Direct Pulp Capping Treatment Research Articles

EFFECT OF GELAM LEAF EXTRACT (Melaleuca cajuputi) AND TRICALCIUM SILICATE CEMENT AS DIRECT PULP CAPPING

Background: Reversible pulpitis is mild pulp inflammation. The treatment is direct pulpcapping. Tricalcium silicate cement has been better at inducing reparative dentin than other materials. Tricalcium silicate cement can cause inflammation 1-2 weeks after application, that natural ingredients need to improve the quality. Tricalcium silicate cement can be combined with galam leaf extract which contains anti-inflammatory properties by accelerating lymphocyte cells. Purpose: To analyzed the effect of gelam leaf extract (Melaleuca cajuputi) concentration of 100% and Tricalcium Silicate Cement on the number of lymphocyte cells on day 3 and 5 in direct pulp capping treatment. Methods: This research is a true experimental study with a post test-only with control design. This study used 24 Wistar rats, divided into 3 treatment groups with 2 different days, namely the group given a combination of Gelam leaf 100% + tricalcium silicate cement, tricalcium silicate cement as positive control, and without treatment as negative control. Results: One-way ANOVA test obtained p value=0.00<0.05, which indicates there is a significant difference between each group. Post Hoc Bonferroni test showed significant difference between galam leaf extract and tricalcium silicate cement, tricalcium silicate cement, and no treatment on days 3 and 5. Conclusion: The combination of galam leaf extract and tricalcium silicate cement can increase the number of lymphocyte cells on day 3 of pulp inflammation and reduce the number of lymphocyte cells on day 5 more effectively than tricalcium silicate cement and without treatment on days 3 and 5 so that the healing process is faster.

Potency of the Combination of Chitosan and Hydroxyapatite on Angiogenesis and Fibroblast Cell Proliferation in Direct Pulp Capping of Rattus norvegicus.

The aim of this research was to analyze expression of vascular endothelial growth factor (VEGF), blood vessels, and fibroblast cell proliferation in direct pulp capping treatment of Rattus norvegicus using a combination of chitosan and hydroxyapatite paste. The samples were male R. norvegicus strains of Wistar rats, weighing 200 to 250 g and aged between 8 and 16 weeks. The occlusal surface of the molars of R. norvegicus was prepared with class I cavity and then perforated with the tip of an explorer. Sixty male R. Norvegicus rats were divided into the following: control group (KA) in which the cavity was filled with glass ionomer cement; control group (KB), in which the cavity was filled with Ca(OH)2; PA group, in which the cavity was filled with chitosan (CH); PB group, in which the cavity was filled with hydroxyapatite (HA); and PC group, in which the cavity was filled with chitosan and hydroxyapatite (CH-HA). Each group was divided into 3-, 7-, and 14-day observation groups. The mandibular bone of the molar was cut and histopathological examination was performed to analyze the blood vessels and fibroblast cell proliferation. Immunohistochemistry examination was done to examine the expression of VEGF. The data variation was analyzed with One Way Analysis of Variance (ANOVA) test and continued with multiple comparison Least Significant (LSD) test to determine the different pairs of group. Analysis of variance (ANOVA) showed a significant increase in the expression of VEGF, blood vessels, and fibroblast cell proliferations (p ≤ 0.05;), especially in the PC group compared to the other four groups. The least significant test (LSD) test showed significant differences between the groups on the expression of VEGF, blood vessels, and fibroblast cell proliferations. The combination of chitosan and hydroxyapatite could promote healing of direct pulp capping treatment by increasing the expression of VEGF, blood vessel, and fibroblast cell proliferation.

Effectiveness of lasers in direct pulp capping among permanent teeth - A systematic review and meta-analysis.

Laser-assisted direct pulp capping (DPC) has considerable advantages compared to traditional methods such as: decontaminant effect; hemostatic and coagulant effect; reduced rise in pulp temperature; reduction of intracavitary pressure; dentinal melting; and biostimulation effect. The aim of this study was to conduct a systematic review of the literature and meta-analysis to evaluate the effectiveness of laser as adjuvant therapy in DPC among permanent teeth. Research question was formulated based on the population, intervention, comparison, and outcomes strategy. A comprehensive electronic literature search was conducted through Cochrane, PubMed, and Google scholar using MeSH words, text words, and Boolean operators, independently by two reviewers. Based on the specified inclusion and exclusion criteria, the selected articles were subjected to quality assessment and the risk of bias (ROB) was evaluated. Cochrane ROB 2.0 and Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tools were used to assess the ROB. Initially, 45 studies recovered, 9 articles were selected for systematic review and 7 articles could be included in the meta-analysis. Teeth treated with low level laser therapy pulp capping therapy showed lower clinical/radiological failure as compared to nonlaser pulp capping therapy with an odds ratio of 0.24 (95% confidence interval = 0.15-0.38; Z = 6.15); and the difference between two groups was statistically significant (P < 0.00001). This systematic review and meta-analysis included both the randomized and nonrandomized controlled trial (RCT). The non-RCTs had low ROB when compared to the RCTs included in the study. All included RCT studies met the inclusion and exclusion criteria, but some did not adequately describe their methods in detail. Based on the limited evidence, the results of the meta-analysis demonstrated DPC treatment could achieve better clinical outcomes with the aid of lasers.

Laser in endodontics: a scoping review

Objective: To evaluate the effect of LASER (Light Amplification by Stimulated Emission of Radiation) in endodontics and its effectiveness compared to conventional techniques and methods currently used. Material and method: The electronic databases PubMed, Science direct and Cochrane library, were searched from 2010-2022 to identify clinical trials and in vitro/in vivo trials evaluating the clinical application of laser in endodontics. The search terms utilized various combinations as follows: endodontics or root canal therapy or dentin or dental pulp and laser. Articles were selected according to the inclusion criteria, data were extracted and methodological quality was assessed. Results: Twenty articles were deemed eligible and included in the review. Of these twenty studies, eleven were in vitro trials and nine were in vivo trials. An assessment of the risk of bias of the included studies was used to classify the studies into three categories: low, medium, and high risk of bias. To evaluate the results of these articles, we established the following analysis criteria: root canal disinfection, direct pulp capping, post endodontic pain and opening of dentinal tubuli. The results of the studies included in this review showed that laser appears to improve root canal disinfection, removal of debris and smear layer, adaptation of filling materials to dentin by increasing the penetration of root canal sealants into the dentinal tubuli, improved prognosis of direct pulp capping treatment as well as decreased postoperative endodontic pain. Conclusion: Although laser appears to improve the quality of endodontic treatment, the heterogeneity in the methodology among the eligible studies did not allow a meta-analysis to be performed for clinical decisions with greater certainty of evidence. Further in vivo studies with standardization of laser parameters are needed to validate its utility as an innovative technology in modern endodontics.

Calcium Phosphate Cement Promotes Odontoblastic Differentiation of Dental Pulp Cells In Vitro and In Vivo

In the case of pulp injury, odontoblastic differentiation of dental pulp cells (DPCs) at the site of the exposed pulp is necessary for a successful direct pulp capping treatment. Calcium phosphate cement (CPC), a kind of hydroxyapatite-like bone cement, exhibits therapeutic potential in osteogenesis by regulating cell cycle progression and promoting osteoblastic differentiation. Based on the similar biological process of osteo/odontoblastic differentiation, the present study evaluated the effects of CPC on odontoblastic differentiation of DPCs in vitro and in vivo, respectively. The morphology of CPC was observed by scanning electron microscopy. Colony-forming units were used to assess the antibacterial activity. The effects of CPC on cell proliferation and odontoblastic differentiation of human dental pulp cells (hDPCs) were also measured. Histological staining was performed to observe the reparative dentin formation in rat molars. In vitro, results of antibacterial studies showed that CPC significantly inhibited the growth of Streptococcus mutans. The appropriate concentration of CPC extract showed low cytotoxicity on hDPCs. Furthermore, CPC extract also promoted odontoblastic differentiation and mineralization compared with the control group, as shown by a dynamic increase in the expression of odontogenic marker genes and the increased number of mineralized nodules at 21 days. The pulpotomy models with CPC facilitated the formation of dentin bridge with the highly expressed dentin matrix protein 1 (DMP1) in odontoblast-like cells. In conclusion, the favorable biocompatibility, antibacterial property and bio-inductivity of CPC suggest that CPC can be used as a promising direct pulp capping material.

Comparison of Clinical Success between Three Different Materials- Direct Pulp Capping of Carious Molars- An In-vivo Study

Aim: To evaluate the clinical success of Calcium Hydroxide (CH), Mineral trioxide aggregate (MTA) and Biodentine as pulp capping materials for Direct pulp capping in carious molars.&#x0D; Materials and Methods: Thirty-six molars of thirty-six patients with deep caries lesions, diagnosed with reversible pulpitis were subjected to direct pulp capping treatment. They were randomly divided into three groups, Biodentine (12 teeth) or MTA group (12 teeth) or CH group (12teeth). Simple randomization of three was employed to allocate the treatment materials. Patients were recalled at one, three and six months to evaluate the clinical success of the treatment outcome.&#x0D; Results: In clinical trial/study, the pulp capping materials gave different success rate, 91.67% success in the Biodentine group, 75% success in the MTA group and 41.67% success in Calcium Hydroxide group.&#x0D; Conclusion: In our study the materials tested at 1 month, 3 month and 6-month follow-up, Calcium Silicate materials are better than calcium hydroxide and comparably Biodentine is better than MTA for Direct pulp capping.&#x0D; Clinical Significance: The findings of this clinical trial could promote the reliability of pulp capping materials for treatment of deep carious lesions by conservative approach rather than opting endodontic management.

Secreted Frizzled-Related Protein 1 Promotes Odontoblastic Differentiation and Reparative Dentin Formation in Dental Pulp Cells.

Direct pulp capping is an effective treatment for preserving dental pulp against carious or traumatic pulp exposure via the formation of protective reparative dentin by odontoblast-like cells. Reparative dentin formation can be stimulated by several signaling molecules; therefore, we investigated the effects of secreted frizzled-related protein (SFRP) 1 that was reported to be strongly expressed in odontoblasts of newborn molar tooth germs on odontoblastic differentiation and reparative dentin formation. In developing rat incisors, cells in the dental pulp, cervical loop, and inner enamel epithelium, as well as ameloblasts and preodontoblasts, weakly expressed Sfrp1; however, Sfrp1 was strongly expressed in mature odontoblasts. Human dental pulp cells (hDPCs) showed stronger expression of SFRP1 compared with periodontal ligament cells and gingival cells. SFRP1 knockdown in hDPCs abolished calcium chloride-induced mineralized nodule formation and odontoblast-related gene expression and decreased BMP-2 gene expression. Conversely, SFRP1 stimulation enhanced nodule formation and expression of BMP-2. Direct pulp capping treatment with SFRP1 induced the formation of a considerable amount of reparative dentin that has a structure similar to primary dentin. Our results indicate that SFRP1 is crucial for dentinogenesis and is important in promoting reparative dentin formation in response to injury.

Clinico-Histological Evaluation of Dentino-Pulpal Complex of Direct Pulp Capping Agents: A Clinical Study.

Introduction:Direct pulp capping treatment (DPC) maintains pulp vitality by promoting healing or repair in dentistry, which can be attributed to the advent of bioceramic materials.Aim:This examination looked to evaluate the clinical and histological effectuality of Biodentine with Dycal for DPC.Materials and Methodology:In this study, 30 intact human orthodontic teeth undergoing therapeutic extraction were chosen to perform DPC. They were arbitrarily divided into two groups (n = 15) and DPC with Biodentine and Dycal was performed. Composite resin was used as permanent restoration. After a period of 1 and 6 weeks, clinical as well as electric pulp tests were carried out. Asymptomatic patients were re-called after 6 weeks; follow-up radiograph was taken. Electric pulp testing and thermal testing was done to check the pulpal status of the teeth. This was followed by atraumatic extraction, and the teeth were sent for histological examination. SPSS Version 21.0. Armonk, NY: IBM Corp.was used for data analysis.Results:There was no pain and sensitivity in using Biodentine. Whereas, sensitivity and pain was noted when Dycal was used. The dentinal bridge was better with Biodentine when compared with Dycal.Conclusion:In accordance with the obtained results, it was concluded that on clinical and histological evaluation, Biodentine performed better as DPC agent. Subsequently, Biodentine is more dependable for the long-haul protection of dental pulp than Dycal.

Effect of Hydrogel Epigallocatechin-3-Gallate (EGCG) to the Number of Fibroblast Cell Proliferation in the Perforation of Wistar Rat Tooth Pulp

Background: Pulpitis can occur because the deep cavity preparation and it causes increasing of NO levels. Perforated teeth require direct pulp capping (DPC) treatment. The current standard DPC material is calcium hydroxide. However, several studies have found weaknesses of calcium hydroxide that can affect the success of DPC treatment and new, more biocompatible materials are needed. Epigallocatechin-3-gallate (EGCG) in green tea has many benefits, including antioxidant, anticolagenase, anticancer, anti-inflammatory and has the ability of radical scavenging to clean NO so that pulp healing can occur better by increasing the number of fibroblast cells that play a role in wound healing. Purpose: To determine the concentration of hydrogel EGCGs that are effective in increasing the number of fibroblast cell proliferation in the dental pulp perforation of Wistar rats. Method: This research is a laboratory experimental study with a randomized post test only control group design. Samples used in the study were 24 male Wistar rats which were divided into four groups, namely the negative control group and the treatment group were given EGCG 60 ppm, 90 ppm, and 120 ppm and were decapitated on the 7th day after treatment. The maxilla and the 1st molar were taken and decalcified, to process the HPA reading with HE staining. Observations were made using a microscope with a magnification of 400x. Results: There were significant differences in the treatment groups with 60 ppm and 90 ppm hydrogel hydrogels on the results of the Oneway ANOVA difference test (p &lt;0.05). Conclusion: The concentration of hydrogel EGCG which is effective in increasing fibroblast cell proliferation is 90 ppm.

Combination effects of diode laser and resin-modified tricalcium silicate on direct pulp capping treatment of caries exposures in permanent teeth: a randomized clinical trial.

The purpose of this randomized clinical trial was to evaluate efficiency of diode 808-nm (Picasso-AMD, USA) laser using power 1.5 W, continuous wave (CW), fiber diameter of 400 μm, non-initiated and in contact mode, tip angle set at 90°, beam divergence 16°, 2 s per an area with 1-mm diameter, power density 190.98 W/cm2, energy density 381.97 J/cm2, vertical and horizontal scanning movement on the exposure site, and laser irradiation combined with a resin-based tricalcium silicate material (TheraCal LC, Bisco, USA) in direct pulp capping in caries exposures of permanent teeth over a period of 6 months. In this randomized clinical trial, a total of 20 anterior and posterior vital teeth without symptoms and radiographic changes of 14 patients between the age group of 15-35 years, of which randomly 10 teeth were considered, each for TheraCal LC, the exposed area was sealed with TheraCal paste and TheraCal combined with diode laser; the treated area was sealed with TheraCal paste after diode 808-nm laser irradiation. At the 1-, 3-, and 6-month recall examinations, the loss of vitality, spontaneous pain, reactions to thermal stimuli and percussion, and radiographic changes were considered failure. The samples were randomly divided using runs test. Measurements on the digitized radiograph were performed at the recalls. The data were analyzed by repeated measurements ANOVA using SPSS 25. Analysis had indicated that at the end of follow-ups, a statistically significant increase in dentin thickness with both groups (p value < 0.001) was found. Clinically, diode laser group has shown better results (p value < 0.001); however, radiographically, no significant difference was observed between groups (p value = 0.56). In both groups, the highest thickness of dentin formed was at the first month; 0.40 mm ± 0.19 mm (p value < 0.001). Diode laser 808 nm under proper parameters combined with TheraCal LC can be recommended for direct pulp therapy in caries exposure of permanent teeth. This research was approved by Esfahan Medical University, Dental School, Azad Branch (KHUISF)) Esfahan, Iran [IR.IAU.KHUISF.REC.1397.261].

Comparison of Biocompatibility of Fibroin Cocoon &lt;i&gt;Bombyx mori&lt;/i&gt; L., Mineral Trioxide Aggregate (MTA), and Resin Modified Glass Ionomer Cement (RMGIC) as Pulp Capping Materials to Human Primary Dental Pulp Cells

One of the requirements of endodontic material is to have good biocompatibility of pulp tissue that has direct contact with the material, to promote the process of tissue repair. Reversible pulpitis needs direct pulp capping treatment with medicament materials i.e. RMGIC (Resin-Modified Glass Ionomer Cement) and MTA (Mineral Trioxide Aggregate) which are used as the gold standard for direct pulp capping treatment. Both of the materials have several disadvantages including the necrotic tissue in the area has direct contact with the pulp so that it affects the successful treatment results. Nowadays, the new materials are being developed which are expected to improve the existing material deficiencies. In this study, fibroin was extracted from Bombyx mori L. cocoon. This study aimed to examine the biocompatibility of fibroin as a new pulp capping material with RMGIC (Fuji II LC, GC, Japan) and MTA (Rootdent, Technodent, Russia). An experimental study was conducted using extracted human primary dental pulp cells in vitro through orthodontic treatment. A methyl thiazole tetrazolium (MTT) assay was employed to test biocompatibility using ELISA Reader 590 nm wavelengths for 24, 48, and 72 h, respectively. The findings showed that the biocompatibility of fibroin had the highest value of all. In conclusion, fibroin biocompatibility toward MTA and RMGIC as pulp capping materials can be aligned, however, there were no significant differences.

Melatonin as an Agent for Direct Pulp-Capping Treatment.

Melatonin plays an essential role in the regulation of bone growth. The actions that melatonin exerts on odontoblasts may be similar to its action on osteoblasts. This research aimed to evaluate the pulp response to melatonin used for direct pulp capping to evaluate the antioxidant effect of melatonin administered orally and its influence on dental pulp. Direct pulp capping was performed on the upper molars of Sprague Dawley rats using melatonin or Mineral Trioxide Aggregate (MTA). The study groups were: MTA; Melatonin; MTA + Melatonin administered orally; and Melatonin + Melatonin administered orally. In the latter two groups, the animals drank water dosed with melatonin ad libitum (10 mg/100 mL). After 30 days, the animals were sacrificed, and 5 ml of blood, the kidneys, and the liver were extracted in order to evaluate oxidative stress using thiobarbituric acid reactive substances testing (TBARS). Fragments of the maxilla containing the study molars were prepared for histological evaluation. The degree of pulp inflammation and pulp necrosis, the presence of reparative dentin and dentin bridging the pulp chamber, the presence and regularity of the odontoblastic layer, and the presence of pulp fibrosis were evaluated. No significant differences were found between the four study groups for any of the studied histological variables. The oral administration of melatonin did not modify the local effects of MTA or melatonin on dental pulp, or reduce basal-level oxidative stress. The effect of melatonin on pulp is similar to that of MTA and may be used as an agent for direct pulp capping.

Long-term survival of different deep dentin caries treatments: A 5-year clinical study.

The aim of this in-vivo study was to evaluate the long-term clinical survival of different deep dentin caries treatment options. : In total, 391 patients with at least one permanent tooth with clinically diagnosed deep dentin caries were inspected. Two hundred and fourteen patients were examined at recall visits. Inclusion criteria were teeth with deep caries lesions with pulp vitality but absence of spontaneous pain and periapical alterations. The subjects received either stepwise removal (SWR), complete caries removal (CCR), or direct pulp capping (DPC). The radiological and clinical exams were performed after a mean observation time of 62 months. Success was defined as pulp sensitivity to vitality test and absence of periapical lesions as well as a clinical symptom. Data were statistically analyzed using Kaplan-Meier and log-rank (Mantel-Cox) tests (α = 0.05). Of the total 214 patients evaluated, 126 received SWR, 88 received CCR, and 67 received DPC treatment. One hundred and twenty-seven restorations were amalgam and 141 were composite. The mean observation period was 62 months. Survival rates were 85.7%, 90.9%, and 59.7% for SWR, CCR, and DPC, respectively (P = 0.001). Success rates of amalgam restorations (86.6%) were similar to composite restorations (83%), and both were found to be successful (P = 0.401). SWR treatment should be considered to preserve pulp vitality of deep dentin lesions instead of CCR or DPC. SWR method for deep dentin caries management had acceptable results over 5 years.

The Effect of Low Level Laser Therapy on Direct Pulp Capping in Dogs.

Introduction: The aim of this study was to determine the histologic effect of low level laser therapy (LLLT) with or without the use of mineral trioxide aggregate (MTA) on exposed pulp tissues of dogs. Methods: Twenty-five premolar teeth in three healthy mature dogs were randomly divided into five groups. In group 1, the pulp tissue was capped with MTA. In groups 2 and 3, before capping with MTA, the exposure site was irradiated by low power lasers at 630 nm (20 mW, 150 seconds, 7.5 J/cm2) and 810 nm (peak power 80 W, average power 50 mW, 1500 Hz, 50 seconds, 6.25 J/cm2) wavelengths, respectively. In groups 4 and 5, the exposure site was irradiated similar to that described in groups 2 and 3, but the pulp tissue was covered by gold foil instead of MTA. After 2 months, the animals were sacrificed and the samples were prepared for histologic evaluation. Results: There were differences in pulpal response and dentinal barrier formation among the study groups. The morphology of pulpal tissue and the integrity of dentinal barrier and formation of odontoblastic layer were more favorable in the first three groups. The occurrence of extensive and intense inflammation and necrosis was more frequent in groups 4 and 5. Conclusion: Under the conditions used in this study, the presence of MTA as a pulp capping material was more important than laser therapy in the success of direct pulp capping (DPC) treatment. MTA proved to be an effective material either alone or in combination with laser irradiation in vital pulp therapy.

The healing actions of propolis on direct pulp capping treatment : A review

Direct pulp capping is a technique used to seal the dental pulp which may become exposed due to mechanical and/or chemical factors as well as bacterial activity in order to stimulates reparative dentin formation. Wound healing on an exposed dental pulp needs an interactive process which requires highly organized activity of various cells, synthesizing cytokines, growth factors, and also collagen. Propolis or bee glue is a natural occuring resinous substance collected by honeybee, represents a popular remedy, well known for its broad spectrum of biological and pharmacological properties.The exact chemical composition of propolis varies depends on plants around the beehive. Generally, its contains a rich variety of potent terpene, benzoic, caffeic, cinnamic, aromatic aldehyde, phenolic acid, and high in flavonoid. Its also contains vitamin A, B complex, C, E and minerals. Many studies showed that propolis improves wound healing on an exposed dental pulp due to its several activities such as antioxidant, anti-inflammatory, antibacterial, and improved tissue regeneration. Therefore, the aim of this review is to discuss the use of propolis with emphasis on its healing actions on direct pulp capping treatment.

Direct pulp capping versus root canal treatment

Direct pulp capping versus root canal treatment

Clinical Outcomes for Teeth Treated with Electrospun Poly(ε-caprolactone) Fiber Meshes/Mineral Trioxide Aggregate Direct Pulp Capping

IntroductionMineral trioxide aggregate (MTA) is a biocompatible material for direct pulp capping. This study was designed to compare the clinical outcomes of pulp-exposed teeth treated with either poly(ε-caprolactone) fiber mesh (PCL-FM) as a barrier for MTA (so-called PCL-FM/MTA) or MTA direct pulp capping. MethodsSixty human vital teeth were evenly divided into 4 groups (n = 15 in each group). Teeth in groups 1 and 3 had pulp exposure <1 mm in diameter, whereas teeth in groups 2 and 4 had pulp exposure of 1–1.5 mm in diameter. Teeth in groups 1 and 2 were treated with PCL-FM/MTA direct pulp capping, and those in groups 3 and 4 were treated with MTA direct pulp capping. ResultsTeeth treated with PCL-FM/MTA direct pulp capping needed a significantly shorter mean duration for dentin bridge formation than teeth treated with MTA direct pulp capping. Moreover, teeth with pulp exposure <1.0 mm in diameter needed a significantly shorter mean duration for dentin bridge formation than teeth with pulp exposure of 1–1.5 mm in diameter after either PCL-FM/MTA or MTA direct pulp capping treatment. In addition, teeth treated with PCL-FM/MTA direct pulp capping formed an approximately 3-fold thicker dentin bridge than teeth treated with MTA direct pulp capping 8 weeks or 3 months later. Furthermore, none of the teeth treated with PCL-FM/MTA direct pulp capping showed tooth discoloration after treatment for 3 months. ConclusionsPCL-FM/MTA is a better combination material than MTA alone for direct pulp capping of human permanent teeth.

The use of lasers for direct pulp capping.

Direct pulp capping helps extend the life of a diseased tooth by maintaining tooth vitality. Nowadays, lasers are more frequently used during direct pulp capping in the clinic, but their use has not been previously reviewed. This review presents the basic properties of currently available lasers, scientific evidence on the effects of laser application on direct pulp capping, and future directions for this technology. An extensive literature search was conducted in various databases for articles published up to January 2015. Original in vitro, in vivo, and clinical studies, reviews, and book chapters published in English were included. Various laser systems have been increasingly and successfully applied in direct pulp capping. Lasers offer excellent characteristics in terms of hemostasis and decontamination for field preparation during direct pulp capping treatment; however, the sealing of exposed pulp with one of the dental materials, such as calcium hydroxide, mineral trioxide aggregates, and bonded composite resins, is still required after laser treatment. Clinicians should consider the characteristics of each wavelength, the emission mode, irradiation exposure time, power, type of laser tip, and the distance between the laser tip and the surface being irradiated.

Effects of diode laser on direct pulp capping treatment : a pilot study.

At the present time, evidence-based, best practices have yet to be established for maintaining the vitality of teeth by managing caries-associated pulp exposure in permanent teeth. In terms of biomechanical and esthetic considerations, pulp capping has proven to be more effective than root-canal therapy. Given the low success rate of conventional methods, new techniques, such as laser-assisted repairs, should be developed. The purpose of this study was to compare the effectiveness of conventional and diode laser-assisted methods in direct pulp capping of carious teeth. Ten patients ranging in age from 12 to 40 were assigned randomly to experimental and control groups in this clinical trial in which the participants' teeth were treated with different techniques, i.e., conventional treatment and diode 808-nm, laser-assisted treatment. For each of these groups, five cases were chosen for treatment with the same method under rubber dam isolation. The data were analyzed by the runs test using SPSS software. The success rate was significantly different between conventional (60 %) and diode 808-nm, laser-assisted (100 %) groups after one year (P > 0.05). The laser-assisted procedure proved to be more effective than the conventional technique in enhancing the outcomes of pulp-capping therapy in carious exposures.

Effect of CO2 laser irradiation on wound healing of exposed rat pulp

This study examined the effects of direct pulp capping treatment using super-pulsed CO₂ laser preirradiation on the wound healing process of exposed rat pulp on days 1, 3, 7, 14, and 28 postoperatively. Group 1 was irradiated with a CO₂ laser and directly capped with a self-etching adhesive system. The laser was operated in super-pulse mode (pulse duration, 200 μs; interval, 5800 μs; 0.003 J/pulse). The irradiation conditions were a power output of 0.5 W, an irradiation time of 3 s, and repeat mode (10 ms of irradiation at 10-ms intervals for a total beam exposure time of 1.5 s), defocused beam diameter of 0.74 mm (approximately 20 mm from the exposed pulp surface), energy density of 0.698 J/cm² per pulse, total applied energy of 0.75 J, and an activated air-cooling system. Group 2 was capped with the self-etching adhesive system. Group 3 was capped with commercially available calcium hydroxide, and the self-etching adhesive system was applied to the cavity. The following parameters were evaluated: pulp tissue disorganization, inflammatory cell infiltration, reparative dentin formation, and bacterial penetration. The results were statistically analyzed using the Kruskal-Wallis test for differences among the groups at each observation period (P < 0.05). There were no significant differences among the experimental groups in any parameters at any postoperative period (P > 0.05). CO₂ laser irradiation was effective in arresting hemorrhaging but showed a tendency to delay reparative dentin formation compared with the application of calcium hydroxide.