Mineral Trioxide Aggregate (MTA) Upregulates the Expression of DMP1 in Direct Pulp Capping in the Rat Molar.

Mineral trioxide aggregate (MTA) is an alternative endodontic material that predicts conductive or inductive calcified tissue formation from immature pulp mesenchymal stem cells (IPMSCs). The purpose of this study was to investigate whether MTA could promote reparative odontoblast differentiation via IPMSCs in the early phase of regeneration and compare with calcium hydroxide (CH). Direct pulp capping using calcium hydroxide (CH), MTA, and MTA with platelet-rich plasma (MTA + PRP) was performed on maxillary first molars of 8-week-old male Wistar rats (n = 36). After 3, 7, or 14 days, the teeth were analyzed for mineral density (MD) and volume of MD (VMD) via micro-focusing computed tomography (µCT), nestin, dentin matrix acidic phosphoprotein 1 (DMP1) immunohistochemistry, and real-time PCR for DMP1 mRNA expression. MTA stimulated the early phase differentiation of the IPMSCs into odontoblasts, with positive results for nestin and DMP1 compared with CH. Moreover, MTA + PRP stimulated calcified granule and dentin bridge formation through calcium mineral deposition, following the induction of DMP1 mRNA expression in IPMSCs. Our results suggested that the combination of MTA and PRP is an effective and clinically applicable method for activating endogenous dental pulp stem cells into odontoblasts in the early stages of pulp regeneration.

Evaluation of the mechanical properties and biocompatibility of gypsum-containing calcium silicate cements.

Mineral trioxide aggregate (MTA) cement is widely used in the field of endodontic treatment. We herein synthesized calcium silicates from calcium carbonate and silicon dioxide, with the aim of reducing the cost associated with the MTA. Additionally, we prepared gypsum-containing calcium silicate cement to reduce the setting time while enhancing the mechanical strength. We evaluated the physical properties of this cement and investigated the response of human dental pulp stem cells (hDPSCs) grown in culture media containing cement eluate. Our results revealed that calcium silicates could be easily synthesized in lab-scale. Furthermore, we demonstrate that gypsum addition helps shorten the setting time while increasing the compressive strength of dental cements. The synthesized gypsum-containing calcium silicate cement showed minimal cytotoxicity and did not inhibit the proliferation of hDPSCs. These results suggested that the newly developed calcium silicate material could be a promising pulp capping material.

Pulpal Disease Arising from Medication-related Osteonecrosis of the Jaw: A Case Report.

Although bisphosphonates are widely used to treat conditions such as osteoporosis, they may cause osteonecrosis of the jaw. We treated a patient with no history of tooth extraction or other surgical treatment who developed medication-related osteonecrosis of the jaw (MRONJ) with secondary pulpal disease. A 79-year-old woman presented with purulent discharge from the gum at the incisor region. She had been using bisphosphonates for 9 years. Tooth #6 had undertaken root canal treatment at a general practice. All teeth other than tooth #6 reacted to electric pulp testing. Computed tomographic imaging revealed signs suggestive of necrotic bone, and MRONJ was diagnosed. Teeth #7 and #8, which had initially exhibited vital reactions, also subsequently ceased to react to thermal and electric pulp testing. Root canal treatment was performed on teeth #6-8, and their condition was monitored. Computed tomographic imaging at 9 months after the first presentation revealed that the bone defect had greatly enlarged with separation of the necrotic bone; therefore, excision of the necrotic bone and curettage were performed in the department of oral and maxillofacial surgery. The loss of pulp reaction in teeth that had exhibited a vital reaction at the first presentation was considered to indicate that teeth #6-8 had developed dental pulp pathosis as a result of MRONJ.

Cleaning efficacy and dentin micro-hardness after root canal irrigation with a strong acid electrolytic water.

The purpose of this study was to evaluate the cleaning effect of root canal walls using strong acid electrolytic water (SAEW) as a root canal irrigant, and to investigate the influence of SAEW on the root canal dentin by micro-hardness test. Forty-three single-rooted, single-canaled teeth were instrumented using standard step-back technique with K-files. Irrigation was performed using distilled water, 5.25% NaOCl and 3% H(2)O(2), SAEW, or 15% EDTA solution in five groups. Samples were prepared to be examined under a scanning electron microscope (SEM) and micro Vickers hardness (H(V)) test machine. Our results showed that the root cleaning effects of the combined use of SAEW and NaOCl solution as root canal irrigants were equivalent to those in the group with NaOCl and 15% EDTA. When SAEW was used for 1 min under ultrasonic vibration, no decreases in the hardness of dentin inside the root canal were detected.

Inflammatory Myofibroblastic Tumor Mimicking Apical Periodontitis.

Inflammatory myofibroblastic tumors (IMTs) are rare. IMTs of the head and neck occur in all age groups, from neonates to old age, with the highest incidence occurring in childhood and early adulthood. An IMT has been defined as a histologically distinctive lesion of uncertain behavior. This article describes an unusual case of IMT mimicking apical periodontitis in the mandible of a 42-year-old man. At first presentation, the patient showed spontaneous pain and percussion pain at teeth #28 to 30, which continued after initial endodontic treatment. Panoramic radiography revealed a radiolucent lesion at the site. Cone-beam computed tomographic imaging showed osteolytic lesions, suggesting an aggressive neoplasm requiring incisional biopsy. Histopathological examination indicated an IMT. The lesion was removed en bloc under general anesthesia, and the patient manifested no clinical evidence of recurrence for 24 months. Lesions of nonendodontic origin should be included in the differential diagnosis of apical periodontitis. Every available diagnostic tool should be used to confirm the diagnosis. Cone-beam computed tomographic imaging is very helpful for differential diagnosis in IMTs mimicking apical periodontitis.

Tri-calcium phosphate (ß-TCP) can be artificially synthesized by recycling dihydrate gypsum hardened.

Calcium phosphate is known as a major component of biological hard tissues. This study aimed to produce calcium phosphate by recycling kneaded surplus gypsum. ß-dihydrate gypsum was derived from commercial dental ß-hemihydrate gypsum, which was mechanically powdered and mixed with the liquid component of a commercial zinc phosphate cement. This mixture was fired at 1,200°C and evaluated by XRD analysis, thermal analysis and scanning electron microscopy (SEM). An acceptable ratio of mixing was 4 g of ß-dihydrate gypsum powder to 1.5 mL of phosphoric acid liquid. XRD peaks were monotonic below 800°C, but new ß-TCP was formed by firing at 900°C or more, although TG-DTA analysis of synthetic ß-TCP suggested that some residual dihydrate gypsum remained in the sample. SEM images indicated a fused-block bone-like structure covered with phosphorus and calcium. These results suggest that production of synthetic ß-TCP is possible through ecological techniques using recycled materials.

The development of carbonate-containing apatite/collagen composite for osteoconductive apical barrier material.

The current report describes the properties of a new apical barrier material formulated from carbonate-containing apatite (CAp) and collagen. CAp particles of around 50 nm were deposited on reconstituted collagen fibers. CAp/col with about 60 wt % CAp (corresponding to apatite content of bone) was obtained after 1 day of calcification. CAp content increased up to about 80 wt % in a 15-day calcification reaction. CAp/col was composed of fine calcified collagen fibers. The crystallinity and Ca/PO(4) ratio of CAp were comparable to those of bone apatite. The mixture of CAp/col and saline reached a pH of about 9. The optimum powder-to-liquid ratio (P/L) to set into a root canal was determined to be 1.2. Furthermore, the mixture (P/L = 1.2) condensed in a root canal was liquid permeable. Thus, the CAp/col was expected as an apical barrier material with osteoconductivity.