Download PDF
CC BY 4.0 · Journal of Health and Allied Sciences NU 2024; 14(01): 047-053
DOI: 10.1055/s-0043-1768594
Review Article

Potential Combination of Acemannan Sponge and Calcium Phosphate Cement-Calcium Sulfate Hemihydrate (CPC-CSH) as Direct Pulp Capping Alternative Materials for Reparative Dentin Formation

Anis Irmawati 
1   Department of Oral Biology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
,
Annisa Indah Pratiwi
2   Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
,
Muh Rizki Aqsanu Azizi
2   Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
,
Nurul Annisa Apriliyanti
2   Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
,
Ayu Annafi
2   Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
,
Yassir Ahmad Azzaim 
3   Magister Program, Dental Health Sciences, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
,
Ala'a Saif Alqhtani 
4   Depertment of Dental Medicine, Faculty of Medicine, Ibb University, Ibb, Yemen
› Author Affiliations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
› Further Information
   Permissions and Reprints

Abstract

Background Health problem that affects hard tissues of the teeth is dental caries, which is experienced by around 2.3 billion people in the world, with prevalence in Indonesia reaching 88.8. Direct pulp capping (DPC) is a vital pulp therapy used to maintain pulp vitality. Calcium hydroxide (Ca(OH)2) is the gold standard pulp capping material, but has poor adhesion to dentin and mechanical properties, bacterial infiltration, formation of tunnel defects in the pulp resorption, and dentin bridge. Therefore, it is necessary to develop alternative therapy, namely, a combination of acemannan sponge and calcium phosphate cement (CPC)-calcium sulfate hemihydrate (CSH) for reparative dentin formation.

Purpose This article describes the potential combination of acemannan sponge and CPC-CSH as DPC alternative materials for reparative dentin formation.

Reviews Acemannan extracted from aloe vera exhibits anti-inflammatory, antimicrobial, and cytocompatibility properties. As DPC material, acemannan induces pulp proliferation and differentiation to osteoblast-like, growth factor synthesis, and promotes reparative dentin formation. However, acemannan sponge is radiolucent, allowing misinterpretation between pulp and acemannan sponge. CPC can be combined with CSH to shorten the setting time. CPC-CSH is radiopaque, has good compressive strength, and biocompatibility. CPC-CSH is a calcium-based material with neutral pH that can induce the dentin bridge formation. CPC-CSH showed good bioactivity because it induces the formation of apatite which plays a significant part in dentin and pulp regeneration.

Conclusion The combination of acemannan sponge and CPC-CSH has the potential as DPC alternative materials for reparative dentin formation.

Keywords

acemannan sponge - calcium phosphate cement-calcium sulfate hemihydrate - direct pulp capping - dental caries - reparative dentine - human and health

Authors' Contributions

A.I.: research concept and design, data analysis and interpretation, writing the article, critical revision of the article, final approval of article. A.I.P.: research concept and design, collection and/or assembly of data, data analysis and interpretation, writing the article, critical revision of the article, final approval of article. M.R.A.A.: collection and/or assembly of data, writing the article, critical revision of the article, final approval of article. N.A.A.: research concept and design, collection and/or assembly of data, data analysis and interpretation, writing the article. A.A.: research concept and design, collection and/or assembly of data, data analysis and interpretation, writing the article. Y.A.A.: writing the article, critical revision of the article, final approval of article. A.S.A.: critical revision of the article, final approval of article.




Publication History

Article published online:
16 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 World Health Organization. World Health Assembly Resolution paves the way for better oral health care. World Health Organization. 2020. Accessed April 7, 2023, at: http://www.who.int/mediacentre/factsheets/fs396/en/
    Google Scholar
  • 2 Kementerian Kesehatan Republik Indonesia. Laporan Nasional Riskesdas 2018. Lembaga Penerbit: Badan Penelitian dan Pengembangan Kesehatan 2019. 2019. p, 204
    Google Scholar
  • 3 Teshome A, Muche A, Girma B. Prevalence of dental caries and associated factors in East Africa, 2000-2020: systematic review and meta-analysis. Front Public Health 2021; 9: 645091
    CrossrefPubMedGoogle Scholar
  • 4 Vu TT, Nguyen MT, Sangvanich P, Nguyen QN, Thunyakitpisal P. Acemannan used as an implantable biomaterial for vital pulp therapy of immature permanent teeth induced continued root formation. Pharmaceutics 2020; 12 (07) 1-16 , 644
    CrossrefPubMedGoogle Scholar
  • 5 Goldberg M. Indirect and direct pulp capping: reactionary vs reparative dentins. JSM Dentist 2020; 8 (01) 1119
    Google Scholar
  • 6 Chang HH, Chang YJ, Yeh CL, Lin TA, Lin CP. Development of calcium phosphate/calcium sulfate biphasic biomedical material with hyaluronic acid containing collagenase and simvastatin for vital pulp therapy. Dent Mater 2020; 36 (06) 755-764
    CrossrefPubMedGoogle Scholar
  • 7 Aguilar P, Linsuwanont P. Vital pulp therapy in vital permanent teeth with cariously exposed pulp: a systematic review. J Endod 2011; 37 (05) 581-587
    CrossrefPubMedGoogle Scholar
  • 8 Songsiripradubboon S, Banlunara W, Sangvanich P, Trairatvorakul C, Thunyakitpisal P. Clinical, radiographic, and histologic analysis of the effects of acemannan used in direct pulp capping of human primary teeth: short-term outcomes. Odontology 2016; 104 (03) 329-337
    CrossrefPubMedGoogle Scholar
  • 9 Chang KC, Chang CC, Chen WT, Hsu CK, Lin FH, Lin CP. Development of calcium phosphate/sulfate biphasic cement for vital pulp therapy. Dent Mater 2014; 30 (12) e362-e370
    CrossrefPubMedGoogle Scholar
  • 10 Shieh TM, Hsu SM, Chang KC, Chen WC, Lin DJ. Calcium phosphate cement with antimicrobial properties and radiopacity as an endodontic material. Materials (Basel) 2017; 10 (11) 1256
    CrossrefPubMedGoogle Scholar
  • 11 Sicca C, Bobbio E, Quartuccio N, Nicolò G, Cistaro A. Prevention of dental caries: a review of effective treatments. J Clin Exp Dent 2016; 8 (05) e604-e610
    PubMedGoogle Scholar
  • 12 Tahir L, Nazir R. Dental caries, etiology, and remedy through natural resources [Internet]. Dental Caries - Diagnosis, Prevention and Management. InTech; 2018. Available at: http://dx.doi.org/10.5772/intechopen.75937
    CrossrefGoogle Scholar
  • 13 Conrads G. About I. Pathophysiology of dental caries. Monogr Oral Sci 2018(27): 1-10
    Google Scholar
  • 14 Sachidananda MP, Mallya S. Microbiology and clinical implications of dental caries–a review. J Evol Med Dent Sci 2020; 9 (48) 3670-3676
    CrossrefGoogle Scholar
  • 15 Brizuela C, Ormeño A, Cabrera C. et al. Direct pulp capping with calcium hydroxide, mineral trioxide aggregate, and biodentine in permanent young teeth with caries: a randomized clinical trial. J Endod 2017; 43 (11) 1776-1780
    CrossrefPubMedGoogle Scholar
  • 16 Schwendicke F, Brouwer F, Schwendicke A, Paris S. Different materials for direct pulp capping: systematic review and meta-analysis and trial sequential analysis. Clin Oral Investig 2016; 20 (06) 1121-1132
    CrossrefPubMedGoogle Scholar
  • 17 Mali RS, Mangala TM. Histological analysis of reparative dentin formation using bio dentine and MTA as pulp capping agent: an in vivo study. J Crit Rev 2020; 7 (07) 653-657
    Google Scholar
  • 18 Ahmed ME, Ali A, El-Bayoumy SY, Al-Azhar AAE. Clinical and radiographic evaluation of acemannan as direct pulp capping material in young permanent teeth. J Dent Sci 2020; 23 (04) 415-421
    Google Scholar
  • 19 Qureshi A. E Soujanya, Nandakumar, Pratapkumar, Sambashivarao. Recent advances in pulp capping materials: an overview. J Clin Diagn Res 2014; Jan; 8 (01) 316-321
    PubMedGoogle Scholar
  • 20 Dubey A. Calcium hydroxide in dentistry: a review. Chetinad Health City Medical Journal. 2016; 5: 30-33
    Google Scholar
  • 21 Chandrasekhar H, Sharma S. Efficient agents for pulp protection: a review. J Pharmaceut Sci Res 2016; 8 (11) 1308-1311
    Google Scholar
  • 22 Ariesdyanata C, Lunardhi CGJ, Subiwahjudi A. Perbedaan Angiogenesis Pada Pulpa Setelah Aplikasi Ekstrak Propolis Dan Kalsium Hidroksida. Conserv Dentist J 2019; 9 (01) 48
    CrossrefGoogle Scholar
  • 23 Jung JK, Gwon GJ, Neupane S. et al. Bortezomib facilitates reparative dentin formation after pulp access cavity preparation in mouse molar. J Endod 2017; 43 (12) 2041-2047
    CrossrefPubMedGoogle Scholar
  • 24 Kurniasari A. Efektivitas Pasta Biji Kopi Robusta (coffea robusta) Sebagai Bahan Direct Pulp Capping Terhadap Jumlah Sel Makrofag Dan Sel Limfosit Pulpa Gigi. Fakultas Kedokteran Gigi, Universitas Jember; 2017
    Google Scholar
  • 25 Liu C, Cui Y, Pi F, Cheng Y, Guo Y, Qian H. Extraction, purification, structural characteristics, biological activities and pharmacological applications of acemannan, a polysaccharide from aloe vera: a review. Molecules 2019; 24 (08) 1554
    CrossrefPubMedGoogle Scholar
  • 26 Le Van C, Thi Thu HP, Sangvanich P, Chuenchompoonut V, Thunyakitpisal P. Acemannan induces rapid early osseous defect healing after apical surgery: a 12-month follow-up of a randomized controlled trial. J Dent Sci 2020; 15 (03) 302-309
    CrossrefPubMedGoogle Scholar
  • 27 Taschieri S, Corbella S, Tsesis I, Bortolin M, Del Fabbro M. Effect of guided tissue regeneration on the outcome of surgical endodontic treatment of through-and-through lesions: a retrospective study at 4-year follow-up. Oral Maxillofac Surg 2011; 15 (03) 153-159
    CrossrefPubMedGoogle Scholar
  • 28 Elhag A, El-Bayoumy S, Eisa AE. Clinical and radiographic evaluation of acemannan as direct pulp capping material in young permanent teeth. Al-Azhar J Dental Sci 2020; 23 (04) 415-421
    CrossrefGoogle Scholar
  • 29 Boonyagul S, Banlunara W, Sangvanich P, Thunyakitpisal P. Effect of acemannan, an extracted polysaccharide from aloe vera, on BMSCs proliferation, differentiation, extracellular matrix synthesis, mineralization, and bone formation in a tooth extraction model. Odontology 2014; 102 (02) 310-317
    CrossrefPubMedGoogle Scholar
  • 30 Songsiripradubboon S, Kladkaew S, Trairatvorakul C. et al. Stimulation of dentin regeneration by using acemannan in teeth with lipopolysaccharide-induced pulp inflammation. J Endod 2017; 43 (07) 1097-1103
    CrossrefPubMedGoogle Scholar
  • 31 Al-Sanabani JS, Madfa AA, Al-Sanabani FA. Application of calcium phosphate materials in dentistry. Int J Biomater 2013; 2013: 876132
    PubMedGoogle Scholar
  • 32 Gu Y, Zhuang R, Xie X, Bai Y. Osteogenic stimulation of human dental pulp stem cells with self-setting biphasic calcium phosphate cement. J Biomed Mater Res B Appl Biomater 2020; 108 (04) 1669-1678
    CrossrefPubMedGoogle Scholar
  • 33 Xu HH, Wang P, Wang L. et al. Calcium phosphate cements for bone engineering and their biological properties. Bone Res 2017; 5 (01) 17056
    CrossrefPubMedGoogle Scholar
  • 34 Ulusoy AT, Bayrak S, Bodrumlu EH. Clinical and radiological evaluation of calcium sulfate as direct pulp capping material in primary teeth. Eur J Paediatr Dent 2014; 15 (02) 127-131
    PubMedGoogle Scholar
  • 35 Sinjab YH, Sinjab KH, Navarrete-Bedoya C, Gutmann JL. Calcium sulfate applications in dentistry: a literature review. Endodontology 2020; 32 (04) 167
    CrossrefGoogle Scholar
  • 36 Li Z, Cao L, Fan M, Xu Q. Direct pulp capping with calcium hydroxide or mineral trioxide aggregate: a meta-analysis. J Endod 2015; 41 (09) 1412-1417
    CrossrefPubMedGoogle Scholar
  • 37 Song M, Yu B, Kim S. et al. Clinical and molecular perspectives of reparative dentin formation: lessons learned from pulp-capping materials and the emerging roles of calcium. Dent Clin North Am 2017; 61 (01) 93-110
    CrossrefPubMedGoogle Scholar
  • 38 Vallés M, Mercadé M, Duran-Sindreu F, Bourdelande JL, Roig M. Color stability of white mineral trioxide aggregate. Clin Oral Investig 2013; 17 (04) 1155-1159
    CrossrefPubMedGoogle Scholar
  • 39 Gonna S, Deraz E, Ghoname N, Kabbash A, Yagi A. Acemannan and formocresol pulpotomies in primary teeth: a comparative histopathological study. Gastroenterol Hepatol Res 2017; 6 (04) 2386-2391
    CrossrefGoogle Scholar