Cellular responses in the dental pulp: a review

Clinical and Radiographic Outcomes of Calcium Hydroxide vs Other Agents in Indirect Pulp Capping of Primary Teeth: A Systematic Review

Aim

To extract and systematically identify the existing literature on the “Clinical and radiographic outcome of calcium hydroxide vs other agents in indirect pulp capping of primary teeth”.

Objective

To compare the clinical and radiographic outcome of calcium hydroxide and other agents in indirect pulp capping of primary teeth.

Search strategy

The following databases were searched: PubMed Central, Cochrane Database of Systematic Reviews, Lilacs, Science Direct, Sigle. Bibliographies of clinical studies identified in the electronic search were analyzed for studies published outside the electronically searched journals.

Selection criteria

Studies comparing the clinical and radiographic success rate of one or more indirect pulp capping agents with calcium hydroxide in primary molars were included.

Results

The initial search revealed 243 of which only 9 met the inclusion criteria and 234 were excluded based on the exclusion criteria. All the 9 included studies analysed the clinical and radiographic outcome of calcium hydroxide in comparison with other agents in indirect pulp capping of primary teeth.

Conclusion

There is a very limited good quality studies estimating the clinical and radiographic outcome of calcium hydroxide in comparison with other agents in indirect pulp capping of primary teeth. The review identified the need for more studies on the clinical and radiographic outcome of calcium hydroxide in comparison with other agents in indirect pulp capping of primary teeth.

How to cite this article

Nair M, Gurunathan D. Clinical and Radiographic Outcomes of Calcium Hydroxide vs Other Agents in Indirect Pulp Capping of Primary Teeth: A Systematic Review. Int J Clin Pediatr Dent 2019;12(5):437–444.

Recent advances in pulp capping materials: an overview

Emphasis has shifted from the "doomed" organ concept of an exposed pulp to one of hope and recovery. The era of vital-pulp therapy has been greatly enhanced with the introduction of various pulp capping materials. The aim of this article is to summarize and discuss about the various and newer pulp capping materials used for protection of the dentin-pulp complex.

A comparative evaluation of cytotoxicity of root canal sealers: an in vitro study

OBJECTIVES

The objective of this in vitro study was to evaluate and compare the cytotoxicity of four different root canal sealers i.e. Apexit Plus (Ivoclar Vivadent), Endomethasone N (Septodont), AH-26 (Dentsply) and Pulpdent Root Canal Sealer (Pulpdent), on a mouse fibroblast cell line (L929).

MATERIALS AND METHODS

Thirty two discs for each sealer (5 mm in diameter and 2 mm in height) were fabricated in Teflon mould. The sealer extraction was made in cell culture medium (Dulbecco's Modified Eagle's Medium, DMEM) using the ratio 1.25 cm(2)/mL between the surface of the sealer samples and the volume of medium in a shaker incubator. Extraction of each sealer was obtained at 24 hr, 7th day, 14th day, and one month of interval. These extracts were incubated with L929 cell line and 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide (MTT) assay was done. Two-way ANOVA for interaction effects between sealer and time and Post-hoc multiple comparison using Tukey's test across all the 16 different groups were used for statistical analysis.

RESULTS

Apexit Plus root canal sealer was significantly less toxic than other sealers (p < 0.05) and showed higher cellular growth than control. Endomethasone N showed mild cytotoxicity. AH-26 showed severe toxicity which became mild after one month while Pulpdent Root Canal Sealer showed severe to moderate toxicity.

CONCLUSIONS

Apexit Plus was relatively biocompatible sealer as compared to other three sealers which were cytotoxic at their initial stages, however, they became biocompatible with time.

Risk aspects of dental restoratives: From amalgam to tooth-colored materials

Dental materials’ choice of patients has considerably changed. Whereas cast gold and amalgam have been the predominant biomaterials for decades, today tooth-colored materials like resin-based composites and ceramics are more and more successful. However, are we going to replace a good but biologically questionable material (amalgam) with an equal material (resin composite) being more esthetic but also biologically questionable For amalgam, long-term clinical studies reported some significant hints that in single cases amalgam may be a health hazard for patients, finally Norway banned amalgam completely. The main advantage of a resin-based composite over amalgam is its tooth-like appearance and more or less absence of extensive preparation rules. For many years it was believed that resin-based composites may cause pulpal injury. However, pulpal injury associated with the use of resin-based composites is not correlated with their cytotoxic properties. Nevertheless, resin-based composites and other dental materials require rigorous safety evaluation and continuous monitoring to prevent adverse events similar like with amalgam. Because of non-biocompatible pulp responses to resin-based composites and amalgam, they should not be placed in direct contact with the dental pulp. The less dentin remaining in the floor of preparations between resin-based composites or other dental materials is more likely to cause pulpitis. Percentage of patients and dental practitioners who display allergic reactions is between 0.7% and 2%. The release of cytotoxic monomers from resin-based materials is highest after polymerization and much lower after 1 wk. Substances released from resin-based composites have been shown to be toxic in cytotoxicity tests. Nevertheless, in vitro cytotoxicity assays have shown that amalgam has greater toxic effects than resin-based composites, sometime 100-700-fold higher. Altogether, the risk of side-effects is low, but not zero, especially for dental personnel.

Immunocytochemical investigation of immune cells within human primary and permanent tooth pulp

AIM

The aim of this study was to determine whether there are any differences in the number and distribution of immune cells within human primary and permanent tooth pulp, both in health and disease.

DESIGN

The research took the form of a quantitative immunocytochemical study. One hundred and twenty-four mandibular first permanent molars and second primary molars were obtained from children requiring dental extractions under general anaesthesia. Following exodontia, 10-microm-thick frozen pulp sections were processed for indirect immunofluorescence. Triple-labelling regimes were employed using combinations of the following: (1) protein gene product 9.5, a general neuronal marker; (2) leucocyte common antigen (LCA); and (3) Ulex europaeus I lectin, a marker of vascular endothelium. Image analysis was then used to determine the percentage area of immunostaining for LCA.

RESULTS

Leucocytes were significantly more abundant in the pulp horn and mid-coronal region of intact and carious primary teeth, as compared to permanent teeth (P < 0.05, anova). Both dentitions demonstrated the presence of well-localized inflammatory cell infiltrates and marked aborization of pulpal nerves in areas of dense leucocyte accumulation.

CONCLUSIONS

Primary and permanent tooth pulps appear to have a similar potential to mount inflammatory responses to gross caries The management of the compromised primary tooth pulp needs to be reappraised in the light of these findings.

The cytotoxicity of RoekoSeal and AH plus compared during different setting periods

The aim of this study was to evaluate the cytotoxicity of the root canal sealers RoekoSeal Automix (RSA) and AH Plus in vitro on human cervical carcinoma (HeLa) cells and mouse skin fibroblasts (L929). The sealers were covered with a 3 x 10(4) cell suspension 1 h, 24 h, 48 h, 7 days and 1 month after mixing. Four samples and respective controls without sealer were prepared. After 5 days of incubation, the number of cells was determined using an electronic counter; the number of viable cells was determined under light microscopy following the addition of nigrosin dye. The experiment was repeated twice for each sealer and each period. AH Plus was significantly more cytotoxic after 1 h, 24 h, and 48 h, compared to the 7 day and 1 month setting period on both cell lines. RoekoSeal had no cytotoxic effect on either cell line at any setting time.

Tooth slice organ culture for cytotoxicity assessment of dental materials

The purpose of this work was to develop a tooth slice organ culture method to assess the response of the cells of the dental pulp to commonly used dental materials and products. Wistar rat tooth slices were grown in culture for two and ten days in the presence of dental materials. After culture, the tooth tissues were processed and the responses of the pulpal cells were analysed histomorphometrically. Cytotoxic cell destruction was observed following the direct application of test materials to tooth slices (n = 298) after 10 days in culture (MANOVA, P = 0.0001), whilst the restoration of prepared deep dentine cavities (n = 30), with test products, did not result in a significant amount of pulpal injury (MANOVA, P = 0.287). In rank order of causing pulpal injury, the test materials from the most to the least cell destructive, was; Salicylic acid. Calcium hydroxide, Kalzinol zinc oxide eugenol, high-mercury Amalgam, Prime & Bond, Dycal, Barium sulphate, Hypocal, Scotchbond, Calasept, Life and One-step. Tooth slice organ culture, provided a cytotoxicity screening method for dental materials, bearing a closer physiological resemblance to the clinical situation than cell culture screening methods. Tooth slice culturing may have the potential to replace some types of in vivo animal experimentation, as there is a clear need to reduce this form of testing.

Success of pulpotomy in the management of hyperplastic pulpitis

Hyperplastic pulpitis is a variety of chronic open pulpitis which is regarded as irreversible. This condition is usually treated by root canal treatment, unless coronal damage does not permit restoration, in which case extraction is indicated. In the present study, 24 permanent teeth of individuals, aged 10-22 years and diagnosed as hyperplastic pulpitis were treated by pulpotomy using an atraumatic surgical technique with calcium hydroxide alone. The treatment was successful in 22 teeth, according to the following criteria: absence of clinical symptoms, absence of any intraradicular or periradicular radiographic pathological changes, presence of dentine bridge detected by clinical examination and sometimes observed radiographically, and sensitivity to electrical stimulation. The follow-up examination ranged from 12 to 48 months. The high frequency of clinical healing in this study appears to justify recommending pulpotomy as the treatment regime in selected cases of chronic hyperplastic pulpitis.