Abstract
Periapical periodontitis results from pulpal infection leading to pulpal necrosis and resorption of periapical bone. The current treatment is root canal therapy, which attempts to eliminate infection and necrotic tissue. But, in some cases periapical inflammation doesn't resolve even after treatment. Resolvins belongs to a large family of specialized pro-resolving lipid mediators that actively resolves inflammation signaling via specific receptors. Resolvin D2 (RvD2), a metabolite of docosahexaenoic acid (DHA), was tested as an intracanal medicament in rats in vivo. Mechanism was evaluated in rat primary dental pulp cells (DPCs) in vitro. The results demonstrate that RvD2 reduces inflammatory cell infiltrate, periapical lesion size, and fosters pulp like tissue regeneration and healing of periapical lesion. RvD2 enhanced expression of its receptor, GPR18, dentin matrix acidic phosphoprotein 1 (DMP1) and mineralization in vivo and in vitro. Moreover, RvD2 induces phosphorylation of Stat3 transcription factor in dental pulp cells. We conclude that intracanal treatment with RvD2 resolves inflammation and promoting calcification around root apex and healing of periapical bone lesions. The data suggest that RvD2 induces active resolution of inflammation with pulp-like tissue regeneration after root canal infection and thus maybe suitable for treating periapical lesions.
Highlights
Periapical periodontitis is an inflammatory disease that occurs around the tooth root apex
Micro-computed tomography analysis was used to quantify the area of mineralized tissue and showed that the periapical lesion size was greatly reduced, and root canal apices were calcified in Resolvin D2 (RvD2)-treated molars
We demonstrate that active control of excess inflammation in an infected root canal is permissive for the healing of periapical lesions
Summary
Periapical periodontitis is an inflammatory disease that occurs around the tooth root apex. It is caused by infection of the dental pulp tissue subsequent to carious lesions and leads to resorption of root dentin and bone [1]. Conventional root canal treatment goals to eliminate bacteria from the root canal system as completely. Resolvin D2 Resolutes Periapical Periodontitis as possible by physically removing the pulp soft tissue and irrigating the root canal system with potent antiseptic solutions (e.g., sodium hypochlorite), as well as mechanically removing infected dentin in the root canal [4]. Root canal therapy desiccates the tooth leading to the potential for subsequent fracture. Considering the course which pulpal inflammation initiates tissue destruction, it is obvious that an important step in supporting the regeneration of pulp-like tissue is the attenuation of inflammation
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