Development of an analytical prepCheck-supported approach to evaluate tutor-based assessments of dental students' practical skills.

The aim of the present study was to develop an analytical computer-supported assessment concept for the objective evaluation of students' practical skills, and to investigate the assessor-dependent differences by setting tolerance limits applied during the 'glance and grade' evaluation. A sample of 54 conventionally supervised dental undergraduates were given training in the preparation of a macroretentive Class II cavity. The course participants then took a mandatory practical examination. Three (plus one) course instructors performed the visual evaluations of the examination tasks according to predefined assessment criteria, followed by optical impressions (quadrant scan using Omnicam; Cerec; Dentsply Sirona, Wals, Austria) and subsequent assessment of the prepared cavities (tooth 46) using the prepCheck application (Dentsply Sirona). In this course, the maximum permissible deviation was set at ± 10% from the predefined assessment criteria. If no tolerance was applied, the statistical analysis revealed a significant difference between the actually achieved cavity dimensions and the predefined values of a master preparation (P = 0.0001; Student's t-test), thus leading to an overall failure rate of 100%. The application of the initially targeted 10% tolerance led to an insignificant reduction (96.3%), while the stepwise elevation of the permissible deviation up to 35% finally matched with the result of the visual assessment (total failure rate of approximately 20%). Unlike the pronounced subjectivity of the tutors during the assessment of students' practical skills, the utilization of the prepCheck application enables precise evaluations. Further studies are clearly warranted to investigate the possible educational outcome of an advanced interactive computer-supported training with implemented tolerance corridors.

Accuracy of CBCT-based root canal length predetermination using new endodontic planning software compared to measurements performed with an electronic apex locator ex vivo.

OBJECTIVE: To evaluate the accuracy of the new endodontic planning software (3D Endo Dentsply Sirona) based on cone beam computed tomography (CBCT) to predetermine root canal lengths compared with measurements performed with an electronic apex locator (Raypex 6; VDW) ex vivo. MATERIALS AND METHODS: CBCT scans of forty extracted human maxillary (n = 20) and mandibular (n = 20) molars were taken, and root canal lengths were predetermined with the 3D Endo software using the apical foramen (AF) and the adjoining cusp as references. Root canal lengths were determined with the Raypex 6 using the same references. To evaluate the accuracy, absolute differences between both methods and the actual root canal length (gold standard) were calculated and statistically analyzed. RESULTS: Differences between lengths measured with the 3D Endo and the Raypex 6 compared with the gold standard showed no significant differences (P = 0.879). Mean differences were 0.37 mm versus 0.35 mm in the maxillary molars, and 0.30 mm versus 0.31 mm in the mandibular molars. A total of 75.8% (3D Endo) and 79.1% (Raypex 6) of all measurements were within the limits of ± 0.5 mm. Both methods showed a tendency to result in short measurements (P < 0.001). CONCLUSIONS: Within the limitations of this study, the 3D Endo software enables an accurate three-dimensional (3D) predetermination of root canal lengths.

Tridimensional surface roughness analysis after resin infiltration of (deproteinized) natural subsurface carious lesions.

OBJECTIVES: The objectives of this study were to evaluate ex vivo the effects of resin infiltration on the areal surface roughness of natural non-cavitated proximal subsurface lesions with or without previous deproteinization and to determine differences between E2 and D1 lesions or between premolars and molars. MATERIALS AND METHODS: Forty premolars and 40 molars with proximal carious lesions and macroscopically intact surfaces (International Caries Detection and Assessment System (ICDAS) II; code 2) were radiologically assessed and randomly allocated to four groups (with 20 E2 and 20 D1 lesions, respectively). In each group, 10 lesions were deproteinized (NaOCl; 1%) before etching (HCl; 15%) and resin infiltration (Icon). Areal surface roughness (Sa) at the most demineralized lesion part (DIAGNOdent) was evaluated topometrically before and after deproteinization, after etching, and after infiltration using focus variation 3D scanning microscopy. RESULTS: Pretreatment with NaOCl (n = 40) had no significant effects on Sa (p = 0.208), but resulted in significantly differing Sa values between premolars and molars after etching (p = 0.011). Regarding the effects between etching and baseline, significantly differing Sa values (p = 0.0498) were found for premolars and molars (n = 40/40); Sa after resin infiltration (compared to etching) differed significantly between premolars and molars (p = 0.009). No treatment regimen lead to differences among the radiological grades (E2 vs. D1; p > 0.106). CONCLUSIONS: Resin infiltration showed only minor effects on Sa values of etched subsurface lesions (p < 0.170) and did neither equal nor improve baseline surface roughness (p > 0.401) of the different tooth types. CLINICAL RELEVANCE: Deproteinization should be recommended before etching and infiltration, even if surface roughness of infiltrated advanced (pre-)molar lesions will not be improved.

A Systematic Review and Meta-Analysis on the Efficacy of Locally Delivered Adjunctive Curcumin (Curcuma longa L.) in the Treatment of Periodontitis.

This meta-analysis intended to assess evidence on the efficacy of locally delivered curcumin/turmeric as an adjunctive to scaling and root planing (SRP), on clinical attachment level (CAL) and probing pocket depth (PPD), compared to SRP alone or in combination with chlorhexidine (CHX). RCTs were identified from PubMed, Cochrane Library, BASE, LIVIVO, Dentistry Oral Sciences Source, MEDLINE Complete, Scopus, ClinicalTrials.gov, and eLibrary, until August 2022. The risk of bias (RoB) was assessed with the Cochrane Risk of Bias tool 2.0. A random-effects meta-analysis was performed by pooling mean differences with 95% confidence intervals. Out of 827 references yielded by the search, 23 trials meeting the eligibility criteria were included. The meta-analysis revealed that SRP and curcumin/turmeric application were statistically significantly different compared to SRP alone for CAL (-0.33 mm; p = 0.03; 95% CI -0.54 to -0.11; I2 = 62.3%), and for PPD (-0.47 mm; p = 0.024; 95% CI -0.88 to -0.06; I2 = 95.5%); however, this difference was considered clinically meaningless. No significant differences were obtained between patients treated with SRP and CHX, compared to SRP and curcumin/turmeric. The RoB assessment revealed numerous inaccuracies, thus raising concerns about previous overestimates of potential treatment effects.

Systematic Review on Saliva Biomarkers in Patients Diagnosed with Morbus Alzheimer and Morbus Parkinson.

Extracellular plaques composed of the hydrophobic peptide amyloid-ß and intraneuronal accumulation of the hyperphosphorylated protein tau (p-tau) are pathological hallmarks found in the brains of most people affected by Alzheimer's disease (AD). In Parkinson's disease (PD), Lewy bodies, i.e., intraneuronal protein deposits comprising the protein α-synuclein, are a typical disease feature. As these hallmarks located in the brain are hardly traceable, reliable biomarkers from easily accessible body fluids are key for accurate diagnosis. The aim of the present work was to review the available literature regarding potential biomarkers of AD and PD in the saliva. The databases PubMed, Google Scholar, LILACS, LIVIVO, VHL regional portal, Cochrane Library, eLIBRARY, and IOS Press were consulted for the literature search. Screening of titles and abstracts followed the PRISMA guidelines, while data extraction and the assessment of full texts were carried out in accordance with the Newcastle-Ottawa Scale assessment. The review shows significant increases in levels of the amyloid-ß Aß1-42 and elevated p-tau to total tau (t-tau) ratios in salivary samples of AD patients, in comparison with healthy controls. In PD patients, levels of α-synuclein in salivary samples significantly decreased compared to healthy controls, whereas oligomeric α-synuclein and the ratio of oligomeric α-synuclein to total α-synuclein markedly increased. Salivary biomarkers represent a promising diagnostic tool for neurodegenerative diseases. Further high-quality case-control studies are needed to substantiate their accuracy.

In vitro wear of (resin-coated) high-viscosity glass ionomer cements and glass hybrid restorative systems.

OBJECTIVES: The aim of the present study was to investigate the volumetric abrasive wear of a high-viscosity glass ionomer cement (hvGIC; Equia Fil) and a glass hybrid restorative system (ghRS; Equia Forte), each being recommended as amalgam alternatives. Both materials were applied with or without their respective resinous coating, and were compared with a conventional GIC (Ketac Fil) and a hybrid composite resin (CR; G-ænial Posterior). METHODS: 78 standardized occlusal Class I cavities were restored with the various materials (n = 13 per group). Before and after chewing simulation (30,000 cycles at 40 N), each sample underwent optical scanning procedures (Omnicam). A comparison of the total wear using a fluorescence-aided identification technique (OraCheck) followed, and differences (α = 5%) between groups were compared by means of MANOVA. RESULTS: Regarding the wear rates of hvGIC and ghRS, no differences could be observed (p > .050), and this was not affected by the resinous coating. All hvGIC and ghRS restorations showed significantly higher abrasive wear than CR (p < .001), while the conventional GIC displayed a significant underperformance compared with any other material (p < .001). CONCLUSIONS: Resinous coating of hvGIC or ghRS does not appear to exert an effective long-term protection against advanced abrasive wear. Compared to the conventional GIC showing a considerable substance loss, both hvGIC and ghRS materials revealed an improved abrasion resistance, but clearly failed to meet the excellent values of the CR. CLINICAL SIGNIFICANCE: Occlusal loading should be carefully considered when using hvGIC or ghRS as amalgam (or composite resin) alternatives for the restoration of posterior teeth.

A randomized controlled trial on the plaque-removing efficacy of a low-abrasive air-polishing system to improve oral health care.

OBJECTIVES: While air polishing with abrasive powders has been proved efficient for sub- and supragingival application, only few studies concerning the quality of supragingival biofilm removal using the low-abrasive erythritol powder (EP) exist. The aim of the present randomized controlled trial was to clinically compare the efficacy of supragingival air polishing using EP in comparison with the rubber cup method, and to juxtapose the corresponding biofilm regrowth rates. METHOD AND MATERIALS: Thirty-two young adults, suspending oral hygiene for 48 hours, were enrolled in the present double-blind short-term investigation. Using a split-mouth design, tooth polishing was conducted by means of either air polishing or rubber cups with prophylaxis paste (control). While 16 participants received air polishing in the second and fourth quadrants (and rubber cup prophylaxis in the first and third ones), the reverse sequence was applied with the remaining 16 subjects. Biofilms were assessed using the modified Quigley-Hein index (QHI), and QHI sum scores achieved both prior to and immediately after the polishing procedure, as well as 24 hours later, were assessed using a two-way analysis of variance (ANOVA), followed by Tukey's HSD to test multiple pairwise comparisons. RESULTS: Both methods revealed a significant reduction of QHI scores (P < .001). Compared to the rubber cup method, air polishing resulted in significantly lower scores, both after tooth cleaning and after 24 hours (P < .001). CONCLUSIONS: Supragingival biofilm removal by means of air polishing combined with low-abrasive erythritol seems to be more efficacious than the traditional polishing method, and should improve oral health care.

Publisher Correction: A systematic review of the caries prevalence among children living in Chernobyl fallout countries.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

A systematic review of the caries prevalence among children living in Chernobyl fallout countries.

The present study analyzed the data concerning the caries prevalence in children born and permanently residing in Chernobyl fallout areas. Setting forth to evaluate if differences regarding the caries prevalence can be observed compared to non-contaminated sites of affected East European countries. Methods used to assess the caries prevalence were limited to DMFT/dmft (decayed, missing and filled teeth) for the primary and the permanent dentitions. The databases PubMed, EMBASE/Ovid, Cochrane Library, Scopus, and eLIBRARY were consulted for the electronic literature search. Screening of titles and abstracts followed the MOOSE guidelines, while data extraction and the assessment of the full texts were performed in accordance to the Newcastle Ottawa Scale. The statistical analysis revealed considerable heterogeneity of DMFT/dmft values (from I2 = 94% up to I2 = 99.9%; p < 0.05) in children of different ages (5-7; 12-15; and average of 12 years). Scattering of the weighted mean differences (95% CI) ranged from -1.03 (-1.36; -0.7) to 6.51 (6.11; 6.91). Although individual studies demonstrated a greater prevalence of dental caries in children residing in radiation-contaminated areas, no conclusive statement is possible regarding the effect of small dose radiation on the dentition. Hence, further high-quality epidemiologic investigations are needed.

Systematic review on highly viscous glass-ionomer cement/resin coating restorations (Part II): Do they merge Minamata Convention and minimum intervention dentistry?

BACKGROUND: With the Minamata Convention the use of mercury will be phased down, and this undoubtedly will have an effect on dental treatment regimens and economic resources. Composite resin restorations are considered viable alternatives to amalgam fillings; however, these will not be covered completely by health insurance systems in many countries. Recently, a high-viscosity glass-ionomer cement (hvGIC) processed with a resinous coating (RC) has been introduced, and has been marketed as a restorative material in load-bearing Class I cavities (and in Class II cavities with limited size), thus serving as a possible alternative to amalgam fillings. OBJECTIVE: To discuss the outcome based on the evaluation presented in Part I of this paper, and to critically appraise the methodologies of the various studies. RESULTS: Two of the included studies were industry-funded, and status of the other clinical trials remained unclear. Quality of study reporting was considered perfectible. The use of a light-cured nanofilled resin coating material would seem advantageous, at least when regarding short- and medium term outcomes. CONCLUSION: Within the respective indications and cavity geometries, the hvGIC/RC approach would seem promising, could merge the phase-down of mercury and the objectives of minimally invasive treatment to some extent, and might be a restorative alternative for patients suffering from allergies or not willing to afford other sophisticated or expensive techniques. These recommendations are based on studies evaluating EQUIA Fil (GC), but are not transferable to clinical perspectives of the glass hybrid successor product (EQUIA Forte; GC).

Inflammatory cytokines in normal and irreversibly inflamed pulps: A systematic review.

OBJECTIVE: To review the available literature in regard to the inflammatory process and pulpitis. Setting forth to evaluate if differences in the levels of various cytokines (TNF-α, IL-1ß, IL-2, IL-6 and IL-8) can be observed in clinically diagnosed normal and irreversibly inflamed pulps that could serve as possible markers and/or diagnostic tools to predict and differentiate between certain states of inflammation. Methods used to measure and assess levels of cytokines have been limited to two protein quantification methods ELISA and/or Multiplex Array. DESIGN: The databases PubMed, EMBASE/Ovid, The Cochrane Central Register of Controlled Trials, Cochrane Reviews and Scopus were consulted for the electronic literature search. Screening of titles and abstracts followed the PRISMA guidelines while data extraction and the assessment of the full texts were carried out in accordance to the GRADES assessment. RESULTS: The review showed that significant increases in levels of IL-1ß, IL-2, IL-6, IL-8 and TNF-α in irreversible pulpitis samples exist, in comparison to normal pulp samples which serve as a good basis for potential markers. Due to larger discrepancies in available literature, IL-2 seems rather unsuitable at the moment, while IL-6 and TNF alpha seem to be more promising. CONCLUSION: It may be concluded that even by combining two protein quantification methods inconsistencies between studies exist. At the moment it is difficult to select just one specific cytokine suitable for testing, rather it supports the rationale that further high-quality clinical studies are needed.

Ex vivo investigation on the postoperative integrity of the apical constriction after the sole use of electronic working length determination.

AIM: The present study investigated the accuracy of root canal preparation with regard to the integrity of the apical constriction (AC) using two different working length determination approaches: (1) the electronic method of working length determination (EWLD), and (2) the radiologic "gold standard" method (GS). METHODOLOGY: Simulation models were constructed by arranging extracted human teeth by means of silicon bolstered gingiva masks, along with a conductive medium (alginate). Electronic working length determination (group 1; EWLD) and radiologic plus initial electronic working length determination for posterior comparability (group 2; GS) preceded manual root canal preparation of teeth in both groups. Master cones were inserted according to working lengths obtained from the group specific method. Subsequently, root apices (n=36) were longitudinally sectioned using a diamond-coated bur. The distance between the achieved apical endpoint of the endodontic preparation and the apical constriction (AC) was measured using digital photography. Then, distances between radiologically identified apical endpoints and AC (GS-AC) were compared with the corresponding distances EWLD-AC. Moreover, the postoperative status of the AC was examined with regard to both preparation approaches. RESULTS: Differences between distances GS-AC and EWLD-AC were not statistically significant (p >0.401) (Mann-Whitney-U). Among EWLD samples, 83% of the master cones exhibiting tugback at final insertion terminated close to the apical constriction (±0.5 mm), and no impairment of the minor diameter's integrity was observed. CONCLUSIONS: The sole use of EWLD allowed for a high accuracy of measurements and granted precise preparation of the apical regions.

Systematic review on highly viscous glass-ionomer cement/resin coating restorations (Part I): Do they merge Minamata Convention and minimum intervention dentistry?

BACKGROUND: With the Minamata Convention the use of mercury will be phased down, and this undoubtedly will have an effect on dental treatment regimens and economic resources. Composite resin restorations are considered viable alternatives to amalgam fillings; however, these will not be covered completely by health insurance systems in many countries. Recently, a high-viscosity glass-ionomer cement (hvGIC) processed with a resinous coating (RC) has been introduced, and has been marketed as a restorative material in load-bearing Class I cavities (and in Class II cavities with limited size), thus serving as a possible alternative to amalgam fillings. OBJECTIVE: To evaluate the literature on this treatment approach, and to focus particularly on the clinical performance of the hvGIC/RC combination. SEARCH STRATEGY: The Cochrane Library as well as Ebsco, Embase, PubMed, and Scopus databases were screened. Moreover, relevant abstracts published with dental meetings were reviewed. SELECTION CRITERIA: All available randomized clinical trials focusing on the hvGIC/RC approach (published either as full-texts or abstracts until June 2016) were selected. Moreover, single-group studies using hvGIC/RC were included. DATA COLLECTION AND ANALYSIS: Screening of titles and abstracts, data extraction, and quality assessments of full-texts according to Oxford scoring were performed. RESULTS: Regarding failure rates, minor differences between hvGIC/RC and GIC or composite resins as comparators could be observed in seven clinical studies. The hvGIC/RC combination showed high survival rates (with only few catastrophic failures) of up to 6 years. CONCLUSION: Class I retention rates of hvGIC/RC seem promising, but further high-quality clinical studies are clearly warranted.

Conservative, Surgical, and Prosthetic Treatment of a Patient with a Periapical Lesion Associated with an Atypical Intraoral Sinus Tract.

This report describes a clinical case with an atypical intraoral sinus tract formation from diagnosis and treatment to short-term outcome and definitive prosthetic rehabilitation. In detail, the patient underwent conservative nonsurgical root canal treatment followed by guided bone augmentation of the regions involved in periapical inflammation and sinus tract formation. The removal of the inflammatory source of the lesion as well as the affected tissue clearly led to a healing of the surrounding bone tissues. Subsequently, the tooth was reconstructed using a fibreglass post and a metal-ceramic crown; an implant was successfully placed in the previously inflamed bone region.

Development and Evaluation of an Endodontic Simulation Model for Dental Students.

The aims of this study were to develop an endodontic simulation model able to implement the electronic method of working length determination (electronic apex locators, EALs) in a dental school, to evaluate the practicality of this tool for dental students, and to compare the accuracy of working length measurements achieved by the EAL and the radiographic method. A new simulation model was constructed by embedding extracted human teeth in a self-cured resin, along with a conductive medium. After radiographic and electronic working length determinations, root canal instrumentation was performed by students at a dental school in Austria according to the working lengths obtained from the EAL. Subsequently, root apices (n=44) were longitudinally sectioned using a diamond coated bur. Measurements of the distance between the anatomical root apex (ARA) and the apical constriction (AC) as well as between ARA and the ascertained apical point of endodontic instrumentation were performed using digital photography and a 3D computer-assisted design software. The distance between ARA and the radiologic (ARA-R) or electrometric (ARA-EL) readings of the apical point of endodontic instrumentation was compared with the actual distance ARA-AC. The accuracy of both methods was determined. The difference between the actual distance ARA-AC and the targeted radiological distance was statistically significant (p=0.0001), as was the measured distance between ARA-R and ARA-EL (p=0.016). The electronic method seems to be more precisely referring to the AC (R(2)=0.0198) than the radiographic method (R(2)=0.0019). These results suggest that the endodontic simulation model described in this study can be successfully used in preclinical dental education.

Gene expression of human beta defensins-1 and -2 is significantly reduced in non-inflamed keratinized oral tissue of smokers.

OBJECTIVE: The impact of smoking on the local innate immune response in the oral cavity, and, commonly, on oral health is actively discussed in the scientific literature. The aim of the present study was to evaluate possible effects of smoking on gene expression of human beta-defensin-1 and -2 in human gingival tissue. MATERIAL AND METHODS: Biopsies of keratinized gingival tissues were taken from donors (with written informed consent) undergoing routine surgical treatment. Prior to the sample collection, participants with clinically healthy periodontium were classified as smokers (n=9) or non-smokers (n=9). Gingival tissue was homogenized, and total RNA was extracted and analysed by real-time RT-PCR for human beta-defensins-1-, -2-, and interleukins IL-1ß- and IL-6-, as well as GAPDH-mRNA. The data obtained were analysed for significant differences using the Mann-Whitney-U test. RESULTS: hBD-1- and hBD-2-, as well as IL-1ß- and IL-6-mRNA were detected in all gingival samples. Expression of hBD-1 and -2 was significantly reduced by nearly 2.5-fold (p<0.05; Mann-Whitney) in gingival samples of smokers compared to control group specimens (non-smokers). In contrast, no significant differences of the gene expression of IL-6 and IL-1ß were observed in human gingival tissue of smokers and non-smokers. CONCLUSION: The results presented here suggest that expression of human beta-defensins hBD-1 and -2, and, thus, the basal levels of innate immune defense reactions in the oral cavity are reduced by smoking.

HBD-1 and hBD-2 expression in HaCaT keratinocytes stimulated with nicotine.

OBJECTIVE: The impact of nicotine on the local innate immune response in the oral cavity is unclear. The aim of the present study was to evaluate the possible effects of nicotine on the gene expression of human beta-defensin-1 and -2 in HaCaT keratinocytes. MATERIALS AND METHODS: HaCaTs were cultured in six-well plates in Dulbecco's minimum essential medium (DMEM) supplemented with 10% FBS at a density of ×10(6). Cells were pretreated with 10 µg/ml nicotine (12 h), and then stimulated with 50 ng/ml TNF-α (during the following 12 h); or were pretreated with 50 ng/ml TNF-α, and then stimulated with 10 µg/ml nicotine; or were not pretreated but only stimulated with either nicotine or TNF-α, or a combination of both. Total RNA was extracted and analysed by real-time RT-PCR for human beta-defensins-1-, -2-, and interleukins IL-1ß- and IL-6-, as well as GAPDH-mRNA. The obtained data were analysed using Tukey's B multiple comparison test for post hoc analysis. RESULTS: Pretreatment with nicotine caused a significant 2.5-fold inhibition of TNF-α-stimulated hBD-2 mRNA expression compared to TNF-α alone (p = 0.004). Simultaneous treatment with TNF-α and nicotine caused a significant 2-fold inhibition of hBD-2 mRNA compared to TNF-α alone (p = 0.041). CONCLUSION: The present results suggest that the pre-exposition to nicotine seems to reduce a stimulating effect of TNF-α on the gene expression of hBD-2.

Etiologic factors of hyposalivation and consequences for oral health.

Hyposalivation is represented by a reduced salivary flow rate and can be caused by etiologic factors such as systemic diseases and intake of various medications or by radiotherapy following head and neck cancer. The aim of this review was to compile data about the qualitative and quantitative changes of salivary components during hyposalivation, and to summarize their consequences for oral health. A Medline/PubMed/Scopus search was conducted to identify and summarize articles published in English and German that reported on etiology of hyposalivation and changes in the salivary composition due to hyposalivation of different origins. The search revealed 94 articles, 71 of which were original articles. Apart from the reduction of the salivary flow rate, the quality of saliva is strongly altered because of systemic diseases, medications, and radiotherapy, including increased viscosity and pH shift to more acidic values and changes in salivary protein compositions. Furthermore, hyposalivation may be accompanied by pronounced shifts in specific microbial components, in particular toward a highly acidogenic microflora. Moreover, therapy of hyposalivation is often restricted to palliative treatment (ie, saliva substitutes or gels). To prevent tooth tissue demineralization, clinicians should consider saliva substitutes that are supersaturated with calcium and phosphates and contain fluoride.

Gene expression of human beta-defensins in healthy and inflamed human dental pulps.

Human beta-defensins (hBDs) are antimicrobial peptides that play an important role in the innate host defense against bacterial invasion, contribute to promotion of adaptive immune responses, and show chemotactic activities. The aim of this study was to compare the gene expression of hBD-1, -2, -3, and -4 in healthy teeth and teeth with pulpitis. Samples of healthy and inflamed dental pulps were obtained from extracted third molars and during treatment of teeth with pulpitis. Gene expression was assessed by using reverse transcriptase reaction and real-time polymerase chain reaction. HBD-2 and hBD -3 were only weakly expressed in healthy and inflamed pulps. In contrast, the expression of hBD-1 and hBD -4 was significantly increased in inflamed compared with healthy pulps. These results suggest that hBD-1 and hBD-4 might play a role in the pulpal host defense.