Effect of whitening toothpastes with different hydrogen peroxide concentrations: Penetration into the pulp chamber and color change

OBJECTIVES

This study evaluated the efficacy of simulated brushing with toothpastes containing different concentrations of hydrogen peroxide (HP) in pulp chamber penetration and color change. Also, physical-chemical properties (concentration, pH and viscosity) were evaluated.

METHODS

Forty-nine premolars were divided into seven groups (n = 7): untreated (control); whitening gel (White Class 6 %, 6 %BG) with one 90  min application (6 %BG 90  min) and 14 applications of 90  min (6 %BG 14×90 min); toothpastes (Colgate Luminous White Glow 3 %, 3 %TP; Crest 3D White Brilliance 4 %, 4 %TP; Colgate Optic White Pro-Series 5 %, 5 %TP) and 6 %BG toothbrushing for 14 applications of 90 s. HP penetration into the pulp chamber was measured through UV-Vis spectrophotometry and color change with a spectrophotometer (ΔEab, ΔE00, and ΔWID). Initial concentration, pH, and viscosity were measured through Titration, Digital pH-meter, and Rheometer, respectively. Statistical analysis used one-way ANOVA and Tukey's test (α = 0.05).

RESULTS

6 %BG (14×90 min) and 4 %TP groups showed acidic pH and higher concentrations of HP in the pulp chamber compared to the other groups (p < 0.05). On the other side, 3 %TP and 5 %TP groups showed alkaline pH, higher viscosity between the toothpastes and lower HP penetration (p < 0.05). The 6 %BG AH (14×90 min) group exhibited the most significant color change (ΔEab, ΔE00, and ΔWID) (p < 0.05).

CONCLUSIONS

Brushing with whitening toothpaste with an acidic pH leads to greater HP penetration into pulp chamber; but, even when a high concentrated HP whitening toothpaste was used, a lower whitening effect was observed when compared to a two-week at-home bleaching.

CLINICAL SIGNIFICANCE

Whitening toothpastes containing up to 5 % HP produced lower whitening effect than two-week at-home bleaching. Additionally, HP was detected within the pulp chamber which can potentially impact in tooth sensitivity.

Reduced C-reactive protein levels after root canal treatment in clinically healthy young apical periodontitis individuals at cardiovascular risk. A prospective study

AIM

To determine the systemic inflammatory burden, including hsCRP and its monomeric forms, in patients with apical lesions of endodontic origin treated with root canal treatment (RCT).

METHODOLOGY

Prospective pre-/post-study. Apical periodontitis (AP) individuals aged 16-40 were included (N = 29). Individuals received RCT and were followed at 1 and 6 months. Fasting blood samples were obtained. Apical lesions of endodontic origin (ALEO) diameter (mm), and periapical index (PAI), were recorded. The serum concentrations of total hsCRP were determined by turbidimetry. Tumour necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, IL-1β, and soluble (s) E-selectin were assessed by Multiplex assay. Additionally, mCRP forms were determined in the serum of AP patients with a baseline moderate to high cardiovascular risk based on hsCRP stratification (hsCRP ≥1 mg/L) by immunowestern blot (n = 15). Also, CRP isoforms were explored in ALEOs from AP individuals (n = 4). Data were analysed with StataV16.

RESULTS

Periapical index and ALEO sizes were reduced at both follow-up visits after RCT (p < .05). Serum levels of TNF-α, IL-6, IL-10, IL-1β, and sE-selectin did not show significant differences. CRP was borderline reduced at 1 month (p = .04); however, in AP individuals at cardiovascular risk (hsCRP ≥ 1 mg/L), hsCRP and its monomeric isoform significantly decreased at 1 and 6 months (p < .05).

CONCLUSIONS

High-sensitivity CRP and mCRP are reduced after RCT in AP individuals at cardiovascular risk.

Butyrate Stimulates Histone H3 Acetylation, 8-Isoprostane Production, RANKL Expression, and Regulated Osteoprotegerin Expression/Secretion in MG-63 Osteoblastic Cells

Butyric acid as a histone deacetylase (HDAC) inhibitor is produced by a number of periodontal and root canal microorganisms (such as Porphyromonas, Fusobacterium, etc.). Butyric acid may affect the biological activities of periodontal/periapical cells such as osteoblasts, periodontal ligament cells, etc., and thus affect periodontal/periapical tissue destruction and healing. The purposes of this study were to study the toxic effects of butyrate on the matrix and mineralization marker expression in MG-63 osteoblasts. Cell viability was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. Cellular apoptosis and necrosis were analyzed by propidium iodide/annexin V flow cytometry. The protein and mRNA expression of osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-B ligand (RANKL) were analyzed by Western blotting and reverse transcriptase-polymerase chain reaction (RT-PCR). OPG, soluble RANKL (sRANKL), 8-isoprostane, pro-collagen I, matrix metalloproteinase-2 (MMP-2), osteonectin (SPARC), osteocalcin and osteopontin (OPN) secretion into culture medium were measured by enzyme-linked immunosorbant assay. Alkaline phosphatase (ALP) activity was checked by ALP staining. Histone H3 acetylation levels were evaluated by immunofluorescent staining (IF) and Western blot. We found that butyrate activated the histone H3 acetylation of MG-63 cells. Exposure of MG-63 cells to butyrate partly decreased cell viability with no marked increase in apoptosis and necrosis. Twenty-four hours of exposure to butyrate stimulated RANKL protein expression, whereas it inhibited OPG protein expression. Butyrate also inhibited the secretion of OPG in MG-63 cells, whereas the sRANKL level was below the detection limit. However, 3 days of exposure to butyrate (1 to 8 mM) or other HDAC inhibitors such as phenylbutyrate, valproic acid and trichostatin stimulated OPG secretion. Butyrate stimulated 8-isoprostane, MMP-2 and OPN secretion, but not procollagen I, or osteocalcin in MG-63 cells. Exposure to butyrate (2⁻4 mM) for 3 days markedly stimulated osteonectin secretion and ALP activity. In conclusion, higher concentrations of butyric acid generated by periodontal and root canal microorganisms may potentially induce bone destruction and impair bone repair by the alteration of OPG/RANKL expression/secretion, 8-isoprostane, MMP-2 and OPN secretion, and affect cell viability. However, lower concentrations of butyrate (1⁻4 mM) may stimulate ALP, osteonectin and OPG. These effects are possibly related to increased histone acetylation. These events are important in the pathogenesis and repair of periodontal and periapical destruction.

In vivo Fluid Movement through Dentin Adhesives in Endodontically Treated Teeth

Fluid transudation through simplified dentin adhesives can occur in bonded vital crown dentin, since these adhesives behave as permeable membranes after polymerization. The effect of adhesive permeability in endodontically treated teeth is unknown. This study examined the hypothesis that in vivo fluid movement through simplified adhesives occurs when they are applied to root canals. Dowel spaces were prepared in endodontically treated teeth with single root canals. Six adhesives were applied to the intra-radicular dentin of canal walls. Impressions were obtained with polyvinyl siloxane, and replicas were fabricated with the use of polyether impression material. Replica hemisections were gold-coated for SEM examination. Fluid transudation was evident on the adhesive surfaces of all simplified total-etch and self-etch adhesives. Conversely, most of the specimens bonded with the control three-step total-etch adhesive were devoid of fluid droplets. Permeability of simplified adhesives results in water movement, even in root-treated dentin. This may adversely affect the coupling of auto-/dual-cured resin cements.

Pulp-Dissolving Ability of Several Endodontic Irrigants: A Spectro-Photometry Evaluation

The aim of this study is to test the dissolving action of different concentrations of NaOCl (0.5%, 2.5% and 5%) and EDTA 17% on bovine pulp tissue, testing solutions at three different times (1, 5, 10 minutes). 100 mg. of dental pulp placed into a becher with 20 ml of solution was evaluated using a spectrophotometer. A solution of NaOCl 5% showed the highest solubility value. Samples treated with 2.5% NaOCl showed solubility values of 0.98 in one minute, 29.1 in five minutes and 57 in ten minutes. Groups treated with NaOCl 0.5% showed small dissolving modifications. 17% EDTA showed the lowest values of solubility. 5% NaOCl solution showed highest pulp dissolving ability, even a 2.5% solution showed high dissolving ability but in longer times.

Effects of the concentration and composition of in-office bleaching gels on hydrogen peroxide penetration into the pulp chamber

In tooth whitening, the hydrogen peroxide (HP) diffuses in the enamel and dentin, reaching the pulp. This in vitro study aimed to quantify the penetration of HP in the pulp chamber in teeth submitted to bleaching agents of different concentrations of HP without calcium (HP 20% [20CF], HP 35% [35CF]) and with calcium (HP 20% [20CC], HP 35% [35CC]).

METHOD

Fifty human premolars were sectioned 3 mm from the cemento-enamel junction and the pulp tissue was removed. The teeth were divided into five groups according to treatment and with a control group (n=10). An acetate buffer solution was placed in the pulp chamber of all teeth. The control group was exposed only to distilled water, while the other groups were treated with a bleaching procedure, according to the manufacturer's recommendations. After treatment, the acetate buffer solution was transferred to a glass tube in which leuco-crystal violet and peroxidase solutions were added, resulting in a blue solution. The optical density of this blue solution was determined spectrophotometrically and converted into micrograms equivalent to the HP. Data were analyzed using analysis of variance and Tukey tests (α=0.05).

RESULTS

The HP concentration did not affect the HP inside the pulp chamber, but the presence of calcium significantly reduced it (p<0.0001).

CONCLUSION

The amount of HP that reaches the pulp chamber depends on the bleaching protocol and the product employed, and it seems to be less affected by HP concentration.

Hydrogen peroxide penetration into the pulp chamber and dental permeability after bleaching

This study sought to quantify the concentration of hydrogen peroxide (HP) in the pulp chamber and evaluate changes on dental permeability after bleaching with 3 HP concentrations (10%, 35%, and 50%). This study was divided into 2 experiments and the bleaching treatments consisted of 3 applications of HP for 30 minutes during a single session. The first experiment tested HP penetration into the pulp chamber of 4 experimental groups (n = 10) of bovine crowns, which were divided by HP concentration: an unbleached control group (0% HP), 10% HP, 35% HP, and 50% HP. Acetate buffer solution was placed into the pulp chamber and after each application of HP. This solution was collected to determine spectrophotometrically the concentration of HP that reached the pulp chamber. The second experiment evaluated dental permeability. Bovine crowns were divided into 3 groups (n = 10). The crowns were connected to a permeability device and the initial permeability was measured at 10 psi. Three different concentrations of HP gels (10%, 35% and 50%) were applied to the buccal enamel surfaces and the dental permeability was measured after the first, second, and third applications of HP. The data were analyzed by 2-way ANOVA and Tukey test (P ≤ 0.05). All concentrations of HP reached the pulp chamber, although no significant differences were noted between the 3 concentrations tested (P > 0.05). However, the increase of dental permeability in the group that received 50% HP was significantly higher than the 10% HP group (P < 0.05). The results indicate that the HP bleaching treatments increased dental permeability.

Dynamic model of hydrogen peroxide diffusion kinetics into the pulp cavity

AIM

To measure the time course hydrogen peroxide penetration into the pulp cavity and evaluate short-term tooth color changes after bleaching.

MATERIALS AND METHODS

Twenty extracted human canines were sectioned, pulp tissue removed and the cavity enlarged. Teeth were painted with nail varnish to leave a 6-mm diameter circle on the buccal surface. Baseline color was measured spectrophotometrically. Teeth were randomized into a control group (n = 10) treated with 30 µl of glycerin base and a bleaching group (n = 10) exposed to 30 µl of 40% hydrogen peroxide for 1 hour. A linear low density polyethylene wrap was placed to prevent evaporation of the material. Acetate buffer was placed into the cavity and replenished every 10 minutes and placed into plastic tubes. Hydrogen peroxide amount was estimated spectrophotometrically using leukocrystal violet and horseradish peroxidase. Specimen color was remeasured immediately after bleaching, 1 hour, 1 day 1, 2 and 6 weeks postbleaching. Color change was measured per Commission Internationale de l'Eclairage methodology. Mann-Whitney procedure was used to assess baseline color measurements and total hydrogen peroxide penetration amount. Friedman's test was used to assess within group differences for color change and hydrogen peroxide penetration.

RESULTS

There was significantly greater hydrogen peroxide penetration in the bleaching group (p < 0.05). Hydrogen peroxide penetration levels were constant throughout the 1-hour evaluation period in the bleaching group. The groups showed no difference at baseline with respect to any of L*a*b color measurements (p > 0.05). The postbleaching color measurement showed an increase of change in overall color (ΔE) and lightness (ΔL) up to 1 week followed by a gradual stabilization up to 6 weeks.

CONCLUSION

This dynamic model provided information about the time course diffusion kinetics into the pulp cavity, demonstrating constant penetration of hydrogen peroxide into the pulp cavity during a 1-hour bleaching session.

CLINICAL SIGNIFICANCE

A prolonged application of 40% hydrogen peroxide bleaching material for 1 hour produces constant penetration of hydrogen peroxide into the pulp cavity in vitro.

[The role of pulp in the root resorption of primary teeth without permanent tooth germs]

OBJECTIVE

To investigate the role of pulp in the root resorption of primary teeth without permanent tooth germs.

METHODS

The animal model without permanent tooth germs was established by surgery in Beagle dog. The root resorption was observed by taking periapical radiographs periodically. The samples of mandibular bone and pulp at different resorption stages were collected. The distribution of odontoclasts and the activating factor was analyzed by histological staining and semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR). The role of pulp in the root resorption of primary teeth was tested by early pulpectomy.

RESULTS

In the root resorption of primary molars without permanent teeth germs, a large number of odontoclasts were present on the pulpal surface of the root canal. Semi-quantification RT-PCR showed that the ratios of the expression of receptor activator of NF-κB ligand (RANKL) mRNA and β-actin in the pulp of permanent teeth and primary teeth without permanent teeth germ during different periods of root resorption are 0.1314, 0.1901, 0.2111 and 0.6058 (P > 0.05). The root resorption of primary teeth without permanent teeth germs in test groups was about 5 weeks later than that of control group.

CONCLUSIONS

The pulp of primary tooth played an important role in the root resorption of primary tooth without permanent tooth germ.

Effect of dentin treatment time with tetraclean on its residual antibacterial activity

The goal of this study was to evaluate the effect of dentin treatment duration (10 minutes, 24 hours, and seven days) with Tetraclean on its residual antibacterial activity in bovine root dentin. Results showed that the number of colony-forming units in all three experimental groups was zero at the first culture. Furthermore, the 10-minute group and seven-day group demonstrated the highest and the lowest number of colony-forming units, respectively.

Time-Course Diffusion of Hydrogen Peroxide Through Human Dentin: Clinical Significance for Young Tooth Internal Bleaching

The purpose of this study was to record the time-course diffusion of hydrogen peroxide through human dentin from a peroxide carbamide gel designed for the walking bleach technique in order to determine its optimal renewal time. It was considered that the optimal renewal rate corresponded to the time necessary to achieve 80% of the maximal diffusion because a much longer time does not involve further significant diffusion. Thirty-six freshly extracted human premolars were used for this study. Eighteen were extracted for orthodontic reasons on patients under 20 years old (young-teeth group). Eighteen were extracted for periodontal reasons on patients between 40 and 60 years old (old-teeth group). The teeth were endodontically treated, and a flat defect was created at the enamel-cementum junction. The teeth were suspended in vials containing water, and the access cavities were filled with 20 microL of 20% hydrogen peroxide gel. The amount of diffusing hydrogen peroxide was assessed at 1 hour, 24 hours, 48 hours, and 120 hours. The diffusive flux and the maximal diffusion were calculated as well as the optimal renewal time. Hydrogen peroxide diffusion through young teeth lasted 352 hours but lasted 291 hours through old teeth. Diffusive flux and maximal diffusion were higher through young teeth than through old teeth. The optimal renewal time for young teeth was 33 hours and for old teeth was 18 hours.

Evaluation of dentin permeability after light activated internal dental bleaching

The aim of this in vitro study was to assess quantitatively the dentin permeability of human teeth after intracoronal bleaching therapy with 35% hydrogen peroxide activated by LEDs, halogen lamp or using the walking bleach technique. Forty human maxillary central incisors had standard access cavities performed and the cervical thirds of the canals were prepared with Gates-Glidden drills up to a size 130. Roots were resected between the coronal and middle thirds and the apical portions were discarded. A glass ionomer, 2 mm thick cervical plug was placed inside the canal, at the cement-enamel junction level. Group I received 35% hydrogen peroxide gel activated by LEDs. Group II was submitted to 35% hydrogen peroxide gel activated by halogen lamp. Group III received 35% hydrogen peroxide gel and the walking bleach technique was followed. Group IV (control) received a dry cotton pellet inside the pulp chamber with temporary restoration. Dentinal permeability was quantified by copper ion penetration. Linear measurements were obtained by analysis of digital images under x 5 magnification. Mean values and SD for the experimental groups were: I, 7.1% (+/-3.2%); II, 8.4% (+/-3.0%); III, 9.1% (+/-3.0%); IV, 1.3% (+/-2.8%). One-way ANOVA was used to analyze the results. Results showed an increase of permeability values for groups I, II and III when compared to group IV (control); however, no statistical differences were found between the three tested bleaching techniques. It can be concluded that 35% hydrogen peroxide activated by LED, halogen lamp or used following the walking bleach technique produced similar increase in dentinal permeability.

The Effect of Endodontic Therapy on Periapical Exudate Neutrophil Elastase and Prostaglandin-E2 Levels

This study aimed to investigate periapical exudate neutrophil elastase (NE) and prostaglandin E2 (PGE2) levels and their relationships with clinical symptoms, and to determine the changes of their levels following first treatment visit. Periapical exudate samples were collected from the canals of 34 nonvital single-rooted teeth at two sequential treatment visits. Periapical exudate NE and PGE2 levels were found to be higher in the presence of clinical symptoms (pus discharge, swelling) (p < 0.05). The canals of teeth with larger periapical radiolucent area (>or=1 cm) contained more PGE2 levels than with smaller ones (<1 cm) (p < 0.05). Periapical exudate NE levels were significantly correlated with PGE2 levels (p < 0.05), and their levels at first treatment visit did not change following root canal therapy (p > 0.05). The periapical exudate NE and PGE2 levels may regulate periapical disease expression, but the results of this study were unable to reveal this association.

In vitro peroxide penetration into the pulp chamber from newer bleaching products

AIM

To investigate peroxide penetration from newer bleaching products into the pulp chamber.

METHODOLOGY

Fifty extracted human maxillary central incisor teeth were separated into five groups (n = 10). All the teeth were sectioned 3 mm apical to the cemento-enamel junction; the intracoronal pulp tissue was removed, and the pulp chamber filled with acetate buffer. Buccal crown surfaces of teeth in the experimental groups were subjected to either a whitening strip (containing 5.3% hydrogen peroxide-G1) or one of three paint-on liquid whiteners (containing 19% sodium percarbonate peroxide-G2, 18% carbamide peroxide-G3 and 8.7% hydrogen peroxide-G4). The teeth in the control group (G5) were exposed only to distilled water. The acetate buffer solution in each tooth was then transferred to a glass test tube after 30 min and leuco-crystal violet and enzyme horseradish peroxidase were added, producing a blue solution. The optical density of the resultant blue colour in the tubes was measured by a UV-visible spectrophotometer at a wavelength of 596 nm. The values were converted into microgram equivalents of HP using a spectrophotometric calibration curve. Data were analysed statistically using the Kruskal-Wallis Analysis of Variance and the Mann-Whitney U-test.

RESULTS

Statistically significant differences were found between all of the groups (P < 0.05). Pulpal peroxide was not observed in the control group. The amount of hydrogen peroxide (microg) found in the pulp chamber of G1 (0.726 +/- 0.024) > G4 (0.443 +/- 0.017) > G3 (0.231 +/- 0.011) > G2 (0.175 +/- 0.012).

CONCLUSIONS

The peroxides from the whitening strip and paint-on whiteners penetrated into the pulp chamber to varying degrees.

Peroxide penetration into the pulp from whitening strips

It was observed that externally applied bleaching gels may penetrate into the pulp chamber. This study was conducted to evaluate the peroxide diffusion from two whitening strips into the pulp chamber. Twenty-four, human, extracted, maxillary central teeth were separated into three groups (n = 8). All teeth were sectioned 3-mm apical to CEJ, the intracoronal pulp tissue was removed, and the pulp chamber was filled with acetate buffer. Vestibuler crown surfaces of teeth in the experimental groups were subjected to whitening strips; the teeth in the control group were exposed only to distilled water. The acetate buffer solution in each tooth was transferred to the tube. Leuco-crystal violet and enzyme horseradish peroxidase also were added to the tube. The pulpal peroxide was determined spectrophotometrically. The results indicated that the whitening strip containing 14% hydrogen peroxide presented a higher pulpal peroxide penetration than 6.5 % hydrogen peroxide (p < 0.001).

Apical Diffusion of Calcium Hydroxide in an in vitro Model

An in vitro agar model was developed to study the effect of intracanal medicaments on periapical tissues and was used to study the diffusion of three calcium hydroxide (Ca(OH)2) medicaments of varying viscosity through simulated root canals with various sizes of apical foramina. Experimental medicaments were added to pipette tips used to represent tooth roots, which were fixed in syringes containing brain heart infusion agar and calcium-reactive dye. OH and Ca concentrations were measured in the agar at 30 minutes and 24 hours. Ca concentration and pH increased with larger aperture sizes, and higher pH and Ca diffusion was produced by a 10% Ca(OH)2 solution than was produced by Pulpdent or a Ca(OH)2 paste. The results suggest that the properties of the Ca(OH)2-containing vehicle could affect the action of the medicament in the periapical tissues.

In vitro penetration of bleaching agents into the pulp chamber

AIM

To investigate pulp chamber penetration of bleaching agents in teeth following restorative procedures.

METHODOLOGY

Bovine lateral incisors were sectioned 3 mm apical to the cemento-enamel junction and the coronal pulpal tissue was removed. Teeth were divided into six groups (n = 10): G1, G2 and G3 were not submitted to any restorative procedure, while G4, G5 and G6 were submitted to Class V preparations and restored with composite resin. Acetate buffer was placed in the pulp chamber and treatment agents were applied for 60 min at 37 degrees C as follows: G1 and G4, immersion into distilled water; G2 and G5, 10% carbamide peroxide (CP) exposure; G3 and G6, 35% CP bleaching. The buffer solution was removed and transferred to a glass tube where leuco crystal violet and horseradish peroxidase were added, producing a blue solution. The optical density of the blue solution was determined spectrophotometrically at 596 nm. A standard curve made with known amounts of hydrogen peroxide was used to convert the optical density values of the coloured samples into microgram equivalents of hydrogen peroxide. Data were submitted to anova and Tukey's test (5%).

RESULTS

Amounts of hydrogen peroxide found in the pulp chamber of G2 and G5 specimens (0.1833 +/- 0.2003 micro g) were significantly lower (P = 0.001) when compared to G3 and G6 specimens (0.4604 +/- 0.3981 micro g). Restored teeth held significantly higher (P = 0.001) hydrogen peroxide concentrations in the pulp chamber than intact teeth.

CONCLUSION

Higher concentrations of the bleaching agent produced higher levels of hydrogen peroxide in the pulp chamber, especially in restored teeth.

The co-expression of P2X3 receptor with VR1 and VRL-1 in the rat trigeminal ganglion

The co-expression of P2X3 receptor with the vanilloid receptor subtype I (VR1) and vanilloid receptor 1-like receptor (VRL-1) was examined in the rat trigeminal ganglion (TG) by a double immunofluorescence method. P2X3 receptor-immunoreactive (ir) neurons were predominantly small to medium-sized (range=93.8-1844.4 microm(2), mean+/-S.D.=503.8+/-286.5 microm(2)); 35% and 9% of P2X3 receptor-ir TG neurons were immunoreactive for VR1 and VRL-1, respectively. Small and medium-sized P2X3 receptor-ir neurons contained VR1-immunoreactivity (ir), whereas medium-sized and large P2X3 receptor-ir neurons showed VRL-1-ir. The retrograde tracing and immunohistochemical methods revealed that 30% of the TG neurons retrogradely labeled from the facial skin and tooth pulp exhibited P2X3 receptor-ir. The co-expression of P2X3 receptor and VR1 was detected in 16% of cutaneous TG neurons and 6% of tooth pulp neurons. On the other hand, the co-expression of P2X3 receptor and VRL-1 was common in tooth pulp neurons (23%) and rare in cutaneous TG neurons (8%). In the tooth pulp, 95% of P2X3 receptor-ir TG neurons contained VRL-1-ir. The present study indicates that P2X3 receptor-ir TG neurons, which co-express VR-ir, are abundant in the facial skin. The tooth pulp is probably innervated by TG neurons, which contain both P2X3-and VRL-1-ir.

The smear layer in the root canal and its removal

Instrumentation of the root canal during endodontic treatment produces a smear layer which is not uniformly attached to the canal wall. Its morphological structure comprises dentin particles, organic debris, odontoblast processes, microorganisms and their metabolic products. The view that has currently gained wide popularity holds that leaving the smear layer in the root canal contradicts the principles of efficient treatment as this might compromise the optimal progression of the healing process. The proven unfavorable effects of the smear layer on treatment outcome bring forward the necessity for additional application of agents aimed at its complete removal. As the smear layer has a complex structure, these agents should possess a potential for dealing with both its organic and inorganic components. The wide range of used medications includes different concentrations of sodium hypochlorite as a major irrigant of the root canal, chlorhexidine gluconate, chelating agents (EDTA), organic acids, combined preparations (MTAD), combined use of agents that can tackle both the organic and inorganic components. Lasers find manifold applications in various medical fields and can be regarded as a future solution to the problem of total smear layer removal. In the present review we have made a critical analysis of currently used agents placing the emphasis on the potential use of new medications, capable of attacking the smear layer.

[The development and in vitro release rate determination of controlled-release delivery gutta-percha point containing metronidazole compound]

OBJECTIVE

To prepare the controlled-release delivery gutta-percha points containing metronidazole compound (CDGMC) and to determine its release rate in vitro.

METHODS

The drug points were made by using compound drugs and gutta-percha as a carrier, and CDGMC were prepared followed by enveloping a release membrane outward. The best formula was selected according to the release parameters of the drugs extracted in the release experiments in vitro. The CDGMC were placed into the extracted teeth after root canals were routinely prepared. The non-drug CDGMC was used as the control. The absorbency of the drugs in normal saline (37 degrees C, pH 7.4) was determined timely. The percentage of release and cumulated release of the drugs were calculated according to the concentrations of drugs in medium.

RESULTS

The in vitro experiments showed that this system contained 1,880 micrograms of metronidazole and 267 micrograms of ciprofloxacin. The experiments in healthy single root canal showed that the drug release amounts around the perioapical area were metronidazole 88.54 micrograms/ml and ciprofloxacin 9.05 micrograms/ml in 10 days.

CONCLUSION

CDGMC can continuously release effective drug concentrations more than 10 days and could be considered as an ideal method for clinical application.

Immunohistochemical localization of MMP-2, MMP-9, TIMP-1, and TIMP-2 in the forming rat incisor

Western blots analyses and gelatin zymography established the presence of matrix metalloproteinase (MMP)-2 and -9 in the forming zone of rat incisor. Light microscope immunohistochemistry carried out on undemineralized material provided evidence for strong MMP-2 staining in the secretory ameloblasts, odontoblasts, in the enamel organ, and in the pulp. A weaker staining was observed in predentin and in the outer part of the forming enamel. Using MMP-9 antibodies, the staining was generally weak, except for the secretory ameloblasts that were positively stained. Electron microscopic immunohistochemistry of undemineralized sections revealed a close association between gold-antibodies complexes and cytoskeletal microfilaments in the cytosol of secretory ameloblasts and odontoblasts, within the rough endoplasmic reticulum and along the plasma membrane. The striking feature of MMP-2 and -9 electron immunostaining was the particularly high labeling in the mantle dentin. By contrast, staining of tissue inhibitors of metalloproteinases (TIMP-1 and -2) was lowest in this region. We suggest that this uneven distribution may have some functional implications.

Penetration of propylene glycol into dentine

AIM

This study aimed to evaluate penetration of propylene glycol into root dentine.

METHODOLOGY

Safranin O in propylene glycol and in distilled water were introduced into root canals with and without artificial smear layer. Dye diffusion through dentinal tubules was determined spectrophotometrically. The time required for dye to exit through the apical foramen using propylene glycol and distilled water as vehicles was also determined. The extent and areas of dye penetration on the split surfaces of roots were assessed using Adobe Photoshop and NIH Image Software.

RESULTS

Propylene glycol allowed dye to exit faster through the apical foramen. The area and depth of dye penetration with propylene glycol was significantly greater than with distilled water (P < 0.0001). Smear layer significantly delayed the penetration of dye.

CONCLUSION

Propylene glycol delivered dye through the root canal system rapidly and more effectively indicating its potential use in delivering intracanal medicaments.

Production of interleukin-8 and nitric oxide in human periapical lesions

Bacterial infection of the pulp and root canal system leads to the recruitment of immunocompetent cells in the periapex and stimulates inflammatory cell responses to produce a variety of inflammatory mediators. Cytokines, reactive oxygen intermediates, and reactive nitrogen intermediates are frequently found at sites of acute inflammation. In this study, we measured the levels of interleukin (IL)-8 and nitric oxide (NO) in the periapical exudate (PE) from human periapical lesions and investigated the association of these mediators with the clinical symptoms of periapical periodontitis. PE samples were collected from root canals during routine endodontic treatments. The IL-8 concentration was measured by the enzyme-linked immunosorbent assay, and the NO level was measured as nitrite/nitrate concentration assayed by the Griess reaction. Detectable levels of IL-8 and nitrite/nitrate were found in 24 and 19 of 27 PE-samples, respectively. Although PE-IL-8 and nitrite/nitrate concentration showed a broad range, a significantly positive correlation was found between both mediators. Also, significantly higher IL-8 levels were found in PE from lesions that had painful symptoms at the sampling visit. However, there was no relationship between elevated NO levels and clinical symptoms. These results suggest that the up-regulation of IL-8 may have a critical role in the development of the symptoms of periapical disease.

Influence of serotonin receptor antagonists on substance P and serotonin release evoked by tooth pulp stimulation with electro-acupuncture in the trigeminal nucleus cudalis of the rabbit

We studied the effect of NAN-190 (5-HT(1A) antagonist), ketanserin (5-HT(2) antagonist) and ICS 205-930 (5-HT(3) antagonist) on tooth pulp stimulation (TPS)-induced 5-HT release and substance P (SP) release in the superficial layers of the trigeminal nucleus caudalis (SpVc-I,II) in the presence or absence of electro-acupuncture (EAP). TPS slightly increased 5-HT release and significantly increased SP release. In combination with EAP, TPS-induced 5-HT release was remarkably enhanced, whereas SP release was significantly suppressed. Pretreatment with NAN-190 (3.5 mg/kg, i.v.) significantly enhanced the increase in TPS-induced 5-HT release in the presence of EAP. On the other hand, the increase of 5-HT release induced following TPS in the presence of EAP was inhibited by pretreatment with ketanserin (2.5 mg/kg, i.v.) and ICS 205-930 (1 mg/kg, i.v.). When NAN-190 was pre-treated in the animals combined TPS and EAP, the amount of SP release was significantly reduced compared with the absence of this drug. On the other hand, pretreatment with ketanserin and ICS 205-930 reversed the inhibitory effect of EAP on the TPS-generated SP release, especially ICS 205-930, which remarkably enhanced TPS-induced SP release compared with the absence of this drug. On the basis of the obtained results, we concluded that NAN-190 and ICS 205-930 act on EAP-induced analgesia positively and suppressively, respectively, by regulation of TPS-generated SP release through activation of their subtype receptors. On the other hand, ketanserin does not affect TPS-induced 5-HT release and SP release in the presence of EAP.

Gallium diffusion in human root dentin: quantitative measurements by pulsed Nd:YAG laser ablation combined with an inductively coupled plasma mass spectrometer

OBJECTIVE

The purpose of this work was to determine if gallium nitrate placed in human root canals would diffuse across root dentin and reach concentrations high enough to inhibit osteoclasts (approximately 10(-4) M).

BACKGROUND DATA

External root resorption by osteoclasts is a common sequela of dental trauma. If not detected and treated, it can lead to the loss of a tooth. Gallium has recently been reported to inhibit osteoclastic resorption in vitro.

METHODS

Roots were cleaned and shaped using standard endodontic procedures and the tips sealed with cyanoacrylate cement. The root canal space was filled with an aqueous solution of 1.0 M gallium nitrate chelated with 1.0 M sodium citrate buffer (pH 7.2). The roots were then sectioned longitudinally into two equal halves. Each half was fixed to a translation stage that moved at a constant rate beneath a frequency-quadrupled Nd-YAG laser (266 nm) laser that was used to sample the concentration of 43Ca, 69Ga, and 71Ga by laser ablation across the thickness of root dentin to the periodontal surface. The plume of ablated dentin was swept into an inductively heated plasma chamber by argon gas and hence into a mass spectrometer.

RESULTS

Quantitative analyses of the distribution of gallium showed it was highest adjacent to the root canal space and fell as more peripheral sites were sampled but then rose slightly at the external boundary of the root which is covered with a thin layer of atubular cementum.

CONCLUSIONS

Even the lowest concentrations of gallium found in peripheral root dentin exceeded the 10(-4) M concentration required to inhibit osteoclastic activity. This simple endodontic treatment should undergo clinical trials to determine its efficacy in vivo. The laser ablation, inductively coupled mass spectrometry method is a powerful analytic tool for measuring spatial distribution of materials in mineralized tissues.

Deposition profile of antibacterial anodic silver in root canal systems of teeth

Electrically activated silver was shown to have an antibacterial effect in vitro and in vivo. In this study the effect of placing a silver anode in the root canal systems of teeth was examined to establish a base for treatment of infected teeth. Pure silver wires were placed in the main canals of extracted human teeth (n = 26) whose roots were partly submerged in a lactated Ringer's solution. Seventeen microamperes of anodic direct current were applied to one group of silver wires (n = 15) for 4 days. Then the wires were removed and the roots of both group teeth were cut into six sections and demineralized Silver concentrations of the root sections and their bathing solutions were measured with an atomic absorption spectrophotometer. In the anode group, the electrically activated silver concentrations (range, 1-30 micrograms/microL) exceeded the antibacterial levels (minimum inhibitory concentration, 0.1 micrograms/microL Ag) in all sections, particularly in the middle and lower sites of the root. The amount of anodic silver that leaked out of the root was found as to be 0.4 +/- 0.2 micrograms/microL in the fluid medium. This was 10 to 100-fold higher than that found in the nonactivated controls.

Chronic tooth pulp inflammation causes transient and persistent expression of Fos in dynorphin-rich regions of rat brainstem

We have analyzed central Fos immunoreactivity (Fos-IR) brainstems of adult rats after three clinically relevant dental injuries: filled dentin (DF) cavities that cause mild pulp injury and heal within 1-2 weeks; open pulp exposures (PX) that cause gradual pulp loss and subsequent periodontal lesions; and filled pulp exposures (PXF). By 1 week after DF cavities, no Fos-IR remained except for sites such as lateral-ventral periolivary nucleus (LVPO) that had Fos-IR in all rats including controls. PX injury induced (1) a delayed transient expression of Fos at 1-2 weeks at three loci (ipsilateral neurons in dorsomedial nucleus oralis, paratrigeminal nucleus, and trigeminal tract), (2) persistent ipsilateral Fos for at least 4 weeks after injury in dynorphin (Dyn)-rich regions (rostral lateral solitary nucleus, periobex dorsal nucleus caudalis), and (3) late Fos-IR at 2-4 weeks (bilateral superficial cervical dorsal horn, contralateral dorsal nucleus caudalis, contralateral rostral lateral solitary nucleus). Rats with PXF injury were examined at 2 weeks, and they had greater numbers and more extensive rostro-caudal distribution of Fos neurons than the PX group. One week after PX injury, Fos-IR neurons were found in regions with strong Dyn-IR central fibers. Co-expression of Dyn and Fos was found in some unusually large neurons of the ipsilateral rostral lateral solitary nucleus, trigeminal tract, and dorsal nucleus caudalis. Immunocytochemistry for the p75 low affinity neurotrophin receptor (p75NTR) or for calcitonin gene-related peptide (CGRP) showed no consistent change in trigeminal central endings in any Fos-reactive brainstem areas, despite the extensive structural and cytochemical reorganization of the peripheral endings of the dental neurons. The Fos responses of central neurons to tooth injury have some unusual temporal and spatial patterns in adult rats compared to other trigeminal injury models.

Effect of endodontic smear layer and various solvents on the calcium ion diffusion through radicular dentin--an in vitro study

External root resorption and ankylosis remains the major cause of failure of replanted teeth. This study was conducted to explore the different ways to increase the pH of periradicular area in order to overcome the problem of root resorption and ankylosis. 60 freshly extracted permanent anteriors were used after removing the crown at CEJ. After biomechanical preparation Ca (OH)2 was injected and assays were done using EDTA, Citric and tannic acid Assays were repeated. Calcium diffusion and pH in the root exterior was measured using spectrophotometer. Results showed that dentin is permeable to calcium & hydroxyl ions and placement of Ca (OH)2 in the canal resulted in its increased recovery and alkaline pH periradicularly. Smear layer removal did not result in significant increase in Ca++ recovery or alkaline pH however combination of EDTA & NaOCl was found best than the other two.

Diffusion of calcium through dentin

The purpose of this research was to investigate whether calcium ions from a paste of calcium hydroxide [Ca(OH)2] and saline introduced into root canals diffuse through the dentin to reach the surface of the root. Six teeth were opened and submitted to a biomechanical process, after which all the smear layer was removed. The experiment was divided into three phases: dissolution, dissolution and diffusion I, and dissolution and diffusion II. Dissolution-each tooth, with no Ca(OH)2 paste in place, was sealed both cervically and apically and stored in 700 ml of deonized water until calcium losses from the tooth into the water were stabilized. Dissolution and diffusion I-each root canal was filled with a paste of Ca(OH)2 and saline, sealed again apically and cervically, and returned to its solution. Dissolution and diffusion II-samples were divided into three parts: the control group or group 1, containing the original paste; group 2, in which the existing paste was diluted and the teeth were resealed and replaced in their solutions; and group 3, in which the existing paste was removed and a fresh paste was introduced. The diffusion was greater in group 3, followed by group 2. In the control group, we found a diffusion of calcium, which is statistically null. The results showed that calcium diffusion was observed, in the first 16 days, in all situations in which there was Ca(OH)2 paste inside the root canals.

Diffusion of monomers from bonding resin-resin composite combinations through dentine in vitro

OBJECTIVES

Previous work has demonstrated diffusion of the monomer triethylene glycol dimethacrylate (TEGDMA) from resin composite through dentine in vitro. The objective of the present work was to examine monomer diffusion from bonding resins and resin composites used in combination.

METHODS

Occlusal cavities were prepared in tooth crowns and restored with bonding resin-resin composite combinations. Aqueous samples from the 'pulpal chamber' of each tooth were removed at timed intervals for analysis by reversed phase-high performance liquid chromatography and mass spectrometry.

RESULTS

Bonding resins contributed to monomer diffusion. A TEDGMA-containing bonding resin used in combination with a TEGDMA-containing resin composite hastened and increased TEGDMA diffusion through dentine. A 2-hydroxyethyl methacrylate (HEMA)-containing bonding resin used in combination with a TEGDMA-containing resin composite reduced TEGDMA diffusion only slightly compared with the resin composite alone and added substantial diffusion of HEMA.

CONCLUSION

The bonding resins tested contributed to monomer passage to the pulp space and did not prevent movement of monomer from resin composites to the pulp.

Intra-canal dissolution of Sargenti paste

Although the efficacy and safety of the Sargenti technique have remained controversial for more than a decade, the technique still is widely used by many dentists throughout the world. The following report describes a retrospective analysis of 367 cases that looked at the contribution of instrumentation technique and fill adequacy to paste dissolution.

Diffusion of carbon-14-labeled formocresol and glutaraldehyde in tooth structures

14C-Formocresol and 14C-glutaraldehyde were placed in the root canals of freshly extracted human teeth. The outward diffusion of labeled aldehydes was then measured and autoradiograms of cross-sections taken. No diffusion of glutaraldehyde was detectable within 72 hours, whereas there was a rapidly increasing outflow of formocresol during the same period. In a separate group normal root canal treatment was completed until 2 mm. short of the roentgenologic apex with glutaraldehyde as an irrigant. The walls of the root canals of some of the specimens were examined with electron microscopy and the outflow of 14C-formocresol which was later placed in some specimens was counted. The use of glutaraldehyde as an irrigant resulted in closure of the apical third of the root canal as indicated by the absence of 14C-formocresol diffusion.

The distribution of [14C] leucine and 85Sr labeled microspheres from rat incisor root canals

The distribution of [14C] leucine and 85Sr labeled tracer microspheres from rat incisor pulp canals was investigated in an effort to establish the potential for passage of substances from within the root canal to the systemic circulation. Following introduction of the tracer materials into the pulp canals, the radioactivity in the lungs, spleen, kidney, liver, heart, blood, skeletal muscle, adrenal glands, salivary glands, and submandibular lymph nodes was determined. At all of the time intervals studied the incorporation of [14C] leucine into the adrenal gland was significantly greater than the [14C] leucine incorporation into the other organs. High levels of 85Sr labeled microspheres were detected in the ipsilateral submandibular glands and submandibular lymph nodes and in the lungs.

Release of endotoxin in an experimental model simulating the dental root canal

The action of endotoxin on subcutaneous connective tissue was examined in an experimental model simulating the dental root canal. The local Shwartzman reaction was used as a tool to detect slight tissue alterations that might otherwise go unobserved. The experimental results warrent, in our opinion, the tentative conclusion that the primary toxicity of endotoxins has no major part in the initiation or maintenance of chronic periapical inflammation.

Chelating agents: their effect on the permeability of root canal dentin

An in vitro assessment was made of the ability of three chelating agents used in endodontics to alter the dye penetration of dentinal tubules from the root canal surface. The experiment and control for this study were within the same root. It was found that all three agents significantly reduced the dye penetration into dentin, but there was no difference among the agents in the degree of reduction of dye penetration.