Clinical, radiographic, and histologic analysis of the effects of acemannan used in direct pulp capping of human primary teeth: short-term outcomes

Partial pulpotomy success in primary molars followed up for 24 months: A randomized controlled clinical trial using mineral trioxide aggregate, biodentine, and acemannan

BACKGROUND

Finding the best treatment approach and suitable capping materials in primary molars with deep carious lesions remains unresolved.

AIM

To compare the success rates of partial pulpotomy in deep caries lesions in primary molars treated with mineral trioxide aggregate (MTA), biodentine, or acemannan for 6-24 months.

DESIGN

A parallel-design, non-inferiority randomized controlled clinical trial was performed. Ninety mandibular primary molars from 65 children meeting the criteria, aged 3-8 years, were included. After inflamed pulp tissue removal and hemostasis, each tooth was randomly allocated into the MTA control group, or the biodentine or acemannan experimental group (N = 30 per group). All teeth were restored with a stainless steel crown. The outcomes were evaluated for 6-24 months. A generalized estimating equation model was used to compare the overall success rate in each group.

RESULTS

After 24 months, 58 children (83 teeth) were available for evaluation. The results indicated that the success rate in the MTA, biodentine, and acemannan groups was 83.3%, 76.9%, and 74.1%, respectively. No significant difference in success rates among groups, however, was observed at the 6- to 24-month follow-ups (at 24th month, p = .30).

CONCLUSION

There was no statistically significant difference between MTA, biodentine, or acemannan in the partial pulpotomy success after 24 months.

Effects of direct pulp capping with recombinant human erythropoietin and/or mineral trioxide aggregate on inflamed rat dental pulp

OBJECTIVE

This study aimed to evaluate the dental pulp responses to recombinant human erythropoietin (rhEPO) and/or mineral trioxide aggregate (MTA) in pulp capping of inflamed dental pulp in vivo.

MATERIALS AND METHODS

In accordance with ARRIVE guidelines, pulp inflammation was induced by exposing the maxillary first molars (n = 64) of Wistar rats (n = 32) to the oral environment for two days. The exposed pulps were randomly assigned four groups based on the pulp capping material: rhEPO, MTA, MTA + rhEPO, or an inert membrane. An additional eight rats formed the healthy control group. After four weeks, the animals were euthanized, and histological, qRT-PCR, and spectrophotometric techniques were employed to analyze the left maxillary segments, right first maxillary molars, and blood samples, respectively. Statistical significance was set at p < 0.05 and < 0.001.

RESULTS

Pulp capping with rhEPO, MTA, or MTA + rhEPO resulted in lower inflammation and higher mineralization scores compared to untreated control. MTA + rhEPO group exhibited significantly decreased expression of tumor necrosis factor-alpha, and interleukin 1-beta, while MTA group showed substantially reduced expression of interferon-gamma. Both rhEPO and MTA + rhEPO groups presented elevated dentin matrix protein 1 levels compared to untreated control. Furthermore, pulp capping with rhEPO and/or MTA led to increased transforming growth factor-beta 1 expression and reductions of pro-inflammatory/immunoregulatory cytokine ratios and prooxidative markers. Pulp capping with rhEPO also resulted in increase of systemic antioxidative stress markers.

CONCLUSION

Capping with rhEPO or MTA + rhEPO resulted in a favorable effect that was similar or even superior to that of MTA.

A New Biomaterial Derived from Aloe vera-Acemannan from Basic Studies to Clinical Application

Aloe vera is a kind of herb rich in polysaccharides. Acemannan (AC) is considered to be a natural polysaccharide with good biodegradability and biocompatibility extracted from Aloe vera and has a wide range of applications in the biomedical field due to excellent immunomodulatory, antiviral, antitumor, and tissue regeneration effects. In recent years, clinical case reports on the application of AC as a novel biomedical material in tissue regenerative medicine have emerged; it is mainly used in bone tissue engineering, pulp-dentin complex regeneration engineering, and soft tissue repair, among other operations. In addition, multiple studies have proved that the new composite products formed by the combination of AC and other compounds have excellent biological and physical properties and have broader research prospects. This paper introduces the preparation process, surface structure, and application forms of AC; summarizes the influence of acetyl functional group content in AC on its functions; and provides a detailed review of the functional properties, laboratory studies, clinical cutting-edge applications, and combined applications of AC. Finally, the current application status of AC from basic research to clinical treatment is analyzed and its prospects are discussed.

Characterization of a bioscaffold containing polysaccharide acemannan and native collagen for pulp tissue regeneration

Dental pulp regeneration exploits tissue engineering concepts using stem cells/scaffolds/growth-factors. Extracted collagen is commonly used as a biomaterial-scaffold due to its biocompatibility/biodegradability and mimics the natural extracellular matrix. Adding biomolecules into a collagen-scaffold enhanced pulp regeneration. Acemannan, β-(1-4)-acetylated-polymannose, is a polysaccharide extracted from aloe vera. Acemannan is a regenerative biomaterial. Therefore, acemannan could be a biomolecule in a collagen-scaffold. Here, acemannan and native collagen were obtained and characterized. The AceCol-scaffold's physical properties were investigated using FTIR, SEM, contact angle, swelling, pore size, porosity, compressive modulus, and degradation assays. The AceCol-scaffold's biocompatibility, growth factor secretion, osteogenic protein expression, and calcification were evaluated in vitro. The AceCol-scaffolds demonstrated higher hydrophilicity, swelling, porosity, and larger pore size than the collagen scaffolds (p < 0.05). Better cell-cell and cell-scaffold adhesion, and dentin extracellular matrix protein (BSP/OPN/DSPP) expression were observed in the AceCol-scaffold, however, DSPP expression was not detected in the collagen group. Significantly increased cellular proliferation, VEGF and BMP2 expression, and mineralization were detected in the AceCol-scaffold compared with the collagen-scaffold (p < 0.05). Computer simulation revealed that acemannan's 3D structure changes to bind with collagen. In conclusion, the AceCol-scaffold synergistically provides better physical and biological properties than collagen. The AceCol-scaffold is a promising material for tissue regeneration.

Direct pulp capping in asymptomatic carious primary molars using three different pulp capping materials: a prospective clinical trial

PURPOSE

Τo assess the outcome of direct pulp capping in asymptomatic carious primary molars using three pulp capping materials.

METHODS

In this prospective clinical trial, carious primary molars free of irreversible pulp inflammation signs and symptoms, with negative pain history and pulp exposure following caries removal were included. Teeth were divided into groups: A: Ca(OH)₂, B: Pure Portland cement^®, C: Biodentine™. Following anaesthesia, isolation, caries removal, pulp exposure, hemorrhage control, pulp capping, additional lining in groups A, B, teeth were restored with composite resin. Descriptive statistics, Chi-squared and Fisher's exact tests, Kaplan-Meier survival curves, multivariable random effects Cox regression model were performed.

RESULTS

Sixty-six patients (25 girls, 41 boys) with mean age 7.2 (± 1.7) years participated. The mean follow-up time was 13 months. Seventy-nine primary molars were assigned to groups A (n = 27), B (29), C (n = 23). The overall failure was 16% and the distribution by group was: A: 5 teeth, B: 5 teeth, C: 3 teeth. No significant differences in failure rates between capping materials, tooth types, age bands and genders were identified.

CONCLUSIONS

Direct pulp capping in asymptomatic carious primary molars may be an acceptable option, when treating an exposed pulp with bioceramic materials as pulp capping agents.

The Effect of Aloe vera and Chlorhexidine as Disinfectants on the Success of Selective Caries Removal Technique: A Randomized Controlled Trial

This study aimed to evaluate the effect of Aloe vera and chlorhexidine "CHX" as disinfectants on the success of selective caries removal technique in deep carious lesions. A total of 60 patients with: (I) deep class II carious lesion diagnosed with reversible pulpitis; (II) good oral hygiene; (III) no gingival recession or periodontal diseases; (IV) no antibiotic or antifungal treatment in the last three months; and (V) no systematic disease or pregnancy were included in the study. Sixty patients were distributed randomly to three experimental groups (n = 20): Group 1: no disinfectant solution was applied (control group); group 2: the cavity was filled with 2% CHX for 5 mins and then dried with a sterilized cotton pellet; group 3: the cavity was filled with Aloe vera extract for 5 mins and then dried with sterilized cotton pellet. One week later, only teeth with vital pulp characteristics were restored definitely with resin composite. After 18 months, clinical and radiographic examination was performed by using a blinded separated evaluator. The data were tabulated and analyzed using the chi-square test by SPSS 13.0 with a significance level (p ≤ 0.05). It was observed that 13 teeth of the control group, 14 teeth of the CHX group, and 16 teeth of the Aloe vera group were diagnosed with healthy vital pulp after 18 months. There was no significant difference between the CHX and the control group; however, there was a significant difference between the Aloe vera and control group (p ≤ 0.007). Aloe vera extract as a cavity disinfectant increases the success rate of selective caries removal technique of deep carious lesions.

Herbal Medications in Endodontics and Its Application-A Review of Literature

Herbal products are gaining popularity in dental and medical practice nowadays due to their biocompatibility, higher antimicrobial activity, antioxidant and anti-inflammatory properties. Herbal medicine has experienced rapid growth in recent years due to its beneficial properties, ease of availability, and lack of side effects. As pathogenic bacteria become more resistant to antibiotics and chemotherapeutic agents, researchers are becoming more interested in alternative products and treatment choices for oral diseases. As a result, natural phytochemicals separated from plants and utilized in traditional medicine are suitable substitutes for synthetic chemicals. The aim of this review article is to list and understand several herbal alternatives that are currently accessible for use as efficient endodontic medicaments. The herbal products used in endodontics have several advantages, including safety, ease of use, increased storability, low cost, and a lack of microbial tolerance. However, preclinical and clinical testing and interactions with other materials and adverse effects are required for these herbal products.

Pulse Oximetry and Three-Dimensional Analysis in Evaluating Immature Permanent Teeth Apexogenesis: Two Case Reports

Background:

Apexogenesis is a vital pulp therapy that aims to preserve pulp vitality and maintain root formation in not-fully-formed permanent teeth with exposed pulp from trauma or caries. To achieve success, reliable diagnostic tools are required to assess the pulp health and tooth development stage, design an appropriate treatment plan and evaluation, and follow-up. Pulse oximetry is a non-invasive method for monitoring pulp oxygen saturation, which corresponds to pulp vitality.

Case Presentation:

This case report describes the successful apexogenesis of two pulp exposure-immature permanent teeth treated with acemannan, an implantable natural biomaterial extracted from aloe vera. Based on pulp oxygen saturation level, clinical evaluation, and radiographic examination, the teeth were asymptomatic with preserved pulp vitality and continued root development.

Conclusion:

Therefore, as an auxiliary tool, pulse oximetry could be useful for diagnosis, treatment, and follow-ups of apexogenesis therapy.

The effect of acemannan in implant placement with simultaneous guided bone regeneration in the aesthetic zone: a randomized controlled trial

Acemannan, a linear polysaccharide produced by Aloe vera, has been shown to have important biological effects promoting wound healing and tissue regeneration. The aim of this randomized clinical trial was to investigate the impact of acemannan in guided bone regeneration (GBR) with simultaneous implant placement. Twenty patients were randomly allocated to a test group (deproteinized bovine bone with particulate acemannan (mean size 32.45 μm)) and a control group (deproteinized bovine bone only). Twenty implants were placed with simultaneous GBR. Radiographic measurements were conducted on cone beam computed tomography (CBCT) scans immediately post-surgery and at 3 and 6 months. Vertical and horizontal dimensions of the buccal bone were measured at the implant platform (0) and at points 2, 4, 6, and 8 mm apically. The dimensional reduction of vertical and horizontal buccal bone was significantly smaller in the test group at 3 months postoperative (P < 0.05) at every position measured (0, 2, 4, 6, 8 mm), but the difference was not statistically significant at 6 months. Acemannan was found to be a safe and predictable biomaterial for GBR, which resulted in enhanced dimensional stability of the regenerated tissue at 3 months. However, these results were not replicated at 6 months. Further studies are required to document the long-term efficacy and potential of acemannan use as a supplement in bone regeneration.

Current herbal medicine as an alternative treatment in dentistry: In vitro, in vivo and clinical studies

Since the time that human population comprehended the importance of general health maintenance and the burden of disease, there has been a search for healing properties in the natural environment. Herbal medicine is the use of plants with medical properties for prevention and treatment of conditions that can affect general health. Recently, a growing interest has been observed toward the use of traditional herbal medicine alongside synthetic modern drugs. Around 80% of the population, especially in developing countries relies on it for healthcare. Oral healthcare is considered a major part of general health. According to the world health organization (WHO), oral health is considered an important part of general health and quality of life. The utilization of natural medications for the management of pathologic oro-dental conditions can be a logical alternative to pharmaceutical methods due to their availability, low costs, and lower side effects. The current literature review aimed at exploration of the variety and extent of herbal products application in oral health maintenance including different fields of oral healthcare such as dental caries, periodontal maintenance, microbial infections, oral cancers, and inflammatory conditions.

Clinical and Radiographic Evaluation of the Efficacy of Formocresol, Allium sativum Oil, and Aloe barbadensis Gel as Pulpotomy Medicaments in Primary Molars: A Randomized Controlled Trial

AIM

The aim of the study was to clinically and radiographically evaluate the efficacy of formocresol, Allium sativum oil, and Aloe barbadensis gel as pulpotomy medicaments in primary molars.

MATERIALS AND METHODS

Eighty-two primary molars indicated for pulpotomy were included in the study. The molars included were divided into three groups by simple random sampling, and treatment was done with formocresol as control, comparing it with Aloe barbadensis gel and Allium sativum oil.

RESULTS

The teeth were then followed up for 6 and 12 months clinically and radiographically. Chi-square test was used to compare the clinical and radiographic results between the groups. McNemar test was used to compare the clinical and radiographic results at 6 and 12 months. The results revealed that there was no significant difference between the groups when comparing the experimental groups to the control.

CONCLUSION

The study shows that Aloe barbadensis gel and Allium sativum oil may be used as an alternative to formocresol as pulpotomy medicaments.

HOW TO CITE THIS ARTICLE

Abirami K, Ramkumar H, Senthil D. Clinical and Radiographic Evaluation of the Efficacy of Formocresol, Allium sativum Oil, and Aloe barbadensis Gel as Pulpotomy Medicaments in Primary Molars: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2020;13(5):518-522.

Outcomes of direct pulp capping in vital primary teeth with cariously and non-cariously exposed pulp: A systematic review

OBJECTIVE

To summarize the clinical/radiographic outcomes from the evidence of studies published since 1988 on different DPC agents applied on vital pulp-exposed primary teeth.

METHODS

The following electronic databases were searched: PubMed, Embase, Cochrane Library, Dentistry and Oral Science Source, and Google Scholar. Inclusion criteria were randomized controlled trials (RCTs) published between January 1988 and December 2019, with at least 6 months of follow-up, comparing the clinical and radiographic success rates of two or more DPC agents applied in primary teeth with cariously and non-cariously exposed pulp.

RESULTS

Initial searches identified 83 potentially relevant studies on DPC in primary teeth. Sixty-four of these studies were excluded, whereas 19 articles satisfied the inclusion criteria and were retrieved in full text for data extraction and a methodological quality assessment. Finally, 12 of these articles were included in the systematic review. Low and moderate risks of bias were observed. Overall, DPC clinical and radiographic success rates among the selected studies ranged between 53% and 100%.

CONCLUSIONS

For DPC in primary teeth, this systematic review found that diverse new biologically and compatible agents with promising success rates are currently available for paediatric dentistry practitioners. There is no evidence that justifies discarding the judicious use of DPC procedures in primary teeth.

Acemannan Used as an Implantable Biomaterial for Vital Pulp Therapy of Immature Permanent Teeth Induced Continued Root Formation

Direct pulp-capping, a vital pulp therapy, is used to protect and preserve pulp vitality by applying a biomaterial on the pulp exposure site. Acemannan, a polysaccharide extracted from Aloe vera, induces osteodentin-bridge formation to cover the exposure site in vivo. We evaluated the effect of acemannan sponges on partial pulpotomized permanent teeth with caries or accident-induced pulp exposure (n = 50). After removing infected dentin and inflamed pulp tissue, the teeth were randomly divided into acemannan or control (mineral trioxide aggregate (MTA) groups (n = 25). The teeth were examined immediately after treatment (baseline) and at 6- and 12-month follow-ups for clinical and cone beam computed tomography (CBCT) examination. The three-dimensional tooth length and root apex area were simulated to determine treatment success. We found that the overall success rate in the acemannan and MTA groups from baseline to 12-month follow-up was 90.91% and 95.65%, respectively, with no significant difference between the two groups (p > 0.05). In the success teeth in both groups, the root length increased, and the apex area significantly decreased (p < 0.05), indicating continued root formation. Our results suggest that acemannan is a promising low-cost biomaterial for partial pulpotomy treatment for immature permanent teeth requiring vital pulp therapy.

Extraction, Purification, Structural Characteristics, Biological Activities and Pharmacological Applications of Acemannan, a Polysaccharide from Aloe vera: A Review

Aloe vera is a medicinal plant species of the genus Aloe with a long history of usage around the world. Acemannan, considered one of the main bioactive polysaccharides of Aloe vera, possesses immunoregulation, anti-cancer, anti-oxidation, wound healing and bone proliferation promotion, neuroprotection, and intestinal health promotion activities, among others. In this review, recent advancements in the extraction, purification, structural characteristics and biological activities of acemannan from Aloe vera were summarized. Among these advancements, the structural characteristics of purified polysaccharides were reviewed in detail. Meanwhile, the biological activities of acemannan from Aloe vera determined by in vivo, in vitro and clinical experiments are summarized, and possible mechanisms of these bioactivities were discussed. Moreover, the latest research progress on the use of acemannan in dentistry and wound healing was also summarized in details. The structure-activity relationships of acemannan and its medical applications were discussed. Finally, new perspectives for future research work on acemannan were proposed. In conclusion, this review summarizes the extraction, purification, structural characteristics, biological activities and pharmacological applications of acemannan, and provides information for the industrial production and possible applications in dentistry and wound healing in the future.

Long-term clinical and radiographic evaluation of the effectiveness of direct pulp-capping materials

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

Relative effectiveness of direct and indirect pulp capping in the primary dentition

INTRODUCTION

Carious or traumatised teeth with a normal pulp status or with reversible pulpitis need an indirect or direct pulp capping procedure to keep the pulp vital.

AIM

To evaluate the clinical outcome of both interventions for treating vital primary teeth.

STUDY DESIGN

Two reviewers on Pubmed and ISI Web of Science performed a comprehensive literature review of publications from 1966 until December 2017. Among PubMed abstracts, publications were selected according to the following criteria: prospective clinical study, correct indication for the performed treatment, and clear definition of clinical and/or radiographic success criteria. The strict selection criteria limited the amount of randomised controlled trials (RCT) or controlled clinical trials (CT); especially for "indirect pulp therapy", "direct pulp capping" and the number of RCTs was limited.

CONCLUSIONS

Based on a systematic review (20 controlled clinical studies or randomised controlled clinical studies), the following statements can be given: Due to the opportunity of tissue repair, indirect pulp treatment can be an acceptable procedure for reversible pulp inflammation. The use of adhesives for indirect pulp capping in a single-visit procedure after gentle caries removal can be recommended. Successful pulp capping is possible under defined conditions (symptom-free tooth, disinfection of pulp exposures, Class-I cavity) and appropriate sealing of the cavity with an effective dentine seal being a conditio sine qua non. There is maximum evidence for the use of disinfecting solutions prior to pulp capping and Dycal as pulp capping material. Longer follow-up periods, more clinical studies, comparable conditions, and clear definitions of evaluation criteria are needed to confirm the results of endodontic treatment in primary teeth.

The effect of dental pulp-capping materials on hard-tissue barrier formation: A systematic review and meta-analysis

BACKGROUND

The authors of this systematic review aimed to compare the effects of pulp-capping materials on hard-tissue barrier formation using histologic assessments.

TYPE OF STUDIES REVIEWED

The authors included randomized controlled trials and controlled clinical trials in humans, with vital therapies performed on healthy permanent teeth undergoing experimental mechanical pulp exposures. They searched electronically in the PubMed, Cochrane, Embase, and Summon databases and carried out a manual search. Twenty-seven full-text articles were eligible for inclusion in the systematic review. After data extraction, the authors performed 2 sets of meta-analyses with odds ratios (OR) and their 95% confidence intervals (CI) on 22 studies. Ten studies compared mineral trioxide aggregate (MTA) with calcium hydroxide (CH), and 12 compared bonding agents with CH. The authors assessed bias by means of Cochrane Collaboration's tool for assessing risk, funnel plots, and Harbord test.

RESULTS

The use of MTA was associated with a higher rate of hard-tissue barrier formation than CH. The OR comparing the 2 groups was 2.45 (95% CI, 1.39 to 4.29; P = .002). Use of bonding agents was associated with a lower rate of hard-tissue barrier formation than CH. The OR comparing the 2 groups was 0.02 (95% CI, 0.01 to 0.05; P < .001).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The results suggest that MTA and CH have positive effects on hard-tissue barrier formation. On the basis of the evidence, the authors conclude that MTA has better effects than CH regarding dental pulp protection in the capping of mechanical pulp exposures. Conversely, bonding agents are inferior to CH.

Acemannan increased bone surface, bone volume, and bone density in a calvarial defect model in skeletally-mature rats

Background/purpose

Acemannan, a β-(1-4)-acetylated polymannose extracted from Aloe vera gel, has been proposed as biomaterial for bone regeneration. The aim of this study was to investigate the effect of acemannan in calvarial defect healing.

Materials and methods

Acemannan was processed to freeze-dried sponge form and disinfected by UV irradiation. Thirty-five female Sprague-Dawley rats were used in the in vivo study. Seven-mm diameter mid-calvarial defects were created and randomly allocated into blood clot control (C), acemannan 1 mg (A1), 2 mg (A2), 4 mg (A4), and 8 mg (A8) groups (n = 7). After four weeks, the calvarial specimens were subjected to microcomputed tomography (microCT) and histopathological analysis.

Results

MicroCT revealed a significant increase in bone surface and bone volume in the A1 and A2 groups, and tissue mineral density in the A4 and A8 groups compared with the control group (p < 0.05). Histologically, the acemannan-treated groups had denser bone matrix compared with the control group.

Conclusion

Acemannan is an effective bioactive agent for bone regeneration, enhancing bone growth as assayed in two- and three-dimensions.

Stimulation of Dentin Regeneration by Using Acemannan in Teeth with Lipopolysaccharide-induced Pulp Inflammation

INTRODUCTION

This study investigated the effects of acemannan, a polysaccharide from Aloe vera, on human deciduous pulp cells in vitro and the response after vital pulp therapy in dog deciduous teeth.

METHODS

Human primary dental pulpal cells were treated with acemannan in vitro and evaluated for proliferation, alkaline phosphatase activity, type I collagen, bone morphogenetic protein (BMP-2), BMP-4, vascular endothelial growth factor, and dentin sialoprotein expression and mineralization. Osteogenesis-related gene expression was analyzed by complementary DNA microarray. Pulpal inflammation was induced in dog teeth for 14 days. The inflamed pulp was removed, retaining the healthy pulp. The teeth were randomly divided into 3 treatment groups: acemannan, mineral trioxide aggregate, and formocresol. Sixty days later, the teeth were extracted and evaluated histopathologically.

RESULTS

Acemannan significantly increased pulp cell proliferation, alkaline phosphatase, type I collagen, BMP-2, BMP-4, vascular endothelial growth factor, and dentin sialoprotein expression and mineralization approximately 1.4-, 1.6-, 1.6-, 5.5-, 2.6-, 3.8-, 1.8-, and 4.8-fold, respectively, compared with control. In vivo, partial pulpotomy treatment using acemannan generated outcomes similar to mineral trioxide aggregate treatment, resulting in mineralized bridge formation with normal pulp tissue without inflammation or pulp necrosis. In contrast, the formocresol group demonstrated pulp inflammation without mineralized bridge formation.

CONCLUSIONS

Acemannan is biocompatible with the dental pulp. Furthermore, acemannan stimulated dentin regeneration in teeth with reversible pulpitis.