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Pulp biology: progress during the past 25 years.

During the past 25 years there has been a rapid expansion in our knowledge of the dentine and pulp complex. This paper provides representative examples of important advances that researchers have made in this field. Topics to be considered include: differentiation of odontoblasts, dentine matrix proteins, extent of odontoblast processes, pulpal stem cells, apoptosis, interstitial fluid pressure in normal and inflamed pulps, class II antigen-presenting cells of the pulp, cytokines, antibodies, pulpal calcifications, tertiary dentine and pulpal inflammation associated with bacterial contamination of exposed dentine beneath restorations.

Antigen-Presenting Cells↗

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↗

[Pitfalls to avoid in the cleaning and shaping of the pulp canal].

Chemomechanical instrumentation of the root canal system is without doubt the most important but most challenging part of endodontic treatment. The first essential in cleaning and shaping is gaining direct access to the root canals. A properly prepared endodontic access opening can eliminate many of the technical problems encountered in root canal treatment. Excessive calcification in the root canal system and performing root canal treatment through existing artificial crowns however can be a challenge for the clinician. Secondly, enlargement of a curved root canal often results in loss of working length, incomplete removal or extrusion of the root canal content and unwanted alterations in the canal shape, such as transportation (stripping, zipping, elbow formation), ledge formation and perforation. This article focuses on the causes and effects of procedural errors during root canal cleaning and shaping. Each of these complications is addressed in a manner designed to prevent problems rather than to manage them once they are recognized. Throughout the immense amount of literature published the last 30 years on this topic, concensus is obtained concerning the preferential procedure of cleaning and shaping the root canal.

Crowns↗

The aesthetic and endodontic dilemmas of calcific metamorphosis.

Traumatic injuries to dentition can initiate either a resorptive or calcific pulpal response. In the sequelae of calcific degeneration, the clinical crown frequently becomes discolored, requiring an aesthetic correction to restore the tooth to its natural color. Four potential solutions are currently available to achieve this goal. The learning objective of this article is to describe the etiology of calcific metamorphosis, discuss the four potential solutions, and present the responses of endodontists polled as to the treatment indications. While the posterior dentition may experience the identical pathologic response to trauma and crown discoloration, this article focuses on the restoration of the anterior dentition. Several cases are presented to illustrate the four treatment modalities, and recommendations for follow-up of traumatic injuries are indicated.

Bicuspid↗

[Advances in investigation of calcified root canal therapy].

Calcified root canal occurs often during root canal therapy. It's important to understand various methods to deal with calcified root canal, which may increase the successful rate. From anatomy, radiography, chemical root canal preparation, ultrasonic root canal preparation and endodontic microscopic system etc., this paper reviews the present research about the treatment techniques for calcified root canal.

Dental Pulp Calcification↗

A study of the mineral phase of pulp calcification.

Physico-chemical properties of pulp calcification were studied by means of X-ray microbeam diffraction, electron spin resonance (ESR), X-ray energy-dispersive analysis, and chemical analysis. The material was obtained from the second molar of the right mandible of a 25-year-old woman. X-ray diffraction and ESR analyses showed that calcium salts of the calcification are deposited in the form of apatitie, possibly carbonate-containing apatite. Furthermore, the mineral phase of the calcification was found to be similar to that of bone rather than that of dentin with regard to crystallinity and inorganic content. An unexpected finding was that high concentrations of iron were detected in some areas near the surface of the calcification. The question remains open as to what role, if any, iron may play in the formation of pulp calcification.

Adult↗

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Dental Pulp Calcification↗

Tablet fluoridation influences the calcification of primary tooth pulp.

This study was conducted to determine the influence of long-term tablet fluoridation on primary pulp calcification by light microscopy. Twenty-four caries-free primary molars (after continuous postpartally initiated 1- to 10-year tablet fluoridation) were compared to 17 primary molars of children without fluoride prophylaxis. Pulp calcification in children with tablet fluoridation was significantly more frequent and more pronounced than in untreated children (p = 0.001). Besides the known pulp stones, the prophylaxis group evidenced a special form of calcification consisting of fibrodentin-like hard tissue not observed in the untreated children. These hard tissue bodies developed "intramurally" on the pulp floor and the inside of the dental roots with an irregular extramural spread into the coronal and radicular pulp by displacement and fibrotization of the pulp tissue. Moreover, some of the teeth had more or less extensive areas of interglobular dentin. The affected teeth were ankylosed in the area of the bi- and trifurcation and on the inside of the roots and were thus infra-occluded. Although the duration of tablet fluoridation has no statistically significant influence on pulp calcification, there is a correlation between extensive pulp calcification, postnatally initiated fluoride prophylaxis and the infraocclusion of primary molars.

Child↗