Understanding dental pulp inflammation: from signaling to structure.

The pulp is a unique tissue within each tooth that is susceptible to painful inflammation, known as pulpitis, triggered by microbial invasion from carious lesions or trauma that affect many individuals. The host response involves complex immunological processes for pathogen defense and dentin apposition at the site of infection. The interplay of signaling between the immune and non-immune cells via cytokines, chemokines, neuropeptides, proteases, and reactive nitrogen and oxygen species leads to tissue reactions and structural changes in the pulp that escalate beyond a certain threshold to irreversible tissue damage.

In-vitro-cytotoxicity of self-adhesive dental restorative materials.

Objectives: Although the introduction of self-adhesive composites in restorative dentistry is very promising, the innovation of new materials also presents challenges and unknowns. Therefore, the aim of this study was to investigate the cytotoxicity of four different self-adhesive composites (SAC) in vitro and to compare them with resin-modified glass ionomer cements (RM-GIC), a more established group of materials.

Methods: Samples of the following materials were prepared according to ISO 7405/10993-12 and eluted in cell culture medium for 24 h at 37 °C: Vertise Flow, Fusio Liquid Dentin, Constic, Surefil One, Photac Fil and Fuji II LC.

An in vitro coculture approach to study the interplay between dental pulp cells and Streptococcus mutans.

Aim: To develop a new coculture system that allows exposure of dental pulp cells (DPCs) to Streptococcus mutans and dentine matrix proteins (eDMP) to study cellular interactions in dentine caries.

Methodology: Dental pulp cells and S. mutans were cocultured with or without eDMP for 72 h.

Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline.

Background: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease.

Aim: To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss.

Engineering the Future of Dental Health: Exploring Molecular Advancements in Dental Pulp Regeneration.

Protected by the surrounding mineralized barriers of enamel, dentin, and cementum, dental pulp is a functionally versatile tissue that fulfills multiple roles [...

External Inflammatory Root Resorption in Traumatized Immature Incisors: MTA Plug or Revitalization? A Case Series.

Introduction: External inflammatory root resorption (EIRR) in immature permanent teeth is a common complication after severe dental trauma. The management of this condition requires thorough disinfection of the root canal in order to arrest the resorptive process. However, current guidelines regarding the recommended treatment of EIRR following traumatic dental injuries vary, mainly in regard to the type of intracanal medication and its retention time in the root canal system.

Endodontic Tissue Regeneration: A Review for Tissue Engineers and Dentists.

The paradigm shift in the endodontic field from replacement toward regenerative therapies has witnessed the ever-growing research in tissue engineering and regenerative medicine targeting pulp-dentin complex in the past few years. Abundant literature on the subject that has been produced, however, is scattered over diverse areas of knowledge. Moreover, the terminology and concepts are not always consensual, reflecting the range of research fields addressing this subject, from endodontics to biology, genetics, and engineering, among others.

MicroRNAs-mediated regulation of the differentiation of dental pulp-derived mesenchymal stem cells: a systematic review and bioinformatic analysis.

Background: Human dental pulp-derived mesenchymal stem cells (hDP-MSCs), which include human dental pulp stem cells (hDPSCs) and stem cells from human exfoliated deciduous teeth (SHEDs), are promising cell sources for regenerative therapies. Nevertheless, a lack of knowledge relating to the mechanisms regulating their differentiation has limited their clinical application. microRNAs (miRNAs) are important regulatory molecules in cellular processes including cell differentiation.

Impact of Endodontic Irrigant Activation on Smear Layer Removal and Surface Disintegration of Root Canal Dentine In Vitro.

The objective of this study was to compare the ability of different endodontic irrigation activation methods to enable irrigant penetration, remove the smear layer from root canal walls after preparation, and investigate surface effects on dentine. Root canals of 90 single-rooted teeth were prepared and irrigated with EDTA (17%) and sodium hypochlorite (5%), where both irrigants or sodium hypochlorite only were activated as follows: conventional needle irrigation, ultrasonic activation, sonic activation (EDDY), or laser-based activation (photon-induced photoacoustic streaming/PIPS). For the evaluation of irrigant penetration into dentinal tubules, methylene blue was injected and activated as well.

A Compilation of Study Models for Dental Pulp Regeneration.

Efforts to heal damaged pulp tissue through tissue engineering have produced positive results in pilot trials. However, the differentiation between real regeneration and mere repair is not possible through clinical measures. Therefore, preclinical study models are still of great importance, both to gain insights into treatment outcomes on tissue and cell levels and to develop further concepts for dental pulp regeneration.

Advances in scaffolds used for pulp-dentine complex tissue engineering: A narrative review.

Background: Pulp-dentine complex regeneration via tissue engineering is a developing treatment modality that aims to replace necrotic pulps with newly formed healthy tissue inside the root canal. Designing and fabricating an appropriate scaffold is a crucial step in such a treatment.

Objectives: The present study aimed to review recent advances in the design and fabrication of scaffolds for de novo regeneration of pulp-dentine complexes via tissue engineering approaches.

Impact of access cavity cleaning on the seal of postendodontic composite restorations in vitro.

Aim: The aim of the study was to investigate the influence of cavity cleaning and conditioning on marginal integrity of directly placed post-endodontic composite class-I-restorations in vitro.

Methodology: A total of 168 fully intact teeth without caries or fillings received pre-endodontic composite restorations (class-II) after their extraction. Occlusal endodontic access-cavities were prepared, and root canals were instrumented and filled with gutta-percha and an epoxy resin-based sealer.

Fourteen years clinical evaluation of leucite-reinforced ceramic inlays luted using two different adhesion strategies.

Objectives: Aim of the present prospective study was to clinically evaluate the long-term performance of two different luting-materials for leucite-reinforced glass-ceramic inlays/onlays after 14 years.

Methods: A total of 83 IPS-Empress-inlays/onlays were placed in 30 patients. Restorations were luted according to two different strategies: 43 restorations were fixed with a self-adhesive resin-cement (RelyXUnicem, RX), 40 restorations were inserted with VariolinkII-low (SV) after pretreatment with an etch-and-rinse multi-step adhesive.

A critical analysis of clinical research methods to study regenerative endodontics.

Regenerative endodontic treatment such as revitalization provides a treatment option for immature teeth with pulp necrosis. The main difference to the alternative procedure, the apical plug, is the induction of a blood clot inside the canal as a scaffold for healing and new tissue formation. Due to the biology-based and minimally-invasive nature of the treatment, revitalization has raised considerable interest in recent years.

Molecular Biological Comparison of Dental Pulp- and Apical Papilla-Derived Stem Cells.

Both the dental pulp and the apical papilla represent a promising source of mesenchymal stem cells for regenerative endodontic protocols. The aim of this study was to outline molecular biological conformities and differences between dental pulp stem cells (DPSC) and stem cells from the apical papilla (SCAP). Thus, cells were isolated from the pulp and the apical papilla of an extracted molar and analyzed for mesenchymal stem cell markers as well as multi-lineage differentiation.

Isolation of Endogenous TGF-β1 from Root Canals for Pulp Tissue Engineering: A Translational Study.

Cell homing for dental pulp tissue engineering has been advocated as a feasible approach to regenerate dental pulp in a clinical setting. In order to develop a translational protocol for clinical application, we wanted to determine the effects of disinfectants on the availability of growth factors from the root canal, the amount that can be obtained in this context, and whether they can be processed for use in tissue engineering procedures. The extraction of growth factors should also be confirmed in a clinical setting.

Biology of selective caries removal: a systematic scoping review protocol.

Introduction: Primary goal of restorative caries therapy is to preserve pulp vitality and the dentition. Whereas the conventional approach of complete caries removal aims at the elimination of all affected substances without regard to losses of hard tissue or pulp vitality, the innovative concept of selective caries removal (SCR) is characterised by a targeted and non-invasive excavation. It presents a lower risk of accidental pulp exposure, which reportedly has a positive effect on tooth survival.

The colocalizations of pulp neural stem cells markers with dentin matrix protein-1, dentin sialoprotein and dentin phosphoprotein in human denticle (pulp stone) lining cells.

Background: The primary dentin, secondary dentin, and reactive tertiary dentin are formed by terminal differentiated odontoblasts, whereas atubular reparative tertiary dentin is formed by odontoblast-like cells. Odontoblast-like cells differentiate from pulpal stem cells, which express the neural stem cell markers nestin, S100β, Sox10, and P0. The denticle (pulp stone) is an unique mineralized extracellular matrix that frequently occurs in association with the neurovascular structures in the dental pulp.

Pathophysiological mechanisms of root resorption after dental trauma: a systematic scoping review.

Background: The objective of this scoping review was to systematically explore the current knowledge of cellular and molecular processes that drive and control trauma-associated root resorption, to identify research gaps and to provide a basis for improved prevention and therapy.

Methods: Four major bibliographic databases were searched according to the research question up to February 2021 and supplemented manually. Reports on physiologic, histologic, anatomic and clinical aspects of root resorption following dental trauma were included.

Inflammatory Response Mechanisms of the Dentine-Pulp Complex and the Periapical Tissues.

The macroscopic and microscopic anatomy of the oral cavity is complex and unique in the human body. Soft-tissue structures are in close interaction with mineralized bone, but also dentine, cementum and enamel of our teeth. These are exposed to intense mechanical and chemical stress as well as to dense microbiologic colonization.

Clinical Perspectives of Pulp Regeneration.

Introduction: A sound and vital pulp is an essential prerequisite for long-term tooth survival and preservation. However, current endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by a synthetic biomaterial. Recently, total or partial pulp regeneration has been proposed as an alternative treatment concept.

Cell-Free Approaches for Dental Pulp Tissue Engineering.

In past years, both cell transplantation and cell homing have been explored for dental pulp tissue engineering. Sufficient evidence shows that after cell transplantation, the regeneration of a functional dentin-pulp complex is possible. A new milestone was reached recently.

Shotgun Proteomics of Human Dentin with Different Prefractionation Methods.

Human dentin is not only a composite material of a collagenous matrix and mineral to provide strength and elasticity to teeth, but also a precious reservoir full of bioactive proteins. They are released after demineralization caused by bacterial acids in carious lesions, by decalcifying irrigants or dental materials and they modulate tissue responses in the underlying dental pulp. This work describes a first-time analysis of the proteome of human dentin using a shotgun proteomic approach that combines three different protein fractionation methods.

Isolation of primary odontoblasts: Expectations and limitations.

The purpose of this study was to evaluate different protocols of enzymatic treatment (collagenase with either protease, trypsin or hyaluronidase) to isolate mature odontoblasts. Primary odontoblasts were obtained from human molars, which was confirmed by histology and scanning electron microscopy. The combination of collagenase with protease appeared most suitable and resulted in higher cell numbers and better integrity of the odontoblast processes, whereas combination with hyaluronidase or trypsin led to truncated processes and detachment of cell patches instead of single cells.