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Chua SKX, Sim YF, Wang WC, Mok BYY, Yu VSH. One-year outcome of selective caries removal versus pulpotomy treatment of deep caries: A pilot randomized controlled trial. Int Endod J 2023; 56:1459-1474. [PMID: 37795835 DOI: 10.1111/iej.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/20/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
AIM This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine. METHODOLOGY This two-armed, parallel-group, randomized, superiority trial included vital mature permanent teeth with deep primary or secondary caries diagnosed radiographically as being at least 75% into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were blindly allocated to receive either SCR or Pulpotomy using computer-generated randomized patient codes concealed in opaque envelopes. All teeth were reviewed clinically and radiographically at 6 months and 1 year post-treatment. Using a significance level of p < .05, the log rank test and Cox proportional hazards regression were used to compare the outcome of SCR and Pulpotomy and to identify potential prognostic factors, respectively. RESULTS In all, 58 teeth in the SCR group and 55 teeth in the pulpotomy group completed treatment, after excluding 6 teeth because they did not complete the allocated treatment and another due to severe periodontal disease. At one year, 57/58 (98.3%) teeth from the SCR group and 48/55 (87.3%) teeth from the Pulpotomy group were available for analysis. One tooth in the Pulpotomy group (2.1%) and eight teeth in the SCR group (14.0%) required the further intervention of root canal treatment (p < .05). There were no other significant prognostic factors for survival. Overall, 91.4% of teeth treated with either SCR or Pulpotomy survived without requiring further intervention over a period of one year. No other adverse events occurred over the review period. CONCLUSION Within the limitations of this study, Pulpotomy fares better than SCR in preserving the remaining pulp and periapical health. As a treatment modality, Pulpotomy carries greater cost outlay to patient and takes a longer time to complete treatment than SCR. Long-term follow-up is needed to study the pulpal and restorative outcomes of Pulpotomy and SCR.
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Affiliation(s)
- S K X Chua
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - Y F Sim
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - W C Wang
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - B Y Y Mok
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - V S H Yu
- National University Centre for Oral Health Singapore (NUCOHS), Singapore City, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
- Oral Care Health Innovation and Designs Singapore (ORCHIDS), National University of Singapore, Singapore City, Singapore
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2
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Chung M, Lee S, Kim S, Kim E. Inflammatory response and odontogenic differentiation of inflamed dental pulp treated with different pulp capping materials: An in vivo study. Int Endod J 2023; 56:1118-1128. [PMID: 37350351 DOI: 10.1111/iej.13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
AIM Previous studies have evaluated the pulpal responses to calcium silicate cements (CSCs) on normal dental pulp, but investigations on the effects of CSCs on inflamed pulp are limited. This study aimed to test the inflammatory response and odontogenic differentiation of inflamed rat dental pulp after direct pulp capping with CSCs. METHODOLOGY Wistar rat molars pulps were exposed for 48 h to induce inflammation and then capped with ProRoot MTA (Dentsply), Biodentine (Septodont), RetroMTA (Bio MTA) and Dycal (Dentsply Caulk). The degree of pulpal inflammation and hard tissue formation was evaluated by histological analysis. Immunofluorescence staining for interleukin (IL)-6, osteocalcin (OCN) and runt-related transcription factor 2 (RUNX2) was also performed. RESULTS After 4 weeks, complete recovery from inflammation was evident in 22%, 37.5%, 10% and none of the ProRoot MTA, Biodentine, RetroMTA and Dycal samples, respectively. Heavy hard tissue deposition as a continuous hard tissue bridge was observed in 77.8%, 75%, 70% and 60% of the ProRoot MTA, Biodentine, RetroMTA and Dycal samples, respectively. IL-6, OCN and RUNX2 were detected in all materials, mainly adjacent to areas of inflammation and reparative dentine formation. At one, two and 4 weeks, significant differences were not observed between the inflammation and hard tissue formation scores of the four material groups (p > .05). CONCLUSIONS In this study, pulpal inflammation was still present in most specimens at 4 weeks after pulp capping and a significant number of samples showed incomplete and discontinuous dentine bridge formation. The results of this study suggest that initial inflammatory conditions of the pulp may risk the prognosis of teeth treated with CSCs.
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Affiliation(s)
- M Chung
- Department of Conservative Dentistry and Oral Science Research Center, Microscope Center, Yonsei University College of Dentistry, Seoul, South Korea
| | - S Lee
- Oral Science Research Center, Yonsei University College of Dentistry, Seoul, South Korea
| | - S Kim
- Department of Conservative Dentistry and Oral Science Research Center, Microscope Center, Yonsei University College of Dentistry, Seoul, South Korea
| | - E Kim
- Department of Conservative Dentistry and Oral Science Research Center, Microscope Center, Yonsei University College of Dentistry, Seoul, South Korea
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R R, Wani W, Sharma S, Kumar V, Chawla A, Kalaivani M, Logani A. Selective Removal to Soft Dentine versus Full Pulpotomy for Management of Proximal Deep Carious Lesions: A Randomized Controlled Non-Inferiority Trial. Caries Res 2023; 57:536-545. [PMID: 37552970 DOI: 10.1159/000530895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/25/2023] [Indexed: 08/10/2023] Open
Abstract
The management of the deep carious lesion with reversible pulpitis is a dilemma for the dentist. The current study compared selective removal to soft dentine (SRSD) and full pulpotomy (FP) for treating proximal deep carious lesions in teeth with reversible pulpitis. Visual-tactile examination and bitewing radiographs were used to determine the depth of carious lesion, and American Association of Endodontists recommendations were used to formulate pulp diagnosis. Sixty mandibular molar teeth from healthy patients between the ages of 16-35 years and a diagnosis of proximal deep carious lesion with reversible pulpitis were included. Teeth were randomly allocated to two study groups. SRSD group (n = 30): soft dentine was preserved over the pulpal aspect. A hard-setting calcium hydroxide cement liner and resin-modified glass ionomer cement base were applied over the remaining soft carious dentine. FP group (n = 30): complete caries removal followed by mineral trioxide aggregate FP was performed. The teeth in both groups were restored with composite resin restoration. The established criteria for outcome assessment of SRSD and pulpotomy were used. Accordingly, only asymptomatic teeth with no radiological evidence of periapical rarefaction were considered successful at the 12-month follow-up. Two-sample t test, Pearson χ2 test/Fisher's exact test, and percentage agreement were used for statistical evaluation. According to the per-protocol analysis, the success rate of both SRSD and FP treatment was 95.45% and 95.65%, respectively, and the actual difference between the two treatments was 1% (95% CI: [-10, 9]). The data suggests that both treatments (SRSD and FP) appear to have a good success rate (>95%) when used to manage permanent mandibular molar teeth with proximal deep carious lesion and reversible pulpitis. As SRSD is a noninvasive procedure, it should be favored over FP in these instances.
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Affiliation(s)
- Rechithra R
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Wasim Wani
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Sharma
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Kumar
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Amrita Chawla
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Logani
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Aldeen RZ, Aljabban O, Almanadili A, Alkurdi S, Eid A, Mancino D, Haikel Y, Kharouf N. The Influence of Carious Lesion and Bleeding Time on the Success of Partial Pulpotomy in Permanent Molars with Irreversible Pulpitis: A Prospective Study. Bioengineering (Basel) 2023; 10:700. [PMID: 37370631 DOI: 10.3390/bioengineering10060700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
This prospective study aimed to evaluate the success rate of partial pulpotomy using mineral trioxide aggregate (MTA), in permanent molars with symptomatic irreversible pulpitis. Moreover, this study aimed to investigate the effect of carious lesion depth and activity and bleeding time on the outcome of partial pulpotomy. Forty permanent molars with deep and extremely deep carious lesions clinically diagnosed with symptomatic irreversible pulpitis were included. The status of the carious lesion was evaluated clinically and radiographically to determine its activity (rapidly or slowly progressing) and depth (deep or extremely deep). A partial pulpotomy was performed and MTA was used. Clinical and radiographic analysis were performed at 3, 6 and 12 months. Chi-square analysis and Fisher's exact test were used. Scanning electron microscope and energy dispersive X-rays were used to investigate the crystalline structures and their chemical composition onto MTA surfaces after immersion in several conditions. The partial pulpotomy was 88.9% successful, with no significant difference in outcome between deep and extremely deep carious lesions (p = 0.22) or between rapidly and slowly progressing lesions (p = 0.18). Nevertheless, all failed cases were associated with rapidly progressing lesions and extremely deep lesions. All failures occurred when the bleeding time was more than 3 min (p = 0.10). Different crystalline structures were detected on MTA surfaces, with higher calcium percentages in PBS conditions. Within the limitations of the present study, favorable results demonstrated that MTA might be recommended as a suitable agent for partial pulpotomy in permanent molars with irreversible pulpitis. The depth and activity of the carious lesion as well as the bleeding time are important factors in the success of partial pulpotomy treatment. The prolonged bleeding time and the extremely deep rapidly progressing caries could be related with the failure cases in partial pulpotomy treatment of irreversible pulpitis.
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Affiliation(s)
- Rami Zen Aldeen
- Department of Endodontics, Faculty of Dentistry, Damascus University, Damascus 0100, Syria
| | - Ossama Aljabban
- Department of Endodontics, Faculty of Dentistry, Damascus University, Damascus 0100, Syria
| | - Ahmad Almanadili
- Department of Oral Pathology, Faculty of Dentistry, Damascus University, Damascus 0100, Syria
| | - Saleh Alkurdi
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus 0100, Syria
| | - Ammar Eid
- Department of Endodontics, Faculty of Dentistry, Damascus University, Damascus 0100, Syria
| | - Davide Mancino
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Strasbourg University, 67000 Strasbourg, France
- Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Youssef Haikel
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Strasbourg University, 67000 Strasbourg, France
- Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
- Pôle de Médecine et Chirurgie Bucco-Dentaire, Hôpital Civil, Hôpitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Naji Kharouf
- Department of Biomaterials and Bioengineering, INSERM UMR_S 1121, Strasbourg University, 67000 Strasbourg, France
- Department of Endodontics, Faculty of Dental Medicine, Strasbourg University, 67000 Strasbourg, France
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Huang F, Cheng L, Li J, Ren B. Nanofibrous scaffolds for regenerative endodontics treatment. Front Bioeng Biotechnol 2022; 10:1078453. [PMID: 36578510 PMCID: PMC9790898 DOI: 10.3389/fbioe.2022.1078453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
Untreated dental caries, tooth trauma and dental anatomical variations such as dens invaginatus can result in pulpitis. However, standard root canal therapy cannot treat immature permanent teeth due to an open apical foramen and thin dentinal walls. Thus, regenerative endodontics treatment (RET) following a disinfection step with pulp regeneration has been developed. Pulp connective-tissue, dentin formation, revascularization and reinnervation can occur in this procedure which should be supplemented with intelligent biomaterials to improve repeatability and support well-coordinated regeneration. Furthermore, nanofibrous scaffolds, as one of the most commonly used materials, show promise. The purpose of this article is to highlight the advantages of nanofibrous scaffolds and discuss the future modification and application of them.
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Affiliation(s)
- Fangting Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,Department of Preventive Dentistry, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China,*Correspondence: Jiyao Li, ; Biao Ren,
| | - Biao Ren
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China,*Correspondence: Jiyao Li, ; Biao Ren,
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Gözetici-Çil B, Erdem-Hepşenoğlu Y, Tekin A, Özcan M. Selective removal to soft dentine or selective removal to firm dentine for deep caries lesions ın permanent posterior teeth: a randomized controlled clinical trial up to 2 years. Clin Oral Investig 2022; 27:2125-2137. [PMID: 36460919 PMCID: PMC9734731 DOI: 10.1007/s00784-022-04815-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/27/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES The aim of this randomized clinical trial was to compare selective removal to soft dentin (SRSD) and selective removal to firm dentin (SRFD) in permanent teeth. The primary outcome of the study was to compare the success rates of the two caries removal techniques. The secondary outcome of the study was to investigate whether or not calcium silicate-based material (CS) had an effect on the success rate of the treatment. MATERIALS AND METHODS Between November 2018 and March 2020, patients with deep caries lesions were invited to participate in the study. Posterior teeth (N = 165) with primary caries lesion radiographically extending ¾ of dentin and positive response to cold test were randomly selected. A total of 134 participants meeting the inclusion criteria were randomized to SRSD and SRFD (control) groups. After the caries removal procedure, teeth with exposed pulps were assigned to the pulp exposure (PE) group, and the SRSD group was further divided into test 1 (with CS) and test 2 groups (without CS). Success was defined as a positive response to the cold test, a negative response to percussion, the absence of pain, an abscess, a fistula, and periapical alterations. Fisher-Freeman-Halton exact tests, Kaplan-Meier survival analysis, and the log-rank tests were performed for comparisons between groups. RESULTS No statistically significant difference was found between the success rates of test 1 (100%) and test 2 (93.5%) groups, whereas the proportion of success in control (82.4%) and PE (84%) groups were significantly lower when compared with test groups (p = 0.024; p < 0.05) at the end of 2-year follow-up. CONCLUSIONS SRSD had a higher success rate when compared to SRFD to treat deep carious lesions after 2 years of follow-up. The use of CS material after SRSD as a liner had no effect on the treatment outcome. CLINICAL RELEVANCE SRSD with good coronal sealing might be recommended without CS application for the treatment of deep caries lesions in permanent teeth. TRIAL REGISTRATION Clinical trial registration number NCT04052685 (08/09/2019).
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Affiliation(s)
- Burcu Gözetici-Çil
- grid.411781.a0000 0004 0471 9346Department of Restorative Dentistry, School of Dentistry, Istanbul Medipol University, Birlik Mah. Bahçeler Cad. No. 5, Esenler, Istanbul, Turkey
| | - Yelda Erdem-Hepşenoğlu
- grid.411781.a0000 0004 0471 9346Department of Endodontics, School of Dentistry, Istanbul Medipol University, Birlik Mah. Bahçeler Cad. No. 5, Esenler, Istanbul, Turkey
| | - Alperen Tekin
- grid.411781.a0000 0004 0471 9346Oral Diagnosis and Maxillofacial Radiology, School of Dentistry, Istanbul Medipol University, Birlik Mah. Bahçeler Cad. No. 5 Esenler, Istanbul, Turkey
| | - Mutlu Özcan
- grid.7400.30000 0004 1937 0650Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
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Elgezawi M, Haridy R, Abdalla MA, Heck K, Draenert M, Kaisarly D. Current Strategies to Control Recurrent and Residual Caries with Resin Composite Restorations: Operator- and Material-Related Factors. J Clin Med 2022; 11:jcm11216591. [PMID: 36362817 PMCID: PMC9657252 DOI: 10.3390/jcm11216591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
This review addresses the rationale of recurrent and/or residual caries associated with resin composite restorations alongside current strategies and evidence-based recommendations to arrest residual caries and restrain recurrent caries. The PubMed and MEDLINE databases were searched for composite-associated recurrent/residual caries focusing on predisposing factors related to materials and operator’s skills; patient-related factors were out of scope. Recurrent caries and fractures are the main reasons for the failure of resin composites. Recurrent and residual caries are evaluated differently with no exact distinguishment, especially for wall lesions. Recurrent caries correlates to patient factors, the operator’s skills of cavity preparation, and material selection and insertion. Material-related factors are significant. Strong evidence validates the minimally invasive management of deep caries, with concerns regarding residual infected dentin. Promising technologies promote resin composites with antibacterial and remineralizing potentials. Insertion techniques influence adaptation, marginal seal, and proximal contact tightness. A reliable diagnostic method for recurrent or residual caries is urgently required. Ongoing endeavors cannot eliminate recurrent caries or precisely validate residual caries. The operator’s responsibility to precisely diagnose original caries and remaining tooth structure, consider oral environmental conditions, accurately prepare cavities, and select and apply restorative materials are integral aspects. Recurrent caries around composites requires a triad of attention where the operator’s skills are cornerstones.
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Affiliation(s)
- Moataz Elgezawi
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
- Correspondence: (M.E.); (D.K.); Tel.: +49-89-4400-59452 (D.K.); Fax: +49-89-4400-59302 (D.K.)
| | - Rasha Haridy
- Department of Clinical Dental Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
- Department of Conservative Dentistry, Faculty of Dentistry, Cairo University, Cairo 4240310, Egypt
| | - Moamen A. Abdalla
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Katrin Heck
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethe Str. 70, 80336 Munich, Germany
| | - Miriam Draenert
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethe Str. 70, 80336 Munich, Germany
| | - Dalia Kaisarly
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethe Str. 70, 80336 Munich, Germany
- Correspondence: (M.E.); (D.K.); Tel.: +49-89-4400-59452 (D.K.); Fax: +49-89-4400-59302 (D.K.)
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8
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Ruiz-González P, Cabanillas-Balsera D, Saúco-Márquez JJ, Segura-Egea JJ. Outcome of Direct Pulp Capping in Teeth Diagnosed as Irreversible Pulpitis: Systematic Review and Meta-Analysis. J Clin Exp Dent 2022; 14:e594-e603. [PMID: 35912026 PMCID: PMC9328486 DOI: 10.4317/jced.59668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
Background This review and meta-analysis investigates the outcome of direct pulp capping in teeth diagnosed as irreversible pulpitis.
Material and Methods This systematic review includes experimental and descriptive clinical studies according to the PRISMA criteria, using PubMed and Scopus as database. We have included studies that performed direct pulp capping on human permanent teeth previously diagnosed with irreversible pulpitis and that carried out a subsequent follow-up. The outcome of interest was the clinical success of direct pulp capping.
Results A total of four studies met the inclusion criteria for this review, however only three of these could be included in the meta-analysis. These three studies represent a total sample of 62 teeth with irreversible pulpitis treated with direct pulp capping that showed an overall success rate of 0.953 (CI=0.900-1.005; p<0.001; I²=0). Additionally, the success rates of vital pulp therapies were compared, all of them being greater than 75%; and the success rates of the materials used were analyzed, giving values above 80% in all cases. The risk of bias of the included articles was established using the ROBINS-I tool, showing that two of the articles had a moderate risk of bias and the remaining two had a very high risk of bias.
Conclusions Based on the results of this review, direct pulp capping should be clinically included as a successful technique for the treatment of irreversible pulpitis. However, a larger number of studies with more rigorous methodologies are necessary to confirm the efficacy of this technique. Key words:Irreversible pulpitis, direct pulp capping (DPC), vital pulp therapy (VPT), indirect pulp capping (IPC), partial pulpotomy, total pulpotomy.
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Affiliation(s)
- Paula Ruiz-González
- DDS, Department of Stomatology, Section of Endodontics, School of Dentistry, University of Sevilla, C/ Avicena s/n, 41009-Sevilla, Spain
| | - Daniel Cabanillas-Balsera
- DDS, MSc, PhD, Professor of Master in Clinical Endodontics, University of Sevilla, C/ Avicena s/n, 41009-Sevilla, Spain
| | - Juan J Saúco-Márquez
- DDS, MD, PhD Professor of Master in Clinical Endodontics, University of Sevilla, C/ Avicena s/n, 41009-Sevilla, Spain
| | - Juan J Segura-Egea
- MD, DDS, PhD, Professor, Department of Stomatology, Section of Endodontics, School of Dentistry, University of Sevilla, C/ Avicena s/n, 41009-Sevilla, Spain
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9
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Arora S, Cooper PR, Friedlander LT, Rizwan S, Seo B, Rich AM, Hussaini HM. Potential application of immunotherapy for modulation of pulp inflammation: opportunities for vital pulp treatment. Int Endod J 2021; 54:1263-1274. [PMID: 33797765 DOI: 10.1111/iej.13524] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022]
Abstract
Caries results in the demineralization and destruction of enamel and dentine, and as the disease progresses, irreversible pulpitis can occur. Vital pulp therapy (VPT) is directed towards pulp preservation and the prevention of the progression of inflammation. The outcomes of VPT are not always predictable, and there is often a poor correlation between clinical signs and symptoms, and the events occurring at a molecular level. The inflamed pulp expresses increased levels of cytokines, including tumour necrosis factor (TNF)-α, interleukin (IL)-1α, IL-1β, IL-4, IL-6, IL-8, IL-17 and IL-23, which recruit and drive a complex cellular immune response. Chronic inflammation and sustained cytokine release can result in irreversible pulp damage and a decreased capacity for tissue healing. Other chronic inflammatory diseases, such as psoriasis, inflammatory bowel diseases and rheumatoid arthritis, are also characterized by an dysregulated immune response composed of relatively high cytokine levels and increased numbers of immune cells along with microbial and hard-soft tissue destructive pathologies. Whilst anti-cytokine therapies have been successfully applied in the treatment of these diseases, this approach is yet to be attempted in cases of pulp inflammation. This review therefore focuses on the similarities in the aetiology between chronic inflammatory diseases and pulpitis, and explores how anti-cytokine therapies could be applied to manage an inflamed pulp and facilitate healing. Further proof-of-concept studies and clinical trials are justified to determine the effectiveness of these treatments to enable more predictable outcomes in VPT.
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Affiliation(s)
- S Arora
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - P R Cooper
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - L T Friedlander
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - S Rizwan
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - B Seo
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - A M Rich
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - H M Hussaini
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
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KALYONCUOĞLU E, KESKİN C, ACAR D, GONULOL N. THE BOND STRENGTH OF UNIVERSAL ADHESIVES WITH DIFFERENT ACIDITIES TO CALCIUM SILICATE-BASED MATERIALS. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.740487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Preserving pulp vitality: part two - vital pulp therapies. Br Dent J 2021; 230:148-155. [PMID: 33574536 DOI: 10.1038/s41415-020-2599-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/23/2020] [Indexed: 12/29/2022]
Abstract
Vital pulp therapies (VPTs) aim to preserve the vitality of the pulp. The European Society of Endodontology have begun a campaign to raise awareness on the efficacy of VPTs following on from the publication of their 2019 position statement, aimed at both specialists and general dental practitioners. This review examines the current evidence surrounding VPTs and provides a rational approach to the management of the exposed pulp with the aid of case studies. Success lies in accurate diagnosis and case selection, along with well-executed treatment and appropriate follow-up protocols. The introduction of calcium silicate cements has made these treatments more predictable.
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Galler KM, Weber M, Korkmaz Y, Widbiller M, Feuerer M. Inflammatory Response Mechanisms of the Dentine-Pulp Complex and the Periapical Tissues. Int J Mol Sci 2021; 22:ijms22031480. [PMID: 33540711 PMCID: PMC7867227 DOI: 10.3390/ijms22031480] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 02/08/2023] Open
Abstract
The macroscopic and microscopic anatomy of the oral cavity is complex and unique in the human body. Soft-tissue structures are in close interaction with mineralized bone, but also dentine, cementum and enamel of our teeth. These are exposed to intense mechanical and chemical stress as well as to dense microbiologic colonization. Teeth are susceptible to damage, most commonly to caries, where microorganisms from the oral cavity degrade the mineralized tissues of enamel and dentine and invade the soft connective tissue at the core, the dental pulp. However, the pulp is well-equipped to sense and fend off bacteria and their products and mounts various and intricate defense mechanisms. The front rank is formed by a layer of odontoblasts, which line the pulp chamber towards the dentine. These highly specialized cells not only form mineralized tissue but exert important functions as barrier cells. They recognize pathogens early in the process, secrete antibacterial compounds and neutralize bacterial toxins, initiate the immune response and alert other key players of the host defense. As bacteria get closer to the pulp, additional cell types of the pulp, including fibroblasts, stem and immune cells, but also vascular and neuronal networks, contribute with a variety of distinct defense mechanisms, and inflammatory response mechanisms are critical for tissue homeostasis. Still, without therapeutic intervention, a deep carious lesion may lead to tissue necrosis, which allows bacteria to populate the root canal system and invade the periradicular bone via the apical foramen at the root tip. The periodontal tissues and alveolar bone react to the insult with an inflammatory response, most commonly by the formation of an apical granuloma. Healing can occur after pathogen removal, which is achieved by disinfection and obturation of the pulp space by root canal treatment. This review highlights the various mechanisms of pathogen recognition and defense of dental pulp cells and periradicular tissues, explains the different cell types involved in the immune response and discusses the mechanisms of healing and repair, pointing out the close links between inflammation and regeneration as well as between inflammation and potential malignant transformation.
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Affiliation(s)
- Kerstin M. Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93093 Regensburg, Germany;
- Correspondence:
| | - Manuel Weber
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Yüksel Korkmaz
- Department of Periodontology and Operative Dentistry, University of Mainz, 55131 Mainz, Germany;
| | - Matthias Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93093 Regensburg, Germany;
| | - Markus Feuerer
- Department for Immunology, University Hospital Regensburg, 93053 Regensburg, Germany;
- Regensburg Center for Interventional Immunology (RCI), University Hospital Regensburg, 93053 Regensburg, Germany
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Edwards D, Stone S, Bailey O, Tomson P. Preserving pulp vitality: part one - strategies for managing deep caries in permanent teeth. Br Dent J 2021; 230:77-82. [PMID: 33483661 DOI: 10.1038/s41415-020-2590-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/23/2020] [Indexed: 11/09/2022]
Abstract
This is the first article in a series reviewing the current literature surrounding the management of deep caries in permanent teeth. Approaches to caries management are continuing to evolve, with more conservative management increasingly favoured. This philosophy has never been more important than in managing the deep carious lesion. Evidence is emerging that the use of selective caries removal to reduce the risk of pulp exposure, in conjunction with calcium silicate cements, can be successful in maintaining pulp vitality, delaying the restorative cycle and prolonging the lifespan of the tooth.
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Affiliation(s)
- David Edwards
- Restorative Dentistry (Endodontics), Newcastle Dental Hospital, Richardson Road, Newcastle upon Tyne, NE2 4AZ, UK.
| | - Simon Stone
- Restorative Dentistry, School of Dental Sciences, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
| | - Oliver Bailey
- Restorative Dentistry, School of Dental Sciences, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
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14
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Macrophage modulation of dental pulp stem cell activity during tertiary dentinogenesis. Sci Rep 2020; 10:20216. [PMID: 33214653 PMCID: PMC7678850 DOI: 10.1038/s41598-020-77161-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/02/2020] [Indexed: 01/10/2023] Open
Abstract
The interaction between immune cells and stem cells is important during tissue repair. Macrophages have been described as being crucial for limb regeneration and in certain circumstances have been shown to affect stem cell differentiation in vivo. Dentine is susceptible to damage as a result of caries, pulp infection and inflammation all of which are major problems in tooth restoration. Characterising the interplay between immune cells and stem cells is crucial to understand how to improve natural repair mechanisms. In this study, we used an in vivo damage model, associated with a macrophage and neutrophil depletion model to investigate the role of immune cells in reparative dentine formation. In addition, we investigated the effect of elevating the Wnt/β-catenin pathway to understand how this might regulate macrophages and impact upon Wnt receiving pulp stem cells during repair. Our results show that macrophages are required for dental pulp stem cell activation and appropriate reparative dentine formation. In addition, pharmacological stimulation of the Wnt/β-catenin pathway via GSK-3β inhibitor small molecules polarises macrophages to an anti-inflammatory state faster than inert calcium silicate-based materials thereby accelerating stem cell activation and repair. Wnt/β-catenin signalling thus has a dual role in promoting reparative dentine formation by activating pulp stem cells and promoting an anti-inflammatory macrophage response.
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15
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Demant S, Dabelsteen S, Bjørndal L. A macroscopic and histological analysis of radiographically well-defined deep and extremely deep carious lesions: carious lesion characteristics as indicators of the level of bacterial penetration and pulp response. Int Endod J 2020; 54:319-330. [PMID: 33012046 DOI: 10.1111/iej.13424] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/29/2020] [Indexed: 12/26/2022]
Abstract
AIM To investigate the relationship between radiographically and macroscopically well-defined carious lesions and the dentine-pulp complex with regard to: (i) level of bacterial penetration; (ii) inflammatory status including the presence of hyperplastic pulp stroma; and (iii) formation of hard and/or ectopic connective tissue. METHODOLOGY The material comprised 68 untreated cavitated permanent teeth divided into well-defined radiographic categories based on the lesion penetration depth: (i) deep lesions ( ≥3/4 of the dentine thickness with a radio-dense zone separating the lesion from the pulp) and (ii) extremely deep lesions (the carious lesion penetrated the entire thickness of the dentine, without a radio-dense zone). After extraction, the teeth were processed for histology. The material was scored with regard to coronal breakdown, macroscopic variables describing caries activity and histological variables describing the dentine-pulp complex (bacteria, inflammatory infiltrate, partial pulp necrosis, hyperplastic changes and hard tissue/ectopic presence of connective tissue). Interrater agreement was assessed using Cohen's kappa. Associations between variables were assessed using Pearson's chi-squared or Fisher's exact test. The effect size was reported by odds ratio (OR) and associated 95% confidence interval (CI). Level of significance was set to 5%. RESULTS There were significant associations between a closed environment (1-2 surfaces involved) and the presence of biofilm, retrograde demineralization and light-coloured demineralized dentine. Whereas radiographically defined deep lesions tended to have bacteria only in the primary dentine (P < 0.001, OR = 20.55, 95% CI [4.44, 107.89]), extremely deep carious lesions tended to have bacteria in contact with the pulpal tissue (P = 0.007, OR = 6.84, 95% CI [2.00, 62.83]), presence of an inflammatory infiltrate (Fisher's exact; P < 0.001) and partial pulp necrosis. Hyperplastic pulps were seen only in extremely deep lesions. CONCLUSIONS Unlike deep lesions, extremely deep carious lesions were often associated with severe pulp inflammation and infection. A radiographic threshold between deep and extremely deep lesions is suggested as indicator of the bacterial penetration level and the severity of the pulpal response prior to intervention.
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Affiliation(s)
- S Demant
- Section of Clinical Oral Microbiology, Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Section of Oral Biology and Immunopathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Dabelsteen
- Section of Oral Biology and Immunopathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L Bjørndal
- Section of Clinical Oral Microbiology, Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Mocquot C, Attik N, Pradelle-Plasse N, Grosgogeat B, Colon P. Bioactivity assessment of bioactive glasses for dental applications: A critical review. Dent Mater 2020; 36:1116-1143. [PMID: 32605848 DOI: 10.1016/j.dental.2020.03.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In the context of minimally invasive dentistry and tissue conservation, bioactive products are valuable. The aim of this review was to identify, clarify, and classify the methodologies used to quantify the bioactive glasses bioactivity. METHODS Specific search strategies were performed in electronic databases: PubMed, Embase, Cochrane Library, and Scopus. Papers were selected after a review of their title, abstract, and full text. The following data were then examined for final selection: BAG investigated, objectives, criteria, methods, and outcomes. RESULTS Sixty-one studies published from 2001 to 2019, were included. The bioactivity of BAG can be evaluated in vitro in contact with solutions, enamel, dentin, or cells. Other studies have conducted in vivo evaluation by BAG contact with dentin and dental pulp. Studies have used various analysis techniques: evaluation of apatite with or without characterization or assessment of mechanical properties. Reprecipitation mechanisms and pulp cell stimulation are treated together through the term 'bioactivity'. SIGNIFICANCE Based on these results, we suggested a classification of methodologies for a better understanding of the bioactive properties of BAG. According to all in vitro studies, BAG appear to be bioactive materials. No consensus has been reached on the results of in vivo studies, and no comparison has been conducted between protocols to assess the bioactivity of other bioactive competitor products.
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Affiliation(s)
- Caroline Mocquot
- Université de Lyon - Université Claude Bernard Lyon 1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, 69372 Lyon Cedex 08, France; Assistance Publique-Hôpitaux de Paris, Hôpital Rothschild, Service d'Odontologie, Université de Paris, Faculté dentaire, France.
| | - Nina Attik
- Université de Lyon - Université Claude Bernard Lyon 1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, 69372 Lyon Cedex 08, France; Université de Lyon, Université Claude Bernard Lyon 1, Faculté d'Odontologie, 69008 Lyon, France.
| | - Nelly Pradelle-Plasse
- Université de Lyon - Université Claude Bernard Lyon 1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, 69372 Lyon Cedex 08, France; Assistance Publique-Hôpitaux de Paris, Hôpital Rothschild, Service d'Odontologie, Université de Paris, Faculté dentaire, France
| | - Brigitte Grosgogeat
- Université de Lyon - Université Claude Bernard Lyon 1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, 69372 Lyon Cedex 08, France; Université de Lyon, Université Claude Bernard Lyon 1, Faculté d'Odontologie, 69008 Lyon, France; Hospices civils de Lyon, Service d'Odontologie, 69007 Lyon, France
| | - Pierre Colon
- Université de Lyon - Université Claude Bernard Lyon 1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, 69372 Lyon Cedex 08, France; Assistance Publique-Hôpitaux de Paris, Hôpital Rothschild, Service d'Odontologie, Université de Paris, Faculté dentaire, France
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17
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Mese M, Tok YT, Kaya S, Akcay M. Influence of ozone application in the stepwise excavation of primary molars: a randomized clinical trial. Clin Oral Investig 2020; 24:3529-3538. [PMID: 32025883 DOI: 10.1007/s00784-020-03223-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 01/23/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this randomized, controlled, three-arm parallel-group, double-blinded clinical trial was to investigate the clinical and microbiological effects of the ozone application in stepwise excavation of primary molars. MATERIALS AND METHODS This study was conducted in in vivo conditions with 105 lower primary molars that had deep caries lesions. The teeth were randomly divided into three groups: (I) control group, conventional stepwise excavation with no disinfectants; (II) CHX (positive control) group, 2% chlorhexidine digluconate; and (III) experimental group, ozone application. Dentine samples were collected at 4 different time points (T0, at the first appointment, after partial removal of carious dentin; T1, at the first appointment, after applying disinfection procedure; T2, at the second appointment - at the end of the 4-month period - immediately after the removal of the temporary restoration; T3, at the second appointment, after the final excavation) for the microbiological analysis of mutans streptococci and lactobacilli and the total number of colony-forming units. Clinical changes including dentin color, humidity, and consistency were recorded. Data were analyzed using the Mann-Whitney U test, Friedman test, and chi-squared test (p = 0.05). RESULTS The dentin became harder and drier after 4 months in all the groups. There was a gradual reduction in the total number of microorganisms in all the three groups. Bacterial reduction was greater in the CHX group compared to the ozone group (p = 0.002) and was greater in the ozone group compared to the control group (p = 0.015) after 4 months (control, 78%; CHX, 93%; ozone, 82%). CONCLUSION Stepwise excavation of primary teeth provided successful outcomes in all the groups. Moreover, CHX, due to its practicality and cost-effectiveness, can be effectively used with one- or two-step indirect pulp therapies. CLINICAL RELEVANCE Usage of cavity disinfectants in the stepwise excavation procedure contributes to the reduction of bacterial population in the cavity, which may allow the avoidance of the second step of the indirect pulp therapy for primary teeth.
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Affiliation(s)
- Merve Mese
- Department of Pedodontics, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - Yesim Tuyji Tok
- Department of Medical Microbiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Selcuk Kaya
- Department of Medical Microbiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Merve Akcay
- Department of Pedodontics, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey.
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18
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Manhas S, Pandit IK, Gugnani N, Gupta M. Comparative Evaluation of the Efficacy of Stepwise Caries Excavation vs Indirect Pulp Capping in Preserving the Vitality of Deep Carious Lesions in Permanent Teeth of Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2020; 13:S92-S97. [PMID: 34434021 PMCID: PMC8359879 DOI: 10.5005/jp-journals-10005-1874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aims and objectives To comparatively evaluate the clinical efficacy of stepwise caries excavation with indirect pulp capping (IPC) in managing the young permanent teeth in pediatric patients who have deep carious lesions. Materials and methods Eighty-eight teeth (first/second permanent molars) were included and randomly divided into two groups: group I (stepwise caries excavation) and group II (IPC). For group I, i.e., stepwise caries excavation, in the initial visit, bulk caries removal was done from walls of the cavity, however, soft and infected dentin was left untouched on the pulpal floor. The final excavation was performed after 2 months. The dentin parameters like the color, the consistency, and the humidity of dentin were noted at the first and second visits. A final follow-up to assess the primary outcome, i.e., sustained pulp vitality, was done after 1 year. Results When both the groups were compared with each other using the Chi-squared test, a highly significant difference was found (p < 0.05) between them. The success rate of stepwise caries excavation (97.3%) was found to be significantly greater than IPC (82.4%). After doing statistical analysis, a significant difference between stepwise excavation at baseline and at re-entry for parameters like the color, the consistency, and the humidity (p < 0.05), where dentin was observed to be darker in color, harder in consistency, and drier to touch at re-entry was found. Conclusion Stepwise caries excavation was considered a safer technique than IPC for preserving the vitality of young permanent teeth. Also, the clinical changes recorded during the re-entry in the case of stepwise caries excavation technique indicated the arrest of the carious process. Clinical significance Pulp preservation is of utmost importance especially in the case of young permanent teeth which have open apex to aid in apexogenesis. Failure to do so in maintaining the vitality of pulp before root completion may lead to the unfavorable crown to root ratio resulting in thin dentinal walls which are prone to fracture. How to cite this article Manhas S, Pandit IK, Gugnani N, et al. Comparative Evaluation of the Efficacy of Stepwise Caries Excavation vs Indirect Pulp Capping in Preserving the Vitality of Deep Carious Lesions in Permanent Teeth of Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(S-1):S92–S97.
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Affiliation(s)
- Swati Manhas
- Trauma Center, IMS, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Inder Kumar Pandit
- Department of Pediatric Dentistry, DAV Dental College, Yamunanagar, Haryana, India
| | - Neeraj Gugnani
- Department of Pedodontics and Preventive Dentistry, DAV Dental College, Yamunanagar, Haryana, India
| | - Monika Gupta
- Department of Pedodontics and Preventive Dentistry, DAV Dental College, Yamunanagar, Haryana, India
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19
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Bletsa A, Iden O, Sulo G, Berggreen E. Work experience influences treatment approaches in endodontics: a questionnaire survey among dentists in Western Norway. Acta Odontol Scand 2019; 77:617-623. [PMID: 31271077 DOI: 10.1080/00016357.2019.1631470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To collect information on endodontic treatment procedures among dentists in the public dental service (PDS) in Western Norway and relate this information to their work experience. Materials and methods: A survey comprised of 35 questions related to personal information, frequency of endodontic treatment, endodontic procedures and treatment principles was distributed electronically to 187 dentists in PDS in two counties of Western Norway. Results: The response rate was 74%, and 130 dentists participated. Among them, 57.0% had completed their education less than 13 years ago, and almost all were below 39 years old (95%). The majority (81.0%) had graduated in Norway. Stepwise caries excavation in primary and permanent teeth and direct pulp capping in primary teeth were more frequently performed by dentists with less than 13 years from graduation. Routine use of rubber dam was high among the responders (87%). However, use of rubber dam and master-cone radiograph uptakes were more frequent among the younger dentists. The majority used rotary instrumentation systems, and almost all participants followed the current guidelines for use of antibiotics in endodontics. Conclusions: In general, dentists in PDS follow the current endodontic treatment guidelines. However, it seems that the more recently graduated dentists perform more endodontic procedures and tend to adhere more to the taught principles regarding rubber dam use and radiograph uptakes.
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Affiliation(s)
- Athanasia Bletsa
- Oral Health Center of Expertise in Western Norway-Hordaland, Bergen, Norway
| | - Ole Iden
- Oral Health Center of Expertise in Western Norway-Hordaland, Bergen, Norway
| | - Gerhard Sulo
- Oral Health Center of Expertise in Western Norway-Hordaland, Bergen, Norway
- Center for Disease Burden, The Norwegian Institute of Public Health, Bergen, Norway
| | - Ellen Berggreen
- Oral Health Center of Expertise in Western Norway-Hordaland, Bergen, Norway
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20
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Abstract
Abstract
The dentine-pulp complex response in deep caries is histological characterized by tertiary formation and mild chronic pulp inflammation. The quiescent primary odontoblasts are reactivated, laying down reactionary tertiary dentine. In more severe carious damage the primary odontoblasts die and reparative tertiary dentine is secreted by odontoblast-like cells, which are differentiated in adult teeth mainly from dental pulp stem cells DPSC. Though associated with reversible pulpitis DPSC still preserve in deep caries the capability of migration, proliferation and differentiation. Some common mechanisms of molecular signals involved in tertiary dentine formation might also explain the balance between inflammation and regeneration of dentine-pulp complex.
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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: 169] [Impact Index Per Article: 33.8] [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.
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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
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22
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Effectiveness of the ozone application in two-visit indirect pulp therapy of permanent molars with deep carious lesion: a randomized clinical trial. Clin Oral Investig 2019; 23:3789-3799. [PMID: 30759283 DOI: 10.1007/s00784-019-02808-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this randomized, three-arm parallel, single-blinded clinical trial was to evaluate the clinical and microbiological effectiveness of the ozone application in two-visit indirect pulp therapy. MATERIALS AND METHODS One hundred five lower first molar teeth with deep caries lesion were included and randomly assigned three groups to apply the two-visit indirect pulp therapy. Treatment procedure was applied without any disinfectant (control), with 60-s 2% chlorhexidine digluconate (CHX) or 60-s ozone application. In four different stages (after initial excavation, ozone/CHX application before the temporary restoration, 4 months later immediately after removing temporary restoration, and final excavation), dentin humidity, consistency, and color properties were recorded to evaluate the clinical characteristics of the tissue, and standard dentin samples were collected for the microbiological analysis of mutans streptococci, lactobacilli, and the total number of colony-forming units. The data were analyzed by using Mann-Whitney U test for multiple comparisons. RESULTS The remaining dentin became harder, drier, and darker after 4 months in all groups. However, CHX and ozone application were statistically better than the control group (p < 0.05). There was a gradual decrease in the total number of microorganisms in all groups. While cavity disinfectant applications were improved the antibacterial efficacy (control, 79.11%; CHX, 98.39%; ozone, 93.33%), CHX application exhibited a greater significant reduction than both groups (p = 0.000). CONCLUSION The two-visit indirect pulp therapy yielded successful results for all study groups. However, CHX would be conveniently preferable due to improving the treatment success. CLINICAL RELEVANCE The two-visit indirect pulp therapy applied with cavity disinfectant is a proper alternative treatment procedure in deep carious lesions, instead of conventional technique.
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23
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Rosa WLO, Lima VP, Moraes RR, Piva E, Silva AF. Is a calcium hydroxide liner necessary in the treatment of deep caries lesions? A systematic review and meta‐analysis. Int Endod J 2018; 52:588-603. [DOI: 10.1111/iej.13034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
- W. L. O. Rosa
- Graduate Program in Dentistry Department of Restorative Dentistry Federal University of Pelotas Pelotas RS Brazil
| | - V. P. Lima
- Graduate Program in Dentistry Department of Restorative Dentistry Federal University of Pelotas Pelotas RS Brazil
| | - R. R. Moraes
- Graduate Program in Dentistry Department of Restorative Dentistry Federal University of Pelotas Pelotas RS Brazil
| | - E. Piva
- Graduate Program in Dentistry Department of Restorative Dentistry Federal University of Pelotas Pelotas RS Brazil
| | - A. F. Silva
- Graduate Program in Dentistry Department of Restorative Dentistry Federal University of Pelotas Pelotas RS Brazil
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24
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Li T, Zhai X, Song F, Zhu H. Selective versus non-selective removal for dental caries: a systematic review and meta-analysis. Acta Odontol Scand 2018; 76:135-140. [PMID: 29073814 DOI: 10.1080/00016357.2017.1392602] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Selective and non-selective methods for caries removal were controversial so far, thus we aimed to compare the efficacy of selective and non-selective caries removal by conducting meta-analysis of randomized controlled trials (RCTs). MATERIALS AND METHODS Eligible RCTs studies comparing selective caries removal with non-selective caries removal were retrieved by searching PubMed, EMBASE and Cochrane Library till 15 July 2017. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for outcome indictors, including pulpal exposure, pulpal symptoms and failure using Inverse variance-random effects or Mantel-Haenszel-fixed effects models. RESULTS Totally, seven studies were eligible for the meta-analysis. Compared with the non-selective caries removal group, the risk of pulpal exposure was significantly reduced in the selective caries removal group (OR = 0.11, 95% CI: 0.04-0.30). No significant difference was observed in pulpal symptoms (OR = 0.79, 95% CI: 0.30-2.12) and failure (OR = 1.40, 95% CI: 0.69-2.84) between the groups. CONCLUSIONS The efficacy of selective caries removal appears comparable to that of non-selective caries removal in children, with similar pulpal symptoms and failure, but selective caries removal may result in a low incidence of pulpal exposure. However, larger-scale RCTs with long-term follow-up are required to confirm this conclusion.
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Affiliation(s)
- Ti Li
- Department of Dentistry, People’s Hospital of Weifang, Weifang, Shandong Province, P.R. China
| | - Xiangkai Zhai
- Department of Dentistry, People’s Hospital of Weifang, Weifang, Shandong Province, P.R. China
| | - Feifei Song
- Department of Dentistry, People’s Hospital of Weifang, Weifang, Shandong Province, P.R. China
| | - Hongguang Zhu
- Department of Dentistry, People’s Hospital of Weifang, Weifang, Shandong Province, P.R. China
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Parirokh M, Torabinejad M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy. Int Endod J 2017; 51:177-205. [PMID: 28836288 DOI: 10.1111/iej.12841] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/21/2017] [Indexed: 01/09/2023]
Abstract
Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick-Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term 'bioactive endodontic cements (BECs)', which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.
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Affiliation(s)
- M Parirokh
- Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - M Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Wolters WJ, Duncan HF, Tomson PL, Karim IE, McKenna G, Dorri M, Stangvaltaite L, van der Sluis LWM. Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs. Int Endod J 2017; 50:825-829. [DOI: 10.1111/iej.12793] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- W. J. Wolters
- Center of Dentistry and Oral Hygiene; University Medical Center Groningen; Groningen The Netherlands
| | - H. F. Duncan
- Division of Restorative Dentistry & Periodontology; Dublin Dental University Hospital; Trinity College Dublin; Dublin Ireland
| | - P. L. Tomson
- College of Medical & Dental Sciences; The University of Birmingham School of Dentistry; Birmingham UK
| | - I. E. Karim
- Centre for Dentistry; School of Medicine; Dentistry and Biomedical Sciences; Queen's University Belfast; Belfast UK
| | - G. McKenna
- Centre for Public Health; Queens University Belfast; Belfast UK
| | - M. Dorri
- School of Oral and Dental Sciences; Bristol Dental School; Bristol UK
| | - L. Stangvaltaite
- Department of Clinical Dentistry; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
| | - L. W. M. van der Sluis
- Center of Dentistry and Oral Hygiene; University Medical Center Groningen; Groningen The Netherlands
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Bjørndal L, Fransson H, Bruun G, Markvart M, Kjældgaard M, Näsman P, Hedenbjörk-Lager A, Dige I, Thordrup M. Randomized Clinical Trials on Deep Carious Lesions: 5-Year Follow-up. J Dent Res 2017; 96:747-753. [PMID: 28410008 DOI: 10.1177/0022034517702620] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Deep caries presents a dilemma in terms of which treatment that will render an optimal prognosis by maintaining pulp vitality with absence of apical pathology. Previously, 2 randomized clinical trials were performed testing the short-term effects of stepwise carious tissue removal versus nonselective carious removal to hard dentin with or without pulp exposure. The aim of this article was to report the 5-y outcome on these previously treated patients having radiographically well-defined carious lesions extending into the pulpal quarter of the dentin but with a well-defined radiodense zone between the carious lesion and the pulp. In this long-term study, 239 of 314 (76.2%) patients were analyzed. The stepwise removal group had a significantly higher proportion of success (60.2%) at 5-y follow-up compared with the nonselective carious removal to hard dentin group (46.3%) ( P = 0.031) when pulp exposures per se were included as failures. Pulp exposure rate was significantly lower in the stepwise carious removal group (21.2% vs. 35.5%; P = 0.014). Irrespective of pulp exposure status, the difference (13.3%) was still significant when sustained pulp vitality without apical radiolucency and unbearable pain was considered (95% confidence interval, 3.1-26.3, P = 0.045). After pulp exposure, only 9% ( n = 4) of the analyzed patients were assessed as successful, indicating that the prognosis is highly dubious following conventional pulp-capping procedures (direct pulp capping or partial pulpotomy) in deep carious lesions in adults. In conclusion, the stepwise carious removal group had a significantly higher proportion of pulps with sustained vitality without apical radiolucency versus nonselective carious removal of deep carious lesions in adult teeth at 5-y follow-up ( ClinicalTrials.gov NCT00187837 and NCT00187850).
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Affiliation(s)
- L Bjørndal
- 1 Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - H Fransson
- 2 Faculty of Odontology, Malmö University, Malmö, Sweden
| | - G Bruun
- 1 Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - M Markvart
- 1 Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - M Kjældgaard
- 3 Department of Oral Medicine, Karolinska Institute, Stockholm, Sweden
| | - P Näsman
- 3 Department of Oral Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - I Dige
- 4 Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - M Thordrup
- 4 Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Molecular detection of bacteria associated to caries activity in dentinal lesions. Clin Oral Investig 2016; 21:2053-2061. [DOI: 10.1007/s00784-016-1995-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
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Alzraikat H, Taha NA, Qasrawi D, Burrow MF. Shear bond strength of a novel light cured calcium silicate based-cement to resin composite using different adhesive systems. Dent Mater J 2016; 35:881-887. [PMID: 27680033 DOI: 10.4012/dmj.2016-075] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The shear bond strength (SBS) of TheraCal LC to resin composite was evaluated in comparison to Mineral trioxide aggregate (ProRoot MTA) and conventional glass ionomer cement (GIC) using two adhesive systems. A hole was prepared in 90 acrylic blocks (6 mm diameter, 2 mm deep) then filled with TheraCal LC, MTA or Fuji IX (n=30/group). Each group was bonded with either an etch and rinse or 1-step self-etch adhesive. Filtek Z250 composite was bonded to each capping material. Bond strength was tested in a universal testing machine, and data were analyzed using 2-way ANOVA and Duncan's Multiple range test (p<0.05). TheraCal LC displayed the highest SBS (p<0.001). MTA bonded with the 1-step self-etch adhesive showed the lowest SBS (p<0.001), while SBS of TheraCal LC and Fuji IX did not differ between either adhesive (p>0.05). TheraCal LC is the preferred choice in pulp capping procedures when using resin composite restorations.
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Affiliation(s)
- Hanan Alzraikat
- Department of Conservative Dentistry, Jordan University of Science and Technology
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Assessment and Quantification of Noncollagenic Matrix Proteins Released from Human Dentin Powder Incorporated into a Silated Hydroxypropylmethylcellulose Biomedical Hydrogel. J Endod 2016; 42:1371-6. [DOI: 10.1016/j.joen.2016.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/11/2016] [Accepted: 05/23/2016] [Indexed: 11/23/2022]
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Schwendicke F, Frencken J, Bjørndal L, Maltz M, Manton D, Ricketts D, Van Landuyt K, Banerjee A, Campus G, Doméjean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona A, Innes N. Managing Carious Lesions. Adv Dent Res 2016; 28:58-67. [DOI: 10.1177/0022034516639271] [Citation(s) in RCA: 372] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The International Caries Consensus Collaboration undertook a consensus process and here presents clinical recommendations for carious tissue removal and managing cavitated carious lesions, including restoration, based on texture of demineralized dentine. Dentists should manage the disease dental caries and control activity of existing cavitated lesions to preserve hard tissues and retain teeth long-term. Entering the restorative cycle should be avoided as far as possible. Controlling the disease in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal or control first. Only when cavitated carious lesions either are noncleansable or can no longer be sealed are restorative interventions indicated. When a restoration is indicated, the priorities are as follows: preserving healthy and remineralizable tissue, achieving a restorative seal, maintaining pulpal health, and maximizing restoration success. Carious tissue is removed purely to create conditions for long-lasting restorations. Bacterially contaminated or demineralized tissues close to the pulp do not need to be removed. In deeper lesions in teeth with sensible (vital) pulps, preserving pulpal health should be prioritized, while in shallow or moderately deep lesions, restoration longevity becomes more important. For teeth with shallow or moderately deep cavitated lesions, carious tissue removal is performed according to selective removal to firm dentine. In deep cavitated lesions in primary or permanent teeth, selective removal to soft dentine should be performed, although in permanent teeth, stepwise removal is an option. The evidence and, therefore, these recommendations support less invasive carious lesion management, delaying entry to, and slowing down, the restorative cycle by preserving tooth tissue and retaining teeth long-term.
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Affiliation(s)
- F. Schwendicke
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - J.E. Frencken
- Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L. Bjørndal
- Department of Cariology and Endodontics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M. Maltz
- Department of Preventive and Social Dentistry, Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - D.J. Manton
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - D. Ricketts
- Section of Operative Dentistry, Fixed Prosthodontics and Endodontology, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
| | - K. Van Landuyt
- KULeuven BIOMAT, Department of Oral Health Sciences, University of Leuven and Dentistry University Hospitals Leuven, Leuven, Belgium
| | - A. Banerjee
- Conservative and MI Dentistry, King’s College London Dental Institute, London, UK
| | - G. Campus
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Italy; WHO Collaborating Centre for Epidemiology and Community Dentistry, University of Milan, Milan, Italy
| | - S. Doméjean
- CHU Clermont-Ferrand, Service d’Odontologie, Hôtel-Dieu, Clermont-Ferrand, France; Univ Clermont1, UFR d’Odontologie, Clermont-Ferrand, France; Centre de Recherche en Odontologie Clinique EA 4847, F-63000 Clermont-Ferrand, France
| | - M. Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - S. Leal
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
| | - E. Lo
- Faculty of Dentistry, University of Hong Kong, Hong Kong, China
| | - V. Machiulskiene
- Department of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - A. Schulte
- Department of Special Care Dentistry, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - C. Splieth
- Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - A.F. Zandona
- Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA
| | - N.P.T. Innes
- Paediatric Dentistry, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
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Hernandéz-Gatón P, Serrano CR, Nelson Filho P, De Castañeda ER, Lucisano MP, Silva RAD, Silva LAD. Stepwise Excavation Allows Apexogenesis in Permanent Molars with Deep Carious Lesions and Incomplete Root Formation. Caries Res 2015; 49:637-9. [DOI: 10.1159/000442392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 11/10/2015] [Indexed: 11/19/2022] Open
Abstract
This study evaluated the stepwise excavation technique in 138 permanent molars with deep carious lesions and incomplete root formation within a 24-month clinical and radiographic follow-up period. In 96.7% of the cases, success was observed (no pain, integrity of restoration margins, absence of radiographic alterations and apexogenesis). The cases of failure (3.3%) were due to the loss of the temporary restoration. In conclusion, the stepwise excavation is a promising technique for permanent teeth with deep carious lesions and incomplete root formation as a minimally invasive approach because it allows the preservation of pulp vitality and occurrence of apexogenesis.
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Louwakul P, Lertchirakarn V. Response of Inflamed Pulps of Rat Molars after Capping with Pulp-capping Material Containing Fluocinolone Acetonide. J Endod 2015; 41:508-12. [DOI: 10.1016/j.joen.2014.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 11/01/2014] [Accepted: 12/10/2014] [Indexed: 12/19/2022]
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Schwendicke F, Paris S, Stolpe M. Cost-effectiveness of caries excavations in different risk groups - a micro-simulation study. BMC Oral Health 2014; 14:153. [PMID: 25511906 PMCID: PMC4279684 DOI: 10.1186/1472-6831-14-153] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst being the most prevalent disease worldwide, dental caries is increasingly concentrated in high-risk populations. New caries treatments should therefore be evaluated not only in terms of their cost-effectiveness in individuals, but also their effects on the distribution of costs and benefits across different populations. To treat deep caries, there are currently three strategies: selective (one-step incomplete), stepwise (two-step incomplete) and complete excavation. Building on prior research that found selective excavation generally cost-effective, we compared the costs-effectiveness of different excavations in low- and high-risk patients, hypothesizing that selective excavation had greater cost-effectiveness-advantages in patients with high compared with low risk. METHODS An average tooth-level Markov-model was constructed following the posterior teeth in an initially 18-year old male individual, either with low or high risk, over his lifetime. Risk was assumed to be predicted by several parameters (oral hygiene, social position, dental service utilization), with evidence-based transition probabilities or hazard functions being adjusted for different risk status where applicable. Total lifetime treatment costs were estimated for German healthcare, with both mixed public-private and only private out-of-pocket costs being calculated. For cost-effectiveness-analysis, micro-simulations were performed and joint parameter uncertainty introduced by random sampling of probabilities. Cohort analyses were used for assessing the underlying reasons for potential differences between strategies and populations. RESULTS Selective excavation was more effective and less costly than both alternatives regardless of an individual's risk. All three strategies were less effective and more costly in patients with high compared with low risk, whilst the differences between risk groups were smallest for selective excavation. Thus, the cost-effectiveness-advantages of selective excavation were more pronounced in high-risk groups, who also benefitted the most from reduced private out-of-pocket treatment costs. CONCLUSIONS Whilst caries excavation does not tackle the underlying sources for both the development of caries lesions and the potential differences of individuals' risk status, selective excavation seems most suitable to treat deep lesions, especially in patients with high risk, who over-proportionally benefit from the resulting health-gains and cost-savings.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str, 4-6, 14197 Berlin, Germany.
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Schwendicke F, Stolpe M. Direct Pulp Capping after a Carious Exposure Versus Root Canal Treatment: A Cost-effectiveness Analysis. J Endod 2014; 40:1764-70. [DOI: 10.1016/j.joen.2014.07.028] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 07/16/2014] [Accepted: 07/20/2014] [Indexed: 11/25/2022]
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