Serum levels of inflammatory markers and HbA1c in patients with type 2 diabetes and apical periodontitis: Preliminary findings.

This pilot study assessed the glycaemic control and the serum levels of inflammatory mediators in type 2 diabetes (T2DM) patients with apical periodontitis (AP). Thirty individuals were divided into four groups: Healthy (H); with AP (AP); with T2DM (T2DM); and with T2DM and AP (T2DM-AP). Demographic and pharmacological data were registered. The body mass index (BMI) and the levels of glycated haemoglobin (HbA1c) and IL-1ß, IL-6, IL-10, CCL3 and CCL4 were evaluated. AP areas were determined radiographically. Mean age was 64 ± 12 years, with 63% females. Most T2DM patients were under treatment with metformin and antihypertensives. BMI and H1bAc were significantly higher in T2DM patients in relation to H and AP groups. The AP areas were larger in the T2DM-AP group, compared with the AP group. These preliminary findings suggest no influence of AP on glycaemic control or inflammatory levels amongst T2DM patients, although T2DM increased the AP severity.

Correction to: Influence of foraminal enlargement on the healing of periapical lesions in rat molars.

Figures 2 and 3 in the published version of this article contained a mistake. CCP and DCP should have been FEG and NFEG. Correct figures are presented here.

Antimicrobial efficacy of 0.5% peracetic acid and EDTA with passive ultrasonic or manual agitation in an Enterococcus faecalis biofilm model.

We compared the antimicrobial efficacy of EDTA and 0.5% peracetic acid (PAA), with manual agitation (MA) or passive ultrasonic irrigation (PUI) in an Enterococcus faecalis biofilm model. Fifty-five single-rooted human premolar teeth were chemo-mechanically prepared and inoculated with E. faecalis for biofilm formation. These were divided into five groups (n = 11): saline solution, PAA+MA, PAA+PUI, EDTA+MA and EDTA+PUI. Root canal sampling and scanning electron microscopy of the canal lumen and dentinal tubule areas at the different root thirds were performed. The images were ranked based on contamination level. Only the PAA groups presented with no bacterial growth, with the remaining groups not presenting significant differences among them. PAA+PUI presented with the highest median position rankings in every third and location, whereas EDTA+MA performed similarly to the saline control. No differences were found when comparing MA and PUI within the same solution, however, PUI was associated with lower contamination levels mean rankings.

Influence of foraminal enlargement on the healing of periapical lesions in rat molars.

OBJECTIVES: The aim of this study was to evaluate the influence of foraminal enlargement on the healing of induced apical periodontitis in a rat model. MATERIAL AND METHODS: Periapical lesions were bilaterally induced in mandibular first molars of 24 Wistar rats, through root canals exposure to the oral environment during 3 weeks. Endodontic treatment was performed in the mesial canal of right molars, which were separated into two experimental groups (n = 12/group). The foraminal enlargement group (FEG) received instrumentation in the entire root canal length, including the cemental canal, while in the non-foraminal enlargement group (NFEG), instrumentation was carried out 1 mm short of the apical foramen. Root canals were filled with gutta-percha and AH Plus sealer, in the same visit, 1 mm short of the apical foramen in both experimental groups. Left molars were not treated and served as a baseline control group. The animals were killed after 4 weeks, and their hemi-mandibles were prepared for radiographic and histological analysis. Data were analyzed by Student's t test and ANOVA. RESULTS: Only FEG presented lower areas of periapical radiolucency compared to the control (p < .05). Both FEG and NFEG allowed decreased inflammation intensity (p < .0001 and p < .01) and higher scores of cementum neoformation when compared to non-treated samples (p < .0001). FEG was more effective than NFEG in promoting biological seal, i.e., apical closure with cementum (p < .01). FEG, but not NFEG, showed lower scores of root resorption than the control. CONCLUSIONS: Foraminal enlargement during root canal preparation improved periapical healing in rat molars. CLINICAL SIGNIFICANCE: Foraminal enlargement has been suggested to improve disinfection at the apical portion of root canals. This procedure may favor the healing of chronic periapical lesions.

Dendritic cells and their relation to apical peridontitis.

The purpose of this manuscript was to re-discuss apical periodontitis, apical biofilm, and its possible relationship with dendritic cells (DC). DCs are potent regulators of the immune system and their function is divided into three categories that involve the presentation of antigens: the presentation of antigens and activation of T cells; a not well established category suggested that DCs induce and maintain immunological tolerance; and the maintenance of the immune memory in conjunction with B cells. DCs in periapical inflammatory lesions are composed of at least two subpopulations that can be distinguished on the basis of ultrastructure and phenotype. These populations might differ in lineage, state of maturation, differentiation, activation, and/or function. The authors hereby analyzed the root apexes of teeth under SEM, after performing apicoectomy due to the failure of conventional endodontic treatment. Microbial biofilm with multispecies and areas of resorption with the presence of Howship lacunae, and images suggestive of denditric cells could be observed. The presence of DCs in periapical lesion could be an indication of the severity of the lesion, with a constant presence of antigen in the periradicular region.

Associação entre saúde bucal e acidente vascular encefálico isquêmico (AVEI) - uma revisão da literatura / Association between oral health and ischemic stroke (IS) - a literature review

A associação entre saúde bucal e desfechos de saúde geral vem sendo estudada de modo crescente nas últimas décadas, com ênfase na relação entre doenças inflamatórias crônicas bucais e doenças cardiovasculares (DCV) de origem aterosclerótica. OBJETIVO: revisar a literatura, atualizando os conhecimentos sobre a associação entre parâmetros de saúde bucal (doença periodontal (DP), periodontite apical (PA) e perda dentária) e a ocorrência de acidente vascular encefálico isquêmico (AVEI). METODOLOGIA: foram pesquisadas as seguintes bases eletrônicas, sem restrições de idiomas ou data: PubMed/ MEDLINE, LILACS, Scielo e ISI Web of Science e Schoolar Google, além de buscas manuais. Estudos realizados em animais ou in vitro, relatos e séries de casos foram excluídos. RESULTADOS: a presente revisão identificou e incluiu 11 estudos clínicos observacionais avaliando a associação entre diferentes indicadores de saúde bucal e AVEI, além de uma meta-analise sobre o assunto. Nenhum estudo de intervenção foi identificado. CONCLUSÃO: a evidência disponível, oriunda de estudos observacionias, sugere que as principais doenças inflamatórias crônicas bucais (DP e PA) estão associadas de modo independente com DCV de origem aterosclerótica. A relação entre DP e AVEI parece consistente, porém há carência de estudos analisando a associação entre AVEI e outros parâmetros de saúde bucal, especialmente cárie e PA. Até o momento, uma relação de causalidade entre DP, PA e AVEI não pode ser confirmada ou rejeitada, em face à ausência de estudos de intervenção. Futuros estudos deverão contribuir para o esclarecimento dos mecanismos biológicos que embasam a associação entre as doenças crônicas bucais e o AVEI.

The association between oral health and general health has been under study for decades, with emphasis on the relationship between chronic oral inflammatory diseases and atherosclerotic cardiovascular diseases (ACVD). OBJECTIVE: to review the literature, updating the knowledge about the association between oral health (periodontal disease (PD), apical periodontitis (AP) and tooth loss) and the occurrence of ischemic stroke (IS). METHODOLOGY: the following electronic databases were searched, without language or date restrictions: PubMed/MEDLINE, LILACS, Scielo, ISI Web of Science and Schoolar Google, as well as manual searches. Studies in animals or in vitro, reports and series of cases were excluded. RESULTS: the present review identified and included 11 clinical observational studies evaluating the association between different indicators of oral health and IS, and one meta-analysis on the field. No interventional studies were identified. CONCLUSION: the available evidence from observational studies suggests that the main chronic oral inflammatory diseases (PD and PA) are independently associated with ACVD. In addition, the relationship between PD and IS seems consistent, but there is a lack of studies analyzing the association between IS and other oral health parameters, such as caries and AP. To now, a causal relationship between DP, PA and IS cannot be confirmed or rejected, considering the lack of interventional studies on the area. Future studies should contribute to the comprehension of the biological mechanisms underlying the association between the main chronic oral diseases and IS.

Effectiveness of lateral and secondary canal filling with different endodontic sealers and obturation techniques

Objective: this study aimed to compare the performance of the new endodontic sealer GuttaFlow 2 (GF2) with two conventional sealers - AH Plus (AHP) and EndoFill (EF) - for filling artificial lateral and secondary canals with the following two obturation techniques: cold lateral condensation (CLC) and Tagger's hybrid technique (THT). Materials and method: sixty single-rooted human teeth were selected and subjected to root canal preparation. Next, specimens were subjected to a diaphanization method. During this process, artificial lateral and secondary canals were produced at 2, 5, 9, and 12 mm from the root apex. The specimens were randomly assigned into six groups (n = 10) according to endodontic sealer (GF2, AHP, or EF) and obturation technique (CLC or THT). The filling of lateral and secondary canals was analyzed by stereomicroscopy. The images were obtained and transferred to the ImageJ software. The mean filling percentages were calculated considering total linear measurements of artificial canals and their filled portions. Data were compared by two-way Anova, followed by Bonferroni Post-Hoc Test, at 5% significance level. Results: all materials showed the ability to penetrate into artificial lateral and secondary canals. There was no significant difference (P>0.05) between sealers and obturation techniques. Only GF2 showed a significantly improved flow into lateral canals when compared to secondary canals (P<0.05). Conclusion: GF2 shows proper flow for filling ramifications of the main root canal, but presents no advantage over conventional zinc oxide-eugenol-based or epoxy resin-based filling materials.

In vitro antibacterial activity of a silicone-based endodontic sealer and two conventional sealers.

The aim of this study was to evaluate whether the modification in the silver component is capable of providing GuttaFlow 2 with antibacterial activity against Enterococcus faecalis compared with epoxy resin-based (AH Plus) and zinc oxide and eugenol-based (Endofill) sealers. The antibacterial activity was evaluated using a reference strain of E. faecalis (ATCC 29212). Freshly mixed sealers were subjected to the agar diffusion test (ADT), while the direct contact test (DCT) was performed after materials setting. ADT results were obtained through measurements, in millimeters, of the inhibition zones promoted by the materials, using a digital caliper. In DCT, values of CFU/mL promoted by the three sealers were compared in three experimental periods (1 min, 1 h, and 24 h). The data were analyzed using Kruskal-Wallis and Dunn post-hoc tests (p < 0.05). In both ADT and DCT, GuttaFlow 2 presented no effect against E. faecalis, while Endofill and AH Plus showed similar inhibition zones. Endofill was the only material capable of reducing bacterial growth in DCT. In conclusion, modifications in the silver particle of GuttaFlow 2 did not result in a sealer with antibacterial effect against E. faecalis.

In vitro antibacterial activity of a silicone-based endodontic sealer and two conventional sealers

Abstract The aim of this study was to evaluate whether the modification in the silver component is capable of providing GuttaFlow 2 with antibacterial activity against Enterococcus faecalis compared with epoxy resin-based (AH Plus) and zinc oxide and eugenol-based (Endofill) sealers. The antibacterial activity was evaluated using a reference strain of E. faecalis (ATCC 29212). Freshly mixed sealers were subjected to the agar diffusion test (ADT), while the direct contact test (DCT) was performed after materials setting. ADT results were obtained through measurements, in millimeters, of the inhibition zones promoted by the materials, using a digital caliper. In DCT, values of CFU/mL promoted by the three sealers were compared in three experimental periods (1 min, 1 h, and 24 h). The data were analyzed using Kruskal-Wallis and Dunn post-hoc tests (p < 0.05). In both ADT and DCT, GuttaFlow 2 presented no effect against E. faecalis, while Endofill and AH Plus showed similar inhibition zones. Endofill was the only material capable of reducing bacterial growth in DCT. In conclusion, modifications in the silver particle of GuttaFlow 2 did not result in a sealer with antibacterial effect against E. faecalis.