Salivary histatin 5 is an inhibitor of both host and bacterial enzymes implicated in periodontal disease

One of the salient features of periodontitis and gingivitis is the increase in the levels of bacterial and host-derived proteolytic enzymes in oral inflammatory exudates. This study evaluated the potential of histatin 5, a 24-residue histidine-rich salivary antimicrobial protein, to inhibit these enzymes. Using biotinylated gelatin as a substrate, histatin 5 was found to inhibit the activity of the host matrix metalloproteinases MMP-2 and MMP-9 with 50% inhibitory concentrations (IC50s) of 0.57 and 0.25 microM, respectively. To localize the domain responsible for this inhibition, three peptides containing different regions of histatin 5 were synthesized and tested as inhibitors of MMP-9. Peptides comprising residues 1 to 14 and residues 4 to 15 of histatin 5 showed much lower inhibitory activities (IC50, 21.4 and 20.5 microM, respectively), while a peptide comprising residues 9 to 22 showed identical activity to histatin 5 against MMP-9. These results point to a functional domain localized in the C-terminal part of histatin 5. To evaluate the effect of histatin 5 on bacterial proteases, a detailed characterization of histatin 5 inhibition of gingipains from Porphyromonas gingivalis was carried out using purified Arg- and Lys-specific enzymes. Kinetic analysis of the inhibition of the Arg-gingipain revealed that histatin 5 is a competitive inhibitor, affecting only the Km with a K(i) of 15 microM. In contrast, inhibition of Lys-gingipain affected both the Km and Vmax, suggesting that both competitive and noncompetitive competitive processes underlie this inhibition. The inhibitory activity of histatin 5 against host and bacterial proteases at physiological concentrations points to a new potential biological function of histatin in the oral cavity.

Is salivary histatin 5 a metallopeptide?

Histatins are small histidine-rich salivary polypeptides which exhibit antimicrobial activity against Candida albicans. This antimicrobial activity has been ascribed in part to a high content of basic amino acids. However, unlike most other antimicrobial proteins histatins have a high content of histidine, tyrosine and acidic amino acids known to participate in metal ion coordination. This study was conducted to test whether histatin 5 could bind zinc and copper which are metals present in salivary secretions and whole saliva. Physical binding parameters and spectral properties of zinc- and copper-histatin complexes were investigated in order to obtain direct evidence of these interactions. A spectrophotometric competition assay using the metallochromic indicator murexide showed that histatin 5 dissociates metal indicator complexes containing zinc or copper ions. Absorption spectra of histatin 5 at increasing copper chloride concentrations resulted in higher absorbance in the 230-280 nm wavelength range and this spectral change was saturated at a peptide:metal molar ratio of approx. 1:1. A corresponding band was observed in the visible range of the spectrum with a maximum and molar extinction coefficient corresponding to that of copper binding to an ATCUN motif. Quantitative assessment of zinc and copper binding to histatin 5 using isothermal titration calorimetry revealed at least one high affinity site for each metal, with binding constants of 1.2x10(5) and 2.6x10(7) M(-1), respectively. These results indicate that histatin 5 exhibits metallopeptide-like properties. The precise biological significance of this has not yet been established but histatins may contribute significantly to salivary metal binding capacity.

Matrix metalloproteinase levels and gelatinolytic activity in clinically healthy and inflamed human dental pulps

The role of matrix metalloproteinases (MMPs) in the breakdown of pulp tissue of teeth with severe caries has not yet been directly elucidated. This study was to determine the levels of selected MMPs and the overall gelatinolytic activity in clinically healthy and inflamed human dental pulps of 29 healthy subjects, aged 10-19 yr. Seventeen pulps were collected from subjects diagnosed with symptomatic pulpitis, and 18 control pulps were obtained from 12 subjects following premolar extraction for orthodontic reasons. The levels of MMP-1, MMP-2, MMP-3 and MMP-9 were determined with enzyme-linked immunosorbent assay. Densitometric analysis of gelatin zymograms was used to assay gelatinolytic activity in pulp supernatants. The MMP-1 levels were below the detection limit for both groups. Levels of MMP-2 and MMP-3 were significantly lower in symptomatic vs. clinically healthy pulps. In contrast, levels of MMP-9 in inflamed pulps were significantly higher than those recorded in clinically normal pulps. The overall gelatinolytic activity was elevated in inflamed pulps compared with healthy counterparts. Further, the gelatinolytic activity was positively correlated with MMP-9 levels. The data obtained suggest a key role of MMP-9 in the breakdown of inflamed human dental pulp tissue.

Human salivary gland-specific daily variations in histatin concentrations determined by a novel quantitation technique

Histatins constitute a distinct family of human salivary antimicrobial peptides, of which histatins 1, 3 and 5 are the most abundant. To evaluate salivary gland-specific differences in histatin secretion, we used the recently developed histatin-zinc precipitation method to quantify histatins and to assess daily variations in secretions. Stimulated pure secretions from parotid glands (HPS) and submandibular/sublingual glands (SMSL) were collected from 10 different subjects at four different times of the day (9:35 a.m.; 12:40 p.m.; 2:50 p.m. and 5:00 p.m.). Zinc precipitation and subsequent reversed phase HPLC analysis were performed to determine concentrations of histatins 1, 3 and 5 with reference to purified histatin standards. Both HPS and SMSL secretions displayed daily variations in histatin concentrations. HPS values showed a maximum at mid-day and SMSL samples showed a maximum in the morning. Mean daily histatin concentrations were almost three fold higher in SMSL than in HPS. Mean histatin 1, 3 and 5 concentrations in HPS from 10 subjects ranged from 0.7 to 2.8, 0.6 to 4.3 and 1.0 to 4.3mg%, respectively. The corresponding means in SMSL were 2.8-12.2, 1.5-7.5 and 2.6-9.0mg%, respectively. Remarkably, although histatins constitute only 3-10% of total protein in these secretions, an almost perfect correlation between total protein and total histatin concentrations was observed for both glands. Despite a broad range in histatin concentrations between individuals, this study demonstrated a hitherto unidentified daily variation in histatin concentrations in HPS and SMSL secretions and a differential expression pattern which might have functional implications.

A new method for the isolation of histatins 1, 3, and 5 from parotid secretion using zinc precipitation

Histatins, a family of small-molecular-weight, histidine-rich cationic salivary proteins, have been difficult to isolate in an efficient way by conventional procedures due to their anomalous interactions with chromatographic resins. In the present study we explored the possibility of developing a new isolation procedure based on recent observations that histatins associate with various metal ions, including zinc. Since solubility studies showed that histatin 5 forms precipitates with zinc under alkaline conditions, we investigated whether this characteristic could be exploited for the preparative isolation of histatins from salivary secretions. A fast and efficient two-step procedure was developed using zinc precipitation of histatins from human parotid secretion followed by final purification using reversed-phase high-performance liquid chromatography (HPLC). Analysis of zinc precipitates by Tricine-SDS-PAGE, cationic PAGE, HPLC, and mass spectrometry revealed the presence of the three major histatins, 1, 3, and 5, as well as statherin. The histatin yield obtained by the precipitation step was approximately 90%. Therefore, zinc precipitation of histatins from glandular salivary secretions is a novel, rapid, and effective means for the isolation of these proteins.

Salivary histatin 5 is a potent competitive inhibitor of the cysteine proteinase clostripain

Histatin 5 is a low molecular weight salivary protein which is known to exhibit inhibitory activity against several proteinases, including the cysteine proteinases gingipains. The purpose of this study was to characterize the effect of salivary histatin on the proteolytic activity of the cysteine proteinase clostripain derived from the pathogen Clostridium histolyticum. Using a synthetic nitroanilide substrate, we studied in detail the inhibition of clostripain by histatin 5 and compared the effect of this peptide to that of leupeptin, a known competitive inhibitor of clostripain. It was found that the concentration of histatin 5 required to inhibit 50% of clostripain activity was 23.6+/-1.6 nM. Kinetic analysis revealed that histatin 5 is a competitive inhibitor of clostripain with an inhibition constant (K(i)) of 10 nM. The K(i) for the inhibition of clostripain activity against nitroanilide substrate by leupeptin was found to be 60 nM, significantly higher than that of histatin 5. Thus, histatin 5 inhibits clostripain more effectively than leupeptin and other cysteine protease inhibitors studied here. No significant proteolysis of histatin 5 was observed when histatin 5 was incubated at physiologic concentrations with clostripain. The potent inhibition of clostripain by histatin 5 points towards the possibility that this protein may prevent establishment of clostridial infections and therefore may have significant potential for the treatment of diseases associated with this enzyme.

Effect of photodynamic therapy and non-thermal plasma on root canal filling: analysis of adhesion and sealer penetration

Objective

The aim of this study was to evaluate the effect of photodynamic therapy (PDT) and non-thermal plasma (NTP) on adhesion and sealer penetration in root canals.

Material and Methods

Sixty single-rooted premolars were used. The teeth were prepared using a crown-down technique. NaOCl and EDTA were used for irrigation and smear layer removal, respectively. The root canals were divided into three groups: control, PDT, and NTP. After treatments, the roots were filled using gutta-percha and either AH Plus (AHP) or MTA Fillapex (MTAF) sealers. Samples were sectioned at 4, 8, and 12 mm from the apex (1-mm slices)and analyzed by the push-out bond strength test (adhesion) and confocal laser scanning microscopy (sealer penetration). Data were statistically evaluated using Kruskal-Wallis, Dunn’s, and Spearman’s tests.

Results

Regarding AHP, bond strength was similar in the NTP group and in the control group, but significantly lower in the PDT group. As to MTAF, both therapies showed lower values than the control group. In the confocal analysis of AHP, maximum and mean penetration, and penetrated area were statistically higher in the control group than in the PDT and NTP groups. Penetrated perimeter was similar among groups. Regarding MTAF, all parameters yielded better results in the NTP than in the control group. The PDT and control groups showed similar results except for penetrated area.

Conclusion

PDT and plasma therapy affected the adhesion and sealer penetration of root canals filled with AH Plus and MTA Fillapex and there is no positive correlation between adhesion and sealer penetration.

Morphometric Analysis of the Furcation Anatomy of Mandibular Molars

BACKGROUND

Successful treatment of molar furcation defects remains a challenge in clinical practice. Knowledge of anatomic factors facilitates predictable management of furcation involvement lesions. The degree of success in managing furcation involvement is inversely related to the horizontal probing depth. The depth of the horizontal component of attachment loss can vary depending on the external tooth-surface reference points used. However, the anatomical factors affecting horizontal component of attachment loss have not been previously assessed. Therefore, this study determined the bucco-lingual measurements of the cemento-enamel junction and the mesial and distal roots and at the level of root separation.

METHODS

One hundred extracted permanent human mandibular first (N = 50) and second (N = 50) molars were studied. Four horizontal bucco-lingual widths were measured with calibrated calipers: 1) furcation entrance/roof (FE); 2) cemento-enamel junction level (CEJ); 3) mesial root width (MRW); and 4) distal root width (DRW).

RESULTS

The mean widths at FE, CEJ, MRW, and DRW were, respectively, 5.53 +/- 0.45 mm, 8.71 +/- 0.54 mm, 8.57 +/- 0.54 mm, and 7.97 +/- 0.65 mm in the first molars and 5.61 +/- 0.65 mm, 8.40 +/- 0.65 mm, 7.95 +/- 0.88 mm, and 7.16 +/- 0.84 mm in the second molars. Analysis of variance revealed significant differences between FE and the other variables tested. The results showed that the bucco-lingual width of the furcation roof is considerably shorter than the MRW and DRW. The difference in the mean bucco-lingual dimension between FE and the other measurements occurred in all teeth evaluated and varied between 0.7 and 4.30 mm.

CONCLUSIONS

Our findings demonstrate that clinical measurements of horizontal probing depth that use the external surfaces of roots as reference points overestimate the true anatomical component of furcation involvement in mandibular molars. Conversely, positive treatment outcomes in these teeth may be underestimated. This has implications not only for clinical practice but also for clinical research studies evaluating treatment outcomes.

The use of auxiliary devices during irrigation to increase the cleaning ability of a chelating agent

Objectives

This study investigated the cleaning ability of ultrasonically activated irrigation (UAI) and a novel activation system with reciprocating motion (EC, EasyClean, Easy Equipamentos Odontológicos) when used with a relatively new chelating agent (QMix, Dentsply). In addition, the effect of QMix solution when used for a shorter (1 minute) and a longer application time (3 minutes) was investigated.

Materials and Methods

Fifty permanent human teeth were prepared with K3 rotary system and 6% sodium hypochlorite. Samples were randomly assigned to five groups (n = 10) according to the final irrigation protocol: G1, negative control (distilled water); G2, positive control (QMix 1 minute); G3, QMix 1 minute/UAI; G4, QMix 1 minute/EC; G5, QMix 3 minutes. Subsequently the teeth were prepared and three photomicrographs were obtained in each root third of root walls, by scanning electron microscopy. Two blinded and pre-calibrated examiners evaluated the images using a four-category scoring system. Data were statistically analyzed using Kruskal-Wallis and Dunn tests (p < 0.05).

Results

There were differences among groups (p < 0.05). UAI showed better cleaning ability than EC (p < 0.05). There were improvements when QMix was used with auxiliary devices in comparison with conventional irrigation (p < 0.05). Conventional irrigation for 3 minutes presented significantly better results than its use for 1 minute (p < 0.05).

Conclusions

QMix should be used for 1 minute when it is used with UAI, since this final irrigation protocol showed the best performance and also allowed clinical optimization of this procedure.

Micro-computed tomographic evaluation of smear layer and accumulated hard tissue debris removal

Background:

The isthmus and irregularities present in the root canal system are potential areas for debris accumulation areas and therefore the seach for devices and solutions to improve cleaning of these areas is of utmust importance. This study evaluated, by micro–computed tomography, the efficiency of 37% phosphoric acid solution with that of 17% EDTA in the removal of smear layer and accumulated hard tissue debris (AHTD) after canal preparation.

Methods and Materials:

Twenty-six mesial roots of mandibular molars were subjected to microtomographic scanning using the SkyScan 1173 X-ray microtomograph at a resolution of 14,97 µm. The canals were prepared using Reciproc R40 instruments, 6% NaOCl and EndoVac System® to irrigation/aspiration. After instrumentation, the specimens were divided into two groups: 37% phosphoric acid solution or 17% EDTA.

Results:

The results demonstrated that 37% phosphoric acid was significantly more effective in removing smear layer and AHTD than 17% EDTA (Mann-Whitney, P <0.05). It was shown that both 37% phosphoric acid and 17% EDTA are effective agents in the removal of smear layer and debris, but better results were obtained with the use of 37% phosphoric acid.

Conclusion:

The results suggest that this solution can be a potential alternative to remove smear layer after root canal preparation.

The effectiveness of passive ultrasonic irrigation and the easy-clean instrument for removing remnants of filling material

Objective

This study aimed to evaluate the efficacy of passive ultrasonic irrigation (PUI) and the easy clean instrument by micro-computed tomography (CT) for removing remnant filling materials during endodontic retreatment.

Materials and Methods

Forty mesial roots of mandibular molars were divided into four groups (n = 10) according to the agitation system and sealer used: Group 1: PUI/AH Plus; Group 2: PUI/TotalFill; Group 3: Easy Clean/AH Plus; and Group 4: Easy Clean/TotalFill. The groups were compared by micro-CT analysis according to the volumes of the obturation and the remaining material before and after the agitation systems were used.

Results

There was no difference between the groups for total filling volume and initial and final remaining filling volume (P > 0.05).

Conclusions

Both the PUI and easy-clean instrument are effective for removing remnants of filling material with no difference between the groups.

Hydroxyapatite calvaria graft repair in experimental diabetes mellitus in rats

Among the systemic conditions that impact negatively on the planning and execution of surgical procedures, diabetes mellitus (DM) is the primary clinical condition responsible for complications. This study investigated bone formation in critical defects surgically filled with hydroxyapatite (HA) in diabetic rats. A descriptive, randomized sample and blinded analysis were conducted to test bone regeneration in critical bone defects surgically performed in rat calvaria. Twenty adult male Wistar rats were randomly divided into two groups: control, normoglycemic animals (CG); and test, streptozotocin-induced hyperglycemic animals (TG). A circular bone defect was filled with HA and maintained subperiosteally. The clinical parameters evaluated were body weight, water and food intake, fasting blood glucose, and bone alkaline phosphatase. Bone-grafted area samples were submitted for histomorphometric and stereological analysis. The TG showed a significantly higher rate of new bone formation compared with the CG, sacrificed 15 days after surgery (p < 0.0001). However, at the end of the study, there was no significant difference in the amount of bone formed between groups (p = 0.077). In parallel, with the increase in osteoblastic activity observed in the TG by the measurement of systemic bone alkaline phosphatase (p = 0.016), the analysis of polarized microscopy and stereology demonstrated a lower level collagen maturation and mineralization in the TG. Quantitatively, the TG showed significantly better results for bone gain in the first 15 days. Qualitative assessments, however, showed fewer collagen fibers and bone maturation in the TG compared with the CG both at 15 and 45 days. Therefore, the postoperative evaluation of bone grafts with HA in hyperglycemic situations should consider the systemic and local effects of this condition on the quality of bone repair, rather than identifying the filling or stability of the grafted area after the process. We conclude that clinically detectable bone repair in diabetic animal models submitted to hydroxyapatite grafts may be satisfactory in the early stages. However, hyperglycemia compromises the quality of the newly formed bone and the collagen cross-linking involved in this process.

The accuracy of electronic apex locators for determining working length: An in vitro study with artificial teeth

This study aimed to determine the accuracy of four electronic apex locators (EALs) (I-Root, Propex Pixi, Novapex and Bassi iRoot Apex), using artificial mandibular and maxillary permanent molars. The root length (RL) from 40 artificial teeth was initially determined with Kerr hand files. Then, the electronic RL were obtained for the same root canals with each EAL, and the results were compared with those obtained using hand files. The accuracy of the EALs was determined through analysis of the divergences observed in relation to the lengths obtained with files. All EALs were effective for determining the RL in the artificial teeth, showing results similar to those obtained by hand. The Bassi iRoot Apex had higher accuracy (96.7%) than the Propex Pixi (89.1%) and Novapex (85.8%) (P < 0.05). Based on the results, all EALs tested had a similar performance, and artificial teeth may be used to determine the accuracy of these devices.

Effectiveness of three methods for evaluating root canal anatomy of mandibular incisors

This study compared the effectiveness of clinical observation, clinical microscopic observation, and tooth-clearing technique in determining the number of canals in mandibular incisors. Root canal ramifications were also analyzed. Using clinical and microscopic analyses, we determined the number of canal entrances in 277 mandibular incisors. In addition, tooth-clearing technique was used to determine the number of canals and frequency of ramifications in the samples. The kappa coefficient was used to compare the different methods with regard to frequency of canals. Most teeth had one canal entrance. The proportion of teeth with two canals was 23.5% by tooth-clearing analysis, 5.8% by clinical microscopy, and 1.1% by clinical analysis. A large number of samples had some type of ramification (40.1%), and most ramifications were present in teeth with two canals. The most frequent ramification was lateral canals (8.3%). Clinical microscopy improved identification of a second canal in mandibular incisors. However, it did not identify second canals in all teeth with two canals. (J Oral Sci 58, 347-351, 2016).

Retreatment of mesial roots of mandibular molars filled with resin- based and bioceramic sealers

Aim: The aim of this study was to evaluate, by micro-computed tomography (micro-CT) analysis, the remaining filling material during endodontic retreatment performed with Protaper retreatment without solvent. Methods: Forty mandibular molars were divided into two groups (n = 20) according to the sealer used in the obturation: the bioceramic TotalFill BC (TF) or the resin-based AH Plus (AHP). The specimens were scanned before instrumentation, after obturation and after filling removal. Only the mesial roots were analysed. The filling volumes and the remaining filling material were calculated in the entire root canal and in the cervical, middle and apical thirds. Results: The volume of obturation and the volume of remaining filling material in the entire root canal and in the cervical, middle and apical thirds of the canal between the groups were not statistically different (independent t-test, p > 0.05). In the AHP group, there was a higher percentage of remaining filling material in the middle third than in the cervical third (p < 0.05). Conclusion: The filling material could not be entirely removed from any specimen.

Effects of auxiliary device use on smear layer removal

This study evaluated the effects of different auxiliary irrigation devices on smear layer removal with a chelating solution (QMix). Fifty single-rooted permanent human teeth were shaped with a sequence of nickel-titanium instruments. A 2% chlorhexidine gel was used as a chemical auxiliary substance during preparation. Samples were assigned to five groups (n = 10 each) according to final irrigation protocol, namely, distilled water (control group), QMix 1 min, QMix + passive ultrasonic irrigation (PUI), QMix + plastic endodontic finishing file (EC), and QMix 3 min. Teeth were prepared and evaluated by scanning electron microscopy, and three photomicrographs (magnification, 1,000×) were obtained for each root third. Two blinded and precalibrated evaluators analyzed and scored the images, and the data were statistically analyzed by the Kruskal-Wallis and Dunn tests (P < 0.05). Groups were ranked according to the extent of smear layer removal. The total area of the root canal walls and apical root thirds was calculated, and the groups ranked PUI > EC = QMix 3 min > QMix 1 min > control. QMix 1 min was effective for smear layer removal only when used with auxiliary devices, and QMix + passive ultrasonic irrigation yielded the best results, particularly for the apical third.(J Oral Sci 58, 561-567, 2016).

<b>Tecnologia de Plasma na Odontologia</b>: Revisão de literatura

A presente revisão de literatura tem como objetivo realizar uma breve introdução ao plasma, abordando o que é, como ele é gerado, seu mecanismo de ação, assim como seu uso na odontologia, nas diferentes especialidades. Apesar de ainda não estar disponível rotineiramente para uso clínico, estudos mostram que o plasma, quando utilizado a temperatura ambiente, se mostra como uma inovação promissora apresentando atividade antimicrobiana, efeitos positivos em relação à adesão, clareamento dental e osteointegração, sem gerar danos ao tecido oral. Estes efeitos estão relacionados ao tempo de aplicação e ao gás utilizado.

Root canal dentin wear during final irrigation in endodontic retreatment with passive ultrasonic irrigation and easy clean instruments

Context

Complementary procedures have been proposed to improve the endodontic retreatments.

Aim

The aim of this study was to evaluate, by microcomputed tomography (micro-CT), the dentin wear caused by passive ultrasonic irrigation (PUI) and easy clean (EC) instruments, when used for the final removal of filling material during endodontic retreatment.

Methods

Thirty-six mesial roots of the lower first molars were divided into four groups (n = 9), according to the final irrigation and sealer: PUI/AH Plus, EC/AH Plus, PUI/Total Fill (TF), and EC/TF. Canal volume was evaluated, both before and after the final irrigation, by micro-CT analysis. The Kruskal-Wallis test was used to compare the volumes among groups and the paired Wilcoxon test was used to compare the volume values before and after the final irrigation within each group.

Results

Both complementary cleaning procedures promoted dentin wear that was observed only when the volume was analyzed for each third of the root canal. In the apical third, both instruments showed significant wear, where the use of the EC instrument resulted in greater wear than the PUI, in teeth filled with both AH Plus and TF BC Sealers (P < 0.05).

Conclusion

Both complementary cleaning procedures promoted dentin wear and must be used cautiously.