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Risk of pulp damage due to temperature increase during thermodebonding of ceramic brackets.

The purpose of this study was to perform in vitro measurements of the temperature increase at the enamel-dentine interface during electrothermal removal of ceramic brackets, and to analyse, in vivo, whether signs of pulp damage can be observed 4 weeks after the procedure. In vitro study: a total of 29 caries-free human teeth were cut into buccal and lingual halves. The buccal halves were bonded with ceramic brackets, and miniature thermocouples were placed from the pulpal side into holes drilled to the enamel-dentine interface under the centre of the bracket slot. From the onset of thermodebonding, the temperature increase relative to room temperature was recorded for a period of 43 seconds. The maximum temperature increase at the enamel-dentine interface was 6.9 degrees C. In vivo study: a total of 12 human premolars scheduled for extraction for orthodontic reasons were bonded with ceramic brackets. Electrothermal debonding was performed the following day. After 4 weeks, the teeth were extracted and prepared for histological examination. Following demineralization, sections were prepared for light microscopic examination. No signs of pulpal inflammation were observed.

Acrylic Resins↗

Histopathological evaluation of the dental pulps in crown-fractured teeth.

Trauma is a common cause of pulpal damage. In traumatic injuries, the first priority is to protect the vitality of pulps. But the time between the trauma and treatment must be short to preserve vital, noninflamed pulps. The aim of this study was to investigate the histopathological changes in pulpal tissues at different time periods after crown fractures. Twenty-three teeth with enamel and dentin fractures, with and without pulp exposure were evaluated. The reasons for seeking dental treatment were aesthetic consideration, pain, or discomfort. The extirpated pulps were histologically prepared for microscopical evaluation. There was myelin degeneration surrounding the axons and edema in the early posttraumatic stages (17 h). In the later stages (4 to 20 days), the tissues showed varying degrees of inflammation, and neuronal degeneration such as intramyelin edema, aberrant myelin synthesis, and axonal swelling.

Axons↗

Immunohistochemical localization of tenascin, fibronectin, and type III collagen in human dental pulp.

The distribution of tenascin (TN), fibronectin (FN), and type III collagen (col III) in the extracellular matrix of the connective tissue of normal, inflamed, and hyalinized human dental pulp was studied by immunohistochemical staining with monoclonal antibodies against these molecules. TN, FN, and col III were present in all normal tissues studied. In areas of hyalinization only col III was observed. None of the molecules studied were seen in areas of inflammatory exudate. Strong staining for TN and FN was found in the periphery of all specimens analyzed next to the odontoblastic layer. We therefore conclude that TN, FN, and col III are present in the extracellular matrix of normal human dental pulp. TN, FN, and col III distribution in inflammatory and degenerative processes is different from that observed in normal human dental pulp.

Antibodies, Monoclonal↗

The effectiveness of prophylactic etodolac on postendodontic pain.

To determine if prophylactic etodolac would significantly reduce postendodontic pain, when compared with ibuprofen or placebo, 36 patients consented to single blind oral administration of either 400 mg of etodolac, 600 mg of ibuprofen, or a placebo, before conventional one-appointment root canal therapy. Patient-reported visual analog scale ratings of pain intensity were conducted upon initial clinical presentation, immediately postoperative, 4, 8, 12, 24, 48, and 72 h after initiation of root canal therapy. Results showed that prophylactic ibuprofen administration significantly reduced postendodontic pain at 4 and 8 h after initiation of root canal therapy, when compared with etodolac and a placebo. Patients with a periapical diagnosis of acute apical periodontitis or with a Phoenix abscess showed a significant increased need for additional medication after completion of root canal therapy, compared with all other periapical diagnoses.

Acute Disease↗

Quantitation of catecholamines in inflamed human dental pulp by high-performance liquid chromatography.

Catecholamines may play an important role in the control of intrapulpal pressure as mediators of vasoconstriction. A baseline level of catecholamines (dopamine, epinephrine, and norepinephrine) in the uninflamed human dental pulp was previously reported using high-performance liquid chromatography. The purpose of this study was to compare the level of catecholamines present in the inflamed human dental pulp with the baseline level established in virgin teeth. Twelve uninflamed pulps were analyzed as a control and to validate previous findings. Pulp tissue was obtained from 10 vital and inflamed teeth requiring endodontic treatment. Selective criteria for each patient included: absence of systemic disease, medications, and allergies; a vital response to ice, heat, and electric pulp tests; and periodontal probing < or = 3 mm. A prior history of pain associated with the tooth was an additional criterion for inflamed pulps. To avoid the presence of an exogenous catecholamine, local anesthesia without epinephrine was administered. Dopamine, epinephrine, and norepinephrine were chemically extracted and analyzed by high-performance liquid chromatography with ultraviolet detection. Catecholamine levels found to be present in the pulp during inflammation were greater than the baseline level established in uninflamed pulp tissue.

Chromatography, High Pressure Liquid↗

The anti-inflammatory effects of human recombinant copper-zinc superoxide dismutase on pulp inflammation.

Inflammation in the dental pulp is accompanied by release of a wide variety of highly oxidative molecules known as reactive oxygen species (ROS). ROS concentrations are controlled in vivo by an antioxidant enzyme scavenger system that may be overwhelmed by the increases in ROS production seen during inflammation. Supplementation of the antioxidant defense system, therefore, may limit the severity of the inflammatory response to injury due to this component. To test this hypothesis, this study examined the effects of superoxide radical scavenging on pulpal inflammation induced in rat molars by standardized cavity preparation. The extent of pulp inflammation was compared histomorphometrically between animals treated with exogenous administration of a human recombinant antioxidant enzyme, copper-zinc superoxide dismutase, conjugated to polyethylene glycol (hr-CuZn-SOD), versus saline-vehicle controls. There was a statistically significant reduction in area of inflammation involvement in those animals treated with hrCuZn-SOD, compared with controls. Although hrCuZn-SOD administration did not completely eliminate inflammation in all animals treated, there was a statistically significant lessening of the severity of the inflammatory response, as well as a greater degree of reparative dentin observed in the hrCuZn-SOD-treated animals.

Analysis of Variance↗

Regulation of interleukin-6 expression in human dental pulp cell cultures stimulated with Prevotella intermedia lipopolysaccharide.

Interleukin (IL)-6 expression in human dental pulp cell cultures after stimulation with Prevotella intermedia lipopolysaccharide (LPS) was investigated by Northern blot analysis, enzyme immunoassay, and bioassay. The IL-6 mRNA expression began to increase after 1 hr and continued after up to 8 hr of exposure on stimulation with 10 microg/ml of P. intermedia LPS. The bioactivity was dose-dependent on the concentration of P. intermedia LPS (0 to 100 microg/ml). The IL-6 mRNA expression was inhibited by actinomysin D and super-induced by cycloheximide. Anti-CD14 monoclonal antibody (MY4) inhibited the IL-6 mRNA expression when administered at a 0.5 microg/ml concentration before stimulation with P. intermedia LPS at 1 microg/ml. The immunoregulatory cytokines (interferon-gamma, IL-10, and IL-4) inhibited LPS-induced IL-6 production with a combined treatment. These results suggest the IL-6 expression by pulp cell cultures is CD14-dependent and regulated at the transcriptional level, and a combined treatment with immunoregulatory cytokines may be effective for control of pulpal inflammation due to P. intermedia LPS.

Antibodies, Monoclonal↗

Prophylactic treatment of dens evaginatus using mineral trioxide aggregate.

Two case reports with dens evaginatus are presented. Each patient had one tooth affected. There was a prominent tubercle on the occlusal surface of the mandibular second premolar. Under local anesthesia and rubber dam isolation a partial pulpotomy was conducted and mineral trioxide aggregate was placed. After 6 months the teeth were removed as part of planned orthodontic treatment. Histological examination of these teeth showed an apparent continuous dentin bridge formation in both teeth, and the pulps were free of inflammation. These cases show that mineral trioxide aggregate can be used as an alternative to existing materials in the proplylactic treatment of dens evaginatus.

Aluminum Compounds↗

An immunohistochemical study of osteoprotegerin in the human dental pulp.

This study investigated the expression of osteoprotegerin (OPG) in healthy and inflamed dental pulps. Histological sections 7 microm thick of 47 teeth, either caries-free or affected by gross caries, were used. Sections were stained with hematoxylin-eosin, and other sections of the same specimen were subjected to the avidin-biotin peroxidase complex immunohistochemical procedure for detection of OPG. The study focused on the coronal pulp that was divided into peripheral and central regions. In the peripheral pulp healthy and inflamed specimens showed high OPG immunoreactivity of the odontoblastic layer. When no inflammation was present in the central pulp OPG immunoreactivity was light. Fibroblasts and endothelial cells showed immunoreactivity ranging from none to intense. When inflammation was present in the central pulp the chronic inflammatory cells showed intense immunoreactivity.

Chi-Square Distribution↗

Regulation of matrix metalloproteinase-2 production by cytokines and pharmacological agents in human pulp cell cultures.

Type IV matrix metalloproteinases (MMPs) are members of the family of MMPs and are thought to play an important role in degradation of extracellular components. Human pulp cells can secrete and produce these enzymes. Recent evidence shows that MMPs may play a role in pulpal inflammation. To date little is known regarding the regulation of MMPs in human pulp cell cultures. The purpose of this study was to determine the effects of cytokines (interleukin-1 and transforming growth factor-beta (TGF-beta), protein synthesis inhibitor cycloheximide (CD), and protein kinase C inhibitors (H7 and Go6976) on the secretion and production of MMPs by human pulp cell cultures using gelatin zymography. The main gelatinase secreted by human pulp cells migrated at 72 kDa and represented MMP-2. Minor gelatinolytic bands were also observed at 92 kDa regions that correspond to MMP-9. After an 8-day culture period TGF-beta, CD, H7, and Go6976 were found to depress MMP-2 production. The inhibition decreased in an order of CD > H7 > TGF-beta > Go6976. IL-1 was found to elevate MMP-2 production. Human pulp cells, however treated with either cytokines or pharmacological agents had no effect on the pattern of MMP-9 produced or secreted in either cell extracts or conditioned medium fractions. These observations suggest that the cytokines and pharmacological agents can regulate MMP-2 produced by human pulp cells. Inflammatory cytokines stimulate the production of elevated levels of MMP-2 and MMP-2 might play a role in pulpal inflammation. In addition agents that target protein synthesis or the protein kinase C pathway in human pulp cells inhibit MMP-2 production, and such inhibition may contribute to the pathogenesis of pulpal inflammation. Such inhibition might contribute to therapeutic efficacy.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗

Interleukin-1beta activity and collagen synthesis in human dental pulp fibroblasts.

Immunopathologic reactions play a significant role in inflammatory diseases of dental pulp. Interleukin-1beta (IL-1beta) is recognized as a key player in mediating cellular immune response. In this study, we measured the content of IL-1beta and its effect on collagen synthesis in cultures of fibroblasts derived from healthy and diseased dental pulps. We found that diseased pulp fibroblasts contain 2.5-fold greater amounts of IL-1beta and synthesized 80% greater amounts of collagen compared with healthy pulp fibroblasts. However, exogenous IL-1beta failed to stimulate collagen synthesis by diseased fibroblasts, whereas collagen synthesis by healthy pulp fibroblasts was stimulated by more than 2-fold. These observations imply that pulp disease induces abnormalities associated with fibroblast response toward IL-1beta.

Analysis of Variance↗

Effect of methotrexate-induced neutropenia on pulpal inflammation in rats.

The purpose of this study was to determine the role of neutropenia in pulpal inflammation. We investigated the effect of methotrexate-induced neutropenia on pulpal inflammation in rats. Pulpal inflammation was produced by pulpal exposure. Thirty-six rats were divided equally into control and experimental groups. The control animals received no injection, whereas the experimental animals were injected with 7.5 mg/kg of methotrexate once a day for 3 days before the pulpal exposure. The pulp was exposed in the mandibular first molar of all animals, and the exposed areas were left open. Animals were killed at 2, 4, and 7 days thereafter. Before they were killed, peripheral blood was taken. The number of total leukocytes and neutrophils in the peripheral blood of experimental animals was significantly decreased compared with those of control animals. The methotrexate-induced neutropenia resulted in the initiation of a bacterial invasion into the pulpal tissue and an increase in pulpal necrosis, as well as lessened abscess formation. Histometrically, the area of pulpal necrosis in experimental animals was significantly greater than that in the control animals. Immunohistochemically, the neutropenia resulted in inhibition of the infiltration by neutrophils. These results suggest that the neutrophil plays an important role in the defense against bacteria in pulpal tissue.

Animals↗

Evaluating IL-2 levels in human pulp tissue.

In murine and human CD4+ T cell populations, there are three subpopulations of T helper cell types. Hahn et al. demonstrated the ratio of CD4/ CD8 + cells significantly increases in inflamed dental pulps compared with normal pulps. Elevated levels of interleukin (IL)-2 have been detected in inflamed dental pulps and the level of IL-2 could be used as a marker for inflammation. In this study, levels of IL-2 were evaluated by using a human IL-2 cytokine assay kit on 80 samples of freshly extracted human pulp tissue. Applying standard diagnostic procedures, the tissue samples were clinically categorized into one of three experimental groups. The results demonstrated that there were no significant differences between the concentrations of IL-2 in any of the experimental groups. Our findings are different from results reported previously. Further investigation is warranted to determine if a correlation exists between the concentration of IL-2 or other interleukins and the degree of inflammation present in the dental pulp.

Adolescent↗

Changes in TrkB-like immunoreactivity in rat trigeminal ganglion after tooth injury.

The purpose of this study was to characterize the impact of tooth injury on the distribution of tyrosine receptor kinase B (TrkB) among trigeminal ganglion neurons and assess the time course for tooth injury-induced TrkB distribution changes. In addition, we sought to further characterize the subpopulation of the afferents expressing TrkB receptors. Fifteen adult male Sprague-Dawley rats were studied. Pulpal inflammation was induced and ganglia were subsequently harvested and processed at different time points. Standard immunohistochemical fluorescence techniques were used to visualize TrkB-like immunoreactivity and isolectin B4 binding. Results indicate that full-length TrkB receptors are present in 36.6% of trigeminal ganglion neurons. This percentage decreases for the first 48 h and then increases to 41% by 7 days after tooth injury. Finally, TrkB appears to be present in a large percentage (54%) of isolectin B4+ neurons, suggesting that it is present in nociceptive afferents. These data highlight the fact that even mild injury results in sustained changes in nociceptive circuitry and raise the possibility that the brain-derived neurotrophic factor/TrkB system may contribute to persistent pain after tooth repair.

Animals↗

Proinflammatory cytokines induce cyclooxygenase-2 mRNA and protein expression in human pulp cell cultures.

The increased release of prostaglandins (PG) within pulpal tissues is considered to play a pathogenic role during pulpal disease progression. The rate-limiting step in the formation of PG from arachidonic acid is catalyzed by cyclooxygenase (COX). COX-2 is an inducible enzyme believed to be responsible for PG synthesis at site of inflammation. The effect of proinflammatory cytokines on human pulp cells with special reference to COX-2 expression has not been reported earlier. The aim of the present study was to investigate the effects of interleukin (IL)-1alpha and tumor necrosis factor-alpha (TNF-alpha) on the expression of COX-2 mRNA gene and protein in cultured human pulp cells. Investigations of the time dependence of COX-2 mRNA expression in proinflammatory cytokines-treated human pulp cells revealed a rapid accumulation of the transcript, a significant signal first detectable 1 h after exposure. In addition, both IL-1alpha and TNF-alpha up-regulated COX-2 protein expression by human pulp cells. The kinetics of this response showed that COX-2 was detectable in cell lysates as early as 2 h post proinflammatory cytokines challenge and remained elevated throughout the 24-h incubation period. This suggests that one of the pathogenic mechanisms of pulpal inflammation in vivo may be the synthesis of COX-2 by resident cells in response to a proinflammatory cytokines challenge. COX-2 may play an important role in the regulation of prostanoid formation in the pathogenesis of pulpal inflammation. Taken together, we propose that the use of selective COX-2 inhibitors might provide a valuable tool in the control of pulpal inflammation.

Cell Culture Techniques↗

Induction of cyclooxygenase-2 mRNA and protein expression in human pulp cells stimulated with black-pigmented bacteroides.

Cyclooxygenase-2 (COX-2) is induced after the activation of cells by a variety of proinflammatory agents. Recently, evidence has shown that COX-2 may play a role in the pathogenesis of pulpal inflammation. However, little is known regarding the mechanism of pulpal inflammation at the site of bacterial infection. The purpose of this study was to determine the effects of the supernatants from black-pigmented Bacteroides (Porphyromonas endodontalis, Porphyromonas gingivalis, and Prevotella intermedia) on the COX-2 expression in primary human pulp cells in vitro. Investigations of the time dependence of COX-2 mRNA expression in black-pigmented Bacteroides-treated human pulp cells revealed a rapid accumulation of the transcript, a significant signal first detectable after 1 h of exposure. In addition, black-pigmented Bacteroides also up-regulated COX-2 protein expression in human pulp cells. Data from our in vitro experiment showed that black-pigmented Bacteroides were capable of stimulating COX-2 expression in human pulp cells. These results indicate that black-pigmented Bacteroides species may play an important role in the pathogenesis of pulpal inflammation. The activation of COX-2 may be one of the distinct host degradative pathways in the pathogenesis of microbial-induced pulpal/periapical inflammation.

Blotting, Western↗

Histological and scanning electron microscopy assessment of various vital pulp-therapy materials.

Pulp capping and pulpotomy procedures were performed on 15 male mongrel dogs. Three materials were used: calcium hydroxide, acid-etched dentin bonding, and mineral trioxide aggregate. Six of the animals were killed at 50 days and nine were killed at 150 days. Samples from 11 dogs were used for histological evaluation, and the remaining dog samples were used for scanning electron microscopy evaluation. Each slide was graded histologically according to previously published criteria. Scanning electron microscopy analysis was performed, and the weight percentage of elements found in the dentin of a nontreated tooth versus the bridge formed in the exposed specimen was established. By evaluating pulp inflammation in vital pulp-therapy treatments, it was found that mineral trioxide aggregate was not significantly different from the untreated control group, both in pulp-capping procedures at 50 days (p = 0.357) or 150 days (p = 0.198) and pulpotomy procedures at 50 days (p = 0.357) or 150 days (p = 0.198). Moreover, histologically mineral trioxide aggregate was a considerably better material than calcium hydroxide or acid-etched dentin bonding in maintaining the integrity of the pulp.

Aluminum Compounds↗

Mental nerve paresthesia associated with an adhesive resin restoration: a case report.

A case is reported in which mental nerve paresthesia was associated with an adhesive resin restoration placed in direct contact with the pulp of a mandibular molar. The restoration was removed, and the paresthesia had completely resolved after nonsurgical endodontic therapy. Epicutaneous patch testing response indicated a possible causal relationship between the filling material and paresthesia.

Adult↗