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Introduction: This work studied the synergistic effect of chitosan and mineral trioxide aggregate (MTA) on mechanically exposed dental pulp following pulp capping in dogs' teeth. Materials and Methods: Class V cavities were prepared in 60 teeth of 3 mongrel dogs. These cavities were prepared approximately 1 mm coronal to the gingival margin by using a round carbide bur #2 with water cooling. These teeth were divided according to the pulp capping material into 2 groups (30 teeth each); Group I: MTA and Group II: a combination of MTA and chitosan compound. The cavities were restored by self-curing glass ionomer cement, followed by varnish application to provide the suitable conditions for pulpal repair. Both groups were further subdivided according to the evaluation period into 3 subgroups (10 teeth each); subgroup A: 7 days, subgroup B: 21 days, and subgroup C: 60 days. Histological evaluation of dentin bridge formation was performed after pulp capping in all subgroups. Data were statistically analyzed by ANOVA, Tukey's post hoc, Kruskal–Wallis, and Mann–Whitney U-tests. The significance level was set at P ≤ 0.05. Results: No statistically significant difference was found between both groups at all evaluation times (P > 0.05). The combination of MTA and chitosan did not improve the quality of dentin bridge produced by the MTA alone. Conclusion: Mixing of chitosan and MTA as a direct pulp capping material has no synergistic odontogenic effect in dog's teeth.

Aim: It is to evaluate using of Platelet Rich Fibrin (PRF) And Calcium Hydroxide as a pulpotomy agent. Subjects and Methods : The present study was carried out on 9 adult healthy mongrel dogs which classified into 3 equal groups. Under general anesthesia, by means of split-mouth technique the dog’s mandibular teeth were used. After the period of study, the animals were sacrificed by overdose of thiopental sodium and the lower jaw was excised with a bone saw. The study was carried out under the histological evaluation of cellular and pulp tissue response using H&E stains. Results: The result of the present study revealed that, the early response of pulp tissue to all tested materials was inflammatory reactions, of various degrees, that were subsided by time completely only in PRF group. PRF has a powerful agent for regenerative effect on pulp tissue in an absence of dentin bridge formation. It also showed that, the PRF was well tolerated by pulp tissue of dogs’ teeth. On the contrary, pulp degeneration and necrosis were the end results of pulpotomy with Calcium hydroxide agent. Conclusion: PRF can be more reliable than Calcium hydroxide in pulpotomy. PRF is the new material of choice that could be used as alternative to calcium hydroxide in pulpotomy.

Aim: To compare strontium ranelate as a pulp capping agent to bisphosphonate and calcium hydroxide. Materials and methods: The pulps of 36 premolars from 4 dogs were exposed and capped with one of 3 test materials, namely strontium ranelate, bisphosphonate, and calcium hydroxide. Half of the specimens underwent histologic evaluation at 6 weeks and the remaining half were assessed at 12 weeks. Each slide was scored from 1 to 3 according to hard tissue formation, inflammation, and odontoblastic differentiation. The pH of the 3 materials was also measured. Data were inspected using SPSS software and the recorded scores were statistically analyzed at 6 and 12 weeks. Results:Calcium hydroxide was the only material that exhibited discontinuous dentin bridge at both evaluation periods. Strontium ranelate showed irregular hard tissue formation in few of the samples at 12 weeks; while bishphonate did not induce any hard tissue formation. All the materials exhibited severe to moderate inflammatory reaction at 6 weeks which subsided to mild inflammation at 12 weeks. Differentiation of odontoblasts was observed with all materials at both evaluation periods with no significant differences among them. The average pH obtained for Dycal base was 9, and 12 for the catalyst; for bisphosphonate the value was 6.8; and 8.6 for strontium ranelate. Conclusions: Strontium ranelate was not as effective as calcium hydroxide as a pulp capping agent, while bisphosphonate failed to show any potential for hard tissue formation up to 12 weeks. However, all the test materials allowed healing of the pulp tissues.

Background: Regenerative endodontics aims to restore normal pulp function in necrotic and infected teeth, restoring protective functions, such as innate pulp immunity, pulp repair through mineralization, and pulp sensibility. The aim of this systematic review was to assess the dentin regeneration efficacy of direct pulp capping (DPC) biomaterials. Methods: The literature published between 2005 and 2021 was searched by using PubMed, Web of Science, Science Direct, Google Scholar, and Scopus databases. Clinical controlled trials, randomized controlled trials, and animal studies investigating DPC outcomes or comparing different capping materials after pulp exposure were included in this systematic review. Three independent authors performed the searches, and information was extracted by using a structured data format. Results: A total of forty studies (21 from humans and 19 from animals) were included in this systemic review. Histological examinations showed complete/partial/incomplete dentin bridge/reparative dentin formation during the pulp healing process at different follow-up periods, using different capping materials. Conclusions: Mineral trioxide aggregate (MTA) and Biodentine can induce dentin regeneration when applied over exposed pulp. This systematic review can conclude that MTA and its variants have better efficacy in the DPC procedure for dentin regeneration.

Mineral trioxide aggregate (MTA) is an alternative endodontic material that predicts conductive or inductive calcified tissue formation from immature pulp mesenchymal stem cells (IPMSCs). The purpose of this study was to investigate whether MTA could promote reparative odontoblast differentiation via IPMSCs in the early phase of regeneration and compare with calcium hydroxide (CH). Direct pulp capping using calcium hydroxide (CH), MTA, and MTA with platelet-rich plasma (MTA + PRP) was performed on maxillary first molars of 8-week-old male Wistar rats (n = 36). After 3, 7, or 14 days, the teeth were analyzed for mineral density (MD) and volume of MD (VMD) via micro-focusing computed tomography (µCT), nestin, dentin matrix acidic phosphoprotein 1 (DMP1) immunohistochemistry, and real-time PCR for DMP1 mRNA expression. MTA stimulated the early phase differentiation of the IPMSCs into odontoblasts, with positive results for nestin and DMP1 compared with CH. Moreover, MTA + PRP stimulated calcified granule and dentin bridge formation through calcium mineral deposition, following the induction of DMP1 mRNA expression in IPMSCs. Our results suggested that the combination of MTA and PRP is an effective and clinically applicable method for activating endogenous dental pulp stem cells into odontoblasts in the early stages of pulp regeneration.

Purpose: To evaluate clinically, radiographically and histologically the postoperative success of Ankaferd Blood Stopper (ABS) and formocreosl (FC) in pulpotomy procedures for primary teeth. Materials and Method: 70 Primary molars found in 27 patients were selected according to inclusion criteria. In the first part of the study pulpotomy was accomplished in 22 patients having 60 teeth (30 each group) and depending on the type of radicular pulp medicament, the teeth were divided randomly and equally into 2 groups: Group I(FC) and Group II (ABS). Clinical follow up was done after 1,3,6 and 9 months.Periapical radiographs were taken at 3 ,6 and 9 months follow up visits . In the second part of the study 10 primary molars were found in 5 patients planned for extraction due to orthodontic purpose were treated by pulpotomy procedure. Teeth were divided into2 groups(5 each group) and the teeth were extracted after 2 months for observation under light microscope. Results: No statistically significant difference between groups in the overall cumulative clinical or radiographic success at follow up periods. Histopathological examination revealed dentin bridge formation and continuous regular arrangement of odontoblastic layer at the pulp dentin junction along the root length in primary molars treated with ABS while FC specimens revealed Severe pulp hyperemia with thrombus formation at the entrance of pulp canal. Conclusion: ABS can be considered as good natural alternative to FC in primary molars pulpotomy.

Objective: Evaluation of the histological pulp response following direct pulp capping with Galla Chinensis Extract (GCE) in comparison to Mineral Trioxide Aggregate (MTA) in rabbits’ teeth. Methodology: Intentional pulp exposure on the labial surfaces of permanent central incisors of twenty male rabbits was done. Split mouth technique was utilized for applying the capping material where MTA was used for capping upper and lower right central incisors while, GCE was used for capping upper and lower left central incisors. The teeth were restored by glass inonomer cement (GIC) as permanent restorations. Rabbits were divided randomly into two groups 10 rabbits each according to pulp capping period (two and four weeks). After animal scarification teeth were dissected and prepared for histological evaluation using Hematoxylin Eosin (HE) stains.Results: GCE group showed significantly higher mean dentin bridge thickness than MTA group at four weeks, also it showed significantly higher median inflammatory cell scores than MTA group at both time intervals. Conclusions: GCE is a promising direct pulp capping material with less biological pulp response in comparison to MTA.

Dental pulp vitality is a desideratum for preserving the health and functionality of the tooth. In certain clinical situations that lead to pulp exposure, bioactive agents are used in direct pulp-capping procedures to stimulate the dentin-pulp complex and activate reparative dentinogenesis. Hydraulic calcium-silicate cements, derived from Portland cement, can induce the formation of a new dentin bridge at the interface between the biomaterial and the dental pulp. Odontoblasts are molecularly activated, and, if necessary, undifferentiated stem cells in the dental pulp can differentiate into odontoblasts. An extensive review of literature was conducted on MedLine/PubMed database to evaluate the histological outcomes of direct pulp capping with hydraulic calcium-silicate cements performed on animal models. Overall, irrespective of their physico-chemical properties and the molecular mechanisms involved in pulp healing, the effects of cements on tertiary dentin formation and pulp vitality preservation were positive. Histological examinations showed different degrees of dental pulp inflammatory response and complete/incomplete dentin bridge formation during the pulp healing process at different follow-up periods. Calcium silicate materials have the ability to induce reparative dentinogenesis when applied over exposed pulps, with different behaviors, as related to the animal model used, pulpal inflammatory responses, and quality of dentin bridges.

Melatonin plays an essential role in the regulation of bone growth. The actions that melatonin exerts on odontoblasts may be similar to its action on osteoblasts. This research aimed to evaluate the pulp response to melatonin used for direct pulp capping to evaluate the antioxidant effect of melatonin administered orally and its influence on dental pulp. Direct pulp capping was performed on the upper molars of Sprague Dawley rats using melatonin or Mineral Trioxide Aggregate (MTA). The study groups were: MTA, Melatonin, MTA + Melatonin administered orally, and Melatonin + Melatonin administered orally. In the latter two groups, the animals drank water dosed with melatonin ad libitum (10 mg/100 mL). After 30 days, the animals were sacrificed, and 5 ml of blood, the kidneys, and the liver were extracted in order to evaluate oxidative stress using thiobarbituric acid reactive substances testing (TBARS). Fragments of the maxilla containing the study molars were prepared for histological evaluation. The degree of pulp inflammation and pulp necrosis, the presence of reparative dentin and dentin bridging the pulp chamber, the presence and regularity of the odontoblastic layer, and the presence of pulp fibrosis were evaluated. No significant differences were found between the four study groups for any of the studied histological variables. The oral administration of melatonin did not modify the local effects of MTA or melatonin on dental pulp, or reduce basal-level oxidative stress. The effect of melatonin on pulp is similar to that of MTA and may be used as an agent for direct pulp capping.

Aim: is to histopathologically evaluate dental pulp response to eggshell powder as a direct pulp capping material and compare it to Calcium Hydroxide as regard to inflammation, calcific bridge formation and fibrosis. Material and methods: 30-New Zealand rabbits were selected in this study and divided into 3 groups according to the time of sacrifice after pulp capping procedure (1, 2 and 4weeks). The two lower central incisors were used, where the pulp was exposed and capped directly by one of the two materials used in this study; Calcium Hydroxide (Dycal) or eggshell powder. The cavities were then sealed by glass ionomer cement (Fuji IX). Animals were sacrificed at each time interval and teeth were collected for histopathological evaluation. Results: Eggshell group showed significantly less inflammation, less fibrosis and thicker calcific bridge formation than Calcium hydroxide group. When the effect of time was considered, inflammation significantly decreased from 1 to 4 weeks while calcific bridge significantly increased for both materials. Also fibrosis increased significantly from 1week to 4 weeks. Conclusions: Eggshell powder should be considered as a direct pulp capping material as it led to a better calcific bridge formation than calcium hydroxide with less inflammation and fibrosis. Keywords: Eggshell, Pulp capping, Dentin bridge, Calcium hydroxide

Background Maintaining pulp vitality is a major objective in restorative dentistry. Direct pulp capping (DPC) is considered a way to enhance pulp healing and induce reparative dentin. In the present study, 3 capping materials were used and compared in terms of promoting pulp tissue healing after mechanical exposure. Objectives The aim of the study was to evaluate the reparative capacity of Biodentine™ (BD), TheraCal® LC and TotalFill® as DPC materials and to assess dentin bridge formation. Material and methods The experiment required 3 groups (1-week group, 1-month group and 3-months group), each consisting of 24 fresh human premolars extracted for orthodontic reasons. A cavity was prepared on the buccal surface of each tooth and the pulp tissue was penetrated to a depth of approx. 1.0 mm. After exposure, hemostasis was obtained and the pulp-capping agents BD, TheraCal LC and TotalFill were applied. A final restoration with GC Fuji IX GP Fast (GC Corporation, Tokyo, Japan) was applied to each tooth to ensure an adequate coronal seal. Tissue samples were collected at 1 week, 1 month and 3 months. The samples were demineralized, sectioned, stained, and histologically graded. Results There was a statistically significant difference between TheraCal LC and both BD and TotalFill in terms of pulpal inflammation during the 3 capping periods, while BD and TotalFill showed comparable results, with no statistically significant difference between their results in the 3 capping periods. Conclusions TotalFill a newly developed pulp-capping material, offers results comparable to BD in addition to its advantageous handling properties. Although TheraCal LC contains resin ingredients, given proper curing, it seems to be a successful material for DPC and offers superior handling properties.

Introduction: Direct pulp-capping is an alternative procedure to extraction or endodontic therapy, in which a medicament is placed directly over the exposed pulp to maintain pulp vitality and facilitate the formation of protective barrier. Aim of study: The purpose of this study was to evaluate and compare the histological response of dog’s pulp after direct pulp capping with 3 different materials; MTA, Bioactive glass, CEM and their nanoparticles, at 1 month and 3 month time intervals. Materials & Methods: A total of 112 teeth in 8 dogs were used for this study, where 96 teeth were pulp capped with the investigated materials and 16 teeth were serving as negative control. The 14 teeth of each dog were classified into 6 experimental groups and one control (2 teeth each) as follows: Group A: was capped with MTA, Group B: was capped with NMTA, Group C: was capped with CEM, Group D: was capped with NCEM, Group E: was capped with Bioactive glass, Group F: was capped with Nano Bioactive glass and Group G: unprepared tooth (negative control). Dogs were randomly divided into 2 groups (4 dogs each), relative to the observation periods tested, 1 month and 3 months for histomorphological evaluation of pulp response after direct pulp capping with tested materials. Results: Regarding the dentin bridge formation, both NMTA and NCEM groups induced thick dentin bridge with irregular dentin pattern in 1 and 3 months evaluation time period while MTA and CEM induced thinner dentin bridge with regular dentin pattern. BG and NBG groups showed the lowest mean dentin bridge thickness values with no tubular dentin pattern. About the inflammatory reaction of the dental pulp to materials with conventional particle size; MTA displayed the highest prevalence of no inflammation followed by CEM while BG showed the highest prevalence of moderate inflammation and the highest inflammatory cell counts. All nanomaterials showed the highest mean inflammatory cell counts at both evaluations time periods. Conclusion: MTA and CEM can be considered favorable materials for direct pulp capping, while BG and NBG produced the worst inflammatory cell reaction, dentin bridge thickness and quality. Nanoparticles although increased dentin bridge thickness, they also increased the inflammatory cell reaction.

O objetivo desta revisão é abordar os materiais de capeamento pulpar direto, hidróxido de cálcio, MTA e Biodentine comparando os seus resultados. Metodologia: A pesquisa bibliográfica foi realizada na base de dados PubMed. Foram reunidos num total de 162 artigos, dos quais 21 foram considerados relevantes para a realização deste trabalho. Desenvolvimento: Hidróxido de cálcio é um material introduzido na medicina dentária no ano 1920 que ficou como a melhor opção para o capeamento pulpar direto por várias décadas. Agregado de trióxido mineral é utilizado como material de capeamento pulpar direto, chegando à formulação de silicato de cálcio mais conhecida e amplamente utilizada. Para ultrapassar algumas das limitações do agregado de trióxido mineral, outros materiais de silicato de cálcio foram introduzidos no mercado. Um destes é o Biodentine. Conclusão: Foi concluído que o hidróxido de cálcio, de baixo custo, tem uma taxa de sucesso a curto prazo muito semelhante aos materiais agregado de trióxido mineral e Biodentine. Permite a formação de uma ponte dentinária menos mineralizada, com túbulos menos organizados, e dissolve-se ao longo do tempo. Agregado de trióxido mineral tornou-se um material revolucionário que permite uma melhor ponte dentinária, menor inflamação e alta taxa de sucesso, mas apresenta um alto custo, pigmentação dentária e dificuldade de manuseamento. O Bioentine parece ser o material de eleição, com uma taxa de sucesso elevada, indução de ponte dentinária e menor inflamação.

Objective: To evaluate the pulpal and periapical response of dogs’ teeth after pulpotomy and use of Enamel Matrix Derivative (EMD) as capping agent. Methods: Pulpotomy was performed in 40 teeth from 4 dogs and the remaining pulp tissue was recovered with the following materials: Groups I and IV: EMD (Emdogain®); Groups II and V: calcium hydroxide; Groups III and VI: zinc oxide and eugenol cement. After 7 days (Groups I, II, and III) and 70 days (Groups IV, V, and VI), the animals were euthanized and the teeth were removed and processed for histological analysis; were analyzed using Kruskal-Wallis test followed by Dunn test or Mann Whitney test ( =0.05). Results: 7-day period: in Group I, it was observed a mild to moderate inflammatory infiltrate and intense vascular proliferation while Group II presented a mild inflammatory infiltrate and an intact pulp tissue (p < 0.05). Group III presented a moderate to severe inflammatory infiltrate. 70-day period: Groups IV and VI showed no dentin bridge formation, the remaining pulp tissue presented necrotic areas with inflammatory cells in the periapical region and bone and cementum resorption (p > 0.05). In Group V, there was dentin bridge formation, absence of inflammation and absence of mineralized tissue resorption (p < 0.05). Conclusion: EMD as a capping material after pulpotomy did not show either satisfactory tissue response or capacity of inducing deposition of mineralized tissue in dental pulp. Objetivo: Avaliar a resposta pulpar e periapical de dentes de cães após pulpotomia e uso de Derivados de Matriz de Esmalte (EMD) como agente de capeamento. Métodos: A pulpotomia foi realizada em 40 dentes de 4 cães e o tecido pulpar remanescente foi recuperado com os seguintes materiais: Grupos I e IV: EMD (Emdogain®); Grupos II e V: hidróxido de cálcio; Grupos III e VI: cimento de óxido de zinco e eugenol. Após 7 dias (Grupos I, II e III) e 70 dias (Grupos IV, V e VI), os animais foram eutanásiados e os dentes foram removidos e processados para análise histológica; foram analisados pelo teste de Kruskal-Wallis, seguidopelo teste de Dunn ou Mann Whitney ( = 0,05). Resultados: Período de 7 dias: no Grupo I, observou-se infiltrado inflamatório leve a moderado e intensa proliferação vascular, enquanto o Grupo II apresentou infiltrado inflamatório leve e tecido pulpar intacto (p 0,05). No Grupo V, houve formação de ponte de dentina, ausência de inflamação e ausência de reabsorção tecidual mineralizada (p

Aim To compare and evaluate the effect of different liners separately and in combination with lasers that is resin modified glass-ionomer cement (RMGIC), Laser+RMGIC, Biodentine, Laser+Biodentinein the treatment of deep carious lesions. Materials and methods Forty patients with deep caries indicated for pulp capping were selected. Curative procedure including the cavity preparation with maximal removal of softened dentine using spoon excavator, slow speed handpiece with round burs was performed. Patients were divided into four groups with 10 patients in each group In group A RMGIC liner, group B laser biostimulation followed by RMGIC liner, group C biodentine liner, group D laser biostimulation followed by Biodentine liner were placed in the cavity after caries removal. Cavities were temporarily restored with IRM for 8 weeks. After 8 weeks, liners in each group were removed, and cavities were permanently restored lower half of the cavity with a layer of flowable Z350 XT composite, and then the remaining half of the cavity with P60 filled composites (3 M ESPE, USA) in all the groups. The observation period was 12 months. Results All the patients showed a positive response to cold test and electric pulp test at 3 months, 6 months, 12 months follow-up. In group A (RMGIC) two patients and in group B (Laser+Biodentine) three patients did not return back for the follow-up. To standardize the samples, seven patients were selected from each group with a total of 28 samples included in the study (n = 7) and statistical analysis was done using analysis of variance (ANOVA) test. The mean for the total amount of dentine deposited after 12 months was highest in: Group D-(Laser+Biodenitne) 0.32 mm > Group C-(Biodentine) 0.25 mm > Group B-(Laser+RMGIC) 0.10 > Group A-(RMGIC) 0.07 mm Conclusion: Within the limitation of the present study the following conclusion was drawn: • Lasers and biodentine are good indirect pulp capping agents • Laser has an additional effect on the tertiary dentine formation. Clinical significance Lasers with antibacterial effect penetrate into dentinal tubules and accelerate the rate of dentin bridge formation in deep carious lesions.

Nowadays, the preservation of dental pulp vitality is an integral part of our daily therapies. The success of these treatments depends on the clinical situation as well as the biomaterials used. Mineral Trioxide aggregate and BiodentineTM are commonly used as pulp capping materials. One objective of vital pulp therapy is the repair/regeneration of the pulp. In addition to the initial inflammatory status of the pulp, the nature and quality of the new mineralized tissue obtained after pulp capping directly influence the success of the treatment. In order to characterize the reparative dentin, in the current study, the chemical composition and microstructure of the dentin bridge after direct pulp capping using Biodentine&trade, and mineral trioxide aggregate (MTA) was studied by using Raman microspectroscopy and scanning electron microscopy, respectively. The results showed that the reparative dentin bridge observed in both groups presented dentin tubules and chemical composition similar to primary dentin. With the limitations of this study, the calcium-silicate-based cements used as pulp capping materials provide an optimal environment for pulp healing, resulting in a reparative dentin resembling on certain points of the primary dentin and the regeneration of the pulp.

Two cases of traumatized permanent maxillary central incisors with complicated crown fractures of young patients are reported. Partial pulpotomy by Cvek technique was performed using mineral trioxide aggregate filling material. The tooth fragment was reattached to the tooth structure with composite resin. Follow-up revealed normal pulpal response, complete apical closer, and dentin bridge formation.

Introduction Direct pulp capping is an important therapeutic method that has goal to provide formation of dentin bridge and healing process of the pulp. The aim of this study was to investigate the effects of new nanostructural materials based on calcium silicate systems and hydroxyapatite on exposed dental pulp in Vietnamese pigs. Material and Methods The study was conducted on 30 teeth of two Vietnamese pigs (Sus scrofa verus). On buccal surfaces of incisors, canines and first premolars, class V cavities were prepared with a small round bur and pulp horn was exposed. In the first experimental group (10 teeth) the perforation was covered with new nanostructural material based on calcium silicate systems (CS). In the second experimental group, the perforation was covered with compound of calcium silicate systems and hydroxyapatite (HA-CS) (10 teeth). In the control group, exposed pulp was covered with Pro Root MTA® (Dentsply Tulsa Dental, Johnson City, TN, USA) (10 teeth). All cavities were restored with glass ionomer cement (GC Fuji VIII, GC Corporation, Tokyo, Japan). Observation period was 28 days. After sacrificing the animals, histological preparations were done to analyze the presence of dentin bridge, inflammatory reaction of the pulp, pulp tissue reorganization and the presence of bacteria. Results Dentin bridge was observed in all teeth (experimental and control groups). Inflammation of the pulp was mild to moderate in all groups. Neoangiogenesis and many odontoblast like cells responsible for dentin bridge formation were detected. Necrosis was not observed in any case, neither the presence of Gram-positive bacteria in the pulp. Conclusion Histological analysis indicated favorable therapeutic effects of new nanostructural materials based on calcium silicate systems and hydroxyapatite for direct pulp capping in teeth of Vietnamese pigs. Uvod Direktno prekrivanje pulpe je važan terapijski postupak koji ima zadatak da obezbedi zatvaranje pulpne komore i omogući proces zarastanja. Cilj ovog rada je bio da se ispita efekat novih nanostrukturnih materijala na bazi kalcijum-silikatnih sistema i hidroksiapatita na eksponiranu pulpu zuba vijetnamskih svinja. Materijal i metode rada Istraživanje je sprovedeno na 30 zuba kod dve vijetnamske svinje (Sus scrofa verus). Na vestibularnim površinama sekutića, očnjaka i prvih premolara urađene su preparacije kaviteta V klase, pri čemu je malim okruglim svrdlom napravljena namerna eksploracija komore pulpe. U prvoj eksperimentalnoj grupi (10 zuba) perforacija je prekrivana novim nanostrukturnim materijalom na bazi kalcijum-silikatnih sistema (CS). U drugoj eksperimentalnoj grupi (10 zuba) perforacija je prekrivana smešom kalcijum-silikatnog sistema i hidroksiapatita (HA-CS). U kontrolnoj grupi (10 zuba) perforacija je prekrivana sa MTA® (Dentsply Tulsa Dental, Džonson Siti, Tenesi, SAD). Svi kaviteti su restaurirani glas-jonomer cementom (GC Fuji VIII, GC Corporation, Tokio, Japan). Opservacioni period iznosio je 28 dana. Nakon žrtvovanja životinja napravljeni su histološki preparati na kojima su analizirani postojanje dentinskog mostića, inflamatorna reakcija pulpe, reorganizacija pulpnog tkiva i prisustvo bakterija. Rezultati Na svim zubima eksperimentalnih grupa i kontrolne grupe zabeleženo je stvaranje dentinskog mostića. Zapaljenje pulpe je bilo blago do umereno i u eksperimentalnim i u kontrolnoj grupi. Uočeni su znaci neoangiogeneze i mnoštvo ćelija sličnih odontoblastima koje su odgovorne za stvaranje dentinskog mostića. Nekroza nije zabeležena ni u jednom slučaju, kao ni prisustvo gram-pozitivnih bakterija u pulpi. Zaključak Histološka analiza je ukazala na povoljne terapijske efekte novih nanostrukturnih materijala na bazi kalcijum-silikatnih sistema i hidroksiapatita u direktnom prekrivanju pulpe zuba vijetnamskih svinja.

Introduction: The usage of Calcium hydroxide (CaOH 2 ) has wide applications due to the property of osteo-inductive, protective, and antibacterial actions. However, it is not used in primary teeth, as it fails to form reparative dentin and the exact mechanism has not been explained. The hypothesis: The authors propose an explanation that lack of dentin bridge formation in response to (CaOH 2 ) in primary teeth could be multifactorial: inability of the deciduous stem cells to generate complete dentin-pulp-like tissue; the absence of calcium-magnesium-dependent adenosine triphosphatase (Ca-Mg ATPase) in the odontoblasts; the pre-existing predilection of deciduous dentine pulp to form odontoclasts; the solubility of (CaOH 2 ). Evaluation of the hypothesis: The hypothesis discusses the innate traits of the deciduous stem cells that lack the ability to form the dentin bridge, the absence of Ca-Mg ATPase enzyme and increased solubility of (CaOH 2 ) together fail to stimulate the odontoblasts. Alternatively, pre-existing progenitor cells with proclivity to change into odontoclasts may cause internal resorption and hamper formation of reparative dentin.

Aim The aim was to clinically and radiographically evaluate mineral trioxide aggregate (MTA) and TheraCal LC as direct pulp capping (DPC) materials. Materials and methods Twenty male patients aged 17–35 years with immediate mechanical pulp exposure in lower molars were randomly divided into two equal groups (n = 10). Group 1: pulp exposures were capped using MTA. Group 2: pulp exposures were capped using TheraCal LC. Immediately after DPC, a base-line digital bitewing and periapical radiographs were taken. Clinical evaluation was performed at 1, 4, 12, and 24 weeks after DPC for presence/absence of spontaneous pain, tenderness to percussion, draining sinuses and pulp response to thermal pulp vitality test. At 24 weeks after DPC, digital periapical, and bitewing radiographs were taken. Digitalized bitewing radiographs were submitted to image analysis software to measure dentin bridge thickness in comparison to the base-line bitewing radiographic image. Digitalized preoperative and postoperative periapical radiographs were submitted to the same software to evaluate changes in the width of periodontal ligament space. Results Clinically, all cases showed criteria of successful treatment except 3, four cases in groups 1 and 2, respectively. Statistical analysis revealed no statistically significant difference between both groups (P > 0.05). All of the thirteen cases that were available for evaluation after 6 months showed dentin bridge formation. In MTA group, the mean value of dentin bridge formed was higher than in TheraCal LC group with no statistically significant difference (P = 0.710). Changes in the width of periodontal ligament space were not significantly different between both groups recording (P > 0.05). Conclusion Clinically and radiographically, MTA and TheraCal LC are favorable materials for DPC inducing adequate dentin bridge formation and minimal widening of periodontal ligament space.

Introduction Direct pulp capping is therapeutic method of applying medication on exposed pulp in order to allow bridge formation and healing process. The aim of this study was to investigate the effect of Biodentine on exposed dental pulp of Vietnamese pigs. Material and Methods The study was conducted on 20 teeth of Vietnamese pigs (Sus scrofa domesticus). On buccal surfaces of incisors, canines and first premolars, class V cavities were prepared and pulp was exposed. In the experimental group (six incisors, two canines and two premolars) the perforation was covered with BiodentineR (Septodont, Saint-Maur-des-Fosses, France). In the control group, the perforation was covered with MTAR (Dentsply Tulsa Dental, Johnson City, TN, USA). All cavities were restored with glass ionomer cement (GC Fuji VIII, GC Corporation, Tokyo, Japan). Observation period was 28 days. After sacrificing the animals, histological preparations were done to analyze the presence of dentin bridge, an inflammatory reaction of the pulp, pulp tissue reorganization and the presence of bacteria. Results Dentin bridge was observed in all teeth (experimental and control groups). Inflammation of the pulp was mild to moderate in both groups. Neoangiogenesis and many odontoblast like cells responsible for dentin bridge formation were detected. Necrosis was not observed in any case, neither the presence of Gram-positive bacteria in the pulp. Conclusion Histological analysis indicated favorable therapeutic effects of Biodentine for direct pulp capping in teeth of Vietnamese pigs. Findings were similar with Biodentine and MTA. Uvod Direktno prekrivanje pulpe je terapijski postupak primene leka na eksponiranu pulpu zuba radi zatvaranja pulpne komore i omogućavanja procesa zarastanja. Cilj ovog rada je bio da se ispita efekat biodentina na eksponiranu pulpu zuba vijetnamske svinje. Materijal i metode rada Istraživanje je izvršeno na 20 zuba vijetnamske svinje (Sus scrofa domesticus). Na vestibularnim površinama sekutića, očnjaka i prvih premolara urađene su preparacije kaviteta V klase, pri čemu je napravljena namerna eksploracija komora pulpe. U eksperimentalnoj grupi (šest sekutića, dva očnjaka i dva premolara) perforacija je prekrivana preparatom Biodentine ® (Septodont, Sent Mor de Fos, Francuska). U kontrolnoj grupi perforacija je prekrivana sa MTA® (Dentsply Tulsa Dental, Džonson Siti, Tenesi, SAD). Svi kaviteti su restaurirani glasjonomer- cementom (GC Fuji VIII, GC Corporation, Tokio, Japan). Opservacioni period trajao je 28 dana. Nakon žrtvovanja životinja napravljeni su histološki preparati na kojima su analizirani postojanje dentinskog mostića, inflamatorna reakcija pulpe, reorganizacija pulpnog tkiva i prisustvo bakterija. Rezultati Na svim zubima eksperimentalne i kontrolne grupe zabeleženo je stvaranje dentinskog mostića. Zapaljenje pulpe je bilo blago do umereno i u eksperimentalnoj i u kontrolnoj grupi uzoraka. Uočeni su znaci neoangiogeneze i mnoštvo ćelija sličnih odontoblastima koje su odgovorne za stvaranje dentinskog mostića. Nekroza nije zabeležena ni u jednom slučaju, kao ni prisustvo Gram-pozitivnih bakterija u pulpi. Zaključak Histološka analiza je ukazala na povoljne terapijske efekte biodentina u direktnom prekrivanju pulpe zuba vijetnamskih svinja. Reakcija pulpe bila je slična onima koje je izazvao MTA.

Introduction: Ferric sulfate and Laser has been used for conventional pulpotomy therapy. Clinical and radiographic evaluation of pulpotomies using these have been done in numerous studies but there exists few studies analysing the histologic response of pulp to laser and ferric sulfate. Aim: The aim of the study was to evaluate and compare histological changes seen in the pulp following ferric sulfate and laser pulpotomy and compare these effects. Materials and Methods: This was a single blind in vivo study, consisting of 24 primary teeth. The teeth were randomly divided into two groups based on the material to be used and subgrouped based on the time period (30 and 45 days) of evaluation. The teeth were extracted after the study period and tissue processing done and subjected to Haematoxylin and Eosin staining procedure. The tissues were evaluated for dentin bridge formation, quality of dentin formation in the bridges, location of dentin bridges, tissue reaction to the material, inflammatory cell response and necrosis. The statistical analysis was done using SPSS 20.0 software. Intragroup comparisons of the observed values were analysed using Chi-square test. Results: Statistical analysis revealed non-significant difference between the two materials to produce reparative dentin and also the quality of dentin bridges formed in both the groups during both the observational periods. Majority of the samples in both ferric sulfate and laser group exhibited dentin bridge at the interface of the exposed pulp, bridging or attempting to bridge the site exposed to the pulpotomy material. The ability of the materials to evoke a foreign body and inflammatory cell responses in the pulpal tissue was not significant. All the samples of both the groups showed signs of necrosis with two samples of laser group showing severe necrosis in 45 days period. The difference between the groups in 30 days group was statistically significant. Conclusion: Laser and ferric sulfate are found to be able to initiate dentin bridge at the interface between the pulp and the material but the quality of bridge formed was better in laser group. Laser group showed more macrophage infiltration, inflammatory cell infiltration and areas of necrosis compared to ferric sulfate group though not statistically significant

Aim To compare the histomorphological response of rat dental pulps capped with MM-MTA and ProRoot MTA at 1, 2 and 4 weeks postoperatively. Materials and methods Direct pulp capping with MM-MTA and ProRoot MTA, overlaid with light-cured composite resin, was performed on right and left maxillary first molars of 20 Wistar rats. Animals were killed at 1, 2 and 4 weeks postoperatively. Biopsy samples were stained and viewed by light microscopy to determine dentin bridge formation. Data were statistically evaluated with the Kruskal-Wallis test (p < 0.05). Results Absence of dentin bridge formation at 1 week, partial dentin bridge formation at 2 weeks and complete dentin bridge formation at 4 weeks are observed with MM-MTA and ProRoot MTA. The results showed no statistically significant difference between both materials at 4 weeks. Conclusion Both materials produced similar responses in the pulp when used for pulp capping in intact, caries-free molars of rats. How to cite this article Khalil IT, Sarkis T, Naaman A. MM-MTA for Direct Pulp Capping: A Histologic Comparison with ProRoot MTA in Rat Molars. J Contemp Dent Pract 2013;14(6):1019- 1023.

Background: The purpose of this study was to compare the outcome of direct pulp capping by statins with α-tricalcium phosphate (α-TCP) and mineral trioxide aggregate (MTA) on pulp tissue of human teeth through histological evaluation. Aims: The aim of the present study is to compare the pulpal response of statins (simvastatin or atorvastatin) with α-TCP to that of MTA on human teeth by light microscopic histological evaluation. Materials and Methods: Ninety intact premolar teeth scheduled for orthodontic extraction were used for the study. Class 1 cavities were prepared, and the pulp was mechanically exposed under rubber dam isolation. The samples were divided into three groups of thirty teeth each (Group I – simvastatin + α-TCP, Group II – atorvastatin + α-TCP, and Group III – MTA), and the test materials were placed accordingly. After the experimental periods of 7, 30, and 90 days, the teeth were extracted atraumatically. The samples were then evaluated for the degree of inflammation, tissue damage, and hard tissue formation under light microscope, and they were scored based on the histopathologic findings. Statistical Analysis: The results were analyzed statistically using the Chi-square test. Results: There was no statistically significant difference between Groups I, II, and III in terms of inflammation, tissue damage, and hard tissue formation for all the three observation periods (P > 0.05). Conclusions: Simvastatin and atorvastatin with α-TCP were found to be effective in inducing dentin bridge formation which was comparable to MTA.

O capeamento pulpar é uma medida importante e muito usada no cotidiano da prática odontológica e, quando realizado de forma consciente, baseado em um bom diagnóstico da condição pulpar no momento da exposição, pode prevenir o dente de sofrer uma intervenção endodôntica. Além do hidróxido de cálcio, outros materiais vêm sendo testados quanto a sua ação em promover o reparo pulpar pela formação de ponte de dentina, após capeamento pulpar direto. Uma das alternativas de materiais viáveis para o capeamento pulpar são as cerâmicas à base de fosfatos de cálcio, destacando-se a hidroxiapatita (HAp) e o fosfato tricálcico (β-TCP). Estes materiais não promovem a formação de área necrótica, característica da utilização do hidróxido de cálcio, são biocompatíveis e favorecem o reparo do tecido pulpar. Para avaliar os efeitos desses materiais no capeamento pulpar foi realizada esta revisão de literatura, abordando desde a resposta do tecido pulpar, até o protocolo para o uso clínico.

The purpose of this study was to investigate dentin-bridge formation in teeth following the transplantation of dental pulp-derived cells seeded on hydroxyapatite/tricalcium phosphate (HA/TCP) scaffolds. The dental pulp tissues were removed from the extracted first molar teeth of miniature pigs and single cell populations were subcultured. Second-passage cells that had alkaline phosphatase activity were combined with scaffolds. Cell-scaffold constructs were placed in contact with the exposed pulp tissue. The dimensions of the exposed pulp site were approximately 1–2.5 mm in diameter and 2–3 mm in depth from the tooth surface. After placing the constructs, the tooth was restored with composite resin. Six weeks after transplantation, hard tissue formation was observed on the pulp tissue in histology. Dentinal tubule-like structures were observed in most of the hard tissue generated, and columnar cells, which showed positive immunoreactions with dentin sialoprotein (DSP) and heat shock protein (HSP)-25, were aligned beneath the hard tissues. When only scaffolds were placed on the pulp tissues, particles of hard tissue were formed, however dentinal tubule-like structures and odontoblasts were not observed despite the formation of hard tissue. In conclusion, the implantation of dental pulp constructs into pulp exposed stimulates the formation of calcified dentin-like structures.

The aim of this case series was to determine the clinical and radiographic success rate of pulpotomy, with new endodontic cement (NEC), in human mature permanent molar teeth. Twelve molars with established irreversible pulpitis were selected from patients 14 - 62 years old. The selection criteria included carious pulp exposure with a positive history of lingering pain. After isolation, caries removal, and pulp exposure, pulpotomy with NEC was performed and a permanent restoration was immediately placed. At the first recall (+1 day) no patients reported postoperative pain. One wisdom tooth had been extracted after two months because of failure in coronal restoration. Eleven patients were available for the second recall, with a mean time of 15.8 months. Clinical and radiographic examination revealed that all teeth were functional and free of signs and symptoms. Histological examination of the extracted teeth revealed complete dentin bridge formation and a normal pulp. Although the results favored the use of NEC, more studies with larger samples and a longer recall period were suggested, to justify the use of this novel material for treatment of irreversible pulpitis in human permanent molar teeth.

The purpose of treating permanent teeth with exposed pulp, which can be a result of trauma or dental caries progression, is to preserve the vitality and function of the damaged pulp. The therapeutic procedure, along with an adequate indication, most often involves the use of methods of direct pulp capping or vital pulpotomy. Direct pulp capping (DPC) is a therapeutic aplication of drug on exposed dental pulp in order to ensure the closure of the pulp chamber and allow healing process. The treatment includes wound closure with a bioactive material that accelerates healing of the pulp by forming a reparatory dentin or dentin bridge at the site of injury. Recovery of the pulp involves migration of stem/progenitor cells of the pulp to the site of the injury and their proliferation and differentiation into odontoblasts like cells. These cells secrete tertiary dentin matrix with subsequent formation of a reparatory dentin bridge. The success of DPC therapy is often very uncertain and the ideal material does not yet exist. Recent decades have seen a considerable effort by researchers and clinicians in the development of biomaterials which should be characterized not only by biocompatibility, but by bioactivity and bioinductivity. Although MTA still represents the gold standard in DPC today, efforts have been made to overcome the disadvantages of this material (long setting time, difficult handling and application, high market price) along with the introduction of new materials which improved the therapeutic procedure of DPC. Biomimetic regenerative procedures, tissue engineering and nanotechnology provide such possibilities. Biomimetic therapeutic approach and application of amelogenin-enamel proteins in tissue regeneration or the application of new procedures by active regeneration and tissue engineering, can significantly improve the therapeutic results. Emdogain is a newer generation material which consists of enamel proteins and growth factors. For many years it has been successfully used in regenerative therapy of periodontal tissue, but its effect on the pulp tissue is not yet proven. Assumptions have been made about increasing amounts of growth factors at the site of the damaged pulp which can accelerate the healing of pulp wounds and stimulate regeneration..., Osnovni cilj terapije mladih stalnih zuba sa eksponiranom pulpom, koja nastaje kao posledica dentalne traume ili progresije karijesa, je očuvanje vitaliteta i funkcije oštećene pulpe. Terapijski postupak, uz pravilno postavljenu indikaciju, najčešće uključuje primenu metoda direktnog prekrivanja pulpe ili vitalne pulpotomije. Direktno prekrivanje pulpe (DPP) je terapijski postupak aplikacije leka na eksponiranu pulpu zuba sa ciljem da obezbedi zatvaranje pulpne komore i omogući proces zarastanja. Tretman obuhvata zatvaranje rane bioaktivnim materijalom koji pospešuje ozdravljenje pulpe formiranjem reparatornog dentina tj, dentinskog mosta na mestu povrede. Ozdravljenje pulpe podrazumeva migraciju stem/progenitor ćelija pulpe do mesta povrede i njihovu proliferaciju i diferencijaciju u ćelije slične odontoblastima. Ove ćelije sekretuju matriks tercijarnog dentina, sa posledičnim formiranjem reparatornog dentinskog mosta. Kako je uspeh terapije DPP često veoma neizvestan, a idealan materijal za DPP još uvek ne postoji, poslednjih decenija se ulažu veliki napori istraživača i kliničara u razvoj biomaterijala koji bi pored biokompatibilnosti, trebalo da odlikuje i bioaktivnost i bioinduktivnost. Iako danas MTA još uvek predstavlja zlatni standard u DPP, čine se napori kako bi se prevazišli nedostaci ovog materijala (dugo vreme vezivanja, teškoće u rukovanju i aplokaciji, visoka cena na tržištu) i uvođenjem novih materijala unapredila terapijska procedura DPP. Mogućnosti za to svakako postoje u biomimetičkim regenerativnim procedurama, tkivnom inžinjeringu i nanotehnologiji. Biomimetički terapijski pristup i moguća primena amelogenina-gleđnog proteina u tkivnoj regeneraciji, odnosno primena novih koncepata aktivne regeneracije i tkivnog inžinjeringa, može značajno unaprediti terapijske rezultate. Emdogain je materijal novije generacije koji u svom sastavu sadrži gleđne proteine i faktore rasta i kao takav se dugi niz godina uspešno upotrebljava u regenerativnoj terapiji parodoncijuma, ali njegov efekat na pulpno tkivo još uvek nije dokazan. Postoje pretpostavke da se povećanjem količine faktora rasta na mestu oštećenja pulpe može ubrzati zarastanje pulpne rane i stimulisati njena regeneracija...