Outcome of novel pulp capping modalities after full pulpotomy in teeth diagnosed with irreversible pulpitis: A prospective randomized clinical trial

Objective

The study aimed to compare and evaluate the effect of biodentine (BD) alone, BD along with Lyophilised freeze dried platelet rich concentrate (LPC + BD), and BD along with low-level laser therapy (BD + LLLT) after pulpotomy in mature permanent molars with irreversible pulpitis.

Materials and Methods

The study was designed as a randomized, pragmatic, parallel, double-blinded clinical trial registered under the Clinical Trial Registry-India (CTRI/2020/02/023245). 120 permanent molars fulfilling the inclusion and exclusion criteria with symptoms of irreversible pulpitis were randomized after performing pulpotomy into three pulp capping groups: Group 1, BD; Group 2, lyophilized freeze-dried platelet-rich concentrate + BD (LPC + BD); and Group 3, Low level laser therapy + BD Group 3, LLLT + BD. The intergroup comparison was done using one-way analysis of variance followed by the Bonferroni test. The level of significance and confidence interval were 5% and 95%, respectively. Interobserver reliability was measured using Cohen's kappa analysis.

Results

At 1 week, there was a significant difference (P < 0.005) observed in the mean postoperative pain levels between the three groups with Group 1 (BD) exhibiting the highest postoperative pain followed by Group 2 (LPC + BD) and least pain was exhibited by Group 3 (LLLT + BD). A similar pattern was observed regarding the analgesic intake with maximum frequency in Group 1 (BD) and least with Group 3 (LLLT + BD). No significant difference in success rates was reported among the groups.

Conclusion

Pulpotomy as a treatment option for mandibular molars with irreversible pulpitis has an acceptable clinical success rate; however, long-term overall success rate remains questionable. The outcomes of incorporating adjunctive modalities with BD are remarkable and show tremendous potential for continued development and research.

Clinico-Histological Evaluation of Dentino-Pulpal Complex of Direct Pulp Capping Agents: A Clinical Study

Introduction:

Direct pulp capping treatment (DPC) maintains pulp vitality by promoting healing or repair in dentistry, which can be attributed to the advent of bioceramic materials.

Aim:

This examination looked to evaluate the clinical and histological effectuality of Biodentine with Dycal for DPC.

Materials and Methodology:

In this study, 30 intact human orthodontic teeth undergoing therapeutic extraction were chosen to perform DPC. They were arbitrarily divided into two groups (n = 15) and DPC with Biodentine and Dycal was performed. Composite resin was used as permanent restoration. After a period of 1 and 6 weeks, clinical as well as electric pulp tests were carried out. Asymptomatic patients were re-called after 6 weeks; follow-up radiograph was taken. Electric pulp testing and thermal testing was done to check the pulpal status of the teeth. This was followed by atraumatic extraction, and the teeth were sent for histological examination. SPSS Version 21.0. Armonk, NY: IBM Corp.was used for data analysis.

Results:

There was no pain and sensitivity in using Biodentine. Whereas, sensitivity and pain was noted when Dycal was used. The dentinal bridge was better with Biodentine when compared with Dycal.

Conclusion:

In accordance with the obtained results, it was concluded that on clinical and histological evaluation, Biodentine performed better as DPC agent. Subsequently, Biodentine is more dependable for the long-haul protection of dental pulp than Dycal.

Effects of different pulp-capping materials on cell death signaling pathways of lipoteichoic acid-stimulated human dental pulp stem cells

PURPOSE

This study aimed to evaluate the response of dental pulp stem cells (DPSCs) cultured with and without lipoteichoic acid (LTA) to different pulp-capping materials.

METHODS

The cells were cultured and seeded in 6-well plates and exposed to 1% LTA solution. Dycal, ProRoot MTA and Biodentine materials were applied on cells and all groups were evaluated by cell proliferation, viability, cell cycle and cell death signaling pathways for 24 and 72 h.

RESULTS

LTA + Dycal treatment significantly inhibited the proliferation of DPSCs and increased the apoptosis rate of cells more than the other groups at 72 h. Compared to other groups, LTA + Dycal treatment significantly increased the levels of Caspase-3 and AKT and decreased the levels of p-AKT.

CONCLUSIONS

The results of this study revealed that all tested materials caused apoptosis in DPSCs via an extrinsic apoptotic pathway. The DPSCs showed an early apoptosis response to the Dycal and a late apoptosis response to the ProRoot MTA and Biodentine treatments. LTA led autophagy and inhibited the proliferation of DPSCs. ProRoot MTA and Biodentin eliminated the LTA's bioactivity with higher efficiency than Dycal.

Glycerol Salicylate-based Pulp-Capping Material Containing Portland Cement

The purpose of this study was to evaluate the water sorption, solubility, pH and ability to diffuse into dentin of a glycerol salicylate-based, pulp-capping cement in comparison to a conventional calcium hydroxide-based pulp capping material (Hydcal). An experimental cement was developed containing 60% glycerol salicylate resin, 10% methyl salicylate, 25% calcium hydroxide and 5% Portland cement. Water sorption and solubility were determined based on mass changes in the samples before and after the immersion in distilled water for 7 days. Material discs were stored in distilled water for 24 h, 7 days and 28 days, and a digital pHmeter was used to measure the pH of water. The cement's ability to diffuse into bovine dentin was assessed by Raman spectroscopy. The glycerol salicylate-based cement presented higher water sorption and lower solubility than Hydcal. The pH of water used to store the samples increased for both cements, reaching 12.59 ± 0.06 and 12.54 ± 0.05 after 7 days, for Hydcal and glycerol salicylate-based cements, respectively. Both cements were able to turn alkaline the medium at 24 h and sustain its alkalinity after 28 days. Hydcal exhibited an intense diffusion into dentin up to 40 µm deep, and the glycerol salicylate-based cement penetrated 20 µm. The experimental glycerol salicylate-based cement presents good sorption, solubility, ability to alkalize the surrounding tissues and diffusion into dentin to be used as pulp capping material.

Solubility and pH of direct pulp capping materials: a comparative study

BACKGROUND

The objective of the present study was to compare solubility and pH of 6 direct pulp capping materials.

METHODS

Specimens of each material - i.e., Dycal, Calcicur, Calcimol LC, TheraCal LC, MTA Angelus and ProRoot MTA - were prepared and immersed in water. Solubility was determined after 24 hours and 2 months and analyzed statistically using a 1-way ANOVA and post hoc Tukey test. pH values were measured 3 and 24 hours after manipulation.

RESULTS

All direct pulp capping materials showed low solubility; the pH of tested materials ranged from 10 to 12 and showed a nonsignificant increase/reduction after 24 hours.

CONCLUSIONS

Within the limitations of this in vitro study, the direct pulp capping materials studied showed different solubility even if no changes were recorded over time. All of the materials showed a very alkaline pH.

Tertiary dentinogenesis with calcium hydroxide: a review of proposed mechanisms

Calcium hydroxide has been used extensively in dentistry for a century. Despite its widespread use as a pulp-capping agent, its mechanisms of action still remain ambiguous. Understanding its modes of action will lead to a broader understanding of the mechanisms associated with induced dentinogenesis and help in optimizing the currently available agents to target specific regenerative processes to obtain the best possible clinical outcomes. A literature search relating to mechanisms of dentinogenesis of calcium hydroxide up to December 2011 was carried out using pubmed and MEDLINE database searches as well as manual searching of cross-references from identified studies. Resulting suggestions regarding dentinogenic mechanisms of calcium hydroxide range from direct irritating action of the material to induction of release of biologically active molecules. The purpose of this article is to discuss various mechanisms through which calcium hydroxide may induce tertiary dentinogenesis in the light of observations made in included studies.

Mineral trioxide aggregate or calcium hydroxide direct pulp capping: an analysis of the clinical treatment outcome

INTRODUCTION

The use of mineral trioxide aggregate (MTA) might improve the prognosis of teeth after pulp exposure. The treatment outcome of teeth after direct pulp capping, either with mineral trioxide aggregate (MTA) or calcium hydroxide (controls), was investigated, taking into account possible confounding factors.

METHODS

One hundred forty-nine patients treated between 2001 and 2006 who received direct pulp capping treatment in 167 teeth met the inclusion criteria. Treatment was performed by supervised undergraduate students (72%) and dentists (28%). Assessment of clinical and radiographic outcomes was performed by calibrated examiners 12-80 months after treatment (median, 27 months).

RESULTS

One hundred eight patients (122 treated teeth) were available for follow-up (72.5% recall rate). A successful outcome was recorded for 78% of teeth (54 of 69) in the MTA group and for 60% of teeth (32 of 53) in the the calcium hydroxide group. The univariate analysis (generalized estimation equations model [GEE model] showed a significant difference in the success rate (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.05-5.32; P = .04). In the multiple analysis (GEE model), the OR is marginally inside the nonsignificant range (OR, 0.43; 95% CI, 0.19-1.02; P = .05) when conspicuous confounding factors are stabilized (univariate analysis). Multiple analysis showed that teeth that were permanently restored >or=2 days after capping had a significantly worse prognosis in both groups (OR, 0.24; 95% CI, 0.09-0.66; P = .01).

CONCLUSIONS

MTA appears to be more effective than calcium hydroxide for maintaining long-term pulp vitality after direct pulp capping. The immediate and definitive restoration of teeth after direct pulp capping should always be aimed for.

Reparative dentinogenesis induced by mineral trioxide aggregate: a review from the biological and physicochemical points of view

This paper aims to review the biological and physicochemical properties of mineral trioxide aggregate (MTA) with respect to its ability to induce reparative dentinogenesis, which involves complex cellular and molecular events leading to hard-tissue repair by newly differentiated odontoblast-like cells. Compared with that of calcium hydroxide-based materials, MTA is more efficient at inducing reparative dentinogenesis in vivo. The available literature suggests that the action of MTA is attributable to the natural wound healing process of exposed pulps, although MTA can stimulate hard-tissue-forming cells to induce matrix formation and mineralization in vitro. Physicochemical analyses have revealed that MTA not only acts as a "calcium hydroxide-releasing" material, but also interacts with phosphate-containing fluids to form apatite precipitates. MTA also shows better sealing ability and structural stability, but less potent antimicrobial activity compared with that of calcium hydroxide. The clinical outcome of direct pulp capping and pulpotomy with MTA appears quite favorable, although the number of controled prospective studies is still limited. Attempts are being conducted to improve the properties of MTA by the addition of setting accelerators and the development of new calcium silicate-based materials.

Polymerized bonding agents and the differentiation in vitro of human pulp cells into odontoblast-like cells

OBJECTIVES

Odontoblasts are highly differentiated post-mitotic cells, which under pathological conditions such as carious lesions and dental injuries may degenerate and be replaced by other pulp cells. We have recently shown that this physiological event can be reproduced in an in vitro assay system, but is highly modified by the presence of unpolymerized resinous monomers. Our hypothesis was that the photopolymerization of the monomers in the bonding agents might abolish these negative effects. The purpose of this study was to evaluate the effects of polymerized dentin bonding agents, through dentin slices, on odontoblast differentiation in vitro.

METHODS

Pulp cells were obtained from human third molars. They were used to study the effects of four dentin bonding agents through 0.7 mm dentin slices which served as a barrier between the bonding agents and the culture medium. The media containing the bonding agents' extracts were added at non-toxic concentrations onto the cultured cells. Immunohistochemistry was performed to study the differentiation of pulp fibroblasts into odontoblasts under these conditions by evaluating the expression of several odontoblast specific genes.

RESULTS

Pulp fibroblasts cultivated under these conditions synthesized type I collagen, osteonectin, dentin sialoprotein and nestin at the same level as in control cultures. Moreover, pulp cells synthesized a mineralized nodular extracellular matrix. Expression of these proteins was higher in the cells contributing to the nodule formation. In addition, except nestin, all these proteins were expressed in the mineral nodules.

SIGNIFICANCE

This work shows the lack of effects of photopolymerized bonding agents, through dentin slices, on cytodifferentiation of secondary odontoblasts.