Takashi Matsuo, DDS, PhD, Tadashi Nakanishi, DDS, Hirotoshi Shimizu, DDS, and Shigeyuki Ebisu, DDS, PhD A Clinical Study of Direct Pulp Capping Applied to Carious-Exposed Pulps. The treatment options for a pulp-exposed permanent tooth include direct pulp capping (DPC), pulpotomy, and pulpectomy. The calcium hydroxide sealer Apexit, for example, was found to have a high solubility when set compared with other types of endodontic sealer [39] and, in some studies, sealer particles have been found to occur with the tissues at a considerable distance from the sample [40,41]. John Nicholson, Beata Czarnecka, in Materials for the Direct Restoration of Teeth, 2016. A direct pulp capping is a procedure in which a medicament is placed directly over the exposed dental pulp, with the specific aim of maintaining pulp vitality and health (Camp and Fuks, 2006; Hilton, 2009; Mente et al., 2010). It is a hydraulic cement, based on calcium silicate and like calcium hydroxide, it is highly alkaline and this makes it both bactericidal and bioactive. When the pulp tissue is actually exposed, a direct pulp capping procedure can be performed. Pulp capping: Conserving the dental pulp-Can it be done? The physical properties of calcium hydroxide materials are acceptable for their use as endodontic sealers. 12. There are two types of pulp capping: direct and indirect. It gives excellent clinical results and is currently typically used in association with some sort of glass-ionomer cement. Two reviewers independently screened electronic databases (Medline, Central, Embase) and performed hand searches. biocompatibility, radiopacity, sealing ability, low solubility, The cement is used to act as a liner to provide a reliable seal against the ingress of bacteria, and is needed because calcium hydroxide alone is unable to provide an adequate seal [1]. Direct pulp capping is a procedure in which a medicament, dressing, or dental material is placed directly over exposed dental pulp to preserve its vitality. Once the FGD cap is constructed, the site can be resoiled and revegetated. The following materials have been studied as potential materials for direct pulp capping. T.J. Hilton1*, J.L. Another example of the application of SEC as an efficient nanoseparation technique is the purification of monomer AuNPs from NPs dimers, trimers, and tetramers, which are covalently bonded to phenylethynyl di-, tri-, and tetrathiols. On the other hand, if there is a direct exposure to the pulp, treatment with direct pulp capping requires careful and specific selection of the pulp capping material. The latter is necessary to both raise the local pH and to promote hard tissue regeneration, in other words, to confer therapeutic benefits. Alex G. Direct and indirect pulp capping: a brief history, material innovations, and clinical case report. This material causes the formation of a 1–1.5 mm thick necrosis layer in the superficial pulp. Materials Used in Direct and Indirect Pulp Capping Historically, calcium hydroxide (Ca(OH)2) has been considered the gold standard.Long term clinical observations of calcium hydroxide are incomparable to any other bioactive material, as the Ravindra K. Dhir OBE, ... Ciarán J. Lynn, in Sustainable Construction Materials, 2017. Sulphate soundness resistance of municipal incinerated bottom ash. Harold R. Stanley, LIDS, MS,” Gainesville, Fla. Coal refuse piles are comprised mainly of the coal shales that encased the coal seam prior to the coal extraction. Using triblock copolymer coating, QDs modified with prostate tumor targeting ligands were used to tag injected cancer cells as well as to locate tumors and in mice using a whole-body illumination system with spectral QD imaging.59 Polyethylene glycol–phosphatidylethanolamine (PEG–PE) and PEG-phosphatidylcholine modified CdSe/ZnS-QDs were used to image Xenopus embryo development. If the pulp appears infected or symptomatic, the dentist may decide a root canal is the best treatment option. By and large, dentists use what they know, are comfortable with, and … Conclusions.MTA can be a reliable pulp-capping material on direct car-ious exposures in permanent teeth when a two-visit treatment protocol is observed. I. However, because of the association of some cases of contact allergy, onychodystrophy, and eczema with ethyl-2-cyanoacrylatenone, these compounds have been accepted as a practicable technique [62]. 1971;32(1):126-134. As the He diffuses out of the cavity (either through the poly-SiGe cap which is to be studied or through the SiO2), the pressure drops and thus the Q increases. When the pulp tissue is actually exposed, a direct pulp capping procedure can be performed. • 5- Biodentin • 6- Bonding systems. As a direct limestone filler replacement, SSA led to minor reductions in the mix stability, though, in contrast, as a fine aggregate, improvements were evident, due to its filling effect. It is also used as a medicament for intra-canal treatment and in some apexification procedures [30]. It also has to be used in association with some sort of glass-ionomer liner, in this case to protect the MTA while it undergoes its prolonged setting process [1]. Practice Implications.Vital pulp therapy using MTA is a treatment option for teeth diagnosed with a condition no more severe than reversible pulpitis. Direct pulp capping involves placing a pulp capping material directly over the exposed pulp with the aim of promoting pulp healing and the generation of reparative dentine [1]. De Wolf, ... S. Sangameswaran, in Handbook of Mems for Wireless and Mobile Applications, 2013. However, similar to the hydraulically bound results, Cr was again the only element that exceeded the limit at times, which prevents the designation of SSA as suitable for full unrestricted use in bituminous bound applications. First, the affected tooth is isolated from the rest of the mouth to prevent contamination (usually with a thin, flexible barrier called a dental dam), and the decay is removed. Nanoscale ferromagnetic particles are superparamagnetic, getting attracted toward the external magnet and are fine-tuned with surface modification for use as a strong absorbent. A particular advantage of calcium hydroxide sealers is their anti-bacterial nature, a feature which is related to their high pH. Scheme of the technique of direct pulp cap-ping “step by step” As a pulp capping material we used mineral triox-ide aggregate (MTA) which is recommended and applied in many newly published scientific studies. Likewise, few NPs have been separated or concentrated with magnetic NPs as sorbents. Unfortunately, most new products … The synthesis of small clusters was done by random aggregation of AuNPs surface functionalized with 2-naphthalenethiol. This sample was separated with the same gradient resulting in an 81% trimer [21]. Zinc oxide-eugenol, resin-modified glass-ionomer and dental adhesives have all been studied, but all proved to have unacceptable cytotoxicity. Leached concentrations with SSA as a partial fine aggregate fully satisfied the more lenient hazardous classification limits. The layer will undergo calcification eventually and it is called a dentine-bridge. While a new cement (mineral trioxide aggregate, MTA) has become a popular alternative. Typical cyanoacrylate products contain ethyl cyanoacrylate, isobutyl cyanoacrylate, or N-butyl-cyanoacrylate. Direct pulp-capping is a method for treating exposed vital pulp with dental material to facilitate the formation of reparative dentin and to maintain vital pulp. Compend Contin Educ Dent. Indirect Pulp Cap. The major benefits include good. It gives excellent clinical results and is currently typically used in association with some sort of glass-ionomer cement. In the experiment, the test structure is placed in a pure He atmosphere of 1000 mbar for 12 h. Since it is known that He will diffuse through the SiO2 layer, the He pressure in the cavity is 1000 mbar after this dwell time. On the other hand, if there is a direct exposure to the pulp, treatment with direct pulp capping requires careful and specific selection of the pulp capping material. It is described in detail in Chapter 10, which deals with materials specifically designed for use in endodontic therapy. Chicago/Turabian Style 10. However, this approach is controversial, because the alkalinity is potentially damaging to the gingiva, and the material would be expected to erode quickly. For this, 15 nm AuNP (14.6 ± 1.6) were prepared by citrate reduction with narrow size distribution. Drainage from the site was highly acidic, and unstable slopes were eroding into a local creek. Zinc oxide-eugenol released eugenol at concentrations capable of damaging pulp cells [22,23], resin-modified glass-ionomer led to chronic inflammation of the pulp that persisted for at least 300 days following placement, and dental adhesives were also been shown to be cytotoxic [24,25]. Leaching results for the SSA base course mixture satisfied the stringent Japanese water quality limits, with the exception of Cr(VI). [26] Sodium hypochlorite (NaOCl) in concentrations 2.5-5.25% when placed on an exposed pulp, in addition to being ideal for hemorrhage control, provides asepsis. Direct pulp capping was performed using these 2 materials, and clinical and radiographic evaluations were performed at 1, 2, 4, and 12 weeks after the treatments. Compend Contin Educ Dent. Resin-Modified Calcium Silicate Pulp Protectant/Liner TheraCal LC is a light-cured, resin-modified calcium silicate filled liner designed for use in direct and indirect pulp capping and as a protective liner under composites, amalgams, cements, and other base materials. ObjectivesWe systematically assessed randomized controlled trials comparing direct pulp capping materials.MethodsTrials comparing materials for direct capping and evaluating clinically and/or radiographically determined success after minimum 3 months were included. 9. Control bleeding with water or saline. A direct pulp capping is a procedure in which a medicament is placed directly over the exposed dental pulp, with the specific aim of maintaining pulp vitality and health (Camp and Fuks, 2006; Hilton, 2009; Mente et al., 2010). DPC is defined as “placing a dental material such as calcium hydroxide or mineral trioxide aggregate (MTA) directly on a mechanical or traumatic vital pulp exposure, thereby sealing the pulpal wound to facilitate the formation of reparative dentin and maintenance of … Approximately 75% of the cavity was filled with Biodentine™ (Fig. 7) using the "MAP System" dental materials micro-ap-plicator. Several in vitro studies have demonstrated that these show considerable anti-bacterial activity [42–44]. A direct pulp cap is done on permanent teeth when the removal of deep decay results in exposing the pulp. A Retrospective Clinical Study. Physiology of the human dental pulp. direct contact with) pulp, their use as direct pulp capping agents is generally contraindicated in the literature.1,29,37,38 Clearly, the remaining dentin thickness, which is very difficult to access clinically, has an effect on the pulpal response to any indirect pulp capping material.38 The … Though these are not target limits, this suggests that the use of SSA in this form may need some restrictions. 2015;8(10):17055-17060. Endodontics is the specialty of dentistry that focuses on the management of prevention, diagnosis and treatment of diseases of the dental pulp and periradicular tissues (region around the root of the tooth).. The solution was linearly aggregated by NaCl and isolated by centrifugation. Alex G. Direct and indirect pulp capping: a brief history, material innovations, and clinical case report. Surface coating can affect the charge on the NP, which in turn can affect the affinity of the material to the cell surface [20]. Direct pulp capping in an immature incisor using a new bioactive material Sham S. Bhat , Sundeep K. Hegde , Fardin Adhikari , and Vidya S. Bhat 1 Department of Paedodontics and Preventive Dentistry, Yenepoya Dental College, Mangalore, Karnataka, India As subbase, capping or fill material, the material is exposed to natural outdoor conditions, potentially including sulphates that may be present in the surrounding soils. Consequently, the exposed pulp does not become infected or inflamed. They flow well in their unset state, so they can reach and seal the apical foramen of the affected tooth, and also adapt to the shape of any irregularities of the dentinal wall. Calcium hydroxide (CaOH) has been considered the “gold standard” of direct pulp-capping materials for several decades (Baume and Holz, 1981; Camp and Fuks, 2006; Hilton, 2009). However, surface coating is not solely the factor that determines surface charge; the overall charge depends on the primary core. 2018; 39(3):182-189. This is an important parameter in determining the environmental and biological fate of a nanomaterial as the surface is the primary mode of contact. 10.36. However, there is evidence that they are not always able to fulfil this requirement, and studies have shown a significant degree of disintegration of these materials [30]. As a result, obtaining a sound seal becomes more difficult, and the possibility of bacterial infection is more likely. When this procedure is applied successfully, it eliminates the need for alternative, more invasive treatments. The pulp is not exposed - a layer of infected dentine is … Advantages of a successful direct pulp capping are numerous, including the avoidance of more extensive treatment, such as root canal treatment or extraction. Oral Surg Oral Med Oral Pathol. (a) Schematic cross-section of the test structure, (b) Measured Q as a function of time during evacuation of a He-filled cavity, for two different lengths of the diffusion path. Direct Pulp capping is done mostly when there is accidental exposure of Pulp either by any Trauma or by accidental exposure by the dentist. Rutting performance with SSA as a complete filler component was comparable to that of control mixes that used cement, hydrated lime or limestone as fillers, whilst in one case, the addition of 2% SSA to the overall mix led to an improvement in rutting and fatigue. Calcium hydroxide materials have variable setting times. Unplugged abandoned water wells pose a direct and immediate hazard to Michigan’s fresh water aquifers. The literature suggests that either conventional or resin-modified glass-ionomer may be used, though monomer release may occur from the latter type of material, which is potentially damaging, so probably less satisfactory in this application. Experimental disks (diameter, 7 mm; height, 4 mm) were stored in a humified incubator at 37 °C for 48 h. Calcium hydroxide sealers need to maintain a high degree of integrity in order to remain in place for the necessary time, and ideally should not disintegrate in situ. Direct pulp capping involves the application of a dental material to the exposed pulp in an attempt to act as a barrier, protect the dental pulp complex and preserve its vitality (1). Mineral trioxide aggregate, MTA, has also been used as a direct pulp capping material, though its primary use in dentistry as an endodontic sealer [18]. Pulp capping Material • 1- Calcium Hydroxide Ca(OH)2. In the past decade, there has been a debate on the best available material to be used in direct pulp capping. • 3- Tri-calcium phosphate. Ferracane2, and L. Mancl3, for Northwest Practice-based Research Collaborative in Evidence-based Dentistry (NWP) Comparison of CaOH with MTA for Direct Pulp Capping: A PBRN Randomized Clinical Trial. Two types of pulp-capping materials, calcium hydroxide and mineral trioxide aggregate, have been most commonly used in clinics, and an adhesive resin has been considered a promising capping material. Leakage appears to be related to both the solubility of the material and the questionable adhesion to both the dentine walls and the gutta percha points. Hawes, Continued evaluation of direct and indirect pulp capping J Dent Res 43: (1964) 808- 11. Kits. 2009) and the PICO framework to address the following clinical questions: ‘Is direct pulp capping a clinically effective treatment for cariously exposed pulps with a diagnosis of reversible pulpitis and does success differ with different pulp capping materials?’ Dental materials have an important role within endodontics. This was first introduced to dentistry in 1921 [11], and it is probably the most highly regarded of the available materials. As described in Chapter 9, the main use of calcium hydroxide is as a pulp capping material. Life is a hard-set calcium-hydroxide base indicated for use as a direct and indirect pulp-capping material and as a cement base for all restorative filling materials. Priyanka Rani, ... Amit Kumar Nayak, in Applications of Nanocomposite Materials in Dentistry, 2019. Materials 2020, 13, 1204 3 of 20 3. In fact, Biodentine is primarily offered as a material for pulp capping, so will be dealt with in detail in the current chapter, though its additional potential uses in clinical dentistry will also be described. Commonly used irrigants and intracanal medicaments include 0.5% sodium hypochlorite solution (as a disinfectant or antimicrobial), EDTA (as a chelating agent and lubricant), chlorhexidine (antimicrobial), non-setting calcium hydroxide (as an antibacterial agent), and some antibiotics and anti-inflammation drugs (non-setting Ledermix paste). This is because caries penetration is inevitably associated with bacterial invasion, and therefore results in infection and inflammation of the pulp [10]. The procedure usually requires a follow-up visit after several weeks to see if the dentin is developing as expected. These materials can be generally classified into two groups: materials used to maintain the vitality of the pulp (pulp capping materials), and materials used to disinfect (irrigants and intracanal medicaments) and fill the pulp in root canal therapy. Leakage around calcium hydroxide sealers has been studied experimentally, and findings have generally been satisfactory [34–36]. Approximately 0.6 m of stabilized FGD were placed and compacted to form an impermeable cap over the regraded site. Rehoboth reclamation site. SSA is not best suited to use on its own in these applications, though it could possibly be useful in combination with a coarser subbase or capping material, as a filler to improve the grading. The properties and clinical performances of four calcium-silicate cements (ProRoot MTA, MTA Angelus, RetroMTA, Biodentine), a light-cured calcium silicate-based material (TheraCal LC) and an enhanced resin-modified glass-ionomer (ACTIVA BioACTIVE) are widely discussed. However, there was one set of test samples, taken from a plant in the United States (Chandler et al., 1997), that exhibited exceptionally high soundness losses ranging from 10.38% to 14.32% and, as such, surpassed the acceptable limit. First, the affected tooth is isolated from the rest of the mouth to prevent contamination (usually with a thin, flexible barrier called a dental dam), and the decay is removed. They can act as direct conduits for contaminant entry from the surface into deeper drinking water aquifers. Practice Implications.Vital pulp therapy using MTA is a treatment option for teeth diagnosed with a condition no more severe than reversible pulpitis. 11. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9780081009970000063, URL: https://www.sciencedirect.com/science/article/pii/B978008100491300009X, URL: https://www.sciencedirect.com/science/article/pii/B9780128127926000194, URL: https://www.sciencedirect.com/science/article/pii/B9780081004913000106, URL: https://www.sciencedirect.com/science/article/pii/B9780857092717500104, URL: https://www.sciencedirect.com/science/article/pii/B9780128137420000043, URL: https://www.sciencedirect.com/science/article/pii/B9780123850898000029, URL: https://www.sciencedirect.com/science/article/pii/B9780081009871000081, URL: https://www.sciencedirect.com/science/article/pii/B9780128012383110335, URL: https://www.sciencedirect.com/science/article/pii/B978008100945100006X, Ravindra K. Dhir OBE, ... Rui V. 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