LECZENIE BIOLOGICZNE MIAZGI ZĘBÓW STAŁYCH

The vitality of dental pulp is essential for long‍‑term tooth survival. The aim of vital pulp therapy is to preserve vital, healthy pulp tissue. This therapy’s foundation is the elimination of bacteria from the dentin‍‑pulp complex. The treatment option depends on the cause and extent of mineralised tooth tissue destruction. The outcome of such treatment is determined by accurate assessment of the pulp’s status and the dentist’s ability to predict the success of the therapy. The aim of this review is to facilitate the dentist in making a proper decision referring to vital pulp therapy in permanent teeth, and to provide an overview of new approaches in such treatment.

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Acemannan Used as an Implantable Biomaterial for Vital Pulp Therapy of Immature Permanent Teeth Induced Continued Root Formation

Pharmaceutics ◽

10.3390/pharmaceutics12070644 ◽

2020 ◽

Vol 12 (7) ◽

pp. 644

Author(s):

Tien Thuy Vu ◽

Minh Truong Nguyen ◽

Polkit Sangvanich ◽

Quang Ngoc Nguyen ◽

Pasutha Thunyakitpisal

Keyword(s):

Root Formation ◽

Treatment Success ◽

Permanent Teeth ◽

Pulp Tissue ◽

Pulp Therapy ◽

Exposure Site ◽

Vital Pulp Therapy ◽

Significant Difference ◽

Pulp Exposure

Direct pulp-capping, a vital pulp therapy, is used to protect and preserve pulp vitality by applying a biomaterial on the pulp exposure site. Acemannan, a polysaccharide extracted from Aloe vera, induces osteodentin-bridge formation to cover the exposure site in vivo. We evaluated the effect of acemannan sponges on partial pulpotomized permanent teeth with caries or accident-induced pulp exposure (n = 50). After removing infected dentin and inflamed pulp tissue, the teeth were randomly divided into acemannan or control (mineral trioxide aggregate (MTA) groups (n = 25). The teeth were examined immediately after treatment (baseline) and at 6- and 12-month follow-ups for clinical and cone beam computed tomography (CBCT) examination. The three-dimensional tooth length and root apex area were simulated to determine treatment success. We found that the overall success rate in the acemannan and MTA groups from baseline to 12-month follow-up was 90.91% and 95.65%, respectively, with no significant difference between the two groups (p > 0.05). In the success teeth in both groups, the root length increased, and the apex area significantly decreased (p < 0.05), indicating continued root formation. Our results suggest that acemannan is a promising low-cost biomaterial for partial pulpotomy treatment for immature permanent teeth requiring vital pulp therapy.

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Biodentine Total Pulpotomy as an Effective Alternative to Conventional Endodontic Therapy for Young Permanent Teeth – A Study from Calicut, India

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/332 ◽

2021 ◽

Vol 10 (21) ◽

pp. 1593-1597

Author(s):

Amith Adyanthaya ◽

Prathyusha P ◽

Risana K ◽

Aparna Sivaraman ◽

Nazreen Ayub K ◽

...

Keyword(s):

Treatment Options ◽

Clinical Signs ◽

Effective Alternative ◽

Permanent Teeth ◽

Pulp Tissue ◽

Term Survival ◽

Pulp Therapy ◽

Vital Pulp Therapy ◽

Permanent Molars

BACKGROUND The vitality of dental pulp is essential for long-term survival of the tooth. Vital pulp therapy (VPT) intends to maintain healthy pulp tissue by eliminating bacteria from the dentin-pulp complex. There are many treatment options for vital pulp therapy in extensively decayed teeth. Pulp capping or pulpotomy procedures rely upon an accurate assessment of the pulp status, and careful management of the remaining pulp tissue. We wanted to evaluate as to whether biodentine total pulpotomy is an effective alternative to conventional endodontic therapy for young permanent teeth. METHODS Full coronal pulpotomy was performed in young permanent molars diagnosed with acute irreversible pulpitis with Biodentine as the pulpotomy medicament. Follow up evaluation was done clinically and radiographically at 3, 6 and 12 months. RESULTS During follow-up periods clinical signs/symptoms were absent including pulpal pain, swelling or presence of sinus and percussion pain. Continuous root development and healing of periapical radiolucency were noticed in the study which were indicative of maintenance of vitality of the pulp. CONCLUSIONS Within the limitations of this clinical study, it is concluded that total pulpotomy with Biodentine has a promising scope in regenerative approaches in the treatment of carious young permanent teeth. KEY WORDS Biodentine, Coronal Pulpotomy, Permanent Teeth, Total Pulpotomy

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Vital Pulp Therapy—Current Progress of Dental Pulp Regeneration and Revascularization

International Journal of Dentistry ◽

10.1155/2010/856087 ◽

2010 ◽

Vol 2010 ◽

pp. 1-9 ◽

Cited By ~ 45

Author(s):

Weibo Zhang ◽

Pamela C. Yelick

Keyword(s):

Stem Cells ◽

Dental Pulp ◽

The Body ◽

Void Space ◽

Synthetic Material ◽

Pulp Tissue ◽

Pulp Regeneration ◽

Pulp Therapy ◽

Vital Pulp Therapy ◽

Review Current

Pulp vitality is extremely important for the tooth viability, since it provides nutrition and acts as biosensor to detect pathogenic stimuli. In the dental clinic, most dental pulp infections are irreversible due to its anatomical position and organization. It is difficult for the body to eliminate the infection, which subsequently persists and worsens. The widely used strategy currently in the clinic is to partly or fully remove the contaminated pulp tissue, and fill and seal the void space with synthetic material. Over time, the pulpless tooth, now lacking proper blood supply and nervous system, becomes more vulnerable to injury. Recently, potential for successful pulp regeneration and revascularization therapies is increasing due to accumulated knowledge of stem cells, especially dental pulp stem cells. This paper will review current progress and feasible strategies for dental pulp regeneration and revascularization.

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Stem Cells Derived from Human Exfoliated Deciduous teeth [shed] in Neuronal Disorders: A Review

Current Stem Cell Research & Therapy ◽

10.2174/1574888x16666201221151512 ◽

2020 ◽

Vol 16 ◽

Author(s):

Minu Anoop ◽

Indrani Datta

Keyword(s):

Stem Cells ◽

Neurodegenerative Diseases ◽

Dental Pulp ◽

Therapeutic Potential ◽

Permanent Teeth ◽

Deciduous Teeth ◽

Proliferative Potential ◽

Pulp Tissue ◽

Human Exfoliated Deciduous Teeth

: Most conventional treatments for neurodegenerative diseases fail due to their focus on neuroprotection rather than neurorestoration. Stem cell‐based therapies are becoming a potential treatment option for neurodegenerative diseases as they can home in, engraft, differentiate and produce factors for CNS recovery. Stem cells derived from human dental pulp tissue differ from other sources of mesenchymal stem cells due to their embryonic neural crest origin and neurotrophic property. These include both dental pulp stem cells [DPSCs] from dental pulp tissues of human permanent teeth and stem cells from human exfoliated deciduous teeth [SHED]. SHED offer many advantages over other types of MSCs such as good proliferative potential, minimal invasive procurement, neuronal differentiation and neurotrophic capacity, and negligible ethical concerns. The therapeutic potential of SHED is attributed to the paracrine action of extracellularly released secreted factors, specifically the secretome, of which exosomes is a key component. SHED and its conditioned media can be effective in neurodegeneration through multiple mechanisms, including cell replacement, paracrine effects, angiogenesis, synaptogenesis, immunomodulation, and apoptosis inhibition, and SHED exosomes offer an ideal refined bed-to-bench formulation in neurodegenerative disorders. However, in spite of these advantages, there are still some limitations of SHED exosome therapy, such as the effectiveness of long-term storage of SHED and their exosomes, the development of a robust GMP-grade manufacturing protocol, optimization of the route of administration, and evaluation of the efficacy and safety in humans. In this review, we have addressed the isolation, collection and properties of SHED along with its therapeutic potential on in vitro and in vivo neuronal disorder models as evident from the published literature.

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A Prospective Analysis of the Correlation Between Postoperative Pain and Vital Pulp Therapy

Frontiers in Dental Medicine ◽

10.3389/fdmed.2021.647417 ◽

2021 ◽

Vol 2 ◽

Author(s):

Mark Shallal-Ayzin ◽

Tam Trinh ◽

William Yeung ◽

Peter Z. Tawil ◽

Carol L. Haggerty ◽

...

Keyword(s):

Postoperative Pain ◽

Permanent Teeth ◽

Pulp Therapy ◽

Standardized Protocol ◽

Vital Pulp Therapy ◽

Post Operative Pain ◽

Experienced Pain ◽

Functional Tooth ◽

Poor Treatment ◽

Poor Treatment Outcome

Vital pulp therapy (VPT) is a viable treatment option for carious teeth with exposed pulps. To our knowledge, no study has examined the correlation between postoperative pain and the outcome of VPT on asymptomatic permanent teeth. The aim of this study was to examine whether odontogenic pain experienced after VPT on asymptomatic teeth with a carious pulp exposures is correlated with the progression of pulpal disease into a more inflamed or necrotic state. Direct pulp caps or partial pulpotomies using a tricalcium silicate (MTA Angelus, Angelus, Londrina, Brazil) were performed on asymptomatic permanent teeth using a standardized protocol. Patients were contacted at 24 h, 1 week, and 3 months following treatment and data was collected on post-operative pain and analgesic intake using a standardized questionnaire. At 6 months after treatment, an in-person clinical exam was performed which included standard vitality tests along with exposure of a periapical radiograph. Success was defined as an asymptomatic, functional tooth without any clinical or radiographic pathology. Data was analyzed using logistic regression. VPT was successful in 84.3% of patients at the 6 months timepoint. The percentage of patients that experienced pain at 24-h, 1 week, and 3-month time periods was 38, 22, and 12%, respectively. Pain at 3 months was significantly correlated with decreased outcome (p = 0.028). This data suggests that postoperative pain in the first 3 months after VPT is predictive of a poor treatment outcome.

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Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals—A Review

Journal of Veterinary Dentistry ◽

10.1177/08987564211046325 ◽

2021 ◽

pp. 089875642110463

Author(s):

Amalia Zacher ◽

Sandra Manfra Marretta

Keyword(s):

Treatment Options ◽

Mineral Trioxide Aggregate ◽

Permanent Teeth ◽

Small Animals ◽

Unique Challenge ◽

Pulp Capping ◽

Pulp Therapy ◽

Vital Pulp Therapy ◽

Pulp Vitality ◽

And Function

Immature permanent teeth with crown fractures present a unique challenge in human and animal patients. Immature permanent teeth have not yet developed completely, often presenting with thin dentin walls, incomplete apical formation, and increased crown-to-root ratios. Loss of pulp function at this stage has devastating long-term implications for these teeth. Ideally, attempts should be made to preserve pulp vitality in immature permanent teeth to allow for continued dental development. The range of treatment options for vital teeth includes odontoplasty with bonding and sealing +/− restoration, indirect pulp capping, and direct pulp capping/vital pulp therapy. These treatments have long been established in human and veterinary medicine, and cases have been reported in dogs and cats. Apexification using calcium hydroxide is a well-established treatment for nonvital immature teeth. The advent of mineral trioxide aggregate and other bioceramic materials for use in vital pulp therapy and apexification has reduced treatment sessions and improved outcomes. Recent developments in the field of regenerative endodontic therapy further expand treatment options and provide the possibility for continued development of a formerly nonvital tooth. Selecting the appropriate treatment based on the severity of tooth fracture and status of pulp vitality can avoid a lifetime of poor structure and function for the affected tooth. This article provides multiple step-by-step protocols for the management of immature permanent teeth with crown fractures in small animals.

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Wound Lavage in Studies on Vital Pulp Therapy of Permanent Teeth with Carious Exposures: A Qualitative Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm9040984 ◽

2020 ◽

Vol 9 (4) ◽

pp. 984 ◽

Cited By ~ 2

Author(s):

Amina Munir ◽

Matthias Zehnder ◽

Dan-Krister Rechenberg

Keyword(s):

Permanent Teeth ◽

Pulp Capping ◽

Recall Interval ◽

Pulp Therapy ◽

Vital Pulp Therapy ◽

Qualitative Systematic Review ◽

Significant Difference ◽

Study Characteristics ◽

Pulp Exposure ◽

Calcium Silicate Cements

The aim of this study was to systematically review pulp wound lavage in vital pulp therapy (VPT). A search was conducted in six life science databases to identify clinical trials carried out on permanent teeth with a carious pulp exposure and a recall interval of at least six months. Twenty-seven trials of low to moderate risk of bias (RoB-2 and ROBINS-I) were included. Data was extracted and analyzed regarding study characteristics and methods used for pulp wound lavage. The agent used for pulp wound lavage was specified in all included trials. Most of the identified trials (23/27) randomized the pulp capping material. Many (14/27) reported the use of sodium hypochlorite (NaOCl); ten used only saline or water. One trial was identified that compared pulp wound lavage with 2.5% (NaOCl) to saline, another compared 5% glutaraldehyde to water, both in immature molar pulpotomies. Both studies were underpowered. Neither showed a significant difference between treatments. The use of NaOCl was positively correlated to recent year of publication and use of hydraulic calcium silicate cements for pulp capping (p < 0.05). In conclusion, despite a lack of well-designed trials on pulp wound lavage in VPT, a trend towards using NaOCl for this purpose was observed.

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In vitro histomorphometric comparison of dental pulp tissue in different teeth

PeerJ ◽

10.7717/peerj.8212 ◽

2019 ◽

Vol 7 ◽

pp. e8212

Author(s):

Marytere Guerrero-Jiménez ◽

Geovanny I. Nic-Can ◽

Nelly Castro-Linares ◽

Fernando Javier Aguilar-Ayala ◽

Michel Canul-Chan ◽

...

Keyword(s):

Stem Cells ◽

Cell Density ◽

Dental Pulp ◽

Pearson Correlation ◽

Third Molar ◽

Permanent Teeth ◽

Deciduous Teeth ◽

Pulp Tissue ◽

Valuable Source

Background Dental pulp (DP) represents an accessible and valuable source promising of stem cells for clinical application. However, there are some disadvantages associated with the isolation of dental pulp stem cells (DPSCs), which include the size and weight of the pulp tissue needed to yield sufficient cells for culturing in vitro. Therefore, the objective of this study was to compare in vitro histomorphometry of DP from permanent (premolars, third molar), supernumerary and deciduous teeth of patients between 5 and 25 years old with regards to weight, length, width and the cell density in the four regions of the DP in order to obtain quantitative parameters in a tissue that represents a valuable source of stem cells. Methods DPs were obtained from 10 central incisors deciduous, 20 permanent teeth (10 premolars, 10 third molars) and 10 supernumeraries (six mesiodents and four inferior premolar shapes). The pulps were carefully removed, and the entire tissue was weighed. The pulp length and the width were measured with a digital Vernier caliper. The cellular density analysis was performed according to the four regions of the DP (coronal, cervical, medial and apical) in histological slides using photography and the ImageJ® program for quantification. Results The Pearson correlation test revealed that DP weight among different types of teeth is correlated with age in male patients. A significant positive correlation was noted between length and width of the DP with age in both genders. The mean DP weight for supernumerary and third molar teeth was greater than deciduous and premolar teeth. Finally, the histological analysis showed that the coronal and apical portions of DP in supernumerary and premolar teeth have the highest cell density. Conclusions The DP of supernumerary teeth has quantitatively the best morphometric parameters and cell density comparable with the quality of DP obtained from deciduous teeth.

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Dentist-related factors influencing the use of vital pulp therapy: a survey among dental practitioners in China

Journal of International Medical Research ◽

10.1177/0300060519843406 ◽

2019 ◽

Vol 47 (6) ◽

pp. 2381-2393

Author(s):

Mengjie Li ◽

Xiaoli Hu ◽

Xiaolan Li ◽

Shuxiang Lei ◽

Ming Cai ◽

...

Keyword(s):

Mineral Trioxide Aggregate ◽

Permanent Teeth ◽

Direct Pulp Capping ◽

Online Questionnaire ◽

Related Factors ◽

Pulp Capping ◽

Factors Associated ◽

Pulp Therapy ◽

Vital Pulp Therapy ◽

Dental Practitioners

Objective To evaluate dentist-related factors associated with the use of vital pulp therapy (VPT) for the treatment of pulp exposures in permanent teeth. Methods This survey-based study sent an online questionnaire to collect data on the demographics of the respondents, the use of VPT and the choice of materials for VPT, to all members of the Society of Endodontology of Guangdong, China. Results A total 183 of 380 members responded (48.2%). The majority (89.6%; 164 of 183) had performed direct pulp capping (DPC) while 55.2% (101 of 183) had performed partial pulpotomy (PP) at least once. The most-cited reason for not performing VPT was unfamiliarity with the technique. Mineral trioxide aggregate was the most commonly used material for both DPC (67.1%; 110 of 164) and PP (73.3%; 74 of 101). Endodontists, compared with general practitioners, preferred to perform DPC and chose calcium silicate materials (CSMs) for VPT (odds ratios 5.81 and 8.07, respectively). DPC and CSMs for VPT were also favoured more by respondents who had practised for > 5 years. Senior respondents were more likely to use PP. Conclusions Speciality, years of practise and age of dentists influenced the decision making and the choice of materials for VPT. Continuing education is essential to promote the clinical use of VPT.

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