Management of the aging patient and the aging pulp.
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Biomedical subjects
Publications and source records attributed to H R Stanley.
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This report describes a 6-month screening study comparing the tissue responses of several bioglass natural tooth implants in adult female baboons. The dental implants were designed to elicit osteogenesis at the interface of the implant and the oral tissues. This is in contrast to those types of implant materials that are merely biologically acceptable. Incisor teeth were extracted, dupplicated in bioglass, returned to the natural sockets, and splinted to the adjacent natural tooth, where they remained splinted for 3 months and then free standing for an additional 3 months. Microscopic evaluation revealed distinct histopathologic characteristics with certain bioglass formulas, such as ankylosis, a pseudofibrous capsule with fibers running parallel to the root surface, or an apparently true periodontal membrane with properly oriented Sharpey's fibers. True cementogenesis was not found.
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In order for the dental profession to obtain reliable data as to whether new or experimental restorative materials and adjunct agents are more or less irritating to pulp tissues than dental products currently in use, pulp studies at the national and international level are being standardized to enhance corroboration. The purpose of this study was to reduce the number of human teeth required in any experimental pulp toxicity study by controlling the problem of cavity depth. Many valuable teeth are wasted by making cavity preparations that are either too shallow or too deep, with consequent pulp exposures. This needs to be corrected.
Calcium hydroxide, in its various forms, has become the preferred agent of most practitioners who perform pulp capping. The application of calcium hydroxide to the pulp stimulates the growth of new dentin and protects the pulp from subsequent irritation. However, the new dentin generated by the pulp may, in turn, infringe on the pulp. If the thickness of the pulp tissue is large, this infringement will not be significant. If the volume of pulp tissue is shallow, the same amount of infringement may cause sufficient impairment of circulation to the cornal area of the pulp, leading to an area of the necrosis may then contaminate the entire pulp, and root canal therapy will become necessary. Therefore, pulpal amputation is the preferred treatment in such situations.
The newer composites, although free of methacrylic acid and of a neutral pH, were still found to be toxic to the pulp. The intensity of response was increased after acid pretreatment procedures; this indicates an increase in dentin permeability. When the remaining dentin thickness was 1.0 mm or less, regardless of whether the dentin was primary dentin or primary and reparative dentin, the percentage of teeth with abscess formations increased. Use of calcium hydroxide bases or liners to coat the dentin before acid pretreatment of enamel is therefore highly recommended.
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