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PubMed1997

Expression of osteocalcin in cementoblasts forming acellular cementum.

To determine the phenotypic expression of cementoblasts responsible for acellular cementum, an immunohistochemical study was performed using a polyclonal antibody raised against the aminoterminal peptide of rat osteocalcin (OC). Maxillary first molars of Wistar male rats aged 2 and 3 wk were used for observations. Serial sections of decalcified paraffin embedded specimens were stained either with hematoxylin and eosin or with the anti-OC antibody. In 2-wk-old rats, apical roots were lined with the epithelial root sheath. A thin layer of acellular cementum was seen at most of the root surface, but was not seen near to root apex. In 3-wk-old rats, cellular cementum began to be formed at root apex, and acellular cementum became more thick than in 2-wk-old rats. Acellular and cellular cementum were lined with the fibroblast-like cells. Osteocalcin staining was detected in cells lining root surface in both 2- and 3-wk-old rats. Almost all cells lining cellular cementum were positive for OC. In contrast OC positive cells lining acellular cementum and root surface devoid of cementum appeared at a specific site of the root. The cells at the interradicular area of root surface were positive but the cells at the outer area (the opposite side of the interradicular area) were negative for OC. Osteoblasts and odontoblasts were positive with the antibody. The present results suggest that the OC expression of cementoblasts forming acellular cementum is similar to that of cells forming cellular cementum as well as osteoblasts and odontoblasts, and has a role for calcification of acellular cementum.

Animals↗

PubMed1995

[Localization of the apical foramen using the newest electronic instruments: stereomicroscopy and SEM (scanning electron microscopy)].

Introduction of double impedence as new parameter in root canal length electronic measurement allowed first and second generation electronic apical localizers main problems overcoming: precision failure in presence of conducting fluids. Our study's purpose was an in vitro evaluation of two third generation instruments (Apit-Osada and Root ZX-Morita Corp.) ability in apical foramen localization using sodium hypoclorite as irrigating solution. 40 human monorooted teeth with immature apex were studied. 20 samples were measured by Apit and 20 by Root ZX; measurements were recorded when apical foramen was reached. Samples were fixed for stereomicroscope observation before and after apical 3 mm worn and prepared for SEM observation. Evaluations about each system's precision were made by calculating difference between foramen position determined by electronic localizer and its real anatomical position determined by a computed image analizing system linked to SEM. All measurements were included between a minimum value of -0.45 mm and a maximum value of 0.26 mm. Mann Whithney U test was performed to compare average values of the two sample groups but his was not meaningful (p = 0.18) showing that there is no valuable difference in accuracy between Apit and Root ZX. According to most researchers, who consider a +/- 0.5 mm error range clinically acceptable, and considering that in vitro measurements never exceded this limit value we conclude confirming both instruments' safety.

Dental Equipment↗

PubMed2004

Periodontal regeneration of transplanted rat molars after cryopreservation.

The effects of cryopreservation on periodontal regeneration of transplanted rat molars were investigated histologically and histochemically in rats. Bilateral first and second maxillary molars of 4-week-old Wistar rats were gently extracted and transplanted into the abdominal subcutaneous connective tissue immediately or after cryopreservation in liquid nitrogen overnight. Donor teeth were slowly frozen by a rate-controlling freezer (program freezer) using 5% dimethylsulfoxide (DMSO) and 6% hydroxyethyl starch (HES) as cryoprotectants. One-four weeks after transplantation, they were carefully excised with the surrounding tissues. Regeneration of acellular cementum, periodontal ligament, and alveolar bone were observed 2 weeks after immediate transplantation. The pulp was repaired by the ingrowth of granulation tissue from the root apex followed by the formation of calcified tissue. The regenerated periodontal ligament was positive for alkaline phosphatase (ALP). Small or mononuclear tartrate resistant acid phosphatase (TRAP) positive cells were scattered on the newly formed alveolar bone and on the hard tissue in the pulp, but there was no external or internal progressive root resorption at 4 weeks. Cryopreserved teeth had acellular cementum with a rough surface at 1 week, but with the increase of cementoblasts and the appearance of periodontal ligament and alveolar bone, the surface became smooth at 3 weeks. Epithelial rests of Malassez (ERM) also revived. After regeneration of the periodontal tissues at 4 weeks, there was no evidence of root resorption. Although the process proceeded slowly, the cryopreserved teeth showed the periodontal regeneration substantially similar to that of the immediately transplanted teeth without progressive root resorption, indicating that they could be applicable for clinical use.

Alkaline Phosphatase↗

PubMed1993

An evaluation of the durability of apex locator insulated probes after autoclaving.

The purpose of this study was to evaluate the durability of insulated probes designed to be used with the Endocater Apex Locator when put through multiple cleaning and autoclaving cycles. The manufacturer has reported that the plastic coating on the probes is reliable with normal use and sterilizable up to a maximum of three cycles. The quality of the seal provided against electrical conductivity by the coating was evaluated using 60 probes of various sizes (10, 15, 20, 25, 40) before and after autoclaving. Visual and electrical field methods were used to detect any leakage in the insulated coating. Defects were detected electronically before they could be detected visually. Statistically significant differences in millimeters of coating lost were found between the original evaluation and after each autoclaving cycle. The size 40 probes lost statistically significantly more coating than did any of the other sizes. The loss of coating seemed to be related to the millimeter markings. The quality of the probes as they came from the manufacturer was excellent; no defects were found in the coating prior to autoclaving.

Dental Cavity Preparation↗

PubMed1995

Elemental distributions in predentine associated with dentine mineralization in rat incisor.

Electron probe microanalysis was applied to study quantitatively and semi quantitatively the elemental concentrations and distributions that occur in predentine during the dentine mineralization of rat incisor. Apex regions of the continuously growing incisors were rapidly dissected and cryofixed in liquid nitrogen-cooled propane. Ultrathin cryosections were prepared from the dentine tissue. On the average in the extracellular predentine element concentrations of calcium and phosphorus were about 0.5% (w/w) and 0.5-1% (w/w), respectively; so the calcium content in the extracellular predentine is higher while the phosphorus content is much lower than in the odontoblast area. Due to the high content of glycosaminoglycans in the extracellular matrix the concentration of sulfur in the predentine was more than 1% (w/w); the potassium content was found in the range of 0.6-0.8% (w/w) which is quite high for an extracellular area and the concentrations of sodium and chlorine were higher than 2% (w/w). Elemental mapping analysis was carried out to demonstrate the distribution of some important elements at the predentine/dentine border during mineralization.

Animals↗

PubMed2003

Prevalence of third molar impaction in orthodontic patients treated nonextraction and with extraction of 4 premolars.

The purposes of this study were to confirm that premolar extraction treatment is associated with mesial movement of the molars concomitant with an increase in the eruption space for the third molars and to test the hypothesis that such treatment reduces the frequency of third molar impaction. Lateral cephalograms, panoramic or periapical radiographs, and study models made before (T1) and after (T2) treatment and a minimum of 10 years postretention (T3) of 157 patients were selected from the postretention sample at the Department of Orthodontics of the University of Washington, Seattle. Treatment for 105 patients included the extraction of 4 premolars; the other 53 were treated nonextraction. These patients represented all the extraction and nonextraction patients in the sample who had at least 1 third molar at T1 or T2 and who showed evidence of full eruption or closure of the root apex at T2 or T3. Student t tests showed higher scores for third molar impaction (P <.01), less mesial movement of the molars from T1 to T2 (P <.01), and smaller retromolar space at T2 (P <.001) in both arches of the nonex patients than in the ex patients. Similarly, molar movement was more mesial from T1 to T2 in the maxilla (P <.01) and in the mandible (P <.05), and the retromolar space was larger in both arches (P <.001) of the patients with eruption than in those with impaction of the third molars. Our results suggest that premolar extraction therapy reduces the frequency of third molar impaction because of increased eruption space concomitant with mesial movement of the molars during space closure.

Adolescent↗

PubMedDate not supplied

An immunological evaluation of type II diabetic patients with periodontal disease.

Peridontal disease is a frequent complication of diabetes, and diabetic subjects often exhibit decreased immune response with increased susceptibility to infection. We evaluated the possible relationship between immune response and periodontal disease in 40 type II diabetic patients, mean (+/- SD) age 59 +/- 8 years and mean disease duration 17 +/- 4 years, with good metabolic control (mean fasting plasma glucose, 10.5 +/- 3.8 mM/L, mean HbA1c 8.1 +/- 1.66%), and in 40 age and gender-matched controls. Interproximal alveolar bone loss (ABL), as the percentage of bone loss from the cement enamel junction (CEJ) to the apex, was measured with a modified Schei ruler at the deepest point on the mesial/distal surface of the teeth, except third molars, on a panoramic radiograph. Immunological evaluation involved study of NADPH neutrophil superoxide production, neutrophil chemotaxis, lymphocyte subpopulations, immunoglobulins and complement. Diabetic patients showed significant differences compared with controls regarding ABL (30.6 +/- 14.7% versus 17.6 +/- 4.3%; p < 0.0001) and the T-helper/T-suppressor ratio (2.3 +/- 1.0% versus 1.8 +/- 0.8%; p < 0.05). Other parameters of cell-mediated immunity and humoral immune response did not show any significant variations. No correlation between immunological and radiographic analysis parameters were found. Further studies are needed to verify the exact role played by immunological factors in type II diabetic patients with periodontal disease.

Alveolar Bone Loss↗

PubMed2000

Resorption of incisors after ectopic eruption of maxillary canines: a CT study.

The purpose of the study was to analyze the extent and prevalence of resorption of maxillary incisors after ectopic eruption of the maxillary canines in a sample of subjects referred to an orthodontic specialist clinic for consultation. The subjects consisted of 107 children, 39 boys and 68 girls, between 9 and 15 years of age (mean 12.5 years), with 156 ectopically and 58 normally erupting maxillary canines. All children were subjected to a basic clinical and intraoral radiographic investigation. These radiographs were supplemented with computerized tomography (CT) of the upper alveolar bones in order to get more precise information on the positions and relationships between the maxillary canines and adjacent incisors and to evaluate resorptions on the roots of the incisors. The results showed that, relative to the roots of the adjacent incisors, the crowns of 21% the ectopically positioned canines were located to the buccal, 18% to the distobuccal, 27% to the lingual, 23% to the distolingual, 5% apically and 6% between the central and lateral incisors. Ninety-three percent of the ectopically positioned canines were in contact with the roots of the adjacent lateral incisor and 19% were in contact with the central incisor. The corresponding figures for the normally erupting canines were 49%. Resorptions on the roots of the incisors adjacent to the ectopically positioned canine occurred in 38% of the laterals and in 9% of the centrals. The resorptions were graded and tended to be extensive. Among the 58 resorbed lateral incisors, resorptions were slight in 31%, moderate in 9%, and severe with pulpal involvement in 60%. The corresponding figures for the 14 resorbed centrals were 36%, 21%, and 43%, respectively. About 60% of the resorptions involved the middle and apical thirds, the tip of the apex not included. On the sides with normally erupting canines, 3 lateral maxillary incisors were slightly or moderately resorbed distally. In all, 51 of the 107 subjects with ectopically erupting maxillary canines (48%) had resorbed maxillary incisors during the eruption of the maxillary canines. There were statistically significant correlations between ectopic eruption of the maxillary canine, contacts between the teeth and resorptions on the adjacent incisors. It was concluded that resorption on maxillary incisors after ectopic eruption of the maxillary canines is a more common phenomenon than previously reported and has to be considered in all cases with seriously diverging eruption of maxillary canines. It was also concluded that the resorptions of the roots of the incisors were caused by pressure during the eruption of the adjacent, aberrant canine. Finally, it was shown that CT scanning substantially increased the detection of root resorptions on incisors adjacent to ectopically erupting maxillary canines (about 50%). The sensitivity of intraoral films was low when diagnosing the resorptions, being calculated to 0.68.

Adolescent↗

PubMed2005

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

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

Adolescent↗

PubMed1993

Histological evaluation of therapy using a calcium hydroxide dressing for teeth with incompletely formed apices and periapical lesions.

Periapical tissue response was evaluated histologically in teeth of 6-month-old dogs with incomplete root formation and periapical lesions in order to compare the effects of two calcium hydroxide-containing pastes prepared with different vehicles on induced root apex formation and repair of the periapical region. A group of teeth with no root canal dressing was used as control. After induction of the periapical lesion, the root canals were instrumented and filled with one of the two pastes (Calen and Calasept), which were renewed monthly for 90 days. At the end of the follow-up period (3 months), the animals were killed. Block sections from the actual areas were dissected free and prepared for histopathological analysis. Both calcium hydroxide pastes helped induce apical sealing and repair of the region, but the Calen paste yielded better results than Calasept. The induced mineralized tissue was predominantly of the cementoid type after the use of both pastes, but the inflammatory infiltrate was significantly less intense with the use of the Calen paste. In the control group, the absence of a root canal dressing impaired the process of periapical repair and yielded no apical root closure in any of the cases analyzed.

Animals↗

PubMed1992

Comparison of three imaging techniques for assessing endodontic working length.

The accuracy of endodontic working length estimation was investigated using three imaging techniques: radiography (Rd), Xeroradiography (Xr) and Radiovisiography (RVG positive and negative prints). An in-vitro model of extracted single straight roots, mounted in wooden blocks with wax, was employed in the study. Optimum exposures were established for each of the imaging techniques. The magnification of the images was measured and the resolution of the RVG images was also investigated. Comparable Rd (D-speed film), Xr,RVG positive and RVG negative images were made of five roots with size 10 files in situ. Images of 10 standard files were made, ranging from 2.0 mm through the root apex to 2.5 mm short of the apex, resulting in 200 images. Six observers each assessed the working distance on 100 images, measuring the distance from the apical foramen to the file tip. After allowing for the magnification of the images, these results were compared with the 'true' file tip to apical foramen (measured with the aid of a reflex microscope). The inaccuracy of working distance estimations was considered to be of clinical significance (> 0.5 mm) in 6% of measurements made from Rd and Xr, 19.2% of measurements from RVG negative and 32.3% from RVG positive images. In addition, 14% of RVG images were too poorly defined to be assessed. The first-generation RVG system was used in this study. It was therefore concluded that the most accurate estimates of working distance were made from Xr and Rd images, and that RVG images, particularly the RVG positive images, were the least accurate and most difficult to read.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

PubMed1995

Dentinal diffusion of hydroxyl ions of various calcium hydroxide pastes.

The aim of this study was to analyze in vitro the dentinal diffusion of hydroxyl ions of calcium hydroxide pastes, prepared with different acid-base vehicles, in an inert nitrogen atmosphere. Sixty maxillary incisors with mature apexes were selected and after access and root canal preparation each root was filled with calcium hydroxide pastes prepared with different vehicles: saline solution, anesthetic and polyethylene glycol 400. The roots were then sectioned 2 mm from the apical vertex and the teeth mounted in the center of a round platform, filled with saline solution up to 2 mm from the root tip. The platforms remained inert in an atmosphere of nitrogen, completely sealed, in the absence of light and with a constant temperature of 36.5 degrees C. Diffusion analysis of the hydroxyl ions was carried out by a colorimetric method on days 7, 15, 30, 45 and 60. Calcium hydroxide pastes prepared with saline solution and anesthetic showed a pH change of 5-7 to 7-8 after 30 days, remaining at this level at 60 days. In the polyethylene glycol 400 group, the same alteration occurred at 45 days, and continued at 60 days.

Calcium Hydroxide↗

PubMed2004

Comparison of mandibular premolars and canines with respect to their resistance to vertical root fracture.

OBJECTIVE: To compare the force required to vertically fracture uninstrumented and instrumented mandibular premolars and canines. METHODS: Two groups of single round-canal mandibular premolars and two groups of single oval-canal mandibular premolars were selected after radiographs indicated an internal long:short diameter of 1 or >2 at a level 5 mm from the apex. In addition, two groups of maxillary and mandibular canines were selected. The root canals of three of these groups (one from each category) were conventionally enlarged using same-sized instruments, while the other three groups were uninstrumented. Each root was mounted in an acrylic resin cylinder, and the force required to cause vertical root fracture (VRF) was measured using an Instron tester. RESULTS: No significant difference in resistance to VRF was found between the round- and oval-canal premolars with (p = 0.9) or without (p = 0.6) instrumentation. The average force required to fracture the uninstrumented premolars and canines was 698 and 566 N, respectively. The average force required to fracture the instrumented premolars and canines was 490 and 554 N, respectively. The force required to fracture the instrumented premolars and canines was 30% (p < 0.05) and 2% (p = 0.9) lower, respectively, than that required to fracture their uninstrumented counterparts. CONCLUSIONS: The instrumented mandibular premolars have a higher risk to fracture than the uninstrumented mandibular premolars.

Bicuspid↗

PubMed1989

An in vitro comparison of five root canal length measuring instruments.

Several new root canal length measuring instruments (RCLMI) have recently been introduced claiming superiority over older systems. The purpose of this study was to compare five models of these instruments with respect to their accuracy under a given set of specified conditions. The five RCLMI tested were: the, Exact-a-pex, the Endocater, the Neosono-D, the Apex Finder, and the Sono-Explorer, Mark III. The conditions tested were the accuracy of the instruments in determining the working length, the consistency of measurement following canal instrumentation and with conductive gutta-percha points in place, and the operation of the RCLMI in the presence of fluids frequently found in root canals during endodontic treatment. An in vitro model was used to test these instruments. A set of 20 teeth was tested using the conditions specified above. All data were compared using the mean difference from the actual canal length of the teeth. The results indicated that there were no significant differences among measurements derived from the five instruments, under the specified conditions. There was a slight variation of the measurements by all instruments when they were used following instrumentation and with the use of conductive gutta-percha points. When fluids were present in the canals, the reliability of the RCLMI depended on the electrical conductivity of the fluid tested. The poorest results were obtained when either sodium hypochlorite or blood were present in the canals.

Dental Instruments↗

PubMed1989

Labial root torque: effect on the maxilla and incisor root apex.

This study was designed to determine the effectiveness of labial root torque on anterior nasomaxillary development. Quantification was made of the angular and linear changes in Downs' point A (representing midsagittal basal bone) and incisor point A (representing the dentoalveolar bone) and any concomitant incisor root resorption. The study was divided into two parts: part 1--to determine the anatomic configuration of the premaxillary region by use of laminagraphy on skulls, and part 2--to use the morphologic landmarks found in part 1 to assess the development of the nasomaxillary complex in maxillary retrusive patients. The clinical study involved 17 maxillary retrusive patients, aged 8.0 to 15.7 years, who had been treated for a period between 0.31 and 3.70 years with edgewise advancing mechanics. Clinical results indicate that during the first phase of orthodontic treatment with labial root torque, encompassing a 0.63-year mean treatment period, a greater rate of advancement of Downs' point A was produced when compared with normal growth. The skeletal convexity increased, whereas normal growth straightened the profile. Incisor point A advanced at a greater rate than Downs' point A, suggesting that treatment caused a larger dentoalveolar effect than the effect on midsagittal basal bone. When treatment was extended to 1.57 years, similar changes were found but at a reduced rate. Overall apical root resorption was 12.7%/year. Sex and age were not found to have any correlation to the amount of apical root loss.

Cephalometry↗

PubMed1985

Linear variation of the root surface area of the maxillary first molar.

The variation of root surface area (RSA) in 1-mm increments from the cementoenamel junction (CEJ) to the apex was determined for the maxillary first molar. Twenty extracted maxillary first molars were cross sectioned every millimeter, and each section was photographed, projected and measured with a calibrated opisometer. The RSA and percentage of RSA were calculated for each 1-mm section. The location of furcation entrances, root separations and roofs of the furcations was also determined. Analysis of the mean measurements demonstrated that (1) the largest per cent of RSAs were found in the furcation area; (2) the mean distance from the CEJ was 3.6 mm for the mesial furcation entrance, 4.2 mm for the facial furcation entrance and 4.8 mm for the distal furcation entrance; (3) the mean distance from the CEJ to the point at which the roots separate from the root trunk was 5.0 mm for the mesiobuccal root and 5.5 mm for the distobuccal root; (4) in 11 of the 20 teeth the roof of the furcation was coronal to all root separations, forming a concave dome between roots. According to the individual and mean measurements, horizontal attachment loss of 6.0 mm or greater would have resulted in Grade III furcation involvement in all the teeth studied.

Dental Cementum↗

PubMed2004

Scanning electron microscopy (SEM) and optical microscopy: effects of Er:YAG and Nd:YAG lasers on apical seals after apicoectomy and retrofill.

OBJECTIVE: This study evaluated the dentinal and marginal permeability of the cut surface after apicoectomy, treatment and retrocavity preparation with Er:YAG and Nd:YAG lasers. Furthermore, scanning electron microscopy (SEM) analysed the morphological alteration of dentin caused by laser irradiation through an optical fiber. BACKGROUND DATA: Numerous studies have shown the beneficial effects of laser treatment upon sealing dental apex, avoiding the changes of organic fluids, microorganisms and their by-products between the root canal system and periapex. MATERIALS AND METHODS: Twenty-four extracted and endodontically treated teeth were divided into three groups: GI, apices were resected with Er:YAG laser (350 mJ; 4 Hz) treatment of cut dentinal surface and retrocavity were lased with this same laser (120 mJ; 4 Hz; bur 2051) using the optical fiber 50/10; GII, apicoectomy was performed similar to GI, however the cut dentinal surface was treated with Nd:YAG laser through optical fiber, as well as the retrocavity preparation (100 mJ; 15 Hz; 1.5 W); and GIII (control group), high speed burs were used. RESULTS: Analysis of methylene blue dye penetration into dentin demonstrated that the specimens of the groups irradiated with laser showed to have lower infiltration indices than the control group. These results were compatible with structural and morphological injuries, evidenced by SEM. CONCLUSION: Under the conditions of the present study, apicoectomy using Er:YAG laser, followed by dentinal surface irradiation and retrocavity preparation with Nd:YAG laser, showed to be an alternative clinical tool able to reduce the dentinal permeability.

Humans↗

PubMed1987

Periodontal wound healing in the absence of periodontal ligament cells.

This experiment was designed to study the ability of mucoperiosteal flap connective tissue to form new attachment on partially demineralized roots as well as nondemineralized roots in a wound-model where periodontal ligament (PDL) cells are absent, and ingrowth of bone granulation tissue is controlled. After reflecting mucoperiosteal flaps, bone was removed circumferentially around the distal root of mandibular second premolars and the mesial root of mandibular third premolars in five beagle dogs. The roots were completely denuded from the cementoenamel junction to the apex and curetted to remove PDL and cementum. Following root canal filling, the denuded roots on one side were conditioned with citric acid while the contralateral roots served as controls. To prevent bone-derived granulation tissue from contacting denuded roots, sheets of Nuclepore membrane were placed over the exposed bone margins and secured in place with steel ligatures. The flaps were coronally positioned and sutured. Histologic examination was made after three months of healing accompanied by regular plaque control. Both the experimental (acid conditioned) and control roots showed epithelium extending into the apical third of denuded roots and root resorption confined to the root apices. Some experimental specimens showed connective tissue adhesion in the apical third of roots without any new cementum or oriented fibers. Inflammatory cell infiltrate was seen extending to the apical third of denuded roots in both groups. In this model, the flap connective tissue cells failed to form new cementum and inserting fibers. Whether this was the result of inflammation and epithelial downgrowth or the inability of flap connective tissues to form new attachment could not be concluded from the study.

Alveolar Process↗