Edward M. Osetek

The Clinical Toxicity of Endodontic Medicaments

A clinical study was conducted to determine the effect of intracanal medicaments on the incidence and degree of interappointment pain. After completing the canal preparation, one of three solutions was sealed in the pulp chamber. Statistical analysis showed no significant relationship between interappointment pain and the use of camphorated parachlorophenol, formocresol, or distilled H~O. Of 191 cases treated, 82.2% were free of interappointment pain, 13.6% had slight discomfort, and 4.2% required palliative treatment for pain.

A comparative study of the wound healing of three types of flap design used in periapical surgery

The clinical and histological features of wound healing of three common types of surgical flap designs used in periapical surgery were evaluated. A semilunar incision of alveolar mucosa, a submarginal incision of attached gingiva, and an intrasulcular incision of the attachment apparatus and papillae of the teeth were performed on beagles and observed at intervals of up to 60 days. Inflammatory changes persisted longer in the semilunar and intrasulcular incisions and retarded healing of the wound. Loss of alveolar bone occurred with the intrasulcular incision. Visible scarring occurred in the submarginal and semilunar incisions.

Human Polymorphonuclear Granule Components: Relative Levels Detected by a Modified Enzyme- linked Immunosorbent Assay in Normal and Inflamed Dental Pulps

Lysosomal granules of polymorphonuclear leukocytes (PMNs) contain proteolytic enzymes and other components important in the regulation of inflammation and the elimination of bacteria or debris associated with pulp disease. However, PMN lysosomal degranulation is nonspecific and can result in destruction of healthy connective tissue adjacent to the areas of damaged or infected tissue. For this study a modified enzyme-linked immunosorbent assay was used to detect the human PMN lysosomal granule products: elastase, cathepsin G, and lactoferrin. Evaluation of 55 pulp samples yielded a statistically significant difference (p less than 0.05) among the levels of elastase and lactoferrin in normal and moderate to severely inflamed pulps. Although cathepsin G levels were increased, there was no statistical significance (p greater than 0.05) among groups. The results indicate that a modified enzyme-linked immunosorbent assay technique can be used to measure PMN lysosomal granule components in dental pulp tissues. Additionally, elastase and lactoferrin levels appear to be valid diagnostic markers of advanced dental pulp disease.

Natural modifiers of the inflammatory process in the human dental pulp

Concentrations of the protease inhibitors alpha 1-antitrypsin and alpha 2-macroglobulin were determined in normal and inflamed human dental pulps. Carious pulpal exposure which is associated with polymorphonuclear leukocyte infiltration and release of lysosomal enzymes was chosen as the point of verifiable inflammatory activity in the pulp. Normal samples were collected from nondiseased third molar teeth treatment planned for extraction and inflamed human pulps were collected from teeth with deep carious lesions. One half of each sample was assayed for concentration of protease inhibitors by enzyme-linked immunosorbent assay and the remaining half was examined histologically to verify the clinical diagnosis and categorize the extent of the inflammatory process. alpha 1-Antitrypsin and alpha 2-macroglobulin were detected in normal and inflamed human dental pulps in the nanogram per milliliter range. Statistically significant differences were found in the concentrations of alpha 2-macroglobulin (p less than 0.01) in moderate to severe inflammation versus normal pulp categories and between mildly inflamed pulps and moderate to severely inflamed pulps (p less than 0.05). Although differences in concentrations of alpha 1-antitrypsin were seen between inflamed and normal pulps, the differences were not statistically significant. The presence of these two protease inhibitors in the human dental pulp tissue and the increase in their concentration in acute inflammation indicates that these proteins play a role in the pathogenesis of pulpal inflammatory disease.

Determination and Relationship of C-Reactive Protein in Human Dental Pulps and in Serum

C-reactive protein (CRP), an acute phase protein synthesized by the liver, increases in serum as much as 3000 times above its normal level in response to acute inflammation. The purpose of this study was to determine whether CRP levels in dental pulps could be correlated with the histological disease status of the pulp and with systemic blood levels of CRP. Inflamed and necrotic pulps were extirpated during routine endodontic therapy. Normal pulps were removed from extracted, intact third molars. One half of each pulp specimen was placed in formalin for histological study; the other half was frozen for immunological study. A serum sample was obtained from each patient at the end of the dental visit. CRP levels were determined by the enzyme-linked immunosorbent assay. Pulps were categorized histologically as normal, inflamed, inflamed/necrotic, or necrotic. The correlation between CRP levels of pulp and serum was not significant. CRP levels of normal pulps differed significantly only from inflamed pulps (p less than 0.05, Dunnett). This increase in CRP appears to be a local phenomenon resulting from the interaction of CRP with various inflammatory mediators in the pulp.

Humoral response to endodontic cements

Calcium hydroxide and set zinc oxide-eugenol, RC2B, and ProcoSoI were tested to determine whether they can induce antibody responses in rabbits. In vivo skin tests have shown that the materials are inflammatory, but in vitro assays for detection of antibody directed against the materials were negative. The data suggest that test materials in the set state are nonspecific irritants.

Leukocyte migration response to dental materials using Boyden chambers

Leukocyte migration in response to six representative dental materials (root canal sealers) was measured in Boyden chambers as an indicator of the inflammatory potential of the materials. The leukocyte migration response to extracts of freshly mixed sealers was low, but an apparent dose-related effect was observed. Extract from one sealer inhibited migration. After further refinement of the technique, leukocyte migration in Boyden chambers may offer a simple but sensitive method for evaluating the biocompatibility of dental materials.

Evaluation of a solvent-softened gutta-percha obturation technique in curved canals

The purpose of this study was to compare the efficacy of three obturation techniques in curved canals. Twenty-four sets of three (triplets) morphologically similar molars having root curvatures of 45 to 90+ degrees were assembled. Following canal preparation, one sample from each group was obturated by either a halothane-dipped, a chloroform-dipped, or an untreated lateral condensation technique. Twenty triplets were cleared, evaluated, and graded for homogeneity of fill, canal wall adaptation, and replication of internal anatomy. Four triplets had windows prepared to expose the apical 6 mm of filling and were viewed with scanning electron microscopy. Kruskal-Wallis test of cleared teeth indicated a significant difference in favor of the solvent-softened techniques (p = 0.01). There was no difference between chloroform- and halothane-dipped groups (p = 0.03). Scanning electron microscope evaluations of halothane-dipped samples revealed more homogeneous fills with greater canal replication than untreated gutta-percha. In addition, halothane-treated samples had appreciably less surface porosity than chloroform. Lateral condensation of halothane-treated gutta-percha was judged to be a viable obturation technique.

Incomplete polymerization of Cavalite with the use of recommended photopolymerization times: A warning of possible cytotoxic effects☆

As part of a study of the suitability of new materials for use as a retrofilling material, we examined the polymerization properties of Cavalite, a light-cured, hydroxyapatite and glass ionomer-containing cavity liner. By varying the time of photopolymerization, it was found that polymerization for 20 to 30 seconds according to the manufacturers recommendations is not sufficient to ensure complete polymerization. The implications of this incomplete polymerization are discussed in terms of possible cytotoxic effects on tissues exposed to unpolymerized Cavalite, both when used in retrofilling situations and as a deep cavity liner.