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Microglia-Mediated Neuroinflammation: A Potential Target for the Treatment of Cardiovascular Diseases. Journal of inflammation research Microglia are tissue-resident macrophages of the central nervous system (CNS). In the CNS, microglia play an important role in the monitoring and intervention of synaptic and neuron-level activities. Interventions targeting microglia have been shown to improve the prognosis of various neurological diseases. Recently, studies have observed the activation of microglia in different cardiovascular diseases. In addition, different approaches that regulate the activity of microglia have been shown to modulate the incidence and progression of cardiovascular diseases. The change in autonomic nervous system activity after neuroinflammation may be a potential intermediate link between microglia and cardiovascular diseases. Here, in this review, we will discuss recent updates on the regulatory role of microglia in hypertension, myocardial infarction and ischemia/reperfusion injury. We propose that microglia serve as neuroimmune modulators and potential targets for cardiovascular diseases. 10.2147/JIR.S350109
Response of inflamed pulps of rat molars after capping with pulp-capping material containing fluocinolone acetonide. Louwakul Phumisak,Lertchirakarn Veera Journal of endodontics INTRODUCTION:Capping inflamed dental pulp tissue is currently a controversial issue. To reduce pulp inflammation and stimulate pulp healing, a pulp-capping material containing fluocinolone acetonide (PCFA) has been developed. This study was aimed to evaluate the inflammatory response and hard tissue formation of inflamed dental pulps of rat maxillary molars after capping with Dycal, mineral trioxide aggregate (MTA), or PCFA. METHODS:Sixty maxillary rat molars were exposed to the oral environment for 48 hours. The exposed pulps were randomly divided into 6 groups (n = 10) according to pulp-capping materials (Dycal, MTA, or PCFA) and time (8 or 30 days). The cavities were capped and sealed with Fuji II LC. The animals were sacrificed after 8 and 30 days. Histologic specimens were prepared and evaluated for inflammatory response and hard tissue formation. RESULTS:Eight days after pulp capping, all experimental groups showed disruption of the odontoblast layer in areas corresponding to the pulpal exposure. Acute inflammation was found in 80%, 60%, and 40% of samples in the Dycal, MTA, and PCFA groups, respectively. PCFA significantly decreased the pulp inflammation compared with Dycal. After 30 days, slight to moderate inflammation was found in all experimental groups. Hard tissue formation was found in 78%, 63%, and 100% of samples in the Dycal, MTA, and PCFA groups, respectively. No significant difference was found among the experimental groups. CONCLUSIONS:Pulp capping with PCFA reduced the inflammation and stimulated hard tissue formation in the exposed pulps of rat molars. It may be used as a pulp-capping agent in inflamed pulps. 10.1016/j.joen.2014.12.004
Stem/progenitor cell-mediated pulpal tissue regeneration: a systematic review and meta-analysis. International endodontic journal BACKGROUND:Stem/progenitor cell-mediated pulpal regeneration could represent a promising therapeutic alternative in the field of clinical endodontics. AIM:The present study aimed to systematically assess and meta-analyse dental pulpal tissue regeneration, pulpal vitality and apical healing after the transplantation of stem/progenitor cells versus no transplantation. DATA SOURCES:MEDLINE, Cochrane CENTRAL and EMBASE were searched up to January 2019 for animal experiments and human trials evaluating the pulpal transplantation of stem/progenitor cells. Cross-referencing and hand search were additionally performed. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS:Based on randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs), conducted in animals or humans, the effect of the transplantation of stem/progenitor cells compared to no transplantation on pulpal tissue regeneration, pulpal vitality and apical healing was examined. STUDY APPRAISAL AND SYNTHESIS METHODS:The primary outcome was histologically determined pulpal tissue regeneration, whilst pulpal vitality and apical healing were secondary outcomes. The SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) guidelines and the revised Cochrane risk of bias tool (RoB 2.0) were used for risk-of-bias assessment. Pooled standardized differences in means (SDM) and 95% confidence intervals (95% CI) were calculated using random-effects meta-analyses. RESULTS:From 2834 identified articles, eight animal experiments (82 animals with 336 experimental pulpal defects) and one human trial (40 humans with 40 pulpal defects) were included. Risk of bias of most animal studies was high, whilst the human trial revealed 'some concerns'. Stem/progenitor cell-transplanted pulps demonstrated significantly increased pulpal tissue regeneration compared with controls (SDM [95%CI]: 6.29 [3.78-8.80]). LIMITATIONS:Data on pulpal vitality and apical healing were sparse and inconsistent. Heterogeneity across studies was substantial, publication bias was present, and mainly indirect, surrogate outcome measures were applied. The overall strength of evidence was very low. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:The transplanation of stem/progenitor cells shows promise for pulp regeneration, whilst clinical routine application is still not in reach. Further investigations, employing a comprehensive set of outcomes including those demonstrating functional pulp regeneration relevant for patient-centred care, are required. 10.1111/iej.13177
Comparative study of xeno-free induction protocols for neural differentiation of human dental pulp stem cells in vitro. Madanagopal Thulasi Thiruvallur,Franco-Obregón Alfredo,Rosa Vinicius Archives of oral biology OBJECTIVE:To compare three different xeno-free protocols for neural differentiation of human dental pulp stem cells (DPSC). METHODS:DPSC were treated with three different media to induce neural differentiation namely N1 (DMEM for 5 days), N2 (PSC neural induction media for 7 days) and N3 (neural media with B27 supplement, 40 ng/ml bFGF and 20 ng/ml EGF for 21 days). Cell proliferation (MTS assay), morphology, gene (qPCR for NESTIN, VIMENTIN, TUB-3, ENO2, NF-M and NF-H) and protein expression (flow cytometry) of neurogenic markers were assessed at different time points and compared to untreated cells (DMEM supplemented with 10% FBS). Statistical analysis was performed with global significance level of 5%. RESULTS:N1 and N2 formulations increased the genetic expression of two out of six genes TUB-3, NF-M and TUB-3, NF-H, respectively, whereas N3 elevated the expression of all genes by the late stage. N3 also stimulated protein expression for NESTIN, TUB-3 and NF-H. Cells treated with both N2 and N3 presented neuron-like morphology, decreased proliferation and expression of stemness genes at protocol end point. CONCLUSION:N3 was the most effective formulation in promoting a neurogenic shift in gene and protein expression. Cells provided with the N3 formulation exhibited neuron-like morphology, elaborating axonal-like projections concomitant with cell cycle withdrawal and reduced expression of stemness genes indicating greater commitment to a neurogenic lineage. 10.1016/j.archoralbio.2019.104572
Pulp ECM-derived macroporous scaffolds for stimulation of dental-pulp regeneration process. Bakhtiar Hengameh,Pezeshki-Modaress Mohammad,Kiaipour Zahra,Shafiee Mahdieh,Ellini Mohammad Reza,Mazidi Amir,Rajabi Sarah,Zamanlui Benisi Soheila,Ostad Seyed Naser,Galler Kerstin,Pakshir Pardis,Azarpazhooh Amir,Kishen Anil Dental materials : official publication of the Academy of Dental Materials OBJECTIVE:Recent studies suggest xenogeneic extracellular matrices as potential regenerative tools in dental pulp regeneration. This study aimed to fabricate and characterize a novel three-dimensional macroporous pulp-derived scaffold that enables the attachment, penetration, proliferation and differentiation of mesenchymal stem cells. METHOD:Bovine pulp was decellularized and characterized with histological and DNA content methods. This scaffold was prepared using finely milled lyophilized decellularized pulp extracellular matrix (ECM) digested with pepsin. Three different concentrations of ECM (1.50, 2.25 and 3.00mg/ml) were freeze-dried and were tested with/without chemical crosslinking. The specimens were subjected to physicochemical characterization, cell viability and quantitative real time polymerase chain reaction assessments with human bone marrow mesenchymal stem cells (hBMMSCs). All scaffolds were subcutaneously implanted in rats for two weeks and histological and immunostaining analyses were performed. RESULTS:Histological and DNA analysis confirmed complete decellularization. All samples demonstrated more than 97% porosity and 1.50mg/ml scaffold demonstrated highest water absorption. The highest cell viability and proliferation of hBMMSCs was observed on the 3.00mg/ml crosslinked scaffolds. The gene expression analysis showed a significant increase of dmp-1 and collagen-I on 3.00mg/ml crosslinked scaffolds compared to the other scaffolds. Histological examination of subcutaneous implanted scaffolds revealed low immunological response, and enhanced angiogenesis in cross-linked samples compared to non-crosslinked samples. SIGNIFICANCE:The three-dimensional macroporous pulp-derived injectable scaffold developed and characterized in this study displayed potential for regenerative therapy. While the scaffold biodegradability was decreased by crosslinking, the biocompatibility of post-crosslinked scaffold was significantly improved. 10.1016/j.dental.2019.10.011
Evaluation of the Apical Complex and the Coronal Pulp as a Stem Cell Source for Dentin-pulp Regeneration. Park Min-Kyoung,Kim Seunghye,Jeon Mijeong,Jung Ui-Won,Lee Jae-Ho,Choi Hyung-Jun,Choi Ja-Eun,Song Je Seon Journal of endodontics INTRODUCTION:This study compared the stemness and differentiation potential of stem cells derived from the apical complex (apical complex cells [ACCs]) and coronal pulp (dental pulp stem cells [DPSCs]) of human immature permanent teeth with the aim of determining a more suitable source of stem cells for regeneration of the dentin-pulp complex. METHODS:ACC and DPSC cultures were established from 13 human immature permanent teeth using the outgrowth method. The proliferation capacity and colony-forming ability of ACCs and DPSCs were evaluated. ACCs and DPSCs were analyzed for mesenchymal stem cell markers using flow cytometry. The adipogenic and osteogenic differentiation potential of ACCs and DPSCs were evaluated using the quantitative real-time polymerase chain reaction and histochemical staining. ACCs and DPSCs were transplanted subcutaneously in immunocompromised mice using macroporous biphasic calcium phosphate as a carrier. The histomorphologic characteristics of the newly formed tissues were verified using hematoxylin-eosin staining and immunohistochemical staining. Quantitative alkaline phosphatase analysis and quantitative real-time polymerase chain reaction using BSP, DSPP, POSTN, and ColXII were performed. RESULTS:ACCs and DPSCs showed similar cell proliferation potential and colony-forming ability. The percentage of mesenchymal stem cell markers was similar between ACCs and DPSCs. In the in vitro study, ACCs and DPSCs showed adipogenic and osteogenic differentiation potential. In the in vivo study, ACCs and DPSCs formed amorphous hard tissue using macroporous biphasic calcium phosphate particles. The quantity and histomorphologic characteristics of the amorphous hard tissue were similar in the ACC and DPSC groups. Formation of periodontal ligament-like tissue, positive to Col XII, was observed in ACC transplants, which was absent in DPSC transplants. CONCLUSIONS:ACCs and DPSCs showed similar stemness, proliferation rate, and hard tissue-forming capacity. The notable difference was the periodontal ligament-like fiber-forming capacity of ACCs, which indicates the presence of various lineages of stem cells in the apical complex compared with the coronal pulp. Regarding regeneration of the dentin-pulp complex, the coronal pulp can be a suitable source of stem cells considering its homogenous lineages of cells and favorable osteo/odontogenic differentiation potential. 10.1016/j.joen.2019.10.025
Effect of the Periapical "Inflammatory Plug" on Dental Pulp Regeneration: A Histologic In Vivo Study. Zaky Samer H,AlQahtani Qahtan,Chen Jingming,Patil Avinash,Taboas Juan,Beniash Elia,Ray Herbert,Sfeir Charles Journal of endodontics INTRODUCTION:In the current study, we investigate the effect of the inflammation occupying the apical foramen-a phenomenon we refer to as "inflammatory plug"-on the regenerative potential of a root canal therapy. METHODS:We performed root canal treatment (RCT) in 12 canine root canals while aseptically instrumenting the apex to a 0.5-mm-wide foramen and obturating the canals with the following materials: collagen sponge, platelet-rich fibrin, and blood clot (no material introduced). RESULTS:We were successful in maintaining the integrity of the periapical tissue in 8 of 12 RCTs. Injury to the periapical tissue occurred during the remaining 4 RCTs, which initiated inflammation accompanied by bone and dentin resorption. Our histologic analyses showed that the resulting inflammatory plug contained abundant M1 macrophages and was associated with an absence of intracanal cellular infiltration. On the contrary, noninflamed samples showed signs of repair, as indicated by the migration of periapical cells throughout the root canal. CONCLUSIONS:We conclude that controlling periapical inflammation is key while attempting to achieve dental pulp regeneration. 10.1016/j.joen.2019.10.006
Comparative Evaluation of Postoperative Pain and Success Rate after Pulpotomy and Root Canal Treatment in Cariously Exposed Mature Permanent Molars: A Randomized Controlled Trial. Galani Mohit,Tewari Sanjay,Sangwan Pankaj,Mittal Shweta,Kumar Vinay,Duhan Jigyasa Journal of endodontics INTRODUCTION:The aim of this study was to compare postoperative pain and success rate following pulpotomy and root canal treatment. METHODOLOGY:Fifty-four permanent teeth with carious exposures were randomly divided equally into 2 groups. Mineral trioxide aggregate pulpotomy was performed in the experimental group and root canal treatment was performed in the control group, using standardized protocols. The treated teeth were restored with base of glass-ionomer cement followed by composite restoration. Pain was recorded every 24 hours for 7 days after intervention. Clinical and radiographic evaluations were done every 3 months for 18 months. The data collected were statistically analyzed. RESULTS:At the end of follow-up, overall success rate was 85% in the pulpotomy group and 87.5% in the root canal treatment group (P > .05). Significant difference in pain incidence and pain reduction was found between the 2 groups (P < .05), with lower scores reported in the pulpotomy group. CONCLUSION:Pulpotomy can be an alternative treatment for management of symptomatic permanent teeth with deep caries lesions. 10.1016/j.joen.2017.08.007
Tooth Discoloration Induced by Different Calcium Silicate-based Cements: A Systematic Review of In Vitro Studies. Możyńska Joanna,Metlerski Marcin,Lipski Mariusz,Nowicka Alicja Journal of endodontics 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. 10.1016/j.joen.2017.04.002
[Contemporary concept and clinical perspective of direct pulp capping therapy]. Wei X,Ling J Q Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese journal of stomatology There are several trends in contemporary endodontics such as development of minimally invasive biologically based therapies, preservation of dental pulp in a healthy status with sustained vitality, prevention of apical periodontitis and improvement of long-term survival rates of teeth with pulpal disorders. As for the vital pulp therapy, direct pulp capping is a less invasive approach to keep the exposed dental pulp intact, which may improve the long-term treatment outcome employing a minimally invasive biologically strategy. With the recent progress in pulp biology, improvement of treatment modality and development of bioactive dental cements, great advancements have been achieved in direct pulp capping therapy. This review article focuses on the transition of indications, prognostic factors and future perspectives of direct pulp capping therapy, attempting to provide evidence and practical guidance for minimally invasive biologically based therapies of teeth with injured pulp. 10.3760/cma.j.issn.1002-0098.2019.09.001
A clinical trial of pulpotomy vs. root canal therapy of mature molars. Asgary S,Eghbal M J Journal of dental research Root canal therapy (RCT) and tooth extraction are the main treatment options for irreversible pulpitis or its sequelae. Pulpotomy is an alternative treatment; however, more evidence is required. If outcomes of pulpotomy with a calcium-enriched mixture (PCEM) are non-inferior for mature molars with irreversible pulpitis compared with those from one-visit RCT (ORCT), this may be a beneficial treatment option. Four hundred seven individuals met the inclusion criteria and were randomly allocated [PCEM (n = 205), ORCT (n = 202)]. We used NRS questionnaires to record pain intensity. Six-month clinical and radiographic successes were assessed. Individuals in the ORCT arm reported significantly more post-operative pain than those in the PCEM arm (P < 0.001). Clinical success rates in the two arms showed no statistically significant difference; however, the radiographic success rates were significantly greater in the PCEM arm (P < 0.001). This trial suggests PCEM as an alternative for treatment of irreversible pulpitis. If long-term results confirm initial ones, PCEM may revolutionize oral health worldwide. 10.1177/0022034510374057
Comparison of pulpal responses to pulpotomy and pulp capping with biodentine and mineral trioxide aggregate in dogs. De Rossi Andiara,Silva Lea Assed Bezerra,Gatón-Hernández Patrícia,Sousa-Neto Manoel Damião,Nelson-Filho Paulo,Silva Raquel Assed Bezerra,de Queiroz Alexandra Mussolino Journal of endodontics INTRODUCTION:This study evaluated the pulpal and periapical responses of dogs' teeth after pulpotomy and pulp capping with a new tricalcium silicate-based cement (Biodentine) when compared with mineral trioxide aggregate (MTA) by radiographic, histopathologic, and histomicrobiological analyses. METHODS:Sixty roots (30 teeth) of dogs were divided into 2 groups, Biodentine (n = 36 roots) and ProRoot MTA (control, n = 24 roots). Animals were killed after 120 days, and the teeth were subjected to histotechnical processing (hematoxylin-eosin and Brown and Brenn staining). Qualitative and quantitative histopathologic data were analyzed by Fisher exact and Mann-Whitney tests (α = 0.05). RESULTS:Radiographically, mineralized tissue bridge formation was observed in more specimens treated with Biodentine (96.8%) than with MTA (72.2%) (P = .02). Integrity of the lamina dura and absence of periapical bone rarefaction and root resorption (external and internal) were observed in all specimens. Histopathologic and histomicrobiological analyses revealed mineralized tissue bridge formation, pulpal vitality, odontoblast layer integrity, preserved periodontal ligament, and absence of bone or root resorption and microorganisms in both groups. Although the bridges formed at the amputation site had similar morphology, they were significantly thicker in the Biodentine group (P < .0001). Comparison between the radiographic and histopathologic results showed that radiographic visualization of more bridges in the Biodentine group was related to bridge thickness because radiographic diagnosis was flawed for bridges with thickness less than 0.5 mm. Fluorescence microscopy improved the visualization of bridge structure. CONCLUSIONS:Biodentine presented tissue compatibility and allowed for mineralized tissue bridge formation after pulpotomy in all specimens with similar morphology and integrity to those formed with use of MTA. Periapical radiographs failed in detecting mineralized tissue bridges with thickness less than 0.5 mm. 10.1016/j.joen.2014.02.006
Correlation between clinical and histologic pulp diagnoses. Ricucci Domenico,Loghin Simona,Siqueira José F Journal of endodontics INTRODUCTION:Clinicians routinely face conditions in which they have to decide whether the dental pulp can be saved or not. This study evaluated how reliable the clinical diagnosis of normal pulp/reversible pulpitis (savable pulp) or irreversible pulpitis (nonsavable pulp) is when compared with the histologic diagnosis. METHODS:The study material consisted of 95 teeth collected consecutively in a general practice over a 5-year period and extracted for reasons not related to this study. Based on clinical criteria, teeth were categorized as having normal pulps, reversible pulpitis, or irreversible pulpitis. The former 2 were grouped together because they represent similar conditions in terms of prognosis. Teeth were processed for histologic and histobacteriologic analyses, and pulps were categorized as healthy, reversibly inflamed, or irreversibly inflamed according to defined criteria. The number of matching clinical/histologic diagnosis was recorded. RESULTS:The clinical diagnosis of normal pulp/reversible pulpitis matched the histologic diagnosis in 57 of 59 (96.6%) teeth. Correspondence of the clinical and histologic diagnosis of irreversible pulpitis occurred in 27 of 32 (84.4%) cases. Infection advancing to the pulp tissue was a common finding in teeth with irreversible pulpitis but was never observed in normal/reversibly inflamed pulps. CONCLUSIONS:Findings using defined criteria for clinical and histologic classification of pulp conditions revealed a good agreement, especially for cases with no disease or reversible disease. This means that the classification of pulp conditions as normal pulps, reversible pulpitis, and irreversible pulpitis has high chances of guiding the correct therapy in the large majority of cases. However, there is still a need for refined and improved means for reliable pulp diagnosis. 10.1016/j.joen.2014.08.010
Disclosing the physiology of pulp tissue for vital pulp therapy. da Rosa W L O,Piva E,da Silva A F International endodontic journal The discovery that dentine is a reservoir of bioactive molecules that can be recruited on demand has attracted efforts to develop new protocols and materials for vital pulp therapy (VPT). The noncollagenous proteins (NCPs) present in the dentine extracellular matrix (ECM) include growth factors (TGF-β1, BMP-7, FGF-2, IGF-1 and IGF-2, NGF and GDNF), extracellular matrix molecules (DSP, DPP, BSP, DMP-1 and DSPP) and both anti-inflammatory and pro-inflammatory chemokines and cytokines (TNF-α, IL-1, IL-6 and IL-10). Molecules such as DSP and DPP are mainly expressed by odontoblasts, and they are cleaved products from dentine sialophosphoprotein (DSPP). Some molecules, such as TGF-β1, specifically interact with decorin/biglycan in dentine. Although TGF-β1 increases the expression and secretion of NGF in human pulp cells, NGF induces mineralization and increases the expression of DSPP and DMP-1. Furthermore, GDNF may act as a cell survival factor and mitogen during tooth injury and repair. Pulp capping materials, such as MTA and calcium hydroxide, can solubilize bioactive dentine molecules (TGF-β1, NGF and GDNF) that stimulate tertiary dentinogenesis. The binding of these signalling molecules leads to activation of several signalling transduction pathways involved in dentinogenesis, odontoblast differentiation and inflammatory responses, such as the p38 MAPK, NF-kβ and Wnt/β-catenin signalling pathways. Understanding the cascade of cellular and molecular events underlying the repair and regeneration processes provides a reasonable new approach to VPT through a targeted interaction between tooth tissue and bioactive molecules. 10.1111/iej.12906
Changes in the radicular pulp-dentine complex in healthy intact teeth and in response to deep caries or restorations: A histological and histobacteriological study. Ricucci Domenico,Loghin Simona,Niu Li-Na,Tay Franklin R Journal of dentistry INTRODUCTION:The present study reported the histological events that occurred in the radicular pulp of human mature teeth in the presence of medium/deep untreated caries lesions, and those teeth with restorations or direct pulp capping, with particular emphasis on the morphology of the canal wall dentine and the odontoblast layer. METHODS:Sixty-two teeth with medium/deep caries lesions, extensive restorations or after application of a direct pulp capping procedure were obtained from 57 subjects. Fourteen intact mature teeth served as controls. Stained serial sections were examined for the pulp conditions of the coronal pulp. The teeth were classified as those with pulpal inflammation, or those with healed pulps. Histological changes that occurred in the roots at the pulp-dentine junction were investigated in detail. RESULTS:All teeth (100%) in the experimental group showed pathologic changes in the radicular pulp, with varying amounts of tertiary dentine on the canal walls and absence of odontoblasts. These changes were identified from different portions of the canal wall surface. Non-adherent calcifications in the pulp tissue were observed in more than half of the specimens. Changes that deviate from classically-perceived histological relationships of the pulp-dentine complex were also observed in the radicular pulps of 33.7% of the control teeth. CONCLUSION:When challenged by bacteria and bacterial by-products invading dentinal tubules, odontoblasts in the radicular pulp may undergo cell death, possibly by apoptosis. This phenomenon may be caused by progressive root-ward diffusion of bacterial by-products, cytokines or reactive oxygen species through the pulp connective tissue. CLINICAL SIGNIFICANCE:Although the vitality of the dental pulp in teeth with deep dentinal caries may be maintained with direct pulp capping or pulpotomy, the repair tissue that is formed resembles mineralised fibrous connective tissues more than true tubular dentine. 10.1016/j.jdent.2018.04.007
Pulp capping materials modulate the balance between inflammation and regeneration. Giraud Thomas,Jeanneau Charlotte,Rombouts Charlotte,Bakhtiar Hengameh,Laurent Patrick,About Imad Dental materials : official publication of the Academy of Dental Materials The interrelations between inflammation and regeneration are of particular significance within the dental pulp tissue inextensible environment. Recent data have demonstrated the pulp capacity to respond to insults by initiating an inflammatory reaction and dentin pulp regeneration. Different study models have been developed in vitro and in vivo to investigate the initial steps of pulp inflammation and regeneration. These include endothelial cell interaction with inflammatory cells, stem cell interaction with pulp fibroblasts, migration chambers to study cell recruitment and entire human tooth culture model. Using these models, the pulp has been shown to possess an inherent anti-inflammatory potential and a high regeneration capacity in all teeth and at all ages. The same models were used to investigate the effects of tricalcium silicate-based pulp capping materials, which were found to modulate the pulp anti-inflammatory potential and regeneration capacity. Among these, resin-containing materials such as TheraCal shift the pulp response towards the inflammatory reaction while altering the regeneration process. On the opposite, resin-free materials such as Biodentine™ have an anti-inflammatory potential and induce the pulp regeneration capacity. This knowledge contradicts the new tendency of developing resin-based calcium silicate hybrid materials for direct pulp capping. Additionally, it would allow investigating the modulatory effects of newly released pulp capping materials on the balance between tissue inflammation and regeneration. It would also set the basis for developing future capping materials targeting these processes. 10.1016/j.dental.2018.09.008
Success of Direct Pulp Capping Using Mineral Trioxide Aggregate and Calcium Hydroxide in Mature Permanent Molars with Pulps Exposed during Carious Tissue Removal: 1-year Follow-up. Suhag Komal,Duhan Jigyasa,Tewari Sanjay,Sangwan Pankaj Journal of endodontics INTRODUCTION:This randomized clinical trial aimed to compare the success rate and postoperative pain of direct pulp capping (DPC) using calcium hydroxide (CH) and mineral trioxide aggregate (MTA) in teeth with carious pulp exposures and reversible pulpitis. METHODS:Sixty-four permanent teeth were randomly divided after caries excavation into 2 groups: CH and MTA (n = 32 in each group). Exposed pulps were capped using standardized protocols. The treated teeth were restored with glass ionomer cement and composite restoration. The primary outcome was success rate at the 12-month follow-up, and the secondary outcome was postoperative pain after 7 days. Clinical and radiographic evaluations were performed at 3, 6, and 12 months. Pain was recorded using the visual analog scale every 24 hours for 7 days after intervention. RESULTS:Fifty-six patients were analyzed at the 12-month follow-up, 29 treated with CH and 27 with ProRoot MTA (Dentsply Tulsa Dental, Tulsa, OK). The success rate was 69% for CH and 93% for ProRoot MTA (P < .05). The kappa value of interrater agreement was 0.773.No significant difference in pain incidence was found between the 2 groups (P > .05) although a significant pain reduction was found 6 hours after the procedure in both the groups. Significantly lower pain scores were reported in the MTA group (6.3 ± 9.5) compared with the CH group (18.5 ± 20.8) after 18 hours. CONCLUSIONS:Teeth with carious pulp exposures and reversible pulpitis can be treated successfully with DPC. MTA proved better than CH in terms of both success rate and pain intensity. 10.1016/j.joen.2019.02.025
Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review. Aguilar Panuroot,Linsuwanont Pairoj Journal of endodontics INTRODUCTION:This systematic review aims to illustrate the outcome of vital pulp therapy, namely direct pulp capping, partial pulpotomy, and full pulpotomy, in vital permanent teeth with cariously exposed pulp. METHODS:Electronic database MEDLINE via Ovid, PubMed, and Cochrane databases were searched. Hand searching was performed through reference lists of endodontic textbooks, endodontic-related journals, and relevant articles from electronic searching. The random effect method of weighted pooled success rate of each treatment and the 95% confidence interval were calculated by the DerSimonian-Laird method. The weighted pooled success rate of each treatment was estimated in 4 groups: >6 months-1 year, >1-2 years, >2-3 years, and >3 years. All statistics were performed by STATA version 10. The indirect comparison of success rates for 4 follow-up periods and the indirect comparison of clinical factors influencing the success rate of each treatment were performed by z test for proportion (P < .05). RESULTS:Overall, the success rate was in the range of 72.9%-99.4%. The fluctuation of the success rate of direct pulp capping was observed (>6 months-1 year, 87.5%; >1-2 years, 95.4%; >2-3 years, 87.7%; and >3 years, 72.9%). Partial pulpotomy and full pulpotomy sustained a high success rate up to more than 3 years (partial pulpotomy: >6 months-1 year, 97.6%; >1-2 years, 97.5%; >2-3 years, 97.6%; and >3 years, 99.4%; full pulpotomy: >6 months-1 year, 94%; >1-2 years, 94.9%; >2-3 years, 96.9%; and >3 years, 99.3%). CONCLUSIONS:Vital permanent teeth with cariously exposed pulp can be treated successfully with vital pulp therapy. Current best evidence provides inconclusive information regarding factors influencing treatment outcome, and this emphasizes the need for further observational studies of high quality. 10.1016/j.joen.2010.12.004
Pulp canal obliteration: an endodontic diagnosis and treatment challenge. McCabe P S,Dummer P M H International endodontic journal AIM:To review the literature on pulp chamber and root canal obliteration in anterior teeth and to establish a clear protocol for managing teeth with fine, tortuous canal systems. SUMMARY:Pulp canal obliteration (PCO) occurs commonly following traumatic injuries to teeth. Approximately 4-24% of traumatized teeth develop varying degrees of pulpal obliteration that is characterized by the apparent loss of the pulp space radiographically and a yellow discoloration of the clinical crown. These teeth provide an endodontic treatment challenge; the critical management decision being whether to treat these teeth endodontically immediately upon detection of the pulpal obliteration or to wait until symptoms or signs of pulp and or periapical disease occur. The inevitable lack of responses to normal sensibility tests and the crown discoloration add uncertainty to the management; however, only approximately 7-27% of teeth with PCO will develop pulp necrosis with radiographic signs of periapical disease. Root canal treatment of teeth with pulpal obliteration is often challenging. This article discusses the various management approaches and highlights treatment strategies for overcoming potential complications. KEY LEARNING POINTS:Up to 25% of traumatized anterior teeth can develop pulp canal obliteration; Discolouration is a common clinical finding in teeth with pulp canal obliteration; Up to 75% of teeth with pulp canal obliterations are symptom-free and require no treatment other than radiographic monitoring; Routine pulp sensibility tests are unreliable in the presence of pulp canal obliteration; Teeth with pulp canal obliteration in need of root canal treatment pose particular diagnostic and treatment challenges. 10.1111/j.1365-2591.2011.01963.x
Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal. Schwendicke F,Frencken J E,Bjørndal L,Maltz M,Manton D J,Ricketts D,Van Landuyt K,Banerjee A,Campus G,Doméjean S,Fontana M,Leal S,Lo E,Machiulskiene V,Schulte A,Splieth C,Zandona A F,Innes N P T Advances in dental research The International Caries Consensus Collaboration undertook a consensus process and here presents clinical recommendations for carious tissue removal and managing cavitated carious lesions, including restoration, based on texture of demineralized dentine. Dentists should manage the disease dental caries and control activity of existing cavitated lesions to preserve hard tissues and retain teeth long-term. Entering the restorative cycle should be avoided as far as possible. Controlling the disease in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal or control first. Only when cavitated carious lesions either are noncleansable or can no longer be sealed are restorative interventions indicated. When a restoration is indicated, the priorities are as follows: preserving healthy and remineralizable tissue, achieving a restorative seal, maintaining pulpal health, and maximizing restoration success. Carious tissue is removed purely to create conditions for long-lasting restorations. Bacterially contaminated or demineralized tissues close to the pulp do not need to be removed. In deeper lesions in teeth with sensible (vital) pulps, preserving pulpal health should be prioritized, while in shallow or moderately deep lesions, restoration longevity becomes more important. For teeth with shallow or moderately deep cavitated lesions, carious tissue removal is performed according toselective removal to firm dentine.In deep cavitated lesions in primary or permanent teeth,selective removal to soft dentineshould be performed, although in permanent teeth,stepwise removalis an option. The evidence and, therefore, these recommendations support less invasive carious lesion management, delaying entry to, and slowing down, the restorative cycle by preserving tooth tissue and retaining teeth long-term. 10.1177/0022034516639271
Could the application of bioactive molecules improve vital pulp therapy success? A systematic review. Luiz de Oliveira da Rosa Wellington,Machado da Silva Tiago,Fernando Demarco Flávio,Piva Evandro,Fernandes da Silva Adriana Journal of biomedical materials research. Part A This study aimed to systematically review the literature of animal studies to evaluate whether bioactive dentin proteins could improve vital pulp therapy success. The review is reported in accordance with the PRISMA Statement. Two reviewers independently conducted a literature search of seven databases: PubMed (Medline), Lilacs, IBECS, BBO, Web of Science, Scopus, and SciELO. Animal experiments in which bioactive dentin proteins were applied directly or indirectly to the pulp tissue were included. Data regarding the characteristics of the proteins evaluated, the delivery systems used and the main findings from each study were tabulated to assess the outcomes of interest (tertiary dentin formation, inflammatory response, intratubular mineralization). After screening, 32 papers were subjected to qualitative analysis. In 75% of the studies, direct pulp capping was performed. Additionally, the most studied proteins were BMP-7, TGF-β1, and extracted soluble dentin matrix proteins. In conclusion, there is evidence in the literature suggesting that bioactive dentin molecules could enhance tertiary dentin formation with fewer initial inflammatory responses in direct and indirect pulp therapy in animal models. There are potential areas to be explored for novel therapeutic approaches for dental tissue repair and regeneration with bioactive materials. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 941-956, 2017. 10.1002/jbm.a.35968
Treatment Outcomes of Mineral Trioxide Aggregate Pulpotomy in Vital Permanent Teeth with Carious Pulp Exposure: The Retrospective Study. Linsuwanont Pairoj,Wimonsutthikul Kongthum,Pothimoke Uht,Santiwong Busayarat Journal of endodontics INTRODUCTION:This study aimed to illustrate the treatment outcomes of mineral trioxide aggregate (MTA) pulpotomy in vital permanent teeth with carious pulp exposure. METHODS:MTA pulpotomy was performed in 66 vital permanent teeth with carious pulp exposure including teeth with signs and symptoms of irreversible pulpitis and the presence of periapical radiolucency. Patients were assessed for clinical and radiographic outcomes by 2 examiners. The relationship between treatment outcomes and factors was analyzed by means of univariate analysis and binary logistic regression. RESULTS:Fifty patients (a total of 55 teeth) attended the follow-up examination. The age of the patients ranged from 7-68 years old (mean = 29 years old). For the follow-up period as far as 62 months, 48 teeth showed successful outcomes (success rate = 87.3%). Teeth with clinical signs of irreversible pulpitis and the presence of periapical radiolucency could be treated successfully by MTA pulpotomy with success rates of 84% and 76%, respectively.Three of 7 failed cases required pulpectomy after MTA pulpotomy to relieve painful pulpitis. Four other failed cases were asymptomatic, and failure was detected from radiographic examination. The relationship between treatment outcomes and treatment factors could not be detected statistically. CONCLUSIONS:Teeth with carious pulp exposure can be treated successfully by MTA pulpotomy. Clinical signs of irreversible pulpitis and the presence of periapical radiolucency should not be considered as a contraindication for pulpotomy. 10.1016/j.joen.2016.10.027
Human Pulp Responses to Partial Pulpotomy Treatment with TheraCal as Compared with Biodentine and ProRoot MTA: A Clinical Trial. Bakhtiar Hengameh,Nekoofar Mohammad Hossein,Aminishakib Pouyan,Abedi Fatemeh,Naghi Moosavi Fereshteh,Esnaashari Ehsan,Azizi Arash,Esmailian Samar,Ellini Mohammad Reza,Mesgarzadeh Vahid,Sezavar Mehdi,About Imad Journal of endodontics INTRODUCTION:Questions exist regarding the efficacy of resin-containing materials such as TheraCal directly applied on the pulp. This study sought to investigate the clinical efficacy of TheraCal as compared with Biodentine and ProRoot mineral trioxide aggregate (MTA) for partial pulpotomy. METHODS:In this clinical trial, partial pulpotomy was performed for 27 sound human maxillary and mandibular third molars scheduled for extraction. The teeth were randomly divided into 3 groups (n = 9) and underwent partial pulpotomy with TheraCal, Biodentine, and ProRoot MTA. The teeth were then restored with glass ionomer cement. Clinical and electric pulp tests were performed after 1 and 8 weeks. The teeth were radiographed and extracted at 8 weeks. Histologic sections were prepared and analyzed for pulp inflammation and dentinal bridge formation. Data were analyzed by using one-way analysis of variance. RESULTS:Clinical examination showed no sensitivity to heat, cold, or palpation in ProRoot MTA and Biodentine groups. Two patients in TheraCal group (20%) reported significant pain at 1 week. Periapical radiographs showed no periapical pathology, and electric pulp test revealed a normal pulp response with no hypersensitivity. Inflammation was absent with all materials at 8 weeks. Normal pulp organization was seen in 33.33% of the teeth in ProRoot MTA, 11.11% in TheraCal, and 66.67% in Biodentine group (P = .06). Biodentine group showed complete dentinal bridge formation in all teeth, whereas this rate was 11% and 56% in TheraCal and ProRoot MTA groups, respectively (P = .001). CONCLUSIONS:Overall, Biodentine and MTA performed better than TheraCal when used as partial pulpotomy agent and presented the best clinical outcomes. 10.1016/j.joen.2017.06.025
Treatment Outcomes of 4 Vital Pulp Therapies in Mature Molars. Asgary Saeed,Hassanizadeh Raheleh,Torabzadeh Hassan,Eghbal Mohammad Jafar Journal of endodontics INTRODUCTION:Vital pulp therapy (VPT) is a biological approach to minimally invasive endodontics. This randomized clinical trial aimed to evaluate and compare clinical and radiographic success of 4 VPTs (indirect pulp capping [IPC], direct pulp capping [DPC], miniature pulpotomy [MP], and full pulpotomy [FP]) using calcium-enriched mixture cement for deep caries management of mature permanent molars including teeth with clinical signs of irreversible pulpitis and the presence of apical periodontitis. METHODS:Blinded participants (N = 302) were randomly allocated to 4 study arms. Random allocation was disregarded when visible pulp exposures did not happen after complete caries removal and the tooth was transferred to the IPC arm. Pre- and intraoperative data including vitality test results, pulpal/periapical status, and exposure type/location were recorded. Pain was measured using a numeric rating scale before treatment initiation up to 1 week postoperatively. Participants were followed up for 1 year. RESULTS:The groups were homogenous in terms of age, sex, marital status, education, and practitioner; pre- and intraoperative conditions were similar in all arms and did not affect the long-term success. Preoperative pain and apical periodontitis were significantly different among arms (P < .05); however, it was not the case when the IPC group was excluded. After baseline pain adjustment, pain relief was continuous with similar patterns in all treatment groups. The 3- and 12-month success rates of the VPT techniques were comparable in the IPC (98.7% and 100%, respectively), DPC (98.4% and 94.7%, respectively), MP (98.4% and 91.4%, respectively), and FP (93.5% and 95.5%, respectively) arms, respectively (P > .05). CONCLUSIONS:In deep caries management of mature permanent molars, the 4 VPTs were associated with favorable/comparable clinical and radiographic outcomes. The pulpal and periapical status as well as pulpal exposure type/location had no effect on treatment outcomes. 10.1016/j.joen.2017.12.010
Retraction. Clinical oral implants research Ramírez-Fernández MP, Calvo-Guirado JL, Arcesio Delgado-Ruiz R, Maté-Sánchez del Val JE, Gómez-Moreno G, Guardia J. Experimental model of bone response to xenografts of bovine origin (Endobon ): a radiological and histomorphometric study. Clin Oral Impl Res. 2011;22: 727-734. The above article, published online on 29 December 2010 in Wiley Online Library (wileyonlinelibrary.com), and in Volume 22, pp. 727-734, has been retracted by agreement between the journal editor in chief, L Heitz-Mayfield, and John Wiley & Sons Ltd. The retraction has been agreed due to image discrepancies, resulting in unreliable data. Images in Figures 2b, 2c, 3a and 4a have been used in other publications representing different time points and experimental materials. Reference Ramírez-Fernández MP, Calvo-Guirado JL, Arcesio Delgado-Ruiz R, Maté-Sánchez del Val JE, Gómez-Moreno G, Guardia J. Experimental model of bone response to xenografts of bovine origin (Endobon®): a radiological and histomorphometric study. Clin Oral Impl Res. 2011;22: 727-734.https://doi.org/10.1111/j.1600-0501.2010.02052.x. 10.1111/clr.13085
Clinical evaluation of direct pulp capping using a calcium silicate cement-treatment outcomes over an average period of 2.3 years. Harms Carolin Sabine,Schäfer Edgar,Dammaschke Till Clinical oral investigations 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. 10.1007/s00784-018-2767-5
European Society of Endodontology position statement: Management of deep caries and the exposed pulp. ,Duncan H F,Galler K M,Tomson P L,Simon S,El-Karim I,Kundzina R,Krastl G,Dammaschke T,Fransson H,Markvart M,Zehnder M,Bjørndal L International endodontic journal This position statement on the management of deep caries and the exposed pulp represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Preserving the pulp in a healthy state with sustained vitality, preventing apical periodontitis and developing minimally invasive biologically based therapies are key themes within contemporary clinical endodontics. The aim of this statement was to summarize current best evidence on the diagnosis and classification of deep caries and caries-induced pulpal disease, as well as indicating appropriate clinical management strategies for avoiding and treating pulp exposure in permanent teeth with deep or extremely deep caries. In presenting these findings, areas of controversy, low-quality evidence and uncertainties are highlighted, prior to recommendations for each area of interest. A recently published review article provides more detailed information and was the basis for this position statement (Bjørndal et al. 2019, International Endodontic Journal, doi:10.1111/iej.13128). The intention of this position statement is to provide the practitioner with relevant clinical guidance in this rapidly developing area. An update will be provided within 5 years as further evidence emerges. 10.1111/iej.13080
Outcome of Partial Pulpotomy in Cariously Exposed Posterior Permanent Teeth: A Systematic Review and Meta-analysis. Elmsmari Firas,Ruiz Xavier-Fructuós,Miró Queralt,Feijoo-Pato Nancy,Durán-Sindreu Fernando,Olivieri Juan Gonzalo Journal of endodontics INTRODUCTION:The current systematic review and meta-analysis aimed to evaluate the success rate of partial pulpotomy in treating permanent posterior teeth with carious vital pulp exposure. A secondary aim was to assess the prognostic factors using a meta-regression. METHODS:An electronic search was performed for studies from January 1950 to November 2018 in the following databases: PubMed, ScienceDirect, and Cochrane. All searches were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies evaluating the success rate of cariously exposed vital human permanent posterior teeth treated with a partial pulpotomy were selected. Only randomized clinical trials and prospective clinical studies were included for evaluation. The Newcastle-Ottawa Scale and the Cochrane Collaboration's tool were used to evaluate risk assessment. RESULTS:From the 218 studies identified through the initial search, 11 studies qualified for the final analysis (5 randomized clinical trials and 6 prospective studies). The results of the meta-analysis indicate a success rate of 98% (confidence interval [CI]: 0.94-1), 96% (CI: 0.92-0.99), and 92% (CI: 0.83-0.97) after 6 months and 1 and 2 years of follow-up. Examining the probable prognostic factors using meta-regression analysis, only preoperative pulp status (P = .001) was identified as a significant factor, with studies including teeth with the presumptive diagnosis of irreversible pulpitis displaying significantly lower results. The final solution, pulp capping material, apex closure, and the age of the patient did not affect the treatment success rate (P > .05). CONCLUSIONS:The available data suggest that a partial pulpotomy results in high success rates in treating cariously exposed permanent posterior teeth up to 2 years. Six months of monitoring can be considered an appropriate period when evaluating the success of a partial pulpotomy although more clinical and radiographic controls are essential to ensuring success. 10.1016/j.joen.2019.07.005
Long-term Pulpal and Restorative Outcomes of Pulpotomy in Mature Permanent Teeth. Tan Shao Yong,Yu Victoria Soo Hoon,Lim Kian Chong,Tan Beng Choon Keson,Neo Chiew Lian Jennifer,Shen Liang,Messer Harold Henry Journal of endodontics INTRODUCTION:Pulpotomy in mature permanent cariously exposed teeth preserves the remaining pulp tissues, but long-term outcomes of the pulp and the restoration are unknown. This prospective study examined the immediate and long-term status of the pulp and the restored tooth and identified potential predictors of early and late failures in teeth that were asymptomatic or experiencing only mild symptoms at the time of treatment. METHODS:Pulpotomy was performed using the aseptic technique and a tricalcium silicate cement under local anesthesia. Teeth were assessed for up to 5 years for pulpal and apical signs and symptoms, restorative marginal integrity, and periodontal health. RESULTS:Fifty-two patients (61 teeth) with a median age of 40 years (range, 21-75 years) were included in this study; 17 (32.7%) men and 35 (67.3%) women were treated and reviewed. Overall pulp survival was 90.2% (95% confidence interval, 79.8%-96.3%); 6 teeth developed irreversible pulpitis or pulp necrosis when the restoration was intact. Preoperative pain was a potential predictor (P < .05) for early failure. Eleven late failures occurred between 2 and 4 years: 1 tooth with intact coronal restoration had pulp necrosis and asymptomatic apical periodontitis, 4 had recurrent caries resulting in asymptomatic apical periodontitis, 4 remained vital and only needed new restorations, 1 was unrestorable, and 1 was extracted for periodontal reasons. The type of definitive restoration was a potential predictor for late failure (P < .05). CONCLUSIONS:Carious pulp exposures in asymptomatic mature permanent teeth can be predictably managed by pulpotomy using a tricalcium silicate cement. Short-term failures were few and managed by pulpectomy. Appropriate coronal restoration is critical to long-term success. 10.1016/j.joen.2019.11.009
Apical limit of root canal instrumentation and obturation, part 2. A histological study. Ricucci D,Langeland K International endodontic journal The results of an in vivo histological study involving apical and periapical tissues following root canal therapy after different observation periods demonstrated the most favourable histological conditions when the instrumentation and obturation remained at or short of the apical constriction. This was the case in the presence of vital or necrotic pulps, also when bacteria had penetrated the foramen and were present in the periapical tissues. When the sealer and/or the gutta-percha was extruded into the periapical tissue, the lateral canals and the apical ramifications, there was always a severe inflammatory reaction including a foreign body reaction despite a clinical absence of pain.
Complex Apical Intraradicular Infection and Extraradicular Mineralized Biofilms as the Cause of Wet Canals and Treatment Failure: Report of 2 Cases. Ricucci Domenico,Candeiro George T M,Bugea Calogero,Siqueira José F Journal of endodontics This article describes 2 cases that showed persistent intracanal exudation (wet canal) even after several visits of antimicrobial endodontic treatment. Histologic and histobacteriologic investigation was conducted for determination of the cause. The 2 cases involved teeth with apical periodontitis lesions, which presented persistent exudation refractory to treatment after several visits. In case 1, it was not possible to achieve a dry canal, and surgery had to be performed. In case 2, attempts to dry the canal succeeded and the canal was filled, but follow-up examination showed an enlarged apical periodontitis lesion and extraction was performed. Biopsy specimens consisting of the root apex and apical periodontitis lesion for case 1 and the whole root for case 2 were subjected to histologic and histobacteriologic analyses. Both cases showed complex bacterial infection in the apical root, affecting both the intraradicular space and the outer root surface. Case 1 showed bacterial biofilms in ramifications, on untouched walls, and extending to the external root surface to form a thick and partially mineralized structure with high bacterial density. Different bacterial morphotypes were evidenced. Case 2 had a ledge on the apical canal wall created during instrumentation, which was filled with necrotic debris, filling material, and bacteria. The walls of the apical portion of the canal were covered by a bacterial biofilm, which was continuous with a thick extraradicular biofilm covering the cementum and dentin in resorptive defects. The extraradicular biofilm showed areas of mineralization and was dominated by filamentous bacteria. The 2 cases with wet canals and treatment failure were associated with complex persistent infection in the apical part of the root canal system extending to form thick and partially mineralized biofilm structures (calculus) on the outer apical root surface. 10.1016/j.joen.2015.12.014
Fate of the tissue in lateral canals and apical ramifications in response to pathologic conditions and treatment procedures. Ricucci Domenico,Siqueira José F Journal of endodontics INTRODUCTION:This article reviews and reports on the histopathologic and histobacteriologic status of the tissue in lateral canals and apical ramifications (LC/AR) in diverse clinical conditions as well as in response to endodontic treatment. METHODS:In total, serial sections from 493 human tooth specimens obtained by extraction or apical surgery were screened for the presence of LC/AR. RESULTS:LC/AR were observed in about 75% of the teeth. In clinically vital teeth, vital tissue was consistently found in LC/AR. In teeth with periodontal disease, the whole pulp became necrotic only when the subgingival biofilm reached the main apical foramen. In teeth with pulp exposure by caries, the tissue in LC/AR remained vital as far as the pulp tissue in the main canal did so. When pulp necrosis reached the level of the LC/AR, the tissue therein was either partially or completely necrotic. Chemomechanical preparation partially removed necrotic tissue from the entrance of LC/AR, whereas the adjacent tissue remained inflamed, sometimes infected, and associated with periradicular disease. Vital tissue in LC/AR was not removed by preparation. In cases in which lateral canals appeared radiographically "filled," they were actually not obturated, and the remaining tissue in the ramification was inflamed and enmeshed with the filling material. CONCLUSIONS:Overall, the belief that lateral canals must be injected with filling material to enhance treatment outcome was not supported by literature review or by our histopathologic observations. It appears that strategies other than finding a technique that better squeezes sealer or gutta-percha within LC/AR should be pursued to effectively disinfect these regions. 10.1016/j.joen.2009.09.038
Histologic investigation of root canal-treated teeth with apical periodontitis: a retrospective study from twenty-four patients. Ricucci Domenico,Siqueira José F,Bate Anna L,Pitt Ford Thomas R Journal of endodontics This study intended to examine histologically root canal-treated teeth evincing apical periodontitis lesions and correlate the findings with clinical observations. Specimens were obtained from 24 patients (12 asymptomatic and 12 symptomatic) by extraction or endodontic surgery and consisted of roots or root tips and the associated pathologic lesion. Specimens were processed for histologic analysis, and serial sections were evaluated. Findings were correlated with clinical observations according to the presence or absence of symptoms. The mean period elapsed from treatment to specimen retrieval in the asymptomatic group was 7.5 years, as compared with 2.2 years in the symptomatic group. All specimens exhibited periradicular inflammation. Bacteria were visualized in all cases, except for 1 specimen from the asymptomatic group in which a foreign body reaction to overfilled material was the probable reason for emergent disease in a previously vital case. Irrespective of the presence of symptoms, bacteria were always located within the root canal system, although they were also observed in the periradicular tissues in 1 asymptomatic and 4 symptomatic teeth. In general, intraradicular bacterial colonization was heavier in symptomatic failed teeth. The present findings support the role of intraradicular infections, usually in the form of biofilms, as the primary cause of endodontic treatment failure. 10.1016/j.joen.2008.12.014
Wound healing of apical tissues after root canal therapy: a long-term clinical, radiographic, and histopathologic observation study. Ricucci Domenico,Lin Louis M,Spångberg Larz S W Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics OBJECTIVE:The purpose of this study was to evaluate the pulp healing process and the dentin-cementum complex in 51 endodontically treated human teeth after long observation periods and to correlate histologic observations with conventional periapical radiographic findings. STUDY DESIGN:Specimens were obtained from the extraction of 77 treated teeth, which were deemed to be unrestorable, with no evidence of periapical bone lesion at the follow-up. After stringent evaluation of the radiographs, 51 cases that 3 independent evaluators assessed as having normal periapical conditions were selected. The specimens were histologically evaluated using serial sections. RESULTS:In the majority of the cases, complete healing was observed, with no signs of acute or chronic inflammatory processes in the remaining apical tissue or periodontal tissue fragments. Some cases showed moderate inflammation in the root canal tissue. Narrowing of the apical root canal by cementum was a common finding in most cases, but total closure was not observed. Debris intermixed with necrotic tissue and sealer particles was a common finding in the pulp stump. Bacteria were present in the coronal portion of the root in almost all cases, but in only 1 case could bacteria be demonstrated in the coronal and apical portions of the root. CONCLUSIONS:Apical tissue of properly treated teeth with no signs of periapical changes is only rarely significantly inflamed. When the tissue is inflamed, microbial causes can always be demonstrated. Despite the presence of microorganisms coronally in nearly all cases, apical tissue is seldom affected. 10.1016/j.tripleo.2009.05.028
Calculus-like deposit on the apical external root surface of teeth with post-treatment apical periodontitis: report of two cases. Ricucci D,Martorano M,Bate A L,Pascon E A International endodontic journal AIM:To report two cases in which calculus-like material was found on external root surfaces of (i) an extracted root and (ii) an apicected part of a root, both of which were removed due to post-treatment refractory apical periodontitis. SUMMARY:In each case, there was a fistulous tract, which did not heal after conventional root canal treatment. The first case did not heal even after apical surgery, and subsequent tooth extraction revealed calculus-like material on a root surface of complex anatomy. The second case showed radiographic signs of healing after apicectomy. Histology of the apical biopsy revealed a calculus-like material on the external surface of the root apex. It is suggested that the presence of calculus on the root surfaces of teeth with periapical lesions may contribute towards the aetiology of failure. KEY LEARNING POINTS:Biofilm on the external root surface has been implicated in the failure of apical periodontitis to heal, despite adequate root canal treatment. Calculus-like material was found, in two cases, on the root surface of teeth with post-treatment apical periodontitis, where the only communication externally was a sinus tract. 10.1111/j.1365-2591.2005.00933.x
One- versus two-visit endodontic treatment of teeth with apical periodontitis: a histobacteriologic study. Vera Jorge,Siqueira José F,Ricucci Domenico,Loghin Simona,Fernández Nancy,Flores Belina,Cruz Alvaro G Journal of endodontics INTRODUCTION:This study analyzed the in vivo microbiological status of the root canal systems of mesial roots of mandibular molars with primary apical periodontitis after 1- or 2-visit endodontic treatment. METHODS:Mesial root canals were instrumented by using either a combination of K3 and LightSpeed instruments (mesiobuccal canals) or the ProTaper system (mesiolingual canals), with 5% NaOCl irrigation. Patency files were used. Smear layer was removed, and a final rinse with 5 mL of 2% chlorhexidine was performed. In the 2-visit group (7 roots, 14 canals), canals were medicated with calcium hydroxide for 1 week and then obturated by using the continuous wave of compaction technique. In the 1-visit group (6 roots, 12 canals), canals were immediately obturated after chemomechanical procedures. Teeth were extracted 1 week after root canal instrumentation and processed for histobacteriologic analysis. RESULTS:In the 1-visit group, no case was completely free of bacteria; residual bacteria occurred in the main root canal (5 of 6 cases), isthmus (5 of 6), apical ramifications (4 of 6), and dentinal tubules (5 of 6). In the 2-visit group, 2 cases were rendered bacteria-free; residual bacteria were found in the main canal only in 2 cases (none of them with persistent dentinal tubule infection), in the isthmus (4 of 7 cases), and in ramifications (2 of 7). The 2 instrumentation techniques performed similarly. When filling material was observed in ramifications, it was usually intermixed with necrotic tissue, debris, and bacteria. CONCLUSIONS:The 2-visit protocol by using an interappointment medication with calcium hydroxide resulted in improved microbiological status of the root canal system when compared with the 1-visit protocol. Residual bacteria were more frequent and abundant in ramifications, isthmuses, and dentinal tubules when root canals were treated without an interappointment medication. Apical ramifications and isthmuses were never completely filled. The use of an antibacterial interappointment agent is necessary to maximize bacterial reduction before filling. 10.1016/j.joen.2012.04.010
Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure. Ricucci Domenico,Siqueira José F,Li Yuanyuan,Tay Franklin R Journal of dentistry OBJECTIVES:Vital pulp therapy (VPT) encompasses distinct treatment modalities for deep caries that approximate the pulp chamber in vital teeth. Confusion exists in the literature in terms of the indication and rationale for each VPT approach. The objectives of the present study are to elucidate the indications for VPT and to present a set of histopathology and histobacteriology-based guidelines for VPT in teeth with deep caries. METHODS:Two hundred and sixty-four carious, unrestored and VPT-treated human teeth, which were extracted for reasons not related to the present study. The teeth were processed for histological and histobacteriological examination. Other 757 clinical cases that received different VPT procedures were followed-up to identify success rates, with the longest observational period of 30 years. RESULTS:Follow-up of the clinical cases indicated that direct pulp capping was successful in 73.2%, partial pulpotomy in 96.4% and full pulpotomy in 77.8% of the cases. Histological and histobacteriological examination showed a localised inflammatory response that commonly occurred in the subjacent pulp tissue as soon as the enamel was penetrated by caries. If the softened and infected dentine were completely excavated, without pulp exposure, and the cavity restored with an adequate restoration, pulp inflammation frequently subsided. In teeth showing pulp exposure, the extent of bacterial penetration varied and areas of infection presented severe pulp inflammation, including micro-abscesses. However, the pulp tissue apical to the infected/inflamed area was usually uninflamed and normal. Guidelines based on the present histopathological, histobacteriological and clinical findings are proposed for VPT and mainly involve direct examination of dentine and the exposed pulp tissue under deep caries for decision-making, and require strict asepsis during procedures. CONCLUSIONS:Vital pulp therapy following the guidelines proposed in the present article has the potential to improve the outcome of the conservative treatment of mature teeth with deep caries and in some occasions may be an alternative to pulpectomy. CLINICAL SIGNIFICANCE:A guideline for VPT in the treatment of deep caries is proposed, focusing on direct observation of dentine and the exposed pulp tissue under deep caries. Stringent aseptic techniques are mandatory for VPT procedures to be successful. 10.1016/j.jdent.2019.05.022
The effect of partial pulpotomy with iRoot BP Plus in traumatized immature permanent teeth: A randomized prospective controlled trial. Yang YingTing,Xia Bin,Xu Zheng,Dou Guili,Lei Yue,Yong Wei Dental traumatology : official publication of International Association for Dental Traumatology BACKGROUND/AIM:A new bioceramic material iRoot BP Plus has been introduced and reported to have good biocompatibility, sealing ability and antibacterial activity. It has also been reported to be successfully used for procedures such as pulpotomy, pulp floor perforation repair and so on. However, there are only a few reports on the use of iRoot BP Plus in the management of traumatized teeth with an exposed pulp. The aim of this study was to investigate the clinical and radiographic outcomes of partial pulpotomy with iRoot BP Plus in immature permanent teeth with complicated crown fracture or complicated crown-root fracture. MATERIAL AND METHODS:The study was prospectively designed, and 110 immature permanent teeth with complicated crown fracture or complicated crown-root fracture were randomly allocated into two groups (n = 55). All teeth were clinically and radiographically assessed at 1, 3, 6, 12, 18 and 24 months after partial pulpotomy with iRoot BP Plus (experimental group, n = 50) or calcium hydroxide (control group, n = 49) as the pulp capping agent. Eleven cases were lost during follow up, and 99 teeth were finally analysed. RESULTS:There were no intergroup differences in the survival rate, survival time, root length and dentin wall thickness. The calcific bridge was significantly thinner in the iRoot BP Plus group than in the calcium hydroxide group (0.97 ± 0.13 mm vs 1.36 ± 0.12 mm; F = 5.128, P = .029). CONCLUSIONS:iRoot BP Plus may be an effective capping material for partial pulpotomy. 10.1111/edt.12563
Evaluation of a bioceramic as a pulp capping agent in vitro and in vivo. Liu Siyi,Wang Sainan,Dong Yanmei Journal of endodontics INTRODUCTION:This study aims to investigate the effects of the bioceramic iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, Canada) as a pulp capping agent in vitro and in vivo. METHODS:In vitro, human dental pulp cells (hDPCs) were seeded into plates with the prepared iRoot BP Plus or mineral trioxide aggregate (MTA) packed in the bottom of different wells. The proliferation of hDPCs was determined using the 3,(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay. Meanwhile, 2 animal models of direct pulp capping and pulpotomy were applied in Wistar rats in vivo. The exposed pulps were capped with iRoot BP Plus or MTA. After 1 and 4 weeks, maxillary segments were obtained and prepared for histologic analysis. RESULTS:hDPCs grew very well even in the place contacted with MTA or iRoot BP plus in vitro. MTA and iRoot BP Plus both enhanced the proliferation of hDPCs (P < .05). In vivo, results revealed that few inflammatory cells were present in the pulpal area corresponding to the pulp exposure. A slight layer of newly generated matrix was also observed next to MTA and iRoot BP Plus after 1 week. A complete reparative dentin bridge with polarizing odontoblastlike cells was detected in all specimens in the iRoot BP Plus group after 4 weeks. CONCLUSIONS:iRoot BP Plus exhibited good biocompatibility to pulp tissue and induced the proliferation of dental pulp cells and the formation of reparative dentin bridge. iRoot BP plus may be used as a pulp capping material for vital pulp therapy. 10.1016/j.joen.2014.12.009
Bioactive tri/dicalcium silicate cements for treatment of pulpal and periapical tissues. Acta biomaterialia Over 2500 articles and 200 reviews have been published on the bioactive tri/dicalcium silicate dental materials. The indications have expanded since their introduction in the 1990s from endodontic restorative and pulpal treatments to endodontic sealing and obturation. Bioactive ceramics, based on tri/dicalcium silicate cements, are now an indispensable part of the contemporary dental armamentarium for specialists including endodontists, pediatric dentists, oral surgeons andfor general dentists. This review emphasizes research on how these materials have conformed to international standards for dental materials ranging from biocompatibility (ISO 7405) to conformance as root canal sealers (ISO 6876). Potential future developments of alternative hydraulic materials were included. This review provides accurate materials science information on these important materials. STATEMENT OF SIGNIFICANCE: The broadening indications and the proliferation of tri/dicalcium silicate-based products make this relatively new dental material important for all dentists and biomaterials scientists. Presenting the variations in compositions, properties, indications and clinical performance enable clinicians to choose the material most suitable for their cases. Researchers may expand their bioactive investigations to further validate and improve materials and outcomes. 10.1016/j.actbio.2019.05.050
Calcium silicate bioactive cements: Biological perspectives and clinical applications. Prati Carlo,Gandolfi Maria Giovanna Dental materials : official publication of the Academy of Dental Materials OBJECTIVE:To introduce and to examine the research progress and the investigation on hydraulic calcium silicate cements (HCSCs), well-known as MTA (mineral trioxide aggregate). METHODS:This review paper introduces the most important investigations of the last 20 years and analyze their impact on HCSCs use in clinical application. RESULTS:HCSCs were developed more than 20 years ago. Their composition is largely based on Portland cement components (di- and tri-calcium silicate, Al- and Fe-silicate). They have important properties such as the ability to set and to seal in moist and blood-contaminated environments, biocompatibility, adequate mechanical properties, etc. Their principal limitations are long setting time, low radiopacity and difficult handling. New HCSCs-based materials containing additional components (setting modulators, radiopacifying agents, drugs, etc.) have since been introduced and have received a considerable attention from laboratory researchers for their biological and translational characteristics and from clinicians for their innovative properties. HCSCs upregulate the differentiation of osteoblast, fibroblasts, cementoblasts, odontoblasts, pulp cells and many stem cells. They can induce the chemical formation of a calcium phosphate/apatite coating when immersed in biological fluids. These properties have led to a growing series of innovative clinical applications such as root-end filling, pulp capping and scaffolds for pulp regeneration, root canal sealer, etc. The capacity of HCSCs to promote calcium-phosphate deposit suggests their use for dentin remineralization and tissue regeneration. Several in vitro studies, animal tests and clinical studies confirmed their ability to nucleate apatite and remineralize and to induce the formation of (new) mineralized tissues. SIGNIFICANCE:HCSCs play a critical role in developing a new approach for pulp and bone regeneration, dentin remineralization, and bone/cementum tissue healing. Investigations of the next generation HCSCs for "Regenerative Dentistry" will guide their clinical evolution. 10.1016/j.dental.2015.01.004
Retraction notice. JAAD case reports [This retracts the article DOI: 10.1016/j.jdcr.2017.10.009.]. 10.1016/j.jdcr.2018.08.026
iRoot BP Plus promotes osteo/odontogenic differentiation of bone marrow mesenchymal stem cells via MAPK pathways and autophagy. Lu Jiamin,Li Zehan,Wu Xiao,Chen Yan,Yan Ming,Ge Xingyun,Yu Jinhua Stem cell research & therapy BACKGROUND:iRoot BP Plus is a novel bioceramic endodontic material. Recently, it has been considered as an alternative to MTA which is the most popular scaffold cover during regenerative endodontic therapy. This study aimed to evaluate the effects of iRoot BP Plus on the osteo/odontogenic capacity of bone marrow mesenchymal stem cells (BMMSCs), including the underlying mechanisms. METHODS:BMMSCs were collected by a whole marrow method and treated with iRoot BP Plus-conditioned medium (BP-CM). The proliferation ability was evaluated by cell counting kit 8 and flow cytometry. Complete medium was used as a blank control, and 2 mg/ml MTA-conditioned medium was served as a positive control. Alkaline phosphatase (ALP) activity assay, ALP staining, western blot, real-time RT-PCR, Alizarin Red S staining, and immunofluorescence staining were performed to explore the osteo/odontogenic potential and the involvement of MAPK pathways. Besides, autophagy was investigated by western blot, immunofluorescence staining, and transmission electron microscopy. RESULTS: 10.1186/s13287-019-1345-3
Comparison of pulp response to mineral trioxide aggregate and a bioceramic paste in partial pulpotomy of sound human premolars: a randomized controlled trial. Azimi S,Fazlyab M,Sadri D,Saghiri M A,Khosravanifard B,Asgary S International endodontic journal AIM:This randomized clinical trial evaluated clinical sign/symptoms as well as histological pulp reactions in terms of inflammation and mineralized bridge formation after partial pulpotomy of sound human premolars and placement of a bioceramic paste (iRoot BP) or tooth-colored ProRoot MTA as pulp-covering biomaterials. METHODOLOGY:Twenty-four human sound premolars were randomly allocated into two experimental groups (n = 12) treated either with iRoot BP or MTA subsequent to partial pulpotomy. Six weeks after treatment, clinical sign/symptoms and radiographic changes were evaluated. The teeth were then extracted and examined histologically for inflammatory status of the pulp, formation of hard tissue bridge and appearance of the bridge. In terms of pulp inflammation and dentinal bridge formation, the Mann-Whitney U, and for clinical signs, the chi-square test was used (α = 0.05). RESULTS:In terms of pulp inflammation, formation of hard tissue bridge and its appearance, the differences between the two experimental groups were not significant. However, clinical sensitivity to cold was significantly less for teeth treated with MTA (P < 0.05). All cases had formed a hard tissue bridge, and none of the specimens in either group had pulpal necrosis. CONCLUSION:When treating teeth with healthy pulps, the response to partial pulpotomy treatment with both MTA and iRoot BP was favourable. However, pulps covered with iRoot BP were more sensitive to cold stimuli. 10.1111/iej.12231
Gene Expression Profiling and Molecular Signaling of Dental Pulp Cells in Response to Tricalcium Silicate Cements: A Systematic Review. Rathinam Elanagai,Rajasekharan Sivaprakash,Chitturi Ravi Teja,Martens Luc,De Coster Peter Journal of endodontics INTRODUCTION:Signaling molecules and responding dental pulp stem cells are the 2 main control keys of dentin regeneration/dentinogenesis. The aim of this study was to present a systematic review investigating the gene expression of various dental pulp cells in response to different variants of tricalcium silicate cements. METHODS:A systematic search of the literature was performed by 2 independent reviewers followed by article selection and data extraction. Studies analyzing all sorts of dental pulp cells (DPCs) and any variant of tricalcium silicate cement either as the experimental or as the control group were included. RESULTS:A total of 39 articles were included in the review. Among the included studies, ProRoot MTA (Dentsply, Tulsa Dental, OK) was the most commonly used tricalcium silicate cement variant. The extracellular signal regulated kinase/mitogen-activated protein kinase pathway was the most commonly activated pathway to be identified, and similarly, dentin sialophosphoprotein osteocalcin dentin matrix acidic phosphoprotein 1, alkaline phosphatase, bone sialoprotein, osteopontin, type I collagen, and Runx2 were the most commonly expressed genes in that order of frequency. CONCLUSIONS:Biodentine (Septodont Ltd, Saint Maur des Faussés, France), Bioaggregate (Innovative Bioceramix, Vancouver, BC, Canada), and mineral trioxide aggregate stimulate the osteogenic/odontogenic capacity of DPCs by proliferation, angiogenesis, and biomineralization through the activation of the extracellular signal regulated kinase ½, nuclear factor E2 related factor 2, p38, c-Jun N-terminal kinase mitogen-activated protein kinase, p42/p44 mitogen-activated protein kinase, nuclear factor kappa B, and fibroblast growth factor receptor pathways. When DPCs are placed into direct contact with tricalcium silicate cements, they show higher levels of gene activation, which in turn could translate into more effective pulpal repair and faster and more predictable formation of reparative dentin. 10.1016/j.joen.2015.07.015
Dentinal tubule penetration of AH Plus, iRoot SP, MTA fillapex, and guttaflow bioseal root canal sealers after different final irrigation procedures: A confocal microscopic study. Akcay Merve,Arslan Hakan,Durmus Nazli,Mese Merve,Capar Ismail Davut Lasers in surgery and medicine BACKGROUND AND OBJECTIVE:Varied physical and chemical characteristic of root canal sealers and different irrigant agitation systems can influence the depth of penetration. The aim of this in vitro study was to use a laser scanning confocal microscope in order to assess the dentinal tubules penetration of various sealers after the application of different final irrigation techniques. STUDY DESIGN/MATERIALS AND METHODS:A total of 156 single-rooted extracted mandibular premolars were prepared up to size 40 and randomly distributed into four groups according to the sealer type (n = 39): AH Plus, iRoot SP, MTA Fillapex, and GF Bioseal. Each group was randomly subdivided into three groups according to the final irrigation protocol (n = 13): conventional needle irrigation (CI), photon-induced-photoacoustic streaming activation (PIPS), and passive ultrasonic irrigation (PUI). After the final irrigation procedures, the root canals were obturated with single gutta-percha and labeled sealer mixed with 0.1% fluorescent rhodamine B isothiocyanate. Specimens were sectioned at 2, 5, and 8 mm from the apex, and all the sections were examined under confocal microscope to calculate the dentinal tubule penetration area. Data were analyzed using three-way analysis of variance and Tukey's post hoc tests (P = 0.05). RESULTS:iRoot SP exhibited a significantly higher penetration area than the other groups (P < 0.001), although there were no statistically significant differences between AH Plus, MTA Fillapex, and GF Bioseal (P > 0.05). Er:YAG laser activation with PIPS and PUI had significantly higher penetration than CI (P < 0.001). Statistically significant differences were also determined at each root canal third (coronal > middle > apical; P < 0.001). CONCLUSIONS:The dentinal tubule penetration area was significantly affected by the selection of root canal sealer, final irrigation procedure, and root canal third. Use of iRoot with PIPS tip or PUI seems advantageous in dentinal tubule penetration. 10.1002/lsm.22446
Comparison of Mineral Trioxide Aggregate and iRoot BP Plus Root Repair Material as Root-end Filling Materials in Endodontic Microsurgery: A Prospective Randomized Controlled Study. Zhou Wei,Zheng Qinghua,Tan Xuelian,Song Dongzhe,Zhang Lan,Huang Dingming Journal of endodontics INTRODUCTION:This prospective randomized controlled study evaluated the clinical and radiographic outcome of endodontic microsurgery when using iRoot BP Plus Root Repair Material (BP-RRM; Innovative BioCeramix Inc, Vancouver, BC, Canada) or mineral trioxide aggregate (MTA) as the retrograde filling material and analyzed the relationship between some potential prognostic factors and the outcome of the surgery. METHODS:By using strict inclusion and exclusion criteria, 240 teeth were successfully enrolled and randomly and equally allocated to either the MTA or BP-RRM treatment group. A standardized surgical procedure was performed by a single operator. The patients were followed up at 1 week, 3 months, 6 months, and 12 months; follow-up included clinical and radiographic examination. Clinical and radiographic evaluations acquired at the 12-month follow-up were taken as the primary outcome. For the identification of prognostic factors, the dichotomous outcome (success vs failure) was taken as the dependent variable. RESULTS:A total of 158 teeth were analyzed at the 12-month follow-up, including 87 teeth in the MTA group and 71 teeth in the BP-RRM group. The success rate in the MTA and BP-RRM groups was 93.1% (81/87 teeth) and 94.4% (67/71 teeth), respectively (P > .05). Three significant outcome predictors were identified: quality of root filling (P < .05), tooth type (P < .05), and size of the lesion (P < .05) CONCLUSIONS: These results suggest that BP-RRM is comparable with MTA in clinical outcome when used as root-end filling materials in endodontic microsurgery. 10.1016/j.joen.2016.10.010
Outcome of Endodontic Microsurgery Using Mineral Trioxide Aggregate or Root Repair Material as Root-end Filling Material: A Randomized Controlled Trial with Cone-beam Computed Tomographic Evaluation. Safi Chafic,Kohli Meetu R,Kratchman Samuel I,Setzer Frank C,Karabucak Bekir Journal of endodontics INTRODUCTION:The purpose of this randomized clinical trial was to evaluate healing after endodontic microsurgery (EMS) using mineral trioxide aggregate (MTA) versus EndoSequence root repair material (RRM; Brasseler, Savannah, GA) as root-end filling materials. METHODS:Two hundred forty-three teeth with persistent or recurrent apical periodontitis were randomly assigned to either the MTA or RRM group. EMS was performed, and follow-up visits with clinical and radiographic investigation were scheduled at 6, 12, and 24 months with follow-up cone-beam computed tomographic (CBCT) imaging after 12 months. RESULTS:One hundred twenty teeth with an average follow-up of 15 months were evaluated. The overall success rate was 93.3% for periapical (PA) evaluation and 85% for CBCT evaluation. The RRM group exhibited 92% and 84% success rates as assessed on PA and CBCT imaging, respectively. The MTA group exhibited 94.7% and 86% success rates as assessed on PA and CBCT imaging, respectively. No significant difference was observed between the 2 groups. Microsurgical classification, root canal filling quality, root-end filling material depth, and root fracture were found to be significant outcome predictors. CONCLUSIONS:EMS is a predictable procedure with successful outcome both 2-dimensional and 3-dimensional radiographic evaluation when RRM or MTA was used as the root-end filling material. 10.1016/j.joen.2019.03.014
Comparison of iRoot BP Plus and Calcium Hydroxide as Pulpotomy Materials in Permanent Incisors with Complicated Crown Fractures: A Retrospective Study. Rao Qian,Kuang Jin,Mao Chuanxia,Dai Jing,Hu Linying,Lei Zhiyun,Song Guangtai,Yuan Guohua Journal of endodontics INTRODUCTION:Calcium hydroxide has been used as a traditional pulpotomy agent for a long time but has some disadvantages. iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, Canada) is a newly developed, ready-to-use calcium silicate-based bioactive ceramic with excellent bioactivity and sealing ability. However, whether iRoot BP Plus shows superiority over calcium hydroxide as a pulpotomy material on permanent incisors with complicated crown fractures remains unknown. METHODS:This research included 205 permanent incisors with complicated crown fractures. These teeth were treated with pulpotomy and divided into 2 groups according to the pulpotomy material (105 treated with iRoot BP Plus and 100 with calcium hydroxide). Clinical and radiographic information was collected during the 12- to 24-month follow-up period. The formation of reparative dentin bridges and pulp canal obliteration were analyzed using radiographs in both groups. RESULTS:The success rates for recall in the average follow-up period of 17.5 ± 4.4 months (12-24 months) after pulpotomy treatment were significantly different between the 2 groups, with 99% for the iRoot BP Plus group and 93% for the calcium hydroxide group. Reparative dentin bridges were observed in 92.4% of the iRoot BP Plus group and 90% of the calcium hydroxide group, but the difference was not significant. Pulp canal obliteration was observed in 2 teeth (2%) in each group. CONCLUSIONS:The success rates obtained in our study indicate that iRoot BP Plus as a pulpotomy agent can be a suitable alternative to calcium hydroxide to manage complicated crown fractures. 10.1016/j.joen.2019.12.010
Comparison of indirect pulp treatment and iRoot BP Plus pulpotomy in primary teeth with extremely deep caries: a prospective randomized trial. Chen Xiaoxian,Zhang Hongmei,Zhong Jie,Yan Wenjuan,Lin Bichen,Ding Meili,Xue Shihua,Xia Bin Clinical oral investigations OBJECTIVES:The purpose of this randomized controlled trial was to compare the 24-month success rates of indirect pulp treatment (IPT) and iRoot BP Plus pulpotomy of primary molars with extremely deep caries. MATERIALS AND METHODS:Generally healthy children aged 3-7 years requiring general anesthesia for treating primary molars with extremely deep caries or reversible pulpitis were recruited. Patients with systemic disease, mental health problems, or manifestations of irreversible pulpitis were excluded. In total, 175 molars were randomized and blinded for either IPT (n = 87) or iRoot BP Plus pulpotomy (n = 88). All teeth were restored with stainless steel crowns and evaluated after 6, 12, 18, and 24 months by two blinded calibrated investigators. Kaplan-Meier survival curves were used to compare the survival rates between the groups. The correlations between success rate and patient characteristics were explored with the Cox proportional hazards model. RESULTS:A total of 168 primary molars in 67 patients (average age: 3.83 years) were evaluated. The cumulative survival probability at 24 months was not significantly different between the IPT (93.8%) and pulpotomy (97.7%) groups (P = 0.238). IPT treatment success was significantly associated with age (odds ratio = 2.347; 95% CI: 1.068-5.156; P = 0.034) and preoperative sensitivity (odds ratio = 9.742; 95% CI: 1.079-87.970; P = 0.043). CONCLUSIONS:The 24-month success rates of IPT and iRoot BP Plus pulpotomy performed in primary molars with extremely deep caries were not significantly different. Increasing age and preoperative sensitivity were found to be associated with the cumulative survival probability in IPT-treated primary molars with extremely deep caries. Primary teeth with extremely deep carious lesions without signs of irreversible pulpitis can be treated successfully by either indirect pulp capping or iRoot BP Plus pulpotomy. TRIAL REGISTRATION:ChiCTR2000032462. 10.1007/s00784-020-03627-4
Influence of occlusal and proximal caries on the outcome of full pulpotomy in permanent mandibular molar teeth with partial irreversible pulpitis: A prospective study. R Rechithra,Aravind Archana,Kumar Vijay,Sharma Sidhartha,Chawla Amrita,Logani Ajay International endodontic journal AIM:To assess the influence of occlusal and proximal deep carious lesions on the outcome of full pulpotomy performed in mandibular teeth with pulpal diagnosis of symptomatic partial irreversible pulpitis. METHODOLOGY:Eighty deep carious mandibular molar teeth with clinical and radiographic diagnosis of symptomatic partial irreversible pulpitis without periapical rarefaction from patients of either gender between the age of 16-35 years were included. Depending upon the location of deep carious lesion, the teeth were distributed equally into occlusal (n = 40) and proximal caries groups (n = 40). Full pulpotomy was performed under local anaesthesia and aseptic conditions. The pulp tissue was removed until the root canal orifices, and 2.5% sodium hypochlorite (NaOCl) was applied to arrest pulpal bleeding. Mineral trioxide aggregate (MTA) was compacted over the radicular pulp. Teeth were restored with resin-modified glass ionomer cement (RMGIC) and bulk-fill composite resin. Pre- and post-operative pain was assessed at 24, 48 and 72 h using a 11-point Numerical Rating Scale (NRS). Patients were followed at 6 and 12 months for clinical and radiographic evaluation. Asymptomatic teeth without any radiographic evidence of periapical rarefaction were considered successful. The data were analysed using the Shapiro-Wilk W test, two-sample Wilcoxon rank-sum test, Pearson chi-square test, Fisher's exact test and Kappa coefficient. The significance level was predetermined at p < .05. RESULT:An intergroup comparison revealed that the pre- and post-operative pain scores at 24, 48 and 72 h were not significantly different (p > .05). At the end of follow-up period (12 months), success of full pulpotomy in occlusal and proximal caries group was 95% and 92.5%, respectively (p = .644). For both groups, the combined success rate of full pulpotomy was 93.75%. CONCLUSION:The site of carious lesions (i.e., occlusal or proximal) did not affect the clinical and radiographic outcome of full pulpotomy performed in mature permanent mandibular teeth with symptomatic partial irreversible pulpitis. 10.1111/iej.13588
Should pulp chamber pulpotomy be seen as a permanent treatment? Some preliminary thoughts. Simon S,Perard M,Zanini M,Smith A J,Charpentier E,Djole S X,Lumley P J International endodontic journal AIM:To investigate the benefits of pulpotomy (to the level of the floor of the pulp chamber) as an endodontic treatment for teeth with vital pulps. METHODOLOGY:Seventeen patients, aged 7-54 years (mean of 37.2 year), were treated by pulpotomy and filling with ProRoot MTA(®) in premolar or molar teeth with vital pulps and without clinical evidence of irreversible pulpitis. The patients were then followed up for 12 to 24 months and the teeth then assessed by clinical and radiographic examination. Statistical analysis was performed with Kaplan-Meier survival probability statistics to estimate the survival of the treated teeth. RESULTS:At 24 months, the survival rate without any complementary treatment was estimated to be 82%. Two of the 17 treated teeth required root canal treatment for pain control and one for prosthetic reasons. CONCLUSIONS:Under the conditions of this study, pulpotomy offered a viable alternative to root canal treatment for teeth with vital pulps in the short term. However, there is insufficient clinical evidence to consider this technique for the treatment of every permanent tooth. Nevertheless, it should be considered as a potential alternative approach to be further developed for future applications. 10.1111/j.1365-2591.2012.02113.x
Mineral trioxide aggregate pulpotomy for permanent molars with clinical signs indicative of irreversible pulpitis: a preliminary study. Qudeimat M A,Alyahya A,Hasan A A International endodontic journal AIM:To prospectively investigate the clinical and radiographic success rates of pulpotomy in permanent molars with clinical signs and symptoms suggestive of irreversible pulpitis using mineral trioxide aggregate (MTA) as a pulp dressing agent. METHODOLOGY:Sixteen patients with 23 restorable permanent molars exhibiting signs and symptoms indicative of irreversible pulpitis were enrolled. A standardized operative procedure was followed for all participants. All teeth were isolated with a dental dam and caries was removed, and then, pulpotomy performed with a sterile round and/or flame shape diamond burs. Haemostasis was achieved with 5% sodium hypochlorite (NaOCl). A mixture of MTA was placed against the wound, and a moistened cotton pellet was placed over the MTA. Teeth were temporized with a glass-ionomer restoration. Three to ten days later, the interim restoration was removed and setting of MTA was evaluated. Teeth were restored with stainless steel crowns. Follow-up evaluations were scheduled at 3, 6, 12 months and annually thereafter. Descriptive statistics were used to assess outcomes. RESULTS:The age of patients at time of pulpotomy ranged between 7.6 and 13.6 years (mean = 10.7± 1.7 yrs). The majority of teeth (91%) had clinical signs and symptoms consistent with a diagnosis of symptomatic irreversible pulpitis and symptomatic apical periodontitis (78%). The follow-up examination period ranged from 18.9 to 73.6 months. Clinically and radiographically, all pulpotomies were considered successful at the end of the follow-up period. Radiographically, a hard tissue barrier was noticed in 13 (57%) teeth. CONCLUSION:In children, MTA was associated with high clinical and radiographic success as a pulpotomy agent in permanent teeth with clinical signs and symptoms suggestive of irreversible pulpitis. 10.1111/iej.12614
Human Pulp Response to Direct Pulp Capping and Miniature Pulpotomy with MTA after Application of Topical Dexamethasone: A Randomized Clinical Trial. Mousavi Seyed Amir,Ghoddusi Jamileh,Mohtasham Nooshin,Shahnaseri Shirin,Paymanpour Payam,Kinoshita Jun-Ichiro Iranian endodontic journal INTRODUCTION:The aim of this randomized clinical trial was to compare the histologic pulp tissue response to one-step direct pulp capping (DPC) and miniature pulpotomy (MP) with mineral trioxide aggregate (MTA) after application of dexamethasone in healthy human premolars. METHODS AND MATERIALS:Forty intact premolars from 10 orthodontic patients, were randomly chosen for DPC (n=20) or MP (n=20). In 10 teeth from each group, after exposure of the buccal pulp horn, topical dexamethasone was applied over the pulp. In all teeth the exposed/miniaturely resected pulp tissue was covered with MTA and cavities were restored with glass ionomer. Teeth vitality was evaluated during the next 7, 21, 42, and 60 days. Signs and/or symptoms of irreversible pulpitis or pulp necrosis were considered as failure. According to the orthodontic schedule, after 60 days the teeth were extracted and submitted for histological examination. The Kruskal-Wallis and Fisher's exact tests were used for statistical analysis of the data (P=0.05). RESULTS:Although dexamethasone specimens showed less inflammation, calcified bridge, pulpal blood vasculature, collagen fibers and granulation tissue formation were not significantly different between the groups (P>0.05). CONCLUSION:Topical dexamethasone did not hindered pulp healing but reduced the amount of underlying pulpal tissue inflammation after DPC and MP in healthy human premolars. 10.7508/iej.2016.02.002
MTA pulpotomy of human permanent molars with irreversible pulpitis. Eghbal Mohammad Jafar,Asgary Saeed,Baglue Reza Ali,Parirokh Masoud,Ghoddusi Jamileh Australian endodontic journal : the journal of the Australian Society of Endodontology Inc The histological success of mineral trioxide aggregate (MTA) pulpotomy for treatment of irreversible pulpitis in human teeth as an alternative treatment was investigated in this study. Fourteen molars which had to be extracted were selected from patients 16-28 years old. The selection criteria include carious pulp exposure with a history of lingering pain. After isolation, caries removal and pulp exposure, MTA was used in pulpotomy treatment. Patients were evaluated for pain after 24 h. Two patients were lost from this study. Twelve teeth were extracted after 2 months and were assessed histologically. Recall examinations confirmed that none of the patients experienced pain after pulpotomy. Histological observation revealed that all samples had dentin bridge formation completely and that the pulps were vital and free of inflammation. Although the results favour the use of MTA as a pulpotomy material, more studies with larger samples and a longer recall period are suggested to justify the use of MTA for treatment of irreversible pulpitis in human permanent teeth. 10.1111/j.1747-4477.2009.00166.x
Partial Pulpotomy in Mature Permanent Teeth with Clinical Signs Indicative of Irreversible Pulpitis: A Randomized Clinical Trial. Taha Nessrin A,Khazali Mohammad A Journal of endodontics INTRODUCTION:This study aimed to assess the outcome of partial pulpotomy using mineral trioxide aggregate (MTA) compared with calcium hydroxide (CH) in mature cariously exposed permanent molars. METHODS:Fifty permanent molar teeth with carious exposures in 50 patients >20 years old were included. Preoperative pulpal and periapical diagnosis was established based on a history of presenting pain, results of cold testing, and radiographic findings. After informed consent, the tooth was anesthetized, isolated via a dental dam, and disinfected with 5% sodium hypochlorite before caries excavation. Partial pulpotomy was performed by amputating 2 mm of the exposed pulp, hemostasis was achieved, and the tooth was randomly assigned for the placement of either white MTA (White ProRoot; Dentsply, Tulsa, OK) or CH (Dycal; Dentsply Caulk, Milford, DE) as the pulpotomy agent. Postoperative periapical radiographs were taken after placement of the permanent restoration. Clinical and radiographic evaluation was completed after 6 months and 1 and 2 years postoperatively. Statistical analysis was performed using the Fisher exact test. RESULTS:Clinical signs and symptoms suggestive of irreversible pulpitis were established in all teeth. Immediate failure occurred in 4 teeth. At 1 year, MTA showed a higher tendency toward success compared with the CH group, and the difference was statistically significant after 2 years (83% vs 55%, P = .052 at 1 year; 85% vs 43%, P = .006 at 2 years). Sex did not have a statistically significant effect on the outcome. CONCLUSIONS:MTA partial pulpotomy sustained a good success rate over the 2-year follow-up in mature permanent teeth clinically diagnosed with irreversible pulpitis. More than half of the CH cases failed within 2 years. 10.1016/j.joen.2017.03.033
Effect of Pulpotomy Procedures With Mineral Trioxide Aggregate and Dexamethasone on Post-endodontic Pain in Patients with Irreversible Pulpitis: A Randomized Clinical Trial. European endodontic journal OBJECTIVE:Endodontic post-treatment pain continues to be one of the main problems encountered by dental professionals. Therefore, pain control during and after endodontic treatment is one of the most important issues in endodontics. The purpose of this clinical trial was to compare postoperative pain relief achieved with dexamethasone (DEX) and mineral trioxide aggregate (MTA) used as pulp coverage after pulpotomy in human molars with irreversible pulpitis. METHODS:This prospective double-blind study was conducted on 54 patients complaining of dental pain due to irreversible pulpitis. The standard pulpotomy procedure was performed by the same dentist in all patients. At the time of the cotton pellet placement, patients were randomly divided into three groups: those in whom a sterile dry cotton (DC) pellet was used, patients treated with a cotton pellet soaked in MTA, and those who were treated with a cotton pellet soaked in DEX. After completion of the treatment, patients received rescue medication every 6 hours for the first day. Postoperative pain was assessed at 6-hour intervals for 24 hours, and then every day until day 7 using a visual analog scale. RESULTS:In general, patients treated with MTA suffered the lowest levels of pain at all time intervals. Post-pulpotomy pain was significantly reduced at 18 and 24 hours and from days 2 to 7 post-treatment in the MTA group. DEX lowered the pain level more than the DC pellet. However, the differences observed in the mean pain scores of the DEX and DC pellet groups at all-time intervals were not statistically significant. CONCLUSION:Pulpotomy procedures can reduce pain related irreversible pulpitis. Pulpotomy with MTA-soaked cotton pellet significantly reduces pain intensity in patients with irreversible pulpitis. 10.14744/eej.2019.91885
Association between concentration of active MMP-9 in pulpal blood and pulpotomy outcome in permanent mature teeth with irreversible pulpitis - a preliminary study. Sharma R,Kumar V,Logani A,Chawla A,Mir R A,Sharma S,Kalaivani M International endodontic journal AIM:To investigate the correlation between the concentration of active-matrix metalloproteinases-9 (aMMP-9) in pulpal blood and the outcome of pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis (SIP). METHODOLOGY:Forty permanent molar teeth with a clinical diagnosis of SIP and normal apical tissues with periapical index (PAI) score ≤ 2 and ten permanent teeth (8 molars and two premolars) with a diagnosis of normal pulp that required root canal treatment for prosthetic reasons from patients between the ages of 15-35 years were recruited. All clinical procedures were performed under local anaesthesia and rubber dam isolation. After access opening, the coronal pulp tissue was amputated up to the canal orifice. A 100 μL volume of the pulpal blood was collected using a micropipette and transported to the laboratory. Sodium hypochlorite (2.5 %) was used as a haemostatic agent, and mineral trioxide aggregate (MTA) was used as the pulp capping material. The tooth was restored with composite at the same visit. Teeth with normal pulps were treated with single-visit root canal treatment. Patients with pulpotomy were recalled at 6 and 12 months. Outcome assessment of teeth with pulpotomy was carried out at 12 months and was categorized as success (asymptomatic patients with PAI score ≤ 2) or failure (symptomatic patients or PAI score ≥ 3). Quantification of aMMP-9 in pulpal blood was achieved using a fluorometric assay. The following statistical analyses were performed to assess the data: t-test, Fisher's exact test, kappa coefficient, non-parametric test, Wilcoxon rank-sum test, Spearman rank correlation test and receiver operating characteristic curve (ROC). RESULT:The success rate of pulpotomy was 88 % at 12-months. There was a significant difference between the median concentrations of aMMP-9 in pulpal blood of teeth with normal pulps (52 (12-96) ng mL :) and SIP (193.3 (25.8-607.7) ng mL :) (P = 0.0003) and successful (132.3 (25.8-548.3) ng mL :) and failed cases (512.4 (334.8-607.7 ng mL :) (P = 0.0015) of MTA pulpotomy. A significant association was established between aMMP-9 concentration and outcome of pulpotomy. The area under the receiver operating characteristics curve (0.9484, 95%CI) suggested excellent discriminatory power of aMMP-9 concentration in pulpal blood to predict the pulpotomy outcome. CONCLUSION:The pulpal blood concentration of aMMP-9 was significantly associated with the outcome of pulpotomy in teeth with symptomatic irreversible pulpitis, where it may be used as a potential prognostic biomarker. 10.1111/iej.13437
Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide. Kundzina R,Stangvaltaite L,Eriksen H M,Kerosuo E International endodontic journal AIM:The aim of this multicentre, parallel-group randomized clinical trial was to compare the effectiveness of mineral trioxide aggregate (MTA) and a conventional calcium hydroxide liner (CH) as direct pulp capping materials in adult molars with carious pulpal exposure. METHODOLOGY:Seventy adults aged 18-55 years were randomly allocated to two parallel arms: MTA (White ProRoot, Dentsply, Tulsa Dental, Tulsa, OK, USA; n = 33) and CH (Dycal , Dentsply DeTrey GmbH, Konstanz, Germany; n = 37). The teeth were temporized for 1 week with glass-ionomer (Fuji IX, GC Corp, Tokyo, Japan) and then permanently restored with a composite resin. The subjects were followed up after 1 week and at six, 12, 24 and 36 months. The primary outcome was the survival of the capped pulps, and the secondary outcome was postoperative pain after 1 week. Survival was defined as a nonsymptomatic tooth that responded to sensibility testing and did not exhibit periapical changes on radiograph. At each check-up, the pulp was tested for sensibility and a periapical radiograph was taken (excluding the radiographs taken at the 1-week follow-up). Kaplan-Meier survival analysis and log-rank test were used to assess the significant difference in the survival curves between groups. Chi-square test was used to assess the association between the materials and preoperative and postoperative pain. RESULTS:At 36 months, the Kaplan-Meier survival analysis showed a cumulative estimate rate of 85% for the MTA group and 52% for the CH group (P = 0.006). There was no significant association between the capping material and postoperative pain. CONCLUSIONS:Mineral trioxide aggregate performed more effectively than a conventional CH liner as a direct pulp capping material in molars with carious pulpal exposure in adult patients. This study has been registered at ClinicalTrials.gov, number NCT01224925. 10.1111/iej.12719
Cytotoxicity evaluation of root repair materials in human-cultured periodontal ligament fibroblasts. Samyuktha Voruganti,Ravikumar Pabbati,Nagesh Bolla,Ranganathan K,Jayaprakash Thumu,Sayesh Vemuri Journal of conservative dentistry : JCD AIM:To evaluate the cytotoxicity of three root repair materials, mineral trioxide aggregate (MTA), Endosequence Root Repair Material and Biodentine in human periodontal ligament fibroblasts. MATERIALS AND METHODS:Periodontal ligament fibroblasts were cultured from healthy premolar extracted for orthodontic purpose. Cells in the third passage were used in the study. The cultured fibroblast cells were placed in contact with root repair materials: (a) Biodentine, (b) MTA, (c) Endosequence, (d) control. The effects of these three materials on the viability of Periodontal ligament (PDL) fibroblasts were determined by trypan blue dye assay after 24 hours and 48-hour time period. Cell viability was determined using inverted phase contrast microscope. STATISTICAL ANALYSIS:Cell viability was compared for all the experimental groups with Wilcoxons matched pair test. RESULTS:At the 24-hour examination period, all the materials showed increased cell viability. At 48-hour time period, there is slight decrease in cell viability. Mineral trioxide aggregate showed statistically significant increase in the cell viability when compared to other root repair materials. CONCLUSION:Mineral trioxide aggregate was shown to be less toxic to periodontal ligament fibroblasts than Endosequence Root Repair Material and Biodentine. 10.4103/0972-0707.139844
A comparative study on root canal repair materials: a cytocompatibility assessment in L929 and MG63 cells. Jiang Yuqing,Zheng Qinghua,Zhou Xuedong,Gao Yuan,Huang Dingming TheScientificWorldJournal Cytocompatibility of repair materials plays a significant role in the success of root canal repair. We conducted a comparative study on the cytocompatibility among iRoot BP Plus, iRoot FS, ProRoot MTA, and Super-EBA in L929 cells and MG63 cells. The results revealed that iRoot FS was able to completely solidify within 1 hour. iRoot BP Plus required 7-day incubation, which was much longer than expected (2 hours), to completely set. ProRoot MTA and Super-EBA exhibited a similar setting duration of 12 hours. All the materials except Super-EBA possessed negligible in vitro cytotoxicity. iRoot FS had the best cell adhesion capacity in both L929 and MG63 cells. With rapid setting, negligible cytotoxicity, and enhanced cell adhesion capacity, iRoot FS demonstrated great potential in clinical applications. Future work should focus on longer-term in vitro cytocompatibility and an in vivo assessment. 10.1155/2014/463826
[Study of clinical outcome and prognosis in pediatric core binding factor-acute myeloid leukemia]. Wu J,Lu A D,Zhang L P,Zuo Y X,Jia Y P Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi To analyze the clinical outcome and the prognostic factor in pediatric patients with core binding factor-acute myeloid leukemia (CBF-AML). A total of 121 newly diagnosed pediatric CBF-AML patients enrolled from Aug. 2005 to Sep. 2017 were retrospectively reviewed. Cumulative incidence of relapse (CIR), event-free survival (EFS) and overall survival (OS) rates were estimated by Kaplan-Meier method and prognostic factors were evaluated by Cox regression with SPSS. Of the 121 patients, 120 patients were assessed for bone marrow remission after induction chemotherapy. 100 cases (83.3%) achieved complete remission (CR) after the first course of chemotherapy. 119 cases (99.2%) achieved CR after the second course of chemotherapy. Of the 121 patients, 13 patients (10.7%) had recurrence with the median interval of recurrence as 13.8 months (3.7 to 58.8 months). 17 patients (14.0%) died. The CIR, EFS and OS at 3 years were 12.7%, 77.5% and 82.8%, respectively. The factors including age at diagnosis, sex, initial WBC count, presence of extramedullary leukemia, C-KIT expression, additional chromosomal abnormalities, and CR after the first course of chemotherapy were analyzed by multivariate regression analysis of Cox. Multivariate analysis identified that additional chromosomal abnormalities was the only independent risk factor affecting OS (=4.289, 95% 1.070-17.183, =0.040). Pediatric CBF-AML was a unique setting of prognostic subtypes. Chemotherapy produced good responses. Additional chromosomal abnormalities was the only independent risk factor for OS in pediatric CBF-AML. 10.3760/cma.j.issn.0253-2727.2019.01.010
IL-10 enhances cell-to-cell communication in chondrocytes via STAT3 signaling pathway. Cellular signalling Gap junction intercellular communication (GJIC) allows the transfer of material, message and energy between cells, which influences cell behaviors including cell proliferation, migration, differentiation and apoptosis and determines cell fate. Interleukin-10 (IL-10), a versatile cytokine, attracts more and more attention in the cartilage pathology such as osteoarthritis (OA) due to its potential in anti-inflammation and wound repair. However, whether IL-10 can mediate GJIC in chondrocytes remains elusive. In the current study, we aimed to explore the role of IL-10 on GJIC and its underlying mechanism. We found that IL-10 can promote GJIC in living chondrocytes. IL-10-enhanced GJIC in chondrocytes was dependent on the up-regulation of connexin 43 (Cx43). Knockdown experiment based on siRNA interference then confirmed that IL-10-enhanced GJIC required participation of IL-10 receptor 1 (IL-10R1). IL-10 activated signal transducer and activator of transcription 3 (STAT3) signaling and promoted the nuclear accumulation of p-STAT3 through IL-10 receptor 1. Inhibitor experiment further confirmed the importance of STAT3 signaling in IL-10-mediated GJIC. Taking together, our results provided a thorough process of IL-10-modulated cell-to-cell communication in chondrocytes and established a bridge between inflammatory factor, IL-10, and GJIC, which can increase our understanding about the physiology and pathology of cartilage. 10.1016/j.cellsig.2023.110605
Ion Release, Microstructural, and Biological Properties of iRoot BP Plus and ProRoot MTA Exposed to an Acidic Environment. Tian Jun,Zhang Yuanhe,Lai Zhihui,Li Mengjie,Huang Yu,Jiang Hongwei,Wei Xi Journal of endodontics INTRODUCTION:This study evaluated how exposing the novel calcium silicate nanoparticulate bioceramic iRoot BP Plus (Innovative Bioceramix, Vancouver, Canada) to an acidic environment affects ion release from this material and alters MC3T3-E1 preosteoblast viability on and attachment to this material. These factors were compared against those of ProRoot MTA under similar conditions. METHODS:Each material was exposed to phosphate-buffered saline (pH = 7.4) or butyric acid (pH = 5.4) for 5 days. Trace metal elements within the 2 materials and released ions were identified using inductively coupled plasma optical emission spectroscopy. The microstructures and elemental compositions of MTA and iRoot BP Plus after treatment with butyric acid were determined using scanning electron microscopy with an energy-dispersive X-ray spectrometer. Furthermore, the viability of MC3T3-E1 cells on and their levels of attachment to the materials after the butyric acid treatment were compared. RESULTS:iRoot BP Plus contained fewer toxic metal elements than MTA. Under acidic conditions, both materials displayed similar ion release abilities, with increased release of Si and Ca ions. Substantial changes in microstructure, including reduced apatite formation, were observed for both materials after exposure to acidic pH. Furthermore, exposing iRoot BP Plus and MTA to an acidic environment increased and decreased MC3T3-E1 cell viability on these materials, respectively. MC3T3-E1 cell attachment to both materials was not significantly affected by acidic pH. CONCLUSIONS:iRoot BP Plus seems more biologically appropriate for application in an inflamed acidic environment than ProRoot MTA. 10.1016/j.joen.2016.10.011
Laser pulpotomy-an effective alternative to conventional techniques-a systematic review of literature and meta-analysis. Ansari Ghassem,Safi Aghdam Hanane,Taheri Pardis,Ghazizadeh Ahsaie Mitra Lasers in medical science The aim of this systematic review and subsequent meta-analysis was to elaborate the efficacy of laser pulpotomy over the formocresol pulpotomy of human primary teeth. Published materials in the MedLine were looked for through "PUBMED" and "PUBMED CENTRAL". The MESH terms of "Laser", "Pulpotomy", "Primary teeth", and "Children" were used to carry the search from the years 1999 to 2017. Collected data were assessed by four investigators using inclusion and exclusion criteria in order to select those studies with precise method targeted. Only clinical trials on all types of lasers were included for this systematic reviews but only four articles were used for the meta-analysis as the rest did not meet the requirements. Statistical analysis was conducted to see the differences. Seventeen articles completely fulfilled the inclusion criteria of this study. In general, high clinical, radiographic, and histopathological success rates were reported in laser groups in comparison to other assessed methods. Meta-analysis indicated that except at 36 months, in all other time intervals, Laser proved better or close results to formocresol. At 36 months, laser showed better clinical results. Laser may be considered as an adjuvant alternative for vital pulp therapy on human primary teeth but due to the limited number of high-quality clinical research articles on laser-assisted pulpotomy, various types of laser application methods, and different follow-up periods, reaching a net consensus is still challenging. 10.1007/s10103-018-2588-4
Pulpotomy for carious pulp exposures in permanent teeth: A systematic review and meta-analysis. Li Yuanyuan,Sui Bingdong,Dahl Christian,Bergeron Brian,Shipman Peter,Niu Lina,Chen Jihua,Tay Franklin R Journal of dentistry OBJECTIVES:The most commonly-accepted strategy for managing irreversible pulpitis, an irreversible condition of dental pulp inflammation, is root canal treatment, which is limited by high costs and complex techniques. High success rates have been reported for the use of pulpotomy in managing pulp exposure resulting from extensive caries. The objective of the present work was to evaluate the effectiveness and cost-effectiveness of pulpotomy and associated medicaments in saving permanent teeth with pulp exposure resulting from extensive caries. SOURCES:Multiple databases were searched on January 12, 2019, without limitations on the language or year of publication. STUDY SELECTION:Randomized controlled trials comparing pulpotomy with alternative treatments, or comparing two or more medicaments in pulpotomy for permanent teeth with carious pulp exposure were included. DATA:Seventeen studies reported in 21 articles were included. Intention-to-treat analyses on studies comparing pulpotomy and other treatment modalities tended to favor pulpotomy. Meta-analysis was not performed on comparisons of pulpotomy and other treatments because of the limited number of studies. Most evidence on comparisons among different pulpotomy medicaments was found in trials comparing mineral trioxide aggregate (MTA) and calcium hydroxide, with the results of meta-analyses favoring MTA. Data were insufficient to determine the cost-effectiveness of successful modality. CONCLUSIONS:Pulpotomy is a prospective substitute for root canal treatment in managing permanent teeth with carious pulp exposures, even in permanent teeth with irreversible pulpitis. Large, well-designed trials comparing pulpotomy with other treatments in terms of cost-effectiveness should be informative. CLINICAL SIGNIFICANCE:The success of pulpotomy in managing irreversible pulpitis challenges the rhetoric that irreversible pulpitis can only be managed by root canal treatment. Cost-effectiveness analysis rather than analysis on effectiveness of treatment outcome alone should be considered in all health care domains to evaluate the benefits of alternative treatment options. 10.1016/j.jdent.2019.03.010
Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: A systematic review. Cushley Siobhan,Duncan Henry F,Lappin Mark J,Tomson Phillip L,Lundy Fionnuala T,Cooper Paul,Clarke Mike,El Karim Ikhlas A Journal of dentistry OBJECTIVES:Management of carious teeth with signs and symptoms indicative of irreversible pulpitis is traditionally invasive, but emerging evidence suggests successful treatment outcomes with less invasive vital pulp treatment such as coronal pulpotomy. The objective of this systematic review is to determine whether coronal pulpotomy is clinically effective in treating carious teeth with signs and symptoms indicative of irreversible pulpitis. SOURCES:MEDLINE; PubMed; Embase, Web of Science, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform and ClinicalTrials.gov were searched until December 2018. STUDY SELECTION:Prospective, retrospective and randomised clinical trials investigating coronal pulpotomy or comparing pulpotomy to root canal treatment in permanent mature carious teeth with signs and symptoms indicative of irreversible pulpitis were included. Studies were independently assessed for risk of bias using Cochrane Systematic Reviews of intervention criteria and modified Downs and Black quality assessment checklist. DATA:Eight articles were selected for analysis. The average success rate for coronal pulpotomy was 97.4% clinical and 95.4% radiographic at 12 month follow-up. This was reduced to 93.97% clinical and 88.39% radiographic success at 36 months follow-up. Results from the only comparative clinical trial showed pulpotomy to have comparable success to root canal treatment at 12, 24 and 60 month follow-up. CONCLUSIONS:The evidence suggests high success for pulpotomy for teeth with signs and symptoms of irreversible pulpitis, however, results are based on heterogeneous studies with high risk of bias. Well-designed, adequately powered randomised controlled trials are required for evidence to change clinical practice. CLINICAL SIGNIFICANCE:Management of carious teeth with irreversible pulpitis is traditionally invasive, but emerging evidence suggests potentially successful treatment outcomes with less invasive therapies such as coronal pulpotomy. 10.1016/j.jdent.2019.06.005
Comparison between iRoot BP Plus (EndoSequence Root Repair Material) and Mineral Trioxide Aggregate as Pulp-capping Agents: A Systematic Review. Journal of International Society of Preventive & Community Dentistry INTRODUCTION:iRoot BP Plus, also known as EndoSequence root repair material (EERM) is a premixed bioceramic thick/putty. According to its instruction manual, iRoot BP Plus is composed of tricalcium silicate, zirconium oxide, tantalum pentoxide, dicalcium silicate, calcium sulfate, calcium phosphate monobasic, and filler agents. This systematic review was carried out to evaluate and present the iRoot BP Plus material as a pulp-capping agent. MATERIALS AND METHODS:A systematic search for articles with the scope of the selection criteria undergoing for data extraction was conducted through electronic databases. Studies on evaluation of the cytotoxicity, bioactivity, and dentinal bridge formation of iRoot BP, iRoot BP Plus, ERRM putty, or ERRM paste (ERRM) on variant human cells were selected for models, and dentinal bridge formation on human and animals teeth for in vivo models were selected. RESULTS:A total of 22 articles were discussed in the review, 14 studies, five studies, and three articles with both studies. Methyl thiazol tetrazolium was the most used method for evaluating cytotoxicity. As for dentinal bridge formation, histological assessment and micro-Computed tomography were used. Human dental pulp cells (hDPCs) were the most investigated for models and rats for models. Except for one study, all studies involved in this review were primarily examining the material and comparing it to different types of mineral trioxide aggregate. CONCLUSION:iRoot BP, iRoot BP Plus, and ERRM are biocompatible materials that enhance hDPCs and other variant human cells proliferation, migration, attachment adhesion, mineralization, and dentinal bridge formation. 10.4103/jispcd.JISPCD_249_19
Prognostic factors for the survival of primary molars following pulpotomy with mineral trioxide aggregate: a retrospective cohort study. Kim Chi Hoon,Bae Jee Soo,Kim Ik-Hwan,Song Je Seon,Choi Hyung-Jun,Kang Chung-Min Clinical oral investigations OBJECTIVES:The aim of the present study was to evaluate potential factors influencing the success rates of mineral trioxide aggregate (MTA) pulpotomy performed in primary molars. MATERIALS AND METHODS:A total of 347 teeth treated between March 2012 and December 2016 in 258 patients, with a mean age of 5.3 ± 1.7 years, were included in the analysis. Kaplan-Meier analyses were used to analyze were used time to failure. Multivariate Cox regression analysis with shared frailty was used to evaluate the clinical factors associated with failures. RESULTS:The mean (standard deviation) follow-up period was 35.8 (19.6) months. Within 84 months, the survival rate was 87.1%. In multivariate Cox regression, treatment performed in lower primary molars had a lower survival rate than upper primary molars (hazard ratio [HR] = 3.38, P = 0.012). Caries extension below the cemento-enamel junction had more risk of failure (HR = 10.9, P < 0.001). Final restoration using resin-modified glass ionomer or amalgam (direct filling) had a lower survival rate than stainless steel crown (HR = 5.62, P = 0.002). CONCLUSIONS:Clinical variables such as arch type, degree of caries extension, and type of final restoration may affect the survival of primary molars following MTA pulpotomy. CLINICAL RELEVANCE:The results of this study indicate that specific clinical variables can be used to predict the prognosis of MTA pulpotomy in primary teeth, and estimate the risk of treatment failure. Assessments of these variables should be performed in the context of evidence-based clinical decision making. 10.1007/s00784-020-03482-3
Partial pulpotomy without age restriction: a retrospective assessment of permanent teeth with carious pulp exposure. Eggmann Florin,Gasser Thomas J W,Hecker Hanjo,Amato Mauro,Weiger Roland,Zaugg Lucia K Clinical oral investigations OBJECTIVES:This study aimed to retrospectively evaluate clinical and radiographic outcomes of partial pulpotomy performed in permanent teeth with carious pulp exposure. MATERIALS AND METHODS:Records of patients undergoing treatment at an undergraduate dental clinic between 2010 and 2019 were screened for partial pulpotomies in teeth with a presumptive diagnosis of normal pulp or reversible pulpitis. The follow-up had to be ≥ 1 year. Patient data were retrieved and analyzed using Mantel-Cox chi square tests and Kaplan-Meier statistics. The level of significance was set at α = 0.05. RESULTS:Partial pulpotomy was performed in 111 cases, of which 64 (58%) fulfilled the eligibility criteria. At the time of partial pulpotomy, the mean age was 37.3 (± 13.5) years (age range 18-85). The mean observation period was 3.1 (± 2.0) years. Two early failures (3.1%) and five late failures (7.7%) were recorded. The overall success rate of maintaining pulp vitality was 89.1%, with 98.4% tooth survival. The cumulative pulp survival rates of partial pulpotomy in patients aged < 30 years, between 30 and 40 years, and > 40 years were 100%, 75.5%, and 90.5%, respectively, with no significant difference between the age groups (p = 0.225). At follow-up, narrowing of the pulp canal space and tooth discoloration were observed in 10.9% and 3.1% of cases, respectively. CONCLUSIONS:Across age groups, partial pulpotomy achieved favorable short and medium-term outcomes in teeth with carious pulp exposure. CLINICAL RELEVANCE:Adequate case selection provided, partial pulpotomy is a viable operative approach to treat permanent teeth with deep carious lesions irrespective of patients' age. 10.1007/s00784-021-04007-2
Retraction: Valproic acid protects neurons and promotes neuronal regeneration after brachial plexus avulsion. Neural regeneration research [This corrects the article DOI: 10.3969/j.issn.1673-5374.2013.30.006]. 10.4103/1673-5374.317993
Correction. International journal of developmental disabilities [This corrects the article DOI: 10.1080/20473869.2019.1651142.][This corrects the article DOI: 10.1080/20473869.2019.1665783.][This corrects the article DOI: 10.1080/20473869.2019.1670007.][This corrects the article DOI: 10.1080/20473869.2019.1675429.][This corrects the article DOI: 10.1080/20473869.2019.1679471.][This corrects the article DOI: 10.1080/20473869.2019.1683367.][This corrects the article DOI: 10.1080/20473869.2020.1769333.]. 10.1080/20473869.2022.2030952
Retreatability of a bioceramic root canal sealing material. Hess Darren,Solomon Eric,Spears Robert,He Jianing Journal of endodontics INTRODUCTION:The efficacy of retreatment techniques for BC Sealer (BCS) (Brasseler USA, Savannah, GA) removal has not yet been assessed. The purpose of this study was to evaluate the efficacy of solvent and rotary instrumentation in the removal of BCS when used in combination with gutta-percha (GP) as compared with AH Plus sealer (Dentsply, Tulsa, OK). METHODS:The mesiobuccal canals of 40 mandibular molars were instrumented and obturated with either GP/AH Plus with warm vertical compaction or GP/BCS using a single cone. The groups were subdivided into samples with the master GP cone placed to the working length (WL) or intentionally 2 mm short of the WL. Canals were then retreated using heat, chloroform, rotary instruments, and hand files. The ability to regain the WL and patency were evaluated as well as the time required to remove obturation material. Representative samples were also analyzed via scanning electron microscopy. RESULTS:The WL was not regained in 70% of samples with BCS/master cone short of the WL. Patency was not re-established in 20% of samples with BCS/master cone to the WL or in 70% of samples with BCS/master cone short of the WL. CONCLUSIONS:Conventional retreatment techniques are not able to fully remove BCS. 10.1016/j.joen.2011.08.016
Dentin extends the antibacterial effect of endodontic sealers against Enterococcus faecalis biofilms. Wang Zhejun,Shen Ya,Haapasalo Markus Journal of endodontics INTRODUCTION:The purpose of this study was to evaluate the antimicrobial effects of root canal sealers on Enterococcus faecalis biofilms in dentinal tubules by using a novel dentin infection model. METHODS:Cells of E. faecalis were introduced into the dentinal tubules by centrifugation and incubated in brain-heart infusion broth for 3 weeks. An equal thickness of AH Plus, Endosequence BC sealer (BC sealer), and pulp canal sealer EWT (PCEWT) was placed on the root canal wall of the dentin specimens for 1, 7, and 30 days in humid conditions at 37°C. Gutta-percha and water were used in a similar manner as the tested sealers. The proportions of dead and live bacteria inside the dentinal tubules after exposure to root canal sealers were assessed by confocal laser scanning microscopy. RESULTS:Significantly more bacteria were killed in the 3 sealer groups than in the 2 control groups (P < .05). BC sealer and AH Plus resulted in significantly more dead cells than PCEWT did. There was no statistically significant difference between BC sealer and AH Plus at any time point (P > .05). Thirty days of exposure to BC sealer and AH Plus resulted in significantly more dead bacteria in dentin than 7-day and 1-day exposures in the biofilms, whereas no statistically significant increase of the proportion of dead bacteria was detected between 7-day and 30-day PCEWT (P > .05). CONCLUSIONS:The 3 endodontic root canal sealers had antibacterial effects against E. faecalis in the dentinal tubules. BC sealer and AH Plus had superior antibacterial effects compared with PCEWT. The antibacterial effects of sealers in dentinal tubules continued after setting. 10.1016/j.joen.2013.10.042
In vitro and in vivo evaluation of a nanoparticulate bioceramic paste for dental pulp repair. Zhu Lingxin,Yang Jingwen,Zhang Jie,Lei Dongqi,Xiao Lan,Cheng Xue,Lin Ying,Peng Bin Acta biomaterialia Bioactive materials play an important role in facilitating dental pulp repair when living dental pulp is exposed after injuries. Mineral trioxide aggregate is the currently recommended material of choice for pulp repair procedures though has several disadvantages, especially the inconvenience of handling. Little information is yet available about the early events and molecular mechanisms involved in bioceramic-mediated dental pulp repair. We aimed to characterize and determine the apatite-forming ability of the novel ready-to-use nanoparticulate bioceramic iRoot BP Plus, and investigate its effects on the in vitro recruitment of human dental pulp stem cells (DPSCs), as well as its capacity to induce dentin bridge formation in an in vivo model of pulp repair. It was found that iRoot BP Plus was nanosized and had excellent apatite-forming ability in vitro. Treatment with iRoot BP Plus extracts promoted the adhesion, migration and attachment of DPSCs, and optimized focal adhesion formation (Vinculin, p-Paxillin and p-Focal adhesion kinase) and stress fibre assembly. Consistent with the in vitro results, we observed the formation of a homogeneous dentin bridge and the expression of odontogenic (dentin sialoprotein, dentin matrix protein 1) and focal adhesion molecules (Vinculin, p-Paxillin) at the injury site of pulp repair model by iRoot BP Plus. Our findings provide valuable insights into the mechanism of bioceramic-mediated dental pulp repair, and the novel revolutionary ready-to-use nanoparticulate bioceramic paste shows promising therapeutic potential in dental pulp repair application. 10.1016/j.actbio.2014.08.014
Antifungal activity of endosequence root repair material and mineral trioxide aggregate. Alsalleeh Fahd,Chung Nicole,Stephenson Lane Journal of endodontics INTRODUCTION:The purpose of this study was to investigate the antifungal activity of Endosequence Root Repair Material (ERRM; Brasseler USA, Savannah, GA) as compared with mineral trioxide aggregate (MTA) using Candida albicans. METHODS:All materials were packed into sterilized intravenous tubing to obtain standardized samples and allowed to set for 3 or 24 hours and then exposed to a suspension of C. albicans for incubations of 24 or 48 hours. To analyze the mechanisms of the material's antifungal activity, additional samples of each test material were prepared in the same manner and allowed to set for 24 hours; these were then incubated in a culture medium for 24 hours. The pH of each conditioned media was measured before transferring to wells containing C. albicans. The development of biofilm was analyzed after 24 and 48 hours with 2,3-bis (2-methoxy-4-nitro-5-sulfophenyl)-5-([phenyl amino] carbonyl)-2H-tetrazolium hydroxide reduction assay. RESULTS:Materials in both experimental groups significantly limited biofilm formation at each interval (ie, 24 and 48 hours). After incubating for a 24-hour period in the presence of C. albicans, ERRM in both experimental groups showed a reduction in biofilm formation that was statistically significant in comparison with MTA. However, when set for 24 hours and incubated for 48 hours, gray MTA and white MTA showed a more substantial reduction in biofilm formation than comparable samples of ERRM. Cultured media conditioned with test materials showed statistically significant antifungal biofilm activity after 48 hours. CONCLUSIONS:All materials tested have comparable antifungal biofilm activity. It appeared that changing the environment, such as the pH, contributed to this activity. 10.1016/j.joen.2014.08.002
The effect of obturation technique on the push-out bond strength of calcium silicate sealers. DeLong Christopher,He Jianing,Woodmansey Karl F Journal of endodontics INTRODUCTION:Calcium silicate-based sealers are known to have excellent sealing ability and bioactivities. They are typically recommended to be used in a single-cone (SC) technique. No studies have evaluated the effects of the thermoplastic obturation technique on the dentin interface of these sealers. The purpose of this study was to evaluate the push-out bond strengths of MTA Plus Sealer (Avalon Biomed Inc, Bradenton, FL) and EndoSequence BC Sealer (BC; Brasseler USA, Savannah, GA) when they were used in a thermoplastic technique. METHODS:Fifty single-rooted human extracted teeth were randomly divided into 5 groups (n = 10), instrumented, and obturated with the SC technique or continuous wave (CW) technique: group 1, BC-SC; group 2, BC-CW; group 3, MTA Plus-SC; group 4, MTA Plus-CW; and group 5, AH Plus (Dentsply DeTrey, Konstanz, Germany)-CW. The roots were sectioned into 1.0-mm-thick slices, and bond strengths were measured using a standardized push-out test. The mode of failure was determined by visual inspection under magnification. RESULTS:The MTA Plus-CW had statistically significant lower bond strengths than all other groups. The BC-SC group had statistically higher bond strengths than the MTA Plus-SC and AH Plus-CW groups. No significant differences were seen among the other groups. Modes of failure were predominately cohesive or mixed except for group 4 (ie, MTA Plus-CW) in which nearly half the specimens had no visible sealer. CONCLUSIONS:BC and MTA Plus sealer showed favorable bond strengths when used in an SC technique. The CW obturation technique decreased the bond strengths of these sealers. 10.1016/j.joen.2014.11.002
Clinical outcome of endodontic microsurgery that uses EndoSequence BC root repair material as the root-end filling material. Shinbori Nicole,Grama Ana Maria,Patel Yogesh,Woodmansey Karl,He Jianing Journal of endodontics INTRODUCTION:The purpose of this retrospective study was to determine the clinical and radiographic outcome of root-end surgery when EndoSequence BC Root Repair (ES-BCRR) was used as the root-end filling material and to identify any possible prognostic factors that may have affected the healing outcome. METHODS:Clinical records and periapical radiographs were collected from patients who had undergone endodontic microsurgery between 2009 and 2013 in a private endodontic office and had a minimum 1-year follow-up. All surgical procedures were performed by a single endodontist. ES-BCRR was used as the root-end filling material in all cases. Outcome was categorized into healed, healing, and non-healing on the basis of clinical and radiographic findings. The healed and healing cases were pooled and considered as success, and non-healing cases were considered failure. For statistical analysis of the prognostic factors, the dependent variable was the dichotomous outcome (ie, success versus failure). RESULTS:Ninety-four patients with 113 teeth met the inclusion criteria and were included in the study. The overall success rate was 92.0%. None of the prognostic factors, including age, sex, tooth position, size of periapical radiolucency, presence of a sinus tract, preoperative symptoms, and retreatment previous to surgery, appeared to have any significant effects on the outcome (P > .05). CONCLUSIONS:This current study suggests that ES-BCRR is a suitable root-end filling material to be used in endodontic surgery. 10.1016/j.joen.2014.12.028
A Comparison of Coronal Tooth Discoloration Elicited by Various Endodontic Reparative Materials. Marconyak Louis J,Kirkpatrick Timothy C,Roberts Howard W,Roberts Mark D,Aparicio Arnau,Himel Van T,Sabey Kent A Journal of endodontics INTRODUCTION:The purpose of this study was to evaluate coronal tooth discoloration of ProRoot MTA (Dentsply Tulsa Dental, Johnson City, TN), white ProRoot MTA, EndoSequence Root Repair Material (Brasseler USA, Savannah, GA), MTA Angelus (Angelus Solucoes Odontologicas, Londrina, Brazil), and Biodentine (Septodont, Saint Maur des Fosses, France) when used in an ex vivo pulpotomy model. METHODS:Freshly extracted mandibular third molars were collected and stored in 1% chloramine-T solution. Teeth were randomly assigned into 6 groups (n = 15) and stored individually in phosphate buffered saline at 37 °C in 100% humidity. A standardized endodontic access was made in 5 groups. A 3-mm-thick increment of reparative material was placed on the pulpal floor, covered by glass ionomer, and the access opening restored with composite. Color (Commission Internationale de l'eclairage L*a*b*) was recorded with the Vita Easy Shade spectrophotometer (VITA Zahnfabrik, Bad Säckingen, Germany) on the midbuccal surface at baseline; after access preparation; after material placement; and then after 1, 7, 30, and 60 days. Changes in Commission Internationale de l'eclairage L*a*b* were measured for each experimental group and compared with ProRoot MTA (positive control) and no treatment (negative control) using the following equation: ΔE = ([Li - L0*]2 + [ai - a0*]2 + [bi - b0*]2)(1/2). The mean results were analyzed within each group and between groups using the Friedman 2-way analysis post hoc test (P < .05). RESULTS:There were no significant differences between white ProRoot MTA, MTA Angelus, and the positive control group. EndoSequence Root Repair Material and Biodentine produced significantly less discoloration than white ProRoot MTA, MTA Angelus, and ProRoot MTA. CONCLUSIONS:Under the conditions of this study, EndoSequence and Biodentine had significantly less discoloration compared with white ProRoot MTA, MTA Angelus, and ProRoot MTA. The potential for discoloration may or may not correlate when materials are used clinically. 10.1016/j.joen.2015.10.013
Comparison of the Osteogenic Potential of Mineral Trioxide Aggregate and Endosequence Root Repair Material in a 3-dimensional Culture System. Rifaey Hisham S,Villa Max,Zhu Qiang,Wang Yu-Hsiung,Safavi Kamran,Chen I-Ping Journal of endodontics INTRODUCTION:The ability to promote osteoblast differentiation is a desirable property of root-end filling materials. Several in vitro studies compare the cytotoxicity and physical properties between mineral trioxide aggregate (MTA) and Endosequence root repair material (ERRM), but not their osteogenic potential. Three-dimensional cultures allow cells to better maintain their physiological morphology and better resemble in vivo cellular response than 2-dimensional cultures. Here we examined the osteogenic potential of MTA and ERRM by using a commercially available 3-dimensional Alvetex scaffold. METHODS:Mandibular osteoblasts were derived from 3-week-old male transgenic reporter mice where mature osteoblasts express green fluorescent protein (GFP) driven by a 2.3-kilobase type I collagen promoter (Col(I)-2.3). Mandibular osteoblasts were grown on Alvetex in direct contact with MTA, ERRM, or no material (negative control) for 14 days. Osteoblast differentiation was evaluated by expression levels of osteogenic genes by using quantitative polymerase chain reaction and by the spatial dynamics of Col(I)-2.3 GFP-positive mature osteoblasts within the Alvetex scaffolds by using 2-photon microscopy. RESULTS:ERRM significantly increased alkaline phosphatase (Alp) and bone sialoprotein (Bsp) expression compared with MTA and negative control groups. Both MTA and ERRM increased osterix (Osx) mRNA significantly compared with the negative control group. The percentage of Col(I)-2.3 GFP-positive cells over total cells within Alvetex was the highest in the ERRM group, followed by MTA and by negative controls. CONCLUSIONS:ERRM promotes osteoblast differentiation better than MTA and controls with no material in a 3-dimensional culture system. Alvetex scaffolds can be used to test endodontic materials. 10.1016/j.joen.2016.02.001
Outcome of Revascularization Procedure: A Retrospective Case Series. Bukhari Sarah,Kohli Meetu R,Setzer Frank,Karabucak Bekir Journal of endodontics INTRODUCTION:The purpose of this retrospective case series was to investigate the outcome of the revascularization procedure in necrotic immature teeth. METHODS:The residents and faculty members at the University of Pennsylvania endodontic department were invited to submit consecutive revascularization cases treated by them, irrespective of the outcome, during the time period of 2009 to 2012. Twenty-eight of 35 submitted necrotic immature teeth met the inclusion criteria. The treatment protocol included minimal instrumentation and irrigation with 3% sodium hypochlorite and 17% EDTA. Triple antibiotic paste was placed for a minimum of 21 days. After blood clot induction, either EndoSequence Bioceramic Putty (Brasseler, Savannah, GA) or mineral trioxide aggregate was placed below the cementoenamel junction, and composite was used as a final restoration. The follow-up period ranged from 7 to 72 months. The outcome was assessed as complete healing (the absence of clinical signs and symptoms, complete resolution of periradicular radiolucency, increase in the root dentin thickness/length, and apical closure), incomplete healing (the absence of clinical signs and symptoms, the periapical lesion completely healed without any signs of root maturation or thickening, the periapical lesion either reduced in size or unchanged with/without radiographic signs of increasing root dentin thickness/length, or apical closure), and failure (persistent clinical signs and symptoms and/or increased size of the periradicular lesion). RESULTS:Twenty-one of 28 cases (75%) healed completely, 3 cases (10.7%) failed during the observation period and needed further treatment, and 4 cases (14%) presented with incomplete healing. CONCLUSIONS:Within the limitation of this study, the outcome of revascularization, wherein healing of periapical periodontitis and maturation of roots occurs, is fairly high, making it a viable treatment option in comparison with apexification. 10.1016/j.joen.2016.06.021
Influence of Warm Vertical Compaction Technique on Physical Properties of Root Canal Sealers. Qu Wei,Bai Wei,Liang Yu-Hong,Gao Xue-Jun Journal of endodontics INTRODUCTION:The aim of this study was to evaluate the influence of warm vertical compaction on the physical properties of root canal sealers. METHODS:The physical properties of 4 sealers (zinc oxide -eugenol [ZOE], AH Plus [Dentsply International, York, PA], RoekoSeal [Roeko/Coltene/Whaledent, Langenau, Germany], and iRoot SP [Innovative Bioceramix, Vancouver, Canada]) were tested. The setting time and flow of these sealers were measured at standard and high temperatures using ISO 6876 (2012) specifications. The percentage of voids in each sealer after complete setting at 37°C and 140°C was analyzed under a stereoscopic microscope. RESULTS:The setting time of ZOE sealer increased significantly from 144.0 ± 4.1 minutes to 274.2 ± 7.4 minutes when the temperature increased from 37°C to 140°C, whereas there was a significant reduction in the other 3 sealers. At 37°C, the setting time of AH Plus, iRoot SP, and RoekoSeal was 543.8 ± 16.4, 245.8 ± 15.9, and 49.3 ± 1.5 minutes, and at 140°C the setting time decreased significantly to 12.9 ± 0.7, 14.2 ± 0.6, and 2.7 ± 0.4 minutes (P < .05). The flow of AH Plus increased when the temperature changed from 25°C to 140°C (P < .05), whereas the flow reduced for RoekoSeal and iRoot SP (for RoekoSeal from 24.8 ± 0.9 to 12.4 ± 1.3 mm and for iRoot SP from 22.9 ± 0.9 to 13.3 ± 1.5 mm) (P < .05). However, the flow of ZOE sealer was unaffected by the high temperature. ZOE sealer and iRoot SP exhibited a reduction of porosity at a high temperature (P < .05). CONCLUSIONS:Warm vertical compaction influenced some properties (the setting time, flow, and porosity) of 4 sealers. A significant reduction of setting time and flow was found in RoekoSeal and iRoot SP sealers at a high temperature. 10.1016/j.joen.2016.08.014
Effect of Resin-based and Bioceramic Root Canal Sealers on Postoperative Pain: A Split-mouth Randomized Controlled Trial. Graunaite Indre,Skucaite Neringa,Lodiene Greta,Agentiene Indre,Machiulskiene Vita Journal of endodontics INTRODUCTION:The aim of this study was to compare the effect of resin-based and bioceramic root canal sealers on the occurrence and intensity of postoperative pain in patients with asymptomatic apical periodontitis (AAP). METHODS:Patients presenting with AAP in previously endodontically treated teeth were included in this split-mouth blinded randomized controlled trial. For each patient, 2 single-rooted teeth were retreated and obturated using the warm vertical condensation technique and different obturation materials (ie, a gutta-percha point with resin-based sealer and a bioceramic-coated gutta-percha point with bioceramic sealer). Treatment of 1 root canal was performed in a single visit. Postoperative pain was recorded by a visual analog scale (VAS) at 24 hours, 48 hours, 72 hours, and 7 days after obturation. RESULTS:Of the 61 included patients, 57 individuals presenting 114 teeth completed the study. There was no statistically significant difference between the tested root canal sealers regarding postoperative pain at any time points assessed (P > .05). In total, 20 (35%) patients perceived pain. Only 1 patient reported severe pain. VAS scores of 80 and 70 were reported in the AH Plus (Dentsply Maillefer, Ballaigues, Switzerland) and Total Fill (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) groups, respectively. Pain intensity decreased about 2-fold in both groups at 48 hours after treatment. There were no reports of pain since 72 hours after obturation. The odds ratio for pain occurrence in the lower premolars was 7.2 (95% confidence interval, 1.708-30.352) compared with the upper front teeth. CONCLUSIONS:AH Plus and Total Fill perform similarly in terms of the occurrence and intensity of postoperative pain in teeth with AAP with no material extrusion beyond the apex. 10.1016/j.joen.2018.02.010
Clinical Outcome of Non-Surgical Root Canal Treatment Using a Single-cone Technique with Endosequence Bioceramic Sealer: A Retrospective Analysis. Chybowski Elizabeth A,Glickman Gerald N,Patel Yogesh,Fleury Alex,Solomon Eric,He Jianing Journal of endodontics INTRODUCTION:One of the important steps in root canal treatment is to create a well-sealed root canal system. EndoSequence BC Sealer (BC; Brasseler USA, Savannah, GA) has several beneficial properties and thus has been incorporated into the practitioner's armamentarium. No studies to date have evaluated the clinical success of using BC. The purpose of this study was to evaluate the outcome of nonsurgical root canal treatment using a single-cone and BC technique and to identify factors associated with success or failure. METHODS:This retrospective cohort study included patients treated in a private practice environment between 2009 and 2015. All cases, including initial and retreatment, were obturated with BC using a single-cone technique with a minimum of a 1-year recall. Patient and treatment factors were analyzed to determine their significance as prognostic factors. Outcome was evaluated based on clinical and radiographic findings at recall. Teeth were classified as healed, healing (success), or not healed (failure). Statistical analysis of potential prognostic factors was performed using the chi-square test (α = 0.05). RESULTS:Three hundred seven teeth were included in the analysis, and the average follow-up time was 30.1 months. The overall success rate was 90.9%. Lesions <5 mm in diameter had a significantly higher success rate than lesions >5 mm in diameter. Sealer extrusion was observed in 47.4% of the cases. The presence of sealer extrusion did not have any significant effect on the treatment outcome. CONCLUSIONS:BC used with a single-cone technique is a viable option for obturation. 10.1016/j.joen.2018.02.019
The effect of two endodontic sealers and interval before post-preparation and cementation on the bond strength of fiber posts. Yuanli He,Juan Wu,Mengzhen Ji,Xuan Chen,Kaixin Xiong,Xueqin Yang,Xin Qiao,Hantao Hu,Yuan Gao,Ling Zou Clinical oral investigations OBJECTIVES:To evaluate the effect of different endodontic sealers (epoxy resin-based and bioceramic-based) and the time of post-cementation on the bond strength of a fiber post cemented with resin cement. METHODS:Forty human premolars were instrumented and divided into 4 groups. According to the type of sealer and the time of post-cementation: AH-IM (AH Plus, post-cemented immediately after root canal treatment), SP-IM (iRoot SP, post-cemented immediately after root canal treatment), AH-OW (AH Plus, post-cementation after one week), and SP-OW (iRoot SP, post-cementation after one week). In each group, the samples were submitted to push-out test, and failure mode was assessed. Levene's test, one-way ANOVA, and Kruskal-Wallis analysis were applied for statistical analysis (α = 5%). RESULTS:The highest mean push-out bond strength was obtained from the SP-IM group in the apical part (10.45 ± 5.15MPa), while the lowest was observed in samples from the AH-OW group in the middle part (2.63 ± 1.54 MPa). One-way ANOVA showed that within the same root region, the time of post-cementation had a negative influence on the bonding strength in the SP groups in the middle and apical portion (P<0.05), however, when comparing the effect of type of sealers on bonding strength between the OW groups or IM groups within the same root region, no significant difference was observed regardless of the post cementation time (P>0.05). CONCLUSIONS:The bond strength of the fiber post was higher when the post was cemented immediately after root canal treatment when the bioceramic sealer was applied. CLINICAL RELEVANCE:The correct choice of an endodontic sealer and the proper time of post-cementation may help to obtain the best quality of post-and-core restoration. 10.1007/s00784-021-03920-w