Rat subcutaneous tissue response to calcium silicate containing different arsenic concentrations

Are resin-containing pulp capping materials as reliable as traditional ones in terms of local and systemic biological effects?

The aim of this study was to compare the local and systemic effects of current pulp capping materials containing resin with those of traditional materials in an animal study. A total of 48 rats were used: a control group (n=12) (sub-control and negative control), a resin-containing group (n=18) (Calcimol LC, Theracal LC, Activa-BioActive Base/Liner), and a traditional group (n=18) (Biodentine, ProRoot MTA, Dycal). The materials which had been placed in polyethylene tubes were implanted in subcutaneous pockets. The rats were sacrificed at 1, 2, or 4 weeks. Evaluations were made of subcutaneous connective tissue, the left kidney, liver, and blood samples. Of all the study groups, MTA demonstrated biocompatibility at a level close to that of the control groups. Inflammation was observed to be more severe in resin-containing materials, but Activa Base/Liner showed a more successful local and systemic tissue response.

In Vitro Mitigation of Arsenic-Induced Toxicity by Reduced Glutathione in Rat Pulp Cells

Objective:

Despite the controversial results regarding the amount of arsenic (As) in mineral trioxide aggregate (MTA) and MTA-like cements, it is prudent to assess the effect of this heavy metal on pulpal cells and search for methods to attenuate its toxicity. This study investigated the toxic effect of As on pulpal-like cells and evaluated the influence of reduced glutathione (GSH) on As-induced toxicity.

Methods:

The cytotoxicity of 50 µm As, 50 µm As+50 µM GSH, 50µm As+500 µM GSH or 50 µm As+5000 µM GSH on rat pulpal cells (RPC-C2A) was evaluated at 24 hours and 72 hours. Cell culture in fresh medium without experimental solution served as the control. Cell viability was measured by means of 3-(4.5-dimethylthiazol-2-yl)-2.5-diphenyltetrazolium bromide (MTT) assay and the optical density was measured with microplate reader. The morphology of the cultured cells was observed under phase contrast microscope. Cytotoxicity data were analyzed by two-way ANOVA and Tukey post hoc tests (P<0.05).

Results:

There were statistically significant differences in cell viability amongst the tested groups (P<0.05). As elicited remarkable toxic effect on pulpal cells, while 5000 µM GSH protected the cells from As-induced damage at 24-hour exposure time. The cultured control cells were polygonal-shaped; however, As-treated cells exhibited contracted and spherical morphology with increased intercellular spaces indicative of cellular death and decreased proliferation.

Conclusion:

As negatively affected the viability of pulpal cells; however, controlled concentration of GSH had a short-term protective effect against As-induced toxicity. Future research is warranted on the clinical use of GSH with MTA and MTA-like cements to minimize initial inflammation resulting from As release during the setting of the aforementioned cements thus enhancing the success of procedures where these cements are placed in direct contact with vital pulp tissues.

The Hormetic Effect of Arsenic Trioxide on Rat Pulpal Cells: An In Vitro Preliminary Study

Objectives  Despite the agreement that there is no longer any indication for arsenic use in modern endodontics, some concerns are surfacing about the minute amount of arsenic trioxide (As ₂ O ₃ ) released from Portland cement-based materials. The present study investigated the effect of different concentrations of As ₂ O ₃ on rat pulpal cells and the efficacy of N -acetylcysteine (NAC) in preventing As ₂ O ₃ -mediated toxicity.

Materials and Methods  Cytotoxicities of 50, 10, or 5 µm As ₂ O ₃ and the effect of cells co-treatment with 50 µm As ₂ O ₃ and 5,000 µm NAC or 500 µm NAC were tested at 24 hours or 3 days. Cell viability was assessed by means of MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay and cellular morphological changes were observed under phase contrast microscope.

Statistical Analysis  Two-way analysis of variance with Tukey’s post-hoc test was used to evaluate differences between the groups (α = 0.05).

Results  At both exposure times, 50 µm As ₂ O ₃ resulted in lower optical density (OD) values when compared with 10 or 5 µm As ₂ O ₃ . At 24 hours, 10 µm As ₂ O ₃ resulted in a higher OD value compared with the control; however, at 3 days the difference was statistically insignificant. At each exposure time, the OD value of 5 µm As ₂ O ₃ group was comparable to the control and 10 µm As ₂ O ₃ group. There were no significant differences between 50 µm As ₂ O ₃ group and 500 μm NAC+50 μm As ₂ O ₃ group; however, these two groups had lower OD values when compared with 5,000 μm NAC+50 μm As ₂ O ₃ group at 24 hours and 3 days. The latter group showed significantly lower OD value in comparison with the control at 24 hours and 3 days. Control cells were polygonal-shaped while 50 µm As ₂ O ₃ -treated cells exhibited contracted and spherical morphology with increased intercellular spaces. At 24 hours, 10 μm and 5 µm As ₂ O ₃ -treated cells were slightly hypertrophic. Cells co-treated with NAC and As ₂ O ₃ showed increased intercellular spaces and lower cellular density compared with the control.

Conclusions  As ₂ O ₃ displayed a hormetic effect on pulpal cells; however, the proliferative effect induced by low As ₂ O ₃ concentrations should be interpreted with caution. NAC did not prevent As ₂ O ₃ -mediated toxicity; however, it demonstrated potential for ameliorating this toxicity.

Egyptian Propolis-Loaded Nanoparticles as a Root Canal Nanosealer: Sealing Ability and in vivo Biocompatibility

Background

Successful endodontic therapy is mainly governed by the satisfactory sealing ability of the applied root canal sealer. Also, tolerability of root canal structure to accommodate the presence of a sealer participates in the efficiency of the treatment. Hence, this study was aimed to extrapolate our previous one that was concerned with the preparation and evaluation of novel nature-based root canal sealers. Our current work is focused on the evaluation of sealing ability and in vivo biocompatibility.

Materials and Methods

Egyptian propolis was extracted (ProE) and encapsulated in polymeric nanoparticles (ProE-loaded NPs). Two root sealers, PE sealer and PE nanosealer, were fabricated by incorporating ProE and ProE-loaded NPs, respectively. The sealing ability of the developed sealers was tested by a dye extraction method. An in vivo biocompatibility study was conducted using a subcutaneous implantation method for two and four weeks. At the same time, a model sealer (AH Plus®) was subjected to the same procedures to enable accurate and equitable results.

Results

The teeth treated with PE sealer exhibited weak sealing ability which did not differ from that of unfilled teeth. PE nanosealer enhanced the sealing ability similarly to the model sealer with minimal apical microleakage. Studying in vivo biocompatibility indicated the capability of the three tested sealers to induce cell proliferation and tissue healing. However, PE nanosealer had superior biocompatibility, with higher potential for cell regeneration and tissue proliferation.

Conclusion

PE nanosealer can be presented as an innovative root canal sealer, with enhanced sealing ability as well as in vivo biocompatibility. It can be applied as a substitute for the currently available sealers that demonstrate hazardous effects.

Reactions of Subcutaneous Connective Tissue to Mineral Trioxide Aggregate, Biodentine®, and a Newly Developed BioACTIVE Base/Liner

AIM

There is an increasing interest in the application of BioACTIVE materials to achieve hard tissue formation and maintain pulp vitality. Mineral trioxide aggregate (MTA) and Biodentine® are BioACTIVE materials used for pulp capping. Recently, dental researchers have produced BioACTIVE glass-incorporated light-curable pulp capping material. The study is aimed at evaluating the subcutaneous connective tissue reactions to MTA, Biodentine®, ACTIVA BioACTIVE Base/Liner. These materials were placed in polyethylene tubes and implanted into the dorsal connective tissue of Sprague Dawley rats. The presence of inflammation, predominant cell type, calcification, and thickness of fibrous connective tissue was recorded by histological examination 7, 30, and 60 days after the implantation procedure. Scores were defined as follows: 0 = none or few inflammatory cells, no reaction; 1 = <25 cells, mild reaction; 2 = 25 to 125 cells, moderate reaction; and 3 = ≥125 cells, severe reaction. Fibrous capsule thickness, necrosis, and formation of calcification were recorded. ANOVA and post hoc Dunnett's tests were used for statistically analyses (p < 0.05).

RESULTS

In terms of oedema, inflammation, fibrous capsule, and necrosis, no significant differences were found in any time period for any material. MTA and Biodentine® showed higher calcification than in the ACTIVA BioACTIVE on day 30, and the difference was statistically significant (p < 0.05). After 60 days, while calcification was not seen in the control group, it was observed in the test groups. There was a statistically significant difference between the control and the others.

CONCLUSION

All materials were well tolerated by the tissues in the 60-day evaluation period. One notable finding is the presence of dystrophic calcification in the connective tissue adjacent to the newly developed BioACTIVE Base/Liner material. Therefore, this new BioACTIVE Base/Liner material may be safely recommended to clinicians as a pulp capping material.

Biocompatibility of new bioactive resin composite versus calcium silicate cements: an animal study

Background

The purpose of this study was to compare the biocompatibility of three bioactive materials, namely ACTIVA bioactive restorative resin composite, iRoot BP plus and Mineral Trioxide Aggregate (MTA) Angelus-HP.

Methods

Seventy-five Wistar male rats were subjected to subcutaneous implantation of four polyethylene tubes; one empty tube was used as control (Group 1), and the other tubes were filled with ACTIVA (Group 2), iRoot BP (Group 3) and MTA-HP (Group 4). Then, the rats were subdivided into 3 groups according to the sacrification time into one, two and 4 weeks (n = 25 rats). Tissue specimens were submitted to histopathological and immunohistochemical analysis of α-SMA and caspase 3.

Results

The one-way Anova test revealed that ACTIVA group exhibited minimal inflammation in comparison to calcium silicate cements (iRoot BP and MTA-HP groups). iRoot BP group significantly revealed a more severe degree of chronic inflammation in comparison to other groups (P < 0.05). ACTIVA group showed marked regression of inflammation and fibrosis comparable to the control, while iRoot BP group revealed remarkable fibrosis and calcification, with less degrees in MTA-HP group (P < 0.05). Immunostaining of both α-SMA and caspase 3 revealed lower indexes in ACTIVA group consistent with the control (P < 0.05).

Conclusions

ACTIVA showed a higher degree of biocompatibility to subcutaneous tissues in comparison to both iRoot BP and MTA-HP cements in regard to decrease the intensity of inflammation, with subsequent fibrous connective tissue remodeling and better healing patterns.

Clinical significance

Preliminary data suggests that the application of ACTIVA in retrograde fillings.

Systemic effect of mineral aggregate-based cements: histopathological analysis in rats

Objective:

Several studies reported the local tissue reaction caused by mineral aggregate-based cements. However, few studies have investigated the systemic effects promoted by these cements on liver and kidney when directly applied to connective tissue. The purpose of this in vivo study was to investigate the systemic effect of mineral aggregate-based cements on the livers and kidneys of rats.

Material and Methods:

Samples of Mineral Trioxide Aggregate (MTA) and a calcium aluminate-based cement (EndoBinder) containing different radiopacifiers were implanted into the dorsum of 40 rats. After 7 and 30 d, samples of subcutaneous, liver and kidney tissues were submitted to histopathological analysis. A score (0-3) was used to grade the inflammatory reaction. Blood samples were collected to evaluate changes in hepatic and renal functions of animals.

Results:

The moderate inflammatory reaction (2) observed for 7 d in the subcutaneous tissue decreased with time for all cements. The thickness of inflammatory capsules also presented a significant decrease with time (P<.05). Systemically, all cements caused adverse inflammatory reactions in the liver and kidney, being more evident for MTA, persisting until the end of the analysis. Liver functions increased significantly for MTA during 30 d (P<.05).

Conclusion:

The different cements induced to a locally limited inflammatory reaction. However, from the systemic point of view, the cements promoted significant inflammatory reactions in the liver and kidney. For MTA, the reactions were more accentuated.

Mineral Trioxide Aggregate-A Review of Properties and Testing Methodologies

Mineral trioxide aggregate (MTA) restoratives and MTA sealers are commonly used in endodontics. Commonly referenced standards for testing of MTA are ISO 6876, 9917-1 and 10993. A PubMed search was performed relating to the relevant tests within each ISO and "mineral trioxide aggregate". MTA restoratives are typically tested with a mixture of tests from multiple standards. As the setting of MTA is dependent upon hydration, the results of various MTA restoratives and sealers are dependent upon the curing methodology. This includes physical properties after mixing, physical properties after setting and biocompatibility. The tests of flow, film thickness, working time and setting time can be superseded by rheology as it details how MTA hydrates. Physical property tests should replicate physiological conditions, i.e. 37 °C and submerged in physiological solution. Biocompatibility tests should involve immediate placement of samples immediately after mixing rather than being cured prior to placement as this does not replicate clinical usage. Biocompatibility tests should seek to replicate physiological conditions with MTA tested immediately after mixing.

Analysis of the reaction of subcutaneous tissues in rats and the antimicrobial activity of calcium hydroxide paste used in association with different substances

The aim of this study was to evaluate the subcutaneous tissue response in rats and the antimicrobial activity of intracanal calcium hydroxide dressings mixed with different substances against E. faecalis. Fifty four rats were divided into three experimental groups according to the vehicle in the calcium hydroxide treatment: 0.4% chlorohexidine in propylene glycol (PG), Casearia sylvestris Sw in PG and calcium hydroxide+PG (control group). The pastes were placed into polyethylene tubes and implanted into the subcutaneous tissue. After 7, 14 and 30 days, the samples were processed and histologically evaluated (hematoxylin and eosin). The tissue surface in contact with the material was analyzed, and the quantitative analysis determined the volume density occupied by the inflammatory infiltrate (giant cells, polymorphonuclear cells and mononuclear cells), fibroblasts, collagen fibers and blood vessels. For the antimicrobial analysis, 20 dentin blocks infected with E. faecalis were treated with calcium hydroxide pastes in different vehicles; 0.4% chlorhexidine in PG, PG, extract from Casearia sylvestris Sw in PG and a positive control (infection and without medication) for 7 days. The efficiency of the pastes was evaluated by the live/dead technique and confocal microscopy. The results showed that 0.4% chlorhexidine induced a higher inflammatory response than the other groups. The Casearia sylvestris Sw extract showed satisfactory results in relation to the intensity of the inflammatory response. In the microbiological test, there were no statistical differences between the evaluated intracanal dressings and the percentage of bacterial viability was between 33 and 42%. The control group showed an 86% viability. Antimicrobial components such as chlorhexidine or Casearia sylvestris Sw did not improve the antimicrobial activity against E. faecalis in comparison to the calcium hydroxide+PG treatment. In addition, the incorporation of chlorhexidine in the calcium hydroxide paste promoted the highest inflammatory response.