European Society of Endodontology position statement: Management of deep caries and the exposed pulp

This position statement on the management of deep caries and the exposed pulp represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Preserving the pulp in a healthy state with sustained vitality, preventing apical periodontitis and developing minimally invasive biologically based therapies are key themes within contemporary clinical endodontics. The aim of this statement was to summarize current best evidence on the diagnosis and classification of deep caries and caries‐induced pulpal disease, as well as indicating appropriate clinical management strategies for avoiding and treating pulp exposure in permanent teeth with deep or extremely deep caries. In presenting these findings, areas of controversy, low‐quality evidence and uncertainties are highlighted, prior to recommendations for each area of interest. A recently published review article provides more detailed information and was the basis for this position statement (Bjørndal et al. 2019, International Endodontic Journal, doi:10.1111/iej.13128). The intention of this position statement is to provide the practitioner with relevant clinical guidance in this rapidly developing area. An update will be provided within 5 years as further evidence emerges

Evaluation of pulpotomy in primary molars with mineral trioxide aggregate and formocresol

Background and Aim: Vital pulpotomy in primary teeth is performed to maintain the vitality of the pulp and tooth until normal exfoliation. Different materials such as zinc oxide- eugenol, calcium hydroxide and formocresol are used in this procedure. The aim of this study was to evaluate the application of formocresol (FC) and mineral trioxide aggregate (MTA) in pulpotomy of primary molars. Materials and Methods: In this clinical trial, one hundred and twenty six children (aged 5 to 9 years old) with dental caries that were candidate for pulpotomy were selected and randomly divided into two groups. After removing the roof of the pulp chamber, coronal pulp was cut at the orifices and bleeding controlled. In control group, formocresol was applied for 5 minutes. In case group, MTA paste was used as pulpotomy agent. The crowns of both groups were restored with amalgam and the teeth were evaluated clinically and radiographically after 3 and 6 months follow up. Data were analyzed by Fisher test with p<0.05 as the limit of significance. Results: No sign of clinical failure was observed after 3 and 6 months follow-up. Comparison between the two methods revealed no significant difference in radiographic findings of the teeth and surrounding tissues after 3 months follow-up. However, after 6 months follow-up, internal resorption was observed radiographically in four cases of formocresol group. Conclusion: Based on the results of this study, pulpotomy with MTA showed more successful results than formocresol radiographically. MTA is recommended as a good substitute for formocresol in pulpotomy of primary molars

Mineral trioxide aggregate (MTA) and calcium hydroxide as pulp-capping agents in human teeth: a preliminary report

Abstract Aeinehchi M, Eslami B, Ghanbariha M, Saffar AS. Aim To compare mineral trioxide aggregate (MTA) with calcium hydroxide when used as pulp-capping materials in human teeth. Methodology Eleven pairs of maxillary third molars in subjects between 20 and 25 years of age were subjected to mechanical pulp exposure. The exposed pulps were capped with MTA or calcium hydroxide, covered with ZOE and restored with amalgam. A total of 14 teeth were extracted after periods of1 week (two molars), 2 months (three molars), 3 months (¢ve molars), 4 months (two molars) and 6 months (two molars). Results Histological evaluation demonstrated less in£ammation, hyperaemia and necrosis plus thicker dentinal bridge and more frequent odontoblastic layer formation with MTA than calcium hydroxide. Conclusions Although the results favour the use of MTA, more studies with larger samples and a longer follow up are suggested

Calcium ions promote osteogenic differentiation and mineralization of human dental pulp cells: implications for pulp capping materials

Calcium (Ca) is the main element of most pulp capping materials and plays an essential role in mineralization. Different pulp capping materials can release various concentrations of Ca ions leading to different clinical outcomes. The purpose of this study was to investigate the effects of various concentrations of Ca ions on the growth and osteogenic differentiation of human dental pulp cells (hDPCs). Different concentrations of Ca ions were added to growth culture medium and osteogenic inductive culture medium. A Cell Counting Kit-8 (CCK-8) was used to determine the proliferation of hDPCs in growth culture medium. Osteogenic differentiation and mineralization were measured by alkaline phosphatase (ALP) assay, Alizarin red S/von kossa staining, calcium content quantitative assay. The selected osteogenic differentiation markers were investigated by quantitative real-time polymerase chain reaction (qRT-PCR). Within the range of 1.8–16.2 mM, increased concentrations of Ca ions had no effect on cell proliferation, but led to changes in osteogenic differentiation. It was noted that enhanced mineralized matrix nodule formation was found in higher Ca ions concentrations; however, ALP activity and gene expression were reduced. qRT-PCR results showed a trend towards down-regulated mRNA expression of type I collagen (COL1A2) and Runx2 at elevated concentrations of Ca ions, whereas osteopontin (OPN) and osteocalcin (OCN) mRNA expression was significantly up-regulated. Ca ions content in the culture media can significantly influence the osteogenic properties of hDPCs, indicating the importance of optimizing Ca ions release from dental pulp capping materials in order to achieve desirable clinical outcomes