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.

Autotransplantation of a Buccally Erupted Matured Mandibular Third Molar to Replace a Grossly Decayed Second Molar.

Autotransplantation can be a treatment option for tooth loss as an alternative to fixed or implant-supported prostheses. It has predictable results comparable to implants, with reported success rates often greater than 90%. In present case, buccally erupted matured third molar was autotransplanted in extraction socket of grossly carious mandibular second molar. The tooth was splinted for 1 week followed by root canal treatment. After 12 months follow up, tooth was in perfect state of function and aesthetic with healthy periapical and periodontal architecture. High success rate was found in immature tooth transplantation in previous case reports. This case report describes that even matured tooth can also be used as donor if atraumatic extraction is possible and endodontic treatment is well performed.

The role of cone beam computed tomography in the endodontic management of a mandibular first molar with three distal canals.

The presence of three root canals in the distal root of the mandibular first permanent molars is rare; based on in vitro studies its incidence is reported to be between 0.2% and 3%. With the advent of cone beam computed tomography (CBCT) as an adjunctive diagnostic aid, the determination of root canal anatomy in teeth with extra canals and complex canal configurations has become more precise. CBCT provides three dimensional visualization of the pulp canal space, allowing the clinician in determining the spatial relationships of the root canals with each other at various cross sectional levels along the length of the root. The present report discusses the endodontic management of a mandibular first permanent molar with three canals in the distal root, employing CBCT as an adjunctive diagnostic aid to conventional radiography.