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Objective: The aim of this study was to investigate the human pulp response to Scotchbond Multi Purpose Plus (SMPP) bonding agent in non-exposed Class V cavities., Methods: SMPP was placed in 24 of 40 cavites according to manufacturer's instructions and the cavities were restored with amalgam. The remaining 16 cavities were capped with a calcium hydroxide formulation (Dycal) sealed with zinc-oxide eugenol, and restored with the amalgam. After extraction at 10 and 35 days, the teeth were fixed, sectioned and stained for light microscopy., Results: All Dycal-capped teeth, at both 10 and 35 days, exhibited no pulp inflammation and no demonstrable bacteria. Six cases sealed with SMPP at 10 days showed no pulp inflammation or stained bacterial profiles. The remaining six teeth demonstrated mild to moderate inflammatory pulpal responses and five out of these six cases exhibited stained bacterial profiles. Nine out of 12 teeth showed no inflammatory pulp responses at 35 days, the remaining three cases exhibited mild to moderate pulp inflammation without stained bacteria., Conclusions: None of the teeth sealed with SMPP presented severe inflammatory pulpal reactions histologically. SMPP did not exhibit significant deleterious effects on the human pulp tissue during the test periods.

Purpose: To evaluate clinically and microscopically the human pulp response when directly capped with an adhesive system or calcium hydroxide over short (9-12 days) and long (53-204 days) experimental periods., Materials and Methods: Fifty-one sound human premolars scheduled for orthodontic extraction, had their pulp horns gently exposed with a diamond point. Debris in the pulp wound was washed out with a sterile saline solution. The pulps were then capped with either an adhesive system (Scotchbond Multi-Purpose Plus) or calcium hydroxide. All teeth were subsequently restored with resin-based composite (Z-100) according to the manufacturer's instructions. After the experimental periods, the teeth were extracted and processed for light microscopic examination., Results: Short-term: the pulp tissue capped with SBMP-P exhibited dilated and congested blood vessels associated with a moderate inflammatory response and blanching of pulp cell nuclei. Long-term: no evidence of healing and bridge formation was observed. A persistent mild inflammatory pulp response was present. Micro-abscesses were detected in three cases associated with bacterial infiltration. Calcium hydroxide stimulated early pulp repair and dentin bridging which extended into the longest period.

Colonization of dental pulp by blood-borne bacteria in the absence of previous inflammation has been hypothetized but has never been convincingly demonstrated. In order to provide convincing support for this hypothesis we attempted to detect Coxiella burnetii DNA in the dental pulp of bacteremic, intraperitoneally inoculated guinea-pigs by PCR amplification and direct sequencing of two molecular targets. Coxiella burnetii DNA was recovered from 20-50% of the animals depending on the molecular target, from 15-20 days after experimental challenge. These results demonstrated, for the first time, that dental pulp is contaminated by blood-borne bacteria and can be detected by molecular tools., (Copyright 2000 Academic Press.)

To evaluate the histopathological outcome of two preparation techniques (featheredge preparation/shoulder preparation) on teeth exhibiting pulp reactions due to age and periodontal disease, 11 teeth were prepared for full veneer crowns. Laboratory made resin crowns were fixed with a zinc phosphate cement for a period of 90 days. After extraction, adjacent pulpal areas were histopathologically rated according to the BRD criteria comprising the parameters (i) Bacterial invasion, (ii) Regenerative parameters, (iii) Degenerative parameters. Degenerative reactions were more correlated with tooth preparation than with advanced periodontal disease. The severity of endondontal reactions depends more on remaining dentin thickness than on the type of preparation.

The widespread use of resin and resin-monomers for bonding of dental restorations to dentin has occurred because of a fundamental shift in the view that injury to the pulp is induced by restorative procedures. While, for many years, the toxic effects of restorative materials were thought to be of crucial importance in the development of adverse pulpal responses, the key role of bacterial leakage at the restoration-tooth interface is now well-recognized. Consequently, if optimal conditions for the preservation of pulpal health are to be ensured, dental restorations should provide an impervious seal against the surrounding tooth structure. However, polymerization shrinkage and contraction stresses induced during setting, as well as a variety of technical difficulties encountered during the clinical operation, often produce less than perfect results. Therefore, modern restorative procedures involving resin and resin-bonded restoratives must still rely on the ability of the pulp to cope with the injurious elements to which it may be exposed during and after the procedure. This review examines factors that may govern the pulp's response to restorative procedures that involve adhesive technologies. An assessment is made of the risks involved as far as the continued vital function of the pulp is concerned. It is concluded that an intact, although thin, wall of primary dentin often enables the pulp to overcome both toxic material effects and the influences of bacterial leakage. In contrast, the pulp may not do equally well following capping of open exposures with resin composites. A dearth of controlled clinical studies in this area of dentistry calls for confirmation that pulpal health prevails over the long term following the use of total-etch and resin-bonding techniques.

Bacterial infection causes significant morbidity, mediated in part by the up-regulation of inflammatory cytokines. Cytokine induction is thought to stimulate osteolysis in conditions such as periodontal disease and otitis media. To establish the relative importance of interleukin-1 (IL-1) and tumor necrosis factor (TNF) in mediating the response to a mixed anaerobic infection, we used an in vivo model in which the dental pulp was inoculated with six anaerobic pathogens, in mice with functional deletions of receptors to IL-1 (IL-1RI(-/-)), TNF (TNFRp55(-/-)-p75(-/-)), or both (TNFRp55(-/-)-IL-1RI(-/-)). Polymorphonuclear and mononuclear phagocyte recruitment occurred to the greatest extent in TNFRp55(-/-)-IL-1RI(-/-) mice, and to a lesser extent in IL-1RI(-/-) or TNFRp55(-/-)-p75(-/-) mice, and the least in wild-type mice, demonstrating that recruitment of these phagocytes is not dependent on IL-1 or TNF receptor signaling. A similar pattern was observed for bacterial penetration into host tissue. Because it had recently been reported that TNF played a critical role in mediating lipopolysaccharide-induced bone loss, we anticipated that mice with targeted deletions of TNFRp55(-/-) would have reduced osteoclastogenesis. Surprisingly, osteolytic lesion formation was greatest in animals lacking TNF and/or IL-1 receptors. These results indicate that IL-1 or TNF receptor signaling is not required for bacteria-induced osteoclastogenesis and bone loss, but does play a critical role in protecting the host against mixed anaerobic infections.

The purpose of this study was to evaluate histopathologically the effect on pulp tissue of microleakage in resin composite restorations. Seventy-two class V cavities were prepared on buccal surfaces of monkeys and divided into 3 groups, F, O, and S. Every cavity was etched with 37% phosphoric acid. In group F cavities, each cavity was restored with photo-curable composite without any dentin adhesives. In group O, the cavities were left unfilled. In group S, each cavity was treated with a dentin adhesive system and restored with a restorative composite. After 3, 30, or 90 days, animals were sacrificed and the subjected teeth were immediately removed, then fixed and decalcified. Following sectioning and staining with hematoxylin and eosin or Taylor's modified bacteria staining, each sample was examined with a light microscope. In most teeth with group S cavities, bacterial invasion was not found indicating excellent marginal sealing. The pulpal reaction was much less than that in other groups. In group F as well as in group O, bacteria were frequently observed in the cavity; however, bacteria penetrated into dentinal tubules more in group F than in group O at 30 and 90 days. A correlation between the presence of bacteria and pulpal inflammation was strongly indicated. It was suggested that a leaky restoration was more harmful to the pulp than an open prepared cavity without restoration.

Purpose: To investigate with the scanning electron microscopy (SEM) the inner surface of the resin restorative used as a direct pulp capping., Materials and Methods: Class V cavities were prepared on the facial surfaces of 90 intact monkey teeth, and the pulps were intentionally exposed with a carbide bur through the cavity floor. Each exposed pulp was capped with one of three commercially available adhesive resin systems (BondWell LC, GC; Imperva Bond, Shofu; Clearfil Liner Bond II, Kuraray). The cavities were restored with an adhesive resin and a hybrid resin-based composite. Histopathological changes of the mechanically exposed pulp were evaluated at 3, 30 and 60 days postoperatively. The interface between the resin and pulp tissues on the inner surface of the resin restorative was observed by SEM., Results: Bacterial penetration along the cavity walls and pulp tissue could not be detected in any specimen. Slight inflammatory cell infiltration was the main initial reaction, while dentin bridge formation was the major long-term reaction in all groups. The resin surface adjacent to the etched cavity floor contained numerous resin tags corresponding to the dentin tubules. Remnants of pulpo-dentin complex, such as fragments of blood clots, pulpal cell, and dentin were also seen scattered along the inner resin surface.

The dentin-pulp complex is sensitive to infection. Restorative treatment should function as a Band-Aid protecting the dentin-pulp complex from bacteria and their byproducts. This article describes different ways of treating the exposed dentin-pulp complex in such a way that bacterial infection can be avoided.

The aim of the investigation was to assess two methods of the treatment of III type perio-endo syndrome by Simon, Glick and Frank. In group I only periodontic treatment was performed including scaling, root planing and curettage. In group II periodontic treatment was supplemented by endodontic therapy. The results were registered by: Plaque Index, Sulcus Bleeding Index, Sulcus Fluid Rate, Bone Lost Index EMR, pocket depth and tooth mobility; before treatment, 7 days after treatment, 6 weeks and 6 months after treatment. In group II in selected cases (teeth with vital pulp and pocket depth more than 6 mm), microbiological examination of the dental pulp and dental plaque from the pocket was carried out. The results showed that the periodontal therapy was not effective. In first group, after 6 months the teeths mobility was extend, the pocket depth was reduced by 1 mm only, in gingiva there was registered still with chronic inflammation and the bone growth was not significant. In the second group the teeth mobility was less significant, the pocket depth was reduced more than 3.5 mm, in 21% persons the gingiva was in good health condition and the bone growth was significant (7.5%). The anaerobic bacteria were incubated in 9 probes of dental pulp for 10 examinations.

Purpose: Baby bottle tooth decay (BBTD) affects 6% of children under three years of age and is associated with inappropriate bottle use. The objective of this study was to estimate the caries-related risk associated with 26 infant formulas and whole milk., Methods: First, the plaque pH of adult volunteers was monitored before and after an oral rinse with infant formula to determine the minimum pH obtained in response to each formula. Second, Streptococcus sobrinus 6715 was cultured in each infant formula, and the increase in the number of colony forming units was measured. Third, each infant formula was incubated with powdered enamel and the solubility of enamel mineral was calculated in the absence of bacteria. Fourth, each formula was mixed with standardized concentrations of acid to determine the buffering capabilities. Finally, enamel windows were created on extracted permanent molars and exfoliated primary incisor crowns that were then colonized with mutans streptococci and incubated with infant formula. Caries was assessed visually and radiographically for 18 weeks. The length of time required for the development of enamel caries, dentinal caries and pulpal involvement was recorded., Results: One-way or two-way ANOVA of these five assays demonstrated that 1. Plaque pH varied in response to oral rinsing with infant formula and most formulas did have the ability to reduce the pH significantly below the pH obtained after rinsing with water 2. Some infant formulas supported significant bacterial growth 3. Enamel mineral was dissolved by incubation with certain infant formula 4. The buffer capacity varied among the infant formulas tested 5. The length of time required for caries to reach dentin or pulp differed for the formulas, with some formulas causing dentinal caries by 3.4 weeks and pulpal involvement by 7.2 weeks.

Ancient septicemic plague epidemics were reported to have killed millions of people for 2 millenniums. However, confident diagnosis of ancient septicemia solely on the basis of historical clinical observations is not possible. The lack of suitable infected material has prevented direct demonstration of ancient septicemia; thus, the history of most infections such as plague remains hypothetical. The durability of dental pulp, together with its natural sterility, makes it a suitable material on which to base such research. We hypothesized that it would be a lasting refuge for Yersinia pestis, the plague agent. DNA extracts were made from the dental pulp of 12 unerupted teeth extracted from skeletons excavated from 16th and 18th century French graves of persons thought to have died of plague ("plague teeth") and from 7 ancient negative control teeth. PCRs incorporating ancient DNA extracts and primers specific for the human beta-globin gene demonstrated the absence of inhibitors in these preparations. The incorporation of primers specific for Y. pestis rpoB (the RNA polymerase beta-subunit-encoding gene) and the recognized virulence-associated pla (the plasminogen activator-encoding gene) repeatedly yielded products that had a nucleotide sequence indistinguishable from that of modern day isolates of the bacterium. The specific pla sequence was obtained from 6 of 12 plague skeleton teeth but 0 of 7 negative controls (P < 0.034, Fisher exact test). A nucleic acid-based confirmation of ancient plague was achieved for historically identified victims, and we have confirmed the presence of the disease at the end of 16th century in France. Dental pulp is an attractive target in the quest to determine the etiology of septicemic illnesses detected in ancient corpses. Molecular techniques could be applied to this material to resolve historical outbreaks.

Purpose: The objective of this project was to develop an in vitro model system for investigations of dentinal caries., Methods: Five extracted primary molar teeth with circular cavity preparations to the depth of the dentinoenamel junction were mounted individually in cold-cure acrylic bases constructed to fit a positioning jig in a Schick-Technologies digital radiographic imaging apparatus. The mounted teeth (MT) were incubated with pure cultures of Streptococcus mutans for 7 days and Lactobacillus casei for 38 days. At baseline and on day 23 and 45, four digital radiographs of each MT were made. Subtraction radiography was performed and analyzed using custom interactive software., Results: Lesions progressed roughly halfway through the dentin in all teeth at 23 days and approximated the pulp chambers at 45 days of incubation. Images resulting from subtraction procedures clearly revealed incremental caries progression which could be quantitated., Conclusion: The model may be useful for screening cariostatic dental materials or treatments and investigating microbial mechanisms in dentinal caries.

Objective: The purpose of this study was to evaluate the histologic pulp responses of Optibond and Syntac adhesive resin systems placed directly on exposed pulp tissues., Study Design: Class V facial cavities with pulpal exposures were prepared in dogs. After acid etching of enamel margins, the cavities were restored with a composite resin after pulp-capping with one of the dentin bonding agents. The remaining exposures were capped with calcium hydroxide and amalgam as controls. The animals were killed after 7, 21, and 90 days and the pulps were evaluated histologically. Statistical analysis was carried out with the chi-square test., Results: There was no statistically significant difference with respect to inflammatory cell response, fibrosis, bleeding, or bacterial staining criteria over the time intervals of evaluation among the Optibond, Syntac, and calcium hydroxide groups. New dentin formation was also observed for all of the groups at the end of 90 days., Conclusion: The results of direct pulp-capping with a dentinal adhesive and composite resin appear promising but further in vivo studies are recommended.

Non-amalgam filling materials may release substances which have been shown to be toxic in cytotoxicity tests and implantation studies. However, results from systemic toxicity tests do not indicate any unacceptable risk to the patient's general health, but data for non-amalgam dental filling materials are scarce in comparison to amalgam. Although estrogen-like effects of one fissure sealant have been claimed, no conclusions can be drawn at present for the patient from these in vitro data because of the limitation of the test methods and materials used. Some components of composite resins/dentin adhesives and a resin-modified glass ionomer cement were mutagenic mainly in in vitro tests. Due to the limitations of the test systems and the comparatively high concentrations needed to elicit the reactions, no unacceptable risk can yet be derived from those data for the patient. However, a no-touch technique is recommended for the dental personnel. As with amalgam, local reactions of the pulp are not expected with alternative filling materials, if the pulp tissue is not exposed and if bacterial penetration is avoided. The latter requirement is still difficult to fulfill, especially for composite resin systems and related materials in posterior teeth situations. Slight gingival reactions to alternative filling materials and to amalgams are mainly attributed to plaque accumulation. From all these data it can be concluded that, for the time being, it is not possible to rank dental filling materials in respect to their biocompatibility, and it is evident that biocompatibility must be considered to the same extent for both amalgams and commonly used or recommended alternative filling materials.

Objective: Recent studies have demonstrated that acid etching of vital dentin and pulpal tissue does not retard pulpal healing, odontoblastoid cell differentiation, or dentinal bridge formation when the pulp is capped with adhesive resins. The purpose of this study was to evaluate the pulpal response in nonexposed and exposed monkey pulps to treatment with the Clearfil Liner Bond 2 and Clearfil AP-X system., Method and Materials: Class V and Class I cavities in nonexposed and exposed pulps were observed at 7 or 8, 27, and 97 days., Results: There were no differences in pulpal inflammation between the Clearfil Liner Bond 2/Clearfil AP-X specimens and calcium hydroxide controls in either Class V or Class I cavities at the various time periods., Conclusion: Clearfil Liner Bond 2 and Clearfil AP-X system is not toxic to either nonexposed or exposed pulpal tissues when placed according to manufacturer's directions.

The purpose of this study was to determine if endodontic bacterial act in vitro on human gingival fibroblast functions via extracellular products. The bacteria used were Prevotella nigrescens, Capnocytophaga ochracea, Peptostreptoccocus micros and Actinobacillus actinomycetemcomitans. Supernatants were collected from bacterial cultures at the beginning of the stationary phase when their density was similar. Toxins that inhibited fibroblast proliferation were found in all culture supernatants of Gram-positive or Gram-negative bacterial strains, except for Prev. nigrescens. The cytotoxicity of A. actinomycetemcomitans supernatant was about 1000 fold higher than the others. This supernatant diluted to 1/1000 led to total fibroblast growth inhibition whereas only 25% growth inhibition was obtained with Capn. ochracea and Pept. micros diluted to 1/10. Bacterial supernatant proteolytic activity was investigated in confluent fibroblast cultures that were incubated for 48 hr with each of the supernatants diluted to 1/2 except for A. actinomycetemcomitans supernatant diluted to 1/20. Indirect immunofluorescence studies of extracellular-matrix molecules, followed by immunoelectrophoretic analysis of extracts of whole-cell layers, demonstrated that only conditioned medium of Prev. nigrescens had a proteolytic activity capable of degrading the greater part of type I collagen and fibronectin fibres in the extracellular matrix.

The purpose of this review is to "revisit" an earlier paper (1992) on the subject of direct pulp capping in primary teeth and bring some new considerations for the procedure by the use of dentin bonding adhesives. It has come to be recognized that the customary employment of calcium hydroxide for this therapy has some shortcomings that reduce the prognosis for a favorable outcome. For at least a decade, many investigations have found that postoperative sensitivity, thermal stimuli, pulp inflammation and pathosis can be attributed not to the composition of various dental materials and their insertion techniques, but to microleakage with subsequent bacterial invasion at the enamel/restoration and the dentin/pulp interfaces. It is imperative, as pointed out, that there be an impervious resinous bond between the dentin and the dentinopulpal complex which can be achieved by the use of dentinal adhesive agents to eliminate microleakage outward movement of pulpal fluids. Various steps in the bonding technique for the treatment of deep dentin caries and/or a pulp exposure has raised some concerns for their effect on the pulp. This review discusses these concerns, which can lead to the conclusion that the use of dentinal bonding adhesives is a safe and biologically feasible procedure, whether it be in permanent or primary teeth.

This study evaluated the histologic response of total-etched and nonetched compomer restored cavity preparations. One hundred fifteen class 5 cavity preparations were placed in the teeth of four healthy adult monkeys at 7, 27, and 90 days. A 37% H3PO4 was applied for 10 seconds and rinsed in total-etched preparations. No statistical differences were seen in inflammatory reactions among total-etched or nonetched compomers at 7, 27, and 90 days. There were no statistical differences in inflammatory cell responses among all compomer systems in regard to time intervals. Pulpal responses of compomers were greater than IRM at each time period. Pulp responses were associated with stained bacteria in 32 of 89 compomer teeth. No necrotic pulps were seen in any teeth. Statistical data show a positive correlation (P < 0.05) between bacterial presence and pulpal inflammation. IRM pulps showed no inflammation or bacterial staining. Compomers are biologically compatible with pulp tissues when bacteria are excluded.

Background and Objective: It was shown in previous studies [1] that the Nd:YAG laser can be used as an excellent tool for killing bacteria in root canals. The present examinations were carried out with a high power diode laser in comparison with a conventionally treated control group., Study Design/materials and Methods: In this in vivo study, 40 patients with infected root canals underwent diode laser treatment. To verify the findings, microbiological tests were performed and the results compared to those obtained with conventional antibacterial treatment., Results: The microbiological examination revealed streptococci at relevant concentrations in 20 cases and staphylococci in 5 cases. Extensive bacterial reduction was achieved in all cases by repeating laser treatment only once. Following the first irradiation, minimal streptococcal growth was observed in 7 root canals and minimal staphylococcal growth in 2 root canals. The maximum log kill was 4.22 for streptococci and 3.33 for staphylococci. In the control group, a maximum reduction by only one log step could be achieved in 6 of 10 patients., Conclusions: Compared with the results achieved with the conventional bactericidal technique in the control group, the high power diode laser seems to be highly suitable for killing bacteria in infected root canals.

The dental pulp possesses an intrinsic healing capacity, by which pulpal reactions remain initially localised; they are often completely reversible. The younger and healthier the pulp is, the greater its healing capacity will be. Only in case of bacterial infection will the sterile pulpal inflammation convert into a local necrosis of the pulpal tissue that gradually will expand apically until the whole pulp is contaminated. The profit-effect of pulpal protection by means of traditional calcium hydroxide medicaments is compared with a more modern adhesive dentin sealing. Potential pulpal response to restorative materials and procedures are reviewed. Finally, clinical guidelines for optimal pulpal protection and dentinal sealing are formulated.

The fourth generation bonding systems demonstrate an excellent adhesion to the dental hard tissues. The marginal seal along the composite-resin restoration does, however, not totally prevent microleakage and, moreover, the bonding system may deteriorate with time. Due to the attention that has been given to possible microleakage, the toxic effects of composite and its components have got less attention in recent years. The present article deals with the question whether the dental pulp is damaged by either microleakage and/or components of the bonding system.

The prevention of degeneration and necrosis of the endodont is one of the main goals of dental treatment. Kerschbaum and Voss (1979, 1981) described that 15% of teeth showed negative results to sensitivity testing 10 years after crown preparation. Pulpal responses to dental treatment depend on many factors including thermal injury, transsection of the odontoblastic process, vibration, desiccation of dentin, pulp exposure, smear layer, remaining dentin thickness and used materials. The knowledge concerning endodontic reactions in short and medium term observation is mainly based on research by Klötzer and Langeland. Histological assessment of reactions is a well accepted method for biocompatibility testing (i.e. ISO/TR 7405). It is consistent to apply its principles to the evaluation of endodontic reactions of teeth with long term restorations. As pulpal injury is furthermore due to microleakage between filling material and the wall of the cavity the analysis of infected dentin tubules seems to be important. A consideration of the location of the tubules and of the severity of the invasion is necessary. Using a classification (grade 1-6) comprising the parameters of degenerative and regenerative reactions and bacterial invasion, 24 teeth restored with different types of fixed prosthodontic restorations were investigated. The restorations were between 0-6, 7-12 and 13-18 years in situ. Serial sections (5 microns) were stained with haematoxylin-eosin, azan, according to Goldner and J. Hopkins. 22 of 24 teeth showed typical degenerative reactions. Negative sensitivity testing occurred in teeth with no pain and no or partial necrosis. The histobacteriological assessment showed bacterial invasion of the dentin tubules of 21 teeth. From this investigation it was concluded that the proposed classification shows sufficient sensitivity for the evaluation of progressive endodontic changes of long-term restored teeth. Furthermore it was shown that bacterial invasion must be considered as a possible co-factor for the described degenerative character of the pulpal tissue.

Porphyromonas endodontalis was known to be important microorganisms in the etiology of pulp and apical infection. In this paper, we generated hybridomas secreting monoclonal antibody against Porphyromonas endodontalis ATCC 35406. The specificity of the monoclonal antibody was examined by ELISA against a battery organisms (109 Strains). The results indicated that the monoclonal antibody did not react with any non-Porphy romanas endodontalis (104 Strains). So our monoclonal antibody is specific for Porphyromanas endodontalis and can be used in clinical samples for detection of pulp and apical infections.

Twenty human permanent teeth were used to study the pulpal response of two calcium hydroxide products, Dycal and Pulpdent Multi-Cal, after partial pulpotomy. Teeth were extracted at 4 months, fixed, and prepared for histologic examination. All 10 teeth treated with Dycal showed complete soft tissue healing and bridge formation. No stained bacteria were seen throughout the serial sections. One tooth treated with Dycal showed acceptable histologic results, dentin deposition in the root canal. Six cases dressed with Pulpdent Multi-Cal showed acceptable histologic results, whereas four teeth showed severe inflammation or necrosis associated with bacterial penetration into the pulp tissue. Clinically, one tooth treated with Pulpdent Multi-Cal showed pulpal pain and was extracted at 90 days. Our data support the thesis that human permanent pulps will promote tissue healing and dentin bridge formation as long as bacterial microleakage is excluded.

In the last years several dental adhesives have been developed. They are supposed to chemically adhere to dentin and a liner to protect the pulp is not used. The aim of this study was to compare the short-term pulpal reaction, in an intra-toothpair study, between a dental adhesive, Scotchbond 2, and a lining system, Tubulitec, in combination with P-50 in surface-sealed cavities. Deep buccal cavities in 16 human pairs of premolars, 32 teeth, were restored in vivo with a light cured composite resin, P-50. To minimize bacterial contamination all cavities were treated with a cleanser, Tubulicid, and the cavities were surface-sealed with temporary cement, Coltosol. One tooth in each pair, the test, was treated with Scotchprep Dentin Primer and Scotchbond 2 Light Cure Dental Adhesive. In the other tooth in the pair, the control, Tubulitec Primer and Liner were used. The teeth were extracted after 6-14 days. The sections were evaluated for degree of inflammation and the presence of bacteria. Irrespective of treatment of dentin the majority of teeth, 23, including one pulpal exposure, revealed no inflammation or a few inflammatory cells. In four test teeth, including one pulpal exposure, and two controls, growth of bacteria was found on the cavity walls and slight or moderate inflammation was seen in the corresponding pulps. In one test and two control teeth slight inflammation was seen but no bacteria could be detected. In the absence of bacteria Scotchbond 2 did not seem to irritate the pulp.(ABSTRACT TRUNCATED AT 250 WORDS)

Fusobacterium nucleatum-derived components were studied for their effect on the ability of accessory pulpal cells to induce T-lymphocyte proliferation. In initial experiments, spleen cells were used to establish concentration ranges at which testing of the effect of the bacterial components would be suitable. At low concentrations, bacterial substances induced a stimulatory effect on the proliferation rate of spleen cells, but not when purified T-lymphocytes were incubated in the presence of concanavalin A and pulpal accessory cells. At increasing concentrations, a dose-dependent reduction was observed. Pretreatment with the bacterial products for 4 h gave a stimulatory effect in the absence of concanavalin A for both spleen cells and T-lymphocytes. Removal of low-molecular weight components (<3.5 kDa) did not influence the inhibitory effect, whereas preheating the bacterial substances to 100 degrees C eliminated the observed inhibition. Findings show that heat-sensitive, high-molecular-weight components of F. nucleatum can evoke a concentration-dependent stimulatory or suppressive effect on the proliferation rate of T-lymphocytes in the presence of accessory cells derived from the dental pulp.

Recombinant human osteogenic protein-1 (hOP-1, BMP-7) induces cartilage and bone formation when implanted in extra- and intraskeletal sites in vivo. rOP-1 also preserves pulp vitality and stimulates reparative dentine formation when placed on partially amputated vital dental pulp tissue. The amount of dentine formed in 6 weeks was earlier found to be proportional to the total amount of rOP-1/carrier placed on the pulp and the capacity of the pulp to respond to rOP-1 appeared to be independent of the amount of coronal pulp removed. This reparative dentine was not completely mineralized after 6 weeks healing. Experiments were now made to determine the capacity of hOP-1 to preserve the vitality of and induce reparative dentine in vital radicular pulps. The extent of tissue mineralization present after 1, 2, 4 and 6 months' healing time in permanent monkey teeth was assessed. Radicular pulp vitality was maintained, reparative dentine formed, and mineralization was nearly 75% complete after 1 month and more than 95% after 4 months. The effects of irrigating the exposed pulps with EDTA, sodium hypochlorite or saline were also compared. Significantly more sodium hypochlorite-treated pulps became non-vital and the root canals of all the non-vital teeth contained bacteria at the time of sacrifice.

This study compares pulp responses to 3 formulations of calcium hydroxide, namely: a) An experimental adhesive calcium hydroxide cement containing polyacrylic acid, b) Dycal (L.D> Caulk Co, Milford, Delaware) Batch Nos 176970/176990, c) "Analar" calcium hydroxide mixed with sterile distilled water. After 28 days dentine bridges were present in 77% of teeth capped with the test material, 64% of teeth treated with Dycal and in 62% of teeth capped with calcium hydroxide and water. Inflammatory infiltrates were observed in a number of teeth remote from the bridges. Bacteria were detected in these specimens. Exposed rat molar pulp responses to an experimental adhesive calcium hydroxide cement were similar to to those observed with 2 other calcium hydroxide formulations.

Cytotoxicity in culture media of various growing bacterial strains was estimated by Cr-51 release of labelled target-cells. Interaction studies were made by adding each of the different UV-killed bacteria to the medium with viable bacteria. The reference oral bacterial strains were: Actinobacillus actinomycetemcomitans Y4, Porphyromonas gingivalis, Fusobacterium nucleatum and Streptococcus mitis, which were compared with the reference bacteria Staphylococcus aureus 209 and Staphylococcus epidermidis. The target cells were: gingival fibroblasts (GF), periodontal membrane fibroblasts (PMF), pulpal fibroblasts (PF), HeLa-cells (HeLa), and lymphoid neoplasm cells (LN). Synergistic, as well as antagonistic, effects on target cells were observed. The cytotoxicity of A. actinomycetemcomitans in presence of P. gingivalis is neutralized while in presence of S. aureus it was increased. Bacterial interactions with F. nucleatum and P. gingivalis cytotoxicity were observed. The cytotoxicity of F. nucleatum was increased when cultured together with A. actinomycetemcomitans. Each cell type reacted differently to the toxicity of the supernatant of growth medium in which the same bacterial strain had been cultivated, which indicates cell specificity of the toxins.

Under study were the effects of bacterial stimulation of prepared dentin on dental pulp. Traditional method of drug treatment of prepared cavity with alcohol and either was compared with methods reducing dentin permeability making use of calcium hydroxide, potassium nitrate, and calcium oxalate. Inflammatory reaction of the pulp was more pronounced after traditional treatment. Reduction of dentin permeability with agents blocking dentin tubes reduced the severity of inflammatory reaction.

Because of cosmetic reason and fear of mercury released from amalgam, many patients prefer tooth coloured restorations, i.e. made of composite. However, like in the case of amalgam, one has to ask whether composite is a biocompatible material. Whether or not biotransformed, all components of composite may be released. Damage to the pulp of teeth restored with composite has been proven to be due to bacterial leakage, which in turn is a consequence of the shrinkage associated with the material itself. Rarely local and general symptoms of allergy appear, but they may become more common, as is already the case with the dentists and their assistants. Toxicity of composite seems unlikely in view of their smallness and carcinogenicity for the time being is excluded.

The spread of mouse hepatitis virus, strain JHM and herpes simplex virus type 1 in the central nervous system after inoculation into the nares and main olfactory bulb has been examined. The results show that each virus infects a subset of the possible connections of the olfactory bulb and that the subset infected by each virus is different. Thus, both viruses will be useful for studying the neuroanatomic connections of the olfactory bulb, and possibly for functional analyses as well.

Effects of a number of chemicals and of the time elapsed since the preparation on dentine permeability for microorganisms were under study. Dentine permeability was found the highest immediately after the preparation and after acid treatment. Potassium oxalate and calcium hydroxide reduced dentine permeability.

Many studies have shown that the major cause of pulpal disease is the presence of bacteria or their by-products in the dentinal tubules. The purpose of this investigation was to develop an in vitro model, simulating the pulp chamber, that would permit the study of the transport of bacterial by-products through dentin and their effect on pulpal cells. Human pulpal cells were cultured in a modified Sykes-Moore chamber and exposed through dentin to sonicated extracts of Porphyromonas gingivalis ATCC 33277. The cell response was evaluated with the thymidine incorporation method. The results were compared with the cell response obtained after direct exposure to the same irritant. It was found that dentin significantly restricts the diffusion of bacterial proteins in a 24-h experimental period. The time needed for the first bacterial protein molecule to cross the dentin barrier was 6 h. The "diffusion velocity" of the bacterial proteins was 0.023 microns/s. The proposed model has further applications in biocompatibility and microleakage research.

Pulpal response to marginal enamel etching or both enamel and dentine etching with 37% phosphoric acid for adhesive composite restorations was studied in the teeth of the Japanese monkey (Macaca fuscata). Dentine etching irritated the pulp and caused moderate to severe initial changes along the odontoblastic layer at 3 days. When no bacteria were present along the cavity walls, the subsequent pulpal reactions at 30 and 90 days decreased with time and large amounts of irritation dentine were formed. These inflammatory reactions were less than those caused by enamel etching only, or zinc oxide/eugenol cement. Significant correlation (P less than 0.01) was found between the intensity of the inflammatory reactions and the degree of bacterial infection. The pulpal irritation caused by acid etching of dentine for composite restorations is transitory only when the fillings have a good marginal seal and wall adaptation.

Many viruses cause opportunistic infections in HIV-positive patients. Those that cause oral lesions include herpes simplex, varicella zoster, Epstein-Barr virus, cytomegalovirus, and papillomavirus. Importantly, many of the herpes-group viruses are able to augment immunosuppression and some actually transactivate HIV replication-inducing genetic sequences. This article reviews the role of viral agents in the activation of HIV replication and details the features of the reported oral lesions that represent viral opportunistic infections.

Anaerobic procedures were adopted to demonstrate the early bacterial invasion of non-exposed dental pulps, and to isolate and identify the bacteria. Of 19 freshly extracted teeth which originally exhibited deep dentinal lesions, clinical examination and electric pulp testing showed that nine of them had no pulpal exposure. Thus the pulps of these teeth were covered by clinically sound dentine beneath the carious lesion. Bacteria were found to have invaded the pulps of six of these nine teeth. The predominant bacteria were obligate anaerobes belonging to the genera Eubacterium, Propionibacterium and Actinomyces. Other obligate anaerobes were Lactobacillus, Peptostreptococcus, Veillonella and Streptococcus. The bacterial composition resembled that of the deep layers of dentinal lesions described previously, suggesting that the bacteria isolated in this study had passed through some individual dentinal tubules, to invade the dental pulp.

The purpose of this study was to investigate pulpal response and bacterial invasion associated with five dentin bonding systems placed in cavities without an enamel margin. Two hundred and twenty-four dentin margin cavities were created by removing the surrounding marginal enamel of class V cavities in monkey teeth. These cavities were restored with a resin composite using various current dentin bonding systems. All of the dentin bonding systems showed odontoblastic layer changes to varying degrees, and slight to moderate inflammation at the initial stage. With the lapse of time, the degree of inflammation tended to decrease markedly, except for those cases in which bacteria were present. The result of SA/Photo Bond corresponded to that of the glass ionomer cement (negative control). Accordingly, this study suggests that a good bond and adaptation between resin and dentin should be obtained for eliminating pulpal irritation, even in the dentin cavity.

Human pulpal fibroblasts and L929 cells were treated with sonicated extracts of two strains of Bacteroides gingivalis (W83 and ATCC 33277). The cell reaction was evaluated by monitoring cell growth and DNA synthesis. Light and scanning electron microscopic analysis were used to evaluate morphological changes of the cells. Extracts from both bacterial strains exerted a growth inhibitory effect on the cells. The pulpal cells were more sensitive than L929 cells. The ATCC 33277 strain of B. gingivalis was more cytotoxic than the W83 strain. Pulpal cells appeared to be markedly affected on the microscopic level. The diffusion of these toxic bacterial by-products, through dentin to the pulp, may account for pulpal cell damage that contributes to the initiation of pulpal pathosis.

Compared with a step-by-step procedure, the one-step excavation of deep carious lesions in primary molars proved to be the treatment of choice in a clinically, microbiologically and histologically controlled trial. The stepwise method failed to produce any significant reduction in pulp exposure. Sensitivity assessment and percussion findings did not result in a reliable and unambiguous evaluation of treatment success. Histology showed inflammation-free pulps in 67% of the deciduous molars irrespective of the treatment method used. Microbiological examination revealed slightly softened dentin to be significantly more infected than clinically acceptable, hard dentin; although only 59.3% of the cavity floors were free of microorganisms. Chronic pulp inflammations were correlated with the presence of streptococci and lactobacilli, whereas actinomycetes were associated with inflammation-free pulps.

Presence of human immunodeficiency virus (HIV) within noninflamed human dental pulps was documented by polymerase chain reaction assays in 11 of 12 pulps from HIV-seropositive patients. The purpose of the present study was to determine the cellular location of HIV in vivo within these tissues by means of in situ hybridization. Results of the in situ hybridization indicated HIV within fibroblasts of the pulp. These results are especially relevant because fibroblasts lack the CD4 receptor thought necessary for in vivo infection with HIV. These results suggest the fibroblast as a possible reservoir for HIV in the body.

Only slight pulp reactions to glass ionomer cements occurred when inserted in Class V cavities of dog teeth. Most inflammatory reactions were due to bacteria at the tooth/filling interface. Special dentin reactions were noted in almost half the teeth, including hematoxyphilic bands in the dentin and a disturbance of the mineralization pattern of predentin. The clinical significance of these dentin reactions is not known.

This histopathological study investigated the pulp reaction to a restoration system employing a posterior composite resin with or without the pulp protection of visible light curing calcium hydroxide composition and alpha-TCP cement lining to dentin. Black's class V cavities were prepared in 120 adult dog teeth. They were then extracted for histological examination. As a result of this study, their lining materials were found to be effective in pulp protection. To understand the pathological finding, the pH values of "Fulfil", "Universal bond", "VLC Dycal" and "Vitacemen Type II" were measured. The pH levels of "Fulfil" and "Universal Bond" were mildly acidic (4.79-5.18) before polymerization, with no subsequent changes. "VLC Dycal" was initially a strongly alkaline (11.75) and remained this condition. "Vitacemen Type II" was initially acidic (3.78), but eventually reached the milder acidity of 5.12 after 24 hours.

In 32 monkeys 105 immature maxillary incisors were extracted and reimplanted either immediately or after 30 or 60 min wet or dry storage. Of the monkeys, 17 (group I) did not receive and 15 (group II) received prophylactic treatment with 4 mg/kg doxycycline before extraction and 2 mg/kg for 5 d after reimplantation. The observation time varied from 6 to 8 weeks. After being histologically processed, the material was evaluated with respect to the amount of vital tissue and presence of micro-organisms in the pulpal lumen. A comparison revealed no difference in the results between the groups. The results were therefore pooled and statistically analysed with respect to the significance of apical foramen width, extra-alveolar time, wet or dry storage and presence of micro-organisms in the pulpal lumen for the occurrence of complete pulp revascularization (CPR). The overall frequency of CPR was 18%. Log-linear analyses (SAS, 1985) of the material as a whole or of separate parameters consistently revealed a relationship between presence of micro-organisms and absence of CPR (P = 0.0001). A higher frequency of CPR and a lower frequency of micro-organisms (P = 0.05) was found only for the group of immediately reimplanted teeth. The presence of micro-organisms could be explained for 61 teeth. In 27 of these, blood clots containing bacteria in the apical portion of pulpal lumen indicated contamination during the extra-alveolar time, while in 34, the micro-organisms originated from plaque covered mechanical damage in the cervical part of the root surface.

Maxillary incisors in 47 monkeys, 54 in the experimental group (I) and 117 in the control group (II), were extracted and reimplanted, either immediately or after 30 or 60 min wet or dry storage. Incisors in the experimental group I were additionally kept 5 min in a suspension of 1 mg doxycycline in 20 ml physiologic saline, freshly prepared for each of the 15 animals before reimplantation. The observation time varied from 6 to 8 weeks. The teeth were removed in tissue blocks, histologically processed and evaluated for occurrence of complete pulp revascularization (CPR), presence of the micro-organisms in the pulpal lumen and ankylosis or inflammatory root resorption. Then the results were statistically evaluated, using log-linear analyses and chi-square tests (SAS, 1985) for the comparisons between group I and group II. These analyses revealed that topical application of doxycycline increased the frequency of complete pulp revascularization (P less than 0.002) and decreased the frequency of micro-organisms in the pulpal lumen (P less than 0.001). Furthermore, the frequencies of ankylosis (P less than 0.05) and inflammatory root resorption (P less than 0.001) were also decreased compared with the control group of teeth. It was concluded that the effect of topical treatment with doxycycline was most probably exerted on the micro-organisms that contaminated root surface during the extra-alveolar time; contamination of necrotic pulp tissue from the mechanical damage in the cervical part of the root surface was not affected.

The unpredictable response of the dental pulp to clinical insults is frequently encountered in the daily practice of dentistry. Even though the pulp often shows remarkable capacity for recovery, painful symptoms and pulp tissue breakdown may follow such clinical insults as caries, dental trauma, or operative dental procedures. In recent years pulp biology research has provided a deeper insight into the basic mechanisms that govern pulpal defense and repair. This communication focuses on dentin permeability to bacterial antigens and how bacterial elements may be processed and dealt with by the dentin-dental pulp complex.