Selective versus stepwise removal of deep carious lesions: A meta-analysis of randomized controlled trials.

Background/purpose: Stepwise removal (SWR) and selective removal (SCR) are proposed techniques to treat deep carious lesions, but it is currently uncertain which technique is better. This meta-analysis aimed to compare the therapeutic effects of SCR and SWR for deep carious lesions in both primary and permanent teeth. Materials and methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP databases were searched until June 9, 2021. Success was the primary outcome. Secondary outcomes included pulp exposure, tooth extraction, pulp necrosis, pulpitis, and endodontic treatment. The effect size of each outcome was tested for heterogeneity. The source of heterogeneity was explored by meta regression analysis. Subgroup analysis and sensitivity analysis were conducted for the outcomes. Results: Nine studies of 1550 patients with 1929 deep carious teeth were included. SCR had a significantly higher success rate than SWR (pooled relative risk [RR] = 1.123, 95% confidence interval [CI] = 1.056-1.194, I2 = 52.3%, P < 0.001). The incidence of pulp exposure was significantly lower in the SCR group than that in the SWR group (pooled RR = 0.266, 95%CI = 0.096-0.740, I2 = 0.0%, P = 0.011). The incidence of pulp necrosis in the SCR group was approximately 14.2% of that in the SWR group (pooled RR = 0.142, 95%CI = 0.026-0.789, I2 = 0.0%, P = 0.026). Compared with SWR, SCR reduced the incidence of pulpitis by about 76.3% (pooled RR = 0.237, 95%CI = 0.090-0.623, I2 = 0.0%, P = 0.003). Conclusion: SCR may be a better treatment for deep caries to achieve better outcomes than SWR. Future research on comparing SCR and SWR for different outcomes in deep carious lesions is warranted to confirm our findings.

Lactobacillus salivarius CPU-01 Ameliorates Temozolomide-Induced Intestinal Mucositis by Modulating Gut Microbiota, Maintaining Intestinal Barrier, and Blocking Pro-inflammatory Cytokines.

Chemotherapy-induced intestinal mucositis is one of the major toxic side effects in the treatment of cancer patients. The purpose of this study is to screen lactic acid bacteria which could alleviate intestinal inflammation and damage induced by chemotherapeutic agents and explore the possible underlying mechanisms. Lactobacillus salivarius CPU-01 was selected from traditional Chinese fermented foods due to its protective effects on the toxicity of temozolomide in Caenorhabditis elegans. Eighteen ICR mice were randomly divided into 3 groups including control group, temozolomide-induced intestinal mucositis group, and temozolomide + L. salivarius CPU-01 group, and were used to investigate the effect of L. salivarius CPU-01 on chemotherapy-induced intestinal mucositis. It has been demonstrated that the administration of L. salivarius CPU-01 can prevent colon shortening and alleviate colon tissue damage caused by temozolomide-induced intestinal mucositis in mice. L. salivarius CPU-01 relieved the intestinal microbiota disorders caused by temozolomide and contributed to the growth of beneficial bacteria, such as Lactobacillus, Clostridia UCG - 014_norank, and Akkermansia. In vivo experiments also indicated that L. salivarius CPU-01 can suppress the level of temozolomide-induced pro-inflammatory cytokines in serum and mRNA expression in the small intestine tissues. It was also found that L. salivarius CPU-01 significantly increased the expressions of intestinal tight junction (TJ) proteins, ZO-1, and Occludin proteins in mice treated with temozolomide. These findings suggest that L. salivarius CPU-01 can ameliorate temozolomide-induced intestinal mucositis by modulating gut microbiota, blocking pro-inflammatory cytokines, and repairing the intestinal barrier. These findings suggest probiotics may serve as a potential alternative therapeutic strategy for the prevention of chemotherapy-induced intestinal mucositis in the future.

Phenotypes, roles, and modulation of regulatory lymphocytes in periodontitis and its associated systemic diseases.

Periodontitis is a common chronic inflammatory disease that can result in tooth loss and poses a risk to systemic health. Lymphocytes play important roles in periodontitis through multiple mechanisms. Regulatory lymphocytes including regulatory B cells (Bregs) and T cells (Tregs) are the main immunosuppressive cells that maintain immune homeostasis, and are critical to our understanding of the pathogenesis of periodontitis and the development of effective treatments. In this review, we discuss the phenotypes, roles, and modulating strategies of regulatory lymphocytes including Bregs and Tregs in periodontitis and frequently cooccurring inflammatory diseases such as rheumatoid arthritis, Alzheimer disease, diabetes mellitus, and stroke. The current evidence suggests that restoring immune balance through therapeutic targeting of regulatory lymphocytes is a promising strategy for the treatment of periodontitis and other systemic inflammatory diseases.

Effects of short-chain fatty acids in inhibiting HDAC and activating p38 MAPK are critical for promoting B10 cell generation and function.

B10 cells are regulatory B cells capable of producing IL-10 for maintaining immune homeostasis. Dysregulation of B10 cells occurs in autoimmune and inflammatory diseases. Modulation or adoptive transfer of B10 cells is a promising therapeutic strategy. The short-chain fatty acids (SCFAs), the metabolites of microbiota, play a critical role in maintaining immune homeostasis and are the potential drugs for the modulation of B10 cells. It is not clear whether and how SCFAs upregulate the frequency of B10 cells. Here, we found that SCFAs could promote murine and human B10 cell generation in vitro. Upregulation of B10 cells by butyrate or pentanoate was also observed in either healthy mice, mice with dextran sodium sulfate (DSS)-induced colitis, or mice with collagen-induced arthritis. Moreover, SCFA treatment could ameliorate clinical scores of colitis and arthritis. Adoptive transfer of B cells pretreated with butyrate showed more alleviation of DSS-induced colitis than those without butyrate. A further study demonstrates that SCFAs upregulate B10 cells in a manner dependent on their histone deacetylase (HDAC) inhibitory activity and independent of the G-protein-coupled receptor pathway. Transcriptomic analysis indicated that the MAPK signaling pathway was enriched in B10 cells treated with butyrate. A study with inhibitors of ERK, JNK, and p38 MAPK demonstrated that activating p38 MAPK by butyrate is critical for the upregulation of B10 cells. Moreover, HDAC inhibitor has similar effects on B10 cells. Our study sheds light on the mechanism underlying B10 cell differentiation and function and provides a potential therapeutic strategy with SCFAs and HDAC inhibitors for inflammation and autoimmune diseases.

[Clinical performance of chairside monolithic lithium disilicate glass-ceramic CAD-CAM crowns].

PURPOSE: To investigate the clinical performance of chairside monolithic lithium disilicate glass-ceramics computer-aided design(CAD)-computer aided manufacturing(CAM) crowns, and to analyze the influencing factors of cumulative survival rate. METHODS: Two hundred and fourteen patients who had chairside posterior lithium disilicate glass-ceramic CAD-CAM crowns in Peking University Shenzhen Hospital from March 2015 to March 2017 were enrolled. The crown preparations were milled using Cerec Omnicam system. The clinical and esthetic effects of the crowns were analyzed at 3, 6, 12, 24, and 36 months. The cumulative survival rate of crowns was calculated, and the effects of gender, age, pulp condition, tooth position and adhesive type on the cumulative survival rate were analyzed. SPSS 20.0 software package was used for statistical analysis. RESULTS: After a 36-month follow-up, the failed crowns were mainly caused by marginal integrity, crown fracture and loss of retention. During the observation period of 3, 6, 12, 24 and 36 months, the scores of color, shape, quality of proximal contact, and chewing ability were greater than 9. The cumulative survival rates were 100.00%, 96.17%, 94.89%, 92.77% and 91.06% at 3, 6, 12, 24 and 36 months, respectively. The cumulative survival rate had no significant difference among different gender, age, and dental pulp status(P>0.05). CONCLUSIONS: Chairside monolithic lithium disilicate glass-ceramic CAD-CAM crowns have a high 3-year cumulative survival rate and good esthetic outcome, which is not affected by gender, age, and pulp status with high clinical value.

Porphyromonas gingivalis induces periodontitis, causes immune imbalance, and promotes rheumatoid arthritis.

Periodontitis induced by bacteria especially Porphyromonas gingivalis (P. gingivalis) is the most prevalent microbial disease worldwide and is a significant risk factor for systemic diseases such as rheumatoid arthritis (RA). RA and periodontitis share similar clinical and pathologic features. Moreover, the prevalence of RA is much higher in patients with periodontitis than in those without periodontitis. To explore the immunologic mechanism of periodontitis involved in RA, we established a mouse model of periodontitis and then induced RA. According to the results of paw thickness, arthritis clinical score, arthritis incidence, microscopic lesion using H&E staining, and micro-CT analysis, periodontitis induced by P. gingivalis promoted the occurrence and development of collagen-induced arthritis (CIA) in mice. Furthermore, periodontitis enhanced the frequency of CD19+ B cells, Th17, Treg, gMDSCs, and mMDSCs, whereas down-regulated IL-10 producing regulatory B cells (B10) in CIA mice preinduced for periodontitis with P. gingivalis. In vitro stimulation with splenic cells revealed that P. gingivalis directly enhanced differentiation of Th17, Treg, and mMDSCs but inhibited the process of B cell differentiation into B10 cells. Considering that adoptive transfer of B10 cells prevent RA development, our study, although preliminary, suggests that down-regulation of B10 cells may be the key mechanism that periodontitis promotes RA as the other main immune suppressive cells such as Treg and MDSCs are up-regulated other than down-regulated in group of P. gingivalis plus CIA.

Effects of platelet-rich plasma and cell coculture on angiogenesis in human dental pulp stem cells and endothelial progenitor cells.

INTRODUCTION: Platelet-rich plasma (PRP) has been described as platelet concentrate. Growth factors released by activated platelets can improve wound vasculogenesis and enhance wound healing. In this study, we used PRP instead of serum to culture human dental pulp stem cells (hDPSCs) and endothelial progenitor cells (EPCs) and investigated revascularization ability. The effect of hDPSC and EPC coculture on vasculogenesis was also studied. METHODS: PRP was prepared by secondary centrifugation. Real-time polymerase chain reaction and Western blotting were used to determine the expression of vasculogenesis-related factors vascular endothelial growth factor, platelet-derived growth factor, fetal liver kinase 1 (Flk-1), and stromal cell-derived factor 1 (SDF-1) in cultured hDPSCs and EPCs. The cells were divided into 4 groups: EPCs + 10% fetal bovine serum (FBS), EPCs + 10% PRP, EPCs + hDPSCs + 10% FBS, and EPCs + hDPSCs + 10% PRP. Then, the formation of vessel-like structures was tested by the tube formation assay. RESULTS: On day 3, the expression levels of all the markers in the coculture groups were much higher than in the single-culture groups and were also higher in the PRP groups compared with the FBS groups (P < .05), except for SDF-1. Expression levels were significantly higher in the experimental groups (EPCs + 10% PRP, EPCs + hDPSCs + 10% FBS, and EPCs + hDPSCs + 10% PRP) than in the control group (EPCs + 10% FBS) and in the PRP groups/coculture groups compared with the FBS groups/single-culture groups (P < .01). The tube formation assay showed the area of vessel-like structures formed by the PRP group to be larger than in the FBS group (P < .05). CONCLUSIONS: PRP and coculture can both promote vasculogenesis, and PRP can promote EPCs to form vessel-like structures.