Effects of sodium hypoclorite as disinfectant material previous to pulpotomies in primary teeth.

OBJECTIVES: Sodium hypochlorite (NaOCl) can be used to promote healing vital pulpotomies as an antibacterial agent. The aim of the present study was to histologically analyze the pulpal response of human primary teeth pulp following calcium hydroxide (CH) and mineral trioxide aggregate (MTA) pulpotomies with and without 5% NaOCl. MATERIALS AND METHODS: One hundred twenty-eight primary molars were randomly divided into two main groups according to pulpotomy material (CH/MTA) and into two subgroups according to selected cleansing agent (NaOCl/physiologic saline) used in the pulpotomy procedure. Thirty-four successfully treated teeth whose successor roots had completed formation of at least two thirds of their lengths were extracted for histological evaluation. Fisher's exact test, Pearson's Chi-square test, and Mann-Whitney U test with Bonferroni correction were used for statistical analysis. RESULTS: No significant differences in any of the tested parameters were observed between the NaOCl and physiologic saline subgroups of either the CH or MTA groups. Pulpal inflammation was significantly higher in the CH-treated teeth as compared with the MTA-treated teeth, whereas hard tissue bridge formation was significantly higher in the MTA-treated teeth as compared with the CH-treated teeth but regardless of cleansing agent (p < 0.025). CONCLUSIONS: The use of NaOCl does not affect the success of CH or MTA pulpotomies. Regardless of cleansing agent, MTA was found to be superior to CH. CLINICAL RELEVANCE: The proper medicament selection is more important than the choice of cleaning agent in vital pulpotomies.

Immunocompetent cell level as a diagnostic reference for pulpal pathosis of primary teeth.

OBJECTIVE: The present study was designed to measure changes in the level of immunocompetent cells as healthy pulp becomes inflamed in order to evaluate the use of CD4+/CD8+ and B/CD3+ lymphocyte ratios as a diagnostic reference for pulpal pathosis in primary teeth pulp. DESIGN: Based on clinical and radiographic examinations, 113 carious and non-carious primary teeth were grouped as healthy teeth, teeth with reversible pulpitis and teeth with irreversible pulpitis. Following dental extraction, pulp samples were collected from all teeth, and 81 of the samples were found to be suitable for flow-cytometric analysis of lymphocyte subset. Kolmogorov-Smirnov's test, One-way ANOVA and Tukey's Post Hoc tests were used for statistical analysis. RESULTS: Statistical analysis revealed no increases in the mean percentages of T, B and CD4+ lymphocytes in inflamed pulp when compared to healthy pulp. However, both CD8+ and NK cell numbers decreased in line with progressive inflammation. Whereas the CD4+/CD8+ ratios increased in accordance with the severity of pulpitis, B/T ratios remained unaffected. CONCLUSIONS: Immunocompetent cell levels did not change in line with progressive inflammation; therefore, the use of CD4+/CD8+ and B/CD3+ lymphocyte ratios cannot be used as a diagnostic reference for pulpal pathosis in primary teeth.

Ca(OH)2 pulpotomy in primary teeth. Part I: internal resorption as a complication following pulpotomy.

OBJECTIVES: The aim of this study was to analyze the outcomes of Ca(OH)(2) pulpotomies, to investigate the incidence of internal resorption following pulpotomy, and to investigate the relationship between internal resorption and physiological root resorption. STUDY DESIGN: Pulpotomies were performed in 84 primary molars. Teeth were grouped according to type of exposure (mechanical or carious) and according to whether or not physiological root resorption has started. All teeth were followed for 12 months. RESULTS: Teeth with larger-than-pinpoint carious exposure had the lowest success rate (65.5%). Internal resorption accounted for 15 out of 17 failures (88.2%). There was no significant difference in the rate of internal resorption between teeth with and without physiological root resorption (19.6% and 15.8%, respectively; P > .05). CONCLUSION: The greater the area of carious exposure, the lower the success rate in pulpotomies. Internal resorption was the main reason for failure; however, internal resorption was not affected by physiological root resorption.

Radiographic evaluation of periapical healing of permanent teeth with periapical lesions after extrusion of AH Plus sealer.

The aim of this study was to clinically and radiographically examine the effects of extrusion of AH Plus sealer on the healing of permanent teeth with apical periodontitis. A total of 87 root canals radiographically detected with apical periodontitis were included in the study. Posttreatment radiographs indicated sealer extrusion into 49 canals (Group 1) and no sealer extrusion into 38 canals (Group 2). Periapical treatment was judged as complete healing (CH), incomplete healing (IH) and no healing (NH) at the end of a 4-year follow-up period. Amounts of extraradicular sealer were recorded as "unchanged," "reduced," "almost absent," or "absent." The t test was used for the statistical analyses. In Group 1, CH was detected in 41 canals, IH in 4 canals, and NH in 4 canals. Differences between CH and both IH and NH were statistically significant (P < .001). In Group 2, CH was detected in 34 canals and NH in 4 canals. The difference between CH and NH was statistically significant (P < .001). A statistically significant difference (P < .05) between treatment groups was observed for CH at the 6-month follow-up appointment only; other than that instance, there were no statistical differences for CH or NH between the groups. In conclusion, extruded AH Plus does not prevent periapical healing, but can be a delaying factor for healing in children.

A flow cytometric analysis of the biodefensive response of deciduous tooth pulp to carious stimuli during physiological root resorption.

The present study observed biodefensive responses of deciduous tooth pulp to advancing caries lesions and analysed the role of physiological root resorption on pulpal defense potential. For this purpose, immunocompetent cell content of deciduous tooth pulp was examined using flow cytometry. A total of 49 deciduous incisor and molar teeth at various stages of physiological root resorption (carious or non-carious) to be extracted for clinical reasons were used in this study. Teeth were classified according to carious lesion depth and root resorption stage. CD3+ lymphocytes were observed to be most prevalent in the pulp and to show remarkable increase along with increase in carious lesion depth. Numbers of CD8+ lymphocytes also increased significantly as carious lesions approached the pulp. However, increase in the number of CD3+ and CD8+ cells did not significantly alter CD4+/CD8+ ratios. The study also found that while B-lymphocytes increased significantly in association with root resorption, there were no significant differences in B/CD3+ lymphocyte ratios. Thus, there was no evidence of irreversible pulpal pathosis in any groups. It can be concluded that pulp maintains its healing and defense capacity against advancing carious lesion and progressive root resorption in deciduous teeth.