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PubMed2005

[Endodontic treatment of primary teeth. Pulp exposure and pulp necrosis].

With management of the deep caries in primary teeth we have to take account into the coping strategies of the patient and the state of the development of the dentition. That's why in most cases a root canal treatment of primary incisors or even a pulpotomy is not indicated. Often Intellectual Decision Not To Restore is a good alternative for treatment of deep caries in primary incisors. In deep caries lesions of primary canines and molars preferably minimal invasive techniques as indirect pulp capping are performed. In case of a exposure, the dentist can choose between several types of treatment. Improved techniques have lead to clinical satisfying results of the calcium hydroxide pulpotomy. A partial pulpotomy is if possible the treatment of choice. A resin modified glass ionomer cement is used to cover the pulp wound because it has good sealing properties and it is easy to handle. To limit the burden in young children a root canal treatment in primary teeth is seldom indicated. Overfilling with calcium hydroxide in root canal treatment of primary teeth never causes problems.

Child↗
PubMed1998

A histopathologic study of direct pulp-capping with adhesive resins.

OBJECTIVE: The purpose of this study was to evaluate the histologic pulp responses of Optibond and Syntac adhesive resin systems placed directly on exposed pulp tissues. STUDY DESIGN: Class V facial cavities with pulpal exposures were prepared in dogs. After acid etching of enamel margins, the cavities were restored with a composite resin after pulp-capping with one of the dentin bonding agents. The remaining exposures were capped with calcium hydroxide and amalgam as controls. The animals were killed after 7, 21, and 90 days and the pulps were evaluated histologically. Statistical analysis was carried out with the chi-square test. RESULTS: There was no statistically significant difference with respect to inflammatory cell response, fibrosis, bleeding, or bacterial staining criteria over the time intervals of evaluation among the Optibond, Syntac, and calcium hydroxide groups. New dentin formation was also observed for all of the groups at the end of 90 days. CONCLUSION: The results of direct pulp-capping with a dentinal adhesive and composite resin appear promising but further in vivo studies are recommended.

Acid Etching, Dental↗
PubMed1993

Pulp capping with Bioglass and autologous demineralized dentin in miniature swine.

The purpose of this study was to compare the responses of mechanically exposed dental pulps which had been capped with three dissimilar materials: a bioactive ceramic (Bioglass), autologous demineralized dentin matrix (DDM), and a calcium hydroxide product (Life), with Teflon discs as controls. Mechanical dental pulp exposures were made after preparation of deep buccal Class V cavities in 48 teeth in four miniature swine. The exposures were capped and the cavity preparations restored with zinc oxide-eugenol (IRM) cement. The animals were killed after 90 days, the coronal 2/3 of the teeth removed, and sections prepared for either histological or microradiographic examination. The pulpal inflammatory reactions and the degree of reparative dentin formation were assessed from demineralized serial sections. A qualitative assessment of the degree of mineralization of the reparative dentin was made from microradiographs of undecalcified sections. The observations suggest that reparative dentin formation occurs under a variety of pulp-capping materials, but the structure of the reparative dentin varies with the material and the condition of the underlying pulp.

Analysis of Variance↗
PubMed2001

Technique sensitivity: biological factors contributing to clinical success with various restorative materials.

Since the 1950s, clinicians have relied on various formulations of Ca(OH)2 to stimulate dentin bridge formation. Various studies (Kozlov and Massler, 1966; Massler, 1967; Brännström, 1978; Cox et al., 1987; Snuggs et al., 1993) have demonstrated that pulp healing and dentin bridging can occur against a pH spectrum of materials. Recent studies (Akimoto et al., 1998; Cox et al., 1998, 1999; Tarim et al., 1998; Kitasako et al., 1999; Hafez et al., 2000) have reported successful pulp healing and dentin bridging using adhesives for direct capping of exposed pulps. However, others (Costa et al., 1997; Stanley and Pameijer, 1997; Pameijer, 1998; Hebling et al., 1999; Carvalho et al., 2000) have reported unsatisfactory results when exposures were direct-capped with adhesives. Biological and technical factors, or a combination of both, might be postulated to explain these differences. Recent studies have demonstrated that biological success is dependent upon proper hemorrhage control at the exposure site. This review explores the differences and common factors influencing successful dentin bridging, focusing on data derived from animal studies conducted according to ISO usage guidelines for cavity preparation and material placement. In the past, there has been concern that etching of vital dentin leads to immediate pulp death due to low pH. Recent studies have reported that acidic cements cause breakdown of only the smear layer and fail to seal the restoration interface, leading to inflammation and necrosis. A properly hybridized dentinadhesive interface provides a "bacteriometic" seal to both dentin and pulp tissues. Recent ISO usage studies have shown a high incidence of dentin bridging with adhesives following proper hemorrhage control and removal of both operative debris and biofilm at the dentin-pulp interface by agents such as NaOCl. These are important technique-sensitivity factors to be considered for pulp healing and dentin bridge formation.

Acid Etching, Dental↗
PubMed2000

Short term human primary pulpal response after direct pulp capping with fourth-generation dentin adhesives.

The purpose of this study was to evaluate the effects of the total-etch and direct pulp capping techniques on the short-term response of mechanically exposed human primary tooth pulps using three commercially available adhesive resin systems. Class V cavities were prepared on the buccal surface of intact mandibular primary molars and exposed with a carbide bur on the cavity floor. The entire cavity except the exposure site received 36% phosphoric acid gel conditioning. Exposed pulps were capped with one of the three adhesive resins, followed by restoration of the cavities with the respective restorative materials. The teeth were extracted after 60 days and prepared according to normal histological techniques. Serial sections were stained with H/B for histological evaluations. The histopathological evaluation showed that a few of the samples in the Scotchbond Multi Purpose (SMP) and Prime & Bond 2.1 (PB) groups exhibited "attempted bridge formation", while no bridge formation was evident in the other samples. Syntac Single Component (Syntac) exhibited the most severe histological response, while the mildest reactions were observed in the SMIP group. Based on the conditions of the present study, direct pulp capping with dentin bonding agents following the total-etch technique in primary teeth can not be recommended.

Acid Etching, Dental↗
PubMed1997

A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals.

Concern about the survival of microorganisms in deep carious lesions may often lead to unnecessary exposure of the pulp during final excavation. There are reasons, therefore, to initiate systematic studies on the alternative procedure known as stepwise excavation. Clinical evaluation of stepwise excavation was performed on 31 deep carious lesions considered to result in pulp perforation by traditional excavation. This study examines the clinical and microbiological alterations during the final excavation performed during long intervals (6-12 months) after the initial treatment that included peripheral dentine excavation and removal of the central cariogenic biomass and the superficial necrotic dentine. The dentine colour and consistency were assessed by means of standardized scales before application of a Ca(OH)2 compound and a temporary sealing for 6-12 months. Reassessments were performed before the after final excavation. Microbiological dentine samples were obtained in 19 randomly selected lesions by a sterile bur, transferred to and diluted in reduced transport fluid, and plated on tryptic soy agar. After anaerobic incubation at 37 degrees C for 7 days, total colony-forming units per millilitre were counted from (1) peripheral excavated and hard dentine (control), (2) central demineralized dentine before and final excavation, and (3) central dentine after the final excavation. Six samples of central demineralized dentine were without any cultivable flora increasing to 9 samples after the final excavation. The clinical dentine changes occurring during stepwise excavation were characterized by enhanced hardness of the dentine which was associated with a marked reduction in bacterial growth after the final excavation. Despite the presence of bacteria in the excavated dentine none of the carious lesions resulted in pulp perforation, suggesting that the initial removal of the cariogenic biomass appears to be essential for control of caries progression. Stepwise excavation is not only an appropriate treatment of deep carious lesions but is also considered a suitable model for microbiological studies to determine the bacteria persisting in clinically excavated lesions.

Anaerobiosis↗
PubMed1975

Endodontic emergency dilemma: leave tooth open or keep it closed?

Various methods of emergency endodontic treatment for teeth with vital pulps have been suggested, and some authors have advised that the access be left open if the tooth is tender to percussion. This study evaluated 225 open and closed teeth which were referred after emergency treatment where pulps had been vital. When the access had been left open, a statistically significant greater number of appointments were needed to complete treatment and more intratreatment exacerbations occurred than when the tooth was kept sealed.

Dental Pulp Exposure↗
PubMed2004

Effect of Carisolv on the human dental pulp: a histological study.

OBJECTIVES: The aim of this study was to investigate histopathologically after 1 week and 1 month the effect of Carisolv on exposed human pulp after a contact period of 10 min in comparison to sterile saline solution. METHODS: Class V cavities were prepared in 40 human first premolars, and the pulp chambers were perforated. The pulp tissue was either exposed to Carisolv or sterile saline solution for 10 min, covered with Teflon and restored with compomer filling material. After observation periods of 1 week and 1 month, the teeth were extracted and examined by light microscopy. RESULTS: Histological evaluation revealed similar pulpal response which consisted of a slight inflammation in both groups after 1 week. The only difference was localized haemorrhage in controls while no haemorrhage was observed in the test group which may show the haemostatic effect of Carisolv. After 1 month the test teeth displayed a very mild inflammation adjacent to the perforation area while haemorrhage disappeared in the controls. In general, pulps showed structural integrity in both groups. Statistical analysis showed no difference between the test and the control groups in both test periods. CONCLUSIONS: The results suggest that Carisolv is biocompatible with human pulp tissue and may have a haemostatic effect.

Adolescent↗
PubMed2000

Factors influencing pulpal response to cavity restorations.

OBJECTIVES: The purposes of this retrospective work were: (1) to determine the relative importance of bacteria on cavity walls, remaining dentin thickness and post-operative time on pulpal inflammation after cavity restoration; (2) to compare the respective influences of bacterial microleakage and the restorative material itself on pulp reaction severity. METHODS: 317 class V cavities, in human bicuspids scheduled for extraction for orthodontic reasons were used for this study. Nine different materials were included. The severity of the pulpal reaction was ranked on hematoxylin/eosin stained sections according to FDI standards. The further parameters recorded were: (1) the presence or absence of bacteria on the cavity walls was noted on Brown and Brenn stained sections; (2) the remaining dentin thickness was measured and the teeth classified into three groups (< 500, 500-1000, > 1000 microns); and (3) the post-operative delay before extraction was recorded and classified as short time (< 5 weeks) or long time (> 5 weeks). Three two-way analyses of variance (ANOVA) followed by Kruskall and Wallis tests evaluated the influence of the three parameters on pulpal reaction severity. The third ANOVA also compared pulpal reactions under the different materials when the teeth were pooled, on bacteria free teeth and on bacteria contaminated teeth. RESULTS: The first ANOVA ranked by decreasing order of importance: the presence of bacteria (p < 0.0001), the remaining dentin thickness (p = 0.02) and the post-operative delay (p = 0.04). The second ANOVA showed no difference among the restorative materials when bacteria were present on the cavity walls. SIGNIFICANCE: The presence of bacteria on the cavity walls is the main factor influencing pulpal reaction under restorative materials, but does not account for 100% of the cases.

Adolescent↗
PubMed2001

Social deprivation and traumatic dental injuries among 14-year-old schoolchildren in Newham, London.

AIMS: To assess the epidemiology of dental injuries among schoolchildren in Newham, London. MATERIAL AND METHODS: This study was carried out as part of the annual Community Dental Service's School Dental Inspection (SDI) programme in Newham. All schoolchildren aged 14 years were invited to participate in the study. Dental examinations were carried out by one trained examiner (SM) and included presence of clinical evidence of dental injuries, treatment provided and needed in the upper and lower permanent incisors, size of incisal overjet and type of lip coverage. The postcode was recorded to assess the levels of social deprivation. FINDINGS: 2242 out of 2684 children were examined. The prevalence of dental injuries was 23.7%. Treatment of dental injuries was neglected. Being male, having an incisal overjet greater than 5 mm and living in an overcrowded household increased the risk of having dental injuries. CONCLUSIONS: The prevalence of dental injuries in Newham (23.7%), which is a deprived area of London, was much higher than the overall prevalence in the UK (17%). Traumatic dental injuries seem to be a serious dental public health problem among children in deprived areas. Thus, there is an urgent need to collect local data on dental injuries in order to obtain a more comprehensive picture of the dental health.

Adolescent↗
PubMed2002

Crown fractures in the permanent dentition: pulpal and restorative considerations.

Crown fractures account for the highest percentage of all traumatic injuries in the permanent dentition. This review paper will discuss the different types of crown fracture, from the uncomplicated to complicated, including crown-root fractures. It will focus on two different aspects: the pulp, with an attempt to correlate epidemiological, experimental, histopathological and clinical studies, so that the clinician can better understand the underlying processes accounting for success or failure to maintain pulp vitality. Also, we will consider the restoration: knowledge about bonding to dentin and new material is evolving extremely quickly making it difficult for the clinician to keep up with the developments. If handled properly, prognosis of the pulp, after traumatic crown fracture, is good. Prognosis of the restoration has also improved considerably over the last few years, and it appears that this trend will continue in the future.

Composite Resins↗
PubMed2000

A retrospective study of treatment provided in the primary and secondary care services for children attending a dental hospital following complicated crown fracture in the permanent dentition.

OBJECTIVES: To investigate treatment provision in primary and secondary dental care following complicated crown fracture of permanent teeth. DESIGN AND METHODS: Retrospective observational survey of dental records of all patients attending a dental hospital trauma clinic during a 2-year period with complicated crown fracture. RESULTS: Eighty children (70% male) aged 6-16 years (mean age 10.3 years) with 98 complicated crown fractures were identified. Of these children, 54% were seen for emergency treatment on the day of their injury, 75% within 48 h. Of the 98 injured teeth, 60% were seen initially in general dental practice but only 56% of these 59 cases were provided with emergency treatment in practice, the others being referred immediately to the trauma clinic for treatment. The main cause of fractures was transport, in particular, bicycles. Radiographs were available for 96 teeth; for the 43 open apex teeth, the definitive treatment was pulp capping (44% of cases) and pulpotomy (30%), with vitality maintained in five cases up to 4.8 years after trauma. The 53 closed apex cases were treated definitively with pulp capping (38%) and pulpectomy (36%) and six teeth had maintained their vitality up to 4.3 years after trauma. Sixty-seven per cent of the pulp caps and 47% of the 19 pulpotomies provided relied on a doubtful coronal seal. This was primarily due to the extensive use of a conventional glass ionomer cement as an emergency bandage. The use of an etched or bonded material at initial presentation extended the Median Survival Time for vitality in open apex teeth from 188 to 377 days and in closed apex teeth from 15 to 64 days. CONCLUSIONS: Emergency treatment of complicated crown fractures, particularly in primary care services is often inappropriate or inadequate with regard to emergency management of the exposed pulp and provision of a hermetic coronal seal.

Adolescent↗
PubMed2003

Histopathological study of dental pulp tissue capped with enamel matrix derivative.

The purpose of this study was to examine the histopathological response of dental pulp tissue to enamel matrix derivative (EMD) used as a pulp capping material. Thirty-two teeth from two mongrel dogs were divided into four equal groups. One group served as controls, and the others were used for deep Class V cavity preparation followed by direct pulp capping with enamel matrix derivative. The treated teeth were extracted after 1, 4, and 8 weeks and prepared for histopathological examination by light microscopy. All teeth prepared after 4 and 8 weeks demonstrated an increase in tertiary dentin, suggesting that enamel matrix derivative exerts a considerable influence on odontoblasts and endothelial cells of capillaries in dental pulp tissue. These results imply that enamel matrix derivative used as a pulp capping material may play a role in the calcification of dental pulp tissue.

Animals↗
PubMed2005

Pulp tissue reactions to a dentin bonding agent as a direct capping agent.

The aim of this study was to investigate the response of human pulp tissue to a dentin bonding agent, Scotchbond Multi-Purpose Plus (SMPP), in exposed class V cavities. Sixteen human premolar teeth were mechanically exposed. Ten pulps were capped with SMPP and six teeth were capped with Dycal. The cavities were filled with a composite. After 40 days, the teeth were extracted and processed for histologic evaluation. Of the 10 teeth capped with SMPP, eight showed moderate chronic inflammation, one was severely inflamed, and one pulp had no to slight inflammation. None of the teeth capped with SMPP showed dentin bridge formation. Of the six teeth capped with Dycal, three exhibited incomplete dentin bridges associated with no to slight inflammation, and three showed no to slight inflammation, without formation of dentin bridges. Direct capping with Dycal with subsequent sealing with SMPP may show favorable results in pulp tissue. SMPP may cause inflammatory changes when applied directly to exposed pulp tissue.

Bicuspid↗
PubMed2006

Preserving pulpal health of a geminated maxillary lateral incisor through multidisciplinary care.

AIM: To report the multidisciplinary care of an unaesthetic geminated maxillary lateral incisor tooth, which allowed its preservation in the mouth. SUMMARY: Preoperative examination of an unsightly geminated maxillary lateral incisor (tooth 22) demonstrated two pulp chambers and open apices, with normal pulp sensitivity responses. At surgery, a periodontal mucoperiosteal flap was reflected and the distal part of the geminated tooth was removed. The exposed root canal of the preserved tooth was sealed with mineral trioxide aggregate (MTA). The extraction socket and osseous defect was grafted with decalcified freeze-dried bone allograft (DFDBA) before flap closure. During follow-up, distal caries in tooth 22 and a diastema between tooth 22 and 23 were managed with composite resin restorations. Forty-two months postoperatively, normal thermal and electrical pulp sensitivity tests confirmed pulp health. Convincing apexogenesis and dentinogenesis of the developing root was confirmed by radiographic examination. Acceptable periodontal health including 3-4 mm clinical probing depths was achieved. Optimizing aesthetics and occlusion was accomplished without orthodontic treatment.

Aluminum Compounds↗
PubMed2002

Capping the inflamed pulp under different clinical conditions.

BACKGROUND: A great deal of controversy exists regarding the reliability of capping the inflamed pulp. In particular, the use of calcium hydroxide as a capping agent has come into question. In this study, hard tissue barrier formation after inflamed pulps were capped directly or after partial pulpotomy was compared with calcium hydroxide or bonded resin and with no additional seal or an IRM surface seal. Seventy teeth in five dogs were used. Ten untreated teeth were used as negative controls. In 60 teeth, pulpal inflammation was induced by preparing a cavity close to the pulp and sealing a cotton pellet soaked in plaque in it for 1 to 2 weeks. The cavities were then re-entered and extended to expose the pulps. MATERIALS AND METHODS: In half the teeth (n = 30) a partial pulpotomy was performed and in the other half (n = 30) pulpal treatment was performed on the superficial exposed pulp. Both pulpal treatment groups received the same restorative procedures: (1) calcium hydroxide + amalgam + IRM surface seal; (2) OptiBond Solo, Prodigy with IRM surface seal; or (3) OptiBond Solo, Prodigy without IRM surface seal. The presence, absence, and quality of a hard tissue barrier were evaluated histologically. RESULTS: The calcium hydroxide groups were statistically superior to all other groups. The IRM surface seal resulted in significantly better healing. Although there was no statistically significant difference between direct pulp capping and partial pulpotomy with the numbers in this study, power statistics indicated that in clinical practice a partial pulpotomy would be preferable. CLINICAL SIGNIFICANCE The results of this study suggest that a partial pulpotomy, calcium hydroxide medicament, and a bacteria-tight coronal restoration represent a viable technique for capping the inflamed pulp.

Animals↗