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)

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)

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.

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.

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.

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.

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.

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.

Reparative dentin formation using stem cell therapy versus calcium hydroxide in direct pulp capping: an animal study

Abstract Direct pulp capping process is a therapeutic method aimed at maintenance of pulp vitality and health by using a biocompatible material placed directly over the exposed pulp. The aim of this study was to evaluate and compare the effect of direct pulp capping procedures by dental pulp stem cells (DPSCs) or calcium hydroxide on dentin tissue formation. Three mongrel dogs were used as experimental model. Two access cavities were prepared in the right and left mandibular fourth premolars in all dogs to expose and extirpate the pulp tissues which were processed in the lab to obtain a single-cell suspensions. The isolated cells were cultures in odontogenic medium for subsequent differentiation. The maxillary teeth (3 incisors and one canine) of the corresponding dog number were subjected to class V cavities to expose their pulps which were assigned into 2 groups of 12 teeth each ( group I - pulp capping with calcium hydroxide) and (group II - pulp capping with dental stem cells DPSCs). The operated teeth were collected after 3 months and processed for histological and electron microscopic examinations. Specimens were subjected to elemental analysis of calcium and phosphorus. EDX elemental analysis revealed significant differences in the calcium and phosphorous wt, % in the reparative dentin of calcium hydroxide treated group which confirmed histologically. Direct pulp capping by DPSCs has shown promising generative potential for regaining normal dentin.

Resumo O processo de capeamento pulpar direto é um método terapêutico que visa a manutenção da vitalidade e saúde da polpa, usando um material biocompatível colocado diretamente sobre a polpa exposta. O objetivo deste estudo foi avaliar e comparar o efeito do capeamento pulpar direto usando células-tronco da polpa dentária (CTPDs) ou hidróxido de cálcio sobre o tecido da dentina formação. Três cães sem raça definida foram utilizados como modelo experimental. Duas cavidades de acesso foram preparados nos quartos pré-molares inferiores direito e esquerdo em todos os cães para expor e extirpar os tecidos pulpares que foram processados ​​em laboratório para obter suspensões de uma célula única. As células isoladas foram cultivadas em meio odontogênico para posterior diferenciação. Os dentes superiores (3 incisivos e um canino) do respectivo cão foram submetidos ao preparo de cavidades classe V para expor suas polpas, as quais foram atribuídas a 2 grupos de 12 dentes cada (grupo I - capeamento pulpar com hidróxido de cálcio) e (grupo II - capeamento pulpar com CTPDs). Os dentes operados foram extraídos após 3 meses e processado para exames histológicos e por microscopia eletrônica de varredura. Os espécimes foram submetidos a análises elementares de cálcio e fósforo. Análise elementar por EDX revelaram diferenças significativas no peso de cálcio e fósforo, % na massa reparadora dentina do grupo tratado com hidróxido de cálcio, o que foi confirmado histologicamente. O capeamento pulpar com CTPDs mostrou potencial promissor para recuperar a dentina normal.

In vivo evaluation of inflammation and matrix metalloproteinase expression in dental pulp induced by luting agents in dogs

Objectives: To evaluate the inflammatory tissue response and matrix metalloproteinase (MMP)-2 and -9 expression in the pulp-dentin complex in response to RelyX TM Unicem (RU) and Ketac Cem TM Easymix (KC) cements. Methods : Class V cavities were prepared in 56 teeth from six dogs, and indirect pulp capping was performed using RU (n=20), KC (n=20), zinc oxide, and eugenol cement (control, n=16). At 7 and 70 days following indirect pulp capping, the animals were euthanized, and tissues were removed for histological evaluation. The distance from the cavity floor to the odontoblastic layer was measured, and the numbers of inflammatory cells, fibroblasts, and odontoblasts were counted in pulp tissue. MMP-2 and -9 expression levels were immunohistochemically assessed. Statistical analyses were performed for all experiments (significance level=5%). Results : The dentin remnant thickness between the cavity floor and the pulp chamber was similar for all materials, ranging from 469 to 739 µm (p>0.05). At 7 days, KC and RU induced a small inflammatory response in the pulp-dentin complex, similar to the control (p>0.05). At 70 days, RU induced a tissue response characterized by fewer odontoblasts and more mononuclear cells (p<0.05), whereas KC induced a response similar to the control (p>0.05). Lutingagents induced low levels of MMP-2 and MMP-9 expression, similar to the control (p>0.05). Conclusion : KC and RU luting agents are compatible materials for use in deep cavities close to dental pulp tissue, although RU led to a slightly diminished odontoblastic population with a higher percentage of mononuclear cells.

Objetivo : Avaliar a resposta tecidual inflamatória e a expressão de metaloproteinase de matriz (MMP) -2 e -9 no complexo polpa-dentina em resposta aos cimentos RelyX TM Unicem (RU) e Ketac Cem TM Easymix (KC). Métodos : Cavidades classe V foram preparadas em 56 dentes de seis cães, e capeamento pulpar indireto foi realizado com cimento de RU (n = 20), KC (n = 20), óxido de zinco e eugenol (controle, n = 16). Aos 7 e 70 dias após o capeamento pulpar indireto, os animais foram eutanasiados, e os tecidos foram removidos para avaliação histológica. A distância entre o assoalho da cavidade e a camada odontoblástica foi medida, e os números de células inflamatórias, fibroblastos e odontoblastos foram contados no tecido pulpar. Os níveis de expressão de MMP-2 e -9 foram avaliados por imuno-histoquímica. Análises estatísticas foram realizadas para todos os experimentos (nível de significância = 5%). Resultados : A espessura da dentina remanescente entre o assoalho da cavidade e a câmara pulpar foi semelhante para todos os materiais, variando de 469 a 739 µm (p> 0,05). Aos 7 dias, KC e RU induziram uma pequena resposta inflamatória no complexo polpa-dentina, semelhante ao controle (p> 0,05). Aos 70 dias, a RU induziu uma resposta tecidual caracterizada por menos odontoblastos e mais células mononucleares (p <0,05), enquanto o KC induziu uma resposta semelhante ao controle (p> 0,05). Os agentes cimentantes induziram baixos níveis de expressão de MMP-2 e MMP-9, semelhantes ao controle (p> 0,05). Conclusão : Os agentes cimentantes KC e RU são materiais compatíveis para uso em cavidades profundas próximas ao tecido da polpa dentária, embora a UR tenha levado a uma população odontoblástica levemente diminuída, com maior porcentagem de células mononucleares.

Influence of pregnancy on the inflammatory process following direct pulp capping: a preliminary study in rats

Abstract The purpose of this study was to evaluate the inflammatory process following direct pulp capping during pregnancy. This experimental study involved 48 maxillary first molars of female Wistar rats. The procedures were performed in pregnant and non-pregnant animals (n =20 each). Direct pulp capping with mineral trioxide aggregate (MTA) and restoration with a light-cured resin composite was performed in half of exposed pulp specimens. In the other half of specimens, light-cured composite was placed directly on the exposed pulp. In the control groups (n=4 each), no intervention was performed. Animals were euthanized at 3 and 7 days. All sections (three per slide) were viewed under an optical microscope. One previously calibrated pathologist performed descriptive analysis and assigned scores for inflammatory response and tissue organization adjacent to the pulp exposure. The Kappa value for intra-examiner variability was 0.91. At 3 days, in animals treated with MTA, inflammatory infiltrate was absent in non-pregnant animals while mild inflammatory infiltrate was observed in some pregnant animals. The inflammatory response ranged from mild to severe in both groups treated with composite alone. At 7 days, the inflammatory response was more intense in pregnant than in non-pregnant animals treated with MTA; while this difference were not evident in animals treated with composite alone. In conclusion, pregnancy may not influence the inflammatory process following direct pulp capping with light-cured resin composite, which was always harmful to the pulp; while the tissue response after the direct pulp with MTA were more favorable in non-pregnant animals.

Resumo O objetivo deste estudo foi avaliar o processo inflamatório do tecido pulpar após o capeamento pulpar direto, realizado durante a gestação. Este estudo experimental envolveu 48 primeiros molares superiores de ratos Wistar fêmeas. Os procedimentos foram realizados em animais prenhes e não prenhes (n=20). Após as exposições pulpares, o capeamento pulpar direto foi efetuado com agregado trióxido mineral (MTA) ou restauração direta com resina composta. Nos grupos controle (n=4), nenhuma intervenção foi realizada. Os animais foram submetidos à eutanásia após 3 e 7 dias. Todos os cortes foram avaliados através de um microscópio ótico. Um patologista previamente calibrado realizou analise histológica descritiva e estabeleceu escores para intensidade da resposta inflamatória e para o grau de organização tecidual na região adjacente à exposição pulpar. O valor de Kappa intra-examinador foi 0,91. No período experimental de 3 dias, nos animais tratados com MTA, o infiltrado inflamatório estava ausente nos não prenhes, enquanto infiltrado inflamatório moderado estava presente nos animais prenhes. A resposta inflamatória variou de moderada a severa em ambos os grupos tratados apenas com resina composta. Após o periodo experimental de 7 dias, a resposta inflamatória foi mais intensa nos animais prenhes que nos não prenhes do grupo do MTA, enquanto esta diferença não foi tão evidente nos animais que receberam capeamento pulpar direto com resina composta. Pode-se concluir, que a gestação pode não exercer influência no processo inflamatório do tecido pulpar após proteção pulpar direta com resina composta; a qual foi sempre danosa aos tecidos pulpares. No entanto, a resposta tecidual ao capeamento pulpar com MTA foi mais favorável nos animais não prenhes.

Influencia de la medicación intracanal con pasta de hidróxido de calcio en la penetración del cemento obturador / obturadorInfluence of intracanal medication with calcium hydroxide paste in the penetration of the shutter cement / Influência da medicação intracanal com pasta de hidróxido de cálcio na infiltração do cimento obturador

La eliminación del hidróxido de calcio en el conducto radicular es determinante para el éxito del tratamiento endodóntico, los remanentes pueden interaccionar negativamente con los selladores endodónticos aumen-tando las filtraciones y disminuyendo la calidad de la obturación. Objetivo: Evaluar el efecto de la medicación intraconducto con pasta de hidróxido de calcio en la penetración del cemento obturador en el interior de los túbulos dentinarios. Materiales y métodos: 20 raíces distales de molares superiores se instrumentaron uti-lizando el Sistema Wave One Large 40/.08. Se dividieron aleatoriamente en dos grupos: uno obturado con técnica de cono único y cemento Ah plus con rodamina-B y otro obturado con la misma técnica y cemento Ah plus con rodamina B, previa colocación por 15 días y remoción mediante recapitulación de la pasta de hidróxido de calcio. Posteriormente los dientes fueron cortados transversalmente y se realizaron fotomicro-grafías del tercio cervical, medio y apical a través de la técnica de microscopia confocal de barrido por láser. La profundidad máxima de penetración fue determinada a través del programa Image J. Resultados: El ce-mento sellador Ah plus presentó menores valores de penetración cuando fue empleada previamente la pasta de hidróxido de calcio como medicación intracanal (p<0,01). El tercio del conducto con mayor penetración fue el tercio cervical seguido por el tercio medio y por último el apical (p<0,01). Conclusión: Los remanentes de hidróxido de calcio disminuyen la penetración del cemento sellador Ah plus en los túbulos dentinarios en todos los tercios del conducto radicular.

The elimination of calcium hydroxide in the root canal is decisive for the success of endodontic treatment, the remnants can interact negatively with endodontic sealants increasing filtrations and decreasing the quality of the seal. Objective: To evaluate the effect of intra-duct medication with calcium hydroxide paste on the pen-etration of the sealing cement inside the dentinal tubules. Materials and methods: 20 distal roots of upper molars were instrumented using the Wave One Large 40 / .08 System. They were randomly divided into two groups: one sealed with a single cone technique and Ah plus cement with rhodamine-B and another sealed with the same technique and Ah plus cement with rhodamine B, previous placement for 15 days and removal by recapping the paste calcium hydroxide. Subsequently, the teeth were cut transversely and photomicro-graphs of the cervical, middle and apical third were performed using the laser scanning confocal microscopy technique. The maximum depth of penetration was determined through the Image J program. Results: The Ah plus sealing cement had lower penetration values when the calcium hydroxide paste was previously used as an intra-channel medication (p <0.01). The third of the duct with the highest penetration was the cervical third followed by the middle third and finally the apical (p <0.01). Conclusion: Remaining calcium hydroxide decreases the penetration of the sealing cement Ah plus in the dentinal tubules in all thirds of the root canal.

A eliminação do hidróxido de cálcio do canal radicular é determinante para o sucesso do tratamento endo-dôntico; os remanescentes podem interagir negativamente com os cimentos endodônticos, aumentando as filtrações e diminuindo a qualidade do selamento. Objetivo: Avaliar o efeito da medicação intracanal com pasta de hidróxido de cálcio na penetração do cimento de selamento no interior dos túbulos dentinários. Materiais e métodos: 20 raízes distais de molares superiores foram instrumentadas usando o sistema Wave One Large 40 /.08. Eles foram divididos aleatoriamente em dois grupos: um selado com técnica de cone único mais cimento Ah plus com rodamina-B e outro selado com a mesma técnica e cimento Ah plus com rodami-na-B, prévia colocação por 15 dias e remoção recolocação da pasta hidróxido de cálcio. Posteriormente, os dentes foram cortados transversalmente e fotomicrografias do terço cervical, médio e apical foram realizadas pela técnica de microscopia confocal de varredura a laser. A profundidade máxima de penetração foi de-terminada pelo programa Image J. Resultados: O cimento selante Ah plus apresentou menores valores de infiltração quando a pasta de hidróxido de cálcio foi utilizada anteriormente como medicamento intracanal (p <0,01). O terço do conduto com maior penetração foi o terço cervical, seguido pelo terço médio e finalmente o apical (p <0,01). Conclusão: O hidróxido de cálcio restante diminui a penetração do cimento selante Ah plus nos túbulos dentinários em todos os terços do canal radicular.

An experimental study of simvastatin-collagen composite sponge as a direct pulp capping material in rat molars / 华西口腔医学杂志

OBJECTIVE@#To assess the feasibility and efficacy of simvastatin-collagen composite sponge as a novel, direct pulp capping material.@*METHODS@#A total of 120 Sprague-Dawley rats were randomly divided into three groups: the simvastatin-collagen composite sponge group (SIM group), the collagen sponge group (CS group), and the Ca(OH)2 group (CH group). An endodontic entry cavity was prepared on the occlusion of the first molar on the left maxillary of each rat. The contralateral teeth were utilized as the normal control group. The rats were experimented after 1, 3, 7, 14, and 28 days. X-ray observations were conducted and the specimens underwent hematoxylin-eosin (HE) and Masson's Thichrome staining. Dentin bridge formations and pulpal biology reactions were evaluated histopathologically.@*RESULTS@#X-ray results: high-density images could be observed on the pulp exposure sites in the CH group on the 28th day. In the SIM group, high-density images could be observed after 14 and 28 days, whereas in the CS group, high-density images were not observable in the exposed area. HE and Masson's Thichrome staining results: different degrees of inflammation under the cavity were detected in the three groups at different time points. The inflammatory reaction of the CS group was the most serious. The degree of the inflammatory reaction varied significantly between the SIM and the CS groups on the 14th and 28th days (P<0.01). The inflammatory reaction in the SIM group was lighter than in the CH group. There was a statistical difference between the SIM and the CH groups on the 14th day (P<0.05). During the observation period, the SIM group induced the best and fastest formation of reparative dentin. As for dentin bridge formation, a significantly higher complete bridge rate was observed in the SIM group than in the CH and in the CS groups on the 14th day (P<0.05) and for the SIM and the CH groups compared with the CS group on the 28th day (P<0.05).@*CONCLUSIONS@#The simvastatin-collagen composite sponge exhibited satisfactory biocompatibility with the pulp tissue and promoted the formation of reparative dentin. The application of simvastatin-collagen composite sponge as a pulp-capping material has satisfactory potential.

Comparison of the Microleakage and Shear Bond Strength to Dentine of Different Tricalcium Silicate-based Pulp Capping Materials / 대한소아치과학회지

This study evaluated the microleakage of three restorative materials and three tricalcium silicate-based pulp capping agents. The restorative materials were composite resin (CR), resin-reinforced glass ionomer cement (RMGI), and traditional glass ionomer cement (GIC) and the pulp capping agents were TheraCal LC® (TLC), Biodentine® (BD), and ProRoot® white MTA (WMTA). Additionally, shear bond strengths between the pulp-capping agents and dentine were compared.Class V cavities were made in bovine incisors and classified into nine groups according to the type of pulp-capping agent and final restoration. After immersion in 0.5% fuchsin solution, each specimen was observed with a stereoscopic microscope to score microleakage level. The crowns of the bovine incisors were implanted into acrylic resin, cut horizontally, and divided into three groups. TLC, BD and WMTA blocks were applied on dentine, and the shear bond strengths were measured using a universal testing machine.The microleakage was lowest in TLC + GIC, TLC + RMGI, TLC + CR, and BD + GIC groups and highest in WMTA + RMGI and WMTA + CR groups. The shear bond strength of BD group was the highest and that of WMTA group was significantly lower than the others.

Traumatismos dentoalveolares: reporte de casos clínicos / Dentoalveolar trauma: report of clinical cases

Los traumatismos dentoalveolares que afectan a escolares pueden involucrar a los tejidos blandos y/o duros de las piezas primarias y permanentes jóvenes. Las causas por las que se producen son múltiples e incluyen caídas, accidentes en el hogar, actividad deportiva en el colegio o el club, accidentes de tránsito. El objetivo de este trabajo es presentar la resolución y el seguimiento a dos años de dos situaciones clínicas de traumatismos dentoalveolares en pacientes escolares que concurrieron a la Universidad de Buenos Aires, Facultad de Odontología, Odontología Integral Niños (AU)

Dentoalveolar trauma in schoolchildren can involve soft and/or hard tissues of deciduous and young permanent teeth. It has multiple causes, including falls, home accidents, sports accidents at school or at a club, and car accidents. The aim of the present work was to show treatmentand two-year clinical follow up of dentoalveolar trauma in schoolchildren seen at the Universidad de Buenos Aires, Facultad de Odontología, Odontología Integral Niños (AU)