Pulpotomy reconsidered: application of an adhesive system to pulpotomized permanent primate pulps.
OBJECTIVE
This study was undertaken to compare the healing response of permanent primate pulps to pulpotomy procedures following hemorrhage control and adhesive hybridization to their response after conventional treatments.


METHODS
Forty-two cavities were placed throughout the dentitions of 4 adult monkeys. In 24 teeth, following mechanical bur exposure and pulpotomy, hemorrhage was controlled with application of 3% sodium hypochlorite. The cavity was rinsed and the enamel-dentin-pulp surface was restored with an adhesive system for 6 and 7 months. Calcium hydroxide, formocresol, and resin-modified glass-ionomer cement were placed as conventional treatments in 18 teeth for 70 days and cavities were sealed with resin-modified glass-ionomer cement. Following perfusion fixation, tissues were demineralized, sectioned, stained, and histologically graded using defined criteria.


RESULTS
Of 24 adhesive system pulps, 10 showed no or minimal pulpal response, 1 showed an acute response, 6 showed a chronic response, 2 showed a severe response, and 5 showed compartmentalized zones of localized necrosis. Only 8 adhesive system pulps showed stained bacteria associated with inflamed tissues. Thirteen adhesive system pulps showed dentin bridging directly at the adhesive system interface. Calcium hydroxide-treated specimens showed healing and dentin formation, while resin-modified glass-ionomer cement and formocresol treatments failed to result in any bridging. Apical tissues in all adhesive-treated specimens showed normal pulps and primary odontoblasts along their entire walls.


CONCLUSIONS
Permanent pulps without periapical radiolucencies may survive pulpotomy, provided that hemorrhage is properly controlled and the pulp-restoration interface is hybridized to exclude all microleakage.
Hafez
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AA
Department of Restorative Dentistry, University of Alabama, School of Dentistry, 609-A, 1530 3rd Avenue South, Birmingham, Alabama 35294, USA. ahafez@uab.edu
Kopel
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HM
Cox
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CF
D000818:Animals; D002126:Calcium Hydroxide; D003790:Dental Pulp Necrosis / Q000517:prevention & control; D017220:Dentin-Bonding Agents; D006487:Hemostasis; D008253:Macaca mulatta; D008689:Methacrylates; D011672:Pulpotomy / Q000379:methods*; D019279:Resin Cements
C112828:Clearfil AP-X; C112274:Clearfil Liner Bond 2; D017220:Dentin-Bonding Agents; D008689:Methacrylates; D019279:Resin Cements; D002126:Calcium Hydroxide