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Contemporary treatment of uncomplicated and complicated crown fractures is presented in this article. New concepts and approaches are discussed in relation to modern research and new restorative materials. Practical suggestions for the recognition and clinical management of various types of crown fractures are described.
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This article presents the long-term follow-up of a patient in whom an incisor that had been fractured through the pulp was replaced with the original tooth fragment. In the replacement process, the enamel, dentin, and pulp were acid etched and bonded as part of the restoration protocol. More than 5 years have passed since the original treatment, and the treatment has thus far been a success.
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To examine if human dental pulp cells are useful for assessing the carcinogenic potential of chemical agents, we cultured human dental pulp cells from adults and studied the ability of chemical agents known to be carcinogenic to induce chromosome aberrations in these cells. We confirmed that human dental pulp cells in primary or secondary cultures had the capability of accumulating calcium in vitro as detected by Alizarin red staining and generating dentin-like tissue in immunocompromised mice. These phenotypes were maintained even in cells at seven passages. Next, we examined if chromosome aberrations were induced by exposure of human dental pulp cells (designated here as D824 cells) at seven to nine passages to chemical agents with carcinogenic activity. Statistically significant increases in the frequencies of chromosome aberrations were induced in D824 cells treated with a direct-acting carcinogen, mitomycin C, for 3 h. Chromosome aberrations were also induced at statistically significant levels in D824 cells treated with an indirect-acting carcinogen, cyclophosphamide, for 2 h in the presence of exogenous metabolic activation with rat liver postmitochondrial supernatant. Cyclophosphamide failed to induce chromosome aberrations in the absence of exogenous metabolic activation. Although the reliability of chromosome aberration tests using human dental pulp cells remains to be validated by studying the ability of various other chemical agents with or without carcinogenic activity to induce chromosome aberrations, this chromosome aberration test system may be useful for carcinogenic risk assessment in the target cells.
Fluoride has been adopting as an anticariogenic agent for many years. Many histologic experiments with the effect of fluoride were made on dental hard tissue, but little is known about its effect on dental pulp. We made histopathological tests on dental pulp of rabbits during administration of fluoride. In this study, 24 young New Zealand rabbits aged 7 days were used. The experimental group (N = 20) was given two intraperitoneal injections of sodium fluoride that contained approximately 7 mg F/kg body mass. The control group (N = 4) was injected with an equivalent volume of normal saline. At the thirteenth day after the final injection, the mandibles were collected and processed according to routine histologic methods. Selected sections were stained with hematoxylin and eosin stain. The mandibular incisor pulp was microscopically examined. The following results were obtained. In the experimental group, histopathologic alterations were observed in the pulp, with loss of palisading of the odontoblastic layer. Slightly elongated swollen odontoblasts were found which showed hydropic alterations. Dilatation and hyperemia of blood vessels were also noted. This dose affected deciduous root resorption and changes in secretory ameloblasts; and also appeared to disturb the dental pulp. The present observations of initial reactions in the pulp following intraperitoneal injection of fluoride are considered suitable as a basis for detailed discussion of histopathologic implications.
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It has been suggested that dental instruments can be used as bridging instruments to facilitate electric pulp testing of teeth with extensive restorations. This study reports a clinical investigation to evaluate the effectiveness of this procedure. One hundred seventeen vital teeth in 20 volunteers were tested. Ten endodontically treated teeth functioned as controls. Following appropriate isolation and asepsis technique, baseline recordings of the threshold response with the electric pulp tester were taken. With the use of dental explorers and endodontic files to bridge between the probe tip and the tooth surface, recordings were made of the threshold responses. Findings indicate that electrically conductive dental instruments can be reliably used as bridging instruments with the electric pulp tester.
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