Direct and Indirect Pulp Capping: A Brief History, Material Innovations, and Clinical Case Report.

Among the goals of pulp capping are to manage bacteria, arrest caries progression, stimulate pulp cells to form new dentin, and produce a durable seal that protects the pulp complex. This article will provide a general discussion of direct and indirect pulp capping procedures, offering practitioners a pragmatic and science-based clinical protocol for treatment of vital pulp exposures. A clinical case will be presented in which a novel light-cured resin-modified mineral trioxide aggregate hybrid material was used to manage a mechanical vital pulp exposure that occurred during deep caries excavation.

Current trends and future perspectives of dental pulp capping materials: A systematic review.

To systematically review the literature to analyze the current trends and future perspectives of dental pulp capping materials through an analysis of scientific and technological data. This study is reported in accordance with the PRISMA Statement. Nine databases were screened: PubMed (MedLine), Lilacs, IBECS, BBO, Web of Science, Scopus, SciELO, Google Scholar, and The Cochrane Library. Additionally, the following patent applications were searched online in Questel Orbit (Paris, France), USPTO, EPO, JPO, INPI, and Patentscope databases. A total of 716 papers and 83 patents were included. Calcium hydroxide was the main type of material studied, especially for direct pulp capping, followed by MTA. Patents related to adhesives or resins increased from 1998 e 2008, while in the last years, a major increase was observed in bioactive materials (containing bioactive proteins), materials derived from MTA (calcium silicate, calcium phosphate and calcium aluminate-based cements) and MTA. It was possible to obtain a scientific and technological overview of pulp capping materials. MTA has shown favorable results in vital pulp therapy that seem to surpass the disadvantages of calcium hydroxide. Recent advances in bioactive materials and those derived from MTA have shown promising results that could improve biomaterials used in vital pulp treatments. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1358-1368, 2018.

Bioceramic Materials and the Changing Concepts in Vital Pulp Therapy.

Vital pulp therapy (VPT) is devised to preserve and maintain vitality of pulpally involved teeth challenged by a variety of intraoral conditions. Notable progress has been made in this field due to a better understanding of pulp physiology, improved clinical protocols and advanced bioceramic materials paired with adhesive technology. With focused case selection, conservative VPT can provide reliable treatment options for permanent teeth diagnosed with normal pulps or reversible pulpitis.

Frequently asked questions in direct pulp capping of permanent teeth.

UNLABELLED: Direct pulp capping is a proven method of preserving tooth vitality of a mature permanent tooth in cases of pulp exposures. The indications for this treatment, treatment modalities and materials are discussed in this paper. CLINICAL RELEVANCE: This paper answers many of the frequently asked questions by general practitioners, dental students and specialists about direct pulp capping.

Avaliação da biocompatibilidade do compósito: biocerâmica/ácido poli (lático-co-glicólico) em fibroblastos e macrófagos e da resposta pulpar após capeamento direto / The cell biocompatibility of a bioceramic/poly (lactic-co-glycolic acid) composite and its pulp response in vivo for pulp capping application

Biocerâmicas associadas a polímeros para capeamento pulpar estão sendo investigadas pela capacidade de induzir a formação de tecido mineralizado. Esses materiais são usados na ortopedia e implantodontia com resultados clínicos eficientes. Contudo, pouco se sabe sobre seu efeito sobre a polpa dental e seus componentes celulares. O objetivo deste estudo foi avaliar a biocompatibilidade do compósito: biocerâmica de B-tricálcio fosfato/hidroxiapatita (BC) e co-polímero ácido poli (lático-co-glicólico) (PLGA) (BC/PLGA), em cultura de fibroblastos da polpa dental humana (FP5) e de macrófagos peritoneais (MP), e avaliar a resposta pulpar após capeamento direto após 30 e 60 dias...

Current trends in primary tooth pulp therapy.

Pulp therapy in the primary dentition remains a technique generating a tremendous amount of study. Formocresol has been and continues to be the most commonly used intrapulpal medicament despite its known ability to escape the microcirculation of the pulp. Ferric sulfate has gained significant favor as a result of formocresol's disadvantages, though at the cost of requiring a much more acute awareness of the potential for remaining disease and its ability to mask that process. Mineral trioxide aggregate perhaps offers the best immediate alternative to either of the above though at this time it is still cost-prohibitive in a practice that actively treats many children. And, as MTA has no fixative properties of its own, accurately analyzing the extent of the pulpal disease becomes even more critical to the overall success of the procedure. As with other techniques in dentistry, the debate is sure to continue for severl years to come.

Bioactive molecules and the future of pulp therapy.

Direct capping of bioactive molecules or implantation of these molecules in the pulp may induce the formation of reparative dentin and coronal or radicular pulp mineralization. In this review, we summarize what is known and/or assumed on the biological mechanisms of these therapies. We report on the effects which were obtained experimentally in rat maxillary molars by implantation of Bone Sialoprotein (BSP)/collagen pellets and Specific Amelogenin Gene Splice Products [A+4] and [A-4]) adsorbed on agarose beads. The effects were compared with those of BMP-7 (OP-1) and Ca(OH)2. Depending on the molecule that was used, we obtained either the formation of a dentin bridge, or the filling of the pulp in the mesial part of the coronal pulp chamber, or the total mineralization of the root canal. These molecules may provide new therapeutic tools in the next future in dentistry.

Tratamento conservador pulpar: bases científicas e tendência atual / Conservative pulpar therapy: scientific bases and actual tendency

O órgão dentário desempenha importantes funções durante o desenvolvimento e para manutenção da saúde do elemento dentário. Assim, a possibilidade do emprego de um agente verdadeiramente biológico capaz de induzir a formação de tecido calcificado sobre uma polpa exposta significa um grande avanço no tratamento conservador pulpar. Recentemente, pesquisas no campo de biomateriais introduziram um fator que pode induzir a formação de dentina quando aplicado diretamente a polpa dentária. Este fator é a proteína óssea morfogenética. Foi realizada uma revisão de literatura sobre a possibilidade da utilização clíncia deste fator de crescimento no tratamento conservador pulpar

Current and potential pulp therapies for primary and young permanent teeth.

OBJECTIVES: This paper aims to alert the dental practitioner to the rapidly evolving therapies for treating the pulps of primary and young permanent teeth. DATA SOURCES: Experimental research on animals, clinical studies and case reports. STUDY SELECTION: Indirect pulp capping, direct pulp capping, pulpotomies, and pulpectomies are standard procedures for treating primary teeth. However, direct pulp capping, heretofore not very successful, is being revisited. Based on studies in animals and clinical findings in humans, there has been a movement in pediatric dentistry to find alternatives to formocresol and calcium hydroxide for pulpotomy therapy. Venues range from eradication by cautery to the possibility of healing with growth factors. New studies with iodoform paste for pulpectomies are confirming the success rates of previous publications. The new dental adhesives are being tested as agents for direct pulp capping, as well as partial and complete pulpotomy protocols. CONCLUSIONS: More thought is being given by clinicians to preserving pulp, either through more ambitious indirect pulp therapy or partial pulpotomy. Formocresol and calcium hydroxide pulpotomies, while still popular, may soon be challenged by other chemical treatments, electrocautery or stimulation of reparative dentine by growth factors. Iodoform pastes are promising easier and more successful pulpectomy therapy. Total etch direct bonding materials could soon transform direct pulp capping, as well as partial and complete pulpotomy protocols.