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Objective: The pulpal response to Hoffmann's Pulpine mineral (PMIN) and Pulpine NE (PNE) was compared to mineral trioxide aggregate (MTA) when used as pulpotomy materials in immature permanent teeth in dogs. Materials and methods: Immature premolars were randomly divided according to the observation period into three equal groups (n = 24) (10 days, 30 days, and 90 days) then furtherly subdivided into 3 subgroups according to the material used. Histopathological analysis regarding inflammatory cell infiltration and dentin bridge (DB) formation was done. Immunohistochemical analysis was performed using osteopontin marker. Results: The results showed that after 90 days, both MTA and PMIN subgroups had 100% complete thick DB without inflammation in 87.5% of the samples, while the PNE subgroup failed to form DB in 37.5% of the samples and 50% of samples showed thin initial DB with heavy inflammation in 62.5% of the samples. There was no significant difference between MTA and PMIN, while there was a statistically significant difference between PNE and the two other subgroups in DB formation and inflammatory cell infiltration (P > 0.05). After 90 days, MTA showed the highest mean value of osteopontin positive fraction area followed by PMIN without statistically significant differences, while the least value was recorded in PNE subgroup with statistically significant difference with the remaining subgroups (P < 0.05). Conclusion: PMIN is a promising alternative to MTA when used for pulpotomy. Clinical relevance: Vital pulp therapy in immature teeth can be done using PMIN as an alternative to MTA. [ABSTRACT FROM AUTHOR]

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

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.

OBJECTIVE: This study is to compare the dentin bridge thickness achieved using calcium hydroxide and MTA using radiographs. METHODOLOGY: Single blinded randomized controlled trial conducted in the Operative Dentistry department at Fatima Jinnah Dental College and Hospital, Karachi. A total of 100 premolar and molar teeth with class I and II cavities were included in this study. The study participants were assigned into two groups, A and B of 50 participants each. Under local anesthesia, Group A was indirectly pulp capped with Calcium hydroxide (Dycal) and Group B received Mineral Trioxide Aggregate as an indirect pulp capping material. Both groups were then restored with Glass Ionomer Cement. Radiographic follow up was carried out at three and six months to determine mean dentin thickness of reparative dentin bridge. RESULTS: Statistical analysis was performed using SPSS v 23. Independent Sample t-test was applied to evaluate the formation of dentin bridge formation using Ca(OH)2 and MTA at 3 months & 6 months, the outcomes were highly significant (p-value<0.001). Paired sample t-test was applied to evaluate the difference in dentin bridge formation at three months and 6 months, the results were highly significant (p-value <0.001). CONCLUSION: Statistically significant difference was observed in the dentin thickness of reparative dentin bridge amongst the two groups after three months and six months. A greater success rate was noted in the MTA group as compared to the Ca(OH)2 group after 6 months. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the pulpal response after pulp capping using either biodentine (BD) or tech biosealer capping (TBC) in the dog model. Materials and Methods: Class V cavities were carried out on 45 teeth in three mongrel dogs. The dental pulp was exposed in 30 teeth (2 experimental groups) and left unexposed in 15 teeth (control group). The cavities of the experimental groups were capped with either BD (n = 15 teeth) or TBC (n = 15 teeth). All cavities in the experimental and control groups were restored with resin-modified glass ionomer. Dentin bridge formation, architecture of the odontoblastic layers, and signs of inflammation were assessed after 1, 2, and 3 months using the computer image analyzer. Results: The BD group exhibited a thick newly formed reparative dentin bridge completely closing the exposure site with cell inclusions and mineralization, variable numbers of odontoblast-like cells, preserved pulp tissue, marked numerous collagen fibers, and blood vessels. While the TBC group exhibited an incomplete newly formed reparative dentin bridge with tunnel defect, vacuolated odontoblasts, complete pulp degeneration with multiple edematous spaces, hyperemic blood vessels, extravasated red blood cells, multiple calcified structures scattered just beneath the dentin bridge and through the pulp tissue, and newly ill-defined odontoblasts. Conclusion: For pulp capping, BD has a better dentin bridge formation and pulp preservation than TBC in the dog model.

Purpose: The purpose of this study was to examine the reaction and hard tissue derivation of rat pulp directly capped with experimentally developed adhesive resin systems after CO2 laser irradiation. Materials and Methods: The experimentally developed bonding agents used for direct pulp capping contained four kinds of calcium phosphate: hydroxyapatite, dicalcium phosphate dehydrate, β-tricalcium phosphate, and octacalcium phosphate, as well as Mega Bond (MB) primer (MBP) used for adhesive treatment. The intensities of irradiation of the CO2 laser were set at three stages: low, medium (standard) with LLLT action, and high. The 12 experimental groups were formed by combining the three laser groups with four kinds of experimentally developed bonding agents. MBP was applied to the control group after direct pulp capping with Dycal without laser irradiation. In all groups, the cavities were filled with Clearfil AP-X and photopolymerized. Histopathological and immunohistochemical examinations were undertaken 3, 7, and 14 days after direct pulp capping. Results: There was no significant difference in the wound healing of exposed pulp among the laser-irradiated experimental groups. However, the group irradiated with the low-intensity laser showed faster pulp healing and dentin bridge formation than the other laser groups. Conclusion: There was no significant difference in wound healing of exposed pulp between each experimental group and the control group. It was suggested that low irradiation condition of CO2 laser and direct pulp capping with experimentally developed bonding agents containing calcium phosphate were comparable to the preparation of calcium hydroxide DY. The thickness of irritative dentin formed on the pulpal wall showed a tendency to increase as the intensity of irradiation was raised. [ABSTRACT FROM AUTHOR]

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.

Aims and Objectives: The aim of this study was to compare the clinical performance of mineral trioxide aggregate (MTA) and calcium hydroxide as indirect pulp-capping agents in permanent teeth. Materials and Methods: Search strategy includes randomized control trials and clinical trials from the databases of PubMed Central, Cochrane, EBSCO, and MEDLINE from January 1998 to May 2018. A total of six clinical trials that met all inclusion criteria were included in this systematic review. Meta-analysis was performed for three among the included studies. The primary clinical outcome of the included studies was to evaluate the pulp vitality with a normal response to thermal, electrical, and tactile tests without signs of spontaneous pain. The radiological outcome was to evaluate the absence of periapical radiolucency, periodontal ligament space widening, and the dentin bridge formation. The primary and predominant results were assessed based on the success or failure of pulp capping. The restorations were considered failure when there are clinical symptoms such as pain and tenderness and radiographic evidence of radiolucency in periapical region or widening of periodontal ligament. Results: In the six trials that are included, two studies are judged as low risk and four as medium risk of bias. With the help of meta-analysis, the evidence produced concluded that after six-month and one-year follow-up there was no statistically significant difference between MTA and calcium hydroxide as an indirect pulp-capping material. Conclusion: This systematic review of the available evidence reveals that MTA and calcium hydroxide demonstrated good consistent endurance in clinical studies and indistinguishable performance. [ABSTRACT FROM AUTHOR]

Background: Considering the biological concerns of calcium hydroxide (CH) as a pulpotomy agent, an alternative silicate based dentin substitute i.e. Biodentine (Ca3SiO5) was evaluated clinically and radiographically. Aims: To evaluate the effectiveness of dentin substitute (Biodentine) in regenerative pulpotomy of vital primary teeth that would giv a biological base to its use in forming reactive dentin bridge and overcoming the drawbacks of calcium hydroxide. Material and Methods: Randomised clinical trial on 40 bilateral carious primary molars in 20 participant children (aged 5-10 years) was carried out by same operator using Ca3SiO5(group-1) and CH (group-2) as vital pulpotomy agents. Blinded clinical and radiographic outcomes were observed at 3, 6 and 12 months interval. Results: Clinical outcomes of both protocols were analysed using Pearson's chi-square test applied at P < 0.05. Descriptive statistics were expressed as mean increase in dentin bridge formation in mms from two reference points in standardized radiographs using paired 't'- test at baseline and 12 months and found to be statistically significant (P < 0.05) in group-1 when compared with group-2. Conclusion: Group-1 revealed statistically favourable regenerative potential along with clinical success compared to group 2 thereby sharing both indications and mode of action with CH, but without its drawbacks of physical and clinical properties.

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.

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Introduction: The usage of Calcium hydroxide (CaOH2) 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 (CaOH2) 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 (CaOH2). 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 (CaOH2) 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.

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

Emphasis has shifted from the “doomed” organ concept of an exposed pulp to one of hope and recovery. The era of vital-pulp therapy has been greatly enhanced with the introduction of various pulp capping materials. The aim of this article is to summarize and discuss about the various and newer pulp capping materials used for protection of the dentin-pulp complex.

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 Biodentine® (Septodont, Saint-Maur-des-Fosses, France). In the control group, the perforation was covered with MTA® (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.

Introduction The purpose of this study was to compare Biodentine and mineral trioxide aggregate (MTA) for direct pulp capping in young permanent molars by clinical and radiographic evaluation in 7- to 9-year-old children. Methods In 50 patients, 29 patients with bilateral asymptomatic first permanent molars with carious involvement were selected. According to split mouth design, these patients were then divided into 2 groups, Biodentine group (right side) and MTA group (left side). The pulp-capping procedure was performed by using Biodentine and MTA in 58 asymptomatic bilateral permanent molars with pulp exposure. At each recall (baseline, 6 and 12 months), treatment outcome was assessed clinically through pulpal sensitivity tests as well as radiographically to evaluate dentin bridge formation. Results The study reported 100% success rate with both Biodentine and MTA at baseline and 6- and 12-month follow-up on the basis of clinical and radiographic parameters. These findings were statistically non-significant ( P < .05) between both groups (Biodentine and MTA). Radiographically, dentin bridge formation was not evident with both groups at baseline, but it was evident after 6- and 12-month follow-up. These findings were statistically non-significant ( P < .05) in both Biodentine and MTA groups. Conclusions This study reported 100% success rate with both MTA and Biodentine when used as direct pulp-capping agent in first permanent molars in 7- to 9-year-old children. The major limitations of the study were smaller sample size and short follow-up period. [ABSTRACT FROM AUTHOR]

This study evaluates the biological properties of a new pulp capping material developed from Portland cement. This study was conducted on 48 teeth in 4 dogs (12 teeth/dog). The dogs were classified into two equal groups (n = 24 teeth) according to the evaluation period including: group A (3 weeks) and group B (3 months). Each group was further subdivided into three equal subgroups (n = 8 teeth) according to the capping material including: subgroup 1: mineral trioxide aggregate (MTA), subgroup2: Portland cement + 10% calcium hydroxide + 20% bismuth oxide (Port Cal) and subgroup 3: Portland cement + bismuth oxide. After general anesthesia, a class V buccal cavity was prepared coronal to the gingival margin. After pulp exposure and hemostasis,the capping materials and glass ionomer filling were placed on the exposure sites. All histopathological findings, inflammatory cell count and dentin bridge formation were recorded. Data were analyzed statistically. After 3 months, the histopathological picture of the pulp in subgroup 1 showed normal pulp, continuous odontoblastic layer and complete dentin bridge formation while subgroup 2 showed partial and complete dentin bridge over a normal and necrotic pulps. Subgroup 3 showed loss of normal architecture, areas of necrosis, complete, or incomplete dentin bridge formation, attached and detached pulp stones and fatty degeneration in group B. For group A, MTA subgroup showed the least number of inflammatory cell infiltrate followed by Port Cal subgroup. While subgroup 3 showed the highest number of inflammatory cell infiltrate. For group B, the mean inflammatory cell count increased with the three tested materials with no statistical difference. Regarding dentin bridge formation at group A, no significant differences was found between subgroups, while at group B, MTA subgroup exhibited significantly higher scores than other subgroups. In conclusion, addition of calcium hydroxide to Portland cement improves the dentin bridge formation qualitatively and quantitatively. [ABSTRACT FROM AUTHOR]

The effect of dental pulp capping materials on hard-tissue barrier formation. Didilescu AC, Cristache CM, Andrei M, Voicu G, Perlea P. J Am Dent Assoc 2018; 149 (10):903 – 17. None. Systematic review and meta-analysis of data. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Considering the biological concerns of calcium hydroxide (CH) as a pulpotomy agent, an alternative silicate based dentin substitute i.e. Biodentine (Ca3SiO5) was evaluated clinically and radiographically. Aims: To evaluate the effectiveness of dentin substitute (Biodentine) in regenerative pulpotomy of vital primary teeth that would giv a biological base to its use in forming reactive dentin bridge and overcoming the drawbacks of calcium hydroxide. Material and Methods: Randomised clinical trial on 40 bilateral carious primary molars in 20 participant children (aged 5-10 years) was carried out by same operator using Ca3SiO5 (group-1) and CH (group-2) as vital pulpotomy agents. Blinded clinical and radiographic outcomes were observed at 3, 6 and 12 months interval. Results: Clinical outcomes of both protocols were analysed using Pearson's chi-square test applied at P < 0.05. Descriptive statistics were expressed as mean increase in dentin bridge formation in mms from two reference points in standardized radiographs using paired 't'- test at baseline and 12 months and found to be statistically significant (P < 0.05) in group-1 when compared with group-2. Conclusion: Group-1 revealed statistically favourable regenerative potential along with clinical success compared to group 2 thereby sharing both indications and mode of action with CH, but without its drawbacks of physical and clinical properties. [ABSTRACT FROM AUTHOR]

Introduction: This clinical trial was conducted to evaluate the response of human dental pulp to direct capping with betamethasone/gentamicin (BG) cream and mineral trioxide aggregate (MTA). We hypothesized that the results of direct pulp capping with a topical BG combination would be similar to or better than those with MTA. Methods: Thirty-six human first premolar teeth scheduled for orthodontic extraction were randomly divided into 4 groups: BG1 group (n = 9), BG cream with 2-week follow-up; BG2 group (n = 10), BG cream with 8-week follow-up; MTA1 group (n = 8), MTA with 2-week follow-up; and MTA2 group (n = 9), MTA with 8-week follow-up. Teeth were extracted and evaluated at respective time intervals. Micro-computed tomography scanning and histologic analyses were performed for all specimens. Pulp pathology (inflammation, pulp abscesses, and pulp necrosis) and reparative reaction (formation of dentin bridges) were recorded. Results: Both BG cream and MTA resulted in significantly better pulpal responses at 8 weeks than at 2 weeks. Dentin bridge formation was significantly thicker in the MTA group at 8 weeks than in any other group (P < .05). Inflammation was of the acute type in all groups; no statistically significant differences in the distribution of inflammatory cells were found among the groups. Pulpal abscesses and/or necrosis were observed more often in teeth capped with BG than with MTA. Conclusions: Direct pulp capping with both BG cream and MTA was associated with dentin bridge formation. MTA resulted in a significantly better pulpal response, with less inflammation and a thicker dentin bridge at 8 weeks. [ABSTRACT FROM AUTHOR]

Introduction Mineral trioxide aggregate (MTA) is a biocompatible material for direct pulp capping. This study was designed to compare the clinical outcomes of pulp-exposed teeth treated with either poly(ε-caprolactone) fiber mesh (PCL-FM) as a barrier for MTA (so-called PCL-FM/MTA) or MTA direct pulp capping. Methods Sixty human vital teeth were evenly divided into 4 groups ( n = 15 in each group). Teeth in groups 1 and 3 had pulp exposure <1 mm in diameter, whereas teeth in groups 2 and 4 had pulp exposure of 1–1.5 mm in diameter. Teeth in groups 1 and 2 were treated with PCL-FM/MTA direct pulp capping, and those in groups 3 and 4 were treated with MTA direct pulp capping. Results Teeth treated with PCL-FM/MTA direct pulp capping needed a significantly shorter mean duration for dentin bridge formation than teeth treated with MTA direct pulp capping. Moreover, teeth with pulp exposure <1.0 mm in diameter needed a significantly shorter mean duration for dentin bridge formation than teeth with pulp exposure of 1–1.5 mm in diameter after either PCL-FM/MTA or MTA direct pulp capping treatment. In addition, teeth treated with PCL-FM/MTA direct pulp capping formed an approximately 3-fold thicker dentin bridge than teeth treated with MTA direct pulp capping 8 weeks or 3 months later. Furthermore, none of the teeth treated with PCL-FM/MTA direct pulp capping showed tooth discoloration after treatment for 3 months. Conclusions PCL-FM/MTA is a better combination material than MTA alone for direct pulp capping of human permanent teeth. [ABSTRACT FROM AUTHOR]

Introduction: The usage of Calcium hydroxide (CaH) 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 CaH 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 preexisting predilection of deciduous dentine pulp to form odontoclasts; the solubility of CaH. 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 CaH 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. [ABSTRACT FROM AUTHOR]

Emphasis has shifted from the "doomed" organ concept of an exposed pulp to one of hope and recovery. The era of vital-pulp therapy has been greatly enhanced with the introduction of various pulp capping materials. The aim of this article is to summarize and discuss about the various and newer pulp capping materials used for protection of the dentin-pulp complex. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Polyphasic calcium phosphates (Poly-CaP), a complex of hydroxyapatite (HAp) and soluble calcium phosphates including α-tricalcium phosphate and tetracalcium phosphate, demonstrate promoting effects on hard tissue formation by osteoblasts. We hypothesized that a Poly-CaP block with a soluble calcium phosphates phase on one side and an insoluble HAp phase on the other side is useful for vital pulp therapy as it may promote dentin regeneration and provide the surface effective to achieve sealing. The purpose of this study was to investigate the efficacy of Poly-CaP as a direct pulp capping material by examining the Ca-release profile, the in vivo ability to induce reparative dentinogenesis, and the bonding of HAp surface with adhesive systems. Methods: Poly-CaP prepared by annealing crude HAp disc was immersed in buffer solution at pH 7.4 or 4.0, and the concentration of Ca released was measured until 15 days. The pulp of 9-week-old Wister rat molar was exposed and capped with Poly-CaP or HAp block, and dentin bridge formation and pulpal inflammation was evaluated histopathologically after 2 or 4 weeks. Etch & rinse or self-etching adhesive was bonded to HAp surface, and the interface was observed using SEM. Results: Poly-CaP exhibited continuous release of Ca with significantly greater amount than HAp at both pH conditions (P <0.05, Student''s t-test). Animal tests demonstrated formation of complete dentin bridge at higher rate for Poly-CaP compared with HAp after 4 weeks (P <0.05, Steel–Dwass test). Impregnation of resin into etched HAp surface, with production of intimate contact at the bonding interface, was seen for all adhesives. Conclusions: Poly-CaP is a potentially useful material for direct pulp capping with the advantages to promote dentin bridge formation and to provide tight sealing by adhesives. [Copyright &y& Elsevier]

Purpose: The purpose of this multisite, multioperator, prospective, randomized, controlled clinical trial was to evaluate the 6-month outcomes of diluted formocresol (DFC) compared to gray mineral trioxide aggregate (GMTA) as pulpotomy medicament. Methods: Determined by a power analysis, 252 molars of 152 children were recruited. The teeth were randomly assigned to receive GMTA or DFC. At the 6-month follow-up, 118 children with 203 treated teeth were evaluated. Results: Four blinded and calibrated evaluators scored each radiograph for pathologies. Clinical success was similar for DFC (97%) and GMTA (100%), (P<.09). Radiographic success differed significantly (P<.04) for DFC (86%) and GMTA (95%). Pulp canal obliteration was radiographically observed in 25% of the DFC group and in 37% of the GMTA group (P=.O7). Dentin bridging was observed in 22% of the GMTA group but was not found in the DFC group (P<.01). Conclusion: Teeth treated with GMTA showed more favorable radiographic outcomes than DFC at 6 months post-treatment. [ABSTRACT FROM AUTHOR]

Abstract: This study was conducted to evaluate the pulpal response to direct capping with either mineral trioxide aggregate (MTA) or calcium hydroxide (CH) cement in humans, with a focus on dentin bridge formation and dentin sialoprotein (DSP) and heme oxygenase-1 (HO-1) expression. Direct pulp capping was performed in 20 cases of caries-free human third molars. The pulps were exposed and capped with either MTA or hard-setting CH. After 2 months, the teeth were extracted, and the specimens were prepared for histologic and immunohistochemical evaluations. Histologically, 100% of the MTA group and 60% of the CH group developed dentin bridges. The mean thickness of the dentin bridges observed in the MTA group was statistically greater than that of CH group. In addition, DSP and HO-1 were expressed in the odontoblast-like cells and pulp fibroblasts beneath the dentin bridge; furthermore, significantly greater immunostaining was observed in the MTA group than in the CH group. Collectively, these results indicate that MTA is superior to CH in terms of inducing the dentinogenic process in human pulp capping. [Copyright &y& Elsevier]

Since the 1950s, clinicians have relied on various formulations of Ca(OH)2 to stimulate dentin bridge formation. Various studies (Kozlov and Massler, 1966; Massler, 1967; Brännström, 1978; Cox et al., 1987; Snuggs et al., 1993) have demonstrated that pulp healing and dentin bridging can occur against a pH spectrum of materials. Recent studies (Akimoto et al., 1998; Cox et al., 1998, 1999; Tarim et al., 1998; Kitasako et al., 1999; Hafez et al., 2000) have reported successful pulp healing and dentin bridging using adhesives for direct capping of exposed pulps. However, others (Costa et al., 1997; Stanley and Pameijer, 1997; Pameijer, 1998; Hebling et al., 1999; Carvalho et al., 2000) have reported unsatisfactory results when exposures were direct-capped with adhesives. Biological and technical factors, or a combination of both, might be postulated to explain these differences. Recent studies have demonstrated that biological success is dependent upon proper hemorrhage control at the exposure site. This review explores the differences and common factors influencing successful dentin bridging, focusing on data derived from animal studies conducted according to ISO usage guidelines for cavity preparation and material placement. In the past, there has been concern that etching of vital dentin leads to immediate pulp death due to low pH. Recent studies have reported that acidic cements cause breakdown of only the smear layer and fail to seal the restoration interface, leading to inflammation and necrosis. A properly hybridized dentin-adhesive interface provides a "bacteriometic" seal to both dentin and pulp tissues. Recent ISO usage studies have shown a high incidence of dentin bridging with adhesives following proper hemorrhage control and removal of both operative debris and biofilm at the dentin-pulp interface by agents such as NaOCl. These are important technique-sensitivity factors to be considered for pulp healing and dentin bridge formation. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Recent advances in biotechnology and translational research have made it possible to provide treatment modalities that protect the vital pulp, allow manipulation of reactionary and reparative dentinogenesis, and, more recently, permit revascularization of an infected root canal space. These approaches are referred to as regenerative procedures. The method currently used to determine the origin of the tissue secreted during the repair/regeneration process is largely based on the identification of cellular markers (usually proteins) left by cells that were responsible for this tissue production. The presence of these proteins in conjunction with other indicators of cellular behavior (especially biomineralization) and analysis of the structure of the newly generated tissue allow conclusions to be made of how it was formed. Thus far, it has not been possible to truly establish the biological mechanism controlling tertiary dentinogenesis. This article considers current therapeutic techniques to treat the dentin-pulp complex and contextualize them in terms of reparative and regenerative processes. Although it may be considered a semantic argument rather than a biological one, the definitions of regeneration and repair are explored to clarify our position in this era of regenerative endodontics. [ABSTRACT FROM AUTHOR]