The aim of this study was to investigate the effect of prolonged release of iloprost, a prostacyclin analog, on angiogenesis and dental pulp healing in a rat model of mechanical pulp exposure. The profile of iloprost release from poly (lactic-co-glycolic) acid (PLGA) microspheres was evaluated, and expression of vascular endothelial growth factor (VEGF) mRNA was determined. The molars of rats were subjected to mechanical pulp exposure and 5 different forms of treatment: Ca(OH)₂, PLGA (blank), iloprost, and iloprost/PLGA. Blood flow was determined at 0, 3, and 7 days using laser Doppler flowmetry. After 30 days, the tooth specimens were collected, and subjected to micro-CT and immunohistological analysis. The results showed that iloprost release from the microspheres was prolonged for 4 days, and that the treatment increased tooth blood flow for up to 7 days. At 30 days, an increase of mineralized tissue formation and dentin bridge formation was observed in the iloprost and iloprost/PLGA microsphere groups. VEGF expression was significantly increased in the iloprost/PLGA microsphere group relative to the other groups. In conclusion, this PLGA microsphere iloprost delivery system significantly increased dental pulp blood flow in a prolonged manner and increased tertiary dentin formation in this rat pulp injury model. Prolonged prostacyclin release could be a potentially useful approach for regeneration of dental pulp.

Minimally invasive treatment protocols may leave a residual layer of carious dentin, which requires treatment for the inhibition of bacterial growth beneath restorations. We aimed to examine the in vivo effect of silver diammine fluoride (SDF) and SDF + potassium iodide (KI) application on bacteria present in deep carious lesions. We studied the in vivo efficacy in five patients, each of which had five carious lesions. Dentin samples taken before and after treatment were subjected to microbial analyses. Following treatment with SDF, the median colony-forming unit (CFU) counts per mg of dentin reduced from 9 × 10⁵ to 1.6 × 10² (P < 0.05), and following that with SDF + KI, the counts decreased from 2.9 × 10⁵ to 9.2 × 10 (P < 0.05). The use of chlorhexidine gluconate (CHX) reduced CFU counts from 1.1 × 10⁵ to 4.8 × 10² (P < 0.05). In four of the five patients, no CFUs were found on mitis salivarius-bacitracin agar with respect to SDF or SDF + KI application. For CHX, the median CFU count before treatment was 1.6 × 10³ and that after treatment was 1.1 × 10². SDF completely inhibited mutans streptococci growth in four of the five patients, while the growth of anaerobes was not completely inhibited.

This in vitro study assessed morphological changes and efficiency of reciprocating files after multiple uses. Sixty standardized Endo Training Blocks and 10 ReciprocR25 files were selected (six blocks for each file). Each file was its own control (before use vs. after each instrumentation). The instruments were used according to the manufacturer’s instructions, and scanning electron microscopy was used to observe fatigue cracks, metal strips/metal flash, pitting, fretting, debris, disruption of the cutting edge, and plastic deformations after each instrumentation. The presence of seven wear variables was scored semiquantitatively by viewing micrographs collected before and after use. The prepared areas in resin blocks were calculated and compared by using AutoCAD software. The control group had significantly lower values for all wear variables except fretting and plastic deformation. The presence of fatigue cracks and metal strips/metal flash significantly differed between unused instruments and instruments used four or five times, in all observed sections. The area of instrumented Endo Training Blocks significantly differed in relation to the number of instrument uses. The Reciproc files wore progressively, and repeated use affected their shaping efficiency in simulated canals.

The bleaching efficacy of common bleaching agents and deionized water treated with non-thermal atmospheric pressure plasma in the pulp chamber for nonvital tooth bleaching was evaluated. A total of 120 extracted human maxillary first incisors were stained using human blood. Teeth were randomly divided into eight groups (n = 15). In the first four groups, teeth were bleached using 35% hydrogen peroxide gel, 37% carbamide peroxide gel, 2:1 (w/v) sodium perborate paste, and deionized water for 30 min. In the remaining groups, bleaching agents were treated with non-thermal atmospheric plasma for 5 min inside the pulp chamber. Overall color changes (∆E) were determined using Commission Internationale de L’Eclairage Lab Colour System. The plasma-assisted tooth bleaching has not increased tooth temperature beyond 37°C. Bleaching efficacies of bleaching agents were significantly improved when treated with non-thermal atmospheric plasma compared to their application (P < 0.05). A remarkable bleaching effect was obtained when bleaching agents were substituted with water and when treated with non-thermal atmospheric plasma. Non-thermal atmospheric plasma treatment could be a novel tool for activation of bleaching agents in the pulp chamber for nonvital tooth bleaching procedure. Moreover, water could be used as a novel bleaching agent when treated with the non-thermal atmospheric plasma to eliminate possible risks which might arise from peroxide-containing agents.

The aim of this study was to evaluate the effects of a fiberotomy-like procedure using Er:YAG laser irradiation on the velocity of orthodontic tooth movement. To produce experimental tooth movement in rats, orthodontic force was applied to the upper first molars with a nickel-titanium closed coil. The right molars were irradiated with an Er:YAG laser while the non-irradiated left molars were used as controls. The rats were sacrificed at 4 weeks after the start of tooth movement and the distance between the mesial side of the second molar and the distal side of the upper first molar was measured on CT images. The amount of tooth movement was significantly greater in the irradiation group than in the control group. The TRAP-positive nuclei count at the pressure site was higher in the laser-irradiation group than in the control group. Expression of RANKL and ALP was higher at the mesial-coronal pressure site in the laser-irradiation group than in the control group. In addition, expression of OPG was higher at the pressure site in the control group than in the laser-irradiation group. These results suggest that a fiberotomy-like procedure using an Er:YAG laser stimulates osteoclasts and osteoblasts and may promote bone metabolism in the context of experimental tooth movement.

High-magnitude mechanical strain inhibits bone nodule formation by reducing expression of bone morphogenetic protein-2 (BMP-2), Runt-related transcription factor 2 (Runx2), and muscle segment homeobox 2 (Msx2). Mechanical strain also induces production of proinflammatory factor prostaglandin E₂ (PGE₂) by osteoblasts. We measured the effect of mechanical strain-induced PGE₂ production on bone nodule formation and expression levels of bone formation-related factors. Osteoblast-like cells isolated from fetal rat calvariae were loaded with 18% cyclic tension force (TF) for 48 h in the presence or absence of NS-398, a selective inhibitor of cyclooxygenase-2. To investigate the effect of TF-induced PGE₂ on bone formation, bone nodule area on day 21 was measured by von Kossa staining. BMP-2, Runx2, and Msx2 expression levels were examined at 1 day after TF loading. Bone nodule formation was significantly inhibited by TF but was restored to control level by PGE₂ inhibition. Furthermore, TF loading-induced reductions in expressions of these factors were restored to control level by PGE₂ suppression. These results indicate that PGE₂ production induced by high-magnitude mechanical strain inhibits bone nodule formation by reducing expression levels of bone formation-related factors.

Assessment and treatment of masticatory myofascial pain syndrome (MPS) are not standardized and remain controversial. We examined whether muscle hardness was useful for evaluating masticatory MPS and analyzed the effectiveness of treatments such as stretching and massage (SM) and trigger point injection (TPI). Twenty healthy volunteers and 20 MPS patients were enrolled. MPS patients were divided into TPI and SM treatment groups. Hardness of masticatory muscle with a taut band (TB) and change in hardness were evaluated after SM and TPI treatments. Hardness values were significantly higher in muscle including a TB (TB point) than in the muscle of healthy controls. Visual analogue scale scores were significantly lower after SM and TPI treatments, and hardness of the TB point was significantly lower after SM but not after TPI. These results suggest that measurement of muscle hardness, including the TB, is useful for evaluating masticatory MPS. However, TPI analgesia might not be caused by change in muscle hardness. The mechanisms underlying the effects of SM and TPI on reducing pain in MPS may differ and thus warrant further research.

The aim of this review was to assess the effectiveness of different direct pulp-capping (DPC) materials for human pulp-exposed teeth. An electronic search was performed on 20 February 2018. Long-term clinical and radiographic evaluations of the effectiveness of different DPC materials for use on human pulp-exposed teeth were included. Risk-of-bias assessment and data extraction were performed. From the 496 identified articles, 15 met the eligibility criteria. Among the studies included in those articles, a total of 1,322 teeth were treated with 12 types of DPC materials, and 1,136 teeth were evaluated at a final follow-up examination. For mineral trioxide aggregate (MTA) and calcium hydroxide (CH), the number of included studies, the number of treated teeth, and the mean follow-up period of studies were almost equal, and the success rates of MTA was superior to CH. Therefore, MTA is likely to be a more effective and predictable material for DPC compared to CH. However, the results were based on the included studies, which were all judged to have a high risk of bias. Therefore, more long-term clinical and radiographic studies designed with lower risk of bias are needed. Moreover, the other 10 materials were only investigated by a small number of studies; therefore, further studies are required.

Transplantation of mesenchymal stem cells (MSCs) has been extensively studied in the field of regenerative medicine. Bone regeneration is achieved via the interaction of osteoblasts and osteoclasts. However, the influence of MSCs on osteoclasts is unknown. The purpose of this study was to investigate the effect of MSCs on the expression of genes for osteoclast differentiation factors using qPCR after indirect co-culture of MSCs and RAW264 cells. The numbers of osteoclasts after addition of soluble receptor activator of nuclear factor kappa B (NF-κB) ligand (sRANKL) were also compared. Expression of osteoprotegerin (OPG) by MSCs was significantly elevated in co-culture over time. The differentiation of RAW264 cells into mature osteoclasts following addition of sRANKL was significantly inhibited by co-culture with MSCs. Expression of RANK, colony stimulating factor 1 receptor, NF-κB, and nuclear factor of activated T-cell cytoplasmic 1 in RAW264 cells was significantly inhibited by co-culture with MSCs. Expression of OPG protein was higher in co-culture with RAW264 cells than in MSCs alone, and the expression level was clearly higher than that of RANKL. MSCs appeared to inhibit osteoclast differentiation via expression of OPG.

This study investigated the stability of mini-screws placed in the median palate. The study included 25 patients (7 males, 18 females; mean age, 23.4 ± 5.6 years; age range, 15.0-34.5 years) who had mini-screws placed during orthodontic treatment at Nihon University School of Dentistry Dental Hospital. Mini-screws (diameter, 2.0 mm; length, 9.0 mm) were placed in the median palatal region; the first screw was inserted mesiodistally at the distal contact of the maxillary first molar, and the second screw was placed 6-9 mm mesial to the first screw. Immediately after placement, the placement sites were carefully examined with cone-beam computed tomography and a Periotest device. Screw stability was not related to perforation of the nasal cavity, patient age, or patient sex. The success rate was significantly higher in patients with screw-suture distances of 1.5-2.7 mm than in those with distances of 0-1.4 mm. Moreover, mini-screws could be stabilized when palatal cortical bone thickness was ≥1.5 mm. The success rate was significantly higher in the group with insertion depths of ≥4.5 mm. These results indicate that primary stability of mini-screws requires sufficient cortical bone thickness, insertion depth, and screw-suture distance.