sodium-hypochlorite and Dental-Pulp-Exposure

Dentistry has experienced exponential growth in the biologic and physiologic knowledge of enamel, dentin, and pulp tissues. In one decade, material development has exceeded clinical testing limits, allowing their arrival to the commercial market without proper validation. This article clarifies the enigma of acid etching; explaining and clarifying the diverse opinions and issues of material toxicity between in vitro and in vivo usage test perspectives. This article also demystifies the biology of pulp healing regarding calcium hydroxide and adhesive systems to promote dentin bridge formation. Lastly, this article provides biologically lucid pulp exposure treatment regimens with agents such as NaOCl, allowing clinicians to increase their long-term clinical success.

Topics: Acid Etching, Dental; Adhesives; Biocompatible Materials; Calcium Hydroxide; Dental Enamel; Dental Materials; Dental Pulp; Dental Pulp Exposure; Dental Restoration, Permanent; Dentin; Dentin, Secondary; Disinfectants; Humans; Sodium Hypochlorite; Treatment Outcome; Wound Healing

This study investigated the expression of extracellular matrix glycoproteins tenascin (TN) and fibronectin (FN) in pulp repair after capping with calcium hydroxide (CH), following different hemostasis protocols. Class I cavities with a pulp exposure were prepared in 42 human third molars scheduled for extraction. Different hemostatic agents (0.9% saline solution, 5.25% sodium hypochlorite and 2% chlorhexidine digluconate) were used and pulps were capped with CH cement. After 7, 30 or 90 days, teeth were extracted, formalin-fixed, and prepared for immunohistochemical technique. Hemostatic agents did not influence the expression of TN and FN. Both glycoproteins were found in the entire the pulp tissue and around collagen fibers, but were absent in the mineralized tissues. In the predentin, TN showed positive immunostaining and FN had a variable expression. Within 7 days post-treatment, a slightly more pronounced immunostaining on the pulp exposure site was observed. Within 30 days, TN and FN demonstrated a positive expression around the dentin barrier and at 90 days, a thin and linear expression of TN and FN was delimitating the reparative dentin. In conclusion, hemostatic agents did not influence TN and FN expression. Immunostaining for TN and FN was seen in different regions and periods, demonstrating their role in pulp repair.

Topics: Adult; Bisphenol A-Glycidyl Methacrylate; Calcium Hydroxide; Chlorhexidine; Collagen; Composite Resins; Dental Pulp; Dental Pulp Capping; Dental Pulp Exposure; Dental Restoration, Permanent; Dentin; Dentin, Secondary; Fibronectins; Follow-Up Studies; Hemostatics; Humans; Pulp Capping and Pulpectomy Agents; Sodium Chloride; Sodium Hypochlorite; Tenascin; Tooth Extraction; Young Adult

Topics: Adult; Dental Alloys; Dental Pulp Cavity; Dental Pulp Exposure; Dentin; Equipment Design; Female; Humans; Male; Middle Aged; Nickel; Pulpitis; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Smear Layer; Sodium Hypochlorite; Surface Properties; Titanium; Tooth Apex; Tooth Fractures; Young Adult

In vital pulp therapy such as direct pulp capping, clinical success rates depend on achieving hemostasis in exposed pulp tissue. For hemostasis of exposed pulp tissue, gentle pressure by cotton pellets moistened with sodium hypochlorite is most commonly used. However, more rapid and reliable methods are necessary. Therefore, we focused on high-frequency radio waves (HRW).. To evaluate reparative dentin induction by HRW, we used a rat direct pulp capping model and performed hemostasis by using HRW of several strengths, covering the pulp with calcium hydroxide as a direct capping agent. After 14 or 28 days, rats were killed, and reparative dentin and pulp inflammation were investigated histologically.. Radio wave-induced hemostasis required less time when compared with the control group. Reparative dentin with regularly arranged dentinal tubules was observed in the HRW group.. HRW induce hemostasis and produce high-quality reparative dentin and reduced pulpal inflammation.

Topics: Animals; Calcium Hydroxide; Dental Pulp Capping; Dental Pulp Exposure; Dentin, Secondary; Hemostatic Techniques; Hydrogen Peroxide; Male; Models, Animal; Odontoblasts; Pulp Capping and Pulpectomy Agents; Pulpitis; Radiofrequency Therapy; Rats; Rats, Wistar; Sodium Hypochlorite; Time Factors

A sodium hypochlorite accident is a rare event in adults, but even more so in children. The purposes of this paper were to: report the case of a one-year, 10-month-old toddler who was treated under general anesthesia for early childhood caries, incurred a sodium hypochlorite accident following attempted pulpectomy in his primary maxillary central incisors, but made a full recovery without any sequelae after a typical four to six weeks course of disease; review the pertinent literature; and give recommendations on how to minimize the potential occurrence of such incidents.

Topics: Anesthesia, Dental; Anesthesia, General; Dental Caries; Dental Pulp Exposure; Ecchymosis; Edema; Facial Dermatoses; Humans; Incisor; Infant; Maxilla; Pulpectomy; Pulpitis; Root Canal Irrigants; Sodium Hypochlorite; Tooth, Deciduous

To collect quantitative information about the numbers of odontoblast-like cells and reparative dentine thickness after direct pulp capping with platelet-rich plasma (PRP) and enamel matrix derivative (EMD).. The experiment was conducted on 36 Wistar albino rats and a total of 144 incisor teeth. Calcium hydroxide, mineral trioxide aggregate, PRP and EMD were applied as direct capping agents on the pulps of 96 incisors (n = 24). Positive and negative control groups were created on the remaining 48 incisors. The teeth were extracted on the 7th and 28th days. After routine histological preparation, cross-sections were stained with haematoxylin and eosin. The numbers of the odontoblast-like cells were measured histomorphometrically on day 7 and day 28. The thickness of the reparative dentine was also measured. The number of odontoblast-like cells was also measured beneath the dentine bridge. The normal distribution of all data was tested with the Mann-Whitney U test. The statistical differences between groups were analysed using the Kruskal-Wallis test.. The mean number of odontoblast-like cells increased between day 7 and 28 following pulp exposure (P > 0.01) in all groups except for the EMD group (P < 0.01), when compared with both the experimental and negative control groups (P < 0.01). Reparative dentine formation was observed in all groups of teeth (P > 0.01).. Reparative dentine formation was observed, but with no significant difference between the groups. Odontoblast-like cells were observed in association with the outcome of pulps capped with PRP and EMD. PRP and EMD are possible capping agents that influence the thickness of reparative dentine formation.

Topics: Aluminum Compounds; Animals; Calcium Compounds; Calcium Hydroxide; Cell Count; Dental Enamel Proteins; Dental Pulp Capping; Dental Pulp Cavity; Dental Pulp Exposure; Dentin, Secondary; Drug Combinations; Image Processing, Computer-Assisted; Incisor; Odontoblasts; Oxides; Platelet-Rich Plasma; Pulp Capping and Pulpectomy Agents; Rats; Rats, Wistar; Root Canal Irrigants; Silicates; Sodium Hypochlorite; Time Factors

Root canal bacteria in teeth with apical periodontitis were enumerated after extraction and incubation. Canals in 36 teeth were sampled after: S1, incubation for 2 hours (group A), 2 days (group B), 4 days (group C), and 6 days (group D); S2, subsequent incubation for 1 week; S3, canal disinfection; and S4, final incubation for 1 week. Bacterial concentrations were determined by culture (colony-forming unit [CFU]) and epifluorescence-microscopy (EFM) and compared by using pairwise and exact-permutation tests (p < 0.05). CFU counts were lower than EFM counts. CFU counts in S1 were higher in Gp(A) than in Gp(C) (p < 0.004) and Gp(D) (p < 0.02). EFM counts in S1 were higher in Gp(A) than in Gp(C) (p < 0.02). Both enumeration methods showed bacterial counts decreasing from S1 to S2 (p < 0.04). EFM was superior to culture in this ex vivo model. The indigenous flora survived incubation for 6 days, but the adverse effect of initial access would preclude testing of disinfection protocols that require two sessions.

Topics: Bacteria; Colony Count, Microbial; Dental Disinfectants; Dental Pulp Cavity; Dental Pulp Exposure; Dentin; Humans; Materials Testing; Microscopy, Fluorescence; Periapical Periodontitis; Root Canal Irrigants; Root Canal Preparation; Sodium Hypochlorite; Time Factors

To investigate the hypothesis that different haemostatic agents could impair the histological response of human pulps capped with calcium hydroxide.. Forty-five third molars scheduled for extraction were selected. Class I cavities with pulp exposures were prepared. Three agents were used to control bleeding: 0.9% saline solution (control, n = 14), 5.25% sodium hypochlorite (n = 16) and 2% chlorhexidine digluconate (n = 15). The pulps were dressed with hard-setting calcium hydroxide cement. After 7, 30 or 90 days, teeth were extracted, formalin-fixed and prepared for histochemical techniques. The biological response was categorized using the following criteria: inflammatory response, soft tissue organization, reactionary dentine and reparative dentine. Data were submitted to statistical analysis, using nonparametric Kruskal-Wallis one-way analysis of variance on ranks. Differences amongst groups were detected using Dunn's method.. The statistical analysis disclosed that whilst inflammatory response decreased over time, reactionary dentine deposition and reparative dentine formation increased in the latter periods of evaluation (P < 0.05). The three agents had similar performances for all criteria evaluated. The conventional pulp response to calcium hydroxide was observed over time, and complete pulp healing was observed in 88% of the specimens after 90 days.. The three haemostatic agents did not impair the healing process following pulp exposure and capping with calcium hydroxide at different time intervals investigated.

Topics: Adult; Calcium Hydroxide; Chlorhexidine; Dental Pulp; Dental Pulp Capping; Dental Pulp Exposure; Dentin, Secondary; Female; Hemostatics; Humans; Male; Molar, Third; Root Canal Filling Materials; Sodium Chloride; Sodium Hypochlorite; Wound Healing

This study evaluated the biologic ability of sodium hypochlorite to control hemorrhage via chemical amputation of the coagulum, to remove dentin chips, to assist healing, and to facilitate formation of a dentinal bridge under two adhesive systems.. Ninety Class V cavities with mechanical pulpal exposures were placed in the teeth of five adult monkeys and histologically observed. All exposures were prepared with a No. 330 bur, and hemorrhage was controlled with 3% sodium hypochlorite. Twenty-two exposures were capped with All-Bond 2 and AElitefil, and 26 exposures were capped with One-Step (OS) and Resinomer (RS). Two pulps were excluded from the final data. Forty-two exposures were capped with calcium hydroxide and amalgam as controls. At 7, 27, and 90 days, tissues were obtained by perfusion fixation, demineralized, sectioned, stained, and histologically graded according to published qualitative criteria.. For both adhesives, at 7 days, 12 of 16 pulps showed no coagulum remnants or dentin chips at the material interface. No necrotic pulps were observed. At 27 and 97 days, 26 of 30 capped pulps had dentinal bridges at the adhesive interface. Reparative dentin was present in 28 pulps. Four 97-day pulps exhibited necrosis associated with stained bacteria. One 97-day pulp contained dentin chips throughout the pulp and demonstrated no healing, no reparative dentin, and no stained bacterial profiles.. Normal soft tissue reorganization and dentinal bridge formation were observed in 86% of pulps treated with sodium hypochlorite and either adhesive system.

Topics: Animals; Bisphenol A-Glycidyl Methacrylate; Calcium Hydroxide; Composite Resins; Dental Amalgam; Dental Pulp Capping; Dental Pulp Diseases; Dental Pulp Exposure; Dental Pulp Necrosis; Dental Restoration, Permanent; Dentin-Bonding Agents; Dentin, Secondary; Hemorrhage; Hemostatics; Macaca mulatta; Methacrylates; Resin Cements; Root Canal Irrigants; Silanes; Silicon Dioxide; Sodium Hypochlorite; Time Factors; Wound Healing

To evaluate the in vitro cytotoxic effects of three cleansing solutions used for chemical lavage of pulp exposures.. The immortalized odontoblast cell line (MDPC-23) was plated (30,000 cells/cm2) and incubated for 72 hrs in 24-well dishes. After counting the cell number under inverted light microscopy, 20 microl of the experimental and control solutions were added to 980 microl of fresh culture medium. Then, hydrogen peroxide (3%, H2O2), sodium hypochlorite (6%, NaOCl) or calcium hydroxide-saline solution (5g of Ca(OH)2 in 10 ml of sterile distilled water) were added to wells for experimental Groups 1, 2 and 3, respectively. The positive and negative control groups received Syntac Sprint bonding agent (SS) and phosphate buffered saline (PBS), respectively. Following incubation for 120 min the cell number was counted again, the cell morphology was evaluated by scanning electron microscopy (SEM) and the cell metabolism was determined by the methyltetrazolium (MTT) assay. The scores obtained from cell counting and MTT assay were analyzed with an ANOVA followed by Fisher's PLSD tests.. H2O2, NaOCl solutions, and SS bonding agent were more cytotoxic than Ca(OH)2 or PBS. In the groups with H2O2 or SS, only a few cells remained attached to the bottom of wells. The difference between these two groups was not statistically significant. H2O2, NaOCl and SS depressed the mitochondrial enzyme response by 97.7%, 97.3%, and 95.0%, respectively. On the other hand, Ca(OH)2 depressed the metabolic activity of cells by only 5%. While H2O2, NaOCl and SS caused extreme changes on the cell morphology, neither Ca(OH)2 nor PBS promoted dramatic changes in the cell morphology.

Topics: Analysis of Variance; Animals; Anti-Infective Agents, Local; Calcium Hydroxide; Cell Adhesion; Cell Count; Cell Line; Coloring Agents; Culture Media; Dental Pulp Exposure; Dentin-Bonding Agents; Hydrogen Peroxide; Mice; Microscopy, Electron, Scanning; Mitochondria; Odontoblasts; Oxidants; Resin Cements; Sodium Chloride; Sodium Hypochlorite; Statistics as Topic; Tetrazolium Salts; Therapeutic Irrigation; Thiazoles