Pulpal responses following direct pulp capping of healthy dog teeth with dentine adhesive systems

Pulpal and periapical tissue response after direct pulp capping with endosequence root repair material and low-level laser application

Background

The study aims to investigate the pulp and periapical reaction and healing after capping with EndoSequence Root Repair Material (ERRM) combined with low-level laser application.

Methods

In 6 rabbits, pulps were exposed via class V, half of the samples received a low-level diode laser at 980 nm. Thereafter, cavities were capped with regular-set ERRM. The specimens were processed for histomorphological examination after 2 weeks and two months.

Results

After 2 weeks, images show mild inflammation and organized odontoblasts in lased group. The non-lased group shows more severe inflammation. The predentin thickness was thicker in the lased group with statistical significance (p < 0.05). After 2 months, inflammatory cells were sparse in both lased and non-lased groups. In the periapical area, group one showed dilated blood vessels and thick fibrous connective tissues. In group two, there were more numerous maturations of PDL fibers with scattered inflammatory cells and congested blood vessel.

Conclusions

Using low-level laser therapy in combination with ERRM for pulp capping shortens the inflammatory phase and enhances healing.

Application of Selected Biomaterials and Stem Cells in the Regeneration of Hard Dental Tissue in Paediatric Dentistry-Based on the Current Literature

Currently, the development of the use of biomaterials and their application in medicine is causing rapid changes in the fields of regenerative dentistry. Each year, new research studies allow for the discovery of additional possibilities of dental tissue restoration. The structure and functions of teeth are complex. They consist of several diverse tissues that need to act together to ensure the tooth’s function and durability. The integrity of a tooth’s enamel, dentin, cementum, and pulp tissue allows for successful mastication. Biomaterials that are needed in dentistry must withstand excessive loading forces, be biocompatible with the hosts’ tissues, and stable in the oral cavity environment. Moreover, each tooth’s tissue, as well as aesthetic qualities in most cases, should closely resemble the natural dental tissues. This is why tissue regeneration in dentistry is such a challenge. This scientific research focuses on paediatric dentistry, its classification of caries, and the use of biomaterials in rebuilding hard dental tissues. There are several methods described in the study, including classical conservative methods such as caries infiltration or stainless-steel crowns. Several clinical cases are present, allowing a reader to better understand the described methods. Although the biomaterials mentioned in this work are artificial, there is currently ongoing research regarding clinical stem cell applications, which have a high potential for becoming one of the most common techniques of lost dental-tissue regeneration in the near future. The current state of stem cell development is mentioned, as well as the various methods of its possible application in dentistry.

Effectiveness of Direct Pulp Capping Bioactive Materials in Dentin Regeneration: A Systematic Review

Background: Regenerative endodontics aims to restore normal pulp function in necrotic and infected teeth, restoring protective functions, such as innate pulp immunity, pulp repair through mineralization, and pulp sensibility. The aim of this systematic review was to assess the dentin regeneration efficacy of direct pulp capping (DPC) biomaterials. Methods: The literature published between 2005 and 2021 was searched by using PubMed, Web of Science, Science Direct, Google Scholar, and Scopus databases. Clinical controlled trials, randomized controlled trials, and animal studies investigating DPC outcomes or comparing different capping materials after pulp exposure were included in this systematic review. Three independent authors performed the searches, and information was extracted by using a structured data format. Results: A total of forty studies (21 from humans and 19 from animals) were included in this systemic review. Histological examinations showed complete/partial/incomplete dentin bridge/reparative dentin formation during the pulp healing process at different follow-up periods, using different capping materials. Conclusions: Mineral trioxide aggregate (MTA) and Biodentine can induce dentin regeneration when applied over exposed pulp. This systematic review can conclude that MTA and its variants have better efficacy in the DPC procedure for dentin regeneration.

Potential of tailored amorphous multiporous calcium silicate glass for pulp capping regenerative endodontics-A preliminary assessment

INTRODUCTION/OBJECTIVE

The tailored amorphous multi-porous (TAMP) material fabrication technology has led to a new class of bioactive materials possessing versatile characteristics. It has not been tested for dental applications. Thus, we aimed to assess its biocompatibility and ability to regenerate dental mineral tissue.

METHODS

30CaO-70SiO₂ model TAMP discs were fabricated by a sol-gel method followed by in vitro biocompatibility testing with isolated human or mini-swine dental pulp stem cells (DPSCs). TAMP scaffolds were tested in vivo as a pulp exposure (pin-point, 1 mm, 2 mm, and entire pulp chamber roof) capping material in the molar teeth of mini-swine.

RESULTS

The in vitro assays showed that DPSCs attached well onto the TAMP discs with comparable viability to those attached to culture plates. Pulp capping tests on mini-swine showed that after 4.5 months TAMP material was still present at the capping site, and mineral tissue (dentin bridge) had formed in all sizes of pulp exposure underneath the TAMP material.

CONCLUSIONS

TAMP calcium silicate is biocompatible with both human and swine DPSCs in vitro and with pulp in vivo, it may help regenerate the dentin bridge after pulp exposure.

Evaluation of human pulp tissue response following direct pulp capping with a self-etching adhesive system containing MDPB

This study evaluated the human pulp tissue response following direct pulp capping with Clearfil Protect Bond (CPB) self-etching adhesive containing an antibacterial monomer MDPB. The pulps of third molar teeth were exposed by the removal of carious tissue. In an experimental group, CPB was applied to the exposed pulp and dentin. In the control groups, Clearfil SE Bond (CSE) or calcium hydroxide-based cement (CH) was applied to the exposed pulp surfaces. All teeth were filled with resin composite, extracted after 90 days, and the pulp responses were histologically analyzed. No severe inflammation or soft tissue disorganization was observed in CPB and CH groups. CSE group exhibited a disorganized odontoblastic layer and severe inflammatory infiltration. No hard tissue formation was observed in CSE group, and CH formed more of a hard tissue formation than CPB. CPB induced an acceptable healing response when directly applied to exposed pulps with bacterial contamination.

Comparative evaluation of pulpal repair after direct pulp capping using stem cell therapy and biodentine: An animal study

The response of the dentin-pulp complex in rat teeth was investigated after direct capping with biodentine with or without bone marrow-derived stem cells (BMDSCs). Following mechanical exposure, pulps were randomly capped with one of the followings materials: calcium hydroxide, biodentine or 1 × 10⁵ BMDSCs mL^-1 + biodentine. Histological examination was performed by light microscopy after 1, 3 and 5 weeks. Inflammatory reaction, necrotic tissue formation and calcific bridge formation were scored. Analysis showed that compared with the effects of calcium hydroxide or biodentine, BMDSCs + biodentine substantially reduced inflammatory reaction and necrotic tissue while promoting calcified tissue formation. Therefore, the combination of biodentine and BMDSCs could potentially stimulate pulp tissue regeneration after direct pulp capping.

RGD- and VEGF-Mimetic Peptide Epitope-Functionalized Self-Assembling Peptide Hydrogels Promote Dentin-Pulp Complex Regeneration

INTRODUCTION

Cell-based tissue engineering is a promising method for dentin-pulp complex (DPC) regeneration. The challenges associated with DPC regeneration include the generation of a suitable microenvironment that facilitates the complete odontogenic differentiation of dental pulp stem cells (DPSCs) and the rapid induction of angiogenesis. Thus, the survival and subsequent differentiation of DPSCs are limited. Extracellular matrix (ECM)-like biomimetic hydrogels composed of self-assembling peptides (SAPs) were developed to provide an appropriate microenvironment for DPSCs. For functional DPC regeneration, the most important considerations are to provide an environment that promotes the adequate attachment of DPSCs and rapid vascularization of the regenerating pulp. Morphogenic signals in the form of growth factors (GFs) have been incorporated into SAPs to promote productive DPSC behaviors. However, the use of GFs has several drawbacks. We envision using a scaffold with SAPs coupled with long-term factors to increase DPSC attachment and vascularization as a method to address this challenge.

METHODS

In this study, we developed synthetic material for an SAP-based scaffold with RGD- and vascular endothelial growth factor (VEGF)-mimetic peptide epitopes with the dual functions of dentin and pulp regeneration. DPSCs and human umbilical vein endothelial cells (HUVECs) were used to evaluate the biological effects of SAP-based scaffolds. Furthermore, the pulpotomized molar rat model was employed to test the reparative and regenerative effects of SAP-based scaffolds.

RESULTS

This scaffold simultaneously presented RGD- and VEGF-mimetic peptide epitopes and provided a 3D microenvironment for DPSCs. DPSCs grown on this composite scaffold exhibited significantly improved survival and angiogenic and odontogenic differentiation in the multifunctionalized group in vitro. Histological and functional evaluations of a partially pulpotomized rat model revealed that the multifunctionalized scaffold was superior to other options with respect to stimulating pulp recovery and dentin regeneration in vivo.

CONCLUSION

Based on our data obtained with the functionalized SAP scaffold, a 3D microenvironment that supports stem cell adhesion and angiogenesis was generated that has great potential for dental pulp tissue engineering and regeneration.

Preclinical effectiveness of an experimental tricalcium silicate cement on pulpal repair

OBJECTIVES

To investigate the pulpal repair potential of an experimental zirconium-oxide containing tricalcium-silicate cement, referred to as 'TCS 50'.

MATERIALS AND METHODS

The effect of TCS 50 on viability, proliferation, migration, and odontoblastic differentiation of human dental pulp cells (HDPCs) was assessed using XTT assay, in-vitro wound healing assay and RT-PCR, respectively. Additionally, the pulp-capping potential was evaluated using a vital human tooth model. Statistical analysis was performed using non-parametric Kruskal-Wallis test and post-hoc test (Mann-Whitney U test). The tests were performed at a significance level of α = 0.05.

RESULTS

The effect of TCS 50 towards HDPCs was dose dependent. Undiluted TCS 50 extract showed no immediate adverse impact on cell viability (p > .05); however, it significantly inhibited proliferation and migration of HDPCs (p < .05). A 25% diluted TCS 50 extract showed no significant effect on cell viability, proliferation or migration (p > .05), and it significantly enhanced odontoblastic differentiation of HDPCs (p < .05). In pulps capped with TCS 50 for both 2 and 4 weeks, H&E staining revealed a normal morphology of pulp tissue; mineralized foci with cellular components entrapped in the matrix were formed underneath the exposure site. Collagen I expression was weak within the matrix of mineralized foci, while the expression of nestin was positive for entrapped cellular components within the mineralized foci, indicating that the formed mineralized foci corresponded to an initial form of reparative dentin formation.

CONCLUSION

TCS 50 is capable of generating an early pulp-healing reaction and therefore could serve as a promising pulp-capping agent.

Reparative Dentin Formation Using Stem Cell Therapy versus Calcium Hydroxide in Direct Pulp Capping: An Animal Study

Direct pulp capping process is a therapeutic method aimed at maintenance of pulp vitality and health by using a biocompatible material placed directly over the exposed pulp. The aim of this study was to evaluate and compare the effect of direct pulp capping procedures by dental pulp stem cells (DPSCs) or calcium hydroxide on dentin tissue formation. Three mongrel dogs were used as experimental model. Two access cavities were prepared in the right and left mandibular fourth premolars in all dogs to expose and extirpate the pulp tissues which were processed in the lab to obtain a single-cell suspensions. The isolated cells were cultures in odontogenic medium for subsequent differentiation. The maxillary teeth (3 incisors and one canine) of the corresponding dog number were subjected to class V cavities to expose their pulps which were assigned into 2 groups of 12 teeth each ( group I - pulp capping with calcium hydroxide) and (group II - pulp capping with dental stem cells DPSCs). The operated teeth were collected after 3 months and processed for histological and electron microscopic examinations. Specimens were subjected to elemental analysis of calcium and phosphorus. EDX elemental analysis revealed significant differences in the calcium and phosphorous wt, % in the reparative dentin of calcium hydroxide treated group which confirmed histologically. Direct pulp capping by DPSCs has shown promising generative potential for regaining normal dentin.

Clinical and Molecular Perspectives of Reparative Dentin Formation: Lessons Learned from Pulp-Capping Materials and the Emerging Roles of Calcium

The long-term use of calcium hydroxide and the recent increase in the use of hydraulic calcium-silicate cements as direct pulp-capping materials provide important clues in terms of how reparative dentin may be induced to form a "biological seal" to protect the underlying pulp tissues. In this review article, we discuss clinical and molecular perspectives of reparative dentin formation based on evidence learned from the use of these pulp-capping materials. We also discuss the emerging role of calcium as an odontoinductive component in these pulp-capping materials.

Experimental tricalcium silicate cement induces reparative dentinogenesis

OBJECTIVES

To overcome shortcomings of hydraulic calcium-silicate cements (hCSCs), an experimental tricalcium silicate (TCS) cement, named 'TCS 50', was developed. In vitro research showed that TCS 50 played no negative effect on the viability and proliferation of human dental pulp cells, and it induced cell odontogenic differentiation. The objective was to evaluate the pulpal repair potential of TCS 50 applied onto exposed minipig pulps.

METHODS

Twenty permanent teeth from three minipigs were mechanically exposed and capped using TCS 50; half of the teeth were scheduled for 7-day and the other half for 70-day examination (n=10). Commercial hCSCs ProRoot MTA and TheraCal LC were tested as references (n=8). Tooth discoloration was examined visually. After animal sacrifice, the teeth were scanned using micro-computed tomography; inflammatory response at day 7 and day 70, mineralized tissue formation at day 70 were assessed histologically.

RESULTS

Up to 70 days, TCS 50 induced no discoloration, ProRoot MTA generated gray/black discoloration in all teeth. For TCS 50, 40.0% pulps exhibited a mild/moderate inflammation at day 7. No inflammation was detected and complete reparative dentin with tubular structures was formed in all pulps after 70 days. ProRoot MTA induced a similar response, TheraCal LC generated a less favorable response in terms of initial inflammation and reparative dentin formation; however, these differences were not significant (Chi-square test of independence: p>0.05).

SIGNIFICANCE

TCS 50 induced reparative dentinogenesis in minipig pulps. It can be considered as a promising pulp-capping agent, also for aesthetic areas.

Development of a Direct Pulp-capping Model for the Evaluation of Pulpal Wound Healing and Reparative Dentin Formation in Mice

Dental pulp is a vital organ of a tooth fully protected by enamel and dentin. When the pulp is exposed due to cariogenic or iatrogenic injuries, it is often capped with biocompatible materials in order to expedite pulpal wound healing. The ultimate goal is to regenerate reparative dentin, a physical barrier that functions as a "biological seal" and protects the underlying pulp tissue. Although this direct pulp-capping procedure has long been used in dentistry, the underlying molecular mechanism of pulpal wound healing and reparative dentin formation is still poorly understood. To induce reparative dentin, pulp capping has been performed experimentally in large animals, but less so in mice, presumably due to their small sizes and the ensuing technical difficulties. Here, we present a detailed, step-by-step method of performing a pulp-capping procedure in mice, including the preparation of a Class-I-like cavity, the placement of pulp-capping materials, and the restoration procedure using dental composite. Our pulp-capping mouse model will be instrumental in investigating the fundamental molecular mechanisms of pulpal wound healing in the context of reparative dentin in vivo by enabling the use of transgenic or knockout mice that are widely available in the research community.

Effect of biomaterials on angiogenesis during vital pulp therapy

This review intended to provide an overview of the effects of dental materials, used in dentin-pulp complex and dental pulp regeneration, on angiogenesis processes during regenerative endodontic procedures. An electronic search was performed in PubMed and MEDLINE databases via OVID using the keywords mentioned in the PubMed and MeSH headings for English language published articles from January 2005-April 2014 that evaluated the angiogenic properties of different dental materials used in regenerative endodontic procedures. Of the articles identified in an initial search, only 40 articles met the inclusion criteria set for this review. Vital pulp therapy materials might have positive effects on angiogenesis events, while most of the canal irrigating solutions and antibiotic pastes have anti-angiogenic activity except for EDTA. Future clinical studies will be helpful in defining the mechanisms of action for dental materials that promote or inhibit angiogenesis events at applied areas.

Histological response of human pulps capped with calcium hydroxide and a self-etch adhesive containing an antibacterial component

Aim:

To compare human pulp tissue response following direct pulp capping with calcium hydroxide and a self-etch adhesive containing antibacterial component.

Materials and Methods:

Sixty-six erupted sound premolars scheduled to be extracted for orthodontic reasons were selected from 17 human subjects. Pulp exposures were made. Direct pulp capping was then performed using calcium hydroxide and a self-etch adhesive containing antibacterial component in its primer. The teeth were then restored with composite resin. Two teeth were maintained intact as a control group. After 7 and 30 days, teeth were extracted and processed for light microscopic examination using a histological scoring system. The teeth were divided into four groups (N = 16) according to the pulp capping materials used and their days of extraction. The results were then statistically analyzed by Mann-Whitney U-test.

Results:

After the 7-day observation period, the inflammatory reaction to the self-etch adhesive containing antibacterial component group was significantly less severe than that in the calcium hydroxide group (P < 0.05). After the 30-day observation period, the inflammatory reaction was slight in both groups, but specimens with dentin bridge formation in the self-etch adhesive group were significantly less common than those in the calcium hydroxide group (P < 0.05).

Improved secondary caries resistance via augmented pressure displacement of antibacterial adhesive

The present in vitro study evaluated the secondary caries resistance potential of acid-etched human coronal dentin bonded using augmented pressure adhesive displacement in conjunction with an experimental antibacterial adhesive. One hundred and twenty class I cavities were restored with a commercial non-antibacterial etch-and-rinse adhesive (N) or an experimental antibacterial adhesive (A) which was displaced by gentle air-blow (G) or augmented pressure air-blow (H). After bonding and restoration with resin composite, the resulted 4 groups (N-G, N-H, A-G and A-H) were exposed to Streptococcus mutans biofilm for 4, 8, 15, 20 or 25 days. The development of secondary caries in the bonding interface was then examined by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Data acquired from 15, 20 and 25 days of artificial caries induction were analyzed with three-way ANOVA at α = 0.05. The depth of the artificial carious lesions was significantly affected by “adhesive type” (Single Bond 2 vs experimental antibacterial adhesive p = 0.003), “intensity of adhesive displacement” (gentle vs augmented-pressure adhesive displacement; p < 0.001), as well as “artificial caries induction time” (p < 0.001). The combined use of augmented pressure adhesive displacement and experimental antibacterial adhesive reduces the progression of secondary caries.

Dentinogenic Specificity in the Preclinical Evaluation of Vital Pulp Treatment Strategies: A Critical Review

Reviews on the clinical performance of vital pulp treatment strategies and capping materials repeatedly showed an insufficient grade of evidence concerning their therapeutic validity. The biological mechanisms underlying the regenerative potential of pulp-dentin complex have attracted much attention during the last two decades, since new pulp treatment modalities have been designed and tested at the preclinical level. It has been recognized that evaluation should be based on the specific ability of therapeutic interventions to signal recruitment and differentiation of odontoblast-like cells forming a matrix in a predentin-like pattern, rather than uncontrolled hard tissue deposition in a scar-like form. The aim of the present article was to critically review data from histological experimental studies on pulp capping, published during the last 7 decades. A comprehensive literature search covering the period from 1949 to 2015 was done using the Medline/Pubmed database. Inclusion of a study was dependent on having sufficient data regarding the type of capping material used and the unit of observation (human permanent tooth in vivo or animal permanent dentition; primary teeth were excluded). The post-operatively deposited matrix was categorized into three types: unspecified, osteotypic, or dentin-like matrix. One hundred fifty-two studies were included in the final evaluation. Data from the present systematic review have shown that only 30.2% of the 152 experimental histological pulp capping studies described the heterogenic nature of the hard tissue bridge formation, including osteotypic and tubular mineralized tissue. Structural characteristics of the new matrix and the associated formative cells were not provided by the remaining 106 studies. Analysis showed that more careful preclinical evaluation with emphasis on the evidence regarding the dentinogenic specificity of pulp therapies is required. It seems that selection of appropriate vital pulp treatment strategies and pulp capping materials would be further facilitated in terms of their therapeutic validity if international consensus could be reached on a select number of mandatory criteria for tissue-specific dentinogenic events.

2-Hydroxyethyl methacrylate inhibits migration of dental pulp stem cells

INTRODUCTION

Cell migration is an important step in pulpal wound healing. Although components in the resin-based dental materials are known to have adverse effects on pulp wound healing including proliferation and mineralization, their effects on cell migration have been scarcely examined. Here, we investigated the effects of 2-hydroxyethyl methacrylate (HEMA) on the migration of dental pulp stem cells (DPSC) in vitro.

METHODS

Cell viability was assessed using the MTT (3-(4, 5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide) assay, and cell migration was evaluated using the wound scratch assay and transwell migration assay at noncytotoxic doses. The Western blot was used to examine pathways associated with migration such as focal adhesion kinase, mitogen-activated protein kinase, and glycogen synthase kinase 3.

RESULTS

There were no drastic changes in the cell viability below 3 mmol/L HEMA. When DPSCs were treated with HEMA at 0.5, 1.0, and 2.5 mmol/L, cell migration was diminished. HEMA-treated DPSCs exhibited the loss of phosphorylated focal adhesion kinase in a dose-dependent manner. The HEMA-mediated inhibition of cell migration was associated with phosphorylation of p38 but not glycogen synthase kinase 3, Extracellular signal-related kinase (ERK), or c-Jun N-terminal kinase (JNK) pathways. When we inhibited the p38 signaling pathway using a p38 inhibitor, the migration of DPSCs was suppressed.

CONCLUSIONS

HEMA inhibits the migration of dental pulp cells in vitro, suggesting that poor pulpal wound healing under resin-based dental materials may be caused, in part, by the inhibition of cell migration by HEMA.

Pulp response to dentine adhesives: A study on mature human pulps

Objective:

To clinically investigate the antibacterial effects of a commercially available self-etch 12-methacryloyloxy- dodecylpyridinium bromide (MDPB)-containing adhesive system in comparison with its respective non-MDPB-containing adhesive and to evaluate the pulp responses when in use on human teeth.

Materials and Methods:

Sixty-two viable human teeth scheduled for extraction were used. Class V cavities were prepared on the buccal surfaces of the teeth and filled with the tested materials (Protect Bond/Clearfil AP-X, SE Bond/Clearfil AP-X and Dycal/Ketac Fill Plus) as a control group, according to manufacturer's recommendations. Randomly divided to two groups teeth remained intra-orally for 4 and 8 weeks. After extraction, teeth were decalcified, sectioned and stained using the Mayer's hematoxylin and eosin, and modified Brown-Brenn's technique. Pulp responses were evaluated microscopically under a microscope and remaining dentine thickness measured under a stereomicroscope.

Results:

No statistically significant differences regarding pulp inflammation or bacterial infiltration were found either for the materials tested or for periods of post-operative evaluation.

Conclusions:

The results suggested that for a short period of evaluation there are no quantitative differences, regardless to restoring material used.

Evaluation of antibacterial and remineralizing nanocomposite and adhesive in rat tooth cavity model

Antibacterial and remineralizing dental composites and adhesives were recently developed to inhibit biofilm acids and combat secondary caries. It is not clear what effect these materials will have on dental pulps in vivo. The objectives of this study were to investigate the antibacterial and remineralizing restorations in a rat tooth cavity model, and determine pulpal inflammatory response and tertiary dentin formation. Nanoparticles of amorphous calcium phosphate (NACP) and antibacterial dimethylaminododecyl methacrylate (DMADDM) were synthesized and incorporated into a composite and an adhesive. Occlusal cavities were prepared in the first molars of rats and restored with four types of restoration: control composite and adhesive; control plus DMADDM; control plus NACP; and control plus both DMADDM and NACP. At 8 or 30days, rat molars were harvested for histological analysis. For inflammatory cell response, regardless of time periods, the NACP group and the DMADDM+NACP group showed lower scores (better biocompatibility) than the control group (p=0.014 for 8days, p=0.018 for 30days). For tissue disorganization, NACP and DMADDM+NACP had better scores than the control (p=0.027) at 30days. At 8days, restorations containing NACP had a tertiary dentin thickness (TDT) that was five- to six-fold that of the control. At 30days, restorations containing NACP had a TDT that was four- to six-fold that of the control. In conclusion, novel antibacterial and remineralizing restorations were tested in rat teeth in vivo for the first time. Composite and adhesive containing NACP and DMADDM exhibited milder pulpal inflammation and much greater tertiary dentin formation than the control adhesive and composite. Therefore, the novel composite and adhesive containing NACP and DMADDM are promising as a new therapeutic restorative system to not only combat oral pathogens and biofilm acids as shown previously, but also facilitate the healing of the dentin-pulp complex.

Mechanism of detoxification of the cationic antibacterial monomer 12-methacryloyloxydodecylpyridiniumbromide (MDPB) by N-acetyl cysteine

OBJECTIVES

The protective effects of N-acetyl cysteine (NAC) against cytotoxicity induced by conventional dental resin monomers have been widely documented. However, its effectiveness to detoxify cationic antibacterial monomers has not yet been elucidated. The aim of the present study was to investigate the possible protective effects of NAC against the cytotoxicity of 12-methacryloyloxydodecylpyridiniumbromide (MDPB) and explore the role of adduct formation in NAC-directed detoxification.

METHODS

The influences of NAC on the cytotoxicity of MDPB were studied in mouse osteoblast-like MC3T3-E1 cells using the MTT assay. Ultra-performance liquid chromatography (UPLC) and liquid chromatography-mass spectrometry (LC-MS) analysis were performed to investigate the possible chemical reaction between NAC and MDPB.

RESULTS

While only slight reduction in the cytotoxicity of MDPB by NAC was observed immediately after mixing with MDPB, remarkable protection against MDPB-induced cell death was detected when the mixture was tested after 24h of pre-incubation. UPLC and LC-MS analysis revealed that chemical binding of MDPB and NAC occurred under neutral conditions after 24h of pre-incubation.

SIGNIFICANCE

Our findings suggest that NAC reduces the toxicity of the cationic antibacterial monomer MDPB, and adduct formation is partially responsible for the detoxification ability of NAC against MDPB-induced cell damage.

Physical properties and cytotoxicity comparison of experimental gypsum-based biomaterials with two current dental cement materials on L929 fibroblast cells

Aim:

To evaluate physical properties and cytotoxicity of pure gypsum-based (pure-GYP) and experimental gypsum-based biomaterials mixed with polyacrylic acid (Gyp-PA). The results were compared with calcium hydroxide (CH) and glass ionomer cement (GIC) for application as base/liner materials.

Materials and Methods:

Vicat's needle was used to measure the setting time and solubility (%) was determined by percentage of weight loss of the materials following immersion in distilled water. For cytotoxicity test, eluates of different concentrations of materials were obtained and pipetted onto L-929 mouse fibroblast cultures and incubated for 3 days. Cellular viability was assessed using Dimethylthiazol diphenyltetrazolium bromide test to determine the cytotoxicity level. Statistical significance was determined by one-way analysis of variance followed by post hoc test (P < 0.05).

Results:

Setting time was significantly higher for pure-GYP and Gyp-PA; solubility test showed a similar tendency (pure-Gyp > Gyp-PA > CH = GIC). The pure-Gyp was found as the least cytotoxic materials at different concentrations. At 100 mg/mL dilutions of materials in growth medium highest cytotoxicity was observed with CH group.

Conclusion:

Cytotoxic effect was not observed with pure-Gyp; application of this novel biomaterial on deeper dentin/an exposed pulp and possibility of gradual replacement of this biodegradable material by dentin like structure would be highly promising.

Pulpal and Periapical Response After Restoration of Deep Cavities in Dogs' Teeth With Filtek Silorane and Filtek Supreme XT Systems

Objective:

This study evaluated, histopathologically, the pulpal and periapical response to a silorane-based resin (Filtek Silorane) and a methacrylate-based nanoparticle resin (Filtek Supreme XT) in deep cavities in dogs, having zinc oxide and eugenol-based cement (ZOE) as a control.

Methods:

The tooth/bone blocks were collected after 10 and 90 days and processed for microscopic analysis of the dentin, pulp, and periapical tissues using a score system. Data were analyzed statistically by Kruskal-Wallis and Dunn post-test (α=0.05).

Results:

At 10 days, the pulp, connective tissue, and periodontal ligament showed normal characteristics. No resorption areas were observed. Both resins caused significantly less (p&lt;0.05) periapical and pulpal inflammatory response than ZOE. At 90 days, for all materials, the connective pulp tissue was healthy and dense, with a normal blood vessel system. The apical and periapical region had normal structure and thickness.

Conclusions:

The use of the Filtek Silorane and the Filtek Supreme XT resins caused no adverse pulpal and periapical reactions after restoration of deep dentin cavities in vivo.

A feasibility study for the analysis of reparative dentinogenesis in pOBCol3.6GFPtpz transgenic mice

AIM

To examine the feasibility of using the pOBCol3.6GFPtpz [3.6-green fluorescent protein (GFP)] transgenic mice as an in vivo model for studying the biological sequence of events during pulp healing and reparative dentinogenesis.

METHODOLOGY

Pulp exposures were created in the first maxillary molar of 12-16-week-old 3.6-GFP transgenic mice with CD1 and C57/Bl6 genetic background. Direct pulp capping on exposed teeth was performed using mineral trioxide aggregate followed by restoration with a light-cured adhesive system (AS) and composite resin. In control teeth, the AS was placed in direct contact with the pulp. Animals were euthanized at various time points after pulp exposure and capping. The maxillary arch was isolated, fixed and processed for histological and epifluorescence analysis to examine reparative dentinogenesis.

RESULTS

Analysis of teeth immediately after pulp exposure revealed absence of odontoblasts expressing 3.6-GFP at the injury site. Evidence of reparative dentinogenesis was apparent at 4 weeks in 3.6-GFP mice in CD1 background and at 8 weeks in 3.6-GFP mice with C57/Bl6 background. The reparative dentine with both groups contained newly formed atubular-mineralized tissue resembling a dentine bridge and/or osteodentine that was lined by cells expressing 3.6-GFP as well as 3.6-GFP expressing cells embedded within the atubular matrix.

CONCLUSION

This study was conducted in a few animals and did not allow statistical analysis. The results revealed that the 3.6-GFP transgenic animals provide a unique model for direct analysis of cellular and molecular mechanisms of pulp repair and tertiary dentinogenesis in vivo. The study also shows the effects of the capping material and the genetic background of the mice in the sequence and timing of reparative dentinogenesis.

Pulp capping materials exert an effect on the secretion of IL-1β and IL-8 by migrating human neutrophils

Pulp repair is a complex process whose mechanisms are not yet fully understood. The first immune cells to reach the damaged pulp are neutrophils that play an important role in releasing cytokines and in phagocytosis. The objective of this study was to analyze the effect of different pulp-capping materials on the secretion of interleukin-1 beta (IL-1β) and interleukin-8 (IL-8) by migrating human neutrophils. Neutrophils were obtained from the blood of three healthy donors. The experimental groups were calcium hydroxide [Ca(OH)(2)], an adhesive system (Single Bond), and mineral trioxide aggregate (MTA). Untreated cells were used as control. Transwell chambers were used in performing the assays to mimic an in vivo situation of neutrophil chemotaxis. The pulp-capping materials were placed in the lower chamber and the human neutrophils, in the upper chamber. The cells were counted and the culture medium was assayed using ELISA kits for detecting and quantifying IL-1β and IL8. The data were compared by ANOVA followed by Tukey's test (p < 0.05). The secretion of IL-8 was significantly higher in all groups in comparison to the control group (p < 0.05). The adhesive system group showed higher IL-8 than the MTA group (p < 0.05). The secretion of IL-1β was significantly greater only in the MTA group (p < 0.001). It was concluded that only MTA is able to improve the secretion of IL-1β, and all materials tested increased IL-8 secretion. These results combined with all the other biological advantages of MTA indicate that it could be considered the material of choice for dental pulp capping.

Dentin-Pulp Complex Regeneration

Dentistry is entering an exciting era in which many of the advances in biotechnology offer opportunities for exploitation in novel and more effective therapies. Pulp healing is complex and dependent on the extent of injury, among many other factors. Many of the molecular and cellular processes involved in these healing events recapitulate developmental processes. The regulation of odontoblast activity is clearly central to pulp healing, and an understanding of the mechanisms involved in these processes is necessary to enable laboratory studies to be translated to clinic application. Transcriptome analysis has identified changes in many odontoblast genes during the life-cycle of this cell and its responses to injurious challenge. The p38 MAPKinase pathway appears to be central to the transcriptional control of odontoblasts and may provide a key target for therapeutic intervention. The many recent advances in knowledge of pulpal stem cells and molecular signaling molecules within the tooth, now provide exciting opportunities for clinical translation to novel therapies. Such translation will require the partnership of researchers and skilled clinicians who can effectively apply advances in knowledge to appropriate clinical cases and develop novel therapies which can be realistically introduced into the clinic.

Histologic assessment of human pulp response to capping with mineral trioxide aggregate and a novel endodontic cement

INTRODUCTION

This study was conducted to compare human pulp response to mineral trioxide aggregate (MTA) and a novel endodontic cement (NEC) when used as pulp capping materials after a time period of 2 and 8 weeks.

METHODS

Thirty-two premolar teeth that were scheduled for extraction for orthodontic reasons were exposed and capped with either MTA or NEC. Half of the specimens underwent extraction and histologic analysis after 2 weeks, and the remaining half were assessed after 8 weeks. Each slide was graded histologically according to the morphology of the dentinal bridge, thickness of the dentinal bridge, presence of odontoblast cells, and inflammation of the pulp.

RESULTS

Both MTA and NEC showed significantly better pulp response after 8 weeks compared with 2 weeks, with a thicker and more tubular pattern of the dentinal bridge, less pulp inflammation, and a palisade pattern of odontoblast cells. Although MTA and NEC groups had no significant difference in each measure in both time intervals, NEC induced a thicker dentinal bridge with less pulp inflammation at both 2 weeks and 8 weeks, compared with MTA.

CONCLUSIONS

MTA and NEC showed similar biocompatibility and favorable response in pulp capping treatment and inducing the formation of the dentinal bridge.

Preclinical effectiveness of a novel pulp capping material

INTRODUCTION

The purpose of this study was to evaluate the direct pulp capping response to a novel resin-based calcium phosphate cement (RCPC).

METHODS

The RCPC was placed in contact with the exposed healthy pulps of dog teeth and in a follow-up study on the healthy or inflamed pulps of ferret teeth. The inflamed ferret teeth had reversible pulpitis induced with Salmonella typhimurium lipopolysaccharides. After direct pulp capping with RCPC or visible light-curing resin-modified calcium hydroxide material (VLCCH) as a control, the restorations were bonded using a composite resin. The pulp responses and dentin repair were evaluated histologically in dog teeth after 7, 28, or 90 days and in ferret teeth after 45 days.

RESULTS

Most of the RCPC-treated healthy pulps and 75% of the RCPC-treated inflamed ferret teeth had dentin healing and repair, whereas those teeth treated with VLCCH had minimal healing and dentin repair.

CONCLUSIONS

The direct pulp capping of ferret and dog teeth with RCPC was associated with superior healing in comparison to VLCCH.

Can interaction of materials with the dentin-pulp complex contribute to dentin regeneration?

Understanding outcomes of the interaction between a dental material and tooth tissue is important in terms not only of biocompatibility but also of the potential for the material to modulate the response of the tissue. This interaction is influenced by many factors, including the chemistry of the material and any of its eluted components or degradation products, and the manner in which the tissue responds to these agents. Past studies of this interaction have primarily been aimed at identifying cytotoxic effects. More recently, investigations have focused on specific cellular responses, and in particular, on understanding how the materials themselves actually may contribute to regenerative processes in the tooth. Recent work has demonstrated the solubilization of proteins from dentin exposed to certain materials, such as calcium hydroxide, mineral trioxide aggregate, and acidic solutions that relate to those used in dentin bonding agents, with the subsequent modulation by these proteins of gene expression in odontoblast-like cells. This work suggests that dentin bridge formation under such materials may be stimulated through this process. Thus, there is much merit in examining both how new dental materials can be developed and how more traditional ones can be modified to preferentially stimulate regenerative processes when preferred. This review summarizes current knowledge about the potential beneficial effects derived from the interaction of dental materials with the dentin-pulp complex, as well as potential future developments in this exciting field.

Comparative cytotoxicity of five current dentin bonding agents: role of cell cycle deregulation

To compare the cytotoxicity of three nano-dentin bonding agents (nano-DBAs) and two non-nano-DBAs using Chinese hamster ovary (CHO-K1) cells. We found that nano fillers were not the major contributing factor in DBA cytotoxicity, as analyzed by colony forming assay and 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay. Exposure of CHO-K1 cells to all three tested total-etching DBAs led to G(0)/G(1) cell cycle arrest, whereas exposure to higher concentrations of two tested nano-DBAs induced G(2)/M arrest. All five DBAs further induced apoptosis at the highest concentration, as analyzed by propidium iodide staining flow cytometry. The toxicity of all DBAs (1:4000v/v or higher) is related to increased reactive oxygen species (ROS) production, as analyzed by single cell DCF fluorescence flow cytometry. These results indicate that clinical application of DBAs may be potentially toxic to dental pulp tissues. Cytotoxicity of DBAs is associated with ROS production, cell cycle deregulation and apoptosis. Presence of methacrylate monomers such as PENTA and UDMA is possibly the major cytotoxic factor for DBAs. Further studies on other toxicological endpoints of nano-DBAs are necessary to highlight their safe use.

Direct pulp capping with a self-etching adhesive system: histopathologic evaluation in dogs' teeth

OBJECTIVE

This study evaluated histopathologically the response of pulp and periradicular tissues after pulp capping with an all-in-one self-etching adhesive system in dogs' teeth.

STUDY DESIGN

Forty teeth of 4 dogs were assigned to 3 groups according to the pulp capping material: G1 (n = 20): self-etching adhesive system; G2 (n = 10): Ca(OH)(2); G3 (n = 10): zinc oxide-eugenol. The animals were killed 7 and 70 days after pulp capping. The pieces containing the pulp-capped teeth were removed and processed for histologic analysis.

RESULTS

At 7 days, no dentin bridge formation was observed; G1 and G3 exhibited inflammatory pulpal alterations, whereas G2 presented only mild inflammatory infiltrate in the pulp tissue adjacent to the capping material, the remainder being intact. At 70 days, no specimen in G1 or G3 presented dentin bridge formation. The remaining pulp tissue exhibited severe inflammatory alterations and areas of necrosis. In G2, all specimens showed dentin bridge formation and absence of inflammation and mineralized tissue resorption. No bacteria were identified using Brown and Brenn staining techniques in all 3 groups at any observation period.

CONCLUSION

According to the conditions of this study, direct pulp capping with the self-etching adhesive system did not allow pulp tissue repair and failed histopathologically in 100% of the cases.

A comparative study of histologic response to different pulp capping materials and a novel endodontic cement

OBJECTIVE

The aim of this study was to compare dogs' pulp response to capping with calcium hydroxide cement (Dycal), mineral trioxide aggregate (MTA), and a novel endodontic cement (NEC).

STUDY DESIGN

Twenty-four canine teeth in 6 beagle dogs were buccocervically exposed and capped with MTA, Dycal, or NEC. Eight weeks later, retrieved samples were observed by optical microscope to grade inflammation, formation of dentinal bridge, calcification, necrosis, and presence of odontoblast cells.

RESULTS

No inflammation was observed in MTA and NEC groups, and in 75% of each, dentinal bridge was completely formed. In the Dycal group, inflammation and incomplete dentinal bridge were detected in all cases. Although MTA and NEC groups had no significant difference between them in each measure, the difference between all 3 groups was significant (P < .001).

CONCLUSION

MTA and NEC showed similar favorable biologic response in pulp cap treatment, better than Dycal, especially in inducing the formation of dentinal bridge.

Pulpal responses to bacterial contamination following dentin bridging beneath hard-setting calcium hydroxide and self-etching adhesive resin system

To evaluate the pulp healing to bacterial contamination beneath a hard-setting calcium hydroxide (DY: Dycal, L.D. Caulk Co.) and a self-etching adhesive resin (2V: Clearfil Liner Bond 2V, Kuraray Medical Inc.) following dentin bridge formation. Class V cavities were prepared on 30 monkey teeth, and the pulps were exposed with a carbide bur through the cavity floor. Each exposed pulp was capped with either DY or 2V. The cavities were restored with a hybrid resin composite. The resin composite was removed at 180 days after capping, and then cavities were left open to the oral environment for 2 weeks to obtain bacteria contamination DY (BDY) and 2V (B2V; n = 10). A non-bacterial-contaminated group capped with DY was used as control. After bacterial challenges, inflammatory cell infiltration, incidence and differentiation of dentin bridges were evaluated histologically. There were significant differences in the presence of inflammatory cell infiltration among all groups (P < 0.05). No moderate or severe inflammatory reaction was found in Group DY. Group BDY showed moderate or severe inflammatory cell infiltration in 50%, and showed four necrotic specimens. Although no statistically significant difference was found in the formation and differentiation of dentin bridges among all groups, tunnel defects in dentin bridges were detected in 70% (DY), 80% (BDY), and 50% (B2V). Group B2V showed a significantly lower presence of inflammatory cell infiltration than Group BDY (P < 0.05). Bonding agent is supposed to seal the exposure site, and the remaining bonding agent on the cavities was effective as the barrier in the dentin bridges after bacterial challenges.

Direct capping of human pulps with a dentin bonding system and calcium hydroxide: an immunohistochemical analysis

Pulp capping is a treatment where a protective agent is applied to an exposed pulp to allow the maintenance of its vitality and function. The present study analyzed the immunohistochemical expression of fibronectin and type III collagen in human dental pulps submitted to direct pulp capping with calcium hydroxide [Ca(OH)2] or the Single Bond adhesive system (SBAS). The results demonstrated that both proteins were not expressed in the SBAS group, although in the group capped with Ca(OH)2 a diffuse labeling in the extracellular matrix was initially observed, followed by a late expression in the odontoblast-like layer and beneath the dentin bridge. It seems that application of adhesive systems in direct contact with healthy pulps will not lead to expression of proteins that are believed to be essential for pulpal repair. Moreover, Ca(OH)2 showed good biocompatibility properties with the dental pulp tissue, inducing the expression of reparative molecules, and therefore remains the material of choice for the treatment of accidental pulp exposures.

Effects of a new antibacterial adhesive on the repair capacity of the pulp-dentine complex in infected teeth

AIM

To evaluate the effects of a self-etching/priming adhesive system, containing the antibacterial monomer 12-methacryloyloxy-dodecylpyridinium bromide (MDPB), on the repair capacity of the pulp-dentine complex in infected cavities in dog's teeth.

METHODOLOGY

Class V cavities with a residual dentine thickness ranging from 0.3-0.8 mm were prepared on the buccal surface of permanent teeth in four dogs. Pulpal exposures were performed in half of the cavities. Millipore filters that had been incubated for 3 h in a 10(5) milky suspension of a-streptococci were placed in the cavities, which were then filled temporarily. After 24 h, the filters were removed and both the exposed and non-exposed cavities were washed with sterile saline and assigned to four groups which were treated with either the experimental antibacterial adhesive system, or Clearfil SE bond, Dycal and Teflon discs. Stereotype connective tissue reactions (inflammatory cell response and/or tissue necrosis) and pulp-specific reparative tissue responses (reduction of odontoblasts and tertiary dentine formation) were assessed at post-operative periods of 4 and 8 weeks.

RESULTS

Neither severe inflammation nor tissue necrosis was observed, either in the dentinal cavities or pulpal exposures treated with the self-etch adhesive containing MDPB. Rates of tertiary dentine formation in infected dentinal cavities treated with this system were comparable with those observed after dentine treatment with the Ca(OH)2-based material. Dentinal bridging was not seen in pulpal exposures treated with the experimental adhesive.

CONCLUSIONS

The new antibacterial adhesive system maintained pulp vitality and primary odontoblastic function in infected nonexposed and exposed cavities but interfered with reparative dentine formation in infected pulpal exposures.

Gene-enhanced tissue engineering for dental hard tissue regeneration: (2) dentin-pulp and periodontal regeneration

Potential applications for gene-based tissue engineering therapies in the oral and maxillofacial complex include the delivery of growth factors for periodontal regeneration, pulp capping/dentin regeneration, and bone grafting of large osseous defects in dental and craniofacial reconstruction. Part 1 reviewed the principals of gene-enhanced tissue engineering and the techniques of introducing DNA into cells. This manuscript will review recent advances in gene-based therapies for dental hard tissue regeneration, specifically as it pertains to dentin regeneration/pulp capping and periodontal regeneration.

Direct Pulp Capping with a Dentin Bonding System in Human Teeth: A Clinical and Histological Evaluation

This study evaluated the pulpal response in human dental pulp to direct pulp capping with the Single Bond Adhesive System (SBAS) after 10% or 37% phosphoric acid etching and after capping with Calcium Hydroxide (CH). The degree of bleeding and hemostasis conditions was considered during the adhesive technique. The pulps of 78 sound premolars were capped with SBAS after 37% phosphoric acid etching (Group I) or 10% phosphoric acid etching (Group II) and CH (Group III-control). The cavities were restored with a resin composite (Charisma). After 1, 3, 7 and 30 days, the teeth were extracted and processed for light microscopical examination (H/E, AgNOR silver stain and Brown-Brenn). The patients were followed for postoperative symptomatology evaluation. Clinical results showed the possibility of hemostasis with saline solution only. There was no statistical difference between bleeding generated by 10% and 37% acid solutions. In some cases, contact of the pulp tissue with SASB started the bleeding process, thus damaging the adhesive technique. The histological response was similar in Groups I and II, without signs of cellular differentiation and dentin neoformation up to 30 days. Bacteria were not observed in any specimens. In the control group (CH) at day 7, the pulps exhibited cells with high synthetic activity (Ag-NOR-positive) underneath the area of coagulation necrosis. Dentin bridging was observed at the thirtieth day. The postoperative period was asymptomatic for all groups. In conclusion, SBAS should be avoided for vital pulp therapy, while CH remains the capping agent of choice for mechanically exposed human dental pulp.