| 1. |
- Bjorndal, Lars, et al.
(författare)
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Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy
- 2010
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Ingår i: European Journal of Oral Sciences. - : Wiley. - 0909-8836 .- 1600-0722. ; 118:3, s. 290-297
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Tidskriftsartikel (refereegranskat)abstract
- Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (−22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.
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| 2. |
- Fransson, Helena, et al.
(författare)
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Dentine sialoprotein and Collagen I expression after experimental pulp capping in humans using Emdogain(R) Gel
- 2011
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Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 44:3, s. 259-267
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Tidskriftsartikel (refereegranskat)abstract
- Aim To characterize the hard tissue formed in human teeth experimentally pulp capped either with calcium hydroxide or with Emdogain®Gel (Biora AB, Malmö, Sweden) – , a derivative of enamel matrix (EMD), using two markers for dentine; dentine sialoprotein (DSP) and type 1 collagen (Col I). Formation of hard tissue following pulp capping in these teeth has previously been observed and reported. Methodology Affinity-purified rabbit anti-Col I and anti-DSP polyclonal antibodies were used to stain histological sections from 9 pairs of contra-lateral premolars, that had been experimentally pulp amputated and randomly capped with EMDgel or calcium hydroxide. The teeth were extracted 12 weeks after being pulp capped. Results In the calcium hydroxide treated teeth DSP was seen in the new hard tissue which formed a bridge. DSP was also seen in the newly formed hard tissue in the EMDgel treated teeth. Proliferated pulp tissue partly filled the space initially occupied by EMDgel and DSP-stained hard tissue was observed alongside exposed dentine surfaces as well as in isolated masses within the proliferated pulp tissue, although the new hard tissue did not cover the pulp exposure. DSP staining was also seen in the cells lining the hard tissue in both groups. Col I staining was seen in the newly formed hard tissue in both groups. Conclusions The new hard tissue formed after pulp capping with EMDgel or calcium hydroxide contained DSP and Col I, considered to be markers for dentine.
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| 3. |
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| 4. |
- Fransson, Helena, et al.
(författare)
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DSP and Collagen I Expression After Pulp Capping in Humans
- 2008
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Konferensbidrag (refereegranskat)abstract
- Formation of hard tissue following treatment of pulp exposures has been observed in both clinical and experimental studies. However it is not known if such tissue has the functions of primary dentin which are likely to be important in protecting the pulp from the oral environment. Objectives: To study the expression of two relatively specific markers for dentin; dentin sialoprotein (DSP) and type 1 collagen (Col I) in human teeth experimentally pulp capped either with Emdogain®Gel (Biora AB, Malmö, Sweden) - a derivative of enamel matrix (EMD) in a propylene glycol alginate vehicle, or with calcium hydroxide. Methods: Nine pairs of contra-lateral premolars scheduled for extraction on orthodontic grounds were experimentally pulp amputated and capped with EMDgel or calcium hydroxide. After 12 weeks the teeth were extracted, prepared for light microscopic examination and stained using affinity-purified rabbit anti-Col I and anti-DSP polyclonal antibodies. Results: In the EMDgel treated teeth, new tissue partly filled the space initially occupied by the gel and hard tissue was formed alongside exposed dentin surfaces and in patches in the adjacent pulp tissue. In the calcium hydroxide treated teeth, the new hard tissue was formed as a bridge. DSP staining was seen in the newly formed hard tissue and in the cells lining it in both groups but was more marked in the EMDgel treated teeth. Col I staining was seen in the newly formed hard tissue in both groups. Conclusion: The expression of DSP and Col I suggests that the new hard tissue formed after pulp capping with EMDgel or calcium hydroxide is dentin. Supported by Biora AB, Malmö, Sweden, the European Society of Endodontology and the Swedish Dental Society.
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| 5. |
- Fransson, Helena, et al.
(författare)
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Effects of bacterial products on the activity of odontoblast-like cells and their formation of type 1 collagen
- 2014
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Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 47:4, s. 397-404
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To study how products released from different bacteria in a deep carious lesion affect the metabolic activity of odontoblast-like cells and their ability to produce the major organic component of dentine, collagen 1. METHODOLOGY: MDPC-23 cells were exposed to supernatants from biofilm cultures of strains isolated from the deepest part of a carious lesion as well as from a clinical isolate of Enterococcus faecalis. Lipoteichoic acid (LTA) and lipopolysaccharide (LPS) were used for comparison. Cell activity was assessed using an methyl-thiazolyl-diphenyl tetrazolium bromide (MTT) assay, and collagen 1 levels were determined by ELISA. RESULTS:The lesion microflora was dominated by Lactobacillus spp. Neither extracellular products from the isolates nor LPS affected the activity of the MDPC-23 cells, whereas extracellular products from E. faecalis and LTA significantly reduced total cell activity (P < 0.01). Enterococcus faecalis had an inhibitory effect upon collagen 1 production by the cells, whereas no such effect or even a slight stimulatory effect was seen for the isolates from the deep carious lesion. CONCLUSIONS: These studies indicate that culture supernatants from E. faecalis reduced the metabolic activity of odontoblast-like cells as shown using the MTT assay. No effect was seen for supernatants from biofilms of bacteria recovered from a deep carious lesion. Different bacteria varied in their effects upon collagen 1 production suggesting that the nature of the bacterial species in a carious lesion may have a direct influence upon the ability of the odontoblasts to produce tertiary dentine.
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| 6. |
- Fransson, Helena, et al.
(författare)
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Formation of a hard tissue barrier after experimental pulp capping or partial pulpotomy in humans : an updated systematic review
- 2016
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Ingår i: International Endodontic Journal. - : John Wiley & Sons. - 0143-2885 .- 1365-2591. ; 49, s. 533-542
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Forskningsöversikt (refereegranskat)abstract
- The aim was to update a systematic review of pulp capping and partial pulpotomy by Olsson et al. (2006), by evaluating new evidence on formation of a hard tissue barrier after pulp capping and partial pulpotomy of experimental exposures in humans. PubMed (01-01-2005 to 01-03-2014) and CENTRAL were searched using specific keywords. Hand searches were made and the level of evidence for each included article was evaluated by the authors. The evidence of the conclusions was graded as strong, moderately strong, limited or insufficient. The initial search in PubMed yielded 215 abstracts. Hand searches of reference lists yielded no additional original scientific articles. After a selection process and interpretation, 22 articles were included and rated for level of evidence: no article was rated as high and seven as moderate. Overall the methodological quality of studies has improved since the previous systematic review was published in 2006. The conclusions are that there is limited scientific evidence that application of calcium hydroxide or mineral trioxide aggregate to an exposed pulp frequently results in formation of a hard tissue barrier, whereas adhesives or enamel matrix derivatives do not. There is insufficient scientific evidence that mineral trioxide aggregate promotes hard tissue formation more frequently than calcium hydroxide.
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| 7. |
- Petersson, Kerstin, et al.
(författare)
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Twenty-year follow-up of root filled teeth in a Swedish population receiving high-cost dental care
- 2016
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Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 49:7, s. 636-645
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Tidskriftsartikel (refereegranskat)abstract
- AimTo study the 20-year survival rate and periapical status of root filled teeth in a Swedish population requiring high-cost dental care and to identify factors related to survival and normal periapical status at follow-up. MethodologyThe study population comprised 104 patients selected from four local health insurance districts with treatment plans including radiographs submitted for approval for reimbursement from the Swedish National Dental Insurance in 1977. In 1998, a clinical and radiographic follow-up examination was conducted, to register the status of 449 teeth identified as root filled at baseline. Differences in tooth survival and periapical status at follow-up, with reference to periapical status and quality of root filling at baseline, were analysed by chi-square tests. Multiple regression analysis was used to describe tooth survival and normal periapical status at follow-up, with the explanatory baseline variables: tooth type, type of restoration, type of post, quality of root filling, periapical status, marginal bone loss and caries. Differences were considered significant at a 5% level. ResultsTwo hundred and ninety (65%) of the root filled teeth survived at follow-up. Baseline variables associated with low odds for tooth survival were mandibular molar, maxillary premolar, prefabricated posts other than screw posts, severe marginal bone loss, caries and apical periodontitis (AP). Normal periapical status at follow-up was registered in 49% of the root filled teeth. Baseline variables associated with low odds for normal periapical status (high risk for AP) at follow-up were mandibular molar, maxillary premolar, AP, severe marginal bone loss and inadequate root filling quality. Of the root filled teeth with AP at baseline, 42% had been left untreated during the observation period, and at follow-up, the AP persisted in 57% of these teeth. ConclusionsAfter 20years, 65% of the root filled teeth had survived and one-third remained with a sound periapical condition, without any further treatment. Almost half of the APs registered at baseline were left without treatment, and more than half of them persisted after 20years.
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