RESUMO
Treatment of high-risk traumatic immature teeth due to incomplete root development is challenging. Apexogenesis is currently the ideal treatment option that allows normal root development. The purpose of this study was to evaluate the apexogenesis process of immature permanent teeth of dogs when co-administered with calcium hydroxide and photobiomodulation therapy (PBMT). A total of 36 immature permanent anterior and premolar teeth were selected from three 4-6-month-old dogs of Iranian mixed generation. The teeth were categorized into two groups, calcium hydroxide with laser irradiation (CHL) and calcium hydroxide without laser irradiation (CH). All the selected teeth received calcium hydroxide pulpotomy. After restoring teeth with amalgam, the CHL group received galliumaluminum-arsenide (GaAlAs) diode laser (810 nm, 4.2 J/cm2, 0.3 W, 9 s,CW) on apical one-third of both buccal and lingual roots. The irradiation was repeated every 48 h for fourteen days. Intravenous tetracycline was used to observe newly formed dentin in the first, third, seventh, and fourteenth days. The distance between tetracycline lines (DTL) was examined by Fluorescence microscopy. Generalized estimating equations (GEE) were used for data analysis. In all assessments, the mean DTL were greater in the CHL group. However, the two groups had no significant differences in the amount of deposited dentin between the first and third, third and seventh, and first and seventh lines. Meanwhile, there was a significant difference between the two groups in terms of the distances between lines 7 and 14, 1 and 14 and also 3 to 14 (P < .001). In other words, from the 7th day onwards, there was a significant difference between the two groups. Within the limitation of this study, the combination therapy of PBMT and pulpotomy with calcium hydroxide accelerated apexogenesis in immature permanent dogs' teeth.
Assuntos
Apexificação/métodos , Hidróxido de Cálcio/metabolismo , Terapia com Luz de Baixa Intensidade/métodos , Materiais Restauradores do Canal Radicular/metabolismo , Raiz Dentária/metabolismo , Animais , Hidróxido de Cálcio/efeitos adversos , Dentina/metabolismo , Cães , Lasers Semicondutores , Exposição Ocupacional , Pulpotomia , Medição de Risco , Materiais Restauradores do Canal Radicular/efeitos adversos , Tetraciclina/metabolismo , Fatores de TempoRESUMO
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.
Assuntos
Apexificação/métodos , Cavidade Pulpar/efeitos da radiação , Necrose da Polpa Dentária/radioterapia , Lasers Semicondutores/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Ápice Dentário/efeitos da radiação , Doenças Dentárias/radioterapia , Compostos de Alumínio/uso terapêutico , Animais , Compostos de Cálcio/uso terapêutico , Polpa Dentária/citologia , Cavidade Pulpar/patologia , Necrose da Polpa Dentária/patologia , Combinação de Medicamentos , Imuno-Histoquímica , Sialoproteína de Ligação à Integrina/análise , Óxidos/uso terapêutico , Distribuição Aleatória , Ratos Wistar , Reprodutibilidade dos Testes , Silicatos/uso terapêutico , Células-Tronco , Ápice Dentário/patologia , Doenças Dentárias/patologia , Resultado do TratamentoRESUMO
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.
Assuntos
Animais , Doenças Dentárias/radioterapia , Necrose da Polpa Dentária/radioterapia , Ápice Dentário/efeitos da radiação , Terapia com Luz de Baixa Intensidade/métodos , Cavidade Pulpar/efeitos da radiação , Lasers Semicondutores/uso terapêutico , Apexificação/métodos , Óxidos/uso terapêutico , Células-Tronco , Doenças Dentárias/patologia , Imuno-Histoquímica , Distribuição Aleatória , Reprodutibilidade dos Testes , Resultado do Tratamento , Ratos Wistar , Silicatos/uso terapêutico , Compostos de Cálcio/uso terapêutico , Compostos de Alumínio/uso terapêutico , Necrose da Polpa Dentária/patologia , Ápice Dentário/patologia , Polpa Dentária/citologia , Cavidade Pulpar/patologia , Combinação de Medicamentos , Sialoproteína de Ligação à Integrina/análiseRESUMO
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.
Assuntos
Necrose da Polpa Dentária/terapia , Neovascularização Fisiológica , Materiais Restauradores do Canal Radicular/uso terapêutico , Tratamento do Canal Radicular/métodos , Resultado do Tratamento , Adolescente , Adulto , Compostos de Alumínio/uso terapêutico , Antibacterianos/uso terapêutico , Apexificação/métodos , Compostos de Cálcio/uso terapêutico , Criança , Restauração Dentária Permanente/métodos , Dentina/patologia , Combinação de Medicamentos , Ácido Edético/uso terapêutico , Humanos , Óxidos/uso terapêutico , Pennsylvania , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/terapia , Tecido Periapical , Radiografia Dentária , Regeneração , Estudos Retrospectivos , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Tratamento do Canal Radicular/instrumentação , Silicatos/uso terapêutico , Hipoclorito de Sódio/uso terapêutico , Dente , Ápice Dentário/diagnóstico por imagem , Ápice Dentário/patologia , Falha de Tratamento , Adulto JovemRESUMO
This report compares and evaluates the treatment outcomes of regenerative endodontic treatment and apical plug as two accepted treatment protocols in a pair of necrotic immature maxillary central incisors of a 12-year old female. The patient was referred complaining of a dull pain and swelling in her upper lip area. She had a history of trauma to the anterior maxilla two years earlier. Both teeth were clinically diagnosed with pulp necrosis and periapical radiographs revealed that separate periapical radiolucent lesions surrounded the immature apices of both teeth. The left and right incisors were treated with apical plug and regenerative endodontic treatment, respectively, using calcium-enriched mixture (CEM) cement. The patient was followed-up for three years. During this period, both teeth were clinically asymptomatic and showed complete radiographic healing of the periapical lesions. The right central incisor showed root development. No tooth discoloration was evident. Apexification by apical plug placement and pulp regeneration are both reliable treatments for immature non-vital teeth. In order to choose the right treatment the advantages of either technique should be weighed against its drawbacks. CEM cement can be successfully applied for both purposes. This biomaterial causes less discoloration of the tooth.
Assuntos
Apexificação/métodos , Necrose da Polpa Dentária/terapia , Incisivo/patologia , Dente não Vital/terapia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Compostos de Cálcio , Criança , Ciprofloxacina/administração & dosagem , Cimentos Dentários/uso terapêutico , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Incisivo/efeitos dos fármacos , Metronidazol/administração & dosagem , Minociclina/administração & dosagem , Óxidos , Abscesso Periapical/terapia , Periodontite Periapical/terapia , Compostos de Fósforo , Regeneração/fisiologia , Materiais Restauradores do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Silicatos , Ápice Dentário/fisiologia , Resultado do TratamentoRESUMO
This study evaluates the regenerative potential of immature permanent non-vital teeth following different dentin surface treatments in dogs. Periapical lesions and necrotic pulps were induced in 288 roots of 144 teeth in twelve dogs. Teeth were randomly divided into 3 equal groups according to the evaluation period. Each group was subdivided into 8 subgroups according to the treatment modalities including; blood clot, blood clot and collagen, blood clot and Ethylenediaminetetraacetic acid (EDTA), blood clot, collagen and EDTA, blood clot and Mixture Tetracycline Citric Acid and Detergent (MTAD), blood clot, collagen and MTAD, positive control and negative control. Apart from control subgroups, all infected root canals were cleaned with sodium hypochlorite solution and triple antibiotics paste before different treatment protocols. After different treatments, the root length, thickness and apical diameter were evaluated by radiographic examination. Histopathological examination was carried out to evaluate the inflammation, bone/root resorption, tissue in-growth in pulp space, new hard tissue formation and apical closure. Using EDTA solution as a surface modifier showed significantly higher levels of tissue in-growth in the pulp space after 6 weeks and 3 months. Addition of collagen as a scaffold caused significantly more bone/root resorption than the other subgroups while EDTA caused significantly lower inflammatory cell counts only after 2 weeks. Final rinse with 17% EDTA solution before blood clot induction has positive impact on tissue interaction along dentinal walls without modification of the cell type. Moreover, the use of collagen as a scaffold material and MTAD as a surface modifier did not improve the quality of the regenerative process.
Assuntos
Apexificação/métodos , Necrose da Polpa Dentária/terapia , Polpa Dentária/efeitos dos fármacos , Dentina/efeitos dos fármacos , Materiais Restauradores do Canal Radicular/uso terapêutico , Raiz Dentária/efeitos dos fármacos , Animais , Polpa Dentária/irrigação sanguínea , Polpa Dentária/fisiologia , Dentina/irrigação sanguínea , Dentina/fisiologia , Cães , Masculino , Tecido Periapical/irrigação sanguínea , Tecido Periapical/efeitos dos fármacos , Tecido Periapical/fisiologia , Distribuição Aleatória , Regeneração , Alicerces Teciduais , Raiz Dentária/irrigação sanguínea , Raiz Dentária/fisiologiaRESUMO
The aim of this report is to describe a novel method of revascularization therapy done in a non-vital, immature permanent tooth using Platelet-rich fibrin (PRF),in a recently developed scaffold material to overcome limitations associated with the traditional method of revascularization using natural blood clot. PRF prepared from autologous blood was placed in the root canal and patient was followed up regularly at one, three, six, nine and 12 months for detailed clinical and radiographic evaluation. At 12 months, radiographic examination revealed root elongation, root end closure, continued thickening of the root dentinal walls, obliteration of root canal space, and normal periradicular anatomy. However, more long term prospective trials and histological studies are highly needed before to testify PRF a panacea for the regenerative endodontic therapy in children.
Assuntos
Apexificação/métodos , Plaquetas/fisiologia , Fibrina/uso terapêutico , Incisivo/efeitos dos fármacos , Dente não Vital/terapia , Antibacterianos/administração & dosagem , Criança , Ciprofloxacina/administração & dosagem , Cavidade Pulpar/efeitos dos fármacos , Necrose da Polpa Dentária/etiologia , Necrose da Polpa Dentária/terapia , Dentina/efeitos dos fármacos , Combinação de Medicamentos , Seguimentos , Humanos , Incisivo/lesões , Masculino , Metronidazol/administração & dosagem , Minociclina/administração & dosagem , Preparo de Canal Radicular/métodos , Alicerces Teciduais , Ápice Dentário/efeitos dos fármacos , Fraturas dos Dentes/complicaçõesRESUMO
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.
Assuntos
Apexificação/métodos , Plaquetas/fisiologia , Fibrina/uso terapêutico , Incisivo/lesões , Dente não Vital/terapia , Compostos de Alumínio/uso terapêutico , Antibacterianos/uso terapêutico , Compostos de Cálcio/uso terapêutico , Criança , Ciprofloxacina/uso terapêutico , Cavidade Pulpar/efeitos dos fármacos , Dentina/efeitos dos fármacos , Combinação de Medicamentos , Seguimentos , Humanos , Masculino , Metronidazol/uso terapêutico , Minociclina/uso terapêutico , Óxidos/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Silicatos/uso terapêutico , Ápice Dentário/efeitos dos fármacos , Fraturas dos Dentes/terapia , Raiz Dentária/efeitos dos fármacosRESUMO
INTRODUCTION: Revascularization treatment is rapidly becoming an accepted treatment alternative for the management of endodontic pathology in immature permanent teeth with necrotic dental pulps. However, the success and timing of clinical resolution of symptoms, and radiographic outcomes of interest, such as continued hard tissue deposition within the root, are largely unknown. METHODS: In this prospective cohort study, 20 teeth were treated with a standardized revascularization treatment protocol and monitored for clinical and radiographic changes for 1 year. Standardized radiographs were collected at regular intervals, and radiographic changes were quantified. RESULTS: All 20 treated teeth survived during the 12-month follow-up period, and all 20 also met the clinical criteria for success at 12 months. As a group, the treated teeth showed a statistically significant increase in radiographic root width and length and a decrease in apical diameter, although the changes in many cases were quite small (such that the clinical significance is unclear). The within-case percent change in apical diameter after 3 months was 16% and had increased to 79% by 12 months, with 55% (11/20) showing complete apical closure. The within-case percent change in root length averaged less than 1% at 3 months and increased to 5% at 12 months. The within-case percent change in root thickness averaged 3% at 3 months and 21% at 12 months. CONCLUSIONS: Although clinical success was highly predictable with this procedure, clinically meaningful radiographic root thickening and lengthening are less predictable after 1-year of follow-up. Apical closure is the most consistent radiographic finding.
Assuntos
Apexificação/métodos , Polpa Dentária/lesões , Ápice Dentário/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Antibacterianos/uso terapêutico , Coagulação Sanguínea , Criança , Ciprofloxacina/uso terapêutico , Estudos de Coortes , Exposição da Polpa Dentária/terapia , Necrose da Polpa Dentária/terapia , Teste da Polpa Dentária , Dentina/diagnóstico por imagem , Dentina/patologia , Feminino , Seguimentos , Humanos , Masculino , Metronidazol/uso terapêutico , Minociclina/uso terapêutico , Tecido Periapical/patologia , Estudos Prospectivos , Radiografia , Preparo de Canal Radicular/instrumentação , Preparo de Canal Radicular/métodos , Ápice Dentário/patologia , Raiz Dentária/patologia , Resultado do TratamentoRESUMO
INTRODUCTION: Regenerative endodontic therapy is currently used to treat immature permanent teeth with necrotic pulp and/or apical periodontitis. However, mature teeth with necrotic pulp and apical periodontitis have also been treated using regenerative endodontic therapy. The treatment resulted in resolution of apical periodontitis, regression of clinical signs and symptoms but no apparent thickening of the canal walls, and/or continued root development. A recent study in an animal model showed that the tissues formed in the canals of mature teeth with apical periodontitis after regenerative endodontic therapy were cementumlike, bonelike, and periodontal ligament-like tissue with numerous blood vessels. These tissues are similar to the tissues observed in immature permanent teeth with apical periodontitis after regenerative endodontic therapy. METHODS: A 23-year-old woman had a history of traumatic injury to her upper anterior teeth when she was 8 years old. Subsequently, #8 developed pulp necrosis and an acute apical abscess and #7 symptomatic apical periodontitis. The apex of #8 was slightly open, and the apex of #7 was completely formed. Instead of nonsurgical root canal therapy, regenerative endodontic therapy was attempted, including complete chemomechanical debridement on #8 and #7. This was based on the premise that filling of disinfected root canals with the host's biological vital tissue might be better than filling with foreign materials. RESULTS: After regenerative endodontic therapy of #8 and #7, there was radiographic evidence of periapical osseous healing and regression of clinical signs and symptoms. The pulp cavity of #8 decreased in size, and the apex closed. The pulp cavity of #7 appeared to be obliterated by mineralized tissue. These indicated ingrowth of new vital tissue into the chemomechanically debrided canals. CONCLUSIONS: Regenerative endodontic therapy of mature teeth with apical periodontitis and apical abscess can result in the regression of clinical signs and/or symptoms and healing of apical periodontitis but no apparent thickening of the canal walls or continued root development. Filling of the disinfected canals with the host's vital tissue may be better than with foreign materials because vital tissue has innate and adaptive immune defense mechanisms.
Assuntos
Necrose da Polpa Dentária/terapia , Abscesso Periapical/terapia , Periodontite Periapical/terapia , Tratamento do Canal Radicular/métodos , Antibacterianos/uso terapêutico , Apexificação/métodos , Coagulação Sanguínea/fisiologia , Ciprofloxacina/uso terapêutico , Feminino , Seguimentos , Humanos , Metilmetacrilatos/química , Metronidazol/uso terapêutico , Minociclina/uso terapêutico , Planejamento de Assistência ao Paciente , Regeneração/fisiologia , Preparo de Canal Radicular/métodos , Adulto Jovem , Cimento de Óxido de Zinco e Eugenol/químicaRESUMO
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.
Assuntos
Apexificação/métodos , Coagulação Sanguínea/fisiologia , Cavidade Pulpar/anatomia & histologia , Plasma Rico em Plaquetas/fisiologia , Ápice Dentário/anatomia & histologia , Compostos de Alumínio/uso terapêutico , Animais , Compostos de Cálcio/uso terapêutico , Cementogênese/fisiologia , Ciprofloxacina/uso terapêutico , Cemento Dentário/anatomia & histologia , Cemento Dentário/citologia , Polpa Dentária/anatomia & histologia , Polpa Dentária/fisiologia , Cães , Combinação de Medicamentos , Metronidazol/uso terapêutico , Minociclina/uso terapêutico , Óxidos/uso terapêutico , Periodontite Periapical/terapia , Radiografia Interproximal , Distribuição Aleatória , Regeneração/fisiologia , Materiais Restauradores do Canal Radicular/uso terapêutico , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Silicatos/uso terapêutico , Cicatrização/fisiologiaRESUMO
INTRODUCTION: Revascularization outcome depends on microbial elimination because apical repair will not happen in the presence of infected tissues. This study evaluated the microbial composition of traumatized immature teeth and assessed their reduction during different stages of the revascularization procedures performed with 2 intracanal medicaments. METHODS: Fifteen patients (7-17 years old) with immature teeth were submitted to the revascularization procedures; they were divided into 2 groups according to the intracanal medicament used: TAP group (n = 7), medicated with a triple antibiotic paste, and CHP group (n = 8), dressed with calcium hydroxide + 2% chlorhexidine gel. Samples were taken before any treatment (S1), after irrigation with 6% NaOCl (S2), after irrigation with 2% chlorhexidine (S3), after intracanal dressing (S4), and after 17% EDTA irrigation (S5). Cultivable bacteria recovered from the 5 stages were counted and identified by means of polymerase chain reaction assay (16S rRNA). RESULTS: Both groups had colony-forming unit counts significantly reduced after S2 (P < .05); however, no significant difference was found between the irrigants (S2 and S3, P = .99). No difference in bacteria counts was found between the intracanal medicaments used (P = .95). The most prevalent bacteria detected were Actinomyces naeslundii (66.67%), followed by Porphyromonas endodontalis, Parvimonas micra, and Fusobacterium nucleatum, which were detected in 33.34% of the root canals. An average of 2.13 species per canal was found, and no statistical correlation was observed between bacterial species and clinical/radiographic features. CONCLUSIONS: The microbial profile of infected immature teeth is similar to that of primarily infected permanent teeth. The greatest bacterial reduction was promoted by the irrigation solutions. The revascularization protocols that used the tested intracanal medicaments were efficient in reducing viable bacteria in necrotic immature teeth.
Assuntos
Antibacterianos/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Apexificação/métodos , Hidróxido de Cálcio/uso terapêutico , Clorexidina/uso terapêutico , Cavidade Pulpar/microbiologia , Irrigantes do Canal Radicular/uso terapêutico , Traumatismos Dentários/microbiologia , Actinomyces/efeitos dos fármacos , Actinomyces/isolamento & purificação , Adolescente , Carga Bacteriana/efeitos dos fármacos , Criança , Ciprofloxacina/uso terapêutico , Cavidade Pulpar/efeitos dos fármacos , Necrose da Polpa Dentária/microbiologia , Necrose da Polpa Dentária/terapia , Ácido Edético/uso terapêutico , Fusobacterium nucleatum/efeitos dos fármacos , Fusobacterium nucleatum/isolamento & purificação , Géis , Humanos , Metronidazol/uso terapêutico , Viabilidade Microbiana/efeitos dos fármacos , Minociclina/uso terapêutico , Peptostreptococcus/efeitos dos fármacos , Peptostreptococcus/isolamento & purificação , Porphyromonas endodontalis/efeitos dos fármacos , Porphyromonas endodontalis/isolamento & purificação , Hipoclorito de Sódio/uso terapêutico , Ápice Dentário/efeitos dos fármacos , Ápice Dentário/microbiologiaRESUMO
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.
Assuntos
Compostos de Alumínio/uso terapêutico , Apexificação/métodos , Compostos de Cálcio/uso terapêutico , Necrose da Polpa Dentária/terapia , Óxidos/uso terapêutico , Regeneração/fisiologia , Materiais Restauradores do Canal Radicular/uso terapêutico , Silicatos/uso terapêutico , Engenharia Tecidual/métodos , Adolescente , Antibacterianos/administração & dosagem , Coagulação Sanguínea/fisiologia , Densidade Óssea/fisiologia , Criança , Ciprofloxacina/administração & dosagem , Doxiciclina/administração & dosagem , Combinação de Medicamentos , Feminino , Fator 2 de Crescimento de Fibroblastos/uso terapêutico , Seguimentos , Humanos , Masculino , Metronidazol/administração & dosagem , Tecido Periapical/fisiopatologia , Radiografia Interproximal/métodos , Radiografia Dentária Digital/métodos , Alicerces Teciduais , Ápice Dentário/fisiopatologia , Raiz Dentária/fisiopatologiaRESUMO
AIM: To investigate the effect of medicaments used in endodontic regeneration on root fracture resistance and microhardness of radicular dentine. METHODOLOGY: The root canals of mandibular premolars (n = 180) were instrumented and randomized into three treatment groups and an untreated control group. Each treatment group received either triple antibiotic paste (TAP), double antibiotic paste (DAP) or calcium hydroxide paste [Ca(OH)2] intracanal medicament. Teeth were kept in saline for 1 week, 1 month or 3 months. After each time-point, 15 teeth were randomly selected from each group and two root cylinders were obtained from each tooth. One cylinder was subjected to a fracture resistance test, and the other cylinder was used for a microhardness test. Two-way ANOVA and Tukey's pairwise comparisons were used for statistical analysis. RESULTS: For the microhardness test, the two-way interaction between group and time was significant (P < 0.001). The intracanal application of TAP and DAP caused significant and continuous decrease in root dentine microhardness after one (P < 0.05) and 3 months (P < 0.001), respectively. The three-month intracanal application of Ca(OH)2 significantly increased the microhardness of root dentine (P < 0.05). The time factor had a significant effect on fracture resistance (P < 0.001). The three intracanal medicaments caused significant decreases in fracture resistance ranging between 19% and 30% after 3-month application compared to 1-week application. CONCLUSION: In this laboratory study, the 3-month application of triple antibiotic paste, double antibiotic paste or calcium hydroxide paste medicaments significantly reduced the root fracture resistance of extracted teeth compared to a 1-week application.
Assuntos
Apexificação/métodos , Dentina/efeitos dos fármacos , Irrigantes do Canal Radicular/uso terapêutico , Fraturas dos Dentes/fisiopatologia , Raiz Dentária/efeitos dos fármacos , Antibacterianos/administração & dosagem , Dente Pré-Molar/efeitos dos fármacos , Hidróxido de Cálcio/uso terapêutico , Ciprofloxacina/administração & dosagem , Dentina/ultraestrutura , Combinação de Medicamentos , Dureza , Humanos , Teste de Materiais , Metronidazol/administração & dosagem , Microscopia Eletrônica de Varredura , Minociclina/administração & dosagem , Preparo de Canal Radicular/métodos , Camada de Esfregaço , Fatores de Tempo , Raiz Dentária/lesões , Raiz Dentária/ultraestruturaRESUMO
This case series reports the outcomes of 8 patients (ages 9-4 years) who presented with 9 immature permanent teeth with pulpal necrosis and apical periodontitis. During treatment, 5 of the teeth were found to have at least some residual vital tissue remaining in the root canal systems. After NaOCI irrigation and medication with ciprofloxacin, metronidazole, and minocycline, these teeth were sealed with mineral trioxide aggregate and restored. The other group of 4 teeth had no evidence of any residual vital pulp tissue. This second group of teeth was treated with NaOCl irrigation and medicated with ciprofloxacin, metronidazole, and minocycline followed by a revascularization procedure adopted from the trauma literature (bleeding evoked to form an intracanal blood clot). In both groups of patients, there was evidence of satisfactory postoperative clinical outcomes (1-5 years); the patients were asymptomatic, no sinus tracts were evident, apical periodontitis was resolved, and there was radiographic evidence of continuing thickness of dentinal walls, apical closure, or increased root length.
Assuntos
Necrose da Polpa Dentária/terapia , Periodontite Periapical/terapia , Ápice Dentário/fisiologia , Adolescente , Compostos de Alumínio/uso terapêutico , Antibacterianos/uso terapêutico , Apexificação/métodos , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Criança , Ciprofloxacina/uso terapêutico , Polpa Dentária/fisiologia , Dentina Secundária/anatomia & histologia , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Metronidazol/uso terapêutico , Minociclina/uso terapêutico , Odontogênese/fisiologia , Óxidos/uso terapêutico , Regeneração/fisiologia , Materiais Restauradores do Canal Radicular/uso terapêutico , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Silicatos/uso terapêutico , Hipoclorito de Sódio/uso terapêutico , Dente não Vital/terapia , Resultado do TratamentoRESUMO
INTRODUCTION: Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation of root development. In this article we describe successful revascularization treatment of 2 necrotic immature first mandibular molars. METHODS: The clinical and radiographic examinations showed extensive coronal caries, immature roots, and periapical radiolucencies in mandibular first molars of a 9-year-old boy and an 8-year-old girl. The exam findings suggested revascularization treatment in both cases, which was started with irrigation of the canals by using NaOCl 5.25% for 20 minutes, followed by 3 weeks of triple antibiotic (metronidazole, ciprofloxacin, and minocycline) paste dressing. Next, the antibiotic paste was removed, bleeding was induced in the canals, and calcium enriched mixture (CEM) cement was placed over blood clots. RESULTS: In radiographic and clinical follow-ups both cases were asymptomatic and functional, periapical radiolucencies were healed, and roots continued to develop. CONCLUSIONS: Revascularization is a realistic treatment in immature necrotic molars. In addition, placing CEM cement as a new endodontic biomaterial over the blood clot formed inside the canals provided good seal and favorable outcomes.
Assuntos
Apexificação/métodos , Materiais Biocompatíveis/uso terapêutico , Cimentos Dentários/uso terapêutico , Necrose da Polpa Dentária/terapia , Dente Molar/patologia , Neovascularização Fisiológica/fisiologia , Antibacterianos/uso terapêutico , Cálcio/uso terapêutico , Criança , Ciprofloxacina/uso terapêutico , Necrose da Polpa Dentária/patologia , Feminino , Seguimentos , Humanos , Masculino , Mandíbula , Metronidazol/uso terapêutico , Minociclina/administração & dosagem , Odontogênese/fisiologia , Abscesso Periapical/terapia , Periodontite Periapical/terapia , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Hipoclorito de Sódio/uso terapêutico , Fatores de Tempo , Raiz Dentária/irrigação sanguínea , Raiz Dentária/fisiologia , Resultado do TratamentoRESUMO
INTRODUCTION: Inflammatory external root resorption is one of the major complications after replantation of avulsed teeth. Here we report a case of inflammatory external root resorption in a maxillary left central incisor in an 11-year old male patient that was managed and treated by using calcium enriched mixture (CEM) cement. METHODS: The patient's chief complaint was mobility of avulsed and replanted maxillary left central incisor and pain in chewing on left central and lateral incisors. Radiographic examination showed progressive inflammatory external root resorption of the left central incisor with an inadequately obturated root canal treatment. Both teeth were immature and had periapical radiolucencies. Both teeth were irrigated copiously with 2.5% NaOCl and obturated with CEM cement. However, the central incisor was treated with calcium hydroxide 6 weeks before CEM cement obturation. RESULTS: The clinical and radiographic examinations at 3-, 6-, 12-, 24-, and 40-month follow-up showed that treated teeth were functional with normal mobility, the progression of the inflammatory external root resorption ceased, the resorptive lacunae were filled with newly formed bone, and periapical radiolucencies healed. CONCLUSIONS: Considering the biological properties of CEM cement, especially its alkalinity and sustained calcium hydroxide release, using this novel cement for treatment of inflammatory external root resorption and obturation of immature necrotic teeth might be an applicable choice.
Assuntos
Compostos de Cálcio/uso terapêutico , Cimentos Dentários/uso terapêutico , Incisivo/patologia , Óxidos/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Reabsorção da Raiz/terapia , Apexificação/métodos , Hidróxido de Cálcio/uso terapêutico , Criança , Necrose da Polpa Dentária/terapia , Seguimentos , Humanos , Masculino , Osteogênese/efeitos dos fármacos , Doenças Periapicais/terapia , Irrigantes do Canal Radicular/uso terapêutico , Obturação do Canal Radicular , Tratamento do Canal Radicular , Reabsorção da Raiz/patologia , Hipoclorito de Sódio/uso terapêutico , Avulsão Dentária/terapia , Reimplante Dentário/métodosRESUMO
External root resorption may occur as a consequence of trauma, orthodontic treatment, bacterial infection or incomplete sealing of the root canal system (bacterial re-infection), and lead to crater formation on the resorbed apex. This would deform the root apex surface, and cause loss of apical constriction. Depending on the extent of the resorptive process, different treatment regimens have been proposed. A 34-year-old male patient presented with an intra-radicular retainer and an inadequate filling on tooth #21, as well as a radiographic image suggesting periapical bone rarefaction. After root canal retreatment, the defect was accessed coronally. The resorption area was chemo-mechanically debrided and since the apical end was very wide, a calcium sulphate matrix was made. Mineral trioxide aggregate (MTA) was used to fill the resorptive defect, and the coronal access was temporarily sealed. After 24 h, the quality of the apical seal was evaluated with the aid of an operating microscope, and then the root canal system was filled. A 12-month follow-up radiograph showed adequate repair of the resorption. Clinically, the tooth was asymptomatic. We concluded that MTA can be successfully used to avoid overextension of the filling material when treating a tooth with external resorption.
Assuntos
Compostos de Alumínio/uso terapêutico , Apexificação/métodos , Compostos de Cálcio/uso terapêutico , Óxidos/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Reabsorção da Raiz/terapia , Silicatos/uso terapêutico , Adulto , Sulfato de Cálcio/uso terapêutico , Resinas Compostas , Restauração Dentária Temporária , Combinação de Medicamentos , Resinas Epóxi/uso terapêutico , Seguimentos , Guta-Percha/uso terapêutico , Humanos , Masculino , Doenças Periapicais/terapia , Retratamento , Preparo de Canal Radicular/instrumentação , Preparo de Canal Radicular/métodos , Fatores de Tempo , Ápice Dentário/efeitos dos fármacosRESUMO
Three clinical cases involving teeth with open apices and apical periodontitis were treated using different protocols. The first case was managed with intracanal calcium hydroxide paste for 12 months before obturation with gutta-percha and sealer. In the second case, an apical plug of mineral trioxide aggregate (MTA) was used before obturation with gutta-percha and sealer and treatment was completed during 2 appointments. In the third case, the tooth, which had a divergent root canal system, was completely obturated with MTA and treatment was also completed over 2 appointments. In all 3 cases, signs of bone healing were observed after treatment.