Dentin Bridge Research Articles

Pulpal Response to Ferric Sulfate and Diode Laser When Used as Pulpotomy Agent: An In vivo Study.

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

Histological evaluation of direct pulp capping with all-in-one adhesives in rat teeth.

The aim of this study was to histologically evaluate direct pulp capping using different all-in-one adhesives in rat teeth. Five all-in-one adhesives and a control material (MTA) were used. Each material was applied on the exposed pulp, and each cavity was subsequently restored with the resin composite. Rats were sacrificed 14 days after the surgical procedure. Serial stained sections were histologically evaluated for examining pulp tissue disorganization (PTD), inflammatory cell infiltration (ICI), dentin bridge formation (DBF), and bacterial penetration (BP). We found that rat pulps, which were direct capped with all-in-one adhesives, showed various degrees of PTD, ICI, and DBF depending on the material, and that there were no complete dentin bridges. In contrast, rat pulps capped with MTA showed no PTD and ICI, and there were complete dentin bridges in all, but one specimen. No BP was observed in any specimen.

A comparison of human dental pulp response to calcium hydroxide and Biodentine as direct pulp-capping agents.

Context:Direct pulp capping involves the placement of a biocompatible agent on pulp tissue that has been inadvertently exposed from traumatic injury or by iatrogenic means.Aim:To compare the human pulp response to calcium hydroxide and Biodentine as direct pulp-capping agents.Materials and Methods:Pulp exposures were performed on the pulpal floor of forty human permanent premolars. The exposure sites were dressed with either Dycal or Biodentine as pulp-capping materials. After 45 days, teeth were extracted and processed for histological examination.Statistical Analysis:The histological data were subjected to Wilcoxon rank-sum test.Results:The dentinal bridges in teeth that were capped with Biodentine were significantly thicker (P < 0.0001) and more continuous (P = 0.0001) with less pulpal inflammation (P = 0.0044) in comparison to Dycal.Conclusion:Based on the result of this study, Biodentine can be suggested as the material of choice for direct pulp capping procedure instead of Dycal. However, further long-term follow-up in vivo human studies using Biodentine on cariously exposed pulpal teeth are warranted to derive a definite conclusion.

Regeneration of dental pulp tissue using pulpal autologous mesenchymal stem cells and platelet-rich plasma

Regeneration of pulp and dentin could be important in operative dentistry as a method to save teeth. Currently cell population from dental pulp of deciduous and permanent teeth of humans and laboratory animals are isolated and characterized. The paper presents a study on pulp regeneration using autologous mesenchymal stromal cells from pulp of molars in combination with fibrin clot, transplanted in pulp chamber of miniature pigs after pulp removal. The results proved that transplantation of autologous multipotent stromal cells of dental pulp in combination with autologous platelet-rich plasma in pulp chamber of miniature pigs after pulp removal leads to pulp restoration and reparative dentinogenesis with dentinal bridge formation on the 30th day. However, the completion of regeneration also results in a decrease in the pulp chamber volume due to the neodentin bedding. Tissue regeneration of dental pulp by direct pulp capping in the absence of inflammatory processes is a promising direction of the use of cellular technologies.

Optimization of reparative dentinogenesis in experimental osteoporosis

The aim of the study was to assess histochemical changes of the dental pulp in direct pulp capping/experimental osteoporosis animal model. The study was performed on 20 two-year sheep with simulated acute pulpitis divided in 2 groups: main (15 animals/120 teeth) and control (5 animals/40 teeth). Direct pulp capping in the main group included tissue-engineered structure composed of a hydrogel PuraMatrix/3DM with ectomesenchymal stem cells immobilized on collagen sponge. In the control group collagen sponges with hydrocortisone furatsilin, chondroitin sulfate, аnaesthesinum were used for the same purpose. Dentinal bridge formation was much slower in controls than in the main group. Developed tissue-engineered design optimizes each stage of the healing process by protecting the pulp from infection, reduction of exudation, hemostatic effect and in long term contributes to a significant acceleration of the formation of the dentinal bridge.

Pattern and distribution of extracellular matrix proteins in human reparative dentin by an immunohistochemical approach

Dentin is a large and complex component of the tooth synthesized by odontoblasts during the process of dentinogenesis. Dentin formed, before the completion of root formation, is define primary dentin (PD), while dentin formed after and associated with the normal aging process is designated secondary dentin (SD). Tertiary dentin (TD) is produced in reaction to external noxious stimulus/injury, such as attrition or dental caries, adjacent to the preexisting dentin layer and further classified reparative dentin (RD) (1, 2). Aim this study was to compare pattern and distribution of extracellular matrix proteins, produced by odontoblast cells during dentin mineralization and during reparative process, in response to stimulus in human sound dentin vs human reparative dentin matrix. Sixteen sound carious human molars were selected, demineralized, fixed in paraformaldehyde and then processed for immunohistochemical approach to detect extracellular matrix proteins. In particular specimens were submitted to an immunolabeling technique by using primary antibodies anti dentin matrix protein 1 (DMP1), dentin sialophosphoprotein (DSPP), bone sialoprotein (BSP), osteoponti (OPN). Results indicate that the region of the exposed pulp, formed a layer of reparative dentin bridge sealing the communication between the cavity and pulp chamber. In addition results indicate that in RD is present a lower levels of DMP1 and DSP than PD layer, while BSP and OPN are present in RD but absent in PD layer. The expression of BSP and OPN in RD indicates that the odontoblast-like cells were attempting to produce a hard tissue at a very rapid process. In according with previous scientific literature, our results suggested that the deposition of OPN and BSP at the calcification front is essential for the type I collagen secretion by newly differentiated odontoblast-like cells to form reparative dentin during pulpal healing following cavity preparation.

Management of coronal fracture of traumatized central incisor: Report of two cases

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

Acemannan and Formocresol Pulpotomies in Primary Teeth: a Comparative Histopathological Study

AIM: The present study was conducted to compare the histopathological effects of acemannan to that of formocresol as pulp-dressing agents in primary teeth underwent pulpotomy. MATERIALS AND METHODS: Aloe vera gel high molecular weight fractions (AHM) containing native ingredients of polysaccharide (acemannan) and glycoprotein (verectin) were obtained by using the patented hyper dry system after washing out coloured materials with running water from Aloe vera gel slurry. Forty-six primary first teeth from children between 6-9 years, which formerly planned for serial extraction were selected. The children were distributed into two equal groups; twelve teeth for each. Pulpotomy was done in both groups; where group I treated by AHM, acemannan, as a dressing agent while formocresol used as a dressing agent in group II. The teeth from each group were extracted at two, four, and twelve week intervals for histopathological evaluation. RESULTS: In group I (Acemannan), after twelve weeks significantly better results in pulp inflammation, incomplete dentine bridge formation, and soft tissue organization were demonstrated (p<0.05). Most of the acemannan-treated group demonstrated no pulp inflammation with only (3/12, 25%) revealed mild pulp inflammation under the exposure site and only one tooth 1/12 teeth (8.3%) showed partial dentine bridge formation. In contrast, group II (Formocresol) moderate or severe pulp inflammation (10/12, 83%), no dentine bridge formation were observed. In almost all cases (10/12, 83%) the soft tissue of the pulp was not well organized. CONCLUSION: According to these findings, AHM, acemannan may be a suitable agent for pulpotomy in primary teeth. Moreover, the inflammatory response was less severed and no necrosis was noted after pulpotomy with acemannan compared to formocresol.

Clinical evaluation of mineral trioxide aggregate and biodentine as direct pulp capping agents in carious teeth.

Background:Root canal treatment has been a routine treatment option for carious exposure of the dental pulp. In the context of minimally invasive dentistry, direct pulp capping (DPC) procedure with a reliable biomaterial may be considered as an alternative provided the pulp status is favorable. Mineral trioxide aggregate (MTA), a bioactive cement with excellent sealing ability and biocompatibility is capable of regenerating relatively damaged pulp and formation of dentin bridge when used as DPC agent. Biodentine is comparatively a new biomaterial claimed to possess properties similar to MTA and is currently explored for vital pulp therapy procedures.Aim:The aim of the present study was to evaluate the clinical response of pulp-dentin complex after DPC with MTA and biodentine in carious teeth.Subjects and Methods:Twenty-four permanent molars with carious exposure having no signs and symptoms of irreversible pulpitis were selected and assigned to one of the two groups, Group I - MTA and Group II - biodentine. Patients were recalled at 3 weeks, 3 months, and 6 months for clinical and radiographic evaluation. Fisher's exact test was used along with Chi-square test for statistical analysis.Results:Over a period of 6 months, MTA and biodentine showed 91.7% and 83.3% success rate, respectively, based on the subjective symptoms, pulp sensibility tests, and radiographic appearance.Conclusion:MTA and biodentine may be used as DPC agents when the pulpal diagnosis is not more than reversible pulpitis.

Biological evaluation of a new pulp capping material developed from Portland cement

This study evaluates the biological properties of a new pulp capping material developed from Portland cement. This study was conducted on 48 teeth in 4 dogs (12 teeth/dog). The dogs were classified into two equal groups (n=24 teeth) according to the evaluation period including: group A (3 weeks) and group B (3 months). Each group was further subdivided into three equal subgroups (n=8 teeth) according to the capping material including: subgroup 1: mineral trioxide aggregate (MTA), subgroup2: Portland cement+10% calcium hydroxide+20% bismuth oxide (Port Cal) and subgroup 3: Portland cement+bismuth oxide. After general anesthesia, a class V buccal cavity was prepared coronal to the gingival margin. After pulp exposure and hemostasis,the capping materials and glass ionomer filling were placed on the exposure sites. All histopathological findings, inflammatory cell count and dentin bridge formation were recorded. Data were analyzed statistically. After 3 months, the histopathological picture of the pulp in subgroup 1 showed normal pulp, continuous odontoblastic layer and complete dentin bridge formation while subgroup 2 showed partial and complete dentin bridge over a normal and necrotic pulps. Subgroup 3 showed loss of normal architecture, areas of necrosis, complete, or incomplete dentin bridge formation, attached and detached pulp stones and fatty degeneration in group B. For group A, MTA subgroup showed the least number of inflammatory cell infiltrate followed by Port Cal subgroup. While subgroup 3 showed the highest number of inflammatory cell infiltrate. For group B, the mean inflammatory cell count increased with the three tested materials with no statistical difference. Regarding dentin bridge formation at group A, no significant differences was found between subgroups, while at group B, MTA subgroup exhibited significantly higher scores than other subgroups. In conclusion, addition of calcium hydroxide to Portland cement improves the dentin bridge formation qualitatively and quantitatively.

The thickness of odontoblast-like cell layer after induced by propolis extract and calcium hydroxide

Background: Propolis is a substance made from resin collected by bees (Apis mellifera) from variety of plants, mixed with its saliva and various enzymes to build a nest. Propolis has potential antimicrobial and antiinflammatory agents with some advantages over calcium hydroxide (Ca(OH)2). Ca(OH)2 has been considered as the “gold standard” of direct pulp-capping materials, but there are still some weakness of its application. First, it can induce pulp inflammation which last up to 3 months. Second, the tissue response to Ca(OH)2 is not always predictable. Third, the tunnel defect can probably formed in dentinal bridge with possible bacterial invasion in that gap. Purpose: This study was aimed to determine and compare the thickness of odontoblast-like cells layer after induced by propolis extract and Ca(OH)2 in rat’s pulp tissue. Method: Class 1 preparation was done in maxillary first molar tooth of wistar mice until the pulp opened. The Ca(OH)2 and propolis extract was applied to induce the formation of odontoblast-like cells, the cavity was filled with RMGIC. The teeth were extracted (after 14 and 28 days of induction). The samples were then processed for histological evaluation. Result: There were significant differences between the thickness of odontoblast-like cells after induced by propolis extract and Ca(OH)2. Conclusion: The propolis extract as the direct pulp capping agent produces thicker odontoblast-like cell layer compared to Ca(OH)2.

Direct pulp capping with novel nanostructural materials based on calcium silicate systems and hydroxyapatite

Summary Introduction Direct pulp capping is an important therapeutic method that has goal to provide formation of dentin bridge and healing process of the pulp. The aim of this study was to investigate the effects of new nanostructural materials based on calcium silicate systems and hydroxyapatite on exposed dental pulp in Vietnamese pigs. Material and Methods The study was conducted on 30 teeth of two Vietnamese pigs (Sus scrofa verus). On buccal surfaces of incisors, canines and first premolars, class V cavities were prepared with a small round bur and pulp horn was exposed. In the first experimental group (10 teeth) the perforation was covered with new nanostructural material based on calcium silicate systems (CS). In the second experimental group, the perforation was covered with compound of calcium silicate systems and hydroxyapatite (HA-CS) (10 teeth). In the control group, exposed pulp was covered with Pro Root MTA® (Dentsply Tulsa Dental, Johnson City, TN, USA) (10 teeth). All cavities were restored with glass ionomer cement (GC Fuji VIII, GC Corporation, Tokyo, Japan). Observation period was 28 days. After sacrificing the animals, histological preparations were done to analyze the presence of dentin bridge, inflammatory reaction of the pulp, pulp tissue reorganization and the presence of bacteria. Results Dentin bridge was observed in all teeth (experimental and control groups). Inflammation of the pulp was mild to moderate in all groups. Neoangiogenesis and many odontoblast like cells responsible for dentin bridge formation were detected. Necrosis was not observed in any case, neither the presence of Gram-positive bacteria in the pulp. Conclusion Histological analysis indicated favorable therapeutic effects of new nanostructural materials based on calcium silicate systems and hydroxyapatite for direct pulp capping in teeth of Vietnamese pigs.

Pulp Response to Lyophilized Bone in Rat Teeth

Background: This article will review different materials for the treatment of pulps of primary and young permanent teeth. However, innovations in materials and advances in biology suggest that there may soon be a convergence of therapies for teeth of either dentition needing pulp treatment. Objectives: The objective of this study was evaluated the pulp and liver response to biocompatible agents such as lyophilized bone in comparison with classical formocresol. Materials and Methods: Treatment was applied to the upper right and left first molar of each animal, for a total of 120 teeth. Six groups were established according to the agent used and the time elapsed (30, 45 and 60 days). In each group five livers were selected, and a control group subjected to no treatment was also evaluated. At the end of the study the rats were sacrificed and the samples were processed for histological evaluation. Analysis of variance (ANOVA) for repeated measures was used. Results: Dentinal bridge formation and reparative dentin reached higher values in the group treated with lyophilized bone. The formocresol treatment group showed increased inflammation and necrosis. Conclusions: Lyophilized bone afforded improved pulp tissue response. No histological evidence of liver damage was observed in any of the hepatic samples studied.

Histologic tissue response to furcation perforation repair using mineral trioxide aggregate or dental pulp stem cells loaded onto treated dentin matrix or tricalcium phosphate

ObjectivesThe aim of this study is to compare the effect of treated dentine matrix (TDM) and tricalcium phosphate (TCP) scaffolds on odontogenic differentiation and mineralization of dental pulp stem cells (DPSCs) in furcation perforations created in the pulp chamber floor of premolar teeth in dogs.Material and methodsDPSCs were isolated and cultured from the dental pulp of the maxillary left second and third premolars of dogs. The DPSCs were loaded on TCP (SC+TCP) and TDM (SC+TDM) scaffolds and inserted into intentionally perforated pulp chamber floors of premolars in dogs; six teeth were used for each group. Three more groups of six specimens were created, and mineral trioxide aggregate (MTA), TDM, and TCP were inserted into the perforations to act as controls. An intact premolar and no treatment in the perforation site were used as positive and negative controls respectively. After 3 months, the animals were sacrificed and the type of inflammation, presence of dentine, continuation and type of cementum, type of connective tissue, and presence of foreign body reaction were evaluated, and significant differences were between groups determined using the Fisher’s exact test. The evaluation of the amount of inflammation and the percentage of new bone formation was evaluated using the Mann-Whitney U test.ResultsThe negative control group was associated with severe inflammation and granulation tissue formation. In the positive control group, intact periodontal tissues and no inflammation were observed. Dentine bridge formation was not seen in specimens of any group. The specimens in the SC+TDM group were associated with significantly more bone formation than other groups (P < 0.001). The amount of inflammation was less than 10 % in specimens of all groups with the exception of three specimens in the TCP group that were categorized as 10–30 %. Chronic inflammation without foreign body reactions was the major pattern of inflammation in groups. Formation of cementum with a cellular and continuous appearance was seen in all specimens.ConclusionsSC+TDM was associated with significantly more bone formation when used to repair uninfected furcation perforations in the premolar teeth of dogs.Clinical relevanceApplication of TDM as a biological scaffold in combination with DPSCs may offer an advantage during the repair of root perforation defects.

Role of laser irradiation in direct pulp capping procedures: a systematic review and meta-analysis.

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

Review suggests direct pulp capping with MTA more effective than calcium hydroxide.

Data sourcesPubMed, the Cochrane Library, Embase, and the Web of Knowledge.Study selectionRandomised controlled trials (RCTs) or retrospective non-randomised trials (RNTs) of direct pulp capping in patients comparing mineral trioxide aggregate (MTA) with calcium hydroxide (CH) were considered.Data extraction and synthesisTwo reviewers independently abstracted data. Risk of bias for the RCTs was assessed using the Cochrane risk of bias tool and RNTs were assessed according to the methodological index for non-randomised studies. Different study designs were analysed separately.ResultsThirteen studies were included, ten of which were RCTs. Meta-analysis demonstrated a significantly higher success rate for MTA compared with the CH-capped groups. For RCT studies (2 studies, 405 teeth): OR = 2.26; (95% CI, 1.33-3.85; P = .003) and for RNTs (3 studies - 526 teeth): OR = 2.88; (95% CI, 1.86-4.44; P < .00001). Nine studies (325 teeth) compared the inflammatory response with MTA showing significantly less inflammation compared with CH samples (OR = 4.56; 95% CI, 2.65 7.83; P < .00001). Nine studies (325 teeth) compared dentine bridge formation with a higher percentage of calcified dentin bridge formation in the MTA than CH-capped groups (OR = 3.56; 95% CI, 1.89 6.70; P < .0001).ConclusionsMTA has a higher success rate and results in less pulpal inflammatory response and more predictable hard dentin bridge formation than CH. MTA appears to be a suitable replacement of CH used for direct pulp capping.

Clinical and computed tomographic evaluation of portland cement pulpotomy in primary molar: A case report

The present case describes the clinical &amp; radiographic outcome of a Portland Cement pulpotomy. The 5 years old girl presenting extensive carious exposure in her mandibular left 2nd deciduous molar and was suffering pain in her left lower jaw only on exposure to cold for last 2 days. She was ultimately diagnosed clinic-radio-graphically as a case of irreversible pulpitis. Coronal pulpotomy procedure was carried out in the responsible tooth and Portland cement (PC) was applied as a medicament after pulpotomy. At the 3 &amp; 6-months follow-up appointments, treated tooth was asymptomatic clinically and radiographic examinations revealed no sign of periradicular pathosis in the pulpotomized teeth. Additionally, the formation of a dentin bridge immediately below the PC in the treated tooth was confirmed by RVG and CBCT.

Reactionary and reparative dentin formation after pulp capping: Hydrogel vs. Dycal

Abstract Background After indirect capping, injured odontoblasts generate reactionary dentin, whereas after direct capping of a pulp exposure pulp, cells stimulate the formation of reparative dentin. The aim of this study was to evaluate and compare the effects of two direct capping agents on pulp tissue reactions: Hydrogel (a bovine serum albumin (BSA)/glutaraldehyde,) and Dycal (a calcium hydroxide-based capping agent). Methods In 6-week-old male Sprague–Dawley rats, occlusal cavities were drilled in the first maxillary molars, and the pulps were exposed. In one of the groups, 24 right molars were capped with Hydrogel (G1), whereas in the other group 24 M were capped with Dycal (G2). After 1 to 4 weeks, the rats were anaesthetized intraperitoneally (six rats per group) and perfused intracardiacally with 4 % paraformaldehyde fixative. Maxillary molar’s blocks were demineralized with a 4.13 % EDTA solution, embedded in paraffin, and the sections were histologically stained. Measurements of the thickness of reactionary dentin and area of inflammation were measured with ImageJ software. Results were compared with Kruskal Wallis and Mann Whitney U tests at p = 0.05. Results One week after Dycal capping, a statistically significant large number of aggregates of pulp cells enlightened pulpal inflammation compared to Hydrogel. At 2–3 weeks, reactionary dentin formation was increased at the periphery of the pulp chamber. After 4 weeks, a dentinal bridge sealed partially the pulp exposure, while tunnel defects persisting across reparative osteodentin. In contrast, 1 week after Hydrogel capping, inflammation was barely detectable. Hydrogel induced the massive apposition of reactionary dentin at the pulp periphery, and reparative dentin was developing within the pulp. The degradation of Hydrogel releases glutaraldehyde acting on pulp cells as a fixative and consequently favoring BSA bioactivity. Conclusion After Hydrogel capping, nemosis stimulates pulp mineralization, improving reactionary and reparative dentin formation. In contrast, the highly alkaline compound Dycal produced inflammation within the pulp. The differences between the two capping agents suggest that Hydrogel might present some clinical advantages over Dycal.

Combined effects of mineral trioxide aggregate and human placental extract on rat pulp tissue and growth, differentiation and angiogenesis in human dental pulp cells

Objective The aim of this study was to evaluate the combined effects of mineral trioxide aggregate (MTA) and human placental extract (HPE) on cell growth, differentiation and in vitro angiogenesis of human dental pulp cells (HDPCs) and to identify underlying signal transduction mechanisms. In vivo dental pulp responses in rats for a pulp-capping agent were examined. Materials and methods MTS assay. ALP activity test, alizarin red S staining and RT-PCR for marker genes were carried out to evaluate cell growth and differentiation. HUVEC migration, mRNA expression and capillary tube formation were measured to evaluate angiogenesis. Signal transduction was analysed using Western blotting and confocal microscopy. The pulps of rat maxillary first molars were exposed and capped with either MTA or MTA plus HPE. Histologic observation and scoring were performed. Results Compared to treatment of HDPCs with either HPE or MTA alone, the combination of HPE and MTA increased cell growth, ALP activity, mineralized nodules and expression of marker mRNAs. Combination HPE and MTA increased migration, capillary tube formation and angiogenic gene expression compared with MTA alone. Activation of Akt, mammalian target of rapamycin (mTOR), p38, JNK and ERK MAPK, Akt, and NF-κB were significantly increased by combining HPE and MTA compared with MTA alone. Pulp capping with MTA plus HPE in rats showed superior dentin bridge formation, odontoblastic layers and dentinal tubules and lower inflammatory cell response, compared to the MTA alone group. Conclusions This study demonstrates for the first time that the use of MTA with HPE promotes cell growth, differentiation and angiogenesis in HDPCs, which were associated with mTOR, MAPK and NF-κB pathways. Direct pulp capping with HPE plus MTA showed superior results when compared with MTA alone. Thus, the combination of MTA and HPE may be useful for regenerative endodontics.

Comparative evaluation of calcium silicate-based dentin substitute (Biodentine®) and calcium hydroxide (pulpdent) in the formation of reactive dentin bridge in regenerative pulpotomy of vital primary teeth: Triple blind, randomized clinical trial.

Background:Considering the biological concerns of calcium hydroxide (CH) as a pulpotomy agent, an alternative silicate based dentin substitute i.e. Biodentine (Ca3SiO5) was evaluated clinically and radiographically.Aims:To evaluate the effectiveness of dentin substitute (Biodentine) in regenerative pulpotomy of vital primary teeth that would giv a biological base to its use in forming reactive dentin bridge and overcoming the drawbacks of calcium hydroxide.Material and Methods:Randomised clinical trial on 40 bilateral carious primary molars in 20 participant children (aged 5-10 years) was carried out by same operator using Ca3SiO5(group-1) and CH (group-2) as vital pulpotomy agents. Blinded clinical and radiographic outcomes were observed at 3, 6 and 12 months interval.Results:Clinical outcomes of both protocols were analysed using Pearson's chi-square test applied at P < 0.05. Descriptive statistics were expressed as mean increase in dentin bridge formation in mms from two reference points in standardized radiographs using paired ‘t’- test at baseline and 12 months and found to be statistically significant (P < 0.05) in group-1 when compared with group-2.Conclusion:Group-1 revealed statistically favourable regenerative potential along with clinical success compared to group 2 thereby sharing both indications and mode of action with CH, but without its drawbacks of physical and clinical properties.