The response of the rat molar pulp of two proprietary calcium hydroxide preparations.
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The methods of treatment of talon cusps are reviewed. A case is reported in which a calcium hydroxide pulpotomy was carried out on an upper central incisor with a talon cusp. This was necessary to enable (a) complete reduction of the cusp within a feasible time span, and (b) maintenance of pulpal vitality in order to allow apical development of the immature root.
For more than 70 years calcium hydroxide has played a major role in endodontic therapy, although many of its functions are now being taken over by the recently introduced material MTA. Calcium hydroxide may be used to preserve the vital pulp if infection and bleeding are controlled; to repair root fractures, perforations, open apices and root resorptions. Endo-perio lesions are complex and the correct diagnosis is essential if treatment is to be successful. However, root canal treatment will always be the first phase in treating such lesions.
Root canal treatment for children has particular difficulties and considerations. It must be planned in light of the remaining teeth, and the need for balancing or compensating extraction borne in mind. Diagnosis may be difficult, as may prolonged treatment under local anaesthesia and rubber dam. Vital pulpotomy techniques with formocresol and/or calcium hydroxide must be carefully executed in line with the UK National Guidelines. The treatment of the avulsed tooth has been the subject of much research, and practitioners should ensure that they are up-to-date with current treatment modalities.
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AIM: The purpose of this study was to evaluate clinically and radiographically pulpotomies carried out under intrapulpal injection of anaesthetic solution. METHODOLOGY: Forty-one permanent mandibular molar teeth presenting with deep carious lesions and/or exposed pulps, with or without periapical changes on radiographic examination, were treated with pulpotomy and dressed with calcium hydroxide. The teeth were divided into three groups. Group A consisted of 15 teeth, where intrapulpal anaesthesia was administered by a slow injection of lidocaine hydrochloride 2%. Group B, with 14 teeth, where intrapulpal anaesthesia was obtained with lidocaine hydrochloride 2% with adrenaline 1:100,000. Group C consisted of 12 teeth in which anaesthesia was performed with a mandibular block using prilocaine hydrochloride 3% with felypressin 1: 100,000. Healing was evaluated using clinical and radiographic criteria: dentine barrier formation, absence of clinical symptoms and resolution of periapical involvement. RESULTS: After an observation time of 6-8 weeks (postoperative control) and 24-32 weeks (intermediate control), healing occurred in 13 teeth from group A (87%), in 11 teeth from group B (79%) and in 10 teeth from group C (83%). No statistical difference was demonstrated between the three groups (Fisher's exact test). CONCLUSIONS: Based on the methodology adopted, intrapulpal injection of anaesthetic solution did not impair healing in pulpotomized teeth.
Two case reports with dens evaginatus are presented. Each patient had one tooth affected. There was a prominent tubercle on the occlusal surface of the mandibular second premolar. Under local anesthesia and rubber dam isolation a partial pulpotomy was conducted and mineral trioxide aggregate was placed. After 6 months the teeth were removed as part of planned orthodontic treatment. Histological examination of these teeth showed an apparent continuous dentin bridge formation in both teeth, and the pulps were free of inflammation. These cases show that mineral trioxide aggregate can be used as an alternative to existing materials in the proplylactic treatment of dens evaginatus.
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Calcium hydroxide is a material which has been used for a variety of purposes since its introduction into dentistry in the early part of the twentieth century. In its pure form, the substance has a high pH, and its dental use relates chiefly to its ability to stimulate mineralization, and also to its antibacterial properties. A range of products has been formulated with different therapeutic actions, the effects of which are partially dependent upon the tissue to which they are applied. The material is reviewed under the following general headings: biochemical actions; dental formulation; uses.
A clinical study using vital maxillary central incisors was performed to evaluate the incidence of postoperative pain after pulpectomy and dressing with a corticosteroid-antibiotic preparation or a calcium-hydroxide paste. Sixty teeth from 45 patients were prepared and dressed on the first visit and re-evaluated 7 days later. No difference was observed in the incidence of postoperative pain between the two groups.
Several studies have questioned the antimicrobial role of calcium hydroxide cements. This study assessed the antimicrobial activity of four commercially available calcium hydroxide cements on Streptococcus sanguis NCTC 7864 using inoculated Mueller-Hinton growth medium. Growth curves from optical density analysis, pH measurements, and viability counts were compared over a 24 h period. Significant differences occurred (P < 0.05) between pH measurements but not the growth curves or the viability counts. All cements exerted a cidal effect although this cannot be attributed to an increase in alkalinity alone.
AIM: The purpose of the study was to evaluate the biological effects of a flowable resin composite on erythrocytes and rat spleen lymphocytes (RSL) using an in vitro model. METHODOLOGY: Rat spleen lymphocytes were placed into microcentrifuge tubes as a pulp model. An artificial pulp exposure was made through the top of the microcentrifuge tube with a 16G needle. The exposure site was filled with a flowable resin composite and photo-polymerized, and the other specimens were not polymerized. The survival rates were determined by a haemocytometer. Red blood cell (RBC) suspension (0.5%) was reacted with the flowable resin composite. The haemolytic activity was evaluated at room temperature (20 degrees C) using a supernatant of each sample by measuring 545 nm of absorbency with a spectrophotometer. To evaluate the effect of flowable resin composite on RBCs, supernatant and precipitated samples were analysed by sodium dodecyl sulphate-polyacrylamide gel (SDS-PAGE). RESULTS: The cell survival rate of the polymerized group was significantly lower compared with that of the nonpolymerized group at the same areas (P < 0.05). The values of haemolysis (absorbency) were 2.16 for the polymerized group, 2.14 for the nonpolymerized group, and 2.18 for the control group (saline). There were no significant differences among them (P > 0.05). The protein component in the supernatant and precipitate exhibited the same reaction with flowable resin composite regardless of the completion of the polymerization, resulting in no change of protein band mobility on SDS-PAGE. CONCLUSIONS: The degree of haemolysis was not influenced by the completion of polymerization. The flowable resin composite tested provoked an adverse effect on lymphocytes when it was not polymerized and the degree of haemolysis was not affected by the status of the polymerization.
This paper reviews the literature on the constituents and biocompatibility of mineral trioxide aggregate (MTA). A Medline search was conducted. The first publication on the material was in November 1993. The Medline search identified 206 papers published from November 1993 to August 2005. Specific searches on constituents and biocompatibility of mineral trioxide aggregate, however, yielded few publications. Initially all abstracts were read to identify which fitted one of the two categories required for this review, constituents or biocompatibility. Based on this assessment and a review of the papers, 13 were included in the constituent category and 53 in the biocompatibility category. Relatively few articles addressed the constituents of MTA, whilst cytological evaluation was the most widely used biocompatibility test.