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

To assess clinically and radiographically the success of pulp capping procedure done in traumatically exposed permanent posterior teeth using a novel injectable treated dentin matrix hydrogel (TDMH), Biodentine, and MTA and to evaluate the formed dentin bridge under the capping materials using CBCT imaging. 45 patients subjected to accidental traumatic pulp exposures by undergraduate dental students are allocated for this study. For each patient, a pulp capping procedure was done. TDMH was formed of TDM powder and sodium alginate to be injected and then hardened in the defect area. Patients were assigned to 3 groups: TDMH, Biodentine, and MTA, respectively, and returned to the clinic after 3, 6, 12, 18, and 24 months for clinical and radiographic examinations. Tomographic data, including thickness and density of formed dentin bridges, were evaluated at the end of the study period compared to the base line. Pulp sensitivity was evaluated throughout the study period using thermal testing and electric pulp tester. During the follow-up period, all patients were asymptomatic with no clinical signs and symptoms and revealed no radiographic signs of pathosis. However, tomographic evaluation showed the tested materials to have different levels of impact on formed dentin bridges with TDMH group resulted in significantly superior dentin bridges of a higher radiodensity and thickness than Biodentine and MTA. TDMH has a greater potential to induce dentin bridge formation than Biodentine and MTA under standardized conditions. Additionally, CBCT imaging was confirmed as a non-invasive and inclusive approach to evaluate the formed dentin bridges after pulp capping procedure. Direct pulp capping can be done successfully with this novel injectable pulp capping material in future clinical applications. PACTR201901866476410

Objective The aim: The research was to evaluate the effectiveness of acute traumatic pulpitis treatment with the use of bioceramics according to the results of a clinical study. Patients and methods Materials and methods: Acute traumatic pulpitis of 25 teeth in 25 patients aged 18-25 years were treated by biological direct pulp capping. In 13 patients of the main group, bioceramics was placed on the exposed pulp, and in 12 patients of the control group, calcium hydroxide paste was applied on the exposed pulp. Treatment effectiveness was evaluated according to the following criteria: the absence of clinical signs of pulpal inflammation, on X-ray - signs of dentinal bridge formation, the absence of periapical changes. Results Results: The use of bioceramic material in patients of the main group provided a positive dynamic of treatment in 12 teeth. The need for re-treatment was diagnosed only in 1 clinical case (7.7%), in the control group - in 4 cases (33.3%). Conclusion Conclusions: Pulpitis treatment with the use of bioceramics provides preserving the functional properties of pulp, creation of a calcified barrier - dentin bridge and prevents the periodontal complications compared to the pulp capping with a material based on calcium hydroxide. The effectiveness of treatment in the main group was 92.3%, in the control - 66.7%.

The aim of the current study was to evaluate the impact of a new silicate-based capping material on healing potential of traumatically exposed healthy dog's dental pulp. Materials and Methods: Two pulp capping materials were evaluated in this study; Mineral trioxide aggregate (MTA), and Five mineral oxides (5MO). Glass ionomer as overlying restorative material. Six adult healthy dogs with intact permanent dentition were selected for the study. A total of sixteen anterior teeth were used in each dog. Both pulp capping materials were used in the same dog. Class V cavities were prepared on the teeth. After pulp exposure, the pulp capping materials were applied directly to the exposed pulp. All cavities were sealed with glass ionomer restorative material. The used six dogs were divided into two groups; three dogs each, according to the capping periods to 7 days and 90 days. At the end of each period the dogs were sacrificed by injecting an overdose of pentobarbital sodium. Teeth were separated from bone with immediate sectioning of their roots in the mid-way between cementoenamel junction and apex. The teeth were fixed in 10% neutral buffered formalin. Then the teeth were demineralized in Morse's solution (50% formic acid and 20% sodium citrate) for 3 months. In the last, the teeth were embedded in paraffin wax and serially sectioned buccolingually and stained with hematoxylin-eosin. The specimens were examined under optical light microscope to estimate the amount of pulp inflammation and dentin bridge formation at the interface of the capping materia

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

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

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

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

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

Objective This study aimed to evaluate the effect of direct pulp capping using an experimental self-adhesive resin for direct pulp capping (SRD) containing silica and surface pre-reacted glass-ionomer (S-PRG) filler on pulpal healing and to monitor the dentin bridge formation in rat pulp 2–4 weeks after operation. Methods Five types of SRDs (SRD-0: S-PRG fillers 0 wt%; SRD-1: S-PRG fillers 9.1 wt%; SRD-2: S-PRG fillers 18.4 wt%; SRD-3: S-PRG fillers 27.8 wt%; and SRD-6: S-PRG fillers 57.4 wt%) were prepared, and mineral trioxide aggregate (MTA) was used as control (n = 8). Direct pulp capping was performed on rats that were sacrificed for further evaluation 2 or 4 weeks after the operation. The pulp tissue disorganization (PTD), inflammatory cell infiltration (ICI), and reparative dentin formation were histopathologically evaluated; the data were statistically analyzed using the Kruskal–Wallis and the Mann–Whitney U tests. Results The histopathological evaluation of SRD-1-treated test animals 2 weeks post-operation revealed inferior PTD and ICI when compared with that of MTA. Even 4 weeks after the operation in SRD-1- and SRD-2-treated rats, the PTD and ICI were inferior when compared with those of MTA. The dental specimens of SRD-0 and MTA showed orthodentin formation, whereas SRD-treated test animals showed osteodentin formation at a position slightly deeper than the site of the pulpal exposure. Significance The reparative dentin formed by SRD-0 and MTA was genuine, whereas that formed by SRD-3 and SRD-6 was ossified and ectopic. SRD may have the potential to be utilized clinically as a direct pulp capping material.

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

Aim : This study aim to evaluate the physicochemical properties (pH, calcium ion release, solubility and setting time) of different pulp capping materials [Bioaggregate (BA), Nano Bioactive glass (NBAG), Nano MTA& MTA] in vitro, and to observe the histopathological pulp response following direct pulp capping of dog’s teeth. Material &Methods : for the weight loss, pH changes and calcium ions release, the tested specimens were immersed in distilled water. The solubility tests recorded weight loss of the test materials after immersion in distilled water. The evaluations were performed at 1h, 24h and 7 days. For the histological evaluation twenty adult dogs were used in this study, (8 teeth for each dog), classified into 4 experimental groups as follows :Group 1: BA. Group 2: NBAG. Group 3: MTA. Group 4: NMTA, the pulpal tissue response was assessed at 1 month and 3 months time intervals. Results: Bioaggregate showed the highest mean values for ph, ca ions release and solubility tests, while MTA showed the highest setting time mean value. On the other hand, Nanobioactive glass was the only material which recorded negative solubility. Histological results showed that dental pulpal tissues of teeth capped with MTA revealed absence of inflammatoion in addition to tubular pattern dentin bridge formation at site of exposure, BA showed dentin bridge formation and minimal inflammatory reaction, NMTA and NBAG enhanced the dentin bridge thickness, but of inferior quality than MTA and BA. Conclusion: based on histological analysis MTA and Bioaggregate are favorable materials for direct pulp capping, however BA revealed the superior physicochemical properties.

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

Article Title and Bibliographic Information 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. Source of Funding None. Type of Study/Design Systematic review and meta-analysis of data.

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

The aim of this study was to compare the responses of mineral trioxide aggregate (MTA) and combined MTA/treated dentin matrix (TDM) as direct pulp capping material. In this clinical trial study, 33 intact third molars in 11 healthy volunteers (three molars in each) were included. Partial pulpotomies were performed in a split mouth manner in two of the third molars in each patient randomly and the third tooth had used as TDM source. The coronal dentin was chopped to dentine chips and transformed to TDM using different concentrations of ethylene diamine tetraacetic acid (EDTA) solution. Pulps were directly capped by MTA alone or using a combination layering of MTA/TDM. Following 6-week clinical and radiological evaluations, each tooth was extracted and prepared for histological evaluation. There were no significant differences in the clinical and radiographic responses or in the quality of dentin bridges (P > 0.05). However, the dentin bridge was significantly thicker in MTA/TDM group than MTA group (P = 0.003). Using the combination of MTA/TDM as a pulp-dressing agent may form a thicker dentin bridge compared to MTA alone.

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

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

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

Objectives The aim of this study was to evaluate the biocompatibility, odontogenic, angiogenic and inflammatory effects of commercially available calcium silicate cements (CSCs) on dental pulp cells. Data In vitro, animal and human in vivo studies reporting on biocompatibility, odontogenic, angiogenic and inflammatory effects of CSCs on dental pulp cells were screened using a systematic review, and a descriptive analysis performed. Sources We searched Medline via PubMed, Google Scholar and Scopus, followed by hand search and cross-referencing. Study selection From 7007 identified studies; 38 were included. At least one MTA-type product was evaluated in each study, with ProRooT MTA being the most frequently assessed, followed by Biodentine and iRoot BP Plus. Nearly all CSCs exhibited a high biocompatibility and induced odontogenic and angiogenic effects. There was great heterogeneity in methodology and findings. In vivo, effects differed between materials; also, differences between human or animal pulp cell effects were noted. In vitro, the dilution of the cement, the period of exposure to the CSC and the specific effect measure influenced the outcomes. No CSC was clearly superior to alternatives. Conclusions All commercially available CSCs are biocompatible, exhibit comparable and favorable effects on odontogenic differentiation of dental pulp cells in vitro and can efficiently enhance dentin bridge formation of high quality with minimal inflammation. No specific CSC can be recommended. Clinical significance Most CSCs are highly biocompatible, promoting pulp healing at minimal pulp inflammation. While the variation in methodology limits comparisons across studies, it seems that nearly all CSCs show favorable effects on dental pulp cell. We are unable to recommend one specific material over the others.

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

The aim of the present study is to evaluate risk factors influencing the success rates of pulpotomies both in young and adult populations.Pulpotomies (n=273) performed by a single endodontic specialist were analyzed, and data on success rates were collected. Additionally, possible explanatory variables were noted such as: age, gender, clinical findings (teeth, type of restoration after pulpotomy), radiographic findings (dentin bridge formation) and systemic conditions. The follow-up period varied from 1 to 29 years, and the results were analyzed by Kaplan-Meier survival curves and also by Cox regression.Age at the time of pulpotomy ranged from 8 to 79 and had not influenced the success rates (p=0.35). The formation of dentin bridge had a strong protective effect (hazard ratio-HR=0.16, p0.001). The prosthetic crown restorations following pulpotomy had the smallest failure rate, and amalgam has not increased the risk of failure significantly in relation to prosthesis. Resin composite restorations following pulpotomy increased in 263% the risk of failure (HR=3.63, p0.001).This study allowed inferences that pulpotomy may be a successful treatment at any age, and not only for young permanent teeth. It was also possible to conclude that the use of direct composite restorations following pulpotomies is associated with higher failure rates.

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

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

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

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

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

Introduction This study aimed to investigate dental pulp responses to novel bioactive glass (BG) pulp capping materials after direct pulp capping in vivo . Methods Novel BG pulp capping materials are composed of powder and fluid. The powder is BG (82.36% SiO 2 , 15.36% CaO, and 2.28% P 2 O 5 ), and the fluid is provided in 2 kinds: (1) phosphate buffer solution (BG-PB) and (2) phosphate buffer solution with the addition of 1 wt% sodium alginate (BG-PB-SA). After mixing the powder and fluid, BG-PB and BG-PB-SA were prepared. Cavities with mechanical pulp exposure were prepared on maxillary first molars of Wistar rats. The exposures were randomly capped with BG-PB, BG-PB-SA, or mineral trioxide aggregate (MTA). After 1 ( n = 6) and 4 weeks ( n = 8), maxillary segments were obtained and prepared for histologic analysis with a scoring system. Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney U tests with the significance set at .05. Results After 1 week, few inflammatory cells were present in the BG-PB, BG-PB-SA, and MTA groups. Moreover, a thin layer of newly generated matrix was observed in most specimens. After 4 weeks, all specimens from the 3 groups formed a heavy dentin bridge. BG-PB and BG-PB-SA groups exhibited no or slight inflammatory response, whereas the MTA group exhibited a slight to moderate inflammatory response. No significant difference was observed in pulp inflammation and dentin formation among the 3 groups at either time point ( P > .05). Conclusions When used as a pulp capping agent, BG-PB and BG-PB-SA had similar favorable cellular and inflammatory pulp responses to those of MTA. Therefore, BG is a promising pulp capping material.

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.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.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.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.

A variety of materials are available to treat exposed dental pulp by direct pulp capping. The healing response of the pulp is crucial to form a dentin bridge and seal off the exposed pulp. Studies have used lasers to stimulate the exposed pulp to form tertiary dentin. The aim of the present systematic review and meta-analysis was to evaluate the evidence on the effects of laser irradiation as an adjunctive therapy to stimulate healing after pulp exposure. A systematic literature search was conducted up to April 2016. A structured search using the keywords “Direct pulp capping,” “Lasers,” “Calcium hydroxide pulp capping,” and “Resin pulp capping” was performed. Initially, 34 potentially relevant articles were identified. After removal of duplicates and screening by title, abstract, and full text when necessary, nine studies were included. Studies were assessed for bias and data were synthetized using a random-effects meta-analysis model. Six studies were clinical, and three were preclinical animal trials; the follow-up period ranged from 2 weeks to 54 months. More than two thirds of the included studies showed that laser therapy used as an adjunct for direct pulp capping was more effective in maintaining pulp vitality than conventional therapy alone. Meta-analysis showed that the success rate in the laser treatment group was significantly higher than the control group (log odds ratio = 1.737; 95 % confidence interval, 1.304–2.171). Lasers treatment of exposed pulps can improve the outcome of direct pulp capping procedures; a number of confounding factors may have influenced the outcomes of the included studies.

Introduction: A number of vital pulp therapy techniques havebeenrecommended to preserve pulpvitality in teeth with complicated crown fractures, especially in young patients. Calcium hydroxide has been the gold standard as a pulp capping material, but recently mineral trioxide aggregate (MTA) has been recommended. This case report describes the treatment of tooth discoloration caused by white MTA (WMTA) used for the management of a complicated crown fracture. Methods: A partial pulpotomy was performed with the use of WMTA after a complicated crown fracture of the upper right central incisor. Seventeen months later, the WMTA was removed because of tooth discoloration, and internal bleaching was performed. Results: Upon access, the WMTA was completely discolored. After it was removed, a significant color change was observed in the tooth crown, which was further improved with internal bleaching. The tooth remained vital, and a dentin bridge was confirmed clinically and radiographically. Conclusions: The recommendation to use WMTA for vital pulp therapy in the esthetic zone may need to be reconsidered. Should discoloration occur with the use of WMTA, the technique described may be used to improve the esthetics. (J Endod 2011;37:1017‐1020)

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

Understanding outcomes of the interaction between a dental material and tooth tissue is important in terms not only of biocompatibility but also of the potential for the material to modulate the response of the tissue. This interaction is influenced by many factors, including the chemistry of the material and any of its eluted components or degradation products, and the manner in which the tissue responds to these agents. Past studies of this interaction have primarily been aimed at identifying cytotoxic effects. More recently, investigations have focused on specific cellular responses, and in particular, on understanding how the materials themselves actually may contribute to regenerative processes in the tooth. Recent work has demonstrated the solubilization of proteins from dentin exposed to certain materials, such as calcium hydroxide, mineral trioxide aggregate, and acidic solutions that relate to those used in dentin bonding agents, with the subsequent modulation by these proteins of gene expression in odontoblast-like cells. This work suggests that dentin bridge formation under such materials may be stimulated through this process. Thus, there is much merit in examining both how new dental materials can be developed and how more traditional ones can be modified to preferentially stimulate regenerative processes when preferred. This review summarizes current knowledge about the potential beneficial effects derived from the interaction of dental materials with the dentin-pulp complex, as well as potential future developments in this exciting field.

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

To evaluate the pulp healing to bacterial contamination beneath a hard-setting calcium hydroxide (DY: Dycal, L.D. Caulk Co.) and a self-etching adhesive resin (2V: Clearfil Liner Bond 2V, Kuraray Medical Inc.) following dentin bridge formation. Class V cavities were prepared on 30 monkey teeth, and the pulps were exposed with a carbide bur through the cavity floor. Each exposed pulp was capped with either DY or 2V. The cavities were restored with a hybrid resin composite. The resin composite was removed at 180 days after capping, and then cavities were left open to the oral environment for 2 weeks to obtain bacteria contamination DY (BDY) and 2V (B2V; n = 10). A non-bacterial-contaminated group capped with DY was used as control. After bacterial challenges, inflammatory cell infiltration, incidence and differentiation of dentin bridges were evaluated histologically. There were significant differences in the presence of inflammatory cell infiltration among all groups (P < 0.05). No moderate or severe inflammatory reaction was found in Group DY. Group BDY showed moderate or severe inflammatory cell infiltration in 50%, and showed four necrotic specimens. Although no statistically significant difference was found in the formation and differentiation of dentin bridges among all groups, tunnel defects in dentin bridges were detected in 70% (DY), 80% (BDY), and 50% (B2V). Group B2V showed a significantly lower presence of inflammatory cell infiltration than Group BDY (P < 0.05). Bonding agent is supposed to seal the exposure site, and the remaining bonding agent on the cavities was effective as the barrier in the dentin bridges after bacterial challenges.

The aim of this study was to investigate the response of human pulp tissue to a dentin bonding agent, Scotchbond Multi-Purpose Plus (SMPP), in exposed class V cavities. Sixteen human premolar teeth were mechanically exposed. Ten pulps were capped with SMPP and six teeth were capped with Dycal. The cavities were filled with a composite. After 40 days, the teeth were extracted and processed for histologic evaluation. Of the 10 teeth capped with SMPP, eight showed moderate chronic inflammation, one was severely inflamed, and one pulp had no to slight inflammation. None of the teeth capped with SMPP showed dentin bridge formation. Of the six teeth capped with Dycal, three exhibited incomplete dentin bridges associated with no to slight inflammation, and three showed no to slight inflammation, without formation of dentin bridges. Direct capping with Dycal with subsequent sealing with SMPP may show favorable results in pulp tissue. SMPP may cause inflammatory changes when applied directly to exposed pulp tissue.

Air abrasion is regaining popularity especially in the area of pediatric dentistry due to its ease of use and its advantages. Due to the lost of tactile information, while using this technique, there is an increased risk for pulpal exposure. On the other hand, Ca(OH)2 medicament has been proven to induce dentin bridge formation, but an adequate sealing seems to be even more important that the capping material used. The purpose of this study was two fold: to assess the pulpal response after pulpal exposure by air abrasion and to evaluate the healing potential after using Ca(OH)2 medicament or Liner Bond II™ as a capping agent. Two hundred sixteen teeth from mixed-bred dogs were used in this study. The teeth were divided into three groups,A) pulpal exposure by air-abrasion followed by sealing of the cavity with Liner Bond II™, B) pulpal exposure by air-abrasion and Ca(OH)2 pulp capping and C) pulpal exposure by high-speed followed by air-abrasion and Ca(OH)2 pulp capping as a control group. The animals were sacrificed after 7, 14, 30 and 60 days and a histopathological evaluation was undertaken. After applying Analysis of Variance to compare the groups, it was observed that at earlier observation periods, the inflammatory criteria near the exposure site were different among the groups. As time elapsed, the inflammation was resolved in the pulp tissue, however, the odontoblastic layer and the dentin bridge formation had a highly statistically significant difference (p

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.Sixty human vital teeth were evenly divided into 4 groups (n = 15 in each group). Teeth in groups 1 and 3 had pulp exposure1 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.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 exposure1.0 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.PCL-FM/MTA is a better combination material than MTA alone for direct pulp capping of human permanent teeth.

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; Brannstrom, 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.

– This study was conducted to observe the response of dogs’ dental pulp to mineral trioxide aggregate (MTA) and a calcium hydroxide cement when used as pulp capping materials. After the pulps of 30 teeth were exposed, they were capped with either MTA or a calcium hydroxide cement. Histological analysis was performed 2 months after treatment. Results showed a healing process with complete tubular dentin bridge formation and no inflammation in any of the pulps capped with MTA. On the other hand, only five specimens from the calcium hydroxide cement group formed a complete dentin bridge. In this experimental group, pulp inflammation was observed in all but three cases. In conclusion, MTA exhibited better results than the calcium hydroxide cement for the capping of the pulp in dogs.

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.

The aim of this study was to examine the effect of Biodentine® and two new nanostructured materials based on active silicate cements on exposed tooth pulp of Vietnamese pigs. The study comprised 40 teeth in two Vietnamese pigs (24 months old). After class V cavity preparation, the pulp on each tooth was exposed using a small round bur. The following materials were applied on pulp exposures: Biodentine® (10 teeth), ALBO MPCA-I (10 teeth), and aLbO MPCA-II (10 teeth). In the control group, exposed pulp was covered with ProRoot MTA® (10 teeth). After the observation period of 28 days, the animals were sacrificed and the teeth prepared for histological analysis. Light microscope was used for the analysis of dentin bridge formation, tissue reorganization and inflammation, and the presence of bacteria in the pulp. In the group of Biodentine®, a complete dentin bridge was noted in 3 cases, while incomplete dentin bridge in the form of dental islets was detected in 4 cases. Nanostructured material ALBO-MPCA I provided complete dentin bridge formation in 5 teeth, in 3 teeth the formed dentin bridge was incomplete. ALBO MPCA-II showed complete closure of the pulp opening by dentin bridge in 4 samples, while in the same number of teeth it was incomplete. In the control group, 4 teeth showed a complete dentin bridge, whereas in 6 teeth it was incomplete. Histological analysis indicated favourable therapeutic effects of Biodentine® and the two materials ALBO-MPCA I and ALBO-MPCA II after teeth pulp capping in Vietnamese pigs. Pulp reaction was similar to that caused by ProRoot MTA®. Cilj ovog rada je bio dase ispita efekat Biodentina i dva nova nanostrukturna materijala na bazi aktivnih cilikatnih cemenata na eksponiranu pulpu zuba vijentamskih svinja. Istraživanje je obuhvatilo 40 zuba i dve vijetnamske svinje starosti 24 meseca. Na svima zubima je urađena preparacije kaviteta V klase i malim okruglim svrdlom eksponirana komora pulpe. Na perforaciju pulpe aplikovani su materijali: Biodentin (10 zuba), ALBO-MPCA I (10 zuba), ALBO-MPCA II (10 zuba). U kontrolnoj grupi pulpa je prekrivena MTA-om (10 zuba). Nakon observacionog perioda od 28 dana, životinje su žrtvovane i pripremljene za histološku analizu. Svetlosnom mikroskopijom analizirano je formiranje dentinskog mostića, postojanje reorganizacije tkiva, prisustvo inflamacije i bakterija u pulpi. Kod Biodentina kompletan dentinski mostić je zabeležen u 3 slučaja, a inkompletan dentinski mostić u vidu dentinskih ostrvaca u 4 slučaja. Nanostrukturni materijal ALBO-MPCA I je doveo do stvaranja kompletnog dentinskog mostića kod 5 zuba, a kod 3 zuba dentinski mostić je bio inkompletan. ALBO-MPCA II je pokazao kompletno zatvaranje komore pulpe dentinskim mostićem u 4 uzorka, dok je kod 4 uzorka on bio inkompletan. Kontrolni materijal MTA je kod 4 zuba imao stvoren kompletan dentinski mosti}, a u kod 6 zuba je on bio inkompletan. Histološka analiza je ukazala na povoljne terapijske efekte i Biodentina i dva novosintetisana materijala ALBO-MPCA I i ALBO-MPCA II u direktnom prekrivanju pulpezuba vijentamskih svinja. Reakcija pulpe bilaje slična onima koje je izazvao MTA.

Aim: To compare human pulp tissue response following direct pulp capping with calcium hydroxide and a self-etch adhesive containing antibacterial component. Materials and Methods: Sixty-six erupted sound premolars scheduled to be extracted for orthodontic reasons were selected from 17 human subjects. Pulp exposures were made. Direct pulp capping was then performed using calcium hydroxide and a self-etch adhesive containing antibacterial component in its primer. The teeth were then restored with composite resin. Two teeth were maintained intact as a control group. After 7 and 30 days, teeth were extracted and processed for light microscopic examination using a histological scoring system. The teeth were divided into four groups (N = 16) according to the pulp capping materials used and their days of extraction. The results were then statistically analyzed by Mann-Whitney U-test. Results: After the 7-day observation period, the inflammatory reaction to the self-etch adhesive containing antibacterial component group was significantly less severe than that in the calcium hydroxide group (P < 0.05). After the 30-day observation period, the inflammatory reaction was slight in both groups, but specimens with dentin bridge formation in the self-etch adhesive group were significantly less common than those in the calcium hydroxide group (P < 0.05).

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.

Aim: The aim of this study is to evaluate the response of human pulp tissue to mineral trioxide aggregate (MTA), Emdogain (EMD), and combination of MTA/EMD. Materials and Methods: This study was performed on sixty intact first and second premolars of human maxillary and mandibular teeth. A standard pulpal exposure was done on all the teeth and was divided into three groups of twenty teeth each and was capped with MTA, EMD, and MTA/EMD combination. The final restoration was done with resin-modified glass ionomer cement. The teeth were then extracted on the 15th or 45th day and histological evaluation done. Results: Differences in inflammatory response and thickness of dentin bridge formation of the exposed pulp to the three different groups were statistically evaluated using Chi-square and Mann–Whitney tests and were found to be significant. No significant difference was found between MTA/EMD and MTA in terms of calcified bridge formation and pulp inflammatory response to the capping materials. Conclusions: MTA and MTA/EMD combination produced a better quality hard tissue response compared with the use of EMD.

The purpose of this study was to compare clinical, radiographic, and histopathologic effects of Nd:YAG laser pulpotomy to formocresol pulpotomy on human primary teeth. Patients with at least two vital primary molar teeth that required pulpotomy, because of pulpal exposure to caries, were selected for this study. After hemorrhage control, complete hemostasis into the canal orifice was achieved by exposure to Nd:YAG laser (1064 nm) and an He-Ne laser (the aiming beam of the Nd:YAG laser) in noncontact mode at 2 W, 20 Hz, 100 mJ, or was achieved by applying 1:5 dilution of formocresol. Forty-two teeth in two groups were to be followed up clinically and radiographic at 1, 3, 6, 9, and 12 months. Eighteen teeth planned for serial extractions were selected for histopathologic study. The teeth were extracted at 7 and 60 days. The teeth in the laser group had a clinical success rate of 85.71% and a radiographic success rate 71.42% at 12 months. The teeth in the formocresol group had a clinical and radiographic success rate of 90.47% at 12 months. There were no statistically significant differences between laser and formocresol group with regard to both clinical and radiographic success rates. There was a statistically significant difference between 7- and 60-day laser groups with regard to inflammatory cell response criteria. Dentin bridge was absent in all samples. No stained bacteria were observed in any of these samples. In conclusion, Nd:YAG laser may be considered as an alternative to formocresol for pulpotomies in primary teeth.

The purpose of this study was to study the histologic changes in the dental pulp following pulpotomy with Mineral Trioxide Aggregate (MTA) and Calcium hydroxide. Pulpotomies were performed on premolar teeth that were to be extracted for orthodontic reasons. The radicular pulp was capped with either MTA or Calcium hydroxide and restored with IRM. The teeth were extracted at 4 and 8 week intervals, fixed in 10% formalin and then kept in 5% nitric acid for 28 days for demineralization. Longitudinal sections were then prepared and viewed under light microscope.The pulps capped with MTA (at the end of 4 weeks and 8 weeks) showed dentin bridge formation which was more homogenous and continuous with the original dentin when compared to the pulps capped with calcium hydroxide. The pulpal inflammation was also less in the MTA group as compared to the calcium hydroxide group at the end of 4 and 8 weeks.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:58:55Z No. of bitstreams: 1 S0103-64402004000200004.pdf: 227445 bytes, checksum: 530177c20577be247c34d8c3cf62a9bc (MD5) Made available in DSpace on 2013-08-22T18:58:55Z (GMT). No. of bitstreams: 1 S0103-64402004000200004.pdf: 227445 bytes, checksum: 530177c20577be247c34d8c3cf62a9bc (MD5) Previous issue date: 2004-01-01 Made available in DSpace on 2013-09-30T19:55:09Z (GMT). No. of bitstreams: 2 S0103-64402004000200004.pdf: 227445 bytes, checksum: 530177c20577be247c34d8c3cf62a9bc (MD5) S0103-64402004000200004.pdf.txt: 17941 bytes, checksum: 13fb133e5dc68c8daa7a4943db9123a0 (MD5) Previous issue date: 2004-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:14:20Z No. of bitstreams: 2 S0103-64402004000200004.pdf: 227445 bytes, checksum: 530177c20577be247c34d8c3cf62a9bc (MD5) S0103-64402004000200004.pdf.txt: 17941 bytes, checksum: 13fb133e5dc68c8daa7a4943db9123a0 (MD5) Made available in DSpace on 2014-05-20T15:14:20Z (GMT). No. of bitstreams: 2 S0103-64402004000200004.pdf: 227445 bytes, checksum: 530177c20577be247c34d8c3cf62a9bc (MD5) S0103-64402004000200004.pdf.txt: 17941 bytes, checksum: 13fb133e5dc68c8daa7a4943db9123a0 (MD5) Previous issue date: 2004-01-01 Foi objetivo deste trabalho estudar a reação do tecido pulpar ao capeamento com agregado de trióxido mineral (MTA) branco. Para isto, foram utilizados 15 dentes de cães, onde após o preparo de cavidades na região cervical da face vestibular e exposição pulpar, estas foram capeadas com MTA branco. Os animais foram sacrificados após 60 dias do término dos procedimentos clínicos e os dentes processados em laboratório para obtenção de cortes histológicos. Foi observada formação de ponte de tecido duro em todas as polpas. em alguns casos, não havia dentina tubular mas somente uma estrutura de aspecto morfológico peculiar, selando a cavidade de exposição pulpar. Apenas dois casos apresentaram inflamação pulpar. Conclui-se que o MTA branco possui as características necessárias de um material para capeamento pulpar. This study was conducted to observe the response of dogs' dental pulp to white mineral trioxide aggregate (MTA) when used as pulp capping material. The pulp of 15 dogs' teeth was experimentally exposed and capped with white MTA. The animals were sacrificed two months later and the specimens were prepared for histomorphological study. The pulp capped with white MTA showed a healing process with complete dentin bridge formation in all samples. In some cases, there was not a tubular dentin shape, but only a structure with an interesting morphological aspect sealing the exposure site. Only 2 specimens exhibited pulp inflammation. In conclusion, the data obtained in this study showed that white MTA has the necessary properties of a pulp capping material. Lutheran University of Brazil Faculty of Dentistry Department of Pediatric Dentistry UNESP Faculty of Dentistry of Araçatuba Department of Restorative Dentistry UNESP Faculty of Dentistry of Araçatuba Department of Restorative Dentistry

Two case reports with dens evaginatus are presented. Each patient had one tooth affected. There was a prominent tubercle on the occlusal surface of the mandibular second premolar. Under local anesthesia and rubber dam isolation a partial pulpotomy was conducted and mineral trioxide aggregate was placed. After 6 months the teeth were removed as part of planned orthodontic treatment. Histological examination of these teeth showed an apparent continuous dentin bridge formation in both teeth, and the pulps were free of inflammation. These cases show that mineral trioxide aggregate can be used as an alternative to existing materials in the proplylactic treatment of dens evaginatus.