Randomized controlled trial of mineral trioxide aggregate and formocresol for pulpotomy in primary molar teeth

AIM: To compare the outcome after 6 months of the application of formocresol (FC) or mineral trioxide aggregate (MTA) during pulpotomy in primary molar teeth. METHODOLOGY: A maximum of 126 children (aged 5-9 years) with carious primary teeth that required pulpotomy were selected. Following randomization, a standard pulpotomy preparation was undertaken, and the coronal pulp removed and bleeding arrested. In the FC group, cotton balls, soaked in FC, were placed for 5 min, and then the pulp chamber was filled with Zonalin, a pulpotomy agent. In the MTA group, a 1-mm-thick paste of MTA was used as a pulpotomy agent. The crowns in both groups were restored with amalgam or glass ionomer. The teeth of 100 patients were evaluated and compared clinically and radiographically after 3 and 6 months. RESULTS: No signs of clinical failure were observed at the 3- and 6-month follow-up appointments in either group. There were no significant differences in the radiographic findings of the teeth and surrounding tissue at the 3-month follow-up. However, at the 6-month follow-up, significantly more cases (P = 0.036) with root resorption were seen in the FC group; no cases of resorption occurred amongst the MTA cases. The surrounding tissue showed radiographic signs of post-treatment disease in four FC cases; none was seen in the MTA cases. CONCLUSION: After 6 months, pulpotomy with MTA was associated with fewer cases of root resorption and post-treatment disease. MTA appears to be a reliable alternative material for pulpotomy in primary molar teeth.     

Scanning electron microscopy evaluation of the hard tissue barrier after pulp capping with calcium hydroxide,mineral trioxide aggregate (MTA) or ProRoot MTA

The aim of this study was to investigate the morphology and localisation of calcium hydroxide‐ and mineral trioxide aggregate (MTA)‐induced hard tissue barriers after pulpotomy in dogs' teeth. Pulpotomies were performed on maxillary and mandibular premolars of five dogs. The teeth were assigned into three groups according to the pulp‐capping agent used. The pulpal wounds were capped with calcium hydroxide (Ca(OH)₂– control), MTA or ProRoot MTA, and the cavities were restored with amalgam. After a 90‐day follow‐up period, the dogs were euthanised and the teeth were examined under scanning electron microscopy (SEM). An image‐processing and analysis software was used to delimit the perimeters of the root canal area and the hard tissue barrier to determine the percentage of root canal obliteration. SEM data were used to assess the morphology, localisation and extension of the reparative hard tissue barriers. ProRoot MTA was statistically different from MTA and Ca(OH)₂ (P < 0.05) regarding tissue barrier morphology. Localisation data showed that ProRoot MTA was significantly different from Ca(OH)₂ (P < 0.05) and similar to MTA (P > 0.01; P > 0.05). No statistically significant difference (P > 0.01; P > 0.05) was observed between MTA and Ca(OH)₂. A larger number of complete (centroperipheral) hard tissue barriers with predominance of dentinal tubules was observed to the ProRoot MTA when compared with the Ca(OH)₂ group.     

Histological evaluation of the effect of three medicaments; trichloracetic acid,formocresol and mineral trioxide aggregate on pulpotomised teeth of dogs

The aim of this study was to use clinical, radiographic and histological examinations to compare the dental pulp response in 162 premolar roots of eight dogs when trichloracetic acid (TCA), formocresol, mineral trioxide aggregate (MTA) and zinc oxide eugenol were used as pulpotomy agents. The teeth were divided into four groups. Following pulpotomy, the teeth were restored with amalgam. The animals were sacrificed at 48 h, 2, 4 and 8 weeks (two dogs at each interval). Histological evaluation indicated no cases with necrosis. After 8 weeks follow up, dentine bridge formation was evident in 20%, 50% and 91.7% of formocresol, TCA and MTA cases respectively. The first signs of bridge formation were seen for MTA at 2 weeks and for TCA at 4 weeks. MTA was superior to formocresol and TCA in treating pulps in dogs. However, bridge formation was seen in 50% of TCA cases after 8 weeks which is a desirable finding in pulpotomy procedures.     

Mineral trioxide aggregate (MTA) and calcium hydroxide as pulp-capping agents in human teeth: a preliminary report

AIM: To compare mineral trioxide aggregate (MTA) with calcium hydroxide when used as pulp-capping materials in human teeth. METHODOLOGY: Eleven pairs of maxillary third molars in subjects between 20 and 25 years of age were subjected to mechanical pulp exposure. The exposed pulps were capped with MTA or calcium hydroxide, covered with ZOE and restored with amalgam. A total of 14 teeth were extracted after periods of 1 week (two molars) 2 months (three molars), 3 months (five molars), 4 months (two molars) and 6 months (two molars). RESULTS: Histological evaluation demonstrated less inflammation, hyperaemia and necrosis plus thicker dentinal bridge and more frequent odontoblastic layer formation with MTA than calcium hydroxide. CONCLUSIONS: Although the results favour the use of MTA, more studies with larger samples and a longer follow up are suggested.     

无机三氧化合物在牙髓根尖周病治疗中的研究进展

无机三氧化合物是一种新的牙髓根尖周病治疗材料,它与氢氧化钙在某些理化、生物及组织学特征和治疗机制上有相似之处,但也有它的特点,如封闭性、体积稳定性、亲水性等,明显优于氢氧化钙制剂,这就使它在直接盖髓、根尖诱导成形、根管侧穿或根分叉穿孔的修补及根尖倒充填和根管充填等方面的应用显示出优越性,成为一种有发展前景的牙髓根尖周病治疗材料。     

Evaluation of the antifungal effects of mineral trioxide aggregate materials

The aim of this study was to evaluate and compare the antifungal effect of white-coloured mineral trioxide aggregate (WMTA) and grey mineral trioxide aggregate (GMTA) using a tube-dilution test. MTA preparations were freshly mixed and tested after 24 h on Candida albicans. The experiment was carried out in 24-well culture plates. Fifty wells were used and divided into four experimental groups (freshly mixed WMTA, freshly mixed GMTA, 24 h-set WMTA and 24 h-set GMTA) of 10 wells each and control groups of five wells each. Plates of Sabouraud dextrose agar mixed with C. albicans served as positive control, and Sabouraud dextrose agar without C. albicans served as negative control. Fresh inoculate of C. albicans was prepared by growing an overnight culture from a stock culture. Aliquots of C. albicans were then taken from the stock culture and plated on the agar compound of the experimental and control groups. All plates were incubated at 37 degrees C for 1, 24 and 72 h. Growth of fungi was monitored daily by the presence of turbidity. Results showed that in the freshly mixed as well as 24 h-set MTA cements fungal growth was observed during 1-h incubation, whereas by increasing the incubation time, no fungal growth was observed in 24 and 72 h. It was concluded that MTA cements (freshly mixed and 24-h set) were effective against C. albicans.     

三氧化矿物凝聚体对人乳牙牙髓细胞增殖和分化影响的实验研究

目的 对比三氧化矿物凝聚体(mineral trioxide aggregate,MTA)和氢氧化钙对人乳牙牙髓细胞增殖和分化的影响,为MTA应用于乳牙活髓保存治疗提供实验依据.方法 培养原代人乳牙牙髓细胞,采用噻唑蓝比色法检测乳牙牙髓细胞生长增殖的变化;von Kossa染色观察牙髓细胞钙结节形成情况,并计数分析;使用实时荧光定量聚合酶链反应法检测碱性磷酸酶(alkaline phosphatase,ALP)、牙本质涎磷蛋白(dentin sialophosphoprotein,DSPP)基因的表达.结果 氢氧化钙组牙髓细胞增殖率显著低于对照组和MTA组(F=1792.301,P<0.01),最大增殖率为89.7%;MTA组牙髓细胞增殖率显著高于氢氧化钙组和对照组(F=1835.065,P<0.01),最大增殖率为118.4%.氢氧化钙组和MTA组牙髓细胞von Kossa染色均呈阳性,两组间钙结节计数分析差异无统计学意义(P>0.05).三组间ALP基因表达量差异有统计学意义(F=349.651,P<0.01),氢氧化钙组显著低于对照组和MTA组,MTA组显著高于氢氧化钙组和对照组;三组间DSPP基因表达量差异也有统计学意义(F=1653.001,P<0.01),氢氧化钙组显著低于对照组和MTA组,MTA组显著高于氢氧化钙组和对照组.结论 从促进乳牙牙髓细胞的增殖和分化来看,MTA比氢氧化钙更适合作为乳牙的盖髓剂.     

The use of mineral trioxide aggregate to achieve root end closure: three case reports

Abstract – The use of mineral trioxide aggregate (MTA) to achieve root end closure has many advantages over the traditional calcium hydroxide (Ca(OH)₂) technique including the reduced number of visits and the reduced mechanical damage to dentine. Limited studies have reported the outcome of using MTA as an apexification material and a one‐stage obturation technique in non‐vital immature teeth. This article illustrates three successful clinical cases where MTA was used as an apexification material. In case study one: Type 1 Dens Invaginatus tooth with incomplete root formation, case study two: an immature tooth that suffered pulp necrosis following an enamel and dentine fracture trauma and case study three: a non‐vital tooth following an apical root fracture.     

Treatment of tooth discoloration after the use of white mineral trioxide aggregate

Introduction

A number of vital pulp therapy techniques have been recommended to preserve pulp vitality in teeth with complicated crown fractures, especially in young patients. Calcium hydroxide has been the gold standard as a pulp capping material, but recently mineral trioxide aggregate (MTA) has been recommended. This case report describes the treatment of tooth discoloration caused by white MTA (WMTA) used for the management of a complicated crown fracture.

Methods

A partial pulpotomy was performed with the use of WMTA after a complicated crown fracture of the upper right central incisor. Seventeen months later, the WMTA was removed because of tooth discoloration, and internal bleaching was performed.

Results

Upon access, the WMTA was completely discolored. After it was removed, a significant color change was observed in the tooth crown, which was further improved with internal bleaching. The tooth remained vital, and a dentin bridge was confirmed clinically and radiographically.

Conclusions

The recommendation to use WMTA for vital pulp therapy in the esthetic zone may need to be reconsidered. Should discoloration occur with the use of WMTA, the technique described may be used to improve the esthetics.     

Clinical, radiographic and histological analysis of the effects of mineral trioxide aggregate used in direct pulp capping and pulpotomies of primary teeth

Background : Primary teeth pulp exposures have traditionally been treated with formocresol or ferric sulphate pulpotomies or calcium hydroxide pulp capping. The aim of this study was to observe the tissue response when mineral trioxide aggregate (MTA) was used.
Methods : Ten primary teeth had direct pulp caps and 11 had a pulpotomy with MTA. The teeth were restored and then clinically reviewed monthly for five months and before extraction. Radiographs were taken prior to treatment, after one month and prior to extraction. After extraction, the teeth were examined histologically and the responses to treatment were assessed.
Results : One pulpotomy and two pulp capping cases had postoperative pain and signs of pulp degeneration. Radiographs showed no root resorption, no periodontal pockets and no furcation radiolucencies. No cases had draining sinuses or increased mobility. Most pulps responded favourably from a clinical perspective although a variety of responses were noted Histologicallyormal odontoblasts, irregular odontoblasts, intrapulpal calcifications, dentinal bridges, cementum formation, internal resorption, inflammatory infiltrate and pulp necrosis.
Conclusions : The responses of pulps in primary teeth to MTA pulpotomies and pulp caps were favourable from clinical and radiographic perspectives although a variety of histological responses were noted. MTA may be a favourable material for pulp capping and pulpotomies in primary teeth.     

Histological comparison of alendronate, calcium hydroxide and formocresol in amputated rat molar

Abstract –  The purpose of this study was to evaluate the potential of alendronate sodium (ALN), a biphosohonate to stimulate hard tissue formation in pulpotomized (amputated) rat molars. Two commonly used pulpotomy materials, calcium hydroxide (CH) and formocresol (FC) were utilized for comparisons. Histological evaluations were performed by observers blinded to treatment allocation on days 7, 15, 30 and 60, followed by statistical analysis of selected histological criteria. In all evaluation periods, hard tissue deposition was evident along the radicular dentin in ALN and CH groups. In days 30 and 60, the latter two groups showed no differences in inflammatory cell response and hard tissue deposition scores ( P  > 0.05). ALN appears to be capable of maintaining pulpal vitality, while promoting hard tissue formation, similar to CH.     

三氧化物多聚体盖髓剂的研究进展

三氧化物多聚体是一种新的盖髓材料，可以用于直接盖髓或活髓切断术，牙髓组织对其反应良好，尤其是修复性牙本质的形成状况优于氢氧化钙、甲醛甲酚等盖髓材料。本文就这方面的研究进展作一综述。     

无机三氧化物聚合体用于年轻恒牙根尖封闭的短期疗效观察

目的 观察无机三氧化物聚合体(MTA)一次性封闭根尖开放年轻恒牙的疗效.方法 13颗年轻恒牙采用MTA一次性封闭根尖开放部位,形成硬组织屏障后行流动牙胶充填根管,冠部永久性充填,术后定期复诊.结果 所有患牙在治疗后的复诊期间均无不适症状,同时原根尖周透射区局限、缩小或消失.结论 MTA用于年轻恒牙根尖封闭的短期疗效确切.     

Dentin formation in formocresol pulpotomized primary monkey teeth studied by tetracycline and 3H-proline incorporation

Abstract – The influence of formocresol treatment on the pulp tissue of 24 primary monkey teeth was studied using tetracycline and ³H-proline labeling techniques. Six untreated monkey teeth served as controls. The tetracycline labeled teeth were examined between 352 and 600 d, following treatment. The ³H-proline labeled teeth were observed over a period of 22–607 d, the isotope being administered 15 d before extraction. The labeling was evaluated in the coronal, middle and apical area of the roots. Dentin formation as indicated by tetracycline labeling was observed in both control teeth and successfully treated teeth, as well as in some of the unsuccessfully treated teeth. The average dentin formation rate per day varied from 1 μm in the control teeth to 0.14 μm in the pulpotomized teeth ( P <0.01). Success of treatment was of significant importance for the amount of dentin formation ( P <0.001). Labeling with ³H-proline, indicating collagen synthesis, could be observed in the pulp and predentin of the majority of areas judged to be normal, degenerated or inflamed. Labeling was not observed in fixed or necrotic tissue. In degenerated pulp tissue the proline labeling was clearly reduced. The findings indicate that dentin formation and collagen synthesis may take place in formaldehyde influenced pulp tissue although at a decreased rate.     

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目的对比观察氢氧化钙和甲醛甲酚用于根尖周炎患牙根管内封药的疗效。方法选择2008年1月到2009年12月在中国医学科学院整形外科医院口腔中心就诊的135例牙根尖周炎患者的156颗患牙,随机分为A组(81颗)和B组(75颗)。步退法根管预备后分别于根管内封入氢氧化钙(A组)和甲醛甲酚(B组)进行消毒。于封药后1周、根充后1周和治疗后3个月对两组疗效进行观察并作出相应评价。结果根管封药后1周A组的有效率为92.59%,B组的有效率为78.67%,两组间差异有统计学意义(P<0.05);根管充填后1周,A、B两组的急症发生率(3.70%对12.0%)差异有统计学意义(P<0.05)。治疗后3个月A组的成功率为91.36%;B组为84.00%,两组间差异有统计学意义(P<0.05)。结论氢氧化钙用于根尖周炎患牙根管内消毒的疗效优于甲醛甲酚。     

Response of the pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement

Abstract – This study was conducted to observe the response of dogs' dental pulp to mineral trioxide aggregate (MTA) and a calcium hydroxide cement when used as pulp capping materials. After the pulps of 30 teeth were exposed, they were capped with either MTA or a calcium hydroxide cement. Histological analysis was performed 2 months after treatment. Results showed a healing process with complete tubular dentin bridge formation and no inflammation in any of the pulps capped with MTA. On the other hand, only five specimens from the calcium hydroxide cement group formed a complete dentin bridge. In this experimental group, pulp inflammation was observed in all but three cases. In conclusion, MTA exhibited better results than the calcium hydroxide cement for the capping of the pulp in dogs.