Zoledronic Acid Modulates Cytokine Expression and Mitigates Bone Loss during the Development of Induced Apical Periodontitis in a Mice Model.

INTRODUCTION: Bisphosphonates are antiresorptive drugs used worldwide to treat systemic bone pathologies. This study aimed to assess the impact of zoledronic acid on the progression of induced apical periodontitis and the expression of cytokines interleukin (IL)-1ß, IL-10, IL-6, and tumor necrosis factor alpha (TNF-α) in a mouse model. METHODS: Sixteen female isogenic BALB/c mice 6 weeks of age were distributed into 2 groups: mice with induced apical periodontitis (the AP group, n = 8) and mice with induced apical periodontitis treated with zoledronic acid (the AP-ZA group, n = 8). The AP-ZA group received a dose of 125 µg/kg zoledronic acid diluted in sterile saline solution administered intraperitoneally once a week for 4 weeks before pulp exposure, whereas the AP group received only saline solution. Pulp exposures were performed on the maxillary first molars for the induction of apical periodontitis, and mice were euthanized after 7 and 21 days. The jaws were collected; scanned using micro-computed tomographic imaging; and processed for polymerase chain reaction analysis of IL-1ß, IL-10, IL-6, and TNF-α. The Student t test was performed for parametric data, and Mann-Whitney U tests were used for nonparametric data. The level of significance was set at 5%. RESULTS: Micro-computed tomographic imaging revealed higher bone resorption in the AP group compared with the AP-ZA group at both time points (P < .05). Real-time polymerase chain reaction demonstrated higher TNF-α expression in the AP group at both time points and higher IL-6 and IL-1ß expression in the AP group at the 7- and 21-day time points, respectively, compared with the AP-ZA group (P < .05). No differences were observed regarding IL-10 expression between the groups. CONCLUSIONS: Zoledronic acid had significant anti-inflammatory and antiresorptive effects on apical periodontitis in mice.

Guided Tissue Regeneration in Class IV External Cervical Resorption: A Case Report.

External cervical resorption (ECR) is a type of dental resorption that originates from the loss of the cementum's protective layer. The direct exposure of dentin to the periodontal ligament may lead to the invasion of clastic cells through an entry point on the external root surface into the dentinal tissue, causing resorption. Depending on the extension of ECR, different treatments are proposed. Although the literature presents distinct materials and methods for restoring ECR areas, an existing gap is related to care in the treatment of the supporting periodontal tissue. Guided tissue regeneration (GTR)/guided bone regeneration includes the stimulation of bone formation in bone defects using different types of membranes (resorbable and nonresorbable), regardless of its association with bone substitutes or grafts. Despite the benefits of guided bone regeneration, the application of this method in cases of ECR is still under-explored in the literature. Thus, the present case report uses GTR with xenogenic material and polydioxanone membrane in a case of class IV ECR. The success of the present case is related to the correct diagnosis and treatment plan. Complete debridement of resorption areas and restoration with biodentine were effective in tooth repair. GTR contributed to the stabilization of supporting periodontal tissues. The association of the xenogeneic bone graft with the polydioxanone membrane proved to be a viable option for restoring the health of the periodontium.

High-plasticity mineral trioxide aggregate and its effects on M1 and M2 macrophage viability and adherence, phagocyte activity, production of reactive oxygen species, and cytokines.

Objectives: This study evaluated the effects of high-plasticity mineral trioxide aggregate (MTA-HP) on the activity of M1 and M2 macrophages, compared to white MTA (Angelus). Materials and Methods: Peritoneal inflammatory M1 (from C57BL/6 mice) and M2 (from BALB/c mice) macrophages were cultured in the presence of the tested materials. Cell viability (MTT and trypan blue assays), adhesion, phagocytosis, reactive oxygen species (ROS) production, and tumor necrosis factor (TNF)-α and transforming growth factor (TGF)-ß production were evaluated. Parametric analysis of variance and the non-parametric Kruskal-Wallis test were used. Results were considered significant when p < 0.05. Results: The MTT assay revealed a significant decrease in M1 metabolism with MTA-HP at 24 hours, and with MTA and MTA-HP later. The trypan blue assay showed significantly fewer live M1 at 48 hours and live M2 at 48 and 72 hours with MTA-HP, compared to MTA. M1 and M2 adherence and phagocytosis showed no significant differences compared to control for both materials. Zymosan A stimulated ROS production by macrophages. In the absence of interferon-γ, TNF-α production by M1 did not significantly differ between groups. For M2, both materials showed higher TNF-α production in the presence of the stimulus, but without significant between-group differences. Likewise, TGF-ß production by M1 and M2 macrophages was not significantly different between the groups. Conclusions: M1 and M2 macrophages presented different viability in response to MTA and MTA-HP at different time points. Introducing a plasticizer into the MTA vehicle did not interfere with the activity of M1 and M2 macrophages.

Morphological alterations of the apical foramen after foraminal enlargement: a systematic review of ex vivo studies / Alterações morfológicas do forame apical após ampliação foraminal: uma revisão sistemática de estudos ex vivo

Foraminal enlargement has been recommended to optimize the disinfection of infected root canals, although some authors still claim that the foramen should be kept in its original shape and position. This study aimed to evaluate morphological alterations of apical foramen after foraminal enlargement through a systematic review. An electronic search was conducted until April 2022. Ex vivo studies evaluating influence of foraminal enlargement in the morphologic changes of apical foramen were included. Studies without a control group or available full text were excluded. Foraminal deformation and area increase were considered as primary outcomes. Risk-of-bias assessment was performed according to a modified Joanna Briggs Institute's Checklist. From 702 studies retrieved, five were eligible. Most studies used single-rooted teeth, and rotary systems for instrumentation ranging from ­ 2 mm to + 1 mm to the apex. All studies found increased major foramen deformation after foraminal enlargement. Among four studies that evaluated foraminal area, all found increased area after foraminal enlargement. Insufficient data for touched/untouched walls by instruments and dentinal microcrack formation was observed. A low risk of bias was found. Foraminal enlargement during root canal preparation seems to increase deformation and major apical foramen area. Future investigations with standardized methodologies are encouraged (AU)

A ampliação foraminal tem sido recomendada para otimizar a desinfecção de canais radiculares infectados, embora alguns autores ainda afirmem que o forame deve ser mantido em sua forma e posição originais. Este estudo teve como objetivo avaliar alterações morfológicas do forame apical após ampliação foraminal por meio de uma revisão sistemática. Uma busca eletrônica foi realizada até abril de 2022. Foram incluídos estudos ex vivo que avaliaram a influência da ampliação foraminal nas alterações morfológicas do forame apical. Foram excluídos estudos sem grupo controle ou com texto completo indisponível. A deformação foraminal e o aumento da área foram considerados desfechos primários. A avaliação do risco de viés foi realizada de acordo com uma lista de verificação modificada do Instituto Joanna Briggs. Dos 702 registros recuperados, cinco foram elegíveis. A maioria dos estudos utilizou dentes unirradiculares e sistemas rotatórios para instrumentação, com comprimento de trabalho variando de ­ 2 mm a + 1 mm até o ápice. Todos os estudos encontraram aumento da deformação do forame maior após ampliação foraminal. Dos quatro estudos que avaliaram a área foraminal, todos encontraram aumento de área após alargamento foraminal. Foram observados dados insuficientes para paredes tocadas/intocadas pelos instrumentos e formação de microfissuras dentinárias. Um baixo risco de viés foi encontrado. A ampliação foraminal durante o preparo do canal radicular parece aumentar a deformação e a área do forame apical. Futuras investigações com metodologias padronizadas são incentivadas (AU)

Cytotoxicity of two self-adhesive resin cements and their interference in the phagocytic activity of murine macrophages.

Objectives: This study aimed to evaluate in vitro the effects of the self-adhesive resin cements RelyX U200 (3M ESPE) and seT PP (SDI Limited) on murine macrophages and the interference of the photoactivation. Materials and Methods: Cell viability assays, cell adherence, yeast phagocytosis of Saccharomyces boulardii and production of reactive oxygen species (ROS) were performed in the presence of capillaries containing the respective self-adhesive cement when photoactivated or not. Results: After long periods of contact, both types of cements, when not photoactivated, are more cytotoxic for macrophages. The seT PP cement when only chemically activated seems to interfere more negatively in the process of phagocytosis of yeasts S. boulardii. Both types of cements interfere in the cell adhesion process, independent of photoactivation. None of the types of cements tested was able to induce the production of ROS. Conclusions: Our results highlight the great importance of the photoactivation of self-adhesive resin cements in the dental clinic, since RelyX U200, when photoactivated, presented the best results within the evaluated parameters.

The influence of prophylaxis with amino acid glycine powder and sodium bicarbonate jet on the bond strength of dental enamel / A influência da profilaxia com aminoácido glicina em pó e jato de bicarbonato de sódio na resistência de união do esmalte dentário

Aim: To compare the influence of prophylaxis with sodium bicarbonate and amino acid glycine powder on the bond strength of bovine teeth enamel and on the properties of two adhesive systems. Methods:Thirty-six extracted bovine incisors were randomly divided into six groups (n = 6) according to the prophylactic treatment received: no prophylactic treatment (NT), sodium bicarbonate powder (SB), and glycine powder (GL). Each group was subdivided into 2 groups based on what adhesive systems were used: conventional system (A) and universal system (B). Composite resin was applied on the buccal surface of the teeth in a block measurement 8x8x6 mm. The specimens were cut to obtain beams measuring 1.0 x 1.0 mm and were subjected to microtensile bond strength tests. Results were compared using two-way ANOVA (p ≤ 0.05). Results: The GLA group obtained the highest bond strength value for the conventional adhesive (18.97 MPa), but the GLB group obtained a lower strength value than the SBB group (GLB: 21.05 MPa and SBB: 22.29 MPa) (p < 0.05). Conclusions: Cleaning of the enamel surface increases the adhesive properties of restorative materials, and the bond strength was more effective in the group that received glycine prophylaxis and the conventional adhesive system.

Objetivo:Comparar a influência da profilaxia com bicarbonato de sódio e ClinproProphy ™ na resistência de união do esmalte de dentes bovinos e nas propriedades de dois sistemas adesivos.Métodos: Trinta e seis incisivos bovinos extraídos foram divididos aleatoriamente em 6 grupos (n = 6), cada um de acordo com o tratamento profilático recebido: nenhum tratamento profilático (NT), bicarbonato de sódio em pó (SB), glicina em pó (GL). Cada grupo foi subdividido em 2 grupos com base nos sistemas adesivos utilizados: sistema convencional (A) e sistema universal (B). A resina composta foi aplicada na superfície bucal dos dentes em um bloco de 8x8x6 mm. As amostras foram cortadas para obter blocos medindo 1,0 x 1,0 mm e submetidas a testes de resistência de união por microtração. Os resultados foram comparados usando o teste two-way ANOVA (p ≤ 0,05). Resultados: O grupo GLA obteve o maior valor de resistência de união para o adesivo convencional (18,97 MPa), mas o grupo GLB obteve um valor de resistência menor que o grupo SBB (GLB: 21,05 MPa e SBB: 22,29 MPa) (p < 0,05). Conclusão: A limpeza da superfície do esmalte aumenta as propriedades adesivas dos materiais restauradores, e a resistência adesiva foi mais eficaz no grupo que recebeu profilaxia com glicina e sistema adesivo convencional.

Comparison between immediate and delayed post space preparations: a systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis compared the effects of immediate and delayed post space preparation on apical sealing. MATERIALS AND METHOD: Two independent authors conducted a systematic search (PubMed/Medline, Cochrane Library, and other databases, until February 2020) and a risk of bias evaluation. Only in vitro studies that compared the effects of immediate and delayed post space preparations on apical filling and adhesion of the post were eligible. RESULT: Of the 742 articles retrieved, 32 were included. Most of the studies used single-rooted human teeth and rotary files for root canal preparation, a single-cone technique for the filling protocol, and rotary instruments for post space preparation. Various delayed preparation times were evaluated: 8-72 h, 5-30 days (mainly 7 days), and 4 months. In nine studies, the delayed groups showed more apical leakage, while four studies reported more leakage in the immediate groups; ten studies found no significant difference. One study found more bacterial penetration in the delayed group, whereas three studies showed no significant difference. One study reported more voids in the delayed group, while another found no such difference. Three studies showed better post-bond strength in the delayed group, one in the immediate group, whereas three found no significant difference in post-bond strength. Three studies employing varied sealers for root canal fillings were considered for meta-analysis. Two subgroup analyses were also performed (one concerning the use of resin-based sealers (AH Plus), another for zinc oxide-eugenol-based sealers). The results of the meta-analysis showed that a delayed post space preparation led to a significantly higher apical leakage than an immediate preparation (mean difference = 0.41 mm, confidence interval = 0.24-0.59, p < 0.001). CONCLUSION: Delayed post space preparation seems to negatively influence apical sealing; however, further studies are needed to determine the influence of the timing of post space preparation on the other parameters. CLINICAL RELEVANCE: Immediate post space preparation may be the safest clinical choice to prevent apical leakage.

The use of antimicrobial photodynamic therapy in the successful management of an invasive cervical resorption class 4: A case report with five years follow-up.

A 41-year-old male with a dental history of invasive cervical resorption (ICR) was initially treated with a surgical endodontics approach and secondly with antimicrobial photodynamic therapy (aPDT) along with endodontic retreatment. The use of aPDT was essential to promote bacterial reduction in the resorption defect. Combining these techniques allowed for clinical, radiographic, and tomographic success after five years of follow-up.

Selenium intracanal dressing: effects on the periapical immune response.

OBJECTIVES: To evaluate the selenium (Se) behavior when used as an endodontic dressing in teeth with pulp necrosis. Additionally, its effects was also compared with the calcium hydroxide (C.H.), which is used globally as a root canal dressing, and the combination of the C.H. with Se (C.H. + Se). MATERIALS AND METHODS: The sample consisted of 60 patients requiring endodontic treatment who were divided into groups, i.e., without intracanal medication (empty) and with medications as follows: selenium (Se), calcium hydroxide (C.H.), and calcium hydroxide + selenium (C.H. + Se) (n = 15). After the coronary opening, three absorbent paper points were placed in the RCS and maintained for 2 min for microbial evaluation. Following the cleaning and shaping procedures, new paper points were introduced into the root canal system, passing passively through the root apex (2 mm) into the periapical tissues for 2 min, for immune evaluation. The collections were performed again 15 days later. Real-time PCR quantified the expression of the prokaryotic 16S ribosomal RNA. The 16S mRNA was evaluated before the cleaning and shaping procedures and 15 days later in the groups treated with or without medication. RESULTS: A significant reduction in the microbial load was observed only in the groups that received endodontic dressing (p < 0.05). The cytokines IFN-γ, TNF-α, IL-1α, IL-17A, IL-10, IL-6 and MCP-1, were also quantified by real-time PCR. There was an increase in the gene expression level of the cytokines (T15) TNF-α and IL-10 in the C.H. group compared to the other groups (p < 0.05). The IFN-γ mRNA expression was reduced in the groups treated with the medications (Se, C.H., and C.H. + Se). CONCLUSIONS: The findings of the present study indicate that in the case of treatment over multiple sessions, the use of root canal dressing is essential to avoid the root canal system (RCS) microbial recolonization. Selenium potentiated the effects of calcium hydroxide inducing an anti-inflammatory response in periapical tissues. CLINICAL RELEVANCE: Se is a mineral essential for the formation of the amino acid selenocysteine, which is directly involved in the maintenance of the immune response. Selenium has been widely used in the medical field in the treatment of cancer, as an activator of bone metabolism, and as a stimulator of the immune system. In this study, it was shown that the incorporation of Se, whether as intracanal medication alone or in conjunction with other medications, may potentiate periapical tissue repair after RCS cleaning and shaping procedures.

Use of technology in endodontics by undergraduate dental students in a south-eastern state of Brazil.

INTRODUCTION: This study aimed to determine the level of incorporation of current technologies for endodontic treatment in undergraduate dentistry courses in a south-eastern state of Brazil. METHODS: For data collection, a self-assessment-based online questionnaire was created using the "Google Forms" platform, consisting of 12 multiple-choice and a few open-ended questions. The questions were related to the use of current technologies for diagnosis, imaging, use of ultrasonics in endodontics, instrumentation, use of apex locator, microscopy, photodynamic therapy and thermoplastic techniques during endodontic treatment. The questionnaire was sent to 54 dental schools in Minas Gerais. RESULTS: The results show low technological incorporation during the various stages of endodontic treatment by undergraduate students in dentistry courses in Minas Gerais. CONCLUSION: Despite the availability of several technologies to help perform different stages of endodontic treatment, it was observed that most universities do not teach the use of these technologies. Additional studies are needed to correlate how the lack of incorporation of these technologies could impact on the quality of the endodontic learning for undergraduate students.

Antimicrobial photodynamic therapy and guided endodontics: A case report.

A 35-year-old woman with a history of pulp canal obliteration (PCO) and apical periodontitis was treated with guided endodontics combined with antimicrobial photodynamic therapy (aPDT). The use of aPDT was paramount to the approach performed, and its application should be encouraged in cases of severely calcified canals when apical patency is unachievable. The combination of these techniques ensured successful clinical, radiographic, and tomographic outcomes at the 1-year follow-up. Key Words: Antimicrobial PDT, guided endodonics, periodontitis, pulp canal obliteration.

The apical root canal system microbial communities determined by next-generation sequencing.

The aim of this study was to explore the microbial communities of endodontic infections at their apical portion by 16S rRNA Illumina sequencing and delineate the core microbiome of root canal infections and that of their associated clinical symptomatology. Samples were collected from fifteen subjects presenting one tooth with a root canal infection, and their associated symptoms were recorded. Samples were collected from the apical third of roots using a #10 K file and then amplified using multiple displacement amplification and PCR-amplified with universal primers. Amplicons were sequenced (V3-V4 hypervariable region of the 16S rRNA gene) using MiSeq (Illumina, CA). The microbial composition of the samples was determined using QIIME and HOMINGS. Data were analyzed using t tests and ANOVA. A total of 1,038,656 good quality sequences were obtained, and OTUs were assigned to 10 bacterial phyla, led by Bacteroidetes (51.2%) and Firmicutes (27.1%), and 94 genera were represented primarily by Prevotella (17.9%) and Bacteroidaceae G-1 (14.3%). Symptomatic teeth were associated with higher levels of Porphyromonas (p < 0.05) and Prevotella. P. endodontalis and P. oris were present in both cores. The present study demonstrated the complexity of the root canal microbiome and the "common denominators" of root canal infections and identified taxa whose virulence properties should be further explored. The polymicrobial etiology of endodontic infections has long been established. However, few studies have focused on expanding the breadth and depth of coverage of microbiome-infected root canals at their apical portion.

Adaptable fiberglass post after 3D guided endodontic treatment: Novel approaches in restorative dentistry.

OBJECTIVE: The rehabilitation of extensively damaged teeth with great structural loss and calcified root canals represents a challenge for dentistry. Classically, this restorative procedure of endodontically treated teeth involves intraradicular post placement. Retentive function post that can closely adapt to the root canal without the excessive wear of intraradicular dentin has a fundamental importance to ensure the longevity of the restoration. CLINICAL CONSIDERATIONS: This report presents a clinical case of 3D guided access to a severely calcified pulp canal followed by the cementation of a fiberglass post that is adaptable to the root canal and prosthetic rehabilitation with full ceramic crown. CONCLUSIONS: 3D guided access allowed conservative and safe root canal treatment. The adaptable fiberglass post meets the specific needs of the described case and has a simple technique and low cost. CLINICAL SIGNIFICANCE: Guided endodontics is a minimally invasive approach for teeth with calcified root canals. The post used in this study meets the demands of teeth endodontically treated with conservative techniques. The professional should not need to adapt the anatomy of the root canal to the anatomical reality of the post. This one adapts itself to the shape of the canal.

3D Apicoectomy Guidance: Optimizing Access for Apicoectomies.

When conventional endodontic treatment resources are depleted, endodontic surgery becomes an alternative treatment for apical periodontitis to remove unreachable infected areas and seal the root canal. Digital workflows have been used more frequently in many dental applications in recent years. In endodontics, virtual 3-dimensional (3D) planning and endodontic guidance are new aspects important for the treatment of complex cases. This report aimed to present 3D Apicoectomy Guidance, a novel method of performing guided ultraconservative endodontic surgery with conventional implant-guided drills, and to describe its application in a case with a complex anatomic scenario and intimate contact with the maxillary sinus. Implantology computer software, as well as cone-beam computed tomography images and a digital scanning 3D impression, enabled virtual planning of the surgical procedure. Subsequently, a 3D template was produced to guide the instruments used in the osteotomy and root resection. The patient was completely asymptomatic at the 1-week follow-up visit. Cone-beam computed tomography scans were performed at 1 and 6 months after surgery and showed that resection of the apex of the root was performed accurately and that a thin dentin slice remained distally, preventing the rupture of the sinus membrane. The patient remained asymptomatic, and the tissue healed normally. The method used was shown to be very straightforward and reliable. This method allowed the patient to be treated expeditiously with very precise tissue removal.

Influence of genetic regulatory effects modified by environmental immune activation on periapical disease.

The objective of this study was to compare the periradicular responses in endodontic infections among members of two populations: an urban Brazilian population and a non-mixed indigenous population. Samples were collected immediately and 7 days after the cleaning and shaping procedures (after reducing the intracanal microbial load) in an attempt to characterize the expression of tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, IL-9, interferon (IFN)-γ, IL-17, IL-10, and the chemokines CXCR4, CCL2/monocyte chemotactic protein (MCP)-1, and CCR6. The endogenous cytokine and chemokine expression levels were analyzed using real-time PCR. Only the urban population showed a significant increase in TNF-α, CCL2/MCP-1, CXCR4, and CCR6 expression following the cleaning and shaping of the root canal system. The IFN-γ levels were increased at the 2nd collection (p < 0.05) in the indigenous population. In turn, a significant increase in IL-10 and IL-17 expression (p < 0.05) was observed after the cleaning and shaping procedures (2nd collection) in both populations. No significant differences in the IL-1ß, IL-9, and CCL4 expression levels were observed between the 1st and 2nd collections in both populations. The results demonstrate a cytokine and chemokine expression profile that is specific to each analyzed population. However, immune modulation mediated by IL-10 began on the 7th day after the beginning of the endodontic treatment in both populations.

Murine Experimental Root Canal Infection: Cytokine Expression in Response to F. nucleatum and E. faecalis.

The aim of this study was to evaluate the gene expression of proinflammatory (RANKL, TNF-a and IFN-g) and regulatory (TGF-b and IL-10) cytokines as reaction to experimental infection by mono or bi-association of Fusobacterium nucleatum (ATCC 10953) and Enterococcus faecalis (ATCC 19433). F. nucleatum and E. faecalis, either in mono- or bi-association were inoculated into the root canal system (RCS) of Balb/c mice. Animals were sacrificed at 10 and 20 days after infection and periapical tissues surrounding the root were collected. The mRNA expression of the cytokines RANKL, TNF-a, IFN- g, TGF-b and IL-10 was assessed using real-time PCR. The Kruskal-Wallis test was used for statistical analysis. F. nucleatum mono-infection induced high expression of RANKL and TNF-a, while its modulation was due to IL-10. High expression of IFN-g at day 20 was up-regulated by E. faecalis and RANKL; TNF-a was up-regulated by an independent mechanism via IL-10 and TGF-b. Bi-association (F. nucleatum and E. faecalis) stimulated high expression of RANKL, TNF-a and IFN-g, which seemed to be modulated by TGF-b 20 days later. The gene expression of proinflammatory cytokines was more prominent in the earlier periods of the experimental periapical infection, which concomitantly decreased in the later period. This expression may be regulated by IL-10 and TGF-b in an infection-specific condition.

Murine Experimental Root Canal Infection: Cytokine Expression in Response to F. nucleatum and E. faecalis

Abstract The aim of this study was to evaluate the gene expression of proinflammatory (RANKL, TNF-a and IFN-g) and regulatory (TGF-b and IL-10) cytokines as reaction to experimental infection by mono or bi-association of Fusobacterium nucleatum (ATCC 10953) and Enterococcus faecalis (ATCC 19433). F. nucleatum and E. faecalis, either in mono- or bi-association were inoculated into the root canal system (RCS) of Balb/c mice. Animals were sacrificed at 10 and 20 days after infection and periapical tissues surrounding the root were collected. The mRNA expression of the cytokines RANKL, TNF-a, IFN- g, TGF-b and IL-10 was assessed using real-time PCR. The Kruskal-Wallis test was used for statistical analysis. F. nucleatum mono-infection induced high expression of RANKL and TNF-a, while its modulation was due to IL-10. High expression of IFN-g at day 20 was up-regulated by E. faecalis and RANKL; TNF-a was up-regulated by an independent mechanism via IL-10 and TGF-b. Bi-association (F. nucleatum and E. faecalis) stimulated high expression of RANKL, TNF-a and IFN-g, which seemed to be modulated by TGF-b 20 days later. The gene expression of proinflammatory cytokines was more prominent in the earlier periods of the experimental periapical infection, which concomitantly decreased in the later period. This expression may be regulated by IL-10 and TGF-b in an infection-specific condition

Resumo O objetivo deste trabalho foi avaliar a expressão gênica de citocinas pró-inflamatórias (RANKL, TNF-a e IFN-g) e regulatórias (TGF-b e IL-10) em resposta à infecção experimental por Fusobacterium nucleatum (ATCC 10953) e Enterococcus faecalis (ATCC 19433) como mono-infecção ou em bi-associação. F. nucleatum e E. faecalis foram inoculados no sistema de canais radiculares de camundongos Balb/c, tanto isoladas como em bi-associação. Os animais foram sacrificados em 10 e 20 dias após a infecção, e os tecidos periapicais foram coletados. As expressões do mRNA das citocinas RANKL, TNF-a, IFN-g, TGF-b e IL-10 foram analisadas por meio do real-time PCR. O teste de Kruskal-Wallis foi utilizado para análise estatística. A mono-infecção com F. nucleatum induziu alta expressão de RANKL e TNF-a, enquanto sua modulação ocorreu devido à IL-10. A alta expressão de IFN-g no dia 20 foi regulada positivamente por E. faecalis e RANKL; TNF-a foi regulada positivamente por um mecanismo independente via IL-10 e TGF-b. A bi-associação (F. nucleatum e E. faecalis) estimulou uma alta expressão de RANKL, TNF-a e IFN-g, que parece ser modulada por TGF-b após 20 dias. A expressão gênica de citocinas pró-inflamatórias foi mais proeminente nos estágios iniciais da infecção periapical experimental, com concomitante redução no período tardio. Este fenômeno pode ser regulado por IL-10 e TGF-b em uma condição de infecção específica.

Maintenance of pulpal vitality in a tooth with deep caries: a case report.

Deep caries can induce severe inflammatory reactions. However, inflamed pulp can heal if the demineralization process is interrupted and inactivated sufficiently early. The aim of this case report is to describe the use of stepwise excavation to treat a mature permanent tooth that exhibited deep caries and apical periodontitis. A 12-year-old girl was experiencing lingering pain lasting for a few minutes in the mandibular left second molar when drinking cold water. Clinical and radiographic examinations suggested that a conservative therapeutic approach could be successful. The tooth was anesthetized and isolated, and the unsupported enamel was removed. The remaining affected dentin was left on the pulpal floor, which was protected by a thin layer of calcium hydroxide cement. The tooth was sealed with temporary cement. Three months later, pulpal sensitivity was reduced. The pulp was found to be healthy at a 9-month follow-up examination. The cavity was definitively restored with glass ionomer cement and composite resin applied with the sandwich technique. At the 4-year follow-up, the tooth remained functional, presenting standard color and satisfactory restoration. The periodontal tissues were healthy, and radiographic images indicated that the width of the periodontal ligament space was normal. This case demonstrates that clinical diagnosis should prevail over radiographic findings, even in cases where a radiographic widening of the periodontal ligament space suggests irreversible pulpal damage.

Sickle cell anemia in Brazil: personal, medical and endodontic patterns.

Sickle cell anemia (SCA) is the most prevalent genetic disease worldwide. Recurrent vaso-occlusive infarcts predispose SCA patients to infections, which are the primary causes of morbidly and mortality. This study aimed to evaluate the relationship between SCA and endodontic diseases. Personal information, medical data (hematological indices, virologic testing, blood transfusions, medications received, splenectomy) and information on the need for endodontic treatment were obtained from SCA patients who were registered and followed up by the Fundação Hemominas, Minas Gerais, Brazil.These data were compared with the need for root canal treatment in SCA patients. One hundred eight patients comprised the studied population, and the rate of the need for endodontic therapy was 10.2%. Among the medical data, a significant difference was observed for eosinophil (p = 0.045) counts and atypical lymphocyte counts (p = 0.036) when the groups (with and without the need for endodontic treatment) were compared. Statistical relevance was observed when comparing the patients with and without the need for root canal therapy concerned eosinophil counts and atypical lymphocyte counts. The differences in statistical medical data, observed between the groups suggest that both parameters are naturally connected to the stimulation of the immune system that can occur in the presence of root canal infections and that can be harmful to SCA individuals.

Resolução de complicações clínicas em casos de obliteração cálcica da polpa: relato de dois casos / Management of clinical complications fol- lowing pulp canal obliteration: a report of two cases

Introdução: a obliteração cálcica da polpa (PCO), é de nida como a deposição de tecido mineralizado no espaço do canal radicular. Tal alteração pode ocorrer de forma idiopática ou após capeamento direto ou trauma. Nessas situações, o clínico pode se deparar com um canal de negociação difícil ou impossível, com alto risco de insucesso. Nesse complexo cenário, o clínico deverá estar preparado para empregar diferentes condutas para resolução do caso. Quando uma região estética se encontra envolvida, os esforços clínicos devem ser ainda mais judiciosos. O presente trabalho tem por objetivo apresentar e discutir os métodos empregados na resolução clínica de dois casos clínicos de incisivos centrais superiores com PCO que apresentavam complicações iatrogênicas prévias.