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Durelon for pulp capping

 
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gatordmd



Joined: 29 Jul 2008
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Location: Orlando

PostPosted: Tue Jul 29, 2008 9:58 am    Post subject: Durelon for pulp capping Reply with quote

Dr. Kanka,
I saw you in Orlando last weekend.
I am interested in the information you have regarding Durelon for pulp capping. Can you send me the name of the article that recommends this.
I think the article was from 1976.

Which brings me to my next question...
If you say Duralon is the best material for pulp capping then why has there not been any studies since 1976 (or there has then why are you using one from so long ago) and why are you the only one, that I have heard, that recommends this?

I appreciate this forum and look forward to hearing from you,
john
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john kanca



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PostPosted: Tue Jul 29, 2008 10:23 am    Post subject: Re: Duralon for pulp capping Reply with quote

gatordmd wrote:
Dr. Kanka,
I saw you in Orlando last weekend.
I am interested in the information you have regarding Duralon for pulp capping. Can you send me the name of the article that recommends this.
I think the article was from 1976.

Which brings me to my next question...
If you say Duralon is the best material for pulp capping then why has there not been any studies since 1976 (or there has then why are you using one from so long ago) and why are you the only one, that I have heard, that recommends this?

I appreciate this forum and look forward to hearing from you,
john


McWalter and el-Kafrawy, JADA, 1976
100% success at short and long term intervals.

The reason it's not used is tradition, and not response.

Money was being pumped into calcium hydroxide. The other reason is that these materials came into being when there was no bonding, no sealing of teeth. Thus it was felt that something used as a pulp cap needed to be obnoxious enough to cause the pulp to sclerose and form a callus- a pathologic response to a chemical insult- to keep bugs out.

Materials such as ZOP and carboxylate cement will allow pulps to heal without the callus formation. They are not obnoxious and allow simple physiologic healing. We can seal teeth to prevent bacterial ingress so the additional toxicity of the pulp cap material is no longer necessary.

Pulp biology became a fascination for me twenty years ago and I have read every biocompatibility paper written since 1945.
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gatordmd



Joined: 29 Jul 2008
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PostPosted: Tue Jul 29, 2008 12:32 pm    Post subject: Reply with quote

I wrote to 3M and asked them about articles on Durelon. Then I asked them if they recommend using Durelon for pulp capping and here is Jon Fundingsland from 3M ESPE response...


Here is the abstract:

J Am Dent Assoc. 1976 Jul;93(1):105-10.

Long-term study of pulp capping in monkeys with three agents.

McWalter GM, el-Kafrawy AH, Mitchell DF.

The pulps of 40 permanent teeth of two monkeys were mechanically exposed and contaminated with adjacent saliva or plaque for 3 to 5 1/2 hours. The pulps were then capped with either Keflin (an antibiotic), Durelon (a polycarboxylate cement), or Dycal (a calcium hydroxide compound). Varnish and then amalgam were inserted. Each monkey received at least one dose of Procion red H-8BS vital dye.
The teeth were extracted from one monkey 23 months after capping and from the other monkey 29 months after capping. Serial, decalcified, 7 mum-thick paraffin sections were prepared. Alternate slides were stained with hematoxylin ane eosin.

Unstained sections were examined for Procion labeling, and selected slides were stained by the Brown-Brenn method for bacteria. Of 13 teeth capped with Keflin, only 4 responded satisfactorily. All of the Dycal and Durelon-capped pulps were successful at both time intervals. All of the Dycal-capped pulps showed complete bridging and no inflammation or pulp obliteration. Bridging was complete in only three of the Durelon-capped pulps. The findings of this study support the findings in our previous study3 and further substantiate the effectiveness of Dycal as a pulp-capping agent. The often-repeated claim that calcium hydroxide compounds exert a persistent stimulating effect on the pulp resulting in its eventual obliteration was not supported. Durelon is not recommended for pulp capping since the material apparently lacks an antibacterial effect and does not stimulate reparative dentinogenesis at the exposure site. The low rate of satisfactory responses of pulps capped with Keflin, as used, precludes its use of pulp capping.

The official 3M ESPE position is that in addition to luting metal-based restorations (except titanium), Durelon can be used as a liner, but not as a pulp capping material.

As you can see, the authors concluded that Durelon should NOT be used for pulp capping and the 3M people don't even recommend it for a pulp capping material.


What do you think of this?

Help a brother out?
I look forward to hearing from you,
john gammichia
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john kanca



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PostPosted: Tue Jul 29, 2008 1:52 pm    Post subject: Reply with quote

" Durelon is not recommended for pulp capping since the material apparently lacks an antibacterial effect and does not stimulate reparative dentinogenesis at the exposure site."

Just like I said.

Jon Fundingsland is a friend of mine and I could not expect him to say anything different. Tell me you really didn't expect 3M to say anything different!

Now go read Cox et al, JPD, 1987, p.1-8.

The one I showed you.

Then ask around here and see what kind of success they're having doing this technique.

Things have gotten considerably more sophisticated since they did that study, including methods of hemostasis and cavity sealing. The lack of sealing could be the reason for the lack of dentinogenesis. See Cox for the difference. The teeth in the study were not biologically sealed, so the results are pertinent for amalgam and copal varnish.

In spite of that they did really well. And since Dycal can only screw up bonding I think the choice is clear.
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gatordmd



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PostPosted: Tue Jul 29, 2008 3:00 pm    Post subject: Reply with quote

I am confused (I know not hard to believe)

You are saying that 3M Durelon is the right material for pulp capping. The makers of the material are saying not to use it.
And you are saying that doesn't suprise you.
I am not getting it. If it worked then why wouldn't they say, "Hey, you can also use this for pulp capping."

How I am as a consumer, a regular guy, am not suppose to be suprised at that?!
(Do you see my confusion or am I just dense?).

And I don't want to ask the people on your forum because they are all Kanka-ites. Not that this is a bad thing.
What it means if people start doing the things you tell them to do and it doesn't work, they don't come back and say "this didn't work for me"...they just don't come back. So then all the opinions slowly become all the same.
It is also like DT that everyone becomes an expert.

I am not trying to be a thorn in your side I am just trying to find the best product for my patients.

I appreciate your response.
john

You say go and read Cox. It took me a week to find the first article.
Can you give me the abstact for the Cox study?
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john kanca



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PostPosted: Tue Jul 29, 2008 4:26 pm    Post subject: Reply with quote

[quote="gatordmd"]I am confused (I know not hard to believe)

You are saying that 3M Durelon is the right material for pulp capping. The makers of the material are saying not to use it.
And you are saying that doesn't suprise you.
I am not getting it. If it worked then why wouldn't they say, "Hey, you can also use this for pulp capping."

3M didn't make it. Premier did originally.

How I am as a consumer, a regular guy, am not suppose to be suprised at that?!
(Do you see my confusion or am I just dense?).

My track record is pretty good. What I showed you is exactly what I do with my patients. And I showed you cases and I showed you recalls.

And I don't want to ask the people on your forum because they are all Kanka-ites. Not that this is a bad thing.
What it means if people start doing the things you tell them to do and it doesn't work, they don't come back and say "this didn't work for me"...they just don't come back. So then all the opinions slowly become all the same.
It is also like DT that everyone becomes an expert.

They wouldn't lie. They know how I feel about that.

I am not trying to be a thorn in your side I am just trying to find the best product for my patients.


John, you'll have to decide for youself what to do. I have zero vested interest in Durelon. I believe it is the best practical treatment for pulp capping, and I laid out the reasons for that in the lecture. The data does say it is successful.

You say go and read Cox. It took me a week to find the first article.
Can you give me the abstact for the Cox study?

Below
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john kanca



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PostPosted: Tue Jul 29, 2008 4:32 pm    Post subject: Reply with quote

J Prosthet Dent. 1987 Jan;57(1):1-8.Links
Biocompatibility of surface-sealed dental materials against exposed pulps.Cox CF, Keall CL, Keall HJ, Ostro E, Bergenholtz G.


This is all I can get right now.

I have the original, of course. It likely can be obtained online.
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john kanca



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PostPosted: Tue Jul 29, 2008 9:15 pm    Post subject: Reply with quote

The bottom line on the Cox study was that many materials, including zinc phosphate cement, functioned really well as pulp capping materials when the cavity was biologically sealed aftwerwards.

Carboxylate cement is much kinder to the pulp than even ZOP.
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PostPosted: Tue Jul 29, 2008 9:33 pm    Post subject: Reply with quote

Int J Periodontics Restorative Dent. 1996 Jun;16(3):240-51.Links
Biocompatibility of various dental materials: pulp healing with a surface seal.Cox CF, Sübay RK, Suzuki S, Suzuki SH, Ostro E.
Department of Restorative Dentistry, School of Dentistry, UAB Station, Birmingham 35294-0007, USA.

Class V cavities with mechanical exposures were prepared in 178 teeth of seven monkeys to observe the temporal healing of exposed pulps in direct contact with various dental materials, with or without a biologic seal of zinc-oxide eugenol cement against microleakage. Thirty pulps were direct capped as calcium hydroxide controls. The remaining 148 exposures were direct capped, 41 with silicate, 39 with zinc phosphate, 33 with amalgam, and 35 with an auto-cured composite. Sixty-four were restored to their cavosurface margin with their respective material and 84 were sealed to the covosurface margin with zinc-oxide eugenol cement. Tissues were obtained by perfusion fixation at intervals of 35, 21, 14, 10, 5, and 3 days, and then processed and evaluated. The results of this study demonstrated that exposed dental pulps possess an inherent healing capacity, allowing cell reorganization and dentin bridge formation when adequately sealed with zinc-oxide eugenol cement to prevent bacterial microleakage.
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PostPosted: Tue Jul 29, 2008 9:34 pm    Post subject: Reply with quote

Quintessence Int. 1993 Jul;24(7):501-10.Links
Pulpal healing and dentinal bridge formation in an acidic environment.Snuggs HM, Cox CF, Powell CS, White KC.
Department of Restorative Dentistry, University of Alabama at Birmingham, School of Dentistry 35294-0007.

This study was designed to observe the healing and bridging capacity of mechanically exposed pulps that were capped with silicate or zinc phosphate cements and biologically sealed with zinc oxide-eugenol cement to exclude bacteria. In six monkeys, Class V facial cavities with pulpal exposures were randomly distributed throughout 105 teeth, of which 80 were directly capped, 40 with silicate cement and 40 with zinc phosphate cement. Twenty of each group were filled to the cavosurface margin with the respective cement and 20 were surface sealed to the cavosurface margin with zinc oxide-eugenol cement. The remaining 25 exposures were capped with calcium hydroxide and amalgam as controls. Tissues were obtained by perfusion fixation after intervals of 21, 14, 10, 5 and 3 days. The 25 pulps capped with calcium hydroxide showed cell migration and organization at 5 days and dentinal matrix deposition at 10 days. At 3 and 5 days, all exposures in the experimental groups showed clot resolution. At 10 days, fibroblasts had stratified against the cement interface. At 14 days, pulps in both experimental groups showed new dentinal bridge formation directly adjacent to the acidic cements. The 21-day experimentally capped and sealed pulps presented healing similar to the controls. This study indicates that acidic components of silicate and Zinc phosphate cements are not directly responsible for pulpal inflammation or necrosis. The exposed dental pulp possesses an inherent healing capacity for cell reorganization and dentinal bridge formation when a bacterial seal is provided.
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PostPosted: Tue Jul 29, 2008 9:37 pm    Post subject: Reply with quote

Quintessence Int. 1994 Apr;25(4):259-68.Links
Pulpal response to adhesive resin systems applied to acid-etched vital dentin: damp versus dry primer application.White KC, Cox CF, Kanka J 3rd, Dixon DL, Farmer JB, Snuggs HM.
Department of Restorative Dentistry, University of Alabama, Birmingham.

A number of studies have reported that acid etching of dentin is toxic to the cells of the odontoblastic layer and dental pulp. Other studies report that pulpal inflammation is a consequence of bacterial microleakage. The purpose of this study was to observe the degree of pulpal healing after pretreatment of vital dentin prior to placement of All-Bond and Scotch-bond 2 composite resin adhesives. Zinc oxide-eugenol cement and an acidic cement were employed as controls. One hundred twelve Class V nonexposed cavity preparations were placed throughout the dentitions of five healthy adult rhesus monkeys and observed at 3, 25, and 80 days. Various dentinal pretreatment procedures were employed. The All-Bond Universal primer system was placed on air-dried vital dentin in 23 cavities and on damp vital dentin in 27 cavities. Scotchbond 2 was placed as per manufacturer's instructions. All treatment procedures, materials, and times were represented in all animals. Placement of silicate cement resulted in the most severe pulpal responses at all time periods. Stained bacterial profiles in the remaining dentin on the axial walls of inflamed control pulps were associated with severe pulpal inflammation. These results indicate that acid etching of vital dentin does not impair pulpal healing in deep Class V cavities.
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PostPosted: Tue Jul 29, 2008 9:39 pm    Post subject: Reply with quote

Quintessence Int. 1998 Aug;29(Cool:535-42.Links
Pulpal response to a resin-modified glass-ionomer material on nonexposed and exposed monkey pulps.Tarim B, Hafez AA, Cox CF.
Department of Conservative Dentistry, Faculty of Dentistry, Istanbul University, Turkey.

OBJECTIVE: This study evaluated the biocompatibility of a resin-modified glass-ionomer material on monkey pulps. METHOD AND MATERIALS: Standardized Class V cavities were prepared in 112 teeth distributed in six healthy adult monkeys. The resin-modified glass-ionomer cement was placed in 24 nonexposed and 36 exposed pulps according to manufacturer's instructions. ZOE was used as a control in nonexposed pulps, while calcium hydroxide was used as a control for exposed pulps. Tissues were collected at 6 to 7, 21 to 27, and 90 to 97 days. After demineralization, the teeth were serially sectioned, stained, and observed by light microscopy. RESULTS: Except for one resin-modified glass-ionomer pulp at 6 days, there were no differences between the responses of nonexposed pulps to resin-modified glass-ionomer specimens and ZOE controls. In exposed pulps, eight of 36 resin-modified glass-ionomer pulps showed various grades of inflammatory response, all associated with stained bacteria. Pulpal healing was similar in both resin-modified glass-ionomer and calcium hydroxide direct-capped exposures. Twenty-two of 26 exposed pulps restored with the resin-modified glass-ionomer cement showed dentin bridge formation at 21 and 97 days. CONCLUSION: The resin-modified glass-ionomer material exhibited acceptable biologic compatibility in exposed and nonexposed cavities.


RMGIC is far more cytotxic than is polycarboxylate cement.
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