Pulp Calcification Research Articles

Glycation promotes pulp calcification in Type 2 diabetes rat model.

Intrapulpal calcifications can occur in the dental pulp of patients with diabetes. We focused on the association between ectopic calcifications in the dental pulp and advanced glycation end products (AGEs) in Spontaneously Diabetic Torii (SDT)-fatty rats, an obese type 2 diabetic rat model, to determine the mechanism of calcification with pulp stone in the dental pulp. Pathologic calcification in the dental pulp of SDT-fatty rats was observed using electron microscopy and immunohistochemical analysis. Moreover, mechanical analysis of periapical region of molar tooth against occlusal force was performed. In SDT-fatty rats, pathogenic pulpal calcifications occurred during blood glucose elevation after 6 weeks, and granular calcification was observed in the dental pulp after 11 weeks. Pentosidine, a major AGE, and the receptor for AGEs were strongly expressed in the dental pulp of SDT-fatty rats. S100A8, TNF-α, and IL-6 also showed positive response in the dental pulp of the SDT-fatty rat, which indicated pulpal inflammation. Blood flow disorder and hypoxic dental pulp cells were also observed. In silico simulation, strain from occlusal force concentrates on the root apex. Glycation makes blood vessels fragile, and occlusal forces damage the vessels mechanically. These are factors for intrapulpal calcification of diabetes.

Prevalence of Development of Dental Pulp Calcifications in Molars following Orthodontic Treatment - A Clinical Retrospective Study

Abstract Aim: This study aims to find the prevalence of pulp calcifications and their correlations with age, gender, tooth type, dental arches, or their location in patients following orthodontic treatment. Materials and Methods: The sample comprised 150 patients (15–25 years) who underwent orthodontic treatment. Pre- and posttreatment panoramic radiographs were evaluated to detect pulp calcification. Pearson Chi-square test was used to investigate the associations between pulp calcification and gender, age, tooth type, dental arches, and their location. Results: The statistical analysis showed that pulp calcification increased significantly from 35.30% to 50% (P < 0.05). They were significantly higher in mandibular molars than in maxillary molars. Radicular and coronal calcifications were present concomitantly in maximum cases followed by radicular and coronal pulp calcification occurring independently. Conclusion: The results of this study showed that the number of dental pulp calcification increased significantly after orthodontic treatment.

Irritation of Dental Sensory Nerves Promotes the Occurrence of Pulp Calcification

IntroductionPulp calcification (PC) often appears in strong association with nerve fiber bundles, which indicates the important role of dental nerves in the formation of PC. Additionally, given that sensory nerves and calcitonin gene-related peptide (CGRP) secreted from sensory nerve fibers are involved in physiological and pathological bone formation, we aimed to determine whether chronic irritation of sensory nerves can promote the occurrence of PC. MethodsA sensory nerve irritation rat model was established via ligation of the inferior alveolar nerve (IAN), and face grooming behavior was analyzed as a measure of pain sensation. Two months post-surgery, PC was determined by imaging and histologic analyses. ResultsRats in the IAN-chronic constriction injury (IAN-CCI) group showed spontaneous pain-associated behavior after the operations and pain tolerance on the 60th postoperative day. The imaging and histological analysis showed more calcified particles in the IAN-innervated first and second molars after day 60 of the dental sensory nerve irritation. These calcified masses had a dentin-like structure that contained sparse, irregularly oriented tubules. Compared to the control and sham groups, the odontoblasts located in the periphery of radicular pulp aligned along a thicker layer of predentin; which expressed more nestin with longer and stouter processes in the IAN-CCI group. Additionally, more CGRP-positive nerves were observed in the IAN-CCI group. ConclusionsIrritation of sensory nerves promotes PC formation, and the increased density of CGRP-immunolabeled fibers probably contributes to this process. This highlights the significance of dental sensory nerves in the formation of PC.

Pulpal calcifications in orthodontically moved teeth: Scoping review.

The application of forces during orthodontic treatment can induce pulpal calcifications, characterized by the deposition of mineralized tissue in the pulp cavity space, there may be repercussions on dental procedures, especially endodontic treatment. The objective of this article is to map the scientific evidence and any gaps in knowledge regarding the relationship between orthodontics and dental pulp calcifications. The study comprised a scoping review whose guiding question was: "What is the scientific evidence of the association between pulpal calcifications and orthodontic treatment?" Two independent reviewers searched the PubMed, Scopus, and Web of Science databases and the grey literature. Original articles and observational and clinical trials, which addressed the repercussions on the pulp cavity of teeth submitted to orthodontic treatment, were included. There was no language restriction or limitation of the year of publication until October 2022. After critical reading and applying the eligibility criteria, 11 studies were included in this scoping review: six observational and five experimental studies. A statistically significant association of orthodontic treatment with changes in pulp cavity volume and increased incidence of pulp stones was observed among the studies findings. The orthodontic force can promote changes in the dental pulp that may cause direct implications in other dental treatments, especially endodontic treatment. Key words:Dental pulp calcifications, pulp node, pulp obliteration, orthodontic treatment, orthodontics.

Detection of pulpal calcifications on bite-wing radiographs using deep learning.

Pulpal calcifications are discrete hard calcified masses of varying sizes in the dental pulp cavity. This study is aimed at measuring the performance of the YOLOv4 deep learning algorithm to automatically determine whether there is calcification in the pulp chambers in bite-wing radiographs. In this study, 2000 bite-wing radiographs were collected from the faculty database. The oral radiologists labeled the pulp chambers on the radiographs as "Present" and "Absent" according to whether there was calcification. The data were randomly divided into 80% training, 10% validation, and 10% testing. The weight file for pulpal calcification was obtained by training the YOLOv4 algorithm with the transfer learning method. Using the weights obtained, pulp chambers and calcifications were automatically detected on the test radiographs that the algorithm had never seen. Two oral radiologists evaluated the test results, and performance criteria were calculated. The results obtained on the test data were evaluated in two stages: detection of pulp chambers and detection of pulpal calcification. The detection performance of pulp chambers was as follows: recall 86.98%, precision 98.94%, F1-score 91.60%, and accuracy 86.18%. Pulpal calcification "Absent" and "Present" detection performance was as follows: recall 86.39%, precision 85.23%, specificity 97.94%, F1-score 85.49%, and accuracy 96.54%. The YOLOv4 algorithm trained with bite-wing radiographs detected pulp chambers and calcification with high success rates. Automatic detection of pulpal calcifications with deep learning will be used in clinical practice as a decision support system with high accuracy rates in diagnosing dentists.

One Visit Endodontic with Internal Bleaching on Tooth 12 Post Trauma: A Case Report

Introduction: Post-traumatic non-vital teeth is one of the indications for One Visit Endodontic. Trauma to the teeth may arise from conditions that cause the teeth to become necrotic so that the teeth will look darker and experience discoloration. Clinical conditions that indicate the death of the dental pulp and teeth require endodontic treatment. This situation will cause discoloration of the teeth that occur as a result of the metamorphosis of calcified pulp. Internal whitening is a treatment that can be done after the first treatment. Purpose: To provide information about discolored teeth management after trauma which causes pulp necrosis by doing root canal treatment and internal bleaching to change tooth color. Case: A 31-year-old woman came to the RSKGMP Universitas Airlangga with a referral from the orthodontics department where her teeth were darker in color and interfered with her appearance. In the previous history, the patient had an accident and trauma 10 years ago. Case Management: The first step is access opening and a good glide path. Root canal preparation was performed using the Crown Down Pressureless technique. The obturation technique used is Single Cone. The results were good and there were no symptoms during the control. Conclusion: One visit endodontic can be a treatment option for post-traumatic non-vital teeth. Internal bleaching with Walking Bleach Technique is also proven effective in restoring the original tooth color without excessive reduction of the dental crown.

Characterization of pulp calcifications and changes in their composition after treatments with citric acid and ethylenediaminetetraacetic acid solutions.

The ectopic calcifications of non-mineralized tissues can occur in several forms throughout life, such as pulpal calcification. The presence of pulp stones is a challenge in endodontic treatment because they partially or fully obliterate the pulp chamber hindering access to root canals and their subsequent shaping. This study aimed to determine their crystallographic properties and evaluate the capacity of citric acid (CA) and ethylenediaminetetraacetic acid (EDTA) to promote the demineralization of pulp calcifications. The samples were obtained from patients with indications of endodontic treatment, and the radiographic examination was suggestive of pulp stone in at least one permanent tooth. The samples were isolated and analyzed by scanning electron microscopy/energy-dispersive x-ray spectroscopy (SEM/EDX). The Fourier Transform by high resolution-transmission electron microscopy, Raman microscopy, and X-ray diffraction (XRD) were used to identify the mineral phase and crystallographic characteristics. To evaluate the effect of CA and EDTA on the crystallinity of calcifications, they were submerged into these two individual solutions and the changes were assessed in situ by Raman spectroscopy. The SEM images obtained from calcifications demonstrated irregular morphologies. EDX of sample surfaces shows a high presence of oxygen, carbon, calcium, and phosphorous, however, other elements such as sodium, magnesium, nitrogen, chlorine, potassium, sulfur, and zinc were identified in less quantity. According to Raman, XRD, and high-resolution transmission electron microscopy, the predominant mineral phase identified in the pulpal calcification was a poor crystallinity apatite. According to in situ analyses, the effect of CA and EDTA was observed on the signals of PO4 3- and CH2 groups corresponding to inorganic and organic components. The changes with CA were evident at 7min while the effect of EDTA was observed until 15 min of treatment. All results indicate that pulp stones have a heterogeneous composition principally composed of apatite with low crystallinity. The solubility of these pathological minerals is adequate using solutions such as EDTA or CA; however, the effectivity depends on the mineralization grade of calcifications, time, and concentration of exposition to this chemical.

Histopathological evaluation of pulp response to portland cement compared to MTA after primary canines pulpotomy (in vivo study)

IntroductionECC (Early childhood caries) is very common in children. Because of the small size of primary anterior teeth, endodontic exposures occur early. Pulp tissue response after pulpotomy of primary anterior teeth by both MTA and Portland Cement is very important when pulp exposures occur in these teeth.AimThis study aimed to evaluate in vivo pulp tissue responses after the primary canines pulpotomy with either White Portland Cement (WPC) or White Mineral Trioxide Aggregate (WMTA), by histopathological analysis.Materials and methodsThe study included 30 primary canines in 21 healthy children aged 6–9 years old and it was classified into 2 groups according to the material. Group 1: included 15 teeth capped by White Portland Cement, and Group 2: included 15 teeth capped by white MTA. The dentine bridge formation, soft Tissue Organization, tissue fibrosis, formed dentin bridge thickness, pulp calcifications, hemorrhage in the pulp tissue, and deposition of new dentin on the inner surface of the dentin at 3 months periods were recorded.ResultsData were analyzed statistically; the Mann–Whitney U test was performed for the assessment of histopathological criteria. Descriptive statistics were performed for the analysis of participant properties. Histopathological analysis showed complete dentin bridge formation and normal soft tissue organization for both materials. Statistical analysis showed no significant differences in dentine bridge formation (P value = 0.213), soft Tissue Organization (P value = 0.339), tissue fibrosis (P value = 0.079), formed dentin bridge thickness (P value = 0.139), pulp calcifications (P value = 0.581), hemorrhage in the pulp tissue (P value = 0.117), and deposition of new dentin (P value = 0.097), during the observation period.ConclusionsWithin the limitation of the current study WPC was similar to WMTA in terms of histological criteria so PC may serve as a good alternative to MTA in primary teeth pulpotomy.

Association between Periodontitis and Pulp Calcifications: Radiological Study.

Objective The presence of intrapulpal calcifications is one of the effects reported as a consequence of periodontal pathology. Although the impact of the pulp pathology on the periodontium is obvious, the contrary remains unclear and controversial. This study was conducted in order to better understand this fact and establish a potential association between periodontitis and intrapulpal calcifications and then to determine the factors associated with their occurrence. Materials and Methods To investigate the issue, a retrospective radiological study using periapical preoperative radiographics assessed 332 teeth taken from the records of 79 patients who received treatment for periodontitis. In the second part of the study, 81 of the sample with intact dental crowns presenting an attachment loss were compared to their contralateral with intact dental crowns without any attachment loss. The study of the association between periodontitis and intrapulpal calcifications and the factors associated with their occurrence was performed by the Chi squared and Fisher's exact tests. The significance level was set at 0.05. Results The results indicated that 251 (75.6%) teeth had an attachment loss while 102 (30.7%) had intrapulpal calcification. Among the 206 (62%) teeth with intact crown, only 6 (1.8%) showed calcification in the pulp cavity and 20 (6%) showed calcification in the root canals, with a statistically significant difference (p < 0.005) compared to teeth with restorations and caries. For the 32 (19.7%) teeth with coronary calcification, 18 (22.2%) presented an attachment loss versus 14 (17.2%) without attachment loss; the difference was not statistically significant (p=0.6). Similarly, only 13 (16%) of a total of 22 (13.5%) teeth with root canal calcification had attachment loss versus 9 (11.1%) without attachment loss. This difference was not statistically significant (p=0.5). Conclusion This radiographic study revealed no association between the presence of periodontitis and the occurrence of intrapulpal calcifications. Although intrapulpal calcifications were present in some teeth with loss of attachment, they were not necessarily the consequence of periodontal disease.

Cone beam computed tomography assessment of the prevalence and association of pulp calcification with periodontitis.

Periodontitis has a known association with pathological calcification in the cardiovascular system. Considering the close anatomic and circulatory association between dental pulp and the periodontium, this study aimed to evaluate the prevalence of pulp calcification (PC) under different periodontal conditions, as well as the associations of PC with the degree of periodontal damage, via cone beam computed tomography (CBCT) examination. In this study, 55 patients were categorized into three groups according to periodontal condition: group 1 (healthy controls), group 2 (periodontitis stage I-II), and group 3 (periodontitis stage III-IV). PC and radiographic bone loss (RBL) was assessed by CBCT in sagittal, axial, and coronal views, and statistical analyses were conducted. PC was identified in 378 of 1170 teeth (32.3%). The prevalence significantly differed among the three groups (P < 0.001). Group 2 had a 2.43-fold (P < 0.001, 95% confidence interval [CI] 1.64-3.61) higher risk of PC than group 1; and the risk of PC was 3.04-fold (P < 0.001, 95% CI 2.06-4.48) higher in group 3 than group 1. Teeth with more severe RBL exhibited a higher prevalence of PC (P < 0.001). Molar teeth had a higher risk of PC than incisors and premolars. In conclusion, the occurrence of PC is related to the periodontal state, and the prevalence of PC is higher in teeth with periodontitis; tooth type and periodontitis status are important risk factors for PC.

Hallermann–Streiff syndrome: Case report with abnormal pulp calcifications

Hallermann–Streiff syndrome (HSS) is a disorder of rare occurrence affecting the craniofacial complex, with approximately 200 cases reported in the literature. Nonetheless, its distinctive facial features render it highly recognizable. We present the case of a 5-year-old girl with this syndrome and review the dental manifestations and management in this patient. In addition to the diagnostic facial features of brachycephaly with frontal bossing, beak-shaped nose, microphthalmia, and mandibular retrusion, multiple dental manifestations were noted, including the absence of the mandibular condyle, ghost teeth, and unusual pulpal calcifications in both the primary and the permanent teeth, which have not been previously reported in a case of HSS. There is no consensus on the suitable treatment plan to be given for HSS patients from a young age due to an underreporting of these cases in the literature. In this report, we discuss pediatric dental management options for a patient with HSS and share her perspective of the treatment.

Comparative analysis of the knowledge, attitude and practice of calcified canals and its management by general dentists and endodontists

Calcifications in the pulp space pose a challenge to most dental practitioners. Although they are a common finding, their management is not done appropriately in many cases. This leads to numerous iatrogenic mishaps like ledging, gouging, perforations, etc. Hence, adequate knowledge about pulp calcifications and their proper management is necessary for successful endodontics. Such detailed knowledge is usually achieved only during post graduation in endodontics. General practitioners may or may not have the sufficient knowledge and skill to manage such cases. This survey aims at comparing the knowledge of pulp calcifications, and the attitude and practice of their management between general practitioners and endodontists.

ENDODONTIC MANAGEMENT OF CALCIFIC METAMORPHOSIS IN MAXILLARY CENTRAL INCISOR: A CASE REPORT

Calcific metamorphosis is a pulpal reaction to dental trauma where the root canal gets obliterated by the deposition of hard tissue within the root canal space. Calcified root canal possesses a great challenge to the endodontist as negotiating such canal is very much difficult and tiring job along with risk of iatrogenic root perforation. Negotiation of root canal during endodontic treatment is very much crucial for its success as it could affect the cleaning, shaping, disinfection and finally 3 dimensional obturation of the root canal. This case report demonstrates the clinical management of maxillary central incisor with calcified canal in a 28 years old female patient with a history of trauma 2 years back. The preoperative radiograph shows complete obliteration of the canal up to coronal 2/3rd of the root canal along with widening of the periodontal ligament space. The only way to locate and negotiate such calcified canal was to remove the calcified pulp tissue from the canal while staying centered within the root during negotiation. Control radiograph was taken to rule out any deviation from the root’s centre during negotiation. Once the calcified tissue from the coronal 3rd of the root was removed using fine ultrasonic instruments, a #08 C+ file in a watch winding motion along with alternate use of 5.25% sodium hypochlorite and 17% EDTA was then used to negotiate the remainder of the canal. After negotiation of the calcified canal of tooth #21, it was then successfully cleaned, shaped and obturated till the apical terminus.

Endodontic Challenges in the Management of Multiple Pulp Stones and Root Canal Calcification - A Case Report

Root canal calcification is currently a challenging and interesting case for endodontists. Removing microorganisms and their by-products from the root canal system is the goal of root canal treatment. Worse outcomes from root canal procedures can occur due to root canal calcification, as it can block access to the root canal and hinder cleaning and shaping. Iatrogenic errors may occur in the treatment of such cases which will lead to failure of endodontic treatment. This case report describes a 20-year-old woman with multiple pulp stones in the pulp chamber of the mandibular left first molar. In addition, there were also calcified root canals in the mesiolingual and mesiobuccal canals. The patient had asymptomatic irreversible pulpitis and had to undergo endodontic treatment. Several challenges were faced in this case. The initial challenge was to determine the location of the pulp stone in the pulp chamber. Radiographs taken from multiple angles, as well as a direct assessment of the cavity during access preparation, addressed this initial challenge. Retrieval of the pulp stone which in this case is the embedded type that was carried out by grinding it with the help of an ultrasonic tip. Other difficult challenges were avoiding perforation of the pulp chamber floor during treatment, especially when removing the pulp stone, and identifying the location of the orifice. With clinical knowledge, magnification aids and ultrasonic tips, successful treatment in this challenging case was achieved.&#x0D; Calcific metamorphosis, sometimes known as pulp canal obliteration (PCO), is the extensive formation of tertiary dentin in the pulp chamber leading to circumferential narrowing of the pulp chamber and root canal.[1] According to the AAE (American Academy of Endodontics), PCO is radiographic evidence of increased dentin production mainly in response to trauma. The result is a calcified canal and does not necessarily indicate pulp disease.[2] Pulp calcification is a common occurrence. The incidence varies, but overall it can be estimated that 50 % of teeth have one or more calcifications.[3]&#x0D; There is no evidence to explain whether pulp calcification is a pathological process associated with various forms of injury or natural phenomena.[3] In general, the pulp chamber becomes progressively smaller and often very small, a phenomenon known as calcified metamorphosis or obliteration of the pulp canal. Dentin can be accelerated by caries, trauma, abrasion, restoration, and periodontal disease and is not uniform.[1]&#x0D; Calcifications are divided into denticle (pulp stones) and diffuse (linear) calcifications. Pulp stones are divided into free, attached, and embedded types. Pulp stones tend to be found in the coronal pulp, and diffuse calcifications are found in the radicular pulp. It has been speculated that the nidi of calcification arise from degenerating nerves or blood vessels, but this has not been proven.[1

Prevalence of dental alterations in patients under bisphosphonates therapy: a systematic review.

This systematic review aimed to estimate the prevalence and describe dentoalveolar lesions associated with bisphosphonates therapy. A systematic review of the literature was conducted using the following databases: PubMed, Embase, Cochrane, CINAHL, Scopus, Web of Science, Lilacs, SciElo, and Grey Literature. Quality of individual studies analysis was performed by using Newcastle-Ottawa Scale. Certainty of cumulative evidence was achieved by applying Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. The software R Statistics version 4.0.5 (The R Foundation) was used for proportion estimations per study and corresponding confidence intervals were estimated through the Clopper-Pearson method. Four articles were included for the qualitative synthesis. Two studies were considered of good quality, one of fair, and one of poor quality. A total of 231 patients were encompassed. Widening of the periodontal ligament space (22.2-39.7%), periradicular radiolucencies (20-22.9%), and pulp calcifications (33.3-69.2%) were the most frequent alterations. Certainty of evidence was rated as very low. Based on limited evidence, this systematic review reports a variety of dentoalveolar alterations in patients under bisphosphonate therapy. These features might impact on dental clinical practice. However, the level of evidence is considered very low due to important limitations.

ASSOCIATION OF PULP CALCIFICATIONS AND CARDIOVASCULAR DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS.

This systematic review and meta-analysis was performed to evaluate the association between pulp calcifications (PC) and cardiovascular disease (CVD). Five databases (PubMed, Scopus, Embase, Web of Science and ProQuest) were searched to identify articles. Quality assessment of the selected articles was done using Joanna Briggs Institute critical appraisal tool and the inter-examiner agreement was calculated using the Cohen-Kappa test. The random-effects maximum likelihood model was used to evaluate the association between the conditions. Trim-and-fill funnel plot was used to evaluate the presence of publication bias. The level of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. A total of 2487 articles were identified from the initial search. Ten articles were included in this review of which 7 were cross-sectional and 3 were case-control studies. Eight articles had a low risk of bias (RoB), one article each had a moderate and high RoB. Inter-examiner reliability score was 0.8592. Seven articles reported a statistically significant positive association between CVD patients and PC. Two articles reported a non-significant positive association and one article reported no association between the same. A significant difference was observed in favor of CVD patients to possess more PC in comparison to non-CVD patients with an OR of 4.30 (95% confidence interval (CI): 2.19, 8.46; p = .000). Asymmetry in the Trim-and-fill funnel Plot suggested the presence of publication bias. GRADE analysis demonstrated low certainty of the evidence for the overall sample. There exists a low level of evidence to show that CVD patients are more prone to have PC in comparison to non-CVD patients.

Regenerative endodontic procedures for two traumatized mature anterior teeth with transverse root fractures

BackgroundRegenerative endodontic procedures (REPs) are an alternative treatment in immature traumatized teeth with necrotic pulp/apical periodontitis. However, this procedure has been infrequently reported in multiple transverse root fractures of mature teeth. This case report describes management of a patient with multiple horizontal root fractures in 2 maxillary central incisors that were successfully treated with REPs.Case presentationA 17-year-old girl had a history of traumatic injury to mature teeth 11 and tooth 21 resulting in multiple transverse root fractures. Clinical examination showed that both teeth responded to electric and thermal pulp sensibility tests with prolonged severe pain and were tender to percussion and palpation. Periapical radiographic examination showed both teeth were fully developed and had multiple transverse fractures in the mid-root. The pulp diagnosis was consistent with symptomatic irreversible pulpitis. REPs were initiated with only the coronal fragments treated to preserve pulp vitality in the apical fragment for potential pulp tissue regeneration. After REPs, clinical signs/symptoms subsided, and the two teeth were followed for 48 months when cone beam computed tomography (CBCT) imaging was also undertaken. At the last review, the case demonstrated root fractures healing with calcified tissue and pulp calcification in the apical fragments. Both teeth were stable and in function.ConclusionsREPs have the potential to be used to treat traumatized and symptomatic mature permanent teeth that have sustained transverse root fractures.

Type 2 diabetes and the clinically normal pulp: An in vitro study.

AimThe aim of this study was to investigate the effect of type 2 diabetes (T2D) on clinically normal dental pulp tissue by using special stains and immunohistochemistry (IHC) to determine the morphology of the coronal pulp and distribution of immune markers in non‐T2D and T2D groups.MethodologyEthics approval for this in vitro pilot study was obtained from the University of Otago Human Ethics Committee (16/069). Twenty extracted permanent molar teeth diagnosed as having clinically normal pulp status were collected. Ten teeth were from participants with well‐controlled T2D and ten from participants without diabetes (non‐T2D). Each tooth was sectioned transversely at the cemento‐enamel junction before the crowns were decalcified and embedded in paraffin. Sections were stained with haematoxylin and eosin, Massons trichrome, and van Gieson stains for histological and morphological evaluation. IHC using anti‐CD4, anti‐CD68 and anti‐CD83 and anti‐IL1β, anti‐IL6, anti‐IL17, anti‐TNF‐α, anti‐TLR2, anti‐TLR4 and anti‐FOXP3 identified proteins of interest. Qualitative and semi‐quantitative analyses evaluated the morphology of the dental pulp and protein expression. Data analyses were performed with GraphPad Prism, using Student's t‐test and multiple regression using SPSS at p < .05.ResultsSpecial stains demonstrated morphological differences in the T2D dental pulp compared with non‐T2D. Qualitative analysis indicated that the pulp in the T2D samples was consistently less cellular, less vascular, showed evidence of thickened blood vessel walls, increased pulp calcification and collagen deposition. Semi‐quantitative analysis of IHC samples showed the T2D pulp had significantly increased expression of macrophage and dendritic cell markers CD68 (p < .001) and CD83 (p = .04), and there was significantly greater expression of inflammatory cytokines IL1β (p = .01), IL6 (p < .0001), IL17 (p < .0001) and TNF‐α (p = .01). T2D samples showed a significant increase in markers of innate inflammation, TLR2 (p < .001) and TLR4 (p < .001) and decreased expression of regulatory T‐cell marker, FOXP3 (p = .01). Multiple regression showed that age‐corrected differences were statistically significant.ConclusionPreliminary findings suggest that T2D may exert a similar response in the pulp to complications in other body sites. Hyperglycaemia is associated with changes in the morphology of the clinically normal dental pulp with altered immune cell and cytokine expression.

Causes, diagnosis and treatment strategies for dental pulp calcification

Dental pulp calcification can lead to root canal stenosis or obliteration. It is usually difficult to negotiate the root canal if the affected tooth needs to be treated and intraoperative complications are easily brought about during the root canal treatment. The etiologies of dental pulp calcification are complicated and careful considerations should be given to the diagnosis and treatment. Only by weighing the advantages and disadvantages can appropriate treatment plan be chosen. Based on the literature and authors' clinical experiences, the present article summarizes the causes, pathogenesis, diagnosis and treatment strategies of dental pulp calcification, in order to provide some references in diagnosis and treatment for the dental clinicians.

Endodontic procedural errors: Analysis of images from cone beam computed tomography

• The most prevalent errors in endodontics were underfilling in the posterior maxilla region and tooth resorption in anterior mandibular region. • The interpretation of this results of this study can be applied in clinical practice. The study aimed to verify the prevalence of endodontic procedural errors and to compare errors between teeth in the maxilla and mandible region using CBCT. This is a cross-sectional study, whose sample whose sample consisted of tomographic images of 672 teeth from 373 individuals. The most prevalent endodontic procedural errors in descending order of involvement were: underfilling (22.3%), tooth resorption (9.4%), pulp nodule (8%), overfilling (5%), pulp calcification (5.1%), root fracture (3.4%), untreated canal (3.3%), and root perforation (0.1%). In the analysis between the teeth of the maxilla and mandible region, there was a statistically significant difference between the underfilling, untreated canal, and tooth resorption (p-value<0.05), with underfilling being more prevalent in the posterior region of the mandible and maxilla than in the previous. When analyzing the untreated canals, it was observed that the most affected was the posterior maxilla region. However, concerning tooth resorption, the most affected region was the anterior mandibular region. Among the most frequently found endodontic procedural errors, underfilling was the most prevalent, while root drilling was the least. In the comparison analysis between different maxillary regions, there was a statistically significant difference in the underfilling, untreated canal, and tooth resorption outcomes.