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vital pulp therapy.pptx
- 1. Materials used in VPT Cairo University Faculty of Dentistry Department of Endodontics
- 4. 1 Maintain pulp vitality Bactericidal/ bacteriostatic 3 5 Resist the forces under restoration 2 Stimulate reparative dentin formation 4 Adhere well to dentin and RM 6 Sterile & RO Ideal properties of a pulp capping agents Cohen & Combe. Development of new adhesive pulp capping materials. Dent Update. 1994; 21(2):57-62.
- 5. ZnO/E • Lack of calcific bridge formation • Releases eugenol in high concentration which is cytotoxic dentin bonding agents • Have cytotoxic effect • Absence of calcific bridge formation GI / resin modified GI • Causes chronic inflammation • Lack of dentin bridge formation • Cytotoxic when in direct cell contact Poly-carboxylate cement • Lack of antibacterial effect • Fail to stimulate calcific bridge formation Classic pulp capping materials
- 7. OH- Ca++ Stimulate deposition of Ca phosphates Constriction of blood vessels Optimum PH Bactericidal action Affect bacterial cytoplasmic membrane, protein & DNA (1) Ca OH 1 Neutralize lactic acid from odontoclast Prevent dissolution of mineralized components of D 2 Activate alkaline phosphatase (2) Hard tissue formation Mechanism of action of CaOH (antibacterial effect and mineralization) (1)Siqueira & Lopes 1999 (2) Estrela et al. 1995
- 8. Highly soluble in oral fluids Low cytotoxicity Lack of adhesion Excellent Antibacterial properties Extensive dentin formation obliterating the pulp chamber Induction of Mineralization tunnel defects Degradation after acid etching Seltzer & Bender (1975) Advantages Disadvantages Calcium hydroxide
- 9. Numerous studies have demonstrated Dentinal bridge formation in about 50–87% of cases treated with various Ca(OH)2 formulations (Hargreaves & Goodis 2002). Tunnel defects within dentin bridges may provide a pathway for the penetration of microorganisms to activate circulating immune cells, induce pulpal irritation and produce subsequent Dystrophic calcification
- 11. Mineral Trioxide Aggregate (MTA) Advantages Disadvantages • Good Biocompatibility. • More predictable hard tissue barrier formation. • Sustained high alkaline PH. • Antibacterial property . • Radiopacity. • Higher compressive strength. • Long Setting time. • Tooth Discoloration. • Two step procedure . • Poor handling characterstics.
- 12. Over an observation period of nine years, the authors found that 97.96 % had favorable outcomes on the basis of radiographic appearance, subjective symptoms and cold testing. Clinical and radiographic outcomes
- 13. 3 month 6 month 12 month reduced Pain maintain pulp vitality 96% of MTA and 76% of CaOH showed Reparative dentin formation. MTA Versus CaOH Sultana et al. Evaluation of clinical and radiological outcomes of mineral trioxide aggregate and calcium hydroxide as indirect pulp capping agents in the treatment of deep carious lesion of permanent teeth. BSMMU J 2016; 9: 140-145
- 14. MTA resulted in less pulpal inflammation and showed higher rate of D bridge formation with superior structural integrity than CaOH CaoH after 3 months Histological outcome of MTA and CaOH MTA after 3 months Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial Int Endod J. 2008
- 16. 1 Higher biocompatibility 3 Easier manipulation 5 Superior compressive ST 4 Less discoloration 2 Faster setting J Clin Diagn Res. 2017 Aug; 11(8): ZG01–ZG05.Published online 2017 Aug 1. doi: 10.7860/JCDR/2017/25840.10374 Biodentin Versus MTA
- 17. Bhat, et al.: Biodentine: The new bioactive material for direct pulp capping
- 18. CaOH MTA Biod CBCT multiplanner reconstruction imaging using OnDemand3D App allowed for the identification of the location of dentin bridges and tunnel defects.
- 19. Composed of nanospheres Micromechanical bonding shortening the setting time (20 min) Better penetration into DT utilizes the water inherent in the dentinal tubules in hydration reaction 1 2 Zoufan et al: Cytotoxicity evaluation of Gutta Flow and Endo Sequence BC sealers, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:657, 2011. Endosequence
- 20. At the 6-month follow-up visit, the tooth was asymptomatic and tested vital and a reparative barrier had formed and the canal was not calcified Endosequence Trope M. The Expanding Role of Vital Pulp Therapy., Dent Today. 2016 Jun;35(6):82-5.
- 21. higher upregulation of Mineraliziation Odontoblastic differentiation associated gene expressions (DSP) when compared to MTA BioAggregate Zhang S., X. Yang & M. Fan. BioAggregate and iRoot BP Plus optimize the proliferation and mineralization ability of human dental pulp cells. International Endodontic Journal, 46, 923–929, 2013 based on Nanotechnology
- 22. after 24 months
- 24. 01 02 03 Light cured resin modified Calcium silicate filled liner . facilitates the immediate placement of final restoration. used for direct and indirect pulp capping. Theracal LC (Bisco, Schaumburg, IL, USA) The security blanket for pulpal protection *Suh et al (2008) Polymerizable dental pulp healing, capping, and lining material and method for use. **Hebling et al (2009) Cytotoxicity of resin-based light-cures liner cements. Journal of Dental Research 87B, 470.
- 25. Theracal higher calcium releasing ability cured to a depth of 1.7 mm may avoid the risk of dissolution lower solubility
- 26. CEM + H2O CaOH Ca++ & OH- HA formation Calcium enriched mixture ( CEM) Asgary et al 2015 in a multicenter RCT, evaluated vital pulp therapy of mature permanent molars diagnosed with irreversible pulpitis treaeted with CEM successful control of pain and 92% success in clinical and radiograph during follow up 1, 2, and 5 years 18 month Asgary et al. Five-year results of vital pulp therapy in permanent molars with irreversible pulpitis: a non-inferiority multicenter randomized clinical trial. Clin Oral Investig. 2015 Mar;19(2):335-41. This novel cement has an antibacterial effect superior to (MTA) and sealing ability similar to MTA.
- 27. 01 03 02 04 Propolis Lasers (PRF) Resolvins Recent advances
- 28. Anti (oxidant, bacterial, fungal, viral and inflammatory) properties. Induce bridge formation. Reduces both pulp inflammation and degeneration. Propolis Properties
- 29. Parolia et al.2010 , concluded that Propolis and MTA showed similar bridge formation when compared to Dycal. Teeth treated with Dycal showed more pulpal inflammation. Dycal Propolis MTA Parolia A et al, . A comparative histological analysis of human pulp following direct pulp capping with Propolis, mineral trioxide aggregate and Dycal. Aust Dent J. 2010
- 30. stimulation of the cell regeneration following injuries. inducing the odontoblast for laying down tertiary dentin and forming a dentin bridge. Lasers Technique sensitive. Causes thermal damage to pulp in high doses.
- 31. A meta analysis conducted by Yang et al, in 2016 evaluated the use of Laser in pulp capping. Results showed that the success rate of the laser group was 89.9% while the control groups (Ca OH) was 67.2% Lasers Yang Deng, et al. Laser use in direct pulp capping : A meta-analysis Journal of American Dental Association, 147, Issue 12, December 2016, Pages 935–942
- 32. PRF
- 33. Resolvins RV showed great promises regarding the potential to resolve pulpitis and subsequently enhance dental pulp tissue regeneration. Caution Unfavorable host reaction Inflammation and Necrosis of the tissue.
- 34. “ a treatment established to preserve and sustain the healthy state of pulp tissue that has been jeopardized by either restorative procedures, trauma or caries.” conclution
- 35. THANKS
Editor's Notes
- Sultana et al 2016 assessed the outcomes of MTA and CaOH in 50 permanent teeth having deep carious lesions with reversible pulpitis