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Komora P, Vámos O, Gede N, Hegyi P, Kelemen K, Galvács A, Varga G, Kerémi B, Vág J. Comparison of bioactive material failure rates in vital pulp treatment of permanent matured teeth - a systematic review and network meta-analysis. Sci Rep 2024; 14:18421. [PMID: 39117767 PMCID: PMC11310317 DOI: 10.1038/s41598-024-69367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024] Open
Abstract
Mineral Trioxide Aggregate (MTA) is the gold standard for vital pulp treatment (VPT), but its superiority over novel calcium silicate-based cements in permanent teeth lacks systematic evidence. This study aimed to compare the efficacy of these materials in VPT through a network meta-analysis. A systematic search was conducted in MEDLINE, EMBASE, Cochrane Library, and Web of Science until January 20, 2024. The inclusion criteria were randomized controlled trials involving VPT with biomaterials and reversible or irreversible pulpitis diagnoses in mature permanent teeth. The primary outcome was the odds ratio (OR) of failure rates with 95% confidence intervals. In the 21 eligible trials, failure rates were significantly higher with calcium-hydroxide than MTA at six (OR 2.26 [1.52-3.36]), 12 (OR 2.53 [1.76-3.62]), and 24 months (OR 2.46 [1.60-3.79]). Failure rates for Totalfill at six (OR 1.19 [0.55-2.58]) and 12 months (OR 1.43 [0.71-2.92]), and Biodentine at six (OR 1.09 [0.66-1.78]), 12 (OR 1.21 [0.74-1.96]), and 24 months (OR 1.47 [0.81-2.68]) were not significantly different from MTA. The results were similar in the direct pulp capping subgroup, whereas, in the partial and full pulpotomy subgroup, there was not enough evidence to achieve significant differences. MTA, Biodentine, and Totalfill are the most efficient materials for VPT. However, calcium-hydroxide-based materials are not recommended in VPT.
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Affiliation(s)
- Péter Komora
- Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest Szentkiralyi Utca 47, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Orsolya Vámos
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Kata Kelemen
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Adél Galvács
- Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest Szentkiralyi Utca 47, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Gábor Varga
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Beáta Kerémi
- Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest Szentkiralyi Utca 47, Budapest, Hungary.
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
| | - János Vág
- Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest Szentkiralyi Utca 47, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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Thomas NA, Jobe J, Thimmaiah C, Shetty K, Vergis BA, Krishnan D, Sabu N, Muralidaran G. Comparative Evaluation of Effectiveness of Calcium Hydroxide, MTA, and TheraCal LC in Indirect Pulp Capping in Primary Molars: In Vivo Study. J Contemp Dent Pract 2024; 25:365-371. [PMID: 38956853 DOI: 10.5005/jp-journals-10024-3680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
AIM This investigation aimed to observe the effects of Dycal, mineral trioxide aggregate (MTA), and TheraCal LC, as indirect pulp-capping materials in primary molars. MATERIALS AND METHODS About 75 children with lower primary molars aged between 4 and 7 years suggested for IPC were selected and randomly allocated into: Group I - Dycal, group II - MTA, and group III - TheraCal LC. An immediate postoperative radiograph was taken after the procedure. Recall examination was done after 3 and 6 months for clinical and radiographic assessment. The radiographs were digitized, and the amount of thickness of dentin was assessed using Corel Draw software. The values were tabulated and subjected to paired t-tests and independent t-tests for intra and intergroup analysis, respectively. The p-value < 0.05 was considered statistically significant. RESULTS There was a statistically significant increase in dentin thickness in the first 3 months compared to the 6-month follow-up. At the end of the research phase, TheraCal LC had more tertiary dentin deposited than MTA, followed by Dycal. CONCLUSION TheraCal LC can be a reliable indirect pulp-capping agent in primary teeth. CLINICAL SIGNIFICANCE Indirect pulp capping (IPC) is a very extensively employed treatment regimen to manage extensive caries. For many decades, calcium hydroxide has been regarded as the benchmark of pulp capping materials. With several advancements in materials for restoration, TheraCal LC a resin-modified, light-cured calcium silicate-filled liner serves as a pulp-capping agent and dentin protector, promoting pulp healing and preserving vitality as an obstacle cum protector of the dental pulp complex. How to cite this article: Thomas NA, Jobe J, Thimmaiah C, et al. Comparative Evaluation of Effectiveness of Calcium Hydroxide, MTA, and TheraCal LC in Indirect Pulp Capping in Primary Molars: In Vivo Study. J Contemp Dent Pract 2024;25(4):365-371.
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Affiliation(s)
- Nithya A Thomas
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Manipal; Manipal Academy of Higher Education, Manipal, Karnataka, India, Orcid: https://orcid.org/0000-0002-9314-4171
| | - Justin Jobe
- Department of Pediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Nellikuzhi, Kothamangalam, Kerala, India, Orcid: https://orcid.org/0009-0002-8989-0419
| | - Charisma Thimmaiah
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangaluru; Manipal Academy of Higher Education, Manipal, Karnataka, India, Phone: +91 9036149138, e-mail: , Orcid: https://orcid.org/0000-0002-4920-4624
| | - Kaushik Shetty
- Department of Orthodontics and Dentofacial Orthopedics, AB Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangaluru, Karnataka, India, Orcid: https://orcid.org/0000-0002-5688-6635
| | - Bettina A Vergis
- Department of Conservative Dentistry and Endodontics, Srinivas Institute of Dental Sciences, Mangaluru, Karnataka, India, Orcid: https://orcid.org/0000-0001-5205-5597
| | - Darsana Krishnan
- Department of Pediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Nellikuzhi, Kothamangalam, Kerala, India, Orcid: https://orcid.org/0000-0003-3795-9920
| | - Nimmy Sabu
- Department of Pediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Nellikuzhi, Kothamangalam, Kerala, India
| | - Gayathri Muralidaran
- Department of Periodontics, Mamata Dental College, Khammam, Telangana, India, Orcid: https://orcid.org/0000-0002-9427-1172
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Vaghasiya J, Mittal S, Choudhari SR, Rishitha N. Complete versus incomplete caries removal procedures and their effects on dental pulp in primary teeth - An in vivo study. J Indian Soc Pedod Prev Dent 2024; 42:149-155. [PMID: 38957913 DOI: 10.4103/jisppd.jisppd_116_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/16/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Dental caries results from an ecologic shift within the dental biofilm from a balanced population of microorganisms to an acidogenic, aciduric, and cariogenic microbiological population developed and maintained by frequent consumption of fermentable dietary carbohydrates. Total caries removal (TCR) of deep lesion may result in pulpal exposure requiring more invasive treatment. Hence, current pediatric dentistry has shifted to minimally invasive treatment that avoids more complex, time-consuming procedure, and the child's discomfort. AIM The aim of this study is to evaluate and compare clinical performance and radiographic changes after complete and incomplete caries removal procedures. MATERIALS AND METHODS The study was conducted on 60 primary molars in children aged 6-9 years. Selected 60 primary molars were randomly divided into two groups. Group 1 (PCR): infected dentin was removed, while the affected dentin was maintained on the pulpal wall. Group 2 (TCR): both infected and affected dentin were removed through low-speed carbide bur and hand excavator. Teeth were evaluated at 4 and 6 months clinically and radiographically. RESULTS The proportion was compared using Fisher's exact test. The Statistical Package for the Social Sciences version 21 was used for analysis. The level of significance was kept at 5%. CONCLUSION The clinical and radiographic success rates of ICR and CCR in primary teeth with deep carious lesions were high and did not differ significantly, indicating that the retention of carious dentin does not interfere with pulp vitality. Thus, ICR is a reliable minimally invasive approach that might replace the CCR in primary teeth when correctly indicated.
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Affiliation(s)
- Jigna Vaghasiya
- Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Ahmedabad, Gujarat, India
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Cho SY, Park S, Shin Y, Jung IY. Randomized clinical trial of pulpotomy using a premixed injectable calcium silicate cement on mature permanent teeth with reversible pulpitis. Sci Rep 2024; 14:2994. [PMID: 38316823 PMCID: PMC10844323 DOI: 10.1038/s41598-024-52818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
The aim of this two-center randomized controlled trial was to assess the outcomes and relative factors associated with pulpotomies performed using a premixed injectable calcium silicate cement, as compared to mineral trioxide aggregate in mature permanent premolar and molar teeth with reversible pulpitis. Included teeth were randomly divided into two groups according to pulpotomy material (ProRoot MTA [PMTA] group, Endocem MTA Premixed [EPM] group). After pulp exposure, the superficial pulp was either removed to a depth of 2 mm (partial pulpotomy) or completely amputated to the level of the root canal orifice (full pulpotomy). A 3-mm layer of either material was randomly placed over the pulp wound, followed by the application of a thin layer of a light-cured glass ionomer composite liner. The restoration procedure was then carried out during the same visit. After one year of treatment, the pulpotomy success rate was 94.4% (67/71), with no significant difference between the PMTA and EPM groups. The success rate was 93.9% in the PMTA group and 97.1% in the EPM group. There were no significant factors related to the procedures. EPM is a viable alternative to PMTA for single-visit pulpotomies of permanent premolars and molars.
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Affiliation(s)
- Sin-Yeon Cho
- Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-Do, Korea
| | - Seonghun Park
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Sudaemun-gu, Seoul, 03722, Korea
| | - Yooseok Shin
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Sudaemun-gu, Seoul, 03722, Korea
| | - Il-Young Jung
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Sudaemun-gu, Seoul, 03722, Korea.
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Semprum-Clavier A, Rodriguez A, Salazar D, Afshari F, Manzotti A, Saleh-Hassan L, Viana M, Bedran-Russo A. Clinical Comparison of Three Indirect Pulp Capping Restorative Protocols: A Randomized Controlled Prospective Study. Oper Dent 2024; 49:11-19. [PMID: 38180467 DOI: 10.2341/22-094-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES The objective of this prospective double-blind clinical trial was to compare clinical outcomes of indirect pulp capping restorative protocols on permanent teeth over a 12-month period. METHODS AND MATERIALS Deep carious lesions in permanent teeth (90) were randomly assigned to three indirect pulp capping protocols (n=30: TheraCal LC, Dycal, and no liner). All teeth were restored with resin composite. The outcome measures were pain (VAS scale) and success rate (pulp vitality based on percussion, palpation, cold test, and radiographic findings), collected at screening, intervention, and 24-hour, 7-day, 3-month, 6-month, and 12-month follow-up visits. RESULTS There was no statistically significant difference in tooth sensitivity among the three indirect pulp capping protocols nor in success rates among the restorative protocols after 1 year of follow-up (p>0.1).The respective success rates, as defined by the tooth remaining vital, after 1 year were: 96.2% for TheraCal LC, 100% for Dycal, and 100% for no liner. CONCLUSIONS After 12-month evaluation, the success rate of indirect pulp capping therapy on permanent teeth was not affected by the pulp capping restorative protocol.
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Affiliation(s)
- A Semprum-Clavier
- *Adriana Semprum-Clavier, DDS, MS, clinical associate professor, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA ORCID ID: 0000-0003-1396-7520
| | - A Rodriguez
- Alexandra Rodriguez, DDS, MS, clinical associate professor, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - D Salazar
- Daisy Salazar, DDS, MS, clinical associate professor, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - F Afshari
- Fatemeh Afshari, DDS, MS, clinical professor, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - A Manzotti
- Anna Manzotti, DDS, MS, clinical assistant professor, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - L Saleh-Hassan
- Lina Saleh-Hassan, DDS, MS, clinical assistant professor, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
| | - M Viana
- Marlos Viana, DDS, MS, adjunct associate professor, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA, Department of Pharmaceutical Sciences, College of Pharmacy, University Illinois at Chicago, Chicago, IL, USA
| | - A Bedran-Russo
- Ana K Bedran-Russo, DDS, MS, PhD, professor, Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
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Tzanetakis GN, Koletsi D, Georgopoulou M. Treatment outcome of partial pulpotomy using two different calcium silicate materials in mature permanent teeth with symptoms of irreversible pulpitis: A randomized clinical trial. Int Endod J 2023; 56:1178-1196. [PMID: 37452640 DOI: 10.1111/iej.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/25/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
AIM To assess the clinical and radiographic outcome of partial pulpotomy by comparing MTA Angelus and Total Fill BC, as pulpotomy agents, in mature teeth with deep caries and symptoms indicative of irreversible pulpitis. METHODOLOGY The study was designed as a parallel-two arm, double-blind, randomized superiority clinical trial registered at www. CLINICALTRIALS gov (NCT04870398). Symptomatic mature permanent teeth with deep caries fulfilling the inclusion criteria were randomly treated using either MTA Angelus or Total Fill BC. A partial pulpotomy was performed and following complete haemostasis, the capping material was placed over the remaining pulp tissue and a postoperative periapical radiograph was taken. Clinical and radiographic follow-up evaluation was performed for a median time of 2 years, whereas levels of pain intensity were evaluated preoperatively and for 7 days after intervention using Visual Analogue Scale. For the primary outcome (failure/success of treatment), the Kaplan-Meier survival curves for the capping materials were plotted and a log-rank test for equality of survivor functions was applied. A multivariable random effects Cox Regression model was also applied. For the secondary outcome (postoperatively reported pain), a multivariable mixed effects ordinal logistic regression was structured. RESULTS One hundred and thirty-seven teeth in 123 patients underwent partial pulpotomy using randomly either MTA Angelus (N = 74) or Total Fill BC (n = 63). The percentage failure for MTA Angelus and Total Fill BC was 10.8% (8/74) and 17.5% (11/63), respectively, but the difference was not statistically significant [adjusted HR: 1.83; 95% confidence interval (CI): 0.68, 4.91; p = .23]. Weak evidence was found that secondary caries involvement may impose a 3.54 times greater hazard for treatment failure (adjusted HR: 3.54; 95% CI: 1.00, 12.51; p = .05). For each passing minute of procedural bleeding control, there was also a 57% higher hazard for treatment failure (adjusted HR: 1.57; 95% CI: 0.99, 2.48; p = .05). The odds for higher postoperative pain were 4.73 times greater for the Total Fill BC compared to MTA Angelus (adjusted OR: 4.73; 95% CI: 2.31, 9.66; p < .001). CONCLUSIONS Both materials exhibited similar and favourable outcome rates after partial pulpotomy in teeth with deep caries and symptoms of irreversible pulpitis. Total Fill BC was associated with a higher level of postoperative pain intensities.
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Affiliation(s)
- Giorgos N Tzanetakis
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Maria Georgopoulou
- Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Kim M, Lee SH, Shin DH. In Vitro Study of the Biological and Physical Properties of Dual-Cure Resin-Modified Calcium Silicate-Based Cement. Dent J (Basel) 2023; 11:dj11050120. [PMID: 37232772 DOI: 10.3390/dj11050120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/14/2023] [Accepted: 04/23/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The aim of the present study was to compare the biological and mechanical properties of a novel dual-cure, resin-modified calcium silicate material, Theracal PT® (TP), with those of Theracal LC® (TL) and BiodentineTM (BD). METHODS The cell counting kit-8 was used on human dental pulp cells to test cell the viability of the three materials. Antibacterial activity of TP, TL, and BD against Enterococcus faecalis was investigated under anaerobic conditions. The ability of the materials to support odontogenic differentiation was studied by examining the relative gene expression of osteocalcin (OCN), osteopontin (OPN), and Collagen I (ColI) using real-time polymerase chain reaction. For mechanical property tests, microhardness was evaluated using the Vickers microhardness (VHN) test, and the bond strength to the resin was evaluated using a shear bond test machine. RESULTS There was no significant difference in cell viability between TL and TP after 48 h, and BD showed the highest cell viability, while TP showed the highest antibacterial effect. At the 12-h time point, there was no significant difference in ColI and OCN expression between BD and TP, but TP showed a higher expression of OPN than BD. However, at the 48-h time point, ColI and OCN showed higher levels of expression for BD than for TP and TL. At the same time point, only OPN had a higher diffusion for TP than for BD. TP demonstrated a VHN of approximately 30-35. This value was higher than that of TL and lower than that of BD. In contrast to VHN, the shear bond strength to resin was significantly higher for TL and TP than for BD. CONCLUSION TP showed lower biocompatibility than BD but higher OPN expression and antibacterial effects than BD and TL. TP showed higher shear bond strength than BD and higher VHN than TL and BD at the 24-h time point.
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Affiliation(s)
- Minjung Kim
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan 31116, Republic of Korea
| | - Sung-Hoon Lee
- Department of Oral Microbiology and Immunology, College of Dentistry, Dankook University, Cheonan 31116, Republic of Korea
| | - Dong-Hoon Shin
- Department of Conservative Dentistry, College of Dentistry, Dankook University, Cheonan 31116, Republic of Korea
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Al-Ali M, Camilleri J. The scientific management of deep carious lesions in vital teeth using contemporary materials—A narrative review. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.1048137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AimThe aim of this article is to review the scientific evidence for deep caries removal in permanent vital teeth and the choice of dentine replacement material and restoration of the teeth to maintain long term tooth vitality and function.MethodThe two position statements namely the European Society of Endodontology and the American Association of Endodontists position statements on vital pulp therapy will be scrutinized and compared with regards to the deep caries removal strategy and assessed for evidence of best practice. The properties of materials used to manage vital pulps and the best way to restore the teeth will be reviewed and guidance on the full management of vital teeth will be suggested.ConclusionsPromoting new treatment modalities for reversible and irreversible pulpitis allowing for pulp preservation should be considered. Although debatable, cases with deep caries should be managed by complete non-selective caries removal which will allow for pulpal management if needed and a more predictable outcome can be expected when using the new materials and treatment modalities of vital pulp therapy.
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Camilleri J, Atmeh A, Li X, Meschi N. Present status and future directions: Hydraulic materials for endodontic use. Int Endod J 2022; 55 Suppl 3:710-777. [PMID: 35167119 PMCID: PMC9314068 DOI: 10.1111/iej.13709] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hydraulic materials are used in Endodontics due to their hydration characteristics namely the formation of calcium hydroxide when mixing with water and also because of their hydraulic properties. These materials are presented in various consistencies and delivery methods. They are composed primarily of tricalcium and dicalcium silicate, and also include a radiopacifier, additives and an aqueous or a non-aqueous vehicle. Only materials whose primary reaction is with water can be classified as hydraulic. OBJECTIVES Review of the classification of hydraulic materials by Camilleri and the literature pertaining to specific uses of hydraulic cements in endodontics namely intra-coronal, intra-radicular and extra-radicular. Review of the literature on the material properties linked to specific uses providing the current status of these materials after which future trends and gaps in knowledge could be identified. METHODS The literature was reviewed using PUBMED, and for each clinical use, the in vitro properties such as physical, chemical, biological and antimicrobial characteristics and clinical data were extracted and evaluated. RESULTS A large number of publications were retrieved for each clinical use and these were grouped depending on the property type being investigated. CONCLUSIONS The hydraulic cements have made a difference in clinical outcomes. The main shortcoming is the poor testing methodologies employed which provide very limited information and also inhibits adequate clinical translation. Furthermore, the clinical protocols need to be updated to enable the materials to be employed effectively.
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Affiliation(s)
- Josette Camilleri
- School of DentistryCollege of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Amre Atmeh
- Hamdan Bin Mohammed College of Dental Medicine (HBMCDM)Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU)DubaiUnited Arab Emirates
| | - Xin Li
- Department of Oral Health SciencesBIOMAT – Biomaterials Research GroupKU Leuven and DentistryUniversity Hospitals LeuvenLeuvenBelgium
| | - Nastaran Meschi
- Department of Oral Health SciencesBIOMAT – Biomaterials Research GroupKU Leuven and DentistryUniversity Hospitals LeuvenLeuvenBelgium
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A prospective clinical study with one year follow up of deep caries management using a novel biomaterial. BMC Res Notes 2022; 15:150. [PMID: 35484566 PMCID: PMC9052485 DOI: 10.1186/s13104-022-06041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/20/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The objectives of this study was to check the outcome of the direct and indirect pulp capping procedure using MTA (Mineral Trioxide Aggregate) by comparing the pre-and post-operative pain by using VAS scale, associating the pre- and post- operative changes in intraoral periapical radiograph and clinical symptoms. MATERIALS AND METHODS In this prospective clinical study 10 cases (5 for direct and 5 for indirect) with deep carious lesions (symptomatic) with no periapical changes were selected for the trial. The participants were subjected to deep caries management procedure under rubber dam where MTA is placed as pulp capping material followed by immediate restoration with sandwich technique using composite resin. The participants were followed up at recall visits of 1 month, 3 months, 6 months and 1 year intervals for clinical and radiographic evaluation. RESULTS The results of the study, analyzing the VAS, clinical symptoms and radiographic changes did not show any signs of pain, clinical and radiographic symptoms at 1 month, 3 months, 6 months and 1 year intervals. CONCLUSIONS It was concluded that MTA can be used for deep caries management as a pulp capping material which being equivalent to calcium hydroxide.
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Arhakis A, Cotti E, Kotsanos N. Pulp Therapy in Pediatric Dentistry. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seck A, Ndiaye D, Niang SO, Leye Benoist F, Fioretti F, Toure B. Evaluation of complete pulpotomy with Biodentine® on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis: 12 months follow-up. J Endod 2021; 48:312-319. [PMID: 34974080 DOI: 10.1016/j.joen.2021.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Complete pulpotomy is the removal of the coronal portion of a vital pulp and is a means of preserving the vitality of the remaining root portion. The objective of this study was to evaluate the 12-month success rate of complete pulpotomy with Biodentine® on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis. MATERIALS AND METHODS A total of 68 molars diagnosed with symptomatic irreversible pulpitis in 68 patients aged 20 years and older were included in this study. The exclusion criteria were intraoperative clinical signs of pulp necrosis on the molar to be treated such as no bleeding, or uncontrollable pulp hemorrhage (more than 5 min of hemostasis) on at least one canal. A complete pulpotomy with Biodentine® was performed on molars with symptomatic irreversible pulpitis by the same operator and with the same protocol. At 12-month post-operative follow-up was conducted to evaluate clinical and radiological success. RESULTS A total of 66 patients received complete pulpotomy. Fifty-two could be examined at 12 months postoperatively. Clinical and radiological analysis at 12 months postoperatively revealed a success rate of 87% (45/52 molars) and a failure rate of 13% (7/52 molars). There was a relationship between age, tooth type, pre-operative periapical condition and treatment success with P<0.05. CONCLUSION Compliance with the indications and protocol for complete pulpotomy with Biodentine® on mature permanent molars with symptomatic irreversible pulpitis gives positive results at 12 month follow-up.
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Affiliation(s)
- Anta Seck
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal.
| | - Diouma Ndiaye
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
| | - Seydina Ousmane Niang
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
| | - Fatou Leye Benoist
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
| | - Florence Fioretti
- University of Strasbourg, Faculty of Dental Surgery of Strasbourg, INSERM UMR 1260, Pôle de Médecine et Chirurgie Bucco-Dentaire des Hôpitaux Universitaires de Strasbourg, France
| | - Babacar Toure
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
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Youssef AR, Elsherief S. Evaluation of the cytotoxic effects of a new Harvard MTA compared to MTA Flow and ProRoot MTA on human gingival fibroblasts. Saudi Dent J 2021; 33:679-686. [PMID: 34803319 PMCID: PMC8589600 DOI: 10.1016/j.sdentj.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/25/2020] [Accepted: 04/26/2020] [Indexed: 10/27/2022] Open
Abstract
Background Biocompatibility is an essential property for any dental root repair material that may interact with the surrounding periodontal tissues. We hypothesise that the three mineral trioxide aggregate (MTA) restorative brands ProRoot MTA, MTA Flow and Harvard MTA have similar biocompatibility. To test this hypothesis, we compared the cytotoxic effects of these materials on human gingival fibroblast (GF). Methods MTA cements were prepared, and after completion of setting, they were incubated in Dulbecco's Modified Eagle Medium for 1 day or 4 days to obtain low and high concentrations of MTA elutes respectively. The elutes of MTA supplemented with fetal bovine serum were added to GF and incubated for 3 days at 37 °C and 5% CO2. Untreated cells were used as control. The cell viability was assessed using a 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) assay at 24, 48 and 72 h. Results After 24 h, the MTT assay showed that both 1- and 4-day elutes of MTA flow and Harvard MTA reduced cell viability significantly compared to control (P < 0.05). After 48 h, the 1-day elute of ProRoot MTA induced GF proliferation (P = 0.0136) while MTA flow and Harvard MTA were similar to control. After 72 h, the 1-day elute of ProRoot MTA and Harvard MTA induced GF proliferation, while the elute of MTA flow was comparable to control. The 4-day elute of Harvard MTA continued to be cytotoxic to GF after 24 h, 48 h, and 72 h incubation, while the 4-day elute of ProRoot MTA and MTA flow were similar to control. Conclusion ProRoot MTA and MTA Flow showed comparable biocompatibility. However, the 4-day elute of Harvard MTA was cytotoxic to GF. Further studied are required to assess the cell viability after direct contact with these materials versus eluent in vitro and compare these sealers in the clinical setting.
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Affiliation(s)
- Abdel-Rahman Youssef
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Saudi Arabia.,Department of Microbiology, Faculty of Medicine, Suez Canal University, Egypt
| | - Samia Elsherief
- Department of Endodontics, Faculty of Dentistry, Umm Al-Qura University, Saudi Arabia.,Department of Endodontics, Faculty of Oral and Dental Medicine, Cairo University, Egypt
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Yan H, Oshima M, Raju R, Raman S, Sekine K, Waskitho A, Inoue M, Inoue M, Baba O, Morita T, Miyagi M, Matsuka Y. Dentin-Pulp Complex Tissue Regeneration via Three-Dimensional Cell Sheet Layering. Tissue Eng Part C Methods 2021; 27:559-570. [PMID: 34583551 DOI: 10.1089/ten.tec.2021.0171] [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: 01/09/2023] Open
Abstract
The dentin-pulp complex is a unique structure in teeth that contains both hard and soft tissues. Generally, deep caries and trauma cause damage to the dentin-pulp complex, and if left untreated, this damage will progress to irreversible pulpitis. The aim of this study was to fabricate a layered cell sheet composed of rat dental pulp (DP) cells and odontogenic differentiation of pulp (OD) cells and to investigate the ability to regenerate the dentin-pulp complex in a scaffold tooth. We fabricated two single cell sheets composed of DP cells (DP cell sheet) or OD cells (OD cell sheet) and a layered cell sheet made by layering both cells. The characteristics of the fabricated cell sheets were analyzed using light microscopy, scanning electron microscope (SEM), hematoxylin-eosin (HE) staining, and immunohistochemistry (IHC). Furthermore, the cell sheets were transplanted into the subrenal capsule of immunocompromised mice for 8 weeks. After this, the regenerative capacity to form dentin-like tissue was evaluated using micro-computed tomography (micro-CT), HE staining, and IHC. The findings of SEM and IHC confirmed that layered cell sheets fabricated by stacking OD cells and DP cells maintained their cytological characteristics. Micro-CT of layered cell sheet transplants revealed a mineralized capping of the access cavity in the crown area, similar to that of natural dentin. In contrast, the OD cell sheet group demonstrated the formation of irregular fragments of mineralized tissue in the pulp cavity, and the DP cell sheet did not develop any hard tissue. Moreover, bone volume/tissue volume (BV/TV) showed a significant increase in hard tissue formation in the layered cell sheet group compared with that in the single cell sheet group (p < 0.05). HE staining also showed a combination of soft and hard tissue formation in the layered cell sheet group. Furthermore, IHC confirmed that the dentin-like tissue generated from the layered cell sheet expressed characteristic markers of dentin but not bone equivalent to that of a natural tooth. In conclusion, this study demonstrates the feasibility of regenerating dentin-pulp complex using a bioengineered tissue designed to simulate the anatomical structure. Impact statement The dentin-pulp complex can be destroyed by deep caries and trauma, which may cause pulpitis and progress to irreversible pulpitis, apical periodontitis, and even tooth loss. Current treatments cannot maintain pulp health, and teeth can become brittle. We developed a three-dimensional (3D) layered cell sheet using dental pulp cells and odontogenic differentiation of pulp cells for dentin-pulp complex regeneration. Our layered cell sheet enables the regeneration of an organized 3D dentin-pulp-like structure comparable with that of natural teeth. This layered cell sheet technology may contribute to dentin-pulp complex regeneration and provide a novel method for complex tissue engineering.
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Affiliation(s)
- Huijiao Yan
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Masamitsu Oshima
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Resmi Raju
- Department of Oral Disease Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Swarnalakshmi Raman
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kazumitsu Sekine
- Department of Biomaterials and Bioengineering, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Arief Waskitho
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Miho Inoue
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Masahisa Inoue
- Laboratories for Structure and Function Research, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima, Japan
| | - Otto Baba
- Department of Oral and Maxillofacial Anatomy, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tsuyoshi Morita
- Department of Oral and Maxillofacial Anatomy, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Mayu Miyagi
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yoshizo Matsuka
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Özcan M, Garcia LDFR, Volpato CAM. Bioactive Materials for Direct and Indirect Restorations: Concepts and Applications. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.647267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Currently, minimally invasive restorations could be made in dentistry applying adhesive materials and adhesion principles to the dental structures. Following this philosophy, endodontic interventions have been avoided largely, preserving hard tissues, and maintaining dental vitality. Advances in biologically favorable bioactive materials enabled clinicans to induce repair and regeneration of dental tissues. Such materials are primarily used for pulp protection and cementation of indirect restorations. This review highlights current bioactive materials available, principles of bioactivity and their mechanisms of action.
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Edwards D, Bailey O, Stone S, Duncan H. The management of deep caries in UK primary care: A nationwide questionnaire-based study. Int Endod J 2021; 54:1804-1818. [PMID: 34089184 DOI: 10.1111/iej.13585] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
AIM To investigate current approaches and attitudes towards the management of deep caries in primary dental care within the United Kingdom (UK). METHODOLOGY Open distribution of an electronic questionnaire survey was undertaken to primary care dental professionals working in publicly funded National Health Service [NHS], privately funded, military and community dental services. Demographic variables investigated included the following: place of qualification, method of remuneration, level of restorative training, materials available, years qualified, appointment length and clinician type. Management variables focussed on case-based scenarios. Univariate analyses of responses to questions were undertaken using χ2 tests with sequential Bonferroni correction. Variables with a statistical relationship of p ≤ .2 were selected for binary logistic regression modelling. RESULTS A total of 657 responses were received. Practitioners with formal postgraduate qualifications (PGQ) were more likely (OR, 95%CI) to undertake further tests to aid diagnosis including: gaining a patient history (1.80, 1.01-3.20), periapical radiography (1.43, 1.01-2.03), cold pulp testing (2.079, 1.46-2.97) and electric pulp testing (1.65, 1.02-2.65). Rubber dam was infrequently used for deep caries management (29.2%). Non-NHS practitioners were much more likely to use rubber dam (3.40, 2.15-5.37), as were those that had completed PGQ (2.24, 1.48-3.38). Non-selective caries removal was used in deep caries by 41.4% of practitioners. Indirect pulp caps were carried out by 56.7% of practitioners. NHS practitioners were more likely to place calcium hydroxide (3.74, 1.97-7.15), whilst non-NHS practitioners were more likely to place calcium silicate cements (CSCs) (3.303, 1.71-6.38) as were non-UK graduates (5.63, 2.47-12.86) and those with PGQ (2.12, 1.17-3.87). CONCLUSIONS This UK survey highlights significant variation in the management of deep caries. There is lack of consensus regarding the use of a standard systematic approach to diagnosing disease, with a reliance on history and tests with poor specificity. Non-selective caries removal for managing deep carious lesions remains common, with low rubber dam compliance underlining a lack of asepsis. Notably, a significant number of practitioners placed indirect pulp caps, but CSCs and GIC were not commonly used. At present, although clear guidelines are available this is not translating into consistent management approaches in practice, suggesting that better dissemination of current treatments is essential to undergraduate and postgraduate groups.
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Affiliation(s)
- David Edwards
- Restorative Department, Newcastle Dental Hospital, Newcastle upon Tyne, UK
| | - Oliver Bailey
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Stone
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hal Duncan
- Division of Restorative Dentistry and Periodontology, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
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Tomographic Evaluation of the Internal Adaptation for Recent Calcium Silicate-Based Pulp Capping Materials in Primary Teeth. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5523145. [PMID: 34046496 PMCID: PMC8128549 DOI: 10.1155/2021/5523145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022]
Abstract
Objectives To evaluate the internal adaptation of recent pulp capping materials (TheraCal and Biodentine) relative to MTA when used as indirect pulp capping for primary teeth. Materials and Methods Thirty primary molars were randomly allocated into three groups, group (A) was TheraCal, group (B) was Biodentine, and MTA was the control group (C). A standardized round class-V cavity (1.5 mm diameter and 2 mm depth) was prepared using a milling machine on the buccal surface of each tooth with the pulpal floor located on the dentin. Then, pulp-capping materials were applied. Finally, all teeth were restored by composite restoration. The internal adaptation of the pulp-capping materials to the dentinal surface was investigated by microcomputed tomography (Micro-CT) to determine the internal gap volume, and by optical coherence tomography (OCT) to determine the high-intensity reflection of light from the floor. Results Based on Micro-CT findings, TheraCal showed significantly higher internal gap volume than both MTA and Biodentine (p < 0.001), while MTA and Biodentine did not show a significant difference in the gap volume. Based on the OCT findings, TheraCal showed a significantly higher intensity of light reflection than both MTA and Biodentine (p < 0.001); however, there was no significant difference between MTA and Biodentine. Pearson's correlation test showed that there was a strong positive correlation between Micro-CT and OCT (r = 0.686, N = 30, p < 0.001). Conclusions Biodentine and MTA showed a comparable result in terms of their internal adaptation on the dentinal surface of the primary teeth, and both were better than TheraCal. There is a moderate to a strong positive correlation between Micro-CT and OCT in the measurement of internal adaptation of the tested pulp capping materials. OCT can be helpful and beneficial for the clinical setting and allow dentists to screen and evaluate restorations during follow-up.
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Detection of Inflammatory and Homeostasis Biomarkers after Selective Removal of Carious Dentin-An In Vivo Feasibility Study. J Clin Med 2021; 10:jcm10051003. [PMID: 33801317 PMCID: PMC7958315 DOI: 10.3390/jcm10051003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/20/2022] Open
Abstract
Deep carious dentin lesions induce an immune reaction within the pulp-dentin complex, leading to the release of cytokines, which might be suitable biomarkers in pulp diagnostics. This in vivo feasibility study determines the concentration of different cytokines after selective removal of carious infected dentin (SCR). In our methodology, paired samples are obtained from 21 patients—each of them with two deep carious lesions at posterior teeth without clinical symptoms. After SCR, lesions are randomly assigned to treatment strategy: Group 1 (11 patients): Carious dentin is covered either with BiodentineTM (n = 11) or gutta-percha (n = 11) before using the adhesive OptibondTM FL. Group 2 (10 patients): The adhesives ClearfilTM SE Protect Bond (n = 10) or ClearfilTM SE Bond 2 (n = 10) are directly applied. Prepared cavities are rinsed with phosphate buffered saline containing 0.05% Tween 20 (10X) for five minutes immediately after SCR (visit 1) and eight weeks later (visit 2). Rinsing liquid is regained. Concentrations of IL-1β, IL-6, IL-10, C-reactive protein (CRP), TNF-α, IFN-γ, TIMP-1, -2, and MMP-7, -8, -9 are assessed by customized multiplex assays, evaluated with fluorescence analyzer. Non-parametric statistical analysis (Wilcoxon, Mann–Whitney U Test, p < 0.05) is performed (SPSS 25). Our results show that concentrations of CRP, IL-1β, IL-6, TIMP-1, -2, and MMPs were detectable. Median concentrations of CRP, IL-1β und IL-6 were significantly higher in visit 1 (304.9, 107.4, 3.8 pg/mL), compared to visit 2 (67.8, 2.3, 0.0 pg/mL; pi < 0.001). The study revealed that the non-invasive determination of cytokines from prepared dental cavities is possible.
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Brusnitsyna EV, Barabanshchikova EV, Zakirov TV, Ioshchenko ES. Modern methods for treatment of deciduous teeth pulpitis: a literature review. Pediatr Dent 2021. [DOI: 10.33925/1683-3031-2020-20-4-275-287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Stafuzza TC, Vitor LLR, Lourenço Neto N, Rios D, Cruvinel T, Sakai VT, Moretti ABS, Machado MAAM, Oliveira TM. Pulp liner materials in selective caries removal: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e029612. [PMID: 33419899 PMCID: PMC7798680 DOI: 10.1136/bmjopen-2019-029612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The literature shows that selective carious tissue removal (SCTR) decreases the number and diversity of bacteria, stops the caries process and reduces the risk of pulp exposure. However, no consensus exists on which pulp liner would be suitable for teeth undergoing SCTR. So, this study will verify the in vivo response of dentine-pulp complex after SCTR in primary teeth with or without pulp liner material. METHODS AND ANALYSIS A randomised clinical trial, double-blinded, parallel-group and allocation concealment will be conducted with the enrolment of 384 patients from 5 to 9 years, with one maxillary/mandibular first/second primary molars with deep occlusal/occlusoproximal cavities. The remaining dentine will be lined with calcium hydroxide cement-group 1; mineral trioxide aggregate-group 2 and without liner-group 3. The primary outcome will be success of the of dentine-pulp complex evaluated clinically and radiographically at 6, 12 and 24 months, while the secondary outcomes will be the measurement of the dentine barrier on periapical radiographs. During all study, two trained and calibrated examiners will evaluate the treated teeth clinically and radiographically. Interexaminer and intraexaminer reliability will be verified by casual and systematic error. The Kolmogorov-Smirnov test will be adopted to test the normality of continuous variables. Comparisons among groups will be performed by using the χ2 test and anaylsis of variance, followed by Tukey test (p<0.05). The logistic regression will be applied, and the degrees of this association will be measured using the OR and 95% CI. ETHICS AND DISSEMINATION The present protocol was submitted and approved by the Ethical Committee of the University of São Paulo, Bauru, São Paulo, Brazil (CAAE: 79123517.0.0000.5417). Consent for publication will be obtained from all parents or legal guardians. Results of this study will be reported in full through peer-reviewed journals. TRIAL REGISTRATION NUMBER RBR-9fsxnn.
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Affiliation(s)
- Tássia Carina Stafuzza
- Department of Pediatric Dentistry, Orthodontics and Public Health, School of Dentistry of Bauru, University of São Paulo, São Paulo, Brazil
| | - Luciana Lourenço Ribeiro Vitor
- Department of Pediatric Dentistry, Orthodontics and Public Health, School of Dentistry of Bauru, University of São Paulo, São Paulo, Brazil
| | - Natalino Lourenço Neto
- Department of Pediatric Dentistry, Orthodontics and Public Health, School of Dentistry of Bauru, University of São Paulo, São Paulo, Brazil
| | - Daniela Rios
- Department of Pediatric Dentistry, Orthodontics and Public Health, School of Dentistry of Bauru, University of São Paulo, São Paulo, Brazil
| | - Thiago Cruvinel
- Department of Pediatric Dentistry, Orthodontics and Public Health, School of Dentistry of Bauru, University of São Paulo, São Paulo, Brazil
| | - Vivien Thiemy Sakai
- Department of Clinics and Surgery, School of Dentistry, Federal University of Alfenas, Alfenas, Brazil
| | | | | | - Thais Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, School of Dentistry of Bauru, University of São Paulo, São Paulo, Brazil
- Department of Pediatric Dentistry, Hospital for the Rehabilitation of Craniofacial Anomalies, University of São Paulo, São Paulo, Brazil
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Sahin N, Saygili S, Akcay M. Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial. Clin Oral Investig 2021; 25:3945-3955. [PMID: 33404764 DOI: 10.1007/s00784-020-03724-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this randomized, controlled, three-arm parallel group, and double-blinded clinical trial was to evaluate the clinical, radiographic, and histopathological success of three different pulp-capping materials in one-stage indirect pulp treatment of primary teeth. MATERIALS AND METHODS The study included a total of 109 patients aged 5-9 years who had primary teeth with deep carious lesions and symptoms of reversible pulpitis. The teeth were divided into three groups according to the pulp-capping agents: (I) hard-setting calcium hydroxide (Dycal) (control group) (n = 36), (II) bioactive tricalcium silicate (Biodentine) (n = 37), and (III) resin-based tricalcium silicate (TheraCal LC) (n = 36). All the teeth were evaluated clinically and radiographically at 6, 12, 18, and 24 months postoperatively. A total of 23 primary mandibular second molars that were in their regular exfoliation period (24-40 months) were extracted and fixed in 10% formaldehyde solution. The specimens were evaluated histologically to assess the integrity of the odontoblastic layer, tertiary dentin formation quality of the dentin formed, severity of pulpitis, and other pulpal changes. Data were analyzed using Fisher's exact test, Pearson's chi-square test, and McNemar's test (p = 0.05). RESULTS At the end of the 24-month follow-up period, the clinical and radiographic success rates for Dycal, Biodentine, and TheraCal LC were 100%, 100%, and 93.3%, respectively, and there was no significant difference among the groups (p > 0.05). However, the TheraCal LC group was statistically unsuccessful when compared to the other groups with regard to the integrity of the odontoblastic layer, severity of pulpitis, and other pulpal changes in histological examination (p < 0.05). CONCLUSION Indirect pulp capping exhibited high clinical and radiographic success rates in the treatment of primary teeth regardless of the chosen pulp-capping agent. However, histological examination indicated that the pulp status was affected by the chosen capping material especially when selecting a resin-containing material such as TheraCal LC. CLINICAL RELEVANCE Resin-free calcium silicate-based materials appear to be more favorable in the indirect pulp treatment of primary teeth, particularly in young-age groups that require long-term success.
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Affiliation(s)
- Nur Sahin
- Department of Pedodontics, Faculty of Dentistry, Izmir Katip Celebi University, 35640, Izmir, Turkey
| | - Suna Saygili
- Department of Histology and Embryology, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Merve Akcay
- Department of Pedodontics, Faculty of Dentistry, Izmir Katip Celebi University, 35640, Izmir, Turkey.
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Maru V, Dixit U, Patil RSB, Parekh R. Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review. Int J Clin Pediatr Dent 2021; 14:30-39. [PMID: 34326580 PMCID: PMC8311779 DOI: 10.5005/jp-journals-10005-1880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Knowledge of the cytotoxicity and bioactivity of endodontic materials may assist in understanding their ability to promote dental pulp stem cell activity and pulp healing in primary teeth. Materials and methods This systematic review was carried out by searching the electronic databases such as PubMed, Google Scholar, and Cochrane reviews for the articles published between January 2000 and December 2018 using the appropriate MeSH keywords. An independent investigator evaluated the abstracts and titles for possible inclusion, as per the stipulated inclusion and exclusion criteria. The topics considered for extracting data from each study were: cell lineage, cytotoxicity assay used, and type of material tested. Results Seven eligible studies were selected for assessing the quality of evidence on the bioactivity of bioactive endodontic cements (BECs) (1 human cell line, 2 animal cell lines, and 4 in vitro, animal, and human studies) and 13 studies were selected for reviewing the quality of evidence on cytotoxicity (7 human cell lines, 4 animal cell lines, and 2 animal model studies). Very limited studies had been conducted on the bioactivity of materials other than mineral trioxide aggregate (MTA). With regards to cytotoxicity, the studies were diverse and most of the studies were based on MTT assay. Mineral trioxide aggregate is the most frequently used as well as studied root-end filling cement, and the literature evidence corroborated its reduced cytotoxicity and enhanced bioavailability. Conclusion There was a lack of sufficient evidence to arrive at a consensus on the ideal material with minimal cytotoxicity and optimal bioactivity. More focused human/cell line-based studies are needed on the available root filling materials. Clinical significance The present systematic review provides an update on the available literature evidence on the cytotoxicity and bioactivity of various BECs including MTAs and their influence on the different cells with respect to their composition and strength. How to cite this article Maru V, Dixit U, Patil RSB, et al. Cytotoxicity and Bioactivity of Mineral Trioxide Aggregate and Bioactive Endodontic Type Cements: A Systematic Review. Int J Clin Pediatr Dent 2021;14(1):30–39.
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Affiliation(s)
- Viral Maru
- Department of Pediatric and Preventive Dentistry, DY Patil School of Dentistry, Nerul, Navi Mumbai, Maharashtra, India
| | - Uma Dixit
- Department of Pediatric and Preventive Dentistry, DY Patil School of Dentistry, Nerul, Navi Mumbai, Maharashtra, India
| | - Rucha Shivajirao Bhise Patil
- Department of Pediatric and Preventive Dentistry, DY Patil School of Dentistry, Nerul, Navi Mumbai, Maharashtra, India
| | - Rupanshi Parekh
- Department of Pediatric and Preventive Dentistry, DY Patil School of Dentistry, Nerul, Navi Mumbai, Maharashtra, India
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Kishan K, Parikh M, Shah N, Parikh M, Saklecha P. Comparative evaluation of biodentine and endosequence root repair material as direct pulp capping material: A clinical study. J Conserv Dent 2021; 24:330-335. [PMID: 35282571 PMCID: PMC8896135 DOI: 10.4103/jcd.jcd_321_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/25/2021] [Accepted: 09/21/2021] [Indexed: 11/20/2022] Open
Abstract
Aim: The study was designed to clinically evaluate biodentine and endosequence root repair material (ERRM) as direct pulp capping agent at 3 months, 6 months, and 12 months intervals. Materials and Methods: Sixty permanent posterior teeth with deep caries, without any signs of irreversible pulpitis were allotted into two experimental groups: Group I -Biodentine, Group II-ERRM. Follow-up evaluations were done. Every 24 h for 7 days, the pain was assessed using visual analog scale. Statistical Analysis: Paired t-test along with Pearson's Chi-square test was performed. Results: The success rate of clinical assessment at 12 months for biodentine group is 78.60% and ERRM Group is 64.70%. Conclusion: Biodentine group performed superior than ERRM group clinically at all-time interval and hence it can be successfully used to restore exposed vital tooth.
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Han S, Peng X, Ding L, Lu J, Liu Z, Wang K, Zhang L. TVH-19, a synthetic peptide, induces mineralization of dental pulp cells in vitro and formation of tertiary dentin in vivo. Biochem Biophys Res Commun 2020; 534:837-842. [PMID: 33168184 DOI: 10.1016/j.bbrc.2020.10.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/29/2020] [Indexed: 02/05/2023]
Abstract
Functional peptides derived from the active domains of odontogenesis-related proteins have been reported to promote dental hard tissue regeneration. The purpose of this study was to evaluate the effects of an artificially synthesized peptide, TVH-19, on odontoblast differentiation and tertiary dentin formation in indirect pulp capping (IPC) using in vitro and in vivo experiments. TVH-19 did not exhibit any effect on the proliferation of human dental pulp cells (hDPCs) but significantly promoted cell migration, compared with the control (p < 0.05). TVH-19-treated hDPCs showed significantly higher alkaline phosphatase (ALP) activity and stronger alizarin red staining (ARS) reactivity than the control group (p < 0.05). TVH-19 also upregulated the mRNA and protein expression levels of odontogenic genes. After generating IPC in rats, the samples of teeth were studied using micro-computed tomography (Micro-CT), hematoxylin & eosin (HE) staining, and immunohistochemical staining to investigate the functions of TVH-19. The in vivo results showed that TVH-19 induced the formation of tertiary dentin, and reduced inflammation and apoptosis, as evident from the downregulated expression of interleukin 6 (IL-6) and cleaved-Caspase-3 (CL-CASP3). Overall, the results of our study suggest that TVH-19 induces differentiation of hDPCs, promotes tertiary dentin formation, relieves inflammation, and reduces apoptosis, indicating the potential applications of TVH-19 in IPC.
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Affiliation(s)
- Sili Han
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Renmin South Road no. 14, 3rd Section, Chengdu, China
| | - Xiu Peng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Renmin South Road no. 14, 3rd Section, Chengdu, China
| | - Longjiang Ding
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Renmin South Road no. 14, 3rd Section, Chengdu, China
| | - Junzhuo Lu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Renmin South Road no. 14, 3rd Section, Chengdu, China
| | - Zhenqi Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Renmin South Road no. 14, 3rd Section, Chengdu, China
| | - Kun Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Renmin South Road no. 14, 3rd Section, Chengdu, China
| | - Linglin Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Renmin South Road no. 14, 3rd Section, Chengdu, China.
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Sharma A, Thomas MS, Shetty N, Srikant N. Evaluation of indirect pulp capping using pozzolan-based cement (ENDOCEM-Zr®) and mineral trioxide aggregate - A randomized controlled trial. J Conserv Dent 2020; 23:152-157. [PMID: 33384487 PMCID: PMC7720766 DOI: 10.4103/jcd.jcd_367_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 07/08/2020] [Accepted: 08/04/2020] [Indexed: 11/04/2022] Open
Abstract
Background Pulp capping should always be considered as the primary treatment of choice for teeth without irreversible pulpitis in lesions approaching dental pulp. The predictability of vital pulp therapy has improved with the introduction of newer bioceramic materials. Aim The purpose of this randomized controlled trial was to compare the outcomes of mineral trioxide aggregate (MTA) (Angelus, Londrina, Brazil) and a pozzolan-based cement (ENDOCEM-Zr® [Maruchi, Wonju, Korea]) as an indirect pulp capping (IPC) material. Materials and Methods IPC was performed in forty patients who were randomly divided into ENDOCEM-Zr® and MTA groups. The outcome was assessed using clinical and radiographic tests at different time intervals. The prognostic factors on the outcome of IPC were also evaluated. Results and Conclusions The success rate of ENDOCEM-Zr® and MTA groups was 94.7% and 89.4%, respectively. The results were not statistically significant. Binary logical regression showed that the age of the patient and the status of the pulp before treatment were deciding variables for the outcome of the study. Therefore, it was concluded from the study that the evaluated pozzolan-based cement could be used as an alternative to MTA because of its faster setting time and lower discoloration potential. In addition, pulp capping should be performed with caution in individuals above 40 years and in teeth with reversible pulpitis.
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Affiliation(s)
- Ankita Sharma
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Affiliated to Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Manuel S Thomas
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Affiliated to Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Neeta Shetty
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Affiliated to Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - N Srikant
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Affiliated to Manipal Academy of Higher Education, Mangalore, Karnataka, India
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Cervino G, Laino L, D’Amico C, Russo D, Nucci L, Amoroso G, Gorassini F, Tepedino M, Terranova A, Gambino D, Mastroieni R, Tözüm MD, Fiorillo L. Mineral Trioxide Aggregate Applications in Endodontics: A Review. Eur J Dent 2020; 14:683-691. [PMID: 32726858 PMCID: PMC7536098 DOI: 10.1055/s-0040-1713073] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A current topic in dentistry concerns the biocompatibility of the materials, and in particular, conservative dentistry and endodontics ones. The mineral trioxide aggregate (MTA) is a dental material with biocompatibility properties to oral and dental tissues. MTA was developed for dental root repair in endodontic treatment and it is formulated from commercial Portland cement, combined with bismuth oxide powder for radiopacity. MTA is used for creating apical plugs during apexification, repairing root perforations during root canal therapy, treating internal root resorption, and pulp capping. The objective of this article is to investigate MTA features from a clinical point of view, even compared with other biomaterials. All the clinical data regarding this dental material will be evaluated in this review article. Data obtained from the analysis of the past 10 years' literature highlighted 19 articles in which the MTA clinical aspects could be recorded. The results obtained in this article are an important step to demonstrate the safety and predictability of oral rehabilitations with these biomaterials and to promote a line to improve their properties in the future.
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Affiliation(s)
- Gabriele Cervino
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Policlinico G. Martino, Messina, Italy
| | - Luigi Laino
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Policlinico G. Martino, Messina, Italy
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy
| | - Cesare D’Amico
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Policlinico G. Martino, Messina, Italy
| | - Diana Russo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy
| | - Giulia Amoroso
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Policlinico G. Martino, Messina, Italy
| | - Francesca Gorassini
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Policlinico G. Martino, Messina, Italy
| | - Michele Tepedino
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Clinica Odontoiatrica e Chirurgia Maxillo-Facciale, Roma-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonella Terranova
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Policlinico G. Martino, Messina, Italy
| | - Dario Gambino
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Policlinico G. Martino, Messina, Italy
| | - Roberta Mastroieni
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Policlinico G. Martino, Messina, Italy
| | - Melek Didem Tözüm
- Pre-Doctoral Clinics, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Luca Fiorillo
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Policlinico G. Martino, Messina, Italy
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Matsuura T, Ziauddin SM, Kawata-Matsuura VKS, Sugimoto K, Yamada S, Yoshimura A. Long-term clinical and radiographic evaluation of the effectiveness of direct pulp capping materials: A meta-analysis. Dent Mater J 2020; 40:1-7. [PMID: 32999260 DOI: 10.4012/dmj.2020-043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this review is to evaluate the long-term effectiveness of calcium silicate-based cement (CS) and calcium hydroxide (CH) for direct pulp capping (DPC) to human pulp-exposed permanent teeth. An electronic search and manual search were performed on 21 June 2019. Long-term clinical and radiographic evaluations of the effectiveness of CS and CH for DPC to human pulp-exposed teeth were included, and data extraction, risk-of-bias assessment and meta-analyses were performed. From 645 identified articles, 7 articles met the eligibility criteria. The meta-analyses comparing CS with CH and Biodentine with mineral trioxide aggregates (MTA) on DPC success rate were performed, and significant difference was observed between CS and CH (risk ratio=1.20; p=0.005), whereas no significant difference was observed between Biodentine and MTA. CS seems to be a more effective and predictable DPC material than CH; however, these analyses are based on the studies judged at high risk of bias.
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Affiliation(s)
- Takashi Matsuura
- Department of Periodontology and Endodontology, Nagasaki University Graduate School of Biomedical Sciences
| | - S M Ziauddin
- Department of Periodontology and Endodontology, Nagasaki University Graduate School of Biomedical Sciences
| | - Viviane K S Kawata-Matsuura
- Basic and Translational Research Center for Hard Tissue Disease, Nagasaki University Graduate School of Biomedical Sciences
| | - Kouji Sugimoto
- Department of Periodontology and Endodontology, Nagasaki University Graduate School of Biomedical Sciences
| | - Shizuka Yamada
- Department of Periodontology and Endodontology, Nagasaki University Graduate School of Biomedical Sciences
| | - Atsutoshi Yoshimura
- Department of Periodontology and Endodontology, Nagasaki University Graduate School of Biomedical Sciences
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Yang Y, Xia B, Xu Z, Dou G, Lei Y, Yong W. The effect of partial pulpotomy with iRoot BP Plus in traumatized immature permanent teeth: A randomized prospective controlled trial. Dent Traumatol 2020; 36:518-525. [PMID: 32348009 DOI: 10.1111/edt.12563] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 12/18/2022]
Affiliation(s)
- YingTing Yang
- The Third Clinical Division of Peking University School and Hospital of Stomatology Beijing China
| | - Bin Xia
- Department of Pediatric Dentistry Peking University School and Hospital of Stomatology Beijing China
| | - Zheng Xu
- Department of Pediatric Dentistry The Center for Pediatric Dentistry University of Washington Seattle WA USA
| | - Guili Dou
- Department of Pediatric Dentistry Peking University School and Hospital of Stomatology Beijing China
| | - Yue Lei
- The Third Clinical Division of Peking University School and Hospital of Stomatology Beijing China
| | - Wei Yong
- Department of General Dentistry Peking University School and Hospital of Stomatology Beijing China
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Kim MR, Choi SH, Lee BN, Min KS, Hwang YC. Effect of parathyroid hormone-related protein on odontogenic differentiation in human dental pulp cells. BMC Oral Health 2020; 20:101. [PMID: 32276610 PMCID: PMC7146980 DOI: 10.1186/s12903-020-01085-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 03/25/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Parathyroid hormone-related protein (PTHrP) plays an important role in many physiological processes, including bone regeneration. The function of PTHrP is similar to PTH. It promotes osteogenic differentiation in MC3T3-E1 cells. The aim of this study was to investigate whether PTHrP might have odontogenic differentiation ability in human dental pulp cells (hDPCs). METHODS The viability of hDPCs after stimulation with PTHrP was measured. Real-time polymerase chain reaction and Western blot analysis were performed to evaluate the expression levels of odontogenic markers and activation of protein kinase B (PKB/AKT), extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38 mitogen-activated protein kinase (MAPK). To evaluate mineralized nodule formation, alkaline phosphatase (ALP) staining and alizarin red S staining were performed. RESULTS PTHrP promoted odontogenic differentiation as evidenced by the formation of mineralized nodules, the induction of ALP activity, and the upregulation of odontogenic markers (dentin sialophosphoprotein and dentin matrix protein-1). The phosphorylation of AKT, ERK, JNK, and p38 was increased by PTHrP. However, an AKT inhibitor (LY294002), an ERK inhibitor (U0126), a JNK inhibitor (SP600125), and a p38 inhibitor (SB203580) inhibited the increase of mineralization induced by PTHrP. CONCLUSION The present study revealed that PTHrP could promote odontogenic differentiation and mineralization through activating the AKT, ERK, JNK, and p38 signaling pathways. These results provide novel insights into the odontogenic action of PTHrP.
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Affiliation(s)
- Mi-Ra Kim
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Youngbong-ro 77, Buk-gu, Gwangju, 61186, South Korea
| | - Sung-Hyeon Choi
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Youngbong-ro 77, Buk-gu, Gwangju, 61186, South Korea
| | - Bin-Na Lee
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Youngbong-ro 77, Buk-gu, Gwangju, 61186, South Korea
| | - Kyung-San Min
- Department of Conservative Dentistry, School of Dentistry, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju, 54896, South Korea
| | - Yun-Chan Hwang
- Department of Conservative Dentistry, School of Dentistry, Dental Science Research Institute, Chonnam National University, Youngbong-ro 77, Buk-gu, Gwangju, 61186, South Korea.
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Clinical and radiographic evaluation of indirect pulp treatment of young permanent molars using photo-activated oral disinfection versus calcium hydroxide: a randomized controlled pilot trial. BDJ Open 2020; 6:4. [PMID: 32194986 PMCID: PMC7078204 DOI: 10.1038/s41405-020-0030-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/28/2019] [Accepted: 01/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Calcium hydroxide is the most commonly used material in indirect pulp treatment (IPT). However, its drawbacks required its replacement by other materials. Aim This study aims to estimate clinically and radiographically the success of indirect pulp treatment of young permanent molars with either photo-activated oral disinfection (PAD) or calcium hydroxide. Design This Randomized Controlled Pilot Trial included 32 vital first permanent molars with deep caries that were treated by indirect pulp treatment with either PAD (group 1) or calcium hydroxide (group 2). Clinical and radiographic success in addition to newly-formed dentin thickness were evaluated regularly at 2, 6, 9, and 12 months. Results The success for both groups was 100% clinically and radiographically at all follow-up periods. Regarding the mean thickness of newly-formed dentin for both groups at different follow-up periods, there was no statistically significant difference between both groups at 2, 6, 9, and 12 months, with P values = 0.825, 0.146, 0.280, and 0.400, respectively. Conclusions The clinical and radiographic success for indirect pulp treatment of young permanent molars with both PAD and calcium hydroxide were comparable.
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Manhas M, Mittal S, Sharma AK, Gupta KK, Pathania V, Thakur V. Biological approach in repair of partially inflamed dental pulp using second-generation platelet-rich fibrin and mineral trioxide aggregate as a pulp medicament in primary molars. J Indian Soc Pedod Prev Dent 2019; 37:399-404. [PMID: 31710016 DOI: 10.4103/jisppd.jisppd_133_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The purpose of this study was to evaluate and compare clinically and radiographically PRF, MTA and Ca(OH)2 as a pulp dressing material in primary molars. MATERIAL AND METHODS The study was conducted on 30 children between 6-9 years of age. Pulpotomy was performed using MTA(Gp I), PRF + MTA(Gp II) and PRF +Ca(OH)2(Group III). The teeth were evaluated clinically and radiographically after 1,3 and 6 months and were subjected to statistics analysis. RESULTS After 6 months follow-up the overall success rate was found to be highest in Gp I with success rate of 97% followed by Gp II 95% and Gp III 78.3%. The results were found to be statistically insignificant (P ≤ 0.05). CONCLUSION All materials used in the present study were equally effective as the success rates are statistically insignificant.
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Affiliation(s)
- Maria Manhas
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
| | - Sudhir Mittal
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
| | - A K Sharma
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
| | - K K Gupta
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
| | - V Pathania
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
| | - V Thakur
- Department of Pedodontics, Himachal Dental College, Sundar Nagar, Himachal Pradesh, India
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E A, Gyanendra K, Dhillon JK. Comparative evaluation of clinical outcome of indirect pulp treatment with calcium hydroxide, calcium silicate and Er,Cr:YSGG laser in permanent molars. Laser Ther 2019; 28:123-130. [PMID: 32921911 PMCID: PMC7456655 DOI: 10.5978/islsm.19-or-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/30/2018] [Indexed: 06/11/2023]
Abstract
BACKGROUND The aim of the study was to compare preservation of pulp vitality by indirect pulp treatment with calcium hydroxide, calcium silicate based cement (Biodentine) and Er,Cr:YSGG laser in permanent molars. MATERIALS AND METHODS 30 patients were selected for this study as per the inclusion and exclusion criteria in the age group of 6-14 years and then randomly allocated to three groups A, B & C. In group A, after caries excavation, calcium hydroxide (Dycal) was placed at the floor. In group B, after caries excavation, calcium silicate based cement (Biodentine) was placed at the floor. In group C, after caries excavation, decontamination of the cavity was done with Er,Cr:YSGG laser. This was followed by placement of permanent restorative material in all the groups. Clinical and radiographic success was monitored at 3, 6 and months. Data analysis was performed using Statistical Package for the Social Science-21 (SPSS-21). RESULTS At the end of 9 months, overall success rate of indirect pulp was 86.6%. There was no significant difference between the three groups. (p > 0.05). CONCLUSION The study showed that the success of indirect pulp treatment is independent of the type of liner used for pulp capping. Moreover, the study also shows that Er,Cr;YSGG laser can be effectively used for indirect pulp capping procedures.
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Affiliation(s)
- Arshad E
- Pedodontics & Preventive Dentistry, Maulana Azad Institute of Dental Sciences New Delhi
| | - Kumar Gyanendra
- Pedodontics & Preventive Dentistry, Maulana Azad Institute of Dental Sciences New Delhi
| | - Jatinder Kaur Dhillon
- Pedodontics & Preventive Dentistry, Maulana Azad Institute of Dental Sciences New Delhi
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Duncan HF, Galler KM, Tomson PL, Simon S, El‐Karim I, Kundzina R, Krastl G, Dammaschke T, Fransson H, Markvart M, Zehnder M, Bjørndal L. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. Int Endod J 2019; 52:923-934. [DOI: 10.1111/iej.13080] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - H. F. Duncan
- Division of Restorative Dentistry Dublin Dental University Hospital Trinity College Dublin Dublin Ireland
| | - K. M. Galler
- Department of Conservative Dentistry and Periodontology University Hospital Regensburg Regensburg Germany
| | - P. L. Tomson
- School of Dentistry Institute of Clinical Sciences University of Birmingham Birmingham UK
| | - S. Simon
- Paris Diderot University, Paris 7 Paris France
| | - I. El‐Karim
- School of Medicine Dentistry and Biomedical Sciences Queen's University Belfast Belfast UK
| | - R. Kundzina
- Faculty of Health Sciences Institute of Clinical Odontology UiT the Arctic University of Norway Tromsø Norway
| | - G. Krastl
- Department of Conservative Dentistry and Periodontology University Hospital of Würzburg Würzburg Germany
| | - T. Dammaschke
- Department of Periodontology and Operative Dentistry Westphalian Wilhelms‐University Münster Germany
| | - H. Fransson
- Faculty of Odontology Department of Endodontics Malmö University Malmö Sweden
| | - M. Markvart
- Cariology and Endodontics Faculty of Health and Medical Sciences Department of Odontology University of Copenhagen Copenhagen Denmark
| | - M. Zehnder
- Department of Preventive Dentistry, Periodontology and Cariology University of Zurich Zurich Switzerland
| | - L. Bjørndal
- Cariology and Endodontics Faculty of Health and Medical Sciences Department of Odontology University of Copenhagen Copenhagen Denmark
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Comparative Analysis of Clinical Effects of Mineral Trioxide Aggregate in the Treatment of Endodontic Diseases. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:697-703. [PMID: 31110980 PMCID: PMC6500542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND We aimed to evaluate the efficacy of mineral trioxide aggregate (MTA) in the treatment of endodontic disease. METHODS Oversell, 384 patients with endodontic disease treated in Xuzhou Stomatological Hospital, Xuzhou, China, from June 2015 to June 2017 were selected, and randomly divided into four groups with 96 cases per group. The repair effects of MTA, zinc phosphate cement (ZPC), silver amalgam and light-curing calcium hydroxide (LCH) on the teeth and dental pulp of patients in the four groups were compared. Meanwhile, the ill symptoms of the patients were observed to confirm whether they could be alleviated. Besides, whether the repair effects were related to ages of patients, perforation diameters of diseased teeth and repair materials was discussed. RESULTS The success rates of MTA group, ZPC group, LCH group and silver amalgam group were 90.6%, 68.7%, 70.8% and 52.1%, respectively. The success rate of MTA group was significantly higher than that of ZPC group, silver amalgam group and LCH group. When the success rates of four groups were compared, the differences were statistically significant (P=0.0072). The patient's age, repair material and perforation diameter were positively correlated with MTA repair effect (P=0.003, P=0.002, P=0.01). The patients' teeth in each group were repaired with different materials, and the reexamination was conducted 4 weeks later. Three patients in the silver amalgam group were found to have gingival swelling. CONCLUSION The therapeutic effect of MTA was significant in the treatment of endodontic disease, and it is worthy of clinical application.
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Kiranmayi G, Hussainy N, Lavanya A, Swapna S. Clinical performance of mineral trioxide aggregate versus calcium hydroxide as indirect pulp-capping agents in permanent teeth: A systematic review and meta-analysis. J Int Oral Health 2019. [DOI: 10.4103/jioh.jioh_122_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Choi HW, Um SH, Rhee SH. Synthesis of a Ca 3 SiO 5 -Ca 2 SiO 4 -Ca 3 Al 2 O 6 cement system with rapid setting capacity by spray-pyrolysis coupled with sol-gel method. J Biomed Mater Res B Appl Biomater 2018; 107:1440-1451. [PMID: 30270515 DOI: 10.1002/jbm.b.34236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/18/2018] [Accepted: 08/23/2018] [Indexed: 11/08/2022]
Abstract
A modified mineral-trioxide-aggregate (mMTA) with rapid setting capacity was newly synthesized by spray-pyrolysis following a sol-gel reaction. Its faster setting capacity and initially higher compressive strength compared with Portland cement (PC) were evaluated. The precursor solution of the mMTA was prepared through condensation following hydrolysis among Ca(NO3 )2 ·4H2 O, Si(OC2 H5 )4 , and Al(NO3 )3 ·9H2 O under nitric acid. The mMTA powder was then synthesized by spray-pyrolysis at 1500°C. The particle shape was spherical with an average particle size of 0.8 ± 0.3 μm, while PC particles were irregular and 3.9 ± 3.0 μm in size. The mMTA consisted of mostly Ca3 SiO5 , Ca3 Al2 O6 , and partial Ca2 SiO4 phases, while the PC comprised mainly Ca3 SiO5 , Ca2 SiO4 , and partial Ca3 Al2 O6 phases. The final setting times of mMTA and PC measured under 95% relative humidity were about 11 min and 3 h, respectively. The early stage of setting in mMTA was dominated by the rapid formation of hexagonal-plate-like Ca3 Al2 O6 ·6H2 O crystals, while that in PC was dominated by needle-like calcium-silicate-hydrate gels and columnar-shaped Ca(OH)2 crystals. The late stage of setting in mMTA was dominated by calcium-silicate-hydrate gels and Ca(OH)2 crystals, while that in PC was dominated by Ca3 Al2 O6 ·6H2 O crystals. The compressive strengths of mMTA and PC after 30 min of setting were 4.5 and 0.2 MPa, respectively. The results suggest that mMTA has potential to be used as a filling material for accidental pulp-exposure or pulpal floor perforation cases that require rapid setting capacity and initial good strength. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1440-1451, 2019.
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Affiliation(s)
- Hae Won Choi
- Department of Orthodontics, The Institute of Oral Health Science, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Seung-Hoon Um
- Department of Dental Biomaterials Science, Dental Research Institute and BK21 Plus, School of Dentistry, Seoul National University, Seoul, 03080, South Korea
| | - Sang-Hoon Rhee
- Department of Dental Biomaterials Science, Dental Research Institute and BK21 Plus, School of Dentistry, Seoul National University, Seoul, 03080, South Korea
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Morotomi T, Washio A, Kitamura C. Current and future options for dental pulp therapy. JAPANESE DENTAL SCIENCE REVIEW 2018; 55:5-11. [PMID: 30733839 PMCID: PMC6354285 DOI: 10.1016/j.jdsr.2018.09.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/13/2018] [Accepted: 09/10/2018] [Indexed: 01/01/2023] Open
Abstract
Dental pulp is a connective tissue and has functions that include initiative, formative, protective, nutritive, and reparative activities. However, it has relatively low compliance, because it is enclosed in hard tissue. Its low compliance against damage, such as dental caries, results in the frequent removal of dental pulp during endodontic therapy. Loss of dental pulp frequently leads to fragility of the tooth, and eventually, a deterioration in the patient’s quality of life. With the development of biomaterials such as bioceramics and advances in pulp biology such as the identification of dental pulp stem cells, novel ideas for the preservation of dental pulp, the regenerative therapy of dental pulp, and new biomaterials for direct pulp capping have now been proposed. Therapies for dental pulp are classified into three categories; direct pulp capping, vital pulp amputation, and treatment for non-vital teeth. In this review, we discuss current and future treatment options in these therapies.
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Affiliation(s)
- Takahiko Morotomi
- Division of Endodontics and Restorative Dentistry, Department of Science of Oral Functions, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu 803-8580, Japan
| | - Ayako Washio
- Division of Endodontics and Restorative Dentistry, Department of Science of Oral Functions, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu 803-8580, Japan
| | - Chiaki Kitamura
- Division of Endodontics and Restorative Dentistry, Department of Science of Oral Functions, Kyushu Dental University, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu 803-8580, Japan
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Evaluation of the efficacy of calcium silicate vs. glass ionomer cement indirect pulp capping and restoration assessment criteria: a randomised controlled clinical trial—2-year results. Clin Oral Investig 2018; 23:1931-1939. [DOI: 10.1007/s00784-018-2638-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022]
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Lew WZ, Feng SW, Lin CT, Huang HM. Use of 0.4-Tesla static magnetic field to promote reparative dentine formation of dental pulp stem cells through activation of p38 MAPK signalling pathway. Int Endod J 2018; 52:28-43. [PMID: 29869795 DOI: 10.1111/iej.12962] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/30/2018] [Indexed: 11/29/2022]
Abstract
AIM To investigate whether static magnetic fields (SMFs) have a positive effect on the migration and dentinogenesis of dental pulp stem cells (DPSCs) to promote reparative dentine formation. METHODOLOGY In vitro scratch assays and a traumatic pulp exposure model were performed to evaluate the effect of 0.4-Tesla (T) SMF on DPSC migration. The cytoskeletons of the DPSCs were identified by fluorescence immunostaining and compared with those of a sham-exposed group. Dentinogenic evaluation was performed by analysing the expressions of DMP-1 and DSPP marker genes using a quantitative real-time polymerase chain reaction (qRT-PCR) process. Furthermore, the formation of calcified deposits was examined by staining the dentinogenic DPSCs with Alizarin Red S dye. Finally, the role played by the p38 MAPK signalling pathway in the migration and dentinogenesis of DPSCs under 0.4-T SMF was investigated by incorporating p38 inhibitor (SB203580) into the in vitro DPSC experiments. The Student's t-test and the Kruskal-Wallis test followed by Dunn's post hoc test with a significance level of P < 0.05 were used for statistical analysis. RESULTS The scratch assay results revealed that the application of 0.4-T SMF enhanced DPSCs migration towards the scratch wound (P < 0.05). The cytoskeletons of the SMF-treated DPSCs were found to be aligned perpendicular to the scratch wound. After 20 days of culture, the SMF-treated group had a greater number of out-grown cells than the sham-exposed group (nonmagnetized control). For the SMF-treated group, the DMP-1 (P < 0.05) and DSPP genes (P < 0.05), analysed by qRT-PCR, exhibited a higher expression. The distribution of calcified nodules was also found to be denser in the SMF-treated group when stained with Alizarin Red S dye (P < 0.05). Given the incorporation of p38 inhibitor SB203580 into the DPSCs, cell migration and dentinogenesis were suppressed. No difference was found between the SMF-treated and sham-exposed cells (P > 0.05). CONCLUSION 0.4-T SMF enhanced DPSC migration and dentinogenesis through the activation of the p38 MAPK-related pathway.
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Affiliation(s)
- W-Z Lew
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - S-W Feng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - C-T Lin
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - H-M Huang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Optomechatronics, Taipei Medical University, Taipei, Taiwan
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Clinical and Radiographic Success of Selective Caries Removal to Firm Dentin in Primary Teeth: 18-Month Follow-Up. Case Rep Dent 2018; 2018:9213681. [PMID: 29796320 PMCID: PMC5896234 DOI: 10.1155/2018/9213681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 02/14/2018] [Indexed: 12/11/2022] Open
Abstract
The selective caries removal is increasingly spreading in daily clinical practice because this minimally invasive technique treats deep carious lesion and decreases the risk of pulp exposure. This case report was aimed at describing the selective removal to firm dentin on the primary mandibular left first molar of a girl aged 7 years and 6 months. The Mineral Trioxide Aggregate (MTA Angelus™) was used as liner, and the tooth was definitively restored with resin-modified glass ionomer cement (Vitremer™). The clinical and radiographic following-up was performed at 6, 12, and 18 months after treatment. The treatment showed satisfactory results after 18-month following-up, suggesting that this minimally invasive approach for carious lesion removal can replace the total removal, when properly indicated. Notwithstanding, further randomized clinical trials with longer following-up periods are still necessary.
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Garcia LDFR, Huck C, Magalhães FAC, Souza PPCD, Souza Costa CAD. Systemic effect of mineral aggregate-based cements: histopathological analysis in rats. J Appl Oral Sci 2018; 25:620-630. [PMID: 29211283 PMCID: PMC5701532 DOI: 10.1590/1678-7757-2016-0634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 04/19/2017] [Indexed: 11/29/2022] Open
Abstract
Objective: Several studies reported the local tissue reaction caused by mineral aggregate-based cements. However, few studies have investigated the systemic effects promoted by these cements on liver and kidney when directly applied to connective tissue. The purpose of this in vivo study was to investigate the systemic effect of mineral aggregate-based cements on the livers and kidneys of rats. Material and Methods: Samples of Mineral Trioxide Aggregate (MTA) and a calcium aluminate-based cement (EndoBinder) containing different radiopacifiers were implanted into the dorsum of 40 rats. After 7 and 30 d, samples of subcutaneous, liver and kidney tissues were submitted to histopathological analysis. A score (0-3) was used to grade the inflammatory reaction. Blood samples were collected to evaluate changes in hepatic and renal functions of animals. Results: The moderate inflammatory reaction (2) observed for 7 d in the subcutaneous tissue decreased with time for all cements. The thickness of inflammatory capsules also presented a significant decrease with time (P<.05). Systemically, all cements caused adverse inflammatory reactions in the liver and kidney, being more evident for MTA, persisting until the end of the analysis. Liver functions increased significantly for MTA during 30 d (P<.05). Conclusion: The different cements induced to a locally limited inflammatory reaction. However, from the systemic point of view, the cements promoted significant inflammatory reactions in the liver and kidney. For MTA, the reactions were more accentuated.
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Affiliation(s)
- Lucas da Fonseca Roberti Garcia
- Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Odontologia, Área de Endodontia, Florianópolis, SC, Brasil
| | - Claudia Huck
- Univ. Estadual Paulista, Faculdade de Odontologia de Araraquara, Departamento de Odontologia Restauradora, Araraquara, SP, Brasil
| | | | - Pedro Paulo Chaves de Souza
- Univ. Estadual Paulista, Faculdade de Odontologia de Araraquara, Departamento de Fisiologia e Patologia, Araraquara, SP, Brasil
| | - Carlos Alberto de Souza Costa
- Univ. Estadual Paulista, Faculdade de Odontologia de Araraquara, Departamento de Fisiologia e Patologia, Araraquara, SP, Brasil
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Chauhan A, Dua P, Saini S, Mangla R, Butail A, Ahluwalia S. In vivo Outcomes of Indirect Pulp Treatment in Primary Posterior Teeth: 6 Months' Follow-up. Contemp Clin Dent 2018; 9:S69-S73. [PMID: 29962767 PMCID: PMC6006903 DOI: 10.4103/ccd.ccd_48_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Indirect pulp treatment (IPT) is a minimally invasive procedure based on the application of a protective liner on the affected dentin, thereby preserving the pulp vitality. Aim: This study aims to evaluate and compare the clinical and radiographic outcomes of IPT when a layer of calcium hydroxide (Dycal), mineral trioxide aggregate (MTA), or Biodentine was placed over the affected dentin in primary molars. Materials and Methods: A clinical trial with sample size of 45 primary molars between the age group of 4–9 years, of which 15 teeth were considered, each for Group I (Dycal), Group II (MTA), and Group III (Biodentine). Measurements on digitized radiographs were made at baseline, 3, and 6 months using Corel Draw software. Results: One-way ANOVA and post hoc tests indicated a statistically significant difference in dentin thickness (P < 0.05) in all the groups. Within Group I, the thickness of dentin was 0.066 ± 0.009 mm at 3 months and 0.099 ± 0.011 mm at 6 months. In Group II, 0.081 ± 0.010 mm at 3 months and 0.123 ± 0.016 mm at 6 months. In Group III, 0.102 ± 0.021 mm at 3 months and 0.154 ± 0.022 mm at 6 months. Conclusions: Clinically, 100% success rate was observed in all the groups whereas radiographically, Biodentine was superior to both the groups.
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Affiliation(s)
- Ananya Chauhan
- Department of Paedodontics and Preventive Dentistry, Himachal Institute of Dental Sciences, Sirmaur, Himachal Pradesh, India
| | - Parminder Dua
- Department of Paedodontics and Preventive Dentistry, Himachal Institute of Dental Sciences, Sirmaur, Himachal Pradesh, India
| | - Sheeba Saini
- Department of Paedodontics and Preventive Dentistry, Himachal Institute of Dental Sciences, Sirmaur, Himachal Pradesh, India
| | - Ritu Mangla
- Department of Paedodontics and Preventive Dentistry, Himachal Institute of Dental Sciences, Sirmaur, Himachal Pradesh, India
| | - Apra Butail
- Department of Paedodontics and Preventive Dentistry, Himachal Institute of Dental Sciences, Sirmaur, Himachal Pradesh, India
| | - Shivika Ahluwalia
- Department of Prosthodontics and Implantology, Himachal Institute of Dental Sciences, Sirmaur, Himachal Pradesh, India
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Parirokh M, Torabinejad M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy. Int Endod J 2017; 51:177-205. [PMID: 28836288 DOI: 10.1111/iej.12841] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/21/2017] [Indexed: 01/09/2023]
Abstract
Mineral trioxide aggregate (MTA) is a bioactive endodontic cement (BEC) mainly comprised of calcium and silicate elements. The cement was introduced by Torabinejad in the 1990s and has been approved by the Food and Drug Administration to be used in the United States in 1997. A number of new BECs have also been introduced to the market, including BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, NeoMTA Plus, OrthoMTA, Quick-Set, RetroMTA, Tech Biosealer and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA without its drawbacks. In this article, the chemical composition and the application of MTA and other BECs for vital pulp therapy (VPT), including indirect pulp cap, direct pulp cap, partial pulpotomy, pulpotomy and partial pulpectomy, have been reviewed and compared. Based on selected keywords, all papers regarding chemical composition and VPT applications of BECs had been reviewed. Most of the materials had calcium and silicate in their composition. Instead of referring to the cements based on their chemical compositions, we suggest the term 'bioactive endodontic cements (BECs)', which seems more appropriate for these materials because, in spite of differences in their chemical compositions, bioactivity is a common property for all of them. Numerous articles were found regarding use of BECs as VPT agents for indirect and direct pulp capping, partial pulpotomy and cervical pulpotomy. Most of these investigations used MTA for VPT. In most studies, newly introduced materials have been compared to MTA. Some of the BECs have shown promising results; however, the number of their studies compared to investigations on MTA is limited. Most studies had several methodological shortcomings. Future investigations with rigorous methods and materials are needed.
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Affiliation(s)
- M Parirokh
- Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - M Torabinejad
- Department of Endodontics, School of Dentistry, Loma Linda University, Loma Linda, CA, USA
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Hashemi-Beni B, Khoroushi M, Foroughi MR, Karbasi S, Khademi AA. Tissue engineering: Dentin - pulp complex regeneration approaches (A review). Tissue Cell 2017; 49:552-564. [PMID: 28764928 DOI: 10.1016/j.tice.2017.07.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 01/04/2023]
Abstract
Dental pulp is a highly specialized tissue that preserves teeth. It is important to maintain the capabilities of dental pulp before a pulpectomy by creating a local restoration of the dentin-pulp complex from residual dental pulp. The articles identified were selected by two reviewers based on entry and exit criteria. All relevant articles indexed in PubMed, Springer, Science Direct, and Scopus with no limitations from 1961 to 2016 were searched. Factors investigated in the selected articles included the following key words: Dentin-Pulp Complex, Regeneration, Tissue Engineering, Scaffold, Stem Cell, and Growth Factors. Of the 233 abstracts retrieved, the papers which were selected had evaluated the clinical aspects of the application of dentin-pulp regeneration. Generally, this study has introduced a new approach to provoke the regeneration of the dentin-pulp complex after a pulpectomy, so that exogenous growth factors and the scaffold are able to induce cells and blood vessels from the residual dental pulp in the tooth root canal. This study further presents a new strategy for local regeneration therapy of the dentin-pulp complex. This review summarizes the current knowledge of the potential beneficial effects derived from the interaction of dental materials with the dentin-pulp complex as well as potential future developments in this exciting field.
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Affiliation(s)
- Batool Hashemi-Beni
- Torabinejad Dentistry Research Center and Department of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Khoroushi
- Dental Materials Research Center and Department of Operative and Art, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Foroughi
- Dental Materials Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Saeed Karbasi
- Department of Biomaterials and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Ali Khademi
- Torabinejad Dentistry Research Center and Department of Endodonics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Daniele L. Mineral Trioxide Aggregate (MTA) direct pulp capping: 10 years clinical results. GIORNALE ITALIANO DI ENDODONZIA 2017. [DOI: 10.1016/j.gien.2017.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Sujlana A, Pannu PK. Direct pulp capping: A treatment option in primary teeth?? PEDIATRIC DENTAL JOURNAL 2017. [DOI: 10.1016/j.pdj.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Katge FA, Patil DP. Comparative Analysis of 2 Calcium Silicate-based Cements (Biodentine and Mineral Trioxide Aggregate) as Direct Pulp-capping Agent in Young Permanent Molars: A Split Mouth Study. J Endod 2017; 43:507-513. [PMID: 28216271 DOI: 10.1016/j.joen.2016.11.026] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The purpose of this study was to compare Biodentine and mineral trioxide aggregate (MTA) for direct pulp capping in young permanent molars by clinical and radiographic evaluation in 7- to 9-year-old children. METHODS In 50 patients, 29 patients with bilateral asymptomatic first permanent molars with carious involvement were selected. According to split mouth design, these patients were then divided into 2 groups, Biodentine group (right side) and MTA group (left side). The pulp-capping procedure was performed by using Biodentine and MTA in 58 asymptomatic bilateral permanent molars with pulp exposure. At each recall (baseline, 6 and 12 months), treatment outcome was assessed clinically through pulpal sensitivity tests as well as radiographically to evaluate dentin bridge formation. RESULTS The study reported 100% success rate with both Biodentine and MTA at baseline and 6- and 12-month follow-up on the basis of clinical and radiographic parameters. These findings were statistically non-significant (P < .05) between both groups (Biodentine and MTA). Radiographically, dentin bridge formation was not evident with both groups at baseline, but it was evident after 6- and 12-month follow-up. These findings were statistically non-significant (P < .05) in both Biodentine and MTA groups. CONCLUSIONS This study reported 100% success rate with both MTA and Biodentine when used as direct pulp-capping agent in first permanent molars in 7- to 9-year-old children. The major limitations of the study were smaller sample size and short follow-up period.
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Affiliation(s)
- Farhin A Katge
- Department of Pedodontics and Preventive Dentistry, Terna Dental College, Navi Mumbai, Maharashtra, India.
| | - Devendra P Patil
- Department of Pedodontics and Preventive Dentistry, Terna Dental College, Navi Mumbai, Maharashtra, India
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Huck C, Barud HDS, Basso FG, Costa CADS, Hebling J, Garcia LDFR. Cytotoxicity of New Calcium Aluminate Cement (EndoBinder) Containing Different Radiopacifiers. Braz Dent J 2017; 28:57-64. [DOI: 10.1590/0103-6440201701023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/09/2016] [Indexed: 11/21/2022] Open
Abstract
Abstract This study aimed to evaluate the cytotoxicity of a calcium aluminate cement (EndoBinder) containing different radiopacifiers, Bi2O3, ZnO or ZrO2, compared with Mineral Trioxide Aggregate (MTA). According to ISO 10993-12:2012 (E) recommendations, 0.2 g of each cement were applied in transwell inserts and placed in 24-well culture plates containing 1 mL of culture medium (DMEM). After 24 h of incubation, the extracts (DMEM containing components released from the cements) were applied to immortalized odontoblast-like MDPC-23 cells. Cell viability (MTT test), alkaline phosphatase activity (ALP), total protein production and cell morphology (Scanning Electron Microscopy - SEM) were evaluated. The volume of 50 µL of extract was used to determine the chemical elements released by the cements using Energy Dispersive Spectroscopy (EDS). The following groups were established (n=6): NC - negative control (without treatment); EB - EndoBinder without radiopacifier; EBBO - EndoBinder+Bi2O3; EBZnO - EndoBinder+ZnO; EBZrO - EndoBinder+ZrO2 and WMTA - White MTA. Data were subjected to statistical analysis (Kruskal-Wallis test, level of significance=5%). Cells exposed to the different versions of EndoBinder presented small reduction in viability, total protein production and ALP activity, with values similar to the NC and WMTA groups (p>0.05). Different elements (C, O, Na, Al, P, Si, Cl, Bi, K) released by the cements were detected in the extracts. However, the cells had no significant changes in their morphology. EndoBinder and MTA did not affect negatively the metabolism of the odontoblastic-like cells, showing it to be cytocompatible, irrespective of the used radiopacifier.
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Portella FF, Collares FM, Santos PD, Sartori C, Wegner E, Leitune VCB, Samuel SMW. Glycerol Salicylate-based Pulp-Capping Material Containing Portland Cement. Braz Dent J 2017; 26:357-62. [PMID: 26312972 DOI: 10.1590/0103-6440201300218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 06/16/2015] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Fernando Freitas Portella
- Dental Materials Laboratory, Dental School, UFRGS - Federal Universidade of Rio Grande do Sul, Porto Alegre, RS, BR
| | - Fabrício Mezzomo Collares
- Dental Materials Laboratory, Dental School, UFRGS - Federal Universidade of Rio Grande do Sul, Porto Alegre, RS, BR
| | - Paula Dapper Santos
- Dental Materials Laboratory, Dental School, UFRGS - Federal Universidade of Rio Grande do Sul, Porto Alegre, RS, BR
| | - Cláudia Sartori
- Dental Materials Laboratory, Dental School, UFRGS - Federal Universidade of Rio Grande do Sul, Porto Alegre, RS, BR
| | - Everton Wegner
- Dental Materials Laboratory, Dental School, UFRGS - Federal Universidade of Rio Grande do Sul, Porto Alegre, RS, BR
| | | | - Susana Maria Werner Samuel
- Dental Materials Laboratory, Dental School, UFRGS - Federal Universidade of Rio Grande do Sul, Porto Alegre, RS, BR
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Long-term survival and vitality outcomes of permanent teeth following deep caries treatment with step-wise and partial-caries-removal: A Systematic Review. J Dent 2016; 54:25-32. [PMID: 27664467 DOI: 10.1016/j.jdent.2016.09.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES A systematic review was performed to compare the long-term survival of deep dentine caries-affected permanent teeth treated with partial-caries-removal (PCR) versus similar teeth treated with stepwise-caries-removal techniques (SWT). DATA Clinical studies investigating long-term PCR and SWT outcomes in unrestored permanent teeth with deep dentine caries were evaluated. Failures were defined as loss of pulp vitality or restorative failures following treatment. SOURCES PubMed, Web of Science, Dentistry and Oral Sciences Source, and Central databases were systematically searched. STUDY SELECTION From 136 potentially relevant articles, 9 publications utilizing data from 5 studies (2 RCTs, and 3 observational case-series) reporting outcomes for 426 permanent teeth over two to ten years were analyzed. Regarding restorative failures, >88% success at two years for both techniques was reported. For loss of pulp vitality, observational studies reported >96% vitality at two years for each technique, while one RCT reported significantly higher vitality (p<0.05) at three years for PCR (96%) compared to SWT (83%). Risk of bias was high in all studies. CONCLUSION Successful vitality and restorative outcomes for both PCR and SWT have been demonstrated at two years and beyond in permanent teeth with deep dentine caries. Partial-caries-removal may result in fewer pulpal complications over a three year period than SWT, although claims of a therapeutic advantage are based on very few, limited-quality studies. CLINICAL SIGNIFICANCE Partial-caries-removal and SWT are deep caries management techniques that reduce pulp exposure risk. Permanent teeth with deep dentine caries treated with either technique have a high likelihood for survival beyond two years.
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