A Systematic Review Comparing Mineral Trioxide Aggregate to Other Commercially Available Direct Pulp Capping Agents in Dogs.

Vital pulp therapy (VPT) and direct pulp capping (DPC) are procedures regularly performed in dogs for the management of acute tooth fractures and as part of management for traumatic malocclusions. The purpose of this review is to apply an evidence-based medicine approach to systematically review and evaluate the scientific literature evaluating the efficacy of mineral trioxide aggregate (MTA) to other commercially available materials used for VPT in the permanent teeth of dogs. The 9 studies meeting inclusion criteria were reviewed and each studies evidence was classified using a grading system modified from the Oxford Centre for Evidence-Based Medicine. For the studies meeting inclusion criteria, MTA consistently performed as well or better than other commercially available products in terms of calcific barrier formation and biocompatibility. This review found a lack of consistency between the studies making a direct comparison of the results unreliable. Future studies would benefit from the implementation of a standard scoring system for histology, equivalent and longer study duration times and the correlation of histological and radiographic data.

A histologic assessment of a HYBENX® oral tissue decontaminant in vital pulp therapy in dogs.

The aim of this study was to assess HYBENX® Oral Tissue Decontaminant (HOTD) in treating vital pulp exposure in a canine model. The use of HOTD solution was compared to an accepted and standard regimen for vital pulp exposure, an application of a commercial calcium hydroxide product (Ca(OH)2). Both control and experimental treatments were followed by restoration with a commercial zinc oxide and eugenol obtundant intermediate restorative material and thermal insulator (ZOE). At 7 days there was 100% pulp vitality with HOTD and 50% with Ca(OH)2. New dentin formation was seen in 62.5% of the HOTD treated pulps and none of the Ca(OH)2 treatment group. The vital pulp exposures at day 21 post treatment with HOTD also showed significant improvement over Ca(OH)2 in the presence of odontoblasts, new dentin formation and pulp survivability. The presence of odontoblasts and new dentin was noted in 71% of the HOTD cases versus 50% of the survivable Ca(OH)2 cases. Furthermore, 100% of HOTD cases had vital pulps versus 62.5% of Ca(OH)2 cases. The 60-day specimens of both experimental and control techniques exhibited histologically similar appearances and were similar in outcomes. HOTD treatment at day 7 showed a significant positive difference, both in the formation of new dentin and tooth vitality. HOTD proved better for the post 21-day specimens and equivalent for the 60-day pulp specimens with no evidence of untoward tissue reactions or results.

Análisis morfométrico del número de odontoblastos en recubrimientos directos con hidróxido de calcio y propóleos en canes / Morphometric analysis of odontoblasts number in direct capping with calcium hydroxide and propolis in dogs

El propóleos se ha utilizado en medicina desde épocas antiguas, una de sus indicaciones en medicina oral y odontológica es como material de recubrimiento directo. Así, el objetivo de este estudio fue cuantificar la neoformación odontoblástica en piezas dentarias de canes en recubrimientos directos. Se realizaron perforaciones en un total de 12 piezas dentarias, la mitad de las cuales fueron recubiertas con propóleos y la otra mitad con hidróxido de calcio. En todos los casos se obturaron las piezas dentarias con cemento de vidrio-ionómero. Al cabo de dos semanas, se realizaron las extracciones de las piezas dentarias, fijándolas en formalina tamponada; se efectuaron cortes histológicos de las piezas, los cuales se tiñeron con hematoxilina-eosina, con el fin de poder realizar la cuantificación de los núcleos odontoblásticos presentes tanto en las zonas alejadas de la perforación, como en las zonas cercanas a las lesiones. Se observó una similar actividad odontoblástica en las zonas cercanas a las lesiones al utilizar cualquiera de los dos materiales (p=0,9325), diferenciándose solamente en la disposición de las células neoformadas, que en el caso de utilizar propóleos fueron en empalizada, semejante a las zonas sanas, en cambio, al utilizar hidróxido de calcio no se observó dicho ordenamiento.

Since ancient times, propolis has been used in medicine, while in oral medicine and dentistry it has been indicated as a direct capping material.The aim of this study was to quantify the odontoblast activity in drilling holes on dog's teeth (canine and incisor) during direct capping.Perforations were carried out in a total sample of 12 dental pieces. In half of the sample teeth were capped with propolis, and in the other half with calcium hydroxide. In all cases teeth were obturated with glass ionomer cement. Extraction of the teeth was realized after two weeks, and teeth were fixed in buffered formalin. Histological cuts of the pieces were made and stained with hematoxylin-eosin in order to carry out quantification of nuclei presence in healthy areas (away from the perforation, as well as in areas adjacent to injuries. Results showed similar odontoblast activity while using either of the materials, (p=0.9325), only differing in the arrangement of newly formed cells which in the cases where propolis was used, were palisading, similar to healthy areas. On the other hand, the same order was not observed when calcium hydroxide was used.

Characterization of dental pulp defect and repair in a canine model.

PURPOSE: To explore a relationship between the size of pulp chamber perforation and reparative dentin formation in a canine model. METHODS: Pulp defects were created in the pulp chambers of maxillary and mandibular premolars (N = 64) in 17 healthy mongrel dogs in three different sizes (diameter/depth: 1/1, 2/1, and 2/2 mm3) with sterile round burs under general anesthesia. The perforations were immediately capped with hard-setting calcium hydroxide (CH) in the control group or sealed with Teflon membrane (TM) in the experimental group, followed by restoration with reinforced zinc oxide eugenol cement in vivo. Seven and 30 days after pulp chamber perforation and restoration all treated and control premolars were extracted and prepared for histomorphometric and statistical analyses. RESULTS: Reparative dentin formation was more pronounced for defect sizes up to 2/1 mm3 when treated with CH, and completely bridged the surgically created dentin defects only after 30 days. However, reparative dentin upon CH treatment failed to completely bridge pulp chamber exposure for 2/2 defects. By contrast, TM treatment only yielded mild reparative dentin bridging for defects up to 1/1, but not for either 2/1 or 2/2 defects at 30 days. Inflammatory responses of the exposed dental pulp tissue were more robust with the TM group than with the CH group. Thus, dental pulp tissue possesses a capacity for spontaneous repair by the formation of reparative dentin in this preclinical model, but only up to a defect size of -2 mm in diameter and 1 mm in depth. All observations are based on 30 days post-treatment in the canine model. These findings may serve as baseline for regenerative endodontic studies.

Vital pulp therapy for complicated crown fracture of permanent canine teeth in dogs: a three-year retrospective study.

A 36-month retrospective study compared the results of vital pulp therapy based on the duration of pulp exposure for complicated crown fracture of 97 permanent canine teeth in 76 dogs. Postoperative oral and radiographic examinations were performed at 3, 12, and 36-months following treatment. Based on the 36-month postoperative examinations 88.2%, 41.4 %, and 23.5% of teeth were vital when treated within 48-hours, 1-week, and 3-weeks of pulp exposure, respectively. There was a significant difference in the incidence of tooth vitality between groups. The duration of pulp exposure following complicated crown fracture influenced the success of vital pulp therapy. Vital pulp therapy should be performed as soon as possible following traumatic pulp exposure.

Assessment of vital pulp therapy for nine complicated crown fractures and fifty-four crown reductions in dogs and cats.

Subjective owner assessment of the success of vital pulp therapy was performed for complicated crown fracture (n = 9) and crown reduction (n = 54) of canine teeth in dogs and cats. Our results documented that owners are not able to accurately determine the outcome of vital pulp therapy. Objective assessment of vital pulp therapy for teeth receiving crown reduction indicated maintenance of vitality in 28 of 28 (100%) teeth. Subjective and objective assessments of vital pulp therapy performed > 7-days following complicated crown fracture indicated 9 of 9 (100%) teeth were non-vital. A poor prognosis for maintenance of tooth vitality is warranted for vital pulp therapy of complicated crown fractures with prolonged pulp exposure regardless of the age of the patient. Whereas, an excellent prognosis can be provided for vital pulp therapy following crown reduction. Semiannual, postoperative oral and radiographic examinations are recommended for a minimum of 2-years to assess vitality in all teeth receiving vital pulp therapy.

Defence reaction in dental pulp after pulp capping and partial pulpectomy in dogs.

The dental pulp was capped indirectly or directly, or partial vital pulpectomy was performed on the 12 functionally most important teeth of 24 beagle dogs. For pulp capping, calcium hydroxide was used, followed by zinc phosphate as a lining, and the preparation was restored with amalgam or composite material. Histological sections were prepared and examined for degree and type of pulp inflammation (hyperaemia, pulpitis, necrosis or gangrene). Degenerative changes of dental pulp (vacuolation, calcification, amyloid or hyaline changes) were also determined. For indirect pulp capping the width of predentine in crown and root dental pulp was measured, and for direct pulp capping and partial pulpectomy (vital pulpotomy) the width and quality of the dentinal bridge were graded. The radical method of partial vital pulpectomy of the coronal part of the dental pulp in dogs produced better quality and continuity of the dentinal bridge than the less radical method of direct pulp capping. This was particularly obvious in small single root teeth such as incisors.

Hidróxido de cálcio: uma revisäo crítica / Calcium hydroxide: critical review

Desde sua introduçäo por Hermann em 1930 (30), os produtos à base de hidróxido de cálcio têm sido extensivamente utilizados em Odontologia, sendo suas principais aplicaçöes em Endodontia, como forrador cavitário e como agente de capeamento pulpar. Tamanha utilizaçäo é talvez justificada por propriedades positivas deste material, como seu poder bacteriostático e bactericida, assim como sua açäo "estimulante" de neoformaçäo dentinária relatada em muitos trabalhos. Entretanto, o hidróxido de cálcio é um material muito solúvel, näo possui qualquer adesäo à estrutura dentária e é incapaz de prover um selo hermético à cavidade, propriciando com isso os malefícios provenientes da microinfiltraçäo. Além disso, sua açäo bactericida, sua participaçäo na formaçäo de dentina esclerosada e seu mecanismo de açäo na estimulaçäo da formaçäo de ponte de dentina nunca foram bem esclarecidos, continuando objeto de controvérsia. A intençäo desta revisäo é discutir a validade da utilizaçäo do hidróxido de cálcio como material forrador e como agente de capeamento pulpar, mostrando seus pontos críticos e sugerindo melhores alternativas de tratamento

Feline endodontics.

One misconception in veterinary medicine is that fractured teeth do not need to be treated, or treatment should consist of extraction only. Two common causes of endodontic disease in the cat are fractures and secondary to cervical line lesions. Endodontic technique can be useful in returning a diseased tooth to normal, pain-free function. Conventional endodontics can be used to treat fractured canine teeth or partially destroyed molars. Surgical endodontics is useful in cases in which an apical seal cannot be established by conventional methods. Pulp capping can preserve a vital tooth as an alternative to extraction.

Endodontics.

It is known that pets with broken teeth or teeth with other diseases of the pulp suffer considerable pain and frequent infection. To ignore these problem teeth would not only be inhumane, it would risk chronic infection, abscessation, and tooth loss. Although extraction of these teeth is sometimes necessary, the procedure is often difficult to perform and painful for the animal. The resultant tooth loss is cosmetically displeasing and, frequently, there is compromise in function. The endodontic treatment of these teeth, on the other hand, is relatively easy to perform. It almost always results in immediate cessation of pain and will usually allow the tooth to remain functional for the lifetime of the pet.

Restorative dentistry.

The author considers materials, methods, and techniques used in restorative dentistry. Information about components of cavity preparation, common equipment for restorative work, restorative materials, enamel bonding technique, pin retention, and indirect and direct pulp capping is presented.

A rapid procedure for shortening canine teeth of nonhuman primates.

A modified pulp cap procedure was utilized to shorten canine teeth of nonhuman primates. A temporary cap was made by cutting the tooth with a diamond-faced cutting disc, making a conical cavity in the tooth with a carbide dental burr, and filling the cavity with a rapid-hardening filler material. A permanent pulp cap was made by repeating the above technique, making three anchor holes, connecting the holes with a furrow, and capping with quick-setting dental restorative material or amalgam. These procedures provided a simple, rapid and uncomplicated alternative to canine tooth extraction.

Pulpotomy as an alternative to canine tooth extraction in monkeys [Macaca mulatta].

An effective method for sealing pulp canals after partial removal of canine tooth crowns from adult rhesus monkeys is described.