Vital pulp therapy in carious pulp-exposed permanent teeth: an umbrella review.

OBJECTIVE: There has been increasing evidence indicating rather high success rates of vital pulp therapies. This umbrella review aimed to provide an overview of existing systematic reviews regarding the outcomes of vital pulp therapy, specifically direct pulp capping, partial pulpotomy and full pulpotomy, in carious pulp-exposed permanent human teeth. MATERIALS AND METHODS: The specific PICO questions were as follows: Population - permanent human teeth with carious pulp exposure; Intervention - direct pulp capping with pulp capping materials; Comparators - partial pulpotomy and full pulpotomy; Outcomes - success rate and prognostic factors. PubMed, Ovid and Cochrane databases were searched in conjunction with hand searching. Grey literature was searched too. Study selection, data extraction and study appraisal were performed independently by two authors. A consensus was reached through discussion when disagreements arose. RESULTS: Six articles fulfilled the inclusion criteria. Higher and more predictable success rates of ≥ 2 years were observed for partial pulpotomy and full pulpotomy in carious pulp-exposed permanent human teeth as compared to direct pulp capping. Possible prognostic factors (pre-operative pulp status, pulp capping material and apex closure) yielded conflicting results. Restorative material, periapical status at baseline, final irrigation solution, age and study type did not seem to affect the treatment outcome. CONCLUSIONS: Vital pulp therapy is a reliable treatment option for permanent teeth with carious pulp exposure. However, more high-quality studies are required to corroborate this finding. CLINICAL RELEVANCE: Vital pulp therapy could be considered as an alternative for root canal treatment for carious pulp-exposed permanent teeth.

Outcomes of endodontically treated cracked teeth: a systematic review and meta-analysis.

OBJECTIVE: Systematic review analyzing the treatment outcomes of cracked teeth that received endodontic treatment is unavailable. The purpose of this study was to examine the treatment outcome of cracked teeth that received root canal treatment and to determine factors that influenced outcome. MATERIALS AND METHODS: The specific PIO questions were as follows: Population: patients who were healthy individuals ≥ 18 years old and required root canal treatment due to cracked tooth; Intervention: root canal treatment with at least 1 year in occlusal function; Outcomes: survival rate and pre-operative factors. Ovid, PubMed, and Cochrane databases were searched in conjunction with hand searching. Pooled survival rates were determined from a meta-analysis of the data retrieved from the articles. All statistics were performed by the Comprehensive Meta-Analysis software. RESULTS: Four articles met the inclusion criteria. The overall tooth survival at 60 months was 84.1% (95%CI, 72.3-91.5%). Although no pre-operative factors had statistical significance, 4 factors had possible clinical significance. Teeth with single crack and teeth with cracks contained within crowns exhibited lower extraction risk, while teeth with pre-treatment periodontal probing > 3 mm and teeth that were terminal abutments showed a greater risk of extraction. CONCLUSION: This systematic review determined the survival rate of endodontically treated cracked teeth to be moderately high. More studies in this area are, however, warranted before definitive conclusions can be derived. CLINICAL RELEVANCE: In view of the relatively high survival rate, endodontic treatment rather than extraction should be considered for cracked teeth.

Matrix metalloproteinase 13 is a new contributor to skeletal muscle regeneration and critical for myoblast migration.

Efficient skeletal muscle repair and regeneration require coordinated remodeling of the extracellular matrix (ECM). Previous reports have indicated that matrix metalloproteinases (MMPs) play the pivotal role in ECM remodeling during muscle regeneration. The goal of the current study was to determine if the interstitial collagenase MMP-13 was involved in the muscle repair process. Using intramuscular cardiotoxin injections to induce acute muscle injury, we found that MMP-13 expression and activity transiently increased during the regeneration process. In addition, in muscles from mdx mice, which exhibit chronic injury, MMP-13 expression and protein levels were elevated. In differentiating C2C12 cells, a murine myoblast cell line, Mmp13 expression was most pronounced after myoblast fusion and during myotube formation. Using pharmacological inhibition of MMP-13 to test whether MMP-13 activity is necessary for the proliferation, differentiation, migration, and fusion of C2C12 cells, we found a dramatic blockade of myoblast migration, as well as a delay in differentiation. In contrast, C2C12 cells with stable overexpression of MMP-13 showed enhanced migration, without affecting myoblast maturation. Taken together, these results support a primary role for MMP-13 in myoblast migration that leads to secondary effects on differentiation.

Quality of life of patients with endodontically treated teeth: A systematic review.

This systematic review aimed to appraise the quality of life of patients with restored endodontically treated teeth. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were employed. The specific PEO question was as follows: population: patients who were healthy individuals ≥18 years old and required endodontic treatment; exposure: endodontic treatment with a coronal restoration with at least 6 months in occlusal function; and outcome: quality of life of patients. Databases were searched in conjunction with hand searching of reference lists of endodontic textbooks, endodontic-related journals, and relevant articles from electronic searching. Six articles met the inclusion criteria. Most studies concluded that non-surgical root canal therapy improved patients' quality of life. The effect of operator type yielded conflicting results. Only one paper compared endodontic treatment with implant placement, and it showed similar patient-centric outcome with a high level of patient satisfaction. Current research is still limited, and further studies are warranted.

Biocompatibility of two experimental scaffolds for regenerative endodontics.

OBJECTIVES: The biocompatibility of two experimental scaffolds for potential use in revascularization or pulp regeneration was evaluated. MATERIALS AND METHODS: One resilient lyophilized collagen scaffold (COLL), releasing metronidazole and clindamycin, was compared to an experimental injectable poly(lactic-co-glycolic) acid scaffold (PLGA), releasing clindamycin. Human dental pulp stem cells (hDPSCs) were seeded at densities of 1.0 × 10(4), 2.5 × 10(4), and 5.0 × 10(4). The cells were investigated by light microscopy (cell morphology), MTT assay (cell proliferation) and a cytokine (IL-8) ELISA test (biocompatibility). RESULTS: Under microscope, the morphology of cells coincubated for 7 days with the scaffolds appeared healthy with COLL. Cells in contact with PLGA showed signs of degeneration and apoptosis. MTT assay showed that at 5.0 × 10(4) hDPSCs, COLL demonstrated significantly higher cell proliferation rates than cells in media only (control, p < 0.01) or cells co-incubated with PLGA (p < 0.01). In ELISA test, no significant differences were observed between cells with media only and COLL at 1, 3, and 6 days. Cells incubated with PLGA expressed significantly higher IL-8 than the control at all time points (p < 0.01) and compared to COLL after 1 and 3 days (p < 0.01). CONCLUSIONS: The COLL showed superior biocompatibility and thus may be suitable for endodontic regeneration purposes.