Alvaro Cruz

Association of BAFF, APRIL serum levels, BAFF-R, TACI and BCMA expression on peripheral B-cell subsets with clinical manifestations in systemic lupus erythematosus.

Objective B-cell-activating factor (BAFF) and a proliferation-inducing ligand (APRIL) signaling pathways regulate B-cell survival through interactions with their receptors BAFF-R, TACI and BCMA. We evaluated the association of these ligands/receptors on B-cell subsets according to clinical manifestations of systemic lupus erythematosus (SLE). Methods BAFF and APRIL serum concentrations were measured in 30 SLE patients by enzyme-linked immunosorbent assay. The BAFF-R, TACI and BCMA expression was analyzed on each B cell subset (CD19 + CD27-CD38–/ + naïve; CD19 + CD27 + CD38–/ + memory; CD19 + CD27-CD38 + + immature and CD19 + CD27 + CD38 + + plasma cells) by flow cytometry, and compared among patients with different clinical manifestations as well as healthy controls (HCs). Results Serum BAFF and APRIL levels were high in SLE patients and correlated with the Mex-SLEDAI disease activity index (r = 0.584; p = 0.001 and r = 0.456; p = 0.011, respectively). The SLE patients showed an increased proportion of memory and plasma B cells (p < 0.05). BAFF-R, TACI and BCMA expression in SLE patients was decreased in almost all B cell subsets compared to HCs (p < 0.05). A lower BCMA expression was associated with severe disease activity, glomerulonephritis, serositis and hemolytic anemia (p < 0.01). BCMA expression showed a negative correlation with Mex-SLEDAI score (r = –0.494, p = 0.006). Conclusions Decreased BCMA expression on peripheral B cells according to severe disease activity suggests that BCMA plays an important regulating role in B-cell hyperactivity and immune tolerance homeostasis in SLE patients.

Debris Remaining in the Apical Third of Root Canals after Chemomechanical Preparation by Using Sodium Hypochlorite and Glyde: An In Vivo Study

INTRODUCTION During chemomechanical instrumentation, several liquid or paste substances are used to ease the action of the files and to eliminate debris and the smear layer. The aim of this study was to evaluate whether the use of a paste containing EDTA during cleaning and shaping of the root canal helps to eliminate debris. METHODS Twenty root canals in dog teeth were instrumented by a crown-down technique by using nickel-titanium rotary files. In 10 root canals (group A), sodium hypochlorite was used during instrumentation, followed by a final irrigation with 17% liquid EDTA. In another 10 canals (group B), sodium hypochlorite was again used as the irrigating solution, but Glyde File Prep paste was used with every instrument, and a final irrigation with EDTA was also carried out. Two additional teeth were used as positive and 2 as negative controls. The jaws were prepared for histologic evaluation. RESULTS In group A where Glyde was not used during cleaning and shaping, little or no debris was found in the apical third of the instrumented root canals; however; in group B in which Glyde File Prep paste was used during chemomechanical instrumentation, moderate to high accumulation of debris was observed in the apical third. CONCLUSIONS The use of Glyde File Prep paste during rotary mechanical instrumentation favors the accumulation of debris in the apical third of the root canals. Irrigation with NaOCl and a final flush with EDTA by means of a small-gauge needle with simultaneous aspiration led to less accumulation of debris than in the Glyde File Prep group (P < .05).

Intracanal Cryotherapy Reduces Postoperative Pain in Teeth with Symptomatic Apical Periodontitis: A Randomized Multicenter Clinical Trial

Introduction: A prospective, multicentered, randomized clinical trial was designed to assess if controlled irrigation with cold saline could result in less incidence and intensity of postoperative pain in patients presenting with pulp necrosis and symptomatic apical periodontitis. Methods: A total of 210 patients (presenting with necrotic uniradicular teeth with a diagnosis of symptomatic apical periodontitis and a preoperative visual analog scale (VAS) score higher than 7) were randomly allocated in the control or experimental group after the completion of shaping and cleaning procedures. The experimental group received a final irrigation with 20 mL sterile cold (2.5°C) saline solution delivered to the working length with a sterile, cold (2.5°C) Endovac microcannula (Kerr Endo, Orange Country, CA) for 5 minutes. The same protocol was used in the control group with room temperature saline solution. Patients were instructed to record the presence, duration and level of postoperative pain, and analgesic medication intake. A logistic regression was used to compare the incidence of postoperative pain and the need for painkillers between groups. Differences in general pain intensity between groups were analyzed using the ordinal (linear) chi‐square test. Postoperative pain after 6, 24, and 72 hours (recorded in a VAS scale) and the need for analgesic medication intake between the 2 groups were assessed using the Mann‐Whitney U test. Results: Patients in the control group presented a significantly higher incidence of postoperative pain, intensity, and need for medication intake (P < .05). Conclusions: Cryotherapy reduced the incidence of postoperative pain and the need for medication intake in patients presenting with a diagnosis of necrotic pulp and symptomatic apical periodontitis.

Mandibular Canines with Two Roots and Two Root Canals: Case Report and Literature Review

Usually, the mandibular canine only has one root and one root canal. However, there has been a noticeable increment in evidence showing variations in its morphology, such as the presence of two roots and two root canals. The aim of this article was to present a case of a mandibular canine with two roots and two root canals and to review the available literature on this anatomic variation. Root canal treatment of tooth #43 with such morphology was performed in a 47-year-old woman. Careful inspection of the preoperative radiograph indicated the presence of more than one canal. The 12-month follow-up showed normal periapical tissues, with no pain or tenderness. Literature review revealed that the overall prevalence of such root canal configuration is 5.7%, with a strong preference for female sex (87.5%). Although mandibular canines with two roots and two root canals are not common, clinicians should always anticipate the presence of possible variations. Therefore, timely diagnosis and meticulous exploration of such mandibular canines allow for planning of an individualized treatment protocol, tailored to their peculiar morphology, focused on avoiding excessive weakening or even perforation of the roots.