1
|
Shi X, Hu X, Jiang N, Mao J. Regenerative endodontic therapy: From laboratory bench to clinical practice. J Adv Res 2024:S2090-1232(24)00267-4. [PMID: 38969092 DOI: 10.1016/j.jare.2024.07.001] [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: 04/16/2024] [Revised: 06/16/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Maintaining the vitality and functionality of dental pulp is paramount for tooth integrity, longevity, and homeostasis. Aiming to treat irreversible pulpitis and necrosis, there has been a paradigm shift from conventional root canal treatment towards regenerative endodontic therapy. AIM OF REVIEW This extensive and multipart review presents crucial laboratory and practical issues related to pulp-dentin complex regeneration aimed towards advancing clinical translation of regenerative endodontic therapy and enhancing human life quality. KEY SCIENTIFIC CONCEPTS OF REVIEW In this multipart review paper, we first present a panorama of emerging potential tissue engineering strategies for pulp-dentin complex regeneration from cell transplantation and cell homing perspectives, emphasizing the critical regenerative components of stem cells, biomaterials, and conducive microenvironments. Then, this review provides details about current clinically practiced pulp regenerative/reparative approaches, including direct pulp capping and root revascularization, with a specific focus on the remaining hurdles and bright prospects in developing such therapies. Next, special attention was devoted to discussing the innovative biomimetic perspectives opened in establishing functional tissues by employing exosomes and cell aggregates, which will benefit the clinical translation of dental pulp engineering protocols. Finally, we summarize careful consideration that should be given to basic research and clinical applications of regenerative endodontics. In particular, this review article highlights significant challenges associated with residual infection and inflammation and identifies future insightful directions in creating antibacterial and immunomodulatory microenvironments so that clinicians and researchers can comprehensively understand crucial clinical aspects of regenerative endodontic procedures.
Collapse
Affiliation(s)
- Xin Shi
- Center of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, China
| | - Xiaohan Hu
- Outpatient Department Office, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Nan Jiang
- Central Laboratory, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing 100081, China.
| | - Jing Mao
- Center of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, China.
| |
Collapse
|
2
|
Safy RK, Ragab MH, Abdel-Maksoud HB. Histopathological Evaluation of Human Placental Extract as a Direct Pulp-Capping Material in Dogs' Teeth. Eur J Dent 2024. [PMID: 38942055 DOI: 10.1055/s-0044-1786841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
OBJECTIVE The current research aimed to evaluate the histopathological pulpal alterations in dogs' teeth following direct pulp capping using either mineral trioxide aggregate (MTA) or human placenta extract (HPE). MATERIALS AND METHODS Forty-eight incisors with mature apices from four dogs were involved. The teeth were randomly allocated to three groups (n = 16) based on the material utilized for direct pulp capping: MTA, HPE, and Teflon as the negative control group. All involved teeth were capped and restored at the same session. Each group was subsequently divided into two subgroups (n = 8) based on the post treatment evaluation period: 2 and 4 weeks. The histopathologic changes in each specimen's pulp tissues, including pulp inflammation, hyperemia, necrosis, and dentin bridge development, were assessed. Then, all the data were statistically analyzed using chi-square, t-test, and one-way analysis of variance (p < 0.05). RESULTS At 2 weeks, chronic inflammation was observed in 100% of MTA and 50% of HPE subgroups with a significant difference between them whereas the remaining 50% exhibited no inflammation. In contrast to Teflon that showed acute inflammation, remission of inflammation was time-dependent at both MTA and HPE subgroups as there was a substantial difference between the 2- and 4-weeks evaluation periods within the same group. However, throughout the initially observed 2 weeks, all subgroups exhibited essentially no complete calcified bridge; at 4 weeks, all MTA and HPE subgroups developed dentin bridge formation, with a significant difference between them regarding its thickness. CONCLUSION HPE is a promising pulp-capping material inducing less intense chronic inflammation accompanied with thicker dentine bridge formation in comparison to MTA.
Collapse
Affiliation(s)
- Rehab Khalil Safy
- Department of Conservative Dentistry, Faculty of Dentistry, Suez Canal University, Ismailia Governorate, Egypt
| | - Mai Hamdy Ragab
- Department of Endodontics, Faculty of Dentistry, Suez Canal University, Ismailia Governorate, Egypt
- King Salman International University, Eltor, South Sinai, Egypt
| | - Heba Bahgat Abdel-Maksoud
- Department of Conservative Dentistry, Faculty of Dentistry, Suez Canal University, Ismailia Governorate, Egypt
- Restorative Dentistry Department, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
3
|
Naiboğlu P, Koşar T, Yücel AÇ. Shear bond strength of calcium silicate-based cements to composite resin using a universal adhesive in different application modes: an in vitro study. Aust Dent J 2024; 69:102-111. [PMID: 37875350 DOI: 10.1111/adj.12990] [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] [Accepted: 10/04/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND To assess the shear bond strength (SBS) of four calcium silicate-based cements (CSCs) to composite resin using a universal adhesive in self-etch (SE) and etch-and-rinse (ER) modes and to evaluate surface microstructure and chemical composition of CSCs after acid-etching. METHODS In total, 30 specimens of each cement, Biodentine (BD), mineral trioxide aggregate (MTA) Angelus (MTA-A), ProRoot MTA (MTA-P) and MTA Repair HP (MTA-HP), were prepared and assigned into 2 groups (n = 15) according to universal adhesive (Clearfil Universal Bond Quick) applied in SE and ER mode. After composite resin (Clearfil Majesty Esthetic) was applied, the SBS was measured. Scanning electron microscope-energy dispersive spectroscopy (SEM-EDS) analysis was used to evaluate the changes in surface structure and elemental composition. RESULTS MTA-P demonstrated significantly higher SBS than all CSCs, except for MTA-HP in the SE mode. The ER mode exhibited significantly higher SBS compared to the SE mode for MTA-P and MTA-A. Acid-etching caused morphological differences and affected elemental distribution. CONCLUSIONS MTA-P may be a more suitable pulp capping material due to its superior SBS compared to BD and MTA-A. The application of a universal adhesive in ER mode may be suggested to increase the SBS of MTA-P and MTA-A to composite resin.
Collapse
Affiliation(s)
- P Naiboğlu
- Department of Restorative Dentistry, Faculty of Dentistry, Giresun University, Giresun, Turkey
| | - T Koşar
- Department of Endodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
| | - A Ç Yücel
- Department of Endodontics, Faculty of Dentistry, Giresun University, Giresun, Turkey
| |
Collapse
|
4
|
Islam R, Islam MRR, Tanaka T, Alam MK, Ahmed HMA, Sano H. Direct pulp capping procedures - Evidence and practice. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:48-61. [PMID: 36880059 PMCID: PMC9985044 DOI: 10.1016/j.jdsr.2023.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/11/2023] [Accepted: 02/15/2023] [Indexed: 02/27/2023] Open
Abstract
The aim of direct pulp capping (DPC) is to promote pulp healing and mineralized tissue barrier formation by placing a dental biomaterial directly over the exposed pulp. Successful application of this approach avoids the need for further and more extensive treatment. In order to ensure a complete pulp healing with the placement of restorative materials, a mineralized tissue barrier must form to protect the pulp from microbial invasion. The formation of mineralized tissue barrier can only be induced when there is a significant reduction in pulp inflammation and infection. Consequently, promoting the healing of pulp inflammation may provide a favorable therapeutic opportunity to maintain the sustainability of DPC treatment. Mineralized tissue formation was observed as the favorable reaction of exposed pulp tissue against a variety of dental biomaterials utilized for DPC. This observation reveals an intrinsic capacity of pulp tissue for healing. Therefore, this review focuses on the DPC and its healing procedure as well as the materials used for DPC treatment and their mechanisms of action to promote pulpal healing. In addition, the factors that can affect the healing process of DPC, clinical considerations and future perspective has been described.
Collapse
Affiliation(s)
- Rafiqul Islam
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo 060-8586, Japan
| | - Md Refat Readul Islam
- Department of Restorative Dentistry, Graduate School of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo 060-8586, Japan
| | - Toru Tanaka
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo 060-8586, Japan
| | - Mohammad Khursheed Alam
- Preventive Dentistry Department, College of Dentistry, Jouf University, 72345 Sakaka, Saudi Arabia
| | - Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Hidehiko Sano
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo 060-8586, Japan
| |
Collapse
|
5
|
Miotti LL, Vissotto C, De Nardin L, de Andrades Manjabosco B, Tuchtenhagen S, Münchow EA, Emmanuelli B. Does the liner material influence pulpal vitality in deep carious cavities submitted to selective caries removal? A network meta-analysis review. Clin Oral Investig 2023; 27:7143-7156. [PMID: 37932637 DOI: 10.1007/s00784-023-05372-w] [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: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To evaluate whether the restorative material in direct contact with the dentin influences pulp vitality in primary and permanent teeth with deep carious lesions restored after selective caries removal (SCR). MATERIAL AND METHODS Systematic searches of databases MEDLINE via PubMed, Scopus and ISI Web of Science were performed for primary and permanent teeth. Inclusion criteria were applied for title and abstract reading of databases search results. After full texts review of included studies, those that did not meet exclusion criteria were excluded from meta-analysis. RESULTS For meta-analysis, 2 studies were included for permanent teeth and 6 for primary teeth. The failure events reported were meta-analyzed using two statistical methods: standard pairwise meta-analysis (SPMA) and network meta-analysis (NMA). The SPMA identified similar failure occurrence of restorations performed with calcium hydroxide (CH) and other liner materials (RR 0.84, 95% CI 0.41, 1.74; p = 0.64), no significant difference between the use of alternative liners or CH regardless deciduous or permanent teeth (RR 0.79, 95% CI 0.36, 1.71; p = 0.55) and similar risk of failing at different follow-ups for all liner materials tested (RR 0.77, 95% CI 0.35, 1.70; p = 0.52). Probabilistic analysis indicated GIC as liner material with the highest probability of clinical success (SUCRA = 72.76%), and CH ranked as the worst liner material (SUCRA = 21.81%). CONCLUSION Pulpal vitality was not affected by material used as liner after selective caries removal in deep carious cavities. CLINICAL RELEVANCE Current clinical evidence supports the weak recommendation to not use calcium hydroxide as liner after SCR.
Collapse
Affiliation(s)
- Leonardo Lamberti Miotti
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil.
| | - Cariane Vissotto
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Letícia De Nardin
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Bianca de Andrades Manjabosco
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil
| | - Simone Tuchtenhagen
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Eliseu Aldrighi Münchow
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil
| | - Bruno Emmanuelli
- Stomatology Department, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande Do Sul (RS), Brazil
| |
Collapse
|
6
|
Yurdagüven GY, Işık V, Çiftçioğlu E, Ulukapı H, Kayahan MB. Evaluation of treatment and restoration preferences in deep carious teeth with various pulp exposure sizes: A questionnaire-based survey. AUST ENDOD J 2023; 49:574-583. [PMID: 37555383 DOI: 10.1111/aej.12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Abstract
This study evaluated the management preferences in a deep carious vital tooth. A questionnaire was e-mailed to members of the Turkish Dental Association. The questionnaire included a photograph and radiographs of an extremely deep carious molar (#16) of a 30-year-old man suffering from cold and chewing sensitivity. The dentists were asked to choose treatments for pulp exposure of <1, 1-2, and ≥2 mm and a permanent restoration. Chi-squared test was used to analyse data (p < 0.05). 504 (4.84%) of 10 411 dentists responded. When the pulp exposure was <1 mm: direct pulp capping (84.9%); 1-2 mm: root canal treatment (49.6%); ≥2 mm: root canal treatment (85.7%) were the most preferred treatments. 69.6% of the respondents chose direct composite restorations. If the tooth would be an abutment, most respondents preferred root canal treatment, regardless of the perforation size. The extent of pulp exposure and the type of permanent restoration influenced the treatment decision-making process.
Collapse
Affiliation(s)
- Gülşah Yenier Yurdagüven
- Department of Restorative Dentistry, Faculty of Dentistry, Istanbul Okan University, Istanbul, Turkey
| | - Vasfiye Işık
- Department of Endodontics, Faculty of Dentistry, Istanbul Health and Technology University, Istanbul, Turkey
| | - Elif Çiftçioğlu
- Department of Endodontics, Faculty of Dentistry, Istanbul Okan University, Istanbul, Turkey
| | - Haşmet Ulukapı
- Department of Restorative Dentistry, Faculty of Dentistry, Istanbul Okan University, Istanbul, Turkey
| | - Mehmet Baybora Kayahan
- Department of Endodontics, Faculty of Dentistry, Istanbul Health and Technology University, Istanbul, Turkey
| |
Collapse
|
7
|
dos Santos FFV, Habelitz S, Nascimento FD, Arana-Chavez VE, Braga RR. Poly(Aspartic Acid) Promotes Odontoblast-like Cell Differentiation in Rat Molars with Exposed Pulp. J Funct Biomater 2023; 14:537. [PMID: 37998106 PMCID: PMC10672631 DOI: 10.3390/jfb14110537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
In recent years, alternative pulpal therapies targeting dentinogenesis signaling pathways using different peptides have been investigated. The aim of this study was to verify the effectiveness of poly(aspartic acid), pAsp, in dentin regeneration using an animal model. METHODS Mechanical pulp exposure was performed in the upper molars of 56 Wistar rats, randomly divided as follows (n = 14): control (no treatment); MTA group-pulp capping with mineral trioxide aggregate (MTA Angelus); pAsp group-application of 20 μL of pAsp solution (25 mg·mL-1); MTA+pAsp group-application of MTA mixed with pAsp (5:1 by mass). Animals were euthanized after 7 or 21 days. Histological sections were submitted to hematoxylin-eosin and Brown and Brenn staining and immunohistochemical analysis for osteopontin (OPN) and dentin matrix protein 1 (DMP 1). RESULTS At 7 days, an acute inflammatory infiltrate and the presence of disorganized mineralized tissue were observed in all groups. At 21 days, the quality and thickness of the reparative dentin in treated groups were superior to the control, and bacterial contamination was observed in two MTA-pAsp specimens. While all treated groups showed intense immunostaining for OPN at 21 days, only the pAsp group expressed DMP 1, indicating the presence of fully differentiated odontoblast-like cells. CONCLUSION Poly(aspartic) acid promoted dentin regeneration in rat molars in the absence of an additional calcium source and may be an alternative to MTA as a pulp-capping agent.
Collapse
Affiliation(s)
- Fernanda Furuse Ventura dos Santos
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo 05508-000, SP, Brazil; (V.E.A.-C.); (R.R.B.)
| | - Stefan Habelitz
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, CA 94143, USA;
| | - Fábio Dupart Nascimento
- Molecular Biology Division, Department of Biochemistry, Federal University of São Paulo, São Paulo 04044-020, SP, Brazil;
| | - Victor Elias Arana-Chavez
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo 05508-000, SP, Brazil; (V.E.A.-C.); (R.R.B.)
| | - Roberto Ruggiero Braga
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo 05508-000, SP, Brazil; (V.E.A.-C.); (R.R.B.)
| |
Collapse
|
8
|
Negi NP, Prakash G, Narwal P, Panwar R, Kumar D, Chaudhry B, Rustagi A. The calcium connection: exploring the intricacies of calcium signaling in plant-microbe interactions. FRONTIERS IN PLANT SCIENCE 2023; 14:1248648. [PMID: 37849843 PMCID: PMC10578444 DOI: 10.3389/fpls.2023.1248648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/24/2023] [Indexed: 10/19/2023]
Abstract
The process of plant immune response is orchestrated by intracellular signaling molecules. Since plants are devoid of a humoral system, they develop extensive mechanism of pathogen recognition, signal perception, and intricate cell signaling for their protection from biotic and abiotic stresses. The pathogenic attack induces calcium ion accumulation in the plant cells, resulting in calcium signatures that regulate the synthesis of proteins of defense system. These calcium signatures induct different calcium dependent proteins such as calmodulins (CaMs), calcineurin B-like proteins (CBLs), calcium-dependent protein kinases (CDPKs) and other signaling molecules to orchestrate the complex defense signaling. Using advanced biotechnological tools, the role of Ca2+ signaling during plant-microbe interactions and the role of CaM/CMLs and CDPKs in plant defense mechanism has been revealed to some extent. The Emerging perspectives on calcium signaling in plant-microbe interactions suggest that this complex interplay could be harnessed to improve plant resistance against pathogenic microbes. We present here an overview of current understanding in calcium signatures during plant-microbe interaction so as to imbibe a future direction of research.
Collapse
Affiliation(s)
- Neelam Prabha Negi
- University Institute of Biotechnology, Chandigarh University, Mohali, India
| | - Geeta Prakash
- Department of Botany, Gargi College, New Delhi, India
| | - Parul Narwal
- University Institute of Biotechnology, Chandigarh University, Mohali, India
| | - Ruby Panwar
- Department of Botany, Gargi College, New Delhi, India
| | - Deepak Kumar
- Department of Botany, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | | | | |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Tabassum N, Khalid S, Ghafoor S, Woo KM, Lee EH, Samie M, Konain K, Ponnusamy S, Arany P, Rahman SU. Tideglusib-incorporated nanofibrous scaffolds potently induce odontogenic differentiation. J Biomater Appl 2023:8853282231190470. [PMID: 37485690 DOI: 10.1177/08853282231190470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Pulp-Dentin regeneration is a key aspect of maintain tooth vitality and enabling good oral-systemic health. This study aimed to investigate a nanofibrous scaffold loaded with a small molecule i.e. Tideglusib to promote odontogenic differentiation. Tideglusib (GSK-3β inhibitor) interaction with GSK-3β was determined using molecular docking and stabilization of β-catenin was examined by confocal microscopy. 3D nanofibrous scaffolds were fabricated through electrospinning and their physicochemical characterizations were performed. Scaffolds were seeded with mesenchymal stem cells or pre-odontoblast cells to determine the cells proliferation and odontogenic differentiation. Our results showed that Tideglusib (TG) binds with GSK-3β at Cys199 residue. Stabilization and nuclear translocation of β-catenin was increased in the odontoblast cells treated with TG. SEM analysis revealed that nanofibers exhibited controlled architectural features that effectively mimicked the natural ECM. UV-Vis spectroscopy demonstrated that TG was incorporated successfully and released in a controlled manner. Both kinds of biomimetic nanofibrous matrices (PCLF-TG100, PCLF-TG1000) significantly stimulated cells proliferation. Furthermore, these scaffolds significantly induced dentinogenic markers (ALP, and DSPP) expression and biomineralization. In contrast to current pulp capping material driving dentin repair, the sophisticated, polymeric scaffold systems with soluble and insoluble spatiotemporal cues described here can direct stem cell differentiation and dentin regeneration. Hence, bioactive small molecule-incorporated nanofibrous scaffold suggests an innovative clinical tool for dentin tissue engineering.
Collapse
Affiliation(s)
- Nadia Tabassum
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
- PGMI, De Montmorency College of Dentistry, Lahore, Pakistan
| | - Saira Khalid
- PGMI, De Montmorency College of Dentistry, Lahore, Pakistan
| | - Sarah Ghafoor
- Oral Biology, University of Health Sciences, Lahore, Pakistan
| | - Kyung Mi Woo
- Department of Molecular Genetics, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Eun Hye Lee
- Department of Molecular Genetics, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Muhammad Samie
- Institute of Pharmaceutical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Kiran Konain
- Molecular Biology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Sasikumar Ponnusamy
- Oral Biology, Surgery and Biomedial Engineering, University at Buffalo, NY, USA
| | - Praveen Arany
- Oral Biology, Surgery and Biomedial Engineering, University at Buffalo, NY, USA
| | - Saeed Ur Rahman
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
- Oral Biology, Surgery and Biomedial Engineering, University at Buffalo, NY, USA
- Oral Biology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| |
Collapse
|
11
|
Chhabra N, Parolia A. Effect of Various Acid Solutions as an Aid in Removing the OrthoMTA-Based Root Canal Filling. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4535. [PMID: 37444849 DOI: 10.3390/ma16134535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
The objectives of this study were to compare the effects of various acid solutions combined with ultrasonics as an aid to remove mineral trioxide aggregate (MTA)-based root canal filling and to assess their effect on the surface topography and microhardness of root canal dentin. MATERIALS AND METHOD Fifty human permanent single rooted and single canaled freshly extracted teeth were decoronated and sectioned apically to prepare the middle third of root sections of 5 mm length. The canals were prepared in a step-back manner. OrthoMTA was packed throughout the prepared canals. These root sections were incubated for one week and subsequently randomly allocated to five groups (n = 10) according to the OrthoMTA removal method: No treatment (NT); 5% glycolic acid + ultrasonics (5% GA+U); 10% glycolic acid + ultrasonics (10% GA+U); 10% citric acid + ultrasonics (10% CA+U); Distilled water + ultrasonics (DW+U). A 1 mm deep well was created within the coronal end of the set OrthoMTA. Wells were filled with each respective test solution and left for 5 min. Thereafter, further removal of OrthoMTA used a specific ultrasonic tip. Finally, the canals were flushed using 1 mL of the respective test solutions and activated with a Controlled Memory ultrasonic tip for two cycles of 20 s each followed by flushing with 1 mL of distilled water and paper point drying of the canals. Then, specimens were longitudinally split into two halves and examined under a scanning electron microscope (1000×) to assess the residual OrthoMTA and surface topography of root canal dentin. The Vickers surface microhardness of treated radicular dentin was measured using the HMV-2 microhardness tester. RESULT Data were analysed using one-way ANOVA followed by Tukey's post hoc test. Significant differences for residual OrthoMTA were observed between (10% GA+U) with (5% GA+U), (10% CA+U), (DW+U) and (NT) (p value < 0.01). In the context of microhardness, (5% GA+U) and (10% GA+U) showed statistically significant difference compared to (NT), (10% CA+U) and (DW+U) (p value < 0.01). CONCLUSION 10% GA+U was superior to other tested groups in removing OrthoMTA, but it substantially reduced dentin microhardness.
Collapse
Affiliation(s)
- Naveen Chhabra
- Restorative Dentistry Division, School of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Abhishek Parolia
- Restorative Dentistry Division, School of Dentistry, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| |
Collapse
|
12
|
Silva PAO, Martins DCM, de Castro Cantuária AP, de Andrade RV, Lacorte C, de Almeida JA, Aguiar LR, Corrêa JR, da Silva IGM, Franco OL, Rezende TMB. Host defense peptides combined with MTA extract increase the repair in dental pulp cells: in vitro and ex vivo study. Sci Rep 2023; 13:9531. [PMID: 37308525 DOI: 10.1038/s41598-023-36748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 06/09/2023] [Indexed: 06/14/2023] Open
Abstract
Host Defense Peptides (HDPs) have, in previous studies, been demonstrating antimicrobial, anti-inflammatory, and immunomodulatory capacity, important factors in the repair process. Knowing these characteristics, this article aims to evaluate the potential of HDPs IDR1018 and DJK-6 associated with MTA extract in the repair process of human pulp cells. Antibacterial activity of HDPs, MTA and HDPs combined with MTA in Streptococcus mutans planktonic bacteria and antibiofilm activity was evaluated. Cell toxicity was assayed with MTT and cell morphology was observed by scanning electron microscopy (SEM). Proliferation and migration of pulp cells were evaluated by trypan blue and wound healing assay. Inflammatory and mineralization related genes were evaluated by qPCR (IL-6, TNFRSF, DSPP, TGF-β). Alkaline phosphatase, phosphate quantification and alizarin red staining were also verified. The assays were performed in technical and biological triplicate (n = 9). Results were submitted for the calculation of the mean and standard deviation. Then, normality verification by Kolmogorov Smirnov test, analyzing one-way ANOVA. Analyses were considered at a 95% significance level, with a p-value < 0.05. Our study demonstrated that HDPs combined with MTA were able to reduce biofilms performed in 24 h and biofilm performed over 7 days S. mutans biofilm (p < 0.05). IDR1018 and MTA, as well as their combination, down-regulated IL-6 expression (p < 0.05). Tested materials were not cytotoxic to pulp cells. IDR1018 induced high cell proliferation and combined with MTA induced high cellular migration rates in 48 h (p < 0.05). Furthermore, the combination of IDR1018 and MTA also induced high expression levels of DSPP, ALP activity, and the production of calcification nodules. So, IDR-1018 and its combination with MTA could assist in pulp-dentine complex repair process in vitro.
Collapse
Affiliation(s)
| | - Danilo César Mota Martins
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | | | - Rosangela V de Andrade
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, SGAN 916N - Av. W5 - Campus II - Modulo C, Room C-22170.790-160, Brasília, Distrito Federal, Brazil
| | - Cristiano Lacorte
- Laboratório de Biologia Sintética, Embrapa Recursos Genéticos e Biotecnologia, Brasília, Distrito Federal, Brazil
| | - Jeeser Alves de Almeida
- Curso de Educação Física, Universidade Federal de Mato Grosso do Sul, UFMS, Campo Grande, Mato Grosso do Sul, Brazil
| | - Lana Ribeiro Aguiar
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, SGAN 916N - Av. W5 - Campus II - Modulo C, Room C-22170.790-160, Brasília, Distrito Federal, Brazil
| | - José Raimundo Corrêa
- Laboratório de Microscopia e Microanálises, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - Ingrid Gracielle Martins da Silva
- Laboratório de Microscopia e Microanálises, Instituto de Ciências Biológicas, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - Octávio Luiz Franco
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, SGAN 916N - Av. W5 - Campus II - Modulo C, Room C-22170.790-160, Brasília, Distrito Federal, Brazil
- S-Inova Biotech, Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Mato Grosso do Sul, Brazil
| | - Taia Maria Berto Rezende
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília, Brasília, Distrito Federal, Brazil.
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, SGAN 916N - Av. W5 - Campus II - Modulo C, Room C-22170.790-160, Brasília, Distrito Federal, Brazil.
- Curso de Odontologia, Universidade de Brasília, Brasília, Distrito Federal, Brazil.
| |
Collapse
|
13
|
Hatipoğlu Ö, Pertek Hatipoğlu F, Javed MQ, Nijakowski K, Taha N, El-Saaidi C, Sugumaran S, Elhamouly Y, Drobac M, Machado R, Abdullah T, Kobayashi H, Alfirjani S, Abidin IZ, Martín B, Maira K, Lim WY, Palma PJ, Martins JFB. Factors Affecting the Decision-Making of Direct Pulp Capping Procedures Amongst Dental Practitioners: A Multinational Survey from 16 Countries with Meta-Analysis. J Endod 2023:S0099-2399(23)00215-7. [PMID: 37094712 DOI: 10.1016/j.joen.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Direct pulp capping (DPC) procedures require the placement of a bioactive material over an exposure site without selective pulp tissue removal. This web-based multicentered survey had three purposes: i) to investigate the factors that affect clinicians' decisions in DPC cases, ii) to determine which method of caries removal is preferred, and iii) to evaluate the preferred capping material for DPC. METHODS The questionnaire comprised three sections. The first part comprised questions regarding demographic features. The second part comprised questions on how treatment plans change according to factors such as nature, location, number and size of the pulp exposure and patients' age. The third part composed of questions on the common materials and techniques used in DPC. To estimate the effect size, the risk ratio (RR) and 95% confidence interval (CI) were calculated using a meta-analysis software. RESULTS A tendency towards more invasive treatment was observed for the clinical scenario with carious-exposed pulp (RR=2.86, 95% CI:2.46,2.32; p<0.001) as opposed to the clinical scenario with two pulp exposures (RR=1.38, 95% CI:1.24,1.53; p<0.001). Complete caries removal was significantly preferred to selective caries removal (RR=4.59, 95% CI: 3.70, 5.69; p<0.001). Among the capping materials, calcium silicate-based materials (CS) were preferred over calcium hydroxide-based materials (CH) (RR=0.58, 95% CI: 0.44,0.76; p<0.05). CONCLUSION While carious-exposed pulp is the most important factor in clinical decisions regarding DPC, the number of exposures has the least impact. Overall, complete caries removal was preferred over selective caries removal. In addition, the use of CS appears to have replaced CH.
Collapse
Affiliation(s)
- Ömer Hatipoğlu
- Department of Restorative Dentistry, Nigde Omer Halisdemir University, Turkey.
| | | | - Muhammad Qasim Javed
- Department of Conservative Dental Sciences and Endodontics, College of Dentistry, Qassim University, Saudi Arabia.
| | - Kacper Nijakowski
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, Poland.
| | - Nessrin Taha
- Department of Conservative Dentistry, Jordan University of science and Technology Irbid, Jordan.
| | | | - Surendar Sugumaran
- Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India.
| | - Yasmine Elhamouly
- Pediatric Dentistry Pediatric and Community Dentistry Department, Faculty of Dentistry, Pharos University in Alexandria, Egypt.
| | - Milan Drobac
- Department of Conservative Dentistry and Endodontics, Faculty of Medicine, University of Novi Sad, Serbia.
| | - Ricardo Machado
- Clinical practice limited to Endodontics, Navegantes, Santa Catarina, Brazil.
| | - Thiyezen Abdullah
- Department of Orthodontic and Pediatric Dentistry, College of Dentistry, Qassim University, Saudi Arabia.
| | - Hiro Kobayashi
- Department of Removable Partial Prosthodontics, Tokyo Dental College, Japan.
| | - Suha Alfirjani
- Department of Conservative Dentistry and Endodontics, Dental school/university of Benghazi, Libya.
| | | | - Benjamín Martín
- Department of Conservative Dentistry, Universidade de Santiago de Compostela (USC), Spain.
| | - Kopbayeva Maira
- Department of Conservative Dentistry and Endodontics, Kazakh National Medical University Asfendiyarov, Kazakhstan.
| | - Wen Yi Lim
- Restorative Department, National Dental Centre Singapore, Singapore.
| | - Paulo J Palma
- Endodontic Institute, Faculty of Medicine, University of Coimbra, Portugal.
| | | |
Collapse
|
14
|
Cunha D, Souza N, Moreira M, Rodrigues N, Silva P, Franca C, Horsophonphong S, Sercia A, Subbiah R, Tahayeri A, Ferracane J, Yelick P, Saboia V, Bertassoni L. 3D-printed microgels supplemented with dentin matrix molecules as a novel biomaterial for direct pulp capping. Clin Oral Investig 2023; 27:1215-1225. [PMID: 36287273 PMCID: PMC10171721 DOI: 10.1007/s00784-022-04735-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To develop a 3D-printed, microparticulate hydrogel supplemented with dentin matrix molecules (DMM) as a novel regenerative strategy for dental pulp capping. MATERIALS AND METHODS Gelatin methacryloyl microgels (7% w/v) mixed with varying concentrations of DMM were printed using a digital light projection 3D printer and lyophilized for 2 days. The release profile of the DMM-loaded microgels was measured using a bicinchoninic acid assay. Next, dental pulp exposure defects were created in maxillary first molars of Wistar rats. The exposures were randomly capped with (1) inert material - negative control, (2) microgels, (3) microgels + DMM 500 µg/ml, (4) microgels + DMM 1000 µg/ml, (5) microgels + platelet-derived growth factor (PDGF 10 ng/ml), or (6) MTA (n = 15/group). After 4 weeks, animals were euthanized, and treated molars were harvested and then processed to evaluate hard tissue deposition, pulp tissue organization, and blood vessel density. RESULTS All the specimens from groups treated with microgel + 500 µg/ml, microgel + 1000 µg/ml, microgel + PDGF, and MTA showed the formation of organized pulp tissue, tertiary dentin, newly formed tubular and atubular dentin, and new blood vessel formation. Dentin bridge formation was greater and pulp necrosis was less in the microgel + DMM groups compared to MTA. CONCLUSIONS The 3D-printed photocurable microgels doped with DMM exhibited favorable cellular and inflammatory pulp responses, and significantly more tertiary dentin deposition. CLINICAL RELEVANCE 3D-printed microgel with DMM is a promising biomaterial for dentin and dental pulp regeneration in pulp capping procedures.
Collapse
Affiliation(s)
- Diana Cunha
- Post-Graduation Program in Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Nayara Souza
- Post-Graduation Program in Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Manuela Moreira
- School of Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Nara Rodrigues
- School of Dentistry, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Paulo Silva
- School of Dentistry, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Cristiane Franca
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Sivaporn Horsophonphong
- Department of Pediatric Dentistry, Faculty of Dentistry, Mahidol University, Salaya, Thailand
| | - Ashley Sercia
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Ramesh Subbiah
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Anthony Tahayeri
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Jack Ferracane
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA
| | - Pamela Yelick
- Department of Orthodontics, School of Medicine, School of Engineering, Tufts University, Boston, MA, 02111, USA
| | - Vicente Saboia
- Department of Restorative Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Luiz Bertassoni
- Division of Biomaterials and Biomechanics, Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, Portland, OR, USA.
- Center for Regenerative Medicine, School of Medicine, Oregon Health & Science University, Portland, OR, USA.
- Department of Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, OR, USA.
- Cancer Early Detection Advanced Research Center (CEDAR), Knight Cancer Institute, Portland, OR, USA.
| |
Collapse
|
15
|
Zhang D, Zheng C, Zhu T, Yang F, Zhou Y. Identification of key module and hub genes in pulpitis using weighted gene co-expression network analysis. BMC Oral Health 2023; 23:2. [PMID: 36593446 PMCID: PMC9808982 DOI: 10.1186/s12903-022-02638-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/30/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Pulpitis is a common disease mainly caused by bacteria. Conventional approaches of diagnosing the state of dental pulp are mainly based on clinical symptoms, thereby harbor deficiencies. The accurate and rapid diagnosis of pulpitis is important for choosing the suitable therapy. The study aimed to identify pulpits related key genes by integrating micro-array data analysis and systems biology network-based methods such as weighted gene co-expression network analysis (WGCNA). METHODS The micro-array data of 13 inflamed pulp and 11 normal pulp were acquired from Gene Expression Omnibus (GEO). WGCNA was utilized to establish a genetic network and categorize genes into diverse modules. Hub genes in the most associated module to pulpitis were screened out using high module group members (MM) methods. Pulpitis model in rat was constructed and iRoot BP plus was applied to cap pulp. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used for validation of hub genes. RESULTS WGCNA was established and genes were categorized into 22 modules. The darkgrey module had the highest correlation with pulpitis among them. A total of 5 hub genes (HMOX1, LOX, ACTG1, STAT3, GNB5) were identified. RT-qPCR proved the differences in expression levels of HMOX1, LOX, ACTG1, STAT3, GNB5 in inflamed dental pulp. Pulp capping reversed the expression level of HMOX1, LOX, ACTG1. CONCLUSION The study was the first to produce a holistic view of pulpitis, screen out and validate hub genes involved in pulpitis using WGCNA method. Pulp capping using iRoot BP plus could reverse partial hub genes.
Collapse
Affiliation(s)
- Denghui Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Chen Zheng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Tianer Zhu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Fan Yang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Yiqun Zhou
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China.
| |
Collapse
|
16
|
Li T, He W, Jiang W, Wang X, Nie M, Wang S. Interdisciplinary management of combined periodontal-endodontic lesions with palatogingival grooves of the maxillary lateral incisors: a case report. Br Dent J 2023; 234:27-33. [PMID: 36639473 DOI: 10.1038/s41415-022-5370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/26/2022] [Indexed: 01/15/2023]
Abstract
A palatogingival groove of the maxillary lateral incisor is an anatomic malformation, which always predisposes the tooth to pulpal and periodontal disease. The diagnosis and treatment planning become complicated, with uncertain prognosis. Herein, we present an effective interdisciplinary management of a case of combined periodontal-endodontic lesions caused by palatogingival grooves. A series of treatment modalities were undertaken to preserve the two teeth, including root canal treatment, periodontal initial therapy, splinting the mobile teeth, occlusal adjustment, apical microsurgery, grinding and sealing grooves, and guided tissue regeneration. An apparent healing of the lesions was visible after 12 months. Therefore, interdisciplinary management of combined periodontal-endodontic lesions with palatogingival grooves of the maxillary lateral incisors is necessary for a favourable long-term outcome.
Collapse
Affiliation(s)
- Tong Li
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, 145 West Chang-le Road, Xi´an 710032, Shaanxi, People's Republic Of China
| | - Wenxi He
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, 145 West Chang-le Road, Xi´an 710032, Shaanxi, People's Republic Of China
| | - Wenkai Jiang
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, 145 West Chang-le Road, Xi´an 710032, Shaanxi, People's Republic Of China
| | - Xiaoli Wang
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, 145 West Chang-le Road, Xi´an 710032, Shaanxi, People's Republic Of China
| | - Min Nie
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, Department of Endodontics, School and Hospital of Stomatology, Wuhan University, 237 Luo-yu Road, Wuhan, 430079, Hubei, People's Republic Of China
| | - Shengchao Wang
- State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Key Laboratory of Stomatology, Department of Operative Dentistry and Endodontics, School of Stomatology, The Fourth Military Medical University, 145 West Chang-le Road, Xi´an 710032, Shaanxi, People's Republic Of China.
| |
Collapse
|
17
|
Philip N, Suneja B. Minimally invasive endodontics: a new era for pulpotomy in mature permanent teeth. Br Dent J 2022; 233:1035-1041. [PMID: 36526777 PMCID: PMC9758046 DOI: 10.1038/s41415-022-5316-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/08/2022] [Indexed: 12/23/2022]
Abstract
Emerging clinical and histologic evidence is challenging the long-established dogma that root canal treatment (RCTx) is the only therapeutic option for preservation of vital mature permanent teeth diagnosed with irreversible pulpitis or carious pulp exposure. Vital pulp therapy procedures like pulpotomy are not only technically simpler and more economical, but also afford patients a host of other benefits over conventional RCTx. This narrative review provides an update on the contemporary understanding of pulp pathophysiology and defence mechanisms, the proposed new diagnostic terminologies for pulpal inflammation, and how the biological characteristics of hydrophilic calcium silicate cements have enabled consistent successful outcomes for pulpotomy-treated mature teeth. The paper also details the evidence base from clinical trials and systematic reviews conducted over the past decade and outlines the practical treatment considerations for pulpotomy in mature permanent teeth.
Collapse
Affiliation(s)
- Nebu Philip
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Bharat Suneja
- Baba Jaswant Singh Dental College and Hospital, Ludhiana, India
| |
Collapse
|
18
|
Kadowaki M, Yoshida S, Itoyama T, Tomokiyo A, Hamano S, Hasegawa D, Sugii H, Kaneko H, Sugiura R, Maeda H. Involvement of M1/M2 Macrophage Polarization in Reparative Dentin Formation. Life (Basel) 2022; 12:1812. [PMID: 36362965 PMCID: PMC9694428 DOI: 10.3390/life12111812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 08/31/2023] Open
Abstract
In cases in which dental pulp tissue is accidentally exposed, direct pulp capping is often performed to induce reparative dentin formation. Although macrophages are essential for the inflammatory response and tissue repair, the emergence pattern and the role of macrophages in dental pulp tissue have not been clarified. Here, we investigated the emergence of M1/M2 macrophages in dental pulp tissue after a direct pulp capping and the effects of M2 macrophages on odontoblastic differentiation of the dental pulp stem cell (DPSC) clones. The emergence of macrophages in dental pulp tissue was investigated using a rat direct pulp capping model. Alizarin Red S staining and quantitative RT-PCR was performed to examine the effect of M2 macrophages on the mineralization and odontoblastic differentiation of DPSC clones. Immunohistochemical staining revealed that M1 macrophages were detected in dental pulp tissue after treatment and increased in number at three days after treatment. However, M2 macrophages gradually increased in number in dental pulp tissue after treatment, with the highest level recorded at seven days post-operation. Additionally, conditioned medium from M2 macrophages induced odontoblast-like differentiation of DPSC clones. These results suggest that macrophages play a role in the inflammatory response and reparative dentin formation after dental pulp exposure.
Collapse
Affiliation(s)
- Masataka Kadowaki
- Department of Endodontology and Operative Dentistry, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Shinichiro Yoshida
- Department of Endodontology, Kyushu University Hospital, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomohiro Itoyama
- Department of Endodontology, Kyushu University Hospital, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Atsushi Tomokiyo
- Department of Endodontology, Kyushu University Hospital, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Sayuri Hamano
- Department of Endodontology and Operative Dentistry, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
- Faculty of Dental Science, OBT Research Center, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Daigaku Hasegawa
- Department of Endodontology, Kyushu University Hospital, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hideki Sugii
- Department of Endodontology and Operative Dentistry, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroshi Kaneko
- Department of Endodontology, Kyushu University Hospital, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Risa Sugiura
- Department of Endodontology and Operative Dentistry, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hidefumi Maeda
- Department of Endodontology and Operative Dentistry, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
- Department of Endodontology, Kyushu University Hospital, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| |
Collapse
|
19
|
Ricucci D, Rôças IN, Alves FR, Cabello PH, Siqueira JF. Outcome of direct pulp capping using calcium hydroxide: a long-term retrospective study. J Endod 2022; 49:45-54. [DOI: 10.1016/j.joen.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
|
20
|
An Updated Review on Properties and Indications of Calcium Silicate-Based Cements in Endodontic Therapy. Int J Dent 2022; 2022:6858088. [PMID: 36349079 PMCID: PMC9637478 DOI: 10.1155/2022/6858088] [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: 08/24/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022] Open
Abstract
Regarding the common use of calcium silicate cements (CSCs) in root canal therapy, their position in the context of past and present dentistry agents can provide a better understanding of these materials for their further improvement. In this context, the present review article addresses a wide range of recent investigations in the field of CSC-based products and describes details of their composition, properties, and clinical applications. The need for maintaining or reconstructing tooth structure has increased in contemporary endodontic treatment approaches. This research thus discusses the attempts to create comprehensive data collection regarding calcium ion release, bond strength, alkalinizing activity and bioactivity, and the ability to stimulate the formation of hydroxyapatite as a bioactive feature of CSCs. Sealing ability is also highlighted as a predictor for apical and coronal microleakage which is crucial for the long-term prognosis of root canal treatment integrity. Other claimed properties such as radiopacity, porosity, and solubility are also investigated. Extended setting time is also mentioned as a well-known drawback of CSCs. Then, clinical applications of CSCs in vital pulp therapies such as pulpotomy, apexification, and direct pulp capping are reviewed. CSCs have shown their benefits in root perforation treatments and also as root canal sealers and end-filling materials. Nowadays, conventional endodontic treatments are replaced by regenerative therapies to save more dynamic and reliable hard and soft tissues. CSCs play a crucial role in this modern approach. This review article is an attempt to summarize the latest studies on the clinical properties of CSCs to shed light on the future generation of treatments.
Collapse
|
21
|
Dentin Sialoprotein/Phosphophoryn (DSP/PP) as Bio-Inductive Materials for Direct Pulp Capping. Polymers (Basel) 2022; 14:polym14173656. [PMID: 36080731 PMCID: PMC9460548 DOI: 10.3390/polym14173656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/23/2022] Open
Abstract
Conventional direct pulp capping, such as calcium hydroxide (Ca(OH)2) or silicate products, usually induces an inflammatory reaction to provoke pulp regeneration. Phosphophoryn (PP) and dentin sialoprotein (DSP), the two most abundant non-collagenous proteins in the dentin matrix, are responsible for dentin mineralization, pulp cell migration, and differentiation. Here we examined the PP and combined DSP/PP as bio-inductive pulp capping materials by in vitro and in vivo tests. Firstly, the effects of the PP dose on pulp cell migration and matrix protein expression were examined by an agarose bead test. Secondly, the role of recombinant DSP (recDSP) and recDSP/PP on stimulating DSP-PP transcript expression was examined by RT-PCR. DSPP mRNA was also knocked down by RNA interference (RNAi) to examine their functions on dentin matrix mineralization. Finally, we used ferret animal models to test PP and recDSP/PP acting as capping agents on in vivo pulp responses and reparative dentin formation. The result showed that intermediate-dose PP was the most effective to enhance cell migration and differentiation. RecDSP/PP strongly enhanced the DSP-PP transcript expression, while inhibition of DSPP mRNA expression by siRNAs partially or completely affected dental pulp cell mineralization. The in vivo results showed that intermediate-dose PP and recDSP/PP proteins induced less pulp inflammation and promoted reparative dentin formation. Contrarily, conventional calcium hydroxide induced severe pulp inflammation. With these findings, DSP and PP could serve as capping agents for pulp capping therapy.
Collapse
|
22
|
Leite ML, Anselmi C, Soares IPM, Manso AP, Hebling J, Carvalho RM, de Souza Costa CA. Calcium silicate-coated porous chitosan scaffold as a cell-free tissue engineering system for direct pulp capping. Dent Mater 2022; 38:1763-1776. [DOI: 10.1016/j.dental.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022]
|
23
|
Prognostic Factors and Primary Healing on Root Perforation Repaired with MTA: A 14-year Longitudinal Study. J Endod 2022; 48:1092-1099. [PMID: 35714727 DOI: 10.1016/j.joen.2022.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Few data are available on the long-term efficacy of mineral trioxide aggregate (MTA) in treating root canal perforations. This prospective cohort study builds on a previously reported trial to determine the outcome for teeth with root perforations treated with orthograde MTA after longer follow-up and identify potential prognostic factors. METHODS A prospective cohort study was performed, enrolling (1999-2009) patients with a single dental perforation treated with MTA. Preoperative, intraoperative, and postoperative information was evaluated, and the outcomes were dichotomized as healed or nonhealing. Patients were followed up yearly until 2018 for a maximum of 17 years after treatment, with controls carried out until 14 years. Clinical and radiographic outcomes were evaluated using standardized follow-up protocols. RESULTS Of the 124 entrolled patients (median age = 36.5 years, 53.2% male), 115 were healed at the first (n = 110, 89%) or second (n = 5, 4%) annual posttreatment checkup, while 9 subjects (7%, 4 females, 18-65 years old) did not heal. Characteristics significantly associated with nonhealing were gender, positive probing, size, and perforation site. Perforations recurred in 48 teeth during the follow-up with the estimated probability of reversal at 5, 10, and 14 years of 6% (95% confidence interval [CI], 2%-10%), 30% (95% CI, 20%-38%), and 62% (95% CI, 46%-73%), respectively. Positive probing had a higher reversal risk (hazard ratio = 3.3, P ≤ .001), and perforations >3 mm were more likely to have a reversal (hazard ratio = 4.1, P < .001). CONCLUSIONS The risk of reversal for healed MTA-treated root canal perforations, initially relatively low, vastly increases over time.
Collapse
|
24
|
Igna A, Igna C, Miron MI, Schuszler L, Dascălu R, Moldovan M, Voicu AA, Todea CD, Boariu M, Mârțu MA, Stratul ȘI. Assessment of Pulpal Status in Primary Teeth Following Direct Pulp Capping in an Experimental Canine Model. Diagnostics (Basel) 2022; 12:diagnostics12082022. [PMID: 36010372 PMCID: PMC9407383 DOI: 10.3390/diagnostics12082022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This study aimed to assess the pulpal response of primary teeth by pulse-oximetry (PO) in a canine model, following direct pulp capping (DPC). (2) Methods: Forty-eight primary teeth from eight canine subjects were divided into three treatment groups, based on the DPC material—calcium hydroxide (CH), MTA, BiodentineTM)—and three corresponding control groups. Data from PO pulp testing were correlated with laser Doppler flowmetry (LDF) testing, computer tomographic (CT) densitometry and histological analysis; the experiment lasted 14 days. (3) Results: SpO₂ recordings revealed statistically significant differences (p = 0.002, <0.05) between the treatment and control groups, and no significant differences (p = 0.257, >0.05) were observed between treatment groups. LDF recordings showed significant differences (p = 0.002, <0.05) between the treatment and control groups and identified significant differences between materials (p = 0.001, <0.05). CT densitometry indicated vital pulps in all teeth, with pulpal inflammation detected in 6/8 CH-capped teeth and 2/8 MTA-capped teeth. Histologic evaluation confirmed vital pulp in all specimens, with different degrees of inflammation. (4) Conclusions: Within its limitations, the present study confirms the diagnostic value of PO evaluation of pulpal status in primary teeth with histologic means after pulp-capping procedures in a canine model. However, various degrees of pulpal inflammation elicited by different pulp-capping materials seem not to correlate with the obtained PO values.
Collapse
Affiliation(s)
- Andreea Igna
- Department of Pediatric Dentistry, Pediatric Dentistry Research Center, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: (A.I.); (M.I.M.)
| | - Cornel Igna
- Department of Surgery, Faculty of Veterinary Medicine, Banat University of Agricultural Sciences and Veterinary Medicine “Regele Mihai I al Romaniei”, 300645 Timisoara, Romania
| | - Mariana Ioana Miron
- Department of Oral Rehabilitation and Dental Emergencies, Interdisciplinary Research Center for Dental Medical Research, Lasers and Innovative Technologies, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: (A.I.); (M.I.M.)
| | - Larisa Schuszler
- Department of Surgery, Faculty of Veterinary Medicine, Banat University of Agricultural Sciences and Veterinary Medicine “Regele Mihai I al Romaniei”, 300645 Timisoara, Romania
| | - Roxana Dascălu
- Department of Imagistic Diagnosis, Faculty of Veterinary Medicine, Banat University of Agricultural Sciences and Veterinary Medicine “Regele Mihai I al Romaniei”, 300645 Timisoara, Romania
| | - Mihaela Moldovan
- Department of Pathological Anatomy, Municipal Emergency Clinical Hospital, 300231 Timisoara, Romania
| | - Adrian Aristide Voicu
- Department of Functional Sciences, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Carmen Darinca Todea
- Department of Oral Rehabilitation and Dental Emergencies, Interdisciplinary Research Center for Dental Medical Research, Lasers and Innovative Technologies, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Boariu
- Department of Endodontics, Faculty of Dental Medicine, TADERP Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Maria-Alexandra Mârțu
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ștefan-Ioan Stratul
- Department of Periodontology, Faculty of Dental Medicine, Anton Sculean Research Center for Periodontal and Peri-Implant Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| |
Collapse
|
25
|
Sharma V, Nawal RR, Augustine J, Urs AB, Talwar S. Evaluation of Endosequence Root Repair Material and Endocem MTA as direct pulp capping agents: An in vivo study. AUST ENDOD J 2022; 48:251-257. [PMID: 34278657 DOI: 10.1111/aej.12542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 12/31/2022]
Abstract
The study aimed to assess the human pulpal response to direct pulp capping using Endosequence Root Repair Material (ERRM) and Endocem MTA against ProRoot MTA as control. Intentional direct pulp capping was done using the three materials in 30 caries-free human premolars. After 30 days, the teeth were extracted, fixed and decalcified. Sections were prepared for histologic examination using light microscopy. Thickness and quality of dentine bridge formed and level of inflammation were evaluated. Difference between dentine bridge thickness of the three groups was statistically significant. Mean thickness of dentine bridges formed in ProRoot MTA group was greater than other two groups, and difference was statistically significant. Difference in dentine bridge thickness between ERRM and Endocem MTA was statistically significant. No significant difference was observed between the 3 groups with respect to inflammation. Results indicate ProRoot MTA performed best with ERRM giving better results than Endocem MTA.
Collapse
Affiliation(s)
- Vivek Sharma
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Ruchika Roongta Nawal
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Jeyaseelan Augustine
- Department of Oral Pathology and Microbiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Aadithya B Urs
- Department of Oral Pathology and Microbiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sangeeta Talwar
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Cushley S, Duncan HF, Lundy FT, Nagendrababu V, Clarke M, El Karim I. Outcomes reporting in systematic reviews on vital pulp treatment: A scoping review for the development of a core outcome set. Int Endod J 2022; 55:891-909. [PMID: 35704241 PMCID: PMC9545459 DOI: 10.1111/iej.13785] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/18/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
Background A large number of research reports on vital pulp treatment (VPT) has been published over the last two decades. However, heterogeneity in reporting outcomes of VPT is a significant challenge for evidence synthesis and clinical decision‐making. Objectives To identify outcomes assessed in VPT studies and to evaluate how and when outcomes are measured. A subsidiary aim was to assess evidence for selective reporting bias in the included studies. The results of this review will be used to inform the development of a core outcome set (COS) for endodontic treatments. Methods Multiple healthcare bibliographic databases, including PubMed/MEDLINE, Ovid EMBASE, Scopus, Cochrane Database of Systematic Reviews and Web of Science were searched for systematic reviews published between 1990 and 2020, reporting on VPT. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Outcomes' information was extracted and aligned with a healthcare taxonomy into five core areas: survival, clinical/physiological changes, life impact, resource use and adverse events. Results Thirty‐six systematic reviews were included, 10 reporting on indirect pulp capping or selective caries removal, nine on direct pulp capping, eight on pulpotomy and nine on combined VPTs. There was considerable variation in the outcomes reported in these reviews and their included studies. Clinician‐reported outcomes were used considerably more often than patient‐reported outcomes. A range of instruments and time points were used for measuring outcomes. Several of the reviews were assessed as having low risk of selective reporting bias, but many did not specifically report this domain, whilst others did not provide risk of bias assessment at all. Discussion Considerable variation in selection of outcomes and how and when they are measured and reported was evident, and this heterogeneity has implications for evidence synthesis and clinical decision‐making. Conclusions Whilst there is a lack of consistency, several potentially important outcomes for VPT, including pulp survival, incidence of post‐operative pain and need for further intervention, have been identified which could inform the development of a COS for endodontic treatment. Registration Core Outcome Measures in Effectiveness Trials (COMET) (No. 1879).
Collapse
Affiliation(s)
- Siobhan Cushley
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland
| | - Henry F Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Lincoln Place, Dublin, Ireland
| | - Fionnuala T Lundy
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland
| | - Ikhlas El Karim
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland
| |
Collapse
|
28
|
Araújo IJDS, Guimarães GN, Machado RA, Bertassoni LE, Davies RPW, Puppin-Rontani RM. Self-assembly peptide P 11-4 induces mineralization and cell-migration of odontoblast-like cells. J Dent 2022; 121:104111. [PMID: 35460865 PMCID: PMC10171720 DOI: 10.1016/j.jdent.2022.104111] [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: 11/16/2021] [Revised: 03/13/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Self-assembling peptide P11-4 is amphiphilic and pH-triggered, effective on repairing early enamel carious lesions and dentin remineralization. However, P11-4 effects on dentin biomineralization and repair ability remain unexplored. Thus, cytocompatibility and effectiveness of P11-4 on inducing mineralization and migration of odontoblast-like cells (MDPC-23) were investigated. METHODS MDPC-23 were seeded in contact with P11-4 (0.5 and 1 µg/ml), Dentin Matrix Protein 1 (DMP1 0.5 and 1 µg/ml) or Calcium hydroxide (Ca(OH)2 100 µg/ml) solutions. Cell viability was verified using MTT (n = 6/group). Mineral deposition was tested using Alizarin Red (n = 4/group). Cell migration was assessed by light microscopy (n = 2/group). MTT and Alizarin Red data were compared using Kruskal-Wallis and Mann-Whitney (α=0.01). RESULTS P11-4 (0.5 and 1 µg/ml) and DMP1 (0.5 and 1 µg/ml) resulted the highest cell viability; Ca(OH)2 presented the lowest. 1 µg/ml DMP1 and 1 µg/ml P11-4 promoted the highest mineral deposition. Ca(OH)2 presented lower values of mineral deposits than DMP1 1 µg/ml (p < 0.01), but similar to P11-4 1 µg/ml. P11-4 and DMP1 at 0.5 µg/ml induced lesser mineral precipitation than P11-4 and DMP1 at 1 µg/ml (p < 0.01), with no difference to Ca(OH)2. All materials stimulated cell migration, however, lower concentrations of DMP1 and P11-4 demonstrated a higher migration potential. CONCLUSION P11-4 did not affect cell viability, induces mineral deposition and MDPC-23 migration like DMP1. CLINICAL SIGNIFICANCE Self-assembling peptide P11-4 does not affect the cell viability and induces mineral deposition comparable to native protein involved in biomineralization. Combined with its ability to bind type I collagen, P11-4 is a promising bioinspired molecule that provides native-tissue conditions and foster further studies on its ability to form dentin bridges in pulp-capping strategies.
Collapse
Affiliation(s)
- Isaac Jordão de Souza Araújo
- Dental Materials Graduate Program; Piracicaba Dental School, Unicamp; Department of Dentistry, Faculdade Nova Esperança - FACENE/RN, Mossoró, Rio Grande do Norte, Brazil
| | - Gustavo Narvaes Guimarães
- Department of Biosciences, Histology area, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Renato Assis Machado
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, São Paulo, Brazil; Department of Oral Diagnosis, School of Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Luiz Eduardo Bertassoni
- Department of Biomaterials and Biomechanics, School of Dentistry Center for Regenerative Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | | | - Regina Maria Puppin-Rontani
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, State University of Campinas, Limeira Ave. 901, Areão, Piracicaba, São Paulo, Brazil.
| |
Collapse
|
29
|
Queiroz MB, Inada RNH, Lopes CS, Guerreiro-Tanomaru JM, Sasso-Cerri E, Tanomaru-Filho M, Cerri PS. Bioactive potential of Bio-C Pulpo is evidenced by presence of birefringent calcite and osteocalcin immunoexpression in the rat subcutaneous tissue. J Biomed Mater Res B Appl Biomater 2022; 110:2369-2380. [PMID: 35583398 DOI: 10.1002/jbm.b.35083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/11/2022]
Abstract
As the biocompatibility and bioactive potential of repair materials are desired characteristics in dentistry, the tissue response of Bio-C Pulpo, a bioceramic material launched on the marked by Angelus (Brazil), was compared with Biodentine (Septodont, France) and White MTA (WMTA; Angelus, Brazil). In 32 rats, 148 polyethylene tubes filled with Bio-C Pulpo, Biodentine or WMTA, and empty (CG, control group) were implanted into subcutaneous tissues for 7, 15, 30, and 60 days. The capsule thickness, numerical density of inflammatory cells (IC) and fibroblasts (Fb), amount of collagen, immunohistochemistry detection of interleukin-6 (IL-6) and osteocalcin (OCN), von Kossa and analysis under polarized light were performed. Data were subjected to two-way ANOVA followed by Tukey's test (p ≤ 0.05). At 7 and 15 days, the capsules around Bio-C Pulpo were thicker than in WMTA while, at 30 and 60 days, significant differences were not observed among the groups. Although at 7, 15, and 30 days, a greater number of IL-6-immunostained cells was found in Bio-C Pulpo and Biodentine than in WMTA, no significant difference was detected among the groups at 60 days. In all groups, the number of Fb and collagen content increased significantly over time. The capsules around materials exhibited von Kossa-positive and birefringent structures, and OCN-immunostained cells whereas, in the CG, these structures were not observed. Bio-C Pulpo, similarly to Biodentine and WMTA, is biocompatible, allows the connective tissue repair and presents bioactive potential in connective tissue of rats.
Collapse
Affiliation(s)
- Marcela Borsatto Queiroz
- Department of Restorative Dentistry, Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Odontologia Campus de Araraquara, Araraquara, Brazil.,Laboratory of Histology and Embryology, Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, Dental School, São Paulo State University (UNESP), Araraquara, Brazil
| | - Rafaela Nanami Handa Inada
- Department of Restorative Dentistry, Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Odontologia Campus de Araraquara, Araraquara, Brazil.,Laboratory of Histology and Embryology, Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, Dental School, São Paulo State University (UNESP), Araraquara, Brazil
| | - Camila Soares Lopes
- Department of Restorative Dentistry, Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Odontologia Campus de Araraquara, Araraquara, Brazil.,Laboratory of Histology and Embryology, Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, Dental School, São Paulo State University (UNESP), Araraquara, Brazil
| | - Juliane Maria Guerreiro-Tanomaru
- Department of Restorative Dentistry, Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Odontologia Campus de Araraquara, Araraquara, Brazil
| | - Estela Sasso-Cerri
- Laboratory of Histology and Embryology, Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, Dental School, São Paulo State University (UNESP), Araraquara, Brazil
| | - Mário Tanomaru-Filho
- Department of Restorative Dentistry, Universidade Estadual Paulista Julio de Mesquita Filho Faculdade de Odontologia Campus de Araraquara, Araraquara, Brazil
| | - Paulo Sérgio Cerri
- Laboratory of Histology and Embryology, Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, Dental School, São Paulo State University (UNESP), Araraquara, Brazil
| |
Collapse
|
30
|
Nano-hydroxyapatite-incorporated polycaprolactone nanofibrous scaffold as a dentin tissue engineering-based strategy for vital pulp therapy. Dent Mater 2022; 38:960-977. [PMID: 35331551 DOI: 10.1016/j.dental.2022.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/14/2022] [Accepted: 03/12/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Targeting a tissue engineering-based vital pulp therapy (VPT), this study investigated the incorporation of nano-hydroxyapatite (nHA) into polycaprolactone (PCL) nanofibers, and the metabolism of human dental pulp cells (HDPCs) seeded on the scaffolds. METHODS PCL-based solutions (10% w/v) containing nHA (0 - control; 0.5; 1.0; or 2.0% w/v) were electrospun into nanofibrous scaffolds. The scaffolds were characterized for morphology and composition (MEV/EDS), solubility, the release of calcium/phosphate (C/P), and modulation of medium pH. Then, HDPCs were seeded on the scaffolds and evaluated for cell viability (alamarBlue and live/dead), adhesion and spreading (F-actin), total protein (TP; Lowry), alkaline phosphatase activity (ALP; thymolphthalein assay), expression of odontogenic genes (RT-qPCR), and formation of a mineralized matrix (Alizarin Red). Data were analyzed with ANOVA and post-hocs (α = 5%). RESULTS Higher nHA concentrations roughened fiber surfaces, whereas PCL+ 2%nHA increased the interfibrillar spaces. PCL+ 1%nHA or PCL+ 2%nHA significantly released more C/P but the medium pH was maintained below 8.0. HDPCs viability was not affected by nHA, while cell adhesion/spreading was favored, especially for PCL+ 2%nHA. Higher protein content and ALP activity were seen for scaffolds incorporated with nHA, after 21 days. PCL+ 1%nHA and PCL+ 2%nHA upregulated the expression of DSPP and DMP1 in 14 days, and COL1A1, ALPL, and DMP1 in 21 days. The formation of a mineralized matrix was nHA concentration-dependent, and it was about 9 × higher for PCL+ 2%nHA. SIGNIFICANCE nHA-incorporated PCL nanofibrous scaffolds are cytocompatible and can stimulate the adhesion and odontogenic potential of HDPCs. PCL+ 2%nHA formulation is a bioactive tissue engineering-based cell-homing strategy for VPT.
Collapse
|
31
|
Isolation and Identification of Cytotoxic Compounds Present in Biomaterial Life ®. MATERIALS 2022; 15:ma15030871. [PMID: 35160817 PMCID: PMC8838329 DOI: 10.3390/ma15030871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
Direct pulp capping consists of a procedure in which a material is directly placed over the exposed pulp to maintain dental vitality. Although still widely used in clinical practice, previous in vitro studies found that the biomaterial Life® presented high cytotoxicity, leading to cell death. This study aimed to identify the Life® constituents responsible for its cytotoxic effects on odontoblast-like cells (MDPC-23). Aqueous medium conditioned with Life® was subjected to liquid-liquid extraction with ethyl acetate. After solvent removal, cells were treated with residues isolated from the organic and aqueous fractions. MTT and Trypan blue assays were carried out to evaluate the metabolic activity and cell death. The organic phase residue promoted a significant decrease in metabolic activity and increased cell death. On the contrary, no cytotoxic effects were observed with the mixture from the aqueous fraction. Spectroscopic and spectrometric methods allowed the identification of the toxic compounds. A mixture of the regioisomers ortho, para, and meta of N-ethyl-toluenesulfonamide was identified as the agent responsible for the toxicity of biomaterial Life® in MDPC-23 cells. These findings contribute to improving biomaterial research and development.
Collapse
|
32
|
Ahlawat M, Grewal M, Goel M, Bhullar H, Saurabh, Nagpal R. Direct pulp capping with mineral trioxide aggregate and biodentine in cariously exposed molar teeth: 1-year follow-up – An In vivo study. J Pharm Bioallied Sci 2022; 14:S983-S985. [PMID: 36110733 PMCID: PMC9469447 DOI: 10.4103/jpbs.jpbs_837_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 11/04/2022] Open
|
33
|
Effectiveness of Direct Pulp Capping Bioactive Materials in Dentin Regeneration: A Systematic Review. MATERIALS 2021; 14:ma14226811. [PMID: 34832214 PMCID: PMC8621741 DOI: 10.3390/ma14226811] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 12/18/2022]
Abstract
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.
Collapse
|
34
|
Guan X, Zhou Y, Yang Q, Zhu T, Chen X, Deng S, Zhang D. Vital Pulp Therapy in Permanent Teeth with Irreversible Pulpitis Caused by Caries: A Prospective Cohort Study. J Pers Med 2021; 11:jpm11111125. [PMID: 34834477 PMCID: PMC8620894 DOI: 10.3390/jpm11111125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 01/09/2023] Open
Abstract
Background: When a tooth is diagnosed with irreversible pulpitis, root canal therapy (RCT) is generally performed to completely remove pulp tissue, which might lead to a higher risk of loss of vascularity, and teeth being more prone to fracture. Vital pulp therapy (VPT) is a personalized method of treating irreversible pulpitis, which conforms to the trend of minimally invasive endodontics. The remaining vital pulp could promote the physiological development of the roots of young permanent teeth with incomplete apical foramen. However, clear guidelines for VPT indication are still missing. Objective: This prospective cohort study evaluated the outcomes of vital pulp therapy (VPT) using iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, BC, Canada) in permanent teeth of 6- to 20-year-old patients with irreversible pulpitis caused by caries and analyzed the preoperative factors affecting VPT prognosis. Methods: Fifty-nine permanent teeth in 59 patients with irreversible pulpitis caused by caries were treated with VPT using iRoot BP Plus. All patients received VPT under a standardized protocol. After informed consent, teeth were isolated with a dental dam, then operators performed VPT with iRoot BP Plus and restored the teeth with composite resin or stainless steel crown. Patients were postoperatively recalled after 3, 6 and 12 months and then recalled annually. Successful cases were defined as successful in both clinical and radiographic evaluations. A statistical analysis was performed using the Fisher exact test, and the level of significant difference was p < 0.05. Results: After 6–36 months of follow-up, a total of 57 teeth from 57 patients were accessible for evaluation. The mean age of subjects was 11.75 ± 3.81 years. The overall clinical and radiographic success rate of VPT was 91.2% (52/57). With an observation time of one year or more, the success rate was 90.5% (38/42). All the symptoms and physical examination findings showed no significant effect on VPT prognosis (p > 0.05) using a binary logistic regression model. Conclusions: Permanent teeth in 6- to 20-year-old patients diagnosed as irreversible pulpitis caused by caries can be successfully treated with VPT using iRoot BP Plus.
Collapse
|
35
|
Klein-Junior CA, Zimmer R, Dobler T, Oliveira V, Marinowic DR, Özkömür A, Reston EG. Cytotoxicity assessment of Bio-C Repair Íon+: A new calcium silicate-based cement. J Dent Res Dent Clin Dent Prospects 2021; 15:152-156. [PMID: 34712404 PMCID: PMC8538145 DOI: 10.34172/joddd.2021.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background. Direct pulp capping is a method designed to preserve the exposed dental pulp. Due to good biological, physical, and mechanical properties, new versions of calcium silicate-based materials have been developed as pulp capping materials. The present study aimed to evaluate the cytotoxic effects of four calcium silicate-based pulp capping materials, of which the Bio-C Repair Íon+ is still in an experimental phase.
Methods. Biodentine, MTA Repair HP, Bio-C Repair, and Bio-C Repair Íon+ cements were dispensed in a metallic matrix to produce 125-mm3 specimens, which were immersed in Dulbecco’s Modified Eagle Medium (DMEM) to obtain extracts. NIH 3T3 cells were cultured and exposed to the extracts for 24 hours and seven days. Cell viability was assessed by the methyl tetrazolium test (MTT). The mean values for the experimental and control groups (without treatment) were compared by analysis of variance (ANOVA) and post hoc Tukey tests, considering a significance level of 5%.
Results. All the tested materials demonstrated a reduction in cell viability (P < 0.05). According to ISO 10993-5: 2009 (E), Bio-C Repair Íon+ exhibited mild and moderate cytotoxicity in the 24- hour and 7-day analyses, respectively. Bio-C Repair and Biodentine showed mild cytotoxicity, and MTA Repair HP exhibited moderate cytotoxicity at both intervals.
Conclusion. The highest cell viability was demonstrated by Biodentine, MTA, and Repair HP, in descending order. Bio-C Repair and Bio-C Repair Íon+ showed moderate cytotoxicity, similar to MTA Repair HP in the 7-day analysis.
Collapse
Affiliation(s)
- Celso Afonso Klein-Junior
- Department of Operative Dentistry, School of Dentistry, Lutheran University of Brazil, Canoas, RS, Brazil.,Department of Operative Dentistry, School of Dentistry, Lutheran University of Brazil, Cachoeira do Sul, RS, Brazil
| | - Roberto Zimmer
- Department of Operative Dentistry, School of Dentistry, Lutheran University of Brazil, Canoas, RS, Brazil
| | - Tãnyre Dobler
- Department of Operative Dentistry, School of Dentistry, Lutheran University of Brazil, Cachoeira do Sul, RS, Brazil
| | - Vanessa Oliveira
- Department of Operative Dentistry, School of Dentistry, Lutheran University of Brazil, Cachoeira do Sul, RS, Brazil
| | - Daniel Rodrigo Marinowic
- Brain Institute, Neuroscience laboratory, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ahmet Özkömür
- Department of Operative Dentistry, School of Dentistry, Lutheran University of Brazil, Canoas, RS, Brazil
| | - Eduardo Galia Reston
- Department of Operative Dentistry, School of Dentistry, Lutheran University of Brazil, Canoas, RS, Brazil
| |
Collapse
|
36
|
Silva PAO, Lima SMDF, Martins DCM, Amorim IA, Lacorte C, de Almeida JA, Franco OL, Rezende TMB. Concentrated MTA Repair HP reduced biofilm and can cause reparative action at a distance. Int Endod J 2021; 54:1925-1936. [PMID: 34164821 DOI: 10.1111/iej.13592] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/31/2022]
Abstract
AIM To evaluate in vitro whether MTA Repair HP can induce repair processes at a distance, including its effects on biofilm, cell viability, migration, production of TGF-β, phosphate and ALP, evaluated through MTA diluted extracts. METHODOLOGY Initially, antibacterial tests were performed with the bacterium Streptococcus mutans (ATCC 25175) in the presence of MTA extracts (dilutions of 1:1, 1:2 and 1:4). Growth inhibition assay by microdilution in broth, antibiofilm plate assay of young biofilm and antibiofilm assay in confocal microscopy of mature biofilm were carried out. Then, pulp cells were stimulated in the presence of several MTA dilutions, and cell viability (MTT assay), proliferation and migration capacity (scratch assay) were evaluated. To evaluate the capacity of 1:1, 1:2 and 1:4 dilutions of MTA Repair HP to promote the production of important agents of odontogenic differentiation and mineralization, ALP activity, TGF-β secretion and phosphate quantification were measured. Statistical differences were verified using one-way and two-way anova and Tukey's post-tests. RESULTS The test dilutions of MTA Repair HP did not inhibit planktonic S. mutans growth but were able to reduce young and mature S. mutans biofilm (p < 0.001). In addition, none of the MTA Repair HP dilutions was cytotoxic for pulp cells. The 1:2 and 1:4 dilutions of MTA Repair HP induced migration and proliferation of pulp cells (p < 0.05). ALP activity and TGF-β secretion were independent of the tested dilution (p < 0.001). Diluted 1:4 MTA Repair HP produced less phosphate than the more concentrated 1:1 and 1:2 MTA dilutions (p < 0.001). CONCLUSIONS Undiluted MTA Repair HP reduced S. mutans biofilm, when compared to 1:2 and 1:4 MTA dilutions. Furthermore, none of the tested dilutions was cytotoxic to pulp cells. MTA Repair HP promoted cell migration and proliferation at a distance, assessed through the dilution of the MTA. Even from a distance, MTA Repair HP has the ability to participate in some events related to repair, such as migration, proliferation and TGF production.
Collapse
Affiliation(s)
| | - Stella Maris de Freitas Lima
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Brazil.,Curso de Odontologia, Universidade Católica de Brasília, Brasília, Brazil
| | - Danilo César Mota Martins
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Brasília, Brasília, Brazil.,Curso de Odontologia, Centro Universitário ICESP, Brasília, Brazil
| | - Ingrid Aquino Amorim
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Brazil.,Curso de Odontologia, Centro Universitário UNIEURO, Brasília, Brazil
| | - Cristiano Lacorte
- Laboratório de Biologia Sintética, Embrapa Recursos Genéticos e Biotecnologia, Brasília, Brazil
| | - Jeesser Alves de Almeida
- Curso de Educação Física, Universidade Federal de Mato Grosso do Sul, UFMS, Campo Grande, Brazil
| | - Octávio Luiz Franco
- Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Brazil.,S-Inova Biotech, Pós-graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Distrito Federal, Brazil
| | - Taia Maria Berto Rezende
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Brasília, Brasília, Brazil.,Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Brazil.,Curso de Odontologia, Universidade Católica de Brasília, Brasília, Brazil
| |
Collapse
|
37
|
Parhizkar A, Asgary S. Local Drug Delivery Systems for Vital Pulp Therapy: A New Hope. Int J Biomater 2021; 2021:5584268. [PMID: 34567123 PMCID: PMC8457968 DOI: 10.1155/2021/5584268] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/18/2021] [Accepted: 09/09/2021] [Indexed: 12/24/2022] Open
Abstract
Vital pulp therapy (VPT) is deliberated as an ultraconservative/minimally invasive approach for the conservation of vital pulpal tissues, preservation of dental structure, and maintenance of tooth function in the oral cavity. In VPT, following the exposure of the dental pulp, the environment is prepared for the possible healing and probable refunctionalisation of pulpal connective tissue. However, to succeed in VPT, specific biomaterials are used to cover and/or dress the exposed pulp, lower the inflammation, heal the dental pulp, provoke the remaining odontoblastic cells, and induce the formation of a hard tissue, i.e., the dentinal bridge. It can be assumed that if the employed biomaterial is transferred to the target site using a specially designed micro-/nanosized local drug delivery system (LDDS), the biomaterial would be placed in closer proximity to the connective tissue, may be released in a controlled and sustained pattern, could properly conserve the remaining dental pulp and might appropriately enhance hard-tissue formation. Furthermore, the loaded LDDS could help VPT modalities to be more ultraconservative and may minimise the manipulation of the tooth structure as well as pulpal tissue, which could, in turn, result in better VPT outcomes.
Collapse
Affiliation(s)
- Ardavan Parhizkar
- Iranian Centre for Endodontic Research, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran
| | - Saeed Asgary
- Iranian Centre for Endodontic Research, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran
| |
Collapse
|
38
|
Liu K, Yu S, Ye L, Gao B. The Regenerative Potential of bFGF in Dental Pulp Repair and Regeneration. Front Pharmacol 2021; 12:680209. [PMID: 34354584 PMCID: PMC8329335 DOI: 10.3389/fphar.2021.680209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
Regenerative endodontic therapy intends to induce the host’s natural wound-healing process, which can restore the vitality, immunity, and sensitivity of the inflammatory or necrotic pulp tissue destroyed by infection or trauma. Myriads of growth factors are critical in the processes of pulp repair and regeneration. Among the key regulatory factors are the fibroblast growth factors, which have turned out to be the master regulators of both organogenesis and tissue homeostasis. Fibroblast growth factors, a family composed of 22 polypeptides, have been used in tissue repair and regeneration settings, in conditions as diverse as burns, ulcers, bone-related diseases, and spinal cord injuries. Meanwhile, in dentistry, the basic fibroblast growth factor is the most frequently investigated. Thereby, the aim of this review is 2-fold: 1) foremost, to explore the underlying mechanisms of the bFGF in dental pulp repair and regeneration and 2) in addition, to shed light on the potential therapeutic strategies of the bFGF in dental pulp–related clinical applications.
Collapse
Affiliation(s)
- Keyue Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sijing Yu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ling Ye
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bo Gao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| |
Collapse
|
39
|
Laird NZ, Acri TM, Tingle K, Salem AK. Gene- and RNAi-activated scaffolds for bone tissue engineering: Current progress and future directions. Adv Drug Deliv Rev 2021; 174:613-627. [PMID: 34015421 PMCID: PMC8217358 DOI: 10.1016/j.addr.2021.05.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/30/2021] [Accepted: 05/11/2021] [Indexed: 01/02/2023]
Abstract
Large bone defects are usually managed by replacing lost bone with non-biological prostheses or with bone grafts that come from the patient or a donor. Bone tissue engineering, as a field, offers the potential to regenerate bone within these large defects without the need for grafts or prosthetics. Such therapies could provide improved long- and short-term outcomes in patients with critical-sized bone defects. Bone tissue engineering has long relied on the administration of growth factors in protein form to stimulate bone regeneration, though clinical applications have shown that using such proteins as therapeutics can lead to concerning off-target effects due to the large amounts required for prolonged therapeutic action. Gene-based therapies offer an alternative to protein-based therapeutics where the genetic material encoding the desired protein is used and thus loading large doses of protein into the scaffolds is avoided. Gene- and RNAi-activated scaffolds are tissue engineering devices loaded with nucleic acids aimed at promoting local tissue repair. A variety of different approaches to formulating gene- and RNAi-activated scaffolds for bone tissue engineering have been explored, and include the activation of scaffolds with plasmid DNA, viruses, RNA transcripts, or interfering RNAs. This review will discuss recent progress in the field of bone tissue engineering, with specific focus on the different approaches employed by researchers to implement gene-activated scaffolds as a means of facilitating bone tissue repair.
Collapse
Affiliation(s)
- Noah Z Laird
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Timothy M Acri
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Kelsie Tingle
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Aliasger K Salem
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
40
|
Tucker RL, Ha WN. A Systematic Review Comparing Mineral Trioxide Aggregate to Other Commercially Available Direct Pulp Capping Agents in Dogs. J Vet Dent 2021; 38:34-45. [PMID: 34192968 DOI: 10.1177/08987564211024905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vital pulp therapy (VPT) and direct pulp capping (DPC) are procedures regularly performed in dogs for the management of acute tooth fractures and as part of management for traumatic malocclusions. The purpose of this review is to apply an evidence-based medicine approach to systematically review and evaluate the scientific literature evaluating the efficacy of mineral trioxide aggregate (MTA) to other commercially available materials used for VPT in the permanent teeth of dogs. The 9 studies meeting inclusion criteria were reviewed and each studies evidence was classified using a grading system modified from the Oxford Centre for Evidence-Based Medicine. For the studies meeting inclusion criteria, MTA consistently performed as well or better than other commercially available products in terms of calcific barrier formation and biocompatibility. This review found a lack of consistency between the studies making a direct comparison of the results unreliable. Future studies would benefit from the implementation of a standard scoring system for histology, equivalent and longer study duration times and the correlation of histological and radiographic data.
Collapse
Affiliation(s)
- Rebecca Lee Tucker
- Advanced Animal Dentistry, Veterinary Specialist Services, Underwood, Queensland, Australia
| | - William Nguyen Ha
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
41
|
Krug R, Ortmann C, Reich S, Hahn B, Krastl G, Soliman S. Tooth discoloration induced by apical plugs with hydraulic calcium silicate-based cements in teeth with open apices-a 2-year in vitro study. Clin Oral Investig 2021; 26:375-383. [PMID: 34151389 PMCID: PMC8791895 DOI: 10.1007/s00784-021-04009-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022]
Abstract
Objectives To assess tooth discoloration induced by different hydraulic calcium silicate-based cements (HCSCs), including effects of blood and placement method. Materials and methods Eighty bovine teeth cut to a length of 18 mm (crown 8 mm, root 10 mm) were randomly assigned to 10 groups (n = 8), receiving orthograde apical plug treatment (APT). Apical plugs were 4 mm in length and made of ProRoot MTA (Dentsply), Medcem MTA (Medcem), TotalFill BC RRM Fast Set Putty (Brasseler), or Medcem Medical Portland Cement (Medcem) plus bismuth oxide (Bi2O3) with and without bovine blood. Further, orthograde (with or without preoperative adhesive coronal dentin sealing) and retrograde APT were compared. Teeth were obturated with gutta-percha and sealer, sealed with composite and stored in distilled water. Tooth color was measured on apical plug, gutta-percha/sealer, and crown surface before treatment versus 24 h, 1, 3, 6, 12, and 24 months after treatment by spectrophotometry. Color difference (ΔE) values were calculated and analyzed by Shapiro–Wilk test, ANOVA with post hoc tests, Friedman test, t test, and post hoc tests with Bonferroni correction (α = .05). Results Tooth discoloration occurred in all groups with no significant differences between HCSCs (p > .05). After 24 months, color changes were prominent on roots but insignificant on crowns. Blood contamination induced a significantly decreased luminescence (p < .05). Blood had a stronger impact on tooth color than Bi2O3. No relevant effects of retrograde placement (p > .05) or preoperative dentin sealing (p > .05) were detected. Conclusions Apical plugs of the tested HCSCs cause discoloration of bovine roots, but not discoloration of bovine tooth crowns within a 24-month period. Clinical relevance APT should be performed carefully while avoiding direct contact with the coronal dentin, and in that case no aesthetic impairments occur.
Collapse
Affiliation(s)
- Ralf Krug
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
| | | | | | - B Hahn
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - G Krastl
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - S Soliman
- Department of Conservative Dentistry and Periodontology and Center of Dental Traumatology, University Hospital of Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| |
Collapse
|
42
|
Islam R, Toida Y, Chen F, Tanaka T, Inoue S, Kitamura T, Yoshida Y, Chowdhury AFMA, Ahmed HMA, Sano H. Histological evaluation of a novel phosphorylated pullulan-based pulp capping material: An in vivo study on rat molars. Int Endod J 2021; 54:1902-1914. [PMID: 34096634 DOI: 10.1111/iej.13587] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the dental pulp response to a novel mineral trioxide aggregate containing phosphorylated pullulan (MTAPPL) in rats after direct pulp capping. METHODS Ninety-six cavities were prepared in the maxillary first molars of 56 male Wistar rats. The dental pulps were intentionally exposed and randomly divided into four groups according to the application of pulp capping materials: MTAPPL; phosphorylated pullulan (PPL); a conventional MTA (Nex-Cem MTA, NCMTA; positive control); and Super-Bond (SB; negative control). All cavities were restored with SB and observed for pulpal responses at 1-, 3-, 7- and 28-day intervals using a histological scoring system. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U-test with Bonferroni's correction, and the level of significance was set at 0.05. DMP1 and CD34 antigen were used to evaluate odontoblast differentiation and pulpal vascularization, respectively. RESULTS On day 1, mild inflammatory cells were present in MTAPPL and NCMTA groups; fewer inflammatory cells were present in the PPL, whereas SB was associated with a mild-to-moderate inflammatory response. A significant difference was observed between PPL and SB (p < .05). No mineralized tissue deposition was observed. On day 3, moderate-to-severe inflammatory cells were present in PPL and SB, whereas MTAPPL and NCMTA had a mild inflammatory response. Initial mineralized tissue deposition was observed in the NCMTA, MTAPPL and SB. A significant difference was observed between MTAPPL and PPL (p < .05). On day 7, a thin layer of mineralized tissue was observed in all tested groups with no or mild inflammatory response. On day 28, no inflammatory response was observed in MTAPPL, whereas NCMTA, PPL and SB had mild inflammatory responses. A significant difference was observed between MTAPPL and SB (p < .05). Complete mineralized tissue barrier formation was observed in MTAPPL, NCMTA and PPL with no significant difference (p > .05). SB exhibited incomplete mineralized tissue barriers, significantly different from NCMTA, MTAPPL and PPL (p < .05). The staining with CD34 was positive in all the groups on all observation days. CONCLUSION The favourable pulpal responses and induction of mineralized tissue formation associated with MTAPPL indicate its potential application as a direct pulp capping material.
Collapse
Affiliation(s)
- Rafiqul Islam
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Yu Toida
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Fei Chen
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Toru Tanaka
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Satoshi Inoue
- Section for Clinical Education, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Tetsuya Kitamura
- Department of Vascular Biology and Molecular Pathology, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Yasuhiro Yoshida
- Department of Biomaterials and Bioengineering, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Abu Faem Mohammad Almas Chowdhury
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan.,Department of Conservative Dentistry and Endodontics, Sapporo Dental College and Hospital, Dhaka, Bangladesh
| | - Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Hidehiko Sano
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| |
Collapse
|
43
|
Khatore S, Kathuria S, Rawat MK, Thakare AA, Abrol S, Pinnamaneni SP, Tiwari RV. Knowledge, Perception, and Attitude on Conservative and Endodontic Practice on COVID Pandemic Situation: A Qualitative Research. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2021; 13:S353-S358. [PMID: 34447108 PMCID: PMC8375861 DOI: 10.4103/jpbs.jpbs_740_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/30/2022] Open
Abstract
AIM The purpose of our study was to analyze the knowledge and attitude of conservative as well as endodontic practice among dental professionals during coronavirus pandemic situation. METHODOLOGY A cross-sectional study was conducted over a period of 3 months among 1256 dental surgeons, which included 400 MDS and 856 BDS dentists. Questionnaire assessed knowledge of the participants about COVID-19, risk assessment about the pandemic, preparedness of the participants, as well as specific precautions in cases which require conservative and endodontic treatment strategies against COVID-19. RESULTS It was observed that around 83% of the study participants felt that rubber dams are a useful tool to prevent cross-infections, even COVID-19. However, COVID-19 prevention techniques such as use of low-speed handpiece and chemicomechanical techniques were preferred by a smaller number of participants: 25% of participants by former, only 12% for the latter. To prevent aerosol splatter, use of high-volume suction was preferred by 49% of dental surgeons. CONCLUSION In our study, we concluded that dental surgeons, who come under high risk category; had good basic knowledge about COVID-19 disease process as well as transmission. However, it is imperative that these clinicians need to be extra cautious in handling cases during this pandemic time and limit the disease spread as well.
Collapse
Affiliation(s)
- Sumit Khatore
- Department of Conservative Dentistry and Endodontics, Awadh Dental College and Hospital, Jamshedpur, Jahrkhand, India
| | | | - Manoj Kumar Rawat
- Department of Dentistry, Pt. Jawaharlal Nehru Government Medical College, Chamba, Himachal Pradesh, India
| | - Amar Ashok Thakare
- Department of Prosthodontist, College of Dentistry, Al Zufli, Majmaah University, Kingdom of Saudi Arabia
| | | | - Sai Prashanth Pinnamaneni
- Department of Conservative Dentistry and Endodontics, S Nijalingappa Institute of Dental Science and Research, Gulbarga, Karnataka, India
| | - Rahul VinayChandra Tiwari
- Department of OMFS, Narsinbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India
| |
Collapse
|
44
|
Andrei M, Vacaru RP, Coricovac A, Ilinca R, Didilescu AC, Demetrescu I. The Effect of Calcium-Silicate Cements on Reparative Dentinogenesis Following Direct Pulp Capping on Animal Models. Molecules 2021; 26:molecules26092725. [PMID: 34066444 PMCID: PMC8125639 DOI: 10.3390/molecules26092725] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 12/11/2022] Open
Abstract
Dental pulp vitality is a desideratum for preserving the health and functionality of the tooth. In certain clinical situations that lead to pulp exposure, bioactive agents are used in direct pulp-capping procedures to stimulate the dentin-pulp complex and activate reparative dentinogenesis. Hydraulic calcium-silicate cements, derived from Portland cement, can induce the formation of a new dentin bridge at the interface between the biomaterial and the dental pulp. Odontoblasts are molecularly activated, and, if necessary, undifferentiated stem cells in the dental pulp can differentiate into odontoblasts. An extensive review of literature was conducted on MedLine/PubMed database to evaluate the histological outcomes of direct pulp capping with hydraulic calcium-silicate cements performed on animal models. Overall, irrespective of their physico-chemical properties and the molecular mechanisms involved in pulp healing, the effects of cements on tertiary dentin formation and pulp vitality preservation were positive. Histological examinations showed different degrees of dental pulp inflammatory response and complete/incomplete dentin bridge formation during the pulp healing process at different follow-up periods. Calcium silicate materials have the ability to induce reparative dentinogenesis when applied over exposed pulps, with different behaviors, as related to the animal model used, pulpal inflammatory responses, and quality of dentin bridges.
Collapse
Affiliation(s)
- Mihai Andrei
- Division of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania; (M.A.); (R.P.V.); (A.C.)
| | - Raluca Paula Vacaru
- Division of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania; (M.A.); (R.P.V.); (A.C.)
| | - Anca Coricovac
- Division of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania; (M.A.); (R.P.V.); (A.C.)
| | - Radu Ilinca
- Division of Biophysics, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania;
| | - Andreea Cristiana Didilescu
- Division of Embryology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Boulevard, 050474 Bucharest, Romania; (M.A.); (R.P.V.); (A.C.)
- Correspondence: ; Tel.: +40-722536798
| | - Ioana Demetrescu
- Department of General Chemistry, University Politehnica Bucharest, Spl. Independentei 313, 060042 Bucharest, Romania;
- Academy of Romanian Scientists, 3 Ilfov, 050044 Bucharest, Romania
| |
Collapse
|
45
|
Shallal-Ayzin M, Trinh T, Yeung W, Tawil PZ, Haggerty CL, Wu D, Khan AA. A Prospective Analysis of the Correlation Between Postoperative Pain and Vital Pulp Therapy. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.647417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Vital pulp therapy (VPT) is a viable treatment option for carious teeth with exposed pulps. To our knowledge, no study has examined the correlation between postoperative pain and the outcome of VPT on asymptomatic permanent teeth. The aim of this study was to examine whether odontogenic pain experienced after VPT on asymptomatic teeth with a carious pulp exposures is correlated with the progression of pulpal disease into a more inflamed or necrotic state. Direct pulp caps or partial pulpotomies using a tricalcium silicate (MTA Angelus, Angelus, Londrina, Brazil) were performed on asymptomatic permanent teeth using a standardized protocol. Patients were contacted at 24 h, 1 week, and 3 months following treatment and data was collected on post-operative pain and analgesic intake using a standardized questionnaire. At 6 months after treatment, an in-person clinical exam was performed which included standard vitality tests along with exposure of a periapical radiograph. Success was defined as an asymptomatic, functional tooth without any clinical or radiographic pathology. Data was analyzed using logistic regression. VPT was successful in 84.3% of patients at the 6 months timepoint. The percentage of patients that experienced pain at 24-h, 1 week, and 3-month time periods was 38, 22, and 12%, respectively. Pain at 3 months was significantly correlated with decreased outcome (p = 0.028). This data suggests that postoperative pain in the first 3 months after VPT is predictive of a poor treatment outcome.
Collapse
|
46
|
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.
Collapse
|
47
|
Abo El‐Mal EO, Abu‐Seida AM, El Ashry SH. Biological evaluation of hesperidin for direct pulp capping in dogs' teeth. Int J Exp Pathol 2021; 102:32-44. [PMID: 33405328 PMCID: PMC7839952 DOI: 10.1111/iep.12385] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 11/17/2020] [Accepted: 11/29/2020] [Indexed: 02/05/2023] Open
Abstract
This study compared the biological effect of Hesperidin, Mineral Trioxide Aggregate (MTA)-Angelus and calcium hydroxide for direct pulp capping. A total of 126 dogs, teeth were divided according to the post-treatment evaluation period into three groups (42 teeth each), group I: 2 weeks, group II: 4 weeks and group III: 8 weeks. Each group was further subdivided according to the pulp capping material into three subgroups (14 teeth each), subgroup A (Hesperidin), subgroup B (MTA-Angelus) and subgroup C (Dycal). Both inflammatory response and dentine bridge formation were assessed by histopathology. All data were statistically analysed. Resolution of the inflammation was recorded by the time with a significant difference between subgroups within the same group (P<.05). Hesperidin, MTA-Angelus and Dycal showed either mild or moderate inflammation at 2 weeks with significant differences between subgroups (P < .05). At 4 and 8 weeks, there were no significant differences between subgroups (P > .05). Absence of complete or partial calcified bridge with no odontoblastic layer was reported in all subgroups at 2 weeks while at 4 weeks, the majority of samples in Hesperidin and MTA subgroups showed amorphous calcified deposit. At 8 weeks, there was no significant difference (P > .05) between subgroups except that 78.5% and 92.9% of Hesperidin and MTA-Angelus samples, respectively, showed moderate dentine bridge. Also, 78.5% of Hesperidin and Dycal samples revealed moderately thick dentine bridge while 78.7% of MTA-Angelus showed a thin dentine bridge with a significant difference between them (P < .05). In conclusion, Hesperidin is a promising pulp capping material inducing mild inflammation and good dentine bridge formation.
Collapse
Affiliation(s)
- Ebtesam O. Abo El‐Mal
- Department of EndodonticsFaculty of Dental and Oral SurgeryMisr University for Science and TechnologyGizaEgypt
| | - Ashraf M. Abu‐Seida
- Department of Surgery, Anesthesiology & RadiologyFaculty of Veterinary MedicineCairo UniversityGizaEgypt
| | - Salma H. El Ashry
- Department of EndodonticsFaculty of DentistryAin Shams UniversityCairoEgypt
| |
Collapse
|
48
|
Brusnitsyna EV, Barabanshchikova EV, Zakirov TV, Ioshchenko ES. Modern methods for treatment of deciduous teeth pulpitis: a literature review. Pediatr Dent 2021. [DOI: 10.33925/1683-3031-2020-20-4-275-287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
49
|
Kucukyildiz EN, Dayi B, Altin S, Yigit O. In vitro comparison of physical, chemical, and mechanical properties of graphene nanoplatelet added Angelus mineral trioxide aggregate to pure Angelus mineral trioxide aggregate and calcium hydroxide. Microsc Res Tech 2021; 84:929-942. [PMID: 33410148 DOI: 10.1002/jemt.23654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 11/11/2022]
Abstract
It is important to cover the pulp surface with a biocompatible material that is physically, mechanically, and chemically adequate. Graphene has the potential to form hard tissue, but at high doses, it shows toxic effects. It can be added to biocompatible materials at low doses to enhance their hard tissue forming potential. The aim of this study was to compare the physical, chemical, and mechanical properties of graphene nanoplatelet (GNP) added Angelus mineral trioxide aggregate (A-MTA) to pure A-MTA and calcium hydroxide. Homogeneous mixtures (created by adding +0.1 weight[wt]% and 0.3 wt% GNP to A-MTA), pure A-MTA, and Dycal were used. Three disc-shaped samples of each material were prepared using Teflon mold. Scanning electron microscope-energy dispersive X-ray (SEM-EDX), particle size, microhardness, and Fourier transform infrared spectroscopy (FTIR) analysis of the materials were performed in vitro. Data were analyzed using Kruskal-Wallis test followed by Conover test (p < .001). A-MTA and GNP added samples showed similar peaks in FTIR analysis. In the EDX analysis, the amount of carbon was observed with a higher increase at A-MTA + 0.3 wt% GNP than A-MTA + 0.1 wt% GNP. In the SEM image, hollow structure and particle size decreased as the amount of GNP increased; particle size was smaller at A-MTA + 0.3 wt% GNP than A-MTA + 0.1 wt% GNP (p < .001). A-MTA + 0.3 wt% GNP showed the highest microhardness while Dycal showed the lowest microhardness. The addition of GNP, a material with high potential for forming hard tissue, to the structure of capping materials can also positively contribute to the microhardness of the capping materials.
Collapse
Affiliation(s)
- Elif Nihan Kucukyildiz
- Department of Restorative Dentistry, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - Burak Dayi
- Department of Restorative Dentistry, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - Serdar Altin
- Department of Physics, Faculty of Science and Art, Inonu University, Malatya, Turkey
| | - Oktay Yigit
- Department of Metallurgical and Materials Engineering, Faculty of Technology, Firat University, Elazig, Turkey
| |
Collapse
|
50
|
Cushley S, Duncan HF, Lappin MJ, Chua P, Elamin AD, Clarke M, El-Karim IA. Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta-analysis. Int Endod J 2020; 54:556-571. [PMID: 33222178 DOI: 10.1111/iej.13449] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The outcome of vital pulp treatment after carious pulp exposure is multifactorial and related to the procedure, biomaterial and pre-operative pulpal diagnosis. OBJECTIVES To conduct a systematic review and meta-analysis determining the outcome of direct pulp capping (DPC) in mature permanent teeth with a cariously exposed pulp and a clinical diagnosis of reversible pulpitis, and ascertain whether the capping material influences the outcome. METHODS Sources: MEDLINE Ovid-SP, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Embase and Web of Science until April 2020. Inclusion: Prospective, retrospective cohort studies and randomized trials investigating DPC outcome or comparing different capping materials after carious pulp exposure. Exclusion: Primary teeth, mechanical, traumatic or not specified pulp exposure, teeth with irreversible pulpitis or no pulpal diagnosis. Risk of bias assessed using Cochrane and modified Downs and Black quality assessment checklist. Meta-analysis on combined clinical/radiographic outcome was performed using a random effect model. Success was defined as absence of signs and symptoms of irreversible pulpitis, apical periodontitis or loss of pulp vitality. RESULTS Quality assessment highlighted four non-randomized studies to be of fair and five of poor quality. Four randomized trials had a high risk of bias. The pooled success rate differed based on material and follow-up. Calcium hydroxide success rate was 74% at 6-months, 65% at 1-year, 59% at 2-3 years and 56% at 4-5 years. Mineral trioxide aggregate (MTA) success was 91%, 86%, 84% and 81% at the same time points. Biodentine success was 96% at 6-months, 86% at 1 year and 86% at 2-3 years. The meta-analysis revealed MTA had better success than calcium hydroxide at 1-year (OR 2.66, 95% CI; 1.46- 4.84, P = 0.001) and 2- to 3-year follow-up (OR 2.21, 95% CI; 1.42-3.44, P = 0.0004). There was no difference between MTA and Biodentine. DISCUSSION These results were based on poor methodological quality studies. The effect size for of MTA vs Ca(OH)2, although modest, was consistent with narrow CI. CONCLUSIONS Low-quality evidence suggests a high success rate for direct pulp capping in teeth with cariously exposed pulps with better long-term outcomes for MTA and Biodentine compared with calcium hydroxide.
Collapse
Affiliation(s)
- S Cushley
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - H F Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - M J Lappin
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - P Chua
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - A D Elamin
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - M Clarke
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - I A El-Karim
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| |
Collapse
|