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PubMed1991

Electron microscope characteristics of dentin repair after hydroxylapatite direct pulp capping in rats.

In order to study the osteogenic action of hydroxylapatite (HA) on the dental pulp, a pulp capping experiment was designed using the rat upper molar. Under general anesthesia, molar teeth in 14 male Sprague-Dawley rats were pulp capped with Osteogen (HA) or with Dycal as a control material. After pulp capping, the maxillary molars cavities were restored with amalgam and a pedodontic steel crown was adjusted and sealed over the molar teeth on either side of the maxilla. After 7 days, the areas of necrosis and acute inflammation were more evident in the pulps treated with Dycal than with Osteogen. Hard tissue formation began to appear around dentinal chips in the pulp and extended from the cavity walls into the pulp regardless of the material that was used. Furthermore, this calcified material was scattered throughout the pulp when Osteogen was used, but was not observed in the Dycal treated pulps. The hard tissue formation was thought to be due to the putative fibroblasts and odontoblasts found in the pulp. After 28 days dense dentinal tissue was observed bridging the exposure site when Dycal was used. The dentinal tissues formed with Osteogen was always of a globular type, and showed an irregular distribution. Since Osteogen tends to cause areas of dystrophic calcification in the pulp, its use is not be recommended for pulp capping purposes in humans, because these areas of calcification would make future endodontic treatment difficult.

Animals↗
PubMed2000

Biocompatibility of a resin-modified glass-ionomer cement applied as pulp capping in human teeth.

PURPOSE: to evaluate the human pulp response following pulp capping with calcium hydroxide (CH, Group 1), and the resin-modified glass-ionomer Vitrebond (VIT, Group 2). MATERIALS AND METHODS: Intact teeth with no cavity preparation were used as control Group (ICG, Group 3). Buccal Class V cavities were prepared in 34 sound human premolars. After exposing the pulps, the pulp capping materials were applied and the cavities were filled using Clearfil Liner Bond 2 bonding agent and Z100 resin-based composite. The teeth were extracted after 5, 30, and from 120 to 300 days, fixed in 10% buffered formalin solution, and prepared according to routine histological techniques. 6-microm sections were stained with hematoxylin and eosin, Masson's trichrome, or Brown & Brenn technique for bacterial observation. RESULTS: At 5 days, CH caused a large zone of coagulation necrosis. The mononuclear inflammatory reaction underneath the necrotic zone was slight to moderate. VIT caused a moderate to intense inflammatory pulp response with a large necrotic zone. A number of congested venules associated with plasma extravasation and neutrophilic infiltration was observed. Over time, only CH allowed pulp repair and complete dentin bridging around the pulp exposure site. VIT components displaced into the pulp tissue triggered a persistent inflammatory reaction which appeared to be associated with a lack of dentin bridge formation. After 30 days a few histological sections showed a number of bacteria on the lateral dentin walls. In these samples the pulp response was similar to those samples with no microleakage. VIT was more irritating to pulp tissue than CH, which allowed pulp repair associated with dentin bridge formation. These results suggested that VIT is not an appropriate dental material to be used in direct pulp capping for mechanically exposed human pulps.

Adolescent↗
PubMed2005

[Development of a visible light-curing calcium hydroxide cement].

A visible light-curing calcium hydroxide cement is presented here and the effects of its resin matrix on the Ca2+ releasing, compressive strength of set material and the pH value of water in which set materials immersed are evaluated. Experimental results show that the effects of the selected resin matrix on Ca2+ releasing, compressive strength and pH value are significant. The calcium hydroxide cement containing BEMA or EMA and HEMA as resin matrix has good properties. The pulp capping test showed that an excellent dentin bridge appeared in dogs capped teeth at 70 days. pulp, pulp capping, calcium hydroxide, visible light-curing, dental materials

Animals↗
PubMed2001

Application of bioactive molecules in pulp-capping situations.

To evaluate the effects of bioactive molecules in pulpal wound healing, we carried out experiments using the rat upper molars as an in vivo model. Cavities were prepared on the mesial aspect, and pulp perforation was accomplished by the application of pressure with the tip of a steel probe. After the pulp-capping procedure, the cavities were filled with a glass-ionomer cement. Comparison was made between and among: (1) sham-operated controls with dentin and predentin fragments implanted in the pulp during perforation after 8, 14, and 28 days; (2) carrier without bioactive substance; (3) calcium hydroxide; (4) Bone Sialoprotein (BSP); (5) different concentrations of Bone Morphogenetic Protein-7 (BMP-7), also termed Osteogenic Protein-1 (OP-1); and (6) N-Acetyl Cysteine (NAC), an anti-oxidant agent preventing glutathione depletion. Histologic and morphometric comparison, carried out among the first 4 groups on demineralized tissue sections, indicated that, at 28 days after implantation, BSP was the most efficient bioactive molecule, inducing homogeneous and well-mineralized reparative dentin. BMP-7 gave reparative dentin of the osteodentin type in the coronal part of the pulp, and generated the formation of a homogeneous mineralized structure in the root canal. These findings indicate that the crown and radicular parts of the pulp bear their own specificity. Both BSP and BMP-7 were superior to calcium hydroxide in their mineralization-inducing properties, and displayed larger areas of mineralization containing fewer pulp tissue inclusions. The overall mineralization process to these molecules appeared to proceed by mechanisms that involved the recruitment of cells which differentiate into osteoblast-like cells, producing a mineralizing extracellular matrix. We also provide preliminary evidence that NAC induces reparative dentin formation in the rat molar model. Pulp-capping with bioactive molecules provides new prospects for dental therapy.

Acetylcysteine↗
PubMed1995

Histologic evaluation of tetracalcium phosphate-based cement as a direct pulp-capping agent.

Histologic healing processes were observed at 1, 3, 7, and 10 days after application with either tetracalcium phosphate cement or calcium hydroxide cement to the exposed pulp of the rat maxillary incisors. In teeth applied with calcium hydroxide cement, necrotic tissue was present beneath the cement before new hard tissue formed. In contrast, tetracalcium phosphate cement elicited a dentine bridge formation with no evidence of either intervening tissue necrosis or marked inflammation. Furthermore on ultrastructural examination the newly formed hard tissue was in direct contact with the material. This study suggests that 4CP cement possesses a biocompatible property, which indicates its potential for use as a direct pulp-capping agent.

Animals↗
PubMed1989

Pulp capping with hydroxyapatite ceramic in rat molars.

Direct pulp capping with a hydroxyapatite ceramic in rat molars induced the formation of reparative dentin in the exposure sites after 2 weeks. In addition, foci of acute and chronic pulpitis were detected. After 6-8 weeks of application of the material partial or total necrosis occurred. The use of hydroxyapatite as a possible pulp capping material is discussed.

Animals↗
PubMed1992

[592 pulp cappings in a dental office--a clinical study (1966-1990)].

In a dental office 592 direct and indirect pulp cappings were followed up to 24 years. 404 of these pulps remained vital. The success of this treatment seemed to be related to age, type of tooth, and the extent of pulp exposure. In some advanced cases the clinical outcome was better than expected.

Adolescent↗
PubMed2006

The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study.

BACKGROUND: The decision between pulp capping and root canal therapy after pulp exposure is a clinical issue. The aim of the authors' study was to evaluate the outcome of direct pulp-capping procedures performed by dental students. METHODS: The authors followed the treatment outcomes of 193 patients with 204 pulp exposures with direct pulp capping. They determined the outcome of pulp capping radiographically using periapical radiographs taken at least three years after pulp exposure. The outcome was considered as successful if the tooth was present and not associated with periapical radiolucency or root canal treatment; otherwise, the outcome was considered as being a failure. RESULTS: Overall, the success rate of pulp capping was 59.3 percent. The success was associated more with mechanical exposure than with carious exposure (92.2 versus 33.3 percent) (P < .001), more with permanent restoration than with temporary restoration (80.8 versus 47.3 percent) (P < .001) and more with class I occlusal restoration (83.8 percent) than with proximal multiple surface restorations (Class II, 56.1 percent; Class III, 58.8 percent; mesial-occlusal-distal, 28.6 percent) (P = .009). Patients' age, sex, and tooth location and position had no significant effect on the outcome (P > .05). CONCLUSION: The success rate of direct pulp capping was 92.2 percent with mechanical exposure and 33.3 percent with carious exposure. CLINICAL IMPLICATIONS: Direct pulp capping is recommended after mechanical exposure with immediate placement of permanent restoration, while root canal therapy would be the choice of treatment if the exposure was due to caries.

Adolescent↗
PubMed1998

The disastrous effects of the "total etch" technique in vital pulp capping in primates.

PURPOSE: To determine by means of a histopathological study in sub-human primates whether etching of an exposed pulp (the "Total Etch" technique) followed by capping with dentin bonding agents is a viable clinical treatment modality. MATERIALS AND METHODS: In six sub-human primates, 147 Class V preparations were made for five experimental and two control groups. After exposing the pulps, the preparations were intentionally contaminated, rinsed, dried and then disinfected with a 2% chlorhexidine solution for 60 s. In the five experimental groups, the entire preparation including the exposed pulp was etched with a 35% phosphoric acid gel, which was rinsed after 20 s. This was followed by a second application of chlorhexidine. In Groups 1-3, All Bond 2, ProBond and Permagen A&B dentin bonding agents were applied as pulp capping materials. In Group 4, a light-cured calcium hydroxide was tested while Group 5 was treated with a chemically-cured calcium hydroxide. Groups 6 and 7, the controls, were also contaminated, rinsed, dried and disinfected. After the exposed pulps had been protected with a chemically-cured calcium hydroxide (Group 6) or a light-cured calcium hydroxide (Group 7) the preparations were etched and restored with a bonded resin composite. The effect of the above described treatments were evaluated at 5, 25 and 75 days. After sacrifice and routine histological preparation, histological sections were graded among other parameters for inflammatory response, bridge formation, maintenance of vitality, presence of dentin chips and evidence of microleakage microorganisms. RESULTS: The 2% chlorhexidine applied immediately after exposure was an effective hemostatic agent. After subsequent etching, the hemostatic effectiveness was greatly reduced. Exposure size for all seven groups ranged from 0.13-1.55 mm. The average at 5, 25 and 75 days measured 0.74, 0.66 and 0.77 mm, respectively. In the five experimental groups, the 25- and 75-day groups had a total of 68 teeth of which 24 (35%) became non-vital and 23 (33%) teeth demonstrated bridge formation. In the three experimental groups using a bonding agent, the 25- and 75-day groups had a total of 40 teeth of which 18 (45%) became non-vital and 10 (25%) exhibited bridge formation. In the "No Etch" control groups, the 25- and 75-day groups had 28 teeth of which two (7%) became non-vital and 23 (82%) exhibited bridge formation. Microorganisms were found in a large percentage of all groups, although their numbers were few. However, they were present in vital and non-vital teeth, in the presence and absence of bridge formation and had no direct bearing on the success or failure of the pulp capping procedure.

Acid Etching, Dental↗
PubMed1999

Treatment options for the exposed vital pulp.

The exposure of dental pulp generally occurs as the result of accidental trauma or preparation techniques utilized during the restoration of carious lesions. While frank carious exposures are optimally treated with pulpectomy and root canal therapy, the ideal treatment of mechanically exposed pulps has remained controversial. This article describes the indications, clinical techniques, and prognosis for direct pulp capping and partial pulpotomy.

Anti-Infective Agents, Local↗
PubMed1999

Vital pulp capping: a worthwhile procedure.

Despite the progress made in the field of pulp biology, the technique and philosophy of direct vital pulp capping remains a controversial subject. Clinicians are well aware of the immediate and long-term success rates after root canal therapy, but are less certain of the success of vital pulp capping. Researchers have demonstrated that exposed pulps will heal and form reparative dentin. It is realized now that the variable prognosis of vital pulp capping is predominately a restorative issue. The factors that can produce a successful vital pulp cap are discussed in conjunction with two popular techniques.

Acid Etching, Dental↗
PubMed2003

Direct capping of human pulps with a dentin bonding system or with calcium hydroxide cement.

OBJECTIVE: To study human pulp reactions to direct cappings with a dentin adhesive compared with a calcium hydroxide cement, especially with respect to formation of hard tissue in the exposure site. STUDY DESIGN: Direct pulp cappings were made in 34 caries-free premolars scheduled for extraction due to orthodontic treatment. Half of the teeth were capped with a dentin adhesive, the other half with a calcium hydroxide cement. After periods of from 7 to 70 days, the teeth were extracted and processed for light microscopical examination. RESULTS: No postoperative sensitivity was experienced. A slight inflammatory reaction was seen in both groups in the short observation period. In the long observation period, significantly more "dentin bridging" was seen in the calcium hydroxide group than in the dentin adhesive group (P < .05). CONCLUSION: The findings from the present limited material is in accordance with previous findings from human studies and contraindicate use of dentin adhesives for direct pulp capping.

Adolescent↗