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PubMed1985

Considerations and treatment of direct and indirect pulp-capping.

Depending on the clinical setting, vital pulp therapy can be managed with an indirect or direct pulp-capping procedure. The determination of which therapy to employ is a decision that must be made by the clinician at the time of treatment. It is hoped that the preceding discussion has informed the clinician as to both the indications and contraindications for each type of treatment and the rationale for selection. Because every possible clinical situation cannot be presented, it is anticipated that by understanding the principles presented in this article, the clinician will be able to correctly identify which therapeutic modality will most benefit the patient. Table 1 is presented as a quick reference to aid in selecting appropriate candidates for pulp-capping procedures.

Bacteria↗
PubMed2001

Dentin regeneration in vital pulp therapy: design principles.

The nature and specificity of the mechanisms by which the amputated dentin-pulp interface is therapeutically healed determine the properties of the barrier at this site and play a critical role in the outcome of vital pulp therapy. Healing of the dentin-pulp complex proceeds either by natural repair-which results in defensive hard-tissue formation, or therapeutically regulated dentin regeneration, which aims to reconstitute the normal tissue architecture at the pulp periphery. Progress in biomedical research opens new directions for the design of biologically effective pulp therapies. Application of biocompatible and biodegradable carrier vehicles for local delivery of signaling molecules in pulp-capping situations showed induction of fibrodentin/reparative dentin formation, but often at the expense of underlying pulp tissue. An alternative pre-clinical model aiming to reconstitute normal tissue architecture directly at the dentin-pulp interface should be designed on the basis of the direct induction of odontoblast-like cell differentiation and reparative dentin formation at the pulp-capping material interface. Experimental data clearly showed that pulpal cells can differentiate directly into odontoblast-like cells in association with specific extracellular matrices (dentinal or fibrodentinal matrix) or TGF beta 1-containing artificial substrates. Dentin-induced dentinogenesis can be used as a master plan for the achievement of new therapeutic opportunities. In the present study, several short-term experimental studies on dog teeth for potential direct induction of odontoblast-like cell differentiation at the surface of rhTGF beta 1-containing artificial substrates (Millipore filters, hydroxyapatite granules, calcium hydroxide, pure titanium) failed to induce any specific reparative dentinogenic effects.

Animals↗
PubMedDate not supplied

Histologic evaluation of pulpotomy performed with ethyl-cyanoacrylate and calcium hydroxide.

The aim of this study was to evaluate histological aspects of the pulp-dentin complex of dogs submitted to pulpotomy and capped with ethyl-cyanoacrylate and calcium hydroxide. Thirty dog teeth were divided into 2 groups of 15 as follows: Group 1 - ethyl-cyanoacrylate; Group 2 - calcium hydroxide. The pulpotomies were carried out following all of the treatment precautions recommended for dogs. After 30 days the specimens were submitted to histological preparation and were then blindly evaluated by a histologist. Data were analyzed statistically by the Fisher exact test, comparing the two groups. After 30 days, the presence of a hard tissue barrier was observed in 83.3% of Group 1, and in 100% of Group 2 (p = 0.478). A continuous hard tissue barrier was observed in 50% of the ethyl-cyanoacrylate group and 75% of the calcium hydroxide group (p = 0.652). It can be concluded that both materials induced hard tissue barrier formation, but Group 2 had a higher percentage than Group 1, with no significant statistical differences; the differences observed between the different barriers (continuous/non-continuous) were not significant between groups and there was no pulpal necrosis in either group.

Animals↗
PubMed2001

Response of the pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement.

This study was conducted to observe the response of dogs' dental pulp to mineral trioxide aggregate (MTA) and a calcium hydroxide cement when used as pulp capping materials. After the pulps of 30 teeth were exposed, they were capped with either MTA or a calcium hydroxide cement. Histological analysis was performed 2 months after treatment. Results showed a healing process with complete tubular dentin bridge formation and no inflammation in any of the pulps capped with MTA. On the other hand, only five specimens from the calcium hydroxide cement group formed a complete dentin bridge. In this experimental group, pulp inflammation was observed in all but three cases. In conclusion, MTA exhibited better results than the calcium hydroxide cement for the capping of the pulp in dogs.

Aluminum Compounds↗
PubMedDate not supplied

Primary tooth pulp therapy as taught in predoctoral pediatric dental programs in the United States.

A survey of all predoctoral pediatric dental programs in the United States was conducted to ascertain the contemporary teaching philosophies and techniques for pulp therapy in primary teeth. All 53 predoctoral programs responded to a two-part survey consisting of multiple choice questions regarding which pulp therapies and specific techniques were taught and which pulp therapies would be employed under certain hypothetical clinical scenarios. The results of the survey confirmed some lack of consensus on the selection and application of certain treatment modalities and techniques taught for primary tooth pulp therapy in predoctoral dental programs in the United States.

Child↗
PubMed1992

Reaction of the dental pulp to hydroxyapatite.

The purpose of this study was to evaluate the action of hydroxyapatite (HA) (Osteogen HA Resorb, GBD Marketing Group Inc., Valley Stream, N.Y.) on the dental pulp of rats. Four upper molar pulps in 45 rats were exposed and capped with synthetic HA (Osteogen) with a stereoscopic microscope. Pulps capped with calcium hydroxide (Dycal, L.D. Caulk Co., Milford, Del.) served as controls. The cavities were filled with amalgam, and the molars on each side of the maxilla were protected by the placement of a pedodontic steel crown. Pulp inflammation and dentin repair were compared by histologic observations and computer image analysis after 7, 14, and 28 days. After 7 days a partial acute pulpitis were observed in specimens treated with Osteogen or Dycal. Reparative dentin formation along the pulp walls was also seen. After 14 days the pulpitis was more extensive in the Osteogen-treated teeth than in the control teeth. Dentin formation as measured by morphometric analysis was more pronounced in Osteogen-treated teeth. Neo-odontoblasts were observed after the use of both materials. After 28 days an acute inflammatory reaction was still evident in the Osteogen-treated group. A complete dentinal bridge was observed more frequently with Dycal than with Osteogen. Despite the putative abilities of HA to be osteoconductive, osteogenic, and dentinogenic, the results of this study indicate that it should not be used as a pulp-capping agent because of its tendency to cause scattered dystrophic calcification in the dental pulp, which could interfere with future endodontic treatment.

Animals↗
PubMed1999

[Experimental study on the effect of restorative dentin formation with human dentin phosphoprotein in immature permanent teeth of minipig].

OBJECTIVE: To investigate the function of human dentin phosphoprotein(DPP) on dentine mineralization in vivo. METHODS: Pulp capping with human DPP was made in the permanent teeth of minipigs with calcium hydroxide and zinc oxide eugenol cement as controls. The minipigs were sacrificed at intervals of 14, 30, 90 days respectively after operation. RESULTS: The histopathological results revealed that pulp cells had developed into odontoblastoid cells around the major restorative dentin body after two weeks. There was complete restorative dentin bridge a month later. The bridge became thick and dense, and mainly was tubular dentin in 3 month. There were well developed odontoblasts under the bridge. In the calcium hydroxide capping group, inflammatory cytonecrosis zone was found in the surface of dental pulp and only a little calcial bodies formed in two weeks. Complete restorative dentin bridge was formed in 1 to 3 months, the speed of dentin bridge formation was not as quick as that of DPP group. CONCLUSION: DPP can induce pulp cells to develop into odontoblasts and formation of dentin bridge with little stimulation to the dental pulp. This study suggests that DPP plays an important role in the biomineralization of dentin development and restoration.

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