Intentional replantation of a mandibular canine with multiple iatrogenic endodontic complications.

Teeth being exposed to multiple iatrogenic complications during root canal treatment are usually extracted and replaced with a dental implant. This case report presents the treatment of a mandibular canine that had multiple endodontic complications using an intentional replantation technique. The case was showing swelling and pain, unusual canal anatomy, periapical lesion, broken instruments, and root perforation in association with overfilling. After extraction of the root, the resected root end and perforation were sealed using mineral trioxide aggregate. The root was replanted extrusively, fixed and restored with a crown. Appearances of slowly progressing replacement resorption were detected radio graphically at 6-, 12- and 24-month recalls. The tooth was functioning successfully without showing clinical symptoms at 6-, 12-and 24-month recalls.

Response of human pulpal tissue to orthodontic extrusive applications.

The aim of this study was to investigate histologically the human pulp response to orthodontic extrusive force applications. In group 1, 20 teeth were extruded with the use of a fixed sectional orthodontic appliance. In group 2, 20 teeth were extruded by means of 1/4-inch 4.5-oz elastics. The test periods were 10 and 40 days. None of the teeth in the groups showed any inflammatory reactions or reparative dentin formation at the test periods. Five teeth from the elastics group and two teeth from the sectional appliance group showed large and numerous pulp stones in the serial sections (17.5% of all cases). Seven teeth from the sectional appliance group and two teeth from the elastics group showed odontoblast aspiration into the dentin tubules (22.5%). The results of the study showed that the extrusive forces applied in this study did not cause significant pathological changes in human pulp tissue.

Human pulp reaction to dentine bonded amalgam restorations: a histologic study.

OBJECTIVE: The aim of this study was to investigate the human pulp response to Scotchbond Multi Purpose Plus (SMPP) bonding agent in non-exposed Class V cavities. METHODS: SMPP was placed in 24 of 40 cavites according to manufacturer's instructions and the cavities were restored with amalgam. The remaining 16 cavities were capped with a calcium hydroxide formulation (Dycal) sealed with zinc-oxide eugenol, and restored with the amalgam. After extraction at 10 and 35 days, the teeth were fixed, sectioned and stained for light microscopy. RESULTS: All Dycal-capped teeth, at both 10 and 35 days, exhibited no pulp inflammation and no demonstrable bacteria. Six cases sealed with SMPP at 10 days showed no pulp inflammation or stained bacterial profiles. The remaining six teeth demonstrated mild to moderate inflammatory pulpal responses and five out of these six cases exhibited stained bacterial profiles. Nine out of 12 teeth showed no inflammatory pulp responses at 35 days, the remaining three cases exhibited mild to moderate pulp inflammation without stained bacteria. CONCLUSIONS: None of the teeth sealed with SMPP presented severe inflammatory pulpal reactions histologically. SMPP did not exhibit significant deleterious effects on the human pulp tissue during the test periods.

In vitro sealing ability of dentin bonding agents and cavity varnish with amalgam as retrofills.

The aim of this study was to test the effect on the seal produced by an amalgam retrofill of two dentin bonding agents (Amalgambond and All-Bond) and a cavity varnish (Copalite). The three materials were tested when placed before the retrofill (group I) and before and after the retrofill (group II). Ninety teeth distributed into three groups were prepared for the retrofilling. Each group was divided into subgroups of I and II. Linear apical leakage was measured by a stereomicroscope after 1 month in dye. All materials permitted dye leakage around the retrofill, regardless of the application type. No statistical difference was found between the Amalgambond subgroups or between the All-Bond subgroups. There was less leakage in varnish group I than group II. Amalgambond group I leaked significantly less than All-Bond group I.

Biocompatibility of various dental materials: pulp healing with a surface seal.

Class V cavities with mechanical exposures were prepared in 178 teeth of seven monkeys to observe the temporal healing of exposed pulps in direct contact with various dental materials, with or without a biologic seal of zinc-oxide eugenol cement against microleakage. Thirty pulps were direct capped as calcium hydroxide controls. The remaining 148 exposures were direct capped, 41 with silicate, 39 with zinc phosphate, 33 with amalgam, and 35 with an auto-cured composite. Sixty-four were restored to their cavosurface margin with their respective material and 84 were sealed to the covosurface margin with zinc-oxide eugenol cement. Tissues were obtained by perfusion fixation at intervals of 35, 21, 14, 10, 5, and 3 days, and then processed and evaluated. The results of this study demonstrated that exposed dental pulps possess an inherent healing capacity, allowing cell reorganization and dentin bridge formation when adequately sealed with zinc-oxide eugenol cement to prevent bacterial microleakage.

Tunnel defects in dentin bridges: their formation following direct pulp capping.

This study was conducted to observe the formation and nature of tunnel defects in dentin bridges, assess the nature of the associated soft tissue elements, and note the relationship of pulp inflammation and necrosis associated with these defects. A total of 235 teeth with class 5 cavity preparation exposures were randomly distributed throughout the dentitions of 14 adult rhesus monkeys. Each pulp was exposed and left open to the oral microflora at one of four time intervals, flushed with saline, debrided, capped with one of two hard-set calcium hydroxide medicaments [Ca(OH)2 (Dycal or Life)] and restored with a dispersed-phase amalgam alloy. Observation times were 14 days, 5 weeks, and 1 and 2 years. A total of 192 dentin bridges formed against the Ca(OH)2 medicaments Life or Dycal in 235 pulp-capped teeth. Considering all four capping periods, 89% of all dentin bridges contained tunnel defects (172 of 192). Forty-one percent (78) of the 192 dentin bridges were associated with recurring pulp inflammation or necrosis and were always associated with the presence of inflammatory cells and stained bacterial profiles. This study demonstrates that a statistically significant number of dentin bridges contain multiple tunnel defects, most of which appear to remain patent. These patent tunnels fail to provide a hermetic seal to the underlying pulp against recurring infection due to microleakage. Most Ca(OH)2 medicaments have been reported to disintegrate and wash out after 6 months, leaving a void underneath the restoration and thereby a pathway for bacterial infection. This study reemphasizes the need to employ biologically relevant measures that will provide a long-term clinical seal against microleakage following direct pulp capping with Ca(OH)2 medicaments alone.

Human pulp response after partial pulpotomy with two calcium hydroxide products.

Twenty human permanent teeth were used to study the pulpal response of two calcium hydroxide products, Dycal and Pulpdent Multi-Cal, after partial pulpotomy. Teeth were extracted at 4 months, fixed, and prepared for histologic examination. All 10 teeth treated with Dycal showed complete soft tissue healing and bridge formation. No stained bacteria were seen throughout the serial sections. One tooth treated with Dycal showed acceptable histologic results, dentin deposition in the root canal. Six cases dressed with Pulpdent Multi-Cal showed acceptable histologic results, whereas four teeth showed severe inflammation or necrosis associated with bacterial penetration into the pulp tissue. Clinically, one tooth treated with Pulpdent Multi-Cal showed pulpal pain and was extracted at 90 days. Our data support the thesis that human permanent pulps will promote tissue healing and dentin bridge formation as long as bacterial microleakage is excluded.

Human pulpal response to hydroxyapatite and a calcium hydroxide material as direct capping agents.

Forty maxillary and four mandibular first premolars that were to be extracted for orthodontic reasons were used in this study to evaluate human pulpal response to hydroxyapatite and Dycal as direct capping materials. After the postoperative periods of 2 days, 30 days and, 60 days, teeth were extracted and prepared for the histologic examination. The results of this study showed that hydroxyapatite does not induce hard tissue bridging at the exposure site in human dental pulp. No hard tissue bridging at the exposure site was observed in any of the teeth capped with hydroxyapatite. Moderate infiltration of the inflammatory cells was seen generally in the teeth capped with hydroxyapatite. However, this study has verified that exposed human dental pulp will heal under Dycal application with hard tissue bridging and with none or minimal inflammatory response.