Vital Pulp Tissue Research Articles

Non-Surgical Endodontic Management of Teeth with Aberrant Anatomy: A Case Series

The root canal therapy aims to remove the necrotic and vital pulp tissue remnants from the root canal to treat the periradicular inflammation. The knowledge of the tooth anatomy is essential to ensure a successful treatment. However, the deviation of the tooth anatomy complicates the diagnostic and treatment processes. Effective management of such complexities requires a tailored approach, utilizing detailed imaging and precise endodontic techniques to achieve successful outcomes and restore patient function and comfort. This case series presents the endodontic management of three different anatomic variations of permanent teeth that include taurodontism in the mandibular molar, two rooted mandibular canine and dilacerated maxillary central incisor and underscores the importance of personalized treatment planning and advanced diagnostic tools in managing complex dental anomalies.

Comparative Evaluation of Dentinal Microcrack Formation During Root Canal Preparation Using Different Rotary Files: An In Vitro Study

Background:The success of endodontic treatment depends on completely removing all vital and necrotic pulp tissue, microorganisms, and microbial toxins from the root canal. During the cleaning and shaping process, the canal is shaped through the interaction between instruments and the dentin walls. These interactions can create several temporary stress points within the dentin, which may lead to the development of dentinal defects, craze lines, or microcracks. As a result, the techniques employed for shaping root canals carry the risk of starting crack formation, which, under functional pressure, could progress into complete fractures. This study was aimed to compare and evaluate the incidence of dentinal microcrack formation during root canal preparation using ProTaper Universal, ProTaper Gold, NeoEndo Flex and Hyflex EDM files. Materials and Methods: A total of 95 freshly extracted single rooted premolars with single straight canal were selected and stored in normal saline. Each specimen was examined using dental operating microscope to exclude cracked samples. Specimens then decoronated using a diamond disc and water as a coolant to a standardized length of 14 mm. Canal patency was determined by passing 10 K file passively and the working length was established 1 mm short of the file length at which the file become visible at the apical foramen. Canal was then enlarged upto15 k size file. Teeth samples were then divided into 5 groups having 19 teeth each. Group 1: Control Group (Uninstrumented teeth), Group 2 : Protaper Universal, Group 3 : Protaper Gold, Group 4 : NeoEndo Flex ,Group 5 : Hyflex EDM. After completion of cleaning and shaping procedure (to a standard apical diameter of 25), canal was rinsed with distilled water. Root was then horizontally sectioned at 3 mm, 6 mm and 9 mm from the apex with diamond disc at low speed under water cooling. All the sections were evaluated under stereomicroscope for presence of cracks and images were recorded. Cracks were observed as lines extending from the root canal lumen to the dentin or from the outer surface into the dentin. Results: All the file systems used in this study showed dentinal microcracks. ProTaper Universal exhibited the highest percentage of dentinal defects, while Hyflex EDM displayed the lowest among the file systems used (ProTaper Universal, ProTaper Gold, NeoEndo Flex and Hyflex EDM). The defects were present more in the apical third (3 mm) as compared to 6 mm (middle third) and 9 mm (coronal third) sections

Preserving pulp vitality for teeth with post-vital pulp therapy symptoms by retrying pulp-preserving procedures: A retrospective clinical study

Background/purposeThe occurrence of post-vital pulp therapy (VPT) symptoms is perplexing for dentists, and root canal treatment (RCT) is preferred for such conditions. Furthermore, managing post-VPT symptoms, rather than performing RCT, would preserve pulp vitality and enhance VPT outcomes. This study aimed to evaluate the efficacy of VPT retrials in preserving pulp vitality and substituting RCT in teeth with post-VPT symptoms. Materials and methodsVPT was performed on the exposed pulp during caries removal in symptomatic and asymptomatic teeth. VPTs were repeated in teeth with post-VPT symptoms. This study screened multi-time-practiced VPT cases from a VPT-performed data pool. The presence of vital pulp tissue after minimized pulp resection (MPR) was a prerequisite for substituting RCT with VPT retrials. A total of 22 cases from 19 patients were included in this study. MPR was introduced to maximize the preservation of the vital pulp. ResultsAfter performing VPT, post-VPT symptoms occurred in pre-VPT asymptomatic teeth, or pre-VPT symptoms were modified in teeth with pre-VPT symptoms. The rate of pre-VPT irreversible pulpitis (IP), comprising symptomatic/asymptomatic IP, was 81.68%. The most prevalent post-VPT symptom was heightened sensitivity to thermal stimuli (68.2%), followed by spontaneous pain (45.5%). The post-VPT IP was 63.6%. VPT retrials resolved 90.9% of cases with post-VPT symptoms. ConclusionVPT retrials using MPR could enhance VPT outcomes and be a viable alternative to RCT for teeth with post-VPT symptoms.

Novel L-(CaP-ZnP)/SA Nanocomposite Hydrogel with Dual Anti-Inflammatory and Mineralization Effects for Efficient Vital Pulp Therapy.

Vital pulp therapy (VPT) is considered a conservative treatment for preserving pulp viability in caries and trauma-induced pulpitis. However, Mineral trioxide aggregate (MTA) as the most frequently used repair material, exhibits limited efficacy under inflammatory conditions. This study introduces an innovative nanocomposite hydrogel, tailored to simultaneously target anti-inflammation and dentin mineralization, aiming to efficiently preserve vital pulp tissue. The L-(CaP-ZnP)/SA nanocomposite hydrogel was designed by combining L-Arginine modified calcium phosphate/zinc phosphate nanoparticles (L-(CaP-ZnP) NPs) with sodium alginate (SA), and was characterized with TEM, SEM, FTIR, EDX, ICP-AES, and Zeta potential. In vitro, we evaluated the cytotoxicity and anti-inflammatory properties. Human dental pulp stem cells (hDPSCs) were cultured with lipopolysaccharide (LPS) to induce an inflammatory response, and the cell odontogenic differentiation was measured and possible signaling pathways were explored by alkaline phosphatase (ALP)/alizarin red S (ARS) staining, qRT-PCR, immunofluorescence staining, and Western blotting, respectively. In vivo, a pulpitis model was utilized to explore the potential of the L-(CaP-ZnP)/SA nanocomposite hydrogel in controlling pulp inflammation and enhancing dentin mineralization by Hematoxylin and eosin (HE) staining and immunohistochemistry staining. In vitro experiments revealed that the nanocomposite hydrogel was synthesized successfully and presented desirable biocompatibility. Under inflammatory conditions, compared to MTA, the L-(CaP-ZnP)/SA nanocomposite hydrogel demonstrated superior anti-inflammatory and pro-odontogenesis effects. Furthermore, the nanocomposite hydrogel significantly augmented p38 phosphorylation, implicating the involvement of the p38 signaling pathway in pulp repair. Significantly, in a rat pulpitis model, the L-(CaP-ZnP)/SA nanocomposite hydrogel downregulated inflammatory markers while upregulating mineralization-related markers, thereby stimulating the formation of robust reparative dentin. The L-(CaP-ZnP)/SA nanocomposite hydrogel with good biocompatibility efficiently promoted inflammation resolution and enhanced dentin mineralization by activating p38 signal pathway, as a pulp-capping material, offering a promising and advanced solution for treatment of pulpitis.

A Combined Endodontic Management Approach in immature Permanent Molar tooth with Periapical Lesion: Case Report

Immature dental pulp, which has a highly cellular structure and a rich vascular nutrition system, is highly resistant to inflammation, In these teeth, determining the treatment option based on clinical and radiographic findings alone may result in the removal of diseased pulp tissue as well as vital pulp tissue. In order to increase the prognosis of these teeth, vital pulp treatments are highly recommended to preserve pulp vitality. By evaluating the condition of the root pulps of young permanent molars separately, it is possible to increase the prognosis of the tooth by combining regenerative endodontic treatment and pulpotomy treatment according to the condition of the pulps. In this case report, regenerative endodontic treatment and pulpotomy treatment were applied to different root canals of the first molar, which became necrotic before completing its maturation due to caries and had an apical lesion, and excellent healing was demonstrated. Key words: Biodentine, immature permanent teeth, periapical lesions, pulpotomy, regenerative endodontic treatment.

Use of irrigating substances of natural origin in Endodontics

The success of pulpo-radicular treatment involves the complete cleaning, disinfection and conformation of the canal system, which depends on the elimination of vital or necrotic pulp tissue, dentinal remnants and microorganisms. For this, the use of irrigating solutions with antimicrobial, chelating, solvent and hemostatic activity is essential. There are biopharmaceutical products created for this purpose. The objective was: to analyze the irrigating substances of natural origin used in the treatment of endodontic canals, considering the importance of this knowledge for stomatologists. The methods were used: documentary analysis, historical-logical analysis and analytical-synthetic. For the development of this research, 17 bibliographies were selected. Products of natural origin constitute an effective alternative for the irrigation of endodontic canals due to their antibacterial, antifungal, anti-inflammatory and analgesic properties; its main advantages are easy availability, profitability, low toxicity and the lack of microbial resistance reported to date.

Implications of root, pulp chamber, and canal anatomy on pulpotomy and revitalization procedures.

This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures. This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures. Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up. Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups. CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.

Three-Dimensional Culture of Human Dental Pulp Tissue: A Preliminary Experimental In Vitro Model for Regenerative Endodontic Procedures

Introduction: Dental pulp regeneration is fundamental in dentistry and endodontics; however, few in vitro experimental models are available to study its biological process. This study aimed to develop a three-dimensional (3D) culture model of human dental pulp-like tissue mimicking the possible complexity of human pulp tissue. This new and innovative human-like tissue model could be used for testing drugs and materials, particularly those involved in regenerative endodontics. Methods: Vital pulp tissue samples were obtained from human third molars (n = 4) immediately after extraction and cultured in a 3D fibrin matrix to create a sustainable ex vivo experimental model. The angiogenesis degrees and the nitric oxide levels were evaluated following the culture of pulp-like tissues in the fibrin matrix for 21 days. The expression of Transforming growth factor- beta (TGF-β1), TGF-β2, TGF-β3, and their relevant receptors, tumor necrosis factor (TNF) and vascular endothelial growth factor A (VEGFA) was evaluated using a reverse transcription polymerase chain reaction (RT-PCR) method. Results: Pulp tissue angiogenesis was initiated, and completed on days 7 and 21, and pulp-like tissue cells expressed TGF-β1, TGF-β2, TGF-β3, and their relevant receptors, TNF and VEGFA. Conclusion: This model provided a precise observation of dental pulp angiogenesis at early stages.

Clinical determination of anatomical diameter in different dental groups correlating them with gender, age, tooth/canal and pulpoperiradicular diagnosis: an observational clinical study

The aim of this observational clinical study (OCS) was to determine the clinical anatomical diameter (CAD) in several dental groups, thus correlating them with gender, age, tooth/canal and pulpoperiradicular diagnosis. Three-hundred fifty-nine teeth/584 vital or necrotic root canals from patients of both genders and different ages composed the sample. After performing the necessary previous procedures, K-Flexofiles were used to determine the CAD. Then, the gender and age of the patients, as well as the pulpoperiradicular diagnosis of the teeth were tabulated to conduct the statistical analysis (p < 0.05). Of the 359 teeth/584 root canals evaluated, 208/342 were from women (mean age 38.85 ± 13.42 years) and 151/242 were from men (mean age 45.41 ± 14.90 years). Statistically significant differences between the CAD means of root canals from women and men were not identified (p = 0.411). The analysis of the correlation between the CAD and age also showed a total independence (p = 0.271). Teeth with pulp necrosis and asymptomatic apical periodontitis diagnosed radiographically (TPNAAPDR) had a significantly larger CAD mean than teeth with pulp necrosis and no asymptomatic apical periodontitis diagnosed radiographically (TPNNAAPDR) and teeth with vital pulp and normal apical tissues (TVPNAT) (p = 0.0297); and the last two did not differ statistically (p > 0.05). The largest CAD mean was observed in single canals of maxillary central incisors. The lowest values of this variable were identified in the mesiobuccal and mesial canals of maxillary and mandibular first molars, respectively. The CAD of the root canals was influenced only by the root canal/tooth and pulpoperiradicular diagnosis.

Clinical evaluation of culturable bacteria, endotoxins and lipoteichoic acid in teeth with vital normal pulp tissues.

The objective of this study was to investigate the presence of culturable bacteria, endotoxins (LPS) and lipoteichoic acid (LTA) levels in teeth with normal vital pulp (NVP) with intact crowns (IC) and those with coronal restoration (CR) limited to the enamel level. A total of 20 teeth indicated for endodontic treatment due to prosthetic reasons were selected. Samples were collected from the root canals. The levels of cultivable bacteria, LPS and LTA were assessed. Statistical analyses were performed at significance level set at 5%. None of the teeth presented microbial growth. In the IC group, the LPS levels were limited to the lowest concentration of LPS. On the contrary, higher LPS and LTA levels were detected in teeth with CR. It was concluded that teeth with NVP and IC were negative for bacteria, LPS and LTA; while teeth with CR were positive for bacterial virulence factors.

Microbiota present in combined endodontic-periodontal diseases and its risks for endocarditis.

Infective endocarditis (IE) is an inflammatory disease usually caused by bacteria that enter the bloodstream and establish infections in the inner linings or valves of the heart, including blood vessels. Despite the availability of modern antimicrobial and surgical treatments, IE continues to cause substantial morbidity and mortality. Oral microbiota is considered one of the most significant risk factors for IE. The objective of this study was to evaluate the microbiota present in root canal (RC) and periodontal pocket (PP) clinical samples in cases with combined endo-periodontal lesions (EPL) to detect species related to IE using NGS. Microbial samples were collected from 15 RCs and their associated PPs, also from 05 RCs with vital pulp tissues (negative control, NC). Genomic studies associated with bioinformatics, combined with structuring of a database (genetic sequences of bacteria reported for infective endocarditis), allowed for the assessment of the microbial community at both sites. Functional prediction was conducted using PICRUSt2. Parvimonas, Streptococcus, and Enterococcus were the major genera detected in the RCs and PPs. A total of 79, 96, and 11 species were identified in the RCs, PPs, and NCs, respectively. From them, a total of 34 species from RCs, 53 from PPs, and 2 from NCs were related to IE. Functional inference demonstrated that CR and PP microbiological profiles may not be the only risk factors for IE but may also be associated with systemic diseases, including myocarditis, human cytomegalovirus infection, bacterial invasion of epithelial cells, Huntington's disease, amyotrophic lateral sclerosis, and hypertrophic cardiomyopathy. Additionally, it was possible to predict antimicrobial resistance variants for broad-spectrum drugs, including ampicillin, tetracycline, and macrolides. Microorganisms present in the combined EPL may not be the only risk factor for IE but also for systemic diseases. Antimicrobial resistance variants for broad-spectrum drugs were inferred based on PICRUSt-2. State-of-the-art sequencing combined with bioinformatics has proven to be a powerful tool for conducting studies on microbial communities and could considerably assist in the diagnosis of serious infections. Few studies have investigated the microbiota in teeth compromised by combined endo-periodontal lesions (EPL), but none have correlated the microbiological findings to any systemic condition, particularly IE, using NGS techniques. In such cases, the presence of apical periodontitis and periodontal disease can increase IE risk in susceptible patients.

Quantitative analysis of culturable bacteria, levels of endotoxins, inflammatory mediators and substance P in teeth with symptomatic irreversible pulpitis and in teeth with vital normal pulp tissues.

To comparatively analyse the levels of culturable bacteria, endotoxins (LPS), tumour necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β) and substance P in teeth with symptomatic irreversible pulpitis (SIP) and vital normal pulp (VNP) tissues. Thirty-two patients were included (20 teeth with SIP and 12 teeth with VNP tissues) in this cross-sectional study. Samples were collected from the full length of the root canals (microbial analysis) and periapical tissues (2 mm beyond the apex for immunological analysis), using sterile absorbent paper points. The levels of culturable bacteria (culture method), endotoxins (LAL Pyrogent 5000), TNF-α, IL-1β and substance P (ELISA) were assessed. The Mann-Whitney test was used for comparisons between the levels of CFU/mL, LPS, TNF-α, IL-1β and substance P in the SIP and VNP groups. The statistical analysis was performed with the significance level set at 5%. Culturable bacteria were recovered from all teeth with SIP. On the other hand, no positive cultures were observed in the VNP tissues group (p > .05). The levels of LPS were approximately four times higher in teeth with SIP than in teeth with VNP tissues (p < .05). Higher levels of TNF-α and substance P were detected in teeth with SIP (p < .05). On the other hand, no difference in the levels of IL-1β was detected between the two groups (p > .05). Teeth with symptomatic irreversible pulpitis present higher levels of culturable bacteria, endotoxins, TNF-α and substance P than those with vital normal pulp tissues. On the other hand, the levels of IL-1β were similar in teeth from both groups suggesting reduced implications of this inflammatory mediator in the early stages of infection.

Dopamine is involved in reparative dentin formation through odontoblastic differentiation of dental pulp stem cells

Conventional direct pulp-capping materials induce pulp cells to secrete various biomolecules in pulp tissues that promote reparative dentin formation through induction of odontoblastic differentiation of dental pulp stem cells (DPSCs). However, these biomolecules sometimes induce bone-like dentin with poor sealing properties. Therefore, exploration of biomolecules that allow tight sealing by tubular reparative dentin is required. We recently reported that dopamine (DA) is involved in dentinogenesis. Hence, we investigated the effect of DA on odontoblastic differentiation of DPSCs and reparative dentin formation. Both tyrosine hydroxylase (TH), a DA synthetase, and DA were expressed in odontoblast-like cells in vivo. In vitro, their expression was increased during odontoblastic differentiation of DPSCs. Furthermore, TH-overexpressing DPSCs had promoted odontoblastic differentiation and DA production. Moreover, DA stimulation promoted their differentiation and induced tubular reparative dentin. These results suggest that DA produced by TH is involved in odontoblastic differentiation of DPSCs and has an inductive capacity for reparative dentin formation similar to primary dentin. This study may lead to the development of therapy to preserve vital pulp tissues.

ASSESSMENT OF BIODENTINE PULPOTOMY AS AN ALTERNATIVE TO CONVENTIONAL ROOT CANAL TREATMENT FOR PERMANENT TEETH IN CHILDREN-AN IN VIVO STUDY

A vital pulp tissue is responsible for supporting the tooth structure through reparative dentin production. Preserving pulp vitality is essential in maintaining vascularization and nutrition to the tooth that eventually will support tooth structure &amp; reduce teeth mortality. Root canal treatment for permanent teeth in children is a complex procedure requiring lengthy appointments and multiple visits and often require a full coverage restoration. on the other hand vital pulpotomy requires shorter appointments and usually accomplished in one visit. Vital pulp therapy can help to retain vital permanent teeth that are able to withstand normal function. Vital pulp therapy (VPT) has been increasingly considered as a minimally invasive approach for the management of teeth with inflamed pulps compared to the conventional approach of root canal treatment. Aim To assess the outcome of Biodentine in complete coronal pulpotomy in permanent teeth with symptomatic reversible pulpitis. Methodology In the present study 30 healthy children of age below 12 years requiring pulpotomy were selected after clinical and radiographic assessment. Pulpotomy technique was carried out after local anaesthesia and rubber dam application. After exposure, pulp was amputated to the level of canal orifices (full pulpotomy) using a sterile spoon excavator and high-speed round bur under water coolant. Hemostasias is achieved by cotton pellet moistened with 3 % NaOCl for 2 minutes and repeat as needed, after haemostasis achieved Biodentine was mixed according to the manufacturer’s instructions and gently placed over the pulp to a thickness of 2-3 mm and after that a permanent restoration was placed. All treated patients were followed up at 3-month,6-month,9-month interval for clinical and radiographic evaluation. Resulting data were tabulated and statistically analyzed. Results. Out of the 30 study samples,2 patient cases revealed abnormal clinical and radiographical changes at the end of 3 months and one more patient reported with pain and tenderness to percussion at the end of 6 months. At the end of 9 months follow up, clinical and radiographical success rate was 90.0% respectively. Conclusion Biodentine as a pulpotomy agent has a high successful rate and fulfilled all requirements of an ideal pulpotomy medicament.

Influence of Direct Pulp Capping with Calcium Hydroxide and Mineral Trioxide Aggregate on Systemic Oxidative Stress in Rats

Abstract Direct pulp capping is a procedure where materials are placed on exposed vital pulp tissue in order to stimulate reparative dentinogenesis and preserve pulp vitality. Carious pulp exposure and direct pulp capping are usually accompanied by pulp inflammation which can affect pro- and anti-oxidative systems locally or systemically. Therefore, this study aimed to investigate the potential influence of direct capping of inflamed rat dental pulp with calcium hydroxide (CH) and mineral trioxide aggregate (MTA) on parameters of systemic oxidative status. Dental pulps of the first maxillary molars of Albino rats (n=32) were exposed and capped with either CH (n=8), MTA (n=8) or were left untreated (n=8). Animals with healthy pulp were used as a healthy control (n=8). After four weeks, animals were euthanized and blood samples were collected for biochemical analysis of parameters of systemic oxidative stress by spectrophotometric method. Untreated control had the significantly higher (p &lt;0.05) values of pro-oxidative parameters and lower (p &lt;0.05) values of anti-oxidative parameters (superoxide dismutase and reduced glutathione) compared to healthy control. CH and MTA groups showed reduced values of pro-oxidative parameters compared to untreated control and values of anti-oxidative parameters comparable to healthy control. Pulp exposure led to disbalance in systemic oxidative parameters while direct pulp capping with calcium hydroxide and mineral trioxide aggregate restored the levels of systemic oxidative parameters to that of animals with healthy dental pulp. These results indicate the importance of direct pulp capping and the potential influence of untreated inflamed pulp on systemic health.

Enhanced conservation of vital pulp and apical tissues by the application of crown rotation surgery for inversely impacted central incisors: A follow‐up analysis of two patients over 4 years

To describe a novel surgical method (crown rotation surgery) to manage inversely impacted central incisors with immature roots. Two young patients each presented with an inversely impacted maxillary central incisor. To protect the apical tissues, the two impacted incisors were rotated downwards to a relatively normal position without extraction from their bony sockets. After crown rotation surgery, spontaneous eruption, continuous root development, and periodontal healing of the rotated incisors were observed. The pulp retained vitality and blood flow was normal. Moreover, there were no obvious signs of pulp canal obliteration (PCO), as indicated by Cone Beam Computed Tomography (CBCT) imaging. • By optimising protection of the vital pulp and apical tissues, crown rotation surgery represents a minimally invasive, conservative, and practical surgical technique for treating inversely impacted incisors with developing roots. • In contrast to existing surgical methods, crown rotation surgery may avoid certain complications, including PCO and abnormal or arrested root development.

A critical review of in vitro research methodologies used to study mineralization in human dental pulp cell cultures.

BackgroundThe pulp contains a resident population of stem cells which can be stimulated to differentiate in order to repair the tooth by generating a mineralized extracellular matrix. Over recent decades there has been considerable interest in utilizing in vitro cell culture models to study dentinogenesis, with the aim of developing regenerative endodontic procedures, particularly where some vital pulp tissue remains.ObjectivesThe purpose of this review is to provide a structured oversight of in vitro research methodologies which have been used to study human pulp mineralization processes.MethodThe literature was screened in the PubMed database up to March 2021 to identify manuscripts reporting the use of human dental pulp cells to study mineralization. The dataset identified 343 publications initially which were further screened and consequently 166 studies were identified and it was methodologically mined for information on: i) study purpose, ii) source and characterization of cells, iii) mineralizing supplements and concentrations, and iv) assays and markers used to characterize mineralization and differentiation, and the data was used to write this narrative review.ResultsMost published studies aimed at characterizing new biological stimulants for mineralization as well as determining the effect of scaffolds and dental (bio)materials. In general, pulp cells were isolated by enzymatic digestion, although the pulp explant technique was also common. For enzymatic digestion, a range of enzymes and concentrations were utilized, although collagenase type I and dispase were the most frequent. Isolated cells were not routinely characterized using either fluorescence‐activated cell sorting (FACS) and magnetic‐activated cell sorting (MACS) approaches and there was little consistency in terming cultures as dental pulp cells or dental pulp stem cells. A combination of media supplements, at a range of concentrations, of dexamethasone, ascorbic acid and beta‐glycerophosphate, were frequently applied as the basis for the experimental conditions. Alizarin Red S (ARS) staining was the method of choice for assessment of mineralization at 21‐days. Alkaline phosphatase assay was relatively frequently applied, solely or in combination with ARS staining. Further assessment of differentiation status was performed using transcript or protein markers, with dentine sialophosphoprotein (DSPP), osteocalcin and dentine matrix protein‐1 (DMP ‐1), the most frequent.DiscussionWhile this review highlights variability among experimental approaches, it does however identify a consensus experimental approach.ConclusionStandardization of experimental conditions and sustained research will significantly benefit endodontic patient outcomes in the future.

Histological Evaluation of Multisonic Technology for Debridement of Vital and Necrotic Pulp Tissues from Human Molar Teeth. An Observational Study

Background: This study evaluated the efficacy of a multisonic technology for the debridement of vital and necrotic pulp tissues in freshly extracted human mandibular molar teeth. Methods: Twelve teeth with a diagnosis of symptomatic irreversible pulpitis (SIP) and twelve teeth with a diagnosis of pulp necrosis with symptomatic apical periodontitis (SAP) were extracted. The GentleWave® procedure was performed on 10 teeth from each group. Four non-treated teeth served as histologic controls. Histological consecutive 5 µm sections were obtained from the apical, middle, and coronal portion of the canals. The canals were evaluated for the presence of pulpal debris and bacteria. Results: In nine out of the ten specimens with SIP, no pulpal debris was detected in any portion of the canals. In the necrotic pulp group, eight out of the ten specimens had no detectable pulpal debris in any portion of the canal spaces. No bacteria were detected in the main canals, isthmuses, or lateral canals, but were detected deep within the dentinal tubules in 10 specimens. Conclusions: This study demonstrated that the multisonic technology was effective at removing vital and necrotic pulp tissue as well as bacteria from the root canal system, including inaccessible areas.

Development of a novel direct dental pulp-capping material using 4-META/MMA-TBB resin with nano hydroxyapatite

In the case of dental pulp exposure, direct pulp capping is often performed to preserve vital dental pulp tissue. Numerous studies regarding the development of direct pulp-capping materials have been conducted, but materials with an appropriate sealing ability, which induce dense reparative dentin formation, have not been developed. Although nano hydroxyapatite (naHAp) is a bone-filling material with bioactivity and biocompatibility, the inductive effects of naHAp on reparative dentin formation remain unclear. In the present study, the effects of dental adhesive material 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate tri-n-butylborane [4-META/MMA-TBB or Super-bond (SB)], which included 10%, 30%, and 50% naHAp (naHAp/SB) on odontoblastic differentiation of dental pulp stem cells (DPSCs) and reparative dentin formation were investigated. Scanning electron microscopy (SEM) and energy dispersive X-ray spectrometer analysis were performed to verify the existence of naHAp particles on the surface of naHAp/SB discs. The tensile adhesive strength of naHAp/SB was measured using a universal testing machine. As a result, 10% naHAp/SB and 30% naHAp/SB showed almost the same tensile adhesive strength as SB but 50% naHAp/SB showed significantly lower than the other experimental group. WST-1 proliferation assay and SEM analysis revealed that naHAp/SB did not affect the proliferation of DPSCs. Calcium release assay, quantitative RT-PCR, and western blotting analysis demonstrated that naHAp/SB did not release calcium ion but 30% naHAp/SB increased the expression of calcium-sensing receptor (CaSR) in DPSCs. Additionally, quantitative RT-PCR, western blotting analysis, Alizarin Red S- and von Kossa staining revealed that 30% naHAp/SB induced odontoblastic differentiation of DPSCs, which was inhibited by a MEK/ERK inhibitor and CaSR antagonist. Furthermore, 30% naHAp/SB promoted dense reparative dentin formation in an experimentally-formed rat dental pulp exposure model. These findings suggest that 30% naHAp/SB can be used as an ideal direct pulp capping material.

The Management of Transalevolar Surgery Teeth with Pulpal Polyps Condition

Background: The failure of intra-alveolar tooth extraction in cases of tooth extraction with complications is generally resolved by performing transalveolar tooth extraction. The open method of tooth extraction involves surgery by cutting the tooth or bone. Flap creation and partial removal of alveolar bone, refinement of alveolar bone, curettage, and suturing are the principles of this extraction method. The planning of the stages of the transalveolar extraction method must be made as carefully as possible to avoid complications of tooth extraction. Tooth extraction treatment in dental practice can be carried out due to various causes, including caries. Pulp polyps or also known as chronic hyperplastic pulpitis is another form of irreversible pulpitis in the chronically inflamed pulp so that the pulp tissue appears to the occlusal surface. Treatment in cases of pulp polyps varies widely depending on the remaining tooth crown wall. The usual treatments for polyps pulp patients are root canal treatment (RCT), pulpotomy to extraction. The transalveolar extraction method is performed by first taking a portion of the bone supporting the tooth. Objective: Knowing the treatment management of polyp pulp extraction with transalveolar surgery methods, indications and contraindications for transalveolar surgery and knowing the correct medical selection in cases of transalveolar surgical extraction of teeth with polyp pulp. Discussion: Chronic hyperplastic pulpitis or pulp polyp is a pathological condition that attacks vital pulp tissue so that it experiences a chronic inflammation as a defense response from the body to the pulp tissue against bacterial infection. The term use of the term chronic hyperplastic pulpitis occurs due to granulation of the pulp tissue covered with epithelial tissue due to chronic infection. The management of cases of pulp polyps for which restoration is no longer possible is to remove them. Extraction is the last step that can be done if restoration measures do not eliminate the source of infection. The transalveolar extraction procedure of the teeth located in the mandible is preceded by asepsis and anesthesia and removal of the polypoid tissue. Conclusion: In several cases of brittle teeth, extraction by intraalveolar method often failed so that it needs to be extracted by transalveolar method. Management of extraction with polyp pulp includes removal of the polypoid tissue first before extraction. The administration of medical therapy with the antibiotic amoxicillin 500 mg for 5 days, paracetamol for 5 days and dexamethasone for 3 days can control the patient's pain and help the healing process quickly.