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Clinical evaluation of direct pulp capping using a calcium silicate cement—treatment outcomes over an average period of 2.3 years

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Clinical Oral Investigations
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Objectives This study aims to assess the treatment outcomes of direct pulp capping with a calcium silicate cement (Biodentine) after caries excavation. Materials and methods A total of 245 teeth of 226 patients diagnosed to be clinical healthy or showing spontaneous pain were directly capped. The teeth were examined 0.19 to 7.4 (mean 2.3 ± 2.04) years after treatment. The following data were recorded: age and sex of the patient, type of tooth and restoration (glass ionomer cement [GIC], amalgam, composite resin, ceramic, gold) and symptoms before or after treatment. The evaluation of the treatment was carried out by sensibility and percussion testing and by the patient’s questioning. A positive sensibility test, a negative percussion test, the absence of swelling and discomfort were considered as treatment success. Survival analysis was performed using the Kaplan-Meier, log-rank, Chi-square and Fisher’s exact test, respectively. Results After an average period of 2.3 years, 86.0% of the teeth remained vital; the survival rate after 7.4 years was 83.4%. The treatment outcome was significantly worse for cavities restored with GIC compared to all other restorative materials (p < 0.05). All other evaluated factors had no significant influence on the success rate (p > 0.05). Conclusion Exposed pulps of asymptomatic vital permanent teeth and teeth with spontaneous pain before treatment can be successfully capped directly using Biodentine. A subsequent restoration with GIC does not appear to be suitable as it significantly reduces the success of the treatment. Clinical relevance Direct pulp capping can be done successfully with this type of calcium silicate cement.
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ORIGINAL ARTICLE
Clinical evaluation of direct pulp capping using a calcium silicate
cementtreatment outcomes over an average period of 2.3 years
Carolin Sabine Harms
1
&Edgar Schäfer
2
&Till Dammaschke
1
Received: 15 August 2018 /Accepted: 4 December 2018 / Published online: 11 December 2018
#Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract
Objectives This study aims to assess the treatment outcomes of direct pulp capping with a calcium silicate cement (Biodentine)
after caries excavation.
Materials and methods A total of 245 teeth of 226 patients diagnosed to be clinical healthy or showing spontaneous pain were
directly capped. The teeth were examined 0.19 to 7.4 (mean 2.3 ± 2.04) years after treatment. The following data were recorded:
age and sex of the patient, type of tooth and restoration (glass ionomer cement [GIC], amalgam, composite resin, ceramic, gold)
and symptoms before or after treatment. The evaluation of the treatment was carried out by sensibility and percussion testing and
by the patients questioning. A positive sensibility test, a negative percussion test, the absence of swelling and discomfort were
considered as treatment success. Survival analysis was performed using the Kaplan-Meier, log-rank, Chi-square and Fishers
exact test, respectively.
Results After an average period of 2.3 years, 86.0% of the teeth remained vital; the survival rate after 7.4 years was 83.4%. The
treatment outcome was significantly worse for cavities restored with GIC compared to all other restorative materials (p<0.05).
All other evaluated factors had no significant influence on the success rate (p>0.05).
Conclusion Exposed pulps of asymptomatic vital permanent teeth and teeth with spontaneous pain before treatment can be
successfully capped directly using Biodentine. A subsequent restoration with GIC does not appear to be suitable as it significantly
reduces the success of the treatment.
Clinical relevance Direct pulp capping can be done successfully with this type of calcium silicate cement.
Keywords Biodentine .Calcium silicate cement .Direct pulp capping .Treatment outcome
Introduction
Originally, calcium silicate cements like mineral trioxide ag-
gregate (MTA) were developed to seal perforations in the root
canal system. However, it soon became obvious that MTA is
also suited for maintaining the vitality of the dental pulp [13].
The advantages of this calcium silicate-based material over the
usually used calcium hydroxide products lie in the higher
mechanical strength, lower solubility and tighter sealing of
the dentine. Three major disadvantages of calcium hydroxide
could thus be avoided when using MTA: dissolution of the
capping material as well as the mechanical instability and
consequent lack of long-term protection against bacterial
microleakage [3]. Despite these advantages, literature is still
inconclusive concerning the superiority of MTA over calcium
hydroxide suspensions. In some reports, MTA produced better
clinical outcomes and showed higher success rates than calci-
um hydroxide in direct capping [46]. Thus, in a meta-analy-
sis, it was stated that direct pulp capping with MTA has a
higher success rate, results in a lower pulpal inflammatory
response and a more reliable formation of hard tissue than
calcium hydroxide. MTA appears to be a suitable substitute
for calcium hydroxide in direct capping [7], whereas other
systematic reviews [8,9] and randomised control trials [10]
failed to confirm any superiority of MTA and MTA-like ma-
terials when covering the exposed pulp tissue in vital pulp
therapy.
*Till Dammaschke
tillda@uni-muenster.de
1
Department of Periodontology and Operative Dentistry, Westphalian
Wilhelms-University, Albert-Schweitzer-Campus 1, building W 30,
48149 Münster, Germany
2
Central Interdisciplinary Ambulance in the School of Dentistry,
Albert-Schweitzer-Campus 1, building W 30,
48149 Münster, Germany
Clinical Oral Investigations (2019) 23:34913499
https://doi.org/10.1007/s00784-018-2767-5
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Its success rate varies according to the literature, ranging from 70.49 to 100%. 3,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Direct pulp capping has different protocols depending on the study carried out, and the success rate of this treatment depends on a combination of factors, including the type of capping material used, the size and location of the pulp exposure, the degree of hemostasis achieved, the presence of infection or inflammation, and the quality of the restoration placed over the capped tooth. Careful patient selection and thorough diagnosis prior to performing DPC are crucial, as certain factors such as the age of the patient, the extent of the cavity, and the presence of systemic disease can also impact the success of the treatment. ...
... The studies by Çalışkan 3,10,17,[19][20][21][22][23] Direct pulp capping is a viable treatment in teeth with immature apexes, or with a diagnosis of irreversible pulpitis. 10,[12][13][14][15] The size of the pulp exposure treated ranged from less than 0.5 mm to greater than 2 mm, and its location was in the occlusal and axial areas of the tooth, according to the data from the selected studies. 3,13,16,17,19,21,22 The control of hemostasis within 5-10 minutes is an important factor in the outcome of direct pulp capping, as reported in the studies selected for this review. ...
... 3,10,12,13,[20][21][22] The capping material used is one of the most influential factors since calcium hydroxide reflects a higher failure rate than MTA at 1 year follow-up. 3,15,16 In a study by Cho et al., 30 of 105 cases coated with calcium hydroxide failed, compared to 7 of 70 in which MTA was used. This trend was similar in the follow-ups at 2 and 3 years. ...
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Aim To elucidate the factors that determine the success of direct pulp capping (DPC) in permanent teeth with pulp exposure due to dental caries. Materials and methods A comprehensive electronic search from 1980 to 2023 across PubMed, Scopus, and ISI Web databases was conducted using specific keywords and MeSH terms in Q1 or Q2 journals. Only prospective/retrospective clinical studies in English on 15 or more human permanent teeth with carious pulpal exposure treated with DPC agents—mineral trioxide aggregate (MTA), Biodentine, or calcium hydroxide with a rubber dam and minimum 1-year follow-up, were considered. The factors retrieved and analyzed were based on study design, patient age, sample size, type of cavity, exposure size and location, pulp diagnosis, solutions to achieve hemostasis, hemostasis time, capping material, restoration type, follow-up period, methods of evaluation, and overall success. Review results Out of 680 articles, only 16 articles were selected for the present systematic review on application of the selection criteria. A wide age range of patients from 6 to 88 years were considered among these studies with sample sizes ranging from 15 to 245 teeth with reversible pulpitis being the predominant diagnosis of the cases. Mineral trioxide aggregate as a capping material was evaluated in 4 studies as a lone agent, while compared with other capping agents such as biodentine or calcium hydroxide in 7 studies. The follow-up period ranged from 9 days to nearly 80 months. While both clinical and radiographic evaluation was carried out in all studies, cold testing dominated the clinical tests while IOPR was the common radiograph considered. Mineral trioxide aggregate success rate was higher and similar to biodentine than calcium hydroxide. Conclusion Direct pulp capping has a high and predictable success rate in permanent teeth with carious exposure to reversible and irreversible pulpitis. Currently, mineral trioxide aggregate and biodentine have better long-term results in DPC than calcium hydroxide, hence, they should be used as an alternative to calcium hydroxide. Definitive restoration within a short period improves long-term prognosis. Clinical significance The significance of this review lies in its provision of evidence-based information on the effectiveness of DPC and the factors that influence its success. By considering these factors, clinicians can optimize treatment outcomes and improve the long-term prognosis of the treated teeth. This systematic review serves as a valuable resource for clinicians and researchers in the field of endodontics. How to cite this article Gomez-Sosa JF, Granone-Ricella M, Rosciano-Alvarez M, et al. Determining Factors in the Success of Direct Pulp Capping: A Systematic Review. J Contemp Dent Pract 2024;25(4):392–401.
... 8,9,11 The recent guidelines therefore provide a useful model for investigating the declared and taught curriculum and are summarised in Figure 1. 8,9,10,12,13,14,15,16,17,18,19 Method Ethical approval was awarded by Newcastle University Research Ethics Committee (REF: 12993/2020). ...
... Haemostasis and disinfection achieved using CW and NaOCl/CHX 12,13 CSC should be placed over pulp tissue, which has superior histological and clinical outcomes when compared to CH 14,15 Emergency intervention aimed at pain relief prior to later definitive management The formal taught endodontic curriculum ...
Article
Introduction This paper explores the declared and formal and informal taught endodontic curriculum within an undergraduate dental programme in the UK as part of a wider study, which also investigates the learned curriculum. Management of the dental pulp was chosen due to the availability of clear internationally recognised guidelines.Method The declared curriculum was identified through existing course guides and seminar and practical session plans. The formal taught curriculum was identified by cataloguing all lectures, practical teaching sessions, seminars and handouts available to dental students. Questionnaires using clinical vignettes were used to explore the informal taught curriculum.Results Valid responses to the questionnaire were received from 25/40 (62.5%) clinical supervisors. Disparities between national guidelines and the declared and taught curriculum were primarily due to broad learning objectives and disparate information from lectures and supervising clinicians. Although the majority of formal teaching aligned with national guidelines, the main deviation occurred within the informal taught curriculum.Conclusion This study highlights disparities between current evidence-based guidelines and the declared and taught curriculum in relation to pulp management in a UK dental school. Recommendations are that all policies, procedures and protocols are updated and aligned to a contemporaneous evidence base annually, plus engagement with clinical lecturers, to enable more standardised teaching.
... Además, promueve un ambiente desfavorable para el crecimiento bacteriano, especialmente Streptococcus mutans, Candida albicans, Escherichia coli y Enterococcus faecalis. (Harms et al., 2019). Con respecto a sus propiedades biológicas, el silicato tricálcico ha demostrado ser biocompatible ya que no induce daño a las células pulpares, no se han reportado casos de citotoxicidad, genotoxicidad o mutagenicidad, lo cual es de particular importancia clínica, pues indica que el material se puede colocar directamente en el tejido pulpar, sin ningún efecto adverso sobre el proceso de la cicatrización pulpar (Zenaldeen et al., 2023). ...
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RESUMEN Durante años, el área de la odontología clínica se en-frentó al desafío de reponer la dentina dañada. Debi-do a su excelente biocompatibilidad, la capacidad de adhesión dentinaria, longevidad y propiedades me-cánicas superiores, el silicato tricálcico que actúa como sustituto bioactivo dentinario, se ha propuesto como un material de recubrimiento pulpar, especial-mente en piezas permanentes jóvenes. El recubri-miento pulpar desde el punto de vista clínico y bioló-gico representa un importante procedimiento para el mantenimiento de la vitalidad y función pulpar, para completar el desarrollo radicular y estimular el cie-rre apical. Se presenta el reporte de un caso clínico en un primer molar permanente joven con caries pe-netrante. Luego de la remoción del tejido cariado y la realización de una pulpotomía parcial, se llevó a cabo un recubrimiento pulpar con silicato tricálcico y se restauró la pieza dentaria con resina compuesta. En el control clínico a distancia a los tres años posterio-res al tratamiento, se evidenció respuesta positiva y normal a la prueba de sensibilidad pulpar, ausencia de dolor espontáneo y a la percusión y, radiográfi-camente, se observó una imagen compatible con la formación de un puente dentinario y engrosamiento de la pared radicular en la zona periapical. El silicato tricálcico, en este caso clínico, demostró ser efectivo para el tratamiento conservador de la vitalidad pul-par. Palabras clave: silicato tricálcico, recubrimiento pulpar directo, diente permanente joven, pulpotomía, vitalidad pulpar. ABSTRACT Clinical dentistry has been facing the challenge of replacing lost dentine for years. Due to its high biocompatibility, longevity, dentin adhesion and excellent mechanical properties tricalcium silicate, which acts as a bioactive dentin substitute, has been proposed as a pulp capping material especially for immature posterior´s permanent teeth. Pulp capping represents an important mechanism for maintaining
... Además, promueve un ambiente desfavorable para el crecimiento bacteriano, especialmente Streptococcus mutans, Candida albicans, Escherichia coli y Enterococcus faecalis. (Harms et al., 2019). Con respecto a sus propiedades biológicas, el silicato tricálcico ha demostrado ser biocompatible ya que no induce daño a las células pulpares, no se han reportado casos de citotoxicidad, genotoxicidad o mutagenicidad, lo cual es de particular importancia clínica, pues indica que el material se puede colocar directamente en el tejido pulpar, sin ningún efecto adverso sobre el proceso de la cicatrización pulpar (Zenaldeen et al., 2023). ...
Article
Full-text available
Durante años, el área de la odontología clínica se enfrentó al desafío de reponer la dentina dañada. Debido a su excelente biocompatibilidad, la capacidad de adhesión dentinaria, longevidad y propiedades mecánicas superiores, el silicato tricálcico que actúa como sustituto bioactivo dentinario, se ha propuesto como un material de recubrimiento pulpar, especialmente en piezas permanentes jóvenes. El recubrimiento pulpar desde el punto de vista clínico y biológico representa un importante procedimiento para el mantenimiento de la vitalidad y función pulpar, para completar el desarrollo radicular y estimular el cierre apical. Se presenta el reporte de un caso clínico en un primer molar permanente joven con caries penetrante. Luego de la remoción del tejido cariado y la realización de una pulpotomía parcial, se llevó a cabo un recubrimiento pulpar con silicato tricálcico y se restauró la pieza dentaria con resina compuesta. En el control clínico a distancia a los tres años posteriores al tratamiento, se evidenció respuesta positiva y normal a la prueba de sensibilidad pulpar, ausencia de dolor espontáneo y a la percusión y, radiográficamente, se observó una imagen compatible con la formación de un puente dentinario y engrosamiento de la pared radicular en la zona periapical. El silicato tricálcico, en este caso clínico, demostró ser efectivo para el tratamiento conservador de la vitalidad pulpar.
... In clinical trials, the treatment success is frequently evaluated in the absence of histological assessments, given the current clinical impracticality of detecting and standardizing the preoperative histological status of the pulp across experimental and control groups [16,44,45]. Animal studies generally involve the immediate capping of mechanically exposed pulp, so if the properties of hydraulic calcium silicates vary with pulpal inflammation, studies using induced pulpitis models would be beneficial in evaluating the formation of hard tissue resulting from the interaction of mineral trioxide aggregate with an inflamed pulp [43]. ...
Article
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This systematic review aimed to compare the histological response of inflamed pulpodentinal complex to the hydraulic calcium silicate cements in experimental animal models of pulpitis. Articles that evaluated the histological response of inflamed pulp to mineral trioxide aggregate (MTA) in comparison with other restorative materials were selected and analysed in detail. The risk of bias assessment was conducted using SYRCLE's RoB tool. The GRADEpro tool was used to determine the overall quality of evidence. Out of the 2947 retrieved articles from databases, five articles fulfilled the inclusion criteria. MTA induced significantly more hard tissue formation compared to calcium hydroxide. The use of pulp‐capping material containing fluocinolone acetonide and ASP/PLGA‐ASP/ACP/PLLA‐PLGA composite membrane was comparable. This systematic review could not demonstrate enhanced efficiency of capping materials compared to MTA. Future well‐conducted animal studies are warranted for demonstrating the hard tissue formation abilities of pulp‐capping materials with convenient inflammatory conditions.
... This property is particularly useful in areas where it is difficult to isolate from moisture for a longer time period. Indications for this group of materials include cervical fillings, applications in pediatric dentistry, temporary fillings, and the fixation of slow or non-curing pulp capping materials [4][5][6]. As filled, flowable composites, SAC are similar to conventional composites in terms of polishability and aesthetics, and show promising clinical results [7]. ...
Chapter
In the absence of microorganisms, the pulp tissue shows good regenerative capacity when capped with materials indicated for direct pulp capping. Sufficient haemostasis after pulp exposure is also important. Success rates of approximately 80 % are quite realistic, whereby direct pulp capping with hydraulic calcium silicate cements (e.g. MTA, and Biodentine) show significantly higher success rates than with calcium hydroxide. The success rates are independent of the age of the patient and the size of the pulp exposure. In contrast, remaining caries, microorganisms and monomers from restorative materials have a negative influence on success, as these lead to inflammation of the tissuenegatively influence success, as these lead to tissue inflammation. A correct indication is important for success. According to current knowledge, direct capping is indicated for teeth that show symptoms of reversible pulpitis at best. Success rates for direct capping after traumatic and iatrogenic exposures are generally higher than after exposure to cariogenic dentine. https://www.wiley.com/en-br/Vital+Pulp+Treatment-p-9781119930402
Article
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Introducción: Se han desarrollado materiales bioactivos para el recubrimiento pulpar directo con el objetivo de preservar la pulpa dentaria y mantener el diente por mayor tiempo en la cavidad oral. Objetivo: El objetivo de esta revisión fue evaluar la efectividad del uso de bioceramicos como material de recubrimiento directo pulpar para mantener la vitalidad pulpar en dientes primarios y permanentes con pulpitis reversible. Metodología: Se realizó una revisión sistemática con meta análisis. Se estudió el éxito en el tratamiento del mantenimiento de la vitalidad, el dolor postoperatorio y la decoloración. Se realizó una búsqueda Electrónica en las bases de datos: MEDLINE, EMBASE, COCHRANE, SCOPUS, LILACS, BBO. Se extrajeron los datos y se analizaron con Rev Man. Resultados: Se incluyeron ensayos clínicos aleatorizados en la cual se realizaron recubrimiento pulpar directo con silicatos tricalcicos comparado con otros materiales de recubrimiento. Comparando tres biocerámicos no se encontraron diferencias significativas en el mantenimiento de la vitalidad pulpar. En cuanto a la decoloración se observaron diferencias estadísticamente significativas a favor de Biodentine (p <0,001). Discusión: la relevancia clínica de estos hallazgos es discutible debido a su pequeña magnitud general y al alto riesgo de sesgo de los estudios incluidos.
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Purpose of Review Tricalcium silicates are considered as materials of choice for vital pulp therapy. Recent development improved their mechanical and bioactive properties and broadened their clinical application fields. Incorporating resins to tricalcium silicates further decreased the setting time and simplified clinical procedures but raised questions about their potential toxicity. Recent Findings Tricalcium silicates represent an added value in vital pulp therapy. This is ascribed to the pulp high regeneration potential, material byproducts production upon hydration and growth factor release from target cells. Adding resins to tricalcium silicates decreases their hydration and subsequently leads to pulp toxicity. Summary Tricalcium silicates can be successfully used for vital pulp therapy in a broad range of clinical applications. Although long-term clinical studies are still required with these new materials, adding resins to tricalcium silicates is responsible for pulp disorganization and toxicity and cannot be recommended for direct pulp capping.
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Objective The aim of the study was to evaluate the effects of the capping materials mineral trioxide aggregate (MTA), calcium hydroxide (CH) and BiodentineTM (BD) on stem cells from human exfoliated deciduous teeth (SHED) in vitro. Material and Methods SHED were cultured for 1 – 7 days in medium conditioned by incubation with MTA, BD or CH (1 mg/mL), and tested for viability (MTT assay) and proliferation (SRB assay). Also, the migration of serum-starved SHED towards conditioned media was assayed in companion plates, with 8 μm-pore-sized membranes, for 24 h. Gene expression of dentin matrix protein-1 (DMP-1) was evaluated by reverse-transcription polymerase chain reaction. Regular culture medium with 10% FBS (without conditioning) and culture medium supplemented with 20% FBS were used as controls. Results MTA, CH and BD conditioned media maintained cell viability and allowed continuous SHED proliferation, with CH conditioned medium causing the highest positive effect on proliferation at the end of the treatment period (compared with BD and MTA) (p<0.05). In contrast, we observed increased SHED migration towards BD and MTA conditioned media (compared with CH) (p<0.05). A greater amount of DMP-1 gene was expressed in MTA group compared with the other groups from day 7 up to day 21. Conclusion Our results show that the three capping materials are biocompatible, maintain viability and stimulate proliferation, migration and differentiation in a key dental stem cell population.
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IntroductionThis study aimed to evaluate the prognostic value of factors with regard to the treatment outcome of direct pulp capping using Biodentine (Septodont, Saint-Maur-des-Fossés, France), in permanent teeth in which the pulps were exposed during caries removal. Methods Between 2010 and 2014, 112 teeth with deep carious lesions underwent direct pulp capping. The patients were followed up at 2–3 months and 1–1.5 years with a routine examination on both recall visits. Periapical radiographs were taken at 1–1.5 years. Lack of patient complaints, positive reactions to cold and electric testing, no sensitivity to percussion, and no widening of the periapical ligament indicated success. The Fisher exact test was used for statistical analysis. The significance level was P = .05. ResultsEighty-six teeth were available for 1–1.5 years follow-up. The overall success rate was 82.6%. Only age had a significant effect on the pulpal survival rate: the success rate was 90.9% in patients younger than 40 years and 73.8% in patients 40 years or older (P = .0480). Sex, initial or secondary caries treatment, occlusal or cervical/proximal caries, delayed placement of permanent filling, tooth position, and arch type did not influence the outcome. ConclusionsA patient’s age influenced the outcome of direct pulp capping using this new calcium silicate cement. Clinical relevanceAsymptomatic vital permanent teeth with cariously exposed pulp can be treated successfully by direct pulp capping using Biodentine.
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Introduction: On the basis of many clinical observations, some calcium silicate-based cements have a high potential for staining tooth tissue. This feature greatly limits the use of those cements, particularly for anterior teeth. This review aimed to provide a systematic evaluation of published in vitro studies to determine the effect of different calcium silicate-based cements on dental tissue discoloration. Methods: This literature review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The literature search was based on all publications without a year limit. The last search was performed on October 22, 2016. An electronic search was performed on MEDLINE (PubMed), Cochrane, and Scopus. The articles were selected to address the following research question: Which materials based on calcium silicate-based cements have hard tissue staining potential? The necessary information was extracted by 2 authors independently using a standardized form. Results: The search resulted in 390 titles from all databases. Twenty-three studies met the inclusion criteria. Most of the studies exhibited a moderate risk of bias. The results indicated that some materials showed a strong potential for staining, including gray and white MTA Angelus (Londrina, PR, Brazil), gray and white ProRoot MTA (Dentsply, Tulsa, OK), and Ortho MTA (BioMTA, Seoul, Korea). Individual study results showed that Biodentine (Septodont, Saint Maur des Fosses, France), Retro MTA (BioMTA), Portland cement, EndoSequence Root Repair Material (Brasseler USA, Savannah, GA), Odontocem (Australian Dental Manufacturing, Brisbane, Australia), MM-MTA (Micro Mega, Besancon Cedex, France), and MTA Ledermix (Riemser Pharma GmbH, Greiswald-Insel Riems, Germany) were materials with the smallest staining potential. Conclusions: This review clearly showed that some calcium silicate-based cements have a high potential for staining hard tissue. On the other hand, some showed only a small change in color, which was nearly invisible to the human eye (ΔE <3.3). However, more long-term clinical studies are needed.
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Background: Root canal treatment has been a routine treatment option for carious exposure of the dental pulp. In the context of minimally invasive dentistry, direct pulp capping (DPC) procedure with a reliable biomaterial may be considered as an alternative provided the pulp status is favorable. Mineral trioxide aggregate (MTA), a bioactive cement with excellent sealing ability and biocompatibility is capable of regenerating relatively damaged pulp and formation of dentin bridge when used as DPC agent. Biodentine is comparatively a new biomaterial claimed to possess properties similar to MTA and is currently explored for vital pulp therapy procedures. Aim: The aim of the present study was to evaluate the clinical response of pulp-dentin complex after DPC with MTA and biodentine in carious teeth. Subjects and Methods: Twenty-four permanent molars with carious exposure having no signs and symptoms of irreversible pulpitis were selected and assigned to one of the two groups, Group I - MTA and Group II - biodentine. Patients were recalled at 3 weeks, 3 months, and 6 months for clinical and radiographic evaluation. Fisher's exact test was used along with Chi-square test for statistical analysis. Results: Over a period of 6 months, MTA and biodentine showed 91.7% and 83.3% success rate, respectively, based on the subjective symptoms, pulp sensibility tests, and radiographic appearance. Conclusion: MTA and biodentine may be used as DPC agents when the pulpal diagnosis is not more than reversible pulpitis.
Article
Objectives: To evaluate the effect of the eluates from 3 freshly-mixed and setting hydraulic calcium-silicate cements (hCSCs) on human dental pulp cells (HDPCs) and to examine the effect of a newly developed hCSC containing phosphopullulan (PPL) on HDPCs. Methods: Human dental pulp cells, previously characterized as mesenchymal stem cells, were used. To collect the eluates, disks occupying the whole surface of a 12-well plate were prepared using an experimental hCSC containing phosphopullulan (GC), Nex-Cem MTA (GC), Biodentine (Septodont) or a zinc-oxide (ZnO) eugenol cement (material-related negative control). Immediately after preparing the disks (non-set), 3ml of Dulbecco's Modified Eagle Medium (DMEM) with 10% fetal bovine serum (FBS) were added. The medium was left in contact with the disks for 24h before being collected. Four different dilutions were prepared (100%, 50%, 25% and 10%) and cell-cytotoxicity, cell-proliferation, cell-migration and odontogenic differentiation were tested. The cell-cytotoxicity and cell-proliferation assays were performed by XTT-colorimetric assay at different time points. The cell-migration ability was tested with the wound-healing assay and the odontogenic differentiation capacity of hCSCs on HDPCs was tested with RT-PCR. Results: Considering all experimental data together, the eluates from 3 freshly-mixed and setting hCSCs appeared not cytotoxic toward HDPCs. Moreover, all three cements stimulated proliferation, migration and odontogenic differentiation of HDPCs. Significance: The use of freshly-mixed and setting hCSCs is an appropriate approach to test the effect of the materials on human dental pulp cells. The experimental material containing PPL is non-cytotoxic and positively stimulates HDPCs.
Article
Aim: To assess the outcome of full pulpotomy using Biodentine in permanent teeth with carious exposures and symptoms indicative of irreversible pulpitis. Methodology: Sixty-four permanent molar teeth with symptomatic vital pulps in 52 patients aged 19-69 years were included. Preoperative pulpal and periapical diagnosis was established. After informed consent the tooth was anaesthetized, isolated using rubber dam and disinfected with 5% NaOCl before caries excavation; subsequently the pulp was amputated to the level of the canal orifices. Haemostasis was achieved and a 3 mm layer of Biodentine (Septodont, Saint-Maur-des-Fosses, France) was placed as the pulpotomy agent. Resin modified glass ionomer liner was placed and the tooth restored with either resin composite or amalgam, and a postoperative periapical radiograph exposed. Clinical and radiographic evaluation was completed at 6 months and 1 year postoperatively. Pain levels were scored preoperatively and 2 days post treatment. Results: Clinical signs and symptoms indicative of irreversible pulpitis were established in all teeth, and periapical rarefaction was present in 9 teeth. After 2 days 93.8% reported complete relief of pain. At 6 months 63/64 attended recall with 98.4% clinical and radiographic success. At 1 year 59/63 attended recall, with 100% clinical and 98.4 radiographic success. Seven out of eight cases with periapical rarefaction who attended recall had improvement in the periapical index (PAI) score. A hard tissue barrier was detected radiographically in 4 cases. Conclusion: Full pulpotomy using Biodentine was a successful treatment option for cariously exposed pulps in mature permanent molar teeth with clinical signs and symptoms indicative of irreversible pulpitis, up to one year. This article is protected by copyright. All rights reserved.
Article
Introduction: This study aimed to compare the success rates of direct pulp capping (DPC) by using either ProRoot Mineral Trioxide Aggregate (MTA) or Biodentine in the cariously exposed permanent teeth of 6- to 18-year-old patients. Gray discoloration was also evaluated. Methods: Fifty-nine cariously exposed permanent teeth, including teeth with diagnosis of normal pulp, reversible pulpitis, or irreversible pulpitis, early periapical involvement, and exposure size of up to 2.5 mm, were included. Each patient with only 1 cariously exposed tooth was randomly allocated to DPC with either ProRoot MTA (n = 30) or Biodentine (n = 29). Patients were recalled every 6 months. Clinical and radiographic examinations were used to determine success. Results: Fifty-five patients (mean age, 10 ± 2 years), 27 treated with ProRoot MTA and 28 with Biodentine, were included in the analysis. At mean follow-up of 18.9 ± 12.9 months, the success rate was 92.6% with ProRoot MTA and 96.4% with Biodentine (P > .05; difference, 4%; 95% confidence interval [CI], -8% to 16%). Biodentine was non-inferior to ProRoot MTA. Failures were distributed equally in all categories of pulpal diagnosis and occurred in teeth with no periapical involvement and small exposures (0.5 mm). The survival probabilities of DPC with ProRoot MTA and Biodentine were 0.92 (95% CI, 0.73-0.98) and 0.96 (95% CI, 0.80-0.99). No significant difference was observed between them (P > .05). Gray discoloration was observed only with ProRoot MTA (55%). Conclusions: Biodentine was non-inferior to ProRoot MTA when used as a DPC material for cariously exposed permanent teeth of 6- to 18-year-old patients. However, Biodentine did not cause any gray discoloration in this study.
Article
Introduction: Direct pulp capping treatment is intended to preserve pulp vitality, to avoid or retard root canal treatment, and, in cases with an open apex, to allow continued root development. Historically, calcium hydroxide (CH) was the gold standard material, but nowadays calcium silicate materials (CSMs) are displacing CH because of their high bioactivity, biocompatibility, sealing ability, and mechanical properties. However, more randomized clinical trials are needed to confirm the appropriateness of CSMs as replacement materials for CH in direct pulp capping procedures. Methods: A randomized clinical trial was conducted that included 169 patients (mean age, 11.3 years) from the Maipo district (Chile). The inclusion criterion was patients with 1 carious permanent tooth with pulpal exposure, a candidate for a direct pulp capping procedure. The patients were randomly allocated to one of the experimental groups (CH, Biodentine, or mineral trioxide aggregate [MTA]). Clinical follow-up examinations were performed at 1 week, 3 months, 6 months, and 1 year. The Fisher exact test was performed. Results: At the follow-up examination at 1 week, the patients showed 100% clinical success. At 3 months, there was 1 failure in the CH group. At 6 months, there were 4 new failures (1 in the CH group and 3 in the MTA group). At 1 year, there was another failure in the CH group. There were no statistically significant differences among the experimental groups. Conclusions: CSMs appear to be suitable materials to replace CH. Although no significant differences were found among the materials studied, Biodentine and MTA offered some advantages over CH.
Article
Introduction: The aim of this study was to investigate the sequelae of direct pulp capping (DPC) using mineral trioxide aggregate (MTA) and Biodentine in mature permanent teeth with carious exposure. Methods: Clinical records of 30 patients (15 each with MTA and Biodentine) treated with DPC technique from January 2015 to June 2015 were retrieved. Success rates (based on symptoms, sensibility tests, and radiographic analysis) and adverse events were analyzed. Results: The patients were reviewed at 1, 3, 6, 12, and 18 months after treatment. Four cases (2 each of MTA and Biodentine) were lost to follow-up. MTA and Biodentine groups showed success rates of 84.6% and 92.3%, respectively, with overall success rate of 88.5%. Radiographically visible dentin bridge formation was observed in 69.2% (9/13) and 61.5% (8/13) of cases done with MTA and Biodentine, respectively. The cases done with MTA showed coronal discoloration on review. Diffuse calcifications of the pulp chamber were observed in 1 (7.7%) case done with MTA and 3 (23.1%) cases done with Biodentine. Conclusions: The advent of bioceramic materials with better biocompatibility and sealing properties can make the outcome of DPC technique in mature permanent teeth with carious exposure more predictable. The success rate observed in this study should be confirmed through randomized controlled trials with long follow-up periods. Effects of adverse events like coronal discoloration and calcifications of the pulp chamber also need to be evaluated.