Conservative pulp therapy in the management of reversible and irreversible pulpitis

Drug sensitivity testing during dental pulp-dentin complex repair: its effect on treatment outcome and prognosis

OBJECTIVE

To assess the efficacy of targeted therapy based on drug sensitivity testing (DST) results in patients with acute pulpitis (AP).

METHODS

A total of 80 cases of AP were included retrospectively and divided into two groups: control (Ctrl) group (conventional drug palliative therapy, n=40) and experimental (Exp) group (DST + non-resistant drugs, n=40). The clinical data and laboratory examination data of patients, including bacterial culture data, drug sensitivity test results, Ca and P contents in dental pulp, visual analogue scale (AVS), treatment satisfaction, and dental pulp incidence, were collected and analyzed.

RESULTS

Prevotella melaninogenica, Fusobacterium nucleatum, and Porphyromonas gingivalis exhibited higher resistance rates (RS) to penicillin and amoxicillin but no resistance to imipenem and metronidazole. The content of Ca and P in the dental pulp of the Exp group patients was significantly higher than that of the Ctrl group (P=0.006). The total response rate (95% vs. 77.5%, P=0.018) and overall patient satisfaction (92.5% vs. 80%, P=0.021) were also significantly higher in the Exp group than in the Ctrl group. Additionally, when the follow-up duration exceeded 1 year, the incidence of dental pulp reactions in the Exp group was significantly lower than that of the Ctrl group (P=0.026).

CONCLUSIONS

These findings suggest that Gram-negative anaerobes are the predominant oral pathogens in patients with AP. Imipenem and metronidazole demonstrate the most effective anti-infective properties against these anaerobes. Utilizing DST to select non-resistant drugs for treatment prior to therapy effectively enhances clinical outcomes for patients with AP.

Odontogenic and anti-inflammatory effects of magnesium-doped bioactive glass in vital pulp therapy

This study aimed to investigate the effects of magnesium-doped bioactive glass (Mg-BG) on the mineralization, odontogenesis, and anti-inflammatory abilities of human dental pulp stem cells (hDPSCs). Mg-BG powders with different Mg concentrations were successfully synthesized via the sol-gel method and evaluated using x-ray diffraction, Fourier-transform infrared spectroscopy, scanning electron microscopy, and transmission electron microscopy. Apatite formation was observed on the surfaces of the materials after soaking in simulated body fluid. hDPSCs were cultured with Mg-BG powder extracts in vitro, and no evident cytotoxicity was observed. Mg-BG induced alkaline phosphatase (ALP) expression and mineralization of hDPSCs and upregulated the expression of odontogenic genes, including those encoding dentin sialophosphoprotein, dentin matrix protein 1, ALP, osteocalcin, and runt-related transcription factor 2. Moreover, Mg-BG substantially suppressed the secretion of inflammatory cytokines (interleukin [IL]-4, IL-6, IL-8, and tumor necrosis factor-alpha). Collectively, the results of this study suggest that Mg-BG has excellent in vitro bioactivity and is a potential material for vital pulp therapy of inflamed pulps.

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

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

Pulpotomy for teeth with irreversible pulpitis in immature permanent teeth: a retrospective case series study

To evaluate the success of pulpotomy in treating immature permanent teeth with irreversible pulpitis. This case series included patients with irreversible pulpitis admitted to the Department of Oral Medicine at the author's Hospital between 2015 and 2020. The pulpotomies were carried out by clinicians with > 5 years of working experience. The follow-up findings and radiographic images were reviewed by two attending dentists. This study included 49 teeth from 48 children (25 boys and 23 girls). The follow-up was 23.3 ± 6.8 months (from 12 to 40 months). The success rate of pulpotomy was 85.7% (42/49). Pulpotomy failed in seven teeth (14.3%). The treatment success rate for traumatic crown fracture was lower than for dental caries and dens evaginatus (P < 0.001). There were no significant differences in the success rate of the pulp-capping agent, tooth root developmental phase, and pulpotomy method (all P > 0.05). Pulpotomy might be successfully used to treat immature permanent teeth with irreversible pulpitis in young patients mainly caused by caries and a fractured tubercle of dens evaginatus.

Prefabricated Zirconia Crowns and Preformed Metal Crowns in the Treatment of Severely Childhood Caries and Anterior Crossbite in a Child with Autistic Spectrum Disorder

Crowns have been recommended to treat decayed teeth and rebuild teeth function. The dental management of children with autism is a tremendous challenge for pediatric dentists due to the impaired behaviors and communication disorders. In this context, a 5-year-old boy with autism was treated to solve carious lesions under the assistance of general anesthesia. The posterior occlusal function was restored, and the crossbite existing in the primary anterior teeth was approached merely by NuSmile® zirconia crowns (ZCs) rather than orthodontic intervention. We conducted an 18-month period. Throughout the long-term follow-up, the boy's masticatory efficiency was remarkably improved and the anterior teeth had transferred into the correct position with adequate overbite to maintain the new relationship, thus ameliorating the appearance of tissue on the labial surface and enhancing his quality of life and oral health.

Injectable Xenogeneic Dental Pulp Decellularized Extracellular Matrix Hydrogel Promotes Functional Dental Pulp Regeneration

The present challenge in dental pulp tissue engineering scaffold materials lies in the development of tissue-specific scaffolds that are conducive to an optimal regenerative microenvironment and capable of accommodating intricate root canal systems. This study utilized porcine dental pulp to derive the decellularized extracellular matrix (dECM) via appropriate decellularization protocols. The resultant dECM was dissolved in an acid pepsin solution to form dECM hydrogels. The analysis encompassed evaluating the microstructure and rheological properties of dECM hydrogels and evaluated their biological properties, including in vitro cell viability, proliferation, migration, tube formation, odontogenic, and neurogenic differentiation. Gelatin methacrylate (GelMA) hydrogel served as the control. Subsequently, hydrogels were injected into treated dentin matrix tubes and transplanted subcutaneously into nude mice to regenerate dental pulp tissue in vivo. The results showed that dECM hydrogels exhibited exceptional injectability and responsiveness to physiological temperature. It supported the survival, odontogenic, and neurogenic differentiation of dental pulp stem cells in a 3D culture setting. Moreover, it exhibited a superior ability to promote cell migration and angiogenesis compared to GelMA hydrogel in vitro. Additionally, the dECM hydrogel demonstrated the capability to regenerate pulp-like tissue with abundant blood vessels and a fully formed odontoblast-like cell layer in vivo. These findings highlight the potential of porcine dental pulp dECM hydrogel as a specialized scaffold material for dental pulp regeneration.

Identification and Experimental Validation of LINC00582 Associated with B Cell Immune and Development of Pulpitis: Bioinformatics and In Vitro Analysis

BACKGROUND

Pulpitis is a common oral disease. Increasing evidence has demonstrated that long non-coding RNAs (lncRNAs) can regulate the immune response in pulpitis. This study focused on finding the key immune-related lncRNAs that regulate the development of pulpitis.

METHODS

Differentially expressed lncRNAs were analyzed. Enrichment analysis was performed to explore the function of differentially expressed genes. Immune cell infiltration was evaluated with Immune Cell Abundance Identifier. Cell Counting Kit-8 (CCK-8) and lactate dehydrogenase release assays were conducted to measure the viability of human dental pulp cells (HDPCs) and BALL-1 cells. Transwell assay was processed to prove migration and invasion of BALL-1 cells.

RESULTS

Our results revealed that 17 lncRNAs were significantly upregulated. Pulpitis-related genes were mainly enriched in inflammatory relative signal pathways. The abundance of various immune cells was significantly abnormal in pulpitis tissues, among which the expression of eight lncRNAs was significantly correlated with the expression of B cell marker protein CD79B. As the most relevant lncRNA for B cells, LINC00582 could regulate the proliferation, migration, invasion, and CD79B expression of BALL-1 cells.

CONCLUSIONS

Our study identified eight B cell immune-related lncRNAs. Meanwhile, LINC00582 has a positive effect on B cell immunity in the development of pulpitis.

Minimally invasive endodontics: a new era for pulpotomy in mature permanent teeth

Emerging clinical and histologic evidence is challenging the long-established dogma that root canal treatment (RCTx) is the only therapeutic option for preservation of vital mature permanent teeth diagnosed with irreversible pulpitis or carious pulp exposure. Vital pulp therapy procedures like pulpotomy are not only technically simpler and more economical, but also afford patients a host of other benefits over conventional RCTx. This narrative review provides an update on the contemporary understanding of pulp pathophysiology and defence mechanisms, the proposed new diagnostic terminologies for pulpal inflammation, and how the biological characteristics of hydrophilic calcium silicate cements have enabled consistent successful outcomes for pulpotomy-treated mature teeth. The paper also details the evidence base from clinical trials and systematic reviews conducted over the past decade and outlines the practical treatment considerations for pulpotomy in mature permanent teeth.

Investigation of a Novel Injectable Chitosan Oligosaccharide-Bovine Hydroxyapatite Hybrid Dental Biocomposite for the Purposes of Conservative Pulp Therapy

This study aimed to develop injectable chitosan oligosaccharide (COS) and bovine hydroxyapatite (BHA) hybrid biocomposites, and characterise their physiochemical properties for use as a dental pulp-capping material. The COS powder was prepared from chitosan through hydrolytic reactions and then dissolved in 0.2% acetic acid to create a solution. BHA was obtained from waste bovine bone and milled to form a powder. The BHA powder was incorporated with the COS solution at different proportions to create the COS-BHA hybrid biocomposite. Zirconium oxide (ZrO₂) powder was included in the blend as a radiopacifier. The composite was characterised to evaluate its physiochemical properties, radiopacity, setting time, solubility, and pH. Fourier-transform infrared spectroscopic analysis of the COS-BHA biocomposite shows the characteristic peaks of COS and hydroxyapatite. Compositional analysis via ICP-MS and SEM-EDX shows the predominant elements present to be the constituents of COS, BHA, and ZrO₂. The hybrid biocomposite demonstrated an average setting time of 1 h and 10 min and a pH value of 10. The biocomposite demonstrated solubility when placed in a physiological solution. Radiographically, the set hybrid biocomposite appears to be more radiopaque than the commercial mineral trioxide aggregate (MTA). The developed COS-BHA hybrid biocomposite demonstrated good potential as a pulp-capping agent exhibiting high pH, with a greater radiopacity and reduced setting time compared to MTA. Solubility of the biocomposite may be addressed in future studies with the incorporation of a cross-linking agent. However, further in vitro and in vivo studies are necessary to evaluate its clinical feasibility.

Evaluation of Bioceramic Putty in Pulpotomy of Immature Permanent Molars With Symptoms of Irreversible Pulpitis

Purpose This study aimed to evaluate the effectiveness of both mineral trioxide aggregate (MTA) and bioceramic putty (Well-Root PT) in the pulpotomy of immature permanent molars diagnosed with symptoms of irreversible pulpitis. Materials and methods The study included 30 immature permanent molars with symptoms of irreversible pulpitis in 30 healthy children aged six to eight years. They were randomly distributed into the following two groups according to the material used: group 1 included 15 first permanent molars capped by MTA and group 2 included 15 first permanent molars capped by bioceramic putty. Clinical and radiographical evaluations of the treatment results were made after one week, three months, six months, nine months, and 12 months. Results The success rate in the bioceramic putty group was 93.3% clinically and radiographically after a 12 months follow-up, whereas in the group that underwent MTA treatment no cases of failure were registered with a 100% success rate. No statistical differences were observed between groups (p=0.309). The dentin bridge was formed in 60% of the MTA group and 33.3% of the bioceramic group without any statistically significant differences (p=0.272) after a 12 months follow-up. Conclusion Pulpotomy using biocompatible materials (MTA and bioceramic putty) on immature permanent molars with symptoms of irreversible pulpitis is considered acceptable and effective.

Anti-Inflammatory and Mineralization Effects of an ASP/PLGA-ASP/ACP/PLLA-PLGA Composite Membrane as a Dental Pulp Capping Agent

Dental pulp is essential for the development and long-term preservation of teeth. Dental trauma and caries often lead to pulp inflammation. Vital pulp therapy using dental pulp-capping materials is an approach to preserving the vitality of injured dental pulp. Most pulp-capping materials used in clinics have good biocompatibility to promote mineralization, but their anti-inflammatory effect is weak. Therefore, the failure rate will increase when dental pulp inflammation is severe. The present study developed an amorphous calcium phosphate/poly (L-lactic acid)-poly (lactic-co-glycolic acid) membrane compounded with aspirin (hereafter known as ASP/PLGA-ASP/ACP/PLLA-PLGA). The composite membrane, used as a pulp-capping material, effectively achieved the rapid release of high concentrations of the anti-inflammatory drug aspirin during the early stages as well as the long-term release of low concentrations of aspirin and calcium/phosphorus ions during the later stages, which could repair inflamed dental pulp and promote mineralization. Meanwhile, the composite membrane promoted the proliferation of inflamed dental pulp stem cells, downregulated the expression of inflammatory markers, upregulated the expression of mineralization-related markers, and induced the formation of stronger reparative dentin in the rat pulpitis model. These findings indicate that this material may be suitable for use as a pulp-capping material in clinical applications.

Clinical Symptoms and Quality of Life Improvement Value of Ornidazole Mixture in Auxiliary Filling Treatment of Patients with Endodontic Disease

To evaluate the clinical effect of ornidazole mixture in auxiliary filling of patients with endodontic disease. A total of 124 patients with endodontic diseases admitted to our hospital from January 2020 to December 2021 were included and divided into two groups according to the random number table. The observation group (n = 62) was given ornidazole mixture-assisted filling, while the control group (n = 62) was given pulp mummification filling to evaluate its application effect. Compared with the control group, the disappearance time of tooth hyperesthesia, gingival redness, and pain symptoms in the observation group were significantly shorter and the difference had statistical significance $\left(P<0.05\right)$ ; the excellent and good rate of the observation group was 96.77% and 85.48%, respectively, and the difference had statistical significance $\left(P<0.05\right)$ ; the masticatory efficiency, occlusal force, and oral health-related quality of life scores in the observation group were higher than those in the control group after treatment, and the difference had statistical significance $\left(P<0.05\right)$ . Ornidazole mixture can promote the curative effect, shorten the time of symptom disappearance, and effectively improve the masticatory function and quality of life in patients with endodontic diseases.