Pulp Therapy of Primary Dentition; its Relevance despite Insufficient Histological Evidence: A Review

Application of mineral trioxide aggregate pulpotomy in the treatment of early pulpitis of primary molars

OBJECTIVE

To evaluate the effectiveness of mineral trioxide aggregate (MTA) on pulpotomy in primary molars.

METHODS

Two hundred and sixty-three cases (310 teeth) of children with early pulpitis of primary molars admitted between February 2019 to February 2022 were enrolled, and their clinical data were retrospectively analyzed. Of them, 130 cases with 155 teeth treated with root canal treatment were set as the control group (CG) and 133 cases with 155 teeth receiving MTA pulpotomy were set as the observation group (OG). Clinical data such as efficacy evaluation, inflammatory factor levels, postoperative adverse reactions, and quality of life (QoL) were compared.

RESULTS

After surgery, the overall response rate in the OG was statistically higher than that in the CG, while the levels of inflammatory factors in the OG were significantly lower than those in the CG (all P<0.05). Moreover, the total incidence of complications was significantly lower in OG at 3, 6, and 12 months after surgery (P=0.018, P=0.007, P=0.015, respectively). The QoL of the two groups differed insignificantly before surgery; however, after the treatment, the QoL in OG was significantly higher than those in the CG at 3, 6, and 12 months after surgery (P=0.037, P=0.012, P=0.028, respectively). Moreover, the teeth location and treatment method were independent factors of efficacy (P=0.047, P=0.001, respectively).

CONCLUSIONS

MTA pulpotomy outperformed root canal treatment for superior efficacy in children with early pulpitis of primary molars, with a positive effect on improving QoL, and patient prognosis.

The Effect of Calcium hydroxide, Glass Ionomer and light cured resin modified calcium silicate on viability, proliferation and differentiation of stem cells from human exfoliated deciduous teeth

BACKGROUND

Vital pulp therapy, based on the use of stem cells, has promising research and therapeutic applications in dentistry. It is essential to understand the direct effect of capping materials on the dental pulp stem cells of primary teeth, which contribute to the healing powers of the tooth. The aim of this study is to evaluate the effect of different capping materials (Calcium Hydroxide (DyCal®) - Glass Ionomer (Fuji IX®) and light-cured resin modified calcium silicate (TheraCal LC®)) on the viability, proliferation, and differentiation of stem cells from human exfoliated deciduous teeth (SHEDs).

METHODS

SHEDs were isolated from extracted primary teeth, then divided into four groups and each of the capping materials were applied to the stem cells as follows: group I the controls, group II with Ca(OH)2, group III with the GIC, and group IV with the Theracal LC. For all groups assessment of viability and proliferation rate was done using the MTT cell proliferation assay. Also, Differentiation was evaluated by measuring the gene expression of Alkaline phosphatase enzyme activity (ALP) and Dentin matrix protein-1 (DMP1) through quantitative real-time PCR. Morphological assessment was conducted using Alizarin Red S staining. All evaluations were performed after 7 and 14 days of culture.

RESULTS

TheraCal LC showed the highest values of proliferation, which was significant only compared to the control group after 2 weeks (p = 0.012). After one week, TheraCal LC showed the highest significant values of ALP and DMP1 compared to all other groups (p < 0.001).

CONCLUSION

The three materials under study are biocompatible, maintain viability, and stimulate the proliferation and differentiation of SHEDs. However, TheraCal LC allows better proliferation of SHEDs than Dycal Ca(OH)2 and Fuji IX GIC.