Immunohistochemical identification of immunocompetent and inflammatory cells in healthy and inflamed dental pulps

Orientador: Alexandre Augusto ZaiaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Este estudo teve como objetivos identificar por técnica de imunohistoquímica linfócitos T4, linfócitos T8, linfócitos B, macrófagos e mastócitos em tecidos pulpares normais e inflamados de dentes humanos e correlacionar a presença dessas células com os sinais e sintomas apresentados pelos pacientes e aspectos clínicos dos dentes. Após a determinação do diagnóstico clínico das condições pulpares, 24 polpas normais e 18 polpas inflamadas foram coletadas de dentes extraídos clivados ou por extirpação em dentes que foram submetidos à endodontia. As polpas foram processadas histologicamente, sendo que uma secção tecidual de cada amostra foi corada por hematoxilina e eosina e as demais foram utilizadas para a imunohistoquímica. As lâminas foram analisadas em microscopia de luz. Cinco campos com maior intensidade de marcação foram capturados, tiveram suas áreas mensuradas e o número de células contado. Em polpas normais, os linfócitos T8 apresentaram maior número de células marcadas, seguidos pelos linfócitos T4, macrófagos, linfócitos B e mastócitos. Diferenças significantes foram encontradas, com maior número de linfócitos T8 quando comparados aos linfócitos B e mastócitos (Kruskal-Wallis - p 0,05). Dessa forma, concluiu-se que os linfócitos T4, T8 e B, macrófagos e mastócitos podem ser identificados em diferentes proporções nos tecidos pulpares normais e inflamados. Entretanto, não houve correlação entre a sintomatologia apresentada pelos pacientes e o aumento do número dessas células em todos os tecidos pulpares classificados clinicamente como inflamadosAbstract:The aim of this study was to identify by immunohistochemical technique T4 lymphocytes, T8 lymphocytes, B lymphocytes, macrophages and mast cells in normal and inflamed human dental pulps and to correlate the presence of these cells to the signals and symptoms presented by the patients and the teeth clinical aspects. After the clinical diagnoses, 24 normal dental pulps and 18 inflamed dental pulps were collected from extracted teeth or by extirpation during endodontic procedures. After dental pulp histological procedures, one tissue section from each specimen was stained with hematoxylin and eosin and the other sections were used to immunohistochemical analyses. The slides were analyzed by light microscopy. Five fields with more intensive immunostaining were captured, measured and the positive cells were counted. In normal pulps, T8 lymphocytes presented more positive cells followed by T4 lymphocytes, macrophages, B lymphocytes and mast cells. Statistical significance was founded with more T8 lymphocytes than B lymphocytes and mast cells (Kruskal-Wallis ¿ p 0.05). It was concluded that T4, T8 and B lymphocytes, macrophages and mast cells could be identified with different rates in normal and inflamed dental pulps. However, no correlation was detected between the patient¿s symptomatology and these cells increase in all inflamed dental pulpsDoutoradoEndodontiaDoutor em Clínica Odontológic

Antimicrobial and cytotoxic effects of phosphoric acid solution compared to other root canal irrigants

Phosphoric acid has been suggested as an irrigant due to its effectiveness in removing the smear layer. The purpose of this study was to compare the antimicrobial and cytotoxic effects of a 37% phosphoric acid solution to other irrigants commonly used in endodontics. The substances 37% phosphoric acid, 17% EDTA, 10% citric acid, 2% chlorhexidine (solution and gel), and 5.25% NaOCl were evaluated. The antimicrobial activity was tested against Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Actinomyces meyeri, Parvimonas micra, Porphyromonas gingivalis, and Prevotella nigrescensaccording to the agar diffusion method. The cytotoxicity of the irrigants was determined by using the MTT assay. Phosphoric acid presented higher antimicrobial activity compared to the other tested irrigants. With regard to the cell viability, this solution showed results similar to those with 5.25% NaOCl and 2% chlorhexidine (gel and solution), whereas 17% EDTA and 10% citric acid showed higher cell viability compared to other irrigants. Phosphoric acid demonstrated higher antimicrobial activity and cytotoxicity similar to that of 5.25% NaOCl and 2% chlorhexidine (gel and solution).232158163CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP302575/2009-0Sem informação2009/53976-0; 2010/50817-5; 2011/09047-

Surface Morphology Alterations In Bovine Dentin Exposed To Different Bleaching Agents

Aim: This study evaluated the morphological changes caused by internal bleaching agents on dentin surface. Methods: Twenty crowns of bovine incisors were cut into slabs that were randomly distributed in six experimental groups (n = 5), according to the bleaching agent used: G1 – sodium perborate + water, G2 – sodium perborate + 2% chlorhexidine gel, G3 – sodium perborate + 30% hydrogen peroxide, G4 – 30% hydrogen peroxide, G5 – 37% carbamide peroxide and G6 – gel base without carbamide. Two Control Groups were used: C1 with distilled water and C2 with 2% chlorhexidine gel. The specimens were immersed in the respective test bleaching agent and incubated at 37 °C for seven days. Following, they were prepared for scanning electron microscopy and five images from each tooth segment were recorded and analyzed for surface morphological alterations, by three previously calibrated examiners. Inter-examiner agreement was verified using the Kappa test. The rank averages obtained for the groups were subjected to Kruskal-Wallis analysis of variance at 5% significance level. Results: The analysis of the scores obtained indicated that all tested materials caused some morphological alteration on dentin, except for sodium perborate + water (G1) and Control Groups 1 and 2. Hydrogen peroxide and carbamide peroxide caused significantly more severe alterations (p < 0.05) to dentin structure, than the other bleaching agents evaluated. Conclusions: Sodium perborate-based pastes seemed to be the most harmless agent to dentin structures in non-vital tooth bleaching, while hydrogen peroxide solutions and carbamide peroxide agents caused the greatest alterations.8125-2

Apexification with a New Intra-Canal Medicament: A Multidisciplinary Case Report

Dental trauma generally requires multidisciplinary planning and treatment for good prognosis. When immature teeth are traumatized to a degree where pulp necrosis ensues, the objective of root canal treatment should be apexogenesis and root maturation. Apexification of the root is the conventional choice, which involves cleaning the canal and filling it with a temporary medication that stimulates the formation of a calcific apical barrier. Dental Trauma Service of Piracicaba Dental School, State University of Campinas (UNICAMP), Brazil employs a dressing for apexification treatments with calcium hydroxide, chlorhexidine gel 2% and zinc oxide. This paper reports the case of a dental trauma of the maxillary central incisors and subluxation on teeth 11, 12 and 21 that were treated with multidisciplinary collaboration (Endodontics, Periodontology and Operative Dentistry) to improve prognosis. After five-years there were no pathological conditions and the teeth showed every evidences of success

Treatment outcomes of pulp revascularization in traumatized immature teeth using calcium hydroxide and 2% chlorhexidine gel as intracanal medication

Objective: Pulp revascularization is an effective treatment for immature necrotic teeth. Calcium hydroxide has been used in pulp revascularization as an intracanal medication due to its antimicrobial action and the non-exhibition of crown discoloration and cytotoxicity for stem cells from the apical papilla. Our study aimed to investigate the clinical success and quantitative radiographic changes of root development in immature traumatized teeth using calcium hydroxide plus 2% chlorhexidine gel as intracanal medication. Methodology: In this retrospective study, 16 patients were treated with a standardized pulp revascularization protocol. Calcium hydroxide and 2% chlorhexidine gel were manipulated in a 1:1 (v/v) ratio and inserted into root canals with Lentulo spirals (Dentsply Maillefer, Baillaigues, Switzerland). Patients were followed up for a period from 9 to 36 months for the evaluation of clinical and radiological data. Radiographic measurements of root length, root width, apical diameter, and MTA placement from the apex were quantified using software ImageJ. Wilcoxon test and t-test were used, according to nonparametric or parametric data, respectively, for changes over time in root length, root width, and apical diameter. Results: Fifteen teeth survived during the follow-up period (93.75%) and met the criteria for clinical success. Although the changes seem to be very small in many cases, significant increases in the average root length (14.28%, p&lt;0.0001), root width (8.12%, p=0.0196), and decrease in apical diameter (48.37%, p=0.0007) were observed. MTA placement from the apex and age at the time of treatment was not significantly associated with the quantitative radiographic outcomes. Conclusions: Pulp revascularization in traumatized immature teeth treated with calcium hydroxide plus 2% chlorhexidine gel as intracanal medication had high success and survival rates, showing periodontal healing and resolution of signs and symptoms. However, concerning the continued root development, the outcomes can still be considered unpredictable

Dentin-pulp complex reactions in conventional and radiation-related caries : a comparative study

Radiation-related caries (RRC) is one of the most significant oral toxicities of head and neck radiotherapy (HNRT); however, the potential of radiation to directly cause harmful dentin and pulpal effects and impair response to caries progression is controversial. Therefore, the aim of this study was to characterize the reactions of the dentin-pulp complex in teeth affected by RRC. Patients and methods: Twenty-two carious teeth extracted from 22 head and neck cancer (HNC) patients were divided into control (conventional caries; n=11) and irradiated (RRC; n=11) groups and paired matched by dental homology, clinical patterns of caries progression following the Post-Radiation Dental Index (PRDI) and microscopic depth of carious invasion. Histopathological characteristics based on morphological hierarchy, cell populations of dental pulp, blood vessels, neural elements, extracellular matrix components, inflammation, patterns of carious invasion and reactionary dentin presence were evaluated by optical light microscopy and histomorphometry. Mean PRDI scores were 3.2 for the control group and 3.8 for the irradiated group. Dentin demineralization patterns were also similar between the groups and the mean depths of demineralization were 1,158.58µm and 1,056.89µm for the control and irradiated groups, respectively. Pulp histopathological changes and dentin reaction patterns were similar between groups and varied according to the PRDI scores and carious lesions depth. Dentin and pulp reactions are highly preserved in RRC teeth

Epidemiology and outcomes of non-cardiac surgical patients in Brazilian intensive care units

OBJECTIVES: Due to the dramatic medical breakthroughs and an increasingly ageing population, the proportion of patients who are at risk of dying following surgery is increasing over time. The aim of this study was to evaluate the outcomes and the epidemiology of non-cardiac surgical patients admitted to the intensive care unit. METHODS: A multicenter, prospective, observational, cohort study was carried out in 21 intensive care units. A total of 885 adult surgical patients admitted to a participating intensive care unit from April to June 2006 were evaluated and 587 patients were enrolled. Exclusion criteria were trauma, cardiac, neurological, gynecologic, obstetric and palliative surgeries. The main outcome measures were postoperative complications and intensive care unit and 90-day mortality rates. RESULTS: Major and urgent surgeries were performed in 66.4% and 31.7% of the patients, respectively. The intensive care unit mortality rate was 15%, and 38% of the patients had postoperative complications. The most common complication was infection or sepsis (24.7%). Myocardial ischemia was diagnosed in only 1.9% of the patients. A total of 94 % of the patients who died after surgery had co-morbidities at the time of surgery (3.4 ± 2.2). Multiple organ failure was the main cause of death (53%). CONCLUSION: Sepsis is the predominant cause of morbidity in patients undergoing non-cardiac surgery. In this patient population, multiple organ failure prevailed as the most frequent cause of death in the hospital.OBJETIVO: Devido aos avanços da medicina e ao envelhecimento da população, a proporção de pacientes em risco de morte após cirurgias está aumentando. Nosso objetivo foi avaliar o desfecho e a epidemiologia de cirurgias não cardíacas em pacientes admitidos em unidade de terapia intensiva. MÉTODOS: Estudo prospectivo, observacional, de coorte, realizado em 21 unidades de terapia intensiva. Um total de 885 pacientes adultos, cirúrgicos, consecutivamente admitidos em unidades de terapia intensiva no período de abril a junho de 2006 foi avaliado e destes, 587 foram incluídos. Os critérios de exclusão foram; trauma, cirurgias cardíacas, neurológicas, ginecológicas, obstétricas e paliativas. Os principais desfechos foram complicações pós-cirúrgicas e mortalidade na unidade de terapia intensiva e 90 dias após a cirurgia. RESULTADOS: Cirurgias de grande porte e de urgência foram realizadas em 66,4% e 31,7%, dos pacientes, respectivamente. A taxa de mortalidade na unidade de terapia intensiva foi de 15%, e 38% dos pacientes tiveram complicações no pós-operatório. A complicação mais comum foi infecção ou sepse (24,7%). Isquemia miocárdica foi diagnosticada em apenas 1,9%. Um total de 94 % dos pacientes que morreram após a cirurgia tinha co-morbidades associadas (3,4 ± 2,2). A principal causa de óbito foi disfunção de múltiplos órgãos (53%). CONCLUSÃO: Sepse é a causa predominante de morbidade em pacientes submetidos a cirurgias não cardíacas. A grande maioria dos óbitos no pós-operatório ocorreu por disfunção de múltiplos órgãos.Faculdade de Medicina de São José do Rio PretoServidor Público Estadual Serviço de Terapia IntensivaHospital São Lucas Unidade Coronariana IntensivaHospital Moinhos de Vento Centro de Terapia IntensivaClínica Sorocaba Centro de Terapia IntensivaClínica São Vicente Centro de Terapia IntensivaUniversidade Federal da Paraíba Hospital Universitário Unidade de Terapia Intensiva de AdultosUniversidade Federal de São Paulo (UNIFESP)Hospital Pró-Cardíaco Centro de Terapia IntensivaUniversidade Federal do Mato Grosso do Sul Hospital Universitário Centro de Terapia Intensiva AdultoUniversidade Estadual de LondrinaHospital de Terapia IntensivaUniversidade Estadual do PiauíHospital Santa Luzia Centro de Terapia IntensivaUniversidade Estadual do Oeste do ParanáFaculdade de Medicina de São José do Rio Preto Hospital de BaseHospital do Servidor Público EstadualHospital Cardiotrauma IpanemaSanta Casa de Misericórdia Centro de Terapia IntensivaUNIFESPSciEL

Effect of the smear layer on the filling of artificial lateral canals and microleakage

Aim: To evaluate the influence of the smear layer on the filling and prevention of microleakage in artificial lateral canals after use of different irrigating solutions. Methods: Two lateral canals were produced in 44 human dental roots with drills of 0.1 mm in diameter. The roots were divided in 4 groups according to the irrigation protocol: GI - 0.9% saline solution (control); GII - 2.5% sodium hypochlorite + 17% EDTA; GIII - 2% chlorhexidine gel + 17% EDTA; GIV - 2% chlorhexidine solution + 17% EDTA. Four roots were used as negative (n=2) and positive (n=2) controls. Lateral condensation technique and AH Plus were used to fill the root canals. Digital buccolingual radiographs were exposed and after the sealer had set, the roots were immersed in Indian ink dye and then cleared in methyl salicylate. The extent of filling and microleakage were measured and the values analyzed statistically. Results: No difference was found in the percentage of filling and microleakage among the groups, regardless of the location of the artificial lateral canals and the irrigation protocol used. Twenty percent of lateral canals produced no radiographic images, but their filling was confirmed using the clearing technique. Conclusions: The presence or absence of the smear layer did not affect the filling ability and the prevention of microleakage in artificial lateral canals

Sodium thiosulfate for recovery of bond strength to dentin treated with sodium hypochlorite

The aim of this study was to evaluate the efficacy of sodium thiosulfate (Na2S2O3) for restoring adhesion to pulp chamber dentin treated with sodium hypochlorite (NaOCl) and EDTA. Methods Sixty-three crowns of bovine incisors were cut to expose the dentin pulp chamber. The specimens were polished and randomly distributed into 9 groups (n = 7) according to the following protocols used: 0.9% sodium chloride for 30 minutes (negative control), 5.25% NaOCl for 30 minutes, 17% EDTA for 3 minutes, and 5.25% NaOCl for 1 minute (positive control). The other groups, after treatments with NaOCl and EDTA, were immersed in 0.5% or 5% Na2S2O3 for 1, 5, and 10 minutes or just immersed in an inert solution for 10 minutes (0.9% sodium chloride). After drying the specimens, Scotchbond Multi-Purpose (3M ESPE, St Paul, MN) was applied to the pulp chamber dentin followed by Filtek Z250 composite (3M ESPE). Six rectangular slabs were obtained from each specimen, and the dentin/resin interface was tested by using a universal testing machine. The resulting data were submitted to 1-way analysis of variance and the Duncan test (P = .05). Results There was a significant decrease in bond strength regarding NaOCl and EDTA (P < .05). When 5% Na2S2O3 was used for 10 minutes, the bond strength was found to be statistically equal to the negative control and higher than the positive control (P < .05). Conclusions The use of Na2S2O3 can significantly increase the bond strength of composite resin to NaOCl/EDTA-treated dentin, allowing adhesive restorations to be immediately applied after endodontic treatment422284288COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP33003033008P811/05302-