Management of deep caries and the exposed pulp

The outcome of full and deep pulpotomy in teeth with extremely deep carious lesion and symptomatic irreversible pulpitis: A non-inferiority randomized controlled trial

AIM

To compare the outcome of full and deep pulpotomy performed in mature permanent teeth with extremely deep carious lesion and symptomatic irreversible pulpitis.

METHODOLOGY

This parallel-group, double-blind, non-inferiority randomized controlled trial was conducted after ethical clearance. Patients with mature permanent teeth with extremely deep carious lesion and diagnosis of symptomatic irreversible pulpitis were recruited. Teeth were randomly allocated to two study groups, i.e. Group I: full pulpotomy (excision of pulp tissue up to the level of root canal orifices) and Group II: deep pulpotomy (excision of radicular pulp tissue 2-3 mm apical to root canal orifices). Haemostasis was achieved using cotton pellet moistened with 2.5% NaOCl for up to 10 min. Mineral trioxide aggregate was used as a pulp capping agent and teeth were restored in the same visit with resin composite. Outcome assessment was performed at 12-month follow-up based on clinical and radiographic evaluation. The success rate was determined by intention-to-treat (ITT) and per-protocol (PP) analysis. Two sample t-tests were used to compare the time taken to achieve haemostasis and determine its association with treatment outcome.

RESULTS

A total of sixty teeth received treatment in both study groups. The bleeding time was significantly more in Group I (6.13 ± 1.59 min) compared to group II (5.23 ± 1.22 min) (p < .0171). The recall rate was 86.6% at study end point when fifty-two teeth were analysed at 12-month follow up. The success rate was 88.46% and 92.30% for per protocol analysis and 76.67 and 80% for ITT analysis for Group I and Group II, respectively, without any statistically significant difference (p = .610). The absolute risk difference between each treatment was within the 10% non-inferiority limit. There was no statistically significant association between time taken to achieve haemostasis and treatment outcome in both study groups.

CONCLUSIONS

There was no significant difference between full and deep pulpotomy techniques, with respect to achievement of haemostasis and treatment outcome for management of teeth with extremely deep caries and irreversible pulpitis.

Assessing the dental health needs of children in the paediatric intensive care unit

Many children admitted to paediatric intensive care units (PICUs) present with unmet dental health needs or develop these during their admission. It is important to maintain good oral health because suboptimal oral hygiene is linked to various dental and medical conditions, with intubated patients being at risk of developing hospital-acquired pneumonia. This article outlines the role of PICU nurses in identifying children's dental health needs by undertaking oral assessments when each child is admitted to the unit and by implementing national initiatives and guidelines on oral health. The article also details the findings of a service evaluation in the PICU at Evelina London Children's Hospital, England, which demonstrated the importance of maintaining good oral hygiene and the benefit of opportunistic dental treatment while children are admitted to the unit.

Two-stepped pH-responsive peptide microsphere/carboxymethyl chitosan complex: enhanced protection of an inflamed dentin-pulp complex

Dental caries is the most prevalent infectious disease affecting oral health, leading to the destruction of tooth hard tissues and dental pulp inflammation. The dentin-pulp complex, as the biological core of the tooth, can generate reparative dentin to protect the dental pulp from infection progression. However, untreated carious lesions chronically disrupt the structural integrity and reparative capacity of the dentin-pulp complex, thereby significantly compromising pulp vitality as deep caries progresses. In this study, a two-stepped pH-responsive peptide microsphere/carboxymethyl chitosan complex (PM/CS) was designed to offer comprehensive protection for the inflamed dentin-pulp complex. PM/CS has a three-dimensional network structure, and it constructs an intelligent drug delivery system by integrating TVH-19 self-assembled peptide microspheres that we developed earlier into carboxymethyl chitosan. This complex not only exhibited pH-controlled release characteristics, but also showed antibacterial properties against Streptococcus mutans and a mineralization-promoting effect on human dental pulp cells (hDPCs). PM/CS exerted acute anti-inflammatory effects on early pulpal lesions in rats, while longitudinal studies revealed its remarkable capacity to induce tertiary dentinogenesis, indicating therapeutic efficacy through biological modulation. This study provides a potential pulp capping complex material for the restoration treatment of the dentin-pulp complex under the influence of deep caries.

Clinical and radiographic assessment of mineral trioxide aggregate with platelet rich fibrin as pulp capping biomaterials: a 12-month randomized trial

This study aimed to comparatively assess the clinical success and radiographic regenerative dentin formation of Platelet Rich Fibrin (PRF) and mineral trioxide aggregate (MTA) when used as direct pulp capping agents. This double-blinded two parallel armed randomized controlled clinical trial comprised the allocation of 108 patients with traumatically exposed dental pulp during the management of deep carious lesions by undergraduate students after fulfilling inclusion and exclusion criteria. Patients were randomized into two groups (n = 54 in each group) using computer-generated simple randomization, wherein one group Platelet Rich Fibrin (PRF) was prepared from patients' blood samples and applied directly over exposed pulp followed by MTA application and in the other group MTA was applied directly over pulp exposure. In both groups, cavities were restored with resin-modified glass ionomer liner and resin composite restoration. The overall success of treatment was calculated at 6 and 12 months after assessing pulp sensibility, history of pain, tenderness on percussion and the existence of any periapical pathosis using in periapical radiographs. Moreover CBCT was used at 12 months to determine the presence or absence of dentin bridge as a secondary outcome. After 12 months follow-up, there was no statistically significant difference in overall success of pulp capping in both groups. As the both groups showed 92.59% success rate. CBCT evaluation of dentin bridge formation by Platelet Rich Fibrin (PRF) demonstrated a significantly higher percentage than that formed in cases treated with MTA alone (p < 0.001). Direct pulp capping with Platelet Rich Fibrin (PRF) exhibited a clinical and radiographic success rate comparable to that of MTA. Platelet Rich Fibrin (PRF) can be implemented as a direct pulp capping agent in forthcoming clinical applications.

Selective removal of dental caries in permanent teeth: an 18-month clinical trial

OBJECTIVES

This study aimed to evaluate the clinical efficacy of restorations after selective removal of carious tissue (SRCT) in permanent teeth.

MATERIAL AND METHODS

A randomized, controlled, and blinded clinical trial was conducted on 74 teeth to compare SRCT with two types of non-selective removal (nSRCT), which served as control groups. For medium-depth lesions (D2) that reached the middle third of the dentin, SRCT was compared with non-selective removal to hard dentine (nSRCT-HD). For deep lesions (D3) extending to the inner third of the dentin, SRCT was compared with stepwise removal of carious tissue (StRCT). Outcomes included pulp sensitivity and restoration quality, assessed using FDI Functional Property criteria. Adjusted analyses were performed using Poisson regression with robust variance to assess the risk ratio (RR) and its respective 95% confidence interval.

RESULTS

A total of 62, 50, and 39 teeth were followed at 6, 12, and 18 months, respectively. Three pulp sensitivity failures occurred at 6 months (2 nSRCT, 1 SRCT), with no additional failures at 12 and 18 months. Regarding quality of restoration, no failure was observed and there was not significant difference between groups up to the 18-month period.

CONCLUSION

SRCT was clinically effective in both mid-depth (D2) and deep (D3) lesions, addressing pulp sensitivity and restoration quality. In D3 lesions, it minimized the risk of pulp exposure while preserving dentin integrity, while in D2 lesions, it preserved tooth structure without compromising restoration performance.

CLINICAL RELEVANCE

SRCT is a less invasive strategy, preserves more dental tissue and presents satisfactory results in relation to the preservation of pulp sensitivity and quality of restorations.

The performance of silver diamine fluoride on bond strength and ultramorphology of universal adhesive to artificial carious dentin under thermocycling conditions

OBJECTIVES

To investigate the effect of silver diamine fluoride (SDF) on the microtensile bond strength (µTBS) and resin-dentin interface of universal adhesive (etch-and-rinse mode) under thermocycling.

MATERIALS AND METHODS

Artificial caries lesions were induced on human dentin discs using a bacterial model and divided into four groups: C (no treatment), CT (no treatment, thermocycling), CS (SDF), and CST (SDF, thermocycling). The treated-dentin surface was bonded with universal adhesive (etch-and-rinse mode) and stored for 24 h or subjected to 10,000 thermocycles. µTBS was performed with 1 mm/min crosshead speed with a 50 N load cell (n = 16/group). The resin-dentin interface was examined using confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDX) (n = 3/group). Statistical analyses included two-way ANOVA with Bonferroni post-hoc tests for µTBS and Fisher's Exact Test with Bonferroni correction for failure mode distribution.

RESULTS

The highest bond strength was observed in C (24.28 ± 2.27 MPa) followed by CST (18.26 ± 5.63 MPa). Significantly lower µTBS was detected in CS (14.20 ± 3.32 MPa) and CT (12.72 ± 2.12 MPa). CT exhibited a distinct failure mode from the other groups (p < 0.05). CLSM revealed less uniform resin tags in CS and CST. EDX demonstrated silver deposition at 50 μm beneath the adhesive layer in CS and at 120 μm with lower intensity in CST.

CONCLUSIONS

SDF enhances bonding durability, as evidenced by increased µTBS and modified resin-dentin interface.

CLINICAL RELEVANCE

SDF may enhance the durability of bonding with universal adhesive in etch-and-rinse mode.

Comparison of oral health-related quality of life among endodontic patients with irreversible pulpitis and pulp necrosis using the oral health-related endodontic patient's quality of life scale

This prospective cohort study aimed to clarify differences in the longitudinal effects on oral health-related quality of life (OHRQoL) among patients undergoing endodontic treatment for irreversible pulpitis and for pulp necrosis, using a newly developed oral health-related endodontic patient's quality of life (OHQE) scale. This study included 131 patients diagnosed with irreversible pulpitis and pulp necrosis. Comprehensive data regarding the patient's background, medical history, and dental history were collected. The OHQE was administered three times to each patient: before and after endodontic treatment, as well as 2 weeks after endodontic treatment as a follow-up. Statistical analysis was performed using a linear mixed model for repeated measurements of changes in the OHQE score over time in cases of irreversible pulpitis and pulp necrosis. The patients consisted of 48 (36.6%) males and 83 (63.4%) females with a mean age of 36.2 (standard deviation, 12.6) years. Of these, 62 (47.3%) had irreversible pulpitis, and 69 (52.7%) had pulp necrosis. Intragroup comparisons showed an improvement in the OHQE scores over time in both groups (p < 0.001). Group comparisons revealed no significant differences at any time point. No interactions or changes over time were observed between the two groups. No difference in the improvement of quality of life after endodontic treatment was seen in the two disease groups, and both groups improved over time. However, patients' expectations of receiving endodontic treatment remained unchanged after treatment. Therefore, dental providers should consider explaining the value of endodontic treatment to patients and address the measures that contribute to patient satisfaction.

Diffusion of Silver Diamine Fluoride Solution in Dentine: An In Vitro Study

OBJECTIVES

The aim of this research was to assess the diffusion dynamics of silver and fluoride ions after 38% silver diamine fluoride (SDF) solution application on dentine of varying thicknesses over 24 weeks.

METHODS

Bovine dentine discs of 5.5 mm in diameter were prepared and separated into 3 groups with thicknesses of 0.5 mm (group 1), 1.0 mm (group 2), and 1.5 mm (group 3). The diameter and number of dentinal tubules of discs were assessed. Each disc received a topical application of 0.05 mL 38% SDF solution. The deionised water in the tube was collected weekly for 24 weeks. The silver and the fluoride ion concentrations in the collected deionised water were determined. Generalised estimating equations was used to explore the potential effects of the key factors on the silver/fluoride diffusion.

RESULTS

The amount of silver and fluoride ion diffusion through dentine almost levelled off after 4 weeks and showed a decline trend over 24 weeks. The mean (SD) 24-week cumulative ion diffusion through dentine in groups 1, 2, and 3 was as follows: 20 (4) μg, 10 (2) μg, and 5 (1) μg for silver (P < .05) and 18 (2) μg, 13 (2) μg, and 7 (1) μg for fluoride (P < .05), respectively.

CONCLUSIONS

Silver and fluoride ion diffusion through dentine showed a decline trend over 24 weeks. The diameter and the number of dentinal tubules on dentine with different thicknesses affects the ion diffusion dynamics. This study provides indications on the pattern of silver/fluoride ions diffusion through dentine to pulp after 38% SDF application. An increased amount of silver/fluoride diffuses through dentine into the pulp with decreased remaining dentine thickness.

Ginsenoside RB1 Influences Macrophage-DPSC Interactions in Inflammatory Conditions

INTRODUCTION AND AIMS

Unresolved inflammation and tissue destruction are supposed to underlie the failure of dental pulp repair. As crucial regulators of the injury response, dental pulp stem cells (DPSCs) play a key role in pulp tissue repair and regeneration. M2 macrophages have been demonstrated to induce osteogenic/odontogenic differentiation of DPSCs. Ginsenoside Rb1 (GRb1) is the major component of ginseng and manifested an anti-inflammatory role by promoting M1 macrophage polarised into M2 macrophage in inflammatory disease. However, whether GRb1 facilitates odontogenic differentiation of DPSCs via promoting M2 macrophage polarisation under inflammatory conditions has yet to be established.

METHODS

Human monocyte leukemic cells (THP-1) differentiated macrophages were induced into M1 subsets and then treated with GRb1. After that, the conditioned medium was added to DPSCs. The cell co-cultured system was then subjected to odontogenic differentiation in osteogenic media. Effects of GRb1 on human dental pulp stem cells' (hDPSCs') osteogenic/odontogenic differentiation under inflammatory conditions were assessed by alkaline phosphatase (ALP) staining, Alizarin Red S (ARS) staining, and quantitative polymerase chain reaction testing.

RESULTS

Results demonstrated that GRb1 could facilitate the polarisation of macrophages from the M1 subtype to the M2 subtype. Conditioned medium from GRb1 + M1 macrophages, in comparison with M1 macrophages, may markedly increase the gene expression of ALP, DSPP, and DMP1. Moreover, ALP and ARS staining uncovered that the osteogenic/odontogenic differentiation ability of hDPSCs was strengthened in the M1 + GRb1 co-culture group.

CONCLUSIONS

GRb1 plays a crucial role in the inflammatory response and reparative dentine formation after dental pulp injury. Findings show that GRb1 modulates the interaction between macrophages and DPSCs during inflammation. The current study discusses modifications of deep caries therapy.

Management of deep carious lesions among Syrian dentists: a cross-sectional study

BACKGROUND

Deep carious lesions present significant challenges in dental practice, requiring effective management strategies to preserve tooth sensibility and function. This study aimed to assess Syrian dentists 'practices related to deep carious lesions and managing exposed pulps in teeth with reversible pulpitis in permanent teeth. It also examined the impact of dentists' experience and specialization on their choice of techniques and diagnostic tools.

METHODS

A cross-sectional study was conducted using a self-administered paper-based questionnaire distributed to dentists in Damascus. The questionnaire collected 1- demographic data, 2- clinical decisions before the start of the treatment, and 3- clinical decisions to treat deep carious lesions in different clinical cases and the management of exposed pulps. Data were analyzed to identify trends and differences in practices based on experience and specialization. Data were coded into excel and analyzed using SPSS V.25.

RESULTS

The study included responses from 252 dentists. The majority of dentists chose to take radiographs before treatment (69.4%), or do a sensibility test (70.6%). A strong preference for minimally invasive techniques was observed, such as partial caries removal to avoid pulp exposure (71.7%) and the use of hand excavators (53.2%). Dentists with more than 10 years of experience were more likely to work without rubber dam (< 0.001), while endodontists tended to apply rubber dam more than other clinicians (< 0.001). Experienced and specialist dentists were more likely to use rubber dam (p = 0.001) and perform sensibility tests (p = 0.000). The unique context of practicing in Syria, marked by conflict and political sanctions, significantly influenced decision-making of the biomaterials used, with the majority using calcium hydroxide (60.7%) and avoiding other materials, such as MTA and Biodentine, due to cost (31.5%) and availability (9.2%).

CONCLUSIONS

This study documented the clinical decision among Syrian dentist before and during the treatment of deep carious lesions. Clinical decisions and practices are significantly affected by years of experience and whether the dentist is specialized or not. General dentists and other specialists were less likely to perform vital pulp therapies when pulp exposed in teeth with reversible pulpitis than endodontists. Complementary education of Syrian dentists in the domain of pulps exposed management appears necessary regarding current recommendations.

Effect of low-level laser on proliferation, angiogenic and dentinogenic differentiation of human dental pulp stem cells

BACKGROUND

The aim was to evaluate the effect of single and double doses of low-level laser irradiation on proliferation of human dental pulp stem cells (DPSC) and expression of vascular endothelial growth factor (VEGF) and dentine sialoprotein (DSP).

METHODS

In this experimental in vitro study, after confirming the stemness of DPSCs, the cells were cultured in Dulbecco's Modified Eagle Medium (DMEM) for MTT assay and VEGF-ELISA and osteogenic medium for DSP-ELISA. The wells containing DPSCs were divided into three main groups and 9 subgroups (n = 7). In groups with single low-level laser, 660-nm diode laser was irradiated at 100 mW and 3 J/cm2 energy density for 15 s. In groups with double doses of low-level laser the second identical irradiation was after 48 h. The MTT-assay and ELISA for DSP/VEGF (dentinogenic/angiogenic differentiation) were performed at 1, 7 and 14 days post irradiation. Using the SPSS software 20 (SPSS, Chicago, Ill, USA) with 95% confidence interval (P = 0.05), a two-way ANOVA test with Tukey's post hoc test was used for the effect of LLLI on VEGF and DSP. The One-Way ANOVA was used for of cell proliferation.

RESULTS

Higher proliferation rate in both single and double low-level laser was reported. The difference was statistically significant for double doses of low-level laser (P = 0.001, P = 0.020 and P = 0.000 for 1, 7 and 14 days, respectively). Also after one, 7 and 14 days, cells in significant increase in DSP (P > 0.05) and VEGF (P > 0.05) was observed that was significantly higher for double doses of low-level laser.

CONCLUSIONS

Low level laser enhanced the mitochondrial activity and proliferation of DPSCs. Increased production of DSP/VEGF indicates dentinogenic/angiogenic activity.

CLINICAL RELEVANCE

Low level laser increases the proliferation of DPSCs, elevates the production of VEGF (which means better angiogenesis in regenerative treatments) and increases the production of DSP (which means better dentinogenesis in vital pulp treatments).

Assessment of the Number of Missing Tooth Surfaces and the Molecular Findings on the Outcomes of Vital Pulp Therapy Using 2 Calcium Silicate Materials: A Randomized Clinical Study

INTRODUCTION

This study aimed to evaluate the clinical and radiographic outcomes of full pulpotomy in mandibular molar teeth with symptomatic irreversible pulpitis. It compared class I and class II cavity defects and correlated these outcomes with the quantification of 2 biomolecules (tumor necrosis factor-alpha [TNF-α] and matrix metalloproteinase-9 [MMP-9]) using 2 types of pulpotomy dressing materials (MTA+ and Well-Root PT).

METHODS

Sixty patients were selected and categorized based on cavity class. Full pulpotomy was conducted under aseptic conditions and rubber dam isolation. Pulpal blood samples were taken for TNF-α and MMP-9 quantification. Sodium hypochlorite was used as a hemostatic agent. The teeth were randomly divided based on the pulpotomy dressing material, MTA+, or Well-Root PT. Clinical and radiographic assessments were conducted after 1 week, 3, 6, and 12 months.

RESULTS

The overall clinical and radiographic success rate of pulpotomy procedures after a 1-year follow-up was 88.3%. There were nonsignificant differences in the success rates between the groups and subgroups (93.3% in MTA class I, 86.7% in Well-Root PT class I, 80.0% in MTA class II, and 93.3% in Well-Root PT class II). TNF-α and MMP-9 showed a significant correlation with the outcomes.

CONCLUSION

Class I and II cavity defects do not significantly impact the pulpotomy success rate. TNF-α and MMP-9 levels are potential indicators of pulpotomy outcomes. Well-Root PT offers easier handling and lacks the discoloration effect associated with MTA+.

Biocompatibility and photoinactivation evaluation of zinc hydroxide chloride nanosheets against Streptococcus mutans

BACKGROUND

Considering the efficacy of antimicrobial photodynamic therapy (PDT) in inactivating bacteria, this study reports that zinc hydroxide chloride nanosheets (ZHC-NSs) are useful for this purpose.

MATERIALS & METHODS

The characterization of ZHC-NSs was performed using microscopic and spectroscopic techniques. The irritation test, acute toxicity test, and genotoxicity test of ZHC-NSs were evaluated and their effects on human pulp fibroblast cells (HPFC) viability, intracellular reactive oxygen species (ROS) levels, and antibacterial activity of ZHC-NSs (1-8 mg ml-1) alone or in light conditions were investigated.

RESULTS

The ZHC-NSs structure showed a crystalline form and their sheets' thickness had an average size of 129.6 ± 19.50 nm. ZHC-NSs did not severely damage internal organs and were not genotoxic. The cytotoxic effect of ZHC-NSs on HPFC was concentration-dependent so that ZHC-NSs at higher concentrations (4 and 8 mg ml-1) killed half of the HPFC cells. When ZHC-NSs were used in combination with a 980 nm diode laser, namely ZHC-NS©, ROS production increased and led to enhanced antibacterial activity against Streptococcus mutans in planktonic and biofilm form. A statistically significant difference was found between ZHC-NSs without laser irradiation and photoexcited ZHC-NSs.

CONCLUSION

ZHC-NSs© with the potential ability to produce ROS could be effective in complementary treatment against S. mutans.

Managing the cracked and deeply carious tooth: a case report

An understanding of the immunomodulating activities of the dentine-pulp complex and developments of bioactive materials, such as Biodentine, have shaped vital pulp treatment (VPT) and minimally invasive conservative techniques over recent years. However, a lack of consensus in the management of deep carious lesions remains. Furthermore, cracked teeth pose both a compromised endodontic and restorative prognosis due to deficits in coronal seal, the risk of crack propagation and associated uncertain treatment outcomes. The combination of these two situations, which often arise in teeth with occlusal effect caries, complicates their overall restorative management. There is a paucity of evidence relating to clinical protocols which aim to preserve pulpal vitality when managing deep carious lesions in cracked teeth. This may explain why some clinicians enter more advanced stages of the restorative cycle immediately through elective root canal treatment, or, even more radically, through proceeding to extraction. This clinical case report aims to illustrate the value of VPT and indirect restoration in a cracked tooth.

Engineering soft-hard tissue interfaces in dental and craniofacial system by spatially controlled bioactivities

The interface between soft and hard tissues is constituted by a gradient change of cell types and matrix compositions that are optimally designed for proper load transmission and injury protection. In the musculoskeletal system, the soft-hard tissue interfaces at tendon-bone, ligament-bone, and meniscus-bone have been extensively researched as regenerative targets. Similarly, extensive research efforts have been made to guide the regeneration of multi-tissue complexes in periodontium. However, the other soft-hard tissue interfaces in the dental and craniofacial system have been somewhat neglected. This review discusses the clinical significance of developing regenerative strategies for soft-hard tissue interfaces in the dental and craniofacial system. It also discusses the research progress in the field focused on bioengineering approaches using 3D scaffolds equipped with spatially controlled bioactivities. The remaining challenges, future perspectives, and considerations for the clinical translation of bioactive scaffolds are also discussed.

MicroRNA-27a transfected dental pulp stem cells undergo odonto/osteogenic differentiation via targeting DKK3 and SOSTDC1 in Wnt/BMP signaling in vitro and enhance bone formation in vivo

BACKGROUND

MicroRNAs (miRNAs) play a crucial role in cell differentiation through epigenetic regulation of gene expression. In human dental pulp cells, we have identified miRNA-27a being upregulated under inflammatory conditions. Here, we aimed to examine whether (i) overexpression of miRNA-27a in human dental pulp stem cells (hDPSCs) enhances their odonto/osteoblastic differentiation via Wnt and bone morphogenetic protein signaling; and (ii) hDPSCs overexpressing miRNA-27a promote new bone formation in vivo.

METHODS

hDPSCs were cultured in osteogenic medium to promote differentiation. To examine the role of miRNA-27a, hDPSCs were transfected with either a miRNA-27a mimic to enhance or an inhibitor to suppress miRNA-27a expression. Odonto/osteoblastic differentiation was assessed by evaluating the expression of specific markers, Wnt and bone morphogenetic protein (BMP) signaling molecules, and mineralization capacity using RT-qPCR, western blotting, Alizarin Red S (ARS) staining, and alkaline phosphatase (ALP) activity. Potential miRNA-27a binding sites in the 3'UTRs of DKK3 and SOSTDC1 were identified via bioinformatics analysis and validated through the luciferase reporter assay. In vivo, miRNA-27a-overexpressing hDPSCs were seeded into collagen honeycomb scaffolds and implanted into mouse calvarial bone cavities to assess new bone formation.

RESULTS

MiRNA-27a was highly upregulated in hDPSCs committed to odonto/osteoblastic differentiation. Overexpression of miRNA-27a led to increased expression of odonto/osteoblastic markers and enhanced mineralization capacity, while inhibition of miRNA-27a had the opposite effect. MiRNA-27a targeted DKK3, promoting β-catenin nuclear translocation and inhibiting SOSTDC1, which enhanced SMAD1/5 phosphorylation. Binding sites for miRNA-27a were identified in the 3'UTRs of DKK3 and SOSTDC1. In vivo, miRNA-27a-overexpressing hDPSCs promoted new bone formation in mouse calvaria bone cavities.

CONCLUSION

Transfection of miRNA-27a in hDPSCs enhanced their odonto/osteoblastic differentiation by targeting DKK3 and SOSTDC1, thereby promoting the Wnt and BMP signaling. Transplantation of miRNA-27a-overexpressing hDPSCs promoted new bone formation in vivo. These findings deepen our understanding of the effects of miRNA on Wnt and BMP pathways and suggest a potential clinical application for miRNA-27a in promoting hard tissue regeneration, offering a promising therapeutic target for dental and craniofacial tissue reconstruction.

Turkish dentist practice and opinions on diagnosing and treating deep caries lesions: a web-based survey

BACKGROUND

This study investigated the practices and opinions of Turkish dentists regarding the management of deep caries lesions using an online questionnaire.

METHODS

The questionnaire had two sections: the first collected demographic data, while the second focused on clinical practices, including radiographic techniques, rubber dam usage, liner choices, pulp protection, and post-endodontic restoration methods.

RESULTS

The survey response rate was 20.4%. 18 participants were excluded due to incomplete responses in the survey. A total of 390 survey texts (19.5%) were analyzed. The gender distribution of the participants was as follows: 60% female and 40% male. Notably, none of the respondents used rubber dams for endodontic treatment. Male dentists were less likely to use a base under restorations (p < 0.05). Female dentists preferred single-session pulp capping for pulpal perforations (p < 0.05). Public hospitals utilized fewer panoramic films, while Oral and Dental Health Centers used fewer periapical films for diagnoses (p < 0.05). Glass ionomer cement was the most commonly used base material, and direct composite resin was the preferred choice for post-endodontic restorations, in contrast to the less favored indirect composite resin.

CONCLUSIONS

Despite its advantages, the application of rubber dam was infrequent. Glass ionomer cement emerged as the predominant base material across all restoration types, exhibiting variability among dentists in diagnosis, treatment, and material selection.

Effect of selective caries removal and photobiomodulation on postoperative sensitivity in deep cavities: randomized clinical trial

This randomized clinical trial aimed to evaluate the effect of selective caries removal in deep Class I cavities in posterior teeth followed or not by photobiomodulation (PBM) therapy at two different wavelengths on postoperative sensitivity. Baseline spontaneous and stimulated sensitivity scores of 33 vital permanent molars were determined by the participants using a numeric rating scale. The teeth had their affected dentine preserved and were randomly allocated into three groups (n = 11): selective removal of infected dentine (control), selective removal of infected dentine followed by infrared (IR; 810 nm) or red (R; 660 nm) laser irradiation. The teeth were restored with a two-step self-etch adhesive and nanoparticle composite layers, and followed by laser irradiation only for IR and R groups. Both spontaneous and stimulated sensitivity were recorded after 12 h, 7 days, and 14 days. Data were statistically analyzed by Kruskal-Wallis, Friedman, and Wilcoxon tests (p < 0.05). The pulp of all teeth positively responded to cold a stimulus. The control group presented a significant increase in spontaneous sensitivity at 12 h (p < 0.05), which decreased to the preoperative level after 14 days. In both IR and R groups, the sensitivity levels remained stable over time (p > 0.05). At both 7- and 14-day follow-ups, the spontaneous sensitivity for the IR group was significantly lower than the other groups (p < 0.05). In addition to preserving tooth sensitivity, selective deep caries removal can be associated with R or IR to respectively attenuate or completely resolve postoperative sensitivity within one week.

Deep caries and pulp exposures management preferences in permanent teeth: A survey amongst Spanish dentists

AIM

To assess Spanish dentists' management preferences for deep caries removal and exposed pulps in permanent teeth.

METHODOLOGY

A web-based open and anonymous survey was distributed by social media and a specific website for this project amongst dentists practicing in Spain. The questionnaire comprised 40 questions, divided into five sections: (1) demographic data and professional activity; (2) carious tissue removal; (3) decision-making regarding pulp exposure; (4) direct pulp capping and (5) pulpotomy procedures in permanent teeth. Results were descriptively analysed. Logistic regression (95% CI) analyses and X2 tests were carried out.

RESULTS

A total of 538 responses were received. Half the respondents (53.7%) preferred to perform complete caries excavation for shallow and moderate carious dentin lesions, and selective excavation to firm dentin for deep lesions (57.8%). Selective removal to soft dentin and stepwise removal were much less indicated (15.4% and 10.9%, respectively). Exposed pulps in asymptomatic teeth were treated by direct pulp capping (over 80%), decreasing in the presence of reversible pulpitis symptoms (57.1%). If irreversible pulpitis was diagnosed, a pulpectomy would be performed by 53.5% and 89.9% of the respondents in, respectively, immature and mature teeth. Pulpotomy was performed routinely only by 26.4% of the clinicians. Patients' attitudes and priorities were the most relevant criteria when performing direct pulp capping and pulpotomy, together with the history of pain and the presence of bleeding. Regarding the clinical procedure, dry cotton was preferred to obtain haemostasis and Biodentine was the material of election.

CONCLUSIONS

Caries removal preferences and management of pulp exposure by dentists practicing in Spain deviated from vital pulp treatment guidelines, mainly regarding indications and case selection. Pulp exposure was managed by direct pulp capping in asymptomatic cases, whilst immature permanent molars favoured the indication of pulpotomy when pulpitis was diagnosed. Most clinicians used hydraulic calcium silicate cement, specifically Biodentine, to perform vital pulp treatments. Postgraduate formation and continuing education in caries lesions management and vital pulp treatments were consistently related to more conservative and updated decisions.

Physicochemical properties and biological interaction of calcium silicate-based sealers - in vivo model

OBJECTIVES

To investigate volumetric changes, in vivo biocompatibility, and systemic migration from eight commercial endodontic sealer materials in paste/paste, powder/liquid, and pre-mixed forms.

MATERIALS AND METHODS

The sealers AH Plus Bioceramic, AH Plus Jet, BioRoot RCS, MTApex, Bio-C Sealer, Bio-C Sealer Ion+, EndoSequence BC Sealer and NeoSEALER Flo were studied. After characterisation by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), Raman spectroscopy and X-ray diffractometry (XRD), tubes were implanted in Wistar rats' alveolar bone and subcutaneous tissues. Micro-CT evaluated volumetric changes pre/post 30 days of implantation. Histological and immunohistochemistry analyses assessed biocompatibility. Kidney samples underwent spectrometry (ICP-MS) for tantalum, tungsten and zirconium. Statistical analysis determined normality and significance (udp < 0.05).

RESULTS

Characterisation revealed calcium, silicon, and radiopacifiers in the materials. Volumetric changes showed greater alteration in subcutaneous tissues than alveolar bone; BioRoot RCS and MTApex (powder/liquid) were most stable. Histological analysis indicated intense inflammation for AH Plus Jet, moderate for others; IL-10 was marked positively for all materials. AH Plus Jet had an 18-fold higher tungsten and a 37-fold higher zirconium mass fraction in kidneys versus controls, while tantalum showed lower accumulation patterns.

CONCLUSION

Root canal filling materials' responses varied by implantation site and form, demonstrating acceptable biocompatibility. Tantalum and zirconium oxide radiopacifiers appear systemically safe; tungsten-based radiopacifiers are unsuitable due to metal accumulation risks.

CLINICAL RELEVANCE

This study highlights the need for further in vivo studies on endodontic sealers' chemical, biological, and physical behaviors and their systemic migration.

Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic review and meta-analysis

BACKGROUND

Dental caries is one of the most common non-communicable diseases in humans. Various interventions are available for the management, of which microinvasive techniques such as infiltration, sealants, glass ionomers, are novel and convenient. The purpose of this systematic review and meta-analysis was to compare microinvasive techniques with noninvasive or invasive treatment modalities in terms of effectiveness in halting interproximal caries lesion progression radiographically assessed.

METHODOLOGY

The review was registered on PROSPERO (CRD42024557636). Three electronic databases, PubMed, Google Scholar and Cochrane Oral Health Group Trial Register, were searched for the randomized controlled trials comparing any of the microinvasive techniques with either non- invasive or invasive treatments for non-cavitated proximal lesions both in primary and permanent teeth. The radiographic lesion progression was set as primary outcome. Rayyan and EndNote X9 were used for screening and full text review respectively. The risk of bias was assessed using Cochrane Risk of Bias tool. We performed analysis with the help of RevMan5.4 and calculated odds ratio and 95% confidence interval for evaluation of efficacy. The quality of evidence was assessed with the help of GRADEpro.

RESULTS

A total of 185 studies were recruited after initial search, of which 18 were recruited after screening. Finally, 13 studies were included, and all were split mouth randomized controlled trials comparing various microinvasive techniques with non-invasive techniques. Five of the included trials studied primary teeth in children ranging from 3 to 9 years and seven trials assessed permanent teeth in children and adults ranging from 11 to 45 years while one trial included children having lesions on both primary and permanent teeth. The risk of bias assessment showed that 2 of the included studies had unclear risk of bias whereas 11 were at low risk of bias. Tau2, I2, and Chi-Square tests (0.04, 10% and 7.50 respectively) showed minimum level of heterogeneity. The overall odds ratio (95% confidence interval) of 0.29 (95% CI 0.19-0.38) showed that microinvasive techniques were superior as compared to noninvasive techniques for the management of proximal lesions. The subgroup analysis was also performed for types of dentitions, various microinvasive interventions and levels of caries depth. All showed improved outcomes in case of microinvasive interventions as compared to noninvasive techniques. The publication bias was assessed using forest plot and there was no significant publication bias. The quality of evidence assessed by GRADEpro came out to be moderate.

CONCLUSION

This review concludes that microinvasive techniques are superior to noninvasive interventions for the treatment of non-cavitated proximal lesions in both primary and permanent dentition. However, cost effectiveness, feasibility, durability, and long-term effects of microinvasive techniques need to be explored further.

High-intensity focused ultrasound: an innovative approach for micro-manipulation of demineralized dentine

BACKGROUND

Treatment of deep carious lesions poses significant challenges in dentistry, as complete lesion removal risks compromising pulp vitality, while selective removal often reduces the longevity of restorations. Herein, we propose a minimally invasive approach using High-Intensity Focused Ultrasound (HIFU) for microscale removal of carious dentine. Concurrently, HIFU's antimicrobial effects against associated cariogenic biofilms and the corresponding thermal and biological impacts on surrounding tissues were investigated.

METHODS

A total of 238 sound human molars were utilized, with 203 samples of artificial carious-simulated dentine (ACSD) prepared for HIFU exposure. HIFU (250 kHz) was applied at 20 W for varying durations (60, 120, and 180 s). The acoustic waves were administered via a collimated cone coupled to the dentine surface using ultrasonic gel.

RESULTS

Advanced characterization techniques including scanning electron microscopy (n = 5/group), Raman spectroscopy, atomic force microscopy, and nano-indentation (n = 5/group), demonstrated HIFU's effectiveness in removing demineralized collagen-fibrils. This was reflected in the increased mineral content, nano-hardness, and reduced elastic-modulus of ACSD lesions. Micro-CT (n = 6/group) confirmed the increase in mineral density post-HIFU exposure. Confocal microscopy of Rhodamine-B stained ACSD (n = 5/group) quantified the depth of dentine microscale removal post-HIFU exposure in a time-dependent manner. HIFU's potent anti-biofilm effect (n = 9/group) against Streptococcus mutans biofilms was evidenced by microscopic characterizations and significant reductions in metabolic-activity and colony-forming units. Furthermore, HIFU promoted the proliferation of dental pulp stem cells (n = 3/group) while maintaining the associated temperature-rise within the physiological tolerance.

CONCLUSION

HIFU's potential as an innovative, minimally invasive, non-ionizing tool for dentine carious lesion micromanipulation was demonstrated through the interaction between focused acoustic waves and dentine, warranting further studies for future clinical translation in restorative and/or preventive dentistry.

Survival analysis and risk factors of indirect pulp capping in children with severe early childhood caries: a retrospective study

Background Indirect pulp capping (IDPC) is a preferred treatment for pulp preservation in primary teeth. However, the survival rate of IDPC in primary teeth and impact factors is still equivocal.Aims To evaluate the survival rate of IDPC in primary teeth with a deep carious lesion approximating the pulp but without irreversible pulpitis or periapical disease.Methods The medical records of children who were diagnosed with severe early childhood caries (S-ECC) and received IDPC under dental general anaesthesia from January 2015 to December 2020 were screened and collected. The shared frailty model was used to explore potential factors affecting the success rate of IDPC in primary teeth.Results There were 352 children with S ECC and 1,197 teeth were included in the study. A total of 47 children had IDPC that failed in the follow-up period (67 teeth). The survival rates of the teeth treated with IDPC at 48 months was 82.3%. The risk of IDPC primary tooth treatment failure in mandibular teeth was 2.35 times that of maxillary teeth and risk of failure in lesions with mesial surface involvement was 2.76 times higher than those without mesial surface involvement.Conclusion In the present study, the overall survival rate of IDPC did not decrease remarkably with time, regardless of anterior or posterior teeth. The tooth arch position and whether the mesial surface was involved in the carious lesion were found to influence the outcome of IDPC.

The effectiveness of partial pulpotomy compared with full pulpotomy in managing deep caries in vital permanent teeth with a diagnosis of non-traumatic pulpitis

BACKGROUND

Pulpitis may be pain free or alternatively characterized by mild to severe pain and associated symptoms. Evidence has recently emerged that patients presenting with carious pulp exposure range of symptoms can be treated effectively with pulpotomy.

OBJECTIVE

The current systematic review aimed to answer the following research question: "In patients with deep caries lesions in permanent teeth associated with no symptoms, reversible pulpitis or signs and symptoms indicative of irreversible pulpitis (P), is partial pulpotomy (I) as effective as full pulpotomy (C), in terms of a combination of patient and clinical reported outcomes (O), with "tooth survival" as the most critical outcome?

METHODS

The systematic literature search was conducted in the following electronic databases: OVID, Scopus, PubMed (Including MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL) supplemented with Grey literature and hand searching of relevant journals. The English language clinical trials comparing the patient and clinical reported outcomes between partial and full/complete were included. After a structured literature search, two authors independently performed study selection, extracted data and performed a risk of bias assessment; a third reviewer resolved disagreements. As there were only two studies with different exclusion criteria, no meta-analysis was performed and the quality of evidence was assessed by the GRADE approach.

RESULTS

After study selection a total of two randomised clinical trials with a total of 156 teeth were included both for the management of teeth with irreversible pulpitis. There were no studies for asymptomatic teeth or teeth with reversible pulpitis. A "Low" risk of bias was noted for both studies with a high level of overall evidence. A meta-analysis was not carried out due to differences in inclusion criteria between the studies related principally to caries depth. Both studies reported a high rate of clinical success for pulpotomy with a pooled unadjusted success rate for full pulpotomy of 90% and 83% partial pulpotomy of at 1-year; however, no significant difference between the treatments was noted in either study. There was significantly reduced postoperative pain reported in the full pulpotomy group over 1-week compared with the partial pulpotomy in one but not in the other study.

DISCUSSION

Pulpotomy as a definitive treatment modality is as effective in managing teeth exhibiting signs and symptoms indicative of irreversible pulpitis and challenges the established protocols to manage this condition. Although based on only two RCTs with a limited number of patients, no difference was shown in terms of clinical or radiographic outcome or postoperative pain between groups. Further well designed randomised clinical trials of longer duration are required in this area to improve the evidence available.

CONCLUSION

There is no consistent difference in patient-reported pain between partial and full pulpotomy at day 7 postoperatively and the clinical success rate was similar after 1 year for both treatment modalities.

Effect of lateral extent of pulp tissue removal on the outcome of partial pulpotomy for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis: A randomized clinical trial

AIM

The aim of this study is to compare the outcomes of restricted partial pulpotomy (R-PP) versus extended partial pulpotomy (E-PP) for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis (SIP).

METHODOLOGY

This double-arm, parallel designed randomized clinical trial was registered at clinicaltrials.gov (registration number: NCT05406557). Following random allocation, 43 participants of each group received the designated intervention. In the R-PP group, 2-3 mm of superficial pulp tissue was removed only from the exposure site, while chamber was completely de-roofed and 2-3 mm of superficial pulp tissue from entire chamber was removed in the E-PP group. Haemostasis was achieved using 3% sodium hypochlorite-soaked cotton pellets. Upon haemostasis, ProRoot mineral trioxide aggregate (ProRoot MTA) was placed over the pulpal wound, overlaid with a resin-modified glass ionomer liner, and restored with composite resin in the same visit. Outcome measures included clinical and radiographic success evaluation at 6 and 12 months, and pain assessment using the visual analogue scale pre-operatively and daily for 7 post-operative days. Nonparametric tests were used for variables including patient's age, pain intensities, mean analgesic consumption, and haemostasis time. Categorical variables including gender, caries type, analgesic intake, hard tissue barrier formation, clinical and radiographic success, and pulp sensibility responses were assessed using Chi-square or Fisher's exact test. Tooth survival was analysed using Kaplan-Meier analysis.

RESULTS

A total of 81 cases were analysed at 12 months follow-up. Comparable success was observed in both groups (97.6% in E-PP & 97.5% in R-PP; p > .05). The R-PP group reported significantly lower pain scores on the 1st and 2nd post-operative days than E-PP (p < .05) and required significantly less analgesic intake (p < .05). Hard tissue barrier formation was significantly lower in the R-PP group (p < .05). No significant differences were observed between groups regarding haemostasis time, pulp sensibility responses, and tooth survival (p > .05).

CONCLUSIONS

Both the PP approaches exhibited comparable success for managing cariously exposed mature permanent molars with SIP. Given the conservative nature of R-PP, it may be used as preferred PP approach for managing such cases. Being the first study of this kind, further work is necessary to draw definitive conclusions.

Microbial Dynamics in Endodontic Pathology-From Bacterial Infection to Therapeutic Interventions-A Narrative Review

Endodontic infection is a penetration of microorganisms into the dental pulp. Bacteria are the most common entities that induce an infection. This state is associated with significant pain and discomfort. Therapeutic intervention involves removal of infected pulp from the tooth and roots, which eliminates viable tissue, thus creating a tooth less resistant to mechanical pressure. Studies suggest that there are several types of bacteria most commonly associated with endodontic infections. Furthermore, it is considered that different types of pathogens could play a major role in primary and secondary endodontic infections. The aim of this review is to summarize major bacteria involved in the process of endodontic infection. Furthermore, we discuss the bacterial properties that allow them to penetrate dental pulp and hypothesize about possible future treatment strategies.

Clustering human dental pulp fibroblasts spontaneously activate NLRP3 and AIM2 inflammasomes and induce IL-1β secretion

Objectives

The objective of the present study was to investigate whether NOD-like receptor family pyrin domain-containing 3 (NLRP3) and absent in melanoma 2 (AIM2) inflammasomes pathways were involved in an experimental model of fibroblast activation named nemosis, which was used to mimic circumstances without bacteria stimulation.

Methods

Nemosis of human dental pulp fibroblast (DPFs) was induced by three-dimensional culture in U-shaped 96-well plates and investigated by scanning electron microscopy (SEM). DPFs monolayers were used as control. Annexin V-FITC/7-AAD apoptosis assay was performed on the DPFs spheroids by flowcytometry. Caspase-1 activity detection assay was conducted on the DPFs spheroids. Quantitative real-time polymerase chain reaction (qRT-PCR), cytokine measurements, Western blot and the effect of COX-2 inhibitor on spheroids was studied.

Results

SEM study observed human dental pulp fibroblast clusters and cell membranes damage on the surface of DPFs spheroids. The percentages of necrotic cells from DPFs spheroids gradually increased as the incubation time increased. A statistically significant increase in caspase-1 activity was observed after DPFs spheroids formation. DPFs spheroids displayed significant amounts of NLRP3, AIM2 mRNA and protein expression, caspase-1 mRNA expression and cleaved Caspase-1 protein expression and high IL-1β concentrations (P < 0.05) than DPFs monolayers. Specific COX-2 inhibitor (NS-398) decreased NLRP3 mRNA and protein expression, cleaved Caspase-1 protein expression, Caspase-1 activity and IL-1β mRNA expression and IL-1β concentrations (P < 0.05). However, Specific COX-2 inhibitor had no impact on AIM2 mRNA and protein expression, caspase-1 mRNA expression and pro-Caspase-1 protein expression.

Conclusions

In conclusion, clustering human DPFs spontaneously activated NLRP3 and AIM2 inflammasomes and induced IL-1β secretion which could be partially attenuated by COX-2 inhibitor. Thus, nemosis could become a powerful model for studying mechanisms underlying aseptic pulpitis.

Comparison of iRoot BP Plus and mineral trioxide aggregate for pulpotomy in primary molars under general anesthesia: a 3-year retrospective study

Background

Pulpotomy is a widely recommended treatment for deep caries and reversible pulpitis in primary teeth. However, there is a significant lack of large-scale clinical studies evaluating the long-term efficacy of pulpotomy in primary molars, especially in studies with follow-up periods extending beyond a two years.

Aim

This study aimed to evaluate the long-term efficacy of mineral trioxide aggregate (MTA) and iRoot BP Plus for pulpotomy in primary molars performed under general anesthesia and to investigate factors influencing the success rate.

Methods

In this retrospective study, a total of 942 primary molars from 422 children who met the inclusion criteria underwent pulpotomy. Propensity score matching method (PSM) was used to match the MTA and iRoot BP Plus groups in a 1:1 ratio based on covariates. Efficacy was assessed using the Zurn & Seale criteria. Kaplan-Meier survival analysis and Cox proportional hazards model were performed to analyze the outcomes.

Results

PSM resulted in 266 pairs of matched teeth from 532 teeth of 291 children (mean age: 4.64 ± 1.07 years, ranging from 2 to 8 years). Long-term clinical and radiographic evaluations revealed higher success rates for iRoot BP Plus (24-month: 99.54%/97.25%; 36-month: 97.22%/95.83%) compared to MTA (24-month: 94.76%/95.29%; 36-month: 92.50%/91.25%). Survival analysis indicated a statistically significant difference between two groups (P = 0.0042). Age, gender, tooth position, and decayed tooth surface showed no significant impact on pulpotomy success, whereas the choice of pulp capping materials significantly influenced the outcome (HR [95% CI]=0.3745[0.1857-0.7552], P = 0.006).

Conclusion

Clinical and radiographic evaluations support the use of iRoot BP Plus for pulpotomy in primary molars.

Applications of smart materials in minimally invasive dentistry - some research and clinical perspectives

OBJECTIVES

Dental caries is one of the most prevalent bacteria-induced non-communicable diseases globally. It is known to be the top oral health burden in both developing and developed nations. There is substantial literature on the disease process and there is still debate on the extent of caries removal needed and the adequacy of the materials available to restore the lost tooth structure. The current review discusses the disease process together with the contemporary management of the carious lesion and also presents substantial evidence on novel materials and techniques that make minimally invasive dentistry predictable.

METHODS

The written work presented shows the most relevant literature for the management of dental caries focusing on novel materials used in minimally invasive dentistry.

RESULTS

There is still much to learn about specific antimicrobial and caries prevention mechanisms of novel materials. Materials that respond to a single or a few stimuli remain "weakly intelligent" in the face of the complex microenvironment in the oral cavity. Engineered systems that combine artificial intelligence and chemical engineering, are expected to possess higher intelligence, self-healing capabilities as well as environmental adaptability, and may be future promising research directions.

SIGNIFICANCE

The targeted approach in managing dental caries will hopefully have a better clinical outcome. The strategies discussed are alternatives to the contemporary approach and will improve the clinical management.

Understanding dental pulp inflammation: from signaling to structure

The pulp is a unique tissue within each tooth that is susceptible to painful inflammation, known as pulpitis, triggered by microbial invasion from carious lesions or trauma that affect many individuals. The host response involves complex immunological processes for pathogen defense and dentin apposition at the site of infection. The interplay of signaling between the immune and non-immune cells via cytokines, chemokines, neuropeptides, proteases, and reactive nitrogen and oxygen species leads to tissue reactions and structural changes in the pulp that escalate beyond a certain threshold to irreversible tissue damage. If left untreated, the inflammation, which is initially localized, can progress to pulpal necrosis, requiring root canal treatment and adversely affecting the prognosis of the tooth. To preserve pulp vitality and dental health, a deeper understanding of the molecular and cellular mechanisms of pulpitis is imperative. In particular, elucidating the links between signaling pathways, clinical symptoms, and spatiotemporal spread is essential to develop novel therapeutic strategies and push the boundaries of vital pulp therapy.

Vertical root fracture detection with cone-beam computed tomography in Biodentine™ filled teeth

PURPOSE

This study aimed to evaluate the accuracy of detecting vertical root fractures in Biodentine™-filled teeth using the Promax 3Dmax cone-beam computed tomography (CBCT) unit compared to periapical radiographs. It tested hypotheses regarding CBCT's diagnostic superiority in non-root-filled and Biodentine™-root-filled maxillary central incisors and assessed the impact of smaller field of view and lower intensity settings on detection accuracy.

MATERIALS AND METHODS

Extracted maxillary incisors were divided into groups based on fracture status and root filling material, then placed in a Thiel-embalmed skull to simulate clinical conditions. The teeth were imaged using periapical radiographs and the CBCT unit under different settings. Fracture thickness was measured with microcomputed tomography for accuracy benchmarking. Multiple observers assessed the images, and statistical analyses were conducted to evaluate diagnostic performance.

RESULTS

Intra-rater reliabilities of consensus scores ranged from good to very good. Specificities were generally higher than sensitivities across all imaging modalities, but sensitivities remained constantly low. None of the Area Under the Curve scores exceeded 0.6, indicating poor overall accuracy for all imaging modalities. Paired comparisons of the area differences under Receiver Operator Characteristic curves revealed no significant differences between the CBCT and periapical radiograph techniques for detecting vertical root fractures in either Biodentine™-filled or non-root-filled teeth.

CONCLUSIONS

There was no significant accuracy improvement of the current CBCT device (Promax 3Dmax, Planmeca, Finland) over periapical radiographs in detecting small vertical root fractures in both non-root-filled and Biodentine™-root-filled maxillary central incisors. A smaller field of view with lower intensity did not enhance detection accuracy. These results highlight the challenges in accurately detecting small VRFs, emphasizing the need for further research and technological advancements in this domain.

Effects of direct pulp capping with recombinant human erythropoietin and/or mineral trioxide aggregate on inflamed rat dental pulp

OBJECTIVE

This study aimed to evaluate the dental pulp responses to recombinant human erythropoietin (rhEPO) and/or mineral trioxide aggregate (MTA) in pulp capping of inflamed dental pulp in vivo.

MATERIALS AND METHODS

In accordance with ARRIVE guidelines, pulp inflammation was induced by exposing the maxillary first molars (n = 64) of Wistar rats (n = 32) to the oral environment for two days. The exposed pulps were randomly assigned four groups based on the pulp capping material: rhEPO, MTA, MTA + rhEPO, or an inert membrane. An additional eight rats formed the healthy control group. After four weeks, the animals were euthanized, and histological, qRT-PCR, and spectrophotometric techniques were employed to analyze the left maxillary segments, right first maxillary molars, and blood samples, respectively. Statistical significance was set at p < 0.05 and < 0.001.

RESULTS

Pulp capping with rhEPO, MTA, or MTA + rhEPO resulted in lower inflammation and higher mineralization scores compared to untreated control. MTA + rhEPO group exhibited significantly decreased expression of tumor necrosis factor-alpha, and interleukin 1-beta, while MTA group showed substantially reduced expression of interferon-gamma. Both rhEPO and MTA + rhEPO groups presented elevated dentin matrix protein 1 levels compared to untreated control. Furthermore, pulp capping with rhEPO and/or MTA led to increased transforming growth factor-beta 1 expression and reductions of pro-inflammatory/immunoregulatory cytokine ratios and prooxidative markers. Pulp capping with rhEPO also resulted in increase of systemic antioxidative stress markers.

CONCLUSION

Capping with rhEPO or MTA + rhEPO resulted in a favorable effect that was similar or even superior to that of MTA.

Investigation of the biocompatibility of various pulp capping materials on zebrafish model

Testing the biocompatibility of commercially available dental materials is a major challenge in dental material science. In the present study, the biocompatibility of four commercially available dental materials Mineral Trioxide Aggregate, Biodentine, Harvard BioCal-CAP and Oxford ActiveCal PC was investigated. The biocompatibility analysis was performed on zebrafish embryos and larvae using standard toxicity tests such as survivability and hatching rates. Comparative toxicity analysis of toxicity was performed by measuring apoptosis using acridine orange dye and whole mount immunofluorescence methods on zebrafish larvae exposed to the dental materials at different dilutions. Toxicity analysis showed a significant decrease in survival and hatching rates with increasing concentration of exposed materials. The results of the apoptosis assay with acridine orange showed greater biocompatibility of Biodentine, Oxford ActiveCal PC, Harvard BioCal-CAP and Biodentine compared to MTA, which was concentration dependent. Consequently, this study has shown that showed resin-modified calcium silicates are more biocompatible than traditional calcium silicates.

Postoperative pain after total pulpotomy and root canal treatment in mature molars according to the new and traditional classifications of pulpitis: a prospective, randomized controlled trial

BACKGROUND

The aim of this study was to compare postoperative pain following total pulpotomy (TP) and root canal treatment (RCT) in mature molar teeth with irreversible pulpitis. To compare the traditional pulpitis classification system with the Wolters system in evaluating postoperative pain.

METHODS

Eighty mandibular molars with irreversible pulpitis were included and classified according to the Wolters (moderate/severe pulpitis). The teeth were randomly assigned to two groups (RCT or TP). RCT was performed following standardized protocols. TP was performed to the level of the canal orifices, and hemostasis was achieved with 2.5% sodium hypochlorite. A 3 mm layer of MTA was placed as the pulpotomy material. The teeth were restored with glass ionomer cement followed by composite. Pain scores were recorded preoperatively and, at 6, 12, 24, 48, and 72 h and 7 days after the interventions. The data were statistically analyzed using the Mann-Whitney U test, the Friedman test, the Wilcoxon signed-rank test, and the Spearman's correlation test. The significance level was set at 0.05.

RESULTS

Sixty-four patients were analyzed at the one-week follow-up and all were diagnosed as irreversible pulpitis according to the AAE; 22 teeth were classified as moderate and 42 teeth were classified as severe pulpitis according to Wolters. There was no significant difference between TP and RCT in pain scores in moderate pulpitis patients (p > 0.05). There was a significant difference between TP and RCT at 24 and 72 h of severe pulpitis; higher pain scores were observed in the RCT (p < 0.05).

CONCLUSIONS

In patients with moderate pulpitis, the TP procedure allowed symptom relief more quickly than RCT. In patients with severe pulpitis, TP provided for significantly lower pain scores compared to RCT at both 24 and 72 h.

CLINICAL TRIAL REGISTRATION

The study was retrospectively registered with ClinicalTrials.gov (NCT05923619). Date of Registration: 06/16/23.

Comparison of Modified NeoPutty MTA®, Biodentine, and Calcium Hydroxide in Indirect Pulp Therapy in Deciduous Teeth: An In Vivo Clinical Study

BACKGROUND

Pulp capping is a vital dental procedure used to preserve the vitality of teeth affected by deep caries lesions without irreversible pulpitis. The use of modern bioceramic materials has enhanced the predictability of vital pulp therapy (VPT).

AIM

This study aimed to assess the clinical success of Biodentine, modified NeoPutty mineral trioxide aggregate (MTA), and calcium hydroxide (Ca(OH)2) as pulp capping materials for indirect pulp capping in carious primary teeth.

MATERIALS AND METHODS

Indirect pulp treatment (IPT) was performed on 36 deciduous molars in 36 patients presenting with deep carious lesions. The teeth were randomly assigned to three groups: Biodentine (12 teeth), NeoPutty MTA (12 teeth), and Ca(OH)2 (12 teeth). Patients were monitored at 1, 3, and 6 months post-treatment to evaluate the clinical success of the procedures.

STATISTICAL ANALYSIS

Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) software version 21.0. Pearson's Chi-squared test was employed to compare success and failure rates among Biodentine, MTA, and Ca(OH)2 at three different time intervals (30, 90, and 180 days) and overall success and failure rates regardless of the time intervals.

RESULTS

In the statistical analysis, different pulp capping materials yielded varying success rates. The NeoPutty MTA group demonstrated a success rate of 91.67%, the Biodentine group 83.33%, and the Ca(OH)2 group 58.33% after 6 months. However, these differences were not statistically significant.

CONCLUSION

Indirect pulp treatment with calcium silicate-based materials, such as Biodentine and modified NeoPutty MTA, showed superior results compared to the use of calcium hydroxide (Ca(OH)2). Although differences in success rates were observed among the materials, they did not reach statistical significance.

HOW TO CITE THIS ARTICLE

Acharya S, Gurunathan D, Assiry AA, et al. Comparison of Modified NeoPutty MTA®, Biodentine, and Calcium Hydroxide in Indirect Pulp Therapy in Deciduous Teeth: An In Vivo Clinical Study. Int J Clin Pediatr Dent 2024;17(9):1025-1029.

Biological evaluation of novel phosphorylated pullulan-based calcium hydroxide formulations as direct pulp capping materials: An in vivo study on a rat model

AIM

Calcium hydroxide (CH) has been considered as a direct pulp capping materials (DPC) for the last decades despite having some limitations. Phosphorylate pullulan (PPL) incorporated with CH (CHPPL) is a novel biomaterial that was introduced as a promising DPC material. Thus, the aim of the study was to evaluate the inflammatory response and mineralized tissue formation (MTF) ability of PPL-based CH formulations on rat molars after DPC.

METHODOLOGY

This study consisted of six groups: CH with 1% PPL (CHPPL-1); 3% PPL (CHPPL-3); 5% PPL (CHPPL-5); Dycal and NEX MTA Cement (N-MTA) as the positive control, and no capping materials (NC). One hundred twenty maxillary first molar cavities were prepared on Wistar rats. After capping, all the cavities were restored with 4-META/MMA-TBB resin and pulpal responses were evaluated at days 1, 7, and 28. Kruskal-Wallis followed by Mann-Whitney U-test was performed with a significance level of 0.05. Immunohistochemical expression of IL-6, Nestin, and DMP-1 was observed.

RESULTS

At day 1, CHPPL-1, N-MTA, and Dycal exhibited no to mild inflammation, whilst CHPPL-3, CHPPL-5, and NC showed mild to moderate inflammation, and the results were significantly different (p < .05). At day 7, mild to moderate inflammation was observed in CHPPL-1, N-MTA, and Dycal, whereas CHPPL-3, CHPPL-5, and NC exhibited moderate to severe inflammation. Significant differences were observed between CHPPL-1 and N-MTA with NC (p < .05), CHPPL-1 and CHPPL-3 with CHPPL-5 and Dycal (p < .05), and CHPPL-3 with N-MTA (p < .05). A thin layer of mineralized tissue formation (MTF) was observed in all groups. At day 28, CHPPL-1, Dycal, and N-MTA showed no to mild inflammation, whilst CHPPL-3, CHPPL-5, and NC exhibited mild to severe inflammation, and statistically significant difference was detected (p < .05). CHPPL-1, Dycal, and N-MTA exhibited continuous MTF, whilst CHPPL-3, CHPPL-5, and NC had thicker and interrupted MTF. Significant differences were observed between CHPPL-1, CHPPL-3, and N-MTA with NC group (p < .05). Variable expressions of IL-6, Nestin, and DMP-1 indicated differences in the materials' impact on odontoblast-like cell formation and tissue mineralization.

CONCLUSIONS

These findings suggest that CHPPL-1 has the potential to minimize pulpal inflammation and promote MTF and had similar efficacy as MTA cement.

Unleashing the therapeutic role of cannabidiol in dentistry

Cannabidiol (CBD) found in Cannabis sativa is a non-psychoactive compound which is capable of binding to CB1 and CB2 receptors. CBD has recently gained interest in dentistry although it has not been explored sufficiently yet. The therapeutic effects of CBD include anti-inflammatory, analgesic, antioxidant, biological and osteoinductive properties. The aim of this review is to highlight these effects with respect to various oral conditions and shed light on the current limitations and prospects for the use of CBD in maintaining oral health.

Comparative analysis of shear bond strength of MTA and Theracal PT with different restorative materials

BACKGROUND

This study aimed to compare the in vitro shear bond strength (SBS) of mineral trioxide aggregate (MTA) and dual-cured, resin-modified calcium silicate material (Theracal PT) to composite resin, compomer, and bulk-fill composite, and to evaluate the bond failure mode under a stereomicroscope.

METHODS

Ninety acrylic specimens, each with a 4 mm diameter and 2 mm height central hole, were prepared. These specimens were randomly divided into two groups based on the capping materials: MTA and Theracal PT. Each group was further subdivided into three subgroups (n = 15) according to the restorative materials: composite resin, compomer, and bulk-fill composite. The specimens were then subjected to shear testing using a universal testing machine at a crosshead speed of 1 mm/min. Post-test, the fracture locations were examined using a stereomicroscope. Data were analyzed using a two-way analysis of variance (ANOVA) and the Tukey test.

RESULTS

The SBS values for the Theracal PT group were significantly higher than those for the MTA group (p < 0.001). Within the MTA groups, no significant differences were observed in SBS values across the different restorative materials. However, a significant difference was found between the mean SBS values of the Theracal PT + composite resin group and the Theracal PT + compomer group (p < 0.001).

CONCLUSIONS

Theracal PT shows promise in dentistry due to its superior bond strength. Given its bond values, Theracal PT appears capable of forming durable and long-lasting restorations by establishing reliable bonds with various restorative materials commonly used in dentistry.

Comparison of bioactive material failure rates in vital pulp treatment of permanent matured teeth - a systematic review and network meta-analysis

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.

Comparative evaluation of dual-cure resin (TheraCal PT) and Biodentine in coronal pulpotomy of patients with symptoms indicative of irreversible pulpitis: A randomized clinical trial

Background

New and innovative materials are being marketed for the treatment of coronal pulpotomy. It is crucial to compare their efficacy with already-established materials. TheraCal PT (TP) is such a new material that studies are scarce.

Aim

This study aim to compare and evaluate the outcome of coronal pulpotomy using Biodentine and a newly introduced calcium silicate-based dual-cure resin cement, TP, in patients with symptoms of irreversible pulpitis.

Materials and Methods

Sixty patients with exposed carious pulp and symptomatic irreversible pulpitis were included, aged 18-40, randomly allocated to two groups: TP (group I) and Biodentine (group II). Coronal pulpotomy was performed following a standardized protocol, with TP or Biodentine applied accordingly. The pain was recorded using Visual Analog Scale preoperatively for up to 1 week. Success was assessed clinically and radiographically for up to 12 months.

Statistical Analysis Used

The data were analyzed using the Friedman test and the Mann-Whitney U-test. Intragroup pain was analyzed using the Wilcoxon signed-rank test.

Results

Among 60 patients, intervention was done in 53. By removing dropout patients, 47 were analyzed, with 38 available for follow-up at 3, 6, and 12 months. The Biodentine group exhibited a 12-month success rate of 84%, while the TP group revealed 77.3%, with statistically insignificant difference (P = 0.563).

Conclusion

TP can be effectively utilized as a pulpotomy material in cases of symptomatic irreversible pulpitis in mature permanent teeth, offering rapid setting and ease of use, although Biodentine yielded slightly better results in this study.

Decision-Making in Endodontics Prior to the Surgical Removal of Large Cysts Involving Vital Teeth

Introduction Maintaining pulp vitality is crucial; however, treatment options for large lesions may hinder the vitality of the teeth involved within the lesion. Some clinicians are not updated about the diagnostic terminology of the American Association of Endodontists (AAE) which may affect their decision-making. In the literature, there was no absolute treatment to manage such cases. The purpose of this study is to explore different opinions, identify the evidence of practice and treatment options to help in decision-making and assess if clinicians are acknowledged by the AAE guidelines.  Materials and methods This cross-sectional study was conducted through a qualitative survey designed to interview randomly selected endodontists, oral maxillofacial surgeons, oral medicine specialists, oral pathologists, and general partitioners to record their decisions and management about a structured case scenario. A total of 120 participants were included in the study. The interviews were conducted by a single investigator, and the answers were recorded by another investigator. Finally, the responses of the interviewees were collected using Google Forms (Google, Mountain View, California). Results We found that there are dissimilarities between the different groups in decision-making concerning the management of teeth involved in large cystic lesions. Regarding the AEE guidelines, almost all the endodontics and general dentists were aware of the guidelines when compared with the other groups.  Conclusion The management of teeth involved in large cystic lesions is controversial. Furthermore, the AEE guidelines are not a common language between the different disciplines. Randomized clinical trials are needed to investigate the prognosis and management of teeth associated with large cystic lesions.

Evaluation of dentin features in teeth after caries removal by three techniques (chemomechanical, mechanical with a smart bur, and air-abrasion): an in vitro study

Background

Different methods for removing dental carious lesions exist, including conventional rotary caries removal and new advanced technology like polymer-based burs, chemomechanical agents, air abrasion, and laser.

Objectives

This study shows the differences in features of dentin (smear layer, patency of dentinal tubules, surface irregularities, intertubular micro porosities, and exposed dentinal tubules) among different types of caries removal techniques.

Materials and Methods

An in vitro study was done on 60 primary molars with occlusal class I active caries. Teeth were divided into three groups according to a method of caries removal (G1: chemomechanical, G2: mechanical with a smart bur, and G3: air-abrasion). After complete caries excavation, the teeth were examined under a scanning electronic microscope (SEM) with the power of magnification 4,000x and 8,000x to show the morphological dentinal features with SEM microphotographs. Data obtained was analyzed using the SPSS program where Fisher exact, Kruskal-Wallis and multiple Wilcoxon sum rank tests were used. The level of significance is when the p-value is less than 0.05.

Results

Generally, SEM showed the highest ratio of score 1 of smear layer presence, surface irregularities, and microporosity in all groups in both magnifications. The patency of tubules showed the highest ratio of score 1 in G1, scores 2 in both G2 and G3 in magnification 4,000x, while 8,000x there was the highest ratio of its score 1 in G1 and G2 while the G3 has score 2 as the highest score. The exposed dentinal tubules showed the highest ratio in G1 in score 3, in G2 in score 2, and in G3 in score 1 in magnification 4,000x, while 8,000x there was the highest ratio of its score 2 in both G1 and G3 while the G3 has highest score 1. The study with magnification 4,000x showed a significant difference (S) among three groups in exposed dentinal tubules with a p-value (0.012), and there was S between chemomechanical and smart, chemomechanical and air-abrasions groups with a p-value (0.041, 0.001 subsequentially). Other dentin features showed non-significant differences (NS) among or between groups in both magnifications (4,000x, 8,000x).

Conclusions

All groups were effective in removing caries and can successfully treat young, scared or stressed patients. All methods of caries removal produce clinically parametric changes in the residual dentin.

Resolvin D2-induced reparative dentin and pulp stem cells after pulpotomy in a rat model

Introduction

Vital pulp therapy (VPT) is performed to preserve dental pulp. However, the biocompatibility of the existing materials is of concern. Therefore, novel materials that can induce pulp healing without adverse effects need to be developed. Resolvin D2 (RvD2), one of specialized pro-resolving mediators, can resolve inflammation and promote the healing of periapical lesions. Therefore, RvD2 may be suitable for use in VPT. In the present study, we evaluated the efficacy of RvD2 against VPT using in vivo and in vitro models.

Methods

First molars of eight-week-old male Sprague-Dawley rats were used for pulpotomy. They were then divided into three treatment groups: RvD2, phosphate-buffered saline, and calcium hydroxide groups. Treatment results were assessed using radiological, histological, and immunohistochemical (GPR18, TNF-α, Ki67, VEGF, TGF-β, CD44, CD90, and TRPA1) analyses. Dental pulp-derived cells were treated with RvD2 in vitro and analyzed using cell-proliferation and cell-migration assays, real-time PCR (Gpr18, Tnf-α, Il-1β, Tgf-β, Vegf, Nanog, and Trpa1), ELISA (VEGF and TGF-β), immunocytochemistry (TRPA1), and flow cytometry (dental pulp stem cells: DPSCs).

Results

The formation of calcified tissue in the pulp was observed in the RvD2 and calcium hydroxide groups. RvD2 inhibited inflammation in dental pulp cells. RvD2 promoted cell proliferation and migration and the expression of TGF-β and VEGF in vitro and in vivo. RvD2 increased the number of DPSCs. In addition, RvD2 suppressed TRPA1 expression as a pain receptor.

Conclusion

RvD2 induced the formation of reparative dentin, anti-inflammatory effects, and decreased pain, along with the proliferation of DPSCs via the expression of VEGF and TGF-β, on the pulp surface in pulpotomy models.

Selective Caries Removal: A Case Report with 21-Year Follow-Up

Dental caries remains the most prevalent chronic disease globally, and its management should adhere to the principles of minimal intervention dentistry. This study reports a series of successful cases involving the selective removal of carious tissue in permanent molars, with follow-up periods of up to 21 years. Six permanent molars with severe and deep carious lesions were treated with selective caries removal and restored with high-viscosity glass ionomer cement. Clinical examination revealed that the teeth were free from pain and sensitivity. Follow-up assessments were conducted at 7 and 21 years posttreatment. Treatment success was defined by the absence of clinical and radiographic signs, symptoms of pulp alterations, and lesion arrest. Successful minimally invasive approaches were observed with selective removal of carious tissue and maintenance of pulp vitality for up to 21 years.

Enhancing the Physical, Antimicrobial, and Osteo/Odontogenic Properties of a Sol-Gel-Derived Tricalcium Silicate by Graphene Oxide for Vital Pulp Therapies

OBJECTIVES

This study developed a sol-gel tricalcium silicate/graphene oxide (TCS-GO) composite and examined its physicochemical properties, antimicrobial activity, and osteo/odontogenic effect on dental pulp stem cells.

METHODS

Tricalcium silicate was synthesized and combined with graphene oxide at three different concentrations, namely 0.02%, 0.04%, and 0.08% w/w, while tricalcium silicate and mineral trioxide aggregate served as controls. The setting time, compressive strength, pH, and calcium ion release of the composites were evaluated, as well as antimicrobial properties against Streptococcus mutans and Lactobacillus acidophilus. Additionally, the viability of dental pulp stem cells; apatite forming ability; and the gene expression of Alkaline phosphatase, Dentin sialophosphoprotein, and Runt-related transcription factor 2 were assessed.

RESULTS

TCS-GO (0.08%) showed a significantly shorter setting time and higher compressive strength when compared to MTA (p < 0.05). Additionally, tricalcium silicate and TCS-GO groups showed a higher release of Ca ions than MTA, with no significant difference in pH values among the different groups. TCS-GO (0.08%) also demonstrated a significantly stronger antimicrobial effect against Lactobacillus acidophilus compared to MTA (p < 0.05). ALP expression was higher in TCS-GO (0.08%) than MTA on days 3 and 7, while DSPP expression was higher in TCS-GO (0.08%) than MTA on day 3 but reversed on day 7. There was no significant difference in RUNX2 expression between TCS-GO (0.08%) and MTA on days 3 and 7.

CONCLUSIONS

The TCS-GO (0.08%) composite demonstrated superior physicochemical characteristics and antimicrobial properties compared to MTA. Moreover, the early upregulation of ALP and DSPP markers in TCS-GO (0.08%) indicates that it has the potential to promote and enhance the osteo/odontogenic differentiation of DPSCs.

Long-Term Evaluation of Pulp Vitality Preservation in Direct and Indirect Pulp Capping: A Retrospective Clinical Study

Background: This retrospective clinical study aimed to assess dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. Methods: A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), direct pulp capping with Mineral Trioxide Aggregate cement; Group (2), direct pulp capping with a resin-based glass ionomer; Group (3), direct pulp capping with TheraCal; Group (4), indirect pulp capping with a three-step total-etch adhesive system; and Group (5), indirect pulp capping with a two-step self-etch adhesive system. Results: A 72.5% success rate was achieved overall. A statistically significant difference was found when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively. For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis (p = 0.035), while bleeding after exposure appeared independent (p = 0.053). Patient age was significantly related to the maintenance of pulp vitality (p = 0.013). A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered (p = 0.017). For the indirect pulp-capping treatments, a significant correlation between patient age (p = 0.021) and the adhesive system (p = 0.019) with pulp necrosis was described. Conclusions: The pulp-capping material, patient age, and the width of the pulp exposure before the procedure should be carefully considered when performing direct pulp-capping treatments. The performance of the etch-and-rinse adhesive systems was superior to the self-etch system during the indirect pulp-capping procedures.

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

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

Outcome and Prognostic Factors for Partial and Full Pulpotomy in the Management of Spontaneous Symptomatic Pulpitis in Carious Mature Permanent Teeth: A Randomized Clinical Trial

INTRODUCTION

The aim of this study was to compare the outcome and prognostic factors for partial and full pulpotomy in the management of mature teeth with spontaneous symptomatic pulpitis.

METHODS

The study was a parallel double-blind randomized clinical trial; 200 carious mature permanent teeth with spontaneous symptomatic pulpitis were randomized using a block randomization technique to either partial pulpotomy (n = 99) or full pulpotomy (n = 101). Intraoperative assessment of the pulp under magnification was performed, hemostasis was achieved with a 2.5% sodium hypochlorite moist pellet, and NeoPUTTY (Avalon Biomed, Bradenton, FL) was the pulpotomy material. Preoperative pain levels were recorded and re-evaluated after 1 week. Clinical and radiographic evaluation was performed after 6 and 12 months. Data were analyzed using the chi-square test, the Wilcoxon rank test, and regression analysis.

RESULTS

At 1 week, immediate failure occurred in 4 cases in partial pulpotomy, and 196 of 200 subjects reported pain relief and were satisfied with the treatment with no significant difference. At 6 months, 6 teeth failed in the partial pulpotomy group and 1 tooth in the full pulpotomy group, with a higher success rate for full pulpotomy (98.96 vs 89.69, P = .003). At 12 months, the recall rate was 98% (96/200). Full pulpotomy was more successful than partial pulpotomy (98.98% [98/99] vs 84.53% [82/97], P < .001). Multivariate analysis revealed that the odds of success for full pulpotomy were 13.6 times higher than partial pulpotomy. Increased age and higher time to hemostasis were significantly associated with decreased odds of success.

CONCLUSIONS

Full pulpotomy has a higher success rate than partial pulpotomy in the management of spontaneous symptomatic pulpitis. Hemostasis within 4 minutes in partial pulpotomy can be set as the cutoff point beyond which further tissue removal is indicated.

Heparin-Functionalized Bioactive Glass to Harvest Endogenous Growth Factors for Pulp Regeneration

Pulp and periapical diseases can lead to the cessation of tooth development, resulting in compromised tooth structure and functions. Despite numerous efforts to induce pulp regeneration, effective strategies are still lacking. Growth factors (GFs) hold considerable promise in pulp regeneration due to their diverse cellular regulatory properties. However, the limited half-lives and susceptibility to degradation of exogenous GFs necessitate the administration of supra-physiological doses, leading to undesirable side effects. In this research, a heparin-functionalized bioactive glass (CaO-P2O5-SiO2-Heparin, abbreviated as PSC-Heparin) with strong bioactivity and a stable neutral pH is developed as a promising candidate to addressing challenges in pulp regeneration. Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, and thermogravimetric analysis reveal the successful synthesis of PSC-Heparin. Scanning electron microscopy and X-ray diffraction show the hydroxyapatite formation can be observed on the surface of PSC-Heparin after soaking in simulated body fluid for 12 h. PSC-Heparin is capable of harvesting various endogenous GFs and sustainably releasing them over an extended duration by the enzyme-linked immunosorbent assay. Cytological experiments show that developed PSC-Heparin can facilitate the adhesion, migration, proliferation, and odontogenic differentiation of stem cells from apical papillae. Notably, the histological analysis of subcutaneous implantation in nude mice demonstrates PSC-Heparin is capable of promoting the odontoblast-like layers and pulp-dentin complex formation without the addition of exogenous GFs, which is vital for clinical applications. This work highlights an effective strategy of harvesting endogenous GFs and avoiding the involvement of exogenous GFs to achieve pulp-dentin complex regeneration, which may open a new horizon for regenerative endodontic therapy.

CONSORT statement adherence and risk of bias in randomized controlled trials on deep caries management: a meta-research

BACKGROUND

Recently, trials have supported changes in deep caries management. However, reporting might lack details, affecting interpretation and implementation. Thus, we aimed to evaluate the adherence to the CONSORT statement and the risk of bias of randomized controlled trials (RCTs) on deep caries management published in pediatric dental journals.

METHODS

We searched PubMed for RCTs in six pediatric dental journals between 2010 and 2022, focusing on deep caries lesion management. Adherence to the CONSORT guideline and the risk of bias were assessed using a modified tool with 19 items; each scored from 0 to 2 (maximum of 38 points), and the Cochrane risk-of-bias (RoB 2) tool. We performed descriptive and regression analyses (α = 5%).

RESULTS

We analyzed 127 RCTs. The mean (standard deviation) CONSORT adherence score was 21.1 (6.7). Notably, 96.1% of the studies received a score of 2 for the "intervention" item, whereas 83.5% scored 0 for the "estimated effect size". The risk of bias assessment revealed that 40.2% of the RCTs were at high risk, 59% were at low risk, and 0.8% were at low risk. RCTs with a high risk of bias had lower CONSORT scores (p<0.001) than those with low or some concerns. RCTs published in journals without the endorsement of the CONSORT statement had lower scores than those in journals with the endorsement of the CONSORT statement. Older RCTs (6-10 years old and more than 10 years old) showed significantly lower CONSORT statement compliance than trials published recently within 5 years.

CONCLUSION

Adherence to the CONSORT was relatively low among the investigated RCTs. Moreover, lower adherence to the CONSORT was associated with a higher risk of bias.

TRIAL REGISTRATION

This study protocol was prospectively registered on the Open Science Framework - DOI ( 10.17605/OSF.IO/V6SYZ ).