A comparative study of histologic response to different pulp

capping materials and a novel endodontic cement

Saeed Asgary, DDS, MS,a Mohammad Jafar Eghbal, DDS, MS,a Masoud Parirokh, DDS, MS,b
Farzin Ghanavati, DDS, MS,c and Hessam Rahimi, DDS,d Tehran and Kerman, Iran, and
Boston, Massachusetts, USA
SHAHID BEHESHTI UNIVERSITY M.C., IRANIAN CENTER FOR ENDODONTIC RESEARCH, DENTAL
RESEARCH CENTER, KERMAN SCHOOL OF DENTISTRY AND IRAN RESEARCH CENTER FOR ORAL AND
DENTAL DISEASES, AND HARVARD SCHOOL OF DENTAL MEDICINE

Objective. The aim of this study was to compare dogs’ pulp response to capping with calcium hydroxide cement
(Dycal), mineral trioxide aggregate (MTA), and a novel endodontic cement (NEC).
Study design. Twenty-four canine teeth in 6 beagle dogs were buccocervically exposed and capped with MTA, Dycal,
or NEC. Eight weeks later, retrieved samples were observed by optical microscope to grade inflammation, formation of
dentinal bridge, calcification, necrosis, and presence of odontoblast cells.
Results. No inflammation was observed in MTA and NEC groups, and in 75% of each, dentinal bridge was
completely formed. In the Dycal group, inflammation and incomplete dentinal bridge were detected in all cases.
Although MTA and NEC groups had no significant difference between them in each measure, the difference between
all 3 groups was significant (P ⬍ .001).
Conclusion. MTA and NEC showed similar favorable biologic response in pulp cap treatment, better than Dycal,
especially in inducing the formation of dentinal bridge. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;
106:609-14)

Direct pulp capping is covering the exposed surface of
the pulp to maintain its vitality and preserve its func-
tional and biologic activities.1 Inducing hard tissue
formation by pulp cells as an ultimate goal of capping
material use has been widely accepted.2
Because of its low-grade irritation of the traumatized
pulp tissue, calcium hydroxide [Ca(OH)2] has been the
material of choice for pulp capping.3 Known disadvan-
tages for this material include gradual degradation,
tunnel defects in dentinal bridge, and poor sealing
properties.4
Mineral trioxide aggregate (MTA) has been intro-
duced as a suitable material for direct pulp capping
treatment, demonstrating a remarkable success rate
Supported in part by Iran Center for Dental Research, Shahid Be-
heshti University M.C., Tehran, Iran.
a
Professor of Endodontics, Iranian Center for Endodontic Research,
Dental Research Center, Shahid Beheshti University M.C.
b
Professor of Endodontics, Kerman School of Dentistry and Iran
Research Center for Oral and Dental Diseases.
c
Research Assistant, Dental Research Center, Shahid Beheshti Uni-
versity M.C.
d
Orthodontics Program, Department of Oral and Developmental Bi-
ology, Harvard School of Dental Medicine.
Received for publication May 9, 2008; returned for revision May 9,
2008; accepted for publication Jun 3, 2008.
1079-2104/$ - see front matter
© 2008 Mosby, Inc. All rights reserved.
doi:10.1016/j.tripleo.2008.06.006
compared with various Ca(OH)2 preparations.5-7 Al-
though MTA has superior biocompatibility compared
with the conventional root-end filling materials, it has a
delayed setting time,8 poor handling characteristics,9
and off-white color, and it is in comparison an expen-
sive material. To decrease the expenses, Portland ce-
ment (PC) has been compared with MTA in recent
studies, revealing that PC is compositionally similar to
MTA.10-11 The advantages and disadvantages of differ-
ent commercial types of MTA and PC have also been
well documented.11-13 Considering these facts, the
present authors designed a project to evaluate a new
dental material that combines reasonable biocompat-
ibility of MTA with appropriate setting time, handling
characteristics, chemical properties, and color. The
novel endodontic cement (NEC*) contains several cal-
cium compounds and has been evaluated in several
research projects.14-15
The purpose of the present investigation was to evalu-
ate the histomorphologic response of dental pulp to cap-
ping with calcium hydroxide cement (Dycal), MTA, and
NEC, using dogs’ canine teeth in an 8-week follow-up.
MATERIAL AND METHODS
In this prospective randomized controlled trial, 24
intact canine teeth in 6 18- to 24-month-old healthy
*Patent pending as Endodontic Filling Material (ENDOFILMAT).

609

610 Asgary et al.
Table I. Histologic features and the grading method used in the present study to evaluate the samples
Feature Category I (worst)
Hard tissue (dentinal Continuity Severe communication of the capping
bridge) material with dental pulp
Morphology No tubules present
Thickness ⬍0.1 mm
Pulp inflammation Type Acute and chronic inflammation
Intensity Severe inflammation or abscess formation Minimal to moderate inflammation
Extension All coronal pulp
Other histologic Calcification Diffuse calcification
features Necrosis Complete
Odontoblastic Absent
layer
male beagle dogs were randomly divided into 3 groups
for Dycal, MTA, and NEC (n ⫽ 8 for each). The
maxillary and mandibular canine teeth from each ani-
mal were randomly allocated to 1 of the 3 groups.
Four intact incisor teeth were selected in 4 dogs as
the control group. The protocol of the study was ap-
proved by the Ethics Committee of Shahid Beheshti
University of Medical Sciences, Tehran, Iran, in 2005.
General anesthesia was achieved by IM injection of 10
mg/kg ketamine HCl (Alfasan, Woerden, the Nether-
lands) and 1 mg/kg xylazine (Bayer, Munich, Ger-
many). The oral cavity was rinsed with 0.2% chlorhexi-
dine glucunate (Shahrdaru, Tehran, Iran) to disinfect
the area. An infiltration injection with mepivacaine
(Espe Dental, Seefeld, Germany) was used for local
anesthesia. A rubber dam was then installed to isolate
the teeth.
Class V cavities were prepared on the buccal surface
of the teeth using buccocervical access by a no. 1
high-speed round bur with copious water spray. The
preparations were cut 0.5-1 mm above the free gingiva,
parallel to the cementoenamel junction. Pulp exposure
was performed in the middle of the cavity floor. The
pulp exposures produced were about the same size (1
mm). Following exposure of the pulp, the access cavity
was rinsed with sterile saline solution and dried with
sterile cotton pellets with a light pressure to control the
bleeding. The pulp was covered with each material
depending on the group to which it belonged. Tooth-
colored ProRoot MTA (Dentsply, Tulsa Dental, Tulsa,
OK) and Dycal (LD Caulk, Milford, DE) were prepared
according to the manufacturers’ directions, and NEC
was mixed with its liquid to provide a dense creamy
mixture. The coronal opening of every tooth was then
restored immediately with Fuji II glass ionomer (GC
International Corp., Tokyo, Japan). After the operation,
animals were supervised according to the protocol of
OOOOE
October 2008
Grading
II III (best)
Moderate communication of the capping Complete
material with dental pulp
Irregular pattern of tubules Regular pattern of
tubules
0.1-0.25 mm ⬎0.25 mm
Chronic inflammation No inflammation
No inflammation
Under exposure area or calcified bridge Absent
Pulp stone Absent
Partial Absent
Presence of odontoblast cells Palisade pattern
of cells
Tehran Veterinary School, Tehran, Iran, with a special
soft diet and supporting analgesics and other medica-
ments (i.e., vitamin and minerals).
The animals were sacrificed after 8 weeks, vital
perfusion fixation was performed with 10% buffered
formalin solution, and block sections were retrieved
using cutting discs. The teeth and their surrounding
tissues were placed in 10% buffered formalin solution
for 2 weeks. The specimens were then demineralized
for 4 weeks in 10% formic acid. After decalcification of
the samples, the specimens were rinsed with running
tap water for 2 h, followed by dehydration in ascending
concentrations of alcohol (70%, 90%, and 100%), and
were then embedded in paraffin. The glass ionomer
restoration (with a part of the capping material) was
gently removed from every sample before embedding.
Six-micrometer labiolingual sections were prepared
through the exposure site and were stained with hema-
toxylin and eosin (H&E). The labiolingual section pass-
ing through the center of the exposure site was used for
histologic observations. Using an optical microscope
(Zeiss, Goettingen, Germany), samples were evaluated
by an experienced oral pathologist who was not aware
of the types of capping material. Coded samples were
used throughout the study to avoid possible bias. The
amount of pulp inflammation (type, intensity, and ex-
tension), hard tissue formation at the interface of the
capping material (continuity, morphology, and thick-
ness), and other histologic features of the pulp tissue,
including calcification of the pulp, necrosis, and the
odontoblast cell layer were graded from I to III by the
oral pathologist (Table I) according to the standards
defined by several earlier observers.16-18
The data were analysed with Kruskal-Wallis and
Mann-Whitney tests. Statistically significant differ-
ences were set at P ⬍ .05.
OOOOE
Volume 106, Number 4 Asgary et al. 611

Table II. Number (%) of different categories of the histologic features for each group according to the scores (see
Table I) received during histopathologic evaluations (n ⫽ 8 for each group)
Dycal MTA NEC
Feature Category I II III I II III I II III
Hard tissue (dentinal Continuity 0 (0%) 8 (100%) 0 (0%) 0 (0%) 2 (25%) 6 (75%) 0 (0%) 2 (25%) 6 (75%)
bridge) Morphology 7 (87.5%) 1 (12.5%) 0 (0%) 0 (0%) 5 (62.5%) 3 (37.5%) 0 (0%) 4 (50%) 4 (50%)
Thickness 2 (25%) 5 (62.5%) 1 (12.5%) 0 (0%) 4 (50%) 4 (50%) 0 (0%) 2 (25%) 6 (75%)
Pulp inflammation Type 1 (12.5%) 7 (87.5%) 0 (0%) 0 (0%) 0 (0%) 8 (100%) 0 (0%) 0 (0%) 8 (100%)
Intensity 1 (12.5%) 7 (87.5%) 0 (0%) 0 (0%) 0 (0%) 8 (100%) 0 (0%) 0 (0%) 8 (100%)
Extension 4 (50%) 4 (50%) 0 (0%) 0 (0%) 0 (0%) 8 (100%) 0 (0%) 0 (0%) 8 (100%)
Other histologic Calcification 0 (0%) 4 (50%) 4 (50%) 0 (0%) 0 (0%) 8 (100%) 0 (0%) 2 (25%) 6 (75%)
features Necrosis 0 (0%) 2 (25%) 6 (75%) 0 (0%) 0 (0%) 8 (100%) 0 (0%) 0 (0%) 8 (100%)
Odontoblastic 7 (87.5%) 1 (12.5%) 0 (0%) 0 (0%) 5 (62.5%) 3 (37.5%) 0 (0%) 4 (50%) 4 (50%)
layer
Dycal, Calcium hydroxide cement; MTA, mineral trioxide aggregate; NEC, novel endodontic cement.

RESULTS
Specimens of control sound teeth showed normal
pulp tissue with palisade columnar odontoblast cells at
the coronal portion of the pulp. No inflammatory cell
could be observed.
A summary of the observed criteria is presented in
Table II. In the Dycal group, a complete calcified
bridge was not detected (Fig. 1). As shown in Fig. 1, a
great deal of material had been pushed into the pulp
space and dystrophic calcification observed around
them. Although partial necrosis was observed in 2
samples, all pulps were vital. In 100% of the samples,
mild to severe chronic inflammation was observed
around the exposure site and the calcified bridge. It was
also scattered throughout the coronal pulp chamber. In
one of the samples in this group, an odontoblast-like
cell layer with irregular tubular dentin was observed
adjacent to the dentinal bridge. The remaining 87.5% of
the samples showed amorphous and nontubular calci-
fied bridge, exhibiting a dense structure. In some cases,
the appearance of cellular inclusions was similar to that
of lacunae found in the bone. Also, only 1 sample
demonstrated a bridge formation with adequate thick-
ness (⬎0.25 mm). In addition, in 50% of the samples,
pulp stones were detected in the pulp tissue.
In the MTA group, complete dentin bridge formation
was detected in 75% of the samples (Fig. 2). None of
the samples showed inflammation, and in all samples
the pulp was vital. In this group, 37.5% of the samples Fig. 1. Pulp cap with Dycal (CH). Top, Formation of a thin
had well organized odontoblast cell layer in close rela- calcified bridge at pulp-Dycal interface (⫻100); bottom
tion to a dentinal bridge composed of tubular dentin. In right, communication path between pulp and Dycal (arrow)
the remainder, odontoblast-like cells were discovered (⫻400); bottom left, phagocyte cell containing particles (ar-
adjacent to a dentinal bridge with irregular tubules. rowhead) (⫻1,000).
Also, in one-half of the samples, the dentinal bridge had
sufficient thickness (⬎0.25 mm).
In the NEC group, complete dentin bridge formation
was reported in 75% of the cases (Fig. 3). None of the

612 Asgary et al.
Fig. 2. Pulp cap with mineral trioxide aggregate (MTA).
Top, Formation of a thick dentinal bridge at pulp-MTA
interface (⫻100); bottom, formation of odontoblast-like
cells, dentin, and dentinal tubules (⫻1,000).
samples demonstrated inflammation in relation to the
exposure, and in 100% of the cases the pulp was vital.
Also, in 50% of the cases, a well organized odonto-
blast-like cell layer was formed adjacent to the dentinal
bridge with tubular dentin. In the remaining samples,
odontoblast-like cells were discovered adjacent to the
dentinal bridge with irregular pattern of tubules. In
addition, in 75% of the cases, the dentinal bridge had
sufficient thickness (⬎0.25 mm).
Kruskal-Wallis test revealed that all groups had
strong significant difference (P ⬍ .001). Mann-Whit-
ney test was used for further assessment, and the results
demonstrated that the Dycal group had strong signifi-
cant difference from the MTA and NEC groups (P ⬍
.001), whereas these 2 groups did not show a significant
difference in any observed criterion (P ⬎ .05).
DISCUSSION
Stanley19 advocated that pulp-capping procedures
could be performed successfully on asymptomatic ex-
OOOOE
October 2008
Fig. 3. Pulp cap with novel endodontic cement (NEC). Top,
Formation of a thick dentinal bridge at pulp-NEC interface
(⫻100); bottom, formation of multilayer odontoblast-like
cells, dentin, and dentinal tubules (⫻1,000).
posures. In the present study, Dycal was used as the
conventional pulp capping material and a keystone for
comparison. The reason for selecting Dycal instead of
Ca(OH)2 lies in the fact that Ca(OH)2, with its very
high pH, creates superficial obliteration zones and co-
agulation necrosis where reparative dentine ultimately
begins to form in deeper zones, although Dycal, with its
lower pH, may avoid major tissue damage and stimu-
late reparative dentine more directly.19 The results of
the present study for the Dycal group were poor. All of
the samples showed incomplete calcified bridge forma-
tion with inflammation of the pulp tissue. In some
cases, black particles of the capping material were
detected within the phagocytes (Fig. 1). This finding
may suggest that the material is gradually dissolved. A
recently published study on humans suggested that
Dycal should be substituted with MTA, because the
latter showed less inflammation and more predicable
results after pulp capping.20
OOOOE
Volume 106, Number 4
In the present study, a period of 8 weeks was used to
evaluate the effect of capping materials on pulp tissues.
Briso et al.,16 in a recently published study on dogs,
used the same time interval. Although similar time
intervals were used in many studies,7,21-23 several other
studies evaluated pulp tissue at different time intervals
up to 150 days.20,24-27
Various studies have reported excellent results for
MTA when used as a pulp capping material.5,25 The
results of the present study confirmed the favorable
outcome of this material compared with Dycal in terms
of lack of inflammation, thicker and more complete
dentinal bridge formation, and presence of odontoblast-
like cell layer in most samples. These results also
confirm the studies carried out by others on these ma-
terials as pulp-capping agents.6,24
Although MTA does not have Ca(OH)2 in its com-
position, calcium oxide is one of its components, which
can form Ca(OH)2 in reaction with water.5 On the other
hand, Ca(OH)2 has been described as a compound with
direct effect on microvasculature resulting in less
plasma outflow, which in turn favors a calcific response
in the adjacent pulp tissue.28 Holland et al.29 observed
granulations nearest to the opening of dentinal tubules
that were filled with MTA in an animal model. They
reported that these structures were similar to the calcite
crystals observed in Ca(OH)2. According to Seux et
al.30 calcite crystals attract fibronectin, which is respon-
sible for cellular adhesion and differentiation. There-
fore, they hypothesized that MTA and Ca(OH)2 have a
similar mechanism for hard-tissue formation. The fa-
vorable properties of MTA reported by several authors
have high alkalinity (that has been related to its bacte-
ricidal properties),31 excellent tight seal,8,14,32 and bio-
compatibility.33,34 On the other hand, it has also been
reported to have disappointing properties, such as de-
layed setting time8 and poor handling characteristics.9
As has been reported, formation of hard tissue at the
interface of the pulp and the foreign material is a
controversial issue, because dentinal bridge presence
does not necessarily prove a healthy status of the pulp
or establishment of an optimum seal, but it can be
interpreted as a sign of healing or a reaction to irrita-
tion.2 In the present study, formation of the dentinal
bridge was interpreted as a sign of healing and a pos-
itive reaction to stimulation.
According to the results of this study and parallel
research being performed,14,15 the authors introduced
NEC as a material that has similar biologic features to
MTA but lacks its disadvantages to an extent. In the
present study, NEC resulted in a better pulpal response
compared with MTA when used as pulp-capping agent
(Table II), although the difference was not statistically
significant. The NEC group had no inflammation in any
Asgary et al. 613
of the samples. Mean thickness of the dentinal bridge in
the NEC group was higher than MTA, and the presence
of a layer of odontoblast-like cells could be observed
more frequently in the NEC group. This new cement
contains several calcium compounds that result in a rich
pool of calcium and phosphorus ions. These elements
are used in the process of hydroxyapatite production,
which is a natural product of dental pulp cells.35 This
feature is hypothetically responsible for its biocompat-
ibility and its other optimum specifications.
Anyhow, NEC contains calcium oxide and hydrox-
ide which ultimately produce Ca(OH)2 through the
hydration process. As explained before, Ca(OH)2 if
leached out in sufficient quantities may stimulate cal-
cific bridge formation.28
It should be emphasized that the present experiment
was carried out in ideal controlled conditions with
artificially exposed healthy pulp tissue. The use of
direct pulp capping is an attempt to maintain the vitality
of an exposed dental pulp. The effects of various dental
materials on the prognosis of pulp exposure have been
evaluated in several studies.2-7,15,17,20 It is generally
accepted that accidental pulpal exposure offers more
favorable prognosis compared with carious pulp expo-
sure for continuing pulp vitality with direct capping
techniques. There is not general agreement whether the
toxicity of medicaments and materials placed on vital
pulp tissues determines outcome or the material’s abil-
ity to seal the cavity from further bacterial ingress is the
key to success. Possibly it is a combination of both
factors. Most of the previously published studies for
evaluation of pulp-capping agents were performed on
healthy intact teeth of animals.7,24-26 In the present
investigation, to compare the effect of the testing ma-
terials on pulp tissues, a small pulp exposure was made
and restored by glass ionomer after direct pulp-capping
procedure. Therefore, although this study is an in vivo
evaluation, careful consideration is essential to adapt
these favorable results with clinical situations.
In conclusion, the results of the present in vivo study
demonstrated that MTA and NEC showed similar fa-
vorable results, better than Dycal, when used as pulp-
capping materials. The pulp response indicated similar
biocompatibility for NEC, compared with MTA, by
inducing the formation of a complete dentinal bridge at
its interface with the pulp tissue. These results led to the
conclusion that NEC could be considered as an alter-
native to MTA in pulp cap treatment. In addition, the
authors believe that further assessment is required for
better understanding of biologic characteristics of NEC.
The authors wish to thank Dr. Davood Sharifi from Tehran
Veterinary School, Dr. Sanam Kheirieh, and Dr. Majid
Akbarzadeh from Iran Center for Dental Research, Tehran,
Iran, for their assistance and contribution to this project.

614 Asgary et al.
REFERENCES
1. Bakland LK. Endodontic considerations in dental trauma. In:
Ingle JI, Bakland LK, editors. Endodontics. 5th ed. Hamilton
(Ontario): Decker; 2002. p. 795-844.
2. Schroder U. Effects of calcium hydroxide– containing pulp-cap-
ping agents on pulp cell migration, proliferation, and differenti-
ation. J Dent Res 1985;64:541-8.
3. Cvek M, Granath L, Cleaton-Jones P, Austin J. Hard tissue
barrier formation in pulpotomized monkey teeth capped with
cyanoacrylate or calcium hydroxide for 10 and 60 minutes. J
Dent Res 1987;66:1166-74.
4. Schuurs AH, Gruythuysen RJ, Wesselink PR. Pulp capping with
adhesive resin– based composite vs. calcium hydroxide: a re-
view. Endod Dent Traumatol 2000;16:240-50.
5. Faraco IM Jr, Holland R. Response of the pulp of dogs to
capping with mineral trioxide aggregate or a calcium hydroxide
cement. Dent Traumatol 2001;17:163-6.
6. Aeinehchi M, Eslami B, Ghanbariha M, Saffar AS. Mineral
trioxide aggregate (MTA) and calcium hydroxide as pulp-cap-
ping agents in human teeth: a preliminary report. Int Endod J
2003;36:225-31.
7. Dominguez MS, Witherspoon DE, Gutmann JL, Opperman LA.
Histological and scanning electron microscopy assessment of
various vital pulp-therapy materials. J Endod 2003;29:324-33.
8. Torabinejad M, Watson TF, Pitt Ford TR. Sealing ability of a
mineral trioxide aggregate when used as a root end filling ma-
terial. J Endod 1993;19:591-5.
9. Chng HK, Islam I, Yap AU, Tong YW, Koh ET. Properties of a
new root-end filling material. J Endod 2005;31:665-8.
10. Funteas UR, Wallace JA, Fochtman EW. A comparative analysis
of mineral trioxide aggregate and Portland cement. Aust Endod
J 2003;29:43-4.
11. Asgary S, Parirokh M, Eghbal MJ, Brink F. A comparative study
of white mineral trioxide aggregate and white Portland cements
using X-ray microanalysis. Aust Endod J 2004;30:89-92.
12. Asgary S, Parirokh M, Eghbal MJ, Brink F. Chemical differences
between white and gray mineral trioxide aggregate. J Endod
2005;31:101-3.
13. Asgary S, Parirokh M, Eghbal MJ, Stowe S, Brink F. A quali-
tative X-ray analysis of white and grey mineral trioxide aggre-
gate using compositional imaging. J Mater Sci Mater Med
2006;17:187-91.
14. Asgary S, Eghbal MJ, Parirokh M. Sealing ability of a novel
endodontic cement as a root-end filling material. J Biomed Mater
Res A 2008. Jan 15. [Epub ahead of print].
15. Asgary S, Parirokh M, Eghbal MJ, Ghoddusi J. SEM evaluation
of pulp reaction to different pulp capping materials in dog’s
teeth. Iran Endod J 2006;4:117-22.
16. Briso ALF, Rahal V, Mestrener SR, Dezan Junior E. Biological
response of pulps submitted to different capping materials. Braz
Oral Res 2006;20:219-25.
17. Mestrener SR, Holland R, Dezan E Jr. Influence of age on the
behavior of dental pulp of dog teeth after capping with an
adhesive system or calcium hydroxide. Dent Traumatol
2003;19:255-61.
18. Borissov I, Tsanova S, Sivrev D. Tissue response of dental pulp
in dogs following direct capping with potassium nitrate in poly-
carboxylate cement. Bulg J Vet Med 2007;10:35-43.
19. Stanley HR. Pulp capping: conserving the dental pulp— can it be
done? Is it worth it? Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 1989;68:628-39.
20. Nair PNR, Duncan HF, Pitt Ford TR, Luder HU. Histological,
OOOOE
October 2008
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;41:128-50.
21. Ishizaki NT, Matsumoto K, Kimura Y, Wang X, Yamashita A.
Histopathological study of dental pulp tissue capped with enamel
matrix derivative. J Endod 2003;29:176-9.
22. Koliniotou-Koumpia E, Tziafas D. Pulpal responses following
direct pulp capping of healthy dog teeth with dentine adhesive
systems. J Dent 2005;33:639-47.
23. Accorinte MDLR, Holland R, Ries A, Bortoluzz MCI, Murata
SS, Dezan E Jr, et al. Evaluation of mineral trioxide aggregate
and calcium hydroxide cement as pulp-capping agents in human
teeth. J Endod 2008;34:1-6.
24. Pitt Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariya-
wasam SP. Using mineral trioxide aggregate as a pulp-capping
material. J Am Dent Assoc 1996;127:1491-4.
25. Tziafas D, Pantelidou O, Alvanou A, Belibasakis G, Papadimi-
triou S. The dentinogenic effect of mineral trioxide aggregate
(MTA) in short-term capping experiments. Int Endod J
2002;35:245-54.
26. Parirokh M, Asgary S, Eghbal MJ, Stowe S, Eslami B, Eskan-
darizade A, Shabahang S. A comparative study of white and grey
mineral trioxide aggregate as pulp capping agents in dogs’ teeth.
Dent Traumatol 2005;21:150-4.
27. Lu Y, Liu T, Li X, Li H, Pi G. Histologic evaluation of direct
pulp capping with a self-etching adhesive and calcium hydroxide
in beagles. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2006;102:e78-84.
28. Heithersay GS. Calcium hydroxide in the treatment of pulpless
teeth with associated pathology. J Br Endod Soc 1975;8:74-93.
29. Holland R, de Souza V, Nery MJ, Otoboni Filho JA, Bernabe PF,
Dezan Junior E. Reaction of rat connective tissue to implanted
dentin tubes filled with mineral trioxide aggregate or calcium
hydroxide. J Endod 1999;25:161-6.
30. Seux D, Couble ML, Hartmann DJ, Gauthier JP, Magloire H.
Odontoblast-like cytodifferentiation of human dental pulp cells
in vitro in the presence of a calcium hydroxide-containing ce-
ment. Arch Oral Biol 1991;36:117-28.
31. Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical
and chemical properties of a new root-end filling material. J
Endod 1995;21:349-53.
32. Aqrabawi J. Sealing ability of amalgam, super EBA cement, and
MTA when used as retrograde filling materials. Br Dent J
2000;188:266-8.
33. Mitchell PJ, Pitt Ford TR, Torabinejad M, McDonald F. Osteo-
blast biocompatibility of mineral trioxide aggregate. Biomateri-
als 1999;20:167-73.
34. Economides N, Pantelidou O, Kokkas A, Tziafas D. Short-term
periradicular tissue response to mineral trioxide aggregate
(MTA) as root-end filling material. Int Endod J 2003;36:44-8.
35. Smith AJ. Dentin formation and repair. In: Hargreaves KM,
Goodis HE, editors. Seltzer and Bender’s dental pulp. Chicago:
Quintessence; 2002. p. 41-62.
Reprint requests:
Prof. Saeed Asgary
Iranian Center for Endodontic Research
Shaheed Beheshti Dental School
Evin, Tehran 19834
Iran
saasgary@yahoo.com
 ID Title Pages

A comparative study of histologic response to different pulp capping materials and a novel endodontic
3168780 6
cement

http://fulltext.study/journal/2860

http://FullText.Study