Direct Pulp Capping Material Research Articles

Biocompatibility of Regular and White MTA and A Grey Portland Cement in Human Dental Pulp Cells

Currently many materials have been used with pulpotomies in primary teeth. These include MTA, that as a direct pulp capping material seemed to stimulate natural dentin repair at pulpal exposure sites. The composition of this product is based on Portland cement. Later, white MTA was introduced as an esthetic improvement over the original material (grey MTA). A number of studies have been performed on this new material to determine if it shows the same properties as gray MTA. The biocompatibility of MTA has been previously investigated in vitro using a number of the cell lines. However, the use of primary cultures (in this case pulp fibroblasts) is often desirable. Objective: The objective of this in vitro study was to compare the cytotoxicity in a pulp fibroblasts culture, of regular (grey) MTA, white MTA and Portland cement Material and method: A cytotoxicity study was made in a primary pulp fibroblasts culture of MTA, white and grey, and a grey Portland cement. Results: Without taking into account concentrations, there were no significant differences between regular MTA and white MTA (p=0.146). A significant difference was recorded between grey Portland cement, which were less biocompatible, and regular MTA (p=0.029), and white MTA (p=0.002). Conclusion: The results found in the present study might be an additional argument to support that MTA is biocompatible, and may be considered as a pulp dressing agent in pulpotomized primary molars with carious pulp exposures. However, the grey Portland cement, under the same conditions, shows reduced biocompatibility.

Recent advances in direct pulp capping materials

The long-term effect of direct pulp capping and pulpotomy is closely related to the type of pulp capping materials. Various kinds of direct pulp capping materials are available, such as calcium hydroxide and mineral trioxide aggregates. Diverse new pulp capping materials have been reported recently. The excellent performance of calcium silicates has attracted much attention in previous studies. Moreover, enamel matrix derivative (Emdogain), which is capable of regeneration and remineralization, and other materials with similar capabilities have shown potential for use in pulp capping.

Outcomes of Vital Pulp Therapy Using Mineral Trioxide Aggregate or Biodentine: A Prospective Randomized Clinical Trial

IntroductionMineral trioxide aggregate (MTA) has been used in pulp capping of cariously exposed mature permanent teeth with promising results. The search for alternative materials that seal better and set faster than MTA and do not stain is ongoing. Biodentine (Septodont, St Maur-des-Fossés, France) exhibits these advantages but has not been tested yet for a prolonged duration in mature teeth. This study aimed to evaluate the clinical performance of Biodentine and white MTA (Angelus, Londrina, Brazil) in cariously exposed mature permanent teeth. MethodsThis was a prospective longitudinal randomized controlled study of 68 vital permanent teeth with deep caries. Patients were randomly allocated into 2 study arms: Biodentine and MTA. Teeth were assessed clinically and radiographically before the procedure. Caries were excavated under local anesthesia; hemostasis was achieved after pulp exposure using sodium hypochlorite and capped with Biodentine or MTA. Clinical and radiographic follow-ups were performed by a blinded calibrated evaluator after 6 months and 1, 2, and 3 years. ResultsThere were no significant differences in the overall success rate between Biodentine and MTA; it was 93.3% (Biodentine = 93.1% and MTA = 93.5%) at 6 months. The overall success rate increased to 96.2% (Biodentine = 96.0% and MTA = 100%) at 1 year and to 100% at 2 years. At the 3-year follow-up, it decreased to 93.8% (Biodentine = 91.7% and MTA = 96.0%). ConclusionsBiodentine and MTA have favorable and comparable success rates when used as direct pulp capping or pulpotomy material in permanent mature teeth with carious exposure. The remaining tooth structure and durability of coronal restoration might affect significantly the long-term success of vital pulp therapy.

Tricalcium Silicate Capping Materials Modulate Pulp Healing and Inflammatory Activity In Vitro

IntroductionOn stimulation by lipoteichoic acid or by a physical injury, fibroblasts have been shown to play a major role in the initiation of the pulp inflammatory reaction and healing through secretion of complement proteins and growth factors. The application of direct pulp-capping materials on these cells may interfere with the inflammatory and the healing processes within the pulp's inextensible environment. This work was designed to study in vitro the effects of silicate-based materials on pulp fibroblast modulation of the initial steps of pulp inflammation and healing. MethodsThe effects of Biodentine, TheraCal, and Xeno III eluates were studied on lipoteichoic acid–stimulated and physically injured fibroblasts. Cytokine secretion (interleukin 6, vascular endothelial growth factor, fibroblast growth factor-2, and transforming growth factor-β1) was quantified by enzyme-linked immunosorbent assay. Inflammatory THP-1 adhesion to endothelial cells and their migration and activation were studied in vitro. Human pulp fibroblast proliferation was investigated with the MTT test, and their migration to the injury site was studied with the scratch healing assay. ResultsInterleukin 6 and vascular endothelial growth factor secretion increased with all materials but to a lesser extent with Biodentine. Fibroblast growth factor-2 and transforming growth factor-β1 secretion was significantly higher with Biodentine than with all other materials. THP-1 cell adhesion to endothelial cells and their activation were reduced by Biodentine and TheraCal. However, their migration decreased only with Biodentine. Fibroblast proliferation significantly increased with Biodentine but significantly decreased with Xeno III after day 6. Finally, only Biodentine induced fibroblast migration to the injury site in the scratch assay. ConclusionsThese results confirm that pulp-capping materials affect the early steps of pulp inflammation and healing. They show that Biodentine had the highest pulp healing and anti-inflammatory potential when compared with the resin-containing materials. This highlights the interest of the material choice for direct pulp-capping.

Gypsum-Based Material for Dental Pulp Capping: Effect of Chitosan and BMP-2 on Physical, Mechanical, and Cellular Properties.

Effective pulp capping material must be biocompatible and have the ability to induce dentin bridge formation as well as having suitable physical and mechanical properties; however, many current materials do not satisfy the clinical requirements. This study aimed to assess the physical and mechanical properties of gypsum-based chitosan material (Gp-CT) and to evaluate its effects on cellular properties of stem cells from human exfoliated deciduous teeth (SHED). The experimental material was prepared with different concentrations of chitosan (CT) with or without BMP-2. Then, setting time, compressive strength, and pH were determined. In addition, cell viability, alkaline phosphatase (ALP) activity, and cell attachment were assessed. The setting time, compressive strength, and pH obtained were 4.1–6.6 min, 2.63–5.83 MPa, and 6.5–5.7, respectively. The cell viability to gypsum (Gp) with different CT concentrations was similar to that of the control on day 1 but statistically different from that of Gp alone on day 3. The ALP activity of SHED was significantly higher (p < 0.05) in CT- and BMP-2-containing materials than those in the control and Dycal at days 3 and 14. The scanning electron microscopy (SEM) image revealed that flattened cells were distributed across and adhered to the material surface. In conclusion, Gp-CT material shows promise as a potential material for direct pulp capping.

Management of deep carious lesions and pulps exposed during carious tissue removal in adults: a questionnaire study among dentists in Finland.

To find out which management methods are preferred by dentists in Finland for a deep carious lesion or a pulp exposed during carious tissue removal in adult patients. An electronic questionnaire consisting of 25 questions was sent to 1000 randomly sampled dentists in Finland. The response rate was 32%. Less invasive excavation strategies (stepwise or selective removal) were preferred by 64% for an asymptomatic deep lesion, while 34% chose nonselective removal to hard dentine. In the presence of an asymptomatic pulpal exposure, vital pulp therapy was preferred, as 71% of the respondents chose direct pulp capping (DPC) or partial pulpotomy, compared to root canal treatment (26%). Mineral trioxide aggregate (MTA) and calcium hydroxide-based materials were both chosen by 40% for vital pulp therapy. In the management of a deep carious lesion, less invasive excavation strategies were significantly associated with having clinical guidelines vs. no guidelines at the practice [odds ratio (OR) 3.5, confidence interval (CI) 1.4-9.0]. MTA was favored over other DPC materials significantly more often by those who had attended continuing education courses during the last 3years (OR 2.8, CI 1.2-6.5). Less invasive management strategies have been adopted into clinical practice by the majority of dentists in Finland. There is a need to encourage the use of MTA in the case of a pulpal exposure. The results of this study can be utilized in continuing education, to raise awareness of management strategies supported by present scientific evidence.

The Effect of Incorporating Nanocalcium Phosphate Particles into Biodentine on Pulpal Tissue Response (In Vitro Study)

Objectives: This study was conducted to evaluate the effect of incorporating Nanocalcium phosphate (NCP) particles into Biodentine™ on pulpal tissue response as a direct pulp capping material (entire tooth culture model). Materials and methods: - A total of forty freshly human premolar teeth extracted for orthodontic reasons were used. After cavity preparation and mechanical pulp exposure, the teeth were divided into 2 main groups (20 teeth each) according to the capping material used; where group (M1) refers to pulps capped with Biodentine™, and group (M2) refers to pulps capped with Biodentine incorporated with NCP. Each group was further subdivided into two subgroups according to the culture period; where subgroup (P1) refers to teeth cultured for 14 days, and subgroup (P2) refers to teeth cultured for 28 days. At the end of each culture period, the teeth were histologically examined to assess the dentine bridge thickness of each group after 14 and 28 days. Moreover, elemental analysis of Calcium and Phosphorous ions in the dentine bridge was performed using SEM-EDX. Results: Direct pulp capping with Biodentine incorporated with NCP showed thicker dentine bridge when compared to Biodentine™ alone. There is a positive correlation between the weight % of Calcium and Phosphorous ions in the dentine bridge below both capping materials and the dentine bridge thickness. Conclusion: Biodentine incorporated with NCP could be a good candidate for pulp capping in the future

Comparing direct pulp capping materials

Comparing direct pulp capping materials

Evaluation of eggshell powder as an experimental direct pulp capping material

Aimis to histopathologically evaluate dental pulp response to eggshell powder as a direct pulp capping material and compare it to Calcium Hydroxide as regard to inflammation, calcific bridge formation and fibrosis. Material and methods30-New Zealand rabbits were selected in this study and divided into 3 groups according to the time of sacrifice after pulp capping procedure (1, 2 and 4weeks). The two lower central incisors were used, where the pulp was exposed and capped directly by one of the two materials used in this study; Calcium Hydroxide (Dycal) or eggshell powder. The cavities were then sealed by glass ionomer cement (Fuji IX). Animals were sacrificed at each time interval and teeth were collected for histopathological evaluation. ResultsEggshell group showed significantly less inflammation, less fibrosis and thicker calcific bridge formation than Calcium hydroxide group. When the effect of time was considered, inflammation significantly decreased from 1 to 4 weeks while calcific bridge significantly increased for both materials. Also fibrosis increased significantly from 1week to 4 weeks. ConclusionsEggshell powder should be considered as a direct pulp capping material as it led to a better calcific bridge formation than calcium hydroxide with less inflammation and fibrosis.

The effect of mineral trioxide aggregate as a direct pulp capping agent in permanent teeth

Aims and Objectives: Direct pulp capping is a procedure which aims at protecting pulp vitality. When the dental pulp is exposed as a result of trauma, caries or by the dentist preparing for a deep restoration, then, it can be capped with a biocompatible material. It is expected that this procedure was allowed the pulp to heal normally and regenerate reparative dentine, thus preventing the need for more extensive and expensive root canal treatment (RCT). Materials and Methods: A total of 86 teeth of 85 patients diagnosed with reversible pulpitis were included in this study. After administration of local anesthesia, teeth were isolated with rubber dam. Mineral trioxide aggregate (MTA) was mixed according to manufacturers' instructions and 1–2 mm of MTA was placed over the pulpal exposure with a plastic filling instrument. All patients were scheduled for routine recall visits after 1, 3, and 6 months to monitor for pain on visual analog scale. All these readings were recorded on pro forma. The collected data were entered into SPSS version 19 and analyzed accordingly. Mean and standard deviation was calculated for quantitative variables like age. Frequency and percentage were calculated for qualitative variables such as the efficacy of MTA and gender. Stratification with respect to age and gender was done. Poststratification Chi-square test was applied. P ≤ 0.05 was considered statistically significant. Results: The average age of the patients was 37.59 ± 10.88 years. There were 30 (35.29%) male and 55 (64.71%) female. The effectiveness of MTA as a direct pulp capping material in cariously exposed mature permanent teeth was observed in 87.06% (74/85). Conclusion: Taking into consideration, the results of this study, it seems that when an exposure site is immediately sealed with MTA, the prognosis is promising. We found success rate of 87.06%. MTA can induce the formation of reparative dentine thus allow the pulp to heal normally and maintain pulp's vitality and regenerative potential so the need of RCT can be avoided.

TheraCal LC: From Biochemical and Bioactive Properties to Clinical Applications.

Background Direct pulp capping is a popular treatment modality among dentists. TheraCal LC is a calcium silicate-based material that is designed as a direct/indirect pulp capping material. The material might be very attractive for clinicians because of its ease of handling. Unlike other calcium silicate-based materials, TheraCal LC is resin-based and does not require any conditioning of the dentine surface. The material can be bonded with different types of adhesives directly after application. There has been considerable research performed on this material since its launching; however, there are no review articles that collates information and data obtained from these studies. This review discusses the various characteristics of the material with the aim of establishing a better understanding for its clinical use. Methods A search was conducted using search engines (PubMed and Cochrane databases) in addition to reference mining of the articles that was used to locate other papers. The process of searching for the relevant studies was performed using the keywords pulp protection, pulp capping, TheraCal, and calcium silicates. Only articles in English published in peer-reviewed journals were included in the review. Conclusion This review underlines the fact that further in vitro and in vivo studies are required before TheraCal LC can be used as a direct pulp capping material.

Histologic comparison of direct pulp capping of rat molars with MTA and different concentrations of simvastatin gel.

Previous in vitro studies have suggested that simvastatin can be used as a direct pulp capping material due to its ability to induce odontoblastic differentiation and angiogenesis. The aim of this animal study was to evaluate the pulpal response to mineral trioxide aggregate (MTA) and four concentrations of simvastatin/MTA in combination. The study was conducted in two stages using four different simvastatin concentrations and MTA as a capping material for rat maxillary molars. The grades of inflammation and continuity of dentin formation were evaluated in hematoxylin and eosin (HE)-stained samples. Dentin thickness was determined by histomorphometric analysis, and the data were subjected to statistical analysis. On day 3, mild inflammation was observed in all groups. On day 7, the simvastatin groups showed a slightly higher rate of chronic inflammation. Inflammation was not present on day 30. Discontinuous dentin was present in all methylcellulose (control) samples. Continuous dentin was formed in all of the samples treated with 1.5% simvastatin. The greatest dentin thickness was observed after treatment with 1.5% simvastatin and MTA, followed by 0.5% simvastatin. Statistical analysis demonstrated no significant differences in dentin thickness and continuity between MTA and simvastatin at 0.5% and 1.5% (P > 0.05).

Biodentine versus mineral trioxide aggregate as a direct pulp capping material for human mature permanent teeth - A systematic review.

Background:Biodentine is comparatively a new biomaterial claimed to have properties comparable to mineral trioxide aggregate (MTA). Biodentine and MTA are effectively used for direct pulp capping (DPC), and they are capable of regenerating relatively damaged pulp and formation of hard dentine bridge.Objectives:The aim of this systematic review was to test the null hypothesis of no difference between Biodentine and MTA as DPC materials for human permanent mature teeth, against the alternative hypothesis of a difference.Data Sources:Clinical trials were identified by electronic databases searches of Midline, CENTRAL Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scopus, Scientific Electronic Library Online, evidence-based endodontics literature, KoreaMed, and Google Scholar. The literature search was performed from January 2010 to February 2018. Hand searches were also performed for relevant abstracts, books, and reference lists. Titles and abstracts of studies identified using the above-described protocol were independently screened by two authors. Full texts of studies judged by title and abstracts to be relevant were independently evaluated by two authors for stated eligibility criteria.Study Eligibility Criteria:The eligibility criteria included randomized clinical trials (RCTs) and non-RCTs.Participants:Patients with permanent mature molars indicated for surgical extraction or molars that have symptomless exposure of vital pulp tissue by caries or trauma. In both cases, the molars were subjected to DPC.Interventions:The pulp exposures were directly treated by Biodentine or MTA.Study Appraisal:To assess article quality, two authors independently used the risk of bias in nonrandomized studies – of interventions.Methods:Qualitative metasynthesis was used to analyze data across qualitative studies.Results:The initial search identified 8725 unique references through the search process. No additional studies were identified through handsearching. After filtering, 915 references were recorded and screened. After the eligibility criteria were applied, seven unduplicated prospective and retrospective cohort studies were included in the qualitative metasynthesis.Limitations:Further RCTs with much larger sample size and proper methodology with longer observational time are still in need to adequately address the questions of the present systematic review.Conclusion and Implications of Key Findings:Within the limitations of this review, it may be concluded that Biodentine had a similar effect on dentin bridge formation likely to MTA. However, this conclusion is based on only very few well-conducted prospective and retrospective cohort studies.Systematic Review Registration Number:The review had been registered with PROSPERO (registration number CRD42018089302).

Outcomes of Direct Pulp Capping by Using Either ProRoot Mineral Trioxide Aggregate or Biodentine in Permanent Teeth with Carious Pulp Exposure in 6- to 18-Year-Old Patients: A Randomized Controlled Trial

IntroductionThis study aimed to compare the success rates of direct pulp capping (DPC) by using either ProRoot Mineral Trioxide Aggregate (MTA) or Biodentine in the cariously exposed permanent teeth of 6- to 18-year-old patients. Gray discoloration was also evaluated. MethodsFifty-nine cariously exposed permanent teeth, including teeth with diagnosis of normal pulp, reversible pulpitis, or irreversible pulpitis, early periapical involvement, and exposure size of up to 2.5 mm, were included. Each patient with only 1 cariously exposed tooth was randomly allocated to DPC with either ProRoot MTA (n = 30) or Biodentine (n = 29). Patients were recalled every 6 months. Clinical and radiographic examinations were used to determine success. ResultsFifty-five patients (mean age, 10 ± 2 years), 27 treated with ProRoot MTA and 28 with Biodentine, were included in the analysis. At mean follow-up of 18.9 ± 12.9 months, the success rate was 92.6% with ProRoot MTA and 96.4% with Biodentine (P > .05; difference, 4%; 95% confidence interval [CI], –8% to 16%). Biodentine was non-inferior to ProRoot MTA. Failures were distributed equally in all categories of pulpal diagnosis and occurred in teeth with no periapical involvement and small exposures (0.5 mm). The survival probabilities of DPC with ProRoot MTA and Biodentine were 0.92 (95% CI, 0.73–0.98) and 0.96 (95% CI, 0.80–0.99). No significant difference was observed between them (P > .05). Gray discoloration was observed only with ProRoot MTA (55%). ConclusionsBiodentine was non-inferior to ProRoot MTA when used as a DPC material for cariously exposed permanent teeth of 6- to 18-year-old patients. However, Biodentine did not cause any gray discoloration in this study.

Evaluation of ornidazole-loaded nanofibers as an alternative material for direct pulp capping

Direct pulp capping is an alternative treatment for dental pulp injuries caused by decay, trauma, or cavity preparation. Ornidazole is an antibiotic that is commonly used to treat dental infections against anaerobic bacteria. The purpose of this study was to examine the feasibility of using ornidazole-loaded nanofibers as a coating material for pulp capping. Ornidazole-free and ornidazole-loaded nanofibers were prepared with various polymeric biomaterials, including chitosan, polycaprolactone, and polyethylene oxide using electro-spinning method. After characterization (scanning electron microscopy, mechanical properties, contact angle measurements) of the nanofibers, WST-1 tests performed at 24, 48, and 72 h showed that the nanofibers of both groups had minimal cytotoxic effects on pulp cells. Furthermore, pathological examinations showed higher numbers of cells on the nanofibers in the 72-h samples. Antimicrobial activity tests with ornidazole showed more significant formation of inhibition zones in with the ornidazole-loaded nanofibers, demonstrating their potential applicability for direct pulp capping.

Controlled release of lovastatin from poly(lactic-co-glycolic acid) nanoparticles for direct pulp capping in rat teeth.

Statin at appropriate concentrations has been shown to induce odontoblastic differentiation, dentinogenesis, and angiogenesis. However, using a carrier to control statin release might reduce toxicity and enhance its therapeutic effects. The aim of this study was to prepare poly(d,l-lactide-co-glycolide acid) (PLGA) nanoparticles that contain lovastatin for application in direct pulp capping. The PLGA–lovastatin particle size was determined using dynamic light scattering measurements and transmission electron microscopy. In addition, the release of lovastatin was quantified using a UV–Vis spectrophotometer. The cytotoxicity and alkaline phosphatase (ALP) activity of PLGA–lovastatin nanoparticles on human dental pulp cells were investigated. Moreover, a real-time polymerase chain reaction (PCR) assay, Western blot analysis, and an enzyme-linked immunosorbent assay (ELISA) were used to examine the osteogenesis gene and protein expression of dentin sialophosphoprotein (DSPP), dentin matrix acidic phosphoprotein 1 (DMP1), and osteocalcin (OCN). Finally, PLGA–lovastatin nanoparticles and mineral trioxide aggregate (MTA) were compared as direct pulp capping materials in Wistar rat teeth. The results showed that the median diameter of PLGA–lovastatin nanoparticles was 174.8 nm and the cumulative lovastatin release was 92% at the 44th day. PLGA–lovastatin nanoparticles demonstrated considerably a lower cytotoxicity than free lovastatin at 5, 9, and 13 days of culture. For ALP activity, the ALP amount of PLGA–lovastatin (100 μg/mL) was significantly higher than that of the other groups for 9 and 13 days of culture. The real-time PCR assay, Western blot analysis, and ELISA assay showed that PLGA–lovastatin (100 μg/mL) induced the highest mRNA and protein expression of DSPP, DMP1, and OCN in pulp cells. Histological evaluation of the animal studies revealed that MTA was superior to the PLGA–lovastatin in stimulating the formation of tubular dentin in an observation period of 2 weeks. However, in an observation period of 4 weeks, it was evident that the PLGA–lovastatin and MTA were competitive in the formation of tubular reparative dentin and a complete dentinal bridge.

Best direct pulp capping materials

Best direct pulp capping materials

No evidence from randomized trials to prefer any direct pulp capping material over another

No evidence from randomized trials to prefer any direct pulp capping material over another

Direct Pulp Capping in Primary Molars using Mineral Trioxide Aggregate: An in Vivo Study.

To do a clinical and radiographic evaluation of the effectiveness of MTA when used as a direct pulp capping material in primary molars. Clinical and radiographic follow-up was performed on 30 primary molars with deep caries lesions in 30 patients from 3 to 9.75 years of age. Pulps exposed during cavity preparation were treated by direct pulp capping with MTA. The follow-up clinical and radiographic examinations were carried out at different time intervals: 6, 7-12, 13-18, 19-24, and >24 months after treatment. Twenty-four teeth were evaluated during the entire observation period. Positive clinical and radiographic outcomes were achieved in 19 teeth (13 teeth were saved and 6 were exfoliated). In five teeth, complications were observed only in children under 7 years old. Based on these clinical and radiographic results, MTA was found to be successful when used as a direct pulp capping material in primary teeth.

Cytotoxicity and biocompatibility of resin-free and resin-modified direct pulp capping materials: A state-of-the-art review.

Direct pulp capping is the placement of a dental material directly over exposed pulp to prevent dental pulp from dying and avoid the need for root canal treatments. Calcium hydroxide and calcium silicates/mineral trioxide aggregates (MTA) have been commonly used for direct pulp capping with great success clinically. In recent years, resin-modified calcium hydroxide and calcium silicates have been developed with the advantages of precise placement, command set, and superior physical strength. As pulp capping materials would be in direct contact with the pulp, the cytotoxicity and biocompatibility is of particular importance in order to avoid pulp irritation and maintain pulp vitality. Therefore, this review article will summarize the cytotoxicity and biocompatibility of direct pulp capping materials, particularly resin-modified materials.