Publications by authors named "Juan J Segura-Egea"

32 Publications

Use of contemporary technologies and new materials in undergraduate Endodontics teaching.

J Clin Exp Dent 2021 Apr 1;13(4):e383-e388. Epub 2021 Apr 1.

DDS, MSc, Doctoral fellow, Department of Stomatology, Section of Endodontics, School of Dentistry, University of Sevilla, C/ Avicena s/n, 41009-Sevilla, Spain.

Background: This study aims to analyze the use of contemporary technologies and materials in undergraduate endodontic teaching in Spain.

Material And Methods: The survey was sent to the undergraduate endodontic programme leads in the 23 Spanish dental schools. The survey asked about the use of magnification, ultrasonic devices, electronic apex locator, rotary instruments, root-filling techniques, and bioceramic cements in the teaching of endodontics.

Results: The response rate was 91%, and the final number of schools included in the study was twenty. Only two schools (10%) used magnification (loupes or operative microscope). Five schools (25%) used ultrasonic devices to prepare the access cavity, and four (20%) to activate the irrigation solution. In 14 dental schools (70%) no type of ultrasonic instrument was used. Electronic apex locators in working length determination was used in 19 schools (95%). All schools used rotary instrumentation in the teaching of endodontics, and 45% of schools used reciprocating instruments. Five schools (25%) used warm vertical compaction technique, four (20%) single cone gutta-percha technique, and four (20%) thermoplastic injection techniques. No school used carrier-based gutta-percha. Bioceramic cements were used in 19 of the schools (95%).

Conclusions: Spanish dental schools have incorporated some of the new endodontic technologies and materials, including the electronic apex locator, rotary instruments, and the new bioceramic cements; however, the modern root filling techniques, magnification, and ultrasonic instruments are not yet used in most dental schools. Bioceramic materials, dental schools, endodontic curriculum, magnification, online survey, rotary instrumentation, ultrasonic devices.
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http://dx.doi.org/10.4317/jced.57795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020320PMC
April 2021

Apical periodontitis and glycemic control in type 2 diabetic patients: Cross-sectional study.

J Clin Exp Dent 2020 Oct 1;12(10):e964-e971. Epub 2020 Oct 1.

MD, DDS, PhD, Associate Professor, Department of Odontostomatology, Faculty of Medicine and Health Sciences, University of Barcelona- Dental Hospital, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.

Background: The objective of this study was to analyze the possible relationship between the glycemic control and the prevalence of apical periodontitis in type 2 diabetic patients. The null hypothesis was that apical periodontitis is not associated with glycemic control.

Material And Methods: In a cross-sectional design, the radiographic records of 216 type 2 diabetic patients (65.0 ± 10.7 years), 117 men (54.2%) and women (45.8%), were examined. Glycated hemoglobin (HbA1c) was used to assess glycemic control, considering an HbA1c level < 6.5% as well-controlled diabetes. Apical periodontitis was diagnosed as radiolucent periapical lesions using the periapical index score. The Student t test, chi-square test, and logistic regression analysis were used in the statistical analysis.

Results: The average HbA1c value was 7.0 ± 2.2%. Forty seven (21.8%) had HbA1c levels under 6.5% (mean ± SD = 6.0 ± 2.2%), being considered well-controlled patients, and 169 (78.2%) had an HbA1c level ≥ 6.5% (mean ± SD = 7.8 ± 2.24%), being considered poor controlled patients. Forty four per cent of diabetics had apical periodontitis, 12.5% had root-filled teeth, and 52.3% had root filled teeth with radiolucent periapical lesions. No significant differences were observed in any of these three variables between patients with good or poor glycemic control. In the multivariate logistic regression analysis the presence of radiolucent periapical lesions in at least one tooth did not correlate significantly with HbA1c levels (OR = 1.4; 95% C.I. = 0.70 - 3.09; = 0.31).

Conclusions: The results reveal no association of glycemic control with the prevalence of apical periodontitis or root canal treatment in diabetic patients. Apical periodontitis, diabetes mellitus, endodontic medicine, glycated haemoglobin.
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http://dx.doi.org/10.4317/jced.57191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600214PMC
October 2020

Smoking and Radiolucent Periapical Lesions in Root Filled Teeth: Systematic Review and Meta-Analysis.

J Clin Med 2020 Oct 29;9(11). Epub 2020 Oct 29.

Department of Stomatology, Section of Comprehensive Dentistry, School of Dentistry, University of Sevilla, 41009 Sevilla, Spain.

Aim: This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT).

Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was: in adult patients who have RFT, does the absence or presence of a smoking habit affect the prevalence of RPLs associated with RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, Scopus, and PRISMA protocol were used to evaluate and present the results. Studies comparing smokers with control non-smoker subjects, including RFT, and providing data on the prevalence of RFT with RPLs, were included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279.

Results: Four studies reported data on inclusion criteria, representing data from 9257 root-filled teeth-4465 from non-smokers and 4792 from smoker patients. The meta-analysis provided an odds ratio indicating a significant association between smoking and higher prevalence of root filled teeth with radiolucent periapical lesions (OR = 1.16; 95% CI = 1.07-1.26; = 0.0004). The certainty of the literature assessment was moderate per GRADE. The ROBINS-I tool classified three studies as low risk of bias, and the fourth as moderate risk of bias.

Conclusions: Moderate, quality scientific evidence indicates a weak but significant relationship between smoking and the prevalence of RPLs in RFT. Smoking can be considered a negative prognostic factor for the outcome of root canal treatment. Endodontic providers should be aware of the relationship between smoking and persistent apical periodontitis, assessed as RPLs, in RFT.
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http://dx.doi.org/10.3390/jcm9113506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692336PMC
October 2020

Cigarette Smoking and Root Filled Teeth Extraction: Systematic Review and Meta-Analysis.

J Clin Med 2020 Sep 30;9(10). Epub 2020 Sep 30.

Department of Stomatology, Section of Endodontics, School of Dentistry, University of Sevilla, 41009 Sevilla, Spain.

Aim: The aim of this systematic review and meta-analysis was to investigate the possible association between smoking habits and the occurrence of root-filled teeth (RFT) extraction.

Material And Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was in adult patients who had RFT, does the absence or presence of smoking habits affect the prevalence of extracted RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, and PRISMA protocol was used to evaluate and present the results. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279.

Results: After search strategy, 571 articles were recovered, seven were selected for full-text analysis, and two reported data on inclusion criteria, including 516 RFT, 351 in non-smokers, and 165 in smoker subjects. The meta-analysis provided an odds ratio indicating significant association between smoking and the prevalence of extracted RFT (OR = 3.43, 95% CI = 1.17-10.05, = 0.02, I² = 64%). The certainty of the literature assessment was low per GRADE. Both studies were considered as moderate risk of bias.

Conclusions: Tobacco smoking should be considered a negative prognostic factor for the outcome of root canal treatment, although the quality of the evidence is low. RFT of smoking patients are three times more likely to be extracted. Continuing to smoke after endodontic treatment may increase the risk of treatment failure. However, the overall strength of evidence is low. This must be considered a limitation of the present study and the conclusion should be valued with caution.
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http://dx.doi.org/10.3390/jcm9103179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601225PMC
September 2020

Long-Term Clinical Outcomes of Treatment with Dental Implants with Acid Etched Surface.

Materials (Basel) 2020 Mar 27;13(7). Epub 2020 Mar 27.

Faculty of Dentistry, Medical-Surgical Area of Dentistry Hospital, University of Barcelona, Gran Via de les Corts Catalanes, 585, 08007 Barcelona, Spain.

Implant dentistry constitutes a therapeutic modality in the prosthodontic treatment of partially and totally edentulous patients. This study reports a long-term evaluation of treatment by the early loading of acid-etched surface implants. Forty-eight partially and totally edentulous patients were treated with 169 TSA Defcon® acid-etched surface implants for prosthodontic rehabilitation. Implants were loaded after a healing free-loading period of 6-8 weeks in mandible and maxilla, respectively. Implant and prosthodontic clinical findings were followed during at least 17 years. Clinical results indicate a survival and success rate of implants of 92.9%, demonstrating that acid-etched surface achieves and maintains successful osseointegration. Five implants in three patients were lost during the healing period. Sixty-five prostheses were placed in 45 patients over the remaining 164 implants, 30 single crowns, 21 partially fixed bridges, 9 overdentures, and 5 full-arch fixed rehabilitations. A total of 12 implants were lost during the follow-up period. Mean marginal bone loss was 1.91 ± 1.24 mm, ranging from 1.1 to 3.6 mm. The most frequent complication was prosthetic technical complications (14.2%), followed by peri-implantitis (10.6%). The mean follow-up was of 214.4 months (208-228 months). Prosthodontic rehabilitation with an early-loading protocol over acid-etched surface implants is a successful implant treatment.
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http://dx.doi.org/10.3390/ma13071553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177283PMC
March 2020

High Prevalence of Apical Periodontitis in Patients With Inflammatory Bowel Disease: An Age- and Gender- matched Case-control Study.

Inflamm Bowel Dis 2020 01;26(2):273-279

Department of Stomatology, School of Dentistry, University of Sevilla, Calle Avicena s/n, Sevilla, Spain.

Background: Deep carious lesions cause pulpitis, pulpal necrosis and, finally, apical periodontitis (AP). Root canal treatment (RCT) is the treatment of choice for AP, changing the tooth into a root-filled tooth (RFT). Several studies have linked AP and RFT to systemic diseases. Likewise, previous studies have also found an association among inflammatory bowel disease (IBD) and periodontal disease. This study aims to analyze the frequency of AP and RCT in IBD patients and healthy control subjects.

Methods: An age- and gender-matched case-control study design was used. The study group (SG) included 54 IBD patients (28 with Crohn´s disease, 26 with ulcerative colitis). Another 54 healthy subjects without IBD and age- and gender-matched were included in the control group (CG). The radiographic records were analyzed, and periapical radiolucencies were diagnosed as AP, using the periapical index (PAI). The statistical analysis was carried out using the Student t test, χ 2 test, and multivariate logistic regression.

Results: The presence of 1 or more teeth with radiolucent periapical lesions (RPLs) was found in 19 patients (35.2%) in the study group and in 9 subjects (16.7%) in the control group (P = 0.03). No differences were found among the 2 groups neither in the amount of teeth with AP nor in the number of RFTs (P > 0.05). However, multivariate logistic regression analysis adjusting for number of teeth and number of RFTs showed that patients with IBD have RPLs with higher likelihood than control patients (odds ratio, 5.7; confidence interval 95%, 1.7-19.1; P = 0.0048).

Conclusions: Subjects with inflammatory bowel disease have higher prevalence of apical periodontitis. An oral health protocol should be established to address the higher prevalence of inflammatory oral processes.
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http://dx.doi.org/10.1093/ibd/izz128DOI Listing
January 2020

MTA HP Repair stimulates in vitro an homogeneous calcium phosphate phase coating deposition.

J Clin Exp Dent 2019 Apr 1;11(4):e322-e326. Epub 2019 Apr 1.

Materials Science Institute of Sevilla (ICMS), Joint CSIC-University of Sevilla Center, Sevilla, Spain.

Background: To study the mineralization capacity of the bioceramic endodontic material MTA HP Repair.

Material And Methods: Bioactivity evaluation was carried out, by soaking processed cement disk in simulated body fluid (SBF) during 168 h. The cement surface was studied by Fourier transform infrared spectroscopy (FT-IR), field emission gun scanning electron microscopy (FEG-SEM) and energy dispersive X-ray analysis (EDX). Release to the SBF media of ionic degradation products was monitored using inductively coupled plasma atomic emission spectroscopy (ICP-AES).

Results: FT-IR showed increasing formation of phosphate phase bands at 1097, 960, 607 and 570 cm-1 with prolonged SBF soaking. FEG-SEM analysis reveals that HP produces a effectively surface covering consisting in homogeneous spherical phosphate phase aggregates with an average diameter of 0.5-1.0 µm. EDX analysis comparing un-treated (hydrated), 24 h and 72 h SBF treated surfaces of MTA HP Repair revealed phosphate deposition after 24 h, with high phosphorous/silicon element ratio signal measured after 24 h, indicating a very high phosphate phase deposition for this material.

Conclusions: The study shows that MTA HP Repair produces a quick and effective bioactive response in terms of crystalline calcium phosphate surface coating formation. The high bioactive response of MTA HP Repair makes it an interesting candidate for endodontic use as repair cement. Bioactive endodontic cements, bioactive response, MTA HP Repair.
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http://dx.doi.org/10.4317/jced.55661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522111PMC
April 2019

Correction: Criteria and treatment decisions in the management of deep caries lesions: Is there endodontic overtreatment?

J Clin Exp Dent 2019 Jan 1;11(1):e103. Epub 2019 Jan 1.

MD, DDS, PhD, Department of Stomatology - Endodontic Section, School of Dentistry, University of Sevilla, C/ Avicena S/N, 41009 Sevilla, Spain.

[This corrects the article on p. 751 in vol. 10, PMID: 30305872.].
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http://dx.doi.org/10.4317/jced.532742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343993PMC
January 2019

Dentist´s knowledge, attitudes and determining factors of the conservative approach in teeth with reversible pulpitis and deep caries lesions.

J Clin Exp Dent 2018 Dec 1;10(12):e1205-e1215. Epub 2018 Dec 1.

Endodontics Section, Department of Stomatology, (Conservative Dentistry Section), University of Sevilla, Spain.

Background: The aim of this study was to investigate dentists` knowledge, attitudes and factors regarding the conservative approach in the management of deep caries lesions (DCLs) in teeth with reversible pulpitis.

Material And Methods: 187 dentists were contacted directly or by mail, and 125 (67%) were finally included in the study. Dentists were requested to answer an open/discursive questionnaire about the routine approach to the diagnosis and treatment of DCLs, including knowledge-related attitudinal items.

Results: Total caries excavation was the preferred treatment option for more than 80% of dentists in case of DCL with reversible pulpitis. Only a small percentage (8%) chose partial caries removal, leaving some carious dentin close to the pulp to avoid pulp exposure. More than a half (51%) of respondents considered that cariogenic microorganisms must be removed or caries would progress. Dentists teaching at the University strongly disagreed with this statement (OR = 4.6; 95% C.I. = 1.3 - 15.8; = 0.017). Good clinical result was the most chosen reason (83%) to choose a specific treatment. Patient's oral health (84%) and patient's age (70%) were the two patient-related factors most taken into account for the choice of treatment.

Conclusions: Total caries excavation is still the most frequently chosen treatment in teeth with DCL and reversible pulpitis. The joint assessment of the answers given by respondents allows to conclude that the new knowledge and concepts about caries lesions and the more conservative approach to DCLs have not still been incorporated by dentists into their usual clinical practice. Caries, deep caries lesions, dental pulp capping, dental pulp health, dentists, endodontic therapy, reversible pulpitis, treatment decisions.
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http://dx.doi.org/10.4317/jced.55395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343973PMC
December 2018

Criteria and treatment decisions in the management of deep caries lesions: Is there endodontic overtreatment?

J Clin Exp Dent 2018 Aug 1;10(8):e751-e760. Epub 2018 Aug 1.

MD, DDS, PhD, Department of Stomatology - Endodontic Section, School of Dentistry, University of Sevilla, C/ Avicena S/N, 41009 Sevilla, Spain.

Background: The aim of this study was to investigate the diagnostic criteria and treatment decisions in the management of deep caries lesions (DCLs). The null hypothesis tested was that DCLs are managed according to the current scientific evidence.

Material And Methods: A total of 288 dentists were contacted directly or by mail, and 125 (43%) were included in the study. Dentists were requested to answer a questionnaire about the routine approach to the diagnosis and treatment of DCLs. Logistic regression analyses were carried out to calculate odds ratios (OR).

Results: Pulp sensitivity tests were used by 65% of dentists when assessing pulpal health in cases of DCLs, particularly those who had followed courses in cariology (OR = 3.8; = 0.005). Dentine hardness was the most frequent criterion used during DCLs excavation (98%). Two thirds of the respondents (65%) removed carious tissue until they felt hard dentine, and feeling hard dentine correlated with caries removal even at the risk of pulpal exposure (OR = 15.8; = 0.0000). Acute transient pain or sensitivity to cold or heat (reversible pulpitis) were considered by 58% of respondents as a reason to provide endodontic therapy.

Conclusions: The null hypothesis tested is rejected. The evidence-based more conservative approach on the management of DCLs is not being translated to clinical dentistry. Root canal treatment is being indicated in cases of DCLs in which the diagnosis is reversible pulpitis. Likewise, it can be concluded that non-conservative management of DCLs, with endodontic overtreatment, could be occurring. Deep caries lesions, dental pulp capping, dental pulp health, dentists, endodontic therapy, pulpal diagnosis, reversible pulpitis, treatment decisions.
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http://dx.doi.org/10.4317/jced.55050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174009PMC
August 2018

Use of antibiotics by spanish dentists receiving postgraduate training in endodontics.

J Clin Exp Dent 2018 Jul 1;10(7):e687-e695. Epub 2018 Jul 1.

Department of Endodontics, School of Dentistry, University of Sevilla, Spain.

Background: The incidence of endodontic infections is high. The contribution of Endodontics to the global problem of antibiotic resistance could be significant. The ESE, together with the World Health Organization, are promoting the World Antibiotic Awareness Week (13-19 November 2017) to promote the appropriate use of systemic antibiotics in Endodontics. The objective of this study was to determine the prescription pattern of antibiotics in the treatment of endodontic infections of Spanish dentists attending specialization programs in Endodontics.

Material And Methods: Dentists from five Spanish endodontic postgraduate programs were requested to answer a one-page questionnaire surveying about antibiotics indications. Seventy-three dentists were required to participate in this investigation, and 67 (91.2%) fulfilled satisfactorily the survey and were included in the study. Data were analyzed using descriptive statistics and chi square test.

Results: The average duration of antibiotic therapy was 6.8±1.2 days. All respondents chose amoxicillin as first choice antibiotic in patients with no medical allergies, alone (40%) or associated to clavulanic acid (60%). The first drug of choice for penicillin allergic patients was clindamycin (72%). For cases of irreversible pulpitis, 22% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, symptomatic apical periodontitis and no swelling, 37% prescribed antibiotics. A quarter of dentists prescribed antibiotics for necrotic pulps with asymptomatic apical periodontitis and a sinus tract.

Conclusions: The results of this study show that postgraduate training in Endodontics provides greater awareness of the correct indications of antibiotics. Dentists who have received specialized training in Endodontics have a prescription pattern of antibiotics more adjusted to the guidelines recommended by international organizations and by scientific societies. Antibiotics, apical periodontitis, dental curriculum, endodontic infections, postgraduate endodontic training.
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http://dx.doi.org/10.4317/jced.54894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057074PMC
July 2018

Association between diabetes and the prevalence of radiolucent periapical lesions in root-filled teeth: systematic review and meta-analysis.

Clin Oral Investig 2016 Jul 8;20(6):1133-41. Epub 2016 Apr 8.

Oral Medicine, Department of Odontostomatology, School of Dentistry, University of Barcelona, Barcelona, Spain.

Introduction: The question of whether diabetes mellitus can influence the outcome of root canal treatment (RCT) remains unclear. The aim of this systematic review and meta-analysis was to analyze scientific available evidence on the association between diabetes and the presence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT).

Methods: The review question was as follows: in adult patients who had endodontically treated teeth, does the absence or presence of diabetes result in an increase in the prevalence of RPL associated to RFT? A systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, and Scopus search was conducted using the following MeSH and keywords: Diabetes Mellitus OR Diabetes OR Diabetic OR Hyperglycemia, AND Endodontics, Periapical Periodontitis, Periapical Diseases, Apical Periodontitis, Periradicular Lesion, Periapical Radiolucency, Radiolucent Periapical Lesion, Root Canal Treatment, Root Canal Preparation, Root Canal Therapy, Root Filled Teeth, Endodontically Treated Teeth. Seven studies reporting data on the prevalence of RPL associated to RFT both in diabetic and control subjects were included.

Results: After the study selection, seven epidemiological studies fulfilled the inclusion criteria, representing data from 1593 root canal treatments, 1011 in non-diabetic control subjects, and 582 in diabetic patients. The calculated pooled odds ratio (OR = 1.42; 95 % CL = 1.11-1.80; p = 0.0058) indicates that diabetic patients have higher prevalence of RFT with RPLs than controls.

Conclusion: Available scientific evidence indicates that diabetes is significantly associated to higher prevalence of periapical radiolucencies in endodontically treated teeth, being an important putative pre-operative prognostic factor in RCT.

Clinical Relevance: Taking into account that diabetes is the third most prevalent chronic medical condition among dental patients, endodontic providers should be aware of the relationship between the outcome of endodontic treatment and diabetes.
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http://dx.doi.org/10.1007/s00784-016-1805-4DOI Listing
July 2016

Expression and immunohistochemical localization of leptin in human periapical granulomas.

Med Oral Patol Oral Cir Bucal 2015 May 1;20(3):e334-9. Epub 2015 May 1.

Facultad de Odontología, Univ. de Sevilla, C/ Avicena s/n, 41009, Sevilla, Spain,

Background: Leptin, initially described as an adipocyte-derived hormone to regulate weight control, is expressed in normal and inflamed human dental pulp, being up-regulated during pulp experimental inflammation. Leptin receptor (LER) has been identified in human periapical granulomas. The aim of this study was to analyze and characterize the expression of leptin in human periapical granulomas.

Material And Methods: Fifteen periapical inflammatory lesions were obtained from extracted human teeth and teeth which underwent periapical surgery. After their morphological categorization as periapical granulomas and gradation of the inflammatory infiltrate, they were examined by immunohistochemistry using human leptin policlonal antibodies. Leptin mRNA expression was also determined by quantitative real-time PCR (qRT-PCR) and the amount of leptin protein was analyzed by immunoblot.

Results: All periapical lesions exhibited the characteristic of chronic granulomatous inflammatory process with inflammatory infiltrate grade III. Leptin+ cells were detected in 13 periapical granulomas (86.6%). The median number of Leptin+ cells in periapical granulomas was 1.70 (0.00-7.4). Amongst the inflammatory cells in the periapical granulomas, only macrophages were reactive to leptin antibodies. Western blot analysis revealed the presence in all samples of a protein with apparent molecular weight of approximately 16 kDa, corresponding to the estimated molecular weights of leptin. The expression of leptin mRNA was confirmed by qRT-PCR analysis and the size of the amplified fragment (296 bp for leptin and 194 bp for cyclophilin) was assessed by agarose gel electrophoresis.

Conclusions: For the first time, it has been demonstrated that human periapical granuloma expresses the adipokine leptin.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464921PMC
http://dx.doi.org/10.4317/medoral.20385DOI Listing
May 2015

Pregabalin in the treatment of inferior alveolar nerve paraesthesia following overfilling of endodontic sealer.

J Clin Exp Dent 2014 Apr 1;6(2):e197-202. Epub 2014 Apr 1.

Full Professor. Department of Endodontics, School of Dentistry, University of Sevilla, C/ Avicena s/n, 41009-Sevilla, Spain.

A case of orofacial pain and inferior alveolar nerve (IAN) paraesthesia after extrusion of endodontic sealer within the mandibular canal treated with prednisone and pregabalin is described. A 36-year-old woman underwent root canal treatment of the mandibular second right premolar tooth. Post-operative panoramic radiograph revealed the presence of radiopaque canal sealer in the mandibular canal. Damage to IAN consecutive to extrusion of endodontic sealer was diagnosed. Non-surgical management was decided, including: 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. Six weeks after the incident the signs and symptoms were gone. The complete resolution of paraesthesia and the control of pain achieved suggest that a non-surgical approach, combining prednisone and the GABA analogue pregabalin, is a good option in the management of the IAN damage subsequent to endodontic sealer extrusion. Key words:Endodontics, inferior alveolar nerve, neuropathic pain, orofacial pain, paraesthesia, pregabalin.
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http://dx.doi.org/10.4317/jced.51420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4002354PMC
April 2014

Endodontic treatment failure consecutive to unsystematic radiographic examination.

Oral Health Dent Manag 2013 Dec;12(4):300-4

Department of Stomatology (Endodontics), School of Dentistry, University of Sevilla, C/Avicena S/N, 41009 Sevilla, Spain, Tel: +34 954481146; Fax: +34 954481111; e-mail:

This case report describes the endodontic therapy on a three-rooted mandibular first molar. The initial endodontic treatment was carried out after misreading preoperative periapical radiograph. Moreover, the working length was determined only with the apex locator. So, the additional disto-lingual root left unidentified and remained untreated, failing the treatment. A thorough radiographic examination in the initial therapy would have allowed the identification of the supernumerary root and its canal. Although the apex locators determine accurately the working length, it does not inform about the root canal morphology. It can be concluded and remarked that a systematic radiographic examination, including preoperative radiographs, is essential for success in endodontic therapy.
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December 2013

Leptin receptor is up-regulated in inflamed human dental pulp.

J Endod 2013 Dec 10;39(12):1567-71. Epub 2013 Oct 10.

Department of Stomatology (Endodontics section), School of Dentistry, University of Sevilla, Sevilla, Spain.

Introduction: After leptin receptor (LEPR) identification in hematopoietic, immune system, and other tissues, a role for leptin regulating inflammation and immune response has been accepted. This study aims to describe the possible expression of LEPR in healthy human dental pulp and to compare it with LEPR expression in inflamed human dental pulp.

Methods: Twenty-one pulp samples were obtained from freshly extracted caries-free and restoration-free human third molars. In 7 third molars (inflamed pulp group), inflammation was experimentally induced before extraction. Pulp samples were processed, and LEPR expression was determined by quantitative real-time polymerase chain reaction, and the amount of LEPR protein was analyzed by immunoblot.

Results: All healthy and inflamed dental pulp samples expressed LEPR. Western blot analysis of human dental pulp revealed the presence of a protein with an apparent molecular weight of approximately 120 kDa, which corresponds to the estimated molecular weight of LEPR. The expression of LEPR mRNA was confirmed by quantitative real-time polymerase chain reaction analysis, and the size of the amplified fragment (338 base pairs for LEPR and 194 base pairs for cyclophilin) was assessed by agarose gel electrophoresis. The relative amount of LEPR in inflamed pulps was approximately 50% higher than in healthy pulps (P < .05).

Conclusions: The presence of LEPR in human dental pulp tissues has been demonstrated for the first time. The up-regulation of LEPR expression in inflamed pulp samples suggests that leptin can play a role in inflammatory and local immune responses in human dental pulp.
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http://dx.doi.org/10.1016/j.joen.2013.08.014DOI Listing
December 2013

Prevalence of apical periodontitis and frequency of root canal treatments in liver transplant candidates.

Med Oral Patol Oral Cir Bucal 2013 Sep 1;18(5):e773-9. Epub 2013 Sep 1.

University of Sevilla, C/ Avicena s/n, 41009-Sevilla, Spain,

Aim: The purpose of this study was to investigate the prevalence of apical periodontitis (AP) and endodontic treatment in liver transplant candidates and control healthy subjects.

Material And Methods: A descriptive cross-sectional study. Forty two liver transplant candidates (LTC) (study group) and 42 control subjects. Digital panoramic radiographs where used. Periapical status was scored according to the periapical index (PAI). Results were analysed statistically using the Chi-squared test and logistic regression.

Results: Radiographic signs of AP in one or more teeth was found in 79% of patients in the study group and in 50% of control subjects (p = 0.008; OR = 3.7; C. I. 95% = 1.4 - 9.5). One or more root-filled teeth (RFT) were found in 19% and 62% of study and control subjects, respectively (p = 0.0001; OR = 0.14; 95% C. I. = 0.05 - 0.38). Among LTC patients 14.7% of the teeth had AP, whereas in the control subjects 4.2% of teeth were affected (p= 0.0002). The percentage of RFT in the study and control groups was 1.5% and 6.8%, respectively (p = 0.0002).

Conclusions: Liver transplant candidates have significantly higher prevalence of radiographic periapical lesions and lower frequency of RFT than controls healthy subjects.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790651PMC
http://dx.doi.org/10.4317/medoral.19148DOI Listing
September 2013

Reply to Drs Celeste and Gomes.

J Endod 2013 Feb;39(2):157-8

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http://dx.doi.org/10.1016/j.joen.2012.12.001DOI Listing
February 2013

Postoperative pain after one-visit root-canal treatment on teeth with vital pulps: comparison of three different obturation techniques.

Med Oral Patol Oral Cir Bucal 2012 Jul 1;17(4):e721-7. Epub 2012 Jul 1.

Department of Endodontics, School of Dentistry, University of Zaragoza, Huesca, Spain.

Objectives: To investigate and compare postoperative pain after one-visit root canal treatment (RCT) on teeth with vital pulps using three different obturation techniques.

Study Design: Two hundred and four patients (105 men and 99 women) aged 12 to 77 years were randomly assigned into three treatments groups: cold lateral compaction of gutta-percha (LC), Thermafil technique (TT), and Backfill - Thermafil obturation technique (BT). Postoperative pain was recorded on a visual analogue scale (VAS) of 0 - 10 after 2 and 6 hours, and 1, 2, 3, 4, 5, 6 and 7 days. Data were statistically analyzed using multivariate logistic regression analysis.

Results: In the total sample, 87% of patients experienced discomfort or pain in some moment between RCT and the seventh day. The discomfort experienced was weak, light, moderate and intense in 6%, 44%, 20% and 6% of the cases, respectively. Mean pain levels were 0.4 ± 0.4, 0.4 ± 0.3, and 1.4 ± 0.7 in LC, BT, and TT groups, respectively. Patients of TT group experienced a significantly higher mean pain level compared to other two groups (p < 0.0001). In TT group, all patients felt some level of pain at six hours after RCT.

Conclusions: Postoperative pain was significantly associated with the obturation technique used during root canal treatment. Patients whose teeth were filled with Thermafil obturators (TT technique) showed significantly higher levels of discomfort than patients whose teeth were filled using any of the other two techniques.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476040PMC
http://dx.doi.org/10.4317/medoral.17898DOI Listing
July 2012

Clinical measurement of tooth wear: Tooth wear indices.

J Clin Exp Dent 2012 Feb 1;4(1):e48-53. Epub 2012 Feb 1.

Professor, Department of Endodontics, School of Dentistry, University of Sevilla.

Attrition, erosion, and abrasion result in alterations to the tooth and manifest as tooth wear. Each classification corresponds to a different process with specific clinical features. Classifications made so far have no accurate prevalence data because the indexes do not necessarily measure a specific etiology, or because the study populations can be diverse in age and characteristics. Tooth wears (attrition, erosion and abrasion) is perceived internationally as a growing problem. However, the interpretation and comparison of clinical and epidemiological studies, it is increasingly difficult because of differences in terminology and the large number of indicators/indices that have been developed for the diagnosis, classification and monitoring of the loss of dental hard tissue. These indices have been designed to identify increasing severity and are usually numerical, none have universal acceptance, complicating the evaluation of the true increase in prevalence reported. This article considers the ideal requirements for an erosion index. A literature review is conducted with the aim of analyzing the evolution of the indices used today and discuss whether they meet the clinical needs and research in dentistry. Key words:Tooth wear, tooth wear indices, attrition, erosion, abrasion, abfraction.
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http://dx.doi.org/10.4317/jced.50592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908810PMC
February 2012

Frequency and distribution of root-filled teeth and apical periodontitis in an adult population of Barcelona, Spain.

Int Dent J 2012 Feb;62(1):40-6

Department of Stomatology, University of Barcelona, Barcelona, Spain.

Aim:  To determine the prevalence of apical periodontitis (AP) and the frequency of root canal treatment in a sample of Spanish adults.

Design:  A descriptive cross-sectional study.

Setting:  Barcelona, Spain.

Participants:  A total of 397 adult subjects, 49% males and 51% females.

Methods:  Digital panoramic radiographs were used. Periapical status was scored according to the periapical index. Results were analysed statistically using the chi-squared test and logistic regression.

Results:  Radiographic signs of AP in one or more teeth were found in 135 patients (34%). The prevalence of AP was significantly higher in males (42.3%) than females (26.1%) [odds ratio (OR)=2.1; 95% confidence interval (95% CI)= 1.4-3.2; P= 0.0007]. At least one root-filled tooth (RFT) was found in 233 patients (59%). Twenty-six per cent of subjects with RFT had at least one RFT with AP. The prevalence of AP increased with age (P < 0.05). Patients with RFT showed a higher prevalence of AP (42%) relative to patients without RFT (23%) (OR = 2.4; 95% CI = 1.5-3.7; P = 0.00013). Adjusting for age, gender and teeth number, endodontic status remained significantly associated with periapical status (OR = 2.3; 95% CI = 1.4-3.6; P = 0.0005).

Conclusions:  Both the prevalence of AP and the frequency of root canal treatment are high among Spanish adults. AP affects more frequently RFT relative to untreated teeth. Patients with one or more RFT have a greater likelihood of having AP than patients without RFT.
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http://dx.doi.org/10.1111/j.1875-595X.2011.00087.xDOI Listing
February 2012

Clinical indicators of periodontal disease in patients with coronary heart disease: a 10 years longitudinal study.

Med Oral Patol Oral Cir Bucal 2012 Jul 1;17(4):e569-74. Epub 2012 Jul 1.

Department of Special Patients, Faculty of Odontology, University of Seville, Spain.

Objectives: There is evidence about a possible relationship existing between periodontal diseases and coronary heart disease. The aim of the present longitudinal study was to investigate the changes in periodontal evolution after etiological periodontal treatment, comparing a healthy control group with another having coronary heart disease.

Study Design: The study included initially 55 patients of which 44 finished it. They were placed into two groups: Healthy Control Group (HCG) n =9, and Coronary Heart Disease Group (CHDG) n=35. The gingival level (GL), probing depth (PD), clinical attachment level (CAL), plaque index (PI) and bleeding on probing (BOP) were measured to compare the periodontal status in both groups. The patients were examined and etiological periodontal treatment was performed and they were then examined at the end of 1 and 10 years.

Statistical Method: A one way-ANOVA and a MR-ANOVA were established; significance p<0.05.

Results: No significant differences between both groups were detected on the first visit (p>0.5). However, at the second visit the CHDG presented a significantly higher PD (p<0.05) and PI (p<0.01). CHDG patients gradually increase PD through time and in comparison to the control group (p<0.041). CHDG patients present a significantly higher CAL loss (p<0.0385) and a significant increase in PI (p<0.0041) at the end of one year, while on the third visit no significant differences were detected in any of these indices. Likewise, a similar fact can be observed on evaluating BOP at the end of ten years causal treatment, a smaller decrease in the cardiac group was observed in regards to the initial values (p<0.001).

Conclusion: Patients with coronary heart disease showed a worse evolution of periodontal indices than healthy ones, when referring to probing depth, plaque index and bleeding on probing index.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476017PMC
http://dx.doi.org/10.4317/medoral.17848DOI Listing
July 2012

Treatment of a large maxillary cyst with marsupialization, decompression, surgical endodontic therapy and enucleation.

J Can Dent Assoc 2011 ;77:b87

University of Seville, Seville, Spain.

A large maxillary cyst was treated for 3 months with marsupialization and decompression, followed by surgical endodontic therapy of the affected teeth and cystectomy. Although small cystic lesions will typically heal with nonsurgical endodontic therapy, larger lesions may need additional treatment. Surgical enucleation of a large cystic lesion may lead to damage of other teeth or anatomic structures. Therefore, treatment should begin with the more conservative approach of decompression, to reduce the size of the lesion, followed by apicoectomy and cystectomy.
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December 2011

Hypertension and dental periapical condition.

J Endod 2010 Nov;36(11):1800-4

Department of Endodontics, School of Dentistry, University of Seville, Seville, Spain.

Introduction: The purpose of this study was to investigate the prevalence of apical periodontitis and endodontic treatment in hypertensive patients and control subjects without hypertension.

Methods: In a cross-sectional study, the records of 40 hypertensive patients and 51 control subjects were examined. Periapical status of all teeth was assessed by using the periapical index score.

Results: Apical periodontitis in 1 or more teeth was found in 75% of hypertensive patients and in 61% of control subjects (P = .15; odds ratio, 1.94; 95% confidence interval, 0.78-4.81). One or more root-filled teeth were found in 45% and 39% of hypertensive and control subjects, respectively (P > .0.5). Among hypertensive patients 5.2% of the teeth had apical periodontitis, whereas in the control subjects 4.2% of teeth were affected (P > .05). The percentages of root-filled teeth in the study and control groups were 3.1% and 1.8%, respectively (P > .05). Among hypertensive patients 65% of root-filled teeth had apical periodontitis, whereas in the control subjects 43% of the root-filled teeth were associated with apical periodontitis (P > .05).

Conclusions: The prevalence of apical periodontitis and endodontic treatment was not significantly different in hypertensive patients compared with control subjects without hypertension.
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http://dx.doi.org/10.1016/j.joen.2010.08.004DOI Listing
November 2010

Assessment of periapical status: a comparative study using film-based periapical radiographs and digital panoramic images.

Med Oral Patol Oral Cir Bucal 2010 Nov 1;15(6):e952-6. Epub 2010 Nov 1.

Department of Stomatology, School of Dentistry, University of Seville, C/ Avicena s/n, 41009-Seville, Spain.

Aim: To compare the use of film-based periapical radiographs and digital panoramic images displayed on monitor and glossy paper in the assessment of the periapical status of the teeth.

Methodology: A total of 86 subjects were examined. All participants underwent a full-mouth radiographic survey (14 periapical radiographs) and a digital panoramic radiography. The periapical status of all appraised teeth was assessed.

Results: Periapical radiographs allowed the assessment of the periapical status of a significantly higher percentage of teeth (87.4%) Digital radiography had a significantly reduced potential to allow assessment of the periapical status (p<0.01). Only 58.0% and 34.3% of teeth could be appraised using digital panoramic images displayed on monitor and glossy paper respectively (p<0.01). The total percentage of teeth with periapical pathosis was four-fold higher when assessed with digital panoramic images displayed on glossy paper compared with periapical radiographs (p<0.01).

Conclusions: Periapical radiographs allowed the assessment of a significantly higher percentage of teeth when comparing to digital radiography, which had a significantly lower potency in the assessment of periapical status of the teeth. Digital panoramic images displayed on a monitor resulted in a significantly higher percentage of appraised teeth compared to digital images displayed on glossy paper. Apical periodontitis was scored more often on paper than on screen, and more often on screen than in periapical radiographs.
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http://dx.doi.org/10.4317/medoral.15.e952DOI Listing
November 2010

In vitro evaluation of cytotoxicity and genotoxicity of a commercial titanium alloy for dental implantology.

Mutat Res 2010 Sep 6;702(1):17-23. Epub 2010 Jul 6.

Department of Stomatology, School of Dentistry, University of Seville, C/ Avicena s/n, Seville, Spain.

Titanium and its alloys have many applications in dentistry, being used in orthodontics, endodontics, prosthetics and implantology. But the use in the biomedical field depends on its biocompatibility, as the Council Directive 93/42/EEC of 14 June 1993 concerning medical devices has established. The aim of this study was to investigate the cytotoxicity and genotoxicity of a commercial titanium/aluminium/vanadium alloy (Ti-6Al-4V) developed by an innovative sand-blast process with aluminium oxide, and nitric-acid passivation. This procedure created a material with an average surface roughness of 1.73±0.16μm with applications in dental implants. International Organization for Standardization (ISO) procedures 7405:2008 and 10993-5:2009 were used to perform the cytotoxicity tests, and bacterial and cell-mutation assays to evaluate genotoxicity. The results show that this titanium alloy (Ti-6Al-4V) was neither cytotoxic nor genotoxic in any of the tests performed. It can be concluded that this new Ti-6Al-4V material with the roughness characteristics specified shows good biocompatibility and can be considered of choice in dental implantology.
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http://dx.doi.org/10.1016/j.mrgentox.2010.06.013DOI Listing
September 2010

Osteocalcin in serum, saliva and gingival crevicular fluid: their relation with periodontal treatment outcome in postmenopausal women.

Med Oral Patol Oral Cir Bucal 2007 May 1;12(3):E193-7. Epub 2007 May 1.

Periodontics Department, School of Medicine, University of Sevilla, Sevilla, Spain.

Background: Osteocalcin levels have been postulated as a marker of inhibition of bone formation. The aim of the present study was to assess plasma, saliva and GCF levels of osteocalcin and correlate them with periodontal treatment outcome in postmenopausal women.

Methods: Thirty-nine postmenopausal women (57.8 -/+8.5 years old) were recruited for the study. Periodontal examination of all women was carried out and plaque, bleeding on probing, probing depth (PD), and clinical attachment level (CAL) were recorded. Serum, saliva and gingival crevicular fluid osteocalcin were measured. Then, periodontal treatment was carried out. Six months after the first appointment a second periodontal examination was carried out.

Results: Mean PD and mean CAL decreased significantly at second appointment in the group with serum osteocalcin concentration <10 ng/ml (15.8 -/+15.8% and 15.3 -/+ 21.2% respectively; p < 0.05). Mean PD decreased significantly at second appointment in the groups with saliva osteocalcin concentration < 3 ng/ml (17.1 -/+ 15.9%; p < 0.05) and 3-7 ng/ml (16.2 -/+18.1%; p < 0.05).

Conclusions: Low serum osteocalcin concentration is associated to a significantly higher percentage of decrease in PD and CAL after periodontal treatment in postmenopausal women. Low saliva osteocalcin concentrations are significantly associated to a higher percentage of decrease in PD.
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May 2007

Correlation between infant birth weight and mother's periodontal status.

J Clin Periodontol 2005 Mar;32(3):299-304

Dental School, University of Itajai, Itajai, Brazil.

Objectives: Recent studies have suggested that periodontal disease is a risk factor for low birth weight (LBW) with other multiple factors. A cross-sectional study was undertaken to help further evaluate the proposed association between periodontal disease and infant birth weight.

Material And Methods: Caucasian pregnant women (n=152), aged 14-39 years, were enrolled while receiving prenatal care. Dental plaque, probing depth, bleeding on probing and clinical attachment level were recorded and three groups were made: healthy group (HG) (n=38), gingivitis group (GG) (n=71) and periodontitis group (PG) (n=43). At delivery, birth weight was recorded.

Results: Infant mean weight at delivery was 3293.9+/-508.1 g. The total incidence of preterm birth and LBW infants was 5.3% and 4.6%, respectively. The incidence of LBW infants was 3.5% in term gestations and 25% in preterm gestations. Mothers height correlated with infant birth weight (p=0.03). Significant difference in birth weight existed between mothers with <1.55 m (3229.23+/-462.57) and those with > or =1.65 m (3475.55+/-505.07). In the group of women >25 years old infant mean weight in HG was 3588.33+/-531.83, being lower in GG (3466.75+/-334.45) and even lower (3092.60+/-592.94) in PG (p=0.0198). Bleeding on probing was significantly greater in women with <2500 g infants (40.2+/-21.8%) compared with 2500-3499 g (18.6+/-15.1%) and > or =3500 g (17.1+/-16.1%) (p=0.009).

Conclusions: Periodontal disease in normal Caucasian pregnant women, older than 25 years, is statistically associated with a reduction in the infant birth weight. These data provide new evidence on the relationship between periodontal disease and birth weight.
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http://dx.doi.org/10.1111/j.1600-051X.2005.00661.xDOI Listing
March 2005

Dens evaginatus of anterior teeth (talon cusp): report of five cases.

Quintessence Int 2003 Apr;34(4):272-7

Department of Stomatology, School of Dentistry University of Seville, Seville, Spain.

The talon cusp, or dens evaginatus of anterior teeth, is a relatively rare dental developmental anomaly characterized by the presence of an accessory cusplike structure projecting from the cingulum area or cementoenamel junction. This occurs in either maxillary or mandibular anterior teeth in both the primary and permanent dentition. This article reports five cases of talon cusp, two of them bilateral, affecting permanent maxillary central and lateral incisors and canines that caused clinical problems related to caries or occlusal interferences.
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April 2003

In vitro inhibitory effect of EGTA on macrophage adhesion: endodontic implications.

J Endod 2003 Mar;29(3):211-3

Department of Stomatology, School of Dentistry, University of Seville, Spain.

Ethylene glycol-bis-(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid (EGTA) is an specific calcium ion chelator proposed as endodontic irrigant. This study investigates the effect of EGTA on substrate adherence capacity of rat inflammatory macrophages. Inflammatory macrophages were obtained from Wistar rats and resuspended in RPMI-1640 medium. Substrate adherence capacity assays were carried out in Eppendorf tubes for 15 min of incubation at 37 degrees C in a humidified atmosphere of 5% CO2. The adherence index was calculated. Results showed that EGTA decreased substrate adherence capacity of inflammatory macrophages in a time- and dose-dependent manner. The EGTA concentration that caused half-maximal inhibition (IC50) was 202 +/- 32 mM (p < 0.01). EDTA was more potent than EGTA in inhibiting macrophage adherence (IC50 = 185 +/- 22 mM). Calcium chloride (10 mM) decreased the EGTA inhibitory effect on adherence index by 60.2% (p < 0.01). We conclude that EGTA significantly decreased substrate adherence capacity of macrophages.
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http://dx.doi.org/10.1097/00004770-200303000-00012DOI Listing
March 2003