Root Surface Treatment Research Articles

Engineered Immunomodulatory Nanoparticles Inhibit Root Resorption and Ankylosis

IntroductionExternal root resorption following avulsion injury is a complex process wherein differentiation of macrophages (Mϕ) to multinucleated osteoclasts is temporally regulated by resident periodontal fibroblasts (PDLF). The current study aims to assess the effect of engineered bioactive chitosan nanoparticles (CSNP), sustained released dexamethasone conjugated CSNP (CS-DEX) and CSNP functionalized with photosensitizer Rose Bengal (CSRB) for application in root resorption using an in-vitro PDLF-Mϕ direct coculture model and in-vivo delayed reimplantation model. MethodsPDLF-Mϕ direct coculture system was exposed to lipopolysaccharide (LPS), macrophage colony stimulating factor, receptor activator of nuclear factor kappa β ligand with or without CSNP/CS-DEX for 7 days. Clastic differentiation was assessed by tartrate resistant acid phosphatase (TRAP) staining on day 7. On day 2 and 7, immunofluorescence analysis was conducted to assess the expression of Mϕ polarization markers (CD80, CD206), multinucleation markers (NFATc1, STAT6) in Mϕ and matricellular protein periostin in PDLF and cytokine profiling in cell culture supernatants. Delayed replantation model with extraoral air dry/LPS exposure for 1h followed by root surface treatment with CS-DEX/CSRB was used in Wistar rats. After 21 days, rats were euthanized for histologic and immunofluorescence analysis. Statistical analysis one-way ANOVA with Tukey's multiple comparisons was used to analyze the data (P < .05). ResultsCS-DEX significantly reduced TRAP+ multinucleated cells and CSNP treatment showed no TRAP+ cells. Immunofluorescence analysis showed that CSNP/CS-DEX reduced CD80, NFATc1 and STAT6 expression and increased periostin as expressed by fluorescence intensity. CSNP/CS-DEX significantly reduced TNFα, MMP9 and increased IL10, TGFβ1. Osteoprotegerin was upregulated only by CSNP. Root surface treatment in delayed replantation model showed that CS-DEX and CSRB substantially reduced the degree of resorption and ankylosis. Further, CD80, CD206, and MMP2 expression in groups with root surface treatment with CS-DEX and CSRB was lower than airdry/LPS group and similar to healthy control and NFATc1, STAT6, and MMP9 expressions were lower than healthy control. ConclusionThe engineered nanosized immunomodulatory bioactive materials chitosan nanoparticles functionalized with photosensitizer and dexamethasone effectively reduced the clastic differentiation of Mϕ in in-vitro coculture and minimized the resorption and ankylosis in a delayed reimplantation model. These biomaterials have the potential to serve as root modification agents, promoting favorable healing outcomes in cases of dental avulsion.

Deciphering 3D periodontal fibroblast-macrophage crosstalk in bioactive nanoparticle-guided immunomodulation for treating traumatic dental avulsion

Prolonged extra-oral period in dental avulsion is often associated with loss of viability of Periodontal fibroblasts (PDLF) and increased risk of ankylosis. Root surface treatment with bioactive agents to reduce the risk of ankylosis can be a potential strategy. The objective of the study was to investigate the impact of an engineered chitosan nanoparticles (CSNP), photosensitizer Rose Bengal (RB) functionalized CSNP (CSRB) and sustained dexamethasone (CSDEX) releasing CSNP for application in management of delayed replantation of avulsed teeth. The 3D PDLF-macrophage (Mϕ) collagen model was developed and exposed to LPS, MCSF, RANKL with and without CSDEX/CSNP. Immunofluorescence and cytokine analysis was done at 2 and 7 days to assess cellular interactions. Maxillary right incisors in male Wistar rats were extracted, exposed to extraoral dry or LPS for 1 h and treated with or without CSDEX/CSRB for 1 min before replantation. Rats were euthanized after 21 days for micro-CT, TRAP, and immunofluorescence analysis. CSDEX/CSNP treatment in 3D model significantly reduced CD80, NFATc1, STAT6 and increased CD206 and periostin expression (p < 0.05). TNFα, MMP9 was downregulated and IL10, TGFβ1, MMP2 upregulated with CSDEX/CSNP (p < 0.05). CSDEX/CSRB in animal study significantly reduced resorption, ankylosis, TRAP activity and osteocalcin expression and increased periostin (p<0.05). CSDEX demonstrated higher anti-inflammatory activity by downregulating TNFα, while CSNP upregulated TGFβ1, periostin, and downregulated MMP9. The combination of matrix stabilization with CSRB with periostin upregulation and sustained releasing CSDEX showed potential for hampering root resorption and ankylosis in dental avulsion.

Effects of Doxycycline-Loaded NO-Releasing Nanomatrix Gel on Delayed Replanted of Rat Molar.

Tooth avulsion and delayed replantation may cause inflammatory responses and root resorption of the tooth. The aim of this study is to investigate the effect of a doxycycline-loaded nitric oxide-releasing nanomatrix (DN) gel on the delayed replantation of avulsed rat teeth, with a focus on assessing the gel's potential to promote regeneration and inhibit complications associated with the replantation process. Twenty-four right maxillary first molars from male Sprague-Dawley rats were atraumatically extracted using sterile extraction forceps. The molars were dried for 1 h at room temperature (approximately 23 °C) and divided into four groups according to the root conditioning methods after extra-alveolar 60-min drying: Group 1, no root conditioning treatment prior to replantation; Group 2, soaking in 2% NaF solution for 5 min before replantation; Group 3, 5-min soaking in NO gel and injection of the gel into the alveolar socket; Group 4, 5-min soaking in DN gel and injection of the gel into the alveolar socket before replantation. The animals were euthanized four weeks after the operation and the specimens were evaluated histologically. The use of NO gel alone showed better anti-inflammatory and periodontal effects than the control group, but it did not show a significant effect compared to the group using NaF. When using NO gel loaded with doxycycline, it showed a significant anti-inflammatory effect compared to the control group and showed a similar inhibitory effect to the group using NaF. Within the limits of this study, in delayed replantation situations, the control of inflammatory resorption and replacement resorption is an important factor for achieving a better prognosis of replanted teeth. Root surface treatment with DN gel decreased root resorption after delayed replantation.

Effect of icariin surface treatment on the resorption of denuded roots after replantation in rat.

Limiting the incidence of resorption associated with delayed replantation of avulsed teeth is critical for long-term tooth survival. In this study, we assessed whether icariin, a natural product with anti-osteoclastic properties, could reduce root resorption in a rat model of tooth replantation. Cytocompatibility of icariin (10, 20, 40 and 80 μM) was evaluated by CCK-8 proliferation assay in vitro, and an osteoclastogenesis assay was performed to evaluate the effect of icariin on the differentiation of rat bone marrow macrophages and human peripheral blood monocytes into tartrate-resistant acid phosphatase-stained (TRAP+ ) multinucleated giant cells (MNGCs). Differentiation of human periodontal ligament stem cells (hPDLSCs) treated with icariin (10 μM) was also evaluated at 5, 10 and 21 days of osteogenic induction. The first maxillary molars of five-week-old male Sprague-Dawley rats were extracted, denuded of PDL, then treated either with neutralized collagen solution (Carrier control) or icariin in collagen (3 μg/μL) before replantation into their sockets. The animals were euthanized 2 weeks post-surgery for micro-computed tomography (micro-CT) imaging and histological analyses. Icariin was cytocompatible and significantly reduced the differentiation of TRAP+ MNGCs in a dose-dependent manner compared to the control. Moreover, icariin enhanced alkaline phosphatase activity, expression of osteogenic marker genes and proteins, and calcium deposition in hPDLSCs. Micro-CT imaging of the replanted samples demonstrated a significantly higher volume of remaining roots in the icariin-treated group than in the control group. Histological analysis revealed a marked number of resorptive lacunae with TRAP activity in the control group, whereas icariin-treated samples showed signs of functional healing and reduced osteoclastic activity. Icariin was biocompatible and demonstrated potent anti-osteoclastic and pro-osteogenic properties that reduced resorption and promoted functional healing of denuded roots in a rat maxillary first molar model of replantation. These findings indicate that root surface treatment with icariin may be a clinically relevant and practical method for improving the retention and survival of teeth with compromised PDL after delayed replantation following traumatic avulsion.

Effect of Orthodontic Combined with Implant Repair on Aesthetic Effect and Gingival Crevicular Fluid Factor in Patients with Dentition Defect and Periodontitis.

In order to solve the effect of orthodontics combined with implant repair on the aesthetic effect and gingival crevicular fluid factor of patients with dentition defect and periodontitis, 60 patients who met the diagnostic criteria of chronic periodontitis were proposed. They were randomly divided into treatment group (taking Bushen Huoxue Guchi recipe for 3 courses while basic periodontal treatment) and control group (only basic periodontal treatment without taking any drugs). The experimental method of 30 cases in each group showed that PD, Al, and GI in the treatment group and control group decreased to varying degrees compared with those before treatment. The treatment group decreased significantly compared with the control group (P < 0.01). Chronic periodontitis is a common clinical periodontal disease, accounting for up to 95%, local stimulation, a variety of anaerobic bacteria infection, and periodontal plaque, and other factors may cause the occurrence of diseases. Routine treatment mainly includes upper gingival cleaning, lower curettage treatment, and equal root surface treatment. Although the clinical symptoms can be alleviated to a certain extent, the cause cannot be fundamentally excluded, leading to the disease progression in some patients and the formation of aggressive periodontitis and necrotizing periodontal disease.

The Prostacyclin Analog Iloprost Promotes Cementum Formation and Collagen Reattachment of Replanted Molars and Up-regulates Mineralization by Human Periodontal Ligament Cells

IntroductionThis study evaluated the use of the prostacyclin analog iloprost as a root surface treatment agent in promoting acellular cementum (AC) formation and collagen reattachment after tooth replantation in vivo. In addition, its effect on human periodontal ligament cell (hPDLC) mineralization was assessed in vitro. MethodsFirst molars of 8-week-old Wistar rats were extracted. In 1 group, the root surfaces were treated with Hank's balanced salt solution (HBSS), and the other group's root surfaces were treated with 10−6 mol/L iloprost before replantation. At day 30, maxillae were prepared for micro–computed tomographic imaging and histomorphometric analysis. The effect of iloprost on mineralization by hPDLCs was analyzed by mineralized nodule formation and quantitative polymerase chain reaction at 7 and 14 days. ResultsMicro–computed tomographic imaging demonstrated a significant higher bone volume in the iloprost groups, whereas the HBSS groups had extensive bone and root resorption. Histologic analysis revealed deposition of a thick AC layer along the root in the iloprost group with well-organized periodontal ligament fibers inserted into the cementum. The HBSS group demonstrated more osteoclasts than the iloprost group. In vitro, iloprost-treated hPDLCs had a significantly increased RUNX2, OSX, BSP, and ALP gene expression that coincided with an increased deposition of mineralized nodules. These effects were abrogated by a PGI2 receptor inhibitor. ConclusionsOur results revealed that iloprost promoted PDL regeneration in replanted molars. Furthermore, resorption of the roots was decreased, whereas AC deposition was stimulated. Iloprost-treatment increased hPDLC mineralization and was mediated by PGI2 receptor activation. These observations indicate that iloprost may be a promising root surface treatment agent.

Effect of Photobiomodulation on Periodontal Ligament Cells Under Inflamed and Nutrient-Deficient Conditions Simulating Damaged Cells of Avulsed Teeth: An In Vitro Study.

Background: The prognosis of replanted teeth is depended on the vitality of periodontal ligament cells residual on the root surface. Photobiomodulation has photobiological effects that can promote cell vitality. The study aimed to explore the effect of photobiomodulation on the periodontal ligament cells under inflamed or starved conditions mimicking clinically damaged periodontal ligament cells of avulsed teeth and provide the adjuvant procedure for tooth replantation. Materials and methods: Normal, starved, or inflamed periodontal ligament cells were irradiated with an 808 nm laser at densities of 0, 1, 3, 5, or 10 J/cm2. The cell counting kit-8 (CCK-8) assay and scratch test were applied to determine the effects on the proliferation and migration of cells. Anti-inflammatory effects were assessed according to the mRNA expression of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) measured by reverse-transcription polymerase chain reaction. Osteogenic capacity was evaluated by alkaline phosphatase (ALP) staining, ALP activity assay, Alizarin Red S staining, and ALP and osteocalcin (OCN) mRNA expression. Results: The CCK-8 assay and scratch test demonstrated that the 808 nm laser significantly promoted proliferation and migration of normal condition periodontal ligament cells at a density of 3 J/cm2 versus 5 J/cm2 under the starved and inflamed conditions. Moreover, the 808 nm laser had anti-inflammatory effects and promoted osteogenesis of periodontal ligament cells at 3 J/cm2 under normal conditions, while photobiomodulation at 5 J/cm2 upregulated the osteogenesis of periodontal ligament cells under starved and inflamed conditions. Conclusions: The photobiomodulation of 808 nm laser reduced inflammation and improved the proliferation, migration, and osteogenesis of normal, starved, and inflamed periodontal ligament cells. These effects required a higher energy density under starved or inflamed conditions compared with normal conditions. The photobiomodulation of 808 nm has a potential application in root surface treatment for replanted teeth.

Deferoxamine Reduces Inflammation and Osteoclastogenesis in Avulsed Teeth.

Replacement and inflammatory resorption are serious complications associated with the delayed replantation of avulsed teeth. In this study, we aimed to assess whether deferoxamine (DFO) can suppress inflammation and osteoclastogenesis in vitro and attenuate inflammation and bone resorption in a replanted rat tooth model. Cell viability and inflammation were evaluated in RAW264.7 cells. Osteoclastogenesis was confirmed by tartrate-resistant acid phosphatase staining, reactive oxygen species (ROS) measurement, and quantitative reverse transcriptase–polymerase chain reaction in teeth exposed to different concentrations of DFO. In vivo, molars of 31 six-week-old male Sprague–Dawley rats were extracted and stored in saline (n = 10) or DFO solution (n = 21) before replantation. Micro-computed tomography (micro-CT) imaging and histological analysis were performed to evaluate inflammation and root and alveolar bone resorption. DFO downregulated the genes related to inflammation and osteoclastogenesis. DFO also reduced ROS production and regulated specific pathways. Furthermore, the results of the micro-CT and histological analyses provided evidence of the decrease in inflammation and hard tissue resorption in the DFO group. Overall, these results suggest that DFO reduces inflammation and osteoclastogenesis in a tooth replantation model, and thus, it has to be further investigated as a root surface treatment option for an avulsed tooth.

Doxycycline-Loaded Nitric Oxide-Releasing Nanomatrix Gel in Replanted Rat Molar on Pulp Regeneration.

The aim of the present study was to evaluate the effect of doxycycline-loaded NO-releasing nanomatrix gel on pulp regeneration in replantation of avulsed rat teeth. A total of 28 maxillary first molars extracted from rats were replanted. The rats were divided into two groups based on the use of root surface treatment: doxycycline-loaded NO-releasing nanomatrix group and no treatment. Eight weeks after replantation, the rats were sacrificed, and the teeth were evaluated using histomorphometric analysis. On histomorphometric analysis, the NO-releasing nanomatrix group demonstrated a significantly lower grade of pulp inflammation (1.00 ± 1.11, mean ± standard deviation) compared to the no treatment group (2.21 ± 1.25, p = 0.014). NO-releasing nanomatrix group showed a significantly higher grade of pulp regeneration (2.57 ± 0.85, p = 0.012) and significantly lower grade of pulp inflammation (1.00 ± 0.68, p = 0.025) compared to the no treatment group. In conclusion, NO-releasing nanomatrix gel improved pulp regeneration of replanted teeth, though the sample size of this study was rather small. Within the limits of this study, NO-releasing nanomatrix gel can provide more favorable pulpal regeneration despite replantation.

In Vitro Comparison of Root Surface Treatment Effect between Root Scaling with Ultrasonic Inserts and Gracey Curette and Polishing with Different Cleaning Pastes

The aim of this study was the morphological evaluation of root surfaces subjected to manual (curette) and ultrasonic (conventional and diamond tips) scaling. The surface was then polished with a rubber cup and three medium-sized pastes. Ninety teeth were randomly divided into three groups of 30 and subjected to three different root instrumentation: (1) manual instrumentation with a Gracey® curette; (2) ultrasonic instrumentation with a standard steel tip (Universal Perio S-SERIES: USU, Hu-Friedy, Chicago, IL, USA) at a power equal to 50%; and (3) with a diamond tip (Punta Piezo Serie E Scaling, Hu-Friedy, Chicago, IL, USA) at a power of 20%. Each group of the instrumented teeth was then divided in three subgroups of 10 and subjected to 30 s of rubber polishing with three different polishing pastes with medium grain sizes in single-dose cups: (1) Ultrapro Tx cool mint medium®; (2) Stomyprox media®; and (3) Nupro medium orange®. Polyether root surface replicas were then taken from all 90 samples and analyzed by SEM to evaluate surface morphology after scaling and polishing procedures. All scaling techniques caused an alteration of the root surface without statistically significant difference, whereas polishing resulted in maintenance or improvement of the surface texture.

THE APPROVAL OF COMPLEX TREATMENT EFFECTIVENESS OF GENERALIZED PERIODONTITIS FOR THE PATIENTS AFTER TRANSMITTED CORONAVIRUS DISEASE AND REMAIN ON REHABILITATION

THE APPROVAL OF COMPLEX TREATMENT EFFECTIVENESS OF GENERALIZED PERIODONTITIS FOR THE PATIENTS AFTER TRANSMITTED CORONAVIRUS DISEASE AND REMAIN ON REHABILITATION

Systematic Review on Relation Between Surface Treatment and Outcome of Delayed Replantation of Permanent Anterior Avulsed Teeth

Introduction: One of the most severe dental injury is Tooth Avulsion or exarticulation. Tooth avulsion is the complete displacement of tooth out of the socket. The common treatment employed for avulsed teeth is replantation, the prognosis of which depends on the handling of the tooth specimen and time lag between avulsion and replantation of the teeth. Surface treatment of root surface of avulsed teeth prior to delayed replantation is a common practice and a variety of agents and methods have been used for the same. The literature lacks evidence that establishes a definitive relation between surface treatment and prognosis of delayed replantation of avulsed teeth. Aim: To understand the effect of surface treatment and outcome after replantation of avulsed anterior permanent teeth with an extraoral dry time of more than 60 minutes. Materials and Methods: The protocol for systematic review was registered on PROSPERO, registration number was CRD42020222919. A search was performed on case reports and case series available on delayed replantation of avulsed anterior permanent teeth on databases like Medline/PubMed, Google Scholar, and Cochrane from the year 2000 to 2018.The MESH terms and keywords like tooth avulsion*, tooth fractures*, tooth injuries*, traumatology*, delayed replantation methods and delayed replantation standards with Boolean operators were used for data identification and screening. After applying inclusion and exclusion criteria, total five articles were included. Results: The duration of storage of the teeth were variable with cases reported from 24 hours to 72 hours of extraoral dry time. All five reports used different methods for surface treatments. No complications were reported after 12 months in three cases. No complication was reported after 24 months in one case. After 12 weeks, one article reported ankylosis and infraocclusion after replantation. Conclusion: As a result of data heterogenicity and a short follow-up period of the articles, a clear relation between surface treatment and delayed replantation of an avulsed teeth could not be established. However, it can be safely concluded that surface treatment of avulsed teeth prior to delayed replantation results in a better prognosis and predictable outcomes.

Comparative evaluation of changes in the periodontal microbiome in patients with chronic generalized periodontitis after Vector-therapy

Relevance. The development and implementation into wide clinical practice an effective methods for removing subgingival biofilms, which allow qualitatively removing periodontopathogens and preserving the structure of the root surface for the subsequent restoration of the supporting-retaining apparatus of the tooth, is an important aspect in the treatment of chronic generalized periodontitis. Purpose. To evaluate the effectiveness of removing microbial biofilm in patients with chronic generalized periodontitis using Vector-therapy in comparison with hand-held instruments. Materials and methods . The study involved 119 patients (68 women and 51 men) in the age of 26-70 years (mean age 47.0 ± 12.5 years) with chronic generalized periodontitis of moderate and severe degree. The patients were divided into 3 groups depending on the method of root surface treatment (Curettes, Vector Paro, combined Curette Vector Paro treatment). Patients of all groups was evaluated such parameters, as BOP, PD / HPA, CAL / RFP and radiological parameters. For microbiological examination, real-time PCR was used with the sampling of the contents of the periodontal pocket before treatment for 10 days and 6 weeks. The dynamics of clinical indicators, frequency of occurrence, absolute, and the participation of key periodontal pathogenic microorganisms (A. actinomycetemcomitans, P. Gingivalis, P. intermedia, T. forsythia, T. denticola) and Candida albicans from the total bacterial mass of the contents of the periodontal pocket were assessed. The results were processed statistically using the Statistica software. Results. When comparing the groups with each other, a statistically significant relationship was found for a decrease in PB in group 2 (Vector) and group 3 (Curettes Vector Paro) in group 1 (Curettes), an inverse correlation between the level of bleeding (BOR) at a follow-up of 10 days (rs -0.463, p < 0.001) and 6 weeks (rs -0.342, p-value 0.025) and by the method of removing subgingival dental plaque. Statistically significant changes in the frequency of occurrence, number and proportion of periodontal pathogenic microorganisms in the groups were found in the dynamics of observation, indicating changes in the structure of the subgingival microbiome. Conclusion. The inclusion of Vector therapy in conservative treatment significantly accelerates the timing of inflammation in the periodontal tissues and leads to some significant shifts in the structure of the subgingival microbiome.

Effect of root surface treatment with denusomab after delayed tooth replantation.

To evaluate denosumab, a human monoclonal antibody that mimics the effects of osteoprotegerin in bone metabolism, as a topical treatment of root surface to be used prior to delayed tooth replantation. Thirty-six rats' right incisors were used. Teeth were extracted and divided into: delayed replantation without root surface treatment (control); delayed replantation with root surface treatment with denosumab 60mg/mL and 30mg/mL, respectively, for 10min both experimentals groups. After that, the root canals were filled with calcium hydroxide and replanted. After 15 and 60days, the animals were euthanized, and the samples were collected and processed for microscopic analysis. Histological sections were performed, and stained with HE to describe the dental characteristics, measure ankylosis, replacement resorption, and dental resorption by conventional microscopy. Also, was performed Brown & Brenn staining and immunohistochemistry for RANKL, OPG, and periostin. Denosumab 60mg/mL reducted ankylosis (p < 0.0001), replacement resorption (p < 0.0001), and tooth resorption, 60days after replantation, compared to untreated replanted teeth (p < 0.005). Lower bacterial contamination in root surface in the denosumab treatment groups was found, regardless of the concentration used (p < 0.001). Also, denosumab treatment inhibited the expression of RANKL without modulating OPG. Periostin was observed in periodontal ligament of replanted tooth, although this labelling was absent in the ankylosis areas, in both experimental periods. Treatment of the root surface with denosumab at 60mg/mL of rat teeth before delayed replantation reduced dental root resorption compared with the untreated teeth after 60days. Survival of a replanted tooth has been a challenge in clinical practice. The use of a medication, such as denosumab, to limit dental root resorption represents an important therapeutical approach.

Condicionamento ácido de superfícies radiculares periodontalmente comprometidas como adjuvante a terapia periodontal: uma revisão da literatura

Como adjunto ao tratamento periodontal convencional, o condicionamento ácido dessas superfícies foi introduzido com o intuito de auxiliar a tornar a região mais propícia ao reestabelecimento dos tecidos previamente lesionados. O objetivo da presente revisão é avaliar a partir da literatura existente, os principais benefícios das soluções do ácido cítrico e etilenodiaminotetracético (EDTA) em diferentes concentrações como adjuvante ao tratamento das superfícies radiculares em Periodontia. Para a realização desse estudo foram consultadas as bases de dados: Biblioteca Virtual em Saúde (BVS), Publicações Médicas (PubMed), Google Acadêmico, Medline e biblioteca virtual Scientific Eletronic Library online (SCIELO). Para se realizar tal busca foram utilizados os Descritores em Ciência da Saúde (DECS): Doenças periodontais, Ácido cítrico, Ácido edético e Periodontia. Sabe-se então que o condicionamento químico pode ser um importante coadjuvante no tratamento periodontal de superfícies radiculares periodontalmente comprometidas, principalmente nas concentrações de 1% e 25% do ácido cítrico e de 24% do EDTA, que segundo os estudos, mostraram serem as mais eficazes em suas diferentes apresentações comerciais. Então se conclui com isso que o tratamento coadjuvante com ataque ácido contribui para a: remoção da camada final de esfregaços (smear layer), exposição da rede de fibras colágenas, efetiva adesão de elementos sanguíneos a superfície radicular e principalmente respeito aos tecidos periodontais anteriormente lesionados, permitindo assim o reestabelecimento da posição anatômica dos tecidos.

Delayed Tooth Replantation after Root Surface Treatment with Papain and Sodium Fluoride in Rats: A Histological and Histomorphometrical Evaluation.

The aim of this study was to examine the histological effect of papain and sodium fluoride in delayed replantation of rat incisor teeth on the repair process. Forty upper incisors of Wistar rats were randomly assigned to four groups (n=10). In group I, the dental papilla and the pulp tissue of extracted teeth were removed before immediate replantation in their sockets. In the other groups, the extracted teeth were maintained in dry storage for 60 min and subjected to different root surface treatments. In group II, the teeth were immersed in 10% papain for 20 min, scrubbed with gauze soaked in saline for 1 min, and immersed in a 2% acidulated-phosphate sodium fluoride solution for 20 min. In group III, the teeth were immersed in saline for 20 min, scrubbed with gauze soaked in saline for 1 min, and immersed in a 2% acidulated-phosphate sodium fluoride solution for 20 min. In group IV, root surface treatment was not applied. The root canals were treated and filled with a calcium hydroxide paste and the teeth were replanted. The animals were euthanized after 60 days and anatomic specimens containing the teeth were subjected to routine histochemical processing and staining with hematoxylin and eosin. The Kruskal-Wallis test was used, followed by the Dunn's test for multiple comparisons. Groups I and II had less inflammatory root resorption and total area of root resorption (P<0.05) than groups III and IV respectively. Based on this animal study, root surface treatment with papain and sodium fluoride in delayed tooth replantation showed greater efficacy in controlling inflammatory root resorption and may be a viable option for clinical application.

Root Surface Treatment of Avulsed Teeth-A Review

Root Surface Treatment of Avulsed Teeth-A Review

ROOT SURFACE TREATMENT USING DIODE LASER IN TOOTH REPLANTATION (EXPERIMENTAL STUDY IN RATS)

INTRODUCTION: Avulsion of teeth radically affects the integrity of the tooth and the supporting tissue, and impairs the natural dentition as a whole; thus, all efforts must be directed to the replantation of traumatically avulsed teeth. However, its success is limited due to the occurrence of external root resorption. The challenge is to follow an effective protocol that reduces the occurrence of root resorption and allow for reestablishment of the natural architecture of the periodontal tissue. Biomodulation provided by low level laser therapy provides a promising tool in managing the inflammatory process and augmentation of the reparative process. OBJECTIVES: Was to evaluate the effect of low-level laser therapy (LLLT) on the healing process of rat teeth replanted after delayed replantation. MATERIALS AND METHODS: Thirty healthy Albino male rats had their maxillary left incisors extracted; According to the root surface treatment before the replantation, the teeth were assigned randomly to two groups (n = 15): G1 (control) – no root surface treatment; G2 (study group)-laser diode treatment on the root surface. The teeth were replanted into their respective sockets after 30 minutes, mimicking the natural timing it would take to replant an avulsed tooth. G2 were treated with LLLT performed on the buccal and palatal mucosa every 48 hours for 15 days. The rats were sacrificed after 15, 30 and 45 days of replantation. The specimens were processed for histological and histomorphometric analysis to determine the average root resorption areas and to evaluate the histological events. RESULTS: Histomorphometric analysis showed that the study group (Laser irradiated group) showed lower areas of root resorption and ankylosis, than in control group (non-irradiated group); with a significant statistical difference (p > 0.05). Histological assessment showed restoration of periodontal ligament attachment and increased vascularity in the study group. CONCLUSIONS: Laser irradiation reduces external root resorption and ankylosis in delayed tooth replantation.

Guided tissue regeneration of intrabony defects with perforated barrier membranes, simvastatin, and EDTA root surface modification: A clinical and biochemical study.

Perforated barrier membranes (PBM) were suggested to enhance periodontal regeneration by allowing positive charity of wanted elements from the gingival tissue side. The present study was designed to evaluate clinically and biochemically the use of PBM combined with simvastatin (SMV) gel with and without an associated EDTA gel root surface etching as a suggested option that could improve SMV availability and clinical outcomes of PBM. Forty patients having moderate-to-severe chronic periodontitis with 40 intrabony defects were randomly divided into four treatment groups (10 sites each). Patients in group 1 received 1.2% SMV gel and covering the defect with occlusive membrane (OM). Patients in group 2 received 1.2% SMV gel and covering the defect with PBM. Group 3 received 24% EDTA root surface etching, 1.2% SMV gel, and defect coverage with OM (eOM). Patients in group 4 were treated as in group 3 but the defect was covered with PBM (ePBM). Clinical parameters were recorded at baseline before surgical procedures and were reassessed at 6 and 9months after therapy. The mean concentration of SMV in gingival crevicular fluid (GCF) was estimated by reverse-phase high-performance liquid chromatography at days 1, 7, 14, 21, and 30. At 6- and 9-month observation periods, groups 3 and 4 showed a statistically significant improvement in PD reduction and CAL gain compared with groups 1 and 2. Group 4 showed a statistically significant more defect fill compared with groups 1, 2, and 3 (P≤.05). Group 2 showed statistically significant higher defect fill compared with group 1 and group 3 (P<.05). Bone density was significantly increased with no significant difference between the four groups at 6- and 9-month observation periods. SMV-GCF concentration in group 4 showed the highest mean concentration with no significant difference than that of group 3. The use of perforated barrier membranes in association with SMV enhances the clinical hard tissue parameters compared with occlusive ones in treating intrabony periodontal defects. Moreover, EDTA root surface treatment could enhance SMV availability in the defect area.

Effects of silver diamine fluoride/potassium iodide on artificial root caries lesions with adjunctive application of proanthocyanidin

Treatment of carious root surfaces remains challenging due to the complex pathological processes and difficulty in restoring the original structure of root dentine. Current treatments targeting the de-/re-mineralisation processes are not entirely satisfactory in terms of the protection of the dentinal organic matrix and the highly organised structure of dentine. In this in vitro study, a cross-linking agent – proanthocyanidin (PA) was used in conjunction with a fluoride-based treatment – silver diamine fluoride/potassium iodide (SDF/KI) to putatively stabilise the organic dentinal framework as well as strengthen the collagen-mineral phase interaction. The effectiveness of this strategy was evaluated 24 h after application in terms of the distribution of ion uptake and microstructure of dentine after treatment as well as analysis of the nano-mechanical properties using a dynamic behaviour model. Results showed that individual use of SDF/KI significantly improved the surface microhardness and integrated mineral density (Z) up to 60 µm depth and the recovery of creep behaviour of demineralised dentine in the surface area compared to that treated with deionised distilled water (DDW). The combined treatment of PA and SDF/KI achieved a more homogenous mineral distribution throughout the lesions than SDF/KI alone; a more significant incremental increase in surface microhardness and Z was observed. Specifically, a superior effect on the subsurface area occurred with PA + SDF/KI, with significant improvements in microhardness, elastic modulus and recovery of creep behaviour of the demineralised dentine. Application of SDF/KI induced small discrete crystal formation distributed over the dentine surface and PA contributed to the formation of slit-shaped orifices of the dentinal tubules that were partially occluded. Statement of SignificanceDemographic transitions and improved oral health behaviour have resulted in increased tooth retention in elderly people. As a consequence, the risk of root dentine caries is increasing due to the age-associated gingival recession and the related frequent exposure of cervical root dentine. Root caries is difficult to repair because of the complex aetiology and dentine structure. The recovery of dentine quality depends not only on reincorporation of minerals but also an intact dentinal organic matrix and the organic-inorganic interfacial structure, which contribute to the biomechanics of dentine. With the capability of dentine modification, cross-linking agents were applied with a fluoride regimen, which improved its treatment efficacy of root caries regarding the distribution of ion uptake and recovery of dentine biomechanics.