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Yi P, Chen S, Zhao Y, Ku W, Lu H, Yu D, Zhao W. An injectable dental pulp-derived decellularized matrix hydrogel promotes dentin repair through modulation of macrophage response. BIOMATERIALS ADVANCES 2024; 161:213883. [PMID: 38762928 DOI: 10.1016/j.bioadv.2024.213883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/27/2024] [Accepted: 04/26/2024] [Indexed: 05/21/2024]
Abstract
Maintaining the viability of damaged pulp is critical in clinical dentistry. Pulp capping, by placing dental material over the exposed pulp, is a main approach to promote pulp-dentin healing and mineralized tissue formation. The dental materials are desired to impact on intricate physiological mechanisms in the healing process, including early regulation of inflammation, immunity, and cellular events. In this study, we developed an injectable dental pulp-derived decellularized matrix (DPM) hydrogel to modulate macrophage responses and promote dentin repair. The DPM derived from porcine dental pulp has high collagen retention and low DNA content. The DPM was solubilized by pepsin digestion (named p-DPM) and subsequently injected through a 25G needle to form hydrogel facilely at 37 °C. In vitro results demonstrated that the p-DPM induced the M2-polarization of macrophages and the migration, proliferation, and dentin differentiation of human dental pulp stem cells from deciduous teeth (SHEDs). In a mouse subcutaneous injection test, the p-DPM hydrogel was found to facilitate cell recruitment and M2 polarization during the early phase of implantation. Additionally, the acute pulp restoration in rat models proved that injectable p-DPM hydrogel as a pulp-capping agent had excellent efficacy in dentin regeneration. This study demonstrates that the DPM promotes dentin repair by modulating macrophage responses, and has a potential for pulp-capping applications in dental practice.
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Affiliation(s)
- Ping Yi
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Guangzhou, Guangdong, China
| | - Sixue Chen
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Guangzhou, Guangdong, China
| | - Yifan Zhao
- Changsha Medical University, Changsha, Hunan, China
| | - Weili Ku
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Guangzhou, Guangdong, China
| | - Hui Lu
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Guangzhou, Guangdong, China
| | - Dongsheng Yu
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Guangzhou, Guangdong, China.
| | - Wei Zhao
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Guangzhou, Guangdong, China.
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Direct pulp capping in asymptomatic carious primary molars using three different pulp capping materials: a prospective clinical trial. Eur Arch Paediatr Dent 2022; 23:803-811. [PMID: 35780237 DOI: 10.1007/s40368-022-00720-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/11/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Τo assess the outcome of direct pulp capping in asymptomatic carious primary molars using three pulp capping materials. METHODS In this prospective clinical trial, carious primary molars free of irreversible pulp inflammation signs and symptoms, with negative pain history and pulp exposure following caries removal were included. Teeth were divided into groups: A: Ca(OH)2, B: Pure Portland cement®, C: Biodentine™. Following anaesthesia, isolation, caries removal, pulp exposure, hemorrhage control, pulp capping, additional lining in groups A, B, teeth were restored with composite resin. Descriptive statistics, Chi-squared and Fisher's exact tests, Kaplan-Meier survival curves, multivariable random effects Cox regression model were performed. RESULTS Sixty-six patients (25 girls, 41 boys) with mean age 7.2 (± 1.7) years participated. The mean follow-up time was 13 months. Seventy-nine primary molars were assigned to groups A (n = 27), B (29), C (n = 23). The overall failure was 16% and the distribution by group was: A: 5 teeth, B: 5 teeth, C: 3 teeth. No significant differences in failure rates between capping materials, tooth types, age bands and genders were identified. CONCLUSIONS Direct pulp capping in asymptomatic carious primary molars may be an acceptable option, when treating an exposed pulp with bioceramic materials as pulp capping agents.
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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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Atom J, Devi NR, Lairenlakpam R, Dafer Al Wadei MH, Hakami AR, BinShaya AS. Antimicrobial Efficacy of Different Pulp-Capping Materials against Enterococcus faecalis: An In vitro Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2021; 13:S608-S611. [PMID: 34447163 PMCID: PMC8375796 DOI: 10.4103/jpbs.jpbs_586_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022] Open
Abstract
Aim: The present study aims to assess the antimicrobial action of three different pulp-capping agents against Enterococcus faecalis. Materials and Methods: Three pulp-capping agents were chosen for this study: Calcicur, mineral trioxide aggregate (MTA)-Angelus, and Dycal. The zone of inhibition produced by these three pulp-capping agents was measured at 24 h and 72 h to assess their antimicrobial efficacy against E. faecalis. The agar diffusion method was used to examine the antimicrobial effect of pulp-capping agents. Mueller-Hinton agar plates were used to inoculate the microorganisms. Analysis of variance (ANOVA) and Tukey's post hoc tests were done to compare the different groups. P < 0.05 was considered as statistically significant. Results: At 24 h, the highest zone of inhibition was found in MTA-Angelus (3.32 ± 0.11 mm), followed by Dycal (2.02 ± 0.46 mm) and Calcicur (1.84 ± 0.92 mm). After 72 h, MTA-Angelus demonstrated a zone of inhibition of 4.60 ± 0.22 mm, followed by Dycal (3.48 ± 0.74 mm) and Calcicur (2.90 ± 0.18 mm). ANOVA test showed a highly statistical significance. A statistically significant difference (P < 0.001) was shown between MTA-Angelus and Dycal. Calcicur did not show any significant difference. Conclusion: This trial found that the freshly mixed MTA-Angelus has a significantly superior antimicrobial effect against E. faecalis than Dycal and Calcicur.
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Affiliation(s)
- Jenny Atom
- Department of Conservative Dentistry and Endodontics, Dental College, RIMS, Imphal East, Manipur, India
| | - Ningthoukhongjam Rati Devi
- Department of Conservative Dentistry and Endodontics, Dental College, JNIMS, Imphal East, Manipur, India
| | - Ronel Lairenlakpam
- Department of Conservative Dentistry and Endodontics, Dental College, JNIMS, Imphal East, Manipur, India
| | | | - Abdulrahim R Hakami
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, 61481, Saudi Arabia
| | - Abdulkarim S BinShaya
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Cobanoglu N, Alptekin T, Kitagawa H, Blatz MB, Imazato S, Ozer F. Evaluation of human pulp tissue response following direct pulp capping with a self-etching adhesive system containing MDPB. Dent Mater J 2021; 40:689-696. [PMID: 33563846 DOI: 10.4012/dmj.2020-145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study evaluated the human pulp tissue response following direct pulp capping with Clearfil Protect Bond (CPB) self-etching adhesive containing an antibacterial monomer MDPB. The pulps of third molar teeth were exposed by the removal of carious tissue. In an experimental group, CPB was applied to the exposed pulp and dentin. In the control groups, Clearfil SE Bond (CSE) or calcium hydroxide-based cement (CH) was applied to the exposed pulp surfaces. All teeth were filled with resin composite, extracted after 90 days, and the pulp responses were histologically analyzed. No severe inflammation or soft tissue disorganization was observed in CPB and CH groups. CSE group exhibited a disorganized odontoblastic layer and severe inflammatory infiltration. No hard tissue formation was observed in CSE group, and CH formed more of a hard tissue formation than CPB. CPB induced an acceptable healing response when directly applied to exposed pulps with bacterial contamination.
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Affiliation(s)
- Nevin Cobanoglu
- Department of Restorative Dentistry, Faculty of Dentistry, University of Selcuk
| | - Tuncay Alptekin
- Department of Restorative Dentistry, Umitkoy Polyclinic, Baskent Hospital
| | - Haruaki Kitagawa
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry
| | - Markus B Blatz
- Department of Preventive and Restorative Sciences, University of Pennsylvania
| | - Satoshi Imazato
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry
| | - Fusun Ozer
- Department of Preventive and Restorative Sciences, University of Pennsylvania
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Pedano MS, Li X, Yoshihara K, Landuyt KV, Van Meerbeek B. Cytotoxicity and Bioactivity of Dental Pulp-Capping Agents towards Human Tooth-Pulp Cells: A Systematic Review of In-Vitro Studies and Meta-Analysis of Randomized and Controlled Clinical Trials. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E2670. [PMID: 32545425 PMCID: PMC7345102 DOI: 10.3390/ma13122670] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
Background. In the era of biology-driven endodontics, vital pulp therapies are regaining popularity as a valid clinical option to postpone root-canal treatment. In this sense, many different materials are available in the market for pulp-capping purposes. Objectives. The main aim of this systematic review and meta-analysis was to examine literature regarding cytotoxicity and bioactivity of pulp-capping agents by exposure of human dental pulp cells of primary origin to these materials. A secondary objective was to evaluate the inflammatory reaction and reparative dentin-bridge formation induced by the different pulp-capping agents on human pulp tissue. Data sources. A literature search strategy was carried out on PubMed, EMBASE and the Web of Science databases. The last search was done on 1 May 2020. No filters or language restrictions were initially applied. Two researchers independently selected the studies and extracted the data. Study selection included eligibility criteria, participants and interventions, study appraisal and synthesis methods. In vitro studies were included when human dental pulp cells of primary origin were (in)directly exposed to pulp-capping agents. Parallel or split-mouth randomized or controlled clinical trials (RCT or CCT) were selected to investigate the effects of different pulp-capping agents on the inflammation and reparative bridge-formation capacity of human pulp tissue. Data were synthesized via odds ratios (95% confidence interval) with fixed or random effects models, depending on the homogeneity of the studies. The relative risks (95% confidence interval) were presented for the sake of interpretation. Results. In total, 26 in vitro and 30 in vivo studies were included in the systematic review and meta-analysis, respectively. The qualitative analysis of in vitro data suggested that resin-free hydraulic calcium-silicate cements promote cell viability and bioactivity towards human dental pulp cells better than resin-based calcium-silicate cements, glass ionomers and calcium-hydroxide cements. The meta-analysis of the in vivo studies indicated that calcium-hydroxide powder/saline promotes reparative bridge formation better than the popular commercial resin-free calcium-silicate cement Pro-Root MTA (Dentsply-Sirona), although the difference was borderline non-significant (p = 0.06), and better than calcium-hydroxide cements (p < 0.0001). Moreover, resin-free pulp-capping agents fostered the formation of a complete reparative bridge better than resin-based materials (p < 0.001). On the other hand, no difference was found among the different materials tested regarding the inflammatory effect provoked at human pulp tissue. Conclusions. Calcium-hydroxide (CH) powder and Pro-Root MTA (Dentsply-Sirona) have shown excellent biocompatibility in vitro and in vivo when tested on human cells and teeth. Their use after many years of research and clinical experience seems safe and proven for vital pulp therapy in healthy individuals, given that an aseptic environment (rubber dam isolation) is provided. Although in vitro evidence suggests that most modern hydraulic calcium-silicate cements promote bioactivity when exposed to human dental pulp cells, care should be taken when these new materials are clinically applied in patients, as small changes in their composition might have big consequences on their clinical efficacy. Key findings (clinical significance). Pure calcium-hydroxide powder/saline and the commercial resin-free hydraulic calcium-silicate cement Pro-Root MTA (Dentsply-Sirona) are the best options to provide a complete reparative bridge upon vital pulp therapy. Systematic review registration number. PROSPERO registration number: CRD42020164374.
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Affiliation(s)
- Mariano S. Pedano
- Department of Oral Health Sciences, KU Leuven (University of Leuven), BIOMAT—Biomaterials Research Group & UZ Leuven, University Hospitals Leuven, 3000 Leuven, Belgium; (M.S.P.); (X.L.); (K.V.L.)
| | - Xin Li
- Department of Oral Health Sciences, KU Leuven (University of Leuven), BIOMAT—Biomaterials Research Group & UZ Leuven, University Hospitals Leuven, 3000 Leuven, Belgium; (M.S.P.); (X.L.); (K.V.L.)
| | - Kumiko Yoshihara
- National Institute of Advanced Industrial Science and Technology (AIST), Health Research Institute, 2217-14 Hayashi-Cho, Takamaysu, Kagawa 761-0395, Japan;
- Department of Pathology & Experimental Medicine, Dentistry and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kirsten Van Landuyt
- Department of Oral Health Sciences, KU Leuven (University of Leuven), BIOMAT—Biomaterials Research Group & UZ Leuven, University Hospitals Leuven, 3000 Leuven, Belgium; (M.S.P.); (X.L.); (K.V.L.)
| | - Bart Van Meerbeek
- Department of Oral Health Sciences, KU Leuven (University of Leuven), BIOMAT—Biomaterials Research Group & UZ Leuven, University Hospitals Leuven, 3000 Leuven, Belgium; (M.S.P.); (X.L.); (K.V.L.)
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Wawrzynkiewicz A, Rozpedek-Kaminska W, Galita G, Lukomska-Szymanska M, Lapinska B, Sokolowski J, Majsterek I. The Cytotoxicity and Genotoxicity of Three Dental Universal Adhesives-An In Vitro Study. Int J Mol Sci 2020; 21:ijms21113950. [PMID: 32486393 PMCID: PMC7312029 DOI: 10.3390/ijms21113950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/23/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022] Open
Abstract
Dental universal adhesives are considered an useful tool in modern dentistry as they can be used in different etching techniques, allow for simplified protocol and provide sufficient bond strength. However, there is still no consensus as to their toxicity towards pulp. Thus, the present study aimed to evaluate the cytotoxicity and genotoxicity of three universal adhesives: OptiBond Universal, Prime&Bond Universal and Adhese in an in vitro experimental model, monocyte/macrophage cell line SC (ATCC CRL-9855). The cytotoxicity was measured by means of XTT assay, whereas the genotoxicity (comet assay) was evaluated based on the percentage of DNA present in the comet tail. Furthermore, the ability of the adhesives to induce apoptosis was analyzed using flow cytometry (FC) with the FITC annexin V/propidium iodide (PI) double staining. The analysis of the cell cycle progression was performed with FC using PI staining. OptiBond Universal presented significant, while Prime&Bond Universal and Adhese Universal had minimal cytotoxicity and genotoxicity towards human SC cells. Moreover, only OptiBond Universal increased the level of apoptosis in SC cell line. None of the adhesives showed significant cell cycle arrest, as revealed by FC analysis. Due to substantial differences in toxicity in in vitro studies of dental adhesives, there is a great need for further research in order to establish more reliable test protocols allowing for standardized methodology.
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Affiliation(s)
- Adam Wawrzynkiewicz
- Department of Clinical Chemistry and Biochemistry, Medical University of Lodz, 90-419 Lodz, Poland; (A.W.); (W.R.-K.); (G.G.)
| | - Wioletta Rozpedek-Kaminska
- Department of Clinical Chemistry and Biochemistry, Medical University of Lodz, 90-419 Lodz, Poland; (A.W.); (W.R.-K.); (G.G.)
| | - Grzegorz Galita
- Department of Clinical Chemistry and Biochemistry, Medical University of Lodz, 90-419 Lodz, Poland; (A.W.); (W.R.-K.); (G.G.)
| | - Monika Lukomska-Szymanska
- Department of General Dentistry, Medical University of Lodz, 90-419 Lodz, Poland; (M.L.-S.); (B.L.); (J.S.)
| | - Barbara Lapinska
- Department of General Dentistry, Medical University of Lodz, 90-419 Lodz, Poland; (M.L.-S.); (B.L.); (J.S.)
| | - Jerzy Sokolowski
- Department of General Dentistry, Medical University of Lodz, 90-419 Lodz, Poland; (M.L.-S.); (B.L.); (J.S.)
| | - Ireneusz Majsterek
- Department of Clinical Chemistry and Biochemistry, Medical University of Lodz, 90-419 Lodz, Poland; (A.W.); (W.R.-K.); (G.G.)
- Correspondence: ; Tel.: +48-42-272-53-00
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Zhu N, Chatzistavrou X, Papagerakis P, Ge L, Qin M, Wang Y. Silver-Doped Bioactive Glass/Chitosan Hydrogel with Potential Application in Dental Pulp Repair. ACS Biomater Sci Eng 2019; 5:4624-4633. [DOI: 10.1021/acsbiomaterials.9b00811] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ningxin Zhu
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, #22 Zhongguancun Nandajie, Haidian District, Beijing 100081, China
| | - Xanthippi Chatzistavrou
- Department of Chemical Engineering and Materials Science, Michigan State University, East Lansing, Michigan 48824, United States
| | - Petros Papagerakis
- College of Dentistry and Biomedical Engineering, Toxicology, Pharmacy/Nutrition, Anatomy and Cell Biology Colleges Graduate Programs, University of Saskatchewan, Saskatoon, Canada
| | - Lihong Ge
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, #22 Zhongguancun Nandajie, Haidian District, Beijing 100081, China
| | - Man Qin
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, #22 Zhongguancun Nandajie, Haidian District, Beijing 100081, China
| | - Yuanyuan Wang
- Department of Pediatric Dentistry, School and Hospital of Stomatology, Peking University, #22 Zhongguancun Nandajie, Haidian District, Beijing 100081, China
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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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12
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Cui CY, Wang SN, Ren HH, Li AL, Qiu D, Gan YH, Dong YM. Regeneration of dental–pulp complex-like tissue using phytic acid derived bioactive glasses. RSC Adv 2017. [DOI: 10.1039/c7ra01480e] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Phytic acid derived bioactive calcium phosphosilicate (PSC) glasses were synthesised by using phytic acid as a phosphorus precursor. PSC have superior biocompatibility for dental pulp cells and ability to regenerate dentin–pulp complex to 45S5.
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Affiliation(s)
- Cai-Yun Cui
- Department of Cariology and Endodontology
- Peking University School and Hospital of Stomatology
- Beijing 100081
- P. R. China
- National Engineering Laboratory for Digital and Material Technology of Stomatology
| | - Sai-Nan Wang
- Department of Cariology and Endodontology
- Peking University School and Hospital of Stomatology
- Beijing 100081
- P. R. China
- National Engineering Laboratory for Digital and Material Technology of Stomatology
| | - Hui-Hui Ren
- Beijing National Laboratory for Molecular Sciences
- State Key Laboratory of Polymer Physics and Chemistry
- Institute of Chemistry
- Chinese Academy of Sciences
- Beijing 100190
| | - Ai-Ling Li
- Beijing National Laboratory for Molecular Sciences
- State Key Laboratory of Polymer Physics and Chemistry
- Institute of Chemistry
- Chinese Academy of Sciences
- Beijing 100190
| | - Dong Qiu
- Beijing National Laboratory for Molecular Sciences
- State Key Laboratory of Polymer Physics and Chemistry
- Institute of Chemistry
- Chinese Academy of Sciences
- Beijing 100190
| | - Ye-Hua Gan
- National Engineering Laboratory for Digital and Material Technology of Stomatology
- Beijing Key Laboratory of Digital Stomatology
- Beijing 100081
- P. R. China
- Central Laboratory
| | - Yan-Mei Dong
- Department of Cariology and Endodontology
- Peking University School and Hospital of Stomatology
- Beijing 100081
- P. R. China
- National Engineering Laboratory for Digital and Material Technology of Stomatology
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13
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Jalan AL, Warhadpande MM, Dakshindas DM. A comparison of human dental pulp response to calcium hydroxide and Biodentine as direct pulp-capping agents. J Conserv Dent 2017; 20:129-133. [PMID: 28855762 PMCID: PMC5564240 DOI: 10.4103/0972-0707.212247] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Context: Direct pulp capping involves the placement of a biocompatible agent on pulp tissue that has been inadvertently exposed from traumatic injury or by iatrogenic means. Aim: To compare the human pulp response to calcium hydroxide and Biodentine as direct pulp-capping agents. Materials and Methods: Pulp exposures were performed on the pulpal floor of forty human permanent premolars. The exposure sites were dressed with either Dycal or Biodentine as pulp-capping materials. After 45 days, teeth were extracted and processed for histological examination. Statistical Analysis: The histological data were subjected to Wilcoxon rank-sum test. Results: The dentinal bridges in teeth that were capped with Biodentine were significantly thicker (P < 0.0001) and more continuous (P = 0.0001) with less pulpal inflammation (P = 0.0044) in comparison to Dycal. Conclusion: Based on the result of this study, Biodentine can be suggested as the material of choice for direct pulp capping procedure instead of Dycal. However, further long-term follow-up in vivo human studies using Biodentine on cariously exposed pulpal teeth are warranted to derive a definite conclusion.
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Affiliation(s)
- Anushka Lalit Jalan
- Department of Conservative Dentistry and Endodontics, Government Dental College, Nagpur, Maharashtra, India
| | - Manjusha M Warhadpande
- Department of Conservative Dentistry and Endodontics, Government Dental College, Nagpur, Maharashtra, India
| | - Darshan M Dakshindas
- Department of Conservative Dentistry and Endodontics, Government Dental College, Nagpur, Maharashtra, India
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14
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Clinical and Histological Evaluation of Direct Pulp Capping on Human Pulp Tissue Using a Dentin Adhesive System. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2591273. [PMID: 27803922 PMCID: PMC5075585 DOI: 10.1155/2016/2591273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/10/2016] [Accepted: 09/01/2016] [Indexed: 12/15/2022]
Abstract
Objective. This study presents a clinical and histological evaluation of human pulp tissue responses after direct capping using a new dentin adhesive system. Methods. Twenty-eight caries-free third molar teeth scheduled for extraction were evaluated. The pulps of 22 teeth were mechanically exposed and randomly assigned to 1 of 2 groups: Single Bond Universal or calcium hydroxide. Another group of 6 teeth acted as the intact control group. The periapical response was assayed, and a clinical examination was performed. The teeth were extracted after 6 weeks, and a histological analysis was performed. The pulp status was assessed, and the thickness of the dentin bridge was measured and categorized using a histological scoring system. Results. The clinical phase was asymptomatic for Single Bond Universal patients. Patients in the calcium hydroxide group reported mild symptoms of pain, although the histological examination revealed that dentin bridges with or without limited pulpitis had begun forming in each tooth. The universal adhesive system exhibited nonsignificantly increased histological signs of pulpitis (P > 0.05) and a significantly weaker thin mineralized tissue layer (P < 0.001) compared with the calcium hydroxide group. Conclusion. The results suggest that Single Bond Universal is inappropriate for human pulp capping; however, further long-term studies are needed to determine the biocompatibility of this agent.
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15
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Puspita S, Utoro T, Haniastuti T. Nestin expressions of exposed pulp after direct pulp capping by calcium hydroxide and platelet rich plasma. Eur J Dent 2016; 10:341-344. [PMID: 27403050 PMCID: PMC4926585 DOI: 10.4103/1305-7456.184157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate nestin expression of pulp tissue following direct pulp capping with platelet-rich plasma (PRP). MATERIALS AND METHODS The thirty sound teeth from Sprague-Dawley rats were used and divided into two groups: Groups 1, teeth were capped with calcium hydroxide/Ca(OH)2 (n = 15) and Group 2 with PRP (n = 15). After 1(st), 7(th), and 21(st) days, respectively, 5 teeth each group (American Dental Association 41) were processed for light microscopic examination. Expressions of nestin were assessed by immunohistochemical techniques. RESULTS Nestin expression of Ca(OH)2 on the distance place of exposure at 1(st) and 7(th) days were 80% and at 21(st) day were 60%. Nestin expression of PRP on the distance place at 1(st) day was 80%, 7(th) 100%, and 21(st) day was 80%. At day 21 observation, Kruskal-Wallis test shows nestin expression was increased significantly in PRP groups (P < 0.05), but it was not increase significantly compare with Ca(OH)2. CONCLUSION PRP had ability as a direct pulp capping material to induce nestin expression.
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Affiliation(s)
- Sartika Puspita
- Biomedical Department, School of Dentistry, Medical and Health Sciences Faculty Universitas Muhammadiyah Yogyakarta (UMY), Indonesia
| | - Totok Utoro
- Department of Pathology Anatomi, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Tetiana Haniastuti
- Department of Oral Biology, Faculty of Dentistry, Gadjah Mada University, Yogyakarta, Indonesia
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16
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Parthasarathy A, Kamat SB, Kamat M, Kidiyoor KH. Histological response of human pulps capped with calcium hydroxide and a self-etch adhesive containing an antibacterial component. J Conserv Dent 2016; 19:274-9. [PMID: 27217644 PMCID: PMC4872585 DOI: 10.4103/0972-0707.181947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: To compare human pulp tissue response following direct pulp capping with calcium hydroxide and a self-etch adhesive containing antibacterial component. Materials and Methods: Sixty-six erupted sound premolars scheduled to be extracted for orthodontic reasons were selected from 17 human subjects. Pulp exposures were made. Direct pulp capping was then performed using calcium hydroxide and a self-etch adhesive containing antibacterial component in its primer. The teeth were then restored with composite resin. Two teeth were maintained intact as a control group. After 7 and 30 days, teeth were extracted and processed for light microscopic examination using a histological scoring system. The teeth were divided into four groups (N = 16) according to the pulp capping materials used and their days of extraction. The results were then statistically analyzed by Mann-Whitney U-test. Results: After the 7-day observation period, the inflammatory reaction to the self-etch adhesive containing antibacterial component group was significantly less severe than that in the calcium hydroxide group (P < 0.05). After the 30-day observation period, the inflammatory reaction was slight in both groups, but specimens with dentin bridge formation in the self-etch adhesive group were significantly less common than those in the calcium hydroxide group (P < 0.05).
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Affiliation(s)
- Ambalavanan Parthasarathy
- Department of Conservative Dentistry and Endodontics, MES Dental College and Hospital, Perinthalmanna, Kerala, India
| | - Sharad B Kamat
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India
| | - Mamta Kamat
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India
| | - Krishnamurthy Haridas Kidiyoor
- Department of Conservative Dentistry and Endodontics, P.M. Nadagouda Memorial Dental College, Bagalkot, Karnataka, India
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17
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Schwendicke F, Brouwer F, Schwendicke A, Paris S. Different materials for direct pulp capping: systematic review and meta-analysis and trial sequential analysis. Clin Oral Investig 2016; 20:1121-32. [PMID: 27037567 DOI: 10.1007/s00784-016-1802-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/16/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVES We systematically assessed randomized controlled trials comparing direct pulp capping materials. METHODS Trials comparing materials for direct capping and evaluating clinically and/or radiographically determined success after minimum 3 months were included. Two reviewers independently screened electronic databases (Medline, Central, Embase) and performed hand searches. Risk of bias was assessed and meta-analyses were performed, separated for dentition. Trial sequential analysis was used to assess risk of random errors. Strength of evidence was graded using the GRADE approach. RESULTS From a total of 453 identified studies, 11 (all with high risk of bias) investigating 1094 teeth (922 patients) were included. Six studies were on primary teeth (all with carious exposures) and five on permanent teeth (carious and artificial exposures). Mean follow-up was 14 months (range 3-24). Most studies used calcium hydroxide as control, comparing it to mineral trioxide aggregate (MTA) (three studies), bonding without prior etching/conditioning (two), or bonding with prior etching/conditioning, enamel matrix proteins, resin-modified glass ionomer cement, calcium sulfate, zinc oxide eugenol, corticosteroids, antibiotics, or formocresol (each in only one study). One study compared MTA and calcium-enriched cement. In permanent teeth, risk of failure was significantly decreased if MTA instead of calcium hydroxide was used (risk ratio (RR) [95 % confidence intervals (CI)] 0.59 [0.39/0.90]); no difference was found for primary teeth. Other comparisons did not find significant differences or were supported by only one study. No firm evidence was reached according to trial sequential analysis. CONCLUSION There is insufficient data to recommend or refute the use of a specific material. More long-term practice-based studies with real-life exposures are required. CLINICAL RELEVANCE To reduce risk of failure, dentists might consider using MTA instead of calcium hydroxide (CH) for direct capping. Current evidence is insufficient for definitive recommendations.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
| | - Fredrik Brouwer
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Anja Schwendicke
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
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18
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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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Poggio C, Beltrami R, Colombo M, Ceci M, Dagna A, Chiesa M. In vitro antibacterial activity of different pulp capping materials. J Clin Exp Dent 2015; 7:e584-8. [PMID: 26644833 PMCID: PMC4663059 DOI: 10.4317/jced.52401] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 09/12/2015] [Indexed: 11/26/2022] Open
Abstract
Background Direct pulp capping involves the application of a dental material to seal communications between the exposed pulp and the oral cavity (mechanical and carious pulp exposures) in an attempt to act as a barrier, protect the dental pulp complex and preserve its vitality. The aim of this study was to evaluate and compare, by the agar disc diffusion test, the antimicrobial activity of six different pulp-capping materials: Dycal (Dentsply), Calcicur (Voco), Calcimol LC (Voco), TheraCal LC (Bisco), MTA Angelus (Angelus), Biodentine (Septodont). Material and Methods Streptococcus salivarius, Streptococcus sanguis and Streptococcus mutans strains were selected to evaluate the antimicrobial activity by the agar disc diffusion test of different pulp capping materials. Paper disks were impregnated whit each pulp capping materials and placed onto culture agar-plates pre-adsorbed with bacterial cells and further incubated for 24 h at 37°C. The growth inhibition zones around each pulp capping materials were recorded and compared for each bacterial strain. Results For the investigation of the antibacterial properties the ANOVA showed the presence of significant differences among the various materials. Tukey test showed that MTA-based materials induced lower growth inhibition zones. Conclusions MTA-based products show a discrete antibacterial activity varying from calcium hydroxide-based materials which present an higher antibacterial activity. Key words:Agar disc diffusion test, antimicrobial activity, calcium hydroxide, MTA, pulp capping materials.
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Affiliation(s)
- Claudio Poggio
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences - Section of Dentistry, University of Pavia, Piazzale Golgi 3, 27100 Pavia, Italy
| | - Riccardo Beltrami
- Department of Brain and Behavioural Sciences - Section of Statistic, University of Pavia, Piazzale Golgi 3, 27100 Pavia, Italy
| | - Marco Colombo
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences - Section of Dentistry, University of Pavia, Piazzale Golgi 3, 27100 Pavia, Italy
| | - Matteo Ceci
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences - Section of Dentistry, University of Pavia, Piazzale Golgi 3, 27100 Pavia, Italy
| | - Alberto Dagna
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences - Section of Dentistry, University of Pavia, Piazzale Golgi 3, 27100 Pavia, Italy
| | - Marco Chiesa
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences - Section of Dentistry, University of Pavia, Piazzale Golgi 3, 27100 Pavia, Italy
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20
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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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Songsiripradubboon S, Banlunara W, Sangvanich P, Trairatvorakul C, Thunyakitpisal P. Clinical, radiographic, and histologic analysis of the effects of acemannan used in direct pulp capping of human primary teeth: short-term outcomes. Odontology 2015; 104:329-37. [DOI: 10.1007/s10266-015-0215-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/22/2015] [Indexed: 01/28/2023]
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22
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Nowicka A, Wilk G, Lipski M, Kołecki J, Buczkowska-Radlińska J. Tomographic Evaluation of Reparative Dentin Formation after Direct Pulp Capping with Ca(OH)2, MTA, Biodentine, and Dentin Bonding System in Human Teeth. J Endod 2015; 41:1234-40. [DOI: 10.1016/j.joen.2015.03.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 03/03/2015] [Accepted: 03/06/2015] [Indexed: 12/30/2022]
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23
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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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24
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Liu S, Wang S, Dong Y. Evaluation of a Bioceramic as a Pulp Capping Agent In Vitro and In Vivo. J Endod 2015; 41:652-7. [DOI: 10.1016/j.joen.2014.12.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/13/2014] [Accepted: 12/13/2014] [Indexed: 10/24/2022]
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Cobanoglu N, Ozer F, Demirci M, Erganis O, Imazato S. Bacterial penetration of restored cavities using two self-etching bonding systems. Eur J Dent 2014; 8:166-171. [PMID: 24966765 PMCID: PMC4054045 DOI: 10.4103/1305-7456.130590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: The aim of this study was to investigate the effects of two bonding systems, with and without antibacterial monomers, on marginal bacterial and dye leakage. Materials and Methods: Class V cavities were prepared in extracted teeth for a bacterial leakage test, and the teeth were sterilized using a steam autoclave. Four cavities were not restored for the controls, and the other teeth were divided into two groups (n = 16 cavities each): Clearfil Protect Bond group (CPB) and Clearfil SE Bond group (CSE). After application of the bonding agent, the cavities were restored using a composite resin (Clearfil AP-X). The teeth were thermocycled, stored in a broth culture of 1.56 × 108 colony forming units (CFU)/ml of Streptococcus mutans at 37°C for 10 days, and subsequently processed for bacterial staining. Sections from the demineralized teeth were evaluated under a light microscope. In the dye leakage test, the cavities were restored as described in the bacterial penetration test. After thermocycling, the teeth were immersed in 5% basic fuchsin for 24 h, and then divided in half and observed under a stereomicroscope. The data were analyzed using the Kruskal–Wallis and Mann–Whitney U-tests (P = 0.05). Results: The bacterial stain was detected at the cavity wall of five cavities in both bonding systems. Additionally, two cavities in the CSE group, one cavity in the CPB group, and all control cavities showed bacterial staining within the cut dentinal tubules. Dye staining at the axial cavity wall was detected in only three of the teeth for both bonding systems. Conclusion: The bonding systems used in this study provided an acceptable marginal seal to prevent bacterial and dye leakage.
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Affiliation(s)
- Nevin Cobanoglu
- Department of Restorative Dentistry, Faculty of Dentistry, Selcuk University, Konya, Turkiye
| | - Fusun Ozer
- Department of Preventive and Restorative Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Mustafa Demirci
- Department of Restorative Dentistry, Faculty of Dentistry, Istanbul University, Istanbul, Turkiye
| | - Osman Erganis
- Department of Microbiology, Faculty of Medicine, Selcuk University, Konya, Turkiye
| | - Satoshi Imazato
- Department of Restorative Dentistry, Faculty of Dentistry, University of Osaka, Osaka, Japan
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26
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Cytocompatibility and antibacterial properties of capping materials. ScientificWorldJournal 2014; 2014:181945. [PMID: 24959601 PMCID: PMC4052471 DOI: 10.1155/2014/181945] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/24/2014] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to evaluate and compare the antimicrobial activity and cytocompatibility of six different pulp-capping materials: Dycal (Dentsply), Calcicur (Voco), Calcimol LC (Voco), TheraCal LC (Bisco), MTA Angelus (Angelus), and Biodentine (Septodont). To evaluate antimicrobial activity, materials were challenged in vitro with Streptococcus mutans, Streptococcus salivarius, and Streptococcus sanguis in the agar disc diffusion test. Cytocompatibility of the assayed materials towards rat MDPC-23 cells was evaluated at different times by both MTT and apoptosis assays. Results significantly differed among the different materials tested. Both bacterial growth inhibition halos and cytocompatibility performances were significantly different among materials with different composition. MTA-based products showed lower cytotoxicity and valuable antibacterial activity, different from calcium hydroxide-based materials, which exhibited not only higher antibacterial activity but also higher cytotoxicity.
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Azimi S, Fazlyab M, Sadri D, Saghiri MA, Khosravanifard B, Asgary S. Comparison of pulp response to mineral trioxide aggregate and a bioceramic paste in partial pulpotomy of sound human premolars: a randomized controlled trial. Int Endod J 2014; 47:873-81. [DOI: 10.1111/iej.12231] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 12/07/2013] [Indexed: 11/30/2022]
Affiliation(s)
- S. Azimi
- Department of Endodontics; Islamic Azad University; Dental Branch; Tehran Iran
| | - M. Fazlyab
- Department of Endodontics; Islamic Azad University; Dental Branch; Tehran Iran
| | - D. Sadri
- Department of Endodontics; Islamic Azad University; Dental Branch; Tehran Iran
| | - M. A. Saghiri
- Department of Endodontics; Islamic Azad University; Dental Branch; Tehran Iran
| | - B. Khosravanifard
- Department of Endodontics; Islamic Azad University; Dental Branch; Tehran Iran
| | - S. Asgary
- Department of Endodontics; Islamic Azad University; Dental Branch; Tehran Iran
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28
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Silva GAB, Gava E, Lanza LD, Estrela C, Alves JB. Subclinical Failures of Direct Pulp Capping of Human Teeth by Using a Dentin Bonding System. J Endod 2013; 39:182-9. [DOI: 10.1016/j.joen.2012.09.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/10/2012] [Accepted: 09/24/2012] [Indexed: 12/31/2022]
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29
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Neelakantan P, Rao CVS, Indramohan J. Bacteriology of deep carious lesions underneath amalgam restorations with different pulp-capping materials--an in vivo analysis. J Appl Oral Sci 2012; 20:139-45. [PMID: 22666827 PMCID: PMC3894753 DOI: 10.1590/s1678-77572012000200003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 05/30/2010] [Indexed: 11/21/2022] Open
Abstract
Microorganisms remaining in dentin following cavity preparation may induce pulp
damage, requiring the use of pulp-capping agents with antimicrobial activity
underneath permanent restorations.
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Affiliation(s)
- Prasanna Neelakantan
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha University, Chennai, India.
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Sangwan P, Sangwan A, Duhan J, Rohilla A. Tertiary dentinogenesis with calcium hydroxide: a review of proposed mechanisms. Int Endod J 2012; 46:3-19. [PMID: 22889347 DOI: 10.1111/j.1365-2591.2012.02101.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 06/25/2012] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- P Sangwan
- Department of Conservative Dentistry, Government Dental College, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India.
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31
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Leye Benoist F, Gaye Ndiaye F, Kane AW, Benoist HM, Farge P. Evaluation of mineral trioxide aggregate (MTA) versus calcium hydroxide cement (Dycal(®) ) in the formation of a dentine bridge: a randomised controlled trial. Int Dent J 2012; 62:33-39. [PMID: 22251035 PMCID: PMC9374926 DOI: 10.1111/j.1875-595x.2011.00084.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
AIM To assess the effectiveness of mineral trioxide aggregate (MTA) used as an indirect pulp-capping material in human molar and premolar teeth. METHODOLOGY We conducted a clinical evaluation of 60 teeth, which underwent an indirect pulp-capping procedure with either MTA or calcium hydroxide cement (Dycal(®) ). Calcium hydroxide was compared with MTA and the thickness of the newly formed dentine was measured at regular time intervals. The follow-up was at 3 and 6 months, and dentine formation was monitored by radiological measurements on digitised images using Mesurim Pro(®) software. RESULTS At 3 months, the clinical success rates of MTA and calcium hydroxide were 93% and 73%, respectively (P = 0.02). At 6 months, the success rate was 89.6% with MTA, and remained steady at 73% with calcium hydroxide (P = 0.63). The mean initial residual dentine thickness was 0.23 mm, and increased by 0.121 mm with MTA and by 0.136 mm with calcium hydroxide at 3 months. At 6 months, there was an increase of 0.235 mm with MTA and of 0.221 mm with calcium hydroxide. CONCLUSIONS A higher success rate was observed in the MTA group relative to the Dycal(®) group after 3 months, which was statistically significant. After 6 months, no statistically significant difference was found in the dentine thickness between the two groups. Additional histological investigations are needed to support these findings.
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Affiliation(s)
- Fatou Leye Benoist
- Institute of Dentistry, Route de l'Université, University Cheikh Anta Diop, Dakar, Senegal.
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LOUWAKUL P, LERTCHIRAKARN V. Incorporation of anti-inflammatory agent into calcium hydroxide pulp capping material: An in vitro study of physical and mechanical properties. Dent Mater J 2012; 31:32-9. [DOI: 10.4012/dmj.2011-072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yano J, Kitamura C, Nishihara T, Tokuda M, Washio A, Chen KK, Terashita M. Apoptosis and survivability of human dental pulp cells under exposure to Bis-GMA. J Appl Oral Sci 2011; 19:218-22. [PMID: 21625736 PMCID: PMC4234332 DOI: 10.1590/s1678-77572011000300007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 03/27/2010] [Indexed: 12/29/2022] Open
Abstract
Objective In the present study, we examined whether 2, 2-bis
[4-(2-hydroxy-3methacryloxypropoxy) phenyl] propane (Bis-GMA) has effects on LSC2
cells, human dental pulp cell line. Material and Methods The viability, cell cycle, and morphology of LSC2 cells were analyzed after
exposure to several different concentrations of Bis-GMA. The recovery of viability
of Bis-GMA exposed cells was also analyzed in the condition without Bis-GMA.
Further, penetration of Bis-GMA to dentin disc was examined using isocratic
high-performance liquid chromatography. Results There was a concentration-dependent decrease in cell proliferation and an increase
in cell number in the sub-G1 population after exposure to Bis-GMA. Furthermore,
the cells showed typical characteristics of apoptotic cells after the exposure to
high concentration of Bis-GMA. In contrast, cells exposed to lower concentrations
of Bis-GMA recovered their viability after being cultured without Bis-GMA. We also
found that Bis-GMA is capable of penetrating 1-mm-thick dentin discs, though the
penetrated concentration was lower than that showing cytotoxicity. Conclusion These results suggest that Bis-GMA has cytotoxic effects, though dental pulp
exposed to lower concentrations is able to recover their viability when Bis-GMA is
removed.
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Affiliation(s)
- Junya Yano
- Division of Pulp Biology, Operative Dentistry, and Endodontics, Department of Cariology and Periodontology, Kyushu Dental College, Japan
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Suzuki M, Ogisu T, Kato C, Shinkai K, Katoh Y. Effect of CO₂ laser irradiation on wound healing of exposed rat pulp. Odontology 2011; 99:34-44. [PMID: 21271324 DOI: 10.1007/s10266-010-0140-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 05/20/2010] [Indexed: 11/28/2022]
Abstract
This study examined the effects of direct pulp capping treatment using super-pulsed CO₂ laser preirradiation on the wound healing process of exposed rat pulp on days 1, 3, 7, 14, and 28 postoperatively. Group 1 was irradiated with a CO₂ laser and directly capped with a self-etching adhesive system. The laser was operated in super-pulse mode (pulse duration, 200 μs; interval, 5800 μs; 0.003 J/pulse). The irradiation conditions were a power output of 0.5 W, an irradiation time of 3 s, and repeat mode (10 ms of irradiation at 10-ms intervals for a total beam exposure time of 1.5 s), defocused beam diameter of 0.74 mm (approximately 20 mm from the exposed pulp surface), energy density of 0.698 J/cm² per pulse, total applied energy of 0.75 J, and an activated air-cooling system. Group 2 was capped with the self-etching adhesive system. Group 3 was capped with commercially available calcium hydroxide, and the self-etching adhesive system was applied to the cavity. The following parameters were evaluated: pulp tissue disorganization, inflammatory cell infiltration, reparative dentin formation, and bacterial penetration. The results were statistically analyzed using the Kruskal-Wallis test for differences among the groups at each observation period (P < 0.05). There were no significant differences among the experimental groups in any parameters at any postoperative period (P > 0.05). CO₂ laser irradiation was effective in arresting hemorrhaging but showed a tendency to delay reparative dentin formation compared with the application of calcium hydroxide.
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Affiliation(s)
- Masaya Suzuki
- Department of Operative Dentistry, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata, 951-8580, Japan.
| | - Takahito Ogisu
- Comprehensive Dentistry, The Nippon Dental University Niigata Hospital, Niigata, Japan
| | - Chikage Kato
- Department of Operative Dentistry, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata, 951-8580, Japan
| | - Koichi Shinkai
- Department of Operative Dentistry, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata, 951-8580, Japan
| | - Yoshiroh Katoh
- Department of Operative Dentistry, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata, 951-8580, Japan
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