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The inflammatory response of the pulp after direct capping with platelet-rich plasma and enamel matrix derivative: A controlled animal study

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DOI: 10.4236/ojst.2014.41004    4,367 Downloads   8,568 Views   Citations


Aims: To evaluate the inflammatory response of the exposed pulp of incisor teeth in rats after direct pulp capping, using platelet rich plasma (PRP), enamel matrix derivate (EMD), mineral trioxide aggregate (MTA) and calcium hydroxide (Ca(OH)2). Methods: The study was conducted on 36 Wistar albino rats with a total of 144 incisor teeth. The pulps of 96 teeth of the rats were perforated and capped with different agents. Serving as the positive control group, the pulps of 24 teeth were only perforated and capped without capping agents, whereas the pulps of 24 teeth were used as the negative control group without being perforated (without any process). The research was ended with the extracting of the teeth on the 7th day-28th day. The teeth were taken to the routine and histological follows; cross sections were prepared and painted with hematoxylen & eosin. All of the sections were evaluated in terms of inflammatory reaction by histologic analysis taken by light microscope. Statistical analysis was used. The normal distribution of all data was tested with the Mann Whitney U and the differences between the groups were analyze dusing Kruskal Wallis test at 0.05 level. Results: There are no statistically significant differences in terms of inflammation type and necrosis among the treatment groups on 7 days’ post capping. However, improved inflammatory cell accumulation, hyperemia and lowest necrosis were observed from the samples treated with PRP (p < 0.05). Conversely, the EMD group indicated that the criteria of inflammation scores and hyper-

emia were higher in the 28th day (p < 0.05). Conclusions: Most of cells accumulating in the PRP group and most necrosis were seen in the EMD group. These new PRP materials might serve as pulp capping biomaterials to induce initial healing response in the future.

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Maden, M. , Orhan, E. , Ertuğrul, İ. and Sengüven, B. (2014) The inflammatory response of the pulp after direct capping with platelet-rich plasma and enamel matrix derivative: A controlled animal study. Open Journal of Stomatology, 4, 14-21. doi: 10.4236/ojst.2014.41004.


[1] Zander, H.A. (1939) Reaction of the pulp calcium hydroxide. Journal of Dental Research, 18, 373-379.
[2] Kozlov, M. and Massler, M. (1966) Histologic effects of various drugs on amputated pulps of rat molars. Oral Surgery, 13, 455-469.
[3] Dammaschke, T. (2008) The history of direct pulp capping. Journal of HistoricalDentistry, 56, 9-23.
[4] Weider, S.R., Schour, I. and Mohammed, C.I. (1956) Reparative dentin following cavity and fillings in the rat molar. Oral Surgery, 9, 221-222.
[5] Rutherford, B. and Spangberg, L. (1995) Transdentinal stimulation of reparative dentin formation by osteogenic protein-1 in monkeys. Achieves of Oral Biology, 40, 681-683.
[6] Murray, P.E., About, I., Franquin, J.-C., Remsuat, M. and Smith, A.J. (2001) Restorative pulpal and repair responses. Journal of American Dental Association, 132, 482-490.
[7] Pitt Ford, T.R., Torabinejad, M., Abedi, H.R., Bakland, L.K. and Kariyawasam, S.P. (1996) Using mineral oxide aggregate as a pulp capping material. Journal of American Dental Association, 127, 1491-1494.
[8] Abedi, H.R., Torabinejad, M., Pitt Ford, T.R. and Bakland, L.K. (1996) The use of mineral trioxide aggregate cement (MTA) as a direct pulp capping agent. Journal of Endodontics, 22, 199.
[9] Junn, D.J., McMillan, P., Bakland, L.K. and Torabinejad, M. (1998) Quantitive assessment of dentin bridge formation following pulp capping with mineral trioxide aggregate (MTA). Journal of Endodontics, 24, 278-288.
[10] Yuan, K., Chen, C.L. and Lin, M.T. (2003) Enamel matrix derivative exhibits angiogenic effect in vitro and in a murine model. Journal of Clinical Periodontology, 30, 732-738.
[11] Nakamura, Y., Hammarström, L., Matsumoto, K. and Lyngstadaas, S.P. (2002) The induction of reparative dentin by enamel proteins. International Endodontic Journal, 35, 407-417.
[12] Hammarström, L. (1997) Enamel matrix, cementum development and regeneration. Journal of Clinical Periodontology, 24, 658-668.
[13] Heijl, L., Heden, G., Svardstrom, G. and Ostegren, A. (1997) Enamel matrix derivative (Emdogain) in the treatment of intrabony periodontal defects. Journal of Clinical Periodontology, 24, 705-714.
[14] Esposito, M., Grusovin, M.G., Coulthard, P. and Worthington, H.V. (2005) Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects. Cochrane Database System Review, 19, CD003875.
[15] Lyngstadaas, S., Lundberg, E., Ekdahl, H., Andersson, C. and Gestrelius, S. (2001) Autocrine growth factors in human periodontal ligament cells cultured on enamel matrix derivative. Journal of Clinical Periodontology, 28, 181-188.
[16] Lam, K. and Sae-Lim, V. (2004) The effect of Emdogain gel on periodontal healing in replanted monkeys teeth. Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics, 97, 100-107.
[17] Nakamura, Y., Hammarström, L., Lundberg, E., Ekdahl, H., Matsumoto, K. and Gestrelius, S. (2001) Enamel matrix derivative promotes reparative processes in the dental pulp. Advanced Dental Research, 15, 105-107.
[18] Tatsunari, N. and Matsumoto, K. (2003) Histopathological study of dental pulp tissue capped with enamel matrix derivative. Journal of Endodontics, 29, 176-179.
[19] Igarashi, R., Sahara, T., Shimizu, M. and Sasaki, T. (2003) Porcine enamel matrix derivative enhances the formation of reparative dentin and dentin bridges during wound healing of amputated rat molars. Journal of Electron Microscopy, 52, 227-236.
[20] Smith, A.J., Tobias, R.S. and Cassidy, N. (1994) Odontoblast stimulation in ferrets by dentin matrix components. Achieves Oral Biology, 39, 13-22.
[21] Sloan, A.J. and Smith, A.J. (1999) Stimulation of the dentin-pulp complex of rat incisor teeth by transforming growth factor-beta isoforms 1-3 in vitro. Achieves Oral Biology, 44, 149-156.
[22] Marx, R.E. and Garg, A.K. (1998) Bone structure, metabolism, and physiology: Its impact on dental implantology. Implant Dentistry, 7, 267-276.
[23] Anitua, E. (1999) Plasma rich in growth factors: Preliminary results of use in the preparation of future sites/or implants. International Journal of Oral & Maxillofacial Implants, 14, 529-535.
[24] Gerard, D., Carlson, E.R., Goteher, J.E. and Jaeobs, M. (2006) Effects of platelet-rich plasma on the healing of autologous bone grafted mandibular defects in dogs. Journal of Oral & Maxillofacial Surgery, 64, 443-445.
[25] Hasheminia, S.M., Feizi, G., Razavi, S.M., Feizianfard, M., Gutknecht, N. and Mir, M. (2010) A comparative study of three treatment methods of direct pulp capping in canine teeth of cats: A Histologic evaluation. Lasers Medical Sciences, 25, 9-15.
[26] Obersztyn, A. (1965) A new method for testing drugs used in direct pulp capping on a rat incisor as an experimental model. Czas Stomatology, 18, 213-220.
[27] Hu, J.C.C., Zhang, C., Yun, S.S., Qian, Q. and Ranly D.D.M. (1997) Platelet derived growth factor-BB and epidermal growth factor as pulp capping medicaments in rat incisors. Journal of Hard Tissue Biology, 6, 121-129.
[28] Sloan, A.J. and Smith, A.J. (1999) Stimulation of the dentin-pulp complex of rat incisor teeth by transforming growth factor-beta isoforms 1-3 in vitro. Achieves Oral Biology, 44, 149-156.
[29] Hebling, J., Giro, E.M. and Costa, C.A. (1999) Biocompatibility of an adhesive system applied to exposed human dental pulp. Journal of Endodontics, 25, 676-682.
[30] Holland, R. (1971) Histochemical response of amputes pulps to calcium hydroxide. Pesquisa Odontológica Brasileira, 4, 83-95.
[31] Modena, K.C., Casas-Apayco, L.C., Atta, M.T., Costa, C.A., Hebling, J., Sipert, C.R., Navarro, M.F. and Santos, C.F. (2009) Cytotoxicity and biocompatibility of direct and indirect pulp capping materials. Journal of Applied Oral Science, 17, 544-554.
[32] Wilson, T. (1999) Safety testing of Emdogain. In: Wilson, T., Ed., Periodontal Regeneration Enhanced, Quintessence, Chicago, 23-25.
[33] Hu, J.C.C., Sun, X., Zhang, C. and Zimmer, J.P. (2001) A comparison of enamelin and amelogenin expression in developing mouse molar. European Journal of Oral Science, 109, 125-132.
[34] Jakse, N., Tangl, S., Gilli, R., Berghold, A., Lorenzoi, M., Eskici, A., Haas, R. and Pertl, C. (2003) Influence or PRP on autogenous sinus grafts. An experimental study on sheep. Clinical Oral Implants Research, 14, 578-583.
[35] Butterfield, K.J., Bennett, J., Gronowicz, G. and Adams, D. (2005) Effect of platelet-rich plasma with autogenous bone graft for maxillary sinus augmentation in a rabbit model. Journal of Oral & Maxillofacial Surgery, 63, 370-376.
[36] Furst, G., Gruber, R., Tangl, S., Zechner, W., Haas, R., Mailath, G., Sanroman, F. and Watzek, G. (2003) Sinus grafting with autogenous platelet-rich plasma and bovine hydroxyapatite. A histomorphometric study in minipigs. Clinical Oral Implants Research, 14, 500-508.
[37] Thorwarth, M., Wehrhan, F., Schultze-Mosgau, S., Wiltfang, J. and Schlegel, K.A. (2006) PRP modulates expression of bone matrix proteins in vivo without longterm effects on bone formation. Bone, 38, 30-40.
[38] Wiltfang, J., Schlegel, K.A., Schultze-Mosgau, S., Nkenke, E., Zimmermann, R. and Kessler, P. (2003) Sinus floor augmentation with β-tricalciumphosphate (β-TCP): Does platelet-rich plasma promote its osseous integration and degradation? Clinical Oral Implants Research, 14, 213-218.
[39] Landesberg, R., Moses, M. and Karpatkin, M. (1998) Risks of using platelet rich plasma gel. Journal of Oral & Maxillofacial Surgery, 56, 1116-1117.
[40] Torneck, C., Moe, H. and Howlwy, T.P. (1983) The effect of calcium hydroxide on porcine pulp fibroblasts in vitro. Journal of Endodontics, 9, 131-136.
[41] Takita, T., Hayashi, M., Takeichi, O., Ogiso, B., Suzuki, N., Otsuka, K. and Ito, K. (2006) Effect of mineral trioxide aggregate on proliferation of cultured human dental pulp cells. International Endodontic Journal, 39, 415-422.
[42] Zhu, Q., Haglund, R., Safave, K.E. and Spangberg, L.S.W. (2000) Adhesion of human osteoblasts on root ending filling materials. Journal of Endodontics, 26, 404406.

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