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Wang W, Zeng Q, Li Y, Sun Y, Kim T, Tang J, Bergeron BE, Tay F, Gu L. Effectiveness of pulpotomy in managing carious exposure in mature permanent teeth: A systematic review and meta-analysis. J Dent 2024:105392. [PMID: 39369880 DOI: 10.1016/j.jdent.2024.105392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 10/01/2024] [Accepted: 10/03/2024] [Indexed: 10/08/2024] Open
Abstract
OBJECTIVES This quantitative systematic review evaluated whether pulpotomy performed with hydraulic calcium silicate cements may be used as an alternative to root canal treatment (RCT) in mature permanent teeth with carious pulp exposure. DATA SOURCES A comprehensive search was conducted in PubMed, Web of Science, Scopus, and the Cochrane Library. No language restrictions were applied. The search included randomised controlled trials that compared pulpotomy to root canal treatment for managing carious exposure in mature permanent teeth. STUDY SELECTION Studies were selected based on predetermined inclusion criteria: randomised controlled trials involving mature permanent teeth with carious pulp exposure, using hydraulic calcium silicate cements for pulpotomy. Non-comparative studies, case reports, and trials involving primary or immature permanent teeth were excluded. DATA Data were extracted on success rates, clinical outcomes, follow-up periods, pain profiles, and potential complications. A meta-analysis was performed, revealing no statistically significant differences in success rates between pulpotomy and RCT. Both interventions demonstrated success rates exceeding 90% at one-year and two-year follow-up periods. Pain profiles consistently showed lower post-operative pain intensity in the pulpotomy group compared to the RCT group during the first week. Potential complications, such as non-responsive pulp and difficulties in determining pulp vitality, were reported more frequently in the pulpotomy group. CONCLUSIONS Pulpotomy with bioactive hydraulic calcium silicate cements shows comparable success rates to RCT in managing carious pulp exposure in mature permanent teeth. The results suggest pulpotomy as a viable, less invasive alternative to RCT, particularly in cases where preservation of pulp vitality is paramount. CLINICAL SIGNIFICANCE This systematic review highlights pulpotomy as a less invasive and cost-effective alternative to root canal treatment in mature permanent teeth. With comparable success rates and lower post-operative pain, pulpotomy offers a promising approach to managing carious exposure and preserving tooth vitality.
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Affiliation(s)
- Wenying Wang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Qian Zeng
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Yuanyuan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration & National Clinical Research Centre for Oral Diseases & Shaanxi International Joint Research Centre for Oral Diseases, Centre for Tissue Engineering, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China; Department of General Dentistry, Xiamen University Affiliated Chenggong Hospital & The 73rd Army Hospital of Chinese PLA, Amoy, Fujian, PR China
| | - Yutong Sun
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Timothy Kim
- The Dental College of Georgia, Augusta University, GA, USA
| | - Jocelyn Tang
- The Dental College of Georgia, Augusta University, GA, USA
| | | | - Franklin Tay
- The Dental College of Georgia, Augusta University, GA, USA.
| | - Lisha Gu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China.
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Sriudomdech P, Santiwong B, Linsuwanont P. Outcomes of vital pulp treatment in permanent teeth with carious pulp exposure with signs and symptoms of irreversible pulpitis. Clin Oral Investig 2024; 28:551. [PMID: 39320508 DOI: 10.1007/s00784-024-05923-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 09/08/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVE To investigate the outcomes and factors influencing the success of vital pulp treatment (VPT) in permanent teeth with carious pulp exposure and signs and symptoms of irreversible pulpitis (IP). MATERIALS AND METHODS Dental records from 2016 to 2023 of patients who received VPT for carious pulp-exposed permanent teeth with IP symptoms were reviewed. Outcomes were assessed using clinical and radiographic criteria. Univariate and multivariate analyses were performed to identify factors affecting treatment success. The Kaplan-Meier estimator was used to compare survival probabilities. RESULTS The overall success and survival rates were 88.24% and 97.06%, respectively. Success rates for direct pulp capping, partial pulpotomy, and full pulpotomy were 87.7%, 92.0%, and 87.7%, respectively. Key factors influencing outcomes included the presence of periapical radiographic lesions, type of pulp dressing material, and quality of the final restoration. Full pulpotomy demonstrated the highest survival time, followed by partial pulpotomy and direct pulp capping. CONCLUSION VPT in permanent teeth with carious pulp exposure and IP symptoms shows high success rates. Crucial factors include periapical radiographic findings, type of pulp dressing material, and quality of the final restoration. Full pulpotomy exhibited the longest survival time. CLINICAL RELEVANCE VPT in teeth with IP symptoms shows promising outcomes, highlighting the importance of certain clinical factors in treatment success.
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Affiliation(s)
- Pasukarn Sriudomdech
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Wangmai, Pathumwan, Bangkok, 10330, Thailand
| | - Busayarat Santiwong
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Wangmai, Pathumwan, Bangkok, 10330, Thailand
| | - Pairoj Linsuwanont
- Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henri-Dunant Road, Wangmai, Pathumwan, Bangkok, 10330, Thailand.
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Jiménez-Martín C, Martín-González J, Crespo-Gallardo I, Montero-Miralles P, Cabanillas-Balsera D, Segura-Egea JJ. Elective full pulpotomy in mature permanent teeth diagnosed with symptomatic irreversible pulpitis: a two years retrospective study. Clin Oral Investig 2024; 28:421. [PMID: 38976067 PMCID: PMC11231018 DOI: 10.1007/s00784-024-05814-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/28/2024] [Indexed: 07/09/2024]
Abstract
AIM To investigate the outcome of elective full pulpotomy, using calcium silicate-based cements (CSBC), after 2 years, in symptomatic mature permanent teeth with carious lesions, diagnosed as irreversible pulpitis, and analyse the capacity of Wolters et al. (2017) classification to predict the likelihood of treatment failure. METHODS The treatment records of 56 patients with symptomatic mature teeth with carious lesions, diagnosed as irreversible pulpitis and treated by elective full pulpotomy, using CSBCs as pulp capping materials, were reviewed. Thirteen teeth were excluded. The remaining 43 teeth were evaluated retrospectively at 24 months. Fisher`s exact test with the Lancaster's mid-P adjustment was used to assess different outcomes amongst the diagnostic categories. RESULTS Four of the cases failed before 24 months and required root canal treatment (RCT). Overall success rate at 2 years was 90.7% (39 of 43). An inverse, but non-significant, correlation was observed between the severity of pulpitis according to the Wolters classification and the treatment success rate (p > 0.05). The type of CSBC used was associated to the success rate (OR = 10.5; 95% C.I. = 0.5 - 207.4; p = 0.027), being 82% with Endosequence and 100% with Biodentine. Postoperative pain associated significantly to lower success rate (66.7%) (Odds ratio = 8.0; 95% C.I. = 0.7 - 95.9; p = 0.047). CONCLUSIONS Elective full pulpotomy using a CSBC was a successful choice for the treatment of mature permanent teeth with symptoms indicative of irreversible pulpitis. There were no significant differences between the success rate of mild, moderate and severe pulpitis. Postoperative pain could be considered a risk marker for failure of full pulpotomy. The term "irreversible pulpitis" should be re-signified to indicate the need for access to the pulp chamber, rather than an indication for extraction or RCT.
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Affiliation(s)
- Cristina Jiménez-Martín
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Jenifer Martín-González
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Isabel Crespo-Gallardo
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Paloma Montero-Miralles
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Daniel Cabanillas-Balsera
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain.
- Facultad de Odontología, Universidad de Sevilla, 41009, Sevilla, Spain.
| | - Juan J Segura-Egea
- Department of Stomatology (Endodontic section), School of Dentistry, University of Sevilla, Sevilla, Spain.
- Facultad de Odontología, Universidad de Sevilla, 41009, Sevilla, Spain.
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Li W, Yang B, Shi J. Efficacy of pulpotomy for permanent teeth with carious pulp exposure: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2024; 19:e0305218. [PMID: 38968236 PMCID: PMC11226044 DOI: 10.1371/journal.pone.0305218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/25/2024] [Indexed: 07/07/2024] Open
Abstract
This meta-analysis aims to assess the success rate of pulpotomy in the treatment of permanent teeth with carious pulp exposure and to compare the efficacy of different capping materials. Randomized controlled trials were searched in PubMed, EMBASE, Web of Science, Clinicaltrial.gov, and Cochrane Library until August 31, 2023. The pooled success rate was estimated in the overall population and in subgroups. Additional analyses comparing different capping materials using odds ratio (OR) and 95% confidence interval (95%CI) were performed. The certainty of evidence was graded using the GRADE approach. A total of 25 randomized trials with an average follow-up duration ≥ 12 months were finally included. The overall success rate of pulpotomy was 86.7% (95%CI: 82.0-90.7%). The success rate was not significantly affected by root development, pulpotomy type, and follow-up duration. Teeth with irreversible pulpitis had a relatively lower success rate than teeth with normal pulp or reversible pulpitis (82.4% [95%CI: 74.6-89.0%] vs 92.0% [95%CI: 87.9-95.4%], P = 0.013). Directly compared to conventional calcium hydroxide, mineral trioxide aggregate (88.2% vs 79.1%, OR = 2.41, 95%CI: 1.28-4.51, P = 0.006) and Biodentine (97.5% vs 82.9%, OR = 6.03, 95%CI: 0.97-37.6, P = 0.054) had higher successful rates. No significant difference between MTA and other biomaterials was found. The results were graded as very low to low certainty of evidence. In conclusion, pulpotomy is an effective treatment of permanent teeth with carious pulp exposure. Mineral trioxide aggregate and Biodentine can be recommended with more favorable outcomes as capping materials.
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Affiliation(s)
- Wenjun Li
- Department of Oral Medicine, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi Province, China
| | - Bo Yang
- Department of Oral Medicine, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi Province, China
| | - Jing Shi
- Department of Oral Medicine, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi Province, China
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Zhang X, Zhou X, Zhai W, Cui J, Pan Z, Du L, Wen L, Ye R, Zhang B, Huang L, Li D, Wang C, Sun H. Novel L-(CaP-ZnP)/SA Nanocomposite Hydrogel with Dual Anti-Inflammatory and Mineralization Effects for Efficient Vital Pulp Therapy. Int J Nanomedicine 2024; 19:6659-6676. [PMID: 38975320 PMCID: PMC11227880 DOI: 10.2147/ijn.s464871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/26/2024] [Indexed: 07/09/2024] Open
Abstract
Background Vital pulp therapy (VPT) is considered a conservative treatment for preserving pulp viability in caries and trauma-induced pulpitis. However, Mineral trioxide aggregate (MTA) as the most frequently used repair material, exhibits limited efficacy under inflammatory conditions. This study introduces an innovative nanocomposite hydrogel, tailored to simultaneously target anti-inflammation and dentin mineralization, aiming to efficiently preserve vital pulp tissue. Methods The L-(CaP-ZnP)/SA nanocomposite hydrogel was designed by combining L-Arginine modified calcium phosphate/zinc phosphate nanoparticles (L-(CaP-ZnP) NPs) with sodium alginate (SA), and was characterized with TEM, SEM, FTIR, EDX, ICP-AES, and Zeta potential. In vitro, we evaluated the cytotoxicity and anti-inflammatory properties. Human dental pulp stem cells (hDPSCs) were cultured with lipopolysaccharide (LPS) to induce an inflammatory response, and the cell odontogenic differentiation was measured and possible signaling pathways were explored by alkaline phosphatase (ALP)/alizarin red S (ARS) staining, qRT-PCR, immunofluorescence staining, and Western blotting, respectively. In vivo, a pulpitis model was utilized to explore the potential of the L-(CaP-ZnP)/SA nanocomposite hydrogel in controlling pulp inflammation and enhancing dentin mineralization by Hematoxylin and eosin (HE) staining and immunohistochemistry staining. Results In vitro experiments revealed that the nanocomposite hydrogel was synthesized successfully and presented desirable biocompatibility. Under inflammatory conditions, compared to MTA, the L-(CaP-ZnP)/SA nanocomposite hydrogel demonstrated superior anti-inflammatory and pro-odontogenesis effects. Furthermore, the nanocomposite hydrogel significantly augmented p38 phosphorylation, implicating the involvement of the p38 signaling pathway in pulp repair. Significantly, in a rat pulpitis model, the L-(CaP-ZnP)/SA nanocomposite hydrogel downregulated inflammatory markers while upregulating mineralization-related markers, thereby stimulating the formation of robust reparative dentin. Conclusion The L-(CaP-ZnP)/SA nanocomposite hydrogel with good biocompatibility efficiently promoted inflammation resolution and enhanced dentin mineralization by activating p38 signal pathway, as a pulp-capping material, offering a promising and advanced solution for treatment of pulpitis.
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Affiliation(s)
- Xu Zhang
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
| | - Xue Zhou
- Department of Chemistry, Northeast Normal University, Changchun, 130024, People’s Republic of China
| | - Wenhao Zhai
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
| | - Jing Cui
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
| | - Ziyi Pan
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
| | - Liuyi Du
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
| | - Linlin Wen
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
| | - Rongrong Ye
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
| | - Boya Zhang
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
| | - Lei Huang
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
| | - Daowei Li
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
| | - Chungang Wang
- Department of Chemistry, Northeast Normal University, Changchun, 130024, People’s Republic of China
| | - Hongchen Sun
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, 130021, People’s Republic of China
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Alfaisal Y, Idris G, Peters OA, Peters CI, Zafar S. Factors influencing treatment decisions in permanent mature teeth with irreversible pulpitis: a questionnaire-based study. Aust Dent J 2024. [PMID: 38850075 DOI: 10.1111/adj.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Decision-making in dentistry is a complex process, and this study evaluated factors that influence dentists' approaches in permanent mature teeth with irreversible pulpitis. METHODS An online questionnaire was distributed to a group of dental practitioners. The questionnaire surveyed dentists' opinions about the management of vital permanent teeth with irreversible pulpitis including a case scenario. RESULTS Data from 262 respondents were analysed. Barriers to perform vital pulp therapy (VPT) included presuming it an inappropriate long-term treatment (29.7%), lack of knowledge, insufficient access to materials, inadequate training and lack of confidence. Patient's preference (79.44%) and tooth restorability (91%) were the most frequently reported factors influencing treatment decisions. Dentists aged 25-35 years and who have 1-5 years of experience ranked extraction as a more successful treatment (P = 0.008; P = 0.003, respectively). Non-Australian graduates ranked pulpotomy to be a more successful procedure (P = 0.007), and public sector/hospital practitioners favoured extraction more than practitioners from other sectors (P = 0.003). Postgraduates/specialists preferred pulpotomy (P = 0.012) more than general dentists. Participants' clinical approaches for the management of symptomatic irreversible pulpitis: root canal treatment (45.0%), indirect pulp capping (22.9%), direct pulp capping (15.8%), pulpotomy (17.1%) and extraction (6.3%). CONCLUSIONS Female, more experienced, overseas-educated dentists and endodontists preferred VPT for irreversible pulpitis in permanent mature teeth more than other participants. © 2024 Australian Dental Association.
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Affiliation(s)
- Y Alfaisal
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - G Idris
- Metro North Hospital and Health Services, Queensland Health, Brisbane, QLD, Australia
| | - O A Peters
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - C I Peters
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - S Zafar
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
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Kalantzis N, Gioti M, Sofia F, Kodonas K, Gogos C. The management of deep carious lesions and the exposed pulp in fully developed and immature teeth with irreversible pulpitis: a questionnaire-based study among Greek dentists. Clin Oral Investig 2024; 28:359. [PMID: 38844571 DOI: 10.1007/s00784-024-05756-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 05/29/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVES The study aimed to identify the preferred management techniques used by dentists in Greece for treating deep carious lesions or pulp exposure during the removal of carious tissue in teeth with irreversible pulpitis. Additionally, the study sought to explore how patient-related factors (such as age and symptoms) and operator-related factors (like material choice and the use of antibiotics) influence these management decisions. MATERIALS AND METHODS The questionnaire, developed by five investigators, was divided into two parts: the first gathered respondent demographics, and the second presented clinical scenarios of deep carious lesions, requesting treatment strategies, materials used, and antibiotic prescription practices. The scenarios described patients with intense spontaneous pain and very deep carious lesions, differentiated by age and tooth development status.Data collection was via Google Drive, with analysis performed using SPSS 28, Chi-square, and Fisher's exact tests, with significance set at p < 0.05. RESULTS The study polled 453 Greek dentists about their treatment choices, for deep carious lesions in mature and immature teeth with irreversible pulpitis The majority favored root canal treatment for mature teeth, however quite a few opted for partial or cervical pulpotomy. MTA emerged as the preferred capping material, emphasizing its biocompatibility. Hemostasis management varied, with saline and sodium hypochlorite as popular choices. In cases of immature teeth, a shift towards vital pulp therapy was evident, reflecting a preference for preserving healthy pulp to avoid complex procedures. CONCLUSIONS Challenges identified include varying treatment preferences, the significance of bleeding control in vital pulp therapy, and the limited use of antibiotics for irreversible pulpitis. While the study has limitations, including sample size and potential biases, its findings offer valuable insights into the decision-making processes of Greek dentists. CLINICAL RELEVANCE Future research and ongoing education within the dental community could contribute to standardizing treatment approaches and optimizing outcomes for patients with deep carious lesions and irreversible pulpitis.
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Affiliation(s)
- Nikolaos Kalantzis
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Mavreta Gioti
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Filippou Sofia
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Kodonas
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Gogos
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Farhadian A, Issa MA, Kingsley K, Sullivan V. Analysis of Pediatric Pulpotomy, Pulpectomy, and Extractions in Primary Teeth Revealed No Significant Association with Subsequent Root Canal Therapy and Extractions in Permanent Teeth: A Retrospective Study. Pediatr Rep 2024; 16:438-450. [PMID: 38921703 PMCID: PMC11206693 DOI: 10.3390/pediatric16020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Recent evidence suggests that an ever-growing number of pediatric patients require invasive treatments such as root canal therapy (RCT) in their permanent dentition, albeit with little information about risk factors such as prior invasive treatments of pulpotomy or pulpectomy in their primary dentition. Therefore, the primary objectives of this study were to determine the number of pediatric patients who have had any type of invasive treatment in their primary teeth, to assess their association with any subsequent invasive treatment (root canal therapy, extractions) in their permanent dentition, and to assess these trends over time. This retrospective study utilized summary data from a clinical pediatric patient pool (ages 0-17) over the period of 2013-2022. This analysis revealed that pediatric patients requiring pulpotomies and pulpectomies in primary dentition declined between 2013 (n = 417, n = 156) and 2022 (n = 250, n = 12), while root canal therapy (RCT) in permanent dentition increased six-fold from n = 54 to n = 330. In addition, few (7.8%) patients with RCT had a previous history of pulpotomy or pulpectomy, which suggests that invasive treatments performed in primary dentition have no direct association with the subsequent need for invasive treatments in permanent dentition, although more research is needed to determine the explanations for these observations.
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Affiliation(s)
- Arash Farhadian
- Department of Advanced Education in Pediatric Dentistry, School of Dental Medicine, University of Nevada, Las Vegas, 1700 West Charleston Blvd, Las Vegas, NV 89106, USA (V.S.)
| | - Mayce Arreem Issa
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, 1700 West Charleston Blvd, Las Vegas, NV 89106, USA
| | - Karl Kingsley
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, 1001 Shadow Lane, Las Vegas, NV 89106, USA
| | - Victoria Sullivan
- Department of Advanced Education in Pediatric Dentistry, School of Dental Medicine, University of Nevada, Las Vegas, 1700 West Charleston Blvd, Las Vegas, NV 89106, USA (V.S.)
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Lin GSS, Chin YJ, Choong RS, Wafa SWWSST, Dziaruddin N, Baharin F, Ismail AF. Treatment Outcomes of Pulpotomy in Primary Teeth with Irreversible Pulpitis: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:574. [PMID: 38790569 PMCID: PMC11119415 DOI: 10.3390/children11050574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
AIM This systematic review and meta-analysis aimed to evaluate the success rates of pulpotomy treatment for irreversible pulpitis in primary teeth. METHODS This study was registered and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Relevant studies published between January 1980 and April 2023 were identified across eight online databases and two paediatric dentistry textbooks. Study selection, data extraction, and quality assessment were conducted by multiple investigators independently. Data analysis involved single-arm and two-arm meta-analyses, leave-one-out sensitivity analysis, meta-regression, and assessment of publication bias. The risks of bias were evaluated using the Cochrane Collaboration's assessment tools. The levels of evidence were determined using the Oxford Centre for Evidence-Based Medicine (OCEBM) tool. RESULTS Five primary studies were included. The weighted mean overall success rates at 6-month and 12-month follow-ups were 97.2% and 94.4%, respectively. Two-arm meta-analysis revealed no significant difference (p > 0.05) between the use of mineral trioxide aggregate (MTA) and non-MTA bioceramic-based materials as pulpotomy medicaments. The sample size of each study did not affect the degree of data heterogeneity. Egger's test revealed no significant publication bias. CONCLUSIONS Pulpotomy may be regarded as an alternative modality for treating primary teeth with irreversible pulpitis. Nevertheless, future well-designed trials and extended follow-up periods are warranted.
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Affiliation(s)
- Galvin Sim Siang Lin
- Department of Restorative Dentistry, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan Campus, Kuantan 25200, Pahang, Malaysia
| | - Yu Jie Chin
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (Y.J.C.); (R.S.C.); (N.D.)
| | - Rob Son Choong
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (Y.J.C.); (R.S.C.); (N.D.)
| | | | - Nabihah Dziaruddin
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (Y.J.C.); (R.S.C.); (N.D.)
| | - Fadzlinda Baharin
- Paediatric Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu 16150, Kelantan, Malaysia;
| | - Ahmad Faisal Ismail
- Department of Paediatric Dentistry and Dental Public Health, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan Campus, Kuantan 25200, Pahang, Malaysia;
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Sousa GH, Gonçalves RL, Figueiredo B, Dias VCM, Mendes ACS, de Cássia Bueno Melo V, Rodrigues AG, dos Santos Chaves HG. Exploring vital pulp Therapies: A bibliometric analysis of the most cited articles. Saudi Dent J 2024; 36:778-788. [PMID: 38766288 PMCID: PMC11096604 DOI: 10.1016/j.sdentj.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 05/22/2024] Open
Abstract
Aim The aim of this study was to identify and analyze the most cited articles on vital pulp therapies. Methodology Bibliographical data related to the abstract, citations, keywords, and other relevant information was extracted using different combinations of keywords. Further evaluation and visualization of the selected data were performed with the help of various tools, including MS Excel, Microsoft Word, Google open refine, BibExcel, and VOS viewer. An initial search revealed 91 documents, of which 40 were chosen for further analysis. We used the Kolmogorov-Smirnov test and Spearman correlation coefficient test, and our adopted significance level was p < 0.05. Results In total, the articles received 1,905 citations, with six of them receiving at least 100 citations. Among the top 40 articles, the United States of America (10 articles) and Ireland (6 articles) were the countries with the highest number of cited articles. The journals "Journal of Endodontics" (14 articles; 650 citations) and "International Endodontic Journal" (13 articles; 577 citations) published most of the articles among the 50 most cited ones. Duncan H. was the author with the highest number of works cited (11 articles; 339 citations). Of the articles, systematic reviews accounted for 32%, literature reviews for 14%, in vitro experimental studies for 12%, clinical trials for 8%. Among the biomaterials used in vital pulp therapies, mineral trioxide aggregate (MTA) was discussed in 37 articles (74%), followed by calcium hydroxide, mentioned in 30 studies (60%). Interestingly, the publication year did not demonstrate a significant impact on citation count. Conclusion The present study provided a detailed list of the top 50 most cited and classic articles on vital pulp therapies. This will help researchers, students, and clinicians in the field of endodontics with an impressive source of information.
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Affiliation(s)
- Gustavo Henrique Sousa
- Postgraduate Department in Endodontics, Faculdades Unidas do Norte de Minas, Campus Funorte – Montes Claros, MG, Brazil
| | - Rodolfo Lima Gonçalves
- School of Dentistry, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | - Barbara Figueiredo
- Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Vilton Cardozo Moreira Dias
- Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Ana Carolina Soares Mendes
- Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Valéria de Cássia Bueno Melo
- Postgraduate Department in Endodontics, Faculdades Unidas do Norte de Minas, Campus Funorte – Montes Claros, MG, Brazil
| | - Adriana Guimarães Rodrigues
- Postgraduate Department in Endodontics, Faculdades Unidas do Norte de Minas, Campus Funorte – Montes Claros, MG, Brazil
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11
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Afkhami F, Rostami G, Xu C, Peters OA. The application of lasers in vital pulp therapy: clinical and radiographic outcomes. BMC Oral Health 2024; 24:333. [PMID: 38486157 PMCID: PMC10938664 DOI: 10.1186/s12903-024-04026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/14/2024] [Indexed: 03/18/2024] Open
Abstract
The main purpose of vital pulp therapy (VPT) is to preserve the integrity and function of the pulp. A wide variety of materials and techniques have been proposed to improve treatment outcomes, and among them, the utilization of lasers has gained significant attention. The application of lasers in different stages of VPT has witnessed remarkable growth in recent years, surpassing previous approaches.This study aimed to review the applications of lasers in different steps of VPT and evaluate associated clinical and radiographic outcomes. An electronic search using Scopus, MEDLINE, Web of Science and Google Scholar databases from 2000 to 2023 was carried out by two independent researchers. The focus was on human studies that examined the clinical and/or radiographic effects of different laser types in VPT. A total of 4243 studies were included in this narrative review article. Based on the compiled data, it can be concluded that although current literature suggests laser may be proposed as an adjunct modality for some procedural steps in VPT, more research with standardized methodologies and criteria is needed to obtain more reliable and conclusive results.
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Affiliation(s)
- Farzaneh Afkhami
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
- School of Dentistry, The University of Queensland, Brisbane, Australia.
| | | | - Chun Xu
- School of Dentistry, The University of Queensland, Brisbane, Australia
| | - Ove A Peters
- School of Dentistry, The University of Queensland, Brisbane, Australia
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12
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Naved N, Umer F, Khowaja AR. Irreversible pulpitis in mature permanent teeth: a cost-effectiveness analysis of pulpotomy versus root canal treatment. BMC Oral Health 2024; 24:285. [PMID: 38418999 PMCID: PMC10902936 DOI: 10.1186/s12903-024-04052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Evidence-based dentistry suggests pulpotomy as a potential alternative to root canal treatment in mature permanent teeth with irreversible pulpitis. However, the evidence surrounding the cost-valuation and cost-efficacy of this treatment modality is not yet established. In this context, we adopted an economic modeling approach to assess the cost-effectiveness of pulpotomy versus root canal treatment, as this could aid in effective clinical decision-making. METHODS A Markov model was constructed following a mature permanent tooth with irreversible pulpitis in an 18-year-old patient over a lifetime using TreeAge Pro Healthcare 2022. Transition probabilities were estimated based on existing literature. Costs were estimated based on the United States healthcare following a private-payer perspective and parameter uncertainties were addressed using Monte-Carlo simulations. The model was validated internally by sensitivity analyses, and face validation was performed by an experienced endodontist and health economist. RESULTS In the base case scenario, root canal treatment was associated with additional health benefit but at an increased cost (1.08 more years with an incremental cost of 311.20 USD) over a period of an individual's lifetime. The probabilistic sensitivity analysis revealed pulpotomy to be cost-effective at lower Willingness-To-Pay (WTP) values (99.9% acceptable at 50 USD) whereas increasing the values of WTP threshold root canal treatment was a cost-effective treatment (99.9% acceptable at 550 USD). CONCLUSION Based on current evidence, pulpotomy was a cost-effective treatment option at lower WTP values for the management of irreversible pulpitis in mature permanent teeth. However, by increasing the WTP threshold, root canal treatment became a more cost-effective treatment option over a period of lifetime of an individual.
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Affiliation(s)
- Nighat Naved
- Operative Dentistry & Endodontics, Aga Khan University Hospital, Karachi, Pakistan
| | - Fahad Umer
- Operative Dentistry & Endodontics, Aga Khan University Hospital, Karachi, Pakistan.
| | - Asif R Khowaja
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Canada
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13
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Mishra S, Taneja S, Bhalla VK, Rathore A. Outcome of novel pulp capping modalities after full pulpotomy in teeth diagnosed with irreversible pulpitis: A prospective randomized clinical trial. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:205-213. [PMID: 38463483 PMCID: PMC10923234 DOI: 10.4103/jcde.jcde_257_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 03/12/2024]
Abstract
Objective The study aimed to compare and evaluate the effect of biodentine (BD) alone, BD along with Lyophilised freeze dried platelet rich concentrate (LPC + BD), and BD along with low-level laser therapy (BD + LLLT) after pulpotomy in mature permanent molars with irreversible pulpitis. Materials and Methods The study was designed as a randomized, pragmatic, parallel, double-blinded clinical trial registered under the Clinical Trial Registry-India (CTRI/2020/02/023245). 120 permanent molars fulfilling the inclusion and exclusion criteria with symptoms of irreversible pulpitis were randomized after performing pulpotomy into three pulp capping groups: Group 1, BD; Group 2, lyophilized freeze-dried platelet-rich concentrate + BD (LPC + BD); and Group 3, Low level laser therapy + BD Group 3, LLLT + BD. The intergroup comparison was done using one-way analysis of variance followed by the Bonferroni test. The level of significance and confidence interval were 5% and 95%, respectively. Interobserver reliability was measured using Cohen's kappa analysis. Results At 1 week, there was a significant difference (P < 0.005) observed in the mean postoperative pain levels between the three groups with Group 1 (BD) exhibiting the highest postoperative pain followed by Group 2 (LPC + BD) and least pain was exhibited by Group 3 (LLLT + BD). A similar pattern was observed regarding the analgesic intake with maximum frequency in Group 1 (BD) and least with Group 3 (LLLT + BD). No significant difference in success rates was reported among the groups. Conclusion Pulpotomy as a treatment option for mandibular molars with irreversible pulpitis has an acceptable clinical success rate; however, long-term overall success rate remains questionable. The outcomes of incorporating adjunctive modalities with BD are remarkable and show tremendous potential for continued development and research.
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Affiliation(s)
- Sneh Mishra
- Private Practitioner, I.T.S Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Sonali Taneja
- Department of Conservative Dentistry and Endodontics, I.T.S Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Vidhi Kiran Bhalla
- Department of Conservative Dentistry and Endodontics, I.T.S Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
| | - Akshay Rathore
- Department of Oral Medicine and Radiology, I.T.S Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India
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14
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Umale KG, Gade VJ, Raut AW. Comparative evaluation of shear bond strength and modes of failure of five different reinforced glass ionomer restorative cements to TheraCal LC: An in vitro study. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:200-204. [PMID: 38463478 PMCID: PMC10923224 DOI: 10.4103/jcde.jcde_260_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 03/12/2024]
Abstract
Aim The aim of the study is to evaluate and compare the shear bond strength (SBS) and modes of failure of different reinforced glass ionomer cement restorative materials such as GC IX, GC Gold Label 2 LC, Amalgomer CR, Equia Forte, and Secure Core Z to TheraCal LC. Methodology A total of 50 acrylic blocks, each containing a cylindrical hole in the center were prepared from self-cure acrylic resin and randomly divided into five groups and restored, namely Group A - TheraCal LC + GC Fuji IX, Group B - TheraCal LC + GC Gold Label 2 LC, Group C - TheraCal LC + Amalgomer CR, Group D - TheraCal LC + Equia Forte, and Group E - TheraCal LC + Secure Core Z. All the specimens were stored in artificial saliva at 37°C for 24 h before testing. The statistical tests used for the analysis of the result were: one-way ANOVA, Tukey multiple comparison test, and the Chi-squared test, and P < 0.05 is considered as the level of significance. Results Equia Forte showed the highest SBS, while GC type IX showed the lowest SBS with TheraCal LC. Conclusion Equia Forte can be the restorative material of choice when TheraCal LC is used as a base materials for better clinical efficacy.
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Affiliation(s)
- Kalyani Gajanan Umale
- Department of Conservative Dentistry and Endodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
| | - Vandana Jaykumar Gade
- Department of Conservative Dentistry and Endodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
| | - Ambar W. Raut
- Department of Conservative Dentistry and Endodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
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15
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Celiksoz O, Irmak O. Delayed vs. immediate placement of restorative materials over Biodentine and RetroMTA: a micro-shear bond strength study. BMC Oral Health 2024; 24:130. [PMID: 38273289 PMCID: PMC10811922 DOI: 10.1186/s12903-024-03917-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The aim of the present study was to investigate the micro-shear bond strength (µSBS) of various restorative materials applied on two different fast-setting calcium silicate-based materials and to evaluate the effect of restoration time on µSBS. METHODS A total of 180 acrylic blocks with a cavity in the center were randomly divided into 2 main groups according to the capping material to be used (Biodentine or RetroMTA). The specimens were also randomly divided into 3 groups according to the restoration time (3 min, 12 min, 24 h). After the specified waiting periods, glass hybrid material (EQUIA Forte HT), resin composite (Filtek Z550) and light-cured calcium silicate material (Theracal LC) were placed on the specimens with tygon tubes. The specimens were kept for 24 h and then subjected to µSBS test. Statistical analysis was performed by 3-way ANOVA followed by Tukey test for pairwise comparisons (α = 0.05). RESULTS There is a statistically significant difference (p < 0.05) between the µSBS values obtained by applying resin composite on RetroMTA after different setting times (24 h > 12 min > 3 min). The µSBS obtained for the Biodentine-resin composite at the end of the 3 min setting time is significantly lower (p < 0.05) than the µSBS values at 12 min and 24 h. For both calcium silicate cements, at the end of all time periods, the µSBS obtained when resin composite was applied at the end was higher than the other materials (p < 0.05). CONCLUSIONS For Biodentine-resin composite bonding, the manufacturer's recommendation of 12 min can be considered an appropriate time, whereas for RetroMTA-resin composite bonding, the µSBS increased as the waiting time increased. Regardless of the waiting time, it is recommended to prefer direct composite resin restoration over Biodentine and RetroMTA.
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Affiliation(s)
- Ozge Celiksoz
- Department of Restorative Dentistry, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Ozgur Irmak
- Department of Restorative Dentistry, Faculty of Dentistry, Cyprus Health and Social Sciences University, Guzelyurt, Cyprus
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16
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Asgary S, Roghanizadeh L, Eghbal MJ, Akbarzadeh Baghban A, Aminoshariae A, Nosrat A. Outcomes and predictive factors of vital pulp therapy in a large-scale retrospective cohort study over 10 years. Sci Rep 2024; 14:2063. [PMID: 38267594 PMCID: PMC10808198 DOI: 10.1038/s41598-024-52654-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/22/2024] [Indexed: 01/26/2024] Open
Abstract
This cohort study evaluated the long-term success/survival of vital pulp therapies (VPTs) after carious pulp exposure in adult teeth. Additionally, factors influencing long-term success were identified. Teeth treated during 2011-2022 in a private clinic were studied with clinical/radiographic follow-ups. Data included patient demographics, tooth specifics, and treatment details. Outcomes were classified as success/failure based on clinical/radiographic findings, with tooth functionality determining the survival rate. Encompassing 1149 patients and 1257 VPT-treated teeth, the average monitoring period was 42.2 months. Overall VPTs' survival and success rates were 99.1% and 91.6%, respectively. Success rates for 768 direct pulp cappings, 217 miniature pulpotomies, and 272 full pulpotomies were 91.9%, 92.6%, and 90.1%, respectively (P > 0.05). Influencing factors included symptomatic irreversible pulpitis (SIP; HR 1.974, 95% CI 1.242-3.137; P = 0.004), radiographic signs of apical periodontitis (AP; HR 2.983, 95% CI 1.961-4.540; P < 0.001), restoration type (HR 2.263, 95%CI 1.423-3.600; P = 0.001), and restoration surfaces (HR 1.401, 95%CI 1.034-1.899; P = 0.030). This study concludes that VPT techniques consistently exhibit high long-term success/survival rates in treating carious pulp exposures. Critical predictors include initial clinical signs of SIP/AP, caries extent, and use of composite restorations.
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Affiliation(s)
- Saeed Asgary
- Iranian Centre for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Leyla Roghanizadeh
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mohammad Jafar Eghbal
- Iranian Centre for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anita Aminoshariae
- Department of Endodontics, CWRU School of Dental Medicine, Cleveland, OH, USA
| | - Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, School of Dentistry, Baltimore, MD, USA
- Private Practice, Centreville Endodontics, Centreville, VA, USA
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17
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Umre U, Sedani S, Patel A, Bansod A, Kriplani S. Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth. Cureus 2024; 16:e51837. [PMID: 38327954 PMCID: PMC10848179 DOI: 10.7759/cureus.51837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
Strict protocols for evaluating the pulp's preoperative state should be developed, along with a new classification scheme for the different pulp states, as case selection plays a major role in the effectiveness of adult pulpotomy. In this case report, a male patient, age 15, who had a carious lower left first molar underwent pulpotomy. The pulp's initial state was ascertained by pulse oximetry, electric pulp testing (EPT), and cold testing. The final diagnosis was symptomatic irreversible pulpitis. A 12-month follow-up period following the placement of mineral trioxide aggregate (MTA) (MTA Angelus Angelus, Londrina, Brazil; Clinician's Choice, New Milford, CT) and tooth-colored composite restoration revealed no visible anomalies in the postoperative radiographs, and the tooth remained functional and free of symptoms.
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Affiliation(s)
- Utkarsh Umre
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shweta Sedani
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aditya Patel
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akansha Bansod
- Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Simran Kriplani
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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18
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Xie Y, Chen S, Sheng L, Sun Y, Liu S. A New Landscape of Human Dental Aging: Causes, Consequences, and Intervention Avenues. Aging Dis 2023:AD.2022.1224. [PMID: 37163430 PMCID: PMC10389823 DOI: 10.14336/ad.2022.1224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/24/2022] [Indexed: 05/12/2023] Open
Abstract
Aging is accompanied by physical dysfunction and physiologic degeneration that occurs over an individual's lifetime. Human teeth, like many other organs, inevitably undergo chronological aging and age-related changes throughout the lifespan, resulting in a substantial need for preventive, restorative as well as periodontal dental care. This is particularly the case for seniors at 65 years of age and those older but economically disadvantaged. Dental aging not only interferes with normal chewing and digestion, but also affects daily appearance and interpersonal communications. Further dental aging can incur the case of multiple disorders such as oral cancer, encephalitis, and other systemic diseases. In the next decades or even hundreds of years, the proportion of the elderly in the global population will continue to rise, a tendency that attracts increasing attention across multiple scientific and medical disciplines. Dental aging will bring a variety of problems to the elderly themselves and poses serious challenges to the medical profession and social system. A reduced, but functional dentition comprising 20 teeth in occlusion has been proposed as a measurement index of successful dental aging. Healthy dental aging is critical to healthy aging, from both medical and social perspectives. To date, biomedical research on the causes, processes and regulatory mechanisms of dental aging is still in its infancy. In this article, updated insights into typical manifestations, associated pathologies, preventive strategies and molecular changes of dental aging are provided, with future research directions largely projected.
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Affiliation(s)
- Yajia Xie
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
- Department of Endodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Lu Sheng
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Yu Sun
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China
- Department of Pharmacology, Institute of Aging Medicine, Binzhou Medical University, Yantai, Shandong, China
- Department of Medicine and VAPSHCS, University of Washington, Seattle, WA 98195, USA
| | - Shangfeng Liu
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
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19
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Liu G, Bae KB, Yang Y, Lee BN, Hwang YC. Icariin negatively regulated lipopolysaccharide-induced inflammation and ameliorated the odontogenic activity of human dental pulp cells in vitro. Heliyon 2023; 9:e23282. [PMID: 38144358 PMCID: PMC10746513 DOI: 10.1016/j.heliyon.2023.e23282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/27/2023] [Accepted: 11/30/2023] [Indexed: 12/26/2023] Open
Abstract
Alleviating inflammation and promoting dentine regeneration is critical for the healing of pulpitis. In this study, we investigated the anti-inflammatory, angiogenesis and odontogenesis function of icariin on Human dental pulp cells (HDPCs) under inflammatory state. Furthermore, the underlying mechanisms was also evaluated. Icariin attenuated the LPS-induced pro-inflammatory marker expression, such as interleukin-1β (IL-1β), IL-6 and IL-8. The immunoblotting and immunofluorescence staining results showed that icariin suppressed the inflammatory responses mediated by the protein kinase B (Akt) and nuclear factor kappa-B (NF-κB) signaling cascades. Additionally, icariin also upregulated the expression of odontogenic and angiogenic genes and proteins (namely dentin sialophosphoprotein (DSPP), dentin matrix protein 1 (DMP1), anti-collagen Ⅰ (COL-Ⅰ), and vascular endothelial growth factor (VEGF) and fibroblast growth factor-1 (FGF-1)), alkaline phosphatase activity, and calcium nodule deposition in LPS-exposed HDPCs. In a word, our findings indicated that icariin attenuated pulp inflammation and promoted odontogenic and angiogenic differentiation in the inflammatory state. Icariin may be a promising vital pulp therapy agent for the regenerative treatment of the inflamed dental pulp.
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Affiliation(s)
- Guo Liu
- Department of Endodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325000, China
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, 61186, South Korea
| | - Kkot-Byeol Bae
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, 61186, South Korea
| | - Ying Yang
- Dental Implant Center, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325000, China
| | - Bin-Na Lee
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, 61186, South Korea
| | - Yun-Chan Hwang
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, 61186, South Korea
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20
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Pugdee K, Klaisiri A, Phumpatrakom P. The viability of human dental pulp cells and apical papilla cells after treatment with conventional calcium hydroxide and nanoparticulate calcium hydroxide at various concentrations. Saudi Dent J 2023; 35:1000-1006. [PMID: 38107041 PMCID: PMC10724347 DOI: 10.1016/j.sdentj.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Nanoparticulate Ca(OH)2 had greater antibacterial effect than conventional Ca(OH)2. Conversely, a study reported that nanoparticulate Ca(OH)2 had toxicity against murine fibroblast. However, the study of nanoparticulate Ca(OH)2, involving human dental pulp cells (DPCs) and apical papilla cells (APCs) is lacking. The aim of this study is to compare the effects of conventional Ca(OH)2 and nanoparticulate Ca(OH)2 on the viability of DPCs and APCs. Methods Primary human DPCs/APCs from the 3rd to 5th passage were divided into control and experimental groups. In the control group, cells were cultured in complete media. In the experimental group, cells were cultured in complete media containing 10, 100, or 1000 μg/mL of either conventional Ca(OH)2 or nanoparticulate Ca(OH)2 for 1, 3, 5, and 7 days. After the treatment period, the cells were tested for viability using MTT assay. Results DPCs treated with conventional Ca(OH)2 in all concentrations at day 5 revealed significantly higher proliferation compared to nanoparticulate Ca(OH)2 treated groups. In additions, DPCs treated with 1000 µg/ml nanoparticulate Ca(OH)2 at day7 were significantly lower proliferation compared to DPCs treated with conventional Ca(OH)2. In contrast, APCs treated with 1000 µg/ml nanoparticulated Ca(OH)2 were significantly higher proliferation than APCs treated with 1000 µg/ml conventional Ca(OH)2 at day7. Conclusions Nanoparticulate Ca(OH)2 increased the viability of APCs and can be an alternative choice of intracanal medication for regenerative endodontic procedures. However, Nanoparticulate Ca(OH)2 exerted some effects on DPCs. The use of nanoparticulate Ca(OH)2 has no advantages over the conventional Ca(OH)2 for vital pulp therapy.
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Affiliation(s)
- Kamolparn Pugdee
- Division of Oral Biology, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - Awiruth Klaisiri
- Division of Operative Dentistry, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - Panupat Phumpatrakom
- Division of Endodontics, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
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Ngamthuam I, Manmontri C, Chompu-Inwai P, Phinyo P, Nirunsittirat A, Chaipattanawan N. Outcomes of coronal pulpotomy on permanent first molars in children: a retrospective cohort study. Clin Oral Investig 2023; 27:7473-7488. [PMID: 37857735 DOI: 10.1007/s00784-023-05336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES To investigate the survival probability of permanent first molars (PFMs) after coronal pulpotomy (CP) using two outcome definitions: success-focused and functional survival-focused, and to identify factors influencing tooth survival. MATERIALS AND METHODS A retrospective cohort study reviewing records of children undergoing CP with calcium silicate-based cements (CSCs) on PFMs. Each CP-treated PFM was classified as success, uncertain, failure, or censored. Survival probability was analyzed using Kaplan-Meier estimators. Success-focused definition considered failures and uncertain outcomes as events, while functional survival-focused definition considered only failures as events. Prognostic factors were analyzed using Cox regression analysis. RESULTS Seventy-seven CP-treated PFMs with a follow-up period of 6-111 months. Using the success-focused definition (two failures and 12 uncertain outcomes as events), survival probabilities were 93.1% (95% CI 84.3-97.1%) at 12 months, 78.7% (95% CI 65.6-87.3%) at 36 months, and 74.9% (95% CI 59.5-89.0%) at 60-111 months. However, with the functional survival-focused definition, survival probabilities were 100% at 12 months and 96.6% (95% CI 86.9-99.1%) at 24-111 months. In multivariable analysis, proximal lesions increased failure risk compared to occlusal lesions (HR 17.17, 95% CI 2.18-135.31, p < 0.01), and resin composite restorations had higher failure risk than stainless steel crowns (HR 13.97, 95% CI 1.49-130.69, p < 0.05). CONCLUSIONS CP using CSCs shows long-term survival potential as an alternative treatment for cariously exposed PFMs in children. CLINICAL RELEVANCE Proximal lesions and resin composite restoration could contribute to the lower survival, indicating the need for careful consideration of restoration options and lesion location during treatment planning.
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Affiliation(s)
- Inruja Ngamthuam
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Chanika Manmontri
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Chiang Mai University, Chiang Mai, Thailand.
| | - Papimon Chompu-Inwai
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Department of Family Medicine and Center for Clinical Epidemiology and Clinical Statistics, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research (MSTR) cluster, Chiang Mai University, Chiang Mai, Thailand
| | - Areerat Nirunsittirat
- Division of Community Dentistry, Department of Family and Community Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Nattakan Chaipattanawan
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Chiang Mai University, Chiang Mai, Thailand
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22
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Fasoulas A, Keratiotis G, Spineli L, Pandis N, De Bruyne MAA, De Moor RJ, Meire MA. Comparative efficacy of materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth: A systematic review and meta-analysis. Clin Exp Dent Res 2023; 9:1129-1148. [PMID: 37710421 PMCID: PMC10728530 DOI: 10.1002/cre2.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Different materials have been used for capping the pulp after exposure during caries removal in permanent teeth. The purpose of this study was to collate and analyze all pertinent evidence from randomized controlled trials (RCTs) on different materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth. MATERIALS AND METHODS Trials comparing two or more capping agents used for direct pulp capping (DPC) or pulpotomy were considered eligible. An electronic search of four databases and two clinical trial registries was carried out up to February 28, 2021 using a search strategy properly adapted to the PICO framework. Screening, data extraction, and risk of bias (RoB) assessment of primary studies were performed in duplicate and independently. The primary outcome was clinical and radiological success; secondary outcomes included continued root formation, tooth discoloration, and dentin bridge formation. RESULTS 21 RCTs were included in the study. The RoB assessment indicated a moderate risk among the studies. Due to significant clinical and statistical heterogeneity among the studies, performing network meta-analysis (NMA) was not possible. An ad hoc subgroup analysis revealed strong evidence of a higher success of DPC with Mineral Trioxide Aggregate (MTA) compared to calcium hydroxide (CH) (odds ratio [OR] = 3.10, 95% confidence interval [CI]: 1.66-5.79). MTA performed better than CH in pulp capping (both DPC and pulpotomy) of mature compared to immature teeth (OR = 3.34, 95% CI: 1.81-6.17). The GRADE assessment revealed moderate strength of evidence for DPC and mature teeth, and low to very low strength of evidence for the remaining subgroups. CONCLUSIONS Considerable clinical and statistical heterogeneity among the trials did not allow NMA. The ad hoc subgroup analysis indicated that the clinical and radiographic success of MTA was higher than that of CH but only in mature teeth and DPC cases where the strength of evidence was moderate. PROSPERO Registration: number CRD42020127239.
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Affiliation(s)
- Athanasios Fasoulas
- Department of Oral Health Sciences, Section of EndodontologyGhent UniversityGhentBelgium
| | - Georgios Keratiotis
- Department of Oral Health Sciences, Section of EndodontologyGhent UniversityGhentBelgium
| | - Loukia Spineli
- Midwifery Research and Education UnitHannover Medical SchoolHannoverGermany
| | - Nikos Pandis
- Department of Orthodontics and Dentofacial OrthopaedicsUniversity of BernBernSwitzerland
| | - Mieke A. A. De Bruyne
- Department of Oral Health Sciences, Section of EndodontologyGhent UniversityGhentBelgium
| | - Roeland J.G. De Moor
- Department of Oral Health Sciences, Section of EndodontologyGhent UniversityGhentBelgium
| | - Maarten A. Meire
- Department of Oral Health Sciences, Section of EndodontologyGhent UniversityGhentBelgium
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23
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Chua SKX, Sim YF, Wang WC, Mok BYY, Yu VSH. One-year outcome of selective caries removal versus pulpotomy treatment of deep caries: A pilot randomized controlled trial. Int Endod J 2023; 56:1459-1474. [PMID: 37795835 DOI: 10.1111/iej.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/20/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
AIM This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine. METHODOLOGY This two-armed, parallel-group, randomized, superiority trial included vital mature permanent teeth with deep primary or secondary caries diagnosed radiographically as being at least 75% into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were blindly allocated to receive either SCR or Pulpotomy using computer-generated randomized patient codes concealed in opaque envelopes. All teeth were reviewed clinically and radiographically at 6 months and 1 year post-treatment. Using a significance level of p < .05, the log rank test and Cox proportional hazards regression were used to compare the outcome of SCR and Pulpotomy and to identify potential prognostic factors, respectively. RESULTS In all, 58 teeth in the SCR group and 55 teeth in the pulpotomy group completed treatment, after excluding 6 teeth because they did not complete the allocated treatment and another due to severe periodontal disease. At one year, 57/58 (98.3%) teeth from the SCR group and 48/55 (87.3%) teeth from the Pulpotomy group were available for analysis. One tooth in the Pulpotomy group (2.1%) and eight teeth in the SCR group (14.0%) required the further intervention of root canal treatment (p < .05). There were no other significant prognostic factors for survival. Overall, 91.4% of teeth treated with either SCR or Pulpotomy survived without requiring further intervention over a period of one year. No other adverse events occurred over the review period. CONCLUSION Within the limitations of this study, Pulpotomy fares better than SCR in preserving the remaining pulp and periapical health. As a treatment modality, Pulpotomy carries greater cost outlay to patient and takes a longer time to complete treatment than SCR. Long-term follow-up is needed to study the pulpal and restorative outcomes of Pulpotomy and SCR.
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Affiliation(s)
- S K X Chua
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - Y F Sim
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - W C Wang
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - B Y Y Mok
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - V S H Yu
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
- Oral Care Health Innovation and Designs Singapore (ORCHIDS), National University of Singapore, Singapore City, Singapore
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24
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dos Santos FFV, Habelitz S, Nascimento FD, Arana-Chavez VE, Braga RR. Poly(Aspartic Acid) Promotes Odontoblast-like Cell Differentiation in Rat Molars with Exposed Pulp. J Funct Biomater 2023; 14:537. [PMID: 37998106 PMCID: PMC10672631 DOI: 10.3390/jfb14110537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
In recent years, alternative pulpal therapies targeting dentinogenesis signaling pathways using different peptides have been investigated. The aim of this study was to verify the effectiveness of poly(aspartic acid), pAsp, in dentin regeneration using an animal model. METHODS Mechanical pulp exposure was performed in the upper molars of 56 Wistar rats, randomly divided as follows (n = 14): control (no treatment); MTA group-pulp capping with mineral trioxide aggregate (MTA Angelus); pAsp group-application of 20 μL of pAsp solution (25 mg·mL-1); MTA+pAsp group-application of MTA mixed with pAsp (5:1 by mass). Animals were euthanized after 7 or 21 days. Histological sections were submitted to hematoxylin-eosin and Brown and Brenn staining and immunohistochemical analysis for osteopontin (OPN) and dentin matrix protein 1 (DMP 1). RESULTS At 7 days, an acute inflammatory infiltrate and the presence of disorganized mineralized tissue were observed in all groups. At 21 days, the quality and thickness of the reparative dentin in treated groups were superior to the control, and bacterial contamination was observed in two MTA-pAsp specimens. While all treated groups showed intense immunostaining for OPN at 21 days, only the pAsp group expressed DMP 1, indicating the presence of fully differentiated odontoblast-like cells. CONCLUSION Poly(aspartic) acid promoted dentin regeneration in rat molars in the absence of an additional calcium source and may be an alternative to MTA as a pulp-capping agent.
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Affiliation(s)
- Fernanda Furuse Ventura dos Santos
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo 05508-000, SP, Brazil; (V.E.A.-C.); (R.R.B.)
| | - Stefan Habelitz
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, CA 94143, USA;
| | - Fábio Dupart Nascimento
- Molecular Biology Division, Department of Biochemistry, Federal University of São Paulo, São Paulo 04044-020, SP, Brazil;
| | - Victor Elias Arana-Chavez
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo 05508-000, SP, Brazil; (V.E.A.-C.); (R.R.B.)
| | - Roberto Ruggiero Braga
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo 05508-000, SP, Brazil; (V.E.A.-C.); (R.R.B.)
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25
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Alhilou AM, Al-Moraissi EA, Bakhsh A, Christidis N, Näsman P. Pain after emergency treatments of symptomatic irreversible pulpitis and symptomatic apical periodontitis in the permanent dentition: a systematic review of randomized clinical trials. FRONTIERS IN ORAL HEALTH 2023; 4:1147884. [PMID: 37920592 PMCID: PMC10618681 DOI: 10.3389/froh.2023.1147884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023] Open
Abstract
Background Symptomatic irreversible pulpitis (SIP) or symptomatic apical periodontitis (SAP) are two painful conditions often warranting emergency treatment. The most common emergency treatments supported by evidence are pulpotomy and pulpectomy and are normally performed under time-constrained circumstances. However, there is no strong evidence of which treatment suggested in literature a clinician can use to reduce endodontic pain effectively. Therefore, the aim of this systematic review is to investigate the present knowledge on postoperative pain related to the two types of emergency treatments available for treating SIP and SAP. Methods Randomized controlled trials investigating postoperative pain after emergency treatments (pulpotomy and/or pulpectomy) on permanent dentition with signs and symptoms of SIP and/or SAP were searched in three major databases from 1978 until 2022. Risk of bias was assessed with Cochrane's tool. Results Only five studies fulfilled the inclusion criteria. The included studies indicated that pulpotomy and pulpectomy are both suitable treatment options for SAP and SIP, as they provide sufficient alleviation of pain in permanent dentition. However, inconsistent results were found between the included trials on which emergency treatment is more effective in reducing pain. Cochrane's tool revealed that the studies had a low risk of bias. Limitations found in the design of the included randomized control trials decreased the level of evidence. None of the included studies accounted for essential confounding variables, such as factors affecting pain (including the psychological aspects). Moreover, possible non-odontogenic pain was not assessed, and therefore, it was not excluded; hence, affecting the internal validity of the studies. Conclusion There are controversies within the available randomized control trials on which treatment is most effective in reducing emergency pain. This could be due to some weaknesses in the design of the clinical trials. Thus, further well-designed studies are warranted to draw conclusions on which emergency treatment is more effective in reducing pain. Systematic Review Registration PROSPERO (CRD42023422282).
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Affiliation(s)
- Abdelrahman M. Alhilou
- Department of Restorative Dentistry, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
| | - Abdulaziz Bakhsh
- Department of Restorative Dentistry, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
| | - Peggy Näsman
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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26
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Zenaldeen R, Kaddoura R, Alzoubi H, Achour H, Aljabban O. Partial Pulpotomy in Mature Permanent Molars with Symptoms Indicated Irreversible Pulpitis Using MTA: A Study of Three Case Reports over Four-Year Follow-Up. Case Rep Dent 2023; 2023:1344101. [PMID: 37885448 PMCID: PMC10598476 DOI: 10.1155/2023/1344101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/13/2023] [Accepted: 09/08/2023] [Indexed: 10/28/2023] Open
Abstract
VPT is vital pulp therapy, a biologically based procedure that combines several therapeutic techniques to maintain the entire or a portion of the dental pulp. Interest in VPT has grown due to recent developments in bioactive materials and an understanding of biological pulp reparative responses. This case report is aimed at evaluating the success rate of partial pulpotomy in permanent molars with symptoms indicating irreversible pulpitis using MTA and presenting with extremely deep carious lesions over four years of follow-up. All patients came with spontaneous and severe pain. Each tooth was isolated with a rubber dam and disinfected with 5.25% NaOCl before caries excavation. After caries removal, a partial pulpotomy was performed on 2-3 mm of the exposed pulp. Bleeding time was recorded after hemostasis was achieved, and then MTA was placed over the exposed pulp. The permanent restoration was placed after pulp capping, and postoperative periapical radiographs were taken. Patients were scheduled for clinical and radiological examinations for four years based on 6-month intervals. All teeth revealed a successful outcome throughout the follow-up periods (clinically and radiographically) with complete resolution of clinical signs and symptoms. Partial pulpotomy using MTA might be an effective long-term management strategy for permanent molars clinically diagnosed with irreversible pulpitis.
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Affiliation(s)
- Rami Zenaldeen
- Department of Endodontics and Operative Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Rami Kaddoura
- Department of Endodontics and Operative Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Hasan Alzoubi
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Hassan Achour
- Department of Endodontics and Operative Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Ossama Aljabban
- Department of Endodontics and Operative Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
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27
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Jakovljevic A, Jaćimović J, Aminoshariae A, Fransson H. Effectiveness of vital pulp treatment in managing nontraumatic pulpitis associated with no or nonspontaneous pain: A systematic review. Int Endod J 2023; 56 Suppl 3:340-354. [PMID: 35579062 DOI: 10.1111/iej.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The exposed pulp has been the topic of numerous studies, but well-designed and well-executed comparative trials on the outcome and treatment of these teeth have been limited. OBJECTIVES This study was conducted to answer the following questions: in patients with nontraumatic pulpitis associated with no or nonspontaneous pain in permanent teeth, (i) is direct pulp capping or pulpotomy (partial/full) as effective as selective or stepwise caries removal [Population/participants, Intervention(s), Comparator(s)/control, Outcome(s) (PICO) 1], (ii) is pulpotomy (partial/full) as effective as direct pulp capping (PICO 2) and (iii) is pulpotomy (partial/full) as effective as a pulpectomy (PICO 3), in terms of a combination of patient and clinical reported outcomes, with 'tooth survival' as the most critical outcome? METHODS A literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials from inception to November 3rd 2021. Grey literature and contents of the major subject journals were examined. Eligibility criteria followed the PICO questions. Two independent reviewers performed study selection, data extraction and appraisal; disagreements were resolved by a third reviewer. The risk of bias was assessed by the revised Cochrane risk-of-bias tool for randomized trials. RESULTS Three randomized clinical trials (RCTs) were included in the review. No study fulfilled the criteria to answer PICO 1. There were no significant differences in the reported outcomes between investigated treatments in all included RCTs. None of the included studies reported the most critical outcome 'tooth survival'. A high loss of patients during the follow-up period was observed. DISCUSSION Although a few studies fulfilled strict eligible criteria, the results of this systematic review clearly highlight a paucity of available evidence. At the present time, clinical decisions cannot be substantiated by direct comparative trials. CONCLUSIONS Based on limited evidence, this systematic review discovered no significant differences in effectiveness between compared vital pulp treatments in managing nontraumatic pulpitis associated with no or nonspontaneous pain. Further high-quality RCTs are necessary to investigate the effectiveness of direct pulp capping or pulpotomy (partial/full) compared to selective or stepwise caries removal. REGISTRATION PROSPERO database (CRD42021259742).
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Affiliation(s)
- Aleksandar Jakovljevic
- Department of Pathophysiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Jaćimović
- Central Library, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Anita Aminoshariae
- Department of Endodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Helena Fransson
- Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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28
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Rueda-Ibarra V, Robles-Bermeo NL, González-López BS, Medina-Solís CE, Serrano-Robles JG, Márquez Rodríguez S, Bermeo-Escalona JR, Delgado-Pérez VJ, Maupomé G. Full Pulpotomy as a Treatment for Irreversible Pulpitis in Permanent Teeth: A Systematic Review of the Literature Based on Case Reports. Cureus 2023; 15:e46808. [PMID: 37954774 PMCID: PMC10635780 DOI: 10.7759/cureus.46808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
The objective of this systematic review was to evaluate the current evidence of case reports where the treatment for permanent teeth with a diagnosis of irreversible pulpitis was a full pulpotomy. This study was carried out by two reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic electronic search was carried out in the PubMed, Google Scholar, and Scopus databases until the year 2022 to find articles in English where the treatment for irreversible pulpitis in permanent teeth was a full pulpotomy. Literature reviews, in vitro or animal studies, abstracts, and unpublished data were excluded. The intervention, control, and outcome parameters were selected following the "Population, Interventions, Control, and Outcome" (PICO) guidelines. A total of 636 articles were found, and 14 articles were selected to be included in this review. The selected articles describe cases of full pulpotomies in mature permanent teeth with a diagnosis of irreversible pulpitis with a total of 34 (100%) successful cases, where 18 were men and 16 were women, with an average age of 19.20 ± 10.59 years and an average follow-up of 35.82 ± 26.39 months, with 12 months being the minimum follow-up time. The material used most frequently for obturation of the full pulpotomy was mineral trioxide aggregate in 16 cases (47.06%). Within the limitations of this review, full pulpotomy presents a high success rate regardless of the tooth, age, or sex as a treatment for teeth diagnosed with irreversible pulpitis.
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Affiliation(s)
- Vicente Rueda-Ibarra
- School of Dentistry, Autonomous University of the State of Mexico, Toluca, MEX
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of the State of Hidalgo, Pachuca, MEX
| | - Norma L Robles-Bermeo
- Advanced Studies and Research Center in Dentistry "Dr. Keisaburo Miyata", School of Dentistry, Autonomous University of the State of Mexico, Toluca, MEX
| | - Blanca S González-López
- Advanced Studies and Research Center in Dentistry "Dr. Keisaburo Miyata", School of Dentistry, Autonomous University of the State of Mexico, Toluca, MEX
| | - Carlo E Medina-Solís
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of the State of Hidalgo, Pachuca, MEX
| | - José G Serrano-Robles
- Center for Research in Health Sciences, Faculty of Health Sciences, Anahuac University North Campus, Ciudad de Mexico, MEX
| | - Sonia Márquez Rodríguez
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of the State of Hidalgo, Pachuca, MEX
| | | | - Victor J Delgado-Pérez
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of the State of Hidalgo, Pachuca, MEX
| | - Gerardo Maupomé
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, USA
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29
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Ma Z, Shen P, Xu X, Li W, Li Y. Role of alpha smooth muscle actin in odontogenic differentiation of dental pulp stem cells. Eur J Oral Sci 2023; 131:e12956. [PMID: 37849216 DOI: 10.1111/eos.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023]
Abstract
Pulpotomy is an effective treatment for retaining vital pulp after pulp exposure caused by caries removal and/or trauma. The expression of alpha smooth muscle actin (α-SMA) is increased during the wound-healing process, and α-SMA-positive fibroblasts accelerate tissue repair. However, it remains largely unknown whether α-SMA-positive fibroblasts influence pulpal repair. In this study, we established an experimental rat pulpotomy model and found that the expression of α-SMA was increased in dental pulp after pulpotomy relative to that in normal dental pulp. In vitro results showed that the expression of α-SMA was increased during the induction of odontogenic differentiation in dental pulp stem cells (DPSCs) compared with untreated DPSCs. Moreover, α-SMA overexpression promoted the odontogenic differentiation of DPSCs via increasing mitochondrial function. Mechanistically, α-SMA overexpression activated the mammalian target of rapamycin (mTOR) signaling pathway. Inhibition of the mTOR signaling pathway by rapamycin decreased the mitochondrial function in α-SMA-overexpressing DPSCs and suppressed the odontogenic differentiation of DPSCs. Furthermore, we found that α-SMA overexpression increased the secretion of transforming growth factor beta-1 (TGF-β1). In sum, our present study demonstrates a novel mechanism by which α-SMA promotes odontogenic differentiation of DPSCs by increasing mitochondrial respiratory activity via the mTOR signaling pathway.
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Affiliation(s)
- Zeyi Ma
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Peiqi Shen
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Xiaoqing Xu
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Weiyu Li
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Yaoyin Li
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
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30
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Tomson PL, Vilela Bastos J, Jacimovic J, Jakovljevic A, Pulikkotil SJ, Nagendrababu V. Effectiveness of pulpotomy compared with root canal treatment in managing non-traumatic pulpitis associated with spontaneous pain: A systematic review and meta-analysis. Int Endod J 2023; 56 Suppl 3:355-369. [PMID: 36209498 DOI: 10.1111/iej.13844] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulpitis characterized by spontaneous pain can result in debilitating pain. Dogma has existed to offer only have two treatment options, namely root canal treatment (RCT) or extraction, although pulpotomy has always remained a potential treatment modality. OBJECTIVE This review aimed to answer the following research question: 'Does pulpotomy (partial or full) (I) result in better patient and clinical reported outcomes (O), compared with RCT (C) in permanent teeth with pulpitis characterized by spontaneous pain (P) evaluated at various time intervals?' (T). METHODS Two authors independently performed study selection, data extraction and risk of bias assessment. The literature search was conducted in the following electronic databases: Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials. English language clinical trials comparing the patient and clinical reported outcomes between RCT and pulpotomy were included. The meta-analysis was performed on a fixed-effect model and the quality of evidence assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS Two randomized clinical trials were included. Amongst two trials, one has published four reports at different time points involving the same cohorts. The meta-analysis revealed no difference in postoperative pain (Day 7) between RCT and pulpotomy (OR = 0.99, 95% CI 0.63-1.55, I2 = 0%) and quality of evidence was graded as 'High'. Clinical success was high at year 1, 98% for both interventions, however, decreased over time to 78.1% (pulpotomy) and 75.3% (RCT) at 5 years. DISCUSSION Pulpotomy is a definitive treatment modality that is as effective as RCT. This could have a significant impact on treatment of such patients affording the advantages of retaining a vital pulp and preventing the need for RCT. CONCLUSION This review could only include two trials, hence there is insufficient evidence to draw robust conclusions. The clinical data accumulated so far suggests no difference in pain between RCT and pulpotomy at Day 7 postoperatively and a single randomized control trial suggests that the clinical success rate for both treatment modalities is similar long term. There is a need for more well-designed trials by different research groups to develop a stronger evidence base in this area. REGISTRATION PROSPERO database (CRD42021259744).
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Affiliation(s)
- Phillip L Tomson
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Juliana Vilela Bastos
- Department of Restorative Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jelena Jacimovic
- Central Library, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Jakovljevic
- Department of Pathophysiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Shaju Jacob Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Afkhami F, Rostami G, Xu C, Walsh LJ, Peters OA. The application of lasers in vital pulp therapy: a review of histological effects. Lasers Med Sci 2023; 38:215. [PMID: 37733149 PMCID: PMC10514114 DOI: 10.1007/s10103-023-03854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/08/2023] [Indexed: 09/22/2023]
Abstract
Vital pulp therapy (VPT) is primarily intended to preserve the vitality of pulp tissues, which have been exposed for any reason. Various materials and techniques have been proposed to improve treatment outcomes, including the use of lasers. This study aimed to review the histological results of different dental lasers including low-level lasers, carbon dioxide (CO2), erbium-doped yttrium aluminum garnet laser (Er:YAG), neodymium-doped yttrium aluminum garnet (Nd:YAG), erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, and diode lasers for VPT. This focused review included a comprehensive electronic search of Scopus, MEDLINE, Web of Science, and Google Scholar databases from 2000 to 2022 by two independent investigators. Different combinations of keywords were used, and reference mining of related papers was done. The review included studies related to histologic evaluation of laser-assisted vital pulp therapy that stated the laser parameters that were used. Articles with radiographic or clinical assessments or articles lacking necessary data were excluded. Non-English articles were excluded unless their abstract was in English and encompassed the necessary data. Most studies indicated the efficacy of lasers for reduction of inflammation, acceleration of healing, and increasing the thickness of dentinal bridge. According to the evidence, lasers used in combination with pulp capping agents are beneficial to enhance the success rate of VPT.
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Affiliation(s)
- Farzaneh Afkhami
- School of Dentistry, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia.
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
| | - Golriz Rostami
- Laser Research Center of Dentistry, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Chun Xu
- School of Dentistry, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia
| | - Laurence J Walsh
- School of Dentistry, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia
| | - Ove A Peters
- School of Dentistry, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia
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Tzanetakis GN, Papanakou S, Koletsi D, Georgopoulou M. Outcome of Partial Pulpotomy in Immature Permanent Teeth with Symptomatic Irreversible Pulpitis: A Prospective Case Series Assessment. J Endod 2023; 49:1120-1128. [PMID: 37442339 DOI: 10.1016/j.joen.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION The aim of this prospective case series was to assess the clinical and radiographic outcome of partial pulpotomy in caries-exposed symptomatic, vital, immature, permanent molars. METHODS Thirty-four immature molars with deep caries and symptoms of irreversible pulpitis were treated by partial pulpotomy and ProRoot MTA as a capping material. After complete caries removal, the inflamed part of the pulp was removed. Complete hemostasis was achieved using a sterile cotton pellet moist initially with sodium hypochlorite 1.5% and then with sterile saline. ProRoot MTA (Dentsply Sirona, Charlotte, NC) was placed as a capping material onto the remaining pulp tissue. The cavity was sealed using a light-curing resin-modified Ca(OH)2 cavity liner, and patients were referred to a pediatric dentist for permanent restoration. Descriptive statistics and cross tabulations were performed including variables examined before, during, and after the procedure. RESULTS All examined teeth presented a favorable clinical and radiographic outcome with normal periapical tissues, complete apical closure, and formation of a dentinal bridge beneath the capping material. Signs of partial pulp chamber calcification were only detected in 2 cases. Postoperatively, most patients did not report any pain (23/34, 67.7%), whereas the rest reported minor intensity pain (11/34, 32.3) and the use of analgesic or anti-inflammatory drugs only for 1 day (10/34, 29.4%). CONCLUSIONS Partial pulpotomy seems to provide a universally successful outcome when managing symptomatic vital immature teeth with no signs of complications and completion of apical closure. It could be a viable treatment of choice in cases of caries-exposed vital immature teeth with symptoms of irreversible pulpitis.
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Affiliation(s)
- Giorgos N Tzanetakis
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | | | - Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland; Meta-Research Innovation Center at Stanford, Stanford University, Stanford, California
| | - Maria Georgopoulou
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Xie F, Zhu C, Gong L, Zhu N, Ma Q, Yang Y, Zhao X, Qin M, Lin Z, Wang Y. Engineering core-shell chromium nanozymes with inflammation-suppressing, ROS-scavenging and antibacterial properties for pulpitis treatment. NANOSCALE 2023; 15:13971-13986. [PMID: 37606502 DOI: 10.1039/d3nr02930a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Oral diseases are usually caused by inflammation and bacterial infection. Reactive oxygen species (ROS), which come from both autologous inflammation tissue and bacterial infection, play an important role in this process. Thus, the elimination of excessive intracellular ROS can be a promising strategy for anti-inflammatory treatment. With the rapid development of nanomedicines, nanozymes, which can maintain the intracellular redox balance and protect cells against oxidative damage, have shown great application prospects in the treatment of inflammation-related diseases. However, their performance in pulpitis and their related mechanisms have yet to be explored. Herein, we prepared dozens of metallic nanoparticles with core-shell structures, and among them, chromium nanoparticles (NanoCr) were selected for their great therapeutic potential for pulpitis disease. NanoCr showed a broad antibacterial spectrum and strong anti-inflammatory function. Antibacterial assays showed that NanoCr could effectively inhibit a variety of common pathogens of oral infection. In vitro experiments offered evidence of the multienzyme activity of NanoCr and its function in suppressing ROS-induced inflammation reactions. The experimental results show that NanoCr has optimal antibacterial and anti-inflammatory properties in in vitro cell models, showing great potential for the treatment of pulpitis. Therefore, the use of NanoCr could become a new therapeutic strategy for clinical pulpitis.
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Affiliation(s)
- Fei Xie
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing 100081, P.R. China.
| | - Chuanda Zhu
- Institute of Systems Biomedicine, School of Basic Medical Sciences, Beijing Key Laboratory of Tumor Systems Biology, Peking University Health Science Center, Beijing 100191, P.R. China.
- Department of Biochemistry and Biophysics, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, P.R. China
| | - Lidong Gong
- Institute of Systems Biomedicine, School of Basic Medical Sciences, Beijing Key Laboratory of Tumor Systems Biology, Peking University Health Science Center, Beijing 100191, P.R. China.
| | - Ningxin Zhu
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing 100081, P.R. China.
| | - Qiang Ma
- Institute of Environment and Sustainable Development in Agriculture, Chinese academy of Agriculture, Beijing 100081, P.R. China
| | - Yuanyuan Yang
- Institute of Systems Biomedicine, School of Basic Medical Sciences, Beijing Key Laboratory of Tumor Systems Biology, Peking University Health Science Center, Beijing 100191, P.R. China.
| | - Xinrong Zhao
- Center of Medical and Health Analysis, Peking University Health Science Center, Beijing 100191, P.R. China
| | - Man Qin
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing 100081, P.R. China.
| | - Zhiqiang Lin
- Institute of Systems Biomedicine, School of Basic Medical Sciences, Beijing Key Laboratory of Tumor Systems Biology, Peking University Health Science Center, Beijing 100191, P.R. China.
| | - Yuanyuan Wang
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, Beijing 100081, P.R. China.
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Chung M, Lee S, Kim S, Kim E. Inflammatory response and odontogenic differentiation of inflamed dental pulp treated with different pulp capping materials: An in vivo study. Int Endod J 2023; 56:1118-1128. [PMID: 37350351 DOI: 10.1111/iej.13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
AIM Previous studies have evaluated the pulpal responses to calcium silicate cements (CSCs) on normal dental pulp, but investigations on the effects of CSCs on inflamed pulp are limited. This study aimed to test the inflammatory response and odontogenic differentiation of inflamed rat dental pulp after direct pulp capping with CSCs. METHODOLOGY Wistar rat molars pulps were exposed for 48 h to induce inflammation and then capped with ProRoot MTA (Dentsply), Biodentine (Septodont), RetroMTA (Bio MTA) and Dycal (Dentsply Caulk). The degree of pulpal inflammation and hard tissue formation was evaluated by histological analysis. Immunofluorescence staining for interleukin (IL)-6, osteocalcin (OCN) and runt-related transcription factor 2 (RUNX2) was also performed. RESULTS After 4 weeks, complete recovery from inflammation was evident in 22%, 37.5%, 10% and none of the ProRoot MTA, Biodentine, RetroMTA and Dycal samples, respectively. Heavy hard tissue deposition as a continuous hard tissue bridge was observed in 77.8%, 75%, 70% and 60% of the ProRoot MTA, Biodentine, RetroMTA and Dycal samples, respectively. IL-6, OCN and RUNX2 were detected in all materials, mainly adjacent to areas of inflammation and reparative dentine formation. At one, two and 4 weeks, significant differences were not observed between the inflammation and hard tissue formation scores of the four material groups (p > .05). CONCLUSIONS In this study, pulpal inflammation was still present in most specimens at 4 weeks after pulp capping and a significant number of samples showed incomplete and discontinuous dentine bridge formation. The results of this study suggest that initial inflammatory conditions of the pulp may risk the prognosis of teeth treated with CSCs.
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Affiliation(s)
- M Chung
- Department of Conservative Dentistry and Oral Science Research Center, Microscope Center, Yonsei University College of Dentistry, Seoul, South Korea
| | - S Lee
- Oral Science Research Center, Yonsei University College of Dentistry, Seoul, South Korea
| | - S Kim
- Department of Conservative Dentistry and Oral Science Research Center, Microscope Center, Yonsei University College of Dentistry, Seoul, South Korea
| | - E Kim
- Department of Conservative Dentistry and Oral Science Research Center, Microscope Center, Yonsei University College of Dentistry, Seoul, South Korea
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Brizuela C, Meza G, Toro P, Phillips D, Cabrera C, Dezerega A, Concha G. Regenerative endodontic procedure combined with non-surgical root canal treatment in an immature permanent maxillary molar: A 7-year follow-up case report. AUST ENDOD J 2023; 49 Suppl 1:462-469. [PMID: 36533889 DOI: 10.1111/aej.12719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
Abstract
The aim of this report is to present the results of a personalised endodontic treatment for an immature molar, using regenerative endodontic procedure (REP) combined with non-surgical root canal treatment (NSRCT), with 7 years of follow-up. The tooth#3 presented combined endodontic pathologies in each root, with different pulpal and periapical status. A REP in the palatal (P) canal and a NSCRT in the mesio-buccal (MB) and disto-buccal (DB) canals were performed. Absence of clinical signs/symptoms and continuous palatal root development with apical closure were observed over 4-years. After 5-years an apical lesion in the MB root was observed. Both MB canals were selectively retreated by completely filling them with TotalFill BC RRM Fast Set putty. After 7-years, the tooth remained functional and the apical lesion was resolving. The palatal root was completely mature. This case report reveals the potential for use of combined treatment approaches for immature multirooted teeth.
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Affiliation(s)
- Claudia Brizuela
- Biology and Oral Regeneration Research Center (CIBRO), Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Gastón Meza
- Biology and Oral Regeneration Research Center (CIBRO), Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Paulina Toro
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Domingo Phillips
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Carolina Cabrera
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Andrea Dezerega
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Guillermo Concha
- Department of Endodontics, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
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Skitioui M, Seck A, Niang SO, Fikhar A, Touré B. The treatment of mature permanent teeth with irreversible pulpitis by cervical pulpotomy: A systematic review. AUST ENDOD J 2023; 49 Suppl 1:488-493. [PMID: 36149016 DOI: 10.1111/aej.12694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 07/08/2022] [Accepted: 09/09/2022] [Indexed: 01/13/2023]
Abstract
Pulpotomy has been used in primary teeth and immature permanent teeth. However, with the advent of new bioactive material, the procedure is shifting towards permanent teeth with mature apices of roots. The objective of this systematic review was to evaluate the success of pulpotomy on mature permanent teeth with acute irreversible pulpitis and to compare it with root canal treatment or between the effectiveness of the bioactive material used. The following databases were searched: PubMed, Cochrane Library: Cochrane Central Register of Controlled Trials, Embase, ClinicalTrials.gov, International Clinical Trials Registry Platform. After using the keywords predefined, the electronic search yielded a total of 86 articles. After undergoing a thorough screening and eligibility process, only four articles were finally selected. Unexpectedly, pulpotomy demonstrated a better tendency for success in such cases over the years. This shows that pulpotomy is not inferior to root canal treatment for permanent treatment of irreversible pulpitis. In addition, the results obtained showed that pulpotomy is rapid, biologically reliable and more cost-effective in all situations compared to root canal therapy. Complete pulpotomy appears to have a high success rate as a permanent treatment of irreversible pulpitis and could be considered as an alternative to root canal therapy. Pulpotomy is not inferior to root canal treatment for a permanent treatment of irreversible pulpitis. In addition, the results obtained have shown that complete pulpotomy is faster and more profitable in all situations compared to root canal treatment. Furthermore, with the advent of new so-called bioactive materials, the use of this therapeutic is increasingly considered. This is why a review based on studies of reliable articles is above all necessary to be able to generalise the indication of this therapy.
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Affiliation(s)
- Mohamed Skitioui
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, College of Health Sciences, International University of Rabat, Rabat, Morocco
| | - Anta Seck
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, University Cheikh Anta Diop, Dakar, Senegal
| | - Seydina Ousmane Niang
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, University Cheikh Anta Diop, Dakar, Senegal
| | - Anass Fikhar
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, Mohammed V University in Rabat, Rabat, Morocco
| | - Babacar Touré
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, College of Health Sciences, International University of Rabat, Rabat, Morocco
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Liu X, Xie Y, Gao W, Zhan L, Hu L, Zuo L, Li Y. Experimental study of dexamethasone-loaded hollow hydroxyapatite microspheres applied to direct pulp capping of rat molars. Front Endocrinol (Lausanne) 2023; 14:1192420. [PMID: 37600685 PMCID: PMC10435764 DOI: 10.3389/fendo.2023.1192420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Dexamethasone (DEX) exerts anti-inflammatory and osteogenic effects. Hydroxyapatite is commonly used in bone repair due to its osteoconductivity, osseointegration, and osteogenesis induction. Hollow hydroxyapatite (HHAM) is often used as a drug carrier. Objective This study aimed to investigate the histological responses of exposed dental pulp when dexamethasone-loaded nanohydroxyapatite microspheres (DHHAM) were used as a direct capping agent. Methods Cavities were created in the left maxillary first molar of Wistar rats and filled with Dycal, HHAM, and DHHAM. No drug was administered to the control group. The rats were sacrificed at 1, 2, and 4 weeks after the procedure. The molars were extracted for fixation, demineralization, dehydration, embedding, and sectioning. H&E staining was performed to detect the formation of reparative dentin. H&E and CD45 immunohistochemical staining were performed to detect pulp inflammation. Immunohistochemical staining was performed to assess the expressions of dentin matrix protein 1 (DMP-1), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-1β. Results The results of H&E and CD45 immunohistochemical staining showed that the degree of inflammation in the DHHAM group was less than that in the Control and HHAM groups at 1, 2, and 4 weeks after capping of the rat molar teeth (p<0.01). The H&E staining showed that the percentage of reparative dentin formed in the DHHAM group was higher than that in the Control, HHAM (p<0.001), and Dycal groups (p<0.01) at 1 and 2 weeks, and was significantly higher than that in the Control group (p<0.001) and the HHAM group (p<0.01) at 4 weeks. The immunohistochemical staining showed a lower range and intensity of expression of IL-1β, IL-6, and TNF-α and high expression levels of DMP-1 in the DHHAM group at 1, 2, and 4 weeks after pulp capping relative to the Control group. Conclusions DHHAM significantly inhibited the progression of inflammation and promoted reparative dentin formation.
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Affiliation(s)
- Xiaoli Liu
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Yuandong Xie
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Weijia Gao
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Department of Dental Implantology, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Luoning Zhan
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Ling Hu
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Linjing Zuo
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Yi Li
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
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Mohamed M, Hashem AAR, Obeid MF, Abu-Seida A. Histopathological and immunohistochemical profiles of pulp tissues in immature dogs' teeth to two recently introduced pulpotomy materials. Clin Oral Investig 2023; 27:3095-3103. [PMID: 36781475 PMCID: PMC10264498 DOI: 10.1007/s00784-023-04915-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE The pulpal response to Hoffmann's Pulpine mineral (PMIN) and Pulpine NE (PNE) was compared to mineral trioxide aggregate (MTA) when used as pulpotomy materials in immature permanent teeth in dogs. MATERIALS AND METHODS Immature premolars were randomly divided according to the observation period into three equal groups (n = 24) (10 days, 30 days, and 90 days) then furtherly subdivided into 3 subgroups according to the material used. Histopathological analysis regarding inflammatory cell infiltration and dentin bridge (DB) formation was done. Immunohistochemical analysis was performed using osteopontin marker. RESULTS The results showed that after 90 days, both MTA and PMIN subgroups had 100% complete thick DB without inflammation in 87.5% of the samples, while the PNE subgroup failed to form DB in 37.5% of the samples and 50% of samples showed thin initial DB with heavy inflammation in 62.5% of the samples. There was no significant difference between MTA and PMIN, while there was a statistically significant difference between PNE and the two other subgroups in DB formation and inflammatory cell infiltration (P > 0.05). After 90 days, MTA showed the highest mean value of osteopontin positive fraction area followed by PMIN without statistically significant differences, while the least value was recorded in PNE subgroup with statistically significant difference with the remaining subgroups (P < 0.05). CONCLUSION PMIN is a promising alternative to MTA when used for pulpotomy. CLINICAL RELEVANCE Vital pulp therapy in immature teeth can be done using PMIN as an alternative to MTA.
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Affiliation(s)
- Mai Mohamed
- Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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AlSunbul H, Murriky A. Efficacy of methylene blue and curcumin mediated antimicrobial photodynamic therapy in the treatment of indirect pulp capping in permanent molar teeth. Photodiagnosis Photodyn Ther 2023; 42:103598. [PMID: 37150490 DOI: 10.1016/j.pdpdt.2023.103598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE This study aimed to evaluate the adhesive bond strength and antibacterial efficacy of methylene blue (MB)-mediated antimicrobial photodynamic therapy (aPDT) and curcumin (CUR)-mediated aPDT versus the conventional disinfectants, such as chlorhexidine gluconate (CHX) gel and sodium hypochlorite (NaOCl), for indirect pulp capping (IPC) treatment of permanent molars. METHODS One Hundred grossly carious human permanent molars were collected through non-traumatic extraction. All specimens were embedded in polyvinyl cross-sections to the cemento-enamel junction. The cavity preparation was conducted by grinding the samples using silicon carbide discs. After culturing Streptococcus mutans (S. mutans), a 10 µL of S. mutans suspension (106 colony forming units/mL) was transferred in each tooth cavity and anaerobically incubated for 48 hours at 37°C. All specimens were randomly divided into 5 groups: Group-I: samples treated IPC; Group-II: samples treated with 2% CHX gel; Group-III: samples treated with 6% NaOCl; Group-IV: irradiation of prepared cavity with MB-mediated aPDT; and Group-V: irradiation of prepared cavity with CUR-mediated aPDT. After disinfection methods, the universal adhesive was used, and all specimens were restored using giomer. Eventually, confocal laser scanning microscopy, shear bond strength (SBS), micro-tensile bond strength (μTBS), four-point bending strength (4P-BS) analyses were performed, and the data were analyzed statistically. RESULTS At baseline, the highest SBS (48.8 ± 6.5 MPa), μTBS (54.3 ± 3.9 MPa), and 4P-BS (123 ± 32 MPa) scores were demonstrated by the samples treated with MB-mediated aPDT. However, after 12 months of storage, the highest SBS (42.3 ± 3.9 MPa) and μTBS (45.2 ± 6.6 MPa) scores were shown by samples treated with MB-mediated aPDT, while CUR-mediated aPDT treated samples demonstrated the highest 4P-BS scores (70 ± 18 MPa). Moreover, the highest antibacterial activity against S. mutans was shown by the samples treated with MB-mediated aPDT. CONCLUSIONS The application of aPDT, especially MB-mediated, demonstrated superior SBS, μTBS, and 4P-BS values as well as antibacterial activity against S. mutans as compared to 2% CHX gel and 6% NaOCl as cavity disinfectants for IPC treatment of permanent molars.
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Affiliation(s)
- Hanan AlSunbul
- Department of Restorative Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
| | - Afraa Murriky
- Department of Restorative Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
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Drouri S, El Merini H, Sy A, Jabri M. Evaluation of Direct and Indirect Pulp Capping With Biodentine in Vital Permanent Teeth With Deep Caries Lesions. Cureus 2023; 15:e39374. [PMID: 37250608 PMCID: PMC10225160 DOI: 10.7759/cureus.39374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Pulp capping is a procedural method of preserving pulp vitality following deep caries damage or accidental pulp exposure. Biodentine is a calcium silicate material that has been promoted for use in pulp capping among various clinical applications. This study evaluated the outcome of pulp capping with Biodentine following curettage of deep caries in the case series of permanent mature teeth. MATERIALS AND METHODS The study was carried out on 40 teeth with advanced caries treated by direct and indirect pulp capping using Biodentine, within a follow-up of six months. This was carried out at the Department of Conservative Dentistry-Endodontics of the CCTD Ibn Rochd-Casablanca. Results: In this study, 43 teeth from 37 patients were treated with direct pulp capping and indirect pulp capping using Biodentine. The success rate of pulp capping was 90% at one month, 85% at three months, and 80% at six months. CONCLUSION The results of the studies conducted using Biodentine indicate that it is a suitable material for direct and indirect pulp capping, due to its bioactivity and ability to form a dentinal bridge.
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Affiliation(s)
- Sofia Drouri
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Hafsa El Merini
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Aly Sy
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
| | - Mouna Jabri
- Department of Conservative Dentistry and Endodontics, Faculty of Dental Medicine, University Hassan II, Casablanca, MAR
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Hatipoğlu Ö, Pertek Hatipoğlu F, Javed MQ, Nijakowski K, Taha N, El-Saaidi C, Sugumaran S, Elhamouly Y, Drobac M, Machado R, Abdullah T, Kobayashi H, Alfirjani S, Abidin IZ, Martín B, Maira K, Lim WY, Palma PJ, Martins JFB. Factors Affecting the Decision-Making of Direct Pulp Capping Procedures Amongst Dental Practitioners: A Multinational Survey from 16 Countries with Meta-Analysis. J Endod 2023:S0099-2399(23)00215-7. [PMID: 37094712 DOI: 10.1016/j.joen.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Direct pulp capping (DPC) procedures require the placement of a bioactive material over an exposure site without selective pulp tissue removal. This web-based multicentered survey had three purposes: i) to investigate the factors that affect clinicians' decisions in DPC cases, ii) to determine which method of caries removal is preferred, and iii) to evaluate the preferred capping material for DPC. METHODS The questionnaire comprised three sections. The first part comprised questions regarding demographic features. The second part comprised questions on how treatment plans change according to factors such as nature, location, number and size of the pulp exposure and patients' age. The third part composed of questions on the common materials and techniques used in DPC. To estimate the effect size, the risk ratio (RR) and 95% confidence interval (CI) were calculated using a meta-analysis software. RESULTS A tendency towards more invasive treatment was observed for the clinical scenario with carious-exposed pulp (RR=2.86, 95% CI:2.46,2.32; p<0.001) as opposed to the clinical scenario with two pulp exposures (RR=1.38, 95% CI:1.24,1.53; p<0.001). Complete caries removal was significantly preferred to selective caries removal (RR=4.59, 95% CI: 3.70, 5.69; p<0.001). Among the capping materials, calcium silicate-based materials (CS) were preferred over calcium hydroxide-based materials (CH) (RR=0.58, 95% CI: 0.44,0.76; p<0.05). CONCLUSION While carious-exposed pulp is the most important factor in clinical decisions regarding DPC, the number of exposures has the least impact. Overall, complete caries removal was preferred over selective caries removal. In addition, the use of CS appears to have replaced CH.
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Affiliation(s)
- Ömer Hatipoğlu
- Department of Restorative Dentistry, Nigde Omer Halisdemir University, Turkey.
| | | | - Muhammad Qasim Javed
- Department of Conservative Dental Sciences and Endodontics, College of Dentistry, Qassim University, Saudi Arabia.
| | - Kacper Nijakowski
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, Poland.
| | - Nessrin Taha
- Department of Conservative Dentistry, Jordan University of science and Technology Irbid, Jordan.
| | | | - Surendar Sugumaran
- Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India.
| | - Yasmine Elhamouly
- Pediatric Dentistry Pediatric and Community Dentistry Department, Faculty of Dentistry, Pharos University in Alexandria, Egypt.
| | - Milan Drobac
- Department of Conservative Dentistry and Endodontics, Faculty of Medicine, University of Novi Sad, Serbia.
| | - Ricardo Machado
- Clinical practice limited to Endodontics, Navegantes, Santa Catarina, Brazil.
| | - Thiyezen Abdullah
- Department of Orthodontic and Pediatric Dentistry, College of Dentistry, Qassim University, Saudi Arabia.
| | - Hiro Kobayashi
- Department of Removable Partial Prosthodontics, Tokyo Dental College, Japan.
| | - Suha Alfirjani
- Department of Conservative Dentistry and Endodontics, Dental school/university of Benghazi, Libya.
| | | | - Benjamín Martín
- Department of Conservative Dentistry, Universidade de Santiago de Compostela (USC), Spain.
| | - Kopbayeva Maira
- Department of Conservative Dentistry and Endodontics, Kazakh National Medical University Asfendiyarov, Kazakhstan.
| | - Wen Yi Lim
- Restorative Department, National Dental Centre Singapore, Singapore.
| | - Paulo J Palma
- Endodontic Institute, Faculty of Medicine, University of Coimbra, Portugal.
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Abed D, Bchara J, Bshara N. Vital Pulpotomy on immature lower first permanent molars using Portland cement, a case of failure and success-case report with 2 years follow-up. Clin Case Rep 2023; 11:e7272. [PMID: 37124546 PMCID: PMC10130414 DOI: 10.1002/ccr3.7272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/14/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023] Open
Abstract
Key clinical message While the importance of vital pulp therapy comes from its ability to promote pulp healing allowing the tooth to continue its development and giving the patient a more convenient treatment, dental practitioners should be more aware of the minor mistakes which they might commit during treatment procedures that could reflect negatively on the treatment's outcome. Developing behavior management skills as well as learning from reported mistakes are beneficial to practitioners to provide a more precise and successful treatment. Abstract Vital pulp therapies are known to preserve tooth development and give pulp tissues a chance to heal. Despite the progress of biocompatible materials used in this field, these treatments are still facing some failure for several known and unknown reasons that might not only be related to the material used. This case report presents and discusses the possible reasons for the success of one vital pulpotomy procedure and the failure of another, both conducted on two immature lower first permanent molars of the same patient, in an attempt to conclude what led to both results.
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Affiliation(s)
- Dajma Abed
- Department of Pediatric Dentistry, Faculty of DentistryDamascus UniversityDamascusSyria
| | - Jamila Bchara
- Department of Pediatric Dentistry, Faculty of DentistryDamascus UniversityDamascusSyria
| | - Nada Bshara
- Department of Pediatric Dentistry, Faculty of DentistryDamascus UniversityDamascusSyria
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Duncan HF, El-Karim I, Dummer PMH, Whitworth J, Nagendrababu V. Factors that influence the outcome of pulpotomy in permanent teeth. Int Endod J 2023; 56 Suppl 2:62-81. [PMID: 36334098 DOI: 10.1111/iej.13866] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
The promotion of minimally invasive treatments focussed on the maintenance of pulp vitality has become a priority area in Endodontics. These vital pulp treatments (VPT) include partial and full pulpotomy, during which diseased coronal pulp tissue is removed prior to placement of a capping biomaterial and restoration. Traditionally, pulpotomies were confined to the treatment of carious primary and traumatized permanent teeth. However, these treatments have now been proposed as definitive solutions for cariously exposed permanent teeth with mild symptoms or even symptoms indicative of irreversible disease. Until recently, it was recommended that carious exposure of mature permanent teeth be managed by root canal treatment. The promotion of pulpotomy as an alternative treatment has opened up a wave of laboratory and clinical research aimed at improving therapies or evaluating clinical outcomes. In modern evidence-based endodontics, it is imperative that the outcomes of both partial and full pulpotomy are considered and important prognostic factors identified, so that improvements can be made to aid clinical decision-making and to direct new research. In this narrative review, the outcomes of partial and full pulpotomy are discussed, before analysis of patient, intraoperative and postoperative factors that influence the outcome of the pulpotomy procedure. The review highlights that although partial and full pulpotomy for the treatment of even pulpal disease are highly successful procedures, this is based on low-quality evidence with a lack of prospective, comparative trials investigating potential prognostic factors. Based on current evidence, it appears that age, gender, tooth type, root development and intraoperative pulpal haemorrhage do not impact significantly on pulpotomy outcome, whilst others such as caries depth, inflammatory status of the pulp, capping material, level of inflammatory pulpal-biomarkers and the final restoration integrity do. Other factors, including the influence of exposure type, periodontal condition, pulpal lavage, magnification, operator experience, isolation of the operating field and type of pulpotomy, require further experimental investigation before definitive conclusions can be made relating to the success of the pulpotomy procedure. Finally, there is not only a need for future well-designed prospective research addressing these issues but also a widening of our understanding of outcome to include patient-reported as well as clinician-reported outcomes.
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Affiliation(s)
- Henry F Duncan
- Division of Restorative Dentistry & Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Ikhlas El-Karim
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - John Whitworth
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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Cunha D, Souza N, Moreira M, Rodrigues N, Silva P, Franca C, Horsophonphong S, Sercia A, Subbiah R, Tahayeri A, Ferracane J, Yelick P, Saboia V, Bertassoni L. 3D-printed microgels supplemented with dentin matrix molecules as a novel biomaterial for direct pulp capping. Clin Oral Investig 2023; 27:1215-1225. [PMID: 36287273 PMCID: PMC10171721 DOI: 10.1007/s00784-022-04735-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To develop a 3D-printed, microparticulate hydrogel supplemented with dentin matrix molecules (DMM) as a novel regenerative strategy for dental pulp capping. MATERIALS AND METHODS Gelatin methacryloyl microgels (7% w/v) mixed with varying concentrations of DMM were printed using a digital light projection 3D printer and lyophilized for 2 days. The release profile of the DMM-loaded microgels was measured using a bicinchoninic acid assay. Next, dental pulp exposure defects were created in maxillary first molars of Wistar rats. The exposures were randomly capped with (1) inert material - negative control, (2) microgels, (3) microgels + DMM 500 µg/ml, (4) microgels + DMM 1000 µg/ml, (5) microgels + platelet-derived growth factor (PDGF 10 ng/ml), or (6) MTA (n = 15/group). After 4 weeks, animals were euthanized, and treated molars were harvested and then processed to evaluate hard tissue deposition, pulp tissue organization, and blood vessel density. RESULTS All the specimens from groups treated with microgel + 500 µg/ml, microgel + 1000 µg/ml, microgel + PDGF, and MTA showed the formation of organized pulp tissue, tertiary dentin, newly formed tubular and atubular dentin, and new blood vessel formation. Dentin bridge formation was greater and pulp necrosis was less in the microgel + DMM groups compared to MTA. CONCLUSIONS The 3D-printed photocurable microgels doped with DMM exhibited favorable cellular and inflammatory pulp responses, and significantly more tertiary dentin deposition. CLINICAL RELEVANCE 3D-printed microgel with DMM is a promising biomaterial for dentin and dental pulp regeneration in pulp capping procedures.
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Affiliation(s)
- Diana Cunha
- Post-Graduation Program in Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Nayara Souza
- Post-Graduation Program in Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Manuela Moreira
- School of Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Nara Rodrigues
- School of Dentistry, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Paulo Silva
- School of Dentistry, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Cristiane Franca
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Sivaporn Horsophonphong
- Department of Pediatric Dentistry, Faculty of Dentistry, Mahidol University, Salaya, Thailand
| | - Ashley Sercia
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Ramesh Subbiah
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Anthony Tahayeri
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Jack Ferracane
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Pamela Yelick
- Department of Orthodontics, School of Medicine, School of Engineering, Tufts University, Boston, MA, 02111, USA
| | - Vicente Saboia
- Department of Restorative Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Luiz Bertassoni
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA.
- Center for Regenerative Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA.
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, OR, USA.
- Cancer Early Detection Advanced Research Center (CEDAR), Knight Cancer Institute, Portland, OR, USA.
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Al-Ali M, Camilleri J. The scientific management of deep carious lesions in vital teeth using contemporary materials—A narrative review. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.1048137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AimThe aim of this article is to review the scientific evidence for deep caries removal in permanent vital teeth and the choice of dentine replacement material and restoration of the teeth to maintain long term tooth vitality and function.MethodThe two position statements namely the European Society of Endodontology and the American Association of Endodontists position statements on vital pulp therapy will be scrutinized and compared with regards to the deep caries removal strategy and assessed for evidence of best practice. The properties of materials used to manage vital pulps and the best way to restore the teeth will be reviewed and guidance on the full management of vital teeth will be suggested.ConclusionsPromoting new treatment modalities for reversible and irreversible pulpitis allowing for pulp preservation should be considered. Although debatable, cases with deep caries should be managed by complete non-selective caries removal which will allow for pulpal management if needed and a more predictable outcome can be expected when using the new materials and treatment modalities of vital pulp therapy.
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A Pilot Feasibility Study to Establish Full Pulpotomy in Mature Permanent Teeth with Symptomatic Irreversible Pulpitis as a Routine Treatment in Mexican Public Healthcare Services. Healthcare (Basel) 2022; 10:healthcare10122350. [PMID: 36553875 PMCID: PMC9778542 DOI: 10.3390/healthcare10122350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
Symptomatic irreversible pulpitis is a common dental disease for which root canal treatment (RCT) has been the standard treatment. However, in many countries, RCT is considered a high-cost treatment that is not covered by public healthcare services; this forces patients to have dental extraction as their only option to relieve pain. In the last decade, several investigations have provided evidence that an alternative treatment known as full pulpotomy (FP) could be an alternative for patients who could not afford the cost of an RCT. Nevertheless, evidence is lacking on the success rate that could be obtained if it is performed in a public dental care clinic (PDCC). The present investigation has two main objectives. To be the first approach of a multicentric feasibility study to find out whether an FP performed by a general practice dentist (GPD) in a PDCC could be suitable and establish its success rate and patient satisfaction. Patients attending a PDCC with symptoms of irreversible pulpitis were invited to participate. FP was performed and followed up at 1, 3, 6, 9, and 12 months. The treatment success was assessed by combining three variables, patient satisfaction, clinical, and radiographic outcomes. Forty-one patients from 17 to 78 years old received the intervention. In total, 97.5% were completely satisfied with the treatment and were considered successful since none of the clinical or radiographic variables were present in any of the follow-ups. An FP performed by a GPD in a PDCC could be suitable as a routine treatment for symptomatic irreversible pulpitis due to the excellent success rate and patient satisfaction.
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Outcome of pulpotomy in permanent teeth with irreversible pulpitis: a systematic review and meta-analysis. Sci Rep 2022; 12:19664. [PMID: 36385132 PMCID: PMC9669040 DOI: 10.1038/s41598-022-20918-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Treatment planning is key to clinical success. Permanent teeth diagnosed with "irreversible pulpitis" have long been implied to have an irreversibly damaged dental pulp that is beyond repair and warranting root canal treatment. However, newer clinical approaches such as pulpotomy, a minimally invasive and biologically based procedure have re-emerged to manage teeth with pulpitis. The primary aim of the study was to conduct a meta-analysis to comprehensively estimate the overall success rate of pulpotomy in permanent teeth with irreversible pulpitis as a result of carious pulp exposure. The secondary aim of the study was to investigate the effect of predictors such as symptoms, root apex development (closed versus open), and type of pulp capping material on the success rate of pulpotomy. Articles were searched using PubMed, Scopus, CENTRAL, and Web of Science databases, until January 2021. Outcomes were calculated by pooling the success rates with a random effect model. Comparison between the different subgroups was conducted using the z statistic test for proportion with significance set at alpha = 0.05. A total of 1,116 records were retrieved and 11 studies were included in the quantitative analysis. The pooled success rate for pulpotomy in teeth with irreversible pulpitis was 86% [95% CI: 0.76-0.92; I2 = 81.9%]. Additionally, prognostic indicators of success were evaluated. Stratification of teeth based on (1) symptoms demonstrated that teeth with symptomatic and asymptomatic irreversible pulpitis demonstrated success rate of 84% and 91% respectively, with no significant difference (p = 0.18) using z-score analysis; (2) open apex teeth demonstrated a significantly greater success rate (96%) compared to teeth with closed apex (83%) (p = 0.02), and (3) pulp capping materials demonstrated that Biodentine yielded significantly better success rates compared to Mineral Trioxide Aggregate (MTA), calcium hydroxide, and Calcium Enriched Mixture (CEM.) Collectively, this is the first meta-analytical study to determine the clinical outcome of pulpotomy for carious teeth with irreversible pulpitis and it's predictors for success. Moreover, we identify the stage of root development and type of biomaterial as predictors for success of pulpotomy.
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Ricucci D, Rôças IN, Alves FR, Cabello PH, Siqueira JF. Outcome of direct pulp capping using calcium hydroxide: a long-term retrospective study. J Endod 2022; 49:45-54. [DOI: 10.1016/j.joen.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
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Radwanski M, Caporossi C, Lukomska-Szymanska M, Luzi A, Sauro S. Complicated Crown Fracture of Permanent Incisors: A Conservative Treatment Case Report and a Narrative Review. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9090481. [PMID: 36135027 PMCID: PMC9495796 DOI: 10.3390/bioengineering9090481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022]
Abstract
Dental trauma may have a severe impact on the social and psychological wellbeing of a patient. Most cases of dental injuries involve anterior teeth, especially the maxillary upper incisors. Crown fractures, with or without pulp exposure, are the most common trauma in permanent dentition. There are many methods of management, in which the initial state of the pulp, the time since the injury, and the presence of an accompanying injury play a key role. This case report aimed at showing a possible conservative treatment after complicated tooth fracture that consisted of partial pulpotomy followed by adhesive reattachment of the tooth fragment using a technique based on heated resin composite. Such a specific procedure represents a conservative approach to traumatic coronal lesions, providing a suitable opportunity to maintain the tooth vitality, aesthetics, and function. Indeed, reattachment of tooth fragment using a composite/adhesive is a simple technique to achieve excellent results in terms of aesthetic and function.
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Affiliation(s)
- Mateusz Radwanski
- Department of Endodontics Chair, Conservative Dentistry, Endodontics Medical University of Lodz, 251 Pomorska Str., 92-213 Lodz, Poland
| | | | - Monika Lukomska-Szymanska
- Department of General Dentistry, Medical University of Lodz, 251 Pomorska Str., 92-213 Lodz, Poland
- Correspondence: (M.L.-S.); (S.S.); Tel.: +48-426-757461 (M.L.-S.)
| | - Arlinda Luzi
- Group of Dental Biomaterials and Minimally Invasive Dentistry, Department of Dentistry, Cardenal Herrera-CEU Universities, C/Santiago Ramón y Cajal, s/n., Alfara del Patriarca, 46115 Valencia, Spain
| | - Salvatore Sauro
- Group of Dental Biomaterials and Minimally Invasive Dentistry, Department of Dentistry, Cardenal Herrera-CEU Universities, C/Santiago Ramón y Cajal, s/n., Alfara del Patriarca, 46115 Valencia, Spain
- Department of Therapeutic Dentistry, I. M. Sechenov First Moscow State Medical University, 119146 Moscow, Russia
- Correspondence: (M.L.-S.); (S.S.); Tel.: +48-426-757461 (M.L.-S.)
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Gürcan AT, Şişmanoğlu S, Sengez G. Effect of Different Adhesive Strategies on the Microshear Bond Strength of Calcium-Silicate-Based Materials. JOURNAL OF ADVANCED ORAL RESEARCH 2022. [DOI: 10.1177/23202068221118979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To evaluate the microshear bond strength (µSBS) of mineral trioxide aggregate and Biodentine to various resin-based materials using different adhesive strategies. Materials and Methods: Three resin-based materials—a self-adhering resin composite with or without acid etching (Vertise flow; Kerr, Orange, CA, USA), a conventional flowable composite with a total-etch adhesive (Filtek Ultimate Flowable; 3M ESPE, St. Paul, MN, USA), and a flowable resin-modified glass ionomer cement (RMGIC) without any surface modification (Ionoseal; VOCO GmbH, Cuxhaven, Germany)—and two calcium-silicate-based materials—Biodentine and BIOfactor mineral trioxide aggregate (MTA)—were tested. A total of 100 cylindrical acrylic molds were prepared. Biodentine and BIOfactor MTA were prepared and placed into the central holes on the molds. Specimens were divided into two main groups according to materials and into five subgroups ( n = 10). µSBS were evaluated using a µSBS testing device. The failure modes were examined under a stereomicroscope with magnification. They were categorized as adhesive, cohesive, or mixed. Data were analyzed using two-way analysis of variance (ANOVA) and Tukey test. The significance level was taken as α = 0.05. Results: It was observed that both calcium-silicate-based material type and resin-based material type influenced the µSBS significantly according to two-way ANOVA. Biodentine exhibited higher bond strength values than MTA. However, no statistically significant interaction was demonstrated between these factors ( P = .396). The µSBS values of intermediate materials to Biodentine and MTA were listed from the lowest to the highest as follows: RMGIC < Acid Etch + RMGIC < SARC (self-adhering resin composite) < FC (flowable composite) < Acid Etch + SARC. Conclusion: Self-adhering composites can be used on calcium-silicate-based materials in vital pulp treatments because of their mechanical properties. Acid-etching ensures high µSBS values. Although the µSBS of Biodentine were higher than MTA according to this study’s results, there was no statistically significant difference in µSBS of FC and acid-etched SARC to MTA.
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Affiliation(s)
- Aliye Tuğçe Gürcan
- Department of Pediatric Dentistry, Faculty of Dentistry, Altinbas University, Bakirkoy, Istanbul, Turkey
| | - Soner Şişmanoğlu
- Department of Restorative Dentistry, Faculty of Dentistry, Altinbas University, Bakirkoy, Istanbul, Turkey
| | - Görkem Sengez
- Department of Restorative Dentistry, Faculty of Dentistry, Altinbas University, Bakirkoy, Istanbul, Turkey
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