Early Response of Mechanically Exposed Dental Pulps of Swine to Antibacterial-Hemostatic Agents or Diode Laser Irradiation

The purpose of this study was to compare the effectiveness of an antibacterial and hemostatic agent to diode laser irradiation in the healing of mechanically exposed porcine pulps. Materials and Method: The experiment required three adult swine (Sus scrofa domestica, Yorkshire) with 36 teeth prepared with occlusal penetrations into the pulpal tissues. The preparations were performed under general anesthesia and the pulps were exposed using high speed instrumentation with rubber dam isolation and a disinfected field. Following instrumentation the coronal pulpal tissue was amputated and immediately treated with ferric sulfate and chlorhexidine semi-gel (12), diluted Buckley’formocresol solution (12) for 5 minutes or laser irradiation with a diode laser (12). After treatment, hemostasis was obtained and a ZOE base applied to the treated pulps (36). The pulpal bases were all covered with a RMGI (Fuji II LC). The tissue samples were collected at 4 weeks (28 days). Following fixation, the samples were de-mineralized, sectioned, stained and histologically graded with a scale of 0-4. Results: The treatment groups were statistically different with the Laser Treated Group demonstrating the least inflammation. Conclusion: Pulpotomy treatment with the KaVo Gentle Ray Diode Laser demonstrated significantly less inflammation than the other two pulpal therapy modalities. The ferric sulfate and chlorhexidine mixture demonstrated the greatest inflammation as histologically graded. Also, the histological sections of pulpotomized swine teeth treated with the ferric sulfate and chlorhexidine mixture presented with black pigmented areas in the pulp and surrounding tissue. The formocresol group (clinical standard) and the diode laser group did not present with the black precipitate.

pulp exposures, pulp response, bacteria, swine.

1. Russo MC, Holland R, Okamoto T, de Mell W. In vivo fixative effect of formocresol on pulpotomized deciduous teeth of dogs. Oral Surg, 58: 706–14, 1984.

2. Pashley EL, Myers DR, Pashley DH, Whitford GM, Systemic distribution of 14C-formaldehyde from formocresol-treated pulpotomy sites. J Dent Res, Mar, 59(3): 602–8, 1980.

3. Waterhouse, P.J. Formocresol and alternative primary molar pulpotomy medicaments: a review. Endod Dent Traumatol 11: 157–62, 1995.

4. Fuks, A. Pulp therapy for the primary and young permanent dentitions. Dent Clin North Am, 44: n.5, 2000.

5. Ranly, DM. Pulpotomy therapy in primary teeth: new modalities for old relationales. Pediatr Dent, 16: 403–9, 1994.

6. Waterhouse, P.J. Nunn JH, Whitworth JM, Soames JV. Primary molar pulp therapy-histological evaluation of failure. Int J Paediatr Dent, 10, 313–321, 2000.

7. Ibricevic H, al-Jame Q. Ferric sulfate as pulpotomy agent in primary molars: twenty month clinical follow-up. J Clin Pediatr Dent Summer; 24(4): 269–72, 2000.

8. Peng l, Ye l, Guo X, Zhou X, Wang C and Li R. Evaluation of formocresol versus ferric sulpahte primary molar pulpotomy: a systematic review and meta-analysis. Int Endod J, Oct, 40(10): 751–7, 2007.

9. Ibricevic H, al-Jame Q. Ferric sulphate and formocresol in pulpotomy of primary molars: long term follow-up study. Eur J Paediatr Dent, Mar, 4(1): 28–32, 2003.

10. Loh A, O’Hoy P, Tran X, Charles R, Hughes A, Kubo K, Messer LB. Evidence-based assessment: evaluation of the formocresol versus ferric sulfate primary molar pulpotomy. Pediatr Dent, Sep-Oct, 26(5): 401–9, 2004.

11. Deery C. Formocresol and ferric sulfate have similar success rates in primary molar pulpotomy. In carious primary molar does a pulpotomy performed with ferric sulphate, compared with formocresol, result in greater clinical/radiographic success? Evid Based Dent, 6(3), 70, 2005.

12. Jeansonne MJ, White RR. A comparison of 2.0% chlorhexidine gluconate and 5.25% sodium hypochlorite as antimicrobial endodontic irrigants. J Endod, Jun, 20(6): 286–8, 1994.

13. White RR, Hays GL, Janer L. Residual antimicrobial activity after canal irrigation with chlorhexidine. J Endod, Apr, 23(4): 229–31, 1997.

14. Leonard M, Tanomaru F, Silva LA, Nelson F, Bonifacio K. Ito I. In vivo antimicrobial activity of 2% chlorhexidine used as a root canal irrigating solution. J Endod, 199 Mar, 25(3): 167–1.

15. Ercan E, Ozekinci T, Atakul F, Gul K. Antibacterial activity of 2% chlorhexidine gluconate and 5.25% sodium hypochlorite in infected root canal: in vivo study. J Endod, Feb, 30(2): 84–7, 2004.

16. Estrela C, Ribeiro RG, Estrela CR, Pecora JD, Sousa-Neto MD. Antimicrobial effect of 2% sodium hypochlorite and 2% chlorhexidine tested by different methods. Braz Dent J, 14(1): 58–62, 2003.

17. Dumani A, Yoldas O, Isci AS, Koksal F, Kayar B, Polat E. Disinfection of artificially contaminated Resilon cones with chlorhexidine and sodium hypochlorite at different time. Oral Surg Oral Med Oral Pathol Oral Radiol, Mar, 103(3): 82–5, 2007.

18. Cannon M, Wagner CJ, Thobaben Z, Zheng X, Johnson RV. Pilot Study to measure inhibition zones of pulpotomy medicaments. J Dent Res, sp is 88 (A), 87th General Session, 2009.

19. Wilkerson MK. et al., Effects of the argon laser on primary tooth pulpotomies in swine. J. Clin. Laser Med Surg, Feb, 14(1): 37–42, 1996.

20. Huth KC et al., Effectiveness of 4 pulpotomy techniques-randomized controlled trial. J Dent Res, Dec, 84(12): 1144–8, 2005.

21. Odabas ME et al., Clinical radiographic, and histopathological evaluation of Nd:YAG laser pulpotomy on human primary teeth. J Endod, Apr, 33(4): 415–21, 2007.

22. Saltzman B et al., Assessment of a novel alternative to conventional formocresol-zinc oxide eugenol pulpotomy for the treatment of pulpally involved human primary teeth: diode laser-mineral trioxide aggregate pulpotomy. Int J Paediatric Dent, Nov, 15(6): 437–47, 2005.

23. Liu JF. Effects of Nd:YAG laser pulpotomy on human primary molars. J Endod, May, 32(5): 404–7, 2006.

24. Hauser-Gerspach I, Stubinger S, Meyer J. Bacetericidal effects of different laser systems on bacteria adhered to dental implants sufaces: an in vivtro study comparing zirconia with titanium. Clin Oral Implants Res, Jan 13, 2010.

25. Eldeniz A, Ozer F, Hadimli H, Eganis O. Bactericidal efficacy of Er,Cr:YSGG laser irradiation against Enterococcus faecalis compared with NaOCI irrigation: an ex vivo pilot study. Int Endod J, Feb, 40(2): 112–9, 2007.

26. Kustarci A, Sumer Z, Altunbag D, Kosum S. Bactericidal effect of KTP laser irradiation against Enterococcus faecalis compared with gaseous ozone: an ex vivo study. Oral Surg Oral med Oral Pathol Oral Radiol Endod, May, 107(5): e73–9, 2009.

27. Gordon W, Atabakhsh V, Meza F, Doms A, Nissan R, Risolu I, Stevens R. The antimicrobial efficacy of the erbium, chromium:yttrium-scandium-gallium-garnet laser with radial emitting tips on root canal dentin walls infected with Enterococcus faecalis. J Am Dent Assoc, Jul, 38(7): 992–1002, 2007.

28. Noetzel J, Nonhoff L, Bitter K, Wagner J, Neumann K, Kielbassa AM. Efficiay of calcium hydroxide, Er:YAG laser of gaseous against Enterococcus faecalis in root canals. Am J Dent, Feb, 22(1): 14–6, 2009.

29. Kuvvetli S, Sandalli, Topcuoglu N, Kulekci G. Antibacterial efficacy of diode and Er:YAG laser irradiation in experimentally contaminated primary molar root canals. J Clin Pediatr Dent, Fall, 34(1): 43–6, 2009.

30. Meire M, De Prijck K, Coenye T, Nelis HJ, De Moor RJ. Effectiveness of different laser systems to kill Enterococcus faecalis in aqueous suspension and in an infected tooth model. Int Endod J, Apr, 42(4): 351–9, 2009.

31. Cannon M, Cernigliaro J, Vieira AE, Pericinoto C, Jurado R, Effects of Antibacterial Agents on Dental Pulps Of Monkeys Mechanically Exposed and Contaminated. J Clin Ped Dent, 33 (1): 21–28, 2008.

32. Cannon M, Gerodias I, Vieira AE, Percinoto C, Jurado R, Application of a Light Cured Pulp Capping Material: An Adjunct to the Practice of Minimally Invasive Dentistry. Dental Research and Applications, (1) 1: 60–64, 2007.

33. Trope M et al, Capping the inflamed pulp under different clinical conditions. J Esthet Restor Dent, 2002: 14(6): 349–57.