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Abstract 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.

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]

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.

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.

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 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.

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]

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]

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]

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]

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]

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

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]

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]

Abstract Objective A retrospective study of the success rate of direct pulp capping (DPC) and indirect pulp capping (IPC) was carried out in children between 6–14 years‐old, considering separately primary caries or caries affecting teeth with molar incisor hypomineralization (MIH). Material and methods Data were collected in a dental public health service. Following the inclusion criteria, 232 treatments were analyzed. Success was defined by the presence of a functional tooth without clinical signs or symptoms of pulpal or periapical disease. The success rate was correlated to patient gender, the affected tooth and the indication of therapy using the chi‐squared and Fisher exact test. The success time related to treatment type was evaluated through the Mann–Whitney test. Results The IPC and DPC success rate was 99.4%, and 84.6%, respectively (p = .01). Success was significantly lower when caries affected teeth with MIH than when caries affected teeth without MIH (p = .01). The mean survival for DPC and IPC was 14.07 ± 1.30 and 15.98 ± 0.80 months, respectively (p = .07). Conclusions When caries were located in teeth that were not affected by MIH, IPC was significantly more successful than DPC, but did not differ significantly when caries were placed in teeth with MIH. Key points Minimally invasive therapy is a successful approach for decayed young permanent teeth. The success of IPC was greater than the success of DPC wen caries was placed in teeth not affected by MIH. In teeth not affected by MIH the success of DPC or IPC did not differ significantly.

The present paper is the first article providing a systematic literature review on the visualization of tertiary dentin influenced by modern bioactive materials in CBCT and micro-CT. Six database searches of studies on tertiary dentin visualization using CBCT produced 622 records in total, and the search of the studies on tertiary dentin using micro-CT produced 502 records in total. The results were thoroughly selected considering the inclusion criteria, and five research papers using CBCT and nine research papers using micro-CT for visualization of tertiary dentin were eventually qualified for the analysis. All the non-randomized and randomized studies presented good and high levels of quality evidence, respectively. Among the bioactive materials used, the most frequently analysed were: MTA, Biodentine dentin matrix hydrogel, Pro Root MTA, and EndoSequence root repair material. The highest thickness of the tertiary dentin was achieved after the use of MTA material in both imaging techniques. The remaining parameters had different results, taking into account the CBCT and micro-CT analysis. The possibilities of the qualitative and quantitative assessment of the particular parameters of tertiary dentin using CBCT and micro-CT techniques were presented and analysed. CBCT and micro-CT analyses can be useful in the assessment of tertiary dentin formed beneath the bioactive material applied during vital pulp treatment. The research argues that the presented results differ depending on the material applied to the pulp, the study duration (4–6 weeks), difference in teeth, species (rats, human), as well as the applied technique and differences in computer software used for the analysis. [ABSTRACT FROM AUTHOR]

Bone-marrow derived stem cells (BMSCs) can differentiate into several mesenchymal cell lines that are suitable for bone and dental tissue engineering. This study was aimed to assess the efficacy of cell therapy in direct pulp capping (DPC) of canine teeth using autologous BMSCs along with collagen/hydroxyapatite hybrid scaffold in terms of the quantity and quality of calcified bridge formation. The teeth were randomly divided into three groups of DPC with mineral trioxide aggregate (MTA), hydroxyapatite/collagen hybrid scaffold alone and BMSCs with hydroxyapatite/collagen hybrid scaffold. DPC was performed under general anesthesia in cavities prepared on the buccal surfaces of mandibular and maxillary premolars of the same dogs from which, stem cells had been isolated. All cavities were then restored with light-cure resin modified glass ionomer cement. Histomorphometric assessments after 12 weeks showed formation of dentinal bridge following DPC with BMSCs and MTA. The efficacy of MTA for calcified bridge formation following DPC was significantly higher than that of BMSCs plus hybrid scaffold. According to the present study, we concluded DPC using BMSCs and hybrid scaffold did not provide clinically noticeable results in canine patients. [ABSTRACT FROM AUTHOR]

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Objective: This study evaluated the effectiveness of Platelet Rich Plasma (PRP), Platelet Rich Fibrin (PRF) and Mineral Trioxide Aggregate (MTA) as direct pulp capping materials in patients with carious pulp exposure using cone beam computed tomography. Methods: This parallel, triple blinded, randomised trial was done on 30 permanent posterior teeth chosen as candidates for direct pulp capping based on stringent inclusion and exclusion criteria. The samples were allocated based on sequentially numbered opaque sealed envelope method into three groups: MTA, PRP and PRF for direct pulp capping. The treated teeth were restored with Glass Ionomer cement liner and light-cured resin composite. Patients were followed up for a period of 12 months. Statistical analyses were performed with statistical software SPSS version 25. Data were analysed for normality using Shapiro Wilk's test. Dentine bridge volume analysis across the groups were done using Kruskal Wallis test with the significance level at P=0.05. As the test revealed a significant difference, post hoc analysis was done with Dunn test. Results: CBCT analysis revealed that the volume of dentine bridge formed by PRP and PRF was significantly higher than the volume of dentine bridge formed by MTA (P<0.001; CI: 90%). There was no significant difference in the efficacy between the three direct pulp capping agents based on clinical assessment. A total of 27 teeth (90%) showed positive response to pulp sensibility testing and evidence of dentine bridge formation in radiograph at 12 months. No adverse events were encountered. Conclusion: Platelet concentrates could be the future of vital pulp therapy for adult permanent teeth with reversible pulpitis. [ABSTRACT FROM AUTHOR]

In the case of pulp injury, odontoblastic differentiation of dental pulp cells (DPCs) at the site of the exposed pulp is necessary for a successful direct pulp capping treatment. Calcium phosphate cement (CPC), a kind of hydroxyapatite-like bone cement, exhibits therapeutic potential in osteogenesis by regulating cell cycle progression and promoting osteoblastic differentiation. Based on the similar biological process of osteo/odontoblastic differentiation, the present study evaluated the effects of CPC on odontoblastic differentiation of DPCs in vitro and in vivo, respectively. The morphology of CPC was observed by scanning electron microscopy. Colony-forming units were used to assess the antibacterial activity. The effects of CPC on cell proliferation and odontoblastic differentiation of human dental pulp cells (hDPCs) were also measured. Histological staining was performed to observe the reparative dentin formation in rat molars. In vitro, results of antibacterial studies showed that CPC significantly inhibited the growth of Streptococcus mutans. The appropriate concentration of CPC extract showed low cytotoxicity on hDPCs. Furthermore, CPC extract also promoted odontoblastic differentiation and mineralization compared with the control group, as shown by a dynamic increase in the expression of odontogenic marker genes and the increased number of mineralized nodules at 21 days. The pulpotomy models with CPC facilitated the formation of dentin bridge with the highly expressed dentin matrix protein 1 (DMP1) in odontoblast-like cells. In conclusion, the favorable biocompatibility, antibacterial property and bio-inductivity of CPC suggest that CPC can be used as a promising direct pulp capping material. [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. [Display omitted] [ABSTRACT FROM AUTHOR]

INTRODUCTION: There is no consensus regarding the options of treatments and materials used in the management of exposed pulps among dentists. OBJECTIVES: The aim of this study was to investigate dentists' options of treatments (TO) and materials (MO) used to manage exposed pulps that occur during deep caries removal in asymptomatic permanent teeth, and how background characteristics of dentists influence these options. MATERIAL AND METHODS: A web-based questionnaire was constructed and distributed randomly. The questionnaire' investigated background characteristics, TO (direct pulp capping [DPC], root canal treatment [RCT], and partial and full pulpotomies) and MO (calcium hydroxide, TheraCal, MTA, and Biodentine). RESULTS: There were 363 dentists who participated in the study. In asymptomatic exposed pulps, 43.0%, 45.5%, 2.5%, and 2.5% of respondents performed DPC, RCT, partial pulpotomy, and full pulpotomy, respectively. Performing vital pulp therapies (VPT) was significantly associated with endodontists (OR: 2.85, 95% CI: 1.30-6.20%, p < 0.01), academic members (vs. non-academicians) (OR: 2.86, 95% CI: 1.36-6.03%, p < 0.01), and respondents with a PhD degree (vs. bachelor's degree) (OR: 4.87, 95% CI: 1.39-17.02%, p < 0.05), respectively. The preferred material for pulp capping was TheraCal (39.7%), followed by calcium hydroxide (33.9%), MTA (21.55%), and Biodentine (5.0%). Using calcium silicate-based materials was significantly associated with male dentists (OR: 4.09, 95% CI: 2.25-7.43%, p < 0.001) or respondents with MSc degrees (OR: 3.63, 95% CI: 1.68-7.84%, p < 0.01). CONCLUSIONS: Vital pulp therapy and the use of MTA or Biodentine to manage exposed pulps are not performed routinely by general dental practitioners, non-academician, females, and dentists with bachelor's degrees in dental surgery. [ABSTRACT FROM AUTHOR]

Effective treatment of pulpitis of teeth is an important and urgent problem of modern dentistry. The aim of the work was to evaluate the clinical effectiveness of the bioactive dentin substitute in the treatment of reversible forms of pulpitis. The doctors performed a procedure for direct coating of pulp in 87 teeth in 62 patients. . Most of the teeth in an objective study met all the criteria for success: the restoration was fully preserved (98.8% of the score was «good» and «excellent» according to the specified criteria), postoperative sensitivity was absent in the next (89.3%) and in the long term (95, 2%), the vitality of the teeth was confirmed with a cold test and radiologically (97.6% success).

This systematic review and meta-analysis aimed to evaluate the success rate of direct pulp capping (DPC) on permanent teeth, comparing the use of MTA with calcium hydroxide and calcium silicate-based cements. A systematic search was carried out in 4 databases until July 2023. The selection was based on PICOS criteria and only randomized clinical trials were included. The risk of bias was assessed using RoB-2 tool, and meta-analyses were performed using RevMan 5.3 software. The overall quality of evidence was determined using the GRADE tool. Thirteen studies were included. Meta-analyses indicated significantly higher success rate for DPC using MTA compared to calcium hydroxide, while no significant difference was observed between MTA and Biodentine, showing a success rate from 80% to 100% even after 3 years of follow-up. Five studies were classified as having high risk of bias and the GRADE assessment revealed low certainty of evidence. DPC is highly effective for permanent teeth when using MTA or Biodentine. There is a need for future well-designed randomized clinical trials to evaluate the efficacy of DPC using newer bioceramic materials., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2024. The Korean Academy of Conservative Dentistry.)

Resumen Objetivo: Describir el tratamiento de un paciente que presentó un incisivo superior permanente con exposición pulpar y desarrollo radicular incompleto utilizando Biodentine como material para la protección pulpar directa. Caso clínico: Un paciente de 9 años fue derivado para la evaluación y el tratamiento del diente 11. El examen clínico y radiográfico reveló la presencia de una fractura amelodentinaria, con exposición pulpar y desarrollo radicular incompleto. Luego de lavar y desinfectar el área de la fractura, se protegió la pulpa expuesta con Biodentine y se restauró la cavidad. El paciente fue citado para control a los 18 y 25 meses. En los controles se comprobó que el diente se mantuvo asintomático y funcional. Luego de 25 meses, el examen clínico y radiográfico confirmó la presencia de pulpa vital y el completo desarrollo del remanente radicular. Los resultados obtenidos en el presente caso clínico sugieren que el empleo de Biodentine puede ser considerado como una valiosa alternativa para la protección de la pulpa expuesta en dientes con desarrollo radicular incompleto. Palabras clave: Biodentine, silicato tricálcico, sustituto dentinario, protección pulpar directa// Abstract Aim: To describe the treatment of a patient that presented a permanent maxillary central incisor with pulp exposure and incomplete root formation, using Biodoentine as the material for direct pulp protection. Clinical case: A 9-year-old male patient was referred for evaluation and treatment of tooth 11. The clinical and radiographic examination revealed the presence of a dentinoenamel fracture, with pulp exposure and incomplete root formation. After cleaning and disinfecting the area, the exposed pulp was protected with Biodentine and the cavity was restored. The patient was scheduled for control after 18 and 25 months. In these evaluations, it was confirmed that the tooth remained asymptomatic and functional. After 25 months, the clinical and radiographic examination showed the presence of vital pulp and a completed development of the root. The obtained results of this clinical case suggest that Biodentine can be considered a valuable alternative for pulp capping in teeth with incomplete root formation. Key words: Biodentine, dentine substitute, direct pulp capping, tricalcium silicate.

Traumatic human dental injuries involving the pulp might necessitate direct capping procedures. This clinical study aimed to analyse the histological outcomes using two different direct capping materials. Twenty patients with bilateral premolars, scheduled for orthodontic extraction, were selected. The teeth were treated either using ProRoot MTA or RetroMTA. All patients were recalled after 30 and 60 days for teeth extraction. The histopathologically stained specimens were blindly evaluated using hard tissue bridge formation, inflammatory reaction and pulpal findings criteria. Data were evaluated statistically. Results: After 60 days, only the parameter for hard tissue bridge formation showed significant difference in the ProRoot MTA group (p = 0.010), while both direct capping materials performed similarly regarding inflammatory pulp reaction and pulpal findings. Although, during the first 30 days, RetroMTA presented better results in terms of continuity, morphology, hard tissue bridge localisation, and extension/general state of the inflammatory reaction, the continuity was better at 60 days when ProRoot MTA was applied. Treatment with RetroMTA healed the pulpal tissue faster compared with ProRoot MTA but it seemed to be rather a reparative process. [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.

Purpose This study aimed to compare the effects of the collagen-BioAggregate mixture (CBA-M) and collagen-BioAggregate composite (CBA-C) sponge as a scaffolding material on the reparative dentin formation. Materials and Methods CBA-C sponge (10:1 w/w) was obtained and characterized by Scanning Electron Microscopy (SEM) and Mercury Porosimetry. Cytotoxicity of the CBA-C sponge was tested by using the L929 mouse fibroblast cell line. Dental pulp stem cells (DPSCs) were isolated from the pulp tissue of sheep teeth and characterized by flow cytometry for the presence of mesenchymal stem cell marker, CD44. The osteogenic differentiation capability of isolated DPSCs was studied by Alizarin Red staining. The cells were then used to study for the compatibility of CBA-C sponge with cell proliferation and calcium phosphate deposition. The effect of CBA-C sponge and CBA-M on the induction of dentin regeneration was studied in the perforated teeth of sheep for the eight-week period. All the analyses were performed with appropriate statistical hypothesis tests. Results CBA-C sponge was found to be biocompatible for DPSCs. The DPSCs seeded on the CBA-C sponge were able to differentiate into the osteoblastic lineage and deposit calcium phosphate crystals in vitro. Reparative dentin formation was observed after the second week in the CBA-C sponge applied group. At the end of eight weeks, a complete reparative dentin structure was formed in the CBA-C sponge applied group, whereas necrotic tissue residues were observed in groups treated with the CBA-M. Conclusion CBA-C sponge represents a better microenvironment for reparative dentin formation probably due to maintaining DPSCs and allowing their osteogenic differentiation and thus calcium phosphate deposition. [ABSTRACT FROM AUTHOR]

The aim of this study was to summarize and systemically review the different types of bioceramics that have been proposed to be used as direct dental pulp capping materials for dentin regeneration in permanent teeth. This article reviewed the studies carried out on the bioceramic materials as dental pulp capping agents. PubMed, Embase, Cochrane Central Register of Controlled Trials, and Scopus electronic databases were searched with the selected keywords. The retrieved articles were evaluated by 2 reviewers according to the inclusion and exclusion criteria and the extracted data were arranged in Tables. After removing duplicate articles and further screening, 3126 articles were retrieved in this review. Following discussing the composition and characteristics of different types of bioceramics reported in the literature, 47 articles that met the inclusion criteria were included in this systematic review. The results of this review showed that certain types of calcium silicate-based materials, mineral trioxide aggregate (MTA), and Biodentine seem to be the most effective bioceramics currently used for direct pulp capping in permanent teeth compared with that of other types of bioceramics. In addition, different types of calcium phosphate materials like tricalcium phosphates and bioactive glasses have been recently introduced as alternative bioceramics for dental pulp capping. Calcium phosphates might be considered as more appropriate pulp capping materials in future because of their unique characteristics. However, because of lack of promising information, only further well-designed in vitro and long term clinical studies are required to confirm the most appropriate type of bioceramics for direct dental pulp capping procedures. [ABSTRACT FROM AUTHOR]

Objective: A retrospective study of the success rate of direct pulp capping (DPC) and indirect pulp capping (IPC) was carried out in children between 6–14 years‐old, considering separately primary caries or caries affecting teeth with molar incisor hypomineralization (MIH). Material and methods: Data were collected in a dental public health service. Following the inclusion criteria, 232 treatments were analyzed. Success was defined by the presence of a functional tooth without clinical signs or symptoms of pulpal or periapical disease. The success rate was correlated to patient gender, the affected tooth and the indication of therapy using the chi‐squared and Fisher exact test. The success time related to treatment type was evaluated through the Mann–Whitney test. Results: The IPC and DPC success rate was 99.4%, and 84.6%, respectively (p =.01). Success was significantly lower when caries affected teeth with MIH than when caries affected teeth without MIH (p =.01). The mean survival for DPC and IPC was 14.07 ± 1.30 and 15.98 ± 0.80 months, respectively (p =.07). Conclusions: When caries were located in teeth that were not affected by MIH, IPC was significantly more successful than DPC, but did not differ significantly when caries were placed in teeth with MIH. Key points: Minimally invasive therapy is a successful approach for decayed young permanent teeth.The success of IPC was greater than the success of DPC wen caries was placed in teeth not affected by MIH.In teeth not affected by MIH the success of DPC or IPC did not differ significantly. [ABSTRACT FROM AUTHOR]

Conventionally the cases accepted for direct pulp capping are the inadvertently exposed normal pulps and carious exposures in teeth without apical radiolucency. The recent advances in dental materials, namely the bioceramics, allowed successful vital therapy by direct pulp capping even in young permanent teeth with irreversible pulpitis. The choice of pulp capping material is pivotal in pulp vital therapy of carious exposures as tricalcium silicates shift the balance inflammation-healing toward the regeneration of damaged dentin-pulp complex. Anticipating a reliable outcome, the high anti-inflammatory potential and modulating capacity of cytokines and growth factors proved by bioactive endodontic cements in direct pulp capping should be associated with new molecular diagnostic tests and cautious clinical evaluation. However, it seems that a paradigm shift is expected in the decision of direct pulp capping.

Objective: The aim of this study was to investigate the effect of photobiomodulation therapy (PBMT) on postoperative pain provoked by thermal stimulation in direct pulp capping (DPC).Subjects and Methods: A retrospective study was performed using the records of patients who received DPC using mineral trioxide aggregate. Teeth irradiated with a laser were assigned as the PBMT group, and nonirradiated teeth were considered as the control group. Before treatment and 6 h, 1 day, and 7 days after treatment, tooth sensitivity to a cold stimulus was recorded using a visual analog scale.Results: From a total of 123 documented DPC procedures, only 72 directly capped permanent teeth met the inclusion criteria. Age, gender, and tooth location were comparable between the groups. A statistically significant difference was found in sensitivity to cold stimulus between groups on day 7 (p = 0.007), but no difference was found at the preoperative, 6 h, and day 1 time points (p = 0.055, p = 0.132, and p = 0.100, respectively). In the intragroup evaluation, a significantly greater decrease in sensitivity to cold stimulus was detected in the PBMT group than that in the control group, although both groups showed a reduction in discomfort throughout the follow-up period (p = 0.000).Conclusion: PBMT is an effective method for enhancing patient comfort by reducing thermal sensitivity following DPC procedures. [ABSTRACT FROM AUTHOR]

Aim: To assess and compare the treatment outcome of direct pulp capping with mineral trioxide aggregate (MTA) and Biodentine, after complete excavation of caries in permanent dentition with a 2-visit treatment protocol. Materials and Methods: Direct pulp capping with white MTA was performed in 70 teeth. Direct pulp capping with Biodentine was also done in 72 teeth. In the subsequent visits after 2 weeks, pulp sensibility tests were attempted in both studied groups. All clinical outcomes were categorized as success or failure. Results: The success rate of the pulp capping procedure in the MTA group at the end of 12 months study was 94.3% in the Class I subgroup and 93.3% in the Class II subgroup. Conclusion: Direct pulp capping with MTA and Biodentine, after pulp exposure during excavation of deep caries could maintain pulp vitality in permanent teeth. [ABSTRACT FROM AUTHOR]

Background: This retrospective clinical study aimed to assess dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. Methods: A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), direct pulp capping with Mineral Trioxide Aggregate cement; Group (2), direct pulp capping with a resin-based glass ionomer; Group (3), direct pulp capping with TheraCal; Group (4), indirect pulp capping with a three-step total-etch adhesive system; and Group (5), indirect pulp capping with a two-step self-etch adhesive system. Results: A 72.5% success rate was achieved overall. A statistically significant difference was found when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively. For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis ( p = 0.035), while bleeding after exposure appeared independent ( p = 0.053). Patient age was significantly related to the maintenance of pulp vitality ( p = 0.013). A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered ( p = 0.017). For the indirect pulp-capping treatments, a significant correlation between patient age ( p = 0.021) and the adhesive system ( p = 0.019) with pulp necrosis was described. Conclusions: The pulp-capping material, patient age, and the width of the pulp exposure before the procedure should be carefully considered when performing direct pulp-capping treatments. The performance of the etch-and-rinse adhesive systems was superior to the self-etch system during the indirect pulp-capping procedures.

Background: Maintaining the vitality and functionality of dental pulp is paramount for tooth integrity, longevity, and homeostasis. Aiming to treat irreversible pulpitis and necrosis, there has been a paradigm shift from conventional root canal treatment towards regenerative endodontic therapy., Aim of Review: This extensive and multipart review presents crucial laboratory and practical issues related to pulp-dentin complex regeneration aimed towards advancing clinical translation of regenerative endodontic therapy and enhancing human life quality., Key Scientific Concepts of Review: In this multipart review paper, we first present a panorama of emerging potential tissue engineering strategies for pulp-dentin complex regeneration from cell transplantation and cell homing perspectives, emphasizing the critical regenerative components of stem cells, biomaterials, and conducive microenvironments. Then, this review provides details about current clinically practiced pulp regenerative/reparative approaches, including direct pulp capping and root revascularization, with a specific focus on the remaining hurdles and bright prospects in developing such therapies. Next, special attention was devoted to discussing the innovative biomimetic perspectives opened in establishing functional tissues by employing exosomes and cell aggregates, which will benefit the clinical translation of dental pulp engineering protocols. Finally, we summarize careful consideration that should be given to basic research and clinical applications of regenerative endodontics. In particular, this review article highlights significant challenges associated with residual infection and inflammation and identifies future insightful directions in creating antibacterial and immunomodulatory microenvironments so that clinicians and researchers can comprehensively understand crucial clinical aspects of regenerative endodontic procedures., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Production and hosting by Elsevier B.V.)