Ciencias de la salud

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https://repository.ucc.edu.co/handle/20.500.12494/8

Contenidos producidos por la comunidad de la Universidad Cooperativa de Colombia. Incluye temas relacionados con enfermería, epidemiología, medicina, odontología, ortodoncia, ortopedia funcional, periodoncia y oseointegración. Está conformada por trabajos de grado, artículos, imágenes, documentos de trabajo, recursos educativos digitales, libros, capítulos de libros, ponencias, webinars, videos, lecturas críticas, reportes de investigación, consultorías, guías y experiencias significativas.

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Abordaje quirúrgico y no quirúrgico de la regeneración de la papila interdental
(Universidad Cooperativa de Colombia, Facultad de Ciencias de la Salud, Especialización en Endodoncia, Medellín y Envigado, 2021-08-23) Giraldo Guzman, Catalina; Serna Sierra, Vanessa; Giraldo Guzman, Catalina Maria; Giraldo Guzman, Catalina
Dolor Postendodoncia en Una o Multiples citas: Umbrella Review
(Universidad Cooperativa de Colombia, Facultad de Ciencias de la Salud, Especialización en Endodoncia, Pasto, 2022-10-19) Mueses Guerrero, Ximena Del Pilar; Sanchez Figueroa, Anabell Alexandra; Muñoz, Hernán Darío
Postendodontic pain after endodontic procedures is an undesirable event for both patients and specialists. It affects the patient's quality of life and the success of their relationship with the specialist, which can impact confidence in the procedure and treatment satisfaction.However, the perception of pain is relatively common even if the treatment was carried out with the highest quality standards; being a recurring constant. In this reasoning, it is necessary to incorporate prediction criteria, in order to warn the patient and consolidate pain control strategies. For this, there are factors that are reported to have significant effects on post-obturation pain, among which are: type of tooth or location, the presence and severity of preoperative pain; pulp state; presence and size of the periapical lesion; number of root canals present; intracanal irrigant, medications; obturation; presence of pain between appointments and number of treatment visits. These factors have been implemented as an outcome measure to justify a difference from single or multi-appointment root canal treatment.After the completion of the procedure, either in one or several appointments, the treated teeth may experience pain for the patient. Despite technological advances with rotary systems, whether continuous or reciprocating, it is likely that extrusion of debris inherent to the treatment will occur; which translates as pain. This causes the pain experienced to be associated with manual or rotary instrumentation. Following instrumentation, another factor that can affect pain is irrigation, this procedure being a means of transporting drugs, infected debris, and bacteria to the periapical tissue .Indeed, the persistence of pain may be unavoidable, since in the treatment of a single appointment or multiple appointments there may be a resistant biofilm that cannot be eliminated, generating an inflammatory reaction and pain after treatment. In the most detrimental setting, inflammatory reactions may evidence persistent pathology. Factors such as instrumentation, irrigation, passage of drugs or infected debris into periapical tissues, damage to vital neural or pulp tissue, or central sensitization have been shown to cause post-endodontic pain with a variation of approximately 3% and 58%. Taking into account that it is complex to classify pain precisely, since there is a subjective and particular perception that starts from the threshold or the psychological perception towards the consultation;there is a need to respond to the controversy about the influence of discomfort after endodontic treatment between one and several appointments. In this sense, the Umbrella Review methodology provides the optimal tools and protocols to examine the academic reviews on the subject, in order to consolidate specific variables that allow a clearer appreciation of the viability of endodontic treatment in one and several appointments. With evolution of new techniques, instruments, materials and a better understanding of the anatomy of the root canal, endodontics has had considerable development.Thus, in light of scientific and technological advances, it is necessary to reconsider the debate regarding the number of sessions that must be taken to perform an endodontic treatment and its influence on post-endodontic pain. Based on the previous contextualization, it is feasible to perform a root canal in a single visit, being a common practice today and revealing advantages such as: reduction in appointments, reduction in filtration, immediate preparation of the canal for the solution of aesthetic problems, reduction of procedure costs, reduction of risks due to the use of anesthesia, the use of a single isolation and a considerable rate of reduction of pain derived from the treatment. On the other hand, the endodontic treatment in multiple visits shows different care protocols, finding that in the first appointment the complete instrumentation is carried out and in the second appointment the obturation continues.Based on the aforementioned, this study arises with the need to determine the incidence of post-endodontic pain in the endodontic treatment of one or several appointments, taking into account, in turn, the role played by factors such as the type of Instrumentation, Irrigation and Medication in the clinical manifestation of pain and in the perception of pain by patients.
Efectividad del retratamiento endodóntico y la cirugía apical como primera opción terapéutica para el manejo de la periodontitis apical persistente, un umbrella review
(Universidad Cooperativa de Colombia, Posgrado, Especialización en Endodoncia, Pasto, 2023-04-19) Quintero Romero, Laionel Camilo; Viveros Rebolledo, Elizabeth; Onofre Narváez, Deivison Omar; Javier Caviedes Buchelli; Hernán Darío Muñoz Alvear
Persistent apical periodontitis is a dental disease that occurs due to persistent inflammation in the tissue surrounding the root of the tooth. This condition can cause pain and discomfort, and may require treatment to prevent loss of the affected tooth. The article focuses on two treatment options for persistent apical periodontitis: endodontic retreatment and apical surgery. Endodontic retreatment consists of removing the filling material and performing the root canal treatment again. On the other hand, apical surgery involves removal of inflamed tissue at the tip of the root. To determine the effectiveness of these two treatment options, several previous studies on the subject were reviewed.
Expression of early angiogenesis indicators in mature versus immature teeth
(Universidad Cooperativa de Colombia, Posgrado, Especialización en Endodoncia, Pasto, 2020-11-01) Muñoz-Alvear, Hernan Dario
Background: Proper oxygen balance in the dental pulp is essential for cell metabolism. Angiogenesis in the pulp is a constant process during the life of the tooth. Hypoxia indicators in a tissue, such as HIF‐1α, as well as vascular desta‐ bilization markers, such as ANG2 and its receptor TIE2, are necessary for angiogenesis. Therefore the purpose of this study is to evaluate the expression of HIF‐1α, ANG1, ANG2 and TIE2 in dental pulp as early angiogenesis indicators in teeth with complete and incomplete root development. Methods: Forty human dental pulps were obtained from freshly extracted third molars divided into two groups: incomplete (n = 20) and complete (n = 20) root development. Dental pulps were stored at − 80 °C, defrosted in an ice bath and re‐frozen with their respective thaws to disintegrate the tissue. Three sonication cycles were performed until the tissues were homogenized, then thaw were centrifuged and the supernatant was collected for the detection of the markers to be studied. The samples were processed for the ELISA test using the ELISA‐sandwich principle. Student t and Mann–Whitney U tests were performed to determine statistically significant differences between groups. Results: In the complete root development, HIF‐1α, ANG1, ANG2 and TIE2 expressions were significantly higher than their expression in the incomplete root development group. Conclusions: The angiogenic process seems to be a physiological process in the dental pulp. Angiogenic activity is higher in teeth with mature than immature apex teeth.
Expression of substance P, calcitonin gene-related peptide and vascular endothelial growth factor in human dental pulp under different clinical stimuli
(Departamento de Endodoncia Pasto, 2021-03) Muñoz-Alvear, Hernan-Dario
Background: The aim of this study was to measure the dental pulp inflammatory response through neuropeptides (SP and CGRP) as a response to occlusal trauma, orthodontic movements and a combination of both, as well as the angiogenic defense mechanism through VEGF expression, which could be the initial step to mineralized tissue formation. Methods: Forty human dental pulp samples were collected from healthy first premolars with extraction indicated due to orthodontic reasons from a sample of 20 patients. Patients were divided into four groups with 10 premolars each (1 mandibular and 1 maxillary premolar from each patient): healthy pulp control group, occlusal trauma group, moderate orthodontic forces group; and occlusal trauma plus moderate orthodontic forces group. Stimuli were applied for 24 h before tooth extraction in all experimental groups. All samples were processed, and SP, CGRP, and VEGF were measured by radioimmunoassay. The Kruskal–Wallis test was performed to assess significant differences among groups and Mann–Whitney’s U post hoc pairwise comparisons were also performed. Results: The highest increase in SP, CGRP, and VEGF expressions was found in the occlusal trauma plus orthodontic forces group, followed by the moderate orthodontic forces, the occlusal trauma and the control groups, with statisti‐ cally significant differences between all groups for each of the 3 peptides analyzed (Kruskal–Wallis p < 0.001). All pos‐ sible pairwise post‐hoc comparisons were also significant for each peptide analyzed (Mann–Whitney’s U p < 0.001). Conclusion: SP, CGRP, and VEGF expressions significantly increase in human dental pulps when stimulated by occlusal trauma combined with moderate orthodontic forces, as compared with these two stimuli applied independently.
Niveles de HIF-1α, ANG-1, ANG-2, TIE-2 en pulpa dental de terceros molares con desarrollo radicular completo e incompleto
(Universidad Cooperativa de Colombia, Posgrado, Especialización en Endodoncia, Pasto, 2020-06-12) Hernandez Acosta, Francisco Javier; Pantoja Mora, Gloria Melissa; Rodriguez Guerrero, Angie Santina; Caviedes, Javier; Muñoz, Hernan; Lopez, Eddison
Aim To evaluate the expression of HIF-1α, ANG1, ANG2 and TIE2 in human dental pulp as an alternative pathway to initiate angiogenesis in teeth with complete and incomplete root development. Methodology Forty human dental pulps were obtained from freshly extracted third molars divided into two groups: incomplete (n = 20) and complete (n = 20) root development. Dental pulps were stored at -80°C, defrosted in an ice bath and re-frozen with their respective thaws to disintegrate the tissue. Three sonication cycles were performed until the tissues were homogenized, then thew were centrifuged and the supernatant was collected for the detection of the markers to be studied. The samples were processed for the ELISA test using the ELISA-sandwich principle. For each analyzed protein, mean and standard deviation were calculated for each group. Student t and Mann-Whitney U tests were performed according to their parametric or non-parametric behaviour. Result In the complete root development, HIF-1α, ANG1, ANG2 and TIE2 expressions were statistically significant higher than their expression in the incomplete root development group. Conclusion A significant increase in the expression of HIF-1α, ANG1, ANG2 and TIE2 was found in teeth with mature apexes.
Use of scaffolds and regenerative materials for the treatment of immature necrotic permanent teeth with periapical lesion: Umbrella review
(Universidad Cooperativa de Colombia, Posgrado, Especialización en Endodoncia, Pasto, 2022-10) Muñoz-Alvear, Hernan Dario
Abstract Background: Current treatment of immature necrotic permanent teeth with a peri- apical lesion is regenerative endodontics, which is based on tissue engineering under the triade of stem cells, scaffolds and bioactive molecules. Objectives: This Umbrella Review was aimed to evaluate the success of scaffold and regenerative materials used for the treatment of these teeth, in terms of apical closure, tooth length increase, widening of root canal walls, tissue vitality and peri- apical lesion repair. Methods: An extensive literature research was carried out in the Medline, ISI Web of Science, and Scopus databases for relevant systematic reviews matching the keyword search strategy. Based on inclusion and exclusion criteria, reviewers independently rated the quality of each study to determine their level of evidence. Methodological quality assessment of each article was obtained using A Measurement Tool to Assess Systematic Reviews (AMSTAR)-2 tool, and risk of bias was assessed with the Risk of Bias in Systematic Reviews (ROBIS) tool. Results: After removing duplicates, 155 articles were found; from which 133 were excluded for being non-relevant and 15 other due to exclusion criteria. One more was discarded after methodological quality evaluation, for a total of six articles re- maining. The most common scaffold used was the blood clot, others used were poly lactic-co-glycolic acid and platelet-rich fibrin matrix. The most common regenera- tion material used was Mineral Trioxide Aggregate (MTA), followed by Biodentine. An increase in tooth length and widening of root canal walls were reported in all selected studies with different proportions, as well as periapical lesion repair. ROBIS analysis showed that only one article had low bias, two were classified as unclear bias, while the remaining three had high risk of bias. Discussion: An exhaustive literature search was carried out applying language filters, high-quality indexed journals, year of publication, which ensures the best quality arti- cles were included. Blood clot was the most used scaffold as is the most easy to place inside the canal and does not require to extract blood from the patient. The use of MTA and Biodentine as sealing materials has been associated with thickening of canal walls, apical closure and reduced signs and symptoms of apical periodontitis. However, most of the included reviews assessed were case reports and only in a few of them were clini- cal trials included. There is also a lack of risk of bias analysis in most reviews. Conclusion: The blood clot is the most common scaffold used for inducing regen- eration during the treatment of immature necrotic teeth. Tooth length increase and widening of root canal walls are the most common criteria used in the studies as suc- cess indicators. MTA and Biodentine did not show differences in the results analysed. Quality assessment and bias risk evaluation showed that it is necessary to design bet- ter studies with rigorous methodology to recommend a trustable and predictable pro- tocol for the treatment of immature necrotic permanent teeth with periapical lesions.

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Examinando Ciencias de la salud por Programa "Especialización en endodoncia"

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