Comparative evaluation of pro-inflammatory cytokine levels in pulpotomized primary molars

Abstract

The present in vivo study was performed to investigate the levels of the pro-inflammatory cytokines, interleukin (IL)-1α, IL-6, and IL-8, in primary molars for which pulpotomy was clinically indicated, and to evaluate the success rates of three different pulpotomy agents employed for cariously (CExp) or mechanically exposed (MExp) primary molars. Forty-seven primary molars were classified as MExp or CExp according to the type of pulpal exposure. Pulp tissue was harvested and analyzed using enzymelinked immunosorbent assay (ELISA). Subsequently, three pulpotomy agents-calcium hydroxide (CH), mineral trioxide aggregate (MTA), and formocresol (FC)-were applied randomly, and the outcome was observed radiographically for 18 months. Levels of IL-6 and IL-8 were significantly higher in CExp pulp than in MExp pulp (P < 0.05). In the CH pulpotomy group, MExp teeth showed a higher success rate than CExp teeth. There was no significant difference in success rate between MExp and CExp teeth in both the FC and MTA groups. The levels of IL-6 and IL-8 have the potential to become indicators of pulp status and can be monitored by researchers to make the prognosis of vital pulp therapies less uncertain. As MTA and FC yielded higher rates of success than CH in CExp teeth, the choice of pulpotomy agent appears to be important in this context. (J Oral Sci 57, 145-150, 2015)

Carious Exposure versus Mechanical Exposure for MTA Pulpotomy in Primary Teeth

“…According to Yıldırım et al [16], under appropriate conditions, spontaneous pulpal healing is possible and this process also depends upon treatment material. In line with these earlier studies, a recent study by Özdemir et al [7] reported that the outcome of vital pulp therapy is affected not only by exposure type, but also by the choice of pulpotomy agent, which can have an important effect on pulp inflammatory status.…”

“…Systematic reviews and many studies uncovered various expressions that generalized inclusion criteria as “carious pulp exposures” [21–24, 29]. However, in all of these studies, caries were reportedly removed completely prior to opening of the pulp chamber, which would mean these teeth should be included in Starkey's definition of “mechanical exposure” rather than “carious exposure.” In a small number of other studies in which exposure characteristics were described in detail, carious exposure was found to reduce the success rate of vital pulpotomy treatment [4, 7]. In addition to the nature of exposure, the material used for vital pulpotomy has been shown to have a significant effect on treatment prognosis [7, 13–15].…”

“…While the majority of clinical studies consider hemostasis at the pulp stump to be a required criteria for pulpotomy [21, 22, 24–29] a few studies use hemostasis at the exposure site [4–7, 30, 31]. In this study, hemostasis at the pulp stump was required as an inclusion criteria.…”

“…Clinical and radiological success rates for MTA pulpotomies have been reported to range from 66.6% to 100% [4, 7, 23, 25, 29]. However, in these studies, inclusion criteria did not provide specific information regarding type of exposure as mentioned above, stating only that exposures after complete removal of decay were included.…”

“…There is limited data about comparison of success of carious and mechanical exposure types [4, 5, 7]. It was claimed that the low success rate of teeth with carious exposure larger than pinpoint size is related to the size and type of exposure, with a large area of exposure surrounded by carious dentin implying a greater risk of bacterial contamination and expansion of inflammation deeper into the pulp [4, 5].…”