Outcome of Partial Pulpotomy in Immature Permanent Teeth with Symptomatic Irreversible Pulpitis: A Prospective Case Series Assessment.

INTRODUCTION: The aim of this prospective case series was to assess the clinical and radiographic outcome of partial pulpotomy in caries-exposed symptomatic, vital, immature, permanent molars. METHODS: Thirty-four immature molars with deep caries and symptoms of irreversible pulpitis were treated by partial pulpotomy and ProRoot MTA as a capping material. After complete caries removal, the inflamed part of the pulp was removed. Complete hemostasis was achieved using a sterile cotton pellet moist initially with sodium hypochlorite 1.5% and then with sterile saline. ProRoot MTA (Dentsply Sirona, Charlotte, NC) was placed as a capping material onto the remaining pulp tissue. The cavity was sealed using a light-curing resin-modified Ca(OH)2 cavity liner, and patients were referred to a pediatric dentist for permanent restoration. Descriptive statistics and cross tabulations were performed including variables examined before, during, and after the procedure. RESULTS: All examined teeth presented a favorable clinical and radiographic outcome with normal periapical tissues, complete apical closure, and formation of a dentinal bridge beneath the capping material. Signs of partial pulp chamber calcification were only detected in 2 cases. Postoperatively, most patients did not report any pain (23/34, 67.7%), whereas the rest reported minor intensity pain (11/34, 32.3) and the use of analgesic or anti-inflammatory drugs only for 1 day (10/34, 29.4%). CONCLUSIONS: Partial pulpotomy seems to provide a universally successful outcome when managing symptomatic vital immature teeth with no signs of complications and completion of apical closure. It could be a viable treatment of choice in cases of caries-exposed vital immature teeth with symptoms of irreversible pulpitis.

Assessment of bone quality of apical periodontitis treated with MTA plug and regenerative endodontic techniques.

Fractal analysis (FA) is a quantitative, objective and non-invasive method that facilitates the characterisation of the tissue architecture. This study aims to compare the periapical healing at 1-year follow-up by evaluating newly generated trabecular bone with FA after Mineral trioxide aggregate (MTA) plug and regenerative endodontic treatment (RET). A total of 55 asymptomatic teeth with a single-canal, open apex and periapical lesion, treated with MTA plug or RET, were evaluated retrospectively. After considering the inclusion/exclusion criteria, FA was conducted on 30 periapical images using the box-counting method. In both groups, a significant decrease was observed in the periapical lesion size at 1-year follow-up (p < 0.01). However, there was no significant difference between the MTA plug and RET (p > 0.01). Significantly higher fractal dimension values were detected at 1-year follow-up in both MTA plug and RET cases (p < 0.01). However, the difference was not significant between the groups (p > 0.01). Both procedures seem to improve periapical healing with a new resistant bone of similar density and complexity.

In Vitro Assessment of Sealing Ability of Various Materials Used for Repair of Furcal Perforation: A SEM Study.

AIM: The aim of the current in vitro research was to evaluate the sealing capacity of three different agents employed for the repair of perforations at the furcation area. MATERIALS AND METHODS: Recently 60 extracted human mandibular permanent molars having well apart plus fully formed roots, and intact furcation were chosen. The 60 samples were allocated at random to three groups of 20 samples: Group I: Furcation perforation repair by means of mineral trioxide aggregate (MTA)-Angelus, Group II: Furcal perforation repair using Biodentine, Group III: Furcal perforation repair by EndoSequence. The specimens were subjected to sectioning with a hard tissue microtome and the sectioned parts of the samples were then examined. The specimens were subjected to gold sputtering and visualizing beneath scanning electron microscope (SEM) at 2000× magnification for assessing the sealing capacity of the agents. RESULTS: The highest sealing capacity was noted with the use of Biodentine at 0.96 ± 0.10, in pursuit by EndoSequence use at 1.18 ± 0.14 and MTA-Angelus use at 1.74 ± 0.08. The disparity amid the three groups was statistically significant with p < 0.001. CONCLUSION: In conclusion, it may be inferred that Biodentine exhibited the finest sealing capacity than EndoSequence and MTA- Angelus. It may thus be given consideration as a substance of preference for the repair of furcal perforation. CLINICAL SIGNIFICANCE: Using biologically compatible substances may be suggested to amend perforations thereby decreasing the occurrence of inflammatory response in the neighboring tissues. The sealing capacity is a significant feature in supporting the result of a root canal treatment of a tooth.

Maintaining pulpal vitality: Cost-effectiveness analysis on carious tissue removal and direct pulp capping.

OBJECTIVES: When managing deep carious lesions, dentists can maintain pulp vitality via (1) avoiding pulp exposure and complications by performing selective (SE) instead of non-selective (NS) carious tissue removal, and/or (2) treat exposed pulps by direct capping with mineral-trioxide-aggregate (MTA) instead of calcium hydroxide (CH). We assessed the cost-effectiveness of SE vs. NS combined with direct pulp capping using MTA vs. CH. METHODS: A mixed public-private-payer perspective within German healthcare was applied. We modeled a permanent molar with a deep carious lesion and a vital asymptomatic pulp. The lesion was treated by SE/NS and, in case of exposure, direct pulp capping using MTA/CH. The tooth was followed over the lifetime of an initially 30-year-old patient using Markov-models, informed by pairwise and Bayesian network meta-analyses and further data sources. The primary health outcome was tooth-retention time. Costs were derived from German fee item catalogues, combined with micro-costing. Monte-Carlo micro-simulation was performed, and uncertainty introduced via probabilistic and univariate sensitivity analyses. Value-of-information-analysis (VOI) was performed to quantify the value of further research. RESULTS: SE and, in case of pulp exposure, MTA had a high chance (>95 %) of being cost-effective, with teeth being retained for 37.37 years at costs of 2140 Euro in mean. Alternative strategies were both more costly and less effective; this ranking was robust in sensitivity analyses. The VOI was 1.18 Euro per treated case and 12.86 million Euro on population-level. CONCLUSION: Selective carious tissue removal and, in case of pulp exposure, direct capping with MTA was the most cost-effective strategy. CLINICAL SIGNIFICANCE: Avoiding pulp exposure was more relevant for cost-effectiveness than how the exposed pulp was managed. Overall differences remain limited, though, and dentists may want to tailor treatment strategies according to their expertise and patients' expectations.

Postoperative assessment of diode laser zinc oxide eugenol and mineral trioxide aggregate pulpotomy procedures in children: A comparative clinical study.

AIM: The present study is an attempt to compare and evaluate postoperative assessment of diode laser zinc oxide eugenol (ZOE) pulpotomy and diode laser mineral trioxide aggregate (MTA) pulpotomy procedures in children. MATERIALS AND METHODS: Forty carious primary molars indicated for pulpotomy within the age group of 4-9 years were selected and divided into two groups of 20 each using simple randomization, Group 1: Diode laser MTA and Group 2: Diode laser ZOE pulpotomy. The teeth were evaluated clinically for 1 year at 3, 6, and 12 months interval and radiologically for 6 and 12 months. RESULTS: Clinically and radiographically, 100% teeth treated with diode laser MTA and 94% treated with diode laser ZOE were considered successful after 12-month follow-up interval. No significant difference was seen between two groups. CONCLUSION: Despite the success rate, the cost factor of diode laser and MTA could be the limiting factor in its judicious use in pulpotomy procedure.

MTA Pulpotomies: A Long-Term Case Series Outcomes Assessment of Complicated Crown Fractures.

BACKGROUND: This retrospective case series describes the outcomes of anterior teeth with complicated fractures treated using mineral trioxide aggregate (MTA) in pulpotomy procedures. METHODS: 33 teeth were treated with MTA pulpotomy procedures in an endodontic private practice. All patients had been referred to the practice for diagnosis and treatment of a pulpal exposure due to complicated crown fractures. The teeth were either recalled directly or "indirectly" by the referring dentist. Teeth recalled directly were categorized as healed, healing, non- surgical root canal treatment completed for either aesthetic or restorative reasons, or persistent disease. Teeth recalled indirectly were categorized as successful or failed. RESULTS: 27 teeth were available for recall; 20 teeth directly and 7 teeth indirectly. The mean recall for teeth recalled directly was 3.94 years and the mean recall for teeth recalled indirectly was 5.9 years. The recall range for teeth recalled directly was 0.51 to 10.49 years and for teeth recalled indirectly was 3.58 to 10.66 years. Of the cases available for direct recall, 13 of 20 teeth were healed positive to pulp tests, 4 of 20 teeth were healed negative to pulp tests and 3 of 20 teeth had non-surgical root canal treatment completed. 15 of the 20 teeth recalled directly where discolored. 7 of 7 teeth recalled indirect were successful as determined by the radiographs and a report from the restorative dentist. CONCLUSIONS: MTA is a viable alternative to calcium hydroxide for pulpotomies.

Direct pulp capping of permanent teeth in New Zealand general dental practice--a practice based research study.

OBJECTIVES: This study aimed to investigate treatment protocols and opinions towards direct pulp capping (DPC) amongst New Zealand (NZ) general dental practitioners (GDP) through a Practice Based Research Network (PBRN) study. DESIGN: Mixed-methods approach using qualitative thematic and quantitative analysis. METHODS: An on-line survey containing Likert scale items and open-ended questions was distributed to GDPs on the Dental Council of New Zealand (DCNZ) register (2012) to collect information on practitioner demographics, treatment protocols, continuing professional development (CPD) and philosophies towards DPC. RESULTs: Two hundred and ten GDPs from North and South Islands providing care in main centres and rural areas engaged with the PBRN and participated in the study. Almost all performed DPC treatment although it was not a common procedure. DPC was perceived as 'successful' or 'very successful' by 95% of respondents, mostly for cases of reversible pulpitis. Most provided DPC for patients of all ages but younger patients were perceived to have the best clinical outcomes. Calcium hydroxide and MTA were the most commonly used materials for DPC. MTA was believed to have the best outcome but cost and handling properties were barriers to its use. The majority of respondents had participated in CPD related to vital pulp therapy and regarded this treatment as conservative and providing time and financial benefits compared with more invasive treatment. Clinicians' timeframes for assessing healing were variable, and combined clinical and radiographic findings were considered most useful. CONCLUSION: New Zealand dentists perceive DPC as a successful and conservative treatment in selected cases. The findings have provided insights into engagement of NZ dentists in using research to inform everyday clinical practice through a PBRN study.

Clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial.

The aims of this study were to assess the effectiveness of calcium silicate cement (Biodentine) versus glass ionomer cement (GIC; control group) as indirect pulp capping materials in patients with reversible pulpitis and to compare the effectiveness of cone beam computed tomography (CBCT) versus periapical (PA) radiographs in detecting PA changes at baseline (T0) and at 12 mo (T12) postoperatively. Seventy-two restorations (36 Biodentine, 36 Fuji IX) were placed randomly in 53 patients. CBCT/PA radiographs were taken at T0 and T12. Two calibrated examiners assessed the presence/absence and increase/decrease in the size of existing PA radiolucencies under standardized conditions. The Kappa coefficient evaluated statistically the effectiveness of CBCT versus PA radiographs in detecting PA changes. Chi-square/Mann-Whitney tests were used to evaluate the association between PA changes in CBCT with various clinical measures. Significance was predetermined at α = 0.05. Clinical success rates for Biodentine and Fuji IX GIC were 83.3%. CBCT was significantly more effective in detecting PA radiolucencies compared with radiographs (P = 0.0069). Of the teeth, 65.4% and 90.4% were deemed healthy using CBCT and PA radiographs, respectively, at T12. Healing/healed rates were 17.3%/0%, while new/progressed radiolucency were 30.8%/9.6% with CBCT/PA radiographs, respectively. Seventy-one percent of healed lesions had received Biodentine; 88% of new/progressed lesions received Fuji IX GIC. Teeth presenting with an initial CBCT PA lesion had a failure rate of 63%, whereas teeth with no initial lesion had a failure rate of 16%. Although no statistically significant difference was detected in the clinical efficacy of Biodentine/Fuji IX when used as indirect pulp capping materials in patients with reversible pulpitis, CBCT showed a significant difference in that most healed CBCT lesions had received Biodentine while most that did not heal received Fuji IX. Longer-term follow-up is needed to establish their effect on the healing dynamics of PA tissues (ClinicalTrials.gov NCT02201641).

In vitro assessment of 3 dentifrices containing fluoride in preventing demineralization of overdenture abutments and root surfaces.

STATEMENT OF PROBLEM: Caries development under overdentures has been a continuing problem and requires the daily use of fluoride to prevent demineralization. PURPOSE: The purpose of this in vitro study was to compare the effectiveness of dentifrices containing tricalcium phosphate or calcium phosphosilicate in combination with fluoride to prevent the demineralization of overdenture abutments and root surfaces. MATERIAL AND METHODS: A total of 56 caries-free extracted teeth were prepared as overdenture abutments. The teeth were painted with acid-resistant varnish, leaving one 1×4-mm window on occlusal and root surfaces. The teeth were randomly divided into 4 groups: a control group treated with distilled/deionized water only, a group treated with ClinPro 5000, a group treated with ReNew, and a group treated with Prevident 5000 gel. Each tooth was subjected to a demineralizing/remineralizing cycling protocol for 12 days with the appropriate treatment products. The teeth were sectioned longitudinally through both windows. Photomicrographs were made of 3 representative sections from each tooth. A representative section was defined as one that included both windows and was cut from the part of the tooth that had the flattest surface to reduce the edge effect. The depths of the lesions were measured on representative sections from each group. A 1-way MANOVA and a 1-way ANOVA with the post hoc Tukey-Kramer test were used to evaluate the treatment effects on the criterion variables (α=.05). RESULTS: The total lesion depths of the control teeth on the occlusal surface were not statistically significantly deeper than for the 3 dentifrices (P=.7705). However, all 3 dentifrices had narrower cavitation depths than the control (mean cavitation band depth, 43.59 [ReNew] versus 37.99 [Prevident 5000 gel] versus 36.70 [ClinPro 5000] versus 246.86 [control]) (P<.001). The mean remineralization band depth for ClinPro 5000 was significantly greater than for the other 2 treatment groups (118.03 [ClinPro 5000] versus 107.80 [ReNew] versus 102.28 [Prevident 5000 gel]) (P<.001). On root surfaces, the total lesion depth for the control group was statistically significantly deeper than for the 3 dentifrices (mean total lesion depth, 150.31 [control] versus 82.05 [ReNew] versus 68.10 [ClinPro 5000] versus 56.97 [Prevident 5000 gel]) (P<.001). The data indicated that teeth treated with Prevident 5000 gel had the shallowest total lesion depth and were statistically significantly different from those treated with ReNew and ClinPro 5000. Moreover, teeth treated with ReNew were found to have the largest remineralization band depth, which was statistically significantly different compared with ClinPro 5000 and Prevident 5000 gel (mean remineralization band depth, 49.66 [ReNew] versus 36.14 [ClinPro 5000] versus 23.27 [Prevident 5000 gel]) (P<.001), but no difference was found in cavitation depth of the root lesions between the 3 dentifrices. CONCLUSIONS: The addition of tricalcium phosphate or calcium phosphosilicate to fluoride-containing dentifrices (5000 ppm) does not significantly improve their ability to prevent demineralization of the cut dentin surface of overdenture abutments. However, on root surfaces, ReNew, which contains calcium phosphosilicate, was found to improve remineralization of the lesions compared with Prevident 5000 gel or ClinPro 5000.

Effectiveness of MTA pulpotomy in primary molars: a critical assessment of relevant studies.

DATA SOURCES: Medline. STUDY SELECTION: Studies that evaluated the efficacy of MTA as a pulpotomy medicament in primary teeth were included, abstracts, observational studies and case reports were excluded. Only English language studies were considered. DATA EXTRACTION AND SYNTHESIS: Studies were assessed and graded by two reviewers using a weighted criteria based system and a qualitative summary of the evidence provided. RESULTS: Twenty-two studies were included, 17 studies compared MTA with formocresol, four studies compared MTA with calcium hydroxide, ferric sulphate, Portland cement, calcium-enriched mixture cement (CEM) and one study compared white MTA with grey MTA. CONCLUSIONS: Based on the assessment criteria employed, there was no evidence that MTA was better than present materials and techniques as a pulpotomy medicament.

Five-year longitudinal assessment of the prognosis of apical microsurgery.

INTRODUCTION: Apical surgery is an important treatment option for teeth with post-treatment apical periodontitis. Knowledge of the long-term prognosis is necessary when weighing apical surgery against alternative treatments. This study assessed the 5-year outcome of apical surgery and its predictors in a cohort for which the 1-year outcome was previously reported. METHODS: Apical microsurgery procedures were uniformly performed using SuperEBA (Staident International, Staines, UK) or mineral trioxide aggregate (MTA) (ProRoot MTA; Dentsply Tulsa Dental Specialties, Tulsa, OK) root-end fillings or alternatively Retroplast capping (Retroplast Trading, Rorvig, Denmark). Subjects examined at 1 year (n = 191) were invited for the 5-year clinical and radiographic examination. Based on blinded, independent assessment by 3 calibrated examiners, the dichotomous outcome (healed or nonhealed) was determined and associated with patient-, tooth-, and treatment-related variables using logistic regression. RESULTS: At the 5-year follow-up, 9 of 191 teeth were unavailable, 12 of 191 teeth were extracted, and 170 of 191 teeth were examined (87.6% recall rate). A total of 129 of 170 teeth were healed (75.9%) compared with 83.8% at 1 year, and 85.3% were asymptomatic. Two significant outcome predictors were identified: the mesial-distal bone level at ≤ 3 mm versus >3 mm from the cementoenamel junction (78.2% vs 52.9% healed, respectively; odds ratio = 5.10; confidence interval, 1.67-16.21; P < .02) and root-end fillings with ProRoot MTA versus SuperEBA (86.4% vs. 67.3% healed, respectively; odds ratio = 7.65; confidence interval, 2.60-25.27; P < .004). CONCLUSIONS: This study suggested that the 5-year prognosis after apical microsurgery was 8% poorer than assessed at 1 year. It also suggested that the prognosis was significantly impacted by the interproximal bone levels at the treated tooth and by the type of root-end filling material used.

Use of mineral trioxide aggregate (MTA by postgraduates in restorative dentistry in the UK.

All postgraduate trainees in Restorative Dentistry within the United Kingdom were contacted by e-mail and invited toparticipate in a structured on-line questionnaire regarding MTA usage. Responses were received from 46/65 (70.8%) postgraduate trainees. MTA was used by 15/46 (32.6%) trainees in the primary dentition and 46/46 (100%) in the permanent dentition. Barriers to the use of MTA in the permanent dentition related to material cost and in the primary dentition, the lack of an evidence base. Overall, 32/46 (69.6%) had received tuition during their postgraduate programme and 21/46 (45.7%) indicated an interest in further educational opportunities in material use.

Histologic assessment of human pulp response to capping with mineral trioxide aggregate and a novel endodontic cement.

INTRODUCTION: This study was conducted to compare human pulp response to mineral trioxide aggregate (MTA) and a novel endodontic cement (NEC) when used as pulp capping materials after a time period of 2 and 8 weeks. METHODS: Thirty-two premolar teeth that were scheduled for extraction for orthodontic reasons were exposed and capped with either MTA or NEC. Half of the specimens underwent extraction and histologic analysis after 2 weeks, and the remaining half were assessed after 8 weeks. Each slide was graded histologically according to the morphology of the dentinal bridge, thickness of the dentinal bridge, presence of odontoblast cells, and inflammation of the pulp. RESULTS: Both MTA and NEC showed significantly better pulp response after 8 weeks compared with 2 weeks, with a thicker and more tubular pattern of the dentinal bridge, less pulp inflammation, and a palisade pattern of odontoblast cells. Although MTA and NEC groups had no significant difference in each measure in both time intervals, NEC induced a thicker dentinal bridge with less pulp inflammation at both 2 weeks and 8 weeks, compared with MTA. CONCLUSIONS: MTA and NEC showed similar biocompatibility and favorable response in pulp capping treatment and inducing the formation of the dentinal bridge.

Mineral trioxide aggregate as a pulpotomy medicament: an evidence-based assessment.

AIM: The principles of evidence-based dentistry were used to compare mineral trioxide aggregate (MTA), formocresol (FC), ferric sulphate (FS) and calcium hydroxide (CH) as primary molar pulpotomy medicaments. METHODS: Electronic databases were searched and sieved for relevant papers by examining titles, abstracts and finally full texts. Included were randomized clinical trials (RCTs) and clinical trials (CTs) comparing the clinical and radiographic successes of MTA, FC, FS and CH pulpotomies. Data were extracted and common odds ratios (CORs) were derived by fixed effects meta-analysis (direct or indirect MA). Mean clinical and radiographic success rates from relevant study arms were examined. RESULTS: Eighteen RCTs and 10 CTs (total 1,260 molars) were identified to compare MTA and FC. Direct MAs found MTA was significantly more successful clinically (COR=3.11; 95%CI=1.09-8.85) and radiographically (COR=4.50; CI=1.78-11.42) than FC, and clinical and radiographic data confirmed this. Fourteen RCTs and 4 CTs (total 959 molars) were identified to compare MTA and FS. Indirect MAs found no statistically significant difference in clinical successes, but a statistically significant difference in the radiographic successes of MTA and FS (COR=4.69; CI=1.70-12.95). Clinical and radiographic data showed MTA was significantly more successful than FS. Nine RCTs and 7 CTs (total 531 molars) were identified to compare MTA and CH. Indirect MAs found statistically significant differences in the clinical (COR=6.48; CI=1.75-24.0) and radiographic (COR=10.47; CI=3.35-32.76) successes of MTA and CH. Clinical and radiographic data confirmed MTA was significantly more successful than CH. CONCLUSION: Currently available evidence suggests MTA compared with FC, FS and CH as a pulpotomy medicament resulted in significantly higher clinical and radiographic successes in all time periods up to exfoliation.

The current opinions and use of MTA for apical barrier formation of non-vital immature permanent incisors by consultants in paediatric dentistry in the UK.

The purpose of the study was to assess the current opinions and usage of mineral trioxide aggregate (MTA) for apical barrier formation of non-vital immature permanent teeth by consultants in paediatric dentistry in the UK. A semi-structured postal questionnaire was sent to all known consultants in paediatric dentistry in the UK. The response rate was 78.6% (44 of 56). Thity-eight consultants (86.3%) agreed that the use of this material was a good idea with 68.2% having used or arranged for its use in apical barrier formation. Forty-two consultants (95.5%) agreed that reduced number of visits was an advantage to the technique, with only 34.1% agreeing that this procedure was less likely to weaken the tooth and 63.6% agreed that material and equipment costs were a drawback and 50% agreed that lack of available evidence was a disadvantage to its use. The results from this study give an indication of the extent of MTA use by consultant-led services in paediatric dentistry in the UK and highlights the need for a multi-centre randomised controlled clinical trial.

Mineral trioxide aggregate pulpotomies: a case series outcomes assessment.

BACKGROUND: The greatest threats to developing teeth are dental caries and traumatic injury. A primary goal of all restorative treatment is to maintain pulp vitality so that normal root development or apexogenesis can occur. If pulpal exposure occurs, then a pulpotomy procedure aims to preserve pulp vitality to allow for normal root development. Historically, calcium hydroxide has been the material of choice for pulpotomy procedures. Recently, an alternative material called mineral trioxide aggregate (MTA) has demonstrated the ability to induce hard-tissue formation in pulpal tissue. The authors describe the clinical and radiographic outcome of a series of cases involving the use of MTA in pulpotomy procedures. METHODS: Twenty-three cases in 18 patients were treated with MTA pulpotomy procedures in an endodontic private practice. All of the patients had been referred to the practice for diagnosis and treatment of a symptomatic tooth. All of the authors provided treatment. Pulpal exposures were either due to caries or complicated enamel dentin fractures. RESULTS: Nineteen teeth in 14 patients were available for recall. The mean time of recall was 19.7 months. Of the 19 cases, 15 involved healed teeth, and three involved teeth that were healing. One of 19 cases involved a tooth with persistent disease. CONCLUSIONS: MTA may be useful as a substitute for calcium hydroxide in pulpotomy procedures. Further research, however, is required to clarify this conclusion. CLINICAL IMPLICATIONS: MTA conceivably could replace calcium hydroxide as the material of choice for pulpotomy procedures, if future research continues to show promising results.

Clinical assessment of mineral trioxide aggregate (MTA) as direct pulp capping in young permanent teeth.

UNLABELLED: Carious pulp exposure in permanent molars of children is a common incident. Mineral trioxide aggregate is a new material that possesses numerous exciting possibilities for pulp therapy. AIM: The purpose of this study was to evaluate the efficiency of MTA as a direct pulp capping agent in young permanent teeth. METHODS: Thirty asymptomatic permanent molars with pulp exposures were treated by pulp capping using MTA. At each recall (6 12, 18 and 24 months), the teeth were assessed clinically, through pulpal sensitivity tests, as well as radiographically to evaluate periapical healing. RESULTS: None of the cases reported spontaneous pain at the six months follow up and the pulp showed signs of vitality and absence of periapical radiolucency. At 24 months, the clinical and radiographic success rate was 93% with evidence of continued root growth. CONCLUSION: Pulp capping with MTA is recommended for teeth with carious pulp exposures specially immature teeth with high potential for healing.

Assessment of a novel alternative to conventional formocresol-zinc oxide eugenol pulpotomy for the treatment of pulpally involved human primary teeth: diode laser-mineral trioxide aggregate pulpotomy.

OBJECTIVE: The purpose of this study was to investigate whether a diode laser pulpotomy with mineral trioxide aggregate (MTA) sealing could be an acceptable alternative to the conventional formocresol pulpotomy and zinc oxide eugenol (ZOE) sealing in human primary teeth. METHODS: A randomized, single-blind, split-mouth study was used with a sample of 16 children aged from 3 to 8 years (mean age=5.10 years). A total of 26 pairs of teeth from these 16 patients were selected based on clinical and radiographic criteria. One tooth from each pair was randomly assigned to either the laser-MTA pulpotomy group or the formocresol-ZOE pulpotomy group. All teeth were followed up clinically and radiographically at 2.3, 5.2, 9.5 and 15.7 months. All extracted failures were sectioned and photographed to assess possible reasons for this. RESULTS: A total of seven laser-MTA-treated teeth were deemed to be radiographic failures (mean time until failure=9.1 months) compared to three formocresol-ZOE treated teeth (mean time until failure=12.5 months). These results were not significant using Fisher's exact test (P>0.05). Six of the laser-MTA failures and all three formocresol-ZOE failures exhibited furcal and/or periapical radiolucencies with or without pathologic root resorption. One of the laser-MTA failures displayed premature root resorption and is being observed for exfoliation. Analysis of photographs of teeth available for extraction revealed errors in clinical technique in addition to expected signs of a disease process such as the presence of granulation tissue and areas of pathologic root resorption. CONCLUSIONS: The laser-MTA pulpotomy showed reduced radiographic success rates compared to the formocresol-ZOE pulpotomy at 15.7 months; however, these results were not statistically significant. Improved success rates among a larger patient sample and a longer follow-up period would be required for the laser-MTA pulpotomy to be considered a routine alternative to the conventional formocresol-ZOE procedure. Meticulous restorative techniques must be followed to ensure the success of laser-MTA pulpotomies.

In vivo assessment of hydroxyapatite and silicate-substituted hydroxyapatite granules using an ovine defect model.

Phase pure hydroxyapatite (HA) and two silicate-substituted hydroxyapatites (0.8 and 1.5 wt% Si, or 2.6 and 4.9 wt% SiO4) were prepared by aqueous precipitation methods. The filter-cakes of HA and silicate-substituted hydroxyapatite (SiHA) compositions were processed into granules 1.0-2.0 mm in diameter and sintered at 1200 degrees C for 2 h. The sintered granules underwent full structural characterisation, prior to assessment in an ovine defect model by implantation for a period of 6 and 12 weeks. The results indicate that HA and SiHA implants were well accepted by the host tissue, with no evidence of inflammation. New bone formation was observed directly on the surfaces and in the spaces between the granular implants. Quantitative histomorphometry as determined by the percentage of bone ingrowth and bone coverage for both SiHA implant compositions was significantly greater than that for phase pure HA. These findings indicate that the in vivo bioactivity of hydroxyapatite was significantly improved by the incorporation of silicate ions into the HA structure, making SiHA ceramics attractive alternatives to conventional HA materials for use as bone graft substitute ceramics.

Microleakage assessment of pit and fissure sealant with and without the use of pumice prophylaxis.

OBJECTIVES: This study evaluated the effect of pumice prophylaxis on the level of microleakage around and between the sealant and enamel. MATERIALS AND METHODS: A total of 32 freshly extracted sound upper first premolars, assigned as suitable for sealant application, were chosen and divided randomly into two groups: (1) a test group, without prophylaxis; and (2) a control group, with prophylaxis. Sealant was applied to all teeth using the same conventional technique, with prophylaxis being omitted in the test group. The sealed teeth were thermocycled (120 x 30 s, 5 and 55 degrees C cycles) and then immersed in 2% Basic Fuchsin solution for 72 h. Each tooth was sectioned and examined for dye penetration under a stereomicroscope (x 60 magnification). RESULTS: No dye penetration was seen in 19 (29.6%) of the teeth in the test group and 36 (56.2%) of the teeth in the control group. Dye had penetrated to the base of the fissure in 31 (48.4%) of the teeth in the test group and 23 (35.9%) of the teeth in the control group. Using a chi-square test for trend, the frequency of microleakage was significantly higher in the test group compared to the controls (P < 0.016). CONCLUSION: Prophylaxis has a role in improving sealant retention. Removing this step may cause an increase in microleakage.