Research progress on direct pulp capping of primary teeth / 口腔疾病防治

@#The timely treatment of dental caries and pulp disease in primary teeth holds significant importance for maintaining children's oral health. Direct pulp capping (DPC) is a vital pulp treatment that involves covering the exposed pulp with bioactive materials to promote dentin bridge formation. DPC is commonly used in primary teeth with vital pulp and mechanical pulp exposure not exceeding 1 mm. DPC offers advantages such as minimal invasiveness, comfort, simplicity of operation and short chair-side time, making it suitable for pediatric dental clinical practice. Early studies suggested negative treatment outcomes for DPC in primary teeth with carious pulp exposure. Over the years, there have been advancements in materials and technology demonstrating positive outcomes in the clinical research of primary teeth with deep caries. However, due to the limited quality of related studies, DPC has not been widely recommended for the treatment of primary teeth with carious pulp exposure, and its widespread use needs further support by more high-quality evidence-based medical research. The success rate of DPC in primary teeth is influenced by factors including pulp status, clinical operations (such as isolation and caries removal), pulp capping material, cavity type, tooth position, coronal sealing, and dental fear. In clinical operation, dentists should accurately assess pulp status and minimize bacterial contamination. Mineral trioxide aggregate (MTA) is a DPC agent with relatively sufficient evidence and good therapeutic effects, and the crown should be tightly sealed after pulp capping. Additionally, the effects of novel biocompatible materials such as iRoot BP Plus used in DPC of primary teeth, and the influence of other factors like hemostatic methods on the prognosis of affected teeth, need further exploration.

Effective Debridement And Subsequent Obturation Of Tooth With Morphoanatomic Variations In Non Syndromic Patients– A Series Of 3 Case Reports

Taurodontism is a morphoanatomical anomaly of teeth characterised by enlarged pulp chamber with apically displaced pulp chamber floor and furcation.Endodontic treatment of a taurodont is challenging and requires special handling because of proximity and apical displacement of roots. In performing root canal treatment on such teeth, one should appreciate the complexity of the root canal system, canal obliteration and configuration, and the potential for additional root canal systems. Careful exploration of the grooves between all orifices particularly with magnification, use of ultrasonic irrigation; and a modified filling technique are of particular use. This paper presents three case reports on diagnosis and successful endodontic management of hypertaurodontic teeth, in non-syndromic patients

A clinical study on the revascularization of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis / 实用口腔医学杂志

Objective:To evaluate the clinical effect of the revaseularization procedure for immature teeth with necrotic pulp and apical periodontitis.Methods:12 immature teeth with necrotic pulp and apical periodontitis in 12 patients(9-13 years old) were treated with revascularization protocol.The patients were followed up for 21-24 months.Results:All teeth were cured.4 types of responses were observed:①Increased thickening of the canal walls and continued root maturation;②Severe calcification of the canal space beneath MTA;③Partial pulp canal obliteration;④Continued root development with an open apex.Conclusion:Revascularization procedure may the formation of the root apex but not in all the cases.Excessive deposition of hard tissue might caused calcification in canal space.

Histopathologic responses of human dental pulp to calcium hydroxide and mineral trioxide aggregate as pulp capping agents / 实用医学杂志

Objective To investigate human pulpal response to mineral trioxide aggregate (MTA) and calcium hydroxide (CH) as pulp capping agents. Methods This study was conducted on 90 intact first and second premolars of human maxillary and mandibular teeth of 30 volunteers. The patients were randomly assigned into three groups with 10 in each group. Under local anesthesia, the teeth were exposed and capped either with MTA, or CH. After 30, 60, and 90 days, 10 teeth of each group were extracted and prepared for histologic ob-servation. The data were analyzed with Wilcoxon rank sum test and paired t-tests (α = 0.05). Results MTA had a higher success rate and resulted in less pulpal inflammatory response and more predictable hard dentin bridge formation than CH (P < 0.05). Conclusion MTA appears to be a suitable replacement for CH in direct pulp capping.

The effects of bone morphogenetic protein-2 and enamel matrix derivative on the bioactivity of mineral trioxide aggregate in MC3T3-E1cells

OBJECTIVES: The effects of bone morphogenetic protein-2 (BMP-2) and enamel matrix derivative (EMD) respectively with mineral trioxide aggregate (MTA) on hard tissue regeneration have been investigated in previous studies. This study aimed to compare the osteogenic effects of MTA/BMP-2 and MTA/EMD treatment in MC3T3-E1 cells. MATERIALS AND METHODS: MC3T3-E1 cells were treated with MTA (ProRoot, Dentsply), BMP-2 (R&D Systems), EMD (Emdogain, Straumann) separately and MTA/BMP-2 or MTA/EMD combination. Mineralization was evaluated by staining the calcium deposits with alkaline phosphatase (ALP, Sigma-Aldrich) and Alizarin red (Sigma-Aldrich). The effects on the osteoblast differentiation were evaluated by the expressions of osteogenic markers, including ALP, bone sialoprotein (BSP), osteocalcin (OCN), osteopontin (OPN) and osteonectin (OSN), as determined by reverse-transcription polymerase chain reaction analysis (RT-PCR, AccuPower PCR, Bioneer). RESULTS: Mineralization increased in the BMP-2 and MTA/BMP-2 groups and increased to a lesser extent in the MTA/EMD group but appeared to decrease in the MTA-only group based on Alizarin red staining. ALP expression largely decreased in the EMD and MTA/EMD groups based on ALP staining. In the MTA/BMP-2 group, mRNA expression of OPN on day 3 and BSP and OCN on day 7 significantly increased. In the MTA/EMD group, OSN and OCN gene expression significantly increased on day 7, whereas ALP expression decreased on days 3 and 7 (p < 0.05). CONCLUSIONS: These results suggest the MTA/BMP-2 combination promoted more rapid differentiation in MC3T3-E1 cells than did MTA/EMD during the early mineralization period.

Eficacia de la obturación ortógrada de conductos radiculares con MTA vs. MTA más conos de gutapercha / Orthograde root canal obturation efficacy of MTA vs. MTA with gutta percha points

Objetivo: Evaluar la capacidad del sellado del MTA usado como material único de sellado o usándolo como cemento sellador más conos de gutapercha. Materiales y métodos: Se seleccionaron las raíces mesiales de 24 molares inferiores y se instrumentaron hasta una lima maestra apical # 40 con la técnica de Crown Down. El grupo I fue obturado con conos de gutapercha y el MTA fue usado como cemento sellador; el grupo II fue obturado con MTA solamente. Se utilizaron cuatro raíces como control positivo y negativo; las muestras fueron cubiertas con cera pegajosa, dejando libre solo los dos últimos milímetros apicales, se centrifugaron en tinta china durante una hora y se les realizó procedimiento de transparentación, para posteriormente medir la microfiltración con un microscopio estereoscópico. Resultados: Los resultados fueron analizados estadísticamente con el test de KRUSKAL-WALLIS para variables independientes, y no se encontró diferencia estadísticamente significativa entre los dos grupos. Conclusiones: No se encontró diferencia estadísticamente significativa entre los dos grupos. En situaciones clínicas que no permiten la obturación convencional con conos de gutapercha, cualquiera de las dos técnicas de colocación del MTA son factibles.

Objetives: This study evaluated the sealing capability of MTA when it is used as the only root canal filling material and when it is used as sealing cement combined with gutapercha points. Materials and methods: The mesial roots of 24 inferior molars were selected; they were instrumented until an apical master file # 40 with Crown Down technique. Group I were obtured with gutapercha points and MTA as sealing cement; group II were obtured only with MTA. Four roots were used as positive and negative control, samples were covered with sticky wax, leaving free the apical last 2 mm, they were centrifugued with chinese ink for one hour and then they were turned transparent, to measure the microleakage with a stereoscopic microscope. Results: Results were analyzed statistically with the KRUSKAL-WALLIS test for independent variables and statistically no significant difference was found between the two groups. Conclusion: Statistically no significant difference was found between the two groups. In such clinical situations that don't permit conventional obturation with gutapercha points, both MTA techniques are viable.

Evaluation of the rat tissue reaction to experimental new resin cement and mineral trioxide aggregate cement

OBJECTIVES: New resin cement (NRC) has been developed as a root repairing material and the material is composed of organic resin matrix and inorganic powders. The aim of this study was to compare the rat subcutaneous tissue response to NRC and mineral trioxide aggregate (MTA) cement and to investigate the tissue toxicity of both materials. MATERIALS AND METHODS: Sixty rats received two polyethylene tube-implants in dorsal subcutaneous regions, MTA and NRC specimens. Twenty rats were sacrificed respectively at 1, 4 and 8 wk after implantation and sectioned to 5 microm thickness and stained with Hematoxylin-Eosin (H-E) or von-Kossa staining. The condition of tissue adjacent to the implanted materials and the extent of inflammation to each implant were evaluated by two examiners who were unaware of the type of implanted materials in the tissues. Data were statistically analyzed with paired t-test (p < 0.05). RESULTS: In specimens implanted with both NRC and MTA, severe inflammatory reactions were present at one wk, which decreased with time. At eighth wk, MTA implanted tissue showed mild inflammatory reaction, while there were moderate inflammatory reactions in NRC implanted tissue, respectively. In NRC group, von-Kossa staining showed more calcification materials than MTA group at eighth wk. CONCLUSIONS: It was concluded that the calcium reservoir capability of NRC may contribute to mineralization of the tissues.

Tratamento clínico-cirúrgico dos insucessos endodônticos / Clinical-surgical treatment of endodontics failure

O tratamento clínico-cirúrgico está indicado nos casos de insucessos endodônticos, principalmente, nos casos onde ocorrem acidentes e complicações, que impedem a terapêutica endodôntica em toda extensão do canal radicular. Contudo, é importante frisar que frente a um insucesso, o primeiro procedimento é o retratamento, só então, deveremos pensar em cirurgia periapical. Todavia, em algumas situações a cirurgia pode vir como primeira escolha, principalmente nos casos onde não é plenamente viável o retratamento, devido a obstruções tipo núcleo de difícil remoção, o que inviabiliza o tratamento endodôntico via coroa. Assim sendo, a indicação criteriosa, técnicas pertinentes, além da utilização de materiais apropriados, tipo MTA (agregado de trióxido mineral), tem-se conseguido reverter a maioria dos insucessos endodônticos.

Clinical-surgical treatment is indicated in cases of endodontics failure, mainly, in cases where accidents and complications occur that prevent the endodontic therapeutics in all the extension of the radicular canal. However, it is important to point out that, when confronted with a failure, the first procedure is retreatment; only then should the professional think of periapical surgery. Nevertheless, in some situations surgery may come as the fist choice, mainly in cases where retreatment is not completely viable, due to obstractions such as a hard remotion nucleus, which prevents the endodontics treatment via crown. Thus, with criterious indications, pertinent techniques as well as the utilization of appropriate materiais, such as MTA (mineral trioxide aggregate) most endodontics failures have been reverted.

Observation of clinical effect of apical barrier and perforation repair with mineral trioxide aggregate / 实用口腔医学杂志

Objective:To observe the clinical effect of apical barrier and perforation repair with mineral trioxide aggregate.Methods:Selected 23 samples from out-patients of the department of conservative dentistry of oral disease treatment center of 306 Hospital of PLA.Among them,7 samples were with unshaped root apical,6 samples were with lateral perforation from root canal internal absorption or root fracture,10 samples were iatrogenic lateral perforation.The course of the disease was 0.5-24 months.The images of dental films showed that there was shadow around the root or apical area in all the samples.All the samples received regular root canal treatment.Under root canal microscope,the open sites were sealed with MTA.After the barrier formed,filled the root canal with warm gutta-percha vertical compaction technique.Patients were ordered to re-check on 6 months and 12 months respectively.Results:1 sample dropped out.On 6 months visit,1 sample showed enlarged shadow at the apical area,20 samples showed shrinked shadow,1 sample showed no significant change.On 12 months visit,the shadow vanished in 9 samples;the shadow decreased in 5 samples,and there were 2 samples showed no significant changes.Conclusion:The treatment with MTA on apical barrier and perforation shows acceptable effect in short term observation.The use of microscope helps to enhance the accuracy and leak tightness of MTA filling.

A clinic study about repairing furcation and root perforations using mineral trioxide aggregate / 实用口腔医学杂志

Objective:To evaluate the results of repairing furcation and root perforation using Mineral Trioxide Aggregate(MTA).Methods:Cases with furcation perforations were divided into two groups randomly,MTA and IRM(control group)methods were adopted in present study.Cases that had root perforations were treated with MTA.Pretreatment,immediate posttreatment,and 1year follow-up radiographs were evaluated in a double-blind manner to determine the presence or absence of any pathologic changes adjacent to the perforation site.Results:21 cases were involved.The healing rate of furcation perforation in MTA group was higher(80%)when compared with that in IRM group(75%).However,statistical analysis showed no significant difference in success rates between both groups(P=0.722).The healing rate of root perforation using MTA was 100%.Conclusion:MTA provides an effective seal of furcation /root perforations,and promises in improving the prognosis of perforated teeth.