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Zheng J, Ding M, Zhang S, Ren Y, Wen Q. Outcomes of partial pulpotomy in permanent molars of children with irreversible pulpitis: A prospective cohort study. Int J Paediatr Dent 2024. [PMID: 39255508 DOI: 10.1111/ipd.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/31/2024] [Accepted: 08/24/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND Vital pulp therapy is gaining traction in dental practice, especially for young patients. AIM To evaluate the outcomes of partial pulpotomy in permanent molars of children diagnosed with irreversible pulpitis (IP) using iRoot BP Plus. DESIGN A total of 94 permanent molars in 88 patients, aged 6-15 years, with symptoms of IP, were treated with partial pulpotomy, using iRoot BP Plus as the pulp capping agent. The treated teeth underwent clinical and radiographic assessments at 1, 6, 12, 18, and 24 months postoperative. The outcomes were determined based on clinical and radiographic criteria by calibrated examiners. RESULTS The success rates were 98.4% (63/64), 93.2% (41/44), and 89.7% (26/29) at the 6-month, 12-month, and 24-month follow-up. By the end of this study, the median follow-up period was 15.1 months, and the estimated survival rate was 95.2% at 24 months. Gender, root maturity, and number of missing walls had no significant effect on success rates. Six molars were failed, and root canal therapy (RCT) was applied. CONCLUSIONS Partial pulpotomy for permanent molars with IP in young patients using iRoot BP Plus as pulp capping material achieved high success. This method presents a viable alternative to apexification and RCT for treating vital, inflamed molars with IP in children.
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Affiliation(s)
- Jiajia Zheng
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Meili Ding
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Shanshan Zhang
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Yulan Ren
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Quan Wen
- First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
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Komora P, Vámos O, Gede N, Hegyi P, Kelemen K, Galvács A, Varga G, Kerémi B, Vág J. Comparison of bioactive material failure rates in vital pulp treatment of permanent matured teeth - a systematic review and network meta-analysis. Sci Rep 2024; 14:18421. [PMID: 39117767 PMCID: PMC11310317 DOI: 10.1038/s41598-024-69367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024] Open
Abstract
Mineral Trioxide Aggregate (MTA) is the gold standard for vital pulp treatment (VPT), but its superiority over novel calcium silicate-based cements in permanent teeth lacks systematic evidence. This study aimed to compare the efficacy of these materials in VPT through a network meta-analysis. A systematic search was conducted in MEDLINE, EMBASE, Cochrane Library, and Web of Science until January 20, 2024. The inclusion criteria were randomized controlled trials involving VPT with biomaterials and reversible or irreversible pulpitis diagnoses in mature permanent teeth. The primary outcome was the odds ratio (OR) of failure rates with 95% confidence intervals. In the 21 eligible trials, failure rates were significantly higher with calcium-hydroxide than MTA at six (OR 2.26 [1.52-3.36]), 12 (OR 2.53 [1.76-3.62]), and 24 months (OR 2.46 [1.60-3.79]). Failure rates for Totalfill at six (OR 1.19 [0.55-2.58]) and 12 months (OR 1.43 [0.71-2.92]), and Biodentine at six (OR 1.09 [0.66-1.78]), 12 (OR 1.21 [0.74-1.96]), and 24 months (OR 1.47 [0.81-2.68]) were not significantly different from MTA. The results were similar in the direct pulp capping subgroup, whereas, in the partial and full pulpotomy subgroup, there was not enough evidence to achieve significant differences. MTA, Biodentine, and Totalfill are the most efficient materials for VPT. However, calcium-hydroxide-based materials are not recommended in VPT.
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Affiliation(s)
- Péter Komora
- Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest Szentkiralyi Utca 47, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Orsolya Vámos
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Kata Kelemen
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Adél Galvács
- Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest Szentkiralyi Utca 47, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Gábor Varga
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Beáta Kerémi
- Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest Szentkiralyi Utca 47, Budapest, Hungary.
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
| | - János Vág
- Department of Restorative Dentistry and Endodontics, Semmelweis University, 1088 Budapest Szentkiralyi Utca 47, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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Sobh YTM, Ahmed MRA. The effect of two different contemporary chelating agents on vital pulp therapy in mature permanent teeth with irreversible pulpitis using bioceramic material: randomized clinical trial. BMC Oral Health 2024; 24:918. [PMID: 39118082 PMCID: PMC11312243 DOI: 10.1186/s12903-024-04627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Vital pulp therapy maintained functionality, vitality, and asymptomatic teeth. Compared to normal root canal treatment, pulpotomy was more helpful for irreversible pulpitis in adult permanent teeth. The research was aimed to assess effectiveness of vital pulp therapy using mineral trioxide aggregate with Apple Vinegar and Ethylene diamine tetra acetic acid (17%) for five minutes in adult carious exposed pulp of permanent teeth. METHODS Forty patients between 18 and 50 years old with a clinical diagnosis of symptomatic irreversible pulpitis but no periapical radiolucency were then divided randomly into two groups based on the irrigation method; ethylene diamine tetraacetic acid or apple vinegar. If pulpal bleeding could not be managed in less than six minutes, the assigned procedure was abandoned. After mineral trioxide aggregate application as a pulpotomy agent, glass ionomer and composite restoration were placed. Using a visual analogue scale, the pre and post-operative pain were recorded after 2,6,24,48, and 72 h. Success was assessed using radiographic and clinical examination data at three, six, and twelve months. RESULTS The success rate was discovered to be non-statistically significant in both groups after a year follow-up. Apple vinegar had a lower mean value than ethylene diamine tetra acetic acid at the preoperative baseline pain level, which was significant.Postoperatively, the ethylene diamine tetraacetic acid group reported the greatest mean value after two hours while Apple vinegar group reported the lowest mean values after 48 h (P < 0.05). After 72 h, pain level recorded insignificant difference. CONCLUSION Apple vinegar yielded a marginally successful outcome but substantially improved pain alleviation. TRIAL REGISTRATION The trial was registered in Clinical trials.gov with this identifier NCT05970536 on 23/7/2023.
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Affiliation(s)
- Yasmin Tawfik Mohamed Sobh
- Lecturer of Endodontics, Department of Endodontics, Faculty of Dentistry, Yasmin Tawfik Mohamed Sobh Lecturer of Endodontics, Sinai University - Kantara branch, Ismailia, 41636, Egypt.
| | - Mona Rizk Aboelwafa Ahmed
- Lecturer of Operative Dentistry, Department of operative Dentistry, Faculty of Dentistry, Sinai University - Kantara branch, Ismailia, 41636, Egypt
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Usta SN, Keskin C, Pirimoğlu B, Aksoy A. Histological response of inflamed pulp to hydraulic calcium silicate cements in direct pulp capping: Systematic review of pulpitis models. AUST ENDOD J 2024. [PMID: 38963183 DOI: 10.1111/aej.12873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024]
Abstract
This systematic review aimed to compare the histological response of inflamed pulpodentinal complex to the hydraulic calcium silicate cements in experimental animal models of pulpitis. Articles that evaluated the histological response of inflamed pulp to mineral trioxide aggregate (MTA) in comparison with other restorative materials were selected and analysed in detail. The risk of bias assessment was conducted using SYRCLE's RoB tool. The GRADEpro tool was used to determine the overall quality of evidence. Out of the 2947 retrieved articles from databases, five articles fulfilled the inclusion criteria. MTA induced significantly more hard tissue formation compared to calcium hydroxide. The use of pulp-capping material containing fluocinolone acetonide and ASP/PLGA-ASP/ACP/PLLA-PLGA composite membrane was comparable. This systematic review could not demonstrate enhanced efficiency of capping materials compared to MTA. Future well-conducted animal studies are warranted for demonstrating the hard tissue formation abilities of pulp-capping materials with convenient inflammatory conditions.
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Affiliation(s)
- Sıla Nur Usta
- Department of Endodontics, Gulhane Faculty of Dentistry, University of Health Sciences, Ankara, Turkey
| | - Cangül Keskin
- Department of Endodontics, Faculty of Dentistry, University of Ondokuz Mayıs, Samsun, Turkey
| | - Burcu Pirimoğlu
- Department of Endodontics, Faculty of Dentistry, University of Ondokuz Mayıs, Samsun, Turkey
| | - Abdurrahman Aksoy
- Department of Veterinary Pharmacology and Toxicology, University of Ondokuz Mayıs, Samsun, Turkey
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Safy RK, Ragab MH, Abdel-Maksoud HB. Histopathological Evaluation of Human Placental Extract as a Direct Pulp-Capping Material in Dogs' Teeth. Eur J Dent 2024. [PMID: 38942055 DOI: 10.1055/s-0044-1786841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
OBJECTIVE The current research aimed to evaluate the histopathological pulpal alterations in dogs' teeth following direct pulp capping using either mineral trioxide aggregate (MTA) or human placenta extract (HPE). MATERIALS AND METHODS Forty-eight incisors with mature apices from four dogs were involved. The teeth were randomly allocated to three groups (n = 16) based on the material utilized for direct pulp capping: MTA, HPE, and Teflon as the negative control group. All involved teeth were capped and restored at the same session. Each group was subsequently divided into two subgroups (n = 8) based on the post treatment evaluation period: 2 and 4 weeks. The histopathologic changes in each specimen's pulp tissues, including pulp inflammation, hyperemia, necrosis, and dentin bridge development, were assessed. Then, all the data were statistically analyzed using chi-square, t-test, and one-way analysis of variance (p < 0.05). RESULTS At 2 weeks, chronic inflammation was observed in 100% of MTA and 50% of HPE subgroups with a significant difference between them whereas the remaining 50% exhibited no inflammation. In contrast to Teflon that showed acute inflammation, remission of inflammation was time-dependent at both MTA and HPE subgroups as there was a substantial difference between the 2- and 4-weeks evaluation periods within the same group. However, throughout the initially observed 2 weeks, all subgroups exhibited essentially no complete calcified bridge; at 4 weeks, all MTA and HPE subgroups developed dentin bridge formation, with a significant difference between them regarding its thickness. CONCLUSION HPE is a promising pulp-capping material inducing less intense chronic inflammation accompanied with thicker dentine bridge formation in comparison to MTA.
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Affiliation(s)
- Rehab Khalil Safy
- Department of Conservative Dentistry, Faculty of Dentistry, Suez Canal University, Ismailia Governorate, Egypt
| | - Mai Hamdy Ragab
- Department of Endodontics, Faculty of Dentistry, Suez Canal University, Ismailia Governorate, Egypt
- King Salman International University, Eltor, South Sinai, Egypt
| | - Heba Bahgat Abdel-Maksoud
- Department of Conservative Dentistry, Faculty of Dentistry, Suez Canal University, Ismailia Governorate, Egypt
- Restorative Dentistry Department, King Abdulaziz University, Jeddah, Saudi Arabia
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LEON-RODRIGUEZ JA, ESPINOZA-SALCEDO M, GUTIERREZ-POLANCO YM, LEON-RODRIGUEZ JD, LOPEZ-TISNADO AA, RIVERA-CRUZ OS. Iron deficiency anemia as a risk factor for pulp disease in children from the central Peruvian jungle: a case‒control study. J Appl Oral Sci 2024; 32:e20240014. [PMID: 38896640 PMCID: PMC11182638 DOI: 10.1590/1678-7757-2024-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 06/21/2024] Open
Abstract
AIM To investigate iron-deficiency anemia as a risk factor for dental pulp disease in children from the central Peruvian jungle. METHODOLOGY A case-control study was carried out with 270 children, of which 90 referred to cases and 180, to controls. Patients with pulp disease were diagnosed according to the criteria of the Association of Endodontists and the American Board of Endodontics. A specific questionnaire was used to assess ferrous sulfate consumption, maternal education level, maternal age, occupation, and household income. Data were analyzed using Pearson's correlation coefficient and a binary logistic regression. RESULTS Iron deficiency anemia offers a risk factor for pulp disease in children (OR 7.44, IC 95% 4.0-13.8). According to multivariate analysis using binary logistic regression, ferrous sulfate consumption (OR 13.8, IC 95% 5.6.33.9), maternal education level (OR 2.4, IC 95% 1.1-5.3), maternal age (OR 7.5, IC 95% 2.9-19.4), household income (OR 4.0, IC 95% 1.6-9.6), and caries (OR 10.7, IC 95% 4.5-25.7) configured independent factors that were statistically associated with pulp disease. CONCLUSION Iron deficiency anemia, ferrous sulfate consumption, maternal education level, maternal age, household income, and dental caries were positively associated with pulp disease in children.
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Affiliation(s)
- Jhair Alexander LEON-RODRIGUEZ
- Antenor Orrego Private UniversityPostgraduate SchoolTrujilloPeruAntenor Orrego Private University, Postgraduate School, Trujillo, Peru.
| | - María ESPINOZA-SALCEDO
- Antenor Orrego Private UniversityPostgraduate SchoolTrujilloPeruAntenor Orrego Private University, Postgraduate School, Trujillo, Peru.
| | - Yovana Melisza GUTIERREZ-POLANCO
- San Martin National UniversityPostgraduate SchoolTarapotoPeruSan Martin National University, Postgraduate School, Tarapoto, Peru.
| | - Jherson David LEON-RODRIGUEZ
- Los Angeles Catholic University of ChimboteDental SchoolTrujilloPeruLos Angeles Catholic University of Chimbote, Dental School, Trujillo, Peru.
| | - Araceli Antonella LOPEZ-TISNADO
- Los Angeles Catholic University of ChimboteDental SchoolTrujilloPeruLos Angeles Catholic University of Chimbote, Dental School, Trujillo, Peru.
| | - Omaly Sulay RIVERA-CRUZ
- National university of TrujilloPostgraduate SchoolTrujilloPeruNational university of Trujillo, Postgraduate School, Trujillo, Peru.
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Kleine Kruthaup FA, Fels M, Timphaus CB, Freise F, Herbrandt S, Große Beilage E. Effects of different tooth grinding procedures on the occurrence of tooth injuries, skin lesions, performance and behaviour of suckling piglets. Porcine Health Manag 2024; 10:22. [PMID: 38867344 PMCID: PMC11167862 DOI: 10.1186/s40813-024-00373-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/20/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Immediately after birth, newborn piglets fight to establish a teat order. During this process, lesions appear on the piglets' faces and on the sows' teats, which is why tooth resection is carried out on many farms in Germany even though it is known that this procedure is frequently resulting in pulp openings. The opening of a pulp cave is suspected to cause painful tooth alterations and may be an entrance for infectious agents. The purpose of this study was to analyse the effect of tooth resection on skin lesions, development of bodyweight and behaviour in suckling piglets. Four days prepartum, 110 sows in farrow-to-finish production were assigned to one of three treatments. Litters had their teeth left intact (control group, CG), ground with a tea-cup roller head (Tea-cup head grinder group, TCG, Wilofa Diamant, D-56,133 Fachbach, Germany) or ground with a diamond rolling head (rolling head grinder group, RG, IBS/E Company Proxxon GmbH, 54,343 Föhren, Germany). The number of pulp openings in the RG and TCG was examined using a random sample. Piglet body weight and skin lesion scores were recorded within the first 24 h after birth and during each week of the suckling period. Each sow's udder was examined before farrowing, in the second week of lactation and at weaning. The behaviour of the litters from nine sows was video-recorded throughout the suckling period. The aim of this study was to investigate the effects of tooth grinding by a tea-cup head (compared to grinding by a diamond roller head and no grinding [control group]) on the behaviour and average daily gain of piglets as well as on skin lesions on sow udder. RESULTS The number of dental injuries was significantly greater in the RG than in the TCG (p < 0.01). Head lesions on piglets were significantly more common in the CG than in the RG (p = 0. 02). Compared to CG piglets, TCG piglets had a significantly greater weight at the end of the suckling period (p = 0.02). No significant difference between treatments was found in the sows' udder (parenchyma, skin, or teat) or in the behaviour of the litters. CONCLUSION As tooth grinding is frequently inducing pulp openings, the necessity of the procedure should be carefully and critically scrutinised. In case tooth resection seems inevitable until the underlying management problems have been solved, the Tea-cup grinding head should be used due to significantly fewer pulp openings.
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Affiliation(s)
- Franziska Anna Kleine Kruthaup
- Veterinary Practice Dümmerland, Bahnhofstraße 40, 49439, Steinfeld, Field, Germany.
- Field Station for Epidemiology in Bakum, University of Veterinary Medicine Hannover, Büscheler Straße 9, 49456, Bakum, Germany.
| | - Michaela Fels
- Institute of Animal Hygiene, Animal Welfare and Farm Animal Behaviour, University of Veterinary Medicine Hannover, Bischofshofer Damm 15, 30173, Foundation, Hannover, Germany
| | - Carolin Bernarda Timphaus
- Institute of Animal Hygiene, Animal Welfare and Farm Animal Behaviour, University of Veterinary Medicine Hannover, Bischofshofer Damm 15, 30173, Foundation, Hannover, Germany
- Veterinary Practice Am Brettberg, Steinfelder Straße 28.a, 49393, Lohne, Germany
| | - Fritjof Freise
- Department of Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Foundation, Bünteweg 2, 30559, Hannover, Germany
| | - Swetlana Herbrandt
- Statistical Consulting and Analysis, TU Dortmund University, Vogelpothsweg 78, 44227, Dortmund, Germany
| | - Elisabeth Große Beilage
- Field Station for Epidemiology in Bakum, University of Veterinary Medicine Hannover, Büscheler Straße 9, 49456, Bakum, Germany
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Zhong Y, Liu C, Yan X, Li X, Chen X, Mai S. Odontogenic and anti-inflammatory effects of magnesium-doped bioactive glass in vital pulp therapy. Biomed Mater 2024; 19:045026. [PMID: 38740053 DOI: 10.1088/1748-605x/ad4ada] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/13/2024] [Indexed: 05/16/2024]
Abstract
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.
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Affiliation(s)
- Yewen Zhong
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
- Institute of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
| | - Cong Liu
- Department of Biomaterials, School of Materials Science and Engineering, South China University of Technology, Guangzhou, Guangdong 510641, People's Republic of China
- National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou, Guangdong 510006, People's Republic of China
| | - Xin Yan
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
- Institute of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
| | - Xiangdong Li
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
- Institute of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
| | - Xiaofeng Chen
- Department of Biomaterials, School of Materials Science and Engineering, South China University of Technology, Guangzhou, Guangdong 510641, People's Republic of China
- National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou, Guangdong 510006, People's Republic of China
| | - Sui Mai
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
- Institute of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, People's Republic of China
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Zhang L, Yin L, Wu J, Wang X, Huang J, Li Q. Clinical influencing factors of vital pulp therapy on pulpitis permanent teeth with 2 calcium silicate-based materials: A randomized clinical trial. Medicine (Baltimore) 2024; 103:e38015. [PMID: 38701294 PMCID: PMC11062667 DOI: 10.1097/md.0000000000038015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Compared with traditional root canal therapy (RCT), vital pulp therapy (VPT) is a personalized and minimally invasive method for the treatment of pulpitis caused by dental caries. However, there are still no clear guidelines for VPT because high-quality randomized clinical trials are scarce. This prospective cohort study evaluated the clinical efficacy of VPT with the light-curable calcium silicate-based material TheraCal LC (TH) and bioceramic material iRoot BP Plus (BP) in reversible and irreversible pulpitis permanent teeth with carious exposures. METHODS 115 teeth with reversible or irreversible pulpitis caused by deep care were randomly divided into 2 groups. TheraCal LC and iRoot BP Plus were used for the pulp capping. Direct pulp capping (DPC), partial pulpotomy (PP) and full pulpotomy (FP) were performed based on observation of the exposed pulp. Postoperative discomforts were enquired and recorded via follow-up phone calls. Clinical and radiographic evaluations were performed 3, 6, and 12 months postoperatively. RESULTS The overall clinical success rate in the first year was 90.4% (47/52) in both groups. The TH group required less operating time, showed lower levels of pain, and had shorter pain duration post-operative (P < .001). According to the binary logistic regression model, preoperative pain duration was significantly correlated with the prognosis of VPT (P = .011). CONCLUSION VPT with TheraCal LC and iRoot BP Plus in pulpitis permanent carious teeth both achieved good clinical outcomes, and TheraCal LC can be easily operated for clinical use. Preoperative pain duration of the affected tooth might have a significant correlation with the prognosis of VPT.
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Affiliation(s)
- Linlin Zhang
- Institute of Oral Science, Department of Stomatology, Longgang Otorhinolaryngology Hospital, Shenzhen, China
| | - Li Yin
- Institute of Oral Science, Department of Stomatology, Longgang Otorhinolaryngology Hospital, Shenzhen, China
| | - Jianbo Wu
- Institute of Oral Science, Department of Stomatology, Longgang Otorhinolaryngology Hospital, Shenzhen, China
| | - Xiaoyan Wang
- Institute of Oral Science, Department of Stomatology, Longgang Otorhinolaryngology Hospital, Shenzhen, China
| | - Jiahui Huang
- Institute of Oral Science, Department of Stomatology, Longgang Otorhinolaryngology Hospital, Shenzhen, China
| | - Quanli Li
- Institute of Oral Science, Department of Stomatology, Longgang Otorhinolaryngology Hospital, Shenzhen, China
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Li Y, Wang W, Zeng Q, Tang M, Massey J, Bergeron BE, Gu L, Tay FR. Efficacy of pulpotomy in managing irreversible pulpitis in mature permanent teeth: A systematic review and meta-analysis. J Dent 2024; 144:104923. [PMID: 38461884 DOI: 10.1016/j.jdent.2024.104923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES This paper evaluated the success rates of pulpotomy, compared its efficacy with non-surgical root canal treatment (NSRCT), evaluated different pulpotomy techniques, and analyzed the effectiveness of contemporary bioactive materials in managing irreversible pulpitis in mature permanent teeth. DATA SOURCES A comprehensive literature search was conducted across multiple databases including PubMed, Web of Science, Scopus, and the Cochrane Library. Search was conducted from the inception of each database to the present, adhering to PRISMA 2020 guidelines. STUDY SELECTION Studies were selected through a multi-step screening process, focusing on adult populations, randomized controlled trials, and single-arm trials. DATA Fifteen randomized controlled trials and eight single-arm trials were included. For a follow-up period of more than 24 months, pooled clinical success rate of pulpotomy was 92.9 % (95 %CI;82.1-99.0 %), whereas pooled radiographic success rate was 78.5 % (95 %CI;66.7-88.4 %). Meta-analyses showed that there was no significant difference in success rates between pulpotomy and NSRCT, between full and partial pulpotomy techniques, or between Mineral Trioxide Aggregate pulpotomy and Calcium Enriched Mixture pulpotomy. The results indicated comparable efficacy across these variables. CONCLUSIONS The study highlights the potential of less invasive treatments. Pulpotomy may be a viable alternative to NSRCT for managing irreversible pulpitis in mature permanent teeth. Limitations such as the low quality of some single-arm trials and the high risk of bias in some randomized controlled trials highlight the need for further research to standardize methodologies and broaden literature inclusion for a more comprehensive understanding of the efficacy of pulpotomy, considering the high success rates reported. Clinical Significance This quantitative systematic review recognizes the potential of full or partial pulpotomy as a viable treatment alternative to root canal therapy for managing irreversible pulpitis in mature permanent teeth. Future studies should aim for standardized protocols to validate these findings and improve patient treatment outcomes.
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Affiliation(s)
- Yuanyuan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China; Department of General Dentistry, Xiamen University Affiliated Chenggong Hospital & The 73rd Army Hospital of Chinese PLA, Amoy, Fujian, PR China
| | - Wenying Wang
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Qian Zeng
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China
| | - Michelle Tang
- The Dental College of Georgia, Augusta University, GA, USA
| | - Joshua Massey
- The Dental College of Georgia, Augusta University, GA, USA
| | | | - Lisha Gu
- Hospital of Stomatology, Sun Yat-sen University, Guangzhou, PR China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, PR China.
| | - Franklin R Tay
- The Dental College of Georgia, Augusta University, GA, USA.
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Akhil VS, Kumar V, Aravind A, Sharma R, Sharma S, Chawla A, Upadhyay AD, Logani A. Novel cryotherapy technique for pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis- a randomized controlled trial. Clin Oral Investig 2024; 28:275. [PMID: 38668793 DOI: 10.1007/s00784-024-05661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/12/2024] [Indexed: 05/24/2024]
Abstract
OBJECTIVES To assess the effect of cryotherapy on haemostasis, post-operative pain, and the outcome of full pulpotomy performed in mature permanent teeth with symptomatic irreversible pulpitis. MATERIALS AND METHODS The study included sixty mature permanent mandibular molar teeth with symptomatic irreversible pulpitis and no periapical rarefaction. After coronal pulp tissue amputation, teeth were randomly allocated to one of two groups (n = 30 each). In group I (conventional pulpotomy), a sterile cotton pellet moistened with 2.5% NaOCl was used for haemostasis. In group II (cryotherapy), the pulp chamber was continuously lavaged with 2.50C normal saline solution for haemostasis using an indigenous portable cryotherapy irrigation unit. Following haemostasis, the pulp was capped with mineral trioxide aggregate and the tooth was restored with resin composite. The time taken to achieve haemostasis was recorded. Preoperative and 24, 48 and 72 h postoperative pain was measured using the Numerical Rating Scale. The pulpotomy outcome was assessed at the 12-month follow-up. Data were analyzed using Fischer's exact test, two-sample t-test, two-sample Wilcoxon rank-sum test, Friedman Test, and Wilcoxon Signed Rank Test. RESULTS The cryotherapy group achieved haemostasis in less time (p < 0.05). There was a significant pain reduction at 24 and 48 h in the cryotherapy group when compared with the conventional pulpotomy group (P < 0.005). The overall success rate of pulpotomy after 12 months was 88% (n = 22) in both study groups(p < 0.05). CONCLUSIONS Cryotherapy application reduces postoperative pain and has no adverse effect on the outcome of pulpotomy in permanent teeth with symptomatic irreversible pulpitis. CLINICAL RELEVANCE The cryotherapy can be incorporated in pulpotomy protocol as an adjunct to minimize post-operative pain.
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Affiliation(s)
- V S Akhil
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Kumar
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
| | - Archana Aravind
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Radha Sharma
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Sidhartha Sharma
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Amrita Chawla
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Datt Upadhyay
- Clinical Research Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Logani
- Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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12
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Cho SY, Park S, Shin Y, Jung IY. Randomized clinical trial of pulpotomy using a premixed injectable calcium silicate cement on mature permanent teeth with reversible pulpitis. Sci Rep 2024; 14:2994. [PMID: 38316823 PMCID: PMC10844323 DOI: 10.1038/s41598-024-52818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
The aim of this two-center randomized controlled trial was to assess the outcomes and relative factors associated with pulpotomies performed using a premixed injectable calcium silicate cement, as compared to mineral trioxide aggregate in mature permanent premolar and molar teeth with reversible pulpitis. Included teeth were randomly divided into two groups according to pulpotomy material (ProRoot MTA [PMTA] group, Endocem MTA Premixed [EPM] group). After pulp exposure, the superficial pulp was either removed to a depth of 2 mm (partial pulpotomy) or completely amputated to the level of the root canal orifice (full pulpotomy). A 3-mm layer of either material was randomly placed over the pulp wound, followed by the application of a thin layer of a light-cured glass ionomer composite liner. The restoration procedure was then carried out during the same visit. After one year of treatment, the pulpotomy success rate was 94.4% (67/71), with no significant difference between the PMTA and EPM groups. The success rate was 93.9% in the PMTA group and 97.1% in the EPM group. There were no significant factors related to the procedures. EPM is a viable alternative to PMTA for single-visit pulpotomies of permanent premolars and molars.
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Affiliation(s)
- Sin-Yeon Cho
- Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-Do, Korea
| | - Seonghun Park
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Sudaemun-gu, Seoul, 03722, Korea
| | - Yooseok Shin
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Sudaemun-gu, Seoul, 03722, Korea
| | - Il-Young Jung
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Sudaemun-gu, Seoul, 03722, Korea.
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13
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Ballal NV, Duncan HF, Wiedemeier DB, Rai N, Jalan P, Bhat V, Belle VS, Zehnder M. 4-Year Pulp Survival in a Randomized Trial on Direct Pulp Capping. J Endod 2024; 50:4-9. [PMID: 37890614 DOI: 10.1016/j.joen.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION This study aimed to assess pulp survival in a randomized trial on pulp lavage in adult nonpainful posterior teeth with carious pulp exposure. The treatment included complete caries excavation, direct pulp capping with mineral trioxide aggregate, and immediate restoration with composite resin. METHODS Fluid was collected from the pulp wound to assess matrix metalloproteinase-9 (MMP-9) and total protein values. Before pulp capping, cavities were randomly (block randomization, n = 48) washed with a physiological saline or a sodium hypochlorite solution (2.5% NaOCl). Treatment outcome was assessed clinically (cold test) and radiographically after at least 1 year and again after at least 3 years. Painful failures were differentiated from nonpainful failures. Pulp survival was estimated using the Kaplan-Meier method including 95% confidence intervals (CIs) up to 1500 days. RESULTS From the 96 patients originally enrolled, 73 individuals could be followed continuously. The clinical observations indicated a beneficial and sustained effect of pulp lavage with 2.5% NaOCl over a control treatment with physiological saline solution on estimated pulp survival 1500 days postintervention, with 7% (95% CI, 1%-40%) in the saline group versus 55% (95% CI, 30%-100%) in the NaOCl group. High MMP-9/total protein values in pulpal fluid collected from the exposed site indicated early and painful treatment failures yet were not associated with failures that occurred more than 250 days after intervention. CONCLUSIONS The low 4-year success rates reported here challenge the concept of direct pulp capping in the cases that were included. NaOCl lavage did not only increase the survival of affected pulps substantially but also particularly diminished painful failures (33% in the NaOCl group vs 62% in the saline group). The lack of the predictive value of MMP-9 assessments beyond early treatment failures points to inflammatory states of the pulp tissue under deep caries, which are not related to neutrophil infiltration.
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Affiliation(s)
- Nidambur Vasudev Ballal
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Henry F Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Ireland
| | - Daniel B Wiedemeier
- Statistics Group, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Namith Rai
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prateek Jalan
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vinutha Bhat
- Department of Biochemistry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vijetha Shenoy Belle
- Department of Biochemistry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Matthias Zehnder
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland.
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14
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Yi JK, Kim AN, Kwon KH. Evaluation of the reasons for preferring root canal treatment in mature permanent teeth potentially indicated for pulp preservation: a clinical case/photo-based questionnaire study. BMC Oral Health 2023; 23:1003. [PMID: 38098000 PMCID: PMC10722753 DOI: 10.1186/s12903-023-03750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND With advances in pulp preservation procedures (PPP), indications for PPP extend to exposed pulp with symptoms in teeth with carious lesions. Scenario/text-based questionnaire studies report a high preference for PPP for exposed pulp with no pulpal symptoms. However, negative perceptions towards PPP for exposed pulp in carious teeth are prevalent among dentists. Identifying the differences in PPP preference rates in questionnaire studies and actual clinical situations is necessary to determine the current status of PPP. In this study, a clinical case/photo-based design was devised to overcome the limitations of scenario/text-based questionnaires. This study aimed to evaluate the reasons dentists prefer root canal treatment (RCT) in cases where PPP is potentially indicated. METHODS A questionnaire containing three cases of PPP with successful results was administered to dentists. The cases were selected to elicit comprehensive responses from the dentists. Clinical photos of the pulp exposure sites were presented to dentists without describing the tooth conditions, including the extent of pulp exposure and tooth decay, pulpal surface conditions, or restorability. The questions were focused on the reasons for selecting RCT in cases where was practiced. Questionnaire data were collected using Google e-forms. Chi-squared and Fisher's exact test (P < 0.05) were used for statistical analyses. RESULTS Pulpal diagnosis was not a dominant factor in treatment decision-making for pulp exposure during caries removal. Reasons for selecting RCT where PPP was potentially indicated included the event of pulp exposure itself and the dentists' desire to prevent post-PPP symptoms. Apart from symptomatic pulp, the tooth conditions influenced the establishment of pulpal diagnosis and selection of treatment modality. Moreover, the tooth condition and dentists' desire for good patient prognosis influenced the negative perceptions towards PPP. CONCLUSIONS Unfavourable tooth conditions, in association with a desire for preventing post-PPP symptoms, prevent dentists from attempting PPP for pulp exposed during caries removal with no/slight symptoms. Improving negative perceptions towards PPP through accumulation of data on the high success rates of PPP is a prerequisite for achieving widespread application of PPP.
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Affiliation(s)
- Jin-Kyu Yi
- Department of Conservative Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea.
- Department of Conservative Dentistry, Kyung Hee University Dental Hospital at Gang-dong, Seoul, Korea.
| | - An Na Kim
- Department of Conservative Dentistry, Kyung Hee University Dental Hospital at Gang-dong, Seoul, Korea
| | - Kyung Hee Kwon
- Department of Conservative Dentistry, Kyung Hee University Dental Hospital at Gang-dong, Seoul, Korea
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15
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Wang MC, Chang KW, Lin SC, Hsu LH, Hung PS. Dental pulp cells cocultured with macrophages aggravate the inflammatory conditions stimulated by LPS. BMC Oral Health 2023; 23:991. [PMID: 38071305 PMCID: PMC10710708 DOI: 10.1186/s12903-023-03625-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Pulp inflammation is complex interactions between different types of cells and cytokines. To mimic the interactions of different types of cells in inflamed dental pulp tissues, dental pulp cells (DPCs) were cocultured with different ratios of macrophages (THP-1) or LPS treatment. METHODS DPCs were cocultured with various ratios of THP-1, then photographed cell morphology and determined cell viability by MTT assay at preset times. Total RNA was also extracted to measure the inflammation marker-IL-6 and IL-8 expressions by RT-Q-PCR. The DPCs and THP-1 were treated with 0.01 - 1μg/ml lipopolysaccharide (LPS) and extract RNA at preset times, and detected IL-6 and IL-8 expression. DPCs were cocultured with various ratios of THP-1 with 0.1 μg/mL LPS, and detected IL-6 and IL-8 expression after 24 and 48 h. The data were analyzed by unpaired t-test or Mann-Whitney test. Differences were considered statistically significant when p < 0.05. RESULTS THP-1 and DPCs coculture models did not suppress the viability of DPCs and THP-1. Cocultured with various ratios of THP-1 could increase IL-6 and IL-8 expressions of DPCs (p = 0.0056 - p < 0.0001). The expressions of IL-6 and IL-8 were stronger in higher ratio groups (p = 0.0062 - p < 0.0001). LPS treatment also induced IL-6 and IL-8 expressions of DPCs and THP-1 (p = 0.0179 - p < 0.0001 and p = 0.0189 - p < 0.0001, separately). Under the presence of 0.1 μg/mL LPS, DPCs cocultured with THP-1 for 24 h also enhanced IL-6 and IL-8 expression (p = 0.0022). After cocultured with a higher ratio of THP-1 for 48 h, IL-6 and IL-8 expressions were even stronger in the presence of LPS (p = 0.0260). CONCLUSIONS Coculturing dental pulp cells and macrophages under LPS treatment aggravate the inflammatory process. The responses of our models were more severe than traditional inflamed dental models and better represented what happened in the real dental pulp. Utilizing our models to explore the repair and regeneration in endodontics will be future goals.
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Affiliation(s)
- Min-Ching Wang
- Division of Pediatric Dentistry, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuo-Wei Chang
- Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Oral Biology, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Chun Lin
- Department of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Oral Biology, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling-Hsin Hsu
- Department of Dentistry, Taipei City Hospital, Taipei, Taiwan
| | - Pei-Shih Hung
- Institute of Oral Biology, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Medical Research, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan.
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16
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Israr F, Masood Ul Hasan S, Hussain M, Qazi FUR, Hasan A. Investigating In Situ Expression of Neurotrophic Factors and Partner Proteins in Irreversible Pulpitis. J Endod 2023; 49:1668-1675. [PMID: 37660765 DOI: 10.1016/j.joen.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/30/2023] [Accepted: 08/26/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION In situ assessments of neurotrophic factors and their associated molecular partners have not been explored to date, particularly in humans. The present investigation aimed to explore the expressional dysregulation of neurotrophic factors (nerve growth factor [NGF], brain derived neurotrophic factor [BDNF], and NT4/5), their receptors (TrkA and TrkB), and their modulators (USP36 and Nedd4-2) directly in irreversibly inflamed human pulp tissues. METHODS Forty samples each of healthy and irreversibly inflamed pulp were extirpated for the study. Immunohistochemical examinations were carried out for the anatomic changes and expression of neurotrophic factors and partner proteins. Expression was digitally quantified using the IHC profiler module of ImageJ and deduced as optical density. Statistical analyses were carried out by GraphPad Prism. RESULTS Decrease in nuclear and vessel diameters was observed in irreversibly inflamed pulp tissues. NGF and BDNF were found to be significantly upregulated in symptomatic irreversible pulpitis (SIP), whereas no significant difference was observed in the expression of TrkA and TrkB. Expression of Nedd4-2, USP36, and TrkA was found positively correlated with the NGF in healthy pulp tissues. However, in SIP, positive correlation was only observed between the expression of USP36 and NGF. Among the ligands, BDNF expression was found positively correlated with NGF in healthy pulp but not with NT4/5. In the case of SIP, no correlation was observed between any neurotrophic factors. CONCLUSIONS Upregulation of NGF, BDNF, USP36 and Nedd4-2 in SIP indicates dysregulation in the molecular events underlying the disease biology and could be exploited as potential markers for the disease diagnosis.
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Affiliation(s)
- Fatima Israr
- Dr Ishrat ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan; Bioinformatics and Molecular Medicine Research Group, Dow Research Institute of Biotechnology and Biomedical Sciences, Dow College of Biotechnology, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Masood Ul Hasan
- Dr Ishrat ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan; Bioinformatics and Molecular Medicine Research Group, Dow Research Institute of Biotechnology and Biomedical Sciences, Dow College of Biotechnology, Dow University of Health Sciences, Karachi, Pakistan
| | - Mushtaq Hussain
- Bioinformatics and Molecular Medicine Research Group, Dow Research Institute of Biotechnology and Biomedical Sciences, Dow College of Biotechnology, Dow University of Health Sciences, Karachi, Pakistan.
| | - Fazal Ur Rehman Qazi
- Dr Ishrat ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Arshad Hasan
- Dow Dental College, Dow University of Health Sciences, Karachi, Pakistan
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17
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Ballikaya E, Çelebi-Saltik B. Approaches to vital pulp therapies. AUST ENDOD J 2023; 49:735-749. [PMID: 37515353 DOI: 10.1111/aej.12772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/14/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
Tooth decay, which leads to pulpal inflammation due to the pulp's response to bacterial components and byproducts is the most common infectious disease. The main goals of clinical management are to eliminate sources of infection, to facilitate healing by regulating inflammation indental tissue, and to replace lost tissues. A variety of novel approaches from tissue engineering based on stem cells, bioactive molecules, and extracellular matrix-like scaffold structures to therapeutic applications, or a combination of all these are present in the literature. Shortcomings of existing conventional materials for pulp capping and the novel approches aiming to preserve pulp vitality highligted the need for developing new targeted dental materials. This review looks at the novel approches for vital pulp treatments after briefly addresing the conventional vital pulp treatment as well as the regenerative and self defense capabilities of the pulp. A narrative review focusing on the current and future approaches for pulp preservation was performed after surveying the relevant papers on vital pulp therapies including pulp capping, pulpotomy, and potential approaches for facilitating dentin-pulp complex regeneration in PubMed, Medline, and Scopus databases.
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Affiliation(s)
- Elif Ballikaya
- Department of Oral and Dental Health Research, Hacettepe University Graduate School of Health Sciences, Ankara, Turkey
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Betül Çelebi-Saltik
- Department of Oral and Dental Health Research, Hacettepe University Graduate School of Health Sciences, Ankara, Turkey
- Department of Stem Cell Sciences, Hacettepe University Graduate School of Health Sciences, Ankara, Turkey
- Center for Stem Cell Research and Development, Hacettepe University, Ankara, Turkey
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18
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Teves-Cordova A, Coloma Calle L, Mejia Rojas P, Goncalves-Pereira J, Duarte MAH. Vital Pulp Therapy in Permanent Teeth Diagnosed with Symptomatic Irreversible Pulpitis: Reports with Long-Term Controls. Case Rep Dent 2023; 2023:2694388. [PMID: 38045017 PMCID: PMC10689073 DOI: 10.1155/2023/2694388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/20/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
The aim of this study was to describe the treatment of permanent teeth diagnosed with irreversible pulpitis, which can be effectively managed with partial or total pulpotomy. This alternative approach has shown great clinical and radiographic success in the long term compared to traditional pulpectomies. In this series of clinical cases, all the teeth exhibited symptoms of intense pain upon exposure to cold and at night. The clinical examination revealed extensive caries, while radiographic imaging showed radiolucent lesions in contact with the pulp chamber, indicating symptomatic irreversible pulpitis. The chosen treatment approach was either partial or total pulpotomy. The tooth was anesthetized, and the operative field was isolated and disinfected. After removing caries with a sterile round drill, the area was rinsed with sodium hypochlorite. In some cases, a portion of the pulp tissue was removed, while in others, the entire tissue of the pulp chamber was extracted using diamond burs. Hemostasis was achieved by applying sterile cotton pellets for 2 to 6 minutes. Following that, the tissue exhibited no signs of bleeding. Bioceramic cements were used, and the tooth was definitively restored. Periodic follow-up examinations were conducted, consistently showing positive pulp responses and no evidence of periradicular radiolucent lesions on radiographs.
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Affiliation(s)
- Abel Teves-Cordova
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo-USP, Bauru, Brazil
| | - Luis Coloma Calle
- Faculty of Dentistry of the Catholic University of Cuenca-Azogues, Ecuador
| | - Pierre Mejia Rojas
- Department of Endodontics, School of Dentistry, Cayetano Heredia Peruvian University, Lima, Peru
| | - Juan Goncalves-Pereira
- Department of Endodontics, School of Dentistry, Central University of Venezuela, Caracas, Venezuela
| | - Marco Antonio Hungaro Duarte
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo-USP, Bauru, Brazil
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Dogan Buzoglu H, Ozcan M, Bozdemir O, Aydin Akkurt KS, Zeybek ND, Bayazit Y. Evaluation of oxidative stress cycle in healthy and inflamed dental pulp tissue: a laboratory investigation. Clin Oral Investig 2023; 27:5913-5923. [PMID: 37642737 DOI: 10.1007/s00784-023-05203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the oxidative stress cycle consisting of reactive oxygen molecules (ROS), glutathione (GSH) and glutathione S-transferase (GST) in caries-related pulp inflammation. METHODOLOGY Fifty-four pulp tissue samples were collected from healthy donors with the diagnosis of reversible pulpitis, symptomatic irreversible pulpitis, and healthy pulp. Twelve pulp samples from each group were homogenized and total protein, ROS, GSH, and GST were measured by spectrophotometer. The remaining 6 samples from each group were prepared for paraffin block and used for the histopathologic and immunohistochemical evaluation of oxidative stress parameters and TUNEL labeling. Data were analyzed statistically. RESULTS The results revealed that total protein levels significantly decreased; however, ROS levels increased in both reversible and irreversible pulpitis compared to the healthy pulp (p < 0.01). Also, as inflammation increases, GST enzyme levels decrease while GSH levels increase significantly (p < 0.05). It was found that the number of TUNEL (+) cells was increased in irreversible pulpitis samples compared to healthy and reversible pulpitis groups (p < 0.05). GSTP1 and GSH immunoreactivity were also observed in irreversible pulpitis samples. CONCLUSIONS It has been revealed that caries-related inflammation alters the oxidative stress cycle in dental pulp tissue. The increase in GSH levels in the inflamed dental pulp due to the increase in ROS levels may improve the defensive ability of the dental pulp. CLINICAL RELEVANCE There is a relationship between oxidative stress and inflammation. Control of excessive oxidative stress in pulpitis can stimulate reparative and regenerative processes. The present findings may provide an overview of the management of oxidative stress in cases with pulpitis during regenerative treatments.
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Affiliation(s)
- H Dogan Buzoglu
- Department of Endodontics, Faculty of Dentistry, Hacettepe University, Sihhiye, 06230, Ankara, Turkey.
| | - M Ozcan
- Department of Medical Biochemistry, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - O Bozdemir
- Department of Stem Cell Sciences, Graduate School of Health Sciences, Hacettepe University, Ankara, Turkey
| | - K S Aydin Akkurt
- Department of Histology & Embryology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - N D Zeybek
- Department of Histology & Embryology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Y Bayazit
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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20
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Donnermeyer D, Dammaschke T, Lipski M, Schäfer E. Effectiveness of diagnosing pulpitis: A systematic review. Int Endod J 2023; 56 Suppl 3:296-325. [PMID: 35536159 DOI: 10.1111/iej.13762] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diagnosis of the status of the inflamed pulp is essential in clinical diagnosis and treatment provision. There are a limited number of well-designed and well-executed clinical trials on the diagnosis of the true status of the pulp. OBJECTIVES Three PICO questions were formulated and agreed a priori by the European Society of Endodontology to evaluate the clinical tests for sensibility testing, determination of biomarkers and pulp bleeding with regard to their suitability to correctly diagnose the condition of the pulp tissue for the development of S3-Level guidelines. METHODS A literature search was conducted using PubMed, Clarivate Analytics' Web of Science, Scopus, Google Scholar and Cochrane Central Register of Controlled Trials from inception to 21 January 2022. Additionally, a hand search was performed, and the contents of the major subject journals were also examined. Eligibility criteria followed the proposed PICO questions. Two independent reviewers were involved in study selection, data extraction and appraising the included studies; disagreements were resolved by a third reviewer. The risk of bias was assessed by the QUADAS-2 tool for diagnostic accuracy studies, the Newcastle-Ottawa scale for noncomparative, nonrandomized studies and the Newcastle-Ottawa Quality Assessment scale adapted for cross-sectional studies. RESULTS In total, 28 studies out of 29 publications were considered eligible and were included in the review. Twelve studies were identified to investigate the diagnostic accuracy of the pulp vitality. Ten studies fulfilled the criteria to evaluate the diagnostic accuracy of the pulpal conditions, while 6 studies investigating the expression of biomarkers were eligible. Three studies addressing the prognostic factors and therapeutic interventions relating to pulpal status were included. DISCUSSION The core problem in pulp diagnostics is that a reliable reference standard is lacking under clinical conditions. Based on limited evidence, the most promising current approach seems to define a combination of different clinical tests and symptoms, probably in future including molecular diagnosis ("diagnostic package") will be required to ascertain the best possible strategy to clinically diagnose true pulpal conditions. CONCLUSIONS The effectiveness of diagnosing pulpitis is low due to limited scientific evidence regarding the accuracy and reproducibility of diagnostic tests. There is a lack of evidence to determine the true status of the pulp or to identify prognostic indicators allowing for a reliable pre-operative estimation of the outcome of vital pulp treatment. REGISTRATION PROSPERO database (CRD42021265366).
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Affiliation(s)
- David Donnermeyer
- Department of Periodontology and Operative Dentistry, Westphalian Wilhelms-University, Münster, Germany
| | - Till Dammaschke
- Department of Periodontology and Operative Dentistry, Westphalian Wilhelms-University, Münster, Germany
| | - Mariusz Lipski
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Edgar Schäfer
- Central Interdisciplinary Ambulance in the School of Dentistry, Münster, Germany
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21
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Astudillo-Ortiz E, Babo PS, Sunde PT, Galler KM, Gomez-Florit M, Gomes ME. Endodontic Tissue Regeneration: A Review for Tissue Engineers and Dentists. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:491-513. [PMID: 37051704 DOI: 10.1089/ten.teb.2022.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
The paradigm shift in the endodontic field from replacement toward regenerative therapies has witnessed the ever-growing research in tissue engineering and regenerative medicine targeting pulp-dentin complex in the past few years. Abundant literature on the subject that has been produced, however, is scattered over diverse areas of knowledge. Moreover, the terminology and concepts are not always consensual, reflecting the range of research fields addressing this subject, from endodontics to biology, genetics, and engineering, among others. This fact triggered some misinterpretations, mainly when the denominations of different approaches were used as synonyms. The evaluation of results is not precise, leading to biased conjectures. Therefore, this literature review aims to conceptualize the commonly used terminology, summarize the main research areas on pulp regeneration, identify future trends, and ultimately clarify whether we are really on the edge of a paradigm shift in contemporary endodontics toward pulp regeneration.
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Affiliation(s)
- Esteban Astudillo-Ortiz
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
- Department of Endodontics, School of Dentistry, University of Cuenca, Cuenca, Ecuador
| | - Pedro S Babo
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
| | - Pia T Sunde
- Department of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Kerstin M Galler
- Department of Operative Dentistry and Periodontology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Manuela E Gomes
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
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22
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Silva EJNL, Pinto KP, Belladonna FG, Ferreira CMA, Versiani MA, De-Deus G. Success rate of permanent teeth pulpotomy using bioactive materials: A systematic review and meta-analysis of randomized clinical trials. Int Endod J 2023; 56:1024-1041. [PMID: 37254176 DOI: 10.1111/iej.13939] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The results of vital pulp treatments in permanent teeth have been encouraging. Currently, pulpotomy treatment for permanent teeth primarily utilizes mineral trioxide aggregate (MTA) as the dressing material, followed by calcium hydroxide. While other calcium-silicate-based cements have been suggested for pulpotomy, there is a limited number of studies evaluating their long-term effectiveness. OBJECTIVES The objective of this systematic review and meta-analysis was to evaluate the success rate of pulpotomies performed on permanent teeth, comparing the use of ProRoot MTA with that of calcium hydroxide and other bioceramic materials. METHODS A comprehensive search was conducted in several electronic databases, including PubMed, Cochrane Library, Scopus, Web of Science, Embase and Science Direct until December 2022. The search was guided by PICOS criteria, including only randomized clinical trials (RCTs) that evaluated the success rate of pulpotomy treatments in permanent teeth using ProRoot MTA in comparison to calcium hydroxide and other bioceramic materials. The quality of the included studies was assessed using the RoB-2 tool to evaluate the risk of bias, and relevant data were extracted and analysed in RevMan software 5.3 using fixed-effect models. The GRADE tool was used to determine the overall quality of evidence. RESULTS The initial search retrieved 1072 studies and, after eliminating duplicates, 677 studies were screened and 28 studies were considered for eligibility. In the final selection process, 16 studies were included in the systematic review, with 10 being determined as having a high risk of bias. Pulpotomy showed an overall mean success rate of 92% after 1 year. The meta-analysis indicated a significantly higher success rate for pulpotomies utilizing MTA in comparison with calcium hydroxide, while no significant difference was seen between MTA and calcium-enriched mixture (CEM) or Biodentine. The GRADE assessment revealed an overall low level of evidence for the included studies. DISCUSSION Most randomized controlled trials exhibited a significant absence of control over confounding factors. CONCLUSIONS This systematic review and meta-analysis demonstrate that pulpotomy is a highly effective treatment for managing permanent teeth. The results indicate that the success rate of pulpotomy using ProRoot MTA is significantly higher than when using calcium hydroxide. However, the certainty of evidence supporting these findings is low, and there is a need for well-designed RCTs to assess the long-term outcomes of pulpotomy using newer bioceramic materials. REGISTRATION This systematic review was registered in the PROSPERO database (registration number CRD42023393970).
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Affiliation(s)
- Emmanuel J N L Silva
- Department of Endodontics, Fluminense Federal University, Rio de Janeiro, Brazil
- Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Endodontics, Grande Rio University, Rio de Janeiro, Brazil
| | - Karem P Pinto
- Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe G Belladonna
- Department of Endodontics, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Claudio M A Ferreira
- Department of Endodontics, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marco A Versiani
- Dental Specialty Center, Brazilian Military Police, Minas Gerais, Brazil
| | - Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Rio de Janeiro, Brazil
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23
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Qiu Y, Tian J, Kong S, Feng Y, Lu Y, Su L, Cai Y, Li M, Chang J, Yang C, Wei X. SrCuSi 4 O 10 /GelMA Composite Hydrogel-Mediated Vital Pulp Therapy: Integrating Antibacterial Property and Enhanced Pulp Regeneration Activity. Adv Healthc Mater 2023; 12:e2300546. [PMID: 37260366 DOI: 10.1002/adhm.202300546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/11/2023] [Indexed: 06/02/2023]
Abstract
Vital pulp therapy (VPT) is considered a conservative treatment for preserving pulp viability in caries-induced dental pulp infections. However, bacterial contamination negatively affects dentine-pulp complex repair. The common capping materials show limited antimicrobial effects against some microorganisms. To improve the VPT efficacy, capping materials with increased antibacterial properties and enhanced odontogenic and angiogenic activities are needed. Herein, a SrCuSi4 O10 /gelatin methacrylate(SC/Gel) composite hydrogel has been proposed for infected dental pulp treatment. SrCuSi4 O10 (SC) is a microscale bioceramic composed of assembled multilayered nanosheets that possesses good near-infrared photothermal conversion ability and multiple bioactivities due to sustained Sr2+ , Cu2+ , and SiO3 2- ion release. It is shown that the SC/Gel composite hydrogel efficiently eliminates Streptococcus mutans and Lactobacillus casei and inhibits biofilm formation under photothermal heating, while the ion extract from SC promotes odontogenesis of rat dental pulp stem cells and angiogenesis of human umbilical vein endothelial cells. The as-designed therapeutic effect of SC/Gel composite hydrogel-mediated VPT has been proven in a rat dental pulp infection model and yielded improved dentine-pulp complex repair compared with the commercially used iRoot® BP Plus. This study suggests that the SC/Gel composite hydrogel is a potential pulp-capping material with improved effects on dentine-pulp complex repair in infected pulp.
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Affiliation(s)
- Yu Qiu
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, 510055, P. R. China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, 510055, P. R. China
| | - Jun Tian
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, 510055, P. R. China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, 510055, P. R. China
| | - Siyi Kong
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, 510055, P. R. China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, 510055, P. R. China
| | - Yanping Feng
- Joint Centre of Translational Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
| | - Yangyu Lu
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, 510055, P. R. China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, 510055, P. R. China
| | - Lefeng Su
- Joint Centre of Translational Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
| | - Yanling Cai
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, 510055, P. R. China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, 510055, P. R. China
| | - Mengjie Li
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, 510055, P. R. China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, 510055, P. R. China
| | - Jiang Chang
- Joint Centre of Translational Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, P. R. China
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, 1295 Dingxi Road, Shanghai, 200050, P. R. China
| | - Chen Yang
- Joint Centre of Translational Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, P. R. China
- Zhejiang Engineering Research Center for Tissue Repair Materials, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, 325000, P. R. China
| | - Xi Wei
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, 510055, P. R. China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, 510055, P. R. China
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Dronamraju S, Baig MM, K S, Naik BK, Gupta H, Singh S. To Assess the Efficacy of Various Disinfection and Hemostasis Procedures in Providing Postoperative Pain Relief Following Pulpotomy in Cases of Symptomatic Irreversible Pulpitis. Cureus 2023; 15:e45163. [PMID: 37842347 PMCID: PMC10574583 DOI: 10.7759/cureus.45163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
AIM The purpose of this study is to assess the efficacy of various disinfection and hemostasis procedures in providing postoperative pain relief following pulpotomy in cases of symptomatic irreversible pulpitis. MATERIALS AND METHODS The data from a cohort of 50 patients who received treatment with sodium hypochlorite (NaOCl) and another cohort of 50 patients who received treatment with potassium titanyl phosphate (KTP) laser were subjected to analysis. The patients were provided a questionnaire to evaluate pain levels before and after surgery. The patients documented their levels of postoperative pain at specific time intervals, including the sixth hour, first day, second day, third day, and eighth day. This was done using a 100 mm visual analog pain scale, where a marking of 0 mm indicated no pain and a marking of 100 mm indicated the highest level of pain, reflecting the severity of the pain experienced. RESULTS The pain score of group B was significantly lower than that of group A on the first day. While no notable disparity was detected among the groups during the remaining postoperative periods, it is worth noting that the KTP laser exhibited comparatively lower pain scores. In both groups, the initial pain score before surgery was found to be significantly higher than the pain scores recorded at all subsequent time intervals after surgery. Within group A, it was observed that the pain score during the sixth hour after the surgical procedure was notably greater compared to the pain scores recorded during all other time intervals following the operation. In group B, the pain score at the sixth hour exhibited a statistically significant increase compared to the pain scores observed on the third day and eighth day. CONCLUSION The KTP laser group exhibited a lower postoperative pain score in comparison to the NaOCl group. The utilization of KTP laser-assisted pulpotomy demonstrated enhanced efficacy in alleviating pain among individuals diagnosed with symptomatic irreversible pulpitis.
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Affiliation(s)
- Savitri Dronamraju
- Department of Conservative Dentistry and Endodontics, Malla Reddy Institute of Dental Sciences, Hyderabad, IND
| | - Muzaamill M Baig
- Department of Conservative Dentistry and Endodontics, Sri Balaji Dental College, Hyderabad, IND
| | - Swetha K
- Department of Conservative Dentistry and Endodontics, Malla Reddy Dental College for Women, Hyderabad, IND
| | - Bhaskar K Naik
- Department of Conservative Dentistry and Endodontics, SVS (Sri Venkata Sai) Dental College, Mahabubnagar, IND
| | - Harshita Gupta
- Department of Conservative Dentistry and Endodontics, Dr. Jaydev Dental Clinic, Hyderabad, IND
| | - Shikha Singh
- Department of Conservative Dentistry and Endodontics, People's Dental Academy, Bhopal, IND
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25
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Camoni N, Cagetti MG, Cirio S, Esteves-Oliveira M, Campus G. Partial Pulpotomy in Young Permanent Teeth: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1447. [PMID: 37761408 PMCID: PMC10527738 DOI: 10.3390/children10091447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
The aim of the present systematic review was to evaluate the clinical and radiographic success of partial pulpotomies in deep caries processes or post-eruptive defects in young, vital permanent teeth. Four electronic databases, PubMed, Scopus, Embase, and Google Scholar, were searched, followed by a manual search in the reference lists. Randomized controlled trials evaluating partial pulpotomy with a follow-up period of ≥12 months were included. A meta-analysis using a random effects model was performed. A total of 3127 articles were retrieved, and after duplicate removal, 2642 were screened by title and abstract; 1 additional article was found during the manual search, and 79 were identified. Finally, six papers were included in the review. Regardless of the partial pulpotomy modalities or material used, there were no significant differences between clinical and radiographic success rates (cumulative success rate 91.8-92.3%). Five studies were included in the meta-analysis that did not indicate any statistically significant differences in success rates when mineral trioxide aggregate was compared to other materials (95% confidence interval: 0.239 to 1.016; p = 0.055). The present research systematically evaluates the evidence and summarizes the available data on partial pulpotomy in young permanent teeth. Given its high clinical and radiographic success rate, partial pulpotomy should be considered when vital pulpal therapy needs to be performed in highly damaged young permanent teeth, as this procedure provides a biological benefit and allows more invasive endodontic treatments to be postponed.
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Affiliation(s)
- Nicole Camoni
- Department of Biomedical, Surgical and Dental Science, University of Milan, Via Beldiletto 1, 20142 Milan, Italy; (N.C.); (S.C.)
| | - Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Science, University of Milan, Via Beldiletto 1, 20142 Milan, Italy; (N.C.); (S.C.)
| | - Silvia Cirio
- Department of Biomedical, Surgical and Dental Science, University of Milan, Via Beldiletto 1, 20142 Milan, Italy; (N.C.); (S.C.)
| | - Marcella Esteves-Oliveira
- Department of Restorative Dentistry and Endodontology, Justus-Liebig-University Giessen, 35392 Giessen, Germany;
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3012 Bern, Switzerland;
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3012 Bern, Switzerland;
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26
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Esteve-Pardo G, Barreiro-Gabeiras P, Esteve-Colomina L. Pulpectomy vs. Pulpotomy as Alternative Emergency Treatments for Symptomatic Irreversible Pulpitis-A Multicenter Comparative Randomised Clinical Trial on Patient Perceptions. Clin Pract 2023; 13:898-913. [PMID: 37623263 PMCID: PMC10453127 DOI: 10.3390/clinpract13040082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/12/2023] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
AIM There needs to be more general agreement on the most effective treatment for the emergency patient with Symptomatic Irreversible Pulpitis (SIP). This equivalence randomised clinical study compared the clinical efficiency, as an urgent treatment, of pulpotomy (POT) and pulpectomy (PEC) in the permanent teeth with SIP. The primary outcome was pain management, and the secondary outcome was the patient's perception of duration, comfort, and satisfaction. MATERIAL & METHODS 80 patients were blindly and randomly allocated into two equal parallel groups, the control group treated by PEC and the test group by POT. Data were collected through numerical rating scales (NRS) during the intervention and 6, 24, and 72 h post-op. Non-parametric tests were used to analyse the data. The Brunner-Longer models were adopted for longitudinal data and the analysis of variance (ANOVA)-type statistical was used. RESULTS The mean preoperative pain levels for the whole sample scored 5.8 ± 2.8 and significantly decreased to 2.1 ± 2.4 at 6 h, 1.5 ± 2.1 at 24 h, and 1.3 ± 2 at 72 h, without any differences between the groups. No significant differences were found in the patient's perception of treatment discomfort or duration between the groups. Three days after the intervention, patient satisfaction was high, with 9.2 ± 1.7 and 9.1 ± 2 in the PEC and POT groups, respectively. Self-reported pain was the only variable penalising the patient's final satisfaction. CONCLUSIONS The current randomised control trial (RCT) showed that both pulpectomy and pulpotomy effectively eliminate pain and achieve high levels of patient satisfaction. Furthermore, the patient's perceptions of the duration and discomfort of the two treatments were similar. Given that pulpotomy is a faster and more straightforward technique, it may be recommended as a viable and pragmatic option for treating emergency patients with symptomatic irreversible pulpitis.
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27
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Kojima Y, Yamaguchi A, Inoue H. Super Minimally Invasive Pulp Therapy for Severe Pulpitis: A Report of Two Cases. Cureus 2023; 15:e42505. [PMID: 37637564 PMCID: PMC10457134 DOI: 10.7759/cureus.42505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
In regions where preventive dentistry is widespread, tooth loss due to root fracture occurs approximately 10 times more frequently than that due to caries and periodontal disease. Root fracture is most likely to occur in non-vital teeth, where the dental pulp has been removed, often through a procedure known as pulpectomy. However, super minimally invasive pulp (SMIP) therapy has recently been reported as a novel treatment approach for pulpitis of any degree. In this study, SMIP therapy was performed to preserve the vitality of teeth in two patients with severe pulpitis. Case one involved a 35-year-old man with a history of hypertension who presented with intense spontaneous pain in tooth #34. The pain was particularly severe while sleeping at night and on exposure to cold water or heat, but it was absent on percussion. Following the detection of cervical caries and severe pulp exposure, SMIP therapy was administered, and the tooth was subsequently restored using glass ionomer cement. Case two involved an 18-year-old woman with no significant medical history who had deep caries in tooth #46. She experienced mild tooth pain when exposed to cold water, and examination revealed pulp exposure. We applied mineral trioxide aggregate over the dental pulp and restored the tooth using composite resin. The vitality of both teeth was maintained at the three-month follow-up. To our knowledge, this is the first report of SMIP therapy for teeth with severe pulpitis. SMIP therapy is an innovative treatment that may cause a paradigm shift from conventional dental treatment.
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Affiliation(s)
- Yuki Kojima
- Anesthesiology, Asahi General Hospital, Asahi, JPN
| | - Atsuki Yamaguchi
- Dental Anesthesiology, Kanagawa Dental University, Yokosuka, JPN
| | - Hiroyuki Inoue
- Anesthesiology, Center Hospital of the National Center for Global Health and Medicine, National Research and Development Agency, Tokyo, JPN
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28
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Altunbas D, Ayhan M, Bilgin O. Evaluation of postoperative pain relief after pulpotomy using different procedures for disinfection and hemostasis in symptomatic irreversible pulpitis. Niger J Clin Pract 2023; 26:819-824. [PMID: 37470658 DOI: 10.4103/njcp.njcp_923_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Aim This study aimed to evaluate postoperative pain scores after sodium hypochlorite (NaOCl) and KTP laser pulpotomies in the permanent teeth with symptomatic irreversible pulpitis retrospectively. Materials and Methods: This study is based on the records of patients treated with pulpotomy using sodium hypochlorite or KTP laser for disinfection and hemostasis at the Department of Endodontics. Sixty patients' molar teeth were treated with either NaOCl or KTP laser. Sodium hypochlorite was used on 31 teeth, and KTP laser was used on another 29 teeth, for disinfection and hemostasis. Initial bleeding control was obtained with saline. 2.5% NaOCl or KTP laser was applied to complete hemostasis. Calcium hydroxide was then placed on the chamber floor to cover the canal orifices. The permanent restoration was completed with composite resin. Pre and postoperative pain scores were recorded with a visual analog scale. The evaluation was performed on the 6th, 24th, 48th, 72nd hours, and 7th days depending on the severity of the pain. Results: There was no significant difference between the groups in terms of demographic data and preoperative pain scores (P > 0.05). The postoperative pain score in the KTP laser group was significantly lower at the 24th hour than in the NaOCl group (P < 0.05). No significant difference was found between the groups at other evaluated time intervals (P > 0.05). The greatest pain score was recorded at the 6th hour in both groups. Conclusion Although the level of pain decreased significantly in both groups in the postoperative period, KTP laser-assisted pulpotomy provided better pain control, especially at the 24th hour.
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Affiliation(s)
- D Altunbas
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Turkey
| | - M Ayhan
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Turkey
| | - O Bilgin
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Turkey
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Zhu X, Zhang Y, Wang J, Wang Z, Wang X, Liu X, Cooper PR, Cheng X, He W. Effect of full pulpotomy using a calcium silicate-based bioactive ceramic in adult permanent teeth with symptoms indicative of irreversible pulpitis: A retrospective study. J Am Dent Assoc 2023; 154:486-494. [PMID: 37115142 DOI: 10.1016/j.adaj.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The authors studied the treatment effect of full pulpotomy using a calcium silicate-based bioactive ceramic in adult permanent teeth with symptoms indicative of irreversible pulpitis. METHODS Eighty-one adult permanent teeth with symptoms indicative of irreversible pulpitis in 78 patients aged 18 through 72 years were evaluated for inclusion in the study. After caries excavation, the pulp was amputated to the level of the canal orifices. After hemostasis was achieved, calcium silicate-based bioactive ceramic was placed as the capping agent. The cavity was sealed temporarily with a glass ionomer cement and then restored with flowable resin and composite resin after 2 weeks if no positive symptoms were reported or detected. Postoperative evaluation was performed by means of clinical and radiographic examination at 2 weeks and 3, 6, and 12 months. RESULTS Overall success rates of the procedure were 96.3% (78 of 81), 93.8% (76 of 81), 92.6% (75 of 81), and 92.6% (75 of 81) at the 2-week, 3-month, 6-month, and 12-month recall visits, respectively. Six of the 81 teeth failed and required root canal therapy. In these 6 teeth, 3 exhibited severe cold stimuli pain and spontaneous pain at the 2-week follow-up, 2 had no response to electric pulp testing with apical percussion pain and periapical rarefaction at the 3-month follow-up, and 1 tooth exhibited periapical rarefaction and labial mucosal fistula at the 6-month follow-up. CONCLUSIONS Under the conditions of this study, full pulpotomy using a calcium silicate-based bioactive ceramic was a successful option for the treatment of adult permanent teeth with carious originated symptoms indicative of irreversible pulpitis. PRACTICAL IMPLICATIONS Vital pulp therapy is no longer impossible for adult permanent teeth with carious originated symptoms indicative of irreversible pulpitis.
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Ayhan M, Altunbaş D. Efficacy of Potassium Titanyl Phosphate Laser and Sodium Hypochlorite on Postoperative Pain Intensity Following Pulpotomy in Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial. Photobiomodul Photomed Laser Surg 2023; 41:225-233. [PMID: 37092958 DOI: 10.1089/photob.2022.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Introduction: This study evaluated the postoperative pain intensity in permanent teeth with symptomatic irreversible pulpitis treated by pulpotomy using physiological saline, sodium hypochlorite (NaOCl), or the potassium titanyl phosphate (KTP) laser. Materials and methods: Ninety patients diagnosed with symptomatic irreversible pulpitis in permanent molars were randomly divided into three groups according to the pulpotomy procedures. Preoperative pain levels were recorded. Complete hemostasis was achieved with physiological saline (control group), NaOCl, or the KTP laser after initial bleeding control. Patients were asked to mark their pain level on the visual pain scale at 6, 24, 48, and 72 h and 7 and 30 days depending on the severity of pain. The permanent restoration was completed after 7 days. Data were statistically analyzed using Kruskal-Wallis, Mann-Whitney U, Friedman, and Bonferroni tests at a significance level of p < 0.05. Results: According to the present study, the statistical difference between the groups in terms of preoperative pain and percussion pain levels was insignificant (p > 0.05). There was no significant difference between groups in terms of demographic data (p > 0.05). The postoperative pain level of the KTP laser group was significantly lower at 6 h compared with the saline group (p < 0.05). There was no significant difference between groups in terms of the postoperative pain level at other time intervals (p > 0.05). The highest pain scores were observed in all groups at 6 h (p < 0.05). Conclusions: The KTP laser can be preferred primarily for reducing postoperative pain in pulpotomy treatments. The KTP laser or NaOCl-assisted pulpotomy can be an effective treatment for pain reduction in permanent teeth with symptomatic irreversible pulpitis. This report is registered at clinicaltrials.gov (ID: NCT05424796).
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Affiliation(s)
- Muhammed Ayhan
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Sivas, Turkey
| | - Demet Altunbaş
- Department of Endodontics, Faculty of Dentistry, Sivas Cumhuriyet University, Sivas, Turkey
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31
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Nijakowski K, Ortarzewska M, Jankowski J, Lehmann A, Surdacka A. The Role of Cellular Metabolism in Maintaining the Function of the Dentine-Pulp Complex: A Narrative Review. Metabolites 2023; 13:metabo13040520. [PMID: 37110177 PMCID: PMC10143950 DOI: 10.3390/metabo13040520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
The cellular metabolic processes ensure the physiological integrity of the dentine-pulp complex. Odontoblasts and odontoblast-like cells are responsible for the defence mechanisms in the form of tertiary dentine formation. In turn, the main defence reaction of the pulp is the development of inflammation, during which the metabolic and signalling pathways of the cells are significantly altered. The selected dental procedures, such as orthodontic treatment, resin infiltration, resin restorations or dental bleaching, can impact the cellular metabolism in the dental pulp. Among systemic metabolic diseases, diabetes mellitus causes the most consequences for the cellular metabolism of the dentine-pulp complex. Similarly, ageing processes present a proven effect on the metabolic functioning of the odontoblasts and the pulp cells. In the literature, several potential metabolic mediators demonstrating anti-inflammatory properties on inflamed dental pulp are mentioned. Moreover, the pulp stem cells exhibit the regenerative potential essential for maintaining the function of the dentine-pulp complex.
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Affiliation(s)
- Kacper Nijakowski
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Martyna Ortarzewska
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Jakub Jankowski
- Student's Scientific Group in the Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Anna Lehmann
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Anna Surdacka
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland
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Huang H, Okamoto M, Watanabe M, Matsumoto S, Moriyama K, Komichi S, Ali M, Matayoshi S, Nomura R, Nakano K, Takahashi Y, Hayashi M. Development of Rat Caries-Induced Pulpitis Model for Vital Pulp Therapy. J Dent Res 2023; 102:574-582. [PMID: 36913545 PMCID: PMC10152557 DOI: 10.1177/00220345221150383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Rodent animal models for vital pulp therapy are commonly used in dental research because their tooth anatomy and cellular processes are similar to the anatomy and processes in humans. However, most studies have been conducted using uninfected sound teeth, which makes it difficult to adequately assess the inflammatory shift after vital pulp therapy. In the present study, we aimed to establish a caries-induced pulpitis model based on the conventional rat caries model and then evaluate inflammatory changes during the wound-healing process after pulp capping in a model of reversible pulpitis induced by carious infection. To establish the caries-induced pulpitis model, the pulpal inflammatory status was investigated at different stages of caries progression by immunostaining targeted to specific inflammatory biomarkers. Immunohistochemical staining revealed that both Toll-like receptor 2 and proliferating cell nuclear antigen were expressed in moderate and severe caries-stimulated pulp, indicating that an immune reaction occurred at both stages of caries progression. M2 macrophages were predominant in moderate caries-stimulated pulp, whereas M1 macrophages were predominant in the severe caries-stimulated pulp. Pulp capping in teeth with moderate caries (i.e., teeth with reversible pulpitis) led to complete tertiary dentin formation within 28 d after treatment. Impaired wound healing was observed in teeth with severe caries (i.e., teeth with irreversible pulpitis). During the wound-healing process in reversible pulpitis after pulp capping, M2 macrophages were predominant at all time points; their proliferative capacity was upregulated in the early stage of wound healing compared with healthy pulp. In conclusion, we successfully established a caries-induced pulpitis model for studies of vital pulp therapy. M2 macrophages have an important role in the early stages of the wound-healing process in reversible pulpitis.
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Affiliation(s)
- H Huang
- Department of Restorative Dentistry and Endodontology, Graduate School of Dentistry, Osaka University, Suita-shi, Osaka, Japan
| | - M Okamoto
- Department of Restorative Dentistry and Endodontology, Graduate School of Dentistry, Osaka University, Suita-shi, Osaka, Japan
| | - M Watanabe
- Department of Restorative Dentistry and Endodontology, Graduate School of Dentistry, Osaka University, Suita-shi, Osaka, Japan
| | - S Matsumoto
- Department of Restorative Dentistry and Endodontology, Graduate School of Dentistry, Osaka University, Suita-shi, Osaka, Japan
| | - K Moriyama
- Department of Restorative Dentistry and Endodontology, Graduate School of Dentistry, Osaka University, Suita-shi, Osaka, Japan
| | - S Komichi
- Department of Restorative Dentistry and Endodontology, Graduate School of Dentistry, Osaka University, Suita-shi, Osaka, Japan
| | - M Ali
- Department of Restorative Dentistry, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
| | - S Matayoshi
- Department of Pediatric Dentistry, Graduate School of Dentistry, Osaka University, Suita-shi, Osaka, Japan
| | - R Nomura
- Department of Pediatric Dentistry, Graduate School of Dentistry, Osaka University, Suita-shi, Osaka, Japan.,Department of Pediatric Dentistry, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima
| | - K Nakano
- Department of Pediatric Dentistry, Graduate School of Dentistry, Osaka University, Suita-shi, Osaka, Japan
| | - Y Takahashi
- Department of Restorative Dentistry and Endodontology, Graduate School of Dentistry, Osaka University, Suita-shi, Osaka, Japan
| | - M Hayashi
- Department of Restorative Dentistry and Endodontology, Graduate School of Dentistry, Osaka University, Suita-shi, Osaka, Japan
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Zhang D, Zheng C, Zhu T, Yang F, Zhou Y. Identification of key module and hub genes in pulpitis using weighted gene co-expression network analysis. BMC Oral Health 2023; 23:2. [PMID: 36593446 PMCID: PMC9808982 DOI: 10.1186/s12903-022-02638-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/30/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Pulpitis is a common disease mainly caused by bacteria. Conventional approaches of diagnosing the state of dental pulp are mainly based on clinical symptoms, thereby harbor deficiencies. The accurate and rapid diagnosis of pulpitis is important for choosing the suitable therapy. The study aimed to identify pulpits related key genes by integrating micro-array data analysis and systems biology network-based methods such as weighted gene co-expression network analysis (WGCNA). METHODS The micro-array data of 13 inflamed pulp and 11 normal pulp were acquired from Gene Expression Omnibus (GEO). WGCNA was utilized to establish a genetic network and categorize genes into diverse modules. Hub genes in the most associated module to pulpitis were screened out using high module group members (MM) methods. Pulpitis model in rat was constructed and iRoot BP plus was applied to cap pulp. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used for validation of hub genes. RESULTS WGCNA was established and genes were categorized into 22 modules. The darkgrey module had the highest correlation with pulpitis among them. A total of 5 hub genes (HMOX1, LOX, ACTG1, STAT3, GNB5) were identified. RT-qPCR proved the differences in expression levels of HMOX1, LOX, ACTG1, STAT3, GNB5 in inflamed dental pulp. Pulp capping reversed the expression level of HMOX1, LOX, ACTG1. CONCLUSION The study was the first to produce a holistic view of pulpitis, screen out and validate hub genes involved in pulpitis using WGCNA method. Pulp capping using iRoot BP plus could reverse partial hub genes.
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Affiliation(s)
- Denghui Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Chen Zheng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Tianer Zhu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Fan Yang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China
| | - Yiqun Zhou
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, China.
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Singh A, Kaur H, Soni P, Choudhary R, Yeluri R. Evaluation of biodentine pulpotomy in caries-exposed symptomatic vital mature permanent teeth in 9‒13-year-old children: A 24-month clinico-radiographic observation. J Dent Res Dent Clin Dent Prospects 2022; 16:264-269. [PMID: 37560489 PMCID: PMC10407868 DOI: 10.34172/joddd.2022.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/01/2022] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The present study evaluated the clinical and radiographic outcomes of Biodentine pulpotomy for 24 months in symptomatic vital mature permanent teeth with caries exposure. METHODS Seventy-three patients with a chief complaint of spontaneous pain in permanent teeth were screened. Finally, 47 mature permanent teeth underwent a Biodentine pulpotomy procedure. Clinical evaluation of 47 teeth was carried out at 1, 3, 6, 9, 12, and 24 months and radiographic evaluations were made at 6, 12, and 24 months. The success of Biodentine pulpotomy was evaluated using Pearson's chi-square test. The significance level was determined at P<0.05. RESULTS At 24 months, the clinical and radiographic success rate was 97.78%, with only one clinical failure at 9 months. CONCLUSION The clinical and radiographic success of Biodentine pulpotomy was high (97.78%). Thus, Biodentine pulpotomy can be an alternative to root canal treatment (RCT) in symptomatic vital mature permanent teeth.
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Affiliation(s)
- Archana Singh
- Department of Pedodontics & Preventive Dentistry, Runta College of Dental Sciences and Research, Chhatisgarh, India
| | - Harsimran Kaur
- Department of Pedodontics & Preventive Dentistry, Teerthanker Mahaveer Dental College & Research Centre, Uttar Pradesh, India
| | - Priyanka Soni
- Department of Conservative and Endodontics, Buddha Institute of Dental Sciences and Hospital, Bihar, India
| | - Rishika Choudhary
- Department of Pedodontics & Preventive Dentistry, Teerthanker Mahaveer Dental College & Research Centre, Uttar Pradesh, India
| | - Ramakrishna Yeluri
- Department of Pedodontics & Preventive Dentistry, Teerthanker Mahaveer Dental College & Research Centre, Uttar Pradesh, India
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Huang F, Cheng L, Li J, Ren B. Nanofibrous scaffolds for regenerative endodontics treatment. Front Bioeng Biotechnol 2022; 10:1078453. [PMID: 36578510 PMCID: PMC9790898 DOI: 10.3389/fbioe.2022.1078453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
Untreated dental caries, tooth trauma and dental anatomical variations such as dens invaginatus can result in pulpitis. However, standard root canal therapy cannot treat immature permanent teeth due to an open apical foramen and thin dentinal walls. Thus, regenerative endodontics treatment (RET) following a disinfection step with pulp regeneration has been developed. Pulp connective-tissue, dentin formation, revascularization and reinnervation can occur in this procedure which should be supplemented with intelligent biomaterials to improve repeatability and support well-coordinated regeneration. Furthermore, nanofibrous scaffolds, as one of the most commonly used materials, show promise. The purpose of this article is to highlight the advantages of nanofibrous scaffolds and discuss the future modification and application of them.
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Affiliation(s)
- Fangting Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China
- Department of Preventive Dentistry, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China
- Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiyao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China
- Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Biao Ren
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, Sichuan, China
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36
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Philip N, Suneja B. Minimally invasive endodontics: a new era for pulpotomy in mature permanent teeth. Br Dent J 2022; 233:1035-1041. [PMID: 36526777 PMCID: PMC9758046 DOI: 10.1038/s41415-022-5316-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/08/2022] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Nebu Philip
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Bharat Suneja
- Baba Jaswant Singh Dental College and Hospital, Ludhiana, India
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37
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Zhang M, Xiong Y, Wang X, Wang Y, Cai Y, Xu J, Zhang C, Li J. Factors affecting the outcome of full pulpotomy in permanent posterior teeth diagnosed with reversible or irreversible pulpitis. Sci Rep 2022; 12:20280. [PMID: 36434032 PMCID: PMC9700813 DOI: 10.1038/s41598-022-24815-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
This study aimed to investigate the factors affecting the success rate of full pulpotomy in permanent posterior teeth with pulpitis. The study included 105 permanent posterior teeth clinically diagnosed as reversible or irreversible pulpitis in 92 patients aged 18-82 years. All teeth underwent a full pulpotomy using mineral trioxide aggregate as a capping material and were recalled for clinical and radiographic evaluation at 3, 6, 12, and 24 months postoperatively. The overall success rate after the 12-month review was above 90%, and failed cases mainly occurred during the first 12 months after treatment. In this study, the treatment outcome of pulpotomy was not related to sex, or tooth position and the cause of pulpitis. To analyze the influence of age on the treatment outcome, all the teeth were allocated to three groups: group 1 (18-39 years); group 2 (40-59 years); and group 3 (≥ 60 years). A significant difference in success rate was found between groups 1 and 3 (P = 0.014). These results suggest that pulpotomy can be used as an alternative treatment for permanent mature teeth diagnosed with pulpitis and that aging is one factor affecting the treatment outcome.
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Affiliation(s)
- Min Zhang
- grid.89957.3a0000 0000 9255 8984Department of Geriatric Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, People’s Republic of China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, People’s Republic of China
| | - Yuhua Xiong
- grid.89957.3a0000 0000 9255 8984Department of Geriatric Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, People’s Republic of China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, People’s Republic of China
| | - Xuerong Wang
- grid.89957.3a0000 0000 9255 8984Department of Geriatric Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, People’s Republic of China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, People’s Republic of China
| | - Yunqin Wang
- grid.89957.3a0000 0000 9255 8984Department of Geriatric Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, People’s Republic of China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, People’s Republic of China
| | - Yixin Cai
- grid.89957.3a0000 0000 9255 8984Department of Geriatric Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, People’s Republic of China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, People’s Republic of China
| | - Junchen Xu
- grid.89957.3a0000 0000 9255 8984Department of Geriatric Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, People’s Republic of China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, People’s Republic of China
| | - Chengfei Zhang
- grid.194645.b0000000121742757Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam, Hong Kong, Special Administrative Region People’s Republic of China
| | - Jin Li
- grid.89957.3a0000 0000 9255 8984Department of Geriatric Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029 People’s Republic of China ,Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, People’s Republic of China ,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing, People’s Republic of China
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Kojima Y, Sendo R. Maintaining Tooth Vitality With Super Minimally Invasive Pulp Therapy. Cureus 2022; 14:e29712. [PMID: 36321001 PMCID: PMC9616580 DOI: 10.7759/cureus.29712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/15/2022] Open
Abstract
In aging humans, tooth loss is a predictor of decreased longevity. Tooth loss is mainly caused by dental caries and periodontal disease. Pulpitis refers to inflammation of the dental pulp caused by bacterial infection secondary to dental caries. It is accompanied by severe toothache and has infectious disease-associated pathophysiology. Pulpitis is mainly treated by pulpectomy, which is aimed at removing the infected dental pulp and controlling pain by removing nociceptive nerve fibers. However, teeth without dental pulp have a poor prognosis. In this report, we proposed a novel “super minimally invasive pulp” therapy for treating pulpitis without pulpectomy, which combines antibiotics, steroids, and ultrasound-guided trigeminal nerve block (UGTNB) to protect the dental pulp. UGTNB is used as an analgesic for severe pain, antibiotics for pulp infections, and steroids as antiinflammatory drugs. This novel therapy could improve the longevity of the tooth and thereby oral health.
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Shang W, Zhang Z, Zhao X, Dong Q, Schmalz G, Hu S. The Understanding of Vital Pulp Therapy in Permanent Teeth: A New Perspective. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8788358. [PMID: 36132084 PMCID: PMC9484899 DOI: 10.1155/2022/8788358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022]
Abstract
The indications of vital pulp therapy (VPT) are expanding, which cases are suitable for VPT, and how to improve the success rate of VPT is a problem that often bothers us. The main purpose of VPT is to eliminate pulpitis by promoting the formation of reparative dentin or calcium bridge, so that it can continue to perform various physiological functions, and finally achieve the purpose of preserving pulp vitality and long-term preservation of affected teeth. Pulp capping and pulpotomy are the most common methods for VPT. The research field of VPT has attracted the attention of many scholars, who have studied it from many aspects (such as indications, material selection, operation requirements, and long-term prognosis). This article reviews the recent advances in the techniques of VPT in permanent teeth.
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Affiliation(s)
- Wei Shang
- Department of Stomatology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000 Shanxi, China
| | - Zeliang Zhang
- Department of Stomatology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000 Shanxi, China
| | - Xicong Zhao
- Department of Stomatology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000 Shanxi, China
| | - Qingquan Dong
- Department of Stomatology, Changzhi Medical College, Changzhi, 046000 Shanxi, China
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr 12, 04103 Leipzig, Germany
| | - Shaonan Hu
- Department of Stomatology, Changzhi Medical College, Changzhi, 046000 Shanxi, China
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40
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Gürcan AT, Şişmanoğlu S, Sengez G. Effect of Different Adhesive Strategies on the Microshear Bond Strength of Calcium-Silicate-Based Materials. JOURNAL OF ADVANCED ORAL RESEARCH 2022. [DOI: 10.1177/23202068221118979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To evaluate the microshear bond strength (µSBS) of mineral trioxide aggregate and Biodentine to various resin-based materials using different adhesive strategies. Materials and Methods: Three resin-based materials—a self-adhering resin composite with or without acid etching (Vertise flow; Kerr, Orange, CA, USA), a conventional flowable composite with a total-etch adhesive (Filtek Ultimate Flowable; 3M ESPE, St. Paul, MN, USA), and a flowable resin-modified glass ionomer cement (RMGIC) without any surface modification (Ionoseal; VOCO GmbH, Cuxhaven, Germany)—and two calcium-silicate-based materials—Biodentine and BIOfactor mineral trioxide aggregate (MTA)—were tested. A total of 100 cylindrical acrylic molds were prepared. Biodentine and BIOfactor MTA were prepared and placed into the central holes on the molds. Specimens were divided into two main groups according to materials and into five subgroups ( n = 10). µSBS were evaluated using a µSBS testing device. The failure modes were examined under a stereomicroscope with magnification. They were categorized as adhesive, cohesive, or mixed. Data were analyzed using two-way analysis of variance (ANOVA) and Tukey test. The significance level was taken as α = 0.05. Results: It was observed that both calcium-silicate-based material type and resin-based material type influenced the µSBS significantly according to two-way ANOVA. Biodentine exhibited higher bond strength values than MTA. However, no statistically significant interaction was demonstrated between these factors ( P = .396). The µSBS values of intermediate materials to Biodentine and MTA were listed from the lowest to the highest as follows: RMGIC < Acid Etch + RMGIC < SARC (self-adhering resin composite) < FC (flowable composite) < Acid Etch + SARC. Conclusion: Self-adhering composites can be used on calcium-silicate-based materials in vital pulp treatments because of their mechanical properties. Acid-etching ensures high µSBS values. Although the µSBS of Biodentine were higher than MTA according to this study’s results, there was no statistically significant difference in µSBS of FC and acid-etched SARC to MTA.
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Affiliation(s)
- Aliye Tuğçe Gürcan
- Department of Pediatric Dentistry, Faculty of Dentistry, Altinbas University, Bakirkoy, Istanbul, Turkey
| | - Soner Şişmanoğlu
- Department of Restorative Dentistry, Faculty of Dentistry, Altinbas University, Bakirkoy, Istanbul, Turkey
| | - Görkem Sengez
- Department of Restorative Dentistry, Faculty of Dentistry, Altinbas University, Bakirkoy, Istanbul, Turkey
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Essa M, Tohamy S. Histopathological Analysis and Comparison between Experimentally Fabricated Hydroxyapatite from Nile Tilapia Bone and Mineral Trioxide Aggregate as A Direct Pulp Capping Agents on Dog Pulp (In Vivo Study). Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM: The aim of this study was to study response of exposed dental dog pulp to the HP from Nile Tilapia bone and MTA on induction of reparative dentin formation and to inflammatory response in pulp tissue.
MATERIALS AND METHODS: Four male mongrel dogs 1 year old with total of 20 teeth from each dog were selected and divided into two groups that each group has 40 teeth according to the material used as pulp capping agents. The maxillary teeth and the mandibular teeth for each dog were capped by both materials alternatively; the cavities were then sealed by glass-ionomer cement. Each group divided in two groups according to 2-time intervals (4 weeks and 8 weeks). Animals were sacrificed and teeth were collected for histopathological analysis.
RESULTS: Specimens capped by fish bone powder after 4 weeks, which showed non-significantly higher of inflammatory cell scores than that capped by MTA. It showed thin (score 1) to moderate (score 2) thickness of dentine bridge formation, mostly a-tubular dentin, in all specimens. After 8 weeks, significant decrease in inflammatory cell infiltration scores for both groups were found, but it was significant in case of fish bone powder. Furthermore, dentine bridge became more significant for both materials with slight histological change in the group capped by fish bone powder.
CONCLUSIONS: HA from Nile Tilapia bone could be considered as a direct pulp capping material. Furthermore, more studies needed on the fabrication of this material to give better result in shape and the pattern of reparative dentine formed.
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Cells and material-based strategies for regenerative endodontics. Bioact Mater 2022; 14:234-249. [PMID: 35310358 PMCID: PMC8897646 DOI: 10.1016/j.bioactmat.2021.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022] Open
Abstract
<p class = "Abstract" style = "margin: 0 cm; line-height: 32px; font-size: 12 pt; font-family: "Times New Roman", serif; color: rgb(0, 0, 0); "><span lang = "EN-US">The carious process leads to inflammation of pulp tissue. Current care options include root canal treatment or apexification. These procedures, however, result in the loss of tooth vitality, sensitivity, and healing. Pulp capping and dental pulp regeneration are continually evolving techniques to regenerate pulp tissue, avoiding necrosis and loss of vitality. Many studies have successfully employed stem/progenitor cell populations, revascularization approaches, scaffolds or material-based strategies for pulp regeneration. Here we outline advantages and disadvantages of different methods and techniques which are currently being used in the field of regenerative endodontics. We also summarize recent findings on efficacious peptide-based materials which target the dental niche.<o:p></o:p></span></p> Pulp infection necessitates removal of necrotic, inflamed and infected tissue. Materials used clinically are inert (such as gutta percha, mineral trioxide aggregate). Recent developments in materials (angiogenic hydrogels, stem cell composites) have tuneable bioactivity. Dental pulp regeneration may now be possible through the use of bioactive systems, that guide regeneration.
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Vital Pulp Therapy of Permanent Teeth with Reversible or Irreversible Pulpitis: An Overview of the Literature. J Clin Med 2022; 11:jcm11144016. [PMID: 35887779 PMCID: PMC9321233 DOI: 10.3390/jcm11144016] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 12/10/2022] Open
Abstract
Vital pulp therapy (VPT) has been recently proposed as an alternative approach even in symptomatic mature permanent teeth with deep caries’ lesions, aiming to maintain the pulp vitality over time and/or to avoid non-surgical root canal therapy (NSRCT). However, to date, the diagnosis of reversible or irreversible pulpitis is only based on clinical pain quantity and quality, without precisely reflecting the pulp inflammation status. Therefore, the aim of the present study was to provide an overview based on the current scientific literature to demonstrate the clinical effectiveness of VPT on mature permanent teeth, validating the use of hydraulic calcium silicate-based cements and their role in pain management. VPT may be successfully applied not only in mature permanent teeth diagnosed with reversible pulpitis, but also in permanent dental elements with signs and symptoms of irreversible pulpitis. Hydraulic cements showed favorable outcomes in terms of decrease of pro-inflammatory mediators and of post-operative pain. Pain plays a central role in the chance to perform VPT in mature permanent teeth, since it may be considered as a pre-operative diagnostic criterion as well as a treatment success parameter. In addition, proper assessment of pulp inflammation and choice of appropriate materials are key factors in enhancing VPT success.
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Clinical Symptoms and Quality of Life Improvement Value of Ornidazole Mixture in Auxiliary Filling Treatment of Patients with Endodontic Disease. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7181258. [PMID: 35909582 PMCID: PMC9283067 DOI: 10.1155/2022/7181258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022]
Abstract
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
; the excellent and good rate of the observation group was 96.77% and 85.48%, respectively, and the difference had statistical significance
; 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
. 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.
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Song H, Lei Y, Xing Z, Liu M. Minocycline plus Zinc Oxide Eugenol Cement Might Be A Promising Alternative for Acute Pulpitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:4653602. [PMID: 35586688 PMCID: PMC9110167 DOI: 10.1155/2022/4653602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/27/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
Objective To investigate the clinical effect of minocycline plus zinc oxide eugenol cement in the treatment of acute pulpitis and its effect on the levels of HIF-1α, Bcl-2, and tumor necrosis factor α. Methods A total of 286 patients with acute pulpitis who were treated in our hospital from January 2019 to October 2020 were recruited and assigned (1 : 1) via random number table method to receive either minocycline (control group) or minocycline plus zinc oxide eugenol cement (study group). Outcome measures included treatment effect, tooth mobility, tooth percussion pain score, hypoxia-inducible factor (HIF)-1α and B-lymphocyte tumor (Bcl)-2 positive rate, and tumor necrosis factor (TNF-α). Results Minocycline plus zinc oxide eugenol cement was associated with significantly lower scores of teeth mobility and percussion pain versus minocycline alone (p < 0.05). Minocycline plus zinc oxide eugenol cement resulted in a significantly higher treatment efficacy (97.20%) versus minocycline alone (72.73%) (p < 0.05). Minocycline plus zinc oxide eugenol cement was associated with significantly lower positive rates of HIF-1α and Bcl-2 and lower levels of TNF-α versus minocycline alone (p < 0.05). The patients receiving minocycline plus zinc oxide eugenol cement showed significantly lower visual analogue scale (VAS) scores and faster pain relief versus those given minocycline alone (p < 0.05). Conclusion Minocycline plus zinc oxide eugenol cement offers a viable alternative for acute pulpitis as it mitigates the pain of patients, alleviates inflammatory responses, and lowers the positive rate of HIF-1α and Bcl-2, so it is worthy of clinical promotion.
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Affiliation(s)
- Hongning Song
- Department of Stomatology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yintao Lei
- Department of Stomatology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Zaichen Xing
- Department of Stomatology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Min Liu
- Department of Stomatology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
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Ballal N, Duncan H, Wiedemeier D, Rai N, Jalan P, Bhat V, Belle V, Zehnder M. MMP-9 Levels and NaOCl Lavage in Randomized Trial on Direct Pulp Capping. J Dent Res 2022; 101:414-419. [PMID: 34706567 PMCID: PMC8935528 DOI: 10.1177/00220345211046874] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Outcome expectations of direct pulp capping in carious teeth are obscured by a clinically unknown infiltration and breakdown of the dental pulp tissue. Histologic studies showed that this soft tissue breakdown is related to the innate immune system. We hypothesized 1) that a neutrophil biomarker could predict the outcome of direct pulp capping and 2) that using sodium hypochlorite (NaOCl) as a lavage solution to remove necrotized infected pulp tissue could improve it. In this randomized trial in mature posterior teeth causing no or mild discomfort with carious pulpal exposures, pulpal fluid was collected to assess neutrophil gelatinase (matrix metalloproteinase 9 [MMP-9]) per total protein (TP) levels as a predictive local biomarker. Subsequently, the dentin-pulp wound was randomly washed with a 2.5% NaOCl or a physiologic saline solution (1:1 allocation), capped with mineral trioxide aggregate, and the tooth was immediately restored with a resin-based composite restoration. Ninety-six patients were included, and 84 individuals could be followed up to treatment failure or clinically confirmed pulp survival after a minimum of 1 y. The entire data were fitted to a Cox proportional hazards model to assess the influence of the observational variables MMP-9/TP and discomfort with the randomized lavage treatment on pulp survival. The Kaplan-Meier pulp survival rates after 1 y were 55% for saline and 89% for NaOCl lavage. The inflammatory state of the pulp tissue as reflected by MMP-9/TP levels and NaOCl lavage had a highly significant (P < 0.001 and P = 0.004, respectively) impact on pulp survival, while mild preoperative discomfort did not. In conclusion, MMP-9/TP showed great promise as a predictive local biomarker, and NaOCl lavage considerably improved the survival time of cariously exposed and directly capped pulps.
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Affiliation(s)
- N.V. Ballal
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences–Manipal, Manipal Academy of Higher Education, Manipal, India
| | - H.F. Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - D.B. Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - N. Rai
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences–Manipal, Manipal Academy of Higher Education, Manipal, India
| | - P. Jalan
- Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences–Manipal, Manipal Academy of Higher Education, Manipal, India
| | - V. Bhat
- Department of Biochemistry, Kasturba Medical College–Manipal, Manipal Academy of Higher Education, Manipal, India
| | - V.S. Belle
- Department of Biochemistry, Kasturba Medical College–Manipal, Manipal Academy of Higher Education, Manipal, India
| | - M. Zehnder
- Clinic of Conservative and Preventive Dentistry, University of Zurich, Zurich, Switzerland
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Asgary S, Eghbal MJ, Shahravan A, Saberi E, Baghban AA, Parhizkar A. Outcomes of root canal therapy or full pulpotomy using two endodontic biomaterials in mature permanent teeth: a randomized controlled trial. Clin Oral Investig 2022; 26:3287-3297. [PMID: 34854987 PMCID: PMC8636579 DOI: 10.1007/s00784-021-04310-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/20/2021] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth. MATERIALS AND METHODS A total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal-Wallis. RESULTS At 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544). CONCLUSION In the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results. CLINICAL RELEVANCE Simple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.
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Affiliation(s)
- Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, 1983963113, Tehran, Iran.
| | - Mohammad Jafar Eghbal
- Iranian Center for Endodontic Research, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, 1983963113, Tehran, Iran
| | - Arash Shahravan
- Endodontology Research Center, Endodontic Department, Dental School, Kerman University of Medical Sciences, 7618751689, Kerman, Iran
| | - Eshaghali Saberi
- Endodontic Department, Oral and Dental Diseases Research Center, Dental School, Zahedan University of Medical Sciences, 9816743463, Zahedan, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, 1971653313, Tehran, Iran
| | - Ardavan Parhizkar
- Iranian Center for Endodontic Research, Research Institute for Dental Sciences, Shahid Beheshti University of Medical Sciences, 1983963113, Tehran, Iran
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Mandviwala DK, Arora AV, Kapoor SV, Shah PB. Internal root resorption: A rare complication of vital pulp therapy using platelet-rich fibrin. J Oral Maxillofac Pathol 2022; 26:132. [PMID: 35571329 PMCID: PMC9106247 DOI: 10.4103/jomfp.jomfp_389_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/08/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Internal root resorption (IRR) is a specific type of pulp disease categorized by the loss of dentin as a consequence of the action of clastic cells stimulated by pulpal inflammation. It is one of the rare complications following a vital pulp therapy (VPT) procedure. Reported here is a case of IRR as a complication of VPT platelet-rich fibrin pulpotomy procedure in a mature permanent tooth. Diagnosed using cone-beam computed tomography and management of the resorptive defect using biodentin with a follow-up of 1 year.
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Affiliation(s)
- Dilshad Kersi Mandviwala
- Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
| | - Ankit V Arora
- Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
| | - Sonali Vinod Kapoor
- Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
| | - Purnil Bhupendrakumar Shah
- Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
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Seck A, Ndiaye D, Niang SO, Leye Benoist F, Fioretti F, Toure B. Evaluation of complete pulpotomy with Biodentine® on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis: 12 months follow-up. J Endod 2021; 48:312-319. [PMID: 34974080 DOI: 10.1016/j.joen.2021.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Complete pulpotomy is the removal of the coronal portion of a vital pulp and is a means of preserving the vitality of the remaining root portion. The objective of this study was to evaluate the 12-month success rate of complete pulpotomy with Biodentine® on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis. MATERIALS AND METHODS A total of 68 molars diagnosed with symptomatic irreversible pulpitis in 68 patients aged 20 years and older were included in this study. The exclusion criteria were intraoperative clinical signs of pulp necrosis on the molar to be treated such as no bleeding, or uncontrollable pulp hemorrhage (more than 5 min of hemostasis) on at least one canal. A complete pulpotomy with Biodentine® was performed on molars with symptomatic irreversible pulpitis by the same operator and with the same protocol. At 12-month post-operative follow-up was conducted to evaluate clinical and radiological success. RESULTS A total of 66 patients received complete pulpotomy. Fifty-two could be examined at 12 months postoperatively. Clinical and radiological analysis at 12 months postoperatively revealed a success rate of 87% (45/52 molars) and a failure rate of 13% (7/52 molars). There was a relationship between age, tooth type, pre-operative periapical condition and treatment success with P<0.05. CONCLUSION Compliance with the indications and protocol for complete pulpotomy with Biodentine® on mature permanent molars with symptomatic irreversible pulpitis gives positive results at 12 month follow-up.
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Affiliation(s)
- Anta Seck
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal.
| | - Diouma Ndiaye
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
| | - Seydina Ousmane Niang
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
| | - Fatou Leye Benoist
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
| | - Florence Fioretti
- University of Strasbourg, Faculty of Dental Surgery of Strasbourg, INSERM UMR 1260, Pôle de Médecine et Chirurgie Bucco-Dentaire des Hôpitaux Universitaires de Strasbourg, France
| | - Babacar Toure
- Department of Conservative Dentistry and Endodontics, Department of Odontostomatology, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Sénégal
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Guan X, Zhou Y, Yang Q, Zhu T, Chen X, Deng S, Zhang D. Vital Pulp Therapy in Permanent Teeth with Irreversible Pulpitis Caused by Caries: A Prospective Cohort Study. J Pers Med 2021; 11:jpm11111125. [PMID: 34834477 PMCID: PMC8620894 DOI: 10.3390/jpm11111125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 01/09/2023] Open
Abstract
Background: When a tooth is diagnosed with irreversible pulpitis, root canal therapy (RCT) is generally performed to completely remove pulp tissue, which might lead to a higher risk of loss of vascularity, and teeth being more prone to fracture. Vital pulp therapy (VPT) is a personalized method of treating irreversible pulpitis, which conforms to the trend of minimally invasive endodontics. The remaining vital pulp could promote the physiological development of the roots of young permanent teeth with incomplete apical foramen. However, clear guidelines for VPT indication are still missing. Objective: This prospective cohort study evaluated the outcomes of vital pulp therapy (VPT) using iRoot BP Plus (Innovative Bioceramix Inc, Vancouver, BC, Canada) in permanent teeth of 6- to 20-year-old patients with irreversible pulpitis caused by caries and analyzed the preoperative factors affecting VPT prognosis. Methods: Fifty-nine permanent teeth in 59 patients with irreversible pulpitis caused by caries were treated with VPT using iRoot BP Plus. All patients received VPT under a standardized protocol. After informed consent, teeth were isolated with a dental dam, then operators performed VPT with iRoot BP Plus and restored the teeth with composite resin or stainless steel crown. Patients were postoperatively recalled after 3, 6 and 12 months and then recalled annually. Successful cases were defined as successful in both clinical and radiographic evaluations. A statistical analysis was performed using the Fisher exact test, and the level of significant difference was p < 0.05. Results: After 6–36 months of follow-up, a total of 57 teeth from 57 patients were accessible for evaluation. The mean age of subjects was 11.75 ± 3.81 years. The overall clinical and radiographic success rate of VPT was 91.2% (52/57). With an observation time of one year or more, the success rate was 90.5% (38/42). All the symptoms and physical examination findings showed no significant effect on VPT prognosis (p > 0.05) using a binary logistic regression model. Conclusions: Permanent teeth in 6- to 20-year-old patients diagnosed as irreversible pulpitis caused by caries can be successfully treated with VPT using iRoot BP Plus.
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