Clinical and radiographic outcomes of traumatized immature permanent necrotic teeth after revascularization/revitalization therapy.

INTRODUCTION: Revascularization treatment is rapidly becoming an accepted treatment alternative for the management of endodontic pathology in immature permanent teeth with necrotic dental pulps. However, the success and timing of clinical resolution of symptoms, and radiographic outcomes of interest, such as continued hard tissue deposition within the root, are largely unknown. METHODS: In this prospective cohort study, 20 teeth were treated with a standardized revascularization treatment protocol and monitored for clinical and radiographic changes for 1 year. Standardized radiographs were collected at regular intervals, and radiographic changes were quantified. RESULTS: All 20 treated teeth survived during the 12-month follow-up period, and all 20 also met the clinical criteria for success at 12 months. As a group, the treated teeth showed a statistically significant increase in radiographic root width and length and a decrease in apical diameter, although the changes in many cases were quite small (such that the clinical significance is unclear). The within-case percent change in apical diameter after 3 months was 16% and had increased to 79% by 12 months, with 55% (11/20) showing complete apical closure. The within-case percent change in root length averaged less than 1% at 3 months and increased to 5% at 12 months. The within-case percent change in root thickness averaged 3% at 3 months and 21% at 12 months. CONCLUSIONS: Although clinical success was highly predictable with this procedure, clinically meaningful radiographic root thickening and lengthening are less predictable after 1-year of follow-up. Apical closure is the most consistent radiographic finding.

Temperature changes in the pulpal chamber and the sealing performance of various methods of direct pulp capping of primary teeth.

AIM: To compare changes in pulpal chamber temperature during the visible-light curing of direct pulp capping compounds and various modes of diode laser irradiation without prior placement of a pulp capping compound and the resultant seals. MATERIALS AND METHODS: Pulp exposure holes were made in 100 extracted human primary first molars, which were randomly assigned to ten equal groups. The holes were sealed by (a= Group 1, 2, 3, 4, 5, 6 and 7) different pulp capping compounds which were cured using various types of visible-light curing units or (b=Group 8, 9 and 10) diode laser irradiation without prior application of a pulp capping compound. Pulpal chamber temperatures were recorded during the procedure, and the resultant seals were examined under a scanning electron microscope. RESULTS: Visible-light curing of the pulp capping compounds and diode laser irradiation at a 0.7 W output power can cause non-injurious temperature rises in the pulpal chamber. At higher output powers of the diode laser, the temperature rises are sufficient to cause thermal injury. The seals were complete when pulp capping compounds were used for direct pulp capping, but were incomplete when laser irradiation without prior placement of a pulp capping compound was used for the identical purpose. CONCLUSION: The visible-light curing of pulp capping compounds is not harmful to vital pulp, and provides an effective seal of the pulp exposure hole. Laser irradiation is not an effective sealant, and can cause thermal injury to vital pulp at high output powers.

MM-MTA for direct pulp capping: a histologic comparison with ProRoot MTA in rat molars.

AIM: To compare the histomorphological response of rat dental pulps capped with MM-MTA and ProRoot MTA at 1, 2 and 4 weeks postoperatively. MATERIALS AND METHODS: Direct pulp capping with MM-MTA and ProRoot MTA, overlaid with light-cured composite resin, was performed on right and left maxillary first molars of 20 Wistar rats. Animals were killed at 1, 2 and 4 weeks postoperatively. Biopsy samples were stained and viewed by light microscopy to determine dentin bridge formation. Data were statistically evaluated with the Kruskal-Wallis test (p < 0.05). RESULTS: Absence of dentin bridge formation at 1 week, partial dentin bridge formation at 2 weeks and complete dentin bridge formation at 4 weeks are observed with MM-MTA and ProRoot MTA. The results showed no statistically significant difference between both materials at 4 weeks. CONCLUSION: Both materials produced similar responses in the pulp when used for pulp capping in intact, caries-free molars of rats.

Periapical healing after direct pulp capping with calcium-enriched mixture cement: a case report.

This article describes a successful direct pulp capping of a mature symptomatic mandibular second molar in a 14-year-old girl. The patient was referred with sensitivity to cold beverages and pain on chewing on the second left mandibular molar. Clinical examinations revealed extensive coronal caries and sensitivity to percussion. Radiographically, the tooth was mature and had a widened apical periodontal ligament (PDL) and a narrow periapical lesion. The concluding diagnosis was symptomatic irreversible pulpitis with symptomatic apical periodontitis. Treatment included caries removal under rubber dam isolation, capping of exposure sites with calcium-enriched mixture (CEM) cement, and permanent coronal restoration. At three-, 10-, and 15-month follow-up, the tooth was functional, had normal response to cold test, and did not have sensitivity to percussion. The PDL space regained its normal width, and the periapical lesion healed.

The effectiveness of using different pulp-capping agents on the healing response of the pulp.

BACKGROUND: Some of the disadvantages of calcium hydroxide Ca(OH) 2 as pulp-capping material are related to the inflammatory response, and its poor sealing ability. Cyanoacrylate glue was proposed in this study as pulp-capping agent because of its sealing ability, and diprogenta, on the other hand, was proposed because of its anti-microbial and anti-inflammatory effects. The aim of this study is to evaluate and compare the histopathological response of the pulp toward cyanoacrylate and diprogenta in direct pulp capping (DPC). MATERIALS AND METHODS: Cyanoacrylate, diprogenta, and calcium hydroxide were applied on 20 permanent teeth of 6 rabbits divided into four groups, each contains five teeth, as follow: G1: Diprogenta and calcium hydroxide. G2: Cyanoacrylate. G3: Diprogenta and cyanoacrylate. G4: Calcium hydroxide (control group). RESULTS: A remarkable dentin bridge formation was found in all groups. No pulp necrosis was found in any tooth of the four groups. Pathological reactions of the pulp were found in 25%, 40%, 20%, and 100% of groups 1, 2, 3, and 4, respectively. Differences between study and control groups were found statistically significant ( P < 0.05). CONCLUSION: All materials used in this study were biocompatible and suggested to be studied further on human teeth. These materials when used in combination with Ca(OH) 2 , may give better results.

Success rates of a mixture of ciprofloxacin, metronidazole, and minocycline antibiotics used in the non-instrumentation endodontic treatment of mandibular primary molars with carious pulpal involvement.

OBJECTIVE: To evaluate the clinical and radiographic success rates of three mixed antibiotics in the non-instrumentation endodontic treatment of primary mandibular molars at 24-27 months postoperatively. METHODS: Eighty cariously involved lower primary molars from 58 children (ages 3-8 years) received a 3Mix medicament by non-instrumentation endodontic treatment and were then sealed with glass-ionomer cement and composite resin before permanent restoration with stainless steel crowns. The patients received a clinical and radiographic assessment every 6 months over a 2-year follow-up period with an intra-examiner reliability of 0.83-1.00 (κ value). RESULTS: In 60 cases at 24- to 27-month follow-up, the success rates as determined by clinical and radiographic evaluation were 75% and 36.7%, respectively; however, the overall success rate of 3Mix non-instrumentation endodontic treatment was 36.7% with 15.8% of cases demonstrating a pulpal response of internal resorption. CONCLUSIONS: Non-instrumentation endodontic treatment using 3Mix-MP showed good clinical success but had a low success rate based on radiographic evaluation at 2-year follow-up. Hence, 3Mix antibiotic treatment cannot replace a conventional root canal treatment agent as a long-term therapy.

Ways of enhancing pulp preservation by stepwise excavation--a systematic review.

OBJECTIVES: The best possible methods and materials in stepwise excavation for deep caries in permanent teeth were investigated. The review considers the questions from many aspects including clinical success, effects of reducing cariogenic bacteria, possibility of hardening softened dentin, and likelihood of generating tertiary dentin. DATA: This systematic review includes the use of data from randomized controlled trials, controlled clinical trials as well as from case series in which pulp exposure resulted following the treatment and removal of deep caries. Only studies of caries in permanent teeth were considered. Those involving treatment of primary teeth were excluded. SOURCES: An electronic search was conducted in the databases of MEDLINE and Igaku Chuo Zasshi (Japanese) from 1970 to 2008. The electronic search was supplemented by a manual search of the references lists of all the relevant studies. STUDY SELECTION: The electronic and manual searches of journals retrieved a total of 266 English and 130 Japanese papers. According to the inclusion and exclusion criteria, 10 English and 3 Japanese studies were finally identified. CONCLUSION: Our research suggests that stepwise excavation is effective for pulp preservation in extremely deep caries that do not show clinical symptoms of irreversible pulpitis. Calcium hydroxide, as well as antimicrobials and polycarboxylate cement combined with tannin-fluoride preparation, is effective in reducing bacteria and promoting remineralization of the carious dentin that remained after stepwise excavation. Further clinical trials with a high level of study design should be conducted to identify the best methods of removing carious dentin using stepwise excavation.

A new haemostatic agent's effect on the success of calcium hydroxide pulpotomy in primary molars.

PURPOSE: The purpose of this study was to evaluate the effect of the application of a new hemostatic agent, Ankaferd Blood Stopper (ABS), on the clinical and radiographic success of calcium hydroxide (CH) pulpotomies in primary molars. METHODS: Patients with bilateral vital mandibular primary molar teeth that required pulpotomies, because of pulpal exposure to caries, were selected for this study. After initial hemorrhage control, complete hemostasis into the canal orifice was achieved by: (1) applying a solution of ABS for 10 to 15 seconds; or (2) placing sterile, saline-wetted cotton pellets. Forty teeth in 2 groups were followed up clinically and radiographic at 1, 3, 6, 9, and 12 months. RESULTS: CH group teeth had a total success rate of 90% at 12 months. CH+ABS group teeth had a total success rate of 95% at 12 months. There were no statistically significant differences between CH and CH+ABS group regarding both clinical and radiographic success rates. CONCLUSION: Ankaferd Blood Stopper may be a useful product in the management of pulpal bleeding during a calcium hydroxide pulpotomy.

Preclinical effectiveness of a novel pulp capping material.

INTRODUCTION: The purpose of this study was to evaluate the direct pulp capping response to a novel resin-based calcium phosphate cement (RCPC). METHODS: The RCPC was placed in contact with the exposed healthy pulps of dog teeth and in a follow-up study on the healthy or inflamed pulps of ferret teeth. The inflamed ferret teeth had reversible pulpitis induced with Salmonella typhimurium lipopolysaccharides. After direct pulp capping with RCPC or visible light-curing resin-modified calcium hydroxide material (VLCCH) as a control, the restorations were bonded using a composite resin. The pulp responses and dentin repair were evaluated histologically in dog teeth after 7, 28, or 90 days and in ferret teeth after 45 days. RESULTS: Most of the RCPC-treated healthy pulps and 75% of the RCPC-treated inflamed ferret teeth had dentin healing and repair, whereas those teeth treated with VLCCH had minimal healing and dentin repair. CONCLUSIONS: The direct pulp capping of ferret and dog teeth with RCPC was associated with superior healing in comparison to VLCCH.

A comparative histological analysis of human pulp following direct pulp capping with Propolis, mineral trioxide aggregate and Dycal.

BACKGROUND: Permanent teeth pulp exposures have traditionally been treated with calcium hydroxide pulp capping. The aim of this study was to investigate the response of human pulp tissue which were mechanically exposed to a new material, Propolis and compare it with two existing and commonly used pulp capping agents (mineral trioxide aggregate and Dycal). METHODS: Thirty-six intact human premolars were mechanically exposed. Teeth were divided into six groups of 6 teeth each and were capped with Propolis, mineral trioxide aggregate and Dycal. Final restoration was done with posterior composite resin using light cured glass ionomer cement as a liner. The teeth were then extracted on the 15th or the 45th day and processed for histological evaluation. RESULTS: Differences in inflammatory response and dentine bridge formation of the exposed pulp to the three different materials were statistically calculated using chi-square test and were found to be non-significant. There was more pulp inflammation in teeth treated with Dycal than with Propolis and MTA on the 15th as well as on the 45th day. Propolis and MTA showed bridge formation in more teeth, and the bridges were in closer proximity to pulp capping material than teeth treated with Dycal on the 45th day. CONCLUSIONS: The response of pulps to Propolis as a pulp capping agent was comparable to MTA and Dycal.

A holistic approach to management of fractured teeth fragments: a case report.

Fracture of anterior teeth is a relatively common outcome of trauma to the teeth. If the fractured teeth fragments are recovered by the patient and brought to the dental office within reasonable time, the fragments may be reattached to the tooth structure. This article presents a case of a 20-year-old man with fractured maxillary central incisors and left maxillary lateral incisor. The fracture involved two-thirds of the crown, compromising the pulp. The procedure used was reattachment of the fractured fragment with bonding system and dual-cure composite resin cement. The techniques described in this case report for reattachment of the fractured fragments are reasonably simple, while restoring providing long-lasting esthetics, improved function, positive psychologic response with a very conservative approach.

Effects of antibacterial agents on dental pulps of monkeys mechanically exposed and contaminated.

OBJECTIVE: The purpose of this study was to compare the effectiveness of antibacterial agents and mineral trioxide aggregate in the healing of bacterial contaminated primate pulps. STUDY DESIGN: The experiment required four adult male primates (Cebus opella) with 48 teeth prepared with buccal penetrations into the pulpal tissues. The preparations were performed under general anesthesia and the exposed pulps were exposed to cotton pellets soaked in a bacterial mixture consisting of microorganisms normally found in human pulpal abscesses obtained from the Endodontic Clinic of UNESP. Following bacterial inoculation (30 minute exposure), the pulpal tissue was immediately treated with either sterile saline, Cipro HC Otic solution (12), diluted Buckley' formecresol solution (12) or Otosporin otic solution (12) for 5 minutes. After removal of the pellet, hemostasis was obtained and a ZOE base applied to the DFC treated pulps and the non-treated controls (12). After hemostasis, the other exposed pulps were covered with mineral trioxide aggregate (ProRoot). The pulpal bases were all covered with a RMGI (Fuji II LC). The tissue samples were collected at one day, two days, one week and over four weeks (34 days). RESULTS: Following perfusion fixation, the samples were demineralized, sectioned, stained and histologically graded. After histologic analysis, presence of neutrophilic infiltrate and areas of hemorrhage with hyperemia were observed. The depth of the neutrophilic infiltrate depended on the agent or material used. The pulpal tissue treated with Otic suspensions demonstrated significantly less inflammation (Kruskal Wallis non parametric analysis, H = 9.595 with 1 degree of freedom; P = 0.0223) than the formocresol and control groups. The hard tissue bridges formed over the exposure sites were more organized in the MTA treatment groups than in the control and ZOE groups (Kruskal Wallis non parametric analysis, H = 18.291 with 1 degree of freedom; P = 0.0004). CONCLUSIONS: Otic suspensions and MTA are effective in treating bacterial infected pulps and stimulate the production of a hard tissue bridge over the site of the exposure.

Histological analysis of rat dental pulp tissue capped with propolis.

The aim of the present study was to assess the response of rat dental pulp to direct pulp capping with propolis. Flavonoid and non-flavonoid materials were purified from an ethanol extract of propolis obtained from South Sulawesi, Indonesia. A Class I cavity was prepared on the occlusal surface of the right maxillary first molar in Sprague Dawley rats. The dental pulp was exposed and then capped with a zinc oxide-based filler as a control (group I), or with propolis flavonoids (group II) or non-flavonoids (group III). The animals were sacrificed at week 1, 2 or 4, biopsy samples were obtained, and these were stained and viewed by light microscopy. The results showed that pulp inflammation occurred in groups I and III as early as week 1. No dentin bridge formation was seen in these groups. In contrast, there was no evident inflammatory response in group II at week 1. Mild and moderate pulp inflammation in this group occurred at 2 and 4 weeks after treatment, respectively. Partial dentinal bridge formation was seen in group II at week 4. Therefore, the present results suggest that direct pulp capping with propolis flavonoids in rats may delay dental pulp inflammation and stimulate reparative dentin.

Effects of antibacterial capping agents on dental pulps of monkeys mechanically exposed to oral microflora.

The effects of antibacterial drugs on bacterially contaminated dental pulps were investigated in monkeys. Class V buccal cavities with pulpal exposures were prepared and then left open to the oral environment for 24 h. The exposed pulps were capped with alpha-tricalcium phosphate (alpha-TCP) containing a mixture of antibacterial drugs. Either alpha-TCP or Ca(OH)2 was used as a control. Pulpal responses were histologically evaluated after 4 wk. Those teeth capped with alpha-TCP alone showed total pulp necrosis and bacterial growth within the pulp chamber. By contrast, the pulps capped with alpha-TCP containing mixed antibacterial drugs remained almost normal without any necrotic layer, but showed persistent absorbing response to capping materials and no signs of hard tissue barrier formation. In teeth capped with Ca(OH)2, a hard tissue barrier was formed below the exposure site, with a wide loss of pulp tissue. No inflammation was seen under the barrier. These results indicate that mixed antibacterial drugs added to alpha-TCP effectively disinfected pulpal lesions, without destroying any of the sound pulp tissue. However, hard tissue barrier formation was delayed by this mixture as compared with Ca(OH)2.