Pulp capping with mineral trioxide aggregate or Biodentine: a comparison of mineralized barrier formation and inflammatory and degenerative events

Reis, Magda de Sousa; Scarparo, Roberta Kochenborger; Signor, Bruna; Bolzan, Juliana Troglio; Steier, Liviu; Figueiredo, José Antonio Poli de

doi:10.1590/1807-3107bor-2021.vol35.0118

Magda de Sousa Reis

Universidade de Santa Cruz do Sul – Unisc, Department of Health Sciences, Santa Cruz do Sul, RS, Brazil.

http://orcid.org/0000-0001-9378-8535

Roberta Kochenborger Scarparo Corresponding Author: Roberta Kochenborger Scarparo, E-mail: roberta.scarparo@ufrgs.br

Universidade Federal do Rio Grande do Sul – UFRGS, School of Dentistry, Department of Conservative Dentistry, Porto Alegre, RS, Brazil.

http://orcid.org/0000-0003-1171-0457

Bruna Signor

Universidade Federal do Rio Grande do Sul – UFRGS, School of Dentistry, Department of Conservative Dentistry, Porto Alegre, RS, Brazil.

http://orcid.org/0000-0003-0030-1236

Juliana Troglio Bolzan

Pontifícia Universidade Católica do Riio Grande do Sul – PUCRS, Clinical Department, Porto Alegre, RS, Brazil.

http://orcid.org/0000-0003-1391-2423

Liviu Steier

University of Pennsylvania, School of Dental Medicine, Division of Restorative Dentistry, Philadelphia, PA, USA.

http://orcid.org/0000-0002-0937-9147

José Antonio Poli de Figueiredo

Universidade Federal do Rio Grande do Sul – UFRGS, School of Dentistry, Department of Conservative Dentistry, Porto Alegre, RS, Brazil.

http://orcid.org/0000-0002-8113-9260

Corresponding Author: Roberta Kochenborger Scarparo, E-mail: roberta.scarparo@ufrgs.br

Declaration of Interests: The authors certify that they have no commercial or associative interest that represents a conflict of interest in connection with the manuscript.

Figures (4)
Tables (3)

Thumbnail

Figure 1
Flowchart showing the study design. A total of 80 animals were divided according to the experimental procedures and periods (n=8 per group/period).

Thumbnail

Figure 2
Inflammatory events after 14 and 21 days of pulp capping. Significant differences amongst groups (indicated by different letters) were assessed by Kruskal-Wallis and Dunn's post hoc tests at a significance level of.05. Significant differences in inflammation intensity (A) and extension (B) comparing the test groups with the positive control (1807-3107-bor-35-e118p< 0.0001) were observed. In the 21-day experimental period, samples capped with Biodentine alone (Biodentine group) showed more intense inflammatory infiltrate compared to the ones capped with Biodentine and sealed with silver amalgam (Biodentine/SA group) (**p< 0.01). (C) Sample capped with gutta-percha and sealed with SA showing abscess formation (*) and intense inflammatory infiltrate extending as far as the root canal middle third (arrow) after 21 days (H/E) Samples capped with MTA (D) and Biodentine (E) and sealed with SA 14 days after treatment. Note that the inflammatory infiltrate is limited to the coronal portion of the root (arrows) (H/E). (F) Sample capped and sealed with Biodentine showing intense inflammatory infiltrate (*) (H/E) associated with loss of coronal seal. (G) Radiographic and clinical image showing the loss of coronal seal.

Thumbnail

Figure 3
Degenerative events observed after capping procedures. (A) Significant differences were observed when test groups were compared with the positive control at both 14 (P< 0.05) and 21 days (P< 0.01). (B) Untreated teeth served as control for the absence of pulp inflammation and/or degeneration, characterized by abundant cell content (H/E). (C) Sample capped with gutta-percha and sealed with SA 14 days after the procedures showing hyalinized area and reduction of dental pulp cell content (arrows) (H/E). (D) Specimen capped with MTA and sealed with SA at 21 days presenting pulp calcification (*) and fibrous condensation (arrows) (H/E). (E) Pulp stones (Δ) and tissue hyalinization in a sample capped with Biodentine and sealed with SA at 21 days after treatment (H/E) (F) Specimen capped and sealed with Biodentine alone presenting both inflammatory infiltrate (*) and degenerative events (arrows) associated with loss of coronal seal after 21 days (H/E).

Thumbnail

Figure 4
(A) Scores for pulp bridge formation after capping procedures. All test groups showed significant differences as compared to the control (P< 0.0001); (B) Sample capped with gutta-percha showing pulp necrosis (*) and absence of hard tissue barrier after 21 days (H/E); (C) healed and well-vascularized tissue (Δ) associated with pulp bridge formation (arrows) at 21 days after pulp capping with MTA/SA (H/E); (D) Sample capped with Biodentine and sealed with silver amalgam at 14 days presenting thick and completely formed hard tissue barrier (arrows) (H/E); (E) Sample capped and sealed with Biodentine showing almost complete hard tissue barrier (arrows) after 14 days (H/E).

Thumbnail

Table 1
Qualitative criteria for restoration following pulpotomy.

Thumbnail

Table 2
Scoring system for pulpal procedures and tissue response.

Thumbnail

Table 3
Evaluation of restorative material (Silver amalgam and Biodentine) following pulpotomy.

Restoration quality	Description
Intact	Intact restorative material within cavity or slight recession
Recessed	Evident recession of dental material and restoration compromised by fracture
Absent	Restorative material not visible within cavity

Scores	Inflammation pulp intensity
1	Absence of inflammation.
2	Mild inflammatory infiltration, predominantly mononuclear, restricted by fibercondensation; underlying tissue with sparse inflammatory cells.
3	Moderate inflammatory infiltrate, with infiltrates of mononuclear cells, or with sparse neutrophils and/or eosinophils, restricted by condensation fibers.
4	Moderate inflammatory infiltrate, with infiltrates of mononuclear cells, or with sparse neutrophils and/or eosinophils, not restricted by condensation fibers.
5	Severe inflammatory infiltrate, with tissue necrosis or abscess, with predominance of neutrophils and/or eosinophils, or a mononuclear infiltrate extending towards the whole pulp tissue.
Scores	Inflammation pulp (extension)
1	Absence of inflammation.
2	Inflammation restricted to area of exposed pulp.
3	Inflammation restricted the access of the root canals.
4	Inflammation affecting the cervical third of the root canals.
5	Inflammation affecting the middle and apical third.
Scores	Degenerative events
1	Slight fiber condensation; underlying tissue with slightly condensed extracellular matrix.
2	Moderate fiber condensation; underlying tissue with presence of slightly condensed extracellular matrix, displaying small areas of hyalinization.
3	Moderate fiber condensation; underlying tissue altered by condensed extracellular matrix (with small areas of hyalinization) and small clusters of calcium degeneration (not related to odontoblastic layer).
4	Extensive hyalinization areas and/or calcific degeneration towards pulp chamber and radicular pulp.
5	Total or partial pulp degradation
Scores	Dentin bridge
1	Complete dentin bridge formation (regular and thick) at the exposure area.
2	Incomplete dentin bridge formation (irregular or thin) at the exposure area.
3	Complete or incomplete dentin bridge together with osteodentin at the exposure area
4	Complete or incomplete dentin bridge together with osteodentin at the exposure area and invading root canal.
5	Absence of dentin bridge

Periods	Groups (n = 8)	Intact	Recessed	Absent
14 days	Gutta/SA	6	2	–
	MTA/SA	8	–	–
	Biodentine/SA	8	–	–
	Biodentine	2	3	3
21 days	Gutta/SA	6	2	–
	MTA/SA	8	–	–
	Biodentine/SA	8	–	–
	Biodentine	1	4	3

[1] Corresponding Author: Roberta Kochenborger Scarparo, E-mail: roberta.scarparo@ufrgs.br

Brasil

Brasil

Pulp capping with mineral trioxide aggregate or Biodentine: a comparison of mineralized barrier formation and inflammatory and degenerative events

Abstract: