Abstract:Purpose: This study evaluated the inflammatory reaction caused by the implantation of iodoform and calcium hydroxide in the back of rats. These drugs may be used as intracanal dressings to eliminate residual bacteria of the root canal system. Methods: Twenty albinic rats (Rattus norvegicus, var Wistar) were divided into four groups: control group 1 (CG1) had normal skin; control group 2 (CG2) had wounded tissue without drugs; in groups 3 and 4, iodoform (IG) and calcium hydroxide (CHG) were inserted into the w… Show more
“…Iodoform being antiseptic due to iodine release in the nascent state. 30 Barium Sulphate is used as an opacifier. This formulation (Metapex) was intentionally pushed into the periapical region.…”
Periapical disease may occur through an inflammatory response in a non-vital tooth. The treatment of choice for most of these periapical lesions may be a conservative non-surgical approach. An accurate diagnosis of the periapical lesion whether it is of endodontic or nonendodontic origin has to be made. Non- surgical endodontic therapy has shown a success rate of 94.4% with complete or partial healing. The present clinical cases show two large periapical lesions in 14 year and 17-year-old male patients respectively which were healed with non- surgical approaches using different formulations of calcium hydroxide. Healing was seen after few months in both the lesion without invasive treatments. As the first case revealed periapical healing within 2 months of calcium hydroxide placement whereas the second case showed a much slower rate of healing over one year.
“…Iodoform being antiseptic due to iodine release in the nascent state. 30 Barium Sulphate is used as an opacifier. This formulation (Metapex) was intentionally pushed into the periapical region.…”
Periapical disease may occur through an inflammatory response in a non-vital tooth. The treatment of choice for most of these periapical lesions may be a conservative non-surgical approach. An accurate diagnosis of the periapical lesion whether it is of endodontic or nonendodontic origin has to be made. Non- surgical endodontic therapy has shown a success rate of 94.4% with complete or partial healing. The present clinical cases show two large periapical lesions in 14 year and 17-year-old male patients respectively which were healed with non- surgical approaches using different formulations of calcium hydroxide. Healing was seen after few months in both the lesion without invasive treatments. As the first case revealed periapical healing within 2 months of calcium hydroxide placement whereas the second case showed a much slower rate of healing over one year.
“…Formulations using calcium hydroxide associated with iodoform have demonstrated antimicrobial efficacy against microbial strains present in periapical lesions [13,15]. Based on this antimicrobial feature, previous authors proposed the use of iodoform and carbowax (a polyethylene glycol with a higher molecular mass, as inert vehicle), without calcium hydroxide, as an intracanal dressing [16,17]. This association was later commercially available on the market in early 2022, regulated by the Brazilian National Health Surveillance Agency (Register No 80013980041) [18] with the manufacturer indication of filling entire root canal and extrusion to periapical tissue [19].…”
Biocompatibility and biomineralization of root canal dressings are important requirements for periapical healing. This study evaluated the inflammatory response, biomineralization and tissue repair by collagen fiber maturation in the subcutaneous tissue of rats. Eighteen Wistar rats (n = 6) received subcutaneous implants: calcium hydroxide + propylene glycol [CH+P], calcium hydroxide + propylene glycol + iodoform [CH+P+I], iodoform + carbowax [I+Cwax] and carbowax [Cwax]. Extra empty tubes were used as a control [C]. After 7, 15 and 30 days, the implants were removed with surrounding tissue for staining of hematoxylin-eosin, Von Kossa, picrosirius red and without staining for analysis under polarized light. Results were analyzed via Kruskal–Wallis followed by Dunn testing for nonparametric data and ANOVA followed by a Tukey post hoc test for parametric data (p < 5%). At 7 days, all groups showed a moderate inflammatory reaction and thick fibrous capsule, except the [Cwax] group, with a severe inflammatory infiltrate (p < 0.05). After 15 days, all groups but control had a decrease in inflammatory response. At 30 days, all groups presented a mild reaction and thin fibrous capsule (p > 0.05). Only groups containing calcium hydroxide were found to be positive using Von Kossa staining and polarized light in all periods. At 7 days, all groups showed a higher proportion of immature fibers. At 15 days, the [CH+P] and [Cwax] groups increased their proportion of mature/immature fibers. At 30 days, only the [CH+P] group presented a significant prevalence of mature collagen fibers (p < 0.05). All groups showed biocompatibility, but only groups containing calcium hydroxide induced biomineralization. The addition of iodoform delayed tissue healing.
“…When in contact with the exposed pulp tissue the CH induces a chemical injury caused by hydroxyl ions, causing an initial superficial necrosis [43]. This necrosis causes mild irritation and stimulates the pulp to repair, forming a dentin bridge of reparative dentin as result of cell differentiation, extracellular matrix secretion and subsequent mineralization by saturation of the zone with calcium ions [42,[44][45][46].…”
The dentin-pulp complex responds to injuries and harmful stimuli that affect the tooth by depositing dentin matrix in order to protect the pulp tissue, maintaining tooth vitality. However, maintaining vitality after pulp tissue exposure is still a challenge in dentistry. In this sense, the re-emergence of vital pulp therapies gained strength, especially due to its biologically minimally invasive approach. Among them, direct pulp capping is considered a low invasive technique based on the placement of a dental material directly on the exposed pulp site, facilitating the formation of a protective barrier and the maintenance of pulp vitality. Calcium hydroxide was the most used material for this purpose in the last decades. However, the development of new biocompatible materials, such as MTA and Biodentine, has being related with higher rates of clinical and radiographic success, reinforcing the effectiveness of this treatment. Despite that, more randomized clinical trials and histomorphological analysis of the newformed hard tissue are still needed to assess the quality of this treatment in the long term.
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