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1.
Evid Based Dent ; 21(4): 136-137, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33339975

RESUMO

Design Systematic review.Data sources PubMed and Scopus databases were searched independently by two authors from inception to July 2018 using keywords and index words combined using Boolean terms. Articles were restricted to English and were not excluded based on study design. Conference proceedings, grey literature, letters and commentaries were excluded.Data extraction and synthesis Demographic data (age, sex), study design, pulpal and periapical pre-treatment diagnosis, pre-operative radiographic findings, intra-operative disinfection protocol, intracanal coronal barrier, duration of follow-up, and clinical and/or radiographic and/or histological outcomes after completion of single-visit regenerative endodontic procedures (REPs) on non-vital, immature permanent teeth. Quality of included case reports were assessed according to the Joanna Briggs Institute Critical Appraisal Checklist. Risk of bias assessment of randomised controlled trials was done using Cochrane Collaboration's tool. The quality of the animal study was assessed by the SYRCLE risk of bias assessment tool.Results A total of five case reports, one randomised controlled trial and one animal study were included in the final analysis. All case reports were rated as high quality while the randomised controlled trial was rated moderate-to-low risk of bias. Case reports and the animal study favoured single-visit REPs, while the results from the randomised trial reported only 50% success. Within this limited pool of studies, there were differences in aetiology, location, disinfection protocol (different concentrations of NaOCl and EDTA, saline, chlorhexidine), follow-up time intervals and subjective reporting of radiographic healing, making syntheses challenging.Conclusions Single-visit REPs may offer benefits of reduced treatment time and visits compared to conventional two-visit REPs.


Assuntos
Endodontia Regenerativa , Dente , Assistência Odontológica , Polpa Dentária , Necrose da Polpa Dentária , Humanos
2.
Prim Dent J ; 9(4): 65-84, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33225847

RESUMO

AIMS: This systematic review aims to identify and synthesise available evidence to determine the clinical and radiographic outcomes of REP involving any disinfection irrigant together with a non-antibiotic intracanal medicament. METHODS: Experimental and observational studies evaluating the outcomes of REP in immature non-vital permanent teeth in 6-16 year olds, where the protocol used any type of disinfectant irrigant together with a non-antibiotic intracanal medicament (non-setting calcium hydroxide) were included. Data was narratively synthesised and presented in respect to the primary outcome (elimination of symptoms and infection) and secondary outcomes (increase in root length/width; positive response to vitality testing; patient-reported outcomes; adverse effects). MAIN FINDINGS: 1628 studies were identified, of which five met the eligibility criteria for inclusion in the review. Studies included one randomised control trial and four observational studies. All five studies showed an absence of clinical signs and symptoms for all teeth postoperatively with radiographic resolution or absence of pathology following the disinfection stages of the REP used. Choice of secondary outcomes were inconsistent but included further root development, coronal discolouration and root canal calcifications postoperatively. There was a high risk of bias in all five studies and subsequently the quality of the evidence base was judged to be low. PRINCIPLE CONCLUSIONS: REP using a non-antibiotic disinfectant approach appears capable of providing satisfactory outcomes for a non-vital immature permanent tooth. Further high-quality research is required before solid recommendations towards clinical practice guidelines for the disinfection portion of REP can be implemented.


Assuntos
Desinfetantes , Endodontia Regenerativa , Necrose da Polpa Dentária , Humanos , Irrigantes do Canal Radicular/uso terapêutico , Tratamento do Canal Radicular
3.
Braz Dent J ; 31(6): 680-684, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33237241

RESUMO

This case report discusses the endodontic treatment of a 7-year-old girl who suffered trauma (intrusion) to the immature upper central incisors secondary to a fall from a bicycle. Thirty days after the accident the patient was brought by her mother for clinical and radiographic assessment with a chief complaint of swelling and tenderness to percussion and palpation. Acute apical abscess associated with immature teeth were diagnosed. A decision was made to perform regenerative endodontic treatment. Access cavities were made and the root canals were disinfected by irrigation with 2.5% sodium hypochlorite. Final irrigation was performed with 17% EDTA. Due to pain and presence of secretions, 2% chlorhexidine gel was applied as an intracanal medicament. Seven days later, at the second visit, the root canals were once again disinfected and the canals of the right and left permanent upper central incisors were filled with double antibiotic paste (metronidazole/ciprofloxacin) and calcium hydroxide paste, respectively. Zinc oxide was mixed in both pastes. At the third visit, after 21 more days, the pastes were removed and the periapical areas were stimulated with a #80 K-file to encourage clot formation within the pulp cavities. A mineral trioxide aggregate (MTA) paste cervical plug was placed and the teeth were restored with glass ionomer cement. Radiographs and CBCT scans demonstrated complete root formations. The patient has been followed for 12 years, with evidence of clinical success throughout.


Assuntos
Incisivo , Endodontia Regenerativa , Abscesso , Compostos de Cálcio , Criança , Necrose da Polpa Dentária , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Óxidos , Silicatos
5.
J Endod ; 46(12): 1867-1875, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32941892

RESUMO

INTRODUCTION: The objective of this study was to determine the effectiveness of several antibiotic-loaded hydrogel scaffolds against Enterococcus faecalis, as well as their ability to stimulate proliferation and mineralization of dental pulp stem cells. METHODS: Fibrin (Fg) or chitosan-fibrin hydrogels (Ch) were prepared using 12.5 mg/mL fibrinogen and 0.4% (w/v) chitosan. Triple antibiotics, clindamycin-modified triple antibiotic paste, or double antibiotics were loaded in gels (1 mg/mL). Antibacterial effect against E. faecalis biofilm was determined by using colony-forming units (CFUs) and confocal laser scanning microscope (CLSM). Cell viability and morphology were determined by loading cells into different gels at 7 and 14 days using the water-soluble tetrazolium salt-1 cell viability assay and Live & Dead cell analysis. Mineralization was detected by using alkaline phosphatase and alizarin red staining activity. RESULTS: Antibiotic-loaded Fg gel and Ch gel alone without antibiotics resulted in a significant reduction in CFUs compared with the positive control (P < .05). When antibiotics were loaded in Ch gel, there were no CFUs detected in any groups (P < .05). CLSM images showed dense red areas with mostly dead bacteria on the dentin surface in antibiotic-loaded Ch groups, which showed significantly less live bacteria compared with the other groups (P < .05). Triple antibiotic-loaded Fg and Ch gels resulted in a dramatic decrease in the mineralized nodule formation compared with all other gel groups (P < .05). Ch hydrogels resulted in round cell morphology up to 7 days. Ch alone or with double antibiotic paste showed more cell spreading with spindle-shaped morphology at 14 days and higher alkaline phosphatase activity compared with other antibiotic-loaded Ch groups (P > .05). CONCLUSIONS: Double antibiotic-loaded Ch gel appears to enhance the antibacterial properties while maintaining higher cell viability, cell spreading, and mineralization activity, compared with all the other scaffolds investigated.


Assuntos
Quitosana , Endodontia Regenerativa , Antibacterianos/farmacologia , Enterococcus faecalis , Hidrogéis
6.
J Endod ; 46(9S): S10-S18, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32950180

RESUMO

INTRODUCTION: The improvement of regenerative endodontic procedures requires an understanding of the key clinical questions combined with a fundamental biological knowledge of how the dental tissues behave during health, disease, and repair. Therefore, partnerships between clinicians and basic scientists are essential to drive the field forward and improve patient outcomes. METHODS: This review aimed to provide a background to dentin-pulp biology and the interaction between infection, inflammation, and regeneration. RESULTS: We have highlighted how the release of neutrophil extracellular traps (NETs) within the pulp are double-edged; while they aim to limit the bacterial infection, they may actually exacerbate cell death and chronic inflammation. Aberrant levels of these structures may occur because of ineffective host immunologic processes, viral infections, or impaired clearance caused by bacterial virulence factors. We also postulate a proinflammatory link in the pulp between NETs and the inflammasome activated by pathogen-associated molecular patterns and damage-associated molecular patterns. Subsequently, we discuss areas potentially fruitful for future clinical exploitation involving NET inhibitors, inflammasome modulators, phototherapies, and novel epigenetic approaches. CONCLUSIONS: Sustained scientist-clinician research partnerships along with an increased understanding of the association between inflammation and regeneration within the dentin-pulp complex will lead to future patient benefit.


Assuntos
Polpa Dentária , Armadilhas Extracelulares , Dentina , Humanos , Imunidade Inata , Regeneração , Endodontia Regenerativa , Engenharia Tecidual
7.
J Endod ; 46(9S): S105-S114, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32950182

RESUMO

INTRODUCTION: Regenerative endodontic therapy (RET) has gained considerable attention and wide approval. Although it is being performed routinely, the outcomes remain unpredictable, and the optimal approaches for treatment are not established. It has been shown that bacterial persistence in root canals in these cases significantly interferes with healing and root maturation. However, few objective clinical studies have evaluated the complex microflora present in the infections or the efficacy of various clinical procedures. In addition, the extent of the infection and biofilm maturation in immature teeth with necrotic pulp has been understudied. Furthermore, most models used in preclinical evaluation of these issues do not fully elucidate the complexity or variability of the clinical situation. RESULTS AND CONCLUSION: In this review, the main biological and clinical problems pertaining to RET will be discussed. Contemporary analysis of complex microbial communities will be reviewed with emphasis on how these types of analyses can provide clinically useful data. In addition, current and proposed approaches for the effective disinfection of the root canal environment without interference with stem cell viability or integrity of the dentin matrix in these cases will be explored. The future of research in this field, including better and more customizable approaches in RET, in light of recent technological advances and progress in endodontics, will be outlined.


Assuntos
Endodontia , Endodontia Regenerativa , Antibacterianos/uso terapêutico , Necrose da Polpa Dentária/tratamento farmacológico , Humanos , Regeneração , Tratamento do Canal Radicular
8.
J Endod ; 46(9S): S115-S127, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32950183

RESUMO

INTRODUCTION: This review aimed to provide a critical appraisal of alternative antimicrobial strategies in lieu of traditional triple antibiotic paste (TAP). METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The literature search was performed in 8 databases (PubMed/Medline, Embase, LILACS, Web of Science, Scopus, BVS, SciELO, and the Cochrane Library), selecting clinical, in vitro, in vivo, and in situ studies that evaluated antimicrobial alternatives to TAP in regenerative endodontics. Studies lacking an experimental TAP group were excluded. RESULTS: A total of 1705 potentially relevant records were initially identified. From the 38 studies retrieved for full-text reading, 16 fulfilled all selection criteria and were included in the qualitative analysis. According to the study design, 11 studies were solely in vitro, 1 study was both in vitro and in vivo (animal model), 2 studies were solely animal experiments, and 2 studies were clinical trials. The alternative antimicrobial agents to TAP consisted of modified TAP formulations (eg, a combination of TAP with chitosan); TAP-eluting nanofibers; propolis; chlorhexidine (CHX) gels/solutions; double antibiotic pastes composed of distinct combinations of antibiotics; Ca(OH)2-based formulations; and sodium hypochlorite. Overall, most of the alternative agents performed similarly to TAP, although some strategies (eg, Ca(OH)2- and CHX-based formulations) seemed to present dubious importance in the control of infection. CONCLUSIONS: TAP still remains an excellent option in terms of the complete elimination of microorganisms. This review points to the use of electrospun fibers as a drug delivery system to offer a controlled release of the antimicrobial agent, as well as the use of natural compounds, deserving future investigation.


Assuntos
Anti-Infecciosos , Endodontia Regenerativa , Animais , Antibacterianos , Clorexidina , Hipoclorito de Sódio
9.
J Endod ; 46(9S): S150-S160, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32950187

RESUMO

Two increasingly common endodontic procedures, vital pulp therapy (VPT) and regenerative endodontic procedures, rely on dental tissue regeneration/repair mechanisms with the aid of biomaterials. These materials are applied in close contact to the pulpal tissue and are required to be biocompatible, form an antimicrobial seal, not induce staining, and be easy to manipulate. Historically, calcium hydroxide played an important role in VPT. However, over the last 3 decades, significant efforts in research and industry have been made to develop various biomaterials, including hydraulic tricalcium silicate cements. The present review summarized various hydraulic tricalcium silicate cements and their biological properties in clinical procedures, namely VPT and regenerative endodontic procedures.


Assuntos
Compostos de Cálcio , Silicatos , Hidróxido de Cálcio , Polpa Dentária , Capeamento da Polpa Dentária , Endodontia Regenerativa
10.
J Endod ; 46(9S): S90-S100, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32950200

RESUMO

INTRODUCTION: The dental pulp is highly vascularized and innervated tissue that is uniquely designed, being highly biologically active, while being enclosed within the calcified structure of the tooth. It is well-established that the dental pulp vasculature is a key requirement for the functional performance of the tooth. Therefore, controlled regeneration of the dental pulp vasculature is a challenge that must be met for future regenerative endeavors in endodontics. METHODS: In this perspective review, we address recent progress and challenges on the use of microengineering methods and biomaterials scaffolds to fabricate the dental pulp vascular microenvironment. RESULTS: The conditions required to control the growth and differentiation of vascular capillaries are discussed, together with the conditions required for the formation of mature and stable pericyte-supported microvascular networks in 3-dimensional hydrogels and fabricated microchannels. Recent biofabrication methods, such as 3-dimensional bioprinting and micromolding are also discussed. Moreover, recent advances in the field of organs-on-a-chip are discussed regarding their applicability to dental research and endodontic regeneration. CONCLUSION: Collectively, this short review offers future directions in the field that are presented with the objective of pointing toward successful pathways for successful clinical and translational strategies in regenerative endodontics, with especial emphasis on the dental pulp vasculature.


Assuntos
Polpa Dentária , Dente , Diferenciação Celular , Regeneração , Endodontia Regenerativa , Engenharia Tecidual
11.
J Endod ; 46(12): 1856-1866.e2, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32827507

RESUMO

INTRODUCTION: The purposes of this review were to appraise the level of evidence of the existing regenerative endodontic therapy (RET) publications, perform a meta-analysis on the survival and healing rates of necrotic immature permanent teeth treated with RET, and run a meta-analysis on the quantitative assessment of the root development of those teeth. METHODS: Electronic searches were performed in Web of Science, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Library databases. Two authors independently screened the titles and abstracts for eligibility. The analyses were performed on the clinical outcomes (ie, survival, healing, and root development) of the procedure. RESULTS: Eleven articles were included in the qualitative and quantitative syntheses. Three studies were randomized controlled trials, 6 were prospective cohort studies, and 2 were retrospective cohort studies. The pooled survival and healing rates were 97.3% and 93.0%, respectively. The pooled rates of root lengthening, root thickening, and apical closure were 77.3%, 90.6%, and 79.1%, respectively. However, if 20% radiographic changes were used as a cutoff point, there were only 16.1% root lengthening and 39.8% root thickening. CONCLUSIONS: Within the limitations of the present study, it can be concluded that RET yielded high survival and healing rates with a good root development rate. However, clinical meaningful root development after RET was unpredictable.


Assuntos
Necrose da Polpa Dentária , Endodontia Regenerativa , Necrose da Polpa Dentária/terapia , Dentição Permanente , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Tratamento do Canal Radicular
12.
J Endod ; 46(10): 1448-1454, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32681848

RESUMO

INTRODUCTION: This study evaluated the bacterial levels after regenerative endodontic procedures and their correlation with the treatment outcome using molecular microbiology methods. METHODS: Root canal samples of 15 necrotic immature teeth were analyzed by quantitative polymerase chain reaction. Bacteria were counted before treatment (S1), after irrigation with 6% sodium hypochlorite (S2), and after intracanal dressing (S3) using either triple antibiotic paste (n = 7) or calcium hydroxide with chlorhexidine (n = 8). The Wilcoxon test for related samples and the Mann-Whitney test were used for statistical analysis (P < .05). After a follow-up period of 12-48 months, clinical and radiographic findings were correlated with microbiological data using a linear regression model (P < .05). RESULTS: All S1 and S2 samples were positive for bacteria, but the number of positive S3 samples decreased to 53.3% (P = .001). Overall, there was a significant reduction of bacterial levels after each treatment step (S1-S2, P = .001; S2-S3, P = .02). In the triple antibiotic paste and chlorhexidine groups, 57.1% and 50% of S3 samples were positive with median numbers of 6.97 × 103 and 3.59 × 104 bacterial cells, respectively. No significant differences were found between the groups. Periapical healing occurred in all cases despite the presence of low levels of residual bacteria. However, the latter had a negative impact on the thickness of dentinal walls (R2 = 0.0043). CONCLUSIONS: Although the bacterial levels were drastically reduced after the regenerative endodontic procedures, the residual bacteria influenced the thickness of the dentinal walls.


Assuntos
Periodontite Periapical/terapia , Endodontia Regenerativa , Hidróxido de Cálcio/uso terapêutico , Cavidade Pulpar , Necrose da Polpa Dentária/terapia , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular , Tratamento do Canal Radicular , Hipoclorito de Sódio/uso terapêutico
13.
J Endod ; 46(8): 1099-1104, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32479803

RESUMO

INTRODUCTION: This study focused on the optimization of sodium hypochlorite-EDTA irrigation in terms of the viability and morphology of dental pulp stem cells (DPSCs) and the effects of an optimized EDTA protocol alone or prepared with nanobubble (NB) water on cell behavior. METHODS: In the first part, human dentin discs were conditioned with the following protocols: (1) Sodium hypochlorite followed by phosphate-buffered saline (PBS), (2) Irrigation protocol from group 1 followed by EDTA, (3) Irrigation protocol from group 2 followed by PBS, (4) Sodium hypochlorite followed by EDTA, (5) Irrigation protocol from group 4 followed by PBS. DPSC viability and morphology were determined. In the second part, dentin discs were conditioned with the (1) optimized protocol in the first part, (2) EDTA prepared using NB water, (3) ultrasonic-activated EDTA, or (4) ultrasonic-activated EDTA prepared using NB water. Transforming growth factor beta release and DPSC viability, morphology, and migration were determined using the enzyme-linked immunosorbent assay, the water-soluble tetrazolium salt-1 cell viability assay and live-dead assay, and the transwell migration assay, respectively. Data were analyzed using Kruskal-Wallis or one-way analysis of variance and post hoc tests. RESULTS: The highest cell viability was observed in group 3 followed by group 5 (P < .05) in which PBS was used as a final rinse. Irrigation protocol from group 3 was used for the subsequent experiments. Ultrasonic-activated EDTA improved transforming growth factor beta release, viability, and migration of the cells compared with EDTA (P < .05). The preparation of EDTA with NBs did not change the biological properties of the EDTA-conditioned dentin (P > .05). CONCLUSIONS: Removing the residual EDTA using PBS improved the cell viability on the dentin surface. Ultrasonic activation enhanced the growth factor release and biological properties, whereas the preparation of EDTA with NBs showed a similar effect to regular EDTA without compromising the cellular effect.


Assuntos
Endodontia Regenerativa , Cavidade Pulpar , Dentina , Ácido Edético , Humanos , Irrigantes do Canal Radicular , Hipoclorito de Sódio
14.
J Endod ; 46(8): 1085-1090, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32553418

RESUMO

INTRODUCTION: This report describes the treatment of an immature mandibular molar by combining vital pulp therapy (VPT) and regenerative endodontic procedures (REPs). It details the use of REP to regain functionality and continued root development of an immature root with pulp necrosis and VPT for an immature root containing vital pulpal tissues. METHODS: An 8-year old male presented for evaluation of a mandibular first right molar with mild buccal swelling and a nontraceable sinus tract. He recently had received a restoration. After intraoral and radiographic examination, a diagnosis of pulp necrosis and chronic apical abscess was made. After access, pulp necrosis was confirmed in the distal root; however, vital pulp tissues were present in the mesial canals. It was decided on pulpotomy (VPT) in the mesial and REP in the distal root. At the initial visit, pulpotomy was completed in the mesial root, and REP was initiated in the distal root. Three weeks later, the patient was asymptomatic and the sinus tract absent. REP was completed in the distal root, and the tooth was restored. RESULTS: At the 6-, 12-, and 18-month follow-up, the patient presented without symptoms, and the tooth responded positively to pulp sensibility tests. Radiographic examinations showed resolution of the apical radiolucency and completed root development. CONCLUSIONS: Combined treatment using both VPT and REP for immature molars with different pulpal status in individual roots may be a preferable treatment option because preservation of vital pulp tissues and regeneration of new vital tissues allow for continued root development and functionality.


Assuntos
Dente Molar , Criança , Necrose da Polpa Dentária , Humanos , Masculino , Pulpotomia , Endodontia Regenerativa , Raiz Dentária
15.
J Endod ; 46(8): 1074-1084, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32560972

RESUMO

INTRODUCTION: Factors that influence clinical outcomes for regenerative endodontic procedures (REPs) are unknown. This retrospective study aimed to assess tooth healing, root development, pulp vitality, and esthetics post-REPs and categorize them into clinician- and patient-centered outcomes. Furthermore, this study identified significant predictors affecting such outcomes. METHODS: Immature permanent teeth diagnosed with pulp necrosis treated with REPs between 2008 and 2018 with a minimum of 1-year follow-up were included. Outcomes included success and survival rates, changes in root development using 2-dimensional radiographic root area (RRA) and 3-dimensional measurements, pulp vitality, and tooth discoloration. Predictor variables of success included age, sex, etiology of pulp necrosis (PN), type of medicament, sodium hypochlorite (NaOCl) concentration, type of biomaterial used over the blood clot, and preoperative apical diagnosis. Statistical analyses included Cox proportional hazard analyses and generalized regression models. RESULTS: Fifty-one teeth with an average of 2.1 years of follow-up satisfied the criteria. The survival rate was 92%. The success rate was 84.3% with age, etiology of PN, type of medicament, and NaOCl concentration being significant predictors of failure. Root development occurred in 91.4% of cases with age, sex, etiology of PN, type of medicament, NaOCl concentration, and apical diagnosis being significant predictors for RRA change. Positive pulp sensibility responses were associated with greater RRA change, and, finally, the type of biomaterial was a significant predictor for tooth discoloration after treatment. CONCLUSIONS: REPs provide a high survival rate. Patient and clinical factors may affect outcomes, and this knowledge may help to define the criteria for optimal treatment planning of REPs.


Assuntos
Endodontia Regenerativa , Polpa Dentária , Necrose da Polpa Dentária , Dentição Permanente , Humanos , Estudos Retrospectivos
16.
J Endod ; 46(9): 1248-1255, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32553876

RESUMO

INTRODUCTION: In this study, we investigated the properties of nanobubble (NB) water and its effect on smear layer removal and strengthening the efficiency of disinfecting agents used in regenerative endodontic treatment. METHODS: NB water was generated in a NB Generator. The NB size, concentration, and pH were measured. Porcine teeth were enlarged to size 60 by using hand-files and irrigated with either NB water or 17% EDTA or received no further irrigation. The ability of irrigants to remove the smear layer was evaluated by using a scanning electron microscope (9 roots/group). Other samples (6 roots/group) were subjected to Vickers hardness test to determine the dentin microhardness. Autofluorescent tetracycline mixed with distilled water or NB water was placed inside the root canal space of porcine teeth, and the depth of medicament penetration into the dentinal tubules was visualized by using fluorescent stereomicroscope (5 roots/group). For the disinfection experiment, human roots were prepared, autoclaved, and inoculated with Enterococcus faecalis for 3 weeks. Canals were then disinfected by (1) standard needle irrigation (SNI) with 5.25% NaOCl, (2) 5.25% NaOCl with ultrasonication (US), (3) 5.25% NaOCl + XP finisher (XP), (4) SNI with 1.5% NaOCl, or (5) SNI with 1.5% NaOCl in NB water (5 roots/group). Teeth were split open and stained with LIVE/DEAD BackLight and visualized by using confocal laser scanning microscope (CLSM) at the coronal, middle, and apical thirds of the canal. The ratio of dead/total bacteria in the dentinal tubules at various depth levels (50, 100, and 150 µm) was calculated. RESULTS: NB water was more effective in removing smear layer than 17% EDTA and could allow infiltration of tetracycline into the dentinal tubule more than 1 mm. NB water did not alter the dentin microhardness compared with 17% EDTA (P < .05). At 50-µm depth, CLSM analysis showed no statistically significant difference between 1.5% NaOCl in NB water and 5.25% NaOCl with or without irrigation activation at the coronal, middle, and apical root segments (P > .05), ie, these groups had stronger bacterial killing than 1.5% NaOCl (P < .05). At deeper levels (100 and 150 µm), higher concentrations of NaOCl were more effective than 1.5% NaOCl with or without NB water. No statistically significant difference was noted between 5.25% NaOCl with and without irrigation activation at most depth levels (P > .05). CONCLUSIONS: NB water can allow smear layer removal and enhance tubular penetration of medicaments without changing dentin microhardness. In large canal models, NB water appears to improve the tubular disinfection capacity of lower concentration of NaOCl up to 50 µm. On the other hand, the use of irrigation activation (US or XP) did not provide any added disinfection into the dentinal tubules compared with SNI. These results suggest that NB water may be a promising adjunct to endodontic irrigants and medicaments.


Assuntos
Irrigantes do Canal Radicular , Camada de Esfregaço , Animais , Cavidade Pulpar , Dentina , Ácido Edético , Humanos , Microscopia Eletrônica de Varredura , Endodontia Regenerativa , Preparo de Canal Radicular , Hipoclorito de Sódio , Suínos
17.
Int. j. odontostomatol. (Print) ; 14(2): 177-182, June 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1090672

RESUMO

Revitalization procedures have been extensively studied during the last decade and offers several advantages over root canal treatment, such as the recovery of the natural immune system. Mature teeth have a small apical foramen diameter (AFD), which could impair the ingrowth of tissue into the root canal. We analysed three methods for apical foramen enlargement by instrumentation in in situ human teeth and evaluated the damage over hard tissues produced by the techniques. Tooth length (TL), defined as the length from the most coronal part of the crown to the point at which the file abandons the root canal, was calculated. Forty-four in situ teeth were randomized: Group I: instrumentation 0.5 mm coronal to TL; Group II: at TL level; Group III: 0.5 mm beyond TL. Teeth were instrumented up to K-file #80. The mandibles were scanned in a micro-CT device before and after treatment. Group I: Only 20 % of teeth presented an enlarged AFD, with augmentation of 0.09 mm. No damage to hard tissues was observed. Group II: 71.4 % of the teeth presented an enlarged AFD with augmentation of 0.42 mm. 35.7 % presented damage to periapical tissues. Group III: 86.7 % presented an enlarged AFD with augmentation of 0.43 mm. 46.7 % presented damage to periapical tissues. All groups presented similar prevalence of teeth with dentine thickness less than 1mm. All mandibular incisors presented areas of thickness less than 1mm. Instrumentation 0.5 mm beyond TL is the most effective technique.


La revitalización de dientes necróticos ha sido ampliamente estudiada durante la última década y ofrece varias ventajas sobre la endodoncia convencional, tal como la recuperación del sistema inmunitario natural del diente. Los dientes maduros tienen un diámetro de foramen apical (FA) pequeño, lo que podría afectar el crecimiento de tejido en el conducto. Se evaluaron tres métodos para la ampliación del foramen apical en dientes humanos in situ y se evaluó el daño sobre los tejidos duros producidos por las técnicas. Mediante radiografía periapical se calculó la longitud del diente (TL), definida como la longitud desde la parte más coronal de la corona hasta el punto en que la lima abandonó el conducto radicular. En el estudio fueron aleatorizados 44 dientes in situ: Grupo I: instrumentación 0,5 mm coronal a TL; Grupo II: a nivel TL; Grupo III: 0,5 mm más allá de TL. Los dientes fueron instrumentados hasta la lima K #80. Las mandíbulas se escanearon en un dispositivo de microCT antes y después del tratamiento. Grupo I: solo el 20 % de los dientes presentaron un diámetro de FA ensanchado, con un aumento de 0,09 mm. No se observó daño a los tejidos duros. Grupo II: el 71,4 % de los dientes presentaban un FA ensanchado con un aumento de 0,42 mm. El 35,7 % presentó daño a los tejidos periapicales. Grupo III: el 86,7 % presentó un FA ensanchado con un aumento de 0,43 mm. El 46,7 % presentó daño a los tejidos periapicales. Todos los grupos presentaron una prevalencia similar de dientes con un espesor de dentina inferior a 1mm. Todos los incisivos mandibulares presentaban áreas de grosor inferior a 1mm. La instrumentación 0,5 mm más allá de TL es la técnica más efectiva, aunque se debe tener especial consideración en aspectos como el debilitamiento de la estructura dentaria.


Assuntos
Humanos , Dente/diagnóstico por imagem , Ápice Dentário/diagnóstico por imagem , Microtomografia por Raio-X , Endodontia Regenerativa , Dente/anatomia & histologia , Cadáver , Ápice Dentário/anatomia & histologia
18.
J Evid Based Dent Pract ; 20(1): 101400, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32381409

RESUMO

OBJECTIVE: To evaluate if there is a connection between the causes of pulp necrosis (eg, caries, trauma, dental anomaly) and the success of regenerative endodontic treatment. METHODS: Electronic databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Embase) were searched for studies on regenerative endodontic treatment, which used both clinical and radiographic evaluation of root maturation after at least 6 months of follow-up. The search terms "necrotic pulp", "regenerative endodontic treatment", "revascularization", and "revitalization" were combined using Boolean operators. The main journals on endodontics and dental traumatology were additionally hand-searched. Studies were included if they specified the causes of pulp necrosis. The primary question under review was, "Does the cause of pulp necrosis affect the outcome of regenerative endodontic treatment?" Other factors such as tooth type, intracanal medicament, irrigation protocol, use of a collagen matrix, and the type of scaffold were evaluated for possible relation with the outcome. The risk-of-bias assessment for randomized and nonrandomized studies was performed separately, using a modified Cochrane Collaboration's tool and risk of bias in non-randomized studies of interventions-I tool, respectively. Meta-analysis was performed, when possible, between studies comparing treatment outcomes of teeth whose pulp necrosis had different etiology. The search strategy yielded 1197 items. After screening, 18 studies reporting 445 regenerative endodontic treatment cases were included. RESULTS: The overall success rate for 274 teeth with trauma etiology was 94.8%, for 95 teeth with dens evaginatus etiology was 93.1%, and for 24 teeth with caries etiology was 96%. No significant difference was found between the results of regenerative endodontic treatment among teeth with trauma, dens evaginatus, and caries etiology (P = .055). Meta-analysis of studies comparing teeth with caries vs dens evaginatus and those with trauma vs caries confirmed that there was no evidence for difference in outcomes. CONCLUSION: Further randomized studies specifically testing such hypothesis are needed to confirm the preliminary results of this review.


Assuntos
Cárie Dentária , Necrose da Polpa Dentária , Humanos , Endodontia Regenerativa , Resultado do Tratamento
19.
Int Endod J ; 53(8): 1140-1152, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32299123

RESUMO

AIM: To analyse the cytotoxicity, colour change and radiopacity of MTA Flow (MTA), UltraCal XS (UC) and Bio-C Temp (BT). METHODOLOGY: Human dental pulp cells (hDPCs) stimulated with lipopolysaccharide (LPS) were placed in contact with several dilutions of culture media previously exposed to the experimental materials and tested for cell viability using MTT. Bovine teeth were prepared to simulate an open apex and to mimic extensive crown fracture. The roots were filled with a mixture of agar and blood, and the materials placed over this mixture. The control group consisted of teeth filled only with agar and blood. Colour assessment analyses were performed before and immediately after material insertion and repeated at 30, 45 and 60 days using a spectrophotometer. The total colour change (ΔEab , ΔE00 and whiteness index (WI)) was calculated based on the CIELAB colour space. Digital radiographs were acquired for radiopacity analysis. Cell viability was analysed by one-way anova, whilst differences in colour parameters (ΔEab , ΔE00 and WI) were assessed by two-way repeated measures anova (α = 0.05). Tukey's test was used to compare the experimental groups, and Dunnett's test was used to compare the experimental groups with the control group. RESULTS: MTA, UC and BT had similar cell viability to that of the control group (DMEM) (P > 0.05), except for the BT group at the 1 : 1 and 1 : 2 dilutions, which had significantly lower viability (P < 0.001). All materials were associated with discoloration values greater than what is considered to be the acceptable threshold, and BT resulted in less or similar tooth colour change than MTA and UC, respectively. Decreasing radiopacity over time was observed only in the MTA group (P = 0.007). Lower values of radiopacity were found in the BT group compared with the UC and MTA groups (P < 0.001). CONCLUSIONS: The new bioceramic material (BT) had acceptable cell viability, similar to that of MTA and UC at the highest dilutions, and BT resulted in less tooth colour change than MTA and UC. Despite its lower radiopacity, BT was identified radiographically.


Assuntos
Materiais Restauradores do Canal Radicular , Descoloração de Dente , Compostos de Alumínio , Animais , Compostos de Cálcio , Bovinos , Sobrevivência Celular , Combinação de Medicamentos , Humanos , Óxidos , Endodontia Regenerativa , Silicatos
20.
Minerva Stomatol ; 69(4): 223-234, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32181614

RESUMO

BACKGROUND: Knowledge, attitudes, and beliefs of the students are important for the Tissue Engineering in Endodontic practice. The opinion of these future dentists would ultimately will decide the endurance of REPs as routine procedures in endodontic practice. The aim of this study was to perform a survey to identify the knowledge, attitudes, and practices of undergraduate students about regenerative endodontic procedures (REPs). METHODS: The questionnaire was obtained after cross-cultural adaptation of a questionnaire previously applied in USA and was applied to two hundred forty-eight undergraduates. Data were statistically analyzed. RESULTS: Most of the students (82.9%) agreed that regenerative therapy should be incorporated to dentistry and 87.5% of them believed that stem cells banks would be useful for the tissue regeneration. Most participants (58.1%) would like to obtain an internship/tutoring that addresses REPs and 80.8% of participants think that the major obstacle to a patient accepting a REP was the expected high cost of the treatment. The freshmen students were more optimistic about offering stem cell treatments to their patients (P≤0.05). CONCLUSIONS: The undergraduates were very optimistic about the future of REPs, stem cell banking, and tissue engineering. Although seniors demonstrated less enthusiasm towards REPs than the freshman, most students are willing to recommend these treatments to their patients.


Assuntos
Endodontia , Endodontia Regenerativa , Atitude , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudantes , Inquéritos e Questionários , Engenharia Tecidual
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