Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Regenerative endodontic procedures are an effective treatment option for immature teeth with infected necrotic pulps to allow for healing and potential continued root development, yet challenges to ideal treatment outcomes remain. Consistent development of root length and width of dentin remains a challenge, as does development of the pulp-dentin complex. Previous in vitro studies have assessed the role of different growth factors and bioactive molecules in combination with scaffolds to potentially facilitate continued development of the pulp-dentin complex using dental pulp stem cells (DPSCs). The proline-rich tyrosine kinase 2 (Pyk2) is linked with osteoblast activity and the regulation of bone mass. Further, the Pyk2 inhibitor PF-4618433 (PF-46) has been shown in previous studies to enhance osteoblast activity and mineral deposition in vitro. However, whether Pyk2 targeting promotes the osteogenic differentiation of DPSCs remains unknown. Objective: The purpose of this study was to investigate the effect of a Pyk2 inhibitor, PF-46, on the proliferation, differentiation, and mineralization of human DPSCs. Materials and Methods: Human DPSCs were cultured in 24-well plates with α-MEM with 10% FBS, and containing 0 μM (vehicle control) or 0.1 μM, 0.3 μM, or 0.6 μM PF-46. Fresh media and treatments were replaced every 2-3 days. After 1 day incubation, cytotoxic effects were evaluated by using an MTS proliferation assay. After 4 days of treatment, direct cell counting was performed. To induce osteogenic differentiation, ascorbic acid and β-glycerol phosphate were added to the culture media and the DPSCs were cultured with PF-46 for 14 days. Then, an alkaline phosphatase (ALP) assay and mineral deposition assay were performed. Differences between treatment groups were analyzed by a one-way ANOVA followed by pair-wise tests conducted using Tukey’s multiple comparisons procedure with a 5% significance level. Results: The 0.6 μM PF-46 group had a significantly higher cell count, ALP activity and mineral deposition when compared to 0 μM PF-46. The 0.1 and 0.3 μM PF-46 groups also had significantly higher ALP activity compared to the 0 μM PF-46 group after 14 days of incubation. There was a general trend of increased differentiation and mineral deposition as the concentration of PF-46 increased from 0.1 μM to 0.6 μM. Conclusion: There was a general concentration-dependent increase in cell count, differentiation, and mineral deposition by human DPSCs as the concentration of PF-46 increased from 0 μM up to 0.6 μM, with the highest activity observed with 0.6 μM PF-46. Although further research is needed, these results suggest that strategies that target Pyk2 may potentially be used to improve the osteogenic differentiation of DPSCs to aid endodontic regeneration.

Indiana University-Purdue University Indianapolis (IUPUI) / Endodontic regeneration treatment of necrotic immature teeth has gained popularity in recent years. The approach suggests a biological alternative to induce a continuous root development. In this project, three in vitro experiments were conducted to investigate the effect of three medicaments used in endodontic regeneration on mechanical properties and chemical structure of radicular dentin. In the first experiment, we investigated longitudinally the effect of medicaments on the indentation properties of the root canal surface of immature teeth using a novel BioDent reference point indenter. A significant difference in the majority of indentation parameters between all groups was found after one-week and one-month application of medicaments (p<0.0001): triple antibiotic paste (TAP) > double antibiotic paste (DAP) > control > calcium hydroxide [Ca(OH)2]. The four-week exposure of dentin to TAP and DAP caused 43% and 31% increase in total indentation distance outcome, respectively. In the second experiment, we investigated longitudinally the effect of medicaments on the chemical structure of immature radicular dentin by measuring the phosphate/amide I ratios of dentin using Attenuated Total Reflection Fourier Transform Infrared Spectroscopy. Phosphate/amide I ratios were significantly different between the four groups after one week, two weeks and four week application of medicaments (p<0.0001): Ca(OH)2-treated dentin > untreated dentin > DAP-treated dentin > TAP-treated dentin. In the third experiment, we investigated longitudinally the effect of medicaments on root fracture resistance and microhardness of radicular dentin. For the microhardness, the two-way interaction between group and time was significant (p<0.001). TAP and DAP caused a significant and continuous decrease in dentin microhardness after one and three month application, respectively. The three-month intracanal application of Ca(OH)2 significantly increased the microhardness of root dentin. The time factor had a significant effect on fracture resistance (p<0.001). All medicaments caused significant decrease in fracture resistance ranging between 19%-30% after three month application compared to one week application. The three medicaments used in endodontic regeneration caused significant change in the chemical integrity of the superficial radicular dentin and significantly affected the indentation properties of the root canal surface. Furthermore, the three month intracanal application of medicaments significantly reduced the fracture resistance of roots.

Indiana University School of Dentistry located on the campus of Indiana University-Purdue University Indianapolis (IUPUI) / This in-vitro, prospective, randomized study microscopically compared the debridement efficacy of negative pressure irrigation with the EndoVac (Discus Dental, Culver City, CA) versus the Canal CleanMax (Maximum Dental, Inc., Secaucus, NJ). Sixty extracted human canines were instrumented using a combination of hand-instrumentation with Lexicon K-type files and rotary instrumentation with ProTaper files. All canals were irrigated with 6.0-percent sodium hypochlorite and 17- percent ethylenediaminetetraacetic acid (EDTA). However, the irrigation/aspiration techniques differed among three groups of 20 randomly selected teeth. Group one (control) was irrigated with only a 12-ml Monoject syringe via 30-gauge side-vented, closed-end needle. Group two was irrigated with the EndoVac system. Group three was irrigated similar to group one, but with the adjunct of the Canal CleanMax system. All teeth were sectioned longitudinally, and the more intact sections were divided into coronal, middle, and apical thirds. Each portion of the canal was photographed with a scanning electron microscope (SEM). The photographs were scored by two independent examiners according to relative amount of debris and/or smear layer present, as well as relative number of patent dentinal tubules. These scores were statistically analyzed using a Krustal-Wallis test and Wilcoxon Rank Sum tests to determine differences between groups. The coronal aspect of root canal walls irrigated with the EndoVac system exhibited significantly less debris and/or smear layer present when compared to the coronal aspect of root canals irrigated with only a standard 12-ml Monoject syringe equipped with 30-gauge ProRinse side-vented, closed-end needle (control). There were no other significant differences in scores between any groups at any location. For all locations combined, the EndoVac system produced significantly cleaner root canal walls as compared to the control. No significant differences were seen between the Canal CleanMax and Control or Canal CleanMax and EndoVac. This study suggested negative pressure irrigation delivery with the EndoVac system during and after hand-rotary instrumentation is more effective in removal of debris and smear layer from the coronal third and combined thirds of root canal walls compared to irrigation with a standard 12-ml Monoject syringe equipped with 30-gauge ProRinse side-vented, closed-end needle.

Indiana University-Purdue University Indianapolis (IUPUI) / Endodontic regeneration (ERP) has been successfully used in the treatment of traumatized immature teeth. The procedure has three essential steps: disinfecting the root canal (i.e. triple antibiotic paste (TAP) or double antibiotic paste (DAP)), provoking bleeding inside the canal to form a scaffold upon which pulp stem cells will be deposited and continue root growth, and creating a good coronal seal. Previous research has reported that antibiotic pastes (TAP and DAP) are cytotoxic to stem cells in the concentrations commonly used in endodontic regeneration (1000 mg/mL). To decrease the adverse effects on stem cells and increase the rate of success of the regeneration, defining appropriate antibiotic concentrations for ERP is critical. In this project, five in-vitro experiments were conducted to determine the breakpoint dilutions of both TAP and DAP medicaments, and to prepare a suitable novel pastes containing diluted TAP or DAP medicaments for ERP. In the first experiment, we compared the antibacterial effect of TAP, and DAP against early biofilm formation of Enterococcus faecalis (E. faecalis) and Porphyromonas gingivalis bacteria. In the second study, we investigated the antibacterial effect of various dilutions of TAP and DAP antibiotic medicaments against established E. faecalis biofilm. In the third experiment, we investigated longitudinally the residual antibacterial activity of human radicular dentin treated with 1000, 1 or 0.5 mg/ml of TAP and DAP. In the fourth study, we investigated the cytotoxic effect of various dilutions of TAP and DAP antibiotic medicaments on the survival of human dental pulp stem cells (DPSC). And in the fifth experiment, we investigated the antibacterial and cytotoxic effect of novel intracanal medicaments consisting of methylcellulose (MC) and/or propylene glycol (PG) mixed with 1mg/ml of TAP or DAP. 1 mg/ml of DAP or TAP medicaments had a significant antibacterial effect against early bacterial biofilm formation, and established bacterial biofilm. Furthermore, 1 mg/ml had a residual antibacterial activity comparable to 1000 mg/ml. The novel intracanal medicaments had comparable antibacterial effect to currently used medicaments (1000 mg/ml). Additionally, the novel intracanal medicaments significantly enhanced DPSC metabolic activity, compared to currently used medicaments in endodontic regeneration procedures.

O controle da extrusão apical durante a reintervenção endodôntica é essencial para o sucesso do novo tratamento. Nesse contexto, o presente estudo teve como objetivo comparar a quantidade de material sólido extruído na desobturação de canais radiculares variando-se a técnica de esvaziamento e o limite de obturação. Foram utilizados 40 incisivos inferiores previamente tratados divididos em dois grupos de acordo com o limite de obturação estabelecido. Cada grupo foi subdividido em dois subgrupos levando-se em conta a técnica de desobturação empregada; manual (subgrupos A1 e B1) e mecânico-rotatória com limas de Ni-Ti (Quantec LX) (subgrupos A2 e B2). O material sólido extruído foi coletado por meio do sistema de filtração Millipore, levado à secagem em dessecador de sílica e pesado em balança analítica de precisão. Os resultados obtidos foram submetidos a ANOVA para dois fatores de variação sendo em seguida empregado o Teste de Tukey (&#945; = 5%). A técnica de desobturação mecânico-rotatória produziu menor extrusão (0,66mg) que a manual (1,11mg), havendo diferença estatística significante entre elas (p < 0,05). Os canais preenchidos até o vértice radiográfico apresentaram maior quantidade de extrusão (1,38mg) do que os obturados 1 mm aquém do forame (0,39mg), observando-se diferença estatística significante entre eles (p < 0,05). A menor quantidade extrusão foi observada no subgrupo A2 (0,20mg), em que foi empregada a técnica rotatória de desobturação em canais obturados 1mm aquém do forame apical, sendo constatada diferença estatisticamente significante deste subgrupo com os demais (p < 0,05). A extrusão de material sólido durante a desobturação de canais radiculares é influenciado pela técnica empregada e pelo limite apical de obturação. / The apical extrusion control during the endodontic retreatment is essential for the success of the new treatment. The purpose of this study was to compare the quantity of solid apically extruded material during filling removal according the gutta-percha removal technique and root filling limit. Forty mandibular incisors with a single straight canal were selected. The canals were previously endodontically treated and then divided into two groups according the filling level. Each group was subdivided in two groups considering the retreatment technique: stainless steel hand files (subgroups A1 and B1) versus niquel-titanium rotatory instruments (subgroups A2 and B2). The extruded solid material was collected by Millipore filtration system, dried in silica desiccators and weighed in an eletrobalance. The results were analyzed using ANOVA with two variation factors and Tukey Test (&#945; = 5%). The niquel-titanium rotatory instruments produced less extrusion (0,66mg) than the stainless steel hand files (1,11mg), with significant statistical difference between them (p < 0,05). The canals filled until the radiographic apex showed larger amount of extruded material (1,38mg) than those filled 1 mm beyond the foramen (0,39mg). It was observed significant statistical difference between them (p < 0,05). The smaller extruded debris amount was observed in subgroup A2 (0,20mg), in which one the rotary technique was used to remove the gutta-percha of canals filled 1mm beyond the apical foramen. It was verified significant statistical difference of this subgroup with the other ones (p < 0,05). The extrusion of solid material during the gutta-percha removal is influenced by the technique as well as the apical filling limit.

O controle da extrusão apical durante a reintervenção endodôntica é essencial para o sucesso do novo tratamento. Nesse contexto, o presente estudo teve como objetivo comparar a quantidade de material sólido extruído na desobturação de canais radiculares variando-se a técnica de esvaziamento e o limite de obturação. Foram utilizados 40 incisivos inferiores previamente tratados divididos em dois grupos de acordo com o limite de obturação estabelecido. Cada grupo foi subdividido em dois subgrupos levando-se em conta a técnica de desobturação empregada; manual (subgrupos A1 e B1) e mecânico-rotatória com limas de Ni-Ti (Quantec LX) (subgrupos A2 e B2). O material sólido extruído foi coletado por meio do sistema de filtração Millipore, levado à secagem em dessecador de sílica e pesado em balança analítica de precisão. Os resultados obtidos foram submetidos a ANOVA para dois fatores de variação sendo em seguida empregado o Teste de Tukey (&#945; = 5%). A técnica de desobturação mecânico-rotatória produziu menor extrusão (0,66mg) que a manual (1,11mg), havendo diferença estatística significante entre elas (p < 0,05). Os canais preenchidos até o vértice radiográfico apresentaram maior quantidade de extrusão (1,38mg) do que os obturados 1 mm aquém do forame (0,39mg), observando-se diferença estatística significante entre eles (p < 0,05). A menor quantidade extrusão foi observada no subgrupo A2 (0,20mg), em que foi empregada a técnica rotatória de desobturação em canais obturados 1mm aquém do forame apical, sendo constatada diferença estatisticamente significante deste subgrupo com os demais (p < 0,05). A extrusão de material sólido durante a desobturação de canais radiculares é influenciado pela técnica empregada e pelo limite apical de obturação. / The apical extrusion control during the endodontic retreatment is essential for the success of the new treatment. The purpose of this study was to compare the quantity of solid apically extruded material during filling removal according the gutta-percha removal technique and root filling limit. Forty mandibular incisors with a single straight canal were selected. The canals were previously endodontically treated and then divided into two groups according the filling level. Each group was subdivided in two groups considering the retreatment technique: stainless steel hand files (subgroups A1 and B1) versus niquel-titanium rotatory instruments (subgroups A2 and B2). The extruded solid material was collected by Millipore filtration system, dried in silica desiccators and weighed in an eletrobalance. The results were analyzed using ANOVA with two variation factors and Tukey Test (&#945; = 5%). The niquel-titanium rotatory instruments produced less extrusion (0,66mg) than the stainless steel hand files (1,11mg), with significant statistical difference between them (p < 0,05). The canals filled until the radiographic apex showed larger amount of extruded material (1,38mg) than those filled 1 mm beyond the foramen (0,39mg). It was observed significant statistical difference between them (p < 0,05). The smaller extruded debris amount was observed in subgroup A2 (0,20mg), in which one the rotary technique was used to remove the gutta-percha of canals filled 1mm beyond the apical foramen. It was verified significant statistical difference of this subgroup with the other ones (p < 0,05). The extrusion of solid material during the gutta-percha removal is influenced by the technique as well as the apical filling limit.