Deep occlusal carious lesions clinical management by Brazilian dentists: a nationwide e-survey / Manejo clínico de lesões cariosas oclusais profundas por cirurgiões-dentistas brasileiros: uma pesquisa eletrônica nacional

Objective: To investigate the clinical management of deep occlusal carious lesions in permanent teeth by Brazilian dentists. Material and Methods: This cross-sectional study included a sample of 732 Brazilian dentists who responded to an electronic questionnaire composed of 20 questions addressing socio-demographic information, training and professional activity characteristics, and clinical management of deep carious lesions. Descriptive analysis was performed, considering relative and absolute frequencies and 95% confidence intervals. The association between the dentists' variables of interest (age group, type of higher education institution, years in practice, highest academic degree completed and main sector of professional activity) and the mean number of incorrect answers regarding deep carious lesions management was analyzed by Analysis of Variance (ANOVA), followed by the Bonferroni post-test (p<0.005). Results: Stepwise removal was the strategy pointed out by most dentists (42.8%). However, 16% of the dentists selected nonselective carious tissue removal. Furthermore, 45.6% of the dentists disagreed with maintaining carious tissue over the pulp in deep lesions with a risk of pulpal exposure. When using instruments to remove carious dentine, 17% of the dentists chose a diamond burn while 13% preferred tungsten carbide burs. Dentists who graduated from public institutions had a lower mean of non-conservative decisions than those from private institutions. Dentists with master's or doctoral degrees were more conservative, as well as dentists from public service compared to those from the private sector. Conclusion: The dissemination of conservative approaches in the management of deep carious lesions needs to be strengthened and increasingly based on updated scientific literature.(AU)

Objetivo: Investigar o manejo clínico de lesões cariosas oclusais profundas em dentes permanentes por cirurgiões-dentistas brasileiros. Material e Métodos: Este estudo transversal incluiu uma amostra de 732 dentistas brasileiros que responderam a um questionário eletrônico composto por 20 questões abordando informações sociodemográficas, formação, características da atividade profissional e manejo clínico de lesões cariosas profundas. Foi realizada análise descritiva, considerando frequências relativas e absolutas, e intervalos de confiança de 95%. A associação entre as variáveis de interesse (faixa etária, tipo de instituição de ensino superior, anos de prática, maior titulação acadêmica concluída e principal setor de atividade profissional) dos cirurgiões-dentistas e a média de acertos no manejo de lesões cariosas profundas foi analisada pela Análise de Variância (ANOVA), seguida do pós-teste de Bonferroni (p<0,005). Resultados: A remoção seletiva foi a estratégia apontada pela maioria dos cirurgiões-dentistas (42,8%). No entanto, 16% dos dentistas selecionaram a remoção não seletiva do tecido cariado. Além disso, 45,6% dos dentistas discordaram da manutenção de tecido cariado sobre a polpa em lesões profundas com risco de exposição pulpar. Ao usar instrumentos para remover a dentina cariada, 17% dos dentistas escolheram uma broca diamantada, enquanto 13% preferiram brocas de carboneto de tungstênio. Cirurgiões-dentistas formados em instituições públicas apresentaram menor média de decisões não conservadoras do que os de instituições privadas. Os cirurgiões-dentistas com mestrado ou doutorado foram mais conservadores, assim como os cirurgiões-dentistas do serviço público em relação aos do setor privado. Conclusão: A disseminação de abordagens conservadoras no manejo de lesões cariosas profundas precisa ser fortalecida e cada vez mais baseada em literatura científica atualizada (AU)

Response of dental pulp capped with calcium-silicate based material, calcium hydroxide and adhesive resin in rabbit teeth

Direct pulp capping induces a local inflammatory process. Several biomaterials have been used for this procedure. The aim of this study was to compare the dentinal bridge thickness using three different pulp capping biomaterials with the conventional technique (high speed diamond bur) or Er-Yag laser, 1 month after pulp effraction. Materials and Methods: Forty two Class V cavities were prepared on the buccal surface of 4 maxillary incisors and 2 mandibular incisors of New Zealand rabbits. Specimens were divided into 6 treatment groups. Teeth were treated with: In Group 1: Er-Yag laser and Biodentine® (Septodont), in Group 2: Er: Yag laser and calcium hydroxide (Dycal® Dentsply), in Group 3: Er: Yag laser and adhesive system (Prime& Bond® NT Dentsply), in Group 4: high speed diamond bur and Biodentine® (Septodont), in Group 5: high speed diamond bur and calcium hydroxide (Dycal® Dentsply), and in Group 6: high speed diamond bur and adhesive system (Prime& Bond® NT Dentsply). The preparation was done with copious irrigation. The animals were sacrificed at 30 days and the teeth were extracted and prepared for histological analysis. Results: In the group of « laser Er-Yag ¼, iatrogenic pulpal wounds treated with Biodentine® were covered with a thick hard tissue barrier after 1 month. The difference was not significant with the groups of Dycal® used with Er: Yag laser and high speed diamond bur. Prime& Bond® NT Dentsply specimens showed a thin dentinal bridge layer. Conclusion: At 1 month, Er-Yag laser proved to be useful with Biodentine® for direct pulp capping procedures

Cementos a base de silicato de calcio: factor clave en el éxito del recubrimiento pulpar directo. Revisión de la literatura / Calcium silicate based cements: key factor in the success of direct pulp capping. Literature review

RESUMEN Tradicionalmente, el hidróxido de calcio (HC) era considerado el material de elección para el recubrimiento pulpar directo (RPD); pero esto ha cambiado con los años debido a las distintas desventajas que presenta. Los cementos a base de silicato de calcio (CSC) tienen propiedades ventajosas al compararlos con el HC como: bioactividad, biocompatibilidad, menor tiempo de fraguado, capacidad de sellado y resistencia, por lo que son usados en una variedad de procedimientos endodónticos, entre ellos el RPD. El presente artículo de revisión recopila información a partir de la búsqueda manual de artículos originales de investigación científica y revisiones de literatura de la base de datos de Medline/PubMed. Se describen las variedades de CSC, su mecanismo de acción, desventajas, factores relacionados y tasas de éxito clínico en su aplicación en casos de RPD.

ABSTRACT Traditionally, calcium hydroxide (HC) was considered the material of choice for direct pulp capping (RPD); but this has changed over the years due to the various disadvantages it presents. Calcium silicate-based cements (CSC) have properties that are advantageous to HC such as: bioactivity, biocompatibility, shorter setting time, sealing capacity and resistance, which they are used in a variety of endodontic procedures, including RPD.This review article compiles information from the manual search of original scientific research articles and literature reviews of the Medline / PubMed database. The varieties of CSC, their mechanism of action, disadvantages, related factors and rates of clinical success in their application in cases of RPD are described.

Experimental resin-based dual-cured calcium aluminate and calcium titanate materials for vital pulp therapy

Abstract: This paper evaluates the physicochemical and biological properties of experimental resin-based dual-cured calcium aluminate (CA) and calcium titanate (CTi) materials for vital pulp therapy (VPT). The experimental dual-cured materials were obtained as two pastes: a) Bis-EMA 10, PEG 400, DHEPT, EDAB, camphorquinone, and butylated hydroxytoluene; and b) fluoride ytterbium, Bis-EMA 10, Bis-EMA 30, benzoyl peroxide, and butylated hydroxytoluene. The materials were divided into six groups based on the added calcium component: MTA (MTA®, Angelus); CLQ (Clinker-Fillapex®, Angelus); CA (calcined at ,1200°C in pastes a and b); CA800 (calcined at 800°C in paste a); CA1200 (calcined at 1,200°C in paste a); and CTi (paste a). The real-time degree of conversion and rate of polymerization (n = 3), diametral tensile strength (n = 10), hydrogen potential (n = 15), calcium ion release (n = 10), water sorption and solubility (n = 10), and cell viability (n = 6) were evaluated. One- and two-way ANOVA and Tukey's post hoc test were used in the analysis of the parametric data, and Kruskal-Wallis and Dunn's multiple tests were used to analyze the nonparametric data (α = 0.05). CLQ, CA800 and CA1200 had the highest diametral tensile strength. The water solubility of MTA was similar to that of CA800, CA1200 and CTi. CA800 and CA1200 resulted in cell viabilities similar to those of MTA and CLQ. The experimental dual-cured CA-based material that calcined at 800°C showed physicochemical and biological properties suitable for VPT, and similar to those of MTA.

Pulp vitality of primary molars with deep caries treated with ART restorations: 2-year RCT

Abstract: The aim of this study was to compare the pulp vitality of primary teeth with deep caries treated with two restorative techniques. The restoration survival rate was also evaluated as a secondary outcome. Children aged from 4 to 8 years with at least one deep carious lesion in molars were selected at the Ibirapuera University dental clinic. One hundred and eight deciduous molars were allocated into two groups: (1) restoration with calcium hydroxide cement lining followed by filling with high-viscosity glass ionomer cement (CHC+HVGIC) or (2) restoration with HVGIC. Pulp vitality and restoration survival were evaluated at 6, 12, and 24 months. Intent-to-treat analysis was used for pulp vitality, and survival analysis was performed with the Kaplan-Meier method (α=5%). Results: At 24 months, 86 restorations were evaluated, and 91 were evaluated at least once during the study. There was no significant difference between the restorative treatments regarding pulp vitality (CHC +HVGIC=70% and HVGIC=68.5%) (OR=1.091; CI95%=0.481-2.475). However, HVGIC (73%) restorations showed a higher survival rate than CHC+HVGIC (50%) (p=0.021). Thus, it can conclude that deep caries in primary molars should be restored with HVGIC, since the technique results in similar pulp vitality to the CHC +HVGIC, but with a higher restoration survival rate.

Decision-making for dental pulp exposure: a survey in graduate programs at Brazilian universities

Abstract Clinical decision-making tends to be based on what clinicians have been taught during undergraduate and graduate programs. The aim of the present study was to assess the clinical approach and to identify the factors that influence the decision-making for dental pulp exposure among graduate students and coordinating professors in endodontics programs offered at Brazilian universities. The study used a mail-out survey developed in the Qualtrics platform, based on seven clinical reports in which dental pulp exposure was evidenced. Descriptive statistics showing vital pulp therapy (VPT) and root canal treatment (RCT) were calculated for each clinical report. Data on the participants' (n = 113) profile and variables related to clinical and radiographic characteristics of the cases were evaluated as to their potential to affect decision-making and analyzed by logistic regression (p < 0.05). VPT was likely to be indicated in cases of patients with immature teeth (OR = 0.017; 95%CI = 0.004 -0.073). RCT indications were related to the presence of symptoms (OR = 5.326; 95%CI = 1.429-19.852) and old age (OR = 21.057; 95%CI=6.809-65.120). In pulp exposure secondary to trauma, time of pulp exposure was significantly associated with RCT indication (OR=3.267; 95%CI=1.332-8.012). The present study demonstrated that patient age, root development, and symptom features were the main factors affecting participants' decision-making.

Investigation of a modified hydraulic calcium silicate-based material - Bio-C Pulpo

Abstract This study evaluated the physicochemical, biological, and antimicrobial properties of a new hydraulic calcium silicate-based modified material, and compared it with MTA Repair HP and MTA Angelus. The materials were assessed regarding color luminosity (L), color change, radiopacity, setting time, and ISO 6876:2012 linear flow. Volumetric filling and volume change were evaluated using microcomputed-tomography (µCT). Chemical characterization after 28 days in Hank's Balanced Salt Solution (HBSS) and pH analysis were also assessed. Biological characterization of cytotoxicity and microbiological assessment were also undertaken. Shapiro-Wilk, ANOVA, Levene and post hoc analyses with Bonferroni correction were performed, adopting a 5% significance level (p <0.05). Bio-C Pulpo exhibited the highest L values after 90 days. All tested materials demonstrated color change during the analyses, and had radiopacity above 5 mm Al. MTA Repair HP set faster than Bio-C Pulpo, whereas the latter had the highest linear flow. MTA Repair HP had the highest volumetric filling in µCT analysis. Bio-C Pulpo showed the highest alkalinity during all tested periods, and the highest volumetric loss (above 9%), in comparison with MTA Repair HP and MTA Angelus. Bio-C Pulpo did not form calcium hydroxide after hydration. MTA Repair HP demonstrated the highest cytocompatibility, and Bio-C Pulpo, the highest cytotoxicity. No inhibition halos were observed for any material, and similar higher turbidity values were seen after direct contact. Composition additives used in Bio-C Pulpo modified its properties, and both the absence of calcium hydroxide deposition after hydration, and the related cytotoxicity of this material are of particular concern.

Pulp capping with mineral trioxide aggregate or Biodentine: a comparison of mineralized barrier formation and inflammatory and degenerative events

Abstract: Biodentine in endodontic practice has been widely investigated, but comprehensive histological descriptions of degenerative and inflammatory responses are not covered in most of the studies that compare pulp capping materials. This study aimed to evaluate pulpal responses to mineral trioxide aggregate (MTA Angelus) and Biodentine, focusing on mineralized barrier formation and on inflammatory and degenerative events. 80 male Wistar rats were assigned to 5 groups, according to the materials used for pulp capping and coronal sealing (n=8 per group/period). The lower first molars were mechanically exposed, capped with either MTA or Biodentine, and restored with silver amalgam. In an additional test group, the teeth were capped and sealed with Biodentine. The teeth capped with gutta-percha and restored with silver amalgam served as positive control, whereas untreated teeth served as negative control. Pulpal responses and coronal sealing were evaluated after 14 or 21 days. Data was statistically analyzed by the Kruskal-Wallis and Dunn's post hoc tests (p<0.05). Biodentine and MTA presented satisfactory results, showing a milder inflammatory response (p<0.0001) and more pronounced formation of mineralized barrier (p<0.0001) compared to the teeth capped with gutta-percha. As a restorative material, Biodentine kept coronal sealing in only 37.5% of the samples. Biodentine showed favorable properties in vital pulp therapy, being similar to MTA. However, it was not effective in protecting dental pulp from microleakage during the experimental period.

Selective carious tissue removal and glass ionomer liner reduction of pulp stress in bulk fill resin composite restorations

Abstract: To evaluate the effect of selective or nonselective carious tissue removal and the use of a resin-modified glass ionomer (RMGIC) liner under bulk fill resin composite restoration on the stress at the pulp chamber, the elastic moduli of hard, firm, soft and intact dentin were calculated using nanoindentation. Post-gel shrinkage of the bulk fill resin composite and RMGIC were determined using the strain-gauge method. Six finite element models were created by using digital radiography with the combination of two study factors: a) carious tissue removal: selective removal or nonselective removal of carious tissue, and b) use of RMGIC liner: with or without 1.0 mm of RMGIC liner. The modified von Mises stresses (mvm) (MPa) were extracted on the nodes of the internal wall of the pulp ceiling chamber at 100 N occlusal loading. Data were analyzed descriptively and recorded quantitively. Both study factors influenced the stress distribution. The mvm stress during the restorative procedure was higher for nonselective carious tissue removal without RMGIC (25.9 MPa) and lower for selective carious tissue removal associated with RMGIC (13.5 MPa). The dentin elastic modulus increased from soft carious (3.6 ± 0.3 MPa) to firm carious (5.2 ± 1.0 MPa) to hard carious (10.9 ± 1.2 MPa) to intact dentin (22.7 ± 3.0 MPa). Molars with carious lesions showed high mvm stress at the pulp ceiling (89.6 MPa) and at fragilized coronal structure remaining. Selective carious tissue removal followed by restoration using a Vitrebond liner and Tetric N-Ceram Bulk fill reduced the stress at the pulp chamber ceiling.

Expression of Matrix Metalloproteinases-8 and Myeloperoxidase in Pulp Tissue after Pulpotomy with Calcium Silicate Cements

ABSTRACT Objective: To evaluate the pulp tissue of rat molars after pulpotomies with mineral trioxide aggregate (MTA), BiodentineTM (BDT) and calcium hydroxide (CH) mixed with sterile saline solution (24 hours, 72 hours, 7 days and 15 days), through correlating MPO activity with active neutrophils and MMP8 activity with tissue remodeling. Material and Methods: Thirty-eight Wistar rats were randomly distributed into groups (control, I (MTA gray), II (BDT), and III (CH)) and subdivided according to the study period of 24 hours, 72 hours, 7 days or 15 days after pulpotomy. MMP8 activity was assessed through fluorescence technique, and MPO activity was determined using the MPO assay. Results: A gradual decrease of MPO and MM8 activity occurred in the group MTA over the experimental periods (p<0.05). Groups BDT and CH exhibited an increase in the activity at 7 and 15 days (p<0.05). Conclusion: MTA demonstrated a decrease in the values of MPO e MMP8. BDT and CH showed high neutrophilic and collagenase activity over the experimental periods.

Biodentine: ¿sustituto de la dentina? / Biodentine: a dentine substitute?

RESUMEN La biodentine es un biomaterial a base de silicato de calcio que ha sido concebido como un sustituto de la dentina. Es frecuentemente utilizada en diversas situaciones clínicas, como el recubrimiento pulpar (directo e indirecto), la pulpotomía, perforaciones endodónticas, apexificación, entre otras. El objetivo de esta revisión es proporcionar un análisis detallado de las propiedades fisicoquímicas, biológicas y las principales aplicaciones clínicas de la biodentine. Se realizó una búsqueda electrónica de literatura en las bases de datos Medline (Pubmed), EBS-CO-Host y Science direct (Elsevier) hasta julio de 2020. El 92 % de los artículos referenciados en esta revisión fueron seleccionados a través de esta búsqueda. Los resultados indican que la biodentine es un cemento de uso odontológico con excelentes propiedades que se caracteriza por una manipulación relativamente fácil, bajo costo, alta resistencia a la compresión y flexión, alta biocompatibilidad y una excelente bioactividad. En conclusión, la biodentine es un material recomendado en el tratamiento de diversas situaciones clínicas de la práctica odontológica dadas sus características fisicoquímicas y biológicas. Sin embargo, se hace necesario ensayos clínicos controlados aleatorizados que permitan determinar y confirmar que la biodentine es realmente un material odontológico capaz de reemplazar la dentina.

ABSTRACT Biodentine is a calcium silicate-based biomaterial that has been conceived as a substitute for dentin. It is frequently used in various clinical situations such as pulp lining (direct and indirect), pulpotomy, endodontic perforations, apexification, among others. The objective of this review is to provide a detailed analysis of the physical-chemical, biological properties and the main clinical applications of biodentine. An electronic literature search was carried out in the databases Medline (Pubmed), EBSCO-Host and Science direct (Elsevier) until July 2020. 92 % of the articles referenced in this review were selected through this search. The results indicate that biodentine is a cement for dental use with excellent properties characterized by relatively easy handling, low cost, high compressive and flexural strength, high biocompatibility and excellent bioactivity. In conclusion, biodentine is a recommended material in the treatment of various clinical situations in dental practice given its physicochemical and biological characteristics. However, randomized controlled clinical trials are necessary to determine and confirm that biodentine is indeed a dental material capable of replacing dentin.

Effect of preheating on cytotoxicity and physicochemical properties of light-cured calcium-based cements / Efeito do pré-aquecimento na citotoxicidade e propriedades físico-químicas de cimentos à base de cálcio fotopolimerizáveis

ABSTRACT The aim of this study was to evaluate the degree of conversion, cytotoxicity, solubility and pH of photopolymerizable calciumbased cements submitted to preheating. The degree of conversion was analyzed by Fourier transform infrared, cytotoxicity by the MTT test and solubility through loss of mass. The data were subjected to statistical tests (ANOVA / Tukey's, p<0.05). The photopolymerizable materials showed a low degree of conversion, regardless of preheating. All materials caused a reduction in cell viability at 24 hours and 7 days, with the Dycal (control) being more cytotoxic. Heat had a positive effect on Biocal at 7 days. Dycal is the most soluble material. Heat had no effect on the solubility or pH of the polymerizable materials. It is concluded that photopolymerizable calcium-based cements have a low degree of conversion and are soluble, which results in mild to moderate cytotoxicity.

RESUMO O objetivo do presente estudo foi avaliar o grau de conversão, citotoxicidade, solubilidade e pH de cimentos à base de cálcio fotopolimerizáveis submetidos a pré-aquecimento. O grau de conversão foi analisado por espectroscopia no infravermelho com transformada de Fourier, a citotoxicidade pelo teste de MTT e a solubilidade através da perda de massa. Os dados foram submetidos a testes estatísticos (ANOVA/Tukey, p<0,05). Os materiais fotopolimerizáveis apresentaram baixo grau de conversão, independente do pré-aquecimento. Todos os materiais causaram redução da viabilidade celular nas análises de 24 horas e 7 dias, sendo que o Dycal (controle) apresentouse mais citotóxico e o calor apresentou efeito positivo sobre o Biocal na análise de 7 dias. O Dycal é o material mais solúvel e o calor não causou efeito na solubilidade e pH dos materiais polimerizáveis. Assim, conclui-se que os cimentos à base de cálcio fotopolimerizáveis apresentam baixo grau de conversão e são solúveis, que resulta em citotoxicidade suave e moderada.

Protección pulpar: cementos a base de silicato de calcio. Relato de un caso clínico / Pulp capping: calcium silicate-based cements. Report of a clinical case

RESUMEN Los cementos a base de silicato de calcio son materiales bioactivos, que poseen la capacidad de liberar mayor cantidad de iones de calcio e hidroxilo, brindando ciertas ventajas como mayor capacidad antimicrobiana y de remineralización, incrementando la longevidad de los tratamientos pulpares. Theracal LC es un cemento a base de silicato de calcio el cual tiene como ventaja su presentación de fácil aplicación a comparación de otros cementos bioactivos. En el presente reporte de caso, Theracal LC fue utilizado como forro cavitario. Al examen clínico el paciente presentó las piezas 36 y 35 con el diagnóstico dental: caries dental con lesión con cavidad y caries dental con lesión profunda adyacente a restauración, respectivamente y como diagnóstico pulpar: Pulpa sana, en ambas piezas. Se realizaron restauraciones directas con resina compuesta en las piezas 36 y 35, considerando los siguientes pasos: grabado selectivo, sistema adhesivo autocondicionante, cemento protector a base de silicato de calcio y resina compuesta para técnica Bulk.

SUMMARY Calcium silicate-based cements are bioactive materials, which have the capacity to release a greater number of calcium and hydroxyl ions, providing some advantages like an increased antimicrobial and remineralise activity, increasing the pulp treatments longevity. Theracal LC is a calcium silicate-based cement that has as an advantage its easy application, comparing to others bioactive cements. In this case report, Theralcal LC was used as a cavity liner. At clinical examination teeth 36 and 35 exhibited diagnosis of Dental caries; 36 with a cavitated lesion and 35 with a lesion adjacent to a previous restoration; and pulp diagnosis, Sound Pulp, for both tooth pieces. Direct restorations were made with composite resin in tooth pieces 36 and 35, considering the following steps: selective etching, self-etch adhesive system, calcium silicate-based cement and Bulk-fill resin composite.

Bioactivity of endodontic biomaterials on dental pulp stem cells through dentin

OBJECTIVES: This study investigated the indirect effect of calcium-enriched mixture (CEM) cement and mineral trioxide aggregate (MTA), as 2 calcium silicate-based hydraulic cements, on human dental pulp stem cells (hDPSCs) through different dentin thicknesses.MATERIALS AND METHODS: Two-chamber setups were designed to simulate indirect pulp capping (IPC). Human molars were sectioned to obtain 0.1-, 0.3-, and 0.5-mm-thick dentin discs, which were placed between the 2 chambers to simulate an IPC procedure. Then, MTA and CEM were applied on one side of the discs, while hDPSCs were cultured on the other side. After 2 weeks of incubation, the cells were removed, and cell proliferation, morphology, and attachment to the discs were evaluated under scanning electron microscopy (SEM). Energy-dispersive X-ray (EDXA) spectroscopy was performed for elemental analysis. Alkaline phosphatase (ALP) activity was assessed quantitatively. The data were analyzed using the Kruskal-Wallis and Mann-Whitney tests.RESULTS: SEM micrographs revealed elongated cells, collagen fibers, and calcified nucleations in all samples. EDXA verified that the calcified nucleations consisted of calcium phosphate. The largest calcifications were seen in the 0.1-mm-thick dentin subgroups. There was no significant difference in ALP activity across the CEM subgroups; however, ALP activity was significantly lower in the 0.1-mm-thick dentin subgroup than in the other MTA subgroups (p < 0.05).CONCLUSIONS: The employed capping biomaterials exerted biological activity on hDPSCs, as shown by cell proliferation, morphology, and attachment and calcific precipitations, through 0.1- to 0.5-mm-thick layers of dentin. In IPC, the bioactivity of these endodontic biomaterials is probably beneficial.

Impact of calcium aluminate cement with additives on dental pulp-derived cells

Abstract Calcium aluminate cement (CAC) has been highlighted as a promising alternative for endodontic use aiming at periapical tissue repair. However, its effects on dental pulp cells have been poorly explored. Objective: This study assessed the impact of calcium chloride (CaCl2) and bismuth oxide (Bi2O3) or zinc oxide (ZnO) additives on odontoblast cell response to CAC. Methodology: MDPC-23 cells were exposed for up to 14 d: 1) CAC with 2.8% CaCl2 and 25% ZnO (CACz); 2) CAC with 2.8% CaCl2 and 25% Bi2O3 (CACb); 3) CAC with 10% CaCl2 and 25% Bi2O3 (CACb+); or 4) mineral trioxide aggregate (MTA), placed on inserts. Non-exposed cultures served as control. Cell morphology, cell viability, gene expression of alkaline phosphatase (ALP), bone sialoprotein (BSP), and dentin matrix protein 1 (DMP-1), ALP activity, and extracellular matrix mineralization were evaluated. Data were compared using ANOVA (α=5%). Results: Lower cell density was detected only for MTA and CACb+ compared with Control, with areas showing reduced cell spreading. Cell viability was similar among groups at days one and three (p>0.05). CACb+ and MTA showed the lowest cell viability values at day seven (p>0.05). CACb and CACb+ promoted higher ALP and BSP expression compared with CACz (p<0.05); despite that, all cements supported ALP activity. Matrix mineralization were enhanced in CACb+ and MTA. Conclusion: In conclusion, CAC with Bi2O3, but not with ZnO, supported the expression of odontoblastic phenotype, but only the composition with 10% CaCl2 promoted mineralized matrix formation, rendering it suitable for dentin-pulp complex repair.

Estudo clínico controlado, randomizado, duplo cego de pulpectomias em dentes decíduos obturados com Bio-C Pulpecto e Vitapex / Controlled, randomized, double-blind clinical study of pulpectomy in primary teeth filled with Bio-C Pulpecto and Vitapex

O objetivo deste estudo foi avaliar os aspectos clínicos e radiográficos de pulpectomias realizadas em dentes decíduos e obturadas com cimento à base de silicato de cálcio, Bio-C Pulpecto, em comparação com a pasta Vitapex®. Sessenta e sete dentes decíduos em 46 crianças foram divididos aleatoriamente em dois grupos, grupo Bio-C Pulpecto (n=32 dentes) e grupo Vitapex® (n=35 dentes). Os critérios para sucesso clínico foram: dente apresentar-se livre dos sinais e sintomas como, dor espontânea, mobilidade patológica, edema, abscesso e fístula, avaliados nos tempos de 7 dias, 1, 3, 6 e 12 meses. Os critérios para sucesso radiográfico foram: ausência de reabsorção radicular interna e radioluscência periapical/furcal recém-formada, avaliados aos 1, 3, 6 e 12 meses. Não foram constatadas diferenças estatisticamente significante nos aspectos clínicos investigados, em nenhum dos tempos avaliados. Aos 12 meses, as taxas de sucesso clínico foram de 84,61% no grupo Bio-C Pulpecto e 90,91% no grupo Vitapex®. Em relação ao desfecho secundário de descoloração da coroa dentária, aos 12 meses de controle, no grupo Bio-C Pulpecto, 15,38% (2/13) dos dentes apresentaram descoloração da coroa dentária enquanto que no grupo Vitapex® este achado foi de 31,82% (7/22), porém sem diferença estatisticamente significante entre os grupos (p= 0,431). Após avaliação de imagens radiográficas realizadas aos 12 meses, foi detectada diferença estatisticamente significante na frequência de reabsorção de pasta obturadora no periápice, aos 3 meses (p = 0,044), sendo a maior quantidade de casos de reabsorção identificada no grupo Bio-C Pulpecto (34,78%) em comparação a pasta Vitapex® (10,35%). Conclui-se que tanto nos aspectos clínico quanto no radiográfico, o Bio-C Pulpecto apresentou resultados favoráveis indicando a possibilidade de uso como material obturador para dentes decíduos(AU)

The aim of this study was to evaluate clinical and radiographic aspects of pulpectomy performed on primary teeth and filled with calcium silicate-based cement, Bio-C Pulpecto, in comparison with Vitapex paste. Sixty-seven primary teeth in 46 children were randomly divided into two groups, Bio-C Pulpecto group (n = 32 teeth) and Vitapex group (n = 35 teeth). The criteria for clinical success were: tooth being free of signs and symptoms, such as spontaneous pain, pathological mobility, edema, abscess and fistula, evaluated at 7 days, 1, 3, 6 and 12 months. The criteria for radiographic success were: absence of internal root resorption and newly formed periapical / furcal radiolucency, evaluated at 1, 3, 6 and 12 months. There were no statistically significant differences in the investigated clinical aspects, in any of the evaluated times. At 12 months, the clinical success rate was 84.61% in Bio-C Pulpecto group and 90.91% in Vitapex group. Regarding the outcome of dental crown discoloration, at 12 months of control, in Bio-C Pulpecto group 15.38% (2/13) of the teeth showed discoloration of the dental crown while in Vitapex group this finding was 31.82% (7/22), but there was no statistically significant difference between Bio-C Pulpecto and Vitapex (p = 0.431). After evaluation of radiographic images taken at 12 months, a statistically significant difference was detected in frequency of resorption of in the periapices, at 3 months (p = 0.044), with the largest number of cases of filling paste resorption identified in Bio-C Pulpecto group (34.78%) compared to Vitapex paste (10.35%). It is concluded that both in clinical and radiographic aspects, Bio-C Pulpecto presented favorable results indicating the possibility of use as a filling material for primary teeth(AU)

Clinical Comparison of Eggshell Derived Calcium Hydroxyapatite with Dycal® as Indirect Pulp Capping Agents in Primary Molars

Abstract Objective: To evaluate and compare the efficacy of eggshell derived calcium hydroxyapatite with Dycal® as indirect pulp capping material in primary molars. Material and Methods: A total of 32 carious primary molars from 22 children (6-10-years) were screened, of which 26 primary molars meeting inclusion criteria were selected and equally divided into two groups. At the first appointment, the infected dentin was excavated using a spoon excavator after treating the carious part with Carie-Care™ chemomechanical caries removal agent. After this, eggshell derived calcium hydroxyapatite in Group 1 and Dycal® in Group 2 were used as liners followed by restoration of the cavity with type IX glass ionomer cement. Clinical assessment for pain and radiographic assessment for measurement of the amount of reparative dentin thickness formation was performed at baseline, 8 weeks and 3 months. The data were subjected to statistical analysis by one-way ANOVA and Kruskal-Wallis tests. Results: Higher mean reparative dentin formation was found in eggshell derived calcium hydroxyapatite group than Dycal® group at the end of 8 weeks and 3 months and the difference was significant statistically (p<0.001). Conclusion: Eggshell derived calcium hydroxyapatite seems to be a suitable alternative to Dycal® (calcium hydroxide) that can be used as a liner for indirect pulp capping in primary molars.

Evaluation of wettability characteristics and adhesion of resin composite to photo-polymerized pulp-capping materials with and without bioactive glass / Avaliação das características de molhabilidade e adesão da resina composta aos materiais fotopolimerizáveis com e sem vidro bioativo

Objective: This study evaluated the wettability and adhesive properties of three different photopolymerized resin-based pulp-capping materials with or without bioactive glass (BAG). Material and Methods: Cylindrical specimens (5 per group) were prepared from photo-polymerized pulp-capping materials (TER-TheraCal LC, BIN-Biner LC, and CAL-CalciPlus LC containing BAG). After surface finishing, contact angle measurements were made (θ)using the sessile drop method and surface free energy was calculated. For shear test, cylindrical acrylic blocks (N = 30) (diameter: 6 mm; height: 1 m) in the center were filled with the pulp-capping materials (N = 10 per group) flattened using a metal spatula and photo-polymerized. The specimens were stored at 37 °C in 100% humidity for 24 h prior to the bonding procedures. An adhesive system (CLEARFIL SE BOND, Kuraray) was applied on the material surfaces and photo-polymerized for 20 s. Then, resin composite material (Filtek Z250, 3M ESPE) was bonded on the substrate materials using translucent plastic molds (internal diameter: 2 mm; height: 2 mm). The specimens were photopolymerized with an LED photo-polymerization unit for 20 s. After polymerization, the specimens were stored at 37 °C, at 100% humidity for 24 h. Shear force was applied at the pulp-capping material and the resin composite interface In a universal testing machine (1 mm/min).Data were analyzed using 1-way ANOVA and Tukey`s tests at the significance level of 0.05. Results: Contact angle values showed significant difference between the 3 materials with group CAL presenting the lowest (35.35 ± 12.89) and group BIN the highest values (74.77 ± 13.56) (p < 0.05). Significantly lower surface energy was observed with BIN (36.22) (p 0.05). Group BIN (9.12 ± 3.45) showed significantly lower (p < 0.05) mean bond strength than those of TER (11.56 ± 5.67) and CAL (12.66 ± 4.34) (p > 0.05). Most of the observed modes of failures in all groups were of mixed type of failures. Conclusion: The bioglass used in Calciplus LC did not adversely affect the wettability, surface energy and adhesive properties. (AU)

Objetivo: Este estudo avaliou as propriedades de molhabilidade e adesivas de três diferentes materiais capeadores pulpares fotopolimerizaveis à base de resina, com ou sem vidro bioativo (BAG). Material e Métodos: Amostras cilíndricas (5 por grupo) foram preparadas a partir de materiais capeadores pulpares fotopolimerizáveis (TER-TheraCal LC, BIN-Biner LC e CAL-CalciPlus LC contendo BAG). Após o acabamento da superfície, as medidas do ângulo de contato foram feitas (θ) usando o método de gota séssil e a energia livre da superfície foi calculada. Para o ensaio de cisalhamento, blocos de acrílico cilíndricos (N = 30) (diâmetro: 6 mm; altura: 1 m) foram preenchidos no centro com os materiais de capeamento pulpar (N = 10 por grupo) achatados usando uma espátula metálica e fotopolimerizados. Os espécimes foram armazenados a 37 ° C em 100% de umidade por 24 h antes dos procedimentos de colagem. Um sistema adesivo (CLEARFIL SE BOND, Kuraray) foi aplicado nas superfícies do material e fotopolimerizado por 20 segundos. Em seguida, o material de resina composta (Filtek Z250, 3M ESPE) foi colado nos materiais do substrato utilizando moldes de plástico translúcido (diâmetro interno: 2 mm; altura: 2 mm). Os espécimes foram fotopolimerizados com um dispositivo de fotopolimerização de LED por 20 s. Após a polimerização, os espécimes foram armazenados a 37 °C, a 100% de umidade por 24 h. A força de cisalhamento foi aplicada no material capeador e na interface da resina composta em uma máquina universal de ensaios (1 mm / min). Os dados foram analisados por meio do teste de ANOVA e teste de Tukey ao nível de significância de 0,05. Resultados: Os valores do ângulo de contato mostraram diferença significativa entre os 3 materiais com o grupo CAL apresentando os menores valores (35,35 ± 12,89) e o grupo BIN os maiores valores (74,77 ± 13,56) (p < 0,05). Uma energia de superfície significativamente menor foi observada com o BIN (36,22) (p 0,05). O grupo BIN (9,12 ± 3,45) apresentou resistência de união média significativamente menor (p 0,05). A maioria dos modos de falhas observados em todos os grupos eram de tipo misto de falhas. Conclusão: O biovidro utilizado no Calciplus LC não afetou negativamente a molhabilidade, energia superficial e propriedades adesivas. (AU)

Effects of the exposure site on histological pulpal responses after direct capping with 2 calcium-silicate based cements in a rat model

OBJECTIVES: Direct pulp capping is a treatment for mechanically exposed pulp in which a biocompatible capping material is used to preserve pulpal vitality. Biocompatibility tests in animal studies have used a variety of experimental protocols, particularly with regard to the exposure site. In this study, pulp exposure on the occlusal and mesial surfaces of molar teeth was investigated in a rat model. MATERIALS AND METHODS: A total of 58 maxillary first molars of Wistar rats were used. Forty molars were mechanically exposed and randomly assigned according to 3 factors: 1) the exposure site (occlusal or mesial), 2) the pulp-capping material (ProRoot White MTA or Bio-MA), and 3) 2 follow-up periods (1 day or 7 days) (n = 5 each). The pulp of 6 intact molars served as negative controls. The pulp of 12 molars was exposed without a capping material (n = 3 per exposure site for each period) and served as positive controls. Inflammatory cell infiltration and reparative dentin formation were histologically evaluated at 1 and 7 days using grading scores. RESULTS: At 1 day, localized mild inflammation was detected in most teeth in all experimental groups. At 7 days, continuous/discontinuous calcified bridges were formed at exposure sites with no or few inflammatory cells. No significant differences in pulpal response according to the exposure site or calcium-silicate cement were observed. CONCLUSIONS: The location of the exposure site had no effect on rat pulpal healing. However, mesial exposures could be performed easily, with more consistent results. The pulpal responses were not significantly different between the 2 capping materials.

Effects of mineral trioxide aggregate, BiodentineTM and calcium hydroxide on viability, proliferation, migration and differentiation of stem cells from human exfoliated deciduous teeth

Abstract Objective: The aim of the study was to evaluate the effects of the capping materials mineral trioxide aggregate (MTA), calcium hydroxide (CH) and BiodentineTM (BD) on stem cells from human exfoliated deciduous teeth (SHED) in vitro. Material and Methods: SHED were cultured for 1 - 7 days in medium conditioned by incubation with MTA, BD or CH (1 mg/mL), and tested for viability (MTT assay) and proliferation (SRB assay). Also, the migration of serum-starved SHED towards conditioned media was assayed in companion plates, with 8 μm-pore-sized membranes, for 24 h. Gene expression of dentin matrix protein-1 (DMP-1) was evaluated by reverse-transcription polymerase chain reaction. Regular culture medium with 10% FBS (without conditioning) and culture medium supplemented with 20% FBS were used as controls. Results: MTA, CH and BD conditioned media maintained cell viability and allowed continuous SHED proliferation, with CH conditioned medium causing the highest positive effect on proliferation at the end of the treatment period (compared with BD and MTA) (p<0.05). In contrast, we observed increased SHED migration towards BD and MTA conditioned media (compared with CH) (p<0.05). A greater amount of DMP-1 gene was expressed in MTA group compared with the other groups from day 7 up to day 21. Conclusion: Our results show that the three capping materials are biocompatible, maintain viability and stimulate proliferation, migration and differentiation in a key dental stem cell population.