Molecular diagnostics in endodontics

Abstract

Recent systematic reviews have substantiated the fact that current testing methods to assess the inflammatory state of the pulp and the periapical tissues are of limited value. Consequently, it may be time to search for alternative routes in endodontic diagnostics. Molecular assessment methods could be the future. However, in the field of endodontics, the research in that direction is only about to evolve. Because pulpal and periradicular diseases are related to opportunistic infections, diagnostics can either target microorganisms or the host reaction. This communication discusses clinical situations in which a molecular assessment of infection or host reaction could be of interest. The methods, collection sites, current state of research, and unresolved problems are evaluated.

Biological Markers for Pulpal Inflammation: A Systematic Review

“…Fig 4 illustrates the potential sampling sites for molecular pulpal diagnostics [34]. While having the benefit to show a direct picture of intrapulpal conditions using pulpal blood [26] or whole pulp tissue requires access to the pulp space and is therefore not applicable as a chairside screening tool.…”

“…GCF analyses may be promising due to the ease of application. Moreover, it may be possible to assess the dynamics of apical periodontitis using GCF [34]. However, the major drawback in the evaluation of host mediators in GCF is that tissue inflammation, independent of its cause, is a non-specific process of innate immunity [112] and this makes it difficult to distinguish on a molecular level between a marginal and apical periodontal inflammation.…”

“…Endodontic diagnosis should therefore focus on either the extent of the microbial infection or the inflammatory reaction of the host tissue; however, current methods do neither [14, 23, 34]. …”

“…In this regard, MMPs were shown to be potential biomarker for both pulpal [33] and periodontal disease [32]. However, the application of molecular diagnostics in pulpal disease is as yet not used for clinical decision-making [34]. …”

MMP-9 in Dentinal Fluid Correlates with Caries Lesion Depth

“…There was a high correlation between MMP-9 from deep and shallow lesions (Spearman's ρ = 0.72, p < 0.001), indicating that patients with more MMP-9 in the deep carious lesion also tended to have more MMP-9 in the shallow lesion. The analysis of molecular cues in dentinal fluid from an excavated cavity or otherwise exposed dentin is a relatively new approach that could improve diagnostics in the context of caries treatment and restorative dentistry [Zehnder et al, 2011;Rechenberg and Zehnder, 2014]. This method appears to be especially promising to further the concept of indirect pulp capping in teeth with caries that appears close to the pulp space on the radiograph [Leksell et al, 1996;Bjorndal et al, 2010].…”