Bonding ability of paste-paste glass ionomer systems to tooth structure: in vitro studies

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Delayed tooth replantation: MTA as root canal filling

MTA has been investigated as a root-end filling material. Its mechanism of action has some similarities to that of Ca(OH())2. The purpose of this study was to evaluate the repair process taking place in the delayed replantation of monkey teeth using calcium hydroxide and MTA as root canal filling materials. Five monkeys had their lateral incisors extracted and bench-dried for 60 minutes. After root canal preparation, the teeth were assigned to two groups according to root canal filling material: I, calcium hydroxide; and II, MTA. The same treatment sequence was followed for both groups: coronal seal, periodontal ligament removal, immersion of the tooth in 2% acidulated-phosphate sodium fluoride, irrigation of the socket with saline and replantation. Both groups exhibited replacement resorption, areas of ankylosis and absence of inflammatory root resorption. Statistically similar results (p > 0.05) were observed for both groups regarding replacement root resorption, but the groups differed significantly (p < 0.05) regarding the occurrence of ankylosis. MTA may be a viable clinical option for filling teeth submitted to delayed replantation, and is an acceptable option for treating replanted permanent teeth in order to prevent tooth resorption, particularly when dressing changes are not possible.

Microabrasion in tooth enamel discoloration defects: three cases with long-term follow-ups

Superficial irregularities and certain intrinsic stains on the dental enamel surfaces can be resolved by enamel microabrasion, however, treatment for such defects need to be confined to the outermost regions of the enamel surface. Dental bleaching and resin-based composite repair are also often useful for certain situations for tooth color corrections. This article presented and discussed the indications and limitations of enamel microabrasion treatment. Three case reports treated by enamel microabrasion were also presented after 11, 20 and 23 years of follow-ups.

Optimizing maxillary aesthetics of a severe compromised tooth through orthodontic movement and dental implants

Treatment of severe compromised tooth in the maxillary anterior area still poses great challenge to the clinicians. Several treatment modalities have been proposed to restore the function and aesthetics in teeth with advanced periodontal disease. The present study aims to report a case of traumatic injury of a left-maxillary central incisor with ridge preservation, orthodontic movement, and implant therapy. A 45-year-old woman underwent the proposed treatment for her left central incisor: basic periodontal therapy, xenogenous bone graft, and guided bone regeneration (GBR). Six months after the graft procedure, orthodontic movement by means of alignment and leveling was made and a coronal displacement of the gingival margin and vertical bone apposition could be observed after 13 months of active movement. Afterwards, a dental implant was placed followed by a connective tissue graft and immediate provisionalization of the crown. In conclusion, orthodontic movement was effective to improve the gingival tissue and alveolar bone prior to implant placement favoring the aesthetic results. Six years postoperatively, the results revealed height and width alveolar bone gain indicating that the treatment proposed was able to restore all the functional and aesthetic parameters.

Early treatment of an intruded primary tooth: a case report

The report is about a case of total intrusion of a deciduous central incisor involving a male patient of 14 months of age. Repositioning of the intruded tooth was performed 20 minutes after the trauma, followed by placement with sutures. Clinical and radiographic monitoring performed after 1, 2, 4, 9, and 13 months showed normal characteristics. We emphasize the development of preventive programs promoting parental awareness of the importance of looking for prompt care, resulting in a better prognosis.

Uncommon crown-root fracture treated with adhesive tooth fragment reattachment: 7 years of follow-up

Crown-root fractures account for 5% of all fractures in permanent teeth and can involve enamel, dentin, and cementum. Depending on whether there is pulpal involvement, these problems may be classified as complicated (which are more common) or noncomplicated. The treatment depends on the level of the fracture line, root length and/or morphology, and esthetic needs. Several treatment strategies are available for esthetic and functional rehabilitation in crown-root fractures. Adhesive tooth fragment reattachment is the most conservative restorative option when the tooth fragment is available and the biological width has no or minimal violation. This article reports a case of an uncomplicated crown-root fracture in the permanent maxillary right central incisor of a young patient who received treatment with adhesive tooth fragment reattachment, preserving the anatomic characteristics of the fractured tooth after periodontal intervention. The fracture line of the fragment had an unusual shape, starting on the palatal side and extending to the buccal side subgingivally. After 7 years, the attached coronal fragment remained in position with good esthetics, as well as clinical and radiographic signs of pulpal vitality, periodontal health, and root integrity, thus indicating success.

Effect of chemical activation of 10% carbamide peroxide gel in tooth bleaching

This study aimed to evaluate the efficacy of chemical agents to increase the bleaching effectiveness of 10% carbamide peroxide. Two hundred and ninety enamel-dentin discs were prepared from bovine incisors. The color measurement was performed by a spectrophotometer using the CIE L*a*b*system. The groups were divided according to the bleaching treatment: negative control group (NC): without bleaching; positive control group (PC): bleached with 10% carbamide peroxide gel without any chemical activator; Manganese gluconate (MG); Manganese chloride (MC); Ferrous gluconate (FG); Ferric chloride (FC); and Ferrous sulphate (FS). Three different concentrations (MG, MC, FG, FC: 0.01, 0.02 and 0.03% w/w; FS: 0.001, 0.002 and 0.003% w/w) for each agent were tested. The bleaching gel was applied on the specimens for 8 h, after which they were immersed in artificial saliva for 16 h, during 14 days. Color assessments were made after 7 and 14 days. The data were analyzed by repeated measures analysis of variance and Tukey's test (5%). Generally, the test groups were unable to increase the bleaching effect (ΔE) significantly compared to the PC group. Only for ΔL, significant higher values compared to the PC group could be seen after 7 days in groups MG (0.02%), and FS (0.002 and 0.003%). The NC group showed significantly lower values than all tested groups. It was concluded that for home bleaching procedures, the addition of chemical activators did not produce a bleaching result significantly higher than the use of 10% carbamide peroxide without activation, and that the concentration of chemical activators used did not significantly influence the effectiveness of treatment.

Influence of occlusal contact area on cusp defection and stress distribution

The purpose of this study was to evaluate the effect of occlusal contact area for loading on the cuspal defection and stress distribution in a first premolar restored with a high elastic modulus restorative material. The Rhinoceros 4.0 software was used for modeling the three-dimensional geometries of dental and periodontal structures and the inlay restoration. Thus, two different models, intact and restored teeth with three occlusal contact areas, 0.1, 0.5 and 0.75 mm(2), on enamel at the occlusal surface of buccal and lingual cusps. Finite element analysis (FEA) was performed with the program ANSYS (Workbench 13.0), which generated a mesh with tetrahedral elements with greater refinement in the regions of interest, and was constrained at the bases of cortical and trabecular bone in all axis and loaded with 100 N normal to each contact area. To analysis of maximum principal stress, the smaller occlusal contact area showed greater compressive stress in region of load application for both the intact and inlay restored tooth. However, tensile stresses at the occlusal isthmus were similar for all three tested occlusal contact areas (60 MPa). To displacement of the cusps was higher for teeth with inlay (0.46-0.48 mm). For intact teeth, the smaller contact area showed greater displacement (0.10 mm). For teeth with inlays, the displacement of the cusps were similar in all types of occlusal area. Cuspal displacement was higher in the restored tooth when compared to the intact tooth, but there were no significant variations even with changes in the occlusal contact area. RELEVANCE CLINICAL: Occlusal contacts have a great influence on the positioning of teeth being able to maintain the position and stability of the mandible. Axial loads would be able to generate more uniform stress at the root presenting a greater concentration of load application in the point and the occlusal surface. Thus, is necessary to analyze the relationship between these occlusal contacts as dental wear and subsequent occlusal interferences.

Diabetes triggers the loss of tooth structure associated to radiographical and histological dental changes and its evolution to progressive pulp and periapical lesions in rats

The aim of this study was to evaluate the putative influence of diabetes without metabolic control in the loss of tooth structure as well as histological changes in dentin and pulp tissue in rats. Diabetes was induced in Wistar rats (n=25) by intravenous administration of alloxan (42mg/kg). Diabetic and non-diabetic control rats were evaluated at 1, 3, 6, 9 and 12 months of follow-up. In order to evaluate the presence and progression of dental caries and periapical lesions, hemimandibles were removed and submitted to radiographical, histological, and morphometrical procedures. Dental caries were detected after radiographical and histological evaluations in diabetic group from the third month of diabetes onset, increasing gradually in frequency and severity in periods. Diabetic rats dental pulps also presented significant reduction in volume density of collagen fibers and fibroblasts at third month, parallel with a trend towards the increase in inflammatory cells volume density. Diabetic rats presented a generalized pulp tissue necrosis after 6 months of diabetes induction. Moreover, periapical lesions were not detected in control group, while these lesions were observed in all rats after 3, 6, 9, and 12 months of diabetes induction. Uncontrolled diabetes seems to trigger the loss of tooth structure, associated to histological dental changes and mediates its evolution to progressive severe pulp and periapical lesions in rats. Therefore, diabetes may be considered a very important risk factor regarding alterations in dental pulp, development of dental caries, and periapical lesions.

Effectiveness of 6% hydrogen peroxide concentration for tooth bleaching-A double-blind, randomized clinical trial

The aim of this clinical randomized double-blind split-mouth study was to assess the effectiveness of a 6% hydrogen peroxide with nitrogen-doped titanium dioxide light activated bleaching agent. 31 patients were treated with: one upper hemiarcade with a 35% hydrogen peroxide bleaching agent and the other hemiarcade with a 6% hydrogen peroxide. Two applications were completed each treatment session and three sessions were appointed, with one week interval between them. Tooth colour was registered each session and 1 week and 1 months after completing the treatment by spectrophotometer, registering parameters L*, a* and b*, and subjectively using VITA Classic guide. Tooth sensitivity was registered by VAS and patient satisfaction and self-perception result was determined using OHIP-14. Tooth colour variation and sensitivity were compared between both bleaching agents. Both treatment showed a change between baseline colour and all check-points with a ΔE=5.57 for 6% and of ΔE=7.98 for the 35% one month after completing the (p<0.05). No statistical differences were seen when subjective evaluations were compared. Also, no differences were seen in tooth sensitivity between bleaching agents. OHIP-14 questionnaire demonstrated a significant change for all patients after bleaching. A 6% hydrogen peroxide with nitrogen-doped titanium dioxide light activated agent is effective for tooth bleaching, reaching a ΔE of 5.57 one month after completing the treatment, with no clinical differences to a 35% agent neither in colour change or in tooth sensitivity. A low concentration hydrogen peroxide bleaching agent may reach good clinical results with less adverse effects.

Delayed tooth replantation following root canal filling with calcium hydroxide and MTA: Histomorphometric study in rats

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

Apoptosis and reduced microvascular density of the lamina propria during tooth eruption in rats

During tooth eruption, structural and functional changes must occur in the lamina propria to establish the eruptive pathway. In this study, we evaluate the structural changes that occur during lamina propria degradation and focus these efforts on apoptosis and microvascular density. Fragments of maxilla containing the first molars from 9-, 11-, 13- and 16-day-old rats were fixed, decalcified and embedded in paraffin. The immunohistochemical detection of vascular endothelial growth factor (VEGF), caspase-3 and MAC387 (macrophage marker), and the TUNEL method were applied to the histological molar sections. The numerical density of TUNEL-positive cells and VEGF-positive blood vessel profiles were also obtained. Data were statistically evaluated using a one-way anova with the post-hoc Kruskal-Wallis or Tukey test and a significance level of P ≤ 0.05. Fragments of maxilla were embedded in Araldite for analysis under transmission electron microscopy (TEM). TUNEL-positive structures, fibroblasts with strongly basophilic nuclei and macrophages were observed in the lamina propria at all ages. Using TEM, we identified processes of fibroblasts or macrophages surrounding partially apoptotic cells. We found a high number of apoptotic cells in 11-, 13- and 16-day-old rats. We observed VEGF-positive blood vessel profiles at all ages, but a significant decrease in the numerical density was found in 13- and 16-day-old rats compared with 9-day-old rats. Therefore, the establishment of the eruptive pathway during the mucosal penetration stage depends on cell death by apoptosis, the phagocytic activity of fibroblasts and macrophages, and a decrease in the microvasculature due to vascular cell death. These data point to the importance of vascular rearrangement and vascular neoformation during tooth eruption and the development of oral mucosa.

Immediate tooth replantation in rats: effect of systemic antibiotic therapy with amoxicillin and tetracycline

The aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in immediate rat tooth replantation. Ninety rats had their incisors extracted and stored in saline for 5 min. Next, the teeth were replanted, and the animals were assigned to three groups according to the antibiotic administered by oral gavage: control group, amoxycillin group, and tetracycline group. Euthanasia was performed at 7, 15, and 30 days after replantation. Regardless of the evaluation period, the connective tissue underlying the epithelial attachment and the periodontal ligament showed statistically significant difference relative to the acute inflammatory infiltrate, which was more intense in the control group followed by the tetracycline group. These results point to the fact that systemic antibiotic therapy (SAT) in immediate tooth replantation is beneficial to pulpal and periodontal ligament repair and that amoxycillin is an excellent option. There is a lack of randomized studies assessing how the use of systemic antibiotics could influence tooth healing after immediate replantation.

Delayed tooth replantation in rats: effect of systemic antibiotic therapy with amoxicillin and tetracycline

Systemic antibiotic therapy (SAT) has usually been recommended after tooth replantation, but its actual value has been questioned. As there are no reports in the literature about its influence on tooth replantation, the aim of this study was to evaluate the influence of systemic administration of antibiotics (amoxicillin and tetracycline) at the different phases of the repair process (7, 15, 30 days) in delayed rat tooth replantation. Ninety Wistar rats (Rattus norvegicus albinus) had their maxillary right incisors extracted and bench-dried for 60 min. The dental papilla, enamel organ, pulp tissue, and root surface-adhered periodontal ligament were removed, and the teeth were replanted. The animals received no antibiotics (n = 30) or were medicated systemically with amoxicillin (n = 30) and tetracycline (n = 30), and were euthanized after 7, 15, and 30 days. Regardless of the evaluation period, the acute inflammatory infiltrate was less intense and root resorption presented smaller extent and depth in the group treated with amoxicillin. The results suggest that SAT has a positive influence on the repair process in delayed tooth replantation and that amoxicillin is an excellent treatment option.

Estudo da erupção dos dentes caninos, primeiros e segundos premolares dos lados direito e esquerdo, pelo método radiográfico

The tooth eruption have been studied for many years about the knowledge of its variations. From these variations the difference between the eruption of the superior and inferior archs, and also the right and left sides have been poorly analysed. The author compared the alveolar eruption of the permanents canines, first and second premolars between the right and left sides of the superior and inferior archs, from 7 and 11 years of age, in males and females, by radiographic method. By the Discipline of Radiology of the Diagnosis and surgery Departament of the School of Dentistry of São José dos Campos - UNESP, observed that: there is early eruption in female; the alveolar eruption sequence in maxillar and mandibular was: first premolar, second premolar e canino. There wasn't statiscally significant difference of the alveolar eruption between the right and left sides of maxillar and mandibular archs