الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Vital pulp therapy aims to treat reversible pulpal injury resulting from caries or trauma. Carious pulp exposures are preferably treated with pulpotomy procedures followed by capping the healthy radicular pulp tissue with a biocompatible material allowing it to heal. The present study aimed to compare the regenerative ability of biodentine (BD) and tailored amorphous multiporous bioglass (TAMP-BG) in pulpotomized primary teeth.
The study was a blinded, parallel design, randomized controlled clinical trial with histological and inflammatory assessments of outcome. It was conducted in the out-patient clinic of the Pediatric Dentistry and Dental Public Health Department after obtainingthe approval of the Research Ethics Committee, Faculty of Dentistry, Alexandria University, Egypt and after obtaining the guardians consent.
The sample size was calculated to be 35 teeth per group. The teeth were randomly and equally assigned to either BD or TAMP-BG groups for the clinical and radiographic assessments of outcome. The treatment follow-up was scheduled at 1, 3, 6, 9 and 12 months. The study was terminated for ethical considerations after showing significant clinical failure in the TAMP-BG group and after performing interim analysis.
The patients that actually received treatment were in the age range of 5-9 years, having 46 teeth showing deep caries requiring pulpotomy. Ten teeth in the BD group were eligible for the clinical assessment of outcome, while 9 teeth in the TAMP-BG group were clinically assessed. The clinical failure was further investigated via laboratory tests including pH and ionic release determination to justify the possible reasons for failure.
The overall clinical success for the BD treated teeth after 3 months was 100 %, while the TAMP-BG group showed zero % overall success, with statistically significant difference between the 2 groups. The radiographic assessment was not carried out because the study was terminated before its scheduled time and was only taken for confirming the clinical findingsand for comparing the 2 groups.
Additional teeth per group were recruited for the histological assessment using light microscope after 6 weeks. Ten teeth were recruited for the BD group, while 8 teeth were recruited for the TAMP-BG group. For the inflammatory response assessment using ELISA, the pulp was harvested from 6 teeth per group before intervention. After intervention, the pulp was harvested from the 6 teeth in the BD group, however, it was harvested only from 3 teeth in the TAMP-BG group due to pulp necrosis.
Histologically, the findings were promising with the BD treated teeth. All treated teeth exhibited no or negligible inflammation with normal underlying pulp. Different forms of hard tissue formation including fibrodentin, osteodentinand thick dentin bridge in direct contact with the capping agent were observed. Moreover, solitary calcific nodules, thin dentin bridge and incomplete bridge formation were also noted in some specimens. On the other hand, the TAMP-BG treated teeth showed empty pulp space denoting pulp necrosis with severe unidentified aggregation of inflammatory cells. Abscess and granuloma formation were observed in some specimens with complete absence of dentin-bridge in all the specimens. Moreover, pathologic root resorption was also noted.
Regarding the inflammatory response assessment, there was a percent decrease in the values of the pro-inflammatory cytokine (IL-8) after intervention with both TAMP-BG and BD. However, the higher decrease was in favor of BD with a statistically significant difference between the 2 groups. On the other hand, there was a percent increase in the values of the anti-inflammatory cytokine (IL-10) in both groups after intervention with the higher percent increase in the BD group with no statistically significant difference between the 2 groups. Moreover, there was a percent decrease in the IL-8/IL-10 ratio in the 2 groups with the higher percent decrease in the BD group and with a statistically significant difference between the 2 groups.
Based on the results of this study, it was concluded that, BD offered the dentinogenic capacity that allowed for healing, regeneration and hard tissue formation in primary teeth. Meanwhile, TAMP-BG, in its current form, is not recommended for pulpotomy of primary teeth as is not compatible with the primary pulp leaving it necrotic. Therefore, TAMP-BG scaffold needs further tailoring to be tissue specific in order to meet the clinical requirements.