sodium-hypochlorite and Dentin--Secondary

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

The results of some short-term experiments suggest that direct capping of a vital pulp with the modern resin-based composite systems may be as effective as capping with calcium hydroxide. Total cavity etching with 10% phosphoric acid seems to be safe for the exposed pulp, but unless annulled by calcium hydroxide 35% phosphoric acid may be disastrous. For hemostasis and cleaning of the pulp wound both sodium hypochlorite and saline seem suitable, whereas the effectiveness of a 2% chlorhexidine solution is questionable. Although hard-setting calcium hydroxide cements may induce the formation of dentin bridges, they appear not to provide an effective long-term seal against bacterial factors. Within a few years, the majority of mechanically exposed and capped pulps show infection and necrosis due to microleakage of such capping materials and tunnel defects in the dentin bridges. It is unknown whether newer types of resin containing calcium-hydroxide-products will act as a permanent barrier. The cytotoxicity of the resin-based composites and the temperature rise during polymerisation may not be of concern, but microleakage, sensitisation and allergic reactions may pose problems. Based on available data, pulp capping with resin-based composites may be said to be promising, but more and long-term research is mandatory before the method can be recommended.

Topics: Acid Etching, Dental; Adhesives; Calcium Hydroxide; Chlorhexidine; Composite Resins; Dental Leakage; Dental Pulp; Dental Pulp Capping; Dentin, Secondary; Disinfectants; Hemostatics; Humans; Phosphoric Acids; Sodium Chloride; Sodium Hypochlorite

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

The purpose of this experiment was to investigate histo-pathologically the pulpal reaction to a glass-ionomer/resin (Geristore) restoration system in human teeth. Black's class I cavities were prepared in 22 human teeth; these were divided into 2 groups, one with the Geristore after cavity was cleaned with 10% NaOCl solution and 3% H2O2 solution (Group G) and the other with the Geristore after the cavity was applied with Mirage-Bond (Group MG). The treated teeth were observed clinically over 90 days after operation. They were then extracted for histological examination. No unpleasant symptoms were noted. A few pathological changes were observed. No histo-pathological score differences were observed between groups G and MG. The average evaluation score of pathological results in both groups G and MG were excellent. Microorganisms observed in the cavity dentin of the group G was fewer than in group MG. In some cases, microorganisms were observed along the dentin walls. In conclusion, the pulpal injury due to this Geristore restoration system was slight, and the system was considered to be safe for the pulp and clinically useful.

Topics: Adult; Colony Count, Microbial; Dental Cavity Preparation; Dental Pulp; Dental Pulp Cavity; Dental Restoration, Permanent; Dentin; Dentin-Bonding Agents; Dentin, Secondary; Female; Glass Ionomer Cements; Humans; Hydrogen Peroxide; Male; Methacrylates; Resins, Synthetic; Sodium Hypochlorite

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

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

To report several types of response of immature permanent teeth with infected necrotic pulp tissue and either apical periodontitis or abscess to revascularization procedures.. Twenty immature permanent teeth with infected necrotic pulp tissue and either apical periodontitis or abscesses from 20 patients were included. The teeth were isolated with rubber dam, and pulp chambers was accessed through the crowns. The canals were gently irrigated with 5.25% sodium hypochlorite with minimal mechanical debridement. Calcium hydroxide was used as an inter-appointment intracanal medicament and placed into the coronal half of the canal space. After resolution of clinical signs and symptoms, bleeding was induced into the canal space from the periapical tissues using K-files. The coronal canal space was sealed with a mixture of mineral trioxide aggregate (MTA) and saline solution. The access cavity was filled with composite resin. These immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscesses were followed up from 6 to 26 months.. Five types of responses of these immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures were observed: type 1, increased thickening of the canal walls and continued root maturation; type 2, no significant continuation of root development with the root apex becoming blunt and closed; type 3, continued root development with the apical foramen remaining open; type 4, severe calcification (obliteration) of the canal space; type 5, a hard tissue barrier formed in the canal between the coronal MTA plug and the root apex.. Based on this case series, the outcome of continued root development was not as predictable as increased thickening of the canal walls in human immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess after revascularization procedures. Continued root development of revascularized immature permanent necrotic teeth depends on whether the Hertwig's epithelial root sheath survives in case of apical periodontitis/abscess. Severe pulp canal calcification (obliteration) by hard tissue formation might be a complication of internal replacement resorption or union between the intracanal hard tissue and the apical bone (ankylosis) in revascularized immature permanent necrotic teeth.

Topics: Adolescent; Aluminum Compounds; Apexification; Calcium Compounds; Calcium Hydroxide; Child; Composite Resins; Dental Materials; Dental Pulp Calcification; Dental Pulp Necrosis; Dental Restoration, Permanent; Dentin, Secondary; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Neovascularization, Physiologic; Odontogenesis; Oxides; Periapical Abscess; Periapical Periodontitis; Periapical Tissue; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Silicates; Sodium Hypochlorite; Tooth Apex; Tooth Root; Treatment Outcome

Dens invaginatus is a developmental anomaly that poses treatment challenges when nonsurgical root canal therapy is deemed necessary. Teeth with complex root canal morphology often require a comprehensive treatment approach to effectively clean, shape, and disinfect the pulp canal space before obturation. Endodontic clinical management of a tooth with dens invaginatus might include using cone-beam computed tomography (CBCT) to aid in the diagnosis and treatment-planning phase and use of the surgical operating microscope in performing the clinical phase of treatment. A novel approach could include using the revascularization technique as the final treatment step in the management of a dens invaginatus case in which the root apex has not completed formation.. This case report will provide both an overview of the feasibility of using CBCT scans in diagnosis and treatment planning and a step-by-step clinical technique, by using surgical operating microscope and the revascularization technique, in the successful endodontic management of a complex dens invaginatus case.. Five-month and 12-month follow-up clinical and radiographic findings will provide a candid view of inherent advantages and challenges of this technique.

Topics: Aluminum Compounds; Anti-Bacterial Agents; Calcium Compounds; Child; Cone-Beam Computed Tomography; Dens in Dente; Dental Pulp Cavity; Dentin Sensitivity; Dentin, Secondary; Drug Combinations; Feasibility Studies; Follow-Up Studies; Glass Ionomer Cements; Humans; Magnesium Oxide; Male; Microscopy; Oxides; Patient Care Planning; Polycarboxylate Cement; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Silicates; Sodium Hypochlorite; Tooth Root; Zinc Oxide

This case series reports the outcomes of 8 patients (ages 9-4 years) who presented with 9 immature permanent teeth with pulpal necrosis and apical periodontitis. During treatment, 5 of the teeth were found to have at least some residual vital tissue remaining in the root canal systems. After NaOCI irrigation and medication with ciprofloxacin, metronidazole, and minocycline, these teeth were sealed with mineral trioxide aggregate and restored. The other group of 4 teeth had no evidence of any residual vital pulp tissue. This second group of teeth was treated with NaOCl irrigation and medicated with ciprofloxacin, metronidazole, and minocycline followed by a revascularization procedure adopted from the trauma literature (bleeding evoked to form an intracanal blood clot). In both groups of patients, there was evidence of satisfactory postoperative clinical outcomes (1-5 years); the patients were asymptomatic, no sinus tracts were evident, apical periodontitis was resolved, and there was radiographic evidence of continuing thickness of dentinal walls, apical closure, or increased root length.

Topics: Adolescent; Aluminum Compounds; Anti-Bacterial Agents; Apexification; Calcium Compounds; Calcium Hydroxide; Child; Ciprofloxacin; Dental Pulp; Dental Pulp Necrosis; Dentin, Secondary; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Metronidazole; Minocycline; Odontogenesis; Oxides; Periapical Periodontitis; Regeneration; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Silicates; Sodium Hypochlorite; Tooth Apex; Tooth, Nonvital; Treatment Outcome

The objective of this study was to evaluate in vivo the revascularization and the apical and periapical repair after endodontic treatment using 2 techniques for root canal disinfection (apical negative pressure irrigation versus apical positive pressure irrigation plus triantibiotic intracanal dressing) in immature dogs' teeth with apical periodontitis.. Two test groups of canals with experimentally induced apical periodontitis were evaluated according to the disinfection technique: Group 1, apical negative pressure irrigation (EndoVac system), and Group 2, apical positive pressure irrigation (conventional irrigation) plus triantibiotic intracanal dressing. In Group 3 (positive control), periapical lesions were induced, but no endodontic treatment was done. Group 4 (negative control) was composed of sound teeth. The animals were killed after 90 days and the maxillas and mandibles were subjected to histological processing. The sections were stained with hematoxylin and eosin and Mallory Trichrome and examined under light microscopy. A description of the apical and periapical features was done and scores were attributed to the following histopathological parameters: newly formed mineralized apical tissue, periapical inflammatory infiltrate, apical periodontal ligament thickness, dentin resorption, and bone tissue resorption. Intergroup comparisons were done by the Kruskal-Wallis and Dunn's tests (alpha = 0.05).. Although statistically significant difference was found only for the inflammatory infiltrate (P < .05), Group 1 presented more exuberant mineralized formations, more structured apical and periapical connective tissue, and a more advanced repair process than Group 2.. From the histological observations, sodium hypochlorite irrigation with the EndoVac system can be considered as a promising disinfection protocol in immature teeth with apical periodontitis, suggesting that the use of intracanal antibiotics might not be necessary.

Topics: Alveolar Bone Loss; Alveolar Process; Animals; Anti-Bacterial Agents; Ciprofloxacin; Connective Tissue; Dental Pulp Cavity; Dentin; Dentin, Secondary; Dogs; Drug Combinations; Metronidazole; Minocycline; Neovascularization, Physiologic; Periapical Periodontitis; Periapical Tissue; Periodontal Ligament; Pressure; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Resorption; Sodium Hypochlorite; Therapeutic Irrigation; Tooth Apex; Wound Healing

This retrospective study included 23 necrotic immature permanent teeth treated for either short-term (treatment period <3 months) or long-term (treatment period >3 months) using conservative endodontic procedures with 2.5% NaOCl irrigations without instrumentation but with Ca(OH)(2) paste medication. For seven teeth treated short-term, the gutta-percha points were filled onto an artificial barrier of mineral trioxide aggregate (MTA). For 16 teeth treated long-term, the gutta-percha points, amalgam, or MTA were filled onto the Ca(OH)(2)-induced hard tissue barrier in the root canal. We found that all apical lesions showed complete regression in 3 to 21 (mean, 8) months after initial treatment. All necrotic immature permanent teeth achieved a nearly normal root development 10 to 29 (mean, 16) months after initial treatment. We conclude that immature permanent teeth with pulp necrosis and apical pathosis can still achieve continued root development after proper short-term or long-term regenerative endodontic treatment procedures.

Topics: Aluminum Compounds; Calcium Compounds; Calcium Hydroxide; Child; Dental Pulp; Dental Pulp Necrosis; Dentin, Secondary; Dentition, Permanent; Drug Combinations; Female; Gutta-Percha; Humans; Male; Oxides; Periapical Abscess; Regeneration; Retrospective Studies; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Therapy; Silicates; Sodium Hypochlorite; Surveys and Questionnaires; Tooth Apex

Pulp capping in carious teeth has been considered unpredictable and therefore contraindicated. A recently developed material, mineral trioxide aggregate (MTA), resists bacterial leakage and may provide protection for the pulp, allowing repair and continued pulp vitality in teeth when used in combination with a sealed restoration.. Forty patients aged 7 to 45 years accepted pulp-capping treatment when they received a diagnosis no more severe than reversible pulpitis after undergoing cold testing and radiographic examination. The primary author removed caries using a caries detector dye and sodium hypochlorite solution for hemostasis and placed MTA over the exposures and all surrounding dentin. The operator then restored the teeth provisionally with unbonded Clearfil Photocore (Kuraray Medical, Okayama, Japan). During a second visit, the operator restored the teeth with bonded composite after sensibility testing and confirmed MTA curing. At recall appointments, patients were evaluated for reparative dentin formation, pulpal calcification, continued normal root development and evidence of pathosis.. Over an observation period of nine years, the authors followed 49 of 53 teeth and found that 97.96 percent had favorable outcomes on the basis of radiographic appearance, subjective symptoms and cold testing. All teeth in younger patients (15/15) that initially had open apexes showed completed root formation (apexogenesis).. MTA can be a reliable pulp-capping material on direct carious exposures in permanent teeth when a two-visit treatment protocol is observed.. Vital pulp therapy using MTA is a treatment option for teeth diagnosed with a condition no more severe than reversible pulpitis.

Topics: Adolescent; Adult; Aluminum Compounds; Calcium Compounds; Child; Dental Caries; Dental Pulp Capping; Dental Restoration, Permanent; Dentin, Secondary; Drug Combinations; Hemostatics; Humans; Kaplan-Meier Estimate; Life Tables; Middle Aged; Oxides; Pulpitis; Silicate Cement; Silicates; Sodium Hypochlorite; Treatment Outcome

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 describe the role of calcium hydroxide in infection control during complex endodontic retreatment.. A case is presented in which two conventional endodontic treatments and two surgical interventions failed to bring periapical healing. Despite this history, a further conventional treatment augmented by long-term disinfection with calcium hydroxide finally delivered a successful outcome.. Periapical healing follows proper intracanal infection control. Despite repeated surgical and nonsurgical intervention, careful retreatment can often bring healing. Calcium hydroxide has long-acting antimicrobial and soft-tissue dissolving activity. It is a helpful adjunct in endodontic retreatment.

Topics: Calcium Hydroxide; Dental Fistula; Dentin, Secondary; Disinfectants; Follow-Up Studies; Humans; Male; Middle Aged; Periapical Abscess; Periapical Diseases; Retreatment; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Tooth Apex; Treatment Failure; Treatment Outcome

Recent studies have demonstrated that acid etching of vital dentin and pulpal tissue does not retard pulpal healing, odontoblastoid cell differentiation, or dentinal bridge formation when the pulp is capped with adhesive resins. The purpose of this study was to evaluate the pulpal response in nonexposed and exposed monkey pulps to treatment with the Clearfil Liner Bond 2 and Clearfil AP-X system.. Class V and Class I cavities in nonexposed and exposed pulps were observed at 7 or 8, 27, and 97 days.. There were no differences in pulpal inflammation between the Clearfil Liner Bond 2/Clearfil AP-X specimens and calcium hydroxide controls in either Class V or Class I cavities at the various time periods.. Clearfil Liner Bond 2 and Clearfil AP-X system is not toxic to either nonexposed or exposed pulpal tissues when placed according to manufacturer's directions.

Topics: Animals; Biocompatible Materials; Dental Cavity Lining; Dental Pulp; Dental Pulp Capping; Dental Pulp Necrosis; Dentin, Secondary; Macaca mulatta; Methacrylates; Odontoblasts; Pulpitis; Sodium Hypochlorite; Wound Healing

Recombinant human osteogenic protein-1 (hOP-1, BMP-7) induces cartilage and bone formation when implanted in extra- and intraskeletal sites in vivo. rOP-1 also preserves pulp vitality and stimulates reparative dentine formation when placed on partially amputated vital dental pulp tissue. The amount of dentine formed in 6 weeks was earlier found to be proportional to the total amount of rOP-1/carrier placed on the pulp and the capacity of the pulp to respond to rOP-1 appeared to be independent of the amount of coronal pulp removed. This reparative dentine was not completely mineralized after 6 weeks healing. Experiments were now made to determine the capacity of hOP-1 to preserve the vitality of and induce reparative dentine in vital radicular pulps. The extent of tissue mineralization present after 1, 2, 4 and 6 months' healing time in permanent monkey teeth was assessed. Radicular pulp vitality was maintained, reparative dentine formed, and mineralization was nearly 75% complete after 1 month and more than 95% after 4 months. The effects of irrigating the exposed pulps with EDTA, sodium hypochlorite or saline were also compared. Significantly more sodium hypochlorite-treated pulps became non-vital and the root canals of all the non-vital teeth contained bacteria at the time of sacrifice.

Topics: Animals; Bacteria; Bone Morphogenetic Protein 7; Bone Morphogenetic Proteins; Dental Pulp; Dental Pulp Cavity; Dentin; Dentin, Secondary; Edetic Acid; Humans; Macaca fascicularis; Proteins; Pulpectomy; Recombinant Proteins; Root Canal Irrigants; Sodium Chloride; Sodium Hypochlorite; Time Factors; Tooth Calcification; Transforming Growth Factor beta; Wound Healing

The purpose of this study was to quantitate the sequential effects of endodontic procedures on the permeability of human root dentin in vitro. Forty single-rooted teeth were used. Both the crown and the apical 2 mm of the root were removed. The hydraulic conductance of the root before and after various endodontic procedures was measured using a fluid filtration method. Measurements were also made of dentin thickness, intracanal diameter changes, and changes in intracanal surface area. The results showed that instrumentation by K files alone or in combination with Gates Glidden drills did not alter radicular dentin permeability when the cementum remained intact. After removing the cementum, the creation of a smear layer and smear plugs on the canal surface tended to offset the expected increase in dentin permeability created by increasing the intracanal surface area and decreasing root dentin thickness. EDTA treatment inside the instrumented canal to remove the smear layer did not increase permeability significantly. The use of K files followed by Gates Glidden drills tended to remove more cervical dentin, increased the intracanal surface area, and increased the hydraulic conductance of root dentin more than the use of K files alone.

Topics: Dental Cementum; Dentin Permeability; Dentin, Secondary; Edetic Acid; Humans; Hydrostatic Pressure; Root Canal Therapy; Smear Layer; Sodium Hypochlorite; Tooth Root