Anti-Inflammatory Effects of Calcium Hydroxide Combined with Ellagic Acid as Pulp Capping Material: In Vivo Study

Pulp capping is a pivotal treatment in dentistry aimed at preserving pulp vitality. While calcium hydroxide has long been considered the gold standard in pulp capping materials, its long-term use can induce chronic inflammation, ultimately leading to pulp necrosis and affecting human health. In this context, ellagic acid, a natural compound with potent anti-inflammatory properties, emerged as a promising adjunct to mitigate inflammation associated with calcium hydroxide application, thereby sustaining pulp vitality. This study aimed to investigate the inflammatory response by alterations in neutrophil, macrophage, lymphocyte, and tumor necrosis factor-α (TNF-α) expression following the treatment with a combination of calcium hydroxide and ellagic acid.

Dental pulp perforation was made on 27 male Wistar rats on the upper first molar and then pulp capped with calcium hydroxide and ellagic acid. The pulp of the control positive group was capped with calcium hydroxide, and the control group was not capped. The teeth were then extracted after 1, 3, and 7 days posttreatment. The differences in the number of neutrophils, macrophages, lymphocytes, and TNF-α expression were analyzed using one-way analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) test.

The treatment combination of calcium hydroxide and ellagic acid showed the lowest neutrophil number and TNF-α expression compared with the other groups (p < 0.05), while the macrophage and lymphocyte numbers were the highest compared with the other groups (p < 0.05).

The combination of calcium hydroxide and ellagic acid as a pulp capping material exhibited a dual effect on the inflammatory response in dental pulp. These findings suggest that calcium hydroxide and ellagic acid modulate the inflammatory response in a complex manner, promoting a more controlled and potentially beneficial healing process.