Deep Caries Research Articles

Exosomes from Human Periodontal Ligament Stem Cells Promote Differentiation of Osteoblast-like Cells and Bone Healing in Rat Calvarial Bone

Deep caries and severe periodontitis cause bone resorption in periodontal tissue, and severe bone resorption leads to tooth loss. Periodontal ligament stem cells (PDLSCs) are important for the healing of defective periodontal tissue. It is increasingly understood that healing of periodontal tissue is mediated through the secretion of trophic factors, particularly exosomes. This study investigated the effects of exosomes from human PDLSCs (HPDLSCs-Exo) on human osteoblast-like cells in vitro and on the healing of rat calvarial bone defects in vivo. HPDLSCs-Exo were isolated and characterized by their particle shape, size (133 ± 6.4 nm), and expression of surface markers (CD9, CD63, and CD81). In vitro results showed that HPDLSCs-Exo promoted the migration, mineralization, and expression of bone-related genes such as alkaline phosphatase (ALP), bone morphogenetic protein 2 (BMP2), osteocalcin (OCN), and osteopontin (OPN) in human osteoblast-like cells. Furthermore, in vivo results showed that more newly formed bone was observed in the HPDLSCs-Exo-treated group than in the non-treated group at the defect sites in rats. These results indicated that HPDLSCs-Exo could promote osteogenesis in vitro and in vivo, and this suggests that HPDLSCs-Exo may be an attractive treatment tool for bone healing in defective periodontal tissue.

Survival analysis of pulpotomy versus pulpectomy in primary molars with carious pulp exposure: a retrospective cohort study.

Both pulpotomy and pulpectomy are indicated in deciduous teeth with carious pulp exposure. Pulpotomy is recommended for treating carious pulp exposure in primary molars with the development of dental biomaterials. However, it is difficult to determine the severity of pulpitis as children frequently have difficulty communicating their clinical symptoms and there is no objective diagnostic method to assess pulpal status. Thus, therapeutic interventions for deciduous teeth with carious pulp involvement are controversial in clinical applications. This study compared the clinical and radiographic survival time of iRoot BP Plus pulpotomy and Vitapex pulpectomy in treating extremely deep caries with carious pulp exposure in deciduous molars under general anaesthesia. The 876 deciduous teeth in patients aged 3 to 6 years diagnosed with extremely deep caries were categorised into Group A (iRoot BP Plus pulpotomy) and Group B (Vitapex pulpectomy) based on treatment methods in this retrospective cohort study. The Kaplan-Meier survival curves were used to compare the survival rates and time between the groups. The Cox proportional hazards model was used to evaluate the factors associated with success. 876 primary molars were collected, including Group A (504) and Group B (372). The clinical and radiographic survival time in Group A (54.394 ± 1.388(months) and 48.978 ± 1.413(months)) were significantly higher than that in Group B (47.867 ± 0.956 (months) and 38.834 ± 0.981 (months)) (P < 0.05). The clinical and radiographic survival rates of Group A at 48 months were 77.0% and 69.5%, respectively. Group B's clinical and radiographic survival rates at 48 months were 53.1% and 29.1%. Younger age and treatment with iRoot BP Plus pulpotomy might predict higher success rates (P < 0.05). The long-term prognosis of iRoot BP Plus pulpotomy for treating extremely deep caries with carious pulp exposure in primary molars under general anesthesia was better than Vitapex pulpectomy.

Comparison of iRoot BP Plus and mineral trioxide aggregate for pulpotomy in primary molars under general anesthesia: a 3-year retrospective study

Background Pulpotomy is a widely recommended treatment for deep caries and reversible pulpitis in primary teeth. However, there is a significant lack of large-scale clinical studies evaluating the long-term efficacy of pulpotomy in primary molars, especially in studies with follow-up periods extending beyond a two years. Aim This study aimed to evaluate the long-term efficacy of mineral trioxide aggregate (MTA) and iRoot BP Plus for pulpotomy in primary molars performed under general anesthesia and to investigate factors influencing the success rate. Methods In this retrospective study, a total of 942 primary molars from 422 children who met the inclusion criteria underwent pulpotomy. Propensity score matching method (PSM) was used to match the MTA and iRoot BP Plus groups in a 1:1 ratio based on covariates. Efficacy was assessed using the Zurn &amp; Seale criteria. Kaplan-Meier survival analysis and Cox proportional hazards model were performed to analyze the outcomes. Results PSM resulted in 266 pairs of matched teeth from 532 teeth of 291 children (mean age: 4.64 ± 1.07 years, ranging from 2 to 8 years). Long-term clinical and radiographic evaluations revealed higher success rates for iRoot BP Plus (24-month: 99.54%/97.25%; 36-month: 97.22%/95.83%) compared to MTA (24-month: 94.76%/95.29%; 36-month: 92.50%/91.25%). Survival analysis indicated a statistically significant difference between two groups (P = 0.0042). Age, gender, tooth position, and decayed tooth surface showed no significant impact on pulpotomy success, whereas the choice of pulp capping materials significantly influenced the outcome (HR [95% CI]=0.3745[0.1857-0.7552], P = 0.006). Conclusion Clinical and radiographic evaluations support the use of iRoot BP Plus for pulpotomy in primary molars.

Beyond The Usual Suspects: A Challenging Case Of Radix Entomolaris With Endodontic-Periodontal Lesion: A Case Report

The purpose of this case report is to present an unusual endodontic periodontal lesion along with radix entomolaris in tooth 46 in a 31-year-old female patient with intermittent pain and sensitivity to hot and cold stimuli. Clinical examination revealed deep dentinal caries and periodontal pocket depth of 5mm in tooth #46.The radiographic examination revealed an extra distal root with a periapical radiolucency in tooth #46. patient was diagnosed with irreversible pulpitis and chronic apical periodontitis, with secondary periodontal involvement due to an endodontic-periodontal lesion. Non-surgical root canal treatment was performed, followed by canal obturation with resin-based sealer and final restoration with a porcelain fused to metal crown. After a 3-month follow-up, the patient remained asymptomatic, radiographs showed bone reposition, and periodontal probing depth decreased, indicating successful treatment.

Deep caries and pulp exposures management preferences in permanent teeth: A survey amongst Spanish dentists.

To assess Spanish dentists' management preferences for deep caries removal and exposed pulps in permanent teeth. A web-based open and anonymous survey was distributed by social media and a specific website for this project amongst dentists practicing in Spain. The questionnaire comprised 40 questions, divided into five sections: (1) demographic data and professional activity; (2) carious tissue removal; (3) decision-making regarding pulp exposure; (4) direct pulp capping and (5) pulpotomy procedures in permanent teeth. Results were descriptively analysed. Logistic regression (95% CI) analyses and X2 tests were carried out. A total of 538 responses were received. Half the respondents (53.7%) preferred to perform complete caries excavation for shallow and moderate carious dentin lesions, and selective excavation to firm dentin for deep lesions (57.8%). Selective removal to soft dentin and stepwise removal were much less indicated (15.4% and 10.9%, respectively). Exposed pulps in asymptomatic teeth were treated by direct pulp capping (over 80%), decreasing in the presence of reversible pulpitis symptoms (57.1%). If irreversible pulpitis was diagnosed, a pulpectomy would be performed by 53.5% and 89.9% of the respondents in, respectively, immature and mature teeth. Pulpotomy was performed routinely only by 26.4% of the clinicians. Patients' attitudes and priorities were the most relevant criteria when performing direct pulp capping and pulpotomy, together with the history of pain and the presence of bleeding. Regarding the clinical procedure, dry cotton was preferred to obtain haemostasis and Biodentine was the material of election. Caries removal preferences and management of pulp exposure by dentists practicing in Spain deviated from vital pulp treatment guidelines, mainly regarding indications and case selection. Pulp exposure was managed by direct pulp capping in asymptomatic cases, whilst immature permanent molars favoured the indication of pulpotomy when pulpitis was diagnosed. Most clinicians used hydraulic calcium silicate cement, specifically Biodentine, to perform vital pulp treatments. Postgraduate formation and continuing education in caries lesions management and vital pulp treatments were consistently related to more conservative and updated decisions.

Research on the method of digital technology assisted direct resin composite restoration for deep distal caries in mandibular second molars

Objective: To explore the digital design and fabrication technology of personalized restorative matrix for dental filling, and to explore the feasibility of direct resin restoration for deep caries lesions in distal neck of mandibular second molar. Methods: For patients with deep caries lesions in the distal neck of the mandibular second molar who visited the Department of Cariology and Endodontology of Peking University School and Hospital of Stomatology from September 2023 to April 2024, after preparing the cavity and gingival retractor, a three-dimensional intraoral scanner was used to obtain three-dimensional data of the patient's dentition. In the dental restoration computer-aided design software, the inlay function was used to generate the restored tooth morphology. The edge range of the personalized restorative matrix was drawn on the restored model by three-dimensional reverse engineering software to achieve edge sealing effect. The selected edge range data was processed with distal shelling to generate a digital model of a personalized restorative matrix with a thickness of 0.5 mm. A metal three-dimensional printer was used to fabricate the titanium alloy restorative matrix, and its application was completed in 10 clinical cases. The marginal adaptation and retention stability of the personalized restorative matrix were evaluated under a dental microscope, and forming effect evaluation was performed through immediate postoperative periapical radiographs. Results: The preliminary clinical application of the personalized restorative matrix fabricated using digital technology revealed that, in the treatment of 10 affected teeth, rubber dam isolation was successfully ensured, resulting in clinically effective direct resin composite restorations with optimal marginal adaptation and reasonable contours. Immediate postoperative periapical radiographs showed good convexity of the filling body, with no overhangs found. Both marginal adaptation and retention stability met the requirements of clinical treatment. Conclusions: The personalized restorative matrix designed in this study can solve the clinical problems of moisture separation and resin forming in the treatment of deep caries lesions in distal neck of the mandibular second molar, and can achieve stable and reliable adhesive restoration effects.

Efficacy of vital pulp therapy for carious pulp injury in permanent teeth: a study protocol for an open-label randomized controlled noninferiority trial.

Vital pulp therapy (VPT) has recently been reported as an effective approach for preventing and treating carious pulp injury in permanent teeth. Compared with root canal treatment (RCT), which involves complete removal of the pulp tissue, VPT effectively maintains pulp vitality and retains the physiological functions of the pulp. In the research pool, large-scale randomized controlled trials evaluating the treatment outcome of VPT using calcium silicate cements and RCT in cariously exposed permanent teeth are lacking. Here, we present a monocentric clinical protocol to compare the effects of VPT using iRoot BP Plus (Innovative Bioceramix, Vancouver, BC, Canada) as a pulp-capping material with RCT. The proposed trial is an open-label, single-centre, randomized, controlled, noninferiority trial. In total, 462 patients will be included in this trial according to the following criteria: adult patients (18-50years old), pulp exposure during the treatment of deep caries in mature permanent teeth, a diagnosis of reversible or partially irreversible pulpitis without apical translucency on X-ray, without periodontitis or systemic disease. Patients with signed informed consent forms will be enrolled and randomly divided into two groups (VPT and RCT) with a balanced treatment allocation (1:1). Clinical evaluations will be conducted at baseline and at 3, 6, 12, and 24months after treatment, with the potential for extension. The primary outcome measure will be the duration of success. The secondary outcomes will include the success rate at the 1-year follow-up and any adverse reactions. The Kaplan‒Meier method and log-rank test will be used to compare the duration of success of both treatments. For other outcomes, the χ2 test or Fisher's exact test will be used for categorical variables, and the t test or Mann‒Whitney U test will be used for continuous variables to assess the differences between groups. The results of this trial will provide a clinical reference for selecting treatments for carious pulp injuries in permanent teeth. ClinicalTrials.gov ChiCTR2100051369. The study has been registered in the Chinese Clinical Trial Registry (ChiCTR) ( www.chictr.org.cn ). Registered on 21 September 2021.

Latest Updates in The Management of Deep Caries Lesions

Latest Updates in The Management of Deep Caries Lesions

Combined surgical luxation and orthodontic traction treatment of a severely infraoccluded primary molar with deep caries: a case report and literature review.

Infraocclusion refers to a tooth located below the occlusal surface compared to adjacent teeth long after it should have reached occlusion. Ankylosis is frequently associated with the infraocclusion of primary molars, but it is challenging to distinguish between the two conditions. Surgical luxation and orthodontic traction have been applied for the treatment of ankylosed, infraoccluded permanent teeth, but reports on primary molars are scarce. A 5-year-old boy presented with a severely infraoccluded primary mandibular second molar with deep caries. A partial pulpotomy was performed to treat the affected tooth when the pulp was exposed after caries removal. A combination of surgical luxation and orthodontic tractionwas performed for the affected tooth, and after 5 months, the tooth successfully erupted to the occlusal level. During the follow-up period of two years, no complications were observed. This report identified that surgical luxation, in conjunction with orthodontic traction, is effective and feasible for severely infraoccluded primary teeth. Additionally, partial pulpotomy may be an alternative for vital pulp therapy on primary teeth.

The role of visual aids in the clinical success of posterior restorations: Randomized controlled clinical trial

ObjectiveThis clinical study aimed to assess the impact of utilizing loupes and dental operating microscopes (DOM) with varying magnifications on the success of class II direct composite restorations. MethodsA total of 130 class II, moderately deep caries teeth from 85 patients were randomly assigned to four groups: naked eye, ×3 loupe, ×5 loupe, and ×8.5 DOM. Cavities were restored with or without magnification. The restorations were evaluated according to World Dental Federation criteria at 1, 6, and 12-month intervals by previously calibrated evaluators. Cochran's Q test was used to compare paired scores across three or more time points within groups, while the Friedman test was employed to compare scores at three or more time points. Multiple comparisons were adjusted using the Bonferroni correction. The significance level was set at p < 0.05. ResultsStatistical analysis revealed no significant differences among the groups at the 1-, 6-, and 12-month follow-up periods (p > 0.05). Although not statistically significant, the magnified groups exhibited higher scores in aesthetic anatomical form, proximal form, postoperative sensitivity, periodontal response, and adjacent mucosalcriteria compared to the naked eye group. ConclusionAlthough no statistically significant difference was observed at the 12-month follow-up between restorations performed with and without magnification, the groups using magnification showed higher scores.

Tactile sensation in relation to roughness and reflection of active initial lesions in primary (deciduous) and permanent dentition in vitro

ObjectivesThis study evaluated whether a relationship exist between tactile sensation, roughness and reflection intensity in active enamel lesions of primary (deciduous) and permanent dentition. MethodsFreshly extracted teeth of the primary (n=29) and permanent (n=60) dentition of patients who underwent serial extractions under general anesthesia due to multiple deep caries lesions showing active lesions (International Caries Detection and Assessment System scores of 2) were selected. The mean linear (Ra), area-related (Sa), volume-related (Vmc) roughness and vertical reflection intensity (VRI) of sound (S) and carious (C) areas were determined by using a 3D-laser-scanning-microscope and a multi-sensor microscope with two different chromatic-confocal optics. Furthermore, two blinded examiners evaluated the roughness by tactile examination using three different explorers (S23H,405CP11, S3C). ResultsMean differences (95%CI) between S and C for teeth of the primary dentition were: Ra:-1.9(-2.3;-0.4)µm, Sa:-31.8(-1.8;0.0)µm, Vmc:-1.8(-1.6;-0.0)ml/m2, VRI:29(20;43) and for teeth of the permanent dentition: Ra:-4.0(-2.5;-1.0)µm, Sa:-4.8(-3.0;-1.1)µm, Vmc:-4.6(-3.4;-0.5)ml/m2, VRI:34(19;44) differing significantly between S and C (p<0.05,Wilcoxon test). No significant difference was observed between 1st and 2nd dentition (p>0.05, Kruskal-Wallis test) as well as commercial and experimental optic (p>0.05). The highest positive predictive value (PPV) was achieved by examiner 1 with explorer S3C (1st dentition 67%;2nd dentition 100%;pooled dentition 88%)), while examiner 2 revealed the highest PPV with explorer S23H (89%;86%;88%). ConclusionDifferences in roughness and reflectance between sound and caries-active enamel surfaces could be evaluated in both primary and permanent dentition. These differences could also be reliably detected using three different explorers with good validity. However, the most predictive explorer seems to differ between examiners. Clinical SignificanceIn both primary (deciduous) and permanent dentition active caries lesions exhibit significantly higher roughness and lower vertical reflection intensity compared with sound enamel. These differences are detectable by blind tactile examination and objective methods such as 3D-laser-scanning or multi-sensor microscopy, highlighting their utility in caries diagnosis in both dentitions.

Influence of Academic Training and Professional Experience on the Management of Deep Caries Lesions.

Managing caries lesions that affect the inner third of the dentin is crucial to ensuring pulp vitality; the clinician must make decisions that will affect the vitality of the tooth. Our purpose is to understand the behavior of Spanish dentists in treating deep cavities and to examine whether variations exist based on their academic training and/or years of professional experience. This study was approved by the ethics committee of the Balearic Islands CEI-IB. A survey was conducted using the SurveyMonkey platform with 11 questions, the first 4 of which focused on defining the characteristics of the respondents. The following six concerned a clinical case of deep caries in tooth number 4.7, and the last regarded the opinion of the actual treatment of the case. The survey was sent by email in April 2022. The results were analyzed with the SPSS 29.0 program using the chi-square test. A total of 347 responses were obtained (93.95%), and those surveyed stated that they apply minimal intervention concepts in their treatments, with 90.49% performing conservative dentistry treatments daily. A total of 56.48% of the respondents had bachelor's degrees, 12.39% had graduated, 33.14% had a postgraduate degree, 38.90% had a master's degree, and 17% had a doctorate. Most (40.63%) had been in professional practice for 16-30 years. Significant differences were identified regarding years of professional experience in terms of decision-making in methods of treatment and the choice of materials used for pulp protection. Likewise, significant differences were found regarding the academic training of the respondents, the cavity cleaning method selected, and the use of chemical substances for removing carious dentin. We can conclude that academic training and years of professional practice influence decision-making at some points in treating deep caries lesions.

Recommended procedures for managing carious lesions in primary teeth with pulp involvement—a scoping review

BackgroundManaging dental caries in primary teeth with pulp involvement is a significant challenge. Clinical guidelines offer recommendations for effective management.AimTo identify and analyze policies, guidelines, and recommendations for treating primary teeth with pulp-involved carious lesions, highlighting existing research gaps and setting the foundation for future research.MethodsA comprehensive search was conducted across databases (PubMed, Scopus, Embase, GIN, and LILACS) and grey literature sources (Trip and ProQuest) to identify guidelines, consensus, policy, and position statements on primary teeth pulp therapy and extraction thresholds. Two independent reviewers screened the abstracts and titles, followed by full-text screening.ResultsAfter removing duplication, of the 1098 records, 14 were selected for analysis. This review examined various treatments for deep caries lesions in primary teeth, including indirect/direct pulp capping, pulpotomy, pulpectomy, lesion sterilization/tissue restoration, and extraction. Time search was restricted to documents published from 30th January 2008 to 30th January 2024, offering insights into evolving clinical practices.ConclusionTreatment for carious lesions in primary teeth involving the pulp depends on clinical indications and may involve minimally invasive techniques. Recommended options are indirect pulp capping, pulpotomy, and pulpectomy, while direct capping and tooth removal are discouraged. Further research is needed to address gaps, improve guideline development, and enhance consistency of recommendations.

The effectiveness of partial pulpotomy compared with full pulpotomy in managing deep caries in vital permanent teeth with a diagnosis of non-traumatic pulpitis.

Pulpitis may be pain free or alternatively characterized by mild to severe pain and associated symptoms. Evidence has recently emerged that patients presenting with carious pulp exposure range of symptoms can be treated effectively with pulpotomy. The current systematic review aimed to answer the following research question: "In patients with deep caries lesions in permanent teeth associated with no symptoms, reversible pulpitis or signs and symptoms indicative of irreversible pulpitis (P), is partial pulpotomy (I) as effective as full pulpotomy (C), in terms of a combination of patient and clinical reported outcomes (O), with "tooth survival" as the most critical outcome? The systematic literature search was conducted in the following electronic databases: OVID, Scopus, PubMed (Including MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL) supplemented with Grey literature and hand searching of relevant journals. The English language clinical trials comparing the patient and clinical reported outcomes between partial and full/complete were included. After a structured literature search, two authors independently performed study selection, extracted data and performed a risk of bias assessment; a third reviewer resolved disagreements. As there were only two studies with different exclusion criteria, no meta-analysis was performed and the quality of evidence was assessed by the GRADE approach. After study selection a total of two randomised clinical trials with a total of 156 teeth were included both for the management of teeth with irreversible pulpitis. There were no studies for asymptomatic teeth or teeth with reversible pulpitis. A "Low" risk of bias was noted for both studies with a high level of overall evidence. A meta-analysis was not carried out due to differences in inclusion criteria between the studies related principally to caries depth. Both studies reported a high rate of clinical success for pulpotomy with a pooled unadjusted success rate for full pulpotomy of 90% and 83% partial pulpotomy of at 1-year; however, no significant difference between the treatments was noted in either study. There was significantly reduced postoperative pain reported in the full pulpotomy group over 1-week compared with the partial pulpotomy in one but not in the other study. Pulpotomy as a definitive treatment modality is as effective in managing teeth exhibiting signs and symptoms indicative of irreversible pulpitis and challenges the established protocols to manage this condition. Although based on only two RCTs with a limited number of patients, no difference was shown in terms of clinical or radiographic outcome or postoperative pain between groups. Further well designed randomised clinical trials of longer duration are required in this area to improve the evidence available. There is no consistent difference in patient-reported pain between partial and full pulpotomy at day 7 postoperatively and the clinical success rate was similar after 1 year for both treatment modalities.

DENTIN-PULP COMPLEX IN DEEP CARIES

Deep caries progress highlights the gradual shift from reactionary to reparative tertiary dentine as main feature illustrated by transition between the secondary and tertiary dentin. Three sorts of odontoblasts are described to exhibit their dentinogenic potential in genesis of reparative dentine, the still active primary odontoblasts, the formerly quiescent odontoblasts recently reactivated by molecular signals sent from carious lesion, and the secondary odontoblasts resulting from pulp stem cells. This complex cellular secretor involvement in dentinogenesis presume a range of resulting matrices that explain the miscellaneous mineralized final structures encountered in natural evolution of deep caries and especially as therapeutic outcome in pulp capping. Depending on intensity of cariogenic stimuli the effect may be either reactionary dentin relying on a mild action or reparative dentin, mirroring a strong microbial action. The histological response of dentin-pulp complex comprises any exclusive reactionary or reparative tertiary dentin feature as both conditions usually may cohabitate as mishmash in the same pulp.

Performance Evaluation of Deep Learning Models for Dental Caries Classification via Panoramic Radiograph Images

Objective: The purpose of this study is to evaluate the ability of deep learning models to classify mandibular molar teeth according to the presence and proximity of caries to the dental pulp. This research summarizes the progress of artificial intelligence and potential dental problems in diagnosis, treatment, and disease prediction in medicine. It discusses data limitations, computational power, ethical considerations, and their implications for dentists. This can lay the groundwork for future research in this rapidly expanding field. Methods: The dataset used in this study consists of 1200 panoramic radiographs, which have been evaluated and classified into three categories: free of dental caries, coded as (H); enamel-dentin caries lesions treated with restorative filling, coded as (R); and deep dental caries that underwent root canal treatment, coded as (E). The images are prepared for the training-testing process using the k-fold crossevaluation technique and then fed into the pre-trained deep learning models for classification. Results: The VGG-19 model achieved superior results compared to the other models, with macro-average scores of 0.9111 for precision, 0.9127 for recall, and 0.9115 for f1-score, respectively. Conclusion: The promising results obtained in this study give confidence in endorsing the use of deep learning models in the dental treatments sector.

Criteria and treatment decisions of dental students in the management of young permanent molars with deep caries lesions

Criteria and treatment decisions of dental students in the management of young permanent molars with deep caries lesions

Ginsenoside RB1 Influences Macrophage–DPSC Interactions in Inflammatory Conditions

Unresolved inflammation and tissue destruction are supposed to underlie the failure of dental pulp repair. As crucial regulators of the injury response, dental pulp stem cells (DPSCs) play a key role in pulp tissue repair and regeneration. M2 macrophages have been demonstrated to induce osteogenic/odontogenic differentiation of DPSCs. Ginsenoside Rb1 (GRb1) is the major component of ginseng and manifested an anti-inflammatory role by promoting M1 macrophage polarised into M2 macrophage in inflammatory disease. However, whether GRb1 facilitates odontogenic differentiation of DPSCs via promoting M2 macrophage polarisation under inflammatory conditions has yet to be established. Human monocyte leukemic cells (THP-1) differentiated macrophages were induced into M1 subsets and then treated with GRb1. After that, the conditioned medium was added to DPSCs. The cell co-cultured system was then subjected to odontogenic differentiation in osteogenic media. Effects of GRb1 on human dental pulp stem cells' (hDPSCs') osteogenic/odontogenic differentiation under inflammatory conditions were assessed by alkaline phosphatase (ALP) staining, Alizarin Red S (ARS) staining, and quantitative polymerase chain reaction testing. Results demonstrated that GRb1 could facilitate the polarisation of macrophages from the M1 subtype to the M2 subtype. Conditioned medium from GRb1 + M1 macrophages, in comparison with M1 macrophages, may markedly increase the gene expression of ALP, DSPP, and DMP1. Moreover, ALP and ARS staining uncovered that the osteogenic/odontogenic differentiation ability of hDPSCs was strengthened in the M1 + GRb1 co-culture group. GRb1 plays a crucial role in the inflammatory response and reparative dentine formation after dental pulp injury. Findings show that GRb1 modulates the interaction between macrophages and DPSCs during inflammation. The current study discusses modifications of deep caries therapy.

Prevalence and Pattern of Mandibular Condensing Osteitis Lesions in Saudi Population at Qassim Region

ABSTRACT Background: Condensing osteitis (CO) is a common radiopaque lesion observed in the jaws, often detected incidentally on panoramic radiographs. Understanding the prevalence and characteristics of CO is essential for early detection and appropriate management. Objective: To determine the prevalence and characteristics of condensing osteitis among the Saudi population in the Qassim region. Methods: A retrospective study was conducted using 876 digital panoramic radiographs. The presence of CO was identified based on specific radiographic features, and data were collected regarding gender, age, lesion localization, lesion shape, and associated dental status. Results: The prevalence of CO was found to be 2.3% (n = 20) in the study population, with a higher predilection in females (1.4%) compared to males (0.9%). The most commonly affected age group was 30–39 years for males and 10–19 and 30–39 years for females. The mandibular molar region was predominantly affected (90%), with a ‘U’ shape observed in 55% of the lesions. Root canal treatment was the most commonly associated dental status (75%), followed by deep caries (20%) and large restorations (5%). Conclusion: The study highlights a 2.3% prevalence of CO in the Saudi population of the Qassim region, with a higher predilection in females and a predominant localization in the mandibular molar region. Dental practitioners should be vigilant in identifying CO, especially in at-risk populations, to facilitate timely diagnosis and appropriate management.

Caries lesions diagnosis with deep convolutional neural network in intraoral QLF images by handheld device

ObjectivesThis study investigated the effectiveness of a deep convolutional neural network (CNN) in diagnosing and staging caries lesions in quantitative light-induced fluorescence (QLF) images taken by a self-manufactured handheld device.MethodsA small toothbrush-like device consisting of a 400 nm UV light-emitting lamp with a 470 nm filter was manufactured for intraoral imaging. A total of 133 cases with 9,478 QLF images of teeth were included for caries lesion evaluation using a CNN model. The database was divided into development, validation, and testing cohorts at a 7:2:1 ratio. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated for model performance.ResultsThe overall caries prevalence was 19.59%. The CNN model achieved an AUC of 0.88, an accuracy of 0.88, a specificity of 0.94, and a sensitivity of 0.64 in the validation cohort. They achieved an overall accuracy of 0.92, a sensitivity of 0.95 and a specificity of 0.55 in the testing cohort. The model can distinguish different stages of caries well, with the best performance in detecting deep caries followed by intermediate and superficial lesions.ConclusionsCaries lesions have typical characteristics in QLF images and can be detected by CNNs. A QLF-based device with CNNs can assist in caries screening in the clinic or at home.Trial registrationThe clinical trial was registered in the Chinese Clinical Trial Registry (No. ChiCTR2300073487, Date: 12/07/2023).