Symptomatic Pulpitis Research Articles

Mandibular first premolar with five root canals: a case report

BackgroundUnderstanding the anatomical morphology of the root canal is key for successful root canal treatment. The aims of this case presentation are to report a unique case of root canal treatment involving five root canals in the mandibular first premolar and to highlight the importance of variation in root canals of mandibular first premolars in clinical practice.Case presentationA 25-year-old male with intermittent pain in relation to the lower right posterior teeth over 3 weeks was diagnosed with symptomatic pulpitis in tooth #44. Four root canals were found, including mesiobuccal, distobuccal-1, distobuccal-2, and distolingual roots, and the Mtwo rotary system was used for root canal preparation. The four root canals were filled after 2 weeks, when a fifth canal was found, located in the buccal cavity. The fifth canal was confirmed to be the mesiolingual root canal by cone beam computed tomography (CBCT) and was found to be curved. After completion of the root canal filling, CBCT was performed, and a three-dimensional root canal image was reconstructed. After 1 week of observation, the tooth was repaired using composite resin filling.ConclusionsThis is the first case presentation of a fifth canal of the mandibular first premolar and advances our understanding of variations in the anatomy of the mandibular first premolar. This case report provides a reference for the treatment of mandibular first premolars.

Inflammatory biomarkers in dentinal fluid as an approach to molecular diagnostics in pulpitis.

To explore a set of inflammatory biomarkers obtained from dentinal fluid (DF) from patients with symptomatic irreversible pulpitis (IP), reversible pulpitis (RP) and normal pulp (NP). A cross-sectional exploratory study was performed, recruiting 64 patients on the basis of their respective pulp condition. DF samples were obtained from all patients (23, from IP patients; 20, from RP patients; and 21, from NP patients). Quantification of biomarkers was performed using a Luminex® MAGPIX platform system and multiplex assay kits. The Kruskal-Wallis test was used for comparisons with regard to pulp state. A simple logistic regression model and the odds ratio (OR) with a 95% level of confidence (P=0.05) were used to evaluate associations between biomarker levels and pulpal diagnosis. The performance discrimination of the biomarkers was evaluated through the construction of a receiver operating characteristic (ROC) curve by calculating the area under the curve (AUC) for IP versus RP after logistic regression modelling. Youden criteria were used to establish cut-off points for biomarkers alone with AUC>70 and P-value<0.05, or estimated probabilities from the multivariable logistic model. The biomarkers that had significantly higher values in participants with IP versus RP were IL-1α, VEGF-α and FGF acid (P<0.05). FGF acid (OR: 12.62; P=0.0085; CI 95% 1.91-83.29) and VEGF-α (OR: 2.61; P=0.0252; CI 95% 1.13-6.03) were associated with pulp diagnoses of IP versus RP. The AUC-ROC curve for FGF acid was 0.79. The model containing FGF acid, IL-1α, IL-6 and TIMP-1 had an AUC-ROC of 0.92 for IP versus RP with a significant difference from the FGF acid ROC curve (P=0.0231). Dentinal fluid could be used to assay pulpal mediators in the molecular diagnosis of pulpitis. Despite the limitation of the clinical diagnostics used in the present study, it was possible to detect a difference between irreversible symptomatic pulpitis and reversible pulpitis associated with the following combined biomarkers: FGF acid+IL-6+IL-1α, +TIMP-1.

Efficacy of submucosal tramadol and lidocaine on success rate of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis.

The aim of the present study is to compare the efficacy of additional 100mg/2ml tramadol and 40mg/2ml lidocaine applications on the anesthetic success of inferior alveolar nerve block (IANB) in mandibular molars with symptomatic irreversible pulpitis (MM-SIP). One hundred and five patients diagnosed with symptomatic pulpitis in the lower first or second molars were included in the study. Patients were randomly divided into three groups (n = 35) composed of control and two experimental groups administered submucosal tramadol and lidocaine. Preoperative pain levels of the patients were measured with Heft-Parker visual analog scale (HP VAS). Following, standard IANB with 2% lidocaine 1: 80,000 was administrated to all groups. After observation of lip numbness, 2ml of saline in the control group, 100mg/2ml tramadol in tramadol group and 40mg/2ml (2%, 1: 80,000) lidocaine in lidocaine group were administered submucosally. After 15min, standard endodontic treatment was initiated and the pain levels measured from access cavity preparation to pulp extirpation were measured with HP VAS. The success rate of pulpal anesthesia was 28.5% in the control group, 45.7% in the submucosal lidocaine group and 48.6% in the tramadol group. There was no statistically significant difference in the success rate between the groups. Additional submucosal administration of 100mg tramadol did not significantly increase the success of IANB applied with a combination of 2% lidocaine 1:80,000 and epinephrine in MM-SIP compared to control group.

Differences in endodontic emergency management by endodontists and general dental practitioners in COVID-19 times.

The aim of this study was to assess the differences, if any, between general dental practitioners (GDPs) and endodontists, in the diagnosis and treatment of endodontic emergencies during the worldwide outbreak of COVID-19. An online questionnaire was randomly sent by social media to clinicians in different countries from 24 April, 2020 to May 4, 2020. The survey consisted of a series of questions about demographic characteristics, endodontic emergency diagnoses, approaches to prevent aerosol formation, drug prescriptions in case of symptomatic irreversible pulpitis, and the ways in which dentists managed endodontic emergencies during the COVID-19 lockdown. A total of 1,058 dentists responded to the questionnaire; 344 (32.6%) of the participants were endodontists. Slightly less than half of the participants (n = 485, 45.8%) worked during the lockdown, but only 303 participants (28.6%) treated endodontic cases/emergencies. The responses showed agreement between endodontists and GDPs regarding the diagnosis of symptomatic irreversible pulpitis (SIP), symptomatic apical periodontitis (SAP), reversible pulpitis, and asymptomatic irreversible pulpitis (AIP). SIP and SAP were considered an emergency, whereas reversible pulpitis and AIP were not considered an emergency (p > 0.05). Non-aerosol-generating procedures and treatment approaches differed between the groups (p < 0.05). One-third of the participants did not use rubber dam (p > 0.05). Ibuprofen and amoxicillin-clavulanic acid were the most frequently prescribed drugs for pain associated with SIP. In conclusion, the most relevant findings in our survey were the differences between endodontists and GDPs in diagnosis, precheck triage, deep caries excavation procedures, and endodontic emergency pain relief strategies.

Limited Evidence Suggests Premedication With Corticosteroids May Help Relieve Postoperative Endodontic Pain in Patients With Symptomatic Pulpitis Undergoing Single-Visit Root Canal Treatment

Effect of preoperative corticosteroids in patients with symptomatic pulpitis on postoperative pain after single-visit root canal treatment: a systematic review and meta-analysis. Suneelkumar C, Subha A, Gogala D. J Endod 2018; 44(9):1347-54. Not provided. Systematic review with meta-analysis of data.

Prognosis of teeth with external root resorption caused by adjacent impacted teeth

This study aimed to investigate the prognosis of permanent teeth with external root resorption (ERR) caused by adjacent impacted teeth. A total of 75 ERR teeth (permanent teeth) caused by adjacent impacted teeth of 63 patients were included. The prognosis of ERR teeth was analyzed followed by minimally invasive extraction of the adjacent impacted teeth. The time of follow-up was six months. The relationship between prognosis of ERR teeth and patients' age, gender, root number, type of root resorption and degree of root resorption were analyzed. In the 75 ERR teeth, 67 teeth (89.3%) did not show pulpitis symptoms. The clinical outcome was found to be related with age (r=0.330, P<0.05), whereas no relationships with gender, root number, as well as type and degree of root resorption were observed (P>0.05). Pulpitis symptom was not found in ERR teeth of patients under 30 years old. For ERR teeth caused by adjacent impacted teeth, keeping the pulp vital after surgical removal of impacted teeth is highly probable. Post-operative follow-up instead of preventive root canal therapy of ERR teeth is recommended.

Evaluation of postoperative pain intensity following occlusal reduction in teeth associated with symptomatic irreversible pulpitis and symptomatic apical periodontitis: a randomized clinical study.

To assess the effect of occlusal reduction on postoperative pain following two visits root canal treatment in posterior mandibular teeth with symptomatic irreversible pulpitis and symptomatic apical periodontitis in a randomized clinical trial. This trial was conducted in the outpatient clinic of the Endodontic Department of the Faculty of Oral and Dental Medicine, Cairo University in Egypt. Forty-four-patients diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis were randomly assigned into two equal groups. The occlusal surfaces of teeth in the intervention group were reduced; whilst those assigned to the control group were left intact. Canal instrumentation was completed in the first visit using Revo-S rotary nickel-titanium files, and pain intensity was assessed using a visual analogue scale (VAS) at 6, 12, 24 and 48h. Canal filling was completed 7days later, and pain intensity was assessed at 6 and 12h. A placebo was given and analgesics were prescribed to be administered in case of severe postoperative pain. Data were analysed using Independent t-test, chi-square and Fisher Exact tests. The mean pain scores within the two groups were associated with a significant continuous decrease over time. Following both instrumentation and canal filling, the mean pain scores in the intervention group were lower than those in the control group at all follow-up periods and this difference was only significant at 12h (P=0.021 and P=0.015, respectively). Occlusal reduction reduced levels of postoperative pain in posterior mandibular teeth with symptomatic pulpitis and apical periodontitis only 12h following both canal preparation and root filling.

Evaluation of the efficacy of calcium silicate vs. glass ionomer cement indirect pulp capping and restoration assessment criteria: a randomised controlled clinical trial\u20142-year results

ObjectivesAssess calcium silicate cement (Biodentine™) vs. glass ionomer cement (Fuji IX™, control) as indirect pulp capping (IPC) materials in patients with reversible pulpitis after a 2-year follow-up. Evaluate the integrity of the overlying resin composite restorations using modified USPHS criteria and FDI criteria. Investigate the sensitivity of the modified USPHS criteria compared to the FDI criteria in the assessment of the restorations.Materials and methodsSeventy-two restorations (36 Biodentine™, 36 Fuji IX™) were placed randomly in 53 patients. Periapical radiographs were taken at pre-treatment (T0), 12-month (T12), and 24-month (T24) review. Restorations were assessed using the modified USPHS and FDI criteria at T12 and T24.ResultsAt 24 months, 15 teeth had failed to maintain vitality (6 Biodentine™, 9 Fuji IX™). Clinical success rate of IPC for both materials was 72% and is related to the intensity of reversible pulpitis symptoms. No difference was found between T12 and T24 in the periapical (PA) radiographs and in the integrity of the resin composite restorations overlying Biodentine™ compared to Fuji IX™. There was no difference in the efficacy of the USPHS criteria compared to the FDI criteria in the assessment of the resin composite restorations.ConclusionsBiodentine™ and Fuji IX™ were clinically effective when used as IPC materials in teeth with reversible pulpitis at T24. Resin composite restorations overlying both materials performed well at T24. Using the USPHS or FDI criteria is equally efficient at T24; however, longer term follow-up is needed to establish whether there are sensitivity differences between these assessment criteria.Clinical significanceTeeth with deep carious lesions approaching the pulp and with signs of reversible pulpitis can be treated successfully by indirect pulp capping using either Biodentine™ or Fuji IX™. Using the USPHS or FDI criteria to assess restorations is equally effective at 2 years.Trial registrationNCT02201641

Tissue Engineering: An Analogous Platelet Rich Fibrin for Coronal Pulpotomy in Revival of Pulp Tissue Vitality in Adult Molar with Pulpitis, a Case Report

Aim: management of a clinical case with irreversible pulpitis for young adult molar with closed apices using analogous blood derivative PRF and evaluating the clinical and radiographic success for coronal pulpotomy. Summary: A 18 years old male patient reported to the screening clinic, was referred to endodontic clinic with acute pulpitis diagnosed in left first molar tooth. Deep occlusal caries involving pulp, with history of spontaneous lingering pain associated with sign and symptoms of pulpitis. Standard clinical care protocol was strictly implemented, rubber dam isolation was followed by coronal pulpotomy. Blood drawn from cuboidal vein. Platelet rich fibrin membrane placed over the remaining pulp and restored with MTA and finally with Glass ionomer cement. Follow-up results clinically and radio-graphically were encouraging and successful at day 1 to 24 months. No post-operative pain, the treated tooth responded to pulp sensibility test and radiographs revealed periapical healing. However, for standardization of the clinical procedure well designed research study is further needed.

The value of ultrasonic elastography in diagnosis of salivary gland lesions in patients with Sjogren's syndrome

The present study was aimed to clinically evaluate transitional treatment of pulpitis during pregnancy. Sixty pregnant women with pulpitis were divided into the first, second and third trimester. They were anesthetized locally using STA system combined with psychological intervention during treatment. The teeth were given one-appointment root canal preparation and filled with vitapex pasta. Normal obturation of the root canal was conducted after delivery. The effects of dental treatment, pregnancy outcomes and neonatal health status were observed. Data of the survey were analyzed by SPSS 20.0 software package, including Student's t test and chi-square test. The symptoms of pulpitis were significantly improved 24h after treatment,and the effective rate was 96.7%. The difference of VAS before and after treatment was statistically significant (P<0.05). Patients had no discomfort till the end of pregnancy,and the success rate was 98.3%. No adverse pregnancy outcomes were observed after treatment during different periods of pregnancy. Neonatal health was good. Significant differences were not found in birth gestational age, body weight, malformations, and neonatal complications between three treatment periods (P>0.05). Transitional treatment of pulpitis during pregnancy is a safe and effective procedure and worthy of wide use clinically.

Outcome Analysis and Unexpected-Scenario Prediction in 2-Stage Orthodontic Lower Third Molar Extraction

We propose a 2-stage orthodontic lower third molar extraction procedure to reduce iatrogenic inferior alveolar nerve injury. We tested our hypothesis that there are factors that can predict both dislodgement of the root portion and limited traction distances. Fifteen patients (mean age, 25.7years; age range, 17 to 65years) with 20 lower third molars were enrolled. Panoramic films and cone beam computed tomography were analyzed. Dislodgement of the root portion, traction distance, duration of the orthodontic phase, and postoperative complications were documented. The predictive factors were analyzed and discussed. Three teeth had dislodgements of the root portion. The mean traction duration was 59.2days (range, 33 to 77days), and the mean traction distance was 2.60mm (range, 0.27 to 5.20mm). Root apex cortical bone indentation and root curvature were significantly associated with traction distance. Pulpitis symptoms were documented in 1 tooth, and no postoperative nerve disturbances occurred. Our proposed 2-stage orthodontic lower third molar extraction procedure reduced iatrogenic inferior alveolar nerve injury. Cortical bone indentation and root curvature predicted dislodgement of the root portion and limited traction distances.

The clinical observation of padding abrasion wear pits of molar occlusal surface by composite resin

Objective To observe the clinical effect of composite resin on padding the abrasion wear pits of molar occlusal surface.Methods To select 20 patients with a total of 68 teeth which all haven't pulpitis symptoms and their posterior occlusal have wear pits and have enough space for filling.Adhensives and corresponding composite resins produced by 3MESPE Company were used to fill the pits.Results After 1-year follow-up,among 68 teeth,55 are successful,11 effective,2 failed,the total effective rate was 97.06％.Conclusion The composite resins made by 3M are good quality materials which are suitable for filling posterior occlusal wear pits. Key words: Composite resins; Posterior occlusal; Abrasion wear

Evaluation of Pain Relieving Ability of Various Medicaments in Symptomatic Pulpitis: An in Vivo Study

Aim: To search for the best pain relieving medicament in acute symptomatic pulpitis. Materials and Method: This study was designed to compare and evaluate the pain relieving ability of vitamins&minerals preparation (Eldervit ZC), corticosteroid preparation (Dexona), and Eugenol in acute symptomatic irreversible pulpitis, when used as sedative dressing. The study sample composed of 60 patients during 15-months period. Pain was recorded on 1st, 3rd and 7th day using visual analog scale for pain. The data obtained were cross tabbed followed by Kruskall-Wallis Test and Mann Whitney U Test performed using statistical package SPSS version 15. Results: On comparison between the groups Eldervit ZC, Dexona, and Eugenol, Eugenol showed consistent pain relieving ability with p < 0.001, which was very highly statistically significant. Conclusion: It can be concluded that Eugenol can be used as sedative dressing in patients with symptomatic pulpitis as a temporary measure though effective treatment will always be pulpectomy.

Induction of Maturogenesis by Partial Pulpotomy: 1 Year Follow-Up

In cariously exposed immature permanent teeth, the treatment choice is controversial in pediatric dentistry. Radical root canal treatment usually appears to be the solution for these teeth. Even partial pulpotomy is a vital treatment for traumatically exposed immature permanent teeth; extending the borders of indication towards cariously exposed immature permanent teeth with reversible pulpitis may abolish the necessity of pulpectomy. This article describes the partial pulpotomy of a cariously affected immature permanent teeth and the follow-up for 1 year. A healthy 11-year-old male patient was referred to Gazi University Faculty of Dentistry Department of Pediatric Dentistry. The patient had reversible pulpitis symptoms on teeth numbered 45. At radiographic examination, immature apex and deep caries lesion were observed and partial pulpotomy was performed by using calcium hydroxide to maintain vitality of the pulp and allow continued development of root dentin expecting the root will attain full maturity. Clinical and radiographic follow-up demonstrated a vital pulp besides not only closure of the apex (apexogenesis), but also physiologic root development (maturogenesis) after 1 year. Partial pulpotomy is an optional treatment for cariously exposed immature permanent teeth for preserving vitality and physiological root development.

A prospective clinical trial on the influence of a triamcinolone/demeclocycline and a calcium hydroxide based temporary cement on pain perception

IntroductionThe aim of this clinical trial was to compare the degree of short term post-operative irritation after application of a triamcinolone/demeclocycyline based or a calcium hydroxide based provisional cement.MethodsA total of 109 patients (55 female and 54 male; mean age: 51 ± 14 years) with primary or secondary dentinal caries were randomly assigned to the two treatment groups of this biomedical clinical trial (phase III). Selection criteria were good systemic health and treated teeth, which were vital and showed no symptoms of pulpitis. Up to three teeth were prepared for indirect metallic restorations, and the provisional restorations were cemented with a triamcinolone/demeclocycyline (Ledermix) or a calcium hydroxide (Provicol) based material. The intensity of post-operative pain experienced was documented according to the VAS (4, 12, 20, 24, and 82 h) and compared to VAS baseline.ResultsA total of 159 teeth were treated (Ledermix: 83 teeth, Provicol: 76 teeth). The minor irritation of the teeth, experienced prior to treatment, was similar in both groups; however, 4 h after treatment this value was significantly higher in the Provicol group than in the Ledermix group (p < 0.005, t-test). After 12 h, the difference was no longer significant. The number of patients taking analgesics for post-treatment pain was higher in the Provicol group (n = 11/53) than in the Ledermix group (n = 3/56).ConclusionsThe patients had no long term post-operative pain experience in both groups. However, within the first hours after cementation the sensation of pain was considerably higher in the Provicol group than in the Ledermix group.

Functional Properties of Tooth Pulp Neurons Responding to Thermal Stimulation

The response properties of tooth pulp neurons that respond to noxious thermal stimulation of the dental pulp have been not well-studied. The present study was designed to characterize the response properties of tooth pulp neurons to noxious thermal stimulation of the dental pulp. Experiments were conducted on 25 male ferrets, and heat stimulation was applied by a computer-controlled thermode. Only 15% of tooth pulp neurons (n = 39) responded to noxious thermal stimulation of the teeth. Tooth pulp neurons were found in both the superficial and deep nuclear regions of the subnucleus caudalis (Vc) and in the interface between the nucleus caudalis and interpolaris (Vc/Vi). Thirty-seven neurons had cutaneous receptive fields and were classified as either NS (16) or WDR (21) neurons. Repeated heat stimulation of the dental pulp sensitized and increased the number of electrically evoked potentials of tooth pulp neurons. These results provide evidence that both the Vc and Vc/Vi regions contain neurons that respond to noxious thermal stimulation of the dental pulp, and that these cells may contribute to the sensitization process associated with symptomatic pulpitis.

Diagnostic and clinical factors associated with pulpal and periapical pain

A retrospective survey was designed to identify diagnostic subgroups and clinical factors associated with odontogenic pain and discomfort in dental urgency patients. A consecutive sample of 1,765 patients seeking treatment for dental pain at the Urgency Service of the Dental School of the Federal University of Goiás, Brazil, was selected. Inclusion criteria were pulpal or periapical pain that occurred before dental treatment (minimum 6 months after the last dental appointment), and the exclusion criteria were teeth with odontogenic developmental anomalies and missing information or incomplete records. Clinical and radiographic examinations were performed to assess clinical presentation of pain complaints including origin, duration, frequency and location of pain, palpation, percussion and vitality tests, radiographic features, endodontic diagnosis and characteristics of teeth. Chi-square test and multiple logistic regression were used to analyze association between pulpal and periapical pain and independent variables. The most frequent endodontic diagnosis of pulpal pain were symptomatic pulpitis (28.3%) and hyperreactive pulpalgia (14.4%), and the most frequent periapical pain was symptomatic apical periodontitis of infectious origin (26.4%). Regression analysis revealed that closed pulp chamber and caries were highly associated with pulpal pain and, conversely, open pulp chamber was associated with periapical pain (p<0.001). Endodontic diagnosis and local factors associated with pulpal and periapical pain suggest that the important clinical factor of pulpal pain was closed pulp chamber and caries, and of periapical pain was open pulp chamber.

Antibiotic prescription for the treatment of endodontic pathology: a survey among Lithuanian dentists

To describe a pattern of antibiotic prescription during root canal treatment procedures based on the reports of Lithuanian general dental practitioners. Questionnaires concerning endodontic treatment were sent to all 2850 Lithuanian dental practitioners registered on the database of the Lithuanian Dental Chamber. Only the questions containing general information and individual decisions about antibiotic prescription for endodontic treatment were selected for the analysis. The response rate was 53.8%. Of the 1532 responses, 1431 questionnaires received from licensed general dental practitioners were analyzed. More than 60% of the respondents reported prescribing antibiotics in cases of symptomatic apical periodontitis. Majority of the respondents (83.9%) reported symptomatic apical periodontitis with periostitis being a clear indication for the prescription of antibiotics. Nearly 2% of the respondents reported prescribing antibiotics in cases of symptomatic pulpitis. With an increasing duration of professional activity, an increase in the proportion of the respondents reporting prescription of antibiotics was observed. Amoxicillin was the most preferable antibiotic during endodontic treatment, followed by amoxicillin with clavulanic acid. An increase in reporting penicillin prescription and decline in prescribing amoxicillin and amoxicillin with clavulanic acid with regard to the increasing age of respondents was observed. Lithuanian dentists, particularly those with longer duration of professional activity, tended to exceed general recommendations for the antibiotics prescription in cases of endodontic infections. However, a trend toward prescription of broader spectrum antibiotics by younger dentists, compared with those with longer professional activity, was observed.

Relationships between Caries Bacteria, Host Responses, and Clinical Signs and Symptoms of Pulpitis

Knowledge of caries bacteria and the inflammatory responses they elicit in the dental pulp is prerequisite to our understanding of the pathogenesis of pulpitis. Recent advances in immunology and neurophysiology can now explain some of the clinical manifestations of pulpitis. The purpose of this review is twofold. The first purpose is to review the literature of the caries microflora, the host immune responses they elicit, and how they do so. The relationship between both proinflammatory and anti-inflammatory cytokines and pulpitis is discussed. The proinflammatory properties of lipoteichoic acid, which is a common virulence factor among Gram-positive bacteria such as those found among the caries bacteria, are reviewed. The second purpose is to review how bacteria and their metabolites, as well as pulpal immune and inflammatory reactions to them, modify the pain sensation in pulpitis.

Copper–zinc superoxide dismutase activity in healthy and inflamed human dental pulp

To examine copper-zinc superoxide dismutase (Cu, Zn-SOD) activity in clinically healthy and symptomatic human dental pulps. Twenty-five systemically healthy patients, 14 females and 11 males (age: 13.1-34.6 years; mean: 21.7 +/- 6.3), were the source of the pulp tissue. The condition of the pulps was assessed using clinical and radiographic evaluation. The pulp tissue was collected by longitudinally grooving and splitting the teeth (if extracted) or during endodontic treatment, and were age- and sex-matched between the healthy and the irreversible symptomatic pulpitis tissue groups. Cu, Zn-SOD activity was determined through spectrophotometric methods and a Mann-Whitney test assessed the significance of differences between the groups. The enzyme activities were 144.8 +/- 42.2 and 68.1 +/- 25.0 U mg(-1) in the healthy and irreversible symptomatic pulp tissue, respectively. The difference between the groups was statistically significant (P < 0.001). These results demonstrate a potential role for Cu, Zn-SOD during dental pulp inflammation in humans.