Repair potential of biodentine in vital pulp therapies in mature permanent teeth: a narrative review / POTENCIAL REPARADOR DEL BIODENTINE EN TERAPIAS PULPARES VITALES EN DIENTES PERMANENTES MADUROS: UNA REVISIÓN NARRATIVA

Vital pulp therapy in dentistry seeks to treat lesions in the dental pulp caused by cavities, trauma or iatrogenic procedures. Its objective is to maintain the vitality and function of the pulp, restoring the continuity of the dentin, known as the dentinal bridge. The dentinal bridge is crucial for injury repair and promotes pulp healing. Stem cells from the dental pulp can differentiate into odontoblasts, responsible for the formation of reparative dentin. To achieve success in vital pulp therapy, factors such as the appropriate choice of biocompatible biomaterials that prevent bacterial infiltration and inflammatory reactions, as well as the response of the pulp to injury, must be considered. An emerging material is Biodentine, a dentin substitute based on calcium silicate that induces the formation of dentin bridges and has demonstrated effectiveness in the repair of the dentine-pulp complex. It acts through specific molecular pathways by inducing the differentiation of dental pulp stem cells. This narrative review aims to describe the restorative potential of Biodentine in vital pulp therapies in mature permanent teeth. Its ability to reduce pulp inflammation, differentiate stem cells, the mechanism of action for the formation of tertiary dentin and characteristics of the dentinal bridge were evaluated. The results indicate that Biodentine has anti-inflammatory properties and stimulates dentin regeneration, influencing cell differentiation and mineralization. To conclude, Biodentine shows broad reparative potential in vital pulp therapies in mature permanent teeth, reduction of pulp inflammation, great cellular bioactivity, differentiation, and high dentin quality.

La terapia pulpar vital en odontología busca tratar lesiones en la pulpa dental causadas por caries, traumatismos o procedimientos iatrogénicos. Su objetivo es mantener la vitalidad y función de la pulpa, restaurando la continuidad de la dentina, conocida como puente dentinario. El puente dentinario es crucial para la reparación de lesiones y promueve la cicatrización de la pulpa. Las células madre de la pulpa dental pueden diferenciarse en odontoblastos, responsables de la formación de dentina reparadora. Para lograr el éxito en la terapia pulpar vital, se deben considerar factores como la elección adecuada de biomateriales biocompatibles que prevengan la infiltración bacteriana y reacciones inflamatorias, así como la respuesta de la pulpa a la lesión. Un material emergente es el Biodentine, un sustituto de dentina basado en silicato de calcio que induce la formación de puentes de dentina y ha demostrado eficacia en la reparación del complejo dentino-pulpar. Actúa mediante vías moleculares específicas al inducir la diferenciación de células madre de la pulpa dental. Esta revisión narrativa tiene como objetivo describir el potencial reparador del Biodentine en terapias pulpares vitales en dientes permanentes maduros. Se evaluó su capacidad para reducir la inflamación pulpar, como de diferenciar células madre, el mecanismo de acción para la formación de dentina terciaria y características del puente dentinario. Los resultados indican que Biodentine tiene propiedades antiinflamatorias y estimula la regeneración dentinaria, influenciando la diferenciación celular y la mineralización. Para concluir, Biodentine muestra un amplio potencial reparador en terapias pulpares vitales en dientes permanentes maduros, reducción de inflamación pulpar, gran bioactividad celular, diferenciación, y alta calidad de dentina.

A terapia pulpar vital em odontologia busca tratar lesões na polpa dentária causadas por cáries, traumas ou procedimentos iatrogênicos. Seu objetivo é manter a vitalidade e função da polpa, restaurando a continuidade da dentina, conhecida como ponte dentinária. A ponte dentinária é crucial para a reparação de lesões e promove a cicatrização pulpar. As células-tronco da polpa dentária podem se diferenciar em odontoblastos, responsáveis ​​pela formação da dentina reparadora. Para obter sucesso na terapia pulpar vital, devem ser considerados fatores como a escolha adequada de biomateriais biocompatíveis que previnam infiltração bacteriana e reações inflamatórias, bem como a resposta da polpa à lesão. Um material emergente é o Biodentine, um substituto dentinário à base de silicato de cálcio que induz a formação de pontes dentinárias e tem demonstrado eficácia na reparação do complexo dentina-polpa. Atua através de vias moleculares específicas, induzindo a diferenciação de células-tronco da polpa dentária. Esta revisão narrativa tem como objetivo descrever o potencial restaurador do Biodentine em terapias pulpares vitais em dentes permanentes maduros. Foram avaliadas sua capacidade de reduzir a inflamação pulpar, diferenciar células-tronco, mecanismo de ação para formação da dentina terciária e características da ponte dentinária. Os resultados indicam que Biodentine possui propriedades anti-inflamatórias e estimula a regeneração da dentina, influenciando a diferenciação e mineralização celular. Concluindo, Biodentine apresenta amplo potencial reparador em terapias pulpares vitais em dentes permanentes maduros, redução da inflamação pulpar, grande bioatividade celular, diferenciação e alta qualidade dentinária.

Crown fractures in maxillary central incisors: 24 months follow-up and clinical outcome in children / Fracturas coronarias en incisivos centrales maxilares: seguimiento de 2 años y resultado clínico en niños

The purpose of this study is to present the results of a group of 5 patients from 7-12 years old for complicated and uncomplicated crown fractures in their maxillary central incisors. A cross sectional survey of series of 5 clinical cases was desined. Re-attachment of coronal fragments and composite restoration the affected teeth were performed. The patients have been recalled for 24 months follow-up period. All teeth to show adequate clinical and radiographic evolution. In relation to the aesthetic considerations, the outcome has been satisfactory. The treatment requires adequate knowledge about diagnosis, treatment plan and biological, aesthetical, functional and economic aspects. Currently, there is great evidence that pulp, restorative and aesthetic prognosis is good, and has improved in the last years. An immediate first emergency attention, to avoid and/or minimize risk of bacterial invasion through dentinal tubules to the pulp tissue should be performed.

El propósito de este estudio es mostrar los resultados de tratamiento por fracturas coronarias complicadas y no complicadas en incisivos centrales maxilares, en un grupo de 5 niños entre 7 y 12 años. Fue realizada una descripción de una serie de 5 casos. Los dientes afectados fueron restaurados con la técnica de reposición de fragmento y/o restauración coronaria con composite. Los pacientes han sido citados a control durante un periodo de seguimiento de 24 meses. Todos los dientes comprometidos han presentado una evolución clínica y radiográfica adecuada. Desde el punto de vista estético, el resultado lo consideramos satisfactorio. El adecuado tratamiento de esta patología, requiere necesariamente tener el conocimiento sobre aspectos de diagnóstico, planificación de tratamiento, aspectos biológicos, estéticos, funcionales y económicos. Actualmente existe una enorme evidencia que el pronóstico pulpar, restaurador y estético para esta patología es muy bueno, y que ha mejorado considerablemente en los últimos años. En condiciones ideales, es necesario realizar una atención de urgencia inmediata para evitar y disminuir el riesgo de invasión bacteriana del complejo dentino-pulpar.

Tooth transplantation after dental injury sequelae in children.

Ten immature autotransplanted lower premolars from six patients from 7 to 12 years of age were studied and assessed clinically and radiographically at Regional Clinical Hospital in Temuco between January 2004 and April 2006. All transplantations were performed both because of a missing anterior tooth by dental trauma or by healing complications after injuries. The mean age at the time of the surgery was 10 years (range 7-12 years) and the postoperative follow-up period varied from 5 to 27 months with a mean of 16.9 months. All teeth were stabilized with flexible composite resin wire splints. Within the follow-up period, clinical evaluation was made through percussion and mobility tests. At radiographic evaluation, pulpal canal obliteration (PCO), presence of perirradicular area, inflammatory root resorption (IRR), replacement resorption (RR), stage of root development, lamina dura formation, outline of the periodontal membrane, and arrest in root growth were registered. Pulp healing was observed in 6 of 10 teeth; the other transplanted teeth developed pulp necrosis after 6-8 months possibly related to operative aesthetic procedures. Four teeth showed different grades of PCO at radiographic examination. None of transplanted teeth developed replacement resorption or ankylosis. In this 27-month follow-up period, the survival rate was 100%, regarding aesthetics, function, clinical appearance, and radiographic image of alveolar process.

Conservative treatment of an ankylosed tooth after delayed replantation: a case report.

An 8-year-old boy sustained avulsion of his upper right maxillary central incisor and lateral luxation of his upper left maxillary incisors. Subsequently, the upper right maxillary central incisor developed replacement resorption, and both upper left maxillary incisors developed pulpal canal obliteration. In the ankylosed tooth, decoronation procedure was performed, and in the 44-month follow-up period the involved alveolar site showed vertical apposition of bone and continuing replacement resorption. Decoronation is a surgical procedure that allows preservation of the bone volume for the future, avoiding aesthetic disturbances and more aggressive treatments in cases where other therapeutic alternatives are not feasible.