Effect of mineral trioxide aggregate plug location on root development in regenerative endodontic procedure.

This retrospective study investigated the effect of mineral trioxide aggregate (MTA) plug location on treatment outcome and root maturation after regenerative endodontic procedures (REP) in immature permanent teeth. Thirty-three roots (n = 33) in cohort that underwent REP consistently according to AAE guideline were included to trace radiographic changes for the root and canal dimensions. Based on intraoral radiographs, roots were divided into two groups depending on the location of MTA plug within whole root length: coronal group (n = 14), within the upper half; apical group (n = 19), within the lower half. Periapical radiographs were standardized to assess treatment outcomes and root maturation including root development stages and digital measurements on the change ratios of root length, apex width, radiographic root area (RRA), modified RRA (mRRA), and periapical rarefaction area. The data were statistically analysed using the Mann-Whitney test. The patients' average age was 11 years and 10 months, with no significant between-group difference in sex. Premolars were the most prevalent tooth type (62.1%), followed by incisiors and molars. Pre-existing symptoms and signs subsided within 6 months in all cases. The teeth showed similar radiographic root development in both groups (P > 0.05). However, mRRA increase ratio was significantly higher in apical group than that in coronal group at early (< 6 months) and late (< 24 months) periods of follow-up (P < 0.05). Significant changes of root development stage were observed at early period for apical group and at late period for coronal group (P < 0.05). All the observed cases showed continuing root development after REP. Significant changes in root developments occurred at different follow-up periods according to the location of MTA plugs.

Morphological measurements of two separate mesiobuccal canals in maxillary first molars using micro-computed tomography.

OBJECTIVES: To obtain radicular measurements of two separate mesiobuccal (MB) root canals in maxillary first molars using micro-computed tomography (µCT) with customized software. MATERIALS AND METHODS: Human maxillary first molar MB roots (N = 36) with two separate canals (MB1, MB2) and apical foramina were scanned by µCT and analyzed with Kappa2 software to reconstruct three-dimensional (3D) surface models of roots and canals. These models were sectioned at 0.1 mm intervals perpendicular to the central axis of each canal. Canal widths, 3D curvatures, and surrounding dentine thicknesses were measured concurrently on each section. Dentine thicknesses were analyzed statistically for differences between each direction and the different levels of both canals. RESULTS: Dentine walls around MB1 were thicker than MB2 (p < 0.05). Thinnest dentine was most often located at disto-inside direction in both canals. Canal widths were significantly smaller in MB2 than MB1 (p < 0.01). Apical constrictions were smaller (p < 0.05) and further (p < 0.05) from the apex in MB2 than MB1. Canal curvatures were greatest in the apical third of both canals (p < 0.001), and they were greater in MB2 than MB1 (p < 0.05). CONCLUSIONS: MB2 canals had shorter lengths, smaller widths, and more severe curvatures and were surrounded by thinner dentine walls. In MB2, apical constrictions were between 1 and 2 mm from the apex, compared to about 1 mm for MB1. CLINICAL RELEVANCE: These detailed measurements and in-depth 3D analyses of maxillary first molar MB roots with two separate canals and apical foramina provide morphologic references for root canal therapy.

Effect of apexification on occlusal resistance of immature teeth.

BACKGROUND: Strain distribution was investigated to assess the occlusal resistance alterations in immature teeth under different occlusal force. METHODS: In vitro apexification models of teeth with a funnel-shaped immature apex were obturated with mineral trioxide aggregate (MTA; ProRoot MTA) using different combinations of core materials (10/group): group 1, full-length orthograde obturation of MTA; group 2, a 5-mm MTA apical plug with a composite core; group 3, a 5-mm MTA apical plug and back-filling with warm gutta-percha. Teeth with calcium hydroxide (CH)-medicated canals and untreated teeth with normal apices were tested as controls. The teeth were arranged between two adjacent normal-apex teeth, embedded in a resin mold with a simulated periodontal ligament space. Strain data were recorded from the 3-unit teeth assembly under static compressive occlusal forces (50, 100, 200, and 300 N). Measurements were repeated 20 times for each condition, and the data were statistically analyzed. RESULTS: The immature teeth showed altered occlusal force resistance, placing increased strain on adjacent teeth. Teeth with CH-medicated canals showed significantly inferior occlusal resistance under all tested forces (P < 0.05). Application of an MTA plug with deep composite resin core resulted in significantly better stress-bearing capacity especially under forces of 50 and 300 N (P < 0.05). CONCLUSIONS: The pattern of occlusal force distribution in immature teeth differed according to the canal obturation materials used for apexification. Immature teeth with an MTA apical plug showed more favorable occlusal force resistance than those with CH-medicated canals.

Evaluation of the safety and efficiency of novel metallic implant scaler tips manufactured by the powder injection molding technique.

BACKGROUND: Although many studies have compared the properties of ultrasonic scaling instruments, it remains controversial as to which is most suitable for implant scaling. This study evaluated the safety and efficiency of novel metallic ultrasonic scaler tips made by the powder injection molding (PIM) technique on titanium surfaces. METHODS: Mechanical instrumentation was carried out using four types of metal scaler tips consisting of copper (CU), bronze (BR), 316 L stainless steel (316 L), and conventional stainless steel (SS) tips. The instrumented surface alteration image of samples was viewed with scanning electron microscope (SEM) and surface profile of the each sample was investigated with confocal laser scanning microscopy (CLSM). Arithmetic mean roughness (Ra) and maximum height roughness (Rmax) of titanium samples were measured and dissipated power of the scaler tip was estimated for scaling efficiency. RESULTS: The average Ra values caused by the 316 L and SS tip were about two times higher than those of the CU and BR tips (p < 0.05). The Rmax value showed similar results. The efficiency of the SS tip was about 3 times higher than that of CU tip, the 316 L tip is about 2.7 times higher than that of CU tip, and the BR tip is about 1.2 times higher than that of CU tip. CONCLUSIONS: Novel metallic bronze alloy ultrasonic scaler tip minimally damages titanium surfaces, similar to copper alloy tip. Therefore, this bronze alloy scaler tip may be promising instrument for implant maintenance therapy.

The Anti-Inflammatory Effect of Human Telomerase-Derived Peptide on P. gingivalis Lipopolysaccharide-Induced Inflammatory Cytokine Production and Its Mechanism in Human Dental Pulp Cells.

Porphyromonas gingivalis is considered with inducing pulpal inflammation and has lipopolysaccharide (LPS) as an inflammatory stimulator. GV1001 peptide has anticancer and anti-inflammation activity due to inhibiting activation of signaling molecules after penetration into the various types of cells. Therefore, this study examined inhibitory effect of GV1001 on dental pulp cells (hDPCs) stimulated by P. gingivalis LPS. The intracellular distribution of GV1001 was analyzed by confocal microscopy. Real-time RT-PCR was performed to determine the expression levels of TNF-α and IL-6 cytokines. The role of signaling by MAP kinases (ERK and p38) was explored using Western blot analysis. The effect of GV1001 peptide on hDPCs viability was measured by MTT assay. GV1001 was predominantly located in hDPC cytoplasm. The peptide inhibited P. gingivalis LPS-induced TNF-α and IL-6 production in hDPCs without significant cytotoxicity. Furthermore, GV1001 treatment markedly inhibited the phosphorylation of MAP kinases (ERK and p38) in LPS-stimulated hDPCs. GV1001 may prevent P. gingivalis LPS-induced inflammation of apical tissue. Also, these findings provide mechanistic insight into how GV1001 peptide causes anti-inflammatory actions in LPS-stimulated pulpitis without significantly affecting cell viability.

Evaluation of dentin tubule occlusion after laser irradiation and desensitizing agent application.

PURPOSE: To evaluate the effects of lasers (Nd:YAG and Er:YAG) and of topical desensitizing agents on dentin tubule occlusion by measuring real-time dentin fluid flow (DFF). METHODS: 32 molars were prepared with V-shape cavity at the cervical area, acid-etched, water rinsed, blotted dry, and treated with (1) Nd:YAG laser; (2) Er:YAG laser; (3) SuperSeal, a desensitizing agent; (4) ClinproXT, a resin-modified glass-ionomer (RMGI) varnish (n = 8 each). A real-time fluid flow measuring instrument (nano-Flow) was used to measure the DFF throughout the procedures. The DFF rates before and after the treatment were compared. Moreover, the surface topography of dentin tubules after each desensitizing method was examined using SEM. RESULTS: DFF varied among the groups. The DFF rate was significantly reduced after laser irradiation/application of the desensitizing agents (P < 0.05). ClinproXT showed the greatest reduction of DFF rate (71.9%), followed by the SuperSeal (34.8%) and laser groups (P< 0.05). However, there was no significant difference between the Nd:YAG (24.1%) and Er:YAG (20.6%) groups (P > 0.05). In SEM images, narrowed dentin tubules were observed in both lased groups and SuperSeal group. In the ClinproXT group, the occluded dentin tubules by the RMGI covering were observed.

Comparison of mandibular first molar mesial root canal morphology using micro-computed tomography and clearing technique.

OBJECTIVE: Micro-computed tomography (MCT) with alternative image reformatting techniques shows complex and detailed root canal anatomy. This study compared two-dimensional (2D) and 3D MCT image reformatting with standard tooth clearing for studying mandibular first molar mesial root canal morphology. MATERIALS AND METHODS: Extracted human mandibular first molar mesial roots (n=31) were scanned by MCT (Skyscan 1172). 2D thin-slab minimum intensity projection (TS-MinIP) and 3D volume rendered images were constructed. The same teeth were then processed by clearing and staining. For each root, images obtained from clearing, 2D, 3D and combined 2D and 3D techniques were examined independently by four endodontists and categorized according to Vertucci's classification. Fine anatomical structures such as accessory canals, intercanal communications and loops were also identified. RESULTS: Agreement among the four techniques for Vertucci's classification was 45.2% (14/31). The most frequent were Vertucci's type IV and then type II, although many had complex configurations that were non-classifiable. Generally, complex canal systems were more clearly visible in MCT images than with standard clearing and staining. Fine anatomical structures such as intercanal communications, accessory canals and loops were mostly detected with a combination of 2D TS-MinIP and 3D volume-rendering MCT images. CONCLUSIONS: Canal configurations and fine anatomic structures were more clearly observed in the combined 2D and 3D MCT images than the clearing technique. The frequency of non-classifiable configurations demonstrated the complexity of mandibular first molar mesial root canal anatomy.

Incidence of three roots and/or four root canals in the permanent mandibular first molars in a Korean sub-population.

OBJECTIVES: The purpose of this study was to evaluate the prevalence of three-rooted permanent mandibular first molars (PMFMs) with four canals and their morphological characteristics among a Korean population from using cone-beam computed tomography scans (CBCTs). MATERIALS AND METHODS: Among the 705 CBCTs screened, 472 patient cases possessing at least one PMFM were identified. A total of 780 PMFMs were evaluated in axial section series to determine the number of roots and canals. The incidences of three-rooted PMFMs were compared with regard to gender and location. For distal root(s) with two canals, inter-orifice distances (IOD) between distobuccal and distolingual canals were measured at pulpal floor and furcation levels. The difference of IOD between males and females was also analyzed using chi-square tests. RESULTS: Among the 472 CBCTs of 225 females and 247 males, 84 females and 107 males were found to have at least one three-rooted PMFM. Among the 780 PMFMs, 191 PMFMs (24.5%, 89 of 397 left and 102 of 383 right) were found to have three roots. The prevalence of distal root(s) with two canals was 34.2% (267 of 780). From the molars with two distal canals, the mean IOD between distobuccal and distolingual canals at the pulpal floor level was 3.1 mm in males and 2.9 mm in females (p = 0.0428). CONCLUSIONS: The occurrence of three-rooted PMFMs among a Korean population was 24.5% and was higher than other countries and ethnicities. Understanding the prevalence of PMFMs with a distolingual root and/or canal in a Korean population and the IOD between distobuccal and distolingual canals may be useful for successful endodontic treatments. CLINICAL RELEVANCE: Acknowledgment of potential incidence of three-rooted permanent mandibular first molars with four canals and the distance between two distal canals may increase the success rate of root canal treatment by reducing the missing canal untreated.

Assessing the efficacy of jet dispenser versus direct syringe injection for calcium hydroxide paste placement in artificial root canals.

This study aimed to evaluate the efficacy of a novel jet dispenser (JD) for filling simulated straight and curved canals with calcium hydroxide (Ca(OH)2) paste by comparing the level of intracanal medicament with traditional direct syringe delivery. The Ca(OH)2 paste was delivered into the canals using either a direct syringe with binding tip and unbinding tip or a JD. The analysis of the ratio of the canal filled area (RCFA) in the coronal, middle, and apical thirds was conducted using the Kruskal-Wallis and Mann-Whitney U tests (α = 0.05). The JD resulted in a significantly higher RCFA of 1.00 in the middle and apical thirds in both the straight and curved canals than the direct syringe method (p < 0.001). Voids were frequently observed in the direct syringe group, whereas JD showed no voids within the filled area. In the direct syringe groups, the apical area was more readily filled in both canal types when the tip was bound (p < 0.001). The JD was found to be more effective in filling the entire canal space than the binding and unbinding conditions of the direct injection method, particularly in the apical area.

Evaluation of the safety and efficiency of novel metallic ultrasonic scaler tip on titanium surfaces.

AIM: To evaluate the safety and efficiency of novel ultrasonic scaler tips, conventional stainless-steel tips, and plastic tips on titanium surfaces. MATERIAL AND METHODS: Mechanical instrumentation was carried out using conventional ultrasonic scalers (EMS, Nyon, Switzerland) with novel metallic implant tip (BS), a plastic-headed tip (ES), a plastic tip (PS) and a conventional stainless-steel tip (CS) on 10 polished commercially pure titanium disks (Grade II) per group. Arithmetic mean roughness (R(a) ) and maximum height roughness (R(y) ) of titanium samples were measured and dissipated power of the scaler tip in the tip-surface junction was estimated to investigate the scaling efficiency. The instrumented surface morphology of samples was viewed with a scanning electron microscope (SEM) and surface profile of the each sample was investigated using contact mode with a commercial atomic force microscope (AFM). RESULTS: There were no significant differences in surface roughness (R(a) and R(y) ) among BS, ES, and PS group. However, CS group showed significant higher surface roughness (R(a) and R(y) ). The efficiency of CS tip is twice as much higher than that of BS tip, the efficiency of BS tip is 20 times higher than that of PS tip, and the efficiency of BS tip is 90 times higher than that of ES tip. CONCLUSION: Novel metallic copper alloy ultrasonic scaler tips may minimally influence the titanium surface, similar to plastic tip. Therefore, they can be a suitable instrument for implant maintenance therapy.

Real-time nanoleakage and the flow characteristics of calcium silicate root canal filling materials.

This study aimed to investigate the real-time nanoleakage and flow characteristics of calcium silicate-based (Ca-Si) root canal filling materials. Extracted human teeth (n = 30) were decoronated and standardized in their inner and outer dimensions. After root canal enlargement, the roots were filled with gutta-percha (GP) and AH26 sealer, GP and EndoSeal MTA sealer, or Biodentine. The roots were connected to a Nanoflow device (IB Systems) under hydrostatic pressure (40 cm∙H2O) and fluid flow was traced through the filled roots. Data were detected at the nanoscale twice per second and automatically recorded in units of nL/s. Leakage was quantified as the mean slope until the curve plateaued over time, and all static flow intervals lasting longer than 1 s were analyzed to identify any increase in flow and duration. Data were statistically analyzed using the Kruskal-Wallis test. The calculated leakage values were 0.0670 ± 0.0516 nL/s for GP/AH26, 0.1397 ± 0.1579 nL/s for GP/EndoSeal MTA, and 0.0358 ± 0.0538 nL/s for Biodentine, with no statistically significant differences among the root filling materials (P > 0.05). An analysis of real-time flow data for 1000 s to identify spot trends and the overall tendency of flow until a plateau was reached revealed a stepwise increase in the roots filled with Ca-Si material, whereas the GP/AH26-filled roots showed a linear increase. Real-time measurements under hydrostatic pressure with the Nanoflow device enabled precise fluid flow tracing through the root canal filling material. In terms of nanoleakage, the tested root canal filling materials showed no significant differences, while the real-time flow patterns of roots filled with Ca-Si material showed different characteristics from those of GP/AH26-filled roots.

Microleakage of accelerated mineral trioxide aggregate and Portland cement in an in vitro apexification model.

The purpose of this study was to evaluate the microleakage of accelerated mineral trioxide aggregate (MTA) and Portland cement by flow porometry analysis in an in vitro apexification model. Sixty-four single-rooted, extracted teeth were divided into 4 groups (group 1, MTA; group 2, MTA with accelerator; group 3, Portland cement; and group 4, Portland cement with accelerator). In an in vitro apexification model, MTA or Portland cement mixed with or without 10% CaCl2 was condensed to 2-mm thickness. The negative control group (n = 4) had the apical foramen sealed with epoxy resin. The maximum and mean flow pore diameters of the samples were tested by capillary flow porometry at 90 minutes and 48 hours after obturation. The addition of accelerator significantly reduced the maximum pore diameters of MTA and Portland cement at the initial setting phase. After 48 hours of obturation, the maximum and mean flow pore diameters of the accelerated samples were significantly reduced compared with the normal samples. There was no statistically significant difference in the maximum pore diameter of MTA and Portland cement between the measurements at 90 minutes and 48 hours. The results imply that the addition of accelerator into MTA or Portland cement can be useful in a one-visit apexification by reducing microleakage even in an early setting time.

Dimethyloxalylglycine-embedded Poly(ε-caprolactone) Fiber Meshes Promote Odontoblastic Differentiation of Human Dental Pulp-derived Cells.

INTRODUCTION: The in vivo effect of prolyl hydroxylase inhibitors on the regeneration of the pulp-dentin complex is unclear. The purpose of this study was to investigate the effect of dimethyloxalylglycine (DMOG)-embedded poly(ε-caprolactone) fiber (PCLF/DMOG) on odontoblastic differentiation of human dental pulp-derived cells (hDPCs) by transplantation of the dentin slice model. METHODS: The hDPCs were seeded onto electrospun PCLF and PCLF/DMOG in dentin slices and then transplanted into nude mice. The surface topography was evaluated for both PCLFs, and DMOG release from the PCLF/DMOG was examined. The effects of the PCLF/DMOG were assessed by histology and quantitative reverse transcription polymerase chain reaction. RESULTS: The PCLF/DMOG-treated dentin slices showed higher cellularity with a palisading arrangement of hDPCs and organized collagen fibers. We found that the PCLF/DMOG significantly stimulated the expression of vascular endothelial growth factor, dentin sialoprotein, and bone sialoprotein in the hDPCs (P < .05) and mouse vascular endothelial growth factor A, mouse platelet endothelial cell adhesion molecule 1, and mouse neurofilament light polypeptide in the surrounding host cells (P < .05). CONCLUSIONS: These results show that PCLF/DMOG has potential in pulp-dentin complex regeneration by promoting odontoblastic differentiation of hDPCs and by enhancing host cell recruitment, angiogenesis, and neurogenesis through the released DMOG-mediated cell responses.

Effects of short-term chemical disinfection of gutta-percha cones: identification of affected microbes and alterations in surface texture and physical properties.

The aims of this study were to identify microorganisms on the surface of gutta-percha (GP) cones using a polymerase chain reaction (PCR) and to evaluate the sterilization effect of 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and ChloraPrep on these bacteria. Alterations of the surface texture and physical properties of GP cone after chemical sterilization were compared. A total of 150 GP cones were randomly selected in endodontic clinics, and a PCR assay was performed to identify the contaminating microorganisms. After inoculation with the same microorganisms followed by drying for 1 day, the GP cones were immersed in the three chemical disinfectants. The sterilization effects were assessed by measuring the turbidity and through subculturing. The changes in surface texture were observed by scanning electron microscopy, and Instron 5500 (Instron Corp, Canton, MA) was used to measure the tensile strength and elongation rate of the GP cones after chemical sterilization. Statistical analysis was performed. Results indicate that 19.4% of GP cones from the clinic were contaminated, and all the species belonged to the genus Staphylococcus. Three chemical disinfectants were all effective in the rapid disinfection of GP cones against Staphylococcus spp, and 1-minute immersion of the GP cones was adequate for disinfection. Microphotographs of the NaOCl-soaked cone showed a cluster of cuboidal crystals. The tensile strength between the NaOCl- and CHX-soaked groups was significantly different (p<0.05), but there was no significant difference between the NaOCl- and ChloraPrep-soaked groups (p>0.05). All disinfectants significantly increased the elongation rate of the GP cones compared with fresh GP cones (p<0.05), especially in the ChloraPrep (Medi-flex, Leawood, KS). These results show that the three chemical disinfectants are effective agents for the rapid sterilization of GP cones. However, further research will be needed to determine the clinical relevance of the changes in physical properties.

In vitro evaluation of the sealing ability of newly developed calcium phosphate-based root canal sealer.

This study compared the sealing ability of newly developed calcium phosphate-based root canal sealers (CAPSEAL I, CAPSEAL II) with other calcium phosphate-based sealer (Sankin Apatite Root Canal Sealer: SARCS I, SARCS III), a resin-based sealer (AH Plus), a ZOE-based sealer (Pulp Canal Sealer EWT), and a calcium hydroxide-based sealer (Sealapex) by using an anaerobic bacterial leakage model with Prevotella nigrescens during a 90-day observation period (n=15/group). SARCS I and III had significantly greater leakage with P. nigrescens than all other groups (P<.05). There was no other statistical difference between the sealers. Field emission-scanning electron microscope observations showed that both CAPSEAL I and II sealers were well-adapted to the canal wall and infiltrated into the dentinal tubules.

The Effects of Torsional Preloading on the Torsional Resistance of Nickel-titanium Instruments.

INTRODUCTION: This study evaluated the effect of torsional preloading on the torsional resistance of nickel-titanium (NiTi) endodontic instruments. METHODS: WaveOne Primary (Dentsply Maillefer, Ballaigues, Switzerland) and ProTaper Universal F2 (Dentsply Maillefer) files were used. The ultimate torsional strength until fracture was determined for each instrument. In the phase 1 experiment, the ProTaper and WaveOne files were loaded to have a maximum load from 2.0 up to 2.7 or 2.8 Ncm, respectively. In the phase 2 experiment, the number of repetitions of preloading for each file was increased from 50 to 200, whereas the preloading torque was fixed at 2.4 Ncm. Using torsionally preloaded specimens from phase 1 and 2, the torsional resistances were calculated to determine the ultimate strength, distortion angle, and toughness. The results were analyzed using 1-way analysis of variance and Duncan post hoc comparison. The fracture surfaces and longitudinal aspect of 5 specimens per group were examined under a scanning electron microscope. RESULTS: All preloaded groups showed significantly higher ultimate strength than the unpreloaded groups (P < .05). There was no significant difference among all groups for distortion angle and toughness. Although WaveOne had no significant difference between the repetition groups for ultimate strength, fracture angle, and toughness, ProTaper had a higher distortion angle and toughness in the 50-repetition group compared with the other repetition groups (P < .05). Scanning electron microscopic examinations of the fractured surface showed typical features of torsional fracture. CONCLUSIONS: Torsional preloading within the ultimate values could enhance the torsional strength of NiTi instruments. The total energy until fracture was maintained constantly, regardless of the alloy type.

Collaborative Management of Combined Periodontal-endodontic Lesions with a Palatogingival Groove: A Case Series.

INTRODUCTION: This article reports 3 representative cases of interdisciplinary management of a palatogingival groove in maxillary lateral incisors. The development, pathology, and effectiveness of management approaches in cases involving a combined periodontal-endodontic lesion with a palatogingival groove are discussed. METHODS: We describe 3 patients with a noncontributory medical history presenting with a chief complaint related to a maxillary incisor and diagnosed with a combined periodontal-endodontic lesion with a palatogingival groove at Seoul National University Dental Hospital, Seoul, Korea. RESULTS: Palatogingival grooves were mostly associated with deep periodontal pockets connected to a periapical lesion. Optional collaborative treatments were performed according to the condition as follows: case 1, root canal treatment (RCT), open flap debridement, odontoplasty, and guided tissue regeneration; case 2, RCT, apicoectomy, open flap debridement, and odontoplasty; and case 3, RCT, crown restoration, root planning, and odontoplasty. After clinical examination and radiographic assessments, the periapical lesion and periodontal deep pocket were successfully resolved with periodontal-endodontic collaborative treatment involving both periodontal surgical procedures (cases 1 and 2) and a nonsurgical procedure (case 3). CONCLUSIONS: Within the limitations of this study, these case reports show that accurate diagnosis of developmental anomalies and elimination of inflammatory irritants are key factors for favorable long-term outcomes.

Effect of calcium hydroxide-treated Prevotella nigrescens on the gene expression of matrix metalloproteinase and its inhibitor in MG63 cells.

The purpose of this study was to monitor the expression of matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) produced by an osteoblastic cell line MG63 stimulated with Prevotella nigrescens lipopolysaccharides (LPS), and to compare the level of secretion before and after the P. nigrescens LPS was treated with calcium hydroxide [Ca(OH)2]. The underlying hypothesis is that the balance between MMP and TIMP secretion is the key to an understanding of the host degradative pathways involved in the pathogenesis of bacterial derived pulpal and periapical diseases. Confluent monolayers of MG63 human osteosarcoma cells were exposed to varying concentrations of P. nigrescens or Escherichia coli LPS. Alternately, confluent cultures were exposed to 10 microg/ml of bacterial LPS pretreated with Ca(OH)2 (12.5 mg/ml) for 72 hours. At the end of the experimental period, total RNA was extracted and real-time quantitative polymerase chain reaction (PCR) was performed for MMP-1, TIMP-1, and glyceraldehyde-3-phosphate dehydrogenase (GAPDH). The results showed that the expression of MMP-1 mRNA was low and invariant for the experimental period in the negative controls. However, exposure to P. nigrescens LPS increased expression after 48 hours. Expression of TIMP-1 mRNA was highly increased at 24 and 48 hours with lower concentrations of LPS in contrast to a suppression with a concentration of 10 microg/ml. Treatment of P. nigrescens LPS with Ca(OH)2 resulted in a down-regulation of MMP-1, whereas pretreated E. coli LPS demonstrated no stimulatory activity for MMP-1 gene expression. Both types of LPS when pretreated with Ca(OH)2 induced slightly up-regulated expression of TIMP-1.

Regenerative Characteristics of Apical Papilla-derived Cells from Immature Teeth with Pulpal and Periapical Pathosis.

INTRODUCTION: The purpose of this study was to ascertain the regenerative characteristics of apical papilla-derived cells (APDCs) from immature teeth with pulpal and periapical pathosis and thus to provide proof-of-principle evidence for further regenerative endodontic research. METHODS: Pulpal and periapical pathosis was induced in immature permanent double-rooted premolars of beagles, which were randomly assigned to experimental treatment groups: group AO (n = 14), pulp disruption and access left open; group PS (n = 14), supragingival plaque suspension-soaked cotton pellet was introduced, and access was sealed; and control (n = 7), untreated. The teeth were extracted at 2- and 4-week periods after experimental treatments. APDCs were cultured from the extracted teeth, and their cellular proliferation, differentiation characteristics, and stemness were assessed. The data were statistically analyzed. RESULTS: After 4 weeks of intentional pulpal and periapical pathosis induction period, all teeth in group PS showed features of apical periodontitis with necrotic pulp, and their APDCs showed significantly increased proliferation rate and osteogenic/odontogenic differentiation capabilities (P < .05). The stemness was maintained in all APDCs, although the stem cell population was smaller in group PS at 2-week period when the inflammatory responses were most fulminant (P < .05). CONCLUSIONS: The APDCs from immature teeth retained the regenerative characteristics with the differences according to their pulpal and periapical pathosis. The results of this study partly provide the evidence for regenerative endodontic research.

Dynamic intratubular biomineralization following root canal obturation with pozzolan-based mineral trioxide aggregate sealer cement.

The application of mineral trioxide aggregates (MTA) cement during the root canal obturation is gaining concern due to its bioactive characteristic to form an apatite in dentinal tubules. In this regard, this study was to assess the biomineralization of dentinal tubules following root canal obturation by using pozzolan-based (Pz-) MTA sealer cement (EndoSeal MTA, Maruchi). Sixty curved roots (mesiobuccal, distobuccal) from human maxillary molars were instrumented and prepared for root canal obturation. The canals were obturated with gutta-percha (GP) and Pz-MTA sealer by using continuous wave of condensation technique. Canals obturated solely with ProRoot MTA (Dentsply Tulsa Dental) or Pz-MTA sealer were used for comparison. In order to evaluate the biomineralization ability under different conditions, the PBS pretreatment before the root canal obturation was performed in each additional samples. At dentin-material interfaces, the extension of intratubular biomineralization was analyzed using scanning electron microscopy (SEM) and energy dispersive spectroscopy. When the root canal was obturated with GP and Pz-MTA sealer, enhanced biomineralization of the dentinal tubules beyond the penetrated sealer tag was confirmed under the SEM observation (p < 0.05). Mineralized apatite structures (calcium/phosphorous ratio, 1.45-1.89) connecting its way through the dentinal tubules were detected at 350-400 µm from the tubule orifice, and the pre-crystallization seeds were also observed along the intra- and/or inter-tubular collagen fiber. Intratubular biomineralization depth was significantly enhanced in all PBS pretreated canals (p < 0.05). Pz-MTA cement can be used as a promising bioactive root canal sealer to enhance biomineralization of dentinal tubules under controlled environment.