Adrenaline in pulp capping treatment of reversible pulpitis

BACKGROUND The role of epinephrine in the treatment of pulp capping in patients with reversible pulpitis is not clear.AIM To explore the role of epinephrine in the treatment of pulp capping in patients with reversible pulpitis.METHODS A total of 100 patients with reversible pulpitis who were treated in Anhui Jieshou People's Hospital from January 2020 to December 2021 were included in the study.They were categorized into an observation group(n=50;treatment with adrenaline)and a control group(n=50;treatment with zinc oxide eugenol paste).The 24-h postoperative pain,regression time of gingival congestion and redness,clinical efficacy,and incidence of adverse reactions were compared between the groups.Patients were further categorized into the ineffective and effective treatment groups based on clinical efficacy.Logistic multiple regression analysis explored factors affecting the efficacy of pulp capping treatment.RESULTS A significant difference in 24-h postoperative pain was observed between the groups(P<0.05),with a higher proportion of grade I pain noted in the observation group than in the control group(P<0.01).The regression time of gingival congestion and swelling was lower in the observation group(2.61±1.44 d and 2.73±1.36 d,respectively)than in the control group(3.85±1.47 d and 4.28±1.61 d,respectively)(P<0.05).The 2-wk postoperative total effective rate was lower in the control group(80.00%)than in the observation group(94.00%)(P<0.05).The incidence of adverse reactions was not significantly different between the control(14.00%)and observation(12.00%)groups(P>0.05).The proportion of adrenaline usage was lower(P<0.05)and that of anaerobic digestion by Streptococcus and Fusobacterium nucleatum was higher in the ineffective treatment group than in the effective treatment group(P<0.05).Logistic multiple regression analysis revealed adrenaline as a protective factor(P<0.05)and anaerobic digestion by Streptococcus and F.nucleatum as risk factors for pulp capping in reversible pulpitis(P<0.05).CONCLUSION Adrenaline demonstrated therapeutic efficacy in pulp capping treatment for reversible pulpitis,reducing pain and improving clinical symptoms safely.It is a protective factor for pulp capping,whereas Streptococcus and F.nucleatum are risk factors.Targeted measures can be implemented to improve clinical efficacy.

Histochemical Observation of Nitric Oxide Synthase in Trigeminal Ganglion of Rats with Experimental Pulpitis

Summary: In order to understand the roles of nitric oxide (NO) in pulpalgia and pulpitis, the histochemistry of nitric oxide synthase (NOS) in the neurons of trigeminal ganglion in experimental pulpitis rat and human inflammatory dental pulp tissues were histochemically studied by NADPH diaphorase (NADPH D) techniques. Results showed that NADPH D positive neurons were scattered in rat trigeminal ganglions, but the sizes of positive neurons were not changed. None of NOS positive fibers was found in human normal and inflammatory dental pulp tissues. The results suggested that NOS in trigeminal ganglion might play an important role in sensory transmission and regulation of pulpalgia. The absence of NOS positive nerves in human pulp suggested that NO may not be related to inflammatory stimulation and transmission in dental pulp tissues.

Effectiveness and Safety of Computer-controlled Periodontal Ligament Injection System in Endodontic Access to the Mandibular Posterior Teeth

Objective To evaluate the effectiveness and safety of a computer-controlled periodontal ligament （PDL） injection system to the local soft tissues as the primary technique in endodontic access to mandibular posterior teeth in patients with irreversible pulpitis. Methods A total of 162 Chinese patients who had been diagnosed with irreversible pulpitis in their mandibular posterior teeth without acute infection or inflammation in the periodontal tissues were enrolled in this clinical study. The patients were divided into 3 groups according to the position of the involved tooth： the premolar group （PM, z2=38）, first molar group （FM, n=66）, and second molar group （SM, n=58）. All the patients received computer-controlled PDL injection with 4% articaine and 1 ＇ 100 000 epinephrine. Immediately after the injection, endodontic access was performed, and the degree of pain during the treatment was evaluated by the patients using Visual Analogue Scale for pain. The success rates were compared among the 3 groups. The responses of local soft tissues were evaluated 3-8 days and 3 weeks after the procedure. Results The overall success rate was 76.5%. There was a significant difference in success rates among the PM, FM, and SM groups （92.1%, 53.0%, 93.1%, respectively; 2 X =34.3, P〈0.01）. Both the PM and SM groups showed higher success rates than that of the FM group （v=l, f=16.73, P〈0.01, v=l, Z = 4.5, X2 2 P〈0.01）. No irreversible adverse effects on the periodontal soft tissues at the injection sites were observed in the follow-up visits in any of the groups. Conclusion The computer-controlled PDL injection system demonstrates both satisfactory anesthetic effects and safety in local soft tissues as primary anesthetic technique in endodontic access to the mandibular posterior teeth in patients with irreversible pulpitis.

Endodontic treatment of the maxillary first molar with palatal canal variations: A case report and review of literature

BACKGROUND Root canal variations frequently occur in maxillary first molars,which greatly affects the success of its treatment.The second mesiobuccal(MB)root canal is the most common root canal variation.However,only a few studies have been conducted on palatal root canal variations.Herein,we report the presence of two separate root canals in a palatal root of the maxillary first molar.CASE SUMMARY A 39-year-old woman complained of pain in the maxillary right region for 1 year,which recently worsened.Clinical examination revealed a poorly restored right maxillary first molar and caries detected at the filling marginal.Cold and heat test results indicated severe pain in the right maxillary first molar.The patient was diagnosed with irreversible pulpitis,and subsequently,root canal treatment(RCT)was performed.In total,five root canals were found in the maxillary first molar,including two separate root canals in the palatal root.RCT was successfully performed using an endodontic microscope and cone-beam computed tomography(CBCT).The CBCT image revealed a vertucci type I canal morphology in the distobuccal root,while the MB and palatal root canals were typeⅣ.At the 1-mo follow-up,the maxillary first molar was completely asy-mptomatic,and the X-ray results indicated a successful RCT.Finally,the ceramic crown restoration was performed.CONCLUSION An endodontic microscope and CBCT are useful in effectively identifying and treating root canal variations.

A ROS-responsive hydrogel incorporated with dental follicle stem cell-derived small extracellular vesicles promotes dental pulp repair by ameliorating oxidative stress

Pulpitis,an inflammatory disease of dental pulp tissues,ultimately results in the loss of pulp defense properties.Existing clinical modalities cannot effectively promote inflamed pulp repair.Oxidative stress is a major obstacle inhibiting pulp repair.Due to their powerful antioxidative capacity,mesenchymal stem cell-derived small extracellular vesicles(MSC-sEVs)exhibit potential for treating oxidative stress-related disorders.However,whether MSC-sEVs shield dental pulp tissues from oxidative damage is largely unknown.Here,we showed that dental follicle stem cell-derived sEVs(DFSC-sEVs)have antioxidative and prohealing effects on a rat LPS-induced pulpitis model by enhancing the survival,proliferation and odontogenesis of H_(2)O_(2)-injured dental pulp stem cells(DPSCs).Additionally,DFSC-sEVs restored the oxidative/antioxidative balance in DPSC mitochondria and had comparable effects on ameliorating mitochondrial dysfunction with the mitochondrion-targeted antioxidant Mito-Tempo.To improve the efficacy of DFSC-sEVs,we fabricated an intelligent and injectable hydrogel to release DFSC-sEVs by combining sodium alginate(SA)and the ROS sensor RhB-AC.The newly formed SA-RhB hydrogel efficiently encapsulates DFSC-sEVs and exhibits controlled release of DFSC-sEVs in a HClO/ClO^(-)concentration-dependent manner,providing a synergistic antioxidant effect with DFSC-sEVs.These results suggest that DFSC-sEVs-loaded SA-RhB is a promising minimally invasive treatment for pulpitis by enhancing tissue repair in the pulp wound microenvironment.