Benjamin Briseño

Association between chronic dental infection and acute myocardial infarction.

INTRODUCTION In patients with cardiovascular diseases several risk factors such as high blood pressure, diabetes, smoking and drinking habits, genetic disposition, and chronic inflammation must be considered. The aim of this study was to investigate whether there is a correlation between dental origin infections and the presence of an acute myocardial infarction (AMI). METHODS A total of 125 patients who had experienced a myocardial infarction and 125 healthy individuals were included in this study. The oral examination was carried out following the consent of the ethics committee and the National Board for Radiation Protection and included the number of teeth, endodontically treated teeth, periodontal screening index (PSI), clinical attachment level, and radiographic apical lesions (radiograph examination). The medical examination included, among others, blood glucose level, C-reactive protein (CRP) serum levels, and leukocyte number. RESULTS The study demonstrated that patients with AMI exhibited an unfavorable dental state of health. After statistical adjustment for age, gender, and smoking, they exhibited a significantly higher number of missing teeth (P = .001), less teeth with root canal fillings (P = .0015), a higher number of radiologic apical lesions (P = .001), and a higher PSI value (P = .001) compared with individuals without myocardial infarction. The medical data showed a nonsignificant correlation between CRP and the number of radiologic apical lesions. CONCLUSIONS This study presents evidence that patients who have experienced myocardial infarction also exhibit an unfavorable dental state of health in comparison to healthy patients and suggests an association between chronic oral infections and myocardial infarction.

In vitro analysis of the cytotoxicity and the antimicrobial effect of four endodontic sealers

IntroductionThe aim of this study was to investigate in vitro the cytotoxicity and antibacterial properties of four different endodontic sealers using human periodontal ligament fibroblast cell proliferation and visual analysis of growth inhibition.MethodsA silicone (GuttaFlow), silicate (EndoSequence BC), zinc oxide eugenol (Pulp Canal Sealer EWT) and epoxy resin (AH Plus Jet) based sealer were incubated with PDL fibroblasts (104 cells/ml, n = 6) up to 96 h. Cell proliferation (RFU) was determined by means of the Alamar Blue assay. Cell growth and morphology was visualized by means of fluorescent dyes. Possible antibacterial properties of the different sealers were visualized by means of SEM (Enterococcus faecalis; Parvimonas micra).ResultsFibroblast proliferation depended on sealer and cultivation time. After 72 and 96 h GuttaFlow and EndoSequence BC showed relatively non-cytotoxic reactions, while Pulp Canal Sealer EWT and AH Plus Jet caused a significant decrease of cell proliferation (p < 0.001). Visualization of cell growth and morphology with various fluorescent dyes supplemented the results. No antibacterial effect of EndoSequence BC to P. micra was found, whereas GuttaFlow showed a weak, Pulp Canal Sealer EWT and AH Plus Jet extensive growth inhibition. Also, no antibacterial effect of GuttaFlow, EndoSequence BC or AH Plus Jet to E. faecalis could be detected.ConclusionsThese in vitro findings reveal that GuttaFlow and EndoSequence BC can be considered as biocompatible sealing materials. However, prior to their clinical employment, studies regarding their sealing properties also need to be considered.

Root canal sealer cytotoxicity on human gingival fibroblasts: II. Silicone- and resin-based sealers

The cytotoxicity of two resin (AH26 and Diaket)- and one silicone (Lee Endo-Fill)-based root canal sealers were tested over a period of 21 days. The incorporation rate of L-[14C]leucine was measured to establish the potential of human gingival fibroblasts to synthesize protein after being in contact with the sealers. The cells were gained from biopsies from healthy patients between 20 and 30 years of age. The sealers were allowed to set for 24 and 48 h before dispensing the fibroblastic suspension into the culture dishes. AH26 showed in the 24-h group a severe cytotoxic reaction during the entire experimental period. Diaket showed a relative severe cytotoxic potential with slight cell recovery after 3 days of culturing. Lee Endo-Fill showed a significantly lower (p less than 0.05) cytotoxic potential during the first 11 days of incubation. However, between the 15th and 21st days of culturing an ascending cytotoxic potential was registered. With Diaket and Lee Endo-Fill a relative lower cytotoxic response was observed in the 48-h group; however, cytotoxic patterns similar to the 24-h group prevailed.

Survey of root canal irrigating solutions used in dental practices within Germany.

AIM Irrigant usage information in relation to years of professional experience was collected from general dentists in different German federal states by means of a questionnaire. METHODOLOGY A short survey concerning endodontic treatment and use of irrigants was mailed to 4240 dentists or delivered to 3720 dental offices as an extra page in a journal in eight German states. Detailed information concerning the most frequently used irrigants, their concentrations, the spectrum of disinfectants used in root canal treatment concepts for vital and nonvital pulps, main topics of continuing education as well as years of professional experience was collected. The statistical analysis of differences found amongst the dentists in relation to professional experience or federal state was performed using the chi-square test. RESULTS Of a total of 7960 invitations, 1630 replies were evaluated (response rate 20.5%). The majority of the dentists (57.3%) had >20 years of professional experience, 23% had >30 years. Dentists with long-standing professional experience (20-30 years) used H2 O2 significantly more often than dentists with less experience (P < 0.001), and of the older colleagues (>30 years of professional experience), 14.6% never used NaOCl, whilst the younger colleagues almost always used it (P < 0.001). Differences were also found for the usage of irrigants amongst dentists from the various German states. CONCLUSIONS Whilst NaOCl was used in almost all states, regional differences were found regarding the choice of additional irrigants, which were mainly determined by the irrigation protocols taught at different universities.

A prospective clinical trial on the influence of a triamcinolone/demeclocycline and a calcium hydroxide based temporary cement on pain perception

IntroductionThe aim of this clinical trial was to compare the degree of short term post-operative irritation after application of a triamcinolone/demeclocycyline based or a calcium hydroxide based provisional cement.MethodsA total of 109 patients (55 female and 54 male; mean age: 51 ± 14 years) with primary or secondary dentinal caries were randomly assigned to the two treatment groups of this biomedical clinical trial (phase III). Selection criteria were good systemic health and treated teeth, which were vital and showed no symptoms of pulpitis. Up to three teeth were prepared for indirect metallic restorations, and the provisional restorations were cemented with a triamcinolone/demeclocycyline (Ledermix) or a calcium hydroxide (Provicol) based material. The intensity of post-operative pain experienced was documented according to the VAS (4, 12, 20, 24, and 82 h) and compared to VAS baseline.ResultsA total of 159 teeth were treated (Ledermix: 83 teeth, Provicol: 76 teeth). The minor irritation of the teeth, experienced prior to treatment, was similar in both groups; however, 4 h after treatment this value was significantly higher in the Provicol group than in the Ledermix group (p < 0.005, t-test). After 12 h, the difference was no longer significant. The number of patients taking analgesics for post-treatment pain was higher in the Provicol group (n = 11/53) than in the Ledermix group (n = 3/56).ConclusionsThe patients had no long term post-operative pain experience in both groups. However, within the first hours after cementation the sensation of pain was considerably higher in the Provicol group than in the Ledermix group.

Radiographic Investigation of Location and Angulation of Curvatures in Human Maxillary Incisors

The aim of this radiographic study was to evaluate the degree and location of root canal curvatures of human maxillary incisors. A total of 286 extracted human maxillary incisors (145 central and 141 lateral incisors) were included in this investigation. Exclusion criteria were teeth with extensive carious lesions, restorations, and root canal treatment. For this in vitro study, the teeth were fixed in a special device and digitally x-rayed with the parallel technique. The distances from the cementoenamel junction (CEJ) to the first curvature and the according angle were recorded. The results were analyzed descriptively, and p values were calculated with the Wilcoxon Mann-Whitney test. The mean distance between the CEJ and the first curvature of the central maxillary incisors was 10.4 mm (standard deviation [SD] +/- 2.8) and that of the lateral incisors was 11.1 mm (SD +/- 3.0). Most of the central incisors (right: 94.2%, left: 98.7%) and all of the lateral incisors exhibited curvatures. Statistically significant differences between central and lateral maxillary incisors could be observed regarding the canal curvature locations (p = 0.016) and the angle values (p < 0.001), but there was no statistical difference between the right and the left side. The results showed the high percentage of root canal curvatures in maxillary incisors with a mean curvature located 10.7 mm apical from the CEJ. These findings are important to minimize failures during post insertion.

The determination of the initial straight length in root canals of mandibular premolars -an in vitro study

The aim of the present roentgenographic in vitro study was to determine the initial straight length from the cemento-enamel junction (CEJ) to the appearance of a root canal curvature in human mandibular premolars. A total number of 282 mandibular premolars were examined. Exclusion criteria comprised root caries, extensive restorations and endodontically treated teeth. The teeth were fixed and digitally radiographed by means of a specially developed fixation device with standardized and reproducible distances with the parallel technique (Heliodent MD; Merlin 2.1). The distances from the CEJ to the first curvature (> 5°) (distance I), from the first curvature to a second curvature (distance II), and from the first or second curvature to the radiological apex (distance III) were recorded. The lengths of the initial straight distance and the appearance of a curvature were statistically analyzed and related to each other. In first mandibular premolars, the mean value for distance I was 10.9 mm, for distance II 3.7 mm and for distance III 3.04 mm. The mean values for the second mandibular premolars were 1.1 mm in distance I, 4.3 mm in distance II and 3.1 mm in distance III. No statistically significant differences between left and right mandibular premolars could be observed regarding the canal curvature location and the angle values. The results of this investigation show that curvatures are increasingly observed 9 to 12 mm from the original path in mandibular premolars.