Dentin-pulp protection in pediatric dentistry: a review

Authors

DOI:

https://doi.org/10.22456/2177-0018.103721

Keywords:

Calcium hydroxide, Dental Pulp, Dentin, Tooth deciduous, Dental materials

Abstract

Dentin and pulp are considered interdependent substrates, known as the dentin-pulp complex. In front of injuries such as caries and trauma, this complex should be protected with restorative materials considered to be protective agents. An ideal material should have properties such as biocompatibility, be antimicrobial, be insoluble in the oral environment, be thermal and electrically insulating, have therapeutic potential, and adequate mechanical properties. As these characteristics are not found in all materials, the dentist must know the advantages and disadvantages of those that are available. This study aimed to perform a critical review of the indirect materials indicated for the protection of dentin-pulp vitality (PDPV) to ensure the success of indirect pulp treatment in primary teeth. A search was carried out in books, theses, dissertations, monographs, printed articles and databases, PubMed, SciELO, and MEDLINE. According to the literature, the success in protecting the dentin-pulp vitality is achieved through an excellent marginal seal, preventing bacterial infiltration in the dentin and controlling the progression of caries. Further clinical studies are needed to evaluate other outcomes after indirect pulp treatment. There isn’t a material that has all the desired characteristics for PDPV, and recent studies show that the key to PDPV isn’t found in the protective material, but in the restorations marginal sealing, enabling the inactivation of the progression of dental caries.

Downloads

Download data is not yet available.

References

Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective. Int J Paed Dent. 2019 May;29(3):238-48.

Dharmani CK, Pathak A, Sidhu HS. prevalence of traumatic dental injuries to anterior teeth in 8-12-year-old schoolchildren of Patiala City, Punjab, India: An Epidemiological study. Int J Clin Pediatr Dent. 2019 Jan-Feb;12(1):25-9.

Zaleckiene V, Peciuliene V, Aleksejüniené J, Drukteinis S, Zaleckas L, Brukiene V. Dental trauma experience, attitudes and trauma prevention in 11-to 13-year-old Lithuanian schoolchildren. Oral Health Prev Dent Oral Health Prev Dent. 2020;18(2):373–8.

Silva CC, Andrade DC, Edo MM, Leache EB. Agregado de trióxido mineral (MTA) Aplicações em odontopediatria. Revista da Ordem dos Médicos Dentistas. 2010 Ago;7:14-22.

Leinfelder KF. Changing restorative traditions: the use of bases and liners. J Am Dent Assoc. 1994 Jan;125(1):65-7.

Ritter AV, Swift Jr EJ. Current restorative concepts of pulp protection. Endod Topics. 2003 Feb;5(1):41-8.

Marchi JJ, Araújo FB, Fröner AM, Straffon LH, Nör JE. Indirect pulp capping in the primary dentition: a 4 year follow-up study. J Clin Pediatr Dent. 2006 Jan;31(2):68-71.

Freires IA, Cavalcanti YW. Proteção do complexo dentino-pulpar: indicações, técnicas e materiais para uma boa prática clínica. RBPS Braz J Health Res. 2011;13(4):69-80.

Santos PS, Pedrotti D, Braga MM, Rocha RO, Lenzi TL. Materials used for indirect pulp treatment in primary teeth: a mixed treatment comparisons meta-analysis. Braz Oral Res. 2017 Dec;31:e101.

Garcia FM, Braga MM, Mendes FM, Novaes TF, Matos R, Imparato JCP. Capeamento pulpar indireto com sistema adesivo e resina composta 42 meses de acompanhamento. J Health Sci Inst. 2009;27(4):417-21.

Hebling J, Ribeiro APD, Costa CAS. Relação entre materiais dentários e o complexo dentino-pulpar. Rev Odontol Bras Central. 2010;48(18):1-9.

Pashley DH, Carvalho RM. Dentine permeability and dentine adhesion. J Dent. 1997 Sep;25(5):355-72.

Ribeiro APD, Sacono NT, Soares DG, Bordini EAF, Costa CAS, Hebling J. Human pulp response to conventional and resin-modified glass ionomer cements applied in very deep cavities Clin Oral Investig. 2020 May;24(5):1739-48.

Peliz MIL, Duarte Jr S, Dinelli W. Scanning eléctron microscope analysis of internal adaptation of materials used for pulp protection under composite resin restorations. J Esthet Restor Dent. 2005;17(2):118-28.

Huang FM, Li YC, Lee SS, Chang YC. Cytotoxicity of dentine bonding agents on human pulp cells is related to intracellular glutathione levels. J Int Endod. 2010 Dec;43(12):1091-7.

Fuks AB. Vital pulp therapy with new materials for primary teeth: new directions and treatment perspectives. Pediatr Dent. 2008 May-Jun;30(3):211-9.

AAPD. American Academy on Pediatric Dentistry Clinical Affairs Committee-Pulp Therapy Subcommittee. Guideline on pulp therapy for primary and young permanent teeth. Pediatr Dent. 2008-2009;30(7 Sup-pl):170-4.

Silva AF, Piva E, Demarco FF, Correr L, Osinga PW. Microleakage in conventional and bonded amalgam restorations: influence of cavity volume. Oper Dent. 2006;31(3):377-83.

Casagrande L, Falster CA, Di Hipolito V, De Goés MF, Straffon LH, Nör JE, et al. Effect of adhesive restorations over incomplete dentin caries removal: 5-year follow-up study in primary teeth. J Dent Child. 2009 May-Aug;76(2):117-22.

Loguercio AD, Reis A, Minto AMP, Mandarino F. Agentes para proteção do complexo dentinopulpar: cimentos odontológicos. In: Reis A, Loguercio AD. Materiais dentários diretos: dos fundamentos à aplicação clínica, Ed. Santos: São Paulo; 2007. p.55-90.

Takanashi PT, Silva LMP, Komori PCP, Rode SM. Avaliação da indicação de materiais para proteção do complexo dentino-pulpar. Ciênc Odontol Bras. 2010;13(4):22-8.

Duque C, Hebling J, Smith AJ, Giro EM, Oliveira MF, de Souza Costa CA. Reactionary dentinogenesis after applying restorative materials and bioactive dentin matrix molecules as liners in deep cavities prepared in nonhuman primate teeth. J Oral Rehabil. 2006 Jun;33(6):452-61.

Filther AZ, Schrederhof VCV, Silva MAR, Piemonte MR, Lima CP, Kirchhoff AL, et al. A importância do complexo dentino pulpar no restabelecimento dentinário. Rev Gest Saúde. 2016;14(2):13-9.

Cruvinel DR, Garcia LFR, Consani S, Pires-de-Souza FCP. Composites associated with pulp-protection material: color-stability analysis after accelerated artificial aging. Eur J Dent. 2010 Jan;4(1):6-11.

Modena KCS, Casas-Apayco LC, Atta MT, Costa CAS, Hebling J, Sipert CR, et al. Cytotoxicity and biocompatibility of direct and indirect pulp capping materials. J Appl Oral Sci. 2009 Nov-Dec;17(6):544-54.

Tedesco TK, Calvo AF, Yoshioka L, Fukushima KA, Cesar PF, Raggio, DP. Does acid challenge affect the properties and bond stability of restorative materials on primary teeth? J Adhes Dent. 2018 May;20(3):223-31.

Goldman AS, Chen X, Fan M, Frencken JE. Cost‐effectiveness, in a randomized trial, of glass‐ionomer‐based and resin sealant materials after 4 yr. Eur J Oral Sci. 2016 Oct;124(5):472-9.

Pires-de-Sousa FCP, Contente MMMG, Casemiro LA. Cianoacrilato como protetor superficial de restaurações de cimento de óxido de zinco e eugenol e de cimento de ionômero de vidro: avaliação da infiltração marginal. Ciênc Odontol Bras. 2006;9(1):47-53.

Queiroz AM, Assed S, Leonardo MR, Nelson-Filho MR, Nelson-Filho P, Silva LAB. MTA and calcium hydroxide for pulp capping. J Appl Oral Sci. 2005 Apr-Jun;13(2):126-30.

Maltz M, Oliveira EF, Fontanella V, Bianchi R. A clinical microbiologic and radiographic study of deep carious lesions after incomplete caries removal. Quintessence Int. 2002 Feb;33(2):151-9.

Cut C, Zhou XN, Chen WM. Self-etching adhesives: possible new pulp capping agentes to vital pulp therapy. Front Med. 2011 Mar;5(1):77-9.

Silva GSQ, Raggio DP, Machado GFR, Mello-Moura ACV, Gimenez T, Floriano I, et al. Impact of different restorative treatments for deep caries lesion in primary teeth (CEPECO 1)–study protocol for a noninferiority randomized clinical trial. BMC Oral Health. 2019;19(1):6.

Franzon R, Casagrande L, Pinto AS, García-Godoy F, Maltz M, Araújo FB. Clinical and radiographic evaluation of indirect pulp treatment in primary molars: 36 months follow-up. Am J Dent. 2007 Jun;20(3):189-92.

Bjorndal L, Simon S, Tomson PL, Duncan HF. Management of deep caries and the exposed pulp. Int Endo J. 2019;52(7):949-73.

Schwendicke F, Frencken JE, Bjorndal L, Maltz M, Manton DJ, Ricketts D, et al. Managing carious lesions: consensus recommendations on carious tissue removal. Adv Dent Res. 2016 May;28(2):58–67.

Ricketts D. Management of the deep carious lesion and the vital pulp dentine complex. British Dent J. 2001 Dec;191(11):606-10.

da Rosa WLO, Lima VP, Moraes RR, Piva E, da Silva AF. Is a calcium hydroxide liner necessary in the treatment of deep caries lesions? - A systematic review and meta-analysis. Int Endod J. 2018 May;52(5):588-603.

Coll JA, Seale NS, Vargas K, Marghalani AA, Al Shamli S, Graham L. Primary tooth vital pulp therapy: a systematic review and meta-analysis. Pediatr Dent. 2017 Feb;39(1):16-27.

Schwendicke F, Gostemeyer G, Gludd C. Cavity lining after excavating caries lesions: meta-analysis and trial sequential analysis of randomized clinical trials. J Dent. 2015 Nov;43(11):1291-7.

Mathur V, Dhillon J, Logani A, Kalra G. Evaluation of indirect pulp capping using three different materials: a randomized control trial using cone-beam computed tomography. Indian J Dent Res. 2016 Nov-Dec;27(6):623-9.

Olmez A, Oztas N, Basak F, Sabuncuoglu B. A histopathologic study of direct pulp-capping with adhesive resins. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jul;86(1):98-103.

Büyükgüral B, Cehreli ZC. Effect of different adhesive protocols vs calcium hydroxide on primary tooth pulp with different remaining dentin thicknesses:24-month results. Clin Oral Investig. 2008 Mar;12(1):91-6.

Marchi JJ, Froner AM, Alves HLR, Bergman CP, Araújo FB. Analysis of primary tooth dentin after indirect pulp capping. J Dent Child. 2008 Sep-Dec;75(3):295-300.

Dalpian DM, Casagrande L, Franzon R, Dutra GMC, Araújo FB. Dentin microhardness of primary teeth undergoing partial carious removal. J Clin Ped Dent. 2012 Summer;36(4):363-7.

Pinto AS, Araújo FB, Franzon R, Figueiredo MC, Henz S, Garcia-Godoy F. Clinical and microbiological effect os calcium hydroxide protection in indirect pulp capping in primary teeth. J Dent. 2006 Dec;19(6):382-6.

Downloads

Published

2020-12-30

How to Cite

Bausen, A. G., Moulin, G. L., Cassano, K., Baldiotti, A. L. P., & Scarparo, A. (2020). Dentin-pulp protection in pediatric dentistry: a review. Revista Da Faculdade De Odontologia De Porto Alegre, 61(2), 113–121. https://doi.org/10.22456/2177-0018.103721

Issue

Vol. 61 No. 2 (2020)

Section

Review articles

License

All articles published in this journal adhere to Creative Commons License Attributions 4.0 (CC BY 4.0), and its use must be ruled by its licensed means. Authors are allowed to agree to additional and separate contracts for the non-exclusive distribution of the article published in this journal, such as publishing in an institutional repository, as long as the article has a recognition of authorship and first publication in this journal.