Vitalidade pulpar em lesões de cárie profundas após restaurações pelo Tratamento Restaurador Atraumático (ART) em molares decíduos: resultado após 24 meses de um ensaio clínico randomizado / Pulp vitality in deep carious lesions after Atraumatic Restorative Treatment (ART) restorations in primary molars: 24 months results of a randomized clinical trial

O objetivo desta tese foi avaliar a vitalidade pulpar de dentes decíduos com lesão de cárie profunda tratados com duas técnicas restauradoras. A taxa de sobrevivência da restauração foi avaliada como um desfecho secundário. Este volume apresenta um compilado do protocolo de pesquisa e os resultados de ensaio clínico randomizado (Clinicaltrials.gov registration NCT02903979) de não inferioridade com dois braços paralelos relatados pelas recomendações SPIRIT e CONSORT, respectivamente. Crianças de 4 a 8 anos com pelo menos uma lesão cariosa profunda oclusal ou ocluso-proximal em molares decíduos foram selecionadas na clínica odontológica da Universidade Ibirapuera. Cento e oito molares decíduos foram alocados em dois grupos: (1) restauração com cimento de hidróxido de cálcio seguido do cimento de ionômero de vidro de alta viscosidade (CHC + HVGIC) ou (2) restauração com HVGIC. A vitalidade pulpar e a sobrevivência da restauração foram avaliadas em 6, 12 e 24 meses. A análise por intenção de tratar foi usada para a vitalidade pulpar e a análise de sobrevida foi realizada com o método de Kaplan-Meier ( = 5%). Aos 24 meses, 86 restaurações foram avaliadas e 91 foram avaliadas pelo menos uma vez durante o estudo. A perda foi de 20%, e o número de participantes no início e no final do estudo foi semelhante entre os grupos (p = 0,872). Não houve diferença significativa entre os tratamentos restauradores em relação à vitalidade pulpar (CHC + HVGIC = 70% e HVGIC = 68,5%) (OR = 1,09; IC95% = 0,48-2,48). No entanto, as restaurações HVGIC (73%) apresentaram uma taxa de sobrevivência maior do que CHC + HVGIC (50%) (p = 0,021). Na análise de regressão de Cox apenas a variável tratamento apresentou p <0,20. Nesse sentido, a análise ajustada não foi realizada. Os dentes tratados com HVGIC tiveram 65% menos chance de falha do que aqueles tratados com CHC + HVGIC. Assim, pode-se sugerir que a aplicação de CHC é dispensável em lesões profundas de molares decíduos, visto que a longevidade da restauração é menor e a vitalidade pulpar não se altera com sua utilização.

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)

Success rate of silver nano-particles in comparison to silver diamine fluoride in management of deep carious lesions: a randomized controlled clinical trial / Taxa de sucesso de nanopartículas de prata em comparação ao fluoreto de diamina de prata no manejo de lesões cariosas profundas: um estudo clínico controlado randomizado

Objective: Evaluate the effectiveness of nanosilver fluoride in comparison to silver diamine fluoride in management of deep carious lesions. Material and Methods: This double-blinded randomized controlled clinical trial included thirty-six patients with deep carious mandibular molars. Patients were recruited form the outpatient clinic of Suez canal university, Egypt and randomly allocated into three groups, Nanosilver fluoride group, Silver diamine fluoride group and control group. For all groups, teeth were isolated by rubber dam. Access was done followed by partial caries removal. Silver diamine fluoride or Nanosilver fluoride were applied, and all teeth were restored with composite resin restorative. Patients were recalled after 3 and 6 months to follow-up the pulp vitality. R-statistical analysis software for Windows, version 4.1.1, was used to conduct the statistical analysis Results: At 3 month, for all groups, all teeth were successful. After 6 months, for silver diamine fluoride group, a single case failed. Regarding the nanosilver fluoride, all cases were successful. For the control group, two cases failed. No statistically significant difference was found between the tested groups. Conclusion: Application of 5% Nanosilver to fluoride varnish has similar clinical efficacy as silver diamine fluoride in arresting the dentin caries progression (AU)

Objetivo: Avaliar a eficácia de fluoreto de nanoprata em comparação ao fluoreto de diamina de prata no manejo de lesões profundas de cárie. Material e Métodos: Este estudo clínico controlado randomizado duplo-cego incluiu trinta e seis pacientes com lesões de cárie profunda em molares inferiores. Os pacientes foram recrutados no ambulatório da Universidade do Canal de Suez, no Egito, e alocados aleatoriamente em três grupos de tratamento: fluoreto de nanoprata, fluoreto de diamina de prata e grupo controle. Para todos os grupos, os dentes foram submetidos ao isolamento absoluto. O acesso à lesão foi feito seguido pela remoção parcial de tecido cariado. Tanto o fluoreto de diamina quanto fluoreto de nanoprata foram aplicados, e todos os dentes foram restaurados com resina composta. Os pacientes foram avaliados após 3 e 6 meses para o acompanhamento da vitalidade pulpar. O software estatístico R-statistical para Windows, versão 4.1.1, foi usado para as análises. Resultados: Em 3 meses, para todos os grupos, todos os dentes apresentaram sucesso no tratamento. Após 6 meses, para o grupo que utilizou o fluoreto de diamina de prata um único caso falhou. Em relação ao fluoreto de nanoprata, todos os casos apresentaram sucesso. Para o grupo controle, dois casos falharam. Não houve diferença estatística entre os grupos testados. Conclusão: A aplicação de verniz de fluoreto de nanoprata a 5% tem eficácia clínica semelhante ao fluoreto de diamina de prata na interrupção da progressão de cárie no tecido dentinário (AU)

X-ray evaluation of pulp calcification in adult permanent teeth after pulpotomy / 北京大学学报(医学版)

OBJECTIVE@#To compare the clinical effects of pulpotomy with two kinds of calcium silicate materials, and to evaluate the formation of dentin bridge and pulp calcification after pulpotomy of adult permanent teeth.@*METHODS@#Patients who visited the General Department of Peking University School and Hospital of Stomatology from November 2017 to September 2019 and planned for pulpotomy on permanent premolars and molars with carious exposed pulp were selected. They were randomly divided into two groups. Bioceramic putty material iRoot BP (iRoot group, n=22) and mineral trioxide aggregate MTA (MTA group, n=21) were used as pulp capping agents, respectively. The patients were recalled after one year and two years. The clinical efficacy, dentin bridge index (DBI) and pulp calcification index (PCI) were recorded. Blinding method was used for the patients and evaluators.@*RESULTS@#There was no significant difference in gender, mean age, dentition and tooth position between the two groups (P>0.05). Seven cases were lost during the first year (4 cases in iRoot group and 3 cases in MTA group). In the iRoot group, 1 case had transient sensitivity at the time of 1-year follow-up. The cure rate of the two groups was 100% at the time of 2-year follow-up. The proportion of dentin bridge formation was 38.9% one year after operation, 55.6% two years after operation. The proportion of partial or even complete disappearance of root canal image was 5.6% before operation, 38.9% and 55.6% one and two years after operation, respectively. The difference was statistically significant by rank sum test (P < 0.05). There was no significant difference in dentin bridge formation and pulp calcification between the two groups (P < 0.05). DBI and PCI after operation was as the same as those before operation (44.4% cases of DBI and 25% cases of PCI) or gradually increased (55.6% cases of DBI and 75% cases of PCI). Spearman's nonparametric correlation analysis showed that age was positively correlated with preoperative pulp calcification index (PCI0, P < 0.05), but not with the dentin bridge index (DBI1, DBI2), pulp calcification index (PCI1, PCI2) and the degree of change (DBI2 vs. DBI1, PCI1 vs. PCI0, PCI2 vs. PCI0) 1-year and 2-year after operation (P>0.05).@*CONCLUSION@#According to this study, good clinical effects were obtained within 2-year after pulpotomy of adult permanent teeth with MTA and iRoot. In some cases, the root canal system had a tendency of calcification aggravation, and there was no statistical difference in the development of this trend between the two groups.

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

Protección pulpar directa y posterior apexogénesis: informe de un caso clínico / Direct pulp capping followed by apexogenesis: a clinical case report

Objetivo: Describir el tratamiento de un paciente que pre- sentó un incisivo superior permanente con exposición pulpar y desarrollo radicular incompleto utilizando Biodentine como material para la protección pulpar directa. Caso clínico: Un paciente de 9 años fue derivado para la evaluación y el tratamiento del diente 11. El examen clínico y radiográfico reveló la presencia de una fractura amelodentinaria, con exposición pulpar y desarrollo radicular incompleto. Luego de lavar y desinfectar el área de la fractura, se protegió la pulpa expuesta con Biodentine y se restauró la cavidad. El paciente fue citado para control a los 18 y 25 meses. En los controles se comprobó que el diente se mantuvo asintomático y funcional. Luego de 25 meses, el examen clínico y radiográfico confirmó la presencia de pulpa vital y el completo desarrollo del remanente radicular. Los resultados obtenidos en el presente caso clínico sugieren que el empleo de Biodentine puede ser considerado como una valiosa alternativa para la protección de la pulpa ex- puesta en dientes con desarrollo radicular incompleto (AU)

Aim: To describe the treatment of a patient that presented a permanent maxillary central incisor with pulp exposure and incomplete root formation, using Biodoentine as the material for direct pulp protection. Clinical case A 9-year-old male patient was referred for evaluation and treatment of tooth 11. The clinical and radio-graphic examination revealed the presence of a dentinoe- namel fracture, with pulp exposure and incomplete root for- mation. After cleaning and disinfecting the area, the exposed pulp was protected with Biodentine and the cavity was re- stored. The patient was scheduled for control after 18 and 25 months. In these evaluations, it was confirmed that the tooth remained asymptomatic and functional. After 25 months, the clinical and radiographic examination showed the presence of vital pulp and a completed development of the root. The obtained results of this clinical case suggest that Biodentine can be considered a valuable alternative for pulp capping in teeth with incomplete root formation (AU)

Research progress in vital pulp therapy in mature permanent teeth with carious pulp exposure / 中华口腔医学杂志

Vital pulp therapy(VPT)is an important pathway to preserve and maintain pulp tissue in a healthy state. VPT has been improved recently as the new progress achieved in pathobiology, bioactive materials and clinical research. The present review summarizes the clinical outcomes and prognostic factors of VPT, including direct pulp capping, partial pulpotomy and full pulpotomy in mature permanent teeth with carious pulp exposure, and briefly introduces the new progress in this field.

New advances in vital pulp therapy and pulp regeneration for the treatment of pulpitis: from basic to clinical application / 中华口腔医学杂志

In recent years, great progress has been made in research on the treatment of pulpitis, mainly due to the rapid development of basic and clinical researches in this field, and some achievement from basic research has been applied in clinical practice. Advances in the diagnostic methods for pulpitis can help the clinicians to recognize the true state of pulpitis more accurately and to adopt the corresponding treatment methods including indirect/direct pulp capping, pulpotomy, pulp regeneration and root canal therapy. The new theory of pulpitis diagnosis and the studies on immune defense, repair function of dental pulp and new pulp capping materials have significantly improved the success rate of vital pulp therapy. For diffuse coronary pulpitis or radicular pulpitis, which is difficult to achieve vital pulp therapy successfully, methods of pulp revascularization, cell homing and pulp stem cells-mediated pulp regeneration can also be used as treatment options in addition to root canal therapy. The present article focuses on the research progress on pulpitis treatments and related clinical transformation practices, in order to provide reference on vital pulp therapy and pulp regeneration for clinicians.

Incorporation of a polymerization catalyst for improved mechanical behavior and physicochemical characteristics of a light-cured pulp capping material / Incorporação de um catalisador de polimerização para aprimorar propriedades mecânicas e fisíco-químicas de um protetor pulpar fotoativável

Objective: To evaluate the influence of the incorporation of a polymerization catalyst to a light-cured pulp capping material on mechanical behavior and physicochemical characteristics. Material and Methods: Different percentages (2 wt%, and 4 wt%) of diphenyliodonium hexafluorophosphate (DPI) were incorporated into the Ultra-Blend Plus, a resin-modified calcium-based cement. The material without incorporation of DPI (0 wt%) served as control. Degree of Conversion (DC), Flexural Strength (FS), Elastic Modulus (EM), Water Sorption (WSp), Solubility (Sl), and pH of eluate at 24-h, 72-h, and 7-day storage times were measured. One-way ANOVA/Tukey posthoc tests were used to analyze the data (p <0.05). Results: For DC, FS, and EM, materials with different % of DPI showed statistically significant differences, so that 0% provided the lowest values and 2% the highest values. Materials with 0% and 2% of DPI provided statistically the lowest WSp, whilst material with 0% of DPI showed statistically the highest Sl. Conclusion: All materials provided statistically similar pH to eluates regardless of storage time, although only materials with DPI at 2% and 4% maintained pH of eluates statistically similar from 72 h to 7 days storage times.(AU)

Objetivo: avaliar a influência nas propriedades mecânicas e físico-químicas da incorporação de um catalisador de polimerização a um protetor pulpar fotoativável. Material e Métodos: foram adicionadas diferentes porcentagens em massa (2% e 4%) de hexafluorofosfato de difeniliodônio (DPI) ao Ultra-Blend Plus, um cimento à base de hidróxido de cálcio modificado por resina. O material sem a adição do DPI (0%) serviu como controle. Foram avaliados: Grau de Conversão (DC), Resistência Flexural (FS), Módulo de Elasticidade (EM), Sorção (WSp), Solubilidade (SI) e o pH do eluato nos tempos de 24h, 72h e 7 dias de armazenamento. ANOVA 1-way com pós-teste de Tukey (p <0.05). Foi utilizado para avaliar os resultados estatisticamente. Resultados: Os materiais com diferentes % de DPI apresentaram diferenças significativas para os testes de DC, FS e EM. A porcentagem em massa de 0% de DPI mostrou valores inferiores a todos os testados e os materiais com adição 2% apresentaram a melhor performance. Materiais com 0% e 2% de DPI apresentaram valores inferiores de WSp; a porcentagem de 0% proporcionou valores estatisticamente maiores para SI. Conclusão: Todos os materiais testados apresentaram pH semelhante nos eluatos independente do tempo de armazenamento, contudo, apenas os materiais com 2% e 4% mantiveram o pH dos eluatos estatisticamente similares nos tempos de estocagem de 72h a 7 dias.(AU)

Vitalidade pulpar em lesões de cárie profundas após restaurações pelo Tratamento Restaurador Atraumático (ART) em molares decíduos: resultado após 24 meses de um ensaio clínico randomizado / Pulp vitality in deep carious lesions after Atraumatic Restorative Treatment (ART) restorations in primary molars: 24 months results of a randomized clinical trial

O objetivo desta tese foi avaliar a vitalidade pulpar de dentes decíduos com lesão de cárie profunda tratados com duas técnicas restauradoras. A taxa de sobrevivência da restauração foi avaliada como um desfecho secundário. Este volume apresenta um compilado do protocolo de pesquisa e os resultados de ensaio clínico randomizado (Clinicaltrials.gov registration NCT02903979) de não inferioridade com dois braços paralelos relatados pelas recomendações SPIRIT e CONSORT, respectivamente. Crianças de 4 a 8 anos com pelo menos uma lesão cariosa profunda oclusal ou ocluso-proximal em molares decíduos foram selecionadas na clínica odontológica da Universidade Ibirapuera. Cento e oito molares decíduos foram alocados em dois grupos: (1) restauração com cimento de hidróxido de cálcio seguido do cimento de ionômero de vidro de alta viscosidade (CHC + HVGIC) ou (2) restauração com HVGIC. A vitalidade pulpar e a sobrevivência da restauração foram avaliadas em 6, 12 e 24 meses. A análise por intenção de tratar foi usada para a vitalidade pulpar e a análise de sobrevida foi realizada com o método de Kaplan-Meier ( = 5%). Aos 24 meses, 86 restaurações foram avaliadas e 91 foram avaliadas pelo menos uma vez durante o estudo. A perda foi de 20%, e o número de participantes no início e no final do estudo foi semelhante entre os grupos (p = 0,872). Não houve diferença significativa entre os tratamentos restauradores em relação à vitalidade pulpar (CHC + HVGIC = 70% e HVGIC = 68,5%) (OR = 1,09; IC95% = 0,48-2,48). No entanto, as restaurações HVGIC (73%) apresentaram uma taxa de sobrevivência maior do que CHC + HVGIC (50%) (p = 0,021). Na análise de regressão de Cox apenas a variável tratamento apresentou p <0,20. Nesse sentido, a análise ajustada não foi realizada. Os dentes tratados com HVGIC tiveram 65% menos chance de falha do que aqueles tratados com CHC + HVGIC. Assim, pode-se sugerir que a aplicação de CHC é dispensável em lesões profundas de molares decíduos, visto que a longevidade da restauração é menor e a vitalidade pulpar não se altera com sua utilização.

Management of dental caries lesions in Latin American and Caribbean countries

Abstract Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.

Caracterizações física e química de cimentos experimentais autoadesivos à base de cálcio / Physical and chemical characterizations of calcium-based self-adhesive experimental cements

Objetivo: Avaliar a Resistência de União (RU), Grau de Conversão (GC), Liberação de Cálcio (LC), Resistência Flexural (RF), Módulo de Elasticidade (ME) e Viscosidade (VS) de cimentos experimentais à base de cálcio autocondicionantes e autoadesivos. Três cimentos experimentais: A (CONTROLE) ­ sem fonte de cálcio, B (HIDROCAL) ­ com hidróxido de cálcio, C (CLORECAL) ­ com cloreto de cálcio foram sintetizados e avaliados juntamente a um cimento comercial D (ULTRAPLUS) (Ultra-Blend Plus®). Metodologia: Para a RU, foi utilizado o teste de cisalhamento, cujas amostras (1,3mm de diâmetro com 2mm de altura) foram aderidas à dentina bovina (n=10) e tensionadas em máquina de ensaios (1 mm/min) até́ ocorrer o deslocamento. Para o GC (n=3), foi utilizada a Espectroscopia Infravermelha com transformada de Fourier (FTIR). Na determinação da LC (n=3) foram utilizadas amostras circulares (1,0 mm x 0,4 mm) e a leitura foi realizada através de um espectrofotômetro de absorção atômica nos tempos de 3h, 24h e 72h. Para RF/ME (n=10), amostras em formato de barra (7mm x 2mm x 1mm) foram confeccionadas e avaliadas por meio de uma Máquina de Ensaios Universal no teste de flexão de três pontos. Para a VS (n=30), a variação da taxa de deformação foi determinada por um reômetro rotacional de cilindros concêntricos. Os dados foram analisados por ANOVA 1 e 2 fatores seguido pelo pós teste de tukey (p<0,05). Resultados: Para RU todos os materiais experimentais apresentaram valores estatisticamente maiores que o comercial (p<0,01). Para o GC os cimentos CONTROLE e HIDROCAL apresentaram valores estatisticamente maiores que os demais (p<0,01). Frente à LC o CLORECAL e ULTRAPLUS apresentaram valores estatisticamente superiores após 72h (p<0,01). O ULTRAPLUS apresentou estatisticamente a maior RF e o menor ME (p<0,05). Os cimentos HIDROCAL e CLORECAL apresentaram valores de VS estatisticamente superiores aos demais (p<0,01). Conclusão: De maneira geral, o cimento experimental à base de cloreto de cálcio mostrou-se mais promissor (AU).

Objective: To evaluate the Bond Strength (BS), Degree of Conversion (DC), Calcium Release (CR), Flexural Strength (FS), Elastic Modulus (EM) and Viscosity (VS) of experimentally calcium based cements self-etching and self-adhesive. Three experimental cements: A (CONTROL), B (HYDROCAL), C (CLORECAL) were synthesized and evaluated with a commercial cement D (ULTRAPLUS) (Ultra-Blend Plus®- South Jordan, Utah, USA). Methodology: For the BS, the shear test was used, whose samples 1.3mm in diameter and 2mm in height) were adhered to the bovine dentin (n=10) and tensioned in a testing machine (1mm/min) until occurring the displacement. For the DC (n=3), Infrared Spectroscopy with Fourier transform (FTIR) was used. In determining the CR (n = 3) circular samples (1.0mmx0.4 mm) were used and the reading was performed through an atomic absorption spectrophotometer at 3h, 24h and 72h. For FS/ ME (n= 0), bar-shaped samples (7mmx 2mmx1mm) were made and evaluated using a Universal Testing Machine in the three-point flexion test. For VS (n = 30), the variation in the strain rate was determined by a rotational concentric cylinder rheometer. Results: For BS, all experimental materials showed statistically higher values than the commercial material (p <0.01). For the DC, the CONTROL and HIDROCAL cements showed statistically higher values than the others (p <0.01). In relation to CR, CLORECAL and ULTRAPLUS showed statistically higher values after 72 hours (p <0.01). ULTRAPLUS showed statistically the highest FS and the lowest EM (p <0.05). The HIDROCAL and CLORECAL cements showed VS values statistically higher than the others (p <0.01) Conclusion: In general, the experimental cement based on calcium chloride proved to be more promising (AU).

Proteção da vitalidade dentino-pulpar em odontopediatria: uma revisão de literatura / Dentin-pulp protection in pediatric dentistry: a review

Dentin and pulp are considered interdependent substrates, known as the dentin-pulp complex. In front of injuries such as caries and trauma, this complex should be protected with restorative materials considered to be protective agents. An ideal material should have properties such as biocompatibility, be antimicrobial, be insoluble in the oral environment, be thermal and electrically insulating, have therapeutic potential, and adequate mechanical properties. As these characteristics are not found in all materials, the dentist must know the advantages and disadvantages of those that are available. This study aimed to perform a critical review of the indirect materials indicated for the protection of dentin-pulp vitality (PDPV) to ensure the success of indirect pulp treatment in primary teeth. A search was carried out in books, theses, dissertations, monographs, printed articles and databases, PubMed, SciELO, and MEDLINE. According to the literature, the success in protecting the dentin-pulp vitality is achieved through an excellent marginal seal, preventing bacterial infiltration in the dentin and controlling the progression of caries. Further clinical studies are needed to evaluate other outcomes after indirect pulp treatment. There isn't a material that has all the desired characteristics for PDPV, and recent studies show that the key to PDPV isn't found in the protective material, but in the restorations marginal sealing, enabling the inactivation of the progression of dental caries.

A dentina e a polpa são consideradas substratos interdependentes, conhecido como complexo dentino-pulpar. Frente a injúrias como cárie e traumatismo, deve-se realizar a proteção desse complexo, baseando-se na inserção de materiais restauradores considerados agentes protetores. Os materiais considerados ideais devem apresentar propriedades como: biocompatibilidade, ser antimicrobiano, ser insolúvel ao meio bucal, ser isolante térmico e elétrico, ter potencial terapêutico e propriedades mecânicas adequadas. Como essas características não são encontradas em todos os materiais, é importante que o cirurgião-dentista conheça as vantagens e as desvantagens daqueles que estão disponíveis comercialmente. O objetivo deste trabalho foi realizar uma revisão crítica da literatura sobre os materiais indicados para proteção indireta da vitalidade dentino-pulpar (PVDP), em dentes decíduos. Para isso, foram pesquisados livros, teses, dissertações, monografias, artigos impressos e das bases de dados, PubMed, SciELO e MEDLINE. De acordo com a literatura, observou-se que a garantia de êxito na proteção da vitalidade dentino-pulpar é alcançada por meio de um ótimo selamento marginal, impedindo a infiltração bacteriana na dentina e controlando a progressão da cárie. São necessários mais estudos clínicos que avaliem outros desfechos após o tratamento indireto da polpa. Não existe um material que possua todas as características desejadas para a PVDP, e estudos recentes demonstram que a chave não se encontra no material protetor, mas sim na vedação marginal das restaurações, propiciando a inativação da progressão da cárie dentária.

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.

Physical-mechanical properties of a resin-modified calcium silicate material for pulp capping

Abstract The purpose of this study was to investigate and to compare the physical-mechanical properties of a resin-modified calcium silicate material (TheraCal LC), used for pulp-capping, to MTA (Angelus) and a calcium hydroxide cement (Dycal). Specimens of each material (n=12) were prepared in Teflon molds (3.58 mm x 3 mm) and measured before and after immersion in distilled water for 24 h and 30 days to evaluate the dimensional change. The same specimens were submitted to compressive strength test on a Universal Testing Machine (Instron) (1 mm/min). Root canals were filled with the cements (n=8), and after 24 h, the bond strength (push-out test) to dentin was also assessed on a Universal Testing Machine (1 mm/min). Eight additional specimens of TheraCal LC were prepared to evaluate the bond strength immediately after light curing. Data were analyzed using One-Way ANOVA, and Tukey or Bonferroni post hoc tests (p<0.05). Percentage expansion of TheraCal LC was above the Specification No. 57 of ANSI/ADA, in both periods. The dimensional change for TheraCal LC was higher than MTA in 24 h and 30 days; and Dycal in 30 days (p<0.05). TheraCal LC had higher compressive and bond strength to dentin in comparison with MTA and Dycal (p<0.05). Although TheraCal LC expanded more than the ANSI/ADA recommendation, its compressive and push-out bond strength to dentin were satisfactory and superior to MTA and Dycal.

Resumo O objetivo deste estudo foi investigar e comparar as propriedades físico-mecânicas de um material à base de silicato de cálcio modificado por resina (TheraCal LC) ao MTA (Angelus) e um cimento de hidróxido de cálcio (Dycal). Espécimes de cada material (n=12) foram fabricados em moldes de Teflon (3,58 mm x 3 mm) e medidos antes e após imersão em água destilada por 24 h e 30 dias para avaliar a alteração dimensional. Os mesmos espécimes foram submetidos ao teste de resistência à compressão em uma Máquina Universal de Testes (Instron) (1 mm/min). Canais radiculares foram preenchidos com os cimentos (n=8), e após 24 h, a resistência de união (teste de push-out) também foi avaliada em uma Máquina Universal de Testes (1 mm/min). Oito amostras adicionais de TheraCal LC foram preparadas para avaliar a resistência de união imediatamente após a fotoativação. Os dados foram analisados utilizando os testes ANOVA de 1-fator e Tukey; ou Bonferroni (p<0,05). A expansão percentual do TheraCal LC ficou acima da Especificação No. 57 do ANSI/ADA, em ambos os períodos. Os valores de alteração dimensional para TheraCal LC foram maiores que MTA em 24 h e 30 dias; e Dycal em 30 dias (p<0,05). TheraCal LC apresentou maior resistência à compressão e união à dentina em comparação ao MTA e Dycal (p<0,05). Embora TheraCal LC tenha expandido mais que a recomendação da ANSI/ADA, sua resistência à compressão e de união à dentina foram satisfatórias e superiores ao MTA e Dycal.

Molecular response of pulp fibroblasts after stimulation with pulp capping materials

Abstract This in vitro study evaluated cell viability and metabolism, nitric oxide release and production of two chemokines and one cytokine by cultured human dental pulp fibroblasts (HDPF) in contact with two glass ionomer cements (Ketac Molar-KM and Vitrebond-VB), Single Bond (SB) and calcium hydroxide (Dycal-DY). Cultures of HDPF were established by means of an explant technique. The specimens were prepared under sterile conditions and in disks measuring 5 mm x 2 mm obtained from a prefabricated mold and placed on a permeable membrane to avoid direct contact with the cells. Cytotoxicity was assessed by Trypan Blue exclusion method and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Nitric oxide release in cell supernatant was detected by the Griess Method whereas stromal derived factor-1 alpha (SDF-1α or CXCL12), chemokine (C-X-C motif) ligand 8 [Interleukin 8 (IL-8 or CXCL8)] and interleukin-6 (IL-6) were detected by ELISA. RT-qPCR was employed for gene expression analysis. Statistical analyses were performed by One-way ANOVA followed by Tukey's post hoc test for materials independent of the time, and Two-way ANOVA followed by Bonferroni correction test for the comparisons between materials and experimental time (p<0.05). Cytotoxic tests showed significant differences only for DY. Protein levels and mRNA expression were significantly increased for IL-8 for both periods of time. IL-6 production increased when fibroblasts were stimulated by KM. SDF-1α protein production and mRNA expression were not affected by any of the materials. There was a decrease in nitrate/nitrite levels only for KM. Although DY caused intense cell death and did not stimulate the production of the inflammatory mediators evaluated in this work, it is known that this event seems to be fundamental for the process of repair of the pulp tissue and formation of mineralized barrier. KM and VB increased production of proteins related to the inflammatory process, thus favoring tissue repair. Therefore, although these glass ionomer cements did not lead to large cell death, they should be used with caution.

Resumo Este estudo avalia in vitro a viabilidade e metabolismo celular, a liberação de óxido nítrico e a produção de duas quimiocinas e uma citocina por fibroblastos de polpa dentária humana em cultura (FPDH) em contato com dois cimentos de ionômero de vidro (Ketac Molar-KM e Vitrebond-VB), Single Bond (SB) e hidróxido de cálcio (Dycal-DY). As culturas de FPDH foram estabelecidas por meio de uma técnica de explante. As amostras foram preparadas em condições estéreis e em discos de 5 mm x 2 mm, obtidas de um molde pré-fabricado e colocadas em uma membrana permeável (Maxicell 24 W 0,4 µm) para evitar o contato direto com as células. A citotoxicidade foi avaliada pelo método de exclusão de Trypan Blue e pelo ensaio de MTT. A liberação de óxido nítrico no sobrenadante celular foi detectada pelo método Griess, enquanto fator 1 derivado do estroma (SDF-1α ou CXCL12), interleucina-8 (IL-8 ou CXCL8) and interleucina-6 (IL-6) foram detectados por ELISA. RT-qPCR foi empregada para análise de expressão gênica. As análises estatísticas foram realizadas por ANOVA a 1 critério, seguida pelo pós-teste de Tukey para os materiais independentes do tempo, e ANOVA a 2 critérios, seguida pelo teste de correção de Bonferroni para comparações entre materiais e tempo experimental (p<0,05). Os testes citotóxicos mostraram diferenças significativas apenas para DY. Os níveis da proteína e a expressão de RNAm para IL-8 aumentaram significativamente para ambos os tempos estudados. A produção de IL-6 aumentou quando os fibroblastos foram estimulados por KM. A produção da proteína e a expressão de RNAm para SDF-1α não foram afetadas por nenhum dos materiais. Houve uma diminuição nos níveis de nitrato/nitrito apenas para KM. Embora o DY tenha causado intensa morte celular e não tenha estimulado a produção dos mediadores inflamatórios avaliados neste trabalho, sabe-se que esse evento parece ser fundamental para o processo de reparo do tecido pulpar e formação de barreira mineralizada. Os cimentos de ionômero de vidro utilizados aumentaram a produção de proteínas relacionadas ao processo inflamatório, favorecendo a reparação tecidual e, portanto, esses materiais, embora não causem grande morte celular, devem ser utilizados com cautela.

Indirect pulp protection after selective caries removal: a preliminary 6 months randomised controlled trial / Proteção pulpar indireta após a remoção seletiva de tecido cariado: acompanhamento de 6 meses de um ensaio clínico randomizado controlado

This randomized controlled clinical trial evaluated the effectiveness of using indirect pulp protection with calcium hydroxide liner or universal adhesive over a period of 6 months in deep caries on permanent teeth after selective removal to soft dentin. The sample con-sisted of 68 patients with 55 molars and 21 premolars with deep caries lesion (with radiographic involvement ≥ 50% dentin deep caries), (median age 27 [distribution 7-54 years]), with signs of pulp vitality (positive respon-se to cold test, absence of spontaneous pain, negative sensitivity to percussion tests, absence of radiographic imaging suggestive of periapical lesion) and absence of cuspid loss. After selective removal to soft dentin, the test group received a universal adhesive (n = 38), whereas the control group indirect pulp protection with Calcium hydroxide (n = 38). All teeth were restored with compo-site resin. The successful outcome for pulp vitality was assessed after six months. The results were submitted to the Kaplan-Meier survival analysis and the Log Rank test. The baseline variables were analyzed for their distribution in the two treatment groups by x2 test and showed a similarly distributed between groups. Success rates to pulp maintenance vitality were 95.5% for the control group and 96.7% for the test group (P = 0,986). Two cases of failure were recorded, one pulp necrosis (control group) and one pulpitis (test group). There is no difference between the use of calcium hydroxide or only universal adhesive in indirect pulp protection after selective removal to soft dentine followed by composite restoration at six months of follow-up, showing a high rate of success for both treatments.

Este ensaio clínico controlado randomizado avaliou a eficácia da proteção pulpar indireta com ci-mento de hidróxido de cálcio ou apenas adesivo universal na remoção seletiva de dentina amolecida em dentes permanentes após 6 meses de tratamento. A amostra consistiu de 68 pacientes com 55 molares e 21 pré-molares com lesão profunda de cárie (envolvimento radiográfico ≥ 50% da dentina), (mediana de idade 27 [distribuição 7-54 anos]), com sinais de vitalidade pulpar (resposta positiva ao teste frio, ausência de dor espontânea, sensibilidade negativa aos testes de percussão, ausência de imagem radiográfica sugestiva de lesão periapical) e ausência de perda cúspidea. Após remoção seletiva o grupo teste recebeu adesivo universal (n = 38) e o grupo controle cimento de hidróxido de cálcio (n = 38) como proteção pulpar indireta. Todos os dentes foram restaurados com resina composta. Os re-sultados de vitalidade pulpar foram avaliados após seis meses e submetidos à análise de sobrevivência de Kaplan-Meier e ao teste Log Rank. As variáveis explanatórias iniciais foram analisadas quanto à sua distribuição nos grupos de tratamento pelo teste x2 e mostraram distribuição similar. O sucesso na manutenção da vitalidade pulpar foi de 95,5% para o grupo controle e 96,7% para o grupo teste (P = 0,986). Duas falhas foram registradas, uma necrose pulpar (grupo controle) e uma pulpite (grupo teste). Resultados sugerem que não há diferença entre o uso de hidróxido de cálcio e/ou apenas adesivo universal após remoção seletiva de dentina amolecida e restauração de resina composta em 6 meses de acompanhamento, com alta taxa de sucesso nos dois tratamentos.

Evaluation of dentinogenesis inducer biomaterials: an in vivo study

Abstract When exposure of the pulp to external environment occurs, reparative dentinogenesis can be induced by direct pulp capping to maintain pulp tissue vitality and function. These clinical situations require the use of materials that induce dentin repair and, subsequently, formation of a mineralized tissue. Objective: This work aims to assess the effect of tricalcium silicate cements and mineral trioxide aggregate cements, including repairing dentin formation and inflammatory reactions over time after pulp exposure in Wistar rats. Methodology: These two biomaterials were compared with positive control groups (open cavity with pulp tissue exposure) and negative control groups (no intervention). The evaluations were performed in three stages; three, seven and twenty-one days, and consisted of an imaging (nuclear medicine) and histological evaluation (H&E staining, immunohistochemistry and Alizarin Red S). Results: The therapeutic effect of these biomaterials was confirmed. Nuclear medicine evaluation demonstrated that the uptake of 99mTc-Hydroxymethylene diphosphonate (HMDP) showed no significant differences between the different experimental groups and the control, revealing the non-occurrence of differences in the phosphocalcium metabolism. The histological study demonstrated that in mineral trioxide aggregate therapies, the presence of moderate inflammatory infiltration was found after three days, decreasing during follow-ups. The formation of mineralized tissue was only verified at 21 days of follow-up. The tricalcium silicate therapies demonstrated the presence of a slight inflammatory infiltration on the third day, increasing throughout the follow-up. The formation of mineralized tissue was observed in the seventh follow-up day, increasing over time. Conclusions: The mineral trioxide aggregate (WhiteProRoot®MTA) and tricalcium silicate (Biodentine™) present slight and reversible inflammatory signs in the pulp tissue, with the formation of mineralized tissue. However, the exacerbated induction of mineralized tissue formation with the tricalcium silicate biomaterial may lead to the formation of pulp calcifications

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.

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.