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Aim Methodology Results Conclusions To assess Spanish dentists' management preferences for deep caries removal and exposed pulps in permanent teeth.A web‐based open and anonymous survey was distributed by social media and a specific website for this project amongst dentists practicing in Spain. The questionnaire comprised 40 questions, divided into five sections: (1) demographic data and professional activity; (2) carious tissue removal; (3) decision‐making regarding pulp exposure; (4) direct pulp capping and (5) pulpotomy procedures in permanent teeth. Results were descriptively analysed. Logistic regression (95% CI) analyses and X2 tests were carried out.A total of 538 responses were received. Half the respondents (53.7%) preferred to perform complete caries excavation for shallow and moderate carious dentin lesions, and selective excavation to firm dentin for deep lesions (57.8%). Selective removal to soft dentin and stepwise removal were much less indicated (15.4% and 10.9%, respectively). Exposed pulps in asymptomatic teeth were treated by direct pulp capping (over 80%), decreasing in the presence of reversible pulpitis symptoms (57.1%). If irreversible pulpitis was diagnosed, a pulpectomy would be performed by 53.5% and 89.9% of the respondents in, respectively, immature and mature teeth. Pulpotomy was performed routinely only by 26.4% of the clinicians. Patients' attitudes and priorities were the most relevant criteria when performing direct pulp capping and pulpotomy, together with the history of pain and the presence of bleeding. Regarding the clinical procedure, dry cotton was preferred to obtain haemostasis and Biodentine was the material of election.Caries removal preferences and management of pulp exposure by dentists practicing in Spain deviated from vital pulp treatment guidelines, mainly regarding indications and case selection. Pulp exposure was managed by direct pulp capping in asymptomatic cases, whilst immature permanent molars favoured the indication of pulpotomy when pulpitis was diagnosed. Most clinicians used hydraulic calcium silicate cement, specifically Biodentine, to perform vital pulp treatments. Postgraduate formation and continuing education in caries lesions management and vital pulp treatments were consistently related to more conservative and updated decisions. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether a correlation exists between residual dentin thickness and quantitative light-induced fluorescence (QLF) values and, if so, to analyze its tendencies. Forty extracted sound human molars were assigned to filled and unfilled groups. The teeth were submerged in a mold with clear acrylic resin. Red utility wax was inserted into the pulp chamber space in the filled group to simulate vital pulp. The specimen was sectioned longitudinally to observe the inside of the pulp space. The samples were cut horizontally from the highest point of the pulp space 2 mm apart. QLF images were then taken of 2 mm, 1 mm, and 0.5 mm samples using the QLF-D Biluminator™ 2 + system. Three operators independently evaluated the QLF images, and the statistical analysis was conducted using one-way analysis of variance, Pearson correlation coefficients, and intraclass correlation coefficients. In the filled group, the mean ΔF values for residual dentin thicknesses of 2 mm, 1 mm, and 0.5 mm were − 3.22, − 7.84, and − 11.52, respectively. In the unfilled group, the mean ΔF values were 0, − 6.90, and − 10.14, respectively. A positive correlation was found between residual dentin thickness and ΔF values (P < 0.05). The intraclass correlation coefficients for observations made by the three operators for the filled and unfilled groups were 0.831 and 0.917, respectively (P < 0.05). In conclusion, residual dentin thickness and ΔF values were significantly correlated and had a highly positive correlation regardless of the QLF device operator. [ABSTRACT FROM AUTHOR]

BACKGROUND: The use of fiber post to repair the endodontically treated non-carious cervical lesions teeth can change the stress distribution of the tooth and significantly reduce the risk of fracture of the affected tooth. However, the mechanical mechanism of fiber posts improving tooth fracture resistance and the optimal crown restoration for endodontically treated non-carious cervical lesions teeth are still debated. OBJECTIVE: To review the stress distribution pattern after restoration of endodontically treated non-carious cervical lesions teeth with fiber posts, the fracture resistance and fracture pattern under various stress states, and the latest research progress on fiber posts combined with different crown restorations. METHODS: The computerized search was applied in PubMed and CNKI to retrieve articles published from September 2008 to September 2023 with Chinese and English search terms "non-carious cervical lesions, endodontically treated teeth restoration, endodontically treated teeth stress distribution." Finally, 56 articles were included for analysis. RESULTS AND CONCLUSION: The application of fiber post restoration for endodontically treated non-carious cervical lesion teeth can partially improve the cervical stress of the tooth without increasing the risk of vertical root fracture, can lead to a more consistent distribution of stress and enhance the tooth's ability to withstand fractures. Non-carious cervical lesion teeth with fiber posts that fracture would show favorable, restorable, or repairable fracture patterns. Fiber posts in combination with porcelain veneers or veneer-type inlays may become a more desirable minimally invasive restoration for repairing endodontically treated non-carious cervical lesion teeth. [ABSTRACT FROM AUTHOR]

The timely treatment of dental caries and pulp disease in primary teeth holds significant importance for maintaining children's oral health. Direct pulp capping (DPC) is a vital pulp treatment that involves covering the exposed pulp with bioactive materials to promote dentin bridge formation. DPC is commonly used in primary teeth with vital pulp and mechanical pulp exposure not exceeding 1 mm. DPC offers advantages such as minimal invasiveness, comfort, simplicity of operation and short chair-side time, making it suitable for pediatric dental clinical practice. Early studies suggested negative treatment outcomes for DPC in primary teeth with carious pulp exposure. Over the years, there have been advancements in materials and technology demonstrating positive outcomes in the clinical research of primary teeth with deep caries. However, due to the limited quality of related studies, DPC has not been widely recommended for the treatment of primary teeth with carious pulp exposure, and its widespread use needs further support by more high-quality evidence-based medical research. The success rate of DPC in primary teeth is influenced by factors including pulp status, clinical operations (such as isolation and caries removal), pulp capping material, cavity type, tooth position, coronal sealing, and dental fear. In clinical operation, dentists should accurately assess pulp status and minimize bacterial contamination. Mineral trioxide aggregate (MTA) is a DPC agent with relatively sufficient evidence and good therapeutic effects, and the crown should be tightly sealed after pulp capping. Additionally, the effects of novel biocompatible materials such as iRoot BP Plus used in DPC of primary teeth, and the influence of other factors like hemostatic methods on the prognosis of affected teeth, need further exploration.

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Abstract Background Introducing artificial intelligence (AI) into the medical field proved beneficial in automating tasks and streamlining the practitioners’ lives. Hence, this study was conducted to design and evaluate an AI tool called Make Sure Caries Detector and Classifier (MSc) for detecting pathological exposure of pulp on digital periapical radiographs and to compare its performance with dentists. Methods This study was a diagnostic, multi-centric study, with 3461 digital periapical radiographs from three countries and seven centers. MSc was built using Yolov5-x model, and it was used for exposed and unexposed pulp detection. The dataset was split into a train, validate, and test dataset; the ratio was 8–1-1 to prevent overfitting. 345 images with 752 labels were randomly allocated to test MSc. The performance metrics used to test MSc performance included mean average precision (mAP), precision, F1 score, recall, and area under receiver operating characteristic curve (AUC). The metrics used to compare the performance with that of 10 certified dentists were: right diagnosis exposed (RDE), right diagnosis not exposed (RDNE), false diagnosis exposed (FDE), false diagnosis not exposed (FDNE), missed diagnosis (MD), and over diagnosis (OD). Results MSc achieved a performance of more than 90% in all metrics examined: an average precision of 0.928, recall of 0.918, F1-score of 0.922, and AUC of 0.956 (P

This study evaluated the management preferences in a deep carious vital tooth. A questionnaire was e‐mailed to members of the Turkish Dental Association. The questionnaire included a photograph and radiographs of an extremely deep carious molar (#16) of a 30‐year‐old man suffering from cold and chewing sensitivity. The dentists were asked to choose treatments for pulp exposure of <1, 1–2, and ≥2 mm and a permanent restoration. Chi‐squared test was used to analyse data (p < 0.05). 504 (4.84%) of 10 411 dentists responded. When the pulp exposure was <1 mm: direct pulp capping (84.9%); 1–2 mm: root canal treatment (49.6%); ≥2 mm: root canal treatment (85.7%) were the most preferred treatments. 69.6% of the respondents chose direct composite restorations. If the tooth would be an abutment, most respondents preferred root canal treatment, regardless of the perforation size. The extent of pulp exposure and the type of permanent restoration influenced the treatment decision‐making process. [ABSTRACT FROM AUTHOR]

Despite growing evidence supporting selective caries removal in managing deep caries, many practitioners still prefer to manage caries in a more invasive way. Although proven to be beneficial in preserving pulp vitality, there is a concern that leaving soft dentin behind will compromise the adhesion of dentin to restoration. This paper aimed to review the evidence supporting selective caries removal of deep dentin caries on primary teeth, and the arguments against the technique using a scoping review method. Various outcome parameters were applied to define and evaluate treatment success, including pulp and dentine responses, dentin micro-hardness, bacterial load of dentin under restoration, and restoration survival. A structured literature search of PubMed and Scopus databases was performed for relevant articles, using specific key words and based on a PICO-structured question: Does selective caries removal in carious deep dentin primary teeth show better results in terms of pulp exposure risk, restoration integrity, micro-hardness, and bacterial load of sub-restorative dentin compared with complete caries removal? Selective caries removal is a minimally invasive approach that evidently protects teeth from the risk of pulp exposure. Several aspects must be considered before making the clinical decision to selectively remove carious tissue in managing deep caries. All dental practitioners are expected to possess a thorough knowledge about pros and cons of selective caries removal to deliver evidence-based treatments to their patients. [ABSTRACT FROM AUTHOR]

Background : Introducing artificial intelligence (AI) into the medical field proved beneficial in automating tasks and streamlining the practitioners' lives. Hence, this study was conducted to design and evaluate an AI tool called Make Sure Caries Detector and Classifier (MSc) for detecting pathological exposure of pulp on digital periapical radiographs and to compare its performance with dentists. Methods : This study was a diagnostic, multi-centric study, with 3461 digital periapical radiographs from three countries and seven centers. MSc was built using Yolov5-x model, and it was used for exposed and unexposed pulp detection. The dataset was split into a train, validate, and test dataset; the ratio was 8–1-1 to prevent overfitting. 345 images with 752 labels were randomly allocated to test MSc. The performance metrics used to test MSc performance included mean average precision (mAP), precision, F1 score, recall, and area under receiver operating characteristic curve (AUC). The metrics used to compare the performance with that of 10 certified dentists were: right diagnosis exposed (RDE), right diagnosis not exposed (RDNE), false diagnosis exposed (FDE), false diagnosis not exposed (FDNE), missed diagnosis (MD), and over diagnosis (OD). Results: MSc achieved a performance of more than 90% in all metrics examined: an average precision of 0.928, recall of 0.918, F1-score of 0.922, and AUC of 0.956 (P<.05). The results showed a higher mean of 1.94 for all right (correct) diagnosis parameters in MSc group, while a higher mean of 0.64 for all wrong diagnosis parameters in the dentists group (P<.05). Conclusions: The designed MSc tool proved itself reliable in the detection and differentiating between exposed and unexposed pulp in the internally validated model. It also showed a better performance for the detection of exposed and unexposed pulp when compared to the 10 dentists' consensus. [ABSTRACT FROM AUTHOR]

Direct pulp capping (DPC) is reliable in pulp exposure management. Objective: This study aimed to assess the success rate of DPC materials and different laser protocols. The included procedures were CO2 laser (n = 1147), Er: YAG laser (n = 69), and 980 nm diode laser (n = 124), on the one hand, and Ca (OH)2 (n = 376) and bioactive tricalcium silicate paste, on the other (n = 279). Materials and methods: Data from 1995 DPC cases were included. For laser groups, irradiation was used to coagulate the pulp exposure followed by Ca (OH)2 placement. Data with follow-up at 12, 24, and 36 months post-treatment were included. The irradiation parameters for the CO2 laser were as follows: energy density per pulse of 141 J/cm², 1 W power, 0.3 mm beam diameter, 100 ms pulse duration, and 1 Hz, and a series of five pulses maximum were delivered during 5 s. For the 980 diode lasers: 1.5 W power, continuous wave (CW), 400 μm fiber diameter, contact mode, 190.98 W/cm2 power density, and total delivered energy density of 2387 J/cm2. For the Er: YAG laser: 0.5 W output power, 9.95 J/cm2 energy density, a beam diameter of 0.8 mm, 300 µsec pulse duration, 10 Hz, non-contact mode, irradiation with air without water spray, and an average irradiation time of 8–10 s. Results: At the 3-year follow-up, the success percentages were as follows: CO2 (88.01%) > Ca (OH)2 (75.72%) > diode (70.01%) > Er: YAG (54.55%) > bioactive tricalcium silicate paste (51.1%). The timing of permanent filling (immediate or delayed), patient age, size of pulp exposure, tooth type, and exposure etiology significantly affected the success rate. Patients aged ≤ 35 years presented higher success (70.91%) compared to those ≥ 36 years (61.2%). Immediate permanent fillings increase the success rate (71.41%) compared to delayed permanent fillings (65.93%). Exposure in molars and premolars significantly lowers the success rate (60.3%) compared to canines and incisors (72.1%). Idiopathic pulp exposure presented higher success (72.58%) compared to caries-related causes (63.7%). Conclusion: The highest success rate was in the CO2 laser group followed by the diode and Ca (OH)2, Er: YAG, and bioactive tricalcium silicate material (biodentine) groups. The age factor, filling timing, size of exposure, tooth type, and exposure etiology can significantly affect the success rate of DPC. [ABSTRACT FROM AUTHOR]

Dentists always prioritize the preservation of the dental pulp. Nowadays, minimally invasive endodontic techniques such as Vital Pulp Therapy (VPT) are considered due to their affordability and remarkable success compared to conventional treatments such as Root Canal Treatment (RCT). VPT aims at preserving healthy portions of the exposed pulp while removing the inflamed parts with biocompatible materials to seal the pulp.The present case report aimed to describe a successful VPT of a right mandibular permanent first molar with reversible pulpitis using Calcium Enriched Mixture (CEM) cement in an 18-year-old female patient. As pulp exposure happened regarding extensive caries removal, 2 mm of the inflamed pulp was removed and replaced with CEM cement. CEM was covered with Resin-modified glass ionomers (RMGI) and the tooth was restored with amalgam. Regular follow-ups were performed at 3 and 6 months and 1, 2, and 4 years after treatment.Conclusion: The tooth was clinically and radiographically functional without signs and symptoms of infection or inflammation. The result of this case suggests that pinpoint pulp exposure during deep caries excavation can be successfully treated with VPT using CEM cement.

Recently, biomimetic bioactive biomaterials have been introduced to the market for dental pulp capping. This systematic review and meta-analysis aimed to determine any variation between the effect of using TheraCal LC and other bioactive biomaterials for pulp capping is different, as measured by dentin increment and clinical success. The risk of bias was assessed using the Risk of Bias 2 and Newcastle–Ottawa tools for randomized clinical trials and observational studies. A search for relevant articles was performed on five databases. Additionally, the quality of the included studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A summary of individual studies and a meta-analysis were performed. The odds ratio of data from clinical success was combined using a random-effects meta-analysis. The meta-analysis results showed homogeneity between the studies (I2 = 0%). They revealed that the clinical success showed no differences between the patients who received TheraCal LC, light-cured calcium silicate-based biomimetic biomaterial, for dental pulp capping or the comparator biomaterials (p > 0.5). However, the certainty of the evidence was low to moderate due to the risk of bias in the included studies. [ABSTRACT FROM AUTHOR]

Objectives: To compare pulpal survival and treatment needs following selective and total caries removal in mature permanent teeth., Methods: The design was a parallel double blind, randomized clinical trial. Mature teeth with caries radiographically extending ≥ 2/3 of dentine and without spontaneous pulpitis were included. Teeth were allocated to either selective (SCR) or total caries removal (TCR) using block randomization technique. In the SCR group, caries removal to firm dentine was followed by placement of Biodentine and composite restoration. In TCR group caries removal was to hard dentine; with immediate management by vital pulp therapy (VPT) using Biodentine in case of pulp exposure. Preoperative pain levels were recorded. Teeth were followed up after 6 and 12 months. Data were analyzed using Chi square test and regression analysis., Results: 124 teeth with a diagnosis of reversible pulpitis were treated (63 in SCR, 61 in TCR). 17/ 61 teeth (28%) in the TCR had pulp exposure, managed by VPT and were successful at recall. Pulp survival was significantly higher in TCR compared to SCR at 6 months (100 % vs 93.65%, p =0.04 respectively) and at 12 months (98.4% vs 82.5, P= 0.003 respectively). Multivariate analysis revealed the type of procedure (SCR vs TCR) and the preoperative pain levels (above or below 5/10) as significant prognostic factors. The odds of failure increased significantly for teeth treated with SCR (OR 27.6, 3.6-212.4, p=0.001) and if preoperative pain levels were ≥5/10 (OR 0.2, 0.04-0.8, P=0.024)., Conclusion: Selective caries removal for deep carious lesions in mature teeth failed to reveal overt pulp exposures in more than one quarter of cases and led to significantly lower pulp survival over one year, when compared with complete caries removal and immediate VPT., Clinical Significance: In deep carious lesions of mature permeant teeth with revrsible pulpitis, total caries removal to hard dentine is recommended for a predictable pulp survival., Clinical Trial Registration: This trial was registered at CliniclTrials.gov (NCT05144711)., Competing Interests: Declaration of competing interest The authors deny any conflicts of interest related to this study., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Direct pulp capping (DPC) is reliable in pulp exposure management. Objective: This study aimed to assess the success rate of DPC materials and different laser protocols. The included procedures were CO2 laser (n = 1147), Er: YAG laser (n = 69), and 980 nm diode laser (n = 124), on the one hand, and Ca (OH)2 (n = 376) and bioactive tricalcium silicate paste, on the other (n = 279). Materials and methods: Data from 1995 DPC cases were included. For laser groups, irradiation was used to coagulate the pulp exposure followed by Ca (OH)2 placement. Data with follow-up at 12, 24, and 36 months post-treatment were included. The irradiation parameters for the CO2 laser were as follows: energy density per pulse of 141 J/cm², 1 W power, 0.3 mm beam diameter, 100 ms pulse duration, and 1 Hz, and a series of five pulses maximum were delivered during 5 s. For the 980 diode lasers: 1.5 W power, continuous wave (CW), 400 μm fiber diameter, contact mode, 190.98 W/cm2 power density, and total delivered energy density of 2387 J/cm2. For the Er: YAG laser: 0.5 W output power, 9.95 J/cm2 energy density, a beam diameter of 0.8 mm, 300 µsec pulse duration, 10 Hz, non-contact mode, irradiation with air without water spray, and an average irradiation time of 8–10 s. Results: At the 3-year follow-up, the success percentages were as follows: CO2 (88.01%) > Ca (OH)2 (75.72%) > diode (70.01%) > Er: YAG (54.55%) > bioactive tricalcium silicate paste (51.1%). The timing of permanent filling (immediate or delayed), patient age, size of pulp exposure, tooth type, and exposure etiology significantly affected the success rate. Patients aged ≤ 35 years presented higher success (70.91%) compared to those ≥ 36 years (61.2%). Immediate permanent fillings increase the success rate (71.41%) compared to delayed permanent fillings (65.93%). Exposure in molars and premolars significantly lowers the success rate (60.3%) compared to canines and incisors (72.1%). Idiopathic pulp exposure presented higher success (72.58%) compared to caries-related causes (63.7%). Conclusion: The highest success rate was in the CO2 laser group followed by the diode and Ca (OH)2, Er: YAG, and bioactive tricalcium silicate material (biodentine) groups. The age factor, filling timing, size of exposure, tooth type, and exposure etiology can significantly affect the success rate of DPC.

Background: Traumatic dental injuries involving the pulp are quite common and there is a need to evaluate the quality of evidence on the success of vital pulp treatment (VPT) interventions in traumatised permanent teeth. Objectives: The aim of this systematic review was to assess the success of VPT in the management of traumatised human vital permanent teeth diagnosed with complicated crown or crown‐root fractures. Methods: An electronic search of the following databases: Web of Science, Scopus, PubMed, MEDLINE, EMBASE, LILACS, Clinical Trial Registries and the grey literature was performed until 25th/8/2021. Controlled clinical trials, cohort studies, case‐control studies, case series with at least five cases and a minimum of 12‐months follow‐up were included. Non‐English language literature was excluded. Two independent assessors performed study selection, data extraction and quality assessment using the National Institutes of Health's quality assessment tool. Disagreements were resolved through consensus/with a third assessor. Results: A total of 14‐studies (2‐controlled clinical trials, 1‐case‐control, and 11‐case series) published between 1978–2020, with a total of 1081 permanent teeth and an age range between 6–42 years‐old were included. Bias analysis ranged considerably from 'good' to 'poor'. Meta‐analysis was not performed due to data heterogeneity, unclear reporting, and limited number of controlled clinical studies. Partial pulpotomy was the main reported clinical procedure with an overall success rate between 82.9–100%. Complete pulpotomy and direct pulp capping were associated with lower success rates of 79.4–85.7% and 19.5%, respectively. Calcium hydroxide was the main pulp capping material with favourable clinical and radiographic success (79.4–100%). Biodentine®, mineral trioxide aggregate and IRoot® BP were also associated with a high clinical and radiographic success, 80–91%, 80–100%, and 90–100%, respectively, albeit in fewer studies. Discussion: Although a high success rate has been reported when using VPT in managing pulpally involved traumatised teeth, the results of this systematic review clearly highlighted a paucity and low quality of the available evidence. Conclusions: Overall high success of VPT in the management of traumatised vital permanent teeth were reported, although based on limited evidence of well‐conducted clinical studies. Registration: PROSPERO database (CRD42020205213). [ABSTRACT FROM AUTHOR]

Background: Consensus on the treatment of choice for complicated crown fractures of teeth is limited. Recent guidance recommends vital‐pulp‐therapy; however, the preferred type is not specified. Higher success rates for pulpotomy compared to pulp‐capping have been documented, which suggests pulpotomy may be a preferable option for complicated crown‐fractures. Objectives: The purpose of this systematic review was to determine the success rate of pulpotomy (partial and complete) on teeth that suffered complicated crown fractures. Participants: patients who have suffered a complicated crown fracture to an anterior permanent tooth. Intervention: pulpotomy (partial or complete). Comparator: pulp‐capping or root canal treatment. Outcome: combined clinical and radiographic success at or after 12 months. Methods: A systematic literature using key search terms was conducted using PubMed, Web of Science and Cochrane‐Central‐Register‐of‐Controlled‐Trials (CENTRAL) as well as a grey literature search from inception to May 2021 and without language restricted to English. Strict inclusion criteria were applied. A standardized tool with defined criteria to assess the risk of bias in each study was used. For non‐randomized comparative trials, the Robins‐I tool was used while the Newcastle‐Ottawa scale was used for non‐comparative non‐randomized studies. Results: Seven retrospective clinical studies were included. The studies reported high success rates for pulpotomy with overall success ranges for partial or complete pulpotomy ranging from 75% to 96%. One study compared the success rates of pulpotomy to an alternative treatment option pulp capping (90.9% vs. 67%, respectively). Due to the lack of homogeneity in the included studies, a meta‐analysis was not possible. Discussion: This review highlights the limited evidence based for the current guidance on treatment of complicated crown fractures. The findings of the review indicate high success rates for pulpotomy; however, there is a moderate risk of bias and small sample sizes in the included studies with the result that the overall results should be interpreted with caution. Conclusion: Within the limitations of this review, the benefits and high success rates reported for partial pulpotomy suggest this procedure, rather than pulp‐capping, should be considered as the treatment of choice for both immature and mature teeth that have suffered complicated crown‐fractures. [ABSTRACT FROM AUTHOR]

Aim: To investigate attitudes and approaches of UK primary care dentists to carrying out vital pulp treatment (VPT) after carious exposure and with additional signs and symptoms indicative of irreversible pulpitis. Methodology: An electronic questionnaire was openly distributed via publicly funded (NHS) local dental committees, corporate dental service‐providers, professional societies and social media. Principally NHS practitioners and those from mixed and private practice were targeted, in addition to community and military dental officers, and dental therapists. Participants were asked questions relating to several clinical scenarios, with responses analysed using descriptive statistics. χ2 tests with sequential Bonferroni correction were used to explore variables including the method of remuneration, practitioner type (dentist/therapist), postgraduate qualification(s), place of graduation and years since qualification. Variables with a relationship p ≤.2 were selected for backwards likelihood ratio logistic modelling. Results: In total, 648 primary care practitioners were included for analysis. Calcium hydroxide (CH) was most frequently used for direct pulp caps (DPCs) (398/600; 66.3%) with calcium silicate cements (CSCs) less frequently used (119/600; 19.8%). Rubber dam was used by 222/599 (37.1%) practitioners. A definitive pulpotomy for the management of teeth with signs and symptoms indicative of irreversible pulpitis was selected by 65/613 (10.6%) dentists. The principal barrier for the provision of definitive pulpotomies was a lack of training (602/612; 98.4%). Regression analysis identified NHS practitioners as a good predictor for using CH for DPCs, having shorter emergency appointments, limited access to magnification and not using rubber dam. Non‐UK graduates were more likely to select CSCs, appropriately control pulpal haemorrhage, undertake appropriate postoperative evaluation and use rubber dam. Conclusions: Practitioners deviated from evidence‐based guidelines in a number of aspects including material selection, asepsis and case selection. A number of other challenges exist in primary care in providing predictable VPTs, including lack of time and access to magnification. These were most evident in NHS practice, potentially exacerbating existing social health inequalities. Possible inconsistencies in the UK undergraduate curriculum were supported by a lack of association between years since qualification and technique employed as well as the fact that non‐UK graduates and dentists with postgraduate qualifications adhered more to evidence‐based VPT guidelines. [ABSTRACT FROM AUTHOR]

Aim: To investigate current approaches and attitudes towards the management of deep caries in primary dental care within the United Kingdom (UK). Methodology: Open distribution of an electronic questionnaire survey was undertaken to primary care dental professionals working in publicly funded National Health Service [NHS], privately funded, military and community dental services. Demographic variables investigated included the following: place of qualification, method of remuneration, level of restorative training, materials available, years qualified, appointment length and clinician type. Management variables focussed on case‐based scenarios. Univariate analyses of responses to questions were undertaken using χ2 tests with sequential Bonferroni correction. Variables with a statistical relationship of p ≤.2 were selected for binary logistic regression modelling. Results: A total of 657 responses were received. Practitioners with formal postgraduate qualifications (PGQ) were more likely (OR, 95%CI) to undertake further tests to aid diagnosis including: gaining a patient history (1.80, 1.01–3.20), periapical radiography (1.43, 1.01–2.03), cold pulp testing (2.079, 1.46–2.97) and electric pulp testing (1.65, 1.02–2.65). Rubber dam was infrequently used for deep caries management (29.2%). Non‐NHS practitioners were much more likely to use rubber dam (3.40, 2.15–5.37), as were those that had completed PGQ (2.24, 1.48–3.38). Non‐selective caries removal was used in deep caries by 41.4% of practitioners. Indirect pulp caps were carried out by 56.7% of practitioners. NHS practitioners were more likely to place calcium hydroxide (3.74, 1.97–7.15), whilst non‐NHS practitioners were more likely to place calcium silicate cements (CSCs) (3.303, 1.71–6.38) as were non‐UK graduates (5.63, 2.47–12.86) and those with PGQ (2.12, 1.17–3.87). Conclusions: This UK survey highlights significant variation in the management of deep caries. There is lack of consensus regarding the use of a standard systematic approach to diagnosing disease, with a reliance on history and tests with poor specificity. Non‐selective caries removal for managing deep carious lesions remains common, with low rubber dam compliance underlining a lack of asepsis. Notably, a significant number of practitioners placed indirect pulp caps, but CSCs and GIC were not commonly used. At present, although clear guidelines are available this is not translating into consistent management approaches in practice, suggesting that better dissemination of current treatments is essential to undergraduate and postgraduate groups. [ABSTRACT FROM AUTHOR]

Abstract Background Pulpotomy is one of the most widely used methods in preserving vital pulp in teeth, which is of great significance in achieving continue root formation in immature permanent teeth suffering from dental caries or trauma. The aim of this meta-analysis and systemic review is to synthesize the available evidences to compare different pulpotomy dressing agents for pulpotomy treatment in immature permanent teeth. Methods Electronic databases including MEDLINE (via Pubmed), EMBASE, the Cochrane library (CENTRAL) and the clinicaltrials.gov database were searched. The references of all included articles or relevant reviews were cross-checked. Only randomized controlled trials (RCTs) comparing two or more pulp dressing agent in permanent teeth with open apex would be included. Also, the studies should have at least 6 months of follow-up, report clinical and radiographic success in detail and publish in English. Results Five RCTs were included for a systematic review, and all of them had a high risk of bias. There is little difference in success rate between mineral trioxide aggregate (MTA) and calcium hydroxide (CH) at 6-month follow-up (risk ratio (RR) 1; 95% confidence interval (CI) 0.94 to 1.06) and 12-month follow-up (RR 1.04; 95% CI 0.96 to 1.13). There is no difference between MTA versus platelet-rich fibrin and MTA versus calcium-enriched mixture (CEM). There is only weak evidence of increased success rate in using MTA and triple antibiotic paste (TAP) rather than abscess remedy. Conclusions Based on the present evidence, similar success rates with MTA were found between the dressing agents CH, CEM, RPF and TAP as pulpotomy-dressing agents in the treatment of immature permanent teeth. More high-quality RCTs are needed in this field in future studies.

Background: The aim of this study was to compare the clinical and radiographic outcomes of partial and complete caries removal (CCR) in permanent teeth with deep carious lesions. Materials and Methods: One hundred and forty-three patients of age group 14–54 years with mature permanent molars having deep carious lesions were divided into two groups: partial caries removal (PCR) and CCR. A layer of soft, wet carious dentin was left adjacent to pulpal wall in PCR group, whereas in CCR group, complete infected caries was removed with the help of caries-detector dye. Teeth were restored with composite resin (Tetric N-Ceram; Ivoclar Vivadent), with base of resin-modified glass ionomer cement (RMGIC) and patients were recalled at 1, 3, 6, 12, and 18 months. Success was defined as absence of signs and symptoms of irreversible pulpitis (spontaneous pain, fistula, and swelling) and absence of periapical alterations (radiolucency at furcal or periapical region). Results: Pulp exposure occurred in 13 (9.55%) cases of CCR group. Statistical significant difference (P = 0.001) in terms of pulp exposure was found between two groups. After 18 months, 123 teeth were evaluated (CCR = 56 and PCR = 67) and the success rate in CCR group (98.21%) and the PCR group (92.53%) did not differ significantly (P = 0.115). Conclusion: PCR could be as an elective treatment option for the mature permanent teeth with deep carious lesions.

Introduction: Treatment of mechanical exposure of the pulp during caries excavation presents a clinical challenge. In this case series of 15 patients, with a follow-up period of over a year, the outcome of direct pulp capping with Biodentine (septodont) after mechanical pulp exposure was assessed. Aim of Study: The aim of this study is to evaluate the outcome of direct pulp capping with Biodentine in deeply carious teeth when pulp was mechanically exposed during caries excavation and cavity preparation. Vital pulps exposed during caries excavation in molar teeth were treated with 3% sodium hypochlorite for 2 min. If adequate hemostasis was achieved, the pulp tissue was capped with Biodentine, which covered the entire pulpal floor. This was followed by the placement of a layer of resin-modified glass ionomer cement and a final layer of composite resin (Filtek Z350-3M) to complete the restoration. The patients were recalled periodically and evaluated for any evidence of pulpal/periapical pathology. Results: In the follow-up period that ranged from 12 to 24 months, all teeth were asymptomatic. Conclusion: Biodentine appears to be a suitable material for direct pulp capping under clinical conditions. However, long-term follow-up studies and controlled trials involving a large sample size are warranted.

Traumatic dental injury (TDI) is an unanticipated event, which has to be managed efficiently to avoid any serious consequences for the patient. Traumatic dental injury is most commonly seen in anterior teeth, main cause being sports activities, accidental fall, physical assaults, vehicle accidents. Among the TDIs crown fracture and luxation are the most common dental injuries which require proper diagnosis, treatment plan and follow up for favourable prognosis. The International Association of Dental Traumatology (IADT) has developed the guidelines for the management of these dental traumatic injuries based on literature search and professional opinion. The main objective of these guidelines is to delineate an approach for the immediate or urgent care of TDIs, while subsequent treatment requires interventions involving specialist consultations, services, and/or materials/methods not always available to the primary treating clinician. The recent IADT Guidelines 2012 has given the guidelines for management of TDI as three parts 1) fractures and luxations of permanent teeth 2) Avulsion of permanent teeth 3) Injuries in the primary dentition .Complicated crown fracture involves enamel, dentin and pulp. Treatment of such complicated fracture depends on various factors like cause of trauma, time elapsed between the occurrence of trauma and the treatment seeked for the same, condition of the oral supporting structures, root development stage, pulpal involvement, availability of fractured tooth fragments, level and position of fracture line. Recent advances in adhesive dentistry has paved the way for more conservative and esthetic approach for the treatment of crown fracture thus preserving the tooth structures. [ABSTRACT FROM AUTHOR]

This article presents the long-term follow-up of a female patient who suffered pulp exposure during removal of a large caries lesion from the mandibular right first molar. The clinical decision to perform direct pulp capping was made. The tooth was treated with 5% chlorhexidine, etched with 37% phosphoric acid, and then restored with Heliomolar composite after application of Gluma dentin adhesive. The patient was followed for more than 8 years. [ABSTRACT FROM AUTHOR]

Caries prevalence remains high throughout the world, with the burden of disease increasingly affecting older and socially disadvantaged groups in Western cultures. If left untreated, caries will advance through dentine stimulating pulpitis and eventually pulp infection and necrosis; however, if conservatively managed, pulpal recovery occurs even in deep carious lesions. Traditionally, deep caries management was destructive with nonselective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has been advocated for selective (partial) caries removal and a reduced risk of pulp exposure. Selective caries removal strategies can be one‐visit as indirect pulp treatment or two‐visit using a stepwise approach. Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy and the re‐emergence of vital pulp treatment (VPT) techniques such as partial and complete pulpotomy. These changes stem from an improved understanding of the pulp–dentine complex's defensive and reparative response to irritation, with harnessing the release of bioactive dentine matrix components and careful handling of the damaged tissue considered critical. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. Unfortunately, the changes in management are only supported by relatively weak evidence with case series, cohort studies and preliminary studies containing low patient numbers forming the bulk of the evidence. As a result, critical questions related to the superiority of one caries removal technique over another, the best pulp capping biomaterial or whether pulp exposure is a negative prognostic factor remain unanswered. There is an urgent need to promote minimally invasive treatment strategies in Operative Dentistry and Endodontology; however, the development of accurate diagnostic tools, evidence‐based management strategies and education in management of the exposed pulp are critical in the future. [ABSTRACT FROM AUTHOR]

Objective: To contribute with information on cost-effectiveness of pulp capping and root canal treatment of posterior permanent vital teeth in children and adolescents with pulp exposures due to caries.Material and Methods: Cost-effectiveness by means of a Markov simulation model was studied in a Scandinavian setting. In a simulated 12-year-old patient, treatment of pulpal exposure of a permanent tooth, either by the initial treatment pulp capping or root canal treatment, was followed for 9 years until the patient was 21. The model was based on outcome data obtained from published literature and cost data based on reference prices.Results: In the simulated case, with the annual failure probalility (AFP) of 0.034 for pulp capping, the total cost for an initial treatment with pulp capping and any anticipated following treatments during the 9 years, was 367 EUR lower than for a root canal treatment as the initial treatment. After an initial treatment with pulp capping 10.4% fewer teeth, compared with initial root canal treatment, were anticipated to be extracted. Pulp capping was thus considered to be the cost-effective alternative. The sensitivity analyses showed that the AFP of a tooth requiring a root canal treatment after an initial pulp capping needed to be 0.2 before root canal treatment may be considered being the cost-effective treatment.Conclusions: This model analysis indicated initial treatment by pulp capping to be cost-effective compared to root canal treatment in children and adolescents with pulp exposures due to caries. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the clinical and radiographic outcomes of partial and complete caries removal (CCR) in permanent teeth with deep carious lesions. Materials and Methods: One hundred and forty-three patients of age group 14–54 years with mature permanent molars having deep carious lesions were divided into two groups: partial caries removal (PCR) and CCR. A layer of soft, wet carious dentin was left adjacent to pulpal wall in PCR group, whereas in CCR group, complete infected caries was removed with the help of caries-detector dye. Teeth were restored with composite resin (Tetric N-Ceram; Ivoclar Vivadent), with base of resin-modified glass ionomer cement (RMGIC) and patients were recalled at 1, 3, 6, 12, and 18 months. Success was defined as absence of signs and symptoms of irreversible pulpitis (spontaneous pain, fistula, and swelling) and absence of periapical alterations (radiolucency at furcal or periapical region). Results: Pulp exposure occurred in 13 (9.55%) cases of CCR group. Statistical significant difference (P = 0.001) in terms of pulp exposure was found between two groups. After 18 months, 123 teeth were evaluated (CCR = 56 and PCR = 67) and the success rate in CCR group (98.21%) and the PCR group (92.53%) did not differ significantly (P = 0.115). Conclusion: PCR could be as an elective treatment option for the mature permanent teeth with deep carious lesions. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of mechanical exposure of the pulp during caries excavation presents a clinical challenge. In this case series of 15 patients, with a follow-up period of over a year, the outcome of direct pulp capping with Biodentine (septodont) after mechanical pulp exposure was assessed.Aim Of Study: The aim of this study is to evaluate the outcome of direct pulp capping with Biodentine in deeply carious teeth when pulp was mechanically exposed during caries excavation and cavity preparation. Vital pulps exposed during caries excavation in molar teeth were treated with 3% sodium hypochlorite for 2 min. If adequate hemostasis was achieved, the pulp tissue was capped with Biodentine, which covered the entire pulpal floor. This was followed by the placement of a layer of resin-modified glass ionomer cement and a final layer of composite resin (Filtek Z350-3M) to complete the restoration. The patients were recalled periodically and evaluated for any evidence of pulpal/periapical pathology.Results: In the follow-up period that ranged from 12 to 24 months, all teeth were asymptomatic.Conclusion: Biodentine appears to be a suitable material for direct pulp capping under clinical conditions. However, long-term follow-up studies and controlled trials involving a large sample size are warranted. [ABSTRACT FROM AUTHOR]

Background/purpose: The aim of this study was to evaluate the pulp–dentin response after pulp chamber perforation by ultrasonic and high-speed air-driven devices. Materials and methods: Eighteen upper incisors from nine dogs were used in this study. We prepared Class V cavity (3 × 5 mm) at the labial side after anesthesia. The pulp was then exposed/perforated by either an ultrasonic or high-speed air-driven device. We evaluated the hemorrhage condition by stopping the bleeding with varying numbers of sponge pellets. Three observation time points were set: immediate, 1 week (1-wk), and 2 weeks (2-wk). Then, we evaluated the pulp–dentin response using scanning electronic microscopy (SEM) and histological examination. Results: The bleeding level caused by an ultrasonic device presented as either no bleeding or mild bleeding, and a high-speed air-driven bur caused worse bleeding conditions. The ultrasonic group showed better response in the immediate pulpal response. In 1 week, both methods presented no pulp necrosis, and those treated using the ultrasonic device presented with a regular odontoblastic layer under SEM observations. In the 2-wk group, both methods showed no pulp necrosis, whereas the high-speed device showed partial necrosis. SEM showed pulp tissue with lacerated wounds in those who had the high-speed device treatment. Conclusion: We conclude that the ultrasonic device causes less damage to the dental pulp tissue in comparison with the high-speed air-driven bur. Moreover, we expect that the ultrasonic device can be applied to vital pulp therapy—such as direct pulp capping, pulptotomy, or pulpectomy—due to its safe approach.

Pulp exposure often leads to pulp necrosis, root fractures, and ultimate tooth loss. The repair of the exposure site with pulp capping treatment is of great significance to preserving pulp vitality, but its efficacy is impaired by the low bioactivity of capping materials and cell injuries from the local accumulation of oxidative stress. This study develops a Wnt3a-loaded hydroxyapatite nanowire@mesoporous silica (Wnt3a-HANW@MpSi) core-shell nanocomposite for pulp capping treatments. The ultralong and highly flexible hydroxyapatite nanowires provide the framework for the composites, and the mesoporous silica shell endows the composite with the capacity of efficiently loading/releasing Wnt3a and Si ions. Under in vitro investigation, Wnt3a-HANW@MpSi not only promotes the oxidative stress resistance of dental pulp stem cells (DPSCs), enhances their migration and odontogenic differentiation, but also exhibits superior properties of angiogenesis in vitro. Revealed by the transcriptome analysis, the underlying mechanisms of odontogenic enhancement by Wnt3a-HANW@MpSi are closely related to multiple biological processes and signaling pathways toward pulp/dentin regeneration. Furthermore, an animal model of subcutaneous transplantation demonstrates the significant reinforcement of the formation of dentin-pulp complex-like tissues and blood vessels by Wnt3a-HANW@MpSi in vivo. These results indicate the promising potential of Wnt3a-HANW@MpSi in treatments of dental pulp exposure., (© 2023 Wiley-VCH GmbH.)

Background and Aim: Restoration of deepdental caries without pulp exposure is usually challenging for dentists. In order to prevent pulp exposure and subsequent root canal therapy (RCT), indirect pulp capping is usually performed. Stepwise excavation (SE) is a conservative method that canreduce the incidence of pulp exposure and maintain tooth vitality without the need for RCT. Considering the high prevalence of dental caries among the Iranian population, knowledge about this treatment modality canbe beneficial for dentists . Case report : A 23 year-old patient with three deep carious lesions presented toour dental clinic. The teeth had normal responses to thermal tests and percussion. Due tothehighrisk ofpulp exposure following conventional complete excavation of caries, stepwise excavation treatment was done. Three different lining materials (calcium hydroxide, MTA, CEM cement) were used to cover the remaining caries. The teeth were restored using posterior restorative glass ionomer (Fuji9, GC, USA). The teeth were followed weekly inthe first month and then every six months up to 30 months clinically and radiographically. At30-month follow-up, the teethdid not show any sensitivity to cold or percussion,had no spontaneous nocturnal painor irreversible pulpitis symptoms and did not need RCT these signs were all indicative of asuccessful treatment .

The role of microbes and their antimicrobial susceptibilities in both acute and chronic infections of the dental pulp in humans has been well studied. Presently, no data are available on endodontic pathogens in cheetahs ( Acinonyx jubatus). The aim of this study was to isolate and identify the bacteria found in the canine teeth of cheetahs, where the pulp was necrotic and exposed due to a complicated crown fracture. Thirty-six microbiologic samples were taken from root canals (RCs) of the canine teeth of 19 cheetahs: one pulp sample was taken from 10 cheetahs, four samples from 2 cheetahs, two samples from 3 cheetahs, and three samples from 4 cheetahs. Exposed pulps were cultured for aerobic and anaerobic bacteria; an additional screening with a 16S rRNA-specific polymerase chain reaction (PCR) was used for the last six samples. Antimicrobial susceptibility of isolates was determined by use of the Kirby-Bauer diffusion test. In total, 59 cultivable isolates belonging to 19 microbial species and 13 genera were recovered from the 36 RCs sampled. Only two samples yielded no cultivable bacteria. Thirty-two (54.49%) of the cultivable isolates were Gram positive and 27 (45.71%) were Gram negative. The maximum number of isolates cultivated from an individual RC was six. Facultative anaerobes (62.72%) were the most common bacteria of the RCs that yielded cultivable bacteria. Of the isolates, 28.81% were aerobic and 8.47% were strict anaerobes. The antimicrobials that showed the greatest efficacy in vitro against the different bacteria isolates were amikacin and gentamicin. The more common bacterial species isolated by PCR were anaerobes (60.8%), facultative anaerobes (30.2%), and aerobes (8.6%). [ABSTRACT FROM AUTHOR]

Objectives: This systematic review was performed to evaluate the clinical outcome of coronal pulpotomy treatment to manage carious vital pulp exposure in permanent posterior teeth with closed root apices.Data/sources: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. A search of articles published between 1960 January and 2015 July was conducted in PubMed, EMBASE, and CENTRAL databases.Study Selection: Only studies that performed full coronal pulpotomy for carious vital pulp exposure of permanent posterior teeth and had clinical and radiographic assessments during at least one-year follow-up were qualified for data analyses. The weighted mean success rate (WSR) was the primary outcome and estimated using DerSimonian-Laird random effects model. Out of 299 articles, six studies were included for the analysis of one-year WSR, and five studies were included in the analysis of two-year WSR. The one-year and two-year WSR were 94% (95% confidence interval (CI): [90,99]) and 92% (CI: [84,100]) respectively. Differences in pulp capping and restoration materials did not significantly affect success rates (Two-year WSR in the MTA and MTA-like products group vs. the calcium hydroxide group: 92% (CI: [85,99]) vs. 88% (CI: [76,100]); the amalgam group vs. the composite group: 92% (CI: [81,100]) vs. 93% (CI: [81,100])).Conclusions: Generally, full coronal pulpotomy had a favorable success rate in treating carious vital pulp exposure of permanent mature teeth with closed root apices. More studies with control group of root canal treated teeth and longer follow-up periods are needed.Clinical Significance: Coronal pulpotomy treatment can be considered as an intermediate treatment option in managing carious vital pulp exposures of permanent teeth with closed root apices. This option may also serve as a substitute to extraction when root canal treatment cannot be performed for low income and uninsured patients or in underserved areas. [ABSTRACT FROM AUTHOR]

Introduction Endogenous cannabinoid compounds are involved in many physiological processes, including bone metabolism. Cannabinoid receptor 2 (CB2) plays a role in modulating bone density, but published research results are conflicting. Furthermore, the specific role of CB2 in inflammation-induced bone resorption and craniofacial bone density has not been reported. The objective of this study was to assess the role of CB2 in dental pulp exposure–induced periapical bone loss and mandibular bone density. Methods Adult female wild-type (WT) and CB2 homozygous knockout (KO) mice were used. Pulp exposures were created unilaterally in the mandibular first molars, and the pulp was left exposed to the oral cavity to induce periapical lesion formation. Mandibles were harvested 26 days after pulp exposure. Mandibular bone mineral density and periapical lesion volume were assessed using micro–computed tomographic imaging. Results Periapical lesion volume measured on the mesial root of the pulp-exposed first molar was significantly less in CB2 KO than WT mice ( P < .05). No significant difference was detected between KO and WT mice in the size of the PDL space measured on the mesial root of the contralateral intact first molar. CB2 KO mice exhibited greater mandibular bone density than WT mice ( P < .05). Conclusions CB2 plays a role in mandibular bone metabolism. Increased bone density in CB2 KO mice may contribute to the smaller periapical lesion size observed after pulp exposure in KO compared with WT mice. Additional experiments are needed to further elucidate the function of CB2 and clinical implications of cannabinoids on bone and periapical pathosis. [ABSTRACT FROM AUTHOR]

This study was conducted to assess association between clinical and radiographic exposure of the pulp in class II carious lesion in first permanent molars. This observational study was carried out in the Operative Department of Bahria Dental College during the period of January -December 2014. Two hundred fifty eight patients with class II carious lesion were examined clinically and radiographically to confirm either pulp was involved or not by a single operator. Data were entered in SPSS (statistical packages of social science, version 17) for descriptive analysis and to check statistically significant relationship between clinical and radiographic pulp exposure. There were 154 males and 104 females. Frequency of left mandibular first molars was 52.7%, high among all molars. This study showed, out of 258 patients, 150 had exposed pulp on clinical examination and 108 were not having exposed pulp on clinical observation. Radiographic analysis of same teeth showed different result. Out of 258 patients, 216 had pulp exposure on radiograph and 42 teeth did not have pulp exposure. About pulp exposure, significant relationship was found between clinical and radiographic examination with p-value 0.000. [ABSTRACT FROM AUTHOR]

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]

Conventionally, few-days-old pulp exposures have been treated with root canal treatment. We report four cases of traumatized, fully matured, maxillary permanent central incisors, which have been treated by Biodentine pulpotomy several days after traumatic pulp exposure. Biodentine pulpotomy consisted of pulp tissue removal to a depth of 2 mm, then capping the pulpal wound with Biodentine, followed by immediate restoration. The teeth were assessed clinically through pulpal sensitivity tests and radiographically for periapical healing. At each recall (24 hours, 1 week, 30 days, 3, 6, 12, and 18 months), no spontaneous pain was observed; the pulp showed signs of vitality and absence of periapical radiolucency after 18 months. Biodentine pulpotomy is recommended as a treatment option for cases of vital pulp exposure in permanent incisors due to trauma. [ABSTRACT FROM AUTHOR]

Aim To compare the treatment outcomes when calcium hydroxide and mineral trioxide aggregate are used for partial pulpotomy in cariously exposed young permanent molars in a randomized control trial. Methodology Eighty-four teeth in 80 volunteers (aged 7-10 years) with reversible pulpitis and carious pulp exposures were randomly divided into two groups. Exposed pulps were severed using high-speed round burs until fresh pulp was seen. Cavities were irrigated with 2.5% sodium hypochlorite, and the pulp exposures were photographed and measured. Dycal or ProRoot MTA was placed on the pulp. Vitremer was placed over the material until the remaining cavity was 2 mm deep; amalgam was then placed. Teeth were evaluated for clinical symptoms and radiographic periapical changes after 24 h, 3 months, 6 months, 1 year and 2 years. Mean survival times and incidence of extraction were calculated using exact binomial confidence intervals. Results The median survival time for both ProRoot MTA and Dycal groups was 24 months. Three teeth had unfavourable outcomes with the incidence rate of 0.20/100 tooth-months with ProRoot MTA (95% CI: 0.02-0.71) and 0.11/100 tooth-months with Dycal (95% CI: 0.001-0.60). The incidence of unfavourable outcomes was 0.05/100 (95% CI: 0.001-0.30) and 2.38/100 (95% CI: 0.29-8.34) tooth-months in teeth with small (<5 mm2) and large (>5 mm2) pulp exposure areas, respectively. Conclusions Partial pulpotomy in teeth of young patients with reversible pulpitis, either using ProRoot MTA or Dycal, resulted in favourable treatment outcomes for up to 2 years. The incidence of unfavourable outcomes tended to be higher in teeth with pulp exposure areas larger than 5 mm2. [ABSTRACT FROM AUTHOR]

Traumatic dental injuries ( TDIs) are a serious public health problem. Epidemiology of dental trauma indicates that these injuries are more prevalent in child population of the world. Children are the sufferers in two-thirds of all TDIs observed. Although being a major fraction, crown-related fractures are a less severe form of TDIs with respect to their complications and sequelae. However, as with other types of traumatic injuries, the delay in seeking for immediate care following a traumatic injury and the lack of appropriate treatment may compromise long-term outcomes. This article reviews the occurrence, management, and prognosis of crown-related fractures in primary and permanent teeth in light of the recent literature. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Cannabinoid receptor 2 (CB2) is an intriguing target for the treatment of pain because of its ability to mediate analgesia without psychoactive effects, but little is known about the role of CB2 in pain of endodontic origin. The purpose of this study was to determine the behavioral effects of dental pulp exposure in wild-type (WT) mice and to explore the contribution of CB2 to these behaviors using CB2 knockout (CB2 KO) mice. Methods: Pulp exposures were created unilaterally in the maxillary and mandibular first molars of female WT and CB2 KO mice. The open field test was used before pulp exposure or sham surgery, and postoperatively at 1 day, 1 week, 2 weeks, and 3 weeks. Mouse body weight and food consumption were recorded preoperatively and postoperatively at 1 day, 2 days, and 1 week. Results: At baseline, CB2 KO mice weighed significantly more and had significantly greater food intake than WT mice. CB2 KO mice exhibited greater anxiety-like behavior in the baseline open field test, having significantly fewer center crossings and less distance traveled than WT mice. Pulp exposure had relatively little effect on the behavior of WT mice. CB2 KO mice with pulp exposures showed a decrease in food intake and body weight after surgery, and pulp exposure resulted in significantly fewer center crossings in the open field test in CB2 KO mice. Conclusions: Pulp exposure in CB2 KO mice resulted in behaviors consistent with an increase in pain and/or anxiety. [Copyright &y& Elsevier]

Abstract: Objectives: The best possible methods and materials in stepwise excavation for deep caries in permanent teeth were investigated. The review considers the questions from many aspects including clinical success, effects of reducing cariogenic bacteria, possibility of hardening softened dentin, and likelihood of generating tertiary dentin. Data: This systematic review includes the use of data from randomized controlled trials, controlled clinical trials as well as from case series in which pulp exposure resulted following the treatment and removal of deep caries. Only studies of caries in permanent teeth were considered. Those involving treatment of primary teeth were excluded. Sources: An electronic search was conducted in the databases of MEDLINE and Igaku Chuo Zasshi (Japanese) from 1970 to 2008. The electronic search was supplemented by a manual search of the references lists of all the relevant studies. Study selection: The electronic and manual searches of journals retrieved a total of 266 English and 130 Japanese papers. According to the inclusion and exclusion criteria, 10 English and 3 Japanese studies were finally identified. Conclusion: Our research suggests that stepwise excavation is effective for pulp preservation in extremely deep caries that do not show clinical symptoms of irreversible pulpitis. Calcium hydroxide, as well as antimicrobials and polycarboxylate cement combined with tannin-fluoride preparation, is effective in reducing bacteria and promoting remineralization of the carious dentin that remained after stepwise excavation. Further clinical trials with a high level of study design should be conducted to identify the best methods of removing carious dentin using stepwise excavation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine whether 1- or 2-visit indirect pulp therapy (IPT) is more successful and to determine if the operator can successfully decide when to stop removing caries without exposing the pulp. Methods: A total of 154 teeth (94 primary second molars and 60 young permanent first molars) were included in the study from a total of 123 4- to 15-year-old patients. The teeth had deep carious lesions but lacked the preoperative signs and symptoms of irreversible pulpitis. The teeth were randomly selected and treated either with 1-visit IPT, 2-visit IPT, or direct complete excavation (DCE). Follow-up examinations were conducted on the teeth over I year at 3-month intervals. Results: The pulp was exposed in 12 teeth (22%) treated by DCE, whereas 3 teeth (6%) were treated by 1-visit IPT and 4 teeth (8%) with 2-visit IPT. A statistically significant difference was found between IPT and DCE groups in terms of pulp exposure (P<.05). The teeth without pulp exposure showed normal clinical and radiographic conditions during the 1-year follow-up, except for 3 primary teeth. Conclusions: Indirect pulp therapy in both primary and young permanent teeth can be used successfully with a 1- or 2-visit approach. [ABSTRACT FROM AUTHOR]

Bjørndal L, Reit C, Bruun G, Markvart M, Kjældgaard M, Näsman P, Thordrup M, Dige I, Nyvad B, Fransson H, Lager A, Ericson D, Petersson K, Olsson J, Santimano EM, Wennström A, Winkel P, Gluud C. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. Eur J Oral Sci 2010; 118: 290–297. © 2010 The Authors. Journal compilation© 2010 Eur J Oral Sci Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (−22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended. [ABSTRACT FROM AUTHOR]