Elisabetta Cotti

Regenerative Treatment of an Immature, Traumatized Tooth With Apical Periodontitis: Report of a Case

This case report describes the treatment of a necrotic immature permanent central incisor with complete crown fracture, suspected root fracture, and sinus tract, which was not treated with conventional apexification techniques. Instead, a regenerative approach based on the trauma literatures methods for revascularization was provided. The root canal was gently debrided of necrotic tissue with a sharp spoon excavator and irrigated for only one third of its length with NaOCl and then medicated with calcium hydroxide. After 15 days the sinus tract had healed, and the tooth was asymptomatic. The tooth was accessed, calcium hydroxide was removed, bleeding was stimulated to form an intracanal blood clot, and mineral trioxide aggregate was placed coronally to the blood clot. After 8 months, a coronal calcified barrier was radiographically evident and accompanied with progressive thickening of the root wall and apical closure. Two and a half years after treatment was initiated, the tooth remained asymptomatic, and the sinus tract had not reappeared. The progressive increase in the thickness of the dentinal walls and subsequent apical development suggest that appropriate biologic responses can occur with this type of treatment of the necrotic immature permanent tooth with sinus tract.

Blue treatment enhances cyclic fatigue resistance of vortex nickel-titanium rotary files.

INTRODUCTION The aim of the present study was to evaluate the difference in cyclic fatigue resistance between Vortex Blue (Dentsply Tulsa Dental, Tulsa, OK) and Profile Vortex nickel-titanium (Dentsply Tulsa Dental) rotary instruments. METHODS Two groups of nickel-titanium endodontic instruments, ProFile Vortex and Vortex Blue, consisting of identical instruments in tip size and taper (15/.04, 20/.06, 25/.04, 25/.06, 30/.06, 35/.06, and 40/.04) were tested. Ten instruments from each system and size were tested for cyclic fatigue resistance, resulting in a total of 140 new instruments. All instruments were rotated in a simulated root canal with a 60° angle of curvature and a 5-mm radius of curvature of a specific cyclic fatigue testing device until fracture occurred. The number of cycles to failure and the length of the fractured tip were recorded for each instrument in each group. The mean values and standard deviation were calculated, and data were subjected to 1-way analysis of variance and a Bonferroni t test. Significance was set at the 95% confidence level. RESULTS When comparing the same size of the 2 different instruments, a statistically significant difference (P < .05) was noted between all sizes of Vortex Blue and Profile Vortex instruments except for tip size 15 and .04 taper (P = 1.000). No statistically significant difference (P > .05) was noted among all groups tested in terms of fragment length. CONCLUSIONS Vortex Blue showed a significant increase in cyclic fatigue resistance when compared with the same sizes of ProFile Vortex.

In vitro cytotoxicity evaluation of a self-adhesive, methacrylate resin-based root canal sealer.

This study compared the cytotoxicity of MetaSEAL (Parkell Inc, Farmington, NY), a methacrylate resin-based sealer with an epoxy resin-based (AH Plus Jet; Dentsply Caulk, Milford, DE) and a zinc oxide-eugenol-based sealer (Pulp Canal Sealer; SybronEndo, Orange, CA). Five-millimeter diameter disks prepared from the respective sealer and disks prepared from Teflon (negative control) and polymethyl methacrylate (positive control) were placed in direct contact with a rat osteosarcoma (ROS) 17/2.8 rat osteoblast-like cell line at six intervals after setting completely at 72 hours and for 5 succeeding weeks after the disks were immersed in simulated body fluid. Succinate dehydrogenase activity was evaluated by using 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyl tetrazolium bromide assay. All sealers exhibited severe toxicity at 72 hours, after which toxicity decreased gradually over the experimental period except for Pulp Canal Sealer, which remained severely toxic. MetaSEAL was more toxic than AH Plus Jet during the first week. Both were similar to the toxicity profile of the positive control after the first week, which was probably diffusion controlled.

Concentrations of Leukotriene B4 in Symptomatic and Asymptomatic Periapical Lesions

Twelve periapical lesions from symptomatic and asymptomatic patients (six each) were obtained and immediately frozen in liquid nitrogen. Six pulps from unerupted third molars as well as chronically inflamed gingival tissues were also obtained, frozen, and used as negative and positive controls, respectively. The concentration of leukotriene (LT) B4 was determined by reverse phase high pressure liquid chromatography. Representative samples from each group were fixed in formalin, sectioned, and stained with hematoxylin and eosin. Extremely low levels of LTB4 were detected in the uninflamed pulpal samples in comparison to those found in chronically inflamed gingival tissues and periradicular lesions. A significant statistical difference was noted between concentrations of LTB4 in periapical lesions of symptomatic patients and those found in asymptomatic patients and samples of chronically inflamed gingival tissues (p < 0.05). In addition, a positive correlation was found between the presence of symptoms, the concentration of LTB4, and presence of polymorphonuclear leukocytes in symptomatic periapical lesions. The results show presence of high concentrations of LTB4 in symptomatic human periapical lesions.

Advanced Techniques for Detecting Lesions in Bone

Imaging is an important clinical aid for the diagnosis of endodontic bone lesions. Traditional radiology performs more accurately than any other diagnostic tool. Computed tomography has been used for the last 20 years with important implications in the management of lesions in bone. Among the newest systems, digital volume tomography is becoming a new standard and real-time echotomography is gaining an interesting space in the diagnostic field of endodontics. These techniques offer some advantages for the increased safety and the amount of detailed information they can provide.

Apical periodontitis and cardiovascular diseases: previous findings and ongoing research

AIM (i) To discuss the possibility that dental infections in general, and endodontic infections (apical periodontitis) more specifically, may affect cardiovascular health, (ii) which preventive measures should be adopted during the treatment of endodontic infections for infective endocarditis (IE), and (iii) What should be the priorities for future research, in the light of the literature available. METHODOLOGY A literature review was performed. RESULTS AND CONCLUSIONS (i) Poor oral health and endodontic infections are associated with cardiovascular diseases, and endodontic infection appears to be associated with initial endothelial damage, (ii) preventive measures for IE should be adopted during endodontic treatment of patients at risk for cardiovascular events according to the American and European available official guidelines, and (iii) more research focused on apical periodontitis and systemic diseases is needed.

Comparison of Tetraacetylethylendiamine + Sodium Perborate and Sodium Hypochlorite Cytotoxicity on L929 Fibroblasts

INTRODUCTION Tetraacetylethylenediamine in association with sodium perborate (TAED+P) can be suggested for its use as an endodontic disinfectant because of its antimicrobial activity against different bacterial species when used at low concentrations. The purpose of this study was to measure the cytotoxicity of TAED+P on L929 fibroblasts and to compare it with that of sodium hypochlorite (NaOCl). METHODS L929 fibroblasts were grown in Dulbecco Modified Eagle Medium containing 10% fetal calf serum (FCS) at 37 degrees C and 5% CO(2). At confluence, cells were split, plated in a 96-well plate, and incubated for 24 hours to allow attachment. The two disinfectants TAED+P and NaOCl were tested at various concentrations. The neutral red uptake and the 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide assays were used to evaluate the cell viability. The 50% inhibitory dose values for both disinfectants were calculated and statistically analyzed. The effect of both disinfectants on fibroblast viability was also determined in the presence of various concentrations of FCS. One-way analysis of variance with post hoc analysis using Tukey multiple comparison test was used for parametric data. RESULTS Both disinfectants induced a dose-related loss of cell viability; TAED+P resulted less cytotoxic than NaOCl in all the examined experimental conditions. CONCLUSIONS These data support the possible use of TAED+P as an endodontic irrigant. Further studies are required to analyze its antibacterial activity against endodontic pathogens.

An Overview on Biologic Medications and Their Possible Role in Apical Periodontitis

INTRODUCTION Apical periodontitis (AP) is the expression of a deficient balance between infection and the host immune response. METHODS If reducing the bacterial load from the root canal and preventing its reinfection may lead to clinical success, then the integrity of the nonspecific immune system has a relevant influence on the outcome of endodontic treatment. RESULTS Compromised immune systems and/or genetic alterations of the hosts response may as well play an important role on the development, progression, and healing of AP. Thus, immunomodulatory drugs might have the potential to influence both the severity of AP and the outcome of endodontic treatment. Biologic medications are a new class of drugs of monoclonal antibodies or fusion proteins that include fragments of a peculiar cytokine receptor. Specific inflammatory molecules or cells, such as tumor necrosis factor, interleukins, and T or B cells, are the selective targets of these drugs. They modulate the altered immune response and perform an important role in the short-term treatment of chronic inflammatory diseases such as rheumatoid arthritis, refractory Crohn disease, or ulcerative colitis. Despite the clinical positive outcomes and their widespread use, the consequences of administering biologic medications on the development of the dental diseases have not been adequately investigated. CONCLUSIONS The aim of this review was to give an overview of biologic medications, their composition, their mechanisms of action, and their possible implications on endodontic and other dental diseases.

Antibiotics in Endodontics: A review

The overuse of antibiotics and the emergence of antibiotic-resistant bacterial strains is a global concern. This concern is also of importance in terms of the oral microbiota and the use of antibiotics to deal with oral and dental infections. The aim of this paper was to review the current literature on the indications and use of antibiotics and to make recommendations for their prescription in endodontic patients. Odontogenic infections, including endodontic infections, are polymicrobial, and in most cases, the prescription of antibiotics is empirical. This has led to the increasing use of broad-spectrum antibiotics even in cases where antibiotics are not indicated, such as symptomatic irreversible pulpitis, necrotic pulps and localized acute apical abscesses. In case of discrete and localized swelling, the primary aim is to achieve drainage without additional antibiotics. Adjunctive antibiotic treatment may be necessary in the prevention of the spread of infection, in acute apical abscesses with systemic involvement and in progressive and persistent infections. Medically compromised patients are more susceptible to complication arising from odontogenic infections and antimicrobials have a more specific role in their treatment. Therefore, antibiotics should be considered in patients having systemic diseases with compromised immunity or in patients with a localized congenital or acquired altered defence capacity, such as patients with infective endocarditis, prosthetic cardiac valves or recent prosthetic joint replacement. Penicillin VK, possibly combined with metronidazole to cover anaerobic strains, is still effective in most cases. However, amoxicillin (alone or together with clavulanic acid) is recommended because of better absorption and lower risk of side effects. In case of confirmed penicillin allergy, lincosamides such as clindamycin are the drug of choice.

Endodontic Infection and Endothelial Dysfunction Are Associated with Different Mechanisms in Men and Women

INTRODUCTION To investigate the potential link between apical periodontitis (AP) and cardiovascular (CV) function, inflammation markers, endothelial flow reserve (EFR), and levels of asymmetrical dimethylarginine (ADMA), the endogenous inhibitor of nitric oxide synthase (NOS), were measured in young adults with AP aged 20-40 years of both sexes. METHODS Forty men and 41 women (31 ± 5.71 years) free from periodontal disease, CV disease, and traditional CV risk factors were enrolled in the study. Twenty men and 21 women had AP; 40 healthy individuals matched for age, sex, and physical characteristics were also recruited as controls. All subjects underwent dental and complete physical examination, electrocardiography, conventional and tissue Doppler imaging echocardiography, and measurement of EFR. Interleukin (IL)-2, tumor necrosis factor alpha, reactive oxygen species (ROS), and ADMA were also assessed. Data were analyzed using the 2-tailed Student t test, the Pearson t test (or the Spearman t test for nonparametric variables), and multivariate linear regression analysis. RESULTS Echocardiography excluded any morphologic and functional cardiac alteration in all the subjects studied. Patients with AP of both sexes showed a significant reduction in EFR (P < .05) and a significant increase in IL-2 (men: P < .01, women: P < .05), whereas ROS were increased significantly only in women (P < .05). ADMA levels were unchanged in women with AP, but they were significantly increased in men (P < .05). A significant direct correlation between ADMA and IL-2 (r = 0.67, P < .001) and an inverse correlation between ADMA and EFR (r = -0.42, P < .05) in men and a significant inverse correlation between ROS and EFR (r = -0.71, P < .01) in female patients were observed. CONCLUSIONS The presence of chronic inflammation in young adults with AP may cause early endothelial dysfunction documented by the reduced EFR. AP in men may influence the metabolism of NOS, whereas in women it appears to implicate a more direct detrimental mechanism. This difference is sex dependent and may be attributable to the protective action of estrogen in women.