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PubMed2003

Histological and scanning electron microscopy assessment of various vital pulp-therapy materials.

Pulp capping and pulpotomy procedures were performed on 15 male mongrel dogs. Three materials were used: calcium hydroxide, acid-etched dentin bonding, and mineral trioxide aggregate. Six of the animals were killed at 50 days and nine were killed at 150 days. Samples from 11 dogs were used for histological evaluation, and the remaining dog samples were used for scanning electron microscopy evaluation. Each slide was graded histologically according to previously published criteria. Scanning electron microscopy analysis was performed, and the weight percentage of elements found in the dentin of a nontreated tooth versus the bridge formed in the exposed specimen was established. By evaluating pulp inflammation in vital pulp-therapy treatments, it was found that mineral trioxide aggregate was not significantly different from the untreated control group, both in pulp-capping procedures at 50 days (p = 0.357) or 150 days (p = 0.198) and pulpotomy procedures at 50 days (p = 0.357) or 150 days (p = 0.198). Moreover, histologically mineral trioxide aggregate was a considerably better material than calcium hydroxide or acid-etched dentin bonding in maintaining the integrity of the pulp.

Aluminum Compounds↗

PubMed2002

An in vivo evaluation of hemorrhage control using sodium hypochlorite and direct capping with a one- or two-component adhesive system in exposed nonhuman primate pulps.

OBJECTIVE: This study evaluated the biologic ability of sodium hypochlorite to control hemorrhage via chemical amputation of the coagulum, to remove dentin chips, to assist healing, and to facilitate formation of a dentinal bridge under two adhesive systems. METHOD AND MATERIALS: Ninety Class V cavities with mechanical pulpal exposures were placed in the teeth of five adult monkeys and histologically observed. All exposures were prepared with a No. 330 bur, and hemorrhage was controlled with 3% sodium hypochlorite. Twenty-two exposures were capped with All-Bond 2 and AElitefil, and 26 exposures were capped with One-Step (OS) and Resinomer (RS). Two pulps were excluded from the final data. Forty-two exposures were capped with calcium hydroxide and amalgam as controls. At 7, 27, and 90 days, tissues were obtained by perfusion fixation, demineralized, sectioned, stained, and histologically graded according to published qualitative criteria. RESULTS: For both adhesives, at 7 days, 12 of 16 pulps showed no coagulum remnants or dentin chips at the material interface. No necrotic pulps were observed. At 27 and 97 days, 26 of 30 capped pulps had dentinal bridges at the adhesive interface. Reparative dentin was present in 28 pulps. Four 97-day pulps exhibited necrosis associated with stained bacteria. One 97-day pulp contained dentin chips throughout the pulp and demonstrated no healing, no reparative dentin, and no stained bacterial profiles. CONCLUSION: Normal soft tissue reorganization and dentinal bridge formation were observed in 86% of pulps treated with sodium hypochlorite and either adhesive system.

Animals↗

PubMed2000

Human pulpal response to direct pulp capping with an adhesive system.

PURPOSE: To evaluate clinically and microscopically the human pulp response when directly capped with an adhesive system or calcium hydroxide over short (9-12 days) and long (53-204 days) experimental periods. MATERIALS AND METHODS: Fifty-one sound human premolars scheduled for orthodontic extraction, had their pulp horns gently exposed with a diamond point. Debris in the pulp wound was washed out with a sterile saline solution. The pulps were then capped with either an adhesive system (Scotchbond Multi-Purpose Plus) or calcium hydroxide. All teeth were subsequently restored with resin-based composite (Z-100) according to the manufacturer's instructions. After the experimental periods, the teeth were extracted and processed for light microscopic examination. RESULTS: Short-term: the pulp tissue capped with SBMP-P exhibited dilated and congested blood vessels associated with a moderate inflammatory response and blanching of pulp cell nuclei. Long-term: no evidence of healing and bridge formation was observed. A persistent mild inflammatory pulp response was present. Micro-abscesses were detected in three cases associated with bacterial infiltration. Calcium hydroxide stimulated early pulp repair and dentin bridging which extended into the longest period.

Abscess↗

PubMed2005

Advances since the paper by Zander and Glass (1949) on the pursuit of healing methods for pulpal exposures: historical perspectives.

Clinical observations and experimental studies in humans and laboratory animals have demonstrated that healing and repair of pulpal exposures by caries, trauma, or iatrogenic causes are possible with a variety of wound treatment methods. Yet clinical trials have shown that predictable long-term pulp tissue preservation may be an elusive goal and has led to doubts about pulp capping and pulpotomy as valid clinical procedures. Nevertheless substantial knowledge has accumulated over the years on the mechanisms and the treatment factors that are important to promote/support continued vital pulp functions. This article highlights some key contributions to our current knowledge base, which have come to light during the more than 50 years since a pioneering experimental study by Zander and Glass was published in the Triple O journal.

Aluminum Compounds↗

PubMed2005

Pulpal responses following direct pulp capping of healthy dog teeth with dentine adhesive systems.

OBJECTIVE: The aim of the present study was to evaluate the pulpal responses following direct pulp capping of mechanically exposed teeth with new dentine adhesive systems, in the preclinical model of dog teeth. METHODS: Class V cavities (approximately 2.50 mm wide, 3.00 mm long, 1.5-2.0 mm deep) were prepared on the buccal surface of permanent maxillary and mandibulary molars, two rooted premolars, canines and third incisors. The cavities were assigned to five experimental groups, representing one control group treated with a Ca(OH)2-based material and four experimental groups where the adhesive systems Clearfil SE Bond, Prompt-L-Pop, Etch & Prime 3.0 and Single Bond were tested. The pulpal tissue responses to dentine adhesives were assessed at post-operative periods of 7, 21, 65 days. RESULTS: Variable responses were recorded, which were characterized by moderate to severe inflammatory reactions, progressive extension of tissue necrosis with time and total absence of continuous hard tissue bridge formation after pulp capping with each of the four adhesive systems. Application of a Ca(OH)2-based material was characterized by inflammatory cell infiltration, limited tissue necrosis as well as partial to complete hard tissue bridging. CONCLUSIONS: It seems evident that application of dentine adhesive systems in direct contact with the mechanically exposed pulp of healthy dog teeth cannot lead to acceptable repair of the dentine-pulp complex e.g. wound healing with tertiary dentine bridge formation.

Animals↗

PubMedDate not supplied

Partial pulpotomy and tooth reconstruction of a crown-fractured permanent incisor: a case report.

Pulp exposure due to traumatic injuries in the anterior permanent teeth of adolescents is a common occurrence. A vital permanent maxillary incisor with complex crown fracture and pulp exposure was treated by partial pulpotomy and assessed clinically through pulpal sensitivity tests and radiographically for periapical healing. Partial pulpotomy consisted of pulp tissue removal to a depth of only 1 to 2 mm, then capping the pulpal wound with calcium hydroxide, lining with resin-modified glass-ionomer cement, and restoration with resin composite. At each recall (7, 15, 21, 50, 90, 150, and 250 days), no spontaneous pain was observed; the pulp showed signs of vitality and absence of periapical radiolucency after 90 days. For long-term success, partial pulpotomy is recommended as an option for cases of traumatic pulp exposure in permanent incisors with crown fractures.

Adolescent↗

PubMed1975

Clinical situations in which amputation is preferred to pulp capping because of biologic considerations.

Calcium hydroxide, in its various forms, has become the preferred agent of most practitioners who perform pulp capping. The application of calcium hydroxide to the pulp stimulates the growth of new dentin and protects the pulp from subsequent irritation. However, the new dentin generated by the pulp may, in turn, infringe on the pulp. If the thickness of the pulp tissue is large, this infringement will not be significant. If the volume of pulp tissue is shallow, the same amount of infringement may cause sufficient impairment of circulation to the cornal area of the pulp, leading to an area of the necrosis may then contaminate the entire pulp, and root canal therapy will become necessary. Therefore, pulpal amputation is the preferred treatment in such situations.

Calcium Hydroxide↗

PubMedDate not supplied

Hierarchy of variables correlated to odontoblast-like cell numbers following pulp capping.

OBJECTIVES: Following tooth pulp exposure, pulpal repair is accomplished by dentine bridge secretion by odontoblast-like cells. However, little information is available about the hierarchy of variables, which influence odontoblast-like cell numbers. The purpose of this study was to examine correlations between pulp capping events and odontoblast-like cell numbers. METHODS: Two hundred and fifty standardised pulp exposed cavities were prepared in non-human primate teeth according to ISO usage guidelines. Exposed pulps were capped with Calcium hydroxide [Ca(OH)(2)], and multi-step and self-etching primer composite resins. Teeth were collected from 3 to 60-days to observe pulp reactions. Statistical analysis was evaluated using analysis of variance. RESULTS: The hierarchy of variables correlated to odontoblast-like cells were the dentine bridge area (P = 0.0001), time since pulp exposure (P = 0.0001), odontoblast numbers opposite the exposure site (P = 0.0002), and pulp capping materials (P = 0.0313). Other pulp capping variables were found to be less likely to be correlated with odontoblast-like cell numbers. CONCLUSIONS: The area of dentine bridge formation is directly related to the numbers of odontoblast-like cells, cell activity is time dependent, and the cell numbers are much lower than original odontoblast cells. The time-lag between the appearance of odontoblast-like cells at the site of pulp exposure, and the limited numbers of these cells, explain why pulpal repair is difficult to achieve successfully following pulp exposure.

Animals↗

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

Biocompatibility of Clearfil Liner Bond 2 and Clearfil AP-X system on nonexposed and exposed primate teeth.

OBJECTIVE: Recent studies have demonstrated that acid etching of vital dentin and pulpal tissue does not retard pulpal healing, odontoblastoid cell differentiation, or dentinal bridge formation when the pulp is capped with adhesive resins. The purpose of this study was to evaluate the pulpal response in nonexposed and exposed monkey pulps to treatment with the Clearfil Liner Bond 2 and Clearfil AP-X system. METHOD AND MATERIALS: Class V and Class I cavities in nonexposed and exposed pulps were observed at 7 or 8, 27, and 97 days. RESULTS: There were no differences in pulpal inflammation between the Clearfil Liner Bond 2/Clearfil AP-X specimens and calcium hydroxide controls in either Class V or Class I cavities at the various time periods. CONCLUSION: Clearfil Liner Bond 2 and Clearfil AP-X system is not toxic to either nonexposed or exposed pulpal tissues when placed according to manufacturer's directions.

Animals↗

PubMed1992

Preliminary studies on pulp capping with demineralized dentin.

The use of osteoinductive demineralized dentin matrix in the repair of vital pulp exposures was examined. The pulps of the maxillary first molars of adult male Long Evans rats were exposed and capped with either demineralized dentin particles or guanidinium extracted demineralized dentin particles; then covered with a glass ionomer cement restoration. The animals were sacrificed after two weeks and the maxillae were dissected free, fixed in formaldehyde and demineralized. Histologic examination revealed that in those cases where the protective glass ionomer restoration was intact, both groups showed some healing. There was some preliminary indication that the extent of reactive matrix formation was greater in the osteoinductive group. In both groups, odontoblast-like cells appeared to incorporate some of the dentin particles into the reparative dentin bridge. This preliminary work suggests that osteoinductive factors present in demineralized incisor dentin might be used to guide the formation of a dentin bridge in a rat model for vital pulp exposures.

Animals↗

PubMed2000

Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study.

One hundred twenty-three pulp cappings had been performed by students in 1984 to 1987 (= 10-yr group) or in 1990 to 1992 (= 5-yr group) and were followed up in 1997. Teeth were checked for sensitivity (CO2/electrical pulp testing), percussion, and palpation; radiographs were taken to assess periapical status. In addition several other factors were determined that might have an influence on the success or failure rates, such as base material, type of restoration, site of exposure, etc. Results showed 44.5% failures (18.5% questionable and 37% successful cases) in the 5-yr group and 79.7% failing, 7.3% questionable, and 13% successful cases in the 10-yr group. As a factor of influence, the placement of a definitive restoration within the first 2 days after pulp exposure was found to contribute significantly to the survival rate of these teeth.

Adolescent↗

PubMed2002

Vital pulp therapy in cariously exposed permanent teeth and its limitations.

Vital pulp therapy for cariously exposed permanent teeth remains one of the most controversial areas in dentistry. Because a vital, functioning pulp is capable of initiating several defence mechanisms to protect the body from bacterial invasion, it is beneficial to preserve the vitality and health of an exposed pulp rather than replace it with a root filling material following pulp exposure. There is no consensus on the survival rate of formerly cariously exposed pulps. Observation time, judgement criteria, pulpotomy/pulp capping technique and, most importantly, pulpal status at the time of treatment, vary to a great extent amongst studies. In mature teeth, a pulp exposed by caries is usually removed and the root canals are cleaned, shaped and filled. Amongst the methods for preservation of a cariously exposed pulp, partial pulpotomy has yielded a markedly high success rate in young teeth. Major limitations in the success of vital pulp therapy in cariously exposed permanent teeth exist. The lack of predictability and long-term success greatly influence decision-making. The decision-making itself is unreliable primarily due to the difficulty of accurately diagnosing the ability of the pulp to repair. While there are indications for vital pulp therapy in young permanent molars, it must be remembered that ultimately, none of these procedures enjoy the long-term success of complete root canal therapy.

Age Factors↗

PubMed2003

Bioactive molecules and the future of pulp therapy.

Direct capping of bioactive molecules or implantation of these molecules in the pulp may induce the formation of reparative dentin and coronal or radicular pulp mineralization. In this review, we summarize what is known and/or assumed on the biological mechanisms of these therapies. We report on the effects which were obtained experimentally in rat maxillary molars by implantation of Bone Sialoprotein (BSP)/collagen pellets and Specific Amelogenin Gene Splice Products [A+4] and [A-4]) adsorbed on agarose beads. The effects were compared with those of BMP-7 (OP-1) and Ca(OH)2. Depending on the molecule that was used, we obtained either the formation of a dentin bridge, or the filling of the pulp in the mesial part of the coronal pulp chamber, or the total mineralization of the root canal. These molecules may provide new therapeutic tools in the next future in dentistry.

Animals↗

PubMed1999

Light and scanning electron microscopy of the inner surfaces of resins used in direct pulp capping.

PURPOSE: To investigate with the scanning electron microscopy (SEM) the inner surface of the resin restorative used as a direct pulp capping. MATERIALS AND METHODS: Class V cavities were prepared on the facial surfaces of 90 intact monkey teeth, and the pulps were intentionally exposed with a carbide bur through the cavity floor. Each exposed pulp was capped with one of three commercially available adhesive resin systems (BondWell LC, GC; Imperva Bond, Shofu; Clearfil Liner Bond II, Kuraray). The cavities were restored with an adhesive resin and a hybrid resin-based composite. Histopathological changes of the mechanically exposed pulp were evaluated at 3, 30 and 60 days postoperatively. The interface between the resin and pulp tissues on the inner surface of the resin restorative was observed by SEM. RESULTS: Bacterial penetration along the cavity walls and pulp tissue could not be detected in any specimen. Slight inflammatory cell infiltration was the main initial reaction, while dentin bridge formation was the major long-term reaction in all groups. The resin surface adjacent to the etched cavity floor contained numerous resin tags corresponding to the dentin tubules. Remnants of pulpo-dentin complex, such as fragments of blood clots, pulpal cell, and dentin were also seen scattered along the inner resin surface.

Animals↗

PubMed2003

Direct pulp capping with an auto-cured sealant resin and a self-etching primer.

PURPOSE: To evaluate an auto-cured resin as a direct pulp capping material on exposed pulp with or without a self-etching primer. MATERIALS AND METHODS: Class V cavities were prepared on the facial surfaces of 90 intact monkey teeth, and the pulps were intentionally exposed with a carbide bur through the cavity floor. Each exposed pulp was capped with a commercially available adhesive resin system (Clearfil Liner Bond 2V: Group LB) or an auto-cured sealant resin (Teethmate-S) with and without the use of a self-etching primer (Group TMP and Group TM, respectively). The cavities were restored with an adhesive resin and a hybrid resin-based composite (Clearfil AP-X). Inflammatory cell infiltration and dentin bridge formation of the exposed pulp as well as protrusion of the exposed pulp tissue into the cavities were evaluated histologically at 3, 30 and 90 days. RESULTS: Slight inflammatory cell infiltration was the main inflammatory reaction of the exposed pulp, and the exposed area became occluded with dentin bridges as the observation period increased. However, significantly higher incidence of slight inflammatory cell infiltration was found in Group TM than in Group LB at 30 days (P<0.05). Group TM showed significantly higher incidence of protrusion of pulp tissue than Groups LB and TMP through all tested periods (P<0.05).

Acid Etching, Dental↗

PubMed2006

Immunohistochemical expression of fibronectin and tenascin after direct pulp capping with calcium hydroxide.

The aim of this study was to investigate the expression of 2 extracellullar matrix glycoproteins, fibronectin (FNC) and tenascin (TNC), following direct pulp capping with calcium hydroxide (CH). Third molars scheduled for extraction were used. Standardized class I cavities with pulp exposures were prepared. After control of bleeding, CH powder was applied in the exposure sites, which were covered with CH cement (Dycal; Dentsply) and the cavities were filled with zinc oxide-eugenol cement. Three teeth were extracted at each post-treatment period (1, 7, 14, and 30 days). Demineralized and paraffin-embedded specimens were stained for histologic technique (hematoxylin-eosin) and for immunohistochemical analysis. Anti-TNC and anti-FNC monoclonal antibodies were used with the streptavidin-biotin complex method. Generally, similar patterns of immunohistochemical expression were observed for TNC and FNC in the pulp tissue as a whole. In the exposure site, TNC immunostaining increased over time, exhibiting a thicker immunostaining pattern within 30 days. The imunohistochemical technique showed expression of both glycoproteins during pulp healing process.

Calcium Hydroxide↗

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↗