Antiplatelet effect of sanguinarine is correlated to calcium mobilization, thromboxane and cAMP production.

Sanguinarine is a plant alkaloid present in the root of Sanguinaria canadensis and Poppy fumaria species. Sanguinarine has been used as an antiseptic mouth rinse and a toothpaste additive to reduce dental plaque and gingival inflammation. In this study, we investigated the antiplatelet effects of sanguinarine, aiming to extend its potential pharmacological applications. Sanguinarine inhibited platelet aggregation induced by arachidonic acid (AA), collagen, U46619 and sub-threshold concentration of thrombin (0.05 U/ml) with IC(50) concentrations of 8.3, 7.7, 8.6 and 4.4 microM, respectively. Sanguinarine (5-10 microM) inhibited 10-31% of platelet TXB(2) production, but not platelet aggregation induced by higher concentration of thrombin (0.1 U/ml). SQ29548, a thromboxane receptor antagonist, inhibited the AA-induced platelet aggregation but not TXB(2) production. Sanguinarine suppressed cyclooxygenase-1 (COX-1) activity (IC(50)=28 microM), whereas its effect on COX-2 activity was minimal. Sanguinarine (8, 10 microM) further inhibited the AA-induced Ca(2+) mobilization by 27-62%. In addition, SQ22536, an adenylate cyclase inhibitor, attenuated the inhibitory effect of sanguinarine toward AA-induced platelet Ca(2+) mobilization and aggregation. These results suggest that sanguinarine is a potent antiplatelet agent, which activates adenylate cyclase, inhibits platelet Ca(2+) mobilization, TXB(2) production as well as suppresses COX-1 enzyme activity. Sanguinarine may have therapeutic potential for treatment of cardiovascular diseases related to platelet aggregation.

Tensile bond strength of Er,Cr:YSGG laser-irradiated human dentin and analysis of dentin-resin interface.

OBJECTIVES: As the bond strength of composite resin to Er,Cr:YSGG laser-irradiated dentin has not yet been evaluated, the objectives of this study were to investigate the tensile bond strength and to analyze the resin-dentin interface among bur-cut/acid-etched, Er,Cr:YSGG laser-ablated/acid-etched and Er,Cr:YSGG laser-ablated human dentin. METHODS: Crown dentin disks prepared from extracted human third permanent molars were used for the observation of surface morphological changes by scanning electron microscope (SEM). The laser energy parameters were 3.5 W and 20 Hz with water spray (air pressure level, 80%; water pressure level, maximum level). Another group of crown dentin disks were prepared for composite resin restoration and observation of resin-dentin bond interface after demineralization in 6N hydrochloric acid (HCl) for 1 min and deproteinization in 1% sodium hypochlorite solution (NaOCl) for 10 min. The tensile bond strengths of the three groups were measured by a universal testing machine at a crosshead speed of 0.5 mm/min. Fracture types at the dentin-resin interface were analyzed using the digital stereoscopic microscope and fractured surfaces of the debonded specimens were examined by SEM. RESULTS: All three groups showed that the treated surfaces were free of dentin debris and smear layer. The peritubular dentin protruded from the surrounding intertubular dentin after laser irradiation. The dentin-resin interface treated with Er,Cr:YSGG laser irradiation and acid etching demonstrated numerous resin tags converging into a bulge and then diverging again. The length of resin tags was greater than 100 microm. The tensile bond strengths of bur-cut/acid-etched, laser-ablated/acid-etched and laser-ablated human dentin were 5.37+/-1.51, 5.17+/-1.41 and 3.29+/-0.86 MPa, respectively. No statistical significance was found between the bur-cut/acid-etched and laser-ablated/acid-etched groups. The predominant fracture modes of bur-cut/acid-etched, laser-ablated/acid-etched and laser-ablated human dentin were Type 1 (50%), Type 2 (70%) and Type 1 (70%), respectively. SIGNIFICANCE: Er,Cr:YSGG laser irradiation affects adversely adhesion of resin to dentin but acid etching following laser irradiation could increase the tensile bond strength as high as that of bur-cut/acid-etched human dentin.

Er:YAG Laser for Surgical Crown Lengthening: A 6-Month Clinical Study.

This study evaluated use of a solid-state laser to avoid the flap technique and suturing. An Er:YAG laser was used in 26 consecutive patients referred for osseous crown lengthening in 32 posterior teeth. The distance from the planned restoration margin to the alveolar crest (B) satisfied a 3-mm dentogingival complex. No tissue necrosis and no significant change in the distance from the gingival margin to B or probing depth were detected at 3 and 6 months. Minimally invasive Er:YAG laser surgery decreases the time needed to establish the gingival margin necessary for definitive restoration.

Signaling mechanism of thrombin-induced gingival fibroblast-populated collagen gel contraction.

1.--Thrombin is activated during gingival tissue injury and inflammation. Thrombin (platelet)-rich plasma has been used for periodontal regeneration with success. Thrombin and other bacterial proteases also affect the functions of adjacent periodontal cells via stimulation of protease-activated receptors (PARs). 2.--We noted that thrombin (0.1-2 U ml(-1)), human, and frog PAR-1 agonist peptide (20-240 microM) induced the gingival fibroblast (GF)-populated collagen gel contraction within 2 h of exposure. However, PAR-2, PAR-3, and PAR-4 agonist peptide (20-240 microM) showed little effect on collagen gel contraction. U73122 (phospholipase C inhibitor) and 2-APB (IP3 antagonist) were effective in inhibition of GF contraction. 3.--Thrombin-induced GF contraction was inhibited by 5 mM EGTA (an extracellular calcium chelator) and verapamil (an L-type calcium channel blocker). In addition, W7 (10 and 25 microM, a calcium/calmodulin (CaM) inhibitor), ML-7 (50 microM, myosin light chain kinase (MLCK) inhibitor), and HA1077 (100 microM, Rho kinase inhibitor) completely inhibited the thrombin-induced collagen gel contraction. Thrombin also induced the phosphorylation of ERK1/ERK2 and elevated the Rho-GTP levels in GF. 4.--However, U0126 only partially inhibited the thrombin-induced GF contraction. Similarly, wortmannin (100 nM), LY294002 (20 microM) (two PI3K inhibitor) and genistein also showed partial inhibition. Moreover, NAC was not able to suppress the GF contraction, as supported by the slight decrease in reactive oxygen species production in GF by thrombin. 5.--Thrombin also stimulated metalloproteinase-2 (MMP-2) and MMP-3 production in GF. But addition of GM6001 or 1,10-phenanthroline, two MMP inhibitors, could not inhibit the thrombin-induced GF contraction. 6.--These results indicate that thrombin is crucial in the periodontal inflammation and wound healing by promoting GF contraction. This event is mainly mediated via PAR-1 activation, PLC activation, extracellular calcium influx via L-type calcium channel, and the calcium/CaM-MLCK and Rho kinase activation pathway.

Treatment of pulp floor and stripping perforation by mineral trioxide aggregate.

Mineral trioxide aggregate (MTA) has been widely used to repair various kinds of tooth perforations, but its use for obturation of the entire root canal has not been reported. We report two cases of tooth perforation successfully repaired with MTA. The first patient was a 78-year-old male with calcified canal and pulp floor perforation in the left maxillary first premolar. After bypass of the calcified palatal canal, both buccal and palatal canals were filled with gutta percha, and the pulp floor perforation was repaired with MTA. Clinical success with no evident radicular lesion was found at the 18-month follow-up. The second patient was a 51-year-old female with a stripping perforation in a C-shaped root canal of the right mandibular second molar detected after removal of a post. Following root canal debridement and calcium hydroxide therapy to control inflammation at the stripping perforation site, apical and furcation bone healing were observed by radiographic examination. The stripping perforation was repaired by obturation of the entire C-shaped root canal with MTA. Observation at the 9-month follow-up revealed bone healing without any clinical symptoms and signs. These cases suggest that MTA is an alternative root canal obturation material for treatment of stripping perforation in a C-shaped root canal and for repair of pulp floor perforation.

Morphometric analysis of mandibular growth in skeletal Class III malocclusion.

BACKGROUND: The craniofacial growth patterns of untreated individuals with skeletal Class III malocclusion have rarely been systemically investigated. This study used morphometric techniques to investigate the growth characteristics of the mandible in individuals with skeletal Class III malocclusion. METHODS: Lateral cephalometric head films of 294 individuals with untreated skeletal Class III malocclusion (134 males, 160 females) were selected and divided into five triennial age groups (T1-T5) and by gender to identify the morphologic characteristics and sexual dimorphism in changes of mandibular growth. Procrustes, thin-plate spline, and finite element analyses were performed for localization of differences in shape and size changes. Maximum and minimum principal axes were drawn to express the directions of shape changes. RESULTS: From T1 (age 6-8 years) to T4 (age 15-17 years), the distribution of localized size and shape changes of the mandible was very similar between the two genders. From T1 to T2 (age 9-11 years), significant lengthening of the condylar region was noted (23.4-39.7%). From T2 to T3 (age 12-14 years), the greatest size and shape change occurred at the condylar head (27.4-34.9%). From T3 to T4, the greatest size and shape changes occurred in the symphyseal region (23.6-42.1%). From T4 to T5 (age>or=18 years), significant sexual dimorphism was found in the distribution and amount of localized size and shape changes. Females displayed little growth increments during T4. Despite differences in the remodeling process, the whole mandibular configurations of both genders exhibited similarly significant upward and forward deformation from T4 to T5. CONCLUSION: We conclude that thin-plate spline analysis and the finite element morphometric method are efficient for the localization and quantification of size and shape changes that occur during mandibular growth. Plots of maximum and minimum principal directions can provide useful information about the trends of growth changes.

Application of nondestructive testing in cyclic fatigue evaluation of endodontic Ni-Ti rotary instruments.

The purpose of this study was to investigate the application of nondestructive testing in cyclic fatigue evaluation of endodontic ProFile nickel-titanium (NiTi) rotary instruments. As-received ProFile instruments were made to rotate freely in sloped metal blocks by a contra-angle handpiece mounted on a testing machine. Rotation was interrupted periodically, and the instrument removed and engaged onto a device to monitor its stiffness by using two strain gauges in four different directions. This monitoring method has the potential to be developed into a convenient, nondestructive turnkey system that allows in situ assessment of the integrity of NiTi instruments in the clinic. Upon fracture, which was indicated by a change in instrument stiffness, the fractured surface would be examined under a scanning electron microscope. Microscopic evaluation indicated a small area of fatigue fracture with a large area of final ductile fracture, whereby the latter was the major cyclic failure mode. Based on the results of this study, we concluded that a potential nondestructive integrity assessment method for NiTi rotary instruments was developed.

Inhibition of cyclooxygenase activity, platelet aggregation and thromboxane B2 production by two environmental toxicants: m- and o-cresol.

Cresol is a well-known environmental pollutant, toluene metabolite, uremic toxicant and accidental poisoning product. Formocresol, a preparation of formalin and cresol, is also used as a root canal medicament and for pulpotomy of primary teeth. However, little is known about its effect on cardiovascular system. In this study, m-cresol inhibited the AA-induced platelet aggregation by 43-97% at concentrations ranging from 0.25 to 1 mM. Collagen-induced platelet aggregation was also inhibited by 0.25-1 mM of m-cresol by 47-98%. Accordingly, o-cresol (0.1-0.5 mM) also inhibited the AA-induced platelet aggregation by 46-96% and the collagen-induced platelet aggregation by 35-88% at concentrations of 0.1-1 mM. AA- and collagen-induced platelet thromboxane B(2) (TXB(2)) production was inhibited by even 0.1 mM of m-cresol with 88 and 54% of inhibition, respectively. The o-cresol (0.1 mM) also inhibited the AA- and collagen-induced platelet TXB(2) production with 91 and 97% respectively. Although m- and o-cresol (<1 mM) showed little effect on thrombin-induced platelet aggregation, they effectively inhibited the thrombin-induced platelet TXB(2) production. The m-cresol (2 and 5 mM) inhibited the COX-1 activity by 55-99%, but showed little effect on COX-2 enzyme activity. Moreover, o-cresol (0.5 and 1 mM) inhibited the COX-1 activity by 40-95%. COX-2 enzyme activity was inhibited by 68% at a concentration of 5 mM o-cresol. These results indicate that acute cresol-poisoning, direct root canal medication with formocresol or long-term occupational exposure to cresol and toluene may potentially suppress blood clot formation and lead to tissue hemorrhage via inhibition of platelet aggregation, TXB(2) production and COX enzyme activity.

In vitro study of dentin hypersensitivity treated by Nd:YAP laser and bioglass.

OBJECTIVES: An ideal material has yet to be discovered that can completely treat dentin hypersensitivity. However, if a highly biocompatible material such as bioglass, could be melted by laser irradiation to achieve better sealing depth for dentinal tubules, it may subsequently bond to dentin structures under a physiological environment and offer a prolonged therapeutic effect. METHODS: The authors used four types of energy parameters to melt the composition-modified bioglass. These four types were 30 Hz, 330 mJ/pulse (G+ mode), 30 Hz, 160 mJ/pulse (G- mode), 10 Hz, 400 mJ/pulse (D+ mode), and 10 Hz, 200 mJ/pulse (D- mode). The temperature elevation, occlusive depth of bioglass, and phase changes in the bioglass after laser irradiation were evaluated by means of scanning electron microscope (SEM), thermometer, and X-ray diffractometer (XRD). RESULTS: The occlusive depths of 2 and 10 microm in the dentinal tubules were achieved when the bioglass underwent 30 Hz, 160 mJ/pulse (G- mode) and 30 Hz, 330 mJ/pulse (G+ mode) of laser treatments, respectively. The bioglass experienced a temperature increase of less than 600 degrees C, and no phase transformation was observed after Nd:YAP laser irradiation. SIGNIFICANCE: The melting point of a composition-modified bioglass could be reduced and its use plus Nd:YAP laser have the potential in clinical use to treat dentin hypersensitivity.

Higher expressions of p53 and proliferating cell nuclear antigen (PCNA) in atrophic oral lichen planus and patients with areca quid chewing.

OBJECTIVE: The aim of the study was to examine the expressions of p53 and proliferating cell nuclear antigen (PCNA) in oral lichen planus (OLP) in relation to its clinical behavior and the patients' oral habits. STUDY DESIGN: Immunohistochemical study was carried out to investigate the expressions of p53 and PCNA in 56 OLP specimens. The results were correlated with the clinical behavior of the disease and the patients' oral habits. The expression rates were further compared with those of normal oral mucosa (NOM), epithelial hyperkeratosis (EH), epithelial dysplasia (ED), and squamous cell carcinoma (SCC). RESULTS: The staining rate of p53 (28.6%) and PCNA labeling index (LI) (27.6 +/- 8.8%) in OLP were similar to those in EH ( P = .868, .074, respectively), but higher than those of NOM and lower than those of ED and SCC (all P < .05). In OLP, no significant correlations were found between p53 or PCNA expression and the patients' age, gender, lesion duration, location, size, number of site, presence of pain, presence of local irritant, and the habits of alcohol drinking and cigarette smoking (all P > .05). In addition, the mean PCNA LI of p53+ cases was close to that of p53- cases (P = .38). However, the staining rate of p53 in OLP was higher in areca quid (AQ) chewers compared to abstainers (P = .001), and the mean PCNA LI in atrophic cases was higher than that in hypertrophic cases (P = .029). Interestingly, the staining rate of p53 and mean PCNA LI were significantly increased in AQ chewers with atrophic OLP (100%, 36.7% +/- 9.0%, respectively), which were similar to those in ED and SCC (all P > .05). CONCLUSIONS: Although this study could not confirm the precancerous nature of OLP by the relatively low p53 and PCNA expression, the results do suggest that atrophic form OLP and patients with AQ chewing habit may have a higher disease activity in view of higher expression rates of p53 and PCNA in the lesions.

Effects of various periodontal ligament elastic moduli on the stress distribution of a central incisor and surrounding alveolar bone.

BACKGROUND AND PURPOSE: Previous studies investigating the effects of core or post on the fracture strength of teeth often omitted the periodontal ligament (PDL) because its physical properties are difficult to reliably quantify. This study investigated the effects of various PDL elastic moduli on the stress distribution around a central incisor and surrounding alveolar bone using 3-dimensional finite element stress analyses. METHODS: Four 3-dimensional finite element models of an upper central incisor and the dento-alveolar complex were established. Five models were constructed, including: no PDL, as well as a PDL with elastic moduli of 6.9 MPa, 68.9 MPa, and 1750 MPa. Two loading conditions were simulated, one with protrusive force and one with intrusive force. Protrusive loading was generated using a point force of 200 N at 45 degrees inclination to the longitudinal axis of the incisor applied on the lingual side. Intrusive loading was generated using a point force of 200 N applied perpendicular to the incisal edge. RESULTS: The absence of a PDL had detrimental effects on the surrounding bone, because the applied stress remained concentrated at the bone crest and cervical third of the root. A PDL with a lower elastic modulus, on the other hand, helped to alleviate the magnitude of stress throughout the surrounding bone and the bone crest, in particular, by distributing the stress deeper towards the apical region. The stress distribution at the crown was unaffected by variations in the PDL elastic modulus. CONCLUSIONS: PDL with a lower elastic modulus can help protect the alveolar bone crest from stress concentration.

In vitro study of DP-bioglass paste for treatment of dentin hypersensitivity.

Sealing of exposed dentinal tubules is generally considered the most effective strategy to treat dentin hypersensitivity. On this account, we fabricated a DP-bioglass paste that created a homogeneous blockage on open dentinal tubules and formed a deep precipitate within dentinal tubules. DP-bioglass paste was prepared by mixing 20% to 60% phosphoric acid and DP-bioglass to treat dentin surfaces. CO2 laser irradiation was used to melt the DP-bioglass paste. The results demonstrated that 30% phosphoric acid was the optimum concentration to produce homogeneous occlusion on exposed dentinal tubules and 60 microm of sealing depth. CO2 laser irradiation could melt the DP-bioglass paste and create about 10 microm of sealing depth. Moreover, temperature rise during CO2 laser irradiation was only 4.86 +/- 0.47 degrees C. The results presented in this work suggested that DP-bioglass paste could produce considerable sealing depth in dentinal tubules with the potential of prolonging the therapeutic effect efficaciously.

Nitric oxide promotes infectious bone resorption by enhancing cytokine-stimulated interstitial collagenase synthesis in osteoblasts.

This experiment was undertaken to determine the role of macrophage-derived nitric oxide (NO) in mediating lipopolysaccharide (LPS)-induced bone resorption by using an in vitro co-culture system and an in vivo model of infectious bone resorption. Our results demonstrated that LPS stimulated the expression of inducible nitric oxide synthase (iNOS) and tumor necrosis factor (TNF)-a mRNAs and nitrite synthesis in the J774 mouse macrophage cell line but not in the UMR-106 (rat) and MC3T3-E1 (mouse) osteoblast cell lines. Conditioned media (CM) from LPS-stimulated J774 triggered only low to moderate levels of iNOS mRNAs in MC3T3-E1 and a trivial effect in UMR-106. On the other hand, CM induced matrix metalloproteinase-1 (MMP-1) gene expression in both osteoblast cell lines. The NOS inhibitor N(G)-monomethyl-L-arginine (L-NMMA) did not alter this effect in MC3T3-E1 and UMR-106, whereas TNF-a antibody diminished the CM-induced MMP-1 gene expression in both cell lines. Interestingly, SNAP, a NO donor, although by itself is not a MMP-1 stimulator for UMR-106, augmented the TNF-alpha-stimulated MMP-1 mRNA production in UMR-106. In a J774/UMR-106 co-culture system, LPS stimulated significant MMP-1 gene expression in UMR-106, and this upregulation was abolished by L-NMMA and TNF-alpha antibodies. Immunohistochemical analysis in a rat model of infectious bone resorption (periapical lesion) showed co-distributions of iNOS+ macrophages and MMP-1+ osteoblasts around the osteolytic areas. Administration of L-NMMA markedly reduced the extent of bone loss and the percentage of MMP-1-synthesizing osteoblasts. These data suggest that NO derived from macrophages after LPS stimulation may enhance bone loss by augmenting the cytokine-induced MMP-1 production in osteoblasts.

Effects of physiological environments on the hydration behavior of mineral trioxide aggregate.

Utilizing scanning electron microscope, X-ray diffraction (XRD) and microhardness tests, we evaluated how various physiological environments affect the hydration behavior and physical properties of mineral trioxide aggregate (MTA). We found that the microstructure of hydrated MTA consists of cubic and needle-like crystals. The former comprised the principal structure of MTA, whereas the later were less prominent and formed in the inter-grain spaces between the cubic crystals. MTA samples were hydrated in distilled water, normal saline, pH 7, and pH 5. However, no needle-like crystals were observed in the pH 5 specimens, and erosion of the cubic crystal surfaces was noted. XRD indicated a peak corresponding to Portlandite, a hydration product of MTA, and the peak decreased noticeably in the pH 5 group. The pH 5 specimens' microhardness was also significantly weaker compared to the other three groups (p<0.0001). These findings suggest that physiological environmental effects on MTA formation are determined, in part, by environmental pH and the presence of ions. In particular, an acidic environment of pH 5 adversely affects both the physical properties and the hydration behavior of MTA.

Successful treatment of oral verrucous hyperplasia with topical 5-aminolevulinic acid-mediated photodynamic therapy.

Previous studies have shown a selective accumulation of 5-aminolevulinic acid (ALA)-derived protoporphrin IX (PpIX) in oral premalignant and malignant tissues. This provides a biologic rationale for the clinical use of ALA-mediated PDT (ALA-PDT) for oral premalignant and malignant lesions. In this study, five patients with oral verrucous hyperplasia (OVH) were treated with a new protocol of ALA-PDT composed of multiple 3-min irradiations with a light emitting diode (LED) red light at 635+/-5 nm separated with several 3-min rests for a total of 1000 s (fluence rate, 100 mW/cm(2); light exposure dose, 100 J/cm(2)) after topical application of 20% ALA for 1.5 or 2 h. Topical ALA-PDT was repeated once a week until the complete regression of the lesion. Complete regression of all OVH lesions was observed after 1-3 treatments (average, 2 treatments) of topical ALA-PDT. At an average follow-up of 5.6 months (range, 3-11 months), all the five OVH patients were free of tumor recurrence. We conclude that topical ALA-PDT with fractionated irradiations by an LED red light at 635+/-5 nm is an effective and successful treatment modality for OVH.

In vitro effect of laser irradiation on cementum-bound endotoxin isolated from periodontally diseased roots.

BACKGROUND: In a previous study, we evaluated the in vivo effects of an Nd:YAG laser on periodontal disease by measuring crevicular interleukin (IL)-1beta levels before and after laser application. It was found that laser therapy was less effective than traditional scaling and root planing. These results might be due to incomplete removal of microbial residues and cementum-bound endotoxin on root surfaces by the laser. In this study, we explored the in vitro effectiveness of an Nd:YAG laser for the elimination of cementum-bound endotoxin by measuring IL-1beta changes in stimulated monocytes. METHODS: Fresh human monocytes were harvested from adults without periodontitis and grown in RPMI 1640 medium. Diseased cementum particles were collected and prepared from teeth with untreated periodontitis and were irradiated with 5 levels of laser energy. Cementum particles were subjected to endotoxin testing by a limulus amebocyte lysate (LAL) assay and then were incubated with cultured monocytes. Production of IL-1beta in stimulated monocytes was measured by enzyme-linked immunosorbent assay and quantified by spectrophotometry. RESULTS: The endotoxin unit (EU) of diseased cementum was 18.4 EU/mg, which seemed to be remarkably lower than that of common periodontal pathogens including Porphyromonas gingivalis (381) at 15,300 EU/mg/ml, Prevotella intermedia (ATCC 25611) at 227 EU/mg/ml, and Fusobacterium nucleatum (ATCC 25586) at 1,987 EU/mg/ml. Monocytes subjected to stimulation by diseased cementum particles without laser irradiation produced 124 to 145 pg/ml IL-1beta, 9- to 18-fold higher than that of unstimulated monocytes (7.07 to 15.95 pg/ml). Diseased cementum particles after irradiation with various energy levels of the Nd:YAG laser could still stimulate monocytes to secrete 89 to 129 pg/ml IL-1beta. No statistically significant difference was found in the production of IL-1beta induced by diseased-bound cementum with or without laser irradiation. CONCLUSIONS: The Nd:YAG laser varying from 50 mJ, 10 pps to 150 mJ, 20 pps, for 2 minutes, did not seem to be effective in destroying diseased cementum endotoxin.

Morphologic study of Nd:YAG laser usage in treatment of dentinal hypersensitivity.

Our previous in vitro study indicated that Nd:YAG laser irradiation on dentin could melt normal dentin surface and close the exposed dentinal tubule orifices without creating surface cracks. This study evaluated the morphologic changes of hypersensitive dentin after Nd:YAG laser irradiation. Thirty patients with clinically diagnosed cervical dentin hypersensitive teeth were treated with a Nd:YAG laser of 30 mJ intensity at 10 pulses per second for 2 min. An impression of the sensitive area was taken before and after laser treatment and then examined with a scanning electron microscope. The impression of the dentin surface after Nd:YAG laser treatment showed no protrusive rods, in contrast with the presence of numerous rods before laser irradiation. Because protrusive rods are a measure of open dentinal tubules, we interpret these data to support the hypothesis that Nd:YAG laser irradiation at specifications of 30 mJ, 10 pulses per second, and 2 min can be used to seal the exposed dentinal tubules.

Repair of perforating internal resorption with mineral trioxide aggregate: a case report.

A case of internal resorption with buccal perforation was found in a maxillary central incisor. Because of the extensive lesion and continuous exudation, surgical intervention was used. The apical third was obturated with gutta-percha, and the perforated lesion was repaired with mineral trioxide aggregate. The residual canal space was filled by thermoplasticized gutta-percha technique, and the coronal cavity was restored with composite resin. The symptoms and signs ceased, and the results were satisfactory at 1-year follow-up.

Cyclic fatigue of endodontic nickel titanium rotary instruments: static and dynamic tests.

Endodontic instruments upon rotation are subjected to both tensile and compressive stress in curved canals. This stress is localized at the point of curvature. The purpose of this study was to evaluate the cyclic fatigue of 0.04 ProFile nickel titanium rotary instruments operating at different rotational speeds and varied distances of pecking motion in metal blocks that simulated curved canals. A total of 150 ProFile instruments were made to rotate freely in sloped metal blocks at speeds of 200, 300, or 400 rpm by a contra-angle handpiece mounted on an Instron machine. The electric motor and Instron machine were activated until the instruments were broken in two different modes, static and dynamic pecking-motion. The fractured surfaces of separated instruments were examined under a scanning electron microscope. All data obtained were analyzed by a stepwise multiple regression method using a 95% confidence interval. The results demonstrated that the time to failure significantly decreased as the angles of curvature or the rotational speeds increased. However, as pecking distances increased, the time to failure increased. This is because a longer pecking distance gives the instrument a longer time interval before it once again passes through the highest stress area. Microscopic evaluation indicated that ductile fracture was the major cyclic failure mode. To prevent breakage of a NiTi rotary instrument, appropriate rotational speeds and continuous pecking motion in the root canals are recommended.

Effects of root-end filling materials and eugenol on mitochondrial dehydrogenase activity and cytotoxicity to human periodontal ligament fibroblasts.

Various root-end filling materials have been used to prevent the entry of root-canal pathogens into periapical regions. Five root-end filling materials were compared regarding the cytotoxicity, apoptosis, and mitochondrial dehydrogenase (MDH) activities of human periodontal ligament (PDL) fibroblasts, with the use of a novel transwell culture system. Exposure to IRM (a ZnO eugenol-based intermediate restorative material), a 2-ethoxybenzoic acid cement (Super EBA), and amalgam for 3 days inhibited the MDH activity of PDL fibroblasts as indicated by decrease in 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) reduction by 97%, 95%, and 51%, respectively. Evident suppression of MTT reduction by amalgam and glass ionomer cement (GIC) was noted after 5 days of exposure, with 73% and 46% of inhibition, respectively. Mineral trioxide aggregates (MTA) showed little effect on MDH activity. IRM and Super EBA were cytotoxic to PDL fibroblasts as indicated by a trypan blue dye exclusion technique. GIC and amalgam showed mild cytotoxicity. IRM, GIC, and amalgam further induced apoptosis of PDL cells, as revealed by the presence of sub-G0/G1 DNA content in flow cytometric histogram. Twenty-four-hour exposure to IRM and Super EBA elevated the MDH activities to 156% and 117%, correspondingly, of that of control. Eugenol, a phenolic ingredient in Super EBA and IRM, also increases MDH activity of PDL fibroblasts by 45% and 51%, at concentrations of 0.5 and 1 mM. However, at concentrations higher than 0.5 mM, eugenol decreased the number of viable PDL fibroblasts. These results suggest that MTA is a biocompatible root-end filling material, followed by self-curing Fuji II GIC and amalgam. IRM and Super EBA ingredients induced marked cytotoxicity and transiently stimulate MDH activities, which is possibly due to their content of eugenol and induction of cellular adaptive response.