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

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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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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Apexogenesis

Journal of Veterinary Dentistry ◽

10.1177/089875649000700303 ◽

1990 ◽

Vol 7 (3) ◽

pp. 12-13 ◽

Cited By ~ 1

Author(s):

Chris J. Visser

Keyword(s):

Root Canal ◽

Root Canal Treatment ◽

Permanent Teeth ◽

Canal System ◽

Tooth Formation ◽

Pulp Therapy ◽

Biological Approach ◽

Immature Teeth ◽

Vital Pulp Therapy ◽

Pulp Exposure

The permanent teeth erupt while undergoing tooth formation and root lengthening. These immature teeth are more vulnerable to pulp exposure. Faced with the necessity for root canal treatment, and taking into account the unlikely possibility of successful obturation of an immature canal system, it is recommended that these developing teeth be treated by a biological approach. When the vital pulp of a tooth is exposed and the pulp is not irreversibly inflamed and apical development and closure is incomplete apexogenesis procedures are recommended. Vital pulp therapy techniques are described.

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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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LECZENIE BIOLOGICZNE MIAZGI ZĘBÓW STAŁYCH

Pomeranian Journal of Life Sciences ◽

10.21164/pomjlifesci.38 ◽

2016 ◽

Vol 60 (2) ◽

Author(s):

Piotr Makowiecki ◽

Matylda Trusewicz ◽

Łukasz Tyszler ◽

Jadwiga Buczkowska-Radlińska

Keyword(s):

Treatment Option ◽

Dental Pulp ◽

Permanent Teeth ◽

Accurate Assessment ◽

Tissue Destruction ◽

Pulp Tissue ◽

Pulp Therapy ◽

Vital Pulp Therapy ◽

Tooth Survival ◽

Tooth Tissue

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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Vital Pulp Therapy in Permanent Teeth with Irreversible Pulpitis Caused by Caries: A Prospective Cohort Study

Journal of Personalized Medicine ◽

10.3390/jpm11111125 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1125

Author(s):

Xiaoxu Guan ◽

Yi Zhou ◽

Qingxia Yang ◽

Tianer Zhu ◽

Xuepeng Chen ◽

...

Keyword(s):

Cohort Study ◽

Success Rate ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Permanent Teeth ◽

Old Patients ◽

Pulp Therapy ◽

Vital Pulp Therapy ◽

Significant Difference ◽

Irreversible Pulpitis

Background: When a tooth is diagnosed with irreversible pulpitis, root canal therapy (RCT) is generally performed to completely remove pulp tissue, which might lead to a higher risk of loss of vascularity, and teeth being more prone to fracture. Vital pulp therapy (VPT) is a personalized method of treating irreversible pulpitis, which conforms to the trend of minimally invasive endodontics. The remaining vital pulp could promote the physiological development of the roots of young permanent teeth with incomplete apical foramen. However, clear guidelines for VPT indication are still missing. Objective: This prospective cohort study evaluated the outcomes of vital pulp therapy (VPT) using iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, BC, Canada) in permanent teeth of 6- to 20-year-old patients with irreversible pulpitis caused by caries and analyzed the preoperative factors affecting VPT prognosis. Methods: Fifty-nine permanent teeth in 59 patients with irreversible pulpitis caused by caries were treated with VPT using iRoot BP Plus. All patients received VPT under a standardized protocol. After informed consent, teeth were isolated with a dental dam, then operators performed VPT with iRoot BP Plus and restored the teeth with composite resin or stainless steel crown. Patients were postoperatively recalled after 3, 6 and 12 months and then recalled annually. Successful cases were defined as successful in both clinical and radiographic evaluations. A statistical analysis was performed using the Fisher exact test, and the level of significant difference was p < 0.05. Results: After 6–36 months of follow-up, a total of 57 teeth from 57 patients were accessible for evaluation. The mean age of subjects was 11.75 ± 3.81 years. The overall clinical and radiographic success rate of VPT was 91.2% (52/57). With an observation time of one year or more, the success rate was 90.5% (38/42). All the symptoms and physical examination findings showed no significant effect on VPT prognosis (p > 0.05) using a binary logistic regression model. Conclusions: Permanent teeth in 6- to 20-year-old patients diagnosed as irreversible pulpitis caused by caries can be successfully treated with VPT using iRoot BP Plus.

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Partial pulpotomy without age restriction: a retrospective assessment of permanent teeth with carious pulp exposure

Clinical Oral Investigations ◽

10.1007/s00784-021-04007-2 ◽

2021 ◽

Author(s):

Florin Eggmann ◽

Thomas J. W. Gasser ◽

Hanjo Hecker ◽

Mauro Amato ◽

Roland Weiger ◽

...

Keyword(s):

Survival Rates ◽

Age Groups ◽

Permanent Teeth ◽

Eligibility Criteria ◽

Presumptive Diagnosis ◽

Tooth Discoloration ◽

Significant Difference ◽

Pulp Exposure ◽

The Mean

Abstract Objectives This study aimed to retrospectively evaluate clinical and radiographic outcomes of partial pulpotomy performed in permanent teeth with carious pulp exposure. Materials and methods Records of patients undergoing treatment at an undergraduate dental clinic between 2010 and 2019 were screened for partial pulpotomies in teeth with a presumptive diagnosis of normal pulp or reversible pulpitis. The follow-up had to be ≥ 1 year. Patient data were retrieved and analyzed using Mantel-Cox chi square tests and Kaplan–Meier statistics. The level of significance was set at α = 0.05. Results Partial pulpotomy was performed in 111 cases, of which 64 (58%) fulfilled the eligibility criteria. At the time of partial pulpotomy, the mean age was 37.3 (± 13.5) years (age range 18–85). The mean observation period was 3.1 (± 2.0) years. Two early failures (3.1%) and five late failures (7.7%) were recorded. The overall success rate of maintaining pulp vitality was 89.1%, with 98.4% tooth survival. The cumulative pulp survival rates of partial pulpotomy in patients aged < 30 years, between 30 and 40 years, and > 40 years were 100%, 75.5%, and 90.5%, respectively, with no significant difference between the age groups (p = 0.225). At follow-up, narrowing of the pulp canal space and tooth discoloration were observed in 10.9% and 3.1% of cases, respectively. Conclusions Across age groups, partial pulpotomy achieved favorable short and medium-term outcomes in teeth with carious pulp exposure. Clinical relevance Adequate case selection provided, partial pulpotomy is a viable operative approach to treat permanent teeth with deep carious lesions irrespective of patients’ age.

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An in Vivo Comparison of Antimicrobial Efficacy of Sodium Hypochlorite and Biopure MTAD™ against Enterococcus Faecalis in Primary Teeth: A qPCR Study

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.39.1.c4q2155r16817219 ◽

2014 ◽

Vol 39 (1) ◽

pp. 30-34 ◽

Cited By ~ 3

Author(s):

SG Tulsani ◽

N Chikkanarasaiah ◽

S Bethur

Keyword(s):

Root Canal ◽

Primary Teeth ◽

Antimicrobial Efficacy ◽

Permanent Teeth ◽

Control Group ◽

Statistical Significant Difference ◽

Anterior Teeth ◽

Significant Difference ◽

Root Canal Irrigant

Objectives: Biopure MTAD™, a new root canal irrigant has shown promising results against the most common resistant microorganism, E. faecalis, in permanent teeth. However, there is lack of studies comparing its antimicrobial effectiveness with NaOCl in primary teeth. The purpose of this study was to compare the in vivo antimicrobial efficacy of NaOCl 2.5% and Biopure MTAD™ against E. faecalis in primary teeth. Study design: Forty non vital single rooted primary maxillary anterior teeth of children aged 4-8 years, were irrigated either with NaOCl 2.5% (n=15), Biopure MTAD™ (n=15) and 0.9% Saline (n=10, control group). Paper point samples were collected at baseline (S1) and after chemomechanical preparation (S2) during the pulpectomy procedure. The presence of E. faecalis in S1 & S2 was evaluated using Real time Polymerase Chain Reaction. Results: Statistical significant difference was found in the antimicrobial efficacy of NaOCl 2.5 % and BioPure MTAD™ when compared to saline (p>0.05). However, no statistical significant difference was found between the efficacies of both the irrigants. Conclusions: NaOCl 2.5% and BioPure MTAD™, both irrigants are equally efficient against E. faecalis in necrotic primary anterior teeth. MTAD is a promising irrigant, however clinical studies are required to establish it as ideal root canal irrigant in clinical practice.

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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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