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Background: Vital pulp therapy preserves and maintains the integrity and the health of dental pulp tissue that has been injured by trauma, caries or restorative procedures. The enhancement of cells viability and formation of reparative dentine and new blood vessels are vital determinants of the success of direct pulp capping. Therefore, the aims of this study was to evaluate and compare the in vitro osteogenic, odontogenic and angiogenic effects of mineral trioxide aggregate (MTA), calcium hydroxide [Ca(OH) 2 ], Biodentine and Emdogain on dental pulp stem cells (DPSCs) and examine the effects of the tested materials on cell viability. Methods: DPSCs were treated with MTA, Ca(OH) 2 , Biodentine or Emdogain. Untreated cells were used as control. The cell viability was measured by MTT assay on day 3. Real-Time PCR with SYBR green was used to quantify the gene expression levels of osteogenic markers (alkaline phosphatase and osteopontin), odontogenic marker (dentin sialophosphoprotein) and angiogenic factor (vascular endothelial growth factor) on day 7 and day 14. Results: All capping materials showed variable cytotoxicity against DPSCs (77% for Emdogain, 53% for MTA, 26% for Biodentine and 16% for Ca(OH) 2 compared to control (P value < 0.0001). Osteopontin (OPN) and dentin sialophosphoprotein (DSPP) gene expression was increased by all four materials. However, alkaline phosphatase (ALP) was upregulated by all materials except Emdogain. Vascular endothelial growth factor (VEGF) expression was upregulated by all four tested materials except Ca(OH) 2. Conclusions: Our results suggest MTA, Biodentine and Emdogain exhibit similar attributes and may score better than Ca(OH) 2. Emdogain could be a promising alternative to MTA and Biodentine in enhancing pulp repair capacity following dental pulp injury. However, further future research is required to assess the clinical outcomes and compare it with the in vitro findings.

Occlusal reduction reduced levels of postoperative pain in posterior mandibular teeth with symptomatic pulpitis and apical periodontitis only 12 h following both canal preparation and root filling.

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Aim To assess postoperative pain and bacterial reduction following the use of XP‐endo Shaper versus conventional rotary files in preparation of oval canals with necrotic pulps. Methodology This superiority, parallel, randomized, double blinded clinical trial was conducted in the clinic of the Endodontic Department, Faculty of Dentistry, Cairo University, Egypt. Sixty single‐canalled mandibular premolars with necrotic pulps were randomly assigned into two equal groups. Canals were instrumented using XP‐endo Shaper files in the intervention group and iRaCe rotary files in the control group. Bacterial samples were taken before and after canal instrumentation. Incidence and severity of postoperative pain was assessed using a modified VAS after 6, 12, 24 h and daily for 5 days. A culture method was used to assess the number of bacterial colony forming units. Incidence of analgesic intake as well as flare‐ups was recorded. Data were analysed using chi‐square, Fisher Exact, Mann–Whitney, Independent t‐test, and Spearman’s correlation for pain and bacterial counts. Results The XP‐endo Shaper compared with the iRaCe group was associated with a significantly lower incidence of postoperative pain at 6, 12, and 24 h (P = 0.039, 0.047, and 0.026, respectively), and severity of postoperative pain at 6 h (mean difference: 1.33, 95% CI: 0.307–2.352, P = 0.02), 12 h (mean difference: 1.1, 95% CI: 0.26–1.936, P = 0.007), 24 h (mean difference: 0.94, 95% CI: 0.178–1.701, P = 0.008) and 48 h (mean difference: 0.97, 95% CI: 0.192–1.747, P = 0.038). There was a significant decrease in bacterial count following canal instrumentation in both groups (P < 0.001) with no significant difference between them (mean difference: 0.83 × 105, 95% CI: 0.336 × 105–1.996 × 105, P = 0.56). A weak correlation existed between postoperative pain severity and bacterial counts (P = 0.54). There was no significant difference in analgesic intake between the two groups (P = 0.085). Flare‐ups occurred in 3.3% of teeth in the iRaCe group, while no flare‐ups occurred in the XP‐endo Shaper group. Conclusions XP‐endo Shaper was associated with a significantly lower frequency of postoperative pain for up to 24 h, and lower severity of postoperative pain for up to 48 h compared with iRaCe files. Both systems were equally effective in bacterial reduction from oval root canals with necrotic pulps.