Correlation Between Proinflammatory Cytokine Expression and Clinical Data in Apical Granuloma.

INTRODUCTION: This study was intended to evaluate the expression of inflammatory cytokines commonly secreted by CD4+ T cells (IL-2, IL-5, IL-17, TGF-ß, TNF-α, and IFN-γ) in apical granulomas and correlate with the clinical conditions and time elapsed since root canal treatment. METHODS: Eighteen biopsy specimens obtained by periradicular surgery of teeth with post-treatment apical periodontitis and diagnosed as apical granuloma were available from the oral pathology laboratory. Silanized slides containing paraffin sections were used for immunohistochemical reactions. Images were analyzed by using an optical microscopy and each slide was subdivided into 5 fields at high magnification. RESULTS: IFN-γ and TGF-ß were the cytokines with the highest expression levels. There were statistically significant differences when comparing IL-2 and IFN-γ (P < .05), and IL-2 and TGF-ß (P < .05). Comparison between the detected cytokines and clinical data and time of treatment demonstrated significant correlation (P < .05) between lower expression of IL-2 and the presence of painful symptoms, absence of sinus tract, and treatments performed more than 4 years before. It was also possible to observe a significant correlation between lower expression of IL-5 and treatments performed less than 4 years before (P < .05). CONCLUSION: IFN-γ and TGF-ß were highly expressed in apical granulomas. However, only IL-2 and IL-5 levels were associated with clinical data and time since previous root canal treatment.

Interleukin 17 expression in periapical lesions from elderly patients.

OBJECTIVE: To compare the expression of IL-17 in periapical lesions (cysts and granulomas) among elderly individuals and adults. We selected 20 periapical lesions of the elderly (12 granulomas and eight cysts) and 20 periapical lesions of adults (12 granulomas and eight cysts). MATERIALS AND METHODS: Immunohistochemistry was performed using a specific antibody for IL-17. The slides were subdivided into five high magnification fields and then the images were observed through an optical microscope. According to the number of positive markings for the antibody, grades were given, ranging from 0 to 2. RESULTS: The results demonstrate that there was no statistical difference when comparing the expression of IL-17 between cysts and granulomas of both groups (study group: cysts 0.7 ± 0.21 × granulomas 0.96 ± 0.58, p = .61; control group: cysts 0.37 ± 0.16 × granulomas 0.31 ± 0.23, p = .27). The comparison between adult (control group) and elderly patients (study group) showed a statistical difference both in cysts (study group: 0.7 ± 0.21 × control group: 0.37 ± 0.16, p = .007) and in granulomas (study group: 0.96 ± 0.58 × control group: 0.31 ± 0.23, p = .0009), in which elderly patients had a higher expression of interleukin 17, in relation to adult patients. CONCLUSION: We concluded that elderly patients have a higher expression of IL-17 in both cysts and granulomas, when compared to adult patients.

Proinflammatory Cytokine Expression in Apical Periodontitis from Diabetic Patients.

Diabetes mellitus has been regarded as a condition capable of influencing the evolution of periapical lesions. Therefore, this study evaluated the immunoexpression of IL-1ß, TNF-α, and IL-17 in apical periodontitis from type 2 diabetic patients through immunohistochemistry. Twenty-six periapical lesions were selected, and the images obtained through immunohistochemistry reactions were analyzed. The statistical significance was set at p < 0.05. IL-1ß expression was considered focal (54%), weak to moderate (38%), and strong (8%) in diabetics, and focal (46%), weak to moderate (31%), and strong (23%), in controls. TNF-α was focal (85%) and weak to moderate (15%) in diabetics, and focal (92%) and weak to moderate (8%), in controls. IL-17 was focal (8%), weak to moderate (46%), and strong (46%) in diabetics, and focal (62%), weak to moderate (8%), and strong (30%), in controls. The quantitative analysis revealed greater expression of IL-17, with a significant difference between IL-17 × IL-1ß × TNF-α(p=0.0009) in the diabetic group. The cytokines IL-1ß and TNF-α did not express statistical differences between the tested groups. The IL-17 showed higher immunoexpression in the diabetic group (p=0.047), which may suggest higher bone resorption activity in chronic apical periodontitis in this group of patients.

Evaluation of Receptor Activator of Nuclear Factor Kappa B Ligand, Osteoprotegerin, Osteopontin, and Tumor Necrosis Factor Alpha on Chronic Apical Periodontitis in Smokers.

INTRODUCTION: Smoking can be considered a risk factor for chronic apical periodontitis (CAP). This study compared the immunoexpression of biomarkers receptor activator of nuclear factor kappa B ligand (RANKL), osteoprotegerin (OPG), osteopontin (OPN), and tumor necrosis factor alpha (TNF-α) in CAP in smokers and nonsmokers. METHODS: Twelve smokers and 12 nonsmokers diagnosed with CAP and indicated for tooth extraction were selected. Exclusion factors were teeth with a diagnosis of root fracture, previous endodontic treatment, or endoperiodontal injury, in addition to individuals with systemic diseases, under 18 years of age, users of anti-inflammatory and/or antibiotics in the last 3 months, and drug users. Specimens were processed for histopathologic and immunohistochemical analysis. RESULTS: Qualitative analysis of RANKL expression showed 66.66% weak/moderate and 33.33% strong in smokers and 100% weak/moderate in nonsmokers. OPG and OPN expressions were 100% negative to focal in the smoker group and 50% negative to focal and 50% weak/moderate in the nonsmoker group. TNF-α was 25% negative to focal and 75% weak/moderate in the smoker group and 33.33% negative to focal and 66.66% weak/moderate in the nonsmoker group. Quantitative analysis of the data using the Mann-Whitney U test showed that there was a significant difference in the immunoexpression of RANKL (P < .05), OPG (P < .05), and OPN (P < .05), but there was no statistical difference in the immunoexpression of TNF-α (P > .05) between the 2 groups. CONCLUSIONS: These findings suggest that smoking is capable of altering the inflammatory response, influencing the evolution of CAP.

Ameloblastomas mimicking apical periodontitis: a case series

Background: Ameloblastomas are benign odontogenic tumors that can eventually mimic the clinical and radiological features of apical periodontitis. The aim of the present study was to evaluate the clinical, radiological andhistological characteristics from a series of ameloblastomas mimicking apical periodontitis diagnosed in a 14-yearperiod.Material and Methods: all cases histologically diagnosed as ameloblastomas from 2005 to 2018 presenting aclinical diagnosis of periapical lesion of endodontic origin were selected for the study. Clinical, radiological andhistological characteristics from all cases were tabulated and descriptively and comparatively analyzed.Results: Twenty cases composed the final sample, including 18 solid and 2 unicystic ameloblastomas. Mean age ofthe affected patients was in the fifth decade with predilection for males (72%). The most common anatomical location was the posterior mandible (55%) and most cases presented a radiolucent unilocular (80%) well-defined (95%)image. Most cases were asymptomatic, but the presence of local swelling and bone cortical rupture were common.Conclusions: Ameloblastomas mimicking periapical lesions of endodontic origin are mostly diagnosed in adultmales as well-defined radiolucent unilocular lesions producing local swelling and bone cortical rupture. (AU)

Pro-and Anti-inflammatory Biomarkers as Potential Prognosis Markers in Oral Squamous Cell Carcinoma

ABSTRACT: The most widely used method to classify prognostic factors in cancers today is TNM. However, Oral Squamous Cell Carcinoma (OSCC) often demonstrates different behaviors in relation to aggressiveness and therapeutic response at the same TNM stage. So, in such cases biomarkers can be used to identify the biological diversity of these tumors more reliably, leading to better therapeutic strategies and disease management. The presence of inflammatory immune cells in the tumor microenvironment can have pro or antitumor effects and the investigation of the expression of inflammatory markers in OSSC can be usefulto design immunotherapeutic interventions. The Transforming Growth Factor alpha is a potent stimulator of cell migration that acts on cell proliferation, invasion and metastasis of cancer, as well as immune suppression and angiogenesis. Inflammatory cytokines, such as Interferon-gamma, mediate macrophage differentiation. Macrophages are an important component of the OSCC microenvironment. The greater amount of tumor-associated macrophages, especially the M2 phenotype, may be associated with a more aggressive biological behavior of the OSCC and, consequently, with reduced survival.

RESUMEN: El método más utilizado para clasificar los factores de pronóstico en los cánceres en la actualidad es TNM. Sin embargo, el carcinoma oral de células escamosas (COCE) a menudo muestra diferentes comportamientos en relación con la agresividad y la respuesta terapéutica en la misma etapa TNM. Entonces, en tales casos, los biomarcadores pueden usarse para identificar la diversidad biológica de estos tumores de manera más confiable, lo que lleva a mejores estrategias terapéuticas y manejo de la enfermedad. La presencia de células inmunes inflamatorias en el microambiente tumoral puede tener efectos pro o antitumorales y la investigación de la expresión de marcadores inflamatorios en COCE puede ser útil para diseñar intervenciones inmunoterapéuticas. El factor de crecimiento transformante α es un potente estimulador de la migración celular que actúa sobre la proliferación celular, la invasión y metástasis del cáncer, así como la inmunosupresión y la angiogénesis. Las citocinas inflamatorias, como el IFN-γ, median en la diferenciación de macrófagos. Los macrófagos son un componente importante del microambiente COCE. La mayor cantidad de macrófagos asociados a tumores, especialmente el fenotipo M2, puede estar asociada a un comportamiento biológico más agresivo del COCE y, en consecuencia, a una menor supervivencia.

Expression of epithelial growth factors and of apoptosis-regulating proteins, and presence of CD57+ cells in the development of inflammatory periapical lesions.

OBJECTIVE: The mechanisms that stimulate the proliferation of epithelial cells in inflammatory periapical lesions are not completely understood and the literature suggests that changes in the balance between apoptosis and immunity regulation appear to influence this process.To evaluate the expression of the epidermal growth factor (EGF), its receptor (EGFR) and of the keratinocyte growth factor (KGF), the presence of CD57+ cells, the epithelial cell proliferation index, and the expression of the Bcl-2 protein in inflammatory periapical lesions (IPL) at different stages of development. METHODOLOGY: Our sample was composed of 52 IPLs (22 periapical granulomas - PG - and 30 periapical cysts - PC), divided into three groups: PGs, small PCs, and large PCs. Specimens were processed for histopathologic and immunohistochemical analyses. Sections were evaluated according to the amount of positive staining for each antibody. RESULTS: We found no significant differences among the groups regarding Bcl-2 (p=0.328) and Ki-67 (p>0.05) expression or the presence of CD57+ cells (p=0.748). EGF (p=0.0001) and KGF (p=0.0001) expression was more frequent in PCs than in PGs, and CD57+ cells were more frequent in IPLs with intense inflammatory infiltrates (p=0.0001). We found no significant differences in KGF (p=0.423), Bcl-2 (p=0.943), and EGF (p=0.53) expression in relation to inflammatory infiltrates or to the type of PC epithelial lining, but observed greater KGF expression (p=0.0001) in initial PCs. EGFR expression was similar among the groups (p>0.05). CONCLUSION: More frequent EGF and KGF expression in PCs and the greater presence of CD57+ cells in lesions with intense inflammatory infiltrates suggest that these factors influence IPL development. The greater KGF expression in initial PCs suggests its importance for the initial stages of PC formation.

Expression of epithelial growth factors and of apoptosis-regulating proteins, and presence of CD57+ cells in the development of inflammatory periapical lesions

Abstract The mechanisms that stimulate the proliferation of epithelial cells in inflammatory periapical lesions are not completely understood and the literature suggests that changes in the balance between apoptosis and immunity regulation appear to influence this process. Objective: To evaluate the expression of the epidermal growth factor (EGF), its receptor (EGFR) and of the keratinocyte growth factor (KGF), the presence of CD57+ cells, the epithelial cell proliferation index, and the expression of the Bcl-2 protein in inflammatory periapical lesions (IPL) at different stages of development. Methodology: Our sample was composed of 52 IPLs (22 periapical granulomas - PG - and 30 periapical cysts - PC), divided into three groups: PGs, small PCs, and large PCs. Specimens were processed for histopathologic and immunohistochemical analyses. Sections were evaluated according to the amount of positive staining for each antibody. Results: We found no significant differences among the groups regarding Bcl-2 (p=0.328) and Ki-67 (p>0.05) expression or the presence of CD57+ cells (p=0.748). EGF (p=0.0001) and KGF (p=0.0001) expression was more frequent in PCs than in PGs, and CD57+ cells were more frequent in IPLs with intense inflammatory infiltrates (p=0.0001). We found no significant differences in KGF (p=0.423), Bcl-2 (p=0.943), and EGF (p=0.53) expression in relation to inflammatory infiltrates or to the type of PC epithelial lining, but observed greater KGF expression (p=0.0001) in initial PCs. EGFR expression was similar among the groups (p>0.05). Conclusion: More frequent EGF and KGF expression in PCs and the greater presence of CD57+ cells in lesions with intense inflammatory infiltrates suggest that these factors influence IPL development. The greater KGF expression in initial PCs suggests its importance for the initial stages of PC formation.

¿Los Quistes Periradiculares Dependen de la Infección Endodóntica?

RESUMEN: Los quistes periradiculares, tanto los de bolsillo como los verdaderos, son de origen inflamatorio; sin embargo, en la literatura ha existido una gran controversia asociada, en primer lugar, a la dependencia de la infección contenida dentro del sistema de conductos radiculares y, en segundo lugar, al tipo de tratamiento endodóntico llevado a cabo en este tipo de lesiones. Con el fin de dilucidar esta controversia se realizará una revisión a la literatura sobre quistes perira diculares donde se explicará cuál es la técnica más adecuada en el diagnóstico de quistes verdaderos y de bolsillo. Igualmente, se explicará la teoría de autosustentabilidad, así como el tratamiento endodóntico de grandes lesiones periradiculares asociadas a dichos quistes. Ahora bien, en la actualidad se ha demostrado que ambos quistes están asociados a infecciones contenidas en el sistema de conductos radiculares y son diferentes solamente en su morfología. Así mismo, se ha recomendado el tratamiento de conducto convencional en dientes con grandes lesiones asociadas a quistes.

ABSTRACT: Radicular cysts, either the pocket or the true cysts, are originated by an inflammation. However, in the literature, there has been great controversy surrounding, firstly, the dependence of the infection contained within the radicular conducts and, secondly, the kind of endodontic treatment performed in this sort of injury. In order to clarify this controversy, the literature concerning radicular cysts will be reviewed and it will be explained what technique is the most appropriate for diagnosing true cysts and pocket cysts. Likewise, the theory of self-sustaining, as well as the endodontic treatment for large radicular injuries associated to such cysts, will be further explained. Nonetheless, nowadays it has been demonstrated that both cysts are associated to infections contained within the system of radicular conducts and that they are only morphologically different. In addition, the root canal treatment has been recommended for teeth with great injuries associated to cysts.

Immunoexpression of Interleukin 17, 6, and 1 Beta in Primary Chronic Apical Periodontitis in Smokers and Nonsmokers.

INTRODUCTION: The purpose of this study was to compare the immunoexpression of biomarkers interleukin (IL)-17, IL-6, and IL-1ß in primary chronic apical periodontitis in smokers and nonsmokers. METHODS: Teeth with primary chronic apical periodontitis indicated for extraction in 16 cigarette smokers and 16 nonsmokers were selected. Silanized sections of tissue were used for immunohistochemical analysis after being stained with hematoxylin-eosin for histopathologic categorization. Subsequently, the images were analyzed with an optical microscope, and each slide was subdivided into 5 high-magnification fields, with scores (0-2) being assigned according to the amount of staining for each antibody. RESULTS: The qualitative analysis of IL-17 cytokine expression showed no focal expression in 5.8%, weak to moderate expression in 17.6%, and strong expression in 76.4% of the smokers and no focal expression in 78.5% and weak to moderate expression in 21.4% of the nonsmokers. IL-6 expression was negative to focal in 13.3%, weak to moderate in 53.3%, and strong in 33.3% of the smokers and negative to focal in 33.3%, weak to moderate in 25%, and strong in 41.6% of the nonsmokers. IL-1ß expression was weak to moderate in 87.5% and negative to focal expression in 12.5% of the smokers and negative to focal expression in 100% of the nonsmokers. Quantitative evaluation of the data using the Mann-Whitney U test showed a significant difference in the immunoexpression of IL-17 (P < .0001) and IL-1ß (P < .0001) and no significant difference in the immunoexpression of IL-6 (P = .46) between the 2 groups (P < .05). CONCLUSIONS: The cytokines IL-17 and IL-1ß were more highly expressed in smokers than nonsmokers, whereas IL-6 expression was similar in the 2 groups.

Influence of a High-fat Diet in the Progression of Apical Periodontitis.

INTRODUCTION: This study evaluated the effects of a high-fat diet (HFD) on the progression of apical periodontitis (AP) in rats. METHODS: Eight-week old Wistar rats (N = 24) were included in this study. Half of the animals received an HFD and the other half a control diet (CD). AP lesions were induced 8 weeks later by creating pulp exposure of the mandibular left first molars. The animal's body mass was verified on a weekly basis. After 21 and 40 days, the animals were sacrificed. Blood was collected for biochemical tests, and the liver was removed for hepatic triglycerides analysis. The left hemimandibles were removed, radiographed, and then prepared for histologic evaluation. The right hemimandibles (region near molars) were removed for bone mineral density analysis by dual-energy X-ray absorptiometry. RESULTS: Radiographs showed that AP lesions were significantly larger in the HFD group compared with the CD group (P < .05). Histologic analysis confirmed that the AP lesions were larger and revealed a more severe inflammatory infiltrate in the HFD group. Bone mineral density was reduced in the HFD group compared with the CD groups (P < .05). The HFD resulted in a significant increase in body mass (P < .05), liver mass (P < .05), relative liver mass (P < .05), and hepatic triglycerides (P < .05). The levels of triglycerides and very-low-density lipoprotein were significantly higher in the 40-day HFD group compared with the 21-day HFD and 21- and 40-day CD groups (P < .05). CONCLUSIONS: Findings suggest that an HFD can influence the progression and severity of AP.

Aging as a Risk Factor on the Immunoexpression of Pro-Inflammatory IL-1ß, IL-6 and TNF-α Cytokines in Chronic Apical Periodontitis Lesions.

Persistent inflammatory responses in the elderly may act as modifiers on the progression and repair of chronic apical periodontitis lesions (CAPLs). While the involvement of IL-1ß, IL-6 and TNF-α in inflammatory responses and, particularly, in CAPL has been documented, their expression in elderly patients needs to be further characterized. Therefore, the purpose of this study was to evaluate and compare the expressions of pro-inflammatory cytokines in CAPL from elderly individuals with young/middle-aged individuals. Thirty CAPL (15 cysts and 15 granulomas) from elderly patients (>60 years) and 30 CAPL (15 cysts and 15 granuloma) from young/middle-aged individuals (20-56 years) were selected. Immunohistochemical reactions were performed against IL-1ß, IL-6 and TNF-α. The slides were subdivided into five high-magnification fields and analyzed. The number of positive stains was evaluated for each antibody. There was no significant difference between the cytokines when the cysts and granuloma were compared in the two groups. In the young/middle-aged, only IL-1ß showed a difference and was significantly higher in granulomas (p = 0.019). CAPL pro-inflammatory cytokine levels in the elderly were significantly higher than in young/middle-aged individuals (p < 0.05). The pro-inflammatory cytokines IL-1ß, IL-6 and TNF-α were significantly higher in CAPL in the elderly compared with the young/middle-aged group. Further elaborate research studies/analyses to elucidate the reasons for and consequences of inflammation in the elderly are recommended.

Expression of Inflammatory Markers RANK, MMP-9 and PTHrP in Chronic Apical Periodontitis from People Living with HIV Undergoing Antiretroviral Therapy.

To compare the expression of the receptor activator of nuclear factor-kappa B (RANK), matrix metalloproteinase 9 (MMP-9) and parathyroid hormone-related protein (PTHrP) in primary chronic apical periodontitis lesions (CAPLs) between people living with HIV (PLWHIV) undergoing antiretroviral therapy (ART) and HIV- individuals, 32 CAPLs (16 lesions from each group) were submitted to histopathological and immunohistochemical analyses and compared between groups. The majority of the PLWHIV group had undetectable plasma viral loads (n = 13; 81.3%). The means of TCD4+ lymphocytes, exposure to HIV-1 and the time of the use of ART were 542.1 cells/mm3 (SD = 256.4), 6.3 years (SD = 2.9) and 5.0 years (SD = 2.5), respectively. Of all variables studied, only histopathological diagnosis showed a significant difference between groups (LWHIV: granuloma n = 11 (68.0%); cyst n = 5 (31.2%); HIV-: granuloma n = 15 (93.8%); cyst n = 1 (6.2%); p = 0.015). When comparing the expressions of the three inflammatory markers between the groups, no significant differences were seen. There was no difference in the expression of RANK, PTHrP and MMP-9 in primary chronic apical periodontitis lesions between PLWHIV under ART and HIV- individuals.

Clinicopathological and ultrastructural characterization of periapical actinomycosis

BACKGROUND: The aim of the present study was to analyze the clinicopathological and the ultrastructural features of periapical actinomycosis (PA) cases. MATERIAL AND METHODS: Data from the files of an oral pathology laboratory were retrieved and the findings of histopathological analysis were evaluated. Hematoxylin-eosin (HE), a modified Brown & Brenn, and Grocott stains as well as ultrastructural analysis using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX) were utilized. RESULTS: Six cases were obtained, 4 females and 2 males, with a mean age of 34 year-old. Two cases were symptomatic, lower teeth and the anterior region were more commonly affected, and all cases were characterized by periapical radiolucencies. All cases presented sulfur granules with a ray-fungus or club-shaped pattern of the Splendore-Hoeppli phenomenon in HE-stained sections, with filamentous gram-positive bacteria aggregates highlighted by the modified Brown & Brenn stain. SEM analysis revealed abundant packed rod-like and filamentous bacteria associated with an extracellular amorphous material. EDX analysis showed predominant picks of calcium and sulfur in actinomycotic colonies. CONCLUSIONS: Our findings suggest that PA manifests either clinically and radiologically as a non-specific and heterogeneous condition and that the actinomycotic colonies consist in a calcium- and sulfur-rich matrix. Furthermore, the results highlight the importance of submitting periapical specimens after surgical removal to histopathological análisis

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Transportation assessment in artificial curved canals after instrumentation with Reciproc, Reciproc Blue, and XP-endo Shaper Systems.

AIM: In the present study, we compared the transportation of three different instrumentation systems in different levels of standardized artificial curved canals. METHODS: Sixty epoxy resin blocks containing simulated canals were divided into three groups (n = 20) according to the instrument used for canal preparation: Reciproc (REC), Reciproc Blue (REC Blue), and XP-endo Shaper (XPS). Pre- and post-instrumentation digital images of each specimen were superimposed by Photoshop software to evaluate the different amount of transportation. The Kruskal-Wallis and Wilcoxon were the non-parametric tests applied for the intergroup and intragroup analyses, respectively. The significance level was set at 5%. RESULTS: The XPS showed significantly less canal transportation than REC Blue at five levels (P < 0.05) and significantly less canal transportation at seven evaluated levels when compared with the REC (P < 0.05). REC Blue showed significant less canal transportation than REC at four of the eight evaluated levels (P < 0.05). All evaluated instruments showed a significantly higher amount of resin removal toward the inner wall compared to the outer wall of the curvature (P < 0.001). CONCLUSION: Although the XPS showed significantly less canal transportation than REC and REC Blue, all systems produced transportation from the original canal anatomy.

Alkalizing potential and calcium release of residues from intracanal dressing containing calcium hydroxide / Potencial de alcalinização e liberação de cálcio de resíduos de medicação intracanal contendo hidróxido de cálcio

Introduction: If the restoration, that seal the root canal from oral environment, failed or solubilize, the intracanal dressing could be partially removed, decreasing the efficiency of calcium hydroxide (CH). Objective: To evaluate the alkalizing potential and calcium ions release of intracanal residues from different medications, in different periods. Materials and method Human incisors were endodontically instrumented and randomly divided (n=10). The root canals were filled with: G1- Calcium hydroxide (CH); G2- CH with 0.4% chlorhexidine digluconate (CHC); G3 - CH with camphorated paramonochlorophenol and glycerin (HPG); G4 - CH was maintained during all experiment, as positive control group (PC) and G5 - No medication was performed in the negative control group (NC). The specimens were immersed in distilled water for 7 days. The intracanal dressing was removed from the experimental groups using F1 instrument (Protaper). The teeth were stored in distilled water for 24 hours, 7, 14 and 28 days. pH value and calcium ions released were evaluated and the data were submitted to ANOVA one-way and Tukey tests. Result All experimental groups presented lower alkalizing potential and calcium ions release than PC (P < 0.05). No significant difference was found among the experimental groups, regardless of the period (P > 0.05). Conclusion The alkalizing potential and calcium ions release of residues from different intracanal dressing, in different periods, were similar and lower than the positive control group, that the medication was maintained inside the root canal, encouraging the replacement of intracanal dressing when the restoration fail.

Introdução: Se a restauração temporária, que sela o canal radicular contra o meio bucal, falhar ou solubilizar, a medicação intracanal pode ser parcialmente removida, diminuindo a eficiência do hidróxido de cálcio (CH). Objetivo: Avaliar o potencial alcalinizante e a liberação de íons cálcio de resíduos de diferentes medicações intracanal, em diferentes períodos. Material e método: Incisivos humanos foram endodonticamente instrumentados e divididos aleatoriamente (n=10). Os canais radiculares foram preenchidos com: G1-Hidróxido de cálcio (CH); G2-CH com 0.4% de digluconato de clorexidina (CHC); G3-CH com paramonoclorofenol camforado e glicerina (HPG); G4-CH mantido durante todo experimento, como controle positivo (PC) e G5- Sem medicação intracanal, como controle negativo (NC). Os espécimes foram imersos em água destilada durante 7 dias. A medicação intracanal foi removida dos grupos experimentais com um instrumento F1 (Protaper). Os dentes foram armazenados em água destilada por 24 horas, 7, 14 e 28 dias. Os dados foram submetidos aos testes ANOVA one-way e Tukey. Resultado: Todos os grupos experimentais tiveram redução no potencial alcalinizante e na liberação dos íons cálcio, quando comparados ao controle positivo (p<0.05). Não houve diferença estatisticamente significante entre os grupos experimentais, independente do período (p>0.05). Conclusão: O potencial alcalinizante e a liberação de íons cálcio dos resíduos de diferentes medicações intracanal, em diferentes períodos, foram similares entre si e menores que o controle positivo, onde a medicação foi mantida dentro do canal radicular, encorajando a sua troca quando a restauração falhar.

Estado perirradicular e radicular de dentes tratados endodonticamente: estudo piloto utilizando a tomografia computadorizada de feixe cônico / Periapical and root status of endodontically treated teeth: a pilot study using cone-beam computed tomograph

As imagens radiográficas periapicais, essenciais para a realização e para o acompanhamento do sucesso do tratamento endodôntico, em virtude de limitações técnicas, não são capazes de oferecer visualização anatômica de toda a estrutura dos elementos dentários. Técnicas contemporâneas de obtenção de imagens, como a tomografia computadorizada realizada pela técnica de feixe cônico (TCFC) parecem ter o potencial de avaliar de forma mais adequada a qualidade da obturação e do remanescente radicular, e o estado perirradicular. O objetivo deste trabalho foi realizar uma avaliação descritiva das imagens obtidas pela técnica de TCFC de 100 elementos dentários tratados endodonticamente, buscando os achados referentes ao estado perirradicular, as lesões de furca, à presença de núcleos intrarradiculares e as fraturas radiculares. Nos 100 dentes analisados, 83 (83%) apresentavam áreas compatíveis com a presença de alteração perirradicular. Dos dentes multirradiculares, 51% apresentavam presença de lesão de furca e 91% apresentavam rarefação perirradicular. Vinte dos 83 dentes com alterações perirradiculares (24%) apresentavam imagem sugestiva de fratura radicular. A TCFC revelou a existência de diversas alterações radiculares e perirradiculares nos dentes tratados endonticamente estudados nesta amostra, sugerindo sua utilidade no acompanhamento imaginológico após o tratamento endodôntico.

Periapical radiographs are essential for endodontic treatment and for following the tooth response after finishing the treatment. Unfortunately, due to their technical limitations, they are not capable of offering a complete anatomical view of the dental structure. More recent image techniques, such as cone-beam computed tomograph (CBCT), seem to offer a more complete picture of the pulp chamber obturation and the remaining dental structure, as well as the periradicular status. The aim of our study was to analyze CBCT images obtained from 100 endodontically treated teeth, focusing on the obturation of the pulp chamber, periapical status, interadicular alterations and root fractures. From the 100 teeth, 83 (83%) presented periradicular alterations. From multiradicular teeth, 51% presented with alterations in the interadicular area and 91% showed periradicular alterations. Twenty out 83 teeth presenting periradicular alterations (24%) showed also root fractures. CBCT images revealed the presence of several root and periradicular alterations in the endodontically treated teeth studied in this sample, suggesting its utility as an adjunctive auxiliary in the follow-up of teeth after endodontic treatment.

Comparative Expression of CD34, Intercellular Adhesion Molecule-1, and Podoplanin and the Presence of Mast Cells in Periapical Granulomas, Cysts, and Residual Cysts.

INTRODUCTION: The aim of the present study was to compare the immunoexpression of CD34, intercellular adhesion molecule-1 (ICAM-1), and podoplanin and the presence of mast cells with clinical, demographic, radiologic, and histologic features from periapical granulomas, periapical cysts, and residual cysts. METHODS: Thirty-one lesions (5 granulomas, 15 periapical cysts, and 11 residual cysts) were selected. Histologic sections in silanized slides were used for the immunohistochemical reactions. The analysis of the images was performed by using an optical microscope, and data were analyzed with 5% significance (P < .05). RESULTS: Cysts presented atrophic and hyperplastic epithelium in 11 cases (35.5%) and 15 cases (48.8%), respectively (P > .05). The intensity of the inflammatory infiltrate was similar when comparing the 3 groups (P > .05). CD34 and podoplanin expression and the presence of mast cells were similar when comparing the 3 groups; ICAM-1 expression was more intense in granulomas than cysts (P < .05). There were no statistically significant differences associated with the expression of the evaluated markers according to the intensity of the inflammatory infiltrate. CONCLUSIONS: There were no differences in the expression of CD34 and podoplanin and in the presence of mast cells when the 3 groups were compared. ICAM-1 expression was more common in periapical granulomas.

Pro-inflammatory and anti-inflammatory cytokine expression in post-treatment apical periodontitis.

OBJECTIVE: This study evaluated the expression of pro-inflammatory (IL-1ß, IL-6, IFN-γ and TNF-α) and anti-inflammatory (IL-4 and TGF-ß) cytokines in apical periodontitis lesions. Correlations between these cytokines and clinical and cone-beam computed tomographic (CBCT) data were also assessed. MATERIAL AND METHODS: Apical periodontitis lesions' data were obtained from 27 patients subjected to periradicular surgery. Specimens were processed for histopathologic and immunohistochemical analysis. Sections were evaluated according to the amount of positive staining for each antibody. Expression levels of the target mediators were compared with clinical and CBCT data. RESULTS: Twenty lesions were diagnosed as granuloma and 7 as cyst. In granulomas, IL-4 expression was significantly higher than IL-6 (p=0.001) and TNF-α (p=0.001). There was a significant relationship between high levels of TNF-α and lesions <5 mm (p=0.017). In cysts, IL-6 expression was significant lower than IL-4 (p=0.001) and IFN-γ (p=0.004). There was a significant relationship between high levels of TGF-ß and endodontic treatment performed ≤4 years before (p=0.045). In general, IL-4 was the most expressed mediator in both cysts and granulomas. CONCLUSIONS: There was a balance between the expression of pro-inflammatory and anti-inflammatory cytokines associated with the chronic periradicular inflammatory process. TNF-α and TGF-ß were related to some clinical and CBCT data.

Effects of aging, gender, and hypogonadism on mandibular bone density.

AIM: The aim of the present study was to evaluate how aging, sex, and hypogonadism influence mandibular bone density with and without the benefits of hormone treatment. METHODS: Three-month old Wistar rats were randomly assigned to three experimental groups, with eights animals per group: controls, castrated (orchiectomized [ORX], ovariectomized [OVX]) and castrated with hormonal treatment (ORX + testosterone, OVX + estradiol benzoate). Females were previously evaluated by vaginal cytology. The corporal mass was verified weekly, and after three experimental periods (90, 120, and 150 days), the animals were killed. Blood was collected, and bones underwent densitometric and biomechanical analyses. RESULTS: After castration, the male rats demonstrated low gain in body weight compared to females (P < .05). Male and female castrated animals presented serum concentrations of sex steroid hormones lower than the control group (P < .05). Bone mineral density and biomechanical properties of the L4 vertebrae and femur were reduced earlier in females than in males (P < .05). However, mandibles were affected only in the male rats at the most chronic experimental period. CONCLUSION: Hypogonadism promotes alterations in the mandible over chronic periods, especially in males, and these alterations could be minimized by hormone treatment.