Management of pre-eruptive intracoronal radiolucency (PEIR): a case series with up to 8 years follow-up

BACKGROUND

Pre-eruptive intra-coronal radiolucency (PEIR) is a rare dental anomaly often incidentally detected during routine radiographic examinations. This condition manifests as a radiolucent lesion beneath the enamel-dentinal junction of unerupted teeth, particularly in lower molars, posing diagnostic and management challenges due to its asymptomatic nature. The treatment of PEIR depends on the extent of the lesion and the degree of pulp involvement.

CASE SERIES

This case series reports on four patients with progressive pre-eruptive intra-coronal radiolucency. In case 1 and 2, lesions were incidentally discovered in an OPG during orthodontic planning (lower permanent 2nd molars), and additional surgical exposure to access the lesion was required as teeth were only partially erupted. Interestingly in case 3, the PEIR was not visible in earlier x-rays though the crown of the tooth was already mineralized (lower permanent 2nd molar). For case 4, the tooth presented with symptoms of reversible pulpitis (lower permanent 1st molar). All lesions were treated with indirect pulp capping using biocompatible material. The patients were followed-up for a period of up to 8 years to evaluate treatment success. Indirect pulp capping and restorations were found to be successful in all four cases in the last follow-up: 1 year (case 2), 1.4 years (case 1), 1.5 years (case 4), and 8 years (case 3).

CONCLUSION

This case series demonstrates the effectiveness of early intervention via surgical exposure and indirect pulp capping and restoration for managing severe cases of PEIR. However, further research with larger samples and long follow-up is necessary.

Biological and physical properties of calcium hydroxide-based pulp-capping materials and their modifications

PURPOSE

To evaluate the biological and physical properties of calcium hydroxide-containing pulp-capping materials and their modifications with different solutions and antioxidant Resveratrol (RES) addition.

METHODS

Calcium hydroxide+distilled-water:C, calcium hydroxide+saline:S, calcium hydroxide+synthetic tissue fluid:STF, Dycal:D, calcium hydroxide+distilled-water+RES:C+RES, calcium hydroxide+saline+RES:S+RES, calcium hydroxide+synthetic tissue fluid+RES:STF+RES, Dycal+RES:D+RES were tested. Cytotoxicity was determined by WST-1. Antibacterial-activity was evaluated by agar-diffusion. The water-absorption and solubility were examined for ISO-6876 and ISO-3107. The color-change was evaluated by spectrophotometer. Radiopacity was evaluated for ISO-6876 and ISO-9917. The normal distribution and homogeneity were determined and comparisons were made with appropriate analysis and post hoc tests (P < 0.05).

RESULTS

The highest cell-viability was determined in the C+RES and the lowest was in D and D+RES after 24 h (P < 0.0001). RES-addition increased cell-viability and the highest rate was detected in C+RES, S+RES and STF+RES after 48 h (P < 0.0001). A limited inhibition-zone against Streptococcus mutans was detected in D and D+RES. RES-addition did not change the water-absorption in S and STF or the solubility in S group.

CONCLUSION

RES-addition may be used to increase the biocompatibility of calcium hydroxide without any adverse effect on physical properties. Saline may be the first choice as a mixing solution.

Assessment of the biointeractivity of a novel vital pulp therapy agent derived from eggshell biowaste: An in vitro study

This study aimed to assess the calcium (Ca2+) and hydroxyl (OH-) ion-releasing ability, namely the biointeractivity of eggshell-derived hydroxyapatite (ESDHA) in comparison with mineral trioxide aggregate (MTA) and calcium hydroxide (CH). ESDHA, MTA and CH samples (n = 10; 8 × 1.6 mm) were immersed in 10 mL of deionised water (37°C, pH 6.8). Ca2+ and OH- ion releases were detected in 1, 7 and 21 days. Scanning electron microscopy and Fourier transform infrared spectroscopy analyses were also conducted. IBM SPSS 20.0 was used for statistical analyses. The cumulative Ca2+ ions (56.22 ± 11.28 ppm) were detected as most significant in ESDHA (day 21; p < 0.05). The OH- ion values of the ESDHA group were statistically higher than MTA and CH (days 1 and 7; p < 0.05). ESDHA and CH showed a similar pattern with sharp peaks in Ca2+, oxygen and carbon elements. ESDHA being a sustainable material with a high ion-releasing ability may be a preferable alternative to the commercial vital pulp therapy agents.

Effect of pulp capping materials on odontogenic differentiation of human dental pulp stem cells: An in vitro study

OBJECTIVES

Migration and differentiation of human dental pulp stem cells (hDPSCs) is a vital and key factor in the success of reparative dentin formation for maintenance of pulp vitality. Pulp capping materials are used to stimulate DPSCs to induce new dentin formation. Thus, the aim of the present study was to compare the response of DPSCs to four commercially available pulp capping materials: a bioactive bioceramic (Material 1), a nonresinous ready-to-use bioceramic cement (Material 2), a bioactive composite (Material 3), and a biocompatible, dual-cured, resin-modified calcium silicate (Material 4).

MATERIALS AND METHODS

hDPSCs were isolated and cultured from freshly extracted teeth and were then characterized by flow cytometry and multilineage differentiation. Discs prepared from pulp capping materials were tested with hDPSCs and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, cell migration assay and odontogenic differentiation assay was performed. Expression of osteogenic markers (osteopontin, RUNX family transcription factor 2, osteocalcin) and the odontogenic marker (dentin sialophosphoprotein) was detected using reverse transcription-polymerase chain reaction.

RESULTS

Materials 1, 2, and 3 generated more cell viability than Material 4. Furthermore, Material 4 showed the least wound exposure percentage, while Material 3 showed the highest percentage. Enhanced mineralization was found in hDSCPs cultured with Material 3, followed by Material 1, and then Material 2, while Material 4 revealed the least calcified mineralization.

CONCLUSIONS

The results of this study were inconclusive regards contemporary bioceramic materials designed for vital pulp therapy as they have different effects on hDPSC. Further testing for cytotoxicity using live-dead staining, animal experiments, clinical trials, and independent analyses of these biomaterials is necessary for clinicians to make an informed decision for their use.

Dentine Remineralisation Induced by "Bioactive" Materials through Mineral Deposition: An In Vitro Study

This study aimed to assess the ability of modern resin-based "bioactive" materials (RBMs) to induce dentine remineralisation via mineral deposition and compare the results to those obtained with calcium silicate cements (CSMs). The following materials were employed for restoration of dentine cavities: CSMs: ProRoot MTA (Dentsply Sirona), MTA Angelus (Angelus), Biodentine (Septodont), and TheraCal LC (Bisco); RBMs: ACTIVA BioACTIVE Base/Liner (Pulpdent), ACTIVA Presto (Pulpdent), and Predicta Bioactive Bulk (Parkell). The evaluation of the mineral deposition was performed through scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) on the material and dentine surfaces, as well as at the dentine-material interface after immersion in simulated body fluid. Additionally, the Ca/P ratios were also calculated in all the tested groups. The specimens were analysed after setting (baseline) and at 24 h, 7, 14, and 28 days. ProRoot MTA, MTA Angelus, Biodentine, and TheraCal LC showed significant surface precipitation, which filled the gap between the material and the dentine. Conversely, the three RBMs showed only a slight ability to induce mineral precipitation, although none of them was able to remineralise the dentine-material interface. In conclusion, in terms of mineral precipitation, modern "bioactive" RBMs are not as effective as CSMs in inducing dentine remineralisation; these latter represent the only option to induce a possible reparative process at the dentin-material interface.

Approaches to vital pulp therapies

Tooth decay, which leads to pulpal inflammation due to the pulp's response to bacterial components and byproducts is the most common infectious disease. The main goals of clinical management are to eliminate sources of infection, to facilitate healing by regulating inflammation indental tissue, and to replace lost tissues. A variety of novel approaches from tissue engineering based on stem cells, bioactive molecules, and extracellular matrix-like scaffold structures to therapeutic applications, or a combination of all these are present in the literature. Shortcomings of existing conventional materials for pulp capping and the novel approches aiming to preserve pulp vitality highligted the need for developing new targeted dental materials. This review looks at the novel approches for vital pulp treatments after briefly addresing the conventional vital pulp treatment as well as the regenerative and self defense capabilities of the pulp. A narrative review focusing on the current and future approaches for pulp preservation was performed after surveying the relevant papers on vital pulp therapies including pulp capping, pulpotomy, and potential approaches for facilitating dentin-pulp complex regeneration in PubMed, Medline, and Scopus databases.

Vital Pulp Therapy of Young First Permanent Molars: A Retrospective Study on Radiographic Findings 24 Months Post-treatment

PURPOSE

With success rates comparable to that of root canal treatment, vital pulp therapy (VPT) has gained clinical interest and has been used in the management of young permanent teeth with inflamed pulps. The aim of the present study was to retrospectively evaluate the radiographic success of VPT in young first permanent molars 24 months post-treatment and correlate findings with tooth and treatment-related characteristics.

MATERIALS AND METHODS

Dental records of all patients with first permanent molars which received VPT in the Department of Paediatric Dentistry (National and Kapodistrian University of Athens) were retrieved. Demographic characteristics and data regarding the treatment performed were recorded. Patients' radiographs were evaluated at 6, 12 and 24 months post-treatment by two qualified paediatric dentists blinded regarding the treatment performed. Radiographic success, reasons for failure and continuation of root development were evaluated. Differences were tested using the Χ2 and Student's t-test, and possible correlations were determined by calculating the odds ratio.

RESULTS

Overall radiographic success rate at 24 months was 77%, ranging between 50% for direct pulp capping and 92% for full pulpotomy. Differences were not statistically significant. Continuation of root development was recorded in almost 1/3 of the teeth and completion in almost 1/5. No statistically significant association was recorded between the outcome and any tooth and treatment-related variables.

CONCLUSION

VPT seems to be a reliable option in the long term for the treatment of deep carious lesions in young permanent molars.

Assessment of Decision-Making and Material Selection for Vital Pulp Therapy in Deep Carious Lesions: A Study at the Faculty of Dentistry, King Abdulaziz University

PURPOSE

The purposes of this study were to assess decision-making, material selection, and management of deep carious lesions in permanent teeth requiring vital pulp therapy (VPT); investigate the intradepartmental and interdepartmental consensus in the management of those cases; and correlate this study's results to the current scientific literature, clinical experience, and postgraduate training among staff and postgraduate students at the Faculty of Dentistry, King Abdulaziz University.

MATERIALS AND METHODS

The survey included faculty from pedodontics, endodontics, and restorative/operative dentistry; postgraduate students; and interns, excluding specific categories such as retired faculty, external trainers, non-faculty hospital specialists, general practitioners, students, interns outside the institution, and other departments. An anonymous electronic questionnaire was developed and validated. Ethical approval was obtained, and the questionnaire was distributed to all 148 English-proficient members of the targeted population via email and WhatsApp, accompanied by a cover letter. The questionnaire encompassed demographic, education, experience, assessment, decision-making, and management sections. Data were collected and analyzed using Microsoft Excel, with results presented using categorical variables, Pareto charts, and statistical tests.

RESULTS

There were 86 responses, representing 58% of the target population, with the key findings including the prominence of "Pre-operative vitality test result" as the most important factor in assessing deep carious lesions, with no significant differences among specialties. The (one-step and one-visit) management approach was preferred by 50% of participants, with no significant specialty differences. For deep carious lesions without pulpal exposure, glass ionomer (GI)/resin-modified glass ionomer (RMGI) base was the top choice, with no variation among all specialties. In cases with pulpal exposure, the one-visit approach (direct pulp capping (DPC), base, and restoration) was the most favored, with no specialty differences. Material availability significantly influenced decision-making, with no specialty variations.

CONCLUSION

The study highlights the crucial role of pre-operative vitality tests in assessing deep carious lesions for VPT or root canal treatment (RCT). Participants generally favored VPT for cases with normal pulp vitality, with some departmental variation. Controlling bleeding post-pulpal exposure was a central concern. Mineral trioxide aggregate (MTA) was the most commonly used VPT material, followed by Ca(OH)2 and Biodentine. Factors such as treatment access, patient compliance, remaining dentin thickness, and oral hygiene had minimal impact on treatment choice. Limited availability of VPT materials was the primary reason for non-use. The survey's acceptable response rate raises concerns about potential non-response bias, though limitations include a lack of data on non-responders. Nevertheless, the survey's strength lies in its comprehensive coverage of key clinical aspects, engaging professionals from diverse specialties and educational levels who are collectively interested in addressing deep caries cases.

Efficacy of Calcium Enriched Mixture Cement, Mineral Trioxide Aggregate and Calcium Hydroxide Used as Direct Pulp Capping Agents in Deep Carious Lesions - A Randomised Clinical Trial

OBJECTIVE

The primary objective of this randomised clinical trial was to evaluate the efficacy of Calcium Enriched Mixture (CEM) cement compared to Mineral Trioxide Aggregate (MTA) and Calcium Hydroxide (CH) in maintaining pulp vitality when used for direct pulp capping (DPC) of deep carious lesions with reversible pulpitis and secondary objective was to assess the overall success of DPC in carious exposures.

METHODS

One hundred and fifty patients diagnosed with reversible pulpitis with deep carious lesions were included in this study. Patients were randomly allocated into three groups (n=50), Group C: CEM group, Group M: MTA group, and Group D: CH (Dycal) group. After caries removal by mechanical excavation except for one carious spot, the removal of which resulted in the exposure of the pulp, the final carious spot was removed with a sterile no.2 round carbide bur. After haemostasis, the pulpal wound was dressed by a capping agent, followed immediately by permanent restoration. Patients were assessed for successful outcomes based on positive vitality tests, absence of clinical signs and symptoms, and PAI scores after 1, 3, 6, 12, and 18-month follow-up periods. The ANOVA test was employed to analyse quantitative variables, and the Pearson Chi-square test was used for qualitative variables. A Bonferroni Test was employed as the post hoc test for intergroup comparison. The significance level was set at p≤0.05 within all tests.

RESULTS

The percentage of success in Group C was 86.7%, Group M was 77.3%, and Group D was 57.9%. This study's overall success rate after direct pulp capping of deep carious lesions was 74.8%. A statistically significant difference in PAI score was found between Groups C and D. Pain on percussion and response to vitality tests also showed significant differences among the three groups at the one-month follow-up.

CONCLUSION

CEM cement had comparable efficacy to MTA and was superior to CH in maintaining pulpal vitality following DPC in teeth with reversible pulpitis. An overall success rate of 74.8% indicated that DPC in deep carious lesions with reversible pulpitis could yield favourable clinical outcomes. (EEJ-2022-11-134).

Human digested dentin matrix for dentin regeneration and the applicative potential in vital pulp therapy

INTRODUCTION

Human dentin is a natural acellular matrix with excellent reported biocompatibility. The aim was to fabricate a novel dentin matrix material from human dentin and investigate its applicative potential for vital pulp therapy.

METHODS

Digested dentin matrix extract (DDME) was fabricated using controlled enzymatic digestion under acidic conditions. The surfaces and biocompatibility of DDME were then investigated, with its effects on the odontogenic differentiation of human dental pulp cells (hDPCs) also studied. The ability of DDME to induce mineralization was assessed in a nude mouse model. The performance of DDME as a pulp capping agent was evaluated in an in-situ rat model. The molecular mechanism was verified by mRNA sequencing.

RESULTS

A novel type of dentin matrix material with a uniform size of 8 μm was fabricated. DDME had a similar band compared with grinded dentin matrix, with a smaller size and more uneven surface, as detected by Fourier Transform Infrared Spectrometer (FTIR) and X-ray photoelectron spectroscopy (XPS). DDME at low concentrations did not affect hDPCs viability or proliferation, but enhanced runt-related transcription factor 2, dentin matrix acidic phosphoprotein 1 and collagen 1A1 expression in hDPCs in vitro. DDME was superior to HA-TCP in dentin-like mineralized tissue formation after subcutaneous transplantation. In the rat model of pulpotomy, DDME showed visible curative effects. The underlying mechanism may be the inhibition of Hippo signaling following DDME treatment. DDME promoted Yes-associated protein (YAP) 1 nuclear influx, thereby enhancing the expression of DMP-1, which was reversed by YAP inhibitor treatment.

CONCLUSIONS

Human DDME can be used as a biomaterial for dentin regeneration. The combined application of DDME and current pulp capping agents is a potential choice for vital pulp therapy.

Characterization of nano-hydroxyapatite incorporated carboxymethyl chitosan composite on human dental pulp stem cells

AIM

To compare the odontogenic differentiation potential of a composite scaffold (CSHA) comprising of nano-hydroxyapatite (nHAp) and carboxymethyl chitosan (CMC) with Biodentine on human dental pulp stem cells (hDPSCs).

METHODOLOGY

A CSHA scaffold was prepared through an ultrasonication route by adding nHAp and CMC (1:5 w/w) in water medium followed by freeze-drying. Physicochemical characterization was achieved using scanning electron microscopy with energy-dispersive X-ray spectroscopy, X-ray diffraction and Fourier transform infrared spectroscopy. In-vitro bioactivity and pH assessments were done by soaking in simulated body fluid (SBF) for 28 days. The angiogenic and odontogenic differentiation abilities were assessed by expression of vascular endothelial growth factor (VEGF) and Dentine sialophosphoprotein (DSPP) markers on cultured hDPSCs by flow cytometry and RT-qPCR at 7, 14 and 21 days. Cell viability/proliferation and biomineralization abilities of CSHA were compared with Biodentine by MTT assay, alkaline phosphatase (ALP) activity, Alizarin Red Staining (ARS) and osteopontin (OPN) expression on hDPSCs following 7 and 14 days. Data were statistically analysed with Kruskal Wallis and Friedman tests as well as one way anova followed by appropriate post hoc tests (p < .05).

RESULTS

Characterization experiments revealed a porous microstructure of CSHA with pore diameter ranging between 60 and 200 μm and 1.67 Ca/P molar ratio along with the characteristic functional groups of both HAp and CMC. CSHA displayed bioactivity in SBF by forming apatite-like crystals and maintained a consistent pH value of 7.70 during 28 days' in vitro studies. CSHA significantly upregulated VEGF and DSPP levels on hDPSCs on day 21 compared with day 7 (p < .05). Further, CSHA supported cell viability/proliferation over 14 days like Biodentine with no statistical differences (p > .05). However, CSHA exhibited increased ALP and ARS activity with an intense OPN staining compared with Biodentine after 14 days (p < .05).

CONCLUSION

The results highlighted the odontogenic differentiation and biomineralization abilities of CSHA on hDPSCs with significant VEGF and DSPP gene upregulations. Further, CSHA exhibited enhanced mineralization activity than Biodentine, as evidenced by increased ALP, ARS and OPN activity on day 14. The nHAp-CMC scaffold has the potential to act as an effective pulp capping agent; however, this needs to be further validated through in-vivo animal studies.

Factors that influence the outcome of pulpotomy in permanent teeth

The promotion of minimally invasive treatments focussed on the maintenance of pulp vitality has become a priority area in Endodontics. These vital pulp treatments (VPT) include partial and full pulpotomy, during which diseased coronal pulp tissue is removed prior to placement of a capping biomaterial and restoration. Traditionally, pulpotomies were confined to the treatment of carious primary and traumatized permanent teeth. However, these treatments have now been proposed as definitive solutions for cariously exposed permanent teeth with mild symptoms or even symptoms indicative of irreversible disease. Until recently, it was recommended that carious exposure of mature permanent teeth be managed by root canal treatment. The promotion of pulpotomy as an alternative treatment has opened up a wave of laboratory and clinical research aimed at improving therapies or evaluating clinical outcomes. In modern evidence-based endodontics, it is imperative that the outcomes of both partial and full pulpotomy are considered and important prognostic factors identified, so that improvements can be made to aid clinical decision-making and to direct new research. In this narrative review, the outcomes of partial and full pulpotomy are discussed, before analysis of patient, intraoperative and postoperative factors that influence the outcome of the pulpotomy procedure. The review highlights that although partial and full pulpotomy for the treatment of even pulpal disease are highly successful procedures, this is based on low-quality evidence with a lack of prospective, comparative trials investigating potential prognostic factors. Based on current evidence, it appears that age, gender, tooth type, root development and intraoperative pulpal haemorrhage do not impact significantly on pulpotomy outcome, whilst others such as caries depth, inflammatory status of the pulp, capping material, level of inflammatory pulpal-biomarkers and the final restoration integrity do. Other factors, including the influence of exposure type, periodontal condition, pulpal lavage, magnification, operator experience, isolation of the operating field and type of pulpotomy, require further experimental investigation before definitive conclusions can be made relating to the success of the pulpotomy procedure. Finally, there is not only a need for future well-designed prospective research addressing these issues but also a widening of our understanding of outcome to include patient-reported as well as clinician-reported outcomes.

Determining the best anti-microbial properties of dental cements used for pulp capping procedures using deep dentinal carious material

Introduction

The exposure of the healthy pulp in cases of deep dentinal caries (DDC) that contain carious microorganisms can be prevented by placing a layer of pulp capping agent on the affected dentin. The cements used for pulp-capping should also ensure good anti-microbial properties. The present study was carried out to detect the antimicrobial efficacy of the commonly used cements by culturing the samples directly from DDC.

Aims

To determine the efficacy of dental cements in the growth inhibition of microorganisms involved in DDC using direct contact anaerobic culture test.

Method

100 samples of DDC were collected in RTF. Ten microliters of the specimen containing RTF was incubated in thioglycolate broth consisting of 1 mm3 cement blocks of GIC, CaOH2, ZnOE and MTA anaerobically for 24 hours. This was further sub-cultured using selective media for streptococcus mutans, lactobacillus and bifidobacterium. Growth inhibition was measured by calculating the number of CFUs and statistically analysed using ANOVA and Tukey's post-hoc tests.

Results

Tests showed variation in the anti-microbial effects of the cements and was highly significant at P < 0.001. Bifidobacterium showed most number of CFUs. MTA was the most effective pulp capping agent exhibiting 87.13% reduction in microbial growth, followed closely by ZnOE (84.6%).

Conclusion

A conservative approach to treat DDC is the need of the hour which calls for the use of pulp capping cements of good antimicrobial efficacy. The current study revealed bifidobacterium to be the most prevalent in DDC and the cement that would best inhibit the mixed culture growth was MTA followed closely by ZnOE.

A comparative evaluation of light cure calcium silicate and resin-modified glass ionomer as indirect pulp capping agent in primary molars: A randomized clinical trial

Background

Minimally invasive techniques should be employed to maintain pulp vitality without affecting physiological tooth resorption for pediatric patients. This study aims to evaluate clinical and radiographic success of light cure calcium silicate and resin-modified glass ionomer (RMGI) as indirect pulp-capping agent in primary molars in children between 5 and 9 years.

Materials and Methods

In this randomized clinical trial study, 40 primary molars with the International Caries Detection and Assessment System criteria 4-6 score were divided randomly into two groups after computerized randomization method. After caries excavation by minimally invasive dentistry principle, affected dentin was lined by either light cure calcium silicate (Group I) or RMGI (Group II) liner followed by composite restoration. Clinical success was determined with the absence of symptoms and bitewing radiographs were taken at baseline, 3, and 6 months' interval to measure increase in dentin increment using ImageJ software. Statistical analysis for intergroup comparison was done using Paired t-test, and Independent t-test was used for intragroup comparison. The level of statistical significance was set at P < 0.05.

Results

Change in dentin increment seen from baseline to 6 months in Group I was 0.19 mm and in Group II was 0.20 mm (P = 0.924). Intragroup increment was statistically significant during all follow-up intervals for both the groups (Group I - P ≤ 0.001, Group II - P = 0.009). For baseline remaining dentin thickness >1.5 mm, statistically significant increase was observed in the dentin increment at 3 months' interval between both the groups.

Conclusion

Both TheraCal LC and Vitrebond show acceptable clinical and radiographic results when used in primary molars as indirect pulp treatment agents. Both the liners are equivalent to each other in terms of feasibility and cost-effectiveness but TheraCal LC can be preferred due to better handling and avoiding the manipulation step thereby reducing treatment time.

Synthesis and Biocompatibility Evaluation of PCL Electrospun Membranes Coated with MTA/HA for Potential Application in Dental Pulp Capping

This study aimed to develop polycaprolactone (PCL) electrospun membranes coated with mineral trioxide aggregate/hydroxyapatite (MTA/HA) as a potential material for dental pulp capping. Initially, the PCL membrane was prepared by an electrospinning process, which was further surface coated with MTA (labeled as PCLMTA) and HA (labeled as PCLHA). The physico-chemical characterization of the fabricated membranes was carried out using field emission scanning electron microscopy (FE-SEM)/Energy dispersive X-ray (EDX), X-ray diffraction (XRD), Raman spectroscopy, and contact angle analysis. The biocompatibility of the human dental pulp stem cells (hDPSCs) on the fabricated membranes was checked by XTT assay, and the hDPSCs adhesion and spreading were assessed by FE-SEM and confocal microscopy. The wound healing ability of hDPSCs in response to different electrospun membrane extracts was examined by scratch assay. The surface morphology analysis of the membranes by FE-SEM demonstrated a uniform nanofibrous texture with an average fiber diameter of 594 ± 124 nm for PCL, 517 ± 159 nm for PCLHA, and 490 ± 162 nm for PCLMTA. The elemental analysis of the PCLHA membrane indicated the presence of calcium and phosphorous elements related to HA, whereas the PCLMTA membrane showed the presence of calcium and silicate, related to MTA. The presence of MTA and HA in the PCL membranes was also confirmed by Raman spectroscopy. The water contact analysis demonstrated the hydrophobic nature of the membranes. The results indicated that PCL, PCLHA, and PCLMTA membranes were biocompatible, while PCLMTA exhibited better cell adhesion, spreading, and migration.

Investigation of a Novel Injectable Chitosan Oligosaccharide-Bovine Hydroxyapatite Hybrid Dental Biocomposite for the Purposes of Conservative Pulp Therapy

This study aimed to develop injectable chitosan oligosaccharide (COS) and bovine hydroxyapatite (BHA) hybrid biocomposites, and characterise their physiochemical properties for use as a dental pulp-capping material. The COS powder was prepared from chitosan through hydrolytic reactions and then dissolved in 0.2% acetic acid to create a solution. BHA was obtained from waste bovine bone and milled to form a powder. The BHA powder was incorporated with the COS solution at different proportions to create the COS-BHA hybrid biocomposite. Zirconium oxide (ZrO₂) powder was included in the blend as a radiopacifier. The composite was characterised to evaluate its physiochemical properties, radiopacity, setting time, solubility, and pH. Fourier-transform infrared spectroscopic analysis of the COS-BHA biocomposite shows the characteristic peaks of COS and hydroxyapatite. Compositional analysis via ICP-MS and SEM-EDX shows the predominant elements present to be the constituents of COS, BHA, and ZrO₂. The hybrid biocomposite demonstrated an average setting time of 1 h and 10 min and a pH value of 10. The biocomposite demonstrated solubility when placed in a physiological solution. Radiographically, the set hybrid biocomposite appears to be more radiopaque than the commercial mineral trioxide aggregate (MTA). The developed COS-BHA hybrid biocomposite demonstrated good potential as a pulp-capping agent exhibiting high pH, with a greater radiopacity and reduced setting time compared to MTA. Solubility of the biocomposite may be addressed in future studies with the incorporation of a cross-linking agent. However, further in vitro and in vivo studies are necessary to evaluate its clinical feasibility.

The Cytotoxicity and Genotoxicity of Bioactive Dental Materials

The promotion of biologically based treatment strategies in restorative dentistry is of paramount importance, as invasive treatments should be avoided to maintain the tooth's vitality. This study aimed to assess the biocompatibility of commercially available bioactive materials that can be used for dental pulp capping. The study was performed with a monocyte/macrophage peripheral blood SC cell line (ATCC CRL-9855) on the following six specific bioactive materials: ProRoot MTA (Dentsply Sirona), MTA Angelus (Angelus), Biodentine (Septodont), TheraCal LC (Bisco), ACTIVA BioACTIVE (Pulpdent) and Predicta Bioactive Bulk (Parkell). The cytotoxicity of the investigated agents was measured using a resazurin-based cell viability assay, while the genotoxicity was evaluated using an alkaline comet assay. Additionally, flow cytometry (FC) apoptosis detection was conducted with a FITC (fluorescein isothiocyanate) Annexin V Apoptosis Detection Kit I. FC cell-cycle arrest assessment was carried out with propidium iodide staining. The results of this study showed no significant cytotoxicity and genotoxicity (p > 0.05) in ProRoot MTA, MTA Angelus, Biodentine, ACTIVA BioACTIVE and Predicta Bioactive. Conversely, TheraCal LC presented a significant decrease (p < 0.001). In conclusion, due to excellent biocompatibility and low cytotoxicity, MTA, Biodentine, ACTIVA BioACTIVE and Predicta Bioactive may be suitable for pulp capping treatments. On the other hand, due to the high cytotoxicity of TheraCal LC, its use should be avoided in vital pulp therapies.

Dentin Sialoprotein/Phosphophoryn (DSP/PP) as Bio-Inductive Materials for Direct Pulp Capping

Conventional direct pulp capping, such as calcium hydroxide (Ca(OH)₂) or silicate products, usually induces an inflammatory reaction to provoke pulp regeneration. Phosphophoryn (PP) and dentin sialoprotein (DSP), the two most abundant non-collagenous proteins in the dentin matrix, are responsible for dentin mineralization, pulp cell migration, and differentiation. Here we examined the PP and combined DSP/PP as bio-inductive pulp capping materials by in vitro and in vivo tests. Firstly, the effects of the PP dose on pulp cell migration and matrix protein expression were examined by an agarose bead test. Secondly, the role of recombinant DSP (recDSP) and recDSP/PP on stimulating DSP-PP transcript expression was examined by RT-PCR. DSPP mRNA was also knocked down by RNA interference (RNAi) to examine their functions on dentin matrix mineralization. Finally, we used ferret animal models to test PP and recDSP/PP acting as capping agents on in vivo pulp responses and reparative dentin formation. The result showed that intermediate-dose PP was the most effective to enhance cell migration and differentiation. RecDSP/PP strongly enhanced the DSP-PP transcript expression, while inhibition of DSPP mRNA expression by siRNAs partially or completely affected dental pulp cell mineralization. The in vivo results showed that intermediate-dose PP and recDSP/PP proteins induced less pulp inflammation and promoted reparative dentin formation. Contrarily, conventional calcium hydroxide induced severe pulp inflammation. With these findings, DSP and PP could serve as capping agents for pulp capping therapy.

Assessment of Pulpal Status in Primary Teeth Following Direct Pulp Capping in an Experimental Canine Model

(1) Background: This study aimed to assess the pulpal response of primary teeth by pulse-oximetry (PO) in a canine model, following direct pulp capping (DPC). (2) Methods: Forty-eight primary teeth from eight canine subjects were divided into three treatment groups, based on the DPC material—calcium hydroxide (CH), MTA, BiodentineTM)—and three corresponding control groups. Data from PO pulp testing were correlated with laser Doppler flowmetry (LDF) testing, computer tomographic (CT) densitometry and histological analysis; the experiment lasted 14 days. (3) Results: SpO₂ recordings revealed statistically significant differences (p = 0.002, <0.05) between the treatment and control groups, and no significant differences (p = 0.257, >0.05) were observed between treatment groups. LDF recordings showed significant differences (p = 0.002, <0.05) between the treatment and control groups and identified significant differences between materials (p = 0.001, <0.05). CT densitometry indicated vital pulps in all teeth, with pulpal inflammation detected in 6/8 CH-capped teeth and 2/8 MTA-capped teeth. Histologic evaluation confirmed vital pulp in all specimens, with different degrees of inflammation. (4) Conclusions: Within its limitations, the present study confirms the diagnostic value of PO evaluation of pulpal status in primary teeth with histologic means after pulp-capping procedures in a canine model. However, various degrees of pulpal inflammation elicited by different pulp-capping materials seem not to correlate with the obtained PO values.

Evaluation of Endosequence Root Repair Material and Endocem MTA as direct pulp capping agents: An in vivo study

The study aimed to assess the human pulpal response to direct pulp capping using Endosequence Root Repair Material (ERRM) and Endocem MTA against ProRoot MTA as control. Intentional direct pulp capping was done using the three materials in 30 caries-free human premolars. After 30 days, the teeth were extracted, fixed and decalcified. Sections were prepared for histologic examination using light microscopy. Thickness and quality of dentine bridge formed and level of inflammation were evaluated. Difference between dentine bridge thickness of the three groups was statistically significant. Mean thickness of dentine bridges formed in ProRoot MTA group was greater than other two groups, and difference was statistically significant. Difference in dentine bridge thickness between ERRM and Endocem MTA was statistically significant. No significant difference was observed between the 3 groups with respect to inflammation. Results indicate ProRoot MTA performed best with ERRM giving better results than Endocem MTA.

Vitronectin-Derived Peptide Promotes Reparative Dentin Formation

Exposed dental pulp can maintain its vitality through a pulp-capping procedure with biocompatible materials, followed by reparative dentin formation. Our previous study demonstrated that a vitronectin-derived peptide (VnP-16) promotes osteoblast differentiation and concomitantly restrains osteoclast differentiation and resorptive function. In this study, we aimed to demonstrate that VnP-16 promotes odontoblast differentiation, mineralization, and reparative dentin formation in a pulp exposure model using a rat tooth. VnP-16 showed no cytotoxicity and promoted cellular behavior in human dental pulp cells, enhancing their differentiation into odontoblast-like cells and mineralization, effects that are comparable to those obtained with vitronectin. In a rat pulp exposure model, VnP-16 showed mild inflammatory responses at 2 and 4 wk or none. Mineral trioxide aggregate (MTA) demonstrated a tendency of early formation of reparative dentin at 2 wk when compared with recombinant human bone morphogenetic protein 2 (rhBMP-2) and VnP-16. However, VnP-16 induced reparative dentin formation similar to MTA and rhBMP-2 without inflammation at 4 wk. In addition, VnP-16 showed a thicker and homogeneous reparative dentin formation versus MTA and rhBMP-2. Collectively, these results suggest that VnP-16 can be a useful, direct pulp-capping agent for highly qualified reparative dentin formation by promoting cell behavior and odontoblastic differentiation of human dental pulp cells.

Effects of calcium silicate-based cements on odonto/osteogenic differentiation potential in mesenchymal stem cells

The objective of this study was to evaluate the biological effects and odonto/osteogenic differentiation potential of Biodentine, NeoMTA Plus and TheraCal LC in tooth germ-derived stem cells (TGSCs). TGSCs were exposed to the material extracts. Biocompatibility was tested with MTS cell proliferation assay. Odonto/osteogenic differentiation was assessed with alkaline phosphatase (ALP) activity and mRNA gene expressions (RUNX2, DSPP and DMP-1). Scanning electronic microscopy/energy-dispersive X-ray (SEM/EDX) analysis and pH analysis were also performed for the materials. Data were evaluated using the one-way ANOVA and Tukey's tests. TGSCs remained viable after 7 days of incubation with all tested materials. Biodentine and NeoMTA Plus showed high ALP activity and increased expression of RUNX2, DSPP and DMP-1 compared to that of TheraCal LC. All materials can induce odonto/osteogenic differentiation of MSCs in various levels. Biocompatibility and odonto/osteogenic differentiation potential of Biodentine and NeoMTA Plus are similar and superior to that of TheraCal LC.

Present status and future directions - Vital pulp treatment and pulp preservation strategies

Therapeutic strategies focussed on the pulp preservation, are important when managing vital teeth with deep caries and an exposed pulp. These vital pulp treatments (VPTs); however, are not new, with indirect and direct pulp capping procedures being described as a therapy for carious teeth for over a century. As a result of unpredictable outcomes, the traditional indications for VPT particularly when the pulp was exposed were limited to the treatment of immature teeth with incomplete root formation. Over the last 20 years, the advent of regenerative endodontics and the promotion of biologically based therapies aimed at reducing intervention have reinvigorated VPT with new waves of basic science and clinical research indicating a role for VPT not only in mature cariously affected teeth, but also in teeth with signs and symptoms indicative of irreversible pulpitis. Driven by new materials such as hydraulic calcium silicate cements, a better understanding of pulpal immunity and biology as well and improved tissue handling, VPT has been at the forefront of treatment recommendations made by global Cariology and Endodontic organizations. Care must be exercised, however, as key gaps in scientific knowledge remain alongside severe limitations in educational dissemination amongst dentists. Although research has highlighted that carious injury to the dentine–pulp complex stimulates a wide range of responses and that the interaction between infection, inflammation and repair will eventually impact on the outcome of pulpitis, our ability to accurately and objectively diagnose the true inflammatory state of the pulp remains poor. An overreliance on symptoms leaves clinicians with subjective, crude diagnostic tools by which to inform treatment planning and decision‐making, which results in large variations in the treatments offered to patients. Not only is there an urgent need to develop preoperative and intraoperative diagnostic tools, but there is also a paucity of the high‐quality comparative evidence required to answer the most important questions and justify treatment options. The aim of this review was to consider the current status of VPT and to discuss the principle problems that are hindering clinical acceptance of these techniques. Potential solutions and opportunities are offered to suggest ways that VPT may become a more consistently prescribed evidenced‐based treatment in dental practice.

Application of Selected Biomaterials and Stem Cells in the Regeneration of Hard Dental Tissue in Paediatric Dentistry-Based on the Current Literature

Currently, the development of the use of biomaterials and their application in medicine is causing rapid changes in the fields of regenerative dentistry. Each year, new research studies allow for the discovery of additional possibilities of dental tissue restoration. The structure and functions of teeth are complex. They consist of several diverse tissues that need to act together to ensure the tooth’s function and durability. The integrity of a tooth’s enamel, dentin, cementum, and pulp tissue allows for successful mastication. Biomaterials that are needed in dentistry must withstand excessive loading forces, be biocompatible with the hosts’ tissues, and stable in the oral cavity environment. Moreover, each tooth’s tissue, as well as aesthetic qualities in most cases, should closely resemble the natural dental tissues. This is why tissue regeneration in dentistry is such a challenge. This scientific research focuses on paediatric dentistry, its classification of caries, and the use of biomaterials in rebuilding hard dental tissues. There are several methods described in the study, including classical conservative methods such as caries infiltration or stainless-steel crowns. Several clinical cases are present, allowing a reader to better understand the described methods. Although the biomaterials mentioned in this work are artificial, there is currently ongoing research regarding clinical stem cell applications, which have a high potential for becoming one of the most common techniques of lost dental-tissue regeneration in the near future. The current state of stem cell development is mentioned, as well as the various methods of its possible application in dentistry.

Endodontic Treatment of a Traumatic Tusk Fracture With Exposed Pulp in an Asian Elephant (Elephas maximus)

Tusk fracture in elephants is a common incident often resulting in pulp exposure and pulpitis. Extensive lavage, endodontic therapy, direct pulp capping, or extraction are treatment options. In this report, the successful management of a broken tusk of a juvenile male Asian elephant (Elephas maximus) including morphological analysis of the tusk tip 2 years after surgery are presented. Treatment was carried out under barn conditions and included antimicrobial photodynamic therapy and partial pulpotomy with direct pulp capping. Immediate pain relief was reached. The fractured tusk was preserved and continued to grow. The therapeutic filling material remained intact for over 1 year but was absent 2 years after treatment. The former pulp cavity of the tusk tip was filled with reparative dentin, osteodentin, and bone, but the seal between these hard tissues and pulp chamber dentin was incomplete. Radiographs obtained 3 years after treatment showed no differences in pulp shape, pulp width, and secondary dentin formation between the treated right and the healthy left tusk. It can be concluded that in case of an emergency, the endodontic therapy of a broken elephant tusk can be attempted under improvised conditions with adequate success. Photodynamic therapy might contribute to prevent infection and inflammation of the pulp. The decision tree published by Steenkamp (2019) provides a valuable tool to make quick decisions regarding a suitable therapy of broken tusks.

Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals-A Review

Immature permanent teeth with crown fractures present a unique challenge in human and animal patients. Immature permanent teeth have not yet developed completely, often presenting with thin dentin walls, incomplete apical formation, and increased crown-to-root ratios. Loss of pulp function at this stage has devastating long-term implications for these teeth. Ideally, attempts should be made to preserve pulp vitality in immature permanent teeth to allow for continued dental development. The range of treatment options for vital teeth includes odontoplasty with bonding and sealing +/- restoration, indirect pulp capping, and direct pulp capping/vital pulp therapy. These treatments have long been established in human and veterinary medicine, and cases have been reported in dogs and cats. Apexification using calcium hydroxide is a well-established treatment for nonvital immature teeth. The advent of mineral trioxide aggregate and other bioceramic materials for use in vital pulp therapy and apexification has reduced treatment sessions and improved outcomes. Recent developments in the field of regenerative endodontic therapy further expand treatment options and provide the possibility for continued development of a formerly nonvital tooth. Selecting the appropriate treatment based on the severity of tooth fracture and status of pulp vitality can avoid a lifetime of poor structure and function for the affected tooth. This article provides multiple step-by-step protocols for the management of immature permanent teeth with crown fractures in small animals.

How is carious pulp exposure and symptomatic irreversible pulpitis managed in UK primary dental care?

AIM

To investigate attitudes and approaches of UK primary care dentists to carrying out vital pulp treatment (VPT) after carious exposure and with additional signs and symptoms indicative of irreversible pulpitis.

METHODOLOGY

An electronic questionnaire was openly distributed via publicly funded (NHS) local dental committees, corporate dental service-providers, professional societies and social media. Principally NHS practitioners and those from mixed and private practice were targeted, in addition to community and military dental officers, and dental therapists. Participants were asked questions relating to several clinical scenarios, with responses analysed using descriptive statistics. χ² tests with sequential Bonferroni correction were used to explore variables including the method of remuneration, practitioner type (dentist/therapist), postgraduate qualification(s), place of graduation and years since qualification. Variables with a relationship p ≤ .2 were selected for backwards likelihood ratio logistic modelling.

RESULTS

In total, 648 primary care practitioners were included for analysis. Calcium hydroxide (CH) was most frequently used for direct pulp caps (DPCs) (398/600; 66.3%) with calcium silicate cements (CSCs) less frequently used (119/600; 19.8%). Rubber dam was used by 222/599 (37.1%) practitioners. A definitive pulpotomy for the management of teeth with signs and symptoms indicative of irreversible pulpitis was selected by 65/613 (10.6%) dentists. The principal barrier for the provision of definitive pulpotomies was a lack of training (602/612; 98.4%). Regression analysis identified NHS practitioners as a good predictor for using CH for DPCs, having shorter emergency appointments, limited access to magnification and not using rubber dam. Non-UK graduates were more likely to select CSCs, appropriately control pulpal haemorrhage, undertake appropriate postoperative evaluation and use rubber dam.

CONCLUSIONS

Practitioners deviated from evidence-based guidelines in a number of aspects including material selection, asepsis and case selection. A number of other challenges exist in primary care in providing predictable VPTs, including lack of time and access to magnification. These were most evident in NHS practice, potentially exacerbating existing social health inequalities. Possible inconsistencies in the UK undergraduate curriculum were supported by a lack of association between years since qualification and technique employed as well as the fact that non-UK graduates and dentists with postgraduate qualifications adhered more to evidence-based VPT guidelines.

Antimicrobial Efficacy of Different Pulp-Capping Materials against Enterococcus faecalis: An In vitro Study

Aim:

The present study aims to assess the antimicrobial action of three different pulp-capping agents against Enterococcus faecalis.

Materials and Methods:

Three pulp-capping agents were chosen for this study: Calcicur, mineral trioxide aggregate (MTA)-Angelus, and Dycal. The zone of inhibition produced by these three pulp-capping agents was measured at 24 h and 72 h to assess their antimicrobial efficacy against E. faecalis. The agar diffusion method was used to examine the antimicrobial effect of pulp-capping agents. Mueller-Hinton agar plates were used to inoculate the microorganisms. Analysis of variance (ANOVA) and Tukey's post hoc tests were done to compare the different groups. P < 0.05 was considered as statistically significant.

Results:

At 24 h, the highest zone of inhibition was found in MTA-Angelus (3.32 ± 0.11 mm), followed by Dycal (2.02 ± 0.46 mm) and Calcicur (1.84 ± 0.92 mm). After 72 h, MTA-Angelus demonstrated a zone of inhibition of 4.60 ± 0.22 mm, followed by Dycal (3.48 ± 0.74 mm) and Calcicur (2.90 ± 0.18 mm). ANOVA test showed a highly statistical significance. A statistically significant difference (P < 0.001) was shown between MTA-Angelus and Dycal. Calcicur did not show any significant difference.

Conclusion:

This trial found that the freshly mixed MTA-Angelus has a significantly superior antimicrobial effect against E. faecalis than Dycal and Calcicur.

MTA: Experimental Study in Animal Model

Background: This study aimed to evaluate the area of dentin growth in rabbit incisors after pulp capping with plasma rich in growth factors (PRGF) compared with mineral trioxide aggregate (MTA) by fluorescence. Methods: twenty-seven upper and lower incisors of rabbits were divided into 4 groups: poor PRGF (F1) (n = 9 teeth), rich PRGF (F2) (n = 8 teeth), ProRoot MTA (positive control, n = 5 teeth), and untreated (NC) (negative control, n = 5). Fluorochrome markers were injected 24 h before surgery and the day before euthanasia, 28 days after the vital pulp therapy (VPT). Two transverse cuts were performed to every tooth: the first cut (A), 1 mm incisal to the gingival margin, and the second cut (B), 5 mm apical to the first cut. The sections were assessed with histomorphometric evaluation by fluorescence microscopy, comparing the dentin area between fluorescence marks and the total mineralized area. Results: The higher percentage of dentin growth was observed in the F2 group (B = 63.25%, A = 36.52%), followed by F1 (B = 57.63%, A = 30,12%) and MTA (B = 38.64%, A = 15.74%). The group with lowest percentage of dentin growth was the NC group (B = 29.22%, A = 7.82%). Significant difference (p < 0.05) was found between F2 group and MTA, also statistically significant difference has been observed comparing dentin growth areas of NC group with F1 and F2 groups. Conclusions: The application of PRGF rich and poor fraction as a pulp capping material stimulated dentin formation more intensively than MTA and NC.

A Systematic Review Comparing Mineral Trioxide Aggregate to Other Commercially Available Direct Pulp Capping Agents in Dogs

Vital pulp therapy (VPT) and direct pulp capping (DPC) are procedures regularly performed in dogs for the management of acute tooth fractures and as part of management for traumatic malocclusions. The purpose of this review is to apply an evidence-based medicine approach to systematically review and evaluate the scientific literature evaluating the efficacy of mineral trioxide aggregate (MTA) to other commercially available materials used for VPT in the permanent teeth of dogs. The 9 studies meeting inclusion criteria were reviewed and each studies evidence was classified using a grading system modified from the Oxford Centre for Evidence-Based Medicine. For the studies meeting inclusion criteria, MTA consistently performed as well or better than other commercially available products in terms of calcific barrier formation and biocompatibility. This review found a lack of consistency between the studies making a direct comparison of the results unreliable. Future studies would benefit from the implementation of a standard scoring system for histology, equivalent and longer study duration times and the correlation of histological and radiographic data.

Identification and validation of novel biomarkers and therapeutics for pulpitis using connectivity mapping

AIM

To create an irreversible pulpitis gene signature from microarray data of healthy and inflamed dental pulps, followed by a bioinformatics approach using connectivity mapping to identify therapeutic compounds that could potentially treat pulpitis.

METHODOLOGY

The Gene Expression Omnibus (GEO) database, an international public repository of genomics data sets, was searched for human microarray datasets assessing pulpitis. An irreversible pulpitis gene expression signature was generated by differential expression analysis. The statistically significant connectivity map (ssCMap) method was used to identify compounds with a highly correlating gene expression pattern. qPCR was used to validate novel pulpitis genes. An ex vivo pulpitis model was used to test the effects of the compounds identified, and the level of inflammatory cytokines was measured with qPCR, ELISA and multiplex array. Means were compared using the t-test or ANOVA with the level of significance set at p ≤ .05.

RESULTS

Pulpitis gene signatures were created using differential gene expression analysis at cutoff points p = .0001 and .000018. Top upregulated genes were selected as potential pulpitis biomarkers. Among these, IL8, IL6 and MMP9 were previously identified as pulpitis biomarkers. Novel upregulated genes, chemokine (C-C motif) ligand 21 (CCL21), metallothionein 1H (MT1H) and aquaporin 9 (AQP9) were validated in the pulp tissue of teeth clinically diagnosed with irreversible pulpitis using qPCR. ssCMap analysis identified fluvastatin (Statin) and dequalinium chloride (Quaternary ammonium) as compounds with the strongest correlation to the gene signatures (p = .0001). Fluvastatin reduced IL8, IL6, CCL21, AQP9 (p < .001) and MMP9 (p < .05) in the ex vivo pulpitis model, while dequalinium chloride reduced AQP9 (p < .001) but had no significant effect on the other biomarkers.

CONCLUSIONS

AQP9, MT1H and CCL21 were identified and validated as novel biomarkers for pulpitis. Fluvastatin and dequalinium chloride identified by the ssCMap as potential therapeutics for pulpitis reduced selected pulpitis biomarkers in an ex vivo pulpitis model. In vivo testing of these licenced drugs is warranted.

Tunable chitosan-calcium phosphate composites as cell-instructive dental pulp capping agents

Dental cavities are the most prevalent, preventable disease worldwide providing a need for robust treatment options to restore both the form and function of decaying teeth. Here is a presentation of a possible regenerative pulp capping agent that can serve to restore tooth function while regenerating healthy dentin tissue over a long period of time. To achieve this goal a material needs to crosslink quickly, be structurally rigid, and support the proliferation and differentiation of stem cells contained within the dental pulp. In this study, calcium phosphate nanoparticles were embedded in polymer hydrogels of carboxymethyl-chitosan and a diglycidyl ether. The particle size, surface, and mechanical properties of these materials were characterized. These composites have moduli up to 3 MPa, support the culture of dental pulp stem cells more than 3 weeks and exhibit osteogenic potential even without osteogenic media. These composites demonstrate a promising potential as the next generation of pulp capping materials.

The management of deep caries in UK primary care: A nationwide questionnaire-based study

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.

Conservative pulp therapy in the management of reversible and irreversible pulpitis

Conservative pulp therapy is an alternative treatment option to tooth removal and root canal treatment in the management of deep caries, traumatic pulp exposures and developmental anomalies. Pulp tissue preservation can extend the long-term survival of teeth through relatively simple restorative procedures. This article aims to update clinicians on the current state of research in materials, techniques and outcomes of vital pulp therapies and provide practical guidelines for their implementation into daily practice.

Evaluating the potential of an amelogenin-derived peptide in tertiary dentin formation

Several novel biomaterials have been developed for dental pulp capping by inducing tertiary dentin formation. The aim of this study was to evaluate the effect of QP5, an amelogenin-based peptide, on the mineralization of dental pulp cells (DPCs) in vitro and in vivo. The cell viability of human DPCs (hDPCs) after treatment with QP5 was determined using the Cell Counting Kit-8 (CCK-8). Migration of hDPCs was assessed using scratch assays, and the pro-mineralization effect was determined using alkaline phosphatase (ALP) staining, alizarin red staining and the expression of mineralization-related genes and proteins. The results showed that QP5 had little effect on the cell viability, and significantly enhanced the migration capability of hDPCs. QP5 promoted the formation of mineralized nodules, and upregulated the activity of ALP, the expression of mRNA and proteins of mineralization-related genes. A pulp capping model in rats was generated to investigate the biological effect of QP5. The results of micro-computed tomography and haematoxylin and eosin staining indicated that the formation of tertiary dentin in QP5-capping groups was more prominent than that in the negative control group. These results indicated the potential of QP5 as a pulp therapy agent.

Premixed bioceramics: A novel pulp capping agent

The main aim of restorative dentistry is to protect the vitality of the Pulp tissue. The pin point carious expoure and iatrogenic errors warrant the need for various pulp capping procedures like Indirect Pulp Capping and Direct Pulp Capping. Pulp Capping is dressing of the dental pulp exposed due to mechanical procedure, carious lesion or traumatic injury to preserve its vitality and function. There has been constant evolution and research on materials used to cap the Pulp tissue. The different kind of chemical and biological materials has been used with varying degree of success. The prognosis based on the pulp capping material has dramatically improved with the introduction of bioactive cement. Though MTA and biodentine have shown a high success rate, their properties can be adversely affected with error in powder/liquid ratio and may present with difficulty in the handling characteristic. Premixed bioceramics have been introduced in the market and present with desirable properties as a pulp capping agent. Owing to good handling characteristics, biocompatibility, odontogenic property, and antibacterial action it is a potent pulp capping agent for clinical application. This review is aimed to discuss the introduction of premixed bioceramics, forms of premixed bioceramics available, and its physical, chemical, and biocompatible properties.

EDTA Promotes the Mineralization of Dental Pulp In Vitro and In Vivo

INTRODUCTION

Dentin regeneration is one of the main goals of vital pulp treatment in which the biological properties of dental pulp cells (DPCs) need to be considered. In our previous study, we showed that EDTA could enhance the stromal cell-derived factor 1 alpha-induced migration of DPCs. The purpose of this study was to explore the effects of EDTA on the mineralization of dental pulp in vitro and in vivo.

METHODS

DPCs were obtained from human premolars or third molars. Alkaline phosphatase assays and alizarin red S staining were used to examine the degree of differentiation and mineralized nodule formation of DPCs. Real-time polymerase chain reaction and Western blot analysis were performed to detect the messenger RNA and protein expressions of mineralization-related markers in DPCs. Extracellular-regulated protein kinase and Smad inhibitors were used to study the roles of these 2 signaling pathways in this process. In addition, pulp exposures were created on 18 premolars of 2 beagle dogs (>12 months) using a high-speed dental handpiece. The experimental group (n = 9) was treated with 12% EDTA for 5 minutes, and the control group (n = 9) was treated with sterile saline for the same duration. Mineral trioxide aggregate was used for direct pulp capping followed by glass ionomer cement sealing. Samples were collected 3 months later, and the regenerated dentin was assessed by micro-computed tomographic and histologic analyses.

RESULTS

Exposure to 12% EDTA promoted the activity of alkaline phosphatase, the formation of mineralized nodules, and the messenger RNA and protein expressions of mineralization-related markers in DPCs. Furthermore, the process of 12% EDTA enhancing the differentiation of DPCs was mediated by the extracellular-regulated protein kinase 1/2 signaling pathway and inhibited by the Smad2/3 signaling pathway. In vivo, compared with the control group, more regenerated dentin that had fewer tunnel defects was formed in the 12% EDTA-treated group.

CONCLUSIONS

Our results showed that 12% EDTA could promote the mineralization of dental pulp in vitro and in vivo.

Comparative evaluation of pulpal repair after direct pulp capping using stem cell therapy and biodentine: An animal study

The response of the dentin-pulp complex in rat teeth was investigated after direct capping with biodentine with or without bone marrow-derived stem cells (BMDSCs). Following mechanical exposure, pulps were randomly capped with one of the followings materials: calcium hydroxide, biodentine or 1 × 10⁵ BMDSCs mL^-1 + biodentine. Histological examination was performed by light microscopy after 1, 3 and 5 weeks. Inflammatory reaction, necrotic tissue formation and calcific bridge formation were scored. Analysis showed that compared with the effects of calcium hydroxide or biodentine, BMDSCs + biodentine substantially reduced inflammatory reaction and necrotic tissue while promoting calcified tissue formation. Therefore, the combination of biodentine and BMDSCs could potentially stimulate pulp tissue regeneration after direct pulp capping.

Efficacy of calcium hydroxide and resin-modified calcium silicate as pulp-capping materials: a retrospective study

The aim of this study was to compare the clinical success rates of light-cured, resin-modified calcium silicate (TheraCal LC) and calcium hydroxide (Dycal) as pulp-capping materials in permanent teeth. In this retrospective electronic record review of patients treated in the years 2012 through 2015, the postoperative data of 120 patients (n = 60 per material) were collected. In these 2 groups, 69 teeth were treated with calcium hydroxide (29 in men, 40 in women) and 79 with calcium silicate (37 in men, 42 in women). The following data were recorded: treated tooth; patient age and sex; reason for treatment; direct or indirect pulp cap; date of treatment; date of most recent dental appointment; and treatment outcome. The selected patients met the following inclusion criteria: They had received either a direct or an indirect pulp cap in an anterior or posterior tooth after excavation of deep caries as part of a routine restorative procedure using either amalgam or composite resin; and they had returned to the clinic for other dental care at least 3 months after the pulp-capping treatment. Patients were excluded from the study if they reported symptoms of irreversible pulpitis or chronic tooth pain before the restorative treatment was started. The treatment outcome was considered clinically successful if the tooth was still present and asymptomatic at the appointments following the procedure. The outcome was considered unsuccessful if the tooth was extracted due to symptoms or if endodontic treatment had been performed postoperatively. There was no statistically significant difference between the clinical success rates of calcium silicate (85.5%) and calcium hydroxide (84.8%), according to the Fisher exact test (P < 0.05). Neither the patient's sex nor the tooth location affected the outcome. Within the limitations of this retrospective clinical study, it may be concluded that TheraCal LC calcium silicate can be considered equivalent inefficacy to calcium hydroxide for both direct and indirect pulp capping. A prospective clinical study with a larger sample size is needed to confirm these findings.

Scientometric analysis of vital pulp therapy studies

AIM

To present a scientometric analysis of the entire body of scientific publications in the field of vital pulp therapy (VPT) and analyse the research trends and popular topics.

METHODOLOGY

A comprehensive literature search was conducted in the Web of Science and Scopus databases on 21 August 2020 to identify all articles related to VPT. The publications were reviewed and basic research parameters were collected, including publication year, patterns of authorship, geographical distribution of scientific productions, journals, h-index, study design and keyword analysis. Web of Science, Scopus and Google Scholar databases were used for the citation analysis of the ten top cited articles. The data were analysed using VOSviewer and visualized by tables and diagrams.

RESULTS

In total, 1197 VPT-associated items were identified from 64 countries in 176 journals. The majority of papers were published in the Journal of Endodontics. The United States of America was the leading country for number of publications, citations, h-index and collaborations. The distribution of articles based on study design was as follows: basic science (35%), clinical (27%), observational studies (26%) and review publications (12%). The most frequently occurring keywords were pulpotomy, mineral trioxide aggregate, calcium hydroxide and direct pulp capping.

CONCLUSIONS

This scientometric analysis outlines the evolutionary trends and the productivity of researchers and countries in the field of vital pulp therapy. Research output is dominated by basic science articles involving innovative materials published in high impact factor dental journals.

The management of deep carious lesions and the exposed pulp amongst members of two European endodontic societies: a questionnaire-based study

AIMS

To investigate and compare views on management of deep caries and the exposed pulp by Endodontic Society members in Ireland (Irish Endodontic Society [IES]) and Italy (Accademia Italiana di Endodonzia [AIE]). Further aims were to investigate the influence of patient-related factors (age, symptoms) and operator-related factors (material choice, antibiotics) on management.

METHODOLOGY

A structured online questionnaire containing two cases (an 18- and 45-year-old) and two scenarios (± mild symptoms), including history and radiograph, was sent to IES and AIE members. The answers were analysed using chi-square and Fisher's exact test (P < 0.05).

RESULTS

In total, 120 dentists participated, representing 49% of the AIE and 48% of the IES membership. Age distribution was similar between the societies; however, most AIE members had no further qualifications (63%), while IES respondents generally had a postgraduate endodontic qualification (71%). AIE respondents carried out a larger volume of vital pulp treatment (VPT) per month, with 69% carrying out over five cases, compared with 22% of IES respondents. The presence of patient symptoms significantly altered treatment planning decisions (P < 0.001) with root canal treatment (RCT) more frequently selected in both societies. Patient age significantly influenced treatment choice in the absence (P = 0.043) or presence (P = 0.012) of symptoms with less VPT advocated in older patients. There were no significant differences in the treatment of a young patient in the presence (P = 0.302) or absence of symptoms (P = 0.297); however, older patient management differed between the societies for symptomatic (P = 0.041) and asymptomatic scenarios (P = 0.044) with significantly more RCTs carried out in the AIE than the IES. Hydraulic calcium silicate materials were commonly selected, accounting for 81% of IES and 69% of AIE VPT materials, although younger members of the AIE preferred calcium hydroxide materials. Younger dentists in both societies prescribed less RCT than older age groups.

CONCLUSIONS

Although VPT is carried out by members of both societies there was no consistency regarding the most appropriate management for the exposed pulp or the VPT material of choice. Patient symptoms and age significantly influence the decision-making process and invasiveness of treatment. Hydraulic calcium silicate materials were the most commonly advocated material in all groups except young AIE members who preferred calcium hydroxide.

Mineral Trioxide Aggregate Applications in Endodontics: A Review

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.

Material Pulp Cells and Tissue Interactions

Two increasingly common endodontic procedures, vital pulp therapy (VPT) and regenerative endodontic procedures, rely on dental tissue regeneration/repair mechanisms with the aid of biomaterials. These materials are applied in close contact to the pulpal tissue and are required to be biocompatible, form an antimicrobial seal, not induce staining, and be easy to manipulate. Historically, calcium hydroxide played an important role in VPT. However, over the last 3 decades, significant efforts in research and industry have been made to develop various biomaterials, including hydraulic tricalcium silicate cements. The present review summarized various hydraulic tricalcium silicate cements and their biological properties in clinical procedures, namely VPT and regenerative endodontic procedures.

In vivo Study of Sealing Capability of Raw Propolis Extract and Calcium Hydroxide on Dentin Surface

Aim

This research aimed to investigate the differences in the sealing capability of propolis extracts and Ca(OH)₂ on dentin surfaces.

Materials and Methods

Eighteen mandible incisors of Wistar rats were prepared at a depth of 0.5 mm after which they were randomly divided into 3 groups (n=6) including control (C), pulp-capped with Ca(OH)₂ group (P1), and indirect pulp-capped with propolis extract group (P2). All the cavities were sealed with glass ionomer restorative cement. Moreover, the sections of the teeth were obtained after six Wistar Rats from each group were sacrificed on the second day after treatment. The rats’ incisors were cleaved transversally to the area where Ca(OH)₂ and propolis extract bonded with dentin for the SEM (scanning electron microscope) analysis and examined using microphotographs test with 5000x magnification. All the samples were measured and examined with spectrophotometry test to determine the bonding distance between Ca(OH)₂ and dentin, as well as propolis extract and dentin. The result from the two tests was analyzed with SPSS using an independent t-test at p <0.05.

Results

There were significant differences between the calcium hydroxide and propolis extract groups (p<0.05) based on the results obtained in the form of spectrums chemical functional groups of spectrophotometry examination. No new chemical bonding or compound was also observed to have been formed between propolis extract with dentin as well as calcium hydroxide with dentin.

Conclusion

The adaptation or sealing capability of propolis extract was found to be better than calcium hydroxide to the dentin surface.

To Compare Mineral Trioxide Aggregate, Platelet-rich Fibrin, and Calcium Hydroxide in Teeth with Irreversible Pulpitis: A Clinical Study

Aim:

Numerous pulp-capping agents such as mineral trioxide aggregate (MTA), calcium hydroxide (Ca(OH)₂), platelet-rich fibrin (PRF), and biodentine have been suggested. This clinical study was conducted to compare MTA, PRF, and Ca(OH)₂ in teeth with irreversible pulpitis.

Materials and Methods:

The 60 mandibular molar teeth with irreversible pulpitis were used in this study, which were restored with Ca(OH)₂, MTA, and PRF. Assessments of the treatment were carried out at 6 months and 1 year by clinical examination and also radiographically.

Results:

A nonsignificant difference was observed in pain intensity recorded at numerical rating scale at baseline, 24h, 1 week, 1 month, 3 months, 6 months, and 1 year. A nonsignificant (P > 0.05) difference was reported in clinical and radiographic success rate recorded at 6 months and 1 year in all groups.

Conclusion:

Pulp-capping agents such as Ca(OH)₂, MTA, and PRF yielded similar success rate when used in teeth with irreversible pulpitis.

Influence of resveratrol application with pulp-capping materials on the genetic expression levels of stem cells

AIM

To evaluate in a laboratory setting the response of human mesenchymal stem cells (MSCs) to pulp-capping materials with and without resveratrol (RSV).

METHODOLOGY

Five materials, Calcimol LC, Life, TheraCal LC, ProRoot MTA and Biodentine, were prepared according to the manufacturers' instructions. Human MSCs were then exposed to these materials, with and without RSV, for 24 h (n = 8). Cell viability was evaluated using the MTT assay, and total cell death was quantified by annexin V-FITC staining with flow cytometry. The expression levels of the IL-8, IL-10, HBD-2 and BCL-2 genes were investigated using real-time polymerase chain reaction (RT-PCR). Data obtained from MTT test were analysed using one-way anova, and Tukey's multiple-comparison test. The paired Student t test was employed to compare the effects of materials on gene expression (significance level of 5%).

RESULTS

The group cell viabilities were Calcimol LC 53%, Life 43%, TheraCal LC 78%, ProRoot MTA 75% and Biodentine 78%. Calcimol LC and Life exhibited significant differences compared with the control groups (P < 0.05). The percentages of necrotic/late apoptotic cells associated with Calcimol LC and TheraCal LC were greater than in the other materials. However, when RSV was added to wells containing materials, cell viability increased to Calcimol LC 63%, Life 52%, TheraCal LC 82%, ProRoot MTA 91% and Biodentine 96%, and the percentages of early apoptotic and late apoptotic/necrotic cells decreased. Calcimol LC + RSV and Life + RSV differed significantly from the control group (P < 0.05). The expression of IL-8 gene was high for all materials, ProRoot MTA caused significant overexpression, and the addition of RSV reduced the expression of IL-8 in the Calcimol LC, TheraCal LC and ProRoot MTA groups and led to increased expression of IL-10 in the Calcimol LC, Life and Biodentine groups. HBD-2 and BCL-2 exhibited increased expression in ProRoot MTA with RSV (P < 0.05).

CONCLUSIONS

The addition of RSV exerted a protective effect on MSCs and regulated the inflammatory process by altering the expression levels of pro- and anti-inflammatory genes.

Evaluation of Resin-Based Material Containing Copaiba Oleoresin (Copaifera Reticulata Ducke): Biological Effects on the Human Dental Pulp Stem Cells

The purpose of this study was to analyze in vitro the biological effects on human dental pulp stem cells triggered in response to substances leached or dissolved from two experimental cements for dental pulp capping. The experimental materials, based on extracts from Copaifera reticulata Ducke (COP), were compared to calcium hydroxide [Ca(OH)₂] and mineral trioxide aggregate (MTA), materials commonly used for direct dental pulp capping in restorative dentistry. For this, human dental pulp stem cells were exposed to COP associated or not with Ca(OH)₂ or MTA. Cell cytocompatibility, migration, and differentiation (mineralized nodule formation (Alizarin red assay) and gene expression (RT-qPCR) of OCN, DSPP, and HSP-27 (genes regulated in biomineralization events)) were evaluated. The results showed that the association of COP reduced the cytotoxicity of Ca(OH)₂. Upregulations of the OCN, DSPP, and HSP-27 genes were observed in response to the association of COP to MTA, and the DSPP and HSP-27 genes were upregulated in the Ca(OH)₂ + COP group. In up to 24 h, cell migration was significantly enhanced in the MTA + COP and Ca(OH)₂ + COP groups. In conclusion, the combination of COP with the currently used materials for dental pulp capping [Ca(OH₎₂ and MTA] improved the cell activities related to pulp repair (i.e., cytocompatibility, differentiation, mineralization, and migration) including a protective effect against the cytotoxicity of Ca(OH)₂.

Performance of a Biodegradable Composite with Hydroxyapatite as a Scaffold in Pulp Tissue Repair

Vital pulp therapy is an important endodontic treatment. Strategies using growth factors and biological molecules are effective in developing pulp capping materials based on wound healing by the dentin-pulp complex. Our group developed biodegradable viscoelastic polymer materials for tissue-engineered medical devices. The polymer contents help overcome the poor fracture toughness of hydroxyapatite (HAp)-facilitated osteogenic differentiation of pulp cells. However, the composition of this novel polymer remained unclear. This study evaluated a novel polymer composite, P(CL-co-DLLA) and HAp, as a direct pulp capping carrier for biological molecules. The biocompatibility of the novel polymer composite was evaluated by determining the cytotoxicity and proliferation of human dental stem cells in vitro. The novel polymer composite with BMP-2, which reportedly induced tertiary dentin, was tested as a direct pulp capping material in a rat model. Cytotoxicity and proliferation assays revealed that the biocompatibility of the novel polymer composite was similar to that of the control. The novel polymer composite with BMP-2-induced tertiary dentin, similar to hydraulic calcium-silicate cement, in the direct pulp capping model. The BMP-2 composite upregulated wound healing-related gene expression compared to the novel polymer composite alone. Therefore, we suggest that novel polymer composites could be effective carriers for pulp capping.

The cytotoxicity test of calcium hydroxide, propolis, and calcium hydroxide-propolis combination in human pulp fibroblast

Calcium hydroxide (Ca(OH)₂) is the gold standard material used for pulp-capping but still has a high failure rate. Thus, an alternative material is needed, one of which is propolis. The combination of Ca(OH)₂propolis is expected to have better quality and to be biocompatible. The aim of this study is to investigate the viability of human pulp fibroblast after the administration of Ca(OH)₂, propolis, and its combination. Human pulp fibroblast culture derived from premolar teeth of 16-year-old patients, were divided into seven groups: Group 1 (10 μg Ca(OH)₂); Group 2 (10 μg propolis); Group 3 (15 μg propolis); Group 4 (20 μg propolis); Group 5 (Ca(OH)₂-propolis 1:1); Group 6 (Ca(OH)₂-propolis 1:1.5); and Group 7 (calcium hydroxide-propolis 1:2). They were placed in a 96 wells plate and put into incubator for 24 h. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide test was conducted to calculate the viability of human pulp fibroblasts. The data were analyzed statistically using Kolmogorov-Smirnov, Levene's test, one-way analysis of variance, and Tukey-honestly significant difference (P < 0.05). The number of living human pulp fibroblast after the administration of Ca(OH)₂and propolis combination is greater than the application of Ca(OH)₂or propolis with significant different between groups (P < 0.05). The viability of human pulp fibroblasts after the administration of Ca(OH)₂-propolis combination is greater than that of the application of Ca(OH)₂and propolis alone.

Dentin Bonding of TheraCal LC Calcium Silicate Containing an Acidic Monomer: An In Vitro Study

The purpose of this study was to evaluate whether the incorporation of an acidic monomer into the pulp-capping material TheraCal LC, which has a weak dentin bonding, increases the shear bond strength (SBS) to dentin. Di-2-hydroxyethyl methacryl hydrogenphosphate was incorporated into the material at 0.0 (TL0, control), 5.0 (TL5), and 10.0 (TL10) wt%. The water contact angle (CA) and mechanical properties for each material were also studied (n = 6). Debonding was performed at two different times (immediate and after 24 h) (n = 12). Hydroxyl and calcium ion releases in water at 37 °C were monitored up to 28 days (n = 6). The addition of the acidic monomer decreased the CAs (p < 0.001) and increased the flexural moduli (p < 0.001). The debonding time did not significantly affect the SBS values (p = 0.600). The TL10 group exhibited the highest SBS values, followed by the TL5 group. The TL10 group released significantly more calcium ions than the other two groups from 3 days (p < 0.05). The incorporation of the acidic monomer at 10.0 wt% into TheraCal LC enhanced bonding to dentin, while not negatively affecting the mechanical properties and ion-leaching capacity of the material.