Treatment Outcomes of 4 Vital Pulp Therapies in Mature Molars.

INTRODUCTION: Vital pulp therapy (VPT) is a biological approach to minimally invasive endodontics. This randomized clinical trial aimed to evaluate and compare clinical and radiographic success of 4 VPTs (indirect pulp capping [IPC], direct pulp capping [DPC], miniature pulpotomy [MP], and full pulpotomy [FP]) using calcium-enriched mixture cement for deep caries management of mature permanent molars including teeth with clinical signs of irreversible pulpitis and the presence of apical periodontitis. METHODS: Blinded participants (N = 302) were randomly allocated to 4 study arms. Random allocation was disregarded when visible pulp exposures did not happen after complete caries removal and the tooth was transferred to the IPC arm. Pre- and intraoperative data including vitality test results, pulpal/periapical status, and exposure type/location were recorded. Pain was measured using a numeric rating scale before treatment initiation up to 1 week postoperatively. Participants were followed up for 1 year. RESULTS: The groups were homogenous in terms of age, sex, marital status, education, and practitioner; pre- and intraoperative conditions were similar in all arms and did not affect the long-term success. Preoperative pain and apical periodontitis were significantly different among arms (P < .05); however, it was not the case when the IPC group was excluded. After baseline pain adjustment, pain relief was continuous with similar patterns in all treatment groups. The 3- and 12-month success rates of the VPT techniques were comparable in the IPC (98.7% and 100%, respectively), DPC (98.4% and 94.7%, respectively), MP (98.4% and 91.4%, respectively), and FP (93.5% and 95.5%, respectively) arms, respectively (P > .05). CONCLUSIONS: In deep caries management of mature permanent molars, the 4 VPTs were associated with favorable/comparable clinical and radiographic outcomes. The pulpal and periapical status as well as pulpal exposure type/location had no effect on treatment outcomes.

Long-term outcomes of pulpotomy in permanent teeth with irreversible pulpitis: A multi-center randomized controlled trial.

PURPOSE: To compare success rates of full pulpotomy (FP) with two endodontic biomaterials on symptomatic vital teeth with closed apices in the presence of apical periodontitis. METHODS: In this multicenter controlled clinical trial, 412 volunteers met the inclusion criteria; they were all randomly allocated to either FP/ProRoot mineral trioxide aggregate (MTA) or FP/calcium enriched mixture (CEM) group. The subjects were followed up for 2 and 5 years to evaluate and compare the treatment outcomes. Data were analyzed using Chi square test and the multiple binary logistic regression model. RESULTS: Data for a total number of 344 and 304 subjects were available for 2- and 5-year follow-ups. In terms of clinical outcomes, 2- and 5-year success rates of both groups were ≥ 98%, without significant differences. In terms of radiographic outcomes, the 2-year result of FP/MTA was significantly superior to FP/CEM (P= 0.005); however, the 5-year success rates were similar (P= 0.413). Age and preoperative periapical status did not affect the treatment outcomes. CLINICAL SIGNIFICANCE: Both MTA and CEM biomaterials were found to be equally effective pulpotomy agents for mature permanent molars with irreversible pulpitis and associated apical periodontitis in different age groups. The performance of this novel minimally invasive biotechnology may support a paradigm shift towards more biologic/conservative treatments in dentistry worldwide.

[Renal hypophosphatemia:pathophysiology and treatment].

Serum level of phosphate is regulated by the kidney, especially proximal tubule. The transcellular transport of phosphate in the proximal tubule is mediated via Na dependent transporters, i.e., NPT2a and NPT2b at the luminal membrane, and unknown channel at the basolateral side. The transport of phosphate via NPT2a and NPT2b is further regulated by factors, such as PTH, FGF23, and 1,25(OH)(2)D. Several hereditary diseases that cause hypophoshatemia specically are known. In addition, dysfunction of proximal tubule may develop Fanconi syndrome, which also causes hypherphosphaturia. In this section, I describe the renal mechanisms of phosphate handling and the causes of hypophosphatemia along with its treatment.

Periapical healing after direct pulp capping with calcium-enriched mixture cement: a case report.

This article describes a successful direct pulp capping of a mature symptomatic mandibular second molar in a 14-year-old girl. The patient was referred with sensitivity to cold beverages and pain on chewing on the second left mandibular molar. Clinical examinations revealed extensive coronal caries and sensitivity to percussion. Radiographically, the tooth was mature and had a widened apical periodontal ligament (PDL) and a narrow periapical lesion. The concluding diagnosis was symptomatic irreversible pulpitis with symptomatic apical periodontitis. Treatment included caries removal under rubber dam isolation, capping of exposure sites with calcium-enriched mixture (CEM) cement, and permanent coronal restoration. At three-, 10-, and 15-month follow-up, the tooth was functional, had normal response to cold test, and did not have sensitivity to percussion. The PDL space regained its normal width, and the periapical lesion healed.

A preliminary study of enamel remineralization by dentifrices based on RecaldentTM (CPP-ACP) and NovaMin® (calcium-sodium-phosphosilicate)

The purpose of this study was to investigate the enamel remineralization potential of two toothpastes, one of which was based on RecaldentTM (CPP- ACP) and the other on NovaMin® (Calcium-sodium-phosphosilicate). Human permanent molar teeth were subjected to three consecutive demineralization cycles. These cycles were followed by remineralization of the experimental groups by toothpastes containing RecaldentTM and NovaMin® respectively. The samples were analyzed by Scanning Electron Microscope, (SEM) and energy-dispersive X-ray spectroscopy analysis (EDX). Extensive demineralization was noted in the control group (without remineralization) while the groups treated with the dentifrices demonstrated various degrees of remineralization, as shown by formation of different types of deposits on the enamel surface. The EDX analysis showed increased amounts of Ca, P, Si and Zn in the enamel of the experimental groups, compared to the control one. Toothpastes containing RecaldentTM and especially NovaMin® have the potential to remineralize enamel, a property which might be important in finding a substitute to pit and fissure sealing.

El objetivo del trabajo fue investigar el potencial de remineralizacion del esmalte de dos pastas dentifricos, una de ella con formulacion basada en RecaldentTM (CPP- ACP) y la otra en NovaMin® (phosphosilicato de calcio y sodio). Se realizaron tres ciclos cosecutivos de desmineralizacion en molares permanentes humanos, seguidos de remineralizacion, en los grupos experimentales con los denti fricos que contenian RecaldentTM y NovaMin® respectivamente. Se analizaron las muestras con microscopia electronica de barrido (SEM) y analisis espectroscopico por dispersion de rayos X (EDX). En el grupo control (sin remineralizacion) se observo una extensa demineralizacion mientras que los grupos tratados con los dentifricos mostraron varios grados de remineralizacion, evidenciados por la formacion de diferentes tipos de depositos sobre la superficie del esmalte. El analisis EDX mostro cantidades aumentadas de Ca, P, Si y Zn en los grupos tratados en comparacion con el grupo control. Los dentifricos conteniendo RecaldentTM y especialmente Nova- Min®, tienen potencial de reminalizacion del esmalte, una propiedad que puede resultar importante como substituto del sellado de fosas y fisuras.

Utilización nutritiva de fósforo en el transcurso de la anemia ferropénica nutricional / Nutritive utilization of phosphorus during the course of nutritional ferropenic anaemia

Se ha estudiado el efecto de la evolución de la anemia ferropénica nutricional sobre la utilización digestiva y metabólica de fósforo en tres periodos 20, 30 y 40 días. Los animales de experimentación han sido 48 ratas macho de la raza Wistar albina que se dividieron en 6 grupos: tres grupos controles(C) y tres grupos ferrodeficientes (FD) que recibieron una dieta AIN 93G con contenido normal (45mg Fe/kg dieta) o con un bajo contenido de hierro (5 mg/Fe Kg dieta) respectivamente durante 20, 30 ó 40 días. Se ha encontrado un aumento significativo en la utilización digestiva y metabólica de fósforo en el transcurso de la anemia ferropénica nutricional, efecto que se va haciendo más patente a medida que evoluciona la ferrodeficiencia. Este incremento en la utilización nutritiva de fósforo es debido principalmente al mecanismo pasivo de absorción de fósforo que opera principalmente en el yeyuno-íleon y es predominante en situación de anemia ferropénica nutricional(AU)

The evolution of the nutritional iron deficiency anemia on the digestive and metabolic utilization of phosphorus has been studied during three periods: 20, 30 and 40 days. 48 male Wistar albino breedrats were divided in 6 groups: three control groups (C) and three Fe-deficient groups (FD) receiving AIN 93G with normal-Fe content (45 mg /kg diet) or with a low-Fe content (5 mg/Kg diet) respectively during 20, 30 ó 40 days. A significant increase in the digestive and metabolic utilization of phosphorus has been found in the course of the nutritional iron deficiency anemia, effect that become more pronounced as the ferrodeficiency is instaured. This increase in the nutritive utilization of phosphorus is due mainly to the passive mechanism of phosphorus absorption which operates principally in the jejunum-ileum and is predominant in situation of nutritional iron deficiency anemia(AU)

A preliminary study of enamel remineralization by dentifrices based on Recalden (CPP-ACP) and Novamin (calcium-sodium-phosphosilicate).

The purpose of this study was to investigate the enamel remineralization potential of two toothpastes, one of which was based on Recaldent (CPP- ACP) and the other on NovaMin (Calcium-sodium-phosphosilicate). Human permanent molar teeth were subjected to three consecutive demineralization cycles. These cycles were followed by remineralization of the experimental groups by toothpastes containing Recalden and NovaMin respectively. The samples were analyzed by Scanning Electron Microscope, (SEM) and energy-dispersive X-ray spectroscopy analysis (EDX). Extensive demineralization was noted in the control group (without remineralization) while the groups treated with the dentifices demonstrated various degrees of remineralization, as shown by formation of different types of deposits on the enamel surface. The EDX analysis showed increased amounts of Ca, P Si and Zn in the enamel of the experimental groups, compared to the control one. Toothpastes containing Recalden and especially NovaMin have the potential to remineralize enamel, a property which might be important in finding a substitute to pit and fissure sealing.

[Bio-inductive effects of inorganic elements on skin wound healing].

OBJECTIVE: To explore the bio-inductive effects of inorganic elements (Dermlin) on the human epithelial proliferation and differentiation and their promoting effects on skin wound healing. METHODS: 1 ). Cellular test: Normal human skin epithelial cells were cultured with 20 g/L Dermlin supplemented culture medium (E group) and regular culture medium (C group), respectively. The cell proliferation rate and the expressions of type IV collagen and epidermal growth factor (EGF) in the supernatant were determined in 12 and 20 post culture days (PCD). (2). Animal test: Self-consubstantiality control was employed in the study. Sixty Sprague - Dawley rats were inflicted with two symmetric 10% TBSA of superficial or deep partial thickness scald on the back of each rat, and were divided into control[ C, with topical application of silver sulfadiazine (SD - Ag) cream to the wounds] and treatment (T, with 1 g/100 cm2 Dermlin topical application to the wounds) groups. The pathological changes in wound skin were observed and the wound healing rate was calculated on 3, 5, 7, 10, 14 and 18 post treatment day (PTD). (3). Randomized, double-blinded and consubstantiality control method was employed in the clinical trial. Ninety patients were enrolled in the clinical study, among them 30 cases with 60 donor site wounds, 30 with 60 superficial and 30 with 60 deep partial thickness burn wounds were included. Dermlin in dose of 1 g/100 cm2 was applied to the wounds in T group and SD - Ag cream in C group for up to 18 days. Furthermore, sixty patients with diabetic foot ulcers were included for 1 g/100 cm2 Dermlin treatment. The wound healing rate was observed. And the blood and urine test and the indices of hepatic and renal function were determined. RESULTS: 1). Cellular test: The cell proliferation rate and the expression of type IV collagen and EGF in the culture supernatant were obviously higher than those in control group at the same time points (P < 0.01). 2). Animal test: Hyperplastic granulation tissue occurred in the rat wound in the T group since 5 PTD, while that occurred in the C group since 7 PTD. The healing rate of superficial thickness wound in T group on 7, 10, 14 PTD, and that of deep partial thickness wound in T group on 5, 10, 18 PTD were obviously higher than that in the C group (P <0.05). 3). Clinical study indicated that the wound healing rate of the patients with superficial or deep partial thickness scald in the T group was evidently higher than that in the C group on 5 and 10 PTD (P <0.05), but the wound healing time of the superficial, deep partial thickness wound and donor site wound in the T group was significantly shorter than that in the C group (P < 0.05). Before treatment, the square of the ulcers on the foot of the patients with diabetic was (39 +/- 28) cm2, and it was reduced to (19 +/- 23) cm2 2 weeks later, with the therapeutic efficacy reaching 62.5% . For all patients, no obvious change was found in the blood test and hepatic and renal function indices. CONCLUSION: The inorganic element (Dermlin) is beneficial to wound healing and to the proliferation and differentiation of epithelial cells.

In vivo evaluation of phosphorous-containing derivatives of dodecahydro-closo-dodecaborate for boron neutron capture therapy of gliomas and sarcomas.

The in vivo uptake of dodecahydro-closo-dodecaborate derivatives substituted with phosphate- and bisphosphonate groups was evaluated in two different experimental tumor model systems and compared to other boronated and non-boronated compounds. These phosphorous-containing boron clusters may have potential for use in boron neutron capture therapy, a chemoradiotherapeutic form of cancer treatment. Using the F98 rat glioma as a brain tumor model in syngeneic Fischer rats, there was selective tumor uptake of the phosphate derivative with 21.5 micrograms boron/g tumor versus 5.2 micrograms/g normal brain and a tumor:blood ratio of 2.7. However, this compound was toxic to test animals and lethal at relatively low doses. The uptake of the bisphosphonate by the murine K8 osteosarcoma was approximately 18 micrograms boron/g tumor with a T:Bl ratio of 7.6 and a tumor:bone ratio of 1.5. This compound was non toxic to the test animals. The results indicate that phosphate- and bisphosphonate derivatives of dodecahydro-closo-dodecaborate may have potential for BNCT of gliomas and osteosarcomas, respectively.