Proforma for registration of subject for dissertation



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE KARNATAKA

ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE AND ADDRESS

DR. GANESH R MORE

P. M. N. M. DENTAL COLLEGE & HOSPITAL,

BAGALKOT- 587101

KARNATAKA
2. NAME OF THE INSTITUTION

P. M. N. M. DENTAL COLLEGE & HOSPITAL,

BAGALKOT- 587101

KARNATAKA


3. COURSE OF STUDY AND SUBJECT

M.D.S (MASTER OF DENTAL SURGERY)

CONSERVATIVE DENTISTRY AND ENDODONTICS
4. DATE OF ADMISSION TO COURSE

24th MAY 2010



5. TITLE OF THE TOPIC

‘“HISTOPATHOLOGICAL EVALUATION OF HUMAN DENTAL PULP TISSUE CAPPED WITH HYDROXYAPATITE, MINERAL TRIOXIDE AGGREGATE AND CALCIUM HYDROXIDE” - AN IN VIVO COMPARATIVE STUDY.


6. BRIEF RESUME OF THE INTENDED WORK
6.1. NEED FOR THE STUDY

Preserving the dental pulp or part of it in a healthy state is important in treating teeth with exposed vital pulp. Direct pulp capping is a therapeutic method aimed at treating reversible pulpal injury whenever dentin and pulp is affected by caries, restorative procedures or trauma. In direct pulp capping the exposed pulp is covered with a protective wound dressing or base placed directly over the site of exposure. Ideally the pulp heals with the formation of a mineralized tissue barrier across the exposed surface commonly referred to as Dentin Bridge. Complete healing of the pulpodentinal complex, which involves maintenance of pulp vitality, function and the restoration of dentin continuity beneath the injury are prerequisite for the long-term success of direct pulp capping treatment. The potential for recovery after oral pulp exposure depends on several factors such as the pulp status, the pre-operative and post-operative prevention of bacterial infection, the size of exposure and the efficacy of treatment strategy.


Calcium hydroxide was found to be the most successful material in inducing the dentinal bridge and it is the widely used direct pulp capping agent. MTA is a relatively novel pulp sealing agent with good sealing ability and biocompatibility. Both MTA and Ca(OH)2 show dentinal bridge formation in four weeks (2). Hydoxyapatite is a type of calcium phosphate which is the major component of hard tissues in the body such as teeth and bone. It is a highly biocompatible material which has been used as bone graft and it was evaluated that in animal in vivo study, hydoxyapatite produces the dentin bridge (5) in 4 weeks and it can be tested in human, as it is major component of teeth.

This study intends to compare hydoxyapatite, MTA and calcium hydroxide as direct pulp capping agents in humans, after direct pulp capping with these material, tooth will be extracted at three different (1 week, 4 weeks, 8 weeks) time intervals. And Evaluated for the difference in Dentinal Bridge Formation and the presence or absence of Inflammation, Calcification, Congestion and Atrophic degeneration according to Histological criteria (2, 4, 5).



6.2. REVIEW OF LITERATURE

In a review literature by T J Hilton highlights two keys to success of calcium hydroxide pulp capping: restricting pulp capping to asymptomatic teeth and providing a well seated restoration following the pulp cap. The article concludes that calcium hydroxide remains the gold standard for direct pulp capping since it has got longest track record of clinical success and is the most cost effective pulp capping material. 1

In a study conducted by P.N.R. Nair et al to investigate the pulpal response to direct pulp capping in healthy human teeth with mineral trioxide aggregate (MTA) as against calcium hydroxide cement as control. MTA was found clinically easier to use as a direct pulp–capping agent and resulted in less pulpal inflammation and more predictable hard tissue barrier formation than calcium hydroxide. 2

Alain Jean et al conducted a study and reported 50% tricalcium phosphate plus 50% hydoxyapatite compound provided the best dentinogenic effects in primary teeth, when compared with calcium hydroxide in pig’s primary teeth. And forms thicker dentin bridge and quicker formation of subjacent normal tubular dentin it’s likely that total time for pulp healing is shorter. 3

M. Aeinehchi et al conducted histological comparative study of mineral trioxide aggregate (MTA) with calcium hydroxide when used as pulp-capping materials in human teeth found that less inflammation, hyperemia and necrosis plus thicker dentinal bridge and more frequent odontoblastic layer formation with MTA than calcium hydroxide. 4

S. Yildirim et al conducted a study aimed to test the availability of different calcium phosphate biomaterials (CPBs), hydroxyapatite (HA), beta tricalcium phosphate (TCP), and a combination of these (TCP+HA) as dental pulp capping systems on healing of dog dental pulp. Thirty days after the operation, HA and TCP group the pulp tissue displayed severe inflammatory response, prompted healing of the pulp tissue in TCP+HA group was seen. Complete bridge of reparative dentin formation was obvious in TCP+HA and CH groups. No reparative dentin deposition was present in all samples of hydroxyapatite (HA). 5



6.3. OBJECTIVES OF THE STUDY
The purpose of this in vivo study is to compare histopathologically the effect of Hydoxyapatite, Mineral Trioxide Aggregate and Calcium Hydroxide as a pulp capping material, for the presence or absence of Inflammation, Calcification, Congestion and Atrophic degeneration on human dental pulp tissue in the extracted pulp capped tooth in three different (1 week, 4 week, 8 week) time intervals after direct pulp capping under light microscope .

7. MATERIAL AND METHODS

7.1. SOURCE OF DATA

Forty-five human teeth from healthy subjects aged 13-30 years scheduled for orthodontics extraction and approved by the ethical committee of PMNM Dental College and Hospital Bagalkot will be selected from the Department of Orthodontics of P.M.N.M Dental College and hospital, Bagalkot.



CRITERIA FOR SELECTION OF DATA

1. Forty five teeth scheduled to be extracted for orthodontic reason.

2. Patient aged between 13-30 years.

3. Intact vital teeth without any caries or any periapical pathosis.



7.2 METHOD

Prior to the research work, informed consent will be taken from the subjects or from the parents of the subjects below 18 years old. Forty-five healthy human teeth scheduled to be extracted for orthodontic reason will be selected for the study. Occlusal cavities will be prepared with a sterile diamond bur at high speed under a water spray coolant. Pulp exposures will be performed in the centre of the floor of the cavity with a round diamond bur under water-coolant. Single bur will be used for the entire preparation of each cavity. Haemostasis was established with a sterile cotton pellet soaked in saline solution. Teeth will be divided into 3 groups based on the agents used for direct pulp capping (15 teeth in each group).

Group 1 - Hydoxyapatite

Group 2 - Mineral trioxide aggregate

Group 3 - Calcium hydroxide

The teeth will be restored with Intermediate Restorative Material. Each group will be subdivided into 3 subgroups (5 teeth in each subgroup) based on the time period of clinical review and tooth will be extracted in each subgroup as following time intervals.

Sub group1: 1 week

Sub group2: 4 weeks

Sub group3: 8 weeks

After extraction, in preparation for histological examination, the extracted teeth will be fixed in 10% neutral formalin, decalcified in acetic acid, sequentially dehydrated in alcohol/acetone, processed in acetone and xylene. Specimen will be immersed and embedded in paraffin wax. Then paraffin blocks will be serially sectioned. The cut section will be stained with hematoxylin and eosin and examined under light microscopy for evaluation of the presence or absence of Inflammation, Calcification, Congestion and Atrophic degeneration will be evaluated histologically depending on presence of infiltration of acute and chronic inflammatory cells, dilated blood vessels filled with RBCs, extravasated erythrocytes, cellular count and nuclear changes under light microscope by an experienced oral pathologist (2, 4, 5). The obtained result will be analyzed statistically using appropriate method by biostatistician.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY

YES. Comparing the pulp capping agents on human vital teeth indicated for orthodontic extraction.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN

CASE OF 7.3?

YES.

8. LIST OF REFERENCES:


  1. T J Hilton, Keys to Clinical Success with Pulp Capping: A Review of the Literature. Oper Dent 2009; 34(5): 615-625.




  1. P N R Nair, H F Duncan, T R Pitt Ford & H U Luder. Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial. Int Endod J 2008; 41:128–150.




  1. Alain Jean, Bertrand Kerebel, Lise-Marie Kerebel, Racquel Z and Henri Hamel. Effect of various calcium phosphate biomaterials on reparative dentin bridge formation. J Endod 1988; 14(2): 83-87.

  2. M Aeinehchi, B Eslami, M Ghanbariha & A S Saffar. Mineral trioxide aggregate (MTA) and calcium hydroxide as pulp-capping agents in human teeth: a preliminary report. Int Endod J 2002; 36:225-231.




  1. S Yildirim, A Alaçam, Z Kadir Sarıtaş, T Oygür. In vivo effect of calcium phosphate biomaterials on dog dental pulp. Biotechnol. & Biotechnol 2007; 21:198-204.


9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE:

11.1 NAME AND DESIGNATION OF THE GUIDE:

DR. SARITHA V M D S

PROFESSOR

DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS

P.M.N.M. DENTAL COLLEGE AND HOSPITAL,

BAGALKOT-587101

KARNATAKA

11.2 SIGNATURE OF THE GUIDE:

11.3 HEAD OF THE DEPARTMENT:

DR. K H KIDIYOOR M D S

PROFESSOR AND HEAD OF THE DEPARTMENT

DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS

P.M.N.M. DENTAL COLLEGE AND HOSPITAL,

BAGALKOT-587101

KARNATAKA

11.4 SIGNATURE OF THE HEAD OF THE DEPARTMENT:

12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL:

12.2 SIGNATURE OF THE PRINCIPAL:

Dr. SRINIVAS VANAKI M D S

PRINCIPAL

P.M.N.M. DENTAL COLLEGE,

BAGALKOT – 587101

KARNATAKA


REMARKS

TITLE OF THE TOPIC

‘“HISTOPATHOLOGICAL EVALUATION OF HUMAN DENTAL PULP TISSUE CAPPED WITH HYDROXYAPATITE, MINERAL TRIOXIDE AGGREGATE AND CALCIUM HYDROXIDE” - AN IN VIVO COMPARATIVE STUDY.’



REMARKS

  1. Being an invivo study what is the time duration of the study?

Ans; Group 1 - Hydoxyapatite

Group 2 - Mineral trioxide aggregate

Group 3 - Calcium hydroxide

Each group will be subdivided into 3 subgroups and tooth will be extracted as following time intervals.

Sub group1: 1 week

Sub group2: 4 weeks



Sub group3: 8 weeks



  1. Ca(OH)2,MTA, Hydroxyapatite, How many weeks does it take to induce dentinal bridge fomation not mentioned.

Ans; Both MTA and Ca(OH)2 show dentinal bridge formation in four weeks in human teeth. Hydoxyapatite produces the dentin bridge (5) in 4 weeks in animal invivo study.

  1. How is inflamation, congestion, atrophic degeneration, histologically assessed?

Pulpal response like inflamation, congestion, atrophic degeneration will be evaluated histologically depending on presence of infiltration of acute and chronic inflammatory cells, dilated blood vessels filled with RBCs, extravasated erythrocytes, cellular count and nuclear changes under light microscope by an experienced oral pathologist.

  1. Will 8 weeks be sufficient?

Ans;8 weeks is more than sufficient for dentinal brigde formation in Both MTA and Ca(OH)2 in human teeth. Hydoxyapatite produces the dentin bridge (5) in 4 weeks in animal invivo study.


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