Biodentine pulpotomy several days after pulp exposure: Four case reports

Influence of the restoration after pulpotomy on the strength of electrical stimulus reaching the pulp space: An in vitro investigation

Introduction

The study evaluated the influence of coronal restoration after pulpotomy on the strength of electrical stimulus reaching the radicular pulp using an electric pulp test (EPT).

Materials and Methods

The pulp tissue from ten freshly extracted mandibular premolar teeth was removed and replaced with an electroconductive gel. The cathode probe of Powerlab was inserted into the pulp space and the anode probe was attached to the EPT handpiece. The EPT probe coated with electro-conducting material was positioned in the middle third of the buccal crown surface. The EPT stimulus reaching the pulp space of an intact tooth at 40 numerical readings was recorded. The tooth was removed from model and endodontic access was made. The 2-mm thick mineral trioxide aggregate was placed at the cementoenamel junction followed by composite resin restoration. The experimental setup was re-established and postpulpotomy EPT stimulus data were recorded. The data collected were compared using the Wilcoxon signed-rank test.

Results

There was a statistically significant difference (P = 0.038) between observed between the strength of EPT stimulus reaching the pulp space in prepulpotomy (mean 91.18 ± 101.02 V and median 25.79 V) and postpulpotomy (mean 58.49 ± 77.13 V and median 13.75 V) tooth samples.

Conclusion

The placement of the restoration and pulp capping agent after pulpotomy dampens the strength of EPT stimulus reaching the pulp canal space.

Evaluation of biodentine pulpotomy in caries-exposed symptomatic vital mature permanent teeth in 9‒13-year-old children: A 24-month clinico-radiographic observation

BACKGROUND

The present study evaluated the clinical and radiographic outcomes of Biodentine pulpotomy for 24 months in symptomatic vital mature permanent teeth with caries exposure.

METHODS

Seventy-three patients with a chief complaint of spontaneous pain in permanent teeth were screened. Finally, 47 mature permanent teeth underwent a Biodentine pulpotomy procedure. Clinical evaluation of 47 teeth was carried out at 1, 3, 6, 9, 12, and 24 months and radiographic evaluations were made at 6, 12, and 24 months. The success of Biodentine pulpotomy was evaluated using Pearson's chi-square test. The significance level was determined at P<0.05.

RESULTS

At 24 months, the clinical and radiographic success rate was 97.78%, with only one clinical failure at 9 months.

CONCLUSION

The clinical and radiographic success of Biodentine pulpotomy was high (97.78%). Thus, Biodentine pulpotomy can be an alternative to root canal treatment (RCT) in symptomatic vital mature permanent teeth.

Biomimetic Approaches in Clinical Endodontics

In the last few decades, biomimetic concepts have been widely adopted in various biomedical fields, including clinical dentistry. Endodontics is an important sub-branch of dentistry which deals with the different conditions of pulp to prevent tooth loss. Traditionally, common procedures, namely pulp capping, root canal treatment, apexification, and apexigonesis, have been considered for the treatment of different pulp conditions using selected materials. However, clinically to regenerate dental pulp, tissue engineering has been advocated as a feasible approach. Currently, new trends are emerging in terms of regenerative endodontics which have led to the replacement of diseased and non-vital teeth into the functional and healthy dentine-pulp complex. Root- canal therapy is the standard management option when dental pulp is damaged irreversibly. This treatment modality involves soft-tissue removal and then filling that gap through the obturation technique with a synthetic material. The formation of tubular dentine and pulp-like tissue formation occurs when stem cells are transplanted into the root canal with an appropriate scaffold material. To sum up tissue engineering approach includes three components: (1) scaffold, (2) differentiation, growth, and factors, and (3) the recruitment of stem cells within the pulp or from the periapical region. The aim of this paper is to thoroughly review and discuss various pulp-regenerative approaches and materials used in regenerative endodontics which may highlight the current trends and future research prospects in this particular area.

The Effect of Irrigation with Citric Acid on Biodentine Tricalcium Silicate-Based Cement: SEM-EDS In Vitro Study

There are various factors that may interfere with the activity of biomaterials during endodontic therapy. One of them is the canal system irrigation procedure with different rinsing solutions performed after the placement of bioactive cements. The authors investigate the influence of citric acid, a chelating agent, on the surface and the chemical composition of Biodentine tricalcium silicate-based cement using a multimethod approach. Twenty samples were divided into two groups based on the material setting time. They were subjected to citric acid irrigation with or without ultrasonic activation for 5 and 20 min. The chemical analysis was made with energy dispersive spectroscopy (EDS). The visual assessment of Biodentine surface was carried out in scanning electron microscope (SEM). The volume of material loss during the procedure was measured with Keyence optic microscope and dedicated digital software. Statistical analysis was performed. The results of the study show that the irrigation with citric acid influenced the surface appearance of the material and changed its chemical composition in both investigated groups. The ultrasonic activation (US) of the liquid has also aggravated its impact. Further research is needed to assess if that fact may change the sealing properties of the material influencing the long-term clinical outcome.

Spectrophotometric Analysis of Coronal Discolouration Induced by ProRoot MTA, Biodentine and MTA Repair HP Used for Pulpotomy Procedures

OBJECTIVE

To assess and quantify coronal tooth discolouration by ProRoot MTA, Biodentine and MTA repair HP as pulpotomy agents and to identify colour stability of these materials in presence of blood contamination.

METHODS

120 human premolar teeth were used in the study. The teeth were sectioned horizontally 1 mm apical to the cementoenamel junction. A retrograde cavity extending within 2 mm of the incisal edge was prepared. The specimens were randomly distributed as; Control: Group 1, ProRoot MTA: Group 2, Biodentine: Group 3 and MTA repair HP: Group 4. The groups werefurther subdivided on basis of exposure to saline (subgroup A) or blood (subgroup B). The access was sealed with light cured Glass ionomer cemet and the specimens were stored in artificial saliva at 37°C. The Colour change was evaluated with a spectrophotometer at: day 0 (T0), day 1 (T1), day 7 (T7), 1 month (T30), 2 months (T60), and 6 months (T180). The colour measurements were recorded using the Commission Internationale de l'Eclairage L*a*b* value.

RESULTS

For all groups, there was a sharp increase in L* parameter at T1. At 6 months, Group 1B (Control + blood) showed maximum decrease in luminosity followed by Group 2A (ProRoot + saline) > Group 4B (MTA repair HP + blood) > Group 2B (ProRoot + blood). Group 3A (Biodentine + saline) showed the least amount of decrease in luminosity followed by Group 4A (MTA repair HP + saline) and Group 3B (Biodentine + blood). No significant difference was found in ∆E change between any of the groups from baseline to 180 days (P>0.05).

CONCLUSION

Relative to L* parameter, it was possible to observe a statistically significant decrease in luminosity in the Group1B (Control + blood) followed by ProRoot MTA (Group 2A and 2B) and MTA repair HP (Group 4A and 4B). Biodentine (Group 3A and 3B) showed least tooth discolouration in terms of L* parameter.

Partial Pulpotomy with Mineral Trioxide Aggregate in Permanent Incisors with Complicated Crown Fracture: 5-Year Follow-Up

Traumatic dental injuries are highly prevalent among children. This article describes a case report of a patient who has experienced dental trauma at 8 years old, which has led to enamel-dentine fracture with pulp exposure in the left central incisor and crown-root fracture with pulp exposure in the right central incisor. Partial pulpotomy was performed with the aim of maintaining the neurovascular bundle, thus allowing normal radicular formation. During follow-up 5 years later, teeth were asymptomatic and with no evidence of radiolucent lesions in radiographic examinations. This report demonstrates that traumatic fractures with pulp exposure can be treated effectively by the described technique.

Influence of sodium hypochlorite and ultrasounds on surface features and chemical composition of Biodentine tricalcium silicate-based material

Biomaterials are subjected to various factors during endodontic workflow. The aim was to evaluate the influence of different concentrations of sodium hypochlorite and ultrasound activation on the features and chemical composition of Biodentine. Fifty-four Biodentine samples were divided into 3 groups based on the material setting time. They were subjected to different modes and times of 2% and 5.25% NaOCl irrigation with or without ultrasounds, 12 min (group I), 45 min (group II) and 24 h (group III) after the material mixing. Visual assessment of the sample's surface was performed using the scanning electron microscope and chemical analysis was made with energy dispersive spectroscopy. Both NaOCl irrigation and ultrasounds affected the surface of the material; however, they did not change its chemical composition. The irrigation enhanced by ultrasounds following the placement of Biodentine should be performed after a longer material setting time. The immediate use of ultrasounds is not recommended.

Which procedures and materials could be applied for full pulpotomy in permanent mature teeth? A systematic review

Objective: Coronal pulpotomies were recently re-investigated as an alternative to root canal treatment in vital permanent teeth. General dentists may be interested in knowing how to perform full pulpotomy, in particular in face of difficult endodontic cases of vital teeth. Material and methods: A systematic review was undertaken on the PubMed and Cochrane databases in order to determine which procedure should be applied for pulp capping and coronal restoration in routine dental practice. Fifty-three publications were included and allocated to one of two methodological categories: histological and clinical studies. Results and conclusions: There is no evidence to recommend one single procedure for full pulpotomy in vital permanent teeth that can be indicated for different pulpal diagnoses which differ greatly in terms of the inflammation process from healthy teeth to irreversible pulpitis. For each clinical case, all actions aiming to prevent pre-operative contamination, to control per-operative infection and to achieve a complete seal above the radicular pulp sections are unavoidable steps that should be complied with. Reproducing procedures adopted in high quality trials could insure high success rates.

Evaluation of the Clinical and Radiological Outcomes of Pulpotomized Primary Molars Treated with Three Different Materials: Mineral Trioxide Aggregate, Biodentine, and Pulpotec. An In-vivo Study

Introduction

The main treatment objective of pediatric dentistry lies in maintaining the integrity of the arches. The loss of primary teeth at an early age causes malocclusion. Primary teeth are considered the best space maintainers in the arch. Hence, every effort should be directed to preserve these teeth as far as possible. One of the most important goals of pediatric dentistry is the restoration of carious primary teeth and the maintenance of optimal oral health.

Aim

The aim of this study is to compare and evaluate different pulpotomy materials like mineral trioxide aggregate (MTA), Biodentine, and Pulpotec in primary molars.

Materials and methods

In the present study, 84 primary molars were selected for the pulpotomy procedure and randomly assigned to one of the three groups of MTA, Biodentine, and Pulpotec, allocating 28 primary molars to each group. The pulpotomy procedure was performed on all selected teeth and followed by permanent restoration with stainless steel crowns. All the molars were evaluated, both clinically and radiographically, at an interval of one, three, and six months.

Results

At the end of the first month, there were no adverse clinical and radiographical findings observed in all three groups. At the end of the third month, Group I showed 96% clinical and radiographical success, Group II showed 100% clinical and 96% radiographical success, and Group III showed 100% clinical and radiographical success. At the end of the sixth month, Group I showed 96% clinical and radiographical success, Group II showed 100% clinical and 90% radiographical success and Group III showed 100% clinical and radiographical success. The observations were subjected to statistical analysis using Fisher’s exact test and the Chi-square test.

Conclusion

MTA, Biodentine, and Pulpotec can be used as materials of choice for pulpotomy. Furthermore, Pulpotec appeared to be clinically and radiographically more successful than MTA and Biodentine.

Human Pulp Fibroblast Implication in Phagocytosis via Complement Activation

INTRODUCTION

Previous works have shown that human pulp fibroblasts synthetize all complement components. Local complement activation in the dental pulp is known to be involved in inflammation and regeneration and also in pathogen destruction through membrane attack complex formation. Bacterial elimination by complement-mediated phagocytosis implies microorganism opsonization with the complement C3b protein, which is recognized by specific phagocytic cell CR1 receptors for subsequent intracellular destruction. This work was designed to find out whether pulp fibroblasts produce C3b and check its subsequent implication in bacteria phagocytosis.

METHODS

The expression of C3b was investigated in carious and healthy human pulp tissues. To simulate a bacterial infection in vitro, cultured human pulp fibroblasts were stimulated with lipoteichoic acid, and C3b secretion was quantified by an enzyme-linked immunosorbent assay. C3b fixation on bacteria (opsonization) and the inflammatory THP-1 cell complement receptor 1 was studied by immunofluorescence. A gentamycin protection assay was used to check the implication of C3b secretion by fibroblasts in bacteria phagocytosis.

RESULTS

Pulp cells constitutively express C3b in vivo, and cultured pulp fibroblasts produce C3b. We observed a fixation of this C3b protein on the bacterial surface (opsonization) and the THP-1 CR1 receptor. This recognition leads to a significant increase in bacteria phagocytosis.

CONCLUSIONS

These results showed that pulp fibroblasts mediate the process of phagocytosis by producing the complement C3b protein and opsonizing bacteria. This highlights a significant role of fibroblasts in the dental pulp local regulation of inflammation.

Biodentine™ material characteristics and clinical applications: a 3 year literature review and update

INTRODUCTION

Biodentine™ has frequently been acknowledged in the literature as a promising material and serves as an important representative of tricalcium silicate based cements used in dentistry.

AIM

To provide an update on the physical and biological properties of Biodentine™ and to compare these properties with those of other tricalcium silicate cements namely, different variants of mineral trioxide aggregate (MTA) such as ProRoot MTA, MTA Angelus, Micro Mega MTA (MM-MTA), Retro MTA, Ortho MTA, MTA Plus, GCMTA, MTA HP and calcium enriched mixture (CEM), Endosequence and Bioaggregate™.

STUDY DESIGN

A comprehensive literature search for publications from November 20, 2013 to November 20, 2016 was performed by two independent reviewers on Medline (PubMed), Embase, Web of Science, CENTRAL (Cochrane), SIGLE, SciELO, Scopus, Lilacs and clinicaltrials.gov. Electronic and hand search was carried out to identify randomised control trials (RCTs), case control studies, case series, case reports, as well as in vitro and animal studies published in the English language.

CONCLUSIONS

The enhanced physical and biologic properties of Biodentine™ could be attributed to the presence of finer particle size, use of zirconium oxide as radiopacifier, purity of tricalcium silicate, absence of dicalcium silicate, and the addition of calcium chloride and hydrosoluble polymer. Furthermore, as Biodentine™ overcomes the major drawbacks of MTA it has great potential to revolutionise the different treatment modalities in paediatric dentistry and endodontics especially after traumatic injuries. Nevertheless, high quality long-term clinical studies are required to facilitate definitive conclusions.

Factors affecting the outcomes of direct pulp capping using Biodentine

Introduction

This study aimed to evaluate the prognostic value of factors with regard to the treatment outcome of direct pulp capping using Biodentine (Septodont, Saint-Maur-des-Fossés, France), in permanent teeth in which the pulps were exposed during caries removal.

Methods

Between 2010 and 2014, 112 teeth with deep carious lesions underwent direct pulp capping. The patients were followed up at 2–3 months and 1–1.5 years with a routine examination on both recall visits. Periapical radiographs were taken at 1–1.5 years. Lack of patient complaints, positive reactions to cold and electric testing, no sensitivity to percussion, and no widening of the periapical ligament indicated success. The Fisher exact test was used for statistical analysis. The significance level was P = .05.

Results

Eighty-six teeth were available for 1–1.5 years follow-up. The overall success rate was 82.6%. Only age had a significant effect on the pulpal survival rate: the success rate was 90.9% in patients younger than 40 years and 73.8% in patients 40 years or older (P = .0480). Sex, initial or secondary caries treatment, occlusal or cervical/proximal caries, delayed placement of permanent filling, tooth position, and arch type did not influence the outcome.

Conclusions

A patient’s age influenced the outcome of direct pulp capping using this new calcium silicate cement.

Clinical relevance

Asymptomatic vital permanent teeth with cariously exposed pulp can be treated successfully by direct pulp capping using Biodentine.

Light-cured Tricalcium Silicate Toxicity to the Dental Pulp

INTRODUCTION

Numerous studies reported dentin bridge formation after pulp capping with tricalcium silicates. By contrast, pulp capping with resins leads to pulp toxicity and inflammation. Hybrid materials made up of tricalcium silicates and resins have also been developed to be used in direct pulp capping. This work was designed to study the consequences of adding resins to tricalcium silicates by investigating TheraCal (BISCO, Lançon De Provence, France) and Biodentine (Septodont, Saint Maur des Fosses, France) interactions with the dental pulp.

METHODS

Media conditioned with the biomaterials were used to analyze pulp fibroblast proliferation using the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) test and proinflammatory cytokine interleukin 8 (IL-8) secretion using the enzyme-linked immunosorbent assay. The effects of conditioned media on dentin sialoprotein (DSP) and nestin expression by dental pulp stem cells (DPSCs) were investigated by immunofluorescence. The materials' interactions with the vital pulp were investigated using the entire tooth culture model.

RESULTS

TheraCal-conditioned media significantly decreased pulp fibroblast proliferation, whereas no effect was observed with Biodentine. When DPSCs were cultured with Biodentine-conditioned media, immunofluorescence showed an increased expression of DSP and nestin. This expression was lower with TheraCal, which significantly induced proinflammatory IL-8 release both in cultured fibroblasts and entire tooth cultures. This IL-8 secretion increase was not observed with Biodentine. Entire tooth culture histology showed a higher mineralization with Biodentine, whereas significant tissue disorganization was observed with TheraCal.

CONCLUSIONS

Within the limits of these preclinical results, resin-containing TheraCal cannot be recommended for direct pulp capping.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part I: vital pulp therapy

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.

Human Pulp Responses to Partial Pulpotomy Treatment with TheraCal as Compared with Biodentine and ProRoot MTA: A Clinical Trial

INTRODUCTION

Questions exist regarding the efficacy of resin-containing materials such as TheraCal directly applied on the pulp. This study sought to investigate the clinical efficacy of TheraCal as compared with Biodentine and ProRoot mineral trioxide aggregate (MTA) for partial pulpotomy.

METHODS

In this clinical trial, partial pulpotomy was performed for 27 sound human maxillary and mandibular third molars scheduled for extraction. The teeth were randomly divided into 3 groups (n = 9) and underwent partial pulpotomy with TheraCal, Biodentine, and ProRoot MTA. The teeth were then restored with glass ionomer cement. Clinical and electric pulp tests were performed after 1 and 8 weeks. The teeth were radiographed and extracted at 8 weeks. Histologic sections were prepared and analyzed for pulp inflammation and dentinal bridge formation. Data were analyzed by using one-way analysis of variance.

RESULTS

Clinical examination showed no sensitivity to heat, cold, or palpation in ProRoot MTA and Biodentine groups. Two patients in TheraCal group (20%) reported significant pain at 1 week. Periapical radiographs showed no periapical pathology, and electric pulp test revealed a normal pulp response with no hypersensitivity. Inflammation was absent with all materials at 8 weeks. Normal pulp organization was seen in 33.33% of the teeth in ProRoot MTA, 11.11% in TheraCal, and 66.67% in Biodentine group (P = .06). Biodentine group showed complete dentinal bridge formation in all teeth, whereas this rate was 11% and 56% in TheraCal and ProRoot MTA groups, respectively (P = .001).

CONCLUSIONS

Overall, Biodentine and MTA performed better than TheraCal when used as partial pulpotomy agent and presented the best clinical outcomes.

Management of pulps exposed during carious tissue removal in adults: a multi-national questionnaire-based survey

OBJECTIVES

The aim of the present study was to investigate and compare the management of pulps exposed during carious tissue removal by French, German, and Norwegian general dental practitioners (GDPs). We further aimed to assess possible dentist- and patient-related factors associated with these management decisions.

MATERIALS AND METHODS

A structured questionnaire was send via mail to a simple random sample of dentists.

RESULTS

The analyzed sample consisted of 661 (33%) French GDPs, 622 (25%) German GDPs, and 199 (34%) Norwegian GDPs. No single management method gained uniform consensus in any of the three countries. However, the most preferred management option in all three countries was direct pulp capping (DPC) (68-93%) mainly performed with calcium hydroxide paste/slurry (CH). Alternatively, root canal treatment was performed (7-22%). The reasons that guided GDPs were the same in all three countries; "good results" and "ease of use, familiar with the technique." Having read scientific articles about cariology/operative dentistry in the last 5 years increased the odds for the preference of DPC instead of root canal treatment (OR = 2.1, 95% CI 1.3-3.2).

CONCLUSIONS

Among GDPs in France, Germany, and Norway, there was no uniform management option for pulp exposures during carious tissue removal. DPC with CH was the most preferred management, even though the current evidence suggests DPC with mineral trioxide aggregate (MTA) to be more successful. The outcome expectations and the assumed ease of use were reasons for GDPs' choice. Moreover, knowledge on current evidence towards such management options influenced treatment decisions.

CLINICAL RELEVANCE

GDPs are encouraged to adopt management options based on current scientific evidence.

A randomized trial of direct pulp capping in primary molars using MTA compared to 3Mixtatin: a novel pulp capping biomaterial

OBJECTIVE

This study aimed to examine the efficacy of 3Mixtatin (a combination of simvastatin and 3Mix antibiotic) as a novel pulp capping biomaterial in DPC of human primary molars.

METHODS

In this randomized clinical trial, 160 primary molars from 83 healthy children aged 3-6 years were randomly allocated into four groups. Small traumatic non-caries pulpal exposures were treated by DPC using simvastatin, 3Mix, 3Mixtatin, or MTA. Capping materials were covered with hard-setting zinc oxide eugenol (ZOE) cement, and then, teeth were restored with amalgam. Clinical and radiographic examinations were conducted at 2, 6, and 12 months after treatment. The data were compared using chi-square test at a significance level of 0.05.

RESULTS

One hundred and twenty-nine teeth were available for follow-up study. By the end of 12 months, the overall success rates were 93.8% in MTA, 91.9% in 3Mixtatin, 62.5% in 3Mix, and 57.1% in simvastatingroups. No statistically significant difference was found between the outcomes of MTA and 3Mixtatin groups (P > 0.05). 3Mixtatin had statistically superior results compared to 3Mix and simvastatin (P < 0.01).

CONCLUSION

Radiographic and clinical outcomes in 3Mixtatin group could suggest it as an acceptable alternative in DPC of primary molar teeth.

Mineral trioxide aggregate pulpotomy in autotransplanted immature mandibular third molar with a 4-year follow-up

Autotransplantation is the surgical transposition of a tooth from its original site to another, replacing a lost or a compromised tooth by another tooth, usually the third molar in the same individual. This technique is considered a viable method due to its high success rate, well-grounded treatment option, provided the case selection and the procedure followed is within the acceptable limits. Autotransplantation is considered as an alternative approach of oral rehabilitations in a conservative manner mainly in young patients with compromised financial conditions to perform a high cost treatment. It is a fast way to recover function and aesthetic properties without interfering with the orofacial growth. This report describes a successful 4-year follow-up of a case of immediately performed mineral trioxide aggregate (MTA) pulpotomy in autotransplantated mandibular left immature third molar to replace the mandibular left first molar that was extracted due to extensive carious lesion.

Spectrophotometric Analysis of Coronal Tooth Discoloration Induced by Various Bioceramic Cements and Other Endodontic Materials

INTRODUCTION

Coronal tooth discoloration induced by various endodontic materials was evaluated in vitro.

METHODS

Eighty extracted human maxillary anterior teeth were accessed, instrumented, and sectioned to standardized root lengths of 10 mm below the cementoenamel junction. Pulp chambers were cleaned chemomechanically to ensure complete tissue removal. Specimens were filled with experimental materials in 8 random groups: RRM, EndoSequence RRM putty (Brasseler, Savannah, GA); RRMF, EndoSequence RRM fast set paste (Brasseler); BD, Biodentine (Septodont, Saint-Maur-des-Fossés, France); WMTA, white MTA (Dentsply, York, PA), GMTA, gray MTA (Dentsply); AH+, AH Plus sealer (Dentsply); TAP, triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline); and NF, no filling (negative control group). After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 7, 30, 60, and 180 after material placement (T0-T180). Data were transformed into Commission International de I'Eclairage's L*a*b color values, and corresponding ΔE values were calculated. Two-way analysis of variance and the Bonferroni method were performed.

RESULTS

Visual discoloration was observed in all specimens in the GMTA, WMTA, and TAP groups at T7, increasing with time. The ΔE value between the initial color at T0 and at T7, T30, T60, and T180 was significantly different for GMTA, WMTA, and TAP (P < .001). ΔE values for the BD, RRM, RRMF, AH+, and NF groups were not statistically significantly different between T0 and T7, T30, T60, and T180, respectively, except for 3 samples below the human perceptible threshold. Values of L* dropped significantly from T0 to T180 in the TAP, GMTA, and WMTA groups.

CONCLUSIONS

Significant coronal tooth discoloration was caused by TAP, GMTA, and WMTA but not by BD, RRM, and RRMF.

Coronal Pulpotomy Technique Analysis as an Alternative to Pulpectomy for Preserving the Tooth Vitality, in the Context of Tissue Regeneration: A Correlated Clinical Study across 4 Adult Permanent Molars

Aim. (1) The aim of the clinical study revolves around the accurate diagnosis, proper case selection, and the management of acute irreversible pulpitis in permanent molars with closed apices using conservative and economical treatment modalities like vital pulpotomies with regenerative approaches over conventional root canal procedures. (2) To evaluate the use of autologous substances such as platelet concentrates and calcium silicate based materials in promoting the healing and regeneration of the inflamed pulp. Summary. Vital pulpotomy was performed on 5 carious involved, permanent molars diagnosed with acute irreversible pulpitis in 17- to 22-year-old patients. Taking into consideration the patient's age and the condition of the underlying pulp tissue, PRF pulpotomy was planned in view of preserving the vitality of the intact radicular pulps. Regenerative procedures with second generation blood matrices were chosen to encourage the recovery of the inflamed pulps. The systematic follow-up examinations performed at 3, 6, 9, 12, 18, 22, and 24 months revealed a successful clinical and radiological outcome. Within the limits of the present clinical study and correlating the success across the treated clinical cases, we safely conclude the potential scope of regenerative pulpotomy approaches in acute irreversible pulpitis in adult permanent teeth.