Microradiographic assessment of neodentinal bridging following direct pulp capping in human teeth.
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Numerous studies using various animal and human models have reported changes in the morphology and metabolic activity of primary odontoblasts in the mature tooth pulp after perturbations of the tooth including cavity preparation and restoration, pulpal exposures and pulp capping with various capping agents. The first part of this study investigated changes in primary and replacement odontoblast activity after cavity preparation or pulpal exposure. Two groups of rats were used in this investigation. One group of rats had Class V cavities prepared to the DEJ of the first maxillary molars. These rats were immediately injected with 3H-proline and killed 15, 30 or 60 minutes later. Rats killed at day 1, 3, 5, 7, 10 or 14 were injected one hour prior to sacrifice. The second group of rats each had a pulp exposure that was capped with a calcium hydroxide containing material and restored with a composite resin. Rats were sacrificed as previously described. Tissue was processed routinely for ultrastructural analysis and E.M. autoradiography. The second part of this study consisted of an injection of 125I-fibrinogen one hour prior to a class V cavity preparation 1/2 the distance through dentin thickness. Rats were sacrificed at 5, 10, 15 and 30 minutes postsurgery. Differences in the location and distribution of the reduced silver halide grains were recorded as well as differences in the amount and distribution of the various organelles measured between primary and replacement odontoblasts. The results of this study suggests that primary and replacement odontoblasts were morphologically and physiologically dissimilar at the time periods tested in this study. 125I-fibrinogen was demonstrated within the dentinal tubules and in the floor of the cavity preparation as early as 5 minutes after completion of the cavity preparation. The preliminary results of the 125I-fibrinogen suggest that operative trauma can effect very rapid changes to the dental pulp leading to leakage of plasma proteins from the circulation, between odontoblasts, out of the tubules to the cut dentin surface.
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The badly decayed molar teeth of a 12-year-old were restored using resin composite and ceramic restorations. The maxillary first left permanent molar, which had an extensive carious lesion that had destroyed most of the coronal hard tissues of the tooth, was restored to shape and function with a heat-treated resin composite onlay restoration. The restoration was followed up for two years. The mandibular right first molar had a failing large amalgam restoration with extensive recurrent caries. After a three-month period of pulp-capping, the tooth was restored with a bonded ceramic onlay restoration. A nine-month follow-up of this restoration is provided. The maxillary right first molar, which also had a failing large amalgam/resin composite restoration, was restored with a direct resin composite restoration. Under traditional treatment regimens, these extensive cavities would have been treated using more invasive procedures such as pin-retained restorations or elective root canal therapy, post placement, core build-up and crowning. Bonded non-metallic restorations avoid the trauma, time and cost that accompany such extensive procedures and offer a more conservative approach.
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A quantitative assessment of dentin bridges was conducted on sections prepared from teeth capped with four pulp-capping agents (Bioglass, Life, Demineralized Dentin Matrix, and Teflon) in a micro-swine model. The degree of mineralization of the dentin bridges relative to the adjacent primary dentin was measured using a computer-based image analysis of microradiographs prepared from the sections. The rate of formation of the dentin bridge was measured from fluorescent bands formed in the same sections by a Demeclocycline dentin marker. There were no statistically significant differences in the relative mineral densities of the dentin bridges and the rate of dentin bridge formation under the four pulp-capping agents. These findings support the suggestion that components of the extracellular matrix rather than pulp-capping agents may be important in the formation and mineralization of dentin bridges in repairing dental pulps.
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