Expert consensus on endodontic therapy for patients withsystemic conditions

The overall health condition of patients significantly affects the diagnosis, treatment, and prognosis of endodontic diseases. Asystemic consideration of the patient’s overall health along with oral conditions holds the utmost importance in determining thenecessity and feasibility of endodontic therapy, as well as selecting appropriate therapeutic approaches. This expert consensus is acollaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence,aiming to provide general guidance on clinical procedures, improve patient safety and enhance clinical outcomes of endodontictherapy in patients with compromised overall health.

Expert consensus on difficulty assessment of endodontic therapy

Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system’s anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.

Dental remineralization via poly(amido amine) and restorative materials containing calcium phosphate nanoparticles

Tooth decay is prevalent,and secondary caries causes restoration failures,both of which are related to demineralization.There is an urgent need to develop new therapeutic materials with remineralization functions.This article represents the first review on the cutting edge research of poly(amido amine)(PAMAM) in combination with nanoparticles of amorphous calcium phosphate (NACP).PAMAM was excellent nucleation template,and could absorb calcium (Ca) and phosphate (P) ions via its functional groups to activate remineralization.NACP composite and adhesive showed acid-neutralization and Ca and P ion release capabilities.PAMAM +NACP together showed synergistic effects and produced triple benefits: excellent nucleation templates,superior acidneutralization,and ions release.Therefore,the PAMAM+NACP strategy possessed much greater remineralization capacity than using PAMAM or NACP alone.PAMAM+NACP achieved dentin remineralization even in an acidic solution without any initial Ca and P ions.Besides,the long-term remineralization capability of PAMAM+NACP was established.After prolonged fluid challenge,the immersed PAMAM with the recharged NACP still induced effective dentin mineral regeneration.Furthermore,the hardness of predemineralized dentin was increased back to that of healthy dentin,indicating a complete remineralization.Therefore,the novel PAMAM+NACP approach is promising to provide long-term therapeutic effects including tooth remineralization,hardness increase,and caries-inhibition capabilities.

Two-in-one strategy:a remineralizing and anti-adhesive coating against demineralized enamel

Tooth enamel is prone to be attacked by injurious factors,leading to a de/remineralization imbalance.To repair demineralized enamel and prevent pulp inflammation caused by biofilm accumulation,measures are needed to promote remineralization and inhibit bacterial adhesion on the tooth surface.An innovative material,poly(aspartic acid)-polyethylene glycol(PASP-PEG),was designed and synthesized to construct a mineralizing and anti-adhesive surface that could be applied to repair demineralized enamel.A cytotoxicity assay revealed the low cytotoxicity of synthesized PASP-PEG.Adsorption results demonstrated that PASPPEG possesses a high binding affinity to the hydroxyapatite(HA)/tooth surface.In vitro experiments and scanning electron microscopy(SEM)demonstrated a strong capacity of PASP-PEG to induce in situ remineralization and direct the oriented growth of apatite nanocrystals.Energy dispersive X-ray spectroscopy(EDS),X-ray diffraction analysis(XRD)and Vickers hardness tests demonstrated that minerals induced by PASP-PEG were consistent with healthy enamel in Ca/P ratio,crystal form and surface micro-hardness.Contact angle tests and bacterial adhesion experiments demonstrated that PASP-PEG yielded a strong antiadhesive effect.In summary,PASP-PEG could achieve dual effects for enamel repair and anti-adhesion of bacteria,thereby widening its application in enamel repair.

Experts consensus on the procedure of dental operative microscope in endodontics and operative dentistry

The dental operative microscope has been widely employed in the field of dentistry,particularly in endodontics and operative dentistry,resulting in significant advancements in the effectiveness of root canal therapy,endodontic surgery,and dental restoration.However,the improper use of this microscope continues to be common in clinical settings,primarily due to operators’insufficient understanding and proficiency in both the features and established operating procedures of this equipment.In October 2019,Professor Jingping Liang,Vice Chairman of the Society of Cariology and Endodontology,Chinese Stomatological Association,organized a consensus meeting with Chinese experts in endodontics and operative dentistry.The objective of this meeting was to establish a standard operation procedure for the dental operative microscope.Subsequently,a consensus was reached and officially issued.Over the span of about four years,the content of this consensus has been further developed and improved through practical experience.

Identification and expression analysis of chlorogenic acid biosynthesis key gene PpHCT in peach

Shikimic acid/quinic acid hydroxy cinnamyl transferase(HCT)is one of the key enzymes in the phenylpropanoid pathway.However,the role of the HCT gene in chlorogenic acid(CGA)biosynthesis in peach fruit remains unclear.For this,we identified the accumulation pattern of CGA in four peach cultivars,cloned and characterized 11 PpHCT gene members,and further analyzed the expression patterns of these PpHCT genes during fruit development.The contents of CGAs in the four peach cultivars all exhibited a trend of increasing and then decreasing during the fruit growth and development.Moreover,the contents of CGAs in the peel and flesh were tissue-specific.Gene structure analysis indicated that the PpHCT genes were highly conserved,containing two exons and one intron.The protein structure analysis demonstrated that the PpHCT proteins contained two conserved motifs(HXXXD,DFGWG)and a transferase domain(PF02458),which belonged to the BAHD acyltransferase family.The cis-acting element analysis suggested that the promoters of PpHCT genes contained many light-related,hormone-related,stress-related,tissue-specific,and circadian-related elements,and they could participate in a variety of biological processes.Phylogenetic analysis showed that the HCT proteins of peach were closely related to the HCT proteins of plum and had a close evolutionary relationship.The qRT-PCR analysis indicated that the expression levels of PpHCT1 and PpHCT2 showed an opposite trend to the accumulation of CGA,whereas the expression levels of PpHCT4,PpHCT5,PpHCT7,PpHCT8,and PpHCT11 demonstrated the same trend as CGA accumulation.It was worth noting that only PpHCT4 and PpHCT5 were highly expressed in the two high-CGA cultivars but showed low levels of expression in the two low-CGA cultivars.Therefore,it was hypothesized that these two genes might be key genes to the synthesis of CGA in peach fruit.Those findings provide a theoretical basis for further study on the biological functions of the HCT gene and help to reveal the molecular mechanism of CGA.

The Oral Microbiome Bank of China

The human microbiome project（HMP） promoted further understanding of human oral microbes. However, research on the human oral microbiota has not made as much progress as research on the gut microbiota. Currently, the causal relationship between the oral microbiota and oral diseases remains unclear, and little is known about the link between the oral microbiota and human systemic diseases. To further understand the contribution of the oral microbiota in oral diseases and systemic diseases, a Human Oral Microbiome Database（HOMD） was established in the US. The HOMD includes 619 taxa in 13 phyla, and most of the microorganisms are from American populations. Due to individual differences in the microbiome, the HOMD does not reflect the Chinese oral microbial status. Herein, we established a new oral microbiome database—the Oral Microbiome Bank of China（OMBC,http：//www.sklod.org/ombc）. Currently, the OMBC includes information on 289 bacterial strains and 720 clinical samples from the Chinese population, along with lab and clinical information. The OMBC is the first curated description of a Chinese-associated microbiome; it provides tools for use in investigating the role of the oral microbiome in health and diseases, and will give the community abundant data and strain information for future oral microbial studies.

Oral health in China: from vision to action

Chinese president Xi Jinping made clear at the National Health and Wellness Conference that health is the prerequisite for people’s all-around development and a precondition for the sustainable development of China. Oral health is an indispensable component of overall health in humans. However, the long neglect of oral health in overall health agendas has made oral diseases an increasing concern. With this perspective, we described the global challenges of oral diseases, with an emphasis on the challenges faced by China. We also described and analyzed the recently released health policies of the Chinese government, which aim to guide midterm and long-term oral health promotion in China. More importantly, we called for specific actions to fulfill the larger goal of oral health for the nation. The implementation of primordial prevention efforts against oral diseases, the integration of oral health into the promotion of overall health, and the management of oral diseases in conjunction with other chronic non-communicable diseases with shared risk factors were highly recommended. In addition, we suggested the reform of standard clinical residency training, the development of domestic manufacturing of dental equipment and materials, the revitalization traditional Chinese medicine for the prevention and treatment of oral diseases, and integration of oral health promotion into the Belt and Road Initiative. We look forward to seeing a joint effort from all aspects of the society to fulfill the goal of Healthy China 2030 and ensure the oral health of the nation.

Fibroblast membrane-camouflaged nanoparticles for inflammation treatment in the early stage

Unrestrained inflammation is harmful to tissue repair and regeneration.Immune cell membrane-camouflaged nanoparticles have been proven to show promise as inflammation targets and multitargeted inflammation controls in the treatment of severe inflammation.Prevention and early intervention of inflammation can reduce the risk of irreversible tissue damage and loss of function,but no cell membrane-camouflaged nanotechnology has been reported to achieve stage-specific treatment in these conditions.In this study,we investigated the prophylactic and therapeutic efficacy of fibroblast membrane-camouflaged nanoparticles for topical treatment of early inflammation(early pulpitis as the model)with the help of in-depth bioinformatics and molecular biology investigations in vitro and in vivo.Nanoparticles have been proven to act as sentinels to detect and competitively neutralize invasive Escherichia coli lipopolysaccharide(E.coli LPS)with resident fibroblasts to effectively inhibit the activation of intricate signaling pathways.Moreover,nanoparticles can alleviate the secretion of multiple inflammatory cytokines to achieve multitargeted anti-inflammatory effects,attenuating inflammatory conditions in the early stage.Our work verified the feasibility of fibroblast membrane-camouflaged nanoparticles for inflammation treatment in the early stage,which widens the potential cell types for inflammation regulation.