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

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

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

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

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

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

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

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

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

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

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

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

Background: This study clinically and histologically compared the human pulp response to direct pulp capping (DPC) with mineral trioxide aggregate (MTA), Biodentine, and propolis in 2 months. Materials and Methods: In this clinical trial evaluated 41 premolars candidate for extraction due to orthodontic purposes of patients between 15 and 25 years of age. A group of 5 was separated randomly as the negative control. The remaining teeth were randomly divided into three experimental groups of 12 after mechanical exposure of the pulp by bur in high-speed handpiece under air and water spray. The exposed areas were capped with MTA, Biodentine, or propolis. Glass ionomer was applied as base over the cap. The teeth were restored with composite resin. Patients were recalled in 2 months for clinical and radiographic examinations and also pulp vitality test. Teeth were then extracted. Slides were prepared and tissue sections were evaluated for the presence and severity of inflammation, dentinal bridge, and continuity. Data were analyzed using the Chi-square and Fisher's exact tests. Results: The clinical success rate was 100% in the MTA and 91.7% in both the propolis and Biodentine groups. The presence and severity of pulpal inflammation and dentinal bridge formation were similar in all the experimental groups (P > 0.05). Dentinal bridge formation was similar in the MTA and Biodentine groups and was higher than in the propolis group. Continuation of dentinal bridge in the MTA group was significantly higher than that in the Biodentine and propolis groups (P < 0.05). Conclusion: MTA, Biodentine, and propolis are equally effective for DPC.

The maintenance of pulp vitality is a major goal of endodontics. Direct pulp capping for tooth decay has always been considered a controversial procedure generating unpredictable and often contraindicated outcomes. The Mineral Trioxide Aggregate (MTA), introduced by Torabinejad about 20 years ago,1–7 retains resistance to bacterial infiltration and can effectively protect the pulp, hastening its repair and maintaining tooth vitality if used correctly and in combination with an adequate coronal restoration. In a group of 77 patients aged 14–68 years, direct pulp capping with MTA was performed in 80 teeth affected by tooth decay, diagnosed with reversible pulpitis by the cold-temperature test and radiographic examination. Four patients had pain, in three teeth the radiograph showed a small area of bone loss due to a widening of the periodontal space. The author has removed the caries by using only rotating instruments and has then placed a thin layer of MTA on the exposed pulp and the surrounding dentin. In some cases 5% sodium hypochlorite solution was used to achieve hemostasis of the operating field. In a second visit, after X-ray examination, pulp vitality-check with the cold thermal test and the assessment of effective hardening of the material, the teeth were reconstructed by using two-component adhesives and last-generation composite resins. Patients were recalled at regular intervals for 10 years to assess the condition of the pulp, the presence of a reparative dentine layer, pulpal or root canal calcifications or root resorptions, pain on percussion and radiographically visible endodontic lesions. After 10-years follow-up period, 6 out of 80 teeth required an endodontic treatment, we did not find an increase of pulp calcifications, root resorptions, endodontic lesions. All teeth still alive have responded positively to the cold-temperature test. The three lesions had disappeared at the last X-ray control. All four symptomatic teeth preserved their pulp vitality. The successful treatment rate was 92.5%. Direct pulp capping with MTA can be considered an effective treatment of exposure due to tooth decay and can be considered a valid treatment option for teeth with a diagnosis of not-severe reversible pulpitis.

The pulp of primary teeth is identical morphologically and physiologically to that of permanent teeth and it is capable to answer to pathological stimuli by producing tertiary dentin. When the inflammation of the pulp is in its reversible stage vital methods of treatment are indicated in order to stimulate the healing processes in it and protect its vitality. In Bulgaria the most popular method of treatment of inflammation diseases of the pulp in primary dentition is the mortal amputation. The biological way of treatment is not very common even in cases where there are indications for it. Purpose: The aim of this paper is to present the approbated by us protocol for application of direct pulp capping for treatment of reversible pulpitis in primary teeth. Material and methods: On the base of world experience and our contemporary meta- analysis of the researches published in the last 15 years concerning the problems of diagnostics. We determined clinical and radiographic diagnostic criteria for reversible pulpitis in primary teeth and indications for application of direct pulp capping as a method of treatment. We give clinical steps for application of the method and summarized the clinical and radiographic criteria for success after treatment. Results/conclusion: We gather all the information for applying direct pulp cappingfor treatment of reversible pulpitis in primary dentition. We offer the method of direct pulp capping as a clinical protocol “step by step” and illustrated by scheme which can be useful for students and dentists in their everyday practice.

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.

Derin dentin çürüğü olan süt ve sürekli dişlerin tedavisinde pulpanın vitalitesini ve fonksiyonunu devam ettirmek amacıyla indirekt ve direkt pulpa kuafajı teknikleri uygulanmaktadır. İndirekt pulpa tedavisi, derin çürüklü dişlerde pulpanın açılmadan canlılığının korunması ve devam ettirilmesi amacıyla uygulanan tek veya iki aşamalı işlemlerdir. Direkt pulpa kuafajı ise, travma sonucu veya derin dentin çürüğünün kaldırılması sırasında ekspoze olan pulpanın vitalitesini korumak için uygulanan tedavi işlemidir ve kalan eks

Background and aims. Mineral trioxide aggregate and calcium hydroxide are considered the gold standard pulp-capping materials. Recently, Portland cement has been introduced with properties similar to those of mineral trioxide aggregate. His-topathological effects of direct pulp capping using mineral trioxide aggregate and Portland cements on dog dental pulp tis-sue were evaluated in the present study. Materials and methods. This histopatological study was carried out on 64 dog premolars. First, the pulp was exposedwith a sterile bur. Then, the exposed pulp was capped with white or gray mineral trioxide aggregates and white or gray Port-land cements in each quadrant and sealed with glass-ionomer. The specimens were evaluated under a light microscope after 6 months. Statistical analysis was carried out using Kruskal-Wallis test. Statistical significance was defined at α=5%. Results. There was no acute inflammation in any of the specimens. Chronic inflammation in white and gray mineral triox-ide aggregates and white and gray Portland cements was reported to be 45.5%, 27.3%, 57.1% and 34.1%, respectively. Al-though the differences were not statistically significant, severe inflammation was observed mostly adjacent to white mineral trioxide aggregate. The largest extent of increased vascularization (45%) and the least increase in fibrous tissue were ob-served adjacent to white mineral trioxide aggregate, with no significant differences. In addition, the least calcified tissue formed adjacent to white mineral trioxide aggregate, although the difference was not significant. Conclusion. The materials used in this study were equally effective as pulp protection materials following direct pulp cap-ping in dog teeth.

Aims and Objectives: To evaluate the effectiveness of mineral trioxide aggregate (MTA) when used as a pulp capping agent in permanent teeth with carious exposure (≤1mm) after root formation is completed. Materials and Methods: Clinical follow-up was performed on 32 mandibular molars with deep occlusal caries, in patients in the age group range of 18 to 42 years. Carious pulpal exposures were treated by direct pulp capping with MTA, followed by a base of light cure glass ionomer cement and restored with amalgam. Clinical and radiographic examinations were carried out periodically at 1, 3, 6, 9, 12, 18 and 24 months. Results: After 24 months clinical and radiographic follow-up, it was found that 25 (out of 32) patients had successful outcome. However, two patients failed to return for evaluation after permanent restoration, and five patients exhibited clinical failure. Conclusions: Mineral trioxide aggregate was found to be an effective material when used for direct pulp capping in permanent teeth. However, further investigations with a larger sample size are needed to support these findings.

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.

Background and Aims: The purpose of this study was to evaluate the tissue responses to octacalcium phosphate (OCP) and calcium hydroxide (CH) used as direct pulp capping (DPC) materials in cat teeth. Materials and Methods: 72 premolar teeth of 9 cats were selected and divided into 3 groups (Two experimental and one control group). After the cats had been anesthetized, the pulp were exposed and capped directly with OCP, CH or no capping material as control group. The cavities of all three groups were filled with Glass ionomer cement (GI). Histological evaluations were performed at two, four and eight weeks after pulp capping. After tissue preparation procedures, paraffin blocks were prepared. After preparation and staining of the sections, the relevant variables were measured by optical microscope. The results were analyzed using Mann-Whitney U and Chi-square tests ( α =0.05). Results: Two weeks after pulp capping, all specimens in three groups showed mild to sever inflammation. The formation of hard tissue (dentinal bridge) at in the exposed areas of the experimental groups was more noticeable for calcium hydroxide than that of octacalcium phosphate group. These differences were statistically significant (P

Background and aims. The aim of present study was to investigate pulp-dentin complex reactions following direct pulp capping (DPC) with calcium hydroxide [Ca(OH)2] and simvastatin as pulp-capping materials in the primary human molars. Materials and methods. 120 primary molar teeth which had to be extracted for orthodontic reasons were randomly allocated into four groups. Group Ι as a control, underwent DPC with calcium hydroxide. The dental pulp in group ІІ, ІІІ and ІV were directly capped with simvastatin-based materials at concentrations of 1, 5 and 10 µM, respectively. All of the teeth were restored with stainless steel crown. After a mean period of 7.41 months teeth were extracted and processed for histological examination and categorized in terms of hard tissue formation and pulp inflammation. Results. Teeth in group I had statistically favorable outcomes in hard tissue formation and pulp inflammation than did the groups ІІ, ІІІ and ІV (P < 0.001). Considering three different concentrations of simvastatin, the result showed a dose dependent trend. Teeth in group ІV showed significantly lower rates of hard tissue formation and higher rates of pulp inflammation and necrosis compared to those of groups ІІ (P < 0.05). Conclusion. The findings of this study depicted that healing with no inflammation and hard tissue formation following statin treatment occurs with a lower rate than that with the calcium hydroxide.

Background: Some of the disadvantages of calcium hydroxide Ca(OH) 2 as pulp-capping material are related to the inflammatory response, and its poor sealing ability. Cyanoacrylate glue was proposed in this study as pulp-capping agent because of its sealing ability, and diprogenta, on the other hand, was proposed because of its anti-microbial and anti-inflammatory effects. The aim of this study is to evaluate and compare the histopathological response of the pulp toward cyanoacrylate and diprogenta in direct pulp capping (DPC). Materials and Methods: Cyanoacrylate, diprogenta, and calcium hydroxide were applied on 20 permanent teeth of 6 rabbits divided into four groups, each contains five teeth, as follow: G1: Diprogenta and calcium hydroxide. G2: Cyanoacrylate. G3: Diprogenta and cyanoacrylate. G4: Calcium hydroxide (control group). Results: A remarkable dentin bridge formation was found in all groups. No pulp necrosis was found in any tooth of the four groups. Pathological reactions of the pulp were found in 25%, 40%, 20%, and 100% of groups 1, 2, 3, and 4, respectively. Differences between study and control groups were found statistically significant ( P < 0.05). Conclusion: All materials used in this study were biocompatible and suggested to be studied further on human teeth. These materials when used in combination with Ca(OH) 2 , may give better results

Mineral trioxide aggregate (MTA) is a material with broad indications in endodontics. Currently, this material is used for pulp capping, pulpotomy, as apical barrier in teeth with necrotic pulp and open apex, and in the treatment of various root canal perforations. By comparing the biological response of pulp tissue capped with calcium hydroxide and MTA, the superiority of MTA has been indicated. The bridge of hard tissue formed under MTA prevented the irritation of pulp. Histological studies of pulpotomy in dog teeth have shown after 120 days a hard tissue without necrosis formed under MTA. MTA is also the material of choice for retrograde root canal obturation and lateral perforation. Meta analysis of published papers on MTA in recent years indicated the great clinical success of this material which ensured a good canal seal and superior biocompatibility. It is the only material for retrograde root canal obturation that encourages tissue regeneration. Studies have also shown that MTA has inductive and conductive properties for hard tissue as well as the ability to release ions in a liquid medium. The main disadvantage of MTA is related to its color, the presence of iron and mangan ions, the difficulties in maintaining the characteristics of material during time, absence of solvent for this material and the difficulty for its removal after crosslinking.

Background: Pulpal perforation care with direct pulp capping in the case of reversible pulpitis due to mechanical trauma was performed with chitosan which has the ability to facilitate migration, proliferation, and progenitor cell differentiation. Purpose: The purpose of this study was to determine the increasing number of odontoblast-like cells in direct pulp capping dental care of Rattus norvegicus using chitosan for seven and fourteen days. Methods: Samples were molars of male Rattus norvegicus strain wistar, aged between 8–16 weeks, divided into two treatment groups, namely group I given chitosan and group II as a control group given Ca(OH)2. Those Rattus norvegicus’ occlusal molar teeth were prepared with class I cavity, and then chitosan and Ca(OH)2 were applied as the pulp capping materials. Afterwards, glasss ionomer cement type IX was used as a restoration material. Their teeth and jaw were then cut on the seventh day and the fourteenth day. Next, histopathological examination was carried out to observe the odontoblast like cells. All data were then analyzed by t test. Degree of confidence obtained, finally, was 95%. Results: The results obtained showed that the significant differences of odontoblast like cells on the seventh day observation was 0.001 (p = 0.001), and on the fourteenth day observation was 0.002 (p = 0.002). Conclusion: The number of odontoblast-like cells in direct pulp capping dental care of rattus norvegicus using chitosan is higher than the one using Ca(OH)2 for seven and fourteen days.Latar belakang: Perawatan perforasi pulpa pada kasus pulpitis reversible karena trauma mekanis bur dilakukan direct pulp capping dengan cara pemberian bahan secara topikal pada daerah perforasi. Kitosan memiliki kemampuan untuk memfasilitasi migrasi, proliferasi dan diferensiasi sel progenitor pulpa. Tujuan: Tujuan penelitian ini adalah untuk menentukan jumlah peningkatan odontoblas-like cell pada perawatan direct pulp capping gigi Rattus norvegicus menggunakan kitosan selama 7 dan 14 hari. Metode: Sampel adalah gigi molar Rattus norvegicus jantan strain wistar, berusia antara 8–16 minggu, dibagi menjadi 2 kelompok perlakuan yaitu kelompok I yang diberi kitosan dan kelompok II sebagai kontrol yang diberi Ca(OH)2. Oklusal gigi molar Rattus norvegicus dipreparasi kelas I kemudian kitosan dan Ca(OH)2 diaplikasikan sebagai bahan pulp capping. Glass ionomer cement tipe IX digunakan sebagai bahan restorasi. Gigi beserta rahang tikus dipotong pada 7 dan 14 hari. Pemeriksaan histopatologi dilakukan untuk mengamati odontoblas-like cell. Semua data dianalisis dengan uji t. Tingkat kepercayaan = 95%. Hasil: Hasil penelitian menunjukkan perbedaan yang signifikan dalam odontoblas like cell pada pengamatan hari ke-7 (p = 0,001) dan pengamatan hari ke 14 (p = 0,002). Kesimpulan: Jumlah odontoblas like cell pada perawatan direct pulp capping gigi Rattus norvegicus menggunakan kitosan lebih tinggi dibandingkan dengan Ca(OH)2 selama 7 dan 14 hari.

INTRODUCTION: The aim of this trial was to compare clinical and radiographic success rates of direct pulp capping (DPC) using a novel biomaterial called Calcium Enriched Mixture (CEM) cement versus Mineral Trioxide Aggregate (MTA) in primary molar teeth. MATERIALS AND METHODS: In this randomized clinical trial 42 deciduous molars in 21 patients who had at least two teeth requiring DPC, were treated. The enrolled patients were between 5-8 years. The molar teeth were randomly divided into two experimental groups. Patients and operators were blinded. The teeth were anaesthetized, caries were removed and after pinpoint exposure of dental pulp, haemostasis was achieved. The exposure points were capped with MTA or CEM cement. All teeth were restored with amalgam. Patients were recalled for the 6-month follow up. Statistical analysis was carried out using McNemar test. RESULTS: Thirty-eight teeth were available for follow up (19 in each group). The radiographic evaluations did not show failure in experimental groups; however, in clinical examinations one sinus tract was found in CEM cement group. Clinical success rates in CEM cement and MTA groups were 94.8% and 100%, respectively. Dentinal bridge formation was not observed in the two experimental groups. CONCLUSION: There is no significant difference between treatment outcomes of direct pulp capping with either CEM cement or MTA; therefore, both biomaterials can be used successfully for DPC in primary molar teeth.

Mechanical pulp exposure by a rotary cutting instrument or a hand-cutting instrument often happens in deep caries. Application of protective dressing can protect the pulp from additional injury by facilitating healing and repair. Pulp capping has been suggested as one treatment of choice after pulp exposure to maintain pulp vitality. TGF-β1 is growth factor that has important rule in wound healing. The application of Ca(OH)2 and exogenous TGF-β1 as direct pulp capping tr4eatment must be experimented in-vivo to see the vacuolization and necrosis in 7, 14, and 21 days after application. This research was done in vivo experiment from orthodontic patients indicated for premolar extraction, between ages 10–15 years. A class V cavity preparation was created in the buccal aspect 1 mm above gingival margin until pulp exposure. Cavity was irrigated slowly with saline solution and dried with a sterile small cotton pellet. Group 1 calcium hydroxide was applied as manufacture procedure. Group 2, the sterile absorbable collagen membrane used, as inert carrier of TGF-β1 was soaked with 5 ml. All groups were covered by a Teflon pledge to separate pulp capping agent from glass ionomer cement restoration. Teeth extracted in 7, 14 and 21 days after treatment. All samples were hystopathologically examined. There were significant difference of TGF-β1 (p < 0.05) in the vacuolization day 14th and 21th compared with 7th. there were not significant difference in necrosis for all variables. Vacuolization and necrosis decreased in the application of TGF-β1.

In this long-term, clinical study, the authors are concerned with the history, development and contemporary possibilities of vital pulp therapy. Our department has been for more than thirty years engaged in following of repair processes in the dental pulp, as well as results after the treatment of injured dental pulp during direct pulp capping. Clinical observation was complemented by experimental study on human teeth.Initial hypothesis of successful direct pulp capping:Biologically high-quality dental pulp can be repairedCapping material should support repair processes in the dental pulpCavity must be closed with hermetic filling without any leakageLong-term observation of histological sections of 539 extracted human teeth was divided into three groups. All teeth were decalcified in the electrolytic way. Then they were processed by the celoidin technique and coloured with H&E stain.Our long-term clinical observation and literary sources confirm that for successful direct pulp capping it is dominant:1. Valid diagnosis of injured pulp biological state (young, up to 30 years, tooth without any clinical symptoms, vital, without possible iatrogenic changes, small perforation in intact dentine, with slight bleeding of clearly red blood, aseptic working procedure).2. For common practice we recommended combined salicylic cement with Ca(OH)2 (Dycal, Dentsply DeTray) for capping, especially for its easy application in small portions and good biologic features.3. Exact making of resin composite filling with high-quality bonding system is necessary.It is necessary to indicate and perform direct pulp capping advisedly and only in sporadic cases. Early and welldone root canal treatment has generally better prognosis.

The aim of the present study was to assess the response of rat dental pulp to direct pulp capping with ethanol extracts of propolis (EEP). An occlusal cavity was prepared on the right maxillary first molar of Spraque-Dawley rats. The dental pulp was exposed and the lined with a zinc-oxide based filler as a control (group I), or with EEP (group II). Then, each cavity was filled with glass ionomer cement. The animals were sacrificed at week 1, 2, or 4. Biopsy samples were obtained, and these were stained and viewed by a light microscope. The histological examination was based on the presence of polymorph nuclear leukocytes and macrophages, and also the dentinal bridge formation. Data were statistically analysed using Kruskall-Wallis and Mann-Whitney tests. The results showed that the inflammatory response of EEP group was relatively milder compared to the control group, but there was no significant difference (p>0.05) between the two groups. There was no dentinal bridge formation seen in both groups. Therefore, the present results suggest that direct pulp capping with EEP in rats may delay pulp inflammatory process and fail to stimulate reparative dentin.

Statement of Problem: The pulp may be exposed during remove of caries or by traumatic and iatrogenicinjuries. The material used to DPC, must be biocompatible, scalable and prevent bacterial leakage.Furthermore, it is better to stimulate dentinogenesis. Calcium hydroxide is most usual material for DPC. But itcannot provide a suitablcbiologic seal. Mineral irioxide aggregate (MTA) is also a suitable material for DPC.Purpose: The aim of this study was to compare the clinical success of DPC done with MTA or calciumhydroxide cement.Materials and Methods: In this study eighteen posterior teeth without previous spontaneous pain thatinvolved mechanicaly exposure was randomly selected and capped with MTA or calcium hydroxide. These teeth were evaluated by clinical vitality test and radiograph after 3 and 12 months, and patients werequestioned about irritative or spontancus pain in this period. Statistical analysis was carried out by Usher exacttest (a-0.05).Results: This study showed that in calcium hydroxid groud three had irreversible pulpitis and two teeth had symptom and signs of reversible pulpitis. While, In MTA group all cases were normaL and no clinical sign was evident.Conclusion: MTA exhibited better results than calcium hydroxide cement for the capping of the pulp in human

Introduction: The aim of this study was to evaluate the clinical and histological status of the pulp in sound human premolars after direct pulp capping (DPC) with four different DPC methods/materials. Methods and Materials: This study was conducted on eight volunteers who had to extract four first premolars due to orthodontic treatment. Subsequent to tooth isolation, standardized class I occlusal cavities were prepared and the buccal pulp horns were exposed. Then four different protocols of DPC were applied randomly: group A (control); calcium hydroxide lining paste (Dycal), group B; ProRoot MTA (standard double-visit method), group C; ProRoot MTA (single-visit method) and group D; calcium hydroxide injectable paste (Multi-Cal). The cavities were then restored and the patients were put on a six-week clinical follow-up and by the end of this period the teeth were extracted for histological evaluation. Data were analyzed with the Kruskal Wallis test and the level of significance was set at 0.05. Results: In terms of clinical symptoms and formation of hard tissue bridge (HTB), no significant differences were found between groups A, B and C (P>0.05); however, group D's results were significantly different as they exhibited minimal HTB formation and excessive sensitivity (P<0.05). Inflammation was significantly lower in group B (P>0.05). Conclusion: Application of MTA during a single-visit protocol of DPC was clinically and histologically as successful as the standard double-visit method but the routine use of Multi-Cal as pulp capping material is questionable and should be reconsidered. [ABSTRACT FROM AUTHOR]

Background: Some of the disadvantages of calcium hydroxide Ca(OH)2 as pulp-capping material are related to the inflammatory response, and its poor sealing ability. Cyanoacrylate glue was proposed in this study as pulp-capping agent because of its sealing ability, and diprogenta, on the other hand, was proposed because of its anti-microbial and anti-inflammatory effects. The aim of this study is to evaluate and compare the histopathological response of the pulp toward cyanoacrylate and diprogenta in direct pulp capping (DPC). Materials and Methods: Cyanoacrylate, diprogenta, and calcium hydroxide were applied on 20 permanent teeth of 6 rabbits divided into four groups, each contains five teeth, as follow: G1: Diprogenta and calcium hydroxide. G2: Cyanoacrylate. G3: Diprogenta and cyanoacrylate. G4: Calcium hydroxide (control group). Results: A remarkable dentin bridge formation was found in all groups. No pulp necrosis was found in any tooth of the four groups. Pathological reactions of the pulp were found in 25%, 40%, 20%, and 100% of groups 1, 2, 3, and 4, respectively. Differences between study and control groups were found statistically significant (P < 0.05). Conclusion: All materials used in this study were biocompatible and suggested to be studied further on human teeth. These materials when used in combination with Ca(OH)2, may give better results. [ABSTRACT FROM AUTHOR]

Direct pulp capping (DPC) is coverage of exposed pulp by a biocompatible material after traumatic or carious exposure. The purpose of this procedure is to seal this spot against bacterial leakage, stimulate dentinal barrier formation, and maintain the vitality of the pulp. Several factors contribute to the consequence of this treatment, such as the kind of material used and the procedural technique. The aim of this study was to evaluate histologically the outcome of DPC using three methods. Thirty-six canine teeth of nine cats were selected for this experiment. After the cats had been anesthetized, the teeth were exposed under sterile condition. The teeth were randomly divided into three groups. In group I, the exposed pulp was covered with mineral trioxide aggregate (MTA) alone. In group II, the pulp, after being treated with erbium:yttrium-aluminum-garnet (Er:YAG) laser (energy = 200 mJ, pulse duration = 700 micros, repetition rate = 3 Hz, exposure time = 15 s, no air, no water, beam diameter = 0.6 mm), was covered with MTA. In group III, the pulp was treated with laser and covered with calcium hydroxide [Ca(OH)(2)]. All cavities were filled with amalgam after DPC. After 4 months, the animals were sacrificed and block sections were prepared. The specimens were histologically evaluated. The data were analyzed by Mann-Whitney and chi-square tests. Dentinal barrier had formed in all groups. The laser + MTA group showed little superiority to the other groups in dentinal barrier formation, type and intensity of inflammatory responses, and soft tissue changes, especially necrosis, but these differences were not statistically significant (P > 0.05). We concluded that laser + MTA produced better healing. According to the conditions in this study, Er:YAG laser could be used in direct pulp capping treatment in combination with both common materials. [ABSTRACT FROM AUTHOR]

The aim of this review is to evaluate the suitability of rat molar teeth in preclinical evaluation of medical devices for direct pulp capping. The ISO standard 7405 states clearly that only non-rodent mammals are suitable species for animal research in dentistry. Furthermore, without clear justification a considerable number of researchers previously rejected results of animal experiments concerning preclinical evaluation of the biocompatibility of dental materials undertaken in rat molar teeth. However, in the past 50 years about 70 studies have been published using rat molar teeth in order to evaluate direct pulp capping, pulpotomies and tissue reactions after pulp exposure. Numerous studies showed that the healing of rat molar pulp tissue after direct pulp capping is histologically comparable with humans and other animal species pulp tissue. Rat molar teeth, including pulp tissue, can be seen anatomically, histologically, biologically, and physiologically as miniature human molar teeth. Hence, the essential biological reactions of the pulp tissue and the interaction during the different stages of wound healing of rat molar teeth are comparable with that of other mammals. Rat molar teeth are a valid study model in order to provide valuable data concerning pulp tissue reaction after direct pulp capping and related questions in dentistry. Therefore, the use of rats may significantly reduce the number of currently used higher animals in research. Tests in higher developed animals should be limited to experiments which clarify inconsistent results. However, some technical difficulties, like the small size of rat molar teeth must be dealt with before undertaking any research. [ABSTRACT FROM AUTHOR]

Statement of Problem: Recently, it has been proposed that different adhesive materials can be used for direct pulp capping. Previous studies have demonstrated that multi steps dentin adhesives could form reparative dentin similar to calcium hydroxide (CH). Purpose: The aim of this study was to evaluate the histological pulp response of ninety mechanically exposed cat pulps to two adhesive resins (Scotch Bond MP and Single Bond 3M) were compared with a calcium hydroxide cement (Dycal, Dentsply). Materials and Methods: Class V facial cavities with similar pulpal exposures were prepared in canines. In the experimental groups phosphoric acid was used to etch the enamel and dentin and pulp exposure, and after it dentin adhesives was applied. The exposure point of the control group was capped with Dycal then the remainder of the cavities was etched and a dentin adhesive (single bond) was applied. All of the cavities were restored with a composite resin (Z 100) in usual manner. The animals were scarified after 7, 30 and 60 days (n=30), and the pulp evaluated histologically, statistical analysis was carried out with Kruskal- Wallis test (α=0.05). Results: The data showed that most of the cases had mild inflammation of pulp tissue. There was no significant difference in inflammatory reaction of pulp by Dycal and two adhesive systems, severe inflammatory reaction of pulp was observed only in most of the 30- day Single Bond group. Soft tissue organization of dentin bridge was less than Scotch Bond and Dycal groups, the differentiation of dentin bridge was less than Scotch Bond group after 7 days. Conclusion: Slight inflammatory cell infiltration was the main reaction of exposed pulp when two commercially available adhesive resins were placed directly on the exposed pulp. There was no significant difference in inflammatory reaction of pulp between Dycal and two adhesive systems after 7 days and 60 days. After 7 days most of the specimens showed an amount of predentin deposition.