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Islam R, Islam MRR, Tanaka T, Alam MK, Ahmed HMA, Sano H. Direct pulp capping procedures - Evidence and practice. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:48-61. [PMID: 36880059 PMCID: PMC9985044 DOI: 10.1016/j.jdsr.2023.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/11/2023] [Accepted: 02/15/2023] [Indexed: 02/27/2023] Open
Abstract
The aim of direct pulp capping (DPC) is to promote pulp healing and mineralized tissue barrier formation by placing a dental biomaterial directly over the exposed pulp. Successful application of this approach avoids the need for further and more extensive treatment. In order to ensure a complete pulp healing with the placement of restorative materials, a mineralized tissue barrier must form to protect the pulp from microbial invasion. The formation of mineralized tissue barrier can only be induced when there is a significant reduction in pulp inflammation and infection. Consequently, promoting the healing of pulp inflammation may provide a favorable therapeutic opportunity to maintain the sustainability of DPC treatment. Mineralized tissue formation was observed as the favorable reaction of exposed pulp tissue against a variety of dental biomaterials utilized for DPC. This observation reveals an intrinsic capacity of pulp tissue for healing. Therefore, this review focuses on the DPC and its healing procedure as well as the materials used for DPC treatment and their mechanisms of action to promote pulpal healing. In addition, the factors that can affect the healing process of DPC, clinical considerations and future perspective has been described.
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Affiliation(s)
- Rafiqul Islam
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo 060-8586, Japan
| | - Md Refat Readul Islam
- Department of Restorative Dentistry, Graduate School of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo 060-8586, Japan
| | - Toru Tanaka
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo 060-8586, Japan
| | - Mohammad Khursheed Alam
- Preventive Dentistry Department, College of Dentistry, Jouf University, 72345 Sakaka, Saudi Arabia
| | - Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Hidehiko Sano
- Department of Restorative Dentistry, Faculty of Dental Medicine, Hokkaido University, Kita 13, Nishi 7, Kita-ku, Sapporo 060-8586, Japan
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Anselmi C, Mendes Soares IP, Leite ML, Kitagawa FA, de Souza Costa CA, Hebling J. Cytocompatibility and bioactivity of calcium hydroxide-containing nanofiber scaffolds loaded with fibronectin for dentin tissue engineering. Clin Oral Investig 2022; 26:4031-4047. [PMID: 35029747 DOI: 10.1007/s00784-022-04372-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/31/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to characterize polycaprolactone-based nanofiber scaffolds (PCL) incorporated with calcium hydroxide (CH) and evaluate their bioactivity on human dental pulp cells (HDPCs) when loaded with fibronectin (FN). MATERIALS AND METHODS CH (0.1%; 0.2%; 0.4% w/v; or 0%) was incorporated into PCL (10% w/v) scaffolds prepared by electrospinning. Morphology and composition were characterized using SEM/EDS. HDPCs were seeded on the scaffolds and evaluated for viability (alamarBlue; Live/Dead), and adhesion/spreading (F-actin). Next, scaffolds containing 0.4% CH were loaded with FN (20 µg/mL). HDPCs were evaluated for viability, adhesion/spreading, migration (Trans-well), gene expression (RT-qPCR), alkaline phosphatase activity (ALP), and mineralization nodules (Alizarin Red). Data were submitted to ANOVA and post-hoc tests (α = 5%). RESULTS Nanofibers with larger diameter were seen as CH concentration increased, while there was no effect on interfibrillar spaces. An increase in cell viability was seen for 0.4% CH, in all periods. Incorporation of CH and FN into the scaffolds increased cellular migration, spread, and viability, all intensified when CH and FN were combined. ALPL and DSPP expression, and ALP activity were not affected by CH and FN. COL1A1 was downregulated in all groups, while DMP1 was upregulated in the presence of CH, with no differences for the groups loaded with FN. CH increased the formation of mineralized matrix, which was not influenced by FN. CONCLUSIONS In conclusion, the incorporation of CH enhanced the odontogenic potential of HDPCs, irrespective of the presence of FN. The PCL + 0.4% CH formulation may be a useful strategy for use in dentin tissue engineering. CLINICAL RELEVANCE A change in the form of presentation of calcium hydroxide-based materials used for direct pulp capping can increase biocompatibility and prolong the vitality of dental pulp.
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Affiliation(s)
- Caroline Anselmi
- Department of Morphology and Pediatric Dentistry, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
| | - Igor Paulino Mendes Soares
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
| | - Maria Luísa Leite
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
| | - Fernanda Ali Kitagawa
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil
| | | | - Josimeri Hebling
- Department of Morphology and Pediatric Dentistry, School of Dentistry, São Paulo State University (UNESP), Araraquara, Brazil.
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Cobanoglu N, Alptekin T, Kitagawa H, Blatz MB, Imazato S, Ozer F. Evaluation of human pulp tissue response following direct pulp capping with a self-etching adhesive system containing MDPB. Dent Mater J 2021; 40:689-696. [PMID: 33563846 DOI: 10.4012/dmj.2020-145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study evaluated the human pulp tissue response following direct pulp capping with Clearfil Protect Bond (CPB) self-etching adhesive containing an antibacterial monomer MDPB. The pulps of third molar teeth were exposed by the removal of carious tissue. In an experimental group, CPB was applied to the exposed pulp and dentin. In the control groups, Clearfil SE Bond (CSE) or calcium hydroxide-based cement (CH) was applied to the exposed pulp surfaces. All teeth were filled with resin composite, extracted after 90 days, and the pulp responses were histologically analyzed. No severe inflammation or soft tissue disorganization was observed in CPB and CH groups. CSE group exhibited a disorganized odontoblastic layer and severe inflammatory infiltration. No hard tissue formation was observed in CSE group, and CH formed more of a hard tissue formation than CPB. CPB induced an acceptable healing response when directly applied to exposed pulps with bacterial contamination.
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Affiliation(s)
- Nevin Cobanoglu
- Department of Restorative Dentistry, Faculty of Dentistry, University of Selcuk
| | - Tuncay Alptekin
- Department of Restorative Dentistry, Umitkoy Polyclinic, Baskent Hospital
| | - Haruaki Kitagawa
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry
| | - Markus B Blatz
- Department of Preventive and Restorative Sciences, University of Pennsylvania
| | - Satoshi Imazato
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry
| | - Fusun Ozer
- Department of Preventive and Restorative Sciences, University of Pennsylvania
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El Kalla IH, Salama NM, Wahba AH, Sallam NM. Histological evaluation of platelet-rich fibrin for revascularization of immature permanent teeth in dogs. PEDIATRIC DENTAL JOURNAL 2019. [DOI: 10.1016/j.pdj.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Estrela C, Decurcio DDA, Rossi-Fedele G, Silva JA, Guedes OA, Borges ÁH. Root perforations: a review of diagnosis, prognosis and materials. Braz Oral Res 2018; 32:e73. [DOI: 10.1590/1807-3107bor-2018.vol32.0073] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/06/2018] [Indexed: 11/22/2022] Open
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Song M, Yu B, Kim S, Hayashi M, Smith C, Sohn S, Kim E, Lim J, Stevenson RG, Kim RH. Clinical and Molecular Perspectives of Reparative Dentin Formation: Lessons Learned from Pulp-Capping Materials and the Emerging Roles of Calcium. Dent Clin North Am 2018; 61:93-110. [PMID: 27912821 DOI: 10.1016/j.cden.2016.08.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The long-term use of calcium hydroxide and the recent increase in the use of hydraulic calcium-silicate cements as direct pulp-capping materials provide important clues in terms of how reparative dentin may be induced to form a "biological seal" to protect the underlying pulp tissues. In this review article, we discuss clinical and molecular perspectives of reparative dentin formation based on evidence learned from the use of these pulp-capping materials. We also discuss the emerging role of calcium as an odontoinductive component in these pulp-capping materials.
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Affiliation(s)
- Minju Song
- The Shapiro Family Laboratory of Viral Oncology and Aging Research, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA; Section of Restorative Dentistry, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Bo Yu
- Section of Restorative Dentistry, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Sol Kim
- The Shapiro Family Laboratory of Viral Oncology and Aging Research, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA; Section of Restorative Dentistry, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Marc Hayashi
- Section of Restorative Dentistry, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Colby Smith
- Section of Restorative Dentistry, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Suhjin Sohn
- The Shapiro Family Laboratory of Viral Oncology and Aging Research, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry, Oral Science Research Center, Yonsei University College of Dentistry, 50 Yonsei-Ro, 03772, Seoul, Korea
| | - James Lim
- Section of Restorative Dentistry, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Richard G Stevenson
- Section of Restorative Dentistry, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Reuben H Kim
- The Shapiro Family Laboratory of Viral Oncology and Aging Research, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA; Section of Restorative Dentistry, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
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Dentinogenic Specificity in the Preclinical Evaluation of Vital Pulp Treatment Strategies: A Critical Review. Dent J (Basel) 2015; 3:133-156. [PMID: 29567934 PMCID: PMC5851195 DOI: 10.3390/dj3040133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 11/16/2015] [Accepted: 11/20/2015] [Indexed: 11/17/2022] Open
Abstract
Reviews on the clinical performance of vital pulp treatment strategies and capping materials repeatedly showed an insufficient grade of evidence concerning their therapeutic validity. The biological mechanisms underlying the regenerative potential of pulp-dentin complex have attracted much attention during the last two decades, since new pulp treatment modalities have been designed and tested at the preclinical level. It has been recognized that evaluation should be based on the specific ability of therapeutic interventions to signal recruitment and differentiation of odontoblast-like cells forming a matrix in a predentin-like pattern, rather than uncontrolled hard tissue deposition in a scar-like form. The aim of the present article was to critically review data from histological experimental studies on pulp capping, published during the last 7 decades. A comprehensive literature search covering the period from 1949 to 2015 was done using the Medline/Pubmed database. Inclusion of a study was dependent on having sufficient data regarding the type of capping material used and the unit of observation (human permanent tooth in vivo or animal permanent dentition; primary teeth were excluded). The post-operatively deposited matrix was categorized into three types: unspecified, osteotypic, or dentin-like matrix. One hundred fifty-two studies were included in the final evaluation. Data from the present systematic review have shown that only 30.2% of the 152 experimental histological pulp capping studies described the heterogenic nature of the hard tissue bridge formation, including osteotypic and tubular mineralized tissue. Structural characteristics of the new matrix and the associated formative cells were not provided by the remaining 106 studies. Analysis showed that more careful preclinical evaluation with emphasis on the evidence regarding the dentinogenic specificity of pulp therapies is required. It seems that selection of appropriate vital pulp treatment strategies and pulp capping materials would be further facilitated in terms of their therapeutic validity if international consensus could be reached on a select number of mandatory criteria for tissue-specific dentinogenic events.
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Korwar A, Sharma S, Logani A, Shah N. Pulp response to high fluoride releasing glass ionomer, silver diamine fluoride, and calcium hydroxide used for indirect pulp treatment: An in-vivo comparative study. Contemp Clin Dent 2015; 6:288-92. [PMID: 26321822 PMCID: PMC4549974 DOI: 10.4103/0976-237x.161855] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aims and Objectives: The study aims at determining pulp response of two high fluoride releasing materials silver diamine fluoride (SDF) and Type VII glass ionomer cement (GIC) when used as indirect pulp treatment (IPT) materials. Materials and Methods: Deep Class V cavities were made on four first premolars indicated for extraction for orthodontic reasons. SDF, Type VII GIC, and calcium hydroxide base are given in three premolars, and one is kept control. Premolars were extracted 6 weeks after the procedure and subjected to histopathological examination to determine the pulp response. The results were analyzed using Chi-square test. Results: No inflammatory changes were observed in any of the groups. Significantly more number of specimens in SDF and Type VII GIC groups showed tertiary dentin deposition (TDD) when compared to control group. No significant difference was seen in TDD when intergroup comparison was made. Odontoblasts were seen as short cuboidal cells with dense basophilic nucleus in SDF and Type VII GIC group. Conclusion: The study demonstrated TDD inducing ability of SDF and Type VII GIC and also established the biocompatibility when used as IPT materials.
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Affiliation(s)
- Atish Korwar
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Sharma
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Logani
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Naseem Shah
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Nair PNR, Duncan HF, Pitt Ford TR, Luder HU. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial. Int Endod J 2007; 41:128-50. [PMID: 17956562 DOI: 10.1111/j.1365-2591.2007.01329.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To investigate the pulpal response to direct pulp capping in healthy human teeth with mineral trioxide aggregate (MTA) as against calcium hydroxide cement (Dycal) as control. METHODOLOGY Twenty healthy human third molars had iatrogenic pulpotomy and direct pulp capping with MTA. Another 13 teeth were capped with Dycal as controls. The teeth were restored, with IRM, clinically reviewed and extracted after a number of pre-determined intervals (1 week, 1 month and 3 months). The specimens were fixed, decalcified, subdivided axially into two halves in the oro-buccal (lingual-buccal) plane, embedded in plastic, serial sectioned and evaluated qualitatively and quantitatively by correlative light and transmission electron microscopy with appropriate statistical evaluation of the quantitative data. RESULTS Iatrogenic pulpal wounds treated with MTA were mostly free from inflammation after 1 week and became covered with a compact, hard tissue barrier of steadily increasing length and thickness within 3 months following capping. Control teeth treated with Dycal revealed distinctly less consistent formation of a hard tissue barrier that had numerous tunnel defects. The presence of pulpal inflammation up to the longest observation period (3 months) after capping, was a common feature in Dycal specimens. CONCLUSIONS The MTA was clinically easier to use as a direct pulp-capping agent and resulted in less pulpal inflammation and more predictable hard tissue barrier formation than Dycal. Therefore, MTA or equivalent products should be the material of choice for direct pulp capping procedures instead of hard setting calcium hydroxide cements.
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Affiliation(s)
- P N R Nair
- Institute of Oral Biology, Section of Oral Structures and Development, Centre of Dental and Oral Medicine, University of Zurich, Zurich, Switzerland.
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Abstract
AIM To present the nonsurgical management of a tooth with class II dens invaginatus with an open apex utilizing contemporary techniques. SUMMARY Root canal treatment of teeth with complex root canal anatomy such as dens invaginatus can be problematic because infected pulpal tissues may remain in inaccessible areas of the canal system. The cleaning and debridement of such root canal systems are therefore challenging and may sometimes be considered impossible. An immature apical root-end development is another challenge in root canal treatment especially in controlling the apical extent of the filling material and achieving an apical seal. When difficulties in cleaning and filling combine, management options may include surgical intervention or extraction. This article reports the nonsurgical endodontic treatment of a case of an open apex and dens invaginatus utilizing the operating microscope, endodontic ultrasonic instruments and mineral trioxide aggregate. KEY LEARNING POINT Teeth with class II dens evaginatus and an open apex may be managed successfully with contemporary nonsurgical materials and techniques.
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Affiliation(s)
- C Sathorn
- Endodontic Unit, School of Dental Science, The University of Melbourne, Melbourne, Australia.
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12
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Okabe T, Sakamoto M, Takeuchi H, Matsushima K. Effects of pH on mineralization ability of human dental pulp cells. J Endod 2006; 32:198-201. [PMID: 16500225 DOI: 10.1016/j.joen.2005.10.041] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to investigate the effect of alkaline pH on calcification in human dental pulp (HDP) cells. HDP cells were cultured in pH 7.8 conditioned medium, and alkaline phosphatase (ALP) activity was measured. The ALP activity was higher in the pH 7.8 conditioned medium group than in the pH 7.2 conditioned medium group. Expression of mRNAs for bone morphogenetic protein (BMP)-2 was measured by the RT-PCR technique. The expression of BMP-2 in the pH 7.8 groups was greater than that in the pH 7.2 group. Furthermore, we determined Calcified nodule formation by von Kossa staining. The number of calcified nodules was increased in the pH 7.8 conditioned medium. These results suggest that HDP cell mineralization was enhanced in alkaline pH (pH 7.8) conditioned medium.
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Affiliation(s)
- Tatsu Okabe
- Department of Endodontics, Nihon University School of Dentistry at Matsudo, Matsudo, Japan.
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Abstract
BACKGROUND The greatest threats to developing teeth are dental caries and traumatic injury. A primary goal of all restorative treatment is to maintain pulp vitality so that normal root development or apexogenesis can occur. If pulpal exposure occurs, then a pulpotomy procedure aims to preserve pulp vitality to allow for normal root development. Historically, calcium hydroxide has been the material of choice for pulpotomy procedures. Recently, an alternative material called mineral trioxide aggregate (MTA) has demonstrated the ability to induce hard-tissue formation in pulpal tissue. The authors describe the clinical and radiographic outcome of a series of cases involving the use of MTA in pulpotomy procedures. METHODS Twenty-three cases in 18 patients were treated with MTA pulpotomy procedures in an endodontic private practice. All of the patients had been referred to the practice for diagnosis and treatment of a symptomatic tooth. All of the authors provided treatment. Pulpal exposures were either due to caries or complicated enamel dentin fractures. RESULTS Nineteen teeth in 14 patients were available for recall. The mean time of recall was 19.7 months. Of the 19 cases, 15 involved healed teeth, and three involved teeth that were healing. One of 19 cases involved a tooth with persistent disease. CONCLUSIONS MTA may be useful as a substitute for calcium hydroxide in pulpotomy procedures. Further research, however, is required to clarify this conclusion. CLINICAL IMPLICATIONS MTA conceivably could replace calcium hydroxide as the material of choice for pulpotomy procedures, if future research continues to show promising results.
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Bergenholtz G. Advances since the paper by Zander and Glass (1949) on the pursuit of healing methods for pulpal exposures: historical perspectives. ACTA ACUST UNITED AC 2006; 100:S102-8. [PMID: 16037786 DOI: 10.1016/j.tripleo.2005.03.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Clinical observations and experimental studies in humans and laboratory animals have demonstrated that healing and repair of pulpal exposures by caries, trauma, or iatrogenic causes are possible with a variety of wound treatment methods. Yet clinical trials have shown that predictable long-term pulp tissue preservation may be an elusive goal and has led to doubts about pulp capping and pulpotomy as valid clinical procedures. Nevertheless substantial knowledge has accumulated over the years on the mechanisms and the treatment factors that are important to promote/support continued vital pulp functions. This article highlights some key contributions to our current knowledge base, which have come to light during the more than 50 years since a pioneering experimental study by Zander and Glass was published in the Triple O journal.
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Abstract
Calcium hydroxide is a multipurpose agent, and there have been an increasing number of indications for its use. Some of its indications include direct and indirect pulp capping, apexogenesis, apexification, treatment of; root resorption, iatrogenic root perforations, root fractures, replanted teeth and interappointment intracanal dressing. The purpose of this paper is to review the properties and various indications for the use of calcium hydroxide.
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Abstract
For more than 70 years calcium hydroxide has played a major role in endodontic therapy, although many of its functions are now being taken over by the recently introduced material MTA. Calcium hydroxide may be used to preserve the vital pulp if infection and bleeding are controlled; to repair root fractures, perforations, open apices and root resorptions. Endo-perio lesions are complex and the correct diagnosis is essential if treatment is to be successful. However, root canal treatment will always be the first phase in treating such lesions.
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Affiliation(s)
- P Carrotte
- Department of Adult Dental Care, Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK.
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Abstract
This paper reviews the rationale and techniques for treatment of the non-vital immature tooth. The importance of careful case assessment and accurate pulpal diagnosis in the treatment of immature teeth with pulpal injury cannot be overemphasized. The treatment of choice for necrotic teeth is apexification, which is induction of apical closure to produce more favorable conditions for conventional root canal filling. The most commonly advocated medicament is calcium hydroxide, although recently considerable interest has been expressed in the use of mineral trioxide aggregate. Introduction of techniques for one-visit apexification provide an alternative treatment option in these cases. Success rates for calcium hydroxide apexification are high although risks such as reinfection and tooth fracture exist. Prospective clinical trials comparing this and one-visit apexification techniques are required.
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Affiliation(s)
- Mary Rafter
- University of Michigan School of Dentistry, Ann Arbor, MI 48109-1078, USA.
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Lee MT. Conservative endodontic management of teeth associated with extensive periapical pathology: report of two cases. AUST ENDOD J 2005; 30:103-9. [PMID: 15633799 DOI: 10.1111/j.1747-4477.2004.tb00422.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Traditionally, long-term calcium hydroxide dressings have been recommended for the conservative management of large periapical lesions. However, calcium hydroxide therapy has some disadvantages such as variability of treatment time, difficulties with patient follow-up and prolonged treatment periods that increase the risk of root canal contamination via microleakage and crown fractures. This paper reports the healing of large periapical lesions following conservative non-surgical treatment with calcium hydroxide dressings.
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Affiliation(s)
- Michael T Lee
- Dental School, University of Queensland, Brisbane, Queensland
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Steinig TH, Regan JD, Gutmann JL. The use and predictable placement of Mineral Trioxide Aggregate in one-visit apexification cases. AUST ENDOD J 2003; 29:34-42. [PMID: 12772971 DOI: 10.1111/j.1747-4477.2003.tb00496.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Endodontic treatment of the pulpless tooth with an immature root apex poses a special challenge for the clinician. The main difficulty encountered is the lack of an apical stop against which to compact an interim dressing of calcium hydroxide (Ca(OH)2), or the final obturation material. In these situations the unpredictability of the result, the difficulty in creating a leak-proof temporary restoration for the duration of treatment, and the difficulty in protecting the thin root from fracture may lead to complications when using traditional (Ca(OH)2-based) apexification techniques. Furthermore, given the increased mobility of today's society, lengthy treatment protocols are fraught with problems, and may not be followed through to completion. This may lead to ultimate failure of the case. Mineral Trioxide Aggregate (MTA) has recently been introduced for use in endodontics. Current literature supports its efficacy in a multitude of procedures including apexification. The focus of this paper is to propose a one-visit apexification protocol with MTA as an alternative to the traditional treatment practices with Ca(OH)2. One-visit apexification may shorten the treatment time between the patient's first appointment and the final restoration. The importance of this approach lies in the expedient cleaning and shaping of the root canal system, followed by its apical seal with a material that favours regeneration. Furthermore, the potential for fractures of immature teeth with thin roots is reduced, as a bonded core can be placed immediately within the root canal.
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Affiliation(s)
- Torsten H Steinig
- Department of Endodontics, Texas A&M University System Health Science Center, Baylor College of Dentistry, Dallas, TX 75246, USA.
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Santucci PJ. Dycal versus Nd:YAG laser and Vitrebond for direct pulp capping in permanent teeth. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 1999; 17:69-75. [PMID: 11189978 DOI: 10.1089/clm.1999.17.69] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To determine the efficacy of laser-assisted direct pulp capping by comparing the survival rates of permanent teeth treated with Nd:YAG laser and Vitrebond (3M Corporation, St. Paul, MN) direct pulp caps to permanent teeth treated with the traditional calcium hydroxide direct pulp cap over intervals of up to 54 months. SUMMARY BACKGROUND DATA While there are case reports and evaluations of various laser techniques in the literature, statistical studies comparing the success of laser-assisted applications to traditional techniques are needed. This is a retrospective investigation of one such laser assisted application. METHODS A retrospective chart review of all active and inactive patients resulted in the identification of 83 patients who received direct pulp caps in a total of 93 permanent teeth; 29 with calcium hydroxide and 64 with Nd:YAG laser and Vitrebond. RESULTS Life table analysis of the data of this retrospective study demonstrated that the teeth treated with the laser and Vitrebond direct pulp cap showed significantly greater survival rates than those treated with Dycal direct pulp cap over intervals of nine to 54 months postoperatively. The cumulative proportion of teeth surviving postoperatively for the Dycal (L.D. Caulk Corporation, Milford, CT) direct pulp cap was 89.7% at 1 month declining to 79.4% at 3 months and 76% at 6 months and then continued to decline in the final two intervals finishing after 54 months at 43.6%. For the laser and Vitrebond direct pulp cap the cumulative proportion surviving stood at 98.4% after 1 month, declining to 93.8% at 3 months and 90.3% after 6 months but then held steady in the final 2 intervals finishing at 90.3% after 54 months. CONCLUSION The laser and Vitrebond direct pulp cap produces a significantly more predictable pulpal response after the first 6 months than the Dycal direct pulp cap. The survival rate of teeth treated with the laser and Vitrebond direct pulp cap is significantly greater than those treated with the Dycal direct pulp cap over intervals of 9 to 54 months. Direct pulp capping is a worthwhile procedure that should be performed when indicated, especially in light of the 90.3% survival rate achieved with the laser and Vitrebond direct pulp cap at 54 months.
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Affiliation(s)
- P J Santucci
- Center for Advanced Dental Education, St. Louis University, St. Louis, Missouri, USA
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21
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Hunter AR, Kirk EE, Robinson DH, Kardos TB. A slow release calcium delivery system for the study of reparative dentine formation. ENDODONTICS & DENTAL TRAUMATOLOGY 1998; 14:112-8. [PMID: 9863419 DOI: 10.1111/j.1600-9657.1998.tb00822.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several liquid, semi-solid and solid delivery systems were formulated and tested to devise a method of reproducibly administering accurate micro-doses of calcium into a 700 microns diameter cavity in a rat maxillary incisor tooth, in the absence of hydroxyl ions. Development of this delivery system was necessary to facilitate studies of the mechanisms of pulpal repair and odontoblast differentiation. The principal requirements for the delivery system were that it should be easily administered into a small pulp exposure in the rat incisor and that a greater than 1000-fold range in calcium ion concentrations could be incorporated and delivered for a period of 2-3 days, preferably in an acidic environment to minimize the effect of non-specific nucleation under alkaline conditions. Poly- (ethylene) glycol microspheres were found to be an ideal vehicle. Under the in vitro dissolution conditions used, complete release of all calcium salts occurred within 12-15 hours, except for the very water-insoluble calcium stearate. It was anticipated that the release of calcium ions would be significantly more prolonged in vivo because of the physical constraints of the prepared cavity as well as the restricted access to fluid flow.
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Affiliation(s)
- A R Hunter
- Department of Oral Rehabilitation, University of Otago School of Dentistry, Dunedin, New Zealand
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22
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Wakabayashi H, Horikawa M, Funato A, Onodera A, Matsumoto K. Bio-microscopical observation of dystrophic calcification induced by calcium hydroxide. ENDODONTICS & DENTAL TRAUMATOLOGY 1993; 9:165-70. [PMID: 8269882 DOI: 10.1111/j.1600-9657.1993.tb00269.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Calcium hydroxide paste was introduced into a rabbit ear chamber, and the effect of calcium hydroxide on the vascular tissue was observed under a bio-microscope continuously up to 14 weeks. Many precipitates were observed at the border of living tissue, after the dissolution of microvessels around the paste. They increased both in size and number to combine like a river bank in the first 48 h. After 1 week, microcirculation recovered, and newly-formed capillaries approached the precipitate-bank, the edge of which became smoother as weeks went by. The bank was stable and compatible to microvessels during the observation period. By SEM observation, the width of the bank was from 200 to 400 microns, and the tissue-side of the bank appeared like amorphous lamellae, while the inner-side showed particle-like appearance. EDX examination revealed high peaks of Ca and P similar to calcium phosphate at the tissue-side of the bank, but only Ca peak at the inner-side. The precipitates seemed to have the potential to induce dystrophic calcification by absorbing Ca and P from the tissue.
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Affiliation(s)
- H Wakabayashi
- Department of Endodontics, Showa University School of Dentistry, Tokyo, Japan
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23
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Abstract
This paper reviews the various calcium hydroxide preparations available for use in restorative dentistry and their constituents. The significance of individual constituents in relation to the properties of such materials and their mode of therapeutic action with respect to the dentine pulpal response and antibacterial activity is discussed. Applications of calcium hydroxide in restorative dentistry are also reviewed.
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Affiliation(s)
- A Milosevic
- Department of Clinical Dental Sciences, School of Dentistry, University of Liverpool, UK
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24
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Rotstein I, Friedman S, Katz J. Apical closure of mature molar roots with the use of calcium hydroxide. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1990; 70:656-60. [PMID: 2234887 DOI: 10.1016/0030-4220(90)90418-r] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Calcium hydroxide may induce apical root closure in affected mature teeth as well as in immature teeth. Once an apical hard tissue barrier is formed, a permanent root canal filling can be safely condensed. Two cases are described in which calcium hydroxide induced apical root closure in mature molar teeth where the apical constriction was lost because of chronic inflammatory process.
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Affiliation(s)
- I Rotstein
- Department of Endodontics, Hebrew University, Jerusalem, Israel
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25
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Abstract
Calcium hydroxide is a material which has been used for a variety of purposes since its introduction into dentistry in the early part of the twentieth century. In its pure form, the substance has a high pH, and its dental use relates chiefly to its ability to stimulate mineralization, and also to its antibacterial properties. A range of products has been formulated with different therapeutic actions, the effects of which are partially dependent upon the tissue to which they are applied. The material is reviewed under the following general headings: biochemical actions; dental formulation; uses.
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Affiliation(s)
- P C Foreman
- Dental School, University of Newcastle upon Tyne, UK
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26
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Heys DR, Fitzgerald M, Heys RJ, Chiego DJ. Healing of primate dental pulps capped with Teflon. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1990; 69:227-37. [PMID: 2304749 DOI: 10.1016/0030-4220(90)90333-n] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The pulps of Rhesus monkey teeth were exposed and capped with three materials: Teflon, a commercial hard-set calcium hydroxide (Ca(OH)2) material, and Ca(OH)2 plus saline. Experimental test periods were 3, 10, and 21 days, and 5 and 8 weeks. After treatment, the teeth were removed and processed for routine histologic evaluation. Teeth treated with the two Ca(OH)2 materials showed resolution of the inflammatory response and hard tissue formation at the exposure site as early as 10 days postoperatively, with consistent healing at 21 days and longer. Teflon had a similar soft tissue healing pattern but at a slower rate. Hard tissue formation at the exposure site in the teeth treated with Teflon was infrequent at the early time periods and present in only 20% of the teeth treated for 5 and 8 weeks. By evaluating the soft and hard tissue responses of the Ca(OH)2-capped and Teflon-capped teeth it may be possible, in future studies, to identify events unique to odontoblast differentiation during pulpal healing.
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Affiliation(s)
- D R Heys
- Department of Restorative Dentistry, University of Michigan School of Dentistry
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27
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Kirk EE, Lim KC, Khan MO. A comparison of dentinogenesis on pulp capping with calcium hydroxide in paste and cement form. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1989; 68:210-9. [PMID: 2780022 DOI: 10.1016/0030-4220(89)90195-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- E E Kirk
- Department of Conservative Dentistry, School of Dentistry, University of Otago, Dunedin, New Zealand
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28
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Abstract
A case is presented in which calcium hydroxide was used in endodontic treatment of external root resorption in a tooth with a necrotic pulp, during active orthodontic movement. A calcified deposit formed, filling a defect, and the tooth was subsequently obturated with gutta-percha. Thus, both types of therapy--endodontic and orthodontic--were performed simultaneously.
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Affiliation(s)
- A Y Saad
- Department of Oral Histology, Al-Azhar University, Faculty of Dental Medicine, Nasr City, Cairo, Egypt
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29
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Barkhordar RA, Kempler D. Antimicrobial activity of calcium hydroxide liners on Streptococcus sanguis and S. mutans. J Prosthet Dent 1989; 61:314-7. [PMID: 2921748 DOI: 10.1016/0022-3913(89)90135-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The antimicrobial activity of 10 calcium hydroxide liners on Streptococcus sanguis and S. mutans was studied. One hundred plates of tryticose soy agar-sheep red blood cells (10%), each with four distinct 3 mm diameter wells, were divided into two groups of 50. One group was inoculated with S. sanguis and the second group with S. mutans. A 4 mg liner was placed in each of three wells; the fourth well was left empty as a control. Plates were incubated at 37 degrees C and observed at 24 hours, 48 hours, and 7 days. All liners inhibited growth of both organisms. The inhibitory zones for S. mutans were larger than inhibitory zones for S. sanguis for all tested liners. Life Fast Set material had significantly less inhibitory effect on S. mutans. VLC Dycal, Life, and Life Fast Set materials had significantly less inhibitory effect on S. sanguis at p = 0.05.
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Affiliation(s)
- R A Barkhordar
- Division of Endodontics, University of California, San Francisco, School of Dentistry
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30
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Abstract
This case report describes the effect of calcium hydroxide in the treatment of traumatized immature tooth. Calcium hydroxide is used to fill the root canal after complete chemomechanical debridement has been performed. The result demonstrated the successful use of calcium hydroxide in stimulating the epithelial cells of Hertwig's sheath and the surrounding undifferentiated progenitor cells to continue formation of the apical portion of the root. Thus, the use of calcium hydroxide stimulated apical bridge formation, as well as inducing apexogenesis.
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Affiliation(s)
- A Y Saad
- Department of Endodontics, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
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31
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Zmener O, Guglielmotti MB, Cabrini RL. Biocompatibility of two calcium hydroxide-based endodontic sealers: a quantitative study in the subcutaneous connective tissue of the rat. J Endod 1988; 14:229-35. [PMID: 3075231 DOI: 10.1016/s0099-2399(88)80175-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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32
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Jean A, Kerebel B, Kerebel LM, Legeros RZ, Hamel H. Effects of various calcium phosphate biomaterials on reparative dentin bridge formation. J Endod 1988; 14:83-7. [PMID: 3162944 DOI: 10.1016/s0099-2399(88)80006-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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33
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Kawakami T, Nakamura C, Hasegawa H, Eda S. Fate of 45Ca-labeled calcium hydroxide in a root canal filling paste embedded in rat subcutaneous tissues. J Endod 1987; 13:220-3. [PMID: 3473178 DOI: 10.1016/s0099-2399(87)80094-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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34
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Zmener O, Cabrini RL. Effects of three calcium hydroxide-based materials on human blood monocytes and lymphocytes. ENDODONTICS & DENTAL TRAUMATOLOGY 1987; 3:28-32. [PMID: 3471514 DOI: 10.1111/j.1600-9657.1987.tb00168.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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35
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Feiglin B. Differences in apex formation during apexification with calcium hydroxide paste. ENDODONTICS & DENTAL TRAUMATOLOGY 1985; 1:195-9. [PMID: 3865767 DOI: 10.1111/j.1600-9657.1985.tb00657.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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36
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Schröder U. Effects of calcium hydroxide-containing pulp-capping agents on pulp cell migration, proliferation, and differentiation. J Dent Res 1985; 64 Spec No:541-8. [PMID: 3857254 DOI: 10.1177/002203458506400407] [Citation(s) in RCA: 341] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The findings from the recent literature on pulpal cell responses to the application of calcium hydroxide to exposed pulps are described. The effect of calcium hydroxide on healthy and inflamed pulp is discussed. The effect of incorporation of calcium hydroxide in various pulp-capping agents is presented. The initial effect of calcium hydroxide applied to exposed pulp is the development of a superficial three-layer necrosis. The beneficial effect of calcium hydroxide is regarded as the result of the chemical injury caused by the hydroxyl ions, limited by a zone of firm necrosis against the vital tissue, and the toleration of calcium ions by the tissue. The firm necrosis causes slight irritation and stimulates the pulp to defense and repair. The observed sequence of tissue reactions is that which is expected when connective tissue is wounded. It starts with vascular and inflammatory cell migration and proliferation, to control and elimination of the irritating agent. This is followed by the repair process, including migration and proliferation of mesenchymal and endothelial pulp cells and formation of collagen. When the pulp is protected from irritation, odontoblasts differentiate, and the tissue formed assumes the appearance of dentin, i.e., the function of the pulp is normalized. The mineralization of the collagen starts with dystrophic calcification of both the zone of firm necrosis and the degenerated cells in the adjacent tissue, leading to deposition of mineral in the newly-formed collagen. The presence of calcium ions stimulates precipitation of calcium carbonate in the wound area and thereby contributes to the initiation of mineralization.(ABSTRACT TRUNCATED AT 250 WORDS)
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37
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38
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Hanks CT, Bergenholtz G, Kim JS. Protein synthesis in vitro, in the presence of Ca(OH)2-containing pulp-capping medicaments. JOURNAL OF ORAL PATHOLOGY 1983; 12:356-65. [PMID: 6415256 DOI: 10.1111/j.1600-0714.1983.tb00348.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Four Ca(OH)2-containing pulp-capping medicaments were compared for their effects on protein synthesis in early subcultures of monkey- and human-pulpal fibroblasts. While protein synthesis, as well as DNA synthesis, was depressed by three of the medicaments, the protein-synthetic rate in human-cell cultures in the presence of Life rose to control levels when the medium was changed daily, but was depressed when the medium was not changed. This suggests that serum proteins play a protective role for pulpal tissues under inflammatory conditions, at least in the case of Life, allowing odontoblasts to differentiate and make dentinal matrix without interference of either toxic components or excess alkalinity.
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39
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41
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Holland R, Pinheiro CE, de Mello W, Nery MJ, de Souza V. Histochemical analysis of the dogs' dental pulp after pulp capping with calcium, barium, and strontium hydroxides. J Endod 1982; 8:444-7. [PMID: 6958782 DOI: 10.1016/s0099-2399(82)80148-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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42
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43
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Eleazer P, Bolanos O, Sinai I, Martin J, Seltzer S. [The effect of unbound powdered materials on dog dental pulps]. J Endod 1981; 7:462-5. [PMID: 6945387 DOI: 10.1016/s0099-2399(81)80307-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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44
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45
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Pereira JC, Brante CM, Berbert A, Mondelli J. Effect of calcium hydroxide in powder or in paste form on pulp-capping procedures: histopathologic and radiographic analysis in dog's pulp. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1980; 50:176-86. [PMID: 6930619 DOI: 10.1016/0030-4220(80)90207-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The pulps of seventy dog teeth were evaluated histopathologically and radiographically following intentional exposure and treatment with either a calcium hydroxide powder or a calcium hydroxide paste prepared with distilled water. The results were recorded after periods of 2, 30, 70, and 120 days. No differences were detected in the pulpal responses to direct pulp capping achieved with a calcium hydroxide paste and with a calcium hydroxide powder.
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Dick HM, Carmichael DJ. Reconstituted antigen-poor collagen preparations as potential pulp-capping agents. J Endod 1980; 6:641-4. [PMID: 6935371 DOI: 10.1016/s0099-2399(80)80165-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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47
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48
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Woehrlen AE. Evaluation of techniques and materials used in pulpal therapy based on a review of the literature: part I. J Am Dent Assoc 1977; 95:1154-8. [PMID: 271680 DOI: 10.14219/jada.archive.1977.0194] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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49
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Watts A, Paterson RC. Simple metallic compounds as pulp-capping agents. A pilot study. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1977; 44:285-92. [PMID: 268580 DOI: 10.1016/0030-4220(77)90282-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A pilot study is described in which the exposed pulps of molar teeth of normal laboratory rats were capped with various metallic compounds in general medical usage. There appeared to be no relationship between the response obtained and the pH of the compounds studied. Aluminum powder, aluminum hydroxide, Aludrox, aluminum oxide, light magnesium oxide, magnesium hydroxide, and titanium dioxide gave poor results. Barium sulfate, calcium carbonate, cupric oxide, ferric oxide, heavy magnesium oxide, and stannic oxide merited more detailed study.
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