567-577. 5. Butler W.T., D'Souza R.N., Bronckers A.L., et. Pulpectomy and root canal therapy represent the optimal treatment for carious or mechanically exposed pulps in mature teeth. During the setting process, the gradual release of calcium ions encourages reparative barrier formation by promoting signaling molecules, such as vascular endothelial growth factor (VEGF), macrophage colony-stimulating factor (MCSF), TGF- β , and interleukins IL-1 β and IL-1 α . Technique In 2001, Witherspoon and Ham reported promising results when using MTA in 1-visit apexification treatment of immature teeth with necrotic pulps. 53. Huang GT, Sonoyama W, Liu Y, et. The first part of this article provides insight into the basic biology of the dental pulp, the mechanisms involved in inflammation, and the reactions of the pulp to various dental materials at the cellular and molecular level whereas the second part deals with the clinical aspects of treatment of the primary and permanent dentition. Determining whether it’s best to perform vital pulp therapy or orthograde root canal therapy for an individual tooth is a judgment call. In young immature teeth with undeveloped roots and nonvital pulp, the conventional treatment (apexification) can take up to 18 months. Formocresol has been the accepted “standard” universal pulpotomy agent in primary teeth and is recommended for young adult teeth; however, it has considerable drawbacks that put into question its continued use in humans. The connective tissue in this zone contains collagen fibers and ground substance. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112: pp. 32. The paste is condensed into the radicular pulp chamber after careful pulp extirpation, cleaning of the canal, and irrigation with saline. The tooth pulp is a unique organ and is encased in a protective layer of dentin, which is encased by a layer of the enamel. Jeeruphan T, Jantarat J, Yanpiset K, et. Although the material demonstrates many advantageous properties, long-term study outcomes in vital pulp therapy have been inconsistent. J Endod 1978; 4: pp. The procedure is also known as Cvek pulpotomy. 15. Therefore, preservation and treatment of the vital pulp are critical for the prevention of apical periodontitis. Reparative bridge formation compared in dog pulps using mineral trioxide aggregate, (Loma Linda University, Loma Linda, California.). 5. Cover the capping material with glass ionomer and restore permanently. 3. The data indicate that MTA promotes a biocompatible, noncytotoxic, antibacterial environment and surface morphology that are favorable for reparative calcific bridge formation. The entire coronal pulp is removed circumferentially with a large round bur, pulling coronally to adequately deroof the pulp chamber and to avoid leaving any ledges or pulp tissue therein. 427-439. Patel and Cohenca also presented a case that demonstrates the use of MTA as a direct pulp capping material for the purpose of continued maturogenesis of the root. A short list of compounds includes CH products, calcium phosphate, zinc oxide, calcium-tetracycline chelate, zinc phosphate and polycarboxylate cements, Bioglass, Emdogain, antibiotic and growth factor combinations, Ledermix, calcium phosphate ceramics, cyanoacrylate, hydrophilic resins, RMGI cements, hydroxyapatite compounds and, recently, MTA and other CSCs. Proc Finn Dent Soc 1992; 88: pp. : The effect of the renewal of calcium hydroxide paste on the apexification and periapical healing of teeth with incomplete root formation. 645-651. The structure of the dental pulp is similar to the other connective tissues in the body. Conversely, if the pulp is vital, there should be few or no bacteria present in the root pulp space and thus the disease (apical periodontitis) should not be present. Dent Traumatol 2006; 22: pp. No history of spontaneous, lingering, or severe pain, No extensive restoration or full crown requirements, History of spontaneous pain or signs of irreversible pulpitis, Clinical or radiographic evidence of pulpal or periradicular pathosis, Tooth requires extensive restoration or full crown. Odontoblastic layer: the outermost stratum of cells in a healthy pulp. Historically many different materials have been used for these procedures, including resin-modified glass ionomer cements, tricalcium phosphates, hydrophilic resins, and calcium hydroxide. Pulp exposures are avoided during caries excavation by removal of the superficial demineralized necrotic dentin and then the removal of the peripheral dentin. 4. J Biomed Mater Res A 2003; 66: pp. Felippe and colleagues evaluated the influence of renewing calcium hydroxide paste on apexification and periapical healing of teeth in dogs with incomplete root formation and previously contaminated canals. The aging of human dental pulp cells is primarily characterized by the formation of reactive oxygen species and senescence-related beta-galactosidase activity. Similar to CH, MTA induces an inflammatory cascade that results from calcium ion release and the creation of an alkaline environment, producing tissue necrosis. The pioneer microbes during caries progression first encounter a positive outward flow of dentinal fluid, characterized by the deposition of immunoglobulins and serum proteins that slow the diffusion of bacterial antigens. (Courtesy Dr. Michael Hülsmann, Göttingen, Germany.). al. The second demineralized carious layer proximal to the pulp featured degraded hydroxyapatite crystals but contained collagen with intact intermolecular cross-links unaffected by cariogenic acids and not stainable with caries detector dyes. Pulp proper: the central mass of the pulp, which consists of larger blood vessels and nerves. All 15 patients with immature apices showed continued root formation, with apical closure over a 6- to 10-year period; five patients with large or multiple exposures exhibited pulpal calcification ( Fig. Oral Microbiol Immunol 2007; 22: pp. 513-517. Heyeraas K.J., Berggreen E.: Interstitial fluid pressure in normal and inflamed pulp. al. 29. Remove soft leathery caries affected tooth structure until dentin consistency changes or pulp exposure is imminent. Ford T.R., Torabinejad M., McKendry D.J., et. 23-1 ). Historically many different materials have been used for these procedures, including resin-modified glass ionomer cements, tricalcium phosphates, hydrophilic resins, and calcium hydroxide. 66. Biodentine is a tricalcium silicate–based cement that also demonstrates exceptional bioactive properties with potential for both direct and indirect pulp capping procedures. No layer of necrosis was seen in the pulp when MTA was used for pulp capping. This procedure aims to leave an intact, vital apical pulp upon which a medicament (ferric sulfate or MTA) is placed prior to the placement of a coronal seal. The results of the two studies indicate increasing failure rates over time, attributable to absorption of the material under permanent restorations proximal to mineralized bridges with tunnel defects. Indications The prime objective in vital pulp therapy is to initiate the formation of tertiary reparative dentin or calcific bridge formation. It is subadjacent to the odontoblastic layer and is traversed by capillaries, unmyelinated nerve fibers, and cytoplasmic processes of fibroblasts. Healthy pulp tissue can generate reparative hard tissue, secondary, and peritubular dentin in response to assorted biologic and pathologic stimuli. MTA was clinically easier to use as a direct pulp capping agent and resulted in less pulpal inflammation and more predictable hard tissue barrier formation than Dycal. Beg A.A., Baltimore D.: An essential role for NF-kappaB in preventing TNF-alpha-induced cell death. There is some debate as to whether the remaining radicular pulp orifices should be further treated with a medicament, such as formocresol or ferric sulfate. Acceptable diagnostic quality intraoral radiographs of the involved tooth must be taken to evaluate accurately the extent of root formation and periradicular or furcation changes associated with the periodontal ligament and supporting bone. 2. A fuchsin dye suspended in propylene glycol was used to reveal that this necrotic and infected layer could be selectively stained, identified, and removed objectively, thus preserving the inner carious layer that remained capable of remineralization. A differential diagnosis based on symptoms and clinical findings is the goal in the assessment of pulp vitality. Dental caries is a progressive infection of the dentin, which may lead to inflammation and ultimately necrosis of the pulp. BA is white nanoparticle ceramic cement with many different applications, like MTA. 19. al. Odontoblasts are considered highly specialized cells that have been shown to express Toll-like receptors (TLRs). 643-649. Toxicol Sci 2009; 108: pp. Felippe and colleagues evaluated the influence of renewing calcium hydroxide paste on apexification and periapical healing of teeth in dogs with incomplete root formation and previously contaminated canals. MTA-Angelus also demonstrates antifungal properties and a lower compressive strength than ProRoot MTA. A better insight into mechanisms of toxicity of dental materials is important for understanding the potential of these materials to cause adverse health effects in a clinical setting. In a retrospective study, Gruythuysen and colleagues examined clinically and radiographically the 3-year survival of teeth treated with indirect pulp therapy performed between 2000 and 2004. Science 1995; 270: pp. Failure was defined as the presence of either a clinical symptom (pain, swelling, or fistula) or radiologic abnormality at recall. HEMA-induced apoptosis has been linked to the decrease in intracellular glutathione levels and the production of reactive oxygen species in the cells. Aeinehchi and colleagues compared the use of MTA and calcium hydroxide in direct pulp capping cases using 11 pairs of third molars (patients 20–25 years old) with pulps mechanically exposed and capped with either MTA or calcium hydroxide, covered with zinc oxide–eugenol, and restored with amalgam. 82. Soluble cytokines and growth factors that mediate wound repair of the dentin-pulp complex are nested in the extracellular matrix, and MTA stimulates reparative hard tissue formation by sequestering these growth factors and cytokines embedded in the surrounding dentin matrix. 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