Calcium hydroxide inhibits substrate adherence capacity of macrophages

Profile of host cell responses to exposure to stressed bacteria in planktonic; dislodged, and intact biofilm mode

The host defense response to microbial challenge emerging from the root canal system leads to apical periodontitis. The aim of this study was to evaluate the expression of inflammatory cytokines and Nitric Oxide (NO) by macrophages after interaction with Enterococcus faecalis in the: plankton and dislodged biofilm mode; intact biofilm mode stimulated by calcium hydroxide (CH), CH and chlorhexidine (CHX) or Triple Antibiotic Paste (TAP). For this purpose, culture of macrophages from monocytes in human peripheral blood (N=8) were exposed to the different modes of bacteria for 24 hours. Subsequently, the cytokines, such as, Tumor Necrotic Factor- alfa (TNF-α), interleukin (IL)-1β, IL-6, IL-10; and NO were quantified by Luminex xMAP and Greiss reaction, respectively. In addition to the potential therapeutic effects of the intracanal medication, their antimicrobial activity against Enterococcus faecalis biofilm were also tested in vitro by confocal microscopy. The experiments` data were analyzed by the Kruskal-Wallis test with the Dunn post hoc test (α < 0.05). Bacteria in dislodged biofilm mode were shown to be more aggressive to the immune system than bacteria in plankton mode and negative control, inducing greater expression of NO and TNF-α. Relative to bacteria in intact biofilm mode, the weakest antimicrobial activity occurred in Group CH. In Groups CH/CHX and TAP the percentage of dead bacteria was significantly increased to the same extent. Interestingly, the biofilm itself did not induce the release of pro-inflammatory cytokines - except for NO - while the biofilm treated with TAP and CH based pastes enhanced the levels of IL-6 and TNF-α; and IL-1 β, respectively. In contrast, the levels of a potent anti-inflammatory (IL-10) were increased in Group TAP.

The potential of a surface pre-reacted glass root canal dressing for treating apical periodontitis in rats

AIM

To evaluate the efficacy of a prototype root canal dressing containing surface pre-reacted glass-ionomer (S-PRG) fillers on repairing induced periapical lesions in a rat model. Calcium hydroxide [Ca(OH)₂ ] was applied as a comparison in the healing process.

METHODOLOGY

The pulp chambers of the maxillary first molars in 64 male Wistar rats aged 16 weeks were opened to induce periapical lesions. After 28 days, the mesial canal of each tooth was prepared, irrigated with 2.5% sodium hypochlorite only (control group: irrigation) or followed by the respective dressing [Ca(OH)₂ group, irrigation + Ca(OH)₂ ; S-PRG group, irrigation + S-PRG] and restored with composite resin for 3 or 7 days (10/group). Four rats with healthy molars were used as blank controls. Descriptive analysis of the periapical radiographs, haematoxylin and eosin staining and immunohistochemical observation was performed 3 and 7 days after treatment. The periapical grey value, CD68 macrophages and osteoclasts (cathepsin-K) were quantified and statistically analysed with Tukey's honest significant difference test. A significant difference was achieved when P values were <0.05.

RESULTS

S-PRG and Ca(OH)₂ dressings were associated with increased periapical grey values and inhibited osteoclast activity at 3 and 7 days; a significant difference in radiographic results and the number of osteoclasts was obtained at 3 and 7 days compared with the control group (P < 0.05). Reparative tissue was observed histologically in the space of the periapical resorbed necrotic area after S-PRG and Ca(OH)₂ treatment for 3 and 7 days. The number of macrophages was significantly decreased at 3 and 7 days in the S-PRG and Ca(OH)₂ specimens when compared with the controls (P < 0.05).

CONCLUSIONS

In a rat experimental model, the S-PRG root canal dressing was comparable to Ca(OH)₂ in promoting the healing of experimentally induced periapical lesions. S-PRG paste has the potential to be used as an alternative intracanal dressing in teeth with apical periodontitis.

Post-mitotic odontoblasts in health, disease, and regeneration

OBJECTIVE

Description of the odontoblast lifecycle, an overview of the known complex molecular interactions that occur when the health of the dental pulp is challenged and the current and future management strategies on vital and non-vital teeth.

METHODS

A literature search of the electronic databases included MEDLINE (1966-April 2019), CINAHL (1982-April 2019), EMBASE and EMBASE Classic (1947-April 2019), and hand searches of references retrieved were undertaken using the following MESH terms 'odontoblast*', 'inflammation', 'dental pulp*', 'wound healing' and 'regenerative medicine'.

RESULTS

Odontoblasts have a sensory and mechano-transduction role so as to detect external stimuli that challenge the dental pulp. On detection, odontoblasts stimulate the innate immunity by activating defence mechanisms key in the healing and repair mechanisms of the tooth. A better understanding of the role of odontoblasts within the dental pulp complex will allow an opportunity for biological management to remove the cause of the insult to the dental pulp, modulate the inflammatory process, and promote the healing and repair capabilities of the tooth. Current strategies include use of conventional dental pulp medicaments while newer methods include bioactive molecules, epigenetic modifications and tissue engineering.

CONCLUSION

Regenerative medicine methods are in their infancy and experimental stages at best. This review highlights the future direction of dental caries management and consequently research.

Chronic maxillary sinusitis caused by root canal overfilling of Calcipex II

This is a case report of chronic maxillary sinusitis caused by root canal overfilling of Calcipex II (Techno-Dent). A 60 year-old male complained of dull pain in the right maxillary molar area after complicated endodontic treatment using Calcipex II paste and was finally diagnosed with a chronic maxillary sinusitis through a clinical and radiological observation. In the biopsy examination, the periapical granuloma contained a lot of dark and translucent Calcipex II granules which were not stained with hematoxylin and eosin. They were usually engulfed by macrophages but rarely resorbed, resulting in scattering and migrating into antral mucosa. Most of the Calcipex II granules were also accumulated in the cytoplasms of secretory columnar epithelial cells, and small amount of Calcipex II granules were gradually secreted into sinus lumen by exocytosis. However, chronic granulomatous inflammation occurred without the additional recruitment of polymorphonuclear leukocytes (PMNs) and lymphocytes, and many macrophages which engulfed the Calcipex II granules were finally destroyed in the processes of cellular apoptosis. It is presumed that Calcipex II granules are likely to have a causative role to induce the granulomatous foreign body inflammation in the periapical region, and subsequently to exacerbate the chronic maxillary sinusitis in this study.

Hydroxyl and calcium ions diffusion from endodontic materials through roots of primary teeth - in vitro study

The purpose of this research was to evaluate the diffusion of calcium (Ca+2) and hydroxyl (OH-) ions from materials with a calcium hydroxide base - Ca(OH)2 through the intact roots of deciduous teeth. This diffusion of ions is important for periapical healing. Forty-six deciduous teeth were selected and instrumented to their working length with #40 files. The teeth were washed during cleaning and shaping with a 1% sodium hypochlorite (NaOCl) solution. The canals were dried with paper points. The teeth were divided into 4 groups based on the sealer type, with 10 specimens in each group. A fifth group of 6 teeth without sealer constituted the control group. The materials used as sealers were: Ca(OH)2 paste associated to propylene glycol (CaPE) thickened at the proportion of 2:1 w/v; UFSC (Federal University of Santa Catarina) paste - a mixture of 0.3g of zinc oxide with 0.3g of Ca(OH)2 with 0.2ml of olive oil 1:1 w/w; Vitapex® and Sealapex®. The coronal access was sealed with a glass ionomer after the root had been filled with each sealer. A one-third apical surface and foramen was hard-pressed with Araldite®. The teeth were stored individually in flasks containing saline solution at 37ºC and 100% humidity. The OH- and Ca+2 ions diffusion levels were determined using a pH meter and an atomic absorption spectrometer. Data were collected at 48 hours and at intervals of 7, 30, 45 and 60 days. Statistical analysis was performed using ANOVA to compare groups. In the pH evaluation, the CaPE group presented the largest OH- ions diffusion, which peaked at sixty days (p=0.0309), when compared to the other groups (p<0.0001). In relation to amount of Ca+2 ions released, the CaPE paste showed the best results, followed by the UFSC's paste. These results suggest that the CaPE paste was the material that allowed the highest diffusion of OH- and Ca+2 ions.

Tertiary dentinogenesis with calcium hydroxide: a review of proposed mechanisms

Calcium hydroxide has been used extensively in dentistry for a century. Despite its widespread use as a pulp-capping agent, its mechanisms of action still remain ambiguous. Understanding its modes of action will lead to a broader understanding of the mechanisms associated with induced dentinogenesis and help in optimizing the currently available agents to target specific regenerative processes to obtain the best possible clinical outcomes. A literature search relating to mechanisms of dentinogenesis of calcium hydroxide up to December 2011 was carried out using pubmed and MEDLINE database searches as well as manual searching of cross-references from identified studies. Resulting suggestions regarding dentinogenic mechanisms of calcium hydroxide range from direct irritating action of the material to induction of release of biologically active molecules. The purpose of this article is to discuss various mechanisms through which calcium hydroxide may induce tertiary dentinogenesis in the light of observations made in included studies.

Proliferation of rat molar pulp cells after direct pulp capping with dentine adhesive and calcium hydroxide

The aim was to evaluate the proliferation of pulp cells 1, 3 and 7 days after direct pulp capping with the dentine adhesive Gluma Comfort Bond (GCB) and to compare it with calcium hydroxide (Ca(OH)(2)). An occlusal cavity was prepared in 72 molar teeth of 36 Wistar rats. Then GCB or Ca(OH)(2) was placed on the exposed pulp. All cavities were restored with composite. After 1, 3 and 7 days, the animals were sacrificed. One hour prior sacrification, 5-bromo-2'-desoxyuridine (BrdU) was injected into the intraperitoneal cavity for immunohistological analysis of 18 animals. BrdU was incorporated into the DNA to tag proliferating cells using an antibody staining. Three animals served as controls and were not further treated. The number of the tagged cells was statistically analysed by comparing the results of the three groups. In 18 rats, routine histological analysis was performed in order to evaluate the pulp tissue for bacterial infection, inflammatory cells and necrosis. The marked cells were identified as fibroblasts, endothelial cells (after 1, 3 and 7 days) and Höhl cells (after 7 days). One day after capping, significantly more cells were stained in the GCB than in the Ca(OH)(2) group (p < 0.05). After 3 days, significantly more cells were stained in the GCB than in the Ca(OH)(2) and the control group (p < 0.016). Direct contact of GCB with pulp tissue leads to an increased formation of granulation tissue (fibroblasts, endothelial cells) because of an inflammatory reaction. This may be explained by missing antibacterial effect and foreign body reactions. Also, GCB may have a negative effect on Höhl cells.

A new resin-bonded retrograde filling material

OBJECTIVE

This study determined the physical properties and cytotoxicity of a novel root-end filling material (NRC).

STUDY DESIGN

NRC is a powder and liquid system. The liquid is composed of hydroxyethylmethacrylate, benzoyl peroxide, toluidine, and toluenesulfinate. And the powder is made of calcium oxide, calcium silicate, and triphenylbismuth carbonate. The setting time, compressive strength, and pH change of NRC and gray and white mineral trioxide aggregate (MTA) were determined according to ISO standardization. MC3T3-E1 cells were cultured on NRC and white MTA for determining MTT scores. The absorbance of formazan was measured at 570 nm with a spectrophotometer. The MTT assay was performed in triplicate and repeated in 2 cultures. One-way analysis of variance was used to determine statistical differences in physical properties and MTT assay (P < .05).

RESULTS

Mean setting time of materials tested were: NRC 12.5 +/- 0.3 minutes, gray MTA 345.5 +/- 96.2 minutes, and white MTA 318.0 +/- 56.0 minutes. After 24 hours, the mean compressive strengths were: NRC, 21.6 +/- 5.5 MPa, gray MTA: 7.7 +/- 3.3 MPa, and white MTA, 18.9 +/- 3.2 MPa. The pH of the test materials were: NRC 12.0, gray MTA 12.2, and white MTA 11.9. There were no statistically significant differences in compressive strength and pH between white MTA and NRC. The compressive strength of gray MTA was significantly lower than white MTA and NRC (P < .05). The setting time of NRC was significantly lower than white and gray MTA. In MTT assay, both NRC and white MTA were not cytotoxic to MC3T3-E1 cells.

CONCLUSIONS

It was concluded that the setting time, compressive strength, pH, and initial biocompatibility results of NRC are favorable for a root-end filling material.

Effect of root canal sealers on mouse peritoneal macrophage functions

Three root canal filling materials, viz. calcium hydroxide-based cement (Apexit, resin-based cement (AH-plus) and glass-ionomer based material (Ketac Endo) were tested for their influence on several functions of peritoneal macrophages from Balb/c mice. Macrophage functions were evaluated by the adherence, phagocytic, candidacidal and Nitro blue tetrazolium-dye assays. Ketac-Endo enhanced all macrophage functions in the first 2 d (p < or = 0.05), when compared to the positive control, but this effect had changed after 7 and 14 d, causing inhibition of these functions. Other materials suppressed substrate adherence capacity and phagocytosis, while significantly stimulating macrophage microbicidal activity (p < or = 0.05) in a time-dependent manner.

Reaction of rat pulp tissue to Carisolv ‘new gel’—-A histocytological evaluation

BACKGROUND

This study was an histological examination of pulp tissue exposed to Carisolv 'new gel' after 1 to 28 days.

METHODS

An occlusal cavity was prepared in 64 caries-free molar teeth of 16 Wistar rats. The roofs of the pulp chambers were perforated and Carisolv 'new gel' solution was placed onto the exposed pulps of 32 molar teeth for 20 minutes. Thirty-two contralateral molar teeth served as controls and were coated with an inert liquid containing isotonic saline solution and carmellose for 20 minutes as well. The pulps of all teeth were capped with Ca(OH)2 and the cavities were filled with a flowable composite in combination with a self-etching dentine adhesive. The animals were sacrificed after 1, 3, 7 and 28 days. Eight teeth per group and the time period were histologically examined, scored, and statistically evaluated (Wilcoxon-test).

RESULTS

The results showed no statistically significant differences between the Carisolv group and the control group (p > 0.05). The observed pulp reaction was essentially the same as those reported in the past being typical for the effect of calcium hydroxide as a direct pulp capping agent.

CONCLUSION

Compared to Ca(OH)2, Carisolv 'new gel' did not cause any different or additional pulp reaction in healthy teeth.

Federal University of Santa Catarina endodontic treatment of traumatized primary teeth - part 2

This research sought to evaluate periapical repair in 28 traumatized deciduous teeth that had suffered endodontic intervention due to the presence of internal or external inflammatory resorption or replacement root resorption. After obtaining endodontic access, work length and biomechanical preparation, the root canals were filled with calcium hydroxide and propylene glycol under the form of a dense slurry, during 12 months. Replacement of the intracanal dressing was performed when monthly radiographic examinations showed its absence. After 12 months the teeth were obturated with zinc oxide and eugenol cement. Halting of the inflammatory and replacement root resorption (64.3%; n = 28) occurred 9 months after the use of calcium hydroxide dressings, in a total of 18 successful cases. Fisher's test was applied to relate success with the type of trauma, work length time, child's age and pulpal condition. The test did not present statistical significance (P < 0.05). However, in the qualitative analysis, failure was observed in those cases (35.7%) where replacement resorption was already present at the moment of treatment (up to two-thirds) associated with severe trauma cases. The authors concluded that endodontic treatment must be initiated at an early stage, and must be coincident with the radiographic signs of resorption. Success of the treatment is directly related to the seriousness of the sequelae at the moment of the first examination or the endodontic treatment.

Secretion of Tumor Necrosis Factor-alpha by Mouse Peritoneal Macrophages in the Presence of Dental Sealers, Sealapex and Endomethasone

After filling root canals, the healing process depends on the chemical composition or physical-chemical properties of the material used, among other factors. All root canal sealers, whether solid or plastic, are foreign matter for the body if they remain in permanent contact with apical and periapical tissues. As a result, the first organic reaction that occurs is an attempt to phagocytize the material. During phagocytosis, macrophages release a large number of cell mediators into the area, among which are cytokines that are essential in intercellular communication and in many physiological and pathophysiological processes. One of these cytokines is tumor necrosis factor-alpha (TNF-alpha), which acts through links to specific receptors on the cell membrane initiating a cascade of events leading to induction, activation, or inhibition of numerous cytokine-regulated genes in the cell nucleus. The release of TNF-alpha in a cell culture of mouse peritoneal macrophages incubated with three concentrations (25, 50, and 100 mg/ml) of two endodontic sealers was measured. The solutions containing the calcium hydroxide-based root canal sealer (Sealapex) released fewer units of TNF-alpha than solutions containing the zinc oxide and eugenol-based sealer (Endomethasone).

In vitro evaluation of the cytotoxicity of two root canal sealers on macrophage activity

Although some studies have been concerned with the cytotoxicity of endodontic sealers and their components, few have approached the effects of endodontic sealers on macrophage viability and activity. In this study the effect of two zinc oxide-eugenol-based sealers, freshly prepared or after setting for 24 h, was determined on macrophage activity in vitro. Sealers were placed inside a glass capillary tube and added to mouse-elicited macrophage cultures. Sealers did not affect macrophage viability; however, adherence to glass and phagocytosis were impaired. Moreover, nitric oxide production in response to activation with interferon-gamma was diminished, but interleukin-12 production in response to Listeria monocytogenes was not altered. Interestingly, freshly mixed and solid test samples had similar inhibitory activities. In conclusion, the tested sealers did not affect a pro-inflammatory response (interleukin-12 production) but had an inhibitory effect on the effector responses measured (phagocytosis and nitric oxide production).

Histocytological evaluation of the reaction of rat pulp tissue to Carisolv

OBJECTIVES

Carisolv is a viscous substance for the chemo-mechanical removal of caries. The aim of this study was to examine the tissue reactions of pulp and dentin tissue to Carisolv in vivo.

METHODS

In 48 caries-free molars (24 Wistar rats, age: 3 months) an occlusal cavity was prepared. The roofs of the pulp chambers were perforated with a sharp probe and Carisolv solution was placed onto the exposed pulp of 24 molars for 1, 10 and 20 min. Twenty-four contralateral molars served as controls and were coated with an inert liquid containing isotonic saline solution, carmellose and erythrosin.

RESULTS

After a contact period of 10 and 20 min in the experimental group, pulpal destruction of intercellular substance and cells including odontoblasts was observed up to a depth of 150 microm, in addition to the mechanical damage by perforation (e.g. dentin particles). The pulpal and predentin fibrils as well as the dentin fibrils appeared to be intact and did not differ from the controls. After a contact time of 1 min a weaker damage of pulp cells and odontoblasts, as well as intact fibrils in pulp, predentin and dentin could be observed.

CONCLUSIONS

Radicals of Carisolv (OH- and OCI-) cause alkaline hydrolysis of cellular components but do not decompose collagenous tissue components.

In vitro effect of the resin component bisphenol A on substrate adherence capacity of macrophages

This study was design to investigate the "in vitro" effect of bisphenol A (BPA), a component of resin used in dentistry, on viability, and substrate adherence capacity of macrophages. Peritoneal macrophages were obtained from Wistar rats and resuspended in RPMI-1640 medium. Viability was determined by trypan blue exclusion. As a test of macrophage adhesion, the adherence capacity of macrophages to a plastic surface was determined and the adherence index was calculated. Assays were conducted in Eppendorf tubes for 60 min of incubation at 37 degrees C in a humidified atmosphere of 5% CO2 in air. BPA did not alter significantly macrophage viability at concentrations as high as 10(-5) M, but BPA decreased in a dose-dependent manner the adherence index of rat peritoneal macrophages. Control peritoneal macrophages showed an adherence index = 81.5 +/- 7.9%. In the presence of 10(-8) M BPA, the Al of macrophages decreased to 41.4 +/- 12.2% (p < 0.05). Higher BPA concentrations (10(-7) to 10(-5) M) also caused a significant inhibition of the adherence index. Half-maximal inhibition (IC50) was obtained at 4.92 +/- 0.39 x 10(-6) M BPA. The in vitro study shows that the resin component BPA can alter macrophage adhesion. Taking into account that adhesion is the first step in the phagocytic process of macrophages and in antigen presentation, BPA could inhibit macrophage function and modulate immune and inflammatory responses in dental pulp and periapical tissues.

Comparative effects of two endodontic irrigants, chlorhexidine digluconate and sodium hypochlorite, on macrophage adhesion to plastic surfaces

This study was designed to compare the "in vitro" effect of chlorhexidine digluconate, proposed as a new irrigant solution, with sodium hypochlorite, the currently irrigant solution used to disinfect the root canal system before obturation of the canal, on substrate adherence capacity of macrophages. Inflammatory macrophages were obtained from Wistar rats and resuspended in RPMI-1640 medium. The adherence capacity of macrophages to a plastic surface was determined. Assays were conducted in Eppendorf tubes for 15 min of incubation at 37 degrees C in an humidified atmosphere of 5% CO2 in air. The adherence index was calculated. Chlorhexidine digluconate inhibited substrate adherence capacity of macrophages in all conditions tested. Half-maximal inhibition (IC50) was observed at 1:5.6 dilution. Chlorhexidine digluconate was less potent than 5.25% sodium hypochlorite (IC50 = 1:24.1 dilution) in inhibiting substrate adherence capacity of macrophages. Taking into account that substrate adherence is the first step in the phagocytic process of macrophages and in antigen presentation, chlorhexidine digluconate could inhibit macrophage function and modulate inflammatory reactions at the level of inflamed periapical tissues.

Effect of eugenol on macrophage adhesion in vitro to plastic surfaces

This study was performed to investigate the in vitro effect of eugenol on substrate adherence capacity of macrophages. Macrophages were obtained from Wistar rats. The adherence capacity of macrophages to the plastic surface of Eppendorf tubes was determined. Assays were carried out in these tubes for 15 min of incubation at 37 degrees C in a humidified atmosphere of 5% CO2 in air. Control peritoneal macrophages showed an adherence index = 52.5%. Eugenol decreased the adherence index of macrophages in a dose-dependent manner. A 1:1000 dilution of eugenol decreased the adherence index of macrophages by 16.6% (P < 0.05). Lower dilutions (1:100 and 1:10) greatly decreased the adherence index by 51% and 96.2% respectively (P < 0.01). Taking into account that substrate adherence is the first step in the phagocytic process of macrophages and in antigen presentation, eugenol could inhibit macrophage function and modulate immune and inflammatory reactions in dental pulp and periapical tissues.