Root canal treatment of compromised teeth as alternative treatment for patients receiving bisphosphonates: 60-month results of a prospective clinical study

AIM

This 60-month prospective study aimed to evaluate tooth survival and healing rates after root canal treatment in patients taking bisphosphonates (BPs). Secondary outcomes were complications and clinical variables observed during and after treatment.

METHODS

Root canal treatment was performed using manual K-file canal instrumentation and a carrier-based filling technique with an epoxy resin-based sealer. Teeth without adequate root/crown integrity were restored by trained operators at the tissue level (TL group) to prevent occlusal/mechanical stress and to enable periapical lesion healing without the risk of root fracture. Other teeth were restored with normal occlusal contacts (OC group). Healthy patients who had undergone one or more root canal treatments of the same type constituted the control group. The relationships of the following variables to survival and health status were examined (chi-squared test and multivariate analysis, P = 0.05): age, gender, smoking habit, tooth location, treatment type, BPs treatment, BPs exposure, initial periapical index (PAI) and occlusal restoration. Survival curves were constructed using Kaplan-Meier analysis, with extraction serving as the end-point.

RESULTS

In total, 65 patients with 109 root canal-treated teeth who were taking BPs were included. At 60 months, data from 57 patients (52F, 5M; median age 65.7 ± 8.6 years) who had undergone 96 root canal treatments were analysed (drop-out rate = 16.9%). The survival rate was 85%, and the success rate was 76%. The control group consisted of 46 patients (21F, 25M; median age 60.3 ± 7.2 years) who had undergone 102 root canal treatments. The survival rate was 88%, with 12 teeth lost during follow-up. The success rate was 73%. In the BP group, 55 teeth were restored normally (OC group) and 41 teeth were restored at the tissue level (TL group). No difference in the success or survival rate was observed between the BP and control groups (P > 0.05). Univariate Kaplan-Meier analysis revealed that only tooth type significantly affected survival status in the BP group. The analysis revealed the clinical relevance of smoking, tooth location and initial PAI on patients' health status (P < 0.05).

CONCLUSION

Root canal treatments and post-endodontic restoration with tissue-level filling procedures represent a safe approach for severely damaged teeth in patients receiving BPs having comparable results to root filled teeth restored with occlusal contacts and to the control group.

Osteoinduction by Chitosan-Complexed BMP: Morpho-Structural Responses in an Osteoporotic Model

Bone quality is the result of a complex relationship between bone mass, bone structure, and mechanical characteristics of these individual components. The mass of bone tissue is affected by nutritional factors and other causes, such as bone growth factors like bone morphogenetic proteins (BMPs). Since chitosans promote ordered regeneration of soft tissue and osteoinduction, an osteoporotic model was studied to evaluate the pattern of bone regeneration in the presence of BMP linked to chitosan. BMP was released from the chitosan matrix as a consequence of chitosan biodegradation. Our data show that the association of BMP with chitosan seemed to improve the bone tissue regeneration in a surgical bone defect. This result provides validity to biochemical approaches for therapeutical correction of afflictions in the elderly, such as osteoporosis.

Osteoinduction in the Presence of Chitosan-Coated Porous Hydroxyapatite

Hydroxyapatite nails, prepared according to a novel method and endowed with better mechanical resistance, were coated with chitosan to impart enhanced biocompatibility and were introduced in the femurs of rabbits. Chitosan was found to be a favorable interface between bone and hydroxyapatite because it promoted an osteoconductive reaction.

Micro-topography and reactivity of implant surfaces: an in vitro study in simulated body fluid (SBF)

The creation of micro-textured dental implant surfaces possessing a stimulating activity represents a challenge in implant dentistry; particularly, the formation of a thin, biologically active, calcium-phosphate layer on their surface could help to strengthen the bond to the surrounding bone. The aim of the present study was to characterize in terms of macrostructure, micro-topography and reactivity in simulated body fluid (SBF), the surface of titanium (Ti) implants blasted with TiO2 particles, acid etched with hydrofluoric acid, and activated with Ca and Mg-containing nanoparticles. Sandblasted and acid-etched implants were analyzed by ESEM-EDX (environmental scanning electron microscope with energy dispersive X-ray system) to study the micromorphology of the surface and to perform elemental X-ray microanalysis (microchemical analyses) and element mapping. ESEM-EDX analyses were performed at time 0 and after a 28-day soaking period in SBF Hank's balanced salt solution (HBSS) following ISO 23317 (implants for surgery—in vitro evaluation for apatite-forming ability of implant materials). Microchemical analyses (weight % and atomic %) and element mapping were carried out to evaluate the relative element content, element distribution, and calcium/phosphorus (Ca/P) atomic ratio. Raman spectroscopy was used to assess the possible presence of impurities due to manufacturing and to investigate the phases formed upon HBSS soaking. Micro-morphological analyses showed a micro-textured, highly rough surface with microgrooves. Microchemical analyses showed compositional differences among the apical, middle, and distal thirds. The micro-Raman analyses of the as-received implant showed the presence of amorphous Ti oxide and traces of anatase, calcite, and a carbonaceous material derived from the decomposition of an organic component of lipidic nature (presumably used as lubricant). A uniform layer of Ca-poor calcium phosphates (CaPs) (Ca/P ratio <1.47) was observed after soaking in HBSS; the detection of the 961 cm⁻¹ Raman band confirms this finding. These implants showed a micro-textured surface supporting the formation of CaPs when immersed in SBF. These properties may likely favor bone anchorage and healing by stimulation of mineralizing cells.

Dynamic sealing ability of MTA root canal sealer

AIMS

To evaluate (i) the sealing ability of two sealers, mineral trioxide aggregate sealer (MTAS) and Pulp Canal Sealer (PCS), used with gutta-percha utilizing the fluid filtration method, (ii) leaching and surface characteristics in Hank's balanced salt solution (HBSS) over a period of time.

METHODOLOGY

Surface characteristics in HBSS were evaluated under the scanning electron microscope after 1 and 28 days, and the leaching of both sealers were assessed by inductively coupled plasma atomic absorption spectrometry (ICP-AAS). In addition, 24 single rooted extracted teeth were root filled using warm vertical compaction with either MTAS or PCS used as sealers with gutta-percha. Four teeth were used as positive and negative controls. Sealing ability was evaluated after 1 or 28 days using the fluid filtration method.

RESULTS

Mineral trioxide aggregate sealer exhibited crystalline deposits rich in calcium and phosphorus on its surface when in contact with a physiological solution. These crystalline deposits were absent in PCS and on MTAS stored at 100% humidity. The sealing ability of MTAS was similar to that of PCS.

CONCLUSIONS

The novel sealer based on mineral trioxide aggregate had comparable sealing ability to a proprietary brand sealer cement. In contact with a simulated body fluid, the MTA sealer released calcium ions in solution that encouraged the deposition of calcium phosphate crystals.

MTA and F-doped MTA cements used as sealers with warm gutta-percha. Long-term study of sealing ability

AIM

To evaluate the long-term sealing ability (up to 6 months) of two experimental calcium silicate MTA cements used as root canal sealers in association with warm gutta-percha.

METHODOLOGY

Calcium silicate (MTA) and calcium-fluoro-silicate powders were prepared. Sodium fluoride was included in FMTA (Fluoride-doped Mineral Trioxide Aggregate) as an expansive and retardant agent. Single-rooted teeth were instrumented with NiTi rotary instruments, filled with warm gutta-percha in association with one of the experimental sealers or with AH Plus as a control (n = 20 for each sealer) and stored at 37 °C. Sealing was assessed at 24, 48 h, 1, 2 weeks and 1, 3, 6 months by a fluid filtration method. Scanning electron microscopy with energy dispersive analysis (SEM/EDX) was used to study the dentine/sealer interface of roots stored for 6 months and the surface of cement disks stored for 24 h.

RESULTS

All sealers revealed a statistically significant reduction (P < 0.05) in fluid filtration after the first 2 weeks. No statistically significant differences were observed between FMTA and AH Plus at all analysis times. At short times (24, 48-h), no statistically significant differences were found between the experimental cements and AH Plus. At long-term evaluations (1, 3, 6 months), FMTA and AH Plus sealed significantly better (P < 0.05) than MTA. FMTA was associated with lower fluid filtration rates, and the seal was stable from 48 h to 6 months, thus proving the most effective material. Scanning electron microscopy with energy dispersive analysis of root sections filled with calcium silicate sealers revealed the formation of a blend layer of gutta-percha and cement consequent to the warm gutta-percha condensation technique. Scanning electron microscopy with energy dispersive analysis of 24-h-stored disks identified a Ca-rich coating on the outer surface consisting of globular particles (calcium hydroxide and calcium carbonate), and a deeper internal Ca- and Si-rich region consisting of needle-like ettringite crystals and round formations of calcium silicate hydrate gel.

CONCLUSION

Fluoride-doped MTA demonstrated stable sealing during a period of up to 6 months and significantly better than conventional calcium silicate MTA cements and comparable to AH Plus. The study supports the suitability of calcium silicate MTA cements as sealers in association with warm gutta-percha for root filling.

Fluoride release and absorption at different pH from glass-ionomer cements

OBJECTIVE

The aim of this study was to evaluate the fluoride release (release-tests) from two glass-ionomer cements (GIC), before and after NaF solution treatment (fluoride treatment) in different pH environments.

MATERIALS AND METHODS

After 21 days, every second sample was submitted to fluoride treatment to simulate a fluoride recharge. After fluoride treatment every second sample was submitted to a further three days of long release-tests. Sample surfaces were analyzed by SEM before and after the release-tests in all pH solutions studied.

RESULTS

The present study showed that GICs released fluoride ions for the duration of the examination period. For both materials the amount of F(-) released at low pH was considerably greater than at higher pH. The massive superficial breaking up observed by SEM probably promoted the releasing processes. Recharge is possible at different pH levels using NaF solution.

CONCLUSIONS

Fluoride release may depend on GICs surface degradation caused by pH in the solution. The use of this kind of material may be an important issue in patients with with low pH saliva and with a high risks caries.

Bioactivity of chitosan in dentistry. Preliminary data on chitosan-based cements

BACKGROUND

The chemical association of chitosan with inorganic salts, such as calcium phosphate, finds a promising application in dentistry as room-temperature self-hardening cement. We present the physical, chemical and crystallographic characterization of newly-developed cements made of 1) calcium-phosphate and a chitosan gel obtained by acetic acid treatment, and 2) calcium phosphate and a chitosan gel obtained by ascorbic acid treatment. Both cements are self-hardening at room temperature.

METHODS

The cements were characterized by X-ray diffractography, scanning electron microscopy and fluorine-selective electrode analysis.

RESULTS

The chitosan-hydroxyapatite cements had hardness comparable to spongy bone and above that of PMMA.

CONCLUSIONS

The cements are promising for application in endodontics and restorative dentistry.

Osteoblast behaviour in the presence of bisphosphonates: ultrastructural and biochemical in vitro studies

OBJECTIVE

A positive balance in bone remodelling is an important goal of bone metabolism both in the presence of the osteoporotic processes characteristic of ageing and, especially, of prosthetic implants. The aim of the present work was to obtain new information about the initial steps of osteoblastic growth in an in vitro osteoblastic model in the presence of two bisphosphonates.

METHODS

Experiments were performed with Alendronate and Neridronate, two molecules used in the therapy of osteoporosis. Since differentiating features into osteoblastic cells are known to parallel the presence in the cytoplasm of alkaline phosphatase and osteocalcin, we also carried out immunohistochemical typing.

RESULTS

Good differentiation and osteoblastic activity were generally observed in the cells in contact with these compounds, except for 10(-4) Neridronate, where biochemical data clearly indicated its toxic effect on the cells.

CONCLUSION

The detection of osteoblastic markers associated with an ultrastructural picture of correct organellar morphology in our cultures further supports the hypothesis of a metabolically positive action of these molecules on osteoblasts.

Bioactivity modulation of bioactive materials in view of their application in osteoporotic patients

The application of bioactive ceramic coatings to prostheses confers strength to a material (ceramic or biological glass) that exerts beneficial effects on bone-tissue growth but that itself lacks the toughness and stability required of an implant device. The rate of bioactivity is related to the chemical reactivity of the material and causes interface dissolution, precipitation and ion-exchange reactions. Ceramics may differ in sintering temperature and thus exhibit differences in their in vitro dissolution features and in vivo performance. To test these effects, in vitro and in vivo studies were carried out on two biocompatible biological glasses and a ceramic of proven bioactivity in view of their potential utilization as covering materials. In addition, a modified chitosan was adsorbed on the surface of a series of hydroxyapatite (HA) samples. Human fibroblasts and/or osteoblasts were used for the in vitro tests, and normal (INT) and osteoporotic (OVX) rats, normal rabbits and sheep for the in vivo studies. Similar chemical changes were observed in both glasses, suggesting that these materials underwent modifications directly dependent on their biological environment. The in vivo tests point to the possibility of improving the bioactivity of ceramic substrates with chitosan. However, the different behaviour of the materials in vitro and in vivo suggests that these tests should be conducted in parallel.

[Effects of synthetic salmon calcitonin and alendronate on bone quality in ovariectomized rats]

BACKGROUND

The aim of this study was to assess the effect of calcitonin (CCT) and alendronate (ALN) on bone quality through histomorphometric, histological, densitometric and crystallographic evaluations in an experimental model of osteoporosis obtained in ovariectomized rats.

METHODS

The animals were randomly assigned to the treatment with CCT (2 IU/kg/day, N-12) or with ALN (6 micrograms/kg/day, N-12) given subcutaneously, starting three months after ovariectomy: treatment lasted 60 days. Six rats untreated after ovariectomy and other 6 non ovariectomized (intact) were taken as controls. At the end of treatment the animals were sacrificed and femurs explanted for laboratory examinations. Results were evaluated by an ANOVA followed by the Tukey's test when appropriate.

RESULTS

The histomorphometric analysis showed a significant increase of the trabecular bone volume and of the cortical bone thickness either with CCT and ALN in comparison with the ovariectomized untreated controls. Optic and electronic microscopy examinations suggest a higher bone remodeling after ALN than after CCT, but accompanied by areas of imperfect mineralization, and more irregular osteon and collagen fibres disposition. The densitometry carried out at the femoral head and diaphysis showed a similar bone mass increase following either CCT and ALN, but significantly higher in comparison to the untreated controls. At the diaphysis level ALN was superior in increasing the bone mass also when compared to the intact rats. The mineralogic exams showed that CCT acted on the re-elaboration of the mineral phase approaching the molar ratio Ca/PO4 to the physiological values typical of senescence, and crystallography revealed that the formation of hydroxyapatite crystals follows a physiological mineral redeposition: those phenomena were not observed for ALN.

CONCLUSIONS

In conclusion both CCT and ALN could reduce the bone loss due to osteoporosis, by increasing the bone mass and thickness. Nevertheless the submicroscopic and chemical bone structure are less similar to the physiologic ones after treatment with ALN.

Biomaterials for orthopedic surgery in osteoporotic bone: a comparative study in osteopenic rats

To evaluate orthopedic devices in pathological bone, an experimental study was performed by implanting Titanium (Ti) and Hydroxyapatite (HA) rods in normal and osteopenic bone. Twenty-four rats were used: 12 were left intact (

CONTROL

C) while the other 12 were ovariectomized (OVX). After 4 months all the animals were submitted to the implant of Ti or HA in the left femoral condyle (Ti-C, HA-C, Ti-OVX, HA-OVX). Two months later the animals were sacrificed for histomorphometric, ultrastructural and microanalytic studies. Our results show a significant difference between the Affinity Index (A.I.) of HA-C and Ti-C (77.0 +/- 7.4 vs 61.2 +/- 9.7) (p < 0.05). No significant differences were observed between the osteointegration of Ti-C and Ti-OVX (61.2 +/- 9.7 vs 48.2 +/- 6.7). Significant differences also exist between the osteointegration of HA-C and HA-OVX (77.0 +/- 7.4 vs 57.6 +/- 11.5) (p < 0.01). Microanalysis shows some modifications in Sulphur (S) concentration at the bone/biomaterial interface of the Ti-OVX group. Therefore our results confirmed the importance of biomaterials characteristics and of bone quality in osteointegration processes.

Osteoporosis by ovariectomy: calcitonin effect in an experimental model on the rat

The authors evaluate the efficacy of the aminosuberic derivative of eel calcitonin (eCT) in preventing post-ovariectomy osteoporosis in adult rats. The drug is administered in a dose of 0.5 U.I./day for four months starting from the moment of the ovariectomy. The results show that the treatment is efficacious in preventing bone mass loss due to ovariectomy and that the action of the drug does not bring about alterations in the normal crystalline structure of the bone.

Morphological and structural characteristics of the myopathic bone

The aim of the present paper was to study the myopathic bone both from the morphological and structural viewpoints. To this end, samples from 8 patients affected by different neuromuscular diseases (DMD, SMA and CMD) have been examined. Thus, by SEM analysis a quantitative reduction of the trabeculae and an increase in porosity of the myopathic bone were found and also, by diffractometric analysis, the presence of pathologic crystalline phases (beta-TCP and beta-TCP-Mg).