Periaqueductal gray inhibition of trigeminal subnucleus caudalis unitary responses evoked by dentine and nonnoxious facial stimulation

The possible pain inhibitory effects of periaqueductal gray (PAG) stimulation were investigated in cats anesthetized with Nembutal and immobilized with Flaxedil. Unitary responses evoked by electrical stimulation of the upper canine dentine and by cutaneous facial noxious and nonnoxious stimuli were recorded extracellularly from the trigeminal subnucleus caudalis. A bipolar electrode was introduced into the PAG to test the effects of PAG excitation on the trigeminal response to dentine (TRED) and cutaneous nonnoxious stimulation. In some experiments, a similar electrode was lowered into the contralateral posterior thalamus to study the antidromic activation of subnucleus caudalis cells and the effects of thalamic stimulation on the TRED. Dentine stimulation evoked brief (6- to 15-ms) bursts of 1 to 10 spikes with 3- to 25-ms latencies. Most units (88%) were also activated by cutaneous facial stimulation. Stimulation of the posterior thalamus had no effect on the TRED or on responses to cutaneous stimulation, but activated antidromically 10% of the units. In 71% of the units PAG stimulation inhibited the TRED. In some of those cases (12%), the inhibitory effect persisted 30- to 60 s. The PAG stimulation could produce paradoxical effects, potentiating the TRED evoked by threshold intensity and inhibiting the TRED elicited by suprathreshold stimulation. About one-half the PAG points evoked detectable effects. Their location had no clear topographical distribution, although ventral sites were more potent than dorsal sites. Responses evoked by nonnoxious facial stimulation were also inhibited by the PAG.     

The use of the replica technique to record fluid emerging from exposed dentine

The effect of pulpal cavity pressure on structures present on etched and unetched dentine was determined in 24 human premolars in vitro. The dentine was exposed in vivo. After extraction, the pulp was removed and the crown stored in 2.5 N sodium hydroxide for 3 days to remove the odontoblasts. The pulp cavity was filled with Ringer's solution at atmospheric pressure, +30 or -5 mmHg. After 30s-5 min a silicone-rubber impression was taken of the cavity floor and a resin cast prepared and examined in a SEM. The replicas reproduced the dentine surface accurately when there was no outward flow through dentine. With a pressure of + 30 mmHg in the pulp cavity, but not at the lower pressures, droplets were present on unetched dentine after 30s. Droplets accumulated less rapidly on etched dentine, indicating that it may act as a sponge.     

A study on the thickness of radicular dentine and cementum in anterior and premolar teeth

AIM: This study aimed to measure the thickness of radicular dentine and cementum in incisors, canines and premolars, and to develop geometric average models. METHODOLOGY: The roots of 220 extracted human teeth were sectioned in three horizontal parallel planes and measured using an optical microscope. For each cut surface buccal, lingual, mesial, and distal thickness of the root wall was measured. Mean values of the thickness at each location of each cut surface were calculated. The observed differences in thickness by tooth type, location, and section were compared by ANOVA and Student's t-test. RESULTS: Maxillary central incisors and maxillary canines had the greatest widths. In all teeth with a single root, the wall thickness were greater on the lingual side than the buccal side. Although differences between mesial and distal thicknesses were not statistically significant. CONCLUSIONS: Wall thickness varied greatly. The lingual surfaces of roots were larger. All roots had thin walls in the apical third.     

The effects of a novel Bioglass dentifrice on dentine sensitivity: a scanning electron microscopy investigation

Dentine sensitivity (DS) is a common condition which affects 8-35% of the population. Both In-Office and Over-the-Counter products have been used in treatment, usually occluding open dentine tubules on the exposed root surface. Currently there appears to be no ideal material which permanently occludes dentine tubules. Bioactive and biocompatible glasses are known to induce osteogenesis in physiological systems and may offer suitable materials for surface reactivity which could theoretically occlude tubules. A new dentifrice formulation containing a modified Bioglass material replacing part of the abrasive silica component was compared with original 45S6 bioactive glass. Dentine discs were treated with original Bioglass, three coded dentifrices containing 0, 2.5 and 7.5% Bioglass and two further selected dentifrice products. These specimens were prepared for scanning electron microscopy (SEM) and viewed in a Cambridge stereoscan 90B. The results demonstrated that original bioactive glass particles covered the dentine surface and/or occluded dentine tubules, although this original formulation was easily dislodged. Dentifrice with different ratios of added Bioglass was assessed to provide greater surface coverage and tubule occlusion than without Bioglass. It was concluded that the inclusion of bioactive glass particles in a suitably formulated vehicle may be an effective agent for the treatment of dentine sensitivity.     

The efficiency of dentine adhesives in treating non-caries cervical lesions

The aim of this study was to prove the hypothesis that dentine adhesives can be used as therapeutic material in treating dentine hypersensitivity, regardless of aetiology. The research was conducted on 492 students of Zagreb University School of Dental Medicine (154 male, 338 female), 20-25-years-old. The defects of the tooth neck were found in 38 patients, on 133 teeth (38 of male patients, 95 of female) and dentine hypersensitivity was recorded according to the subjective sensations of patients. Therapeutic characteristics of three adhesive materials were examined simultaneously: All Bond 2, fourth generation adhesive, Syntac Single Component and One Step, fifth generation adhesives. Teeth treated with dentine lacquer Cervitec were used as a control group. Tooth necks were treated with selected materials according to instructions of a manufacturer. A completed statistical survey of the results has clearly shown that dentine adhesives can be used in symptomatic therapy of dentine hypersensitivity of the non-caries cervical lesions (NCCL). The survey has also shown that dentine adhesives of the fifth generation (Syntac Single Component and One Step) have much higher efficiency rate than dentine adhesives of the fourth generation (All Bond 2) and dentine lacquer (Cervitec). According to data complied through this study the conclusion can be brought forward that dentine adhesives are not a final solution to the problem of dentine hypersensitivity, because their efficiency decreases with time.     

Lasers in endodontics: a review

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of papers on potential applications for lasers in endodontics have been published. The purpose of this paper is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilization of root canals, root canal shaping and obturation and apicectomy. The effects of laser on root canal walls and periodontal tissues are also reviewed. The essential question is whether a laser can provide equal or improved treatment over conventional care. Secondary issues include treatment duration and cost/benefit ratio. This article reviews the role of lasers in endodontics since the early 1970s, summarizes many research reports from the last decade, and surmises what the future may hold for lasers in endodontics. With the potential availability of many new laser wavelengths and modes, much interest is developing in this promising field.     

Effect of eugenol-containing sealer on marginal adaptation of dentine-bonded resin fillings

AIM: Eugenol is claimed to interfere with the polymerization of composite resins and to affect shear bond strengths of dentine-bonded composite restorations. Eugenol-based sealers are used during root canal treatment in teeth that may require build-ups or extensive restorations. Unfortunately, the adverse effect of eugenol has mostly been assessed in shear bond tests and this variable may be clinically inappropriate. The current study evaluate the effect of eugenol in a eugenol-based endodontic sealer on marginal adaptation of composite resin restorations with and without thermo-mechanical stress. METHODOLOGY: Thirty Class V cavities with half of the cavity margins in dentine and half of the cavity margins in enamel were prepared in extracted human premolars and then divided into 5 groups. Teeth in group 1 were not contaminated with eugenol. Cavities in groups 2-4 were contaminated with a eugenol-based sealer (Tubli-Seal, Kerr) and cleaned with: (i) sandblasting, (ii) bur finishing alone or (iii) bur finishing combined with swabbing with alcohol. These 4 groups were temporized for 6 weeks (Ketac, ESPE), whilst group 5 received no eugenol, was not temporized and acted as the control. Cavities were restored with Tetric Ceram using Syntac Classic (Vivadent) as a dentine-bonding agent. The specimens were then thermo-mechanically stressed. The percentages of marginal adaptation in dentinal and enamel margins were assessed in a SEM at x200 magnification before and after stress using a replica method. Mean percentages of marginal adaptation were calculated and compared using a two way-ANOVA (influence of eugenol and cleaning procedure) and non-parametric tests. RESULTS: Marginal adaptation in enamel exceeded 95% and 92% in all specimens before and after thermo-mechanical stress, respectively. Before stress, marginal adaptation in dentine ranged from 92.3 +/- 7.9% to 95.7 +/- 6.2% in groups 1-5. After stress, the percentage of marginal adaptation in dentine decreased significantly overall (P < 0.05, range 39.8 +/- 21.1% to 82.9 +/- 13.7%). The effect of contamination with eugenol was not significant (P > 0.05): in contrast, there was a significantly beneficial effect when the entire cavity was finished with burs (P < 0.01). CONCLUSIONS: Under the conditions of this study, the eugenol containing sealer did not significantly impair marginal adaptation in dentinal margins of mixed Class V restorations when bur finishing was employed before placement. However, no other cleaning method was sufficient to produce acceptable figures of marginal adaptation.     

Clinical in situ study investigating abrasive effects of two commercially available toothpastes

Summary  The aim of this study was to determine if the abrasive effect on dentine of two commercially available toothpastes, known to vary in their in vitro abrasive levels, can be differentiated in an in situ model after 10 days, assessed by contact profilometry. This was a single centre, single blind, randomized, split mouth, two treatment, in situ study, in 34 healthy subjects, evaluating the abrasive effects of two marketed desensitizing toothpastes, (Colgate^® Sensitive Multi Protection toothpaste – C; Sensodyne^® Total Protection – S). Subjects wore bi-lateral, lower buccal appliances, each fitted with four dentine sections which were power brushed three times a day with the treatment regimen. Each subject received two toothpaste treatments for 10 days during the treatment period. Samples were measured at baseline and day 10 by contact and non-contact profilometry and day 5 by contact profilometry. Thirty-four subjects were included in the efficacy analysis. Results from contact profilometry showed statistically significant ( P  < 0·0001) dentine loss compared to baseline at day 5 and 10 for both pastes. At each time point, C showed statistically significantly greater dentine loss than S, P  < 0·0001. After 10 days treatment, the difference in dentine loss between the pastes was 1·4 μm. The non-contact profilometry data showed similar trends. After 10 days of treatment, C showed statistically significantly greater dentine loss than S, with treatment difference of 0·9 μm, P  = 0·0057. The methodology used has successfully differentiated between the abrasivity of the two pastes in respect of dentine surface loss over time in an in situ environment.     

Apexification: the beginning of its end

Apexification is a procedure for treating and preserving immature permanent teeth that have lost pulp vitality. It contrasts apexogenesis in terms of its outcome in that apical maturation and normal root thickness cannot be obtained. Apexification has been a routine practice for such teeth for many decades, and despite a literature replete with discussion, including recent artificial barrier methods with mineral trioxide aggregate, ultimately there has been no major breakthrough to improve this treatment. Recently, two new clinical concepts have emerged. One involves a revitalization approach to achieve tissue generation and regeneration. In this method, new living tissue is expected to form in the cleaned canal space, allowing continued root development in terms of both length and thickness. The other is the active pursuit of pulp/dentine regeneration via tissue engineering technology to implant or re-grow pulps. Although the technology is still at its infancy, it has the potential to benefit immature pulpless teeth by allowing continued growth and maturation. With this understanding, it may be predicted that apexification will become less needed in years to come. This study will overview the recent concept of pulp revitalization in the treatment of immature teeth with nonvital pulps and the emerging research on pulp tissue engineering and regeneration.