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PubMed2000

Nonodontogenic toothache.

Toothache is a common complaint in the dental office. Most toothaches have their origin in the pulpal tissues or periodontal structures. These odontogenic pains are managed well and predictably by dental therapies. Nonodontogenic toothaches are often difficult to identify and can challenge the diagnostic ability of the clinician. The most important step towards proper management of toothache is to be suspicious that the pain may not be of dental origin. The cardinal warning symptoms of nonodontogenic toothache are as follows (28): a. spontaneous multiple toothaches; b. inadequate local dental cause for the pain; c. stimulating, burning, nonpulsatile toothaches; d. constant, unremitting, nonvariable toothaches; e. persistent, recurrent toothaches; f. local anesthetic blocking of the offending tooth does not eliminate the pain; and g. failure of the toothache to respond to reasonable dental therapy.

Facial Pain↗
PubMed1998

Pulpal response to intrusive orthodontic forces.

Many studies have examined the effect of orthodontic forces on supporting tissue. However, their effect on dental pulp has not been sufficiently studied. The aim of the present study was to evaluate, histologically, the pulpal response to the action of intrusive orthodontic forces. The study was performed on 40 first premolars which had to be extracted for orthodontic reasons from 11-17 year-old patients. The twenty teeth of the experimental group received, prior to extraction, an intrusive force with an initial load of 150 g over a period of 15 to 20 days. The control group comprised the 20 homologous teeth which were not submitted to intrusive forces prior to extraction. All the teeth were fixed in 10% buffered formalin, decalcified, embedded in paraffin, sectioned and stained with hematoxylin-eosin. Light microscopy observation revealed alterations in predentine, calcium deposition, fibrohyalinosis, congestion, inflammation and haemorrhage. The data were statistically analysed employing Fisher's exact probability test. Congestion, haemorrhage and fibrohyalinosis were significantly (p < 0.005) greater in the experimental group than in controls.

Adolescent↗
PubMed2002

Pulp-dentin biology in restorative dentistry. Part 7: The exposed pulp.

Exposure of the dental pulp, through a caries lesion, accidentally during routine cavity preparation, or as a result of tooth fracture, is a clinical reality that requires optimal treatment. The potential for healing by formation of a dentinal bridge is good, provided that the pulp is not inflamed. Calcium hydroxide has a long history of inducing dentinal bridge formation to promote successful healing. Resin composites are emerging as alternative materials for pulp capping, but healing is slower, and relatively little clinical experience is available for analysis. The prognosis for healing is poor after exposure of an inflamed pulp. Pulpotomy should be considered to create a wound in an uninflamed location. If an exposure is expected through a caries lesion, stepwise excavation of the carious dentin should be considered to allow healing of the dentin and pulp prior to the final excavation of the carious dentin.

Acrylic Resins↗
PubMed2001

Results of crown-height reduction and partial coronal pulpectomy in rhesus monkeys (Macaca mulatta).

BACKGROUND AND PURPOSE: In research facilities using non-human primates, crown-height reduction with partial coronal pulpectomy ("vital pulpotomy") is routinely performed on canine teeth of adult male monkeys to reduce self-trauma and the potential for injury to staff or cage-mates. Success of pulpotomy techniques in humans is reportedly 40 to 60%. Failure leads to chronic inflammation and pulp necrosis, which introduces variability in research animals, and may affect research results. The purpose of the study reported here was to determine failure rate of this procedure by evaluating clinical and radiographic findings at 3, 9, and 24 months after crown amputation and partial coronal pulpectomy of maxillary canines in adult male rhesus monkeys. METHODS: Forty-seven maxillary canine teeth from 24 adult male rhesus monkeys were treated by use of crown amputation and partial coronal pulpectomy, using standard dental technique. Follow-up clinical and radiographic examination was performed 3, 9, and 24 months after surgery. RESULTS: At three months after surgery, there was no clinical evidence of failure at any of the teeth. On the basis of radiographic findings, 2 of 47 teeth had failed and one was suspicious for early failure. At nine months, clinical evidence of failure was not apparent; radiographically, 5 of 44 teeth appeared to have failed and 3 others were suspect. Two years post-operatively, failure was clinically evident at two teeth, with radiographic evidence of failure in five teeth, and suspicion of early failure in an additional six of 41 teeth [corrected]. CONCLUSIONS: The failure rate of crown amputation and partial coronal pulpectomy of canine teeth in adult male rhesus monkeys is high, and the chronic inflammation associated with this is cause for concern.

Animals↗
PubMedDate not supplied

Pseudo-dental pain and sensitivity to percussion.

Two case reports examine a little-known cause of dental pain and sensitivity to percussion. Contrary to the traditional assumption that pain and sensitivity to percussion almost always are diagnostic of pulpal inflammation and/or necrosis, these symptoms actually may be referred to the sensitive tooth from trigger points in the masticatory muscles. Therefore, myofascial pain syndrome must be ruled out in patients who have dental pain and display sensitivity to percussion.

Adult↗
PubMedDate not supplied

Pulpal response to a fluoride-releasing all-in-one resin bonding system.

Pulp tissue reactions to a fluoride-releasing all-in-one resin bonding system (Reactmer Bond and Reactmer Paste) in non-exposed monkey teeth were histopathologically evaluated at three, 30, and 90 days after restoration. No serious inflammatory reactions of the pulp, such as necrosis or abscess formation, were observed. At 90 days in the Reactmer group, odontoblastic change and inflammatory cell infiltration were not observed, and slight irritation dentin formation was formed. The pulpal response of the Reactmer group was minimally different from that of the control group. Consequently, the Reactmer system was determined as being biologically compatible with vital pulps.

Abscess↗
PubMed2001

Pulp response and cytotoxicity evaluation of 2 dentin bonding agents.

OBJECTIVE: This study evaluated the biocompatibility of two dentin bonding agents (Clearfil Liner Bond 2 and Scotchbond Multi-Purpose) applied in human dental pulps and cell cultures. METHOD AND MATERIALS: In vivo: Twenty human third molars that were scheduled for extraction were used. After cavity preparation, pulp exposure was achieved with a carbide bur. Hemorrhage control was obtained with saline solution. In 16 teeth, adhesive pulp capping was performed and the cavities were sealed with resin composite. In the control group (n = 4), pulps were capped with Ca(OH)2 and the cavities were sealed with IRM. Teeth were extracted 30 or 90 days following treatment and prepared for histological examination and bacterial detection. In vitro: materials were applied in Petri dishes, where NIH-3T3 cells were plated. The cells were counted 2, 4, and 6 days after plating to obtain the growth curves and to determine cell viability. All data were submitted to statistical analysis. RESULTS: In vivo: Dentin bridge formation was seen in all teeth capped with Ca(OH)2, without an inflammatory response. Mild inflammatory responses and dentin bridge formation after 90 days were observed in 50% of specimens treated with Liner Bond 2. Pulps treated with Scotchbond Multi-Purpose presented mild to severe inflammatory response, and no mineralized tissue formation was detected. Bacteria were not disclosed in any specimen. In vitro: The cytotoxicity was similar between the two bonding agents, and both had statistically higher cytotoxic effects (P < 0.002) than Ca(OH)2. CONCLUSION: Ca(OH)2 produced pulp healing in all teeth and exhibited lower cytotoxic effects than both adhesive systems; however, pulp healing was also observed under Liner Bond 2.

3T3 Cells↗
PubMedDate not supplied

Histopathologic study on pulp response to single-bottle and self-etching adhesive systems.

This study compared the pulp response to seven adhesive resins (three single-bottle and four self-etching primers) and their companion resin composite systems with a commercial calcium hydroxide material when applied to exposed monkey pulps. The control group was capped with Dycal (DY), while the experimental groups were capped with one of the following adhesive resin systems: AQ Bond (AQ), Single Bond (SB), Imperva Fluorobond (IF), One Step (OS), Prime&Bond NT (PBNT), Perme Bond F (PBF) and One-up Bond F (OBF). Histopathologic evaluation of pulp tissue disorganization, inflammatory cell infiltration, reparative dentin formation and bacterial penetration at the 3rd, 30th and 90th post-operative days was done using light microscopy. Data were analyzed using the Kruskal-Wallis test followed by the Least Significant Difference Test to determine differences between the control group and the experimental groups at each observation period. The correlation of inflammatory cell infiltration and bacterial presence was investigated by the Kendall correlation analysis. All tests were performed at a 95% level of confidence. The pulpal responses of groups DY, SB, OS, PBF and OBF were generally characterized by none-to-mild pulp tissue disorganization and inflammatory cell infiltration. Also, initiation of reparative dentin formation was found earlier in Group DY, resulting in more complete dentin bridges at the 30- and 90-day observation periods. Groups AQ, IF and PBNT had significantly more inflammatory cell infiltration and a lower incidence of reparative dentin formation than Group DY. A significant correlation was detected between inflammatory cell infiltration and the presence of bacteria. It is concluded that the pulp response to SB, OS, PBF and OBF is not significantly different from the calcium hydroxide preparation. However, calcium hydroxide capping resulted in a higher incidence and faster rate of reparative dentin formation.

Acid Etching, Dental↗
PubMed1999

The effects on pulp tissue of microleakage in resin composite restorations.

The purpose of this study was to evaluate histopathologically the effect on pulp tissue of microleakage in resin composite restorations. Seventy-two class V cavities were prepared on buccal surfaces of monkeys and divided into 3 groups, F, O, and S. Every cavity was etched with 37% phosphoric acid. In group F cavities, each cavity was restored with photo-curable composite without any dentin adhesives. In group O, the cavities were left unfilled. In group S, each cavity was treated with a dentin adhesive system and restored with a restorative composite. After 3, 30, or 90 days, animals were sacrificed and the subjected teeth were immediately removed, then fixed and decalcified. Following sectioning and staining with hematoxylin and eosin or Taylor's modified bacteria staining, each sample was examined with a light microscope. In most teeth with group S cavities, bacterial invasion was not found indicating excellent marginal sealing. The pulpal reaction was much less than that in other groups. In group F as well as in group O, bacteria were frequently observed in the cavity; however, bacteria penetrated into dentinal tubules more in group F than in group O at 30 and 90 days. A correlation between the presence of bacteria and pulpal inflammation was strongly indicated. It was suggested that a leaky restoration was more harmful to the pulp than an open prepared cavity without restoration.

Acid Etching, Dental↗
PubMed2002

The pulpectomy in primary teeth.

BACKGROUND: The pulpectomy is an underutilized treatment modality for severely infected primary teeth. CASE DESCRIPTION: The author presents two pulpectomy cases that were filled with Vitapex. CLINICAL IMPLICATIONS: Vitapex is an excellent filling material for primary tooth pulpectomies. Its clinical characteristics and ease of use may make the pulpectomy procedure a more-attractive alternative to extraction.

Calcium Hydroxide↗
PubMed2002

Histomorphometric analysis of dentinal bridge formation and pulpal inflammation.

OBJECTIVE: The purpose of this study was to evaluate pulpal responses to the use of four resin composite materials as direct pulp capping agents. The importance and effects of individual pulp capping variables are not well understood; consequently histomorphometric analysis was used to analyze these variables. METHOD AND MATERIALS: Two hundred fifty standardized pulp-exposed cavities were prepared in nonhuman primate teeth. Exposed pulps were capped with calcium hydroxide and multistep and self-etching primer resin composites. Teeth were collected from 3 to 60 days to observe pulpal reactions. Following perfusion fixation, tissues were demineralized, sectioned, stained, and histomorphometrically measured. Bridge area, diameter of pulpal exposure, and cavity floor width were measured. Tunnel defects, operative debris, and pulpal inflammation were graded according to defined criteria. RESULTS: The variables correlated to dentinal bridge area were, in decreasing order of significance, time elapsed since exposure, diameter of pulpal exposure, pulp capping material, and tunnel defects. The variables correlated to pulpal inflammation were the type and curing of pulp capping material. Other variables were not statistically significant. CONCLUSION: Pulp capping with resin composite materials provided acceptable pulpal inflammatory and dentinal bridge repair responses, comparable with those of calcium hydroxide. Although resin composites are promising as direct pulp capping agents, further investigations are required to optimize their application protocols to reduce the penetration of potentially cytotoxic monomers into pulpal tissue.

Acid Etching, Dental↗
PubMed2000

Orascopic endodontics: changing the way we "think" about endodontics in the 21st century.

Orascopic endodontics has helped bring visualization to what has literally been a "blind" specialty. The ease of operation and better operating ergonomics of fiber optic instrumentation has allowed the endodontist to identify and treat endodontic etiology more efficiently. The metamorphosis of understanding endodontics from an in vivo perspective is changing the way we "think" about the practice of endodontics. Prior to intracanal visualization, the cognitive process of determining when the canal was ready for obturation was merely an educated guess based on years of in vitro instrumentation research and postoperative follow-up studies.

Aged↗