Hydrogel Scaffold in Pulp Dentin Complex Regeneration

Pulp dentin complex regeneration can be initiated by hydrogel scaffold application in the pulp using tissue engineering concept and it gives many advantages. Excavation in deep dental caries, dental trauma, and iatrogenic reasons are several causes of dental pulp exposure that can affect the pulp vitality. It is crucial to maintain the pulp vitality because it can support the tooth survival by avoiding endodontic treatment which affect the resistance of tooth structure. Pulp vitality can be preserved by inducing pulp regeneration using appropriate material. New approach in endodontic regeneration is using tissue engineering concept with hydrogel scaffold, stem cells and growth factors mechanism. Hydrogel scaffold as three-dimensional media can provide cell homing process in pulp dentin complex and may support adhesion of stem cells to differentiate and initiate growth factors release. Based on several studies, hydrogel scaffold can be formulated to support dental pulp regeneration using tissue engineering concept. Many favorable conditions can be achieved such as acts as delivery drug factor with easy injectable application in tooth and it has a lot of potential in dental pulp tissue regeneration treatmen

Bedah Apikal Dengan MTA dan Bone Graft pada Gigi dengan Kista Radikuler: Laporan Kasus

Background: Apical surgery is an important treatment alternative in the presence of a large periapical cyst. To achieveoptimal healing and regeneration of the bone different bone substitutes can be used. Purpose: This case report aims to description that an apical surgery was indicated to failure in conventional endodontic treatment. Case: A 18 years old female in the left maxillary lateral incisors #22 post endodomtic treatment 3 years ago and felt uncomfortable (dull pain). Clinically, the tooth was hypersensitive to percussion and palpation. Periapical radiograph was taken using the standardized techniques, which revealed a large radiolucent lesion around the apex (ø 10 mm) and over filled gutta percha and resin sealer. Case Management: Retreatment of root canal with resiproc R40 and obturation of the root canal retrogradly was followed by apex resection ultrasonic retropreparation, and then retrograde root filling with MTA and bone graft is used to accelerate the formation of the jawbone after scraped cyst. At the 6 month follow-up visit, the tooth showed progressive healing. Conclusion: Treatment on tooth 22 with pulp necrosis with periapical lession can be performed with endodontic surgery. Retrograde root filling with MTA is the right alternative and the use of bone graft increases bone formation

Management of Open APEX in Maxillary Central Insicivus With Mineral Trioxide Aggregate

The maxillary anterior teeth in both children and adults are often traumatized. As a result, the tooth become necrosis before the development and root growth is complete, thus causing the root canal is not fully formed and open apex. In teeth with open apex, the absence of normal apical constriction of the root canal complicates the management of root filling materials. Management of open apex can be done using mineral trioxide aggregate (MTA). MTA has been proposed as an ideal filler as it can create an apical plug at the end of the root-canal system, so it can preventing the extrusion of filling material. Purpose: The aim of this case report is to show the use of MTA to form an apical plug in open apex followed by complete root canal obturation using thermoplasticized gutta-percha. Case: A 20 year-old male patient came to Clinic of Conservative Dentistry of Airlangga University with the complaint of fractured maxillary right central incisor. The patient reported that the trauma occurred about 7 years ago and no treatment had been performed. Clinical examination revealed crown fracture exposing pulp of maxillary right central incisor. The tooth failed to respond for vitality test. The radiographic examination revealed the presence of periapical lesion and the apex is open. Case management: The treatment was access opening, determined working length with apex locator and working length obtained 20mm, preparation root canal and irrigation, dressing with calcium hydroxide. The next visit, application of MTA and then obturation with thermoplasticized technique and continued with the final restoration Conclusion: Apexification using MTA can reduce treatment time by forming an apical plug in the open apex, obturation can be done immediately and after six-month follow up, there was reduction in sze of periapical lesion radiographically

Effect of Topical Epigallocatechin-Gallate on Lipopolysaccharide-induced Pulpal Inflammation in Rat Models

Introduction: Pulpal inflammation can be marked by an increase in tumor necrosis factor-α (TNF- α), malondialdehyde (MDA) and calcitonin gene-related peptide (CGRP) level. Epigallocatechin-3-gallate (EGCG) demonstrates the ability to reduce cytokine expression, influence immune receptors, reduce inflammation, neutralize reactive oxygen species (ROS) and to inhibit pain conduction. The present research aimed to determine the anti-inflammatory, antioxidant and pain conduction inhibition of topical EGCG hydrogels in Lipopolysaccharide (LPS)-induced pulpal inflammation in rats. Methods and Materials: A total of 28 male Wistar rats were divided equally into four groups. The negative control group (N) received no treatment, while the positive control group (C) and the other two treatment groups (T1, T2) were induced with LPS for 6 h, followed by the application of topical polyethylene glycol (PEG) hydrogels for C group, 25 ppm EGCG hydrogels for T1 group and 75 ppm EGCG hydrogels for T2 group, before being filled with glass ionomer cement (GIC). After 24 h, PEG and EGCG were reapplied and refilled with GIC for 24 h. The pulp tissue samples were examined by means of immunohistochemistry (IHC) to identify TNF-α, MDA and CGRP expression. All the data obtained was analyzed with one-way analyses of variance (ANOVA) test. Results: The T1 and T2 groups showed a significant decrease in TNF-α and CGRP expression compared to the control group, but there was no significant decrease in MDA in either group (P<0.05). Conclusion: Based on the results of this study, topical application of 75 ppm EGCG hydrogels to the tooth cavities with six hours of pulpal inflammation has the optimal result in reducing the expression of TNF-α and CGRP, but not of MDA.Keywords: Calcitonin Gene-related Peptide; Epigallocatechin-3-Gallate; Malondialdehyde; Pulpal Inflammation; Tumor Necrosis Factor-

The Role of Epigallocathecin-3-gallate as an Antioxidant After Dental Bleaching on Shear Bond Strength of Composite Resin Restoration

Background: Tooth discoloration can be treated with dental bleaching using Hydrogen peroxide (H2O2). Dental bleaching may interfere with the shear bond strength of composite resins because the remaining free radicals can affect bonding polymerization. Epigallocatcehin-3-gallate (EGCG) as an antioxidant can neutralize the free radicals produced during bleaching process. Purpose: Analyze the role of EGCG antioxidants in increasing the shear bond strength of composite resin after bleaching.. Review: Of the seven journals included in this literature review, six journals reported significant difference, and one journal noted no significant difference in the shear bond strength of composite resin following the EGCG application. Conclusion: The use of EGCG can increase the shear bond strength value of post-bleaching composite resin restorations

Effect of Epigallocatechin-3-gallate (EGCG) on the number of macrophage cells in inflammation of pulp with mechanical injury

ackground: Pulpitis is an inflammatory pulp that can occur due to mechanical trauma that causes perforation of the pulp. Treatment of pulpitis Emergency frequently using Eugenol. High concentrations of Eugenol have a cytotoxic effect that causes local necrosis and inhibits the recovery process. An alternative consideration with Epigallocatechin 3-gallate (EGCG) which has good antioxidant properties and increases the complexity of inflammation by inhibiting the production of inducible nitric oxide synthase (iNOS) and nitric oxide so that levels migration of inflammatory cells to the area of injury will decrease and inflammation will occur shorter then initiates the proliferation so the recovery process and tissue repair will be more rapidly occurring. One of the cells that support tissue repair is macrophages. Purpose: this study aims to explain the effect of EGCG on the number of macrophage cells in pulp inflammation with mechanical injury. Methods: The study used 24 Wistar rats teeth divided into four groups, namely control (C), and 3 treatment groups T1, T2, and T3. Each group consisted of 6 rats prepared, then T1 was named EGCG hydrogel 60 ppm, T2 was given EGCG hydrogel 90 ppm, while T3 was given EGCG hydrogel 120 ppm. On the 3rd day, Wistar rats were decapitated to continue making HPA preparations. Results:This study showed a significant difference in each group (p< 0.05) using One-Way Anova analysis. Conclusion: EGCG hydrogel 90 ppm is effectivein increasing the number of macrophage cells

Single visit root canal treatment with post crown restoration

Background: Single visit endodontics has been shown to be an effective treatment modality when compared with multiple visit therapy and it does not deviate from achieving the objectives of proper biomechanical preparation, debridement, shaping, disinfection and 3 dimensional obturation of root canal system and is more beneficial to the patient and dentist provided there is careful case selection and strict follow of standard endodontic protocols. Symptomatic teeth can also be managed by single visit after controlling the abscess infection with antibiotic, provided the root canal is dry without any discharge. Purpose: This study aims to perform single visit root canals on teeth with irreversible pulpitis and restoration with post core and crown. Case: A 48-years-old female comes with dental complaints of upper left rear spontaneous pain at night. The tooth has had cavities since about two years ago and has never been previously treated. The patient said had not any systematic health disorder. There is a spontaneous pain that the patient feels. Case Management: From the examination that has been carried out, a clinical diagnosis of tooth 25 were symptomatic pulpitis irreversible with normal apical tissue. The restoration endodontic treatment plan was a single visit endodontic and the restoration is post core and crown. Conclusion: Symptomatic pulpitis irreversible with normal apical tissue treatment can be carried out single visit root canal treatment. Restoration of post endodontic treatment in this case need fiber post and core using composite and finally restoration using crown that made of zirconia. Zirconia has a higher level of material resistance than lithium disilicate. This is what makes zirconia the choice, especially for posterior teeth

Internal Bleaching of a Non vital Anterior Tooth in Patient with Postural Hypotension

Postural hypotension is a form of low blood pressure, characterized a 20 mmHg decrease in systolic blood pressure or a 10 mmHg drop in diastolic blood pressure when rising from a sitting or lying position. This can cause syncope. A patient who comes to a dentist with postural hypotension may be a tough case. A 48-year-old woman arrived with postural hypotension and felt dissatisfied with the discolored and unsightly condition of her upper central incisor. This clinical case shows a management of postural hypotension patient in internal bleaching technique on non-vital teeth using 35% hydrogen peroxide. This therapy is simple, safety and adequate for patients who has postural hypotension with satisfactory results

The Effect of NaF on the Existence of Ameloblasts and the Change of Tooth Dimension

Ameloblasts cell which is very sensitive to the influence of internal and external factors. One external factor is the effect of fluoride elements that are able to affect the integrity of the ameloblasts cells and structure as well as the dimensions of the tooth enamel. This study seeks to analyze the effect of sodium fluoride exposure on the existence of tooth ameloblasts cells using indicators such as caspase-3, B-cel lymphoma 2 (Bcl-2), the distance between ameloblasts cells, as well as changes in the size or teeth dimension. Adult male healthy rats were used to experiment models, control (sterile distilled water treated), treatment group in to fluoride treated. The difference test on Bcl-2 and Caspase-3 between the control and the treatment groups showed different results (p <0.05). Similarly, the difference test on the distance between the ameloblasts cells as well as that on the dimensional change in both groups indicated significantly different results (p <0.05). These results suggest that the induction of sodium fluoride showed the increase of Caspase-3 protein expression, the decrease of Bcl-2 expression, and the widening of the distance between ameloblasts cells, and the changes in the size or teeth dimension

The Monomer Elution of Bulk-Fill Sculptable Composite and Flowable Composite after Photopolymerization

Introduction: Composite resins have excellent mechanical properties, including fast polymerization, aesthetic quality, easy handling, and the ability to adhere to the enamel surfaces. However, there are also some disadvantages from this material, one of them is residual monomers. Bulk-fill composite resins are available in sculptable (solid) and flowable (liquid) form. Most composite resin matrix is aromatic or aliphatic acrylates. Bis-GMA, UDMA, and TEGDMA are the matrix monomers that are commonly used but show a high cytotoxicity level. They also have poor mechanical properties such as wear resistance, hardness, tendency to change color, and may cause pulp reactions. Aim: The aim of this study was to investigate the number of residual monomers in bulk-fill sculptable and flowable composites in the submersion of 75% ethanol solution (10 minutes, an hour, and 24 hours). Methods: Sculptable and flowable composites were used in this study. Samples (4 mm thick, 5 mm diameter) were prepared and polymerized for 10 seconds with an intensity of 1025 mW / cm2 of a light emitted diode (LED). After the sample was made, each sample was immediately immersed in a 75% ethanol solution as an extraction liquid and stored in amber-colored bottles at room temperature. Samples were taken as many as 7 cc at intervals of 10 minutes, an hour, and 24 hours. Samples were analyzed by High-Performance Liquid Chromatography (HPLC). The data obtained were analyzed using the Kruskal-Wallis Test, Independent T-Test and Mann-Whitney Test at a significance level of p <0.05. Result: The amount of elusion remaining monomers of the bulk-fill flowable composite was higher than bulk-fill sculptable composite. UDMA composite of bulk fill flowable submersed in 75% ethanol solution for 24 hours was the highest among other monomers. Conclusion: Residual monomers eluted inside bulk-fill composite resins in all time periods and the amount of eluted monomers increases with time