Maintain Pulp Vitality Research Articles

Removing Carious Tissue: Why and How?

Caries is no longer seen as an infectious disease, and the aim of treating carious lesions is to control their activity, not to remove the lesion itself. Such control can be implemented by sealing off the lesion from the environment, with sealed bacteria being deprived from carbohydrates and thus inactivated. For cavitated lesions, controlling them usually involves the placement of restorations to rebuild the cleansability of the surface. In this case, dental practitioners have traditionally removed carious tissues prior to the restoration. This has historically been for a number of reasons, while today the main reason for restoring a cavity is to maximise restoration longevity. In shallow lesions, dental practitioners should aim to remove as much carious tissue as possible (to allow adequate depth for the restorative material) without unnecessarily removing sound or remineralisable dentine. This means removal to hard dentine around the periphery, to firm dentine centrally for optimising restoration longevity and allowing a tight cavity seal. For deep lesions in teeth with vital pulps (without irreversible pulpitis), maintaining pulp vitality is critical. Dental practitioners should aim to avoid pulp exposure, leaving soft or leathery dentine in pulpoproximal areas. Peripherally, hard tissue is left, again to ensure a tight seal and sufficient mechanical support of the restoration. As an alternative to the selective removal to soft dentine, stepwise removal can be used. With this approach, the soft dentine is temporarily rather than permanently sealed in, and removed in a second step after 6-12 months. Strategies where carious tissue in cavitated lesions is not removed at all, but sealed or managed non-restoratively, are currently restricted to primary teeth.

Comparative Evaluation of Bioactive Materials and Their Nano-Counterpart as Pulp Capping Agents in Dogs’ Teeth

Introduction: Direct pulp-capping is an alternative procedure to extraction or endodontic therapy, in which a medicament is placed directly over the exposed pulp to maintain pulp vitality and facilitate the formation of protective barrier. Aim of study: The purpose of this study was to evaluate and compare the histological response of dog’s pulp after direct pulp capping with 3 different materials; MTA, Bioactive glass, CEM and their nanoparticles, at 1 month and 3 month time intervals. Materials & Methods: A total of 112 teeth in 8 dogs were used for this study, where 96 teeth were pulp capped with the investigated materials and 16 teeth were serving as negative control. The 14 teeth of each dog were classified into 6 experimental groups and one control (2 teeth each) as follows: Group A: was capped with MTA, Group B: was capped with NMTA, Group C: was capped with CEM, Group D: was capped with NCEM, Group E: was capped with Bioactive glass, Group F: was capped with Nano Bioactive glass and Group G: unprepared tooth (negative control). Dogs were randomly divided into 2 groups (4 dogs each), relative to the observation periods tested, 1 month and 3 months for histomorphological evaluation of pulp response after direct pulp capping with tested materials. Results: Regarding the dentin bridge formation, both NMTA and NCEM groups induced thick dentin bridge with irregular dentin pattern in 1 and 3 months evaluation time period while MTA and CEM induced thinner dentin bridge with regular dentin pattern. BG and NBG groups showed the lowest mean dentin bridge thickness values with no tubular dentin pattern. About the inflammatory reaction of the dental pulp to materials with conventional particle size; MTA displayed the highest prevalence of no inflammation followed by CEM while BG showed the highest prevalence of moderate inflammation and the highest inflammatory cell counts. All nanomaterials showed the highest mean inflammatory cell counts at both evaluations time periods. Conclusion: MTA and CEM can be considered favorable materials for direct pulp capping, while BG and NBG produced the worst inflammatory cell reaction, dentin bridge thickness and quality. Nanoparticles although increased dentin bridge thickness, they also increased the inflammatory cell reaction.

Randomized Clinical Trials on Deep Carious Lesions: 5-Year Follow-up

Deep caries presents a dilemma in terms of which treatment that will render an optimal prognosis by maintaining pulp vitality with absence of apical pathology. Previously, 2 randomized clinical trials were performed testing the short-term effects of stepwise carious tissue removal versus nonselective carious removal to hard dentin with or without pulp exposure. The aim of this article was to report the 5-y outcome on these previously treated patients having radiographically well-defined carious lesions extending into the pulpal quarter of the dentin but with a well-defined radiodense zone between the carious lesion and the pulp. In this long-term study, 239 of 314 (76.2%) patients were analyzed. The stepwise removal group had a significantly higher proportion of success (60.2%) at 5-y follow-up compared with the nonselective carious removal to hard dentin group (46.3%) (P = 0.031) when pulp exposures per se were included as failures. Pulp exposure rate was significantly lower in the stepwise carious removal group (21.2% vs. 35.5%; P = 0.014). Irrespective of pulp exposure status, the difference (13.3%) was still significant when sustained pulp vitality without apical radiolucency and unbearable pain was considered (95% confidence interval, 3.1–26.3, P = 0.045). After pulp exposure, only 9% (n = 4) of the analyzed patients were assessed as successful, indicating that the prognosis is highly dubious following conventional pulp-capping procedures (direct pulp capping or partial pulpotomy) in deep carious lesions in adults. In conclusion, the stepwise carious removal group had a significantly higher proportion of pulps with sustained vitality without apical radiolucency versus nonselective carious removal of deep carious lesions in adult teeth at 5-y follow-up (ClinicalTrials.gov NCT00187837 and NCT00187850).

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.

In Vitro Comparison of Cytotoxicity and Genotoxicity of Three Vital Pulp Capping Materials.

Introduction:Direct pulp capping (DPC) is a treatment for maintaining pulp vitality and its biological function. Ideally, pulp capping agents are expected to induce pulp cells to form hard tissue. This in vitro study assessed the cytotoxicity and genotoxicity of three vital pulp capping (VPC) agents naming Biodentine (Septodont, Saint-Maur-des-Fosses, France), mineral trioxide aggregate (ProRoot MTA; Dentsply, Tulsa Dental, Tulsa, OK, USA) and TheraCal LC (Bisco Inc, Schamburg, IL, USA) on human dental pulp fibroblasts. Methods and Materials:Human fibroblasts were exposed to 100 µL of ProRoot MTA, TheraCal LC and Biodentine in 0-1000 µg/mL concentrations and incubated at 37°C for 24 h. Their cytotoxicity and genotoxicity were assessed using the methyl thiazol tetrazolium (MTT) and the comet assays, respectively. The data were analyzed by Kruskal-Wallis test at the level of significance set at 0.05. Results:None of the tested materials had cytotoxicity or genotoxicity. Conclusion:TheraCal LC, Biodentine and ProRoot MTA can be alternately used for VPC treatment of teeth.

WITHDRAWN: Pulp management for caries in adults: maintaining pulp vitality.

There is a range of treatment options for the management of the pulp in extensively decayed teeth. These include direct and indirect pulp capping, pulpotomy or pulpectomy. If the tooth is symptomatic or if there are periapical bone changes, then endodontic treatment is required. However, if the tooth is asymptomatic but the caries is extensive, there is no consensus as to the best method of management. In addition, there has been a recent move towards using alternative materials and methods such as the direct or indirect placement of bonding agents and mineral trioxide aggregate.Most studies have investigated the management of asymptomatic carious teeth with or without an exposed dental pulp using various capping materials (e.g. calcium hydroxide, Ledermix, Triodent, Biorex, etc.). However, there is no long term data regarding the outcome of management of asymptomatic, carious teeth according to different regimens. This study aims to assess the effectiveness of techniques used to treat asymptomatic carious teeth and maintain pulp vitality. Electronic searches of the following databases were undertaken: The Cochrane Oral Health Group's Trials Register (March 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to week 4, February 2006), EMBASE (1974 to 13 March 2006), National Research Register (March 2006), Science Citation Index - SCISEARCH (1981 to March 2006). Detailed search strategies were developed for each database. Handsearching and screening of reference lists were undertaken. There was no restriction with regard to language of publication. Studies included were randomised controlled trials (RCTs). Asymptomatic vital permanent teeth with extensive caries were included. Studies were those which compared techniques to maintain pulp vitality. Outcome measures included clinical success and adverse events. Data were independently extracted by three review authors. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Collaboration's statistical guidelines were followed. Only four RCTs were identified. Interventions examined included: Ledermix, glycerrhetinic acid/antibiotic mix, zinc oxide eugenol, calcium hydroxide, Cavitec, Life, Dycal, potassium nitrate, dimethyl isosorbide, and polycarboxylate cement. Only one study showed a statistically significant finding; potassium nitrate/dimethyl isosorbide/polycarboxylate cement resulted in fewer clinical symptoms than potassium nitrate/polycarboxylate cement or polycarboxylate cement alone when used as a capping material for carious pulps. It was disappointing that there were so few studies which could be considered as being suitable for inclusion in this review. The findings from this review do not suggest that there should be any significant change from accepted conventional practice procedures when the pulp of the carious tooth is considered. Further well designed RCTs are needed to investigate the potential of contemporary materials which may be suitable when used in the management of carious teeth. It is recognised that it is difficult to establish the 'ideal' clinical study when ethical approval for new materials must be sought and strict attention to case selection, study protocol and interpretation of data is considered. It is also not easy to recruit sufficient numbers of patients meeting the necessary criteria.

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

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

Comparison of Compressive Strength of Five Hydraulic Cements

Objectives: Maintaining pulp vitality is a main goal in restorative dentistry. Introduction of pulp capping agents paved the way to eliminate the shortcomings of these materials and obtain successful restorations. On the other hand, nanotechnology is an emerging field of science with increasing use in dental materials. This study sought to assess the effect of addition of nano-TiO2, nano-SiO2 and nano-Al2O3 on compressive strength of five hydraulic cements.Methods: In this in vitro, experimental study, three experimental formulations of nano hybrid MTA, MTA Angelus and MTA Angelus+ nano-oxide particles cements were placed in molds measuring 4±0.1mm in internal diameter and 6±0.1mm in height made of stainless steel (ISO9917-1). Ten samples were fabricated for each of the five groups of materials. Sound samples were stored at 37°C and 95±5% humidity and were subjected to compressive strength testing in a universal testing machine at a crosshead speed of 0.5mm/minute after 24 hours and one month. Two-way ANOVA, one-way ANOVA and independent samples t-test were used for comparison of compressive strength of groups at different time points.Results: The highest compressive strength belonged to MTA Angelus+ nanohydroxyapatite and nano-hybrid MTA C at 24 hours and 30 days, respectively. The lowest compressive strength belonged to nano-hybrid MTA B and MTA Angelus at 24 hours and 30 days, respectively (P<0.05).Conclusion: Addition of nanoparticles affected the compressive strength of cements. Compressive strength significantly increased over time in all groups.

Evaluation of clinical and radiological outcomes of mineral trioxide aggregate and calcium hydroxide as indirect pulp capping agents in the treatment of deep carious lesion of permanent teeth

The maintenance of pulp vitality and conduction of reparative dentin can be possible by indirect pulp capping with mineral trioxide aggregate (MTA) and calcium hydroxide as pulp capping agents. The objective of the study is to assess the clinical and radiological outcomes of MTA and calcium hydroxide as indirect pulp capping agents in deep carious lesions of permanent teeth. The present study included 50 permanent teeth having deep carious lesions with reversible pulp status were selected and then randomly divided into two groups of 25 teeth in a group. Standard indirect pulp capping procedures were followed. Patients were recalled at 3, 6 and 12 months interval to assess postoperative pain, the vitality of the pulp and formation of reparative dentin. In all observation periods, MTA showed more capable of reducing pain and maintain pulp vitality which was statistically significant than that of calcium hydroxide. At 12 months observation period, 24 teeth (96%) of MTA and 19 teeth (76%) of calcium hydroxide showed reparative dentin formation. It can be concluded that MTA is more effective than that of calcium hydroxide.

Intentional Replantation of a Root-Fractured Tooth with Pulp Canal Obliteration

Root fracture is defined as a fracture involving the dentin, cementum, and pulp. Most fractures occur in the maxillary anterior teeth between the ages of 11 and 20 years old. The treatment for root fracture in permanent teeth involves the reduction and fixation of the displaced coronal segment. When signs of pulp necrosis or inflammatory root resorption are present, root canal therapy should be performed. Since most apical fragments maintain pulp vitality, root canal therapy is typically limited to coronal fragments. However, it`s too difficult to achieve a proper apical stop on coronal fragment. Intentional replantation involves performing root apex treatment outside the mouth after intentional extraction of the tooth in a controlled environment and then replanting it. The objective is `perfect` root canal therapy. Intentional replantation may be used in cases of failed typical root canal therapy, problematic endodontic retreatment due to the existing restoration or a calcified root canal, and when apical surgery is contraindicated because of a lack of reasonable approaches. In this case, intentional replantation was carried out to treat a horizontal root fracture in a maxillary central incisor with a calcified root canal due to previous trauma. We achieved a clinically and functionally satisfactory result.

Endodontie in der unreifen bleibenden Dentition — Maßnahmen zur Vitalerhaltung, Apexifikation und Regeneration der Pulpa

Maintaining pulp vitality is the primary goal when treating permanent, immature teeth. Vital pulp therapy allows physiologic completion of root growth (apexogenesis), a favourable crown-root ratio, continuing secondary dentin deposition and thus a better prognosis for the affected tooth. Direct pulp capping is indicated in case of an accidental or trauma based exposure of a healthy or reversibly inflamed pulp. The success rate is high, being in a range between 80–90 %. The most important factor for the success of direct pulp capping is preventing bacterial invasion. With respect to the capping material, Calciumhydroxide (Ca(OH)2) was considered as being the gold standard. Recent studies showed that using MTA as a capping material permitted significantly higher success rates.Pulpotomy includes the excision of reversibly inflamed coronal pulp tissue, leaving the root pulp in a vital condition. According to the extent of removed tissue, a partial or total (cervical) pulptomy is possible. The induction of a hard substance barrier at the interface of the resected tissue and the capping material is the primary intention, thus allowing the remaining pulp to stay vital. Success rates vary between 90–100 %. Removal of the coronal pulp tissue is accomplished by rotary instrumentation in case of partial pulpotomy or manually by cutting instruments in case of cervical pulpotomy. The resected pulp surface is capped using Ca(OH)2 or MTA.In case of irreversible pulp inflammation, infected or necrotic pulp, vital pulp therapy is not indicated. Conventional root canal therapy is difficult in case of immature, permanent teeth. Therapeutic alternatives are apexification by the induction of an apical hard substance barrier using Ca(OH)2 or the establishment of an apical MTA-plug. Success rates are in a range of 77–98 %. Cleaning and chemical disinfection of the root canal system are crucial for the success of apexification therapy. Time required for Ca(OH)2 induced apical barrier formation varies between 3–24 months. Long-term Ca(OH)2 dressing can cause root fractures. Advantages of apexification by MTA include the immediate, predictable apical barrier formation, thus reducing treatment time.Regenerative endodontic therapy aims at re-establishing functional pulp tissue in case of necrotic or infected pulp, thus allowing continued root development. Biological principles of pulp regeneration are based on the triade of tissue engineering with stem cells, growth factors and scaffolds. Clinical regenerative therapy includes disinfection of the root canal system, induction of an apical bleeding into the root canal, subsequent formation of functional pulp tissue and bacteria-tight seal of the access cavity. With today’s clinical protocols a regeneration of true pulp tissue can only partly be achieved. Nevertheless, numerous studies describe healing of apical pathosis, continued root development and positive reaction to sensitivity tests after regenerative endodontic therapy.

Effects of human vascular endothelial growth factor on reparative dentin formation

It is a challenge for dentists to save dental pulp in patients with pulp disease without resorting to root canal therapy. Formation of tertiary dentin to maintain pulp vitality is a key odontoblast response to dental pulp injury. Vascular endothelial growth factor (VEGF) is the most potent angiogenic and vasculogenic factor involved in tertiary dentin formation. It was hypothesized that VEGF may be used to treat pulp diseases such as pulpitis. To explore this hypothesis, the first step was to assess whether VEGF affects dental pulp cells to promote reparative dentin formation. In the current study, an AdCMV-hVEGF vector was constructed to deliver hVEGF into dental pulp cells of exfoliated deciduous teeth (hDPCs) in vitro and dental pulp cells in a rat model in vivo. The collected data clearly demonstrated that hVEGF increased alkaline phosphatase and mineralization by enzymatic activity. RT-qPCR data demonstrated that hVEGF significantly increased the expression levels of genes commonly involved in osteogenesis/odontogenesis. Data from the in vivo assays indicated that hVEGF enhanced pulp cell proliferation and neovascularization, and markedly increased formation of reparative dentin in dental pulp. The in vitro and in vivo data suggest that hVEGF may have potential clinical applications, thus may aid in the development of novel treatment strategies for dental pulpitis.

Outcome of Direct Pulp Capping with Mineral Trioxide Aggregate: A Prospective Study

IntroductionThe aim of this experimental study was to assess the outcome of direct pulp capping with mineral trioxide aggregate (MTA) after complete excavation of caries in permanent dentition with a 2-visit treatment protocol. MethodsSixty-four teeth with deep carious lesions were consecutively selected. The mean age of the patients was 36.1 ± 15 years. An initial diagnosis of deep caries, with no irreversible pulp involvement, was made. Excavation of caries was performed under a rubber dam and operating microscope magnification. White MTA was applied, and a provisional restoration was placed. At the following appointment, positive sensibility testing and the MTA setting were confirmed. Bonded composite restorations were placed afterward. The patient was recalled at least 1 year after treatment for clinical and radiographic control. Outcome was described as success or failure. Success was defined as lack of complaints from the patient, positive reaction to cold testing, no sensitivity to percussion, and no widening of the periodontal ligament on the recall periapical radiograph. ResultsForty-six teeth (77.9%) were recalled after 3.6 years (standard deviation = 1.1 years). The overall success rate was 91.3%. The success rate in occlusal caries was 100% and 89.7% in proximal caries (difference = 10.3%; 95% confidence interval [CI], 8.5–89.1). The success rate in initial caries was 94.7% and 88.9% in secondary caries (difference = 5.8%; 95% CI, −48.1 to 59.7). The success rate in patients younger than 40 years was 100% and 80% in patients aged 40 years or older (difference = 20%; 95% CI, 4.2–35.8). ConclusionsDirect pulp capping with MTA after pulp exposure during excavation of deep caries could maintain pulp vitality in permanent teeth when a 2-visit treatment protocol is observed.

Perawatan Fraktur Kelas Tiga Ellis pada Gigi Tetap Insisif Sentral Atas

The anterior teeth have the essential esthetics function , so when the trauma occur, the immediately treatment must be done to avoid its dysfunction. Andreas Jo reported in 1984 that 18 percent to 20 percent of traumatic injury in young permanent teeth caused the crown fractures with exposed pulps. This traumatic injury must be managed correctly to keep the pulp normal. Accurate examination and anamnesis must be done before treatment. The prompt treatment to relieve pain, to cover pulps from irritating material and maintain pulp vitality is neededOne alternative treatment for crown fracture with exposed pulp in young permanent is by using pulpotomy with calcium hydroxide. The function of calcium hydroxide is to maintain pulp vitality and stimulate reparative dentin and close the apex. Then, glass ionomer cement is used to support the pulp cap and then resin composite as temporary restoration to recover the function of mastication and esthetics, until the permanent restoration is made. In this case, ,the radiographic showed reparative dentin after four weeks of pulpotomy calcium hydroxide applied. So there was the fact that it took six month to make the apex is close from the beginning of treatment. DOI: 10.14693/jdi.v15i2.75

미성숙 영구치에서 혈소판 농축 섬유소를 적용한 생활 치수 치료 : 증례보고

Preserving the pulp is important in the treatment of carious pulp exposure in young permanent teeth. Pulpotomy is a vital pulp therapy in which a portion of the coronal pulp tissue is surgically removed, and the remaining radicular tissue is covered with suitable material that protects the pulp from further injury and permits and promotes healing. It is important to develop biocompatible treatment directed at maintaining pulp vitality and increasing tooth longevity. Platelet-rich fibrin (PRF) has been referred to as a second-generation platelet concentrate. Two clinical cases in which PRF was applied as a medicament after pulpotomy of an immature permanent tooth are presented. After isolation, caries removal and pulpotomy with PRF was performed. A layer of mineral trioxide aggregate (MTA) was placed over the PRF, and the final restoration was performed. Postoperatively, the patient had no pain or discomfort, and follow-up radiographs revealed normal periodontal ligament space and trabecular bone pattern.

Twenty-Four Months Of Follow-Up After Partial Removal Of Carious Dentin: A Preliminary Study

Aim: Minimal intervention seeks to prevent and detect oral diseases at the earliest stage in order to minimize invasive treatment. The aim of this study was to compare the clinical and radiographic outcomes of permanent molar teeth with deep lesions treated by complete or partial removal of carious dentin after follow-up over a 24-month period. Methods: A total of 20 adolescents from Piracicaba, Sao Paulo, Brazil were screened; 11 had at least one deep carious lesion in permanent molars. Adolescents in whom 18 permanent molars required attention were randomly allocated to receive interventions. In the control group, nine teeth were submitted to complete removal of carious dentin, protection with calcium hydroxide and glass ionomer cement and restoration with resin composite. In the experimental group nine teeth were submitted to partial removal of carious dentin, protection with glass ionomer cement and restoration with resin composite. Radiographic examination and pulp vitality tests were performed 12-24 months after cavity sealing and the teeth were not reopened. Results: Complete data were available for 16 teeth. One volunteer in the experimental group felt pain during the pulp vitality test after 12 months; however, there was spontaneous remission of symptoms and no image suggestive of periapical lesion. No teeth presented unsatisfactory clinical and radiographic response to treatment. Conclusions: The results suggest that partial removal of carious dentin in a single session in permanent teeth could be indicated to maintain pulp vitality since no unsatisfactory clinical and radiographic results were shown.

Cariously exposed pulps may benefit from vital pulp therapies: A critical summary of Aguilar P, Linsuwanont P. Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review (published online ahead of print March 5, 2011). J Endod 2011;37(5):581–587. doi:10.1016/j.joen.2010.12.004.

Cariously exposed pulps may benefit from vital pulp therapies: A critical summary of Aguilar P, Linsuwanont P. Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review (published online ahead of print March 5, 2011). J Endod 2011;37(5):581–587. doi:10.1016/j.joen.2010.12.004.

Effect of Fluocinolone Acetonide on Human Dental Pulp Cells: Cytotoxicity, Proliferation, and Extracellular Matrix Formation

Introduction The goal of vital pulp therapy is to maintain pulp vitality and function. Fluocinolone acetonide is a potent topical glucocorticoid used in the treatment of skin disorders and oral lesions that could possibly be used to resolve inflammation and stimulate the healing process of inflamed dental pulp. The purpose of this study was to investigate the effects of fluocinolone acetonide (0.1–50 μmol/L) on cytotoxicity, cell proliferation, and fibronectin and type I collagen synthesis in human dental pulp cells (HDPCs). Methods HDPCs were prepared from freshly extracted human third molars. MTT assay was used to determine toxicity and cell proliferation. Western blot analysis was performed to detect fibronectin and type I collagen synthesis. Results Low concentrations of fluocinolone acetonide were not only nontoxic but also significantly stimulated cell proliferation ( P < .05). Fluocinolone acetonide significantly stimulated fibronectin and type I collagen synthesis ( P < .05). Conclusions Low concentrations (0.1–10 μmol/L) of fluocinolone acetonide might have the potential to stimulate healing of inflamed dental pulp.

Management of teeth with vital pulps and open apices

One of the main functions of the dental pulp is the formation of dentin. When the pulp undergoes pathological changes before complete root development, normal root growth is disrupted. If the pulp is reversibly inflamed due to caries or exposure, the treatment of choice is to maintain pulp vitality by pulp capping or pulpotomy. If the pulp is irreversibly inflamed or necrotic, traditional apexification procedures consist of multiple and long‐term applications of calcium hydroxide in order to create an apical barrier that aids in root canal obturation. Recently, artificial apical barriers using mineral trioxide aggregate (MTA) have been introduced. In addition, pulp regeneration (revascularization) has received attention as an option for such teeth. That topic will be addressed in the next chapter. In this review, we will give a brief description of the embryology of root development, major causes of pulpal inflammation, factors affecting treatment planning, and tests for diagnosing pulpal conditions. This will be followed by a comprehensive literature review from 1908 through June 2010 regarding the definition, history, materials used, animal and human studies, mechanisms of action, prognosis, as well as advantages and disadvantages of apexogenesis by pulp capping and pulpotomy.

A clinical guide to endodontics – update part 2

This second update paper aims to provide a review of changes and developments that have occurred within the field of pulp therapy for primary teeth since the publication of the BDJ's series and textbook A clinical guide to endodontics. The biological basis of pulp therapy is an area where much recent research has taken place, particularly linked to the healing capacity of pulp tissue. This has lead to the adoption of treatment techniques aimed at maintaining pulp vitality. Such techniques are introduced here as a more contemporary, biological approach to pulp management in the primary dentition.