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Comparative Study of Pulpal Responses To Proroot Mta, Vitapex, and Metapex in Canine Teeth
Comparative Study of Pulpal Responses To Proroot Mta, Vitapex, and Metapex in Canine Teeth
ScienceDirect
Original Article
a
Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea
b
Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea
c
Department of Conservative Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of
Korea
KEYWORDS Abstract Background/purpose: ProRoot MTA, Vitapex, and Metapex are widely used for pulp
ProRoot MTA; treatment of primary tooth. The aim of this study was to compare the pulpal responses to Pro-
Vitapex; Root MTA, Vitapex, and Metapex in a canine model of pulpotomy.
Metapex; Materials and methods: Pulpotomy procedure was performed to 34 teeth (21 incisors and 13
Pulpal response premolars) and ProRoot MTA, Vitapex or Metapex was applicated to artificially exposed pulp
tissues. After 13 weeks, the teeth were extracted and processed with hematoxylin-eosin stain-
ing for histologic evaluation. All specimens were evaluated in several categorys related to
calcific barrier, inflammatory responses and the area of calcific barrier formation was
measured.
Results: Most of the specimens in the ProRoot MTA group developed a calcific barrier at the
pulp amputation site and showed a low level of inflammatory response. However, in compar-
ison to ProRoot MTA group, a small amount of calcific barrier formed in Vitapex and Metapex
groups.
Conclusion: This in vivo study found that Vitapex and Metapex induced similar pulpal responses
but showed poor outcomes compared with using ProRoot MTA. Vitapex and Metapex are there-
fore not good substitutes for ProRoot MTA in direct pulp capping and pulpotomy.
ª 2021 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier
B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.
org/licenses/by-nc-nd/4.0/).
* Corresponding author. Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul, 03722, Republic of Korea.
E-mail address: [email protected] (J.S. Song).
y
These authors contributed equally to this work.
https://doi.org/10.1016/j.jds.2020.12.011
1991-7902/ª 2021 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Journal of Dental Sciences 16 (2021) 1274e1280
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Journal of Dental Sciences 16 (2021) 1274e1280
Table 1 (continued )
Scores Odontoblastic cell layer
1 Palisade pattern of cells
2 Presence of odontoblast cells and
odontoblastlike cells
3 presence of dontoblastlike cells only
4 Absent
Table 2 Score percentages for calcific barriers. Figure 1 Hematoxylin-eosin staining for the evaluation of
Scores 1 2 3 4 the histomorphologic characteristics of the newly formed
Calcific barrier continuity (%) calcific barrier (CB) after 13 weeks ((AeC): scale
ProRoot MTA 50 (5/10)a 40 (4/10) e 10 (1/10) bars Z 250 mm, (DeF): scale bars Z 50 mm).
Vitapex 12.5 (1/8) 50 (4/8) e 37.5 (3/8)
Metapex 30 (3/10) 30 (3/10) e 40 (4/10) divided by the coronal pulpal width of each specimen to
Calcific barrier morphology (%) ensure objective comparisons. There was a statistically
ProRoot MTA 70 (7/10) 20 (2/10) e 10 (1/10) significant difference between the ProRoot MTA and Vita-
Vitapex e 25 (2/8) 37.5 (3/8) 37.5 (3/8) pex (P Z 0.019), and Metapex (P Z 0.035) (Fig. 2).
Metapex 50 (5/10) 10 (1/10) e 40 (4/10)
Tubules in calcific barrier (%) Discussion
ProRoot MTA 50 (5/10) 40 (4/10) e 10 (1/10)
Vitapex 12.5 (1/8) 12.5 (1/8) 37.5 (3/8) 37.5 (3/8)
This study evaluated and compared the pulpal responses to
Metapex 30 (3/10) 20 (2/10) 10 (1/10) 40 (4/10)
Vitapex, Metapex, and ProRoot MTA using a canine pul-
a
Number of teeth receiving the score/total number of teeth potomy model. The use of ProRoot MTA resulted in the
evaluated. formation of a calcific barrier that was of higher quality and
larger and exhibited a better inflammatory response
compared with using Vitapex and Metapex, with no signif-
icant differences between the latter two groups.
Table 3 Score percentages for inflammatory responses.
MTA has good physical properties and biocompatibility,
Scores 1 2 3 4 it stimulates tissue regeneration as well as a good pulp
Inflammation intensity (%) response,16,17 and has an excellent long-term sealing abil-
ProRoot MTA 50 (5/10)a 20 (2/10) e 30 (3/10) ity. MTA is the optimum material for vital pulp therapy, and
Vitapex e 25 (2/8) 25 (2/8) 50 (4/8) it is better than calcium hydroxide, which has traditionally
Metapex 10 (1/10) 30 (3/10) 20 (2/10) 40 (4/10) been used.18 In previous in vivo studies, ProRoot MTA
Inflammation extensity (%) showed better calcific barrier generation and pulpal
ProRoot MTA 60 (6/10) 30 (3/10) e 10 (1/10) response than TheraCal (Bisco, Schamburg, IL, USA) and
Vitapex e 25 (2/8) 37.5 (3/8) 37.5 (3/8) Endocem zir (Maruchi, Wonju, Korea), as well as other
Metapex 20 (2/10) 30 (3/10) 20 (2/10) 30 (3/10) types of MTA such as RetroMTA (BioMTA, Seoul, Korea),
Inflammation type (%) Ortho MTA (BioMTA), and Endocem MTA (Maruchi) in canine
ProRoot MTA 60 (6/10) 30 (3/10) 10 (1/10) e pulpotomy models.12e14 The verified biocompatibility of
Vitapex e 50 (4/8) 50 (4/8) e ProRoot MTA meant that it was suitable to use in the pre-
Metapex 10 (1/10) 50 (5/10) 40 (4/10) e sent study as a positive control. The results showed that the
Dental pulp congestion (%) pulpal response was better for ProRoot MTA than for Vita-
ProRoot MTA 40 (4/10) 50 (5/10) 10 (1/10) e pex and Metapex, which implies that ProRoot MTA has
Vitapex 12.5 (1/8) 37.5 (3/8) 50 (4/8) e better tissue affinity than Vitapex and Metapex in direct
Metapex 20 (2/10) 60 (6/10) 20 (2/10) e pulp capping and pulpotomy procedures where pulp tissue
a and the material are in direct contact.
Number of teeth receiving the score/total number of teeth
Vitapex and Metapex are widely used as canal filling
evaluated.
materials for primary teeth because of their radiopaque,
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Journal of Dental Sciences 16 (2021) 1274e1280
validation in infection models and long-term studies are applications, drawbacks, and mechanism of action. J Endod
therefore needed in the future. In addition, considering the 2010;36:400e13.
increased inflammatory responses to all three materials 11. Kim B, Kim IH, Shin Y, Song JS. Comparative histologic study of
over a relatively short 13-week follow-up compared with 3-root canal filling materials for dog’s teeth. J Korean Acad
Pediatr Dent 2019;46:255e64.
the duration of drug application in actual clinical practice,
12. Kang CM, Hwang J, Song JS, Lee JH, Choi HJ, Shin Y. Effects of
clinicians must recognize that not only choosing the correct three calcium silicate cements on inflammatory response and
material but also the characteristics of the sterile envi- mineralization-inducing potentials in a dog pulpotomy model.
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to successful pulp treatment. 13. Lee H, Shin Y, Kim SO, Lee HS, Choi HJ, Song JS. Comparative
In conclusion, this in vivo study found that Vitapex and study of pulpal responses to pulpotomy with ProRoot MTA,
Metapex induced similar pulpal responses but showed poor RetroMTA, and TheraCal in dogs’ teeth. J Endod 2015;41:
outcomes compared with using ProRoot MTA. Vitapex and 1317e24.
Metapex are therefore not good substitutes for ProRoot MTA 14. Lee M, Kang CM, Song JS, et al. Biological efficacy of two
in direct pulp capping and pulpotomy. mineral trioxide aggregate (MTA)-based materials in a canine
model of pulpotomy. Dent Mater J 2017;36:41e7.
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Declaration of competing interest dental pulp capped with biodentine and mineral trioxide
aggregate. J Endod 2013;39:743e7.
16. Camilleri J, Pitt Ford TR. Mineral trioxide aggregate: a review
The authors have no conflicts of interest relevant to this
of the constituents and biological properties of the material.
article.
Int Endod J 2006;39:747e54.
17. Rao A, Rao A, Shenoy R. Mineral trioxide aggregate-a review. J
Acknowledgements Clin Pediatr Dent 2009;34:1e7.
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work. This study was supported by Basic Science Research 19. Gupta S, Das G. Clinical and radiographic evaluation of zinc
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