A 12-month Follow-Up Study of Pulp Oxygen Saturation in Deciduous Molars After Selective and Nonselective Carious-Tissue Removal: A Randomized Pilot Trial

ABSTRACT Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO2). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO2. Pulp exposure and pulp necrosis were primary outcomes, and %SaO2 was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO2 pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO2 minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO2 seems not to differ between teeth treated with SCR or NSCR.

Extreme intrusive force affects the expression of c-Fos and matrix metallopeptidase 9 in human dental pulp tissues.

This study aimed to investigate the expression of c-Fos and matrix metallopeptidase 9 (MMP-9) in dental pulp of patients receiving orthodontic treatment via wire appliance.Fifteen patients (30 teeth in total) were randomly assigned to five groups: t = 0, t = 1, t = 4, t = 8 and t = 12 (n = 6). The first maxillary premolars of patients in the t = 0 group were extracted without any orthodontic treatment. An intrusive force of 300 g was applied on first maxillary premolars in the other four groups via wire appliances. This force was maintained for 1 week for t = 1 group, 4 weeks for t = 4 group, 8 weeks for t = 8 group, or 12 weeks for t = 12 group, before the teeth were extracted.The expression of c-Fos and MMP-9 in the pulps of each group was analyzed by immunohistochemical staining and real-time PCR. The relationship in the protein expression between c-Fos and MMP-9 in the dental pulp was analyzed by Pearson correlation analysis.Intrusive force of 300 g increased the expression of both c-Fos and MMP-9 in the dental pulp. The protein expression of MMP-9 in the dental pulp was significantly correlated with the expression of c-Fos (P < .001).Extreme intrusive force upregulates c-Fos and MMP-9 expression in the dental pulp. Moreover, protein expression of c-Fos and MMP-9 is significantly correlated under intrusive force.

Detection of bone marrow-derived fibrocytes in human dental pulp repair.

AIM: To explore the expression profile of CD45+/pro-collagen I+ fibrocytes in intact dental pulps as well as during wound healing in adult dental pulp tissue. METHODOLOGY: A total of 16 healthy permanent teeth were obtained from young patients (18 to 25 years) undergoing orthodontic treatment. Routine pulp capping with mineral trioxide aggregate (MTA) was performed under local anaesthesia to induce a mineralized barrier at the exposed surface. Teeth were extracted from patients after 7, 14 and 35 days. Sections of the extracted teeth were prepared and stained for various markers using indirect immunofluorescence. Fibrocytes were counted, and the data were statistically evaluated using the Dunnett test. RESULTS: In uninflammed pulp tissue, a pro-collagen I-positive reaction was detected in odontoblasts, as well as in perivascular cells. Most of the CD45-positive cells were negative for pro-collagen I in normal pulp tissue, whereas CD45+/pro-collagen I+ fibrocytes were detected 7 days after injury. At day 14, fibrocytes were recognized under the fibrous matrix in contact with MTA and had infiltrated into regions of new capillary formation, where the fibrocytes were positively stained for vascular endothelial growth factor. By 35 days, fibrocytes were few, coincident with the formation of dentine bridges. The number of fibrocytes peaked 7 days post-injury and decreased at 14 days. CONCLUSIONS: The presence of fibrocytes in human pulp wound healing was observed. The spatiotemporal distribution of fibrocytes suggests that fibrocytes are involved in the early stages of pulp wound healing, specifically by contributing to new blood vessel formation.

Lesão endo-perio: classificação e diagnóstico / Endo-perio lesions: classifi cation and diagnosis

Lesões endo-perio são lesões inflamatórias que acometem, em diversos graus, tanto os tecidos periodontais como a polpa dental. O objetivo deste artigo é mostrar, através de uma revisão da literatura, a importância da classificação das lesões endo-perio, assim como o diagnóstico dessas lesões. A partir dos trabalhos revisados, conclui-se que as lesões endo-perio apresentam uma etiologia variada, sendo de fundamental importância o conhecimento do profissional quanto às causas e seu correto diagnóstico. Assim, para o sucesso e a resolução das lesões endo-perio, uma avaliação clínica e radiográfica eficaz determinará a correta classificação e, consequentemente, a melhor forma de tratamento.

Endo-periodontal lesions are inflammatory conditions that affect the periodontal tissues and the dental pulp. The aim of this article is to show the importance of the classification and the diagnosis of the endo-perio lesions. From the studies reviewed, it is concluded that endo-perio lesions present a varied etiology, being of fundamental importance the knowledge of the professional as to its causative factors and its correct diagnosis. Thus, for the success and resolution of endo-perio lesions an effective clinical and radiographic evaluation will determine the correct classification and consequently the best form of treatment.

Manejo de exacerbación en endodoncia / Exacerbation management in endodontics

Introducción: la exacerbación endodóntica es un problema con bajo reporte de incidencia que puede ocurrir después de un tratamiento de endodoncia por la agudización de una condición pulpar asintomática, así como por una afección perirradicular. Lesiones mecánicas y químicas se asocian con frecuencia con su aparición, sin embargo, la lesión causada por microorganismos y sus productos es la causa principal y más común de ella. Puede presentarse posterior a la realización del tratamiento en una cita o entre sesiones. Objetivo: reportar un caso de exacerbación en endodoncia y el manejo de esta. Presentación del caso: paciente femenina de 49 años que acude a consulta por dolor e inflamación luego de haber iniciado tratamiento de endodoncia. Se llevó a cabo el manejo clínico y farmacológico de la exacerbación en un diente con diagnóstico de periodontitis apical asintomática. Luego de 5 días se termina el tratamiento de conducto usando mineral trióxido agregado y gutapercha. Posteriormente el diente es restaurado y se realizan controles clínicos y radiográficos. Conclusiones: es posible prevenir este tipo de complicaciones de causa variable identificando factores de riesgo, así como por medio de la experiencia del clínico e instauración de protocolos de atención adecuados(AU)

Introduction: endodontic exacerbation is a problem with low incidence that can occur after endodontic treatment due to the aggravation of an asymptomatic pulp condition, as well as a periradicular affection. Mechanical and chemical injuries are frequently associated with their onset; however, the injury caused by microorganisms and their products is the main and most common cause for it. It can occur after the treatment is performed at an appointment or between sessions. Objective: to report a case of endodontic exacerbation and its management. Case presentation: a 49-year-old female patient presented with pain and inflammation after beginning the endodontic treatment. The clinical and pharmacological management of the exacerbation was carried out in a tooth with diagnosis of asymptomatic apical periodontitis. After 5 days, the root canal treatment is finished using mineral trioxide aggregate and gutta-percha. The tooth is then restored and clinical and radiographic controls are carried out. Conclusions: it is possible to prevent this type of complications of variable cause by identifying risk factors, as well as through the experience of the clinician and the establishment of proper management protocols(AU)

O Tabagismo e suas implicações na saúde pulpar e periodontal / El tabaquismo y sus consecuencias para la pulpa y la salud periodontal / Smoking and its impact on pulp and periodontal health

Introdução: o tabagismo é considerado um dos maiores problemas de saúde pública do mundo segundo a Organização Mundial de Saúde. Sabe-se que o tabagismo interfere de diferentes maneiras na saúde dos tecidos da cavidade oral, estando diretamente relacionado aos problemas de saúde bucal. Objetivo: realizar uma revisão bibliográfica sobre o tema Tabagismo e suas implicações na saúde pulpar e periodontal. Métodos: realizou-se um estudo por revisão criteriosa da literatura em artigos científicos publicados nos últimos 5 anos (2012-2016) sobre temas relacionados às seguintes combinações de descritores: polpa dentária e pulpectomia e periodontia e tabaco; polpa dentária e pulpectomia e tabaco; pulpectomia e tabaco; periodontia e tabaco. As bases de dados utilizadas foram: Pubmed; Google Acadêmico; Science Direct; SciELO e Lilacs. Foram encontrados 36 estudos com os descritores instituídos. Análise e integração de informações: os estudos demostraram que o consumo do tabaco e seus derivados influenciam diretamente na saúde e homeostasia dos tecidos pulpar e periodontal, estando relacionado à perda dentária e a um incremento na necessidade de tratamento endodôntico. Conclusão: O Tabagismo possui importantes implicações na saúde pulpar e periodontal, influenciando na fisiologia, no metabolismo e em alterações teciduais nos tecidos conjuntivo pulpar e no tecido periodontal(AU)

Introducción: el tabaquismo es considerado uno de los mayores problemas de salud pública del mundo, según la Organización Mundial de la Salud. Se sabe que fumar interfiere en diferentes formas sobre la salud del tejido de la cavidade bucal, está directamente relacionado con problemas de salud bucal. Objetivo: realizar una revisión de la literatura sobre el tema Tabaquismo y sus consecuencias para la pulpa y la salud periodontal. Métodos: se realizó una cuidadosa revisión de la literatura en los artículos científicos publicados en los últimos cinco años (2012-2016) en temas relacionados con las siguientes combinaciones de descriptores: pulpa dental y pulpectomía y periodoncia y tabaco; pulpa dental y pulpectomía y Tabaco; Pulpectomía y tabaco; periodoncia y tabaco. Las bases de datos utilizadas fueron: Pubmed; Google Académico; Science Direct; SciELO y Lilacs. Se encontraron 36 estudios con descriptores establecidos. Análisis e integración de la información: los estudios demostraron que el consumo de tabaco y sus derivados influyen directamente en la salud y la homeostasis de la pulpa y de los tejidos periodontales y se relaciona con la pérdida de dientes y un aumento en la necesidad de un tratamiento de endodoncia. Conclusiones: El tabaco tiene implicaciones significativas en la pulpa y la salud periodontal, de manera que influye en las alteraciones de la fisiología, el metabolismo y el tejido conectivo de la pulpa y el tejido periodontal(AU)

Introduction: according to the World Health Organization, smoking is one of the greatest public health problems worldwide. It is a well known fact that smoking interferes in different ways with the health of oral tissue, and is directly related to oral health problems. Objective: conduct a bibliographic review on the topic Smoking and its impact on pulp and periodontal health. Methods: a careful review was conducted of scientific papers published in the last five years (2012-2016) about topics related to the following descriptor combinations: dental pulp and pulpectomy and periodontics and tobacco; dental pulp and pulpectomy and tobacco; pulpectomy and tobacco; periodontics and tobacco. The databases used were PubMed, Google Scholar, Science Direct, SciELO and Lilacs. 36 studies were found based on the above descriptors. Data analyse and integration: the studies showed that the use of tobacco and its by-products directly impact the health and homeostasis of the pulp and periodontal tissues, and is related to tooth loss and an increase in the need for endodontic treatment. Conclusions: tobacco use significantly impacts pulp and periodontal health, causing physiological and metabolic alterations, and affecting the pulp connective tissue and the periodontal tissue(AU)

Evaluación in vitro de la adhesión de células troncales mesenquimales a matrices dentales impresas en tercera dimensión / In vitro Evaluation of the Mesenchymal Stem Cell Adhesion to 3D-Printed Dental Matrices

Antecedentes: En ingeniería de tejidos es fundamental estudiar el sinergismo entre las células troncales mesenquimales y el biomaterial para tener un mayor control sobre los biomiméticos. De esto depende el éxito de tratamientos de lesiones de tamaño crítico.Objetivo: Evaluar la adhesión celular in vitro de células troncales de la pulpa dental humana (CTPD) en matrices impresas con ácido poliláctico {API.).Métodos: Se utilizaron muestras de CTPD criopreservadas y expandidas, cultivadas sobre 24 matrices dentales impresas en 3D con APL, y que se analizaron los días 1, 7 y 15. Se evaluó la fenotipificacion de la CTPD por citometría de flujo y la adhesión celular a la matriz por medio de microscopio electrónico de barrido (SEM). Los datos se agruparon en porcentajes, tanto para el marcador analizado como para la cantidad de células adheridas. Resultados: Las CTPD expresaron positivamente anticuerpos CD73 y CD90 en casi un 100 % y CD 105 en un 56,7 %. Asimismo, expresaron negativamente anticuerpos CD34 y CD45 en más del 98 %. Se observó en SEM que a los 15 días el 99,88 % de las CTPD presentó forma fusiforme o estrellada, lo que significa que estas células se adhirieron a la matriz de APP.Conclusión : El APL no es citotóxico para las CTPD por su composición y características biocompatibles, lo que hizo posible que las células se adhirieran y proliferaran sobre la matriz dental impresa en 3D. Este fue un método in vitro efectivo para emplear en futuros estudios de regeneración de tejidos en odontología.

Background: In tissue engineering it is quite important to study the synergy between mesenchymal stem cells and biomaterials to better control the biomimetic elements. Success in the treatment of critical-size lesions depends strongly on this fact. Objective: To evaluate the in vitro human Dental Pulpal Stem Cell (DPSC) adhesion in printed matrices developed with polylactic acid (PLA). Methods'. Cryopreserved and enlarged DPSC samples were used in the culture of 24 dental 3D-printed matrices developed with PLA that were analyzed on days 1, 7 and 15. The DPSC typification was analyzed with flow cytometry and the cell adhesion to the matrix was analyzed under the scanning electron microscope (SEM). Data were gathered as percentages for both the analyzed marker and the amounts of adhered cells. Results: DPSCs expressed positively the CD73 and CD90 antibodies in almost 100%and the CD 105 in 56.7%. Likewise, DPSCs expressed negatively the CD34 and CD45 in more than 98%. After 15 days it was observed in the SEM that 99.88% of the DPSCs had either a star-like or fusiform shape, which means that they adhered successfully to the PLA matrix. Conclusion: The PLA is not cytotoxic on the DPSCs thanks to its composition and biocompatible features, which allowed the cell adhesion and proliferation in the 3D-printed dental matrix. This in vitro method was effective and should be use in future studies on tissue regeneration in dentistry.

Lesões endodôntico-periodontais: do diagnóstico ao tratamento / Endodontic-periodontal lesions: from diagnosis to treatment

As doenças endodôntico-periodontais até hoje representam um desafio para o cirurgião-dentista. Uma única lesão pode apresentar sinais de envolvimento endodôntico e periodontal, o que pode induzir o cirurgião-dentista à realização de um tratamento inadequado. O diagnóstico da doença geralmente é difícil devido às íntimas conexões anatômicas e vasculares entre a polpa e o periodonto. Além disso, o fato dessas doenças serem frequentemente avaliadas como entidades diferentes dificulta ainda mais o diagnóstico. A avaliação do prognóstico e o tratamento também podem ser desafiadores. Microrganismos, trauma, reabsorções radiculares e perfurações estão entre os fatores etiológicos e contribuintes para o desenvolvimento e progressão da doença. Frequentemente, o dente acometido por uma lesão endodôntico-periodontal é condenado devido à falta de conhecimento do cirurgião-dentista. É fundamental reconhecer a relação entre as doenças para o manejo adequado da lesão. A realização de um diagnóstico preciso é um determinante crítico do resultado do tratamento. O presente estudo revisou a literatura relacionada à etiologia, classificação e tratamento dessa doença. A revisão foi feita através de consulta ao pubmed e foram incluídos artigos publicados entre 1974 e 2016. Os termos "lesão endoperio", "lesão endodôntico-periodontal" e "doença endodônticoperiodontal" foram as palavras-chave utilizadas no levantamento. Concluiu-se que é necessário abordar e tratar de forma multidisciplinar, sendo o tratamento direcionado à causa principal diagnosticada. Na lesão combinada verdadeira, o tratamento endodôntico deve preceder o periodontal.(AU)

Until these days endodontic-periodontal lesions remains a challenge to dentists. A single lesion may show signs of endodontic and periodontal involvement, which can induce the dentist to perform an inadequate treatment. The diagnosis is often difficult due to the intimate anatomical and vascular connections between the pulp and periodontium. Furthermore, the fact that these diseases are often evaluated as different entities complicates the diagnosis. Prognosis assessment and treatment can also be challenging. Microorganisms, trauma, perforations and radicular resorptions are among the etiologic factors and contributors to the development and progression of the disease. Often the tooth affected by an endodontic-periodontal lesion is doomed due to lack of knowledge of the dentist. It is important to recognize the relationship between the diseases for the proper management of the injury. This study reviewed the literature related to the etiology, classification and treatment of this disease. The reviewwas done through consultation with pubmed and articles published between 1974 and 2016 were included. The terms "endo perio lesion", "endodontic periodontal lesion" and "endodontic periodontal disease" were the key words used in the survey.It was concluded that it must be addressed and treated in a multidisciplinary way. Treatment should be directed to the main cause. In true combine lesion, endodontic treatment should precede periodontal.(AU)

Clinical and radiographic sequelae to primary teeth affected by dental trauma: a 9-year retrospective study

Abstract This retrospective study aimed at determining the predicted risks of clinical and radiographic complications in primary teeth following traumatic dental injuries, according to injury type, severity and child's age. Data were collected from records of children treated at a Dental Trauma Center in Brazil for nine years. Records of 576 children were included; clinical sequelae were assessed in 774 teeth, and radiographic sequelae, in 566 teeth. A total of 408 teeth (52.7%) had clinical sequelae and 185 teeth (32.7%), radiographic sequelae. The type of injury with the highest number of clinical sequelae was the crown-root fracture (86.4%). Clinical sequelae increased with injury severity (p < 0.001), whereas radiographic sequelae did not (0.236). The predicted risk of color change was 29.0% (95%CI 19-41) for teeth with enamel fracture, and 26.0% (95%CI 14-40) for teeth with enamel dentin fracture as well as enamel dentin pulp fracture. Risk of periapical radiolucency was higher for teeth with enameldentinpulp fracture (61.1% 95%CI 35-82) and those with subluxation (15.8% 95%CI 10-22). Risk of premature loss was 27.3% (95%CI 13-45) for teeth with extrusive luxation, and 10.2% (95%CI 5-17) for those with intrusive luxation. The assessment of predicted risks of sequelae showed that teeth with hard tissue trauma tended to present color change, periapical radiolucency and premature loss, whereas teeth with supporting tissue trauma showed color change, abnormal position, premature loss and periapical radiolucency as the most common sequelae. Knowledge about the predicted risks of complications may help clinicians establish appropriate treatment plans.

Temporal dynamics of anxiety phenotypes in a dental pulp injury model.

BACKGROUND: Accumulating clinical and preclinical evidence indicates that chronic pain is often comorbid with persistent low mood and anxiety. However, the mechanisms underlying pain-induced anxiety, such as its causality, temporal progression, and relevant neural networks are poorly understood, impeding the development of efficacious therapeutic approaches. RESULTS: Here, we have identified the sequential emergence of anxiety phenotypes in mice subjected to dental pulp injury (DPI), a prototypical model of orofacial pain that correlates with human toothache. Compared with sham controls, mice subjected to DPI by mechanically exposing the pulp to the oral environment exhibited significant signs of anxiogenic effects, specifically, altered behaviors on the elevated plus maze (EPM), novelty-suppressed feeding (NSF) tests at 1 but not 3 days after the surgery. Notably, at 7 and 14 days, the DPI mice again avoided the open arm, center area, and novelty environment in the EPM, open field, and NSF tests, respectively. In particular, DPI-induced social phobia and increased repetitive grooming did not occur until 14 days after surgery, suggesting that DPI-induced social anxiety requires a long time. Moreover, oral administration of an anti-inflammatory drug, ibuprofen, or an analgesic agent, ProTx-II, which is a selective inhibitor of NaV1.7 sodium channels, both significantly alleviated DPI-induced avoidance in mice. Finally, to investigate the underlying central mechanisms, we pharmacologically blocked a popular form of synaptic plasticity with a GluA2-derived peptide, long-term depression, as that treatment significantly prevented the development of anxiety phenotype upon DPI. CONCLUSIONS: Together, these results suggest a temporally progressive causal relationship between orofacial pain and anxiety, calling for more in-depth mechanistic studies on concomitant pain and anxiety disorders.

Classification and Epidemiology of Traumatic Dentoalveolar Injuries in Dogs and Cats: 959 Injuries in 660 Patient Visits (2004-2012).

The objective of this study was to determine the epidemiology of traumatic dentoalveolar injuries (TDI) in dogs and cats and to evaluate the applicability of a human classification system for TDI in dogs and cats. All patients diagnosed with a TDI were identified from the University of Wisconsin-Madison School of Veterinary Medicine Dentistry and Oral Surgery Service case log and the hospital patient processing software. The study population consisted of 621 dogs and cats, in a total of 660 patient visits from 2004 to 2012, admitted for oral treatment and subsequently diagnosed with at least one TDI Medical records including diagnostic imaging studies were reviewed to group the injury according to a classification system used in humans for TDI. Patient signalment, tooth injured, and number of injuries per patient were recorded and tabulated. The overall prevalence of TDI was 26.2%. The mean +/- SD number of TDI per patient was 1.45 +/- 0.85. All 14 classes of TDI recognized by the classification system utilized in humans were identified, and all (100%) TDI identified in this study were classifiable using this system. Enamel-dentin-pulp fracture was the most common TDI (49.6%). The most commonly injured teeth were the mandibular or maxillary canine teeth (35.5%). The most common age for dogs and cats with TDI were 3-6 years (33.0%) and 7-10 years (31.3%). With a frequency of 1 in 4 animals, TDI are common and represent a significant pet health concern. Most TDI are considered severe and require timely, and sometimes immediate, treatment. The adoption and utilization of a complete classification system, such as the one used in this study, is recommended in order to improve future epidemiological study of TDI in animals.

Iloprost induces tertiary dentin formation.

INTRODUCTION: Prostacyclin (PGI2), a member of the prostaglandin family, can promote angiogenesis and cell proliferation. METHODS: In this study, the effect of the application of a PGI2 analog (iloprost) on dentin repair was examined in vitro and in vivo. RESULTS: Iloprost significantly stimulated the expression of vascular endothelial growth factor and osteo-/odontogenic marker messenger RNA in human dental pulp cells (HDPCs) under osteoinductive conditions in vitro. In addition, iloprost enhanced HDPC alkaline phosphatase enzymatic activity and mineral deposition. An in vivo study was performed using a rat molar mechanical pulp exposure model. After 30 days, histologic analysis revealed that there was a dramatic tertiary dentin formation in the iloprost-treated group compared with the calcium hydroxide and the untreated control groups. Furthermore, vascular endothelial growth factor protein expression in dental pulp tissue was increased in the iloprost-treated group as determined by immunohistochemical staining. CONCLUSIONS: Taken together, the present study, for the first time, shows that iloprost induces the expression of osteo-/odontogenic markers in vitro and promotes angiogenic factor expression and enhances tertiary dentin formation in vivo. This implies the potential clinical usefulness of iloprost in vital pulp therapy.

Iloprost up-regulates vascular endothelial growth factor expression in human dental pulp cells in vitro and enhances pulpal blood flow in vivo.

INTRODUCTION: Prostacyclin (PGI2) is a biomolecule capable of enhancing angiogenesis and cellular proliferation. METHODS: We investigated the influence of a PGI2 analogue (iloprost) on dental pulp revascularization in vitro and in vivo by using human dental pulp cells (HDPCs) and a rat tooth injury model, respectively. Iloprost stimulated the human dental pulp cell mRNA expression of vascular endothelial growth factor (VEGF), fibroblast growth factor-2 (FGF-2), and platelet-derived growth factor (PDGF) in a significant dose-dependent manner. This mRNA up-regulation was significantly inhibited by pretreatment with a PGI2 receptor antagonist and forskolin (a protein kinase A activator). In contrast, a protein kinase A inhibitor significantly enhanced the iloprost-induced mRNA expression of VEGF, FGF-2, and PDGF. Pretreatment with a fibroblast growth factor receptor inhibitor attenuated the VEGF, FGF-2, and PDGF mRNA expression, indicating opposing regulatory mechanisms. RESULTS: The effect of iloprost on the dental pulp was investigated in vivo by using a rat molar pulp injury model. The iloprost-treated group exhibited a significant increase in pulpal blood flow at 72 hours compared with control. CONCLUSIONS: The present study indicates that iloprost may be a candidate agent to promote neovascularization in dental pulp tissue, suggesting the potential clinical use of iloprost in vital pulp therapy.

Dental pulp stem cells from traumatically exposed pulps exhibited an enhanced osteogenic potential and weakened odontogenic capacity.

OBJECTIVES: Traumatic pulp exposure can bring about some permanent damages to tooth tissues including dental pulps. This study was designed to evaluate the effects of traumatic pulp exposure on the osteo/odontogenic capacity of dental pulp stem cells (DPSCs). METHODS: Rat incisors were artificially fractured and dental pulps were exposed to the oral environment for 48 h. Then, multi-colony-derived DPSCs from the injured pulps (iDPSCs) were isolated. Their osteo/odontogenic differentiation and the involvement of NF-κB pathway were subsequently investigated. RESULTS: iDPSCs presented a lower proliferative capacity than normal DPSCs (nDPSCs), as indicated by MTT and FCM assay. ALP levels in iDPSCs were significantly higher (P<0.01) than those in nDPSCs. Alizarin red staining revealed that iDPSCs exhibited an increased capacity of calcium deposition. Moreover, iDPSCs expressed stronger osteogenic markers (Runx2/RUNX2 and Ocn/OCN) and less odontogenic gene/protein (Dspp/DSP) than nDPSCs in vitro. In vivo transplantation showed that nDPSCs implants generated the typical dentine-pulp complex while all iDPSCs pellets formed the osteodentin-like tissues which were immunopositive for OCN. Mechanistically, iDPSCs expressed the higher levels of cytoplasmic phosphorylated IκBα/P65 and nuclear P65 than nDPSCs, indicating an active cellular NF-κB pathway in iDPSCs. After the inhibition of NF-κB pathway, the osteogenic potential in iDPSCs was significantly down-regulated while odontogenic differentiation was up-regulated, as indicated by the decreased Alp/Runx2/Ocn and uprised Dspp expression. CONCLUSIONS: Pulp exposure for 48 h decreased the odontogenic capacity and enhanced the osteogenic potential of DPSCs via the NF-κB signalling pathway.

Coronal reconstruction following anterior teeth traumatism: multidisciplinary treatment.

This study describes how periodontology, endodontology, and dentistry were integrated for the coronal reconstruction of anterior teeth extensively destroyed by dental trauma. A 15-year-old girl suffered a bicycle accident that resulted in the fracture of teeth No. 8 and 9. Clinical and radiographic examinations confirmed coronal fracture in both teeth, in addition to compromised pulp vitality, invasion of the biologic periodontal space, and loss of coronal space due to mesialization of the neighboring teeth. The protocol consisted of endodontic treatment for the fractured teeth, periodontal surgery to augment the clinical crown and gingival recontouring, intracanal cementation of esthetic glass fiber posts, and coronal reconstruction with resin composite. At a longitudinal follow-up visit 1 year later, clinical and radiographic examinations revealed successful rehabilitation of the fractured teeth.

Fluocinolone acetonide promotes the proliferation and mineralization of dental pulp cells.

INTRODUCTION: The aim of this study was to investigate the role of the steroid fluocinolone acetonide on the proliferation and mineralization of human dental pulp cells (DPCs). The potential effect of fluocinolone acetonide on reparative dentin formation and the recovery of injured dental pulp were evaluated. METHODS: The proliferative effect of fluocinolone acetonide on DPCs was analyzed by cholecystokinin octapeptide assay and flow cytometry. The mineralized effect of fluocinolone acetonide was investigated by the detection of mineralization-related biomarkers including alkaline phosphatase (ALP), bone sialoprotein, and osteocalcin by using ALP histochemical staining, ALP activity, immunostaining, alizarin red staining, and reverse-transcriptase polymerase chain reaction. The molecules, including dentin sialophosphoprotein and Wnt4, involved in the process of mineralization were detected by real-time polymerase chain reaction and Western blot analysis. RESULTS: Low concentrations of fluocinolone acetonide (0.1-40 µmol/L) promoted the proliferation of DPCs. The flow cytometry results showed that the CD146-positive subpopulation of DPCs was significantly increased after treatment with fluocinolone acetonide at 1 and 10 µmol/L for 48 hours, respectively. The messenger RNA expression and activity of the early-stage mineralization marker ALP were evidently increased in fluocinolone acetonide-treated DPCs compared with the untreated control group, so did the middle-stage mineralization marker bone sialoprotein and the late-stage mineralization marker osteocalcin. Meanwhile, Wnt4 and the dentin-specific marker dentin sialophosphoprotein were obviously up-regulated by fluocinolone acetonide compared with the untreated controls. CONCLUSIONS: Fluocinolone acetonide can promote the proliferation of DPCs, especially for the CD146+ subpopulation. Fluocinolone acetonide can initiate the mineralization of DPCs and has the potential role in repairing injured pulp tissues.

Effects of bleaching agents and adhesive systems in dental pulp: a literature review

The dental pulp may be exposed to several irritants that are potentially noxious to the health and functions of this tissue. Each type of irritant or injury has different effects on the pulp, which are generally characterized by acute inflammation, chronic inflammation or necrosis. Common examples of irritants are dental caries, cavity preparation procedures, traumatic injuries, and chemical substances like bleaching agents and adhesive systems. The present study aimed to review the current knowledge about the effect of bleaching agents and adhesive systems in the human dental pulp. The review covered literature from 2004 to 2009, and only relevant manuscripts were included. Hand search of the references completed the review. Based on literature review, it may be concluded that all dental procedures associated with bleaching agents or adhesive systems involve risks to cause pulp damage. However, these risks can be minimized if the causal factors were known and avoided.

Proliferation and multilineage potential of CXCR4-positive human dental pulp cells in vitro.

INTRODUCTION: Although the results of our previous studies showed that the stromal cell-derived factor (SDF)-1α-CXC chemokine receptor 4 (CXCR4) axis may play a role in the recruitment of CXCR4-positive dental pulp cells (CXCR4(+) DPCs) toward the damaged sites, the specific function of CXCR4(+) DPCs in the injured dental pulp was still unknown. The purpose of this study was to verify whether CXCR4(+) DPCs possessed stem cells properties so that we can understand their role in area of injury. METHODS: CXCR4(+) DPCs were isolated from normal DPCs with magnetic-activated cell sorting. The characteristics of the cells from the 3 groups of cells (ie, CXCR4(+) DPCs, CXCR4(-) DPCs, or nonsorted DPCs) were analyzed in colony formation, proliferation, and multilineage differentiation including odontogenic and adipogenic lineages. RESULTS: The results showed that CXCR4(+) DPCs were the most dominant population in colony formation, proliferation, alkaline phosphatase activity, calcium content, and adipogenic differentiation among the 3 groups. CONCLUSIONS: CXCR4(+) DPCs may contain more stem cells than nonsorted DPCs.