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Histological observations of hard tissue barrier formation in amputated dental pulp capped with alpha-tricalcium phosphate containing calcium hydroxide.

This study was performed to evaluate the pulpal response to alpha-tricalcium phosphate (alpha TCP) containing calcium hydroxide (Ca(OH)2). The dental pulps of monkeys were amputated and dressed with four agents: alpha TCP, alpha TCP containing 1% Ca(OH)2, alpha TCP containing 5% Ca(OH)2, and Ca(OH)2 being used as a control. The pulpal responses were histologically evaluated after 4 and 8 weeks. The pulp tissue treated with alpha TCP proliferated above the level of the original wound surface, and a thin layer of hard tissue barrier was formed directly against the capping agent. The barrier demonstrated atubular matrix lined with flattened or cuboidal cells, but occasionally appeared irregular in form. Ca(OH)2 dressing resulted in destruction of pulp tissue, with a thick hard tissue barrier being formed below the level of the exposure site. The barrier consisted coronally of osteodentin and pulpally of tubular dentin lined with odontoblast-like cells. By contrast, 1% Ca(OH)2 added to alpha TCP produced a slight proliferation of pulp tissue. An atubular matrix barrier, pulpally lined with cuboidal cells, formed above the exposure site. It was later followed by the formation of tubular matrix lined with columnar cells. Teeth treated with 5% Ca(OH)2 showed a thin necrotic layer and a thick barrier formation. The barrier was composed of tubular dentin-like tissue lined with odontoblast-like cells. It would appear that alpha TCP containing a small amount of Ca(OH)2 may be clinically useful as a capping agent, as it induced consistent hard tissue formation, without excessive destruction of underlying pulp tissue.

Animals↗

Healing of primate dental pulps capped with Teflon.

The pulps of Rhesus monkey teeth were exposed and capped with three materials: Teflon, a commercial hard-set calcium hydroxide (Ca(OH)2) material, and Ca(OH)2 plus saline. Experimental test periods were 3, 10, and 21 days, and 5 and 8 weeks. After treatment, the teeth were removed and processed for routine histologic evaluation. Teeth treated with the two Ca(OH)2 materials showed resolution of the inflammatory response and hard tissue formation at the exposure site as early as 10 days postoperatively, with consistent healing at 21 days and longer. Teflon had a similar soft tissue healing pattern but at a slower rate. Hard tissue formation at the exposure site in the teeth treated with Teflon was infrequent at the early time periods and present in only 20% of the teeth treated for 5 and 8 weeks. By evaluating the soft and hard tissue responses of the Ca(OH)2-capped and Teflon-capped teeth it may be possible, in future studies, to identify events unique to odontoblast differentiation during pulpal healing.

Animals↗

Dental pulp capping: effect of Emdogain Gel on experimentally exposed human pulps.

AIM: To investigate the effect of Emdogain Gel (Biora AB, Malmo, Sweden), consisting of a enamel matrix derivative (EMD) in a propylene glycol alginate (PGA) vehicle, on experimentally exposed human pulps and to register postoperative symptoms. METHODOLOGY: Nine pairs of contralateral premolars scheduled for extraction on orthodontic indications were included. Following a superficial pulp amputation performed with a small (016) diamond bur, either EMDgel or a mix of calcium hydroxide and sterile saline was placed at random in contact with the pulp wound. The subjects made records of symptoms and were also interviewed about pain/discomfort by a blinded examiner. After 12 weeks the teeth were extracted, prepared and subjected to light microscopic examination in which the inflammation and newly formed hard tissue in the pulp were analysed. Immunohistochemistry was performed using affinity-purified rabbit anti-EMD polyclonal antibodies. RESULTS: Postoperative symptoms were less frequent in the EMDgel-treated than in the calcium hydroxide-treated teeth, especially during the first six weeks. In the EMDgel-treated teeth, new tissue partly filled the space initially occupied by the gel and hard tissue was formed alongside the exposed dentine surfaces and in patches in the adjacent pulp tissue. EMD was detected in the areas where new hard tissue had been formed. The wound area of the EMDgel-treated teeth exhibited inflammation in the majority of the teeth whereas less inflammation was seen in the calcium hydroxide-treated teeth where the hard tissue was formed as a bridge. CONCLUSIONS: In the EMDgel-treated teeth, postoperative symptoms were less frequent and the amount and pattern of hard tissue formation were markedly different than in the teeth treated with calcium hydroxide. However, the operative procedure and the formulation with EMD in a PGA vehicle do not seem to be effective for the formation of a hard tissue barrier.

Adolescent↗

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.

Animals↗

Pulp-capping.

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Dental Pulp Capping↗