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Modena Et Al. (2009) Cytotoxicity and Biocompatibility of Direct and Indirect Pulp Capping Materials
Modena Et Al. (2009) Cytotoxicity and Biocompatibility of Direct and Indirect Pulp Capping Materials
2009;17(6):544-54
www.fob.usp.br/jaos or www.scielo.br/jaos
1- DDS, Graduate student, Department of Operative Dentistry, Endodontics and Dental Materials, University of So Paulo, Bauru School of Dentistry,
Bauru, SP, Brazil.
2- DDS, MSc, PhD, Associate Professor, Department of Operative Dentistry, Endodontics and Dental Materials, University of So Paulo, Bauru
School of Dentistry, Bauru, SP, Brazil.
3- DDS, MSc, PhD, Associate Professor, Department of Physiology and Pathology, State University of So Paulo, Araraquara Dental School, Araraquara,
SP, Brazil.
4- DDS, MSc, PhD, Associate Professor, Department of Orthodontics and Pediatric Dentistry, State University of So Paulo, Araraquara Dental
School, Araraquara, SP, Brazil.
5- DDS, MSc, Graduate student, Department of Biological Sciences, University of So Paulo, Bauru School of Dentistry, Bauru, SP, Brazil.
6- DDS, MSc, PhD, Full Professor, Department of Operative Dentistry, Endodontics and Dental Materials, University of So Paulo, Bauru School of
Dentistry, Bauru, SP, Brazil.
7- DDS, MSc, PhD Associate Professor, Department of Biological Sciences, University of So Paulo, Bauru School of Dentistry, Bauru, SP, Brazil.
Corresponding address: Maria Teresa Atta, Disciplina de Dentstica - Alameda Dr. Octvio Pinheiro Brizolla, 9-75 - 17012-901 - Vila Cidade Universitria
- Bauru, SP - Brazil - Fone: +55-14-3235-8358 - Fax: +55-14-3235-8523 - E-mail: tereatta@usp.br
Received: October 8, 2008 - Modification: January 19, 2009 - Accepted: 27 May, 2009
ABSTRACT
here are several studies about the cytotoxic effects of dental materials in contact with the pulp tissue, such as calcium hydroxide
(CH), adhesive systems, resin composite and glass ionomer cements. The aim of this review article was to summarize and discuss
the cytotoxicity and biocompatibility of materials used for protection of the dentin-pulp complex, some components of resin composites
and adhesive systems when placed in direct or indirect contact with the pulp tissue. A large number of dental materials present
cytotoxic effects when applied close or directly to the pulp, and the only material that seems to stimulate early pulp repair and dentin
hard tissue barrier formation is CH.
Key words: Cytotoxicity. Dental pulp capping. Fibroblasts. Odontoblasts.
INTRODUCTION
The main purpose of restorative dentistry is to restore
and maintain tooth health by an adequate restorative
treatment in order to protect and re-establish pulp function.
Pulp plays an important role in the formation and nutrition
of dentin as well as in the inervation and defense of the
teeth (Figure 1).
The primary pulp function is dentin formation, which
begins in the moment that the peripheric mesenchimal cells
differentiate into odontoblasts and starts the deposition of
collagen matrix, in a sequence of deposition/mineralization
that ends with the complete tooth formation. Even after the
initial formation, pulp continues to physiologically produce
dentin due to the tooth aging. Reparative dentin may also
be produced in response to physical and/or chemical injuries.
Odontoblasts maintain their processes inside the newly
formed tissue, thus creating real channels that are responsible
544
LITERATURE REVIEW
Pulp damage and repair
Pulp tissue is constantly subjected to environmental
impacts. These potential aggressions include microbial
toxins, heat, mechanical trauma, restorative materials,
cleaning solutions and cavity liner cements. Following
various injuries, pulp cells have the intrinsic capacity to
repair, differentiate into odontoblasts and produce various
dentin matrix proteins during wound healing11. Thus, not all
the inflammatory reaction results in permanent damage.
Some studies have shown that gingival38,51 and pulp5,13,84
fibroblasts can secret many types of cytokines in response
to various stimuli in the same manner as odontoblasts,
endothelial cells and immune cells27,65,78,82. Cytokines are
proteins secreted by innate or adaptative immune cells that
act stimulating these cells. Different cytokines are produced
in response to microorganisms and other stimuli, triggering
several responses in immune and inflammatory cells. Some
cytokines have structural homology that stimulate leukocyte
dislocation and regulate the migration of blood to the tissue,
which are denominated chemoattractant cytokines. These
are produced by various cell types in response to
inflammatory stimuli, and consequently recruit leukocytes
to the inflammation area1. Some studies have shown that
pulp fibroblasts are real sources of chemokines59,61,85.
When the injury is removed before pulp damage, a repair
process begins81 and collagen synthesis is accellerated in
this phase 62. The deposition of collagen in the pulp tissue is
increased by the action of cytokines. Collagen synthesis can
be improved by transforming growth factor (TGF)-1 and
TGF-2 and interleukin (IL)-15,11. Fibroblasts at an
inflammatory microenviroment deposit collagen in a
remarkable amount during the inflammatory process as
opposed to normal conditions5. The collagen synthesis by
fibroblasts during the inflammatory process is a key event
for human pulp repair11.
545
1
FIGURE 1- General view of the dentin-pulp complex. Below
the tubular dentin (D) there is the predentin (Pd), which is
underlined by the odontoblast layer (Od). Observe the cellfree zone of Weil horizontal arrow) and the cell-rich zone
(vertical arrows). HE, 64
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548
549
550
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CONCLUSION
Based on this literature review, it may be concluded that:
1. Calcium hydroxide products are the best choice for
conservative treatment of the pulp due to their therapeutic
and biological potential and the property of stimulating the
formation of sclerotic and reparative dentin as well as
protecting the pulp against thermal stimuli.
2. Monomers present in resin composites and adhesive
systems (e.g.: BISGMA, UDMA, TEGDMA, HEMA) have
been shown to have cytotoxic effects as a consequence of
direct contact with fibroblasts and may be leached during
the polymerization when the conversion degree is not fully
reached.
3. In human pulps, direct pulp capping with adhesive
systems produces different degrees of pulp inflammation,
even without bacterial presence and absence of dentin bridge
formation as well as pulp repair. Some studies support the
idea that when hermetic seal of cavity is obtained, the dentinpulp complex protection materials are unnecessary and they
not influence the pulp repair, but hermetic seal of the
restoration is difficult to be obtained.
4. RMGICs are more cytotoxic to the pulp cells than
conventional GICs due to the presence of unpolymerized
monomers, and should not be applied directly to the pulp
tissue.
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