Influência da infecção endodôntica associada ou não à diabetes nos níveis da citocina pró-inflamatória IL-17 nos tecidos periapical, hepático e renal de ratos Wistar

O objetivo deste trabalho foi avaliar a influência da infecção endodôntica associada ou não à diabetes, nos níveis da citocina pró-inflamatória IL-17, nos tecidos periapical, hepático e renal de ratos Wistar. Foram utilizados 40 ratos machos divididos em quatro grupos contendo 10 animais cada grupo: ratos normoglicêmicos (N); ratos normoglicêmicos com periodontite apical (N-PA); ratos com diabetes experimental (DE); ratos com diabetes experimental e com periodontite apical (DE-PA). A diabetes foi induzida por meio da administração de estreptozotocina via veia peniana. Foi realizada avaliação glicêmica, para confirmar o desenvolvimento da doença, no sexto e no último dia do experimento. A infecção endodôntica foi induzida por meio da exposição pulpar do primeiro molar superior direito ao meio bucal. Após 30 dias, foram coletados o fígado e o rim, para a quantificação da IL-17 pelo método ELISA, bem como a hemi-maxila direita para a quantificação da IL-17 pela técnica imunoistoquímica. Os valores obtidos nos testes paramétricos foram tabulados e analisados, estatisticamente, por meio dos testes de análise de variância (ANOVA) e teste de Tukey (p0.05). It may be concluded that diabetes increases IL-17 levels in hepatic and renal tissues, as well as enhances...Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

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 clareação sobre a polpa dentária

Tooth bleaching is the most common treatment and more conservative to get a smile with white teeth. However, the tooth sensitivity has been a major adverse effects caused by this treatment, which raises questions about the effect of bleaching the pulp. Therefore, we performed a literature review in order to study the relationship between bleaching agents and their possible effects on the dental pulp. We review various articles showing that the peroxide compound used to whiten teeth, penetrates through enamel and dentin until the pulp chamber causing changes of variable intensity or induce pulp necrosis. Moreover, we found that the higher the concentration of peroxide in the bleaching agent, and the greater the contact time with this dental structure, the greater the damage caused in the pulp. Although several studies show that the bleaching agent hydrogen peroxide-based pulp can make changes, there are still many gaps to be filled.Um dos tratamentos mais utilizados e mais conservadores para se obter um sorriso com dentes brancos é a clareação dentária. No entanto, a sensibilidade dentária tem sido um dos grandes efeitos adversos causado por este tratamento, o que leva a questionar os efeitos da clareação sobre a polpa dentária. Diante disso, foi realizada uma revisão de literatura com a finalidade de estudarmos a relação entre os agentes de clareação e seus possíveis efeitos sobre a polpa dentária. Revisamos vários artigos que mostram que o peróxido, composto utilizado para clarear os dentes, penetra por esmalte e dentina, até atingir a câmara pulpar, causando alterações de variável intensidade ou mesmo induzir à necrose pulpar. Além disso, vimos que quanto maior a concentração de peróxido no agente clareador, e quanto maior o tempo de contato deste com a estrutura dentária, maiores serão os prejuízos ocasionados na polpa. Embora vários estudos comprovem que o agente clareador a base de peróxido pode promover alterações pulpares, ainda existem várias lacunas a serem preenchidas

Root reconstructed with mineral trioxide aggregate and guided tissue regeneration in apical surgery: a 5-year follow-up

Apical surgery should be considered as the last treatment option and employed when conventional endodontic treatment does not provide the expected result. In teeth undergoing apical surgery, the type of retrograde filling material is one of the factors interfering with the repair of periapical tissues. The material in intimate contact with the periapical tissues plays a fundamental role in the repair process. Several materials have been studied and indicated for use in apical surgery procedures, but the mineral trioxide aggregate (MTA) is still the most frequently used one. Guided tissue regeneration (GTR) techniques have been proposed as an adjunct to apical surgery to enhance bone healing. Here is reported a clinical case in which apical surgery was performed in conjunction with MTA-based root reconstruction of the maxillary right second incisor. After the apical surgery, a root-end cavity was prepared at the vestibular face of the involved tooth and filled with MTA. A bovine bone graft and a cortical collagen membrane were placed on the bone defect. After 5 years, clinical and radiographic assessments showed that the treatment was successful. It may be concluded that MTA presents favorable characteristics in adverse conditions and can be used in conjunction with GTR in cases involving root reconstruction.A cirurgia apical deve ser considerada como a última opção de tratamento, e realizada quando o tratamento endodôntico convencional não proporciona o resultado esperado. Em dentes submetidos à cirurgia apical, o tipo de material retro-obturador é um dos fatores que interferem no reparo dos tecidos periapicais. O material em íntimo contato com os tecidos periapicais desempenha um papel fundamental no processo de reparo. Vários materiais têm sido estudados e indicados para o uso em procedimentos de cirurgias apicais, entretanto o agregado de trióxido mineral (MTA) ainda é o mais frequentemente utilizado. A regeneração tecidual guiada (GTR) tem sido proposta como um auxiliar na cirurgia apical para melhorar a formação óssea. Aqui é relatado um caso clínico em que a cirurgia apical foi realizada em conjunto com a reconstrução radicular do incisivo lateral superior esquerdo com MTA. Após a cirurgia apical, foi preparada uma retro-cavidade na parede vestibular e o dente envolvido foi obturado com MTA. Um enxerto de osso bovino e uma membrana de colágeno cortical foram colocados no defeito ósseo. Após 5 anos, avaliações clínica e radiográfica mostram que o tratamento foi bem sucedido. Pode-se concluir que o MTA apresenta características favoráveis em condições adversas e que pode ser usado em conjunto com GTR em casos envolvendo reconstrução radicular.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

A inter-relação entre as infecções pulpares e a diabetes

Diabetes is a metabolic disease that affects the dental pulp due to some local changes. Before this information, a research through literature was made with the purpose to study the interrelation between pulp infections and diabetes. We analyzed several articles that described researches involving animals and they showed that there is a relation between diabetes and size, progression and severity of the periradicular lesions. There is evidence that diabetes is an important factor over the oral tissue, causing alterations in the inflammatory mediators and changing the structure of the pulp. Although many studies prove that there is an interrelation between diabetes and pulp infections, there are still some gaps in the current literature that need to be filled.O diabetes é uma doença metabólica que afeta a polpa dentária em função de algumas alterações locais. Diante disso, foi realizada uma revisão de literatura com a finalidade de estudarmos a inter-relação entre as infecções pulpares e o diabetes. Revisamos vários artigos, onde a pesquisa foi feita em animais, e os resultados mostraram que há relação entre o diabetes e o tamanho, progressão e severidade de lesões perirradiculares. Há evidências de que o diabetes é um fator crítico sobre os tecidos orais, resultando na alteração de mediadores inflamatórios e modificação dos componentes estruturais da polpa. Embora vários estudos comprovem a inter-relação entre as infecções pulpares e o diabetes, ainda existem várias lacunas na literatura atual que precisam ser preenchidas

Pulpal and periodontal diseases increase triglyceride levels in diabetic rats

Objectives: The aim of this study was to evaluate triglyceride and cholesterol levels in diabetic rats and their relationship with pulpal and periodontal diseases. Methods: Eighty male rats (Rattus norvegicus albinus, Wistar) were divided into the following eight groups comprising ten animals each: normal rats (G1), rats with pulpal diseases (G2), rats with periodontal diseases (G3), rats with both pulpal and periodontal diseases (G4), diabetic rats (G5), diabetic rats with pulpal diseases (G6), diabetic rats with periodontal diseases (G7), and diabetic rats with both periodontal and pulpal diseases (G8). Diabetes was induced by injecting streptozotocin, periapical lesions were induced by exposing pulpal tissue to the oral environment, and periodontal diseases were induced by periodontal ligature. The animals were killed after 30 days, and lipid profile was enzymatically measured using Trinder's method. The total assessed values were statistically analyzed by analysis of variance and Tukey test (p < 0.05). Results: The triglyceride levels of diabetic rats with periodontal disease and of diabetic rats with both periodontal and pulpal diseases were significantly higher than those of normal rats and nondiabetic group rats, respectively. The differences in the cholesterol levels among the groups were not significant. Conclusions: We found that the association of pulpal and periodontal diseases with diabetes increased triglyceride levels in rats. Clinical significance: Changes in lipid profile may be related to the presence of oral infections and diabetes. © 2012 Springer-Verlag Berlin Heidelberg

Apical periodontitis and periodontal disease increase serum IL-17 levels in normoglycemic and diabetic rats

This study aimed to evaluate the influence of apical periodontitis (AP) and/or periodontal disease (PD) on serum interleukin-17 (IL-17) levels in a rat model of diabetes mellitus (DM).Eighty male Wistar rats were divided into eight groups of ten animals each: normoglycemic, AP, PD, AP+PD, DM, DM+AP, DM+PD, and DM+AP+PD. DM was induced using streptozotocin, AP by dental pulp exposure to the oral environment, and PD by periodontal ligature. The animals were sacrificed after 30 days, and venous blood samples were collected via cardiac puncture to determine the serum IL-17 and neutrophil levels. The maxillae were dissected and processed for radiographic analysis. The periapical lesion areas were quantified in pixels. The total assessed values were tabulated according to each experimental group and were statistically analyzed using Spearman's correlation and Kruskal-Wallis test (p < 0.05).A significant difference in the serum IL-17 levels was observed between the groups without oral infections and the groups with AP+PD-associated lesions, regardless of the presence of DM (p < 0.05). Diabetes increased the neutrophil levels, regardless of the presence of oral infection. However, a combination of two oral infections increased the neutrophil levels in DM rats (p < 0.05). The level of bone resorption lesions was greater in DM rats than in normoglycemic rats (p < 0.05).The combination of AP and PD increased the serum IL-17 levels in DM and normoglycemic rats and increased the neutrophil levels in DM rats. Diabetes increased the neutrophil levels and bone resorption in rats.AP is capable of potentiating systemic inflammatory changes when associated with PD, and increases in blood glucose can accelerate the pathogenesis of oral infections.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP