso médio de 30 kg (±5 kg), nas quais foram produzidos três defeitos ósseos em cada tíbia, sendo que quatro desses defeitos foram preenchidos por biomateriais, e dois por fragmentos ósseos (autoenxerto), grupo controle. Os animais foram eutanasiados aos 03 meses após a implantação dos biomateriais. Após a eutanásia, foram coletadas as tíbias para avaliação com o uso da técnica de microscopia eletrônica de varredura (MEV). Os resultados encontrados mostram que os biomateriais granulados microporosos são formados por uma morfologia irregular com tamanho de grânulos entre 200 μm e 500μm, outra constatação foi microestrutura microporosa interconectada dos biomateriais. O resultado obtido da porosidade aberta mostrou que os biomateriais apresentam porosidade superior a 68%. A densidade teórica se apresentou semelhante entre os biomateriais granulados de fosfatos de cálcio e sugerem boa capacidade de neoformação óssea para todos os biomateriais, sendo que o bifásico 20/80 apresentou absorção do biomaterial e neoformação óssea mais rápida quando comparada com os outros biomateriais avaliados neste estudo.

ABSTRACT: Microporous bioceramics of calcium phosphate and biphasic hydroxyapatite and tricalcium phosphate beta (HA/TCP- β) in the form of microporous granules biomaterials are research subjects and stand out as bone substitutes in biomedical application. The biphasic bioceramics are biocompatible, bioactive, osteoinductive and promote osseointegration when applied in vivo or through simulated. Another aspect of such differential solubility bioceramics is associated with the capacity that these biomaterials exhibit when applied in biological environment, enabling the gradual release of calcium and phosphate ions to the biological environment they are absorbable and promote neogenesis of new bone tissue. The biphasic bioceramics of calcium phosphate also have promising applications in traumatology in the repair of injured bone and controlled release of drugs in the bone structure treatments. The performance of these biomaterials as bone substitutes and controlled release of drugs, are associated, their physical, chemical, morphological and surface. The aim of this study was to make morphological, microstructural of biomaterials by the technique of scanning electron microscopy (SEM), physics with X-ray diffraction (XRD) and Arthur method for determination of open porosity. The theoretical density of biphasic biomaterials was determined by theoretical method of biphasic concentrations. Finally, we conducted evaluation of osteogenesis and osseointegration behavior of different biomaterials of calcium phosphates in vivo tests on sheep. In vivo tests were performed on tibias of sheep up to of 03 months. The biomaterials implanted were hydroxyapatite (HA), tricalcium phosphate-β (β-TCP) and biphasic compositions as HA/TCP-β in rates: 80/20, 20/80, 70/30 and 30/70. Eight crossbred Texel sheep, with 12 months of age and average weight of 30 kg (±5 kg) were used, in which were produced three bone defects in the tibia, four of these defects were filled with biomaterials, and two by bone fragments (autograft), as control group. The animals were euthanized at 03 months after implantation of biomaterials. After euthanasia, the tibias were collected for evaluation using the scanning electron microscopy technique (SEM). The results show that the microporous biomaterial granules are formed by an irregular morphology with grain size between 200 μm and 500μm, another finding was microporous interconnected microstructure of biomaterials. The result showed that the open porosity of the biomaterials exhibit porosity greater than 68%. The theoretical density was relatively similar between the granulates biomaterials of calcium phosphates and suggest good capacity of osteogenesis for all biomaterials, with the biphasic absorption of the biomaterial introduced 20/80 and more rapid bone formation when compared with other biomaterials evaluated in study.

Demineralized bone matrix and calcium-phosphate cement in bone regeneration in rats

Abstract Purpose: To compare bone regeneration in critical-sized defects in rat calvarium using demineralized bone matrix and calcium phosphate cement. Methods: Thirty Wistar rats were divided into 3 groups of 10 animals each. Two defects of 5-mm were made in the parietal bones of each animal. Group I had calcium phosphate cement placed in the experimental defect, Group II had filled with demineralized bone matrix and Group III had with the combination of the matrix and cement in equal parts. All animals had one defect left unfilled to serve as controls. Five animals in each group were sacrificed at 4 and 8 weeks. Histomorphometric analysis was used to quantify the amount of new bone within the defects. Results: The results showed that demineralized bone matrix-treated defects had significantly more new bone at 4 weeks compared to calcium phosphate cement-treated defects (p=0.03) and also had significantly more new bone at 8 weeks compared to unfilled defects (p=0.04). Conclusions: The demineralized bone matrix was superior to calcium phosphate cement in bone regeneration. It seems that calcium phosphate cement acted by inhibiting the osteogenesis when associated with a demineralized bone matrix and this combination should not be recommended.