101
|
KOMABAYASHI T, COLMENAR D, CVACH N, BHAT A, PRIMUS C, IMAI Y. Comprehensive review of current endodontic sealers. Dent Mater J 2020; 39:703-720. [DOI: 10.4012/dmj.2019-288] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | | | - Aparna BHAT
- University of New England College of Dental Medicine
| | | | | |
Collapse
|
102
|
Abstract
Two increasingly common endodontic procedures, vital pulp therapy (VPT) and regenerative endodontic procedures, rely on dental tissue regeneration/repair mechanisms with the aid of biomaterials. These materials are applied in close contact to the pulpal tissue and are required to be biocompatible, form an antimicrobial seal, not induce staining, and be easy to manipulate. Historically, calcium hydroxide played an important role in VPT. However, over the last 3 decades, significant efforts in research and industry have been made to develop various biomaterials, including hydraulic tricalcium silicate cements. The present review summarized various hydraulic tricalcium silicate cements and their biological properties in clinical procedures, namely VPT and regenerative endodontic procedures.
Collapse
|
103
|
Chen SJ, Karabucak B, Steffen JJ, Yu YH, Kohli MR. Spectrophotometric Analysis of Coronal Tooth Discoloration Induced by Tricalcium Silicate Cements in the Presence of Blood. J Endod 2020; 46:1913-1919. [PMID: 32949559 DOI: 10.1016/j.joen.2020.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION New tricalcium silicate cements have been shown to induce less coronal discoloration. The purpose of this in vitro study was to evaluate the degree of color change induced by various silicate materials in the presence and absence of blood. METHODS One hundred human extracted anterior single-canal teeth were sectioned to standardized root lengths, accessed, and instrumented. Eight random experimental groups and 2 control groups were created wherein specimens were filled with experimental materials below the buccal cementoenamel junction as follows: EndoSequence RRM putty (Brasseler USA, Savannah, GA), EndoSequence RRM fast set putty (Brasseler USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), and white mineral trioxide aggregate (Dentsply Sirona, York, PA) either with the presence or absence of blood. Blood-only and saline-only samples were used for the positive and negative controls. After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 30, 60, and 180 after material placement. Data were transformed into Commission International de I'Eclairage's L∗a∗b color values, and corresponding ΔE values were calculated. The 1-way analysis of variance test was performed for statistical analysis. RESULTS Discoloration was observed in all specimens in the presence of blood. There was no statistical significance when comparing different materials in contact with blood. Intragroup observation at various time points, Biodentine, and EndoSequence RRM fast set putty showed significant difference between the presence and absence of blood at 180 days (P < .05). CONCLUSIONS Contamination with blood of tricalcium silicate materials has the potential to cause coronal tooth discoloration.
Collapse
Affiliation(s)
- Stephanie J Chen
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Bekir Karabucak
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania.
| | - Joshua John Steffen
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Ya-Hsin Yu
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Meetu R Kohli
- Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
104
|
Haikal L, Ferraz dos Santos B, Vu DD, Braniste M, Dabbagh B. Biodentine Pulpotomies on Permanent Traumatized Teeth with Complicated Crown Fractures. J Endod 2020; 46:1204-1209. [DOI: 10.1016/j.joen.2020.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/26/2020] [Accepted: 06/07/2020] [Indexed: 11/30/2022]
|
105
|
Munoz-Sanchez ML, Linas N, Decerle N, Nicolas E, Hennequin M, Cousson PY. A Combination of Full Pulpotomy and Chairside CAD/CAM Endocrown to Treat Teeth with Deep Carious Lesions and Pulpitis in a Single Session: A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176340. [PMID: 32878168 PMCID: PMC7503687 DOI: 10.3390/ijerph17176340] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022]
Abstract
A higher chance of carrying out a successful full pulpotomy may depend on whether the coronal restoration can be completed within a single appointment. The development of chairside CAD/CAM (Computer Aided Design and Manufacturing) technology has made it possible to carry out indirect restoration of endodontically treated teeth in a single session. This study aimed to evaluate the long-term outcome of a full pulpotomy with Biodentine™ immediately covered with a chairside CAD/CAM endocrown on teeth affected by pulpitis and deep carious lesions. The investigation involved a cohort of 30 molars that were treated by pulpotomy and CAD/CAM endocrown. Clinical and radiological examinations were scheduled at 1, 6, and 12 months postoperatively. Overall, all treatments were effective at any time during the follow-up. The results of this study need to be confirmed with a longer-term follow-up to allow for comparison with the literature. This original combination of endodontic and restorative treatments provides an Endo-prosthetic continuum in a single session, with the objective of long-term success in terms of tooth health.
Collapse
Affiliation(s)
- Marie-Laure Munoz-Sanchez
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.-L.M.-S.); (N.L.); (N.D.); (E.N.); (P.-Y.C.)
- CHU Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
| | - Natacha Linas
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.-L.M.-S.); (N.L.); (N.D.); (E.N.); (P.-Y.C.)
- CHU Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
| | - Nicolas Decerle
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.-L.M.-S.); (N.L.); (N.D.); (E.N.); (P.-Y.C.)
- CHU Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
| | - Emmanuel Nicolas
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.-L.M.-S.); (N.L.); (N.D.); (E.N.); (P.-Y.C.)
- CHU Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
| | - Martine Hennequin
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.-L.M.-S.); (N.L.); (N.D.); (E.N.); (P.-Y.C.)
- CHU Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
- Correspondence:
| | - Pierre-Yves Cousson
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, F-63000 Clermont-Ferrand, France; (M.-L.M.-S.); (N.L.); (N.D.); (E.N.); (P.-Y.C.)
- CHU Clermont-Ferrand, Service d’Odontologie, F-63003 Clermont-Ferrand, France
| |
Collapse
|
106
|
Selective vs stepwise removal of deep carious lesions in primary molars: 24 months follow-up from a randomized controlled trial. Clin Oral Investig 2020; 25:645-652. [PMID: 32857210 PMCID: PMC7819903 DOI: 10.1007/s00784-020-03536-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023]
Abstract
Objectives For well-defined deep (> 2/3 dentin extension) carious lesions, selective (SE) or stepwise (SW) carious tissue removals have been recommended, while there is limited comparative evidence for both. We compared SE and SW over 24 months in a randomized controlled trial. Methods A two-arm superiority trial was conducted comparing SW/SE in primary molars without pulpal symptoms but well-defined deep lesions. Seventy-four children (1 molar/child) aged 3–9 years were recruited. In a first step, peripheral carious tissue was removed until hard dentin remained, while in proximity to the pulp, leathery dentin was left. An adhesive compomer restoration was placed and restorations re-examined after 6 months. In SW, re-entry and removal to firm dentin was conducted pulpo-proximally, followed by re-restoration. Molars were re-evaluated for a total of 24 months. Our primary outcome was success (absence of restorative/endodontic complications or pulp exposures). Secondary outcomes included total treatment and opportunity costs and restoration quality, assessed using modified USPHS criteria. Results After 24 months, 63 molars (31 SE, 32 SW) were re-assessed. Four failures occurred (2 exposures in SW; 2 pulpal complications in SE, 1 of them leading to extraction, p > 0.05). Restoration integrity was satisfying in both groups (USPHS A/B/C in 21/8/0 SE and 23/7/0 SW, p > 0.05). Treatment and opportunity costs were significantly higher in SW than SE (mean 171 ± 51 vs. 106 ± 90; p < 0.001). Conclusions After 2 years, SE and SW showed similar efficacy for managing deep carious lesions in primary molars. The higher costs for SW should be considered during decision-making. Clinical significance In primary molars with well-defined deep carious lesions SE was less costly and similarly efficacious like SW. From a cost and applicability perspective, SW may need to be indicated restrictively, e.g., for very deep (> 3/4 dentin extension) lesions only. Trial registration ClinicalTrials.gov Identifier: NCT02232828
Collapse
|
107
|
Self-Limiting versus Rotary Subjective Carious Tissue Removal: A Randomized Controlled Clinical Trial-2-Year Results. J Clin Med 2020; 9:jcm9092738. [PMID: 32854206 PMCID: PMC7564758 DOI: 10.3390/jcm9092738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 12/01/2022] Open
Abstract
Background: the aim of this study was to assess the 2-year pulp survival of deep carious lesions in teeth excavated using a self-limiting protocol in a single-blind randomized controlled clinical trial. Methods: At baseline, 101 teeth with deep carious lesions in 86 patients were excavated randomly using self-limiting or control protocols. Standardized clinical examination and periapical radiographs of teeth were performed after 1- and 2-year follow-ups (REC 14/LO/0880). Results: During the 2-year period of the study, 24 teeth failed (16 and 8 at T12 and T24, respectively). Final analysis shows that 39/63 (61.9%) of teeth were deemed successful (16/33 (48.4%) and 23/30 (76.6%) in the control and experimental groups, respectively with a statistically significant difference (z score = 2.3, p = 0.021). Of teeth with severe and mild symptoms at T0, 42.9% and 36.7% respectively failed at T24 (p > 0.05). Within the self-limiting group, there was a lower success in premolars compared to molars (p < 0.05). Conclusion: after 2 years, there was a statistically significant higher pulp survival rate of teeth with deep carious lesions excavated using self-limiting protocols in patients with reversible pulpitis. Molars showed higher success than premolars in teeth excavated using the self-limiting protocol. There was no statistically significant association between the outcome and the severity of symptoms at T0 (ClinicalTrials.gov NCT03071588).
Collapse
|
108
|
Lee S, Park YT, Setzer FC. Combined Regenerative and Vital Pulp Therapies in an Immature Mandibular Molar: A Case Report. J Endod 2020; 46:1085-1090. [PMID: 32553418 DOI: 10.1016/j.joen.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/09/2020] [Accepted: 04/19/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This report describes the treatment of an immature mandibular molar by combining vital pulp therapy (VPT) and regenerative endodontic procedures (REPs). It details the use of REP to regain functionality and continued root development of an immature root with pulp necrosis and VPT for an immature root containing vital pulpal tissues. METHODS An 8-year old male presented for evaluation of a mandibular first right molar with mild buccal swelling and a nontraceable sinus tract. He recently had received a restoration. After intraoral and radiographic examination, a diagnosis of pulp necrosis and chronic apical abscess was made. After access, pulp necrosis was confirmed in the distal root; however, vital pulp tissues were present in the mesial canals. It was decided on pulpotomy (VPT) in the mesial and REP in the distal root. At the initial visit, pulpotomy was completed in the mesial root, and REP was initiated in the distal root. Three weeks later, the patient was asymptomatic and the sinus tract absent. REP was completed in the distal root, and the tooth was restored. RESULTS At the 6-, 12-, and 18-month follow-up, the patient presented without symptoms, and the tooth responded positively to pulp sensibility tests. Radiographic examinations showed resolution of the apical radiolucency and completed root development. CONCLUSIONS Combined treatment using both VPT and REP for immature molars with different pulpal status in individual roots may be a preferable treatment option because preservation of vital pulp tissues and regeneration of new vital tissues allow for continued root development and functionality.
Collapse
Affiliation(s)
- Sumin Lee
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Frank C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
109
|
Ballal NV, Duncan HF, Rai N, Jalan P, Zehnder M. Sodium Hypochlorite Reduces Postoperative Discomfort and Painful Early Failure after Carious Exposure and Direct Pulp Capping-Initial Findings of a Randomized Controlled Trial. J Clin Med 2020; 9:E2408. [PMID: 32731401 PMCID: PMC7464668 DOI: 10.3390/jcm9082408] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/14/2020] [Accepted: 07/26/2020] [Indexed: 12/11/2022] Open
Abstract
In this randomized controlled single-center clinical trial on 96 adult patients with parallel experimental groups (n = 48), the effects of washing a dentin/pulp wound in non-symptomatic teeth with extremely deep caries and pulpal exposure were compared between a 2.5% sodium hypochlorite (NaOCl) solution and a chemically-inert physiological saline control solution. After the allocated wound lavage, the pulps were capped with a mineral trioxide aggregate, covered by a glass-ionomer/resin liner, and the teeth were immediately restored with a resin-bonded-composite. In this first report, the early events were analyzed: postoperative discomfort (on an NRS-11 scale) at day-3 and -7 after intervention, and the occurrence of unbearable pain causing patients to contact the principal investigator to perform a root canal treatment (pulpectomy) during the first three months. The NaOCl solution caused a highly significant reduction in post-operative discomfort (p = 0.0010 day 3; p = 0.0007 day 7) and early painful failures (p = 0.0008) compared with the control. These novel findings highlight the importance of infection control in teeth with extremely deep carious lesions. Based on these observations, the use of an NaOCl solution to wash the exposed dentin/pulp wound in the vital pulp treatment is highly recommended in order to reduce pain and early failure.
Collapse
Affiliation(s)
- Nidambur Vasudev Ballal
- Department of Conservative Dentistry & Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India; (N.V.B.); (N.R.); (P.J.)
| | - Henry F. Duncan
- Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, D02 F859 Dublin, Ireland;
| | - Namith Rai
- Department of Conservative Dentistry & Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India; (N.V.B.); (N.R.); (P.J.)
| | - Prateek Jalan
- Department of Conservative Dentistry & Endodontics, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India; (N.V.B.); (N.R.); (P.J.)
| | - Matthias Zehnder
- Division of Endodontology, Clinic of Conservative and Preventive Dentistry, University of Zürich, 8032 Zürich, Switzerland
| |
Collapse
|
110
|
Couto RSD, Rodrigues MFSD, Ferreira LS, Diniz IMA, Silva FDS, Lopez TCC, Lima RR, Marques MM. Evaluation of Resin-Based Material Containing Copaiba Oleoresin ( Copaifera Reticulata Ducke): Biological Effects on the Human Dental Pulp Stem Cells. Biomolecules 2020; 10:biom10070972. [PMID: 32605172 PMCID: PMC7407412 DOI: 10.3390/biom10070972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023] Open
Abstract
The purpose of this study was to analyze in vitro the biological effects on human dental pulp stem cells triggered in response to substances leached or dissolved from two experimental cements for dental pulp capping. The experimental materials, based on extracts from Copaifera reticulata Ducke (COP), were compared to calcium hydroxide [Ca(OH)2] and mineral trioxide aggregate (MTA), materials commonly used for direct dental pulp capping in restorative dentistry. For this, human dental pulp stem cells were exposed to COP associated or not with Ca(OH)2 or MTA. Cell cytocompatibility, migration, and differentiation (mineralized nodule formation (Alizarin red assay) and gene expression (RT-qPCR) of OCN, DSPP, and HSP-27 (genes regulated in biomineralization events)) were evaluated. The results showed that the association of COP reduced the cytotoxicity of Ca(OH)2. Upregulations of the OCN, DSPP, and HSP-27 genes were observed in response to the association of COP to MTA, and the DSPP and HSP-27 genes were upregulated in the Ca(OH)2 + COP group. In up to 24 h, cell migration was significantly enhanced in the MTA + COP and Ca(OH)2 + COP groups. In conclusion, the combination of COP with the currently used materials for dental pulp capping [Ca(OH)2 and MTA] improved the cell activities related to pulp repair (i.e., cytocompatibility, differentiation, mineralization, and migration) including a protective effect against the cytotoxicity of Ca(OH)2.
Collapse
Affiliation(s)
- Roberta Souza D’Almeida Couto
- Department of Restorative Dentistry, School of Dentistry, University of Sao Paulo, São Paulo, SP 05508-060, Brazil; (L.S.F.); (M.M.M.)
- School of Dentistry, Federal University of Pará, Belém, PA 66075-110, Brazil
- Correspondence: ; Tel.: +55-091-3201-7637
| | | | - Leila Soares Ferreira
- Department of Restorative Dentistry, School of Dentistry, University of Sao Paulo, São Paulo, SP 05508-060, Brazil; (L.S.F.); (M.M.M.)
| | - Ivana Márcia Alves Diniz
- Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizionte, MG 31270-901, Brazil;
| | - Fernando de Sá Silva
- Departamento de Ciências da Vida, Federal University of Juiz de Fora, Juiz de Fora, MG 36036-900, Brazil;
| | - Talita Christine Camilo Lopez
- Postgraduation Program in Biophotonics Applied to Health Sciences, Nove de Julho University, São Paulo, SP 02112-000, Brazil; (M.F.S.D.R.); (T.C.C.L.)
| | - Rafael Rodrigues Lima
- Institute of Biological Sciences, Federal University of Pará, Belém, PA 66075-110, Brazil;
| | - Márcia Martins Marques
- Department of Restorative Dentistry, School of Dentistry, University of Sao Paulo, São Paulo, SP 05508-060, Brazil; (L.S.F.); (M.M.M.)
- Post graduation course in Dentistry, Ibirapuera University, São Paulo, SP 04661-100, Brazil
| |
Collapse
|
111
|
Yazdanfar I, Barekatain M, Zare Jahromi M. Combination effects of diode laser and resin-modified tricalcium silicate on direct pulp capping treatment of caries exposures in permanent teeth: a randomized clinical trial. Lasers Med Sci 2020; 35:1849-1855. [PMID: 32529588 DOI: 10.1007/s10103-020-03052-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/01/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this randomized clinical trial was to evaluate efficiency of diode 808-nm (Picasso-AMD, USA) laser using power 1.5 W, continuous wave (CW), fiber diameter of 400 μm, non-initiated and in contact mode, tip angle set at 90°, beam divergence 16°, 2 s per an area with 1-mm diameter, power density 190.98 W/cm2, energy density 381.97 J/cm2, vertical and horizontal scanning movement on the exposure site, and laser irradiation combined with a resin-based tricalcium silicate material (TheraCal LC, Bisco, USA) in direct pulp capping in caries exposures of permanent teeth over a period of 6 months. MATERIAL AND METHODS In this randomized clinical trial, a total of 20 anterior and posterior vital teeth without symptoms and radiographic changes of 14 patients between the age group of 15-35 years, of which randomly 10 teeth were considered, each for TheraCal LC, the exposed area was sealed with TheraCal paste and TheraCal combined with diode laser; the treated area was sealed with TheraCal paste after diode 808-nm laser irradiation. At the 1-, 3-, and 6-month recall examinations, the loss of vitality, spontaneous pain, reactions to thermal stimuli and percussion, and radiographic changes were considered failure. The samples were randomly divided using runs test. Measurements on the digitized radiograph were performed at the recalls. The data were analyzed by repeated measurements ANOVA using SPSS 25. RESULTS Analysis had indicated that at the end of follow-ups, a statistically significant increase in dentin thickness with both groups (p value < 0.001) was found. Clinically, diode laser group has shown better results (p value < 0.001); however, radiographically, no significant difference was observed between groups (p value = 0.56). In both groups, the highest thickness of dentin formed was at the first month; 0.40 mm ± 0.19 mm (p value < 0.001). CONCLUSION Diode laser 808 nm under proper parameters combined with TheraCal LC can be recommended for direct pulp therapy in caries exposure of permanent teeth. CLINICAL TRIAL REGISTRATION This research was approved by Esfahan Medical University, Dental School, Azad Branch (KHUISF)) Esfahan, Iran [IR.IAU.KHUISF.REC.1397.261].
Collapse
Affiliation(s)
- Iraj Yazdanfar
- Laser in Dentistry, RWTH University, Aachen, Germany
- Restorative and Conservative Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Mehrdad Barekatain
- Department of Restorative and Conservative Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
| | - Maryam Zare Jahromi
- Department of Endodontic, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| |
Collapse
|
112
|
Umer F, Haji Z, Zafar K. Role of respirators in controlling the spread of novel coronavirus (COVID-19) amongst dental healthcare providers: a review. Int Endod J 2020; 53:1062-1067. [PMID: 32357257 PMCID: PMC7267233 DOI: 10.1111/iej.13313] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/24/2020] [Indexed: 01/05/2023]
Abstract
During the ongoing COVID‐19 pandemic, healthcare professionals are at the forefront of managing the highly infectious coronavirus. As the most common route of transmission is via aerosols and droplet inhalation, it is critical for healthcare workers to have the correct personal protective equipment (PPE) including gowns, masks and goggles. Surgical masks are not effective in preventing the influenza and SARS, so they are unlikely to be able to resist contaminated aerosols from entering the respiratory system. Therefore, it is vital to use respirators which have been proven to offer better protection against droplets, aerosols and fluid penetration and which form a tight seal around the mouth and nose. Various types of respirators are used in healthcare settings, such as half‐mask filtering facepiece respirators (FFRs) and powered air‐purifying respirators (PAPRs). The most commonly used FFR is the N95 disposable respirator, which is tight fitting and has a 95% or above particle filtering efficiency for a median particle size of 0.3 µm. This review discusses respirators, their purpose, types, clinical efficiency and proper donning and doffing techniques.
Collapse
Affiliation(s)
- F Umer
- Department of Surgery, Operative Dentistry, Aga Khan University Hospital, Karachi, Pakistan
| | - Z Haji
- Department of Surgery, Operative Dentistry, Aga Khan University Hospital, Karachi, Pakistan
| | - K Zafar
- Department of Surgery, Operative Dentistry, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
113
|
Doumani MD, Arnous WA, Alsafadi MF, Alnazer HA, Alanazi SM, Alotaibi KS, Al-Ammari AI. The Vital Pulp Therapy of Permanent Teeth: A Dental Practitioner's Perspective from Saudi Arabia. J Int Soc Prev Community Dent 2020; 10:300-308. [PMID: 32802776 PMCID: PMC7402255 DOI: 10.4103/jispcd.jispcd_69_19] [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: 02/07/2019] [Revised: 06/17/2019] [Accepted: 09/25/2019] [Indexed: 12/02/2022] Open
Abstract
AIMS AND OBJECTIVES The aim of this study was to determine the levels of knowledge and attitude of dental practitioners (DPs) toward vital pulp therapy (VPT) of young permanent teeth in Riyadh city, Saudi Arabia. MATERIALS AND METHODS A descriptive cross-sectional study was carried out by taking convenient sample of general DPs and specialist attending Saudi International Dental Conference, Riyadh, Saudi Arabia. A total of 200 DPs administered a structured, self-administered questionnaire to evaluate their knowledge and attitude toward VPT. The questionnaire comprised four parts: Part I: Characteristics of the study participants; Part II: Items related to indications and diagnosis of VPT; Part III: Questions related to the different VPTs for immature permanent teeth; and Part IV: Dental materials used in VPT and restoration. All the data were entered into the statistical analysis software Statistical Package for the Social Sciences version 21.0 (IBM, Armonk, NY) and analyzed by using descriptive statistics of frequency distribution and percentages for the categorical variables. RESULTS A total of 193 (men = 57% [110] and women = 43% [83]) DPs participated in this study with a response rate of 96.5%. Less than half of correct responses were observed with (Item 1) related to the duration of complete closure of root apex (43%) and (Item 14) use of sodium hypochlorite to serve as an excellent diagnostic tool to differentiate irreversible from reversible pulpitis. A high percentage of correct responses were seen with the (Item 9) indirect pulp capping--a procedure performed in a tooth with a deep carious lesion without signs or symptoms of pulp degeneration (75%). All other item responses ranged in between 52% and 72%. CONCLUSION DPs showed fair-to-good knowledge and attitude toward VPT of young permanent teeth. In general, there is a need to improve knowledge and attitude of dental professionals about the VPT by attending continuing dental educational programs.
Collapse
Affiliation(s)
- Mazen D Doumani
- Department of Restorative Dental Sciences, AlFarabi Colleges of Medicine, Dentistry, Nursing, Riyadh, Saudi Arabia
| | - Waod A Arnous
- Department of Restorative Dental Sciences, AlFarabi Colleges of Medicine, Dentistry, Nursing, Riyadh, Saudi Arabia
| | - Malak F Alsafadi
- Department of Restorative Dental Sciences, AlFarabi Colleges of Medicine, Dentistry, Nursing, Riyadh, Saudi Arabia
| | - Heba A Alnazer
- Department of Restorative Dental Sciences, AlFarabi Colleges of Medicine, Dentistry, Nursing, Riyadh, Saudi Arabia
| | - Salman M Alanazi
- Department of Restorative Dental Sciences, AlFarabi Colleges of Medicine, Dentistry, Nursing, Riyadh, Saudi Arabia
| | - Khaled S Alotaibi
- Department of Restorative Dental Sciences, AlFarabi Colleges of Medicine, Dentistry, Nursing, Riyadh, Saudi Arabia
| | | |
Collapse
|
114
|
Taylor GD, Vernazza CR, Abdulmohsen B. Success of endodontic management of compromised first permanent molars in children: A systematic review. Int J Paediatr Dent 2020; 30:370-380. [PMID: 31778237 DOI: 10.1111/ipd.12599] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Endodontic therapies may be required in the management of compromised first permanent molar teeth; their success in children, however, is unknown. AIM To determine the success of endodontic therapies used on first permanent molar teeth in children aged sixteen and under. DESIGN MEDLINE, Embase, Cochrane library, CENTRAL, Clinicaltrials.gov, and the ISRCTN registry as well as relevant paediatric, endodontic, and traumatology journal were searched using a detailed search strategy. References of included studies were hand-searched. A PICOS question was formulated: (P): children aged sixteen and under; (I): endodontic therapies (not pulp capping) on a first permanent molar tooth; (C): no treatment; (O): clinical success of endodontic therapy; and (S): all study types included. Bias was assessed using the Cochrane and Robins-I risk tools. Quality of evidence was assessed using the GRADE approach. Significant heterogeneity precluded meta-analysis. RESULTS 4172 studies were retrieved and eleven were included in the narrative review. Partial and coronal pulpotomies have high success rates in the short term and long term. Limited evidence is available for conventional pulpectomy or regenerative techniques. CONCLUSIONS Partial and coronal pulpotomies are successful endodontic therapies for use in a compromised child's first permanent molar.
Collapse
Affiliation(s)
- Greig D Taylor
- Centre for Oral Health Research, School of Dental Sciences, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher R Vernazza
- Centre for Oral Health Research, School of Dental Sciences, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Bana Abdulmohsen
- Centre for Oral Health Research, School of Dental Sciences, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
115
|
Tozar KN, Erkmen Almaz M. Evaluation of the Efficacy of Erbium, Chromium-doped Yttrium, Scandium, Gallium, and Garnet Laser in Partial Pulpotomy in Permanent Immature Molars: A Randomized Controlled Trial. J Endod 2020; 46:575-583. [PMID: 32229029 DOI: 10.1016/j.joen.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The use of the erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser in vital pulp therapy contributes to the formation of dentin bridges and a sterile zone as well as the maintenance of the vitality of the pulp. However, no prior studies have used the Er,Cr:YSGG laser in partial pulpotomy of immature permanent teeth. The aim of this study was to compare the efficacy of partial pulpotomy treatment using mineral trioxide aggregate (MTA) alone and MTA with the Er,Cr:YSGG laser in permanent immature molars. METHODS A total of 90 caries-exposed permanent immature molar teeth were included and randomly divided into 2 groups: the MTA group (n = 45) and the laser + MTA group (n = 45). In the MTA group, MTA was applied to the exposed area on the pulp after bleeding control. In the same session, the tooth was restored with a composite resin. In the laser + MTA group, before MTA condensation, the Er,Cr:YSGG laser was applied to the exposure area. Patients were recalled at 1, 3, 6, and 12 months after treatment. The Mann-Whitney U and chi-Square tests were used for statistical analysis. RESULTS The success rate (95.5%) of the laser + MTA group was similar to that of the MTA group (88.8%). There was no significant difference between groups in terms of the frequency of at least 1 pathologic clinical or radiographic failure at 12 months (P > .05). CONCLUSIONS Partial pulpotomy treatment showed a high success rate in immature permanent molars; however, the use of the laser did not contribute to the success rate compared with MTA alone.
Collapse
Affiliation(s)
- Kamile Nur Tozar
- Department of Pediatric Dentistry, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey
| | - Merve Erkmen Almaz
- Department of Pediatric Dentistry, Faculty of Dentistry, Kırıkkale University, Kırıkkale, Turkey.
| |
Collapse
|
116
|
Chang HH, Chang YJ, Yeh CL, Lin TA, Lin CP. Development of calcium phosphate/calcium sulfate biphasic biomedical material with hyaluronic acid containing collagenase and simvastatin for vital pulp therapy. Dent Mater 2020; 36:755-764. [PMID: 32312480 DOI: 10.1016/j.dental.2020.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/13/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In vital pulp therapy (VPT), a barrier is created with appropriate capping to protect the remaining pulp and thus maintain pulp vitality. Here, we evaluated the feasibility of a biphasic calcium phosphate cement (CPC)-calcium sulfate hemihydrate (CSH) biomaterial containing simvastatin (Sim) and collagenase (Col) for VPT. METHODS Combinations of varying CPC and CSH concentrations were analyzed for their handling properties and setting times, with their structures observed through scanning electron microscopy-energy dispersive X-ray spectrometry (SEM-EDS). Drug release patterns of simvastatin and collagenase combined with CPC-CSH (CPC-CSH-Sim-Col) were also analyzed, followed by biocompatibility and bioactivity tests on human dental pulp stem cells (hDPSCs) and in vivo animal study in canine models; the in vivo results were obtained through microcomputed tomography and histological analysis. RESULTS The results revealed that 70 wt% CPC (CPC7) with 30 wt% CSH (CSH3) exhibited optimal setting time and porous structure for clinical use. The cell viability and cytotoxicity analysis demonstrated that CPC7-CSH3 with or without simvastatin or collagenase did not injure hDPSCs. In vivo, the CPC7-CSH3-Sim-Col induced dentin bridge formation. SIGNIFICANCE CPC7-CSH3-Sim-Col in this study has great potential as a VPT biomaterial to enhance the dentin bridge formation.
Collapse
Affiliation(s)
- Hao-Hueng Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Department of Dentistry, Cardinal Tien Hospital Yonghe Branch, New Taipei, Taiwan
| | - Yao-Jen Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Chun-Liang Yeh
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Ting-An Lin
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Chun-Pin Lin
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
117
|
Maintaining pulpal vitality: Cost-effectiveness analysis on carious tissue removal and direct pulp capping. J Dent 2020; 96:103330. [PMID: 32259533 DOI: 10.1016/j.jdent.2020.103330] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES When managing deep carious lesions, dentists can maintain pulp vitality via (1) avoiding pulp exposure and complications by performing selective (SE) instead of non-selective (NS) carious tissue removal, and/or (2) treat exposed pulps by direct capping with mineral-trioxide-aggregate (MTA) instead of calcium hydroxide (CH). We assessed the cost-effectiveness of SE vs. NS combined with direct pulp capping using MTA vs. CH. METHODS A mixed public-private-payer perspective within German healthcare was applied. We modeled a permanent molar with a deep carious lesion and a vital asymptomatic pulp. The lesion was treated by SE/NS and, in case of exposure, direct pulp capping using MTA/CH. The tooth was followed over the lifetime of an initially 30-year-old patient using Markov-models, informed by pairwise and Bayesian network meta-analyses and further data sources. The primary health outcome was tooth-retention time. Costs were derived from German fee item catalogues, combined with micro-costing. Monte-Carlo micro-simulation was performed, and uncertainty introduced via probabilistic and univariate sensitivity analyses. Value-of-information-analysis (VOI) was performed to quantify the value of further research. RESULTS SE and, in case of pulp exposure, MTA had a high chance (>95 %) of being cost-effective, with teeth being retained for 37.37 years at costs of 2140 Euro in mean. Alternative strategies were both more costly and less effective; this ranking was robust in sensitivity analyses. The VOI was 1.18 Euro per treated case and 12.86 million Euro on population-level. CONCLUSION Selective carious tissue removal and, in case of pulp exposure, direct capping with MTA was the most cost-effective strategy. CLINICAL SIGNIFICANCE Avoiding pulp exposure was more relevant for cost-effectiveness than how the exposed pulp was managed. Overall differences remain limited, though, and dentists may want to tailor treatment strategies according to their expertise and patients' expectations.
Collapse
|
118
|
Munir A, Zehnder M, Rechenberg DK. Wound Lavage in Studies on Vital Pulp Therapy of Permanent Teeth with Carious Exposures: A Qualitative Systematic Review. J Clin Med 2020; 9:jcm9040984. [PMID: 32244782 PMCID: PMC7231275 DOI: 10.3390/jcm9040984] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to systematically review pulp wound lavage in vital pulp therapy (VPT). A search was conducted in six life science databases to identify clinical trials carried out on permanent teeth with a carious pulp exposure and a recall interval of at least six months. Twenty-seven trials of low to moderate risk of bias (RoB-2 and ROBINS-I) were included. Data was extracted and analyzed regarding study characteristics and methods used for pulp wound lavage. The agent used for pulp wound lavage was specified in all included trials. Most of the identified trials (23/27) randomized the pulp capping material. Many (14/27) reported the use of sodium hypochlorite (NaOCl); ten used only saline or water. One trial was identified that compared pulp wound lavage with 2.5% (NaOCl) to saline, another compared 5% glutaraldehyde to water, both in immature molar pulpotomies. Both studies were underpowered. Neither showed a significant difference between treatments. The use of NaOCl was positively correlated to recent year of publication and use of hydraulic calcium silicate cements for pulp capping (p < 0.05). In conclusion, despite a lack of well-designed trials on pulp wound lavage in VPT, a trend towards using NaOCl for this purpose was observed.
Collapse
|
119
|
Sadaf D. Success of Coronal Pulpotomy in Permanent Teeth with Irreversible Pulpitis: An Evidence-based Review. Cureus 2020; 12:e6747. [PMID: 32133269 PMCID: PMC7034736 DOI: 10.7759/cureus.6747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Vital pulp therapies have been used in primary teeth and immature permanent teeth. However, with the advent of new bioactive material, the paradigm is shifting toward permanent teeth with mature apices of roots. There are many prospective and retrospective studies, randomized controlled trials, and systematic reviews that report coronal pulpotomy with bioactive material in permanent teeth with pulpal pathosis proved to be as successful as root canal therapy (RCT). Coronal pulpotomy is cost-effective, not very technical demanding like root canal therapy and less time consuming for both the dentists and patients. This treatment can be offered to the patient as an alternative to endodontic therapy. The objective of this study is to review the literature related to the clinical outcome of coronal pulpotomy in permanent teeth with mature apex and having pulpal pathosis. This evidence-based review will facilitate clinical decision making in situations to choose coronal pulpotomy over root canal therapy in mature permanent teeth with irreversible pulpitis.
Collapse
Affiliation(s)
- Durre Sadaf
- Conservative Dentistry, College of Dentistry, Qassim University, Buraydah, SAU
| |
Collapse
|
120
|
Payahoo S, Jamali S, Jabbari G, Jamee A. Efficacy of Lasers Treatment of Exposed Pulps to Stimulate Healing: A Systematic Review and Meta-Analysis. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - Azad Jamee
- Urmia University of Medical Sciences, Iran
| |
Collapse
|
121
|
Lin LM, Ricucci D, Saoud TM, Sigurdsson A, Kahler B. Vital pulp therapy of mature permanent teeth with irreversible pulpitis from the perspective of pulp biology. AUST ENDOD J 2019; 46:154-166. [DOI: 10.1111/aej.12392] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Louis M. Lin
- Department of Endodontics New York University College of Dentistry New York New York USA
| | | | - Tarek M. Saoud
- Department of Restorative Dentistry and Endodontics Faculty of Dentistry University of Benghazi Benghazi Libya
| | - Asgeir Sigurdsson
- Department of Endodontics New York University College of Dentistry New York New York USA
| | - Bill Kahler
- The University of Queensland School of Dentistry Brisbane Queensland Australia
| |
Collapse
|
122
|
Angerame D, De Biasi M, Franco V, Generali L. Multidisciplinary Management and Pulp Vitality Preservation of a Tooth With Extensive Iatrogenic Furcal Root Perforation and Biologic Width Violation. Oper Dent 2019; 45:117-122. [PMID: 31738693 DOI: 10.2341/19-026-t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This article describes the case of a vital molar tooth with a vast furcal iatrogenic root perforation and biologic width violation, which was successfully managed by a multidisciplinary approach aimed at preserving pulp vitality. The root perforation was cleaned and then sealed with mineral trioxide aggregate, which was positioned onto the pulp at the canal orifices. After one month, the patient was not reporting symptoms, and the tooth was positively responding to the thermal test. The tooth was orthodontically extruded, subjected to minimally invasive crown lengthening, and prepared to receive a full-crown restoration. Radiotransparent composite resin was chosen as a permanent restorative material to better monitor possible endodontic complications at the coronal level. The patient's tooth was followed up for eight years uneventfully. The present case is an example of the possibility to subject a root-repaired tooth with fully formed apices to conservative yet complex multidisciplinary treatment while maintaining pulp vitality.
Collapse
|
123
|
Paula A, Carrilho E, Laranjo M, Abrantes AM, Casalta-Lopes J, Botelho MF, Marto CM, Ferreira MM. Direct Pulp Capping: Which is the Most Effective Biomaterial? A Retrospective Clinical Study. MATERIALS 2019; 12:ma12203382. [PMID: 31623190 PMCID: PMC6829284 DOI: 10.3390/ma12203382] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/05/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022]
Abstract
(1) Background: Recently, tricalcium silicate cements, such as Biodentine™, have emerged. This biomaterial has a calcium hydroxide base and characteristics like mineral aggregate trioxide cements, but has tightening times that are substantially more suitable for their application and other clinical advantages. (2) Methods: A retrospective clinical study was conducted with 20 patients, which included a clinical evaluation of the presence or absence of pulp inflammation compatible symptoms, radiographic evaluation of the periapical tissues, and structural alterations of the coronary restoration that supports pulp capping therapies with Biodentine™ and WhiteProRoot®MTA. (3) Results: This clinical study revealed similar success rates between mineral trioxide cement and tricalcium silicates cements at 6 months, with 100% and 95% success rates, respectively. There were no statistically significant differences between both biomaterials and between these and the various clinical circumstances, namely the absolute isolation of the operating field, exposure size, the aetiology of exposure, and even the type of restorative material used. (4) Conclusions: Biodentine™ demonstrated a therapeutic effect on the formation of a dentin bridge accompanied by slight inflammatory signs, with a high clinical success rate, indicating the possibility of its effective and safe use in dental pulp direct capping in humans, similar to the gold standard material.
Collapse
Affiliation(s)
- Anabela Paula
- Institute of Integrated Clinical Practice, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal.
| | - Eunice Carrilho
- Institute of Integrated Clinical Practice, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal.
| | - Mafalda Laranjo
- Biophysics Institute, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI Consortium, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Ana M Abrantes
- Biophysics Institute, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI Consortium, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - João Casalta-Lopes
- Biophysics Institute, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI Consortium, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Radiation Oncology Department, Coimbra University Hospital Centre, 3000-548 Coimbra, Portugal.
| | - Maria Filomena Botelho
- Biophysics Institute, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI Consortium, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Carlos Miguel Marto
- Institute of Experimental Pathology, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Manuel M Ferreira
- Institute of Endodontics, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal.
| |
Collapse
|
124
|
Elmsmari F, Ruiz XF, Miró Q, Feijoo-Pato N, Durán-Sindreu F, Olivieri JG. Outcome of Partial Pulpotomy in Cariously Exposed Posterior Permanent Teeth: A Systematic Review and Meta-analysis. J Endod 2019; 45:1296-1306.e3. [PMID: 31515048 DOI: 10.1016/j.joen.2019.07.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The current systematic review and meta-analysis aimed to evaluate the success rate of partial pulpotomy in treating permanent posterior teeth with carious vital pulp exposure. A secondary aim was to assess the prognostic factors using a meta-regression. METHODS An electronic search was performed for studies from January 1950 to November 2018 in the following databases: PubMed, ScienceDirect, and Cochrane. All searches were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies evaluating the success rate of cariously exposed vital human permanent posterior teeth treated with a partial pulpotomy were selected. Only randomized clinical trials and prospective clinical studies were included for evaluation. The Newcastle-Ottawa Scale and the Cochrane Collaboration's tool were used to evaluate risk assessment. RESULTS From the 218 studies identified through the initial search, 11 studies qualified for the final analysis (5 randomized clinical trials and 6 prospective studies). The results of the meta-analysis indicate a success rate of 98% (confidence interval [CI]: 0.94-1), 96% (CI: 0.92-0.99), and 92% (CI: 0.83-0.97) after 6 months and 1 and 2 years of follow-up. Examining the probable prognostic factors using meta-regression analysis, only preoperative pulp status (P = .001) was identified as a significant factor, with studies including teeth with the presumptive diagnosis of irreversible pulpitis displaying significantly lower results. The final solution, pulp capping material, apex closure, and the age of the patient did not affect the treatment success rate (P > .05). CONCLUSIONS The available data suggest that a partial pulpotomy results in high success rates in treating cariously exposed permanent posterior teeth up to 2 years. Six months of monitoring can be considered an appropriate period when evaluating the success of a partial pulpotomy although more clinical and radiographic controls are essential to ensuring success.
Collapse
Affiliation(s)
- Firas Elmsmari
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Xavier-Fructuós Ruiz
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Queralt Miró
- Department of Basic Sciences, Biostatistics Unit, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Nancy Feijoo-Pato
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Juan Gonzalo Olivieri
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain.
| |
Collapse
|
125
|
Taneja S, Singh A. Evaluation of effectiveness of calcium hydroxide and MTA as pulpotomy agents in permanent teeth: A meta-analysis. PEDIATRIC DENTAL JOURNAL 2019. [DOI: 10.1016/j.pdj.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
126
|
Suhag K, Duhan J, Tewari S, Sangwan P. Success of Direct Pulp Capping Using Mineral Trioxide Aggregate and Calcium Hydroxide in Mature Permanent Molars with Pulps Exposed during Carious Tissue Removal: 1-year Follow-up. J Endod 2019; 45:840-847. [DOI: 10.1016/j.joen.2019.02.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 02/15/2019] [Accepted: 02/27/2019] [Indexed: 10/26/2022]
|
127
|
Cushley S, Duncan HF, Lappin MJ, Tomson PL, Lundy FT, Cooper P, Clarke M, El Karim IA. Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: A systematic review. J Dent 2019; 88:103158. [PMID: 31229496 DOI: 10.1016/j.jdent.2019.06.005] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/24/2019] [Accepted: 06/20/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Management of carious teeth with signs and symptoms indicative of irreversible pulpitis is traditionally invasive, but emerging evidence suggests successful treatment outcomes with less invasive vital pulp treatment such as coronal pulpotomy. The objective of this systematic review is to determine whether coronal pulpotomy is clinically effective in treating carious teeth with signs and symptoms indicative of irreversible pulpitis. SOURCES MEDLINE; PubMed; Embase, Web of Science, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform and ClinicalTrials.gov were searched until December 2018. STUDY SELECTION Prospective, retrospective and randomised clinical trials investigating coronal pulpotomy or comparing pulpotomy to root canal treatment in permanent mature carious teeth with signs and symptoms indicative of irreversible pulpitis were included. Studies were independently assessed for risk of bias using Cochrane Systematic Reviews of intervention criteria and modified Downs and Black quality assessment checklist. DATA Eight articles were selected for analysis. The average success rate for coronal pulpotomy was 97.4% clinical and 95.4% radiographic at 12 month follow-up. This was reduced to 93.97% clinical and 88.39% radiographic success at 36 months follow-up. Results from the only comparative clinical trial showed pulpotomy to have comparable success to root canal treatment at 12, 24 and 60 month follow-up. CONCLUSIONS The evidence suggests high success for pulpotomy for teeth with signs and symptoms of irreversible pulpitis, however, results are based on heterogeneous studies with high risk of bias. Well-designed, adequately powered randomised controlled trials are required for evidence to change clinical practice. CLINICAL SIGNIFICANCE Management of carious teeth with irreversible pulpitis is traditionally invasive, but emerging evidence suggests potentially successful treatment outcomes with less invasive therapies such as coronal pulpotomy.
Collapse
Affiliation(s)
- Siobhan Cushley
- Centre for Dentistry, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Henry F Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Lincoln Place, Dublin, Ireland
| | - Mark J Lappin
- Centre for Dentistry, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Phillip L Tomson
- The University of Birmingham School of Dentistry, Institute of Clinical Sciences, 5 Mill Pool Way, Edgbaston, Birmingham, UK
| | - Fionnuala T Lundy
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, UK
| | - Paul Cooper
- Oral Biology, The University of Birmingham School of Dentistry, Institute of Clinical Sciences, 5 Mill Pool Way, Edgbaston, Birmingham, UK
| | - Mike Clarke
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Institute of Clinical Sciences Block B, Belfast UK
| | - Ikhlas A El Karim
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, UK.
| |
Collapse
|
128
|
Li M, Hu X, Li X, Lei S, Cai M, Wei X, Deng D. Dentist-related factors influencing the use of vital pulp therapy: a survey among dental practitioners in China. J Int Med Res 2019; 47:2381-2393. [PMID: 30991868 PMCID: PMC6567720 DOI: 10.1177/0300060519843406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate dentist-related factors associated with the use of vital pulp therapy (VPT) for the treatment of pulp exposures in permanent teeth. Methods This survey-based study sent an online questionnaire to collect data on the demographics of the respondents, the use of VPT and the choice of materials for VPT, to all members of the Society of Endodontology of Guangdong, China. Results A total 183 of 380 members responded (48.2%). The majority (89.6%; 164 of 183) had performed direct pulp capping (DPC) while 55.2% (101 of 183) had performed partial pulpotomy (PP) at least once. The most-cited reason for not performing VPT was unfamiliarity with the technique. Mineral trioxide aggregate was the most commonly used material for both DPC (67.1%; 110 of 164) and PP (73.3%; 74 of 101). Endodontists, compared with general practitioners, preferred to perform DPC and chose calcium silicate materials (CSMs) for VPT (odds ratios 5.81 and 8.07, respectively). DPC and CSMs for VPT were also favoured more by respondents who had practised for > 5 years. Senior respondents were more likely to use PP. Conclusions Speciality, years of practise and age of dentists influenced the decision making and the choice of materials for VPT. Continuing education is essential to promote the clinical use of VPT.
Collapse
Affiliation(s)
- Mengjie Li
- 1 Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,2 Guangdong Province Key Laboratory of Stomatology, Guangzhou, Guangdong Province, China
| | - Xiaoli Hu
- 1 Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,2 Guangdong Province Key Laboratory of Stomatology, Guangzhou, Guangdong Province, China
| | - Xiaolan Li
- 1 Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,2 Guangdong Province Key Laboratory of Stomatology, Guangzhou, Guangdong Province, China.,3 Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Shuxiang Lei
- 1 Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,2 Guangdong Province Key Laboratory of Stomatology, Guangzhou, Guangdong Province, China
| | - Ming Cai
- 1 Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,2 Guangdong Province Key Laboratory of Stomatology, Guangzhou, Guangdong Province, China
| | - Xi Wei
- 1 Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,2 Guangdong Province Key Laboratory of Stomatology, Guangzhou, Guangdong Province, China
| | - Dongmei Deng
- 2 Guangdong Province Key Laboratory of Stomatology, Guangzhou, Guangdong Province, China.,3 Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
129
|
Voicu G, Didilescu AC, Stoian AB, Dumitriu C, Greabu M, Andrei M. Mineralogical and Microstructural Characteristics of Two Dental Pulp Capping Materials. MATERIALS 2019; 12:ma12111772. [PMID: 31159182 PMCID: PMC6600720 DOI: 10.3390/ma12111772] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 02/07/2023]
Abstract
This paper aims to investigate the composition, surface, and microstructural characteristics, and bioactivity of two commercially available pulp capping materials known as TheraCal LC and BIO MTA+. The materials were prepared as cylindrical samples and assessed by X-ray diffraction (XRD) and complex thermal analysis for mineralogical characterization, and by scanning electron microscopy (SEM) coupled with energy dispersive of X-ray (EDX), Fourier-Transformed Infrared Spectroscopy (FT-IR), and atomic force microscopy (AFM) for microstructural and surface characteristics. The in vitro bioactivity was highlighted by surface mineralization throughout SEM coupled with EDX and FT-IR analysis. XRD analysis performed on both materials showed calcium silicate phases and different radiopacifying compounds. AFM measurements indicated a smoother and more homogenous surface with a lower average roughness for TheraCal LC due to the resin matrix from its composition. FT-IR analysis displayed bands for several compounds in both materials. Both materials exhibited bioactive properties showing surface mineralization after being immersed in solution similar to the human physiological environment. However, the MTA cement showed a better mineralization due to the anhydrous and hydrated phases.
Collapse
Affiliation(s)
- Georgeta Voicu
- Department of Biomaterials and Medical Devices, Faculty of Medical Engineering, University Politehnica of Bucharest, 1-7 Polizu, 011061 Bucharest, Romania.
| | - Andreea C Didilescu
- Division of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania.
| | - Andrei B Stoian
- Department of General Chemistry, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, University Politehnica of Bucharest, 1-7 Polizu, 011061 Bucharest, Romania.
| | - Cristina Dumitriu
- Department of General Chemistry, Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, University Politehnica of Bucharest, 1-7 Polizu, 011061 Bucharest, Romania.
| | - Maria Greabu
- Division of Biochemistry, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania.
| | - Mihai Andrei
- Division of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania.
| |
Collapse
|
130
|
Ricucci D, Siqueira JF, Li Y, Tay FR. Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure. J Dent 2019; 86:41-52. [PMID: 31121241 DOI: 10.1016/j.jdent.2019.05.022] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/28/2019] [Accepted: 05/18/2019] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Vital pulp therapy (VPT) encompasses distinct treatment modalities for deep caries that approximate the pulp chamber in vital teeth. Confusion exists in the literature in terms of the indication and rationale for each VPT approach. The objectives of the present study are to elucidate the indications for VPT and to present a set of histopathology and histobacteriology-based guidelines for VPT in teeth with deep caries. METHODS Two hundred and sixty-four carious, unrestored and VPT-treated human teeth, which were extracted for reasons not related to the present study. The teeth were processed for histological and histobacteriological examination. Other 757 clinical cases that received different VPT procedures were followed-up to identify success rates, with the longest observational period of 30 years. RESULTS Follow-up of the clinical cases indicated that direct pulp capping was successful in 73.2%, partial pulpotomy in 96.4% and full pulpotomy in 77.8% of the cases. Histological and histobacteriological examination showed a localised inflammatory response that commonly occurred in the subjacent pulp tissue as soon as the enamel was penetrated by caries. If the softened and infected dentine were completely excavated, without pulp exposure, and the cavity restored with an adequate restoration, pulp inflammation frequently subsided. In teeth showing pulp exposure, the extent of bacterial penetration varied and areas of infection presented severe pulp inflammation, including micro-abscesses. However, the pulp tissue apical to the infected/inflamed area was usually uninflamed and normal. Guidelines based on the present histopathological, histobacteriological and clinical findings are proposed for VPT and mainly involve direct examination of dentine and the exposed pulp tissue under deep caries for decision-making, and require strict asepsis during procedures. CONCLUSIONS Vital pulp therapy following the guidelines proposed in the present article has the potential to improve the outcome of the conservative treatment of mature teeth with deep caries and in some occasions may be an alternative to pulpectomy. CLINICAL SIGNIFICANCE A guideline for VPT in the treatment of deep caries is proposed, focusing on direct observation of dentine and the exposed pulp tissue under deep caries. Stringent aseptic techniques are mandatory for VPT procedures to be successful.
Collapse
Affiliation(s)
| | - José F Siqueira
- Department of Endodontics, Faculty of Dentistry, Estácio de Sá University, Rio de Janeiro, RJ, Brazil
| | - Yuanyuan Li
- Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, PR China
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, GA, USA.
| |
Collapse
|
131
|
Bjørndal L, Simon S, Tomson PL, Duncan HF. Management of deep caries and the exposed pulp. Int Endod J 2019; 52:949-973. [PMID: 30985944 DOI: 10.1111/iej.13128] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/10/2019] [Indexed: 01/12/2023]
Abstract
Caries prevalence remains high throughout the world, with the burden of disease increasingly affecting older and socially disadvantaged groups in Western cultures. If left untreated, caries will advance through dentine stimulating pulpitis and eventually pulp infection and necrosis; however, if conservatively managed, pulpal recovery occurs even in deep carious lesions. Traditionally, deep caries management was destructive with nonselective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has been advocated for selective (partial) caries removal and a reduced risk of pulp exposure. Selective caries removal strategies can be one-visit as indirect pulp treatment or two-visit using a stepwise approach. Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy and the re-emergence of vital pulp treatment (VPT) techniques such as partial and complete pulpotomy. These changes stem from an improved understanding of the pulp-dentine complex's defensive and reparative response to irritation, with harnessing the release of bioactive dentine matrix components and careful handling of the damaged tissue considered critical. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. Unfortunately, the changes in management are only supported by relatively weak evidence with case series, cohort studies and preliminary studies containing low patient numbers forming the bulk of the evidence. As a result, critical questions related to the superiority of one caries removal technique over another, the best pulp capping biomaterial or whether pulp exposure is a negative prognostic factor remain unanswered. There is an urgent need to promote minimally invasive treatment strategies in Operative Dentistry and Endodontology; however, the development of accurate diagnostic tools, evidence-based management strategies and education in management of the exposed pulp are critical in the future.
Collapse
Affiliation(s)
- L Bjørndal
- Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Simon
- Paris Diderot University, Paris, France.,Hôpital de Rouen Normandie, Rouen, France.,Laboratoire IN SERM UMR 1138, Paris, France
| | - P L Tomson
- School of Dentistry, Institute of Clinical Sciences, Birmingham, UK
| | - H F Duncan
- Division of Restorative Dentistry & Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| |
Collapse
|
132
|
Effects of Different Calcium Silicate Cements on the Inflammatory Response and Odontogenic Differentiation of Lipopolysaccharide-Stimulated Human Dental Pulp Stem Cells. MATERIALS 2019; 12:ma12081259. [PMID: 30999582 PMCID: PMC6514726 DOI: 10.3390/ma12081259] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 11/17/2022]
Abstract
This study aimed to analyze the effects of different calcium silicate cements (CSCs) on the inflammatory response and odontogenic differentiation of lipopolysaccharide-stimulated human dental pulp stem cells. Human dental pulp stem cells (hDPSCs) were stimulated with lipopolysaccharide (LPS) to induce inflammation. These LPS-induced dental pulp stem cells (LDPSCs) were cultured with ProRoot MTA, Biodentine, Retro MTA, and Dycal. Cell viability was evaluated using the Cell Counting Kit-8 assay. Interleukin (IL)-6, IL-8, and transforming growth factor (TGF)-β1 cytokine levels were assessed using the enzyme-linked immunosorbent assay. The expressions of alkaline phosphatase (ALP), osteocalcin, and runt-related transcription factor 2 (RUNX2) were analyzed through real-time polymerase chain reaction. ProRoot MTA, Biodentine, and Retro MTA did not significantly decrease the cell viability of LDPSCs for up to 48 h (p < 0.05). Retro MTA significantly decreased the expression of IL-6 and IL-8 by LDPSCs. ProRoot MTA and Biodentine significantly reduced TGF-β expression by LDPSCs (p < 0.05). Regarding odontogenic differentiation, all CSCs had no effect on ALP expression but increased the production of RUNX2 at 12 h.
Collapse
|
133
|
Li Y, Sui B, Dahl C, Bergeron B, Shipman P, Niu L, Chen J, Tay FR. Pulpotomy for carious pulp exposures in permanent teeth: A systematic review and meta-analysis. J Dent 2019; 84:1-8. [PMID: 30981748 DOI: 10.1016/j.jdent.2019.03.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The most commonly-accepted strategy for managing irreversible pulpitis, an irreversible condition of dental pulp inflammation, is root canal treatment, which is limited by high costs and complex techniques. High success rates have been reported for the use of pulpotomy in managing pulp exposure resulting from extensive caries. The objective of the present work was to evaluate the effectiveness and cost-effectiveness of pulpotomy and associated medicaments in saving permanent teeth with pulp exposure resulting from extensive caries. SOURCES Multiple databases were searched on January 12, 2019, without limitations on the language or year of publication. STUDY SELECTION Randomized controlled trials comparing pulpotomy with alternative treatments, or comparing two or more medicaments in pulpotomy for permanent teeth with carious pulp exposure were included. DATA Seventeen studies reported in 21 articles were included. Intention-to-treat analyses on studies comparing pulpotomy and other treatment modalities tended to favor pulpotomy. Meta-analysis was not performed on comparisons of pulpotomy and other treatments because of the limited number of studies. Most evidence on comparisons among different pulpotomy medicaments was found in trials comparing mineral trioxide aggregate (MTA) and calcium hydroxide, with the results of meta-analyses favoring MTA. Data were insufficient to determine the cost-effectiveness of successful modality. CONCLUSIONS Pulpotomy is a prospective substitute for root canal treatment in managing permanent teeth with carious pulp exposures, even in permanent teeth with irreversible pulpitis. Large, well-designed trials comparing pulpotomy with other treatments in terms of cost-effectiveness should be informative. CLINICAL SIGNIFICANCE The success of pulpotomy in managing irreversible pulpitis challenges the rhetoric that irreversible pulpitis can only be managed by root canal treatment. Cost-effectiveness analysis rather than analysis on effectiveness of treatment outcome alone should be considered in all health care domains to evaluate the benefits of alternative treatment options.
Collapse
Affiliation(s)
- Yuanyuan Li
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, 145 Changle West Road, Xi'an, Shaanxi 710032, PR China
| | - Bingdong Sui
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, 145 Changle West Road, Xi'an, Shaanxi 710032, PR China; State Key Laboratory of Military Stomatology & Center for Tissue Engineering, School of Stomatology, The Fourth Military Medical University, 145 Changle West Road, Xi'an, Shaanxi 710032, PR China
| | - Christian Dahl
- Department of Endodontics, The Dental College of Georgia, Augusta University, 1430, John Wesley Gilbert Drive, Augusta, GA 30912-1129, USA
| | - Brian Bergeron
- Department of Endodontics, The Dental College of Georgia, Augusta University, 1430, John Wesley Gilbert Drive, Augusta, GA 30912-1129, USA
| | - Peter Shipman
- Greenblatt Library, Augusta University, 1430, John Wesley Gilbert Drive, Augusta, GA 30912-1129, USA
| | - Lina Niu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, 145 Changle West Road, Xi'an, Shaanxi 710032, PR China; Department of Endodontics, The Dental College of Georgia, Augusta University, 1430, John Wesley Gilbert Drive, Augusta, GA 30912-1129, USA.
| | - Jihua Chen
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, 145 Changle West Road, Xi'an, Shaanxi 710032, PR China; Department of Endodontics, The Dental College of Georgia, Augusta University, 1430, John Wesley Gilbert Drive, Augusta, GA 30912-1129, USA.
| | - Franklin R Tay
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, 145 Changle West Road, Xi'an, Shaanxi 710032, PR China; Department of Endodontics, The Dental College of Georgia, Augusta University, 1430, John Wesley Gilbert Drive, Augusta, GA 30912-1129, USA.
| |
Collapse
|
134
|
Sanz JL, Rodríguez-Lozano FJ, Llena C, Sauro S, Forner L. Bioactivity of Bioceramic Materials Used in the Dentin-Pulp Complex Therapy: A Systematic Review. MATERIALS 2019; 12:ma12071015. [PMID: 30934746 PMCID: PMC6479584 DOI: 10.3390/ma12071015] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022]
Abstract
Dentistry-applied bioceramic materials are ceramic materials that are categorized as bioinert, bioactive and biodegradable. They share a common characteristic of being specifically designed to fulfil their function; they are able to act as root canal sealers, cements, root repair or filling materials. Bioactivity is only attributed to those materials which are capable of inducing a desired tissue response from the host. The aim of this study is to present a systematic review of available literature investigating bioactivity of dentistry-applied bioceramic materials towards dental pulp stem cells, including a bibliometric analysis of such a group of studies and a presentation of the parameters used to assess bioactivity, materials studied and a summary of results. The research question, based on the PICO model, aimed to assess the current knowledge on dentistry-based bioceramic materials by exploring to what extent they express bioactive properties in in vitro assays and animal studies when exposed to dental pulp stem cells, as opposed to a control or compared to different bioceramic material compositions, for their use in the dentin-pulp complex therapy. A systematic search of the literature was performed in six databases, followed by article selection, data extraction, and quality assessment. Studies assessing bioactivity of one or more bioceramic materials (both commercially available or novel/experimental) towards dental pulp stem cells (DPSCs) were included in our review. A total of 37 articles were included in our qualitative review. Quantification of osteogenic, odontogenic and angiogenic markers using reverse transcriptase polymerase chain reaction (RT-PCR) is the prevailing method used to evaluate bioceramic material bioactivity towards DPSCs in the current investigative state, followed by alkaline phosphatase (ALP) enzyme activity assays and Alizarin Red Staining (ARS) to assess mineralization potential. Mineral trioxide aggregate and Biodentine are the prevalent reference materials used to compare with newly introduced bioceramic materials. Available literature compares a wide range of bioceramic materials for bioactivity, consisting mostly of in vitro assays. The desirability of this property added to the rapid introduction of new material compositions makes this subject a clear candidate for future research.
Collapse
Affiliation(s)
- José Luis Sanz
- Department of Stomatology, Universitat de València, 46010 Valencia, Spain.
| | - Francisco Javier Rodríguez-Lozano
- Cellular Therapy and Hematopoietic Transplant Unit, Hematology Department, Virgen de la Arrixaca Clinical University Hospital, IMIB, University of Murcia, 30120 Murcia, Spain.
- School of Dentistry, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain.
| | - Carmen Llena
- Department of Stomatology, Universitat de València, 46010 Valencia, Spain.
| | - Salvatore Sauro
- Department of Dentistry, Faculty of Health Sciences, Universidad CEU-Cardenal Herrera, 46115 Alfara del Patriarca (Valencia), Spain.
- Faculty of Dentistry, Oral & Craniofacial Sciences at King's College London, Floor 17 Tower Wing, Guy's Hospital, London SE1 9RT, UK.
| | - Leopoldo Forner
- Department of Stomatology, Universitat de València, 46010 Valencia, Spain.
| |
Collapse
|
135
|
Dammaschke T, Nowicka A, Lipski M, Ricucci D. Histological evaluation of hard tissue formation after direct pulp capping with a fast-setting mineral trioxide aggregate (RetroMTA) in humans. Clin Oral Investig 2019; 23:4289-4299. [DOI: 10.1007/s00784-019-02876-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/19/2019] [Indexed: 12/31/2022]
|
136
|
Limjeerajarus CN, Sonntana S, Pajaree L, Kansurang C, Pitt S, Saowapa T, Prasit P. Prolonged release of iloprost enhances pulpal blood flow and dentin bridge formation in a rat model of mechanical tooth pulp exposure. J Oral Sci 2019; 61:73-81. [DOI: 10.2334/josnusd.17-0368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Chalida N. Limjeerajarus
- Department of Physiology, Faculty of Dentistry, Chulalongkorn University
- Excellence Center in Regenerative Dentistry, Faculty of Dentistry, Chulalongkorn University
| | - Seang Sonntana
- Graduate School, Oral Biology Program, Faculty of Dentistry, Chulalongkorn University
| | | | | | - Supaphol Pitt
- The Petroleum and Petrochemical College, Chulalongkorn University
| | - Thumsing Saowapa
- The Petroleum and Petrochemical College, Chulalongkorn University
- Department of Industrial Chemistry, Faculty of Applied Science, King Mongkut University of Technology North
| | - Pavasant Prasit
- Excellence Center in Regenerative Dentistry, Faculty of Dentistry, Chulalongkorn University
- Department of Anatomy, Faculty of Dentistry, Chulalongkorn University
| |
Collapse
|
137
|
|
138
|
Promotion of Dental Pulp Wound Healing in New Zealand White Rabbits’ Teeth by Thai Propolis Product. J Vet Dent 2018; 36:17-24. [DOI: 10.1177/0898756418818891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study examined and compared wound healing between Thai propolis product and calcium hydroxide paste as pulp-capping agents after partial pulpotomy in New Zealand white rabbits. Forty incisor teeth from 10 rabbits were treated. Thirty-six teeth received class V cavity preparations with partial pulpotomy and application of either propolis or calcium hydroxide paste. Similar cavity preparations were performed in 2 teeth without any capping material as a positive control, whereas 2 teeth without the cavity preparation served as a negative control. Histological evaluation showed that both groups had dentin bridge formation. Dentinal tubules in the dentin bridge were more orderly arranged in the Thai propolis group than in the calcium hydroxide group. Wound healing and the median number of hyperemic blood vessels were not statistically significant different between the 2 groups. Thai propolis product may be used as a pulp-capping agent.
Collapse
|
139
|
Harms CS, Schäfer E, Dammaschke T. Clinical evaluation of direct pulp capping using a calcium silicate cement—treatment outcomes over an average period of 2.3 years. Clin Oral Investig 2018; 23:3491-3499. [DOI: 10.1007/s00784-018-2767-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/04/2018] [Indexed: 12/21/2022]
|
140
|
Vascularity and VEGF/VEGFR2 Signaling in the Dentine-Pulp Complex of Immature and Mature Permanent Teeth. Eur Endod J 2018; 3:153-159. [PMID: 32161871 PMCID: PMC7006575 DOI: 10.14744/eej.2018.07269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/04/2018] [Accepted: 09/28/2018] [Indexed: 01/09/2023] Open
Abstract
Objective To examine the microvessel density (MVD) and spatial distribution of endothelial cells and angiogenic activity in immature and mature permanent teeth using immunohistochemistry. Methods Healthy third molars with immature and mature root development were formalin-fixed, decalcified in 10% ethylenediaminetetraacetic acid, and processed for routine immunohistochemistry with endothelial cell markers anti-CD34 and anti-CD146 and angiogenic markers anti-vascular endothelial growth factor (VEGF) and anti-VEGF receptor-2 (VEGFR2). Staining was visualized with diaminobenzidine and examined using light microscopy. The distribution of markers was analyzed qualitatively and quantitatively in the coronal, middle, and apical regions of the dentine-pulp complex. Results There were spatial differences in protein expression for immature and mature teeth. The pulps of immature teeth were more vascular, had a greater number of CD34+ and CD146+ cells, and a significantly higher MVD in the coronal region than those of mature teeth (P=0.03). The apical papilla contained few blood vessels. VEGF/VEGFR2 activity was significantly greater for immature teeth (P=0.001). VEGF was expressed throughout the pulp-dentine complex, but there was significantly more growth factor coronally (immature P=0.04 and mature P=0.02). VEGFR2 was expressed less than VEGF but was seen on the endothelial cells and single cells unrelated to a vessel lumen. Conclusion The spatial distribution of vascular and angiogenic (VEGF/VEGFR2) markers indicates the potential for altered healing responses in the pulps of immature and mature teeth. Immature teeth have a greater MVD and VEGF/VEGFR2 expression than mature teeth, and the increased expression of these markers in the coronal region of both tooth types is important for pulp healing.
Collapse
|
141
|
Awawdeh L, Al-Qudah A, Hamouri H, Chakra RJ. Outcomes of Vital Pulp Therapy Using Mineral Trioxide Aggregate or Biodentine: A Prospective Randomized Clinical Trial. J Endod 2018; 44:1603-1609. [PMID: 30292451 DOI: 10.1016/j.joen.2018.08.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/16/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Mineral trioxide aggregate (MTA) has been used in pulp capping of cariously exposed mature permanent teeth with promising results. The search for alternative materials that seal better and set faster than MTA and do not stain is ongoing. Biodentine (Septodont, St Maur-des-Fossés, France) exhibits these advantages but has not been tested yet for a prolonged duration in mature teeth. This study aimed to evaluate the clinical performance of Biodentine and white MTA (Angelus, Londrina, Brazil) in cariously exposed mature permanent teeth. METHODS This was a prospective longitudinal randomized controlled study of 68 vital permanent teeth with deep caries. Patients were randomly allocated into 2 study arms: Biodentine and MTA. Teeth were assessed clinically and radiographically before the procedure. Caries were excavated under local anesthesia; hemostasis was achieved after pulp exposure using sodium hypochlorite and capped with Biodentine or MTA. Clinical and radiographic follow-ups were performed by a blinded calibrated evaluator after 6 months and 1, 2, and 3 years. RESULTS There were no significant differences in the overall success rate between Biodentine and MTA; it was 93.3% (Biodentine = 93.1% and MTA = 93.5%) at 6 months. The overall success rate increased to 96.2% (Biodentine = 96.0% and MTA = 100%) at 1 year and to 100% at 2 years. At the 3-year follow-up, it decreased to 93.8% (Biodentine = 91.7% and MTA = 96.0%). CONCLUSIONS Biodentine and MTA have favorable and comparable success rates when used as direct pulp capping or pulpotomy material in permanent mature teeth with carious exposure. The remaining tooth structure and durability of coronal restoration might affect significantly the long-term success of vital pulp therapy.
Collapse
Affiliation(s)
- Lama Awawdeh
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
| | - Aladdin Al-Qudah
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Hanan Hamouri
- Department of Mathematics and Statistics, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Rosalie Jean Chakra
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
142
|
Mahmoud SH, El-Negoly SA, Zaen El-Din AM, El-Zekrid MH, Grawish LM, Grawish HM, Grawish ME. Biodentine versus mineral trioxide aggregate as a direct pulp capping material for human mature permanent teeth - A systematic review. J Conserv Dent 2018; 21:466-473. [PMID: 30294104 PMCID: PMC6161524 DOI: 10.4103/jcd.jcd_198_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/21/2018] [Accepted: 07/29/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Biodentine is comparatively a new biomaterial claimed to have properties comparable to mineral trioxide aggregate (MTA). Biodentine and MTA are effectively used for direct pulp capping (DPC), and they are capable of regenerating relatively damaged pulp and formation of hard dentine bridge. OBJECTIVES The aim of this systematic review was to test the null hypothesis of no difference between Biodentine and MTA as DPC materials for human permanent mature teeth, against the alternative hypothesis of a difference. DATA SOURCES Clinical trials were identified by electronic databases searches of Midline, CENTRAL Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scopus, Scientific Electronic Library Online, evidence-based endodontics literature, KoreaMed, and Google Scholar. The literature search was performed from January 2010 to February 2018. Hand searches were also performed for relevant abstracts, books, and reference lists. Titles and abstracts of studies identified using the above-described protocol were independently screened by two authors. Full texts of studies judged by title and abstracts to be relevant were independently evaluated by two authors for stated eligibility criteria. STUDY ELIGIBILITY CRITERIA The eligibility criteria included randomized clinical trials (RCTs) and non-RCTs. PARTICIPANTS Patients with permanent mature molars indicated for surgical extraction or molars that have symptomless exposure of vital pulp tissue by caries or trauma. In both cases, the molars were subjected to DPC. INTERVENTIONS The pulp exposures were directly treated by Biodentine or MTA. STUDY APPRAISAL To assess article quality, two authors independently used the risk of bias in nonrandomized studies - of interventions. METHODS Qualitative metasynthesis was used to analyze data across qualitative studies. RESULTS The initial search identified 8725 unique references through the search process. No additional studies were identified through handsearching. After filtering, 915 references were recorded and screened. After the eligibility criteria were applied, seven unduplicated prospective and retrospective cohort studies were included in the qualitative metasynthesis. LIMITATIONS Further RCTs with much larger sample size and proper methodology with longer observational time are still in need to adequately address the questions of the present systematic review. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS Within the limitations of this review, it may be concluded that Biodentine had a similar effect on dentin bridge formation likely to MTA. However, this conclusion is based on only very few well-conducted prospective and retrospective cohort studies. SYSTEMATIC REVIEW REGISTRATION NUMBER The review had been registered with PROSPERO (registration number CRD42018089302).
Collapse
Affiliation(s)
- Salah H. Mahmoud
- Department of Operative Dentistry, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Salwa A. El-Negoly
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ahmed M. Zaen El-Din
- Department of Operative Dentistry, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Mansoura, Egypt
| | - Mona H. El-Zekrid
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Lamyaa M. Grawish
- Department of Undergraduate Students, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Mansoura, Egypt
| | - Hala M. Grawish
- Department of Undergraduate Students, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Mansoura, Egypt
| | - Mohammed E. Grawish
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| |
Collapse
|
143
|
Kim DH, Jang JH, Lee BN, Chang HS, Hwang IN, Oh WM, Kim SH, Min KS, Koh JT, Hwang YC. Anti-inflammatory and Mineralization Effects of ProRoot MTA and Endocem MTA in Studies of Human and Rat Dental Pulps In Vitro and In Vivo. J Endod 2018; 44:1534-1541. [PMID: 30174104 DOI: 10.1016/j.joen.2018.07.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Few studies have reported direct pulp capping in inflamed pulp conditions. The purpose of this study was to investigate the in vitro and in vivo responses of dental pulp during direct pulp capping using various pulp capping materials in inflamed conditions. METHODS Human dental pulp cells were treated with lipopolysaccharide (LPS) and cultured with Dycal (Dentsply Caulk, Milford, DE), ProRoot MTA (Dentsply Maillefer, Ballaigues, Switzerland), and Endocem MTA (Maruchi, Wonju, South Korea). The expressions of interleukin (IL)-1β, IL-6, dentin matrix protein 1, and dentin sialophosphoprotein were analyzed through real-time polymerase chain reaction. The maxillary molars of Sprague-Dawley rats were exposed for 2 days. The exposed pulps were capped with Dycal, ProRoot MTA, and Endocem MTA and sealed with resin-modified glass ionomer followed by histologic and immunohistochemical analyses. RESULTS The expression of IL-1β and IL-6 was increased with LPS and decreased by Dycal, ProRoot MTA, and Endocem MTA. Dentin matrix protein 1 and dentin sialophosphoprotein levels were decreased with LPS and increased after treatment with pulp capping materials.In the in vivo study, inflammation associated with Dycal was higher than that associated with ProRoot MTA and Endocem MTA at week 1, without any significant difference between the 2. At 4 weeks, inflammation was decreased, and mineralization was increased compared with week 1 in all 3 of the materials. At week 1, IL-6 immunoreactivity was strongly expressed. Dycal exhibited stronger immunoreactivity than ProRoot MTA and Endocem MTA. However, the immunoreactivity was decreased in all groups at week 4. CONCLUSIONS Successful direct pulp capping requires more effective pulp capping materials for the treatment of inflamed pulps.
Collapse
Affiliation(s)
- Do-Hee Kim
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Ji-Hyun Jang
- Department of Conservative Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Bin-Na Lee
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Hoon-Sang Chang
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - In-Nam Hwang
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Won-Mann Oh
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Sun-Hun Kim
- Department of Oral Anatomy, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Kyung-San Min
- Department of Conservative Dentistry, School of Dentistry, Chonbuk National University, Jeonju, Korea
| | - Jeong-Tae Koh
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea; Research Center for Biomineralization Disorders, Chonnam National University, Gwangju, Korea.
| | - Yun-Chan Hwang
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea; Research Center for Biomineralization Disorders, Chonnam National University, Gwangju, Korea.
| |
Collapse
|
144
|
PEREIRA KDF, CRUVINEL RFDS, DANTAS AAR, KUGA MC. Evaluation of calcium release and pH value of light-cured cavity liners for pulp-capping materials. REVISTA DE ODONTOLOGIA DA UNESP 2018. [DOI: 10.1590/1807-2577.06218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction Cavity liners based calcium hydroxide present low strength and high solubility that is consider a disadvantage. In order to enhance these properties it was developed a light-cured cavity liner based calcium hydroxide containing resin. Objective The purpose of this study was to evaluate the pH and calcium release of light-cured cavity liners. Material and method There were prepared specimens (n=10) with the Ultra-Blend ® plus, Biocal® (light cured cements) and Hydro C® (control). The samples were stored in 10 mL of distilled water and maintained at 37 °C. After 24 hours, 7, and 14 days, there were analyzed pH and the release of calcium levels. The data were statistically analyzed by ANOVA and Tukey test (α = 0.05). Result The results of pH showed Hydro C > Ultra-Blend plus > Biocal. Biocal presented worst calcium release. Conclusion Light-cured materials present lower calcium release and alteration in pH values.
Collapse
|
145
|
Endodontic and Restorative Treatment Patterns of Pulpally Involved Immature Permanent Posterior Teeth. Int J Dent 2018; 2018:2178535. [PMID: 30034469 PMCID: PMC6035824 DOI: 10.1155/2018/2178535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/21/2018] [Indexed: 11/18/2022] Open
Abstract
Objective The study aims at investigating the treatment patterns for young permanent posterior teeth with pulp involvement. Materials and Methods A random sample of 1793 dental records of patients aged 6-18 years old who had received dental treatment was investigated. 663 permanent posterior treated teeth had pulp involvement. Demographic and treatment data were gathered from patients' records. Results Prevalence of young permanent teeth with pulp involvement was 36.9%. Treatments received significantly increased as patients' age increased (P=0.001). The first mandibular molar had the most pulp involvement among all teeth (43.89%). Temporary restoration was the most received restoration (59%). The most common pulpal diagnosis, leading to treatment, was irreversible pulpitis (43.04%). Only 19.8% of treated teeth received completed root canal treatment. Conclusion There is a high percentage of children and adolescents with immature permanent posterior teeth with pulp involvement. Similarly, a variety of treatment patterns is present, with a small percentage of completed root canal treatment. Clinical Relevance The study has identified the need to provide guidelines to provide high-quality root canal treatments for young permanent posterior teeth that have pulpal involvement. Only 21.8% of root canal treatments were completed, while 24% of teeth were extracted, and 59% of patients received temporary restorative treatments. This suggests that there might be several factors that might prevent completion of the dental treatment, such as patient preference, insurance coverage, or dentist capability. These factors and guidelines for patient care should be investigated and resolved.
Collapse
|
146
|
Selective vs stepwise removal of deep carious lesions in primary molars: 12-Months results of a randomized controlled pilot trial. J Dent 2018; 77:72-77. [PMID: 30025748 DOI: 10.1016/j.jdent.2018.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/12/2018] [Accepted: 07/14/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES For deep carious lesions, selective or stepwise carious tissue removal (SE, SW) seem advantageous compared with non-selective removal. For primary molars, there is insufficient evidence comparing SE against SW. This randomized pilot trial compared SE and SW over 12 months. METHODS A two-arm superiority trial was conducted comparing SE and SW in primary molars with deep lesions but without pulpal symptoms. We recruited 74 children (one molar/child) aged 3-9 years. In both groups, peripheral carious tissue removal was performed at T1 to hard dentin. In proximity to the pulp, leathery dentin was left followed by an adhesive compomer restoration. Blinded re-examination was performed after six months (T2). Molars allocated to SW were re-entered, removal to firm dentin carried out pulpo-proximally, and again restored. After another 6 months, all molars were re-examined (T3). Our primary outcome was success, defined as no restorative/endodontic complications (including pulp exposure) leading to reinterventions. Secondary outcomes included total treatment and opportunity costs. Patients', dentists' and parents' subjective assessments were recorded. This trial was registered (ClinicalTrials.gov/NCT02232828). RESULTS After 12 months a total of 72 children (36 SE, 36 SW) were analyzed. Three failures occurred (2 exposures in SW, 1 pulpal complication leading to extraction in SE) (p > 0.05). The subjective evaluation by patients, parents or dentists did not differ significantly. Combined treatment and opportunity costs were significantly higher in SW (mean;SD: 186;61 Euro) than SE (100;59) (p < 0.001). CONCLUSIONS The significantly increased costs for performing SW instead of SE in deep carious lesions in primary molars may not be justified. CLINICAL SIGNIFICANCE For primary molars with deep lesions, but vital pulps, SE was less costly at similar efficacy compared with SW. Dentists' decision-making should consider this alongside further clinical aspects.
Collapse
|
147
|
Dentinogenic effects of extracted dentin matrix components digested with matrix metalloproteinases. Sci Rep 2018; 8:10690. [PMID: 30013085 PMCID: PMC6048071 DOI: 10.1038/s41598-018-29112-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/05/2018] [Indexed: 01/28/2023] Open
Abstract
Dentin is primarily composed of hydroxyapatite crystals within a rich organic matrix. The organic matrix comprises collagenous structural components, within which a variety of bioactive molecules are sequestered. During caries progression, dentin is degraded by acids and enzymes derived from various sources, which can release bioactive molecules with potential reparative activity towards the dentin-pulp complex. While these molecules’ repair activities in other tissues are already known, their biological effects are unclear in relation to degradation events during disease in the dentin-pulp complex. This study was undertaken to investigate the effects of dentin matrix components (DMCs) that are partially digested by matrix metalloproteinases (MMPs) in vitro and in vivo during wound healing of the dentin-pulp complex. DMCs were initially isolated from healthy dentin and treated with recombinant MMPs. Subsequently, their effects on the behaviour of primary pulp cells were investigated in vitro and in vivo. Digested DMCs modulated a range of pulp cell functions in vitro. In addition, DMCs partially digested with MMP-20 stimulated tertiary dentin formation in vivo, which exhibited a more regular tubular structure than that induced by treatment with other MMPs. Our results indicate that MMP-20 may be especially effective in stimulating wound healing of the dentin-pulp complex.
Collapse
|
148
|
Orti V, Collart-Dutilleul PY, Piglionico S, Pall O, Cuisinier F, Panayotov I. Pulp Regeneration Concepts for Nonvital Teeth: From Tissue Engineering to Clinical Approaches. TISSUE ENGINEERING. PART B, REVIEWS 2018; 24:419-442. [PMID: 29724156 DOI: 10.1089/ten.teb.2018.0073] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Following the basis of tissue engineering (Cells-Scaffold-Bioactive molecules), regenerative endodontic has emerged as a new concept of dental treatment. Clinical procedures have been proposed by endodontic practitioners willing to promote regenerative therapy. Preserving pulp vitality was a first approach. Later procedures aimed to regenerate a vascularized pulp in necrotic root canals. However, there is still no protocol allowing an effective regeneration of necrotic pulp tissue either in immature or mature teeth. This review explores in vitro and preclinical concepts developed during the last decade, especially the potential use of stem cells, bioactive molecules, and scaffolds, and makes a comparison with the goals achieved so far in clinical practice. Regeneration of pulp-like tissue has been shown in various experimental conditions. However, the appropriate techniques are currently in a developmental stage. The ideal combination of scaffolds and growth factors to obtain a complete regeneration of the pulp-dentin complex is still unknown. The use of stem cells, especially from pulp origin, sounds promising for pulp regeneration therapy, but it has not been applied so far for clinical endodontics, in case of necrotic teeth. The gap observed between the hope raised from in vitro experiments and the reality of endodontic treatments suggests that clinical success may be achieved without external stem cell application. Therefore, procedures using the concept of cell homing, through evoked bleeding that permit to recreate a living tissue that mimics the original pulp has been proposed. Perspectives for pulp tissue engineering in the near future include a better control of clinical parameters and pragmatic approach of the experimental results (autologous stem cells from cell homing, controlled release of growth factors). In the coming years, this therapeutic strategy will probably become a clinical reality, even for mature necrotic teeth.
Collapse
Affiliation(s)
- Valérie Orti
- LBN, Université de Montpellier , Montpellier, France
| | | | | | - Orsolya Pall
- LBN, Université de Montpellier , Montpellier, France
| | | | | |
Collapse
|
149
|
Mello B, C Stafuzza T, Vitor L, Rios D, Silva T, Machado M, M Oliveira T. Evaluation of Dentin-Pulp Complex Response after Conservative Clinical Procedures in Primary Teeth. Int J Clin Pediatr Dent 2018; 11:188-192. [PMID: 30131639 PMCID: PMC6102443 DOI: 10.5005/jp-journals-10005-1509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 05/13/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Although selective caries tissue removal decreases the number and diversity of bacteria, stops the caries process, and reduces the risk of pulp exposure, the studies on the minimally removal of caries tissue are limited and further clinical research is necessary in this field. Aim This study aimed to evaluate through clinical and radiographic assessments the in vivo response of the dentin-pulp complex of human deciduous teeth after either partial or total caries removal (TCR). Materials and methods A total of 49 deciduous molars of children aged between 5 and 9 years were carefully selected. The teeth were divided into two groups: Group I: Partial removal of caries; group II: Total removal of caries. Clinical and radiographic evaluations were performed during the period of 4 to 6 months after the procedure. The intraexam-iner reproducibility was determined by Kappa test. Fisher’s exact test was used to determine the statistical difference between groups. Results All teeth showed clinical success during the 4- to 6-month evaluation period. The radiographic evaluation showed 94.2 and 89.6% of success rate in groups I and II respectively. Radiographic results did not show statistically significant differences between the studied groups (p > 0.05). Conclusion The partial caries removal (PCR) showed satisfactory clinical and radiographic outcomes, suggesting that this minimally invasive approach might replace the TCR when correctly indicated. How to cite this article: Mello B, Stafuzza TC, Vitor L, Rios D, Silva T, Machado M, Oliveira TM. Evaluation of Dentin-Pulp Complex Response after Conservative Clinical Procedures in Primary Teeth. Int J Clin Pediatr Dent 2018;11(3):188-192.
Collapse
Affiliation(s)
- Bianca Mello
- PhD Student, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Tassia C Stafuzza
- PhD Student, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Luciana Vitor
- PhD Student, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Daniela Rios
- Professor, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Thiago Silva
- Professor, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Machado
- Professor, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| | - Thais M Oliveira
- Associate Professor, Department of Pediatric Dentistry, Bauru School of Dentistry University of Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
150
|
Taha NA, Abdulkhader SZ. Full Pulpotomy with Biodentine in Symptomatic Young Permanent Teeth with Carious Exposure. J Endod 2018; 44:932-937. [PMID: 29681479 DOI: 10.1016/j.joen.2018.03.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/25/2018] [Accepted: 03/02/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This prospective study evaluated the outcome of Biodentine (Septodont, Saint Maur des Fosses, France) pulpotomy in young permanent teeth with carious exposure. METHODS Twenty permanent molar teeth in 14 patients with carious pulp exposure were treated with Biodentine pulpotomy. The age of the patients ranged from 9-17 years (12.3 ± 2.7 years). A preoperative pulpal and periapical diagnosis was established. After informed consent, the tooth was anesthetized, isolated via a dental dam, and disinfected with 5% sodium hypochlorite before caries excavation. Full pulpotomy was performed by amputating the exposed pulp to the level of the canal orifices, hemostasis was achieved via a cotton pellet moistened with 2.5% sodium hypochlorite, a 3-mm layer of Biodentine was placed as the pulpotomy agent, a Vitrebond liner (3M ESPE, St Paul, MN) was applied, and the tooth was subsequently restored. Postoperative periapical radiographs were taken after placement of the permanent restoration. Clinical and radiographic evaluation was completed after 6 months and 1 year postoperatively. Pain levels were scored preoperatively and 2 days after treatment. Statistical analysis was performed using the Fisher exact test. RESULTS Clinical signs and symptoms suggestive of irreversible pulpitis were established in all teeth and symptomatic apical periodontitis in 14 of 20 (70%). Two days after treatment, all patients reported complete relief of pain. All teeth were clinically successful at 6 months and 1 year postoperatively. Radiographically, immature roots showed continued root development; dentin bridge formation was detected in 5 of 20 teeth. Seven of 7 teeth with preoperative periapical rarefaction showed signs of healing; 1 tooth had signs of internal root resorption at 1 year with an overall success rate of 95% (19/20). CONCLUSIONS Young permanent teeth with carious exposure can be treated successfully with full pulpotomy using Biodentine, and clinical signs and symptoms of irreversible pulpitis are not a contraindication.
Collapse
Affiliation(s)
- Nessrin A Taha
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
| | - Sakhaa Z Abdulkhader
- Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|