Reacción liquenoide oral en relación con una restauración de amalgama de plata

La amalgama de plata es uno de los materiales de uso odontológico, frente al que se pueden producir reacciones de hipersensibilidad. La forma más frecuente es la aparición de una reacción liquenoide, que afecta a la mucosa oral en contacto directo con la restauración de amalgama y que está producida por una reacción de hipersensibilidad retardada tipo IV, como respuesta inmune mediada por células frente al mercurio o a algún otro componente de la amalgama dental. En este trabajo presentamos un caso de reacción liquenoide oral (RLO) asociada a una restauración de amalgama de plata. Una mujer de 38 años de edad solicitó asistencia odontológica para el tratamiento de la caries del diente #37, realizándose una preparación cavitaria clase I de Black, que se rellenó con amalgama de plata. Pasados 19 meses, la paciente volvió al consultorio dental, apreciándose una zona atrófica, ligeramente eritematosa, en la mucosa yugal izquierda, justamente en la región de mucosa contactante con el molar restaurado con amalgama de plata. La mucosa yugal derecha tenía un aspecto normal. La paciente había sentido cierta sensación rara en esa zona al comer comidas picantes. No había recibido ningún tipo de tratamiento desde la anterior visita, ni presentaba antecedentes alérgicos. Tras la toma de biopsia, el estudio anatomopatológico demostró cambios histológicos compatibles con liquen plano oral. La paciente decidió no recambiar la restauración, por valorar que no tenía molestias importantes y no deseaba someterse de nuevo al tratamiento. Las restauraciones de otros dientes se le realizaron con resina compuesta, sin que se produjese reacción alguna en la mucosa.Hypersensitivity to mercury associated with amalgam restorations may occur and present in one of two different ways. Most commonly it presents as an oral lichenoid reaction affecting oral mucosa in direct contact with an amalgam restoration and represents a delayed, type IV, cell mediated immune response to mercury or one of the other constituents of the dental amalgam. We report a case of oral lichenoid reaction associated to amalgam restoration. A 38 year-old woman presented a caries lesion of tooth #37. A Black's class I preparation was performed and filled with amalgam. After 19 months, intra-oral examination revealed atrophic lesion, lightly erythematous, affecting the left buccal mucous. The lesion contacted directly with the amalgam restoration in the lower first molar. The right buccal mucosa was normal. His medical history was unremarkable, he was taking no medication and had no known allergies. However, the patient had felt certain rare sensation in that zone when eating sharp meals. Biopsy showed histological changes compatible with oral lichen planus. The patient decided not to change again the restoration, because she did not have important annoyances and she did not wish to be treated again. Other restorations were performed with composite resins, and no reaction was evidenced in the mucosa

Outcome of Direct Pulp Capping in Teeth Diagnosed as Irreversible Pulpitis : systematic review and meta-analysis

This review and meta-analysis investigates the outcome of direct pulp capping in teeth diagnosed as irreversible pulpitis. This systematic review includes experimental and descriptive clinical studies according to the PRISMA criteria, using PubMed and S

MTA HP Repair stimulates in vitro an homogeneous calcium phosphate phase coating deposition

To study the mineralization capacity in vitro of the bioceramic endodontic material MTA HP Repair. Bioactivity evaluation in vitro was carried out, by soaking processed cement disk in simulated body fluid (SBF) during 168 h. The cement surface was studied by Fourier transform infrared spectroscopy (FT-IR), field emission gun scanning electron microscopy (FEG-SEM) and energy dispersive X-ray analysis (EDX). Release to the SBF media of ionic degradation products was monitored using inductively coupled plasma atomic emission spectroscopy (ICP-AES). FT-IR showed increasing formation of phosphate phase bands at 1097, 960, 607 and 570 cm-1 with prolonged SBF soaking. FEG-SEM analysis reveals that HP produces a effectively surface covering consisting in homogeneous spherical phosphate phase aggregates with an average diameter of 0.5-1.0 µm. EDX analysis comparing un-treated (hydrated), 24 h and 72 h SBF treated surfaces of MTA HP Repair revealed phosphate deposition after 24 h, with high phosphorous/silicon element ratio signal measured after 24 h, indicating a very high phosphate phase deposition for this material. The study shows that MTA HP Repair produces a quick and effective bioactive response in vitro in terms of crystalline calcium phosphate surface coating formation. The high bioactive response of MTA HP Repair makes it an interesting candidate for endodontic use as repair cement

Root canal disinfection of immature dog teeth with apical periodontitis: comparison of three different protocols

Objectives: The present in vivo study was designed to assess the efficacy of 3 root canal disinfection protocols in immature dog teeth with apical periodontitis (AP). Material and Methods: Forty immature premolars with pulp necrosis and AP of five Beagle dogs were used. Three experimental disinfection protocols were established. After irrigation with 40 ml 5.25% sodium hypochlorite using the Endovac system, in Group 1 canals were flushed with QMix solution; in Group 2, canals were flushed with QMix solution and 2% chlorhexidine gel dressing was placed for two weeks; and in Group 3, triantibiotic paste dressing was placed for two weeks. Canals were sampled after periapical lesions were radiographically visible (S1), after the first disinfection session (S2) and, in groups 2 and 3, after dressing (S3). Results: After the first session of the disinfection protocol (S2), there was significant (p < 0.05) bacterial reduction in the three experimental groups. Microorganisms were absent in 100% of S2 samples in groups 1 and 2, and in 75% of group 3 (p > 0.05). After dressing, 87.5% of the S3 samples showed increased bacterial count: in group 2, CFU counts (median = 891) were significantly higher than in group 3 (median = 18) (p = 0.03). Conclusions: In immature dog teeth with AP, root canal irrigation using QMix solution, with or without chlorhexi - dine gel dressing, or a triantibiotic paste dressing, provides the same level of disinfection than irrigation with 5.25% sodium hypochlorite alone in only one session

Physicochemical parameters - hydration performance relationship of the new endodontic cement MTA Repair HP

To characterize the chemical composition and textural parameters of the MTA Repair HP precursor powder and their influence to hydration performance. Un-hydrated precursor material was characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), X-ray fluorescence (XRF), laser diffraction (LD), N2 physisorption and field emission gun scanning electron microscopy (FEG-SEM). Setting time was assessed according to ASTM specification C 266. Hydrated material was analysed by XRD, FT-IR, energy dispersive X-ray (EDX) analysis and FEG-SEM. Ca3SiO5 and Ca2SiO4, in addition to CaWO4 as radiopacifier are the main compositional phases. Other measured parameter indicates high specific surface area of 4.8 m2 g-1, high aluminium content of 1.7 wt.% and low initial and final setting times of 12 and 199 min, respectively. Singular microstructural features consisting of high aspect ratio nanoparticles are main constituents of un-hydrated precursor. Besides, FEM-SEM observation shows notably growth of hexagonal shaped plate-like morphologies homogeneously distributed along the sample during hydration process. The short setting time measured for HP Repair, is correlated with high surface area of precursor powder, high Al content and the absence of compositional sulphate phases

Clinical indicators of periodontal disease in patients with coronary heart disease : a 10 years longitudinal study

Objectives: There is evidence about a possible relationship existing between periodontal diseases and coronary heart disease. The aim of the present longitudinal study was to investigate the changes in periodontal evolution after etiological periodontal treatment, comparing a healthy control group with another having coronary heart disease. Study Design: The study included initially 55 patients of which 44 finished it. They were placed into two groups: Healthy Control Group (HCG) n =9, and Coronary Heart Disease Group (CHDG) n=35. The gingival level (GL), probing depth (PD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BOP) were measured to compare the periodontal status in both groups. The patients were examined and etiological periodontal treatment was performed and they were then examined at the end of 1 and 10 years. Statistical method: A one way-ANOVA and a MR-ANOVA were established; significance p0.5). However, at the second visit the CHDG presented a significantly higher PD (p<0.05) and PI (p<0.01). CHDG patients gradually increase PD through time and in comparison to the control group (p<0.041). CHDG patients present a significantly higher CAL loss (p<0.0385) and a significant increase in PI (p<0.0041) at the end of one year, while on the third visit no significant differences were detected in any of these indices. Likewise, a similar fact can be observed on evaluating BOP at the end of ten years causal treatment, a smaller decrease in the cardiac group was observed in regards to the initial values (p<0.001). Conclusion: Patients with coronary heart disease showed a worse evolution of periodontal indices than healthy ones, when referring to probing depth, plaque index and bleeding on probing index

Prevalence of dens invaginatus assessed by CBCT : systematic review and meta-analysis

Dens invaginatus is a developmental dental anomaly resulting from an invagination of dental tissues folding from the outer surface towards dental pulp. The aim of this systematic review and meta-analysis was to determine the prevalence of dens invaginatu

Osteocalcin in serum, saliva and gingival crevicular fluid : their relation with periodontal treatment outcome in postmenopausal women

Antecedentes. Los niveles de osteocalcina se han propuesto como marcador de la inhibición de la formación ósea. El propósito de este trabajo es determinar las concentraciones de osteocalcina en plasma, saliva y fluido crevicular correlacionándolo con el resultado del tratamiento periodontal en mujeres postmenopáusicas. Pacientes y métodos. El estudio se realizó en treinta y nueve mujeres postmenopáusicas (57.8 ±8.5 años de edad). El examen periodontal incluyó el control de placa, el sangrado al sondaje, la profundidad de sondaje (PS) y la pérdida de inserción (CAL). Se determinaron los niveles de osteocalcina en suero, saliva y fluido crevicular. A continuación se llevó a cabo el tratamiento periodontal. Pasados seis meses tras la primera cita se llevó a cabo un segundo examen periodontal. Resultados. Las medias de la PS y del CAL disminuyeron significativamente en el segundo examen periodontal en el grupo de mujeres con osteocalcina en suero < 10 ng/ml (15.8± 15.8% y 15.3± 21.2%, respectivamente; p < 0.05). La PS media disminuyó significativamente en el segundo exámen en los grupos con concentraciones de osteocalcina en saliva < 3 ng/ml (17.1± 15.9%; p < 0.05) y 3 ? 7 ng/ml (16.2 ± 18.1%; p < 0.05). Conclusiones. Los niveles bajos de osteocalcina en suero se asocian significativamente a un mayor porcentaje de disminución de la PS y del CAL tras el tratamiento periodontal en mujeres postmenopáusicas. Las bajas concentraciones de osteocalcina en saliva se asociaron significativamente a un mayor porcentaje de disminución de la PS

The effect of passive ultrasonic activation of 2% chlorhexidine or 3% sodium hypochlorite in canal wall cleaning

Objectives: the purpose of this study was to compare debris removal and open tubules effectiveness of sodium hypochlorite (NaOCl) and chlorhexidine (CHX) applied as final irrigation in dif ferent protocols Study Design: sixty extracted premolars were divided into six groups according to the final irrigation technique: A and B 3 % NaOCl or 2 % CHX with the Miraject needle and no agitation; C and D, passive ultrasonic irrigation (PUI) with Irrisafe 20 tips and 3 % NaOCl or 2 % CHX; E and F, PUI with Irrisafe 25 tips and 3 % NaOCl or 2% CHX. The remaining dentine debris and opened tubules were evaluated by SEM at three root levels by two blinded investigators. The Kruskal Wallis and the Mann-Whitney U test was used to compare groups and levels, with a significance of p <0.05. Results: Debris elimination was significantly higher in PUI groups ( p <0.05). PUI groups showed a higher capability to open tubules, compared to groups A and B. In the coronal third, groups D to F eliminated more debris and opened more tubules than conventional irrigation ( p <0.05). In medium third, group E eliminated significantly more debris (1.60) than group A (2.60). No differences were obtained among groups in apical third. Both NaOCl and CHX applied with PUI showed no differences in debris elimination or opened tubules. Conclusions: Final PUI with Irrisafe tips was the most effective procedure for eliminating the debris and opening up dentinal tubules, independent of the irrigant solution or Irrisafe type size