Evaluation of Carbonate Apatite Cement in Inducing Formation of Reparative Dentin in Exposed Dental Pulp

Abstract

Carbonate apatite (CO3Ap) cement is a biocompatible material with the ability to induce osteogenesis and is widely studied as the bone substitute material. The similarity of bone to tooth structure in their organic and inorganic composition offers a good prospect of the application of CO3Ap for regeneration of dentin and pulp tissue repair. This study is a sequel of the previous study in the development of CO3Ap cement for dental application, particularly in pulp capping treatment. In this study, the CO3Ap cement is used to cover an exposed dental pulp in rats and histological evaluation was carried out to evaluate the formation of reparative dentin, which is one of the signs of positive pulp capping treatment outcome. The CO3Ap cement was made by combining 60% dicalcium phosphate anhydrous (DCPA) and 40% vaterite with 1 mol/L Na2HPO4 aqueous solution at liquid to powder ratio of 0.5 and conventional calcium hydroxide [Ca(OH)2], which is the golden standard for pulp capping material was used for control. The coronal part of dental pulp in Wistar Rat was exposed with a small dental bur until bleeding were visible. The CO3Ap cement was applied to the exposed pulp and covered with light cured glass ionomer cement. The same protocol was applied to the control groups using Ca(OH)2. The Evaluation of formation of reparative dentin was done in 3 weeks after application by histological observation. Reparative dentin was histologically visible for all samples in CO3Ap group, as well as in the Ca(OH)2 groups. None of the dental pulps were necrotic and the pulp showed no heavy chronic inflammation. The CO3Ap cement was able to maintain the vitality of the pulp with no sign of chronic inflammation. The formation of reparative dentin was observable in 3 weeks of evaluation. Investigation on other properties and in vivo studies in different types of perforation and animal are to be carried out for further development of this material in dental application.

Matrix levels of metalloproteinase-2 (MMP-2) and toxicity evaluation of carbonate apatite-based endodontic sealer in rat subcutaneous implantation

“…The duration of the inflammatory response can be measured by how long the above signs appear and persist in experimental animals. If inflammation is extensive and ongoing, it can affect the organ tissue function of an organism which can ultimately change the organism's behavior [ 7 , 9 , 18 , 21 , 22 ].…”

“…One of the materials that have been used for quite a long time in healthcare, especially orthopedics, is bioceramic of carbonate apatite as bone graft material [ 1 , 2 , 3 , 4 , 5 ]. Carbonate apatite has the ability to bind to bone structure and can stimulate hard tissue formation [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Besides, when carbonate apatite granules implanted in the cranial bone of rats, after 24 weeks almost all carbonate apatite granules were changed to new bone [ 12 ].…”

The use of carbonate apatite bioglass cement as pulp capping material examined from reparative dentin

“…The subjects were 32 mandibular incisors of Rattus norvegicus rats (at least 8 weeks old, healthy, active, male, weighed at least 300 g) to which pulp perforation was intentionally made using round bur. 11 Ethical clearance was obtained from the Health Research Ethics Committee of the Faculty of Medicine, Universitas Padjadjaran Number 457/UN6/C.1.3.2/KEPK/PN/2016. Before pulp perforation procedure and pulp capping material application, the subjects in all the groups were given general anesthesia with ketamine 40-100 mg/ kg.…”

“…The treatments to the rats were performed at the Animal Laboratory of Universitas Jenderal Achmad Yani, and the evaluation was performed after 21 days. 11 Histopathology specimen of teeth was made by routine hematoxylin-eosin technique, which was previously decalcified using 10% EDTA solution for 15 days at the Pathology Anatomy Laboratory of Universitas Jenderal Achmad Yani and Universitas Padjadjaran. The histopatology samples were subsequently examined with light microscope in 10x and 40x objective magnification to ensure the presence of reparative dentin or dentinal bridge formation.…”

“…Carbonate apatite cement has been applied to open pulp in an in vivo study and showed that the pulp remained vital and reparative dentin was formed in the perforation site. 11 This brings insight that in addition to its biocompatibility, this material is non-toxic and can stimulate tissue mineralization in the pulp.…”