RESUMEN
Abstract Objective: To evaluate and compare the efficacy of eggshell derived calcium hydroxyapatite with Dycal® as indirect pulp capping material in primary molars. Material and Methods: A total of 32 carious primary molars from 22 children (6-10-years) were screened, of which 26 primary molars meeting inclusion criteria were selected and equally divided into two groups. At the first appointment, the infected dentin was excavated using a spoon excavator after treating the carious part with Carie-Care™ chemomechanical caries removal agent. After this, eggshell derived calcium hydroxyapatite in Group 1 and Dycal® in Group 2 were used as liners followed by restoration of the cavity with type IX glass ionomer cement. Clinical assessment for pain and radiographic assessment for measurement of the amount of reparative dentin thickness formation was performed at baseline, 8 weeks and 3 months. The data were subjected to statistical analysis by one-way ANOVA and Kruskal-Wallis tests. Results: Higher mean reparative dentin formation was found in eggshell derived calcium hydroxyapatite group than Dycal® group at the end of 8 weeks and 3 months and the difference was significant statistically (p<0.001). Conclusion: Eggshell derived calcium hydroxyapatite seems to be a suitable alternative to Dycal® (calcium hydroxide) that can be used as a liner for indirect pulp capping in primary molars.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Diente Primario , Durapatita/uso terapéutico , Recubrimiento de la Pulpa Dental , Dentina Secundaria/anatomía & histología , Diente Molar , Radiografía Dental/instrumentación , Eficacia , Análisis de Varianza , Estadísticas no Paramétricas , Cáscara de Huevo , Cementos de Ionómero Vítreo , India/epidemiologíaAsunto(s)
Determinación de la Edad por los Dientes/métodos , Dentina Secundaria/diagnóstico por imagen , Medicina Legal , Tomografía Computarizada Multidetector , Radiografía Panorámica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Dentina Secundaria/anatomía & histología , Femenino , Humanos , Malasia , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Dentin in permanent teeth rarely undergoes resorption in development, homeostasis, or aging, in contrast to bone that undergoes periodic resorption/remodeling. The authors hypothesized that cells in the mesenchymal compartment of dental pulp attenuate osteoclastogenesis. Mononucleated and adherent cells from donor-matched rat dental pulp (dental pulp cells [DPCs]) and alveolar bone (alveolar bone cells [ABCs]) were isolated and separately cocultured with primary rat splenocytes. Primary splenocytes readily aggregated and formed osteoclast-like cells in chemically defined osteoclastogenesis medium with 20 ng/mL of macrophage colony-stimulating factor (M-CSF) and 50 ng/mL of receptor activator of nuclear factor κB ligand (RANKL). Strikingly, DPCs attenuated osteoclastogenesis when cocultured with primary splenocytes, whereas ABCs slightly but significantly promoted osteoclastogenesis. DPCs yielded ~20-fold lower RANKL expression but >2-fold higher osteoprotegerin (OPG) expression than donor-matched ABCs, yielding a RANKL/OPG ratio of 41:1 (ABCs:DPCs). Vitamin D3 significantly promoted RANKL expression in ABCs and OPG in DPCs. In vivo, rat maxillary incisors were atraumatically extracted (without any tooth fractures), followed by retrograde pulpectomy to remove DPCs and immediate replantation into the extraction sockets to allow repopulation of the surgically treated root canal with periodontal and alveolar bone-derived cells. After 8 wk, multiple dentin/root resorption lacunae were present in root dentin with robust RANKL and OPG expression. There were areas of dentin resoprtion alternating with areas of osteodentin formation in root dentin surface in the observed 8 wk. These findings suggest that DPCs of the mesenchymal compartment have an innate ability to attenuate osteoclastogenesis and that this innate ability may be responsible for the absence of dentin resorption in homeostasis. Mesenchymal attenuation of dentin resorption may have implications in internal resorption in the root canal, pulp/dentin regeneration, and root resorption in orthodontic tooth movement.
Asunto(s)
Pulpa Dental/citología , Dentina/fisiología , Homeostasis/fisiología , Células Madre Mesenquimatosas/fisiología , Resorción Dentaria/fisiopatología , Adulto , Proceso Alveolar/citología , Animales , Conservadores de la Densidad Ósea/farmacología , Agregación Celular/fisiología , Técnicas de Cultivo de Célula , Diferenciación Celular/fisiología , Colecalciferol/farmacología , Técnicas de Cocultivo , Cavidad Pulpar/citología , Dentina/patología , Dentina Secundaria/anatomía & histología , Humanos , Factor Estimulante de Colonias de Macrófagos/análisis , Factor Estimulante de Colonias de Macrófagos/farmacología , Masculino , Osteoclastos/fisiología , Osteoprotegerina/análisis , Pulpectomía , Ligando RANK/análisis , Ligando RANK/farmacología , Ratas , Ratas Endogámicas F344 , Ratas Sprague-Dawley , Ratas Transgénicas , Bazo/citología , Reimplante Dental , Resorción Dentaria/patologíaRESUMEN
Dentine becomes infected as a result of caries lesion formation on root surfaces and when lesions progress following cavitation of enamel lesions. However, this infection is unimportant because the driving force for lesion formation and progression is the overlying biofilm. This explains why root surface caries can be controlled by mechanical plaque control and fluoride, and restorations are not needed to arrest these lesions. Similarly, the infected dentine in cavitated coronal lesions does not have to be removed to arrest the lesion. If the lesion is either accessible or opened for cleaning by the patient or parent, the lesion can be arrested. Sealing of infected dentine within the tooth, either by a Hall crown in the primary dentition or by partial caries removal prior to placing a well-sealed filling, will also arrest the lesion. When restoring deep lesions in symptomless, vital teeth, vigorous excavation of infected dentine is likely to expose the pulp and make root canal treatment necessary. Thus complete excavation'is not needed and should be avoided. CPD/CLINICAL RELEVANCE: Root surface caries can be arrested by cleaning and fluoride application. Restorations are not essential. Vigorous excavation of softened dentine in deep cavities of symptomless, vital teeth is contra-indicated. It is not needed and increases the risk of pulp exposure.
Asunto(s)
Caries Dental/microbiología , Dentina/microbiología , Bacterias/metabolismo , Biopelículas , Cariostáticos/uso terapéutico , Caries Dental/prevención & control , Pulpa Dental/anatomía & histología , Exposición de la Pulpa Dental/prevención & control , Restauración Dental Permanente/métodos , Dentina/anatomía & histología , Dentina Secundaria/anatomía & histología , Progresión de la Enfermedad , Fluoruros/uso terapéutico , Humanos , Pulpitis/clasificación , Caries Radicular/microbiología , Caries Radicular/prevención & control , Remineralización Dental/métodos , Cepillado Dental/métodos , Pastas de Dientes/uso terapéuticoRESUMEN
INTRODUCTION: The forces applied during orthodontic treatment bring about effects on the teeth and surrounding tissues. The aim of this study was to evaluate the possible changes in the human pulpal tissue resulting from orthodontic intrusion in a 21-day period using histologic examination. METHODS: The sample consisted of 17 young individuals of both sexes between the ages of 12 and 19 years. A total of 34 premolars were evaluated with orthodontic indication of extraction. Because it is a split-mouth study, in each patient, intrusion force of 60 g was applied randomly on 1 of the dental elements experimental group for 21 days. The counterpart control group received no force. After extractions, these dental elements were fixed in 10% formaldehyde, processed automatically, submitted to histotechnical preparation, and stained with hematoxylin-eosin for analysis under optical microscope. RESULTS: The paired Fisher exact test (P ≤ .05) showed a significant increase of fibrous tissue in the experimental group. The nonparametric paired Wilcoxon test (P ≤ .05) showed a significant increase in the number of pulpal nodules in the elements of the experimental group and showed no difference in the number of blood vessels between the groups. Large-caliber vessels and congested elements were observed in 8 of the experimental group elements. CONCLUSIONS: The orthodontic intrusion force, in these conditions, caused vascular changes in the pulpal tissue and also increased the presence of fibrosis and the number of pulp calcifications in the experimental elements.
Asunto(s)
Diente Premolar/anatomía & histología , Pulpa Dental/anatomía & histología , Técnicas de Movimiento Dental/métodos , Adolescente , Fenómenos Biomecánicos , Niño , Colorantes , Pulpa Dental/irrigación sanguínea , Calcificaciones de la Pulpa Dental/patología , Dentina Secundaria/anatomía & histología , Femenino , Fibrosis , Estudios de Seguimiento , Técnicas de Preparación Histocitológica , Humanos , Masculino , Microvasos/anatomía & histología , Necrosis , Odontoblastos/patología , Pulpitis/patología , Estrés Mecánico , Extracción Dental , Adulto JovenRESUMEN
INTRODUCTION: A growing body of evidence is building a case for the possibility of tissue regeneration within the root canal of necrotic teeth, allowing for continued root development. However, it remains unknown what type of tissue is produced after regenerative endodontics. The purpose of this study was to use blood clots and platelet-rich plasma (PRP) as scaffolds in regenerative endodontics under ideal conditions in a ferret model to examine the tissues generated within the root canals. METHODS: The pulps of 21 canine teeth from 7 young ferrets were extirpated using broaches without filing the canal walls. Bleeding was stimulated from the periapical tissues, and a blood clot was induced in the canal space to the level of the cementoenamel junction in 12 teeth. PRP was prepared and placed in the canals to the level of the cementoenamel junction in 9 teeth. The coronal access was sealed with mineral trioxide aggregate. Seven canines were not operated on and served as controls. Three months later, block sections including each canine and its surrounding tissues were removed for histologic evaluation. The tissues found in the canals of experimental teeth were compared with those in the control teeth. RESULTS: Almost all of the experimental teeth showed the presence of intracanal bonelike tissue. No evidence of dentinal wall thickening or apical narrowing was noted in the experimental teeth. CONCLUSIONS: In this experimental model, the use of either PRP or blood clots during regenerative endodontics leads to the formation of intracanal bonelike tissue without continual root maturation.
Asunto(s)
Coagulación Sanguínea/fisiología , Diente Canino/anatomía & histología , Cavidad Pulpar/anatomía & histología , Plasma Rico en Plaquetas/fisiología , Andamios del Tejido , Compuestos de Aluminio/uso terapéutico , Animales , Compuestos de Calcio/uso terapéutico , Diente Canino/fisiología , Cavidad Pulpar/irrigación sanguínea , Cavidad Pulpar/fisiología , Dentina Secundaria/anatomía & histología , Dentina Secundaria/fisiología , Combinación de Medicamentos , Ácido Edético/uso terapéutico , Hurones , Fibroblastos/fisiología , Linfocitos/fisiología , Macrófagos/fisiología , Masculino , Modelos Animales , Odontogénesis/fisiología , Osteoblastos/fisiología , Osteoclastos/fisiología , Óxidos/uso terapéutico , Pulpectomía/métodos , Distribución Aleatoria , Regeneración/fisiología , Materiales de Obturación del Conducto Radicular/uso terapéutico , Irrigantes del Conducto Radicular/uso terapéutico , Silicatos/uso terapéutico , Factores de TiempoRESUMEN
AIM: The purpose of this in vivo study was to compare the effectiveness of a new light cured resin based dicalcium/tricalcium silicate pulp capping material (TheraCalLC, Bisco), pure Portland cement, resin based calcium hydroxide or glass ionomer in the healing of bacterially contaminated primate pulps. STUDY DESIGN: The experiment required four primates each having 12 teeth prepared with buccal penetrations into the pulpal tissues with an exposure of approximately 1.0 mm. The exposed pulps of the primate teeth were covered with cotton pellets soaked in a bacterial mixture consisting of microorganisms normally found in human pulpal abscesses. After removal of the pellet, hemostasis was obtained and the pulp capping agents applied. The light cured resin based pulp capping material (TheraCal LC) was applied to the pulpal tissue of twelve teeth with a needle tip syringe and light cured for 15 seconds. Pure Portland cement mixed with a 2% Chlorhexidine solution was placed on the exposed pulpal tissues of another twelve teeth. Twelve additional teeth had a base of GIC applied (Triage, Fuji VII GC America) and another twelve had a pulp cap with VLC DYCAL (Dentsply), a light cured calcium hydroxide resin based material. The pulp capping bases were then covered with a RMGI (Fuji II LC GC America). The tissue samples were collected at 4 weeks. The samples were deminerilized, sectioned, stained and histologically graded. RESULTS: There were no statistically significant differences between the groups in regard to pulpal inflammation (H = 0.679, P = 1.00). However, both the Portland cement and light cured TheraCal LC groups had significantly more frequent hard tissue bridge formation at 28 days than the GIC and VLC Dycal groups (H = 11.989, P = 0.009). The measured thickness of the hard tissue bridges with the pure Portland and light cured TheraCal LC groups were statistically greater than that of the other two groups (H = 15.849, P = 0.002). In addition, the occurrence of pulpal necrosis was greater with the GIC group than the others. Four premolars, one each treated according to the protocols were analyzed with a microCT machine. The premolar treated with the light cured TheraCal LC demonstrated a complete hard tissue bridge. The premolar treated with the GIC did not show a complete hard tissue bridge while the premolar treated with VLC Dycal had an incomplete bridge. The pure Portland with Chlorhexidine mixture created extensive hard tissue bridging. CONCLUSION: TheraCal LC applied to primate pulps created dentin bridges and mild inflammation acceptable for pulp capping.
Asunto(s)
Compuestos de Calcio/uso terapéutico , Exposición de la Pulpa Dental/tratamiento farmacológico , Pulpa Dental/efectos de los fármacos , Materiales de Recubrimiento Pulpar y Pulpectomía/uso terapéutico , Silicatos/uso terapéutico , Animales , Hidróxido de Calcio/uso terapéutico , Cebus , Clorhexidina/uso terapéutico , Pulpa Dental/microbiología , Recubrimiento de la Pulpa Dental/métodos , Exposición de la Pulpa Dental/microbiología , Necrosis de la Pulpa Dental/etiología , Dentina Secundaria/anatomía & histología , Fusobacterium nucleatum/fisiología , Cementos de Ionómero Vítreo/uso terapéutico , Curación por Luz de Adhesivos Dentales/métodos , Masculino , Porphyromonas gingivalis/fisiología , Pulpitis/etiología , Cementos de Resina/química , Cicatrización de Heridas/efectos de los fármacos , Microtomografía por Rayos X/métodosRESUMEN
INTRODUCTION: Biodentine is a new bioactive cement that is similar to the widely used mineral trioxide aggregate (MTA). It has dentin-like mechanical properties, which may be considered a suitable material for clinical indications of dentin-pulp complex regeneration such as direct pulp capping. The purpose of the present study was to compare the response of the pulp-dentin complex in human teeth after direct capping with this new tricalcium silicate-based cement with that of MTA. METHODS: Pulps in 28 caries-free maxillary and mandibular permanent intact human molars scheduled for extraction for orthodontic reasons were mechanically exposed and assigned to 1 of 2 experimental groups, Biodentine or MTA, and 1 control group. Assay of periapical response and clinical examination were performed. After 6 weeks, the teeth were extracted, stained with hematoxylin-eosin, and categorized by using a histologic scoring system. RESULTS: The majority of specimens showed complete dentinal bridge formation and an absence of inflammatory pulp response. Layers of well-arranged odontoblast and odontoblast-like cells were found to form tubular dentin under the osteodentin. Statistical analysis showed no significant differences between the Biodentine and MTA experimental groups during the observation period. CONCLUSIONS: Within the limitations of this study, Biodentine had a similar efficacy in the clinical setting and may be considered an interesting alternative to MTA in pulp-capping treatment during vital pulp therapy.
Asunto(s)
Compuestos de Aluminio/uso terapéutico , Compuestos de Calcio/uso terapéutico , Pulpa Dental/efectos de los fármacos , Óxidos/uso terapéutico , Materiales de Recubrimiento Pulpar y Pulpectomía/uso terapéutico , Silicatos/uso terapéutico , Adulto , Pulpa Dental/anatomía & histología , Recubrimiento de la Pulpa Dental/métodos , Exposición de la Pulpa Dental/terapia , Prueba de la Pulpa Dental , Dentina/efectos de los fármacos , Dentina Secundaria/anatomía & histología , Dentina Secundaria/efectos de los fármacos , Combinación de Medicamentos , Humanos , Odontoblastos/citología , Dimensión del Dolor , Tejido Periapical/efectos de los fármacos , Odontalgia/clasificación , Adulto JovenRESUMEN
INTRODUCTION: The health of human teeth depends on the integrity of the hard tissue and the activity of the pulp and periodontal tissues, which are responsible for nutritional supply. Without the nourishing of the pulp tissue, the possibility of tooth fracture can increase. In immature permanent teeth, root development may be influenced as well. This study explored the potential of using autologous dental pulp stem cells (DPSCs) to achieve pulp regeneration in a canine pulpless model. METHODS: The establishment of the pulpless animal model involved pulp extirpation and root canal preparation of young permanent incisor teeth in beagles. Autologous DPSCs were obtained from extracted first molars and expanded ex vivo to obtain a larger number of cells. The biological characteristics of canine DPSCs (cDPSCs) were analyzed both in vitro and in vivo by using the same method as used in human DPSCs. cDPSCs were transplanted into the pulpless root canal with Gelfoam as the scaffold, and root development was evaluated by radiographic and histologic analyses. RESULTS: cDPSCs with rapid proliferation, multiple differentiation capacity, and development potential were successfully isolated and identified both in vitro and in vivo. After they were transplanted into the pulpless root canal with Gelfoam as the scaffold, DPSCs were capable of generating pulp-like tissues containing blood vessels and dentin-like tissue. Thickening of the root canal wall was also observed. CONCLUSIONS: This study demonstrates the feasibility of using stem cell-mediated tissue engineering to realize pulp regeneration in immature teeth.
Asunto(s)
Pulpa Dental/citología , Odontogénesis/fisiología , Regeneración/fisiología , Células Madre/fisiología , Adolescente , Animales , Apexificación/métodos , Técnicas de Cultivo de Célula , Diferenciación Celular/fisiología , Proliferación Celular , Pulpa Dental/fisiología , Cavidad Pulpar/anatomía & histología , Cavidad Pulpar/cirugía , Dentina Secundaria/anatomía & histología , Perros , Durapatita/química , Estudios de Factibilidad , Esponja de Gelatina Absorbible/química , Humanos , Masculino , Células Madre Mesenquimatosas/clasificación , Células Madre Mesenquimatosas/fisiología , Ratones , Ratones SCID , Modelos Animales , Neovascularización Fisiológica/fisiología , Odontoblastos/fisiología , Trasplante de Células Madre/métodos , Andamios del Tejido/química , Raíz del Diente/crecimiento & desarrollo , Diente no Vital/cirugíaRESUMEN
This case series reports the outcomes of 8 patients (ages 9-4 years) who presented with 9 immature permanent teeth with pulpal necrosis and apical periodontitis. During treatment, 5 of the teeth were found to have at least some residual vital tissue remaining in the root canal systems. After NaOCI irrigation and medication with ciprofloxacin, metronidazole, and minocycline, these teeth were sealed with mineral trioxide aggregate and restored. The other group of 4 teeth had no evidence of any residual vital pulp tissue. This second group of teeth was treated with NaOCl irrigation and medicated with ciprofloxacin, metronidazole, and minocycline followed by a revascularization procedure adopted from the trauma literature (bleeding evoked to form an intracanal blood clot). In both groups of patients, there was evidence of satisfactory postoperative clinical outcomes (1-5 years); the patients were asymptomatic, no sinus tracts were evident, apical periodontitis was resolved, and there was radiographic evidence of continuing thickness of dentinal walls, apical closure, or increased root length.
Asunto(s)
Necrosis de la Pulpa Dental/terapia , Periodontitis Periapical/terapia , Ápice del Diente/fisiología , Adolescente , Compuestos de Aluminio/uso terapéutico , Antibacterianos/uso terapéutico , Apexificación/métodos , Compuestos de Calcio/uso terapéutico , Hidróxido de Calcio/uso terapéutico , Niño , Ciprofloxacina/uso terapéutico , Pulpa Dental/fisiología , Dentina Secundaria/anatomía & histología , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Metronidazol/uso terapéutico , Minociclina/uso terapéutico , Odontogénesis/fisiología , Óxidos/uso terapéutico , Regeneración/fisiología , Materiales de Obturación del Conducto Radicular/uso terapéutico , Irrigantes del Conducto Radicular/uso terapéutico , Preparación del Conducto Radicular/métodos , Silicatos/uso terapéutico , Hipoclorito de Sodio/uso terapéutico , Diente no Vital/terapia , Resultado del TratamientoRESUMEN
AIM: To report several types of response of immature permanent teeth with infected necrotic pulp tissue and either apical periodontitis or abscess to revascularization procedures. METHODOLOGY: Twenty immature permanent teeth with infected necrotic pulp tissue and either apical periodontitis or abscesses from 20 patients were included. The teeth were isolated with rubber dam, and pulp chambers was accessed through the crowns. The canals were gently irrigated with 5.25% sodium hypochlorite with minimal mechanical debridement. Calcium hydroxide was used as an inter-appointment intracanal medicament and placed into the coronal half of the canal space. After resolution of clinical signs and symptoms, bleeding was induced into the canal space from the periapical tissues using K-files. The coronal canal space was sealed with a mixture of mineral trioxide aggregate (MTA) and saline solution. The access cavity was filled with composite resin. These immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscesses were followed up from 6 to 26 months. RESULTS: Five types of responses of these immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures were observed: type 1, increased thickening of the canal walls and continued root maturation; type 2, no significant continuation of root development with the root apex becoming blunt and closed; type 3, continued root development with the apical foramen remaining open; type 4, severe calcification (obliteration) of the canal space; type 5, a hard tissue barrier formed in the canal between the coronal MTA plug and the root apex. CONCLUSIONS: Based on this case series, the outcome of continued root development was not as predictable as increased thickening of the canal walls in human immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess after revascularization procedures. Continued root development of revascularized immature permanent necrotic teeth depends on whether the Hertwig's epithelial root sheath survives in case of apical periodontitis/abscess. Severe pulp canal calcification (obliteration) by hard tissue formation might be a complication of internal replacement resorption or union between the intracanal hard tissue and the apical bone (ankylosis) in revascularized immature permanent necrotic teeth.
Asunto(s)
Apexificación/métodos , Necrosis de la Pulpa Dental/terapia , Absceso Periapical/terapia , Periodontitis Periapical/terapia , Adolescente , Compuestos de Aluminio/uso terapéutico , Compuestos de Calcio/uso terapéutico , Hidróxido de Calcio/uso terapéutico , Niño , Resinas Compuestas/química , Materiales Dentales/química , Calcificaciones de la Pulpa Dental/patología , Restauración Dental Permanente/métodos , Dentina Secundaria/anatomía & histología , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neovascularización Fisiológica/fisiología , Odontogénesis/fisiología , Óxidos/uso terapéutico , Tejido Periapical/irrigación sanguínea , Materiales de Obturación del Conducto Radicular/uso terapéutico , Irrigantes del Conducto Radicular/uso terapéutico , Preparación del Conducto Radicular/métodos , Silicatos/uso terapéutico , Hipoclorito de Sodio/uso terapéutico , Ápice del Diente/patología , Raíz del Diente/patología , Resultado del TratamientoRESUMEN
OBJECTIVES: The best possible methods and materials in stepwise excavation for deep caries in permanent teeth were investigated. The review considers the questions from many aspects including clinical success, effects of reducing cariogenic bacteria, possibility of hardening softened dentin, and likelihood of generating tertiary dentin. DATA: This systematic review includes the use of data from randomized controlled trials, controlled clinical trials as well as from case series in which pulp exposure resulted following the treatment and removal of deep caries. Only studies of caries in permanent teeth were considered. Those involving treatment of primary teeth were excluded. SOURCES: An electronic search was conducted in the databases of MEDLINE and Igaku Chuo Zasshi (Japanese) from 1970 to 2008. The electronic search was supplemented by a manual search of the references lists of all the relevant studies. STUDY SELECTION: The electronic and manual searches of journals retrieved a total of 266 English and 130 Japanese papers. According to the inclusion and exclusion criteria, 10 English and 3 Japanese studies were finally identified. CONCLUSION: Our research suggests that stepwise excavation is effective for pulp preservation in extremely deep caries that do not show clinical symptoms of irreversible pulpitis. Calcium hydroxide, as well as antimicrobials and polycarboxylate cement combined with tannin-fluoride preparation, is effective in reducing bacteria and promoting remineralization of the carious dentin that remained after stepwise excavation. Further clinical trials with a high level of study design should be conducted to identify the best methods of removing carious dentin using stepwise excavation.
Asunto(s)
Caries Dental/terapia , Preparación de la Cavidad Dental/métodos , Pulpa Dental/fisiología , Ensayos Clínicos Controlados como Asunto , Caries Dental/microbiología , Recubrimiento de la Pulpa Dental/métodos , Exposición de la Pulpa Dental/terapia , Dentina/patología , Dentina Secundaria/anatomía & histología , Humanos , Materiales de Recubrimiento Pulpar y Pulpectomía/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
This article reports a case of preserving pulp vitality combined with aesthetics and functional reconstruction of an immature permanent molar extensively destroyed because of a carious lesion. After a pulpotomy using calcium hydroxide, the tooth crown was restored by bonding a dental fragment obtained from an extracted tooth from another individual. Aspects of diagnosis and treatment that directly affect the prognosis of the techniques are discussed. Radiographic and clinical follow-up for two years showed complete root development and a very satisfactory restoration with regard to aesthetics and function.
Asunto(s)
Caries Dental/terapia , Esmalte Dental , Diente Molar/patología , Pulpotomía/métodos , Ápice del Diente/patología , Grabado Ácido Dental/métodos , Adolescente , Apexificación/métodos , Compuestos de Boro/química , Hidróxido de Calcio/uso terapéutico , Preparación de la Cavidad Dental/métodos , Cementos Dentales/química , Esmalte Dental/patología , Restauración Dental Permanente/métodos , Dentina Secundaria/anatomía & histología , Estética Dental , Estudios de Seguimiento , Cementos de Ionómero Vítreo/química , Humanos , Metacrilatos/química , Metilmetacrilatos/química , Materiales de Recubrimiento Pulpar y Pulpectomía/uso terapéutico , Cementos de Resina/química , Corona del Diente/patologíaRESUMEN
Aim: To evaluate the treatment with corticosteroid/antibiotic dressing in pulpotomy with calciumhydroxide. Methods: Forty-six premolars were pulpotomized and randomly assigned into 3groups. In Group I pulpal wound was directly capped with calcium hydroxide, and Group II and Group III received corticosteroid/antibiotic dressing for 10 min or 48 h, respectively, before pulp capping. Teeth were processed for histological analysis after 7, 30 or 60 days to determine inflammatory cell response, tissue disorganization, dentin bridge formation and presence of bacteria.Attributed scores were analyzed by Kruskal-Wallis and Mann-Whitney tests (á=0.05). Results:On the 7th day, all groups exhibited dilated and congested blood vessels in the tissue adjacent to pulpal wound. The inflammatory cell response was significantly greater in Group III (p<0.05). On the 30th day, in all groups, a thin dentin matrix layer was deposited adjacent to the pulpal wound and a continuous odontoblast-like cell layer underlying the dentin matrix was observed. On the60th day, all groups presented a thick hard barrier characterized by an outer zone of dystrophic calcification and an inner zone of tubular dentin matrix underlined by a defined odontoblast-like celllayer. Conclusions: Within the limitations of present study, considering that the treatment was performed in healthy teeth, it may be concluded that the use of a corticosteroid/antibiotic dressing before remaining tissue protection with calcium hydroxide had no influence on pulp tissue healing.
Asunto(s)
Humanos , Niño , Adolescente , Corticoesteroides/farmacología , Hidróxido de Calcio/farmacología , Recubrimiento de la Pulpa Dental/métodos , Pulpa Dental/efectos de los fármacos , Técnicas In Vitro , Necrosis de la Pulpa Dental , Pulpa Dental/anatomía & histología , Pulpa Dental/microbiología , Dentina Secundaria/anatomía & histología , Pulpotomía/métodos , Estadísticas no Paramétricas , Factores de TiempoRESUMEN
INTRODUCTION: Racial variations in root form and canal anatomy present endodontic challenges for clinicians. This study examined root canal morphology of three-rooted mandibular first molars by micro-computed tomography scans. METHODS: A total of 122 extracted mandibular first molars were collected from a native Chinese population. After calculating the frequency of occurrence, 20 three-rooted (experimental group) and 25 two-rooted first molars (control group) were scanned and reconstructed three-dimensionally. RESULTS: The frequency of three-rooted mandibular first molars was 31.97% (39/122). The mean interorifice distances from the distolingual (DL) canal to the distobuccal (DB) and mesiolingual canal were 2.93 mm and 2.86 mm, respectively. The mesial root predominately contained a type 2-2 root canal, with an incidence of 65% in the experimental group and 64% in the control group. Type 1-1 canals were seen more frequently in the DL and DB roots of the three-rooted first molars as well as in the distal roots of the two-rooted first molars. The incidences were 100% (20/20), 95% (19/20), and 72% (18/25), respectively. Accessory and lateral canals rarely occurred in the extra DL roots. The incidence was only 10% (2/20). A furcation canal extending from the floor to the furcation region was not observed. CONCLUSION: Three-rooted mandibular first molars commonly have 4 separate canals with high incidences of accessory canals in the mesial and DB root. The geometric data of pulp floors are useful for locating the extra DL canal.
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Cavidad Pulpar/anatomía & histología , Pulpa Dental/anatomía & histología , Mandíbula/anatomía & histología , Diente Molar/anatomía & histología , Raíz del Diente/anatomía & histología , Adolescente , Adulto , Factores de Edad , Anciano , China , Dentina Secundaria/anatomía & histología , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Microtomografía por Rayos X/métodos , Adulto JovenRESUMEN
OBJECTIVES: To analyse the influence of the degree of dentine mineralization on the pulp chamber temperature increase during composite light-activation. METHODS: Dentine discs (2mm thick) obtained from recently extracted teeth or those with extensive dentine sclerosis were analysed by FT-IR spectrometry in order to choose the two discs with the greatest difference in the degree of mineralization. A model tooth was set up with the dentine discs between a molar with the pulp chamber exposed and a crown with a standardized class II cavity. A K-type thermocouple was introduced into the molar root until it came into contact with the dentine discs and the cavity was filled with P60 resin composite. The temperature rise was measured for 120s after light-activation began: Standard (S) 600 mW/cm(2)/40s; Ramp (R) 0-->800 mW/cm(2)/10s+800 mW/cm(2)/10s; Boost (B) 85 0mW/cm(2)/10s and LED (L) 1.300 mW/cm(2)/40s (n=10). The same protocol was repeated after grinding the dentine discs to 1.0 and 0.5mm thickness. RESULTS: The temperature increase was significantly higher in dentine with high degree of mineralization (p<0.05). With respect to the dentine thickness, the following result was found: 2mm<1mm<0.5mm (p<0.05). The light-activation mode also presented significant difference as follows: S>R=L>B (p<0.05). CONCLUSIONS: The higher the degree of dentine mineralization the greater the increase in pulp chamber temperature. The temperature increase was influenced by the light-polymerization mode and dentine thickness.
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Temperatura Corporal/fisiología , Resinas Compuestas/efectos de la radiación , Materiales Dentales/efectos de la radiación , Cavidad Pulpar/fisiología , Dentina Secundaria/fisiología , Dentina/fisiología , Calcificación de Dientes/fisiología , Resinas Compuestas/química , Luces de Curación Dental , Preparación de la Cavidad Dental , Materiales Dentales/química , Pulpa Dental/fisiopatología , Exposición de la Pulpa Dental/fisiopatología , Dentina/anatomía & histología , Dentina Secundaria/anatomía & histología , Humanos , Dosis de Radiación , Espectroscopía Infrarroja por Transformada de Fourier , Termómetros , Factores de TiempoRESUMEN
INTRODUCTION: Optical coherence tomography (OCT), a noninvasive imaging method, was used in this work to image the pulp-dentin complex. Pulp and dentin are integrally connected in the sense that physiologic and pathologic reactions in one of the tissues will also affect the other. METHODS: An OCT system with 6-mum spatial resolution at 800 nm was used to image the pulp-dentin complex of in vitro samples. Five intact human maxillary premolars scheduled for surgical extraction were used in this in vitro study. The occlusal surfaces of teeth were polished with wet 600-, 1,000-, and 1,200-grit aluminum oxide abrasive paper perpendicular to the long axis of teeth, producing a plane on that surface. The images of pulp-dentin complex were taken by scanning the occlusal surface in a mesiodistal direction. The laser penetrated into the teeth structure and a tomographic image of pulp-dentin complex, parallel to the long axis of teeth, was obtained. Histological and OCT images were analyzed and compared. RESULTS: The results showed the capability of the OCT technique to generate images of the boundaries of pulp and its relation to the dentin. It could be clearly seen that the OCT image provided the insight into dentinal substrate about 0.65-mm deep (corrected for the dentin refractive index). CONCLUSION: OCT can be used in the future to prevent iatrogenic exposures of the pulp, complementing other existing methods, and will permit a more predictive prognosis of treatments.
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Pulpa Dental/diagnóstico por imagen , Dentina/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Adolescente , Pulpa Dental/anatomía & histología , Dentina/anatomía & histología , Dentina Secundaria/anatomía & histología , Dentina Secundaria/diagnóstico por imagen , Humanos , Adhesión en Parafina , RadiografíaRESUMEN
The purpose of this study was to compare clinical, radiographic, and histopathologic effects of Nd:YAG laser pulpotomy to formocresol pulpotomy on human primary teeth. Patients with at least two vital primary molar teeth that required pulpotomy, because of pulpal exposure to caries, were selected for this study. After hemorrhage control, complete hemostasis into the canal orifice was achieved by exposure to Nd:YAG laser (1064 nm) and an He-Ne laser (the aiming beam of the Nd:YAG laser) in noncontact mode at 2 W, 20 Hz, 100 mJ, or was achieved by applying 1:5 dilution of formocresol. Forty-two teeth in two groups were to be followed up clinically and radiographic at 1, 3, 6, 9, and 12 months. Eighteen teeth planned for serial extractions were selected for histopathologic study. The teeth were extracted at 7 and 60 days. The teeth in the laser group had a clinical success rate of 85.71% and a radiographic success rate 71.42% at 12 months. The teeth in the formocresol group had a clinical and radiographic success rate of 90.47% at 12 months. There were no statistically significant differences between laser and formocresol group with regard to both clinical and radiographic success rates. There was a statistically significant difference between 7- and 60-day laser groups with regard to inflammatory cell response criteria. Dentin bridge was absent in all samples. No stained bacteria were observed in any of these samples. In conclusion, Nd:YAG laser may be considered as an alternative to formocresol for pulpotomies in primary teeth.
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Terapia por Láser , Pulpotomía/métodos , Diente Primario/patología , Silicatos de Aluminio , Bacterias/aislamiento & purificación , Niño , Caries Dental/terapia , Exposición de la Pulpa Dental/terapia , Dentina Secundaria/anatomía & histología , Femenino , Estudios de Seguimiento , Formocresoles/uso terapéutico , Técnicas Hemostáticas , Humanos , Masculino , Diente Molar/diagnóstico por imagen , Diente Molar/patología , Neodimio , Enfermedades Periapicales/diagnóstico por imagen , Radiografía , Resorción Radicular/diagnóstico por imagen , Diente Primario/diagnóstico por imagen , Resultado del Tratamiento , ItrioRESUMEN
The literature provides linear regression formulas for dental age estimation that is based on radiological two-dimensional measurements of the pulp size. The aim of the present study was to explore whether the previously presented regression formulas could lead to statistically sound results and to appropriate repeatability when applied to young individuals. Orthopantomograms (OPGs) of 44 Austrian individuals, aged between 13 and 24 years, were selected at random. In accordance with the reported method, six teeth on each OPG were chosen to carry out the measurements. Statistical analysis was performed in order to assess the difference between the estimated and the true chronological age. The regression formulas reported by Kvaal et al. (1995) led to a consistent underestimation; the regression formulas reported by Paewinsky et al. (2005) resulted in a constant overestimation of age. The statistical analysis of intraobserver and interobserver variation revealed a variation width below 2%, respectively.
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Determinación de la Edad por los Dientes/métodos , Dentina Secundaria/anatomía & histología , Radiografía Panorámica , Adolescente , Adulto , Austria , Pulpa Dental/anatomía & histología , Femenino , Odontología Forense/métodos , Humanos , Modelos Lineales , Masculino , Variaciones Dependientes del Observador , Diente/anatomía & histología , Raíz del Diente/anatomía & histologíaRESUMEN
We examined the biological effects of porcine enamel matrix derivative (EMD; Emdogain) on the formation of reparative dentine and dentine bridges in rat molars after pulp amputation. The pulp chambers of upper molars of Wistar rats were perforated and the amputated pulp surfaces were directly capped with either EMD or its carrier propylene glycol alginate (PGA) as control. The cavities were then restored with glass-ionomer cement. On post-amputation days 4-30, the dissected maxillae were examined by light and electron microscopy. In PGA-capped pulp, reparative dentine had been formed over the dentine walls under the prepared cavity on day 7 post-amputation and its thickness extended until day 30. On day 30, as well as reparative dentine formation, diffuse calcification had occurred beneath the amputated wound surfaces. Dentine bridge formation under the amputated coronal pulp surface was observed in 18.2% of amputated pulp on day 30. In EMD-capped pulp, reparative dentine had already been formed by odontoblast-like cells over the dentine walls, already on day 4 post-amputation, and its thickness extended until day 30. The Ca and P weight % and Ca/P ratio of reparative dentine matrix were similar to those of pre-existing dentine matrix, and these values were not different between PGA and EMD-capped pulp. Dentine bridge formation was observed in 27.3% of EMD-capped pulp on day 30. Our results suggest that EMD enhances the formation of both reparative dentine and dentine bridges during wound healing of amputated rat molar pulp.