Clinical Research
Tomographic Evaluation of Reparative Dentin Formation
after Direct Pulp Capping with Ca(OH)2, MTA, Biodentine,
and Dentin Bonding System in Human Teeth
_
Alicja Nowicka, DDS, PhD,* Grazyna Wilk, MD, PhD,† Mariusz Lipski, DDS, PhD,‡
Janusz Ko1ecki, MD, PhD,† and Jadwiga Buczkowska-Radlinska, DDS, PhD*
Abstract
Introduction: New materials can increase the efficiency
of pulp capping through the formation of a complete
reparative dentin bridge with no toxic effects. The pre-
sent study involved tomographic evaluations of repara-
tive dentin bridge formation after direct pulp capping
with calcium hydroxide, mineral trioxide aggregate
(MTA), Biodentine (Septodont, Saint Maur des Fosses,
France), and Single Bond Universal (3M ESPE, Seefeld,
Germany) in human teeth. Methods: Forty-four
caries-free, intact, human third molars scheduled for
extraction were subjected to mechanical pulp exposure
and assigned to 1 of 4 experimental groups depending
on the pulp capping agent used: calcium hydroxide,
MTA, Biodentine, or Single Bond Universal. After
6 weeks, the teeth were extracted and processed for
cone-beam computed tomographic imaging and histo-
logic examination. Tomographic data, including the den-
sity and volume of formed reparative dentin bridges,
were evaluated using a scoring system. Results: The
reparative dentin formed in the calcium hydroxide,
MTA, and Biodentine groups was significantly superior
to that formed in the Single Bond Universal group in
terms of thickness and volume. The dentin bridges in
the Biodentine group showed the highest average and
maximum volumes. The mean density of dentin bridges
was the highest in the MTA group and the lowest in the
Single Bond Universal group. Conclusions: The volume
of reparative dentin bridges formed after direct pulp
capping is dependent on the material used. Biodentine
and MTA resulted in the formation of bridges with a
significantly higher average volume compared with Sin-
gle Bond Universal, and cone-beam computed tomo-
graphic imaging allowed for the identification of the
location of dentin bridges. (J Endod 2015;-:1–7)
From the Departments of *Conservative Dentistry, †General and Dental Radiology, and ‡Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian
Medical University, Szczecin, Poland.
Address requests for reprints to Dr Alicja Nowicka, Department of Conservative Dentistry, Pomeranian Medical University, Al.Powstancow Wlkp. 72, 70–111
Szczecin, Poland. E-mail address: nowicka6@gmail.com
0099-2399/$ - see front matter
Copyright ª 2015 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2015.03.017
JOE — Volume -, Number -, - 2015
Key Words
Biodentine, calcium hydroxide, cone-beam computed tomographic imaging, direct pulp
capping, mineral trioxide aggregate, Single Bond Universal
T he most visible reparative response to pulp exposure is the deposition of repar-
ative dentin that provides odontoblasts and other pulp cells and protection
against harmful stimuli (1, 2). Reparative dentin formation can be affected by the
pulp capping material, the degree of mechanical injury, and inflammatory and
bacterial leakage (3). Currently, none of the commercially available direct pulp
capping materials fulfills all the requirements of dentists despite rapid progress
in the field (4–7). Calcium hydroxide (Ca[OH]2) remains the gold standard for
the management of pulp exposure because of its potent antibacterial properties
and its ability to stimulate reparative dentin formation and, consequently, pulp
healing (2, 6, 8, 9). However, Ca(OH)2 is reported to dissolve over time, and
dentin bridges adjacent to the material may contain multiple tunnel defects that
open into the underlying pulp (5, 10–14).
Recent studies showed that other materials and strategies may increase the effi-
ciency of pulp capping through the formation of a complete reparative dentin bridge
with no chemical toxic effects, thus providing better results than those provided by
Ca(OH)2 (12–15). Mineral trioxide aggregate (MTA) is characterized by improved
sealing properties and a greater ability to stimulate reparative dentin formation
compared with Ca(OH)2; however, it has the disadvantages of difficult handling and
application, a longer binding duration, and a relatively high cost (4, 5, 8, 12–14).
Several attempts to improve the binding reaction of MTA by the addition of various
accelerators and modifiers have been made to provide novel materials that can be
effectively used for direct pulp capping (4, 13). Biodentine (Septodont, Saint Maur
des Fosses, France) is a new material based on calcium silicates and has properties
similar to those of Ca(OH)2 and MTA; furthermore, it overcomes some limitations of
the latter 2 preparations (14–16). Previous in vitro and in vivo studies confirmed
that Biodentine has a positive effect on pulp cells and promotes reparative dentin
formation in a manner similar to MTA (14–19).
In recent years, dentin bonding systems have also been investigated (5–7, 20, 21)
as potential direct pulp capping materials because of their superior adhesion to
demineralized dentin tissues. Single Bond Universal (3M ESPE, Seefeld, Germany)
represents the next generation of bonding systems available to dentists, the so-called
universal systems (7, 22). Application of this material on the dentin surface results
in the formation of a hybrid layer, with superior chemical bonding of the monomer
Direct Pulp Capping with Ca(OH)2, MTA, and Biodentine 1
Clinical Research
10-methacryloxydecyl dihydrogen phosphate to hydroxyapatite (23).
However, the effectiveness of this system in reparative dentin formation
after application to exposed pulp remains to be elucidated.
Although the histologic evaluation of dentin bridge sections is
commonly accepted as the gold standard, cone-beam computed
tomographic (CBCT) imaging represents an innovative and noninva-
sive technique that offers the possibility of studying dental tissue
without the need to destroy it (24–27). In addition, 3-dimensional
reconstruction of CBCT images eliminates the superimposition of sur-
rounding structures (24).
The present study aimed to conduct tomographic evaluations of
reparative dentin bridges formed after direct capping with Ca(OH)2,
MTA, Biodentine, and Single Bond Universal in human teeth to verify
the null hypothesis that there is no difference in the quantity and quality
of reparative dentin formation between the evaluated materials used for
direct pulp capping in human teeth.
Materials and Methods
Operative Procedure
The study was conducted in accordance with the tenets of the
Declaration of Helsinki. Forty-four caries-free, intact, maxillary and
mandibular third molars from 21 humans aged 19–32 years (mean
26 years) scheduled for extraction for orthodontic or surgical purposes
were included. Patients received a thorough explanation of the experi-
mental rationale, clinical procedures, and possible complications. All
the patients gave their informed consent. All experimental protocols
were reviewed and approved by the Local Ethics Committee of Pomer-
anian Medical University, Szczecin, Poland (approval number KB–
0012/39/11).
A standardized therapeutic procedure was used. According to the
operative protocol, each tooth was radiologically examined to exclude
the presence of caries or periapical pathology. Thermal testing
(K€altespray; M&W Dental, GmbH, B€udingen, Germany) and electric
sensitivity testing (Vitality Scanner pulp vitality tester; SybronEndo, Or-
ange, CA) were performed to assess pulp vitality. The teeth were me-
chanically cleaned and disinfected with 0.2% chlorhexidine solution
before cavity preparation. After the induction of local anesthesia and
application of a rubber dam, occlusal class I cavities were prepared us-
ing sterile round diamond burs at a high speed under air–distilled water
cooling. An exposure measuring approximately 1.2 mm in diameter was
created using round carbide burs under air–distilled water cooling.
New burs were used for each procedure. Bleeding was controlled
with saline irrigation, and a sterile cotton pellet was placed on the
site of pulp exposure.
The teeth were randomly divided into 4 groups (n = 11 each) de-
pending on the pulp capping material used. In group 1 (CH group), the
exposed pulp and surrounding dentin were capped with Ca(OH)2
pastes Calcipast (Cerkamed, Stalowa Wola, Poland), Life (Kerr Hawe,
Salerno, Italy), and Single Bond Universal with Filtec Ultimate (3M
ESPE) according to the manufacturer’s recommendations. In group 2
(MTA), the exposed pulp and surrounding dentin were capped with
ProRoot White MTA (Dentsply, Tulsa Dental, Tulsa, OK) according to
the manufacturer’s recommendations. After MTA application, the oper-
ator laid a flat, water-moistened cotton pellet directly over the material
and provisionally restored the tooth with glass ionomer cement (Ketac
Molar, 3M ESPE). In group 3 (BIO), the exposed pulp was capped with
Biodentine according to the manufacturer’s recommendations. Bio-
dentine was also used for the temporary restoration so that the entire
cavity was filled with bioactive cement. Patients in both groups 2 and
3 returned to the clinic for clinical examination and final composite
restoration after 7 days. The operator additionally verified the setting
2 Nowicka et al.
of MTA. In group 4 (SBU), the exposed pulp and surrounding dentin
were capped with Single Bond Universal with Filtec Ultimate according
to the manufacturer’s recommendations.
Six weeks after application of the pulp capping material, all teeth
were extracted with minimum trauma by a designated oral surgeon. The
extracted teeth were then subjected to CBCT imaging and light micro-
scopy as described later.
Light Microscopy
After fixation for 2 weeks in 10% buffered formalin solution, the
extracted specimens were demineralized in nitric acid and embedded
in paraffin. Two- to 3-mm-thick serial sections cut in the lingual-
buccal plane were stained with hematoxylin-eosin (H&E). The Brown
and Brenn technique was used to stain bacteria. Coded samples were
used throughout the study to avoid possible bias. Qualitative and quan-
titative histopathological analyses were performed on the H&E-stained
specimens using an optical microscope (Imager D1 Axio; Carl Zeiss,
Goettingen, Germany) connected to a high-resolution video camera
(Axio Cam MRc5; Carl Zeiss Microimaging, Thornwood, NY). Examina-
tions were performed under normal and ultraviolet (UV) light using 38
HE (eGFP) and 43 HE (Cy 3) filters (Carl Zeiss, Goettingen, Germany)
by an experienced examiner. The amount of hard tissue formation at the
interface of the capping material was analyzed using the previously
described criteria (16).
CBCT Imaging
CBCT images (Cranex 3D, No. SE 1100155, Software Version Sca-
nora 5.1.0.9; Soredex, Tuusula, Finland) were obtained to identify
reparative dentin bridges on original and multiplanar reconstruction
images using the dedicated OnDemand3D App 1.0.9.1343 software
(Soredex, Tuusula, Finland) (Fig. 1A). Subsequently, a serial profile
of the dentin bridge formed from the coronal (the first virtual slice)
to the cervical sections (last virtual slice) was ascertained using
0.133-mm axial slices of the tooth; this allowed for the calculation of
the estimated thickness. A series of axial images showing the mineral-
ized reparative tissues formed over the exposed pulp are shown in
Figure 1B.
The Osirix (Version 4.1.2.32 bit; Pixmeo, Geneva, Switzerland)
software was used to analyze the axial images, and the findings from
the axial and multiplanar reconstruction images were compared with
those of histologic examinations. The width (contrast) and level (bright-
ness) of the window (approximately 2000/4500) were used to precisely
show the plane of the formed bridge, and it was ensured that this plane
was consistent with that on the representative histologic section of the
thickest reparative dentin bridge (Fig. 2A). The use of the UV filter shave
allowed for further clarification of the dimensions of the bridge
(Fig. 2A1 and A2). The boundary between the dentin bridge and
pulp tissue was established using the upper limit of the pulp density
and was confirmed from the peak on an individual histogram for
each specimen (Fig. 2B). Then, the dimensions of the dentin bridge ob-
tained from histologic examination were transferred to a CBCT image to
determine the boundary between the dentin bridge and the filling.
Points were located individually for each tooth at the lower limit of
the density values to eliminate artifacts. After merging the points, an
arc depicting the limiting surface was plotted and used to ascertain
the density of the dentin bridge.
To evaluate the characteristics of each tooth, the densities of the
pulp; young dentin, which was located immediately proximal to the
pulp; and mature dentin, which was located external to the young
dentin, were determined. The density of young dentin was determined
by drawing an ellipse with a surface area of 500,000 mm2. Mature
JOE — Volume -, Number -, - 2015

Figure 1. Identification of reparative dentin tissues formed after direct pulp capping with Ca(OH)2. (A) Original and multiplanar reconstruction images obtained
using CBCT imaging and the dedicated OnDemand3D App 1.0.9.1343 software. (B) A series of axial images showing the newly calcified barrier under Ca(OH)2.
dentin could be observed in the area immediately adjacent to young
dentin (Fig. 2B).
The area of the dentin bridge was encircled on each reconstructed
layer to establish the spatial structure and calculate the volume using the
aforementioned principle and Osirix software. The resulting surfaces
were compared with images of histologic sections of successive tooth
layers. Thus, areas of the dentin bridge (regions of interest) obtained
were summed up to derive the volume (Fig. 2C–F).
The volume of the bridge was measured and assigned to 4 groups
according to the authors’ classification: 1, no dentin or unmeasurable
volume of dentin; 2, low volume (<0.1 mm3); 3, moderate volume
(0.1–0.5 mm3); and 4, high volume (>0.5 mm3). Because the mini-
mum measurable distance was limited by tomography resolution,
very small bridges were measurable only on histologic images.
Statistical Analysis
All continuous variables were checked for normality of distribu-
tion using the Kolmogorov-Smirnov test. Statistical differences between
the 2 groups were identified using the Student t test and the Mann-
Whitney U test. Analysis of variance and the Kruskal-Wallis test were
applied for analysis of the groups. Any correlations between discrete
variables were studied using the Pearson chi-square test and the Fisher
exact test. Differences were considered statistically significant at P < .05.
Results
Light Microscopy
Clinically, pulp capping success was found in all teeth after 6
weeks. No detectable periradicular radiographic changes were
JOE — Volume -, Number -, - 2015
Clinical Research
observed. Teeth from all groups responded positively to electric pulp
testing immediately before extraction.
Histologic examinations revealed the formation of 37 dentin
bridges. The maximum and average thicknesses of the dentin bridges
are shown in Figure 3. Ca(OH)2, MTA, and Biodentine actively initiated
the formation of reparative dentin in each tooth (n = 11), whereas Sin-
gle Bond Universal was significantly less active and induced the forma-
tion of 2 small (Fig. 4C) and 2 very small bridges (n = 4). At high
magnification, the reparative hard tissues in the CH and SBU groups
had an uneven thickness and exhibited porosities and tunnel defects
(Figs. 2A2 and 4C), whereas those in the MTA and BIO groups were
thicker and more homogeneous with minimal tunnel defects (Fig. 4A
and B). The thickness of the dentin bridges in the Ca(OH)2, MTA,
and BIO groups was significantly greater than that in the SBU group,
whereas there were no significant differences among the CH, MTA,
and BIO groups There was no bacterial staining in any section.
CBCT Imaging
The average densities of young dentin, mature dentin, dentin
bridges, and pulp in the 4 groups are shown in Figure 5. Mature dentin
had the highest average density (2275.5) followed by young dentin
(1714.0), dentin bridges (1179.1), and pulp (160.6). The largest dif-
ference in density of the tissue was observed in young dentin and dentin
bridges, whereas the smallest difference was observed in mature dentin
and pulp.
The highest and lowest average densities of dentin bridges were
recorded in the MTA (1253.9) and SBU groups (1076.0), respectively,
whereas the values in the CH and BIO groups were similar. However,
statistically significant differences (Mann-Whitney U test) were observed
Direct Pulp Capping with Ca(OH)2, MTA, and Biodentine 3
Clinical Research

Figure 2. Frontal reconstructed CBCT images showing the dentin bridge formed after direct pulp capping with calcium hydroxide (A, A1, and A2) histologic
specimens. (A) The dentin bridge contains particles of the material (H&E; original magnification, 50). (A1) The same image seen through the 38 HE
(eGFP) filter. (A2) A higher magnification of A seen through the 43 HE (Cy 3) filter (original magnification, 400). (B) Measurement of densities and histograms
for the pulp (1), dentin bridge (2), young dentin (3), and mature dentin (4). (C and D) Spatial model of a dentin bridge. (E and F) The same model presented in
several planes. D, dentin; DB, dentin bridge; P, pulp; open arrowheads, tunnel defect.

between the MTA and CH groups (P = .011). Particularly large differ-
ences in density and structure were observed among the dentin bridges
formed in the CH and SBU groups (Figs. 2 and 4C).
Tomographic evaluations confirmed the presence of 25 bridges
out of the 37 identified by histology. The results for all specimens are
provided in Table 1 and Figures 1 and 4. The volume of reparative
dentin formed was moderate in the Ca(OH)2 group and moderate to
high in the MTA and BIO groups, with no significant differences
between the latter 2 groups. In the SBU group, only 2 bridges with a
small volume were identified. Reparative tissue with radiolucent
tunnel defects is visible in Figure 4C. Significant differences in dentin
bridge volume were observed between the CH, MTA, and BIO groups
and the SBU group (Table 1). Notably, the reparative dentin bridges
in the BIO group showed the highest average and maximum volumes
compared with that in the other 3 groups (Table 2). Biodentine and
MTA resulted in the formation of bridges with a significantly higher
average volume compared with Single Bond Universal.

Discussion
To our knowledge, the present study is the first to assess reparative
dentin formation using CBCT imaging in relation to the gold standard,
which is histologic examination. CBCT images allow the acquisition of 3-
dimensional images of dentin bridges and enable their qualitative
assessment (24, 26, 28). The results of our study showed that
Ca(OH)2, MTA, Biodentine, and Single Bond Universal had different
degrees of influence on dentin bridge formation, with the former 3
positively affecting the exposed pulp and actively initiating the
Figure 3. The mean and maximal thickness values of dentin bridges in the 4 formation of reparative dentin in each tooth and the latter one
groups. resulting in the formation of significantly lesser dentin bridges of a

4 Nowicka et al. JOE — Volume -, Number -, - 2015


Figure 4. Histologic images and spatial model of a dentin bridge after direct pulp capping with (A, A1, A2, and A3) MTA, (B, B1, B2, and B3) Biodentine, and
Single Bond Universal (C, C1, C2, and C3). (A–C) The dentin bridge (H&E; original magnification, 25). (A1, B1, and C1) Higher magnification seen through the
38 HE (eGFP) filter (original magnification, 50). (A2, B2, and C2) Higher magnification seen through the 43 HE (Cy 3) filter (original magnification, 400). D,
dentin; DB, dentin bridge; P, pulp. Open arrowhead indicates the tunnel defect.
lower quality, thickness, and volume. Therefore, the null hypothesis that
there is no difference in the quantity and quality of reparative dentin
bridges formed after direct pulp capping with these different
materials in humans is rejected.
The disadvantage of CBCT imaging is a lower contrast and higher
background noise (28, 29). Crown nodules, fillings, and dentures
result in artifacts on CBCT imaging in addition to local band beam-
hardening artifacts of ‘‘cupping’’; therefore, it is necessary to define
an algorithm to eliminate these artifacts (25). In our study, to eliminate
artifacts from the CBCT images, each tooth was scanned separately.
Furthermore, we used a standardized methodology to identify and
determine the spatial structure of the dentin bridges. For best visualiza-
tion of the dentin bridge, we used the parameters of width and window
level and ensured that the plane was compatible with that on the repre-
sentative histologic section of the thickest dentin bridge. Dentin bridges
with the highest average and maximum volumes were formed after the
use of Biodentine followed by the use of MTA, Ca(OH)2, and Single Bond
Universal. Unfortunately, these results could not be compared with
those of other studies because of the lack of relevant literature.
Evaluation of tooth mineralization is crucial for understanding the
repair and pathological processes occurring in the pulp. Although the
CBCT diagnostics used in this study have sensitivity lower than that of
light microscopy, they can provide additional information on tertiary
dentin mineralization (24, 26, 28). The authors observed regions
with different levels of mineralization on CBCT images, which is not
possible in demineralized histologic sections. Histograms were
JOE — Volume -, Number -, - 2015
Clinical Research
plotted to facilitate data analysis and determine the distribution of
gray tones in the images, which helps in assessing the homogeneity of
the structure and mineralization of the dentin bridge (28).
In previous studies (10, 30), micro–computed tomographic
images obtained 4 months after direct pulp capping with Ca(OH)2,
MTA, and white Portland cement in baboons showed the presence of
tissue resembling osteodentin, which was suggested by the
researchers to be the result of dystrophic calcification. Compared
with these studies (10, 30), our study obtained better results in
terms of the quality of tissue repair. Ca(OH)2 induced the formation
of a thick but very porous reparative dentin bridge (10). This porosity
may facilitate the entry of bacteria into pulp (3, 11, 14). Particularly
large variations in density were observed among the dentin bridges
formed in the SBU and CH groups. These variations, along with those
in the structure of the dentin bridges, can be attributed to the content
of particulate material in the reparative tissues, as observed in the
histologic sections. The particles of material present in the dentin
bridge tissue can also affect the growth of density values. Micro–
computed tomographic imaging, which was used in previous studies
(10, 30), ensures a high-resolution and consistent phenotype and is
more accurate than CBCT imaging. Unfortunately, because of the high
doses of radiation, this modality cannot be used in in vivo studies (29).
The ability of Ca(OH)2, MTA, and Biodentine to induce the forma-
tion of reparative dentin bridges in rat (14) and pig (15) pulp injury
models was previously investigated. A significant difference was
observed at 7 days after pulp capping between Biodentine and
Direct Pulp Capping with Ca(OH)2, MTA, and Biodentine 5
Clinical Research

Figure 5. Mean values of the density for the mature dentin, young dentin, dentin bridge, and pulp in the 4 groups.

Ca(OH)2 (15) although at 28 and 90 days there was no significant dif-
ference between MTA, Biodentine, and Ca(OH)2 in terms of hard tissue
formation, which is similar to the results of our study. The reparative
tissues induced by MTA and Biodentine were homogenous, whereas
those induced by Ca(OH)2 were porous, suggesting a reparative process
different from that induced by calcium silicate (14, 31). Studies indicate
greater tissue repair efficiency of calcium silicate compared with that of
Ca(OH)2, probably because of the recruitment of pulp stem cells by the
former. These cells regulate the expression of transcription factors such
as RUNX2, which are involved in the process of molecular
dentinogenesis (14, 32). Stimulation of cell proliferation and
differentiation may be related to calcium silicate itself, which is 1 of
the main components of MTA and Biodentine (14, 16, 17, 33).
Chang et al (31) observed a similar increase in alkaline phosphatase
activity, deposition of mineralized nodules, and up-regulation of
markers for odontoblastic differentiation in MTA and Biodentine.
Other researches (18, 34) after direct pulp capping in animal
teeth noticed that Biodentine showed significantly higher stimulatory
activity on pulp cells in comparison with MTA, resulting in thicker
reparative dentin bridges and greater incidence of ectopic pulp
calcification in developing teeth. In our study, dentin bridges in the
Biodentine group showed the highest maximum thickness and
average and maximum volumes.
Application of Single Bond Universal elicited responses similar to
those observed with the use of bonding systems in humans (6, 9, 35).
Despite the good seal and satisfactory biocompatibility, their ability to
induce dentin repair was significantly weaker than that of Ca(OH)2
and calcium silicate–based materials (5, 6, 9, 35). In a previous
study (5), MTA gave a more predictable, positive response in vital
pulp therapy compared with Ca(OH)2 and acid-etched dentin bonding
systems over longer time frames. Therefore, in consideration of the fact
that bonding of resins to the underlying tissue deteriorates over time in
the absence of a dentin bridge, which increases the risk of pulp infec-
tion, the use of these preparations on exposed pulp should be carefully
considered (36). In addition, the primer may continue etching the
dentin for some time, causing an area of demineralization that is not
filled with the bonding system (37).
Some researchers, because of the lack of a correlation between the
presence of bacteria and the condition of the pulp, indicate that the
toxicity of the materials used could be a cause of the absence of dentin
bridge formation (21). The components of bonding systems can be
cytotoxic to cells and microorganisms and can adversely affect the im-
mune system and induce immunosuppression (38). In a recent study in
humans (7) in which Single Bond Universal was applied using the total-
etch technique during the clinical procedure of direct pulp capping,
light microscopy and scanning electron microscopy revealed subclini-
cal adhesive failure as opposed to the satisfactory visual results. Resid-
ual monomer, resin tags at the margins of the exposed pulp, and blood
and gaps between the adhesive layers were also observed (7). The re-
sults of our study and those of previous studies confirm that materials
such as MTA, Biodentine, and Ca(OH)2 are preferred over bonding sys-
tems such as Single Bond Universal for direct pulp capping.
The present study was conducted under controlled experimental
conditions using third molar human teeth to avoid the interference
by confounding factors. The fact that the teeth had healthy pulp tissue
in all groups means that differences encountered in the pulp can be
attributed exclusively to the capping material used. The intensity of
the pulp reactions demonstrated in healthy teeth may be lower than
in carious teeth (39).
Conclusion
In conclusion, the volume of formed reparative dentin bridges de-
pends on the material used for direct pulp capping. Biodentine and MTA

TABLE 1. Volumes of Reparative Dentin Bridges after Direct Pulp Capping with the 4 Different Materials
CH* (n = 11), MTA† (n = 11), BIO‡ (n = 11), SBU*,†,‡ (n = 11),
Volume of dentin bridge n (%) n (%) n (%) n (%) Total
No dentin (0) or unmeasurable 4 (36.4) 3 (27.3) 3 (27.3) 9 (81.8) 19
volume
Low volume 2 (18.2) 0 1 (9.1) 2 (18.2) 5
Moderate volume 4 (36.4) 6 (54.6) 4 (36.4) 0 (0.0) 14
High volume 1 (9.1) 2 (18.2) 3 (27.3) 0 (0.0) 6
Total 11 11 11 11 44
Pearson c2 test P = .0634
BIO, Biodentine; CH, calcium hydroxide; MTA, mineral trioxide aggregate; SBU, Single Bond Universal.
*Spearman’s rank, P = .0119.
†
Spearman’s rank P = .0011.
‡
Spearman’s rank P = .0017.

6 Nowicka et al. JOE — Volume -, Number -, - 2015


TABLE 2. Mean Volumes of Reparative Dentin Bridges Formed after Direct Pulp Capping in the 4 Groups
Group n Mean Median Minimum
CH 7 0.30 0.33 0.07
MTA* 8 0.45 0.31 0.19
BIO* 8 0.47 0.27 0.09
SBU* 2 0.07 0.07 0.06
BIO, Biodentine; CH, calcium hydroxide; MTA, mineral trioxide aggregate MTA; Q1, first quartile (25th percentile); Q3, third quartile (75th percentile); SBU, Single Bond Universal; SD, standard deviation.
*Mann-Whitney U test, P < .05.
induced the formation of bridges with a significantly higher average vol-
ume compared with Single Bond Universal in this study, and CBCT im-
aging allowed for the identification of the location of dentin bridges.
Determination of the precise location and measurement of the volume
of dentin bridges on CBCT images is very difficult without correlation
with histologic findings because of certain limitations of CBCT imaging,
such as a low contrast, background noise, and a small area of evaluated
tissue. Further studies using computed tomographic imaging and elec-
tron microscopy are required for a more precise evaluation of repara-
tive dentin bridges formed after direct pulp capping with various
materials.
Acknowledgments
The authors deny any conflicts of interest related to this study.
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JOE — Volume -, Number -, - 2015
Clinical Research
Maximum Q1 Q3 SD P value
0.56 0.09 0.39 0.17 .4009
1.27 0.22 0.52 0.37
1.82 0.20 0.69 0.41
0.08 0.06 0.08 0.01
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