Small Molecule GSK-3 Inhibitors Safely Promote the Proliferation and Viability of Human Dental Pulp Stem Cells-In Vitro.

Small molecules have demonstrated promising results as successful alternatives to growth factors. In this study, focus was drawn to CHIR99021 and tideglusib as GSK-3 inhibitors known for their anti-inflammatory and regenerative potential. The effect of both tideglusib and CHIR99021 on the proliferation, viability, and stemness of human dental pulp stem cells (hDPSCs) was investigated to assess their possible role in regenerative dentistry. Briefly, hDPSCs were isolated from sound premolars extracted for orthodontic purposes. Cytotoxicity and proliferation assessment were performed via cell counting kit-8 followed by flow cytometric analysis of apoptotic marker ANNEXIN V. The effect of both small molecules on the stemness of hDPSCs was analyzed by qRT-PCR. Both tideglusib and CHIR99021 were proven to be safe on hDPSCs. The tideglusib concentration that resulted in higher viable cells was 100 nM, while the concentration for CHIR99021 was 5 nM. Both small molecules successfully induced cellular proliferation and demonstrated minimal expression of ANNEXIN V, indicative of the absence of cellular apoptosis and further confirming their positive effect on proliferation. Finally, both small molecules enhanced stemness markers expression as evidenced by qRT-PCR, which, again, highlighted the positive effect of both tideglusib and CHIR99021 on safely promoting the proliferation of hDPSCs while maintaining their stemness.

Root Canal Filling Quality Comparison of a Premixed Calcium Silicate Endodontic Sealer and Different Carrier-Based Obturation Systems.

BACKGROUND: The number of voids within the root canal obturation is a relevant parameter to describe the quality of the technique, as well as to predict long-term prognosis. The aim of this study was to evaluate the quality of root canal obturation in curved root canals filled with Thermafil, GuttaCore, GuttaFusion and lateral compaction with AH Plus and EndoSequence BC sealer, by means of percentage of gutta-percha and sealer filled area. METHODS: 200 curved canals of mandibular molars were divided in five groups (n = 40). Each specimen was evaluated at 3, 6 and 9 mm from the apex. A total of 600 samples were analyzed. Obturation was performed with either Thermafil (TH), GuttaCore (GC), GuttaFusion (GF) or lateral compaction (LC), using AH Plus as sealer. In another group EndoSequence BC sealer (BC) was used. Subgroups (n = 20) were made depending on the use of sonic activation during the placement of the sealer. The percentage of total obturation material was analyzed as an indirect measurement of percentage of voids. RESULTS: GF showed a better performance at the apical level, while GC showed the higher percentage of total obturation at the coronal area. No differences were observed for the activation of sealers in any of the groups. Statistical analysis was performed by using two-way ANOVA. Statistical significance was set at CI: 95% (p < 0.05). CONCLUSIONS: Sonic activation of sealers did not show any benefit to avoid the presence of voids within obturation of curved canals. Following the manufacturer recommendations, we found that TH did not show benefits when applied to curved canals.

Relationship between internal root resorption and dens in dente.

BACKGROUND: The aim is to report the treatment and follow-up of three lateral incisors with internal root resorption and dens in dente as a possible cause for their development, managed by root canal treatment and apical obturation with MTA or gutta-percha. CASE DESCRIPTION: This case report presents three clinical cases in which dens invaginatus type 2 is shown as a potential cause for the development of internal root resorption. Two cases were filled with a MTA apical plug technique and one with gutta-percha, and all were follow-up through time. PRACTICAL IMPLICATIONS: The incidence of the association of internal root resorption with dens invaginatus may be underestimated and should be studied. Key words:Dens in dente, dens invaginatus, internal root resorption, Mineral Trioxide Aggregate, palatal invagination.

Vital Pulp Therapy an Insight Over the Available Literature and Future Expectations.

Vital pulp therapy (VPT) defined as "treatment which aims at preserving and maintaining the pulp tissue that has been compromised but not destroyed by extensive dental caries, dental trauma, and restorative procedures or for iatrogenic reasons", offers some beneficial advantages over the conventional root canal treatment such as protective resistance for mastication forces or to prevent the loss of environmental changes sensation ability, which can lead to unnoticeable progression of caries and later fracture. A wide range of materials are suggested in the literature to be used as pulp capping protective dressing materials that varies from ready-made synthetic materials to biological based scaffolds and composites. The aim of the present review is to provide a full understanding of currently used materials to clinicians in order to help in their decision-making process delivering the best available evidence-based treatments to their patients. An extensive search for recent available data regarding direct pulp capping materials and potential suggestions for future use have been made. Newly developed biological based scaffolds showed promising results in dentine regeneration therefore strengthening the tooth structure and overcoming potential drawbacks of use of currently available recommended materials.

Reimplante intencional de un 4.7 con reabsorción cervical invasiva y seguimiento a seis años / No disponible

Introducción: La Reabsorción Cervical Invasiva (RCI) se origina en la superficie externa de la raíz, generalmente por un daño previo, y quizá crónico, del ligamento periodontal, y una rotura de la capa de tejido no mineralizado que permite una actividad odontoclástica, invadiendo la dentina en cualquier dirección y con diferentes grados. Dejada a su libre evolución conlleva la pérdida del diente. Caso clínico: Paciente de 45 años que acude a la consulta por presentar un tracto sinusal a nivel del 4.7. Se diagnostica necrosis pulpar con absceso apical crónico de etiología dudosa. Tras el fracaso del tratamiento de conductos, se opta por la exodoncia y se realiza el diagnóstico intraoperatorio de RCI. Tratada la causa, se realiza el reimplante intencional (RI). Conclusión: La técnica de RI se presenta como una alternativa a la cirugía periradicular, siendo una herramienta valiosa en la conservación de dientes con pronóstico comprometido

No disponible

Puesta al día en regeneración pulpar / An update on pulp regeneration in endodontics

Cuando se combinan entre sí, las células madre, las matrices y los factores de crecimiento tienen la capacidad de regenerar un tejido, tal como el complejo dentino-pulpar. La ingeniería tisular está adquiriendo cada vez más importancia en el campo de la endodoncia como una alternativa a la obturación clásica con gutapercha. El objetivo de esta revisión es comparar los diferentes materiales que actuarían como matrices disponibles en la actualidad, así como conocer el alcance del conocimiento sobre los factores de crecimiento relacionados con la regeneración de la pulpa, señalando las principales limitaciones y elaborando un protocolo para futuros procedimientos regenerativos. Las matrices de colágeno han demostrado ser una opción óptima, ya que son biodegradables, pueden ser autólogos y existe una alta disposición. El factor de crecimiento insulínico tipo 1 y el factor de crecimiento derivado de plaquetas han demostrado estar implicados en la proliferación celular. El factor de crecimiento endotelial vascular es uno de los más importantes para la proliferación de la red vascular. El aislamiento celular y los altos costos son los principales obstáculos. La combinación de un andamio de colágeno, factor de crecimiento insulínico tipo 1, factor de crecimiento derivado de plaquetas, factor de crecimiento endotelial vascular y células madre de tejido pulpar de dientes deciduos (SHEDs) podría dar buenos resultados en la regeneración de la pulpa dental

When combined together, stem cells, scaffolds and growth factors have the ability of regenerating a whole tissue, for example the dental-pulp complex. Tissue engineering is getting more and more importance in the endodontic field as an alternative to the standard filling of root canals with gutta-percha material. The aim of this review is to compare the different scaffold materials available today, find out the extent of knowledge about the growth factors related to pulp regeneration, pointing out the main limitations and devise a protocol for future regenerative procedures. Collagen scaffolds material have shown to be an optimal choice as they are biodegradable, can be autologous and are highly available. Insulin-like growth factor 1 and platelet derived growth factor have shown to be involved in cells proliferation. Vascular endothelial growth factor is one of the most important for vascular network proliferation. Cells isolation and high costs are the main obstacles. As a conclusion, the combination of a collagen scaffold, insulin-like growth factor 1, platelet derived growth factor, vascular endothelial growth factor and dental pulp stem cells from deciduous teeth (SHEDs) might give good outcomes in dental pulp regeneration

Revisión de las diferentes metodologías in vitro para el estudio de adaptación de los materiales de obturación en endodoncia / Review of the different in vitro methodologies for the study of adaptation of endodontic obturation materials

El éxito del tratamiento de endodoncia reside en una correcta limpieza y sellado tridimensional del sistema de conductos radiculares. En referencia al sellado, se han realizado numerosas investigaciones con el fin de encontrar el material ideal que evite la filtración tanto coronal como apical. Estos estudios in vitro se han llevado a cabo con una amplia gama de sistemas de medición, entre los que destacan los realizados con bacterias, glucosa, diferentes tintes o fluidos y técnicas microscópicas, ya sean ópticas o electrónicas de barrido (SEM). El objetivo de esta revisión bibliográfica es profundizar en las distintas técnicas de estudio que existen para la evaluación del sellado endodóntico y la filtración in vitro para tratar de establecer cuál es la más completa y capaz de aportar los resultados más reales y factibles, que pudieran extrapolarse a la práctica clínica

Success of endodontic treatment relies on the correct cleaning as well as on the three dimensional sealing of the root canal system. Regarding the sealing, many studies have been realized in order to find the ideal material that avoids coronal and apical filtration. This in vitro investigations have been carried out with a wide range of meassurement systems, among the ones are highlightables those dones with bacteria, glucose, different fluid dyes and micrhoscopic techniques, either optical or electronic scanning. The aim of this bibliographic review is to deep dive into the different techniques available for evaluating both in vitro sealing and filtration for try to stablish which is the most complete and accurate when providing results that night be extrapolated to clinical practice

MTA como material de sellado en cirugía endodóntica: puesta al día / MTA as sealing material in endodontic surgery: update

La cirugía endodóntica tiene por objetivo eliminar quirúrgicamente el tejido patológico a nivel periapical y permitir el sellado hermético apical. Para ello resulta fundamental obturar la cavidad realizada con un material que sea biocompatible, insoluble y que impida la filtración bacteriana. Ninguno de los materiales de sellado clásicos ha sido capaz de satisfacer todos los requerimientos necesarios para ser denominado el material ideal en cirugía endodóntica. Sin embargo, con la introducción del Agregado Trióxido Mineral (MTA), se ha presentado un material altamente biocompatible que evita la filtración de bacterias y que es hidrófilo, por lo que podría emplearse en campos húmedos como son los tejidos apicales. El presente trabajo de revisión bibliográfica permitió investigar cuáles son las ventajas que aporta el MTA en cirugía endodóntica. Se han estudiado sus características con respecto a su biocompabilidad y capacidad de sellado. Además, se ha revisado cómo la literatura hace frente a sus desventajas como material de sellado, sobre todo, en referencia su difícil manejo y a su potencial de decoloración del diente obturado (AU)

Endodontic surgery treatment pretends to surgically remove pathological tissue in the periapical area, with the aim to obtain a hermetic and apical seal. For this, it is essential to seal the cavity with a material that is biocompatible in the periapical tissues, insoluble in oral fluid, and that prevents bacterial leakage in dental tissues. None of the conventionally used root end filling materials has been able to meet all the requirements to be designated as the ideal material for this treatment. however, with the introduction of Mineral Trioxide Aggregate (MTA), it was found to be a highly biocompatible material, which prevents bacterial leakage and is hydrophilic, so that the problem of its use in areas with moisture such as the apical tissues can be avoided. This literature review allowed us to investigate the advantages of the MTA in endodontic surgery. Its characteristics have been studied regarding its biocompatibility and sealing ability. Furthermore, it has been revised how the literature confronts its disadvantages regarding the troublesome handling and the potential discoloration of the filled tooth (AU)

Ensayo aleatorizado in vitro sobre la capacidad de obturación de sistemas con vástago en conductos curvos / In vitro randomized-trial on the sealing ability of carrier-based systems in curved root canals

Objetivo: Comparar el porcentaje de área de gutapercha, cemento y huecos en conductos curvos obturados con sistemas con vástago y evaluar la influencia de la activación del cemento durante su colocación. Metodología: 120 conductos curvos de molares mandibulares fueron preparados a un diámetro apical ProFile 30, 0.04. Se obturaron con los sistemas GuttaCore, GuttaFusion o condensación lateral y AHplus (n = 40). Se subdividieron los grupos (n = 20) y se colocó el cemento con activación sónica o no. El cemento se mezcló con Rodamina B para permitir el análisis mediante microscopía confocal. Se calculó el área de gutapercha, cemento y huecos a 3, 6 y 9 mm del ápice. Se realizó el análisis estadístico utilizando ANOVA de dos vías. Para la comparación por pares se realizó el test de Sidak. Resultados: Cuando se comparan los sistemas de gutapercha a 3 mm, GF mostró un mejor comportamiento. CL obtuvo los peores resultados. No se encontró influencia entre los sistemas de obturación y la activación del cemento. Cuando se comparó el porcentaje de huecos entre todos los grupos, los perores resultados fueron para CL a 6 y 9 mm. Conclusiones: Bajo las condiciones de este estudio, el área de gutepercha, cemento y huecos depende del sistema de obturación utilizado. El uso de activación del cemento no influye en la calidad de la obturación

Aim: To compare the percentage of gutta-percha, sealer and voids in curved root canals filled with different gutta-percha carrier-based systems and to assess the influence of activation of the cement during its placement. Methodology: 120 curved canals of mandibular molars were prepared to an apical size ProFile 30, 0.04. They were filled with either GuttaCore, GuttaFusion or lateral condensation and AHplus (n=40). Groups were subdivided (n=20) and sonic activation or not during the placement of the cement was carried out. Cements were labelled with Rhodamine-B dye to allow analysis under confocal microscopy. Percentage of gutta-percha, sealer and voids area were calculated at 3, 6 and 9 mm from the apex. Statistical analysis was performed using two-way ANOVA test. To compare between the obturation systems Sidak correction for multiple comparisons was applied. Results: When comparing the gutta-percha systems at the 3 mm level, GF revealed a better performance. At 6 and 9mm, LC obtained the worst results. An influence between the obturation systems and the activation of the cement was not found. When comparing the percentage of voids among all the groups, worst results were found for LC at 6 and 9 mm. Conclusions: Under the conditions of this study, gutta-percha, sealer area and voids were dependent on the obturation system. The use of activation of the cement do not influence the quality of root filling

Estudio in vitro aleatorizado de la capacidad de obturación de guttacore y thermafil plusmediante cortes transversales / In vitro randomized study of the sealing ability of Guttacore and Thermafil plususing cross sections

El éxito del tratamiento de conductos radica en una adecuada limpieza, conformación y obturación de los mismos. Objetivo: Comparar el PGFA (porcentaje del área rellena por gutapercha) de la obturación de conductos entre el sistema Guttacore(TM) y el sistema Thermafil Plus(R) mediante cortes histológicos. Metodología: Se realizó estudio in vitro aleatorizado sobre 23 conductos cuya curvaturase comprendía entre 21-40º. Los conductos se instrumentaron hasta un calibre apical de 30.04. Tras realizar irrigación final ultrasónica pasiva, se obturaron los conductos con los es realizaron cortes histológicos a 2, 5 y 8 mm del extremo apical. Se fotografió la superficie de los cortes a 2,5x aumentos. Calculamos el PGFA de las muestras. Resultados: Todos los conductos obtuvieron medias superiores al 95% en PGFA (Guttacore: 98,16% a 2 mm, 96,77% a 5 mm y 98,46% a 8 mm; Thermafil: 98,73% a 2 mm, 98,89% a 5 mm y 100% a 8 mm). Existieron diferencias significativas entre ambos grupos en el corte a 8 mm (p=0,011). Conclusiones:1) Thermafil Plus(TM) obtiene significativamente mayor PGFA en corte a 8mm. 2) No existen diferencias significativas a 2 y 5 mm. 3) Se necesitan nuevos estudios comparativos de Guttacore(TM) con otros sistemas de obturación

The success of the root canal treatment takes of in a suitable cleaning, shaping and obturation of the root canal system. Aim: To compare the PGFA (percentage of gutta-percha-filled area) obtained by Guttacore and Thermafil Plus obturation systems using histologic sections. Metodology: a randomized in vitro trial was done on 23 canals in which the angle of curvature was between 21-40º. The instrumentation was done untill a 30.04 file reach the working lenght. After the final irrigation activated with ultrasound, canals were obturated with Thermafil Plus and Guttacore obturation systems. horizontal sections were cut 2, 5 and 8 mm from the apical foramen of each tooth. The crosssectional area of the samples were taken under phtographs to 2.5x increases. The PGFA was calculated. Results: All the canals obtained more than 95% in average of PGFA (Guttacore: 98,16%at 2 mm, 96,77% at 5 mm and 98,46% at 8mm; Thermafil: 98,73% at 2 mm, 98,89% at5 mm and 100% at 8 mm). Significant differences were found between the grups in the cross-sectional area at 8 mm (p=0,011). Conclusions: 1) Thermafil plus gets significantly higher values of PGFA in the cross-sectional area at 8 mm. 2) No significant difference was found between 2 and 5 mm 3) Other studies about comparation of Gutta-core are needed

Actualización en microbiología endodóntica / Update in endodontic microbiology

Los agentes microbiológicos son esenciales en la progresión y perpetuación de la patología inflamatoria perirradicular. Dentro de éstos, las bacterias constituyen la flora más prevalente. Para que un conducto se infecte, la pulpa debe estar necrótica y los microorganismos deben adherirse a los tejidos y multiplicarse en cantidad suficiente, siendo por tanto importante la interacción entre el hospedador y la dosis de infección. Las asociaciones específicas que están implicadas en la patogénesis de la enfermedad perirradicular aún son desconocidas, pero se acepta que las especies aisladas más frecuentemente deben tener una mayor contribución en el grado de patogenicidad. Las diferentes formas de enfermedad perirradicular pueden tener etiologías microbianas distintas. Los tipos de infección endodóntica (primaria, secundaria y persistente) se asocian con diferentes condiciones clínicas. Las infecciones extrarradiculares pueden catalogarse como cualquiera de las anteriores, y están cobrando mucha importancia, por la resistencia que presentan al (..) (AU)

Microbiological agents are essential in the progression and perpetuation of periradicular inflammatory pathologies. Within these, bacteria constitute the most prevalent flora. For a canal to become infected, the pulp must be necrotic and the microorganisms must adhere to the tissues and multiply insufficient quantity, with the interaction being important, therefore, between the host and the infectious dose. The specific associations that are implied in the pathogenesis of the periradicular disease are still unknown, but it is accepted that the most frequently isolated species should have a greater contribution in the degree of pathogenicity. The different forms of periradicular disease maybe classified as different microbial aetiologies. The types of endodontic infections (..) (AU)

Actualización sobre reabsorción radicular interna / Update on internal radicular resorption

La reabsorción dentinaria interna es un proceso patógico que produce la destrucción de estructuras mineralizadas de la raíz del diente. Comienza en el interior del sistema de conductos y, mientras persista tejido pulpar vital, va avanzando hasta llegar incluso a producirse una comunicación con el periodonto. Suele cursar de forma asintomática, siendo detectada en un examen radiológico rutinario. Muchos artículos hablan de una incidencia inferior al 1%, pero estudios recientes demuestran que hay indicios de reabsorción en un alto porcentaje de los dientes con inflamación pulpar o necrosis. Tradicionalmente se ha considerado la mancha rosa en la corona como un signo patognomónico de la reabsorción interna, pero hoy en día se sabe que en realidad suele indicar la presencia de una reabsorción cervical invasiva. Su diagnóstico es radiográfico, siendo de gran utilidad el uso de una técnica de imagen tridimensional como la CBCT (Tomografía Computarizada de Haz Cónico). El tratamiento (..) (AU)

Internal root resorption is a pathologic process that produces the destruction of mineralized structures of the tooth. It is initiated within the root canal system and, whereas part of the pulp remain vital, can be advancing until a perforation to the periodontal ligament takes place. Internal root resorption is usually asymptomatic and is first recognized clinically through routine radiographs. Many studies have described an incidence below 1%, but recent studies demonstrate that there are indications of root resorption in a high percentage of the teeth that present inflammatory tissue or necrosis. The "pink spot" has traditionally been used to describe the (..) (AU)