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PubMed1996

Effect of calcium hydroxide and combinations of Ledermix and calcium hydroxide on inflamed pulp in dog teeth.

The effects of Ledermix+calcium hydroxide (Ca(OH)2) or Ca(OH)2 alone on inflamed pulp tissues of dogs were studied. Fifty-nine upper incisor teeth of 10 dogs were used. Class V cavities were prepared and filled with amalgam after placement of decayed dentin particles. After 7 days, the decayed dentin and alloy were removed, and the pulps of the teeth were exposed. Ledermix and Ca(OH)2 mixtures or Ca(OH)2 alone were applied to the cavities. At the end of 7, 30, and 90 days, the teeth were extracted and examined histopathologically. Inflammation was found to be more prevalent in the 7- and 30-day groups that were treated with the Ledermix+Ca(OH)2 combination, whereas fibrosis and necrosis were nearly similar in both groups. In the 90-day groups, no inflammation was seen. No difference between the two 90-day groups with regard to reparative dentin was found.

Animals↗
PubMed1996

Neurogenic inflammation and tooth pulp innervation pattern in sympathectomized rats.

This study investigated possible collateral C-fiber innervation between the pulps of rat molars by assessing neurogenic inflammation (NI) induced by the C-fiber excitant mustard oil (MO). MO was applied to the pulp of the left mandibular first molar in two groups of rats: group 1, guanethidine sympathectomized rats (to dismiss sympathetic activation by MO); and group 2, unsympathectomized rats. A third group of unsympathectomized rats (group 3) had saline applied to the pulp of the left mandibular molar and served as a MO control. The NI-related plasma extravasation was examined in these teeth and in the remaining left mandibular teeth by a spectrophotometric analysis of extravasated plasma protein bound to Evans' Blue (EB) dye. The collateral innervation pattern was inferred from the NI pattern. EB concentrations were measured in the left mandibular teeth and the corresponding contralateral teeth, and expressed as a ratio. Statistical analysis of the data revealed significant differences in EB ratios in the first, second, and third molars between groups 1 and 3. This result suggests collateral C-fiber innervation exists within the pulps of molar teeth in the same dental quadrant. No difference in EB ratios was noted in the first and second molars between groups 1 and 2. Therefore, sympathetic efferents have no apparent effect on the degree of MO-induced NI.

Animals↗
PubMed1996

Evaluation of periapical injection of Ketorolac for management of endodontic pain.

Effective pain management of the endodontic emergency patient is often a problem. Ketorolac tromethamine is the first nonsteroidal anti-inflammatory drug available for intramuscular injection in the United States. Although its analgesic efficacy is comparable with opiates after intramuscular injection, to date no study has evaluated its efficacy after intraoral periapical injection. Fifty-two endodontic emergency patients were injected (injection routes = intraoral infiltration/intramuscular deltoid) on a double-blind basis with either: (i) placebo/placebo, (ii) 30 mg ketorolac/placebo, (iii) placebo/30 mg ketorolac, or (iv) 2% mepivicaine with 1:20 K levonordefrin/placebo. Infiltration injection of ketorolac at on oral site produced significant analgesic effects, particularly in treating pain of mandibular origin. These results suggest that intraoral injection of ketorolac may prove to be a useful adjunct in the management of endodontic pain patients. Further studies are required to replicate these findings and to develop optimal treatment combinations.

Adolescent↗
PubMed1997

Stimulation of interleukin-1 beta production of human dental pulp cells by Porphyromonas endodontalis lipopolysaccharide.

IL-1 beta is synthesized as an inactive precursor, which is subsequently processed by IL-1 beta converting enzyme (ICE) and found extracellularly as a mature biologically active polypeptide. Also, IL-1 beta has been detected in necrotic and inflamed dental pulp. We examined the IL-1 beta production in human dental pulp (HDP) cells treated with lipopolysaccharide (LPS) from Porphyromonas endodontalis (P. e.) isolated from root canals and radicular cyst fluids. We demonstrated that P. e. LPS stimulated IL-1 beta release from HDP cells in a time- and dose-dependent manner. However, ICE activity was not increased by P. e. LPS. Northern blot hybridization analysis revealed that the IL-1 beta mRNA level in HDP cells was increased by P. e. LPS. These results suggest that stimulation of IL-1 beta release from HDP cells by P. e. LPS may have an important role in the progression of inflammation in pulpal and periapical disease.

Caspase 1↗
PubMed1997

Defense responses of dentin/pulp complex to experimentally induced caries in rat molars: an immunohistochemical study on kinetics of pulpal Ia antigen-expressing cells and macrophages.

Experimental caries was induced in rats that were inoculated orally with Streptococcus mutants and maintained on a cariogenic diet. During the caries process, kinetics of the pulpal la antigen-expressing cells and macrophages was monitored immunohistochemically and was correlated with caries depth and the status of reparative dentin formation. Initial pulpal response was characterized by a localized accumulation of la antigen-expressing cells beneath the dentinal tubules communicating with the superficial caries. This was followed by a caries-depth related increase of la antigen-expressing cells and macrophages in the coronal pulp. The accumulation of these cells under the dentin was most apparent when the caries had progressed into the reparative dentin. These findings suggest that the response of la antigen-expressing cells to carious irritants triggers the defense reactions of the pulp. The intensity of the defense reactions may be correlated with the permeability of carious dentin.

Animals↗
PubMed1997

Some unusual clinical cases on root anatomy of permanent maxillary molars.

Three case reports are presented concerning permanent maxillary molars with fusion of two buccal roots. The morphology is peculiar because it is characterized by the mesiobuccal canal merging into the distobuccal canal in their apical one-third. A thorough review of the literature failed to reveal any previously reported description of permanent maxillary molars with this arrangement of canals, with the exception of a recently reported epidemiological study.

Dental Pulp Cavity↗
PubMed1998

Effect of inflammation on the delivery of drugs to dental pulp.

Although numerous studies have evaluated the effects of drugs on inflammation, comparatively few studies have evaluated the effects of inflammation on drugs. In this study, we have evaluated whether pulpal inflammation alters the delivery of flurbiprofen or Evan's blue, two agents that bind with high affinity to plasma proteins. The results indicate that pulpal inflammation alters the delivery of these agents to inflamed molars, that activation of capsaicin-sensitive nerves increases pulpal content of protein-bound agents, and that reduced pH increases free drug concentrations of flurbiprofen. Thus, alterations in both plasma extravasation and tissue pH seem to be relevant factors regulating the delivery and bioavailability of this nonsteroidal anti-inflammatory drug to dental pulp. Because many drugs used in endodontics (e.g. nonsteroidal anti-inflammatory drugs, clindamycin, bupivacaine, etc.) are heavily bound to plasma proteins, it is likely that the status of pulpal inflammation is a contributing factor in modifying the pharmacological efficacy of these agents.

Animals↗
PubMed1998

Subjective sensation and objective neural discharges recorded from clinically nonvital and intact teeth.

The aim of this study was to compare subjective sensation with objective neural discharges recorded by microneurography. We examined human teeth that did not respond to pulp vitality testing, but that responded to cavity preparation for endodontic treatment (pathophysiological). Intact teeth and endodontically obturated teeth were used as controls. Pulpal blood flow in the clinical crown and histological examination were also used. Most teeth, both in normal and pathophysiological conditions, did not respond to all pulp vitality tests. Even when teeth in the pathophysiological group showed spike discharges evoked by pulp vitality tests or from spontaneous activity no sensation was elicited. These results confirmed the usefulness of microneurography for research on pulpal sensation and the significance of summation in the perception of sensation in chronically inflamed tooth pulp.

Action Potentials↗
PubMed1998

Host mediators in endodontic exudates. II. Changes in concentration with sequential sampling.

Exudate is often found in the root canal of teeth requiring endodontic therapy. The aim of this study was to evaluate the relationship of sequential changes of different host mediators in endodontic exudates to clinical and radiographic findings. Thirty-two nonvital teeth with periapical symptoms were evaluated. Exudates were collected with filter paper strips every 3 min after opening of the pulp chamber. The concentrations of beta-glucuronidase, IgG, IgA, IgM, and interleukin-1 beta in the exudates were analyzed. In general, the concentration of the mediators in exudates from less involved lesions did not change over time. The exception was an increase in the IgM concentration when patients presented with percussion or palpation sensitivity. In contrast, in the more involved lesions, the concentrations of IgA and IgM increased as sampling progressed. The concentrations of beta-glucuronidase and interleukin-1 beta decreased over time in the more involved lesions. These data suggest that the amount of proinflammatory mediators in the canal and periapical lesion is limited. Furthermore, IgM seemed to be a marker for the severity of periapical lesions. This may relate to vascular permeability that allows passage of this larger molecule into the extravascular environment.

Exudates and Transudates↗
PubMed1998

Thrombin-induced DNA synthesis of cultured human dental pulp cells is dependent on its proteolytic activity and modulated by prostaglandin E2.

To clarify the roles of alpha-thrombin and prostaglandin E2 (PGE2) in the healing and inflammatory processes of dental pulp, their effects on the DNA synthesis of human pulp cells were investigated by measurement of [3H]thymidine incorporation. At a concentration range of 1 to 25 units/ml, alpha-thrombin stimulated DNA synthesis of the pulp cells by 1.5 to 2.6-fold. On the contrary, PGE2 (> 0.05 microgram/ml) suppressed DNA synthesis by 24 to 39%. Using reverse transcriptase-polymerase chain reaction, thrombin receptor mRNA expression was identified in the pulp cells. Furthermore, alpha-thrombin-induced DNA synthesis could be inhibited by antithrombin III (2 units/ml) with heparin (2 units/ml) or D-Phe-Pro-ArgCH2Cl (50 micrograms/ml). PGE2 (0.1 to 0.5 microgram/ml) also inhibited the thrombin-induced DNA synthesis by 39 to 64%. These results imply that pulp cells express the thrombin receptor that is activated by the serine protease activity of thrombin. Interactions of thrombin and PGE2 are important in modulating the inflammatory and healing processes of the pulp.

Cells, Cultured↗
PubMed1999

Pulpal exposure alters neuropeptide levels in inflamed dental pulp and trigeminal ganglia: evaluation of axonal transport.

Dental pulp is richly innervated with neurons containing calcitonin gene-related peptide (CGRP) or substance P (SP). Prior studies have demonstrated that inflammation alters these pulpal neuropeptides. In this study, we used a radioimmunoassay to evaluate the specificity of this response and the contribution of axonal transport. Rat mandibular molars were exposed and immunoreactive CGRP (iCGRP) and immunoreactive SP were measured. At 7 to 14 days after exposure, both pulpal iCGRP (73%) and immunoreactive SP (135%) displayed peak increases above control levels. This response was somatotopically restricted, with no changes observed in contralateral (intact) molars, or in ipsilateral mandibular molars after exposure of maxillary molars. Transection of the inferior alveolar nerve on day 13 significantly reduced pulpal levels of iCGRP on day 14. Collectively, these studies indicate that pulpal inflammation evokes a selective alteration in neuropeptide levels, due at least in part to alterations in transport or synthesis of neuropeptides in the trigeminal ganglion.

Analysis of Variance↗
PubMed1999

Biocompatibility of an adhesive system applied to exposed human dental pulp.

Human pulp tissue was directly capped with All Bond 2, or calcium hydroxide and evaluated 7, 30, or 60 days after the procedures. Histological analysis was performed to assess the inflammatory cell response, tissue disorganization, dentin bridging, and the presence of bacteria. At 7 days, with All Bond 2 capping, there was a large area of neutrophilic infiltrate underlying the pulp capping material, and the death of adjacent odontoblasts, was observed. However, with time, the neutrophilic reaction was replaced by fibroblastic proliferation with macrophages and giant cells surrounding globules of resin scattered in the coronal pulp tissue. The persistent inflammatory reaction and hyaline alteration of extracellular matrix inhibited complete pulp repair or dentin bridging. In contrast, at 7 days, the pulp tissue capped with calcium hydroxide exhibited odontoblast-like cells organized underneath coagulation necrosis. Pulp repair evolved into apparent complete dentin bridge formation at 60 days. All Bond 2 did not appear to allow any pulp repair and does not appear to be indicated for direct pulp capping of human teeth.

Adolescent↗
PubMed2000

Factors influencing pulpal response to cavity restorations.

OBJECTIVES: The purposes of this retrospective work were: (1) to determine the relative importance of bacteria on cavity walls, remaining dentin thickness and post-operative time on pulpal inflammation after cavity restoration; (2) to compare the respective influences of bacterial microleakage and the restorative material itself on pulp reaction severity. METHODS: 317 class V cavities, in human bicuspids scheduled for extraction for orthodontic reasons were used for this study. Nine different materials were included. The severity of the pulpal reaction was ranked on hematoxylin/eosin stained sections according to FDI standards. The further parameters recorded were: (1) the presence or absence of bacteria on the cavity walls was noted on Brown and Brenn stained sections; (2) the remaining dentin thickness was measured and the teeth classified into three groups (< 500, 500-1000, > 1000 microns); and (3) the post-operative delay before extraction was recorded and classified as short time (< 5 weeks) or long time (> 5 weeks). Three two-way analyses of variance (ANOVA) followed by Kruskall and Wallis tests evaluated the influence of the three parameters on pulpal reaction severity. The third ANOVA also compared pulpal reactions under the different materials when the teeth were pooled, on bacteria free teeth and on bacteria contaminated teeth. RESULTS: The first ANOVA ranked by decreasing order of importance: the presence of bacteria (p < 0.0001), the remaining dentin thickness (p = 0.02) and the post-operative delay (p = 0.04). The second ANOVA showed no difference among the restorative materials when bacteria were present on the cavity walls. SIGNIFICANCE: The presence of bacteria on the cavity walls is the main factor influencing pulpal reaction under restorative materials, but does not account for 100% of the cases.

Adolescent↗
PubMed2001

Response of human pulps capped with a self-etching adhesive system.

OBJECTIVE: The aim of this study was to evaluate the human pulp response following direct pulp capping with a current self-etching bonding agent and calcium hydroxide (CH). METHODS: Thirty-three sound human premolars had their pulp tissue mechanically exposed. Sterile distilled water was used to control the hemorrhage and exudation from the pulp exposure site. The pulps were capped with Clearfil Liner Bond 2 (CLB-2) or CH and the cavities were filled with a resin composite (Z-100) according to the manufacturer's instructions. After 5, 30 and 120-300 days, the teeth were extracted and processed for microscopic examination. RESULTS: At short-term, CLB-2 elicited a mild to moderate inflammatory pulp response with dilated and congested blood vessels adjacent to pulp exposure site. With time, macrophages and giant cells engulfing globules and particulates of resinous material displaced into the pulp space were observed. This chronic inflammatory pulp response triggered by fragments of bonding agent displaced into the pulp space did not allow pulp repair interfering with the dentin bridging. On the other hand, pulps capped with CH exhibited an initial organization of elongated pulp cells underneath the coagulation necrosis. Pulp repair and complete dentin bridge formation was observed at long-term evaluation. SIGNIFICANCE: The present study demonstrated that CH remains the pulp capping agent of choice for mechanically exposed human pulps. CLB-2 did not allow complete connective tissue repair adjacent to the pulp exposure site. Consequently, this bonding agent cannot be recommended for pulp therapy of sound human teeth.

Acid Etching, Dental↗
PubMed2002

Bacterial microleakage and pulp inflammation associated with various restorative materials.

OBJECTIVES: Many restorative materials are claimed to be successful in preventing bacterial microleakage and minimizing pulp inflammation. However, information regarding the in vivo performance of materials in comparison with each other is limited. The aim of this study was to evaluate and compare the pulp response of nine restorative materials when placed in non-exposed monkey cavities. METHODS: 279 standardized non-exposed Class V cavities, were prepared into buccal dentin. Cavities were restored with a number of materials in the following categories: Zinc oxide eugenol (ZnOE), Calcium hydroxide [Ca(OH)(2)], zinc phosphate (ZP), Resin-modified glass ionomer (RMGI), Composite resin (CR), Bonded amalgam (BA), Gutta-percha (GP), Compomer and Silicate. Pulp tissues were collected and evaluated at short, intermediate and long-term intervals according to ISO guidelines; employing histomorphometric analysis, Spearman's rho and ANOVA statistics. Pulp responses were categorized according to FDI, ISO and ADA standards. Bacteria were detected using McKay stains. RESULTS: Pulp inflammation was found to be correlated to bacterial microleakage around the restoration (p < or =0.0001). The frequency of bacterial microleakage was found to vary between restorative materials (p < or =0.0001). In rank order of preventing bacterial microleakage from best to the worst; RMGI (100%), BA (88%), ZnOE (86%), CR (80%), GP (64%), Ca(OH)(2) (58%), compomer (42%), silicate (36%) and ZP (0%). SIGNIFICANCE: The most effective restorative materials to prevent bacterial microleakage and pulp injury from inflammatory activity were RMGI, BA, ZnOE and CR restorations.

Analysis of Variance↗
PubMed2002

Response of human pulps following acid conditioning and application of a bonding agent in deep cavities.

OBJECTIVES: The aim of this in vivo study was to evaluate the human dental pulp response when a one-bottle adhesive system was applied on etched or unetched deep dentine. METHODS: Eighteen class V deep cavity preparations were divided in three groups: group 1-total etching + two coats of single bond (SB) + composite resin (Z-100); group 2-enamel etching + two coats of SB + Z-100; group 3-cavity floor lined with a calcium hydroxide liner (Dycal) + acid-etching of enamel and lateral walls + two coats of SB + Z-100. Two teeth were used as intact control group. After 30 days the teeth were extracted and processed through H and E, Masson's trichrome and Brown and Brenn staining techniques. RESULTS: Moderate inflammatory response, disorganization of pulp tissue, as well as, deposition of thin layer of reactionary dentin were observed in group 1 teeth in which the remaining dentin thickness (RDT) was less than 300 microm. These histological findings appear to be related to long resin tags formation and bonding agent diffusion through dentinal tubules. In group 2, slight inflammatory response was observed only in one tooth in which the RDT was 162 microm. In group 3, all the teeth showed normal histological characteristics which were similar to the intact control group. Presence of bacteria was not correlated with the intensity of pulpal response. The patients reported no symptoms during the experiment. Radiographic evaluation showed no periapical pathology for any of the teeth. SIGNIFICANCE AND CONCLUSIONS: Acid-etched deep dentin (RDT less than 300 microm) lined with SB causes more intense pulpal response than unetched deep dentin. Based on the results observed in the present study and the conditions in which it was carried out, we recommend the application of a biocompatible liner before etching deep dentin and applying SB.

Acid Etching, Dental↗
PubMed1991

A study of the relationship among pulpal response, microbial microleakage, and particle heterogeneity in a glass-ionomer-base material.

This investigation was designed to study the pulpal responses to glass-ionomer base materials that differ in particle size distribution. The study was carried out according to the BSI (1980) recommendations for testing restorative materials in vivo. The base materials caused more pulpal inflammation than the control material, Kalzinol, although by an indirect mechanism. A significant association was demonstrated in the statistical model between bacterial presence within the experimental cavity and pulpal inflammation. The type of restorative material has no direct association with the degree of inflammation, although the model suggests that it exerts an indirect influence via its antibacterial properties, and hence its influence on microbial microleakage. The base material, with a heterogeneous particle distribution, was associated with greater bacterial microleakage. Particle size distribution, therefore, has some effect upon bacterial microleakage, but, because of its complex effect upon several physical properties of materials, further studies are indicated.

Animals↗
PubMed2000

Effects of topical Catalase application on dental pulp tissue: a histopathological evaluation.

OBJECTIVES: recently, the role of antioxidant enzymes in wound healing and their therapeutic potential has been a subject of interest in medical sciences. However there is restricted knowledge on the results of topical application, optimal therapeutic dosage and carrier types. The purpose of this study was to investigate the wound healing response of dental pulp after direct pulp capping with an antioxidant enzyme; Catalase (C-40). METHODS: three mongrel dogs were used in this study. A total of 32 perforated Cl V preparations were treated with either 0.8mg (n=16) or 1.6mg (n=16) Catalase (C-40) which was incorporated in gelatin carriers whereas 16 control teeth had carriers without Catalase. One millimeter thick Teflon disks were placed over the gelatin pellets and the cavities restored with silver amalgam. Short term and long term histopathologic reactions were evaluated after 7 and 90 days. RESULTS: there were no statistically significant differences between the inflammatory cell responses of control and either dosage groups of Catalase at the 7-day evaluation period. However, after 90 days, better tissue healing was observed in the teeth treated with Catalase, resulting in significant differences with the control group. CONCLUSIONS: it can be concluded that the results of this study encourage the topical use of antioxidant Catalase as a pulp-capping agent. However, further studies are required to determine optimal antioxidant dosages.

Administration, Topical↗