Revisiting Orstavik's PAI score to produce a reliable and reproducible assessment of the outcomes of endodontic treatments in routine practice.

INTRODUCTION: Orstavik's periapical index is widely used for radiographic assessment of periapical status. This study analyses the reliability and reproducibility of a modified guide for the interpretation of the periapical index (PAI) scores recorded by undergraduate students. MATERIALS AND METHOD: Two groups of 4th-year students were asked to assess the PAI scores of 100 X-rays two or three times depending on the group. The reliability of their judgment was evaluated by comparing the students' assessments to those of a standard, based on the evaluations made by three teachers. Short-term stability was evaluated for two lengths of interval separating the Test and Retest phases, respectively, 1 week for Group 1 and 2 weeks for Group 2. Long-term stability was evaluated by having Group 1 repeat the Retest phase after 15 months. RESULTS: Overall mean success rates ranged from 61% to 65% according to the student group and the study phase. Intergroup comparisons showed no statistical difference. The reliability of the PAI score evaluation by students was excellent in both groups. Short-term and long-term stability were also excellent regardless of the duration of the interval between the study's phases. DISCUSSION: The image misinterpretations are discussed according to the study phases and the PAI score values. CONCLUSION: Undergraduate students can be trained to use the modified guide for scoring PAI for self-evaluation of the outcomes of the root canal treatments and re-treatments they are asked to perform during their clinical sessions.

Pulp Inflammation Diagnosis from Clinical to Inflammatory Mediators: A Systematic Review.

INTRODUCTION: Similar to other tissues, the dental pulp mounts an inflammatory reaction as a way to eliminate pathogens and stimulate repair. Pulp inflammation is prerequisite for dentin pulp complex repair and regeneration; otherwise, chronic disease or pulp necrosis occurs. Evaluation of pulp inflammation severity is necessary to predict the clinical success of maintaining pulp vitality. Clinical limitations to evaluating in situ inflammatory status are well-described. A molecular approach that aids clinical distinction between reversible and irreversible pulpitis could improve the success rate of vital pulp therapy. The aim of this article is to review inflammatory mediator expression in the context of clinical diagnosis. METHODS: We searched PubMed and Cochrane databases for articles published between 1970 and December 2016. Only published studies of inflammatory mediator expression related to clinical diagnosis were eligible for inclusion and analysis. RESULTS: Thirty-two articles were analyzed. Two molecular approaches were described by study methods, protein expression analysis and gene expression analysis. Our review indicates that interleukin-8, matrix metalloproteinase 9, tumor necrosis factor-α, and receptor for advanced glycation end products expression increase at both the gene and protein levels during inflammation. CONCLUSIONS: Clinical irreversible pulpitis is related to specific levels of inflammatory mediator expression. The difference in expression between reversible and irreversible disease is both quantitative and qualitative. On the basis of our analysis, in situ quantification of inflammatory mediators may aid in the clinical distinction between reversible and irreversible pulpitis.

A Review of Criteria for the Evaluation of Pulpotomy Outcomes in Mature Permanent Teeth.

INTRODUCTION: During the past decade, with a view to understanding pulp biology better and developing bioactive materials, pulpotomy has been reinvestigated as a definitive treatment in mature permanent teeth. Pulp chamber pulpotomy or coronal pulpotomy is widely used in deciduous and immature permanent teeth, and there is thus a need for trials to evaluate the outcome of pulpotomy as a therapeutic procedure on mature permanent teeth in accordance with Good Clinical Practice guidelines. This study aimed to review publications reporting the outcomes of pulpotomy when indicated as a definitive treatment in mature permanent teeth and to discuss the relevance of the criteria that could be used in clinical practice or research. METHODS: A review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was conducted on publications found by both PubMed and backward research. RESULTS: Seven clinical trials, 9 cohort studies, and 15 cases reports have been included. Overall, goals, criteria for inclusion, and criteria for outcomes of pulpotomy varied among studies. The relevance and the reliability of the success or failure criteria of pulpotomy were discussed regarding the possible evolution of the radicular pulpal status that could be expected after pulpotomy. Finally, criteria for the evaluation of the outcome of pulpotomy are proposed. CONCLUSIONS: The use of standardized outcome criteria would facilitate further meta-analyses, aiming to assess whether pulpotomy should be considered as a true alternative therapy to root treatment.

Biodentine induces immortalized murine pulp cell differentiation into odontoblast-like cells and stimulates biomineralization.

INTRODUCTION: Biodentine (Septodont, Saint Maur des Faussés, France), a new tricalcium silicate-based cement, has recently been commercialized and advertised as a bioactive material. Its clinical application and physical properties have been widely described, but, so far, its bioactivity and biological effect on pulp cells have not been clearly shown. Thus, the aim of this study was to evaluate the biological effect of Biodentine on immortalized murine pulp cells (OD-21). METHODS: OD-21 cells were cultured with or without Biodentine. Cell proliferation was determined by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) colorimetric assay after 2, 3, and 5 days of stimulation. The expression of several biomolecular markers was analyzed to screen differentiation pathways, both on a gene level with Real-time reverse transcription polymerase chain reaction and on a protein level by measuring alkaline phosphatase activity. Alizarin red staining was used to assess and quantify biomineralization. RESULTS: The expression patterns of several genes confirmed the differentiation of OD-21 cells into odontoblasts during the period of cell culture. Our results suggest that Biodentine is bioactive because it increased OD-21 cell proliferation and biomineralization in comparison with controls. CONCLUSIONS: Because of its bioactivity, Biodentine can be considered as a suitable material for clinical indications of dentin-pulp complex regeneration, such as direct pulp capping.