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PubMed1981

Long term clinical assessment of direct pulp capping.

Appropriate definitions, history and success rates of direct pulp capping procedures are reviewed. Two of the disadvantages of this form of treatment are infection of the pulp, either preoperatively or postoperatively due to a non-sterile procedure or bacterial leakage at the capping site. Past results of directly capping potential inflamed pulps have been unsatisfactory, but now an increasing number of endodontists advocate capping when conditions are favourable. Direct capping should only be used on vital pulp which has been accidentally injured and shows no other symptoms. Direct capping with calcium hydroxide should not be used on pulp which has been exposed as a result of penetrating caries. Clinical studies 2338 cases have shown that the risk of failure is increased if the pulp is diseased before capping, but that the age of the tooth does not have an adverse effect. It also appears that capping performed by skilled practitioners is more successful than that performed by students. The results of a re-examination of 110 patients, a minimum of 4 years after they had received direct capping treatment from students, showed a success rate of 80 per cent. In skilled hands, the success rate for direct capping with calcium hydroxide is now 90 per cent provided that a hermetic seal is obtained.

Dental Pulp Capping↗
PubMed2000

Short term human primary pulpal response after direct pulp capping with fourth-generation dentin adhesives.

The purpose of this study was to evaluate the effects of the total-etch and direct pulp capping techniques on the short-term response of mechanically exposed human primary tooth pulps using three commercially available adhesive resin systems. Class V cavities were prepared on the buccal surface of intact mandibular primary molars and exposed with a carbide bur on the cavity floor. The entire cavity except the exposure site received 36% phosphoric acid gel conditioning. Exposed pulps were capped with one of the three adhesive resins, followed by restoration of the cavities with the respective restorative materials. The teeth were extracted after 60 days and prepared according to normal histological techniques. Serial sections were stained with H/B for histological evaluations. The histopathological evaluation showed that a few of the samples in the Scotchbond Multi Purpose (SMP) and Prime & Bond 2.1 (PB) groups exhibited "attempted bridge formation", while no bridge formation was evident in the other samples. Syntac Single Component (Syntac) exhibited the most severe histological response, while the mildest reactions were observed in the SMIP group. Based on the conditions of the present study, direct pulp capping with dentin bonding agents following the total-etch technique in primary teeth can not be recommended.

Acid Etching, Dental↗
PubMed2002

Histomorphometric analysis of dentinal bridge formation and pulpal inflammation.

OBJECTIVE: The purpose of this study was to evaluate pulpal responses to the use of four resin composite materials as direct pulp capping agents. The importance and effects of individual pulp capping variables are not well understood; consequently histomorphometric analysis was used to analyze these variables. METHOD AND MATERIALS: Two hundred fifty standardized pulp-exposed cavities were prepared in nonhuman primate teeth. Exposed pulps were capped with calcium hydroxide and multistep and self-etching primer resin composites. Teeth were collected from 3 to 60 days to observe pulpal reactions. Following perfusion fixation, tissues were demineralized, sectioned, stained, and histomorphometrically measured. Bridge area, diameter of pulpal exposure, and cavity floor width were measured. Tunnel defects, operative debris, and pulpal inflammation were graded according to defined criteria. RESULTS: The variables correlated to dentinal bridge area were, in decreasing order of significance, time elapsed since exposure, diameter of pulpal exposure, pulp capping material, and tunnel defects. The variables correlated to pulpal inflammation were the type and curing of pulp capping material. Other variables were not statistically significant. CONCLUSION: Pulp capping with resin composite materials provided acceptable pulpal inflammatory and dentinal bridge repair responses, comparable with those of calcium hydroxide. Although resin composites are promising as direct pulp capping agents, further investigations are required to optimize their application protocols to reduce the penetration of potentially cytotoxic monomers into pulpal tissue.

Acid Etching, Dental↗
PubMed2000

Evidence for bacterial causation of adverse pulpal responses in resin-based dental restorations.

The widespread use of resin and resin-monomers for bonding of dental restorations to dentin has occurred because of a fundamental shift in the view that injury to the pulp is induced by restorative procedures. While, for many years, the toxic effects of restorative materials were thought to be of crucial importance in the development of adverse pulpal responses, the key role of bacterial leakage at the restoration-tooth interface is now well-recognized. Consequently, if optimal conditions for the preservation of pulpal health are to be ensured, dental restorations should provide an impervious seal against the surrounding tooth structure. However, polymerization shrinkage and contraction stresses induced during setting, as well as a variety of technical difficulties encountered during the clinical operation, often produce less than perfect results. Therefore, modern restorative procedures involving resin and resin-bonded restoratives must still rely on the ability of the pulp to cope with the injurious elements to which it may be exposed during and after the procedure. This review examines factors that may govern the pulp's response to restorative procedures that involve adhesive technologies. An assessment is made of the risks involved as far as the continued vital function of the pulp is concerned. It is concluded that an intact, although thin, wall of primary dentin often enables the pulp to overcome both toxic material effects and the influences of bacterial leakage. In contrast, the pulp may not do equally well following capping of open exposures with resin composites. A dearth of controlled clinical studies in this area of dentistry calls for confirmation that pulpal health prevails over the long term following the use of total-etch and resin-bonding techniques.

Acid Etching, Dental↗
PubMedDate not supplied

[Experimentation of apiarian preparations for the direct and the indirect capping of the dental pulp].

With a view to extend the range of biologically active preparations for the direct and the indirect capping of the dental pulp the authors have used a paste made from an alcoholic solution of propolis and zincoxyde. The study was carried on in 150 teeth with indirect capping of deep cavities, and 50 teeth with direct capping. The evolution of the cappings was followed clinically, radiologically and morphologically. The results obtained showed that the paste with propolis exerts effects similar to those of zinc eugenate. The morphologic study of the indirect capping showed that secondary dentin developed shortly after the application of the paste, and that it was followed by the development of pulpolites and the sclerous transformation of the pulp. In teeth with direct capping a protective film developed at the opening of the dental chamber. With time the pulpal wound undergoes cicatrization by a process of fibrosis and there is a trend to remineralization. No areas of pulpal degenerescence were found the rest of the pulpal tissue, and this suggests that the paste is more histophilic than the pastes based on calcium hydroxide, with which an area of necrosis occurred at the opening of the chamber, and calcium and fibrous degenerescence occurred in the coronal pulp.

Dental Pulp Capping↗
PubMed1988

The tissue reactions after capping of dog teeth with calcium hydroxide experimentally crammed into the pulp space.

The pulps of 48 permanent dog teeth, incisors and canines, were evaluated histopathologically after capping treatment with pure calcium hydroxide placed by two methods: the experimental method, in which the calcium hydroxide was crammed into the pulpal space via the exposure site, and the usual method of direct pulp capping (controls). The results were recorded after periods of 2, 15, and 69 days. The healing process with hard-tissue formation was more evident in the experimentally capped teeth, despite the fact that pulpal necrosis occurred in a higher proportion of these teeth after use of this method of placement of the calcium hydroxide.

Animals↗
PubMedDate not supplied

Histopathologic study on pulp response to single-bottle and self-etching adhesive systems.

This study compared the pulp response to seven adhesive resins (three single-bottle and four self-etching primers) and their companion resin composite systems with a commercial calcium hydroxide material when applied to exposed monkey pulps. The control group was capped with Dycal (DY), while the experimental groups were capped with one of the following adhesive resin systems: AQ Bond (AQ), Single Bond (SB), Imperva Fluorobond (IF), One Step (OS), Prime&Bond NT (PBNT), Perme Bond F (PBF) and One-up Bond F (OBF). Histopathologic evaluation of pulp tissue disorganization, inflammatory cell infiltration, reparative dentin formation and bacterial penetration at the 3rd, 30th and 90th post-operative days was done using light microscopy. Data were analyzed using the Kruskal-Wallis test followed by the Least Significant Difference Test to determine differences between the control group and the experimental groups at each observation period. The correlation of inflammatory cell infiltration and bacterial presence was investigated by the Kendall correlation analysis. All tests were performed at a 95% level of confidence. The pulpal responses of groups DY, SB, OS, PBF and OBF were generally characterized by none-to-mild pulp tissue disorganization and inflammatory cell infiltration. Also, initiation of reparative dentin formation was found earlier in Group DY, resulting in more complete dentin bridges at the 30- and 90-day observation periods. Groups AQ, IF and PBNT had significantly more inflammatory cell infiltration and a lower incidence of reparative dentin formation than Group DY. A significant correlation was detected between inflammatory cell infiltration and the presence of bacteria. It is concluded that the pulp response to SB, OS, PBF and OBF is not significantly different from the calcium hydroxide preparation. However, calcium hydroxide capping resulted in a higher incidence and faster rate of reparative dentin formation.

Acid Etching, Dental↗
PubMed2002

Dens evaginatus--how does it present and how should it be managed?

Dens evaginatus is a developmental dental anomaly predominantly affecting premolars in people of Mongolian origin. It is likely to become more prevalent in New Zealand due to the increase in immigration of Asians. The formation of dens evaginatus is postulated to be an abnormal evagination of the internal enamel epithelium and dental papilla into the stellate reticulum during morphodifferentiation. An important complication resulting from damage to the evagination is periapical abscess. When considering treatment options, the long-term prognosis of the tooth, its root length, the general alignment of the teeth, and overall arch length should be reviewed. Management options include composite resin placed at the base of the tubercle, excision of the tubercle followed by direct or indirect calcium-hydroxide pulp capping and composite-resin restoration, and apexification procedures followed by conventional endodontic therapy. Grinding of the intact tubercles of newly erupted evaginated premolars may contribute to secondary infection of the pulp, and is not recommended.

Adolescent↗
PubMed2003

Identification of hierarchical factors to guide clinical decision making for successful long-term pulp capping.

OBJECTIVE: Clinicians have few quantitative studies that rank the in vivo pulp capping effects of commonly used restorative materials. These factors were investigated to provide guidance to clinicians. METHOD AND MATERIALS: One hundred sixty-one standardized pulp-exposed cavities were prepared in nonhuman primate teeth. Exposed pulps were capped with calcium hydroxide, resin-modified glass-ionomer cements, and resin composites. Teeth were collected from 7 to 720 days to observe a full range of responses. Pulpal reactions were categorized according to the standards set by the International Standards Organization. Bacteria were detected with McKay's stain. RESULTS: The incidence of bacterial microleakage was 19.7% with resin composite, 21.1% with resin-modified glass-ionomer cement, and 47.0% with calcium hydroxide. The severity of pulpal inflammation increased with the presence of bacteria or tunnel defects. The severity of pulpal inflammation prevented dentinal bridge formation at varying levels: slight for resin composite and resin-modified glass-ionomer cement, and severe with calcium hydroxide. The incidence of severe inflammation or pulpal necrosis was 7.9% with resin composite, 10.6% with calcium hydroxide, and 10.5% with resin-modified glass-ionomer cement. Other variables, such as pulpal exposure width and tertiary dentin formation, were not highly correlated to pulpal inflammation. CONCLUSION: Pulp capping with resin composite provided the lowest incidence of bacterial microleakage, the lowest levels of pulpal inflammation, and the lowest incidence of necrosis.

Analysis of Variance↗
PubMed1998

Dens evaginatus: review of the literature and report of several clinical cases.

Dens evaginatus (DE) presents as an innocuous looking tubercle of enamel on the occlusal surface of a tooth, most commonly a bicuspid. Problems can arise when the tubercle is either worn, ground, or fractured off, resulting in pulpal exposure and possible loss of vitality of the tooth. Dentists who perform orthodontic treatment should be aware of this dental anomaly, which occurs in at least two per cent of the Asian and Native Indian populations. Bicuspid extraction cases should involve the extraction of the anomalous premolars rather than the normal ones. In addition, the dentist should be mindful of occlusal changes that may occur during treatment or occlusal equilibration, both of which can jeopardize the vitality of teeth with DE. Pulp capping or partial pulpotomy has been postulated to be one of the most reliable forms of vital tooth treatment when pulp exposure is encountered following the sterile removal of the tubercle. When pulp exposure is not encountered, preventive resin composite sealing of the dentin or class I amalgam cavity preparation seems to be the treatment of choice.

Adolescent↗
PubMedDate not supplied

Long-term evolution of a case of direct pulp capping by adhesion to dentin.

This article presents the long-term follow-up of a female patient who suffered pulp exposure during removal of a large caries lesion from the mandibular right first molar. The clinical decision to perform direct pulp capping was made. The tooth was treated with 5% chlorhexidine, etched with 37% phosphoric acid, and then restored with Heliomolar composite after application of Gluma dentin adhesive. The patient was followed for more than 8 years.

Acrylic Resins↗
PubMed2000

A retrospective study of treatment provided in the primary and secondary care services for children attending a dental hospital following complicated crown fracture in the permanent dentition.

OBJECTIVES: To investigate treatment provision in primary and secondary dental care following complicated crown fracture of permanent teeth. DESIGN AND METHODS: Retrospective observational survey of dental records of all patients attending a dental hospital trauma clinic during a 2-year period with complicated crown fracture. RESULTS: Eighty children (70% male) aged 6-16 years (mean age 10.3 years) with 98 complicated crown fractures were identified. Of these children, 54% were seen for emergency treatment on the day of their injury, 75% within 48 h. Of the 98 injured teeth, 60% were seen initially in general dental practice but only 56% of these 59 cases were provided with emergency treatment in practice, the others being referred immediately to the trauma clinic for treatment. The main cause of fractures was transport, in particular, bicycles. Radiographs were available for 96 teeth; for the 43 open apex teeth, the definitive treatment was pulp capping (44% of cases) and pulpotomy (30%), with vitality maintained in five cases up to 4.8 years after trauma. The 53 closed apex cases were treated definitively with pulp capping (38%) and pulpectomy (36%) and six teeth had maintained their vitality up to 4.3 years after trauma. Sixty-seven per cent of the pulp caps and 47% of the 19 pulpotomies provided relied on a doubtful coronal seal. This was primarily due to the extensive use of a conventional glass ionomer cement as an emergency bandage. The use of an etched or bonded material at initial presentation extended the Median Survival Time for vitality in open apex teeth from 188 to 377 days and in closed apex teeth from 15 to 64 days. CONCLUSIONS: Emergency treatment of complicated crown fractures, particularly in primary care services is often inappropriate or inadequate with regard to emergency management of the exposed pulp and provision of a hermetic coronal seal.

Adolescent↗
PubMed2005

[LASER applications in endodontics].

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of lasers with a wide range of characteristics are now being used in endodontic therapy. In the past two decades much experience and knowledge has been gained The first purpose of the present paper is to provide an understanding of the essential physical science behind laser technology and information on the effects of laser beams on tissue (tissue interaction). A second purpose is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, modification of the root canal walls, sterilization of the root canal system, cleaning--shaping--obturation of the root canal, and endodontic surgery. It will be clear that a number of endodontic procedures with conventional treatments cannot provide comparable results or are less effective.

Dental Instruments↗
PubMed1977

Simple metallic compounds as pulp-capping agents. A pilot study.

A pilot study is described in which the exposed pulps of molar teeth of normal laboratory rats were capped with various metallic compounds in general medical usage. There appeared to be no relationship between the response obtained and the pH of the compounds studied. Aluminum powder, aluminum hydroxide, Aludrox, aluminum oxide, light magnesium oxide, magnesium hydroxide, and titanium dioxide gave poor results. Barium sulfate, calcium carbonate, cupric oxide, ferric oxide, heavy magnesium oxide, and stannic oxide merited more detailed study.

Animals↗