Direct Pulp-capping Agent Research Articles

Pulp Response following Direct Pulp Capping with Dentin Adhesives and Mineral Trioxide Aggregate; An Animal Study.

Introduction:Pulp vitality and its continuous dentin prodution are essential for long-term success of direct pulp capping (DPC). The aim of present study was to evaluate the histopathological response of the canine pulp following DPC using either different dentin adhesive resins (DAR), calcium hydroxide (CH) or mineral trioxide aggregate (MTA). Methods and Materials:DPC was done on 72 dog’s teeth using 6 types of dental materials (n=12) (4 types of DAR, white MTA and CH). Therefore, six healthy dogs were anesthetized and 2 teeth from each dog were allocated to either type of mentioned DPC agents. The dental pulps were exposed mechanically by drilling in the center of class V cavities. The different types of capping materials included DARS (Clearfil S3 Bond, Optibond FL, Single Bond and Clearfil SE Bond), white MTA and CH. After 7, 21 and 63 days, two dogs were euthanized in each interval. Microscopic evaluations were done according to following criteria: intensity of inflammation, presence of necrosis and formation of hard tissue. The recorded data were analyzed by the Kruskal-Wallis, Friedman, Cochran’s and Fisher’s exact tests using SPSS software version 12 at significant level of 0.05. Results:No significant differences were found regarding necrosis among DPC materials (P>0.05). However, MTA caused higher amount of hard tissue formation after 63 days in comparison with 21 days. Conclusion:MTA provided the highest degree of hard tissue formation after 63 days. However, further studies should be performed for administering a definitive material.

Clinical, radiographic, and histologic analysis of the effects of acemannan used in direct pulp capping of human primary teeth: short-term outcomes.

Acemannan has been previously reported as a direct pulp-capping agent in animal study. This natural material demonstrated its biocompatibility and enhanced reparative dentin formation. The objective of this study was to investigate the action of acemannan as a direct pulp-capping material in human primary teeth with deep caries. Forty-two deeply carious mandibular primary molars from 37 children, aged 7-11years old diagnosed with reversible pulpitis were studied. After completely removing the infected dentine, teeth with a pinpoint pulpal exposure were randomly divided into two treatment groups: acemannan or calcium hydroxide. A glass-ionomer cement base was applied to all teeth prior to restoration with stainless steel crowns. Clinical and radiographic evaluation was performed 6months post-treatment. The teeth due to exfoliate were extracted and histopathologically evaluated for inflammation, dentine bridge formation, and soft tissue organization. At 6months, the overall clinical and radiographic success rates of direct pulp capping with acemannan and calcium hydroxide at 6months were 72.73 and 70.0%, respectively. The histopathological results indicated that the acemannan-treated group had significantly better histopathological responses compared with the calcium hydroxide-treated group (p<0.05). These data suggest acemannan offers a valuable alternative biomaterial for vital pulp therapy in primary teeth.

Nano-hydroxyapatite and calcium-enriched mixture for pulp capping of sound primary teeth: a randomized clinical trial.

Nano-hydroxyapatite (NHA) has been used for regeneration of osseous defects. Calcium-enriched mixture (CEM) cement is also used for various dental treatments. This trial compared the efficacy of NHA and CEM cement for direct pulp capping (DPC) of sound primary teeth. In this randomized clinical trial with split-mouth design, after attaining informed consent, 20 sound primary canines scheduled for orthodontic extraction, were selected. After mechanical pulp exposure, the exposed site was capped with either NHA or CEM cement and then immediately restored with glass-ionomer and resin composite. The teeth were extracted after two months and examined histologically. Parameters of hard tissue bridge (HTB) formation, its type and quality as well as pulpal inflammation scores were compared between the two experimental groups. The data were analyzed using the Mann Whitney U and Fisher's exact test. The level of significance was set at 0.001. All CEM specimens showed inflammation score of 0 (less than 10%). However, in NHA group, inflammation scores of 0 (less than 10%), 1 (10%-30%) and 2 (30%-50%) were observed in 2 (20%), 4 (40%) and 4 (40%) specimens, respectively (P<0.001). HTB was formed in all CEM specimens while it was developed in 2 specimens of NHA (20%; P<0.001). All CEM specimens showed normal pulp; only two cases in NHA group (20%) demonstrated uninflamed normal pulp. CEM cement was superior to NHA as a DPC agent in terms of HTB formation and pulp inflammation scores. It is a suitable material for the DPC of primary teeth.

Comparison of CaOH with MTA for Direct Pulp Capping

This practice-based, randomized clinical trial evaluated and compared the success of direct pulp capping in permanent teeth with MTA (mineral trioxide aggregate) or CaOH (calcium hydroxide). Thirty-five practices in Northwest PRECEDENT were randomized to perform direct pulp caps with either CaOH (16 practices) or MTA (19 practices). Three hundred seventy-six individuals received a direct pulp cap with CaOH (n = 181) or MTA (n = 195). They were followed for up to 2 yrs at regular recall appointments, or as dictated by tooth symptoms. The primary outcomes were the need for extraction or root canal therapy. Teeth were also evaluated for pulp vitality, and radiographs were taken at the dentist’s discretion. The probability of failure at 24 mos was 31.5% for CaOH vs. 19.7% for MTA (permutation log-rank test, p = .046). This large randomized clinical trial provided confirmatory evidence for a superior performance with MTA as a direct pulp-capping agent as compared with CaOH when evaluated in a practice-based research network for up to 2 yrs (ClinicalTrials.gov NCT00812887).

The possibility of genistein as a new direct pulp capping agent

Genistein, kind of soy isoflavones, is well-known as natural ingredients and consumed as health foods and supplements. They are expected to improve renal function. They have high-affinity to estrogen receptor β expressed predominantly in bone tissue, they prevent osteoporosis specifically and safely. We examined whether genistein can be a new direct capping agent. In this study, we examined the effect of genistein for the proliferation and differentiation of rat dental pulp cells in vitro and the ability of tertiary dentin formation in vivo. As a result, rat dental pulp cells with genistein were increased activity of ALPase and showed alizarin red positive-staining. Calcification-related genes expression has been confirmed by the addition of genistein. From in vivo study, high quality of tertiary dentin formation and minor pulp reaction were observed. From these findings, it was suggested that genistein may be useful agent for direct pulp capping.

Clinical & Histologie Study of Human Pulpal Response to Calcium Hydroxide, Resorcinol & Zinc Oxide Eugenol as a Direct Pulp Capping Agent

The healthy pulp has the inherent potential for healing provided the exposure site is kept bacteria free. Various materials have been tried as direct pulp capping (DPC) agents. In this study, calcium hydroxide, Resorcinol (Resinifiying Agent) and zinc oxide eugenol were used as DPC agents. Under aseptic conditions, Class I cavity was prepared on premolar teeth and small exposure was made at pulp horn and experimental materials were placed over the exposure site and remaining cavity filled with quick setting zinc oxide eugenol cement. After treatment, the teeth were extracted and processed for routine histologie evaluation. Teeth with calcium hydroxide show resolution of inflammatory response and reparative dentin formation after 90 days. Teeth with resorcinol showed increase fibrosis and widened predentin layer whereas zinc oxide eugenol shows only chronic inflammation and no evidence of reparative dentin formation. By evaluating clinical and histological response with these materials, calcium hydroxide and resorcinol can be used as a direct pulp capping agent but long terni study required

Cytotoxicity Comparison of Three Current Direct Pulp-capping Agents with a New Bioceramic Root Repair Putty

IntroductionThe purpose of this in vitro study was to compare the cytotoxicity of white mineral trioxide aggregate cement (AMTA, MTA-Angelus), Brasseler Endosequence Root Repair Putty (ERRM), Dycal, and Ultra-blend Plus (UBP) by using human dermal fibroblasts and a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. MethodsCultured adult human dermal fibroblasts were exposed to multiple concentrations of material elutes. The test material samples were immersed and incubated in the culture medium for 2, 5, or 8 days at 37°C. The cytotoxic effects were recorded by using an MTT-based colorimetric assay. Positive and negative controls were used. The results were statistically examined by one-way analysis of variance and Tukey post tests. ResultsThe cell viability of cultures exposed to all dilutions of AMTA, ERRM, and UBP was statistically similar to the negative control at 2 and 5 days. Only the Dycal-exposed specimens exhibited a statistically significant increase in cytotoxicity at the 2 initial evaluation periods. After exposure to the 8-day elutes, the respective percentage of cell survivability was 91% (Brasseler), 88% (MTA-Angelus), 76% (Ultra-blend Plus), and 37% (Dycal). ConclusionsFrom the data in this in vitro study, AMTA, ERRM, and UBP had statistically similar adult human dermal fibroblast cytotoxicity levels. Relative to the negative control, only Dycal was shown to have a statistically significant cytotoxic effect to adult human dermal fibroblasts at all tested intervals.

Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial

To investigate the pulpal response to direct pulp capping in healthy human teeth with mineral trioxide aggregate (MTA) as against calcium hydroxide cement (Dycal) as control. Twenty healthy human third molars had iatrogenic pulpotomy and direct pulp capping with MTA. Another 13 teeth were capped with Dycal as controls. The teeth were restored, with IRM, clinically reviewed and extracted after a number of pre-determined intervals (1 week, 1 month and 3 months). The specimens were fixed, decalcified, subdivided axially into two halves in the oro-buccal (lingual-buccal) plane, embedded in plastic, serial sectioned and evaluated qualitatively and quantitatively by correlative light and transmission electron microscopy with appropriate statistical evaluation of the quantitative data. Iatrogenic pulpal wounds treated with MTA were mostly free from inflammation after 1 week and became covered with a compact, hard tissue barrier of steadily increasing length and thickness within 3 months following capping. Control teeth treated with Dycal revealed distinctly less consistent formation of a hard tissue barrier that had numerous tunnel defects. The presence of pulpal inflammation up to the longest observation period (3 months) after capping, was a common feature in Dycal specimens. The MTA was clinically easier to use as a direct pulp-capping agent and resulted in less pulpal inflammation and more predictable hard tissue barrier formation than Dycal. Therefore, MTA or equivalent products should be the material of choice for direct pulp capping procedures instead of hard setting calcium hydroxide cements.

Histological evaluation of calcium hydroxide and dentin bonding agent in direct pulp capping: -an in vivostudy

Direct pulp capping remains an elusive dilemma in pulp therapy. The advent of new materials and the characterization of the role of bacteria in healing response have opened new avenues in direct pulp capping. In this study, four premolars indicated for orthodontic extraction were selected for pulp cupping. One group Bras capped with calcium hydroxide [DYCAL] and other group with dentin bonding agent [Prompt - L - Pop]. The teeth were extracted after one week and two weeks respectively and sectioned and observed . for histological response. Results showed that though both the groups showed odontoblastic activity and evidence of reparative dentin formation, The calcium hydroxide group showed better response. Mild inflammation was seen in both the groups. The results suggest that dentin bonding agents can be used as alternative direct pulp capping agents. However, further research is necessary.

Histologic evaluation of tetracalcium phosphate-based cement as a direct pulp-capping agent

Histologic healing processes were observed at 1, 3, 7, and 10 days after application with either tetracalcium phosphate cement or calcium hydroxide cement to the exposed pulp of the rat maxillary incisors. In teeth applied with calcium hydroxide cement, necrotic tissue was present beneath the cement before new hard tissue formed. In contrast, tetracalcium phosphate cement elicited a dentine bridge formation with no evidence of either intervening tissue necrosis or marked inflammation. Furthermore on ultrastructural examination the newly formed hard tissue was in direct contact with the material. This study suggests that 4CP cement possesses a biocompatible property, which indicates its potential for use as a direct pulp-capping agent.

Providing an environment for reparative dentine induction in amputated rat molar pulp by high molecular-weight hyaluronic acid

To study provision of this environment, wound healing was examined by light and electron microscopy following pulp amputation and direct capping with hyaluronic acid. Molar pulps of female Sprague-Dawley rats were mechanically exposed and directly capped; the cavities were then restored with glass-ionomer cement. As an experimental control, Calvital (a commercial preparation of calcium hydroxide paste) was used as the direct pulp-capping agent in other rats, and its effect on pulp healing was compared with that of hyaluronic acid. In hyaluronic acid-treated pulps, at 2 days after amputation, wound surfaces were covered with blood and fibrin clots and inflammatory cells such as neutrophils and macrophages. At I week, differentiation of fibroblastic and odontoblast-like cells was observed beneath the wound layer: and odontoblast-like cells produced globular calcified nodules along the existing dentine walls. At 2 weeks, a layer of reparative dentine had been formed by odontoblast-like cells over the dentine walls. Between 30 and 60 days, the formation of reparative dentine had extended throughout the pulp chamber. The healing observed after direct capping with hyaluronic acid was, except for the formation of dentine bridges, similar to that seen after Calvital capping. These results suggest that high molecular-weight hyaluronic acid can provide an environment suitable for reparative dentine formation through mesenchymal cell differentiation during healing of the amputated dental pulp.

Pulpal response to a calcium hydroxide material for capping exposures

Two calcium hydroxide cements, Dycal and Life, were compared as direct pulp-capping agents in forty teeth of two beagle dogs. Both materials produced similar responses after observation periods of 4 and 12 weeks. It was noted that the responses in one animal were less favorable, but the reason could not be demonstrated.

Pulpal response to minimal exposure in presence of bacteria and Dycal

Thirty-two teeth from 8-month-old beagle dogs were used to evaluate the influence of Dycal as a direct pulp-capping agent on exposed and bacterially infected teeth. The effects were evaluated with use of serial radiographs, consecutive vital dye injections, and histologic sections. Eight of the nine bacterially infected exposed teeth that were capped with Dycal showed significant amounts of vital pulpal tissue with no noticeable periapical abnormalities. Whereas in all the teeth bacterially infected and exposed but not capped with Dycal, periapical lesions developed by the 15th day after exposure. The results of this study suggest that pulp capping with Dycal of exposed and infected pulps may contribute to the continued viability of pulpal tissue. Thirty-two teeth from 8-month-old beagle dogs were used to evaluate the influence of Dycal as a direct pulp-capping agent on exposed and bacterially infected teeth. The effects were evaluated with use of serial radiographs, consecutive vital dye injections, and histologic sections. Eight of the nine bacterially infected exposed teeth that were capped with Dycal showed significant amounts of vital pulpal tissue with no noticeable periapical abnormalities. Whereas in all the teeth bacterially infected and exposed but not capped with Dycal, periapical lesions developed by the 15th day after exposure. The results of this study suggest that pulp capping with Dycal of exposed and infected pulps may contribute to the continued viability of pulpal tissue.