Microtomographic and histological evaluation of two bioceramics as pulp capping agents in vivo.

Maintaining pulp vitality and function is a priority of the medicaments employed in pulp therapy to preserve tooth integrity. Aim: This study evaluated inflammatory response and reparative dentin bridge formation after direct pulp capping with two different bioceramics. Materials and Method: This was an in vivo controlled experimental study on 12 male Wistar rats. Pulpotomies were performed and the exposed pulps were capped with Biodentine or Neo MTA. After 15, 45 and 90 days, maxillary segments were obtained and prepared for histologic analysis and Micro-CT. Hounsfield Units (HU) were quantified. Results: Micro-CT analysis showed greater mineralization at 90 days with Neo MTA than with Biodentine. HU did not differ significantly (p >0.05) between molars treated with Biodentine and Neo MTA at 15 and 45 days, but at 90 days, there was statistically significant difference (p <0.05) between them. Reparative dentin was observed near the pulp exposure and canal orifice with both bioceramics. At 45 and 90 days, molars treated with Neo MTA showed mineralized tissue filling the canal orifice. Molars treated with Biodentine showed mineralized tissue and dentin bridge at the site of exposure at 45 days, and total pulp exposure coverage and mineralized entin matrix at 90 days. Conclusions: Biodentine and Neo MTA induce the formation of reparative dentin bridge after 45 days with inflammatory cell infiltrate.

Mantener la vitalidad pulpar y su función es una de las prioridades de los medicamentos utilizados en la terapia pulpar con la finalidad de preservar la integridad del diente. Objetivo: El objetivo de este estudio fue evaluar la respuesta inflamatoria y la reparación del puente dentinario con dos biocerámicas. Materiales y Métodos: Se realizó un estudio experimental in vivo en 12 ratas Wistar formando dos grupos de estudio (n = 6), en las que se realizaron pulpotomías. Posterior a 15, 45 y 90 días, se obtuvieron segmentos de los maxilares y se prepararon los especímenes para análisis histológicos y cortes microtomográficos. Las Unidades Hounsfield (UH) se cuantificaron. Resultados: El análisis microtomográfico mostró un incremento en la mineralización después de 90 días con Neo MTA comparado con Biodentine. No existió diferencia significativa (p >0.05) entre las UH posterior a 15 y 45 días, sin embargo, a los 90 días hubo diferencia significativa (p <0.05) entre Biodentine y Neo MTA. A los 45 y 90 días los molares tratados con Neo MTA mostraron la formación de tejido mineralizado en el orificio comunicados. Los molares tratados con Biodentine mostraron la formacion de tejido mineralizado, a los 45 dias se observó un puente de dentina en el sitio expuestos y una cobertura total de la exposición pulpar y una matriz de dentina mineralizada a los 90 días. Conclusiones: Biodentine y Neo MTA inducen la formación del puente dentinario reparador posterior a 45 días con infiltrado de células inflamatorias.

Injectable Tannin-Containing Hydroxypropyl Chitin Hydrogel as Novel Bioactive Pulp Capping Material Accelerates Repair of Inflamed Dental Pulp.

Conventional pulp capping materials have limited anti-inflammatory capacity. It is necessary to develop more effective pulp capping material for the treatment of inflamed pulps. Tannic acid (TA) is a natural, water-soluble polyphenol with antimicrobial and anti-inflammatory properties. This study aimed to investigate the effects of a tannin-containing hydroxypropyl chitin hydrogel (HPCH/TA hydrogel) as an innovative pulp capping material. The physicochemical properties of the composite hydrogels were characterized. The effects of HPCH/TA hydrogel as a pulp capping material were evaluated in vitro and in vivo. The underlying mechanism of the anti-inflammatory effects of HPCH/TA hydrogel was explored. The HPCH/TA hydrogel demonstrated favorable temperature sensitivity, injectability, and antibacterial properties. In vitro, the HPCH/TA hydrogel effectively promoted the proliferation of human dental pulp cells and inhibited interleukin-1ß, interleukin-6, and tumor necrosis factor-α expression, possibly by suppressing the nuclear factor kappa-B pathway. In vivo, on the fourth day after capping, the HPCH/TA hydrogel group showed lower inflammatory scores compared to the control and iRoot BP Plus (commercial pulp capping material) group. By the sixth week, complete reparative dentin formation was observed in the HPCH/TA hydrogel group, with no difference in thickness compared to the iRoot BP Plus group. Collectively, the HPCH/TA hydrogel holds promise as a bioactive pulp capping material for promoting the repair of inflamed pulp in vital pulp therapy.

Investigation of the biocompatibility of various pulp capping materials on zebrafish model.

Testing the biocompatibility of commercially available dental materials is a major challenge in dental material science. In the present study, the biocompatibility of four commercially available dental materials Mineral Trioxide Aggregate, Biodentine, Harvard BioCal-CAP and Oxford ActiveCal PC was investigated. The biocompatibility analysis was performed on zebrafish embryos and larvae using standard toxicity tests such as survivability and hatching rates. Comparative toxicity analysis of toxicity was performed by measuring apoptosis using acridine orange dye and whole mount immunofluorescence methods on zebrafish larvae exposed to the dental materials at different dilutions. Toxicity analysis showed a significant decrease in survival and hatching rates with increasing concentration of exposed materials. The results of the apoptosis assay with acridine orange showed greater biocompatibility of Biodentine, Oxford ActiveCal PC, Harvard BioCal-CAP and Biodentine compared to MTA, which was concentration dependent. Consequently, this study has shown that showed resin-modified calcium silicates are more biocompatible than traditional calcium silicates.

Influence of azathioprine on healing of exposed dogs' dental pulp capped with three different materials.

Background: Azathioprine is one of the earliest immunosuppressants prescribed for several autoimmune diseases. Yet there is a lack of research on the impact of azathioprine on pulp healing following the pulp capping procedure. Aim: This study aimed to investigate the effect of azathioprine on the healing ability of mechanically exposed dogs' dental pulps following direct pulp capping with mineral trioxide aggregate (MTA), bio-aggregates (BA), and Calcium hydroxide (Ca(OH)2). Methods: Four mongrel dogs were randomly assigned to two groups (two dogs/30 teeth in each group): immunosuppressed (group I) and control (group II). Group I received azathioprine for two months before surgical treatments and until the dogs were euthanized. Fifteen class V buccal cavities were performed in each dog. Each group was randomly divided into three subgroups (10 teeth each) based on the pulp capping substance. The pulps in subgroups A, B, and C were immediately capped with MTA, BA, and Ca(OH)2, respectively. Inflammation and dentine bridge development were histopathologically evaluated and scored at one and two months. The data were statistically analyzed. Results: The immunosuppressed group exhibited statistically greater inflammatory cell count and decreased dentine bridge thickness, compared to the control group in all subgroups (p < 0.05). Conclusion: Azathioprine has an adverse effect on the healing of exposed dogs' dental pulp following direct pulp capping with MTA, BA, and Ca(OH)2. Therefore, patients using azathioprine as an immunosuppressive medication may experience delayed healing of mechanically exposed pulps following capping with MTA, BA, or Ca(OH)2.

Implementing microfluidic flow device model in utilizing dural substitutes as pulp capping materials for vital pulp therapy.

Vital pulp therapy (VPT) has gained prominence with the increasing trends towards conservative dental treatment with specific indications for preserving tooth vitality by selectively removing the inflamed tissue instead of the entire dental pulp. Although VPT has shown high success rates in long-term follow-up, adverse effects have been reported due to the calcification of tooth canals by mineral trioxide aggregates (MTAs), which are commonly used in VPT. Canal calcification poses challenges for accessing instruments during retreatment procedures. To address this issue, this study evaluated the mechanical properties of dural substitute intended to alleviate intra-pulp pressure caused by inflammation, along with assessing the biological responses of human dental pulp stem cells (hDPSCs) and human umbilical vein endothelial cells (HUVECs), both of which play crucial roles in dental pulp. The study examined the application of dural substitutes as pulp capping materials, replacing MTA. This assessment was conducted using a microfluidic flow device model that replicated the blood flow environment within the dental pulp. Computational fluid dynamics simulations were employed to ensure that the fluid flow velocity within the microfluidic flow device matched the actual blood flow velocity within the dental pulp. Furthermore, the dural substitutes (Biodesign; BD and Neuro-Patch; NP) exhibited resistance to penetration by 2-hydroxypropyl methacrylate (HEMA) released from the upper restorative materials and bonding agents. Finally, while MTA increased the expression of angiogenesis-related and hard tissue-related genes in HUVEC and hDPSCS, respectively, BD and NP did not alter gene expression and preserved the original characteristics of both cell types. Hence, dural substitutes have emerged as promising alternatives for VPT owing to their resistance to HEMA penetration and the maintenance of stemness. Moreover, the microfluidic flow device model closely replicated the cellular responses observed in live pulp chambers, thereby indicating its potential use as anin vivotesting platform.

A tricalcium phosphate (TCP) and hydroxyapatite (HA) based light-cured biomaterial for vital pulp therapy.

OBJECTIVES: Evaluate a new light-cured material with better properties for vital pulp therapy. METHODS: Light-cured resin materials consisted of polyethylene glycol (600) diacrylate mixed with different ratios of TCP to HA. In addition to the temperature change (n = 5 for each subgroup) were tested, cell viability and Alizarin Red Staining (ARS) assay were also tested in vitro on human dental pulp cells (n = 6 for each subgroup). Lastly, the material was then compared with Biodentine and control groups in the molars of Wistar rats in vivo for histology assessment. RESULTS: The temperature change for the new materials were under 5 degrees Celsius. For the in vitro assessments, there was no significant difference on day 3 and day 7 for cell viability test. ARS assay showed significantly higher mineralized nodule formation when treated without induction medium for Group D and Biodentine on day 10 compared to Group C and control. On the contrary, Biodentine and control groups treated with induction medium showed significant higher mineralization than the new materials. Histology assessments demonstrated higher mineralized content in Group D and Biodentine on week 3 and week 6. The inflammatory cells in the dental pulp complex of the Biodentine group resolved on week 6 while the inflammation resolved in Group D on week 3. SIGNIFICANCE: The new material exhibits low heat production, low cytotoxicity, and good calcium ion release capability. Compared to traditional materials, it has shorter setting time and better aesthetic outcomes, making it highly suitable for use in vital pulp therapy.

Biocompatibility and Cytotoxicity of Pulp-Capping Materials on DPSCs, With Marker mRNA Expressions.

OBJECTIVES: The present study aimed to (1) investigate biocompatibility and cytotoxicity of pulp-capping materials on viability of human dental pulp stem cells (hDPSCs); (2) determine angiogenic, odontogenic, and osteogenic marker mRNA expressions; and (3) observe changes in surface morphology of the hDPSCs using scanning electron microscopy (SEM). METHODS: Impacted third molars were used to isolate the hDPSCs, which were treated with extract-release fluids of the pulp-capping materials (Harvard BioCal-Cap, NeoPUTTY MTA, TheraCal LC, and Dycal). Effects of the capping materials on cell viability were assessed using 3-(4,5-di-methyl-thiazol-2-yl)-5-(3-carboxy-methoxy-phenyl)-2-(4-sulfo-phenyl)-2H-tetrazolium (MTS) assay and the apoptotic/necrotic cell ratios and reactive oxygen species (ROS) levels from flow cytometry. Marker expressions (alkaline phosphatase [ALP], osteocalcin [OCN], collagen type I alpha 1 [Col1A], secreted protein acidic and rich in cysteine [SPARC], osteonectin [ON], and vascular endothelial growth factor [VEGF]) were determined by quantitative reverse-transcription polymerase chain reaction. Changes in surface morphology of the hDPSCs were visualised by SEM. RESULTS: The MTS assay results at days 1, 3, 5, and 7 indicated that Harvard BioCal-Cap, NeoPUTTY MTA, and TheraCal LC did not adversely affect cell viability when compared with the control group. According to the MTS assay results at day 14, no significant difference was found amongst Dycal, Harvard BioCal-Cap, NeoPUTTY MTA, and TheraCal LC affecting cell viability. Dycal was the only capping material that increased ROS level. High levels of VEGF expression were observed with Harvard BioCal-Cap, TheraCal LC, and NeoPUTTY MTA. NeoPUTTY MTA, and Dycal upregulated OCN expression, whereas TheraCal LC upregulated Col1A and SPARC expression. Only Dycal increased ALP expression. HDSCs were visualized in characteristic spindle morphology on SEM when treated with TheraCal LC and Harvard BioCal-Cap. CONCLUSIONS: NeoPUTTY MTA and Harvard BioCal-Cap showed suitable biocompatibility values; in particular, these pulp-capping materials were observed to support the angiogenic marker.

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.

Antibacterial, biocompatible, and mineralization-inducing properties of calcium silicate-based cements.

BACKGROUND: Different pulp capping materials have different origins and compositions, require different preparations, and may vary in their bioactive properties. AIM: The purpose of this study was to evaluate the antibacterial activity, biocompatibility, and mineralization-inducing potential of calcium silicate-based pulp capping materials. DESIGN: Six contemporary calcium silicate-based cements, ProRoot MTA, MTA Angelus, Biodentine, EndoSequence, NeoMTA 2, and NeoPutty, were evaluated. The antibacterial effects of these materials against Streptococcus mutans UA159 and Enterococcus faecalis ATCC 29212 were determined by the agar diffusion assay and the direct culture test. The biocompatibility and mineralization-inducing potential of these materials in preodontoblastic 17IIA11 cells were evaluated by the MTT assay and by Alizarin Red S staining, respectively. RESULTS AND CONCLUSION: In agar diffusion test, only Biodentine showed distinct antibacterial effects against S. mutans. All the tested materials, however, showed antibacterial effects against S. mutans and E. faecalis in the direct culture test, with Biodentine showing the strongest growth inhibition against both S. mutans and E. faecalis. All the tested materials showed acceptable biocompatibility and mineralization-supporting potential in our experimental conditions. In summary, ProRoot MTA, MTA Angelus, Biodentine, EndoSequence, NeoMTA 2, and NeoPutty demonstrated acceptable in vitro antimicrobial, biocompatible, and mineralization-supporting properties.

Anti-inflammatory cerium-containing nano-scaled mesoporous bioactive glass for promoting regenerative capability of dental pulp cells.

AIMS: This study aimed to investigate the anti-inflammatory and odontoblastic effects of cerium-containing mesoporous bioactive glass nanoparticles (Ce-MBGNs) on dental pulp cells as novel pulp-capping agents. METHODOLOGY: Ce-MBGNs were synthesized using a post-impregnation strategy based on the antioxidant properties of Ce ions and proposed the first use of Ce-MBGNs for pulp-capping application. The biocompatibility of Ce-MBGNs was analysed using the CCK-8 assay and apoptosis detection. Additionally, the reactive oxygen species (ROS) scavenging ability of Ce-MBGNs was measured using the 2,7-Dichlorofuorescin Diacetate (DCFH-DA) probe. The anti-inflammatory effect of Ce-MBGNs on THP-1 cells was further investigated using flow cytometry and quantitative real-time polymerase chain reaction (RT-qPCR). Moreover, the effect of Ce-MBGNs on the odontoblastic differentiation of the dental pulp cells (DPCs) was assessed by combined scratch assays, RT-qPCR, western blotting, immunocytochemistry, Alizarin Red S staining and tissue-nonspecific alkaline phosphatase staining. Analytically, the secretions of tumour necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß) were detected with enzyme-linked immunosorbent assay (ELISA). RESULTS: Ce-MBGNs were confirmed to effectively scavenge ROS in THP-1-derived macrophages and DPCs. Flow cytometry and RT-qPCR assays revealed that Ce-MBGNs significantly inhibited the M1 polarization of macrophages (Mφ). Furthermore, the protein levels of TNF-α and IL-1ß were downregulated in THP-1-derived macrophages after stimulation with Ce-MBGNs. With a step-forward virtue of promoting the odontoblastic differentiation of DPCs, we further confirmed that Ce-MBGNs could regulate the formation of a conductive immune microenvironment with respect to tissue repair in DPCs, which was mediated by macrophages. CONCLUSIONS: Ce-MBGNs protected cells from self-produced oxidative damage and exhibited excellent immunomodulatory and odontoblastic differentiation effects on DPCs. As a pulp-capping agent, this novel biomaterial can exert anti-inflammatory effects and promote restorative dentine regeneration in clinical treatment. We believe that this study will stimulate further correlative research on the development of advanced pulp-capping agents.

Effects of mineral trioxide aggregate and methyl sulfonyl methane on pulp exposure via RUNX2 and RANKL pathways.

The aim of this study was to determine the therapeutic effects of mineral trioxide aggregate (MTA) and methyl sulfonyl methane (MSM) on pulp damage due to pulp exposure through the RUNX2 and RANKL pathways. Seventy-two male Sprague-Dawley rats aged 4-6 months and weighing 250-300 g were divided into healthy, control, MTA, and MSM groups. After experimental applications, all rats at 2, 4, and 8 weeks were killed anesthetically with xylazine hydrochloride (Rompun, Bayer) 30 mg/kg and ketamine hydrochloride (Ketalar, Pfizer) 50 mg/kg injections (i.p.). We observed that necrotic odontoblasts, edema, inflammation, and vascular congestion findings were reduced from week 2 to week 8 in the MSM treatment group after pulp capping compared to the control group and MTA group. Similarly, we found a decrease in RUNX2 and RANKL levels in the MSM application group compared to the control and MTA groups (p < 0.05). MSM material has shown therapeutic effects on pulp capping treatment-induced pulp injury via increased RUNX2 ve RANKL expression.

Regenerative potential of a novel aloe vera modified tricalcium silicate cement as a pulp capping material: An animal study.

This study compared the histologic response of a pulp capping material Matreva MTA modified with different concentrations of aloe vera (AV) solutions to Biodentine cement. Ninety dogs' teeth were included and categorized according to the capping material into five groups (18 teeth each); Group I (Biodentine), group II (Matreva MTA), group III (Matreva MTA 10% AV), group IV (Matreva MTA 20% AV) and group V (Matreva MTA 30% AV). The histopathological findings were recorded at 2, 4, and 8 weeks. Matreva MTA and Biodentine groups showed the highest inflammatory cell count compared to the AV-modified Matreva MTA groups at 2- and 4-week intervals (p>0.05). Moreover, the AV-modified Matreva MTA and Biodentine groups showed higher dentin bridge thickness compared to unmodified Matreva MTA at different follow-up periods (p<0.05). AV can significantly enhance the in vivo bioactivity of Matreva MTA, inducing mild inflammation and good dentine bridge formation comparable to Biodentine.

Impact of corticosteroid administration on the response of exposed dental pulp to capping with bioactive cements-experimental study on mongrel dogs.

BACKGROUND: Corticosteroids are commonly used as a treatment for a variety of pathological conditions, however, systemic corticosteroid administration has adverse effects including impaired immune response and wound healing. Such complications may affect pulp healing after direct pulp capping. The current study evaluated the influence of corticosteroids on the healing ability of exposed dogs' dental pulps after direct pulp capping (DPC) with bioactive materials. METHODS: Ten healthy male dogs were assigned randomly into two groups, 5 dogs each: group I represent the control group which did not receive any medication, and group II was given corticosteroid for 45 days before DPC and till the dogs were euthanized (n = 75 teeth for each group). Following mechanical exposure, the pulps were randomly capped with either Ca(OH)2, MTA, or Biodentine. The pulpal tissues' reaction to the capping materials was evaluated 65 days postoperatively according to the following parameters: calcific bridge formation, pulpal inflammation, pulp necrosis, and bacterial infiltration. RESULTS: The corticosteroid-treated group revealed no significant difference compared to the control group concerning the pulp healing response (P > 0.05). Both Biodentine and MTA-treated specimens revealed significant differences with Ca(OH)2-treated specimens (P < 0.05) which displayed a superior positive effect of both MTA and Biodentine to Ca(OH)2 regarding all the parameters. CONCLUSIONS: Direct pulp capping technique whenever indicated in subjects treated with corticosteroid immunosuppressive drugs like prednisone performed well in aseptic conditions especially when capped with bioactive materials.

Inflammatory response and odontogenic differentiation of inflamed dental pulp treated with different pulp capping materials: An in vivo study.

AIM: Previous studies have evaluated the pulpal responses to calcium silicate cements (CSCs) on normal dental pulp, but investigations on the effects of CSCs on inflamed pulp are limited. This study aimed to test the inflammatory response and odontogenic differentiation of inflamed rat dental pulp after direct pulp capping with CSCs. METHODOLOGY: Wistar rat molars pulps were exposed for 48 h to induce inflammation and then capped with ProRoot MTA (Dentsply), Biodentine (Septodont), RetroMTA (Bio MTA) and Dycal (Dentsply Caulk). The degree of pulpal inflammation and hard tissue formation was evaluated by histological analysis. Immunofluorescence staining for interleukin (IL)-6, osteocalcin (OCN) and runt-related transcription factor 2 (RUNX2) was also performed. RESULTS: After 4 weeks, complete recovery from inflammation was evident in 22%, 37.5%, 10% and none of the ProRoot MTA, Biodentine, RetroMTA and Dycal samples, respectively. Heavy hard tissue deposition as a continuous hard tissue bridge was observed in 77.8%, 75%, 70% and 60% of the ProRoot MTA, Biodentine, RetroMTA and Dycal samples, respectively. IL-6, OCN and RUNX2 were detected in all materials, mainly adjacent to areas of inflammation and reparative dentine formation. At one, two and 4 weeks, significant differences were not observed between the inflammation and hard tissue formation scores of the four material groups (p > .05). CONCLUSIONS: In this study, pulpal inflammation was still present in most specimens at 4 weeks after pulp capping and a significant number of samples showed incomplete and discontinuous dentine bridge formation. The results of this study suggest that initial inflammatory conditions of the pulp may risk the prognosis of teeth treated with CSCs.

Comparative Evaluation of Ozonoid Olive Oil and Calcium Hydroxide as an Indirect Pulp Capping Agent in Primary Mandibular Second Molar: A Randomized Controlled Trial.

AIM: The aim of this study was to evaluate clinical and radiographical success of ozonoid olive oil as an indirect pulp capping (IPC) agent in primary mandibular second molar when compared to calcium hydroxide and to evaluate the antimicrobial efficacy of ozonoid olive oil on Streptococcus mutans and Lactobacilli. MATERIALS AND METHODS: A split-mouth randomized controlled trial was conducted on 30 primary mandibular second molars in 15 children of age 5-9 years with deep dentinal carious lesion. Teeth were randomly allocated to two groups of 15 each. After achieving local anesthesia and rubber dam isolation, an IPC procedure was performed using ozonoid olive oil in group I and calcium hydroxide in group II. Teeth were evaluated clinically and radiographically at 6 and 12 months of follow-up for success or failure of IPC. The bacterial counts of S. mutans and Lactobacilli were measured before and after application of ozonoid olive oil for 60 seconds on dentinal tissue in group I and recorded as colony-forming units per mL (CFU/mL). RESULTS: There were no statistically significant differences found between the materials used for IPC (p >0.05). About 93.33% and 100% clinical and radiographical success rates were seen in group I and group II, respectively. Statistically significant differences were observed for bacterial reduction after the application of ozonoid olive oil (p <0.05) for both the microorganisms. CONCLUSION: The results of this study showed that the success of IPC is independent of capping material. Ozonoid olive oil, an antimicrobial agent, can also be used for IPC. The success of the IPC procedure depends on a reduction in the bacterial count and sealing of the tooth with hermetic restoration. More clinical studies with a larger sample size and longer follow-up duration are required for understanding the efficacy of this material. CLINICAL SIGNIFICANCE: Ozonoid olive oil can be used as an IPC agent in primary molars and also for a bacterial reduction in dentinal caries.

Are resin-containing pulp capping materials as reliable as traditional ones in terms of local and systemic biological effects?

The aim of this study was to compare the local and systemic effects of current pulp capping materials containing resin with those of traditional materials in an animal study. A total of 48 rats were used: a control group (n=12) (sub-control and negative control), a resin-containing group (n=18) (Calcimol LC, Theracal LC, Activa-BioActive Base/Liner), and a traditional group (n=18) (Biodentine, ProRoot MTA, Dycal). The materials which had been placed in polyethylene tubes were implanted in subcutaneous pockets. The rats were sacrificed at 1, 2, or 4 weeks. Evaluations were made of subcutaneous connective tissue, the left kidney, liver, and blood samples. Of all the study groups, MTA demonstrated biocompatibility at a level close to that of the control groups. Inflammation was observed to be more severe in resin-containing materials, but Activa Base/Liner showed a more successful local and systemic tissue response.

Multifunctional Ca-Zn-Si-based micro-nano spheres with anti-infective, anti-inflammatory, and dentin regenerative properties for pulp capping application.

While pulp capping using a variety of materials has been applied clinically to preserve the health and vitality of the dental pulp and induce dentin repair no material meets all the anti-infection, anti-inflammation, and promoting pulp tissue regeneration criteria. Micro-nano materials of bioactive glasses (BG) with the biocompatibility and osteogenesis-promoting properties were developed for this study using Zn-doped bioactive glass (BGz) micro-nano spheres for dental pulp capping to control infection and inflammation and promote tissue regeneration. Of three key findings, the co-culture of Porphyromonas gingivalis showed that the BGz had an excellent antibacterial effect, and after being stimulated with BGz in vitro, macrophages showed a significant decrease of pro-inflammatory M1 markers compared with the undoped BG group. It is also noted that the conditioned medium derived from BGz-stimulated macrophages could significantly promote mineralized dentin formation of dental pulp cells (DPCs). In rats, acute pulp restoration experiments proved that BGz used as a pulp capping agent had excellent dentin regenerative properties. This work may provide a novel strategy to promote osteo/dentinogenic differentiation through regulating early inflammation, with potential applications in pulp capping.

The effect of mineral trioxide aggregate on dental pulp healing in the infected pulp by direct pulp capping.

This study aimed to clarify the effect of mineral trioxide aggregate (MTA) on pulp healing in the infected pulp by direct pulp capping (DPC). Thirty-six male ICR mice were divided into infected and uninfected groups. The pulp tissue was exposed to the oral flora for 24 h after pulp exposure in the infected group, or not exposed in the uninfected group, followed by sealing with MTA, calcium hydroxide cement (CH), or no DPC. Pulpal healing process was analyzed by hematoxylin-eosin staining and immunohistochemistry for nestin and Ki67. The active cell proliferation occurred on 1 week in the both MTA and CH groups, followed by the differentiation of odontoblast-like cells on 2 weeks in the MTA group, whereas their differentiation were not facilitated in the CH group. MTA is suggested to be a useful material for DPC with the infected and uninfected pulp tissue.

Graphene oxide-coated porous titanium for pulp sealing: an antibacterial and dentino-inductive restorative material.

Pulp treatment techniques such as pulp capping, pulpotomy and pulp regeneration are all based on the principle of preserving vital pulp. However, specific dental restorative materials that can simultaneously protect pulp vitality and repair occlusal morphology have not been developed thus far. Traditional pulp capping materials cannot be used as dental restorative materials due to their long-term solubility and poor mechanical behavior. Titanium (Ti) is used extensively in dentistry and is regarded as a promising material for pulp sealing because of its favorable biocompatibility, processability and mechanical properties. Originally, we proposed the concept of "odontointegration", which represents direct dentin-like mineralization contact between pulp and the surface of the pulp sealing material; herein, we report the fabrication of a novel antibacterial and dentino-inductive material via micro-arc oxidation (MAO), incorporating self-assembled graphene oxide (GO) for Ti surface modification. The hierarchical micro/nanoporous structure of the MAO coating provides a suitable microenvironment for odontogenic differentiation of human dental pulp stem cells, and GO loading contributes to antibacterial activity. Scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy and Raman spectroscopy were employed for structure and elemental analysis. In vitro studies, including cell adhesion, Live/Dead and CCK-8 assays, alkaline phosphatase activity and calcium deposition assay, real-time polymerase chain reaction, western blot analysis and immunofluorescence staining were used to examine cell adhesion, viability, proliferation, mineralization, and odontogenic differentiation ability. Antibacterial properties against Streptococcus mutans were analyzed by SEM, spread plate, Live/Dead and Alamar blue tests. The Ti-MAO-1.0 mg mL-1 GO group exhibited excellent cell adhesion, odontoblast differentiation, mineralization, and antibacterial ability, which are beneficial to odontointegration.

Development of self-adhesive pulp-capping agents containing a novel hydrophilic and highly polymerizable acrylamide monomer.

Several studies have shown the clinical success of hydraulic calcium-silicate cements (hCSCs) for direct and indirect pulp capping and root repair. However, hCSCs have various drawbacks, including long setting time, poor mechanical properties, low bond strength to dentin, and relatively poor handling characteristics. To overcome these limitations, a light-curable, resin-based hCSC (Theracal LC, Bisco) was commercially introduced; however, it did not exhibit much improvement in bond strength. We developed a light-curable self-adhesive pulp-capping material that contains the novel acrylamide monomer N,N'-{[(2-acrylamido-2-[(3-acrylamidopropoxy)methyl]propane-1,3-diyl)bis(oxy)]bis(propane-1,3-diyl)}diacrylamide (FAM-401) and the functional monomer 4-methacryloxyethyl trimellitate anhydride (4-MET). Two experimental resin-based hCSCs containing different calcium sources (portlandite: Exp_Pl; tricalcium silicate cement: Exp_TCS) were prepared, and the commercial hCSCs Theracal LC and resin-free hCSC Biodentine served as controls. The performance of each cement was evaluated based on parameters relevant for vital pulp therapy, such as curing degree on a wet surface, mechanical strength, as determined using a three-point bending test, shear bond strength to dentin, cytotoxicity, as determined using an MTT assay, and the amount of calcium released, as determined using inductively coupled plasma atomic emission spectrometry. Both experimental cements cured on wet surfaces and showed relatively low cytotoxicity. Furthermore, their flexural and shear bond strength to dentin were significantly higher than those of the commercial references. High calcium release was observed for both Exp_Pl and Biodentine. Thus, Exp_Pl as a new self-adhesive pulp-capping agent performed better than the commercial resin-based pulp-capping agent in terms of mechanical strength, bond strength, and calcium release.