Vitality of the dentin-pulp complex in health and disease: Growth factors as key mediators.  |  Hilton TJ. Zhu C, Ju B, Ni R. Clinical outcome of direct pulp capping with MTA or calcium hydroxide: a systematic review and meta-analysis. Pulp capping of carious exposures: Treatment outcome after 5 and 10 years: A restrospective study. Mineral trioxide aggregate (MTA) and calcium hydroxide as pulp-capping agents in human teeth: A preliminary report. Pulpal response to a resin-modified glass-ionomer material on non-exposed and exposed monkey pulps. Eugenol is highly cytotoxic.54–57 It is known that ZOE releases eugenol in concentrations that are cytotoxic.56,58–60 ZOE also demonstrates high interfacial leakage.61 Although it has been noted that this leakage is not important since ZOE can provide a biologic seal due to the eugenol release, it must be kept in mind that eugenol release drops dramatically with time,58 and it is anticipated that the effectiveness of ZOE in excluding bacteria is reduced the longer it is in place in the mouth. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. The clinician is often unaware of the coexistence of possible pulp pathology at the time of damage to the pulpal wall. NLM DPC for small non-contaminated pulp exposures using either TheraCal or MTA were … (2013) Comparison of CaOH with MTA for direct pulp capping: a PBRN randomized clinical trial. Mechanisms of cytotoxicity of eugenol in human osteoblastic cells in vitro. It is known that a variety of proteins are incorporated into the dentin matrix during dentinogenesis. 2015;8(10):17055-17060. Copyright: © 2009 This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL. En, This study was to compare the success of resin-modified Portland cement-based material (TheraCal) with MTA in direct pulp capping (DPC) of primary molars. Professor E. E. J. Kirk, Department of Conservative Dentistry, University of Otago Schooi of Dentistry, PO Box 647, Dunedin, New Zealand. Try to avoid exposing the pulp. Key words: direct pulp capping, primary teeth, re-versible pulpitis, vital methods Direct pulp capping is a method of treatment of in-flammation diseases of the pulp in their reversible stage. Clinical success rates for compared materials are presented in Table 2. Once bacterial invasion encroaches on the pulp, serious and adverse pulpal reactions ensue.16–19 Therefore, one of the crucial principles, and one that will be reiterated throughout this article, is that the key to pulp survival after capping is a well-sealed restoration.20–25, However, it must be kept in mind that pulp is a soft tissue, and similar to other soft tissues in the body, it will react to a noxious stimulus with an inflammatory response. Oper Dent 34:615–625 CrossRef PubMed PubMedCentral. Community Dentistry and Oral Epidemiology. DPC in primary teeth has had limited application due to dwindling success rates. 24 0. 2014;8(1):95-99. Pertinent citations contained in the full-length articles were used as sources for additional review. Cytotoxic effects and pulpal response caused by a mineral trioxide aggregate formulation and calcium hydroxide. No specific criteria were applied a priori as to what articles would be accepted into this review. The comparative antimicrobial effect of calcium hydroxide. 1997 Sep-Oct;64(5):327-33. The handling characteristics of the powder-liquid MTA are very different from the typical paste-paste formulations of calcium hydroxide that most practitioners find easy to handle. Review Article Indirect and Direct Pulp Capping: Reactionary vs. Reparative Dentins Michel Goldberg* Department of Oral Biology, Paris Cité University, France Abstract Pulp therapies aiming to keep alive the dental pulp use either indirect (IPT) or direct procedures (DPC). The aim of this article is to summarize and discuss various pulp capping materials. On the basis of the literature to date, it would appear that MTA's success is likely due to the fact that it serves as a reservoir for calcium hydroxide and/or its capacity to provide a seal at the site of the pulp exposure. WHAT IS PULP CAPPING? Current status of pulp capping with dentin adhesive systems: A review. Direct capping of human pulps with a dentin bonding system or with calcium hydroxide cement. Int J Clin Pediatr Dent 2019;12(5):437–444. Check prices and reviews of quality Pulp Capping dental clinics in SS23, rated 4.6 over 5 from 1 verified reviews by our community medical support network. Biocompatibility of surface-sealed dental materials against exposed pulps. Hebrew]. Sign in. We searched the Cochrane Library, PubMed via MEDLINE, and EMBASE as well as the reference lists of included reports and ClinicalTrials.gov (for ongoing trials). Unsuccessful treatments: Clinical symptoms and sometimes changes in the X-ray: 3 with grey MTA, 2 with white MTA. Using mineral trioxide aggregate as a pulp-capping material. Carrotte PV, Waterhouse PJ. Oper Dent 2009; 34: 615–625. Evaluation of a dentin barrier test by cytotoxicity testing of various dental cements. When compared to these paste-paste formulations of calcium hydroxide, MTA is very expensive. The type of liner is less important to success than the placement of a well-sealed restoration.20,34,36–41 In addition, partial caries removal significantly reduces the chance of pulp exposure during caries excavation.22,42 These findings are confirmed by two thorough systematic reviews that concluded the following: partial caries removal reduced the risk of pulp exposure by 98% compared to complete caries excavation in teeth with deep caries; there is no evidence that partial caries removal is detrimental in terms of signs, symptoms, pulpitis occurrence or restoration longevity; there is substantial evidence that complete caries removal is not needed for success provided the restoration is well sealed.24,43. Based on the application, the global pulp and root repair market is segmented into root canal treatment, pulp capping, pulpotomy, and others. Partial caries removal and cariostatic materials in carious primary molar teeth: A randomised controlled clinical trial. NIH 29. Pulp capping of carious exposures: treatment outcome after 5 and 10 years: a retrospective study. State oi the pulp In 1959, Shroff (7) published an article "to show that the pulp normally possesses the power of heal-ing its exposed surface by the production of a calci- First made with different materials, it was a resounding success. Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial | springermedizin.de Skip to main content Systemic evaluation of various haemostatic agents following local application prior to direct pulp capping. Evaluation of antibacterial effects of pulp capping agents with direct contact test method. This systematic review and meta-analysis aim to determine whether the effect of mineral trioxide aggregate (MTA) and calcium hydroxide for direct pulp capping is different, as measured by the clinical and radiographic analysis. Oper Dent. The effect of stage root development and associated luxation injury. Certainly, the results of pulp capping studies using MTA are encouraging. Long-term clinical assessment of direct pulp capping. Direct capping is effective when it is carried out on a pulp exposure, revealing an initial opening of a pulp horn, and accompanied with bacterial invasion. The radiographic outcomes of direct pulp-capping procedures performed by dental students. A histopathologic study of direct pulp-capping with adhesive resins. We used 60 third molars with occlusal caries lesions from 30 patients of 17-26 years of age. One study made the following statement: “In light of the results of the present and other relevant studies, MTA is superior to calcium hydroxide for pulp capping mechanically exposed human teeth.”108 In this study, the pulps of 14 teeth were intentionally exposed, half capped with calcium hydroxide and the other half with MTA. First, MTA comes in two colors, white and grey. This review of the literature provides evidence-based recommendations to guide clinicians in their decision-making process when they encounter a situation requiring pulp capping. 11. Pulpal responses to bacterial contamination following dentin bridging beneath hard-setting calcium hydroxide and self-etching adhesive resin system. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: A randomized controlled trial. Is it worth it? To review on various pulp protecting agents in endodontics and analyse the uses, purposes, standard and recent advancement of each. Review Article. Would you like email updates of new search results? It has the longest track record of clinical success, is the most cost-effective and is the likely effective component in MTA. Effect of improved Dycal and IRM on bacteria in deep carious lesions. Pulp capping A. H. B. Schuurs, with adhesive resin-based composite vs. calcium hydroxide: R. J. M. Gruythuysen, P. R. Wesselink a review. The morbidity associated with treating pulp exposures is consequential, often requiring either extraction or root canal therapy. View dentist profiles, clinic contact information and photos. Studies conducted to test Biodentine™ for application as a direct pulp capping agent and for pulpotomy showed that it was well tolerated even when in direct contact with the pulp. Effect of soluble plaque factors on inflammatory reactions in the dental pulp. This can hamper interpreting the results, since it is difficult to determine whether differences in the pulp status are the result of the pulp cap regimen or the restorative procedure.13–15, A controversy has existed within dentistry as to what is more detrimental to the pulp: toxicity from dental materials or bacteria and/or their toxins. Oper Dent 1 September 2009; 34 (5): 615–625. 2. Unset MTA is primarily calcium oxide in the form of tricalcium silicate, dicalcium silicate and tricalcium aluminate. Both procedures have historically been controversial. Response of human pulp capped with a bonding agent after bleeding control with hemostatic agents. If the direct pulp capping procedure has been accomplished properly, the success is significantly lower than for the indirect pulp caps, but still impressive. For many years, even decades, practitioners believed that some restorative materials “killed” pulps due to their inherent toxic properties. Journal of Clinical & Molecular pathology. Maintaining its vitality allows it to continue to warn the patient of a possible carious recovery. Objective The objective of this review deals with the applications,advantages,disadvantages and various recent advancement of various pulp protecting agents. 1985;23(4):927-38. 112–116 As with pulp capping studies comparing adhesives to calcium hydroxide, the results are different when comparing MTA to calcium hydroxide in humans. Like this video? Biological response of pulps submitted to different capping materials. Department of Cariology, Endodontology and C Munksgaard, 2000. 2018; 39(3):182-189. Anntiproliferative effect of mineral trioxide aggregate, zinc oxide-eugenol cement, and glass-ionomer cement against three fibroblastic cell lines. For example, the restorative regimen may vary among the experimental groups. The Cochrane Database of Systematic Reviews. An initial screen of returned abstracts was accomplished, and relevant full-length articles from peer-reviewed periodicals were obtained. Dissolution of bio-active dentine matrix components by mineral trioxide aggregate. It is necessary to be very cautious in taking the results of animal pulp capping studies and applying them to human patients.3–4,7,10–12, Some studies do not maintain a consistent methodology within the study. Table 2 demonstrates that most human studies show similar pulp-cap outcomes of MTA and calcium hydroxide. Direct pulp capping: a review Direct pulp capping: a review Lim, Kian Chong; Kirk, Ewen Eric James 1987-10-01 00:00:00 Key words: puip capping, calcium hydroxide. The formation of tertiary dentin after pulp capping with a calcium phosphate cement, loaded with PLGA microparticles containing TGF-1. In a survey in which private practitioners were asked what direct pulp capping material they use, the respondents listed four different materials, with none being preferred by a clear majority of users.53 This section will review the evidence regarding the effectiveness of various pulp capping materials that have been used for direct pulp capping. PubMed and Ovid databases were searched for any articles that met the criteria of containing “pulp capping,” “direct pulp capping,” “indirect pulp capping,” “sealed dental caries” or “pulp capping materials.” No date limits were applied. It, too, has been used effectively in many studies and clinical reports. Sodium hypochlorite shows increased pulpal inflammatory response but has the advantages of possessing antibacterial properties and providing enhanced hemorrhage control. Therefore, the purpose of this clinical study was to compare the histomorphologic features of MTA and calcium hydroxide cement after 30 and 60 days. Journal of Esthetic Restorative Dentistry. Rather, it was hoped that the span of literature reviewed would be as comprehensive as possible. Zhu C, Ju B, Ni R. Clinical outcome of direct pulp capping with MTA or calcium hydroxide: a systematic review and meta-analysis. REFERENCES 1. With a direct pulp cap, the pulpal tissue is exposed and a medicament is placed over the exposure. Assessment of coronal microleakage in intermediately restored endodontic access cavities. 16.Faraco IM Jr, Holland R. Response of pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement. Aguilar and Linsuwanont performed a systematic review to illustrate the clinical and radiographic success of direct pulp capping, partial pulpotomy, and full pulpotomy in vital permanent teeth with cariously exposed pulp. Pulp exposure remains a source of great frustration to the dental practitioner, because the outcome of any pulp capping procedure is marked with uncertainty. Single-bottle dentin bonding systems. The direct pulp cap, in which a material is placed directly over the exposed pulp tissue, has been suggested as a way to promote pulp healing and generate reparative dentin. Sign in. It is important to use sterile instruments. Analysis of pulpal reactions to restorative procedures, materials, pulp capping, and future therapies. Clinical, radiographic and histological analysis of the effects of mineral trioxide aggregate used in direct pulp capping and pulpotomies of primary teeth. : Aim and Objective: This review focuses on describing the various dentin bridge forming direct pulp capping agent . Dent Traumatol. Calcium hydroxide remains the “gold standard” for direct pulp capping. The second reason is that the moisture and contamination of dentin adjacent to the exposure site due to bleeding can make it more difficult to obtain an adequate seal that will prevent subsequent bacterial exposure. Calcium hydroxide has excellent antibacterial properties.88 One study found a 100% reduction in microorganisms associated with pulp infections after one-hour contact with calcium hydroxide.89 Most importantly, calcium hydroxide has a long-term track record of clinical success as a direct pulp-capping agent in periods of up to 10 years,46,84,90 although reduced success rates have been found in studies in which dental students were the operators.6,25,44–45, Calcium hydroxide has some disadvantages as well. The true “gold standard” of pulp status is histological analysis. If successful, this procedure precludes the need for more invasive, more extensive and more expensive treatment. Provide a well-sealed restoration immediately after pulp capping. The consequences of pulp exposure from caries, trauma or tooth preparation misadventure can be severe, with pain and infection the result. Immediate and delayed direct pulp capping with the use of a new visible light-cured calcium hydroxide preparation. Coronal microleakage of two root-end filling materials using a polymicrobial marker. Symmetrical bilateral primary molars (92) from 46 healthy subjects aged 5–7 years were included in this split-mouth randomised clinical trial. Composite fillings in etched and unetched cavities. Heat generation during curing of a dentin adhesive and composite. The clinician is often unaware of the coexistence of possible pulp pathology at the time of damage to the pulpal wall. Educational video for dental students and dentists on the Direct Pulp Capping procedure. Preserving pulp vitality.Dental health.Volume 52 No 2 of 6 March 2013 2. 2000;26(9):525-528. Follow-up examinations revealed that treatment was successful in preserving pulpal vitality and continued development of the tooth. Glass ionomer also provides an excellent bacterial seal and shows good biocompatibility when used in close approximation but not in direct contact with the pulp.65–68, As with ZOE, this review found only one human study of direct pulp capping using glass ionomer—in this case—RMGI. Confusion and misconceptions surround direct and indirect pulp capping. There is less data on other hemostatic agents that are typically associated with hemorrhage control and tissue retraction for impression taking.  |  2. Alex, G. “Direct and indirect pulp capping: A brief history, innovations, and clinical case report.” Compendium. Bismuth oxide is added for radiopacity.100–101 MTA is considered a silicate cement rather than an oxide mixture, and so its biocompatibility is due to its reaction products.102 Interestingly, the primary reaction product of MTA with water is calcium hydroxide,100,102–104 and so it is actually the formation of calcium hydroxide that provides MTA's biocompatibility.105, As a result, many of the advantages and potential mechanisms of action for MTA are similar to calcium hydroxide, including its antibacterial and biocompatibility properties, high pH, radiopacity and its ability to aid in the release of bioactive dentin matrix proteins.103–104,106–109 There are some differences between MTA and calcium hydroxide. Advantages, disadvantages and various recent advancement of various vital pulp-therapy materials over exposure! 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