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The Veterinary Clinics of North... Jan 2022Endodontic therapy is intended to preserve the function of mature teeth with irreversible pulpitis or pulp necrosis or to maintain the vitality of endodontically... (Review)
Review
Endodontic therapy is intended to preserve the function of mature teeth with irreversible pulpitis or pulp necrosis or to maintain the vitality of endodontically compromised immature teeth. Standard root canal therapy and vital pulp therapy are 2 mainstays of endodontic treatment. Recent knowledge has improved the outcomes of endodontic treatment with newer materials, such as mineral trioxide aggregate. Composite or prosthodontic crown restoration is also a critical key to success.
Topics: Animals; Prosthodontics; Pulpitis; Root Canal Therapy
PubMed: 34838250
DOI: 10.1016/j.cvsm.2021.09.003 -
British Dental Journal Apr 2020Objective To investigate current strategies of acute management of irreversible pulpitis by general dental practitioners.Design A postal survey was sent to a...
Objective To investigate current strategies of acute management of irreversible pulpitis by general dental practitioners.Design A postal survey was sent to a representative sample based on postal code to 180 dentists registered with the General Dental Council in the North East of England. The questionnaire identified general dental practitioners' strategies for the diagnosis and acute management of irreversible pulpitis.Results One hundred and three questionnaires were returned. Irreversible pulpitis was primarily diagnosed from patients' signs and symptoms. There was a high confidence in anaesthetising a tooth with irreversible pulpitis. Treatment was undertaken with either pulpotomy (with a view to single or multi-stage orthograde root canal treatment) or full extirpation in just over half of respondents (51%). Seventy-one percent of respondents reported using different intrapulpal medicaments. Antibiotics were 'frequently' prescribed in cases of irreversible pulpitis by 25% of respondents. For endodontic procedures, dental dam usage was generally low and used 'occasionally' or 'never' by 40% of respondents.Conclusions Antibiotics were being inappropriately prescribed in the management of irreversible pulpitis, transgressing from NICE guidelines on antibiotic usage. Rubber dam use is not universal during the initial management of pulpitis, or during the definitive endodontic procedure, impacting upon the safety and predicility of outcome. Respondents often placed medicaments into the pulp, in spite of a lack of evidence for their efficacy.
Topics: Dentists; England; Humans; Professional Role; Pulpitis; Surveys and Questionnaires
PubMed: 32277210
DOI: 10.1038/s41415-020-1419-8 -
Journal of Visualized Experiments : JoVE Oct 2023Pulpitis, a common cause of natural tooth loss, leads to necrosis and loss of bioactivity in the inflamed dental pulp. Unraveling the mechanisms underlying pulpitis and...
Pulpitis, a common cause of natural tooth loss, leads to necrosis and loss of bioactivity in the inflamed dental pulp. Unraveling the mechanisms underlying pulpitis and its efficient treatment is an ongoing focus of endodontic research. Therefore, understanding the inflammatory process within the dental pulp is vital for improving pulp preservation. Compared to other in vitro experiments, a murine pulpitis model offers a more authentic and genetically diverse context to observe the pathological progression of pulpitis. However, using mice, despite their cost-effectiveness and accessibility, poses difficulties due to their small size, poor coordination, and low tolerance, complicating intraoral and dental procedures. This protocol introduces a novel design and application of a mouth-gag to expose mouse pulp, facilitating more efficient intraoral procedures. The mouth-gag, comprised of a dental arch readily available to most dentists and can significantly expedite surgical preparation, even for first-time procedures. Micro-CT, hematoxylin-eosin (HE) staining, and immunofluorescence staining were used to identify changes in morphology and cell expression. The aim of this article is to help researchers establish a more reproducible and less demanding procedure for creating a pulp inflammation model using this novel mouth-gag.
Topics: Mice; Animals; Pulpitis; Inflammation; Mouth; Dental Pulp
PubMed: 37955368
DOI: 10.3791/66016 -
International Endodontic Journal Dec 2021To prospectively investigate the outcome of partial pulpotomy after 1 year, using a hydraulic calcium silicate cement (HCSC) on symptomatic cariously exposed pulps in...
A prospective clinical study investigating the effectiveness of partial pulpotomy after relating preoperative symptoms to a new and established classification of pulpitis.
AIM
To prospectively investigate the outcome of partial pulpotomy after 1 year, using a hydraulic calcium silicate cement (HCSC) on symptomatic cariously exposed pulps in adult teeth. To compare the traditional American Association of Endodontists (AAE) pulpitis classification with the recently proposed Wolters classification system in predicting the likelihood of treatment failure.
METHODOLOGY
Sixty-two symptomatic adult teeth with deep and extremely deep carious lesions were classified according to the Wolters (mild/moderate/severe pulpitis) and the traditional pulpitis classification (reversible/irreversible pulpitis). Eleven teeth were excluded intraoperatively as there was no pulp exposure after non-selective caries removal. The remaining 51 teeth, regardless of diagnosis, were treated by partial pulpotomy, pulpal lavage with 2.5% sodium hypochlorite solution, haemostasis and HCSC application (Biodentine™) as a pulp capping material. A permanent restoration was placed during a second appointment 1-2 weeks later. Preoperative tenderness to percussion (TTP), bleeding time and material setting time were recorded as was preoperative and postoperative tooth colour under standardized conditions. Clinical review occurred at regular intervals with clinical/radiographic analysis at 12 months. Chi-square analysis and Fisher's exact test assessed different outcomes amongst the diagnostic categories; the Kruskal-Wallis and Wilcoxon rank-sum test assessed influence of pulp bleeding time, TTP or variation in setting time (p < .05).
RESULTS
Ten cases were lost to review, and a total of 41 teeth were reviewed at 1 year and classified as either "success," "successful but unresponsive to sensibility testing" or "failed." This included five severe, 17 moderate and 19 mild pulpitis according to Wolters classification or 23 reversible pulpitis and 18 irreversible pulpitis cases by the AAE classification. The majority of the 62 enrolled cases were "extremely deep" (n = 50), rather than "deep" (n = 12) caries with all failures occurring in the extremely deep group. Partial pulpotomy was 90% successful (100% reversible, 78% irreversible or 100% mild, 88% moderate, 60% severe pulpitis) with a significant difference in outcome between mild and severe pulpitis groups (p = .04). Only one, severe pulpitis/irreversible pulpitis, case failed painfully prior to the 1-year review appointment. Bleeding time (p = .26) and TTP (p = .61) did not influence treatment outcome, whilst Biodentine™ setting time was significantly longer than manufacturers' claim (p < .05). No teeth discoloured.
CONCLUSIONS
Partial pulpotomy using Biodentine™ was successful for treating symptomatic carious pulpal exposures after 1 year, but included cases where pulp vitality could not be confirmed. Within the limitations of this study, cases with signs and symptoms indicative of irreversible pulpitis were not less successful; however, Wolters classification highlighted severe pulpitis to be less successful than mild pulpitis, thereby providing a potential prognostic benefit in diagnostically subdividing pulpitis. Caries depth was an indicator of failure, whilst bleeding time and preoperative tenderness to percussion were not.
Topics: Adult; Dental Pulp Capping; Humans; Oxides; Prospective Studies; Pulpitis; Pulpotomy
PubMed: 34490637
DOI: 10.1111/iej.13629 -
Journal of Endodontics Mar 2024This study aims to investigate the ability of umbilical cord mesenchymal stem cells (UC-MSC) to enhance the regeneration of pulp-dentin complex in immature permanent... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
This study aims to investigate the ability of umbilical cord mesenchymal stem cells (UC-MSC) to enhance the regeneration of pulp-dentin complex in immature permanent teeth with irreversible pulpitis.
METHODS
A total of 32 mandibular premolar teeth with immature apices in 5 dogs were used in this in-vivo randomized controlled trial (RCT). Eight healthy teeth without pre-existing pathosis served as the positive control samples and received no treatment, while in another 8 teeth, the pulp was completely extirpated (negative control). Class V cavities were prepared to induce inflammation in the remaining 16 teeth (groups 3 and 4) and the pulp was extirpated 2-4 mm short of the radiographic apex. Of the 16, the 8 teeth in group 4 received 1 mL of cord blood stem cells with a hydrogel scaffold. Blood clots were covered with mineral trioxide aggregates at the cementoenamel junction in the experimental groups, and teeth were filled with RMGI and composite. Three months later, block sections were removed for histologic evaluations for the evaluation of postoperative apical closure, degree of inflammation, and presence of normal pulp tissue. The data were statistically analyzed with the chi-square test (P < .05).
RESULTS
All teeth with complete pulp extirpation demonstrated pulpal necrosis with no postoperative closure of their apices, while apical closure was seen in all the teeth in the remaining groups. There was a statistically significant (P < .001) difference in the presence of inflammation and normal pulp tissue between the experimental groups. The teeth in group 3 showed normal pulp tissue extending to the level of MTA, but there was inflammation within the canal space. In contrast, the teeth in the UC-MSC group demonstrated organized, normal pulp tissue with no inflammation.
CONCLUSION
Based on these results, the regeneration of the pulp-dentin complex is possible with no inflammation when UC-MSCs are used and 2-4 mm of the apical pulp remains intact in immature teeth with irreversible pulpitis.
Topics: Animals; Dogs; Pulpitis; Regenerative Endodontics; Dental Pulp; Dental Pulp Necrosis; Inflammation
PubMed: 38142887
DOI: 10.1016/j.joen.2023.11.014 -
Oral Surgery, Oral Medicine, and Oral... Jun 1977
Topics: Emergencies; Humans; Periapical Tissue; Periodontitis; Pulpitis; Pulpotomy; Root Canal Therapy; Tooth Avulsion; Tooth Fractures; Tooth Replantation; Tooth Root
PubMed: 266686
DOI: 10.1016/0030-4220(77)90087-1 -
The Journal of Clinical Pediatric... 2010Mechanisms of pulpal pathophysiology are complex and the low compliance environment in which the dental pulp is allocated, further enhances the complexity of this... (Review)
Review
Mechanisms of pulpal pathophysiology are complex and the low compliance environment in which the dental pulp is allocated, further enhances the complexity of this process. Although it is known that it involves the interaction of the immune cells, pulpal cells, cytokines, chemokines and multiple neuropeptides but still there are many gaps in our current knowledge. The understanding of the biochemical and molecular pathways involved in the pulpal inflammation is important so that it can be used clinically to keep the dental pulp vital and healthy. It may thus provide an opportunity to develop potentially new treatment modalities for the inflamed dental pulp in future.
Topics: Cytokines; Dental Pulp; Humans; Inflammation Mediators; Neurogenic Inflammation; Neuroimmunomodulation; Neuropeptides; Pulpitis
PubMed: 21417112
DOI: 10.17796/jcpd.35.2.t13t4834j3567rp5 -
La Quintessenza Sep 1970
Topics: Pulpitis
PubMed: 5292530
DOI: No ID Found -
Zhonghua Kou Qiang Yi Xue Za Zhi =... Jan 2022In recent years, great progress has been made in research on the treatment of pulpitis, mainly due to the rapid development of basic and clinical researches in this...
In recent years, great progress has been made in research on the treatment of pulpitis, mainly due to the rapid development of basic and clinical researches in this field, and some achievement from basic research has been applied in clinical practice. Advances in the diagnostic methods for pulpitis can help the clinicians to recognize the true state of pulpitis more accurately and to adopt the corresponding treatment methods including indirect/direct pulp capping, pulpotomy, pulp regeneration and root canal therapy. The new theory of pulpitis diagnosis and the studies on immune defense, repair function of dental pulp and new pulp capping materials have significantly improved the success rate of vital pulp therapy. For diffuse coronary pulpitis or radicular pulpitis, which is difficult to achieve vital pulp therapy successfully, methods of pulp revascularization, cell homing and pulp stem cells-mediated pulp regeneration can also be used as treatment options in addition to root canal therapy. The present article focuses on the research progress on pulpitis treatments and related clinical transformation practices, in order to provide reference on vital pulp therapy and pulp regeneration for clinicians.
Topics: Dental Pulp; Dental Pulp Capping; Humans; Pulpitis; Pulpotomy; Regeneration
PubMed: 35012247
DOI: 10.3760/cma.j.cn112144-20210917-00417 -
Journal of Endodontics Feb 1981
Topics: Dental Caries; Dentin; Dentin Permeability; Dentin, Secondary; Humans; Pulpitis
PubMed: 6938624
DOI: 10.1016/s0099-2399(81)80242-7