Influence of endodontic sealers artifacts in the detection of vertical root fractures.

The aim of this study was to compare the influence of endodontic sealers artifacts on the detection of vertical root fracture in cone beam computed tomography (CBCT). Premolars and central incisors were assigned into five different groups: Control, Pulp Canal Sealer, AH Plus, Sealer 26, and BC Sealer (n= 10, per group). VRFs were mechanically induced and the teeth were inserted into an image phantom. Subsequently, CBCT (Cranex 3Dx, Soredex, Tuusula, Finland) images were obtained and two observers were asked separately to identify root fracture, by visual analysis. For both premolar and central incisors, kappa coefficients of intraobserver agreement varied from good to excellent (K: 80% - 87%), and the values for interobserver agreement varied from fair to moderate (K: 30% - 35%). As follows, the area under the curve (AUC) of receiver operating characteristic (ROC) values for VRFs highlighted that the use of BC sealer reduced the observers' ability to discriminate VRFs relative to other sealers. Moreover, sensitivity values for premolars teeth ranged from 20% to 60%, and specificity ranged from 60% to 100%; while sensitivity values for central incisors ranged from 30% to 70%, and specificity ranged from 70% to 100%. In conclusion, the low sensitivity values, mainly for premolars, demonstrated the difficulty in VRF diagnosis. Furthermore, BC Sealer induced significantly more imaging artifacts than other sealers. These results highlighting that endodontic sealers may interfere with the diagnosis of VRFs.

Influence of endodontic sealers artifacts in the detection of vertical root fractures

Abstract The aim of this study was to compare the influence of endodontic sealers artifacts on the detection of vertical root fracture in cone beam computed tomography (CBCT). Premolars and central incisors were assigned into five different groups: Control, Pulp Canal Sealer, AH Plus, Sealer 26, and BC Sealer (n= 10, per group). VRFs were mechanically induced and the teeth were inserted into an image phantom. Subsequently, CBCT (Cranex 3Dx, Soredex, Tuusula, Finland) images were obtained and two observers were asked separately to identify root fracture, by visual analysis. For both premolar and central incisors, kappa coefficients of intraobserver agreement varied from good to excellent (K: 80% - 87%), and the values for interobserver agreement varied from fair to moderate (K: 30% - 35%). As follows, the area under the curve (AUC) of receiver operating characteristic (ROC) values for VRFs highlighted that the use of BC sealer reduced the observers' ability to discriminate VRFs relative to other sealers. Moreover, sensitivity values for premolars teeth ranged from 20% to 60%, and specificity ranged from 60% to 100%; while sensitivity values for central incisors ranged from 30% to 70%, and specificity ranged from 70% to 100%. In conclusion, the low sensitivity values, mainly for premolars, demonstrated the difficulty in VRF diagnosis. Furthermore, BC Sealer induced significantly more imaging artifacts than other sealers. These results highlighting that endodontic sealers may interfere with the diagnosis of VRFs.

Resumo O objetivo deste estudo foi comparar a influência dos artefatos de cimentos endodônticos na detecção de fratura radicular vertical (FRV) em tomografia computadorizada de feixe cônico (TCFC). Pré-molares e incisivos centrais foram divididos em cinco grupos diferentes: Controle, Pulp Canal Sealer, AH Plus, Sealer 26 e BC Sealer (n = 10, por grupo). As FRVs foram induzidas mecanicamente e os dentes inseridos em uma réplica da mandibula humana. Posteriormente, imagens de TCFC (Cranex 3Dx, Soredex, Tuusula, Finlândia) foram obtidas e dois observadores foram solicitados a identificar fratura radicular separadamente, o critério utilizado foi a análise visual. Tanto para pré-molares quanto para incisivos centrais, os coeficientes kappa de concordância intraobservador variaram de bom a excelente (K: 80% - 87%), e os valores de concordância interobservador variaram de regular a moderado (K: 30% - 35%). A seguir, a área sob a curva (AUC) dos valores da característica de operação do receptor (ROC) para FRVs destacou que o uso do cimento BC Sealer reduziu a capacidade dos observadores de discriminar FRVs em relação a outros cimentos endodônticos. Além disso, os valores de sensibilidade para pré-molares variaram de 20% a 60%, e a especificidade variou de 60% a 100%; enquanto os valores de sensibilidade para incisivos centrais variaram de 30% a 70%, e a especificidade variou de 70% a 100%. Em conclusão, os baixos valores de sensibilidade, principalmente para pré-molares, demonstraram uma dificuldade no diagnóstico de FRV. Além disso, o BC Sealer induziu significativamente mais artefatos de imagem do que outros cimentos. Esses resultados evidenciam que os cimentos endodônticos podem interferir no diagnóstico das FRVs.

Influência de diferentes materiais obturadores endodônticos em imagens de TCFC: uma avaliação in vitro / Influence of different root canal obturation materials in CBCT imaging: an in vitro evaluation

Objetivo: O presente estudo avaliou a influência de materiais obturadores endodônticos na produção de artefato de imagens de tomografia computadorizada de feixe cônico (TCFC), por meio da análise de densidade de imagem em incisivos centrais e dentes pré-molares unirradiculares. Métodos: Os dentes foram submetidos a instrumentação endodôntica e divididos em cinco grupos: um grupo controle (sem preenchimento endodôntico) e quatro grupos teste, cada um preenchido por um material obturador endodôntico diferente (PulpCanal Sealer, AHPlus, Sealer26 e BCSealer). Após a aquisição da TCFC, as imagens foram avaliadas para determinar variações de tons de cinza nos três terços da raiz (análise objetiva). A segunda análise (subjetiva) comparou o grupo controle com dois dos grupos teste, em um processo randomizado. Resultados: Na análise objetiva, o Sealer26 e o BCSealer mostraram diferença estatística para valores mínimos, em comparação com outros materiais obturadores endodônticos, para dentes anteriores e posteriores. Para valores máximos, apenas o grupo controle diferiu estatisticamente dos grupos teste. Ao comparar os valores dos pré-molares e dos incisivos centrais em tons cinza pelo teste de Kruskal-Wallis, foi encontrada diferença estatisticamente significativa para os valores mínimos. Na análise subjetiva, para dentes anteriores e posteriores, o PulpCanal Sealer foi o material mais frequentemente apontado pelos observadores como aquele que produziu mais interferência de artefato. Conclusões: Os materiais obturadores endodônticos nos dentes posteriores apresentaram comportamento semelhante; somente o PulpCanal Sealer no terço apical apresentou diferenças estatísticas em relação aos demais grupos. Para os dentes anteriores, o BCSealer apresentou valores mínimos maiores em relação aos outros materiais obturadores endodônticos, o que poderia representar maior interferência do artefato (AU).

Objective: This study evaluated the influence of canal obturation materials in the production of cone beam computed tomography (CBCT) images artifact, by means of image density analysis and comparison between four materials in central incisors and monoradicular premolar teeth. Materials and Methods: The teeth were submitted to endodontic instrumentation and divided into 5 groups: one control group (no endodontic filling) and four test groups each one filled by a different endodontic sealer (PulpCanal Sealer, AHPlus, Sealer26 and BCSealer). After CBCT scanning, the images were assessed to determine grayscale variations in three root thirds (objective analysis). The second (subjective) analysis compared the control group with two of the test groups in a randomized process. Results: In the objective analysis, Sealer26 and BCSealer showed statistical difference for minimum values, in comparison with another sealers, for both anterior and posterior teeth. For maximum values, only control group differed statistically from test groups. When comparing premolars and central incisors grayscale values by ANOVA analysis, a statistically significant difference was found mainly for minimum values. At the subjective analysis, for both anterior and posterior teeth, PulpCanal Sealer was the filling most frequently appointed by the observers as the one that produced more artifact interference. Conclusion: Endodontic fillings at posterior teeth performed similar behavior. Only PulpCanal Sealer on apical third presented higher maximum values in relation to others groups, which could represent more white brands. For anterior teeth, BC Sealer performed higher minimum values in relation to other endodontic fillings, which could represent more dark bands (AU).

Response of peripheral blood mononuclear cells to conditioned medium from cultured oral squamous cell carcinomas.

The current study investigated the capacity for tumor factors secreted by head and neck squamous cell carcinoma (HNSCC) cell lines, KB, KB16, and HEP, to induce the secretion of various cytokines from peripheral blood mononuclear cells (PBMCs). PBMCs were isolated from blood samples collected from six healthy volunteers and these cells were incubated for 6, 24, 48, or 72 hours in the presence of 50% conditioned medium collected from cultured cell lines pretreated with, or without, stimulants such as phytohemagglutinin (PHA) or lipopolysaccharides (LPS). Aliquots of each supernatant were then assayed for levels of IFN-Γ, vascular endothelial growth factor (VEGF), TNF-α, and IL-4 using enzyme linked immunosorbent assays (ELISAs). Data collected were analyzed using Student's t-test, an ANOVA test followed by Tukey's test, and tests of Pearson's Correlation. PBMCs cultured with KB16-conditioned medium produced the highest levels of IFN-Γ. VEGF was also detected in conditioned media collected from all of the squamous cell carcinoma (SCC) cell lines used, and a significant difference in VEGF levels between control and KB- or KB16-conditioned media was observed. TNF-α was secreted by all PBMC groups within 6 hours of receiving conditioned media, and these levels increased up to the 24 hour timepoint, after which levels of TNF-α stabilized. In contrast, none of the supernatant samples contained detectable levels of IL-4. In combination, these data suggest that direct contact between fresh human PBMCs and conditioned media from tumor cells induces the secretion of TNF-α and VEGF by PBMCs, and this represents an initial angiogenic response.

Response of peripheral blood mononuclear cells to conditioned medium from cultured oral squamous cell carcinomas

The current study investigated the capacity for tumor factors secreted by head and neck squamous cell carcinoma (HNSCC) cell lines, KB, KB16, and HEP, to induce the secretion of various cytokines from peripheral blood mononuclear cells (PBMCs). PBMCs were isolated from blood samples collected from six healthy volunteers and these cells were incubated for 6, 24, 48, or 72 hours in the presence of 50 percent conditioned medium collected from cultured cell lines pretreated with, or without, stimulants such as phytohemagglutinin (PHA) or lipopolysaccharides (LPS). Aliquots of each supernatant were then assayed for levels of IFN-Γ, vascular endothelial growth factor (VEGF), TNF-α, and IL-4 using enzyme linked immunosorbent assays (ELISAs). Data collected were analyzed using Student's t-test, an ANOVA test followed by Tukey's test, and tests of Pearson's Correlation. PBMCs cultured with KB16-conditioned medium produced the highest levels of IFN-Γ. VEGF was also detected in conditioned media collected from all of the squamous cell carcinoma (SCC) cell lines used, and a significant difference in VEGF levels between control and KB- or KB16-conditioned media was observed. TNF-α was secreted by all PBMC groups within 6 hours of receiving conditioned media, and these levels increased up to the 24 hour timepoint, after which levels of TNF-α stabilized. In contrast, none of the supernatant samples contained detectable levels of IL-4. In combination, these data suggest that direct contact between fresh human PBMCs and conditioned media from tumor cells induces the secretion of TNF-α and VEGF by PBMCs, and this represents an initial angiogenic response.