Biological evaluation of novel phosphorylated pullulan-based calcium hydroxide formulations as direct pulp capping materials: An in vivo study on a rat model.

AIM: Calcium hydroxide (CH) has been considered as a direct pulp capping materials (DPC) for the last decades despite having some limitations. Phosphorylate pullulan (PPL) incorporated with CH (CHPPL) is a novel biomaterial that was introduced as a promising DPC material. Thus, the aim of the study was to evaluate the inflammatory response and mineralized tissue formation (MTF) ability of PPL-based CH formulations on rat molars after DPC. METHODOLOGY: This study consisted of six groups: CH with 1% PPL (CHPPL-1); 3% PPL (CHPPL-3); 5% PPL (CHPPL-5); Dycal and NEX MTA Cement (N-MTA) as the positive control, and no capping materials (NC). One hundred twenty maxillary first molar cavities were prepared on Wistar rats. After capping, all the cavities were restored with 4-META/MMA-TBB resin and pulpal responses were evaluated at days 1, 7, and 28. Kruskal-Wallis followed by Mann-Whitney U-test was performed with a significance level of 0.05. Immunohistochemical expression of IL-6, Nestin, and DMP-1 was observed. RESULTS: At day 1, CHPPL-1, N-MTA, and Dycal exhibited no to mild inflammation, whilst CHPPL-3, CHPPL-5, and NC showed mild to moderate inflammation, and the results were significantly different (p < .05). At day 7, mild to moderate inflammation was observed in CHPPL-1, N-MTA, and Dycal, whereas CHPPL-3, CHPPL-5, and NC exhibited moderate to severe inflammation. Significant differences were observed between CHPPL-1 and N-MTA with NC (p < .05), CHPPL-1 and CHPPL-3 with CHPPL-5 and Dycal (p < .05), and CHPPL-3 with N-MTA (p < .05). A thin layer of mineralized tissue formation (MTF) was observed in all groups. At day 28, CHPPL-1, Dycal, and N-MTA showed no to mild inflammation, whilst CHPPL-3, CHPPL-5, and NC exhibited mild to severe inflammation, and statistically significant difference was detected (p < .05). CHPPL-1, Dycal, and N-MTA exhibited continuous MTF, whilst CHPPL-3, CHPPL-5, and NC had thicker and interrupted MTF. Significant differences were observed between CHPPL-1, CHPPL-3, and N-MTA with NC group (p < .05). Variable expressions of IL-6, Nestin, and DMP-1 indicated differences in the materials' impact on odontoblast-like cell formation and tissue mineralization. CONCLUSIONS: These findings suggest that CHPPL-1 has the potential to minimize pulpal inflammation and promote MTF and had similar efficacy as MTA cement.

Direct pulp capping procedures - Evidence and practice.

The aim of direct pulp capping (DPC) is to promote pulp healing and mineralized tissue barrier formation by placing a dental biomaterial directly over the exposed pulp. Successful application of this approach avoids the need for further and more extensive treatment. In order to ensure a complete pulp healing with the placement of restorative materials, a mineralized tissue barrier must form to protect the pulp from microbial invasion. The formation of mineralized tissue barrier can only be induced when there is a significant reduction in pulp inflammation and infection. Consequently, promoting the healing of pulp inflammation may provide a favorable therapeutic opportunity to maintain the sustainability of DPC treatment. Mineralized tissue formation was observed as the favorable reaction of exposed pulp tissue against a variety of dental biomaterials utilized for DPC. This observation reveals an intrinsic capacity of pulp tissue for healing. Therefore, this review focuses on the DPC and its healing procedure as well as the materials used for DPC treatment and their mechanisms of action to promote pulpal healing. In addition, the factors that can affect the healing process of DPC, clinical considerations and future perspective has been described.

Effects of Short-Term Exposure of Chloramine-T Solution on the Characteristics of Light-Cured and Chemical-Cured Adhesives.

This study evaluated the effect of a 0.5% chloramine T solution on a chemical-cured universal adhesive by comparing the light-cured, one-step, self-etch adhesive for the bonding performance, mechanical properties, and resin-dentin interfacial characteristics. Caries-free human molars were randomly assigned into eight groups based on the bonding systems employed (Bond Force II, BF and Bondmer Lightless, BL), the immersion solutions used before bonding (0.5% chloramine T solution and distilled water), and the immersion durations (5 and 60 min). Microtensile bond strength (µTBS), nanoleakage evaluation, and nanoindentation tests were performed, and the surface morphology of the resin-dentin interface was examined using a focus ion beam/scanning ion microscopy system. Immersion in chloramine-T for 5 min significantly decreased the µTBS of Bondmer Lightless (from 22.62 to 12.87 MPa) compared with that in distilled water. Moreover, there was also a decreasing trend after immersing in chloramine-T for 60 min (from 19.11 to 13.93 MPa). Chloramine T was found to have no effect on the hardness, elastic modulus, or morphological characteristics of the ion-beam milled resin-dentin interfacial surfaces in the tested adhesives, suggesting that chloramine T might reduce the bond strength by interfering with the interaction and the sealing between the adhesive resin and dentin in the chemical-cured universal adhesive, albeit without affecting the mechanical properties.

Teledentistry as an Effective Tool for the Communication Improvement between Dentists and Patients: An Overview.

Teledentistry is an online dental care service that allows patients and dentists to meet in real time, safely, without being at the same location. During the COVID-19 pandemic, real-time videoconferencing has gained popularity in the field of teledentistry, with numerous benefits for both patients and dentists. Online consultations can minimize costs, maximize time, and provide more convenient care options for both patients and dentists. When practicing teledentistry, a dentist must establish a good doctor-patient relationship. Dentists must ensure that the telecommunication solution that they choose meets their clinical requirements and complies with privacy laws. Dentists should provide adequate information to patients about the limitations, advantages, and disadvantages that may occur during online consultation. Dentists must follow guidelines and procedures regarding informed consent, patient details, personal communications, and consultancies' privacy and confidentiality. The patient should be aware of the limitations of teledentistry, and dentists will provide the best advice possible in the absence of a face-to-face consultation. This article discusses how teledentistry could be an effective tool for dentists and patients.

Influence of Novel Experimental Light-Cured Resin Cement on Microtensile Bond Strength.

The purpose of this study was to evaluate the microtensile bond strength (µTBS) and Knoop hardness number (KHN) of a novel experimental light-cured resin cement (HL). Eighteen flat dentin surfaces of human molars were polished using #600 SiC paper and bonded to CAD/CAM resin blocks with the respective resin cements and composites: HL, Panavia V5 (PV), and Clearfil AP-X (AP). All specimens were stored in distilled water at 37 °C for 24 h and 7 days. Scanning electron microscope (SEM) and energy dispersive X-ray (EDX) observations were performed to evaluate filler morphology and to detect the elements. The resin cements had a significant effect on the immediate µTBS (F = 22.59, p < 0.05) and after water storage µTBS (F = 22.83, p < 0.05). Significant differences (p < 0.05) in the KHN between the tested materials were observed, and HL indicated the highest KHN when compared with PV. HL showed a combination of the regular-shaped filler and spherical-shaped filler within the matrix. Silicon was detected in HL from the EDX evaluation. HL exhibited better bonding performance and polymerization, which may have contributed to the improvement of the adhesive strength.