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AIM: To evaluate the influence of an experimental solution of cobalt-doped F18 bioactive glass (F18Co) on tissue repair following regenerative endodontic procedure (REP) in rat molars. METHODOLOGY: The F18Co solution was prepared at a ratio of 1:5 F18Co powder to distilled water. The right or left upper first molars of 12 Wistar rats were used, where the pulps were exposed, removed, and irrigated with 2.5% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA) (5 min each). Subsequently, the molars were divided into two groups (n = 6): REP-SS and REP-F18Co, where they received a final irrigation (5 min) with saline solution (SS) or F18Co solution, respectively. Then, intracanal bleeding was induced, and the tooth was sealed. Untreated molars were used as controls (n = 3). At 21 days, the rats were euthanized, and the specimens were processed for analysis of mineralized tissue and soft tissue formation inside the root canal using haematoxylin-eosin. The presence and maturation of collagen were evaluated by Masson's trichrome and picrosirius red staining. Immunolabelling analyses of proliferating cell nuclear antigen (PCNA) and osteocalcin (OCN) were performed. The data were submitted to the Mann-Whitney U-test (p < .05). RESULTS: There was a similar formation of mineralized tissue in thickness and length in REP-SS and REP-F18Co groups (p > .05). Regarding the presence of newly formed soft tissue, most specimens of the REP-F18Co had tissue formation up to the cervical third of the canal, whilst the REP-SS specimens showed formation up to the middle third (p < .05), and there was higher maturation of collagen in REP-F18Co (p < .05). The number of PCNA-positive cells found in the apical third of the root canal was significantly higher in the F18Co group, as well as the OCN immunolabelling, which was severe in most specimens of REP-F18Co, and low in most specimens of REP-SS. CONCLUSION: The final irrigation with F18Co bioactive glass solution in REP did not influence mineralized tissue formation but induced soft tissue formation inside the root canals, with higher collagen maturation, and an increase in PCNA-positive cells and OCN immunolabelling.

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INTRODUCTION: Regenerative endodontic procedures provide conditions for the continuity of apical formation and increase of the dentin wall thickness, being a useful technique to resume root development of necrotic teeth with incomplete apex. This study aimed to evaluate the coronal discoloration promoted by a new intracanal calcium silicate-based dressing and compare it with other intracanal dressings used in regenerative endodontic procedures. METHODS: Sixty bovine incisors were prepared to simulate teeth with incomplete apexes and divided according to the intracanal dressing used: triple antibiotic paste-double antibiotic paste-DAP, calcium hydroxide associated with 2% chlorhexidine gel, calcium hydroxide associated with saline solution, and Bio-C Temp. As control, no dressing was performed. The intracanal dressings remained in the simulated root canal for 21 days. Luminosity (ΔL) and color difference (ΔEab and ΔE00) were evaluated using long-term (1 year) spectrophotometric analysis. The results were analyzed using the ANOVA test with Tukey post hoc with a significance of 5%. RESULTS: Triple antibiotic paste showed the highest values of ΔEab and ΔE00 and lowest values of ΔL (P < .05). Bio-C Temp showed higher ΔEab than the other groups from 6 months (P < .05), higher ΔE00 and lower ΔL after 1 year (P < .05). CONCLUSIONS: Bio-C Temp induced noticeable coronary discoloration after the 1-year analysis.

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The aim of this report is to present the results of a personalised endodontic treatment for an immature molar, using regenerative endodontic procedure (REP) combined with non-surgical root canal treatment (NSRCT), with 7 years of follow-up. The tooth#3 presented combined endodontic pathologies in each root, with different pulpal and periapical status. A REP in the palatal (P) canal and a NSCRT in the mesio-buccal (MB) and disto-buccal (DB) canals were performed. Absence of clinical signs/symptoms and continuous palatal root development with apical closure were observed over 4-years. After 5-years an apical lesion in the MB root was observed. Both MB canals were selectively retreated by completely filling them with TotalFill BC RRM Fast Set putty. After 7-years, the tooth remained functional and the apical lesion was resolving. The palatal root was completely mature. This case report reveals the potential for use of combined treatment approaches for immature multirooted teeth.

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Este estudo avaliou a influência da fibrina rica em plaquetas injetável (i-PRF) no reparo após procedimento endodôntico regenerativo (REP) em molares imaturos de ratos. Molares superiores direito ou esquerdo de 18 ratos foram divididos em grupos (n = 6): SI ­ foi removido o tecido pulpar do canal mesial, feita irrigação com hipoclorito de sódio e ácido etilenodiaminotetracético, e induzido o sangramento intracanal (SI); iPRF ­ após protocolo de irrigação, foi inserido no interior do canal radicular a i-PRF, sem indução do SI; i-PRF-SI ­ foi realizado o tratamento como no grupo i-PRF, e então, induzido o SI. Ao término, os dentes foram selados. Para produzir a i-PRF, outros 3 animais foram utilizados para a coleta sanguínea intracardíaca, e o sangue foi centrifugado (1200 rpm, 8 min). Aos 21 dias, os animais foram eutanasiados e as peças preparadas para análise histológica e imunohistoquímica para antígeno nuclear de proliferação celular (PCNA) e osteocalcina (OCN). Teste estatístico foi aplicado (p < 0,05). Houve formação de tecido mineralizado em comprimento ou espessura da raiz em todos os grupos (p > 0,05). A formação de tecido conjuntivo nos canais ocorreu até terço médio na maior parte dos espécimes de SI, e até terço cervical em i-PRF e i-PRF-SI (p < 0,05). Houve células semelhantes a odontoblastos no terço apical de metade dos espécimes de i-PRF, e terços apical e médio na maior parte dos espécimes de i-PRF-SI; estas células não foram encontradas no grupo SI (p < 0,05). Os espécimes dos grupos i-PRF e i-PRF-SI tiveram significante número de células positivas para PCNA (p < 0,05) e maior imunomarcação de OCN, principalmente o grupo i-PRF-SI quando comparado ao grupo SI (p < 0,05). Conclui-se que i-PRF auxiliou o processo de reparo após REP em ratos, induzindo formação de tecido conjuntivo nos canais radiculares, presença de células semelhantes a odontoblastos e células positivas para PCNA, e imunomarcação de OCN, principalmente quando associada ao SI.

This study evaluated the influence of injectable platelet-rich fibrin (i-PRF) on repair after regenerative endodontic procedure (REP) in immature molars of rats. Right or left upper molars of 18 rats were divided into groups (n = 6): IB ­ the pulp tissue of the mesial canal was removed, irrigation with sodium hypochlorite and ethylenediaminetetraacetic acid was performed, and intracanal bleeding (IB) was induced; i-PRF ­ after the irrigation protocol, i-PRF was inserted inside the root canal, without inducing of IB; i-PRF-IB ­ the treatment was carried out as in the i-PRF group and then the IB was induced. At the end, the teeth were sealed. To produce the i-PRF, another 3 animals were used for intracardiac blood collection, and the blood was centrifuged (1200 rpm, 8 min). After 21 days, the animals were euthanized and the samples were prepared for histological and immunohistochemical analysis for proliferating cell nuclear antigen (PCNA) and osteocalcin (OCN). Statistical test was applied (P < 0.05). There was formation of mineralized tissue in root length or thickness in all groups (P > 0.05). The formation of connective tissue in the canals occurred up to the medium third in most IB specimens, and up to the cervical third in i-PRF and iPRF-IB (P < 0.05). There were odontoblast-like cells in the apical third of half of the PRF specimens, and apical and medium thirds in most of the i-PRF specimens; these cells were not found in the IB group (P < 0.05). The i-PRF and i-PRF-IB group had significant higher number of PCNA-positive cells (P < 0.05), and higher OCN immunolabeling, mainly i-PRF-IB compared to IB group (P < 0.05). It is concluded that i-PRF helped the repair process after REP in rats, inducing connective tissue formation in root canals, presence of odontoblast-like and PCNA-positive cells, and OCN immunolabeling, mainly when associated with IB.

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Este estudo avaliou os efeitos de uma solução experimental de vidro bioativo F18 dopado com cobalto (F18Co) no reparo tecidual após procedimento endodôntico regenerativo (REP, do inglês regenerative endodontic procedure) em molares de ratos. A solução de F18Co foi preparada misturando o pó de F18Co com água destilada na proporção de 1:5. Os primeiros molares superiores direito ou esquerdo de 12 ratos Wistar foram utilizados, nos quais as polpas foram expostas, removidas e os canais irrigados com hipoclorito de sódio (NaOCl) 2,5%, seguido de ácido etilenodiaminotetraacético (EDTA) 17% (5 min cada). Em seguida, os molares foram divididos em dois grupos (n = 6): REP-SS e REP-F18Co, nos quais receberam irrigação final (5 min) com solução salina (SS) ou solução de F18Co, respectivamente. Em seguida, foi induzido sangramento intracanal e o dente foi selado. Molares não tratados foram usados como controles (n = 3). Após 21 dias, os ratos foram eutanasiados e as peças processadas para análise da formação de tecido mineralizado e tecido mole dentro do canal radicular, pela técnica de hematoxilinaeosina. A presença e maturação do colágeno foram avaliadas por coloração de tricrômio de Masson e picrosírius red. Análises da imunomarcação do antígeno nuclear de proliferação celular (PCNA) e osteocalcina (OCN) foram realizadas. Os dados foram submetidos ao teste de Mann-Whitney U (p < 0,05). Houve formação semelhante de tecido mineralizado em espessura e comprimento nos grupos REP-SS e REP-F18Co (p > 0,05). Em relação à presença de tecido neoformado no interior dos canais radiculares, a maioria dos espécimes de REP-F18Co apresentou formação de tecido até o terço cervical do canal radicular, enquanto do grupo REP-SS, até o terço médio (p < 0,05), e houve maior maturação colágena em REP-F18Co (p < 0,05). O número de células positivas para PCNA encontradas no terço apical do canal radicular foi significativamente maior em REP-F18Co, assim como a imunomarcação de OCN, que foi severa na maior parte dos espécimes do grupo REP-F18Co, e leve em REPSS. Conclui-se que a irrigação final com solução de biovidro F18Co em REP não influenciou a formação de tecido mineralizado, mas induziu a formação de tecido conjuntivo no interior dos canais radiculares, com maior maturação colágena, aumento no número de células positivas para PCNA e na imunomarcação de OCN.

This study evaluated the influence of an experimental solution of cobalt-doped F18 bioactive glass (F18Co) on tissue repair following regenerative endodontic procedure (REP) in rat molars. The F18Co solution was prepared at a ratio of 1:5 F18Co powder to distilled water. The right or left upper first molars of 12 Wistar rats were used, where the pulps were exposed, removed, and irrigated with 2.5% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA) (5 min each). Subsequently, the molars were divided into two groups (n = 6): REP-SS and REP F18Co, where they received a final irrigation (5 min) with saline solution (SS) or F18Co solution, respectively. Then, intracanal bleeding was induced, and the tooth was sealed. Untreated molars were used as controls (n = 3). At 21 days, the rats were euthanized, and the specimens were processed for analysis of mineralized tissue and soft tissue formation inside the root canal using haematoxylin-eosin. The presence and maturation of collagen was evaluated by Masson's trichrome and picrosirius red staining. Immunolabeling analyses of proliferating cell nuclear antigen (PCNA) and osteocalcin (OCN) were performed. The data were submitted to the Mann-Whitney U test (P < 0.05). There was similar formation of mineralized tissue in thickness and length in REP-SS and REP-F18Co groups (P > 0.05). Regarding the presence of newly formed soft tissue, most specimens of the REP-F18Co had tissue formation up to the cervical third of the canal, while the REP-SS specimens showed formation up to the middle third (P < 0.05), and there was higher maturation collagen in REP-F18Co (P < 0.05). The number of PCNA-positive cells found in the apical third of the root canal was significantly higher in the F18Co group, as well as the OCN immunolabeling, which was severe in most specimens of REP-F18Co, and low in most specimens of REP SS. In conclusion, the final irrigation with F18Co bioactive glass solution in REP did not influence mineralized tissue formation but induced soft tissue formation inside the root canals, with higher collagen maturation, and an increase in PCNA-positive cells and OCN immunolabeling

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Introdução: A revascularização pulpar é uma terapêutica que visa regenerar parte do complexo dentino pulpar, proporcionando a continuidade do desenvolvimento radicular, sanando a fragilidade e propensão a fratura que a apicificação apresentava. É um tratamento direcionado a dentes diagnosticados com rizogênese incompleta. Entretanto, a possibilidade de realização da técnica em dentes maduros tem sido alvo de pesquisas e estudo. Objetivo: O objetivo deste estudo, é apresentar através da revisão de literatura e caso clínico, os benefícios dos procedimentos endodônticos regenerativos (REPs), em dentes jovens e maduros, em relação à apicificação. Metodologia: O estudo é uma revisão de literatura, desenvolvida através de pesquisa exploratória e realizada uma abordagem qualitativa. Para a coleta de dados, foi aplicada a técnica de análise documental e revisão bibliográfica consultando PUBMED, Scielo, Google Acadêmico e monografias acadêmicas. O caso clínico foi realizado de acordo com o protocolo atualizado pela AAE em 2016. Discussão: A revascularização pulpar tem mostrado ser um tratamento promissor na endodontia, é preconizada a desinfecção e medicação intracanal, já que não pode haver instrumentação mecânica. Os agentes irrigadores devem ser bactericidas, bacteriostáticos e devem ter baixo teor de toxicidade, já a medicação intracanal deve ter papel inibidor em bactérias gram positivas e gram negativas. Conclusão: A apicificação mesmo com o uso de MTA, que não exige trocas excessivas de medicações, não sana as necessidades que um dente com rizogênese incompleta requer. Sendo assim, a revascularização foi eleita o tratamento de melhor prognóstico para dentes jovens e necrosados. O caso clínico demonstrou qualidade moderada, no tratamento regenerativo em um dente maduro com reabsorção externa, abrindo novas perspectivas para os (REPs)(AU)

Introduction: Pulp revascularization is a therapy that aims to regenerate part of the pulp dentin complex, providing continuity of root development, remedying the fragility and propensity to fracture that apexification presented. It is a treatment aimed at teeth diagnosed with incomplete rhizogenesis. However, the possibility of performing the technique on mature teeth has been the subject of research and study. Objective: The aim of this study is to present, through literature review and clinical case, the benefits of regenerative endodontic procedures (REPs), in young and mature teeth, in relation to apexification. Methodology: The study is a literature review, developed through exploratory research and carried out a qualitative approach. For data collection, the technique of document analysis and bibliographic review was applied, consulting PUBMED, Scielo, Academic Google and academic monographs. The clinical case was performed according to the protocol updated by the SEA in 2016. Discussion: Pulp revascularization has shown to be a promising treatment in endodontics, intracanal disinfection and medication is recommended, as there can be no mechanical instrumentation. Irrigating agents must be bactericidal, bacteriostatic and must have a low level of toxicity, whereas intracanal medication must have an inhibiting role in gram positive and gram negative bacteria. Conclusion: Apexification, even with the use of MTA, which does not require excessive medication changes, does not meet the needs that a tooth with incomplete rhizogenesis requires. Therefore, revascularization was chosen as the treatment with the best prognosis for young and necrotic teeth. The clinical case demonstrated moderate quality in regenerative treatment in a mature tooth with external resorption, opening new perspectives for (REPs)(AU)

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