Search Results (72)

Background and Objectives: The aim of this study was to evaluate how the indirect pulp capping treatment approaches and material choices used by dentists actively practicing in Turkey vary according to demographic data. Materials and Methods: Dentists practicing in Turkey were included in this study. A 13-question survey was used and distributed to the participants via social media. The statistical analysis of the data obtained from this study was performed using IBM SPSS v23. The chi-square test was used to compare categorical variables between groups, and multiple comparisons of the proportions were analyzed using the Bonferroni correction. The results of the analysis are presented as frequencies (percentages) for categorical data. The significance level was set at p < 0.05. Results: A total of 402 dentists from across Turkey participated in this study. A total of 331 participants (82.3%) reported that they performed indirect pulp capping treatment. The most commonly used materials for indirect pulp capping were Ca(OH)₂;-containing liners (73.4%) and glass ionomer cement (58.3%). The use of amalgam and cotton roll isolation was more common among dentists working in the public sector, whereas rubber dam isolation and the use of contemporary materials such as MTA and Biodentine were more frequently observed among dentists working in the private sector. Conclusions: Significant differences were found in the dentists’ indirect pulp capping approaches and the materials they used based on their specialty, years of experience, and workplace setting. These findings suggest that dentists’ knowledge and experience regarding indirect pulp capping should be enhanced during their education and post-graduation training. Full article

Background/Objectives: Deep caries lesions represent an actual concern in preserving tooth vitality and preventing irreversible pulpitis. As presently the non-selective approach is considered an overtreatment, the concept of selective caries removal is highly recommended. The goal of this narrative review is to focus on current trends in carious dentine excavation and adjunctive therapies. Methods: A keyword-based selection of scientific publications issued in the last six years, i.e., 2019–2024, was conducted with the search engine of PubMed (MEDLINE) and ScienceDirect databases, using the following keywords: deep carious lesion; caries removal; indirect pulp capping; adjunctive antimicrobial therapy; adjunctive anti-enzymatic therapy; biomimetic restorative dentistry. Discussions: In deep caries management, the current trends of carious dentine excavation recommend preferentially partial caries removal technique as less risky to pulp exposure and more conservative compared to the stepwise technique (SW). Presently, advanced additional procedures such as antimicrobial photodynamic therapy and an anti-enzymatic approach are also considered for caries arrest. Conclusions: Selective caries removal and adjunctive photodynamic antimicrobial therapy are procedures of choice in preserving pulp vitality. Anti-enzymatic therapies impede decoupling with time of adhesive restorations from the smear layer. Biomimetic restorative dentistry and smart materials introduce the principles of artificial intelligence in the therapeutic approach of deep caries. Full article

Preserving dental pulp vitality is crucial in pediatric and adolescent dentistry to promote long-term oral health and reduce the need for invasive procedures. Vital pulp therapy (VPT) enhances pulp healing and dentin formation through advanced pulp capping materials. While calcium hydroxide-based materials laid the foundation for VPT, calcium silicate-based materials like mineral trioxide aggregate, Biodentine, and TheraCal offer superior biocompatibility and sealing properties. Recent advancements focus on regenerative strategies that enhance biocompatibility, antibacterial efficacy, and anti-inflammatory effects. Tissue engineering approaches, including stem cells, growth factors, and peptide-based scaffolds, are being explored to improve pulp regeneration and long-term treatment success. This review highlights recent developments in VPT for pediatric and adolescent patients, emphasizing minimally invasive techniques, clinical challenges, and the potential of emerging biomaterials. Continued research into biomaterial efficacy and regenerative capabilities holds promise for advancing VPT, ensuring more effective and biologically driven treatment strategies for young patients. Full article

(1) Background: The aim of this in vitro study was to evaluate the success of indirect pulp capping (IPC) procedures over a period of 40 years. (2) Methods: The investigation of 1412 dental records included 159 patients with 366 IPC teeth having been treated from 1969 to 1980. The teeth revealed caries within the inner third of dentin, were symptom-free, and showed no pulp exposure. The caries were excavated thoroughly and teeth with accidentally exposed pulp were excluded. Zinc–oxide–eugenol was used for the IPC procedures. The posterior teeth were restored with amalgam, and the anterior teeth received direct resin composite fillings. The gathered parameters with possible influences on survival rates were age, gender, tooth locations/positions, dates of vital therapy, the number of filled surfaces, types of primary restoration material, successional treatments on each tooth, and the last dates of surveillance. Data collection and statistical analysis were performed using Excel sheets and DataTab. Significant differences among groups were computed by cox regression analysis and the significance level was set at p = 0.05. Kaplan–Meier curves were utilized to illustrate the survival rates. (3) Results: Treatment success was measured by the maintenance of vitality beyond 365 days. The loss of vitality within 365 days was determined as treatment failure. Treatment outcomes were assessed after different time periods (1 and 6 months; 1, 2, 5, 10, 20, and 40 years). Pulp vitality dropped from 95% after 3 months to 32% after 40 years. Cavity size had a significant influence on the survival of pulp, but tooth position did not; however, third molars at least initially showed a better outcome. Beyond the 1-year recall, no differences for the evaluated parameters were present. (4) Conclusions: IPC showed excellent long-term success rates, revealing a 1.7% annual failure rate after 40 years of clinical service. Larger defects suffer more pulp damage in the long run. Full article

Vital pulp therapy (VPT) preserves dental pulp and its functions, offering a minimally invasive alternative to root canal therapy. However, the impact of patient-related factors on success remains unclear. This study aimed to estimate the sample size for a multivariate model predicting VPT success for assessing capping material, age, sex, and pulp conditions. A prospective cohort study was conducted with the inclusion of twenty-seven adult patients with carious pulp exposure in mature permanent teeth. Treatment comprised direct pulp capping, partial pulpotomy, or complete pulpotomy with Mineral Trioxide Aggregate Plus (MTA+) or Biodentine. Success rates were evaluated at 6 months through clinical and radiographic examinations. Statistical analysis included Pearson’s Chi-square tests and logistic regression. The success rates were 64% in the Biodentine group and 92% in the MTA+ group (OR: 0.15; p = 0.108). Sex and age had no significant effect. Success declined with increasing pulp condition severity and treatment invasiveness. MTA+ had a higher incidence of discoloration, while Biodentine showed none. Sample size calculations suggested 140 participants would be needed to detect a significant effect of pulp condition. Both materials were effective, though MTA+ showed higher success based on the strict success criteria. More severe pulpitis correlated with lower success, but a larger study is needed for predictive models. Full article

Bioceramic materials for endodontic treatments have gradually transformed over the years into materials with enhanced biocompatibility and chemical and mechanical properties compared to earlier generations. In endodontics procedures, these materials are used as restorative material in applications such as root-end fillings, pulp capping, perforations repair, and apexification repair procedures. However, they have far from ideal mechanical and handling properties, biocompatibility issues, aesthetic concerns due to tooth discolouration, limited antibacterial activity, and affordability, which are amongst several key limitations. Notably, bioceramic materials are popular due to their biocompatibility, sealing ability, and durability, consequently surpassing traditional materials such as gutta-percha and zinc oxide–eugenol sealers. A lack of recent advancements in the field, combined with nanomaterials, has improved the formulations of these materials to overcome these limitations. The existing literature emphasises the benefits of bioceramics while underreporting their poor mechanical properties, handling difficulties, cost, and various other drawbacks. The key gaps identified in the literature are the insufficient coverage of emerging materials, narrow scope, limited insights into future developments, and underreporting of failures and complications of the existing materials. Consequently, this review aims to highlight the key limitations of various endodontic materials, primarily focusing on calcium silicate, calcium phosphate, and bioactive glass-based materials, which are the most abundantly used materials in dentistry. Based on the literature, bioceramic materials in endodontics have significantly improved over recent years, with different combinations of materials and technology compared to earlier generations while preserving many of their original properties, with some having affordable costs. This review also identified key innovations that could shape the future of endodontic materials, highlighting the ongoing evolution and advancements in endodontic treatments. Full article

Pulpotomy is performed when tooth decay reaches the dental pulp or when the crown is fractured due to trauma. Mineral trioxide aggregate (MTA) is commonly used in pulpotomy, but its prognosis can be variable. N-acetyl-L-cysteine (NAC), an antioxidant amino acid, has garnered attention due to its potential benefits. This study aimed to investigate the effects of MTA and NAC on pulpotomy outcomes. We used Sprague Dawley rat maxillary molars to perform pulpotomy and employed Superbond C&B, MTA, and MTA mixed with NAC (MTA–NAC) for pulp capping. We obtained tissue sections 3 and 7 days postpulpotomy, conducting histological analysis by examining the morphology of pulp tissue and assessing dentin sialophosphoprotein (DSPP) and osteopontin expression levels. At 3 days postpulpotomy, MTA and MTA–NAC reduced the inflammatory response. At 7 days postpulpotomy, dentin bridge formation was observed following MTA–NAC application, and although MTA resulted in DSPP- and osteopontin-positive areas, these areas were more extensive following MTA–NAC application. Given that adding NAC to MTA enhanced dentin bridge formation, MTA–NAC appears to be a superior option for pulp capping. Full article

The advancement of Vital Pulp Therapy (VPT) in dentistry has shown remarkable progress, with a focus on innovative materials and scaffolds to facilitate reparative dentin formation and tissue regeneration. A comprehensive search strategy was performed across PubMed, Scopus, and Web of Science using keywords such as “vital pulp therapy”, “biomaterials”, “dentin regeneration”, and “growth factors”, with filters for English language studies published in the last 10 years. The inclusion criteria focused on in vitro, in vivo, and clinical studies evaluating traditional and next-generation biomaterials for pulp capping and tissue regeneration. Due to the limitations of calcium-based cements in tissue regeneration, next-generation biomaterials like gelatin, chitosan, alginate, platelet-rich fibrins (PRF), demineralized dentin matrix (DDM), self-assembling peptides, and DNA-based nanomaterials were explored for their enhanced biocompatibility, antibacterial properties, and regenerative potential. These biomaterials hold great potential in enhancing VPT outcomes, but further research is required to understand their efficacy and impact on dentin reparative properties. This review explores the mechanisms and properties of biomaterials in dentin tissue regeneration, emphasizing key features that enhance tissue regeneration. These features include biomaterial sources, physicochemical properties, and biological characteristics that support cells and functions. The discussion also covers the biomaterials’ capability to encapsulate growth factors for dentin repair. The development of innovative biomaterials and next-generation scaffold materials presents exciting opportunities for advancing VPT in dentistry, with the potential to improve clinical outcomes and promote tissue regeneration in a safe and effective manner. Full article

With the paradigm shift towards minimally invasive biologic therapies, vital pulp therapy (VPT) has been receiving increasing attention. Currently, bioactive materials (BMs), including MTAs, Biodentine, Bioaggregate, and iRoot BP Plus, are clinically widely used for the repair of damaged pulp tissue. Emerging evidence highlights the crucial role of inflammation in pulp repair, with mild to moderate inflammation serving as a prerequisite for promoting pulp repair. BMs play a pivotal role in regulating the balance between inflammatory response and reparative events for dentine repair. Despite their widespread application as pulp-capping agents, the precise mechanisms underlying the actions of BMs remain poorly understood. A comprehensive literature review was conducted, covering studies on the inflammatory responses induced by BMs published up to December 2023. Sources were identified through searches of PubMed and MEDLINE databases, supplemented by manual review of cross-references from relevant studies. The purpose of this article is to discuss diverse mechanisms by which BMs may regulate the balance between tissue inflammation and repair. A deeper understanding of these regulatory mechanisms will facilitate the optimization of current pulp-capping agents, enabling the development of targeted regenerative strategies to achieve superior clinical outcomes. Full article

Traditional pulp-capping materials like mineral trioxide aggregate (MTA) offer excellent biocompatibility and sealing, but limitations such as prolonged setting time, low bioactivity, and high costs persist. Metformin, with its potential in craniofacial regeneration, could enhance dentin synthesis by targeting pulp cells. This study aimed to: (1) develop a calcium phosphate cement with chitosan (CPCC) with improved physio-mechanical properties; (2) incorporate metformin (CPCC-Met) to assess release; and (3) evaluate human dental pulp stem cells (hDPSCs) response. CPCC was mixed at different powder-to-liquid ratios to evaluate physio-mechanical properties compared to MTA. The optimized CPCC formulation was loaded with 0, 50, 100, and 150 µg of metformin to measure release and assess hDPSCs attachment and proliferation (1, 4, and 7 d) via live/dead imaging and SEM. One-way ANOVA was used for statistical analysis. Results showed CPCC at a 3.25:1 ratio significantly reduced setting time to 41.5 min versus 123 min for MTA (p < 0.05). Metformin release correlated with concentration, and SEM confirmed the presence of a porous, hydroxyapatite-rich surface. Cell viability was consistently high across groups (>93% at 1 d, >95% at 4 d, ≈98% at 7 d), with no significant differences (p > 0.05). These findings suggest that the novel CPCC-Met demonstrates promise as a fast-setting, cost-effective pulp-capping material, offering metformin delivery to enhance dentin repair. Full article

The objective of this research was to synthetize a hydroxyapatite-capsaicin composite (HAp-CAP) and assess its physicochemical properties for potential use in an in-office dental bleaching gel. The HAp-CAP nanocomposite was prepared by the precipitation method using a 4:1 ratio of nano-hydroxyapatite (nano-HAp) to capsaicin (CAP) dissolved in 99.5% ethyl alcohol (q.s.p) with the assistance of zirconia beads in a SpeedMixer^®. Characterization of HAp-CAP involved morphological, spectroscopic, and thermal analyses. Subsequently, HAp-CAP was incorporated into an in-office dental bleaching agent to evaluate its impact on reducing hydrogen peroxide diffusion into the pulp chamber and its effect on tooth color alteration during the bleaching process. The HAp-CAP in a bleaching gel slightly decreased the amount of hydrogen peroxide inside the pulp chamber and did not interfere in the bleaching effectiveness of dental bleaching. The physicochemical characterization indicates that the synthesis process of the HAp-CAP composite was successfully carried out, and its use in dental materials poses a challenging task that warrants further investigation since its incorporation. Full article

Objective. In this study, the biological effect of MTA Repair HP (Mineral Trioxide Aggregate Repair High Plasticity) and Biodentine have been tested on a stabilized fibroblast cell line NCTC clone 929. Materials and Methods. We assessed quantitative and qualitative parameters related to cytotoxic effect of the investigated products. The experimental period was 96 hours. Statistical analysis was performed with Kruskal-Wallis and Wilcoxon tests. Results. The detached cells test showed no statistically significant difference on cell culture for Biodentine and MTA Repair HP, while for the cellular density assay we found the same biological effect on the tested fibroblasts in the first 24 and 48 h, but a significant different cellular response for the investigated pulp capping materials for the next 48 h of the experiment. Conclusions. The results demonstrated that the materials presented a very low level of cytotoxicity. Biodentine showed in all parameters better biological effects than MTA Repair HP, expressed by lower and limited cellular damage and a higher cell density. Full article

Phosphate-based glasses are known for their excellent biocompatibility and adjustable degradation rates. In this study, we fabricated a rapidly soluble zinc-ion-releasing phosphate-based glass (RG) specifically designed for use in dental cavity liners. The aim of this study was to evaluate the ion-releasing properties and antibacterial effects of RG. Additionally, a dental resin incorporating RG was fabricated to serve as a cavity liner, and its effectiveness was investigated in vitro. The RG formulation exhibited high solubility and released high concentrations of Zn²⁺ at various pH values. To assess the antibacterial properties of RG, six bacterial species detected in deep carious regions were incubated in the presence of RG. In vitro antibacterial testing against six bacterial species revealed that RG exhibited strong bactericidal effects against these prevalent bacteria. Furthermore, using a dentin model infected with Lactobacillus casei or Streptococcus mutans, the experimental resin containing RG demonstrated an effective bactericidal effect in the dentinal tubules, highlighting its potential as a promising material for cavity liners or pulp-capping applications. Full article

Conventional pulp capping materials have limited anti-inflammatory capacity. It is necessary to develop more effective pulp capping material for the treatment of inflamed pulps. Tannic acid (TA) is a natural, water-soluble polyphenol with antimicrobial and anti-inflammatory properties. This study aimed to investigate the effects of a tannin-containing hydroxypropyl chitin hydrogel (HPCH/TA hydrogel) as an innovative pulp capping material. The physicochemical properties of the composite hydrogels were characterized. The effects of HPCH/TA hydrogel as a pulp capping material were evaluated in vitro and in vivo. The underlying mechanism of the anti-inflammatory effects of HPCH/TA hydrogel was explored. The HPCH/TA hydrogel demonstrated favorable temperature sensitivity, injectability, and antibacterial properties. In vitro, the HPCH/TA hydrogel effectively promoted the proliferation of human dental pulp cells and inhibited interleukin-1β, interleukin-6, and tumor necrosis factor-α expression, possibly by suppressing the nuclear factor kappa-B pathway. In vivo, on the fourth day after capping, the HPCH/TA hydrogel group showed lower inflammatory scores compared to the control and iRoot BP Plus (commercial pulp capping material) group. By the sixth week, complete reparative dentin formation was observed in the HPCH/TA hydrogel group, with no difference in thickness compared to the iRoot BP Plus group. Collectively, the HPCH/TA hydrogel holds promise as a bioactive pulp capping material for promoting the repair of inflamed pulp in vital pulp therapy. Full article

Background: This retrospective clinical study aimed to assess dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. Methods: A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), direct pulp capping with Mineral Trioxide Aggregate cement; Group (2), direct pulp capping with a resin-based glass ionomer; Group (3), direct pulp capping with TheraCal; Group (4), indirect pulp capping with a three-step total-etch adhesive system; and Group (5), indirect pulp capping with a two-step self-etch adhesive system. Results: A 72.5% success rate was achieved overall. A statistically significant difference was found when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively. For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis (p = 0.035), while bleeding after exposure appeared independent (p = 0.053). Patient age was significantly related to the maintenance of pulp vitality (p = 0.013). A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered (p = 0.017). For the indirect pulp-capping treatments, a significant correlation between patient age (p = 0.021) and the adhesive system (p = 0.019) with pulp necrosis was described. Conclusions: The pulp-capping material, patient age, and the width of the pulp exposure before the procedure should be carefully considered when performing direct pulp-capping treatments. The performance of the etch-and-rinse adhesive systems was superior to the self-etch system during the indirect pulp-capping procedures. Full article