In vitro comparative evaluation of different storage media (hank's balanced salt solution, propolis, Aloe vera, and pomegranate juice) for preservation of avulsed tooth

YouTube™ as a source of tooth avulsion information: A video analysis study

BACKGROUND/AIM

Evaluate the informative content in tooth avulsion videos intended for dentists available on YouTube™ and analyse their compliance with the International Association of Dental Traumatology (IADT) guidelines 2020.

MATERIALS AND METHODS

Google Trends was used to identify the most searched term for tooth avulsion. Tooth avulsion-related videos in Brazilian Portuguese intended for dentists were searched on YouTube™ with a 12-month filter. Two raters reviewed these videos to extract their features and evaluate and qualify them with two 9-point checklists based on the IADT 2020 guidelines. The emergency steps for tooth avulsion at the accident site were assessed before, during and after clinical management; each step received 1 point if present and 0 points if absent. The final score ranged from 0 to 9 points on each checklist (18 points total), and the total score was used to classify the videos as having poor, moderate or rich content. Reliability and video quality were evaluated by an adapted version of the DISCERN tool and global quality scale (GQS), respectively. The data were analysed with the Mann-Whitney U-test, Pearson chi-square test, and the Kappa statistic (p < .05).

RESULTS

Of 60 videos, 8 were included. All were uploaded by dental professionals or undergraduate students; the average duration was 11 min (range: 0.40-65 min), and the average number of views was 56.75. Half the videos (50%) had maximum completeness scores for questions about emergency dentist referral before clinical management, and more than half (75%) had maximum completeness regarding the steps required during and after treatment. Rich videos had higher GQS scores (p = .049) without significant correlation.

CONCLUSIONS

Although most videos in Brazilian Portuguese were considered high-quality according to the IADT checklist, half of them presented partial absence of information regarding orientations at the accident site.

Evaluation of Viability of Periodontal Ligament Cells using Propolis, Coconut Water, Aleo Vera, and Soy Milk: An In vitro Comparative Study

Objectives

This research was done to assess the periodontal ligament cells viability using propolis, coconut water, aloe vera, and soy milk storage media.

Materials and Methods

Periodontal ligament cells were taken from freshly extracted teeth and stored into four groups of storage media: Group A-propolis, Group B-coconut water, Group C-aloe vera, and Group D-soy milk. Later, the cell viability was assessed at 1, 12, and 24 hours.

Results

The periodontal ligament cell viability was significantly greater in propolis, followed by coconut water, aloe vera, and soy milk.

Conclusion

We found that propolis, coconut water, aloe vera, and soy milk can be used as an effective storage media. These are naturally occurring and easily available storage medium.

Periodontal Ligament Fibroblast Cell Viability Following Treatment with Different Concentrations of Green Tea, Aloe Vera and a Mixture of their Extracts

Objectives: Various studies have identified green tea and Aloe vera as a suitable medium for avulsed teeth. The aim of this study was to evaluate and compare the viability of periodontal ligament (PDL) fibroblasts following treatment with the extracts of these two plants and their mixture. Materials and Methods: Human PDL fibroblasts were purchased and treated with different concentrations of Aloe vera, green tea, and a combination of these two extracts. Hank's balanced salt solution and culture medium were employed as positive and negative controls, respectively. Viability was assessed using the MTT assay. Two-way ANOVA and post-hoc tests were used for statistical analysis (P<0.05). Results: There was a significant difference in PDL fibroblast viability between different concentrations of the extracts. Higher concentrations of green tea and the combination of the two extracts significantly increased cell viability. Higher concentrations of Aloe vera had the least positive effect on maintaining the viability of these cells. Conclusion: If confirmed by further studies, the combination of Aloe vera and green tea extracts might be considered as a suitable media for different purposes like storing avulsed teeth.

Network Meta-Analysis of 10 Storage Mediums for Preserving Avulsed Teeth

Many storage mediums are available for the storage of avulsed teeth to preserve the viability of periodontal ligament (PDL) cells before replantation; however, it is unclear which medium is the optimal option. We performed this network meta-analysis to answer this question. A comprehensive search was conducted in PubMed, EMBASE, and the Cochrane library to capture eligible studies investigating the comparative efficacy of Hank's balanced salt solution (HBSS), aloe vera gel (AVG), oral rehydration solution (ORS), coconut water, egg white, green tea, propolis, saline, milk, and water. Statistical analysis was conducted using Review Manager v5.3 and ADDIS v1.16.8. In total, 20 RCTs involving 31 reports were included finally. Direct meta-analysis suggested that HBSS was superior to ORS, milk, saline, and water, ORS was superior to milk but inferior to coconut water and propolis, egg white was superior to milk but inferior to AVG and propolis, propolis was superior to AVG, milk, and saline, and coconut water and water was inferior to saline and milk, respectively. Network meta-analysis suggested that AVG was inferior to the other nine mediums, and propolis was superior to HBSS (SMD, −5260.24; 95% CrI, −10447.39 to −70.37) and milk (SMD, −5461.11; 95% CrI, −10574.99 to −328.51). Moreover, ranking probabilities indicated the highest probability for propolis, followed by saline, ORS, HBSS, milk, egg white, water, green tea, and AVG successively. Propolis may be the optimal media for storing avulsed teeth before replantation. However, given the availability of propolis and HBSS and the hypotonic properties of saline, ORS or milk should also be preferentially selected.

Geomorphologic study of human tooth root surfaces following simulated avulsion by scanning electron microscopy

BACKGROUND/AIMS

Tooth avulsion is the most severe traumatic tooth injury. Immediate replantation after avulsion provides the highest success rate, whereas delayed replantation with dehydration for >1 h always results in ankylosis, replacement resorption, and eventual tooth loss. The aim of this study was to investigate the geomorphologic change of ultrastructure on tooth root surfaces due to dehydration.

MATERIAL AND METHODS

Twenty-four sound human premolars and fully developed third molars without periodontitis were selected for the experiment. Roots were separated into 6-7 pieces with an intact root surface area (3 × 3 mm² ) and then divided into the following groups: fresh group, prolonged dehydration groups (air drying for 1, 2, 4, 12, or 24 h), and dehydrated teeth (air drying for 2 h) treated with acid (Tris-HCl buffer or citric acid buffer). More than six pieces of root from each group were subjected to scanning electron microscopy (SEM) observation. Captured images were exported to ImageJ software to quantitatively analyze the areas covered with fibers. Statistical significance was determined by comparing the means of the different groups using t-testing or one-way analysis of variance followed by post hoc testing.

RESULTS

Fibrous "vegetation" covering the cementum was observed on the fresh root surface by SEM. This was destroyed by dehydration (>1 h), resulting in a root surface resembling the "Gobi Desert." The difference was statistically significant (p < .001). Root surface deteriorated by dehydration could be recovered by the re-use of the fibers embedded in the cementum as acid demineralization of the outer layer of cementum exposed the embedded fibers to simulate the geomorphology of fresh root surface.

CONCLUSIONS

Dehydrated teeth had deteriorated geomorphology of the root surface, which could be reversed by the re-use of the fibers embedded in the cementum using citric acid. Direct evidence from SEM gives new insights into the replantation of dehydrated avulsed teeth.

Banking on teeth - Stem cells and the dental office

Science and commerce advance together and the stem cell field is no exception. With the promise of cures for conditions as diverse as cancer, autism, neural degeneration, organ replacement and addiction, long-term preservation of dental stem cells is a growth market. The discovery nearly twenty years ago, of viable, multipotent, stem cells in dental pulp from both baby and adult teeth initiated, and drives, this market.The dental stem cell preservation services, "tooth banks", focus on the collection of a child's baby teeth, as they are shed naturally, and storage of the stem cells from within the pulp for therapeutic use in later years should the child require them. This review focuses on the procedures related to these stem cell storage services and may serve as an introduction for many to the practice of "tooth banking".

Efficacy of Hank's balanced salt solution compared to other solutions in the preservation of the periodontal ligament. A systematic review and meta-analysis

This systematic review and meta-analysis (MA) aimed to verify the capacity of different storage media to preserve viability of periodontal ligament cells in comparison to Hank’s Balanced Salt Solution. The searches, selection process, data extraction and Risk of Bias control were conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Five MA were conducted to compare the cell viability between milk versus Hank's balanced salt solution (HBSS) in a dichotomous (1) or continuous (2) data model; tap water versus HBSS (3); medicinal herbals versus HBSS (4); and saline solution versus HBSS (5). 693 potentially studies were identified, with 18 studies included in the qualitative and 8 studies included in the quantitative analysis. Most of the articles presented a low risk of bias. HBSS medium showed a superior ratio of cell viability compared to tap water (RR 0.26; 95% CI [0.21, 0.32]; p < 0.00001; I2 = 96%) and saline solution (RR 0.76; 95% CI [0.69, 0.84]; p < 0.0001; I2 = 99%). Herbal medicines showed a similar ratio of cell viability when compared to HBSS (RR 0.97; 95% CI [0.94, 1.00]; p = 0.08; I² = 50%). Mixed results were observed between milk and HBSS: a superior ratio of HBSS was observed in an overall evaluation (RR 0.26; 95% CI [0.21, 0.32]; p < 0.00001; I² = 96%), and a similar ratio was achieved when periodontal ligament (PDL) cells were removed prior to immersion in the solution (RR 0.94; 95% CI [0.87, 1.01]; p = 0.10; I2 = 0%) or rinsed in tap water or maintained in open air prior to immersion (RR 0.63; 95% CI [0.35, 1.12]; p = 0.11; I2 = not applicable). This systematic review and MA suggests that milk and herbal medicines could represent an alternative to HBSS. However, more studies are necessary to obtain a reliable conclusion.

Effect of propolis on preserving human periodontal ligament cells and regulating pro-inflammatory cytokines

BACKGROUND/AIM

Propolis has been suggested as a storage medium for avulsed teeth. The aim of this study was to compare the effectiveness of Brazilian propolis with Hank's balanced salt solution and milk in maintaining the viability of human periodontal ligament cells, their osteogenic differentiation potential, and pro-inflammatory cytokine expression.

MATERIAL AND METHODS

Cell Counting Kit 8 assays were performed to test human periodontal ligament cell viability in different storage media. The preservative effect on osteogenic differentiation was evaluated using alkaline phosphatase staining and activity assays, Alizarin Red S staining, and western blotting. Quantification of pro-inflammatory cytokines was performed using real-time PCR and enzyme-linked immunosorbent assays.

RESULTS

Brazilian propolis at 10 μg/ml was not cytotoxic toward human periodontal ligament cells. The milk group showed the highest cell viability. Brazilian propolis and Hank's balanced salt solution groups showed similar cell viabilities. Alkaline phosphatase staining and activity were similar in all groups. Calcium deposition and mineralization nodule formation were similar in the Brazilian propolis and Hank's balanced salt solution groups, but were higher in the milk group. Osteogenic marker gene and protein levels were similar in all groups. The genes and protein expression levels of IL1β, IL6, and IL8 decreased significantly after treatment with Brazilian propolis. TNFα mRNA expression showed no significant difference among the experimental groups. Pro-inflammatory cytokine levels in the milk group were higher than in the Brazilian propolis and Hank's balanced salt solution groups.

CONCLUSIONS

Brazilian propolis, Hank's balanced salt solution, and milk maintained the viability of human periodontal ligament cells and preserved their osteogenic differentiation ability similarly. However, Brazilian propolis showed a better anti-inflammatory effect. This article is protected by copyright. All rights reserved.

Which is the most recommended medium for the storage and transport of avulsed teeth? A systematic review

BACKGROUND/AIMS

A wide variety of materials has been researched for their use as potential storage media for avulsed teeth, but it is essential to recognize the medium most recommended for improvement of the prognosis of avulsed teeth. The aim of this systematic review was to identify the most recommended medium to store and transport avulsed teeth based on the survival of periodontal ligament (PDL) cells as determined by in vitro studies.

METHODS

Only laboratory-based experimental studies on PDL cells found on adult permanent teeth were included. Data were collected using PubMed, CINAHL plus (EBSCO host), and the Cochrane Library, along with Google Scholar and a hand search. The key terms employed were permutations of [avulsed permanent teeth* OR dental avulsion* OR knocked out teeth*] AND [storage media* OR transport media* OR biological transport* OR PDL cell viability* OR PDL cell survival*]. A customized data extraction pro forma was used to extract the data and to evaluate the quality and risk of bias.

RESULTS

The initial search yielded 978 articles, but only 67 were selected. Milk was the most recommended individual medium followed by Hank's balanced salt solution. Among natural products other than milk, propolis and coconut water were most frequently recommended. Recommendations were based on maintenance of PDL cell viability followed by ease of availability, low cost, and long shelf life.

CONCLUSIONS

Natural products are more effective in maintaining the PDL cell viability compared to synthetic products. Some storage media recommendations were also based upon practical aspects. Although natural products other than milk have more recommendations as a group, milk is the most recommended storage medium individually, based not only on PDL cell viability, but also practical considerations.

Biocompatibility of Acetazolamide and Its Association with Calcium Hydroxide in Rat Subcutaneous Tissue

Introduction

The aim of this study was to evaluate the biocompatibility of acetazolamide and its association with the calcium hydroxide in rat subcutaneous tissues as an intracanal medication for an avulsed tooth.

Methods and Materials

Three medications with acetazolamide base were evaluated: group 1 liquid acetazolamide associated with calcium hydroxide powder (LACH); group 2 liquid acetazolamide (LA); and group 3 acetazolamide powder associated with physiological saline (PAPS). The calcium hydroxide associated to physiological saline represented the control group. The medications were implanted in subcutaneous tissues of thirty-nine male rats for 7, 15 and 45 days; after surgery the animals were sacrificed and the sections were stained with hematoxylin and eosin to be evaluated qualitatively or semi-quantitatively with an optical microscope. The inflammation intensity and type of inflammatory cells and the repair process, were assessed. The obtained data were statistically compared through the Kruskal-Wallis test conducted at the 5% level of significance.

Results

On the seventh day, there was statistically significant difference between PAPS and LA, in relation to the number of neutrophils (P=0.0016). There was a statistically significant difference in the total number of inflammatory cells in PAPS compared to LACH (P=0.0038) on the fifth day. The total number of inflammatory cells from PAPS was significantly higher in relation to LACH (P=0.0038), as well as LA from LACH (P=0.0038) on forty fifth day. A statistically significant reduction in the value of lymphocytes was also observed in LACH (P=0.0072) and LA (P=0.0010) groups in the same period.

Conclusion

The results of this animal study suggest that the association of the liquid acetazolamide with the calcium hydroxide promoted an inflammation reduction and a faster repair process than in the LA and PAPS groups evaluated in 15 and 45 days.

The Antifungal Effect of Propolis Endodontic Irrigant with Three Other Irrigation Solutions in Presence and Absence of Smear Layer: An In Vitro Study

INTRODUCTION

The aim of this in vitro study was to compare the antifungal effect of propolis as an endodontic irrigant agent with a mixture of doxycycline, citric acid, and a detergent mixture (MTAD), 2% chlorhexidine (CHX) and 3% sodium hypochlorite (NaOCl) against Candida albicans in presence and absence of smear layer.

METHODS AND MATERIALS

Extracted teeth with single canals (n=104) were prepared and randomly distributed into four experimental groups; 30% propolis, MTAD, 2% CHX and 3% NaOCl. Each group had two subgroups; with and without smear layer. The antifungal effectiveness was evaluated. The Kruskal-Wallis and Mann-Whitney tests were used to compare the overall effectiveness of different treatments at significance level of 0.05.

RESULTS

Propolis, CHX and NaOCl had similar levels of effectiveness to each other against C. albicans, and these levels were not affected by the presence or absence of the smear layer. Each irrigant was significantly more effective than MTAD or saline solution. MTAD was less effective in the presence of the smear layer than in its absence.

CONCLUSIONS

Propolis irrigation can produce root canals that are free of C. albicans, even in the presence of the smear layer.

Evaluation of intracanal acetazolamide in late reimplanted rat teeth

Objective:

The aim of this study was to evaluate the use of acetazolamide combined with different agents as intracanal medication in late reimplanted rat teeth.

Materials and Methods:

In 100 Wistar rats, divided into 5 groups of 20, one of the following medications was used: Acetazolamide liquid (AL); AL with calcium hydroxide powder (ALHC); acetazolamide powder with AL; acetazolamide powder with physiological solution; and calcium hydroxide with physiological solution (control). At 30 and 60 days after reimplantation, the animals were sacrificed, tissues were processed, and cuts were stained with hematoxylin and eosin. An optical microscope was used to determine the following: percentage of inflammatory root resorption (RRI); percentage of substitute root resorption (RRS); and presence of ankylosis. The data obtained was submitted for statistical analysis.

Results:

Group ALHC had a significantly higher RRS than the control group at 60 days (P = 0.01). Group AL showed significantly less ankylosis than the other groups, including the control, at 30 days. AL showed results similar to those of the control group with respect to RRS.

Conclusion:

Acetazolamide has the potential to be an effective intracanal medication.