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PubMed1985

Effects of calcium hydroxide-containing pulp-capping agents on pulp cell migration, proliferation, and differentiation.

The findings from the recent literature on pulpal cell responses to the application of calcium hydroxide to exposed pulps are described. The effect of calcium hydroxide on healthy and inflamed pulp is discussed. The effect of incorporation of calcium hydroxide in various pulp-capping agents is presented. The initial effect of calcium hydroxide applied to exposed pulp is the development of a superficial three-layer necrosis. The beneficial effect of calcium hydroxide is regarded as the result of the chemical injury caused by the hydroxyl ions, limited by a zone of firm necrosis against the vital tissue, and the toleration of calcium ions by the tissue. The firm necrosis causes slight irritation and stimulates the pulp to defense and repair. The observed sequence of tissue reactions is that which is expected when connective tissue is wounded. It starts with vascular and inflammatory cell migration and proliferation, to control and elimination of the irritating agent. This is followed by the repair process, including migration and proliferation of mesenchymal and endothelial pulp cells and formation of collagen. When the pulp is protected from irritation, odontoblasts differentiate, and the tissue formed assumes the appearance of dentin, i.e., the function of the pulp is normalized. The mineralization of the collagen starts with dystrophic calcification of both the zone of firm necrosis and the degenerated cells in the adjacent tissue, leading to deposition of mineral in the newly-formed collagen. The presence of calcium ions stimulates precipitation of calcium carbonate in the wound area and thereby contributes to the initiation of mineralization.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1989

[Ultrastructural study on the developmental process of the dentin bridge following direct capping using hydroxyapatite ceramic].

Hydroxyapatite ceramics (HAP), which have been used in the endodontics or periodontics because of their bioafinitive characteristics, were applied directly as the capping of the wound surface after the experimental exposure of pulp in versional teeth to be extracted on orthodontics ground. In order to investigate the developmental process of dentine bridge induced by HAP capping, the pulp was studied ultrastructurally, 1, 3, 6 months after the treatment. One month after the capping, the multi-nuclear giant cells being rich in mitochondria and lysosomes were in contact with the HAP granules directly by extending their projections into the granules, which appeared to absorb the HAP granules. At the same time, the osteoblast-like cells with remarked rough endoplasmic reticulum (rER) were also observed just behind the giant cells. Only a few matrix vesicles and fibers were recognized around these osteoblastic cells. The HAP granules embeded in the pulp for 3 months were surrounded by fine matrix fibers which seemed to be produced by adjacent osteoblastic cells. The surrounding of these cells were filled with abundant matrix vesicles and collagen fibers, which would show the production of osteodentin matrix and the minerilization were active in this region. Six months after the treatment, the osteodentin matrix in upper dentin bridge became compact; matrix fiber surrounding the HAP granules became thick and a part of fibers inserted into the granules, which should mean that the HAP granules had bonded to the osteodentin matrix. In the deeper region of the dentin bridge, tubular dentin was formed newly. Both osteodentin and tubular dentin fused tightly without any organelles in the boader between them. The covering of hard tissue of dentin bridge then bonded to primary and reparative dentin closed the wound surface to protect the inner pulp.

Dental Pulp Capping↗

PubMed1987

Hard tissue barrier formation in pulpotomized monkey teeth capped with cyanoacrylate or calcium hydroxide for 10 and 60 minutes.

Monkey incisor teeth were pulpotomized in groups of 10. After physiological hemostasis, the pulps of group I were covered with isobutyl cyanoacrylate, and those of groups II and III with calcium hydroxide for 10 and 60 minutes, respectively, whereafter this compound was washed away and the wound surfaces covered with Teflon. In group IV, calcium hydroxide was used as a positive control, and Teflon as a negative control in group V. The animals were killed after 12 weeks and the teeth removed in tissue blocks. The material was processed and evaluated histologically with respect to location and continuity of a hard tissue barrier, type of newly formed hard tissue, state of the pulp, and presence of stainable bacteria in the coronal cavity. Seven of nine teeth in group I showed a hard tissue barrier. The corresponding figure for group II was eight out of 10 teeth. All teeth in groups III and IV had a barrier. The incidence of a continuous barrier increased from group I through group IV, as did the incidence of its location below the level of the original wound surface. The condition of the pulp was related to the presence of bacteria and the continuity of the barrier to the presence of inflammation. There was no bridging in group V. The results support the theory that a low-grade irritation is responsible for the formation of a hard tissue barrier in exposed pulps.

Animals↗

PubMedDate not supplied

Comparison of mineral trioxide aggregate and formocresol as pulp-capping agents in pulpotomized primary teeth.

PURPOSE: The aim of this study was to use clinical, radiographic, and histologic examinations to compare the relative success of gray mineral trioxide aggregate (MTA), white MTA, and formocresol as pulp dressings in pulpotomized primary teeth. METHODS: Twenty-four children, each with at least 3 primary molars requiring pulpotomy, were selected for this study's clinical and radiographic portion. An additional 15 carious primary teeth planned for serial extraction were selected for this study's histologic portion. All selected teeth were evenly divided into 3 test groups and treated with pulpotomies. Gray MTA was used as the pulp dressing for one third of the teeth, white MTA was the dressing for one third, and the remaining one third were treated with formocresol. The treated teeth selected for the clinical and radiographic evaluations were monitored periodically for 12 months. The treated teeth selected for histologic study were monitored periodically and extracted 6 months postoperatively. RESULTS: Four children with 12 pulpotomized teeth failed to return for any follow-up evaluations in the clinical and radiographic study. Of the remaining 60 teeth in 20 patients, 1 tooth (gray MTA) exfoliated normally and 6 teeth (4 white MTA and 2 formocresol) failed due to abscesses. The remaining 53 teeth appeared to be clinically and radiographically successful 12 months postoperatively. Pulp canal obliteration was a radiographic finding in 11 teeth treated with gray MTA and 1 tooth treated with white MTA. In the histologic study, both types of MTA successfully induced thick dentin bridge formation at the amputation sites, while formocresol induced thin, poorly calcified dentin. Teeth treated with gray MTA demonstrated pulp architecture nearest to normal pulp by preserving the odontoblastic layer and delicate fibrocellular matrix, yet few inflammatory cells or isolated calcified bodies were seen. Teeth treated with white MTA showed a denser fibrotic pattern, with more isolated calcifications in the pulp tissue along with secondary dentin formation. CONCLUSIONS: Gray MTA appears to be superior to white MTA and formocresol as a pulp dressing for pulpotomized primary teeth.

Aluminum Compounds↗

PubMed1980

The response of four calcium hydroxides on monkey pulps.

Dentinal bridge formation and pulpal responses of four calcium hydroxide materials, pulp capping medicaments, MPC, Experimental MPC-12, Dycal and Pulpdent, were evaluated in primary and permanent monkey teeth. A total of 60 primary and 60 permanent teeth were used with each material placed in a Class V cavity exposure in Rhesus monkey teeth. The materials were placed on the exposed pulp tissue and were histologically evaluated at 3 days, 5 weeks and 8 weeks. After perfusion the teeth were processed using routine histological procedures. The 3-day pulpal responses in both primary and permanent teeth were moderate, characterized by disruption of the pulpal tissue directly beneath the exposure site and a zone of acute inflammation and hemorrhage in the underlying pulp. The 5-week response showed histological differences between the four medicaments, with Dycal producing the least amount of pulpal irritation with reparative dentin bridges occurring in 50% of the permanent teeth. Experimental MPC-12 stimulated one reparative dentin bridge, while Pulpdent and MPC showed no evidence of bridge formation. Pulpal responses to Dycal were moderate and moderate to severe for the other calcium hydroxide compounds. No reparative dentin bridges were seen in the primary teeth at 5 weeks with any of the materials, and the pulpal responses were of a moderate degree at that time. Eight-week responses were similar to the 5-week responses Dycal provoked a slight to moderate pulpal response with 50% success at bridging. Experimental MPC-12 initiated pulpal responses in the moderate to severe range with some bridging evident. Pulpdent incited moderate to severe histological responses with three teeth demonstrating bridge formation, and MPC provoked severe pulpal responses with no bridging. Primary teeth showed some bridging for all compounds except those treated with MPC, in which no evidence of bridging occurred, and moderate to severe pulpal responses were present.

Animals↗

PubMed2006

Clinical and histological evaluation of white ProRoot MTA in direct pulp capping.

PURPOSE: To evaluate the clinical, radiographical and histological findings in human third molars in which mechanical pulp exposures were capped with white ProRoot mineral trioxide aggregate (WMTA). METHODS: Forty-eight human third molars, caries-free or with incipient caries, scheduled to be extracted, were used and randomly divided into two groups: Group A: (n= 24) received WMTA and control Group B: (n= 24) received chemical set calcium hydroxide (Dycal). The teeth were isolated with rubber dam and Class I cavities prepared. Pulp exposure was performed using a sterile diamond bur and confirmed by frank bleeding. A sterile cotton pellet dipped in saline solution was placed over the exposure for 60 seconds. The preparation was then lightly rinsed with water and gently air-dried. WMTA or CH was placed over the exposure site followed by a small amount of a light-cured compomer. After etching with 35% phosphoric acid gel for 15 seconds, rinsing and blot drying, Prime and Bond NT adhesive was applied and light-cured. The cavity was then restored with a resin composite and light-cured. Evaluations were performed by phone after 7 days and clinically at 30 +/- 5 and 136 +/- 24 days, using standardized tests and radiographs. The teeth were extracted after 136 +/- 24 days; the roots were cut +/- 4-5 mm from the apex to allow for rapid fixation in 10% neutral buffered formalin. They were then processed for routine histological evaluation, embedded in paraffin, sectioned and stained with hematoxylin and eosin and Brown and Brenn for recognition of bacteria. Statistical analyses were performed using a Mann-Whitney U-test, a Chi-square test, a Fisher's exact test and an ANOVA. RESULTS: No significant differences in post-operative sensitivity were reported after 7 days between the two materials (P> 0.05). Clinical examination demonstrated no significant differences at 30 +/- 5 days (P> 0.05) and at 136 +/- 24 days (P> 0.05). Histological findings: 45 of 48 teeth were suitable for microscopic evaluation (22 with WMTA and 23 with CH). Twenty from the WMTA and 18 from the CH group had developed a bridge. No statistically significant differences were found for superficial and deep inflammatory cell response (P> 0.05), presence of a dentin bridge (P> 0.01), and pulp vitality (P> 0.01), between WMTA and calcium hydroxide. A statistically significant difference was found for the diameter of exposure (P< or = 0.05) between WMTA (x= 0.35 +/- 0.19 mm) and CH (x= 0.25 +/- 0.09 mm). Only a minimal association between clinical and histological findings could be established for either material.

Aluminum Compounds↗

PubMed1998

Viscoelastic properties of demineralized human dentin measured in water with atomic force microscope (AFM)-based indentation.

Using an atomic force microscope (AFM) with an attachment specifically designed for indentation, we measured the mechanical properties of demineralized human dentin under three conditions: in water, in air after desiccation, and in water after rehydration. The static elastic modulus (E(h)r = 134 kPa) and viscoelastic responses (tau(epsilon) = 5.1 s and tau(sigma) = 6.6 s) of the hydrated, demineralized collagen scaffolding were determined from the standard linear solid model of viscoelasticity. No significant variation of these properties was observed with location. On desiccation, the samples showed considerably larger elastic moduli (2 GPa), and a hardness value of 0.2 GPa was measured. Upon rehydration the elastic modulus decreased but did not fully recover to the value prior to dehydration (381 kPa).

Analysis of Variance↗

PubMed1974