Dentin Bridge Research Articles

Comparative efficacy of materials used in patients undergoing pulpotomy or direct pulp capping in carious teeth: A systematic review and meta-analysis.

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

Clinical-therapeutical management of exposed pulp and incomplet apexogenesis: Cases reports

The study of bioactive materials, such as MTA cement, and the availability of this material to clinical professionals are an important step towards conservative treatments, however the using technique of this material is still restricted to practitioners in the field of endodontics. Case reports with short, medium and long-term follow-up are significant data for a reproducible, low-cost technique that is well accepted among professionals. Here we present two case reports with the application of bioactive cements in a tooth with pulp exposure and in another one with deep carious lesion, pulp exposure and open apex. In both cases, definitive restoration was performed in the same visit with favorable prognosis and without the need of endodontic treatment. After one year follow-up, it is underlined the dentin bridge formation in the region of pulp exposure in both cases and complete maturation of the apex in the second case.

Clinical and Radiographic Outcomes of Mineral Trioxide Aggregate Pulpotomies in Vital Permanent Teeth with Carious Pulp Exposure: A Pioneering Retrospective Study.

Vital partial pulpotomy (PP) or cervical pulpotomy (CP) in carious pulp-exposed permanent teeth preserves tooth vitality, promotes pulp healing, decreases treatment costs, and shortens treatment duration, which is a significant factor in treating noncooperative children. The aim of this retrospective study was to compare clinical and radiographic outcomes of partial and CP in vital carious-exposed permanent teeth. All vital permanent teeth with carious pulp exposure, treated by pulpotomy using mineral trioxide aggregate (MTA) during 2017-2019, by two operators in one dental center, were included in the study. Around 118 permanent teeth in 97 children and adolescents (mean age 10.9 years) were evaluated 6-57 months postoperatively. The total success rates of CP and PP were 82.5 and 80.8%, respectively (p = nonsignificant). The only factor that significantly affected the success rate was the presence of preoperative periapical pathology. Teeth without such pathology showed an 87.3% success rate compared to 74.1 and 58.3% in teeth with preoperative enlarged periodontal ligament (PDL) or with periapical radiolucency, respectively (p = 0.0301). Demographic variables, maturation state of the tooth, type of tooth (incisor, premolar, molar), postoperative variables, such as the presence of radiographic dentinal bridge, partial or full obliteration of the pulp during the follow-up period, and the integrity of the final restoration during the recall examinations did not affect the success rate of the treatment. Partial and CP in vital permanent teeth with carious pulp exposure in children and adolescents might be a reliable alternative to full root canal treatment (RCT). Yoshpe M, Kaufman AY, Lin S, et al. Clinical and Radiographic Outcomes of Mineral Trioxide Aggregate Pulpotomies in Vital Permanent Teeth with Carious Pulp Exposure: A Pioneering Retrospective Study. Int J Clin Pediatr Dent 2023;16(4):555-559.

Nano eggshell based slurry as a direct pulp capping material: In vitro characterization and histopathological assessment in an experimental animal model.

Pulp vitality is essential for tooth integrity. Following pulp exposure, choosing a suitable pulp capping material is crucial to maintain pulp vitality. However, the reparative dentine bridge created by calcium hydroxide is generally porous and incomplete. To assess the in vitro and in vivo bioactivity of nano eggshell-based slurry (NES), using NES as direct pulp capping material, compared with calcium hydroxide (Ca(OH)2 ) in rabbit animal model. Nano eggshell powder (NE) was characterized for particle morphology, chemical composition, and ion release. In vitro bioactivity was tested by immersion in simulated body fluid (SBF) for 7 days. For histopathological evaluation, 36 adult New Zealand rabbits (72 pulp exposures) were divided into nine groups (n=8) according to the pulp capping material (NES, Ca(OH)2 and no capping as negative control group) and the animals were sacrificed after 7, 14 or 28 days. The pulps of the two lower central incisors were exposed then directly capped by Ca(OH)2 or NES, or left untreated. The cavities were then sealed with a glass ionomer cement. Teeth were collected for histopathological evaluation using optical microscope. Pulp haemorrhage, inflammation, fibrosis and calcific bridge formation were assessed. Results were statistically analyzed using ANOVA and Tukey's test. NE particles were spherical with 20 nm diameter and were composed mainly of calcite. Statistical analysis showed that there was significant increase in the release of all investigated ions between day 1 and 28, except for copper. NES group showed significantly higher release of all elements as compared to Ca(OH)2 . ESEM micrographs of NES incubated for 7 days in SBF showed the formation of HAp with Ca/P ratio (1.686). For histopathological evaluation, the difference between groups was statistically significant. At day 28, 75% of the pulps of Ca(OH)2 group showed mild calcific bridge in comparison with 100% moderate calcific bridge in NES group. The NES group showed significantly less inflammation at days 7 and 28, and higher fibrosis at day7 as compared with Ca(OH)2 . NES represents a promising novel direct pulp capping material with favourable pulp tissue response.

Outcome of Partial Pulpotomy in Immature Permanent Teeth with Symptomatic Irreversible Pulpitis: A Prospective Case Series Assessment

IntroductionThe aim of this prospective case series was to assess the clinical and radiographic outcome of partial pulpotomy in caries-exposed symptomatic, vital, immature, permanent molars. MethodsThirty-four immature molars with deep caries and symptoms of irreversible pulpitis were treated by partial pulpotomy and ProRoot MTA as a capping material. After complete caries removal, the inflamed part of the pulp was removed. Complete hemostasis was achieved using a sterile cotton pellet moist initially with sodium hypochlorite 1.5% and then with sterile saline. ProRoot MTA (Dentsply Sirona, Charlotte, NC) was placed as a capping material onto the remaining pulp tissue. The cavity was sealed using a light-curing resin-modified Ca(OH)2 cavity liner, and patients were referred to a pediatric dentist for permanent restoration. Descriptive statistics and cross tabulations were performed including variables examined before, during, and after the procedure. ResultsAll examined teeth presented a favorable clinical and radiographic outcome with normal periapical tissues, complete apical closure, and formation of a dentinal bridge beneath the capping material. Signs of partial pulp chamber calcification were only detected in 2 cases. Postoperatively, most patients did not report any pain (23/34, 67.7%), whereas the rest reported minor intensity pain (11/34, 32.3) and the use of analgesic or anti-inflammatory drugs only for 1 day (10/34, 29.4%). ConclusionsPartial pulpotomy seems to provide a universally successful outcome when managing symptomatic vital immature teeth with no signs of complications and completion of apical closure. It could be a viable treatment of choice in cases of caries-exposed vital immature teeth with symptoms of irreversible pulpitis.

Inflammatory Response and Odontogenic Differentiation of Inflamed Dental Pulp Treated with Different Pulp Capping Materials: An In Vivo Study.

Previous studies have evaluated the pulpal responses to calcium silicate cements (CSCs) on normal dental pulp, but investigations on the effects of CSCs on inflamed pulp are limited. This study aimed to test the inflammatory response and odontogenic differentiation of inflamed rat dental pulp after direct pulp capping with CSCs. Wistar rat molars pulps were exposed for 48 hours to induce inflammation and then capped with ProRoot MTA (Dentsply, Tulsa, OK, USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), RetroMTA (Bio MTA, Seoul, Korea) and Dycal (Dentsply Caulk, Milford, DE, USA). The degree of pulpal inflammation and hard tissue formation was evaluated by histological analysis. Immunofluorescence staining for interleukin (IL)-6, osteocalcin (OCN), and runt-related transcription factor 2 (RUNX2) was also performed. After 4 weeks, complete recovery from inflammation was evident in 22%, 37.5%, 10%, and none of the ProRoot MTA, Biodentine, RetroMTA and Dycal samples, respectively. Heavy hard tissue deposition as a continuous hard tissue bridge was observed in 77.8%, 75%, 70%, and 60% of the ProRoot MTA, Biodentine, RetroMTA, and Dycal samples, respectively. IL-6, OCN, and RUNX2 were detected in all materials, mainly adjacent to areas of inflammation and reparative dentine formation. At 1, 2, and 4 weeks, significant differences were not observed between the inflammation and hard tissue formation scores of the four material groups (P > .05). In this study, pulpal inflammation was still present in most specimens at 4 weeks after pulp capping and a significant number of samples showed incomplete and discontinuous dentine bridge formation. The results of this study suggest that initial inflammatory conditions of the pulp may risk the prognosis of teeth treated with CSCs.

Histologic comparison of formocresol, platelet-rich fibrin, and hesperidin in pulpotomy: A randomized trial in dogs.

To histologically assess and compare formocresol (FC), platelet-rich fibrin (PRF), and hesperidin (HPN) as pulpotomy agents in dogs. Pulpotomy was attempted from the buccal surface (class V) of 48 teeth in three mongrel dogs (Canis Lupus). Cavities were randomly allocated for three groups (n = 16) according to the pulpotomy agent used; (group I: FC (control), group II: PRF, and group III: HPN). All cavities were then sealed with zinc oxide eugenol followed by resin-modified glass ionomer restoration. Two months later, dogs were euthanized; the specimens were obtained and prepared for histological assessment followed by statistical analysis. HPN specimens showed the best dentin bridge formation and the least inflammatory signs and pulp disorganization. Followed without statistically significant difference by PRF (P ≥ 0.05). Both of HPN and PRF, however, showed a significant difference statistically (P ≤ 0.05) to FC that showed no dentin bridging with more pronounced inflammation, necrosis, and pulp disorganization. For pulpotomy, HPN and PRF seemed histologically to be good substitutes for FC in the dog model.

The effect addition of epigallocatechin-3-gallate (EGCG) in nano hydroxyapatite on surface porosity as a candidate pulp capping materia

Background: Deep caries, cavity preparation and use of burs or other dental instruments often result in pulpal perforation. In the case of an exposed pulp, regenerative pulp tissue treatment aims to regenerate normal tissue and maintain pulp vitality by inducing pulp regeneration using the right material, so that a good percentage and size of material porosity is needed to help cell regeneration by supporting cell proliferation and attachment, stimulating remineralization and differentiation of odontoblast-like cells. Nano-HA has the ability to produce dentine bridges continuously, has porous properties that allow cell growth, improves mechanical properties, but is not anti-inflammatory so that EGCG is added which has the advantage of being an antioxidant, anti-inflammatory which can optimize pulp tissue regeneration and also acts as an antimicrobial by reduce the growth of bacteria in the oral cavity and can trigger the proliferation and differentiation of human dental pulp cells. Purpose: This study aims to prove the difference in surface porosity of nano hydroxyapatite added with EGCG compared to nano hydroxyapatite and aquadest. Methods: This study used a laboratory experimental study with a posttest-only control group design. The research sample consisted of 32 samples which were divided into 2 groups, the treatment group (nano HA - EGCG) and the control group (nano HA - aquadest). Each research group was subjected to freeze drying and SEM tests. Results: There was a significant difference in the percentage of surface porosity between the nano hydroxyapatite added with EGCG compared to nano hydroxyapatite and aquadest.on the results of the Independent T-test (p<0.05). Conclusion: The addition of EGCG to nano hydroxyapatite has a higher porosity percentage compared to nano hydroxyapatite with aquadest.

Evaluation of the pulp response following direct pulp capping with exogenous nitric oxide and Mineral Trioxide Aggregate (MTA) a histologic study

BackgroundRecently, vital pulp therapy is widely used all over the world. It aims to maintain the viability and function of the injured dental pulp tissue. Direct pulp capping is recognized as one of the most common used techniques in this approach. Aim of the studywe aimed to compare the histopathological response of the dental pulp following direct pulp capping using two different capping materials; the exogenous nitric oxide (NOC-18) and Mineral Trioxide Aggregate (MTA) in dogs’ teeth. Methods and materialsThe pulp of thirty-two premolars and canines from four dogs (eight teeth per each dog) the pulp was exposed and treated with either exogenous nitric oxide (NOC-18) and MTA (four teeth in each group). The treated teeth were extracted and prepared for histologic evaluation after one month and three months, respectively. The histologic study evaluated the formation of dentine bridge, the degree of pulpitis, calcification of the coronal pulp tissue and odontoblasts layer activity. We have the ethical approval to achieve this research from the scientific committee in Faculty of Dentistry, Damascus University. ResultsThe results showed that the active statue of odontoblasts layer in NOC-18 group was significantly more than in MTA group after a month of recall (P: 0.003). No significant difference was found between MTA and NOC-18 categories in the formation of dentine bridge after 3 months (P: 1.000). ConclusionExogenous nitric oxide (NOC-18) maybe has a positive impact on formation of calcified bridge and efficacy of odontoblasts layer on directly capped dog's teeth. Exogenous NO donors might offer alternative to current pulp capping agents in Vital Pulp Therapy in endodontic.

Calcium Hydroxide Pulp Capping Agent: An Overview on Composition, Properties, and Clinical Applications

Calcium hydroxide is a commonly used material in pulp capping procedures due to its favourable biological properties, including the ability to promote dentin bridge formation and stimulate reparative dentinogenesis. The mechanical properties of calcium hydroxide, including its compressive strength, flexural strength, and wear resistance, are relatively low, but they are not critical properties in pulp capping procedures. However, the composition and formulation of calcium hydroxide can vary depending on the manufacturer, and this can affect the material's physical and chemical properties, as well as its handling characteristics. Despite these variations, calcium hydroxide remains a popular choice for pulp capping due to its favourable biological properties and its long-standing history of use in dental procedures.

Evaluation of Direct and Indirect Pulp Capping With Biodentine in Vital Permanent Teeth With Deep Caries Lesions.

Pulp capping is a procedural method of preserving pulp vitality following deep caries damage or accidental pulp exposure. Biodentine is a calcium silicate material that has been promoted for use in pulp capping among various clinical applications. This study evaluated the outcome of pulp capping with Biodentine following curettage of deep caries in the case series of permanent mature teeth. The study was carried out on 40 teeth with advanced caries treated by direct and indirect pulp capping using Biodentine, within a follow-up of six months. This was carried out at the Department of Conservative Dentistry-Endodontics of the CCTD Ibn Rochd-Casablanca. Results: In this study, 43 teeth from 37 patients were treated with direct pulp capping and indirect pulp capping using Biodentine. The success rate of pulp capping was 90% at one month, 85% at three months, and 80% at six months. The results of the studies conducted using Biodentine indicate that it is a suitable material for direct and indirect pulp capping, due to its bioactivity and ability to form a dentinal bridge.

Potential Combination of Acemannan Sponge and Calcium Phosphate Cement-Calcium Sulfate Hemihydrate (CPC-CSH) as Direct Pulp Capping Alternative Materials for Reparative Dentin Formation

Abstract Background Health problem that affects hard tissues of the teeth is dental caries, which is experienced by around 2.3 billion people in the world, with prevalence in Indonesia reaching 88.8. Direct pulp capping (DPC) is a vital pulp therapy used to maintain pulp vitality. Calcium hydroxide (Ca(OH)2) is the gold standard pulp capping material, but has poor adhesion to dentin and mechanical properties, bacterial infiltration, formation of tunnel defects in the pulp resorption, and dentin bridge. Therefore, it is necessary to develop alternative therapy, namely, a combination of acemannan sponge and calcium phosphate cement (CPC)-calcium sulfate hemihydrate (CSH) for reparative dentin formation. Purpose This article describes the potential combination of acemannan sponge and CPC-CSH as DPC alternative materials for reparative dentin formation. Reviews Acemannan extracted from aloe vera exhibits anti-inflammatory, antimicrobial, and cytocompatibility properties. As DPC material, acemannan induces pulp proliferation and differentiation to osteoblast-like, growth factor synthesis, and promotes reparative dentin formation. However, acemannan sponge is radiolucent, allowing misinterpretation between pulp and acemannan sponge. CPC can be combined with CSH to shorten the setting time. CPC-CSH is radiopaque, has good compressive strength, and biocompatibility. CPC-CSH is a calcium-based material with neutral pH that can induce the dentin bridge formation. CPC-CSH showed good bioactivity because it induces the formation of apatite which plays a significant part in dentin and pulp regeneration. Conclusion The combination of acemannan sponge and CPC-CSH has the potential as DPC alternative materials for reparative dentin formation.

Multifunctional and biodegradable methacrylated gelatin/Aloe vera nanofibers for endodontic disinfection and immunomodulation

Currently employed approaches and materials used for vital pulp therapies (VPTs) and regenerative endodontic procedures (REPs) lack the efficacy to predictably achieve successful outcomes due to their inability to achieve adequate disinfection and/or lack of desired immune modulatory effects. Natural polymers and medicinal herbs are biocompatible, biodegradable, and present several therapeutic benefits and immune-modulatory properties; thus, standing out as a clinically viable approach capable of establishing a conducive environment devoid of bacteria and inflammation to support continued root development, dentinal bridge formation, and dental pulp tissue regeneration. However, the low stability and poor mechanical properties of the natural compounds have limited their application as potential biomaterials for endodontic procedures. In this study, Aloe vera (AV), as a natural antimicrobial and anti-inflammatory agent, was incorporated into photocrosslinkable Gelatin methacrylate (GelMA) nanofibers with the purpose of developing a highly biocompatible biomaterial capable of eradicating endodontic infection and modulating inflammation. Stable GelMA/AV nanofibers with optimal properties were obtained at the ratio of (70:30) by electrospinning. In addition to the pronounced antibacterial effect against Enterococcus faecalis, the GelMA/AV (70:30) nanofibers also exhibited a sustained antibacterial activity over 14 days and significant biofilm reduction with minimal cytotoxicity, as well as anti-inflammatory properties and immunomodulatory effects favoring healing. Our results indicate that the novel GelMA/AV (70:30) nanofibers hold great potential as a biomaterial strategy for endodontic infection eradication and enhanced healing.

303 Investigation of the antibacterial and regenerative properties of a novel AHA dental coating for the treatment of deep caries

OBJECTIVES/GOALS: Our objective is to investigate the antibacterial and regenerative properties of a novel AHA dental coating for the prevention and treatment of deep caries (cavities). Further, we aim to investigate and compare these properties through in vivo murine models and assessment on human saliva samples and human pulpal cells collected from clinical samples. METHODS/STUDY POPULATION: In vitro antibacterial studies were performed by collecting and culturing human salivary bacteria with AHA substrates and quantifying survival of cariogenic Sm (S. mutans). In vivo, C57BL/6 mice were treated with AHA composite fillings, infected with Sm clinical isolates, and fed a high sucrose diet with cavity formation assessment after 6 weeks. To evaluate regeneration, mice were similarly given composite with AHA or MTA (standard of care) upon pulpal exposure with regeneration quantified by microCT and histological analysis of dentin bridge formation, ALP production, and odontoblast migration. In vitro, AHA substrates were cultured with MC3T3-E1 pre-osteoblast cells and dental pulp stem cells obtained from clinical samples over 21 days, with mineralization and ALP assessed indicating osteogenesis. RESULTS/ANTICIPATED RESULTS: In vivo studies have shown the reduction of cavity formation in mice treated with AHA as well as dentin regeneration upon pulpal exposure using microCT and histological image analysis. Coinciding with these findings, AHA substrates eradicated cariogenic Sm in human saliva samples and single species cultures in vitro. Further, preliminary results in vitro have shown increased mineralization of MC3T3-E1 cells when cultured with AHA substrates in comparison to uncoated substrates. We anticipate similar increased mineralization as well as increased ALP production of human pulpal stem cells from clinical samples when cultured with AHA substrates, suggesting osteogenesis. Further, we anticipate increased odontoblast migration and ALP production upon additional analysis of in vivo tissue samples. DISCUSSION/SIGNIFICANCE: This work will elucidate the antibacterial and regenerative properties of AHA dental coatings. These results further support the translation of AHA coatings into the clinic as a novel therapeutic for the prevention and treatment of dental decay, which may overcome the limitations associated with the current treatments.

Histopathological and immunohistochemical profiles of pulp tissues in immature dogs’ teeth to two recently introduced pulpotomy materials

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

SVCT2-GLUT1-mediated ascorbic acid transport pathway in rat dental pulp and its effects during wound healing

Ascorbic acid (AA; vitamin C) plays a crucial role in the biosynthesis and secretion of collagen to produce the organic matrix of hard tissues. Nevertheless, the detailed mechanism by which AA induces reparative dentinogenesis is still unknown. This study aimed to investigate the pathway and function of AA during wound healing in a rat pulpotomy model. Sodium-dependent vitamin C transporter (SVCT) 2 and glucose transporter (GLUT) 1 were detected in odontoblasts, endothelial cells, and nerve fibers in normal pulp tissues. SVCT2 and GLUT1 were also expressed in odontoblast-like cells in pulpotomized tissues of Wistar rats, and immunopositive cells of SVCT2 were significantly increased at 5 days after pulpotomy (p < 0.05). By contrast, osteogenic disorder Shionogi (ODS) rats, which cannot generate AA, also expressed SVCT2 and GLUT1 in normal and wound healing conditions. However, in ODS rats, when compared with the AA-addition group, the formation of dentin bridges in the AA-loss group was not evident, a layer of osteopontin was significantly increased beneath the wound surface (p < 0.05), and alpha smooth muscle actin at the odontoblast-like cells observed along this layer was significantly increased (p < 0.05), but not Nestin. Moreover, the amounts of type 1 collagen generated in the reparative dentin and beneath the wound healing site were significantly diminished (p < 0.05). Macrophages expressing CD68 and CD206 increased beneath the wound site. Hence, AA may be involved in odontoblast-like cell differentiation and anti-inflammatory response during dental pulp wound healing. Our results provide new insights into the function of AA through SVCT2 and GLUT1 in reparative dentinogenesis and may help in developing new therapeutic targets for dental pulpal disease.

Wnt3a promotes odonto/osteogenic differentiation in vitro and tertiary dentin formation in a rat model.

To investigate the effect of Wnt3a on odonto/osteogenic differentiation of stem cells isolated from human exfoliated deciduous teeth (SHEDs) and reparative dentine formation in a rat model. Stem cells isolated from human exfoliated deciduous teeth were cultured in media with Wnt3a (50-200 ng/ml). Wnt activation was confirmed by β-catenin immunocytochemistry. Colony-forming unit assay (normalized percentage area), osteogenic gene expression analysis by real-time polymerase chain reaction and mineralization assays measured by the absorption at 540 nm were performed. Tertiary dentine formation in vivo was evaluated using 8-week-old, male Wistar rats. Cavities with pinpoint pulp exposure by a sharp instrument were prepared at the mesial surface of the first molars. Teeth were divided into (n=6): (1) distilled water (negative control), (2) phosphate-buffered saline (PBS), (3) lithium chloride in DI (20 μM), and (4) Wnt3a in PBS (200 ng/ml). Collagen sponge was used as a scaffold. The cavity was sealed with glass ionomer restoration. Four weeks later, animals were euthanized by sodium pentobarbital (120 mg/kg body weight). Hard tissue formation was evaluated using micro-computerized tomography. Sixty consecutive slides from the initial plane were analysed and calculated as bone/dentine volume per total tissue volume. Paraffin sections (2μm) were stained with haematoxylin and eosin and Masson's trichrome for morphological evaluation. Data are presented as the mean ± standard error. Mann-Whitney U test was used for two-group comparison. Kruskal Wallis followed by pairwise comparison was employed for three or more group comparisons. Statistical analysis was performed using GraphPad Prism 7. Differences were considered significant at p < .05. Wnt3a decreased SHEDs colony formation and increased OSX, BMP2, and DMP1 expression, corresponding to an increase in mineralization. Additionally, a significant increase in dentine/bone volume per total tissue volume was observed in Wnt3a treated defects. Dentine bridge formation at the exposure sites treated with Wnt3a demonstrated, while fibrous tissues were observed in the control. Wnt3a suppressed proliferation, increased osteogenic differentiation of SHEDs and promotes tertiary dentine formation. Wnt3a could be utilized as biological molecule for vital pulp therapy.

A histopathological comparison of formocresol, propolis, and growth factor as pulpotomy medicaments in primary teeth: An in vivo study

Pulpotomy is the most common pulp treatment of primary molars, where surgical amputation of infected coronal pulp results in preserving the vitality and function of radicular pulp. With introduction of newer materials, the emphasis has shifted towards regeneration, in this scenario; novel materials such as platelet derived growth factor (PDGF) and propolis (PS) have been considered. This was a single-blind in vivo study; ninety human primary teeth from children aged between 5 and 10 years were divided into three equal groups in whom pulpotomy procedure was performed and they were recalled after 3- and 6-month interval for histological evaluation. Observations were subjected to statistical analysis using Pearson's Chi-square test. No statistically significant difference was found between the three materials with respect to inflammatory response, soft-tissue organization, and dentin bridge formation (P > 0.05). Majority of the samples in both growth factor and propolis exhibited dentin bridges at the interface of the exposed pulp, bringing or attempting to bridge the site exposed to the pulpotomy material. The ability of the material to evoke a foreign and inflammatory cell response in the pulpal tissue was not significant. The samples of both formocresol and growth factor group showed signs of pulpal necrosis which revealed the presence of a mild necrotic zone in one specimen at 3 months. One specimen from the propolis group showed mild areas of necrosis at the end of 6 months, where none of the specimens in the growth factor group showed areas of necrosis at the end of 6 months. The results of the present study showed a positive outcome for growth factor and propolis groups. Further clinical trials with a larger sample size and long-term review have to be conducted for the material to be used widely.

Tampon Vital Pulp Therapy in the Management of Excessive Haemorrhage in Inflamed Pulps: A Hypothesis.

Current principles in vital pulp therapy (VPT) modalities emphasise the importance of haemostasis and normal clotting in the achievement of successful treatment outcomes. However, the aforementioned notion could be challenged by the new and recent emerging evidence; suggesting that prolonged or excessive bleeding/haemorrhage (PB) in cases of intensly inflamed pulps, conventionally infamous as irreversible pulpitis (IP), may not impede the healing potential of the remaining dental pulp tissue following VPTs using endodontic biomaterials. "Tampon VPT (tVPT)" may be considered a treatment approach for the management of stated IP cases; characterised by severe pulpal inflammation and delayed clotting process. The presented hypothesis evaluates clinical studies, experimental research and molecular impacts on clotting within the inflamed dental pulp, so as to explore the efficacy as well as the safety of tVPT as a viable treatment option. Latest clinical investigations have reported positive outcomes with tVPT; even in the presence of IP with PB. It has been shown that inflamed dental pulp tissues exhibit molecular impacts on the clotting cascade, which may contribute to the delayed clotting process. Nonetheless, the healing capacity of the dental pulp is not negatively affected by hyperaemia. Additionally, enhanced blood flow in the inflamed pulpal tissues may be associated with improved healing and boosted hard tissue formation. Moreover, tVPT could possibly promote pulpal healing and/or regeneration through continuing the presentation of essential nutrients, e.g. oxygen, and growth factors to the injured tissue. Furthermore, increased blood flow may facilitate the recruitment of immune and reparative cells; promoting tissue repair and encouraging the formation of dentinal bridge(s) after VPTs. Consequently, the state-of-the-art research and their findings could support the hypothesis that tVPT may effectively manage IP cases with PB and contribute to favourable outcomes.

Evaluation of Mineral Trioxide Aggregate and Biodentine as Direct Pulp-capping Agents in Human Teeth: An Ex-Vivo Study

Introduction: Biodentine (Tricalcium Silicate based) is a modern bioactive cement that is comparable to the broadly utilized mineral trioxide aggregate (MTA). It has dentin-like mechanical properties, which can be considered appropriate material for diseased dentin-pulp complex recovery such as direct pulp capping. The present study was to compare the reaction of the pulp-dentin complex in human teeth after direct pulp capping with use of MTA and Biodentine. Objective: To assess the histomorphologic response of human dental pulps on direct pulp capping with MTA and Biodentine. Methods: Pulps of 34 maxillary permanent intact human third molars planned for extraction were mechanically exposed with sterile rotary round bur and allotted to one of the two exploratory groups, MTA or Biodentine. After four weeks, the teeth were extracted, stained with hematoxylin- eosin, and categorized by employing a preset histologic scoring framework. The histopathologic evaluations scored data were recorded and statically analyzed using SPSS where Mann-Whitney U test was used and p&lt;0.05 was considered statistically significant. Results: No inflammatory pulp reaction seen in 34 (100%) teeth whereas 19 (55.9 %) showed complete dentinal bridge arrangement. Layers of well-arranged odontoblast and odontoblast-like cells were found to make tubular dentin beneath the osteodentin. Inferential statistics using showed insignificance between the MTA and Biodentine test groups amid the perception period, showing similar outcomes. Conclusions: Biodentine had comparative adequacy in the clinical setting and may be considered an appropriate alternative to MTA as the pulp- capping agent.