Pulpal response to an epimine Altug

Kazanoglu,

University

of Missouri

D.D.S., School

M.S.,* H.W. of Dentistry,

Kim, D.D.S.,** Kansas

City,

M

ethyl methacrylate resins have been used for temporary restorations since 1940. These materials are injurious to the pulp and may produce a severe inflammatory response.* Similar materials, introduced later, were also toxic.2. 3 Recently a new group of polymeric materials were introduced for use as temporary restorations. One of these materials, Scutan,? contains ethylene imine as an intermediate compound (Fig. l).’ This results in imino side groups which enable the material to be cross-linked with aromatic sulfonates or related compounds. The clinical and histologic observations of this material offer assurance of pulpal acceptance. Histologic evaluation of the pulp response was determined in accordance with previously published procedures.‘-’

plastic and Fayez Sayegh, D.D.S.,

Table I. Number of teeth filled with experimental materials on Sino monkeys and dogs Group No.

Materials Scutan Self-curing resin ZOE Total Scutan Self-curing resin ZOE Total Scutan Self-curing resin ZOE Total

1

2

3

MATERIALS

AND METHODS

Three adult Sino monkeys and three beagle dogs were used in this experiment. The animals were fed a semiliquid diet during the experimental period. The animals were anesthetized by intravenous injection with Nembutal. The dosage was 0.5 cc/kg body weight. Class V cavities were prepared in 56 teeth with a No. 35 bur in an air turbine with a water spray. The teeth were restored with either Scutan, a self-curing acrylic resin,$ or zinc oxide-eugenol cement. Table I shows the number of teeth restored with each material. The three groups were estab-

Presented before the International Association for Dental Research, Las Vegas, Nev. This research was conducted by Dr. Kazanoglu in partial fulfillment of the requirements for the degree Master of Science at the University of Missouri at Kansas City. *Clinical Instructor, Department of Removable Prosthodontics; Present affiliation, Washington University School of Dental Medicine, St. Louis, MO. **Assistant Professor, Department of Histology. ***Professor and Chairman, Department of Histology. TPremier Dental Products Co., Norristown, Pa. fLang Dental Mfg. Co., Inc., Chicago, Ill.

0022-3913/79/080183

+ 05$00.50/00

1979 The C. V. Mosby

Co.

Ph.D.***

MO.

Total

fillings

No. of teeth fi11ed

No. of days materials

Ieft in

a 6

7 5 19

6

5 14

5 lb

a 6

30-45 7

21 56

lished according to the length of time the restorative materials remained in situ (Table I). The animals in group 1 were sacrificed 7 days after restoration, group 2 after 14 days, and gt-oup 3 after 30 to 45 days. At the designated interval the maqdibles and maxillae were dissected. The teeth were removed with the surrounding alveolar process. The apical third of the root and adherent bone was removed to insure fixation of the pulp. The specimens were fixed in 10% formalin and processed for routine histologic examination. The sections were evaluated for pulp pathosis according to previously published criteria.g

RESULTS The histologic response of the dental pulp to Scutan is shown in Fig. 2. In the first week the pulp appeared essentially normal. There were some inflammatory cells in the area of the odontoblastic

THE

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DENTISTRY

183

KAZANOGLU,

KIM,

AND

SAYEGH

CR3 I ci[j--

Cfi2-CH

-CcOz-(CiI2)

7-O

~~~

--ICH2)2-02C--fH-CH2--CH3

1

CH3 CH2 Fig. 1. The structural

formula

CH2

bf Scutan.

Fig. 2. A, left, B, right. The histologic response of the dental pulp to Scutan after 7 days. There were a few inflammatory cells in the odontoblastic and subodontoblastic areas. A few congested blood vessels were present. 0, Odontoblasts. B, Blood vessels. (Oriiinal magnification: A, X40, B, X 100.) and subodontoblastic layers. In addition, a few congested blood vessels were seen throughout the pulp tissue. These responses were observed in all Class V cavities. After 14 days, teeth treated with Scutan showed a mild reaction with many congested blood vessels. A thick layer of reparative dentin was present (Fig. 3). After 45 days, Scutan revealed pulp responses which were essentially normal (Fig. 4). The overall pulpal reactions for the first week of

184

teeth treated with self-curing resin were essentially normal. The response was comparable to that of Scutan (Table II). The pulp reactions to zinc oxide-eugenol cement were comparable to those of both Scutan and self-curing resin. It should be noted, however, that at this interval, the average remaining dentin of the zinc oxide and eugenol-restored teeth was slightly less than that of self-curing resin-restored teeth and

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PULPAL

RESPONSE

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MATERIALS

Fig. 3. The histologic response of the dental pulp to Scutan after 14 days. Note the mild reaction. R. Reparative dentin. 0, Odontoblasts. P, Primary dentin. (Original magnification, x40.)

Table II. Seven days’ acute pulp

reaction

to Scutan,

self-curing

resin,

and

ZOE --

No. of teeth prepared

M&&al

Scutan Self-curing resin ZOE

Table III. Fourteen

Scutan Self-curing resin ZOE

1.7 2.1 2.0

5

days’ subacute No.

Cellular displacement

(-4

8 6

of teeth prepared

Mate&l

Remaining dentin

pulp

Remaining dentin (mm)

6 5

0.42 0.43 0.31

5

reaction

JOURNAL

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DENTISTRY

Response

(mm)

Superfkial

0.5 0.5 0.5

0.5 0.5 0.5

to Scutan,

Cellular displacement (-4 0.30 0.43 0.50

moderately higher than the remaining dentin of the Scutan-restored teeth. Table III shows the average pulpal responses for the three materials for 14 days. All responses fell below 0.5 degree (based on a scale of 0 to 3) except for zinc oxide-eugenol cement, which showed cell displacement of 0.5 degree. At 45 days, teeth treated with self-curing resin revealed essentially normal pulps, moderate repara-

THE

.

self-curing Response

(mm) Deep

Reparative dentin

0 0 0

resin,

HpmOdlZkgf3

+ + +

+ + +

and ZOE

(mm)

superfkial

DWP

0.35 0.41 0.38

0 0 0

Reparative dentin + + +

-Is@ + + +

tive dentin, and a moderate number of congested blood vessels (Table IV). Pulpal reactions to zinc oxide-eugenol cement at this interval revealed essentially normal pulps with few inflammatory cells and reparative dentin. DISCUSSION A previous study reported that self-curing resin was highly toxic at the onset stage, and that its

185

KAZANOGLU,

KIM,

AND

SAYEGH

Fig. 4. The histologic response of the dental pulp to Scutan after 4.5 days. The pulp and odontoblastic layer below the reparative dentin are normal. 0, Odontoblasts. R, Reparative dentin. (Original magnification, X 100.) Table

IV. Thirty

to forty-five No.

Material

of teeth p-pad

Scutan Self-curing resin

8 6

ZOE

7

days’ chronic

pulp

reaction

Remaining dentin (mm)

Cellular displacement (mm)

0.51

0.09

0.11

0

+

+

0.53 0.34

0.08 0.07

0.2 0.17

0 0

+ +

+ +

toxicity was quickly reduced after curing.10 In this report the pulpal response to Scutan was characterized by congested blood vessels and/or a few inflammatory cells in a localized area of the pulp. In some instan& the affected area was moderately infiltrated with inflammatory cells. These pulp reactions, however, were fairly comparable to those of the self-curing resin and zinc oxide-eugenol cement. All restored teeth, regardless of material used, developed reparative dentin. As in the instances of polymorphonuclear infiltration into the odontoblastic layer, the reactions were confined to the region underlying the tubules injured during cavity preparation. The reparative dentin in the 45-day specimens was tubular. In some instances the matrix of the reparative dentin was well formed and resembled that of primary dentin. The reparative dentin of the teeth treated with Scutan and the other materials

186

to Scutan,

self-curing

Response (mm) Superficial

Deep

resin, and ZOE Reparative dentin

Hemorrhage

was either of the fibrillar or globular type as previously described by Sayegh.” This study established that the biologic compatibility of Scutan is slightly above that of the selfcuring resin. On the basis of this study, it appears that it is safe to use Scutan for temporary crowns and fixed partial dentures. This study indicates that the remaining dentin is a major factor when investigating pulp reaction.j, 6 Thinner remaining dentin increased the severity of the pulp reaction, regardless of materials used. The ethylene imine temporary crown and fixed partial denture material (Scutan) has two important advantages over self-curing resin: (1) the setting reaction is only slightly exodermic and (2) there is no free monomer.‘, I2 Therefore it lacks the characteristic odor of self-curing resin. Scutan has been recommended only for temporary coverage.‘, I2 However,

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others reported a mild pulp reaction experiment conducted on 44 monkeys.‘”

to Scutan in an teeth of two

Pulpal reactions to three dental materials, Scutan, a self-curing resin, and zinc oxide-eugenol cement, were comparable. The pulpal reactions to Scutan appeared to be milder than those to a self-curing resin or to zinc oxide-eugenol cement. REFERENCES

2.

3. 4.

5.

IADR PROSTHODONTIC

10.

A. Tallgren,

W. D. McCall,

of Michigan,

Ann Arbor,

Jr., N. N. Mansour, and State University

Reprint

requests

to:

DR. ALTUC KAZAN~CLU WASHINGTON UNIVERSITY SCHOOL OF DENTAI. MEDICINE 4559 SCOTT AVE. ST. LOUIS, MO. 63110

patients: A 1

and M. M. Ash, Jr.

of New York at Buffalo

This study was supported by USPHS Grant 015356. Reprinted from the Joumai of Dental Research [57 (Special Issue A), 1978 (Abt No. 907)] with permission of the author and the editor.

DENTISTRY

13.

complete denture

EMG silent periods are clinically significant in TMJ dysfunction patients but have not been examined extensively in other patient groups. The purpose here was to examine silent periods in immediate complete denture patients. Surface EM.G was recorded from the masseter and anterior temporal muscles bilaterally during maximal clench while 5 taps were delivered to the chin with a reflex hammer. This was done prior to extraction of remaining anterior teeth, after denture insertion, and 3 months and 6 months later. Two or more sessions of

OF PROSTHETIC

12.

atanley, H. R.: Design for a human pulp study Part II. Oral Surg 25:756, 1968. Sayegh, F. S., and Reed, A. J.: .4nalysis of histologic criteria commonly used in pulp studies. Oral Surg 37:453, 1974. Amet, E. M., and Sayegh, F. S.: Pulp responst to enamelite restorations in teeth of rhesus monkeys. ,J FHOSTHET DENT 37:42, 1977. Sayegh, F. S., and Reed, A.: Critique and comparison of pulp responses in monkey and human teeth. IADR Abst No. 525, 1970. Kawahara, H., Yamagami, A., and Nakamura. M,: Biologic testing of dental materials by means of tissw culture. Int Dent J l&443, 1968. Sayegh, F. S.: Qualitative and quantitative of reparative dentin. J Dent Child 35:7, 1968. Braden, M., and Causton, B. E.: Epimine temporary denture material. J Dent Res 5Or690, 1971. Dahl, B. L., Tronstad, L., and Spangberg, L,.: Biologic tests of a temporary crown and bridge material. J Oral Rehabil 1:299, 1974.

ABSTRACT

EMG siknt periods in immediate study

THE JOURNAL

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11.

Langeland, K., and Langeland, L.K.: Pulp reactions to crown preparation, impression, temporary crown fixation, and permanent cementation. J PROSTHET DENT 15:1’29, 1965. Langeland, K.: Effect of various procedures on the human dental pulp; pulp reactions to cavity preparations and gutta-percha. Oral Surg 14:210, 1961. Massler, M.: Pulp Protection and Preservation, Practical Dental Monographs, Jan. 1958, pp 3-47. Braden, M., Causton, B., and Clarke, R. L.: An ethylene imine derivative as a temporary crown and bridge material. J Dent Res 50:536, 1971. Stanley, H. R.: Design for a human pulp study, Part I. Oral Surg 25:633, 1968.

University

7. 8.

CONCLUSIONS

1.

6.

silent period recordings were available for 18 subjects and complete data for l‘0 subjects. Preliminary results from the 10 subjects showed no significant differences in mean silent period duration among the four muscles within any session. The mean duration at the partially edentulous stage was 36 ms, after denture insertion 43 ms, after 3 months 53 ms, and after 6 months 45 ms. The difference between the pre-extraction and the 3 month means was significant at the 5% level. The silent periods in denture wearers appear to be longer than those of dentate, asymptomatic subjects reported from the University of Michigan laboratory. Periodontal receptors do not seem to be a prerequisite for prolonged silent periods.

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Pulpal response to an epimine plastic.

Pulpal response to an epimine Altug Kazanoglu, University of Missouri D.D.S., School M.S.,* H.W. of Dentistry, Kim, D.D.S.,** Kansas City, M...
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