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International Journal of Paediatric... May 2024Changes in healthy and inflamed pulp on periapical radiographs are traditionally so subtle that they may be imperceptible to human experts, limiting its potential use as...
BACKGROUND
Changes in healthy and inflamed pulp on periapical radiographs are traditionally so subtle that they may be imperceptible to human experts, limiting its potential use as an adjunct clinical diagnostic feature.
AIM
This study aimed to investigate the feasibility of an image-analysis technique based on the convolutional neural network (CNN) to detect irreversible pulpitis in primary molars on periapical radiographs (PRs).
DESIGN
This retrospective study was performed in two health centres. Patients who received indirect pulp therapy at Peking University Hospital for Stomatology were retrospectively identified and randomly divided into training and validation sets (8:2). Using PRs as input to an EfficientNet CNN, the model was trained to categorise cases into either the success or failure group and externally tested on patients who presented to our affiliate institution. Model performance was evaluated using sensitivity, specificity, accuracy and F1 score.
RESULTS
A total of 348 PRs with deep caries were enrolled from the two centres. The deep learning model achieved the highest accuracy of 0.90 (95% confidence interval: 0.79-0.96) in the internal validation set, with an overall accuracy of 0.85 in the external test set. The mean greyscale value was higher in the failure group than in the success group (p = .013).
CONCLUSION
The deep learning-based model could detect irreversible pulpitis in primary molars with deep caries on PRs. Moreover, this study provides a convenient and complementary method for assessing pulp status.
PubMed: 38725105
DOI: 10.1111/ipd.13200 -
Biochemical and Biophysical Research... Jul 2024Pulpitis constitutes a significant challenge in clinical management due to its impact on peripheral nerve tissue and the persistence of chronic pain. Despite its...
Pulpitis constitutes a significant challenge in clinical management due to its impact on peripheral nerve tissue and the persistence of chronic pain. Despite its clinical importance, the correlation between neuronal activity and the expression of voltage-gated sodium channel 1.7 (Nav1.7) in the trigeminal ganglion (TG) during pulpitis is less investigated. The aim of this study was to examine the relationship between experimentally induced pulpitis and Nav1.7 expression in the TG and to investigate the potential of selective Nav1.7 modulation to attenuate TG abnormal activity associated with pulpitis. Acute pulpitis was induced at the maxillary molar (M1) using allyl isothiocyanate (AITC). The mice were divided into three groups: control, pulpitis model, and pulpitis model treated with ProTx-II, a selective Nav1.7 channel inhibitor. After three days following the surgery, we conducted a recording and comparative analysis of the neural activity of the TG utilizing in vivo optical imaging. Then immunohistochemistry and Western blot were performed to assess changes in the expression levels of extracellular signal-regulated kinase (ERK), c-Fos, collapsin response mediator protein-2 (CRMP2), and Nav1.7 channels. The optical imaging result showed significant neurological excitation in pulpitis TGs. Nav1.7 expressions exhibited upregulation, accompanied by signaling molecular changes suggestive of inflammation and neuroplasticity. In addition, inhibition of Nav1.7 led to reduced neural activity and subsequent decreases in ERK, c-Fos, and CRMP2 levels. These findings suggest the potential for targeting overexpressed Nav1.7 channels to alleviate pain associated with pulpitis, providing practical pain management strategies.
Topics: Animals; NAV1.7 Voltage-Gated Sodium Channel; Mice; Male; Pulpitis; Trigeminal Ganglion; Neurons; Nerve Tissue Proteins; Proto-Oncogene Proteins c-fos; Voltage-Gated Sodium Channel Blockers; Disease Models, Animal; Intercellular Signaling Peptides and Proteins
PubMed: 38718567
DOI: 10.1016/j.bbrc.2024.150044 -
International Endodontic Journal May 2024The success of vital pulp treatment (VPT) procedures is dependent on an accurate diagnosis of the pulpal inflammatory condition. Compared with current subjective pulpal...
Discriminatory performance of the pulpal inflammatory biomarkers; Interleukin-8 and TNF-α in patients with symptoms indicative of reversible and irreversible pulpitis: A diagnostic accuracy study.
AIM
The success of vital pulp treatment (VPT) procedures is dependent on an accurate diagnosis of the pulpal inflammatory condition. Compared with current subjective pulpal diagnostic tests, inflammatory molecular biomarkers involved in the pathogenesis of pulpitis represent potential objective indicators of the degree of pulpal inflammation. Therefore, the aim of this study was to quantify level of inflammatory biomarkers - Interleukin 8 (IL-8) and TNF-α in patients diagnosed with reversible pulpitis (RP), irreversible pulpitis (IR) and normal pulp (NP) and investigate their diagnostic accuracy in differentiating between healthy and inflamed conditions.
METHODOLOGY
This prospective, cross-sectional study enrolled 72 patients aged 14-53 years with extremely deep carious lesions after establishing a clinical diagnosis of RP (n = 42), symptomatic IR (n = 22) and NP (n = 8). 50 μL of pulpal blood sample was collected from all the patients using a micropipette after pulpal exposure. The level of IL-8 and TNF-α was assessed in pg/mL using enzyme-linked immunosorbent assays. Mann-Whitney U test was applied to establish the association between IL-8/TNF-α level and degree of pulp inflammation. Receiver operating curve (ROC) analysis was carried out to calculate area under the curve (AUC) for RP versus IR. Cut-off values were established using Youden's index.
RESULTS
IL-8 and TNF-α levels differed significantly between RP and IR groups (p ≤ .001). The median value of IL-8 in RP and IP groups was 259.8 pg/mL [187.5-310.0] and 1357.8 pg/mL [1036.7-2177.6] respectively. The AUC-ROC curve for RP versus IR was 0.997 with 95.5% sensitivity and 99.76% specificity. The median value of TNF-α in RP and IR groups was 75.4 pg/mL [62.7-95.8] and 157.6 pg/mL [94.1-347.3]. The AUC-ROC curve for TNF-α was 0.812 with a sensitivity and specificity of 59.1% and 92.1%, respectively. IL-8 and TNF-α levels were below detection levels for all NP samples.
CONCLUSION
This study showed that pulpal blood could provide an excellent medium for establishing pulpal diagnosis under extremely deep carious lesions. The selected cytokines, IL-8 and TNF-α, demonstrated excellent discriminatory performance for reversible and irreversible pulpitis. Future studies should correlate the IL-8/TNF-α levels with VPT treatment outcomes.
PubMed: 38703070
DOI: 10.1111/iej.14078 -
Medicine May 2024Compared with traditional root canal therapy (RCT), vital pulp therapy (VPT) is a personalized and minimally invasive method for the treatment of pulpitis caused by... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Compared with traditional root canal therapy (RCT), vital pulp therapy (VPT) is a personalized and minimally invasive method for the treatment of pulpitis caused by dental caries. However, there are still no clear guidelines for VPT because high-quality randomized clinical trials are scarce. This prospective cohort study evaluated the clinical efficacy of VPT with the light-curable calcium silicate-based material TheraCal LC (TH) and bioceramic material iRoot BP Plus (BP) in reversible and irreversible pulpitis permanent teeth with carious exposures.
METHODS
115 teeth with reversible or irreversible pulpitis caused by deep care were randomly divided into 2 groups. TheraCal LC and iRoot BP Plus were used for the pulp capping. Direct pulp capping (DPC), partial pulpotomy (PP) and full pulpotomy (FP) were performed based on observation of the exposed pulp. Postoperative discomforts were enquired and recorded via follow-up phone calls. Clinical and radiographic evaluations were performed 3, 6, and 12 months postoperatively.
RESULTS
The overall clinical success rate in the first year was 90.4% (47/52) in both groups. The TH group required less operating time, showed lower levels of pain, and had shorter pain duration post-operative (P < .001). According to the binary logistic regression model, preoperative pain duration was significantly correlated with the prognosis of VPT (P = .011).
CONCLUSION
VPT with TheraCal LC and iRoot BP Plus in pulpitis permanent carious teeth both achieved good clinical outcomes, and TheraCal LC can be easily operated for clinical use. Preoperative pain duration of the affected tooth might have a significant correlation with the prognosis of VPT.
Topics: Humans; Pulpitis; Calcium Compounds; Silicates; Female; Male; Pulpotomy; Adult; Prospective Studies; Dental Pulp Capping; Dental Caries; Young Adult; Treatment Outcome; Adolescent; Middle Aged; Drug Combinations; Calcium Hydroxide; Aluminum Compounds; Oxides
PubMed: 38701294
DOI: 10.1097/MD.0000000000038015 -
Journal of Cellular and Molecular... May 2024Mechanical force induces hypoxia in the pulpal area by compressing the apical blood vessels of the pulp, triggering pulpal inflammation during orthodontic tooth...
Mechanical force induces hypoxia in the pulpal area by compressing the apical blood vessels of the pulp, triggering pulpal inflammation during orthodontic tooth movement. However, this inflammation tends to be restorable. Macrophages are recognized as pivotal immunoreactive cells in the dental pulp. Whether they are involved in the resolution of pulpal inflammation in orthodontic teeth remains unclear. In this study, we investigated macrophage polarization and its effects during orthodontic tooth movement. It was demonstrated that macrophages within the dental pulp polarized to M2 type and actively participated in the process of pulpal inflammation resolution. Inflammatory reactions were generated and vascularization occurred in the pulp during orthodontic tooth movement. Macrophages in orthodontic pulp show a tendency to polarize towards M2 type as a result of pulpal hypoxia. Furthermore, by blocking M2 polarization, we found that macrophage M2 polarization inhibits dental pulp-secreting inflammatory factors and enhances VEGF production. In conclusion, our findings suggest that macrophages promote pulpal inflammation resolution by enhancing M2 polarization and maintaining dental health during orthodontic tooth movement.
Topics: Dental Pulp; Tooth Movement Techniques; Animals; Macrophages; Inflammation; Mice; Cell Polarity; Male; Vascular Endothelial Growth Factor A; Pulpitis; Macrophage Activation
PubMed: 38700030
DOI: 10.1111/jcmm.18350 -
Acta Biomaterialia Jun 2024Dental pulp is the only soft tissue in the tooth which plays a crucial role in maintaining intrinsic multi-functional behaviors of the dentin-pulp complex. Nevertheless,...
Dental pulp is the only soft tissue in the tooth which plays a crucial role in maintaining intrinsic multi-functional behaviors of the dentin-pulp complex. Nevertheless, the restoration of fully functional pulps after pulpitis or pulp necrosis, termed endodontic regeneration, remained a major challenge for decades. Therefore, a bioactive and in-situ injectable biomaterial is highly desired for tissue-engineered pulp regeneration. Herein, a decellularized matrix hydrogel derived from porcine dental pulps (pDDPM-G) was prepared and characterized through systematic comparison against the porcine decellularized nerve matrix hydrogel (pDNM-G). The pDDPM-G not only exhibited superior capabilities in facilitating multi-directional differentiation of dental pulp stem cells (DPSCs) during 3D culture, but also promoted regeneration of pulp-like tissues after DPSCs encapsulation and transplantation. Further comparative proteomic and transcriptome analyses revealed the differential compositions and potential mechanisms that endow the pDDPM-G with highly tissue-specific properties. Finally, it was realized that the abundant tenascin C (TNC) in pDDPM served as key factor responsible for the activation of Notch signaling cascades and promoted DPSCs odontoblastic differentiation. Overall, it is believed that pDDPM-G is a sort of multi-functional and tissue-specific hydrogel-based material that holds great promise in endodontic regeneration and clinical translation. STATEMENT OF SIGNIFICANCE: Functional hydrogel-based biomaterials are highly desirable for endodontic regeneration treatments. Decellularized extracellular matrix (dECM) preserves most extracellular matrix components of its native tissue, exhibiting unique advantages in promoting tissue regeneration and functional restoration. In this study, we prepared a porcine dental pulp-derived dECM hydrogel (pDDPM-G), which exhibited superior performance in promoting odontogenesis, angiogenesis, and neurogenesis of the regenerating pulp-like tissue, further showed its tissue-specificity compared to the peripheral nerve-derived dECM hydrogel. In-depth proteomic and transcriptomic analyses revealed that the activation of tenascin C-Notch axis played an important role in facilitating odontogenic regeneration. This biomaterial-based study validated the great potential of the dental pulp-specific pDDPM-G for clinical applications, and provides a springboard for research strategies in ECM-related regenerative medicine.
Topics: Dental Pulp; Animals; Hydrogels; Swine; Regeneration; Stem Cells; Decellularized Extracellular Matrix; Cell Differentiation; Regenerative Endodontics; Humans; Tissue Engineering
PubMed: 38692468
DOI: 10.1016/j.actbio.2024.04.040 -
The Saudi Dental Journal Apr 2024Pulp therapy aims to maintain the health and integrity of teeth and their supporting tissue and preserve the vitality of the tooth pulp affected by dentinal caries or... (Review)
Review
Pulp therapy aims to maintain the health and integrity of teeth and their supporting tissue and preserve the vitality of the tooth pulp affected by dentinal caries or severe traumatic injury. Thus, the best clinical practice provides pulpal health or pathosis diagnosis and various therapeutic interventions evidenced in both the deciduous and permanent dentition for endodontic treatment. The pulp health status determines the type of pulpal therapy used. Vital pulp therapies for primary teeth include protective liners, pulp capping, and pulpotomy for reversible pulpitis; for permanent teeth, pulpotomy can be considered for irreversible pulpitis. For reversible or irreversible pulpitis, invasive management of decayed teeth has traditionally been performed. However, at present, coronal pulpotomy-like vital pulp therapy has led to successful treatment outcomes that are less invasive. Compared to root canal treatments, coronal pulpotomy is cost-effective, less time-consuming, and less technically demanding. The success of a pulpotomy depends on the clinician's experience, appropriate clinical techniques, and materials used. This narrative review provides insights into the systematic analysis of pulpotomy failure, causes and signs of failure, and alternative endodontic interventions.
PubMed: 38690395
DOI: 10.1016/j.sdentj.2024.01.005 -
International Endodontic Journal Apr 2024To describe the management of the palato-mesiobuccal (PMB) canal in maxillary second molars with fused roots using conventional techniques.
AIM
To describe the management of the palato-mesiobuccal (PMB) canal in maxillary second molars with fused roots using conventional techniques.
SUMMARY
Root canal treatment success hinges upon effectively addressing the intricate and variable anatomy of molar teeth. Failure to do so can lead to persistent infections and treatment failure. Recent advancements in imaging technologies have provided unparalleled insights into dental anatomy, especially in molars. Among these discoveries is the PMB canal, a unique anatomical variant recently reported for the first time in Endodontic literature. This canal, found in maxillary second molars with fused roots and originating from the coronal third of the palatal canal while traversing towards the mesiobuccal root presents challenges in clinical management due to its location. This article is the first to showcase the management of the PMB canal using conventional techniques. In the first case, a 38-year-old male patient presented with asymptomatic irreversible pulpitis in the maxillary second right molar. Following thorough instrumentation and irrigation, the presence of the PMB canal was discovered during root canal preparation. The canal was managed using rotary instruments and obturated successfully, resulting in a symptom-free tooth at an 8-year follow-up. The second case illustrates a similar scenario in a 23-year-old female patient presenting with symptomatic irreversible pulpitis in tooth 17. The PMB canal was identified during treatment and managed using rotary nickel-titanium instruments, leading to a favourable outcome at a 9-year follow-up.
KEY LEARNING POINTS
In fused roots of maxillary second molars, a PMB canal might be expected. Exploration of the buccal wall of the palatal canal under magnification after shaping procedures can reveal the PMB canal orifice in fused roots. Small tapers are suggested for the enlargement of the PMB canal. Continuous bleeding spots in the palatal canal might indicate a possible PMB canal orifice in vital cases. The use of an apex locator is suggested for the differential diagnosis of the PMB canal orifice from a perforation site.
PubMed: 38687130
DOI: 10.1111/iej.14076 -
Cureus Mar 2024Pain is the primary reason dental patients seek endodontic therapy. Post-treatment endodontic discomfort is a sequelae of periapical inflammation and anti-inflammatory...
BACKGROUND AND OBJECTIVES
Pain is the primary reason dental patients seek endodontic therapy. Post-treatment endodontic discomfort is a sequelae of periapical inflammation and anti-inflammatory drugs such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) would be reasonable therapy options. The purpose of this study was to compare and assess the efficacy of intramuscular injections of dexamethasone and ketorolac tromethamine versus placebo in reducing post-treatment endodontic pain in individuals undergoing root canal treatment.
METHODOLOGY
Patients diagnosed with symptomatic irreversible pulpitis were selected. Nonsurgical endodontic therapy was carried out in a single visit. After completion of the root canal therapy, the patients were randomly assigned to one of the three groups for intramuscular drug administration. In group 1, 2 ml of sterile saline was administered, in group 2, 1 ml of 4 mg dexamethasone was administered; and in group 3, 1 ml of 30 mg ketorolac tromethamine was administered. Preoperative and postoperative pain intensity was measured by a verbal rating scale. Postoperatively, the incidence and severity of pain were recorded after four, 24, and 48 hours.
RESULTS
All three groups showed a highly statistically significant reduction in pain scores when compared to preoperative levels. At the end of four hours, dexamethasone and ketorolac tromethamine showed highly significant results. Dexamethasone significantly reduced pain after 24 hours when compared to ketorolac and placebo groups. At the conclusion of 48 hours, all three groups experienced a gradual decrease in pain levels.
CONCLUSION
Effective and complete debridement of infected root canal system provides predictable gradual reduction of post-endodontic pain.
PubMed: 38681426
DOI: 10.7759/cureus.57086 -
Journal of Oral Biology and... 2024The P2X7 receptor, a member of the P2X receptor family, plays a crucial role in various physiological processes, particularly pain perception. Its expression across...
The P2X7 receptor, a member of the P2X receptor family, plays a crucial role in various physiological processes, particularly pain perception. Its expression across immune, neuronal, and glial cells facilitates the release of pro-inflammatory molecules, thereby influencing pain development and maintenance, as evidenced by its association with pulpitis in rats. Notably, P2X receptors such as P2X3 and P2X7 are pivotal in dental pain pathways, making them promising targets for novel analgesic interventions. Leveraging graph neural networks (GNNs) presents an innovative approach to model graph data, aiding in the identification of drug targets and prediction of their efficacy, complementing advancements in genomics and proteomics for therapeutic development. In this study, 921 drug-gene interactions involving P2X receptors were accessed through https://www.probes-drugs.org/. These interactions underwent meticulous annotation, preprocessing, and subsequent utilization to train and assess GNNs. Furthermore, leveraging Cytoscape, the CytoHubba plugin, and other bioinformatics tools, gene expression networks were constructed to pinpoint hub genes within these interactions. Through analysis, SLC6A3, SLC6A2, FGF1, GRK2, and PLA2G2A were identified as central hub genes within the context of P2X receptor-mediated drug-gene interactions. Despite achieving a 65 percent accuracy rate, the GNN model demonstrated suboptimal predictive power for gene-drug interactions associated with oral pain. Hence, further refinements and enhancements are imperative to unlock its full potential in elucidating and targeting pathways underlying oral pain mechanisms.
PubMed: 38680473
DOI: 10.1016/j.jobcr.2024.04.008