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Biomedical subjects

J L Gutmann

Publications and source records attributed to J L Gutmann.

At least 37 records · Page 2Linked to original sources
PubMed2001

Calcific metamorphosis: a challenge in endodontic diagnosis and treatment.

Calcific metamorphosis (CM) is seen commonly in the dental pulp after traumatic tooth injuries and is recognized clinically as early as 3 months after injury. Calcific metamorphosis is characterized by deposition of hard tissue within the root canal space and yellow discoloration of the clinical crown. Opinion differs among practitioners as to whether to treat these cases upon early detection of CM or to observe them until symptoms or radiographic signs of pulpal necrosis are detected. In this review, the clinical, radiographic, and histopathologic appearance of CM is described; a review of the literature is presented to address these issues in an attempt to establish a sound rationale for treatment. Approximately 3.8% to 24% of traumatized teeth develop varying degrees of CM. Studies indicate that of these, approximately 1% to 16% will develop pulpal necrosis. Most of the literature does not support endodontic intervention unless periradicular pathosis is detected or the involved tooth becomes symptomatic. It may be advisable to manage cases demonstrating CM through observation and periodic examination.

Dental Pulp Calcification↗
PubMed2000

Prognosis in periradicular surgery: a clinical prospective study.

AIM: The purpose of this prospective study was to evaluate the prognosis of periradicular surgery using well-defined case selection and a rigorous surgical protocol. METHODOLOGY: Teeth to be treated surgically demonstrated a periradicular lesion of strictly endodontic origin with or without clinical signs and symptoms of inflammation. A total of 114 teeth were treated. Following the reflection of a full mucoperiosteal tissue flap, residual soft tissues were curetted, root ends were resected with a fine high-speed diamond bur, root-end cavities were prepared ultrasonically with diamond tips, and IRM root-end fillings were placed. Cases were followed clinically and radiographically for a period ranging from 1 to 4 years. RESULTS: The results of this study showed 91.2% success out of a total of 102 teeth available for follow-up, based on accepted parameters of evaluation. Cases were considered successful if there were no clinical signs or symptoms present and there was radiographic evidence of complete or incomplete healing (scar tissue). Factors related to case selection, parameters of healing and surgical technique are discussed in relation to the success rate identified in this prospective study. CONCLUSIONS: Adherence to a strict endodontic surgical protocol and the use of contemporary techniques and materials will result in a predictably successful outcome in a wide range of teeth.

Adolescent↗
PubMed2000

Analysis of the healing response to gutta-percha and Diaket when used as root-end filling materials in periradicular surgery.

AIM: To analyse the healing response to gutta-percha and Diaket when used as root-end filling materials in periradicular surgery. METHODOLOGY: Periradicular surgery was completed using the mandibular second, third and fourth premolar teeth from nine male mongrel dogs. The six roots on one side of the mouth were randomly allocated to one of the following groups: group A: a resected root end and a burnished gutta-percha root filling; group B: cavities were prepared to a depth of 4.0 mm, using ultrasonic root-end preparation and filled with Diaket. The response was evaluated histologically at 55 (nine specimens) and 150 (three specimens) days post operatively. RESULTS: The data for the 55-day period was analysed statistically using Wilcoxon's Signed Ranks test. No statistical analysis was carried out on the 150-day group due to the small number of specimens. The level of significance was set at P < 0.05. No statistical significance was observed in the healing response between Diaket and gutta-percha in the following categories at 55 days: inflammatory response, angiogenesis, root-end resorption, and cementum deposition. Statistically significant differences were observed in the healing categories: bone apposition (P < 0.05) and periodontal ligament formation (P < 0.05). CONCLUSIONS: At both time intervals, Diaket had a better healing response that was characterized by hard tissue formation adjacent to the root-end filling material bordered by occasional multinucleated giant cells. The nature of both the hard tissue formation and the adjacent cells, however, remains undetermined. Diaket displayed the best healing of either material used in this study.

Animals↗
PubMed2000

Comparative radiopacity of tetracalcium phosphate and other root-end filling materials.

AIM: This study compared the radiopacity of tetracalcium phosphate (TTCP) and 11 root-end filling materials relative to human dentine. METHODOLOGY: Specimens of 2 mm thickness and a graduated aluminium stepwedge were placed on dental X-ray films and exposed to an X-ray beam. The optical densities of the specimens and aluminium steps were measured. The optical densities of the specimens were correlated to the equivalent thickness of aluminium with a regression analysis equation. The equation was used to calculate the equivalent aluminium thickness of each of the specimens. RESULTS: Nine of the materials were found to be of acceptable radiopacity (at least 2 mm Al more radiopaque than dentine). TCCP and two of the glass-ionomer compounds were found to have insufficient radiopacity to be radiographically distinguishable from human dentine. CONCLUSIONS: All the materials were found to be distinguishable radiographically from dentine, except for Vitrebond, TTCP and Ketac-Fil. Amalgam was the most radiopaque material and Ketac-Fil was the least radiopaque material tested.

Absorptiometry, Photon↗
PubMed2000

In vitro evidence that lipopolysaccharide of an oral pathogen leaks from root-end filled teeth.

AIM: The ability to achieve a complete apical seal of the root canal system is thought to be important in the success of non-surgical and surgical endodontics. The aim of this study was to establish whether or not root-end filled teeth allow leakage of lipopolysaccharide (LPS) from a known oral pathogen in vitro. METHODOLOGY: Lipopolysaccharide (LPS) from a virulent strain of Prophyromonas gingivalis (P. gingivalis) (A7436 from patient with refractory periodontitis), was isolated by the Westphall and Jann technique, dialysed extensively, lyophilyzed, resuspended in distilled water and analysed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Root canals from 10 teeth were instrumented endodontically and the apical 3 mm of resected roots were filled with gutta-percha. The teeth were mounted in 12 mL polypropylene vials by using sticky wax and root surfaces were covered with two layers of nail varnish. Teeth were filled with 3.3 mg mL-1 LPS and the vials filled with 11 mL of Tris Buffered Saline (TBS) containing 0.05% sodium azide. Both positive and negative controls were run in parallel with the experimental specimens. Aliquots were removed each day and subjected to slot blot analysis to quantitate the amount of LPS that had leaked into the bottom of the vials. The density of slots was analyzed using a laser densitometer and regression analysis was used to generate a standard curve, confidence intervals and experimental values. RESULTS: The data indicated that teeth obturated apically with gutta-percha leaked, whilst no LPS leakage was detected in teeth covered completely with nail varnish (P < 0.05). CONCLUSIONS: In vitro teeth with gutta-percha root-end fills can permit leakage of LPS from an identified oral pathogen.

Apicoectomy↗
PubMed2000

TGF-beta 1 alone and in combination with calcium hydroxide is synergistic to TGF-beta 1 production by osteoblasts in vitro.

AIM: To examine the effects of calcium hydroxide (Ca(OH)2), transforming growth factor-beta (TGF-beta 1), and Ca(OH)2/TGF-beta 1 coadministration on TGF-beta 1 and interleukin-6 (IL-6) synthesis by early (subculture 1) and late (subculture 5) osteoblast cultures. METHODOLOGY: Early and late cultures were established using bone cells harvested from 21-day-old fetal rat calvaria. Cell cultures of both early and late osteoblasts were divided into four groups: group 1, control; group 2, cells challenged with Ca(OH)2; group 3, cells challenged with TGF-beta 1; and group 4, cells challenged with Ca(OH)2 and TGF-beta 1 in combination. TGF-beta 1 and IL-6 levels for all groups were determined using ELISA methodology. RESULTS: ANOVA and Tukey HS analyses revealed that osteoblasts of groups 3 and 4 significantly increased (P < 0.001) TGF-beta 1 synthesis in both early and late cultures of osteoblasts. IL-6 was not detected in any of the groups considered in this study. CONCLUSIONS: Exogenous TGF-beta 1 has an autocrine effect on cell cultures of osteoblasts. Administration of TGF-beta 1 alone or in combination with Ca(OH)2 increases the synthesis of TGF-beta 1 in osteoblast cultures. Ca(OH)2 and TGF-beta 1 are compatible when placed in a culture of osteoblasts. Ca(OH)2 provides a favourable environment for the anabolic effects of TGF-beta 1.

Analysis of Variance↗
PubMed2000

Effects of calcium hydroxide and transforming [correction of tumor] growth factor-beta on collagen synthesis in subcultures I and V of osteoblasts.

Collagen protein synthesis by osteoblasts is influenced by transforming growth factor-beta (TGF-beta 1) and is essential to bone formation. The effectiveness of TGF-beta 1 depends on efficient delivery of the growth factor to target cells, adequate binding to cell surface receptors, and an optimum environment for promotion of collagen synthesis. The effects of calcium hydroxide (Ca(OH)2), TGF-beta 1, and Ca(OH)2/TGF-beta 1 co-administration on total protein, collagen protein, and noncollagen protein synthesis by early (subculture I) and late (subculture V) osteoblast cultures were tested. TGF-beta 1 significantly increased all protein synthesis in subculture I osteoblasts (p = 0.001; p < 0.001; p = 0.019). Ca(OH)2/TGF-beta 1 co-administration significantly increased total protein and collagen protein levels in subculture I osteoblasts as well (p = 0.048; p = 0.012). TGF-beta 1 increased total protein and collagen protein synthesis significantly in subculture V cells (p = 0.025; p = 0.01). These data indicate that co-administration of Ca(OH)2 and TGF-beta 1 enhances collagen synthesis by osteoblasts and may have implications for the clinical setting.

Analysis of Variance↗
PubMed1999

The dental hygienist as a co-therapist in the endodontic practice.

This paper explores the potential contributions to patients, the practice, the endodontist, and the dental hygienist that may be realized by the employment of one or more dental hygienists to serve as endodontic co-therapists in the delivery of endodontic treatment. An endodontic co-therapist is an individual who participates with the endodontist in the assessment, planning, implementation, and evaluation of treatment much like the periodontal co-therapist relationship that exists between periodontists and dental hygienists. Dental hygienists are ideal individuals for this role because of their education in basic, clinical, and behavioral sciences. Suggestions are provided for which services could be delegated by the endodontist to the dental hygienist during each phase of care. Advantages of this contemporary approach to the delivery of endodontic treatment are also addressed.

Dental Hygienists↗
PubMed1999

Thermal sensitivity of endodontically treated teeth.

CASE REPORTS: The problem of thermal sensitivity following non-surgical root-canal treatment is explored and case reports are presented. Possible causes for post-treatment discomfort from endodontic and restorative aetiologies are discussed, as are the mechanisms to explain the patients' painful experiences. Treatment of this problem may vary from the simple replacement of a defective restoration to a more extensive non-surgical retreatment of the case, despite radiographic evidence of an acceptable root filling and normal periradicular tissues.

Cold Temperature↗
PubMed1999

Response of periradicular tissues to growth factors introduced into the surgical site in the root-end filling material.

AIM: The objective of this study was to evaluate the healing of the periradicular tissues when exogenous growth factors were delivered to the respected root-end. The healing response was compared with that when Diaket was used as a control. METHODOLOGY: Non-surgical root canal treatment was performed on mandibular teeth in mongrel dogs. Surgical treatment followed and included root-end resection and root-end cavity preparation. Insulin-like growth factor in combination with platelet-derived growth factor, or fibroblast growth factor alone, were then placed in the root-end preparations on a polylactic acid carrier (Atrisorb) with or without the incorporation of the carrier tetracalcium phosphate. The healing was evaluated at 60 days with regard to presence of inflammatory response, bone regeneration, periodontal ligament formation and cementum formation. RESULTS: Osseous regeneration in the excisional would and periodontal formation were significantly greater when Diaket was used as the root-end filling material. Likewise, cementum deposition occurred significantly more frequently in the Diaket group (P < 0.05). The polylactic carrier Atrisorb remained in the surgical sites for the duration of the study. CONCLUSIONS: The use of specific growth factors, FGF and a combination of IGF/PDGF, delivered to the prepared root end in a collagen carrier did not initiate the desired periradicular tissue response of regeneration. Diaket, as used in this study, did stimulate a periradicular tissue response compatible with regeneration.

Analysis of Variance↗
PubMed1999

Assessment of apical and coronal root canal seals using contemporary endodontic obturation and restorative materials and techniques.

AIM: The purpose of this study was to evaluate the sealing ability of two contemporary endodontic obturation and restorative techniques and materials. METHODOLOGY: Seventy-nine extracted human single-rooted teeth were distributed randomly in two experimental groups of 36 and 37 specimens (groups 1 and 2, respectively), one group of three positive controls and one of three negative controls. The teeth were radiographed preoperatively, accessed, and instrumented. After smear layer removal, the teeth in group 1 were obturated using the System B and Obtura and were restored coronally with Core Paste using Tenure as a bonding agent. The teeth in group 2 were obturated using the Microseal technique and were restored coronally with amalgam using Panavia 21 as a bonding agent. All teeth in groups 1 and 2 were coated with three layers of nail varnish on all of their surfaces apart from the apical 4.0 mm and the coronal area above the cemento-enamel junction. The positive control teeth were obturated, restored coronally and completely coated with varnish, whereas the negative control teeth were not obturated, restored coronally, nor coated with varnish. The teeth were radiographed postoperatively and retained in saline solution for 10 days. For the next 10 days they were submerged in India ink. Subsequently all teeth were demineralized, dehydrated and rendered transparent. Dye penetration was measured using a stereomicroscope. RESULTS: All materials and techniques provided minimal to zero dye penetration, apart from one specimen in the Core Paste group that showed 4.0 mm of dye penetration. The Wilcoxon rank sum test and t-test showed no statistically significant differences and all materials and techniques tested presented with a high degree of acceptability. CONCLUSIONS: It was concluded that these contemporary techniques and materials provide equally good results, but long-term studies are needed for outright inferences to be drawn relative to their clinical performance.

Coloring Agents↗
PubMed1999

Adaptation and sealability of two contemporary obturation techniques in the absence of the dentinal smear layer.

AIM: The aim of this study was to evaluate the adaptation and short- and long-term sealability of two different thermoplastic techniques--a core carrier technique, Thermafil; and a warm vertical continuous wave of compaction technique, System B. METHODOLOGY: Fifty-one mesial roots of mandibular molars with separate canals, patent canal orifices and curvature greater than 15 degrees were cleaned and shaped with Orifice Shapers and ProFile.04/.06 taper Ni-Ti rotary files using 5.25% NaOCl and 17% REDTA to a size 30.04 taper Profile at the apex to create a continuous tapered preparation. Canals were randomly obturated with Sealapex root canal sealer and either alpha-phase gutta-percha on a plastic Thermafil carrier, or nonstandardized beta-phase gutta-percha using the System B heat source. Proximal radiographs of roots were evaluated by three examiners based on established criteria for overall material adaptation, apical adaptation and filling material extrusion. Teeth were randomly separated into three groups of 17 each and placed in black India ink for 10 days, 24 h, or after 67 days storage in Hank's Balanced Salt Solution. All roots were demineralized and rendered transparent. Three examiners evaluated the apical leakage by the linear measurement of dye penetration under the stereo-microscope. The movement of filling material into canal irregularities was also evaluated. RESULTS: Both obturation techniques were not significantly different in the overall canal obturation and in the apical third adaptation (P > 0.05). Significantly more filling material extrusion beyond the apex was noted with the Thermafil technique (P < 0.001). No significant difference was found amongst the 67-day, 10-day and 24 h System B groups (P > 0.05). The 67-day Thermafil group showed significantly more leakage than the 10-day and 24 h Thermafil groups. There was a significant difference in the degree of leakage between the 67-day Thermafil group and the 67-day System B group (P < 0.05), but not between the 10-day and 24 h groups (P > 0.05). Both obturation techniques produced substantial filling material movement into canal irregularities. CONCLUSIONS: It was concluded that Thermafil demonstrated more filling material extrusion beyond the apex and significantly more long-term apical leakage.

Dental Leakage↗