Evaluation of Blood Clot, Platelet-rich Plasma, Platelet-rich Fibrin, and Platelet Pellet as Scaffolds in Regenerative Endodontic Treatment: A Prospective Randomized Trial.

INTRODUCTION: Regenerative endodontic procedures (REPs) using autologous platelet concentrates as scaffolds can improve the biologic outcome of treatment. This prospective, randomized trial compared the clinical and radiographic performance of REPs using platelet-rich plasma (PRP), platelet-rich fibrin (PRF), a platelet pellet (PP), and an induced blot clot (BC). METHODS: Sixty-seven healthy children (aged 8-11 years) with 88 immature necrotic incisors were included. After the root canal disinfection step, the teeth were randomly assigned into 1 of the following groups (n = 22/group) according to the scaffold used: PRP, PRF, PP, and BC. In the PRP, PRF, and PP groups, the platelet concentrates were introduced into the root canal without prior induction of apical bleeding. Treatment outcomes were assessed using a combined clinical and radiographic scoring system, whereas the changes in root dimensions were compared using linear measurements of root length and width with ImageJ (National Institutes of Health, Bethesda, MD) and Turboreg (Biomedical Imaging Group, Swiss Federal Institute of Technology, Lausanne, Switzerland) and planar measurements using the radiographic root area (RRA) and radiographic canal area (RCA) techniques. One-way analysis of variance, the Duncan multiple range test, the Kruskal-Wallis test, the Mann-Whitney U test, and chi-square dependency tests were used for statistical analysis of data (all P = .05). RESULTS: Except for 2 teeth in the PRF and BC groups, all teeth showed similar and high success scores (periapical healing, radiographic root development, and positive response to sensitivity tests) after an average follow-up time of 28.25 ± 1.2 months. Of all teeth, 73.9% showed complete apical closure with similar closure rates among groups (P > .05) and a greater tendency for conical-shaped apical closure than a blunt apex. Although linear measurements indicated a similar increase in root length and width among all groups (P > .05), the RRA of the BC group was significantly greater than those of the PRF and PP groups, and the RCA of the BC group was significantly greater than PRP, PRF, and PP (all P < .05) when the follow-up time was not used as a factor. Eighty-six percent of the teeth showed a positive response to sensitivity tests with similar initial response times (P > .05). CONCLUSIONS: PRP, PRF, and PP can yield similar clinical and radiographic outcomes to BC without the need for prior apical bleeding and with significantly less tendency for root canal obliteration. RRA and RCA may reveal minor differences that cannot be determined by linear measurements.

A Comparative Study of Oral Health Parameters in Molar Incisor Hypomineralization and High-Caries-Risk Children Aged 8-11 Years.

OBJECTIVE: To compare oral health parameters: decayed missing filled teeth (dmft, DMFT), gingival index and plaque index in high-caries-risk children and children with molar incisor hypomineralization (MIH). SUBJECTS AND METHODS: A study group of 81 children affected by MIH (49 girls, 32 boys) aged 8-11 years (mean 9.4 ± 1.1) was race-, age- and sex-matched with 81 high-caries-risk children not affected by MIH (controls). The MIH and control groups were divided into four subgroups according to age. The oral health parameters of both groups were recorded under clinical conditions. Mann-Whitney U and Kruskal-Wallis tests were used to compare the differences in the number of MIH-affected teeth between the groups. Other traits were evaluated with the ANOVA test, and Duncan's multiple comparison tests were used for comparing means. Linear and ordinal regression analyses were used to model the variables. RESULTS: The mean age of the participants was 9.4 ± 1.1 years, and the mean number of affected teeth was 7.7 (range 3-12) in the MIH group. The number of affected teeth and severity of MIH did not change significantly with age and sex (p > 0.05). A comparison of the oral health parameters of MIH-affected and control children according to groups did not show any statistically significant differences between the groups for all parameters for all groups (p > 0.05) with the exception of DMFT values at 10 years of age (p < 0.05). In a comparison of the total scores without taking age into account, the children with MIH showed a significantly higher DMFT value than the children without MIH (p < 0.05), but there were no significant differences between the dmft, GI and PI values of the study groups (p > 0.05). CONCLUSION: The children in the MIH group had higher DMFT than those without MIH. Hence, the presence of MIH could have a detrimental effect on oral health parameters, especially on DMFT values.

Antibacterial effect of N-acetylcysteine and taurolidine on planktonic and biofilm forms of Enterococcus faecalis.

AIM: This study investigated the antimicrobial activity of taurolidine and N-acetylcysteine (NAC) on planktonic and biofilm Enterococcus faecalis phenotypes. MATERIALS AND METHODS: The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of NAC and taurolidine were determined using broth microdilution, utilizing calcium hydroxide (CH), sodium hypochlorite, and chlorhexidine for comparisons. Thereafter, the ability of dentin powder to neutralize the antibacterial activity of NAC and taurolidine was studied. The efficacy of both antimicrobial agents on E. faecalis biofilms was examined quantitatively by exposure of 21-day-old E. faecalis biofilms on dentin disks. The cytotoxicity of human dental pulp fibroblast cells in contact with the extracts was evaluated by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyltetrazolium bromide (MTT) assay. RESULTS: The MIC and MBC of NAC, taurolidine, and CH were not affected by pre-incubation in dentin powder. As verified by qualitative assay of E. faecalis biofilms, CH was the strongest bactericidal agent at all test dilutions, regardless of the presence of dentin powder. The antibacterial effect of NAC and taurolidine was significantly lower than that of CH at all test dilutions. At 48 h, all test agents showed similar, but high levels of cytotoxicity. CONCLUSION: NAC and taurolidine were effective against E. faecalis in planktonic state, at the expense of demonstrating cytotoxic effects. For both planktonic and biofilm forms of E. faecalis, neither NAC nor taurolidine offered any advantage over CH.

Evaluation of goat milk as storage media to preserve viability of human periodontal ligament cells in vitro.

BACKGROUND AND AIM: The purpose of this study was to evaluate the effectiveness of goat milk as a storage media for maintenance of periodontal ligament (PDL) cell viability of avulsed teeth and compare it with commonly used and/or investigated storage media. MATERIALS AND METHODS: PDL cells were obtained from the root surface of healthy premolars and were cultured in Eagle's maintenance medium (EMM). Cell cultures were treated with the following storage media: tap water (negative control); EMM (positive control); Hank's balanced salt solution; ultra high temperature (UHT) long-shelf-life lactose-free cow milk; UHT long-shelf-life whole cow milk; UHT long-shelf-life skimmed cow milk; UHT long-shelf-life soy milk; UHT long-shelf-life goat milk, UHT long-shelf-life follow on milk with probiotic, 20% propolis, and egg white. Culture plates were incubated with experimental media at 20°C for 1, 3, 6, 12, and 24 h. PDL cell viability was assessed by tetrazolium salt-based colorimetric (MTT) assay at each test period. One-way anova was used to evaluate the effects of storage solutions at each time point, followed by post hoc Duncan's multiple comparison test (P = 0.05). A dendrogram was constructed to show the arrangement of hierarchical clustering. RESULTS: Goat milk displayed the highest capacity to maintain cell viability at all test intervals (P < 0.001). Between 3 and 24 h, milk with the probiotic showed the lowest time-dependent PDL cell viability among all test media (P < 0.001). Compared with all milks, HBSS performed significantly less effectively in maintaining PDL cell viability during the entire test period (P < 0.001). CONCLUSION: Based on PDL viability, goat milk can be recommended as a suitable storage medium for avulsed teeth.

Management of anterior dental crossbite with removable appliances.

UNLABELLED: This case report describes the treatment of an 8-year-old girl with anterior dental crossbite using a series of removable appliances to bring the teeth into a normal position. CLINICAL PRESENTATION AND INTERVENTION: A removable acrylic appliance with a bite plate incorporating a screw was used to correct the anterior dental crossbite and align the incisors. The subsequent eruption of the maxillary left lateral incisor on the palatinal side was treated with a second acrylic plate incorporating a labiolingual spring. After an 8-month period, the anterior crossbite involving multiple incisors was corrected.

Direct and transdentinal (indirect) antibacterial activity of commercially available dental gel formulations against Streptococcus mutans.

OBJECTIVE: To evaluate the direct and transdentinal (indirect) agar diffusion antibacterial activity of different commercially available antibacterial dental gel formulations against Streptococcus mutans. MATERIALS AND METHODS: The commercially available dental gel formulations were Corsodyl® (COG, 1% chlorhexidine), Cervitec® (CEG, 0.2% chlorhexidine + 0.2% sodium fluoride), Forever Bright® (FOB, aloe vera), Gengigel® (GEG, 0.2% hyaluronic acid), 35% phosphoric acid gel and distilled water (control). Direct agar diffusion was performed by isolating three wells from brain-heart infusion agar plates using sterile glass pipettes attached to a vacuum pump and adding 0.1 ml of the gels to each well. Transdentinal (indirect) agar diffusion was performed by applying gel to 0.2- and 0.5-mm-thick human dentin discs previously etched with phosphoric acid and rinsed with distilled water. Zones formed around the wells and the dentin discs were measured and analyzed using Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction (p < 0.01). RESULTS: Direct agar diffusion tests showed significant differences among all gel formulations (p < 0.01) except for COG and CEG (p > 0.01). COG and CEG exhibited higher antibacterial effects compared to FOB and GEG (p < 0.01) in both direct and transdentinal (indirect) testing procedures. GEG did not show any antimicrobial activity in transdentinal (indirect) testing. CONCLUSION: Commercially available dental gels inhibited S. mutans, which may indicate their potential as cavity disinfectants.

Horizontal migration of pre- and postnatal mental foramen: an anatomic study.

OBJECTIVE: To evaluate the horizontal migration of the human mental foramen before and after birth. METHODS: 54 formalin-fixed fetuses between 17 and 32 weeks of gestation, and 94 panoramic radiographs of children aged between 4 and 12 years were investigated. The distances between the mental foramen and mental symphysis, and the distances between the posterior border of the mandibular ramus and mental foramen were determined according to development periods. RESULTS: Our results confirm that the mental foramen moves in a posterior direction during the development of the mandible. CONCLUSION: The horizontal location of the pre- and postnatal mental foramen changes in a posterior direction as the development progresses, however, prenatal mental foramen features an irregular behavior, while the postnatal mental foramen gradually migrates posteriorly in a regular pattern.