RESUMO
OBJECTIVE: To evaluate the effect of enamel matrix derivative (EMD) in the regeneration of class II furcation defects, used alone or in conjunction with biomaterials. METHODS: Electronic database searches and hand searches were carried out and double-blind randomized controlled trials evaluating the use of EMD in class II furcation therapy were included, and a meta-analysis comparing the effect of open flap debridement (OFD) + ßTCP/HA with and without EMD was carried out. RESULTS: The initial search resulted in a total of 298 articles, after removing the duplicates and exclusions after analysing the titles, abstracts and full text, five studies were included for the qualitative synthesis and two for the quantitative analysis. The meta-analysis showed no statistical difference when comparing OFD + ßTCP/ HA with or without EMD in the treatment of furcation defects in any of the evaluated parameters. According to GRADE, the certainty of the evidence for the variables evaluated was moderate. CONCLUSION: The therapeutic modalities studied improved the periodontal clinical parameters of class II furcations, but the use of EMD in the treatment of these defects did not contribute to a clinical improvement that justified its use associated with the therapies/biomaterials. It is important to emphasize the need for more studies with larger samples to increase the certainty of the evidence reported in this review.
Assuntos
Proteínas do Esmalte Dentário , Defeitos da Furca , Esmalte Dentário , Proteínas do Esmalte Dentário/uso terapêutico , Defeitos da Furca/tratamento farmacológico , Defeitos da Furca/cirurgia , Regeneração Tecidual Guiada Periodontal , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Retalhos CirúrgicosRESUMO
The aim of this study is to evaluate the expression of cytokines in response to mineral trioxide aggregate (MTA) plus selenium in germ-free mice with experimental furcal perforation. The first left maxillary molar was opened, and the furcal area was perforated and treated with post-MTA-Se (experimental group). The same surgical intervention was performed for the maxillary right first molar, which was treated with MTA (control group). Fifteen mice were sacrificed 7, 14, and 21 days after furcal perforation, and periapical tissue samples were collected. The mRNA expression levels of the cytokines TGF-ß, TNF-α, IFN-γ, HPRT, IL-10, IL-4, RANK, RANKL, IL-1, and IL-17 were assessed by using real-time polymerase chain reaction. In the experimental group, at 21-days post-MTA-Se sealing, the mRNA levels of TNF-α and IL-10 were upregulated compared with those in the control group (p < 0.05). Futher assessment revealed basal mRNA expression levels of IL-1α, IFN-γ, RANK, RANKL, IL-17A, IL-4, and TGF-ß, over long experimental times, in both the experimental and control groups (p > 0.05). In conclusion, MTA+Se sealing favoured increased expression of IL-10 and TNF-α at later time points (day 21).
Assuntos
Compostos de Alumínio/farmacologia , Compostos de Cálcio/farmacologia , Citocinas/análise , Cavidade Pulpar/lesões , Defeitos da Furca/tratamento farmacológico , Óxidos/farmacologia , Materiais Restauradores do Canal Radicular/farmacologia , Selênio/farmacologia , Silicatos/farmacologia , Animais , Cavidade Pulpar/efeitos dos fármacos , Cavidade Pulpar/imunologia , Combinação de Medicamentos , Feminino , Defeitos da Furca/imunologia , Masculino , Camundongos , Dente Molar/efeitos dos fármacos , Dente Molar/lesões , Reação em Cadeia da Polimerase em Tempo Real , Reprodutibilidade dos Testes , Tratamento do Canal Radicular/métodos , Fatores de Tempo , Resultado do TratamentoRESUMO
Abstract The aim of this study is to evaluate the expression of cytokines in response to mineral trioxide aggregate (MTA) plus selenium in germ-free mice with experimental furcal perforation. The first left maxillary molar was opened, and the furcal area was perforated and treated with post-MTA-Se (experimental group). The same surgical intervention was performed for the maxillary right first molar, which was treated with MTA (control group). Fifteen mice were sacrificed 7, 14, and 21 days after furcal perforation, and periapical tissue samples were collected. The mRNA expression levels of the cytokines TGF-β, TNF-α, IFN-γ, HPRT, IL-10, IL-4, RANK, RANKL, IL-1, and IL-17 were assessed by using real-time polymerase chain reaction. In the experimental group, at 21-days post-MTA-Se sealing, the mRNA levels of TNF-α and IL-10 were upregulated compared with those in the control group (p < 0.05). Futher assessment revealed basal mRNA expression levels of IL-1α, IFN-γ, RANK, RANKL, IL-17A, IL-4, and TGF-β, over long experimental times, in both the experimental and control groups (p > 0.05). In conclusion, MTA+Se sealing favoured increased expression of IL-10 and TNF-α at later time points (day 21).
Assuntos
Animais , Masculino , Feminino , Óxidos/farmacologia , Materiais Restauradores do Canal Radicular/farmacologia , Selênio/farmacologia , Citocinas/análise , Silicatos/farmacologia , Defeitos da Furca/tratamento farmacológico , Compostos de Cálcio/farmacologia , Compostos de Alumínio/farmacologia , Cavidade Pulpar/lesões , Tratamento do Canal Radicular/métodos , Fatores de Tempo , Reprodutibilidade dos Testes , Resultado do Tratamento , Defeitos da Furca/imunologia , Cavidade Pulpar/efeitos dos fármacos , Cavidade Pulpar/imunologia , Combinação de Medicamentos , Reação em Cadeia da Polimerase em Tempo Real , Dente Molar/efeitos dos fármacos , Dente Molar/lesõesRESUMO
O Agregado Trióxido Mineral (MTA) é considerado um material de eleição em alguns tratamentos endodônticos por apresentar boa capacidade de vedamento, biocompatibilidade, sem efeitos adversos sobre os tecidos dentais, atividade bactericida, boa radiopacidade, capacidade de selamento na presença de sangue e capacidade de induzir a osteogênese e cementogênese. Devido a essas propriedades é considerado o material ideal para reparação de perfuração, apicificação, retrobturação e regeneração tecidual
The Mineral Trioxide Aggregate (MTA) is considered a material of choice in some endodontic treatments because it has good sealing ability, biocompatibility, no adverse effects on dental tissues, bactericidal activity, good radiopacity, sealing ability in t he presence of blood and ability to Induce osteogenesis and cementogenesis. Due to these properties it is considered the ideal material for repair of perforation, apicification, retrobturation and tissue regeneration
Assuntos
Defeitos da Furca/tratamento farmacológico , Materiais Restauradores do Canal Radicular/análise , Dente não Vital/terapia , Cavidade Pulpar/anatomia & histologiaRESUMO
AIM: To investigate the effect of photodynamic therapy (PDT) as adjunct to mechanical therapy in furcations. MATERIALS AND METHODS: A double-blind, parallel, randomized controlled clinical trial was conducted in subjects presenting class II furcations. The subjects were randomly allocated to a test (PDT; n = 16) or control group (non-activated laser/only photosensitizer; n = 21). At baseline, 3 and 6 months, clinical, microbiological and cytokine pattern evaluation was performed. Clinical attachment level was defined as the primary outcome variable. RESULTS: Clinical parameters improved after both therapies (p < 0.05) with no differences between groups at any time point (p > 0.05). At 6 months, real-time PCR evaluation showed a decrease in Porphyromonas gingivalis and Tannerella forsythia only in the PDT group (p < 0.05) with no inter-group differences. Regarding cytokines, IL-4 and IL-10 levels increased in both groups at 6 months. GM-CSF, IL-8, IL-1ß and IL-6 levels decreased only in the PDT group after 3 months (p < 0.05). At 3 months, inter-group analyses showed that GM-CSF, IFN-γ, IL-6 and IL-8 levels were lower in the PDT group. At 6 months, lower IL-1ß levels were also observed in the PDT group (p < 0.05). CONCLUSION: Photodynamic therapy did not promote clinical benefits for class II furcations; however, advantages in local levels of cytokines and a reduction in periodontopathogens were demonstrated.
Assuntos
Defeitos da Furca/tratamento farmacológico , Fotoquimioterapia/métodos , Aggregatibacter actinomycetemcomitans/efeitos dos fármacos , Aggregatibacter actinomycetemcomitans/isolamento & purificação , Carga Bacteriana/efeitos dos fármacos , Bacteroides/efeitos dos fármacos , Bacteroides/isolamento & purificação , Periodontite Crônica/tratamento farmacológico , Periodontite Crônica/microbiologia , Terapia Combinada , Raspagem Dentária/métodos , Método Duplo-Cego , Feminino , Seguimentos , Defeitos da Furca/classificação , Defeitos da Furca/microbiologia , Fator Estimulador de Colônias de Granulócitos e Macrófagos/análise , Humanos , Interferon gama/análise , Interleucina-10/análise , Interleucina-1beta/análise , Interleucina-4/análise , Interleucina-6/análise , Interleucina-8/análise , Lasers Semicondutores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Perda da Inserção Periodontal/tratamento farmacológico , Perda da Inserção Periodontal/microbiologia , Fármacos Fotossensibilizantes/uso terapêutico , Porphyromonas gingivalis/efeitos dos fármacos , Porphyromonas gingivalis/isolamento & purificação , Estudos Prospectivos , Aplainamento Radicular/métodos , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the use of Portland cements with additives as furcation perforation repair materials and assess their biocompatibility. METHODS: The four maxillary and mandibular premolars of ten male mongrel dogs (1-1.5 years old, weighing 10-15 kg) received endodontic treatment (n=80 teeth). The furcations were perforated with a round diamond bur (1016 HL). The perforations involved the dentin, cementum, periodontal ligament, and alveolar bone. A calcium sulfate barrier was placed into the perforated bone to prevent extrusion of obturation material into the periradicular space. The obturation materials MTA (control), white, Type II, and Type V Portland cements were randomly allocated to the teeth. Treated teeth were restored with composite resin. After 120 days, the animals were sacrificed and samples containing the teeth were collected and prepared for histological analysis. RESULTS: There were no significant differences in the amount of newly formed bone between teeth treated with the different obturation materials (p=0.879). CONCLUSION: Biomineralization occurred for all obturation materials tested, suggesting that these materials have similar biocompatibility.
Assuntos
Cimentos Dentários/uso terapêutico , Defeitos da Furca/tratamento farmacológico , Materiais Restauradores do Canal Radicular/uso terapêutico , Obturação do Canal Radicular/métodos , Raiz Dentária/lesões , Compostos de Alumínio/uso terapêutico , Animais , Dente Pré-Molar , Materiais Biocompatíveis/química , Materiais Biocompatíveis/uso terapêutico , Regeneração Óssea , Compostos de Cálcio/uso terapêutico , Sulfato de Cálcio/química , Sulfato de Cálcio/uso terapêutico , Cimentos Dentários/química , Cães , Combinação de Medicamentos , Masculino , Teste de Materiais , Óxidos/uso terapêutico , Materiais Restauradores do Canal Radicular/química , Silicatos/uso terapêutico , Fatores de TempoRESUMO
PURPOSE: To evaluate the use of Portland cements with additives as furcation perforation repair materials and assess their biocompatibility. METHODS: The four maxillary and mandibular premolars of ten male mongrel dogs (1-1.5 years old, weighing 10-15 kg) received endodontic treatment (n=80 teeth). The furcations were perforated with a round diamond bur (1016 HL). The perforations involved the dentin, cementum, periodontal ligament, and alveolar bone. A calcium sulfate barrier was placed into the perforated bone to prevent extrusion of obturation material into the periradicular space. The obturation materials MTA (control), white, Type II, and Type V Portland cements were randomly allocated to the teeth. Treated teeth were restored with composite resin. After 120 days, the animals were sacrificed and samples containing the teeth were collected and prepared for histological analysis. RESULTS: There were no significant differences in the amount of newly formed bone between teeth treated with the different obturation materials (p=0.879). CONCLUSION: Biomineralization occurred for all obturation materials tested, suggesting that these materials have similar biocompatibility.
OBJETIVO: Avaliar o uso de cimentos Portland aditivados na reparação de perfurações radiculares e a biocompatibilidade destes materiais. MÉTODOS: Oitenta pré-molares, quatro da arcada dentária superior e quatro da arcada inferior de 10 cães machos, sem raça definida, com idade em torno de um a um ano e meio, pesando entre 10 e 15 kg foram submetidos a tratamento endodôntico, sendo realizadas perfurações nas furcas com broca de diamante 1016 HL. A cavidade envolveu dentina e cemento, como também periodonto e o osso alveolar. Na porção óssea da obturação, barreira de sulfato de cálcio foi utilizada evitando extravasamento do cimento para o espaço periodontal. Foi realizada a distribuição randomizada dos cimentos MTA (controle), Portland tipo II, Portland tipo V e Portland branco estrutural nas obturações. Os dentes foram restaurados com resina composta. Após 120 dias realizou-se eutanásia, retirada dos dentes, preparação e análise histológica. RESULTADOS: Entre os cimentos não houve diferença estatística significante quanto à neoformação óssea (p=0,879). CONCLUSÃO: Ocorreu biomineralização com os diferentes cimentos usados no estudo, sugerindo que estes são similares em termos de biocompatibilidade.
Assuntos
Animais , Cães , Masculino , Cimentos Dentários/uso terapêutico , Defeitos da Furca/tratamento farmacológico , Materiais Restauradores do Canal Radicular/uso terapêutico , Obturação do Canal Radicular/métodos , Raiz Dentária/lesões , Compostos de Alumínio/uso terapêutico , Dente Pré-Molar , Regeneração Óssea , Materiais Biocompatíveis/química , Materiais Biocompatíveis/uso terapêutico , Compostos de Cálcio/uso terapêutico , Sulfato de Cálcio/química , Sulfato de Cálcio/uso terapêutico , Combinação de Medicamentos , Cimentos Dentários/química , Teste de Materiais , Óxidos/uso terapêutico , Materiais Restauradores do Canal Radicular/química , Silicatos/uso terapêutico , Fatores de TempoRESUMO
The objective of this study was to evaluate histomorphometrically, in dogs, the effect of enamel matrix derivative (EMD), with or without transforming growth factor-beta1 (TGF-beta1), in a periodontal Class III furcation model. Class III furcation defects were created in P3 and P4 of six dogs. The defects were allowed to stabilize for 21 days. Four experimental conditions were established: G1: control (propylene glycol alginate); G2: EMD; G3: TGF-beta1 and G4: EMD + TGF-beta1. After 12 weeks, the dogs were euthanized. Their jaws were removed, fixed, decalcified, dehydrated and embedded in paraffin. Semi-serial sections were obtained, stained and examined with light microscopy. The furcation defects were not completely closed in any specimen, with downgrowth of the junctional epithelium into the furcation area. The morphologic characteristics of the newly formed tissues in the test groups were similar to the control group, with slight differences in average values, but with no statistically significant differences between the groups. This study was not able to provide histological evidence that EMD, TGF-beta1 and EMD + TGF-beta1 present additional advantages in periodontal bone formation in a Class III furcation model in dogs.
Assuntos
Regeneração Óssea , Proteínas do Esmalte Dentário/uso terapêutico , Defeitos da Furca/tratamento farmacológico , Fator de Crescimento Transformador beta1/uso terapêutico , Animais , Regeneração Óssea/efeitos dos fármacos , Cães , Combinação de Medicamentos , Defeitos da Furca/cirurgiaRESUMO
OBJECTIVE: The aim of this controlled clinical trial was to evaluate the effect of topically applied povidone-iodine (PVP-I) used as an adjunct to non-surgical treatment of interproximal class II furcation involvements. MATERIAL AND METHODS: Thirty-two patients presenting at least one interproximal class II furcation involvement that bled on probing with probing pocket depth (PPD) >5 mm were recruited. Patients were randomly chosen to receive either subgingival instrumentation with an ultrasonic device using PVP-I (10 percent) as the cooling liquid (test group) or identical treatment using distilled water as the cooling liquid (control group). The following clinical outcomes were evaluated: visible plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PPD and relative horizontal attachment level (RHAL). BAPNA (N-benzoyl-L-arginine-p-nitroanilide) testing was used to analyze trypsin-like activity in dental biofilm. All parameters were evaluated at baseline and 1, 3 and 6 months after non-surgical subgingival instrumentation. RESULTS: Six months after treatment, both groups had similar means of PPD reduction, RAL and RHAL gain (p>0.05). These variables were, respectively, 2.20±1.10 mm, 1.27±1.02 mm and 1.33±0.85 mm in the control group and 2.67±1.21 mm, 1.50±1.09 mm and 1.56±0.93 mm in the test group. No difference was observed between groups at none of the posttreatment periods, regarding the number of sites showing clinical attachment gain >2 mm. However, at 6 months posttreatment, the test group presented fewer sites with PPD >5 mm than the control group. Also at 6 months the test group had lower BAPNA values than control group. CONCLUSION: The use of PVP-I as an adjunct in the non-surgical treatment of interproximal class II furcation involvements provided limited additional clinical benefits.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anti-Infecciosos Locais/uso terapêutico , Defeitos da Furca/tratamento farmacológico , Povidona-Iodo/uso terapêutico , Administração Tópica , Análise de Variância , Anti-Infecciosos Locais/administração & dosagem , Benzoilarginina Nitroanilida , Índice de Placa Dentária , Seguimentos , Índice Periodontal , Perda da Inserção Periodontal/tratamento farmacológico , Bolsa Periodontal/tratamento farmacológico , Povidona-Iodo/administração & dosagem , Fatores de Tempo , Resultado do Tratamento , Terapia por UltrassomRESUMO
OBJECTIVE: The aim of this study was to assess radiographically the effect of photodynamic therapy (PDT) as an adjunctive treatment to scaling and root planing (SRP) on induced periodontitis in dexamethasone-induced immunosuppressed rats. MATERIAL AND METHODS: The animals were divided into 2 groups: ND group (n=60): saline treatment; D group (n=60): dexamethasone treatment. In both ND and D groups, periodontal disease was induced by the placement of a ligature in the left first mandibular molar. After 7 days, ligature was removed and all animals received SRP, being divided according to the following treatments: SRP: saline and PDT: phenothiazinium dye (TBO) plus laser irradiation. Ten animals per treatment were killed at 7, 15 and 30 days. The distance between the cementoenamel junction and the height of the alveolar bone crest in the mesial surface of the mandibular left first molars was determined in millimeters in each radiograph. he radiographic values were analyzed statistically by ANOVA and Tukey's test at a p value <0.05. RESULTS: Intragroup radiographic assessment (ND and D groups) showed that there was statistically significant less bone loss in the animals treated with PDT in all experimental periods compared to those submitted to SRP. Intergroup radiographic analysis (ND and D groups) demonstrated that there was greater bone loss in the ND group treated with SRP compared to the D group treated with PDT at 7 and 30 days. CONCLUSION: PDT was an effective adjunctive treatment to SRP on induced periodontitis in dexamethasone-induced immunosuppressed rats.