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This retrospective study analyzed the 12-month pulp sensibility (cold and electric) test response after mineral trioxide aggregate (MTA) full pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis.The records of 120 subjects from 3 completed and 1 ongoing clinical study on MTA full pulpotomy were retrieved. Ninety-six first and second mandibular molar teeth with a diagnosis of symptomatic irreversible pulpitis that underwent a single-visit MTA full pulpotomy and had completed a 12-month clinical, radiographic, and pulp sensibility (cold and electric) test follow-up were included. The data were analyzed using the Fisher exact test, the Pearson chi-square test, and the McNemar test. The significance level was predetermined at P .05.A higher percentage of teeth (94.7%) responded to the electric pulp test in comparison with the cold test (13.5%) (P .05). Sex-based responses to the electric pulp test (P .05) and the cold test were similar (P .05). The age-based response was similar for the electric pulp test (P .05) but was significant for the cold test (P .05). The tooth quadrant (left and right), the tooth (mandibular first and second molar), and the location of restoration (proximal or occlusal) did not influence the response of either the electric pulp test (P .05) or the cold test (P .05). At the 1-year follow-up, all the teeth that were classified as clinically and radiographically successful responded to the electric pulp test; however, only 13 teeth responded to the cold test (P = .00).The majority (94.7%) of the teeth that underwent MTA full pulpotomy responded to the electric pulp test at a 1-year time interval.

The prognosis of traumatized teeth depends largely on the fate of the pulp and its treatment. This review aims to update the present status on the endodontic management of traumatic injuries to permanent teeth and to identify relevant research areas that could contribute to an improvement in diagnosis and treatment of traumatized permanent teeth. Future research should pay greater attention to (1) diagnostic methods to assess the perfusion of the pulp and enhance detection of tooth cracks and initial signs of root resorption; (2) improved materials for vital pulp treatment; (3) studies focusing on type and duration of splinting after root fractures; (4) antiresorptive intracanal medication in case of post-traumatic pulp necrosis and infection-related resorption and (5) long-term data on the apical barrier technique compared to revitalization.

Objective The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth. Materials and methods A total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal–Wallis. Results At 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544). Conclusion In the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results. Clinical relevance Simple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.

AIM This prospective in vivo study aimed to optimize the assessment of pulpal contrast-enhancement (PCE) on dental magnetic resonance imaging (dMRI) and investigate physiological PCE patterns. METHODOLOGY In 70 study participants, 1585 healthy teeth were examined using 3-Tesla dMRI before and after contrast agent administration. For all teeth, the quotient of post- and pre-contrast pulp signal intensity (Q-PSI) was calculated to quantify PCE. First, pulp chambers were analysed in 10 participants to compare the coefficient of variation of mean versus maximum Q-PSI values (Q-PSImean versus Q-PSImax ). Second, dynamic PCE was evaluated in 10 subjects to optimize the time interval between contrast agent application and image acquisition. Finally, 50 participants (age groups: 20-29, 30-39, 40-49, 50-59 and 60-69 years) were examined to analyse age, gender, tooth types and maxilla versus mandible as independent factors of PCE. Statistical analysis was performed using Wilcoxon signed rank test and linear mixed models. RESULTS PCE assessment based on Q-PSImax was associated with a significantly smaller coefficient of variation compared with Q-PSImean , with median values of 0.17 versus 0.21 (p = .002). Analysis of dynamic PCE revealed an optimal timing interval for image acquisition 4 min after contrast media application. No significant differences in PCE were observed by comparing age groups, female versus male participants and maxillary versus mandibular teeth (p > .05). Differences between tooth types were small (median Q-PSImax values of 2.52/2.32/2.30/2.20 for molars/premolars/canines/incisors) but significant (p

Fixed partial dentures (FPDs) made of metal ceramic are a popular treatment option for missing teeth. Studies have shown that posterior abutments of FPDs had a higher pulp survival rate than anterior abutments. Postoperative sensitivity following the cementation of a fixed prosthesis is a frequent symptom, especially when the abutments include important pulp. Dentinal hypersensitivity affects between 4 and 74 percent of people. Females are found to have a somewhat greater DH incidence than males. While DH can affect individuals of any age, there have been several theories on what causes abutment sensitivity after tooth preparation and cementation. In this review we included some of it. Also, we discussed methods of management of postoperative sensitivity and Management of fractured abutment screw.

BACKGROUND/PURPOSE The aim was to assess the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical instrumentation (MI) in reducing Enterococcus faecalis (E faecalis) and Candida albicans (C albicans) counts from C-shaped root-canals. METHODS Teeth with C-shaped canals as identified on cone beam computed tomographic images were included. Following incubation with E faecalis and C albicans, samples were divided into 4 groups a four follows: Group-1: MI with adjunct aPDT; Group-2: aPDT alone; Group-3: MI alone; and Group-4: no treatment. The pulp chambers of these teeth were exposed and coronal pulp was mechanically derided using sterile endodontic excavators. Using flexible files, all canals were debrided up to size #30 K-files with intermittent irrigation with 2.5% sodium hypochlorite irrigation. In Groups 1 and 3, methylene-blue was injected in all canals and aPDT was performed using a 600 nm diode laser. Sample-size estimation was done on data from a pilot investigation and group-comparisons were done using one way analysis of variance and Bonferroni post-hoc adjustment tests. P < .05 was considered statistically significant. RESULTS Sixty periodontally hopeless mandibular second molars with C-shaped canals were included. There was a statistically significant reduction CFU/mL of E faecalis (P < .001) and C albicans (P < .001). At post-operative microbial assessments in Group-1. There was no difference CFU/mL of E faecalis and C albicans at post-operative microbial assessments in Groups 2-4. CONCLUSION MI with adjunct aPDT is more effective in reducing count of E faecalis and C albicans from C-shaped root canals.

Background: the main idea behind the pulpotomy of a primary tooth is to remove the infected or inflamed coronal pulp tissues and cover the pulp with a suitable medicament or dressing which promotes healing and preserve the vitality of the teeth especially in young permanent teeth. A medicament should be biologically compatible, have healing capabilities, should be non cytotoxic, or mutagenic and with no carcinogenic potential. Aim: the main aim of the study was to compare and evaluate the efficacy of commonly used two medicaments i.e. formocresol and sodium hypochlorite in pulpotomy of mandibular primary teeth. Material and methodology: a randomized controlled single blinded clinical trial was done on 50 subjects of age ranging from 3 to 6 years with bilateral mandibular first or second molar requiring pulpotomy. The subjects were randomly divided into two groups with 25 subjects in each. Group I, consisted of subjects on which formocresol medicament was used after extirpation of coronal pulp while in Group II, 3% sodium hypochlorite was used. Clinical along with the radiographic signs and symptoms were blindly recorded at an interval of 1, 3, 6 and 12 months respectively. Results: Statistically significant results were obtained in group II, when patients treated with 3% sodium hypochlorite. There was no major difference between the two medicaments used, but to the various adverse effects of formocresol, its usage has been limited. Conclusion: within the limitation of the study, it was concluded that sodium hypochlorite medicament proved to have better prognosis and can be suggested as a pulpotomy agent for primary teeth. Although formocresol was found to have similar significant results can also be used as a medicament. Keywords: Formocresol, Pulpotomy, Primary Teeth, Sodium Hypochlorite

Background: Radiographic visibility of the root pulp in lower third molars is one of the reliable methodologies for chronological age estimation. Objective: To evaluate the radiographic visibility of the lower third molar root pulp using digital panoramic radiographs of the Thai population, and determine the appropriation of this technique in age assessment, especially at the age of 18 years. Methods: A total of 746 digital panoramic radiographs of the Thai population aged from 16 to 26 years were recruited for the present study. The visibility of root pulp of lower third molars with completed root formation was recorded in the four stages. Descriptive statistics were performed for each stage in both males and females. Results: The first appearance of stage 0 is 16.71 years in males and 17.00 years in females. The minimum age of stage 1 was found at 17.08 years in males and 17.18 years in females. The beginning of stage 2 was 18.33 years in males and 18.17 years in females. For stage 3, the earliest presence was started at 18.58 years in males and 18.83 years in females. Conclusion: The occurrence of stages 2 or 3 in both males and females indicated that the subject is over 18 years of age. Further study on the Thai population should be conducted to confirm the results of the present study.

Introduction The purpose of this study was to compare clinically and radiographically the effects of potassium nitrate in polycarboxylate cement and mineral trioxide aggregate (MTA) as pulpotomy agents in vital immature mandibular first molars. Methods The trial design was a parallel randomized, 1:1 allocation ratio, with both the participants and the data assessor blinded. A total of 50 molars of 48 eligible children aged 6–9 years were studied. The children had mandibular immature first molars with extensive caries that revealed pulp exposure during caries excavation. Patients were randomly allocated equally into 2 groups in which potassium nitrate in polycarboxylate cement (the intervention group) and MTA (the control group) were used as pulpotomy biomaterials. The treated teeth were restored permanently. The primary outcome was clinical/radiographic assessment after 1 week, 6 months, and 12 months. The secondary outcomes were radiometric analysis at 6 and 12 months to determine dimensional changes during maturogenesis. The digital radiographs were imported to image processing software to perform radiometric measurements. Data were tabulated and statistically analyzed with significance set at P ≤ .05. Results Only a single tooth failed at the 6-month recall, and another one was lost during recall in each group. Thus, the overall success rate for cases/group who finally attended the 12-month follow-up time point was 92% (23/25) with no statistically significant difference between the 2 groups. At the 12-month recall, successful cases showed root development with an increase in root length and a decrease in apical foramen width. Complete apical closure was observed in 65.2% of the roots in the intervention group and 52.1% in the control group. Conclusions The clinical and radiographic success reported in the present study reveals that potassium nitrate in polycarboxylate cement could be used as a biological and economic alternative to MTA as a pulpotomy agent in vital immature mandibular first molars. Further follow-up for longer periods is recommended.

Introduction Age-at-death estimation is an essential part of the identification process of individuals in many forensic dentistry cases where identity of the individual cannot be resolved by visual recognition or other means. Dental age estimation in adults is more of a challenge as most teeth complete their development by the age of 18 years. Aim This study aims at using the mesio-distal (MD) pulp-to-tooth ratio taken at the cervix of upper third molars (UM3) to estimate age at the time of radiographic imaging. Materials and Methods A set of 135 Cone-beam computed tomography (CBCT) radiographs of UM3s for a random sample of 135 Jordanian adults (65 females, 70 males; age range = 18–63 years, mean age = 34.4 years, SD = 11.2 years) were used. Both pulp and tooth MD diameters were measured at the cervix. MD pulp-to-tooth ratios for UM3s were correlated with age. Results Statistically significant negative moderate correlation was found between the age of the individual and the cervix MD pulp/tooth ratio (r = −0.516). This indicates that only 26.6% of the variation in age can be explained by the cervix MD pulp-to-tooth ratio. Conclusions This study concludes that cervix MD pulp-to-tooth ratio of UM3s, although apparently stronger than that of lower M3s (r = −0.361), is not a sufficiently reliable estimator of age in adults, and this is perhaps attributed to the greater variability in the time line of third molars development.

Apexification procedures are frequently performed on immature permanent teeth with incomplete root formation, open apices and necrotic pulp status with or without periapical lesions in order to induce a calcific barrier prior to root canal therapy. The elimination and control of infection in the root canal space is critical to the success of these procedures. A healthy 21-year old male presented with pulpal necrosis, a large periapical lesion, incomplete root formation and an open apex on a maxillary right lateral incisor. Triple antibiotic paste was used to achieve antimicrobial control after traditional calcium hydroxide paste medicament failed to resolve the symptoms. Obturation was achieved using MTA and the conventional apexification technique. Excellent healing of the large periapical lesion was achieved without surgical intervention and the 4-year follow-up CBCT demonstrated complete bone fill of the lesion. Clinicians should be aware that alternative antimicrobial medicaments, such as triple antibiotic paste, may be beneficial in situations where conventional medicaments prove unsuccessful. The use of triple antibiotic paste may result in sufficient healing of the periapical lesion to justify placement of an MTA apical barrier without the need for surgical intervention

Objetivo. El objetivo de esta revisión bibliográfica es analizar la evidencia científica existente, sobre los diferentes tratamientos regenerativos pulpares, en dientes permanentes jóvenes con necrosis pulpar, para conocer las diversas alternativas de materiales y técnicas utilizadas. Materiales y métodos Se realizó una búsqueda electrónica biomédica avanzada en base de datos PubMed, utilizando palabras clave MeSh Terms (Medical Subject Headings), para identificar la cantidad de artículos científicos disponibles, en la que se encontraron estudios sobre tratamientos de regeneración pulpar en dientes permanentes jóvenes inmaduros, con el fin de identificar los diferentes tratamientos, materiales, técnicas, y resultados obtenidos con dichas maniobras clínicas. Resultados Se encontraron 30 artículos, en los que se identificaron los diversos tratamientos en regeneración pulpar de dientes permanentes jóvenes inmaduros, investigaciones de ensayos clínicos aleatorios, utilizando 11 artículos. Conclusiones En las diversas investigaciones se encuentran diferentes tratamientos, materiales y técnicas a utilizar de para la regeneración pulpar, encontrando variaciones en soluciones irrigadoras, medicaciones intraconductos, número de citas y material de sellado coronal, sin embargo el Trióxido Mineral Agregado MTA es el utilizado con mayor frecuencia; se necesitan más investigaciones que puedan destacar un protocolo de atención.

Background Dental implant placement carries a risk of iatrogenic damage to adjacent root surfaces. Purpose To classify and understand different types of trauma to the tooth root body by dental implants. Materials and methods This prospective case series included 43 implants placed between February 2017 and June 2020 that had primary stability and were in a position that accidentally invaded the adjacent teeth. The type and degree of the injury were evaluated clinically and radiographically. Tenderness, mobility, and sensitivity tests of the injured teeth were conducted at different visits. Implant failure was confirmed by the presence of implant mobility during the healing period. Results Overall, 43 patients had root injuries due to dental implant surgeries. Regarding the 43 injured roots, 32 developed transient tenderness to percussion, 16 developed variable degrees of resorption in the cementum, three lost pulp sensitivity and one had persistent tenderness to percussion. No injured teeth were lost. In three patients, implant periapical lesions were confirmed radiographically as radiolucency near the apex of the involved implants. Out of the 43 implants, 11 failed and were removed within 6 months, with an implant failure rate of (25%). Conclusions Root damage after implant surgery varies depending on the type and severity of injury. Periodic clinical and radiographical examination is necessary to monitor root resorption and implant integration and to rule out pulp necrosis.

Pulp chamber enlargement impacts endodontic treatment planning. The aim of this study was to evaluate alterations in pulp chamber size of posterior teeth in individuals born with cleft lip with or without cleft palate. Ninety individuals were treated at the Cleft Lip and Palate Service of the University Hospital Lauro Wanderley, Federal University of Paraiba, between the ages of 4 and 15 years born with cleft lip with or without cleft palate were selected. Ninety-nine patients from the archives of the residency program in Orthodontics of the Brazilian Dental Association (ABO) were paired by sex and age as a comparison group. Radiographs were evaluated by a single examiner, observing the presence/absence of an enlarged pulp chamber in the first and second permanent molars of all quadrants. Chi square or Fisher’s exact tests were used (α = 0.05) in all comparisons. Pulp enlargement was more frequently found among individuals born with cleft lip with or without cleft palate (p = 0.0005). However, pulp enlargement frequency was different among subjects born with clefts (p = 0.0006). Pulp enlargement was more common in the maxilla, in both groups. Individuals born with cleft lip with or without cleft palate more often had six or more teeth affected (p = 0.02). Furthermore, individuals with a bilateral cleft more often had six or more teeth affected in comparison to unilateral cases (p = 0.002). Pulp enlargement is a frequent finding, particularly among individuals born with cleft lip with or without cleft palate, with a higher prevalence in the maxilla.

Objective: to evaluate the efficacy of non-invasive procedures through biomimetic mineralization of a fluoride gel, bioactive glass materials with and without fluoride and self-organizing biomimetic peptides in the treatment of dentinal hypersensitivity due to early non-carious cervical lesions. Materials and methods: Twenty-eight patients with self-reported history of dentin hypersensitivity were evaluated sequentially for evidence of erosion, abrasion or gingival recession at facial cervical region. Patients were randomly distributed into four treatment groups of seven patients each according to the type of the treatment (group I: Elmex Gele'e, group II: BioMin™ F, group III: BioMin™ C group IV: CurodontTM D’senz). The teeth were subjected to five follow up periods (baseline, after 3,6,9 and 12 weeks) and assessed in response to evaporative air-blast stimulus utilizing Schiff Sensitivity and Visual Analogue Scales. Electrical test was performed utilizing electrical pulp tester. The extent of tubule occlusion was examined under scanning electron microscope using negative replica of randomly selected patients. Results: All the tested groups showed different degrees of relieving dentinal hypersensitivity symptoms. The difference between the studied groups was statistically significant. Under SEM, group II, III and IV showed complete tubule occlusion. However, group I showed partial tubule occlusion. Conclusions: Elmex® gelee, BioMin™ F, BioMin™ C and Curodont™ D’senz were effective to manage dentin hypersensitivity related to early non-carious cervical lesions based on the biomimetic mineralization concept that has focused on permanent management of dentin hypersensitivity. Keywords: Fluoride, Bioactive glass, self-organizing biomimetic peptides, non-carious cervical lesions, dentin hypersensitivity.

Objectives: The purpose of this study was to evaluate the pulpal response of dogs’ teeth after direct pulp capping using Biodentine (BD) and compared it with Mineral Trioxide Aggregate (MTA). Materials and Methods: Following the split-mouth design, forty intact teeth in two healthy Mongrel dogs were randomly assigned to two experimental groups; group I: BD and group II: MTA. Standardized Class V cavities were prepared on the vestibular surface of each tooth where the pulp exposure was performed with a dental explorer. The pulp-exposed teeth were immediately capped with one of the tested materials. The prepared cavities were then finally restored with glass-ionomer cement. After termination of the observation periods (one week and three months), the animals were euthanized. Then, teeth were extracted for histopathological evaluations. Data collected and statistically analyzed by using Fisher’s exact test. The significance level was set at P ≤ 0.05. Results: Histopathological analysis showed complete dentin bridge formation and an absence of inflammatory pulp response. Statistical analysis showed no significant differences between the BD and MTA experimental groups during the observation periods. However, a significantly higher thickness of the dentin bridge was found in the group of teeth treated with BD at three months. Conclusion: BD may be considered an interesting alternative to MTA. Both materials produced favorable pulpal responses that were similar in nature.

Background/purpose MTA is used to induce hard tissue regeneration in various procedures. This study evaluated the biocompatibility and mineralization potential of mineral trioxide aggregate (MTA) containing calcium fluoride (CaF2). To verify if the change of components affected physical properties, the setting time, solubility, and surface roughness were measured. Materials and methods Human dental pulp cells (HDPCs) were treated with powder and set MTA containing CaF2 (0, 1, 5, and 10 wt %). The proliferation of HDPCs was investigated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The mineralization potential of HDPCs was investigated with the relative gene expression of alkaline phosphatase (ALP), collagen type I (ColI), osteocalcin (OCN), and runt-related transcription factor 2 (Runx2) using real-time reverse transcription polymerase chain reaction (RT-PCR). For investigating the physical properties, setting time and solubility were tested. Surface profiles of material were analyzed by a non-contact surface profiler and a scanning electron microscope (SEM). Results MTA-5% CaF2 mixtures increased the proliferation and the mineralization-related gene expression of HDPCs to a greater degree than pure MTA. The addition of CaF2 to MTA delayed the setting, but the difference was only significant in the MTA-10% CaF2. Solubility and surface roughness was not altered. Conclusion The addition of more than 5% CaF2 can be considered to increase the regeneration potential of pulp cells without adverse effects on physical property.

Background The importance of evaluating the pulpal threshold to electrical stimulation, as a side effect of probable neuropathy in Multiple Sclerosis (MS) patients is a novel issue. This study aimed to investigate electrical pulp test thresholds in MS patients without a history of trigeminal neuralgia compared to healthy individuals. Methods Sixty-nine maxillary central incisors, belonging to 34 relapsing-remitting MS patients, and 35 healthy individuals were included in this survey. The MS patients matched for intended variables, were 22–50 years old, had a more than 1-year history of MS, no history of trigeminal neuralgia and/or other neuropathy. The electric pulp sensibility test was performed on all samples. Electric pulp testing (EPT) results were recorded based on the pulp tester’s grade that evoked a response. Data were analyzed with paired T-test, Mann-Whitney test, and Spearman correlation (P Results According to the results of this study, the mean values of response to EPT were 1.2 ± 0.5 and 1.8 ± 0.5 in MS patients and healthy individuals, respectively. The pulpal response to EPT between the two groups was significantly different (P Conclusions MS patients showed a significantly reduced response to the electric pulp test in their maxillary central incisors in comparison to matched healthy persons.

Aim and objective To compare the fracture resistance in teeth managed by root canal treatment after restoring with different types of onlays, inlays, and endocrowns prepared with hybrid ceramics and pulp chambers restored with fiber-reinforced composite and resin composite that were radiopaque, light-cured, and flowable. Materials and methods The present study was carried out on 252 extracted mandibular molars. All the specimens were divided into six groups randomly. Each group consisted of 42 specimens. Group 1 consisted of intact teeth without any access cavity. It was the control group. Group 2 consisted of teeth with endocrown and empty pulp chamber. Group 3 consisted of teeth with mesio-occlusal-distal (MOD) onlay prepared with hybrid ceramics and pulp chamber filled with flowable, light-cured, radiopaque resin composite. Group 4 consisted of teeth with MOD onlay and pulp chamber filled with fiber-reinforced composite. Group 5 consisted of teeth with MOD inlay and pulp chamber filled with flowable, light-cured, radiopaque resin composite. Group 6 consisted of teeth with MOD inlay and pulp chamber filled with fiber-reinforced composite. Inlay, onlay, and endocrowns were prepared with computer-aided design (CAD) and computer-aided machine (CAM) using hybrid ceramics. Universal testing machine was used for the measurement of the fracture resistance of each specimen. Inferential statistics were performed by applying Fisher's exact test and chi-square test. Results Fracture strength was found to be maximum in the intact teeth group followed by the endocrown. The fracture strength was minimum in the inlay group. The fracture strength was intermediate in the onlay groups. Conclusion Endocrown showed maximum fracture resistance as compared to the inlay and onlay restorations. Clinical significance Proper management of root canal-treated teeth is one of the greatest challenges for endodontists. It has been observed that tooth preparation design and the material used for the restoration of root canal-treated teeth play a vital role in the resistance against fracture in the teeth.

AIM To prospectively investigate the outcome of partial pulpotomy after 1 year, using a hydraulic calcium silicate cement (HCSC) on symptomatic cariously exposed pulps in adult teeth. To compare the traditional American Association of Endodontists (AAE) pulpitis classification with the recently proposed Wolters classification system in predicting the likelihood of treatment failure. METHODOLOGY Sixty-two symptomatic adult teeth with deep and extremely deep carious lesions were classified according to the Wolters (mild/moderate/severe pulpitis) and the traditional pulpitis classification (reversible/irreversible pulpitis). Eleven teeth were excluded intraoperatively as there was no pulp exposure after non-selective caries removal. The remaining 51 teeth, regardless of diagnosis, were treated by partial pulpotomy, pulpal lavage with 2.5% sodium hypochlorite solution, haemostasis and HCSC application (Biodentine™) as a pulp capping material. A permanent restoration was placed during a second appointment 1-2 weeks later. Preoperative tenderness to percussion (TTP), bleeding time and material setting time were recorded as was preoperative and postoperative tooth colour under standardized conditions. Clinical review occurred at regular intervals with clinical/radiographic analysis at 12 months. Chi-square analysis and Fisher's exact test assessed different outcomes amongst the diagnostic categories; the Kruskal-Wallis and Wilcoxon rank-sum test assessed influence of pulp bleeding time, TTP or variation in setting time (p

Although root canal therapy is the most common and widely used treatment at clinical presentation, there are still some postoperative complications. As cell biology and tissue engineering techniques advance rapidly, the use of biological therapy to regenerate dental pulp has become a new trend; Relevant literatures in recent five years were searched using key words such as “root canal therapy”, “Dental pulp stem cells”, “Dental pulp regeneration”, and “Cell homing” in PubMed, Web of Science, etc; Dental pulp stem cells (DPSCs) have multi-differentiation potential, self-renewal capability, and high proliferative ability. Stem cell-based dental pulp regeneration has emerged as a new research hot spot in clinical therapy. Recently, dental pulp-like structures have been generated by the transplantation of exogenous DPSCs or the induction of homing of endogenous DPSCs. Studies on DPSCs are important and significant for dental pulp regeneration and dental restoration; In this review, the existing clinical treatment methods, dental pulp regeneration, and DPSC research status are revealed, and their application prospects are discussed. The stem cell-based pulp regeneration exerts promising potential in clinical therapy for pulp regeneration.

To evaluate in a laboratory setting, the impact of three designs of endodontic access cavities on dentine removal and effectiveness of canal instrumentation in extracted maxillary first molars using micro-computed tomography (micro-CT).A total of 30 extracted intact maxillary first molars were selected and scanned by micro-CT with a voxel size of 24 µm and randomly distributed into three groups: the traditional endodontic cavity (TEC) group, the conservative endodontic cavity (CEC) group and the guided endodontic cavity (GEC) group. The pulp chambers of teeth in the groups were accessed accordingly. After root canal preparation, the teeth were rescanned. The volume of dentine removed after canal preparation, the noninstrumented canal areas, canal transportation and centring ratio were analysed. Data were analysed statistically using one-way analysis of variance. Tukey's post hoc test was used for multiple comparisons. The significance level was set at p .05.The total volume of dentine removed was significantly greater in the TEC group after root canal preparation (p .05). No significant differences in the volume of dentine removed occurred between the CEC and GEC groups (p .05). The volume of dentine removed in the crown, pericervical dentine and coronal third of the canal was significantly lower in CEC and GEC groups when compared to that in the TEC group (p .05), no difference was observed in the middle third of the canal and apical third of the canal amongst the three groups (p .05). There was no significant difference in noninstrumented canal area, canal transportation and centring ratio amongst the TEC, CEC and GEC groups (p .05).In extracted maxillary molars tested in a laboratory setting, CEC and GEC preserved more tooth tissue in the crown, pericervical dentine and coronal third of the canal compared with TEC after root canal preparation. The design of the endodontic access cavity did not impact on the effectiveness of canal instrumentation in terms of noninstrumented canal area, canal transportation and centring ratio.

Vital pulp therapy (VPT) is deliberated as an ultraconservative/minimally invasive approach for the conservation of vital pulpal tissues, preservation of dental structure, and maintenance of tooth function in the oral cavity. In VPT, following the exposure of the dental pulp, the environment is prepared for the possible healing and probable refunctionalisation of pulpal connective tissue. However, to succeed in VPT, specific biomaterials are used to cover and/or dress the exposed pulp, lower the inflammation, heal the dental pulp, provoke the remaining odontoblastic cells, and induce the formation of a hard tissue, i.e., the dentinal bridge. It can be assumed that if the employed biomaterial is transferred to the target site using a specially designed micro-/nanosized local drug delivery system (LDDS), the biomaterial would be placed in closer proximity to the connective tissue, may be released in a controlled and sustained pattern, could properly conserve the remaining dental pulp and might appropriately enhance hard-tissue formation. Furthermore, the loaded LDDS could help VPT modalities to be more ultraconservative and may minimise the manipulation of the tooth structure as well as pulpal tissue, which could, in turn, result in better VPT outcomes.

The aim of this case series was to describe the endodontic management of 3 immature permanent teeth that sustained traumatic injuries and subsequently presented with complete ingrowth of mineralized tissue into the canal space. Ingrowth of bone/mineralized tissue into the canal has been considered a poor long-term outcome with an inherent risk of ankylosis. In cases 1 and 2, no endodontic treatment was undertaken, except for emergency management requiring splinting. The cases were followed for 36 and 23 months, respectively. No ankylosis was evident over the review period, and normal teeth eruption was apparent. In case 1, the tooth was treated orthodontically and was responsive to pulp sensibility testing. In both cases, there was an appearance of an internal periodontal ligament–like space on the inner root wall of the canal. In case 3, 2 years postinjury, pulp necrosis and apical periodontitis occurred, and the tooth was managed with regenerative endodontic treatment consistent with the European Society of Endodontology and the American Association of Endodontists guidelines/recommendations for a regenerative procedure. The case was followed for 8 years after regenerative endodontic treatment. No ankylosis was noted with normal eruption of the teeth. The tooth was responsive to pulp sensibility testing despite the ingrowth of mineralized tissue, which was confirmed clinically.

Introduction Thorough pain assessment and thermal and mechanical testing are the primary diagnostic tools used to assess the status of pulp and periapical tissues in teeth with potential endodontic pathology. This study evaluated predictors of acute odontogenic pain to better understand the relationship between endodontic pain, clinical testing, endodontic disease, and diagnoses. Methods Participants (N = 228) presenting with acute odontogenic pain underwent standardized clinical testing and reported their pain intensity. Univariate and multiple regression analyses were performed to evaluate the predictors of acute endodontic pain. Chi-square tests with Bonferroni adjustments were conducted to measure the frequency of endodontic diagnostic test findings and clinical observations in patients with different pulpal diagnoses. Results A negative response to cold stimulation on the causative tooth and percussion hypersensitivity on the healthy adjacent tooth were the strongest predictors of higher levels of acute endodontic pain. Percussion hypersensitivity on the healthy adjacent tooth was present in a quarter of the cohort and was reported with equal frequency in teeth diagnosed with irreversible pulpitis, necrotic pulp, and previously initiated/treated teeth. Although painful percussion on the causative tooth was more frequently reported in teeth diagnosed with necrotic pulp, painful palpation was more frequently reported on teeth diagnosed with previously initiated/treated teeth. Conclusions Percussion hypersensitivity on the healthy adjacent tooth may reveal a lowered pain threshold and heightened pain sensitization. It is also possible that the 2 commonly performed mechanical sensory tests, percussion and palpation hypersensitivity, may detect different aspects of endodontic pathophysiology and pain processing.

Dens invaginatus (DI), which often occurs in the maxillary lateral incisor, is an important issue in endodontics because the treatment complexity increases depending on the degree of invagination and the vitality or nonvitality of the pulp. An 11-year-old female patient with a sinus tract in the gingiva of the maxillary lateral incisors showed peri-invagination periodontitis and double DI on radiography. Cone-beam computed tomographic imaging was used to examine the structure in the root canal in detail, and Oehlers type IIIA and IIIB DI was found. It was also shown that the patient’s bone defect was caused by type IIIA. Because a healthy reaction was observed in the pulp test, the final diagnosis was peri-invagination periodontitis associated with type IIIA of the double DI with vital pulp. We expected the lesion to heal by treating only the type IIIA invaginated pseudo–root canal while preserving the healthy pulp. The invaginated root canal was cleaned under a microscope using ultrasonic instruments and nickel-titanium files to minimize irritation to the pulp. Because the lesion shrinkage was confirmed by cone-beam computed tomographic imaging taken 3 months after the start of treatment, vertical compaction of the warm gutta-percha technique was performed. At the 6-month postoperative recall, the pulp was normal, and the lesions were further improved. Treatment of the main root canal of double DI is complicated. However, proper diagnosis and careful cleaning of the invaginated root canal are essential for healing while preserving the pulp.

Background During the process of deep decay, when decay approaches the pulp, an immune response is triggered inside the pulp, which activates the complement cascade. The effect of complement component 5a (C5a) on the differentiation of dental pulp mesenchymal stem cells (DPSCs) is related to dentin reparation. The aim of the present study was to stimulate DPSCs with different concentrations of C5a and evaluate the differentiation of odontoblasts using dentin sialoprotein (DSP). Methods DPSCs were divided into the following six groups: (i) Control; (ii) DPSCs treated with 50 ng/ml C5a; (iii) DPSCs treated with 100 ng/ml C5a; (iv) DPSCs treated with 200 ng/ml C5a; (v) DPSCs treated with 300 ng/ml C5a; and (vi) DPSCs treated with 400 ng/ml C5a. Flow cytometry and multilineage differentiation potential were used to identify DPSCs. Mineralization induction, Real-time PCR and Western blot were conducted to evaluate the differentiation of odontoblast in the 6 groups. Result DPSCs can express mesenchymal stem cell markers, including CD105, CD90, CD73 and, a less common marker, mesenchymal stromal cell antigen-1. In addition, DPSCs can differentiate into adipocytes, neurocytes, chondrocytes and odontoblasts. All six groups formed mineralized nodules after 28 days of culture. Reverse transcription-quantitative PCR and western blotting indicated that the high concentration C5a groups expressed higher DSP levels and promoted DPSC differentiation, whereas the low concentration C5a groups displayed an inhibitory effect. Conclusion In this study, the increasing concentration of C5a, which accompanies the immune process in the dental pulp, has demonstrated an enhancing effect on odontoblast differentiation at higher C5a concentrations in vitro.

Introduction: Vital pulp therapy has been known as one of the treatment optionsto preserve pulp vitality after being exposed by trauma or caries. Aim: This experimentexplored the effect of injectable-Platelet Rich Fibrin on marginal adaptation of two pulp capping agents (Mineral Trioxide Aggregate and Bioactive Bone Graft). Materials andmethods: A total of 64 teeth were used out of 8 healthy male beagle dogs. The teethwere randomly assigned into four groups, they were exposed and capped with differentcapping agents. Group A; capped with Mineral Trioxide Aggregate (MTA), Group B;capped with MTA+ i-PRF, Group C; capped with Bioactive Bone Graft (BBG), Group D; capped with BBG+i-PRF. Finally the access cavity was restored with IntermediateRestorative Material (IRM). At each predetermined interval, the dogs were sacrificed(1 month, and 3 months). The samples were then prepared for electron microscopicscanning evaluation. To compare between the gap percentage of four groups at eachinterval, Kruskal-wallis test; was used. Mann-Whitney U test; was used to pair-wisecomparison when Kruskal-wallis test is significant. Bonferroni’s correction was utilizedfor the pair-wise comparisons. Statistical significance was considered at P area between the capping materials and dentin, followed by group C (BBG), with theleast value recorded in group A (MTA). Conclusion: the findings from the current studysuggested that i-PRF provided a better marginal adaptation of either MTA or BBG tothe pulp and dentin, which improved with time from one month to three months.

Aim: To evaluate the radiographical success of Regenerative endodontics procedure in permanent immature teeth with necrotic pulp. Methods: This Descriptive case series was conducted at the Department of Operative Dentistry, de’Montmorency College of Dentistry/ Punjab Dental Hospital, Lahore from November 2015 to November 2016. A total of 30 cases were included using non-probability consecutive sampling. Patients of both genders with age range from 9 to 14 years were considered. Performance of procedure and evaluation of success was done in terms of root development on periapical radiographs. . Data was entered and analysed with IBM SPSS 20. Level of significance was kept at p-value ≤ 0.05 Results: Out of 30 patients, 13 were females and 17 were males. Mean age of patients included in this study was 11.5±1.737. Follow up at 12 months showed 90% success, with 27 cases showed root development on periapical radiograph. There was no significant relation of success with age and gender of patient with p- value greater than 0.05. Conclusion: It is concluded from current study that Regenerative Endodontics procedure in permanent immature teeth is encouraging and can be recommended for the treatment of permanent immature teeth with necrotic pulp. Further research studies are required for evaluation of root development in regenerative endodontics procedure. Key words: Regenerative Endodontics, Permanent Immature teeth, Root development

Gumboil is inflammation reaction in the gum caused by pulp infection. Gumboil is seen as an oral lesion characterized by a soft erythematous papule where a periapical abcess is draining into the oral cavity. An adequate root canal treatment can cure gumboil and remove bacteria from the root canal. To support the success of root canal treatment, final restoration used in this case is composite resin restoration with reinforcing fiber (short fiber reinforced composite). The purpose of this treatment was to restore the functions of tooth in mastication and preserving the supporting tissue. A female patient age 23 years old came with complaints of pain in the lower right mandibular molar accompanied by swelling of the gums around the teeth since a week ago. Swelling is intermittent since last 3 months. The tooth have been restored for about 3 years ago. Clinical examination showed a positive percussion, positive palpation, negative vitality, and negative mobility. Radiographic examination showed bifurcation and periapical lesions. Root canal treatment is performed with crown down preparation technique and followed by direct composite resin restoration with short fiber reiforced composite. The success of root canal treatment followed by composite resin restoration with short fiber reinforced fiber is marked by the absence of complaints as well as the dissappearance of gumboil.

Aim of the study: The present study assessed and compared the success of an IPT procedure both clinically and radiographically when Dycal and MTA were used as an IPT material on primary molars. Materials and Methods: Children aged 4-9 years were screened and those who fulfilled the inclusion criteria were selected. Accordingly fiftychildren were divided into 2 groups with 25 patient in each group. Cavity preparation was done and the two test materials (Dycal and MTA) were placed at the base in their respective groups and restored with RMGIC. Post-operative radiograph was taken for baseline data. Patients were assessed at Subsequent at 1 and 6 months both clinically and radiographically. Results: Both the test materials had formed a good biological seal, arrested further caries progression and did not cause any adverse pulpal reaction. However the amount of reparative dentin formed was highest in the Dycal group followed by MTA group. Conclusion: Both the experimental materials Dycal and MTA showed reparative dentin formation at the end of 1 and 6 months and also formed a good biological seal and maintained vitality of the pulp which indicates both are good IPT material. Keywords : Dycal, MTA, Indirect pulp capping, Reparative dentine, Pulp vitality

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 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.

Aim and objective This study was carried out to compare the effectiveness of biodentine, calcium hydroxide, and 2% chlorhexidine gluconate used along with resin-modified glass ionomer cement (RMGIC) as indirect pulp capping (IPC) materials in young permanent molars. Materials and methods In this study, 54 patients were selected. Among these patients, 72 young permanent molars were selected randomly in which IPC was required. These teeth were randomly categorized into three different groups and each group consisted of 24 teeth. The first group was group A consisting of teeth treated with biodentine, the second group was group B consisting of teeth treated with 2% chlorhexidine gluconate being followed by RMGIC, while the third was group C consisting of teeth treated with calcium hydroxide. All cases were subjected to follow-up for clinical and radiographic evaluation at 4, 8, and 16 months. The data were recorded and analyzed statistically by utilizing the Chi-square test. Results After 16 months, 95.83% of cases in group A consisting of teeth treated with biodentine showed successful results both clinically and radiographically. While 87.5% of cases in group B consisting of teeth treated with 2% chlorhexidine gluconate being followed by RMGIC showed successful results. And finally, 91.66% of cases in group C consisting of teeth treated with calcium hydroxide showed successful results. Conclusion Biodentine can be efficiently used as an IPC agent in young permanent molars although all three materials were effective in IPC with a nonsignificant difference statistically. This study highlights the success of IPC in young permanent molars and the choice of better IPC material can be biodentine. Clinical significance Indirect pulp capping is one of the procedures in which preservation of carious affected dentin nearest to the pulp is carried out to protect the pulp. Several new IPC agents like biodentine have been introduced. Hence, it is necessary to evaluate their effectiveness. How to cite this article: Kaul S, Kumar A, Jasrotia A, et al. Comparative Analysis of Biodentine, Calcium Hydroxide, and 2% Chlorhexidine with Resin-modified Glass Ionomer Cement as Indirect Pulp Capping Materials in Young Permanent Molars. J Contemp Dent Pract 2021;22(5):511-516.

This retrospective study aimed to (i) survey the correlation between decayed, missing, filled teeth (DMFT), and presence of first permanent molars (FPMs) with poor prognosis and (ii) evaluate the treatment requirements. Seven hundred seventy-three children with fully erupted FPMs were included in this study. DMFT for the permanent dentition, FPMs, and Global DMFT were evaluated based on clinical and radiographic evaluation. The ratio of deep dentin caries (DDC) and apical lesion presence among FPMs, including treatment requirements, were analysed. Spearman rank correlation coefficient and t tests were used for statistical analysis. The caries prevalence was found at 61.4%, where the mean DMFT was calculated as 1.89 ± 2.15. There was a positive correlation between DMFT values and age (rs = 0.27). On the other hand, there was a negative correlation between global DMFT values and age (rs = − 0.29). Regarding treatment needs of FPM with poor prognosis, 12.03% of the teeth needed pulpectomy, 8.93% pulpotomy, 8.93% pulp capping, and 5.3% extraction. Having higher DMFT values was correlated significantly (p

Objective: Evaluate histologically and compare the inflammatory pulp response following direct pulp capping of mechanically exposed dogs' teeth with: Ca(OH)2 base Dycal, UltraBlend Plus and TheraCal LC, at different time intervals. Subjects and methods. A total of 54 permanent teeth of six healthy dogs were used. They were randomly divided into three groups (n=18) according to pulp capping material used. Group I: Dycal, Group II: UltraBlend Plus (UBP) and Group III: TheraCal LC. All cavities were restored with Riva LC Resin Modified Glass Ionomer. Each group was subdivided into three subgroups according to storage time (n=6) at time intervals of 1 week, 1 month and 3 months. Control samples (3 teeth) were added representing normal untouched teeth for evaluating histological features of normal pulp. Paraffin sections were prepared stained with H&E then examined under light microscope for histologic evaluation of the inflammatory cell response according to the scoring system suggested by Nowicka et al. Results. Theracal specimens showed the lowest inflammatory score among the three capping materials in one week period followed by UBP and Dycal respectively .The inflammatory score by the end of third month improved for all materials. No inflammation was detected in Theracal specimens by the end of third month. Conclusions: Subsiding of inflammation over the study period is a sign of biological acceptance of the materials used in this investigation. Theracal is superior to Dycal and UBP for pulp capping of mechanically exposed human teeth, it can be used as an effective direct pulp capping material.

Background/purpose Effective regulation of the inflammatory process is essential for pulp repair and regeneration. Meloxicam has anti-inflammatory activity in systemic administration. The purpose of this study is to observe effects of topically applied meloxicam on inflamed pulp and to explore its potential value in the treatment of pulpitis. Materials and methods The coronal pulp tissues of rat molars were stimulated with 10 mg/mL lipopolysaccharide (LPS group) and then treated with 500 μmol/L meloxicam (meloxicam group). The untreated pulp tissues were used as the control group. After 3 h of incubation in vitro, the gene expression of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) in each group was detected by real-time RT-PCR. The pulp tissues of each group were randomly subcutaneously implanted into nude mice, and 500 μmol/L meloxicam was injected into the subcutaneous pocket of the meloxicam group. Haematoxylin eosin staining, Masson staining and immunohistochemical staining were performed on samples after 3 days and 4 weeks retrieval, respectively. Results Compared with the LPS group, the mRNA expression levels of TNF-α and IL-6 of the meloxicam group were significantly reduced in vitro. The inflammatory response and cyclooxygenase-2 expression of the meloxicam group were decreased, and osteodentin-like tissue was generated in the pulp cross section of the meloxicam group in vivo. Conclusion The topical application of meloxicam inhibits the inflammatory response of inflamed pulp and further promotes the formation of osteodentin-like tissues but fails to induce the formation of the pulp–dentin complex. Topically applied meloxicam has the potential to regulate pulp inflammation.

Objective: Since the 1960s, there has been contradictory evidence regarding the association between periodontal pathology and the status of the pulp. The purpose of this study was to evaluate the histopathological changes of pulp tissue with severe periodontal disease, including vertical bone loss involving the major apical foramen, and compared them with the histological pulpal status of teeth with healthy periodontium. Methods: This case-controlled study included 35 intact teeth with severe periodontitis of hopeless prognosis (test group) and 35 teeth without periodontitis extracted for orthodontic reasons (control group). For each tooth, periodontal and endodontic parameters such as probing depth and pulpal vitality were recorded, and the pulp tissue was evaluated histologically. The data were analysed with a significance level of 0.05. Results: Vital pulp was observed in all specimens of both groups (P=1). Pulpal inflammation in the apical portion was observed in 81.71% of the severe periodontitis group, whereas all teeth in the control group demonstrated no signs of pulpal inflammation. Dystrophic calcification and pulp stones were observed in 7.5% of the periodontitis group and 5.7% of the healthy group (P>0.05). Pulp fibrosis was observed in 22.8% of the periodontitis group and 2.8% of the control group (P=0.012). Pulpal necrosis was not noted in either group. In the periodontitis group, internal resorption was present in 22.8% of cases (P=0.005) and external resorption was present in 80% of cases (P

Background Variation in the composition of calcium silicate-based pulp capping materials could influence the discoloration potential of some of these materials, thus affecting the color and aesthetic appearance of the coronal tooth structure. Furthermore, contact with blood if hemostasis is not fully achieved may enhance this discoloration for some materials. Therefore the aim of this study was to evaluate in vitro the color change of coronal tooth structure after placing various calcium silicate-based materials in the pulp chamber in the presence or absence of blood. Mehtods Maxillary extracted premolars (n = 144) were sectioned and the crowns were separated from the roots. Pulp chambers were prepared to a standard size and then the tested materials (GMTA Angelus, ProRoot WMTA, Biodentine, TheraCal, and TotalFill) were placed with saline or with blood. Color change was assessed by spectrophotometry; prior to and after material placement at different time intervals of 24 h, 1 week, 1 month, 3 months, and 6 months. Color change (ΔE) values were calculated and statistically analyzed. Results In the saline groups, Biodentine caused the least color change, while GMTA and WMTA caused the highest color change which were significantly different from the others (p < 0.001), TotalFill and TheraCal caused moderate changes. Adding blood increased the ΔE overall the tested materials to various degrees. Biodentine was the most affected by the blood, while MTA groups were the least affected, followed by TotalFill and then TheraCal. The increase in ΔE was significant over time up to 3 months, after which the increase was not significant. Conclusions Overall, WMTA and GMTA caused the most severe discoloration. In saline, Biodentine caused the least discoloration, but it was the most affected by the presence of blood, although it still caused the least discoloration similar to that observed with TotatFill. TheraCal caused moderate discoloration but more than that caused by Biodentine and TotalFill.

Objective: Many studies reported that the subjective clinical and radiographic examination lack the accuracy about the biological status of the pulp tissue. cytokines produced by dental pulp cells may reflect the degree of pulpal inflammation. The purpose of this study is to Correlate the cytokine levels of (IL-1α, IL-6, and IL-8) present in coronal dental pulp of primary molars with the success rate of MTA based vital pulpotomy over 18 months follow up period. Methods: 40 primary molars were enrolled. The cases are divided into group A (caries level code 5), group B (caries level code 6). Blood and pulp tissue were collected from the pulp cavity by sterile cotton pellet. The pellet was placed in 0.5ml (500 µl) phosphate buffered saline solution (PBS) to 1/10 final volume in a heparin-coated tube. Levels of cytokines IL-1 α, IL-6 and IL-8 were measured by using ELISA. Results: We found that IL-1 α, IL-6 and IL-8 were significant higher in group (B) than in (A). IL-6 showed the most significant value of expression in comparison to IL-1 α and IL-8 (p-value: 0.011, 0.014 & 0.027 respectively) which denote the prominent role of IL-6 during the inflammatory process in the pulp tissue of primary molars. Conclusion: IL-1 α, IL-6 and IL-8 cytokine expression in primary pulp molars increase with caries progression. Although the significant difference in the cytokine level expression between group A and B, a high success rate of MTA vital pulpotomy was found during the follow up period in both groups.

Introduction: During the last decades, there was a great interest in the development of bioactive dental material with the ability to interact and induce dental tissues. Biodentine is a calcium silicate-based cement that has beneficial effects on pulp cells and promotes the formation of tertiary dentin. Aim: To analyze the literature on biodentine, as well as its antimicrobial activity, its setting capacity, its clinical applications and its biological properties. Methodology: Using the keywords biodentine, root canal sealing materials, epidemiology, diagnosis, clinical manifestations, antimicrobial resistance, and treatment, the MEDLINE/PubMed and Science Direct databases were searched, with emphasis on the last 5 years. It was evaluated with the PRISMA and AMSTAR-2 guidelines. Results: The antimicrobial activity of Biodentine has been greater against strains such as Streptococcus sanguis, Enterococcus faecalis, Escherichia coli and Candida albicans. Biodentine has benefits such as excellent sealability, biocompatibility, good dimensional stability with the advantage of a setting time of 12 to 13 minutes, less than MTA. Materials used in the vital pulp method must have biocompatibility and bioactivity to promote pulp cell activity. Biodentine induces the differentiation of pulp cells into odontoblast-like cells, formation of mineralized tissue and restorative dentin. Conclusion: The composition and its applications have shown sufficient basis to perform an adequate antimicrobial activity, as well as its setting time improved to 12 minutes. Vital pulp therapy is one of the main uses of this material as it is a widely accepted material for dentin tissues due to its high biological compatibility.

Human-derived composite amnion-chorion membrane (ACM) has been used for various regenerative treatments. The aim of this pilot study was to investigate the effectiveness of the ACM as a scaffold for pulp regeneration in mature canine teeth.A total of 24 roots from mature premolars in dogs were included for regenerative procedures using blood clots (BC) (group 1, n = 8), collagen membrane (CM) (group 2, n = 8), and ACM (group 3, n = 8). Each tooth was left open through a buccal access to induce root canal infection and inflammation. The root canals were disinfected with 1.5% NaOCl and calcium hydroxide intracanal medicament. After 2 weeks, bleeding was evoked to induce blood clot formation (group 1) or before the placement of the membranes (groups 2 and 3). After 12 weeks, the animals were euthanized for histologic assessment. The histologic data including intracanal fibrous connective tissue, odontoblast-like cell lining, intracanal mineralized tissue, periapical inflammation, and apical closure were qualitatively and quantitively analyzed.Histologic analysis revealed that intracanal fibrous connective tissue was identified in all groups, but a higher volume of the fibrous tissues was formed in the ACM group. Odontoblast-like cells were only observed in the ACM group. The intracanal mineralized tissue was observed only in the BC and CM groups. The BC group showed more periapical inflammation than the ACM group (P .05). Apical closure was more often found in the CM group than the BC group (P .05).More intracanal fibrous tissue and odontoblast-like cell lining, and less periapical inflammation were observed after regenerative endodontic treatment in mature teeth using the ACM than blood clot alone or blood clot with collagen membrane. The use of the ACM may be useful for a cell-homing-based pulp regeneration in mature teeth.

Objective: In a tooth with deep dentinal caries; judicious removal of infected dentin and isolating affected dentin from oral fluids with suitable biocompatible material is called indirect pulp therapy (IPT). This randomized clinical trial was done to evaluate and compare the efficacy of Biodentine, Theracal LC and. Dycal as an indirect pulp capping agent in young permanent teeth. Study Design: IPT was performed in 60 young permanent molars with caries approaching pulp in 55 healthy children using Biodentine, Theracal and Dycal. A 2–3mm layer of GIC was placed over the intervening material followed by restoration of cavity with composite. Clinical and radiographic examinations were conducted at 3 weeks, 3 months, 6 months,12 months, 18 months and 24 months. The data was compared using chi-square test at a significance level of 0.05. Results: By end of 24 months ,54 teeth presented for follow up with overall success rate of 100% in Theracal, 94.44% in Biodentine, and 77.78% in Dycal. Overall success of Theracal was statistically significant in comparison to Biodentine and Dycal at 24 months follow up (p= 0.03) Conclusions: Radiographic and clinical outcomes of Theracal and Biodentine suggest their use as an alternative material for IPT in young permanent molars with higher success.

Developmental dental hard tissues disorders are rarely diagnosed both in children and adults, and their treatment is a problem for dentist. Despite the fact that molecular genetics studies allow to discriminate some dentine disorders, pathogenesis of radicular dentin dysplasia is still obscure. Type I dentin dysplasia is characterized by normal or slightly coloured crowns with no roots or only rudimentary roots, reduced pulp space in permanent teeth and incomplete or total obliteration of the pulp chambers, and periapical radiolucent areas or cysts which might result in premature loss of tooth. Fortunately, teeth demonstrate higher resistance to caries than normal teeth do. Dentin dysplasia type II is characterized by yellow, brown, grey, translucent primary teeth with complete pulpal obliteration. Permanent teeth are normal or might be slightly coloured. Roots are normal in size, but pulp chamber has pulp stones. A third type of dentine dysplasia or focal odontoblastic dysplasia has radiographic aspects of the other two types of disease. Also dentine dysplasia type I has subtypes Ia, Ib, Ic and Id. Dentine dysplasia Ia is characterized by complete obliteration of the pulp, disorder of root development, and many periapical radiolucent areas. A single small horizontally oriented and half-moon shaped pulp is presented in case of dentine dysplasia Ib, roots have a few millimetres length and frequent periapical radiolucencies. Dentine dysplasia Ic is characterized by the presence of two horizontal or vertical semicircle-shaped pulpal remnants which surround dentine in pulp chamber. Also teeth have shortened roots and variable periapical radiolucencies. Dentine dysplasia Id is characterized by the distinct pulp chambers with pulp stones in the coronal third of the root canal; periapical radiolucencies are possible as well. Aim of this study was to analyse clinical case of dentine dysplasia in 8,5-year-old boy. A 8,5-year old boy patient with parents came to a dental office due to caries cavity in tooth 62. Shape of tooth crowns was not changed and teeth with no signs of mobility; white lines and spots on teeth are were detected. Based on age, the decision of orthopantomogram was made to evaluate status of primary and permanent teeth. The image showed almost obliterated pulp chamber in both erupted and developing teeth and considerably shortened, blunted and malformed roots without a visible lumen of root canals in primary teeth. Periapical lesions were found about roots of primary molars and follicles of teeth 12 and 14 without caries lesions. Patient's medical history revealed no disturbance in general health. Clinical examination of the patient's mother did not show dental hard tissues disorders, but radiograph examination revealed such disorder in the orthopantomogram. Thus, history, clinical and radiographic findings revealed this case as dentine dysplasia type I subtype 1c inherited from mother. Oral rehabilitation of patients with dentine dysplasia type I require effective prevention and a complex approach. Thus, meticulous oral hygiene measures and dietary instructions, regular check-ups twice a year were established for this patient; orthodontic consultation was recommended. Varnish «Ftoplen-LC» was applied on the permanent teeth 3 times. To prevent early exfoliation, plan of preventive measures was developed included application of fluoride varnish twice a year and fissure sealing in the premolars in 9-10 years and in the second premolars in 12-13 years. Treatment of dentine dysplasia I type that depends on patient age and severity of disease may include also filling of carious teeth, orthodontic, surgical and orthodontic treatment. In this regard, dentist has to know developmental dental hard tissues disorders and select measures to prolong the retention of affected teeth maintaining them as long as possible.

Relevance. The issue of quality endodontic treatment of teeth with complicated caries is still known as requiring thoughtful research. A significant percentage of periodontitis occurs in the area of furcations of multi-rooted teeth, sometimes alone, but more often as combined with apical periodontitis. Among the number of unsolved tasks, there is question about furcation areas and in particularly their antiseptic treatment and obturation in the complex treatment of chronic apical periodontitis of multi-rooted teeth. Aim: to investigate the histo-morphological features of the furcation area of the first, second molars of the upper and lower jaws and, according to the results of the experimental study, to develop a scheme of complex treatment of chronic apical periodontitis of multi-rooted teeth. Materials and methods. Ten first and second molars of both jaws not affected by fluorosis and removed according to orthodontic or surgical indications in patients aged from 25 to 50 years, were used for this study. In the first stage, transverse and longitudinal sections of the molars were made using diamond-coated separation disks. Using an orthopaedic tip, the first half of the molars were cut longitudinally in the mesio-distal direction with separation disks, under water cooling. The other half of the molars were cut transversely along the neck of the tooth and histochemically stained. In the second stage of the study, we used the experimental application of photodynamic therapy for antiseptic treatment of furcation channels and sealing them with citrate buffer. For this purpose, the next two first and two second mandibular molars were selected, respectively dissected in two planes. Samples were fixed in a vertical position; cotton rolls soaked with 2% methylene blue were placed onto the bottom of each half for 30 s., 1 min., 5 min., and 24 h. In this study we used light binocular stereoscopic microscope MBS-9; histochemical dyes: CHIC-thionine, ammonia silver solution "Argentat", reducing agent (hydroquinone), methylene blue, device "UFL - 122" company "Lux Dent", citrate buffer solution and white clay. The results were recorded with a digital camera mounted on a microscope tube. Results and discussion. The results of histochemical examination of ten molars showed the presence of furcation channels in four teeth. Two samples were stained with CHIC-thionine, the others were stained with two-component "Argenate". The selected samples were dissected in the sagittal plane through the area of localization of the furcation channels and studied under the microscope (magnification: 8x32). In teeth dissected in the transverse plane, the crown and mouth pulp were instrumentally removed without dilation of the root canals and stained accordingly. Thus, when modelling the stage of photodynamic treatment using a 2% solution of methylene blue, there is a significant filling of furcation channels and root canals along their entire length. The photosensitizer 2% methylene blue at the exposure of 30s demonstrates the highest efficiency at the minimum staining of surrounding fabrics. The microscopy was performed to confirm the ability of the photosensitizer to penetrate into the furcation channels at х8 – х32 magnification. After the experimental filling of furcation channels and root canals, we can see clear white stripes along their entire length on the dentin surface of the longitudinal section of the root; these stripes are obliquely directed towards the canal surface and consist of numerous dentinal tubules impregnated with citrate buffer. Numerous thin white lines are clearly visible on the surface of the section that run in parallel, tangentially through almost the entire thickness of the root wall and end up their course in the area around the peripulpal dentin. This indicates the formation of calcium citrate in the root canal that tightly covers its entire surface impregnating the dentinal tubules and completely fills them along their entire length. Therefore, the experimental model of using 2% methylene blue photosensitizer at a 30 s. exposure for photodynamic therapy and citrate buffer for obturating furcation and root canals can be applied in the treatment of patients with chronic apical periodontitis and lesions of the furcation area. Conclusions. Thus, morphological studies of the first and second molars of both jaws have shown the presence of furcation channels, which anatomical structure is quite complex and demanding in terms of their antiseptic treatment and filling. Therefore, we developed new effective for disinfection and obturation techniques including applying photodynamic therapy for disinfection of furcation channels and citrate buffer for their obturation.

Developmental anomalies are one of the challenging clinical conditions to achieve successful treatment outcomes. Among these, Palatogingival groove [PGG] is a rare developmental anomaly usually found on the palatal aspect of maxillary anterior teeth. As self-cleansing is difficult in such patients, it can lead to serious localized periodontal lesion or can occur in combination with endodontic lesion. It is our sole responsibility being a specialist in the field of dentistry, to early diagnose and provide treatment for such conditions. On the basis of PGG extension to the pulp, it can be classified as simple or complex; accordingly, plethora of treatment options are available. Clinically taking interdisciplinary treatment modalities into consideration, curettage of the involved gingival tissues, elimination of the groove by grinding (saucerization), or by sealing with a Biocompatible material which might enhance the healing potential. Incase if the groove extends beyond the middle-third of the root, surgical flap debridement along with combined use of barrier membrane and alloplastic bone graft are recommended. This article represents a rare clinical case reports in management of PGG defect with an innovative conservative approach for simple, minimal groove extensive case and groove extension beyond 1/3rd of the root region, treated with surgical multi-interdisciplinary approach. Keywords: Biodentine, Collagen Membranes, Endodontic­periodontal lesion, Maxillary lateral incisor, Palato­ gingival developmental groove, Platelet­rich fibrin, Saucerization.

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 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.

Background/purpose Autophagy is involved in controlling differentiation of various cell types. The present study aimed to investigate the mechanism related to autophagy in regulating odontogenic differentiation of dental pulp cells. Materials and methods Human dental pulp cells (HDPCs) were cultured in differentiation inductive medium (DM) and odontoblastic differentiation and mineralization were evaluated by alkaline phosphatase (ALP) staining and Alizarin red S staining, respectively. Tooth cavity preparation was made on the mesial surface of lower first molars in rat. The expression of autophagy-related signal molecules was detected using Western blot analysis and Immunohistochemistry. Results HDPCs cultured in DM showed increased autophagic flux and declined phosphorylation of phosphoinositide 3-kinases (PI3K), protein kinase B (Akt), and mTOR. Dentin matrix protein-1 (DMP-1) and dentin sialoprotein (DSP), markers of odontoblastic differentiation, were upregulated and autophagic activation showing increased LC3-II and decreased p62 levels was observed during odontogenic differentiation of HDPCs. However, PI3K blocker 3-methyladenine (3MA), lentiviral shLC3 and Akt activator SC79 attenuated the expression of LC3II as well as DMP-1, ALP activity and mineralization enhanced in HDPCs under DM condition. In addition, 3MA, shLC3 and SC79 recovered the expression of pluripotency factor CD146, Oct4 and Nanog downregulated in DM condition. In rat tooth cavity preparation model, the expression of LC3B and DMP-1 was elevated near odontoblast-dentin layer during reparative dentin formation, whereas 3MA significantly reduced the expression of LC3B and DMP-1. Conclusion These findings indicated autophagy promotes the odontogenic differentiation of dental pulp cells modulating stemness via PI3K/Akt inactivation and the repair of pulp.

Objective Dentinogenesis imperfecta (DI) requires dental treatment. This study investigated the characteristics of DI teeth associated with osteogenesis imperfecta (OI) and COL1A2 mutations. Study Design Whole exome and Sanger sequencing were performed. Three primary teeth (called “OIDI teeth”) obtained from 3 unrelated COL1A2 patients were investigated and compared with 9 control teeth from age-matched healthy individuals using colorimetry, micro–computed tomography, Knoop microhardness, energy dispersive X-ray spectroscopy, scanning electron microscopy, and histology. Results All patients were identified with heterozygous glycine substitutions in COL1A2. The COL1A2 mutations, c.1531G>T and c.2027G>T, were de novo, whereas c.3106G>C was inherited. OIDI1, 2, and 3 teeth had a substantial decrease in dentin microhardness and lightness. OIDI2 enamel microhardness was significantly reduced, whereas OIDI1 and 3 had enamel microhardness comparable to that of control individuals. The OIDI1 pulp cavity was large; OIDI2 was narrow; and OIDI3 was obliterated. OIDI1 and 3 had significantly higher carbon levels than those in control individuals. Numerous ectopic calcified masses, sparse and obstructed dentinal tubules, dentin holes, and collagen disorientation were observed. Conclusions OIDI teeth had reduced lightness and variable pulp morphology. Weak dentin, mineral disproportion, and abnormal ultrastructure could contribute to the brittleness of OIDI teeth and adhesive restoration failure. Here, we expand the phenotypic spectrum of COL1A2 mutations and raise awareness among dentists seeing patients with OI.