Pulp Exposure Research Articles

Role of Actinomyces in the Progression of Medication-related Osteonecrosis of the Jaws in an Immunocompromised Mouse Model with Periapical Disease

ObjectivesThis study aimed to investigate the role of Actinomyces on the development of MRONJ in an immunocompromised mouse model with periapical disease. MethodsThirty ovariectomized C57BL/6N female mice were treated with zoledronic acid (ZA) and dexamethasone (DX) for 12 weeks. At the eighth week of drug administration, pulpal exposure operation was performed on the lower right first molar in Group B and C, meanwhile Actinomyces inoculation was performed at the pulpal entrance of Group C. Group A received no operation as control. After 4 weeks, loads of total bacteria and Actinomyces in the oral cavity were assessed by real-time polymerase chain reaction (PCR). Mandibles were harvested for micro-computed tomography (CT) and histological analysis. ResultsReal-time PCR revealed positive detection of Actinomyces in 30% samples in Group C and negative detection in all samples in Group B and control group. Micro-CT examination demonstrated that in ZA treated mice, pulpal exposure significantly increased periapical bone loss, which was significantly aggravated by Actinomyces inoculation. Histological assessment showed vasodilation, acute exudative changes and pulp necrosis in Group B and C. ConclusionsThe present study revealed that inoculation of Actinomyces compromises the bone quality but does not further aggravate bone necrosis significantly.

Morphometric parameters of dental pulp in immature teeth in a sheep model after mechanical pulp exposure and restoration with reinforced zinc oxide-eugenol

Background: The aim of the study was to investigate the morphometric parameters of dental pulp in open apices immature teeth in a sheep model after mechanical pulp exposure and restoration with reinforced zinc oxide-eugenol. Materials and Methods: In this experimental study, a total of 12 immature mandibular central incisors from six adult male sheep, weighing 30–40 kg and with the age of 1 year old with Merino race were examined. After anesthesia, the pulps of the teeth in the case group were mechanically exposed and then were restored with reinforced zinc oxide-eugenol and amalgam. In the control group, the teeth remained intact. The animals were sacrificed at intervals of 2, 4, 6, and 8 weeks (E2, E4, E6, and E8) in the case and 2 and 8 weeks (C2 and C8) in the control groups. Then, their teeth were removed with the surrounding supporting tissues and alveolar bones. Tissue processing and staining were done, and the sections were examined under a light microscope. The Kruskal–Wallis and Mann–Whitney U tests were used to analyze the data and compare the changes between the two groups. P < 0.05 was considered statistically significant. Results: In response to mechanical exposure, reparative or tertiary dentin was formed, and its thickness increased during the time of the study. The thickness of the odontoblastic layer in the E4 group was the highest amount. The pulp chamber diameter in the C2 group was significantly larger than the other groups, and the diameter of the apical foramen in the E8 was decreased significantly compared to the controls (P < 0.05). Conclusion: In response to mechanical exposure and restoration with reinforced zinc oxide-eugenol, some morphometric parameters of the dental pulp changed significantly in the sheep model compared to the controls.

High-Fat Diet Influences Dendritic Cells and T-Cell Infiltration in Apical Periodontitis in Mice

IntroductionDiet-induced metabolic syndrome may influence the progression and healing of apical periodontitis (AP). The aim of this study was to evaluate the inflammatory immune response of dendritic cells (DCs) and T helper (Th) cells in normal versus obese mice with AP. MethodsTwenty male C57BL/6 mice were divided into 2 groups: normal chow (NC) and high-fat diet (HFD) for 12 wk. AP was induced in both groups by creating pulp exposure of the right first maxillary molar to the oral environment. Contralateral first molars from each mouse were used as a control. The animal's body mass was recorded on a weekly basis, and they were euthanized after 30 d. The maxillae were removed and processed for micro-computed tomography (micro-CT), histologic analysis, and immunofluorescence staining for DCs (CD11c), Th17 (IL-17A), and T regulatory cells (FOXP3 and IL-10). Different groups were analyzed by Mann-Whitney U test, Student t test, and ordinary 1-way analysis of variance followed by Tukey's multiple comparisons test. The level of significance (α) was set at 0.05. ResultsThe HFD group showed larger AP lesions than the NC group from micro-CT analysis. For the NC group, induction of AP significantly increased immune cell infiltration when compared with control. HFD showed increased DCs and Th17 infiltration in the control group without AP. In addition, there was no significant change in the amount of DCs and Th17 in the HFD-AP group when compared with the NC-AP and HFD-control groups. ConclusionsHFD resulted in an increased immune cell infiltration in the periapical area without AP. Despite the larger AP lesion observed in HFD-AP than that of NC-AP, the amount of infiltrated inflammatory cells did not differ significantly. The results of this study suggest that the DCs and Th17 inflammatory pathways are affected by HFD in the periapical region, but their contribution toward AP complicated by metabolic syndrome requires further investigation.

Traumatic Dental Injuries Among 6 – 13 – Year - Old - School Children in Tikrit City

Background: An injury to both primary and permanent teeth and the supportingstructures is one of the most common dental problems seen in children. The extentof injury may vary from mild chipping of enamel to sever maxillofacial injury.The aim of this study was to find out the prevalence of traumatized anterior teethamong primary school children.Materials and methods: This study is a cross-sectional survey was carried outthrough clinical examination of anterior teeth among 720, 6-13 year old childrenenrolled in primary public schools of tikrit city. The prevalence of traumatizedanterior teeth was studied in relation to age, gender, type of injury in addition tothe cause of fracture. Recording and diagnosis of dental fracture were assessedaccording to Garcia-Godoy classification.Results: Males were more affected than females with odds ratio was 2.53 andstatistically was significant. The higher prevalence of dental trauma was recordedamong the age 10-11 year old. The permanent maxillary central incisors were themost frequent injured tooth and the most frequent type of fracture was the Class IIEnamel-Dentine, fracture without pulp exposure. Fall and playing were the mostfrequent causes of dental injury.Conclusion: data of the present study clearly show the need for dental healtheducation of children and their parents, so prevention programs are needed toimprove the dental health of Iraqi children.

Outcomes and predictive factors of vital pulp therapy in a large-scale retrospective cohort study over 10 years

This cohort study evaluated the long-term success/survival of vital pulp therapies (VPTs) after carious pulp exposure in adult teeth. Additionally, factors influencing long-term success were identified. Teeth treated during 2011–2022 in a private clinic were studied with clinical/radiographic follow-ups. Data included patient demographics, tooth specifics, and treatment details. Outcomes were classified as success/failure based on clinical/radiographic findings, with tooth functionality determining the survival rate. Encompassing 1149 patients and 1257 VPT-treated teeth, the average monitoring period was 42.2 months. Overall VPTs’ survival and success rates were 99.1% and 91.6%, respectively. Success rates for 768 direct pulp cappings, 217 miniature pulpotomies, and 272 full pulpotomies were 91.9%, 92.6%, and 90.1%, respectively (P > 0.05). Influencing factors included symptomatic irreversible pulpitis (SIP; HR 1.974, 95% CI 1.242–3.137; P = 0.004), radiographic signs of apical periodontitis (AP; HR 2.983, 95% CI 1.961–4.540; P < 0.001), restoration type (HR 2.263, 95%CI 1.423–3.600; P = 0.001), and restoration surfaces (HR 1.401, 95%CI 1.034–1.899; P = 0.030). This study concludes that VPT techniques consistently exhibit high long-term success/survival rates in treating carious pulp exposures. Critical predictors include initial clinical signs of SIP/AP, caries extent, and use of composite restorations.

Which caries removal method to select?

Searches were carried out using PubMed/MEDLINE and Web of Science databases between January 2008 and January 2023. Only articles in English language were included. Boolean operators were used to search: "permanent teeth" OR "permanent tooth" OR "permanent dentition" AND "deep caries" OR "stepwise" AND "partial caries removal OR "stepwise caries removal" OR "pulp vitality" OR "healing rate". Inclusion criteria were randomised controlled trials, which compared the total removal of carious tissue with either a selective or stepwise removal in permanent teeth with deep carious lesions. Criteria also required a follow up of at least 6 months and publications in English. Exclusion criteria were articles in other languages, articles not comparing different types of total or selective caries removal and articles published before January 2008. Data extraction followed PRISMA guidelines. Two reviewers independently screened articles, analysing titles and abstracts using Rayyan's Intelligent Systematic Review Platform. They also collected data and risk of bias assessed using the Cochrane Risk of Bias Tool for Randomised Trials, dividing articles into high risk of bias, few concerns and low risk of bias. A third researcher resolved conflict or doubt in case of divided opinions. In total, 105 articles were identified, and 10 duplicates removed. 95 articles were reviewed by title and abstract and 75 of these did not meet the inclusion criteria. 20 articles were then read, excluding a further 15 due to comparing only partial removal or non-selective caries removal or absence of numerical data. This left 5 articles which met eligibility criteria. These were randomised controlled trials between 2010 and 2021. Follow up ranged from 1 month to 5 years. The inclusion and exclusion criteria in all studies had similar clinical parameters. 3 studies performed management only on permanent molars, whilst the rest also included management on permanent incisors/canines/premolars and molars. Management of caries was divided into non-selective caries removal vs partial caries removal (either selective or stepwise). All but 2 studies included specific information about the materials used. Liners were calcium hydroxide or Dycal, provisional restorations were glass ionomer cements or Ketax Molar and definitive restorations were Herculite Tetric N-Ceram resin, Ivolclar Vivadent or amalgam. Clinical success or failure was measured using pulp vitality, absence of periapical lesions, radiographic analysis and lack of symptoms. Clinical follow up was evaluated by external examiners, although 2 studies did not specify this clearly. There were a variety of tools used for statistical analysis in each study. When comparing non-selective caries removal with either selective or stepwise, 3 studies proposed statistically significant differences in terms of longevity, marginal integrity and success rate of restorations. 1 study stated inexistence of statistically relevant divergences between procedures. Non-selective caries removal is not highly recommended for deep carious lesions and may be considered invasive and risks pulpal exposure. Both selective and stepwise removal are considered conservative approaches. Selective removal is considered the best management option in the short term (with 1.5 years follow up), predominantly related to a lower risk of pulpal exposure. At 5 years, however, the results of selective were similar to those of non-selective, accepting the null hypothesis. There were also no differences in success rates for materials used for definitive restorations.

The Reparative Function of MMP13 in Tertiary Reactionary Dentinogenesis after Tooth Injury.

MMP13 gene expression increases up to 2000-fold in mineralizing dental pulp cells (DPCs), with research previously demonstrating that global MMP13 deletion resulted in critical alterations in the dentine phenotype, affecting dentine-tubule regularity, the odontoblast palisade, and significantly reducing the dentine volume. Global MMP13-KO and wild-type mice of a range of ages had their molar teeth injured to stimulate reactionary tertiary dentinogenesis. The response was measured qualitatively and quantitatively using histology, immunohistochemistry, micro-CT, and qRT-PCR in order to assess changes in the nature and volume of dentine deposited as well as mechanistic links. MMP13 loss affected the reactionary tertiary dentine quality and volume after cuspal injury and reduced Nestin expression in a non-exposure injury model, as well as mechanistic links between MMP13 and the Wnt-responsive gene Axin2. Acute pulpal injury and pulp exposure to oral fluids in mice teeth showed upregulation of the MMP13 in vivo, with an increase in the gene expression of Mmp8, Mmp9, and Mmp13 evident. These results indicate that MMP13 is involved in tertiary reactionary dentine formation after tooth injury in vivo, potentially acting as a key molecule in the dental pulp during dentine-pulp repair processes.

Treatment strategies for deep caries

Deep caries occurs when caries progresses to the deep dentin layer, and further progression has the risk of pulp exposure, which may affect pulp vitality and tooth longevity. Currently, there are no objective standards for the diagnosis of deep caries. In addition, traditional therapy for deep caries emphasizes complete debridement of the decayed tissue, resulting in an incremental high risk of pulp exposure. There are different views on how to deal with the remaining dentin after caries removal, and root canal treatment is often adopted directly after pulp exposure. In recent years, due to advances in dental pulp biology, bioactive pulp-capping materials, and clinical evidence-based medicine, the principle of deep caries treatment has shifted to pulp protection. Based on the latest international research progress, evidence-based medicine and expert consensus, we present a series of advancements in this article, including the terminology of deep caries, pathological changes and defense mechanisms of the pulp close to the deep caries, treatment principles of deep caries, technical strategies for carious tissues removal, and the decision-making of treatment protocols after pulp exposure, with the aim of enhancing the understanding of deep caries among dentists, as well as providing a reference for the clinical diagnosis and treatment of deep caries.

Effects of mineral trioxide aggregate and methyl sulfonyl methane on pulp exposure via RUNX2 and RANKL pathways.

The aim of this study was to determine the therapeutic effects of mineral trioxide aggregate (MTA) and methyl sulfonyl methane (MSM) on pulp damage due to pulp exposure through the RUNX2 and RANKL pathways. Seventy-two male Sprague-Dawley rats aged 4-6months and weighing 250-300g were divided into healthy, control, MTA, and MSM groups. After experimental applications, all rats at 2, 4, and 8 weeks were killed anesthetically with xylazine hydrochloride (Rompun, Bayer) 30mg/kg and ketamine hydrochloride (Ketalar, Pfizer) 50mg/kg injections (i.p.). We observed that necrotic odontoblasts, edema, inflammation, and vascular congestion findings were reduced from week 2 to week 8 in the MSM treatment group after pulp capping compared to the control group and MTA group. Similarly, we found a decrease in RUNX2 and RANKL levels in the MSM application group compared to the control and MTA groups (p < 0.05). MSM material has shown therapeutic effects on pulp capping treatment-induced pulp injury via increased RUNX2 ve RANKL expression.

Evaluation for the efficacy of haemocoagulase agent (botroclot) as a pulpotomy material as compared to ferric sulfate- an animal study.

Deciduous teeth are thought to be best space maintainers; thus efforts are made to preserve these teeth for as long as possible. Grossly carious primary teeth should be restored and maintained which is the primary objective of “Pediatric dentistry”. Pulpotomy is done in the primary teeth where mechanical pulp exposure occurs during caries removal. All the functions of the radicular pulp are expected to be maintained by pulpotomy procedure. The main objectives are 1) managing reversible pulpal inflammation and keeping pulp in a vital condition. 2) maintain the function of the radicular pulp in deciduous teeth. Success of Pulpotomy procedure is dependent on many factors, and the ability of the pulpotomy medicament being hemostatic is one of the most vital factors to maintain the vitality of the radicular pulp. Considering the limitations of commonly used pulpotomy medicaments for primary teeth i.e. Formocresol and also the disadvantages associated with the hemostatic Ferric sulfate, the present study will be carried out using hemocoagulase (“botroclot”) which has shown improved hemocoagulant properties in the medical field and for healing the extraction socket wounds. The available solution of hemocoagulase agent converted in suitable Gel form will be tested for its tissue compatibility and hemocoagulant efficacy when used as pulpotomy material . The study will be conducted in two phases, I) Formulation of the gel and in vitro tests; II) Animal study to check histopathological effect on the pulp tissue as a pulpotomy agent.

Autophagy induced by hypoxia in pulpitis is mediated by HIF-1α/BNIP3

ObjectiveHypoxia-inducible factor-1α (HIF-1α) and its downstream factor, 19 kDa BCL-2 interacting protein 3 (BNIP3), promote cellular autophagy under hypoxic conditions. However, their roles in pulpitis are unclear. Therefore, the changes in inflammatory response and autophagy levels caused by hypoxia during pulpitis were evaluated. Additionally, the regulatory mechanism of HIF-1α/BNIP3 in cellular autophagy in pulpitis was explored. DesignPulp from dental pulp tissues of healthy individuals and patients with pulpitis (n = 10) were exposed and combined with a low oxygen simulation chamber to construct pulpitis (n = 6), hypoxia (n = 6), and hypoxia+pulpitis (n = 6) rat models. Hematoxylin and eosin and immunohistochemical staining were used to detect the localization and expression levels of HIF-1α, BNIP3, and autophagy marker protein, LC3B. Transmission electron microscopy was used to confirm autophagosome formation. An in vitro hypoxic model of human dental pulp cells was established, and HIF-1α chemical inhibitor 3-(5′-hydroxymethyl-2′-furyl)− 1-benzylindazole (YC-1) was administered. Immunofluorescence and western blotting were used to detect the localization and protein levels of HIF-1α, BNIP3, and LC3B. ResultsAutophagy is significantly increased and HIF-1α and BNIP3 are elevated in inflamed dental pulp tissue. Both pulp exposure and hypoxia intervention cause inflammatory reactions in rat dental pulp tissue, accompanied by the autophagy activation. Hypoxia significantly enhances HIF-1α/BNIP3 and autophagy activation. BNIP3 downregulates and autophagy reduces after treatment with YC-1. ConclusionsIn pulpitis, activation of the HIF-1α/BNIP3 signaling pathway driven by hypoxia leads to increased autophagy. This provides a new molecular explanation for autophagy activation in apical periodontitis and new insights into the pathogenesis of the disease.

CXXC5 mitigates P. gingivalis-inhibited cementogenesis by influencing mitochondrial biogenesis

BackgroundCementoblasts on the tooth-root surface are responsible for cementum formation (cementogenesis) and sensitive to Porphyromonas gingivalis stimulation. We have previously proved transcription factor CXXC-type zinc finger protein 5 (CXXC5) participates in cementogenesis. Here, we aimed to elucidate the mechanism in which CXXC5 regulates P. gingivalis-inhibited cementogenesis from the perspective of mitochondrial biogenesis.MethodsIn vivo, periapical lesions were induced in mouse mandibular first molars by pulp exposure, and P. gingivalis was applied into the root canals. In vitro, a cementoblast cell line (OCCM-30) was induced cementogenesis and submitted for RNA sequencing. These cells were co-cultured with P. gingivalis and examined for osteogenic ability and mitochondrial biogenesis. Cells with stable CXXC5 overexpression were constructed by lentivirus transduction, and PGC-1α (central inducer of mitochondrial biogenesis) was down-regulated by siRNA transfection.ResultsPeriapical lesions were enlarged, and PGC-1α expression was reduced by P. gingivalis treatment. Upon apical inflammation, Cxxc5 expression decreased with Il-6 upregulation. RNA sequencing showed enhanced expression of osteogenic markers, Cxxc5, and mitochondrial biogenesis markers during cementogenesis. P. gingivalis suppressed osteogenic capacities, mitochondrial biogenesis markers, mitochondrial (mt)DNA copy number, and cellular ATP content of cementoblasts, whereas CXXC5 overexpression rescued these effects. PGC-1α knockdown dramatically impaired cementoblast differentiation, confirming the role of mitochondrial biogenesis on cementogenesis.ConclusionsCXXC5 is a P. gingivalis-sensitive transcription factor that positively regulates cementogenesis by influencing PGC-1α-dependent mitochondrial biogenesis.A5vAuiTS6Tkq1RfziX_nr_Video

Vascular Endothelial Growth Factor Expression in Pulp Regeneration Treated By Hyaluronic Acid Gel in Rabbits

Among the most common dental problems, dental caries and trauma lead to the development of cavities and even tooth loss. Therefore, new regeneration techniques that are effective and toxic-free are needed. The use of scaffolds has created possibilities for the regeneration of tooth structure. Hydrogels made of hyaluronic acid have drawn many attention in regenerative medicine. Consequently, the objectives of the study were to estimate the impact of hyaluronic acid on pulp regeneration using histological evaluation and immunohistochemical localization of vascular endothelial growth factor (VEGF). The entire sample consisted of 20 teeth (right and left upper central incisors) from ten rabbits, Their ages were between 10 and 12 months. They were used for pulp exposure and coronal pulp tissue removal. After pulp exposure, hyaluronic acid hydrogels were injected into the pulp chambers of the right upper central incisors in the experimental group to promote pulp regeneration. The pulp chambers of the left upper central incisors considered as the control group, and they were temporarily filled in without the injection of hyaluronic acid. The histological and immunohistochemical evaluations were done in two time periods: the first and second week after pulp exposure. The histological results showed the formation of reparative dentin in the experimental group with a high mean value (56.3) regarding predentin thickness, especially in the second-week duration, and a significant difference as compared with the control group. The immunohistochemical results disclosed that the experimental group showed strong positive expression for vascular endothelial growth factor in different pulpal cells with the highest mean value of the number of positively expressed cells (34.3) in the second- week duration, with a significant difference as compared with the control group. Hyaluronic acid hydrogel had a supporting function in pulp regeneration, according to the findings of the current study. This was demonstrated by an increase in the expression of VEGF throughout the cells in pulp tissue.

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 &lt; 0.05). Conclusion: There was a lack of agreement in managing deep carious lesions. There was partial awareness of the management of exposed pulp.

Single-unit cantilevered resin-bonded bridge: an alternative for maxillary lateral incisor replacement

Fixed partial denture (FPD) prostheses restore esthetics and function by connecting and fixing to adjacent teeth. Conventional FPDs require, for better retention and resistance, extensive preparations. Those preparations include buccal, palatal or lingual coverage, proximal guide planes, chamfers and /or grooves to optimize retention.1–4 The removing of such large amount of tooth structure increases the risk of periodontal complications and pulp exposure.1,3 In 1973, Rochette introduced resin bonded FPDs as a less invasive therapeutic option. He pioneered the use of lingual perforated cast alloy framework with acid etch composite for periodontal splinting of the anterior region.5 However, early Rochette bridges presented high failure rates. Since then, resin bonded FPDs have evolved with different framework materials and designs. Even though metal frameworks are highly resistant, they do have esthetical and mechanical limits such as the greyish appearance of the abutment teeth and dislodgment by the early loss of retention.2–4,7 This led to introducing metal free FPDs, also widely developed thanks to adhesive dentistry. The preparation designs for RBFPDs were strictly limited to the enamel. Studies revealed a survival rate of 86% after 3 years without retentive preparation.6 All Ceramic RBFPDs have been introduced in the early nineties of the last century as a treatment option for missing incisors. Adhesive dentistry has undergone major transformations in current concepts. It has launched new resin bonded FPD designs that allowed to be more conservative such as single unit cantilevered ceramic bridges which become the most commonly used design when replacing lateral incisor especially when implant supported crowns cannot be indicated.8 Placing an implant is not always possible in cases where there is an insufficient bone height or width or for patients with general pathologies that may limit implant indications. That is why in some cases it is compulsory to indicate an FPD. Anterior ceramic RBFPDs showed promising results and high survival rates. They have proved to be viable and reliable alternative.8

Cytotoxic effects on human dental pulp stem Cells after exposure to adhesive bonding agents.

Studies regarding cytotoxic effects attributed to the use of adhesive bonding agents on pulp tissue are not conclusive. To point out whether these materials are safe for clinical use, in vivo exposure of dental pulp to adhesive bonding agents was simulated using an experimental setup in which Human Dental Pulp Stem Cells (hDPSC) are exposed to the action of two kinds of adhesives: self-etching adhesives and two-step bonding agents through a dentine barrier. Cytotoxic effects on these cells were evaluated by MTT assay protocol and fluorescence microscopy, and their results were contrasted to those obtained through Raman spectra taken on single hDPSCs. Overall, no significant cytotoxic effects were observed by combining all the techniques, and cell viability close to 90% was achieved for a dentine barrier of at least 1 mm thick. Moreover, Raman spectroscopy was able to detect structural DNA damage in some dental pulp cells when exposed to two-step bonding agents, suggesting that this technique could be considered a complementary tool with the potential to evaluate cell toxicity beyond cell viability.

Effect of submucosal cryotherapy compared with steroids and NSAIDs injections on Substance P and Interleukin 6 pulpal release in experimentally induced pulpal inflammation in rabbits.

To compare the effect of submucosal cryotherapy using cold saline to dexamethasone sodium phosphate and diclofenac sodium injections on substance P and interleukin 6 release in experimentally induced pulpal inflammation in rabbits' molar teeth. Fifteen rabbits were randomly classified into 3 groups according to the submucosal injection given: cold saline, dexamethasone sodium phosphate, and diclofenac sodium. A split-mouth design was adopted, the right mandibular molars were experimental, and the left molars served as the control without injections. Intentional pulp exposures were created and left for 6 hours to induce pulpitis. Pulpal tissue was extracted and examined for SP and IL-6 levels using ELISA. Within each group, the level of cytokines released was measured for both control and experimental groups for intragroup comparison to determine the effect of injection. The percentage reduction of each mediator was calculated compared with the control side for intergroup comparison then the correlation between SP and IL-6 levels was analyzed using Spearman's rank order correlation coefficient. Statistical analysis was performed, and the significance level was set at p<0.05. Submucosal cryotherapy, dexamethasone sodium phosphate, and diclofenac sodium significantly reduced SP and IL-6 pulpal release. Submucosal cryotherapy significantly reduced SP more than and IL-6 more than dexamethasone sodium phosphate and diclofenac sodium. Pulpal reduction of SP and IL-6 showed a strong positive significant correlation. Submucosal cryotherapy reduces the pulpal release of SP and IL-6 and could be tested as an alternative to premedication to potentiate the effect of anesthesia and control postoperative endodontic pain.

Efficacy of pulpotomy for permanent teeth with carious pulp exposure: A systematic review and meta-analysis of randomized controlled trials.

This meta-analysis aims to assess the success rate of pulpotomy in the treatment of permanent teeth with carious pulp exposure and to compare the efficacy of different capping materials. Randomized controlled trials were searched in PubMed, EMBASE, Web of Science, Clinicaltrial.gov, and Cochrane Library until August 31, 2023. The pooled success rate was estimated in the overall population and in subgroups. Additional analyses comparing different capping materials using odds ratio (OR) and 95% confidence interval (95%CI) were performed. The certainty of evidence was graded using the GRADE approach. A total of 25 randomized trials with an average follow-up duration ≥ 12 months were finally included. The overall success rate of pulpotomy was 86.7% (95%CI: 82.0-90.7%). The success rate was not significantly affected by root development, pulpotomy type, and follow-up duration. Teeth with irreversible pulpitis had a relatively lower success rate than teeth with normal pulp or reversible pulpitis (82.4% [95%CI: 74.6-89.0%] vs 92.0% [95%CI: 87.9-95.4%], P = 0.013). Directly compared to conventional calcium hydroxide, mineral trioxide aggregate (88.2% vs 79.1%, OR = 2.41, 95%CI: 1.28-4.51, P = 0.006) and Biodentine (97.5% vs 82.9%, OR = 6.03, 95%CI: 0.97-37.6, P = 0.054) had higher successful rates. No significant difference between MTA and other biomaterials was found. The results were graded as very low to low certainty of evidence. In conclusion, pulpotomy is an effective treatment of permanent teeth with carious pulp exposure. Mineral trioxide aggregate and Biodentine can be recommended with more favorable outcomes as capping materials.

Expression of Selected Inflammatory Mediators with Different Clinical Characteristics of Pulpal Inflammation

IntroductionAccurately diagnosing the state of dental pulp is crucial when addressing tooth pain to determine the best treatment approach. This study aimed to investigate the concentration of inflammatory mediators in the dental pulp of mature teeth that have been exposed via caries but show no signs of apical periodontitis. MethodsSamples of pulpal blood from adults with mature teeth responsive to pulp testing and have carious pulp exposures were obtained. These samples were analyzed for 12 inflammatory cytokines and other inflammatory proteins using the Luminex assay platform. Clinical factors were correlated with cytokine levels, and statistical analysis was performed to evaluate the impact of these factors on cytokine expression. ResultsOf the 36 patients that were included, 44.44% took pain medications, 33.33% had prolonged pulpal bleeding, 41.67% felt spontaneous pain, and 72.22% were diagnosed with symptomatic irreversible pulpitis. Significant correlations existed between presenting pain scores and levels of interleukin (IL)-1α, IL-6, and IL-8 (P < .05). Factors like analgesic medication intake, pain to percussion, pain to thermal testing, spontaneous pain, and nocturnal pain were significantly associated with higher levels of specific inflammatory proteins. No significant associations were observed with pain to palpation, bleeding time, or pulpal diagnosis. ConclusionsInflammatory proteins, including cytokine levels may play a critical role in characterizing pulpal inflammation. Future studies should investigate the role of these potential biomarkers in determining the diagnosis of pulpitis and the prognosis of vital pulp therapy.

Radiographic Outcomes of Mineral Trioxide Aggregate (MTA) with and Without Platelet-Rich Fibrin (PRF) In Direct Pulp Capping: A Clinical Pilot Study

Aim: The purpose of the current investigation was to determine by radiographic means if a calcific dentinal bridge had formed following direct pulp capping (DPC) with calcium hydroxide (CH), mineral trioxide aggregate (MTA), or a combination of platelet-rich fibrin (PRF) and MTA. Materials and Methods: In the beginning, 45 systemically healthy patients who needed DPC and had pulpal exposure were enrolled in the trial. They were then randomly assigned to one of three groups: CH (control, n = 15), MTA ( n = 15), or PRF + MTA ( n = 15). To determine the radiographic density of the dentin immediately underneath the location of pulpal exposure, pre-operative intraoral digital radiographs of the afflicted teeth were acquired. Through sequential imaging, the radiographic evaluation of dentinal bridge formation was performed. All images were studied carefully, keeping the reference point constant. Results: Out of the 45 patients, finally 10 per group were analysed. According to an analysis of variance, difference in mean density values among the various groups was found to be significant [( p = .001). On bi-group comparison (using post-Tukey HSD), difference between CH and PRF + MTA was significant ( p = .001), between MTA and PRF + MTA was significant ( p = .022), and between CH and MTA not significant ( p = .347)]. The PRF + MTA group showed the highest increase in mean density values. Conclusion: The results of the present study suggest that PRF and MTA when used in combination have better radiographic outcomes compared to MTA alone when used as DPC agents.