Pulpotomy reconsidered: application of an adhesive system to pulpotomized permanent primate pulps.

OBJECTIVE: This study was undertaken to compare the healing response of permanent primate pulps to pulpotomy procedures following hemorrhage control and adhesive hybridization to their response after conventional treatments. METHOD AND MATERIALS: Forty-two cavities were placed throughout the dentitions of 4 adult monkeys. In 24 teeth, following mechanical bur exposure and pulpotomy, hemorrhage was controlled with application of 3% sodium hypochlorite. The cavity was rinsed and the enamel-dentin-pulp surface was restored with an adhesive system for 6 and 7 months. Calcium hydroxide, formocresol, and resin-modified glass-ionomer cement were placed as conventional treatments in 18 teeth for 70 days and cavities were sealed with resin-modified glass-ionomer cement. Following perfusion fixation, tissues were demineralized, sectioned, stained, and histologically graded using defined criteria. RESULTS: Of 24 adhesive system pulps, 10 showed no or minimal pulpal response, 1 showed an acute response, 6 showed a chronic response, 2 showed a severe response, and 5 showed compartmentalized zones of localized necrosis. Only 8 adhesive system pulps showed stained bacteria associated with inflamed tissues. Thirteen adhesive system pulps showed dentin bridging directly at the adhesive system interface. Calcium hydroxide-treated specimens showed healing and dentin formation, while resin-modified glass-ionomer cement and formocresol treatments failed to result in any bridging. Apical tissues in all adhesive-treated specimens showed normal pulps and primary odontoblasts along their entire walls. CONCLUSION: Permanent pulps without periapical radiolucencies may survive pulpotomy, provided that hemorrhage is properly controlled and the pulp-restoration interface is hybridized to exclude all microleakage.

The pulp capping procedure in primary teeth "revisited".

The purpose of this review is to "revisit" an earlier paper (1992) on the subject of direct pulp capping in primary teeth and bring some new considerations for the procedure by the use of dentin bonding adhesives. It has come to be recognized that the customary employment of calcium hydroxide for this therapy has some shortcomings that reduce the prognosis for a favorable outcome. For at least a decade, many investigations have found that postoperative sensitivity, thermal stimuli, pulp inflammation and pathosis can be attributed not to the composition of various dental materials and their insertion techniques, but to microleakage with subsequent bacterial invasion at the enamel/restoration and the dentin/pulp interfaces. It is imperative, as pointed out, that there be an impervious resinous bond between the dentin and the dentinopulpal complex which can be achieved by the use of dentinal adhesive agents to eliminate microleakage outward movement of pulpal fluids. Various steps in the bonding technique for the treatment of deep dentin caries and/or a pulp exposure has raised some concerns for their effect on the pulp. This review discusses these concerns, which can lead to the conclusion that the use of dentinal bonding adhesives is a safe and biologically feasible procedure, whether it be in permanent or primary teeth.

Shear bond strength of repaired glass ionomers.

This in vitro study investigated repairs to glass ionomer cements (GIC) with a new GIC layer added after different time intervals (15 minutes, 24 hours, 6 days) and after different types of surface treatments. The results indicated: 1) GIC can be repaired with a new GIC layer added on with specific types of surface treatment. The shear bond strength created at the interface attained no less than 65% of the value for unrepaired specimens; 2) The surface treatment that best enhances the bond was either 20 seconds of etching with phosphoric acid or roughening the surface followed by acid etching. The latter showed higher values but not at a statistically significant level; 3) Both Ketac-Fil and Fuji II provided high bond strengths when the repair occurred on a newly set surface (15 minutes); 4) When Ketac-Fil and Fuji II specimens were repaired at 24 hours, shear bond strength was lower compared to the repair bond strength at 15 minutes and demonstrated less cohesive ability; 5) When 6-day-old specimens were repaired, Fuji II provided higher bond strength values than Ketac-Fil.

Considerations for the direct pulp capping procedure in primary teeth: a review of the literature.

In reviewing the various studies concerning the direct pulp capping procedure in primary teeth, using rigid criteria for case selection and procedure appears to insure a significant amount of success. It is acknowledged that vital primary pulp tissue is capable of healing without resorting to complete pulpectomy, although statistically direct pulp capping has been found to be less successful in primary teeth than indirect pulp therapy or coronal amputation (pulpotomy). To achieve success for direct pulp capping in primary teeth, the considerations involve: selecting teeth with minimal or no clinical signs of pulpal inflammation; or pretreating the carious tooth with a sedative restoration before excavating the caries; disinfecting the cavity floor; enlarging the actual exposure, and flushing out dentinal debris with mild solutions; controlling bleeding by not allowing a clot to form; placing a hard-set, CaOH material over the exposure, followed by a fast-setting, zinc oxide-eugenol cement to achieve a hermetic seal; and lastly, placing a stainless steel crown to minimize microleakage and prevent a fractured or defective restoration. These procedural steps can hardly ensure complete success in direct pulp capping of a primary tooth; but, based on the many cited investigations in this review, a significant amount of success can be expected without resorting more frequently to invasive techniques. Surely the evidence presented leading to the feasibility of direct pulp capping in primary teeth merits further investigations, before dogmatically rejecting this procedure of pulp therapy.

Pediatric dentistry and the child with asthma.

A child with asthma who needs dental treatment can be a source of concern to the pediatric dentist. Recent studies have provided a better understanding of the pathophysiology of asthma as well as the role of emotions in the expression of asthma. The goal in managing the patient with asthma is to prevent an acute asthmatic episode during the dental procedure. Suggestions are made to meet this goal. Asthma does not require alteration of routine dental practices and, most importantly, the well-managed child with asthma does not need special treatment when it comes to possible behavior problems in the dental office.

A dental library current awareness service.

A simple, manual current awareness service at the University of Southern California School of Dentistry, designed to provide the user with photocopied tables of contents from selected journals, is described. Other available current awareness and selective dissemination of information services are discussed, and a general comparison and cost analysis is made between the USC program and SDILINE. The service was evaluated by means of a questionnaire distributed to the 30 faculty participants. Results indicate that the service is of value in the teaching and research programs of the school, and has a high degree of user acceptance. Cost of the service is minimal considering the benefits to the faculty.

The retentive ability of various cementing agents for polycarbonate crowns.

The following conclusions may be made within the limitations of this investigation. - A composite resin processed directly against a roughened stainless steel dye, similar in shape to a primary anterior tooth, which has been shaped to receive a polycarbonate crown, shows the highest retentive force measured in pounds per square inch (psi). - A polmethacrylate resin, when used as a cement, also shows high values, probably due to its ability to unite chemically with polycarbonated acrylic and to its low film thickness. - Composite resins of low viscosity, low film thickness, and high compressive and tensile strengths proved also to provide good retentive values and would contribute insolubility to a greater degree than the unfilled resin. - Polycarboxylate, zinc phosphate, and reinforced zinc oxide-eugenol cements are not to be recommended as agents for cementing polycarbonate crowns. - It can be recommended on the basis of retention only, composite crowns should be fabricated directly onto the tooth preparations of carious primary anterior teeth.