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Background: This study aims to evaluate the compressive strength, solubility, radiopacity, and flow of Bromelain (BR)-modified Biodentine (BD) for direct pulp capping (DPC). This is suggested to determine the impact of BR on the physical properties of BD. Methods: Eighty samples were prepared according to the ISO and ADA specifications and evaluated for compressive strength, solubility, radiopacity, and flow. The compressive strength was evaluated at 24 h and 21 days via a universal testing machine. The solubility was determined by weight loss after 24-hours immersion in deionized water. Radiopacity was assessed via X-ray with aluminum step-wedges, and flow was measured by the diameter of the discs under a standard weight. Independent sample t-tests were used to statistically assess the data. A significance level of 5% was considered. Results: The compressive strength was 41.08 ± 1.84 MPa for BD and 40.92 ± 1.80 MPa for BR + BD after 24 h, and 88.93 ± 3.39 MPa for BD and 87.92 ± 3.76 MPa for BR + BD after 21 days, with no significant differences. Solubility was slightly greater in the BR + BD (2.75 ± 0.10%) compared to BD (2.62 ± 0.25%), but not significantly different. The radiopacity was similar between BD (2.82 ± 0.11 mm) and BR + BD (2.73 ± 0.10 mm). BR + BD resulted in significantly greater flow (9.99 ± 0.18 mm) than did BD (9.65 ± 0.27 mm) (p ≤ 0.05). Conclusion: BR-modified BD maintains BD's physical properties, with improved flow, making it a promising DPC agent that warrants further study. [ABSTRACT FROM AUTHOR]

Aim: Calcium hydroxide (CH) has been considered as a direct pulp capping materials (DPC) for the last decades despite having some limitations. Phosphorylate pullulan (PPL) incorporated with CH (CHPPL) is a novel biomaterial that was introduced as a promising DPC material. Thus, the aim of the study was to evaluate the inflammatory response and mineralized tissue formation (MTF) ability of PPL‐based CH formulations on rat molars after DPC. Methodology: This study consisted of six groups: CH with 1% PPL (CHPPL‐1); 3% PPL (CHPPL‐3); 5% PPL (CHPPL‐5); Dycal and NEX MTA Cement (N‐MTA) as the positive control, and no capping materials (NC). One hundred twenty maxillary first molar cavities were prepared on Wistar rats. After capping, all the cavities were restored with 4‐META/MMA‐TBB resin and pulpal responses were evaluated at days 1, 7, and 28. Kruskal–Wallis followed by Mann–Whitney U‐test was performed with a significance level of 0.05. Immunohistochemical expression of IL‐6, Nestin, and DMP‐1 was observed. Results: At day 1, CHPPL‐1, N‐MTA, and Dycal exhibited no to mild inflammation, whilst CHPPL‐3, CHPPL‐5, and NC showed mild to moderate inflammation, and the results were significantly different (p <.05). At day 7, mild to moderate inflammation was observed in CHPPL‐1, N‐MTA, and Dycal, whereas CHPPL‐3, CHPPL‐5, and NC exhibited moderate to severe inflammation. Significant differences were observed between CHPPL‐1 and N‐MTA with NC (p <.05), CHPPL‐1 and CHPPL‐3 with CHPPL‐5 and Dycal (p <.05), and CHPPL‐3 with N‐MTA (p <.05). A thin layer of mineralized tissue formation (MTF) was observed in all groups. At day 28, CHPPL‐1, Dycal, and N‐MTA showed no to mild inflammation, whilst CHPPL‐3, CHPPL‐5, and NC exhibited mild to severe inflammation, and statistically significant difference was detected (p <.05). CHPPL‐1, Dycal, and N‐MTA exhibited continuous MTF, whilst CHPPL‐3, CHPPL‐5, and NC had thicker and interrupted MTF. Significant differences were observed between CHPPL‐1, CHPPL‐3, and N‐MTA with NC group (p <.05). Variable expressions of IL‐6, Nestin, and DMP‐1 indicated differences in the materials' impact on odontoblast‐like cell formation and tissue mineralization. Conclusions: These findings suggest that CHPPL‐1 has the potential to minimize pulpal inflammation and promote MTF and had similar efficacy as MTA cement. [ABSTRACT FROM AUTHOR]

Evaluate a new light-cured material with better properties for vital pulp therapy. Light-cured resin materials consisted of polyethylene glycol (600) diacrylate mixed with different ratios of TCP to HA. In addition to the temperature change (n = 5 for each subgroup) were tested, cell viability and Alizarin Red Staining (ARS) assay were also tested in vitro on human dental pulp cells (n = 6 for each subgroup). Lastly, the material was then compared with Biodentine and control groups in the molars of Wistar rats in vivo for histology assessment. The temperature change for the new materials were under 5 degrees Celsius. For the in vitro assessments, there was no significant difference on day 3 and day 7 for cell viability test. ARS assay showed significantly higher mineralized nodule formation when treated without induction medium for Group D and Biodentine on day 10 compared to Group C and control. On the contrary, Biodentine and control groups treated with induction medium showed significant higher mineralization than the new materials. Histology assessments demonstrated higher mineralized content in Group D and Biodentine on week 3 and week 6. The inflammatory cells in the dental pulp complex of the Biodentine group resolved on week 6 while the inflammation resolved in Group D on week 3. The new material exhibits low heat production, low cytotoxicity, and good calcium ion release capability. Compared to traditional materials, it has shorter setting time and better aesthetic outcomes, making it highly suitable for use in vital pulp therapy. • Light-cured direct pulp capping material with low cytotoxicity and low temperature rise. • New material for vital pulp therapy tested in vitro on human dental pulp cells. • New material for vital pulp therapy tested in vivo in the molars of Sprague-Dawley (SD) rats. • New light-cured material for vital pulp therapy compared with Biodentine. [ABSTRACT FROM AUTHOR]

The aim of direct pulp caping (DPC) is to support the formation of mineralized tissue and encourage pulp healing by placing a dental biomaterial directly over the exposed pulp. The era of vital pulp therapy has been influenced by the introduction of various pulp-capping materials. Emphasis has shifted from the “doomed” organ concept of an exposed pulp to one of hope and recovery; this comprehensive review thus discusses the ability of different direct pulp-capping materials to form a dentin bridge. Furthermore, this review will discuss the quality and quantity of dentinal bridge formation by different pulp-capping agents.

Objective To explore the effect of leukocyte-and platelet-rich fibrin (L-PRF) as a capping agent in the modulation of inflammation in rat dental pulp. Methods The rat model of pulpitis was established by lipopolysaccharide (LPS) . A total of 30 Sprague-Dawley rats were randomly divided into five groups: Normal control group, Model group, iRoot BP PLUS group, L-PRF group, iRoot BP PLUS+ L-PRF group. Samples were collected on the 14th day after pulp capping. Micro-CT scans, HE and Masson staining, qRT-PCR assays were performed to observe pulp tissue inflammatory and hard tissue formation. Results Micro-CT results: no hard tissue formation was seen in the LPS group, plaque calculus was seen in the L-PRF group, and a more complete calcified bridge was seen at the perforation of the pulp in the BP and combined groups, HE and Masson staining results: the LPS group had the most severe inflammation and no hard tissue formation, the combined group had the least inflammation and the most complete and continuous hard tissue formation, and there was a statistical difference between the two groups(P < 0.01), There was no statistical difference in the degree of inflammatory reaction and hard tissue formation between the BP group and the combined group (P > 0.05), qRT-PCR results: the relative expression levels of TNF-α, IL-1β, and IL-6 mRNA in the pulp tissues of all experimental groups were reduced compared with those of the LPS group, but the differences between the L-PRF and LPS groups were not statistically significant (P > 0.05) . Conclusion The combination of L-PRF and iRoot BP PLUS as a composite pulp capping material can be used for the repair of dental pulp tissue and the regulation of inflammation in dental pulpitis in rats. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the current investigation was to determine by radiographic means if a calcific dentinal bridge had formed following direct pulp capping (DPC) with calcium hydroxide (CH), mineral trioxide aggregate (MTA), or a combination of platelet-rich fibrin (PRF) and MTA. Materials and Methods: In the beginning, 45 systemically healthy patients who needed DPC and had pulpal exposure were enrolled in the trial. They were then randomly assigned to one of three groups: CH (control, n = 15), MTA (n = 15), or PRF + MTA (n = 15). To determine the radiographic density of the dentin immediately underneath the location of pulpal exposure, pre-operative intraoral digital radiographs of the afflicted teeth were acquired. Through sequential imaging, the radiographic evaluation of dentinal bridge formation was performed. All images were studied carefully, keeping the reference point constant. Results: Out of the 45 patients, finally 10 per group were analysed. According to an analysis of variance, difference in mean density values among the various groups was found to be significant [(p =.001). On bi-group comparison (using post-Tukey HSD), difference between CH and PRF + MTA was significant (p =.001), between MTA and PRF + MTA was significant (p =.022), and between CH and MTA not significant (p =.347)]. The PRF + MTA group showed the highest increase in mean density values. Conclusion: The results of the present study suggest that PRF and MTA when used in combination have better radiographic outcomes compared to MTA alone when used as DPC agents. [ABSTRACT FROM AUTHOR]

The timely treatment of dental caries and pulp disease in primary teeth holds significant importance for maintaining children's oral health. Direct pulp capping (DPC) is a vital pulp treatment that involves covering the exposed pulp with bioactive materials to promote dentin bridge formation. DPC is commonly used in primary teeth with vital pulp and mechanical pulp exposure not exceeding 1 mm. DPC offers advantages such as minimal invasiveness, comfort, simplicity of operation and short chair-side time, making it suitable for pediatric dental clinical practice. Early studies suggested negative treatment outcomes for DPC in primary teeth with carious pulp exposure. Over the years, there have been advancements in materials and technology demonstrating positive outcomes in the clinical research of primary teeth with deep caries. However, due to the limited quality of related studies, DPC has not been widely recommended for the treatment of primary teeth with carious pulp exposure, and its widespread use needs further support by more high-quality evidence-based medical research. The success rate of DPC in primary teeth is influenced by factors including pulp status, clinical operations (such as isolation and caries removal), pulp capping material, cavity type, tooth position, coronal sealing, and dental fear. In clinical operation, dentists should accurately assess pulp status and minimize bacterial contamination. Mineral trioxide aggregate (MTA) is a DPC agent with relatively sufficient evidence and good therapeutic effects, and the crown should be tightly sealed after pulp capping. Additionally, the effects of novel biocompatible materials such as iRoot BP Plus used in DPC of primary teeth, and the influence of other factors like hemostatic methods on the prognosis of affected teeth, need further exploration.

Introduction: This study explored the effects of propolis extract calcium hydroxide (Ca(OH)2) combination on malondialdehyde and superoxide dismutase expression in dental pulp, aiming to assess its potential as a direct pulp capping material. Materials and Methods: Thirty male Wistar rats were randomly assigned to three groups. Mandibular molar teeth were prepared using a low-speed round bur. In Group I, no material was applied; in Group II, teeth were treated with Ca(OH)2; and in Group III, teeth were treated with Propolis extract-Ca(OH)2, followed by Cention N filling. Immunohistochemistry was conducted on pulp tissue samples obtained on the third and seventh days post-treatment to assess malondialdehyde and superoxide dismutase expression. Statistical analyses included the Shapiro-Wilk test, Levene test, ANOVA, and Tukey's HSD. Results: The samples treated with propolis extract-Ca(OH)2 combination exhibited significantly lower malondialdehyde expression on both days compared to samples treated with Ca(OH)2 (P<0.05), indicating reduced oxidative stress. Superoxide dismutase expression in the propolis extract-Ca(OH)2 group was higher (P<0.05), suggesting an enhanced antioxidant activity. The control group showed intermediate results. Statistical analyses confirmed significant differences between groups for both malondialdehyde and superoxide dismutase expressions (P<0.05). Conclusion: The study suggests that the propolis extract-Ca(OH)2 combination holds promise for direct pulp capping applications by minimizing oxidative stress and promoting antioxidant defense mechanisms in dental pulp. [ABSTRACT FROM AUTHOR]

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Objective: To compare the clinical outcome in between the mineral trioxide aggregate (MTA) and calcium hydroxide (CaOH) during the direct pulp capping in mature permanent teeth. Study Design: Comparative Cross Sectional. Setting: Department of Operative Dentistry and Endodontics, Institute of Dentistry, Liaquat University of Medical & Health Sciences Jamshoro / Hyderabad. Period: January 2022 to December 2022. Material & Methods: We included all patients who had vital pulp, reversible pulpitis, mature teeth with closed apex, and were between the ages of 18 and 35, regardless of gender. Two groups of patients with equal numbers were formed. Those in groups A and B. Patients in Group A received MTA treatment, whereas those in Group B received CaOH treatment. Patients in both groups were encouraged to follow up to check on the discomfort and sensitivity of the tooth after 24 hours, a week, three months and six months. Data were gathered using a research proforma. Results: The mean age of the patients was 27.13+4.59 years in CaOH group and 27.43+4.40 years in MTA group. Pre-operatively the most of the patients had moderate to severe pain in both groups as 40.0% and 46.7% in CaOH group and 20.0% and 80.0% in MTA group respectively. Severity of the post-operative pain was less in MTA group while findings were statistically insignificant (p-0.143). On the pain assessment after 3 months, only 13.3% cases had mild pain in CaOH group, while no any case found with pain in MTA group (p-0.038). Post operative pain on 7th month was almost decreased complete in both groups. Test validity was positive in all of the cases till 6th months follow-up, which indicted that no nay cases had developed narcosis after treatment in both groups. Furthermore, in this study, there was no any cases found with radiological abnormalities during follow-up of 24 hours to 6 month post-operatively in both groups. Conclusion: After direct pulp capping in adult permanent teeth, both mineral trioxide aggregate and calcium hydroxide were demonstrated to be effective. However, MTA seems to be more effective than calcium hydroxide in preserving longterm pulp vitality. [ABSTRACT FROM AUTHOR]

The development of direct pulp-capping materials with favorable biological and structural properties is an important goal in restorative dentistry. Fucoidan is a sulfated, fucose-containing polysaccharide obtained from brown seaweed, with a wide range of applications; however, its use as a direct pulp-capping material has not been examined. This study aimed to evaluate the mechanical, physical, and biological effects of fucoidan combined with conventional mineral trioxide aggregate (MTA) for direct pulp capping. The capping materials were created using Portland cement (80 wt%) and zirconium oxide (20 wt%) as base components, compared with base components plus 5 wt% fucoidan (PZF5) and base components plus 10 wt% fucoidan (PZF10). The initial and final setting time, compressive strength, chemical components, cell viability, adhesion, migration, osteogenesis, and gene expression were analyzed. Fucoidan significantly reduced the initial and final setting time, regardless of quantity. However, the compressive strength was lower for PZF5. Sulfur levels increased with fucoidan. The biological activity improved, especially in the PZF5 group. Cell migration, Alizarin Red S staining, and alkaline phosphatase activity were upregulated in the PZF5 group. Fucoidan is a useful regenerative additive for conventional pulp-capping materials because it reduces the setting time and improves cell migration and osteogenic ability.

Aim: Lack of unanimity in decision-making regarding the management of deep caries and exposed pulp has been highlighted by several questionnaire-based studies from various geographic regions. There is no research available in the Indian setting. The aim of the present study was to evaluate the perspectives of the Indian Endodontic Society and Indian Association of Conservative Dentistry and Endodontics members using an online questionnaire. Methods: An online structured questionnaire of 17 questions was mailed to 200 members based on the periapical radiographs of two cases (18 and 55 years of age) highlighting deep carious lesions and normal periapex in a mandibular molar. Each case had three hypothetical scenarios based on pulpal symptoms, i.e., asymptomatic pulp, reversible, and irreversible pulpitis, respectively. Results: A response rate of 65.5% (n = 131) was achieved. Nonselective caries removal was chosen by 40% and 36% of the participants in young patients with asymptomatic pulp and reversible pulpitis. On pulpal exposure, direct pulp capping was chosen by a majority of the members (66% and 54%, respectively) in a young patient. For irreversible pulpitis, pulpectomy was favored by 70%. In an older patient, less vital pulp therapy and more pulpectomy were preferred. The symptoms and patient age significantly altered treatment decisions, as determined by Chi-square and Fisher's exact tests (P < 0.05). Conclusion: There was a lack of agreement in managing deep carious lesions. There was partial awareness of the management of exposed pulp.

Abstract Objectives Different materials have been used for capping the pulp after exposure during caries removal in permanent teeth. The purpose of this study was to collate and analyze all pertinent evidence from randomized controlled trials (RCTs) on different materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth. Materials and Methods Trials comparing two or more capping agents used for direct pulp capping (DPC) or pulpotomy were considered eligible. An electronic search of four databases and two clinical trial registries was carried out up to February 28, 2021 using a search strategy properly adapted to the PICO framework. Screening, data extraction, and risk of bias (RoB) assessment of primary studies were performed in duplicate and independently. The primary outcome was clinical and radiological success; secondary outcomes included continued root formation, tooth discoloration, and dentin bridge formation. Results 21 RCTs were included in the study. The RoB assessment indicated a moderate risk among the studies. Due to significant clinical and statistical heterogeneity among the studies, performing network meta‐analysis (NMA) was not possible. An ad hoc subgroup analysis revealed strong evidence of a higher success of DPC with Mineral Trioxide Aggregate (MTA) compared to calcium hydroxide (CH) (odds ratio [OR] = 3.10, 95% confidence interval [CI]: 1.66−5.79). MTA performed better than CH in pulp capping (both DPC and pulpotomy) of mature compared to immature teeth (OR = 3.34, 95% CI: 1.81−6.17). The GRADE assessment revealed moderate strength of evidence for DPC and mature teeth, and low to very low strength of evidence for the remaining subgroups. Conclusions Considerable clinical and statistical heterogeneity among the trials did not allow NMA. The ad hoc subgroup analysis indicated that the clinical and radiographic success of MTA was higher than that of CH but only in mature teeth and DPC cases where the strength of evidence was moderate. PROSPERO Registration: number CRD42020127239.

The aim of direct pulp capping (DPC) is to promote pulp healing and mineralized tissue barrier formation by placing a dental biomaterial directly over the exposed pulp. Successful application of this approach avoids the need for further and more extensive treatment. In order to ensure a complete pulp healing with the placement of restorative materials, a mineralized tissue barrier must form to protect the pulp from microbial invasion. The formation of mineralized tissue barrier can only be induced when there is a significant reduction in pulp inflammation and infection. Consequently, promoting the healing of pulp inflammation may provide a favorable therapeutic opportunity to maintain the sustainability of DPC treatment. Mineralized tissue formation was observed as the favorable reaction of exposed pulp tissue against a variety of dental biomaterials utilized for DPC. This observation reveals an intrinsic capacity of pulp tissue for healing. Therefore, this review focuses on the DPC and its healing procedure as well as the materials used for DPC treatment and their mechanisms of action to promote pulpal healing. In addition, the factors that can affect the healing process of DPC, clinical considerations and future perspective has been described.

Objectives: This study aimed to evaluate the efficacy of Biodentine and a combination of bromelain with Biodentine as direct pulp capping materials. Methods: This clinical study included 26 participants with mature permanent mandibular molars exhibiting deep carious lesions without pulpal exposure. The participants were divided into two groups: Group I received Biodentine alone, while Group II received a combination of bromelain and Biodentine. Clinical and radiographic follow-ups were performed at 1, 3, and 6 months to assess the success rates of the treatment modalities. Results: The clinical success rate of Biodentine as a direct pulp capping agent was 92% at 1 month, 100% at 3 months, and 92% at 6 months follow-up. The radiographic success rate was 100% at all intervals. The clinical success rate of the bromelain with Biodentine group was 85% at 1 month, 91% at 3 months, and 100% at 6 months, with corresponding radiographic success rates of 92%, 91%, and 100% at the respective intervals. Statistical analysis revealed no significant difference in success rates between the two groups. Conclusions: Both Biodentine and the combination of bromelain with Biodentine demonstrated high clinical and radiographic success rates in direct pulp capping. However, there was no statistically significant difference between the two groups, suggesting that bromelain may not provide additional benefits when combined with Biodentine. Further research with larger sample sizes and longer follow-up periods is needed to explore the potential of bromelain and other combinations for direct pulp capping. These findings contribute to our understanding of effective materials for vital pulp therapy and guide clinical decision-making in dental practice. [ABSTRACT FROM AUTHOR]

The aim of direct pulp caping (DPC) is to support the formation of mineralized tissue and encourage pulp healing by placing a dental biomaterial directly over the exposed pulp. The era of vital pulp therapy has been influenced by the introduction of various pulp‑capping materials. Emphasis has shifted from the “doomed” organ concept of an exposed pulp to one of hope and recovery; this comprehensive review thus discusses the ability of different direct pulp‑capping materials to form a dentin bridge. Furthermore, this review will discuss the quality and quantity of dentinal bridge formation by different pulp‑capping agents. [ABSTRACT FROM AUTHOR]

A light-cured bioactive composite, TheraCal LC, is easy to handle and fast-setting. But poor water absorption restricted its bioactivity when applied in direct pulp capping (DPC). Enhancing the water absorption of resin-based bioactive materials may be key to optimizing biomineralization procedure of light-cured bioactive materials. We constructed a hygroscopic, light-cured bioactive composite made up of bioactive glass (BG), poly (ethylene glycol) (PEG) and resin in this study. BG was encapsulated into a porogen (i.e. PEG) and mixed into resin matrix. Inductively coupled plasma showed that light-cured BG (LC-BG) exhibited faster ion release and more ion exchange than TheraCal LC did. The formation of macropores and hydroxyapatite crystal coatings on the BG microparticles was observed using scanning electron microscopy. The shear bond strength between the resin and LC-BG group did not significantly differ from the TheraCal LC group. CCK-8 assay showed that the LC-BG extract was nontoxic. Real-time polymerase chain reaction revealed that LC-BG upregulated odontogenic gene expression in human dental pulp cells. DPC assay proved that the LC-BG group exhibited no significant difference in dentin tubule formation (P  = 0.659) or odontoblast-like cell layer formation (P  = 0.155) from the TheraCal LC group, but exhibited significantly better integrity of the calcified bridge than the TheraCal LC group (P  =   0.039); more DSPP-positive and DMP-1-positive cells were detected in the LC-BG group than in the TheraCal LC group. Although no significant difference in pulpal inflammatory cell infiltration was observed between the LC-BG group and the TheraCal LC group (P  = 0.476), fewer interleukin 1β-positive and tumor necrosis factor α-positive cells were detected in the LC-BG group than in the TheraCal LC group. In conclusion, the newly developed hygroscopic LC-BG composite showed better bioactivity and odontogenic differentiation than the TheraCal LC did in vitro and induced better integrity of the calcified bridge than the TheraCal LC did in vivo. [ABSTRACT FROM AUTHOR]

Background Health problem that affects hard tissues of the teeth is dental caries, which is experienced by around 2.3 billion people in the world, with prevalence in Indonesia reaching 88.8. Direct pulp capping (DPC) is a vital pulp therapy used to maintain pulp vitality. Calcium hydroxide (Ca(OH) 2) is the gold standard pulp capping material, but has poor adhesion to dentin and mechanical properties, bacterial infiltration, formation of tunnel defects in the pulp resorption, and dentin bridge. Therefore, it is necessary to develop alternative therapy, namely, a combination of acemannan sponge and calcium phosphate cement (CPC)-calcium sulfate hemihydrate (CSH) for reparative dentin formation. Purpose This article describes the potential combination of acemannan sponge and CPC-CSH as DPC alternative materials for reparative dentin formation. Reviews Acemannan extracted from aloe vera exhibits anti-inflammatory, antimicrobial, and cytocompatibility properties. As DPC material, acemannan induces pulp proliferation and differentiation to osteoblast-like, growth factor synthesis, and promotes reparative dentin formation. However, acemannan sponge is radiolucent, allowing misinterpretation between pulp and acemannan sponge. CPC can be combined with CSH to shorten the setting time. CPC-CSH is radiopaque, has good compressive strength, and biocompatibility. CPC-CSH is a calcium-based material with neutral pH that can induce the dentin bridge formation. CPC-CSH showed good bioactivity because it induces the formation of apatite which plays a significant part in dentin and pulp regeneration. Conclusion The combination of acemannan sponge and CPC-CSH has the potential as DPC alternative materials for reparative dentin formation. [ABSTRACT FROM AUTHOR]

For many years, calcium hydroxide (CH) was the preferred material for direct pulp capping (DPC), occupying an elevated position. The collapse of this paradigm is due to the emergence of bioceramics with less pulpal inflammation and superior mineralization abilities than CH. The goal of the current article was directed to: (1) review the history of DPC "the idea of an exposed pulp as a hopeless organ has given way to one of healing and optimism," (2) classify the bioceramics in dentistry, and (3) explain and compare the mechanism by which dentin barriers for CH and bioceramics are formed. A comprehensive literature search of the database was conducted using PubMed, Google Scholar, and Scopus utilizing the following terms: Biodentine, calcium hydroxide, calcium aluminate, calcium phosphate, calcium silicate, direct pulp capping, NeoMTA Plus, Quick-Set2, and TotalFill. Reference mining of the selected publications was utilized to discover other studies and strengthen the results. Only works written in English were taken into consideration, and there were no restrictions on the year of publication. Bioceramic materials might be used as an intriguing substitute for CH. Compared to CH, they induced more positive pulpal reactions. [ABSTRACT FROM AUTHOR]

Aim: Lack of unanimity in decision-making regarding the management of deep caries and exposed pulp has been highlighted by several questionnaire-based studies from various geographic regions. There is no research available in the Indian setting. The aim of the present study was to evaluate the perspectives of the Indian Endodontic Society and Indian Association of Conservative Dentistry and Endodontics members using an online questionnaire. Methods: An online structured questionnaire of 17 questions was mailed to 200 members based on the periapical radiographs of two cases (18 and 55 years of age) highlighting deep carious lesions and normal periapex in a mandibular molar. Each case had three hypothetical scenarios based on pulpal symptoms, i.e., asymptomatic pulp, reversible, and irreversible pulpitis, respectively. Results: A response rate of 65.5% (n = 131) was achieved. Nonselective caries removal was chosen by 40% and 36% of the participants in young patients with asymptomatic pulp and reversible pulpitis. On pulpal exposure, direct pulp capping was chosen by a majority of the members (66% and 54%, respectively) in a young patient. For irreversible pulpitis, pulpectomy was favored by 70%. In an older patient, less vital pulp therapy and more pulpectomy were preferred. The symptoms and patient age significantly altered treatment decisions, as determined by Chi-square and Fisher's exact tests (P < 0.05). Conclusion: There was a lack of agreement in managing deep carious lesions. There was partial awareness of the management of exposed pulp. [ABSTRACT FROM AUTHOR]

The aim of direct pulp capping (DPC) is to promote pulp healing and mineralized tissue barrier formation by placing a dental biomaterial directly over the exposed pulp. Successful application of this approach avoids the need for further and more extensive treatment. In order to ensure a complete pulp healing with the placement of restorative materials, a mineralized tissue barrier must form to protect the pulp from microbial invasion. The formation of mineralized tissue barrier can only be induced when there is a significant reduction in pulp inflammation and infection. Consequently, promoting the healing of pulp inflammation may provide a favorable therapeutic opportunity to maintain the sustainability of DPC treatment. Mineralized tissue formation was observed as the favorable reaction of exposed pulp tissue against a variety of dental biomaterials utilized for DPC. This observation reveals an intrinsic capacity of pulp tissue for healing. Therefore, this review focuses on the DPC and its healing procedure as well as the materials used for DPC treatment and their mechanisms of action to promote pulpal healing. In addition, the factors that can affect the healing process of DPC, clinical considerations and future perspective has been described. [ABSTRACT FROM AUTHOR]

Objectives: Different materials have been used for capping the pulp after exposure during caries removal in permanent teeth. The purpose of this study was to collate and analyze all pertinent evidence from randomized controlled trials (RCTs) on different materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth. Materials and Methods: Trials comparing two or more capping agents used for direct pulp capping (DPC) or pulpotomy were considered eligible. An electronic search of four databases and two clinical trial registries was carried out up to February 28, 2021 using a search strategy properly adapted to the PICO framework. Screening, data extraction, and risk of bias (RoB) assessment of primary studies were performed in duplicate and independently. The primary outcome was clinical and radiological success; secondary outcomes included continued root formation, tooth discoloration, and dentin bridge formation. Results: 21 RCTs were included in the study. The RoB assessment indicated a moderate risk among the studies. Due to significant clinical and statistical heterogeneity among the studies, performing network meta‐analysis (NMA) was not possible. An ad hoc subgroup analysis revealed strong evidence of a higher success of DPC with Mineral Trioxide Aggregate (MTA) compared to calcium hydroxide (CH) (odds ratio [OR] = 3.10, 95% confidence interval [CI]: 1.66−5.79). MTA performed better than CH in pulp capping (both DPC and pulpotomy) of mature compared to immature teeth (OR = 3.34, 95% CI: 1.81−6.17). The GRADE assessment revealed moderate strength of evidence for DPC and mature teeth, and low to very low strength of evidence for the remaining subgroups. Conclusions: Considerable clinical and statistical heterogeneity among the trials did not allow NMA. The ad hoc subgroup analysis indicated that the clinical and radiographic success of MTA was higher than that of CH but only in mature teeth and DPC cases where the strength of evidence was moderate. PROSPERO Registration: number CRD42020127239. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the present study was to clinically evaluate the influence of ozone on the vital pulp therapy (VPT) in human mature teeth. Vital pulp therapy – pulp capping helps to salvage caries-exposed pulp and prevent the need for further endodontic treatment. There are in vitro and in vivo studies using extracted teeth that indicate that Biodentine is an interesting alternative to mineral trioxide aggregate (MTA). It is believed that unfavourable outcomes of VPT are caused by infection, either due to residual bacteria in the carious cavity or caused by bacterial microleakage. Ozone is a strong oxidant with a beneficial antimicrobial effect. Materials and methods: Ninety-one teeth were randomly assigned to 1 of 2 groups. Forty-one teeth were treated with ozone and Biodentine (O3 & B) – the experimental group and 50 teeth were treated with Biodentine only (B) – the control group. Clinical evaluations were performed at 3, 6, and 12 months after direct pulp capping. Results: There was no statistically significant difference in success rates between the 2 groups. However, the success rates in both groups were high, ranging from 88.2% to 76.9% (p = 0.34) in the experimental and control groups, respectively. Conclusions: Vitality pulp treatment with Biodentine combined with ozone and without ozone was found to be equivalent in terms of therapy efficacy. Biodentine was found to be a highly effective pulp capping material in VPT. There is a need for further in vivo studies to evaluate whether in vitro results of other studies translate to clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the present study was to clinically evaluate the influence of ozone on the vital pulp therapy (VPT) in human mature teeth. Vital pulp therapy – pulp capping helps to salvage caries-exposed pulp and prevent the need for further endodontic treatment. There are in vitro and in vivo studies using extracted teeth that indicate that Biodentine is an interesting alternative to mineral trioxide aggregate (MTA). It is believed that unfavourable outcomes of VPT are caused by infection, either due to residual bacteria in the carious cavity or caused by bacterial microleakage. Ozone is a strong oxidant with a beneficial antimicrobial effect. Materials and methods: Ninety-one teeth were randomly assigned to 1 of 2 groups. Forty-one teeth were treated with ozone and Biodentine (O3 & B) – the experimental group and 50 teeth were treated with Biodentine only (B) – the control group. Clinical evaluations were performed at 3, 6, and 12 months after direct pulp capping. Results: There was no statistically significant difference in success rates between the 2 groups. However, the success rates in both groups were high, ranging from 88.2% to 76.9% (p = 0.34) in the experimental and control groups, respectively. Conclusions: Vitality pulp treatment with Biodentine combined with ozone and without ozone was found to be equivalent in terms of therapy efficacy. Biodentine was found to be a highly effective pulp capping material in VPT. There is a need for further in vivo studies to evaluate whether in vitro results of other studies translate to clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: On the basis of a large sample size and a long follow-up period, the objectives of this study were to evaluate the outcomes of direct pulp capping (DPC) in mature permanent teeth with carious pulp exposure using a kind of bioaggregate putty (BP) which commercially named iRoot BP Plus (Innovative Bioceramix, Inc., Vancouver, Canada) and to analyze the potential prognostic factors. Materials and methods: The design of this research was retrospective regarding treatment procedures and prospective regarding the assessment of outcomes. The preoperative diagnosis of the teeth was either normal pulp or reversible pulpitis. Results were assessed based on clinical and radiographic examinations with at least 12 months of follow-up after DPC. No symptoms or signs, a positive response to electric pulp testing, a normal response to cold pulp testing and radiographs showing no abnormalities were considered to indicate success. Kaplan–Meier survival analysis was used to calculate the cumulative survival of teeth after DPC. Univariate and multivariate Cox proportional hazard regressions were used to analyze potential prognostic factors. Results: Three hundred thirty-four patients, including a total of 354 teeth, were available for the final clinical examination. The follow-up period ranged from 12 to 85 months, with an average of 27.0 ± 0.8 months. The total success rate was 85% (302/354), and the cumulative survival rates at 1, 2, 3, 4, and 5 years were 92%, 87%, 83%, 76%, and 72%, respectively. Univariate analysis indicated a significantly increased risk of failure in patients aged above 40 years and those treated by resident operators (P ≤ 0.01), with hazard ratios of 2.18 and 2.27, respectively. Conclusions: Under appropriate indication selection and treatment procedures, long-term success is possible in mature permanent teeth with carious pulp exposure by DPC using iRoot BP Plus. Patient age and operator experience are potential prognostic factors. Clinical relevance: Clinical data on iRoot BP Plus as a pulp capping medicament in mature permanent teeth with carious pulp exposure is lacking. This study indicated the efficacy of BP in DPC. Younger patient and sophisticated operator are beneficial for the outcome of DPC. [ABSTRACT FROM AUTHOR]

Background: Laser-assisted direct pulp capping (DPC) has considerable advantages compared to traditional methods such as: decontaminant effect; hemostatic and coagulant effect; reduced rise in pulp temperature; reduction of intracavitary pressure; dentinal melting; and biostimulation effect. Objective: The aim of this study was to conduct a systematic review of the literature and meta-analysis to evaluate the effectiveness of laser as adjuvant therapy in DPC among permanent teeth. Methods: Research question was formulated based on the population, intervention, comparison, and outcomes strategy. A comprehensive electronic literature search was conducted through Cochrane, PubMed, and Google scholar using MeSH words, text words, and Boolean operators, independently by two reviewers. Based on the specified inclusion and exclusion criteria, the selected articles were subjected to quality assessment and the risk of bias (ROB) was evaluated. Cochrane ROB 2.0 and Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tools were used to assess the ROB. Results: Initially, 45 studies recovered, 9 articles were selected for systematic review and 7 articles could be included in the meta-analysis. Teeth treated with low level laser therapy pulp capping therapy showed lower clinical/radiological failure as compared to nonlaser pulp capping therapy with an odds ratio of 0.24 (95% confidence interval = 0.15–0.38; Z = 6.15); and the difference between two groups was statistically significant (P < 0.00001). Discussion: This systematic review and meta-analysis included both the randomized and nonrandomized controlled trial (RCT). The non-RCTs had low ROB when compared to the RCTs included in the study. All included RCT studies met the inclusion and exclusion criteria, but some did not adequately describe their methods in detail. Conclusion: Based on the limited evidence, the results of the meta-analysis demonstrated DPC treatment could achieve better clinical outcomes with the aid of lasers. [ABSTRACT FROM AUTHOR]

Background: Regenerative dentistry is the operation of restoring dental, oral and maxillofacial tissues. Currently, there are no guidelines for the ideal cement/material in regenerative endodontic treatments (RET). Hydraulic calcium silicate-based cements (hCSCs) are currently the material of choice for RET. Objectives: This systematic review was conducted to gather all of the different direct and indirect approaches of using hCSCs in RET in vitro and in vivo, and to ascertain if there are any superiorities to indirect approaches. Methods and Materials: This systematic review was conducted according to the 2020 PRISMA guidelines. The study question according to the PICO format was as follows: Comparison of the biological behavior (O) of stem cells (P) exposed to hCSCs through direct and indirect methods (I) with untreated stem cells (C). An electronic search was executed in Scopus, Google Scholar, and PubMed. Results: A total of 78 studies were included. Studies were published between 2010 and 2022. Twenty-eight commercially available and eighteen modified hCSCs were used. Seven exposure methods (four direct and three indirect contacts) were assessed. ProRoot MTA and Biodentine were the most used hCSCs and had the most desirable results. hCSCs were either freshly mixed or set before application. Most studies allowed hCSCs to set in incubation for 24 h before application, which resulted in the most desirable biological outcomes. Freshly mixed hCSCs had the worst outcomes. Indirect methods had significantly better viability/proliferation and odonto-/osteogenesis outcomes. Conclusion: Biodentine and ProRoot MTA used in indirect exposure methods result in desirable biological outcomes. [ABSTRACT FROM AUTHOR]

This position statement on Vital Pulp Therapy (VPT) procedures, endorsed by the Indian Endodontic Society (IES), aims to provide a comprehensive perspective on the management of deep caries and exposed pulp within the realm of endodontic practice. VPT serves as the cornerstone of modern endodontics, particularly with advancements in biomaterials and regenerative methods. Its primary goal is to preserve the vitality of the dental pulp while simultaneously promoting the overall health of the tooth and periapical structures. In the diverse and dynamic landscape of Indian dentistry, the IES recognizes the need for a position statement tailored to the unique needs and challenges encountered by dental practitioners in India. This position statement presents evidence-based recommendations on VPT, considering not only international perspectives from reputed international organizations, but also the distinct factors influencing dental care in India. Drawing upon the collective expertise of the expert committee, this statement addresses key aspects of VPT, including patient selection, accurate diagnosis, effective treatment techniques, and follow-up protocols. While conventional endodontic therapy remains important, IES emphasizes the significance of VPT in well-selected cases. The statement also addresses areas of potential conflict, identifies avenues for future research, and presents the current status based on the best available scientific evidence. By providing a comprehensive overview of VPT, this position statement aims to serve as a valuable guide for dental practitioners, educators, and researchers, fostering optimal patient care and advancing the field of endodontics in India through evidence-based practice and continuous learning.

This position statement on Vital Pulp Therapy (VPT) procedures, endorsed by the Indian Endodontic Society (IES), aims to provide a comprehensive perspective on the management of deep caries and exposed pulp within the realm of endodontic practice. VPT serves as the cornerstone of modern endodontics, particularly with advancements in biomaterials and regenerative methods. Its primary goal is to preserve the vitality of the dental pulp while simultaneously promoting the overall health of the tooth and periapical structures. In the diverse and dynamic landscape of Indian dentistry, the IES recognizes the need for a position statement tailored to the unique needs and challenges encountered by dental practitioners in India. This position statement presents evidence-based recommendations on VPT, considering not only international perspectives from reputed international organizations, but also the distinct factors influencing dental care in India. Drawing upon the collective expertise of the expert committee, this statement addresses key aspects of VPT, including patient selection, accurate diagnosis, effective treatment techniques, and follow-up protocols. While conventional endodontic therapy remains important, IES emphasizes the significance of VPT in well-selected cases. The statement also addresses areas of potential conflict, identifies avenues for future research, and presents the current status based on the best available scientific evidence. By providing a comprehensive overview of VPT, this position statement aims to serve as a valuable guide for dental practitioners, educators, and researchers, fostering optimal patient care and advancing the field of endodontics in India through evidence-based practice and continuous learning. [ABSTRACT FROM AUTHOR]

Although Mineral trioxide aggregate (MTA) has been widely used for pulp capping procedures and obtains outstanding clinical outcomes, too long setting time and poor anti-washout property of MTA still constrain its widespread applications. This study was aimed to develop a novel rapid-setting and washout resistance bioactive glass cements (BGC) via combining appropriate bioactive glass (BG) and brushite (DCPD) powders. Various ratios of BG and DCPD cement from 10B (10% BG in cement) to 70B (seven groups) had been prepared. The setting mechanism, setting time, compressive strength, degradability, pH, anti-washout and apatite-formation ability of the BGC were evaluated. The results showed that shorter setting time about 5 min and least degradability were achieved for 40–50B cements, and 30–40B cements held superior anti-washout performance. Moreover, the compressive strength varied form 1.48 ± 0.18 MPa (60B) to 12.04 ± 1.32 MPa (20B). Furthermore, all 10–70B BGC exhibited excellent apatite-formation ability and the surface of 30–50B preserved dense structure after immersion in simulated body fluids (SBF). What's more, the 40B cement also possessed good formability, and the extracts of 40B could effectively stimulate the proliferation and odontogenic differentiation of human dental pulp stem cells (DPSC). Overall, the properties of novel BGC could be adjusted effectively by the component and 40B bioactive glass cements possessed comprehensively superb performance, especially for rapid-setting and anti-washout properties, which had great potential as a new class pulp capping material. [ABSTRACT FROM AUTHOR]

Rodent animal models for vital pulp therapy are commonly used in dental research because their tooth anatomy and cellular processes are similar to the anatomy and processes in humans. However, most studies have been conducted using uninfected sound teeth, which makes it difficult to adequately assess the inflammatory shift after vital pulp therapy. In the present study, we aimed to establish a caries-induced pulpitis model based on the conventional rat caries model and then evaluate inflammatory changes during the wound-healing process after pulp capping in a model of reversible pulpitis induced by carious infection. To establish the caries-induced pulpitis model, the pulpal inflammatory status was investigated at different stages of caries progression by immunostaining targeted to specific inflammatory biomarkers. Immunohistochemical staining revealed that both Toll-like receptor 2 and proliferating cell nuclear antigen were expressed in moderate and severe caries-stimulated pulp, indicating that an immune reaction occurred at both stages of caries progression. M2 macrophages were predominant in moderate caries-stimulated pulp, whereas M1 macrophages were predominant in the severe caries-stimulated pulp. Pulp capping in teeth with moderate caries (i.e., teeth with reversible pulpitis) led to complete tertiary dentin formation within 28 d after treatment. Impaired wound healing was observed in teeth with severe caries (i.e., teeth with irreversible pulpitis). During the wound-healing process in reversible pulpitis after pulp capping, M2 macrophages were predominant at all time points; their proliferative capacity was upregulated in the early stage of wound healing compared with healthy pulp. In conclusion, we successfully established a caries-induced pulpitis model for studies of vital pulp therapy. M2 macrophages have an important role in the early stages of the wound-healing process in reversible pulpitis. [ABSTRACT FROM AUTHOR]

This study aimed to determine the impact of human endometrial stem cells (EnSCs) and titanium oxide nanoparticles (TiO 2 NPs) on dental pulp repair and regeneration in an animal model through dentine development and tissue regeneration. The EnSCs were put on a three-dimensional (3D) chitosan scaffold containing TiO 2 NPs after obtaining and purifying the collagenase enzyme. Pulps were exposed on the maxillary left first molar of all rats followed by direct pulp capping with the experimental scaffolds, as follows. Groups were: 1, control group without any treatment; 2, chitosan group (CS); 3, chitosan group with stem cells (CS/SCs); 4, chitosan group with stem cells and TiO 2 NPs (CS/EnSCs/TiO 2). Glass ionomer was used as a sealant in all groups. The teeth were extracted and histologically evaluated after 8 weeks. The quality and amount of dentine in the CS/EnSCs/TiO 2 group were higher than in the other groups. The combination of EnSCs with TiO 2 NPs and 3D chitosan scaffolds had a synergistic effect on each other, evidencing increased speed and quality of dentine formation. Using EnSCs with TiO 2 NPs on a 3D chitosan scaffold can be a suitable combination for direct pulp capping and dentine regeneration in a rat molar tooth model. [Display omitted] [ABSTRACT FROM AUTHOR]

The study aims to investigate the quality of dentin barriers and pulp reaction to EndoSequence Root Repair Material (ERRM) combined with low‐level laser application. In eight dogs, pulps were exposed via class V, half of the samples received low‐level diode laser at 870 nm. Thereafter, cavities were capped with fast‐set or regular‐set ERRM. The specimens were processed for histomorphological and immunohistochemical examination after 2 weeks and 2 months. Dentin bridges were observed in all samples, and 87.5% were complete. The low‐level laser group had significantly more reparative dentin area than the non‐lased group (p < 0.05). The dentin bridges were found to have an unprecedented tubularity of 43%–89%. Tiny dentin island formation was observed within the material particles. Initial mild‐to‐moderate inflammatory reactions were observed, which subsided after 2 months. RUNX2 and osteocalcin staining were evident for all samples at both time intervals. Low‐level laser combined with bioactive ERRM is effective in inducing reparative dentin formation. [ABSTRACT FROM AUTHOR]

This article aims to prove dentin bridge formation in two cases after direct pulp capping in reversible pulpitis using the platelet concentrate A-PRF+ and preservation of the vitality of the dental pulp. The hemostasis process for the pulp wound and cavity disinfection with gaseous ozone was performed under anesthesia. A large A-PRF+ membrane was prepared from blood plasma and applied to the pulp wound. After placing an MTA, the cavity was closed using glass-ionomer cement. Clinical and cone beam computed tomography findings demonstrated the formation of a dentin bridge in both cases. After the definitive restoration was conducted during the sixth month, the teeth from both patients were asymptomatic and had normal electric pulp testing values. Conclusions: Via clinical and CBCT examinations, we observed the dentin bridge formation after placing the platelet concentrate A-PRF+ in both cases. The vitality of the dental pulp was preserved. Further research is needed to refine the clinical protocol, recommended period for control examination, clarification of the precise indications of platelet concentrates, etc. [ABSTRACT FROM AUTHOR]

This study evaluated exposed dogs’ dental pulp response after direct capping with autologous dental pulp stem cells (DPSCs) and compared the results with MTA (Angelus, Brazil). Sixty teeth from six mongrel dogs were included (n = 60), allocated into four groups; negative control (n = 6), positive control (n = 6), MTA (n = 24), and DPSCs (n = 24). DPSCs were isolated and cultured from extracted first premolars (1premolar/dog). The teeth were prepared for histological and immunohistochemical analyses. Statistical analysis was calculated using ANOVA tests, P ≤ 0.05. MTA induced the formation of an almost complete calcific bridge. DPSCs successfully regenerated the injured pulp and dentin. The comparison between the capping groups and time intervals had a statistically significant effect, as well as, the interaction between the two variables. DPSCs had greater ability in the reparative and regenerative process of dentin and odontoblastic differentiation by having a significantly stronger TGFβ1 expression than MTA.

Abstract Background The study aims to investigate the pulp and periapical reaction and healing after capping with EndoSequence Root Repair Material (ERRM) combined with low-level laser application. Methods In 6 rabbits, pulps were exposed via class V, half of the samples received a low-level diode laser at 980 nm. Thereafter, cavities were capped with regular-set ERRM. The specimens were processed for histomorphological examination after 2 weeks and two months. Results After 2 weeks, images show mild inflammation and organized odontoblasts in lased group. The non-lased group shows more severe inflammation. The predentin thickness was thicker in the lased group with statistical significance (p

This retrospective study evaluated the long-term outcome of direct pulp capping in mature teeth using specific case selection and treatment procedures. Teeth with pulp exposure due to advanced caries and clinical diagnosis of reversible pulpitis were treated by direct pulp capping. Treatments were conducted over a period of 15 years by a single operator. Under magnification, caries was completely removed, the exposed pulp examined, and capped with either pure calcium hydroxide or a calcium hydroxide-based cement. The cavity was restored and the long-term outcome evaluated from 1 to >35 years. Teeth that were asymptomatic, responded to sensibility pulp tests within normal limits, and showed no radiographic periapical changes were categorized as success. Teeth with no response to pulp tests and/or showing radiographic evidence of apical periodontitis were classified as failures. The effects of independent variables (sex, age, symptoms, number and size of pulp exposures, bleeding time, capping material, bases used over the capping material, and final coronal restoration) on the outcome were evaluated. In general, 225 teeth from 148 patients were available for follow-up examination in at least one of the evaluated periods. The success rate of the direct pulp capping procedure was 100%, 95%, 95%, 86%, and 89% at 1-, 5-, 10-, 20-, and 35-year follow-up examination, respectively. The main variable significantly affecting the treatment outcome in all follow-up periods was the quality/presence of coronal restoration (P <.001). Other isolated variables associated with the outcome included the size and number of pulp exposures at the 20-year follow-up, and the exposure size, capping material, and restoration type at the 35-year follow-up. Multiple regression analysis confirmed the results for exposure size (P <.05), and disclosed a higher proportion of failures at 5 years when varnish was used as the base. A very high success rate of the direct pulp capping with calcium hydroxide was observed, especially in the first 10 years following treatment. The main variable influencing the outcome was the quality of the coronal restoration. [ABSTRACT FROM AUTHOR]

Therefore, this study aimed to investigate the emergence of macrophages in dental pulp tissue after direct pulp capping, and the effect of M2 macrophages on the odontoblastic differentiation of DPSC clones. In the present study, the number of M1 macrophages increased at the pulp exposure site soon after injury, followed by an increase in the M2 macrophages as M1 macrophages disappeared and the reparative dentin formation started. Keywords: macrophage; direct pulp capping; dental pulp stem cell; reparative dentin formation; odontoblastic differentiation EN macrophage direct pulp capping dental pulp stem cell reparative dentin formation odontoblastic differentiation 1812 11 11/17/22 20221101 NES 221101 1. In the present study, M1 macrophages increased soon after the dental pulp exposure and decreased as the M2 macrophages started to emerge, indicating an inflammatory response at the early phase of the wound healing by the M1 macrophages and their proper polarization to the M2 macrophages. [Extracted from the article]

This study aimed to develop and characterize different formulations of porous chitosan scaffolds (SCH) associated with calcium silicate (CaSi) and evaluate their chemotactic and bioactive potential on human dental pulp cells (hDPCs). Different concentrations of CaSi suspensions (0.5%, 1.0%, and 2.0%, w/v) were incorporated (1:5; v/v) /or not, into 2% chitosan solution, giving rise to the following groups: SCH (control); SCH+ 0.5CaSi; SCH+ 1.0CaSi; SCH+ 2.0 CaSi. The resulting solutions were submitted to thermally induced phase separation followed by freeze-drying procedures to obtain porous scaffolds. The topography, pH, and calcium release kinetics of the scaffolds were assessed. Next, the study evaluated the influence of these scaffolds on cell migration (MG), viability (VB), proliferation (PL), adhesion and spreading (A&S), and on total protein synthesis (TP), alkaline phosphatase (ALP) activity, mineralized matrix deposition (MMD), and gene expression (GE) of odontogenic differentiation markers (ALP, DSPP, and DMP-1). The data were analyzed with ANOVA complemented with the Tukey post-hoc test (α = 5%). Incorporation of the CaSi suspension into the chitosan scaffold formulation increased pore diameter when compared with control. Increased amounts of CaSi in the CH scaffold resulted in higher pH values and Ca release. In Groups SCH+ 1.0CaSi and SCH+ 2.0CaSi, increased VB, PF, A&S, GE of DSPP/DMP-1 and MMD values were shown. However, Group SCH+ 2.0CaSi was the only formulation capable of enhancing MG and showed the highest increase in TP, MMD, and GE of DMP-1 and DSPP values. SCH+ 2.0CaSi formulation had the highest chemotactic and bioactive potential on hDPCs and may be considered a potential biomaterial for pulp-dentin complex regeneration. • Nanotopography, porosity and Ca2+ release influence odontogenic differentiation. • Low dose of calcium silicate can induce cell migration and dentin matrix deposition. • SCH+ 2.0 CaSi scaffold can be applied as a cell-free tissue engineering system. • SCH+ 2.0 CaSi scaffold can guide pulp-dentin complex regeneration. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the clinical and radiographic outcomes of direct pulp capping (DPC) using calcium hydroxide (CH), mineral trioxide aggregate (MTA), and premedicated DPC with formocresol (FC) in primary teeth. Methods: Sixty primary mandibular second molars with pulp exposures in children aged four to eight years old were treated using DPC. The molars were randomly divided into three groups (n equals 20 per group). Pulp exposures in the CH and MTA groups were capped directly using CH and MTA pastes, respectively, while those in the FC group were premedicated with FC and then capped with zinc oxide eugenol (ZOE) cement. All teeth were finally restored with stainless steel crowns, and clinical and radiographic evaluations were carried out at baseline and three, six, and 12 months after restoration. Fisher's exoct test was performed to define the significance between the groups and follow-up periods. Results: The clinical and radiographic findings showed no significant difference between the three groups. The overall success in the CH, MTA, and FC groups were 88.2 percent, 100 percent, and 733 percent, respectively. However, these differences were not statistically significant (P>0.05). Conclusion: All three materials examined in this study exhibited clinical and radiographical efficacy when used as direct pulp capping materials. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate and compare the histological response of rabbit dental pulp after direct pulp capping with 3 different materials: mineral trioxide aggregate (MTA), nanoparticles of fluorapatite (Nano-FA), and nanoparticles of hydroxyapatite (Nano-HA) after 4 and 6-week time intervals., Material and Methods: A total of 72 upper and lower incisor teeth from 18 rabbits were randomly categorized into 3 groups)24 incisors from six rabbits each. MTA Group: teeth were capped with MTA. Nano-FA Group: teeth were capped with fluorapatite nanoparticles. Nano-HA Group: teeth were capped with hydroxyapatite nanoparticles. Blood samples were collected to examine some antioxidant enzymes nitric oxide (NO), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione (GSH), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). After that, three rabbits from each group were euthanized after 4 and 6 weeks, respectively. Pulp tissues of all teeth in all groups were histologically observed., Results: The obtained results showed that both Nano-HA induced the formation of thick dentin bridges with irregular dentin patterns at 6 weeks, while MTA and Nano-FA induced no dentin bridge with no tubular dentin pattern. Blood examination at the two intervals revealed no significant increase or decrease in the values of NO, SOD, CAT, GPx, GSH, and TNF-α. However, there was a significant increase in p-values of IL-6 in the Nano-FA treated group compared to both MTA and Nano-HA treated groups at the two intervals. Regarding the inflammatory reaction of the dental pulp, the MTA and Nano-HA groups displayed moderate inflammation, followed by Nano-FA, which showed the highest prevalence of nonpathological inflammation. Histological results were consistent with the blood examination. After 4 weeks, the Nano-FA and Nano-HA groups showed pulp fibrosis at the operating site, but the MTA showed only granulation tissues. Plus, dilated blood vessels appeared in the Nano-FA group. After 6 weeks, MTA and Nano-FA groups showed pulp fibrosis at the operating site with the persistence of dilated blood vessels with Nano-FA. The nano-HA group showed dentin bridge formation at the operating site., Conclusion: MTA and Nano-HA could be considered favorable materials for direct pulp capping, while Nano-FA produces nonpathological inflammatory cell reactions. Moreover, the Nano-HA was the best in dentin bridge formation. Although nano-FA increased the operating site closure, it was noticed that it significantly increased IL-6 compared to MTA at the two intervals and significantly increased IL-6 compared to Nano-HA at 6 weeks, which may be manifested as some nonpathological inflammations in the Nano-FA group compared to the other groups, but it was deemed acceptable to direct pulp capping procedures., Competing Interests: Declarations. Ethics approval and consent to participate: The present investigation was conducted in adherence to the protocols established by the Research Ethics Committee of the Faculty of pharmacy, Pharos University, under ethical code 239. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Regenerative dentistry is the operation of restoring dental, oral and maxillofacial tissues. Currently, there are no guidelines for the ideal cement/material in regenerative endodontic treatments (RET). Hydraulic calcium silicate-based cements (hCSCs) are currently the material of choice for RET. Objectives: This systematic review was conducted to gather all of the different direct and indirect approaches of using hCSCs in RET in vitro and in vivo, and to ascertain if there are any superiorities to indirect approaches. Methods and Materials: This systematic review was conducted according to the 2020 PRISMA guidelines. The study question according to the PICO format was as follows: Comparison of the biological behavior (O) of stem cells (P) exposed to hCSCs through direct and indirect methods (I) with untreated stem cells (C). An electronic search was executed in Scopus, Google Scholar, and PubMed. Results: A total of 78 studies were included. Studies were published between 2010 and 2022. Twenty-eight commercially available and eighteen modified hCSCs were used. Seven exposure methods (four direct and three indirect contacts) were assessed. ProRoot MTA and Biodentine were the most used hCSCs and had the most desirable results. hCSCs were either freshly mixed or set before application. Most studies allowed hCSCs to set in incubation for 24 h before application, which resulted in the most desirable biological outcomes. Freshly mixed hCSCs had the worst outcomes. Indirect methods had significantly better viability/proliferation and odonto-/osteogenesis outcomes. Conclusion: Biodentine and ProRoot MTA used in indirect exposure methods result in desirable biological outcomes.

Background: The study aims to investigate the pulp and periapical reaction and healing after capping with EndoSequence Root Repair Material (ERRM) combined with low-level laser application. Methods: In 6 rabbits, pulps were exposed via class V, half of the samples received a low-level diode laser at 980 nm. Thereafter, cavities were capped with regular-set ERRM. The specimens were processed for histomorphological examination after 2 weeks and two months. Results: After 2 weeks, images show mild inflammation and organized odontoblasts in lased group. The non-lased group shows more severe inflammation. The predentin thickness was thicker in the lased group with statistical significance (p < 0.05). After 2 months, inflammatory cells were sparse in both lased and non-lased groups. In the periapical area, group one showed dilated blood vessels and thick fibrous connective tissues. In group two, there were more numerous maturations of PDL fibers with scattered inflammatory cells and congested blood vessel. Conclusions: Using low-level laser therapy in combination with ERRM for pulp capping shortens the inflammatory phase and enhances healing. [ABSTRACT FROM AUTHOR]

Purpose: Τo assess the outcome of direct pulp capping in asymptomatic carious primary molars using three pulp capping materials. Methods: In this prospective clinical trial, carious primary molars free of irreversible pulp inflammation signs and symptoms, with negative pain history and pulp exposure following caries removal were included. Teeth were divided into groups: A: Ca(OH)2, B: Pure Portland cement®, C: Biodentine™. Following anaesthesia, isolation, caries removal, pulp exposure, hemorrhage control, pulp capping, additional lining in groups A, B, teeth were restored with composite resin. Descriptive statistics, Chi-squared and Fisher's exact tests, Kaplan–Meier survival curves, multivariable random effects Cox regression model were performed. Results: Sixty-six patients (25 girls, 41 boys) with mean age 7.2 (± 1.7) years participated. The mean follow-up time was 13 months. Seventy-nine primary molars were assigned to groups A (n = 27), B (29), C (n = 23). The overall failure was 16% and the distribution by group was: A: 5 teeth, B: 5 teeth, C: 3 teeth. No significant differences in failure rates between capping materials, tooth types, age bands and genders were identified. Conclusions: Direct pulp capping in asymptomatic carious primary molars may be an acceptable option, when treating an exposed pulp with bioceramic materials as pulp capping agents. [ABSTRACT FROM AUTHOR]

Comprehensive management of severe molar incisor hypomineralization with dental caries in a 9-year-old boy is reported. After the consultation, diagnosis and treatment planning; upon obtaining the consent from parents, and behavior modification of the child over a preparatory visit, three of the four permanent first molars (PFMs) were treated: two with indirect pulp therapy and one with direct pulp capping using tricalcium silicate cement. After observation of 1 month for each tooth, preformed stainless steel crowns (SSCs) were placed on all three PFMs in a diagonal manner for minimizing occlusal discomfort. The remaining PFM (36), restored earlier by another dentist, developed a dentoalveolar abscess during the course; the same was treated endodontically and a coronal seal was established with an SSC. A quadrant approach was adopted to complete extractions of all carious primary teeth along with the treatments of PFMs during the same appointments to minimize the number of visits. Local anesthesia with 4% articaine with adrenaline infiltrations was used for all quadrants except for the third where an inferior alveolar nerve block with 2% lignocaine with adrenaline was given. Follow-up of all PFMs, over a period of over 9 months, was uneventful. The endodontically treated PFM, too, showed satisfactory recovery, posttreatment. [ABSTRACT FROM AUTHOR]

Background: A large number of research reports on vital pulp treatment (VPT) has been published over the last two decades. However, heterogeneity in reporting outcomes of VPT is a significant challenge for evidence synthesis and clinical decision‐making. Objectives: To identify outcomes assessed in VPT studies and to evaluate how and when outcomes are measured. A subsidiary aim was to assess evidence for selective reporting bias in the included studies. The results of this review will be used to inform the development of a core outcome set (COS) for endodontic treatments. Methods: Multiple healthcare bibliographic databases, including PubMed/MEDLINE, Ovid EMBASE, Scopus, Cochrane Database of Systematic Reviews and Web of Science were searched for systematic reviews published between 1990 and 2020, reporting on VPT. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Outcomes' information was extracted and aligned with a healthcare taxonomy into five core areas: survival, clinical/physiological changes, life impact, resource use and adverse events. Results: Thirty‐six systematic reviews were included, 10 reporting on indirect pulp capping or selective caries removal, nine on direct pulp capping, eight on pulpotomy and nine on combined VPTs. There was considerable variation in the outcomes reported in these reviews and their included studies. Clinician‐reported outcomes were used considerably more often than patient‐reported outcomes. A range of instruments and time points were used for measuring outcomes. Several of the reviews were assessed as having low risk of selective reporting bias, but many did not specifically report this domain, whilst others did not provide risk of bias assessment at all. Discussion: Considerable variation in selection of outcomes and how and when they are measured and reported was evident, and this heterogeneity has implications for evidence synthesis and clinical decision‐making. Conclusions: Whilst there is a lack of consistency, several potentially important outcomes for VPT, including pulp survival, incidence of post‐operative pain and need for further intervention, have been identified which could inform the development of a COS for endodontic treatment. Registration: Core Outcome Measures in Effectiveness Trials (COMET) (No. 1879). [ABSTRACT FROM AUTHOR]