Periodontal therapy for patients before and after radiotherapy: A review of the literature and topics of interest for clinicians.

BACKGROUND: To review and discuss important topics regarding periodontal treatment pre- and post-radiotherapy for head and neck cancer in human patients; to discuss the references for adequate techniques, the appropriate moment for tooth extractions and periodontal management; and to discuss the prevention of osteoradionecrosis. MATERIAL AND METHODS: Thirty-nine studies including original studies, randomized clinical trials (RCTs) and reviews were searched in online databases MEDLINE (PubMed) and the Cochrane library. No year of publication restriction was applied. RESULTS: Language was restricted to English, and the following Medical Subject Heading terms were used: radiotherapy, radiation therapy and periodontal treatment. Studies regarding periodontal treatment and tooth extraction that involved clinical management of irradiated patients were selected. CONCLUSIONS: The treatment of periodontal diseases before radiotherapy is mainly required to avoid future dental extraction and to reduce the development of osteoradionecrosis. Periodontal treatment in irradiated patients mostly includes scaling and root planing, extraction of condemned teeth and topical and systemic antimicrobial therapy. Tooth removal should be planned at least 14 days before the first day of radiation treatment. Particular care and mouthwashes should be taken during and after radiation. CLINICAL SIGNIFICANCE: The management of irradiated patients represents a challenge for health professionals, including dentists. It is important to establish recommendations for clinicians concerning dental and periodontal management in irradiated patients before, during and after treatment.

Effect of different storage media on root dentine composition and viability of fibroblasts evaluated by several assay methods.

AIM: To perform multiparametric analysis of the effects of soya milk (SM), whole milk (WM) and Hank's balanced salt solution (HBSS) on the viability of fibroblasts (HGF). The study also aimed to evaluate the influence of these solutions on bovine root dentine according to OH- and PO43- on the surface. METHODOLOGY: The HGF cytotoxicity was determined according to XTT, NR and SRB assays at 1, 3 and 6 h. Root dentine fragments were assessed by Fourier infrared (FTIR) spectrophotometer before and after immersion in the solutions for the same periods. The positive control group included cells and tooth fragments maintained in Dulbecco's modified Eagle's medium (DMEM), and the negative control included tooth fragments that were kept dry. Data were analysed using anova and Tukey's test. RESULTS: No significant difference was found in cell viability evaluated by XTT (P > 0.05). Using the NR assay, WM and HBSS had significantly lower cell viability compared to the positive control group at 6 h (P < 0.05). SM had similar cell viability to the positive control group at all periods evaluated when assessed using all three tests (P > 0.05). A significant difference was found in values of OH- for the negative control group at 1 h (P = 0.002). CONCLUSIONS: Soya milk promoted better cell viability, whereas on dentine composition, the solutions behaved similarly. The association of different assay methods is promising for improving cell viability analysis. The 1-h time-point is a crucial factor in the prognosis of dental replantation because the teeth remain more hydrated and help maintain cell viability.

Powdered coconut water as a storage medium to preserve the viability of periodontal ligament cells: a laboratory study.

AIM: To investigate the ability of newly developed powdered coconut water formulas (ACP) with different osmolarities to maintain the viability of periodontal ligament (PDL) cells over time compared with other solutions. METHODOLOGY: Dogs teeth were extracted and stored for two periods, 3 h or 24 h, in the following media: long-shelf life CW (CW), pH-adjusted long-shelf life CW (pH-CW) and powdered CW that was pH and osmolality adjusted (ACP-404-I, 250 mOsm kg-1 H2 O; pH 7.0; ACP-404-II, 372 mOsm kg-1 H2 O; pH 7.0; ACP-404-III, 300 mOsm kg-1 H2 O; pH 7.4). The positive control group (Pc) corresponded to immediate measurement after tooth extraction, and two negative controls (Nc) corresponded to 3 h and 24 h of dry time. PDL cells were extracted, and cell viability analysed by Trypan blue exclusion. Data were analysed statistically using two-way anova followed by the Tukey test and one-way anova followed by the Dunnett test (P < 0.05). RESULTS: At 3 h and 24 h, ACP-404-I had a performance similar to those of ACP-404-II and pH-CW, with significantly higher (P = 0.004) percentages of viable cells than ACP-404-III and CW. The positive control group had a significantly higher (P = 0.002) percentage of viable cells than the negative control groups, CW and ACP-404-III, irrespective of the period evaluated. CONCLUSION: Powdered coconut water formulas, ACP-404-I and ACP-404-II, preserved viability for up to 24 h.

Effect of anti-rotation devices on biomechanical behaviour of teeth restored with cast post-and-cores.

AIM: To test the hypothesis that the presence of an anti-rotation device (ARD) and its location can influence the biomechanical behaviour of root filled teeth restored with cast post-and-cores and metallic crowns. METHODOLOGY: Fifth two bovine incisor roots were selected and divided into four groups (n = 13): Nd- without ARD; Bd- buccal ARD; Ld- lingual ARD; BLd- buccal and lingual ARD. The specimens were restored with cast post-and-cores and metallic crowns. After a fatigue process (3 x 10(5) 50 N), three strain gauges were attached on the buccal, lingual and proximal surfaces and the samples of each group (n = 3) were submitted to a 0-100 N load. Fracture resistance was assessed in a mechanical testing machine (n = 10). Strain values and fracture resistance data were analysed by one-way anova and Tukey Honestly Significant Difference (HSD) test (alpha = 0.05). The failure mode was then evaluated under an optical stereomicroscope. Bidimensional models of each group were generated for finite element analysis (FEA) and analysed using the von Mises criteria. RESULTS: No significant difference in fracture resistance values and fracture modes occurred between the four groups. The BLd group had higher stress concentrations in the buccal dentine and higher strain values on the proximal surfaces. CONCLUSIONS: The anti-rotation devices did not influence significantly the fracture resistance and fracture mode. However, the stress-strain values were increased when the anti-rotation device was prepared on the buccal and lingual faces concomitantly.

Effects of chlorhexidine and fluoride on irradiated enamel and dentin.

The effectiveness of mouthwash protocols in preventing gamma irradiation therapy damage to the ultimate tensile strength (UTS) of enamel and dentin is unknown. It was hypothesized that the use of chlorhexidine and fluoride mouthwash would maintain the UTS of dental structures. One hundred and twenty teeth were divided into 2 groups: irradiated (subjected to 60 Gy of gamma irradiation in daily increments of 2 Gy) and non-irradiated. They were then subdivided into 2 mouthwash protocols used 3 times per day: 0.12% chlorhexidine, 0.05% sodium fluoride, and control group (n = 10). The specimens were evaluated by microtensile testing. The results of the Tukey test (p < 0.05) indicated that the gamma irradiation therapy significantly reduced the UTS of the enamel, crown, and root dentin. Macromolecular alterations were suggested by optical retardation data in dentin. Structural alterations, in both substrates, were detected by scanning electron microscopy analysis. Mouthwash with 0.12% chlorhexidine partially prevented the damage to the mechanical properties of the irradiated crown dentin, whereas the 0.05% sodium-fluoride-irradiated enamel showed UTS similar to that of non-irradiated enamel.