Discriminatory performance of the pulpal inflammatory biomarkers; Interleukin-8 and TNF-α in patients with symptoms indicative of reversible and irreversible pulpitis: A diagnostic accuracy study.

AIM: The success of vital pulp treatment (VPT) procedures is dependent on an accurate diagnosis of the pulpal inflammatory condition. Compared with current subjective pulpal diagnostic tests, inflammatory molecular biomarkers involved in the pathogenesis of pulpitis represent potential objective indicators of the degree of pulpal inflammation. Therefore, the aim of this study was to quantify level of inflammatory biomarkers - Interleukin 8 (IL-8) and TNF-α in patients diagnosed with reversible pulpitis (RP), irreversible pulpitis (IR) and normal pulp (NP) and investigate their diagnostic accuracy in differentiating between healthy and inflamed conditions. METHODOLOGY: This prospective, cross-sectional study enrolled 72 patients aged 14-53 years with extremely deep carious lesions after establishing a clinical diagnosis of RP (n = 42), symptomatic IR (n = 22) and NP (n = 8). 50 µL of pulpal blood sample was collected from all the patients using a micropipette after pulpal exposure. The level of IL-8 and TNF-α was assessed in pg/mL using enzyme-linked immunosorbent assays. Mann-Whitney U test was applied to establish the association between IL-8/TNF-α level and degree of pulp inflammation. Receiver operating curve (ROC) analysis was carried out to calculate area under the curve (AUC) for RP versus IR. Cut-off values were established using Youden's index. RESULTS: IL-8 and TNF-α levels differed significantly between RP and IR groups (p ≤ .001). The median value of IL-8 in RP and IP groups was 259.8 pg/mL [187.5-310.0] and 1357.8 pg/mL [1036.7-2177.6] respectively. The AUC-ROC curve for RP versus IR was 0.997 with 95.5% sensitivity and 99.76% specificity. The median value of TNF-α in RP and IR groups was 75.4 pg/mL [62.7-95.8] and 157.6 pg/mL [94.1-347.3]. The AUC-ROC curve for TNF-α was 0.812 with a sensitivity and specificity of 59.1% and 92.1%, respectively. IL-8 and TNF-α levels were below detection levels for all NP samples. CONCLUSION: This study showed that pulpal blood could provide an excellent medium for establishing pulpal diagnosis under extremely deep carious lesions. The selected cytokines, IL-8 and TNF-α, demonstrated excellent discriminatory performance for reversible and irreversible pulpitis. Future studies should correlate the IL-8/TNF-α levels with VPT treatment outcomes.

Effect of C-factor on Micro-tensile Bond Strength of Bulk fill V/S Micro-hybrid Composite in Class II Restorations - An In-Vitro Study.

Background: High Configuration factor (C-factor) results into increased polymerization shrinkage causing stress at resin-dentin interface leading to failure of the restoration. The purpose of this study was to evaluate the effect of C-factor on micro-tensile bond strength (µTBS) of bulk fill composites in class-II cavities when restored in 4mm of bulk as compared to conventional composite. Methodology: A total of 90 carious, crack free extracted human mandibular permanent molars were selected and randomly divided into 3 groups (n=30). On all samples, class II cavities (3.5X 3.5cm) were made by single operator and divided as Gp1 (2.5mm), Gp2 (4mm), and Gp3 (6mm) on the basis of depth of cavities. Sampling units of 30 in each group were further randomly subdivided into 3 subgroups (n=10 each subgroup), according to the type of composite resin systems to be used for restoration. Experimental Subgroup includes SubGp1 restored with SDR Surefil (Dentsply, caulk, USA) and SubGp2 restored with Sonic fill (kerr, orange, CA, USA), whereas SubGp3 restored with FILTEK Z250 served as control. After storage in water at 37◦C, the teeth were sectioned perpendicular to the restorative tooth interface as 1×1 mm non-trimmed rectangular micro-specimens for micro-tensile bond strength (µTBS) testing. Beams (n=30 max) from each SubGp were fixed to a metal jig and subjected to micro-tensile bond strength testing. The data collected for micro-tensile bond strength (expressed in Mpa) were statistically analysed using one way ANOVA and Tukey's post hoc test. Results: In class II cavities with high C-factor, SDR Surefil showed better µTBS than SonicFill and micro-filled composite when filled in bulk of 4mm, as compared to micro-hybrid composite filled incrementally. Conclusion: There is no effect of high C-factor on µTBS of tooth restored with both SDR Surefil and Sonic Fill in class II cavities as compared to microhybrid composites.