4-Year Pulp Survival in a Randomized Trial on Direct Pulp Capping.

INTRODUCTION: This study aimed to assess pulp survival in a randomized trial on pulp lavage in adult nonpainful posterior teeth with carious pulp exposure. The treatment included complete caries excavation, direct pulp capping with mineral trioxide aggregate, and immediate restoration with composite resin. METHODS: Fluid was collected from the pulp wound to assess matrix metalloproteinase-9 (MMP-9) and total protein values. Before pulp capping, cavities were randomly (block randomization, n = 48) washed with a physiological saline or a sodium hypochlorite solution (2.5% NaOCl). Treatment outcome was assessed clinically (cold test) and radiographically after at least 1 year and again after at least 3 years. Painful failures were differentiated from nonpainful failures. Pulp survival was estimated using the Kaplan-Meier method including 95% confidence intervals (CIs) up to 1500 days. RESULTS: From the 96 patients originally enrolled, 73 individuals could be followed continuously. The clinical observations indicated a beneficial and sustained effect of pulp lavage with 2.5% NaOCl over a control treatment with physiological saline solution on estimated pulp survival 1500 days postintervention, with 7% (95% CI, 1%-40%) in the saline group versus 55% (95% CI, 30%-100%) in the NaOCl group. High MMP-9/total protein values in pulpal fluid collected from the exposed site indicated early and painful treatment failures yet were not associated with failures that occurred more than 250 days after intervention. CONCLUSIONS: The low 4-year success rates reported here challenge the concept of direct pulp capping in the cases that were included. NaOCl lavage did not only increase the survival of affected pulps substantially but also particularly diminished painful failures (33% in the NaOCl group vs 62% in the saline group). The lack of the predictive value of MMP-9 assessments beyond early treatment failures points to inflammatory states of the pulp tissue under deep caries, which are not related to neutrophil infiltration.

In vitro comparative study of antimicrobial efficacy of endodontic sealers against common pathogens in the dental pulp.

Overview: Different types of bacterial species, Enterococcus faecalis (E. faecalis), Fusobacterium nucleatum (F. nucleatum), and Porphyromonas gingivalis (P. gingivalis), cause pulpal and periradicular diseases. Hence, the antibacterial efficacy of endodontic sealers is of utmost importance from a clinical point of view. Aim: The main objective of the study is to test the antibacterial efficacy of endodontic sealers against endo microflora belonging to E. faecalis, F. nucleatum, and P. gingivalis species. Materials and Methods: The antibacterial effectiveness of five endodontic sealers (AH plus, Apexit, EndoRez, Endomethasone, and Tubliseal) was tested by means of the agar-diffusion test (ADT) and direct contact test (DCT). The bacterial suspension of individual microorganisms was applied separately onto the agar plates for ADT. Subsequently, freshly mixed and set sealer was applied on to the sterile discs. After 48 h of incubation, the inhibition zones were measured. For DCT, the sealers were put in 96-well cell culture plates and overlaid with bacterial suspension and brain heart infusion broth. The bacterial growth density of the liquid was tested by spectrophotometry at 0, 2, 4, 6, and 24 h. Results: The data were analyzed using ANOVA and post hoc Turkey's test. The present study showed that Endomethasone and AH Plus had a good antibacterial effect. Conclusion: In the ADT and DCT, Endomethasone showed the greatest antimicrobial effect against E. faecalis when compared to other endodontic sealers. In the ADT, Apexit had no antimicrobial effect on E. faecalis, whereas AH Plus had the greatest antibacterial effect on F. nucleatum and P gingivalis. Whereas in DCT, EndoRez and Endomethasone showed the greatest effect against F. nucleatum and P. gingivalis.

Sodium Hypochlorite Reduces Postoperative Discomfort and Painful Early Failure after Carious Exposure and Direct Pulp Capping-Initial Findings of a Randomized Controlled Trial.

In this randomized controlled single-center clinical trial on 96 adult patients with parallel experimental groups (n = 48), the effects of washing a dentin/pulp wound in non-symptomatic teeth with extremely deep caries and pulpal exposure were compared between a 2.5% sodium hypochlorite (NaOCl) solution and a chemically-inert physiological saline control solution. After the allocated wound lavage, the pulps were capped with a mineral trioxide aggregate, covered by a glass-ionomer/resin liner, and the teeth were immediately restored with a resin-bonded-composite. In this first report, the early events were analyzed: postoperative discomfort (on an NRS-11 scale) at day-3 and -7 after intervention, and the occurrence of unbearable pain causing patients to contact the principal investigator to perform a root canal treatment (pulpectomy) during the first three months. The NaOCl solution caused a highly significant reduction in post-operative discomfort (p = 0.0010 day 3; p = 0.0007 day 7) and early painful failures (p = 0.0008) compared with the control. These novel findings highlight the importance of infection control in teeth with extremely deep carious lesions. Based on these observations, the use of an NaOCl solution to wash the exposed dentin/pulp wound in the vital pulp treatment is highly recommended in order to reduce pain and early failure.

Evaluating the Effect of Different Conditioning Agents on the Shear Bond Strength of Resin-Modified Glass Ionomers.

AIM OF THE STUDY: This study aims to evaluate the effects three different conditioning agents on the shear bond strength of resin-modified glass ionomers to human dentin. MATERIALS AND METHODS: One hundred and twenty recently extracted, caries-free premolars and molars will be cleaned of debris and disinfected in a 0.5% solution of sodium hypochlorite and sterile water for 30 min. The occlusal surface of each tooth will be reduced using conventional model trimmer with water to produce the dentin surface. Then, three different resin-modified glass ionomer cements (GICs) were triturated and mixed according to the manufacturer's instructions, 10 specimens will be made of each group. The excess restorative material will be removed from matrix band dentin interface with a sharp number 25 bard parker blade. Samples were shear tested with Instron universal testing machine with a crosshead speed of 0.5 mm/min. A shearing bar beveled to a 1 mm thick contact surface area will be placed at the junction of dentin and plastic band matrix. The load required for the failure will be recorded in pounds and converted to megapascals. RESULTS: Statistical analysis was done with analysis of variance and Tukey's test. Ketac primer as conditioning agent along with Fuji II LC as restorative material had the highest shear bond value whereas intact smear layer which was unmodified dentin had the least value. CONCLUSION: Within the limitations of the present study, it can be concluded that surface conditioning of dentin resulted significantly higher bond strength than unconditioned dentin surfaces. CLINICAL SIGNIFICANCE: Resin-modified glass ionomers have several advantages compared to chemically cured GICs. The advantages include command cure, ease of handling, improved physical properties, and esthetics. Resin.modified glass ionomers have been marketed as direct restorative materials for Class V lesions as well as liners, bases, and luting agents. Several conditioning agents have been evaluated to condition dentin before the application of conventional glass ionomers and resin-modified glass ionomers. These have mainly included polyacrylic acid, citric acid, phosphoric acid, and ethylenediamine tetra.acetic acid. Of late, manufactures have recommended other conditioners to replace polyacrylic acid which includes Ketac primer as one of the conditioning agents.