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dc.contributor.advisorDuncan, Halen
dc.contributor.authorCareddu, Robertoen
dc.date.accessioned2024-02-26T09:44:12Z
dc.date.available2024-02-26T09:44:12Z
dc.date.issued2024en
dc.date.submitted2024en
dc.identifier.citationCareddu, Roberto, An investigation of the hydraulic calcium silicate cement, Biodentine, as a vital pulp treatment material, Trinity College Dublin, School of Dental Sciences, Dental Science, 2024en
dc.identifier.otherYen
dc.identifier.urihttp://hdl.handle.net/2262/106235
dc.descriptionAPPROVEDen
dc.description.abstractA recent upsurge in the popularity of Vital Pulp Treatment (VPT) has been attributed to a deeper understanding of the pulp reparative processes, biomaterial development and technological advancement. The introduction of hydraulic calcium silicate cements (HCSCs) nearly 30 years ago has been shown to improve tissue healing and associated patient outcomes. The renewed interest in VPT has, however, also highlighted gaps in knowledge in the area, including; difficulties in accurately diagnosing pulpal disease, practical and biological limitations of new materials and a lack of consensus of the most important way to manage deep caries and the exposed pulp. The current gold standard HCSC material, MTA, is limited by long setting time, inconsistent mixing an discolouration of tooth substance. As a result, next-generation HCSC materials such as Biodentine have been promoted. The overarching aim of this thesis was to investigate the biological and clinical characteristics of the HCSC Biodentine, while exploring some of the most pertinent issues affecting the further development of pulp preservation strategies. Within the thesis, Biodentine and the gold standard VPT material MTA were compared from the existing literature. An questionnaire-based analysis was then presented of two different national endodontic societies regarding the approach to deep caries management, their decision-making process and the material used in a series of clinical vignettes. The findings indicate a lack of consensus among dentists with regards to VPT. In order to understand the response of the pulp tissue to Biodentine and MTA a histological analysis was carried out, after experimental partial pulpotomies, at six months. This study reported a wide range of biological responses, from pulp necrosis, through dystrophic mineral deposits, amorphous tissue to the presence of new tubular dentine. The response was notably not material dependent. Moving towards a clinical outcome study, partial pulpotomy using Biodentine was evaluated after 1 year. The outcome of treatment was related to the preoperative signs and symptoms categorised by an existing and new classification system (Wolters classification). The use of Wolters classification demonstrated that the presence of symptoms and diagnostic classifications can assist in the prediction of treatment outcome compared with the classically employed reversible/ irreversible pulpitis nomenclature. Finally, an attempt to objectively ascertain the level of pulp inflammation and dental infection using a point-of-care assay for CRP was investigated. Although, likely influenced by other systemic inflammatory states the use of CRP appears to confirm an initial correlation between severity of dental inflammation and CRP level for pulpitis as well as apical abscess. In conclusion the overall results demonstrate the suitability of Biodentine as a VPT material and an evidenced-based alternative to MTA while possessing several practical advantages; however, there remains a need for robust prospective studies with long-term follow up as well as improved educational dissemination amongst practitioners.en
dc.publisherTrinity College Dublin. School of Dental Sciences. Discipline of Dental Scienceen
dc.rightsYen
dc.titleAn investigation of the hydraulic calcium silicate cement, Biodentine, as a vital pulp treatment materialen
dc.typeThesisen
dc.type.supercollectionthesis_dissertationsen
dc.type.supercollectionrefereed_publicationsen
dc.type.qualificationlevelDoctoralen
dc.identifier.peoplefinderurlhttps://tcdlocalportal.tcd.ie/pls/EnterApex/f?p=800:71:0::::P71_USERNAME:CAREDDURen
dc.identifier.rssinternalid261918en
dc.rights.ecaccessrightsopenAccess


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