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PubMedDate not supplied

Histopathology of the pulp in primary incisors with deep dentinal caries.

The purpose of this study was to assess the histological appearance of the pulp of human primary incisors extracted because of deep, unrestorable caries, and to determine how clinical pulp exposures affected the histological status of the pulp compared to nonexposures. Caries was removed carefully from all teeth after fixation; 24 incisors had pulp exposures, and 29 teeth had no pulp exposures. Histological examination showed normal pulps in 69% of the teeth without pulp exposures, compared to 33% of teeth with exposed pulps (P < 0.05). Microabscesses were observed in 33% of cases with pulp exposures, compared to 10% of cases without pulp exposures. In this study, 46 of 53 pulps remained vital in spite of the multiple and deep carious lesions. Teeth without pulp exposures were diagnosed in the treatable category in 20 of 26 cases.

Chi-Square Distribution↗
PubMed2006

Exposed human pulp caused by trauma and/or caries in primary dentition: a histological evaluation.

The aim of this study was to compare the pulpal reactions after exposure due to trauma and/or caries and to suggest the appropriate treatment options for the management of pulp, in the light of the histological findings in the primary teeth. Fifteen primary maxillary incisors with pulpal exposure were examined with light microscope in a blind study. After the histological evaluation, teeth were divided into three groups for the etiological factors due to the exposure according to the patient's files: trauma group, caries group and caries and trauma group. The inflammatory infiltration was diminished from the pulp chamber towards the apical third of the root canal in all of the examined teeth. Teeth in the trauma group presented fewer inflammatory cells in the root canal in comparison with other groups. It was concluded that the teeth with traumatic pulp exposure were considered as more likely to respond positively to pulpotomy technique. Pulpectomy or extraction seemed to be indicated for the decayed or decayed and traumatically injured teeth.

Child, Preschool↗
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↗
PubMed1994

Distribution of injected dexamethasone from the buccal vestibule of the rat mandible.

Thirty-six Sprague-Dawley rats were divided into three groups of 12. Group 1 was a control, whereas group 2 had the dental pulp of the first mandibular molar acutely exposed, and group 3 had dental pulp exposure for 10 days. All animals were injected with 125I-labeled dexamethasone phosphate into the right mandibular vestibule. Each group of 12 was divided into subgroups of 4 and sacrificed at 1, 2, or 4 h. The soft tissue on the buccal side and the mandible with the molars were collected and the radioactivity determined. Dexamethasone was absorbed from the injection site and distributed to the ipsilateral mandible and to the contralateral muscle and bone similarly, regardless of the treatment. Results also indicate a possible osseous affinity for this steroid, which could be beneficial in relieving the pain of intraosseous endodontic flare-ups.

Administration, Buccal↗
PubMed1994

Pulpal and periapical tissue reactions after experimental pulpal exposure in rats.

The purpose of this study was to investigate histologically and histometrically the changes in pulpal and periapical tissues after pulpal exposure in rats. All animals received a pulpal exposure in the left mandibular first molar. Animals were killed at 1 to 56 days after pulpal exposure, and their mandibles were evaluated histologically and histometrically. Histologically, pulpal necrosis extended gradually from the upper part of the pulpal tissue to the apex, with inflammation starting in the periapical tissue at an early stage. As the periapical lesion developed, alveolar bone and cementum resorption was also found. Histometrically, the length of pulpal necrosis increased gradually from 1 to 28 days. The vertical length of the periapical lesion after 14 days was significantly increased, while the horizontal length and the overall area after 7 days were also significantly increased. The periapical lesion extended in a mesiodistal direction at first and then in a vertical direction before expansion ceased.

Animals↗
PubMed2000

Pulp response to direct capping with an adhesive system.

PURPOSE: To evaluate the pulp response following direct pulp capping with an adhesive system (Prime & Bond 2.0 - PB 2.0) and a zinc-oxide eugenol cement (ZOE) on pulp exposures in rat molar teeth. MATERIALS AND METHODS: Forty-eight Class I cavities were prepared on the occlusal surface of molar teeth of rats (Rattus Norvegicus, Holtzman). Pulp exposures performed on the cavity floor were capped either with the adhesive system P&B 2.0 or ZOE. After 7, 15, 30, and 60 days, the specimens were processed through H & E and Brown & Brenn staining techniques. RESULTS: Both pulp capping materials allowed pulp repair, characterized by reorganization of a new odontoblast cell layer underlying the dentin bridge formation. However, P&B 2.0 promoted a large zone of cell-rich fibrodentin matrix deposition between the pulp capping material and the dentin bridge, which was deposited far from the pulp exposure site. On the other hand, pulps capped with ZOE showed dentin bridging immediately subjacent to the pulp capping material. In those samples in which microleakage occurred between dental material and cavity walls there was a persistent inflammatory reaction and lack of complete pulp repair.

Animals↗
PubMedDate not supplied

Preliminary report on the effects of propolis on wound healing in the dental pulp.

The purpose of this investigation was to determine the antimicrobial and healing potential of propolis on direct dental pulp exposures. This study used 25 adult male rats. Pulp exposures were performed and animals were allocated to propolis and calcium hydroxide (Ca(OH)2 groups. Animals were killed on days 5, 7, 10, and 14. The teeth were routinely processed for histological evaluation. Non-parametric tests were employed to analyze the data. No significant differences were found between study groups on the wound healing of the dental pulp. Both substances were comparable in exhibiting normal reorganization of the pulp and no increased vascularity, and were equally efficacious in maintaining a low inflammatory and microbial cell population as well as in stimulating the formation of reparative dentin.

Animals↗
PubMed2003

Tooth fragment reattachment: fundamentals of the technique and two case reports.

Coronal fractures must be approached in a methodical and clinically indicated way to achieve successful restoration. One option for treatment is reattachment of the dental fragment. Reattachment creates a very positive emotional response in the patient and simplifies the maintenance of the patient's original occlusion. This article discusses dental fragment reattachment techniques and presents clinical cases of coronal fracture involving enamel, dentin, and pulpal exposure.

Adolescent↗
PubMed2001

Response of human pulps capped with a self-etching adhesive system.

OBJECTIVE: The aim of this study was to evaluate the human pulp response following direct pulp capping with a current self-etching bonding agent and calcium hydroxide (CH). METHODS: Thirty-three sound human premolars had their pulp tissue mechanically exposed. Sterile distilled water was used to control the hemorrhage and exudation from the pulp exposure site. The pulps were capped with Clearfil Liner Bond 2 (CLB-2) or CH and the cavities were filled with a resin composite (Z-100) according to the manufacturer's instructions. After 5, 30 and 120-300 days, the teeth were extracted and processed for microscopic examination. RESULTS: At short-term, CLB-2 elicited a mild to moderate inflammatory pulp response with dilated and congested blood vessels adjacent to pulp exposure site. With time, macrophages and giant cells engulfing globules and particulates of resinous material displaced into the pulp space were observed. This chronic inflammatory pulp response triggered by fragments of bonding agent displaced into the pulp space did not allow pulp repair interfering with the dentin bridging. On the other hand, pulps capped with CH exhibited an initial organization of elongated pulp cells underneath the coagulation necrosis. Pulp repair and complete dentin bridge formation was observed at long-term evaluation. SIGNIFICANCE: The present study demonstrated that CH remains the pulp capping agent of choice for mechanically exposed human pulps. CLB-2 did not allow complete connective tissue repair adjacent to the pulp exposure site. Consequently, this bonding agent cannot be recommended for pulp therapy of sound human teeth.

Acid Etching, Dental↗
PubMed1993

Replacement of a fractured incisor fragment over pulpal exposure: a case report.

This paper is a clinical report demonstrating reattachment of a fractured incisor fragment. The fragment was replaced without the use of a filled composite resin, because the fracture had little splintering of the edges of the opposing pieces. Frank pulpal exposure was treated by an acid-etching procedure, wet bonding and surface disinfection prior to sealing of the wound site. At 1 year, the tooth is vital and has remained totally asymptomatic.

Adolescent↗
PubMed1991

Restoration of exposure sites prior to root canal therapy.

Root canal therapy may be the treatment of choice following pulpal exposure during restorative procedures. The exposure site is not, however, always in the line of the proposed access cavity. This article outlines the problems this situation may pose and presents a solution that may be used in some clinical situations.

Dental Cavity Preparation↗
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↗
PubMed1998

Pulpal response to a resin-modified glass-ionomer material on nonexposed and exposed monkey pulps.

OBJECTIVE: This study evaluated the biocompatibility of a resin-modified glass-ionomer material on monkey pulps. METHOD AND MATERIALS: Standardized Class V cavities were prepared in 112 teeth distributed in six healthy adult monkeys. The resin-modified glass-ionomer cement was placed in 24 nonexposed and 36 exposed pulps according to manufacturer's instructions. ZOE was used as a control in nonexposed pulps, while calcium hydroxide was used as a control for exposed pulps. Tissues were collected at 6 to 7, 21 to 27, and 90 to 97 days. After demineralization, the teeth were serially sectioned, stained, and observed by light microscopy. RESULTS: Except for one resin-modified glass-ionomer pulp at 6 days, there were no differences between the responses of nonexposed pulps to resin-modified glass-ionomer specimens and ZOE controls. In exposed pulps, eight of 36 resin-modified glass-ionomer pulps showed various grades of inflammatory response, all associated with stained bacteria. Pulpal healing was similar in both resin-modified glass-ionomer and calcium hydroxide direct-capped exposures. Twenty-two of 26 exposed pulps restored with the resin-modified glass-ionomer cement showed dentin bridge formation at 21 and 97 days. CONCLUSION: The resin-modified glass-ionomer material exhibited acceptable biologic compatibility in exposed and nonexposed cavities.

Analysis of Variance↗
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↗
PubMedDate not supplied

Treatment of severe pre-eruptive intracoronal resorption of a permanent second molar.

Pre-eruptive intracoronal resorption is a lesion often located within the dentin, adjacent to the dentin-enamel junction, in the occlusal aspect of the crown. As the lesions resemble caries, they are often referred as "pre-eruptive caries." The purpose of this case report was to describe the diagnosis and treatment of a permanent molar with pre-eruptive intracoronal resorption and to elaborate on possible associated clinical problems. After surgical exposure of the unerupted tooth, the tooth structure in the resorbed area was removed and the tooth was restored with glass-ionomer material. Three months after the treatment, partial pulpotomy had been performed and the restoration was replaced by amalgam. Elaboration on possible associated clinical problems is provided.

Child↗
PubMed2002

A new classification for crown fractures of teeth.

The aim of this work is to define a classification for traumatic injuries to crowns of teeth that offers a simplified interpretation, which can be communicated easily. These data will help us to evaluate the future restorations (composite resins, crowns, porcelain veneers) according to the variable design and extension of initial crown fracture lines. For this reason we conducted research on a vast sample of subjects, who presented different traumatic lesions, in order to obtain a specific selection of these typologies of injuries. We reviewed the literature for a complete, brief classification of simple use, which could serve our cause. The traditional classifications (Andreasen, Ellis, OMS) did not satisfy us for different reasons. In fact, they only consider the initial lesion situation, never focusing on the shape of the lesion and therefore never giving suggestions for the best kind of material for restoration. On the contrary, our interest is to define the kind of more valid materials according to the variable design of crown fracture lines, to foresee the duration of these materials and the best time to substitute them. To simplify and make our research a more affordable one, we created a 4 classes classification (A-B-C-D) and 3 subclasses (b1-c1-d1). Class A: all the simple enamel lesions which involve a mesial or distal crown angle, or only the incisal edge; Class B: all the enamel-dentin lesions, which involve a mesial or distal crown angle and the incisal edge. When a pulpal exposure exists we define it a Subclass b1; Class C: all the enamel-dentin lesions, which involve the incisal edge and at least a third of the crown surface. When a pulp exposure exists we define it a Subclass c1. Class D: all the enamel-dentin lesions, which involve a mesial or distal crown angle and the incisal or palatal surface, with root cement involvement (crown-root fractures). When a pulpal exposure exists we define it a Subclass d1. This classification showed how different kinds of lesions (Class B, b1, C and c1, in our new classification) fall under the same definition (enamel-dentinal fractures) in traditional classifications (Andreasen, Ellis). However, they need a wholly different clinical approach, and the material involved in the treatment shows different behavior and duration. This new classification simplified the gathering of data and the communication among practitioners, thus confirming its importance in getting optimal diagnostic and therapeutic protocols. It also allowed us to identify the most frequent crown fractures (Class B, b1 and C, c1) that in our sample of patients (age range: 8-18) are typically treated with composite resins or original fragment reattachment technique. All these studies brought us to develop this new "easy to use" classification of dental crown lesions that helped us to gather data easily, to choose the right materials to improve the communication among practitioners including by electronic means,

Adolescent↗