Comparison of the ability of chondroitin sulfate derived from bovine, fish and pigs to suppress human osteoclast activity in vitro.

Chondroitin sulfate (CS) compounds are commonly used to manage OA symptoms. Recent literature has indicated that abnormal subchondral bone metabolism may have a role in the pathogenesis of OA. The aim of this study was to access the effects of chondroitin sulfate obtained from bovine, fish and porcine sources on human osteoclast formation and activity in vitro. Human osteoclasts were generated from blood mononuclear cells. Cells were cultured over 17 days with the addition of macrophage colony stimulating factor (M-CSF) and then stimulated with receptor activator of nuclear factor kappa B ligand from day 7. Cells were treated with the CS commencing from day 7 onwards. To assess effects on osteoclasts, tartrate resistant acid phosphatate (TRAP) expression and resorption of whale dentine assays were used. Bovine-derived CS consistently suppressed osteoclast activity at concentrations as low as 1 µg/ml. Fish and porcine CS was less consistent in their effects varying with different donor cells. All CS compounds had little effect on TRAP activity. mRNA analysis using real-time PCR of bovine CS treated cells indicated that the inhibition of activity was not due to inhibition of the late stage NFATc1 transcription factor (p > 0.05). These results are consistent with CS inhibition of mature osteoclast activity rather than the formation of mature osteoclasts. It would appear that there are differences in activity of the different CS compounds with bovine-derived CS being the most consistently effective inhibitor of osteoclast resorption, but the results need to be confirmed.

Impact of NSAID etoricoxib on side effects of orthodontic tooth movement.

OBJECTIVES: The non-steroidal anti-inflammatory drug etoricoxib is the most highly selective inhibitor of cyclooxygenase-2 available (344:1) and has been approved for postoperative pain therapy following dental interventions in Europe. At clinically relevant doses it has been reported to only have marginal effects on the velocity of orthodontic tooth movement (OTM). Its effects on associated dental root resorptions, osteoclastogenesis, trabecular number in the alveolar bone and periodontal bone loss during OTM, however, have not yet been investigated. MATERIAL AND METHODS: 40 male Fischer344 rats were divided into four groups: 1.5ml tap water/day p.o. (control, 1), additional 7.8mg/kg/day etoricoxib (normal dose) for three (2) or seven (3) days/week and 13.1mg/kg/day (high dose) for seven days/week, respectively (4). After a week of premedication, OTM in anterior direction of the first left upper molar was performed for 28 days by means of a nickel-titanium coil spring (0.25N). We quantified OTM-associated dental root resorptions, osteoclastogenesis, trabecular number and periodontal bone loss by histomorphometrical, histochemical and µCT analyses of the disected tooth-bearing upper jaw sections. RESULTS: After 28 days of OTM, associated reduction of trabecular number seemed to be slightly alleviated by high doses of etoricoxib, whereas no significant other etoricoxib effects in the doses administered could be detected regarding OTM-induced or -associated dental root resorptions, osteoclastogenesis or periodontal bone loss. CONCLUSIONS: Dental root resorptions, osteoclastogenesis and periodontal bone loss during OTM in rats were not significantly affected by etoricoxib in the clinically relevant dosages investigated with only a slight inhibitory effect on bone remodelling to be expected at high dosages. Etoricoxib is therefore not suitable for the prevention of these detrimental effects, but could be a suitable analgesic during OTM, as it has been reported not to affect tooth movement.

Alendronate binds to tooth root surfaces and inhibits progression of feline tooth resorption: a pilot proof-of-concept study.

Tissue distribution, bioavailability, and efficacy of alendronate in preventing progression of resorption of teeth were evaluated in cats. [Butyl-4-14C-]-alendronate accumulates on subgingival tooth and alveolar bone surfaces adjacent to vascularized tissue resulting in concentration of the drug around tooth roots. Three cats were treated with a 0.03 mg/kg i.v. bolus of [butyl-4-14C-]-alendronate followed by blood, urine, and feces collection and euthanasia 24-hours later. Drug tissue distribution was accessed by autoradiography and sample combustion. To assess bioavailability, 12 cats were administered alendronate orally (3.0 or 9.0 mg/kg in water or 9.0 mg/kg in tuna water) and urine was collected for 24-hours. In these formulations, alendronate oral bioavailability in cats was approximately 3%. In addition, 10 cats with radiographic evidence of pre-existing tooth resorption (14 affected teeth) were treated with vehicle or 3.0 mg/kg alendronate per os once weekly for 22-weeks and, then, 9.0 mg/kg per os twice weekly for 27-weeks in a random, masked study. Radiographic area of resorption was measured and progression scored every 3 to 4-months. In placebo-treated cats, resorption progressed in five of six teeth (+ 97% average increase in area of resorption), whereas progression of resorption was seen in only three of eight affected teeth in alendronate-treated cats with a -22% average change (decrease) in area (P < 0.01 difference in number of teeth showing progression; P < 0.001 difference in area of resorption). Alendronate accumulated preferentially on subgingival tooth surfaces and adjacent alveolar bone and, at a dose of 9 mg/kg twice weekly, effectively slowed or arrested the progression of resorption.

Treatment of avulsed permanent teeth: an update.

Every dental practitioner should be familiar with the current treatment recommendations for avulsed teeth. This article has attempted to update the practitioner in both the collection of data and treatment modalities for such traumatic injuries. The long-term prognosis of avulsed teeth has improved both because of the decrease in splinting time, which decreases the incidence of replacement resorption and the use of calcium hydroxide, which produces a better apical seal and decreases the incidence and severity of inflammatory resorption.

Os pricipais efeitos colaterais do clareamento dentário: como amenizá-los / Tooth whitening: main T collateral effects and how to smooth them

Introdução: em busca de uma perfeita harmonia na forma e nas cores dos dentes, a dentística desenvolveu diversas alternativas para a melhoria da estética dentária, sendo que para o tratamento das alterações cromáticas, o procedimento mais utilizado atualmente é o clareamento dental. Objetivo: realizar uma revisão de literatura a cerca dos possíveis efeitos colaterais advindos das técnicas de clareamento dental e como minimizá-los. Material e Métodos: revisão de literatura por meio de busca bibliográfica nas bases de pesquisa online: PubMED, Medline, Lilacs, Scielo e Scopus, através do rastreio de artigos relevantes publicados entre o período de 2010 a 2016. Resultados: dentre os efeitos colaterais apresentados pelo clareamento dental, a sensibilidade durante e após o clareamento tem sido um dos efeitos adversos mais apontados na literatura, fato que pode ser resultado do aumento da permeabilidade do esmalte, com uma possível difusão do peróxido até a polpa, os tratamentos mais eficazes no controle da sensibilidade são: nitrato de potássio a 5%, fluoreto de sódio neutro a 2%, a terapia a laser e o uso de analgésicos e anti-inflamatórios. O gel clareador deve ser removido totalmente ao final do clareamento, porém se alguma quantidade do mesmo é deixada para trás, o paciente pode eventual deglutir, o que pode levar a irritação na mucosa gastrointestinal, dessa forma é importante que seja evitado o excesso de produto e de aplicações, atentando com a remoção cuidadosa dos excessos, para evitar sua ingestão e contato com tecidos moles. Conclusão: independentemente da técnica de clareamento a ser utilizada é necessária a supervisão e acompanhamento de um cirurgião-dentista, pois com o seu criterioso diagnóstico e adequado tratamento é que os resultados satisfatórios serão alcançados e os efeitos colaterais evitados e/ou minimizados. (AU)

Introduction: in order to achieve a perfect harmony in the shape and colors of the teeth, the dentistry has developed several alternatives for the improvement of dental aesthetics, and for the treatment of chromatic alterations, the most commonly used procedure is tooth whitening. Objective: to carry out a literature review about the possible side effects of dental bleaching techniques and how to minimize them. Material and Methods: a review of the literature was carried out through a bibliographic search in the following online databases: PubMED, Medline, Lilacs, Scielo and Scopus, through the screening of relevant articles published between 2010 and 2016. Results: among the side effects of tooth whitening, sensitivity during and after bleaching has been one of the most commonly reported adverse effects in the literature, a fact that may be a result of increased permeability of the enamel, with a possible diffusion of the peroxide to the pulp. The most effective treatments for sensitivity control are: 5% potassium nitrate, 2% neutral sodium fluoride, laser therapy and the use of analgesics and anti-inflammatories. The bleaching gel should be removed completely at the end of bleaching, but if any amount is left behind, the patient may eventually swallow, which may lead to irritation in the gastrointestinal mucosa, so it is important to avoid excess product And applications, with the careful removal of excess, to avoid its ingestion and contact with soft tissues. Conclusion: regardless of the technique of whitening to be used, it is necessary the supervision and follow-up of a dental surgeon, because with his careful diagnosis and appropriate treatment, satisfactory results will be achieved and the side effects avoided and/or minimized. (AU)

Results after replantation of avulsed permanent teeth. I. Endodontic considerations.

Following avulsion and replantation, teeth are at risk for infection and infection related resorption (IRR). Severe discolorations of tooth crowns and cervical root fractures are common. This study presents data on endodontic related complications of avulsed teeth replanted following an extraoral endodontic treatment. Periodontal aspects will be discussed in the second part of the present publication. Twenty-eight permanent teeth in 24 patients aged seven to 17 years were replanted after avulsion. All teeth could be evaluated. In all teeth extraoral endodontic treatment by retrograde insertion of ceramic or titanium posts was performed. Mean observation period was 31.2 months (median: 24.1 months). Nine teeth healed with a functional periodontal ligament (PDL) (functional healing, FH), 19 teeth exhibited replacement resorption (RR), which was succeeded by IRR in three teeth after observation periods of more than 14 months. Diagnosis was set to tunneling resorption (one case) and to cervical resorption preceded by complete RR (two cases). No early IRR was observed. All six teeth rescued in physiologic conditions (cell culture medium of tooth rescue box) exhibited FH. Discolorations of tooth crowns or other complications (cervical root fractures, fractures of posts) were not observed. No differences in the healing results of immature and mature teeth were observed which is in contrast to previous studies. This finding is explained with the different endodontic treatment protocols. Extraoral endodontic treatment by retrograde insertion of posts prevents early IRR and minimizes the overall incidence of IRR. The method does not negatively influence periodontal healing. As there are further advantages (no discoloration, no root fractures, patient not involved, less radiographs, less time consumption, less costs) the method is recommended in isolated teeth before replantation. Especially immature teeth profit from the prevention of complications.

Results after replantation of avulsed permanent teeth. II. Periodontal healing and the role of physiologic storage and antiresorptive-regenerative therapy.

The status of the periodontal ligament (PDL) and of the pulp are decisive for the healing of avulsed and replanted teeth. A tooth rescue box was developed and distributed to offer optimal storage conditions for avulsed teeth. The therapy comprised extraoral endodontic treatment and applications of medicaments to enhance periodontal healing. In this long-term clinical study the healing results following avulsion and replantation were investigated. Twenty-eight permanent teeth in 24 patients were evaluated. The extraoral storage media and periods varied considerably. Soon after avulsion six teeth were stored in a cell culture medium (tooth rescue box Dentosafe) for 1-53 h; the PDL was defined as not compromised. Sixteen teeth were stored in a non-physiologic situation temporarily, the PDL was considered as compromised. Six teeth were stored in non-physiologic conditions for longer periods; the condition of the PDL was defined as hopeless. On 14 teeth antiresorptive-regenerative therapy (ART) with the local application of glucocorticoids and enamel matrix derivative and the systemic administration of doxycyclin was used. In all teeth extraoral endodontic treatment by retrograde insertion of posts was performed. The mean observation period was 31.2 months (+/-24.1; 5.1-100.2; median: 23.8). All six teeth rescued physiologically healed with a functional PDL (functional healing, FH) irrespective of the storage period. Of eight teeth with a compromised PDL on which ART was used, three teeth healed with a functional PDL. All other teeth showed replacement resorption, in three teeth additionally infection-related resorption was recorded. The predominant influence on the healing results was the immediate physiologic rescue of avulsed teeth (chi-square, P = 0.0001). The use of ART seemed to support FH (chi-square, P = 0.0547) in teeth with a compromised PDL. No other factors (maturity of roots, crown fractures, gender, age, antibiotics) were related to healing. In a linear regression analysis physiologic storage (P = 0.0013) and ART (P = 0.0421) were related to FH. For a good prognosis avulsed teeth should be stored immediately in a cell-compatible medium. Therefore the tooth rescue box should be distributed at places with higher risks of accidents, in families with children and in emergency facilities. The use of ART might have potential for enhancing the prognosis of teeth with a PDL that is compromised but not in a hopeless condition. Extraoral endodontic treatment reduces infection-related complications; this item was discussed in the first part of the publication.

Results after replantation of avulsed permanent teeth. III. Tooth loss and survival analysis.

Avulsed permanent teeth were replanted following immediate extraoral endodontic treatment by insertion of posts from a retrograde direction. Some teeth were rescued in a physiologic environment (tissue culture medium contained in a tooth rescue box), and in some cases antiresorptive-regenerative therapy (ART) was used. The aim of the study was to identify variables that influence the incidence of tooth loss and the survival of avulsed and replanted permanent incisors. Twenty-eight permanent teeth in 24 patients aged 7-17 years were investigated. In all teeth extraoral endodontic treatment by retrograde insertion of posts was performed. All nine teeth with functional healing (FH) were in situ. Of the 19 teeth with non-FH, seven were removed to allow transplantations. Two teeth were removed due to severe infrapositions. One tooth was lost following a new trauma. No tooth was lost due to acute infections. In descriptive statistics the incidence of tooth loss was significantly related to healing (P = 0.0098, Fisher's exact test), to treatment planning, i.e. consecutive replantation of premolars and primary canines (P = 0.0001, Fisher's exact test) and to immediate physiologic rescue (P = 0.0394). ART was related to tooth loss when tested in teeth with a compromised periodontal ligament (P = 0.0389). No influence could be found for the parameters maturity, age and all other factors. In a regression analysis treatment planning was the only factor left which had a significant influence (P = 0.0002). The estimated mean survival time (Kaplan-Meier analysis) for all teeth was 57.3 months. The survival was significantly reduced (P = 0.0002, log rank test) when consecutive transplantations were intended and performed. No influence could be found for maturity, age and all other factors. The different findings to previous studies can be explained by the prevention of complications related to conventional endodontic treatment approaches. Statistics have to be carefully interpreted due to case preselection which is determined by the treatment guidelines and actual treatment options of the individual treating dentist.

Periodontal and pulpal healing of monkey incisors preserved in tissue culture before replantation.

The effect of delayed replantation and tissue culture as a prevention against root resorption was examined in green Vervet monkeys (Cercopithecus aethiops). Extracted incisors were kept in tissue culture medium (Eagle's medium) for 5--14 days before replantation. The extra-alveolar dry period before tissue culture ranged from to 0 to 60 min. Incisors not subjected to tissue culture served as controls. The animals were sacrificed 8 weeks after replantation. The following histologic parameters were registered for each tooth: surface resorption, inflammatory resorption, replacement resorption (ankylosis), downgrowth of pocket epithelium, and periapical inflammatory changes. The evaluation of the pulp included the extent, recorded in mm, of pulp survival. Histometric evaluation showed that teeth immediately placed in tissue culture medium for 5--14 days showed improved periodontal healing, exhibiting significantly less inflammatory resorption than control teeth immediately replanted. Also the extent of pulp survival was significantly increased in teeth replanted after tissue culture. Teeth bench-dried for 60 min and thereafter placed in tissue culture medium also showed a significant reduction in the amount of inflammatory resorption and increased amount of pulp survival compared with control teeth replanted after the 60-min dry extra-alveolar period. Replacement resorption (ankylosis) was found in all teeth in both groups.

[Root canal treatment and esthetic reconstruction in traumatology]. / Le traitement radiculaire et les reconstitutions esthétiques en traumatologie.

The use of calcium hydroxide in the treatment of traumatic injuries are reviewed in this paper and demonstrated by some clinical cases. The necessity of a proper crown reconstruction is also emphasized as it is impossible to use posts in these treatments.

Outcomes of the surgical exposure, bonding and eruption of 82 impacted maxillary canines.

BACKGROUND: Advances in bonding techniques and materials allow for reliable bracket placement on ectopically positioned teeth. This prospective study evaluates the outcome of forced orthodontic eruption of impacted canine teeth in both palatal and labial positions. METHODS: Eighty-two impacted maxillary canines in 54 patients were included in the study and were observed for 18 to 30 months after exposure. Following exposure by means of a palatal flap or an apically repositioned buccal flap, an orthodontic traction hook, with a ligation chain attached, was bonded to each impacted tooth using a light cured orthodontic resin cement. A periodontal dressing was placed over the surgical site for a period of time. RESULTS: All teeth were successfully erupted. Complications consisted of: failure of initial bond, at the time of surgery, which required rebonding; premature debonding at the time of pack removal and; debonding of brackets during orthodontic eruption. There was no infection, eruption failure, ankylosis, resorption or periodontal defect (pocket greater than 3 mm) associated with any of the exposed teeth. Attached gingiva of less than 3 mm was seen in only two of the buccally positioned canines (9%). CONCLUSION: Forced orthodontic eruption of impacted maxillary canines with a well bonded orthodontic traction hook and ligation chain, used in conjunction with a palatal flap or an apically repositioned labial flap, results in predictable orthodontic eruption with few complications.

A lista de checagem do Planejamento Defensivo no tratamento ortodôntico ou os fatores preditivos das reabsorções dentárias / Checklist for defensive planning for Orthodontic treatment or the predictive factor of dental resorptions

Ainda há dificuldades em adotar-se o protocolo “Planejamento Defensivo para o Tratamento Ortodôntico” quanto à ocorrência das reabsorções radiculares. Essa dificuldade está relacionada à falta de acesso a essas informações. Usando-se uma linguagem mais direta e objetiva, apresentamos uma lista de checagem sobre os fatores preditivos das reabsorções dentárias no tratamento ortodôntico, um verdadeiro guia prático para a prevenção das reabsorções radiculares consequentes da terapêutica ortodôntica. No planejamento ortodôntico não se deve valorizar a predisposição genética e/ou hereditária como um fator preditivo para reabsorções dentárias durante o tratamento ortodôntico. Os fatores de risco, ou preditivos, envolvidos nas reabsorções dentárias, têm natureza local e são passíveis de controle e prevenção por parte do profissional. O risco calculado, com a anuência e esclarecimento do paciente, descaracterizam a negligência ou a imperícia.