Maintain Pulp Vitality Research Articles

Microtomographic and histological evaluation of two bioceramics as pulp capping agents in vivo.

Maintaining pulp vitality and function is a priority of the medicaments employed in pulp therapy to preserve tooth integrity. Aim: This study evaluated inflammatory response and reparative dentin bridge formation after direct pulp capping with two different bioceramics. Materials and Method: This was an in vivo controlled experimental study on 12 male Wistar rats. Pulpotomies were performed and the exposed pulps were capped with Biodentine or Neo MTA. After 15, 45 and 90 days, maxillary segments were obtained and prepared for histologic analysis and Micro-CT. Hounsfield Units (HU) were quantified. Results: Micro-CT analysis showed greater mineralization at 90 days with Neo MTA than with Biodentine. HU did not differ significantly (p >0.05) between molars treated with Biodentine and Neo MTA at 15 and 45 days, but at 90 days, there was statistically significant difference (p <0.05) between them. Reparative dentin was observed near the pulp exposure and canal orifice with both bioceramics. At 45 and 90 days, molars treated with Neo MTA showed mineralized tissue filling the canal orifice. Molars treated with Biodentine showed mineralized tissue and dentin bridge at the site of exposure at 45 days, and total pulp exposure coverage and mineralized entin matrix at 90 days. Conclusions: Biodentine and Neo MTA induce the formation of reparative dentin bridge after 45 days with inflammatory cell infiltrate.

Decision-Making in Endodontics Prior to the Surgical Removal of Large Cysts Involving Vital Teeth.

Introduction Maintaining pulp vitality is crucial; however, treatment options forlarge lesions may hinder the vitality of the teeth involved within the lesion.Some clinicians are not updated about the diagnostic terminology of the American Association of Endodontists (AAE) which may affect their decision-making. In the literature, there was no absolute treatment to manage such cases. The purpose of this study is to explore different opinions, identify the evidence of practice and treatment options to help in decision-makingand assess if clinicians are acknowledged by the AAE guidelines. Materials and methods This cross-sectional study was conducted through a qualitative survey designed to interview randomly selected endodontists, oral maxillofacial surgeons, oral medicine specialists, oral pathologists, and general partitioners to record their decisions and management about a structured case scenario. Atotal of 120 participants were included in the study.The interviewswere conducted bya single investigator, and the answers were recorded by another investigator. Finally, the responses of the interviewees were collected using Google Forms (Google, Mountain View, California). Results We found that there are dissimilarities between the different groups in decision-making concerning the management of teeth involved in large cystic lesions. Regarding the AEE guidelines, almost all the endodontics and general dentists were aware of the guidelines when compared with the other groups. Conclusion The management of teeth involved in large cystic lesions is controversial. Furthermore, the AEE guidelines are not a common language between the different disciplines. Randomized clinical trials are needed to investigate the prognosis and management of teeth associated with large cystic lesions.

Effect of four direct pulp capping agents on human dental pulp tissue.

Direct pulp capping (DPC) is a vital pulp therapy, wherein accidental or carious pulp exposures can be capped with various materials to induce reparative dentine formation. One of the major factors that determine the success of direct pulp capping procedures is the material used. Therefore, it is of interest to evaluate and compare the efficacy of a new material, Tristrontium aluminate in comparison with the widely used materials such as ProRoot MTA, Biodentine & TheraCal LC. Hence, 40 premolars scheduled for extraction for orthodontic treatment, were equally divided into 4 groups and iatrogenic DPC was done using one of the study materials. The premolars were then extracted after 90 days & assessed for the formation of Dentine Bridge and pulpal response elicited by the materials using CBCT and histopathological analysis. All the materials tested in the study were successful in inducing dentine bridge formation & maintaining pulp vitality. Thus, the novelty of Tristrontium aluminate for potential applications in future is eminent.

Differences of compressive strength between calcium carbonate from blood clam shells and calcium hydroxide as a candidate for pulp capping material

Background: Pulp capping is one of the treatments for reversible pulpitis and aims to maintain pulp vitality. This treatment requires a material that can protect the pulp with good biocompatibility. The physical and mechanical properties, bio interactivity and bioactivity of pulp capping materials are very important for the formation of reparative dentin. Calcium hydroxide (Ca(OH)2) as the gold standard material in pulp capping treatment also has some disadvantages. Another alternative for pulp capping material is blood clam shell because it contains 98% calcium carbonate (CaCO3), which is a compound with a bone-like structure and can induce pulp cell differentiation. Objective: To investigate and explain the difference in compressive strength between CaCO3 from blood clam shells and Ca(OH)2 as a candidate pulp capping material. Methods: This research is a laboratory experimental study with post test only control group design method. Ca(OH)2 and CaCO3 samples were formed with a mixture of powder and aquadest with 4x6 mm sample size. The samples were dried at room temperature and the compressive strength was measured using a universal testing machine (UTM). Result: There is a significant difference in compressive strength between Ca(OH)2 and CaCO3 blood clam shells in the Mann-Whitney test results (p&lt;0.05). Conclusion: The results of the compressive strength test between the mixture of Ca(OH)2 with aquadest in a ratio of 1:1 are greater than the mixture of CaCO3 blood clam shells with aquadest in a ratio of 3:1 so that pure CaCO3 blood clam shells with distilled water without other additives cannot be used as a candidate for capping pulp material.

Ways of Maintaining Pulp Vitality: Narrative Literature Review

Background: Dental caries is a prevalent global health issue, affecting a significant portion of the population and impacting social and personal well-being. Traditional methods focused on aggressive caries removal, but recent advances emphasize the importance of preserving pulp vitality through minimal invasive techniques. Objective: To evaluate the efficacy of various vital pulp therapy techniques including indirect and direct pulp capping and pulpotomy, and to analyze the effectiveness of new biomaterials in preserving dental pulp vitality in teeth affected by caries or trauma. Methods: A systematic literature review was conducted using the Islamabad Medical and Dental College library and online databases such as PubMed and Google Scholar. The review included peer-reviewed articles that discussed vital pulp therapy, materials used in pulp capping, and their outcomes. Articles were selected based on inclusion and exclusion criteria with no date restrictions, focusing solely on literature published in English. Results: The review identified 32 relevant studies, indicating a shift towards less invasive procedures that prioritize dental pulp preservation. Innovations in biomaterials such as Mineral Trioxide Aggregate (MTA), Biodentin, and resin-based MTA have shown to enhance healing outcomes and are increasingly preferred over traditional materials like Calcium Hydroxide due to their superior properties and clinical results. Conclusion: Vital pulp therapies are crucial for managing teeth with deep carious lesions or trauma, offering a conservative alternative to more invasive treatments. These therapies are instrumental in maintaining the structural integrity and health of natural teeth, thus reducing the need for extensive dental procedures and promoting overall oral health.

Ways of Maintaining Pulp Vitality: Narrative Literature Review

Ways of Maintaining Pulp Vitality: Narrative Literature Review

Pulpotomy v/s pulpectomy in 6 to 9 years old children

Background: The main goal of pulp treatment is to preserve the health and integrity of the oral tissues. Early primary tooth loss can result in malocclusion and temporary or permanent issues with appearance, phonetics, and function. While it is desirable to try to maintain pulp vitality wherever possible, the pulp can be completely removed without seriously impairing the tooth's ability to function. Aim: To compare the prevalence of pulpectomy and pulpotomy procedures done in 6 to 9 years old children Materials and method: The study was a retrospective cross-sectional analysis, evaluating dental outpatient records and analyzing data from 86,000 patients between June 2020 and April 2021 to collect case records of 6 to 9-year-old children undergoing pulpectomy and pulpotomy procedures. We selected children between the ages of 6 and 9 who underwent pulpectomy and pulpotomy procedures. Using the SPSS software, the data was compiled followed by statistical analysis. Results: Of the total number of children screened, about 96% of the patients between 6-9 years of age underwent pulpectomy whereas the remaining 4% underwent pulpotomy. Of these patients, 56% of them were males and about 44% of them were females. About 75% of these pulpectomy procedures were performed in posterior teeth whereas only 25% of them were done in anterior teeth Conclusion: From this study it can be concluded that in a university setting, pulpectomy was most predominantly performed in children of 6-9 years of age and the most commonly involved teeth were the posteriors.

Indirect Pulp Capping Treatment Using Calcium Hydroxide with Follow-Up Class 1 Composite Restoration on Tooth 36

One of the treatments for deep carious lesions that have irritated the pulp tissue is treatment pulp capping to maintain pulp vitality. Indirect pulp capping is a treatment procedure that performed on deep caries but does not yet involve pulp exposure. Calcium Hydroxide is such a medicament gold standards that are often used for the treatment of pulp capping because the characteristic is bactericidal or bacteriostatic. This case report describes of the case indirect pulp capping with two visits treatment to the left mandibular first molar. Patients came with the main complaint of pain when drinking cold water or eating. There is no history of spontaneous pain. The tooth was examined for vitality using a sensibility test and the pulp was found to be vital. Treatment is carried out through proceduresindirect pulp capping with two visits using calcium hydroxide and the cavity was irrigated with aquadest and disinfected with 2% chlorhexidine. The cavity was sealed with Glass Ionomer Cement and the final restoration was made using a composite resin restoration. The patient was then followed up for up to 9 weeks for the placement of the permanent restoration. The patient was followed up for up to 9 weeks for the permanent restoration. Indirect pulp capping is one of the treatments that can be chosen in cases of caries with deep cavities that are close to the pulp. This treatment is carried out to prevent the pulp from opening selective caries removal.

PULPOTOMY AS A CONSERVATIVE TREATMENT IN PEDIATRIC DENTISTRY: a literature review

Pediatric dentistry is the field responsible for the care and treatment of oral health in children and adolescents. Pulpotomy emerges as an important conservative technique used in the treatment of deciduous teeth affected by pulp lesions. Deciduous teeth play a crucial role in facial development, as well as serving as guides for the eruption of permanent teeth and maintaining space for proper occlusion. It is essential to preserve them when possible, avoiding the need for extraction or more invasive procedures. Pulpotomy is indicated when there is inflammation in the coronal pulp caused by caries or trauma but with preservation of radicular pulp vitality. The procedure involves the partial removal of the affected pulp, the application of medication in the cavity, and subsequent restoration, with the aim of maintaining pulp vitality, relieving pain, and preventing future complications. This research aims to analyze pulpotomy as an efficient treatment option in pediatric dentistry. The study is based on the methodology of narrative literature review. The results obtained by analyzing pulpotomy in pediatric dentistry demonstrate its effectiveness in preserving the pulp vitality, function, and aesthetics of affected deciduous teeth, with the technique providing a less traumatic treatment for children. The choice of obturating materials used in pulpotomy is a crucial aspect for the success of the treatment. Various materials, such as formocresol, calcium hydroxide, and biodentine, have been studied and applied in clinical practice. The selection of the appropriate material should take into account characteristics such as biocompatibility, non-irritation of the tooth, ease of manipulation, hermetic sealing, and mechanical resistance. Thus, when performed correctly and with the use of appropriate obturating materials, it offers an effective and safe treatment, respecting the principles of preserving dental integrity and promoting long-term oral health.

Comparison of various pulpotomy techniques: coronal, cervical, and full pulpotomy

The preservation of deciduous teeth is crucial in pediatric dentistry to maintain normal speech, development, and self-esteem, while also preventing secondary issues like space loss and tooth impaction. Different materials and approaches have been explored over time, ranging from mummification to maintaining pulp vitality and promoting healing. In today's conservative dentistry, techniques like indirect pulp treatment and partial pulpotomy (PP) have gained popularity. Adults diagnosed with irreversible pulpitis due to deep caries often receive root canal therapy (RCT). However, coronal pulpotomy treatment (CPT) has emerged as an affordable alternative for those unable to afford RCT. CPT removes the coronal pulp, allowing the remaining pulp to remain vital. PP and complete pulpotomy are explored as treatments for teeth with signs of irreversible pulpitis. Success depends on eliminating infected tissue, using aseptic techniques, and achieving a tight restorative seal. Materials like MTA have shown favorable outcomes. Direct pulp therapy and PP can effectively preserve vital pulp in primary and young permanent teeth. The choice of pulpotomy material, such as MTA, plays a significant role in success rates.

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

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

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

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

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

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

Pulp Revascularization After Autotransplantation of the Mandibular Canines With Partially Resected Roots: Report of 5 Cases With Follow-ups Between 26 and 80 Months

IntroductionTransmigrated (migrated through the midline) mandibular canines constitute a treatment challenge. Advanced transmigration can be successfully treated by autotransplantation. In developing canines, pulp revascularization is typical after transplantation. On the contrary, the pulp of teeth with completed apex formation does not undergo revascularization. In this case, root canal treatment becomes compulsory and decreases the success of autotransplantation. The aim of this observational retrospective study was to evaluate whether partial resection of the root (performed during the autotransplantation of mature canines) would enable revascularization of the pulp after the surgery. MethodsFive transmigrated mandibular canines with complete apex formation before the surgery were evaluated. During the autotransplantation surgery, the resection of 2 to 4 mm of the root apex was performed to open the path for revascularization of the pulp after surgery. The transplanted teeth were observed during healing after the surgery for the presence of pulp obliteration. Clinical and radiographic examinations were performed. ResultsAll treated canines survived the minimum observation period of 2 years (ranging from 26 to 80 months, mean: 55 months) without pulp healing complications. The survival was 100%, and the success was 80%. In one canine, the external cervical root resorption was diagnosed and treated 1 year after the surgery. At the final examination, transplanted canines presented radiographic features of pulp obliteration, normal mobility, and healthy periodontal tissues. ConclusionsThe surgical protocol proved to be successful in promoting revascularization to maintain pulp vitality, in all cases. The outcomes confirm that autotransplantation, combined with the resection of the root, constitutes a valid treatment for mature ectopic canines.

Management of a Multiple Dentoalveolar Trauma in Permanent Teeth: A Case Report with an 18-Month Follow-up

: This case report described a 10-year-old girl injured during a sports accident. Clinical examinations disclosed the extrusion, crown fracture, and subluxation of the anterior teeth of each jaw. At the same time, dental fragments were embedded within the lower lip soft tissue - the projected procedures concerned maintaining pulp vitality and periodontal stability of the fractured teeth with an 18-month follow-up.

Dental Caries and Its Management.

In recent years, the management of dental caries has evolved significantly. Caries prevention, early detection, and a diagnosis based on risk indicators and risk factor assessments are the most current practical approaches. Furthermore, as proposed in minimally invasive dentistry, the new management approaches preserve healthy tissue and maintain pulp vitality. This article overviews the latest minimally invasive dental caries management and treatment options. The information will assist the reader in the early detection, diagnosis, and treatment of dental caries. The PubMed (MEDLINE) search engine was used to gather the most relevant information on dental caries. The search was restricted to five years (May 30, 2018-May 29, 2022), and only English-language studies were accessed. A Boolean search of the PubMed data set was implemented to combine a range of keywords. The following filters were applied: abstract, free full text, full text, clinical trial, randomised control trial, systematic review, meta-analysis, and review. More studies were also obtained by manual searches from Google Scholar and textbooks on dental caries. By using this process, 683 articles and studies were obtained. The most relevant published studies were chosen and used in the current review. The selected articles are included in the references list. However, the search extended to cover the last five years as our understanding and management of dental caries have changed significantly. Early detection and diagnosis of caries based on risk indicators and risk factor assessments are effective. Furthermore, minimally invasive restorative techniques are beneficial in managing dental caries and preserving healthy tissue and should be used whenever possible. This new information, knowledge, and materials should encourage professionals to implement this method. Having a strategy and system based on patient-centred care is critical, and our dental responsibilities must prioritise patient-centred care.

A comparative evaluation of light cure calcium silicate and resin-modified glass ionomer as indirect pulp capping agent in primary molars: A randomized clinical trial.

Minimally invasive techniques should be employed to maintain pulp vitality without affecting physiological tooth resorption for pediatric patients. This study aims to evaluate clinical and radiographic success of light cure calcium silicate and resin-modified glass ionomer (RMGI) as indirect pulp-capping agent in primary molars in children between 5 and 9 years. In this randomized clinical trial study, 40 primary molars with the International Caries Detection and Assessment System criteria 4-6 score were divided randomly into two groups after computerized randomization method. After caries excavation by minimally invasive dentistry principle, affected dentin was lined by either light cure calcium silicate (Group I) or RMGI (Group II) liner followed by composite restoration. Clinical success was determined with the absence of symptoms and bitewing radiographs were taken at baseline, 3, and 6 months' interval to measure increase in dentin increment using ImageJ software. Statistical analysis for intergroup comparison was done using Paired t-test, and Independent t-test was used for intragroup comparison. The level of statistical significance was set at P < 0.05. Change in dentin increment seen from baseline to 6 months in Group I was 0.19 mm and in Group II was 0.20 mm (P = 0.924). Intragroup increment was statistically significant during all follow-up intervals for both the groups (Group I - P ≤ 0.001, Group II - P = 0.009). For baseline remaining dentin thickness >1.5 mm, statistically significant increase was observed in the dentin increment at 3 months' interval between both the groups. Both TheraCal LC and Vitrebond show acceptable clinical and radiographic results when used in primary molars as indirect pulp treatment agents. Both the liners are equivalent to each other in terms of feasibility and cost-effectiveness but TheraCal LC can be preferred due to better handling and avoiding the manipulation step thereby reducing treatment time.

TRAUMATIC DENTAL INJURIES: ETIOLOGY, PREVALENCE AND POSSIBLE OUTCOMES

Traumatic dental injuries are significant public health problem because of its frequency, impact on economic productivity and quality of life. It is not a disease and no individual is ever at zero risk of sustaining these potentially life-changing injuries. Traumatic dental injuries occur most frequently in children and young adults. Older adults also suffer from traumatic dental injuries but at significantly lower rates than individuals in the younger cohorts. Luxation injuries are the most common traumatic dental injuries in the primary dentition, whereas crown fractures are more commonly reported for the permanent teeth. Proper diagnosis, treatment planning and follow up are very important to assure a favorable outcome. The aim was to overview the etiology, prevalence and possible outcomes of dental trauma. An electronic search of Medline (PubMed), Cochrane, SSCI (Social Citation Index), SCI (Science Citation Index) databases from 2000 to the present, using the following search words: tooth injuries, tooth trauma, traumatized teeth, dental trauma, dentoalveolar trauma, oral trauma, epidemiology, etiology, prevalence, prevention, pulp necrosis, inflammatory resorption, ankylosis, cervical resorption, was performed. The current revision represents the best evidence based on the available literature and expert opinions. During last decade traumatic dental injuries were recognized as public dental health problem worldwide. Prevalence of traumatic dental injuries varies between countries. According to the existing data they are more prevalent in permanent than in primary dentition. All treatment procedures in case of dental trauma are directed to minimize undesired consequences despite that treatment of traumatic dental injuries in the young patient is often complicated and can continue during the rest of his/her life. The changing lifestyle and requirements of modern society lead to an emergence of new patterns of dental trauma. Successful treatment of traumatic injuries depends on timely action by the patient and a quick and accurate diagnosis by the dentist. Although most injuries are minor and of an urgent nature, displaced or missing teeth are true emergencies. The mismanagement of traumatic dental injuries has provided much information as well as questions for research that have resulted in the increased retention of teeth with as little treatment as possible. Maintaining pulp vitality when possible, utilizing the therapeutic effects of calcium hydroxide, and returning teeth to function as soon as possible are keys to predictable prognosis. It is the responsibility of the dentist to stay current on the latest techniques available to treat traumatic injuries. The charts included provide most of the potential emergency treatment possibilities, recommended follow-up treatment, and final treatment outcomes essential to providing the best care for our child patients. It is also the responsibility of the dentist to use evidence-based research when adopting treatment protocols.

Pulp neurovascular plexus response as a result of crown-root horizontal fracture and uncomplicated crown fracture in permanent dentition: a case report

Dental trauma often have severe and complex injuries to the dentoalveolar system. Objective: To report the treatment of crown-root horizontal fracture and uncomplicated crown fracture in permanent dentition. Case report: Child patient attended the dental trauma service 30 days after the fall. On clinical and imaging examination, an uncomplicated crown fracture in the right central incisor and crown-root fracture in the left central incisor was possible to identify (tooth 11 and tooth 21 respectively). The conventional restorative treatment (tooth 11) and repositioning (tooth 21) were performed. The endodontic treatment was performed at 6 months of follow-up (tooth 11). At the new imaging exam, cement neoformation was evidenced between the fragments of the crow-root fracture (tooth 21). After 24 months of follow-up, there was a decrease in periapical lesion (tooth 11), and maintenance of pulp vitality (tooth 21). Conclusion: There is a possibility of maintaining pulp vitality in crown-root fractures and highlights the importance of follow-up in non-complicated fractures.

TheraCal as the material of choice for direct pulp treatment compared to two other materials: MTA and biodentine

Introduction: Direct pulp treatment is a procedure in which the exposed vital pulp is treated with a therapeutic material, it is sought to promote healing, maintain pulp vitality and protect the pulp. Objective: To prove that TheraCal is the material of choice as a coating for direct pulp treatment in terms of biocompatibility and cytotoxicity, solubility and clinical management, effects on the pulp, clinical and radiographic success in comparison with current materials used; MTA and Biodentine. Methodology: An electronic search was performed during September 2021 in the PubMed-MEDLINE database. Human or In vitro comparative studies evaluating biocompatibility, clinical and radiographic success were included. No restriction was applied to the date of publication. Case series and expert opinions were excluded. Keywords such as