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International Journal of Molecular... Apr 2024Complex microbial communities have been reported to be involved in endodontic infections. The microorganisms invade the dental pulp leading to pulpitis and initiating...
Complex microbial communities have been reported to be involved in endodontic infections. The microorganisms invade the dental pulp leading to pulpitis and initiating pulp inflammation. is a dominant bacterium implicated in both primary and secondary endodontic infections. Drugs targeting the molecular machinery of will minimize pulp infection. LpxA and LpxD are early acyltransferases involved in the formation of lipid A, a major component of bacterial membranes. The identification of leads which exhibit preference towards successive enzymes in a single pathway can also prevent the development of bacterial resistance. A stringent screening strategy utilizing physicochemical and pharmacokinetic parameters along with a virtual screening approach identified two compounds, Lomefloxacin and Enoxacin, with good binding affinity towards the early acyltransferases LpxA and LpxD. Lomefloxacin and Enoxacin, members of the fluoroquinolone antibiotic class, exhibit wide-ranging activity against diverse bacterial strains. Nevertheless, their effectiveness in the context of endodontic treatment requires further investigation. This study explored the potential of Lomefloxacin and Enoxacin to manage endodontic infections via computational analysis. Moreover, the compounds identified herein serve as a foundation for devising novel combinatorial libraries with enhanced efficacy for endodontic therapeutic strategies.
Topics: Fusobacterium nucleatum; Humans; Anti-Bacterial Agents; Lipopolysaccharides; Molecular Docking Simulation; Computer Simulation; Fusobacterium Infections; Enoxacin; Bacterial Proteins; Pulpitis
PubMed: 38673822
DOI: 10.3390/ijms25084239 -
Journal of Dentistry Jul 2024To design and evaluate a matrix metalloproteinase 9 (MMP-9)-responsive hydrogel for vital pulp therapy.
OBJECTIVE
To design and evaluate a matrix metalloproteinase 9 (MMP-9)-responsive hydrogel for vital pulp therapy.
METHODS
A peptide linker with optimized sensitivity toward MMP-9 was crosslinked with 4-arm poly (ethylene glycol)-norbornene (PEG-NB) by thiol-norbornene photo-polymerization. This resulted in the formation of a hydrogel network in which the peptide IDR-1002 was incorporated. Hydrogel characterization and gelation kinetics were examined with Fourier-transform infrared spectroscopy, scanning electron microscopy, rheological testing, and swelling evaluation. Hydrogel degradation was examined through multiple exposure to pre-activated MMP-9, to simulate flare-ups of dental pulp inflammation. The IDR-1002 released from degraded hydrogels was measured with high-performance liquid chromatography. Effect of IDR-1002 released from hydrogels on one-week-old multispecies oral biofilms was evaluated using confocal laser scanning microscopy.
RESULTS
MMP-9-responsive, injectable, and photo-crosslinkable hydrogels were successfully synthesized. When hydrogel degradation and release of IDR-1002 were examined with exposure to pre-activated MMP-9, IDR-1002 release was significantly correlated with elevated levels of MMP-9 (p < 0.05). The effectiveness of IDR-1002 in killing bacteria in multispecies oral biofilms was significantly enhanced when the hydrogels were immersed in 10 nM or 20 nM pre-activated MMP-9, compared to immersion in phosphate-buffered saline (p < 0.05).
CONCLUSIONS
The MMP-9-responsive hydrogel is a promising candidate for on-demand delivery of bioactive agent in vital pulp therapy.
CLINICAL SIGNIFICANCE
MMP-9 is one of the most important diagnostic and prognostic biomarkers for pulpitis. An MMP-9-responsive hydrogel has potential to be used as an in-situ on-demand release system for the diagnosis and treatment of dental pulp inflammation.
Topics: Matrix Metalloproteinase 9; Hydrogels; Humans; Polyethylene Glycols; Dental Pulp; Biofilms; Spectroscopy, Fourier Transform Infrared; Peptides; Microscopy, Electron, Scanning; Pulpitis; Rheology; Microscopy, Confocal; Cross-Linking Reagents
PubMed: 38670329
DOI: 10.1016/j.jdent.2024.105020 -
Clinical Oral Investigations Apr 2024To assess the effect of cryotherapy on haemostasis, post-operative pain, and the outcome of full pulpotomy performed in mature permanent teeth with symptomatic... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To assess the effect of cryotherapy on haemostasis, post-operative pain, and the outcome of full pulpotomy performed in mature permanent teeth with symptomatic irreversible pulpitis.
MATERIALS AND METHODS
The study included sixty mature permanent mandibular molar teeth with symptomatic irreversible pulpitis and no periapical rarefaction. After coronal pulp tissue amputation, teeth were randomly allocated to one of two groups (n = 30 each). In group I (conventional pulpotomy), a sterile cotton pellet moistened with 2.5% NaOCl was used for haemostasis. In group II (cryotherapy), the pulp chamber was continuously lavaged with 2.5C normal saline solution for haemostasis using an indigenous portable cryotherapy irrigation unit. Following haemostasis, the pulp was capped with mineral trioxide aggregate and the tooth was restored with resin composite. The time taken to achieve haemostasis was recorded. Preoperative and 24, 48 and 72 h postoperative pain was measured using the Numerical Rating Scale. The pulpotomy outcome was assessed at the 12-month follow-up. Data were analyzed using Fischer's exact test, two-sample t-test, two-sample Wilcoxon rank-sum test, Friedman Test, and Wilcoxon Signed Rank Test.
RESULTS
The cryotherapy group achieved haemostasis in less time (p < 0.05). There was a significant pain reduction at 24 and 48 h in the cryotherapy group when compared with the conventional pulpotomy group (P < 0.005). The overall success rate of pulpotomy after 12 months was 88% (n = 22) in both study groups(p < 0.05).
CONCLUSIONS
Cryotherapy application reduces postoperative pain and has no adverse effect on the outcome of pulpotomy in permanent teeth with symptomatic irreversible pulpitis.
CLINICAL RELEVANCE
The cryotherapy can be incorporated in pulpotomy protocol as an adjunct to minimize post-operative pain.
Topics: Humans; Pulpotomy; Pulpitis; Cryotherapy; Female; Male; Pain, Postoperative; Silicates; Adult; Treatment Outcome; Calcium Compounds; Molar; Pain Measurement; Oxides; Aluminum Compounds; Drug Combinations; Sodium Hypochlorite; Dentition, Permanent; Adolescent
PubMed: 38668793
DOI: 10.1007/s00784-024-05661-y -
Journal of Endodontics Jul 2024Most pain studies have been based on a postsurgical, third molar model using ibuprofen (IBU)/acetaminophen (APAP). Studies have found quicker onset of pain relief with a... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Most pain studies have been based on a postsurgical, third molar model using ibuprofen (IBU)/acetaminophen (APAP). Studies have found quicker onset of pain relief with a newer formulation of IBU - ibuprofen sodium dihydrate (ISD). The purpose of this study was to compare pain reduction of ISD/APAP to ISD in an acute endodontic pain model of untreated patients experiencing moderate to severe pain with symptomatic apical periodontitis.
METHODS AND MATERIALS
In this double-blind randomized study, 64 adult emergency patients in acute moderate to severe pain, a pulpal diagnosis of symptomatic irreversible pulpitis or necrosis, and symptomatic apical periodontitis participated. Each patient randomly received either one dose of 768 mg ISD/1000 mg APAP or one dose of 768 mg ISD. Pain intensity scores were recorded every 15 minutes over 240 minutes using the Heft-Parker VAS along with time to first sign of pain relief, time to meaningful pain relief, and time to 50% pain relief also recorded. The data were analyzed statistically.
RESULTS
Both ISD and ISD/APAP groups showed a progressive decrease in pain from baseline to 120 minutes after medication administration. Afterward, a relative plateau was seen in the patients' pain. There was no difference in the VAS scores between the ISD and ISD/APAP at any given time point, time to first sign of pain relief, time to meaningful pain relief, and time to 50% pain relief.
CONCLUSIONS
The addition of APAP to ISD for pain control in an untreated endodontic pain model did not differ significantly from ISD alone.
Topics: Humans; Ibuprofen; Double-Blind Method; Acetaminophen; Adult; Male; Female; Periapical Periodontitis; Analgesics, Non-Narcotic; Young Adult; Pulpitis; Drug Therapy, Combination; Pain Measurement; Middle Aged; Drug Combinations
PubMed: 38657900
DOI: 10.1016/j.joen.2024.04.005 -
Evidence-based Dentistry Apr 2024The study by Chrepa et al. is a randomised, placebo-controlled, triple-arm, phase IIA clinical trial with double masking which investigates the effectiveness and safety...
DESIGN
The study by Chrepa et al. is a randomised, placebo-controlled, triple-arm, phase IIA clinical trial with double masking which investigates the effectiveness and safety of Cannabidiol (CBD) as an analgesic for acute dental pain. The intervention drug, Epidiolex is an FDA-approved CBD oral solution (100 mg/ml) derived from the cannabis plant. The psychoactive ingredient tetrahydrocannabinol (THC) is not included. The maximum recommended daily dose of Epidiolex is 20 mg/kg. 64 patients with moderate-severe odontogenic pain participated in the study and REDCap software was utilised to randomly assign participants into groups: CBD10 (10 mg/kg), CBD20 (20 mg/kg) and placebo. A single dose of the respective oral solution was administered, and participants monitored for 3 h. Patients remained blinded to group assignment, as did the outcome assessor. The provider was not blinded. The primary outcome measure was VAS (visual analogue scale) pain difference, compared to baseline and recorded at 7 subsequent marked times following administration (15, 30, 45, 60, 90, 120, 180 min). Additional outcome measures were also recorded: changes in bite force, pain intensity differences, the onset of significant pain relief, the maximum pain relief, psychoactive effects, mood changes and adverse events.
CASE SELECTION
40 female and 21 male patients with moderate-severe odontogenic pain (defined as ≥30 on a 100 mm VAS) with a diagnosis of irreversible pulpitis or pulp necrosis and symptomatic apical periodontitis were included. Participation required a negative test for recent drug and alcohol use, a negative pregnancy test and no use of analgesics within 6 h of the trial. Pregnancy, breastfeeding, hepatic impairment, recreational cannabis users and patients taking CBD metabolising drugs were excluded along with those with an ASA classification above III. Patient characteristics recorded included: age, gender, race, tooth type affected, weight and BMI.
DATA ANALYSIS
Mixed model analysis was used to compare numerical variables among the cohorts at the marked time intervals. VAS, bite force, Bowdle and Bond/Lader questionnaires were recorded. Inter-group analysis was completed using parametric and non-parametric post-hoc tests, including Holm-Bonferroni adjustment and the Shapiro-Wilk test, to evaluate data normality. NNTs were calculated for both CBD doses- the number of patients needing treatment before one patient experiences a minimum of 50% pain relief. X² tests were used to analyse categorical variables: pain intensity and adverse events. JMP software was used for the statistical analysis.
RESULTS
64 participants had originally enroled in the study, but three were excluded from data analysis due to 'unrealistic results', reporting complete pain relief within the first 15 min. 20 participants were given CBD10, 20 were given CBD20 and 21 placebo. 68% of the participants were Hispanic/Latino whilst 11% were white. The average age was 44 +/- 13.7. There was equal distribution of age, sex, race, tooth type, weight and body mass index (p > 0.05). No subject required rescue pain relief during the 3-h observation period. Compared to baseline VAS, significant pain relief was seen 30 min after drug administration for CBD10, versus after 15 min for CBD20 (p < 0.05). Pain reduction reached 50% at 60 min for CBD10 and at 120 min for CBD20. Both reported maximum pain reduction of 73% of baseline at 180 min. 33% pain reduction from baseline was seen in the placebo group, with a median VAS pain of 67% at 180 min. 45.4% of CBD10 and 46.6% of CBD20 required pain relief after 1-6 h, versus 37.5% of placebo (p > 0.05). Bite force increase was seen in both CBD10 and CBD20 groups at 90 and 180 min, versus no significant differences between time points in the placebo group. On assessing pain intensity, pain reduction was significantly associated with increasing time in the CBD groups (p < 0.001), versus no significant association with the placebo group (p = 0.0521). No statistically significant differences were seen between and within the groups for Bowdle or Bond/Lader questions (p > 0.05). In the 3 h observation period, CBD10 experienced 14 times more sedation symptoms versus placebo (p < 0.05), whilst CBD20 experienced this 8 times more (p < 0.05). Within the 3 h, CBD20 were 10-fold more likely to have diarrhoea and abdominal pain (p < 0.05), with some experiencing pain beyond the 3 h but resolving within the day.
CONCLUSIONS
Based on this randomised clinical trial, pure CBD drug Epidiolex demonstrates effective analgesia against acute toothache.
PubMed: 38649735
DOI: 10.1038/s41432-024-01007-5 -
Cureus Mar 2024Background and objectives Direct pulp capping (dPC) is a therapeutic process that involves the application of a protective chemical to an exposed pulp with the intent to...
Background and objectives Direct pulp capping (dPC) is a therapeutic process that involves the application of a protective chemical to an exposed pulp with the intent to facilitate the restoration and preservation of its vitality and function. Despite numerous proposed solutions, researchers have yet to find a dependable, non-absorbable bioactive pulp capping substance that constantly activates cellular healing processes, consequently preserving pulpal vitality over an extended period of time. The objective of this study was to assess and contrast the efficacy of a novel tricalcium silicate cement and calcium hydroxide in preserving the long-term health of the dental pulp following dPC using clinical and radiographic observations. Materials and methods A total of 60 individuals with symptoms of reversible pulpitis associated with deep carious lesions were chosen for dPC in the study. Two groups comprising 30 patients each underwent dPC using the novel tricalcium silicate cement (experimental group) and calcium hydroxide (control group) out of the total number of patients. A thin protective covering of self-curing glass ionomer base was applied on top of the capping material. The dentist provided instant permanent restoration employing direct posterior composite resin. Follow-up examinations were conducted three, six, nine, and 12 months after the procedure, during which assessments were performed using clinical and radiographic parameters. Results The minimum age of the study group was 16, and its maximum age was 34 (22.35 ± 2.3 years). The control group consisted of 12 males and 18 females, while the Biodentine group consisted of 13 males and 17 females. The age and gender distribution were determined to have insignificant statistical differences across the groups. The pain score exhibited statistical significance at both the three-month and six-month follow-up visits (p < 0.05). The pain score at the 12-month follow-up was 0.38 ± 0.52 in the case group and 0.42 ± 0.61 in the control group (p = 0.79). The average Periapical Index (PAI) score for the Dycal and Biodentin groups after the 12-month follow-up was 1.38 ± 0.97 and 1 ± 0.3, respectively. This difference was found to be statistically significant (p = 0.044). In addition, there was a statistically significant difference in the PAI score at the three-month, six-month, and nine-month follow-ups (p < 0.01). During the entirety of the follow-up duration, one individual in the Biodentine group had tenderness upon percussion, a negative reaction for pulp vitality, pulpal changes, and a widening of the periodontal space. Statistically significant differences were observed in pulpal changes and tenderness on percussion during the nine-month and 12-month follow-up periods (p < 0.05). After 12 months, the rate of success in the group treated with Dycal was 91.3%, while the success percentage in the group treated with Biodentine was 98.55%. This difference in outcomes was determined to be statistically significant (λ = 5.46; p = 0.019). Conclusion The study findings indicate that Biodentine, a novel tricalcium silicate cement, outperforms calcium hydroxide in preserving pulp vitality over the long term following dPC. The Biodentine group attained an overall success rate of 98.55%, whereas the Dycal group had a success rate of 91.3% following 12 months of subsequent follow-up visits.
PubMed: 38646305
DOI: 10.7759/cureus.56508 -
Dental and Medical Problems 2024Curved root canals are associated with the highest number of procedural errors during endodontic instrumentation. Recently, numerous rotary instruments have been... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Curved root canals are associated with the highest number of procedural errors during endodontic instrumentation. Recently, numerous rotary instruments have been developed, with both manual and automated mechanisms, to facilitate endodontic treatment and manage the complications related to it.
OBJECTIVES
The aim of the study was to assess post-endodontic pain after using the HyFlex® EDM OneFile (HEDM), WaveOne® Gold (WOG) and XP-endo® Shaper (XPS) systems in the preparation of curved canals in patients with asymptomatic irreversible pulpitis.
MATERIAL AND METHODS
A total of 45 molars with curved canals and asymptomatic irreversible pulpitis were randomly divided into 3 equal groups based on the instrumentation used: HEDM (group A); WOG (group B); and XPS (group C). All teeth were prepared according to the manufacturers' instructions. Postendodontic pain was assessed using the visual analog scale (VAS) at 6, 12, 18, 24, 48, and 72 h after root canal instrumentation. The data was analyzed using the one-way analysis of variance (ANOVA) and the paired-samples t test with the Bonferroni correction, with a p-value of 0.05 set for statistical significance.
RESULTS
The highest levels of post-endodontic pain were recorded at 6 h after treatment. Then, the values gradually decreased until the pain nearly vanished after 72 h. No statistically significant differences were observed in the VAS scores between groups A and B. At the same time, group C showed the lowest VAS scores at all follow-up time points.
CONCLUSIONS
The use of the XPS system resulted in the lowest pain scores at all follow-ups. The HEDM and WOG groups showed no differences in the pain scores throughout the whole follow-up period.
Topics: Humans; Root Canal Preparation; Dental Pulp Cavity; Pulpitis; Pain; Molar
PubMed: 38642392
DOI: 10.17219/dmp/155105 -
The American Journal of Case Reports Apr 2024BACKGROUND Vital pulp therapy approaches are preferred over non-surgical root canal treatment, giving the advantage of preserving the vitality of the dental pulp and...
BACKGROUND Vital pulp therapy approaches are preferred over non-surgical root canal treatment, giving the advantage of preserving the vitality of the dental pulp and thus maintaining its benefits. Such approaches can be performed in teeth having normal apical area; however, performing vital pulp therapy approaches in teeth associated with periapical pathology remains controversial. CASE REPORT We present a case of a mature mandibular right first permanent molar tooth in a medically fit 10-year-old female diagnosed as asymptomatic irreversible pulpitis with asymptomatic apical periodontitis with periapical radiolucency having a periapical index (PAI) score of 4. Partial pulpotomy was performed instead of non-surgical root canal treatment due to uncooperativeness of the patient. Biodentine was used as a pulp capping material. The tooth was restored with resin composite permanent restoration. Six months after the procedure, an intraoral periapical radiograph revealed normal bone features with complete periapical pathology healing and development of intact lamina dura around the mesial and distal roots. The tooth responded normal to electric pulp testing (EPT), cold, percussion, and palpation tests. CONCLUSIONS Periapical pathology involvement having large periapical radiolucency exhibiting PAI score 4 in inflamed dental pulp tooth diagnosed as irreversible pulpitis does not necessitate non-surgical root canal treatment. Partial pulpotomy should be considered as an alternative treatment to promote the return dental pulp and periapical tissue to a healthy condition. Considering a similar approach in older patients would be interesting to gain a more comprehensive understanding of its potential as a treatment method.
Topics: Female; Humans; Aged; Child; Pulpotomy; Pulpitis; Treatment Outcome; Molar
PubMed: 38641871
DOI: 10.12659/AJCR.942937 -
Cureus Mar 2024This case report explores how the presence of an adjacent implant influenced the restoration of a tooth with pulpitis in a gastro-esophageal reflux disease (GERD)...
This case report explores how the presence of an adjacent implant influenced the restoration of a tooth with pulpitis in a gastro-esophageal reflux disease (GERD) patient. A patient with GERD requires a tooth-colored crown not only for aesthetics but also to address potential galvanic concerns arising from an adjacent implant. GERD, a condition causing non-cavity erosion, weakens tooth structure over time, presenting significant challenges in treatment. It resulted in bite relapse and insufficient occlusal clarity over time. A comprehensive treatment approach was needed to restore both function and appearance. This involved managing galvanism using non-metallic materials to ensure optimal occlusal clarity, as well as meticulously reinforcing and restoring tooth structure. Monoblock post-fused crowns were chosen for their superior durability, stability, and comfort. The ceramic layering not only effectively prevented galvanic issues by insulating the tooth structure but also significantly improved the natural appearance of teeth, thereby promoting long-term oral health and successfully managing complex dental concerns. The dental team successfully restored the damaged tooth by considering specific factors that influenced the treatment plan, including achieving optimal aesthetic outcomes.
PubMed: 38638723
DOI: 10.7759/cureus.56482 -
Cureus Mar 2024Despite substantial breakthroughs in instrumentation systems and pharmaceutical interventions, pain following endodontic therapy remains a serious concern. The effect of...
BACKGROUND
Despite substantial breakthroughs in instrumentation systems and pharmaceutical interventions, pain following endodontic therapy remains a serious concern. The effect of the type of endodontic instrumentation system in post-operative pain after endodontic therapy has been a matter of debate.
AIM
To evaluate different endodontic instrumentation systems, namely Reciproc (GmbH, Munich), OneShape® (MicroMega, France), Protaper Gold (Dentsply Sirona, USA), and Hyflex® EDM (Coltène/Whaledent Inc., USA) file systems, regarding post-operative pain after endodontic therapy Methods and materials: The endodontic department treated healthy patients aged 20 to 50 years who were experiencing symptoms of irreparable pulpitis in one or more maxillary molars or mandibular molars. Five hundred was the determined size of the sample. The study participants were divided into five categories, each comprising 100 participants. These categories were: Category 1: Reciproc instrumentation system. Category 2: OneShape® instrumentation system. Category 3: ProtaperGold instrumentation system. Category 4: HyFlex® EDM instrumentation system. Category 5: Control (stainless steel K-files). Following endodontic therapy, these scores were recorded at 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours using the VAS scale.
RESULTS
The visual analog scale (VAS) score (mean±SD) in the control group was 0.73± 0.40 (<0.001). The VAS score in the Reciproc group was 0.43± 0.05 (<0.001). The VAS score in the OneShape® group was 0.36±0.09 (<0.001). The VAS score in the Protaper Gold group was 0.41 ±0.08 (<0.001). The VAS score in the HyFlex® EDM group was 0.55 ±0.02 (<0.001). The VAS score in all instrumentation techniques at 72 hours follow-up was lesser in comparison to a control group with meaningful statistical significance (<0.001). However, the post-operative pain among the Reciproc, OneShape®, Protaper Gold, and HyFlex® EDM instrumentation systems was not different clinically when compared among themselves. However, VAS values were greater in OneShape® and HyFlex® EDM compared to Reciproc and Protaper Gold, showing increased post-operative pain in OneShape and HyFlex® EDM compared to Reciproc and Protaper Gold. It was also observed that there was a decline in the VAS score in all instrumentation systems as the follow-up period increased from 6 hours to 72 hours, with maximum post-operative pain at 6 hours of follow-up and minimum post-operative pain at 72 hours of follow-up. However, the decline was lesser in OneShape® and HyFlex® EDM in comparison to Reciproc and Protaper Gold, with increased post-operative pain in OneShape® and HyFlex® EDM in comparison to Reciproc and Protaper Gold.
CONCLUSION
Post-operative pain at all follow-ups of endodontic procedures was less in Reciproc, OneShape®, Protaper Gold, and HyFlex® EDM than in the control group. VAS scores were higher in the OneShape® and HyFlex® EDM groups compared to the Reciproc and Protaper Gold groups, indicating increased post-operative pain with OneShape® and HyFlex® EDM instruments in comparison to Reciproc and Protaper Gold.
PubMed: 38638716
DOI: 10.7759/cureus.56466