The present research proposes an assessment of the localized inflammatory burden but also at the systemic level by quantitating the pro-inflammatory molecules (IL1-a, IL1-b, IL2, IL12, IFN-g, TNF-a) with endo-periodontal lesions. The study was performed on a group of 146 subjects who, following clinical and radiological examinations, were divided into five groups: healthy endo-periodontal patients, patients with periodontitis, patients with moderate periodontitis, patients with severe periodontitis and patients presenting combined endo-periodontal lesions. IL1-a, IL1-b, IL2, IL12, IFN-g, TNF-a were analysed in crevicular fluid by ELISA and serum by fluorescence flowcytometry. IL1-a and IL1-b showed serum and crevicular fluid values significantly higher than the healthy subjects. Values for IL2, IL12, TNF-a and IFN-g measured in crevicular fluid were higher for groups II, III, IV, and V compared to the group of healthy endo-periodontal subjects. IL2 showed significantly higher serum values for groups III, IV and V than group I. Serum IL12 values were significantly higher than healthy periodontal subjects only for patients with severe periodontitis and endo-periodontal syndrome. Following serum determinations of proinflammatory molecules, patients with endo-periodontal lesions demonstrated significantly higher values even in subjects with severe periodontitis; these data indicate a much higher risk for these patients to develop and maintain systemic maladies, as is the role local inflammation can play over the general inflammatory status of the patient.

Conventionally the cases accepted for direct pulp capping are the inadvertently exposed normal pulps and carious exposures in teeth without apical radiolucency. The recent advances in dental materials, namely the bioceramics, allowed successful vital therapy by direct pulp capping even in young permanent teeth with irreversible pulpitis. The choice of pulp capping material is pivotal in pulp vital therapy of carious exposures as tricalcium silicates shift the balance inflammation-healing toward the regeneration of damaged dentin-pulp complex. Anticipating a reliable outcome, the high anti-inflammatory potential and modulating capacity of cytokines and growth factors proved by bioactive endodontic cements in direct pulp capping should be associated with new molecular diagnostic tests and cautious clinical evaluation. However, it seems that a paradigm shift is expected in the decision of direct pulp capping.