Impact of systemic health on treatment outcomes in endodontics.

BACKGROUND: The healing of periapical lesions after root canal treatment (RCT) is not the result of the curative action of the treatment. The process of healing begins with inflammation, and is resolved by the clearance of the immunogen that induces the immune response. Then, the periapical tissue itself carries out the healing of the periapical lesion, by repair or by a combination of repair and regeneration, depending on the host's reparative response working properly. The ultimate objective of RCT is to achieve wound healing by removing the source of bacterial antigens and toxins, allowing chronic inflammatory tissue to become reparative tissue. Some systemic conditions increase the susceptibility of the host to infection or impair the tissue reparative response, maintaining the inflammatory process and periapical bone resorption after RCT. This can cause the failure of RCT and even the need for extraction of the affected tooth. OBJECTIVE: To analyse the scientific literature on the possible influence of systemic conditions on the treatment outcomes in endodontics, as well as to discuss the biological mechanisms that may be involved. METHODS: The search was carried out in PubMed, SCOPUS and EMBASE. The inclusion criteria established were original scientific articles reporting data about some systemic condition in relation to treatment outcomes in endodontics, including clinical studies and studies carried out in animal models. RESULTS: Systemic factors (age, nutrition, stress, hormones, smoking habits), and systemic diseases, such as diabetes, cardiovascular diseases, osteoporosis, HIV infection, inflammatory bowel disease, and others, can influence or interfere in the repair of periapical tissues after RCT. DISCUSSION: Some of these systemic diseases can alter bone turnover and fibroblast function, preventing or delaying periapical wound healing. Others can alter the microvasculature, reducing nutrients and oxygen supply to periapical tissues. As a result, these systemic conditions can decrease the success rate of RCT and provoke incomplete wound healing (typically granulomatous tissue formation) in the periapical region. CONCLUSIONS: The results of this narrative review show worse success rate of RCT, with higher percentage of postoperative radiolucent periapical lesions and higher proportion of non-retained teeth (RFT), associated with several systemic conditions, such as smoking habits and diabetes.

Biocompatibility and biomineralization ability of Bio-C Pulpecto. A histological and immunohistochemical study.

AIM: To evaluate the inflammatory response, biomineralization and production of osteocalcin (OCN), osteopontin (OPN), and bone sialoprotein (BSP) of a new root filling material for primary teeth (Bio-C Pulpecto) compared to MTA. DESIGN: Polyethylene tubes containing Bio-C Pulpecto, MTA, and empty tubes were implanted into the dorsal connective tissue. After 7, 15, 30, 60, and 90 days, the tubes with surrounding tissue were removed and histologically processed to be analysed using haematoxylin and eosin, von Kossa staining, or no staining for observation under polarized light and immunohistochemistry for the detection of OCN, OPN, and BSP. The Kruskal-Wallis test was used followed by Dunn's test. The significance level was set at 5%. RESULTS: The inflammatory response observed with MTA and Bio-C Pulpecto was more exacerbated until the 15th day and decreased from 30 days on. No significant difference was found between control, MTA, and Bio-C Pulpecto (P > 0.05). Bio-C Pulpecto and MTA showed positivity for von Kossa and birefringent to polarized light. The immunolabelling for OCN, OPN, and BSP was more intense for MTA and Bio-C Pulpecto on days 60 and 90 (P > 0.05). CONCLUSION: Bio-C Pulpecto was biocompatible, induced biomineralization and was immunopositive for osteogenic markers such as OCN, OPN, and BSP, similarly to MTA.

In vivo biocompatibility and biomineralization of calcium silicate cements.

A new mineral trioxide aggregate (MTA) material has been developed with a modified composition that requires investigations to support its clinical use. This study evaluated the biocompatibility and biomineralization of this new MTA material and compared it with that of two other MTA cements over time. Tubes containing materials (or empty tubes as controls) were inserted into the subcutaneous tissues of 40 rats. On days 7, 15, 30, 60, and 90, the tubes were removed with the surrounding tissues, which were either stained with haematoxylin and eosin or von Kossa for further analyses or unstained for observation under polarized light. On days 7 and 15, moderate inflammation was observed in most specimens, and the fibrous capsule was thick. On day 30, there was mild inflammation in all groups, and the fibrous capsule was thin. On days 60 and 90, there was mild inflammation in the material groups, while the control group showed no inflammation, although no statistically significant difference between the groups was observed and the fibrous capsule was thin. All material groups showed structures that stained with von Kossa and could be observed under polarized light; this was not found for the control. In conclusion, the new MTA material had biocompatibility and biomineralization properties similar to those of the two existing MTA materials.

Anti-inflammatory potential of a carvedilol gel in the pulpal tissue of rats after dental bleaching: A histopathological evaluation.

AIM: Carvedilol is an antioxidant that decreases inflammation in periodontitis. The hydrogen peroxide (H2 O2 ) of bleaching gel causes inflammation and necrosis of the dental pulp. In the present study, we evaluated the anti-inflammatory potential of carvedilol in the pulp of rats after bleaching. METHODS: The right upper molars of rats received 35% H2 O2 (1× 30 minutes), and the left upper molars were used as the control. Half of the rats received carvedilol gel (1× 10 minutes), forming the following groups: bleached, bleached followed by carvedilol (bleached+carvedilol), and control. After 2 and 30 days (N = 7 hemi-maxillae/group), the rats were killed for histological evaluation, and statistical tests were performed (P < 0.05). RESULTS: After 2 days, the bleached group showed necrosis in the occlusal third of the coronal pulp, and in the bleached+carvedilol group, severe inflammation (P > 0.05), both different from the control (P < 0.05). In the middle third, the bleached group showed severe inflammation, and the bleached+carvedilol group showed moderate inflammation (P > 0.05), with the only difference between the bleached and control groups (P < 0.05). In the cervical third, the bleached group showed moderate inflammation, and the bleached+carvedilol group showed mild inflammation (P > 0.05). The difference again was only between the bleached and control groups (P < 0.05). At 30 days, there was no inflammation and a marked amount of tertiary dentin in bleached teeth (P > 0.05). CONCLUSION: Carvedilol gel has the potential of minimizing H2 O2 damage, especially in deep regions of the dental pulp of rats after bleaching.

Chronic alcohol consumption changes blood marker profile and bone density in rats with apical periodontitis.

AIM: The aim of the present study was to evaluate apical periodontitis (AP) development in rats under a chronic alcohol diet by calcium, phosphorus, and alkaline phosphatase blood levels in addition to histological and radiographic analyses. METHODS: Thirty-two rats were arranged into four groups: (a) group 1: without apical periodontitis and on a regular diet; (b) group 2: AP and on a regular diet; (c) group 3: alcoholic diet without apical periodontitis; and (d) group 4: alcoholic diet and apical periodontitis. Alcoholic solution at 20% was given throughout the 8-week experiment. AP was induced in the first molars at the end of the 7th week. At the end, the animals were anesthetized for blood collection, followed by euthanasia, and jaws were removed for digital radiography and histological processing. The level of significance was 5%. RESULTS: Calcium levels remained constant in all groups (P > 0.05). Group 4 showed a higher phosphorous level than group 2 (P < 0.05). The alkaline phosphatase activity was higher in group 3 compared with group 1 (P < 0.05). Three animals in group 4 exhibited a severe inflammatory reaction, whereas the animals in group 2 did not demonstrate any reaction (P < 0.05). The lowest value of radiographic density was given by group 4 (P < 0.05). CONCLUSIONS: Chronic alcohol consumption increased serum phosphorus and decreased bone density in the periapical region, favoring AP development.

Quantitative Sensory Testing of the Effect of Desensitizing Treatment After Dental Bleaching.

The aim of this study was to quantify tooth sensitivity during bleaching and after a desensitizing treatment. Sensitivity was measured with a new device, TSA-II, which uses thermal stimuli for Quantitative Sensory Testing (QST). Ten patients underwent bleaching treatment using Whiteness HP Maxx (FGM Produtos Odontológicos Ltda) containing 35% hydrogen peroxide. After the bleaching session, the teeth were cleaned with air/water spray and the product Desensibilize KF 2% (FGM Produtos Odontológicos Ltda) was applied to the upper left teeth. Saline solution at room temperature was applied in the upper right teeth. QST was performed before bleaching, immediately after bleaching, and immediately after desensitizing treatment. In order to standardize tooth analysis, a 100% ethylene copolymer and vinyl acetate tray with circular perforations was used during measurements. Analysis of variance and the Student's t-test were used (a=0.05). Mean temperatures (SD) of cold sensation threshold for the upper right quadrant were: BB-13.898 (4.81), AB- 19.241 (3.68), AD-20.646 (3.72) and for the upper left quadrant they were: BB-14.102 (3.22), AB-19.646 (4.82), AD- 13.835 (3.63). Dental bleaching with highly concentrated peroxides changed dental cold sensation thresholds, but the topical desensitizer changed the immediate cold sensation thresholds produced by the cold stimulus.

O objetivo do presente estudo foi quantificar a sensibilidade dentária durante o tratamento clareador e após a aplicação de um dessensibilizante utilizando um equipamento de análise neurosensorial, o TSA II, que utiliza estímulos térmicos para a realização do Teste Sensorial Quantitativo (QST). Assim, dez pacientes (n=10) receberam o tratamento clareador com Whiteness HP Maxx (FGM Produtos Odontológicos Ltda.) contendo peróxido de hidrogênio a 35%. Após a sessão clareadora, os dentes foram limpos com jatos de ar/água e foi realizada a aplicação do Desensibilize KF 2% (FGM Produtos Odontológicos Ltda.), um dessensibilizante tópico a base de nitrato de potássio a 5% e fluoreto de sódio a 2%, apenas no hemi-arco esquerdo da maxila, utilizando o método da boca dividida. No hemi-arco direito foi aplicada uma solução salina a temperatura ambiente (controle). O QST foi realizado antes do clareamento (AC), imediatamente depois do clareamento (DC) e imediatamente após a aplicação do dessensibilizante (DD). Para padronizar o local do estímulo, uma moldeira de acetato com perfurações circulares foi utilizada durante as mensurações. A análise estatística foi realizada por meio do teste t de Student (α=0,05). As temperaturas médias (DP) do limiar de sensação ao frio para o hemi-arco direito foram: AC- 13,898 (4,81), DC-19,241 (3,68), DD-20,646 (3,72) e para o hemi-arco esquerdo foram: AC-14,102 (3,22), DC-19,646 (4,82), DD-13,835 (3,63). Clareamento dental com peróxidos de alta concentração exacerbaram a sensibilidade dental ao estímulo térmico e o uso do dessensibilizante foi efetivo para reverter esta situação.

Efeito antimicrobiano de diferentes substâncias químicas associadas ao preparo mecânico e da medicação intracanal em dentes de cães portadores de lesões periapicais induzidas / Efficacy of chemo-mechanical preparation with different substances and the use of a root canal medication in dog’s teeth with induced periapical lesion

Objetivo: avaliar o efeito antimicrobiano de diferentes substâncias químicas auxiliares durante o preparo mecânico de canais radiculares e de uma medicação intracanal.Métodos: foram utilizadas 55 raízes de dentes de cães portadores de lesões periapicais, divididas em cinco grupos experimentais de acordo com a substância química empregada durante o preparo mecânico: GI – solução salina; GII– natrosol gel; GIII – NaOCl 2,5%; GIV – CHX 2% gel; GV– CHX 2% solução. Foram realizadas coletas microbiológicas antes (s1) e após (s2) o preparo químico-mecânico e após o emprego de uma medicação à base de hidróxido de cálcio por 14 dias (s3). Após cada coleta, as amostras foram processadas e realizadas as contagens das unidades formadoras de colônias (UFC). Resultados: em s1, a contagem de UFCs variou de 5,5 x 105 a 1,5 x 106. Esses valores diminuíram significativamente (p<0,05) em s2. Não foi encontrada diferença significativa entre a coleta s2 e s3 (p>0,05).Conclusões: dentre as substâncias testadas, NaOCl 2,5%e CHX gel 2% demonstraram maior potencial antimicrobiano contra patógenos endodônticos in vivo

Objectives: to evaluate the effect of instrumentation, irrigationwith different substances and the use of calcium hydroxideon bacterial load and microbiota profile in dog’s teethwith pulp necrosis and periapical lesion. Methods: Fifty fiveroot canals were divided into groups: I) Saline (SSL) (n=11);II) natrosol gel (n=11); III) 2.5% NaOCl (n=11); IV) 2%CHX-gel (n=11); V) 2% CHX-solution (n=11). Endodonticsamples were cultured, microorganisms counted and themicrobiota analyzed at different sampling times — s1, s2and s3. Results: At s1, the mean CFU counts ranged from5.5 x105 to 1.5 x 106. These values dropped significantly ats2 (p<0.05). No statistical significant difference was foundbetween s2 and s3. Changes in root canal microbiota werefound at s2 and s3. Conclusion: Regardless the use of calciumhydroxide as a root canal medication, 2.5% NaOCl and2% CHX-gel demonstrated a potent antimicrobial activityagainst endododontic pathogens in vivo.