Comparison between calcium hydroxide mixtures and mineral trioxide aggregate in primary teeth pulpotomy: a randomized controlled trial

Abstract Objectives: To evaluate the effect of calcium hydroxide (CH) associated with two different vehicles as a capping material for pulp tissue in primary molars, compared with mineral trioxide aggregate (MTA). Methodology: Forty-five primary mandibular molars with dental caries were treated by conventional pulpotomy using one of the following materials: MTA only (MTA group), CH with saline (CH+saline group) and CH with polyethylene glycol (CH+PEG group) (15 teeth/group). Clinical and periapical radiographic examinations of the pulpotomized teeth were performed 3, 6, and 12 months after treatment. Data were tested by chi-squared analysis and a multiple comparison post-test. Results: The MTA group showed both clinical and radiographic treatment success in 14/14 teeth (100%), at all follow-up appointments. By clinical evaluation, no teeth in the CH+saline and CH+PEG groups had signs of mobility, fistula, swelling or inflammation of the surrounding gingival tissue. However, in the CH+saline group, radiographic analysis detected internal resorption in up to 9/15 teeth (67%), and inter-radicular bone resorption and furcation radiolucency in up to 5/15 teeth (36%), from 3 to 12 months of follow-up. In the CH+PEG group, 2/11 teeth (18%) had internal resorption and 1/11 teeth (9%) presented bone resorption and furcation radiolucency at all follow-up appointments. Conclusion: CH with PEG performed better than CH with saline as capping material for pulpotomy of primary teeth. However, both combinations yielded clinical and radiographic results inferior to those of MTA alone.

Dental Pulp Regeneration: Insights from Biological Processes / Regeneración pulpar: Perspectivas desde los procesos biológicos

Abstract One of the major approaches on dental research in this century is the development of biological strategies (tissue engineering) to regenerate/biomineralize lost dental tissues. During dentin- pulp regeneration, the interaction between stem cells, signaling molecules, biomaterials and the microenvironment in the periapical area drives the process for pulp tissue engineering. Understanding the signaling mechanisms and interactions involved with the biological process for the formation of a new tissue is essential. The knowledge of the micro-environment is the key for the application of tissue engineering. The present article is a short review of the current state of this topic, with the purpose of showing insights of pulp regeneration.

Resumen Actualmente la investigación en odontología se orienta al desarrollo de estrategias basadas en principios biológicos (ingeniería de tejidos) para la regeneración/biomineralización de estructuras dentales perdidas. El proceso de regeneración del complejo dentino-pulpar está guiado por la compleja interacción entre las células indiferenciadas de origen dental (DTSC), moléculas de señalización y biomateriales con el microambiente donde se va a restablecer. Es esencial comprender detalladamente, los mecanismos de señalización e interacciones involucradas en los procesos biológicos para la formación de un nuevo tejido, además de la identificación de los componentes presentes en los tejidos dentales implicados en este proceso (características del microambiente), ya que representan la base sobre la cual se debe emplear la ingeniería de tejidos. El presente articulo es una breve revisión del estado actual del tema, con el fin de entender el proceso de regeneración pulpar, basado en la comprensión de los fundamentos biológicos.

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.

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.

Tenascin and Fibronectin Expression after Pulp Capping with Different Hemostatic Agents: A Preliminary Study

This study investigated the expression of extracellular matrix glycoproteins tenascin (TN) and fibronectin (FN) in pulp repair after capping with calcium hydroxide (CH), following different hemostasis protocols. Class I cavities with a pulp exposure were prepared in 42 human third molars scheduled for extraction. Different hemostatic agents (0.9% saline solution, 5.25% sodium hypochlorite and 2% chlorhexidine digluconate) were used and pulps were capped with CH cement. After 7, 30 or 90 days, teeth were extracted, formalin-fixed, and prepared for immunohistochemical technique. Hemostatic agents did not influence the expression of TN and FN. Both glycoproteins were found in the entire the pulp tissue and around collagen fibers, but were absent in the mineralized tissues. In the predentin, TN showed positive immunostaining and FN had a variable expression. Within 7 days post-treatment, a slightly more pronounced immunostaining on the pulp exposure site was observed. Within 30 days, TN and FN demonstrated a positive expression around the dentin barrier and at 90 days, a thin and linear expression of TN and FN was delimitating the reparative dentin. In conclusion, hemostatic agents did not influence TN and FN expression. Immunostaining for TN and FN was seen in different regions and periods, demonstrating their role in pulp repair.

Este estudo investigou a expressão das glicoproteínas Tenascina (TN) e Fibronectina (FN) da matriz extracelular no reparo pulpar após capeamento com hidróxido de cálcio (HC), seguindo diferentes protocolos de hemostasia. Cavidades de classe I com exposição pulpar foram preparadas em 42 terceiros molares humanos indicados para extração. Diferentes agentes hemostáticos (solução salina a 0,9%, hipoclorito de sódio a 5,25% e clorexidina a 2%) foram usados e as polpas foram capeadas com cimento de HC. Após 7, 30 ou 90 dias, os dentes foram extraídos, fixados em formalina e preparados para análise imunoistoquímica. Os agentes hemostáticos não influenciaram a expressão de TN e FN. Ambas glicoproteínas foram encontradas em todo tecido pulpar, ao redor das fibras colágenas e estiveram ausentes nos tecidos mineralizados. Na pré-dentina, a TN mostrou forte imunoexpressão e a FN teve uma expressão variável. Após 7 dias, foi observada uma expressão levemente mais pronunciada no lugar da exposição pulpar. Aos 30 dias, a TN e a FN demonstraram uma expressão mais forte sob a barreira dentinária e aos 90 dias, uma expressão fina e linear da TN e FN apresentava-se delimitando a dentina reparativa. Em conclusão, os agentes hemostáticos não influenciaram e expressão da TN e da FN. A imunoexpressão da TN e FN foi observada em diferentes regiões e períodos, demonstrando o seu papel no reparo pulpar.

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

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.