Use of vital pulp therapies in primary teeth with deep caries lesions

PURPOSE: This manuscript presents evidence-based guidance on the use of vital pulp therapies for treatment of deep caries lesions in children. A guideline panel convened by the American Academy of Pediatric Dentistry formulated evidence-based recommendations on three vital pulp therapies: indirect pulp treatment (IPT; also known as indirect pulp cap), direct pulp cap (DPC), and pulpotomy. METHODS: The basis of the guideline's recommendations was evidence from "Primary Tooth Vital Pulp Therapy: A Systematic Review and Meta-Analysis." (Pediatr Dent 2017;15;39[1]:16-23.) A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and trial databases to identify randomized controlled trials and systematic reviews addressing peripheral issues of vital pulp therapies such as patient preferences of treatment and impact of cost. Quality of the evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation approach; the evidence-to-decision framework was used to formulate a recommendation. RESULTS: The panel was unable to make a recommendation on superiority of any particular type of vital pulp therapy owing to lack of studies directly comparing these interventions. The panel recommends use of mineral trioxide aggregate (MTA) and formocresol in pulpotomy treatments; these are recommendations based on moderate-quality evidence at 24 months. The panel made weak recommendations regarding choice of medicament in both IPT (moderate-quality evidence [24 months], low quality evidence [48 months]) and DPC (very-low quality evidence [24 months]). Success of both treatments was independent of type of medicament used. The panel also recommends use of ferric sulfate (low-quality evidence), lasers (low-quality evidence), sodium hypochlorite (very low-quality evidence), and tricalcium silicate (very low-quality evidence) in pulpotomies; these are weak recommendations based on low-quality evidence. The panel recommended against the use of calcium hydroxide as pulpotomy medicament in primary teeth with deep caries lesions. Conclusions and practical implications: The guideline intends to inform the clinical practices with evidence-based recommendations on vital pulp therapies in primary teeth with deep caries lesions. These recommendations are based upon the best available evidence to-date.(AU)

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.

Talon's cusp: report of four unusual cases.

Talon cusp is a developmental dental anomaly thought to arise as a result of evagination on the surface of a tooth crown before calcification has occurred. The etiology remains unknown. The incidence is 0.04-10%. Any tooth may have a talon cusp but most of the cases involve maxillary lateral incisors, with some instances of bilateral involvement. The anomaly has been reported to be rare in the mandible. This article reports four cases of talon cusp. The first and the second cases describe bilateral involvement of talon cusp on palatal surfaces of maxillary primary centrals; in the third case talon tubercle occurs on palatal surfaces of both maxillary permanent lateral incisors and the maxillary left central incisor and in the last case a talon cusp in the lingual surface of mandibular permanent lateral incisor.

Total antioxidant levels of saliva in children related to caries, age, and gender.

AIM: The purpose of this study was to evaluate the relationship between the physicochemical properties of saliva such as flow rate, buffering capacity, pH, calcium level, total protein, total antioxidant status, and dental caries, age, and gender. MATERIAL AND METHODS: The antioxidant activity of saliva was investigated in 80 healthy children aged 7-15 years. They were divided into subgroups according to gender, age (7-10 years and 11-15 years), and caries activity (caries active=CA and caries free=CF). Unstimulated saliva samples were collected from all groups. Flow rates were determined, and samples analysed for pH, buffer capacity, calcium, total proteins, and total antioxidant status. Salivary total antioxidant activity (TAA) was estimated by an adaptation of the ABTS (2,2-azino-di (3-ethylbenzthiazoline-6-sulphonate)) assay. RESULTS: The results indicated that in general, although there was no linear association between salivary flow rate pH and buffering capacity values obtained from different groups, salivary calcium concentration values were found to be higher in caries free groups. Total protein and total antioxidant values were higher in caries active groups except those in the 11- to 15-year-old girls group. CONCLUSION: In general, total protein and total antioxidant insaliva were increased with caries activity. Calcium concentrations in saliva were higher in caries-free children. In addition, calcium concentration increased with age. Thus, it can be concluded that a linear association exists between calcium concentration age and caries activity. More clinical and laboratory studies are needed to determine the exact relationship between the physicochemical properties of saliva such as flow rate, buffering capacity, pH, calcium level, total protein, total antioxidant status, and dental caries, age, and gender.

Penetration of radiocalcium at the margins of resin and glass ionomer dentine bonding agents in primary and permanent teeth.

OBJECTIVES: The purpose of this study was to compare the leakage of three resin dentine bonding agents (Prime and Bond, Scotchbond Multi-Purpose, Probond) and a glass ionomer dentine bonding agent (GC Fujibond LC), in cervical cavities prepared in primary and permanent molar teeth restored with a hybrid composite resin (Tetric). METHODS: Cervical cavities without a bevel at the cavo-surface margins were prepared in the buccal and lingual surfaces of extracted primary and permanent molar teeth. After being restored, the teeth were stored for 1 week in a saline solution at 37 degrees C and then thermally cycled between 5 and 55 degrees C. Marginal leakage was determined subsequently using a radioactive isotope containing 45Ca and an autoradiographic technique. RESULTS: The results revealed that there were no statistically significant differences in microleakage of the bond between permanent and primary teeth dentine and Fuji Bond LC and Probond dentine bonding agents. The difference between permanent and primary teeth groups for gingival values of the Prime and Bond 2.1 group U=22.5, p=0.0355 and the Scotchbond Multipurpose group U=24.0, p=0.0406 were statistically significant. There were no significant differences between the occlusal and gingival microleakage values in either primary or permanent teeth with Prime and Bond 2.1, Fuji Bond LC and Probond except the difference at Scotchbond Multipurpose in primary teeth. For primary teeth gingival margins, none of the bonding systems were significantly different from the control group. CONCLUSIONS: These results indicate that although no statistically significant differences were found between test and control group values, the use of Fuji II LC in cervical cavities with cementum margins in primary teeth would provide the best resistance to microleakage among the test materials while the use of Scotchbond Multi-Purpose would provide the best resistance to microleakage in cervical cavities with cementum margins in permanent teeth.

Effects of topical Catalase application on dental pulp tissue: a histopathological evaluation.

OBJECTIVES: recently, the role of antioxidant enzymes in wound healing and their therapeutic potential has been a subject of interest in medical sciences. However there is restricted knowledge on the results of topical application, optimal therapeutic dosage and carrier types. The purpose of this study was to investigate the wound healing response of dental pulp after direct pulp capping with an antioxidant enzyme; Catalase (C-40). METHODS: three mongrel dogs were used in this study. A total of 32 perforated Cl V preparations were treated with either 0.8mg (n=16) or 1.6mg (n=16) Catalase (C-40) which was incorporated in gelatin carriers whereas 16 control teeth had carriers without Catalase. One millimeter thick Teflon disks were placed over the gelatin pellets and the cavities restored with silver amalgam. Short term and long term histopathologic reactions were evaluated after 7 and 90 days. RESULTS: there were no statistically significant differences between the inflammatory cell responses of control and either dosage groups of Catalase at the 7-day evaluation period. However, after 90 days, better tissue healing was observed in the teeth treated with Catalase, resulting in significant differences with the control group. CONCLUSIONS: it can be concluded that the results of this study encourage the topical use of antioxidant Catalase as a pulp-capping agent. However, further studies are required to determine optimal antioxidant dosages.

Microleakage of light-cured resin and resin-modified glass-ionomer dentin bonding agents applied with co-cure vs pre-cure technique.

This in vitro study evaluated the effect of dentin bonding agents in reducing microleakage after three months in Class V restorations restored with Z100 resin composite. Materials tested were three types of resin-based dentin bonding agents: a multi-step (Scotchbond Multi-Purpose); a one-step (Scotchbond One-Step); a self-etching, self-priming (Clearfil Liner Bond) and a resin-modified glass ionomer (GC Fuji Bond LC). Class V cavity preparations with occlusal margins in enamel and gingival margins in cementum were prepared both on labial and lingual surfaces of extracted premolar teeth. Restorations (two per tooth) were distributed randomly into nine test groups (n = 10) consisting of the various DBAs applied with co-cure and pre-cure techniques, and no dentin bonding as a negative control group. Samples were stored in saline for three months, thermocycled, stained with silver nitrate, then sectioned through the middle of the preparation to facilitate the removal of the composite resin restoration. For groups treated with the pre-cure technique, the differences between the enamel leakage values of SBMP-control, CFLB-control and SB1S-control subgroups were significant (p < 0.05). For enamel leakage values of groups treated with the co-cure technique, the differences between the SBMP-control, SB1S-control, CFLB-control and Fuji LC-control subgroups were significant (p < 0.05). For cementum leakage values of groups treated with pre-cure technique, the difference between the CFLB-control and the Fuji, SBMP and SB1S groups was significant (p < 0.05). No significant differences could be detected between the cementum leakage values of groups treated with the co-cure technique (p > 0.05). The differences between the values obtained with application of CFLB with the pre-cure and co-cure techniques at the cementum margins were found to be statistically significant (p = 0.02). No statistically significant differences could be detected between the pre-cure and co-cure values of the other test materials. Generally for every group, cementum microleakage values were greater than enamel microleakage values (p < 0.05). The use of Scotchbond Multi-Purpose, Scotchbond One-Step and Fuji Bond LC with the co-cure technique to decrease the application time did not cause any significant increase in microleakage. Only pre-curing using Clearfil Liner Bond provided better microleakage properties than the other pre-cured adhesives.

The effect of bonding agents on the microleakage and bond strength of sealant in primary teeth.

This in vitro study investigated the effect of use of three dentine bonding agents: Scotchbond Multi-Purpose Plus (3M Dental Products, St. Paul, Minnesota, U.S.A.), Syntac (Vivadent, Schaan, Liechtenstein), Optibond Dual Cure (Kerr, Romulus, MI, U.S.A.) on microleakage and shear bond strength of a fissure sealant (Helioseal F, Vivadent, Schaan, Liechtenstein) bonded to either dry or wet (saliva contaminated) enamels of primary teeth. Newly extracted 112 non-carious primary teeth were sectioned and embedded in resin blocks. Eight groups were formed for each test. Each group consisted of 14 specimens. Group 1 and 2: fissure sealant was applied directly to etched enamel in dry and wet condition, respectively; Group 3 and 4: fissure sealant was applied onto etched and Scotch-bond Multi-Purpose Plus treated enamel in dry and wet condition, respectively; Group 5 and 6: fissure sealant was applied onto etched and Syntac treated enamel in dry and wet condition, respectively; Group 7 and 8: fissure sealant was applied onto etched and Optibond Dual Cure treated enamel in dry and wet condition, respectively. The results revealed that the use of an enamel-dentine bonding agent under fissure sealant increased the bond strength and decreased the microleakage. The use of enamel-dentine bonding agents under sealant in moisture contaminated conditions gave better results than applying sealant alone onto non-contaminated teeth. Finally, Scotchbond Multi-Purpose Plus yielded the best results for both tests.

The effect of cavity disinfectants on microleakage in dentin bonding systems.

The purpose of this study was to determine the effect on microleakage of two disinfectants, one a chlorhexidine based and the other alcohol based, used as cavity washes prior to the application of one step dentin bonding systems Syntac and Prime & Bond in Class V composite restorations. Children between 10-12 years old, with noncarious second primary molars about to exfoliate, were selected for this study. Cavity preparations were treated with either Syntac or Prime & Bond, combinations of one of the two disinfectants washes with Syntac or Prime & Bond or with one of the disinfectants only and filled with Tetric composite resin. All teeth were extracted one month later, stained and sectioned to evaluate dye penetration. As a result, focal dry disinfectant when used as a cavity wash prior to the use of Prime & Bond did not effect the ability of dentin bonding agents to prevent microleakage. Chlorhexidine solution had an adverse effect on Syntac and Prime & Bond and produced significantly higher microleakage when used with these bonding systems. The use of cavity disinfectants with composite resin restorations appears to be material specific regarding the interactions with various dentin bonding systems and the ability to seal dentin.

Superoxide dismutase activity in healthy and inflamed pulp tissues of permanent teeth in children.

The free radicals play an important role in the tissue damage. Oxygen-derived free radicals are controlled by various cellular defense mechanisms consisting of enzymatic such as superoxide dismutase, catalase, glutathion peroxidase and nonenzymatic scavenger components. Superoxide dismutase (SOD) is responsible for the dismutation of the superoxide radicals into hydrogen peroxide and molecular oxygen. In this study, pulp samples extirpated from the teeth of the 27 children between 10-15 ages which diagnosed to be healthy, reversible pulpitis or symptomatic irreversible pulpitis were evaluated for the activity of superoxide dismutase enzyme. There were statistically significant differences between healthy and reversible pulpitis, and between reversible and symptomatic irreversible pulpitis groups. The SOD activity of the reversible pulpitis group were significantly lower than the irreversible pulpitis and healthy pulp groups. The evaluation of the data revealed that the quantity of SOD as a vitality protector enzyme is low at the beginning of the inflammation as a consequence of rapidly depletion and/or destruction of this enzyme, but as the inflammation proceeds the pulp tissue showed adaptation to this situation.

Comparison of the effect of insertion techniques of a resin composite on dentinal adaptation of two visible light-cured bases: direct evaluation versus a replica technique.

This scanning electron microscopic study evaluated the adaptation of two visible light-cured bases, Calcimol LC and Ionoseal, to the dentinal surface after the use of various techniques to insert the resin composite material. Twenty-eight Class I cavities were prepared and restored in four groups: seven Calcimol LC and resin composite placed with a bulk or an incremental technique; and Ionoseal and resin composite placed with a bulk or an incremental technique. The specimens were sectioned longitudinally through the center of the restoration and an impression was made with a poly(vinyl siloxane) impression material. When the tooth surfaces and the impressions made from these surfaces were compared in the scanning electron microscope, extra gaps on tooth surfaces were observed that were not apparent in the impressions. These extra gaps probably resulted from desiccation of tissues; thus, the observation of replicas was useful to eliminate the inclusion of "false" gaps in the analysis. The results indicated that there was no substantial difference between Calcimol LC and Ionoseal base materials placed under resin composite inserted with an incremental technique.