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Cell Biochemistry and Function Aug 2021Autophagy is an evolutionarily conserved cellular process, in which damaged organelles and proteins are engulfed in autophagic vesicles and subsequently fuse with... (Review)
Review
Autophagy is an evolutionarily conserved cellular process, in which damaged organelles and proteins are engulfed in autophagic vesicles and subsequently fuse with lysosomes for degradation. Autophagy is widely involved in different physiologic or pathologic processes in human. Accumulating evidence indicates that autophagy operates as a critical quality control mechanism to maintain pulp homeostasis and structural integrity of the dentin-pulp complex. Autophagy is activated during stresses and is involved in the pathogenesis of pulpitis and periapical infection. Recent discoveries have also provided intriguing insights into the roles of autophagy in tooth development, pulp aging and stress adaptation. In this review, we provide an update on the multifaceted functions of autophagy in physiology and pathophysiology of tooth. We also discuss the therapeutic implications of autophagy modulation in diseases and the regeneration of dentin-pulp complex.
Topics: Animals; Autophagy; Dental Implants; Humans; Periapical Diseases; Pulpitis
PubMed: 33929054
DOI: 10.1002/cbf.3636 -
Journal of the College of Physicians... Oct 2023To determine the clinical efficacy of ultrasonic irrigation combined with epoxy resin-based sealer in single visit root canal treatment of chronic pulpitis.
OBJECTIVE
To determine the clinical efficacy of ultrasonic irrigation combined with epoxy resin-based sealer in single visit root canal treatment of chronic pulpitis.
STUDY DESIGN
Randomised controlled trial. Place and Duration of the Study: Department of Stomatology, Hefei BOE Hospital, Hefei, China, from March 2019 to December 2021.
METHODOLOGY
Ninety patients with chronic pulpitis, comprising 104 affected teeth, were enrolled. Using a random number table, they were divided into Group A (n = 30, 35 teeth), Group B (n = 30, 35 teeth), and the control group (n = 30, 34 teeth). All underwent single visit root canal treatment. Group A received ultrasonic irrigation followed by sealing with epoxy resin-based paste; Group B had conventional syringe irrigation followed by the same sealing; the control group had syringe irrigation and closure with zinc oxide-eugenol paste. Pain during treatment, posttreatment clinical outcomes, and differences in inflammatory markers (IL-4, IL-6, hs-CRP), and quality of life (QOL) scores pre- and posttreatment over two months were observed.
RESULTS
After the treatment, improvement rates for Groups A, B, and the control group were 91.4%, 65.7%, and 61.7%, respectively. Pain occurrence rates were 6.7%, 30.0%, and 36.7%, respectively. Group A outperformed both Group B and the control group in improvement and pain incidence with statistical significance (p<0.016). Posttreatment, Group A had lower IL-4, IL-6, hs-CRP levels than Groups B and the control group (p<0.05), and had higher scores for sleep, mood, and appetite (p<0.05).
CONCLUSION
Ultrasonic irrigation combined with epoxy resin-based paste yields better results for chronic pulpitis treatment, reducing postoperative pain, mitigating inflammation levels, and enhancing quality of life.
KEY WORDS
Chronic pulpitis, Ultrasonic irrigation, Epoxy resin paste, Root canal treatment, Therapeutic effect.
Topics: Humans; Pulpitis; Epoxy Resins; Quality of Life; Ultrasonics; C-Reactive Protein; Dental Pulp Cavity; Interleukin-4; Interleukin-6; Root Canal Preparation; Pain, Postoperative; Root Canal Irrigants; Root Canal Filling Materials
PubMed: 37804018
DOI: 10.29271/jcpsp.2023.10.1130 -
Photobiomodulation, Photomedicine, and... May 2023This study evaluated the postoperative pain intensity in permanent teeth with symptomatic irreversible pulpitis treated by pulpotomy using physiological saline, sodium... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy of Potassium Titanyl Phosphate Laser and Sodium Hypochlorite on Postoperative Pain Intensity Following Pulpotomy in Teeth with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial.
This study evaluated the postoperative pain intensity in permanent teeth with symptomatic irreversible pulpitis treated by pulpotomy using physiological saline, sodium hypochlorite (NaOCl), or the potassium titanyl phosphate (KTP) laser. Ninety patients diagnosed with symptomatic irreversible pulpitis in permanent molars were randomly divided into three groups according to the pulpotomy procedures. Preoperative pain levels were recorded. Complete hemostasis was achieved with physiological saline (control group), NaOCl, or the KTP laser after initial bleeding control. Patients were asked to mark their pain level on the visual pain scale at 6, 24, 48, and 72 h and 7 and 30 days depending on the severity of pain. The permanent restoration was completed after 7 days. Data were statistically analyzed using Kruskal-Wallis, Mann-Whitney , Friedman, and Bonferroni tests at a significance level of < 0.05. According to the present study, the statistical difference between the groups in terms of preoperative pain and percussion pain levels was insignificant ( > 0.05). There was no significant difference between groups in terms of demographic data ( > 0.05). The postoperative pain level of the KTP laser group was significantly lower at 6 h compared with the saline group ( < 0.05). There was no significant difference between groups in terms of the postoperative pain level at other time intervals ( > 0.05). The highest pain scores were observed in all groups at 6 h ( < 0.05). The KTP laser can be preferred primarily for reducing postoperative pain in pulpotomy treatments. The KTP laser or NaOCl-assisted pulpotomy can be an effective treatment for pain reduction in permanent teeth with symptomatic irreversible pulpitis. This report is registered at clinicaltrials.gov (ID: NCT05424796).
Topics: Humans; Pulpitis; Pulpotomy; Sodium Hypochlorite; Lasers, Solid-State; Pain, Postoperative
PubMed: 37092958
DOI: 10.1089/photob.2022.0152 -
Clinical Oral Investigations Jun 2020The aim of this study was to evaluate the composition of microbiota of irreversible pulpitis and primary endodontic infections with respect to clinical and radiographic...
OBJECTIVES
The aim of this study was to evaluate the composition of microbiota of irreversible pulpitis and primary endodontic infections with respect to clinical and radiographic findings by performing cultures and 16s rDNA sequencing in Iranian patients.
MATERIAL AND METHODS
In this prospective cross-sectional study, samples were collected from 41 root canals for 4 main groups of patients. Bacterial identification was performed by the polymerase chain reaction (PCR) and 16s rDNA sequencing of aerobic and anaerobic cultivable colonies taken from patients' culture plates. Additionally, the presence of 13 bacterial species and 3 nonbacterial species was also explored using PCR and species-specific primers.
RESULTS
Sixteen microbial species, 1 fungus (Candida albicans), and 1 virus (Herpes simplex virus) were discovered and isolated. Species with the highest prevalence were Dialister invisus (68.3%), Porphyromonas gingivalis (58.8%), Streptococcus salivarius (58.5%), and Treponema denticola (56.1%). Lysinibacillus fusiformis (19.1%) was detected in the root canals for the first time. Candida albicans was seen in 11 cases (26.8%). Herpes simplex virus (HSV) was seen in 4 patients (9.8%).
CONCLUSIONS
Our results suggest that Gram-negative anaerobic oral bacteria are the majority of the microbes in primary endodontic infections. Various combinations of bacterial species were related to different clinical and radiographic conditions. Lysinibacillus fusiformis was detected for the first time in primary endodontic infections.
CLINICAL RELEVANCE
The results of this investigation might help clinicians choose to identify suspected endodontic pathogens in the etiology of each form of pulpal and periradicular diseases to determine the best therapeutic measures.
Topics: Bacillaceae; Cross-Sectional Studies; DNA, Bacterial; Dental Pulp Cavity; Humans; Infections; Iran; Prospective Studies; Pulpitis; Veillonellaceae
PubMed: 32377864
DOI: 10.1007/s00784-019-03075-9 -
BMC Oral Health May 2024Pulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
Treatment outcomes of pulpotomy versus pulpectomy in vital primary molars diagnosed with symptomatic irreversible pulpitis: protocol for a non-inferiority randomised controlled trial.
BACKGROUND
Pulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. However, despite emerging evidence indicating similarities between primary and permanent tooth pulp response to dental caries, there is limited research on whether pulpotomy can be similarly used as a definitive treatment modality for vital primary teeth with irreversible pulpitis. This randomised controlled trial (RCT) aims to compare the treatment effectiveness of pulpotomy versus pulpectomy in management of vital primary molars diagnosed with symptomatic irreversible pulpitis over a two-year period.
METHODS/DESIGN
This clinical study is a parallel, two-armed, open label, non-inferiority RCT with a 1:1 allocation ratio between the experimental intervention arm (pulpotomy) and the active comparator arm (pulpectomy). Healthy cooperative children, between 4-9 years of age, who have painful primary molars with clinical symptoms typical of irreversible pulpitis will be recruited after obtaining informed consent from their parents/legal guardians. 50 vital primary molars clinically diagnosed with symptomatic irreversible pulpitis will be randomly distributed between the two treatment arms. The primary outcomes that will be assessed are clinical and radiographic success after six-months, one-year and two-years of the trial interventions. The influence of baseline pre-operative variables (age; gender; tooth type; site of caries; pre-operative furcal radiolucency; pre-operative pain intensity) and intra-operative factors (time taken to achieve haemostasis) on treatment outcomes will also be assessed. The secondary outcome evaluated will be the immediate (24 h and 7 d) post-operative pain relief afforded by the two treatment interventions.
DISCUSSION
This trial seeks to provide evidence on whether pulpotomy treatment can be no worse than the standard pulpectomy treatment for the management of symptomatic irreversible pulpitis in vital primary molars.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT06183203). Registered on 30 January 2024.
Topics: Humans; Pulpotomy; Pulpectomy; Pulpitis; Tooth, Deciduous; Molar; Child; Child, Preschool; Treatment Outcome; Equivalence Trials as Topic; Female; Male
PubMed: 38807160
DOI: 10.1186/s12903-024-04411-6 -
Journal of Endodontics Apr 2021The pulpal anesthetic success rates for an inferior alveolar nerve block (IANB) alone in patients presenting with symptomatic irreversible pulpitis are less than... (Randomized Controlled Trial)
Randomized Controlled Trial
Anesthetic Success Using Nitrous Oxide and a Combination of Lidocaine/Clonidine for the Inferior Alveolar Nerve Block and the Effects on Blood Pressure and Pulse in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Study.
INTRODUCTION
The pulpal anesthetic success rates for an inferior alveolar nerve block (IANB) alone in patients presenting with symptomatic irreversible pulpitis are less than adequate. Nitrous oxide and clonidine have shown increases in IANB success when administered individually, but their success has not been evaluated when used together. The purpose of this prospective, randomized, double-blind study was to determine the effect of nitrous oxide/oxygen plus an IANB using lidocaine/clonidine on the success of the IANB in patients with symptomatic irreversible pulpitis and to evaluate the effect of clonidine on blood pressure and pulse.
METHODS
Sixty-two emergency patients experiencing moderate to severe pain and a diagnosis of symptomatic irreversible pulpitis were enrolled. Subjects were randomly divided into 2 groups and received nitrous oxide/oxygen and an IANB using 2% lidocaine with either 27 μg clonidine or 18 μg epinephrine as vasoconstrictors. Blood pressure and pulse were recorded before and during the emergency endodontic treatment. Anesthetic success was defined as no or mild pain upon access and instrumentation of the canals.
RESULTS
The pulpal anesthetic success rate in both treatments was 58%, with no significant difference between the groups. There was no statistically significant difference in pulse or systolic blood pressure with the use of clonidine compared with epinephrine. Diastolic blood pressure was significant.
CONCLUSIONS
The use of nitrous/oxide plus the addition of lidocaine/clonidine for the IANB in teeth with symptomatic irreversible pulpitis resulted in no statistically significant difference in anesthetic success of the IANB. There were no statistically significant differences in pulse or systolic blood pressure with the use of clonidine compared with epinephrine; diastolic blood pressure was significant.
Topics: Anesthesia, Dental; Anesthetics, Local; Blood Pressure; Clonidine; Double-Blind Method; Humans; Lidocaine; Mandibular Nerve; Nerve Block; Nitrous Oxide; Prospective Studies; Pulpitis
PubMed: 33387550
DOI: 10.1016/j.joen.2020.12.014 -
Australian Endodontic Journal : the... Apr 2008The purpose of the study was to histologically analyse transition from pulpitis to periapical periodontitis on dog's teeth. Pulps of mandibular premolars (37 roots) were...
The purpose of the study was to histologically analyse transition from pulpitis to periapical periodontitis on dog's teeth. Pulps of mandibular premolars (37 roots) were exposed using a low-speed handpiece. Teeth were left open to the oral environment for 20, 35, 50 and 65 days. After the experimental period animals were sacrificed. Undemineralised teeth with surrounding bone, embedded in methylmetacrylate, were prepared for standard histological analysis. All teeth with pulpitis (five roots), regardless of the experimental period, had acute serose periapical periodontitis. All teeth (15 roots) with partial pulp necrosis had subacute periapical periodontitis. Teeth with complete pulp necrosis (19 roots) had chronic periapical periodontitis and in one case suppurative apical periodontitis. The condition of the pulp correlates with the histopathological findings of periapical tissue in the open types of pulp infection. Acute periapical periodontitis begins during pulpitis and can occur before 20 days of pulp exposure in the dog.
Topics: Alveolar Bone Loss; Animals; Dental Pulp Exposure; Dental Pulp Necrosis; Disease Progression; Dogs; Periapical Periodontitis; Pulpitis
PubMed: 18352898
DOI: 10.1111/j.1747-4477.2008.00120.x -
International Endodontic Journal Dec 2023This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
This study aimed to compare the outcome of SCR and Pulpotomy in teeth with deep caries extending at least 75% into dentine.
METHODOLOGY
This two-armed, parallel-group, randomized, superiority trial included vital mature permanent teeth with deep primary or secondary caries diagnosed radiographically as being at least 75% into the thickness of dentine, without clinical signs of symptomatic irreversible pulpitis or radiographic evidence of a periapical lesion. Carious teeth were blindly allocated to receive either SCR or Pulpotomy using computer-generated randomized patient codes concealed in opaque envelopes. All teeth were reviewed clinically and radiographically at 6 months and 1 year post-treatment. Using a significance level of p < .05, the log rank test and Cox proportional hazards regression were used to compare the outcome of SCR and Pulpotomy and to identify potential prognostic factors, respectively.
RESULTS
In all, 58 teeth in the SCR group and 55 teeth in the pulpotomy group completed treatment, after excluding 6 teeth because they did not complete the allocated treatment and another due to severe periodontal disease. At one year, 57/58 (98.3%) teeth from the SCR group and 48/55 (87.3%) teeth from the Pulpotomy group were available for analysis. One tooth in the Pulpotomy group (2.1%) and eight teeth in the SCR group (14.0%) required the further intervention of root canal treatment (p < .05). There were no other significant prognostic factors for survival. Overall, 91.4% of teeth treated with either SCR or Pulpotomy survived without requiring further intervention over a period of one year. No other adverse events occurred over the review period.
CONCLUSION
Within the limitations of this study, Pulpotomy fares better than SCR in preserving the remaining pulp and periapical health. As a treatment modality, Pulpotomy carries greater cost outlay to patient and takes a longer time to complete treatment than SCR. Long-term follow-up is needed to study the pulpal and restorative outcomes of Pulpotomy and SCR.
Topics: Humans; Pulpotomy; Dental Caries Susceptibility; Pilot Projects; Calcium Compounds; Treatment Outcome; Pulpitis; Dental Caries; Silicates
PubMed: 37795835
DOI: 10.1111/iej.13978 -
Relationship between post-extraction pain and acute pulpitis: a randomised trial using third molars.International Dental Journal Dec 2016The aim of the present study was to examine the relationship between post-extraction pain and acute pulpitis in third molars. (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
The aim of the present study was to examine the relationship between post-extraction pain and acute pulpitis in third molars.
METHODS
This study was a randomised controlled trial. Sixty patients requiring removal of a single maxillary third molar with acute pulpitis were included and randomly divided into two groups: group A (n = 30); and group B (n = 30). In group A, third molars were directly extracted, and group B received endodontic therapy (pulp chamber opening and drainage) and underwent extraction 24 hours later, aiming to eliminate the acute inflammation. Another 30 patients requiring removal of a single maxillary third molar and with the same inclusion criteria but without caries or acute pulpitis were recruited into group C, in which the maxillary third molars were also directly extracted. The level of postoperative pain reported each day among the three groups was statistically evaluated.
RESULTS
On the first, second and third days after surgery, there was a statistically significant difference between group A and group B and between group A and group C, but there was no statistically significant difference between group B and group C.
CONCLUSION
The results of the present study indicate that there is more pain when third molars with acute pulpitis are directly removed compared with the pain level of the removal of third molars without acute pulpitis.
Topics: Adult; Female; Humans; Male; Molar, Third; Pain, Postoperative; Pulpitis; Tooth Extraction; Young Adult
PubMed: 27424879
DOI: 10.1111/idj.12249 -
Zhonghua Kou Qiang Yi Xue Za Zhi =... Mar 2022To assess the treatment effectiveness of vital inflamed pulp therapy (VIPT) in immature permanent teeth with irreversible pulpitis and apical periodontitis. The faculty...
To assess the treatment effectiveness of vital inflamed pulp therapy (VIPT) in immature permanent teeth with irreversible pulpitis and apical periodontitis. The faculty members in the Department of Pediatric Dentistry, the Ninth People's Hospital were invited to submit consecutive VIPT cases from June 2015 to June 2016 (follow-up periods>12 months). The cases were retrospectively reviewed, clinical symptoms and radiographic changes in periapical radiolucency were evaluated, meanwhile, the data of radiographic changes such as apical diameter and root length were calculated and analyzed with ANOVA. Totally thirteen submitted patients/cases were included (6 males and 7 females) in the present study,. The average age of patients was (9.9±1.4) years old. The average follow-up time was (26.5±6.8) months (17-37 months). At the 12-month visit, all 13 treated teeth survived, 9 out of 11 teeth with apical periodontitis showed normal radiographic manifestation. At the 3, 6 and 12 months visits, the within-case percentage changes in apical diameter were (8.0±5.1)%, (24.1±9.1)% and (70.3±10.7)%, respectively, while the within-case percentage changes in root length were (11.4±9.8)%, (14.5±9.8)% and (27.4±14.2)%, respectively. There were statistically significant differences in the changes of apical diameter (=18.80, <0.001) and root length (=4.64, =0.047) from the preoperative time to the postoperative follow-ups. VIPT might improve clinical outcomes, even achieve continued root development. VIPT can be an option in treating immature teeth with irreversible pulpitis and apical periodontitis.
Topics: Child; Dentition, Permanent; Female; Humans; Male; Periapical Periodontitis; Pulpitis; Retrospective Studies; Root Canal Therapy
PubMed: 35280007
DOI: 10.3760/cma.j.cn112144-20211223-00563