collection of the most recent vpt matreials in Endodontics

2. AGENDA
*DEFINITION
*IDEAL PROPERTIES
*CLASSIFICATION
*TYPES & EXAMPLES

3. WHAT ARE PULP CAPPING MATERIALS ??
Those materials that can be
applied Directly or indirectly on
the pulp helping it to develop
adequate defensive mechanism
with the aim of preserving its
vitality.

4. WHAT ARE IDEAL PROPERTIES FOR PULP
CAPPING MATERIAL??!!
1-Biocompatible (maintain pulp vitality)
2-Bacteriocidal
3-Stimulating Reparative Dentin
4-Good seal
5-low solubility
6-Adhere to Dentnin walls
7-Adhere to the coronal mateial above it
8-RADIOPAQUE in X-ray

5. THEY CAN BE CLASSIFIED ACC TO
THEIR FUNCTION TO 3 MAIN
CATEOGRIES :_
1-Pulp Devitalization
2-Pulp Preservation
3-Pulp Healing

6. A)-PULP DEVITALIZATION
1)FORMECRESOL
2)GLUTERALDHYDE
3)ELECTROSURGERY

7. 1)FORMECRESOL
Formaldhyde 19%
-disadv :-
CARCINOGENIC
TOXIC SYSTEMTICALLY
NOT PERSEVING PULP VITALITY
*Mechanism*
-bind to peptides transform ot to fibrous tissue
After 4-7days
Fibrous tissue))*zone of fixation
*Zone of atrophy ( no cells)
Then,
*zone of vital pulp

8. *Used mostly with pulpotomy in decidous teeth
With
ZNO_E& Final restoration
•WHEN TO USE ????*
•-Emergency RCT
•_Controlling postoperative
•pain

10. 2)GLUTERALDHYDE
The same concept of formaldhyde
But
LESS TOXIC ON UNDERLYING TISSUES
ALSO USEED with PULPOTOMY
As it is in the form of solution

11. 3)ELECTROSURGERY
Coagulative Necrosis

12. B)PULP PRESERVATION
1)ZNO/E
2)RESIN cement
3)Ferric Sulphate
4)GI
5)ZINC polycarboxylate
6)OZONE

13. 1)ZNO/E
Advanges:-
Palliative
Germicidal
Excellent initial setting (give pulp chance to heal )
Disadvantages:-
Liqifactive necrosis
Lack of calcific bridge

14. 2)RESIN CEMENT
No Calcific bridge
Not biocompatible

15. 3)FERRIC SULPHATE
Mode of Action ;-
HEMOSTASIS
By formation of Blood
PLUG

16. GLASS IONOMER
Glass ionomer also provides an excellent bacterial
seal and good biocompatibility when used in
close approximation but not in direct contact
with the pulp.

17. RESIN MODIFIED GLASS
IONOMER
RMGIC as direct pulp capping agent
exhibited chronic inflammation and lack
of dentin bridge formation;

18. 5)ZINC POLYCARBOXYLATE
found that it lacks an
antibacterial effect and calcific
bridge formation

19. C)PULP HEALING
1)Ca (OH)2
2)MTA
3)TRICALCIU PHOSPHATE
4)BIOCERAMICS
5)Calcium Phosphate Gel
6)Enriched Collagen
7)Bone Morphogenic ptn
8)LASER
9)Calcium Enriched Matrix
10)Freezed Dried Bone
11)OZONE
12)biodentin

20. 1)CALCIUM HYROXIDE
Advanges:-
ALKALINE (BACTERIOCIDAL)
Induce dentin bridge formation
Disadvantages;-
High solubility
Low mech prop
Presence of TUNNELS

21. 2)MTA
Excellent Seal property
And more dentin bridge formation in less time with
less inflammation
Disadvantages;-
Expensive
Discoloration
Long setting time

22. MODE OF ACTION ;-
-Need Humidity
In Water >>> give >>>hydroxyl gp & ca
silicate gel
Gel absorp water >>Expand>>enter
Dentinal tubules forming microtags
&Anchorage
Out come is Good seal_

23. 8)LASER
Biostimulation for stem cells to form dentin
But
May cause Thermal pulp damage

24. OZONE
The disinfection power of ozone makes the use of ozone
in dentistry a very good alternative to standard antiseptics,so,
ozonated water can be used as a disinfectant and irrigant
It is also postulated that ozone will penetrate through the
apical foramen, and enter into the surrounding and
supportive bone tissue. The effect of ozone on these
tissues will be to encourage healing and regeneration
(Bioregulator).

25. ENAMEL MATRIX DERIVATIVE
obtained from embryonic enamel of amelogenin
commercially presented as EMDOGAIN®
which
has been successfully employed to initate natural
cementogenesis to restore a fully functional
periodontal ligament, cementum and alveolar bone in
patients with advanced peridontitis.

26. The histopathological response of dental pulp tissue
to EMD used in pulpotomized teeth showed that
(2001-2003:)
-The pulp wound showed features of classic wound healing.
-Subjacent to the healing wound, a bridge of new hard tissue
(tertiary dentin) was formed, sealing off the wound from
the healthy pulp tissue.
-The pulp tissue subjacent to this new hard tissue was
invariably free of all signs of inflammation. Moreover, a
layer of odontoblast-like cells had formed, abutting the
newly formed mineralized tissue.
-Furthermore, it was also reported that growth of some
bacteria including Streptococcus mutans, is inhibited by
the presence of EMD.

27. -After twelve weeks, EMD demonstrated extensive
amounts of hard tissue formed. Moreover, postoperative
symptoms were less frequent
.
-These results offers preliminary evidence that EMD is a
promising material which may be as successful, or more
so, than other pulpotomy agents

28. BIODENTINE
Biodentine is new bioactive cement with dentin like
mechanical properties and can be used as dentin substitute.
It has a positive effect on vital pulp cells and stimulates
tertiary dentin formation
Also used in
Repair of
Perforation root resorption
Apexifcation

29. GROWTH FACTORS
Bone Morphogenic Protein (BMP)
Recombinant Insulin Like Growth
Factor-I

30. BONE MORPHOGENIC PROTEIN (BMP)
is a potent modulator of tissue repair in different
situations. BMP-2, 4, and 7 plays a role in the
differentiation of adult pulp cells into odontoblasts
during pulpal healing.
BMPs are responsible for dentinogenesis,
inducing non differentiated
mesenchymal cells from the pulp to form
odontoblast-like cells, obtaining
osteodentin and tubular dentin
deposition, when used as direct
protectors

31. Recombinant Insulin Like Growth
Factor-I
dentin bridge formation was equal to
dycal after 28 days

32. OTHER EXPERIMENTAL CAPPING
MATERIALS
Enriched Collagen Solution (ECS)
Using of ECS as a Pulp Dressing in pulpotomies showed that:
-80% of the ECS- treated teeth had vital pulps,
-73% dentine bridges were present and
-more than half of the ECS-treated teeth showed no pulpal
inflammation after two months.

33. FREEZE-DRIED BONE (FDB)
Histological findings of pulpotomized teeth using FDB
showed histological findings very similar to calciumhydroxide.
-At 3 m Complete or partial calcific barrier was evident
directly below treatment site.
-Normal appearing odontoblastic cells were noted below the
calcific barrier.
-The apical third was vitalwith an occasional chronic
inflammatory cell visible.

34. ETHYL-CYANOACRYLATE
Present adhesive, haemostatic and bacteriostatic
properties
Induce more rapid tissue repair.
Cyanoacrylate is an adhesive that results from the
chemical reaction between formaldehyde and the esters of
cyanoacetate.

35. TEETH CAPPED WITH ETHYL-
CYANOACRYLATE FOR 30 DAYS
SHOWED:
- Formation of a continuous hard tissue barrier at the level
of pulpal amputation
-These hard tissue barriers consisted of a bone-like layer at
the surface and an underlying layer of dentin-like tissue..
- The pulpal aspect, underneath the barrier, showed signs of
vitality with the presence of a chronic inflammatory
process. The inflammatory response was considered to be
moderate in this area.
- The other two-thirds of the pulpal tissue were free of
inflammation.

36. STEM CELL DELIVERY
A number of recent studies have demonstrated that stem
cells, of both dental and non-dental origin, are capable of
inducing odontogenesis and regenerating dentin.
Deciduous teeth contain a population of more immature
multipotent stem cells ("stem cells from human exfoliated
deciduous teeth"; SHED), that are capable of forming
dentin-like structures but not a complete dentin-pulp
complex.
stem/progenitor cells can be implanted after
differentiation into odontoblasts and might result in
copious amounts of reparative dentin formation.

37. REFERENCES
--Book of clincal endodontics (Fayoum
university)
--Handouts of dr.muhammed nageh lectures
-Plus online sources
--Journal of clinical &diagnostic reasearch
“Recent Advances in Pulp Capping Materials: An
Overview”
--Reaction of the pulp to various capping
materials