Factors affecting the periapical healing process of endodontically treated teeth

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

Influência da diabetes mellitus na resposta tecidual e na capacidade de mineralização dos cimentos Sealapex, MTA Angelus e MTA Fillapex

Objective: The aim of this study was to evaluate the influence of diabetes mellitus on tissue response and mineralization ability of Sealapex® MTA Angelus® and MTA Fillapex® sealers. Methods: Twenty-four Wistar rats were divided into two groups: diabetics induced by Alloxan and non-diabetics. The materials were placed in the polyethylene tubes and implanted into dorsal connective tissue of rats for 7 and 30 days. Six animals from each group received injection with calcein on day 7, alizarin on day 14 and oxytretacycline hydrochloride on day 21. The animals were killed after 7 and 30 days and the specimens were prepared for histologic analysis with hematoxylin and eosin, Von Kossa technique, and not stained for polarized light or fluorescence. Results: On 7 days, it was observed similar inflammatory reactions among all groups characterized by a moderate inflammatory response and on 30 days, it was found a mild inflammatory response. Both materials groups exhibited positive structures on Von Kossa and Polarized light analysis either on 7 and 30 days. Sealapex® and MTA Fillapex® showed more fluorescence intensity than MTA Angelus® (p<0.05) for all fluorochromes in non-diabetic group and for alizarin and oxytretacycline in diabetic group. It was not observed difference between Sealapex® and MTA Fillapex® for all fluorochromes independently on the diabetic condition. Fluorescence intensity was not changed with any material in diabetic rats. Conclusion: It was concluded that diabetes mellitus did not influence the tissue response or mineralization stimulated by Sealapex® or MTA Angelus® or MTA Fillapex®O objetivo deste estudo foi avaliar a influência da diabetes mellitus na resposta tecidual e na capacidade de mineralização dos cimentos Sealapex®, MTA Angelus® e MTA Fillapex®. Vinte e quatro ratos Wistar foram divididos em dois grupos: diabéticos e não diabéticos. A indução de diabetes foi feita por meio da aplicação do Aloxano. Cada animal recebeu três implantes de tubos de polietileno contendo os materiais a serem testados e mais um tubo vazio como controle. Seis animais de cada grupo receberam injeções dos fluorocromos Calceína (7º dia), Alizarina (14o dias) e Oxitetraciclina (21o dias) durante a fase experimental. Os tempos operatórios foram 07 e 30 dias, quando os animais foram mortos e os espécimes processados para análise histológica de hematoxilina e eosina, Von Kossa, luz polarizada e fluorescência. Resultados: No 7o dia, observou-se uma resposta inflamatória moderada entre todos os grupos e no 30o dia, verificou-se uma resposta inflamatória leve. Ambos os grupos diabético e não diabético apresentaram, aos 07 e 30 dias, com todos os materiais testados áreas de mineralização e estruturas birrefringentes à luz polarizada. Sealapex® e MTA Fillapex® apresentaram uma maior intensidade de fluorescência do que MTA Angelus® (p <0,05) para todos os fluorocromos no grupo não diabético e somente para alizarina e oxitetraciclina no grupo diabético. Não houve diferença entre o Sealapex® e o MTA Fillapex® para nenhum fluorocromo independente da condição diabética. A intensidade de fluorescência não se alterou com nenhum material nos ratos diabéticos. Conclusão: A diabetes mellitus não interferiu na resposta tecidual e na capacidade de mineralização do Sealapex®, MTA Angelus® ou MTA Fillapex

Influence of diabetes mellitus on the mineralization ability of two endodontic materials

Abstract The aim of this study was to evaluate the influence of diabetes mellituson tissue response and mineralization ability of Sealapex®and MTA Fillapex® sealers. Twenty-four Wistar rats were divided into two groups: diabetic and non-diabetic. The materials were placed in polyethylene tubes and implanted into dorsal connective tissue of rats for 7 and 30 days. Six animals from each group received injection of calcein, alizarin, and oxytetracycline on days 7, 14, and 21, respectively. The animals were killed after 7 and 30 days and specimens were prepared for histologic analysis by staining with hematoxylin and eosin or Von Kossa or left unstained for polarized light or fluorescence microscopy. On day 7, inflammatory reactions were characterized. Moderate inflammatory responses were observed for all groups and on day 30, a mild inflammatory response against MTA Fillapex® and a moderate inflammatory response against Sealapex® were observed. Von Kossa-positive structures were observed in response to both materials and birefringent structures were observed upon polarized light analysis; these had no relation to the diabetic condition (p > 0.05). The fluorescence intensity was unaffected in diabetic rats (p > 0.05). In conclusion, diabetes mellitus did not influence the tissue response or mineralization stimulated by Sealapex® or MTA Fillapex®

Factors affecting the periapical healing process of endodontically treated teeth

Abstract 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

Endodontic medicine: interrelationships among apical periodontitis, systemic disorders, and tissue responses of dental materials

Abstract: Endodontic medicine, which addresses the bidirectional relationship between endodontic infections and systemic diseases, has gained prominence in the field of endodontics. There is much evidence showing that while systemic disease may influence the pathogenesis of endodontic infection, endodontic infection can also cause systemic alterations. These alterations include more severe bone resorption and inflammation in the periapical area as well as enhanced systemic disease symptoms. Similarly, many reports have described the impact of systemic diseases on the tissue responses to dental materials. Conversely, the local use of dental materials may show systemic effects in the form of altered production of biomarkers. Thus, studies to better understand the mechanisms related to those connections are extremely important. In this context, the objective of this review was to analyze and discuss the current literature regarding the connections among these three factors—systemic diseases, endodontic infection, and endodontic dental materials—and determine how these connections may interfere in the systemic health status and the endodontic treatment outcomes, which are represented by periapical wound healing

Influência da menopausa no tratamento endodôntico

A menopausa é uma das mudanças fisiológicas caracterizadas pelo encerramento dos ciclos menstrual e ovulatório, ocorrendo nas mulheres entre a quarta e a quinta década de vida. Com ela, ocorre uma diminuição na produção de estrógeno, um importante hormônio que atua em muitos processos fisiológicos do indivíduo, como a regulação do sistema esquelético. O declínio nos níveis de estrógeno resulta em perda de densidade mineral óssea, aumento do risco de fratura, bem como no aparecimento de doenças ósseas, como a osteoporose, um processo patológico onde há o aumento na reabsorção de cavidades que não são completamente preenchidas por osso neoformado. Além disso, a deficiência de estrógeno pode causar muitas mudanças na saúde bucal do indivíduo. Na presença de uma infecção bacteriana no tecido pulpar, essa deficiência pode agravar a periodontite apical. Vários medicamentos têm sido estudados como potenciais agentes terapêuticos para suprir a deficiência de estrógeno. Essas drogas têm como objetivo reduzir o risco de fraturas e prevenir a perda óssea e distúrbios cardiovasculares e mentais resultantes de deficiência hormonal pós-menopausa. O raloxifeno (RLX), é uma das drogas terapêuticas mais estudadas, demonstrando prevenir a perda óssea. Mesmo com a indicação e benefícios do raloxifeno no metabolismo ósseo e na manutenção da densidade óssea, estudos sobre o seu papel na infecção endodôntica em organismos osteopênicos precisam ser realizados

Influence of hypertension on oral infections and endodontic treatment

Hypertension is characterized by peripheral vascular resistancethat leads to blood pressure increase and severalsystemic changes that may negatively influence one s oralhealth. Thus, the aim of this study was to conduct a literaturereview on the influence of hypertension over oral conditionsand endodontic treatment. Hypertension mainly affects theblood vessels, brain and kidneys. A hypertensive conditioncan lead to increased levels of parathyroid hormones, abnormalvitamin D metabolism, reduction in the concentrationof ionized calcium and decreased calcium absorption.Therefore, hypertension can be closely associated with oralproblems such as periodontal diseases, implant loss, difficultyin bone healing, reduced salivary flow and protein concentrationin saliva, increased number of neutrophils and, as a consequence,favoring of inflammatory processes. It has alsobeen suggested that the success rate of endodontic treatmentin hypertensive patients is lower than in normotensiveones. The response of hypertensive patients to root canaltreatment, intracanal medications and sealers should be furtherstudied in order to provide knowledge on the changes,failures and success of endodontic treatment

Tested sealers and composition.

The purpose of this study was to evaluate, in vivo, the biocompatibility, biomineralization, collagen maturation and the in vitro antibacterial and cytotoxicity of resinous endodontic sealers containing calcium hydroxide. Forty rats were implanted with polyethylene tubes containing Sealer 26, Sealer Plus, Dia-ProSeal and an empty tube, examined after 7, 15, 30 and 60 days. Antimicrobial activity was evaluated against Enterococcus faecalis by Agar Diffusion Test (ADT) through inhibition zones. For cytotoxicity, undifferentiated pulp cells (OD-21) were cultured and assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, exposed to dilution of serial extracts at 6, 24, 48h. Cytotoxicity was analyzed by two-way ANOVA and Bonferroni correction. Kruskal-Wallis test followed by Dunn test was performed for nonparametric data (pth moderate inflammatory infiltration. After 30 days, Sealer 26 still showed moderate inflammatory infiltrate compared to mild inflammation from control and Dia-ProSeal (p = 0.006). At day 60th, all groups showed similar mild inflammatory infiltrate (p>0.05). Sealer 26 induced more biomineralization than other sealers in all periods. At 7 and 15 days, all sealers had significant percentage of immature collagen fibers. After 60 days Sealer 26 showed more mature fibers compared to other sealers (p0.05). All sealers showed satisfactory biological responses with in vitro/in vivo biocompatibility and antimicrobial activity against planktonic bacteria. Sealer 26 induced more biomineralization than Sealer Plus and Dia-ProSeal.</div

Cell culture.

Statistical results provided by SigmaPlot statistical software with significance. (PDF)</p