Pulpal healing and dentinal bridge formation in an acidic environment

This study was designed to observe the healing and bridging capacity of mechanically exposed pulps that were capped with silicate or zinc phosphate cements and biologically sealed with zinc oxide-eugenol cement to exclude bacteria. In six monkeys, Class V facial cavities with pulpal exposures were randomly distributed throughout 105 teeth, of which 80 were directly capped, 40 with silicate cement and 40 with zinc phosphate cement. Twenty of each group were filled to the cavosurface margin with the respective cement and 20 were surface sealed to the cavosurface margin with zinc oxide-eugenol cement. The remaining 25 exposures were capped with calcium hydroxide and amalgam as controls. Tissues were obtained by perfusion fixation after intervals of 21, 14, 10, 5 and 3 days. The 25 pulps capped with calcium hydroxide showed cell migration and organization at 5 days and dentinal matrix deposition at 10 days. At 3 and 5 days, all exposures in the experimental groups showed clot resolution. At 10 days, fibroblasts had stratified against the cement interface. At 14 days, pulps in both experimental groups showed new dentinal bridge formation directly adjacent to the acidic cements. The 21-day experimentally capped and sealed pulps presented healing similar to the controls. This study indicates that acidic components of silicate and Zinc phosphate cements are not directly responsible for pulpal inflammation or necrosis. The exposed dental pulp possesses an inherent healing capacity for cell reorganization and dentinal bridge formation when a bacterial seal is provided.