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Current Stem Cell Research & Therapy 2021Oral diseases, such as dental caries, pulpitis, periodontitis, and craniofacial trauma, are common. Some individuals suffer from oral cancer or congenital craniofacial... (Review)
Review
Oral diseases, such as dental caries, pulpitis, periodontitis, and craniofacial trauma, are common. Some individuals suffer from oral cancer or congenital craniofacial defects. The oral-systemic disease link reveals that a dental disorder is not a minor problem. Tissue loss is an inevitable consequence of most oral diseases, and repairing the tissue loss and restoring craniofacial function are highly expected by patients and are terminal targets of dental treatment. The current clinical approach for tissue loss due to dental caries, pulpitis, periodontitis, oral cancer, trauma, and developmental diseases depends on the filling of corresponding material, allograft, or autograft bone after lesion removal. Repair of the tissue volume is expectedly followed by promising functional restoration using regenerative dental tissue or tissue engineering, which has currently aroused the interest of clinicians and researchers. This review focuses on the ideas and recent findings on newly identified skeletal stem cells (SSCs) as candidates for craniofacial regeneration, signaling regulation of SSCs extended from embryonic development, and signal molecule delivery for the repair of the craniofacial defect, sincerely hoping that the hypothesis of craniofacial self-healing is true in the future.
Topics: Dental Caries; Humans; Periodontitis; Pulpitis; Regeneration; Regenerative Medicine; Stem Cells; Tissue Engineering; Wounds and Injuries
PubMed: 33511958
DOI: 10.2174/1574888X16999210128193910 -
Clinical Oral Investigations Mar 2022The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The concept of minimally invasive endodontics recommends less-invasive vital pulp therapy (VPT) modalities over more aggressive traditional endodontic approaches in mature permanent teeth with carious pulp exposure, including irreversible pulpitis (IP) cases. Consequently, VPT needs to be compared with root canal therapy (RCT) in terms of treatment outcomes. This randomized clinical trial compares the results of full pulpotomy using two calcium-silicate cements, i.e., mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) cement, with RCT in mature permanent teeth.
MATERIALS AND METHODS
A total of 157 carious pulp exposure cases in two academic centers with/without established IP were selected/included/randomly appointed to three study arms; (i) RCT (n = 51) as the reference treatment, (ii) pulpotomy with ProRoot MTA (PMTA; n = 55), and (iii) pulpotomy with CEM cement (PCEM; n = 51) as two alternative VPT treatments. Two-year clinical/radiographic results were the outcomes of interest. Data were statistically analyzed through the analysis of variance, chi-square, Fisher exact test, and Kruskal-Wallis.
RESULTS
At 2-year recall, 147 teeth were examined (6.4% dropout). All molars, except for one, were clinically functional/symptom-free, and there was no statistical difference between the three study arms (p = 0.653). The radiographic success rates in RCT, PMTA, and PCEM arms were 98%, 100%, and 97.9%, respectively, without statistically significant differences (p = 0.544).
CONCLUSION
In the management of mature permanent teeth with/without established IP, all experimental groups exhibited equivalent/comparable results.
CLINICAL RELEVANCE
Simple VPT using MTA/CEM can be suggested/recommended as a viable advantageous alternative to RCT for the management of carious pulp exposures with/without sign/symptoms of IP.
Topics: Aluminum Compounds; Biocompatible Materials; Calcium Compounds; Drug Combinations; Humans; Molar; Oxides; Pulpitis; Pulpotomy; Root Canal Therapy; Silicates
PubMed: 34854987
DOI: 10.1007/s00784-021-04310-y -
International Immunopharmacology Jul 2023DNA damage-inducible transcript 3 (DDIT3), a stress response gene, engages in the physiological and pathological processes of organisms, whereas its impact on pulpitis...
DNA damage-inducible transcript 3 (DDIT3), a stress response gene, engages in the physiological and pathological processes of organisms, whereas its impact on pulpitis has not been defined yet. It has been demonstrated that macrophage polarization has a significant impact on inflammation. This research intends to investigate the effect of DDIT3 on the inflammation of pulpitis and macrophage polarization. C57BL/6J mice were used to model experimental pulpitis at 6, 12, 24, and 72 h after pulp exposure, with untreated mice as the control. The progression of pulpitis was visible histologically, and DDIT3 showed a trend of initially upward and downward later. Compared with wild-type mice, inflammatory cytokines and M1 macrophages were reduced, while M2 macrophages were increased in DDIT3 knockout mice. In RAW264.7 cells and bone borrow-derived macrophages, DDIT3 was found to enhance M1 polarization while impair M2 polarization. Targeted knockdown of early growth response 1 (EGR1) could rescue the blocking effect of DDIT3 deletion on M1 polarization. In conclusion, our results indicated that DDIT3 could exacerbate inflammation of pulpitis through the regulation of macrophage polarization, and DDIT3 could promote M1 polarization by inhibiting EGR1. It provides a new target for pulpitis treatment and tissue regeneration in the future.
Topics: Animals; Mice; Inflammation; Macrophages; Mice, Inbred C57BL; Pulpitis; RAW 264.7 Cells
PubMed: 37235961
DOI: 10.1016/j.intimp.2023.110328 -
International Endodontic Journal Mar 2023The aim of this study was to assess and compare the clinical and radiographic outcome of partial pulpotomy and full pulpotomy using Biodentine in cariously exposed... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
The aim of this study was to assess and compare the clinical and radiographic outcome of partial pulpotomy and full pulpotomy using Biodentine in cariously exposed mature molar teeth with symptoms indicative of irreversible pulpitis.
METHODOLOGY
This study is an unicentric, double-arm, randomized superiority clinical trial with parallel experimental groups, registered under CTRI (CTRI/2019/12/022559). Fifty mature permanent molar teeth with carious exposures with symptoms indicative of irreversible pulpitis were randomly allocated equally into two groups. Partial pulpotomy (PP) and full pulpotomy (FP) were performed in the first and second group, respectively, following standardized protocols. Exposed pulp tissue was removed up to a depth of 2-3 mm for partial pulpotomy, whereas complete coronal pulp tissue was removed up to the level of root orifices for full pulpotomy. Haemostasis was achieved with placement of 2.5% sodium hypochlorite-moistened cotton pellets placed on amputated pulp tissue for a maximum of 10 min. Biodentine was used as the pulp capping material. Pain scores were evaluated using 11-point Visual Analogue Scale (VAS) preoperatively, at 24 h, 48 h and 7th day after the intervention(s). Clinical and radiographic evaluation was done at 3 months, 6 months and 1 year. The data were statistically analysed using chi-squared test, Mann-Whitney U-test, Friedman's test and Wilcoxon signed-rank test. The significance level was pre-determined at p < .05. Cumulative survival probabilities were assessed at 12 months using Kaplan-Meier analysis.
RESULTS
Intra-group analysis of pain scores revealed significant reduction in pain scores preoperatively and at 24 h, 48 h and 7th day in both the groups. However, the difference in the pain score(s) reduction between both the groups was not statistically significant at any time interval (p > .05). At 1-year follow-up, the success rate was 88% (22/25) and 91.6% (22/24) for PP and FP respectively (p > .05).
CONCLUSIONS
Partial pulpotomy showed comparable results to full pulpotomy in terms of clinical/radiographic treatment outcome. If the long-term results remain the same, partial pulpotomy can be proposed as an alternative treatment modality for mature teeth with cariously exposed pulp tissue presenting with signs of symptomatic irreversible pulpitis.
Topics: Humans; Pulpotomy; Pulpitis; Calcium Compounds; Molar; Silicates; Treatment Outcome; Pain; Oxides; Drug Combinations; Aluminum Compounds
PubMed: 36403208
DOI: 10.1111/iej.13872 -
Journal of Endodontics Oct 2020Regulated cell death (RCD) is a preferred term inclusive of all modes of cell death regulated by multiple intracellular signal transduction pathways under physiological... (Review)
Review
Regulated cell death (RCD) is a preferred term inclusive of all modes of cell death regulated by multiple intracellular signal transduction pathways under physiological and pathologic conditions. Although cell death programs ensure correct growth and developmental processes as well as protect the host against microbial pathogens, some necrotic cell death pathways, such as pyroptosis, NETosis, and necroptosis, release intracellular damage-associated molecular patterns and inflammatory cytokines, thereby skewing the milieu toward a proinflammatory state. Pulpitis is 1 of the most prevalent oral inflammatory diseases. In response to different types of pulpal injury, RCD may occur either in a "single" or an "overlapped mixed" form, including apoptosis, pyroptosis, and NETosis, which can indicate the severity of pulpal inflammation. RCD has received increasing attention because of the cross talk among cell death pathways. Hence, understanding the molecular switch nodes mediating cross talk between diverse RCD pathways may provide new insights into mechanisms underlying cell-fate decision in pulpitis. In this review, we outlined the potential roles of RCD in the progression of pulpitis and some switch nodes connecting different RCD pathways. Ultimately, an in-depth understanding of molecular mechanisms underlying RCD could be translated into effective approaches to preserve pulpal vitality and integrity under pathologic conditions.
Topics: Apoptosis; Humans; Necrosis; Pulpitis; Pyroptosis; Regulated Cell Death
PubMed: 32682790
DOI: 10.1016/j.joen.2020.07.006 -
Journal of Endodontics Sep 2017This study aimed to assess the outcome of partial pulpotomy using mineral trioxide aggregate (MTA) compared with calcium hydroxide (CH) in mature cariously exposed... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
This study aimed to assess the outcome of partial pulpotomy using mineral trioxide aggregate (MTA) compared with calcium hydroxide (CH) in mature cariously exposed permanent molars.
METHODS
Fifty permanent molar teeth with carious exposures in 50 patients >20 years old were included. Preoperative pulpal and periapical diagnosis was established based on a history of presenting pain, results of cold testing, and radiographic findings. After informed consent, the tooth was anesthetized, isolated via a dental dam, and disinfected with 5% sodium hypochlorite before caries excavation. Partial pulpotomy was performed by amputating 2 mm of the exposed pulp, hemostasis was achieved, and the tooth was randomly assigned for the placement of either white MTA (White ProRoot; Dentsply, Tulsa, OK) or CH (Dycal; Dentsply Caulk, Milford, DE) as the pulpotomy agent. Postoperative periapical radiographs were taken after placement of the permanent restoration. Clinical and radiographic evaluation was completed after 6 months and 1 and 2 years postoperatively. Statistical analysis was performed using the Fisher exact test.
RESULTS
Clinical signs and symptoms suggestive of irreversible pulpitis were established in all teeth. Immediate failure occurred in 4 teeth. At 1 year, MTA showed a higher tendency toward success compared with the CH group, and the difference was statistically significant after 2 years (83% vs 55%, P = .052 at 1 year; 85% vs 43%, P = .006 at 2 years). Sex did not have a statistically significant effect on the outcome.
CONCLUSIONS
MTA partial pulpotomy sustained a good success rate over the 2-year follow-up in mature permanent teeth clinically diagnosed with irreversible pulpitis. More than half of the CH cases failed within 2 years.
Topics: Adult; Aluminum Compounds; Calcium Compounds; Calcium Hydroxide; Dental Cements; Dentition, Permanent; Drug Combinations; Female; Humans; Male; Middle Aged; Molar; Oxides; Prospective Studies; Pulpitis; Pulpotomy; Silicates; Single-Blind Method; Young Adult
PubMed: 28673494
DOI: 10.1016/j.joen.2017.03.033 -
International Journal of Molecular... Oct 2023Oral inflammatory diseases (OIDs) include many common diseases such as periodontitis and pulpitis. The causes of OIDs consist microorganism, trauma, occlusal factors,... (Review)
Review
Oral inflammatory diseases (OIDs) include many common diseases such as periodontitis and pulpitis. The causes of OIDs consist microorganism, trauma, occlusal factors, autoimmune dis-eases and radiation therapy. When treated unproperly, such diseases not only affect oral health but also pose threat to people's overall health condition. Therefore, identifying OIDs at an early stage and exploring new therapeutic strategies are important tasks for oral-related research. Mitochondria are crucial organelles for many cellular activities and disruptions of mitochondrial function not only affect cellular metabolism but also indirectly influence people's health and life span. Mitochondrial dysfunction has been implicated in many common polygenic diseases, including cardiovascular and neurodegenerative diseases. Recently, increasing evidence suggests that mitochondrial dysfunction plays a critical role in the development and progression of OIDs and its associated systemic diseases. In this review, we elucidated the critical insights into mitochondrial dysfunction and its involvement in the inflammatory responses in OIDs. We also summarized recent research progresses on the treatment of OIDs targeting mitochondrial dysfunction and discussed the underlying mechanisms.
Topics: Humans; Oxidative Stress; Mitochondria; Periodontitis; Longevity; Pulpitis; Mitochondrial Diseases
PubMed: 37895162
DOI: 10.3390/ijms242015483 -
Cell Biology International Jan 2022Wnts include more than 19 types of secreted glycoproteins that are involved in a wide range of pathological processes in oral and maxillofacial diseases. The... (Review)
Review
Wnts include more than 19 types of secreted glycoproteins that are involved in a wide range of pathological processes in oral and maxillofacial diseases. The transmission of Wnt signalling from the extracellular matrix into the nucleus includes canonical pathways and noncanonical pathways, which play an important role in tooth development, alveolar bone regeneration, and related diseases. In recent years, with the in-depth study of Wnt signalling in oral and maxillofacial-related diseases, many new conclusions and perspectives have been reached, and there are also some controversies. This article aims to summarise the roles of Wnt signalling in various oral diseases, including periodontitis, dental pulp disease, jaw disease, cleft palate, and abnormal tooth development, to provide researchers with a better and more comprehensive understanding of Wnts in oral and maxillofacial diseases.
Topics: Animals; Dental Caries; Gene Expression Regulation; Humans; Mouth; Odontogenesis; Periapical Periodontitis; Periodontal Diseases; Pulpitis; Temporomandibular Joint Dysfunction Syndrome; Tooth Diseases; Wnt Proteins; Wnt Signaling Pathway
PubMed: 34643311
DOI: 10.1002/cbin.11708 -
BMC Oral Health Nov 2023N6-methyladenosine (mA) RNA modification regulators play an important role in many human diseases, and its abnormal expression can lead to the occurrence and development...
BACKGROUND
N6-methyladenosine (mA) RNA modification regulators play an important role in many human diseases, and its abnormal expression can lead to the occurrence and development of diseases. However, their significance in pulpitis remains largely unknown. Here, we sought to identify and validate the mA RNA regulatory network in pulpitis.
METHODS
Gene expression data for mA regulators in human pulpitis and normal pulp tissues from public GEO databases were analyzed. Bioinformatics analysis including Gene ontology (GO) functional, and Kyoto encyclopedia of genes and genomes (KEGG) pathway analyses were performed by R package, and Cytoscape software was used to study the role of mA miRNA-mRNA regulatory network in pulpitis. Quantitative real-time PCR (qRT-PCR) was performed to validate the expression of key mA regulators in collected human pulpitis specimens.
RESULTS
Differential genes between pulpitis and normal groups were found from the GEO database, and further analysis found that there were significant differences in the mA modification-related genes ALKBH5, METTL14, METTL3, METTL16, RBM15B and YTHDF1. And their interaction relationships and hub genes were determined. The hub m6A regulator targets were enriched in immune cells differentiation, glutamatergic synapse, ephrin receptor binding and osteoclast differentiation in pulpitis. Validation by qRT-PCR showed that the expression of methylases METTL14 and METTL3 was decreased, thus these two genes may play a key role in pulpitis.
CONCLUSION
Our study identified and validated the mA RNA regulatory network in pulpitis. These findings will provide valuable resource to guide the mechanistic and therapeutic analysis of the role of key mA modulators in pulpitis.
Topics: Humans; Pulpitis; MicroRNAs; RNA, Messenger; Dental Pulp; Computational Biology; Methyltransferases
PubMed: 37978362
DOI: 10.1186/s12903-023-03578-8 -
International Endodontic Journal Oct 2023The diagnosis of the status of the inflamed pulp is essential in clinical diagnosis and treatment provision. There are a limited number of well-designed and... (Review)
Review
BACKGROUND
The diagnosis of the status of the inflamed pulp is essential in clinical diagnosis and treatment provision. There are a limited number of well-designed and well-executed clinical trials on the diagnosis of the true status of the pulp.
OBJECTIVES
Three PICO questions were formulated and agreed a priori by the European Society of Endodontology to evaluate the clinical tests for sensibility testing, determination of biomarkers and pulp bleeding with regard to their suitability to correctly diagnose the condition of the pulp tissue for the development of S3-Level guidelines.
METHODS
A literature search was conducted using PubMed, Clarivate Analytics' Web of Science, Scopus, Google Scholar and Cochrane Central Register of Controlled Trials from inception to 21 January 2022. Additionally, a hand search was performed, and the contents of the major subject journals were also examined. Eligibility criteria followed the proposed PICO questions. Two independent reviewers were involved in study selection, data extraction and appraising the included studies; disagreements were resolved by a third reviewer. The risk of bias was assessed by the QUADAS-2 tool for diagnostic accuracy studies, the Newcastle-Ottawa scale for noncomparative, nonrandomized studies and the Newcastle-Ottawa Quality Assessment scale adapted for cross-sectional studies.
RESULTS
In total, 28 studies out of 29 publications were considered eligible and were included in the review. Twelve studies were identified to investigate the diagnostic accuracy of the pulp vitality. Ten studies fulfilled the criteria to evaluate the diagnostic accuracy of the pulpal conditions, while 6 studies investigating the expression of biomarkers were eligible. Three studies addressing the prognostic factors and therapeutic interventions relating to pulpal status were included.
DISCUSSION
The core problem in pulp diagnostics is that a reliable reference standard is lacking under clinical conditions. Based on limited evidence, the most promising current approach seems to define a combination of different clinical tests and symptoms, probably in future including molecular diagnosis ("diagnostic package") will be required to ascertain the best possible strategy to clinically diagnose true pulpal conditions.
CONCLUSIONS
The effectiveness of diagnosing pulpitis is low due to limited scientific evidence regarding the accuracy and reproducibility of diagnostic tests. There is a lack of evidence to determine the true status of the pulp or to identify prognostic indicators allowing for a reliable pre-operative estimation of the outcome of vital pulp treatment.
REGISTRATION
PROSPERO database (CRD42021265366).
Topics: Humans; Pulpitis; Cross-Sectional Studies; Reproducibility of Results; Dental Pulp; Dental Pulp Diseases; Biomarkers
PubMed: 35536159
DOI: 10.1111/iej.13762