Accelerating Wound Healing of Traumatic Ulcer with Topical Application of Dental Pulp Mesenchymal Stem Cell Secretome and Robusta Green Coffee Bean Extract Combination in vivo

ABSTRACT Objective: To investigate the ability of a combination dental pulp mesenchymal stem cell secretome (DPMSCS), robusta green coffee bean extract (RGCBE), and Carboxymethylcellulose-Natrium (CMC-Na) in a Wistar rats model of traumatic ulcers. Material and Methods: Twenty-eight young, male, healthy Wistar rats (Rattus norvegicus) were divided into seven groups randomly: Group K0, group K1-3 (traumatic ulcer rats that received CMC-Na gel for three days), group K1-7 (traumatic ulcer rats that received CMC-Na gel for seven days), group K2-3 (traumatic ulcer rats that received RGCBE for three days), group K2-7 (traumatic ulcer rats that received RGCBE for seven days), group K3-3 (traumatic ulcer rats that received DPMSCS for three days), and group K3-7 (traumatic ulcer rats that received DPMSCS for seven days). An ulcer was made with an amalgam stopper on the right buccal mucosa of the rats. DPMSCS 50% gel was applied to the ulcer on the left buccal mucosa. The ulcer diameter was measured on day 3 and day 7. Results: There was a significant difference in the diameter of the ulcer, the number of neutrophils, and fibroblasts in the treatment group compared to the control group on day 7. Conclusion: A combination of DPMSCS and RGCBE 50% accelerates traumatic ulcer wound healing by lowering ulcer diameter, decreasing neutrophil counts, and increasing fibroblast proliferation in vivo.

Efecto de la hipoxia sobre los tejidos de la cavidad oral: revisión de la literatura / Effect of hypoxia on oral tissues: a review of the literature

La exposición a hipoxia es considerada un estímulo estresante, por lo que el organismo desarrolla meca-nismos de aclimatación para asegurar la homeosta-sis. Si bien el efecto de la hipoxia sobre los distintos sistemas de tejidos y órganos ha sido bien documen-tado, el rol de los bajos niveles de O2 en la cavidad oral no ha recibido el mismo análisis. En este trabajo se revisaron los datos bibliográficos disponibles sobre el efecto de la hipoxia sobre el tejido periodontal, las glándulas salivales, la pulpa dental y el hueso mandi-bular y alveolar. De lo analizado en la bibliografía, re-sulta evidente que los bajos niveles de O2 aumentan el número de mediadores inflamatorios que inducen la progresión de la enfermedad periodontal y, a su vez, la inflamación establecida durante dicha enfermedad agrava aún más las condiciones de hipoxia tisular. Las glándulas salivales también se encuentran afectadas durante la exposición a hipoxia, disminuyendo la can-tidad de saliva secretada, observándose alteraciones ultraestructurales en el parénquima glandular. Por otra parte, se ha establecido que la hipoxia puede te-ner efectos deseados para el cultivo de células madre de la pulpa dental, lo cual resulta útil en el campo de la odontología reparativa y también para el movimien-to dental durante los tratamientos ortodónticos. En conclusión, para determinar los efectos de la hipoxia en la cavidad oral se debe analizar no sólo el tipo de tejido involucrado sino también las condiciones de hi-poxia a las cuales éste es sometido, así también como la duración de la exposición y la modalidad de hipoxia (AU)

Exposure to hypoxia is considered a stressful stimulus, therefore the organism develops acclimation mechanisms to try to ensure homeostasis. Although the effect of hypoxia on different tissues and organs has been very well documented, the role of low levels of O2 in the oral cavity has not received the same analysis. In this review, we analyzed the available bibliographic data concerning the effects of hypoxia on periodontal tissue, salivary glands, and dental pulp. The published evidence demonstrates that low O2 levels increase the number of inflammatory mediators that induce the progression of periodontal disease, and, in turn, the inflammation established during the progression of periodontitis aggravates tissue hypoxia conditions. Salivary glands are also affected during hypoxic exposure, decreasing salivary secretion, and leading to ultrastructural alterations in the glandular parenchyma. On the other hand, hypoxia could also be beneficial in some scenarios. It has been established that dental pulp cells grow better in culture under hypoxic conditions than they do in normoxia. Furthermore, mild hypoxia seems to stimulate periodontal ligament cells proliferation and matrix degradation, key events during for orthodontic treatments. In conclusion, to determine the effects of hypoxia in the oral cavity, it is necessary to analyze not only the type of tissue involved but also the hypoxic conditions to which it is subjected, as well as its duration and modality (AU)

Evaluation of dentinogenesis inducer biomaterials: an in vivo study

Abstract When exposure of the pulp to external environment occurs, reparative dentinogenesis can be induced by direct pulp capping to maintain pulp tissue vitality and function. These clinical situations require the use of materials that induce dentin repair and, subsequently, formation of a mineralized tissue. Objective: This work aims to assess the effect of tricalcium silicate cements and mineral trioxide aggregate cements, including repairing dentin formation and inflammatory reactions over time after pulp exposure in Wistar rats. Methodology: These two biomaterials were compared with positive control groups (open cavity with pulp tissue exposure) and negative control groups (no intervention). The evaluations were performed in three stages; three, seven and twenty-one days, and consisted of an imaging (nuclear medicine) and histological evaluation (H&E staining, immunohistochemistry and Alizarin Red S). Results: The therapeutic effect of these biomaterials was confirmed. Nuclear medicine evaluation demonstrated that the uptake of 99mTc-Hydroxymethylene diphosphonate (HMDP) showed no significant differences between the different experimental groups and the control, revealing the non-occurrence of differences in the phosphocalcium metabolism. The histological study demonstrated that in mineral trioxide aggregate therapies, the presence of moderate inflammatory infiltration was found after three days, decreasing during follow-ups. The formation of mineralized tissue was only verified at 21 days of follow-up. The tricalcium silicate therapies demonstrated the presence of a slight inflammatory infiltration on the third day, increasing throughout the follow-up. The formation of mineralized tissue was observed in the seventh follow-up day, increasing over time. Conclusions: The mineral trioxide aggregate (WhiteProRoot®MTA) and tricalcium silicate (Biodentine™) present slight and reversible inflammatory signs in the pulp tissue, with the formation of mineralized tissue. However, the exacerbated induction of mineralized tissue formation with the tricalcium silicate biomaterial may lead to the formation of pulp calcifications

Experimental gel containing bioactive glass-ceramic to minimize the pulp damage caused by dental bleaching in rats

Abstract Objectives This study evaluated if the use of a bioactive glass-ceramic-based gel, named Biosilicate (BS), before, after or mixed with bleaching gel, could influence the inflammation of the dental pulp tissue of rats' molars undergoing dental bleaching with hydrogen peroxide (H2O2). Methodology The upper molars of Wistar rats (Rattus norvegicus, albinus) were divided into Ble: bleached (35% H2O2, 30-min); Ble-BS: bleached and followed by BS-based gel application (20 min); BS-Ble: BS-based gel application and then bleaching; BS/7d-Ble: BS-based gel applications for 7 days and then bleaching; Ble+BS: blend of H2O2 with BS-based gel (1:1, 30-min); and control: placebo gel. After 2 and 30 days (n=10), the rats were euthanized for histological evaluation. The Kruskal-Wallis and Dunn statistical tests were performed (P<0.05). Results At 2 days, the Ble and Ble-BS groups had significant alterations in the pulp tissue, with an area of necrosis. The groups with the application of BS-based gel before H2O2 had moderate inflammation and partial disorganization in the occlusal third of the coronary pulp and were significantly different from the Ble in the middle and cervical thirds (P<0.05). The most favorable results were observed in the Ble+BS, which was similar to the control in all thirds of the coronary pulp (P>0.05). At 30 days, the pulp tissue was organized and the bleached groups presented tertiary dentin deposition. The Ble group had the highest deposition of tertiary dentin, followed by the Ble-BS, and both were different from control (P<0.05). Conclusion A single BS-based gel application beforehand or BS-based gel blended with a bleaching gel minimize the pulp damage induced by dental bleaching.

Experimentally induced diabetes mellitus influences expression of VEFGand CD68 in rat teeth pulp / La diabetes mellitus inducida experimentalmente influye en la expresión de VEGF y CD68 en la pulpa de dientes de rata

The purpose of this study was to examine the expression levels of the dental pulp to elucidate the role of Vascular Endothelial Growth Factor (VEGF) and CD68 on vascular angiogenesis, inflammation and odontoblast differentiation in the pulp tissue of diabetic rats depending on the effect of possible damage induced by diabetes. Wistar rats were used in the study, divided into two groups. Control group was fed with standard rat chow and drinking water ad libitum for 8 weeks. Single dose of streptozotocin (STZ) (55 mg/kg), was disolved in sodium citrate buffer and administered by intraperitoneal injection. Blood glucose concentration of rats exceeding 250 mg/dl were accepted as diabetic. Rats were sacrificed under anesthesia. Tissues were immediately dissected, fixed and embedded in paraffin and cut with a microtome then examined under light microscope. In the cross-sections of pulp tissue of diabetic group; the dilation of blood vessels besides hemorrhage and a significant increase in inflammatory cells were seen. The expression of VEGF in the blood vessel endothelial cells of the pulp was increased. VEGF showed positive reaction for degenerative odontoblast cells in the pulp. In this study, increase in VEGF and CD68 expressions in pulp tissue due to the effect of diabetes was thought to delay pulp treatment by inducing soft tissue damage and hypoxia.

El propósito de este estudio fue examinar los niveles de expresión en la pulpa dental para dilucidar el papel del Factor de Crecimiento Endotelial Vascular (VEGF) y el CD68 en la angiogénesis, la inflamación y la diferenciación de odontoblastos en el tejido pulpar de ratas diabéticas, dependiendo del efecto de daño inducido por la diabetes. Se utilizaron ratas Wistar divididas en dos grupos. El grupocontrol se alimentó con comida estándar para ratas y agua potable ad libitum durante 8 semanas. Se administró mediante inyección intraperitoneal dosis única de estreptozotocina (STZ) (55 mg / kg), se disolvió en tampón de citrato de sodio. La concentración de glucosa en sangre de ratas que excedían los 250 mg / dl se aceptó como diabética. Las ratas fueron sacrificadas bajo anestesia. Los tejidos se disecaron de inmediato, se fijaron en parafina y se cortaron para luego ser examinados con un microscopio óptico. En las secciones transversales del tejido pulpar del grupo diabético se observó la dilatación de los vasos sanguíneos además de hemorragia y un aumento significativo de células inflamatorias. La expresión de VEGF se incrementó en las células endoteliales de los vasos sanguíneos de la pulpa. VEGF mostró una reacción positiva para las células odontoblásticas degenerativas en la pulpa. El aumento en la expresión de VEGF y CD68 en el tejido de la pulpa debido al efecto de la diabetes puede retrasar el tratamiento de la pulpa al inducir hipoxia y daños en los tejidos blandos.

Terapia fotodinâmica como coadjuvante ao tratamento endodôntico: relato de caso / Photodynamic therapy as an endodontic treatment coadjuvant: case report

Introdução: a terapia fotodinâmica surgiu na Endodontia como um método de tratamento que utiliza a laserterapia de baixa potência, com ação analgésica, anti-inflamatória e antibacteriana. Objetivo: o presente trabalho visa apresentar e discutir, por meio do relato de um caso de tratamento endodôntico, o uso de terapia fotodinâmica como um aliado contra bactérias persistentes após o preparo químico-mecânico do canal. Relato de caso: paciente com 40 anos de idade, apresentou-se em consultório particular com dor pulsátil, sensível à percussão, com diagnóstico de periodontite apical aguda no dente #22. Após anamnese, exames radiográficos e odontometria, o tratamento endodôntico foi realizado com o sistema ProTaper® Universal (Dentsply), técnica híbrida, irrigação com hipoclorito de sódio 2,5% e agitação ultrassônica associada; e o elemento foi instrumentado e seco. Então, foi aplicada a terapia fotodinâmica: o corante azul de metileno 0,005% foi aplicado no canal seco durante 5 minutos, seguido de laser vermelho por 180 segundos, totalizando 18J (Laser DUO Portátil-MMO®), com movimentos de apical para incisal. Na sequência, nova irrigação de NaOCl e, então, EDTA 17%, com agitação ultrassônica por um minuto, seguido de NaOCl 2,5%, para se obter a neutralização do meio. Após secagem do canal, a obturação foi realizada com um cone único F3 (ProTaper® Universal) e cimentação com AH Plus®. Conclusão: a terapia fotodinâmica é um método de fácil e rápida aplicação, que surgiu como um coadjuvante ao tratamento endodôntico, sendo indicada para a eliminação de microrganismos persistentes após o preparo químico-mecânico dos canais radiculares (AU).

Introduction: Photodynamic therapy appears in endodontics as a treatment method that uses low level laser therapy with analgesic, anti-inflammatory and antibacterial. Goal: This paper aims to present and discuss through an endodontic treatment using photodynamic therapy as an ally against persistent bacteria after chemical-mechanical canal preparation. Case report: GR patient, 40, appeared in private practice, with throbbing pain, sensitive to shock, with acute apical periodontitis, the element 22. After anamnesis, X-ray examinations and tooth, endodontic treatment was performed with the system ProTaper Universal® (Dentsply), hybrid technique; irrigation with sodium hypochlorite 2.5%, ultrasonic agitation associated; instrumented and dry. Then it was applied to photodynamic therapy, 0.005% methylene blue dye was applied in the dry channel for 5 minutes followed by red laser for 180 seconds totaling 18J (Portable Laser DUO-MMO®) with the apex moves to the incisal, the new sequence NaOCl irrigation and after EDTA 17% with ultrasonic agitation for one minute followed by 2.5% NaOCl for neutralizing medium; Dry the canal obturation was performed with the single cone F3 ProTaper® Universal and cementation with AHPLUS®. Conclusion: We conclude that photodynamic therapy is a method of quick and easy application that comes as an adjunct to endodontic treatment, and is indicated for the elimination of persistent microorganisms after chemical-mechanical preparation of root canals (AU).

Initial inflammatory response after the pulpotomy of rat molars with MTA or ferric sulfate

Abstract Purpose To compare, both qualitatively and quantitatively, the inflammatory cells, vascular density and IL-6 immunolabeled cells present in the pulp after pulpotomy with white MTA versus 15.5% ferric sulfate (FS). Methodology Forty-eight mandibular first molars from 24 Wistar rats were divided into MTA or FS groups and subdivided according to the period after pulpotomy procedure (24, 48 and 72 hours). Four teeth (sound and untreated) were used as controls. Histological sections were obtained and assessed through the descriptive analysis of morphological aspects of pulp tissue and the quantification of inflammatory cells, vascular density and interleukin-6 (IL-6) expression. Data were statistically analyzed (p<0.05). Results The number of inflammatory cells was similar in both groups, being predominantly localized at the cervical radicular third. In the MTA group, increased inflammation was observed at 48 hours. Vascular density was similar in both groups and over time, being predominant in the medium radicular third. No correlation was found between the number of inflammatory cells and the vascular density. Pulp tissue was more organized in MTA-treated teeth. In both groups, a weak to moderate IL-6 expression was detected in odontoblasts and inflammatory cells. Comparing both groups, there was a greater IL-6 expression in the cervical radicular third of teeth treated with MTA at 24 hours and in the medium and apical thirds at 72 hours, while in the FS group a greater IL-6 expression was found in the apical third at 24 hours. Conclusion The MTA group presented better histological features and greater IL-6 expression than the FS group. However, no difference was observed between the groups regarding the inflammatory status and vascularization, suggesting the usefulness of FS as a low-cost alternative to MTA.

Ideal Concentration of Advanced-Platelet Rich Fibrin (A-PRF) Conditioned Media for Human Dental Pulp Stem Cells Differentiation

Abstract Objective: To discover the ideal concentration of Advanced Platelet Rich Fibrin (A-PRF) as modification of PRF, for human Dental Pulp Stem Cells (hDPSCs) differentiation. Material and Methods: hDPSCs were devided into five experimental groups: Group I (control group) consist of hDPSCs cultured in 10% FBS, Group II consist of hDPSCs cultured in 1% A-PRF, Group III consist of hDPSCs cultured in 5% A-PRF, Group IV consist of hDPSCs cultured in 10% A-PRF and Group V consist of hDPSCs cultured in 25% A-APRF. All group have been observed for 7 and 14 days and each group had three biological replicates (triplo). Formation of the mineralized nodules was detected after 7 days by Alizarin red-based assay and Dentin Sialophosphoprotein (DSPP) expression after 7 and 14 days quantified by ELISA reader. Statistical analysis was proven with Kruskal-Wallis and post hoc Mann-Whitney test Results: The differentiation of hDPSCs in all A-PRF groups was significantly different on day-7 (p<0.05) compare to control group (Group I). There were no significant differences between all groups on day-14 (p>0.05). Significantly differences between Group II (1% A-PRF) and Group I (control), Group II (1% A-PRF) and Group III (5% A-PRF), also Group II (1% A-PRF) and Group V (25% A-PRF) was found from post hoc test analysis Conclusion: The ideal conditioned media concentration for differentiation of human dental pulp stem cells was on 1% up to 5% A-PRF group.

Expression of calcitonin gene-related peptide and pulp sensitivity tests in irreversible pulpitis

Abstract The aim of the present study was to identify the relationship between the expression of calcitonin gene-related peptide (CGRP) and the responses of pulp sensitivity tests in healthy pulps and irreversible pulps by performing a cross-sectional study on patients. Two hundred subjects were evaluated. A total of 75 subjects complied with the criteria. The participants were divided into two groups: a) Healthy pulp (subjects [n = 35] having posterior teeth with clinically normal pulp tissue), and b) Irreversible pulpitis (subjects [n = 40] having posterior teeth with irreversible pulpitis). All participants were evaluated using the following variables: a) medical and dental history, b) pulp sensitivity tests, c) expression of CGRP by the enzyme-linked immunosorbent assay (ELISA), and d) expression levels of mRNA CGRP and mRNA CGRP receptor genes. We determined that the responses of the cold test between 4 and ≥12 s presented a higher average of the expression of CGRP in the group having irreversible pulpitis (p = 0.0001). When we compared the groups with the value of the electrical impulse, we found statistically significant differences (p = 0.0001), observing positive responses to the test with electrical impulses of 7 to 10, with an average of 72.15 ng/mL of CGRP in the irreversible pulpitis group. High values of CGRP expression were observed in that group in the responses of pulp sensitivity.

There is no pulp necrosis or calcific metamorphosis of pulp induced by orthodontic treatment: biological basis

ABSTRACT To biologically explain why the orthodontic treatment does not induce pulp necrosis and calcific metamorphosis of the pulp, this paper presents explanations based on pulp physiology, microscopy and pathology, and especially the cell and tissue phenomena that characterize the induced tooth movement. The final reflections are as follows: 1) the orthodontic movement does not induce pulp necrosis or calcific metamorphosis of the pulp; 2) there is no literature or experimental and clinical models to demonstrate or minimally evidence pulp alterations induced by orthodontic movement; 3) when pulp necrosis or calcific metamorphosis of the pulp is diagnosed during orthodontic treatment or soon after removal of orthodontic appliances, its etiology should be assigned to concussion dental trauma, rather than to orthodontic treatment; 4) the two pulp disorders that cause tooth discoloration in apparently healthy teeth are the aseptic pulp necrosis and calcific metamorphosis of the pulp, both only induced by dental trauma; 5) the concussion dental trauma still requires many clinical and laboratory studies with pertinent experimental models, to increasingly explain its effects on the periodontal and pulp tissues.

RESUMO Para fundamentar biologicamente por que o tratamento ortodôntico não induz necrose pulpar e metamorfose cálcica da polpa, apresentou-se explicações com base na fisiologia, microscopia e patologia pulpar, bem como, e principalmente, nos fenômenos celulares e teciduais que caracterizam a movimentação dentária induzida. As reflexões finais foram: 1) o movimento ortodôntico não induz necrose pulpar ou metamorfose cálcica da polpa; 2) não há literatura e modelos experimentais e clínicos que comprovem ou minimamente evidenciem alterações pulpares induzidas pelo movimento ortodôntico; 3) quando a necrose pulpar ou metamorfose cálcica da polpa for diagnosticada durante o tratamento ortodôntico ou logo após a remoção dos aparelhos ortodônticos, a sua etiologia deve ser atribuída ao traumatismo dentário do tipo concussão, e não ao tratamento ortodôntico; 4) as duas doenças pulpares que levam ao escurecimento coronário em dentes aparentemente hígidos são a necrose pulpar asséptica e a metamorfose cálcica da polpa, ambas induzidas exclusivamente pelo traumatismo dentário; 5) o traumatismo dentário do tipo concussão requer, ainda, muitos estudos clínicos e laboratoriais, com modelos experimentais pertinentes, para fundamentar cada vez mais os seus efeitos sobre os tecidos periodontais e pulpares.

Clinical, radiographic and histological evaluation of primary teeth pulpotomy using mta and ferric sulfate

Abstract The aim of this study was to evaluate the clinical, radiographic and histological outcomes of the dentin-pulp complex from primary molars after pulpotomy with mineral trioxide aggregate (MTA) and 15.5% ferric sulfate (FS). Thirty-one primary molars were randomly allocated into MTA or FS groups. Clinical and radiographic evaluations were recorded at 3-, 6-, 12- and 18-month follow-up. Teeth at the regular exfoliation period were extracted and processed for histological analysis. Clinical and radiographic data were tested by statistical analysis (p≤0.01). Histological outcomes were analyzed descriptively. All of the treated teeth presented clinical success over the experimental periods. Both groups exhibited 100% of radiographic success at 3, 6 and 12 months. At the 18-month follow-up, one tooth from FS group presented inter-radicular radiolucency (p>0.01). Histologically, the treated teeth presented pulp vitality and absence of inflammatory infiltrate into the connective tissue. Only MTA group showed hard tissue barrier surrounded by odontoblasts over the pulp stumps. Both MTA and 15.5% FS are effective for pulpotomies of primary teeth. Although MTA is considered the first-choice material, FS may be a suitable alternative when treatment cost is an issue.

Resumo O objetivo deste estudo foi avaliar os resultados clínicos, radiográficos e histológicos do complexo dentino-pulpar de molares decíduos após pulpotomia com agregado trióxido mineral (MTA) e sulfato férrico (SF) 15,5%. Trinta e um molares decíduos foram alocados aleatoriamente nos grupos MTA ou SF. As avaliações clínicas e radiográficas foram realizadas aos 3, 6, 12 e 18 meses de acompanhamento. Os dentes no período regular de esfoliação foram extraídos e processados ​​para análise histológica. Os dados clínicos e radiográficos foram analisados estatisticamente (p≤0,01). O resultados histológicos foram analisados ​​descritivamente. Todos os dentes tratados apresentaram sucesso clínico ao longo dos períodos experimentais. Ambos os grupos exibiram 100% de sucesso radiográfico aos 3, 6 e 12 meses. Aos 18 meses de acompanhamento, um dente do grupo SF apresentou radiolucidez interradicular (p>0,01). Histologicamente, os dentes tratados apresentaram vitalidade pulpar e ausência de infiltrado inflamatório no tecido conjuntivo. Somente o grupo MTA mostrou barreira de tecido duro rodeada por odontoblastos sobre os cotos pulpares. MTA e SF 15,5% são eficazes para pulpotomias de dentes decíduos. Embora o MTA seja considerado o material de primeira escolha, o SF pode ser uma alternativa adequada quando o custo do tratamento é um problema.

Pulp analysis of teeth submitted to different types of forces: a histological study in rats

Abstract Objective: The purpose of this study was to histologically evaluate pulp and dentin under induced tooth movement (ITM) with different types of forces. Material and Methods: The maxillary right first molars of rats were submitted to movement with continuous (CF), continuous interrupted (CIF) and intermittent (IF) forces during 5, 7 and 9 days with nickel-titanium (NiTi) closed-coil springs exerting 50cN force magnitude. The groups were histologically evaluated as for cellularity pattern, presence of dystrophic, hemodynamic alterations in the pulp as well dentin alterations. The main observed alterations were related to hemodynamic pulp characteristics, such as presence of thrombosis, vascular congestion and hemorrhages. The hemodynamic alterations were statistically evaluated by Shapiro-Wilk normality test and analysis of variance by the Kruskall-Wallis test. Results: There was no significant differences observed between groups in the different types of applied forces and duration of ITM (vascular congestion, p=1.000; hemorrhage, p=0.305; thrombosis, p=1.000). Conclusions: Pulp tissue alterations resulting from ITM were limited to hemodynamic events, without progressing to irreversible degeneration, regardless of the type of force applied.

Frecuencia de patologías pulpares atendidas en una clínica docente de Ecuador / Frequency of pulpal pathologies attended in a teaching clinic

Objetivos: Determinar la frecuencia de patologías pulpares en pacientes de 18 a 45 años de edad que acudieron a la clínica de odontología de la Unidad Académica de Ciencia Odontológica de la Universidad Católica de Cuenca en el año lectivo 2013 ­ 2014. Material y métodos: Se realizó un estudio descriptivo transversal en 320 pacientes con un rango de edad entre 18 y 45 años mediante un formulario en el que se recogió nombre, edad, sexo, historia clínica, diente afectado y la patología pulpar presentada por el paciente. Resultados: La patología pulpar más frecuente fue pulpitis irreversible (62 %), seguido de necrosis (38%). Los pacientes de entre 26 a 30 y 40 a 45 años presentaron una frecuencia de pulpitis irreversible de 70 y 75 % respectivamente. Mientras que la frecuencia de necrosis no superó el 50 % de los casos en ningún grupo etario, siendo mayor en los grupos de 36 a 40 años y 18 a 25 años. Conclusiones: No existe diferencia significativa entre ambos sexos. (AU)

Objectives: To determinate pulpal pathologies frequency in patients from 18 to 45 years who were attended in dental clinic of Unidad Académica de Ciencia Odontológica de la Universidad Católica de Cuenca among 2013 ­ 2014 academic year. Material and methods: A cross-sectional descriptive study was performed in 320 patients between 18 and 45 years through a form in which name, age, sex, medical history, affected tooth and the pulp pathology presented by the patient were collected. RESULTS: irreversible pulpitis was the most frequent pulp pathology (62%), followed by necrosis (38%). Patients between 26-30 and 40-45 years had an irreversible pulpitis frequency of 70 and 75%, respectively. While the frequency of necrosis did not exceed 50% of the cases in any age group, being greater in the groups from 36 to 40 years and 18 to 25 years. Conclusions: There is no significant difference between the sex. (AU)

Inflammatory response of human dental pulp to at-home and in-office tooth bleaching

ABSTRACT Tooth bleaching is a technique of choice to obtain a harmonious smile, but bleaching agents may damage the dental pulp. Objective: This study evaluated the inflammatory responses of human dental pulp after the use of two bleaching techniques. Material and Methods: Pulp samples were collected from human third molars extracted for orthodontic reasons and divided into three groups: control - no tooth bleaching (CG) (n=7); at-home bleaching with 15% carbamide peroxide (AH) (n = 10), and in-office bleaching with 38% hydrogen peroxide (IO) (n=12). Pulps were removed and stained with hematoxylin-eosin for microscopic analysis of inflammation intensity, collagen degradation, and pulp tissue organization. Immunohistochemistry was used to detect mast cells (tryptase+), blood vessels (CD31+), and macrophages (CD68+). Chi-square, Kruskal-Wallis, and Mann Whitney tests were used for statistical analysis. The level of significance was set at p<.05. Results: The inflammation intensity and the number of macrophages were significantly greater in IO than in AH and CG (p<0.05). The results of CD31+ (blood vessels per mm2) were similar in CG (61.39±20.03), AH (52.29±27.62), and IO (57.43±8.69) groups (p>0.05). No mast cells were found in the pulp samples analyzed. Conclusion: In-office bleaching with 38% hydrogen peroxide resulted in more intense inflammation, higher macrophages migration, and greater pulp damage then at-home bleaching with 15% carbamide peroxide, however, these bleaching techniques did not induce migration of mast cells and increased the number of blood vessels.

Evaluation of an experimental rat model for comparative studies of bleaching agents

ABSTRACT Dental materials in general are tested in different animal models prior to the clinical use in humans, except for bleaching agents. Objectives To evaluate an experimental rat model for comparative studies of bleaching agents, by investigating the influence of different concentrations and application times of H2O2 gel in the pulp tissue during in-office bleaching of rats’ vital teeth. Material and Methods The right and left maxillary molars of 50 Wistar rats were bleached with 20% and 35% H2O2 gels, respectively, for 5, 10, 15, 30, or 45 min (n=10 rats/group). Ten animals were untreated (control). The rats were killed after 2 or 30 days, and the maxillae were examined by light microscopy. Inflammation was evaluated through histomorphometric analysis with inflammatory cell count in the coronal and radicular thirds of the pulp. Fibroblasts were also counted. Scores were attributed to odontoblastic layer and vascular changes. Tertiary dentin area and pulp chamber central area were measured histomorphometrically. Data were compared by analysis of variance and Kruskal-Wallis test (p<0.05). Results After 2 days, the amount of inflammatory cells increased in the coronal pulp occlusal third up to the 15-min application groups of each bleaching gel. In the groups exposed to each concentration for 30 and 45 min, the number of inflammatory cells decreased along with the appearance of necrotic areas. After 30 days, reduction on the pulp chamber central area and enlargement of the tertiary dentin area were observed, without the detection of inflammation areas. Conclusion The rat model of extracoronal bleaching showed to be adequate for studies of bleaching protocols, as it was possible to observe alterations in the pulp tissues and tooth structure caused by different concentrations and application periods of bleaching agents.

Evaluation of an experimental rat model for comparative studies of bleaching agents

ABSTRACT Dental materials, in general, are tested in different animal models prior to their clinical use in humans, except for bleaching agents. Objectives To evaluate an experimental rat model for comparative studies of bleaching agents by investigating the influence of different concentrations and application times of H2O2 gel in the pulp tissue during in-office bleaching of rats’ vital teeth. Material and methods The right and left maxillary molars of 50 Wistar rats were bleached with 20% and 35% H2O2 gels, respectively, for 5, 10, 15, 30, or 45 min (n=10 rats/group). Ten animals (control) were untreated. The rats were killed after 2 or 30 days, and the maxillae were examined by light microscopy. Inflammation was evaluated by histomorphometric analysis with inflammatory cell counting in the coronal and radicular thirds of the pulp. The counting of fibroblasts was also performed. Scores were attributed to the odontoblastic layer and to vascular changes. The tertiary dentin area and the pulp chamber central area were histomorphometrically measured. Data were compared by the analysis of variance and the Kruskal-Wallis test (p<0.05). Results After 2 days, the amount of inflammatory cells increased in the occlusal third of the coronal pulp until the time of 15 min for both concentrations of bleaching gels. In 30 and 45 min groups of each concentration, the number of inflammatory cells decreased along with the appearance of necrotic areas. After 30 days, a reduction in the pulp chamber central area and an enlargement of tertiary dentin area were observed without the detection of inflammation areas. Conclusion The rat model of extra coronal bleaching showed to be adequate for bleaching protocols studies, as it was possible to observe alterations in the pulp tissues and in the tooth structure caused by different concentrations and periods of application of bleaching agents.

Influência da doença periodontal no estado pulpar: conceitos atuais / The influence of periodontal disease in the pulp state: current concepts

A ocorrência de lesões periodontais derivadas de infecções presentes no canal radicular é bem estabelecida, entretanto, existem questionamentos quanto à possibilidade da doença periodontal induzir lesões pulpares. A revisão da literatura relatada no presente texto revelou que parece não existir correlação entre severidade da doença periodontal e prevalência e severidade de alterações pulpares em dentes periodontalmente envolvidos. As alterações pulpares decorrentes da agressão representada pela doença periodontal parecem ser de natureza atrófica e inflamatória de baixa intensidade. A possível correlação entre severidade da doença periodontal e prevalência e severidade de alterações pulpares é controversa e carece de maior comprovação científica. A ocorrência simultânea de cofatores de agressão (cárie, restauração, instrumentação periodontal) pode aumentar a probabilidade (risco) de alterações pulpares em dentes periodontalmente envolvidos.

Reabsorção interna versus externa: indicadores para um diagnóstico preciso / Internal resorption versus external: indicators for accurate diagnosis

Os diagnóticos equivocados entre absorção interna e externa frequentemente estão presentes nos laudos imaginológicos, em trabalhos publicados e em livros. Objetivo: destacamos, no presente trabalho, os indicadores imaginológicos de diagnóstico preciso para as reabsorções internas e externas, haja vista que são distintas e específicas. Resultados: a preservação dos limites pulpares nos dentes com reabsorção externa se destaca como seu principal indicador diagnóstico. A expansão foco/local balonizante dos limites pulpares com continuidade e a regularidade nas suas margens expandidas, formando uma área pulpar de radiolucidez homogênea, são os principais indicadores do diagnóstico de reabsorção interna. Conclusão: os diagnósticos equivocados geralmente estão associados à falta de conhecimento da etiopatogenia desses processos reabsortivos e/ou de uma experiência prévia em seus diagnósticos.

Microbial Reduction by Two Chemical-Mechanical Protocols in Primary Teeth with Pulp Necrosis and Periradicular Lesion - An In Vivo Study

The objective of this study was to determine the efficacy of chemical-mechanical procedures of two endodontic protocols for septic content reduction of root canals from primary teeth with pulp necrosis and periradicular lesion. Twenty-four primary root canals with pulp necrosis and periradicular lesion were divided into two treatment groups (n=12): multiple-visit and single-visit protocols. Samples were collected using sterile paper points before and after endodontic cleaning followed by microbiological identification through checkerboard DNA-DNA hybridization. Statistical analysis was performed using Proportion Test for score=0 comparing the findings before and after treatment for each group (Wilcoxon's test) as well as the differences in scores between protocols (Mann-Whitney's test) (p<0.05). Data were expressed as prevalence (presence or absence) and estimate of the average count (x105 cells) of each species. Differences in proportions of score=0 prior to treatment were non-significant (p=0.415), demonstrating equivalence between groups. A significant increase in score=0 was detected after treatment for both groups (p<0.0001). Single-visit protocol achieved a significantly greater reduction in mean scoring following endodontic treatment (p=0.024). Both protocols were capable of significantly reducing septic content in root canals of primary teeth with periradicular lesion. Moreover, single-visit protocol showed greater efficacy in reducing endodontic infection.

O objetivo deste estudo foi determinar a eficácia das manobras químico-mecânicas de dois protocolos endodônticos, na redução do conteúdo séptico de canais radiculares de dentes decíduos com polpa necrosada e lesão perirradicular. Vinte e quatro canais radiculares decíduos com necrose pulpar e lesão perirradicular foram divididos em dois grupos de tratamento (n=12): multisessões e sessão única. Amostras foram coletadas usando pontas de papel estéreis, antes e após a limpeza endodôntica, seguido de identificação microbiológica por hibridização DNA-DNA checkerboard. A análise estatística foi realizada usando teste de proporções para escore=0, comparando os achados antes e após tratamento para cada grupo (teste de Wilcoxon) e as diferenças dos escores entre os protocolos (teste de Mann-Whitney) (p<0,05). Os dados foram expressos em prevalência (presença ou ausência) e contagem média (x105 células) de cada espécie. As diferenças nas proporções de escore=0 antes do tratamento não foram significativas (p=0,415), mostrando equivalência entre os grupos. Um aumento significativo de escore=0 foi detectado após o tratamento para ambos os grupos (p<0,0001). O protocolo de sessão única mostrou uma redução significativamente maior dos escores médios após o tratamento endodôntico (p=0,024). Ambos os protocolos são capazes de reduzir significativamente o conteúdo séptico de canais radiculares de dentes decíduos com lesão perirradicular. Entretanto, o protocolo de sessão única mostrou uma maior eficácia na redução da infecção endodôntica.

Avaliação do padrão de metilação em genes relacionados à resposta imune em polpa dental humana / Evaluation of pattern of mehylation in genes related to the immune response in human dental pulp

Receptores de reconhecimento padrão (PRRs), como o Toll-like receptor 2 (TLR-2) e o TLR4, participam da ativação do sistema imune por microrganismos quando a polpa dental está inflamada. Supões-se que seus níveis de expressão em tecido pulpar humano podem ser modulados por fatores epigenéticos, especialmente a metilação do DNA. O objetivo deste estudo foi avaliar o padrão de metilação dos genes TLR-2 e CD14 - um correceptor do TLR4 - em polpas dentais saudáveis e inflamadas. Adicionalmente, verificou-se a associação entre o padrão de metilação do gene interferon-gama (IFN-y), previamente por nós identificado, com sua expressão gênica em polpas dentárias...