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OBJECTIVES: To determine the clinical performance of light-cured calcium silicate-based cement for direct or indirect pulp capping. The research question was as follows: in teeth with deep caries lesions, does the use of resin-modified calcium silicate-containing composites improve the radiological success and prevent irreversible pulpitis and pulpal necrosis compared with other pulp-capping agents? MATERIALS AND METHODS: The following databases were screened until September 2021: PubMed, Web of Science, Scielo, Scopus, Embase, and The Cochrane Library. Randomized clinical trials reporting the clinical evaluation of a resin-modified calcium silicate material as an agent for pulp therapy were included. Meta-analysis was performed using the Rev Manager v5.4.1 software. The risk difference and 95% confidence interval of the dichotomous outcome (restoration failure or success) were calculated for comparison. RESULTS: Ten studies were considered for qualitative analysis and meta-analysis. Studies evaluating the performance of light-cured calcium silicate-based cement from 1 month to a maximum follow-up period of 36 months and comparing it with the performance of CaOH, mineral trioxide aggregate, or Biodentine were included. In the global analysis for direct pulp capping at 6-month follow-up, no statistical differences were observed between the experimental group using the light-cured calcium silicate-based cement and control group (P = .28). However, at 12-month follow-up, global analysis favored the control group (P < .001). For indirect pulp capping, at 6- and 24-month follow-ups, no statistically significant differences were observed between the experimental and control groups (P = .88; P = .21). CONCLUSIONS: Light-cured calcium silicate-based cement showed a limited clinical performance as a direct pulp capping agent, especially when evaluated in the long term. However, using it as an indirect pulp capping agent may be a reliable and easy-to-use option for restoring teeth with deep caries. CLINICAL SIGNIFICANCE: This systematic review provides evidence that supports the use of light-cured calcium silicate-based cement as an indirect pulp capping agent.

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Objetivo: Describir el tratamiento de un paciente que pre- sentó un incisivo superior permanente con exposición pulpar y desarrollo radicular incompleto utilizando Biodentine como material para la protección pulpar directa. Caso clínico: Un paciente de 9 años fue derivado para la evaluación y el tratamiento del diente 11. El examen clínico y radiográfico reveló la presencia de una fractura amelodentinaria, con exposición pulpar y desarrollo radicular incompleto. Luego de lavar y desinfectar el área de la fractura, se protegió la pulpa expuesta con Biodentine y se restauró la cavidad. El paciente fue citado para control a los 18 y 25 meses. En los controles se comprobó que el diente se mantuvo asintomático y funcional. Luego de 25 meses, el examen clínico y radiográfico confirmó la presencia de pulpa vital y el completo desarrollo del remanente radicular. Los resultados obtenidos en el presente caso clínico sugieren que el empleo de Biodentine puede ser considerado como una valiosa alternativa para la protección de la pulpa ex- puesta en dientes con desarrollo radicular incompleto (AU)

Aim: To describe the treatment of a patient that presented a permanent maxillary central incisor with pulp exposure and incomplete root formation, using Biodoentine as the material for direct pulp protection. Clinical case A 9-year-old male patient was referred for evaluation and treatment of tooth 11. The clinical and radio-graphic examination revealed the presence of a dentinoe- namel fracture, with pulp exposure and incomplete root for- mation. After cleaning and disinfecting the area, the exposed pulp was protected with Biodentine and the cavity was re- stored. The patient was scheduled for control after 18 and 25 months. In these evaluations, it was confirmed that the tooth remained asymptomatic and functional. After 25 months, the clinical and radiographic examination showed the presence of vital pulp and a completed development of the root. The obtained results of this clinical case suggest that Biodentine can be considered a valuable alternative for pulp capping in teeth with incomplete root formation (AU)

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BACKGROUND: Dental trauma, restorative operative procedures and/or caries lesions can expose the dental pulp. Facing this clinical condition, where the maintenance of the dentin-pulp complex vitality is imperative, is challenging in Dentistry. Dental pulp stem cells conditioned medium contains trophic factors that could help in this task. This in vivo pilot study aimed to evaluate the effects of the human dental pulp stem cells conditioned medium on the dental pulp tissue response to vital pulp therapy. MATERIAL AND METHODS: Concentrated conditioned medium was obtained by incubating characterized human dental pulp stem cells with fresh culture medium. Pulp exposures performed at the first upper molars (n = 20) of Wistar rats were directly capped with: MTA or MTA + Conditioned Medium. Four and 8 weeks later, the samples were qualitatively analyzed in histological sections (H&E). RESULTS: When the conditioned medium was associated with MTA, there were a high percentage of samples presenting formation of dentin bridges and small percentage of pulp tissue with inflammatory signs in both experimental times. The conditioned medium improved the organization of the newly formed hard tissue. CONCLUSIONS: The association of dental pulp stem cell conditioned medium with MTA showed beneficial effects on dentin-pulp complex regeneration and has promising potential for studies in regenerative dentistry.

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OBJECTIVE: To summarize the clinical/radiographic outcomes from the evidence of studies published since 1988 on different DPC agents applied on vital pulp-exposed primary teeth. METHODS: The following electronic databases were searched: PubMed, Embase, Cochrane Library, Dentistry and Oral Science Source, and Google Scholar. Inclusion criteria were randomized controlled trials (RCTs) published between January 1988 and December 2019, with at least 6 months of follow-up, comparing the clinical and radiographic success rates of two or more DPC agents applied in primary teeth with cariously and non-cariously exposed pulp. RESULTS: Initial searches identified 83 potentially relevant studies on DPC in primary teeth. Sixty-four of these studies were excluded, whereas 19 articles satisfied the inclusion criteria and were retrieved in full text for data extraction and a methodological quality assessment. Finally, 12 of these articles were included in the systematic review. Low and moderate risks of bias were observed. Overall, DPC clinical and radiographic success rates among the selected studies ranged between 53% and 100%. CONCLUSIONS: For DPC in primary teeth, this systematic review found that diverse new biologically and compatible agents with promising success rates are currently available for paediatric dentistry practitioners. There is no evidence that justifies discarding the judicious use of DPC procedures in primary teeth.

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Abstract The purpose of this study was to evaluate the inflammatory process following direct pulp capping during pregnancy. This experimental study involved 48 maxillary first molars of female Wistar rats. The procedures were performed in pregnant and non-pregnant animals (n =20 each). Direct pulp capping with mineral trioxide aggregate (MTA) and restoration with a light-cured resin composite was performed in half of exposed pulp specimens. In the other half of specimens, light-cured composite was placed directly on the exposed pulp. In the control groups (n=4 each), no intervention was performed. Animals were euthanized at 3 and 7 days. All sections (three per slide) were viewed under an optical microscope. One previously calibrated pathologist performed descriptive analysis and assigned scores for inflammatory response and tissue organization adjacent to the pulp exposure. The Kappa value for intra-examiner variability was 0.91. At 3 days, in animals treated with MTA, inflammatory infiltrate was absent in non-pregnant animals while mild inflammatory infiltrate was observed in some pregnant animals. The inflammatory response ranged from mild to severe in both groups treated with composite alone. At 7 days, the inflammatory response was more intense in pregnant than in non-pregnant animals treated with MTA; while this difference were not evident in animals treated with composite alone. In conclusion, pregnancy may not influence the inflammatory process following direct pulp capping with light-cured resin composite, which was always harmful to the pulp; while the tissue response after the direct pulp with MTA were more favorable in non-pregnant animals.

Resumo O objetivo deste estudo foi avaliar o processo inflamatório do tecido pulpar após o capeamento pulpar direto, realizado durante a gestação. Este estudo experimental envolveu 48 primeiros molares superiores de ratos Wistar fêmeas. Os procedimentos foram realizados em animais prenhes e não prenhes (n=20). Após as exposições pulpares, o capeamento pulpar direto foi efetuado com agregado trióxido mineral (MTA) ou restauração direta com resina composta. Nos grupos controle (n=4), nenhuma intervenção foi realizada. Os animais foram submetidos à eutanásia após 3 e 7 dias. Todos os cortes foram avaliados através de um microscópio ótico. Um patologista previamente calibrado realizou analise histológica descritiva e estabeleceu escores para intensidade da resposta inflamatória e para o grau de organização tecidual na região adjacente à exposição pulpar. O valor de Kappa intra-examinador foi 0,91. No período experimental de 3 dias, nos animais tratados com MTA, o infiltrado inflamatório estava ausente nos não prenhes, enquanto infiltrado inflamatório moderado estava presente nos animais prenhes. A resposta inflamatória variou de moderada a severa em ambos os grupos tratados apenas com resina composta. Após o periodo experimental de 7 dias, a resposta inflamatória foi mais intensa nos animais prenhes que nos não prenhes do grupo do MTA, enquanto esta diferença não foi tão evidente nos animais que receberam capeamento pulpar direto com resina composta. Pode-se concluir, que a gestação pode não exercer influência no processo inflamatório do tecido pulpar após proteção pulpar direta com resina composta; a qual foi sempre danosa aos tecidos pulpares. No entanto, a resposta tecidual ao capeamento pulpar com MTA foi mais favorável nos animais não prenhes.

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Objetivos: Evaluar la utilidad de un modelo animal mamífero como la cabra, a fin de estudiar biomateriales indicados para protección pulpar directa. Materiales y métodos: Bajo anestesia general, se realizaron exposiciones pulpares en las caras vestibulares de los ocho incisivos inferiores de cuatro (n=4) cabras de raza criolla. En cada animal, 6 (n=6) exposiciones fueron protegidas con un material experimental (ACPc), y las 2 (n=2) restantes, con un material de control a base de MTA (WMTA). En total se realizaron 24 (n=24) protecciones con ACPc y 8 (n=8) con WMTA. Las cabras fueron separadas en dos grupos de dos (n=2) animales cada uno. Bajo anestesia general, los dientes se extrajeron a los 30 (Grupo 1) y 60 días (Grupo 2), se fijaron en formol búffer fosfato al 10% y se procesaron para el estudio histológico de rutina. Los animales no fueron sacrificados. En cada período, se analizaron 12 (n=12) protecciones pulpares con ACPc y 4 (n=4) con WMTA. Resultados: Grupo 1: Once (n=11) pulpas protegidas con ACPc presentaron puente dentinario completo e inflamación crónica remanente. En un caso no hubo puente dentinario y la pulpa estaba crónicamente inflamada. Las 4 (n=4) pulpas protegidas con WMTA presentaron puente dentinario e inflamación crónica. Grupo 2: Las 12 (n=12) pulpas protegidas con ACPc se encontraban normales, con puente dentinario completo, buena irrigación y capa de odontoblastos continua. Las 4 (n=4) pulpas protegidas con WMTA revelaron condiciones similares. Los resultados se analizaron mediante el test de probabilidad exacta de Fischer (P<0,05). Con respecto al factor inflamación, hubo diferencias significativas (P<0,001) entre los resultados obtenidos a 30 y 60 días, pero no hubo diferencias entre ACPc y WMTA (P>0,05) dentro de cada uno de los períodos de observación. En cuanto a la presencia de puente dentinario, no hubo diferencias significativas (P>0,05) entre ACPc y WMTA en ambos períodos de observación. Conclusiones: Los resultados sugieren que la cabra constituye un modelo animal adecuado para los ensayos de protección pulpar directa (AU)

Aim: To evaluate the suitability of the goat as an animal model for the study of biomaterials indicated for direct pulp capping. Materials and methods: Under general anaesthesia, pulp exposures were performed on the buccal surfaces of the eight mandibular incisors of four (n=4) healthy Creole goats. The exposures were capped with two biomaterials developed for PPD. In each animal, 6 (n=6) exposures were capped with an experimental material (ACPc) while for the remaining 2 (n=2) exposures a white MTA (WMTA) was used as the control. A total of 24 (n=24) direct pulp capping with ACPc and 8 (n=8) with WMTA were done. The goats were separated into two groups of two (n=2) animals each. The teeth were extracted after 30 days (Group 1) and 60 days (Group 2) and fixed in 10% phosphate buffered formalin and processed for routine histology. The animals were not euthanized. In each period, 12 (n=12) PPD with ACPc and 4 (n=4) with WMTA were analyzed. Results: Group 1: Eleven (n=11) pulps capped with ACPc showed complete dentin bridges and chronic inflammation. In one case without dentin bridges the pulp was chronically inflamed. The four pulps capped with WMTA revealed the presence of dentin bridges and chronic inflammation. Group 2: Twelve pulps protected with ACPc showed a complete dentin bridges. In addition, well irrigated and healthy pulp tissues along with a continuous odontoblast palisade were observed. The four pulps capped with WMTA revealed similar features. In cases showing dentin bridges, a few numbers of empty spaces as well as odontoblast like cell inclusions were detected. The results were analyzed by the Fisher's exact test (P<0.05). With respect to the inflammation factor there were significant differences between the 30 and 60-day observation periods (P<0.001), but no differences were observed between ACPc and WMTA (P>0.05) within each of the observation periods. When the presence or absence of a dentin bridges was analyzed, no significant differences (P>0.05) were found between materials at each observation period. Conclusions: The results suggest that the goat seems to be an appropriate animal model for direct pulp capping evaluation (AU)

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