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1.
Pain Res Manag ; 2020: 5853412, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32676136

RESUMO

This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA (n = 188), PCEM (n = 194), or RCT (n = 168) arms. Preoperative "Pain Intensity" (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients' demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (P=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (P=0.939), and the trend/changes in pain relief were parallel (P=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (P=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes (P < 0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (P=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.


Assuntos
Dor Pós-Operatória/etiologia , Pulpotomia/métodos , Materiais Restauradores do Canal Radicular/uso terapêutico , Tratamento do Canal Radicular/métodos , Adulto , Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Cimentos Dentários/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Dente Molar , Óxidos/uso terapêutico , Dor Pós-Operatória/epidemiologia , Prevalência , Pulpotomia/efeitos adversos , Tratamento do Canal Radicular/efeitos adversos , Silicatos/uso terapêutico , Resultado do Tratamento
2.
Lasers Med Sci ; 35(8): 1849-1855, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32529588

RESUMO

OBJECTIVE: The purpose of this randomized clinical trial was to evaluate efficiency of diode 808-nm (Picasso-AMD, USA) laser using power 1.5 W, continuous wave (CW), fiber diameter of 400 µm, non-initiated and in contact mode, tip angle set at 90°, beam divergence 16°, 2 s per an area with 1-mm diameter, power density 190.98 W/cm2, energy density 381.97 J/cm2, vertical and horizontal scanning movement on the exposure site, and laser irradiation combined with a resin-based tricalcium silicate material (TheraCal LC, Bisco, USA) in direct pulp capping in caries exposures of permanent teeth over a period of 6 months. MATERIAL AND METHODS: In this randomized clinical trial, a total of 20 anterior and posterior vital teeth without symptoms and radiographic changes of 14 patients between the age group of 15-35 years, of which randomly 10 teeth were considered, each for TheraCal LC, the exposed area was sealed with TheraCal paste and TheraCal combined with diode laser; the treated area was sealed with TheraCal paste after diode 808-nm laser irradiation. At the 1-, 3-, and 6-month recall examinations, the loss of vitality, spontaneous pain, reactions to thermal stimuli and percussion, and radiographic changes were considered failure. The samples were randomly divided using runs test. Measurements on the digitized radiograph were performed at the recalls. The data were analyzed by repeated measurements ANOVA using SPSS 25. RESULTS: Analysis had indicated that at the end of follow-ups, a statistically significant increase in dentin thickness with both groups (p value < 0.001) was found. Clinically, diode laser group has shown better results (p value < 0.001); however, radiographically, no significant difference was observed between groups (p value = 0.56). In both groups, the highest thickness of dentin formed was at the first month; 0.40 mm ± 0.19 mm (p value < 0.001). CONCLUSION: Diode laser 808 nm under proper parameters combined with TheraCal LC can be recommended for direct pulp therapy in caries exposure of permanent teeth. CLINICAL TRIAL REGISTRATION: This research was approved by Esfahan Medical University, Dental School, Azad Branch (KHUISF)) Esfahan, Iran [IR.IAU.KHUISF.REC.1397.261].


Assuntos
Compostos de Cálcio/farmacologia , Cárie Dentária/terapia , Capeamento da Polpa Dentária/métodos , Lasers Semicondutores/uso terapêutico , Silicatos/farmacologia , Adolescente , Adulto , Compostos de Cálcio/uso terapêutico , Terapia Combinada , Feminino , Humanos , Masculino , Silicatos/uso terapêutico , Adulto Jovem
3.
Gen Dent ; 68(3): 46-49, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348243

RESUMO

Three-dimensional sealing of root canals is essential for long-term endodontic success. It is sometimes difficult to achieve a fluid-tight seal in cases such as furcation defects, resorption lesions, open apices, and root fractures. Such cases require restorative materials that not only are biocompatible and well accepted by the surrounding periodontium but also will set in the wet oral environment without losing their properties. This case series describes management of an open apex, a furcal perforation, and a horizontal root fracture with a bioactive calcium silicate‒based cement (Biodentine) as root repair material. To prevent extrusion of the cement, platelet-rich fibrin was used as an external matrix. The patients were followed for 2-3 years, and the teeth demonstrated remarkable healing.


Assuntos
Fibrina Rica em Plaquetas , Materiais Restauradores do Canal Radicular/uso terapêutico , Cálcio , Compostos de Cálcio/uso terapêutico , Cimentos Dentários/uso terapêutico , Cimentos de Ionômeros de Vidro , Humanos , Silicatos/uso terapêutico
4.
J Dent ; 96: 103330, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32259533

RESUMO

OBJECTIVES: When managing deep carious lesions, dentists can maintain pulp vitality via (1) avoiding pulp exposure and complications by performing selective (SE) instead of non-selective (NS) carious tissue removal, and/or (2) treat exposed pulps by direct capping with mineral-trioxide-aggregate (MTA) instead of calcium hydroxide (CH). We assessed the cost-effectiveness of SE vs. NS combined with direct pulp capping using MTA vs. CH. METHODS: A mixed public-private-payer perspective within German healthcare was applied. We modeled a permanent molar with a deep carious lesion and a vital asymptomatic pulp. The lesion was treated by SE/NS and, in case of exposure, direct pulp capping using MTA/CH. The tooth was followed over the lifetime of an initially 30-year-old patient using Markov-models, informed by pairwise and Bayesian network meta-analyses and further data sources. The primary health outcome was tooth-retention time. Costs were derived from German fee item catalogues, combined with micro-costing. Monte-Carlo micro-simulation was performed, and uncertainty introduced via probabilistic and univariate sensitivity analyses. Value-of-information-analysis (VOI) was performed to quantify the value of further research. RESULTS: SE and, in case of pulp exposure, MTA had a high chance (>95 %) of being cost-effective, with teeth being retained for 37.37 years at costs of 2140 Euro in mean. Alternative strategies were both more costly and less effective; this ranking was robust in sensitivity analyses. The VOI was 1.18 Euro per treated case and 12.86 million Euro on population-level. CONCLUSION: Selective carious tissue removal and, in case of pulp exposure, direct capping with MTA was the most cost-effective strategy. CLINICAL SIGNIFICANCE: Avoiding pulp exposure was more relevant for cost-effectiveness than how the exposed pulp was managed. Overall differences remain limited, though, and dentists may want to tailor treatment strategies according to their expertise and patients' expectations.


Assuntos
Cárie Dentária , Agentes de Capeamento da Polpa Dentária e Pulpectomia , Adulto , Compostos de Alumínio/uso terapêutico , Teorema de Bayes , Compostos de Cálcio/uso terapêutico , Análise Custo-Benefício , Cárie Dentária/terapia , Capeamento da Polpa Dentária , Combinação de Medicamentos , Humanos , Óxidos/uso terapêutico , Agentes de Capeamento da Polpa Dentária e Pulpectomia/uso terapêutico , Silicatos/uso terapêutico
5.
Nephrol Dial Transplant ; 35(4): 616-623, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32160298

RESUMO

BACKGROUND: Phosphate binders are commonly used in the treatment of patients with hyperphosphatemia. While phosphate binders are used to lower phosphate, the effects of specific phosphate binder types on vitamin D metabolism are unknown. METHODS: We performed a secondary analysis of the Phosphate Normalization Trial in which patients with moderate to advanced chronic kidney disease were randomized to receive either placebo, sevelamer carbonate, lanthanum carbonate or calcium acetate for 9 months. We evaluated changes in serum concentrations of vitamin D metabolites including 24,25-dihydroxyvitamin D3 [24,25(OH)2D3], 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], the ratio of 24,25(OH)2D3 to 25-hydroxyvitamin D [the vitamin D metabolite ratio (VMR)] and the ratio of serum 1,25(OH)2D to 25-hydroxyvitamin D. RESULTS: Compared with placebo, randomization to the calcium acetate arm was associated with a 0.6 ng/mL (95% CI 0.2, 1) and 13.5 pg/ng (95% CI 5.5, 21.5) increase in 24,25(OH)2D and VMR, respectively, and a 5.2 pg/mL (95% CI 1.1, 9.4) reduction in 1,25(OH)2D. Randomization to sevelamer carbonate was associated with a 0.5 ng/mL (95% CI -0.9, -0.1) and 11.8 pg/ng (95% CI -20, -3.5) reduction in 24,25(OH)2D3 and VMR, respectively. There was no association of the sevelamer arm with the change in 1,25(OH)2D3, and randomization to lanthanum carbonate was not associated with a change in any of the vitamin D metabolites. CONCLUSION: Administration of different phosphate binders to patients with moderate to severe CKD results in unique changes in vitamin D metabolism.


Assuntos
Acetatos/uso terapêutico , Hiperfosfatemia/metabolismo , Lantânio/uso terapêutico , Fosfatos/metabolismo , Insuficiência Renal Crônica/metabolismo , Sevelamer/uso terapêutico , Vitamina D/metabolismo , Idoso , Compostos de Cálcio/uso terapêutico , Quelantes/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Hiperfosfatemia/tratamento farmacológico , Hiperfosfatemia/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/patologia
6.
J Vet Emerg Crit Care (San Antonio) ; 30(3): 302-307, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32077228

RESUMO

OBJECTIVE: To describe a case series of systemic lime sulfur toxicosis secondary to topical administration in 2 cats. CASE SUMMARY: Two cats from the same household that were being previously treated for Microsporum canis were presented following topical administration of an incorrectly diluted lime sulfur dip. A 30% solution was used rather than the recommended 3% solution, resulting in a 10-fold concentration overdose. The cats presented to the emergency service 1 hour after dermal application of the lime sulfur product at home. The first cat, a 2-year-old female, intact Cornish Rex, had severe hypotension, bradycardia, and hypothermia. Chemical burns were also present on the ventrum and paws. Clinicopathological data revealed profound acid-base disturbances, hypercalcemia, hyperphosphatemia, and azotemia. After aggressive fluid resuscitation, electrolyte supplementation, and treatment, the patient was stabilized and discharged after 5 days of hospitalization; full recovery was later reported. The second littermate, also a 2-year-old female, intact Cornish Rex, presented the following day with similar clinical signs, physical examination findings, and clinicopathological findings. After supportive care and 2 days of hospitalization, the patient was also discharged and reported to fully recover. NEW OR UNIQUE INFORMATION PROVIDED: This case series is the first to report systemic toxicosis secondary to dermal exposure of lime sulfur. As lime sulfur is commonly used in veterinary medicine for the treatment of ectoparasites, veterinary professionals should be aware of the significant signs of poisoning that can be seen as a result of iatrogenic dosing errors by pet owners or veterinary professionals.


Assuntos
Antifúngicos/efeitos adversos , Compostos de Cálcio/efeitos adversos , Doenças do Gato/induzido quimicamente , Sulfetos/efeitos adversos , Administração Tópica , Animais , Anti-Infecciosos , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Compostos de Cálcio/administração & dosagem , Compostos de Cálcio/uso terapêutico , Doenças do Gato/tratamento farmacológico , Gatos , Feminino , Microsporum , Sulfetos/administração & dosagem , Sulfetos/uso terapêutico
7.
J Biol Regul Homeost Agents ; 34(1 Suppl. 1): 33-37, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32064833

RESUMO

An ideal scenario for a tooth in necrosis with immature root would be to continue root development after the regeneration of pulp tissue. We report a case, where the regenerative endodontic procedure (REP) was done using biodentine as a scaffold in an immature mandibular molar tooth.


Assuntos
Compostos de Cálcio/uso terapêutico , Necrose da Polpa Dentária/terapia , Dente Molar , Endodontia Regenerativa , Silicatos/uso terapêutico , Seguimentos , Humanos , Regeneração , Tratamento do Canal Radicular
8.
J Pak Med Assoc ; 70(Suppl 1)(2): S125-S128, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31981352

RESUMO

This case report describes dental management of a 15- year-old boy, undergoing treatment for Thalassaemia Major and Acute Myeloid Leukaemia with bone marrow transplant and immuno-suppressants. During the course of his treatment the patient developed a swelling in anterior maxilla and therefore was referred by the primary physician for evaluation. This case report highlights the management of medically compromised patients in a tertiary care hospital in which apexification was carried out in a permanent immature tooth utilizing MTA as an immediate apical plug.


Assuntos
Apexificação/métodos , Compostos de Cálcio/uso terapêutico , Necrose da Polpa Dentária/terapia , Tratamento do Canal Radicular/métodos , Silicatos/uso terapêutico , Fraturas dos Dentes/terapia , Adolescente , Transplante de Medula Óssea , Necrose da Polpa Dentária/complicações , Humanos , Imunossupressores/uso terapêutico , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/terapia , Masculino , Fraturas dos Dentes/complicações , Talassemia beta/complicações , Talassemia beta/terapia
10.
Braz Oral Res ; 33: e114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800865

RESUMO

This in vitro study aimed to evaluate the effect of different toothpastes on dental enamel subjected to an erosive cycle with and without exposure to cigarette smoke. Bovine enamel specimens were randomly allocated into 12 groups (n = 12). For the in vitro simulation of smoking, half the groups underwent an exposure cycle of 20 cigarettes per day for 5 days. Subsequently, all groups were subjected to a 5-day erosion cycle intercalating demineralization (1 min; 1% citric acid; pH = 3.5) and treatment with toothpaste slurries (2 min) of NaF, SnF2, F/Sn/Chitosan, F/CaSiO3/Na3PO4, and F/bioactive glass. The control group was immersed in distilled water. Surface microhardness (SMH) was measured initially, after exposure to smoke, and after the erosive cycle, and %SMH was calculated. At the end of the experimental cycle, surface roughness, profilometry, and atomic force microscopy (AFM) were performed. SMH increased after exposure to cigarette smoke (p < 0.05). After the erosive cycle, there were no differences between the presence and absence of cigarette smoke exposure in SMH and roughness (p > 0.05). Besides increasing enamel SMH, cigarette smoke did not prevent enamel loss after the erosion cycle (p < 0.05). In profilometry, roughness and surface loss had the lowest values in the groups treated with SnF2 and F/Sn/Chitosan (p < 0.05). AFM showed lower mineral loss with F/CaSiO3/Na3PO4 and F/Sn/Chitosan. For all groups, except F/CaSiO3/Na3PO4, cigarette smoke resulted in higher enamel wear. F/Sn/Chitosan showed the best results against erosion.


Assuntos
Fumar Cigarros/efeitos adversos , Esmalte Dentário/efeitos dos fármacos , Erosão Dentária/etiologia , Erosão Dentária/prevenção & controle , Cremes Dentais/uso terapêutico , Animais , Compostos de Cálcio/uso terapêutico , Cariostáticos/uso terapêutico , Bovinos , Quitosana/uso terapêutico , Testes de Dureza , Humanos , Microscopia de Força Atômica , Valores de Referência , Reprodutibilidade dos Testes , Saliva/química , Silicatos/uso terapêutico , Propriedades de Superfície/efeitos dos fármacos , Fatores de Tempo , Fluoretos de Estanho/uso terapêutico , Desmineralização do Dente/induzido quimicamente , Desmineralização do Dente/prevenção & controle , Água/química
11.
BMC Cancer ; 19(1): 967, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623580

RESUMO

BACKGROUND: Patients with metastatic renal carcinoma frequently have pre-existing renal impairment and not infrequently develop worsening renal function as a complication of their treatment. The presence of pancreatic metastases in patients with metastatic renal carcinoma, often confers a more favourable prognosis and as a consequence this patient group may be exposed to such treatments for more prolonged periods of time. However, the development of renal failure may also be a consequence of the cancer itself rather than its treatment. CASE PRESENTATION: We present an 84-year-old patient receiving the tyrosine kinase inhibitor (TKI) pazopanib for metastatic renal carcinoma who developed oxalate nephropathy as a consequence of pancreatic exocrine insufficiency resulting from pancreatic metastases. CONCLUSIONS: This case demonstrates the importance of investigating unexpected toxicities and highlights the potential consequences of pancreatic insufficiency and its sequelae in patients with pancreatic metastases.


Assuntos
Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/patologia , Insuficiência Pancreática Exócrina/complicações , Falência Renal Crônica/etiologia , Neoplasias Renais/complicações , Neoplasias Renais/patologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/secundário , Acetatos/uso terapêutico , Idoso de 80 Anos ou mais , Compostos de Cálcio/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Humanos , Falência Renal Crônica/terapia , Neoplasias Renais/tratamento farmacológico , Masculino , Oxalatos/urina , Neoplasias Pancreáticas/tratamento farmacológico , Pancrelipase/uso terapêutico , Inibidores de Proteínas Quinases/efeitos adversos , Inibidores de Proteínas Quinases/uso terapêutico , Pirimidinas/efeitos adversos , Pirimidinas/uso terapêutico , Diálise Renal , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , Resultado do Tratamento
12.
BMC Oral Health ; 19(1): 227, 2019 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-31647004

RESUMO

BACKGROUND: Pulpotomy is one of the most widely used methods in preserving vital pulp in teeth, which is of great significance in achieving continue root formation in immature permanent teeth suffering from dental caries or trauma. The aim of this meta-analysis and systemic review is to synthesize the available evidences to compare different pulpotomy dressing agents for pulpotomy treatment in immature permanent teeth. METHODS: Electronic databases including MEDLINE (via Pubmed), EMBASE, the Cochrane library (CENTRAL) and the clinicaltrials.gov database were searched. The references of all included articles or relevant reviews were cross-checked. Only randomized controlled trials (RCTs) comparing two or more pulp dressing agent in permanent teeth with open apex would be included. Also, the studies should have at least 6 months of follow-up, report clinical and radiographic success in detail and publish in English. RESULTS: Five RCTs were included for a systematic review, and all of them had a high risk of bias. There is little difference in success rate between mineral trioxide aggregate (MTA) and calcium hydroxide (CH) at 6-month follow-up (risk ratio (RR) 1; 95% confidence interval (CI) 0.94 to 1.06) and 12-month follow-up (RR 1.04; 95% CI 0.96 to 1.13). There is no difference between MTA versus platelet-rich fibrin and MTA versus calcium-enriched mixture (CEM). There is only weak evidence of increased success rate in using MTA and triple antibiotic paste (TAP) rather than abscess remedy. CONCLUSIONS: Based on the present evidence, similar success rates with MTA were found between the dressing agents CH, CEM, RPF and TAP as pulpotomy-dressing agents in the treatment of immature permanent teeth. More high-quality RCTs are needed in this field in future studies.


Assuntos
Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Dentição Permanente , Pulpotomia/métodos , Silicatos/uso terapêutico , Cárie Dentária/terapia , Capeamento da Polpa Dentária/métodos , Exposição da Polpa Dentária/terapia , Combinação de Medicamentos , Humanos , Óxidos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527218

RESUMO

Oxalate nephropathy is a rare condition and may be overlooked due to lack of recognition and understanding of triggers. An 81-year-old man was sent to nephrologist because of significantly increased creatinine (1.5-1.9 mg/dL) noted for 3 months. He had well-controlled diabetes but no history of kidney disease. He had no chronic diarrhoea or intestinal surgery. He was a health-minded individual who had read extensively about benefit of antioxidants. Initial work-up was unrevealing. Within a few weeks after first visit, he developed acute symptomatic worsening kidney injury with nausea, vomiting and creatinine up to 6.8 mg/dL. Repeat examination of the urine sediment revealed casts containing calcium oxalate crystals. A deeper dietary history revealed widespread oxalate precursor consumption. A kidney biopsy confirmed oxalate nephropathy. Restriction of oxalate consumption combined with adequate hydration, oral calcium acetate resulted in partial renal recovery without need for haemodialysis.


Assuntos
Acetatos/uso terapêutico , Lesão Renal Aguda/tratamento farmacológico , Lesão Renal Aguda/etiologia , Dieta/efeitos adversos , Oxalatos/efeitos adversos , Idoso de 80 Anos ou mais , Compostos de Cálcio/uso terapêutico , Diagnóstico Diferencial , Humanos , Masculino
14.
Biomed Mater ; 14(6): 065013, 2019 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31491772

RESUMO

The treatment of large-area bone defects is a huge challenge and the current research hot spot is to prepare composite materials to promote the new bone formation. In this study, the rat skull defect was repaired by implanting pure wollastonite and hydroxyapatite composites, which proved that it has a good effect on the treatment of bone defects. 60 SD rats were used as research objects. The animals were randomly divided into wollastonite group, wollastonite-hydroxyapatite composite group and hydroxyapatite group. The three groups of bone scaffolds were filled into the rats' skull defects. At 6 and 12 weeks after surgery, we conducted Micro-CT analysis, HE staining, Masson trichrome staining, Alizarin red staining and Microfil analysis, to assess the therapeutic and regeneration effects of three groups. At 6 weeks after implantation, the morphology results showed that little newly formed bone was observed in wollastonite group, on the contrary, more new bone in the surgical defects formed in the wollastonite-hydroxyapatite composite group and hydroxyapatite group. At 12 weeks after surgery, histology analyses revealed that the regenerated bone became more mature in each groups. The morphology showed that the maturity of new bone was improved and the scaffold material was partially absorbed in wollastonite-hydroxyapatite composite group. CT scan observation showed that on the coronal plane, the defect repair area of wollastonite-hydroxyapatite composite group was integrated with the surrounding normal bone tissue, and the sacffold material was tightly integrated with the defect edge. The results of Microfil showed that compared with wollastonite group and hydroxyapatite group, wollastonite-hydroxyapatite composite group formed more blood vessels after 12 weeks of surgery. The wollastonite-hydroxyapatite composite biomaterial can promote the formation and growth of new bone in the defect area, and it is considered safe.


Assuntos
Doenças Ósseas/tratamento farmacológico , Regeneração Óssea , Osso e Ossos/efeitos dos fármacos , Compostos de Cálcio/uso terapêutico , Durapatita/uso terapêutico , Silicatos/uso terapêutico , Animais , Materiais Biocompatíveis/química , Peso Corporal , Transplante Ósseo/métodos , Masculino , Osteogênese , Ratos , Ratos Sprague-Dawley , Engenharia Tecidual/métodos , Tecidos Suporte , Microtomografia por Raio-X
15.
Braz Oral Res ; 33: e084, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31460610

RESUMO

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.


Assuntos
Apexificação/métodos , Cavidade Pulpar/efeitos da radiação , Necrose da Polpa Dentária/radioterapia , Lasers Semicondutores/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Ápice Dentário/efeitos da radiação , Doenças Dentárias/radioterapia , Compostos de Alumínio/uso terapêutico , Animais , Compostos de Cálcio/uso terapêutico , Polpa Dentária/citologia , Cavidade Pulpar/patologia , Necrose da Polpa Dentária/patologia , Combinação de Medicamentos , Imuno-Histoquímica , Sialoproteína de Ligação à Integrina/análise , Óxidos/uso terapêutico , Distribuição Aleatória , Ratos Wistar , Reprodutibilidade dos Testes , Silicatos/uso terapêutico , Células-Tronco , Ápice Dentário/patologia , Doenças Dentárias/patologia , Resultado do Tratamento
16.
J Dent ; 88: 103158, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31229496

RESUMO

OBJECTIVES: Management of carious teeth with signs and symptoms indicative of irreversible pulpitis is traditionally invasive, but emerging evidence suggests successful treatment outcomes with less invasive vital pulp treatment such as coronal pulpotomy. The objective of this systematic review is to determine whether coronal pulpotomy is clinically effective in treating carious teeth with signs and symptoms indicative of irreversible pulpitis. SOURCES: MEDLINE; PubMed; Embase, Web of Science, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform and ClinicalTrials.gov were searched until December 2018. STUDY SELECTION: Prospective, retrospective and randomised clinical trials investigating coronal pulpotomy or comparing pulpotomy to root canal treatment in permanent mature carious teeth with signs and symptoms indicative of irreversible pulpitis were included. Studies were independently assessed for risk of bias using Cochrane Systematic Reviews of intervention criteria and modified Downs and Black quality assessment checklist. DATA: Eight articles were selected for analysis. The average success rate for coronal pulpotomy was 97.4% clinical and 95.4% radiographic at 12 month follow-up. This was reduced to 93.97% clinical and 88.39% radiographic success at 36 months follow-up. Results from the only comparative clinical trial showed pulpotomy to have comparable success to root canal treatment at 12, 24 and 60 month follow-up. CONCLUSIONS: The evidence suggests high success for pulpotomy for teeth with signs and symptoms of irreversible pulpitis, however, results are based on heterogeneous studies with high risk of bias. Well-designed, adequately powered randomised controlled trials are required for evidence to change clinical practice. CLINICAL SIGNIFICANCE: Management of carious teeth with irreversible pulpitis is traditionally invasive, but emerging evidence suggests potentially successful treatment outcomes with less invasive therapies such as coronal pulpotomy.


Assuntos
Compostos de Cálcio/uso terapêutico , Capeamento da Polpa Dentária/métodos , Exposição da Polpa Dentária/terapia , Pulpite/terapia , Pulpotomia/métodos , Humanos , Agentes de Capeamento da Polpa Dentária e Pulpectomia/uso terapêutico , Pulpite/patologia , Tratamento do Canal Radicular , Silicatos/uso terapêutico
17.
J Appl Oral Sci ; 27: e20180700, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31166415

RESUMO

INTRODUCTION: Alternatives for the treatment of caries disease, such as minimally invasive approaches, have been developed in recent years. OBJECTIVE: To carry out clinical and radiographic evaluations of three cavity liners after selective caries removal. METHODOLOGY: Thirty-six primary molars with deep occlusal caries lesions without pulp involvement (from children of both genders, aged between 5 and 8 years) were randomly divided into the following groups: calcium hydroxide cement (CHC) group; mineral trioxide aggregate (MTA) group and Portland cement with added zirconium oxide (PCZ) group. The following-up period was 6- and 12-month. The clinical and radiographic success rates were evaluated through chi-square test. The radiographic measurements were compared by ANOVA followed by Tukey's test (p<0.05). RESULTS: Thirty-six patients were included, but thirty-four returned for 12-month follow-up. The overall success rate of the therapy for the three groups was 94.11% and no statistically significant differences occurred in the comparison among groups (p>0.05). Nineteen radiographs were selected to measure the dentin barrier thickness. The intragroup comparison presented a statistically significant increase of the dentin barrier for all groups, at 12-month follow-up. However, the MTA group showed increase of the dentin barrier, over time, 6- to 12-month follow-up. The intergroup comparison revealed no statistically significant differences (p>0.05). CONCLUSION: The clinical and radiographic data showed that all cavity liners provided effective treatment of primary teeth after selective caries removal.


Assuntos
Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Cárie Dentária/terapia , Forramento da Cavidade Dentária/métodos , Óxidos/uso terapêutico , Silicatos/uso terapêutico , Zircônio/uso terapêutico , Análise de Variância , Criança , Pré-Escolar , Cárie Dentária/diagnóstico por imagem , Cimentos Dentários/uso terapêutico , Cavidade Pulpar/anatomia & histologia , Cavidade Pulpar/efeitos dos fármacos , Restauração Dentária Permanente/métodos , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Radiografia Dentária , Fatores de Tempo , Dente Decíduo , Resultado do Tratamento
18.
J Appl Oral Sci ; 27: e20180030, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31116277

RESUMO

OBJECTIVES: To evaluate the effect of calcium hydroxide (CH) associated with two different vehicles as a capping material for pulp tissue in primary molars, compared with mineral trioxide aggregate (MTA). METHODOLOGY: Forty-five primary mandibular molars with dental caries were treated by conventional pulpotomy using one of the following materials: MTA only (MTA group), CH with saline (CH+saline group) and CH with polyethylene glycol (CH+PEG group) (15 teeth/group). Clinical and periapical radiographic examinations of the pulpotomized teeth were performed 3, 6, and 12 months after treatment. Data were tested by chi-squared analysis and a multiple comparison post-test. RESULTS: The MTA group showed both clinical and radiographic treatment success in 14/14 teeth (100%), at all follow-up appointments. By clinical evaluation, no teeth in the CH+saline and CH+PEG groups had signs of mobility, fistula, swelling or inflammation of the surrounding gingival tissue. However, in the CH+saline group, radiographic analysis detected internal resorption in up to 9/15 teeth (67%), and inter-radicular bone resorption and furcation radiolucency in up to 5/15 teeth (36%), from 3 to 12 months of follow-up. In the CH+PEG group, 2/11 teeth (18%) had internal resorption and 1/11 teeth (9%) presented bone resorption and furcation radiolucency at all follow-up appointments. CONCLUSION: CH with PEG performed better than CH with saline as capping material for pulpotomy of primary teeth. However, both combinations yielded clinical and radiographic results inferior to those of MTA alone.


Assuntos
Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Óxidos/uso terapêutico , Agentes de Capeamento da Polpa Dentária e Pulpectomia/uso terapêutico , Pulpotomia/métodos , Silicatos/uso terapêutico , Dente Decíduo/cirurgia , Hidróxido de Cálcio/química , Criança , Pré-Escolar , Combinação de Medicamentos , Seguimentos , Humanos , Estudos Prospectivos , Agentes de Capeamento da Polpa Dentária e Pulpectomia/química , Radiografia Dentária , Solução Salina/química , Solução Salina/uso terapêutico , Fatores de Tempo , Dente Decíduo/diagnóstico por imagem , Resultado do Tratamento
19.
J Bone Miner Res ; 34(9): 1609-1618, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31063613

RESUMO

Autosomal dominant hypocalcemia type 1 (ADH1) is a rare form of hypoparathyroidism caused by heterozygous, gain-of-function mutations of the calcium-sensing receptor gene (CAR). Individuals are hypocalcemic with inappropriately low parathyroid hormone (PTH) secretion and relative hypercalciuria. Calcilytics are negative allosteric modulators of the extracellular calcium receptor (CaR) and therefore may have therapeutic benefits in ADH1. Five adults with ADH1 due to four distinct CAR mutations received escalating doses of the calcilytic compound NPSP795 (SHP635) on 3 consecutive days. Pharmacokinetics, pharmacodynamics, efficacy, and safety were assessed. Parallel in vitro testing with subject CaR mutations assessed the effects of NPSP795 on cytoplasmic calcium concentrations (Ca2+ i ), and ERK and p38MAPK phosphorylation. These effects were correlated with clinical responses to administration of NPSP795. NPSP795 increased plasma PTH levels in a concentration-dependent manner up to 129% above baseline (p = 0.013) at the highest exposure levels. Fractional excretion of calcium (FECa) trended down but not significantly so. Blood ionized calcium levels remained stable during NPSP795 infusion despite fasting, no calcitriol supplementation, and little calcium supplementation. NPSP795 was generally safe and well-tolerated. There was significant variability in response clinically across genotypes. In vitro, all mutant CaRs were half-maximally activated (EC50 ) at lower concentrations of extracellular calcium (Ca2+ o ) compared to wild-type (WT) CaR; NPSP795 exposure increased the EC50 for all CaR activity readouts. However, the in vitro responses to NPSP795 did not correlate with any clinical parameters. NPSP795 increased plasma PTH levels in subjects with ADH1 in a dose-dependent manner, and thus, serves as proof-of-concept that calcilytics could be an effective treatment for ADH1. Albeit all mutations appear to be activating at the CaR, in vitro observations were not predictive of the in vivo phenotype or the response to calcilytics, suggesting that other parameters impact the response to the drug. © 2019 American Society for Bone and Mineral Research.


Assuntos
Compostos de Cálcio/uso terapêutico , Hipercalciúria/tratamento farmacológico , Hipocalcemia/tratamento farmacológico , Hipoparatireoidismo/congênito , Adulto , Área Sob a Curva , Compostos de Cálcio/efeitos adversos , Compostos de Cálcio/farmacocinética , Linhagem Celular , Feminino , Genótipo , Humanos , Hipercalciúria/genética , Hipocalcemia/genética , Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/genética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
20.
J Endod ; 45(7): 840-847, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31104819

RESUMO

INTRODUCTION: This randomized clinical trial aimed to compare the success rate and postoperative pain of direct pulp capping (DPC) using calcium hydroxide (CH) and mineral trioxide aggregate (MTA) in teeth with carious pulp exposures and reversible pulpitis. METHODS: Sixty-four permanent teeth were randomly divided after caries excavation into 2 groups: CH and MTA (n = 32 in each group). Exposed pulps were capped using standardized protocols. The treated teeth were restored with glass ionomer cement and composite restoration. The primary outcome was success rate at the 12-month follow-up, and the secondary outcome was postoperative pain after 7 days. Clinical and radiographic evaluations were performed at 3, 6, and 12 months. Pain was recorded using the visual analog scale every 24 hours for 7 days after intervention. RESULTS: Fifty-six patients were analyzed at the 12-month follow-up, 29 treated with CH and 27 with ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK). The success rate was 69% for CH and 93% for ProRoot MTA (P < .05). The kappa value of interrater agreement was 0.773.No significant difference in pain incidence was found between the 2 groups (P > .05) although a significant pain reduction was found 6 hours after the procedure in both the groups. Significantly lower pain scores were reported in the MTA group (6.3 ± 9.5) compared with the CH group (18.5 ± 20.8) after 18 hours. CONCLUSIONS: Teeth with carious pulp exposures and reversible pulpitis can be treated successfully with DPC. MTA proved better than CH in terms of both success rate and pain intensity.


Assuntos
Compostos de Alumínio , Compostos de Cálcio , Hidróxido de Cálcio , Cárie Dentária , Capeamento da Polpa Dentária , Óxidos , Manejo da Dor , Agentes de Capeamento da Polpa Dentária e Pulpectomia , Silicatos , Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Cárie Dentária/terapia , Combinação de Medicamentos , Seguimentos , Humanos , Dente Molar , Óxidos/uso terapêutico , Silicatos/uso terapêutico
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