VEGF/BMP-2 loaded three-dimensional model for enhanced angiogenic and odontogenic potential of dental pulp stem cells

AIM

To investigate the proliferation and differentiation potential of human dental pulp stem cells (DPSCs) in a three-dimensional culture model (TDM) by incorporation of VEGF and BMP-2.

METHODOLOGY

TDM was established using fibrin gel (fg) as a soft tissue matrix and demineralized dentine disc (dd) as a hard tissue matrix. DPSCs and vascular endothelial growth factor (VEGF) were encapsulated in fibrin gel (fg-VEGF) and then inserted into bone morphogenetic protein (BMP-2)-coated demineralized dentine discs (dd-BMP-2). DPSCs were incubated for 28 days in various fg/dd combinations in the absence or presence of VEGF and BMP-2. Proliferation and morphology of DPSCs in fibrin gel were analysed using MTT and Live&Dead assays. Release profiles of VEGF and BMP-2 from fibrin gel and dentine discs were quantified using ELISA, and the expressions of angiogenic and odontogenic differentiation markers were determined with RT-qPCR analysis. Data were analysed statistically using Wilcoxon signed rank tests, Kruskal-Wallis tests with Mann-Whitney U tests and Bonferroni adjustment. The level of significance was set at P < 0.05.

RESULTS

DPSCs were able to proliferate and showed interconnected cellular elongations in fibrin gel depending on fibrinogen concentration whilst monolayer control group showed typical fibroblast-like cell morphology. Encapsulating of VEGF in fibrin gel and BMP-2 in gelatin that was used to coat dentine discs allowed the controlled releases of growth factors, which induced angiogenic and odontogenic gene expressions by DPSCs. Higher expressions of PECAM as an angiogenic factor, and BSP, DMP-1, OCN and CBFA as odontogenic factors, were observed in TDM as compared to the other fg/dd combinations and the monolayer control group (P < 0.05).

CONCLUSIONS

TDM consisting of fibrin gel and dentine matrix allowed cell-cell interactions. TDM was highly effective in delivering both VEGF and BMP-2 that enhanced the angiogenic and odontogenic potential of DPSCs.

Influence of nickel-titanium rotary systems with varying tapers on the biomechanical behaviour of maxillary first premolars under occlusal forces: a finite element analysis study

AIM

To evaluate the effect of three nickel-titanium (Ni-Ti) rotary systems with varying tapers on stress distribution and to analyse potential fracture patterns as well as the volume of fracture-susceptible regions in two-rooted maxillary premolars.

METHODOLOGY

The root canals of three single-rooted premolars were prepared with either HeroShaper (Micro-Mega, Besançon, France) to (size 30, .04 taper), Revo-S (Micro-Mega) to AS30 (size 30, .06 taper) or ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland) to F3 (size 30, .09 taper) Ni-Ti files. The three root canals were scanned using micro-computed tomography (μCT) (Skyscan 1174, Skyscan, Kontich, Belgium) and modelled according to the μCT data. An intact tooth model with a root length of 16 mm was also constructed based on μCT images of an extracted maxillary premolar with two roots. New models were constructed by replacing both of the original canals of the intact two-rooted premolar model with the modelled canals prepared with the HeroShaper, Revo-S or ProTaper Universal system. Occlusal forces of 200 N were applied in oblique and vertical directions. Finite element analysis was performed using Abaqus FEA software (Abaqus 6.14, ABAQUS Inc., Providence, RI, USA).

RESULTS

Upon the application of oblique occlusal forces, the palatal external cervical root surface and the bifurcation (palatal side of the buccal root) in tooth models experienced the highest maximum principal (Pmax) stresses. The application of vertical forces resulted in minor Pmax stress values. Models prepared using the ProTaper system exhibited the highest Pmax stress values. The intact models exhibited the lowest Pmax stress values followed by the models prepared with the HeroShaper system.

CONCLUSION

The differences in Pmax stress values amongst the different groups of models were mathematically minimal under normal occlusal forces. Rotary systems with varying tapers might predispose the root fracture on the palatal side of the buccal root and cervical palatal root surface in two-rooted premolars.

Fracture resistance of the buccal cusps of root filled maxillary premolar teeth restored with various techniques

AIM

To compare the cusp fracture resistance of teeth restored with composite resins and two post systems.

METHODOLOGY

Eighty extracted single-rooted human maxillary premolars were randomly assigned to eight groups (n = 10). Group 1 (control) did not receive any preparation. From groups 2 to 8, the teeth were root filled and mesio-occluso-distal (MOD) cavities were prepared. Group 2 remained unrestored. Group 3 was restored with packable resin composite using a single-step adhesive. Group 4 was restored with packable resin composite using a single-step adhesive and a thin layer of flowable resin composite. Group 5 was restored with packable resin composite using a total-etch two-step adhesive. Group 6 was restored with ormocer resin composite using a total-etch two-step adhesive. Group 7 was restored with an endodontic glass fibre post and hybrid resin composite using a total-etch two-step adhesive. Group 8 was restored with an endodontic zirconium post and hybrid resin composite using a total-etch two-step adhesive. The teeth were then mounted in a universal testing machine, the buccal cusp loaded (30 degrees ) until fracture, and the data analysed statistically.

RESULTS

Group 1 had the greatest fracture resistance, and group 2 the poorest. Groups 5-8 had significantly greater (P < 0.05) fracture resistance than groups 3 and 4. No significant differences were found between groups 3 and 4, or amongst groups 5-8 (P > 0.05).

CONCLUSIONS

For root filled maxillary premolars with MOD cavities, adhesive resin composite restorations, with and without glass and zirconium posts, increased the fracture resistance of the buccal cuSPS. A total-etch two-step adhesive increased significantly fracture resistance more than a one-step adhesive. For the one-step adhesive, an additional layer of flowable resin composite did not enhance fracture resistance.

C-shaped root canal in a maxillary first molar: a case report

AIM

This case report presents an unusual C-shaped root canal system in a maxillary first molar tooth.

SUMMARY

Although C-shaped root canals are most frequently seen in the mandibular second molar, they may also appear in maxillary molars. A literature search revealed only a few case reports of C-shaped root canal systems in maxillary molars. The present case describes a C-shaped canal in the buccal root of a maxillary first molar. The endodontic access cavity displayed two canal orifices, one leading to the canal system in the buccal root, the other into the palatal root canal system. In the buccal root, what appeared to be the mesial and distal canals joined to form a single C-shaped canal.

KEY LEARNING POINTS

--Careful examination of radiographs and the internal anatomy of teeth is essential.-- The location and morphology of root canals should be identified at high magnification under the microscope.

In vitro fracture resistance of root-filled teeth using new-generation dentine bonding adhesives

AIM

To compare the fracture resistance of root-filled premolar teeth restored with new-generation dentine bonding adhesives.

METHODOLOGY

Sixty extracted single-rooted human maxillary premolar teeth were used. Access cavities were prepared, and the roots were instrumented with K-files to an apical size 50 using a step-back technique. Root fillings were accomplished using gutta percha (Sure-Endo, Seoul, Korea) and AH Plus root canal sealer (Dentsply DeTrey, Konstanz, Germany) using the lateral condensation technique. The teeth were then randomly divided into six groups of 10 teeth each. A mesiodistocclusal (MOD) cavity was prepared in the teeth to the level of the canal orifices so that the thickness of the buccal wall of the teeth measured 2 mm at the occlusal surface and 3 mm at the cemento-enamel junction. Preparations were restored using the following adhesive systems: Etch & Prime 3.0 (Degussa AG, Hanau, Germany), Clearfil SE Bond (Kuraray, Osaka, Japan), Prompt L-Pop (ESPE, Seefeld, Germany), Panavia F (Kuraray, Osaka, Japan), Optibond Plus (Kerr, Orange, CA, USA) and Admira Bond (Voco, Cuxhaven, Germany); all preparations except those of the Panavia F and Admira Bond groups were further restored with resin composites. The Panavia F group was restored with amalgam and the Admira Bond group with Ormocer (Voco, Cuxhaven, Germany). The teeth were mounted in a Universal Testing Machine (Hounsfield, Surrey, UK), and the buccal walls were subjected to a slowly increasing compressive force until fracture occurred. The force of fracture of the walls of each tooth was recorded and the results in the various groups were compared. Statistical analysis of the data was accomplished using one-way anova.

RESULTS

There was no significant difference in the fracture resistance of any of the test groups.

CONCLUSIONS

In this laboratory study, the type of dentine bonding agents had no influence in the fracture resistance of teeth.

Comparison of the cytotoxic effects and smear layer removing capacity of oxidative potential water, NaOCl and EDTA

This study compared the smear layer removing capability and cytotoxicity of NaOCl, EDTA and Oxidative Potential Water (OPW). Fifteen extracted single-rooted human upper incisors were examined in three groups. The root canals were enlarged to the apical foramen with K files to size #60 and irrigated with: (a) NaOCl followed by OPW, (b) OPW during and after instrumentation and (c) NaOCl followed by EDTA and NaOCl. The effect of these irrigants on the smear layer was evaluated using a scanning electron microscope. In vitro cytotoxicity of these irrigants was examined by MTT colorimetric assay. We found that the combination of NaOCl and OPW as well as the application of OPW alone, failed to remove the smear layer from the apical third, whereas the EDTA and NaOCl combination achieved complete removal. OPW, when used during and after instrumentation, removed the smear layer in the middle third more effectively than NaOCl followed by OPW. EDTA exerted more cytotoxic effects at all concentrations tested when compared with OPW and NaOCl.

IN CONCLUSION

(a) OPW was less cytotoxic than other irrigants but did not effectively remove the smear layer, (b) treatment with EDTA followed by NaOCl efficiently removed of the smear layer, but their cytotoxicity should be considered during endodontic therapy.

Smear layer removal by EGTA

The purpose of this study was to compare the effects of ethylene glycol-bis (beta-aminoethyl ether)-N,N,N', N'-tetraacetic acid (EGTA) and EDTA on removal of the smear layer by using scanning electron microscopy. Fifteen single-rooted teeth were instrumented to size 60. Three teeth served as the control group, and the remaining teeth were assigned into two groups. After instrumentation, root canals of the first group were irrigated with 10 ml of 17% EDTA, and the second group was irrigated with 10 ml of 17% EGTA for 2 min. Both were then irrigated with 10 ml of 5% NaOCl. The teeth in the control group were irrigated with only 10 ml of 5% NaOCl. Then the specimens were sectioned longitudinally and processed for scanning electron microscopy. The results showed that the smear layer was completely removed by EDTA, but it caused erosion of the tubuli. EGTA was somewhat effective in removing the smear layer without inducing erosion. Our results suggest that EGTA is an alternative chelator for removing the smear layer.

Evaluation of the cytotoxicity of calcium phosphate root canal sealers by MTT assay

The purpose of this study was to evaluate the cytotoxicity of some calcium phosphate-based sealers (Sankin apatite root canal sealers (SARCS) types 1 to 3) in comparison with currently used sealers (CRCS, Ketac Endo, AH26, and Endomethasone) by using MTT assay on L929 cells. Monolayer cell cultures were prepared on 96-well plates. After incubation at 37 degrees C in a humidified 5% CO2-containing air atmosphere for 24 h in the presence of each sealer extracts, 25 microliters of 5 mg/ml of MTT in saline were added into each well and incubated a further 3 h at 37 degrees C. A solubilization buffer consisting of 23% sodium dodecyl sulfate in 50% N,N-dimethylformamide (pH 4.7) was used to dissolve formazan precipitate. The optical densities of the plates were then read by a microplate spectrophotometer at 570 nm. Greater magnitude of optical density due to intense blue coloring is regarded as showing a higher percentage of cell viability. Among the different types of sealers, SARCS types 1 to 3 and CRCS did not exert any cytotoxic effects, whereas AH26, Ketac Endo, and Endomethasone produced some cytotoxicity.

Histological and densitometric analysis of the effects of exogeneous heparin on rat pulp tissues

In this study, the effects of heparin on dentinal resorption was investigated in rats. Animals were injected with 2 x 2 IU/g Na-Heparin subcutaneously for 33 days. Histopathological examination of the anterior teeth revealed capillary proliferation, congestion, and fibrosis in the pulp in addition to resorptive lacunae and degenerative bone spiculae in the peripheral bone tissue. Development of fibrosis in the pulp tissue was verified by densitometric analysis, which revealed a 30% increases in mean density after heparin administration. No resorption at all, however, was seen in dentin.

Dentinal tubule penetration of root canal sealers after root canal dressing with calcium hydroxide

The purpose of this study was to evaluate the dentinal tubule penetration of root canal sealers after root canal dressing with calcium hydroxide (Ca(OH)2). Forty-two single-rooted teeth were instrumented to size 60. Six teeth served as the control group, and the remaining teeth were assigned to two groups. Root canals of the first group were filled with the Ca(OH)2 paste; the second group was filled with TempCanal, and all were incubated for 7 days. The samples were either irrigated with only NaOCl or with EDTA, followed by NaOCl to remove Ca(OH)2. All of the teeth were obturated with CRCS, AH26, and Ketac Endo by a lateral condensation technique. The specimens were then kept at the same conditions for another 7 days, and then all of the roots were prepared for scanning electron microscopic evaluation. Scanning electron microscopic examination revealed that Ca(OH)2 was not completely removed from the root canal surfaces, and root canal sealers did not penetrate into the dentinal tubules when only NaOCl was used. EDTA followed by NaOCl irrigation resulted in complete removal of Ca(OH)2 and root canal sealers penetrated into the dentinal tubules.

pH changes and calcium ion diffusion from calcium hydroxide dressing materials through root dentin

The purpose of this study was to evaluate Ca2+ and OH- diffusion properties through root dentin by using different calcium hydroxide (CH) dressing materials. Twenty-eight single-rooted teeth were instrumented and external defects were created on the root surface. 17% EDTA was used to eliminate the smear layer. All surfaces except the external defects were sealed, and the teeth were placed in normal saline. Ca2+ concentrations and the pH in the saline were determined for 3 days as the control period. After removing the teeth from normal saline, they were filled with: (i) DT Temporary Dressing CH; (ii) CH powder and normal saline; (iii) TempCanal; and (iv) CH points. The teeth were then placed in normal saline, and Ca2+ concentrations and pH values were measured at 1, 3, 7, 14, and 28 days. Nonsetting CH pastes gradually released Ca2+, whereas this increase was absent from CH points. None of the test materials induced a pH increase in the media during the observation period. This study demonstrated that, when nonsetting CH pastes are applied to the root canal, diffusion of Ca2+ without an increase in pH to the surrounding media occurs. This implies that these type of material are more suitable than CH points for treatment of external root resorption.

Comparative neurotoxic effects of root canal filling materials on rat sciatic nerve

The neurotoxic effects of the root canal filling materials--Endomethasone, N2 Universal, Traitement SPAD, Sealapex, and Calciobiotic Root Canal Sealer (CRCS)--were investigated on isolated rat sciatic nerves after local application. All of the canal filling materials reversibly inhibited the compound action potential (cAP) amplitudes. N2 Universal produced a 50% inhibition in 4.2 +/- 0.2 min. Traitement SPAD, Endomethasone, and CRCS produced the same inhibition in 6.4 +/- 0.3, 6.5 +/- 0.2, and 6.6 +/- 1.1 min, and Sealapex in 9.2 +/- 2.0 min. The inhibitory effect of Sealapex decreased fastest, and 43% recovery of cAP amplitude was observed in 60 to 70 min. The inhibitory effects of Endomethasone, CRCS, and N2 Universal were more pronounced, and 10 to 20% recovery in cAP amplitudes were observed in 2 h. The inhibitory effect of Traitement SPAD was more persistent with 4% recovery in 2.5 h.