Cryotherapy in the Management of Vital Pulp: A Case Report.

Cryotherapy in vital pulp treatment is a procedure that involves the use of extreme cold temperatures to manage inflammation and promote healing in the dental pulp tissue. It has shown potential in preserving pulp vitality and reducing post-operative discomfort in procedures such as partial and full pulpotomy. Vital pulp therapy (VPT) aims to preserve the vitality and function of the dental pulp. With the proper diagnosis, technique, and materials, it can effectively treat moderately inflamed pulp and minimize the need for more invasive procedures. This article presents a case of vital pulp cryotherapy in a patient having moderately inflamed pulp.

Occlusal veneer restoration treatment outcomes of cracked tooth syndrome: A 22.4-month follow-up study.

OBJECTIVES: The aims of this clinical study were to investigate success rate, vital pulp survival rate, tooth survival rate and patient-reported masticatory ability by evaluating the pain symptoms and signs of the cracked teeth as well as Index of Eating Difficulty (IED) and Oral Health Impact Profile-14 (OHIP-14) questionnaire after cracked teeth were restored with occlusal veneers. MATERIALS AND METHODS: 27 cracked teeth of 24 patients with cold and/or biting pains without spontaneous/nocturnal pains were recruited in this study. The cracked teeth were restored with occlusal veneers fabricated by lithium disilicate ceramic. Cold test and biting test were used to evaluate pain signs. IED and OHIP-14 questionnaire were used to evaluate masticatory ability. FDI criteria was used to evaluate restorations. The paired Wilcoxon test was used to analyze significant differences of detection rate of pain signs, OHIP scores and IED grade before and after restorations. Kaplan-Meier survival curve was used to describe the success rate, vital pulp survival rate, and tooth survival rate. RESULTS: 27 cracked teeth were restored with occlusal veneers with average of 22.4-month follow-up. Two cracked teeth had pulpitis and pain signs of the other cracked teeth completely disappeared. OHIP total scores were significantly reduced after treatment. Scores of 'pain', 'occlusal discomfort', 'uncomfortable to eat', 'diet unsatisfactory' and 'interrupted meals' reduced significantly after treatment. After treatment, IED grades of 25 vital teeth were significantly lower than those before treatment. FDI scores of 25 restorations except for 2 teeth with pulpitis were no greater than 2. The 12 months accumulated pulp survival rate of the cracked teeth was 92.6%. The 12 months accumulated tooth survival rate was 100%. The success rate at the latest recall was 92.6%. CONCLUSION: Occlusal veneer restorations with success rate of 92.6% and the same pulp survival rate might be an effective restoration for treating the cracked teeth. CLINICAL RELEVANCE: The occlusal veneer restorations might be an option for treating the cracked teeth when cracks only involve enamel and dentin, not dental pulp.

Pulp Survival of Cracked Teeth with Reversible Pulpitis after Orthodontic Banding and Coronal Coverage - A Prospective Cohort Study with One Year Follow Up.

INTRODUCTION: The aim of this prospective study was to investigate the 1-year pulp survival of cracked teeth with reversible pulpitis managed with initial stabilization using orthodontic bands, followed by coronal coverage restorations. METHODS: One-hundred-and-twenty-five patients with a cracked tooth with reversible pulpitis each were recruited. Preoperative patient and tooth data were collected. After definitive pulp diagnoses were determined following an interim period of orthodontic banding, coronal coverage restorations were placed. Cox and logistic regression analyses were used to assess possible prognostic factors and to correlate initial time to pulp stabilization while in orthodontic bands with eventual outcome. Pulp survival was determined using both clinical and radiographic findings. RESULTS: One-hundred-and-six cracked teeth were followed up at 1 year. Pulp survival based on clinical and radiographic findings was found in 81 teeth (76.4%). Out of 25 failures, 11 (44%) required root canal treatment (RCT) in the orthodontic band stage and 10 (40%) required RCT during the process of or after coronal coverage restorations. Four teeth (16%) had incidental findings of periapical radiolucencies at the 1-year review without clinical symptoms. Teeth requiring RCT were found to have required longer periods in orthodontic bands prior to a definitive pulp diagnosis (P < .05). CONCLUSION: A step-by-step approach by using orthodontic banding to monitor pulp status may reduce the incidence of RCT required through definitive coronal coverage restorations for cracked teeth with reversible pulpitis.

An animal study on the effectiveness of platelet-rich plasma as a direct pulp capping agent.

Direct pulp capping (DPC) is a conservative approach for preserving tooth vitality without requiring more invasive procedures by enhancing pulp healing and mineralized tissue barrier formation. We investigated the effectiveness of Platelet Rich Plasma (PRP) vs. Mineral Trioxide Aggregate (MTA) as a DPC agent. Forty-two teeth from three mongrel dogs were divided into two equal groups. After three months, the animals were sacrificed to evaluate teeth radiographically using cone-beam computerized tomography, histopathologically, and real-time PCR for dentin sialophosphoprotein (DSPP), matrix extracellular phosphoglycoprotein (MEPE), and nestin (NES) mRNA expression. Radiographically, hard tissue formation was evident in both groups without significant differences (p = 0.440). Histopathologic findings confirmed the dentin bridge formation in both groups; however, such mineralized tissues were homogenous without cellular inclusions in the PRP group, while was osteodentin type in the MTA group. There was no significant difference in dentin bridge thickness between the PRP-capped and MTA-capped teeth (p = 0.732). The PRP group had significantly higher DSPP, MEPE, and NES mRNA gene expression than the MTA group (p < 0.05). In conclusion, PRP enables mineralized tissue formation following DPC similar to MTA, and could generate better cellular dentinogenic responses and restore dentin with homogenous architecture than MTA, making PRP a promising alternative DPC agent.

Systemic Antibiotic Use in Acute Irreversible Pulpitis: Evaluating Clinical Practices and Molecular Insights.

This scoping review systematically evaluates the use of systemic antibiotics in treating acute irreversible pulpitis, integrating clinical practice patterns with recent molecular insights. We analyzed clinical evidence on antibiotic prescription trends among dental professionals and examined molecular research advancements in relation to pulpitis. This review is intended to bridge the gap between clinical practice and molecular research, guiding more evidence-based approaches to treating acute irreversible pulpitis. Electronic databases were searched for relevant articles published in English based on the objective of the review. A second search using all identified keywords and index terms was undertaken across all the included databases. In addition, a reference list of identified articles was searched. Studies including original research, systematic reviews, meta-analyses, clinical trials, and observational and retrospective studies, all written in English and published from 2010 onwards, were included, and an analysis of the text words contained in the titles and abstracts of the retrieved papers and of the index terms used to describe the articles was performed. A total of N = 53 articles were selected. Altogether, N = 43 (76.79%) articles were cross-sectional studies, N = 4 (11.11%) were systematic reviews, and N = 3 (5.36%) were guidelines. The most frequent level of evidence was level VI (N = 43 (76.79%). The mean percentage of dentists who prescribed antibiotics to treat acute irreversible pulpitis was 23.89 ± 23.74% (range: 0.05-75.7). Similarly, for specialists, it was 22.41 ± 15.64 (range 2.2-50.4), and the percentage for undergraduates was 17.52 ± 20.59 (range 0-62.6). The significant developments in research models for pulpitis research and the characterisation of biomarkers have led to better management strategies. Concurrently, significant advancements in molecular research provide new understandings of pulpitis, suggesting alternative therapeutic approaches. Although there are guidelines available, increased rates of antibiotic prescription are still prevalent around the globe.

Assessment of Decision-Making and Material Selection for Vital Pulp Therapy in Deep Carious Lesions: A Study at the Faculty of Dentistry, King Abdulaziz University.

PURPOSE: The purposes of this study were to assess decision-making, material selection, and management of deep carious lesions in permanent teeth requiring vital pulp therapy (VPT); investigate the intradepartmental and interdepartmental consensus in the management of those cases; and correlate this study's results to the current scientific literature, clinical experience, and postgraduate training among staff and postgraduate students at the Faculty of Dentistry, King Abdulaziz University. MATERIALS AND METHODS: The survey included faculty from pedodontics, endodontics, and restorative/operative dentistry; postgraduate students; and interns, excluding specific categories such as retired faculty, external trainers, non-faculty hospital specialists, general practitioners, students, interns outside the institution, and other departments. An anonymous electronic questionnaire was developed and validated. Ethical approval was obtained, and the questionnaire was distributed to all 148 English-proficient members of the targeted population via email and WhatsApp, accompanied by a cover letter. The questionnaire encompassed demographic, education, experience, assessment, decision-making, and management sections. Data were collected and analyzed using Microsoft Excel, with results presented using categorical variables, Pareto charts, and statistical tests. RESULTS: There were 86 responses, representing 58% of the target population, with the key findings including the prominence of "Pre-operative vitality test result" as the most important factor in assessing deep carious lesions, with no significant differences among specialties. The (one-step and one-visit) management approach was preferred by 50% of participants, with no significant specialty differences. For deep carious lesions without pulpal exposure, glass ionomer (GI)/resin-modified glass ionomer (RMGI) base was the top choice, with no variation among all specialties. In cases with pulpal exposure, the one-visit approach (direct pulp capping (DPC), base, and restoration) was the most favored, with no specialty differences. Material availability significantly influenced decision-making, with no specialty variations. CONCLUSION: The study highlights the crucial role of pre-operative vitality tests in assessing deep carious lesions for VPT or root canal treatment (RCT). Participants generally favored VPT for cases with normal pulp vitality, with some departmental variation. Controlling bleeding post-pulpal exposure was a central concern. Mineral trioxide aggregate (MTA) was the most commonly used VPT material, followed by Ca(OH)2 and Biodentine. Factors such as treatment access, patient compliance, remaining dentin thickness, and oral hygiene had minimal impact on treatment choice. Limited availability of VPT materials was the primary reason for non-use. The survey's acceptable response rate raises concerns about potential non-response bias, though limitations include a lack of data on non-responders. Nevertheless, the survey's strength lies in its comprehensive coverage of key clinical aspects, engaging professionals from diverse specialties and educational levels who are collectively interested in addressing deep caries cases.

Development of Rat Caries-Induced Pulpitis Model for Vital Pulp Therapy.

Rodent animal models for vital pulp therapy are commonly used in dental research because their tooth anatomy and cellular processes are similar to the anatomy and processes in humans. However, most studies have been conducted using uninfected sound teeth, which makes it difficult to adequately assess the inflammatory shift after vital pulp therapy. In the present study, we aimed to establish a caries-induced pulpitis model based on the conventional rat caries model and then evaluate inflammatory changes during the wound-healing process after pulp capping in a model of reversible pulpitis induced by carious infection. To establish the caries-induced pulpitis model, the pulpal inflammatory status was investigated at different stages of caries progression by immunostaining targeted to specific inflammatory biomarkers. Immunohistochemical staining revealed that both Toll-like receptor 2 and proliferating cell nuclear antigen were expressed in moderate and severe caries-stimulated pulp, indicating that an immune reaction occurred at both stages of caries progression. M2 macrophages were predominant in moderate caries-stimulated pulp, whereas M1 macrophages were predominant in the severe caries-stimulated pulp. Pulp capping in teeth with moderate caries (i.e., teeth with reversible pulpitis) led to complete tertiary dentin formation within 28 d after treatment. Impaired wound healing was observed in teeth with severe caries (i.e., teeth with irreversible pulpitis). During the wound-healing process in reversible pulpitis after pulp capping, M2 macrophages were predominant at all time points; their proliferative capacity was upregulated in the early stage of wound healing compared with healthy pulp. In conclusion, we successfully established a caries-induced pulpitis model for studies of vital pulp therapy. M2 macrophages have an important role in the early stages of the wound-healing process in reversible pulpitis.

Uso de Petiveria alliacea Linn como tratamiento paliativo del dolor pulpar

Introducción: Entre las plantas de la flora cubana con propiedades medicinales se encuentra la Petiveria alliacea Linn (anamú), planta natural de la América tropical que contiene numerosos principios activos y a la cual se le atribuyen múltiples propiedades. La gran mayoría de los reportes se refieren concretamente a su acción analgésica, proveniente de sus hojas y de sus raíces. Objetivo: Evaluar el efecto terapéutico de la tintura de anamú al 20 % en la remisión del dolor pulpar en la pulpitis aguda serosa transitoria, durante el periodo de septiembre de 2020 a septiembre de 2021. Método: Se realizó un estudio de tipo cuasi-experimental en pacientes con dolor de la consulta de urgencia estomatológica del Policlínico Comunitario "Hermanos Martínez Tamayo". El universo estuvo constituido por todos los pacientes que acudieron a consulta por dolor (N꓿42) y le fue diagnosticado pulpitis aguda serosa transitoria. Los mismos fueron incluidos en el estudio mediante el método no probabilístico intencionado según el orden de recepción en la consulta estomatológica. Se trabajó con las variables: edad, tiempo de refracción del dolor y efecto terapéutico. El procesamiento estadístico de los datos se realizó mediante estadística descriptiva y como medida de resumen se utilizó el porcentaje. Resultados: En el 64,3 % de los casos estudiados se pudo lograr la remisión del dolor en los primeros 5 minutos de aplicado el fitofármaco. Conclusiones: la tintura de la Petiveria alliacea Linn (anamú) al 20 % tiene un efecto favorable en la remisión del dolor provocado por la pulpitis aguda serosa transitoria.

Introduction: Among the Cuban flora plants with medicinal properties is Petiveria alliacea Linn (anamú), a natural plant from tropical Americas that contains numerous active ingredients and to which multiple properties are attributed. The vast majority of reports refer specifically to its analgesic action, coming from its leaves and roots. Objective: To evaluate the therapeutic effect of 20% anamú tincture on the remission of pulpal pain in reversible serous acute pulpitis, during the period from September 2020 to September 2021. Method: A quasi-experimental study was carried out in patients with pain from the stomatological emergency room of the Policlínico Comunitario "Hermanos Martínez Tamayo". The population was made up of all the patients who attended the consultation for pain (No. 42) and were diagnosed with reversible serous acute pulpitis. They were included in the study using the intentional non-probabilistic method according to the order of reception in the dental office. The variables taken into account were: age, pain refraction time and therapeutic effect. The statistical processing of the data was carried out using descriptive statistics and the percentage was used as a summary measure. Results: In 64.3% of the cases studied, pain remission could be achieved in the first 5 minutes of applying the phytopharmaceutical. Conclusions: The tincture of Petiveria alliacea Linn (anamu) at 20% has a favorable effect on the remission of pain caused by reversible serous acute pulpitis.

Introdução: Entre as plantas da flora cubana com propriedades medicinais está a Petiveria alliacea Linn (anamú), uma planta natural da América tropical que contém numerosos princípios ativos e à qual são atribuídas múltiplas propriedades. A grande maioria dos relatos refere-se especificamente à sua ação analgésica, proveniente de suas folhas e raízes. Objetivo: Avaliar o efeito terapêutico da tintura de anamú 20% na remissão da dor pulpar na pulpite serosa aguda transitória, durante o período de setembro de 2020 a setembro de 2021. Método: Foi realizado um estudo quase experimental em pacientes com dor de pronto-socorro estomatológico da Policlínico Comunitario "Hermanos Martínez Tamayo". O universo foi constituído por todos os doentes que compareceram à consulta de dor (N=42) e foram diagnosticados com pulpite serosa aguda transitória. Eles foram incluídos no estudo pelo método não probabilístico intencional de acordo com a ordem de recepção no consultório odontológico. Trabalhamos com as variáveis: idade, tempo de refração da dor e efeito terapêutico. O tratamento estatístico dos dados foi realizado por meio de estatística descritiva e o percentual foi utilizado como medida sumária. Resultados: Em 64,3% dos casos estudados, a remissão da dor foi alcançada nos primeiros 5 minutos de aplicação do fitofármaco. Conclusões: A tintura de Petiveria alliacea Linn (anamu) a 20% tem efeito favorável na remissão da dor causada pela pulpite serosa aguda transitória.

Characteristics of Cracked Teeth with Reversible Pulpitis After Orthodontic Banding-A Prospective Cohort Study.

INTRODUCTION: Cracked teeth with reversible pulpitis can be managed with orthodontic bands in the interim before definitive restorations. The aim of this study was to determine short-term outcomes of these teeth following orthodontic band placement. The time taken for definitive pulp diagnoses after orthodontic band placement and associated prognostic factors was also analyzed. METHODS: One hundred twenty-five patients with a cracked tooth with reversible pulpitis each were recruited. Preoperative data including patient and tooth factors were collected. Cracked teeth were banded and reviewed until symptoms resolved before referral for coronal coverage. Kaplan-Meier and Cox analyses were performed to analyze pulp survival of these teeth. Prognostic factors were investigated using Pearson's chi-square and Student's t-test. RESULTS: One hundred twenty-two cracked teeth were analyzed. One hundred thirteen (92.6%) teeth had the pulpitis resolved within 2 months (median 40.0; interquartile range 28-61). The median time taken for progression to irreversible pulpitis or pulp necrosis for teeth that required root canal treatment was 3 months (median 90.0; interquartile range 68-110). No prognostic factors were associated with the resolution of pulpal symptoms. However, higher preoperative triggered pain scores (P < .05, hazards ratio 1.547) and absence of a distal marginal ridge crack (P < .05, hazards ratio 0.638) were correlated with a longer duration before definitive pulp diagnoses. CONCLUSION: Following orthodontic band placement, a normal pulp diagnosis was achieved in 92.6% of cracked teeth with preoperative reversible pulpitis. Definitive pulp diagnoses could be determined in approximately 2 months. Teeth with higher preoperative triggered pain scores may require a longer review period.

Vital Pulp Therapy of Permanent Teeth with Reversible or Irreversible Pulpitis: An Overview of the Literature.

Vital pulp therapy (VPT) has been recently proposed as an alternative approach even in symptomatic mature permanent teeth with deep caries' lesions, aiming to maintain the pulp vitality over time and/or to avoid non-surgical root canal therapy (NSRCT). However, to date, the diagnosis of reversible or irreversible pulpitis is only based on clinical pain quantity and quality, without precisely reflecting the pulp inflammation status. Therefore, the aim of the present study was to provide an overview based on the current scientific literature to demonstrate the clinical effectiveness of VPT on mature permanent teeth, validating the use of hydraulic calcium silicate-based cements and their role in pain management. VPT may be successfully applied not only in mature permanent teeth diagnosed with reversible pulpitis, but also in permanent dental elements with signs and symptoms of irreversible pulpitis. Hydraulic cements showed favorable outcomes in terms of decrease of pro-inflammatory mediators and of post-operative pain. Pain plays a central role in the chance to perform VPT in mature permanent teeth, since it may be considered as a pre-operative diagnostic criterion as well as a treatment success parameter. In addition, proper assessment of pulp inflammation and choice of appropriate materials are key factors in enhancing VPT success.

Outcome of full pulpotomy in mature permanent molars using 3 calcium silicate-based materials: A parallel, double blind, randomized controlled trial.

AIM: The aim of the study was to compare the outcome of full pulpotomy using 2 calcium silicate-based materials compared with mineral trioxide aggregate (MTA) in symptomatic mature permanent teeth with carious pulp exposure. METHODOLOGY: This study was designed as a parallel, double blind, randomized controlled trial where symptomatic mature permanent teeth with carious pulp exposure meeting the inclusion criteria were randomly treated with full pulpotomy using one of 3 calcium silicate-based materials (ProRoot MTA, Biodentine and TotalFill). Full pulpotomy was performed, and haemostasis was achieved via a cotton pellet moistened with 2.5% NaOCl. A 3-mm layer of the calcium silicate-based material was randomly placed as the pulpotomy agent through a block randomization process followed by a resin-based composite restoration. Postoperative periapical radiograph was taken. Clinical and radiographic evaluation were completed after 6 months and 1 year. The patient and evaluator were blinded to the type of materials used. Pain levels were scored preoperatively and 7 days after treatment. Effect of potential prognosis factors including gender, age, diagnosis, bleeding time and type of caries were also analysed. RESULTS: One hundred and sixty-four teeth in 146 patients received full pulpotomy and were randomly assigned to either the tested or control material through block randomization technique (50 MTA, 50 Biodentine and 64 TotalFill). The age ranged from 10 to 70 years. The diagnosis was irreversible pulpitis in 112 teeth (72%) and reversible pulpitis in 28 teeth (28%). The majority of patients presented with severe pain, during the first week 96.9% reported complete relief of pain or mild pain. Four cases had immediate failure. At 6 months the overall success rate was 92.2%, over 1 year 156/164 teeth attended follow-up with 12 failures (2 restorative failures and 10 endodontic failures), the overall success of pulpotomy at 1 year was 92.3% (144/156); 91.8% in MTA, 93.3% in Biodentine and 91.9% in TotalFill with no significant difference amongst the groups and no side effects observed. No significant association was evident between outcome and the investigated variables. CONCLUSIONS: The 1-year success rate of full pulpotomy did not differ significantly between Biodentine pulpotomy, TotalFill pulpotomy, and MTA pulpotomy. The study was registered with clinical trials; registration number (NCT04345263).

[Comparative analysis of methods to stimulate and collect dentinal fluid: a clinical and experimental study]. / Sravnitel'nyi analiz metodov stimulyatsii i zabora dentinnoi zhidkosti zuba: kliniko-eksperimental'noe issledovanie.

OBJECTIVE: The aim - to determine the most effective method of dentinal fluid collection and dentinal fluid flow rate stimulation. MATERIAL AND METHODS: In a series of dentinal fluid collection tests, 3 types of filter membranes «Technofilter¼ were compared to a blotting nitrocellulose membrane Sartorius 1288. An ability of the studied membranes to adsorb dentinal fluid was assessed based on the data of proton magnetic resonance using signal magnitudes of the organic molecules accumulation in dentine fluid samples. In the study 30 permanent teeth with a diagnosis of K04.00 «Initial pulpitis¼ were included. Teeth were randomly divided into 5 groups in accordance with the method used to stimulate the dentinal fluid flow rate. Dentinal fluid volume before and after stimulation within and between the groups was compared. RESULTS: The nitrocellulose membrane Sartorius 1288 has the highest ability to adsorb dentinal fluid; predominant dentinal fluid volume was obtained using a 10% dextran solution with low molecular weight. Based on the results of the study, the author proposed the method of dentinal fluid collection. CONCLUSION: The proposed stimulation method increases the dentinal fluid yields by 2 times in comparison with sampling under natural conditions.

Relationship between the difference in electric pulp test values and the diagnostic type of pulpitis.

BACKGROUND: According to the diagnosis criteria of the American Association of Endodontists (AAE), sensitive responses to cold and/or heat tests of suspected teeth compared with those of control teeth can be used for the diagnosis of pulpitis, but the role of electric pulp test (EPT) is not mentioned. It is believed that EPT has some limitations in determining the vitality of the pulp. The aim of this study was to explore the association between the difference in EPT values and the differential diagnoses of reversible pulpitis (RP) and symptomatic irreversible pulpitis (SIRP) caused by dental caries. METHODS: A total of 203 cases with pulpitis caused by dental caries were included. A diagnosis of pulpitis was made on the basis of the diagnostic criteria of AAE. Patient demographic and clinical examination data were collected. The EPT values of the suspected teeth and control teeth were measured, and the differences between them were calculated. The correlation between the difference in the EPT values and diagnosis of pulpitis was analyzed using univariate and multivariate logistic regression. RESULTS: In the 203 cases (78 males and 125 females; 115 cases of RP, 88 cases of SIRP; 9 anterior teeth, 59 premolars, and 135 molars), the mean patient age was 34.04 ± 13.02 (standard deviation) years. The unadjusted (crude) model, model 1 (adjusted for age), model 2 (adjusted for age and sex), and model 3 (adjusted for age, sex, and tooth type) were established for the statistical analyses. In model 3 [odds ratio (OR) = 1.025; 95% confidence interval (CI) 1.002-1.050; P = 0.035], the difference in EPT values between RP and SIRP was statistically significant. However, the areas under the curve of predictive probability of the crude model, model 1, model 2, and model 3 were 0.565, 0.570, 0.585, and 0.617, respectively, showing that the model accuracy was low. The P-value for the trend in differences between the EPT values as a categorical variable showed that the differences in the EPT values, comparing RP and SIRP, were not statistically significant. CONCLUSIONS: Based on the present data, the difference in EPT values was not sufficient to differentiate RP from SIRP.

Comparison of indirect pulp treatment and iRoot BP Plus pulpotomy in primary teeth with extremely deep caries: a prospective randomized trial.

OBJECTIVES: The purpose of this randomized controlled trial was to compare the 24-month success rates of indirect pulp treatment (IPT) and iRoot BP Plus pulpotomy of primary molars with extremely deep caries. MATERIALS AND METHODS: Generally healthy children aged 3-7 years requiring general anesthesia for treating primary molars with extremely deep caries or reversible pulpitis were recruited. Patients with systemic disease, mental health problems, or manifestations of irreversible pulpitis were excluded. In total, 175 molars were randomized and blinded for either IPT (n = 87) or iRoot BP Plus pulpotomy (n = 88). All teeth were restored with stainless steel crowns and evaluated after 6, 12, 18, and 24 months by two blinded calibrated investigators. Kaplan-Meier survival curves were used to compare the survival rates between the groups. The correlations between success rate and patient characteristics were explored with the Cox proportional hazards model. RESULTS: A total of 168 primary molars in 67 patients (average age: 3.83 years) were evaluated. The cumulative survival probability at 24 months was not significantly different between the IPT (93.8%) and pulpotomy (97.7%) groups (P = 0.238). IPT treatment success was significantly associated with age (odds ratio = 2.347; 95% CI: 1.068-5.156; P = 0.034) and preoperative sensitivity (odds ratio = 9.742; 95% CI: 1.079-87.970; P = 0.043). CONCLUSIONS: The 24-month success rates of IPT and iRoot BP Plus pulpotomy performed in primary molars with extremely deep caries were not significantly different. Increasing age and preoperative sensitivity were found to be associated with the cumulative survival probability in IPT-treated primary molars with extremely deep caries. Primary teeth with extremely deep carious lesions without signs of irreversible pulpitis can be treated successfully by either indirect pulp capping or iRoot BP Plus pulpotomy. TRIAL REGISTRATION: ChiCTR2000032462.

Evaluation of 3 different treatment modalities for conservative management of attrited, sensitive molar teeth - A preliminary 12-week report.

Management of symptomatic attrited molar teeth presents various challenges. Aim of the study was to manage and evaluate the outcome of sensitive, attrited molar teeth using three different treatment options, including bioglass-containing desensitising toothpaste, Gluma desensitiser and coronal a pulpotomy using a calcium silicate-based product, Biodentine. A total of 61 attrited molar teeth, for which the patients had expressed tooth sensitivity, were included. Depending on the pulp status, treatment groups were allotted using block randomisation. Post-treatment sensitivity was assessed at 48 h, 4 and 12 weeks using 10-point visual analog scale (VAS) and Schiff Cold Air Sensitivity Scale (SCASS). Data were analysed using non-parametric statistical tests. Pulpotomies achieved significantly the least post-treatment sensitivity scores at all scheduled recalls. This interim 12-week report on management concludes that a pulpotomy, using Biodentine, was able to achieve significantly higher number of asymptomatic teeth when compared to other treatment choices.

Incidence of Pulpal Complications after Diagnosis of Vital Cracked Teeth.

INTRODUCTION: This retrospective cohort study aimed to observe the incidence of pulpitis and necrosis in teeth with cracks that were not endodontically treated. METHODS: One hundred eighty-four patients with 199 cracked teeth that were diagnosed with reversible pulpitis and were treated from January 2010 to December 2013 at National Dental Centre, Singapore, were recruited. Cracked teeth were identified by inspection, transillumination, and positive bite tests. A diagnosis of reversible pulpitis was made if the tooth had no history of spontaneous pain, was positive but non-lingering to cold, and there was an absence of any periapical pathosis. Upon diagnosis, orthodontic bands were cemented, and these teeth were referred for crowns. Patients were recalled back at least 3 years after diagnosis, except for those patients whose cracked teeth had undergone endodontic treatment or were extracted. RESULTS: Fifty-eight out of 199 (29.1%) teeth had pulpal complications. Thirty-eight of 58 (65.5%) were diagnosed as irreversible pulpitis after approximately 1.2 years (437 days), and 20 of 58 (34.5%) were diagnosed with necrotic pulp after approximately 2 years (755.5 days). The absence of a full-coverage crown increased the risks of pulp complications (odds ratio = 8.74, P = .000), and males had an increased incidence of pulp complications compared with females (odds ratio = 1.96, P = .056). CONCLUSIONS: Seventy-one percent (141/199) of cracked teeth with reversible pulpitis remained healthy after 3 years. It is essential to brace the cracked tooth to minimize cusp flexion and provide full coverage of the crack from the oral environment. When treated early, these teeth may still reasonably survive for at least 3 years.

Microbiome of Deep Dentinal Caries from Reversible Pulpitis to Irreversible Pulpitis.

INTRODUCTION: This study examined the identity of the microbiome of deep dentinal caries and its correlation with the inflammation status of caries-induced pulpitis. METHODS: Seventy-five cases were diagnosed based on the American Association of Endodontics's diagnostic criteria and divided into 4 groups: normal pulp with deep caries (NP; n = 13), reversible pulpitis with only cold-evoked pain (CRP; n = 17), reversible pulpitis with both cold/heat-evoked pain (CHRP; n = 24), and symptomatic irreversible pulpitis (SIP; n = 21). Samples were sequenced by 16S rDNA. Alpha and beta diversity were determined. Linear discriminant analysis effect size (LEfSe) analysis was used to detect intergroup differences, and receiver operating characteristic (ROC) curves were generated to assess the role of the caries microbiome in caries-induced pulpitis. RESULTS: The 16S rDNA sequencing yielded 9100 operational taxonomic units. Lactobacillus had the highest relative abundance at the genus level among the 4 groups. There were significant differences in the distribution of the microbiome among the groups. In an alpha diversity analysis, species richness differed between the CRP group and the other groups. In a beta diversity analysis, the distribution of microorganisms in the SIP group was significantly different from those in the other 3 groups. LEfSe analysis indicated substantial differences in the microbiome among the groups, and the areas under the ROC curves (AUC) were all high (AUC: 0.734-0.952). CONCLUSIONS: Characterization of the caries microbiome has the potential to become an auxiliary method for the diagnosis of pulpitis. This finding may prompt new research on diagnostic strategies for caries-induced pulpitis.

Vascularity and Angiogenic Signaling in the Dentine-Pulp Complex of Immature and Mature Permanent Teeth.

ABSTRACT. OBJECTIVE: This study aimed to examine the protein and gene expression of vascular endothelial growth factor (VEGF) and angiopoietins-1 and 2 in tissue from healthy and inflamed dental pulps. METHODS: Permanent teeth with pulps diagnosed as healthy or reversible pulpitis were used for immunohistochemistry (IHC) and gene expression experiments. For IHC, a whole pulp tissue was excavated from the pulp chamber, and it was formalin-fixed and processed for routine IHC with angiogenic markers anti-VEGF, anti-Ang1, and anti-Ang2. Staining was visualized with diaminobenzidine (DAB), and examined using light microscopy. The distribution of markers in healthy and inflamed pulps was qualitatively and quantitatively analyzed. Real-time quantitative polymerase chain reaction (RT qPCR) was used to ascertain the gene expression levels of ANGPT1, ANGPT2, and TEK in the presence of inflammation. Statistical analysis was performed using the Mann-Whitney test with the statistical significance level set at 0.05. RESULTS: There was increased protein and mRNA expression of VEGF and Ang-1 markers in inflamed pulp samples as compared with that in the healthy pulp tissue. IHC demonstrated intense expression of the VEGF protein on endothelial cells (EC) and some non-ECs, and there was significantly more staining on ECs associated with inflamed tissue (P<0.001). Ang-1 and Ang-2 were significantly expressed on ECs and non-ECs (P<0.05). RT qPCR did not show significant differences in gene expression between healthy and inflamed samples although similar trends were observed to IHC. CONCLUSION: The presence of Ang-1, Ang-2, VEGF, and TEK gene in healthy and mildly inflamed pulp tissue associated with reversible pulpitis indicates that these angiogenic factors may participate in physiological and pathological angiogenesis and healing. The inflammatory process may regulate Ang-1/Ang2/Tie2 signaling; and together with VEGF, these growth factors have an important role in modulating pulp angiogenesis.

Evaluation of the efficacy of calcium silicate vs. glass ionomer cement indirect pulp capping and restoration assessment criteria: a randomised controlled clinical trial-2-year results.

OBJECTIVES: Assess calcium silicate cement (Biodentine™) vs. glass ionomer cement (Fuji IX™, control) as indirect pulp capping (IPC) materials in patients with reversible pulpitis after a 2-year follow-up. Evaluate the integrity of the overlying resin composite restorations using modified USPHS criteria and FDI criteria. Investigate the sensitivity of the modified USPHS criteria compared to the FDI criteria in the assessment of the restorations. MATERIALS AND METHODS: Seventy-two restorations (36 Biodentine™, 36 Fuji IX™) were placed randomly in 53 patients. Periapical radiographs were taken at pre-treatment (T0), 12-month (T12), and 24-month (T24) review. Restorations were assessed using the modified USPHS and FDI criteria at T12 and T24. RESULTS: At 24 months, 15 teeth had failed to maintain vitality (6 Biodentine™, 9 Fuji IX™). Clinical success rate of IPC for both materials was 72% and is related to the intensity of reversible pulpitis symptoms. No difference was found between T12 and T24 in the periapical (PA) radiographs and in the integrity of the resin composite restorations overlying Biodentine™ compared to Fuji IX™. There was no difference in the efficacy of the USPHS criteria compared to the FDI criteria in the assessment of the resin composite restorations. CONCLUSIONS: Biodentine™ and Fuji IX™ were clinically effective when used as IPC materials in teeth with reversible pulpitis at T24. Resin composite restorations overlying both materials performed well at T24. Using the USPHS or FDI criteria is equally efficient at T24; however, longer term follow-up is needed to establish whether there are sensitivity differences between these assessment criteria. CLINICAL SIGNIFICANCE: Teeth with deep carious lesions approaching the pulp and with signs of reversible pulpitis can be treated successfully by indirect pulp capping using either Biodentine™ or Fuji IX™. Using the USPHS or FDI criteria to assess restorations is equally effective at 2 years. TRIAL REGISTRATION: NCT02201641.

Factores de riesgo de urgencias por caries dental en pacientes de Rafael Freyre / Urgency Risk Factors by Dental Caries in Patients of Rafael Freyre

Introducción: la caries dental es el padecimiento infeccioso multifactorial más prevalente de la cavidad oral. Objetivo: caracterizar los pacientes afectados por caries dental y determinar comportamiento de algunos de sus factores de riesgo en las urgencias. Método: se realizó estudio transversal, en población mayor de 19 años, que acudieron al Policlínico con Servicios de Hospitalización Mario Muñoz del municipio Rafael Freyre, de abril a septiembre de 2012. El universo de estudio estuvo constituido por 247 pacientes que acudieron a consulta con urgencias estomatológicas y la muestra quedó constituida por 235 pacientes. Resultados: el grupo de edad más afectado por las urgencias por caries dental fue el de 35-59 años con 51,5% y el sexo femenino el más representativo con el 64,7%. El nivel de escolaridad que prevaleció fue preuniversitario terminado (43,0%). La enfermedad más prevalente fue la pulpitis reversible con 80,0%. Se determinó comportamiento de algunos factores de riesgo de urgencias por caries: experiencia anterior de caries, deficiente higiene bucal y dieta cariogénica fueron los más frecuentes en las féminas con 64,7%; 65,0% y 73,1%, respectivamente. Conclusiones: la mayoría de los pacientes con urgencias por caries dental se encontraron en el grupo de 35-59 años, sobre todo en sexo femenino. La pulpitis reversible fue la urgencia por caries dental más frecuente. Se observó amplia prevalencia de algunos factores de riesgo de la caries dental.

Introduction: dental caries is the most prevalent infectious multifactorial disease of the oral cavity. Objective: to characterize the patients affected by dental caries and to determine some of the risk factors present in emergency cases. Method: cross-sectional study was conducted in people over 19, who came to the polyclinic to hospital Mario Muñoz municipality Rafael Freyre, from April to September 2012. The study group consisted of 247 patients with Stomatology emergence and the sample was composed of 235 patients. Results: the most affected age group of patients by dental caries was the one from 35-59 years a (51.5%) and females were affected in a 64.7%, the prevailing educational level was high school graduates (43.0%). The most common disease was reversible pulpitis with an 80.0 %. Some of the risk factors include: former history of cavities, inadequate dental hygiene and improper diets. They were more frequent in females with 64.7%, 65.0% and 73.1% respectively. Conclusions: the mayority of the patients suffering from dental caries was between 35-59 years of age, mainly from female sex. The most frequent emergency cases were related to reversible pulpitis. High risk factors were noticed on dental caries.