Cone Beam Computed Tomographic evaluation of dentin bridge formation using Mineral Trioxide Aggregate with Melatonin and Freeze Dried Amniotic Membrane for Direct Pulp Capping in permanent Molars A Randomized Controlled Trial

The vitality of the pulp is essential for the protection of the tooth structure and the maintenance of proper physiological function. Following pulp exposure and Direct Pulp Capping, early changes include hemorrhage and moderate inflammation, resolved during the first week [1] In turn, this might also provide a conducive environment for the formation of reparative dentin if the bacterial irritation and inflammatory reaction are successfully mitigated. The release of calcium ions from the DPC biomaterials stimulates the precipitation of calcium carbonate in the wound area and thereby contributes to the initiation of mineralization. After placing Mineral Trioxide Aggregate (MTA) material over the exposed pulp, MTA activates the progenitor cells (fibroblast) migration from the central pulp to the exposure area. This helps to promote their proliferation and differentiation into odontoblast-like cells without inducing apoptosis in the pulp cells [2]. MTA induces a time-dependent environment that is proinflammatory and promotes wound regeneration through upregulation of cytokines [3]. Cytokine upregulation is responsible for the induction of biomineralization by the production of collagen fibrils or apatite-like clusters at the dentin-MTA interface. MTA releases calcium ions which exert antibacterial effects and promote mineralization beneath the pulp exposure area and has the potential to maintain the vitality of the pulp [4]. Previosly melatonin given orally in animal studies have shown to have similar effects such as MTA. Human Amniotic Membrane has also shown healing of inflammed pulp when placed direcly on exposed pulp.[5,6,7]

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