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

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.

Avances en protección pulpar directa con materiales bioactivos / Recent advances in direct pulp capping with bioactive materials

Con el advenimiento de los materiales Bioactivos hoy hay un cambio de paradigma en el tratamiento de la protección pulpar directa. Está ampliamente demostrado en la literatura tanto en los estudios in vitro como in vivo, que estos materiales son más efectivos que el hidróxido de calcio para lograr cambios biológicos y microestructurales en el tejido pulpar y dentinario. Es así que surgen los materiales bioactivos, los cuales son sustancias que al ponerse en contacto con los tejidos vivos, provocan un efecto positivo sobre los mismos formando tejidos calcificados. Inducen una respuesta biológica específica en la interfase material-tejido. Actualmente los que cuentan con mayor aval científico son: MTA, Biodentine y Theracal LC.

Nowadays with the arrival of the Bioactive Materials, there has been an important change in the treatment of direct pulp capping. It is already probed, in studies in vitro and in vivo that these materials are more effective than calcium hydroxide as they obtain biological and microstructural changes in the pulpar and dentinal tissues.That is the reason for the appearance of the BIOACTIVE materials, which cause a specific biological response in the interface material-tissue when they are in contact with the vital tissues. The actual materials with the best scientific acceptance are: MTA, Biodentine and Theracal.

Materials used for indirect pulp treatment in primary teeth: a mixed treatment comparisons meta-analysis

Abstract: This study aimed to systematically review the literature to address the question regarding the influence of different materials in the clinical and radiographic success of indirect pulp treatment in primary teeth. A literature search was carried out for articles published prior to January 2017 in PubMed/MEDLINE, CENTRAL, Scopus, TRIP and ClinicalTrials databases; relevant articles included randomized clinical trials that compared materials used for indirect pulp treatment in primary teeth. Two reviewers independently selected the studies and extracted the data. The effects of each material on the outcome (clinical and radiographic failures) were analyzed using a mixed treatment comparisons meta-analysis. The ranking of treatments according to their probability of being the best choice was also calculated. From 1,088 potentially eligible studies, 11 were selected for full-text analysis, and 4 were included in the meta-analysis. In all papers, calcium hydroxide liner was used as the control group versus an adhesive system, resin-modified glass ionomer cement or placebo. The follow-up period ranged from 24 to 48 months, with dropout rates of 0-25.7%. The material type did not significantly affect the risk of failure of the indirect pulp treatment. However, calcium hydroxide presented a higher probability of failure. In conclusion, there is no scientific evidence showing the superiority of any material used for indirect pulp treatment in primary teeth.

Tratamiento expectante en molar permanente joven: reporte de caso / Stepwise excavation in young permanent molar: case report

La caries dental es la causa principal por la que se realizan tratamientos de conducto, sin embargo existen procedimientos de protección pulpar para el manejo de lesiones cariosas profundas, que ayudan en la recuperación del tejido pulpar. Uno de los procedimientos es el tratamiento expectante, éste va a ser efectivo en preservar la pulpa que podría ser expuesta durante la remoción de caries profunda donde no hay signos clínicos que indiquen pulpitis irreversible. El tratamiento expectante, al ser en dos etapas tiene como objetivo detener el avance de la lesión cariosa, minimizar la dentina cariada retenida y permitirle a la pulpa recuperarse generando dentina reparativa para evitar cualquier exposición pulpar en una segunda sesión. Se describe el manejo de lesiones cariosas profundas en molar permanente joven mediante el tratamiento expectante a través de un reporte de caso. Paciente femenino de 15 años presenta dolor provocado a los cambios térmicos en el segundo molar inferior izquierdo. Las radiografías revelaron lesión cariosa profunda, clasificación R4 de Pitts, ausencia de radiolucidez apical y espacio del ligamento periodontal normal. A la prueba objetiva de diagnóstico con frío, se observó respuesta positiva, diagnosticándose Pulpitis Reversible. Basado en estos hallazgos se decide mantener la vitalidad pulpar y realizar el tratamiento expectante. El tratamiento expectante constó de dos fases, en la primera se retiró el tejido cariado de paredes y piso, dejándose dentina afectada y se colocó hidróxido de calcio seguido de una restauración temporal. En la segunda fase, 6 meses después, tras confirmar el mantenimiento de la vitalidad pulpar y formación de puente dentinario, se reabrió la cavidad y se colocó la restauración definitiva con resina compuesta. Se realizaron dos controles posteriores, el primero 12 meses después de iniciado el tratamiento y el segundo 60 meses después...

Dental caries is one of the main reasons to perform root canal treatments; however there are procedures to protect the pulp in case of deep caries lesions. During caries removal pulp tissue could be exposed, so stepwise excavation is one procedure which will be effective in pulp preservation. Stepwise excavation consists of two stages, its purpose is stop caries progression, change cariogenic environment and allow the pulp recover generating reparative dentine to avoid pulp exposure in a second visit. Below we describe the management of deep carious lesions in a young permanent molar treated with stepwise excavation. A 15-year-old female patient with cause pain due to thermal changes in second inferior left molar, X-Rays revealed deep caries lesion, R4 Pitts ́s classification, no signs of apical radiolucency or widening of the periodontal ligament space. Presents positive response to sensibility test with cold so Reversible Pulpitis is diagnosed, because of these findings it was decided to keep pulp vitality and perform stepwise excavation. This procedure consists in two phases: the first one is taking out the caries lesion from walls and floor, leaving affected dentin and placed calcium hidroxyde paste over, followed by a temporal restoration with glass ionomer. The second phase is six months later, once pulp vitality is confirmed and dentinal bridge is formed, so the cavity is reopened and definitive restoration is placed with composite resin.Two subsequent check-ups were carried out, the first one 12 months after stepwise excavation had been performed and the second control was 60 months later, clinical and radiographic controls were performed in both controls and no pathology was found considering the treatment as effective.

Tratamientos pulpares en dientes primarios / Pulp therapies in primary teeth

El mantenimiento de las piezas dentarias para desempeñar sus funciones en la alimentación, en la expresión oral, en el mantenimiento de espacios en las arcadas dentarias, en el estímulo para el crecimiento y desarrollo de los maxilares, entre otras acciones, ha sido considerado esencial para el logro de un desarrollo armónico. Por otro lado, y a pesar de los avances en la materia, la caries dental es la causa más frecuente de las patologías pulpares en los dientes primarios y constituye el principal motivo de su deterioro y/o su pérdida. Las características histo-patológicas de la pulpa dental, la brevedad de su ciclo vital, el tamaño relativo de las cámaras pulpares, favorecen el rápido compromiso pulpar y propician que el proceso infeccioso progrese rápidamente a la necrosis. Ello ha determinado y determina el desarrollo de numerosas técnicas y tratamientos, diferentes ofertas terapéuticas de las cuales ninguna ha alcanzado el consenso universal. Como establecen las Guías de Odontología Pediátrica sobre tratamientos pulpares en dientes primarios, la literatura dental en esta área ofrece escasa y pobre evidencia para sustentar las diferentes técnicas y constantemente señalan la necesidad de nuevos y rigurosos estudios que la avalen.

Evaluation of direct pulp capping with a synthetic chalcone: a preliminary histological study / Evaluación del recubrimiento pulpar directo con una chalcona sintética: estudio histológico preliminar

The aim of this study is to evaluate the action of the synthetic chalcone 1-phenyl-3-(4-chlorophenyl)-2-propen-1-one to induce pulp healing in rats. Material and Methods: Sixty lower first molars of male Wistar rats were divided into 3 groups (n=20): control (no treatment); calcium hydroxide and chalcone. After relative isolation, the cavities were prepared using a sterile low-speed » round dental bur. After controlling the hemorrhaging, all the pulp exposures were capped with the capping material, by groups. The cavities were sealed with glass ionomer cement and the repair process was assessed at 21 days of procedure. The data were statistically analyzed using the Fisher exact test (p<0.05). Results: Moderate inflammation was observed in all the experimental groups and significant (p<0.05) reparative dentin (tertiary) formation in the calcium hydroxide and chalcone groups. The chalcone group showed dentinal tubules and a low number of cellular inclusions (p<0.05). Conclusion: The chalcone used in this study indicates potential as an inducer of reparative dentine (tertiary) in a rat model...

El objetivo de este estudio es evaluar la acción de la chalcona sintética 1-fenil-3- (4-clorofenil) -2-propen-1-ona para inducir la reparación de la pulpa dentaria en ratas. Materiales y métodos: Sesenta primeros molares inferiores de ratas Wistar machos se dividieron en 3 grupos (n = 20): control (sin tratamiento); hidróxido de calcio y chalcona. Después del aislamiento relativo, las cavidades se prepararon usando una fresa dental redonda de » estéril a baja velocidad. Después de controlar la hemorragia, todas las exposiciones pulpares se taparon con el material de recubrimiento de acuerdo con los grupos del experimiento. Las cavidades fueron selladas con cemento de ionómero de vidrio y el proceso de reparación se evaluó a los 21 días del procedimiento. Los datos fueron analizados estadísticamente mediante la prueba exacta de Fisher (p<0,05). Resultados: Se observó inflamación moderada en todos los grupos experimentales y significativa (p <0,05) formación de dentina reparadora (terciaria) en los grupos de hidróxido de cálcio y chalcona. El grupo de chalcona mostró túbulos dentinarios y un bajo número de inclusiones celulares (p <0,05). Conclusión: La chalcona utilizada en este estudio indica potencial como un inductor de la dentina reparadora (terciaria) en ratas...

Papacarie: A Chemomechanical Caries Removal Agent.

Chemomechanical caries removal (CMCR) is a noninvasive technique eliminating infected dentine via a chemical agent. Th e objective of CMCR is to eliminate the outer layer or infected dentin, leaving the aff ected layer or partly demineralized dentin, which can be remineralized and repaired. As this process based on minimally invasive dentistry, it not only removes infected tissues, also preserves healthy dental structure, avoiding pulp irritation and patient discomfort. Th is is a method of caries removal based on dissolution. Instead of drilling, this method uses a chemical agent assisted by an a traumatic mechanical force to remove soft carious structure. Th e chemomechanical method for caries removal is most outstanding among other alternative methods. Th is paper reviews one of the chemomechanical removal agent, Papacarie.

Fracturas coronarias con exposición pulpar: reporte de tres casos clínicos en diferentes edades / Crown fractures with pulp exposure: report of three clinical cases at different ages

Los traumatismos dentarios son la causa más frecuente de daño en los dientes anteriores. Las fracturas coronarias con pulpa expuesta representan entre el 18 al 20 por ciento de las lesiones traumáticas que involucran las piezas dentarias. En esta comunicación clínica, los autores muestran un tratamiento preventivo: técnica de Cvek, que evita que los dientes afectados llegen a un tratamiento endodóntico total

Leiomioma intraóseo de maxilar superior: hallazgo radiográfico posterior a un traumatismo dentario / Maxillary intraosseous leiomyoma: radiographic finding after dental trauma

Objetivo: informar sobre un caso inusual de leiomioma intramaxilar, sus características clínico-radiográficas y su diagnóstico diferencial. Caso clínico: se presenta a la consulta una niña de 10 años de edad con una lesión osteolítica en el maxilar superior, inicialmente considerada -según los antecedentes clínicos- una complicación periapical, producto de lesión pulpar postraumática. Luego de realizar el tratamiento endodóntico convencional, los controles radiográficos posteriores evidenciaron, a los 2 meses, falta de remisión de la lesión osteolítica y, a los 4 meses, aumento de su tamaño. Tras su extirpación quirúrgica, el estudio histopatológico correspondiente diagnosticó leiomioma. Conclusiones: el leiomioma es una neoplasia benigna del músculo liso que, habitualmente, se localiza en los tejidos blandos. Su presencia en la cavidad bucal es infrecuente y es aún más rara en los maxilares. Por su aspecto radiográfico inespecífico, puede confundirse con otras patologías, lo cual dificulta el diagnóstico precoz.(

Inflammatory effect of green propolis on dental pulp in rats

Pulpotomy in deciduous teeth is a controversial issue, especially with regard to alternative materials used for the direct pulp capping of the root canal pulp tissue. The aim of the present study was to perform a histological analysis of the initial reaction of the root canal pulp tissue in rats, following pulpotomy and pulp capping with (1) green propolis extract, (2) iodoform paste, (3) green propolis extract + iodoform and (4) calcium hydroxide paste with saline solution. Analyses were performed after 24 hours, 72 hours and 7 days. The substances containing green propolis extract and iodoform led to the production of an intense inflammatory infiltrate and necrosis in the root canal pulp tissue throughout the analyses. In the calcium hydroxide group, inflammatory infiltrate only prevailed at the 72-hour evaluation. Among the substances tested, calcium hydroxide paste induced the lowest intensity of inflammatory response in the root canal pulp tissue. Longer studies should be carried out to analyze the pulp repair process following pulpotomy and pulp capping with the compounds analyzed.

The effectiveness of using different pulp-capping agents on the healing response of the pulp.

Background: Some of the disadvantages of calcium hydroxide Ca(OH) 2 as pulp-capping material are related to the inflammatory response, and its poor sealing ability. Cyanoacrylate glue was proposed in this study as pulp-capping agent because of its sealing ability, and diprogenta, on the other hand, was proposed because of its anti-microbial and anti-inflammatory effects. The aim of this study is to evaluate and compare the histopathological response of the pulp toward cyanoacrylate and diprogenta in direct pulp capping (DPC). Materials and Methods: Cyanoacrylate, diprogenta, and calcium hydroxide were applied on 20 permanent teeth of 6 rabbits divided into four groups, each contains five teeth, as follow: G1: Diprogenta and calcium hydroxide. G2: Cyanoacrylate. G3: Diprogenta and cyanoacrylate. G4: Calcium hydroxide (control group). Results: A remarkable dentin bridge formation was found in all groups. No pulp necrosis was found in any tooth of the four groups. Pathological reactions of the pulp were found in 25%, 40%, 20%, and 100% of groups 1, 2, 3, and 4, respectively. Differences between study and control groups were found statistically significant ( P < 0.05). Conclusion: All materials used in this study were biocompatible and suggested to be studied further on human teeth. These materials when used in combination with Ca(OH) 2 , may give better results

Avaliação do capeamento pulpar indireto e tratamento expectante em molares decíduos / Evaluation of indirect pulp capping and expectante treatment in primary molars

Objetivo: avaliar clínica e radiograficamente o capeamento pulpar indireto e o tratamento expectante em molares decíduos, no período de 12 meses Materiais e Métodos: Foram selecionados 13 molares decíduos com lesão profunda de cárie e realizado a remoção seletiva da dentina cariada, proteção do complexo dentino-pulpar com cimento de hidróxido de cálcio e restauração com cimento de ionômero de vidro. No grupo controle foi realizada reabertura após 30 dias e remoção total do remanescente cariado e no grupo experimental acompanhamento clínico e radiográfico. Resultados: Os resultados foram realizados por meio do teste qui-quadrado e teste de Ficher. Conclusão: Diante dos resultados encontrados é lícito concluir que a remoção do remanescente cariado após o tratamento expectante, não melhorou o desempenho clínico e radiográfico das restaurações ionoméricas, quando comparado com o capeamento pulpar indireto em molares decíduos por um período de 12 meses de acompanhamento. Relevância Clínica: Tratamento de mínima intervenção que diminui os riscos de exposição pulpar em molares decíduos (mantendo a vitalidade pulpar) e o tempo da criança no consultório, podendo ser realizado em sessão única.

Purpose: The aim of this study was to evaluate the clinical and radiographic indirect pulp treatment in primary molars in one or two sessions, within 12 months. Methods: selected 13 primary molars with deep carious lesions and performed partial removal of the decayed tissue, protection of the pulp-dentin complex with calcium hydroxide cement and restored with glass ionomer cement. In the control group was performed 30 days after reopening and removal of the remaining caries in the experimental group and clinical and radiographic. Results: The results showed no statistically significant difference between the two groups.Given the results we may conclude that the removal of remaining carious after expectant treatment, did not improve the clinical and radiographic performance of ionomeric restorations, when compared with the indirect pulp capping in primary molars for a period of 12 months follow-up. Clinical Relevance: Treatment of minimal intervention that reduces the risk of pulp exposure in primary molars (maintaining pulp vitality) and the child's time in office, may be performed in one session.

Furcal-perforation repair with mineral trioxide aggregate: Two years follow-up.

Furcal perforations are significant iatrogenic complications of endodontic treatment and could lead to endodontic failure. Mineral trioxide aggregate (MTA) has been regarded as an ideal material for perforation repair, retrograde filling, pulp capping, and apexification. This case report describes a furcal perforation in a maxillary first molar, which was repaired using MTA. The tooth was endodontically treated and coronally restored with resin composite. After 2 years, the absence of periradicular radiolucent lesions, pain, and swelling along with functional tooth stability indicated a successful outcome of sealing the perforation using MTA.

Relação entre sinvastatina e diferenciação celular da polpa humana dentária / The relationship between sinvastatin and cell differentiation of human dental pup

Nosso organismo é formado a partir de células que se multiplicam e se diferenciam. essas células são chamadas de "stemcells". No tecido dental, podemos observar intensa atividade diferencial em relação à dentina, que tem, como uma de suas funções, a proteção tecido pulpar. Frente a uma injúria (atrição, cárie ou procedimento restaurador), os odontoblastos são estimulados à deposição de dentina. Estudos mostram que materiais como hidróxido de cálcio PA, o cimento de hidróxido de cálcio, o agregado trióxido mineral (MTA) e, mais recetemente, a Sinvastatina são capazes de induzir a estimulação dos odontoblastos, quando em contato direto ou indireto com o tecido pulpar. este trabalho teve como objetivo discorrer, por meio da revisão de literatura, sobre a ação da Sinvastatina e sua relação com o diferencial celular da polpa dental humana, destacando suas implicações odontológicas. assim, pudemos concluir que a Sinvastatina é uma importatnte aliada na regeneração do tecido pulpar, por meio de sua ação anti-inflamatória; promove indução da diferenciação celular, pelo contato com o tecio pulpar, no capeamento pulpar direto ou indireto. Estudos adicionais são necessários para estabelecer a Sinvastatina como medicação para o capeamento pulpar; os métodos existentes promovem ação desejada para esses casos, já comprovada por experiência clínica e estudos. Deve-se avaliar se há vantagem na utilização da Sinvastatina quanto ao custo/benefício, em relação aos medicamentos já utilizados.

The human body is formed from cells that multiply and differentiate theselves. These cells are called "stem cells". In dental tissue, we can observe an intensive differential activity over the dentin, with has pulp tissue protection as one of its functions. Faced withan injury (atrition, caries or restorative procedure), the odontoblast are stimulated at the deposition of dentin. Studies show that materials such as calcium hydroxide cement, the mineral trioxide aggregate (MTA) and, more recently, the Sinvastatin are capable of inducing the stimulation of odontoblasts, when they are in direct or indirect contact with the pulp tissue. This study aimed to discuss, through a literature review on the effect os Sinvastatin and its relationship with tbe cell differentiation of human dental pulp, specially its dental implications. Thus, we concluded that Sinvastatin is an important ally in the regeneration of the of the pulp tissue, through its anti-inflammatory activity; promotes the induction of cell differentiation, through the contact with pulp tissue, in direct or indirect pulp capping; addiotional studies are needed to establish Sinvastatin as medication for pulp capping; the existing methods promote the desired action for these cases, provent by clinical experiences an studies; an assessment must be made in order to find out wether there is an advantage in using Sinvastatin as the cost/benefit in relation to products that have already been used.

Ação do pH do cimento de hidróxido de cálcio / Action pH of calcium hydroxide cement

O cimento de hidróxido de cálcio é utilizado em capeamento pulpar nas cavidades profundas. Sua propriedades bactericida e mineralizadora são dependentes do seu pH alcalino. O objetivo deste estudo foi de realizar uma análise do pH de três marcas comerciais de cimentos de hidróxido de cálcio (Hidro C; Hydcal: Liner) em diferentes períodos de tempo para averiguar a eficácia de cada uma como material terapêutico. Dez amostras de cada material foram preparadas usando a matriz de teflon, em forma de disco com orificio central de 3,5mm de diâmetro e 2,0mm de espessura, armazenadas em 10ml de água destilada em uma estufa a 37°C. Os dados coletados foram submetidos a uma análise de variância a dois critérios e utilizado o teste de Tukey para comparação dos valores individuais de cada variável. Na primeira hora os cimentos apresentaram o pH elevado e nos demais períodos houve um declínio em todos cimentos para um patamar próximo de pH 8. Ainda assim o pH é influente na ação mineralizadora e bacteriana. Como significância clínica pode inferir que os materiais testados Hidro C, Hydcal e Liner são semelhantes e qualquer um deles cumpre a sua finalidade terapêutica

The calcium hydroxide cement is used for pulp-capping in deep cavity preparations. Its bactericide and mineralizing properties depends on the alkaline pH. The aim of this study is to analyze the concentration of hydrogen ions (pH) of three calcium hydroxide cement brands (Hidro C, Hydcal and Liner) over different periods of time to evaluate the efficacy of each brand as a therapeutic material. Ten specimens of each brand were fabricated using a Teflon mould with a diameter of 3,5mm and 2mm thickness, and stored in distilled water (10ml) at 37°C. The results were analyzed with analysis of variance (ANOVA) and Tukey’s test in order to compare the individual values of every variable. At the 1st hour the specimens presented a high pH and through the other periods of time they had a decline on the pH means to a pH 8, approximately. Even with that decline, the pH influences the bactericide and mineralizing action over the dentin-pulp complex. Based on the results obtained, it can be imply that all the tested materials (Hidro C, Hydcal and Liner) are similar and achieve its therapeutic objective

Comparative evaluation of formocresol and mineral trioxide aggregate as pulpotomy agents in deciduous teeth.

Aim: To evaluate and compare mineral trioxide aggregate (MTA) and formocresol as pulpotomy medicaments by clinical and radiographic assessments and to assess the histological features of both pulpotomy medicaments in deciduous teeth. Materials and Methods: This study was performed on 100 mandibular deciduous molar teeth requiring pulpotomy treatment. Children between age four and six years were randomly selected and divided into formocresol or MTA group. The patients were recalled after 3, 6, 9, 12 months respectively and evaluated clinically and radiographically. Histological assessment was done on lower deciduous canine teeth, which were undergoing serial extraction for interceptive orthodontic purpose. Pulpotomy was done on four teeth with formocresol and another four teeth with MTA. The teeth were extracted after six months following pulpotomy procedure and histologically evaluated. Two freshly extracted carious teeth were taken as controls. Results: Clinical and radiographic criteria were laid and Chi analysis revealed significant difference in mobility ( P≤0.05), periodontal ligament widening ( P≤0.01 level) and inter - radicular radiolucency ( P≤0.02 level) between two groups at the end of 12 months. Histologically, in MTA group, a layer of new dentine formation with less dentinal tubules at the pulpotomized site was found. In formocresol group, increased inflammatory cells, a zone of atrophy, were noted in radicular portion of pulp. Conclusion: MTA is superior to formocresol clinically, radiographically. Histological analysis showed better reparative ability with hard tissue barrier formation with MTA compared to formocresol.

Recubrimiento pulpar directo e idirecto: mantenimiento de vitalidad pulpar / Direct and indirect pulp capping: maintaining pulp vitality

El recubrimiento pulpar directo e indirecto, desde el punto de vista biológico y clínico, representa importantes mecanismos para el mantenimiento de la vitalidad pulpar; sin embargo aún es considerado un tema controversial en la clínica odontológica, debido a la complejidad del diagnóstico y a la delicada conducta terapéutica necesaria para obtener éxito en el tratamiento clínico. En tal sentido, este artículo realizará un abordaje biológico y clínico del Recubrimiento Pulpar Directo e Indirecto con la intención de resaltar la importancia fundamental del diagnóstico clínico y radiográfico de la condición pulpar, enfatizando las indicaciones y contra indicaciones de ambos tratamientos. Adicionalmente serán materia de discusión los materiales comúnmente utilizados para la protección del complejo dentinopulpar y las nuevas perspectivas en esta área

Direct and indirect pulp capping represents important mechanisms, from the point of clinical and biological aspects to maintain the pulp vitality. However, it still a controversy issue at dental field, once the complexity diagnosis and the accurately therapeutics are need to achieve the success of clinical treatment. Seeing that, this article outlines the broad of the biological and clinical approach of the direct and indirect pulp capping. Emphasizing fundamentally the importance of the corrected diagnose of clinical and radiographic pulp condition, further the indications and contra-indications of both treatments. Furthermore, it will be discussed regarding the classical dental materials used to dentin-pulp protection and contemporary perspectives in this area

Response of human dental pulp to calcium hydroxide paste preceded by a corticosteroid/ antibiotic dressing agent

Aim: To evaluate the treatment with corticosteroid/antibiotic dressing in pulpotomy with calciumhydroxide. Methods: Forty-six premolars were pulpotomized and randomly assigned into 3groups. In Group I pulpal wound was directly capped with calcium hydroxide, and Group II and Group III received corticosteroid/antibiotic dressing for 10 min or 48 h, respectively, before pulp capping. Teeth were processed for histological analysis after 7, 30 or 60 days to determine inflammatory cell response, tissue disorganization, dentin bridge formation and presence of bacteria.Attributed scores were analyzed by Kruskal-Wallis and Mann-Whitney tests (á=0.05). Results:On the 7th day, all groups exhibited dilated and congested blood vessels in the tissue adjacent to pulpal wound. The inflammatory cell response was significantly greater in Group III (p<0.05). On the 30th day, in all groups, a thin dentin matrix layer was deposited adjacent to the pulpal wound and a continuous odontoblast-like cell layer underlying the dentin matrix was observed. On the60th day, all groups presented a thick hard barrier characterized by an outer zone of dystrophic calcification and an inner zone of tubular dentin matrix underlined by a defined odontoblast-like celllayer. Conclusions: Within the limitations of present study, considering that the treatment was performed in healthy teeth, it may be concluded that the use of a corticosteroid/antibiotic dressing before remaining tissue protection with calcium hydroxide had no influence on pulp tissue healing.

Tratamiento de la caries dentinaria en odontopediatría: remoción parcial de la dentina cariada / The management of dentinal caries lesions in pediatric dentistry: incomplete caries removal

Los avances en el campo de la cariología incorporan permanentemente criterios que modifican sustancialmente el tratamiento de esta enfermedad.Por su impacto en su terapéutica, es objetivo de este trabajo la revisión de las técnicas de remoción parcial de la dentina cariada en dientes primarios y permanentes, tomando en especial consideración los fundamentos biológicos que las sustentan.