Periodontal response to two intracanal medicaments in replanted monkey incisors

Evaluation of the diffusion of triamcinolone and demeclocycline through the dentinal tubules and apical foramen: A mass spectrometry study

Aim:

The aim of this study was to investigate the diffusion of triamcinolone and demeclocycline from an endodontic paste when used unmodified, versus when combined in equal parts with a calcium hydroxide paste, in terms of diffusion through the dentinal tubules versus through the apical foramen.

Methodology:

Medicaments were placed in endodontically prepared roots that were kept in vials of Milli-Q water. The five experimental groups in the study were (1) control – no medicament, (2) medicament containing triamcinolone and demeclocycline (T&D) and occluded apex, (3) T&D paste and patent apex, (4) T&D + calcium hydroxide (Ca(OH)₂) occluded apex, and (5) T&D + Ca(OH)₂ and patent apex. The triamcinolone and demeclocycline concentrations were measured with solid-phase extraction and ultra-high performance liquid chromatography–mass spectrometry, after 1, 3, 8, and 24 h, and after 1 week.

Results:

Most of the triamcinolone and demeclocycline diffused through the apical foramen, with sparse diffusion through the dentinal tubules. The T&D paste mixed with Ca(OH)₂ in equal amounts showed greater than the expected 50% reduction in the diffusion of triamcinolone and demeclocycline from mass dilution alone (89% and 80%, respectively).

Conclusions:

These results stress the importance of maintaining apical patency, for allowing diffusion of active components of the drugs to target tissues in the periapical environment.

Evaluation of the efficacy of a novel antibiotic-steroid paste versus conventionally used intracanal antibiotic pastes and irrigating solutions against a 3-week-old biofilm of Enterococcus faecalis

Introduction

Intracanal medicaments have been used during endodontic regenerative procedures to eradicate endodontic pathogens.

Aims

The aim of our study was (1) to evaluate the antimicrobial efficacy of a novel antibiotic-steroid paste over the regularly used calcium hydroxide (Ca (OH)₂), double antibiotic paste (DAP), and modified triple antibiotic paste (M-TAP) and (2) to check the antimicrobial efficacy of irrigating solutions, Chlorhexidine (CHX), and sodium hypochlorite (NaOCl) against a 3-week-old Enterococcus faecalis (E. faecalis) biofilm.

Materials and Methods

A total of 112 human extracted teeth were contaminated with E. faecalis for a period of 21 days. A novel antibiotic-steroid paste, Ca (OH) ₂, DAP, M-TAP, and a placebo were placed inside the canal, sealed, and incubated in an aerobic environment at 37°C. For irrigating solutions, each prepared sample was immersed in 1 ml of sterile saline for 1 min, followed by irrigating and immersion with 1.5% NaOCl and 2% CHX for 5 min. An antimicrobial assessment was performed at the end of 2 days and 7 days, with seven teeth from each group, for each time interval. Dentin debris collected was transferred to the respective medium for culture. After 24 h, colonies were counted using classical bacterial counting technique as colony-forming units.

Results

Statistical analysis revealed that the novel antibiotic-steroid paste showed a statistically insignificant difference when compared to DAP, which had the highest antimicrobial properties.

Conclusion

This novel functional paste has antimicrobial efficacy comparable with that of DAP.

Spectrophotometric insights: calcium hydroxide influences tooth discolorations induced by short-term application of antibiotic/corticosteroid pastes

OBJECTIVES

This in vitro study aimed to assess the influence of a calcium hydroxide dressing regarding the relative color change (ΔE) of enamel-dentin specimens previously exposed to antibiotic/corticosteroid pastes.

MATERIALS AND METHODS

Eighty bovine enamel-dentin specimens with a cylindrical central cavity were randomly allocated to four groups: NEG (empty), POS (blood), LED (Ledermix), and ODO (Odontopaste) (n = 20 each). The materials were applied and sealed with self-adhesive resin luting material. After 3 weeks, the materials were removed and a calcium hydroxide (Ca(OH)₂) dressing was placed in all cavities. After a further 3-week storage period, the cavities were restored with resin-based composite. Spectrophotometric color measurements were taken over 6 months, and ΔE values were calculated. A Tukey's multiple comparison test was performed to assess significant differences within the treatment groups (p < 0.05).

RESULTS

Tooth discolorations were present after 3 weeks in LED (ΔE 29.14 ± 6.55) and POS (ΔE 18.05 ± 7.03); NEG and ODO remained color stable (ΔE 3.2 ± 1.36 and ΔE 2.3 ± 1.16). The 3-week Ca(OH)₂ dressing decreased discolorations of POS (ΔE 15.93 ± 6.63; p = 0.37), whereas LED showed a further significant increase (ΔE 39.55; p < 0.0001). Between the end of the Ca(OH)₂ dressing and the final restoration no significant color changes were observed in any group (p > 0.9).

CONCLUSIONS

Discolorations induced by LED progressed during the Ca(OH)₂ dressing despite careful removal of all residues.

CLINICAL RELEVANCE

Calcium hydroxide might negatively affect the discoloring potential of Ledermix. This highlights the need for direct intracanal application methods of Ledermix ensuring a material-free access cavity or alternative antibiotic/corticosteroid pastes such as Odontopaste should be used.

Effect of calcium hydroxide on inflammatory root resorption and ankylosis in replanted teeth compared with other intracanal materials: a review

Calcium hydroxide (CH) is the gold-standard intracanal dressing for teeth subjected to traumatic avulsion. A common complication after the replantation of avulsed teeth is root resorption (RR). The current review was conducted to compare the effect of CH with that of other intracanal medications and filling materials on inflammatory RR and replacement RR (ankylosis) in replanted teeth. The PubMed and Scopus databases were searched through June 2018 using specific keywords related to the title of the present article. The materials that were compared to CH were in 2 categories: 1) mineral trioxide aggregate (MTA) and endodontic sealers as permanent filling materials for single-visit treatment, and 2) Ledermix, bisphosphonates, acetazolamide, indomethacin, gallium nitrate, and enamel matrix-derived protein (Emdogain) as intracanal medicaments for multiple-visit management of avulsed teeth prior to the final obturation. MTA can be used as a single-visit root filling material; however, there are limited data on its efficacy due to a lack of clinical trials. Ledermix and acetazolamide were comparable to CH in reducing RR. Emdogain seems to be an interesting material, but the data supporting its use as an intracanal medication remain very limited. The conclusions drawn in this study were limited by the insufficiency of clinical trials.

Management of Root Resorption Using Chemical Agents: A Review

Root resorption (RR) is defined as the loss of dental hard tissues because of clastic activity inside or outside of tooth the root. In the permanent dentition, RR is a pathologic event; if untreated, it might result in the premature loss of the affected tooth. Several hypotheses have been suggested as the mechanisms of root resorption such as absence of the remnants of Hertwig's epithelial root sheath (HERS) and the absence of some intrinsic factors in cementum and predentin such as amelogenin or osteoprotegerin (OPG). It seems that a barrier is formed by the less-calcified intermediate cementum or the cementodentin junction that prevents external RR. There are several chemical strategies to manage root resorption. The purpose of this paper was to review several chemical agents to manage RR such as tetracycline, sodium hypochlorite, acids (citric acid, phosphoric acid, ascorbic acid and hydrochloric acid), acetazolamide, calcitonin, alendronate, fluoride, Ledermix and Emdogain.

Discoloration of roots caused by residual endodontic intracanal medicaments

AIMS

This study examined the extent to which intervisit corticosteroid-based antibiotic pastes (CAP) medicaments contribute to staining of tooth structure after attempted removal by irrigation techniques.

METHODS

A total of 140 roots were prepared and the canals were filled with Ledermix paste (demeclocycline), Odontopaste (clindamycin), and Doxypaste (doxycycline). The pastes were removed after 2 or 4 weeks of storage in the dark using EDTA and NaOCl with either a 27-gauge-slotted needle or an EndoActivator (Dentsply). The roots were then exposed to an intense light source for 30 minutes each week and photographed after a further 1, 3, or 6 months. Digital images were standardized and data for changes in luminosity were analysed using repeated measures ANOVA and a post hoc test.

RESULTS

Removal of the medicament did not prevent later discolouration. There was no significant difference between the paste removal methods. Ledermix paste caused the greatest darkening compared to the untreated controls, for both application periods and both methods of removal. Doxypaste and Odontopaste caused less darkening than Ledermix.

CONCLUSION

Medicaments that stain teeth may continue to discolour teeth despite best attempts to remove them. This study stresses the importance of material selection and minimising contact of Ledermix within the coronal aspects of teeth.

Periodontal healing following avulsion and replantation of teeth: a multi-centre randomized controlled trial to compare two root canal medicaments

BACKGROUND

 Non-setting calcium hydroxide (Ultracal XS(®) ) is recommended by the International Association of Dental Traumatology as the initial medicament following avulsion and replantation for mature teeth. There is experimental evidence to suggest Ledermix(®) , placed as an alternative inter-visit dressing may improve periodontal healing.

AIM

 This study investigated, using a multi-centre randomized controlled trial, the effect of two root canal medicaments, Ledermix(®) and Ultracal XS(®) , on periodontal healing of avulsed and replanted teeth.

MATERIAL AND METHODS

 Children were recruited if they fulfilled all inclusion criteria. Treatment followed a standardized protocol. Assessment of periodontal healing or ankylosis was made clinically and radiographically by an experienced, 'blinded', clinician at 12months.

RESULTS

 Over 200 patients were assessed for eligibility at five centres. Twenty-nine patients were eligible for inclusion. Final analysis involved 22 patients with 27 teeth. Ankylosis was detected in four of the 12 teeth in the Ledermix(®) group and nine of 15 in the Ultracal XS(®) group. No significant difference between medicaments was found in the proportion of teeth or patients showing periodontal healing.

DISCUSSION

 There was no significant difference in periodontal healing between the two medicaments at either a tooth or patient level. The numbers recruited fell short of an estimated power calculation. For patients meeting the inclusion criteria and completing the trial, periodontal healing was seen in 52% of teeth at the 12-month assessment between both groups. The only factor found to significantly influence the periodontal outcome was dry time.

Time of endodontic treatment in autogenic transplants of mature teeth: Histological study in dogs

OBJECTIVE

Root canal therapy is often recommended after mature tooth transplantation. The aim of this work was to histologically evaluate, in dogs, the best time for root canal treatment in autogenic transplants of teeth with complete root formation.

STUDY DESIGN

Mandibular lateral incisors of 8 dogs were extracted and transplanted to the homologous alveolus, endodontically treated after 15 (Group I) or 40 (Group II) days, and processed for routine histological evaluation. Tissue responses on the root surface were evaluated by light microscopy and classified as normal periodontium, active inflammatory root resorption, favorable healing, and unfavorable healing.

RESULTS

The mean of normal periodontal tissue was in 88.6% in Group I and 79.4% in Group II. There were no significant statistical differences between the groups in all analyzed parameters.

CONCLUSION

The results indicated that endodontic therapy can be postponed for 40 days postoperatively when the tooth stability is higher.

Replantation of 45 avulsed permanent teeth: a 1-year follow-up study

Thirty-four patients with 45 avulsed and replanted permanent teeth were followed for 1 year. All teeth were soaked in tetracycline before replantation. In addition, enamel matrix derivative was used in teeth with dry storage times exceeding 30 min. Splinting was carried out with a non-rigid titanium splint and was limited to 7-10 days. Within that period, root canal treatment was begun in all teeth with a closed apex, whereas teeth with an open apex and ideal post-traumatic storage were not instrumented. All patients were given tetracycline systematically for 10 days. The survival rate of replanted avulsed permanent teeth was 95.6% at the 1-year follow-up. In 82.2%, root canal treatment was performed. Pulp survival was never observed, but three teeth had pulp canal obliteration. Normal periodontal healing was observed in 57.7% of teeth; 42.3% of teeth showed external root resorption (28.9% replacement resorption, 6.7% infection-related resorption, 6.7% surface resorption). The occurrence of replacement resorption correlated with the period of extraoral dry storage. Compared with other clinical studies on avulsed and replanted teeth, the present study reports a higher percentage of periodontal healing. The favorable treatment outcome may be associated with a strict protocol to enforce endodontic treatment, the use of topical and systemic tetracycline, and the relatively high number of ideally stored teeth following avulsion. In contrast, the present study has a follow-up period limited to 1 year.

Management of a complex dentoalveolar trauma with multiple avulsions: a case report

Treatment of permanent tooth avulsions in an adolescent poses significant difficulties for the dental clinician. This case report gives details about the treatment of a complex dentoalveolar trauma involving multiple avulsions of primary molars, permanent incisors, permanent molars, and premolar toothbuds. Immediate treatment of the injury and short-term esthetic replacement of the dentition is described. A brief review of current research relative to the treatment of permanent tooth avulsions is provided.