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Shrestha S, Kishen A. Bioactive Molecule Delivery Systems for Dentin-pulp Tissue Engineering. J Endod 2017; 43:733-744. [PMID: 28320538 DOI: 10.1016/j.joen.2016.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/11/2016] [Accepted: 12/13/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Regenerative endodontic procedures use bioactive molecules (BMs), which are active signaling molecules that initiate and maintain cell responses and interactions. When applied in a bolus form, they may undergo rapid diffusion and denaturation resulting in failure to induce the desired effects on target cells. METHODS The controlled release of BMs from a biomaterial carrier is expected to enhance and accelerate functional tissue engineering during regenerative endodontic procedures. This narrative review presents a comprehensive review of different polymeric BM release strategies with relevance to dentin-pulp engineering. RESULTS Carrier systems designed to allow the preprogrammed release of BMs in a spatial- and temporal-controlled manner would aid in mimicking the natural wound healing process while overcoming some of the challenges faced in clinical translation of regenerative endodontic procedures. CONCLUSIONS Spatial- and temporal-controlled BM release systems have become an exciting option in dentin-pulp tissue engineering; nonetheless, further validation of this concept and knowledge is required for their potential clinical translation.
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Affiliation(s)
- Suja Shrestha
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Anil Kishen
- Discipline of Endodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
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Abstract
INTRODUCTION Revascularization/revitalization therapy is considered an alternative procedure for management of teeth with an immature apex and necrotic pulp, mainly when root development is interrupted in the early phases of formation. However, this clinical treatment protocol should be considered a permanent procedure? METHOD A maxillary central incisor with a previous and successful RR treatment was intentionally filled with a biocompatible material with the periapical tissues due to the patient's lack of adherence to the follow-up protocol. RESULTS The 20-month follow-up showed absence of clinical, radiological and tomographic signs and symptoms of an endodontic re-infection. CONCLUSION This case demonstrates that once the increased thickening of the canal walls, incrementing the root length, apical closure and the total resolution of the apical lesion are observed, the main canal of a previously treated tooth with an RR procedure can be filled.
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Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, Sunay H, Tjäderhane L, Dummer PMH. Antibiotics in Endodontics: a review. Int Endod J 2017; 50:1169-1184. [DOI: 10.1111/iej.12741] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/19/2016] [Indexed: 12/20/2022]
Affiliation(s)
- J. J. Segura-Egea
- Department of Endodontics; School of Dentistry; University of Sevilla; Sevilla Spain
| | - K. Gould
- Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | | | - P. Jonasson
- Department of Endodontology; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Cotti
- Department of Conservative Dentistry and Endodontics; University of Cagliari; Cagliari, Sardinia Italy
| | - A. Mazzoni
- Department of Biomedical and Neuromotor Sciences; DIBINEM; University of Bologna; Bologna Italy
| | - H. Sunay
- Department of Endodontology; Dental Faculty of Istanbul Kemerburgaz University; Istanbul Turkey
| | - L. Tjäderhane
- Department of Oral and Maxillofacial Diseases; Helsinki University Hospital; University of Helsinki; Helsinki Finland
- Research Unit of Oral Health Sciences; Medical Research Center Oulu (MRC Oulu); Oulu University Hospital and University of Oulu; Oulu Finland
| | - P. M. H. Dummer
- School of Dentistry; College of Biomedical & Life Sciences; Cardiff University; Cardiff UK
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Nazzal H, Duggal MS. Regenerative endodontics: a true paradigm shift or a bandwagon about to be derailed? Eur Arch Paediatr Dent 2017; 18:3-15. [PMID: 28092093 PMCID: PMC5290056 DOI: 10.1007/s40368-016-0265-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 12/19/2016] [Indexed: 12/15/2022]
Abstract
Aims Regenerative endodontic techniques (RETs) have been hailed as a paradigm shift for the management of traumatised non-vital immature permanent anterior teeth. In this article the aim was to critically appraise the literature with regards to the outcome of regenerative endodontics on root development. Methods Critical review of the literature where regenerative endodontic techniques have been used in the management of immature non-vital teeth with continuation of root development as the main outcome reported. Results Most studies published were in the form of case reports and series with very few randomised controlled trials with a high risk of bias. Continuation of root development following the use of RET has been shown to be unpredictable at best with lower success in those teeth losing vitality as a result of dental trauma. Conclusions Despite the high success of regenerative endodontics in terms of periodontal healing including resolution of clinical and radiographic signs and symptoms of infection, continuation of root development remains an unpredictable outcome. The use of a blood clot as a scaffold in regenerative endodontics should be reviewed carefully as that might offer an environment for repair rather than regeneration. In addition, preservation of structures, such as Hertwig’s epithelial root sheath, may have an important bearing on the success of this approach and should be further investigated.
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Affiliation(s)
- H Nazzal
- Department of Paediatric Dentistry, Leeds School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9LU, UK.
| | - M S Duggal
- Department of Paediatric Dentistry, Leeds School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9LU, UK
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105
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Pulpo-Periodontal Regeneration: Management of Partial Failure Revascularization. Case Rep Dent 2017; 2017:8302039. [PMID: 29075537 PMCID: PMC5623788 DOI: 10.1155/2017/8302039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/23/2017] [Accepted: 08/07/2017] [Indexed: 11/17/2022] Open
Abstract
The aim of this work is to present a case of management of an open apex on a lower molar by using tissue engineering, with two endodontic procedures in the same tooth. We had to resort to pulp regeneration on the distal root and apexification with MTA on the mesial roots after the failure of regenerative therapy on those ones. The management consisted in scheduling regular follow-ups combined with X-rays. After 24 months, the radiological control has shown pulpo-periodontal regeneration associated with walls thickening and distal root elongation and periapical ad integrum healing.
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106
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Regenerative Endodontic Procedures: A Perspective from Stem Cell Niche Biology. J Endod 2017; 43:52-62. [DOI: 10.1016/j.joen.2016.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/19/2016] [Accepted: 09/09/2016] [Indexed: 12/14/2022]
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Alyas SM, Fischer BI, Ehrlich Y, Spolnik K, Gregory RL, Yassen GH. Direct and indirect antibacterial effects of various concentrations of triple antibiotic pastes loaded in a methylcellulose system. J Oral Sci 2016; 58:575-582. [PMID: 28025443 DOI: 10.2334/josnusd.16-0384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
We investigated the direct and indirect (residual) antibacterial effects of various concentrations of triple antibiotic paste (TAP) loaded into a methylcellulose system. Enterococcus faecalis (E. faecalis) was grown on sterilized dentin blocks (n = 60) and treated with clinically used TAP (1,000 mg/mL), low concentrations of methylcellulose-based TAP (100, 10, and 1 mg/mL), placebo paste, or 1.5% NaOCl (n = 10). The pastes were then removed, and biofilm disruption assays were performed. Additional dentin blocks (n = 120) were pretreated with the same experimental groups (n = 20). The pastes were rinsed off, and the samples were immersed independently in phosphate-buffered saline for 2 and 4 weeks (n = 10). E.faecalis was then grown on the dentin blocks, and biofilm disruption assays were performed. Fisher's Exact and Wilcoxon rank sum tests were used for statistical analyses. With regard to direct antibacterial effects, all treatment groups demonstrated complete eradication of biofilms in comparison to placebo paste, while 10 mg/mL of TAP or higher provided substantial residual antibacterial effects. However, dentin treated with 1 mg/mL of TAP or 1.5% NaOCl did not provide substantial residual antibacterial effects. Dentin pretreated with 10 mg/mL of TAP or higher exhibited extended residual antibacterial effects and can thus be used during endodontic regeneration.(J Oral Sci 58, 575-582, 2016).
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Affiliation(s)
- Sarmad M Alyas
- Department of Endodontics, Indiana University School of Dentistry
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Agrafioti A, Taraslia V, Chrepa V, Lymperi S, Panopoulos P, Anastasiadou E, Kontakiotis EG. Interaction of dental pulp stem cells with Biodentine and MTA after exposure to different environments. J Appl Oral Sci 2016; 24:481-486. [PMID: 27812618 PMCID: PMC5083025 DOI: 10.1590/1678-775720160099] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/25/2016] [Indexed: 01/15/2023] Open
Abstract
Objective: The aim of the present study was to evaluate and compare the cytotoxic effects of Biodentine and MTA on dental pulp stem cells (DPSCs) and to assess cell viability and adherence after material exposure to an acidic environment. Material and Methods: DPSCs were cultured either alone or in contact with either: Biodentine; MTA set for 1 hour; or MTA set for 24 hours. After 4 and 7 days, cell viability was measured using the MTT assay. Biodentine and MTA were also prepared and packed into standardized bovine dentin disks and divided into three groups according to the storage media (n=6/group): freshly mixed materials without storage medium (Group A); materials stored in saline (Group B); materials stored in citric acid buffered at pH 5.4 (Group C). After 24 hours, DPSCs were introduced in the wells and cell adherence, viability, and cellular morphology were observed via confocal microscopy after three days of culture. Cell viability was analyzed using repeated-measures analysis of variance test with Tukey's post hoc tests (α=0.05). Results: Biodentine expressed significantly higher cell viability compared with all other groups after 4 days, with no differences after 7 days. Notably, cell viability was significantly greater in 24-hour set MTA compared with 1-hour set MTA and control groups after 7 days. Material exposure to an acidic environment showed an increase in cell adherence and viability in both groups. Conclusions: Biodentine induced a significantly accelerated cell proliferation compared with MTA. Setting of these materials in the presence of citric acid enhanced DPSC viability and adherence.
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Affiliation(s)
- Anastasia Agrafioti
- National and Kapodistrian University of Athens, School of Dentistry, Department of Endodontics, Athens, Greece
| | - Vasiliki Taraslia
- Biomedical Research Foundation of the Academy of Athens, Department of Genetics and Gene Therapy, Athens, Greece
| | - Vanessa Chrepa
- University of Washington, Department of Endodontics, Seattle, WA, USA
| | - Stefania Lymperi
- Biomedical Research Foundation of the Academy of Athens, Department of Genetics and Gene Therapy, Athens, Greece
| | - Panos Panopoulos
- National and Kapodistrian University of Athens, School of Dentistry, Department of Endodontics, Athens, Greece
| | - Ema Anastasiadou
- Biomedical Research Foundation of the Academy of Athens, Department of Genetics and Gene Therapy, Athens, Greece
| | - Evangelos G Kontakiotis
- National and Kapodistrian University of Athens, School of Dentistry, Department of Endodontics, Athens, Greece
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110
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Kishen A, Peters OA, Zehnder M, Diogenes AR, Nair MK. Advances in endodontics: Potential applications in clinical practice. J Conserv Dent 2016; 19:199-206. [PMID: 27217630 PMCID: PMC4872571 DOI: 10.4103/0972-0707.181925] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Contemporary endodontics has seen an unprecedented advance in technology and materials. This article aimed to review some of the challenges and advances in the following sections: (1) endodontic imaging, (2) root canal preparation, (3) root canal disinfection, (4) root canal filling, and (4) regenerative endodontic procedures (REPs). Jointly, these advances are aimed at improving the state of the art and science of root canal treatment.
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Affiliation(s)
- Anil Kishen
- Department of Endodontics, University of Toronto, Toronto, Ontario, Canada
| | - Ove A Peters
- Department of Endodontics, Arthur A Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Matthias Zehnder
- Department of Preventive Dentistry, Periodontology and Cariology, Division of Endodontology, University of Zürich Center for Dental Medicine, Zürich, Switzerland
| | - Anibal R Diogenes
- Department of Endodontics, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Madhu K Nair
- Department of Radiology, College of Medicine, University of Florida, Gainesville, Florida, USA
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111
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Dettwiler CA, Walter M, Zaugg LK, Lenherr P, Weiger R, Krastl G. In vitroassessment of the tooth staining potential of endodontic materials in a bovine tooth model. Dent Traumatol 2016; 32:480-487. [DOI: 10.1111/edt.12285] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Christian A. Dettwiler
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Mirella Walter
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Lucia K. Zaugg
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Patrik Lenherr
- Department of Reconstructive Dentistry and Temporomandibular Disorders; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Roland Weiger
- Department of Periodontology, Endodontology and Cariology; University Center for Dental Medicine; University of Basel; Basel Switzerland
| | - Gabriel Krastl
- Department of Conservative Dentistry and Periodontology; University of Würzburg; Würzburg Germany
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112
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Kahler B, Rossi-Fedele G. A Review of Tooth Discoloration after Regenerative Endodontic Therapy. J Endod 2016; 42:563-9. [DOI: 10.1016/j.joen.2015.12.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/21/2015] [Accepted: 12/22/2015] [Indexed: 12/31/2022]
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113
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Infection and Pulp Regeneration. Dent J (Basel) 2016; 4:dj4010004. [PMID: 29563446 PMCID: PMC5851207 DOI: 10.3390/dj4010004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 11/16/2022] Open
Abstract
The regeneration of the pulp-dentin complex has been a great challenge to both scientists and clinicians. Previous work has shown that the presence of prior infection may influence the characteristics of tissues formed in the root canal space after regenerative endodontic treatment. The formation of ectopic tissues such as periodontal ligament, bone, and cementum has been observed in the root canal space of immature necrotic teeth with apical periodontitis, while the regeneration of dentin and pulp has been identified in previously non-infected teeth. The current regenerative endodontic therapy utilizes disinfection protocols, which heavily rely on chemical irrigation using conventional disinfectants. From a microbiological point of view, the current protocols may not allow a sufficiently clean root canal microenvironment, which is critical for dentin and pulp regeneration. In this article, the significance of root canal disinfection in regenerating the pulp-dentin complex, the limitations of the current regenerative endodontic disinfection protocols, and advanced disinfection techniques designed to reduce the microorganisms and biofilms in chronic infection are discussed.
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114
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Lolato A, Bucchi C, Taschieri S, Kabbaney AE, Fabbro MD. Platelet concentrates for revitalization of immature necrotic teeth: a systematic review of the clinical studies. Platelets 2016; 27:383-92. [DOI: 10.3109/09537104.2015.1131255] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Alessandra Lolato
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
| | - Cristina Bucchi
- Facultad de Odontología, CICO Research Center, Universidad de La Frontera, Temuco, Chile
| | - Silvio Taschieri
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
| | - Ahmed El Kabbaney
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- Conservative Dentistry and Endodontic Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Massimo Del Fabbro
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italia
- IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milano, Italia
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115
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Regenerative Endodontic Treatment of an Immature Necrotic Molar with Arrested Root Development by Using Recombinant Human Platelet-derived Growth Factor: A Case Report. J Endod 2016; 42:72-5. [DOI: 10.1016/j.joen.2015.08.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/07/2015] [Accepted: 08/29/2015] [Indexed: 01/17/2023]
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116
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Agrafioti A, Tzimpoulas N, Chatzitheodoridis E, Kontakiotis EG. Comparative evaluation of sealing ability and microstructure of MTA and Biodentine after exposure to different environments. Clin Oral Investig 2015; 20:1535-40. [PMID: 26541151 DOI: 10.1007/s00784-015-1638-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/23/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the sealing ability and morphological microstructure of Biodentine in comparison to ProRoot mineral trioxide aggregate (MTA) after storage in an acidic environment. MATERIALS AND METHODS Biodentine and ProRoot MTA were prepared and packed into the canal lumen of dentin disks. Twenty specimens of each material were further randomly divided into two groups according to the storage media: group A: materials with saline as storage medium; group B: materials with citric acid buffered at pH 5.4 as storage medium. The sealing ability was evaluated at 1, 3, 6, and 24 h and 1 or 3 months, using a fluid transport model for quantitative analysis of endodontic microleakage. The morphological microstructures of the materials were also evaluated using scanning electron microscopy. RESULTS During the first 24 h, MTA showed greater fluid transport values than Biodentine in both environments. At the 3-month measurement, when the materials were stored in saline, MTA showed greater ability to prevent fluid movement than Biodentine (p < 0.0001). However, when the materials were stored in an acidic environment, no statistical significant difference was found after 3 months. After storage in saline, both materials showed an uneven crystalline surface with similar hexagonal crystals. The microstructure of Biodentine changed after exposure to citric acid, showing a relatively smooth surface with more spheroidal crystals. CONCLUSIONS The exposure to an acidic environment, within the limits of this study, seems to result in morphological changes of Biodentine in a different manner than MTA. MTA shows good ability to prevent fluid movement over time, in both environments. The ability of Biodentine to prevent fluid movement over time was enhanced in the acidic environment. CLINICAL RELEVANCE The findings of the present study could imply that both materials are indicated for use in an acidic environment.
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Affiliation(s)
- Anastasia Agrafioti
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., 11527, Goudi, Athens, Greece
| | - Nestor Tzimpoulas
- Division of Endodontology, Department of Cariology, Endodontology and Pedodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Elias Chatzitheodoridis
- Laboratory of Mineralogy, Petrology and Economic Geology, Department of Geological Sciences, School of Mining and Metallurgical Engineering, National Technical University of Athens, Athens, Greece
| | - Evangelos G Kontakiotis
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., 11527, Goudi, Athens, Greece.
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Santiago CN, Pinto SS, Sassone LM, Hirata R, Fidel SR. Revascularization Technique for the Treatment of External Inflammatory Root Resorption: A Report of 3 Cases. J Endod 2015; 41:1560-4. [DOI: 10.1016/j.joen.2015.03.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 03/11/2015] [Accepted: 03/27/2015] [Indexed: 01/15/2023]
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118
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Antibacterial TAP-mimic electrospun polymer scaffold: effects on P. gingivalis-infected dentin biofilm. Clin Oral Investig 2015; 20:387-93. [PMID: 26319981 DOI: 10.1007/s00784-015-1577-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/18/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study sought to investigate, in vitro, the effects of a recently developed triple antibiotic paste (TAP)-mimic polymer nanofibrous scaffold against Porphyromonas gingivalis-infected dentin biofilm. MATERIALS AND METHODS Dentin specimens (4 × 4 × 1 mm(3)) were prepared from human canines. The specimens were sterilized, inoculated with P. gingivalis (ATCC 33277), and incubated for 1 week to allow for biofilm formation. Infected dentin specimens were exposed for 3 days to the following treatments: antibiotic-free polydioxanone scaffold (PDS, control), PDS + 25 wt% TAP [25 mg of each antibiotic (metronidazole, ciprofloxacin, and minocycline) per mL of the PDS polymer solution], or a saturated TAP-based solution (50 mg of each antibiotic per mL of saline solution). In order to serve as the negative control, infected dentin specimens were left untreated (bacteria only). To determine the antimicrobial efficacy of the TAP-mimic scaffold, a colony-forming unit (CFU) per milliliter (n = 10/group) measurement was performed. Furthermore, additional specimens (n = 2/group) were prepared to qualitatively study biofilm inhibition via scanning electron microscopy (SEM). Statistics were performed, and significance was set at the 5% level. RESULTS Both the TAP-mimic scaffold and the positive control (TAP solution) led to complete bacterial elimination, differing statistically (p < 0.05) from the negative control group (bacteria only). No statistical differences were observed for CFU per milliliter data between antibiotic-free scaffolds (2.7 log10 CFU/mL) and the negative control (5.9 log10 CFU/mL). CONCLUSIONS The obtained data revealed significant antimicrobial properties of the novel PDS-based TAP-mimic scaffold against an established P. gingivalis-infected dentin biofilm. CLINICAL RELEVANCE Collectively, the data suggest that the proposed nanofibrous scaffold might be used as an alternative to the advocated clinical gold standard (i.e., TAP) for intracanal disinfection prior to regenerative endodontics.
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Cao Y, Song M, Kim E, Shon W, Chugal N, Bogen G, Lin L, Kim R, Park NH, Kang M. Pulp-dentin Regeneration. J Dent Res 2015; 94:1544-51. [DOI: 10.1177/0022034515601658] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The goal of regenerative endodontics is to reinstate normal pulp function in necrotic and infected teeth that would result in reestablishment of protective functions, including innate pulp immunity, pulp repair through mineralization, and pulp sensibility. In the unique microenvironment of the dental pulp, the triad of tissue engineering would require infection control, biomaterials, and stem cells. Although revascularization is successful in resolving apical periodontitis, multiple studies suggest that it alone does not support pulp-dentin regeneration. More recently, cell-based approaches in endodontic regeneration based on pulpal mesenchymal stem cells (MSCs) have demonstrated promising results in terms of pulp-dentin regeneration in vivo through autologous transplantation. Although pulpal regeneration requires the cell-based approach, several challenges in clinical translation must be overcome—including aging-associated phenotypic changes in pulpal MSCs, availability of tissue sources, and safety and regulation involved with expansion of MSCs in laboratories. Allotransplantation of MSCs may alleviate some of these obstacles, although the long-term stability of MSCs and efficacy in pulp-dentin regeneration demand further investigation. For an alternative source of MSCs, our laboratory developed induced MSCs (iMSCs) from primary human keratinocytes through epithelial-mesenchymal transition by modulating the epithelial plasticity genes. Initially, we showed that overexpression of ΔN p63α, a major isoform of the p63 gene, led to epithelial-mesenchymal transition and acquisition of stem characteristics. More recently, iMSCs were generated by transient knockdown of all p63 isoforms through siRNA, further simplifying the protocol and resolving the potential safety issues of viral vectors. These cells may be useful for patients who lack tissue sources for endogenous MSCs. Further research will elucidate the level of potency of these iMSCs and assess their transdifferentiation capacities into functional odontoblasts when transplanted into the root canal microenvironment.
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Affiliation(s)
- Y. Cao
- School of Dentistry, UCLA, Los Angeles, CA, USA
| | - M. Song
- School of Dentistry, UCLA, Los Angeles, CA, USA
| | - E. Kim
- School of Dentistry, Yonsei University, Seoul, Korea
| | - W. Shon
- School of Dentistry, UCLA, Los Angeles, CA, USA
| | - N. Chugal
- School of Dentistry, UCLA, Los Angeles, CA, USA
| | - G. Bogen
- School of Dentistry, UCLA, Los Angeles, CA, USA
| | - L. Lin
- New York University College of Dentistry, New York, NY, USA
| | - R.H. Kim
- School of Dentistry, UCLA, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - N.-H. Park
- School of Dentistry, UCLA, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - M.K. Kang
- School of Dentistry, UCLA, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
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Rodríguez-Benítez S, Stambolsky C, Gutiérrez-Pérez JL, Torres-Lagares D, Segura-Egea JJ. Pulp Revascularization of Immature Dog Teeth with Apical Periodontitis Using Triantibiotic Paste and Platelet-rich Plasma: A Radiographic Study. J Endod 2015; 41:1299-304. [DOI: 10.1016/j.joen.2015.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/30/2015] [Accepted: 05/08/2015] [Indexed: 01/12/2023]
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Duncan HF, Smith AJ, Fleming GJP, Cooper PR. Epigenetic modulation of dental pulp stem cells: implications for regenerative endodontics. Int Endod J 2015; 49:431-46. [PMID: 26011759 DOI: 10.1111/iej.12475] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/24/2015] [Indexed: 12/28/2022]
Abstract
Dental pulp stem cells (DPSCs) offer significant potential for use in regenerative endodontics, and therefore, identifying cellular regulators that control stem cell fate is critical to devising novel treatment strategies. Stem cell lineage commitment and differentiation are regulated by an intricate range of host and environmental factors of which epigenetic influence is considered vital. Epigenetic modification of DNA and DNA-associated histone proteins has been demonstrated to control cell phenotype and regulate the renewal and pluripotency of stem cell populations. The activities of the nuclear enzymes, histone deacetylases, are increasingly being recognized as potential targets for pharmacologically inducing stem cell differentiation and dedifferentiation. Depending on cell maturity and niche in vitro, low concentration histone deacetylase inhibitor (HDACi) application can promote dedifferentiation of several post-natal and mouse embryonic stem cell populations and conversely increase differentiation and accelerate mineralization in DPSC populations, whilst animal studies have shown an HDACi-induced increase in stem cell marker expression during organ regeneration. Notably, both HDAC and DNA methyltransferase inhibitors have also been demonstrated to dramatically increase the reprogramming of somatic cells to induced pluripotent stem cells (iPSCs) for use in regenerative therapeutic procedures. As the regulation of cell fate will likely remain the subject of intense future research activity, this review aims to describe the current knowledge relating to stem cell epigenetic modification, focusing on the role of HDACi on alteration of DPSC phenotype, whilst presenting the potential for therapeutic application as part of regenerative endodontic regimens.
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Affiliation(s)
- H F Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - A J Smith
- Oral Biology, School of Dentistry, University of Birmingham, Birmingham, UK
| | - G J P Fleming
- Material Science Unit, Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - P R Cooper
- Oral Biology, School of Dentistry, University of Birmingham, Birmingham, UK
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