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org (E-ISSN 2348-1269, P- ISSN 2349-5138)

COMPARATIVE EVALUATION OF OZONATED ACEMANNAN AND OZONATED CALCIUM

HYDROXIDE FOR DIRECT PULP CAPPING IN HUMAN PERMANENT MOLARS.

SHYAMBHAVI SRIVASTAVA, ANU VASHISHT, POOJA KABRA, EKTA CHOUDHARY.

AUTHOR’S NOTE:-

DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS

SCHOOL OF DENTAL SCIENCES, SHARDA UNIVERSITY
GREATER NOIDA, UTTAR PRADESH.
201308.
CONTACT:- Dr. SHYAMBHAVI SRIVASTAVA, DEPARTMENT OF CONSERVATIVE DENTISTRY AND
ENDODONTICS.
Email:- srivastavashyambhavi@yahoo.com

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Abstract

AIM:- To compare and evaluate the properties and effects of Ozonated Acemannan and Calcium Hy-
droxide used for pulp capping in human permanent molars- An In-Vivo Study.
MATERIALS AND METHODOLOGY:-the pulp capping agents were manipulated either with saline
or freshly prepared ozonated water.
ACEMANNAN EXTRACT PREPARATION:-prepared from Aloe Vera pulp gel at the School Of
Pharmacy, Sharda University.
CHAIR SIDE PREPARATION OF OZONATED WATER:- by using a tabletop “ozone generating de-
vice” by bubbling ozone gas into the distilled water.
IN- VITRO PH COMPARISON:- the samples were divided into four groups namely and The pH
value was measured by a digital pH meter.
IN-VIVO DIRECT PULP CAPPING PROCEDURE:- Comprised 40 healthy participants. Direct pulp
capping procedures were performed in all cases. Follow up of 2, 4, 8 and 12 weeks was done.The par-
ticipants were evaluated by electronic pulp testing as well as radiographic evaluation. CONCLUSION:-
this study is one of the first studies to evaluate the effect of acemannan on dental pulp in vivo and
this study also pioneers the first time usage of ozonated water to manipulate the pulp capping
agents, thus catalysing the antimicrobial efficacy of these agents.

KEYWORDS:- vital pulp therapy, acemannan, ozone, calcium hydroxide.

COMPARATIVE EVALUATION OF OZONATED ACEMANNAN AND OZONATED CALCIUM

HYDROXIDE FOR DIRECT PULP CAPPING IN HUMAN PERMANENT MOLARS.

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INTRODUCTION

VITAL PULP THERAPY defined as a “treatment which aims to preserve and maintain pulp tissue
that has been compromised but not destroyed by caries, trauma, or restorative procedures in a
healthy state” And DIRECT PULP CAPPING defined as the “treatment of a mechanical or traumatic
vital pulp exposure by sealing the pulpal wound with a biomaterial placed directly on exposed pulp
to facilitate formation of reparative dentin and maintenance of the vital pulp”. Are the topics which
have been implored in this research article. According to American Academy on Pediatric Dentistry
Clinical Affairs Committee(2008) Direct pulp capping (DPC) involving the application of a medica-
ment, dressing, or dental material to the exposed pulp in an attempt to preserve its vitality and to
promote reparative dentine formation, i.e., a dentine bridge, and to seal the pulp exposure represents a
preferable choice of treatment. Ideally, a material for vital pulp procedures should biologically stimu-
late odontoblast/dental pulp cells and induce the formation of new hard tissue over the exposed pulp.
Among the materials utilised for pulp capping capping in permanent teeth, calcium hydroxide
Ca(OH)2 has long been the material of choice. New materials have been studied as an alternatives to
Ca(OH)2There has been significant interest in lower cost alternative materials for biologically based
pulpal therapies. Aloe vera is a medicinal plant commonly grown in tropical climate. Acemannan, αβ-
(1,4) acetylated polymannose extracted from A.vera gel, shows cytocompatibility with various cell
types. These studies also showed that acemannan stimulates the proliferation, differentiation and min-
eralization of human dental pulp cells in permanent teeth. Moreover, when used as a DPC agent,
acemannan enhanced reparative dentine formation in an animal model. However, the clinical effects of
acemannan as a DPC material on young permanent teeth in vivo have not been reported.

AIM AND OBJECTIVES

AIM:-TO COMPARE AND EVALUATE THE EFFECTS OF OZONATED ACEMANNAN AND

OZONATED CALCIUM HYDROXIDE USED FOR PULP CAPPING IN HUMAN PERMANENT
MOLARS- AN IN VIVO STUDY.

OBJECTIVE:-To compare the 1 month, 3 months, 6 months clinical and radiographic, responses of the
pulp to ozonated and non ozonated acemannan and Ca(OH)2
When used as a pulp-capping agent in active deeply carious young permanent molar teeth.

METHODOLOGY

ACEMANNAN EXTRACT PREPARATION:-Acemannan extract was prepared with the help from
SCHOOL OF PHARMACY,SDS,GREATER NOIDA by the process of lipid solubilisation and freeze dry-
ing the substrate.

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OZONONATED WATER PREPARATION:-Ozonated saline was prepared by using a tabletop “ozone

generating device” by bubbling ozone gas into the distilled water at the rate of 4mg/litre/hour.The
study was conducted by dividing the study population into 4 groups, namely:-
GROUP 1 :- CALCIUM HYDROXIDE MIXED WITH DISTILLED WATER.
GROUP 2 :- CALCIUM HYDROXIDE MIXED WITH OZONATED DISTILLED WATER.
GROUP 3:- ACEMANNAN EXTRACT MIXED WITH DISTILLED WATER.
GROUP 4 :- ACEMANNAN EXTRACT MIXED WITH OZONATED DISTILLED WATER.
The study subjects comprised of 40 healthy participants. Diagnosed radiographically as well as
clinically with CLASS – I deep dentinal caries approaching pulp in maxillary/mandibular (1st and 2nd)
molars irrespective of gender aged between 19-30 years.All the subjects were healthy individuals free
from systemic diseases. Each group comprised of 10 participants. Written informed consent was taken
from each patient and ethical clearance from the institutional ethics committee (SDS, SHARDA
UNIVERSITY, GREATER NOIDA) was received . The selected cases were evaluated radiographically
for pre-operative records.
Pre-operative electric pulp testing was performed to confirm vitality.This was followed by rubber dam
placement and complete removal of carious lesion by high speed airotor and an ISO standardised
round bur, under local anaesthesia. The cases having pulpal exposure greater than 1mm during caries
removal were discarded and went for immediate access opening and root canal treatment. Once the
pulpal exposure of 0.5 to 1mm was achieved; the exposure and surrounding areas were rinsed with

Figure:-1

sterile normal saline solution to remove debris.

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A damp cotton pellet was used for 2-3 mins to control the bleeding and a radiograph was taken to
efficiently note the exposure site and depth. The subjects were randomly divided into the 4 groups

(Figure:-1).
Figure:-2

The clinical evaluation criteria :-Absence of pain, Presence of adequate response to EPT, Absence
tenderness to percussion, Absence of swelling or abscess, or abnormal tooth mobility. The criteria for
radiographic success(figure :-2):-Mild pathology or no pathology (thickening of the PDL space or a
discontinuous lamina dura) and Absence of Severe pathology (furcation or periapical radiolucency,
pathologic external root resorption, or internal resorption).Treatment was considered as a failure
when:-At least one adverse clinical finding present (such as pain, mobility, swelling , abscess) or
Presence of severe radiographic pathology with or without adverse clinical findings.A case was

considered as a success only when both the clinical and radiographic success was fulfilled(Table:-1).

TABLE:-1

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At the end it was concluded that :-Group one i.e calcium hydroxide mixed with distilled water had an
overall success rate of 53.3%, Group two i.e. calcium hydroxide mixed with ozonated water had a
success rate of 50%, Group three i.e. acemannan extract mixed with distilled water had a success rate
of 63% and Group four i.e. acemannan extract mixed with ozonated water had 71% success
rate(Graphs1-3).

Graphs :-1,2,3.

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DISCUSSION
Direct pulp capping is a therapeutic method aimed at treating reversible pulpal injury whenever dentin
and pulp is affected by caries, restorative procedures, or trauma. Materials able to stimulate pulp tissue
repair and tertiary dentin formation have been investigated extensively in pulp - capping situations.
Calcium hydroxide, Ca(OH)2 has been used for more than 50 years, showing a biological action
mechanism that activates tissue enzymes, promotes mineralization and leads to the formation of
dentinal bridge in approximately 90% of cases. It was used as a gold standard for comparison in this
study. However, It is known to promote superficial necrosis, resulting in a transitory pulp
inflammatory response hence the need to look for lesser aggressive and equally competent
alternatives.
Histological studies by Sangvanich P, et al have shown that ACEMANNAN, a derivative of aloe vera,
stimulates the proliferation, differentiation , mineralization & reparative dentin formation of human
dental pulp cells. It also Promotes macrophage phagocytosis and causes resolution of the inflammation.
It is known to release mannose-6- phosphate shown to act as an anti-inflammatory agent. It also
releases bioactive substances such as glycoprotein, polysaccharides , which stimulate wound healing,
cell proliferation, and angiogenesis. These processes render acemannan as a favourable pulp capping
agent.
Ozonated Water damages the bacterial cell membranes by ozonolysis and oxidates intra cellular
proteins leading to loss of organelle function. It also stimulates release of interleukins, leukotrienes
and prostaglandins, thus reducing inflammation and promoting wound healing. The most important
factors in pulp capping are complete asepsis of the exposed pulp process and sealing of the cavity
with filling material. To achieve sterility all the procedures were performed under rubber dam and all
the chosen cases were that of class I cavity design so as to prevent proximal leakage. Irrigation with
saline solution was done to eliminate any remaining carious debris.Complete sealing off of the cavity
was achieved by restoring all the cavities with RM-GIC after the capping procedure.
CONCLUSION
With the world moving swiftly towards all things herbal having a herbal alternative to chemical pulp
capping agents is indeed a futuristic approach. This study was the first of its kind to evaluate the in
vivo effectiveness of ozonated water and Acemannan in the procedure of direct pulp capping. The
results of this study indicated that using ACEMANNAN along with OZONATED WATER as the
pulp capping agent proved to be the most successful treatment modality.

CONFLICTS OF INTEREST :- None.

REFERENCES

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© 2018 IJRAR December 2018, Volume 5, Issue 04 www.ijrar.org (E-ISSN 2348-1269, P- ISSN 2349-5138)

1. Ralph EM, David RA, Jeffrey AD. Treatment of deep caries, vital pulp exposure, and pulpless teeth. In:
Ralph EM, David RA, Jeffrey AD, editors. Dentistry for the child and adolescent. St. Louis: Mosby Else-
vier Inc; 2011. p. 343.

2. Trairatvorakul C, Sastararuji T. Indirect pulp treatment vs antibiotic sterilization of deep caries in mandib-
ular primary molars. Int J Paediatr Dent. 2014;24:23–31.

3. American Academy on Pediatric Dentistry Clinical Affairs Committee-Pulp. Therapy s, American Acad-
emy on Pediatric Dentistry Council on Clinical A. Guideline on pulp therapy for primary and young per-
manent teeth. Pediatr Dent. 2008;30:170–4.

4. Ferracane JL, Cooper PR, Smith AJ. Can interaction of materials with the dentin-pulp complex contribute
to dentin regeneration.Odontology. 2010;98:2–14.

5. Jettanacheawchankit S, Sasithanasate S, Sangvanich P, Banlunara W, Thunyakitpisal P. Acemannan stim-

ulates gingival fibroblast proliferation; expressions of keratinocyte growth factor-1, vas- cular endothelial
growth factor, and type I collagen; and wound healing. J Pharmacol Sci. 2009;109:525–31.

6. Jittapiromsak N, Sahawat D, Banlunara W, Sangvanich P, Thunyakitpisal P. Acemannan, an extracted

product from Aloe vera, stimulates dental pulp cell proliferation, differentiation, mineralization, and den-
tin formation. Tissue Eng Part A. 2010;16:1997–2006.

7. Sahawat D, Kanthasuwan S, Sangvanich P, Takata T, Kitagawa M, Thunyakitpisal P. Acemannan induces

cementoblast prolif- eration, differentiation, extracellular matrix secretion, and min- eral deposition. J
Med Plant Res. 2012;6:4069–76.

8. Boonyagul S, Banlunara W, Sangvanich P, Thunyakitpisal P. Effect of acemannan, an extracted polysac-

charide from Aloe vera, on BMSCs proliferation, differentiation, extracellular matrix synthesis, minerali-
zation, and bone formation in a tooth extraction model. Odontology/the Society of the Nippon Dental Uni-
versity. 2013.

9. Chantarawaratit P, Sangvanich P, Banlunara W, Soontornvipart K, Thunyakitpisal P. Acemannan sponges

stimulate alveolar bone, cementum and periodontal ligament regeneration in a canine class II furcation
defect model. J Periodontal Res. 2014;49:164–78.

10. Kitasako Y, Ikeda M, Tagami J. Pulpal responses to bacterial contamination following dentin bridging
beneath hard-setting calcium hydroxide and self-etching adhesive resin system. Dent Traumatol.
2008;24:201–6.

IJRAR1944364International Journal of Research and Analytical Reviews (IJRAR) www.ijrar.org 1173