RESUMO
Reactionary dentin formation is an adaptive secretory response mediated by odontoblasts to moderate dentin injury. The implications of this process for neuroimmune interactions operating to contain pathogens have not been fully appreciated. The purpose of the present study was to describe the relationship between reactionary dentinogenesis, the neurogenic changes of dental pulp innervation, and dendritic cell recruitment to caries progression, using a comparative immunohistochemical approach in human teeth from young adult individuals. Reactionary dentin formation during dentin caries progression is associated with changes in the integrity of junctional complexes within the odontoblast layer. Diminished coexpression of Cx43 and zonula occludens 1 implies a reduced level of intercellular connectivity between odontoblasts. Dentin caries also causes overexpression of growth-associated protein 43, a modulator of neural plasticity that promotes extensive sprouting of nerve endings into the reactionary dentin matrix. At the same time, an elevated number of HLA-DR-positive dendritic cells infiltrate the odontoblast layer and subsequently invade reactionary dentin formed underneath the early caries-affected regions. Simultaneous odontoblast layer remodeling, nerve fiber sprouting, and activation of dendritic cells during caries progression suggest a coordinated neuroimmune response to fight caries pathogen invasion and to promote dentin-pulp healing. We propose that reactionary dentin formation hinders pathogen invasion and supports defensive neuroimmune interactions against infection. The eventual understanding of this complex scenario may contribute to the development of novel approaches to dental caries treatment.
Assuntos
Cárie Dentária/patologia , Dentina Secundária/patologia , Dentinogênese/fisiologia , Adolescente , Adulto , Movimento Celular/fisiologia , Conexina 43/análise , Células Dendríticas/imunologia , Polpa Dentária/imunologia , Polpa Dentária/inervação , Dentina Secundária/imunologia , Dentina Secundária/inervação , Dentinogênese/imunologia , Progressão da Doença , Proteína GAP-43/análise , Antígenos HLA-DR/análise , Humanos , Junções Intercelulares/patologia , Terminações Nervosas/ultraestrutura , Fibras Nervosas/ultraestrutura , Neuroimunomodulação/fisiologia , Plasticidade Neuronal/fisiologia , Odontoblastos/patologia , Adulto Jovem , Proteína da Zônula de Oclusão-1/análiseRESUMO
Two cases are reported in which incomplete placement of 4 mm mineral trioxide aggregate (MTA) plug was performed unintentionally at the apical third of permanent immature teeth with open apex and apical periodontitis. As confirmed radiographically, there were gaps between MTA and dentinal walls along the MTA-dentin interface. After setting of MTA was confirmed, endodontic treatment was completed and access was sealed with composite resin. At 6 to 16 months follow-up examinations, formation of dentin in contact with the MTA surface, as well as apical closure and periapical healing were ideied radiographically for both cases. The results of these cases showed that apical barrier formation and complete periapical healing is possible despite the incomplete apical placement of the MTA plug. This might be due to the biological properties of the MTA. Even so, an incomplete three-dimensional placement of the filling material is not advocated.
Assuntos
Compostos de Alumínio/uso terapêutico , Apexificação/métodos , Compostos de Cálcio/uso terapêutico , Óxidos/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Silicatos/uso terapêutico , Ápice Dentário/patologia , Compostos de Alumínio/administração & dosagem , Compostos de Cálcio/administração & dosagem , Hidróxido de Cálcio/uso terapêutico , Criança , Necrose da Polpa Dentária/terapia , Dentina/patologia , Dentina Secundária/patologia , Combinação de Medicamentos , Resinas Epóxi/uso terapêutico , Feminino , Seguimentos , Guta-Percha/uso terapêutico , Humanos , Incisivo/lesões , Masculino , Óxidos/administração & dosagem , Periodontite Periapical/terapia , Irrigantes do Canal Radicular/uso terapêutico , Obturação do Canal Radicular/métodos , Preparo de Canal Radicular/métodos , Silicatos/administração & dosagem , Avulsão Dentária/terapia , Fraturas dos Dentes/terapiaRESUMO
This case report describes successful apexification for a challenging case involving a 30-year-old man, who suffered from dental trauma involving tooth No. 7 (which had occurred several years earlier) and recently experienced acute periapical abscess in this region. Radiographic analysis revealed incomplete root formation, a wide-open apex, thin root canal walls, and an extensive periapical lesion. Chemomechanical debridement was performed gently using K-files and irrigation with a 1% sodium hypochlorite solution. The root canal was filled with a calcium hydroxide paste, which was replaced periodically. At 18 months post-treatment, an apical barrier tissue and significant reduction of periapical radiolucency were observed; at that time, the entire root canal was filled with gray mineral trioxide aggregate (MTA). At a follow-up 16 months later, the tooth had normal function and periapical repair was complete.
Assuntos
Apexificação/métodos , Abscesso Periapical/terapia , Ápice Dentário/patologia , Raiz Dentária/lesões , Adulto , Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Cavidade Pulpar/patologia , Dentina Secundária/patologia , Combinação de Medicamentos , Seguimentos , Humanos , Masculino , Óxidos/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/instrumentação , Silicatos/uso terapêutico , Hipoclorito de Sódio/uso terapêutico , Ápice Dentário/efeitos dos fármacos , Cicatrização/fisiologiaRESUMO
Two cases are reported in which incomplete placement of 4 mm mineral trioxide aggregate (MTA) plug was performed unintentionally at the apical third of permanent immature teeth with open apex and apical periodontitis. As confirmed radiographically, there were gaps between MTA and dentinal walls along the MTA-dentin interface. After setting of MTA was confirmed, endodontic treatment was completed and access was sealed with composite resin. At 6 to 16 months follow-up examinations, formation of dentin in contact with the MTA surface, as well as apical closure and periapical healing were ideied radiographically for both cases. The results of these cases showed that apical barrier formation and complete periapical healing is possible despite the incomplete apical placement of the MTA plug. This might be due to the biological properties of the MTA. Even so, an incomplete three-dimensional placement of the filling material is not advocated.
Assuntos
Criança , Feminino , Humanos , Masculino , Compostos de Alumínio/uso terapêutico , Apexificação/métodos , Compostos de Cálcio/uso terapêutico , Óxidos/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Silicatos/uso terapêutico , Ápice Dentário/patologia , Compostos de Alumínio/administração & dosagem , Compostos de Cálcio/administração & dosagem , Hidróxido de Cálcio/uso terapêutico , Combinação de Medicamentos , Necrose da Polpa Dentária/terapia , Dentina Secundária/patologia , Dentina/patologia , Resinas Epóxi/uso terapêutico , Seguimentos , Guta-Percha/uso terapêutico , Incisivo/lesões , Óxidos/administração & dosagem , Periodontite Periapical/terapia , Irrigantes do Canal Radicular/uso terapêutico , Obturação do Canal Radicular/métodos , Preparo de Canal Radicular/métodos , Silicatos/administração & dosagem , Avulsão Dentária/terapia , Fraturas dos Dentes/terapiaRESUMO
OBJECTIVE: The objective of this study was to evaluate in vivo the revascularization and the apical and periapical repair after endodontic treatment using 2 techniques for root canal disinfection (apical negative pressure irrigation versus apical positive pressure irrigation plus triantibiotic intracanal dressing) in immature dogs' teeth with apical periodontitis. STUDY DESIGN: Two test groups of canals with experimentally induced apical periodontitis were evaluated according to the disinfection technique: Group 1, apical negative pressure irrigation (EndoVac system), and Group 2, apical positive pressure irrigation (conventional irrigation) plus triantibiotic intracanal dressing. In Group 3 (positive control), periapical lesions were induced, but no endodontic treatment was done. Group 4 (negative control) was composed of sound teeth. The animals were killed after 90 days and the maxillas and mandibles were subjected to histological processing. The sections were stained with hematoxylin and eosin and Mallory Trichrome and examined under light microscopy. A description of the apical and periapical features was done and scores were attributed to the following histopathological parameters: newly formed mineralized apical tissue, periapical inflammatory infiltrate, apical periodontal ligament thickness, dentin resorption, and bone tissue resorption. Intergroup comparisons were done by the Kruskal-Wallis and Dunn's tests (alpha = 0.05). RESULTS: Although statistically significant difference was found only for the inflammatory infiltrate (P < .05), Group 1 presented more exuberant mineralized formations, more structured apical and periapical connective tissue, and a more advanced repair process than Group 2. CONCLUSION: From the histological observations, sodium hypochlorite irrigation with the EndoVac system can be considered as a promising disinfection protocol in immature teeth with apical periodontitis, suggesting that the use of intracanal antibiotics might not be necessary.
Assuntos
Antibacterianos/uso terapêutico , Neovascularização Fisiológica/fisiologia , Periodontite Periapical/terapia , Tecido Periapical/irrigação sanguínea , Materiais Restauradores do Canal Radicular/uso terapêutico , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Perda do Osso Alveolar/patologia , Processo Alveolar/patologia , Animais , Antibacterianos/administração & dosagem , Ciprofloxacina/administração & dosagem , Ciprofloxacina/uso terapêutico , Tecido Conjuntivo/patologia , Cavidade Pulpar/patologia , Dentina/patologia , Dentina Secundária/patologia , Cães , Combinação de Medicamentos , Metronidazol/administração & dosagem , Metronidazol/uso terapêutico , Minociclina/administração & dosagem , Minociclina/uso terapêutico , Ligamento Periodontal/patologia , Pressão , Irrigantes do Canal Radicular/administração & dosagem , Reabsorção da Raiz/patologia , Hipoclorito de Sódio/administração & dosagem , Hipoclorito de Sódio/uso terapêutico , Irrigação Terapêutica/métodos , Ápice Dentário/patologia , Cicatrização/fisiologiaRESUMO
OBJECTIVE: To evaluate and compare the responses of human incisor and premolar pulps after bleaching. STUDY DESIGN: A bleaching agent with 38% hydrogen peroxide (H(2)O(2)) was applied on the buccal surface of 10 sound lower teeth (G1: 6 premolars; G2: 4 incisors) for 45 minutes. Three premolars and 3 incisors that received only rubber/pumice prophylaxis were used as control groups G3 and G4, respectively. Two days after the bleaching procedure, the teeth were extracted and processed for histologic evaluation. RESULTS: Only in G2 (4 incisors) were any changes in the pulp detected. In the coronal pulp there was a large zone of coagulation necrosis. The radicular pulp showed mild inflammatory changes manifested as an accumulation of mononuclear cells around congested and dilated blood vessels. No pulpal damage was seen in either of the control groups (G3 and G4) or in group G1. CONCLUSION: Bleaching with 38% H(2)O(2) for 45 minutes causes irreversible pulp damage in lower incisors but not in premolars.
Assuntos
Polpa Dentária/efeitos dos fármacos , Peróxido de Hidrogênio/uso terapêutico , Oxidantes/uso terapêutico , Clareamento Dental/métodos , Adolescente , Dente Pré-Molar/efeitos dos fármacos , Profilaxia Dentária , Polpa Dentária/irrigação sanguínea , Polpa Dentária/patologia , Necrose da Polpa Dentária/induzido quimicamente , Necrose da Polpa Dentária/patologia , Dentina/efeitos dos fármacos , Dentina/patologia , Dentina Secundária/induzido quimicamente , Dentina Secundária/patologia , Humanos , Peróxido de Hidrogênio/administração & dosagem , Hiperemia/induzido quimicamente , Hiperemia/patologia , Incisivo/efeitos dos fármacos , Leucócitos Mononucleares/efeitos dos fármacos , Leucócitos Mononucleares/patologia , Neutrófilos/efeitos dos fármacos , Neutrófilos/patologia , Odontoblastos/efeitos dos fármacos , Odontoblastos/patologia , Oxidantes/administração & dosagem , Pulpite/induzido quimicamente , Pulpite/patologia , Fatores de TempoRESUMO
OBJECTIVE: This study evaluated histopathologically the response of pulp and periradicular tissues after pulp capping with an all-in-one self-etching adhesive system in dogs' teeth. STUDY DESIGN: Forty teeth of 4 dogs were assigned to 3 groups according to the pulp capping material: G1 (n = 20): self-etching adhesive system; G2 (n = 10): Ca(OH)(2); G3 (n = 10): zinc oxide-eugenol. The animals were killed 7 and 70 days after pulp capping. The pieces containing the pulp-capped teeth were removed and processed for histologic analysis. RESULTS: At 7 days, no dentin bridge formation was observed; G1 and G3 exhibited inflammatory pulpal alterations, whereas G2 presented only mild inflammatory infiltrate in the pulp tissue adjacent to the capping material, the remainder being intact. At 70 days, no specimen in G1 or G3 presented dentin bridge formation. The remaining pulp tissue exhibited severe inflammatory alterations and areas of necrosis. In G2, all specimens showed dentin bridge formation and absence of inflammation and mineralized tissue resorption. No bacteria were identified using Brown and Brenn staining techniques in all 3 groups at any observation period. CONCLUSION: According to the conditions of this study, direct pulp capping with the self-etching adhesive system did not allow pulp tissue repair and failed histopathologically in 100% of the cases.
Assuntos
Capeamento da Polpa Dentária/métodos , Polpa Dentária/patologia , Adesivos Dentinários/uso terapêutico , Tecido Periapical/patologia , Animais , Hidróxido de Cálcio/uso terapêutico , Colágeno , Resinas Compostas , Cimentos Dentários/uso terapêutico , Materiais Dentários/uso terapêutico , Exposição da Polpa Dentária/terapia , Necrose da Polpa Dentária/patologia , Restauração Dentária Permanente , Dentina/patologia , Dentina Secundária/patologia , Cães , Feminino , Fibroblastos/patologia , Masculino , Odontoblastos/patologia , Pulpite/patologia , Cimentos de Resina/uso terapêutico , Cimento de Óxido de Zinco e Eugenol/uso terapêuticoRESUMO
AIM: The present randomized, controlled prospective study evaluated the histomorphological response of human dental pulps capped with two grey mineral trioxide aggregate (MTA) compounds. METHODOLOGY: Pulp exposures were performed on the occlusal floor of 40 human permanent pre-molars. The pulp was capped either with ProRoot (Dentsply) or MTA-Angelus (Angelus) and restored with zinc oxide eugenol cement. After 30 and 60 days, teeth were extracted and processed for histological examination and the effects on the pulp were scored. The data were subjected to Kruskal-Wallis and Conover tests (alpha = 0.05). RESULTS: In five out of the 40 teeth bacteria were present in pulp tissue. No significant difference was observed between the two materials (P > 0.05) in terms of overall histological features (hard tissue bridge, inflammatory response, giant cells and particles of capping materials). Overall, 94% and 88% of the specimens capped with MTA-Angelus and ProRoot, respectively, showed either total or partial hard tissue bridge formation (P > 0.05). CONCLUSIONS: Both commercial materials ProRoot (Dentsply) and MTA-Angelus (Angelus) produced similar responses in the pulp when used for pulp capping in intact, caries-free teeth.
Assuntos
Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Cimentos Dentários/uso terapêutico , Capeamento da Polpa Dentária , Exposição da Polpa Dentária/terapia , Óxidos/uso terapêutico , Silicatos/uso terapêutico , Adulto , Polpa Dentária/efeitos dos fármacos , Polpa Dentária/microbiologia , Necrose da Polpa Dentária/patologia , Sensibilidade da Dentina/patologia , Dentina Secundária/patologia , Combinação de Medicamentos , Seguimentos , Células Gigantes/patologia , Humanos , Odontoblastos/patologia , Estudos Prospectivos , Pulpite/patologia , Método Simples-Cego , Cimento de Óxido de Zinco e Eugenol/uso terapêuticoRESUMO
OBJECTIVES: To compare the response of human dental pulp capped with a mineral trioxide aggregate (MTA) and Ca(OH)2 powder. METHODS AND MATERIAL: Pulp exposures were performed on the occlusal floor of 40 permanent premolars. The pulp was then capped with either Ca(OH)2 powder (CH) or MTA and restored with resin composite. After 30 days (groups CH30 and MTA30) and 60 days (groups CH60 and MTA60), the teeth were extracted and processed for HE and categorized in a histological score system. The data were subjected to Kruskal-Wallis and Conover tests (alpha = 0.05). RESULTS: In regard to dentin bridge formation, CH30 showed a tendency towards superior performance compared to MTA30 (p > 0.05), although the products showed comparable results at day 60. In the item "Inflammation" and "General State of the Pulp" (p > 0.05), CH showed a tendency towards presenting a higher inflammatory response. In the item "Other Pulpal Findings," MTA and Ca(OH)2 showed equal and excellent performance after 30 and 60 days (p > 0.05). CONCLUSION: After 30 days, Ca(OH)2 powder covered with calcium hydroxide cement showed faster hard tissue bridge formation compared to MTA. After 60 days, Ca(OH)2 powder or MTA materials showed a similar and excellent histological response with the formation of a hard tissue bridge in almost all cases with low inflammatory infiltrate.
Assuntos
Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Materiais Dentários/uso terapêutico , Capeamento da Polpa Dentária/métodos , Polpa Dentária/efeitos dos fármacos , Óxidos/uso terapêutico , Substâncias Protetoras/uso terapêutico , Silicatos/uso terapêutico , Adolescente , Adulto , Dente Pré-Molar , Resinas Compostas , Polpa Dentária/patologia , Exposição da Polpa Dentária/terapia , Restauração Dentária Permanente , Dentina Secundária/efeitos dos fármacos , Dentina Secundária/patologia , Combinação de Medicamentos , Células Gigantes/patologia , Humanos , Macrófagos/patologia , Teste de Materiais , Pulpite/patologia , Fatores de Tempo , Odontalgia/etiologiaRESUMO
OBJECTIVE: The objective of this study was to evaluate the influence of the surface treatment and acid conditioning (AC) time of bovine sclerotic dentine on the micro-tensile bond strength (micro-TBS) to an etch and rinse adhesive system. MATERIALS AND METHOD: Thirty-six bovine incisors were divided into six groups (n=6): G1 sound dentine submitted to AC for 15s; G2-G6 sclerotic dentine: G2-AC for 15s; G3-AC for 30s; G4-EDTA and AC for 15s; G5-diamond bur and AC for 15s; G6-diamond paste and AC for 15s. An adhesive system was applied to the treated dentine surfaces followed by a hybrid composite inserted in increments and light cured. After 24h storage in water at 37 degrees C, the specimens were perpendicularly cut with a low-speed diamond saw to obtain beams (0.8 mm x 0.8 mm cross-sectional dimensions) for micro-TBS testing. Data was compared by ANOVA followed by Tukey's test (pAssuntos
Condicionamento Ácido do Dente/métodos
, Calcinose/patologia
, Colagem Dentária
, Dentina Secundária/efeitos dos fármacos
, Adesivos Dentinários/farmacologia
, Análise de Variância
, Animais
, Bis-Fenol A-Glicidil Metacrilato/farmacologia
, Bovinos
, Resinas Compostas/farmacologia
, Materiais Dentários/farmacologia
, Dentina/efeitos dos fármacos
, Dentina/patologia
, Dentina Secundária/patologia
, Incisivo
, Estatísticas não Paramétricas
, Estresse Mecânico
, Propriedades de Superfície
, Resistência à Tração
RESUMO
PURPOSE: To evaluate the in vivo pulpal response after pulpotomy with different capping agents. In addition, the in vitro cytotoxic effects of both materials were assessed by applying them on culture of pulp cells. METHODS: For the in vivo test, the coronal pulp of 28 teeth of dogs was mechanically removed and the root pulps were capped with the following dental materials: Group 1: Pro-Root MTA (PRMTA); and Group 2 (control): calcium hydroxide saline paste (CH). After 60 days, the animals were sacrificed and the teeth processed for histological analysis. In the in vitro test, experimental extracts obtained from both capping agents were applied on the cultured MDPC-23 odontoblast-like cells. RESULTS: In the root pulps capped with PRMTA or CH, coagulation necrosis partially replaced by dystrophic calcification as well as tubular dentin matrix laid down by elongated pulp cells was observed. None or mild inflammatory response occurred beneath the capped pulpal wound. Regarding the pulpal response, PRMTA and CH presented no statistical difference. However, the teeth capped CH presented greater healthy pulp loss which resulted in convex shape of the hard barrier than PRMTA. When applied on the cultured cells, it was demonstrated that PRMTA and CH solutions decreased the cell metabolic activity by 9.9% and 29.4%, respectively. CH caused higher cytotoxic effects to the MDPC-23 cells as well as deeper healthy pulp tissue loss than PRMTA. However, similar sequence of healing occurred after pulpotomy with both dental materials.
Assuntos
Compostos de Alumínio/toxicidade , Compostos de Cálcio/toxicidade , Hidróxido de Cálcio/toxicidade , Polpa Dentária/efeitos dos fármacos , Óxidos/toxicidade , Materiais Restauradores do Canal Radicular/toxicidade , Silicatos/toxicidade , Animais , Adesão Celular/efeitos dos fármacos , Linhagem Celular , Membrana Celular/efeitos dos fármacos , Membrana Celular/ultraestrutura , Citoplasma/efeitos dos fármacos , Citoplasma/ultraestrutura , Polpa Dentária/citologia , Calcificações da Polpa Dentária/induzido quimicamente , Calcificações da Polpa Dentária/patologia , Capeamento da Polpa Dentária , Dentina Secundária/induzido quimicamente , Dentina Secundária/patologia , Cães , Combinação de Medicamentos , Microscopia Eletrônica de Varredura , Necrose , Odontoblastos/efeitos dos fármacos , Pulpotomia , Fatores de TempoRESUMO
The aim of this study was to evaluate the reaction of the pulp tissue against mineral trioxide aggregate (MTA) with or without 10% calcium chloride (CaCl(2)). Pulpotomies were performed in 4 canines and 8 premolars of two 8-month-old dogs. MTA with or without CaCl(2) was applied on the pulp tissue. The animals were killed after 90 days, and the specimens were processed for the microscopic analysis. Pulp tissue response was similar for MTA with and without CaCl(2). Pulp vitality was present in all specimens, along with pulp repair with formation of mineralized tissue bridging. The addition of CaCl(2) to MTA did not change its biologic properties in formation of mineralized barrier after pulpotomy.
Assuntos
Compostos de Alumínio/uso terapêutico , Cloreto de Cálcio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Óxidos/uso terapêutico , Pulpotomia , Materiais Restauradores do Canal Radicular/uso terapêutico , Silicatos/uso terapêutico , Animais , Dente Pré-Molar/efeitos dos fármacos , Dente Canino/efeitos dos fármacos , Amálgama Dentário , Polpa Dentária/efeitos dos fármacos , Polpa Dentária/patologia , Cavidade Pulpar/efeitos dos fármacos , Cavidade Pulpar/patologia , Restauração Dentária Permanente , Dentina Secundária/efeitos dos fármacos , Dentina Secundária/patologia , Cães , Combinação de Medicamentos , Metilmetacrilatos/uso terapêutico , Odontoblastos/efeitos dos fármacos , Odontoblastos/patologia , Distribuição Aleatória , Fatores de Tempo , Cimento de Óxido de Zinco e Eugenol/uso terapêuticoRESUMO
The aim of this study was to evaluate the response of human pulps capped with a calcium hydroxide hard-setting cement or with two-step self-etch adhesive systems. Pulp exposures were performed on the occlusal floor, and the bleeding control was performed with saline solution. The exposed pulp tissue was capped with Clearfil LB 2V (2V) or Clearfil SE Bond (SE) and restored with a composite resin. In control group, the pulpal wound was capped with Ca(OH)(2) cement and restored with Clearfil LB 2V or Clearfil SE Bond + composite resin. After 30 and 90 days, the teeth were extracted, processed for hematoxylin and eosin, and categorized in a histological score system. The pulpal response was worse for groups capped with the self-etch adhesive systems (2V and SE) in both periods of evaluation, when compared to their respective control groups at 90 days (p < 0.05). For both self-etch systems evaluated, the pulp tissue exhibited moderate to severe inflammatory cell infiltrate involving the coronal pulp with chronic abscesses. Dentin bridging was observed in a few specimens. For the calcium hydroxide groups, almost all specimens showed dentin bridge formation, with few scattered inflammatory cells and normal tissue below the pulp exposure site. Calcium hydroxide should be used as the material of choice for pulp capping, and the use of two-step self-etch adhesives for human pulp capping is contraindicated.
Assuntos
Hidróxido de Cálcio/uso terapêutico , Cimentos Dentários/uso terapêutico , Capeamento da Polpa Dentária , Exposição da Polpa Dentária/tratamento farmacológico , Polpa Dentária/efeitos dos fármacos , Abscesso/patologia , Adolescente , Adulto , Bactérias/citologia , Resinas Compostas/química , Polpa Dentária/patologia , Restauração Dentária Permanente/métodos , Dentina Secundária/patologia , Humanos , Leucócitos Mononucleares/patologia , Metacrilatos/uso terapêutico , Minerais/uso terapêutico , Neutrófilos/patologia , Pulpite/patologia , Cimentos de Resina/uso terapêutico , Dióxido de Silício/química , Fatores de Tempo , Zircônio/químicaRESUMO
OBJECTIVE: To evaluate the response of human pulps capped with a calcium hydroxide [Ca(OH)2] cement after bleeding control with 2 hemostatic agents. METHOD AND MATERIALS: Pulps were exposed on the occlusal floor, and the bleeding was controlled either with saline solution (SS) or 2.5% sodium hypochlorite (NaOCl) (SH). After that, the pulp was capped with Ca(OH)2 cement and restored with resin composite. After 30 (groups SS30 and SH30) and 60 (groups SS60 and SH60) days, the teeth were extracted and processed with hematoxylin-eosin and categorized in a histologic score system. The data were subjected to Kruskal-Wallis and Mann-Whitney tests (alpha = .05). RESULTS: Regarding dentin bridge formation, an inferior response of SH60 group was observed when compared to SS60 (P < .05). The response of the SH30 group generally was similar to that of the groups treated with saline solution. However, after 60 days, 2.5% NaOCl showed a trend toward having an inferior response. CONCLUSION: Using saline solution as a hemostatic agent before pulp capping with Ca(OH)2 resulted in a significantly better histomorphologic response than using 2.5% NaOCl as a hemostatic agent before capping with Ca(OH)2.
Assuntos
Capeamento da Polpa Dentária , Polpa Dentária/efeitos dos fármacos , Hemostáticos/efeitos adversos , Hemorragia Bucal/prevenção & controle , Hipoclorito de Sódio/efeitos adversos , Adolescente , Adulto , Dente Pré-Molar , Hidróxido de Cálcio , Cimentos Dentários , Polpa Dentária/irrigação sanguínea , Necrose da Polpa Dentária/induzido quimicamente , Dentina Secundária/metabolismo , Dentina Secundária/patologia , Humanos , Pulpite/induzido quimicamente , Cloreto de Sódio/farmacologiaRESUMO
The aim of this study was to evaluate histological aspects of the pulp-dentin complex of dogs submitted to pulpotomy and capped with ethyl-cyanoacrylate and calcium hydroxide. Thirty dog teeth were divided into 2 groups of 15 as follows: Group 1 - ethyl-cyanoacrylate; Group 2 - calcium hydroxide. The pulpotomies were carried out following all of the treatment precautions recommended for dogs. After 30 days the specimens were submitted to histological preparation and were then blindly evaluated by a histologist. Data were analyzed statistically by the Fisher exact test, comparing the two groups. After 30 days, the presence of a hard tissue barrier was observed in 83.3% of Group 1, and in 100% of Group 2 (p = 0.478). A continuous hard tissue barrier was observed in 50% of the ethyl-cyanoacrylate group and 75% of the calcium hydroxide group (p = 0.652). It can be concluded that both materials induced hard tissue barrier formation, but Group 2 had a higher percentage than Group 1, with no significant statistical differences; the differences observed between the different barriers (continuous/non-continuous) were not significant between groups and there was no pulpal necrosis in either group.
Assuntos
Hidróxido de Cálcio/uso terapêutico , Cianoacrilatos/uso terapêutico , Capeamento da Polpa Dentária/métodos , Polpa Dentária/patologia , Pulpite/tratamento farmacológico , Pulpotomia/métodos , Animais , Cimentos Ósseos/farmacologia , Cimentos Ósseos/uso terapêutico , Hidróxido de Cálcio/farmacologia , Cianoacrilatos/farmacologia , Polpa Dentária/efeitos dos fármacos , Capeamento da Polpa Dentária/normas , Cavidade Pulpar/patologia , Necrose da Polpa Dentária/patologia , Dentina Secundária/efeitos dos fármacos , Dentina Secundária/patologia , Modelos Animais de Doenças , Cães , Hemostáticos/farmacologia , Hemostáticos/uso terapêutico , Masculino , Pulpite/induzido quimicamente , Pulpotomia/normasRESUMO
Dental caries continues to be a highly prevalent disease among Brazilian preschoolers, especially those with low socioeconomic status. The purpose of this randomized, controlled trial was to evaluate in vivo 245 simplified restorations in deciduous molars using glass ionomer cements (Vidrion R and Ketac-Molar). Dental restorations were evaluated at 6- and 12-month follow-ups. The teeth restored with Vidrion R (SS White) on a single tooth surface were successful in 87% of the cases evaluated at 6 months and in 63% at 12 months. The teeth restored with Ketac-Molar on one surface achieved a success rate of 95% at 6 months and 82% at 12 months. No recurrent caries or pulpal infection was evident. Logistic regression analysis demonstrated that teeth with cavities restricted to the occlusal surface on sclerotic dentin showed the best adhesion to the restorative material. The restorations with Ketac-Molar had a better clinical performance than those with Vidrion R.
Assuntos
Restauração Dentária Permanente/métodos , Cimentos de Ionômeros de Vidro/química , Dente Molar/patologia , Dente Decíduo/patologia , Brasil , Criança , Pré-Escolar , Colagem Dentária , Cárie Dentária/terapia , Preparo da Cavidade Dentária/classificação , Doenças da Polpa Dentária/etiologia , Dentina/patologia , Dentina Secundária/patologia , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Recidiva , Resultado do TratamentoRESUMO
The aim of this study was to evaluate histological aspects of the pulp-dentin complex of dogs submitted to pulpotomy and capped with ethyl-cyanoacrylate and calcium hydroxide. Thirty dog teeth were divided into 2 groups of 15 as follows: Group 1 - ethyl-cyanoacrylate; Group 2 - calcium hydroxide. The pulpotomies were carried out following all of the treatment precautions recommended for dogs. After 30 days the specimens were submitted to histological preparation and were then blindly evaluated by a histologist. Data were analyzed statistically by the Fisher exact test, comparing the two groups. After 30 days, the presence of a hard tissue barrier was observed in 83.3 percent of Group 1, and in 100 percent of Group 2 (p = 0.478). A continuous hard tissue barrier was observed in 50 percent of the ethyl-cyanoacrylate group and 75 percent of the calcium hydroxide group (p = 0.652). It can be concluded that both materials induced hard tissue barrier formation, but Group 2 had a higher percentage than Group 1, with no significant statistical differences; the differences observed between the different barriers (continuous/non-continuous) were not significant between groups and there was no pulpal necrosis in either group.
O objetivo do presente estudo foi avaliar o aspecto histológico do complexo dentino-pulpar de cachorros quando capeado após a pulpotomia com etil-cianoacrilato e hidróxido de cálcio. Trinta dentes de cães foram divididos em 2 grupos de 15 da seguinte forma: Grupo 1 - Etil-cianoacrilato; Grupo 2 - Hidróxido de cálcio. A pesquisa foi realizada tomando-se todos os cuidados recomendados para o tratamento com os cães. Após 30 dias do procedimento realizado os espécimes foram submetidos ao preparo histológico e logo após foram avaliados de forma cega por um histologista. Os resultados foram analisados estatisticamente através do Teste Exato de Fisher. No grupo 1, 83,3 por cento e no grupo 2, 100 por cento dos dentes apresentaram a barreira de tecido duro (p = 0,478). A barreira de tecido duro contínua foi observada em 50 por cento dos casos tratados com etil-cianoacrilato e em 75 por cento dos com hidróxido de cálcio (p = 0,652). Pode-se concluir que tanto o grupo 1 como o grupo 2 induziram a formação da barreira de tecido duro, porém o grupo 2 teve um percentual maior do que o grupo 1, não havendo diferença estatisticamente significante; a diferença observada entre as estruturas das barreiras (contínuas e não-contínuas) não foi significante. A necrose pulpar não foi observada em nenhum grupo.
Assuntos
Animais , Masculino , Cães , Hidróxido de Cálcio/uso terapêutico , Cianoacrilatos/uso terapêutico , Capeamento da Polpa Dentária/métodos , Polpa Dentária/patologia , Pulpite/tratamento farmacológico , Pulpotomia/métodos , Cimentos Ósseos/farmacologia , Cimentos Ósseos/uso terapêutico , Hidróxido de Cálcio/farmacologia , Cianoacrilatos/farmacologia , Modelos Animais de Doenças , Capeamento da Polpa Dentária/normas , Cavidade Pulpar/patologia , Necrose da Polpa Dentária/patologia , Polpa Dentária/efeitos dos fármacos , Dentina Secundária/efeitos dos fármacos , Dentina Secundária/patologia , Hemostáticos/farmacologia , Hemostáticos/uso terapêutico , Pulpite/induzido quimicamente , Pulpotomia/normasRESUMO
This study evaluated the pulpal response in human dental pulp to direct pulp capping with the Single Bond Adhesive System (SBAS) after 10% or 37% phosphoric acid etching and after capping with Calcium Hydroxide (CH). The degree of bleeding and hemostasis conditions was considered during the adhesive technique. The pulps of 78 sound premolars were capped with SBAS after 37% phosphoric acid etching (Group I) or 10% phosphoric acid etching (Group II) and CH (Group III-control). The cavities were restored with a resin composite (Charisma). After 1, 3, 7 and 30 days, the teeth were extracted and processed for light microscopical examination (H/E, AgNOR silver stain and Brown-Brenn). The patients were followed for postoperative symptomatology evaluation. Clinical results showed the possibility of hemostasis with saline solution only. There was no statistical difference between bleeding generated by 10% and 37% acid solutions. In some cases, contact of the pulp tissue with SASB started the bleeding process, thus damaging the adhesive technique. The histological response was similar in Groups I and II, without signs of cellular differentiation and dentin neoformation up to 30 days. Bacteria were not observed in any specimens. In the control group (CH) at day 7, the pulps exhibited cells with high synthetic activity (Ag-NOR-positive) underneath the area of coagulation necrosis. Dentin bridging was observed at the thirtieth day. The postoperative period was asymptomatic for all groups. In conclusion, SBAS should be avoided for vital pulp therapy, while CH remains the capping agent of choice for mechanically exposed human dental pulp.
Assuntos
Hidróxido de Cálcio/farmacologia , Capeamento da Polpa Dentária , Polpa Dentária/efeitos dos fármacos , Adesivos Dentinários/farmacologia , Condicionamento Ácido do Dente , Adolescente , Adulto , Bis-Fenol A-Glicidil Metacrilato/farmacologia , Diferenciação Celular/efeitos dos fármacos , Criança , Resinas Compostas , Materiais Dentários/farmacologia , Polpa Dentária/patologia , Capeamento da Polpa Dentária/métodos , Restauração Dentária Permanente , Dentina Secundária/efeitos dos fármacos , Dentina Secundária/patologia , Seguimentos , Cimentos de Ionômeros de Vidro , Hemorragia/etiologia , Hemostasia/efeitos dos fármacos , Humanos , Odontoblastos/efeitos dos fármacos , Odontoblastos/patologia , Ácidos Fosfóricos/administração & dosagem , Ácidos Fosfóricos/farmacologia , Cloreto de SódioRESUMO
PURPOSE: This study evaluated the response of human pulps capped with a bonding agent after bleeding control with different hemostatic agents. MATERIAL AND METHODS: Twenty-five Class II cavities were prepared in 25 caries-free human premolars scheduled for extraction due to orthodontic treatment. The pulp exposures were performed on the occlusal floor. The teeth were randomly divided into five groups. Groups 1-4 were capped with an adhesive system after hemostasis with different agents: Group 1--saline solution; 2--ferric sulfate; 3--2.5% NaOCl; 4--Ca(OH)2 solution. In Group 5, after hemostasis with saline solution, the pulp was capped with calcium hydroxide (control group). Then, ScotchBond Multi Purpose Plus was applied and the resin composite Z-100 placed incrementally according to the manufacturers' directions. After 60 days, the teeth were extracted and processed for light microscopic examination (HE) and the groups were categorized in a histological score system. The data were subjected to a non-parametric test (alpha=0.05). RESULTS: Overall, the histological features showed that the pulp response from Groups 1 through 4 was inferior to the response from Group 5, where dentin bridging occurred. In all groups, where the adhesive system was used for capping, the pulp response varied from an acute inflammatory, with varying degrees, to necrosis. No dentin bridge was formed after adhesive capping.
Assuntos
Capeamento da Polpa Dentária/métodos , Polpa Dentária/efeitos dos fármacos , Adesivos Dentinários/química , Hemostáticos/uso terapêutico , Adolescente , Adulto , Adstringentes/uso terapêutico , Dente Pré-Molar , Hidróxido de Cálcio/uso terapêutico , Resinas Compostas/química , Preparo da Cavidade Dentária/classificação , Polpa Dentária/patologia , Necrose da Polpa Dentária/patologia , Restauração Dentária Permanente , Dentina Secundária/efeitos dos fármacos , Dentina Secundária/patologia , Compostos Férricos/uso terapêutico , Humanos , Pulpite/patologia , Cimentos de Resina/química , Dióxido de Silício/química , Cloreto de Sódio , Hipoclorito de Sódio/uso terapêutico , Cicatrização/efeitos dos fármacos , Zircônio/químicaRESUMO
OBJECTIVE: The aim of this study was to evaluate the human pulp response following direct pulp capping with a current self-etching bonding agent and calcium hydroxide (CH). METHODS: Thirty-three sound human premolars had their pulp tissue mechanically exposed. Sterile distilled water was used to control the hemorrhage and exudation from the pulp exposure site. The pulps were capped with Clearfil Liner Bond 2 (CLB-2) or CH and the cavities were filled with a resin composite (Z-100) according to the manufacturer's instructions. After 5, 30 and 120-300 days, the teeth were extracted and processed for microscopic examination. RESULTS: At short-term, CLB-2 elicited a mild to moderate inflammatory pulp response with dilated and congested blood vessels adjacent to pulp exposure site. With time, macrophages and giant cells engulfing globules and particulates of resinous material displaced into the pulp space were observed. This chronic inflammatory pulp response triggered by fragments of bonding agent displaced into the pulp space did not allow pulp repair interfering with the dentin bridging. On the other hand, pulps capped with CH exhibited an initial organization of elongated pulp cells underneath the coagulation necrosis. Pulp repair and complete dentin bridge formation was observed at long-term evaluation. SIGNIFICANCE: The present study demonstrated that CH remains the pulp capping agent of choice for mechanically exposed human pulps. CLB-2 did not allow complete connective tissue repair adjacent to the pulp exposure site. Consequently, this bonding agent cannot be recommended for pulp therapy of sound human teeth.