Advertisement

Histological evaluation of hard tissue formation after direct pulp capping with a fast-setting mineral trioxide aggregate (RetroMTA) in humans

  • Till DammaschkeEmail author
  • Alicja Nowicka
  • Mariusz Lipski
  • Domenico Ricucci
Original Article
  • 53 Downloads

Abstract

Objectives

To histologically evaluate the morphology of the newly formed mineralized tissue and of the adjacent cells, in intact human teeth subjected to mechanical pulp exposure and capping with a fast-setting mineral trioxide aggregate (RetroMTA).

Materials and methods

Seven caries-free third molars from three adults were subjected to pulp exposure, direct capping with RetroMTA, and restoration with a composite resin. Seven months later, the teeth were clinically and radiographically evaluated, extracted, and subjected to histological processing and evaluation.

Results

All teeth were clinically and radiographically inconspicuous and showed no presence of severe inflammatory reactions. Bacteria were absent in all teeth. All cases exhibited some degree of mineralized tissue in the area of exposure to varying extent. This newly formed mineralized tissue was mostly atubular and did not display the features of regular dentine in any of the cases. No cells exhibiting the features of odontoblasts or odontoblast-like cells were observed. Instead, the cells exhibited a flat or cuboidal shape, resembling fibroblasts.

Conclusions

When the exposed pulps were directly capped with RetroMTA, the new calcified hard tissue was not “regular dentine,” and did not seem to be the product of genuine odontoblast differentiation. These results suggest that the formation of calcified tissues after direct pulp capping with RetroMTA may be more appropriately regarded as a reparative process than as a genuine regeneration response.

Clinical relevance

This is the first histological study on humans showing that regular dentine was not regenerated when a bioactive pulp-capping material (RetroMTA) was placed over exposed pulp tissue.

Trial registration

NCT03631511

Keywords

Direct pulp capping Hard tissue formation Histology Humans RetroMTA 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed and all treatments in these studies involving human participants were conducted strictly in full accordance with the ethical principles and standards of the institutional and national research committee and with the 1964 World Medical Association Declaration of Helsinki and its later amendments (version 2008) or comparable ethical standards.

All experimental protocols were independently reviewed and approved by the Local Ethics Committee of the Pomeranian Medical University, Szczecin, Poland (approval number KB–0012/27/13). This study was registered as a clinical trial (ClinicalTrials.gov Identifier: NCT03631511).

Informed consent

Informed written consent was obtained from all individual participants included in the study.

References

  1. 1.
    Pitt Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP (1996) Using mineral trioxide aggregate as a pulp–capping material. J Am Dent Assoc 127:1491–1494CrossRefGoogle Scholar
  2. 2.
    Farsi N, Alamoudi N, Balto K, Mushayt A (2006) Clinical assessment of mineral trioxide aggregate (MTA) as direct pulp capping in young permanent teeth. J Clin Pediatr Dent 31:72–76CrossRefGoogle Scholar
  3. 3.
    Dammaschke T, Camp JH, Bogen G (2014) MTA in vital pulp therapy. In: Torabinejad M (ed) Mineral trioxide aggregate – properties and clinical applications. Wiley Blackwell, Ames, pp 71–110Google Scholar
  4. 4.
    Cao Y, Bogen G, Lim J, Shon WJ, Kang MK (2016) Bioceramic materials and the changing concepts in vital pulp therapy. J Calif Dent Assoc 44:278–290Google Scholar
  5. 5.
    Hilton TJ, Ferracane JL, Mancl L, for Northwest Practice-based Research Collaborative in Evidence-based Dentistry (NWP) (2013) Comparison of CaOH with MTA for direct pulp capping: a PBRN randomized clinical trial. J Dent Res 92(7 Suppl):16S–22S.  https://doi.org/10.1177/0022034513484336 CrossRefGoogle Scholar
  6. 6.
    Mente J, Hufnagel S, Leo M, Michel A, Gehrig H, Panagidis D, Saure D, Pfefferle T (2014) Treatment outcome of mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results. J Endod 40:1746–1751.  https://doi.org/10.1016/j.joen.2014.07.019 CrossRefGoogle Scholar
  7. 7.
    Kundzina R, Stangvaltaite L, Eriksen HM, Kerosuo E (2017) Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide. Int Endod J 50:924–932.  https://doi.org/10.1111/iej.12719 CrossRefGoogle Scholar
  8. 8.
    Li Z, Cao L, Fan M, Xu Q (2015) Direct pulp capping with calcium hydroxide or mineral trioxide aggregate: a meta-analysis. J Endod 41:1412–1417.  https://doi.org/10.1016/j.joen.2015.04.012 CrossRefGoogle Scholar
  9. 9.
    Aguilar P, Linsuwanont P (2011) Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review. J Endod 37:581–587.  https://doi.org/10.1016/j.joen.2010.12.004 CrossRefGoogle Scholar
  10. 10.
    Alqaderi H, Lee CT, Borzangy S, Pagonis TC (2016) Coronal pulpotomy for cariously exposed permanent posterior teeth with closed apices: a systematic review and meta-analysis. J Dent 44:1–7.  https://doi.org/10.1016/j.jdent.2015.12.005 CrossRefGoogle Scholar
  11. 11.
    Chailertvanitkul P, Paphangkorakit J, Sooksantisakoonchai N, Pumas N, Pairojamornyoot W, Leela-Apiradee N, Abbott PV (2014) Randomized control trial comparing calcium hydroxide and mineral trioxide aggregate for partial pulpotomies in cariously exposed pulps of permanent molars. Int Endod J 47:836–842.  https://doi.org/10.1111/iej.12225 CrossRefGoogle Scholar
  12. 12.
    Fransson H, Wolf E, Petersson K (2016) Formation of a hard tissue barrier after experimental pulp capping or partial pulpotomy in humans: an updated systematic review. Int Endod J 49:533–542.  https://doi.org/10.1111/iej.12480 CrossRefGoogle Scholar
  13. 13.
    Lesot H, Bègue-Kirn C, Kubler MD, Meyer JM, Smith AJ, Cassidy N, Ruch JV (1993) Experimental induction of odontoblast differentiation and stimulation during reparative processes. Cell Mater 3:201–217Google Scholar
  14. 14.
    Murray PE, Hafez AA, Smith AJ, Cox CF (2002) Hierarchy of pulp capping and repair activities responsible for dentin bridge formation. Am J Dent 15:236–243Google Scholar
  15. 15.
    Murray PE, Windsor LJ, Smyth TW, Hafez AA, Cox CF (2002) Analysis of pulpal reactions to restorative procedures, materials, pulp capping, and future therapies. Crit Rev Oral Biol Med 13:509–520CrossRefGoogle Scholar
  16. 16.
    Smith AJ, Patel M, Graham L, Sloan AJ, Cooper PR (2005) Dentine regeneration: key roles for stem cells and molecular signalling. Oral Biosci Med 2(3):127–132Google Scholar
  17. 17.
    Almushayt A, Narayanan K, Zaki AE, George A (2006) Dentin matrix protein 1 induces cytodifferentiation of dental pulp stem cells into odontoblasts. Gene Ther 13:611–620.  https://doi.org/10.1038/sj.gt.3302687 CrossRefGoogle Scholar
  18. 18.
    Ricucci D, Loghin S, Lin LM, Spångberg LS, Tay FR (2014) Is hard tissue formation in the dental pulp after the death of the primary odontoblast a regenerative or a reparative procedure? J Dent 42:1156–1170.  https://doi.org/10.1016/j.jdent.2014.06.012 CrossRefGoogle Scholar
  19. 19.
    Ricucci D, Loghin S, Niu L-N, Tay FR (2018) Changes in the radicular pulp-dentine complex in healthy intact teeth and in response to deep caries or restorations: a histological and histobacteriological study. J Dent 73:76–90.  https://doi.org/10.1016/j.jdent.2018.04.007 CrossRefGoogle Scholar
  20. 20.
    Accorinte MLR, Holland R, Reis A, Bortoluzzi MC, Murata SS, Dezan E Jr, Souza V, Alessandro LD (2008) Evaluation of mineral trioxide aggregate and calcium hydroxide cement as pulp-capping agents in human teeth. J Endod 34:1–6.  https://doi.org/10.1016/j.joen.2007.09.012 CrossRefGoogle Scholar
  21. 21.
    Accorinte MLR, Loguercio AD, Reis A, Carneiro E, Grande RH, Murata SS, Holland R (2008) Response of human dental pulp capped with MTA and calcium hydroxide powder. Oper Dent 33:488–495.  https://doi.org/10.2341/07-143 CrossRefGoogle Scholar
  22. 22.
    Accorinte MLR, Loguercio AD, Reis A, Bauer JR, Grande RH, Murata SS, Souza V, Holland R (2009) Evaluation of two mineral trioxide aggregate compounds as pulp-capping agents in human teeth. Int Endod J 42:122–128.  https://doi.org/10.1111/j.1365-2591.2008.01485.x CrossRefGoogle Scholar
  23. 23.
    Eskandarizadeh A, Shahpasandzadeh MH, Shahpasandzadeh M, Torabi M, Parirokh M (2011) A comparative study on dental pulp response to calcium hydroxide, white and grey mineral trioxide aggregate as pulp capping agents. J Conserv Dent 14:351–355.  https://doi.org/10.4103/0972-0707.87196 CrossRefGoogle Scholar
  24. 24.
    Shahravan A, Jalali SP, Torabi M, Haghdoost AA, Gorjestani H (2011) A histological study of pulp reaction to various water/powder ratios of white mineral trioxide aggregate as pulp-capping material in human teeth: a double-blinded, randomized controlled trial. Int Endod J 44:1029–1033.  https://doi.org/10.1111/j.1365-2591.2011.01916.x CrossRefGoogle Scholar
  25. 25.
    Nair PNR, Duncan HF, Pitt Ford TR, Luder HU (2008) Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial. Int Endod J 41:128–150.  https://doi.org/10.1111/j.1365-2591.2007.01329.x Google Scholar
  26. 26.
    Chueh L-H, Chiang C-P (2010) Histology of irreversible pulpitis premolars treated with mineral trioxide aggregate pulpotomy. Oper Dent 35:370–374.  https://doi.org/10.2341/09-307-S CrossRefGoogle Scholar
  27. 27.
    Aeinehchi M, Eslami B, Ghanbariha M, Saffar M (2003) Mineral trioxide aggregate (MTA) and calcium hydroxide as pulp-capping agents in human teeth: a preliminary report. Int Endod J 36:225–231CrossRefGoogle Scholar
  28. 28.
    Chacko V, Kurikose S (2006) Human pulpal response to mineral trioxide aggregate (MTA): a histologic study. J Clin Pediatr Dent 30:202–210Google Scholar
  29. 29.
    Iwamoto CE, Adachi E, Pameijer CH, Barnes D, Romberg EE, Jefferies S (2006) Clinical and histological evaluation of white ProRoot MTA in direct pulp capping. Am J Dent 19:85–90Google Scholar
  30. 30.
    Min KS, Park HJ, Lee SK, Park SH, Hong CU, Kim HW, Lee HH, Kim EC (2008) Effect of mineral trioxide aggregate on dentin bridge formation and expression of dentin sialoprotein and heme oxygenase-1 in human dental pulp. J Endod 34:666–670.  https://doi.org/10.1016/j.joen.2008.03.009 CrossRefGoogle Scholar
  31. 31.
    Sawicki L, Pameijer CH, Emerich K, Adamowicz-Klepalskak B (2008) Histological evaluation of mineral trioxide aggregate and calcium hydroxide in direct pulp capping of human immature permanent teeth. Am J Dent 21:262–266Google Scholar
  32. 32.
    Parolia A, Kundabala M, Rao NN, Acharya SR, Agrawal P, Mohan M, Thomas M (2010) A comparative histological analysis of human pulp following direct pulp capping with Propolis, mineral trioxide aggregate and Dycal. Aust Dent J 55:59–64.  https://doi.org/10.1111/j.1834-7819.2009.01179.x CrossRefGoogle Scholar
  33. 33.
    Nowicka A, Lipski M, Parafiniuk M, Sporniak-Tutak K, Lichota D, Kosierkiewicz A, Kaczmarek W, Buczkowska-Radlińska J (2013) Response of human dental pulp capped with biodentine and mineral trioxide aggregate. J Endod 39:743–747.  https://doi.org/10.1016/j.joen.2013.01.005 CrossRefGoogle Scholar
  34. 34.
    Swarup SJ, Rao A, Boaz K, Srikant N, Shenoy R (2014) Pulpal response to nano hydroxyapatite, mineral trioxide aggregate and calcium hydroxide when used as a direct pulp capping agent: an in vivo study. J Clin Pediatr Dent 38:201–206CrossRefGoogle Scholar
  35. 35.
    Bakhtiar H, Aminishakib P, Ellini MR, Mosavi F, Abedi F, Esmailian S, Esnaashari E, Nekoofar MH, Sezavar M, Mesgarzadeh V, About I (2018) Dental pulp response to RetroMTA after partial pulpotomy in permanent human teeth. J Endod 44:1692–1696.  https://doi.org/10.1016/j.joen.2018.07.013 CrossRefGoogle Scholar
  36. 36.
    Chung CJ, Kim E, Song M, Park JW, Shin JS (2016) Effects of two fast-setting calcium-silicate cements on cell viability and angiogenic release in human pulp-derived cells. Odontology 104:143–151.  https://doi.org/10.1007/s10266-015-0194-5 CrossRefGoogle Scholar
  37. 37.
    Lee H, Shin Y, Kim S-O, Lee H-S, Choi H-J, Song JS (2015) Comparative study of pulpal responses to pulpotomy with ProRoot MTA, RetroMTA, and TheraCal in dogs’ teeth. J Endod 41:1317–1324.  https://doi.org/10.1016/j.joen.2015.04.007 CrossRefGoogle Scholar
  38. 38.
    de Souza LC, Yadlapati M, Dorn SO, Silva R, Letra A (2015) Analysis of radiopacity, pH and cytotoxicity of a new bioceramic material. J Appl Oral Sci 23:383–389.  https://doi.org/10.1590/1678-775720150065 CrossRefGoogle Scholar
  39. 39.
    Pornamazeh T, Yadegari Z, Ghasemi A, Sheykh-Al-Eslamian SM, Shojaeian S (2017) In vitro cytotoxicity and setting time assessment of calcium-enriched mixture cement, retro mineral trioxide aggregate and mineral trioxide aggregate. Iran Endod J 12:488–492.  https://doi.org/10.22037/iej.v12i4.16275 Google Scholar
  40. 40.
    Berzins DW (2014) Chemical properties of MTA. In: Torabinejad M (ed) Mineral trioxide aggregate - properties and clinical applications. Wiley Blackwell, Ames, pp 17–36Google Scholar
  41. 41.
    Schröder U (1972) Evaluation of healing following experimental pulpotomy of intact human teeth and capping with calcium hydroxide. Odontol Revy 23:329–340Google Scholar
  42. 42.
    Schmidt A, Schäfer E, Dammaschke T (2017) Shear bond strength of lining materials to calcium silicate cements at different time intervals. J Adhes Dent 19:129–135.  https://doi.org/10.3290/j.jad.a38100 Google Scholar
  43. 43.
    Matsuo T, Nakanishi T, Shimizu H, Ebisu S (1996) A clinical study of direct pulp capping applied to carious-exposed pulps. J Endod 22:551–556.  https://doi.org/10.1016/S0099-2399(96)80017-3 CrossRefGoogle Scholar
  44. 44.
    Mulisch M, Welsch U (eds) (2015) Romeis - Mikroskopische Technik. Springer, BerlinGoogle Scholar
  45. 45.
    Taylor RD (1966) Modification of the Brown and Brenn gram stain for the differential staining of gram-positive and gram-negative bacteria in tissue sections. Am J Clin Pathol 46:472–476CrossRefGoogle Scholar
  46. 46.
    Langeland K (1987) Tissue response to dental caries. Endod Dent Traumatol 3:149–171CrossRefGoogle Scholar
  47. 47.
    Ricucci D, Siqueira JF Jr (2013) Vital pulp therapy. In: Ricucci D, Siqueira JF Jr (eds) Endodontology. An integrated biological and clinical view. Quintessence, London, pp 67–106Google Scholar
  48. 48.
    Dammaschke T, Galler K, Krastl G (2019) Current recommendations for vital pulp treatment - scientific communication. Dtsch Zahnärztl Z Int 1:43–52.  https://doi.org/10.3238/dzz-int.2019.0043-0052 Google Scholar
  49. 49.
    Kang C-M, Sun Y, Song JS, Pang NS, Roh BD, Lee CY, Shin Y (2017) A randomized controlled trial of various MTA materials for partial pulpotomy in permanent teeth. J Dent 60:8–13.  https://doi.org/10.1016/j.jdent.2016.07.015 CrossRefGoogle Scholar
  50. 50.
    Dammaschke T (2017) Dentine and hard tissue formation after indirect and direct pulp capping. Oralprophylaxe Kinderzahnheilkd 39:27–37.  https://doi.org/10.3238/OPKZH.2017.0027-0037 Google Scholar
  51. 51.
    About I (2018) Recent trends in tricalcium silicates for vital pulp therapy. Curr Oral Health Rep 5:178–185.  https://doi.org/10.1007/s40496-018-0186-y CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Periodontology and Operative DentistryWestphalian Wilhelms-UniversityMünsterGermany
  2. 2.Department of Conservative Dentistry and EndodonticsPomeranian Medical UniversitySzczecinPoland
  3. 3.Department of Preclinical Conservative Dentistry and Preclinical EndodonticsPomeranian Medical UniversitySzczecinPoland
  4. 4.Private PracticeCetraroItaly

Personalised recommendations