Shruti sood

JOE- Vol 39, No. 6, June 2013

INTRODUCTION
The application of biocompatible materials on exposed pulp protects the pulp-dentin complex against chemical irritation by operative procedures, toxicity of the material used, and bacterial penetration due to microleakage.

MTA has been used as an alternative to Ca(OH)2 as it stimulates the formation of dentin bridges faster leading to pulp healing and higher success rates.
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MTA is a bioactive, biocompatible, antibacterial material with unique stability and high sealing ability. However, MTA has many disadvantages long setting time poor handling properties high material costs the discoloration potential of dental tissue The addition of CaCl2 to MTA enables decreased setting time and improves mechanical properties.
JOE- Vol 39, No. 6, June 2013

Biodentine (Septodont, Saint Maur des Fosses, France) is a new calcium silicatebased restorative cement with dentin-like mechanical properties, which can be used as a dentin substitute on crowns and roots similar to how MTA is used.

JOE- Vol 39, No. 6, June 2013

AIM OF THE STUDY

The purpose of the present study was to evaluate the clinical, radiographic, and histologic responses of the pulp-dentin complex after direct capping with the new tricalcium silicatebased cement and MTA in human teeth.

JOE- Vol 39, No. 6, June 2013

MATERIALS AND METHODS

Twenty eight human caries free maxillary and mandibular third molars in 18 patients ranging in age from 1928 years.

Each tooth was radiologically examined to exclude the presence of caries or periapical pathology.

Thermal testing and electric sensitivity testing were performed to assess pulp vitality.

Teeth were cleaned and disinfected with 0.2% chlorhexidine .

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Occlusal Class I cavities were prepared by using round sterile diamond burs at high speed under airdistillated water spray coolant.

An exposure of approximately 1.2 mm in diameter was made with round carbide burs under air distillated water cooling.

Bleeding was controlled with saline irrigation, and a sterile cotton pellet was placed onto the pulp exposure sites.

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The teeth were divided into 3 groups, GROUP 1: Biodentine (n = 11) GROUP 2 : ProRoot White MTA (n = 11) GROUP 3 :1 control group (n = 6). Placement of final composite restoration was done after 7 days.

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CLINICAL EXAMINATION
Patients were asked about postoperative sensitivity or pain throughout the study period.
Thermal testing and electric sensitivity testing were performed to assess pulp health. Radiographs were taken before extraction to observe signs of periapical pathology.

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HISTOLOGICAL EXAMINATION
Specimens were fixed for 2 weeks in 10% buffered formalin solution. specimens were demineralized in a decalcifying solution containing 10% nitric acid and were embedded in paraffin. 2-3 micron-thick buccolingual sections of the paraffin-embedded teeth were stained with hematoxylin-eosin. Presence of stained bacteria was analyzed in the specimens along the cavity walls, within the cut dentinal tubules and the dental pulp.
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Samples were evaluated under an optical microscope( Carl Zeiss Imager D1Axio, Goettingen, Germany) connected to a high resolution video camera.
For continuity of the dentinal bridge 1 = complete dentin bridge formation 2 = partial/incomplete dentin bridge formation extending to more than one-half of the exposure site 3 = initial dentin bridge formation extending to not more than onehalf of the exposure site 4 = no dentin bridge formation
1 BIODENTINE MTA 6 7 2 5 4 3 0 0 4 0 0

JOE- Vol 39, No. 6, June 2013

For morphology of dentinal bridge, 1 = dentin or dentin associated with irregular hard tissue 2 = only irregular hard tissue deposition 3 = only a thin layer of hard tissue deposition 4 = no hard tissue deposition
1 Biodentine MTA 7 7 2 3 2 3 1 2 4 0 0

For thickness of dentinal bridge, 1 = >0.25 mm 2 = 0.10.25 mm 3 = <0.1 mm 4 = partial or absent bridge.
1 Biodentine MTA 4 5 2 4 3 3 3 3 4 0 0

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For type of pulp inflammation 1 = no inflammation 2 = chronic inflammation 3 = acute and chronic inflammation 4 = acute inflammation.
1 2 3 4

BIODENTINE
MTA

8
9

3
2

0
0

0
0

For intensity of pulp inflammation, 1 = absent or very few inflammatory cells 2 = mild, defined as an average of <10 inflammatory cells 3 = moderate, defined as an average of 1025 inflammatory cells 4= severe, defined as an average >25 inflammatory cells.
BIODENTINE MTA 8 9 3 2 0 0 0 0

JOE- Vol 39, No. 6, June 2013

For extensity of pulp inflammation, Biodentine 1 = absent MTA 2 = mild - inflammatory cells next to dentin bridge or area of pulp exposure 3 = moderate - inflammatory cells observed in part of coronal pulp 4 = severe - all coronal pulp is infiltrated or necrotic For odontoblastic layer, Biodentine 1 = palisade pattern of cells MTA 2 = odontoblast cells and odontoblast-like cells 3 = only odontoblast-like cells 4 = absent.
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1 8 9

2 2 1

3 1 1

4 0 0

1 2 2

2 6 7

3 3 2

4 0 0

For bacterial penetration, 1 = absence of stained bacterial profiles in any part of the sections 2 = presence of stained bacterial profiles along the coronal or apical walls of the cavity 3 = presence of stained bacterial profiles within the cut dentinal tubules or axial wall of the cavity 4 = presence of stained bacterial profiles within the dental pulp.
1 BIODENTINE MTA 11 11 2 0 0 3 0 0 4 0 0

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RESULTS
After treatment, 7 patients (4 with Biodentine and 3 with MTA) complained of spontaneous minor pain, mostly on the day of surgery. Histologic evaluation of teeth showed that both materials were well tolerated by the pulp tissue. The mean thicknesses of the hard-tissue dentin bridge in the Biodentine and MTA groups were 211.56 mm and 230.31 mm, respectively. Control group exhibited palisade columnar odontoblast cells, a zone of Weil, a cell-rich zone,and central pulp
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JOE- Vol 39, No. 6, June 2013

DISCUSSION
The findings of our study indicate that iatrogenic pulp defects treated with both calcium silicate cements are essentially free from inflammation and become covered with compact, dentin-like hard tissue bridges. Gorin C et al (2012) stated that both these cements induced an early form of reparative dentin synthesis, probably because of modulation of pulp cell transforming growth factorb1 secretion.

Broon NJ et al (2008) evaluated a combination of CaCl2 and MTA as a pulpotomy agent and described favorable results in calcified bridge formation
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Parirokh et al (2011) reported higher %age of inflammation and a lower %age of calcified bridge formation in MTA containing CaCl2 samples compared with MTA. Prevention of bacterial leakage into cavity preparations contributes to the longevity of cavity restorations . In the present study, an absence of bacteria in the stains may indicate that Biodentine and MTA have excellent sealing properties and prevent microleakage and pulpal inflammation by providing a predictable secondary barrier under the surface seal.
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CONCLUSION
Biodentine had a similar efficacy in the clinical setting and may be considered an interesting alternative to MTA in pulp-capping treatment during vital pulp therapy.

JOE- Vol 39, No. 6, June 2013

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JOE- Vol 39, No. 6, June 2013