Review of matrix metalloproteinases' effect on the hybrid dentin bond layer stability and chlorhexidine clinical use to prevent bond failure

Synthesis and characterization of mesoporous zinc oxide nanoparticles and evaluation of their biocompatibility in L929 fibroblasts

OBJECTIVES

This study aimed to synthesize and characterize mesoporous zinc oxide nanoparticles (ZnO NPs) and also to evaluate the cytotoxicity of mesoporous ZnO NPs on L929 mouse fibroblast cell lines using 3-(4,5- dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay.

MATERIALS AND METHODS

The synthesized mesoporous ZnO NPs were extensively characterized using X-ray diffraction analysis (XRD), transmission electron microscopy (TEM), Brunauer-Emmett-Teller (BET) analysis, field emission scanning electron microscopy (FESEM), energy dispersive X-ray spectra (EDAX), Fourier-transform infrared spectroscopy (FTIR), and dynamic light scattering (DLS). The cytotoxicity of mesoporous ZnO NPs was assessed by MTT assay. The study groups for cytotoxicity assay were normal saline, 0.1% calcined mesoporous ZnO NP solution, 1% calcined mesoporous ZnO NP solution, 0.1% noncalcined mesoporous ZnO NP solution, 1% noncalcined mesoporous ZnO NP solution, 0.1% ZnO NP solution, 1% ZnO NP solution, 2% chlorhexidine, and phosphate-buffered saline (PBS). The percentages of mean ± standard deviation of viable cells were analyzed.

RESULTS

Characterization of mesoporous ZnO NPs revealed that all the particles were in a more or less spherical shape with a wide particle size distribution of 70-100 nm. TEM image showed the uniformed and aggregated ZnO NPs with a typical size of 10-15 nm. BET analysis showed a mesoporous structure for the prepared mesoporous ZnO NPs. According to the MTT assay, chlorhexidine had the lowest cell viability percentage. Cell viability percentages of 0.1% mesoporous ZnO NP solutions (calcined and noncalcined) were statistically, significantly higher than 0.1% ZnO NP solution (p < .05). Cell viability percentages of 0.1% calcined and noncalcined mesoporous ZnO NP solutions and 0.1% ZnO NP solution were statistically, significantly higher than the 1% solutions (p < .05).

CONCLUSION

Mesoporous ZnO NPs exhibited less cytotoxicity against L929 mouse fibroblast cell lines compared to CHX and ZnO NPs, hence are safe to use.

Effect of the use of bromelain associated with bioactive glass-ceramic on dentin/adhesive interface

OBJECTIVES

To evaluate the effect of bromelain associated with Biosilicate on the bond strength (BS) of a universal adhesive system to sound (SD) and caries-affected dentin (CAD), and on the proteolytic activity.

MATERIALS AND METHODS

Cavities were prepared in 360 molars, half submitted to cariogenic challenge. Teeth were separated into groups (n=20): Control-No treatment; CHX-0.12% chlorhexidine; NaOCl-5% sodium hypochlorite; Br5%-5% bromelain; Br10%-10% bromelain; Bio-10% Biosilicate; NaOClBio-NaOCl+Bio; Br5%Bio-Br5%+Bio; Br10%Bio-Br10%+Bio. Following treatments, the adhesive system was applied, and cavities were restored. Samples were sectioned into sticks and stored at 37 °C for 24 h, 6 months, and 1 year. Microtensile BS (2-way ANOVA, Bonferroni's test, α=0.05), fracture patterns (SEM), and adhesive interfaces (TEM) were evaluated. Bacterial collagenase assay and in situ zymography were performed.

RESULTS

In CAD, Br10% presented higher BS (p=0.0208) than Br5%Bio. Br5% presented higher BS (p=0.0033) after 6 months than after 24 h; and association of treatments, higher BS (p<0.05) after aging than after 24 h. Mixed fractures were the most prevalent. Association of treatments promoted a more uniform hybrid layer with embedded Bio particles. Experimental groups presented lower (p<0.0001) relative fluorescence units than Control. Bromelain, associated or not with Bio, showed collagenolytic degradation.

CONCLUSIONS

Bromelain associated with Biosilicate did not affect the BS to SD. In CAD, Br5%Bio decreased immediate BS but had no long-term influence. This association decreased the proteolytic activity.

CLINICAL RELEVANCE

Bromelain and Biosilicate may enhance the longevity of adhesive restorations by inhibiting endogenous proteases.

Insight into the development of versatile dentin bonding agents to increase the durability of the bonding interface

Despite the huge improvements made in adhesive technology over the past 50 years, there are still some unresolved issues regarding the durability of the adhesive interface. A complete sealing of the interface between the resin and the dentin substrate remains difficult to achieve, and it is doubtful whether an optimal interdiffusion of the adhesive system within the demineralized collagen framework can be produced in a complete and homogeneous way. In fact, it is suggested that hydrolytic degradation, combined with the action of dentin matrix enzymes, destabilizes the tooth-adhesive bond and disrupts the unprotected collagen fibrils. While a sufficient resin–dentin adhesion is usually achieved immediately, bonding efficiency declines over time. Thus, here, a review will be carried out through a bibliographic survey of scientific articles published in the last few years to present strategies that have been proposed to improve and/or develop new adhesive systems that can help prevent degradation at the adhesive interface. It will specially focus on new clinical techniques or new materials with characteristics that contribute to increasing the durability of adhesive restorations and avoiding the recurrent replacement restorative cycle and the consequent increase in damage to the tooth.

The effect of mechanical and chemo-mechanical temporary cement cleaning methods on shear bond strength with self-adhesive resin cement (an in-vitro study)

BACKGROUND

Adhesive tooth-colored restorations are strongly dependent on the substrate surface cleanliness to allow intimate contact between resin cement and dentin surface, so several methods were adopted for the total cleaning of temporary cement residues. This study aimed to assess the effect of mechanical and chemo-mechanical cleaning methods of temporary cement on the immediate shear bond strength of self-adhesive resin cement to dentin surface.

METHODS

Forty freshly extracted lower first premolars were cut to expose a flat dentin surface. Discs of temporary crown composite resin material were constructed and cemented to the flat dentin surface using resin-based and non-eugenol temporary cement then stored at room temperature in distilled water. Dividing of samples into two groups according to the method of temporary cement cleaning. Group I (n = 20) mechanical cleaning using the rotary instrument, and group II (n = 20) chemo-mechanical cleaning using chlorhexidine-containing scrub. CAD/CAM reinforced Composite discs were bonded to the dentin surface using self-adhesive composite resin cement, then measurement of shear bond strength was done using a universal testing machine. Further analysis of failure mode after debonding was performed by Scanning electron microscope.

RESULTS

No statistically significant difference was found between the mean shear bond strength of the two cleaning methods (P-value = 0.636). Regardless of the cleaning method, the group cemented with resin-based temporary cement showed statistically significantly higher mean shear bond strength than non-eugenol temporary cement (P-value = 0.048).

CONCLUSION

Both cleaning methods (mechanical and chemo-mechanical) applied in this study were effective in cleaning temporary cement remnants from the dentin substrate surface with statistically significant differences between results of shear bond strength with significantly higher values recorded with resin-based temporary cement.

The comparative evaluation of the effects of quercetin, α-tocopherol, and chlorhexidine dentin pretreatments on the durability of universal adhesives

OBJECTIVE

The aim of this study was to evaluate and compare the effects of chlorhexidine, quercetin, and α-tocopherol on the shear bond strength of universal adhesives in the short (24h) and long term (6 months).

MATERIAL AND METHODS

Ninety-six extracted sound molars were collected and divided randomly into four groups: control (no treatment), 2% chlorhexidine, 10% α-tocopherol, and 1% quercetin. The solutions were prepared and applied to the teeth for 60 s, followed by application of All-Bond universal adhesive and composite build-up. Half of the specimens in each group (n = 12) were tested for shear bond strength (SBS) after 24 h of storage and the other half were kept in distilled water for 6 months and then tested for shear bond strength. The shear bond strength test was performed and the failure modes were determined using a stereomicroscope. The data were analyzed using two-way analysis of variance and Tukey's post hoc tests with p ˂ .05 as the significance level.

RESULTS

The results of the two-way analysis of variance test showed that there was no significant difference in immediate SBS, and after 6 months, α-tocopherol had the lowest SBS in comparison to the control and CHX subgroups (p < .05). The t-test showed that the shear bond strength in the α-tocopherol and quercetin groups was significantly decreased after 6 months.

CONCLUSION

It can be concluded that the solutions used in this study had no adverse effect on immediate SBS. After 6 months, the CHX could preserve SBS in comparison to other groups.

Effect of Endodontic Irrigating Solutions on Radicular Dentine Structure and Matrix Metalloproteinases-A Comprehensive Review

Irrigating solutions play an important role in the eradication of intracanal microbes and debris dissolution during endodontic treatment. Different combinations of solutions and protocols have been advocated, with sodium hypochlorite (NaOCl), ethylenediamine tetra acetic acid (EDTA), and chlorhexidine (CHX) remaining the most widely used ones by many clinicians. Although these solutions provide efficient inorganic dissolution and antimicrobial capacity, their use has also been reported to cause undesired effects on root dentin composition and mechanical and biomechanical properties, such as microhardness, surface roughness, bond strength, and matrix metalloproteinase (MMP) activity. Several corroborating studies attribute these changes in mechanical properties of dentine to the use of irrigating solutions, and there are limited reports on how the solutions affect the expression of MMPs, which may be a correlating link to understanding the role of these enzymes in dentin collagen and changes in the mechanical properties of dentin. Hence, using the basis of several studies from the literature, the objective is to comprehensively review the influence of individual and combined irrigating solutions on root dentine structure and the activity of the MMPs.

Potential of Fluoride-Containing Zinc Oxide and Copper Oxide Nanocomposites on Dentin Bonding Ability

Despite recent advances in bonding restorations, which are the basis of restorative dentistry, secondary caries are still able to form. Previously, a novel fluoride-containing zinc and copper (ZCF) nanocomposite was introduced to prevent the formation of caries due to its antibacterial activity. In this study, we studied the impact of ZCF nanoparticles on the adhesive strength of bonding restorations through micro-tensile bond strength (µTBS) testing. The impact of antibacterial and matrix metalloproteinase (MMP) inhibitors on the nanoparticles was also examined. The nanocomposites were prepared using a simple one-step homogeneous co-precipitation method at a low temperature. A self-etch adhesive was applied to 10 extracted caries-free human molars with (test group) and without (control group) the ZCF nanoparticles. This was followed by composite resin build-up and µTBS testing, MMP activity assays, and evaluation of the antibacterial effects. The results showed no significant differences in the µTBS between the ZCF and the control groups. However, the ZCF exhibited a significant inhibitory effect against MMP-2, MMP-8, and MMP-9, in addition to an antibacterial effect on Streptococcus mutans. Therefore, the present study demonstrated that the addition of ZCF nanoparticles to adhesive systems can result in MMP inhibition and antibacterial action while maintaining the mechanical properties of the bonding restorations.

Effect of Chlorhexidine on Immediate and Delayed Bond Strength between Resin and Dentin of Primary Teeth: A Systematic Review and Meta-Analysis

Objectives: The purpose of this study was to systematically review the literature and use meta-analysis to investigate whether chlorhexidine (CHX) application after acid etching as an adjunct treatment has any influence on the immediate and delayed bond strength to primary dentin. Materials and Methods: In this review, PubMed, ISI (all data bases), Scopus and Cochrane were searched according to the selected keywords up to April 30, 2018. The full texts of all published articles that met our primary inclusion criteria were obtained. The studies were analyzed in two parts: in vitro studies that evaluated the effect of CHX application during the bonding procedures (application after acid etching) on immediate and delay dentin bond strength of resin-dentin interface. Results: The initial search yielded 214 publications, of which 8 were selected after thorough methodological assessment. None of the clinical studies fulfilled the eligibility criteria. Our results indicated that in comparison to the control group, CHX significantly reduced immediate resin-dentin bond strength (P=0.043). These values were increased after aging (P<0.001). Conclusion: Based on this invitro Meta-analysis CHX application, improve resin-dentin bond strength durability in primary teeth.

Selective toxicity of antibacterial agents-still a valid concept or do we miss chances and ignore risks?

BACKGROUND

Selective toxicity antibacteribiotics is considered to be due to interactions with targets either being unique to bacteria or being characterized by a dichotomy between pro- and eukaryotic pathways with high affinities of agents to bacterial- rather than eukaryotic targets. However, the theory of selective toxicity oversimplifies the complex modes of action of antibiotics in pro- and eukaryotes.

METHODS AND OBJECTIVE

This review summarizes data describing multiple modes of action of antibiotics in eukaryotes.

RESULTS

Aminoglycosides, macrolides, oxazolidinones, chloramphenicol, clindamycin, tetracyclines, glycylcyclines, fluoroquinolones, rifampicin, bedaquillin, ß-lactams inhibited mitochondrial translation either due to binding to mitosomes, inhibition of mitochondrial RNA-polymerase-, topoisomerase 2ß-, ATP-synthesis, transporter activities. Oxazolidinones, tetracyclines, vancomycin, ß-lactams, bacitracin, isoniazid, nitroxoline inhibited matrix-metalloproteinases (MMP) due to chelation with zinc and calcium, whereas fluoroquinols fluoroquinolones and chloramphenicol chelated with these cations, too, but increased MMP activities. MMP-inhibition supported clinical efficacies of ß-lactams and daptomycin in skin-infections, and of macrolides, tetracyclines in respiratory-diseases. Chelation may have contributed to neuroprotection by ß-lactams and fluoroquinolones. Aminoglycosides, macrolides, chloramphenicol, oxazolidins oxazolidinones, tetracyclines caused read-through of premature stop codons. Several additional targets for antibiotics in human cells have been identified like interaction of fluoroquinolones with DNA damage repair in eukaryotes, or inhibition of mucin overproduction by oxazolidinones.

CONCLUSION

The effects of antibiotics on eukaryotes are due to identical mechanisms as their antibacterial activities because of structural and functional homologies of pro- and eukaryotic targets, so that the effects of antibiotics on mammals are integral parts of their overall mechanisms of action.

Evaluation of the effect of natural versus synthetic matrix metalloproteinase silencers in preservation of dentin collagen and long-term bond strength of total etch adhesive

Aim

This study investigated the effect of various synthetic (galardin [Gal] and benzalkonium chloride [BAC]) and natural agents (hesperidin [HES] and epigallocatechin gallate) on the stability of dentin collagen matrix to resist collagenase degradation and improve long-term microtensile bond strength.

Materials and Methods

Ten sound-impacted third molars were collected and manual removal of pulp, periodontal ligament, cementum, and enamel was done. Remaining dentin fragments were pulverized under liquid nitrogen to obtain dentin powder. 2 mg aliquot of dentin powder was allocated to each of the test solutions and subjected to hydroxyproline assay. Another 60 sound human third molars were collected and occlusal enamel was ground flat to reach dentinoenamel junction. Class I cavities were prepared in dentin, followed by etching using 37% phosphoric acid for 15 s. Samples were then subjected to surface treatment with different agents for 60 s, followed by application of Optibond S and restoration with P 60 composite resin. Samples of all groups except control were subject to thermocycling. Samples were sectioned to 1 mm thick slabs which were subject to universal testing machine to determine ultimate tensile strength. One-way analysis of variance and Bonferroni post hoc test with a significance level of P < 0.05 were used to analyze data.

Results

HES resulted in maximum resistance to collagen degradation, followed by epigallocatechin gallate (EGCG), Gal, and BAC with a significant difference among the groups. Samples of Gal group showed the highest microtensile bond strength values, followed by HES, EGCG, BAC with a significant difference between the groups except HES and EGCG where the difference was nonsignificant.

Conclusion

The use of matrix metalloproteinase silencers could improve the mechanical properties of collagen and resist enzymatic degradation, leading to an improved long-term intimate restoration.

Human neutrophils compromise the restoration-tooth interface

Neutrophils, cells of the innate immune system, enter the mouth and release factors that are hypothesized to contribute to the degradation of tooth dentin, methacrylate resin composites, and adhesives at the restoration-tooth-dentin interface. The objectives were to characterize neutrophils' degradation towards resin composite, self-etch (SE) and total-etch (TE) adhesives, SE and TE resin-dentin interfaces and to identify proteins that could contribute to the degradation process. Neutrophils' degradation of cured resin composite, and SE and TE adhesives, was quantified by measuring the specific resin degradation by-product, bishydroxy-propoxy-phenyl-propane (bisHPPP), released after 30 days incubation of the materials with the cells. Neutrophils' degradative effect on resin-dentin interfaces was examined by recording the interfacial fracture toughness (FT), and surface analysis of the fracture mode following incubation of SE and TE miniature short-rod (mini-SR) specimens with the cells. Neutrophils increased degradation of polymerized resin composite, and TE adhesive, but not SE adhesive over 30 days (p < 0.05). Incubation of SE and TE resin-dentin interfaces with neutrophils led to a reduction in FT over time (p < 0.05). The effect was more pronounced for TE interfaces. Neutrophils also affected the fracture mode of SE and TE resin-dentin interfaces. Several proteins that could contribute to the degradative activity of neutrophils, including Neutrophil collagenase (MMP-8), Matrix metalloproteinase- 9 (MMP-9), Cathepsin G, Neutrophil- gelatinase associated lipocalin (NGAL) and Myeloperoxidase, were isolated. The ability of neutrophils to degrade resin, tooth dentin, and reduce the bond strength of resin-dentin interfaces suggest neutrophils' potential role in primary and recurrent caries and dental restoration failure.

Evaluation of 2% Chlorhexidine and 2% Sodium Fluoride as Endodontic Irrigating Solutions on Root Dentine Microhardness: An In Vitro Study

Objectives  The aim of this study was to evaluate the effects of 2% chlorhexidine gluconate (CHG) and 2% sodium fluoride (NaF) as endodontic irrigants on microhardness of root dentin.

Materials and Methods  In this in vitro study, access cavity and root canal preparations were done on 24 freshly extracted anterior teeth. After sectioning into 24 dentin discs using hard tissue microtome in 2 mm thickness, all samples were immersed in solutions of 17% ethylenediamine tetra-acetic acid (EDTA) (2 minutes) followed by 2.5% of sodium hypochlorite (NaOCl) (10 minutes). Then samples were randomly divided into three groups based on the irrigant used: Group I: saline (control group); Group II: 2% NaF; Group III: 2% CHG for two minutes each. Dentin microhardness was measured before (pretreatment), during (after treatment with 17% EDTA and 2.5% NaOCl), and after the experimental period (after treatment with saline, 2% NaF, and 2% CHG) using a Vickers indenter. Statistical evaluation of the data was done using one-way analysis of variance (ANOVA) and the Student’s t -test, and the values are tabulated.

Results  Specimens rinsed in 2% CHG showed a significant increase in Vickers hardness number (VHN) values ( p < 0.05), as compared with EDTA and NaOCl groups, whereas saline and 2% NaF groups showed no significant difference.

Conclusions  NaF did not show any significant effect on microhardness of the root dentin. CHG as an irrigant was seen to have a strengthening effect on dentin microhardness in comparison to NaOCl and EDTA, which has decreased the strength of root dentin.

Inhibition of matrix metalloproteinases: a troubleshooting for dentin adhesion

Matrix metalloproteinases (MMPs) are enzymes that can degrade collagen in hybrid layer and reduce the longevity of adhesive restorations. As scientific understanding of the MMPs has advanced, useful strategies focusing on preventing these enzymes' actions by MMP inhibitors have quickly developed in many medical fields. However, in restorative dentistry, it is still not well established. This paper is an overview of the strategies to inhibit MMPs that can achieve a long-lasting material-tooth adhesion. Literature search was performed comprehensively using the electronic databases: PubMed, ScienceDirect and Scopus including articles from May 2007 to December 2019 and the main search terms were “matrix metalloproteinases”, “collagen”, and “dentin” and “hybrid layer”. MMPs typical structure consists of several distinct domains. MMP inhibitors can be divided into 2 main groups: synthetic (synthetic-peptides, non-peptide molecules and compounds, tetracyclines, metallic ions, and others) and natural bioactive inhibitors mainly flavonoids. Selective inhibitors of MMPs promise to be the future for specific targeting of preventing dentin proteolysis. The knowledge about MMPs functionality should be considered to synthesize drugs capable to efficiently and selectively block MMPs chemical routes targeting their inactivation in order to overcome the current limitations of the therapeutic use of MMPs inhibitors, i.e., easy clinical application and long-lasting effect.

Matrix metalloproteinases gene variants and dental caries in Czech children

Background

Matrix metalloproteinases (MMPs) play an important role in tooth formation and the mineralization of dental tissue. The aim of the study was to analyse Czech children with primary/permanent dentition polymorphisms in those genes encoding MMP2, MMP3, MMP9, MMP13, MMP16, and MMP20, which had been previously associated with dental caries in other populations.

Methods

In total, 782 Czech children were included in this case-control study. DNA samples were taken from 474 subjects with dental caries (with decayed/missing/filled teeth, DMFT ≥ 1) and 155 caries free children (DMFT = 0) aged 13–15 years, as well as 101 preschool children with early childhood caries (ECC, dmft ≥ 1) and 52 caries free children (dmft = 0), were analyzed for nine MMPs single nucleotide polymorphisms (SNPs) using real time polymerase chain reaction TaqMan assays.

Results

There were no significant differences in the allele and/or genotype frequencies of all the studied MMPs SNPs among children with dental caries in primary/permanent dentition and the healthy controls (P > 0.05). In addition, similar allele or genotype frequencies of the studied MMPs SNPs were found in children with severe dental caries in their permanent teeth (children with DMFT ≥ 6) and the healthy controls (DMFT = 0, P > 0.05).

Conclusions

This study demonstrated the lack of association between the selected SNPs in candidate genes of MMPs and the susceptibility to or severity of dental caries in both primary and permanent dentitions in Czech children.

A new method for dentine matrix metalloproteinase extraction

In addition to their involvement in tissue remodelling, matrix metalloproteinases (MMPs), in the oral environment, are linked to leakage in the resin-dentine interface through their involvement in the proteolytic degradation of the resin-dentine hybrid layer. Numerous studies have evaluated dentine MMP activity and the vast majority of those studies have used an MMP extraction protocol to semi-purify the MMPs from dentine, first described around 20 years ago. This is a protocol that requires 32 days for completion. The technique is based on the three-step sequential use of NaCl solution for pulverised dentine washing, then guanidine HCl and EDTA to demineralise the pulverised dentine to extract the MMPs. In this study, a new one-step dentine MMP extraction protocol was adapted to extract dentine MMPs in only four days. This was achieved by eliminating the NaCl washing step and combining the guanidine HCl and EDTA into one extraction solution that also contained proteinase inhibitors. Fifty-two dentine MMP extracts were obtained utilising the two different extraction methods. The amount of total and endogenously active MMP-2 in the specimens was assayed utilising a human MMP-2 activity enzyme-linked immunosorbent assay (ELISA). The study results showed that the new extraction method is as effective as the traditional three-step extraction method in semi-purifying dentine MMP-2.

The use of clays for chlorhexidine controlled release as a new perspective for longer durability of dentin adhesion

The adhesive systems have the function to establish the connection between the restorative material and dental tissue, therefore it is of fundamental importance, because failures in the adhesive interface can reduce the life of a dental restoration. This study investigated the possibility of using the adhesive layer as a chlorhexidine modified release system evaluating their impact on the properties of these systems as well as evaluating the impact of these systems on immediate and post-aging dentin adhesion. Were used a matrix with BisGMA, UDMA, HEMA and TEGDMA copolymer and clay particles (Dellite 67G); associated with a chlorhexidine and a camphorquinone photoinitiator system. The properties of these systems were evaluated by the XRD, FTIR spectrophotometer, flexural strength, elasticity modulus, drug release, enzymatic inhibition and dentin adhesion resistance. The presence of the clay can raise the mechanical properties of the adhesive systems engendering a more resistant hybrid layer and led to a more sustained release of chlorhexidine in the systems, allowing a longer effective period of MMP-2 inhibition. The hypothesis that the addition of clays as release modulators could increase the effectiveness of these drugs in inhibiting the dentin's MPPs and consequently enhancing the adhesive durability was confirmed. These results indicate that the controlled release of chlorhexidine is able to reduce the process of loss of adhesion presenting itself as a promising system to increase the longevity of dental restorations.

Effect of 0.12% chlorhexidine and zinc nanoparticles on the microshear bond strength of dentin with a fifth-generation adhesive

Objective:

In this study, we compared the effects of 0.12% chlorhexidine (CHX) and nano zinc oxide (NZO) on the microshear bond strength of dentin with a fifth-generation adhesive after acid etching.

Materials and Methods:

Forty molar teeth were randomly divided into four main groups based on dentin surface treatment technique (a) control (single bond 2); (b) NZO; (c) CHX; and (d) NZO + CHX. In each group, half of the samples underwent thermocycling, with no thermocycling in the other half. Then, failure mode was evaluated under a stereomicroscope. Statistical analysis was performed using t-test, two-way ANOVA, and Chi-squared test.

Results:

The mean microshear bond strength of the groups without thermocycling was more than that of the groups with thermocycling, but there were no statistically significant differences between the groups with and without thermocycling in pair-wise comparisons.

Conclusion:

Pretreatment with NZO and CHX separately and simultaneously had no effect on the microshear bond strength of a fifth-generation adhesive.

Effect of 2% Chlorhexidine on Resin Bond Strength and Mode of Failure Using Two Different Adhesives on Dentin: An In Vitro Study

Aim

To evaluate the shear bond strength and failure mode of total-etch and self-etch bonding agents on human dentin with and without application of 2% chlorhexidine gluconate (CHX).

Materials and Methods

Eighty extracted premolars were chosen and stored in 10% formalin until use. Samples were mounted in cold cure acrylic resin and the occlusal enamel perpendicular to long axis of each tooth was removed using a low-speed diamond saw under water coolant. The prepared teeth were randomly divided into four groups of 20 samples each according to the adhesive system used. Groups 1 and 2 were the control group in which total-etch and self-etch adhesives were applied as per manufacturer's instructions, Groups 3 and 4 were the experimental groups in which 2% CHX was applied and blot dried prior to the application of total-etch and self-etch adhesives. A custom-designed rig was fabricated to place composite on samples. The customized rig comprised a cylindrical mold with height of 3 mm and internal diameter of 2.5 mm. Resin was placed in increments of 1 mm and was cured after each increments. After the composite placements, samples were placed in distilled water at 37°C for 24 h. The samples were then thermocycled between 5°C and 55°C in water with a dwell time of 30 s in each temperature to a total of 10,000 cycles. The shear test was performed using universal testing machine and fracture modes were evaluated using stereomicroscope.

Results

Both the experimental total-etch and self-etch groups showed better shear bond strength than the control groups, which was statistically significant, and also the least mode of failure at the adhesive interface was observed in both the experimental groups.

Conclusion

2% Chlorhexidine gluconate effectively improved the shear bond strength and helped maintaining the durability of adhesive interface in both total-etch and self-etch adhesives.

Evaluation of Hybrid Layer and Bonding Interface after Water Storage with and without the Usage of 2% Chlorhexidine: A Scanning Electron Microscope Study

AIM

Restorative dentists employ different bonding systems between the resin and the dentin and other dentinal tissues to achieve the goal of micromechanical retention. Studies have shown that the bond between composite and dentin degrades over time because of the action of matrix metalloproteinases (MMPs) on collagen fibrils left unprotected by acid etching. The MMPs may be partially responsible for hybrid layer degradation. Since chlorhexidine (CHX) inhibits MMPs, we hypothesized that CHX would decelerate the loss of resin-dentin bonds. Hence, this in vitro study is intended to evaluate the effects of 2% CHX on hybrid layer and bonding interface.

MATERIALS AND METHODS

Totally, 40 freshly extracted molars were randomly divided into four experimental groups. In all 40 specimens, class II cavities were prepared to a depth of 1 mm below the dentinoenamel junction with no axial wall, but the elimination of the proximal enamel ridge. The teeth were then randomly divided into four experimental groups, i.e., All Bond 2 without 2% CHX (group I), All Bond 2 with 2% CHX (group II), One Coat 7.0 without 2% CHX (group III), and One Coat 7.0 with 2% CHX (group IV). All the specimens were derooted and sectioned mesiodistally into two halves and placed under water at 37°C for 3 months and observed under scanning electron microscope for the hybrid layer and resin tag formation.

RESULTS

Groups I and II showed statistically significant difference when the presence/absence of resin tags was compared. When groups III and IV were compared for the presence/absence of hybrid layer and resin tags, the results were statistically significant.

CONCLUSION

Between all the four experimental groups, irrespective of the bonding systems used, we concluded that groups with 2% CHX usage showed promising results with presence/ absence of hybrid layer and resin tags formation.

CLINICAL SIGNIFICANCE

Studies suggest that the bond between composite and dentin degrades over time because of the action of MMPs on collagen fibrils left unprotected by acid etching. Measures should be taken to prevent this from happening and thus allow bond between composite and dentin last longer.

Effect of Chlorhexidine on Dentin Bond Strength of Two Adhesive Systems after Storage in Different Media

The aim of this study was to evaluate the effect of 2% chlorhexidine (CHX) application during the bonding protocol on microshear bond strength of two adhesive systems, after storage in different media. Seventy-two human molars had their crowns cut in half and embedded in PVC cylinders with acrylic resin. The specimens were randomly divided into experimental groups (n=12) according to the adhesive system (Ambar and Single Bond 2), use of CHX in the bonding protocol, and time interval (24 h and 15 days) in the storage media (distilled water, mineral oil and 1% sodium hypochlorite - NaOCl). Adhesive systems were applied in accordance to manufacturers' recommendations, with or without the use of CHX, and resin composite (Z350 XT) cylinders were placed on the hybridized dentin. After photoactivation, the specimens were stored in distilled water, mineral oil and 1% NaOCl for 24 h and 15 days. Microshear bond strength was determined at a crosshead speed of 0.5 mm/min until fracture. The bond strength data were analyzed statistically by 4-way ANOVA and Tukey's test (α=5%). Use of CHX in the bonding protocol did not cause loss of bond strength in any of the evaluated situations, irrespective of time and storage medium. The storage medium had no influence on bond strength values after 15 days when the bond protocol without CHX application was used. However, the use of CHX in the protocol influenced negatively the bond strength values for Single Bond 2 after 15 days storage in distilled water and 1% NaOCl.

Antibacterial Properties of Calcium Fluoride-Based Composite Materials: In Vitro Study

The aim of the study was to evaluate antibacterial activity of composite materials modified with calcium fluoride against cariogenic bacteria S. mutans and L. acidophilus. One commercially available conventional light-curing composite material containing fluoride ions (F2) and two commercially available flowable light-curing composite materials (Flow Art and X-Flow) modified with 1.5, 2.5, and 5.0 wt% anhydrous calcium fluoride addition were used in the study. Composite material samples were incubated in 0.95% NaCl at 35°C for 3 days; then dilution series of S. mutans and L. acidophilus strains were made from the eluates. Bacteria dilutions were cultivated on media afterwards. Colony-forming unit per 1 mL of solution (CFU/mL) was calculated. Composite materials modified with calcium fluoride highly reduced (p < 0.001) bacteria growth compared to commercially available composite materials containing fluoride compounds. The greatest reduction in bacteria growth was observed for composite materials modified with 1.5% wt. CaF₂. All three tested composite materials showed statistically greater antibacterial activity against L. acidophilus than against S. mutans.

Combination Effect of Hemostatic and Disinfecting Agents on Micro-leakage of Restorations Bonded with Different Bonding Systems

STATEMENT OF PROBLEM

Hemostatic agents may affect the micro-leakage of different adhesive systems. Also, chlorhexidine has shown positive effects on micro-leakage. However, their interaction effect has not been reported yet.

OBJECTIVES

To evaluate the effect of contamination with a hemostatic agent on micro-leakage of total- and self-etching adhesive systems and the effect of chlorhexidine application after the removal of the hemostatic agent.

MATERIALS AND METHODS

Standardized Class V cavity was prepared on each of the sixty caries free premolars at the cemento-enamel junction, with the occlusal margin located in enamel and the gingival margin in dentin. Then, the specimens were randomly divided into 6 groups (n = 10) according to hemostatic agent (H) contamination, chlorhexidine (CHX) application, and the type of adhesive systems (Adper Single Bond and Clearfil SE Bond) used. After filling the cavities with resin composite, the root apices were sealed with utility wax. Furthermore, all the surfaces, except for the restorations and 1mm from the margins, were covered with two layers of nail varnish. The teeth were immersed in a 0.5% basic fuschin dye for 24 hours, rinsed, blot-dried and sectioned longitudinally through the center of the restorations bucco- lingualy. The sections were examined using a stereomicroscope and the extension of dye penetration was analyzed according to a non-parametric scale from 0 to 3. Statistical analysis was performed using Kruskal-Wallis test and Mann-Whitney U-test.

RESULTS

While ASB group showed no micro-leakage in enamel, none of the groups showed complete elimination of micro-leakage from the dentin. Regarding micro-leakage at enamel, and dentin margins, there was no significant difference between groups 1 and 2, 1 and 3, and 2 and 3 (p > 0.05). A significantly lower micro-leakage at the enamel and dentin margins was observed in group 3, compared to group 6. No significant difference was observed between groups 4 and 5 in enamel (p = 0.35) and dentin (p = 0.34). Group 6 showed significantly higher micro-leakage, compared to group 4 and 5 (p < 0.05).

CONCLUSIONS

Hemostatic agent contamination had no significant effect on micro-leakage of total- and self-etching adhesive systems. Application of chlorhexidine after the removal of hemostatic agent increased micro-leakage in self-etching adhesives but did not affect when total-etching was used.

Chlorhexidine Nanocapsule Drug Delivery Approach to the Resin-Dentin Interface

In this study, we are introducing a new drug-delivery approach to demineralized dentin substrates through microsized dentinal tubules in the form of drug-loaded nanocapsules. Chlorhexidine (CHX) is widely used in adhesive dentistry due to its nonspecific matrix metalloproteinase inhibitory effect and antibacterial activities. Poly(ε-caprolactone) nanocapsules (nano-PCL) loaded with CHX were fabricated by interfacial polymer deposition at PCL/CHX ratios of 125:10, 125:25, and 125:50. Unloaded nanocapsules (blank) were fabricated as control. The fabricated nanocapsules were characterized in vitro in terms of particle size, surface charges, particle recovery, encapsulation efficiency, and drug loading. Nanocapsule morphology, drug inclusion, structural properties, and crystallinity were investigated by scanning and transmission electron microscopes (SEM/TEM), energy-dispersive x-ray analysis, Fourier transform infrared spectroscopy, and x-ray diffraction. Initial screening of the antibacterial activities and the cytotoxicity of the nanocapsules were also conducted. Nanocapsules, as carried on ethanol/water solution, were delivered to demineralized dentin specimens connected to an ex vivo model setup simulating the pulpal pressure to study their infiltration, penetration depth, and retention inside the dentinal tubules by SEM/TEM. Nanocapsules were Ag labeled and delivered to demineralized dentin, followed by the application of a 2-step etch-and-rinse dentin adhesive. CHX-release profiles were characterized in vitro and ex vivo up to 25 d. Spherical nanocapsules were fabricated with a CHX core coated with a thin PCL shell. The blank nanocapsules exhibited the largest z-average diameter with negatively charged ζ-potential. With CHX incorporation, the nanocapsule size was decreased with a positive shift in ζ-potential. Nano-PCL/CHX at 125:50 showed the highest drug loading, antibacterial effect, and CHX release both in vitro and ex vivo. SEM and TEM revealed the deep penetration and retention of the CHX-loaded nanocapsules inside dentinal tubules and their ability to be gradually degraded to release CHX in vitro and ex vivo. Ag-labeled nanocapsules revealed the close association and even distribution of nanocapsules throughout the resin tag structure. This study demonstrated the potential of introducing this novel drug-delivery approach to demineralized dentin substrates and the resin-dentin interface with nanosized CHX-loaded nanocapsules through the microsized dentinal tubules.

Effect of digluconate chlorhexidine on bond strength between dental adhesive systems and dentin: A systematic review

Aim:

This study aimed to systematically review the literature for the effect of digluconate chlorhexidine (CHX) on bond strength between dental adhesive systems and dentin of composite restorations.

Materials and Methods:

The electronic databases that were searched to identify manuscripts for inclusion were Medline via PubMed and Google search engine. The search strategies were computer search of the database and review of reference lists of the related articles. Search words/terms were as follows: (digluconate chlorhexidine*) AND (dentin* OR adhesive system* OR bond strength*).

Results:

Bond strength reduction after CHX treatments varied among the studies, ranging 0-84.9%. In most of the studies, pretreatment CHX exhibited lower bond strength reduction than the control experimental groups. Researchers who previously investigated the effect of CHX on the bond strength of dental adhesive systems on dentin have reported contrary results, which may be attributed to different experimental methods, different designs of the experiments, and different materials investigated.

Conclusions:

Further investigations, in particular clinical studies, would be necessary to clarify the effect of CHX on the longevity of dentin bonds.

Role of matrix metalloproteinases in dental caries, pulp and periapical inflammation: An overview

Matrix metalloproteinases (MMPs) are a group of more than 25 secreted and membrane bound enzymes that represent class of enzymes responsible for degradation of pericellular substrates. They have been isolated from dentine, odontoblasts, pulp and periapical tissue. They play an important role in dentine matrix formation, modulating caries progression and secondary dentine formation. Earlier microbial proteolytic enzymes were believed to be responsible for degradation of dentine organic matrix, but lately the accumulated body of evidence suggests that MMPs have an important role in the process. During normal tissue modelling, differentiation during development, in modulating the cell behaviour, maintaining homeostasis and in numerous extracellular pathologic conditions, MMPs tends to be an equally important participant. Odontoblasts secrete some of the essential MMPs for both physiologic and pathologic conditions. MMPs also appear to be a participant in the process of reversible and irreversible pulpitis. Although they tend to have low expression and activity in adult tissues but at the onset of any destructive pathologic process, their production shoots up. They appear to have a significant presence during times of inflammation in the periapical region as well. We take a look at the various factors and evidence pointing towards the role of MMPs in the progression of caries, pulpal and periapical inflammation.

Evaluation of Shear Bond Strength of Total- and Self-etching Adhesive Systems after Application of Chlorhexidine to Dentin Contaminated with a Hemostatic Agent

STATEMENT OF THE PROBLEM

Hemostatic agents may influence the bond strength of different bonding agents. Also, chlorhexidine has shown positive effects on bond strength values and their combination effect has not been reported yet.

PURPOSE

The aim of this study was to evaluate the effect of contamination with a hemostatic agent on shear bond strength (SBS) of total- and self-etching adhesive systems and the effect of chlorhexidine application after removal of the hemostatic agent.

MATERIALS AND METHOD

In this experimental study, the occlusal enamel of each sixty caries-free mandibular molars was removed and their midcoronal dentin was exposed. The specimens were then mounted in auto-polymerizing resin 1mm apical to CEJ. Then, the specimens were divided into 6 groups (n=10) based on contamination with a hemostatic agent (H), application of chlorhexidine (CHX) and the adhesive system used; and then were classified as Group 1: Adper Single Bond (ASB); Group 2: H+ASB; Group 3: H+0.2% CHX+ASB; Group 4: Clearfil SE Bond (CSB); Group 5: H+CSB; Group 6: H+0.2% CHX+CSB. Then, composite resin rods (4×2 mm) were built up on the dentin surfaces and after thermocycling, the SBS (MPa) was evaluated. Statistical analysis was performed using two-way ANOVA and post hoc Tukey tests (p< 0.05).

RESULTS

There were statistically significant differences between bond strength values of group 1 (ASB) and group 2 (H+ASB) (p< 0.001) and group 1 (ASB) and group 3 (H+CHX+ASB) (p< 0.001). Similarly, significant differences were seen between group 4 (CSB) and group 5 (H+CSB) (p< 0.001) and between group 4 (CSB) and group 6 (H+CHX+CSB) (p< 0.001).

CONCLUSION

Contamination with hemostatic agent reduced the SBS of both total- and self-etching adhesive systems. In addition, application of chlorhexidine after the removal of hemostatic agent had a negative effect on SBS of total- and self-etching adhesive systems.

Cytotoxicity of a novel nano-silver particle endodontic irrigant

Purpose

The aim of this study was to evaluate the cytotoxic effect of a novel nano-silver particle (25.2±6.5 nm) endodontic irrigant (0.2 mM) and compare it with 3% sodium hypochlorite.

Materials and methods

Two cell types, mouse fibroblast National Institutes of Health 3T3 (NIH 3T3) and primary human periodontal ligament stem cell (hPDLSCs) were used in a test for the effect of direct and indirect (by separating the agent and cell with a layer of agar) exposure to the two solutions. In the direct exposure experiment, ten groups of cell cultures were exposed to one dilution (3:1, 2:1, 1:1, 1:2, 1:3, 1:4, 1:5, 1:6 or 1:7) of a nano-silver irrigant for 48 hours; the concentration-response function was estimated by determining the number of viable cells in each group by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The 50% lethal dose of the testing irrigant for NIH3T3 and hPDLSCs were estimated. In the second part of the experiment, a modified agar overlaying technique was applied. Twelve culture wells (6-well plate) were divided into three groups (n=4). The cell lysis zone (cytotoxic range) created by the stock nano-silver solution, 3% sodium hypochlorite, and an isotonic phosphate buffering saline (control) was measured by two double blinded observers (Kappa score =100%). The cytotoxic score of specific irrigant was derived by modified Sjögren’s method.

Results

The 50% lethal doses of the testing nano silver irrigant for NIH 3T3 and hPDLSCs after 48 hours of direct exposure were 0.58 and 0.608 dilution of stock solution, respectively. The cytotoxic scores of nano-silver irrigant and control (phosphate buffered saline) on NIH 3T3 were 0.25 (95% confidence interval [CI] =0 to 1.04) and 0 (95% CI =0 to 0); and on hPDLSCs were 0.13 (95% CI =0 to 0.52) and 0.25 (95% CI =0 to 1.04), respectively. Toxicity of the test and control group on both mouse fibroblasts (P>0.05) and hPDLSCs (P=1.00) was not statistically different.

Conclusion

Our results showed that the nano-silver irrigant was non-cytotoxic to both NIH 3T3 and hPDLSCs.

Mineral density volume gradients in normal and diseased human tissues

Clinical computed tomography provides a single mineral density (MD) value for heterogeneous calcified tissues containing early and late stage pathologic formations. The novel aspect of this study is that, it extends current quantitative methods of mapping mineral density gradients to three dimensions, discretizes early and late mineralized stages, identifies elemental distribution in discretized volumes, and correlates measured MD with respective calcium (Ca) to phosphorus (P) and Ca to zinc (Zn) elemental ratios. To accomplish this, MD variations identified using polychromatic radiation from a high resolution micro-computed tomography (micro-CT) benchtop unit were correlated with elemental mapping obtained from a microprobe X-ray fluorescence (XRF) using synchrotron monochromatic radiation. Digital segmentation of tomograms from normal and diseased tissues (N=5 per group; 40-60 year old males) contained significant mineral density variations (enamel: 2820-3095mg/cc, bone: 570-1415mg/cc, cementum: 1240-1340mg/cc, dentin: 1480-1590mg/cc, cementum affected by periodontitis: 1100-1220mg/cc, hypomineralized carious dentin: 345-1450mg/cc, hypermineralized carious dentin: 1815-2740mg/cc, and dental calculus: 1290-1770mg/cc). A plausible linear correlation between segmented MD volumes and elemental ratios within these volumes was established, and Ca/P ratios for dentin (1.49), hypomineralized dentin (0.32-0.46), cementum (1.51), and bone (1.68) were observed. Furthermore, varying Ca/Zn ratios were distinguished in adapted compared to normal tissues, such as in bone (855-2765) and in cementum (595-990), highlighting Zn as an influential element in prompting observed adaptive properties. Hence, results provide insights on mineral density gradients with elemental concentrations and elemental footprints that in turn could aid in elucidating mechanistic processes for pathologic formations.

Mechanisms regulating the degradation of dentin matrices by endogenous dentin proteases and their role in dental adhesion. A review

PURPOSE

This systematic review provides an overview of the different mechanisms proposed to regulate the degradation of dentin matrices by host-derived dentin proteases, particularly as it relates to their role in dental adhesion. Significant developments have taken place over the last few years that have contributed to a better understanding of all the factors affecting the durability of adhesive resin restorations. The complexity of dentin-resin interfaces mandates a thorough understanding of all the mechanical, physical and biochemical aspects that play a role in the formation of hybrid layers. The ionic and hydrophilic nature of current dental adhesives yields permeable, unstable hybrid layers susceptible to water sorption, hydrolytic degradation and resin leaching. The hydrolytic activity of host-derived proteases also contributes to the degradation of the resin-dentin bonds. Preservation of the collagen matrix is critical to the improvement of resin-dentin bond durability. Approaches to regulate collagenolytic activity of dentin proteases have been the subject of extensive research in the last few years. A shift has occurred from the use of proteases inhibitors to the use of collagen cross-linking agents. Data provided by 51 studies published in peer-reviewed journals between January 1999 and December 2013 were compiled in this systematic review.

RESULTS

Appraisal of the data provided by the studies included in the present review yielded a summary of the mechanisms which have already proven to be clinically successful and those which need further investigation before new clinical protocols can be adopted.

The effects of host derived metalloproteinases on dentin bond and the role of MMPs inhibitors on dentin matrix degradation

OBJECTIVES

The work has the objective to analyze the literature on the degradation of the adhesive interface. In particular the study is focused on the role of the metalloproteinase in the hydrolytic degradation of collagen matrix in the bonded interface. The survey will concern also the latest innovations to improve and increase the link between dentin and the restorative materials through the MMPs inhibitors.

METHODS

The research has been carried out in the MEDLINE database by choosing keywords as "metalloproteinases" and "dentin bond" and "degradation". In vitro studies were included in the research, excluding studies with no human and deciduous teeth. Language was limited to English.

RESULTS

The collagenolytic enzymes in mineralized dentin have been demonstrated to have an important role in dental hard tissue pathologies, including the degradation of the hybrid layer.

CONCLUSION

The preservation of the collagen matrix integrity is a key issue in the attempts to improve the dentin bonding durability.

Effect of EGCG Application on Collagen Degradation in Dentine Caries

Caries progress might be controlled when collagen matrix could be preserved after demineralization. The aim of this study was to investigate the effect of EGCG, a major polyphenol of green tea, on changes in loss of dry weight or solubilization of collagen from demineralized dentin sections. Dentin sections (1mm×5mm×5mm) were completely exposed to the acetic acid solution to form dentine caries. After baseline measurements of dry mass, the samples were divided into 2 groups and incubated at 37°C in either media containing EGCG or artificial saliva only for 24h, 3 days, 1 week, 2 week and 3 weeks. Following hydrolyzed with HCl, hydroxyproline (HOP) as an index of solubilization of collagen was analysed quantitatively. Both the storage medium and the storage time showed significant effects on mass loss and HOP release (p < 0.05). The incubation in EGCG resulted in relatively rapid and significant (p < 0.05) decrease in the amounts of mass loss. The HOP content of the experimental media also increased with incubation time but was significantly lower (p < 0.05) than in the control artificial saliva medium. It can be concluded that EGCG can inhibit collagen degradation and affects the further demineralization in dentin matrix, which consequently inhibits the advanced dentine caries.

The efficacy of passion fruit juice as an endodontic irrigant compared with sodium hypochlorite solution: an in vitro study

AIM

To assess the effectiveness of several concentrations of two forms of passion fruit juice (PFJ) in the elimination of Enterococcus faecalis and to compare the antibacterial property of PFJ with sodium hypochlorite (NaOCl) as an intracanal irrigant.

METHODS

Two types of PFJs, aqueous and alcohol extracts, were prepared and a minimum inhibitory concentration (MIC) test was performed with both the extracts against E. faecalis. Two concentrations of each extract were selected from the results given by the MIC test and subjected to a broth dilution test (BDT) for nine different time periods. After each time period, samples were inoculated in brain-heart infusion agar plates for 24 h at 37°C and results were compared statistically.

RESULTS

The MIC test showed that E. faecalis was sensitive to PFJ extracts at various concentrations. The results of the BDT showed a negative growth of E. faecalis by PFJ alcohol 20% at 30 min, PFJ aqueous 20% at 1 h, NaOCl 2.5% at 10 min and NaOCl 5.25% at 1 min. NaOCl showed a much better antibacterial efficacy than PFJ.

CONCLUSIONS

The PFJ alcoholic and aqueous extracts had an antibacterial effect against E. faecalis. As PFJ shows promising results, further research in this field could lead to much better results as compared to NaOCl.

Clinical significance of matrix metalloproteinases-3 and vascular endothelial growth factor expression in pancreatic carcinoma

AIM: To investigate the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinases-3 (MMP-3) in pancreatic carcinoma (PC) and to analyze their relationship with tumor angiogenesis, invasion and metastasis.

METHODS: The protein expression of VEGF and MMP-3 and microvessel density (MVD) were detected by immunohistochemistry in 56 PC specimens and 56 normal pancreatic tissue specimens.

RESULTS: The positive rates of both MMP-3 and VEGF were significantly higher in PC than in normal pancreatic tissue (75.00% vs 3.57%, 67.85% vs 1.78%, both P < 0.01). There was a positive correlation between the expression of VEGF and that of MMP-3. Higher expression of MMP-3 was detected in late-stage PC and PC with lymph node metastasis. The expression of VEGF was correlated with clinical stage (P < 0.05). MVD was correlated with expression of MMP-3 and VEGF in PC (both P < 0.05).

CONCLUSION: MMP-3 and VEGF may promote tumor angiogenesis and play an important role in the development and progression of PC. Detection of MMP-3 expression could be used to predict early metastasis of PC. Lower expression of VEGF may be related to lower arterial blood supply in PC.