Antibiotics Used in Regenerative Endodontics Modify Immune Response of Macrophages to Bacterial Infection.

INTRODUCTION: Ciprofloxacin, amoxicillin, and metronidazole are antibiotics used in regenerative endodontic therapy (RET). Although their antimicrobial properties are well-documented, there is a lack of information on the effects of these antibiotics on the immune response by host macrophages and periapical healing. Thus, this study had 2 objectives: (1) to determine the immune response of macrophages to bacterial infection in response to the combination of ciprofloxacin or amoxicillin and metronidazole and (2) using conditioned media produced by these macrophages to simulate the periapical microenvironment, to determine the impact on the expression of extracellular matrix (ECM) components by periodontal fibroblasts. METHODS: Macrophages were treated with ciprofloxacin and metronidazole or amoxicillin and metronidazole at 10-1000 µg/mL. The treated macrophages were exposed to lipopolysaccharide, and the pro- and anti-inflammatory cytokines produced were quantified with enzyme-linked immunosorbent assay. Periodontal fibroblasts were treated with conditioned media from these treated macrophages, and the expression of ECM genes was determined by quantitative polymerase chain reaction. RESULTS: Lipopolysaccharides elicited the production of proinflammatory cytokines interleukin 1 beta and tumor necrosis factor alpha by macrophages, but this was suppressed by ciprofloxacin and metronidazole. Moreover, only conditioned media from macrophages treated with ciprofloxacin and metronidazole rescued microbial-induced down-regulation of ECM genes by periodontal fibroblasts. Specifically, ciprofloxacin was the antibiotic responsible for these observations. In contrast, these effects were not observed with amoxicillin and metronidazole. CONCLUSIONS: Apart from disinfection of the root canal system, the combination of ciprofloxacin and metronidazole also exerts an immunomodulatory effect, which may aid in periapical healing.

Three-dimensional repositioning accuracy of semiadjustable articulator cast mounting systems.

STATEMENT OF PROBLEM: In spite of its importance in prosthesis precision and quality, the 3-dimensional repositioning accuracy of cast mounting systems has not been reported in detail. PURPOSE: The purpose of this study was to quantify the 3-dimensional repositioning accuracy of 6 selected cast mounting systems. Five magnetic mounting systems were compared with a conventional screw-on system. MATERIAL AND METHODS: Six systems on 3 semiadjustable articulators were evaluated: Denar Mark II with conventional screw-on mounting plates (DENSCR) and magnetic mounting system with converter plates (DENCON); Denar Mark 330 with in-built magnetic mounting system (DENMAG) and disposable mounting plates; and Artex CP with blue (ARTBLU), white (ARTWHI), and black (ARTBLA) magnetic mounting plates. Test casts with 3 high-precision ceramic ball bearings at the mandibular central incisor (Point I) and the right and left second molar (Point R; Point L) positions were mounted on 5 mounting plates (n=5) for all 6 systems. Each cast was repositioned 10 times by 4 operators in random order. Nine linear (Ix, Iy, Iz; Rx, Ry, Rz; Lx, Ly, Lz) and 3 angular (anteroposterior, mediolateral, twisting) displacements were measured with a coordinate measuring machine. The mean standard deviations of the linear and angular displacements defined repositioning accuracy. RESULTS: Anteroposterior linear repositioning accuracy ranged from 23.8 ±3.7 µm (DENCON) to 4.9 ±3.2 µm (DENSCR). Mediolateral linear repositioning accuracy ranged from 46.0 ±8.0 µm (DENCON) to 3.7 ±1.5 µm (ARTBLU), and vertical linear repositioning accuracy ranged from 7.2 ±9.6 µm (DENMAG) to 1.5 ±0.9 µm (ARTBLU). Anteroposterior angular repositioning accuracy ranged from 0.0084 ±0.0080 degrees (DENCON) to 0.0020 ±0.0006 degrees (ARTBLU), and mediolateral angular repositioning accuracy ranged from 0.0120 ±0.0111 degrees (ARTWHI) to 0.0027 ±0.0008 degrees (ARTBLU). Twisting angular repositioning accuracy ranged from 0.0419 ±0.0176 degrees (DENCON) to 0.0042 ±0.0038 degrees (ARTBLA). One-way ANOVA found significant differences (P<.05) among all systems for Iy, Ry, Lx, Ly, and twisting. CONCLUSIONS: Generally, vertical linear displacements were less likely to reach the threshold of clinical detectability compared with anteroposterior or mediolateral linear displacements. The overall repositioning accuracy of DENSCR was comparable with 4 magnetic mounting systems (DENMAG, ARTBLU, ARTWHI, ARTBLA). DENCON exhibited the worst repositioning accuracy for Iy, Ry, Lx, Ly, and twisting.