Rezumat Dr_ Colceriu

UNIVERSITATEA DE MEDICIN I FARMACIE IULIU HAIEGANU CLUJ-NAPOCA

FACULTATEA DE MEDICIN DENTAR

ORIENTRI MODERNE N TRATAMENTUL CONSERVATIV AL PULPEI DENTARE N DESCHIDERILE

ACCIDENTALE ALE CAMEREI PULPARE

TEZ PENTRU OBINEREA TITLULUI TIINIFIC DE DOCTOR N DOMENIUL FUNDAMENTAL, TIINE

MEDICALE DOMENIUL MEDICIN DENTAR

REZUMAT

Doctorand, Conductor tiinific, Loredana Colceriu-Burtea Prof. Dr. Angela Pop

-2006-

Cuvinte cheie : neodentinogenez, inoculare, vase de neoformaie,

polimorfonucleare, infiltrat inflamator, coafaj direct, monocite, fagocitare, Mineral

Trioxid Agreggate

Orientarea actual a terapiei conservative se ndreapt spre concepia biologic de

pstrare a vitalitii pulpei dentare o perioad ct mai mare de timp, fiind bine cunoscut

faptul c pulpa indemn este capabil s iniieze mecanisme de aprare mpotriva invaziei

bacteriene, obiectiv care se poate obine n cazul unei deschideri accidentale de camer

pulpar prin coafaj direct. Pentru reuita unui coafaj direct trebuie s inem seama de 2

categorii de factori: generali si locali. ntre factorii generali amintim: vrsta pacientului,

starea sa de sntate i condiiile sociale. Factorii locali se refer la condiiile de lucru,

starea pulpei dentare, caracterul leziunii traumatice.

Dintre materialele cu ajutorul crora se realizeaz coafajul direct cele mai

frecvent utilizate sunt cele pe baz de hidroxid de calciu. Principalul argument care

susine aplicarea hidroxidului de calciu n coafajul direct este legat de proprietile sale:

antimicrobiene, antiinflamatorii, hemostatice i tisulare. Pornind de la proprietile

neodentinogenetice ale materialelor pe baz de hidroxid de calciu, n aceast cercetare am

testat un produs romnesc, Calcidenta elaborat n cadrul Institutului de Chimie Raluca

Ripan, ceea ce dovedete c i n ara noastr continu preocuparea pentru introducerea

materialelor dentare care prin calitile prezentate i preul de cost sczut sunt

avantajoase. Scopul experimentului realizat a fost de a aprecia gradul de

biocompatibilitate al materialului stomatologic Calcidenta la contactul prelungit al

acestuia cu esutul conjunctiv i esutul muscular. Reaciile locale dup implantarea

materialului privind evaluarea preclinic, s-au realizat n cadrul Laboratorului Biobazei

UMF (Dr. Septimiu Toader).

Material i metod de lucru

Compoziia materialului selecionat n vederea testrilor biologice este: Ca (OH)2

42%, ZnO 25,8%, CMC 3,2%, Glicerina 29%. Produsul este prezentat n sistem

monopast i este autopolimerizabil. S-au utilizat ca biotest dou specii de animale de

experien, obolani i cobai, cu dou ci de administrare, calea subcutanat i

intermuscular.

Rezultate i discuii

La toate loturile, indiferent de specie i de calea de inoculare, reacia local a fost

favorabil, implantul fiind acceptat de esut, perceput fiind la palpare sub forma unui mic

nodul subcutanat sau intermuscular, nedureros i semimobil(figura 1).

Figura 1. Implantul fixat i ncapsulat intermuscular la cobai, zona coapsei, la 21 de zile postoperator

Introducerea fragmentelor de material la nivelul celor dou zone anatomice

menionate (subcutanat i muscular) la cele dou specii de animale a evideniat din

punct de vedere histopatologic urmtoarele: zona subcutanat: n jurul corpului

implantului se formeaz o structur capsular constituit din esut conjunctiv de

neoformaie ce acoper implantul pe toate feele; zona muscular: se constituie aceeai

structur capsular, o reacie limfo-histiocitar i rare polimorfonucleare. (figura 2).

Figura 2. Perete capsular constituit din esut conjunctiv de neoformaie, dezvoltat din interstiiul

muscular, cobai la 21 de zile postimplantare. Coloraie H.E. x 200

Concluzii

Nu s-a nregistrat la nici un caz pentru nici una din cile de administrare fenomene

de respingere prin formare de abcese, fistule sau constituire de sechestre. Reacia fa de

produs a fost strict local constnd n formarea unui granulom de corp strin inert n care

afluxul de monocite, macrofage demonstreaz o aciune de fagocitare treptat a

materialului cu inactivarea n timp.

Un alt material aprut recent i utilizat cu succes n coafajul direct este Mineral

Trioxid Agreggate, care a fost descoperit in 1996. ntre proprietile fizico-chimice ale

materialului amintim: pHul foarte ridicat (12,5) i etaneitatea sa superioar, iar dintre

proprietile biologice se remarc biocompatibilitatea fa de pulpa dentar.

n ultimii ani odat cu dezvoltarea impetuoas a tehnicilor adezive au aprut

studii1,2,3,4,5,6) care au artat c se poate obine o vindecare tisular pulpar atunci cnd s-a

folosit terapia cu rini adezive. Aceste studii susin ipoteza c pulpa se poate reface

chiar dup aplicarea sistemelor adezive n cavitile profunde sau chiar pe deschiderea

camerei pulpare att timp ct se realizeaz o hemostaz corect naintea aplicrii rinii7),

asigurndu-se o nchidere etan mpotriva infiltratului bacterian8). Acest concept devine

tot mai popular n ciuda faptului c numeroase cercetri n vitro9) i n vivo10) au artat

citotoxicitatea rinilor compozite aplicate pe medii de cultur sau n contact direct cu

esutul subcutanat la animale. Scopul acestei cercetri experimentale a fost de a

caracteriza i compara rspunsul pulpar n urma realizrii coafajului direct cu rini

adezive, Mineral Trioxid Aggregate i materialul Calcidenta.


Am luat n studiu un numr de 60 de dini mprii n trei loturi. Dinii examinai au

fost premolari integri, care urmau a fi extrai n scop ortodontic de la pacieni cu vrste

cuprinse ntre 10-18 ani. Efectivul experimental pentru fiecare material folosit a fost de

cte 20 caviti realizate pe 20 dini pentru Calcidenta, respectiv MTA i de 20 caviti

realizate pe 20 dini pentru sistemele adezive Optibond SoloPlus (KERR). n anestezie

local, pe fiecare dinte am preparat cte o cavitate de clasa a-V-a, repartizat pe faa

vestibular. Dup deschiderea camerei pulpare s-a realizat hemostaza i s-a aplicat

materialul de coafaj, MTA sau Calcidenta, restul cavitii fiind obturat cu IRM.

Utilizarea sistemului adeziv Optibond SoloPlus s-a efectuat dup demineralizarea cu

acid fosforic 35% pentru 15 secunde, splarea cu ap distilat i uscarea uoar cu bulete

de vat steril. Polimerizarea stratului de adeziv a fost de 20 secunde, ulterior cavitatea

fiind obturat cu material compozit Herculite (KERR).Dinii au fost mprii n 2 grupe,

fiind extrai la intervale variate de timp: scurte (9-12 zile ) i mai lungi (60-90 zile).Dup

fixarea, demineralizarea, secionarea i colorarea preparatelor histologice s-a caracterizat

rspunsul pulpar prin: apariia inflamaiei, existena dentinei de reacie, prezena punilor

dentinare cu caracteristicile acestora.

Rezultate

n ceea ce privete rspunsul inflamator n cazul lotului urmrit pe un interval

cuprins ntre 60- 90 zile analiza statistic nu a relevat nici o diferen semnificativ

statistic ntre cele 3 tipuri de materiale (p >0,05) (tabelul I, figura 3). Totui procentual

analiznd doar 60% dintre dinii tratai cu sisteme adezive nu au nregistrat rspuns

inflamator sau inflamaia observat a fost minim.

Tabelul I: Rspunsul inflamator nregistrat n funcie de tipul materialului studiat la interval de timp lung

Material Inflamaie prezent Inflamaie absent

Ca (OH)2 1 9

MTA 1 9

Sistem adeziv 6 9

Figura 3 : Rezultatele analizei comparative a rspunsului inflamator ntre loturilor studiate, n funcie de tipul de material utlizat, la interval de timp lung.

0

2

4

6

8

10

12

14

16

Ca(OH)2 MTA Sistem adeziv

Inflamaie prezent Inflamaie absent

p=0.1

Inducerea dentinei de reparaie pentru lotul de dini urmrii pe intervalul de

timp scurt arat o diferen semnificativ statistic ntre dinii tratai cu MTA i

Calcidenta, comparativ cu cei tratai cu sisteme adezive.(tabelul II, figura 4)

Tabelul II: Repartiia dentinei de reacie pe numr de dini n funcie de materialul examinat, la interval scurt.

Material Dentina absent Dentina prezent

Ca (OH)2 2 8

MTA 3 7

Sistem adeziv 5 0

Figura 4 : Analiza comparativ ntre repartiia dentinei de reacie n funcie de tipul de material utilizat, la dinii luai n studiu, la interval scurt.

Concluzii

1. Mecanismul de aciune antibactericid al hidroxidului de calciu prin pH-ul su

puternic alcalin, i stimularea procesului de neodentinogenez rmn principalele

argumente n favoarea aplicrii acestui material n terapia cariei profunde.

2. Datorit etaneitii superioare materialelor clasice, i alcalinitii, MTA-ul a permis refacerea esutului pulpar afectat n cazul deschiderii accidentale a camerei pulpare cu

formarea n timp a unor puni de predentin continue i de grosime mare.

0123456789

10

Ca(OH)2 MTA Sistem adeziv

Absent Prezent

p=0.01p=0.03

3. Punile dentinare formate in cazul sistemelor adezive nregistrau multiple defecte tunelare ceea ce ar favoriza ptrunderea microinfiltratului bacterian n camera pulpar

i compromiterea vitalitii pulpei prin apariia fenomenelor inflamatorii.

Studiile clinice din literatur efectuate pe dini cu coafaj direct au urmrit evoluia

acestui tratament pe intervale scurte de timp, iar rezultatele au fost controversate. Pornind

de la datele din literatur scopul acestui studiu clinic a fost de a evalua rata reuitei

coafajului direct n cazul deschiderii accidentale a camerei pulpare realizat cu dou

materiale diferite : Calcidenta, material pe baz de hidroxid de calciu produs la ICCRR

din Cluj-Napoca i MTA, subliniind care dintre factorii clinici influeneaz reuita

tratamentului.


n studiul de fa s-au tratat un numr de 150 dini de la 120 de pacieni. Vrsta

pacienilor a fost cuprins ntre 10 i 40 ani. La ntregul lot luat n studiu n cazul

prezenei leziunilor dentare diagnosticate drept carie profund cnd pe parcursul exerezei

dentinei alterate s-a produs deschiderea accidental a camerei pulpare am efectuat

tratamentul prin coafaj direct. S-a trecut la evaluarea diametrului orificiului de deschidere

i a gradului de sngerare, factori care pot influena reuita unui coafaj direct. Astfel

mrimea diametrului orificiului de comunicare cu pulpa (), a permis divizarea

dinilor n 4 grupe :

Rezultate

Relaia existent ntre vrsta pacienilor i rata de succes a coafajului direct realizat cu

ambele materiale este prezentat n tabelul III. Tabelul III: Rata de succes a coafajului direct repartizat pe grupe de vrst n lotul de pacieni

examinai

Vrsta Nr cazuri succes Nr cazuri eec Rata succesului (%)

10-20 ani 30 0 100

20-30 ani 30 3 90,90

30-40 ani 48 9 84,21

S-a observat n prezentul studiu influena vrstei asupra ratei de succes a tratamentului,

cel mai mare procent nregistrndu-se la pacienii sub 20 ani, fapt subliniat i de unii

autori n cercetrile lor11,12,13).

n ceea ce privete procentul reuitei tratamentului n funcie de materialul

utilizat, ambele materiale au nregistrat rezultate similare (tabelul IV). Tabelul IV: Repartiia procentual a succesului n funcie de materialul utilizat.

Materialul de coafaj Nr dini succes Nr dini eec Rata succesului (%)

Ca (OH)2 54 15 78,26 MTA 66 15 81,48

Influena diametrului orificiului de comunicare cu camera pulpar i a gradului de

sngerare de la nivelul pulpei expuse asupra reuitei coafajului direct au fost analizate n

continuare (tabelul V,VI).

Tabelul V: Influena diametrului comunicrii cu camera pulpar asupra reuitei terapiei de conservare a vitalitii pulpare.

Pentru a aprecia relaia dintre diametrul deschiderii camerei pulpare i rata reuitei

tratamentului de conservare a pulpei vii dinii au fost mprii n 4 grupe funcie de

mrimea orificiului de comunicare. Astfel la grupul unde diametrul de deschidere al

camerei pulpare a fost mai mare de 1 mm dar mai mic de 2 mm rata de succes nregistrat

Simptomatologie obiectiv Observaii Nr dini succes Nr dini eec Rata succesului (%)

0,5 36 3 92,30

0,5 < 1,0 54 6 90,00 1,0 < 2,0 30 6 83,33

Diametrul orificiului de deschidere al camerei

pulpare: (mm) > 2,0 0 15 0

este de 83,33% mai sczut dect a grupului unde diametrul deschiderii a fost mai mic de

0,5 mm, 92,30% i dect a grupului la care deschiderea a fost cuprins ntre 0,5-1 mm,

90%. Pentru grupul unde diametrul orificiului de comunicare a depit 2 mm, rata de

succes este 0, coafajul direct fiind considerat un eec.

n ceea ce privete gradul sngerrii de la nivelul deschiderii camerei pulpare succesul

grupului unde sngerarea este absent (95,23%) sau redus sub 30 secunde (87,5%) este

semnificativ mai crescut dect la grupul unde sngerarea este abundent i persistent

(46,15%) (tabelul VI).

Tabelul VI: Influena timpului de sngerare asupra reuitei meninerii vitalitii pulpare n coafajul direct.

Gradul sngerrii Nr dini succes Nr dini eec Rata succesului (%)

Sngerarea absent 60 3 95,23

Sngerarea uoar 42 6 87,5

Sngerarea persistent 18 21 46,15

Testul de corelaie Pearson (figura 5) ntre gradul de sngerare i rata de succes arat o

valoare a lui r=-0,95 ceea ce demonstreaz o relaie invers proporional ntre cele dou

variabile, probabilitatea ca lipsa sngerrii s determine un succes este de 0,99 (R2=0,99).

Figura 5: Relaia dintre gradul de sngerare pulpar i rata reuitei terapiei deschiderii accidentale a camerei pulpare prin coafaj direct.

r=0.95R2 = 0.9932

Sngerarea absent Sngerarea uoar Sngerarea persistent

Nr dini succes Nr dini eec Linear (Nr dini succes)

Discuii

Procentul reuitei acestei terapii depinde att de factori generali ct i de factori

locali, terenul cel mai favorabil pentru reuita unui coafaj direct constituindu-l dinii

permaneni tineri deoarece au o mare capacitate de reacie, cu multiple resurse de

aprare.

n ceea ce privete factorii locali rata de succes a acestei terapii depinde de diametrul

orificiului de deschidere al camerei pulpare care nu trebuie s depeasc 2 mm i de

posibilitatea de ndeprtare a dentinei alterate care ar trebui realizat n totalitate

naintea nceperii coafajului direct. Statusul inflamator al organului pulpar se reflect

prin nivelul indicelui de sngerare de la nivelul comunicrii cu pulpa. Astfel cu ct

gradul sngerrii este mai mare se reduce ansa unui prognostic favorabil al

tratamentului.

CONCLUZII GENERALE :

1. Leziunile carioase profunde sunt afeciuni dentare frecvent ntlnite n practica

stomatologic. Tratamentul acestor afeciuni ridic probleme multiple medicului

stomatolog legate de stabilirea unui diagnostic corect i de realizarea unei protecii a

pulpei dentare durabil n timp astfel nct s fie posibil refacerea integritii morfo-

funcionale esutului lezat.

2. ntr-o carie dentar naintea preparrii unei caviti este important s se neleag care

sunt modificrile tisulare aprute la nivelul dentinei, determinate de evoluia leziunii

carioase. Modificrile intratubulare i formarea dentinei teriare vor afecta rezultatul

tratamentului. Acolo unde tubulii dentinari sunt deschii, permeabili tratamentul

conservativ va necesita o atenie sporit comparativ cu cazurile la care dentina

restant este impermeabil.

3. n urma testrilor materialului pe baz de hidroxid de calciu (Calcidenta) realizat la

Institutul de Cercetri n Chimie din Cluj-Napoca constnd n teste de evaluare

biologic s-a evideniat c materialul nu este toxic, produsul fiind bine tolerat

neavnd efecte nocive.

4. Experiena clinic nu este la fel de ndelungat n cazul rinilor compozite utilizate

ca materiale de coafaj, prognosticul fiind rezervat. Studiul meu experimental realizat

pe dini indemni a artat c dup aplicarea sistemelor adezive pe camera pulpar

deschis reacia histopatologic a pulpei dentare la 9 dintre dinii studiai a semnalat

prezena punilor dentinare cu multiple defecte tunelare favoriznd astfel ptrunderea

microinfiltratului bacterian n camera pulpar.

5. Mineral Trioxid Aggregate ntrunete calitile unui material de coafaj direct. Prin

adaptarea marginal foarte bun i biocompatibilitatea sa acest material limiteaz

inflamaia pulpar i permite obinerea unor puni dentinare de cea mai bun calitate.

6. Localizarea locului de comunicare cu camera pulpar pe suprafaa dintelui

influeneaz reuita terapiei de conservare a vitalitii pulpare prin coafaj direct,

procentul dinilor nregistrai cu succes fiind semnificativ mai mare n cazul

deschiderilor accidentale ale camerei pulpare localizate la nivelul feei ocluzale.

7. Studiul meu att cel experimental ct i cel clinic a demonstrat c progresele

obinute, urmare a unor cercetri ndelungate n domeniul materialelor de conservare

a vitalitii pulpare, s-au materializat prin obinerea unor produse care prezint

caliti superioare acestea fcnd posibil obinerea unor reuite n cazul

tratamentelor prin coafaj direct aplicate n cazul deschiderilor accidentale ale camerei

pulpare.

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CURRICULUM VITAE

1. Date personale

Nume, prenume: Colceriu-Burtea Adela Loredana

Domiciliul: Cluj-Napoca, Aleea Azuga nr. 2, sc. II, ap. 25

Data i locul naterii: 12. 05.1970, Tg-Jiu, jud.Gorj

Funcie i loc de munc : asistent universitar la UMF"Iuliu Haieganu"

Cluj-Napoca, Facultatea de Medicin Dentar, Catedra de Odontologie-

Parodontologie

2. Studii Gimnaziale : 1977-1985 coala general nr.3, Tg-Jiu

Liceale :1985-1989 Liceul de matematic-fizic "T.Vladimirescu", Tg-Jiu,

pe care l-am absolvit n iulie 1989 cu media general de bacalaureat 7,58.

Universitare : 1990-1992, Facultatea de Medicin General, UMF "Iuliu

Haieganu" Cluj-Napoca; 1992-1995, Facultatea de Stomatologie,

UMF"Iuliu Haieganu" Cluj-Napoca. Media general de promovare anilor de

studiu universitari a fost 9,04. n sesiunea din septembrie 1995 am susinut

examenul de licen i lucrarea de diplom cu titlul "Tulburri de erupie ale

incisivilor centrali superiori", coordonator prof. dr. Elvira Cocrl, obinnd

media general de licen 9,47.

3. Activitate profesional

Dup absolvirea facultii am fost angajat prin concurs din ianuarie 1996

timp de un an ca medic stagiar la Spitalul Judeean Tg-Jiu, Policlinica de

Stomatologie nr.1.

n anul 1996 am participat la concursul de rezideniat unde am ocupat locul

18 pe ar. Am ales specialitatea stomatologie general din februarie 1997

devenind medic rezident n cadrul Facultii de Stomatologie din Cluj

n sesiunea din martie 1997 am concurat pentru postul de preparator la

catedra de Odontologie- Parodontologie, concurs pe care l-am promovat cu

media 9,13.

n octombrie 1998 am susinut examenul de specialitate, devenind medic

specialist.

n martie 1999 am ocupat prin concurs postul de asistent universitar la

catedra de Odontologie-Parodontologie, Facultatea de Stomatologie cu

media general 9,88.

n iunie 2003 am susinut examenul de primariat n urma cruia am devenit

medic primar.

4. Activitate tiinific n noiembrie 2001 m-am nscris la doctorat la catedra de Odontologie-

Parodontologie, sub ndrumarea prof. dr. Angela Pop avnd ca tem de

cercetare conservarea vitalitii pulpare.

n intervalul septembrie 2002- martie 2003 am fost plecat cu burs de studii

la Facultatea de Odontologie din Marsilia, Frana

- lucrri publicate: 2 lucrri publicate in extenso n reviste din ar

-participri la congrese i alte manifestri tiinifice

-cri: 1 carte publicat coautor

5. Limbi strine: franceza bine scris, vorbit engleza bine scris, vorbit

LISTA LUCRRILOR TIINIFICE ELABORATE

Lucrri publicate in extenso:

1. "Studiul proprietilor fizico-chimice ale unui material nou indicat n

coafajul direct"

Autori: Loredana Colceriu, Sanda Cmpean, Angela Pop -Transilvania

Stomatologic, nr.1, 2005, 35-40

2. "Studiul clinic privind influena factorilor ce afecteaz reuita conservrii

vitalitii pulpare, n deschiderile accidentale ale camerei pulpare"



Participri la congrese i alte manifestri tiinifice:

1. Tulburri de erupie ale incisivilor centrali superiori

Autori: Loredana Colceriu, Elvira Cocrl; poster Zilele UMF, Cluj-

Napoca, dec. 1997

2. Materiale fotopolimerizabile-rolul agenilor de cuplare

Autori: Loredana Colceriu; mas rotund Zilele UMF, Cluj-Napoca, dec.

1998

3. Posibiliti de reconstrucie corono-radicular

Autori : Sanda Cmpean, Loredana Colceriu, Angela Pop; poster Zilele

UMF dec. 1999

4. Metode moderne de tratament conservativ n parodontita apical

cronic

Autori : Loredana Colceriu, Dolores Bdulescu, Ada Delean, Angela Pop;

poster Zilele UMF dec. 2001

5. Modaliti de contenie n parodontopatiile marginale cronice

Autori: Loredana Colceriu; mas rotund, Zilele UMF dec 2003

6. Materiale noi folosite n terapia conservatoare a pulpei dentare

Autori: Loredana Colceriu, Ada Delean, Dan Pop-Catedra de Odontologie-

Parodontologie, UMFI.Haieganu i Moldovan Marioara-ICCRR, Cluj-

Napoca, Zilele Stomatologiei Bnene, mai 2004

7. Biocompatibility of a new calcium hydroxide lining cement used as a

pulp capping material

Autori: Loredana Colceriu, AngelaPop-Department of Odontology and

Periodontology, University of Dental MedecineI.Haieganu, M.Moldovan-

ICCRR Cluj-Napoca, poster, Congresul Internaional de Materiale Dentare,

Napoca Biodent 2005, Cluj-Napoca

Lucrri publicate n rezumat:

1. Using MTA and calcium hydroxide as a pulp capping materials

Autori: Loredana Colceriu, Sanda Cmpean, Angela Pop-Catedra de

Odontologie-Parodontologie,UMFI.Haieganu i Moldovan Marioara-

ICCRR, European Cells and Materials Vol 10.Suppl.1, 2005, page 20

Lista crilor publicate:

1. "ndreptar practic pentru asistente de profilaxie stomatologic"

Autori: Angela Pop, Sanda Cmpean, Ada Delean, Loredana Colceriu-Burtea

Dan Pop -, Ed.Medical Universitar "Iuliu Haieganu" Cluj-Napoca, 2002

Lista lucrrilor publicate din domeniul tezei de doctorat:

Lucrri publicate in extenso:


coafajul direct"







Lucrri publicate n rezumat:


Autori: Loredana Colceriu, Sanda Cmpean, Angela Pop-Catedra

de Odontologie-Parodontologie,UMFI.Haieganu i Moldovan

Marioara-ICCRR, European Cells and Materials Vol 10.Suppl.1,

2005, page 20

UNIVERSITY OF MEDICINE AND PHARMACY IULIU HAIEGANU CLUJ-NAPOCA

FACULTY OF DENTAL MEDICINE

MODERN APPROACHES IN THE TREATMENT FOR THE CONSERVATION OF THE DENTAL PULP IN THE CASE OF ACCIDENTAL OPENING OF THE PULP CHAMBER

THESIS FOR ATTAINING THE Ph.D. SCIENTIFIC DEGREE IN THE FUNDAMENTAL DOMAIN OF MEDICAL SCIENCES, THE

DOMAIN OF DENTAL MEDICINE

SUMMARY

Ph.D. Degree Candidate, Scientific coordinator, Loredana Colceriu-Burtea Prof. Dr. Angela Pop

-2006-

CONTENTS INTRODUCTION .....................................................................................................................1 ACTUAL STAGE OF KNOWLEDGE.....................................................................................3 Chapter I: The influence of dental cavity upon the pulp-dentine organ and methods of treatment for the profound cavity...............................................................................................3 1.1.Dentine and pulp modifications in the case of profound cavity...........................................3 1.1.1. Pulp modifications ...........................................................................................................5 1.2 Recent data regarding the methods of pulp conservation in the case of profound cavity....6 1.2.1 Natural capping .................................................................................................................7 1.2.2 Indirect capping.................................................................................................................7 1.2.3 Direct capping ...................................................................................................................9 Chapter II: Materials used for the conservation of pulp vitality ..............................................13 2.1 Calcium hydroxide.............................................................................................................13 2.2 Current conception regarding the conservative therapy of the dental pulp .......................17 2.2.1 Short history of the adhesion to the dentine....................................................................18 2.2.2 The formation mechanism of the hybrid layer................................................................19 2.2.3 The effect of the adhesives upon the dental pulp............................................................23 2.2.3.1.Studies regarding the maintaining of the pulp integrity with the help of dentinal adhesives...................................................................................................................................23 2.3 Mineral Trioxid Aggregate ................................................................................................26 PERSONAL CONTRIBUTIONS............................................................................................31 Chapter III: The evaluation of the biocompatibility of a material based upon Calcium hydroxide (Calcidenta)towards animal tissue..........................................................................31 Introduction..............................................................................................................................31 Material and work method .......................................................................................................31 Results and discussions............................................................................................................33 Conclusions..............................................................................................................................46 Chapter IV: The pulp's response at the action of dentinal adhesives and of the classical materials used in the conservation of the vitality of the dental pulp........................................47 Material and work method: ......................................................................................................51 Results:.....................................................................................................................................56 Discussions: .............................................................................................................................65 Conclusions:.............................................................................................................................68 Case study: ...............................................................................................................................69 Chapter V: Clinical study regarding the influence of the factors which affect the succes of the conservation of the pulp's vitality in the case of the accidental opening of the pulp chamber, realized with two types of capping materials...........................................................................77 Material and work method: ......................................................................................................82 Results:.....................................................................................................................................88 Discussions ............................................................................................................................101 Conclusions............................................................................................................................104 Case study: .............................................................................................................................105 GENERAL CONCLUSIONS................................................................................................137 BIBLIOGRAPHY..................................................................................................................140 APPENDIX............................................................................................................................150 1. List of the figures from the thesis .....................................................................................150 2. List of the tables in the thesis.........153

Key words: neodentine-genesis, inoculation, inflammatory infiltrate, direct capping,

monocites, fagocitation, Mineral Trioxide Aggregate

The current orientation of conservative therapy is towards the biologic concept of

keeping the vitality of the dental pulp for as much as possible. It is a well-known fact that

the pulp is capable of initiating defense mechanisms against the bacterial invasion. This

objective can be attained even in the case of accidental opening of the pulp chamber

through direct capping. In order to succeed with a direct capping, we should take into

account 2 categories of factors: general and local ones. Among the general factors we

mention the age of the patient, his health condition and also social conditions. As local

factors we might mention the work conditions, the state in which the pulp is in, the

character of the traumatic lesion.

Among the materials, which are being used for direct capping most frequently, are

those based on calcium hydroxide. The main point that sustains applying calcium

hydroxide in direct capping is related to its properties: anti-germs, anti-inflammatory,

hemostatic. Starting from the neo-dental-genetic properties of the materials based on

calcium hydroxide, in this research I have tested a Romanian product, Calcidenta,

elaborated in the Chemical Research Institute Raluca Ripan. This proves that in our

country continues the interest of introducing dental material which presents an advantage

from the point of view of the quality but also has a low price.

The purpose of the experiment has been that of appreciating the degree of

biocompatibility of Calcidenta dental material in the situation of prolonged contact with

the conjunctive and muscle tissue. Local reactions after the implantation of the material

regarding preclinical evaluation have been carried out within the UMF Bio-Base

Laboratory (Dr. Septimiu Toader).

Material and work-method

The composition of the material selected for the biological testing is: Ca(OH)2

42%, ZnO 25,8%, CMC 3,2%, Glycerine 29%. The product is presented as a

monopaste and it is autopolymerizable. Two species of animals have been used in the

biotest: rats and Guinea-pigs , with two ways of administration: subcutaneous and intra-

muscular.

Rezults and discussions

In every lot, irrespective of the species and the method of innoculation, the local

reaction has been favorable, the implant was accepted by the tissue and it was perceived

upon palpation as a small subcutaneous or intra-muscular nodule, not painful and semi-

mobile.

Fig.1. The inter-muscular fixed and incapsulated implant at a Guinea-pig, 21 days after the operation

The introduction of material fragments at the level of both anatomical zones

mentioned (subcutaneous and muscular) in the case of both animal species has brought

to light the following observations(from the histo-pathological point of view):

subcutaneous area: around the body of the implant a capsular structure is formed, which

is made of conjunctive tissue of neo-formation which covers the implant on all of its

facets; muscular area: the same capsular structure is constitued , a defence reaction and

rare poli-morpho-nuclear reactions.

Fig. 2. Capsular wall constitued from conjunctive tissue of neo-formation, developed from the

muscular interstitium, Guinea-pig, 21 days after the implantation. Coloration H.E. x 200

Conclusions

There has not been at least one case of rejection phenomena through abcess

formation, fistulae or seizing constitutions; for neither of the methods of administration.

The reaction towards the product has been strictly local, consisting in the formation of an

inactive granuloma of a foreign body in which the afflux of monocites prove a step by step

fagocitation action of the material, once it inactivates in time.

Another recently appeared material and successfully used in direct capping is

Mineral Trioxid Agreggate, which ha been discovered in 1996. Among the physical and

chemical properties of the material we mention: very high pH (12,5) and also its superior

seal capacity. Among its biological properties the bio-compatibility with the dental pulp

stands out.

In the last few years, together with the impetuous development of adhesive

techniques, there have emerged some studies1,2,3,4,5,6) which have shown that the healing

of the pulp tissue can be attained when the adhesive resin therapy has been used. These

studies sustain the hypothesis that pulp can be restructured even after applying adhesive

systems in profound cavities or even on the opening of the pulp chamber as long as a

correct hemostasis is being realized before the applying of the resin7), ensuring a tight

closing against the bacterial infiltration8). This concept is becoming more and more

popular in spite of the fact that numerous in vitro9) and in vivo10) researches have shown

the cito-toxicity of composite resins applied on culture mediums or in direct contact with

the subcutaneous tissue in animals. The purpose of this experimental research has

been that of characterizing and comparing the pulp response after direct capping with

adhesive resins, Mineral Trioxid Aggregate and Calcidenta material.

Material and work method

I have taken under study a number of 60 teeth divided into three lots. The

examined teeth have been whole pemolars, which were about to be extracted for

orthodontic purposes from patients aged between 10 and 18. The experimental effective

for every material used has been that of 20 cavities realized on 20 teeh for Calcidenta,

MTA respectively and that of 20 cavities realized on 20 teeh for Optibond SoloPlus(Kerr)

adhesive systems. Under local anesthetics , I have prepared a V class cavity on each

tooth, with repartition on the vestibular face. After the opening of the vestibular chamber,

hemostasis was realized, and the capping material was applied , MTA or Calcidenta, the

rest of the cavity being obturated with IRM.

The usage of the Optibond SoloPlus adhesive system was realized after the

demineralization with Phosphoric acid 35% for 15 seconds, washing with distilled water

and gentle drying with buds of sterile absorbent cotton. The polimerization of the

adhesive layer has been done for 20 seconds, later the cavity being obturated with the

Herculite compozite material (KERR). The teeth have been divided into 2 groups, being

extracted at varied periods of time: shorter (9-12 days) and longer (60-90 days). After the

fixation, demineralization, sectioning and colouring of the histological preparations, the

pulps response has been characterized by: the appearance of inflamation, the existence

of reaction dentine, the presence of dentine bridges with their characteristics.

Results

Regarding the inflamatory response in the case of the lot being under observation

for a period of 60-90 days, statistics revealed no significant difference between the 3

types of materials (p>0,05) (table I, figure 3). Still, from a percentual point of view, only

60% of the teeth that have undergone treatment with adhesive systems have not presented

an inflamatory response or the inflamation noticed was minimal.

Table I: The inflamatory response registered regarding the type of material, observed after a longer period of time

Material Inflamation being prezent Inflamation absent

Ca (OH)2 1 9

MTA 1 9

Adhesive system 6 9

Figure 3 : The results of the comparative analysis of the inflamatory response between the lots under sudy, regarding the type of material used, for a long period of time

The introduction of reparatory dentine for the lot of teeth under study for the

short period of time reveals a statistically significant difference between the teeth treated

with MTA and Calcidenta, as compared to those treated with adhesive systems. (table II,

figure 4)

Table II: The repartition of reaction dentine per number of teeth according to the examined material, for a short period of time

Material Dentine absent Dentine present

Ca (OH)2 2 8

MTA 3 7

Adhesive system 5 0

Figure 4 : Comparative analysis between the reaction dentines repartition according to the type of material used, in the case of the teeth being under study, for a short period of time

0 2 4 6 8

10 12 14 16

Ca(OH)2 MTA Adhesive system Inflamation present Inflamation absent

p=0.1

0 1 2 3 4 5 6 7 8 9

10

Ca(OH)2 MTA Adhesive system Absent Present

p=0.01 p=0.03

Conclusions

6. The anti-bactericide action mechanism of Calcium hydroxide through its strongly

alkaline pH and the stimulation of the neo-dentine-genesis process remain the main

strong points in favour of applying this material in the therapy of profound cavities

7. Due to the superior impermeability of the classical materials, and also to the alkalinity, MTA has allowed the regeneration of the affected pulp tissue in the case of

accidental opening of the pulp chamber, with the formation in time- of bridges

continuous predentine with large thickness.

8. The dentine bridges formed in the case of adhesive systems registered multiple gaps, which would favour the insertion of bacterial micro-infiltrations into the pulp

chamber and therefore compromising the vitality of the pulp through the appearance

of inflamatory processes

Clinical studies in the specialized literature conducted upon teeth with direct

capping have followed the evolution of this treatment on short periods of time, and

the results have been controversial. Starting from the scientifc literatures data, the

purpose of this clinical study has been that of evaluating the success rate of direct

capping in the case of accidental opening of the pulp chamber, realized with two

different materials: Calcidenta, a material based on Calcium hydroxide produced at

ICCRR Cluj-Napoca, and MTA; underlining which of the clinical factors influence

the success of the treatment.

Material and work method

In the present study a number of 150 teeth from 120 patients have been treated.

The age of the patients was between 10 and 40 years. For the whole group taken under

study, in the case of the presence of dental lesions diagnosed as profound cavities when

during the drilling of the altered dentine occurred the accidental opening of the pulp

chamber- I have undertaken the treatment through direct capping. I have moved on to the

evaluation of the diameter of the opening orifice and that of the degree of bleeding

factors which can influence the success of a direct capping. So, the size of the diameter

of the orifice of communication with the pulp(), has allowed me to divide the teeth

into 4 groups:

percentage of the succesful treatment according to the material being used, both

materials have registered similar results (table IV).

Table IV: The percentual distribution of success according to the material being used

Capping material No. of successful teeth No. of failed teeth Success rate (%) Ca (OH)2 54 15 78,26

MTA 66 15 81,48 The influence of the diameter of the communication orifice with the pulp chamber and

the degree of bleeding at the level of the exposed pulp - over the success of the direct

capping have been analized as follows (table V,VI).

Table V: The influence of the diameter of communication with the pulp chamber over the success of the conservative therapy of the pulp vitality.

In order to appreciate the relationship between the diameter of the opening of the pulp

chamber and the success rate of the conservative treatment of the live pulp; the teeth

have been divided into 4 groups, according to the size of the communication orifice. In

the group where the diameter of the opening of the pulp chamber was bigger than 1mm,

but smaller than 2 mm, the success rate is with 83,33% smaller than that of the group

which had the opening between 0,5 1 mm, 90%. For the group where the diameter of

the communication orifice is larger than 2 mm, the success rate is 0, the capping being

considered a failure. Regarding the degree of bleeding at the level of the opening of the

pulp chamber, the success of the group where the bleeding is absent (95,23%) or reduced

under 30 seconds (87,5%) is significantly increased than in the group where the bleeding

is abundent and persistant. (46,15%) (table VI).

Tabelul VI : The influence of the time of bleeding over the success of maintaining the pulps vitality in direct capping

Degree of bleeding No.of successful teeth No. of failed

teeth Success rate (%)

Objective symptomatology Observations No. of successful teeth No. of failed

teeth Success rate (%)

0,5 36 3 92,30

0,5 < 1,0 54 6 90,00 1,0 < 2,0 30 6 83,33

The diameter of the opening hole of the pulp chamber: (mm)

> 2,0 0 15 0

Absent bleeding 60 3 95,23 Mild bleeding 42 6 87,5

Persistent bleeding 18 21 46,15

The Pearson correlation test (figure 5) between the degree of bleeding and the success

rate shows a value of r=-0,95 , which proves a relationship of inverted proportionality

between the two variables, the probability that the lack of bleeding determines a success

is one of 0,99 (R2=0,99).

Figure 5 : The relationship between the degree of pulp bleeding and the success rate in the therapy of the accidental opening of the pulp chamber through direct capping

Discussions

The successful percentage of this therapy depends both on general factors but also on

local ones, the most favorable medium for the success of the direct capping

consisting of permanent young teeth, because they have a big capacity of reaction,

with multiple defence resources.

Regarding the local factors, the success rate of this therapy depends on the diameter

of the opening orifice of the pulp chamber, which should not exceed 2 mm and on the

possibility of eliminating the altered dentine- which should be carried aut completely

r=0.95R2 = 0.9932

Absent bleeding Moderate bleeding Persistent bleeding

No. of successfull teeth No of failed teeth Linear (No. of successfull teeth)

before the beginning of the direct capping. The inflamatory status of the pulp organ is

reflected through the level of the bleeding factor at the level of communication with

the pulp. So, the bigger the level of the bleeding is, the smaller is the chance of a

favorable prognosis of the treatment.

GENERAL CONCLUSIONS :

8. Profound cavity lesions represent dental afflictions frequently encountered in the

dental practice. The treatment of these afflictions raises multiple problems to dental

physician; problems related to establishing a correct diagnosis and realizing a time-

durable protection for the dental pulp so that the reconstruction of the morpho-

functional integrity of the injured tissue is possible.

9. It is important in the case of a dental cavity before the preparation of a cavity to

understand which are the tissue modifications that appeared at the dentine level,

determined by the evolution of the cavity lesion. The intra-tubular modifications and

the formation reaction dentine will affect the result of the treatment. In the cases in

which the dentine tubes are opened and permeable; the conservative treatment will

ask for increased attention as compared to the cases in which the remaining dentine is

waterproof.

10. As a result of the testing of the material based on Calcium hydroxide (Calcidenta)

realized at the Chemical Research Institute in Cluj-Napoca, consisting of biological

evaluation tests , there has been revealed the fact that the material is not toxic, the

product being well tolerated, without any harmful effects.

11. The clinical experience is not as long in the case of compozite resins used as capping

materials, the prognosis is therefore reserved. My experimental study realized on

healthy teeth has shown that, after applying the adhesive systems on the opened pulp

chamber, the histopathological reaction of the pulp at 9 of the teeth under study has

signaled the presence of dentinal bridges with multiple tunnel flaws, favouring

therefore the insertion of the bacterian micro-infiltrate into the pulp chamber.

12. Mineral Trioxid Aggregate meets the qualities of a direct capping material. Through

very good marginal adaptation and due to its biocompatibility , this material limits

the pulp inflamation and allows the attaining of dentinal bridges of the outmost

quality.

13. The localization of the spot of communication with the pulp chamber on the surface

of the tooth influences the success of the conservative therapy for the pulps vitality

through direct capping. The percentage of successful teeth is significantly bigger in

the case of accidental openings of the pulp chamber situated at the level of the

occlusive face.

14. My studies both the experimental and the clinic one have proved that the progress

attained as a result of long-term researches in the domain of conservative materials

for the pulps vitality , have materialized by the realization of products which present

superior qualities; these making possible great successes in the case of direct capping

treatments, applied in the case of accidental openings of the pulp chamber.

SELECTIVE REFFERENCES 38. Cox C. F., Bergenholtz G.- Healing sequence n capped inflamed dental pulps of Rhesus

monkeys (Macaca ulatto). Int. Endodont. J.1986; 19: 113-120 39. Cehreli ZC, Turgut M, Olmez S, Dagdeviren A.-Short term human primary pulpal

response after direct pulp capping with fourth-generation dentin adhesives. J Clin Pediatr Dent 2000; 25: 65-77

40. Finger WJ, Fritz UB.-Resin bonding to enamel and dentin with one-component UDMA/HEMA adhesives. Europ. J. Dent. 1997; 105: 183-186

41. Rakich D.R., Wataha J.C., Lefebre C.A., Weller R.N.-Effect of dentin-bonding agents on the secretion of inflammatory mediators from macrophages. J. Endodon 1999; 25; 114-7

42. Okita N., Hensten-Pettersen A.-n vitro cytotoxicty of tissue conditioners. J Prosthet Dent 1991; 66: 656-9

43. Dejou J., Remust M., Franquin J.C.-Biocompatibility testing of restorative materials influencing dentin and pulp. J Biomed Mater Res 1993; 27; 877-84

44. Gerzina T.M., Hume W.R.-Diffusion of monomers from bonding resin-resin composite combinations through dentin n vitro. J. Dent 1996; 24: 125-8

45. Hamid A., Hume W.R.-Diffusion of resin monomers through human carious dentin n vitro. Endod Dent Traumatol 1997; 13: 1-5

46. Hashieh IA, Cosset A, Franquin JC, Camps J n Vitro Cytotoxicty of One-Step Dentin Bonding systems. Journal of Endodontics 1999; 25: 89-92

47. Haskel EW., Stanley HR., Chellemi J., et al.-Direct pulp capping treatment. A long- term follow-up. J Am Dent Assoc 1978; 97: 607-612

48. Bjordal L.Dentin and pulp reactions to caries and operative treatment: biological variables affecting treatment outcome. Endodontic Topics 2002; 2: 10-23

49. Katebzadeh N., Dalton BC., Trope M.-Strengthening immature teeth during and after apexification. J Endodon 1998; 24: 256-9

50. Schumacher JW, Rutledge R.E.-An alternative to apexification. J Endodon 1993; 19: 529-31

51. Van Meerbeek B., Perdigao J., Lambrechts P., Vanherle G.-The clinical performance of adhesives. J.Dent. 1998; 26: 1-20

52. Imazato S., Tori Y., Takatsuka T., Inoue N., Ebi N., Ebisu S.-Bactericidal effect of dentin primer containing antibacterial monomer MDPB against bacteria n human carious dentin. J of Oral Rehabilitation 2001; 28: 314-319

53. Katoh Y., Kimura T., InabaT.-Clinical prognosis of pulp tissue direct-capped with adhesive resins. J Dent Res 1997; 76 (special issue): 162

54. Dummer PMH, Hicks R, Huws D i Hyman J, Cohen M.-Clinical signs and symtoms n pulp disease. Int Endod J 2000; 13: 27-35

55. Schrder U.-Effects of calcium hydroxide- containing pulp capping agents on pulp cell migration, proliferation and differentiation. J Dent Res 1995; 64: 541-8

56. Barthel CR., Rosenkranz B., Leuenberg A., Roulet JF.-Pulp capping of carious exposures: treatment outcome after 5 and 10years: a retrospective study. J Endod 2000; 26: 525-8

57. Iliescu A., Gafar M.-Cariologie i odontoterapie restauratoare. Ed Medicala, Bucuresti, 2002

58. Bjordal L.-Buonocore memorial lecture. Dentin caries: Progression and clinical management. Oper Dent 2002; 27: 211-217

59. Aberts B, Johnson A, Lewis J, Raff M, Roberts K, Walter P.-Molecular biology of the cell, 4th edn. New York: Garland Publishing, Inc., 2002

60. Gafar M.-Caria dentar Ed Medicala Bucuresti, 1998 61. Golberg M.-Manuel dhistologie et de biologie buccale, ed Paris : Masson, 1989 62. Kettering JD, Torabinejad M.-Microbilogy and immunology. n: Cohen S., Burns RC.,

eds. Pathways of the pulp. 6th ed. St. Louis: Mosby Year-Book, 1994: 363-76 63. Mjor A, Heyeraas KPulp-dentin biology n restorative dentistry. Quintessence

International 2001; 32: 427-446 64. Perdigao J., Lopes M.-Dentin bonding-state of the art 1999. Compendium 1999; 20:

1151-62 65. Stanley H.R., Spiegl E., Schultz M.-The detection and prevalence of reactive and

hysiologic sclerotic dentin, reparative dentin and dead tracts beneath various types of dental lesions according to tooth surface and age. J.Oral Pathol.1983; 12: 257

66. Trowbridge HO., Kim S.-Pulp development, structure and function. n: Cohen S., Burns RC (eds). Pathways of the pulp. 6th ed St. Louis, Mosby, 1994: 322-5

67. Ciucchi B., Bouillaguet S., Holtz J., Pashley D.H.-Dentinal fluid dynamics n human teeth, n vivo. J.Endod. 1995; 21: 191-194

68. Degrange M.-Les principes actuels de ladhesion a la dentine Clinic 1999 ; 20 (8) : 526-531

69. Attin T, Hellwig E.-Erfolgsussichten der direkten Pulpa-Uberkappung bei Zahnen mit Caries profunda. Quintessensnz 1993; 44: 1613-22

70. Cox CF., Suzuki S., Suzuki SH, Subay R.K., Ostro E.-Biocompatibilite de divers materiaux dentaires: guerison de la pulpe grace a un joint cavo-superficiel. Parodontie& Dentisterie restauratrice 1996 ; 16: 241-251

71. Hanks C.T., Watah J., Sun Z. n vitro models of biocompatibility: a review. Dent Mater 1996; 12: 186-93

72. Cox CF., Keall CL., Keall HJ., et al.-Biocompatibility of surface-sealed dental materials against exposed pulps. J Prosthet Dent 1987; 57: 1-8

73. Mochizuki K, Fuji H, Machida Y.-Dentin bridge formation following direct pulp capping n dogs. Bull Tokyo Dent Coll 1998; 39: 31-9

74. Kitasko Y., Ynokoshi S., Tagami J.,- Effects of direct resin pulp capping techniques on short-term response of mechanically exposed pulps. Journal of Dentistry 1999; 27: 257

CURRICULUM VITAE

4. Personal data

Surname, name: Colceriu-Burtea Adela Loredana

Home address: Cluj-Napoca, Aleea Azuga nr. 2, sc. II, ap. 25

Date of birth: 12. 05.1970

Position and work place : Assistant Professor la UMF"Iuliu Haieganu"

Cluj-Napoca, Faculty of Dental Medicine, Department of Odontology-

Parodontologiy

5. Studies Gymnasium : 1977-1985 General School no.3, Tg-Jiu

High-school :1985-1989Mathematics-PhysicsHigh-School"T.Vladimirescu",

Tg-Jiu

University :1990-1992, Faculty of General Medicine, UMF"Iuliu Haieganu"

Cluj-Napoca;1992-1995, Faculty of Dental Medicine, UMF Cluj-Napoca

3. Professional activity

- January 1996- Intern phisician at the District Hospital Tg-Jiu

- February 1997- Resident phisician

- March 1997- exam for the position of Junior Assistant at the Dental

Medicine Faculty, department of Odontology- Parodontology

- October 1998 I sustained the speciality exam, becoming a specialist

physician

- March 1999 exam for the position of Assistant Professor at the Dental

Medicine Faculty, department of Odontology- Parodontology Dental

Medicine Faculty, department of Odontology- Parodontology

9. Scientific activity - diploma project: "Tulburri de erupie ale incisivilor centrali superiori",

coordinated by prof.dr.Elvira Cocrl

- in November 2001 I have registered for the Ph.D. studies at the Dental

Medicine Faculty, Dental Medicine Faculty, department of Odontology-

Parodontology, under the coordination of prof.dr.Angela Pop, with a

research theme regarding the conservation of the pulp vitality

-September 2002- March 2003 scholarship at the faculty of Odontology in

Marseille, France

- published papers : 2 papers published in extenso in scientific journals in the

country -participations at congresses and other scientific manifestations

-books : 1 book published as a co-author

10. Foreign languages: French (reading, writing, speaking advanced level) English (reading, writing, speaking advanced level)

LIST OF THE SCIENTIFIC PAPERS ELLABORATED

Papers published in extenso:


coafajul direct"

Authors: Loredana Colceriu, Sanda Cmpean, Angela Pop -Transilvania






Participations at congresses and other scientific manifestations:

1.Tulburri de erupie ale incisivilor centrali superiori

Authors: Loredana Colceriu, Elvira Cocrl; poster Zilele UMF, Cluj-

Napoca, dec. 1997

2. Materiale fotopolimerizabile-rolul agenilor de cuplare

Authors: Loredana Colceriu; mas rotund (debate) Zilele UMF, Cluj-

Napoca, dec. 1998

3. Posibiliti de reconstrucie corono-radicular

Authors : Sanda Cmpean, Loredana Colceriu, Angela Pop ; poster Zilele

UMF dec. 1999

4. Metode moderne de tratament conservativ n parodontita apical

cronic

Authors : Loredana Colceriu, Dolores Bdulescu, Ada Delean, Angela Pop ;

poster Zilele UMF dec. 2001

5. Modaliti de contenie n parodontopatiile marginale cronice

Authors: Loredana Colceriu; mas rotund (debate), Zilele UMF dec 2003

6. Materiale noi folosite n terapia conservatoare a pulpei dentare

Authors:LoredanaColceriu,DeleanAda,PopDan,-department of Odontology-

Parodontology,UMFI.Haieganu and Moldovan Marioara-ICCRR, Cluj-

Napoca, Zilele Stomatologiei Bnene, mai 2004

7. Biocompatibility of a new calcium hydroxide lining cement used as a

pulp capping material

Authors:Loredana Colceriu,Angela Pop-Department of Odontology and

Periodontology,University of Dental MedicineI.Hatieganu, M.Moldovan -

ICCRR Cluj-Napoca, poster, Congresul Internaional de Materiale Dentare,

Napoca Biodent 2005, Cluj-Napoca

Papers published as a summary:


Authors: Loredana Colceriu, Sanda Cmpean, Angela Pop-Catedra de

Odontologie-Parodontologie,UMFI.Haieganu and Moldovan Marioara-


List of the published books:

1. "ndreptar practic pentru asistente de profilaxie stomatologic"

Authors: Angela Pop, Sanda Cmpean, Ada Delean, Loredana Colceriu-

Burtea Dan Pop -, Ed.Medical Universitar "Iuliu Haieganu" Cluj-Napoca,

2002

List of the published papers from the Ph.D. research thesis domain:

Papers published in extenso:


coafajul direct"







Papers published as a summary:

1.Using MTA and calcium hydroxide as a pulp capping materials

Authors: Loredana Colceriu, Sanda Cmpean, Angela Pop-Catedra de

Odontologie-Parodontologie,UMFI.Haieganu and Moldovan Marioara-


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