Abstract Irrigation solutions might affect dentin surface characteristics and, consequently, endodontic sealers adhesion. Objective This study analyzed the effect of different final irrigation protocols on push-out bond strength (BS) of AH Plus to dentin seven days and 20 months after obturation. Scanning electron micrographs were obtained from the dentin surface of one sample/group after final irrigation. Methodology Canals of bovine incisors were instrumented and received final irrigation with (n=21): G1 – 2.5% sodium hypochlorite (NaOCl) + distilled water; G2 – 2.5% NaOCl + 17% EDTA; G3 – 2.5% NaOCl + 17% EDTA + 2.5% NaOCl; G4 – 2.5% NaOCl + 17% EDTA + 2% chlorhexidine (CHX); G5 – mixture 5% NaOCl + 18% etidronate (HEDP); and G6 – mixture 5% NaOCl + 10% tetrasodium EDTA (Na4EDTA). After irrigation, one root/group was split and images were obtained by scanning electron microscopy (SEM). The other 20 roots/group were filled with only AH Plus sealer. Three slices/root were used for push-out assessment seven days and 20 months after obturation. One-way analysis of variance and Tukey (α<0.05) were used to compare the results among experimental groups, and unpaired t-test (α<0.05) was used to compare the results of the same group over time. Results The photomicrographs showed that, excepting G1, all groups completely removed the smear layer from the samples. In G2 and G4, the opening of the dentin tubules enlarged. In G3, erosion was observed in the peritubular and intertubular dentin. Values of the BS in the seven days were G2=G3=G4=G5>G6=G1 and in the 20 months were G3=G5>G6=G4>G1=G2. G3, G5, and G6 presented values of BS in 20 months similar to the values of seven days (P>0.05). Conclusions The final irrigation protocols tested produced dentin surfaces with different characteristics. Only G3 and G5 presented high BS values that were stable over time.

ABSTRACT Increased matrix metalloproteinases (MMPs) activity is a hallmark of periapical granulomas. However, the factors underlying the MMPs expression modulation in healthy and diseased periapical tissues remains to be determined. Objective In this study, we evaluated the association between the MMP1-1607 polymorphism (rs1799750) and pro-inflammatory milieu elements with MMP-1 mRNA levels in vivo. Material and Methods MMP1-1607 SNP and the mRNA levels of MMP-1, TNF-a, IFN-g, IL-17A, IL-21, IL-10, IL-4, IL-9, and FOXp3 were determined via RealTimePCR in DNA/RNA samples from patients presenting periapical granulomas (N=111, for both genotyping and expression analysis) and control subjects (N=214 for genotyping and N=26 for expression analysis). The Shapiro-Wilk, Fisher, Pearson, Chi-square ordinal least squares regression tests were used for data analysis (p<0.05 was considered statistically significant). Results The MMP1-1607 1G/2G and 1G/2G+2G/2G genotypes were significantly more prevalent in the patients than in controls, comprising a risk factor for periapical lesions development. MMP-1 mRNA levels were higher in periapical lesions than in healthy periodontal ligament samples, as well as higher in active than in inactive lesions. The polymorphic allele 2G carriers presented a significantly higher MMP-1 mRNA expression when compared with the 1G/1G genotype group. The ordered logistic regression demonstrated a significant correlation between the genetic polymorphism and the expression levels of MMP-1. Additionally, the pro- and anti-inflammatory cytokines IL-17A, IFN-g, TNF-a, IL-21, IL-10, IL-9, and IL-4 were significant as complementary explanatory variables of MMP-1 expression. Conclusion The MMP1-1607 SNP was identified as a risk factor for periapical lesions development, possibly due to its association with increased MMP-1 mRNA levels in periapical lesions. The MMP-1 expression is also under the control of the inflammatory milieu elements, being the cytokines TNF-a, IL-21, IL-17A, and IFN-g associated with increased MMP-1 levels in periapical lesions, while IL-10, IL-9, or IL-4 presented an inverse association.

AbstractObjective RetroMTA® is a new hydraulic bioceramic indicated for pulp capping, perforations or root resorption repair, apexification and apical surgery. The aim of this study was to compare the radiopacity, pH variation and cytotoxicity of this material to ProRoot® MTA.Material and Methods Mixed cements were exposed to a digital x-ray along with an aluminum stepwedge for the radiopacity assay. pH values were verified after incubation period of 3, 24, 48, 72 and 168 hours. The cytotoxicity of each cement was tested on human periodontal ligament fibroblasts using a multiparametric assay. Data analysis was performed using ANOVA and Tukey’spost hoc in GraphPad Prism.Results ProRoot® MTA had higher radiopacity than RetroMTA®(p<0.001). No significant differences were observed for the pH of the materials throughout experimental periods (p>0.05) although pH levels of both materials reduced over time. Both ProRoot® MTA and RetroMTA® allowed for significantly higher cell viability when compared with the positive control (p<0.001). No statistical difference was observed between ProRoot® MTA and RetroMTA® cytotoxicity level in all test parameters, except for the ProRoot® MTA 48-hour extract media in the NR assay (p<0.05).Conclusion The current study provides new data about the physicochemical and biological properties of Retro® MTA concerning radiopacity, pH and cytotoxic effects on human periodontal ligaments cells. Based on our findings, RetroMTA® meets the radiopacity requirements standardized by ANSI/ADA number 572, and similar pH values and biocompatibility to ProRoot® MTA. Further studies should be performed to evaluate additional properties of this new material.

Previous studies demonstrate that the balance between pro- and anti-inflammatory mediators determines the stable or progressive nature of periapical granulomas by modulating the balance of the osteoclastogenic factor RANKL and its antagonist OPG. However, the cytokine networks operating in the development of periapical lesions are quite more complex than what the simple pro- versus anti-inflammatory mediators' paradigm suggests. Here we simultaneously investigated the patterns of Th1, Th2, Th9, Th17, Th22, Thf, Tr1 and Tregs cytokines/markers expression in human periapical granulomas. Methods: The expression of TNF-α, IFN-γ, IL-17A, IL23, IL21, IL-33, IL-10, IL-4, IL-9, IL-22, FOXp3 markers (via RealTimePCR array) was accessed in active/progressive (N=40) versus inactive/stable (N=70) periapical granulomas (as determined by RANKL/OPG expression ratio), and also to compare these samples with a panel of control specimens (N=26). A cluster analysis of 13 cytokine levels was performed to examine possible clustering between the cytokines in a total of 110 granulomas. Results: The expression of all target cytokines was higher in the granulomas than in control samples. TNF-α, IFN-γ, IL-17A and IL-21 mRNA levels were significantly higher in active granulomas, while in inactive lesions the expression levels of IL-4, IL-9, IL-10, IL-22 and FOXp3 were higher than in active granulomas. Five clusters were identified in inactive lesion groups, being the variance in the expression levels of IL-17, IL-10, FOXp3, IFN-γ, IL-9, IL-33 and IL-4 statistically significant (KW p<0.05). Three clusters were identified in active lesions, being the variance in the expression levels of IL-22, IL-10, IFN-γ, IL-17, IL-33, FOXp3, IL-21 and RANKL statistically significant (KW p<0.05). Conclusion: There is a clear dichotomy in the profile of cytokine expression in inactive and active periapical lesions. While the widespread cytokine expression seems to be a feature of chronic lesions, hierarchical cluster analysis demonstrates the association of TNF-α, IL-21, IL-17 and IFN-γ with lesions activity, and the association of FOXP3, IL-10, IL-9, IL-4 and IL-22 with lesions inactivity.

O presente relato descreve o tratamento de uma fratura coronária severa em um incisivo inferior esquerdo de ápice incompletamente formado, em um paciente de 12 anos de idade indicado ao Centro de Traumatologia Dental da Universidade Unigranrio. Após os procedimentos endodônticos convencionais e medicação intracanal com pasta de hidróxido de cálcio, foi realizado um tampão apical com agregado de trióxido mineral na tentativa de evitar um extravasamento de guta-percha e cimento endodôntico para os tecidos periapicais. Após 2 anos de proservação, o dente se encontrava assintomático e o exame radiográfico mostrou o reparo completo da lesão apical.

This case report describes the treatment of a severe crown fracture of an immature mandibular permanent incisor in a 12 year-old boy referred to the Dental Traumatology Center of UNIGRANRIO University. After conventional endodontic procedures and dressing with calcium hydroxide, an apical plug was made with mineral trioxide aggregate in order to avoid an overflow of gutta-percha and endodontic sealer into the periapical tissues. Two years later, the tooth was clinically asymtomatic and radiographs showed total repair of the apical lesion.

A resposta tecidual ao osso inorgânico bovino medular implantado em subcutâneo de rato foi avaliada por análise subjetiva através de microscopia de luz. Quarenta ratos foram divididos em 2 grupos: controle (cápsulas vazias de colágeno) e teste (cápsulas de colágeno contendo 0,1g do biomaterial) e mortos 10, 20, 30 e 60 dias após a implantação. Histologicamente, aos 10 dias, observou-se infiltrado inflamatório crônico composto por macrófagos e Células Gigantes Multinucleadas Inflamatórias (IMGC). Neutrófilos, plasmócitos e linfócitos estavam presentes de maneira discreta, desaparecendo durante o processo de reparo tecidual. A porosidade do material foi preenchida pelo tecido conjuntivo reacional mostrando as IMGC. A fibrose foi mais intensa aos 60 dias e evidentemente superior ao grupo controle. Entretanto, o material não causou reações adversas severas, não estimulando a resposta imunológica. Baseado nos resultados encontrados, concluímos que o osso inorgânico bovino medular foi bem tolerado pelo tecido conjuntivo de rato.

The tissue response to porous bovine anorganic bone implanted in rat connective tissue was evaluated by subjective light microscopy analysis. Forty rats were divided into two groups: control (empty collagen capsules) and test (collagen capsule filled with 0.1g biomaterial) and killed 10, 20, 30 and 60 days after implantation. At 10 days, intense chronic inflammatory infiltrate consisting mainly of macrophages and inflammatory multinucleated giant cells (IMGC) was observed. Neutrophils, plasma cells and lymphocytes were present in discrete amounts and slowly disappeared along the repair process. Porosity of the material was filled by reaction connective tissue exhibiting IMGC. The fibrosis was more intense after 60 days and clearly higher than the control group. Thus, the material did not cause any severe adverse reactions and did not stimulate the immune system. Based on the results it could be concluded that deproteinized bovine cancelous bone was well tolerated by rat connective tissue.

O tecido ósseo possui grande potencial regenerativo com capacidade para restaurar completamente sua estrutura e função originais. Há situações em que os defeitos ósseos não conseguem por si só obter o reparo, casos em que se fazem necessários o uso de enxertos, para um correto tratamento e bom prognóstico. Este experimento teve o propósito de analisar microscopicamente o efeito do tamanho das partículas de matriz de osso medular bovino desmineralizado, nas formas micro e macrogranular, na reparação de defeito ósseo em fêmures de coelhos, tendo como controle o coágulo sanguíneo. Após 1,3 e 6 meses da implantação dos materiais, os animais foram mortos e as peças anatômicas removidas. Uma reação granulomatosa tipo corpo estranho, envolvendo as partículas implantadas, foi observada. Estes resultados sugerem falhas na desmineralização e/ou na retirada de potenciais antigênicos durante a produção do biomaterial. Podemos concluir que o tamanho das partículas não influenciou na evolução do processo reparativo dos defeitos ósseos, atuando apenas como substâncias osteopreenchedoras e que o material implantado deverá sofrer um aprimoramento no controle de qualidade na linha de produção, uma vez que poderá representar uma boa alternativa para enxertos ósseos.

The bone tissue has a great regenerative potential, with ability to completely restore its structure and original functions. In some situations, though, bone defects cannot be self-repaired, thus requiring the use of grafts for a correct treatment and good prognosis. This work aimed at microscopically analyzing the effect of the particle size of demineralized bovine cancellous bone matrix in micro and macrogranular forms on the repair of bone defects in femurs of rabbits, with blood clot used as control. At 1, 3 and 6 months after implantation of the materials, the animals were killed and the anatomic specimens were removed. A foreign body-type granulomatous reaction containing macrophages and multinucleated giant cells in contact with the implanted particles was observed. These results suggest a failure in demineralization and/or interruption of the antigenic potential during production of the biomaterial. It is concluded that the size of the particles did not influence the evolution of the repair process of bone defects, acting only as bone-filler substances, and that the material implanted should be improved by quality control during production, since it may represent a good alternative for bone graft.

Considerando estudos anteriores sobre a similaridade entre a composição química do agregado de trióxido mineral e o cimento Portland, o objetivo deste estudo foi investigar a resposta pulpar de dentes de cães após pulpotomia e proteção pulpar direta com MTA Angelus e cimento Portland branco. Trinta e oito remanescentes pulpares foram recobertos com esses materiais. Cento e vinte dias após o tratamento, os animais foram sacrificados e os espécimes removidos e preparados para análise histológica. Ambos os materiais demonstraram os mesmos resultados quando utilizados como materiais de capeamento pulpar, induzindo a formação de ponte de tecido mineralizado e mantendo a vitalidade pulpar em todos os espécimes. Ambos matérias se mostraram efetivos como protetores pulpares após pulpotomia em dentes de cães.

Considering previous studies on the similarity between the chemical composition of the mineral trioxide aggregate and the Portland cement, the purpose of this study was to investigate the pulp response of dog's teeth after pulpotomy and direct pulp protection with MTA Angelus and white Portland cement. Thirty eight pulp remnants were protected with these materials. One hundred and twenty days after treatment, the animals were sacrificed and the specimens removed and prepared for histological analysis. Both materials demonstrated the same results when used as pulp capping materials, inducing hard tissue bridge formation and maintaining pulp vitality in all specimens. The MTA Angelus and the white Portland cement showed to be effective as pulp protection materials following pulpotomy.

O objetivo deste estudo foi medir as zonas de risco de raízes mesiais de molares inferiores, demonstrando porque perfurações radiculares podem ocorrer durante o preparo do sistema de canais radiculares. Cem raízes mesiais de molares inferiores foram seccionadas horizontalmente 2mm abaixo da bifurcação e as concavidades distais foram medidas com o auxílio de um microscópio, desde a borda dos canais até a superfície externa da raiz. A espessura média para as zonas de risco das raízes mesiais foi 0,789 +/- 0,182 mm. Não houve diferença estatística significante entre as medidas das zonas de risco nos canais mésio-vestibulares e mésio-linguais de molares inferiores.

The aim of this work was to measure the danger zone in mandibular molars, relating to strip perforations that might affect the mesial root during canal instrumentation. One hundred mesial roots were sectioned 2mm below the furcation and the distal concavities were measured with a microscope from the border of the canals to the outer dentin of the root. The average thickness of the danger zone of the mesial roots was 0.789 +/- 0.182mm. No significant statistical differences were observed comparing the danger zone of mesiobuccal and mesiolingual canals.