Analysis of the healing process in delayed tooth replantation after root canal filling with calcium hydroxide, Sealapex and Endofill: a microscopic study in rats

The major concern in the therapeutics of tooth replantation refers to the occurrence of root resorption and different approaches have been proposed to prevent or treat these complications. The purpose of this study was to evaluate tissue response to delayed replantation of anterior rat teeth treated endodontically using calcium hydroxide, Sealapex, and Endofill without the placement of gutta-percha cones. Thirty rats had their right upper incisor extracted and maintained in dry storage for 60 min. After removal of the dental papilla, enamel organ, pulp tissue, and periodontal ligament remnants, the teeth were immersed in 2% sodium fluoride phosphate acidulated, pH 5.5, for 10 min. The root canals were dried with absorbent paper points and the teeth were assigned to three groups (n = 10) according to the filling material. Group I - calcium hydroxide and propyleneglycol paste, Group II - Sealapex, and Group III - Endofill. The sockets were irrigated with saline and the teeth were replanted. Replacement resorption, inflammatory resorption and ankylosis were observed in all groups. Although the occurrence of inflammatory resorption was less frequent in Group I, there were no statistically significant differences among the groups. It may be concluded that compared to the paste, filling the root canals with Sealapex and Endofill sealers without the placement of gutta-percha cones did not provide better results.

Effect of root surface treatment with propolis and fluoride in delayed tooth replantation in rats

Replantation is an acceptable option for treatment of an avulsed permanent tooth. Nevertheless, an extended extraoral period damages the periodontal ligament and results in external root resorption. The purpose of this study was to assess by histologic and histometric analysis, the influence of propolis 15% (natural resinous substance collected by Apis mellifera bees from various plants) and the fluoride solution used as root surface treatment on the healing process after delayed tooth replantation. Thirty Wistar (Rattus norvegicus albinus) rats were submitted to extraction of their upper right incisor. The teeth were maintained in a dry environment for 60 min. After this, the pulp was extirpated and the papilla, enamel organ and periodontal ligament were removed with scalpel. The teeth were divided into three experimental groups: Group I - teeth immersed in 20 ml of physiologic saline; Group II - teeth immersed in 20 ml of 2% acidulated phosphate sodium fluoride; Group III - teeth immersed in 20 ml of 15% propolis. After 10 min of immersion in the solutions, the root canals were dried and filled with calcium hydroxide paste and the teeth were replanted. The animals were euthanized 60 days after replantation. The results showed that similar external root resorption was seen in the propolis and fluoride groups. Teeth treated with physiologic saline tended to have more inflammatory root resorption compared with those treated with fluoride or propolis. However, the comparative analysis did not reveal statistically significant differences (P > 0.05) between the treatment modalities when used for delayed tooth replantation.

Influence of Crown Ferrule Heights and Dowel Material Selection on the Mechanical Behavior of Root-Filled Teeth: A Finite Element Analysis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influence of customized composite resin fibreglass posts on the mechanics of restored treated teeth

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Immediate reimplantation of primary teeth: a histological study in dogs

Reimplantation of primary teeth has been the subject of various clinical and histological studies, but very little is known about the effect of this treatment on primary teeth. The aim of the present study was to histologically evaluate the biological response of dog primary teeth after immediate reimplantation. Twelve dogs were divided into two groups according to postoperative time: 1 week and 3 weeks. Twenty-one upper and lower intermediate incisors were extracted and submitted to endodontic treatment, reimplantation and splinting. The 21 homologous teeth not submitted to treatment served as controls. The animals were killed after the respective experimental periods, and the obtained specimens were processed for histological analysis. Most dogs of the 1-week group exhibited the following alterations: gingival epithelium was inserted in the cemento-enamel junction, with a small number of chronic inflammatory cells being observed in the gingival corium; the periodontal ligament was partially reestablished, with a more expressive chronic inflammatory infiltrate being observed in the apical third; small root resorption was observed on the palatine/lingual side in the apical third. In contrast, in 3-week animals, gingival epithelial insertion was predominantly absent on the buccal side, and a moderate chronic inflammatory infiltrate was present; the periodontal ligament generally showed no bone-cementum reinsertion especially on the palatine/lingual side, with an expressive inflammatory infiltrate in the apical region, and large root resorption was mainly observed on the palatine and lingual sides. In conclusion, reimplantation causes histological alterations in the tooth and its supporting periodontal structures that suggest the impossibility of its maintenance.

Tissue reaction to Endométhasone sealer in root canal fillings short of or beyond the apical foramen

Objective: This study evaluated the response of periapical tissues to the endodontic sealer Endomethasone in root canal fillings short of or beyond the apical foramen. Material and Methods: Twenty root canals of premolars and incisors of 2 mongrel dogs were used. After coronal access and pulp extirpation, the canals were instrumented up to a size 55 K-file and the apical cemental barrier was penetrated with a size 15 K-file to obtain a main apical foramen, which was widened to a size 25 K-file. The canals were irrigated with saline at each change of file. The root canals were obturated either short of or beyond the apical foramen by the lateral condensation of gutta-percha and Endomethasone, originating 2 experimental groups: G1: Endomethasone/short of the apical foramen; G2: Endomethasone/beyond the apical foramen. The animals were killed by anesthetic overdose 90 days after endodontic treatment. The individual roots were obtained and serial histological sections were prepared for histomorphological analysis (H&E and Brown & Brenn techniques) under light microscopy. The following parameters were examined: closure of the apical foramen of the main root canal and apical opening of accessory canals, apical cementum resorption, intensity of the inflammatory infiltrate, presence of giant cells and thickness and organization of the apical periodontal ligament. Each parameter was scored 1 to 4, 1 being the best result and 4 the worst. Data were analyzed statistically by the Wilcoxon nonparametric tests (p=0.05). Results: Comparing the 2 groups, the best result (p<0.05) was obtained with root canal filling with Endomethasone short of the apical foramen but a chronic inflammatory infiltrate was present in all specimens. Conclusions: Limiting the filling material to the root canal space apically is important to determine the best treatment outcome when Endomethasone is used as sealer.

Influence of apical foramen widening and sealer on the healing of chronic periapical lesions induced in dogs' teeth

Objective. The aim of this study was to evaluate the influence of apical foramen widening on the healing of chronic periapical lesions in dogs' teeth after root canal filling with Sealer 26 or Endomethasone.Study design. Forty root canals of dogs' teeth were used. After pulp extirpation, the canals were exposed to the oral cavity for 180 days for induction of periapical lesions, and then instrumented up to a size 55 K-file at the apical cemental barrier. In 20 roots, the cemental canal was penetrated and widened up to a size 25 K-file; in the other 20 roots, the cemental canal was preserved (no apical foramen widening). All canals received a calcium hydroxide intracanal dressing for 21 days and were filled with gutta-percha and 1 of the 2 sealers: group 1: Sealer 26/apical foramen widening; group 2: Sealer 26/no apical foramen widening; group 3: Endomethasone/apical foramen widening; group 4: Endomethasone/no apical foramen widening. The animals were killed after 180 days, and serial histologic sections from the roots were prepared for histomorphologic analysis. Scores were assigned according to preestablished histomorphologic parameters and analyzed statistically by Kruskal-Wallis and Mann-Whitney U tests.Results. Regarding new cementum formation, repair of cementum and bone resorption areas, presence of microorganisms, inflammatory cell infiltrate and periodontal ligament conditions, significantly better periapical healing was obtained when foramen widening was done and Sealer 26 was used.Conclusion. Apical foramen widening and calcium hydroxide-containing sealer were more favorable to the healing of chronic periapical lesions. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:932-940)

Tissue reaction of the EndoREZ in root canal fillings short of or beyond an apical foramenlike communication

This study evaluated the response of periapical tissues to the endodontic sealer EndoREZ in root canal fillings short of or beyond the apical foramenlike communication. Twenty root canals of premolars and incisors of 2 mongrel dogs were used. After coronal access and pulp extirpation, the canals were instrumented up to a size 55 K-file and the apical cemental barrier was penetrated with a size 15 K-file to create an apical foramenlike communication, which was widened to a size 25 K-file. The canals were irrigated with saline at each change of file. The root canals were obturated either short of or beyond the apical foramenlike opening by the lateral condensation of gutta-percha and EndoREZ, originating 2 experimental groups: G1, EndoREZ/short of the apical foramenlike opening, and G2, EndoREZ/beyond the apical foramenlike opening. The animals were killed by anesthetic overdose 90 days after endodontic treatment. The individual roots were obtained and serial histological sections were prepared for histomorphological analysis (H&E and Brown and Brenn techniques) under light microscopy. The following parameters were examined: closure of the apical foramenlike communication and apical opening of accessory canals, apical cementum resorptions, intensity of the inflammatory infiltrate, presence of giant cells, and thickness and organization of the apical periodontal ligament. Each parameter was scored 1 to 4, 1 being the best result and 4 the worst. Data were analyzed statistically by the Wilcoxon nonparametric tests (P = .05). Comparing the 2 groups, the best result (P = .05) was obtained with root canal filling with EndoREZ short of the apical foramenlike opening. In conclusion, limiting the filling material to the root canal space apically was important to determine the best treatment outcome when EndoREZ was used as the sealer. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: e94-e99)

Cytotoxicity of Portland Cement with Different Radiopacifying Agents: A Cell Death Study

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A dominant function of p38 mitogen-activated protein kinase signaling in receptor activator of nuclear factor-kappa B ligand expression and osteoclastogenesis induction by Aggregatibacter actinomycetemcomitans and Escherichia coli lipopolysaccharide

Background and Objective: Lipopolysaccharide from gram-negative bacteria is one of the microbial-associated molecular patterns that initiate the immune/inflammatory response, leading to the tissue destruction observed in periodontitis. The aim of this study was to evaluate the role of the p38 mitogen-activated protein kinase (MAPK) signaling pathway in lipopolysaccharide-induced receptor activator of nuclear factor-kappa B ligand (RANKL) expression by murine periodontal ligament cells.Material and Methods: Expression of RANKL and osteoprotegerin mRNA was studied by reverse transcription-polymerase chain reaction upon stimulation with lipopolysaccharide from Escherichia coli and Aggregatibacter actinomycetemcomitans. The biochemical inhibitor SB203580 was used to evaluate the contribution of the p38 MAPK signaling pathway to lipopolysaccharide-induced RANKL and osteoprotegerin expression. Stable cell lines expressing dominant-negative forms of MAPK kinase (MKK)-3 and MKK6 were generated to confirm the role of the p38 MAPK pathway. An osteoclastogenesis assay using a coculture model of the murine monocytic cell line RAW 264.7 was used to determine if osteoclast differentiation induced by lipopolysaccharide-stimulated periodontal ligament was correlated with RANKL expression.Results: Inhibiting p38 MAPK prior to lipopolysaccharide stimulation resulted in a significant decrease of RANKL mRNA expression. Osteoprotegerin mRNA expression was not affected by lipopolysaccharide or p38 MAPK. Lipopolysaccharide-stimulated periodontal ligament cells increased osteoclast differentiation, an effect that was completely blocked by osteoprotegerin and significantly decreased by inhibition of MKK3 and MKK6, upstream activators of p38 MAPK. Conditioned medium from murine periodontal ligament cultures did not increase osteoclast differentiation, indicating that periodontal ligament cells produced membrane-bound RANKL.Conclusion: Lipopolysaccharide resulted in a significant increase of RANKL in periodontal ligament cells. The p38 MAPK pathway is required for lipopolysaccharide-induced membrane-bound RANKL expression in these cells.

Fracture strength of flared bovine roots restored with different intraradicular posts

Objective: The aim of this study was to evaluate the fracture strength and failure mode of flared bovine roots restored with different intraradicular posts. Material and Methods: Fifty bovine incisors with similar dimensions were selected and their roots were flared until 1.0 mm of dentin wall remained. Next, the roots were allocated into five groups (n=10): GI-cast metal post-and-core; GII-fiber posts plus accessory fiber posts; GIII-direct anatomic post; GIV-indirect anatomic post and GV-control (specimens without intraradicular post). A polyether impression material was used to simulate the periodontal ligament. After periodontal ligament simulation, the specimens were subjected to a compressive load at a crosshead speed of 0.5 mm/min in a servo-hydraulic testing machine (MTS 810) applied at 135 to the long axis of the tooth until failure. The data (N) were subjected to ANOVA and Tukey's post-hoc test (alpha=0.05). Results: GI and GIV presented higher fracture strength (p<0.05) than GII. GIII presented intermediate values without statistically significant differences (p>0.05) from GI, GII and GIV. Control specimens (GV) produced the lowest fracture strength mean values (p<0.05). Despite obtaining the highest mean value, GI presented 100% of unfavorable failures. GII presented 20% of unfavorable failures. GIII, GIV and GV presented only favorable failures. Conclusions: Although further in vitro and in vivo studies are necessary, the results of this study showed that the use of direct and indirect anatomic posts in flared roots could be an alternative to cast metal post-and-core.

Cell death and quantitative reduction of rests of Malassez according to age

Background and Objective: Rests of Malassez are clusters of epithelial cells that remain in the periodontal ligament throughout life. However, it has been reported that the number of these structures decreases with age, and some epithelial cells undergo apoptosis in rests of Malassez of young and adult rats. Therefore, the purpose of the present study was to investigate the incidence of epithelial cell death and the quantitative changes in the rests of Malassez in rat molars of different ages.Material and Methods: Fragments containing the upper molars of rats aged 29, 45 and 120 d were fixed, decalcified and embedded for analysis by light microscopy. In the sections stained by hematoxylin and eosin, the number of rests of Malassez and the number of nuclei of these epithelial structures were obtained. Moreover, the nuclei exhibiting typical features of cell death were also counted in each rest of Malassez. The terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method for detection of cell death was also carried out.Results: In all groups examined, some rests of Malassez exhibited epithelial cell nuclei with typical features of apoptosis and some of them were also TUNEL positive. From 29 to 120 d of age in rats, the quantitative analysis showed a significant decrease in the total number of rests of Malassez in the cervical, middle and furcation regions of the periodontal ligament. Moreover, a significant decrease of epithelial cell nuclei was concomitant to an increase in the frequency of cell death in the oldest rats.Conclusion: These results suggest that epithelial cell death by apoptosis may be, at least in part, responsible for the reduction in the number of rests of Malassez according to age.

Area of Rests of Malassez in Young and Adult Rat Molars: Evidences in the Formation of Large Rests

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A comparison study of periapical repair in dogs' teeth using RoekoSeal and AH plus root canal sealers: A histopathological evaluation

The objective of the study was to evaluate the biocompatibility of RoekoSeal sealer Roeko (Dental Products, Langenau, Germany) with the periapical tissues of dogs and compare it with AH Plus sealer (Dentsply/De Trey, Konstanz, Germany). The pulps of 32 root canals were removed, the apical cementum layer perforated, the biomechanical preparation performed, and the root canals filled by lateral condensation technique. Ninety days after the surgery, the animals were euthanized, the bone with teeth removed, and the samples prepared for histopathological analysis. In group 1 (RoekoSeal Automix), deposition of mineralized tissue was observed, with complete newly mineralized apical formed tissue in 43.8% and partial sealing in 56.2%. In group 2 (AH Plus), in 12.5% there was complete newly mineralized apical formed tissue, in 75% the sealing was partial, and in 12.5% there was no sealing (p < 0.05). There were no differences between the groups in relation to the inflammatory infiltrate; thickness of the periodontal ligament; and the resorption of dentin, cementum or bone (p > 0.05).

Assessment of external root temperature during root canal irradiation by Nd:YAG and Er:YAG lasers

Different types of laser have been widely studied for applicability in the oral health area. In the endodontic area, investigations with some types of laser have been conducted to establish safe parameters for clinical application in root canals. However, it has not been duly explained whether the temperature increase caused by laser irradiation could cause alteration in the temperature on the external surface of the root and, consequently, alterations in the cells of the periodontal ligament, causing resorption and even loss of the dental element. The proposal in this paper was to gauge the external root temperature in the apical and cervical regions of the roots of human teeth during root canal irradiation with Nd:yttrium aluminum garnet (YAG) and Er:YAG lasers using different parameters. The novel approach of this paper is the use of the technique of laser applications along the total length of the root canal with series of repetitive irradiation, however, using time of 1 s of irradiation associated with 1 s off to avoid cumulative thermal effects. Experimental results confirm the accuracy of the parameters and exposure regimen obtained. All the parameters used in this paper are acceptable from a clinical as well as a biological point of view. (C) 2009 Laser Institute of America.