Original article
Biological evaluation of a new pulp capping material developed from Portland cement

https://doi.org/10.1016/j.etp.2016.12.006Get rights and content

Abstract

This study evaluates the biological properties of a new pulp capping material developed from Portland cement. This study was conducted on 48 teeth in 4 dogs (12 teeth/dog). The dogs were classified into two equal groups (n = 24 teeth) according to the evaluation period including: group A (3 weeks) and group B (3 months). Each group was further subdivided into three equal subgroups (n = 8 teeth) according to the capping material including: subgroup 1: mineral trioxide aggregate (MTA), subgroup2: Portland cement + 10% calcium hydroxide + 20% bismuth oxide (Port Cal) and subgroup 3: Portland cement + bismuth oxide. After general anesthesia, a class V buccal cavity was prepared coronal to the gingival margin. After pulp exposure and hemostasis,the capping materials and glass ionomer filling were placed on the exposure sites. All histopathological findings, inflammatory cell count and dentin bridge formation were recorded. Data were analyzed statistically. After 3 months, the histopathological picture of the pulp in subgroup 1 showed normal pulp, continuous odontoblastic layer and complete dentin bridge formation while subgroup 2 showed partial and complete dentin bridge over a normal and necrotic pulps. Subgroup 3 showed loss of normal architecture, areas of necrosis, complete, or incomplete dentin bridge formation, attached and detached pulp stones and fatty degeneration in group B. For group A, MTA subgroup showed the least number of inflammatory cell infiltrate followed by Port Cal subgroup. While subgroup 3 showed the highest number of inflammatory cell infiltrate. For group B, the mean inflammatory cell count increased with the three tested materials with no statistical difference. Regarding dentin bridge formation at group A, no significant differences was found between subgroups, while at group B, MTA subgroup exhibited significantly higher scores than other subgroups. In conclusion, addition of calcium hydroxide to Portland cement improves the dentin bridge formation qualitatively and quantitatively.

Introduction

Pulp capping is defined as the treatment of exposed vital pulp by the application of capping materials to induce the dentinogenic potential of pulp cells (Schröder, 1985). The choice of pulp capping material greatly affects the success of vital pulp therapy. An ideal pulp capping material must be capable of inducing the formation of reparative dentin as well as acceptable biocompatibility and strong antibacterial activity (Mjör et al., 1991)

Calcium hydroxide is considered the gold standard of pulp capping materials, However, the resultant incomplete dentin bridge with tunnel defects that may lead to the failure of pulp capping (Faraco and Holland, 2001; Al-Hezaimi et al., 2011a).

Mineral trioxide aggregate (MTA) was introduced by Torabinejad et al. (1993) and had been recommended as a pulp capping material. It has higher biocompatibility and sealing ability than calcium hydroxide (Parirokh and Torabinejad, 2010). Moreover, MTA can also induce the differentiation of dental pulp cells to odontoblast-like cells and form thicker dentin bridges (Masuda-Murakami et al., 2010, Al-Hezaimi et al., 2011a, Al-Hezaimi et al., 2011b, Parirokh et al., 2011, Saleh et al., 2016).

The success rate of direct pulp capping using MTA was found to be more successful than calcium hydroxide (Aguilar and Linsuwanont, 2011). However, MTA still has some limitations, including difficult handling characteristics, long setting time and relatively high cost.

The base material of MTA is Portland cement in which bismuth oxide has been added to render the mixture radio-opaque (Torabinejad et al., 1995a, Torabinejad et al., 1995b). Recently, the use of Portland cement as an alternative to MTA is gaining much popularity because of its lower cost and ample availability.

Several studies have been investigated the biocompatibility of Portland cement (Abdullah et al., 2002, Camilleri et al., 2005, Ribeiro et al., 2005, De Deus et al., 2005). These studies concluded that Portland cement is a biocompatible material having the potential to be used as a proper pulp-capping agent.

Our previous study showed that addition of 10 wt% calcium hydroxide to Portland cement associated with 20% bismuth oxide produces a new pulp capping material (Port Cal) with acceptable physical and adhesive properties (Negm et al., 2016). Therefore, the aim of the present study was to evaluate the biological properties of this new pulp capping material developed from Portland cement in dog's teeth.

Section snippets

Animals

This study was approved by the Ethics Committee at Faculty of Dentistry, Ain Shams University (2013/03END).

A total of four male mongrel dogs aged approximately 4–6 months were selected for this study at the department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Cairo University. The dogs were bathed in Diazinon (Neocidal® Ningbo Hi-Tech Biochemicals, China) in concentration of 1/1000 ml of water and then were injected subcutaneously with Ivermectin (Ivomec® Merial

Histopathological findings

Histological examination of normal teeth revealed normal architecture of pulp consisting of delicate, loose connective tissue with numerous blood capillaries. A single uniform odontoblastic layer lining the peripheral part of the pulp and separating the loose connective tissue from predentin was seen. This layer is followed by cell rich zone with high densities of fibroblasts which were numerous, either spindle or stellate-shaped (Fig. 1).

Discussion

The objective of the present study was to investigate the biological activity of newly developed material for pulp capping by mixing bismuth oxide and calcium hydroxide to the powder of Portland cement in comparison with MTA.

Mineral trioxide aggregate was developed to seal all of the pathways of communication between root canal system and external surface due to its good physicochemical properties and excellent biocompatibility (Lee et al., 1993, Hassanien et al., 2015).

In the present study 20%

Conclusions

Under the conditions of the present study, it could be concluded that although MTA shows the least inflammatory response with the greatest percentage of complete dentin bridge formation yet, the addition of calcium hydroxide to Portland cement improves the possibility of dentin bridge formation qualitatively and quantitatively.

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