Biological Markers for Pulpal Inflammation: A Systematic Review

Rechenberg, Dan‐Krister; Galicia, Johnah C.; Peters, Ove A.

doi:10.1371/journal.pone.0167289

Cited by 177 publications

(189 citation statements)

References 107 publications

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“…As a result, the development of new pulp tests and chairside assays of potential prognostic indicators (disease biomarkers) should be a focus for translational research (Swedish Council on Health Technology Assessment , Rechenberg et al . , Ballal et al . ).…”

Section: Consensus‐based Recommendationsmentioning

confidence: 99%

European Society of Endodontology position statement: Management of deep caries and the exposed pulp

et al. 2019

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This position statement on the management of deep caries and the exposed pulp represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Preserving the pulp in a healthy state with sustained vitality, preventing apical periodontitis and developing minimally invasive biologically based therapies are key themes within contemporary clinical endodontics. The aim of this statement was to summarize current best evidence on the diagnosis and classification of deep caries and caries‐induced pulpal disease, as well as indicating appropriate clinical management strategies for avoiding and treating pulp exposure in permanent teeth with deep or extremely deep caries. In presenting these findings, areas of controversy, low‐quality evidence and uncertainties are highlighted, prior to recommendations for each area of interest. A recently published review article provides more detailed information and was the basis for this position statement (Bjørndal et al. 2019, International Endodontic Journal, doi:). The intention of this position statement is to provide the practitioner with relevant clinical guidance in this rapidly developing area. An update will be provided within 5 years as further evidence emerges.

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Section: Consensus‐based Recommendationsmentioning

confidence: 99%

European Society of Endodontology position statement: Management of deep caries and the exposed pulp

et al. 2019

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“…Potentially discriminatory biomarkers have been identified, which could potentially set an inflammatory threshold above which the pulp is not viable (Rechenberg et al . , Zanini et al . ); however, at present biomarkers are not specific enough to predictably dictate treatment (Zehnder et al .…”

Section: Reviewmentioning

confidence: 99%

“…A quantitative analysis (the actual number of inflamed cells, inflammatory markers) and a qualitative analysis have been described and correlated to caries depth, caries proximity to the pulp and the inflammatory state of the pulp (McLachlan et al 2003). Potentially discriminatory biomarkers have been identified, which could potentially set an inflammatory threshold above which the pulp is not viable (Rechenberg et al 2016, Zanini et al 2017; however, at present biomarkers are not specific enough to predictably dictate treatment (Zehnder et al 2011). Further clinical studies investigating molecularbased assays are required to develop reliable diagnostic tools and better reproducibility.…”

Section: Pulp Inflammation and In Situ Diagnosismentioning

confidence: 99%

Management of deep caries and the exposed pulp

et al. 2019

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Caries prevalence remains high throughout the world, with the burden of disease increasingly affecting older and socially disadvantaged groups in Western cultures. If left untreated, caries will advance through dentine stimulating pulpitis and eventually pulp infection and necrosis; however, if conservatively managed, pulpal recovery occurs even in deep carious lesions. Traditionally, deep caries management was destructive with nonselective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has been advocated for selective (partial) caries removal and a reduced risk of pulp exposure. Selective caries removal strategies can be one‐visit as indirect pulp treatment or two‐visit using a stepwise approach. Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy and the re‐emergence of vital pulp treatment (VPT) techniques such as partial and complete pulpotomy. These changes stem from an improved understanding of the pulp–dentine complex's defensive and reparative response to irritation, with harnessing the release of bioactive dentine matrix components and careful handling of the damaged tissue considered critical. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. Unfortunately, the changes in management are only supported by relatively weak evidence with case series, cohort studies and preliminary studies containing low patient numbers forming the bulk of the evidence. As a result, critical questions related to the superiority of one caries removal technique over another, the best pulp capping biomaterial or whether pulp exposure is a negative prognostic factor remain unanswered. There is an urgent need to promote minimally invasive treatment strategies in Operative Dentistry and Endodontology; however, the development of accurate diagnostic tools, evidence‐based management strategies and education in management of the exposed pulp are critical in the future.

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“…A systematic review demonstrated that pulpitis was induced by immunocompetent tissues that ultimately result in the release of mediators, which in turn trigger a series of inflammatory events and an attempt to initiate repair (Rechenberg et al . ). It is thus evident that pulp repair is closely related to the inflammatory response.…”

Section: Discussionmentioning

confidence: 97%

“…If the microbial stimulus is removed, mesenchymal stem cells dormant in the pulp are activated and migrate to form new dentine, then resolution of pulpitis and tissue repair occurs (Smith et al 1995a,b); however, if the stimulus is untreated, it will result in progressive inflammatory reactions in the pulp until pulp necrosis. A systematic review demonstrated that pulpitis was induced by immunocompetent tissues that ultimately result in the release of mediators, which in turn trigger a series of inflammatory events and an attempt to initiate repair (Rechenberg et al 2016). It is thus evident that pulp repair is closely related to the inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

Inflammation‐induced overexpression of microRNA‐223‐3p regulates odontoblastic differentiation of human dental pulp stem cells by targeting SMAD3

Huang

Liu²,

Hou

et al. 2018

Int Endodontic J

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Aim To profile miRNA expression between inflamed and healthy human dental pulp tissues and to investigate how the upregulation of miR‐223‐3p in the inflamed pulp tissue regulates odontoblast differentiation and regeneration. Methodology Microarray analysis was used to identify differences in miRNA expression patterns between healthy and inflamed pulp tissue. The results were validated using quantitative real‐time PCR. To determine the effect of miR‐223‐3p on odontoblast differentiation, miR‐223‐3p was overexpressed in human dental pulp stem cells (DPSCs), which were cultured in mineralizing induction medium (to induce odontoblast differentiation). To identify the target genes of miR‐223‐3p, an SABiosciences Human Osteogenesis PCR Array, combined with bioinformatics, was used. Furthermore, a dual‐luciferase reporter assay and a small interfering RNA (siRNA) experiment were used to confirm the relationship between miR‐223‐3p and its target gene. Statistical analysis was performed using the Student's t‐test or one‐way analysis of variance (anova); P < 0.05 was considered statistically significant. Results Seventy‐nine miRNAs were significantly differentially expressed (fold change >2.0; P < 0.05) between the two tissues. In particular, miR‐223‐3p was markedly upregulated in inflamed dental pulp. Overexpression of miR‐223‐3p in DPSCs significantly increased the protein levels of dentine sialophosphoprotein (DSPP) and dentine matrix protein 1 (DMP‐1) (P < 0.05). However, the SMAD family member 3 (SMAD3) protein level was significantly lower than in control DPSCs (P < 0.05). Bioinformatics and the dual‐luciferase assay reporter assay indicated that Smad3 was a potential target of miR‐223‐3p. Knockdown of Smad3 in DPSCs subjected to mineralization induction resulted in detection of DSPP and DMP‐1 earlier than in control DPSCs, and it increased the protein level of alkaline phosphatase (ALP), thereby promoting odontoblast differentiation. Conclusions miR‐223‐3p is implicated in the regulation of odontoblast differentiation, which may be involved in the process of pulpitis repair.

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Biological Markers for Pulpal Inflammation: A Systematic Review

Cited by 177 publications

References 107 publications

European Society of Endodontology position statement: Management of deep caries and the exposed pulp

European Society of Endodontology position statement: Management of deep caries and the exposed pulp

Management of deep caries and the exposed pulp

Inflammation‐induced overexpression of microRNA‐223‐3p regulates odontoblastic differentiation of human dental pulp stem cells by targeting SMAD3

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