Pulpal Response Research Articles

Pulpal Response to the Combined Use of Mineral Trioxide Aggregate and Iloprost for Direct Pulp Capping

Purpose: The present study aims to assess the combined effects of mineral trioxide aggregate (MTA) and iloprost when used as a pulp capping material on pulpal inflammation and tertiary dentin formation compared with MTA and iloprost alone in rat molar teeth. Methods: Eighty maxillary first molar rat teeth were exposed and capped with iloprost solution, MTA, or MTA mixed with iloprost (MTA-iloprost). The cavities were then filled with resin-modified glass ionomer. The cavity was restored with glass ionomer without the use of pulp capping agent in the control group. The rats were sacrificed after one and four weeks. Block sections of the molar specimens were prepared and subjected to hematoxylin and eosin staining for evaluation. Statistical analysis was done using the Kruskal–Wallis test, followed by Dunnett’s test. Results: At week one, the control group showed significantly more severe pulpal inflammatory reactions than the iloprost (p = 0.00), MTA (p = 0.04), and MTA-iloprost (p = 0.00) groups. Hard tissue formation was commonly found in the iloprost, MTA, and MTA-iloprost groups. After four weeks, pulpal tissue degeneration was observed in the control group. Complete hard tissue barriers were found in 50%, 72.7%, and 77.8% of the specimens in iloprost, MTA, and MTA-iloprost groups, respectively, with no significant differences among the experimental groups. The dentinal tubule patterns were mostly regular in the MTA-iloprost group and irregular in the iloprost and MTA groups. Conclusions: The application of iloprost, MTA, and MTA-iloprost as a pulp capping material resulted in similar pulpal responses in the mechanically exposed pulp of rat molars. Therefore, mixing MTA with iloprost might not be clinically significant.

Comparison of Four Dental Pulp-Capping Agents by Cone-Beam Computed Tomography and Histological Techniques—A Split-Mouth Design Ex Vivo Study

Dental pulp-capping is done to preserve vital teeth when the pulp is exposed due to caries, trauma or instrumentation. Various materials are used as pulp-capping agents. The introduction of newer materials requires scientific studies to assess their clinical efficacy. The study was designed as a split-mouth randomized analysis of four pulp-capping agents (calcium hydroxide, mineral trioxide aggregate (MTA), Biodentine and EndoSequence root repair material (ERRM)). Based on selection criteria, 15 orthodontic patients requiring the extraction of four premolars (60 teeth total) were included in the study. After pulp-capping, the teeth were extracted after 8 weeks. We analyzed the extracted teeth using cone-beam computed tomography (CBCT) and histological sections to determine the quality of the dentinal bridge and the pulpal response. Ordinal scores were given based on the completeness of the dentinal bridge, the type of bridge and the degree of pulpal inflammation. Results were analyzed using a Kruskal–Wallis test (p < 0.05) with post hoc Conover values being used when applicable. All four pulp-capping materials elicited dentinal bridge formation (60/60). MTA had the highest scores (10/15) in dentinal bridge formation followed by ERRM (8/15). Both materials showed more samples with complete dentinal bridges (9/15 each) and a favorable pulpal response (15/15). Teeth capped with calcium hydroxide showed more cases of incomplete bridge formation (9/15) and pulpal inflammation. These differences in dentinal bridge formation and pulpal inflammation were statistically significant (p 0.001 and p 0.00005, respectively), with post hoc tests revealing no significant differences between MTA and ERRM (p 0.49 and p 0.71, respectively). MTA and ERRM performed better than the other pulp-capping materials but did not differ significantly from each other. The individual preference for a pulp-capping material may be based on clinical efficacy and handling characteristics.

The variability of electric pulp response thresholds in primary molars: a clinical study

The variability of the EPT response threshold is the most important part of accurate diagnosis of pulp status of caries-affected resorbing primary teeth. This study evaluated the mean EPT threshold values and appropriate electrode placement sites for primary molar teeth based on their physiological root resorption levels. This study was conducted with 100 primary second molars in 100 children ages 3-12 (mean age: 7.88years). Teeth were divided into 2 groups according to physiological root resorption levels. EPT response thresholds were recorded at the mesiobuccal cusp, occlusal third, middle third and cervical third of the crown. Data were analyzed according to resorption level using one-way analysis of variance and Duncan tests, with the level of significance set at 0.05. Mean threshold values at all placement sites were higher in the group with the higher level of physiological root resorption. In terms of placement, the lowest mean EPT threshold values were obtained at the mesiobuccal cusp regardless of resorption level. According to the study results, higher resorption levels were associated with higher physiologocial threshold values for EPT of primary second molars, with the mesiobuccal site identified as the most appropriate electrode placement site, regardless of resorption level.

Pulp Response to Periodontal Disease: Novel Observations Help Clarify the Processes of Tissue Breakdown and Infection

IntroductionThis study evaluated the pulp response to periodontal disease of increasing severity. MethodsThe material comprised human teeth affected by moderate (n = 16) to severe (n = 48) periodontal disease and no clinically identified caries lesions. Specimens were obtained by extraction and were processed for histopathologic and histobacteriologic methods. ResultsIn 13 of 16 teeth with moderate periodontal disease and vital pulp, no frank accumulations of inflammatory cells were observed. In 22 of 32 teeth with severe periodontal disease and vital pulps, no distinct inflammatory cell accumulations were observed in any portion of the pulp when there was an intact or minimally damaged cementum layer in the corresponding areas. Intravascular bacterial aggregations were detected in pulp blood vessels in 6 teeth with symptomatic pulpitis and severe periodontal disease, which had not reached the root apex in 4 of them. Focal areas of infection and varying accumulations of acute and chronic inflammatory cells were observed throughout the pulp tissue and surrounding these infected blood vessels. When the periodontal pocket reached the apex of single-rooted teeth, the entire canal space was necrotic and colonized by bacteria, often forming biofilms. In multirooted teeth, the pulp response varied according to the root(s) affected. Intrapulpal calcifications were observed in 91% of the teeth. The pulp and cementum of the control teeth showed no pathologic changes or bacteria. ConclusionsThe pulp showed a significantly detectable response when the cementum coverage was lost or when the periodontal pocket reached the root apex. In the former condition, the pulp response was usually discrete, whereas in the latter, severe reactions usually developed. In some teeth, vessels with a compromised blood flow may serve as avenues for bacteria to invade the pulp via apical or lateral foramina. This indicates that in some teeth the pulp may undergo severe inflammation and necrosis even before the periodontal disease reaches the apical root segment.

Evaluation of human pulp tissue response following direct pulp capping with a self-etching adhesive system containing MDPB.

This study evaluated the human pulp tissue response following direct pulp capping with Clearfil Protect Bond (CPB) self-etching adhesive containing an antibacterial monomer MDPB. The pulps of third molar teeth were exposed by the removal of carious tissue. In an experimental group, CPB was applied to the exposed pulp and dentin. In the control groups, Clearfil SE Bond (CSE) or calcium hydroxide-based cement (CH) was applied to the exposed pulp surfaces. All teeth were filled with resin composite, extracted after 90 days, and the pulp responses were histologically analyzed. No severe inflammation or soft tissue disorganization was observed in CPB and CH groups. CSE group exhibited a disorganized odontoblastic layer and severe inflammatory infiltration. No hard tissue formation was observed in CSE group, and CH formed more of a hard tissue formation than CPB. CPB induced an acceptable healing response when directly applied to exposed pulps with bacterial contamination.

Pulp healing in immature replanted permanent teeth: A competing risk analysis.

Tooth displacement during avulsion causes total rupture of the pulp's neurovascular supply. Revascularization and pulp healing may occur in immature teeth, which gives rise to the recommendation that root canal treatment may not be required. The aim of this study was to evaluate the prognostic factors for the pulp's response after replantation of young permanent teeth. Records from 117 patients with 133 replanted permanent immature teeth were reviewed, and pulp outcomes were classified as healing (hard tissue deposition on the dentinal walls followed by narrowing of the pulp lumen or ingrowth of bone-like tissue inside the pulp canal) or non-healing (pulp necrosis with infection). The effect of clinical and demographic co-variates on the hazards of both outcomes was assessed performing a competing risk model. Pulp necrosis with infection was diagnosed in 78.2% of the teeth, and healing was observed in 12.8% of the teeth. A total of 12 teeth (9.0%) were censored due to prophylactic removal of the pulp or severe external root resorption caused by eruption of adjacent canines. The cs-Cox model demonstrated that the hazards of pulp healing increased in teeth with extra-alveolar periods <15min (csHR: 7.83, 95% CI 1.76-34.80, p=.01), while the hazards of pulp necrosis with infection decreased (csHR: 0.31, 95% CI: 0.10-0.92, p=.04). Teeth replanted with Moorrees' stages 4 and 5 of root development had higher hazards of pulp necrosis with infection than teeth with stage 2 of root development (csHR: 2.23, 95% CI 1.11-4.50, p=.03; csHR: 2.89, 95% CI: 1.40-5.95; p=.01). Pulp healing rarely occurred after replantation of young permanent teeth being associated with short extra-alveolar periods <15min. Early stages of root development decreased the hazards of pulp necrosis with infection.

Comparative study of pulpal responses to ProRoot MTA, Vitapex, and Metapex in canine teeth

Background/purposeProRoot MTA, Vitapex, and Metapex are widely used for pulp treatment of primary tooth. The aim of this study was to compare the pulpal responses to ProRoot MTA, Vitapex, and Metapex in a canine model of pulpotomy. Materials and methodsPulpotomy procedure was performed to 34 teeth (21 incisors and 13 premolars) and ProRoot MTA, Vitapex or Metapex was applicated to artificially exposed pulp tissues. After 13 weeks, the teeth were extracted and processed with hematoxylin-eosin staining for histologic evaluation. All specimens were evaluated in several categorys related to calcific barrier, inflammatory responses and the area of calcific barrier formation was measured. ResultsMost of the specimens in the ProRoot MTA group developed a calcific barrier at the pulp amputation site and showed a low level of inflammatory response. However, in comparison to ProRoot MTA group, a small amount of calcific barrier formed in Vitapex and Metapex groups. ConclusionThis in vivo study found that Vitapex and Metapex induced similar pulpal responses but showed poor outcomes compared with using ProRoot MTA. Vitapex and Metapex are therefore not good substitutes for ProRoot MTA in direct pulp capping and pulpotomy.

Pulp canal obliteration after extrusive and lateral luxation in young permanent teeth: A scoping review.

In the literature, no single therapeutic approach is preferred for treating dental pulp responses such as pulp canal obliteration (PCO). Some authors still recommend preventive endodontic treatment, whereas others choose not to intervene, to avoid causing possible iatrogenic complications. This review was conducted to explore, in the current scientific literature, the degree of knowledge concerning the onset and development of PCO and pulp necrosis (PN) following dental trauma (i.e. extrusive luxation and lateral luxation) in children and young adults (6-20 years). The authors also evaluated whether and to what extent the stage of dental root development at the time of traumatic dental injury (TDI) influences these pulp responses, and whether PN can arise in teeth already affected by PCO. MATERIALS AND METHODS The literature search was carried out during the period October 2019 to January 2020, using the following databases: PubMed/MEDLINE, SCOPUS and Web of Science. Articles in English reporting on young patients with PCO or PN in permanent teeth affected by trauma were included. Theresearch, whose questions were summarised according to the PICO method, considered the following aspects: patient age, type of TDI, stage of root development, initial treatment, presence of calcification or necrosis, time to onset of the two outcomes (PCO and PN), and duration of follow-up. The articles found were evaluated by two reviewers; in the event of disagreement regarding the inclusion of an article, a third reviewer was called upon to decide. The initial screening of the databases, using the selected search keywords, yielded a total of 343 articles. After exclusion of duplicates and articles not meeting the inclusion criteria, 11 articles remained. Of these, only four completely met the inclusion criteria. Closer analysis of these four publications revealed that they would not easily yield standardised sets of clinical data that might be homogenised in order to produce clear meta-analytical data. Hence the need to limit the data collected to the following seven items: number and type of injuries, type of initial intervention, duration of follow-up, main pulp responses, number and type of pulp responses. PCO is a physiological pulp response associated with a traumatic event, usually a luxation injury. It is diagnosed on the basis of combined radiographic and clinical-anamnesticdata. Signs of PCO start to appear at around one year after the traumatic event, and its development reaches completion by about five years post-trauma. PN, on the other hand, is clearly apparent within the first year. Endodontic treatment, be it carried out as a preventive measure or following detection of PCO, is inappropriate and can cause serious iatrogenic damage. Treatment is indicated only in cases of definite PN.

Pulp capping with mineral trioxide aggregate or Biodentine: a comparison of mineralized barrier formation and inflammatory and degenerative events

Biodentine in endodontic practice has been widely investigated, but comprehensive histological descriptions of degenerative and inflammatory responses are not covered in most of the studies that compare pulp capping materials. This study aimed to evaluate pulpal responses to mineral trioxide aggregate (MTA Angelus) and Biodentine, focusing on mineralized barrier formation and on inflammatory and degenerative events. 80 male Wistar rats were assigned to 5 groups, according to the materials used for pulp capping and coronal sealing (n=8 per group/period). The lower first molars were mechanically exposed, capped with either MTA or Biodentine, and restored with silver amalgam. In an additional test group, the teeth were capped and sealed with Biodentine. The teeth capped with gutta-percha and restored with silver amalgam served as positive control, whereas untreated teeth served as negative control. Pulpal responses and coronal sealing were evaluated after 14 or 21 days. Data was statistically analyzed by the Kruskal-Wallis and Dunn's post hoc tests (p<0.05). Biodentine and MTA presented satisfactory results, showing a milder inflammatory response (p<0.0001) and more pronounced formation of mineralized barrier (p<0.0001) compared to the teeth capped with gutta-percha. As a restorative material, Biodentine kept coronal sealing in only 37.5% of the samples. Biodentine showed favorable properties in vital pulp therapy, being similar to MTA. However, it was not effective in protecting dental pulp from microleakage during the experimental period.

Histological analysis of dental pulp response in immature or mature teeth after extra-oral subcutaneous transplantation into mice dorsum.

The aim of this study was to assess the response of dental pulp associated with donor or host cells in the pulp chamber and root canal after extra-oral transplantation. Wild type or green fluorescent protein (GFP) transgenic first molars from 3-week, 6-week, and 12-week mice were transplanted into the subcutaneous layer of GFP mice or wild type mice. The teeth were histologically and immunohistochemically examined at 5 weeks after transplantation. Blood vessels present in the original coronal pulp had anastomosed with those from the recipient tissue that had invaded the root canal. Two distinct eosin-stained extracellular matrices were observed in the pulp chamber and root canal. Acellular matrix composed of nestin-positive, odontoblast-like cells invaded from the outside and was seen in the root canal of 3-week teeth. Cellular matrix comprising alkaline phosphatase (ALP)-positive fibroblast-like cells appeared in the original coronal pulp. In the root canal of the 6-week and 12-week teeth, cellular extracellular matrix consisting of ALP-positive fibroblast-like cells had invaded the recipient tissue. Dental pulp from immature teeth might be able to regenerate dentin-like tissue. This model could be useful in the development of an optimized vitalization treatment.

A survey assessing the knowledge and perception of dental practitioners on the need for prophylactic endodontic treatment in abutment teeth for fixed partial dentures.

Background:Tooth preparation for fixed prosthodontic procedures often induces enough thermal or mechanical stresses on the pulp. The extent of pulpal injury and ability to repair depends on factors like amount of remaining dentin, extent of heat produced, and permeability of dentinal tubules. However, there is no infallible method to predict the pulpal response and so the treatment outcome.Aim:This survey tries to assess the knowledge and perception among dental practitioners on the need for prophylactic endodontic therapy in abutment teeth for fixed partial denture (FPD).Setting and Design:Questionnaire-based survey.Methodology:An observational study was then conducted among 303 dental practitioners in the state of Tamil Nadu and 250 participants responded.Statistical Analysis Used:Descriptive statistics and multiple linear regression analysis.Results and Conclusion:The survey further imparts light on the clinical outcomes that help minimize the incidence of biological failure underneath a FPD.

Clinical Differential Diagnosis between Nonodontogenic and Endodontic Radiolucent Lesions in Periapical Location: A Critical Review.

In endodontics, accurate diagnoses are important for the selection of appropriate and successful therapy. Several nonendodontic entities in periapical location may resemble those of inflammatory endodontic origin and impact therapeutic approaches. The aim of this study was to review noninflammatory entities mimicking dentoalveolar abscesses or apical periodontitis and to discuss clinical and pathological features. In this review study, the authenticated search engine in PubMed (MEDLINE) database was used to find articles by using "Nonvital Pulp Dentoalveolar Abscess", "Nonvital Pulp And Apical Periodontitis", "Periapical Abscess", "Chronic Dentoalveolar Abscess", "Chronic Apical Periodontitis", "Periapical Granuloma", And "Radicular Cyst". Each of these predefined keywords were combined with the terms "Misdiagnosed", "Mimicking", "Masquerading", or "Simulating" to search for reported cases indexed from 1978 to 2020. All case reports fulfilling the selection criteria were reviewed to identify radiolucent nonendodontic periapical lesions focused on the questions: "Which pathological entities mimick radiolucent endodontic lesions in periapical location? Based on endodontic clinical parameters, what are the contrasting features?" Out of 426 articles, 111 were relevant to the subject, including a series of cases and case reports. Only well-documented English and recent papers were considered. A total of 30 noninflammatory entities appeared clinically as radiolucent endodontic lesion in periapical location. Lesions simulating chronic apical periodontitis represented 83.3% and dentoalveolar abscess 16.7%. Interestingly, primary malignancies and metastasis counted 43.3% and pain was a typical symptom. Swelling was a noncontributory clinical feature in distinguishing periapical lesions. Lack of pulp response was registered in 68.4% of nonedodontic lesions. A flowchart was generated to summarize clinicopathological aspects of radiolucent nonendodontic entities appearing as dentoalveolar abscesses or apical periodontitis In relation to clinical practice, it is very important for us to note that, a group of pathological entities may simulate radiolucencies of endodontic origin in periapical location, especially malignancies and non-inflammatory odontogenic lesions.

The effect of topical application of meloxicam on inflamed dental pulp

Background/purposeEffective regulation of the inflammatory process is essential for pulp repair and regeneration. Meloxicam has anti-inflammatory activity in systemic administration. The purpose of this study is to observe effects of topically applied meloxicam on inflamed pulp and to explore its potential value in the treatment of pulpitis. Materials and methodsThe coronal pulp tissues of rat molars were stimulated with 10 mg/mL lipopolysaccharide (LPS group) and then treated with 500 μmol/L meloxicam (meloxicam group). The untreated pulp tissues were used as the control group. After 3 h of incubation in vitro, the gene expression of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) in each group was detected by real-time RT-PCR. The pulp tissues of each group were randomly subcutaneously implanted into nude mice, and 500 μmol/L meloxicam was injected into the subcutaneous pocket of the meloxicam group. Haematoxylin eosin staining, Masson staining and immunohistochemical staining were performed on samples after 3 days and 4 weeks retrieval, respectively. ResultsCompared with the LPS group, the mRNA expression levels of TNF-α and IL-6 of the meloxicam group were significantly reduced in vitro. The inflammatory response and cyclooxygenase-2 expression of the meloxicam group were decreased, and osteodentin-like tissue was generated in the pulp cross section of the meloxicam group in vivo. ConclusionThe topical application of meloxicam inhibits the inflammatory response of inflamed pulp and further promotes the formation of osteodentin-like tissues but fails to induce the formation of the pulp–dentin complex. Topically applied meloxicam has the potential to regulate pulp inflammation.

A macroscopic and histological analysis of radiographically well-defined deep and extremely deep carious lesions: carious lesion characteristics as indicators of the level of bacterial penetration and pulp response.

To investigate the relationship between radiographically and macroscopically well-defined carious lesions and the dentine-pulp complex with regard to: (i) level of bacterial penetration; (ii) inflammatory status including the presence of hyperplastic pulp stroma; and (iii) formation of hard and/or ectopic connective tissue. The material comprised 68 untreated cavitated permanent teeth divided into well-defined radiographic categories based on the lesion penetration depth: (i) deep lesions ( ≥3/4 of the dentine thickness with a radio-dense zone separating the lesion from the pulp) and (ii) extremely deep lesions (the carious lesion penetrated the entire thickness of the dentine, without a radio-dense zone). After extraction, the teeth were processed for histology. The material was scored with regard to coronal breakdown, macroscopic variables describing caries activity and histological variables describing the dentine-pulp complex (bacteria, inflammatory infiltrate, partial pulp necrosis, hyperplastic changes and hard tissue/ectopic presence of connective tissue). Interrater agreement was assessed using Cohen's kappa. Associations between variables were assessed using Pearson's chi-squared or Fisher's exact test. The effect size was reported by odds ratio (OR) and associated 95% confidence interval (CI). Level of significance was set to 5%. There were significant associations between a closed environment (1-2 surfaces involved) and the presence of biofilm, retrograde demineralization and light-coloured demineralized dentine. Whereas radiographically defined deep lesions tended to have bacteria only in the primary dentine (P< 0.001, OR=20.55, 95% CI [4.44, 107.89]), extremely deep carious lesions tended to have bacteria in contact with the pulpal tissue (P=0.007, OR=6.84, 95% CI [2.00, 62.83]), presence of an inflammatory infiltrate (Fisher's exact; P< 0.001) and partial pulp necrosis. Hyperplastic pulps were seen only in extremely deep lesions. Unlike deep lesions, extremely deep carious lesions were often associated with severe pulp inflammation and infection. A radiographic threshold between deep and extremely deep lesions is suggested as indicator of the bacterial penetration level and the severity of the pulpal response prior to intervention.

Changes in pulp sensitivity across the menstrual cycle in healthy women and women with temporomandibular disorders.

Menstrual cycle may contribute to experimental pain measures in healthy women and women with chronic pain. The present study aimed to investigate variation in pulp sensitivity across the menstrual cycle in healthy women and women with temporomandibular disorders (TMD) and to explore the effect of TMD pain and psychosocial variables on the pulp response. This longitudinal study involved 47 regularly menstruating women aged 20-45, 24 healthy and 23 with diagnosed painful TMD. The electric and cold stimuli were performed by electric pulp tester and refrigerant spray, respectively, on mandibular lateral incisors, in five menstrual phases (menstrual, follicular, periovulatory, luteal and premenstrual). Research Diagnostic Criteria for TMD were used to assess TMD, chronic pain, depression and somatisation. Regression analysis was performed to investigate the effect of the predictor variables on the pulp sensitivity. Significant phase-related differences were observed for pain intensity to cold stimuli. Higher pain sensitivity was reported in menstrual in comparison with luteal phase (P=.019) among healthy women, and in menstrual in comparison with follicular (P=.033), periovulatory (P=.003) and luteal (P=.007) phases in TMD women. No significant differences were recorded for electric stimuli. Regression analysis identified depression as the determinant of cold and electric response in menstrual phase, regardless of age and presence of TMD. Menstrual phase in healthy and TMD women with regular menstrual cycle is characterised with higher pulp sensitivity to cold stimuli. Depressive symptoms independently influence pulp response in this phase.

Evaluation of variability of electric pulp response threshold in molars: an in vivo study

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Electric pulp testers are widely used diagnostic tools in endodontics. Several factors can affect the result of electric pulp test like thickness of enamel and dentin, concentration of sensory fibres (A delta fibres), direction of dentinal tubules, pulp chamber size, neural elements etc. There are very few studies available in the literature which evaluated the variability of electric pulp response in molar teeth, which are more susceptible to caries. Hence aim of current study was proposed to evaluate response threshold in molars with respect to age and sex using electric pulp tester.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Fifty volunteers aged between 20 to 69 years were recruited. The human subjects were divided into 5 groups of 10 each (5 males and 5 females) based on age. EPT was used with appropriate electrolyte as a conducting media. Seven sites on each molar crown were tested which includes mesiobuccal cusp tip, mesiobuccal cuspal surface, mesiobuccal gingival surface, centre of the supporting cusps (palatal of maxillary molar and buccal of mandibular molar), distobuccal cuspal surface, distobuccal gingival surface and centre of the guiding cusps (buccal of maxillary molar and lingual of mandibular molars). Statistical analysed using descriptive statistics and independent sample t test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mesiobuccal cusp tip showed lower response threshold values compared to other sites in all the groups. group 1 responded at lower threshold and group 5 at higher.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The optimum electrode placement site for electric pulp test in molars is the mesiobuccal cusp tip irrespective of age and sex.&lt;/p&gt;

Management of Calcified Root Canal: A Case Report

Background: Calcification of root (calcific metamorphosis) is usually seen as defensive reaction of pulp totrauma. Intensity of trauma/hit, time span since trauma, pulp response to trauma are multiple factor decidingdegree of calcification. Calcification may be seen partially or entirely in root canal. Usually calcifiedtooth remain asymptomatic, but when tooth becomes symptomatic endodontic treatment need to be done.Treatment of calcified canal is challenge to dentist.Case report: A female patient reported to the department of conservative dentistry and endodontics at sharadpawar dental college with chief complain of pain in upper front region of jaw. On radiographic examinationcalcified root canal was associated with upper anterior teeth. Root canal treatment was planned for calcifiedtooth. Access opening was carried out using BR45. To achieve patency within canal file#8, 10 were used, butinitally patency could not be achieved due to calcified canal. With help of chelating agents 17% EDTA liquidand gel and small size K file #8,10 canal negotiation was carried out to achieve patency. Working lengh wasthen determined and canal was instrumented. Naocl, EDTA was used as intermittent irrigant. Final rinse wasdone using 2%CHX. Canal was obturated using cold lateral condensation technique followed by permanentrestoration. Entire procedure was carried out under magnification.Conclusion: Calcified canal treatment is bit tedious then routine endodontic procedure. But it can bemanaged if procedure is carried out under proper illumination, magnification, CBCT, understanding rootcanal anatomy, use of dye, modified access bur, files, chelating agent, irrigants and irrigation activationsystem.

Predicting the response of the dental pulp to SARS-CoV2 infection: a transcriptome-wide effect cross-analysis.

Pulpitis, inflammation of the dental pulp, is a disease that often necessitates emergency dental care. While pulpitis is considered to be a microbial disease primarily caused by bacteria, viruses have also been implicated in its pathogenesis. Here, we determined the expression of the SARS-CoV2 receptor, angiotensin converting enzyme 2 (ACE2) and its associated cellular serine protease TPMRSS2 in the dental pulp under normal and inflamed conditions. Next, we explored the relationship between the SARS-CoV-2/human interactome and genes expressed in pulpitis. Using existing datasets we show that both ACE2 and TPMRSS2 are expressed in the dental pulp and, that their expression does not change under conditions of inflammation. Furthermore, Master Regulator Analysis of the SARS-CoV2/human interactome identified 75 relevant genes whose expression values are either up-regulated or down-regulated in both the human interactome and pulpitis. Our results suggest that the dental pulp is vulnerable to SARS-CoV2 infection and that SARS-CoV-2 infection of the dental pulp may contribute to worse outcomes of pulpitis.

Effect of Tricalcium Silicate on Direct Pulp Capping: Experimental Study in Rats.

Objectives Conduct a histological comparison of the pulp response to different materials, with a focus on the continuity and morphology of the mineralized barrier after direct pulp capping. Materials and Methods One hundred and eight maxillary first molars of 54 Wistar rats were subject to direct pulp capping and divided into three groups according to the materials used: calcium hydroxide (CH), mineral trioxide aggregate (MTA), and Biodentine. All cavities were sealed, and the animals were euthanized at 7, 14, and 21 days. Descriptive histological evaluation of the inflammation and formation of the mineralized barrier was performed. Statistical Analysis Statistical analyses were performed using the Kruskal–Wallis test, which was complemented by the Dunn test; differences with p < 0.05 were considered statistically significant. Results The results showed that MTA and Biodentine elicited less intense inflammatory reactions than CH. With respect to the formation and quality of the dentin barrier formed, differences were observed at 21 days between the analyzed groups; the best results being obtained following treatment with MTA and Biodentine. Conclusion MTA and Biodentine induced formation of a more continuous and uniform mineralized barrier with less intense pulp response than CH.

Histological Evaluation of Human Pulp Response to Direct Pulp Capping with MTA, CEM Cement, and Biodentine.

Statement of the Problem: Direct pulp capping (DPC) is an established method in which the exposed pulp is coated with a suitable material to prevent further damage and to help its repair and healing. Different proposed materials may have different impact on pulp response during this treatment.Purpose: The purpose of this study was to compare the response of human dental pulp after DPC with calcium-enriched mixture (CEM), mineral trioxide aggregate (MTA) cement, and Biodentine.Materials and Method: In this clinical trial study, class V cavities were prepared on the buccal surfaces of 30 human premolar teeth, until the pulps were mechanically exposed. Then, teeth were randomly pulp capped with MTA, CEM cement and Biodentine, followed by resin modified glass ionomer filling. The fourth group was the control group (n= 10), in which the teeth were extracted without any prior intervention. Six weeks after the intervention, the teeth were extracted and prepared for histological evaluation in terms of the type and degree of pulp inflammation, dentin bridge formation and the presence of necrosis. Data were analyzed using Kruskal-Wallis and Mann Whitney U tests.Results: In all groups, necrosis was not observed and inflammation was chronic. The Biodentine group exhibited significantly more pulpal inflammation compared with the other groups (p= 0.001). There were no significant differences among CEM cement, MTA and Biodentine in terms of the dentine bridge formation. The thickness of the dentin bridge formed in the Biodentine group was significantly higher than MTA and control group (p= 0.035 and p= 0.011, respectively).Conclusion: Although the dentin bridge formation and the thickness of dentin bridge formed in the Biodentine group were higher than the other groups, pulp showed greater inflammation compared to CEM cement and MTA. The results of this study suggested that MTA and CEM cement performed better when employed as the direct pulp capping material.