The use of photobiomodulation therapy or LED and mineral trioxide aggregate improves the repair of complete tibial fractures treated with wire osteosynthesis in rodents.

The repair of large bone defects is lengthy and complex. Both biomaterials and phototherapy have been used to improve bone repair. We aimed to describe histologically the repair of tibial fractures treated by wiring (W), irradiated or not, with laser (λ780 nm, 70 mW, CW, spot area of 0.5 cm2, 20.4 J/cm2 (4 × 5.1 J/cm2, Twin Flex Evolution®, MM Optics, Sao Carlos, SP, Brazil) per session, 300 s, 142.8 J/cm2 per treatment) or LED (λ850 ± 10 nm, 150 mW, spot area of 0.5 cm2, 20.4 J/cm2 per session, 64 s, 142.8 J/cm2 per treatment, Fisioled®, MM Optics, Sao Carlos, Sao Paulo, Brazil) and associated or not to the use of mineral trioxide aggregate (MTA, Angelus®, Londrina, PR, Brazil). Inflammation was discrete on groups W and W + LEDPT and absent on the others. Phototherapy protocols started immediately before suturing and repeated at every other day for 15 days. Collagen deposition intense on groups W + LEDPT, W + BIO-MTA + LaserPT and W + BIO-MTA + LEDPT and discrete or moderate on the other groups. Reabsorption was discrete on groups W and W + LEDPT and absent on the other groups. Neoformation varied greatly between groups. Most groups were partial and moderately filed with new-formed bone (W, W + LaserPT, W + LEDPT, W + BIO-MTA + LEDPT). On groups W + BIO-MTA and W + BIO-MTA + LaserPT bone, neoformation was intense and complete. Our results are indicative that the association of MTA and PBMT (λ = 780 nm) improves the repair of complete tibial fracture treated with wire osteosynthesis in a rodent model more efficiently than LED (λ = 850 ± 10 nm).

Influence of photobiomodulation therapy on root development of rat molars with open apex and pulp necrosis.

This study aimed to evaluate the role of photobiomodulation (PBM) in apexification and apexogenesis of necrotic rat molars with an open apex. Rat molars were exposed to the oral environment for 3 weeks. Canals were rinsed with 2.5% NaOCl and 17% EDTA, filled with antibiotic paste and sealed. After 7 days, canals were rinsed and divided into six groups (n=6): mineral trioxide aggregate (MTA); blood clot (BC); human dental pulp stem cells (hDPSC); MTA+PBM; BC+PBM; and hDPSC+PBM. In hDPSC groups, a 1% agarose gel scaffold was used. Two groups were not exposed: healthy tooth+PBM (n = 6), healthy tooth (n = 3); and one was exposed throughout the experiment: necrotic tooth (n = 3). In PBM groups, irradiation was performed with aluminum gallium indium phosphide (InGaAlP) diode laser for 30 days within 24-h intervals. After that, the specimens were processed for histological and immunohistochemical analyses. Necrotic tooth showed greater neutrophil infiltrate (p < 0.05). Necrotic tooth, healthy tooth, and healthy tooth+PBM groups showed absence of a thin layer of fibrous condensation in the periapical area. All the other groups stimulated the formation of a thicker layer of fibers (p < 0.05). All groups formed more mineralized tissue than necrotic tooth (p < 0.05). PBM associated with MTA, BC, or hDPSC formed more mineralized tissue (p < 0.05). MTA+PBM induced apexification (p < 0.05). Rabbit polyclonal anti-bone sialoprotein (BSP) antibody confirmed the histological findings of mineralized tissue formation, and hDPSC groups exhibited higher percentage of BSP-positive cells. It can be concluded that PBM improved apexification and favored apexogenesis in necrotic rat molars with an open apex.

Influence of photobiomodulation therapy on root development of rat molars with open apex and pulp necrosis

Abstract This study aimed to evaluate the role of photobiomodulation (PBM) in apexification and apexogenesis of necrotic rat molars with an open apex. Rat molars were exposed to the oral environment for 3 weeks. Canals were rinsed with 2.5% NaOCl and 17% EDTA, filled with antibiotic paste and sealed. After 7 days, canals were rinsed and divided into six groups (n=6): mineral trioxide aggregate (MTA); blood clot (BC); human dental pulp stem cells (hDPSC); MTA+PBM; BC+PBM; and hDPSC+PBM. In hDPSC groups, a 1% agarose gel scaffold was used. Two groups were not exposed: healthy tooth+PBM (n = 6), healthy tooth (n = 3); and one was exposed throughout the experiment: necrotic tooth (n = 3). In PBM groups, irradiation was performed with aluminum gallium indium phosphide (InGaAlP) diode laser for 30 days within 24-h intervals. After that, the specimens were processed for histological and immunohistochemical analyses. Necrotic tooth showed greater neutrophil infiltrate (p < 0.05). Necrotic tooth, healthy tooth, and healthy tooth+PBM groups showed absence of a thin layer of fibrous condensation in the periapical area. All the other groups stimulated the formation of a thicker layer of fibers (p < 0.05). All groups formed more mineralized tissue than necrotic tooth (p < 0.05). PBM associated with MTA, BC, or hDPSC formed more mineralized tissue (p < 0.05). MTA+PBM induced apexification (p < 0.05). Rabbit polyclonal anti-bone sialoprotein (BSP) antibody confirmed the histological findings of mineralized tissue formation, and hDPSC groups exhibited higher percentage of BSP-positive cells. It can be concluded that PBM improved apexification and favored apexogenesis in necrotic rat molars with an open apex.

Successful treatment of repeated hematemesis secondary to postsclerotherapy esophageal ulcer in a cirrhotic patient: A case report.

Esophageal variceal bleeding is a common lethal complication of cirrhosis. Endoscopic injection sclerotherapy (EIS) is one of the major endoscopic approaches for treating esophageal variceal bleeding. However, complications may occur after EIS, which mainly include retrosternal discomfort/pain, dysphagia, re-bleeding, esophageal ulcer, esophageal strictures, and esophageal perforation, etc. In this article, we reported a 36-year-old male who developed esophageal ulcer related bleeding after EIS. Currently, there is no consensus on the treatment strategy for esophageal ulcer-related bleeding after EIS. In the present case, the following treatment strategy may be effective for ulcer related bleeding. The first step is to inhibit gastric acid secretion and reduce portal pressure by intravenous infusion of esomeprazole and somatostatin, respectively. The second is local hemostasis by oral norepinephrine and lyophilizing thrombin powder. The third is to protect digestive tract mucosa by oral Kangfuxin Ye and aluminum phosphate.

Pulp treatment for extensive decay in primary teeth.

BACKGROUND: In children, dental caries (tooth decay) is among the most prevalent chronic diseases worldwide. Pulp interventions are indicated for extensive tooth decay. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. After treatment, the cavity is filled with a medicament. Materials commonly used include mineral trioxide aggregate (MTA), calcium hydroxide, formocresol or ferric sulphate.This is an update of a Cochrane Review published in 2014 when insufficient evidence was found to clearly identify one superior pulpotomy medicament and technique. OBJECTIVES: To assess the effects of different pulp treatment techniques and associated medicaments for the treatment of extensive decay in primary teeth. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health Group's Trials Register (to 10 August 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2017, Issue 7), MEDLINE Ovid (1946 to 10 August 2017), Embase Ovid (1980 to 10 August 2017) and the Web of Science (1945 to 10 August 2017). OpenGrey was searched for grey literature. The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing interventions that combined a pulp treatment technique with a medicament or device in children with extensive decay in the dental pulp of their primary teeth. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed 'Risk of bias'. We contacted authors of RCTs for additional information when necessary. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. We performed data synthesis with pair-wise meta-analyses using fixed-effect models. We assessed statistical heterogeneity by using I² coefficients. MAIN RESULTS: We included 40 new trials bringing the total to 87 included trials (7140 randomised teeth) for this update. All were small, single-centre trials (median number of randomised teeth = 68). All trials were assessed at unclear or high risk of bias.The 87 trials examined 125 different comparisons: 75 comparisons of different medicaments or techniques for pulpotomy; 25 comparisons of different medicaments for pulpectomy; four comparisons of pulpotomy and pulpectomy; and 21 comparisons of different medicaments for direct pulp capping.The proportion of clinical failures and radiological failures was low in all trials. In many trials, there were either no clinical failures or no radiographic failures in either study arm.For pulpotomy, we assessed three comparisons as providing moderate-quality evidence. Compared with formocresol, MTA reduced both clinical and radiological failures, with a statistically significant difference at 12 months for clinical failure and at six, 12 and 24 months for radiological failure (12 trials, 740 participants). Compared with calcium hydroxide, MTA reduced both clinical and radiological failures, with statistically significant differences for clinical failure at 12 and 24 months. MTA also appeared to reduce radiological failure at six, 12 and 24 months (four trials, 150 participants) (low-quality evidence). When comparing calcium hydroxide with formocresol, there was a statistically significant difference in favour of formocresol for clinical failure at six and 12 months and radiological failure at six, 12 and 24 months (six trials (one with no failures), 332 participants).Regarding pulpectomy, we found moderate-quality evidence for two comparisons. The comparison between Metapex and zinc oxide and eugenol (ZOE) paste was inconclusive, with no clear evidence of a difference between the interventions for failure at 6 or 12 months (two trials, 62 participants). Similarly inconclusive, there was no clear evidence of a difference in failure between Endoflas and ZOE (outcomes measured at 6 months; two trials, 80 participants). There was low-quality evidence of a difference in failure at 12 months that suggested ZOE paste may be better than Vitapex (calcium hydroxide/iodoform) paste (two trials, 161 participants).Regarding direct pulp capping, the small number of studies undertaking the same comparison limits any interpretation. We assessed the quality of the evidence as low or very low for all comparisons. One trial appeared to favour formocresol over calcium hydroxide; however, there are safety concerns about formocresol. AUTHORS' CONCLUSIONS: Pulp treatment for extensive decay in primary teeth is generally successful. Many included trials had no clinical or radiological failures in either trial arm, and the overall proportion of failures was low. Any future trials in this area would require a very large sample size and follow up of a minimum of one year.The evidence suggests MTA may be the most efficacious medicament to heal the root pulp after pulpotomy of a deciduous tooth. As MTA is relatively expensive, future research could be undertaken to confirm if Biodentine, enamel matrix derivative, laser treatment or Ankaferd Blood Stopper are acceptable second choices, and whether, where none of these treatments can be used, application of sodium hypochlorite is the safest option. Formocresol, though effective, has known concerns about toxicity.Regarding pulpectomy, there is no conclusive evidence that one medicament or technique is superior to another, and so the choice of medicament remains at the clinician's discretion. Research could be undertaken to confirm if ZOE paste is more effective than Vitapex and to evaluate other alternatives.Regarding direct pulp capping, the small number of studies and low quality of the evidence limited interpretation. Formocresol may be more successful than calcium hydroxide; however, given its toxicity, any future research should focus on alternatives.

Clinical and histological responses of human dental pulp to MTA and combined MTA/treated dentin matrix in partial pulpotomy.

The aim of this study was to compare the responses of mineral trioxide aggregate (MTA) and combined MTA/treated dentin matrix (TDM) as direct pulp capping material. In this clinical trial study, 33 intact third molars in 11 healthy volunteers (three molars in each) were included. Partial pulpotomies were performed in a split mouth manner in two of the third molars in each patient randomly and the third tooth had used as TDM source. The coronal dentin was chopped to dentine chips and transformed to TDM using different concentrations of ethylene diamine tetraacetic acid (EDTA) solution. Pulps were directly capped by MTA alone or using a combination layering of MTA/TDM. Following 6-week clinical and radiological evaluations, each tooth was extracted and prepared for histological evaluation. There were no significant differences in the clinical and radiographic responses or in the quality of dentin bridges (P > 0.05). However, the dentin bridge was significantly thicker in MTA/TDM group than MTA group (P = 0.003). Using the combination of MTA/TDM as a pulp-dressing agent may form a thicker dentin bridge compared to MTA alone.

Outcome of Revascularization Procedure: A Retrospective Case Series.

INTRODUCTION: The purpose of this retrospective case series was to investigate the outcome of the revascularization procedure in necrotic immature teeth. METHODS: The residents and faculty members at the University of Pennsylvania endodontic department were invited to submit consecutive revascularization cases treated by them, irrespective of the outcome, during the time period of 2009 to 2012. Twenty-eight of 35 submitted necrotic immature teeth met the inclusion criteria. The treatment protocol included minimal instrumentation and irrigation with 3% sodium hypochlorite and 17% EDTA. Triple antibiotic paste was placed for a minimum of 21 days. After blood clot induction, either EndoSequence Bioceramic Putty (Brasseler, Savannah, GA) or mineral trioxide aggregate was placed below the cementoenamel junction, and composite was used as a final restoration. The follow-up period ranged from 7 to 72 months. The outcome was assessed as complete healing (the absence of clinical signs and symptoms, complete resolution of periradicular radiolucency, increase in the root dentin thickness/length, and apical closure), incomplete healing (the absence of clinical signs and symptoms, the periapical lesion completely healed without any signs of root maturation or thickening, the periapical lesion either reduced in size or unchanged with/without radiographic signs of increasing root dentin thickness/length, or apical closure), and failure (persistent clinical signs and symptoms and/or increased size of the periradicular lesion). RESULTS: Twenty-one of 28 cases (75%) healed completely, 3 cases (10.7%) failed during the observation period and needed further treatment, and 4 cases (14%) presented with incomplete healing. CONCLUSIONS: Within the limitation of this study, the outcome of revascularization, wherein healing of periapical periodontitis and maturation of roots occurs, is fairly high, making it a viable treatment option in comparison with apexification.

Adjunct Antimicrobial Therapy and Periodontal Surgery to Treat Generalized Aggressive Periodontitis: A Case Report.

Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. Baseline examination revealed generalized plaque deposition and gingival inflammation. Thirty-nine percent of the sites had a probing depth (PD) of 4-6 mm and 2% a PD of ≥7 mm; 63% exhibited bleeding on probing (BOP). Radiographic examination revealed vertical bone loss in the molars and horizontal bone loss in other teeth. Microbiological examination of subgingival plaque revealed the presence of Aggregatibacter actinomycetemcomitans and Tannerella forsythia. Oral health-related quality of life was assessed as a measure of patient-reported outcome. Based on a clinical diagnosis of generalized aggressive periodontitis, initial periodontal therapy and adjunct antimicrobial therapy were implemented. After reducing inflammation and subgingival bacteria, open flap debridement was performed for teeth with a PD of ≥4 mm. Reevaluation showed no sites with a PD of ≥5 mm, a minimal level of BOP, and a marked reduction in the level of the targeted periodontal pathogens. The patient's oral health-related quality of life was slightly worsened during supportive periodontal therapy (SPT). Implementation of adjunct antimicrobial therapy targeting periodontal pathogens and subsequent periodontal surgery resulted in improvement in periodontal and microbiological parameters. This improvement has been adequately maintained over a 2-year period. However, additional care is necessary to further improve the patient's oral health-related quality of life during SPT.

A Randomized Trial Using 3Mixtatin Compared to MTA in Primary Molars with Inflammatory Root Resorption: A Novel Endodontic Biomaterial.

OBJECTIVES: Novel methods for preserving primary teeth can help to maintain their developmental, esthetic, and functional capabilities. The aim of this study was to assess the success of the repair of bony defects, caused by pre-treatment perforations, with a mixture of three antibiotics combined with simvastatin (3Mixtatin) compared to MTA in hopeless primary molars. STUDY DESIGN: In this randomized clinical trial, 80 teeth from 65 healthy children aged 3-6 years with interradicular or periapical root resorption and/or perforation in primary molars were treated either with 3Mixtatin or MTA before conventional pulpectomy and restoration. The subjects were followed up clinically and radiographically for 4, 6, 12 and 24 months after pulp treatment to evaluate and compare the healing process. The data were compared using chi-square test at a significance level of 0.05. RESULTS: By the end of 24 months in 3Mixtatin group, 31 (96.8%) teeth revealed no clinical signs or symptoms with arrested resorption progress in radiographs. In MTA group, clinical signs and symptoms including pain, mobility and sinus tract were observed in 18 (48.6%) teeth with cessation of root/interradicular radiolucency in 7 (18.9%) teeth without bone repair. CONCLUSIONS: Radiographic and clinical healing occurred more successfully following 3Mixtatin treatment compared to treatment with MTA, it may lead to a paradigm shift in the pulpal treatment of primary teeth in the future.

Revascularization of immature, nonvital permanent tooth using platelet-rich fibrin in children.

The purpose of this paper was to present a new approach wherein revascularization of the immature, nonvital permanent tooth was performed using platelet-rich fibrin (PRF) as a novel scaffold material. This was performed after disinfection of the root canal space using triple antibiotic paste followed by placing a PRF membrane in the root canal. The patient was followed up regularly at three-, six-, nine-, and 12-month intervals for review. After 12 months, clinical examination showed negative response to percussion and palpation tests but positive response to cold and electric pulp tests. Radiographic examination revealed continued thickening of the root dentinal walls, narrowing of root canal space, root lengthening, and closure of the root apex with normal periradicular architecture. However, more clinical research using large samples is necessary to prove it advantageous for regenerative endodontic therapy in children.

Regenerative endodontic therapy: a data analysis of clinical protocols.

INTRODUCTION: The aim of the present study was to systematically analyze the protocols that have been used in regenerative endodontic therapy and to detect any variations in clinical procedures. METHODS: An electronic search was executed in PubMed using appropriate Medical Subject Heading terms covering the period from January 1993 to May 2014. Additional publications from hand searching and the reference section of each relevant article enriched the article list. The relevance of each article was initially evaluated by scanning all titles and corresponding abstracts. The definite inclusion of each article in the study was determined by using specific criteria applied independently by 3 reviewers. RESULTS: Sixty relevant publications were finally included. The canal walls were not mechanically instrumented in 68% of the clinical articles. Sodium hypochlorite was included in 97% of the clinical studies either as the only irrigant or in combination with other irrigants. Antibiotic combination paste was used as the intracanal medicament in 80% of the clinical articles. Sodium hypochlorite, chlorhexidine, and EDTA were used in the final irrigation protocol in 75%, 4%, and 13% of the clinical studies, respectively. Neither the creation of a blood clot nor the use of platelet-rich plasma/platelet-rich fibrin was described in 13% of the clinical articles. Mineral trioxide aggregate was used as an intracanal coronal barrier in 85% of the relevant clinical studies. CONCLUSIONS: The variability of the clinical protocols applied during regenerative enododontic procedures is considerably high. A thorough analysis of regenerative protocols may constitute an additional source to provide useful clinical considerations for REPs.

O efeito do uso de fitoterápicos e da própolis nas propriedades físico-químicas, antimicrobiana e biocompatibilidade do MTA / The effect of the use of phytotherapics and propolis in physicochemical properties, antimicrobial and biocompatibility of MTA

O objetivo deste estudo foi avaliar as propriedades físico-químicas, antimicrobianas e biocompatibilidade do MTA branco manipulado com extratos aquoso e/ou em propilenoglicol da Arctium lappa L., Casearia sylvestris Sw. e própolis. Dentre os testes físico-químicos foram avaliados o tempo de presa, escoamento, pH, liberação de íons cálcio e alteração volumétrica. Para verificar o efeito antimicrobiano foram aplicadas as metodologias do contato direto (Enterococcus faecalis e a Cândida albicans) e da descontaminação dentinária, empregando a microscopia confocal de varredura laser para verificar a viabilidade de Enterococcus faecalis. Para a avaliação da biocompatibilidade, 162 ratos Wistar foram utilizados, onde cada animal recebeu dois implantes subcutâneos e um alveolar. Após os períodos experimentais de 15, 30 e 60 dias foram realizadas análises microtomográfica, histológica descritiva e histomorfométrica. Adicionalmente amostras do tecido alveolar foram processadas para dosagem das citocinas TNF-α e IL-10 por meio do ensaio imunoenzimático (ELISA). Os dados obtidos foram analisados estatisticamente com os testes ANOVA e Tukey ou Kruskal-Wallis e Dunn. Os resultados revelaram que a variação do veículo associado ao MTA aumentou significativamente o tempo de presa, no entanto, não houve influência na alteração volumétrica (P>0,05) e na capacidade do cimento em manter o meio alcalino e liberar íons cálcio. Os cimentos manipulados com extratos em propilenoglicol apresentaram maior escoamento (P<0,05). Apenas o extrato da própolis agregou ao MTA efeito contra o Enterococcus faecalis após 24 e 48 horas (descontaminação dentinária e contato direto respectivamente) e contra a Cândida albicans após 10 horas (P<0,05). De acordo com as avaliações histológica e histomorfométrica dos implantes em tecidos subcutâneo e alveolar não foi constatada diferença significativa entre os grupos experimentais quando comparados com o grupo no qual o MTA foi manipulado...

The aim of this study was to evaluate the physicochemical, antimicrobial properties and biocompatibility of white MTA mixed with aqueous or propylene glycol extracts of Arctium lappa L., Casearia sylvestris Sw. and propolis. Among physicochemical tests were evaluated the setting time, flowability, pH, ion calcium release and volumetric change. To verify the antimicrobial effects were applied the methods of direct contact (Enterococcus faecalis and Candida albicans) and dentin decontamination by using the confocal laser scanning microscopy to verify the Enterococcus faecalis viability. To evaluate the biocompatibility were used 162 Wistar rats. Each animal received one alveolar and two subcutaneous implants. After the experimental periods of 15, 30 and 60 days were performed the microtomography, histological description and histomorphometric analyses. Additionally alveolar tissue samples were processed for the measurement of TNF-α e IL-10 cytokines by enzyme-linked immunosorbent assay (ELISA). The data were statistically analyzed by the ANOVA and Tukey or KruskalWallis and Dunns tests. The results revealed that the variation of the vehicle associated to MTA significantly increased its setting time, however did not influence the volumetric change (P>0,05) and the cement's ability to maintain the alkaline medium and ion calcium release. Cements mixed with propylene glycol extracts showed higher flowability (P<0,05). Only propolis extract added to MTA the effect against E. faecalis after 24 and 48 hours (dentin decontamination and direct contact respectively) and against Candida albicans after 10 hours (P<0,05). According to the histological and histomorphometric evaluation of the implants in subcutaneous and alveolar tissue was not observed significant differences between the experimental groups in comparison to the reference group (MTA was mixed with distilled water). The microtomography analysis and expression of TNF-α and IL-10 showed...

O efeito do uso de fitoterápicos e da própolis nas propriedades físico-químicas, antimicrobiana e biocompatibilidade do MTA / The effect of the use of phytotherapics and propolis in physicochemical properties, antimicrobial and biocompatibility of MTA

O objetivo deste estudo foi avaliar as propriedades físico-químicas, antimicrobianas e biocompatibilidade do MTA branco manipulado com extratos aquoso e/ou em propilenoglicol da Arctium lappa L., Casearia sylvestris Sw. e própolis. Dentre os testes físico-químicos foram avaliados o tempo de presa, escoamento, pH, liberação de íons cálcio e alteração volumétrica. Para verificar o efeito antimicrobiano foram aplicadas as metodologias do contato direto (Enterococcus faecalis e a Cândida albicans) e da descontaminação dentinária, empregando a microscopia confocal de varredura laser para verificar a viabilidade de Enterococcus faecalis. Para a avaliação da biocompatibilidade, 162 ratos Wistar foram utilizados, onde cada animal recebeu dois implantes subcutâneos e um alveolar. Após os períodos experimentais de 15, 30 e 60 dias foram realizadas análises microtomográfica, histológica descritiva e histomorfométrica. Adicionalmente amostras do tecido alveolar foram processadas para dosagem das citocinas TNF-α e IL-10 por meio do ensaio imunoenzimático (ELISA). Os dados obtidos foram analisados estatisticamente com os testes ANOVA e Tukey ou Kruskal-Wallis e Dunn. Os resultados revelaram que a variação do veículo associado ao MTA aumentou significativamente o tempo de presa, no entanto, não houve influência na alteração volumétrica (P>0,05) e na capacidade do cimento em manter o meio alcalino e liberar íons cálcio. Os cimentos manipulados com extratos em propilenoglicol apresentaram maior escoamento (P<0,05). Apenas o extrato da própolis agregou ao MTA efeito contra o Enterococcus faecalis após 24 e 48 horas (descontaminação dentinária e contato direto respectivamente) e contra a Cândida albicans após 10 horas (P<0,05). De acordo com as avaliações histológica e histomorfométrica dos implantes em tecidos subcutâneo e alveolar não foi constatada diferença significativa entre os grupos experimentais quando comparados com o grupo no qual o MTA foi manipulado...

The aim of this study was to evaluate the physicochemical, antimicrobial properties and biocompatibility of white MTA mixed with aqueous or propylene glycol extracts of Arctium lappa L., Casearia sylvestris Sw. and propolis. Among physicochemical tests were evaluated the setting time, flowability, pH, ion calcium release and volumetric change. To verify the antimicrobial effects were applied the methods of direct contact (Enterococcus faecalis and Candida albicans) and dentin decontamination by using the confocal laser scanning microscopy to verify the Enterococcus faecalis viability. To evaluate the biocompatibility were used 162 Wistar rats. Each animal received one alveolar and two subcutaneous implants. After the experimental periods of 15, 30 and 60 days were performed the microtomography, histological description and histomorphometric analyses. Additionally alveolar tissue samples were processed for the measurement of TNF-α e IL-10 cytokines by enzyme-linked immunosorbent assay (ELISA). The data were statistically analyzed by the ANOVA and Tukey or KruskalWallis and Dunns tests. The results revealed that the variation of the vehicle associated to MTA significantly increased its setting time, however did not influence the volumetric change (P>0,05) and the cement's ability to maintain the alkaline medium and ion calcium release. Cements mixed with propylene glycol extracts showed higher flowability (P<0,05). Only propolis extract added to MTA the effect against E. faecalis after 24 and 48 hours (dentin decontamination and direct contact respectively) and against Candida albicans after 10 hours (P<0,05). According to the histological and histomorphometric evaluation of the implants in subcutaneous and alveolar tissue was not observed significant differences between the experimental groups in comparison to the reference group (MTA was mixed with distilled water). The microtomography analysis and expression of TNF-α and IL-10 showed...

Pulp treatment for extensive decay in primary teeth.

BACKGROUND: In children, dental caries is among the most prevalent chronic diseases worldwide. Pulp interventions are indicated for extensive tooth decay. Depending on the severity of the disease, three pulp treatment techniques are available: direct pulp capping, pulpotomy and pulpectomy. After treatment, the cavity is filled with a medicament.This is an update of a Cochrane review first published in 2003. The previous review found insufficient evidence regarding the relative efficacy of these interventions, combining one pulp treatment technique and one medicament. OBJECTIVES: To assess the effects of different pulp treatment techniques and associated medicaments for the treatment of extensive decay in primary teeth. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 25 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 25 October 2013), EMBASE via OVID (1980 to 25 October 2013) and the Web of Science (1945 to 25 October 2013). We searched OpenGrey for grey literature and the US National Institutes of Health Trials Register and the World Health Organization (WHO) Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Eligible studies were randomised controlled trials comparing different pulp interventions combining a pulp treatment technique and a medicament in children with extensive decay involving dental pulp in primary teeth. DATA COLLECTION AND ANALYSIS: Two review authors independently carried out data extraction and risk of bias assessment in duplicate. We contacted authors of randomised controlled trials for additional information if necessary. The primary outcomes were clinical failure and radiological failure, as defined in trials, at six, 12 and 24 months. We performed data synthesis with pairwise meta-analyses using fixed-effect models. We assessed statistical heterogeneity using by I(2) coefficients. MAIN RESULTS: We included 47 trials (3910 randomised teeth) compared to three trials in the previous version of the review published in 2003. All trials were single centre and small sized (median number of randomised teeth 68). Overall, the risk of bias was low in only one trial with all other trials being at unclear or high risk of bias. The overall quality of the evidence was low. The 47 trials examined 53 different comparisons: 25 comparisons between different medicaments/techniques for pulpotomy, 13 comparisons between different medicaments for pulpectomy, 13 comparisons between different medicaments for direct pulp capping and two comparisons between pulpotomy and pulpectomy. Regarding pulpotomy, 14 trials compared mineral trioxide aggregate (MTA) with formocresol (FC). MTA reduced both clinical and radiological failures at six, 12 and 24 months, although the difference was not statistically significant. MTA also showed favourable results for all secondary outcomes measured, although again, differences between MTA and FC were not statistically significant (with the exception of pathological root resorption at 24 months and dentine bridge formation at six months). MTA showed favourable results compared with calcium hydroxide (CH) (two trials) for all outcomes measured, but the differences were not statistically significant (with the exception of radiological failure at 12 months). When comparing MTA with ferric sulphate (FS) (three trials), MTA had statistically significantly fewer clinical, radiological and overall failures at 24 months. This difference was not shown at six or 12 months.FC was compared with CH in seven trials and with FS in seven trials. There was a statistically significant difference in favour of FC for clinical failure at six and 12 months, and radiological failure at six, 12 and 24 months. FC also showed favourable results for all secondary outcomes measured, although differences between FC and CH were not consistently statistically significant across time points. The comparisons between FC and FS showed no statistically significantly difference between the two medicaments for any outcome at any time point.For all other comparisons of medicaments used during pulpotomies, pulpectomies or direct pulp capping, the small numbers of studies and the inconsistency in results limits any interpretation. AUTHORS' CONCLUSIONS: We found no evidence to identify one superior pulpotomy medicament and technique clearly. Two medicaments may be preferable: MTA or FS. The cost of MTA may preclude its clinical use and therefore FS could be used in such situations. Regarding other comparisons for pulpectomies or direct pulp capping, the small numbers of studies undertaking the same comparison limits any interpretation.

Histologic comparison between platelet-rich plasma and blood clot in regenerative endodontic treatment: an animal study.

INTRODUCTION: In regenerative endodontic treatment (RET) for immature permanent tooth, better treatment results could be obtained by applying platelet-rich plasma (PRP) as the scaffold rather than the blood clot. The goal of this study was to compare the histologic differences between using PRP and blood clot in RET. METHODS: Three 6-month-old beagles each carrying 9 premolars with double root canals were randomly assigned to the PRP group, blood clot group, or negative control group. All experimental teeth suffered apical periodontitis, and RET was performed. In the blood clot group, bleeding was induced from the periapical tissues to fill the canal space. In the PRP group, autologous PRP was injected into each root canal. The animals were sacrificed 3 months later. Histologic sections were stained with hematoxylin-eosin. Statistical analysis was performed by the Fisher exact test, with the significance set at 0.05. RESULTS: With the ingrowth of cellular cementumlike tissues, the canal wall was thickened, and the apical apex was closed in both the PRP and blood clot groups. Cementocytelike cells were present in the newly formed tissues. Meanwhile, no statistical difference was found in both experimental groups for the average percentage of apical closure, new tissue formation, and pulplike tissue formation. Noticeably, a large number of inflammatory cells were present in some root canals in both groups although the postoperative radiograph revealed the disappearance of periapical radiolucency. CONCLUSIONS: PRP application could be an option for clinical cases in which little or no bleeding were found when irritating the apical tissue during RET.

Capping a pulpotomy with calcium aluminosilicate cement: comparison to mineral trioxide aggregates.

INTRODUCTION: Calcium aluminate cements have shown little affinity for bacterial growth, low toxicity, and immunogenicity when used as a restoration material, but calcium aluminate cements have not been tested in vivo in pulpotomy procedures. METHODS: To address this question, a calcium aluminosilicate cement (Quick-Set) was tested along with 2 mineral trioxide aggregates, ProRoot MTA and MTA Plus. These cements were used as a capping agent after pulpotomy. Control rats had no pulpotomy, or the pulpotomy was not capped. Proinflammatory cytokines interleukin (IL)-1ß and IL-1α were measured, and histology was performed at 30 and 60 days after capping. The nociceptive response was determined by measuring the lengthening of the rat's meal duration. RESULTS: and CONCLUSIONS: IL-1ß and IL-1α concentrations were reduced in the capped teeth, but no differences were observed among the 3 cements. Dentinal bridging could be detected at both 30 and 60 days with each of the 3 cements, and the pulps were still vital 60 days after capping. Meal duration significantly shortened after placement of the 3 different cements, indicating a nociceptive response, but there were no differences among the materials. Calcium aluminosilicate cement had similar properties to mineral trioxide aggregates and is a viable option for pulpotomy procedures.

Antibacterial activity of various root canal sealers and root-end filling materials in dentin blocks infected ex vivo with Enterococcus faecalis.

OBJECTIVE: The aim was to investigate the antibacterial activity of the root-end filling materials MTA and IRM, different endodontic sealers and calcium hydroxide [Ca(OH)2] in experimentally infected dentinal tubules. MATERIALS AND METHODS: Ninety-four human root segments were prepared and the root canals were enlarged to ISO size 90. After smear removal, the specimens were infected with Enterococcus faecalis for 3 weeks. The roots were divided into eight groups and filled either with MTA, IRM, Ca(OH)2, gutta-percha and EndoRez (ER)/GuttaFlow (GF)/AH Plus (AH+) or with Resilon and Epiphany (EpRe). One group of specimens was left unfilled for control. Half of the specimens were treated for 1 day and the other half for 7 days in humid conditions at 37°C. Dentin samples from each canal were collected by enlarging the canals to ISO size 150; thus a dentinal depth of 300 µm was sampled. The number of cultivable bacteria was determined for each specimen. Statistical significance was set to 5%. RESULTS: After 1-day or 7-days of treatment, compared to control, all materials (except ER and GF at day 7) significantly reduced the number of bacteria. At day 1 and day 7, no significant difference was found between ER and GF and between Ca(OH)2, AH+, EpRe, IRM and MTA. However, a significant difference was found between these two groups of materials (except between GF and EpRe at day 7). Significantly more bacteria were cultured in the ER, GF, EpRe and IRM groups at day 7 compared to day 1. CONCLUSIONS: All materials exerted varying degrees of antibacterial activity which generally tended to decrease with time. The most stable antibacterial effect throughout the 7-day period was for Ca(OH)2, AH+ and MTA.

Hyperhidrosis: review of recent advances and new therapeutic options for primary hyperhidrosis.

PURPOSE OF REVIEW: Primary focal hyperhidrosis is a common condition that negatively impacts quality of life for many pediatric patients and can be challenging to treat. Standard treatments for hyperhidrosis can be used with success in many patients, and newer therapies and techniques offer options that have demonstrated efficacy and safety. This review highlights standard therapies for primary focal hyperhidrosis as well as the most recent technique advancements and alternative treatment options. RECENT FINDINGS: The standard approach to treating primary focal hyperhidrosis remains initiation of topical preparations, followed by advancement to systemic medications, local administration of medication and/or surgical procedures. Recent studies focus on enhancing tolerability of topical preparations as well as evaluating the efficacy of neuromodulator injections, oral anticholinergic medications and laser therapy. Microwave technology has also been introduced for the treatment of focal hyperhidrosis with promising results. SUMMARY: Many therapies exist for hyperhidrosis, and each treatment plan must be evaluated on a patient-by-patient basis. Advances in standard therapies and emergence of new treatment techniques are the main emphases of current published literature on hyperhidrosis. This article presents recent therapeutic options as well as updates on more established strategies to help practitioners treat this challenging condition.

Penetrability of AH plus and MTA fillapex after endodontic treatment and retreatment: a confocal laser scanning microscopy study.

The aim of the study was to assess the penetrability of two endodontic sealers (AH Plus and MTA Fillapex) into dentinal tubules, submitted to endodontic treatment and subsequently to endodontic retreatment. Thirty ex vivo incisors were prepared using ProTaper rotary system up to F3 instrument and divided in three groups according to the endodontic sealer used for root canal filling: AH Plus (AHP), MTA Fillapex (MTAF), and control group (CG) without using EDTA previously to the root canal filling. Rhodamine B dye (red) was incorporated to the sealers in order to provide the fluorescence which will enable confocal laser scanning microscopy (CLSM) assessment. All specimens were filled with gutta-percha cones using the lateral compaction technique. The specimens were submitted to endodontic retreatment using ProTaper Retreatment system, re-prepared up to F5 instruments and filled with gutta-percha cones and the same sealer used during endodontic retreatment. Fluorescein dye (green) was incorporated to the sealer in order to distinguish from the first filling. The roots were sectioned 2 mm from the apex and assessed by CLSM. No difference was found between the two experimental groups (P > 0.05). On the other hand, in the control group the sealers were not capable to penetrate into dentinal tubules after endodontic treatment (P > 0.05). In retreatment cases, none of the sealers were able to penetrate into dentin tubules. It can be concluded that sealer penetrability is high during endodontic treatment. However, MTA Fillapex and AH Plus do not penetrate into dentinal tubules after endodontic retreatment.

Regenerative potential of immature permanent teeth with necrotic pulps after different regenerative protocols.

INTRODUCTION: Regenerative endodontics is a promising alternative treatment for immature teeth with necrotic pulps. The present study was performed to assess the regenerative potential of young permanent immature teeth with necrotic pulp after the following treatment protocols: (1) a mineral trioxide aggregate (MTA) apical plug, (2) the regenerative endodontic protocol (blood clot scaffold), and (3) the regenerative endodontic protocol with a blood clot and an injectable scaffold impregnated with basic fibroblast growth factor. METHODS: Immature necrotic permanent maxillary central incisors (n = 36) of patients 9-13 years old were divided into 3 groups according to the treatment protocol: the MTA group (MTA apical plug), the REG group (regenerative endodontic protocol [blood clot]), and the FGF group (regenerative endodontic protocol [blood clot + injectable scaffold]). Follow-up was done up to 18 months. Standardized radiographs were digitally evaluated for an increase in root length and thickness, a decrease in the apical diameter, and a change in periapical bone density. RESULTS: After a follow-up period of 18 months, most of the cases showed radiographic evidence of periapical healing. Groups 2 and 3 showed a progressive increase in root length and width and a decrease in apical diameter. CONCLUSIONS: The regenerative endodontic procedure allowed the continued development of roots in teeth with necrotic pulps. The use of artificial hydrogel scaffold and basic fibroblast growth factor was not essential for repair.