Biological Properties of Experimental Methacrylate-Based Sealers Containing Calcium Phosphates.

This study aimed to evaluate, in vitro and in vivo, the biocompatibility of experimental methacrylate-based endodontic sealers containing α-tricalcium phosphate (α-TCP) or nanostructured hydroxyapatite (HAp). Experimental methacrylate-based dual-cure sealers with the addition of α-TCP or HAp, at 10%wt were formulated and compared to AH Plus (AHP). Cell viability was assessed by 3-(4,5-dimethyl-thiazoyl)-2,5-diphenyl-tetrazolium bromide (MTT), and sulforhodamine B (SRB). Sealers were implanted in rats' subcutaneous tissue and histologically evaluated. Bioactivity was assessed by alkaline phosphatase enzyme activity (ALP) and Alizarin Red (AR), using apical papillary cells (SCAPs), and by the bone deposition measured in surgical cavities on rats' femur filled with AH Plus or α-TCP. In both viability assays, HAp and AHP sealers were similar, and α-TCP presented lower viability compared to the others at MTT assay (p<0.05). A gradual decrease of the inflammatory response according to the periods was observed and AHP was the only that presented giant cells (7-day period). Collagen fibers condensation increased according to the periods, with no differences among sealers. There was an increase at ALP activity and mineralized nodules deposition according to periods. HAp and α-TCP presented higher values for ALP activity at 5 days and at 5, 10, and 15 days for AR and were different from AHP (p<0.05). α-TCP presented superior values at 10 and 15 days compared to HAp and AHP for AR (p<0.05). At 90 days, α-TCP and control (empty cavity) showed high bone deposition compared to AHP (p<0.05). α-TCP and HAp, in a methacrylate-based sealer, presented biocompatibility and bioactivity, with the potential to be used as endodontic sealers in clinical practice. Further investigations are required to gain information on the physicochemical properties of these sealers formulation before its clinical implementation.

Cytocompatibility and cell proliferation evaluation of calcium phosphate-based root canal sealers.

OBJECTIVES: This study aimed to evaluate the cell viability and migration of Endosequence Bioceramic Root Canal Sealer (BC Sealer) compared to MTA Fillapex and AH Plus. MATERIALS AND METHODS: BC Sealer, MTA Fillapex, and AH Plus were placed in contact with culture medium to obtain sealers extracts in dilution 1:1, 1:2 and 1:4. 3T3 cells were plated and exposed to the extracts. Cell viability and migration were assessed by 3-(4,5-dimethyl-thiazoyl)-2,5-diphenyl-tetrazolium bromide (MTT) and Scratch assay, respectively. Data were analyzed by Kruskal-Wallis and Dunn's test (p < 0.05). RESULTS: The MTT assay revealed greater cytotoxicity for AH Plus and MTA Fillapex at 1:1 dilution when compared to control (p < 0.05). At 1:2 and 1:4 dilutions, all sealers were similar to control (p > 0.05) and MTA Fillapex was more cytotoxic than BC Sealer (p < 0.05). Scratch assay demonstrated the continuous closure of the wound according to time. At 30 hours, the control group presented closure of the wound (p < 0.05). At 36 hours, only BC Sealer presented the closure when compared to AH Plus and MTA Fillapex (p < 0.05). At 42 hours, AH Plus and MTA Fillapex showed a wound healing (p > 0.05). CONCLUSIONS: All tested sealers demonstrated cell viability highlighting BC Sealer, which showed increased cell migration capacity suggesting that this sealer may achieve better tissue repair when compared to other tested sealers.

Influence of photobiomodulation therapy on root development of rat molars with open apex and pulp necrosis.

This study aimed to evaluate the role of photobiomodulation (PBM) in apexification and apexogenesis of necrotic rat molars with an open apex. Rat molars were exposed to the oral environment for 3 weeks. Canals were rinsed with 2.5% NaOCl and 17% EDTA, filled with antibiotic paste and sealed. After 7 days, canals were rinsed and divided into six groups (n=6): mineral trioxide aggregate (MTA); blood clot (BC); human dental pulp stem cells (hDPSC); MTA+PBM; BC+PBM; and hDPSC+PBM. In hDPSC groups, a 1% agarose gel scaffold was used. Two groups were not exposed: healthy tooth+PBM (n = 6), healthy tooth (n = 3); and one was exposed throughout the experiment: necrotic tooth (n = 3). In PBM groups, irradiation was performed with aluminum gallium indium phosphide (InGaAlP) diode laser for 30 days within 24-h intervals. After that, the specimens were processed for histological and immunohistochemical analyses. Necrotic tooth showed greater neutrophil infiltrate (p < 0.05). Necrotic tooth, healthy tooth, and healthy tooth+PBM groups showed absence of a thin layer of fibrous condensation in the periapical area. All the other groups stimulated the formation of a thicker layer of fibers (p < 0.05). All groups formed more mineralized tissue than necrotic tooth (p < 0.05). PBM associated with MTA, BC, or hDPSC formed more mineralized tissue (p < 0.05). MTA+PBM induced apexification (p < 0.05). Rabbit polyclonal anti-bone sialoprotein (BSP) antibody confirmed the histological findings of mineralized tissue formation, and hDPSC groups exhibited higher percentage of BSP-positive cells. It can be concluded that PBM improved apexification and favored apexogenesis in necrotic rat molars with an open apex.

Antimicrobial effect of bioceramic cements on multispecies microcosm biofilm: a confocal laser microscopy study.

OBJECTIVES: To assess the viability of multispecies microcosm biofilm after contact with NeoMTA Plus, Biodentine, and MTA Angelus. MATERIALS AND METHODS: Fifty-four human dentin blocks (4 × 5 × 4 mm) were allocated to Hawley retainers, worn by six volunteers for 72 h. The blocks were then individually incubated in BHI broth for 21 days at 37 °C. At the end of experimental time for biofilm growth, the samples were randomly divided into four groups (n = 12): NeoMTA Plus, Biodentine, MTA Angelus, and negative control. The materials were placed in contact with the blocks. All samples were placed in cell-culture plate wells and incubated in BHI broth for 7 days at 37 °C. One sample from each volunteer (n = 6) was analyzed by SEM to describe the biofilm morphology. CLSM was performed to determine the percentage of viable biofilm biovolume. The data were statistically analyzed by one-way ANOVA and Tukey's multiple comparison test (α = 5%). RESULTS: SEM showed biofilm formed by spherical and rod-shaped bacteria surrounded by an extracellular matrix. No material was able to kill all biofilm cells, and all groups had more than 50% of viable bacteria. NeoMTA Plus was significantly different from the negative control group (P < .05). CONCLUSIONS: All tested materials were not effective against multispecies microcosm biofilm. CLINICAL RELEVANCE: NeoMTA Plus, Biodentine, and MTA Angelus were not effective against multispecies microcosm biofilm. It is essential to understand that these bioceramic cements are indicated for infected clinical situations. Thus, complementary disinfection procedures should be conducted prior to filling with these materials.

Influence of photobiomodulation therapy on root development of rat molars with open apex and pulp necrosis

Abstract This study aimed to evaluate the role of photobiomodulation (PBM) in apexification and apexogenesis of necrotic rat molars with an open apex. Rat molars were exposed to the oral environment for 3 weeks. Canals were rinsed with 2.5% NaOCl and 17% EDTA, filled with antibiotic paste and sealed. After 7 days, canals were rinsed and divided into six groups (n=6): mineral trioxide aggregate (MTA); blood clot (BC); human dental pulp stem cells (hDPSC); MTA+PBM; BC+PBM; and hDPSC+PBM. In hDPSC groups, a 1% agarose gel scaffold was used. Two groups were not exposed: healthy tooth+PBM (n = 6), healthy tooth (n = 3); and one was exposed throughout the experiment: necrotic tooth (n = 3). In PBM groups, irradiation was performed with aluminum gallium indium phosphide (InGaAlP) diode laser for 30 days within 24-h intervals. After that, the specimens were processed for histological and immunohistochemical analyses. Necrotic tooth showed greater neutrophil infiltrate (p < 0.05). Necrotic tooth, healthy tooth, and healthy tooth+PBM groups showed absence of a thin layer of fibrous condensation in the periapical area. All the other groups stimulated the formation of a thicker layer of fibers (p < 0.05). All groups formed more mineralized tissue than necrotic tooth (p < 0.05). PBM associated with MTA, BC, or hDPSC formed more mineralized tissue (p < 0.05). MTA+PBM induced apexification (p < 0.05). Rabbit polyclonal anti-bone sialoprotein (BSP) antibody confirmed the histological findings of mineralized tissue formation, and hDPSC groups exhibited higher percentage of BSP-positive cells. It can be concluded that PBM improved apexification and favored apexogenesis in necrotic rat molars with an open apex.

Photobiomodulation therapy improves multilineage differentiation of dental pulp stem cells in three-dimensional culture model.

Photobiomodulation therapy (PBM) has shown positive effects on stem cell differentiation in monolayer cell culture model, but little is known about its effect on three-dimensional (3-D) agarose gel culture. This study evaluated the PBM effect of human dental pulp stem cells (hDPSCs) differentiation and phosphatase alkaline activity (ALP) using an agarose 3-D model under different nutritional conditions. hDPSCs were characterized and seeded on a 0.3% agarose gel layer with different media (osteogenic, adipogenic, chondrogenic) and were assigned into four groups: control 10% fetal bovine serum (FBS), control 5% FBS, PBM 10% FBS, and PBM 5% FBS. Irradiation was performed with continuous-wave InGaAlP laser, 660 nm, 100 mW, 3,3 J / cm2, spot size 0.3 cm2, 10 s of exposure time, and 1 J of energy per point with 6-h interval between sessions. All groups were evaluated at 7 and 14 days. ALP assay was performed to analyze the deposition of mineralized tissue. At 7 days, PBM 5% FBS group presented better stimulation in osteogenic and adipogenic differentiation compared with control. After 14 days, hDPSCs cultured in 3-D exhibited osteogenic, adipogenic, and chondrogenic differentiation; furthermore, compared to control, PBM significantly stimulated all differentiation processes (p < 0.05). It can be concluded that hDPSCs cultured in 3-D agarose associated to PBM could be a promising tool for tissue engineering applications.

Shaping ability of rotatory or reciprocating instruments in curved canals: a micro-computed tomographic study.

This study aimed to compare apical transportation, centering ratio, and working time during root canal preparation with Wizard Navigator (WN), WaveOne (WO), or ProTaper Universal (PT) and to describe deformation and fracture of these instruments. Thirty-six mesiobuccal roots from maxillary molars were micro-computed tomography (micro-CT) scanned and then sorted into three groups (n = 12): Wizard Navigator (WN), WaveOne (WO), and ProTaper Universal (PT). The root canals were prepared using WN, WO, or PT; the time of each canal preparation was timed; and the specimens were micro-CT re-scanned. The instruments were submitted to scanning electron microscopy (SEM) before and after their use. The data on canal transportation at 1, 2, 3, 4 and 5 mm and preparation time were analyzed by the Kruskal-Wallis test, followed by the Mann-Whitney U test. The centering ratio was analyzed by ANOVA, followed by Tukey's test. Both instrument deformation and fracture were described. Apical transportation was similar among groups at 1, 2, 3 and 4 mm. The WO group showed higher canal transportation at 5mm than the other groups (p = 0.03). There was no significant difference in centering ratio among the groups. Preparation time in the WO group was significantly lower than in the other groups (p = 0.004). Small differences were observed in the surface area of all instruments. The WN, WO, and PT groups had a similar centering ratio without procedural errors or significant structural changes. At 5 mm from the apex, the WO group showed the largest canal transportation toward the furcation and root canal preparation was faster than in the WN and PT groups.

Influence of operating microscope in the sealing of cervical perforations.

CONTEXT: Accidental root canal perforations are among the main complications of endodontic treatment. AIM: This study evaluated the influence of operating microscope (OM) in the marginal adaptation of mineral trioxide aggregate (MTA) (Angelus(®)) and glass ionomer (Vitremer) inserted into cervical perforations. MATERIALS AND METHODS: Perforations were made in the cervical third of the buccal wall of the root canal in mandibular incisors. Next, the teeth were divided into four groups (N = 10): MG - MTA without OM; VG - Vitremer without OM; MOMG - MTA with OM; VOMG - Vitremer with OM. The perforations were sealed according to the group and the teeth were prepared for analysis by confocal laser scanning microscope. Images of perforation region (1,024×) were made and the gap presented by the materials was measured using the Image J program. LEXT OLS4100 three dimensional (3D) measuring laser microscope measured the volumetric misfit. Data of gap were analyzed by Kruskal-Wallis and Dunn's tests. Analysis of variance (ANOVA) and Tukey's tests compared the volumetric misfits. RESULTS: The results showed lower volume and gap in the interface dentin/material in VOMG compared to the other groups (P < 0.05). CONCLUSION: The use of OM improved the quality of cervical perforations sealed with Vitremer, being indicated in clinical situations of iatrogenic cervical perforations.

Shaping ability of rotatory or reciprocating instruments in curved canals: a micro-computed tomographic study

Abstract This study aimed to compare apical transportation, centering ratio, and working time during root canal preparation with Wizard Navigator (WN), WaveOne (WO), or ProTaper Universal (PT) and to describe deformation and fracture of these instruments. Thirty-six mesiobuccal roots from maxillary molars were micro-computed tomography (micro-CT) scanned and then sorted into three groups (n = 12): Wizard Navigator (WN), WaveOne (WO), and ProTaper Universal (PT). The root canals were prepared using WN, WO, or PT; the time of each canal preparation was timed; and the specimens were micro-CT re-scanned. The instruments were submitted to scanning electron microscopy (SEM) before and after their use. The data on canal transportation at 1, 2, 3, 4 and 5 mm and preparation time were analyzed by the Kruskal-Wallis test, followed by the Mann-Whitney U test. The centering ratio was analyzed by ANOVA, followed by Tukey's test. Both instrument deformation and fracture were described. Apical transportation was similar among groups at 1, 2, 3 and 4 mm. The WO group showed higher canal transportation at 5mm than the other groups (p = 0.03). There was no significant difference in centering ratio among the groups. Preparation time in the WO group was significantly lower than in the other groups (p = 0.004). Small differences were observed in the surface area of all instruments. The WN, WO, and PT groups had a similar centering ratio without procedural errors or significant structural changes. At 5 mm from the apex, the WO group showed the largest canal transportation toward the furcation and root canal preparation was faster than in the WN and PT groups.

Effect of low-level laser irradiation on proliferation and viability of human dental pulp stem cells.

A positive effect of low-level laser irradiation (LLLI) on the proliferation of some cell types has been observed, but little is known about its effect on dental pulp stem cells (DPSCs). The aim of this study was to identify the lowest energy density able to promote the proliferation of DPSCs and to maintain cell viability. Human DPSCs were isolated from two healthy third molars. In the third passage, the cells were irradiated or not (control) with an InGaAlP diode laser at 0 and 48 h using two different energy densities (0.5 and 1.0 J/cm²). Cell proliferation and viability and mitochondrial activity were evaluated at intervals of 24, 48, 72, and 96 h after the first laser application. Apoptosis- and cell cycle-related events were analyzed by flow cytometry. The group irradiated with an energy density of 1.0 J/cm² exhibited an increase of cell proliferation, with a statistically significant difference (p < 0.05) compared to the control group at 72 and 96 h. No significant changes in cell viability were observed throughout the experiment. The distribution of cells in the cell cycle phases was consistent with proliferating cells in all three groups. We concluded that LLLI, particularly a dose of 1.0 J/cm², contributed to the growth of DPSCs and maintenance of its viability. This fact indicates this therapy to be an important future tool for tissue engineering and regenerative medicine involving stem cells.

Tratamento de uma perfuração complexa de furca: relato de caso / Treatment of a large furcal perforation: Case Report

Introdução: Comunicações endo-periodontais podem ocorrer a partir de reabsorções, cárie ou eventos iatrogênicos durante o tratamento endodôntico. Perfurações de furca podem ter um impacto negativo no prognóstico por comprometer o aparelho de fixação. Este estudo relata o tratamento de perfuração de furca do primeiro molar inferior direito (46) resultando na manutenção de dente severamente comprometido. Relato do caso: Clinicamente o paciente apresentava fístula ativa, tecido de granulação na área da perfuração e ausência de mobilidade patológica. Na radiografia inicial foi observada área radiolúcida extensa na região de furca e o tratamento endodôntico previamente realizado apresentava-se dentro das condições de normalidade. Através das inspeções visual e radiográfica foi diagnosticada a perfuração complexa de furca. O tratamento foi realizado com MTA branco e o paciente foi proservado. Após um ano de acompanhamento, observaram-se condições de normalidade, após reabilitação protética, sugestiva de saúde, bem como, um quadro clínico revelando o restabelecimento da saúde periodontal. Conclusão: O tamanho da perfuração levaria a um prognóstico sombrio, porém nesta situação de paciente jovem e perfuração severa, torna-se muito importante a adoção de procedimento mais conservador para manutenção do elemento dental

Introduction: Endo-periodontal communications can happens from reabsorption, carie or iatrogenic during endodontic treatment. Furcation perforation may have a negative impact on prognosis because compromising the periodontal attachment. The aim of this study was to report the treatment of furcation perforation of right mandibular first molar (46) resulting in the maintenance of teeth severely compromised. Case Report: Clinically, the patient had active fistula, granulation tissue in the area of drilling and absence of pathological mobility. In the initial radiographic was observed extensive radiolucent area in the furcation area and a previo endodontic treatment in conditions of normality. Through visual and radiographic inspection was diagnosed drilling large furcation perforation. The treatment was performed with white MTA and the case was followed. After a year of monitoring, observed normality conditions, after prosthetic restoration, suggestive of health, as well as, a clinical situation revealing the restoration of periodontal health. Conclusion: The perforation size would lead to a poor prognosis, but in this situation the young patient and severe drilling, it becomes very important to adopt more conservative procedure for maintenance of the dental element. as well as a clinical revealing the restoration of periodontal health.

Enxerto de conjuntivo em implantes imediatos na região anterior / Connective graft in immediate implants in the anterior region - literature review

A evolução da Implantodontia está relacionada com o restabelecimento dos aspectos funcionais e estéticos dos pacientes que apresentam ausências dentárias, principalmente em regiões anteriores superiores. A devolução ou preservação da estética dos pacientes reabilitados com implantes dentários têm permitido o emprego de novas abordagens cirúrgicas, e a sua avaliação ajuda a determinar o comportamento dos tecidos peri-implantares. Desta forma, este artigo teve o objetivo de apresentar uma revisão de literatura referente ao uso do enxerto de tecido conjuntivo, associado a implantes imediatos na região estética, e discutir suas indicações e previsibilidade. De acordo com os estudos analisados, sugere-se que o uso de implantes imediatos em região anterior, associado à colocação do enxerto de tecido conjuntivo subepitelial, pode melhorar o aspecto estético da região anterior superior. Desta forma, esta pode ser uma opção de tratamento para reabilitação daqueles casos em que a função e a estética devem ser priorizadas.

Previsibilidade do recobrimento radicular de recessão gengival classe III de Miller – uma revisão de literatura / Predictability of root coverage of Miller Class III gingival recessions- Review of the literature

As recessões gengivais têm sido consideradas um dos principais objetivos da terapia cirúrgica periodontal com a intenção de atingir a cobertura completa da raiz. Diversas modalidades de tratamento têm sido desenvolvidas, mas poucas técnicas podem obter a cobertura total da raiz em uma recessão gengival classe III de Miller. A solução para o recobrimento de superfícies radiculares expostas a este nível envolve a realização de um procedimento cirúrgico bem executado e por um grau de previsibilidade ainda mais crítico. Diante do exposto, o objetivo deste artigo foi avaliar, por meio de uma revisão de literatura, a previsibilidade e taxas de recobrimento radicular em recessões gengivais Classe III. Os resultados dos estudos mais recentes revelaram que as taxas de sucesso de recobrimento radicular têm aumentado, próximo a 80%, semelhante às técnicas para recessões Classes I e II. Apesar dos poucos estudos disponíveis, tem havido uma modificação na indicação dos procedimentos de recobrimento radicular, modifcação da previsibilidade da sua utilização e melhora dos resultados alcançados. Torna-se uma abordagem disponível ao tratamento das recessões gengivais com perda de inserção interdental

Gingival recessions have been considered one of the main goals of periodontal surgical therapy in attempt to achieve full root coverage. Several treatment modalities have been developed, but few techniques can achieve full root coverage in a Miller class III gingival recession. The solution for the covering of exposed root surfaces at this level involves a well performed surgical procedure and a predictability even more critical. According to this, the aim of this paper was to evaluate, through a literature review, the predictability and rates for root coverage in Miller Class III gingival recessions. The results of recent studies have shown that the success rate has increased root coverage percentage, close to 80%, similar to techniques for Classes I and II gingival recessions. Despite the few studies available, there has been a change in the indication for root coverage procedures as well as the predictability of its use and the results achieved have increased. It becomes an available approach for the treatment of gingival recessions with interdental attachment loss