Vital Pulp Research Articles

The effect of freezing on the fracture pattern of adhesive on debonding: an in-vitro study.

The purpose of this study was to quantitatively evaluate adhesive remnants on the enamel surface following bracket debonding using a freezing element. Thirty-six sound premolars were used in this study. In each case, a bracket was bonded onto each tooth with conventional light-cured composite resin and de-bonded after one week. Freezing of the underlying composite through the bracket was performed immediately before debonding with a portable cryosurgical system (-55 °C). Specimens were divided into three groups according to the duration of freezing: a control group without freezing was used as a reference and two interventional groups with different durations of freezing (15 or 40 s). Brackets were removed by using debonding pliers to squeeze the wings of the bracket in an occluso-gingival manner. Adhesive remnants on the tooth were then quantitatively evaluated by stereo-microscopy. Pearson's Chi-squared test was used to investigate the relationship between the proportion of remaining resin and the group of teeth. In the control group, 100% of the composite remained on the enamel surface of all specimens. Significantly less adhesive remnants were found in the intervention groups (p = 0.001 for the 15 s group and p = 0.043 for the 40 s group). There was no significant difference between the two interventions (p = 0.165) in terms of the proportion of remaining adhesive remnants. Freezing of the bracket and the underlying adhesive resin prior to bracket debonding may favorably alter the behavioral pattern of composite fracture, thus reducing the extent of adhesive remnants on the enamel. Increasing the freezing time from 15 to 40 s did not exert significant effects on adhesive remnants following debonding. Further research now needs to investigate the effect of freezing on the mechanical properties of the adhesive remnants and its in-vivo effect on pulp vitality over both short- and long-terms.

The Management of Hyperplastic Pulpitis in Immature Permanent Molar Using Vital Pulp Therapy: A Case Report with 12 Months Follow‐Up

Hyperplastic pulpitis is an irreversible type of pulpitis that primarily affects young patients. It occurs when an inflamed pulp becomes exposed due to factors such as dental caries, dental trauma, or other causes. Root canal treatment is commonly employed to manage hyperplastic pulpitis. However, vital pulp therapy can be considered as a less invasive option. The main objective of this treatment is to preserve the vitality and functionality of the remaining pulp tissue. This case report discusses the potential management of hyperplastic pulpitis in an immature molar using vital pulp therapy instead of a full root canal treatment. The report includes clinical and radiographic follow‐up at six and twelve months.

Bioceramic Materials: A Boon in Pediatric Dentistry: A Literature Review

Abstract Over the past few decades, bioceramic materials have developed from extremely biocompatible, but low-strength dental materials to novel product compositions for broader clinical uses in pediatric dentistry. The most crucial thing is to better understand the elements that encourage remineralization and how they operate dynamically. Some of the major drawbacks of prior generations of endodontic materials have been effectively solved by new bioceramic materials. In particular, these materials have been used for vital pulp therapy treatment, restorative, and root canal procedures in a variety of dental applications. They may be used in clinical pediatric dentistry since they have been demonstrated to be more biocompatible, induce tissue regeneration, have low cytotoxicity, excel at sealing, cause little to no postoperative pain, and have improved physiochemical properties. When employing bioceramic materials, it is crucial to adhere to suitable clinical standards and techniques to guarantee positive results in pediatric dentistry. Therefore, the focus of this review is on the properties and advantages of using bioceramic materials in pediatric dentistry.

A questionnaire-based study on the management of deep carious lesions and exposed pulp among members of the Indian conservative dentistry and endodontic societies

Aim: Lack of unanimity in decision-making regarding the management of deep caries and exposed pulp has been highlighted by several questionnaire-based studies from various geographic regions. There is no research available in the Indian setting. The aim of the present study was to evaluate the perspectives of the Indian Endodontic Society and Indian Association of Conservative Dentistry and Endodontics members using an online questionnaire. Methods: An online structured questionnaire of 17 questions was mailed to 200 members based on the periapical radiographs of two cases (18 and 55 years of age) highlighting deep carious lesions and normal periapex in a mandibular molar. Each case had three hypothetical scenarios based on pulpal symptoms, i.e., asymptomatic pulp, reversible, and irreversible pulpitis, respectively. Results: A response rate of 65.5% (n = 131) was achieved. Nonselective caries removal was chosen by 40% and 36% of the participants in young patients with asymptomatic pulp and reversible pulpitis. On pulpal exposure, direct pulp capping was chosen by a majority of the members (66% and 54%, respectively) in a young patient. For irreversible pulpitis, pulpectomy was favored by 70%. In an older patient, less vital pulp therapy and more pulpectomy were preferred. The symptoms and patient age significantly altered treatment decisions, as determined by Chi-square and Fisher’s exact tests (P < 0.05). Conclusion: There was a lack of agreement in managing deep carious lesions. There was partial awareness of the management of exposed pulp.

Reparative Mineralized Tissue Characterization by Different Bioactive Direct Pulp-capping Agents

ABSTRACT The aim of direct pulp caping (DPC) is to support the formation of mineralized tissue and encourage pulp healing by placing a dental biomaterial directly over the exposed pulp. The era of vital pulp therapy has been influenced by the introduction of various pulp-capping materials. Emphasis has shifted from the “doomed” organ concept of an exposed pulp to one of hope and recovery; this comprehensive review thus discusses the ability of different direct pulp-capping materials to form a dentin bridge. Furthermore, this review will discuss the quality and quantity of dentinal bridge formation by different pulp-capping agents.

Vital pulp therapies versus conventional endodontics for the treatment of mature teeth with pulp inflammation: A systematic review

Introduction: To compare the effectiveness of vital pulp therapies (pulpotomy and direct pulp capping) with that of conventional endodontics for the treatment of mature teeth with pulp inflammation and to analyze which pulp capping material is more effective for the treatment of mature teeth with pulp inflammation. Materials and Methods: A bibliographic search of electronic databases (PUBMED, COCHRANE LIBRARY, SCOPUS, ScienceDirect, and SciELo) was conducted. The inclusion criteria were comparative studies in patients who underwent conventional endodontic and vital pulp therapy in mature teeth with pulp inflammation and comparative studies comparing Mineral Trioxide Aggregate (MTA) versus calcium hydroxide as direct pulp capping materials in mature teeth with pulp inflammation. Risk of bias was assessed using RoB2 or ROBINS-I. Results: Eight clinical trials were included, all of which had a high risk of bias. The data analysis showed that pulpotomy has similar clinical success rates to conventional endodontics. No studies comparing conventional endodontics versus direct pulp capping were found. MTA has better clinical results than calcium hydroxide as a direct pulp capping material. Conclusion: Vital pulp therapies are a valid alternative for the treatment of mature teeth with pulp inflammation. There is a need for more clinical trials with longer follow-up time and which consider other variables related to the characteristics of the patient and the tooth.

Invasive Cervical Root Resorption: A Comprehensive Review on Pathogenesis, Diagnosis, and Treatment.

Invasive cervical root resorption (ICRR) is a dental pathology, marked by unexpected destruction originating in the cervical region of the tooth. This comprehensive literature review provides a holistic view into the pathogenesis, clinical manifestation, and precise management of ICRR, aiming to guide endodontists and enhance patient care and treatment outcomes. The review delves into the potential etiology of ICRR, covering contributing factors such as trauma, orthodontic treatment, and other pertinent conditions. It outlines the clinical and radiographic indicators, underscoring the crucial role of early detection and precise diagnosis in effectively managing and halting ICRR progression. The exploration of treatment approaches is thorough, ranging from non-surgical methods like vital pulp therapy or root canal treatment to surgical interventions. This review accentuates the essential role of interdisciplinary collaboration among diverse dental specialties in enhancing ICRR management. It highlights the importance of a consolidated strategy in enhancing treatment outcomes and preserving tooth structure and function. Moreover, it investigates prevention methods, risk evaluation, and identifies prospective research pathways to address the existing knowledge gaps.

Comparative Outcomes of Pulpotomy in Mature Molars with Irreversible Pulpitis: A Non-Randomized Trial Evaluating Calcified and Non-Calcified Pulp Chambers.

This non-randomized clinical trial investigated the outcomes of full pulpotomy in adult molars with irreversible pulpitis, comparing those with calcified and non-calcified pulp chambers over 6 and 12 months. A total of 101 adult permanent molars with irreversible pulpitis, in individuals over 12 years old, were categorized based on pulp chamber calcification observed in radiographic images by two endodontists. Subsequently, full pulpotomy procedures were performed, achieving hemostasis, and applying a 2 mm layer of calcium-enriched mixture (CEM) cement as a pulp covering agent. After 48 hours, the setting of the CEM cement was verified, followed by the application of a layer of resin-modified glass-ionomer. The tooth was then restored using amalgam. Clinical and radiographic evaluations were conducted at 6-month and 1-year follow-ups by blinded endodontists. Success rates were compared using Fisher's exact test and logistic regression tests with a significance level of 0.05. Among the 97 patients with 6-month and 1-year follow-ups, all achieved clinical success. Radiographic success rates were 99% at 6 months and 96.9% at 1 year, regardless of pulp calcification. In the 6-month follow-up, success rates were 98.07% for non-calcified pulp chambers and 100% for calcified pulp chambers. At the 1-year follow-up, success rates were 96.1% and 97.8%, respectively. Statistical analysis showed no significant difference in radiographic success rate between the two groups at both follow-ups (P>0.05). Full pulpotomy using CEM cement is a successful treatment for adult permanent teeth with calcified and non-calcified pulp chambers presenting signs and symptoms of irreversible pulpitis up to a 1-year follow-up. This study provides compelling evidence that vital pulp therapy can be effectively employed in the pulpotomy of calcified teeth, at least in the short term.

Normal Saline or Sodium Hypochlorite Irrigation for Vital Pulp Therapy? A Non-Inferiority Randomized Controlled Trial.

criteria were randomized to each irrigant, 65 in the NaOCl and 60 in the NSS groups. ProRoot® MTA was used as a pulp dressing material in both groups and teeth were followed for 12 months. The primary outcome was the success of VPT; requiring both clinical and radiographic success to be considered as success. The hypothesis was that the absolute difference of VPT success in the NSS group was not worse than that in the NaOCl group, by a margin of 5%. The secondary outcome was discoloration; percentages of discolorations between both groups were compared. Results: Using a per protocol analysis, the absolute difference of VPT success between the NSS and NaOCl groups was 2.08% (95% CI: -1.95, 6.1). Perceptible gray discolorations were 80% and 63% in NaOCl and NSS groups (difference -17%; 95% CI: -40.0, 6.2; p=0.15). Conclusions: For MTA-VPT procedure, irrigation with NSS was not worse than that with NaOCl. However, both irrigants caused discoloration. (EEJ-2023-05-065).

Advancements and challenges in stem/progenitor cell transplantation for dentin-pulp regeneration: a systematic review of animal studies (part I).

Dentin-pulp regeneration through stem/progenitor cell transplantation represents a promising frontier in regenerative endodontics. This systematic review meticulously evaluates animal studies to investigate the efficacy of stem cell therapy in repairing/regenerating the dentine-pulp complex in mature/immature animal teeth. Employing a comprehensive electronic search of PubMed and Scopus databases up to October 2023, relevant English studies were identified/assessed. Evaluation parameters encompassed radiographic and histological assessments of dentin-pulp complex formation. Outcome measures included pulp-like and dentin-like tissues regeneration, apical healing, dentin thickening, apical closure, and dentinal bridge formation. The risk-of-bias assessment adhered to the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) guidelines. Out of 3250 identified articles, 23 animal experiments were included, categorized into regenerative procedures in mature teeth (n=11), regenerative procedures in immature teeth (n=4), and vital pulp therapy (n=8). Despite the promising potential, the bias in the included studies was high. Notably, Various scaffolds, and growth factors were employed, highlighting the heterogeneity across the studies. Dental pulp stem cells (DPSCs) and bone marrow stem cells, especially specific subfractions, demonstrated notable regenerative potential: hypoxic conditions and extracellular vesicles from preconditioned DPSCs enhanced regeneration, with considerations of cell fate. Donor age impacted regeneration, and challenges persisted in pulpotomy and direct pulp capping. Scaffold and growth factor choices influenced outcomes, underscoring the need for standardized strategies. Despite the promise, clinical viability faces hurdles, necessitating further investigation into adverse effects, optimized scaffolds, and regulatory considerations. This systematic review illuminates the potential of stem cell transplantation for dentin-pulp complex regeneration. The overall evidence quality, influenced by study heterogeneity and biases, underscores the need for cautious interpretation of findings. Future studies should refine methodologies and establish reliable histological parameters for meaningful advancements in dentin-pulp regeneration.

Biomechanical impact of labiolingual diameter on endodontically treated anterior teeth with crown restoration under occlusal loading.

To evaluate the effect of the labiolingual diameter and construction of an endodontically treated (ET) anterior tooth with crown restoration on stress distribution and biomechanical safety under occlusal loading. Three-dimensional finite element models were generated for maxillary central incisors with all-ceramic crown restorations. The labiolingual diameters of the tooth, defined as the horizontal distance between the protrusion of the labial and lingual surfaces, were changed as follows: (D1) 6.85 mm, (D2) 6.35 mm, and (D3) 5.85 mm. The model was constructed as follows: (S0) vital pulp tooth; (S1) ET tooth; (S2) ET tooth with a 2 mm ferrule, restored with a fiber post and composite resin core; (S3) ET tooth without a ferrule, restored with a fiber post and composite resin core. A total of 12 models were developed. In total, two force loads (100 N) were applied to the crown's incisal edge and palatal surface at a 45° oblique angle to the longitudinal axis of the teeth. The Von Mises stress distribution and maximum stress of the models were analyzed. Regardless of the loading location, stress concentration and maximum stress (34.07~66.78MPa) in all models occurred in the labial cervical 1/3 of each root. Both labiolingual diameter and construction influenced the maximum stress of the residual tooth tissue, with the impact of the labiolingual diameter being greater. A reduction in labiolingual diameter led to increased maximum stress throughout the tooth. The ferrule reduced the maximum stress of the core of S2 models (7.15~10.69 MPa), which is lower compared with that of S3 models (19.45~43.67 MPa). The labiolingual diameter exerts a greater impact on the biomechanical characteristics of ET anterior teeth with crown restoration, surpassing the influence of the construction. The ferrule can reduce the maximum stress of the core and maintain the uniformity of stress distribution.

Apical Periodontitis in Vital and Nonvital Teeth: Clinical and Radiographic Features.

Apical periodontitis (AP) is a common inflammatory condition predominantly caused by the response of the immune system to microbial invasion within the root canal system. Contrary to conventional perception, AP may occur in vital teeth with inflamed pulp; adding complexity to diagnosis and treatment. AP, due to its frequent lack of symptoms and reliance on radiographic evaluation for detection, often presents diagnostic challenges. In addition, AP pathogenesis involves complex interactions between microbial virulence and host immune response at the cellular and molecular levels. Comprehensive diagnostic procedures, including patient history, clinical examination, and radiographic evaluation, are essential for early detection and necessary intervention, with the recognition of clinical signs and symptoms underscoring the importance of regular dental evaluations. The current review primarily discusses the radiographic and clinical features of AP in vital and non-vital teeth; introducing a new taxonomic classification to improve diagnostic precision and treatment outcomes. Moreover, it proposes different treatment categories/options for the management of AP, based on pulp status as well as clinical and radiographic findings; emphasizing vital pulp therapy and root canal treatment for vital and non-vital teeth with AP, respectively. Furthermore, the global and regional epidemiology of AP is presented, along with its association with systemic health conditions; e.g., cardiovascular diseases, diabetes mellitus, and adverse pregnancy outcomes. Moreover, future research directions are advocated to improve the efficacy and predictability of diagnosis and treatments; paving the path for clinicians in early detection, accurate diagnosis, and effective management of AP to enhance oral health outcomes.

A Narrative on Inflammatory Biomarkers in Endodontics

ABSTRACT One of the most common diseases causing the destruction of enamel and remaining tooth structure is dental caries which further leads to pulpal and periapical inflammation if not treated. As tools for revealing important factors in identifying targets disease and pathophysiology for the evolution of prevention and treatment strategies, molecular and cellular biology plays a pivotal role. Finding an accurate diagnosis that will serve as the foundation for effective treatment continues to be one of the key issues in endodontics. Inflammatory biomarkers play a diverse and broad role in endodontics, with the potential to become a key factor in determining treatment plans by assisting in diagnosis and prognosis. Inflammatory biomarkers have the potential to become a key factor in determining treatment plans by assisting in diagnosis and prognosis. Endodontists are still divided on issues such as vital pulp therapy versus traditional root canal therapy and retreatment versus periapical surgery. Furthermore, clinical challenges such as determining the appropriate tissue fluid to analyse, establishing a precise inflammatory threshold, and delivering results at the chairside must be overcome. Endodontists may soon be able to use chairside genetic tests to make more informed treatment decisions for their patients.

Efficacy for Lidocaine and Articaine in Inferior Alveolar Nerve Block - A Comparative Study.

Compare the efficacy of 2% lidocaine with adrenaline (1:200,000) and 4% articaine with adrenaline (1:100,000) in inferior alveolar nerve block prior to extraction of bilateral teeth posterior to canine in interval of one week. Thirty-five patients were selected for the study. Patients were divided into two different groups: Group 1 - (2% lignocaine with adrenaline (1:200,000)) and Group 2 - (4% articaine with adrenaline (1:100,000)) solution. The study variables for each anaesthetic agent were: onset of action and depth of anaesthesia. A pulp tester was used to demonstrate quantitative values and a visual analogue scale (VAS) was used for qualitative evaluation of the two anaesthetic drugs in 2 min cycle for 10 min with respect to test canine. Anaesthesia was considered successful when pulp tester value 64 was achieved in 10 min for both the anaesthetic agent. The difference in the efficacy of lignocaine and articaine was analysed using Student's t test. Within group comparison of the response to the pulp vitality test and VAS over various time periods was analysed using repeated measures Analysis of Variance (ANOVA) with post-hoc Bonferroni test. Data analysis showed statistical differences in onset and depth of anaesthesia between the two groups (P < 0.05). 4% Articaine with adrenaline (1:100,000) onset of action is faster and depth of anaesthesia is better compared to 2% lignocaine with adrenaline (1:200,000). Many previous studies reported onset of anaesthesia, but this study evaluates onset and depth of both the anaesthetic agent quantitatively and qualitatively.

Cytotoxicity of dilutions of bioceramic materials in stem cells of human exfoliated deciduous teeth.

Several materials have been developed to preserve pulp vitality. They should have ideal cytocompatibility characteristics to promote the activity of stem cells of human exfoliated deciduous teeth (SHED) and thus heal pulp tissue. To evaluate the cytotoxicity of different dilutions of bioceramic material extracts in SHED. SHED were immersed in αMEM + the material extract according to the following experimental groups: Group 1 (G1) -BBio membrane, Group 2 (G2) - Bio-C Repair, Group 3 (G3) - MTA Repair HP, Group 4 (G4) - TheraCal LC, and Group 5 (G5) - Biodentine. Positive and negative control groups were maintained respectively in αMEM + 10% FBS and Milli-Q Water. The methods to analyze cell viability and proliferation involved MTT and Alamar Blue assays at 24, 48, and 72H after the contact of the SHED with bioceramic extracts at 1:1 and 1:2 dilutions. Data were analyzed by the three-way ANOVA, followed by Tukey's test (p<0.05). At 1:1 dilution, SHED in contact with the MTA HP Repair extract showed statistically higher cell viability than the other experimental groups and the negative control (p<0.05), except for TheraCal LC (p> 0.05). At 1:2 dilution, BBio Membrane and Bio-C showed statistically higher values in intra- and intergroup comparisons (p<0.05). BBio Membrane, Bio-C Repair, and Biodentine extracts at 1:1 dilution showed greater cytotoxicity than 1:2 dilution in all periods (p<0.05). MTA HP Repair showed the lowest cytotoxicity even at a 1:1 dilution. At a 1:2 dilution, the SHED in contact with the BBio membrane extract showed high cell viability. Thus, the BBio membrane would be a new non-cytotoxic biomaterial for SHED. Results offer possibilities of biomaterials that can be indicated for use in clinical regenerative procedures of the dentin-pulp complex.

The quality of dental care in children with permanent teeth trauma according to analysis of medical records in an emergency unit of a municipal dental clinic

Was to assess the efficacy and timing of emergency dental care in children with permanent teeth trauma according to analysis of medical records in an emergency unit of a municipal dental clinic. The study involved 320 medical records of pediatric patients admitted to emergency dental care unit of a municipal dental clinic in 2021 because of maxillofacial trauma from which 221 records of children with acute dental trauma were extracted. The quality of documentation of the medical records, rationale for diagnosis and adequacy of emergency dental treatment were analyzed. No records included diagnosis code according to ICD-10. Trauma history was described in the majority of records by in 67% of them no trauma time was stated with proper precision. In 67.6% of permanent teeth trauma cases emergency aid was carried out inadequately. All patients with uncomplicated crown fractures were dismissed with no treatment. In complicated crown fractures needing pulp vitality preservation the pulp was devitalized or just anesthetized. Tooth replantation in avulsion cases was not performed. In 13.5% of records the treatment was not properly described. In 67.6% of records there were no recommendations for follow-ups. There is a strong need for the improvement of knowledge of traumatic dental injuries management among Russian pediatric dentists by elaboration and implementation of protocols for dental traumas treatment.

Clinical Comparison of Three Indirect Pulp Capping Restorative Protocols: A Randomized Controlled Prospective Study.

The objective of this prospective double-blind clinical trial was to compare clinical outcomes of indirect pulp capping restorative protocols on permanent teeth over a 12-month period. Deep carious lesions in permanent teeth (90) were randomly assigned to three indirect pulp capping protocols (n=30: TheraCal LC, Dycal, and no liner). All teeth were restored with resin composite. The outcome measures were pain (VAS scale) and success rate (pulp vitality based on percussion, palpation, cold test, and radiographic findings), collected at screening, intervention, and 24-hour, 7-day, 3-month, 6-month, and 12-month follow-up visits. There was no statistically significant difference in tooth sensitivity among the three indirect pulp capping protocols nor in success rates among the restorative protocols after 1 year of follow-up (p>0.1).The respective success rates, as defined by the tooth remaining vital, after 1 year were: 96.2% for TheraCal LC, 100% for Dycal, and 100% for no liner. After 12-month evaluation, the success rate of indirect pulp capping therapy on permanent teeth was not affected by the pulp capping restorative protocol.

Pulpotomy v/s pulpectomy in 6 to 9 years old children

Background: The main goal of pulp treatment is to preserve the health and integrity of the oral tissues. Early primary tooth loss can result in malocclusion and temporary or permanent issues with appearance, phonetics, and function. While it is desirable to try to maintain pulp vitality wherever possible, the pulp can be completely removed without seriously impairing the tooth's ability to function. Aim: To compare the prevalence of pulpectomy and pulpotomy procedures done in 6 to 9 years old children Materials and method: The study was a retrospective cross-sectional analysis, evaluating dental outpatient records and analyzing data from 86,000 patients between June 2020 and April 2021 to collect case records of 6 to 9-year-old children undergoing pulpectomy and pulpotomy procedures. We selected children between the ages of 6 and 9 who underwent pulpectomy and pulpotomy procedures. Using the SPSS software, the data was compiled followed by statistical analysis. Results: Of the total number of children screened, about 96% of the patients between 6-9 years of age underwent pulpectomy whereas the remaining 4% underwent pulpotomy. Of these patients, 56% of them were males and about 44% of them were females. About 75% of these pulpectomy procedures were performed in posterior teeth whereas only 25% of them were done in anterior teeth Conclusion: From this study it can be concluded that in a university setting, pulpectomy was most predominantly performed in children of 6-9 years of age and the most commonly involved teeth were the posteriors.

The regenerative potential of Tideglusib and CHIR99021 small molecules as potent odontogenic differentiation enhancers of human dental pulp stem cells.

To assess the effect of Tideglusib and CHIR99021 small molecules on the odontogenic differentiation potential of human dental pulp stem cells (hDPSCs) via Wnt/β-catenin pathway activation. hDPSCs were isolated from impacted third molars indicated for extraction and were characterized by flow cytometry. hDPSCs were then induced to differentiate into odontogenic lineage in the presence of Tideglusib and CHIR99021. Odontogenic differentiation was evaluated using Alizarin Red stain and RT-PCR for expression of odontogenic specific differentiation markers: DSPP, DMP1, ALP, OPN, and RUNX2 in relation to undifferentiated cells. RT-PCR was also conducted to assess the expression of Wnt/β-catenin pathway activation marker (AXIN2). One-way ANOVA Kruskal-Wallis test was used for statistical analysis. Wnt/β-catenin pathway was successfully activated by Tideglusib and CHIR99021 in hDPSCs where AXIN2 was significantly upregulated. Successful odontogenic differentiation was confirmed by Alizarin Red staining of calcified nodules. RT-PCR for odontogenic differentiation markers DSPP, DMP1, and RUNX expression by hDPSCs induced by CHIR99021 was higher than that expressed by hDPSCs induced by Tideglusib, whereas expression of OPN and ALP was higher in Tideglusib-induced cells than in CHIR99021-induced cells. Both small molecules successfully induced odontogenic differentiation of hDPSCs through Wnt/β-catenin pathway activation. These findings suggest that Tideglusib and CHIR99021 can be applied clinically in pulp regeneration to improve strategies for vital pulp regeneration and to promote dentine repair.

An international consensus study to identify "what" outcomes should be included in a core outcome set for endodontic treatments (COSET) for utilization in clinical practice and research.

Development of a standardized set of topic-specific outcomes known as a Core Outcome Set (COS) is important to address issues of heterogeneity in reporting research findings in order to streamline evidence synthesis and clinical decision making. The aim of the current international consensus study is to identify "what" outcomes to include in the Core Outcome Set for Endodontic Treatments (COSET). Outcomes of various endodontic treatments (non-surgical root canal treatment, surgical endodontics, vital pulp treatmentand revitalization procedures) performed on permanent teeth were considered. A standard validated methodology for COS development and reporting was adopted. The process involved identification of existing outcomes through four published scoping reviews. This enabled creation of a list of outcomes to be prioritized via semi-structured patient interviews, e-Delphi processand a consensus meeting with a range of relevant global stakeholders. Outcomes were prioritized using a 1-9 Likert scale, with outcomes rated 7-9 considered critical, 4-6 are important and 1-3 are less important. Outcomes rated 7-9 by ≥70% and 1-3 by <15% of participants were considered to achieve consensus for inclusion in the COS. The outcomes that did not achieve consensus in the first round were considered for further prioritization in the second Delphi round and consensus meeting. Final decisions about the outcomes to include in COSET were made by voting during the consensus panel meeting using the Zoom Poll function. A total of 95 participants including patients contributed to the COS development process. The consensus panel recommended, with strong consensus, eight outcomes shared across all treatment modalities for inclusion in COSET: pain; signs of infection (swelling, sinus tract); further intervention/exacerbation; tenderness to percussion/palpation; radiographic evidence of disease progression/healing; function; tooth survival; and patient satisfaction. Additional treatment specific outcomes were also recommended. Many of the outcomes included in COSET are patient reported. All should be included in future outcomes studies. COSET identified outcomes that are important for patients and clinicians and validated these using a rigorous methodology. Further work is ongoing to determine "how" and "when" these outcomes should be measured.