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.

The inflammatory response of the pulp after direct capping with platelet-rich plasma and enamel matrix derivative:A controlled animal study

Aims: To evaluate the inflammatory response of the exposed pulp of incisor teeth in rats after direct pulp capping, using platelet rich plasma (PRP), enamel matrix derivate (EMD), mineral trioxide aggregate (MTA) and calcium hydroxide (Ca(OH)2). Methods: The study was conducted on 36 Wistar albino rats with a total of 144 incisor teeth. The pulps of 96 teeth of the rats were perforated and capped with different agents. Serving as the positive control group, the pulps of 24 teeth were only perforated and capped without capping agents, whereas the pulps of 24 teeth were used as the negative control group without being perforated (without any process). The research was ended with the extracting of the teeth on the 7th day-28th day. The teeth were taken to the routine and histological follows;cross sections were prepared and painted with hematoxylen & eosin. All of the sections were evaluated in terms of inflammatory reaction by histologic analysis taken by light microscope. Statistical analysis was used. The normal distribution of all data was tested with the Mann Whitney U and the differences between the groups were analyze dusing Kruskal Wallis test at 0.05 level. Results: There are no statistically significant differences in terms of inflammation type and necrosis among the treatment groups on 7 days’ post capping. However, improved inflammatory cell accumulation, hyperemia and lowest necrosis were observed from the samples treated with PRP (p < 0.05). Conversely, the EMD group indicated that the criteria of inflammation scores and hyper- emia were higher in the 28th day (p < 0.05). Conclusions: Most of cells accumulating in the PRP group and most necrosis were seen in the EMD group. These new PRP materials might serve as pulp capping biomaterials to induce initial healing response in the future.

Self-etching adhesives:possible new pulp capping agents to vital pulp therapy

Pulp capping is one of the solving for keeping vital pulp in the case of dentin caries,reversible pulpitis or traumatic pulp exposure.The presence of bacteria on the cavity walls or in the pulp was the major factor that leads to the failure of pulp capping.Traditional pulp capping agent,calcium hydroxide,may not prevent microleakage.Selfetching system is a newly developed adhesive system,which could provide less microleakage and would not break down or dissolve,preventing the oral fluids and bacteria from the pulp along the cavity wall.This may reduce such clinical problems as postoperative sensitivity,secondary caries and marginal discoloration.Researches showed that some kinds of self-etching adhesives induced the mild to moderate inflammatory pulp response,with negative bacterial staining.Inclusion of antibacterial components into self-etching system,such as 12-methacryloyloxydodecylpyridinium bromide(MDPB)may inhibit bacteria and provide better clinical effects.It is speculated that using the self-etching adhesive system containing the antibacterial agent,such as MDPB,to the dental pulp directly or indirectly,may inhibit bacteria after the placement of restoration as well as residual bacteria in the cavity.

Electrospinning of a sandwich-structured membrane with sustained release capability and long-term anti-inflammatory effects for dental pulp regeneration

Current electro spun membranes used for pulp capping still lack the sustained-release capability and long-term anti-inflammatory effects that are favorable for dental pulp regeneration.In this work,a single-layered poly(lac tic acid)(PLA)electro spun membrane loaded with amorphous calcium phosphate(ACP)and aspirin(PLA/ACP/Aspirin membrane,i.e.,PA A membrane)is sandwiched between two poly(lactic-co-glycolic acid)(PLGA)electro spun membranes as a novel sandwich-structured PLGA and PA A composite electro spun membrane(PLGA-PAA membrane)to resolve the need for sustained-release design and anti-inflammatory effects.Contact angle measurements indicate that the PLGA-PAA membrane is more hydrophilic than the PAA membrane.An in vitro release study reveals that PLGA membranes coated on PAA membrane could slightly slow down ion release,while signiificantly prolonging aspirin release.We also co-cultured membranes with dental pulp stem cells(DPSCs)and human monocytic THP-1 cells to evaluate their osteogenic ability and anti-inflammatory effects,respectively.Compared with the PAA membrane,the PLGA-PAA membrane promotes cell adhesion,proliferation,and osteogenic differentiation.A prolonged anti-inflammatory effect of up to 18 days is also observed in the PLGA-PAA group.The results suggest a promising strategy for fabricating an electro spun membrane system with controlled release capabilities and long-term anti-inflammatory effects for use as pulp-capping material for regeneration of the dentin-pulp complex.

Epigenetic therapeutics in dental pulp treatment: Hopes, challenges and concerns for the development of next-generation biomaterials

This opinion-led review paper highlights the need for novel translational research in vital-pulp-treatment(VPT),but also discusses the challenges in translating evidence to clinics.Traditional dentistry is expensive,invasive and relies on an outmoded mechanical understanding of dental disease,rather than employing a biological perspective that harnesses cell activity and the regenerative-capacity.Recent research has focussed on developing minimally-invasive biologically-based‘fillings’that preserve the dental pulp;research that is shifting the paradigm from expensive high-technology dentistry,with high failure rates,to smart restorations targeted at biological processes.Current VPTs promote repair by recruiting odontoblast-like cells in a material-dependent process.Therefore,exciting opportunities exist for development of next-generation biomaterials targeted at regenerative processes in the dentin-pulp complex.This article analyses recent research using pharmacological-inhibitors to therapeutically-target histone-deacetylase(HDAC)enzymes in dental-pulp-cells(DPCs)that stimulate pro-regenerative effects with limited loss of viability.Consequently,HDAC-inhibitors have the potential to enhance biomaterial-driven tissue responses at low concentration by influencing the cellular processes with minimal side-effects,providing an opportunity to develop a topically-placed,inexpensive bio-inductive pulp-capping material.Despite positive results,clinical translation of these innovations requires enterprise to counteract regulatory obstacles,dental-industry priorities and to develop strong academic/industry partnerships.The aim of this opinion-led review paper is to discuss the potential role of therapeutically-targeting epigenetic modifications as part of a topical VPT strategy in the treatment of the damaged dental pulp,while considering the next steps,material considerations,challenges and future for the clinical development of epigenetic therapeutics or other‘smart’restorations in VPT.

Evaluating the potential of an amelogenin-derived peptide in tertiary dentin formation

Several novel biomaterials have been developed for dental pulp capping by inducing tertiary dentin formation.The aim of this study was to evaluate the effect of QP5,an amelogenin-based peptide,on the mineralization of dental pulp cells(DPCs)in vitro and in vivo.The cell viability of human DPCs(hDPCs)after treatment with QP5 was determined using the Cell Counting Kit-8(CCK-8).Migration of hDPCs was assessed using scratch assays,and the pro-mineralization effect was determined using alkaline phosphatase(ALP)staining,alizarin red staining and the expression of mineralization-related genes and proteins.The results showed that QP5 had little effect on the cell viability,and significantly enhanced the migration capability of hDPCs.QP5 promoted the formation of mineralized nodules,and upregulated the activity of ALP,the expression of mRNA and proteins of mineralization-related genes.A pulp capping model in rats was generated to investigate the biological effect of QP5.The results of micro-computed tomography and haematoxylin and eosin staining indicated that the formation of tertiary dentin in QP5-capping groups was more prominent than that in the negative control group.These results indicated the potential of QP5 as a pulp therapy agent.