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Yoneda M, Ideguchi H, Nakamura S, Arias Z, Ono M, Omori K, Yamamoto T, Takashiba S. Resolvin D2-induced reparative dentin and pulp stem cells after pulpotomy in a rat model. Heliyon 2024; 10:e34206. [PMID: 39091941 PMCID: PMC11292553 DOI: 10.1016/j.heliyon.2024.e34206] [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: 01/20/2024] [Revised: 06/12/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction Vital pulp therapy (VPT) is performed to preserve dental pulp. However, the biocompatibility of the existing materials is of concern. Therefore, novel materials that can induce pulp healing without adverse effects need to be developed. Resolvin D2 (RvD2), one of specialized pro-resolving mediators, can resolve inflammation and promote the healing of periapical lesions. Therefore, RvD2 may be suitable for use in VPT. In the present study, we evaluated the efficacy of RvD2 against VPT using in vivo and in vitro models. Methods First molars of eight-week-old male Sprague-Dawley rats were used for pulpotomy. They were then divided into three treatment groups: RvD2, phosphate-buffered saline, and calcium hydroxide groups. Treatment results were assessed using radiological, histological, and immunohistochemical (GPR18, TNF-α, Ki67, VEGF, TGF-β, CD44, CD90, and TRPA1) analyses. Dental pulp-derived cells were treated with RvD2 in vitro and analyzed using cell-proliferation and cell-migration assays, real-time PCR (Gpr18, Tnf-α, Il-1β, Tgf-β, Vegf, Nanog, and Trpa1), ELISA (VEGF and TGF-β), immunocytochemistry (TRPA1), and flow cytometry (dental pulp stem cells: DPSCs). Results The formation of calcified tissue in the pulp was observed in the RvD2 and calcium hydroxide groups. RvD2 inhibited inflammation in dental pulp cells. RvD2 promoted cell proliferation and migration and the expression of TGF-β and VEGF in vitro and in vivo. RvD2 increased the number of DPSCs. In addition, RvD2 suppressed TRPA1 expression as a pain receptor. Conclusion RvD2 induced the formation of reparative dentin, anti-inflammatory effects, and decreased pain, along with the proliferation of DPSCs via the expression of VEGF and TGF-β, on the pulp surface in pulpotomy models.
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Affiliation(s)
- Mitsuhiro Yoneda
- Department of Periodontics and Endodontics, Division of Dentistry, Okayama University Hospital, Japan
| | - Hidetaka Ideguchi
- Department of Pathophysiology-Periodontal Science, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Shin Nakamura
- Department of Oral Science and Translational Research, College of Dental Medicine, Nova Southeastern University, USA
| | - Zulema Arias
- Department of Pathophysiology-Periodontal Science, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Mitsuaki Ono
- Department of Molecular Biology and Biochemistry, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Kazuhiro Omori
- Department of Pathophysiology-Periodontal Science, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Tadashi Yamamoto
- The Center for Graduate Medical Education (Dental Division), Okayama University Hospital, Japan
| | - Shogo Takashiba
- Department of Pathophysiology-Periodontal Science, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
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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.
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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
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Duncan HF, Kobayashi Y, Kearney M, Shimizu E. Epigenetic therapeutics in dental pulp treatment: Hopes, challenges and concerns for the development of next-generation biomaterials. Bioact Mater 2023; 27:574-593. [PMID: 37213443 PMCID: PMC10199232 DOI: 10.1016/j.bioactmat.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
This opinion-led review paper highlights the need for novel translational research in vital-pulp-treatment (VPT), but also discusses the challenges in translating evidence to clinics. Traditional dentistry is expensive, invasive and relies on an outmoded mechanical understanding of dental disease, rather than employing a biological perspective that harnesses cell activity and the regenerative-capacity. Recent research has focussed on developing minimally-invasive biologically-based 'fillings' that preserve the dental pulp; research that is shifting the paradigm from expensive high-technology dentistry, with high failure rates, to smart restorations targeted at biological processes. Current VPTs promote repair by recruiting odontoblast-like cells in a material-dependent process. Therefore, exciting opportunities exist for development of next-generation biomaterials targeted at regenerative processes in the dentin-pulp complex. This article analyses recent research using pharmacological-inhibitors to therapeutically-target histone-deacetylase (HDAC) enzymes in dental-pulp-cells (DPCs) that stimulate pro-regenerative effects with limited loss of viability. Consequently, HDAC-inhibitors have the potential to enhance biomaterial-driven tissue responses at low concentration by influencing the cellular processes with minimal side-effects, providing an opportunity to develop a topically-placed, inexpensive bio-inductive pulp-capping material. Despite positive results, clinical translation of these innovations requires enterprise to counteract regulatory obstacles, dental-industry priorities and to develop strong academic/industry partnerships. The aim of this opinion-led review paper is to discuss the potential role of therapeutically-targeting epigenetic modifications as part of a topical VPT strategy in the treatment of the damaged dental pulp, while considering the next steps, material considerations, challenges and future for the clinical development of epigenetic therapeutics or other 'smart' restorations in VPT.
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Affiliation(s)
- Henry F. Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Lincoln Place, Dublin, Ireland
| | - Yoshifumi Kobayashi
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Michaela Kearney
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Lincoln Place, Dublin, Ireland
| | - Emi Shimizu
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, USA
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Duncan HF, El-Karim I, Dummer PMH, Whitworth J, Nagendrababu V. Factors that influence the outcome of pulpotomy in permanent teeth. Int Endod J 2023; 56 Suppl 2:62-81. [PMID: 36334098 DOI: 10.1111/iej.13866] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
The promotion of minimally invasive treatments focussed on the maintenance of pulp vitality has become a priority area in Endodontics. These vital pulp treatments (VPT) include partial and full pulpotomy, during which diseased coronal pulp tissue is removed prior to placement of a capping biomaterial and restoration. Traditionally, pulpotomies were confined to the treatment of carious primary and traumatized permanent teeth. However, these treatments have now been proposed as definitive solutions for cariously exposed permanent teeth with mild symptoms or even symptoms indicative of irreversible disease. Until recently, it was recommended that carious exposure of mature permanent teeth be managed by root canal treatment. The promotion of pulpotomy as an alternative treatment has opened up a wave of laboratory and clinical research aimed at improving therapies or evaluating clinical outcomes. In modern evidence-based endodontics, it is imperative that the outcomes of both partial and full pulpotomy are considered and important prognostic factors identified, so that improvements can be made to aid clinical decision-making and to direct new research. In this narrative review, the outcomes of partial and full pulpotomy are discussed, before analysis of patient, intraoperative and postoperative factors that influence the outcome of the pulpotomy procedure. The review highlights that although partial and full pulpotomy for the treatment of even pulpal disease are highly successful procedures, this is based on low-quality evidence with a lack of prospective, comparative trials investigating potential prognostic factors. Based on current evidence, it appears that age, gender, tooth type, root development and intraoperative pulpal haemorrhage do not impact significantly on pulpotomy outcome, whilst others such as caries depth, inflammatory status of the pulp, capping material, level of inflammatory pulpal-biomarkers and the final restoration integrity do. Other factors, including the influence of exposure type, periodontal condition, pulpal lavage, magnification, operator experience, isolation of the operating field and type of pulpotomy, require further experimental investigation before definitive conclusions can be made relating to the success of the pulpotomy procedure. Finally, there is not only a need for future well-designed prospective research addressing these issues but also a widening of our understanding of outcome to include patient-reported as well as clinician-reported outcomes.
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Affiliation(s)
- Henry F Duncan
- Division of Restorative Dentistry & Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Ikhlas El-Karim
- School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - John Whitworth
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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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.
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Careddu R, Duncan HF. A prospective clinical study investigating the effectiveness of partial pulpotomy after relating preoperative symptoms to a new and established classification of pulpitis. Int Endod J 2021; 54:2156-2172. [PMID: 34490637 DOI: 10.1111/iej.13629] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 01/16/2023]
Abstract
AIM To prospectively investigate the outcome of partial pulpotomy after 1 year, using a hydraulic calcium silicate cement (HCSC) on symptomatic cariously exposed pulps in adult teeth. To compare the traditional American Association of Endodontists (AAE) pulpitis classification with the recently proposed Wolters classification system in predicting the likelihood of treatment failure. METHODOLOGY Sixty-two symptomatic adult teeth with deep and extremely deep carious lesions were classified according to the Wolters (mild/moderate/severe pulpitis) and the traditional pulpitis classification (reversible/irreversible pulpitis). Eleven teeth were excluded intraoperatively as there was no pulp exposure after non-selective caries removal. The remaining 51 teeth, regardless of diagnosis, were treated by partial pulpotomy, pulpal lavage with 2.5% sodium hypochlorite solution, haemostasis and HCSC application (Biodentine™) as a pulp capping material. A permanent restoration was placed during a second appointment 1-2 weeks later. Preoperative tenderness to percussion (TTP), bleeding time and material setting time were recorded as was preoperative and postoperative tooth colour under standardized conditions. Clinical review occurred at regular intervals with clinical/radiographic analysis at 12 months. Chi-square analysis and Fisher's exact test assessed different outcomes amongst the diagnostic categories; the Kruskal-Wallis and Wilcoxon rank-sum test assessed influence of pulp bleeding time, TTP or variation in setting time (p < .05). RESULTS Ten cases were lost to review, and a total of 41 teeth were reviewed at 1 year and classified as either "success," "successful but unresponsive to sensibility testing" or "failed." This included five severe, 17 moderate and 19 mild pulpitis according to Wolters classification or 23 reversible pulpitis and 18 irreversible pulpitis cases by the AAE classification. The majority of the 62 enrolled cases were "extremely deep" (n = 50), rather than "deep" (n = 12) caries with all failures occurring in the extremely deep group. Partial pulpotomy was 90% successful (100% reversible, 78% irreversible or 100% mild, 88% moderate, 60% severe pulpitis) with a significant difference in outcome between mild and severe pulpitis groups (p = .04). Only one, severe pulpitis/irreversible pulpitis, case failed painfully prior to the 1-year review appointment. Bleeding time (p = .26) and TTP (p = .61) did not influence treatment outcome, whilst Biodentine™ setting time was significantly longer than manufacturers' claim (p < .05). No teeth discoloured. CONCLUSIONS Partial pulpotomy using Biodentine™ was successful for treating symptomatic carious pulpal exposures after 1 year, but included cases where pulp vitality could not be confirmed. Within the limitations of this study, cases with signs and symptoms indicative of irreversible pulpitis were not less successful; however, Wolters classification highlighted severe pulpitis to be less successful than mild pulpitis, thereby providing a potential prognostic benefit in diagnostically subdividing pulpitis. Caries depth was an indicator of failure, whilst bleeding time and preoperative tenderness to percussion were not.
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Affiliation(s)
- Roberto Careddu
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Henry F Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
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Yoon JH, Choi SH, Koh JT, Lee BN, Chang HS, Hwang IN, Oh WM, Hwang YC. Hard tissue formation after direct pulp capping with osteostatin and MTA in vivo. Restor Dent Endod 2021; 46:e17. [PMID: 34123753 PMCID: PMC8170379 DOI: 10.5395/rde.2021.46.e17] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives In recent in vitro study, it was reported that osteostatin (OST) has an odontogenic effect and synergistic effect with mineral trioxide aggregate (MTA) in human dental pulp cells. Therefore, the aim of this study was to evaluate whether OST has a synergistic effect with MTA on hard tissue formation in vivo. Materials and Methods Thirty-two maxillary molars of Spraque-Dawley rats were used in this study. An occlusal cavity was prepared and the exposed pulps were randomly divided into 3 groups: group 1 (control; ProRoot MTA), group 2 (OST 100 μM + ProRoot MTA), group 3 (OST 10 mM + ProRoot MTA). Exposed pulps were capped with each material and cavities were restored with resin modified glass ionomer. The animals were sacrificed after 4 weeks. All harvested teeth were scanned with micro-computed tomography (CT). The samples were prepared and hard tissue formation was evaluated histologically. For immunohistochemical analysis, the specimens were sectioned and incubated with primary antibodies against dentin sialoprotein (DSP). Results In the micro-CT analysis, it is revealed that OST with ProRoot MTA groups showed more mineralized bridge than the control (p < 0.05). In the H&E staining, it is showed that more quantity of the mineralized dentin bridge was formed in the OST with ProRoot MTA group compared to the control (p < 0.05). In all groups, DSP was expressed in newly formed reparative dentin area. Conclusions OST can be a supplementary pulp capping material when used with MTA to make synergistic effect in hard tissue formation.
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Affiliation(s)
- Ji-Hye Yoon
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Sung-Hyeon Choi
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Jeong-Tae Koh
- Department of Pharmacology and Dental Therapeutics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Bin-Na Lee
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Hoon-Sang Chang
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - In-Nam Hwang
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Won-Mann Oh
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
| | - Yun-Chan Hwang
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea
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Nagendrababu V, Kishen A, Murray PE, Nekoofar MH, de Figueiredo JAP, Priya E, Jayaraman J, Pulikkotil SJ, Camilleri J, Silva RM, Dummer PMH. PRIASE 2021 guidelines for reporting animal studies in Endodontology: a consensus-based development. Int Endod J 2021; 54:848-857. [PMID: 33450080 DOI: 10.1111/iej.13477] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/10/2023]
Abstract
Animal testing is crucial in situations when research on humans is not allowed because of unknown health risks and ethical concerns. The current project aims to develop reporting guidelines exclusively for animal studies in Endodontology, using an established consensus-based methodology. The guidelines have been named: Preferred Reporting Items for Animal Studies in Endodontology (PRIASE) 2021. Nine individuals (PD, VN, AK, PM, MN, JF, EP, JJ and SJ), including the project leaders (PD, VN) formed a steering committee. The steering committee developed a novel checklist by adapting and integrating their animal testing and peer review experience with the Animals in Research: Reporting In Vivo Experiments (ARRIVE) guidelines and also the Clinical and Laboratory Images in Publications (CLIP) principles. A PRIASE Delphi Group (PDG) and PRIASE Online Meeting Group (POMG) were also formed. Thirty-one PDG members participated in the online Delphi process and achieved consensus on the checklist items and flowchart that were used to formulate the PRIASE guidelines. The novel PRIASE 2021 guidelines were discussed with the POMG on 9 September 2020 via a Zoom online video call attended by 21 individuals from across the globe and seven steering committee members. Following the discussions, the guidelines were modified and then piloted by several authors whilst writing a manuscript involving research on animals. The PRIASE 2021 guidelines are a checklist consisting of 11 domains and 43 individual items together with a flowchart. The PRIASE 2021 guidelines are focused on improving the methodological principles, reproducibility and quality of animal studies in order to enhance their reliability as well as repeatability to estimate the effects of endodontic treatments and usefulness for guiding future clinical studies on humans.
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Affiliation(s)
- V Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - A Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - P E Murray
- Private Consultant, Fort Lauderdale, FL, USA
| | - M H Nekoofar
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - E Priya
- Division of Children and Community Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - J Jayaraman
- Department of Developmental Dentistry, University of Texas Health School of Dentistry, San Antonio, TX, USA
| | - S J Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - J Camilleri
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - R M Silva
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Careddu R, Plotino G, Cotti E, Duncan HF. The management of deep carious lesions and the exposed pulp amongst members of two European endodontic societies: a questionnaire-based study. Int Endod J 2020; 54:366-376. [PMID: 32970860 DOI: 10.1111/iej.13418] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
AIMS To investigate and compare views on management of deep caries and the exposed pulp by Endodontic Society members in Ireland (Irish Endodontic Society [IES]) and Italy (Accademia Italiana di Endodonzia [AIE]). Further aims were to investigate the influence of patient-related factors (age, symptoms) and operator-related factors (material choice, antibiotics) on management. METHODOLOGY A structured online questionnaire containing two cases (an 18- and 45-year-old) and two scenarios (± mild symptoms), including history and radiograph, was sent to IES and AIE members. The answers were analysed using chi-square and Fisher's exact test (P < 0.05). RESULTS In total, 120 dentists participated, representing 49% of the AIE and 48% of the IES membership. Age distribution was similar between the societies; however, most AIE members had no further qualifications (63%), while IES respondents generally had a postgraduate endodontic qualification (71%). AIE respondents carried out a larger volume of vital pulp treatment (VPT) per month, with 69% carrying out over five cases, compared with 22% of IES respondents. The presence of patient symptoms significantly altered treatment planning decisions (P < 0.001) with root canal treatment (RCT) more frequently selected in both societies. Patient age significantly influenced treatment choice in the absence (P = 0.043) or presence (P = 0.012) of symptoms with less VPT advocated in older patients. There were no significant differences in the treatment of a young patient in the presence (P = 0.302) or absence of symptoms (P = 0.297); however, older patient management differed between the societies for symptomatic (P = 0.041) and asymptomatic scenarios (P = 0.044) with significantly more RCTs carried out in the AIE than the IES. Hydraulic calcium silicate materials were commonly selected, accounting for 81% of IES and 69% of AIE VPT materials, although younger members of the AIE preferred calcium hydroxide materials. Younger dentists in both societies prescribed less RCT than older age groups. CONCLUSIONS Although VPT is carried out by members of both societies there was no consistency regarding the most appropriate management for the exposed pulp or the VPT material of choice. Patient symptoms and age significantly influence the decision-making process and invasiveness of treatment. Hydraulic calcium silicate materials were the most commonly advocated material in all groups except young AIE members who preferred calcium hydroxide.
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Affiliation(s)
- R Careddu
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | | | - E Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - H F Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
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Paula A, Carrilho E, Laranjo M, Abrantes AM, Casalta-Lopes J, Botelho MF, Marto CM, Ferreira MM. Direct Pulp Capping: Which is the Most Effective Biomaterial? A Retrospective Clinical Study. MATERIALS 2019; 12:ma12203382. [PMID: 31623190 PMCID: PMC6829284 DOI: 10.3390/ma12203382] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/05/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022]
Abstract
(1) Background: Recently, tricalcium silicate cements, such as Biodentine™, have emerged. This biomaterial has a calcium hydroxide base and characteristics like mineral aggregate trioxide cements, but has tightening times that are substantially more suitable for their application and other clinical advantages. (2) Methods: A retrospective clinical study was conducted with 20 patients, which included a clinical evaluation of the presence or absence of pulp inflammation compatible symptoms, radiographic evaluation of the periapical tissues, and structural alterations of the coronary restoration that supports pulp capping therapies with Biodentine™ and WhiteProRoot®MTA. (3) Results: This clinical study revealed similar success rates between mineral trioxide cement and tricalcium silicates cements at 6 months, with 100% and 95% success rates, respectively. There were no statistically significant differences between both biomaterials and between these and the various clinical circumstances, namely the absolute isolation of the operating field, exposure size, the aetiology of exposure, and even the type of restorative material used. (4) Conclusions: Biodentine™ demonstrated a therapeutic effect on the formation of a dentin bridge accompanied by slight inflammatory signs, with a high clinical success rate, indicating the possibility of its effective and safe use in dental pulp direct capping in humans, similar to the gold standard material.
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Affiliation(s)
- Anabela Paula
- Institute of Integrated Clinical Practice, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal.
| | - Eunice Carrilho
- Institute of Integrated Clinical Practice, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal.
| | - Mafalda Laranjo
- Biophysics Institute, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI Consortium, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Ana M Abrantes
- Biophysics Institute, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI Consortium, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - João Casalta-Lopes
- Biophysics Institute, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI Consortium, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
- Radiation Oncology Department, Coimbra University Hospital Centre, 3000-548 Coimbra, Portugal.
| | - Maria Filomena Botelho
- Biophysics Institute, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI Consortium, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Carlos Miguel Marto
- Institute of Experimental Pathology, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Manuel M Ferreira
- Institute of Endodontics, Institute for Clinical and Biomedical Research (iCBR), Centre for Innovative Biomedicine and Biotechnology (CIBB), Area of Environment Genetics and Oncobiology (CIMAGO), CNC.IBILI, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal.
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Suzuki M, Kato C, Kawashima S, Shinkai K. Clinical and Histological Study on Direct Pulp Capping With CO 2 Laser Irradiation in Human Teeth. Oper Dent 2018; 44:336-347. [PMID: 30444691 DOI: 10.2341/18-030-c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The study aimed to histologically evaluate wound healing of exposed human pulp on direct pulp capping using super-pulsed CO2 laser preirradiation. In this single-blind clinical trial, 28 third molar teeth of 17 volunteers were randomly capped with either CO2 laser irradiation (n=14) or Dycal (calcium hydroxide cement; n=14) and restored using resin composite. The laser was operated in super-pulsed mode (pulse duration, 0.2 ms; interval, 5.8 ms; 0.003 J/pulse). The irradiation conditions were a power output of 0.5 W, an irradiation time of 15 seconds, repeat mode (10-ms irradiation and 10-ms intervals, for a total beam exposure time of 7.5 seconds), total applied energy of 3.75 J, and an activated air-cooling system. Each tooth was extracted at six or 12 months posttreatment and prepared for histological evaluation. We evaluated the parameters of pulp tissue disorganization, inflammatory cell infiltration, reparative dentin formation (RDF), and bacterial penetration. There were no significant differences between groups for all parameters at each postoperative period (Mann-Whitney U-test, p>0.05). CO2 laser irradiation completely controlled bleeding and exudate from the exposed pulp. The CO2 laser group had a tendency to delay RDF compared with the Dycal group, but 4 of 7 teeth from the CO2 laser group showed a complete dentin bridge at 12 months posttreatment.
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Didilescu AC, Cristache CM, Andrei M, Voicu G, Perlea P. The effect of dental pulp-capping materials on hard-tissue barrier formation: A systematic review and meta-analysis. J Am Dent Assoc 2018; 149:903-917.e4. [PMID: 30098704 DOI: 10.1016/j.adaj.2018.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The authors of this systematic review aimed to compare the effects of pulp-capping materials on hard-tissue barrier formation using histologic assessments. TYPE OF STUDIES REVIEWED The authors included randomized controlled trials and controlled clinical trials in humans, with vital therapies performed on healthy permanent teeth undergoing experimental mechanical pulp exposures. They searched electronically in the PubMed, Cochrane, Embase, and Summon databases and carried out a manual search. Twenty-seven full-text articles were eligible for inclusion in the systematic review. After data extraction, the authors performed 2 sets of meta-analyses with odds ratios (OR) and their 95% confidence intervals (CI) on 22 studies. Ten studies compared mineral trioxide aggregate (MTA) with calcium hydroxide (CH), and 12 compared bonding agents with CH. The authors assessed bias by means of Cochrane Collaboration's tool for assessing risk, funnel plots, and Harbord test. RESULTS The use of MTA was associated with a higher rate of hard-tissue barrier formation than CH. The OR comparing the 2 groups was 2.45 (95% CI, 1.39 to 4.29; P = .002). Use of bonding agents was associated with a lower rate of hard-tissue barrier formation than CH. The OR comparing the 2 groups was 0.02 (95% CI, 0.01 to 0.05; P < .001). CONCLUSIONS AND PRACTICAL IMPLICATIONS The results suggest that MTA and CH have positive effects on hard-tissue barrier formation. On the basis of the evidence, the authors conclude that MTA has better effects than CH regarding dental pulp protection in the capping of mechanical pulp exposures. Conversely, bonding agents are inferior to CH.
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Paula AB, Laranjo M, Marto CM, Paulo S, Abrantes AM, Casalta-Lopes J, Marques-Ferreira M, Botelho MF, Carrilho E. Direct Pulp Capping: What is the Most Effective Therapy?-Systematic Review and Meta-Analysis. J Evid Based Dent Pract 2018; 18:298-314. [PMID: 30514444 DOI: 10.1016/j.jebdp.2018.02.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/05/2018] [Accepted: 02/05/2018] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Direct pulp capping therapies use biomaterials to protect exposed tissues, inducing repair through the production of a mineralized barrier. The purpose of this study was to compare the effectiveness of biomaterials and techniques by means of a systematic review and meta-analysis. METHODS The PubMed, Cochrane, and Embase databases were used to search the literature published from January 1, 1980 until August 31, 2017. Studies that met inclusion criteria were screened by 2 authors individually. The meta-analysis was performed on mineral trioxide aggregate (MTA) cement vs calcium hydroxide cement, tricalcium silicate cement vs MTA cement, and adhesive systems vs CaOH cement and evaluated the success rate, inflammatory response, and dentin bridge formation. RESULTS Forty-six studies were included in the systematic review, while 22 studies were included in the meta-analysis. There was no significant heterogeneity between the studies. MTA cements showed a significantly higher success rate, in all parameters, compared with calcium hydroxide cements (odds ratio = 2.72; 95% confidence interval [CI] = 1.90-3.90; P = 0.000). However, when compared with the tricalcium silicate cements, there were no statistically significant differences (odds ratio = 1.18; 95% CI = 0.53-2.65; P = 0.672). Adhesive systems showed a significantly lower success rate, in all parameters, compared with calcium hydroxide cements (odds ratio = 0.062; 95% CI = 0.024-0.157; P = 0.000). CONCLUSIONS MTA cements have a higher success rate, with a lower inflammatory response and a more predictable hard dentin barrier formation than calcium hydroxide cements. However, there were no differences, in these parameters, when MTA cement was compared with tricalcium silicate cements. Dental adhesives systems showed the lowest success rates.
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Affiliation(s)
- Anabela B Paula
- Dentistry Area, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI, University of Coimbra, Coimbra, Portugal.
| | - Mafalda Laranjo
- Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - Carlos-Miguel Marto
- Dentistry Area, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI, University of Coimbra, Coimbra, Portugal; Experimental Pathology Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Siri Paulo
- Dentistry Area, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - Ana M Abrantes
- Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - João Casalta-Lopes
- Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Radiation Oncology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Manuel Marques-Ferreira
- Dentistry Area, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - Maria Filomena Botelho
- Dentistry Area, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI, University of Coimbra, Coimbra, Portugal
| | - Eunice Carrilho
- Dentistry Area, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Biophysics Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; CNC.IBILI, University of Coimbra, Coimbra, Portugal
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Parirokh M, Torabinejad M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy. Int Endod J 2017; 51:177-205. [PMID: 28836288 DOI: 10.1111/iej.12841] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/21/2017] [Indexed: 01/09/2023]
Abstract
Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick-Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term 'bioactive endodontic cements (BECs)', which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.
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Affiliation(s)
- M Parirokh
- Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - M Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Komabayashi T, Zhu Q, Eberhart R, Imai Y. Current status of direct pulp-capping materials for permanent teeth. Dent Mater J 2017; 35:1-12. [PMID: 26830819 DOI: 10.4012/dmj.2015-013] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Direct pulp-capping is a method for treating exposed vital pulp with dental material to facilitate the formation of reparative dentin and to maintain vital pulp. Two types of pulp-capping materials, calcium hydroxide and mineral trioxide aggregate, have been most commonly used in clinics, and an adhesive resin has been considered a promising capping material. However, until now, there has been no comprehensive review of these materials. Therefore, in this paper, the composition, working mechanisms and clinical outcome of these types of pulp-capping materials are reviewed.
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Characterization of Chlorhexidine-Loaded Calcium-Hydroxide Microparticles as a Potential Dental Pulp-Capping Material. Bioengineering (Basel) 2017; 4:bioengineering4030059. [PMID: 28952538 PMCID: PMC5615305 DOI: 10.3390/bioengineering4030059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 12/02/2022] Open
Abstract
This study explores the delivery of novel calcium hydroxide [Ca(OH)2] microparticles loaded with chlorhexidine (CHX) for potential dental therapeutic and preventive applications. Herein, we introduce a new approach for drug-delivery to deep dentin-surfaces in the form of drug-loaded microparticles. Unloaded Ca(OH)2 [Ca(OH)2/Blank] and CHX-loaded/Ca(OH)2 microparticles were fabricated by aqueous chemical-precipitation technique. The synthesized-microparticles were characterized in vitro for determination of surface-morphology, crystalline-features and thermal-properties examined by energy-dispersive X-ray scanning and transmission electron-microscopy (EDX-SEM/TEM), Fourier-transform infrared-spectroscopy (FTIR), X-ray diffraction (XRD), thermogravimetric analysis (TGA) and differential scanning-calorimetry (DSC). Time-related pH changes, initial antibacterial/biofilm-abilities and cytotoxicity of CHX-loaded/Ca(OH)2 microparticles were evaluated. Microparticles were delivered to dentin-surfaces with subsequent SEM examination of treated dentin-substrates. The in vitro and ex vivo CHX-release profiles were characterized. Ca(OH)2/Blank were hexagonal-shaped with highest z-average diameter whereas CHX-inclusion evidenced micro-metric spheres with distinguishable surface “rounded deposits” and a negative-shift in diameter. CHX:Ca(OH)2/50 mg exhibited maximum encapsulation-efficiency with good antibacterial and cytocompatible properties. SEM examination revealed an intact layer of microparticles on exposed dentin-surfaces with retention of spherical shape and smooth texture. Microparticles loaded on dentin-surfaces showed prolonged release of CHX indicating substantial retention on dentin-substrates. This study validated the inherent-applicability of this novel drug-delivery approach to dentin-surfaces using micro-metric CHX-loaded/Ca(OH)2 microparticles.
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Suzuki M, Taira Y, Kato C, Shinkai K, Katoh Y. Histological evaluation of direct pulp capping of rat pulp with experimentally developed low-viscosity adhesives containing reparative dentin-promoting agents. J Dent 2016; 44:27-36. [DOI: 10.1016/j.jdent.2015.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 11/17/2015] [Accepted: 11/21/2015] [Indexed: 11/25/2022] Open
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Abstract
Direct pulp capping helps extend the life of a diseased tooth by maintaining tooth vitality. Nowadays, lasers are more frequently used during direct pulp capping in the clinic, but their use has not been previously reviewed. This review presents the basic properties of currently available lasers, scientific evidence on the effects of laser application on direct pulp capping, and future directions for this technology. An extensive literature search was conducted in various databases for articles published up to January 2015. Original in vitro, in vivo, and clinical studies, reviews, and book chapters published in English were included. Various laser systems have been increasingly and successfully applied in direct pulp capping. Lasers offer excellent characteristics in terms of hemostasis and decontamination for field preparation during direct pulp capping treatment; however, the sealing of exposed pulp with one of the dental materials, such as calcium hydroxide, mineral trioxide aggregates, and bonded composite resins, is still required after laser treatment. Clinicians should consider the characteristics of each wavelength, the emission mode, irradiation exposure time, power, type of laser tip, and the distance between the laser tip and the surface being irradiated.
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19
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Schmalz G, Widbiller M, Galler KM. Material Tissue Interaction--From Toxicity to Tissue Regeneration. Oper Dent 2015; 41:117-31. [PMID: 26645359 DOI: 10.2341/15-249-bl] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The topic of material tissue interaction has gained increasing interest over recent decades from both the dental profession and the public. The primary goal initially was to avoid adverse reactions after the application of dental materials. New laboratory test methods have been developed, and currently premarket testing programs, which attempt to guarantee a basic level of patient safety, are legally required worldwide. The dentist is responsible for selecting the correct indication as well as the proper handling of any newly emerging risk. Apart from this phenomenon-oriented "inert materials concept," the "analytical concept" focuses primarily on analyzing the reasons for adverse reactions, and identifying their associated modifying factors, in order to prevent them or to develop new and more biocompatible materials. The "concept of bioactivity" involves addressing the possibility of positively influencing tissue by materials application, such as the generation of tertiary dentin or antibacterial effects. Finally, tissue regeneration may be supported and promoted by the use of various suitable materials (matrices/scaffolds) into which stem cells can migrate or be seeded, leading to cell differentiation and the generation of new tissue. These new dental materials must also fulfill additional requirements such as controlled degradability in order to be suitable for clinical use. Clearly, the field of material tissue interaction is complex and comprises a wide range of issues. To be successful as dentists in the future, practitioners should remain informed of these important new developments and have the argumentative competence to both properly advise and treat their patients.
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Dentinogenic Specificity in the Preclinical Evaluation of Vital Pulp Treatment Strategies: A Critical Review. Dent J (Basel) 2015; 3:133-156. [PMID: 29567934 PMCID: PMC5851195 DOI: 10.3390/dj3040133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 11/16/2015] [Accepted: 11/20/2015] [Indexed: 11/17/2022] Open
Abstract
Reviews on the clinical performance of vital pulp treatment strategies and capping materials repeatedly showed an insufficient grade of evidence concerning their therapeutic validity. The biological mechanisms underlying the regenerative potential of pulp-dentin complex have attracted much attention during the last two decades, since new pulp treatment modalities have been designed and tested at the preclinical level. It has been recognized that evaluation should be based on the specific ability of therapeutic interventions to signal recruitment and differentiation of odontoblast-like cells forming a matrix in a predentin-like pattern, rather than uncontrolled hard tissue deposition in a scar-like form. The aim of the present article was to critically review data from histological experimental studies on pulp capping, published during the last 7 decades. A comprehensive literature search covering the period from 1949 to 2015 was done using the Medline/Pubmed database. Inclusion of a study was dependent on having sufficient data regarding the type of capping material used and the unit of observation (human permanent tooth in vivo or animal permanent dentition; primary teeth were excluded). The post-operatively deposited matrix was categorized into three types: unspecified, osteotypic, or dentin-like matrix. One hundred fifty-two studies were included in the final evaluation. Data from the present systematic review have shown that only 30.2% of the 152 experimental histological pulp capping studies described the heterogenic nature of the hard tissue bridge formation, including osteotypic and tubular mineralized tissue. Structural characteristics of the new matrix and the associated formative cells were not provided by the remaining 106 studies. Analysis showed that more careful preclinical evaluation with emphasis on the evidence regarding the dentinogenic specificity of pulp therapies is required. It seems that selection of appropriate vital pulp treatment strategies and pulp capping materials would be further facilitated in terms of their therapeutic validity if international consensus could be reached on a select number of mandatory criteria for tissue-specific dentinogenic events.
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Fransson H, Wolf E, Petersson K. Formation of a hard tissue barrier after experimental pulp capping or partial pulpotomy in humans: an updated systematic review. Int Endod J 2015; 49:533-42. [DOI: 10.1111/iej.12480] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 06/05/2015] [Indexed: 12/13/2022]
Affiliation(s)
- H. Fransson
- Department of Endodontics; Faculty of Odontology; Malmö University; Malmö Sweden
| | - E. Wolf
- Department of Endodontics; Faculty of Odontology; Malmö University; Malmö Sweden
| | - K. Petersson
- Department of Endodontics; Faculty of Odontology; Malmö University; Malmö Sweden
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Kwon JH, Park HC, Zhu T, Yang HC. Inhibition of odontogenic differentiation of human dental pulp cells by dental resin monomers. Biomater Res 2015; 19:8. [PMID: 26331079 PMCID: PMC4552402 DOI: 10.1186/s40824-015-0030-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/26/2015] [Indexed: 11/12/2022] Open
Abstract
Background Dental resin monomers that are leached from the resin matrix due to incomplete polymerization can affect the viability and various functions of oral tissues and cells. In this study, the effects of triethylene glycol dimethacrylate (TEGDMA) and 2-hydroxyethyl methacrylate (HEMA) on odontogenic differentiation of human dental pulp cells (HDPCs) were examined. To mimic clinical situations, dental pulp cells were treated with resin monomers for 24 h prior to the analysis of alkaline phosphatase (ALP) activity and mRNA expression of genes related to pulp cell differentiation. To elucidate the underlying signaling pathways, regulation of mitogen-activated protein (MAP) kinases by resin monomers was also investigated. Results The ALP activity of HDPCs was reduced by TEGDMA and HEMA at noncytotoxic concentrations. The mRNA expression of dentin sialophosphoprotein (DSPP), osteocalcin (OCN), and osteopontin (OPN) was also downregulated by resin monomers. However, DSPP expression was not affected by hydrogen peroxide (H2O2). Among the MAP kinases examined, ERK activation (ERK phosphorylation) was not affected by either resin monomers or H2O2, whereas JNK was phosphorylated by TEGDMA and HEMA. Phospho-p38 was upregulated by HEMA, while TEGDMA and H2O2 suppressed p38 phosphorylation. Conclusions Exposure to TEGDMA and HEMA for a limited period suppresses differentiation of HDPCs via different signaling pathways.
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Affiliation(s)
- Ji Hyun Kwon
- Department of Dental Biomaterials Science and Dental Research Institute, School of Dentistry, Seoul National University, Chongro-ku, Seoul 110-749 Korea
| | - Hee Chul Park
- Department of Dental Biomaterials Science and Dental Research Institute, School of Dentistry, Seoul National University, Chongro-ku, Seoul 110-749 Korea
| | - Tingting Zhu
- Department of Dental Biomaterials Science and Dental Research Institute, School of Dentistry, Seoul National University, Chongro-ku, Seoul 110-749 Korea
| | - Hyeong-Cheol Yang
- Department of Dental Biomaterials Science and Dental Research Institute, School of Dentistry, Seoul National University, Chongro-ku, Seoul 110-749 Korea
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Borkar SA, Ataide I. Biodentine pulpotomy several days after pulp exposure: Four case reports. J Conserv Dent 2015; 18:73-8. [PMID: 25657533 PMCID: PMC4313486 DOI: 10.4103/0972-0707.148901] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/10/2014] [Accepted: 10/23/2014] [Indexed: 11/04/2022] Open
Abstract
Conventionally, few-days-old pulp exposures have been treated with root canal treatment. We report four cases of traumatized, fully matured, maxillary permanent central incisors, which have been treated by Biodentine pulpotomy several days after traumatic pulp exposure. Biodentine pulpotomy consisted of pulp tissue removal to a depth of 2 mm, then capping the pulpal wound with Biodentine, followed by immediate restoration. The teeth were assessed clinically through pulpal sensitivity tests and radiographically for periapical healing. At each recall (24 hours, 1 week, 30 days, 3, 6, 12, and 18 months), no spontaneous pain was observed; the pulp showed signs of vitality and absence of periapical radiolucency after 18 months. Biodentine pulpotomy is recommended as a treatment option for cases of vital pulp exposure in permanent incisors due to trauma.
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Affiliation(s)
- Swati A Borkar
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Ida Ataide
- Department of Conservative Dentistry and Endodontics, Goa Dental College and Hospital, Bambolim, Goa, India
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Fekrazad R, Seraj B, Ghadimi S, Tamiz P, Mottahary P, Dehghan MM. The effect of low-level laser therapy (810 nm) on root development of immature permanent teeth in dogs. Lasers Med Sci 2014; 30:1251-7. [DOI: 10.1007/s10103-014-1588-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/24/2014] [Indexed: 05/28/2023]
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In vitro cytotoxicity evaluation of four vital pulp therapy materials on l929 fibroblasts. ISRN DENTISTRY 2014; 2014:191068. [PMID: 24724032 PMCID: PMC3958681 DOI: 10.1155/2014/191068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 01/21/2014] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate cytotoxicity of direct pulp capping materials such as Dycal, Life, ProRoot MTA, and Super-Bond C&B on L929 fibroblasts. Freshly mixed or set materials were prepared and eluted by incubation with cell culture medium for working time period (fresh) or for 6 hours (set). The cells were exposed to media containing elutes for 24 hours, after which the cell survival was evaluated by MTS assays. In freshly mixed materials, average ± standard deviation % cell viabilities were 40.2 ± 14.0%, 43.7 ± 16.0%, 72.9 ± 12.7%, and 66.0 ± 13.6% for Dycal, Life, ProRoot MTA, and Super-Bond C&B, respectively. There was no statistical difference in cell viabilities among material groups, whereas in set materials, the cell viabilities were 48.7 ± 14.8%, 37.2 ± 10.6%, 46.7 ± 15.2%, and 100 ± 21.9% for Dycal, Life, ProRoot MTA, and Super-Bond C&B, respectively. Super-Bond C&B showed more cell viabilities than the other three material groups (P < 0.05). The four vital pulp therapy materials had similar cytotoxicity when the materials were fresh. Super-Bond C&B was less cytotoxic than Dycal, Life, and ProRoot MTA after the materials were set, which suggests the use of SB-C&B in future in vivo clinical investigations.
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Pérard M, Le Clerc J, Watrin T, Meary F, Pérez F, Tricot-Doleux S, Pellen-Mussi P. Spheroid model study comparing the biocompatibility of Biodentine and MTA. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:1527-1534. [PMID: 23515903 DOI: 10.1007/s10856-013-4908-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/07/2013] [Indexed: 06/01/2023]
Abstract
The primary objective of this study was to assess the biological effects of a new dentine substitute based on Ca₃SiO₅ (Biodentine™) for use in pulp-capping treatment, on pseudo-odontoblastic (MDPC-23) and pulp (Od-21) cells. The secondary objective was to evaluate the effects of Biodentine and mineral trioxide aggregate (MTA) on gene expression in cultured spheroids. We used the acid phosphatase assay to compare the biocompatibility of Biodentine and MTA. Cell differentiation was investigated by RT-qPCR. We investigated the expression of genes involved in odontogenic differentiation (Runx2), matrix secretion (Col1a1, Spp1) and mineralisation (Alp). ANOVA and PLSD tests were used for data analysis. MDPC-23 cells cultured in the presence of MTA had higher levels of viability than those cultured in the presence of Biodentine and control cells on day 7 (P = 0.0065 and P = 0.0126, respectively). For Od-21 cells, proliferation rates on day 7 were significantly lower in the presence of Biodentine or MTA than for control (P < 0.0001). Col1a1 expression levels were slightly lower in cells cultured in the presence of MTA than in those cultured in the presence of Biodentine and in control cells. Biodentine and MTA may modify the proliferation of pulp cell lines. Their effects may fluctuate over time, depending on the cell line considered. The observed similarity between Biodentine and MTA validates the indication for direct pulp-capping claimed by the manufacturers.
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Affiliation(s)
- Matthieu Pérard
- Faculté d'Odontologie, Univ Rennes1, UEB, Bât. 15, 2 Av du Professeur Léon Bernard, 35043 Rennes Cedex, France.
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Bakopoulou A, Leyhausen G, Volk J, Koidis P, Geurtsen W. Effects of resinous monomers on the odontogenic differentiation and mineralization potential of highly proliferative and clonogenic cultured apical papilla stem cells. Dent Mater 2012; 28:327-39. [DOI: 10.1016/j.dental.2012.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/01/2011] [Accepted: 01/04/2012] [Indexed: 01/09/2023]
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An S, Gao Y, Ling J, Wei X, Xiao Y. Calcium ions promote osteogenic differentiation and mineralization of human dental pulp cells: implications for pulp capping materials. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:789-795. [PMID: 22190198 DOI: 10.1007/s10856-011-4531-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 12/09/2011] [Indexed: 05/31/2023]
Abstract
Calcium (Ca) is the main element of most pulp capping materials and plays an essential role in mineralization. Different pulp capping materials can release various concentrations of Ca ions leading to different clinical outcomes. The purpose of this study was to investigate the effects of various concentrations of Ca ions on the growth and osteogenic differentiation of human dental pulp cells (hDPCs). Different concentrations of Ca ions were added to growth culture medium and osteogenic inductive culture medium. A Cell Counting Kit-8 was used to determine the proliferation of hDPCs in growth culture medium. Osteogenic differentiation and mineralization were measured by alkaline phosphatase (ALP) assay, Alizarin red S/von kossa staining, Ca content quantitative assay. The selected osteogenic differentiation markers were investigated by quantitative real-time polymerase chain reaction (qRT-PCR). Within the range of 1.8-16.2 mM, increased concentrations of Ca ions had no effect on cell proliferation, but led to changes in osteogenic differentiation. It was noted that enhanced mineralized matrix nodule formation was found in higher Ca ions concentrations; however, ALP activity and gene expression were reduced. qRT-PCR results showed a trend towards down-regulated mRNA expression of type I collagen and Runx2 at elevated concentrations of Ca ions, whereas osteopontin and osteocalcin mRNA expression were significantly up-regulated. Ca ions content in the culture media can significantly influence the osteogenic properties of hDPCs, indicating the importance of optimizing Ca ions release from dental pulp capping materials in order to achieve desirable clinical outcomes.
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Affiliation(s)
- Shaofeng An
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, People's Republic of China.
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Abstract
Unreacted monomers released from dental resin-based composites at non-cytotoxic concentrations cause a depletion of glutathione and an increase of reactive oxygen species (ROS), leading to, e.g., DNA damage and apoptosis. ROS-sensitive MAP-kinases are activated by HEMA and TEGDMA. MAP-kinases are also involved in the bacteria-triggered cell responses of the innate immune system, e.g., after bacterial lipopolysaccharide (LPS) binding to the Toll-like receptor (TLR) 4. Therefore, both bacteria and monomers imply environmental stress to pulp tissue, and they may influence the target cell reactions in a combined way. In macrophages, cell-surface antigens and cytokines were up-regulated after exposure to LPS, but TEGDMA caused a significant down-regulation. Regulation was dependent on exposure time, indicating that LPS and TEGDMA act differently on MAP-kinases. Furthermore, the cell type played a decisive role. Inhibition of the immune response may result in a decrease in inflammatory symptoms and/or a reduced defense capacity against bacteria.
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Affiliation(s)
- G. Schmalz
- Department of Operative Dentistry and Periodontology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany
| | - S. Krifka
- Department of Operative Dentistry and Periodontology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany
| | - H. Schweikl
- Department of Operative Dentistry and Periodontology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany
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Stimulatory effect of low-level laser therapy on root development of rat molars: a preliminary study. Lasers Med Sci 2011; 27:537-42. [DOI: 10.1007/s10103-011-0935-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
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Galler KM, Schweikl H, Hiller KA, Cavender AC, Bolay C, D'Souza RN, Schmalz G. TEGDMA reduces mineralization in dental pulp cells. J Dent Res 2010; 90:257-62. [PMID: 21135193 DOI: 10.1177/0022034510384618] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Direct application of dentin bonding agents onto the exposed pulp has been advocated, but in vivo studies indicate a lack of reparative dentin formation. Our objective was to investigate the role of triethylene glycol dimethacrylate (TEGDMA), a commonly used compound in dentin bonding agents, as a potential inhibitor of mineralization. Human pulp cells were exposed to different concentrations of TEGDMA, and expression of the mineralization-related genes collagen I, alkaline phosphatase, bone sialoprotein, osteocalcin, Runx2, and dentin sialophosphoprotein was analyzed. Gene expression studies by real-time polymerase chain-reaction revealed a concentration- and time-dependent decrease of mineralization markers. A subtoxic TEGDMA concentration (0.3 mM) reduced expression levels by 5 to 20% after 4 hrs and by 50% after 12 hrs. Furthermore, alkaline phosphatase activity and calcium deposition were significantly lower in dental pulp cells treated with TEGDMA over 14 days. These findings indicate that even low TEGDMA concentrations might inhibit mineralization induced by dental pulp cells, thus impairing reparative dentin formation after pulp capping with dentin bonding agents.
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Affiliation(s)
- K M Galler
- Department of Operative Dentistry and Periodontology, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany
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Minamikawa H, Yamada M, Iwasa F, Ueno T, Deyama Y, Suzuki K, Yawaka Y, Ogawa T. Amino acid derivative-mediated detoxification and functionalization of dual cure dental restorative material for dental pulp cell mineralization. Biomaterials 2010; 31:7213-25. [DOI: 10.1016/j.biomaterials.2010.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 06/04/2010] [Indexed: 12/13/2022]
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Katoh Y, Suzuki M, Kato C, Shinkai K, Ogawa M, Yamauchi J. Observation of calcium phosphate powder mixed with an adhesive monomer experimentally developed for direct pulp capping and as a bonding agent. Dent Mater J 2010; 29:15-24. [PMID: 20379007 DOI: 10.4012/dmj.2009-023] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this study, morphological shape, elemental distribution and elution properties of Ca, P, Mg in four types of calcium phosphate powder were investigated using SEM, EPMA and ICP-AES. Calcium phosphate powder: OHAp, DCPD, beta-TCP and OCP were observed in the white powder form and in the photopolymerized adhesive monomer they scattered like dispersed fillers in resin composite. In elemental analysis, CaKalpha showed a relatively high concentration in relation to PKalpha. In elution analysis, each calcium phosphate showed different elution of Ca and P. But Mg was almost equal to the detection limit of ICP-AES. Namely it was suggested that reparative dentin formation was effectively promoted under the following conditions: a calcification promoting effect by direct contact of the calcium phosphate powder, an ionic effect of Ca and P eluted from the powder located in the vicinity of the exposed pulp and environmental pH change of the surface in exposed pulp.
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Affiliation(s)
- Yoshiroh Katoh
- Department of Operative Dentistry, School of Life Dentistry at Niigata, The Nippon Dental University, Chuo-ku, Niigata, Japan.
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Dammaschke T, Stratmann U, Fischer RJ, Sagheri D, Schäfer E. Proliferation of rat molar pulp cells after direct pulp capping with dentine adhesive and calcium hydroxide. Clin Oral Investig 2010; 15:577-87. [PMID: 20405184 DOI: 10.1007/s00784-010-0409-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 03/19/2010] [Indexed: 01/19/2023]
Abstract
The aim was to evaluate the proliferation of pulp cells 1, 3 and 7 days after direct pulp capping with the dentine adhesive Gluma Comfort Bond (GCB) and to compare it with calcium hydroxide (Ca(OH)(2)). An occlusal cavity was prepared in 72 molar teeth of 36 Wistar rats. Then GCB or Ca(OH)(2) was placed on the exposed pulp. All cavities were restored with composite. After 1, 3 and 7 days, the animals were sacrificed. One hour prior sacrification, 5-bromo-2'-desoxyuridine (BrdU) was injected into the intraperitoneal cavity for immunohistological analysis of 18 animals. BrdU was incorporated into the DNA to tag proliferating cells using an antibody staining. Three animals served as controls and were not further treated. The number of the tagged cells was statistically analysed by comparing the results of the three groups. In 18 rats, routine histological analysis was performed in order to evaluate the pulp tissue for bacterial infection, inflammatory cells and necrosis. The marked cells were identified as fibroblasts, endothelial cells (after 1, 3 and 7 days) and Höhl cells (after 7 days). One day after capping, significantly more cells were stained in the GCB than in the Ca(OH)(2) group (p < 0.05). After 3 days, significantly more cells were stained in the GCB than in the Ca(OH)(2) and the control group (p < 0.016). Direct contact of GCB with pulp tissue leads to an increased formation of granulation tissue (fibroblasts, endothelial cells) because of an inflammatory reaction. This may be explained by missing antibacterial effect and foreign body reactions. Also, GCB may have a negative effect on Höhl cells.
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Affiliation(s)
- Till Dammaschke
- Department of Operative Dentistry, Westphalian Wilhelms-University, Poliklinik für Zahnerhaltung, Waldeyerstr. 30, 48149 Münster, Germany.
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Direct pulp capping with mineral trioxide aggregate: an immunohistologic comparison with calcium hydroxide in rodents. J Endod 2010; 36:814-9. [PMID: 20416425 DOI: 10.1016/j.joen.2010.02.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 01/29/2010] [Accepted: 02/09/2010] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The aim was to evaluate the proliferation of pulp cells 1, 3, and 7 days after direct pulp capping with ProRoot MTA (MTA) and to compare the results with calcium hydroxide (Ca(OH)(2)). METHODS An occlusal cavity was prepared in 36 molar teeth of 18 Wistar rats. Then MTA or Ca(OH)(2) was placed on the exposed pulp. All cavities were restored with composite. After 1, 3, and 7 days the animals were killed. One hour before scarification 5-bromo-2'-deoxyuridine (BrdU) was injected into the intraperitoneal cavity for immunohistologic analysis. BrdU was incorporated into the cell nucleus during the S phase of the cell cycle. Proliferating cells were tagged and counted by using alkaline phosphatase and anti-alkaline phosphatase antibody staining. Three animals (6 molar teeth) served as controls and were not further treated. The number of the tagged cells was statistically analyzed by comparing the results of the 3 groups. A Bonferroni correction was performed, because the data of the Ca(OH)(2)- group was used 3 times for pairwise comparison. RESULTS The marked cells were identified as fibroblasts, endothelial cells (after 1, 3, and 7 days), and Höhl cells (after 7 days). The MTA group showed a similar amount of Höhl cells when compared with the Ca(OH)(2) group (P > .05). One day and 7 days after capping, no significant differences were observed between the 2 tested groups and the controls (P > .05). After 3 days, significantly more cells were stained in the MTA and Ca(OH)(2) groups than in the control group (P < .016). CONCLUSIONS Immunohistologic analysis demonstrated that MTA showed similar results when compared with Ca(OH)(2) within the first week after direct pulp capping.
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36
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Francisconi LF, de Freitas AP, Scaffa PMC, Mondelli RFL, Francisconi PAS. Water sorption and solubility of different calcium hydroxide cements. J Appl Oral Sci 2010; 17:427-31. [PMID: 19936520 PMCID: PMC4327668 DOI: 10.1590/s1678-77572009000500014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 10/07/2008] [Indexed: 11/21/2022] Open
Abstract
Objectives: Calcium hydroxide cements have been largely used in deep cavities due to their abilities to stimulate dentin formation. However, their resistance can be relatively low and their solubility relatively high, in many instances. This study evaluated water sorption and solubility of different calcium hydroxide cements, in order to show alterations that may reduce their effectiveness. Material and methods: Five discs (20 mm in diameter and 1.5 mm thick) of three different materials (Biocal®, Dycal® and Hidro C®) were prepared with the aid of a ring-shaped metallic matrix. After being stored at 37°C for 24 h, the discs were weighed on a precision weight scale, dehydrated and weighed again. Immediately after weighing, discs were stored for a week in 50 mL of distilled water at 37°C and, then, weighed again, dehydrated and submitted to a new weighing. The loss of soluble material and its water sorption was obtained from the difference between the initial and the final dry mass of each disc, after 1 week of immersion in water. Data were analyzed for significant differences by two-way ANOVA and Tukey's test (p<0.05). Results: Mean water sorption values (g) ± standard deviation and percentage (%), for each evaluated cement, were: Biocal® (0.006 ± 0.001 / 2.15); Dycal® (0.016 ± 0.004 / 5.49); and Hidro C® (0.025 ± 0.003 / 8.27). Mean solubility values (g) ± standard deviation and percentage (%), for each evaluated cement, were: Biocal® (0.002 ± 0.001 / 0.72); Dycal® (0.013 ± 0.004 / 4.21); and Hidro C® (0.023 ± 0.004 / 7.65). Conclusions: Biocal® absorbed less water and was less soluble than the other evaluated cements; Hidro C® exhibited the highest water sorption and solubility values; and there were significant differences among all evaluated experimental groups.
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Affiliation(s)
- Luciana Fávaro Francisconi
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
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Miles JP, Gluskin AH, Chambers D, Peters OA. Pulp Capping with Mineral Trioxide Aggregate (MTA): A Retrospective Analysis of Carious Pulp Exposures Treated by Undergraduate Dental Students. Oper Dent 2010; 35:20-8. [DOI: 10.2341/09-038cr1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Clinical Relevance
Carious pulp exposures present a therapeutic challenge for clinicians. Mineral trioxide aggregate (MTA) is a treatment option that may provide successful outcomes for the capping of carious pulp exposures in adult patients. However, the success measured as pulp survival over a period of one and two years of pulp caps performed by undergraduate dental students may be low. This study provides data regarding the impact of exposure sizes and other pre-operative variables on outcomes of MTA pulp caps in adults.
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Hilton TJ. Keys to clinical success with pulp capping: a review of the literature. Oper Dent 2009; 34:615-25. [PMID: 19830978 DOI: 10.2341/09-132-0] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Thomas J Hilton
- Oregon Health & Science University, School of Dentistry, Department of Restorative Dentistry, Portland, OR, USA.
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39
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Bakland LK. Revisiting traumatic pulpal exposure: materials, management principles, and techniques. Dent Clin North Am 2009; 53:661-vi. [PMID: 19958904 DOI: 10.1016/j.cden.2009.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article presents current concepts of managing teeth with traumatic pulp exposures. The article includes a description of the traumatology of crown fractures, discussion of treatment considerations, a summary of materials for vital pulp therapy, and an outline of techniques for treating pulp exposures.
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Affiliation(s)
- Leif K Bakland
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA.
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40
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Direct pulp capping with a self-etching adhesive system: histopathologic evaluation in dogs' teeth. ACTA ACUST UNITED AC 2009; 108:e34-40. [PMID: 19540442 DOI: 10.1016/j.tripleo.2009.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 02/18/2009] [Accepted: 03/09/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study evaluated histopathologically the response of pulp and periradicular tissues after pulp capping with an all-in-one self-etching adhesive system in dogs' teeth. STUDY DESIGN Forty teeth of 4 dogs were assigned to 3 groups according to the pulp capping material: G1 (n = 20): self-etching adhesive system; G2 (n = 10): Ca(OH)(2); G3 (n = 10): zinc oxide-eugenol. The animals were killed 7 and 70 days after pulp capping. The pieces containing the pulp-capped teeth were removed and processed for histologic analysis. RESULTS At 7 days, no dentin bridge formation was observed; G1 and G3 exhibited inflammatory pulpal alterations, whereas G2 presented only mild inflammatory infiltrate in the pulp tissue adjacent to the capping material, the remainder being intact. At 70 days, no specimen in G1 or G3 presented dentin bridge formation. The remaining pulp tissue exhibited severe inflammatory alterations and areas of necrosis. In G2, all specimens showed dentin bridge formation and absence of inflammation and mineralized tissue resorption. No bacteria were identified using Brown and Brenn staining techniques in all 3 groups at any observation period. CONCLUSION According to the conditions of this study, direct pulp capping with the self-etching adhesive system did not allow pulp tissue repair and failed histopathologically in 100% of the cases.
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Bakopoulou A, Papadopoulos T, Garefis P. Molecular toxicology of substances released from resin-based dental restorative materials. Int J Mol Sci 2009; 10:3861-3899. [PMID: 19865523 PMCID: PMC2769064 DOI: 10.3390/ijms10093861] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 08/24/2009] [Accepted: 09/02/2009] [Indexed: 01/22/2023] Open
Abstract
Resin-based dental restorative materials are extensively used today in dentistry. However, significant concerns still remain regarding their biocompatibility. For this reason, significant scientific effort has been focused on the determination of the molecular toxicology of substances released by these biomaterials, using several tools for risk assessment, including exposure assessment, hazard identification and dose-response analysis. These studies have shown that substances released by these materials can cause significant cytotoxic and genotoxic effects, leading to irreversible disturbance of basic cellular functions. The aim of this article is to review current knowledge related to dental composites' molecular toxicology and to give implications for possible improvements concerning their biocompatibility.
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Affiliation(s)
- Athina Bakopoulou
- Department of Fixed & Implant Prosthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece; E-Mails: (B.A.); (G.P.)
| | - Triantafillos Papadopoulos
- Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, Athens, 115 27, Greece
| | - Pavlos Garefis
- Department of Fixed & Implant Prosthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece; E-Mails: (B.A.); (G.P.)
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Enkel B, Dupas C, Armengol V, Akpe Adou J, Bosco J, Daculsi G, Jean A, Laboux O, LeGeros RZ, Weiss P. Bioactive materials in endodontics. Expert Rev Med Devices 2008; 5:475-94. [PMID: 18573047 DOI: 10.1586/17434440.5.4.475] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Endodontic treatment in dentistry is a delicate procedure and many treatment attempts fail. Despite constant development of new root canal filling techniques, the clinician is confronted with both a complex root canal system and the use of filling materials that are harmful for periapical tissues. This paper evaluates reported studies on biomaterials used in endodontics, including calcium hydroxide, mineral trioxide aggregate, calcium phosphate ceramics and calcium phosphate cements. Special emphasis is made on promising new biomaterials, such as injectable bone substitute and injectable calcium phosphate cements. These materials, which combine biocompatibility, bioactivity and rheological properties, could be good alternatives in endodontics as root canal fillers. They could also be used as drug-delivery vehicles (e.g., for antibiotics and growth factors) or as scaffolds in pulp tissue engineering.
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Affiliation(s)
- Bénédicte Enkel
- Nantes University Hospital, Pôle Odontologie, ERT 10-51 Equipe de Recherche Clinique en Odontologie et Chirurgie Osseuse, Faculté de Chirurgie Dentaire 1 Place Alexis Ricordeau, Nantes Cedex 01, France.
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Vital Pulp Therapy with New Materials: New Directions and Treatment Perspectives—Permanent Teeth. J Endod 2008; 34:S25-8. [DOI: 10.1016/j.joen.2008.02.030] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Fernandes AM, Silva GAB, Lopes N, Napimoga MH, Benatti BB, Alves JB. Direct capping of human pulps with a dentin bonding system and calcium hydroxide: an immunohistochemical analysis. ACTA ACUST UNITED AC 2008; 105:385-90. [PMID: 18280971 DOI: 10.1016/j.tripleo.2007.08.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 08/27/2007] [Accepted: 08/28/2007] [Indexed: 10/22/2022]
Abstract
Pulp capping is a treatment where a protective agent is applied to an exposed pulp to allow the maintenance of its vitality and function. The present study analyzed the immunohistochemical expression of fibronectin and type III collagen in human dental pulps submitted to direct pulp capping with calcium hydroxide [Ca(OH)2] or the Single Bond adhesive system (SBAS). The results demonstrated that both proteins were not expressed in the SBAS group, although in the group capped with Ca(OH)2 a diffuse labeling in the extracellular matrix was initially observed, followed by a late expression in the odontoblast-like layer and beneath the dentin bridge. It seems that application of adhesive systems in direct contact with healthy pulps will not lead to expression of proteins that are believed to be essential for pulpal repair. Moreover, Ca(OH)2 showed good biocompatibility properties with the dental pulp tissue, inducing the expression of reparative molecules, and therefore remains the material of choice for the treatment of accidental pulp exposures.
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Affiliation(s)
- Alexandre M Fernandes
- Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, Brazil
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45
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Ritter AV. Direct Pulp-Capping Performed by Dental Students has a Success Rate Close to 60%. Direct Capping of Carious Pulp Exposures is Significantly Less Successful (33%) than Direct Capping of Mechanical Pulp Exposures (92%). J Evid Based Dent Pract 2007; 7:165-6. [DOI: 10.1016/j.jebdp.2007.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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46
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Response of human pulps capped with different self-etch adhesive systems. Clin Oral Investig 2007; 12:119-27. [DOI: 10.1007/s00784-007-0161-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 10/15/2007] [Indexed: 11/26/2022]
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47
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Fang M, Chai F, Chen JH, Neut C, Jia M, Liu Y, Zhao SJ, Hildebrand HF. Antibacterial functionalization of an experimental self-etching primer by inorganic agents: Microbiological and biocompatibility evaluations. ACTA ACUST UNITED AC 2007; 24:483-8. [PMID: 17869572 DOI: 10.1016/j.bioeng.2007.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Antibacterial activities have been demonstrated on oral bacteria with inorganic antibacterial agents (ABAs) after their incorporations into an experimental self-etching primer (ESP) before curing. This study was to assess their biocompatibility and antibacterial activity after curing. Six ABAs were incorporated respectively into ESP for treating specimens. After curing, their bactericidal activities on Streptococcus mutans and influences to the early bacterial colonization were assessed by direct contact and viable count. Systemic toxicity in rats after short-term oral exposure and direct contact cytotoxicity with NIH3T3 fibroblasts were tested. Incorporation of ZnOw AT-83, Longbei antibiotic, Antim-AMS2 or IONPURE-H significantly enhanced the antibacterial effect of ESP after curing, even after 1 month aging. Specimens treated by ESP with ZnOw AT-83, Longbei antibiotic or Antim-AMS2 showed slightly less bacterial adhesion than control. Animal experiments revealed neither toxic signs nor significant differences in body weight gain between control and other groups. Cell vitality or proliferation rates were ranged from 76% to 100% with respect to controls. Basic magnesium hypochlorite, ZnOw AT-83 and ZnOw AT-88 were less toxic. Toxicity only observed in areas beneath the specimens and/or in the direct vicinity of the specimen edge. From microbiological and biocompatibility aspects, the tested ABAs can be effectively incorporated in ESP to provide antibacterial activity against S. mutans. ZnOw AT-83 was the most promising one.
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Affiliation(s)
- Ming Fang
- Department of Prosthodontics, College of Stomatology, Fourth Military Medical University, 710032 Xi'an, PR China
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Al-Hiyasat AS, Barrieshi-Nusair KM, Al-Omari MA. The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study. J Am Dent Assoc 2007; 137:1699-705. [PMID: 17138715 DOI: 10.14219/jada.archive.2006.0116] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The decision between pulp capping and root canal therapy after pulp exposure is a clinical issue. The aim of the authors' study was to evaluate the outcome of direct pulp-capping procedures performed by dental students. METHODS The authors followed the treatment outcomes of 193 patients with 204 pulp exposures with direct pulp capping. They determined the outcome of pulp capping radiographically using periapical radiographs taken at least three years after pulp exposure. The outcome was considered as successful if the tooth was present and not associated with periapical radiolucency or root canal treatment; otherwise, the outcome was considered as being a failure. RESULTS Overall, the success rate of pulp capping was 59.3 percent. The success was associated more with mechanical exposure than with carious exposure (92.2 versus 33.3 percent) (P < .001), more with permanent restoration than with temporary restoration (80.8 versus 47.3 percent) (P < .001) and more with class I occlusal restoration (83.8 percent) than with proximal multiple surface restorations (Class II, 56.1 percent; Class III, 58.8 percent; mesial-occlusal-distal, 28.6 percent) (P = .009). Patients' age, sex, and tooth location and position had no significant effect on the outcome (P > .05). CONCLUSION The success rate of direct pulp capping was 92.2 percent with mechanical exposure and 33.3 percent with carious exposure. CLINICAL IMPLICATIONS Direct pulp capping is recommended after mechanical exposure with immediate placement of permanent restoration, while root canal therapy would be the choice of treatment if the exposure was due to caries.
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Affiliation(s)
- Ahmad S Al-Hiyasat
- Department of Restorative Dentistry, Faculty of Dentistry, Jordan University of Science & Technology, Irbid, Jordan.
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Souza RA, Gomes SCN, Dantas JDCP, Silva-Sousa YT, Pécora JD. Importance of the diagnosis in the pulpotomy of immature permanent teeth. Braz Dent J 2007; 18:244-7. [DOI: 10.1590/s0103-64402007000300013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 10/18/2006] [Indexed: 11/22/2022] Open
Abstract
Pulpotomy is a conservative therapy performed to remove the inflamed coronal portion of the pulp and preserve the vitality of the remaining radicular pulp. This article reports two cases of immature permanent mandibular molars with clinical signs of pulp vitality and radiographic images of periapical bone rarefaction, which were treated with calcium hydroxide pulpotomy. In Case 1, pulpotomy was performed in a single session, while in Case 2 two sessions were required to complete the treatment. Clinical and radiographic follow up within 13 and 9 months, respectively, showed hard tissue barrier and new bone formation as well as progression of root development. These outcomes are confirmatory that an accurate clinical/radiographic assessment of pulp vitality is of paramount importance for the correct diagnosis and indication of pulpotomy in cases of young permanent teeth with incomplete root formation.
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Tziafas D, Koliniotou-Koumpia E, Tziafa C, Papadimitriou S. Effects of a new antibacterial adhesive on the repair capacity of the pulp-dentine complex in infected teeth. Int Endod J 2007; 40:58-66. [PMID: 17209834 DOI: 10.1111/j.1365-2591.2006.01183.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the effects of a self-etching/priming adhesive system, containing the antibacterial monomer 12-methacryloyloxy-dodecylpyridinium bromide (MDPB), on the repair capacity of the pulp-dentine complex in infected cavities in dog's teeth. METHODOLOGY Class V cavities with a residual dentine thickness ranging from 0.3-0.8 mm were prepared on the buccal surface of permanent teeth in four dogs. Pulpal exposures were performed in half of the cavities. Millipore filters that had been incubated for 3 h in a 10(5) milky suspension of a-streptococci were placed in the cavities, which were then filled temporarily. After 24 h, the filters were removed and both the exposed and non-exposed cavities were washed with sterile saline and assigned to four groups which were treated with either the experimental antibacterial adhesive system, or Clearfil SE bond, Dycal and Teflon discs. Stereotype connective tissue reactions (inflammatory cell response and/or tissue necrosis) and pulp-specific reparative tissue responses (reduction of odontoblasts and tertiary dentine formation) were assessed at post-operative periods of 4 and 8 weeks. RESULTS Neither severe inflammation nor tissue necrosis was observed, either in the dentinal cavities or pulpal exposures treated with the self-etch adhesive containing MDPB. Rates of tertiary dentine formation in infected dentinal cavities treated with this system were comparable with those observed after dentine treatment with the Ca(OH)2-based material. Dentinal bridging was not seen in pulpal exposures treated with the experimental adhesive. CONCLUSIONS The new antibacterial adhesive system maintained pulp vitality and primary odontoblastic function in infected nonexposed and exposed cavities but interfered with reparative dentine formation in infected pulpal exposures.
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Affiliation(s)
- D Tziafas
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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