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[Endodontics in immature teeth].

In case of an exposed pulp, the endodontic treatment of an immature tooth is directed to preservation of the vitality of the pulp, for reason of either the completion of the root genesis or the inducement of an apical constriction. The state of the pulp dictates the choice of treatment, which are, in order of most to least desired, pulp capping, vital (partial) pulpotomy and extirpation followed by obturation after an apexification procedure.

Dental Pulp Capping↗

[Experimental study of the pulpal response of dogs capping with nHA-PA66].

OBJECTIVE: To investigate the responses of dog pulp tissue to the new nano-hydroxyapatite/polyamide 66 biological composites (nHA-PA66) used as direct pulp capping agent. METHODS: Dogs were used in establishing the experimental model. The reparative dentin bridge formation and the histopathological changes at the pulp-exposed site were observed at 7, 30 and 60 days postoperatively. Calcium hydroxide (Dycal) was used as positive control. RESULTS: After capping with nHA-PA66, some dog teeth were found to have formation of reparative dentin bridge and slight inflammatory response during the pulp healing procedure when compared with the effect of using calcium hydroxide. CONCLUSION: The results indicate that nHA-PA66 has good tissue biocompatibility, but its function of inducing reparative dentin bridge formation is not good enough as compared with that of calcium hydroxide. It has the potential to be used as a direct pulp capping agent, but further researches are needed.

Animals↗

Bovine bone morphogenetic protein-induced dentinogenesis.

Differentiation of odontoblasts is important for dentin formation in tooth germs and mature teeth. Although previous reports have indicated that there may be a kind of inductive agent that could induce mesenchymal cells in dental pulps to differentiate into odontoblasts, and secrete dentin matrix, the primary inductive factor of odontoblasts has not been found. Bone morphogenetic protein (BMP), which induces the formation of cartilage and bone when implanted in muscle tissue, is found in dentin matrix. The relationship between the differentiation of odontoblasts and BMP was observed by means of immunohistochemical staining with monoclonal antibody (MAb) against BMP in dental pulp tissue and cell culture; [3H]thymidine incorporation; and measurement of alkaline phosphatase activity. The conclusions are: (1) BMP exists in odontoblasts, ameloblasts, and dentin matrix (the positive reaction in ameloblasts appeared earlier and remained stronger); (2) BMP promotes incorporation of [3H]thymidine and increases the activity of alkaline phosphatase in cultured dental pulp cells; (3) BMP-induced dental pulp cells in dental pulp tissue cultures differentiate from mesenchymal to odontoblast-like cells; and (4) BMP induces formation of osteodentin and tubular dentin when used as a dental capping agent of dogs' teeth. Bone morphogenetic protein plays an important role in differentiation of odontoblasts and might be one of the inductive agents of odontoblasts. Further investigations of BMP as a biologic dental capping agent are warranted.

Animals↗

Human pulpal response to mineral trioxide aggregate (MTA): a histologic study.

The purpose of this study was to study the histologic changes in the dental pulp following pulpotomy with Mineral Trioxide Aggregate (MTA) and Calcium hydroxide. Pulpotomies were performed on premolar teeth that were to be extracted for orthodontic reasons. The radicular pulp was capped with either MTA or Calcium hydroxide and restored with IRM. The teeth were extracted at 4 and 8 week intervals, fixed in 10% formalin and then kept in 5% nitric acid for 28 days for demineralization. Longitudinal sections were then prepared and viewed under light microscope. The pulps capped with MTA (at the end of 4 weeks and 8 weeks) showed dentin bridge formation which was more homogenous and continuous with the original dentin when compared to the pulps capped with calcium hydroxide. The pulpal inflammation was also less in the MTA group as compared to the calcium hydroxide group at the end of 4 and 8 weeks.

Adolescent↗

Long-term study of pulp capping in monkeys with three agents.

The pulps of 40 permanent teeth of two monkeys were mechanically exposed and contaminated with adjacent saliva or plaque for 3 to 5 1/2 hours. The pulps were then capped with either Keflin (an antibiotic), Durelon (a polycarboxylate cement), or Dycal (a calcium hydroxide compound). Varnish and then amalgam were inserted. Each monkey received at least one dose of Procion red H-8BS vital dye. The teeth were extracted from one monkey 23 months after capping and from the other monkey 29 months after capping. Serial, decalcified, 7 mum-thick paraffin sections were prepared. Alternate slides were stained with hematoxylin ane eosin. Unstained sections were examined for Procion labeling, and selected slides were stained by the Brown-Brenn method for bacteria. Of 13 teeth capped with Keflin, only 4 responded satisfactorily. All of the Dycal and Durelon-capped pulps were successful at both time intervals. All of the Dycal-capped pulps showed complete bridging and no inflammation or pulp obliteration. Bridging was complete in only three of the Durelon-capped pulps. The findings of this study support the findings in our previous study3 and further substantiate the effectiveness of Dycal as a pulp-capping agent. The often-repeated claim that calcium hydroxide compounds exert a persistent stimulating effect on the pulp resulting in its eventual obliteration was not supported. Durelon is not recommended for pulp capping since the material apparently lacks an antibacterial effect and does not stimulate reparative dentinogenesis at the exposure site. The low rate of satisfactory responses of pulps capped with Keflin, as used, precludes its use of pulp capping.

Acrylates↗

[Clinical and experimental studies on membranous pulp-capping agent with Chinese medicinal herbs].

A membranous pulp-capping agent of Chinese medicinal herbs was made by ourselves prescription, and was filled in capsules for medication. Direct pulp-capping and pulpotomy were performed on 102 permanent teeth. During the observation period of more than one year, the successful rate was 82.4%. Under light microscope, the artificial exposed sites of normal sheep teeth were fully sealed after capping for 45 days. There were calcification under the exposed sites. The inner lines were preparative dentins. Experiments on dogs' teeth revealed that the pulps were normal after two month's direct pulp-capping, and the new dentins appeared. The bacteria culture test was made before and after the pulp-capping agent was used on ten deep carious teeth. It revealed that the bacteria all converted negative after medication of two weeks. Clinical and experimental studies indicated that the pulp-capping agent is valuable in clinical treatment.

Adolescent↗