UNIVERSITATEA DE MEDICIN I FARMACIE

IULIU HAIEGANU CLUJ-NAPOCA

FACULTATEA DE MEDICIN DENTAR

ORIENTRI MODERNE N TRATAMENTUL

CONSERVATIV AL PULPEI DENTARE N DESCHIDERILE
ACCIDENTALE ALE CAMEREI PULPARE

TEZ PENTRU OBINEREA TITLULUI TIINIFIC DE

DOCTOR N DOMENIUL FUNDAMENTAL, TIINE
MEDICALE DOMENIUL MEDICIN DENTAR
REZUMAT

Doctorand,
Loredana Colceriu-Burtea

-2006-

Conductor tiinific,
Prof. Dr. Angela Pop

Cuvinte

cheie :

neodentinogenez,

inoculare,

vase

de

neoformaie,

polimorfonucleare, infiltrat inflamator, coafaj direct, monocite, fagocitare, Mineral

Trioxid Agreggate

Orientarea actual a terapiei conservative se ndreapt spre concepia biologic de

pstrare a vitalitii pulpei dentare o perioad ct mai mare de timp, fiind bine cunoscut
faptul c pulpa indemn este capabil s iniieze mecanisme de aprare mpotriva invaziei
bacteriene, obiectiv care se poate obine n cazul unei deschideri accidentale de camer
pulpar prin coafaj direct. Pentru reuita unui coafaj direct trebuie s inem seama de 2
categorii de factori: generali si locali. ntre factorii generali amintim: vrsta pacientului,
starea sa de sntate i condiiile sociale. Factorii locali se refer la condiiile de lucru,
starea pulpei dentare, caracterul leziunii traumatice.
Dintre materialele cu ajutorul crora se realizeaz coafajul direct cele mai
frecvent utilizate sunt cele pe baz de hidroxid de calciu. Principalul argument care
susine aplicarea hidroxidului de calciu n coafajul direct este legat de proprietile sale:
antimicrobiene, antiinflamatorii, hemostatice i tisulare. Pornind de la proprietile
neodentinogenetice ale materialelor pe baz de hidroxid de calciu, n aceast cercetare am
testat un produs romnesc, Calcidenta elaborat n cadrul Institutului de Chimie Raluca
Ripan, ceea ce dovedete c i n ara noastr continu preocuparea pentru introducerea
materialelor dentare care prin calitile prezentate i preul de cost sczut sunt
avantajoase. Scopul experimentului realizat a fost de a aprecia gradul de
biocompatibilitate al materialului stomatologic Calcidenta la contactul prelungit al
acestuia cu esutul conjunctiv i esutul muscular. Reaciile locale dup implantarea
materialului privind evaluarea preclinic, s-au realizat n cadrul Laboratorului Biobazei
UMF (Dr. Septimiu Toader).

Material i metod de lucru

Compoziia materialului selecionat n vederea testrilor biologice este: Ca (OH)2
42%, ZnO 25,8%, CMC 3,2%, Glicerina 29%. Produsul este prezentat n sistem
monopast i este autopolimerizabil. S-au utilizat ca biotest dou specii de animale de
experien, obolani i cobai, cu dou ci de administrare, calea subcutanat i
intermuscular.
Rezultate i discuii
La toate loturile, indiferent de specie i de calea de inoculare, reacia local a fost
favorabil, implantul fiind acceptat de esut, perceput fiind la palpare sub forma unui mic
nodul subcutanat sau intermuscular, nedureros i semimobil(figura 1).

Figura 1. Implantul fixat i ncapsulat intermuscular la cobai, zona coapsei, la 21 de zile postoperator

Introducerea fragmentelor de material la nivelul celor dou zone anatomice

menionate (subcutanat i muscular) la cele dou specii de animale a evideniat din
punct de vedere histopatologic urmtoarele: zona subcutanat: n jurul corpului
implantului se formeaz o structur capsular constituit din esut conjunctiv de
neoformaie ce acoper implantul pe toate feele; zona muscular: se constituie aceeai
structur capsular, o reacie limfo-histiocitar i rare polimorfonucleare. (figura 2).

Figura 2. Perete capsular constituit din esut conjunctiv de neoformaie, dezvoltat din interstiiul
muscular, cobai la 21 de zile postimplantare. Coloraie H.E. x 200

Concluzii
Nu s-a nregistrat la nici un caz pentru nici una din cile de administrare fenomene
de respingere prin formare de abcese, fistule sau constituire de sechestre. Reacia fa de
produs a fost strict local constnd n formarea unui granulom de corp strin inert n care
afluxul de monocite, macrofage demonstreaz o aciune de fagocitare treptat a
materialului cu inactivarea n timp.
Un alt material aprut recent i utilizat cu succes n coafajul direct este Mineral
Trioxid Agreggate, care a fost descoperit in 1996. ntre proprietile fizico-chimice ale
materialului amintim: pHul foarte ridicat (12,5) i etaneitatea sa superioar, iar dintre
proprietile biologice se remarc biocompatibilitatea fa de pulpa dentar.
n ultimii ani odat cu dezvoltarea impetuoas a tehnicilor adezive au aprut
studii1,2,3,4,5,6) care au artat c se poate obine o vindecare tisular pulpar atunci cnd s-a
folosit terapia cu rini adezive. Aceste studii susin ipoteza c pulpa se poate reface
chiar dup aplicarea sistemelor adezive n cavitile profunde sau chiar pe deschiderea
camerei pulpare att timp ct se realizeaz o hemostaz corect naintea aplicrii rinii7),
asigurndu-se o nchidere etan mpotriva infiltratului bacterian8). Acest concept devine
tot mai popular n ciuda faptului c numeroase cercetri n vitro9) i n vivo10) au artat
citotoxicitatea rinilor compozite aplicate pe medii de cultur sau n contact direct cu
esutul subcutanat la animale. Scopul acestei cercetri experimentale a fost de a
caracteriza i compara rspunsul pulpar n urma realizrii coafajului direct cu rini
adezive, Mineral Trioxid Aggregate i materialul Calcidenta.
Material i metod de lucru
Am luat n studiu un numr de 60 de dini mprii n trei loturi. Dinii examinai au
fost premolari integri, care urmau a fi extrai n scop ortodontic de la pacieni cu vrste
cuprinse ntre 10-18 ani. Efectivul experimental pentru fiecare material folosit a fost de
cte 20 caviti realizate pe 20 dini pentru Calcidenta, respectiv MTA i de 20 caviti
realizate pe 20 dini pentru sistemele adezive Optibond SoloPlus (KERR). n anestezie
local, pe fiecare dinte am preparat cte o cavitate de clasa a-V-a, repartizat pe faa
vestibular. Dup deschiderea camerei pulpare s-a realizat hemostaza i s-a aplicat
materialul de coafaj, MTA sau Calcidenta, restul cavitii fiind obturat cu IRM.

Utilizarea sistemului adeziv Optibond SoloPlus s-a efectuat dup demineralizarea cu

acid fosforic 35% pentru 15 secunde, splarea cu ap distilat i uscarea uoar cu bulete
de vat steril. Polimerizarea stratului de adeziv a fost de 20 secunde, ulterior cavitatea
fiind obturat cu material compozit Herculite (KERR).Dinii au fost mprii n 2 grupe,
fiind extrai la intervale variate de timp: scurte (9-12 zile ) i mai lungi (60-90 zile).Dup
fixarea, demineralizarea, secionarea i colorarea preparatelor histologice s-a caracterizat
rspunsul pulpar prin: apariia inflamaiei, existena dentinei de reacie, prezena punilor
dentinare cu caracteristicile acestora.
Rezultate
n ceea ce privete rspunsul inflamator n cazul lotului urmrit pe un interval
cuprins ntre 60- 90 zile analiza statistic nu a relevat nici o diferen semnificativ
statistic ntre cele 3 tipuri de materiale (p >0,05) (tabelul I, figura 3). Totui procentual
analiznd doar 60% dintre dinii tratai cu sisteme adezive nu au nregistrat rspuns
inflamator sau inflamaia observat a fost minim.
Tabelul I: Rspunsul inflamator nregistrat n funcie de tipul materialului studiat la interval de timp
lung
Material

Inflamaie prezent

Inflamaie absent

Ca (OH)2

MTA

Sistem adeziv

p=0.1
16
14
12
10
8
6
4
2
0
Ca(OH)2
Inflamaie prezent

MTA

Sistem adeziv
Inflamaie absent

Figura 3 : Rezultatele analizei comparative a rspunsului inflamator ntre loturilor studiate, n

funcie de tipul de material utlizat, la interval de timp lung.

Inducerea dentinei de reparaie pentru lotul de dini urmrii pe intervalul de

timp scurt arat o diferen semnificativ statistic ntre dinii tratai cu MTA i
Calcidenta, comparativ cu cei tratai cu sisteme adezive.(tabelul II, figura 4)
Tabelul II: Repartiia dentinei de reacie pe numr de dini n funcie de materialul examinat, la
interval scurt.
Material

Dentina absent

Dentina prezent

Ca (OH)2

MTA

Sistem adeziv

p=0.03
p=0.01
10
9
8
7
6
5
4
3
2
1
0
Ca(OH)2

MTA
Absent

Sistem adeziv
Prezent

Figura 4 : Analiza comparativ ntre repartiia dentinei de reacie n funcie de tipul de material
utilizat, la dinii luai n studiu, la interval scurt.

Concluzii
1. Mecanismul de aciune antibactericid al hidroxidului de calciu prin pH-ul su
puternic alcalin, i stimularea procesului de neodentinogenez rmn principalele
argumente n favoarea aplicrii acestui material n terapia cariei profunde.
2. Datorit etaneitii superioare materialelor clasice, i alcalinitii, MTA-ul a permis
refacerea esutului pulpar afectat n cazul deschiderii accidentale a camerei pulpare cu
formarea n timp a unor puni de predentin continue i de grosime mare.

3. Punile dentinare formate in cazul sistemelor adezive nregistrau multiple defecte

tunelare ceea ce ar favoriza ptrunderea microinfiltratului bacterian n camera pulpar
i compromiterea vitalitii pulpei prin apariia fenomenelor inflamatorii.
Studiile clinice din literatur efectuate pe dini cu coafaj direct au urmrit evoluia
acestui tratament pe intervale scurte de timp, iar rezultatele au fost controversate. Pornind
de la datele din literatur scopul acestui studiu clinic a fost de a evalua rata reuitei
coafajului direct n cazul deschiderii accidentale a camerei pulpare realizat cu dou
materiale diferite : Calcidenta, material pe baz de hidroxid de calciu produs la ICCRR
din Cluj-Napoca i MTA, subliniind care dintre factorii clinici influeneaz reuita
tratamentului.
Material i metod de lucru
n studiul de fa s-au tratat un numr de 150 dini de la 120 de pacieni. Vrsta
pacienilor a fost cuprins ntre 10 i 40 ani. La ntregul lot luat n studiu n cazul
prezenei leziunilor dentare diagnosticate drept carie profund cnd pe parcursul exerezei
dentinei alterate s-a produs deschiderea accidental a camerei pulpare am efectuat
tratamentul prin coafaj direct. S-a trecut la evaluarea diametrului orificiului de deschidere
i a gradului de sngerare, factori care pot influena reuita unui coafaj direct. Astfel
mrimea diametrului orificiului de comunicare cu pulpa (), a permis divizarea
dinilor n 4 grupe : <0,5mm, 0,5mm <<1mm, 1mm <<2mm, >2mm.
n funcie de gradul de sngerare al pulpei notarea dinilor s-a fcut astfel:
pulpa nu sngereaz la nivelul deschiderii (-), sngerarea este redus (+), sngerarea se
oprete n 30 secunde (++), sngerarea persist peste 30 secunde (+++). Dinii studiai
sunt izolai cu ajutorul sistemului de dig. Toaleta de la nivelul pulpei expuse se va face
prin irigri cu ser fiziologic, dup care se va realiza uscarea cu o bulet de vat steril.
Atunci cnd hemostaza este complet aplicm materialul de coafaj la nivelul deschiderii
camerei pulpare, restul cavitii obturndu-se cu IRM. Evoluia dinilor studiai a fost
urmrit printr-un control clinic i radiologic pe o perioad de 2 ani la un interval de 3
luni. Se consider o reuit atunci cnd dintele: rspunde pozitiv la testele de vitalitate,
relevnd o sensibilitate egal cu cea a dinilor omologi sau vecini sntoi att nainte de
realizarea tratamentului ct i dup efectuarea acestuia; n absena unei simptomatologii
de pulpit ireversibil dup efectuarea tratamentului.

Rezultate
Relaia existent ntre vrsta pacienilor i rata de succes a coafajului direct realizat cu
ambele materiale este prezentat n tabelul III.
Tabelul III: Rata de succes a coafajului direct repartizat pe grupe de vrst n lotul de pacieni
examinai

Vrsta

Nr cazuri succes

Nr cazuri eec

Rata succesului (%)

10-20 ani

30

100

20-30 ani

30

90,90

30-40 ani

48

84,21

S-a observat n prezentul studiu influena vrstei asupra ratei de succes a tratamentului,
cel mai mare procent nregistrndu-se la pacienii sub 20 ani, fapt subliniat i de unii
autori n cercetrile lor11,12,13).
n ceea ce privete procentul reuitei tratamentului n funcie de materialul
utilizat, ambele materiale au nregistrat rezultate similare (tabelul IV).
Tabelul IV: Repartiia procentual a succesului n funcie de materialul utilizat.

Materialul de coafaj

Nr dini succes

Nr dini eec

Rata succesului (%)

Ca (OH)2

54

15

78,26

MTA

66

15

81,48

Influena diametrului orificiului de comunicare cu camera pulpar i a gradului de

sngerare de la nivelul pulpei expuse asupra reuitei coafajului direct au fost analizate n
continuare (tabelul V,VI).
Tabelul V: Influena diametrului comunicrii cu camera pulpar asupra reuitei terapiei de
conservare a vitalitii pulpare.

Simptomatologie obiectiv
Diametrul orificiului de
deschidere al camerei
pulpare: (mm)

Observaii

Nr dini succes

Nr dini eec

Rata succesului (%)

0,5

36

92,30

0,5 < 1,0

1,0 < 2,0
> 2,0

54
30
0

6
6
15

90,00
83,33
0

Pentru a aprecia relaia dintre diametrul deschiderii camerei pulpare i rata reuitei
tratamentului de conservare a pulpei vii dinii au fost mprii n 4 grupe funcie de
mrimea orificiului de comunicare. Astfel la grupul unde diametrul de deschidere al
camerei pulpare a fost mai mare de 1 mm dar mai mic de 2 mm rata de succes nregistrat

este de 83,33% mai sczut dect a grupului unde diametrul deschiderii a fost mai mic de
0,5 mm, 92,30% i dect a grupului la care deschiderea a fost cuprins ntre 0,5-1 mm,
90%. Pentru grupul unde diametrul orificiului de comunicare a depit 2 mm, rata de
succes este 0, coafajul direct fiind considerat un eec.
n ceea ce privete gradul sngerrii de la nivelul deschiderii camerei pulpare succesul
grupului unde sngerarea este absent (95,23%) sau redus sub 30 secunde (87,5%) este
semnificativ mai crescut dect la grupul unde sngerarea este abundent i persistent
(46,15%) (tabelul VI).
Tabelul VI: Influena timpului de sngerare asupra reuitei meninerii vitalitii pulpare n coafajul
direct.

Gradul sngerrii

Nr dini succes

Nr dini eec

Rata succesului (%)

Sngerarea absent

60

95,23

Sngerarea uoar

42

87,5

Sngerarea persistent

18

21

46,15

Testul de corelaie Pearson (figura 5) ntre gradul de sngerare i rata de succes arat o
valoare a lui r=-0,95 ceea ce demonstreaz o relaie invers proporional ntre cele dou
variabile, probabilitatea ca lipsa sngerrii s determine un succes este de 0,99 (R2=0,99).

r=0.95
R2 = 0.9932

Sngerarea absent
Nr dini succes

Sngerarea uoar
Nr dini eec

Sngerarea persistent
Linear (Nr dini succes)

Figura 5: Relaia dintre gradul de sngerare pulpar i rata reuitei terapiei deschiderii accidentale a
camerei pulpare prin coafaj direct.

Discuii
Procentul reuitei acestei terapii depinde att de factori generali ct i de factori
locali, terenul cel mai favorabil pentru reuita unui coafaj direct constituindu-l dinii
permaneni tineri deoarece au o mare capacitate de reacie, cu multiple resurse de
aprare.
n ceea ce privete factorii locali rata de succes a acestei terapii depinde de diametrul
orificiului de deschidere al camerei pulpare care nu trebuie s depeasc 2 mm i de
posibilitatea de ndeprtare a dentinei alterate care ar trebui realizat n totalitate
naintea nceperii coafajului direct. Statusul inflamator al organului pulpar se reflect
prin nivelul indicelui de sngerare de la nivelul comunicrii cu pulpa. Astfel cu ct
gradul sngerrii este mai mare se reduce ansa unui prognostic favorabil al
tratamentului.

CONCLUZII GENERALE :
1. Leziunile carioase profunde sunt afeciuni dentare frecvent ntlnite n practica
stomatologic. Tratamentul acestor afeciuni ridic probleme multiple medicului
stomatolog legate de stabilirea unui diagnostic corect i de realizarea unei protecii a
pulpei dentare durabil n timp astfel nct s fie posibil refacerea integritii morfofuncionale esutului lezat.
2. ntr-o carie dentar naintea preparrii unei caviti este important s se neleag care
sunt modificrile tisulare aprute la nivelul dentinei, determinate de evoluia leziunii
carioase. Modificrile intratubulare i formarea dentinei teriare vor afecta rezultatul
tratamentului. Acolo unde tubulii dentinari sunt deschii, permeabili tratamentul
conservativ va necesita o atenie sporit comparativ cu cazurile la care dentina
restant este impermeabil.
3. n urma testrilor materialului pe baz de hidroxid de calciu (Calcidenta) realizat la
Institutul de Cercetri n Chimie din Cluj-Napoca constnd n teste de evaluare
biologic s-a evideniat c materialul nu este toxic, produsul fiind bine tolerat
neavnd efecte nocive.
4. Experiena clinic nu este la fel de ndelungat n cazul rinilor compozite utilizate
ca materiale de coafaj, prognosticul fiind rezervat. Studiul meu experimental realizat

pe dini indemni a artat c dup aplicarea sistemelor adezive pe camera pulpar

deschis reacia histopatologic a pulpei dentare la 9 dintre dinii studiai a semnalat
prezena punilor dentinare cu multiple defecte tunelare favoriznd astfel ptrunderea
microinfiltratului bacterian n camera pulpar.
5. Mineral Trioxid Aggregate ntrunete calitile unui material de coafaj direct. Prin
adaptarea marginal foarte bun i biocompatibilitatea sa acest material limiteaz
inflamaia pulpar i permite obinerea unor puni dentinare de cea mai bun calitate.
6. Localizarea locului de comunicare cu camera pulpar pe suprafaa dintelui
influeneaz reuita terapiei de conservare a vitalitii pulpare prin coafaj direct,
procentul dinilor nregistrai cu succes fiind semnificativ mai mare n cazul
deschiderilor accidentale ale camerei pulpare localizate la nivelul feei ocluzale.
7. Studiul meu att cel experimental ct i cel clinic a demonstrat c progresele
obinute, urmare a unor cercetri ndelungate n domeniul materialelor de conservare
a vitalitii pulpare, s-au materializat prin obinerea unor produse care prezint
caliti superioare acestea fcnd posibil obinerea unor reuite

n cazul

tratamentelor prin coafaj direct aplicate n cazul deschiderilor accidentale ale camerei
pulpare.
REFERINE SELECTIVE
1.
2.

3.
4.
5.
6.
7.
8.
9.
10.
11.

Cox C. F., Bergenholtz G.- Healing sequence n capped inflamed dental pulps of Rhesus
monkeys (Macaca ulatto). Int. Endodont. J.1986; 19: 113-120
Cehreli ZC, Turgut M, Olmez S, Dagdeviren A.-Short term human primary pulpal
response after direct pulp capping with fourth-generation dentin adhesives. J Clin Pediatr
Dent 2000; 25: 65-77
Finger WJ, Fritz UB.-Resin bonding to enamel and dentin with one-component
UDMA/HEMA adhesives. Europ. J. Dent. 1997; 105: 183-186
Rakich D.R., Wataha J.C., Lefebre C.A., Weller R.N.-Effect of dentin-bonding agents on
the secretion of inflammatory mediators from macrophages. J. Endodon 1999; 25; 114-7
Okita N., Hensten-Pettersen A.-n vitro cytotoxicty of tissue conditioners. J Prosthet
Dent 1991; 66: 656-9
Dejou J., Remust M., Franquin J.C.-Biocompatibility testing of restorative materials
influencing dentin and pulp. J Biomed Mater Res 1993; 27; 877-84
Gerzina T.M., Hume W.R.-Diffusion of monomers from bonding resin-resin composite
combinations through dentin n vitro. J. Dent 1996; 24: 125-8
Hamid A., Hume W.R.-Diffusion of resin monomers through human carious dentin n
vitro. Endod Dent Traumatol 1997; 13: 1-5
Hashieh IA, Cosset A, Franquin JC, Camps J n Vitro Cytotoxicty of One-Step Dentin
Bonding systems. Journal of Endodontics 1999; 25: 89-92
Haskel EW., Stanley HR., Chellemi J., et al.-Direct pulp capping treatment. A long- term
follow-up. J Am Dent Assoc 1978; 97: 607-612
Bjordal L.Dentin and pulp reactions to caries and operative treatment: biological
variables affecting treatment outcome. Endodontic Topics 2002; 2: 10-23

12.
13.
14.
15.

16.
17.
18.
19.

20.
21.
22.
23.
24.
25.
26.
27.
28.

29.
30.

31.
32.
33.

34.

35.
36.
37.

Katebzadeh N., Dalton BC., Trope M.-Strengthening immature teeth during and after
apexification. J Endodon 1998; 24: 256-9
Schumacher JW, Rutledge R.E.-An alternative to apexification. J Endodon 1993; 19:
529-31
Van Meerbeek B., Perdigao J., Lambrechts P., Vanherle G.-The clinical performance of
adhesives. J.Dent. 1998; 26: 1-20
Imazato S., Tori Y., Takatsuka T., Inoue N., Ebi N., Ebisu S.-Bactericidal effect of dentin
primer containing antibacterial monomer MDPB against bacteria n human carious
dentin. J of Oral Rehabilitation 2001; 28: 314-319
Katoh Y., Kimura T., InabaT.-Clinical prognosis of pulp tissue direct-capped with
adhesive resins. J Dent Res 1997; 76 (special issue): 162
Dummer PMH, Hicks R, Huws D i Hyman J, Cohen M.-Clinical signs and symtoms n
pulp disease. Int Endod J 2000; 13: 27-35
Schrder U.-Effects of calcium hydroxide- containing pulp capping agents on pulp cell
migration, proliferation and differentiation. J Dent Res 1995; 64: 541-8
Barthel CR., Rosenkranz B., Leuenberg A., Roulet JF.-Pulp capping of carious
exposures: treatment outcome after 5 and 10years: a retrospective study. J Endod 2000;
26: 525-8
Iliescu A., Gafar M.-Cariologie i odontoterapie restauratoare. Ed Medicala, Bucuresti,
2002
Bjordal L.-Buonocore memorial lecture. Dentin caries: Progression and clinical
management. Oper Dent 2002; 27: 211-217
Aberts B, Johnson A, Lewis J, Raff M, Roberts K, Walter P.-Molecular biology of the cell,
4th edn. New York: Garland Publishing, Inc., 2002
Gafar M.-Caria dentar Ed Medicala Bucuresti, 1998
Golberg M.-Manuel dhistologie et de biologie buccale, ed Paris : Masson, 1989
Kettering JD, Torabinejad M.-Microbilogy and immunology. n: Cohen S., Burns RC.,
eds. Pathways of the pulp. 6th ed. St. Louis: Mosby Year-Book, 1994: 363-76
Mjor A, Heyeraas KPulp-dentin biology n restorative dentistry. Quintessence
International 2001; 32: 427-446
Perdigao J., Lopes M.-Dentin bonding-state of the art 1999. Compendium 1999; 20:
1151-62
Stanley H.R., Spiegl E., Schultz M.-The detection and prevalence of reactive and
hysiologic sclerotic dentin, reparative dentin and dead tracts beneath various types of
dental lesions according to tooth surface and age. J.Oral Pathol.1983; 12: 257
Trowbridge HO., Kim S.-Pulp development, structure and function. n: Cohen S., Burns
RC (eds). Pathways of the pulp. 6th ed St. Louis, Mosby, 1994: 322-5
Ciucchi B., Bouillaguet S., Holtz J., Pashley D.H.-Dentinal fluid dynamics n human teeth,
n vivo. J.Endod. 1995; 21: 191-194
Degrange M.-Les principes actuels de ladhesion a la dentine Clinic 1999 ; 20 (8) : 526531
Attin T, Hellwig E.-Erfolgsussichten der direkten Pulpa-Uberkappung bei Zahnen mit
Caries profunda. Quintessensnz 1993; 44: 1613-22
Cox CF., Suzuki S., Suzuki SH, Subay R.K., Ostro E.-Biocompatibilite de divers
materiaux dentaires: guerison de la pulpe grace a un joint cavo-superficiel. Parodontie&
Dentisterie restauratrice 1996 ; 16: 241-251
Hanks C.T., Watah J., Sun Z. n vitro models of biocompatibility: a review. Dent Mater
1996; 12: 186-93
Cox CF., Keall CL., Keall HJ., et al.-Biocompatibility of surface-sealed dental materials
against exposed pulps. J Prosthet Dent 1987; 57: 1-8
Mochizuki K, Fuji H, Machida Y.-Dentin bridge formation following direct pulp capping n
dogs. Bull Tokyo Dent Coll 1998; 39: 31-9
Kitasko Y., Ynokoshi S., Tagami J.,- Effects of direct resin pulp capping techniques on
short-term response of mechanically exposed pulps. Journal of Dentistry 1999; 27: 257

CURRICULUM VITAE
1. Date personale
Nume, prenume: Colceriu-Burtea Adela Loredana
Domiciliul: Cluj-Napoca, Aleea Azuga nr. 2, sc. II, ap. 25
Data i locul naterii: 12. 05.1970, Tg-Jiu, jud.Gorj
Funcie i loc de munc : asistent universitar la UMF"Iuliu Haieganu"
Cluj-Napoca, Facultatea de Medicin Dentar, Catedra de OdontologieParodontologie
2. Studii
Gimnaziale : 1977-1985 coala general nr.3, Tg-Jiu
Liceale :1985-1989 Liceul de matematic-fizic "T.Vladimirescu", Tg-Jiu,
pe care l-am absolvit n iulie 1989 cu media general de bacalaureat 7,58.
Universitare : 1990-1992, Facultatea de Medicin General, UMF "Iuliu
Haieganu"

Cluj-Napoca;

1992-1995,

Facultatea

de

Stomatologie,

UMF"Iuliu Haieganu" Cluj-Napoca. Media general de promovare anilor de

studiu universitari a fost 9,04. n sesiunea din septembrie 1995 am susinut
examenul de licen i lucrarea de diplom cu titlul "Tulburri de erupie ale
incisivilor centrali superiori", coordonator prof. dr. Elvira Cocrl, obinnd
media general de licen 9,47.
3. Activitate profesional
Dup absolvirea facultii am fost angajat prin concurs din ianuarie 1996
timp de un an ca medic stagiar la Spitalul Judeean Tg-Jiu, Policlinica de
Stomatologie nr.1.

n anul 1996 am participat la concursul de rezideniat unde am ocupat locul

18 pe ar. Am ales specialitatea stomatologie general din februarie 1997
devenind medic rezident n cadrul Facultii de Stomatologie din Cluj
n sesiunea din martie 1997 am concurat pentru postul de preparator la
catedra de Odontologie- Parodontologie, concurs pe care l-am promovat cu
media 9,13.
n octombrie 1998 am susinut examenul de specialitate, devenind medic
specialist.
n martie 1999 am ocupat prin concurs postul de asistent universitar la
catedra de Odontologie-Parodontologie, Facultatea de Stomatologie cu
media general 9,88.
n iunie 2003 am susinut examenul de primariat n urma cruia am devenit
medic primar.
4. Activitate tiinific
n noiembrie 2001 m-am nscris la doctorat la catedra de OdontologieParodontologie, sub ndrumarea prof. dr. Angela Pop avnd ca tem de
cercetare conservarea vitalitii pulpare.
n intervalul septembrie 2002- martie 2003 am fost plecat cu burs de studii
la Facultatea de Odontologie din Marsilia, Frana
- lucrri publicate: 2 lucrri publicate in extenso n reviste din ar
-participri la congrese i alte manifestri tiinifice
-cri: 1 carte publicat coautor
5. Limbi strine: franceza bine scris, vorbit
engleza bine scris, vorbit

LISTA LUCRRILOR TIINIFICE ELABORATE

Lucrri publicate in extenso:
1. "Studiul proprietilor fizico-chimice ale unui material nou indicat n
coafajul direct"
Autori: Loredana Colceriu, Sanda Cmpean, Angela Pop -Transilvania
Stomatologic, nr.1, 2005, 35-40
2. "Studiul clinic privind influena factorilor ce afecteaz reuita conservrii
vitalitii pulpare, n deschiderile accidentale ale camerei pulpare"
Autori: Loredana Colceriu, Sanda Cmpean, Angela Pop -Transilvania
Stomatologic, nr.2, 2005, 27-34

Participri la congrese i alte manifestri tiinifice:

1. Tulburri de erupie ale incisivilor centrali superiori
Autori: Loredana Colceriu, Elvira Cocrl; poster Zilele UMF, ClujNapoca, dec. 1997
2. Materiale fotopolimerizabile-rolul agenilor de cuplare
Autori: Loredana Colceriu; mas rotund Zilele UMF, Cluj-Napoca, dec.
1998
3. Posibiliti de reconstrucie corono-radicular
Autori : Sanda Cmpean, Loredana Colceriu, Angela Pop; poster Zilele
UMF dec. 1999
4. Metode moderne de tratament conservativ n parodontita apical
cronic
Autori : Loredana Colceriu, Dolores Bdulescu, Ada Delean, Angela Pop;
poster Zilele UMF dec. 2001

5. Modaliti de contenie n parodontopatiile marginale cronice

Autori: Loredana Colceriu; mas rotund, Zilele UMF dec 2003
6. Materiale noi folosite n terapia conservatoare a pulpei dentare
Autori: Loredana Colceriu, Ada Delean, Dan Pop-Catedra de OdontologieParodontologie, UMFI.Haieganu i Moldovan Marioara-ICCRR, ClujNapoca, Zilele Stomatologiei Bnene, mai 2004
7. Biocompatibility of a new calcium hydroxide lining cement used as a
pulp capping material
Autori: Loredana Colceriu, AngelaPop-Department of Odontology and
Periodontology, University of Dental MedecineI.Haieganu, M.MoldovanICCRR Cluj-Napoca, poster, Congresul Internaional de Materiale Dentare,
Napoca Biodent 2005, Cluj-Napoca

Lucrri publicate n rezumat:

1.

Using MTA and calcium hydroxide as a pulp capping materials

Autori: Loredana Colceriu, Sanda Cmpean, Angela Pop-Catedra de

Odontologie-Parodontologie,UMFI.Haieganu i Moldovan MarioaraICCRR, European Cells and Materials Vol 10.Suppl.1, 2005, page 20

Lista crilor publicate:

1. "ndreptar practic pentru asistente de profilaxie stomatologic"
Autori: Angela Pop, Sanda Cmpean, Ada Delean, Loredana Colceriu-Burtea
Dan Pop -, Ed.Medical Universitar "Iuliu Haieganu" Cluj-Napoca, 2002

Lista lucrrilor publicate din domeniul tezei de doctorat:

Lucrri publicate in extenso:

1. "Studiul proprietilor fizico-chimice ale unui material nou indicat n

coafajul direct"
Autori: Loredana Colceriu, Sanda Cmpean, Angela Pop -Transilvania
Stomatologic, nr.1, 2005, 35-40

2. "Studiul clinic privind influena factorilor ce afecteaz reuita conservrii

vitalitii pulpare, n deschiderile accidentale ale camerei pulpare"
Autori: Loredana Colceriu, Sanda Cmpean, Angela Pop -Transilvania
Stomatologic, nr.2, 2005, 27-34

Lucrri publicate n rezumat:

1. Using MTA and calcium hydroxide as a pulp capping materials

Autori: Loredana Colceriu, Sanda Cmpean, Angela Pop-Catedra
de Odontologie-Parodontologie,UMFI.Haieganu i Moldovan
Marioara-ICCRR, European Cells and Materials Vol 10.Suppl.1,
2005, page 20

UNIVERSITY OF MEDICINE AND PHARMACY

IULIU HAIEGANU CLUJ-NAPOCA
FACULTY OF DENTAL MEDICINE

MODERN APPROACHES IN THE TREATMENT FOR THE

CONSERVATION OF THE DENTAL PULP IN THE CASE
OF ACCIDENTAL OPENING OF THE PULP CHAMBER

THESIS FOR ATTAINING THE Ph.D. SCIENTIFIC DEGREE IN

THE FUNDAMENTAL DOMAIN OF MEDICAL SCIENCES, THE
DOMAIN OF DENTAL MEDICINE
SUMMARY

Ph.D. Degree Candidate,

Loredana Colceriu-Burtea

-2006-

Scientific coordinator,
Prof. Dr. Angela Pop

CONTENTS
INTRODUCTION .....................................................................................................................1
ACTUAL STAGE OF KNOWLEDGE.....................................................................................3
Chapter I: The influence of dental cavity upon the pulp-dentine organ and methods of
treatment for the profound cavity...............................................................................................3
1.1.Dentine and pulp modifications in the case of profound cavity...........................................3
1.1.1. Pulp modifications ...........................................................................................................5
1.2 Recent data regarding the methods of pulp conservation in the case of profound cavity....6
1.2.1 Natural capping .................................................................................................................7
1.2.2 Indirect capping.................................................................................................................7
1.2.3 Direct capping ...................................................................................................................9
Chapter II: Materials used for the conservation of pulp vitality ..............................................13
2.1 Calcium hydroxide.............................................................................................................13
2.2 Current conception regarding the conservative therapy of the dental pulp .......................17
2.2.1 Short history of the adhesion to the dentine....................................................................18
2.2.2 The formation mechanism of the hybrid layer................................................................19
2.2.3 The effect of the adhesives upon the dental pulp............................................................23
2.2.3.1.Studies regarding the maintaining of the pulp integrity with the help of dentinal
adhesives...................................................................................................................................23
2.3 Mineral Trioxid Aggregate ................................................................................................26
PERSONAL CONTRIBUTIONS............................................................................................31
Chapter III: The evaluation of the biocompatibility of a material based upon Calcium
hydroxide (Calcidenta)towards animal tissue..........................................................................31
Introduction..............................................................................................................................31
Material and work method .......................................................................................................31
Results and discussions............................................................................................................33
Conclusions..............................................................................................................................46
Chapter IV: The pulp's response at the action of dentinal adhesives and of the classical
materials used in the conservation of the vitality of the dental pulp........................................47
Material and work method:......................................................................................................51
Results:.....................................................................................................................................56
Discussions: .............................................................................................................................65
Conclusions:.............................................................................................................................68
Case study: ...............................................................................................................................69
Chapter V: Clinical study regarding the influence of the factors which affect the succes of the
conservation of the pulp's vitality in the case of the accidental opening of the pulp chamber,
realized with two types of capping materials...........................................................................77
Material and work method:......................................................................................................82
Results:.....................................................................................................................................88
Discussions ............................................................................................................................101
Conclusions............................................................................................................................104
Case study: .............................................................................................................................105
GENERAL CONCLUSIONS................................................................................................137
BIBLIOGRAPHY..................................................................................................................140
APPENDIX............................................................................................................................150
1. List of the figures from the thesis .....................................................................................150
2. List of the tables in the thesis.........153

Key words: neodentine-genesis, inoculation, inflammatory infiltrate, direct capping,

monocites, fagocitation, Mineral Trioxide Aggregate

The current orientation of conservative therapy is towards the biologic concept of

keeping the vitality of the dental pulp for as much as possible. It is a well-known fact that
the pulp is capable of initiating defense mechanisms against the bacterial invasion. This
objective can be attained even in the case of accidental opening of the pulp chamber
through direct capping. In order to succeed with a direct capping, we should take into
account 2 categories of factors: general and local ones. Among the general factors we
mention the age of the patient, his health condition and also social conditions. As local
factors we might mention the work conditions, the state in which the pulp is in, the
character of the traumatic lesion.
Among the materials, which are being used for direct capping most frequently, are
those based on calcium hydroxide. The main point that sustains applying calcium
hydroxide in direct capping is related to its properties: anti-germs, anti-inflammatory,
hemostatic. Starting from the neo-dental-genetic properties of the materials based on
calcium hydroxide, in this research I have tested a Romanian product, Calcidenta,
elaborated in the Chemical Research Institute Raluca Ripan. This proves that in our
country continues the interest of introducing dental material which presents an advantage
from the point of view of the quality but also has a low price.
The purpose of the experiment has been that of appreciating the degree of
biocompatibility of Calcidenta dental material in the situation of prolonged contact with
the conjunctive and muscle tissue. Local reactions after the implantation of the material
regarding preclinical evaluation have been carried out within the UMF Bio-Base
Laboratory (Dr. Septimiu Toader).

Material and work-method

The composition of the material selected for the biological testing is: Ca(OH)2
42%, ZnO

25,8%,

CMC

3,2%,

Glycerine 29%. The product is presented as a

monopaste and it is autopolymerizable. Two species of animals have been used in the
biotest: rats and Guinea-pigs , with two ways of administration: subcutaneous and intramuscular.
Rezults and discussions
In every lot, irrespective of the species and the method of innoculation, the local
reaction has been favorable, the implant was accepted by the tissue and it was perceived
upon palpation as a small subcutaneous or intra-muscular nodule, not painful and semimobile.

Fig.1. The inter-muscular fixed and incapsulated implant at a Guinea-pig, 21 days after the operation

The introduction of material fragments at the level of both anatomical zones

mentioned (subcutaneous and muscular) in the case of both animal species has brought
to light the following observations(from the histo-pathological point of view):
subcutaneous area: around the body of the implant a capsular structure is formed, which
is made of conjunctive tissue of neo-formation which covers the implant on all of its
facets; muscular area: the same capsular structure is constitued , a defence reaction and
rare poli-morpho-nuclear reactions.

Fig. 2. Capsular wall constitued from conjunctive tissue of neo-formation, developed from the
muscular interstitium, Guinea-pig, 21 days after the implantation. Coloration H.E. x 200

Conclusions
There has not been at least one case of rejection phenomena through abcess
formation, fistulae or seizing constitutions; for neither of the methods of administration.
The reaction towards the product has been strictly local, consisting in the formation of an
inactive granuloma of a foreign body in which the afflux of monocites prove a step by step
fagocitation action of the material, once it inactivates in time.
Another recently appeared material and successfully used in direct capping is
Mineral Trioxid Agreggate, which ha been discovered in 1996. Among the physical and
chemical properties of the material we mention: very high pH (12,5) and also its superior
seal capacity. Among its biological properties the bio-compatibility with the dental pulp
stands out.
In the last few years, together with the impetuous development of adhesive
techniques, there have emerged some studies1,2,3,4,5,6) which have shown that the healing
of the pulp tissue can be attained when the adhesive resin therapy has been used. These
studies sustain the hypothesis that pulp can be restructured even after applying adhesive
systems in profound cavities or even on the opening of the pulp chamber as long as a
correct hemostasis is being realized before the applying of the resin7), ensuring a tight
closing against the bacterial infiltration8). This concept is becoming more and more
popular in spite of the fact that numerous in vitro9) and in vivo10) researches have shown
the cito-toxicity of composite resins applied on culture mediums or in direct contact with
the subcutaneous tissue in animals. The purpose of this experimental research has
been that of characterizing and comparing the pulp response after direct capping with
adhesive resins, Mineral Trioxid Aggregate and Calcidenta material.

Material and work method

I have taken under study a number of 60 teeth divided into three lots. The
examined teeth have been whole pemolars, which were about to be extracted for
orthodontic purposes from patients aged between 10 and 18. The experimental effective
for every material used has been that of 20 cavities realized on 20 teeh for Calcidenta,
MTA respectively and that of 20 cavities realized on 20 teeh for Optibond SoloPlus(Kerr)
adhesive systems. Under local anesthetics , I have prepared a V class cavity on each
tooth, with repartition on the vestibular face. After the opening of the vestibular chamber,
hemostasis was realized, and the capping material was applied , MTA or Calcidenta, the
rest of the cavity being obturated with IRM.
The usage of the Optibond SoloPlus adhesive system was realized after the
demineralization with Phosphoric acid 35% for 15 seconds, washing with distilled water
and gentle drying with buds of sterile absorbent cotton. The polimerization of the
adhesive layer has been done for 20 seconds, later the cavity being obturated with the
Herculite compozite material (KERR). The teeth have been divided into 2 groups, being
extracted at varied periods of time: shorter (9-12 days) and longer (60-90 days). After the
fixation, demineralization, sectioning and colouring of the histological preparations, the
pulps response has been characterized by: the appearance of inflamation, the existence
of reaction dentine, the presence of dentine bridges with their characteristics.
Results
Regarding the inflamatory response in the case of the lot being under observation
for a period of 60-90 days, statistics revealed no significant difference between the 3
types of materials (p>0,05) (table I, figure 3). Still, from a percentual point of view, only
60% of the teeth that have undergone treatment with adhesive systems have not presented
an inflamatory response or the inflamation noticed was minimal.
Table I: The inflamatory response registered regarding the type of material, observed after a longer
period of time
Material

Inflamation being
prezent

Inflamation absent

Ca (OH)2

MTA

Adhesive system

p=0.1
16
14
12
10
8
6
4
2
0
Ca(OH)2

MTA

Inflamation present

Adhesive system
Inflamation absent

Figure 3 : The results of the comparative analysis of the inflamatory response between the lots under
sudy, regarding the type of material used, for a long period of time

The introduction of reparatory dentine for the lot of teeth under study for the
short period of time reveals a statistically significant difference between the teeth treated
with MTA and Calcidenta, as compared to those treated with adhesive systems. (table II,
figure 4)
Table II: The repartition of reaction dentine per number of teeth according to the examined
material, for a short period of time
Material

Dentine absent

Dentine present

Ca (OH)2

MTA

Adhesive system

p=0.03
p=0.01
10
9
8
7
6
5
4
3
2
1
0
Ca(OH)2

MTA
Absent

Adhesive system
Present

Figure 4 : Comparative analysis between the reaction dentines repartition according to the type of
material used, in the case of the teeth being under study, for a short period of time

Conclusions
6. The anti-bactericide action mechanism of Calcium hydroxide through its strongly
alkaline pH and the stimulation of the neo-dentine-genesis process remain the main
strong points in favour of applying this material in the therapy of profound cavities
7. Due to the superior impermeability of the classical materials, and also to the
alkalinity, MTA has allowed the regeneration of the affected pulp tissue in the case of
accidental opening of the pulp chamber, with the formation in time- of bridges
continuous predentine with large thickness.
8. The dentine bridges formed in the case of adhesive systems registered multiple gaps,
which would favour the insertion of bacterial micro-infiltrations into the pulp
chamber and therefore compromising the vitality of the pulp through the appearance
of inflamatory processes
Clinical studies in the specialized literature conducted upon teeth with direct
capping have followed the evolution of this treatment on short periods of time, and
the results have been controversial. Starting from the scientifc literatures data, the
purpose of this clinical study has been that of evaluating the success rate of direct
capping in the case of accidental opening of the pulp chamber, realized with two
different materials: Calcidenta, a material based on Calcium hydroxide produced at
ICCRR Cluj-Napoca, and MTA; underlining which of the clinical factors influence
the success of the treatment.
Material and work method
In the present study a number of 150 teeth from 120 patients have been treated.
The age of the patients was between 10 and 40 years. For the whole group taken under
study, in the case of the presence of dental lesions diagnosed as profound cavities when
during the drilling of the altered dentine occurred the accidental opening of the pulp
chamber- I have undertaken the treatment through direct capping. I have moved on to the
evaluation of the diameter of the opening orifice and that of the degree of bleeding
factors which can influence the success of a direct capping. So, the size of the diameter

of the orifice of communication with the pulp(), has allowed me to divide the teeth
into 4 groups: <0,5mm, 0,5mm <<1mm, 1mm <<2mm, >2mm.
According to the degree of bleeding of the pulp, I marked the teeth as follows:
the pulp does not bleed at the opening level(-), the bleeding is in small amount(+), the
bleeding stops in 30 seconds(++), the bleeding is prolongued over 30 seconds(+++).
The teeth under study are isolated through the rubber dum sistem. The cleaning at the
level of the exposed pulp is done by irrigations with normal saline solution, followed
afterwards by drying with a bud of sterile cotton. When the bleeding has stopped
completely, we apply the capping material at the level of the opening of the pulp
chamber, the rest of the cavity being obturated with Zinc bloom-eugenic acid cement.
The evolution of the studied teeth has been followed through clinical and radiological
checks every 3 months over a period of 2 years.
Criteria for appreciating the success or failure of the direct capping:
It is considered a success when the tooth responds positively to the vitality tests,
revealing a sensitivity that is similar to the other healthy teeth both before the realization
of the treatment and also after it; also in the absence of a symptomatology of irreversible
inflammation of the pulp(spontaneous pain, increased sensitivity to thermic agents and
positive axe percution) after the treatment has been carried out.
Results
The existing relationship between the age of the patients and the success rate of
the direct capping realized with both materials is presented in table III.
Table III: The success rate of the direct capping, distributed on age groups in the group of examined
patients

Age

Nr of successful cases

Nr of failures

Success rate (%)

10-20 years

30

100

20-30years

30

90,90

30-40 years

48

84,21

It has been noted in the present study the infuence of age over the treatments success
rate, the largest percentage being registered in the case of patients under 20 years old (a
fact which has been noted by some authors in their researches11,12,13). Regarding the

percentage of the succesful treatment according to the material being used, both
materials have registered similar results (table IV).

Table IV: The percentual distribution of success according to the material being used

Capping material

No. of successful teeth

No. of failed teeth

Success rate (%)

Ca (OH)2
MTA

54
66

15
15

78,26
81,48

The influence of the diameter of the communication orifice with the pulp chamber and
the degree of bleeding at the level of the exposed pulp - over the success of the direct
capping have been analized as follows (table V,VI).
Table V: The influence of the diameter of communication with the pulp chamber over the success of
the conservative therapy of the pulp vitality.

Objective symptomatology
The diameter of the opening hole
of the pulp chamber: (mm)

Observations

No. of
successful teeth

No. of failed
teeth

Success rate (%)

0,5

36

92,30

0,5 < 1,0

1,0 < 2,0
> 2,0

54
30
0

6
6
15

90,00
83,33
0

In order to appreciate the relationship between the diameter of the opening of the pulp
chamber and the success rate of the conservative treatment of the live pulp; the teeth
have been divided into 4 groups, according to the size of the communication orifice. In
the group where the diameter of the opening of the pulp chamber was bigger than 1mm,
but smaller than 2 mm, the success rate is with 83,33% smaller than that of the group
which had the opening between 0,5 1 mm, 90%. For the group where the diameter of
the communication orifice is larger than 2 mm, the success rate is 0, the capping being
considered a failure. Regarding the degree of bleeding at the level of the opening of the
pulp chamber, the success of the group where the bleeding is absent (95,23%) or reduced
under 30 seconds (87,5%) is significantly increased than in the group where the bleeding
is abundent and persistant. (46,15%) (table VI).
Tabelul VI : The influence of the time of bleeding over the success of maintaining the pulps vitality
in direct capping

Degree of bleeding

No.of successful
teeth

No. of failed
teeth

Success rate (%)

Absent bleeding

60

95,23

Mild bleeding

42

87,5

Persistent bleeding

18

21

46,15

The Pearson correlation test (figure 5) between the degree of bleeding and the success
rate shows a value of r=-0,95 , which proves a relationship of inverted proportionality
between the two variables, the probability that the lack of bleeding determines a success
is one of 0,99 (R2=0,99).

r=0.95
R2 = 0.9932

Absent bleeding
No. of successfull teeth

Moderate bleeding
No of failed teeth

Persistent bleeding
Linear (No. of successfull teeth)

Figure 5 : The relationship between the degree of pulp bleeding and the success rate in the therapy
of the accidental opening of the pulp chamber through direct capping

Discussions
The successful percentage of this therapy depends both on general factors but also on
local ones, the most favorable medium for the success of the direct capping
consisting of permanent young teeth, because they have a big capacity of reaction,
with multiple defence resources.
Regarding the local factors, the success rate of this therapy depends on the diameter
of the opening orifice of the pulp chamber, which should not exceed 2 mm and on the
possibility of eliminating the altered dentine- which should be carried aut completely

before the beginning of the direct capping. The inflamatory status of the pulp organ is
reflected through the level of the bleeding factor at the level of communication with
the pulp. So, the bigger the level of the bleeding is, the smaller is the chance of a
favorable prognosis of the treatment.
GENERAL CONCLUSIONS :
8. Profound cavity lesions represent dental afflictions frequently encountered in the
dental practice. The treatment of these afflictions raises multiple problems to dental
physician; problems related to establishing a correct diagnosis and realizing a timedurable protection for the dental pulp so that the reconstruction of the morphofunctional integrity of the injured tissue is possible.
9. It is important in the case of a dental cavity before the preparation of a cavity to
understand which are the tissue modifications that appeared at the dentine level,
determined by the evolution of the cavity lesion. The intra-tubular modifications and
the formation reaction dentine will affect the result of the treatment. In the cases in
which the dentine tubes are opened and permeable; the conservative treatment will
ask for increased attention as compared to the cases in which the remaining dentine is
waterproof.
10. As a result of the testing of the material based on Calcium hydroxide (Calcidenta)
realized at the Chemical Research Institute in Cluj-Napoca, consisting of biological
evaluation tests , there has been revealed the fact that the material is not toxic, the
product being well tolerated, without any harmful effects.
11. The clinical experience is not as long in the case of compozite resins used as capping
materials, the prognosis is therefore reserved. My experimental study realized on
healthy teeth has shown that, after applying the adhesive systems on the opened pulp
chamber, the histopathological reaction of the pulp at 9 of the teeth under study has
signaled the presence of dentinal bridges with multiple tunnel flaws, favouring
therefore the insertion of the bacterian micro-infiltrate into the pulp chamber.
12. Mineral Trioxid Aggregate meets the qualities of a direct capping material. Through
very good marginal adaptation and due to its biocompatibility , this material limits
the pulp inflamation and allows the attaining of dentinal bridges of the outmost
quality.

13. The localization of the spot of communication with the pulp chamber on the surface
of the tooth influences the success of the conservative therapy for the pulps vitality
through direct capping. The percentage of successful teeth is significantly bigger in
the case of accidental openings of the pulp chamber situated at the level of the
occlusive face.
14. My studies both the experimental and the clinic one have proved that the progress
attained as a result of long-term researches in the domain of conservative materials
for the pulps vitality , have materialized by the realization of products which present
superior qualities; these making possible great successes in the case of direct capping
treatments, applied in the case of accidental openings of the pulp chamber.

SELECTIVE REFFERENCES
38.
39.

40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.

Cox C. F., Bergenholtz G.- Healing sequence n capped inflamed dental pulps of Rhesus
monkeys (Macaca ulatto). Int. Endodont. J.1986; 19: 113-120
Cehreli ZC, Turgut M, Olmez S, Dagdeviren A.-Short term human primary pulpal
response after direct pulp capping with fourth-generation dentin adhesives. J Clin Pediatr
Dent 2000; 25: 65-77
Finger WJ, Fritz UB.-Resin bonding to enamel and dentin with one-component
UDMA/HEMA adhesives. Europ. J. Dent. 1997; 105: 183-186
Rakich D.R., Wataha J.C., Lefebre C.A., Weller R.N.-Effect of dentin-bonding agents on
the secretion of inflammatory mediators from macrophages. J. Endodon 1999; 25; 114-7
Okita N., Hensten-Pettersen A.-n vitro cytotoxicty of tissue conditioners. J Prosthet
Dent 1991; 66: 656-9
Dejou J., Remust M., Franquin J.C.-Biocompatibility testing of restorative materials
influencing dentin and pulp. J Biomed Mater Res 1993; 27; 877-84
Gerzina T.M., Hume W.R.-Diffusion of monomers from bonding resin-resin composite
combinations through dentin n vitro. J. Dent 1996; 24: 125-8
Hamid A., Hume W.R.-Diffusion of resin monomers through human carious dentin n
vitro. Endod Dent Traumatol 1997; 13: 1-5
Hashieh IA, Cosset A, Franquin JC, Camps J n Vitro Cytotoxicty of One-Step Dentin
Bonding systems. Journal of Endodontics 1999; 25: 89-92
Haskel EW., Stanley HR., Chellemi J., et al.-Direct pulp capping treatment. A long- term
follow-up. J Am Dent Assoc 1978; 97: 607-612
Bjordal L.Dentin and pulp reactions to caries and operative treatment: biological
variables affecting treatment outcome. Endodontic Topics 2002; 2: 10-23
Katebzadeh N., Dalton BC., Trope M.-Strengthening immature teeth during and after
apexification. J Endodon 1998; 24: 256-9
Schumacher JW, Rutledge R.E.-An alternative to apexification. J Endodon 1993; 19:
529-31
Van Meerbeek B., Perdigao J., Lambrechts P., Vanherle G.-The clinical performance of
adhesives. J.Dent. 1998; 26: 1-20
Imazato S., Tori Y., Takatsuka T., Inoue N., Ebi N., Ebisu S.-Bactericidal effect of dentin
primer containing antibacterial monomer MDPB against bacteria n human carious
dentin. J of Oral Rehabilitation 2001; 28: 314-319
Katoh Y., Kimura T., InabaT.-Clinical prognosis of pulp tissue direct-capped with
adhesive resins. J Dent Res 1997; 76 (special issue): 162

54.
55.
56.

57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.

68.
69.
70.

71.

72.
73.
74.

Dummer PMH, Hicks R, Huws D i Hyman J, Cohen M.-Clinical signs and symtoms n
pulp disease. Int Endod J 2000; 13: 27-35
Schrder U.-Effects of calcium hydroxide- containing pulp capping agents on pulp cell
migration, proliferation and differentiation. J Dent Res 1995; 64: 541-8
Barthel CR., Rosenkranz B., Leuenberg A., Roulet JF.-Pulp capping of carious
exposures: treatment outcome after 5 and 10years: a retrospective study. J Endod 2000;
26: 525-8
Iliescu A., Gafar M.-Cariologie i odontoterapie restauratoare. Ed Medicala, Bucuresti,
2002
Bjordal L.-Buonocore memorial lecture. Dentin caries: Progression and clinical
management. Oper Dent 2002; 27: 211-217
Aberts B, Johnson A, Lewis J, Raff M, Roberts K, Walter P.-Molecular biology of the cell,
4th edn. New York: Garland Publishing, Inc., 2002
Gafar M.-Caria dentar Ed Medicala Bucuresti, 1998
Golberg M.-Manuel dhistologie et de biologie buccale, ed Paris : Masson, 1989
Kettering JD, Torabinejad M.-Microbilogy and immunology. n: Cohen S., Burns RC.,
eds. Pathways of the pulp. 6th ed. St. Louis: Mosby Year-Book, 1994: 363-76
Mjor A, Heyeraas KPulp-dentin biology n restorative dentistry. Quintessence
International 2001; 32: 427-446
Perdigao J., Lopes M.-Dentin bonding-state of the art 1999. Compendium 1999; 20:
1151-62
Stanley H.R., Spiegl E., Schultz M.-The detection and prevalence of reactive and
hysiologic sclerotic dentin, reparative dentin and dead tracts beneath various types of
dental lesions according to tooth surface and age. J.Oral Pathol.1983; 12: 257
Trowbridge HO., Kim S.-Pulp development, structure and function. n: Cohen S., Burns
RC (eds). Pathways of the pulp. 6th ed St. Louis, Mosby, 1994: 322-5
Ciucchi B., Bouillaguet S., Holtz J., Pashley D.H.-Dentinal fluid dynamics n human teeth,
n vivo. J.Endod. 1995; 21: 191-194
Degrange M.-Les principes actuels de ladhesion a la dentine Clinic 1999 ; 20 (8) : 526531
Attin T, Hellwig E.-Erfolgsussichten der direkten Pulpa-Uberkappung bei Zahnen mit
Caries profunda. Quintessensnz 1993; 44: 1613-22
Cox CF., Suzuki S., Suzuki SH, Subay R.K., Ostro E.-Biocompatibilite de divers
materiaux dentaires: guerison de la pulpe grace a un joint cavo-superficiel. Parodontie&
Dentisterie restauratrice 1996 ; 16: 241-251
Hanks C.T., Watah J., Sun Z. n vitro models of biocompatibility: a review. Dent Mater
1996; 12: 186-93
Cox CF., Keall CL., Keall HJ., et al.-Biocompatibility of surface-sealed dental materials
against exposed pulps. J Prosthet Dent 1987; 57: 1-8
Mochizuki K, Fuji H, Machida Y.-Dentin bridge formation following direct pulp capping n
dogs. Bull Tokyo Dent Coll 1998; 39: 31-9
Kitasko Y., Ynokoshi S., Tagami J.,- Effects of direct resin pulp capping techniques on
short-term response of mechanically exposed pulps. Journal of Dentistry 1999; 27: 257

CURRICULUM VITAE
4. Personal data
Surname, name: Colceriu-Burtea Adela Loredana
Home address: Cluj-Napoca, Aleea Azuga nr. 2, sc. II, ap. 25
Date of birth: 12. 05.1970
Position and work place : Assistant Professor la UMF"Iuliu Haieganu"
Cluj-Napoca, Faculty of Dental Medicine, Department of OdontologyParodontologiy
5. Studies
Gymnasium : 1977-1985 General School no.3, Tg-Jiu
High-school :1985-1989Mathematics-PhysicsHigh-School"T.Vladimirescu",
Tg-Jiu
University :1990-1992, Faculty of General Medicine, UMF"Iuliu Haieganu"
Cluj-Napoca;1992-1995, Faculty of Dental Medicine, UMF Cluj-Napoca
3. Professional activity
- January 1996- Intern phisician at the District Hospital Tg-Jiu
- February 1997- Resident phisician
- March 1997- exam for the position of Junior Assistant at the Dental
Medicine Faculty, department of Odontology- Parodontology
- October 1998 I sustained the speciality exam, becoming a specialist
physician

- March 1999 exam for the position of Assistant Professor at the Dental
Medicine Faculty, department of

Odontology- Parodontology Dental

Medicine Faculty, department of Odontology- Parodontology

9. Scientific activity
- diploma project: "Tulburri de erupie ale incisivilor centrali superiori",
coordinated by prof.dr.Elvira Cocrl
- in November 2001 I have registered for the Ph.D. studies at the Dental
Medicine Faculty, Dental Medicine Faculty, department of OdontologyParodontology, under the coordination of prof.dr.Angela Pop, with a
research theme regarding the conservation of the pulp vitality
-September 2002- March 2003 scholarship at the faculty of Odontology in
Marseille, France
- published papers : 2 papers published in extenso in scientific journals in the
country
-participations at congresses and other scientific manifestations

-books : 1 book published as a co-author

10. Foreign languages: French (reading, writing, speaking advanced level)
English (reading, writing, speaking advanced level)

LIST OF THE SCIENTIFIC PAPERS ELLABORATED

Papers published in extenso:

1. "Studiul proprietilor fizico-chimice ale unui material nou indicat n
coafajul direct"
Authors: Loredana Colceriu, Sanda Cmpean, Angela Pop -Transilvania
Stomatologic, nr.1, 2005, 35-40
2. "Studiul clinic privind influena factorilor ce afecteaz reuita conservrii
vitalitii pulpare, n deschiderile accidentale ale camerei pulpare"
Authors: Loredana Colceriu, Sanda Cmpean, Angela Pop -Transilvania
Stomatologic, nr.2, 2005, 27-34

Participations at congresses and other scientific manifestations:

1.Tulburri de erupie ale incisivilor centrali superiori
Authors: Loredana Colceriu, Elvira Cocrl; poster Zilele UMF, ClujNapoca, dec. 1997
2. Materiale fotopolimerizabile-rolul agenilor de cuplare
Authors: Loredana Colceriu; mas rotund (debate) Zilele UMF, ClujNapoca, dec. 1998
3. Posibiliti de reconstrucie corono-radicular
Authors : Sanda Cmpean, Loredana Colceriu, Angela Pop ; poster Zilele
UMF dec. 1999

4. Metode moderne de tratament conservativ n parodontita apical

cronic
Authors : Loredana Colceriu, Dolores Bdulescu, Ada Delean, Angela Pop ;
poster Zilele UMF dec. 2001
5. Modaliti de contenie n parodontopatiile marginale cronice
Authors: Loredana Colceriu; mas rotund (debate), Zilele UMF dec 2003
6. Materiale noi folosite n terapia conservatoare a pulpei dentare
Authors:LoredanaColceriu,DeleanAda,PopDan,-department of OdontologyParodontology,UMFI.Haieganu and Moldovan Marioara-ICCRR, ClujNapoca, Zilele Stomatologiei Bnene, mai 2004
7. Biocompatibility of a new calcium hydroxide lining cement used as a
pulp capping material
Authors:Loredana Colceriu,Angela Pop-Department of Odontology and
Periodontology,University of Dental MedicineI.Hatieganu, M.Moldovan ICCRR Cluj-Napoca, poster, Congresul Internaional de Materiale Dentare,
Napoca Biodent 2005, Cluj-Napoca

Papers published as a summary:

1. Using MTA and calcium hydroxide as a pulp capping materials
Authors: Loredana Colceriu, Sanda Cmpean, Angela Pop-Catedra de
Odontologie-Parodontologie,UMFI.Haieganu and Moldovan MarioaraICCRR, European Cells and Materials Vol 10.Suppl.1, 2005, page 20

List of the published books:

1. "ndreptar practic pentru asistente de profilaxie stomatologic"

Authors: Angela Pop, Sanda Cmpean, Ada Delean, Loredana ColceriuBurtea Dan Pop -, Ed.Medical Universitar "Iuliu Haieganu" Cluj-Napoca,
2002

List of the published papers from the Ph.D. research thesis domain:

Papers published in extenso:

1. "Studiul proprietilor fizico-chimice ale unui material nou indicat n

coafajul direct"
Authors: Loredana Colceriu, Sanda Cmpean, Angela Pop -Transilvania
Stomatologic, nr.1, 2005, 35-40

2. "Studiul clinic privind influena factorilor ce afecteaz reuita conservrii

vitalitii pulpare, n deschiderile accidentale ale camerei pulpare"
Authors: Loredana Colceriu, Sanda Cmpean, Angela Pop -Transilvania
Stomatologic, nr.2, 2005, 27-34

Papers published as a summary:

1.Using MTA and calcium hydroxide as a pulp capping materials

Authors: Loredana Colceriu, Sanda Cmpean, Angela Pop-Catedra de
Odontologie-Parodontologie,UMFI.Haieganu and Moldovan MarioaraICCRR, European Cells and Materials Vol 10.Suppl.1, 2005, page 20