Many endodontic sealers are available, but the search for the ideal sealer continues. This study evaluated the cytotoxicity and biocompatibility of Sealer Plus, a new resin epoxy–based endodontic ...sealer containing calcium hydroxide. AH Plus, Endofill, and SimpliSeal endodontics sealers were used for comparison.
L929 fibroblasts were cultured, and an MTT assay was used to determine the cytotoxicity of the sealer extracts at 6, 24, 48, and 72 hours. Tubes containing materials or empty tubes for control were inserted into the subcutaneous tissues of 20 rats. After 7 and 30 days, the rats were killed, and the tubes were removed with the surrounding tissues for histologic analysis. The data were submitted to statistical tests (P < .05).
Undiluted Sealer Plus exhibited less cytotoxicity compared with other undiluted extracts at 6 hours (P < .05), and cell viability was higher for all Sealer Plus extracts after 24 hours (P < .05). At 48 hours, the undiluted and ½ Sealer Plus dilution were the extracts with less cytotoxicity (P < .05). At 72 hours, cell viability was higher for the undiluted and ½ Sealer Plus dilution compared with the other sealers (P < .05). At 7 days, Endofill and SimpliSeal had higher inflammation compared with the control and Sealer Plus (P < .05); AH Plus had moderate inflammation (P > .05). At 30 days, control, Sealer Plus, and AH Plus had less inflammation (P < .05). The fibrous capsule was thick at 7 days and thin at 30 days, except for SimpliSeal.
In general, Sealer Plus promoted greater cell viability and was more biocompatible compared with the other sealers.
•Sealer Plus, a new resin epoxy-based endodontic sealer with calcium hydroxide, was evaluated.•In general, Sealer Plus promoted greater cell viability compared with the other sealers.•In addition, Sealer Plus was the more biocompatible among the tested endodontic sealers.
Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of ...periapical healing. This review aims to discuss the important therapeutic factors associated with the clinical protocol used during root canal treatment and to highlight the systemic conditions associated with the periapical healing process of endodontically treated teeth. The antibacterial strategies indicated in the conventional treatment of an inflamed and infected pulp and the modulation of the host's immune response may assist in tissue repair, if wound healing has been hindered by infection. Systemic conditions, such as diabetes mellitus and hypertension, can also inhibit wound healing. The success of root canal treatment is affected by the correct choice of clinical protocol. These factors are dependent on the sanitization process (instrumentation, irrigant solution, irrigating strategies, and intracanal dressing), the apical limit of the root canal preparation and obturation, and the quality of the sealer. The challenges affecting the healing process of endodontically treated teeth include control of the inflammation of pulp or infectious processes and simultaneous neutralization of unpredictable provocations to the periapical tissue. Along with these factors, one must understand the local and general clinical conditions (systemic health of the patient) that affect the outcome of root canal treatment prediction.
Locally produced osteoclastogenic factor RANKL plays a critical role in the development of bone resorption in periradicular periodontitis. However, because RANKL is also required for healthy bone ...remodeling, it is plausible that a costimulatory molecule that upregulates RANKL production in inflammatory periradicular periodontitis may be involved in the pathogenic bone loss processes. We hypothesized that macrophage migration inhibitory factor (MIF) would play a role in upregulating the RANKL-mediated osteoclastogenesis in the periradicular lesion. In response to pulp exposure, the bone loss and level of MIF mRNA increased in the periradicular periodontitis, which peaked at 14 d, in conjunction with the upregulated expressions of mRNAs for RANKL, proinflammatory cytokines (TNF-α, IL-6, and IL-1β), chemokines (MCP-1 and SDF-1), and MIF's cognate receptors CXCR4 and CD74. Furthermore, expressions of those mRNAs were found significantly higher in wild-type mice compared with that of MIF
mice. In contrast, bacterial LPS elicited the production of MIF from ligament fibroblasts in vitro, which, in turn, enhanced their productions of RANKL and TNF-α. rMIF significantly upregulated the number of TRAP
osteoclasts in vitro. Finally, periapical bone loss induced in wild-type mice were significantly diminished in MIF
mice. Altogether, the current study demonstrated that MIF appeared to function as a key costimulatory molecule to upregulate RANKL-mediated osteoclastogenesis, leading to the pathogenically augmented bone resorption in periradicular lesions. These data also suggest that the approach to neutralize MIF activity may lead to the development of a therapeutic regimen for the prevention of pathogenic bone loss in periradicular periodontitis.
The effects of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) on pro- and anti-inflammatory mediators were evaluated in a rat model of pulp exposure–induced apical periodontitis (AP).
Twenty-eight ...male Wistar rats were divided into 4 groups: control, untreated rats (group C); control rats treated with ω-3 PUFAs (group C-O); rats with pulp exposure–induced AP (group AP); and rats with pulp exposure–induced AP treated with ω-3 PUFAs (group AP-O). Omega-3 PUFAs were administered orally once a day for 15 days before pulp exposure; this treatment was continued for 30 days after pulp exposure. The rats were sacrificed 30 days after pulp exposure, and their dissected jaws were subjected to immunohistochemical analysis to detect immunoreactivity for tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, IL-1β, IL-17, and IL-10 on the periapical bone surface. The results were statistically evaluated using analysis of variance and the Tukey post-test. The significance level was set at 5%.
Immunoreactivity for the proinflammatory cytokines TNF-α, IL-6, IL-1β, and IL-17 was higher in the AP group than in the AP-O, C, and C-O groups (P < .05). Immunoreactivity for the anti-inflammatory cytokine IL-10 was lower in the AP group than in the AP-O group (P < .05).
Supplementation with ω-3 PUFAs can modulate the inflammatory response in rat AP, decreasing levels of TNF-α, IL-6, IL-1β, and IL-17 but increasing levels of IL-10.
•The effects of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) on inflammatory mediators in apical periodontitis are discussed.•ω-3 PUFAs decreased the expression of tumor necrosis factor alpha, interleukin (IL)-6, IL-1β, and IL-17 in periapical tissues.•ω-3 PUFAs increased the expression of IL-10 in periapical tissues.
Abstract Introduction Mineral trioxide aggregate (MTA) has excellent biological properties, but its handling properties have been criticized for both ProRoot MTA (Tulsa Dental Products, Tulsa, OK) ...and white MTA-Angelus (MTA-Ang; Angelus Indústria de Produtos Odontológicos S/A, Londrina, PR, Brazil). Angelus MTA HP (high plasticity) (Angelus Indústria de Produtos Odontológicos S/A) has been introduced recently. Considering the importance of biological properties of materials that will be in contact with the tissues, this study evaluated the cytotoxicity, biocompatibility, and biomineralization of MTA HP compared with white MTA-Ang. Methods L929 fibroblast cell lines were cultured, and cell viability was assessed at 6, 24, 48, and 72 hours using the alamar Blue assay (Thermo Fisher Scientific, Waltham, MA). A subcutaneous implant test was performed with polyethylene tubes containing 1 of the materials or empty tubes (control) using 20 Wistar rats. After 7 and 30 days of implantation, the tubes with surrounding tissues were removed for analysis using hematoxylin-eosin or von Kossa stain or they remained unstained for observation under polarized light. The results were statistically analyzed ( P < .05). Results A significant increase in cell viability for MTA HP was observed after 24, 48, and 72 hours compared with the control ( P < .05). At 72 hours, MTA HP exhibited a higher viability compared with white MTA-Ang ( P < .05). Histologic analysis performed at 7 days showed moderate inflammation and a thick fibrous capsule in all groups ( P > .05). At 30 days, mild inflammation and a thin fibrous capsule were observed in all groups ( P > .05). All materials had structures positive for von Kossa and birefringent to polarized light. Conclusions MTA HP showed biocompatibility and biomineralization similar to MTA-Ang. In addition, MTA HP showed increased fibroblast cell viability compared with white MTA-Ang after a longer period.
Objectives
This systematic review (PROSPERO CRD42021227711) evaluated the influence of diabetes mellitus (DM) on the response of the pulp tissue and in the pulp cells behaviour.
Materials and Methods
...Searches in PubMed/MEDLINE, Embase, Web of Science and OpenGrey were performed until March 2022. Studies evaluating the effects of DM in the pulp tissue inflammation and in the cell behaviour were included, followed by risk of bias assessment (Methodological Index for Non‐Randomized Studies and SYRCLE's RoB tools). The meta‐analysis was unfeasible, and a narrative synthesis for each outcome was provided.
Results
Of the 615 studies, 21 were eligible, mainly with in vivo analysis (16 studies). The pulp inflammation (10 studies) was analysed mainly by haematoxylin–eosin stain; DM increased pulp inflammation/degeneration in 9 studies, especially after dental procedures. The cell viability (5 studies) was analysed mostly using MTT assay; DM and glycating agents decreased cellular viability in 3 studies. DM reduced collagen in all of three studies. There were controversial results regarding mineralization; however, increased alkaline phosphatase was reported in three of four studies.
Conclusions
DM seems to increase inflammation/degeneration and mineralization in the pulp tissue while reducing cell proliferation. Further analyses in human pulp are important to provide stronger evidence.
Background
Several studies have suggested a relationship between AP, as well as the loss of root‐filled teeth (RFT), and hypertension (HTN).
Objectives
The aims of this systematic review and ...meta‐analysis were to investigate the prevalence of AP, and non‐retention of RFT, in hypertensive patients.
Methods
A search was performed in PubMed/MEDLINE, Web of Science, Scopus and EMBASE. The inclusion criteria established were studies published until February 2023, comparing hypertensive subjects with controls, assessing the prevalence of AP and/or providing data on the prevalence of non‐retained RFT. Meta‐analysis was performed using the RevMan (analyst) tool to determine the pooled prevalence of AP and loss of RFT. Risk of bias was assessed using the Cochrane Risk‐of‐Bias tool. The quality of evidence was assessed by GRADE.
Results
The search strategy identified 454 articles, and only eight met the inclusion criteria. Six studies had analysed the association between AP and HTN and two studies had analysed the association between non‐retention of RFT and HTN. Meta‐analysis showed and overall OR = 1.71 (95% CI = 0.92–3.16; p = .09) for the prevalence of AP among patients with HTN. The prevalence of non‐retention of RFT among patients with HTN has an overall OR = 1.78 (95% CI = 1.60–1.98; p = .000001). The risk of bias in the individual studies was low or moderate, and the quality of the overall evidence has shown a level of certainty very low.
Discussion
There is no association between the prevalence of AP and HTN. In addition, hypertensive patients have significantly increased odds of losing RFT. Given the high prevalence of hypertension, it is very common to perform root canal treatments on hypertensive patients. It is imperative to communicate this heightened risk to patients and recommend periodic monitoring of oral health and hypertension, paying special attention to this subset of patients.
Registration
PROSPERO CRD42022302385.
Abstract Introduction This study evaluated the effects of the dietary supplement omega 3 polyunsaturated fatty acids (ω-3 PUFAs) on pulp exposure–induced apical periodontitis (AP) in rats. Methods ...Twenty-eight male rats were divided into groups: control untreated rats (C), control rats treated with ω-3 PUFAs alone (C-O), rats with pulp exposure–induced AP, and rats with pulp exposure–induced AP treated with ω-3 PUFAs (AP-O). The ω-3 PUFAs were administered orally, once a day, for 15 days before pulp exposure and, subsequently, 30 days after pulp exposure. Rats were killed 30 days after pulp exposure, and jaws were subjected to histologic and immunohistochemical analyses. Immunohistochemical analyses were performed to detect tartrate-resistant acid phosphatase–positive osteoclasts and osteocalcin-positive osteoblasts on the bone surface of periapical area. Results were statistically evaluated by using analysis of variance and Tukey honestly significant difference, and P < .05 was considered statistically significant. Results The bone resorption lesion was significantly larger in the AP group compared with AP-O, C, and C-O groups ( P < .05). The level of inflammatory cell infiltration was significantly elevated, and the number of tartrate-resistant acid phosphatase–positive osteoclasts was significantly higher in the periapical lesions of the AP group compared with AP-O, C, and C-O groups ( P < .05). The number of osteocalcin-positive osteoblasts was significantly increased in the AP-O group compared with the AP group ( P > .05). Conclusions Supplementation with ω-3 PUFAs not only suppresses bone resorption but also promotes new bone formation in the periapical area of rats with AP in conjunction with downregulation of inflammatory cell infiltration into the lesion.
Abstract Endodontics has gained emphasis in the scientific community in recent years due to the increase in clinical and in animal models studies focused on endodontic medicine, which aims to ...evaluate the interrelationship between systemic and periapical tissues pathological conditions. These studies have shown that systemic changes can boost the pathogenesis of endodontic infection, favoring its development and progression. A contrary relationship is reported in numerous studies that affirm the potential of endodontic infection to trigger systemic damage and may lead to the worsening of pre-existing pathologies. Recently, the potential of filling materials to develop systemic changes such as neurological alterations had been evaluated, also showing that systemic diseases can negatively influence tissue responses to filling materials after endodontic treatment. Despite advances in endodontic medicine studies, there are still gaps in knowledge on the mechanisms of interactions between apical periodontitis (AP) and systemic diseases and much research to be done. In this sense, this critical narrative literature review aimed to show the evolution of studies in endodontic medicine to help the endodontist to know the role of systemic diseases in the pathogenesis of AP and the possible interference in the repair of periapical tissues after endodontic treatment, as well as to evidence the systemic complications that can be triggered or aggravated in the presence of endodontic infection.
Abstract Introduction This study evaluated whether apical periodontitis (AP) in a single tooth or in multiple teeth affected serum levels of inflammatory mediators and influenced blood homeostasis. ...Methods Thirty male Wistar rats were divided into 3 groups of 10 rats each: control group, healthy rats; 1AP group, rats with AP in 1 tooth; and 4AP group, rats with AP in 4 teeth. After 30 days, the rats were anesthetized, and their blood was collected through cardiac puncture to quantify tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), interleukin (IL)-6, IL-17, IL-23, and nitric oxide (NO) levels. The rats were then sacrificed by administering an anesthetic overdose. Their maxillary and mandibular molars were collected and processed for histologic analysis with hematoxylin-eosin and for immunohistochemical staining of the cytokines and NO-producing enzyme nitric oxide synthase. Results of these analyses were statistically analyzed; P < .05 was considered statistically significant. Results Rats in the 1AP and 4AP groups showed increased IL-6, IL-17, IL-23, TNF-α, IFN-γ, and NO synthase expression; inflammatory cell infiltration; and moderate bone resorption in affected teeth. Serum TNF-α, IL-6, IL-17, and IL-23 levels were higher in rats in the 4AP group than in those in the control group ( P < .05). Serum NO levels were significantly lower in rats in the 1AP and 4AP groups than in those in the control group ( P < .05). Serum IFN-γ levels were not different among rats in the 3 groups ( P > .05). Conclusions These results suggested that AP affected blood homeostasis by altering the serum levels of inflammatory cytokines and NO.
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