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Research Articles
Evaluation of mineral induction ability and cytotoxicity of carbonated hydroxyapatite for pulp tissue regeneration: an in vitro study
S. Swathi Priyadharshini, Chinnasamy Ragavendran, Anand Sherwood, J. Ramana Ramya, Jogikalmat Krithikadatta
Restor Dent Endod 2024;49(4):e40.   Published online October 29, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e40
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to evaluate carbonated hydroxyapatite (CHA)’s ability for mineral induction and its in vitro cytotoxicity with human dental pulp cells.

Materials and Methods

Precursors for the study include di-ammonium hydrogen phosphate and calcium nitrate tetrahydrate, with sodium hydrogen carbonate added to achieve different levels of carbonate substitution. The synthesized CHA samples are characterized using X-ray diffraction, Fourier transform infrared spectroscopy, and Raman spectroscopy. Scanning electron microscopy (SEM) was used to observe morphology. For 14 days at 37°C, samples were submerged in simulated body fluid to assess their mineral induction capabilities. SEM was used to confirm apatite formation on sample surfaces. The cytotoxicity assay was used to assess the vitality of the cells following their exposure to various concentrations of CHA.

Results

The Joint Committee on Powder Diffraction Standards data for HA aligned well with the results from X-ray diffraction analysis of CHA across 3 different concentrations, indicating strong agreement. Fourier transform infrared spectra indicated the presence of phosphate, hydroxyl, and carbonate groups within the samples. SEM and Energy-dispersive X-ray analysis show agglomerated and flaky nanoparticles. All the samples are bioactive, but the formation of apatite differs from one another. In vitro cytotoxicity assay showed that over 70% of cells maintain viability.

Conclusions

The results of this study may provide insight into the potential use of carbonated HA as a dental pulp-capping material for vital pulp therapy.

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Endodontic characteristics of mandibular premolar with dens evaginatus: a retrospective study
Minjin Kim, Sujin Jeon, Min-Seock Seo
Restor Dent Endod 2024;49(3):e28.   Published online July 11, 2024
DOI: https://doi.org/10.5395/rde.2024.49.e28
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to investigate the endodontic characteristics of mandibular premolars with dens evaginatus (DE) that require endodontic treatment.

Materials and Methods

Patients who underwent endodontic treatment were enrolled. The inclusion criteria were patients who underwent root canal treatment in the lower permanent teeth with DE and were followed up for at least 1 year. Preoperative clinical and radiographic variables were obtained. The frequency distribution of the preoperative variables was compared using the χ2 or Fisher’s exact tests. The significance of the change in periapical health index (PAI) and root development stages before and after treatment was examined using the Wilcoxon signed-rank test.

Results

A total of 150 teeth of 134 patients with an average age of 15.3 years were included. The percentage distribution comparison of the preoperative variables and obturation techniques revealed significant differences in pulpal and periapical diagnosis, and percussion, and especially regarding age, root development stage, and PAI. Age was the only statistically significant preoperative variable associated with root growth (p < 0.05).

Conclusions

Approximately, 60% of DEs requiring endodontic treatment had immature roots. Age being the most significant predisposing factor, early treatment provides the greatest opportunity for full root development.

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Can different agents reduce the damage caused by bleaching gel to pulp tissue? A systematic review of basic research
Letícia Aparecida Silva Batista, Alexandre Henrique dos Reis-Prado, Hebertt Gonzaga dos Santos Chaves, Lara Cancella de Arantes, Luís Fernando Santos Alves Morgan, Carolina Bosso André, Thaís Yumi Suzuki, Francine Benetti
Restor Dent Endod 2023;48(4):e39.   Published online November 6, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e39
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Objectives

This study aimed to investigate the effectiveness of different topical/systemic agents in reducing the damage caused by bleaching gel to pulp tissue or cells.

Materials and Methods

Electronic searches were performed in July 2023. In vivo and in vitro studies evaluating the effects of different topical or systemic agents on pulp inflammation or cytotoxicity after exposure to bleaching agents were included. The risk of bias was assessed.

Results

Out of 1,112 articles, 27 were included. Nine animal studies evaluated remineralizing/anti-inflammatories agents in rat molars subjected to bleaching with 35%–38% hydrogen peroxide (HP). Five of these studies demonstrated a significant reduction in inflammation caused by HP when combined with bioglass or MI Paste Plus (GC America), or following KF-desensitizing or Otosporin treatment (n = 3). However, orally administered drugs did not reduce pulp inflammation (n = 4). Cytotoxicity (n = 17) was primarily assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay on human dental pulp cells and mouse dental papilla Cell-23 cells. Certain substances, including sodium ascorbate, butein, manganese chloride, and peroxidase, were found to reduce cytotoxicity, particularly when applied prior to bleaching. The risk of bias was high in animal studies and low in laboratory studies.

Conclusions

Few in vivo studies have evaluated agents to reduce the damage caused by bleaching gel to pulp tissue. Within the limitations of these studies, it was found that topical agents were effective in reducing pulp inflammation in animals and cytotoxicity. Further analyses with human pulp are required to substantiate these findings.

Trial Registration

PROSPERO Identifier: CRD42022337192

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Review Article
Stem cell-derived exosomes for dentin-pulp complex regeneration: a mini-review
Dina A. Hammouda, Alaa M Mansour, Mahmoud A. Saeed, Ahmed R. Zaher, Mohammed E. Grawish
Restor Dent Endod 2023;48(2):e20.   Published online May 3, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e20
AbstractAbstract PDFPubReaderePub

This mini-review was conducted to present an overview of the use of exosomes in regenerating the dentin-pulp complex (DPC). The PubMed and Scopus databases were searched for relevant articles published between January 1, 2013 and January 1, 2023. The findings of basic in vitro studies indicated that exosomes enhance the proliferation and migration of mesenchymal cells, as human dental pulp stem cells, via mitogen-activated protein kinases and Wingless-Int signaling pathways. In addition, they possess proangiogenic potential and contribute to neovascularization and capillary tube formation by promoting endothelial cell proliferation and migration of human umbilical vein endothelial cells. Likewise, they regulate the migration and differentiation of Schwann cells, facilitate the conversion of M1 pro-inflammatory macrophages to M2 anti-inflammatory phenotypes, and mediate immune suppression as they promote regulatory T cell conversion. Basic in vivo studies have indicated that exosomes triggered the regeneration of dentin-pulp–like tissue, and exosomes isolated under odontogenic circumstances are particularly strong inducers of tissue regeneration and stem cell differentiation. Exosomes are a promising regenerative tool for DPC in cases of small pulp exposure or for whole-pulp tissue regeneration.

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Research Articles
Effects of CTHRC1 on odontogenic differentiation and angiogenesis in human dental pulp stem cells
Jong-soon Kim, Bin-Na Lee, Hoon-Sang Chang, In-Nam Hwang, Won-Mann Oh, Yun-Chan Hwang
Restor Dent Endod 2023;48(2):e18.   Published online April 28, 2023
DOI: https://doi.org/10.5395/rde.2023.48.e18
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to determine whether collagen triple helix repeat containing-1 (CTHRC1), which is involved in vascular remodeling and bone formation, can stimulate odontogenic differentiation and angiogenesis when administered to human dental pulp stem cells (hDPSCs).

Materials and Methods

The viability of hDPSCs upon exposure to CTHRC1 was assessed with the WST-1 assay. CTHRC1 doses of 5, 10, and 20 µg/mL were administered to hDPSCs. Reverse-transcription polymerase reaction was used to detect dentin sialophosphoprotein, dentin matrix protein 1, vascular endothelial growth factor, and fibroblast growth factor 2. The formation of mineralization nodules was evaluated using Alizarin red. A scratch wound assay was conducted to evaluate the effect of CTHRC1 on cell migration. Data were analyzed using 1-way analysis of variance followed by the Tukey post hoc test. The threshold for statistical significance was set at p < 0.05.

Results

CTHRC1 doses of 5, 10, and 20 µg/mL had no significant effect on the viability of hDPSCs. Mineralized nodules were formed and odontogenic markers were upregulated, indicating that CTHRC1 promoted odontogenic differentiation. Scratch wound assays demonstrated that CTHRC1 significantly enhanced the migration of hDPSCs.

Conclusions

CTHRC1 promoted odontogenic differentiation and mineralization in hDPSCs.

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Combination of a new ultrasonic tip with rotary systems for the preparation of flattened root canals
Karina Ines Medina Carita Tavares, Jáder Camilo Pinto, Airton Oliveira Santos-Junior, Fernanda Ferrari Esteves Torres, Juliane Maria Guerreiro-Tanomaru, Mario Tanomaru-Filho
Restor Dent Endod 2021;46(4):e56.   Published online October 27, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e56
AbstractAbstract PDFPubReaderePub
Objectives

This study evaluated 2 nickel-titanium rotary systems and a complementary protocol with an ultrasonic tip and a small-diameter instrument in flattened root canals.

Materials and Methods

Thirty-two human maxillary second premolars with flattened canals (buccolingual diameter ≥4 times larger than the mesiodistal diameter) at 9 mm from the radiographic apex were selected. The root canals were prepared by ProDesign Logic (PDL) 30/0.01 and 30/0.05 or Hyflex EDM (HEDM) 10/0.05 and 25/0.08 (n = 16), followed by application of the Flatsonic ultrasonic tip in the cervical and middle thirds and a PDL 25/0.03 file in the apical third (FPDL). The teeth were scanned using micro-computed tomography before and after the procedures. The percentage of volume increase, debris, and uninstrumented surface area were analyzed using the Kruskal-Wallis, Dunn, Wilcoxon, analysis of variance/Tukey, and paired and unpaired t-tests (α = 0.05).

Results

No significant difference was found in the volume increase and uninstrumented surface area between PDL and HEDM (p > 0.05). PDL had a higher percentage of debris than HEDM in the middle and apical thirds (p < 0.05). The FPDL protocol resulted in less debris and uninstrumented surface area for PDL and HEDM (p < 0.05). This protocol, with HEDM, reduced debris in the middle and apical thirds and uninstrumented surface area in the apical third (p < 0.05).

Conclusions

High percentages of debris and uninstrumented surface area were observed after preparation of flattened root canals. The HEDM, Flatsonic tip, and 25/0.03 instrument protocol enhanced cleaning in flattened root canals.

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The effectiveness of the supplementary use of the XP-endo Finisher on bacteria content reduction: a systematic review and meta-analysis
Ludmila Smith de Jesus Oliveira, Rafaella Mariana Fontes de Bragança, Rafael Sarkis-Onofre, André Luis Faria-e-Silva
Restor Dent Endod 2021;46(3):e37.   Published online June 18, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e37
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Objectives

This systematic review evaluated the efficacy of the supplementary use of the XP-endo Finisher on bacteria content reduction in the root canal system.

Materials and Methods

In-vitro studies evaluating the use of the XP-endo Finisher on bacteria content were searched in four databases in July 2020. Two authors independently screened the studies for eligibility. Data were extracted, and risk of bias was assessed. Data were meta-analyzed by using random-effects model to compare the effect of the supplementary use (experimental) or not (control) of the XP-endo Finisher on bacteria counting reduction, and results from different endodontic protocols were combined. Four studies met the inclusion criteria while 1 study was excluded from the meta-analysis due to its high risk of bias and outlier data. The 3 studies that made it to the meta-analysis had an unclear risk of bias for at least one criterion.

Results

No heterogeneity was observed among the results of the studies included in the meta-analysis. The study excluded from the meta-analysis assessing the bacteria counting deep in the dentin demonstrated further bacteria reduction upon the use of the XP-endo Finisher.

Conclusions

This systematic review found no evidence supporting the supplementary use of the XP-endo Finisher on further bacteria counting the reduction in the root canal.

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Evaluation of the relation between the pulp stones and direct restorations using cone beam computed tomography in a Turkish subpopulation
Güzide Pelin Sezgin, Sema Sönmez Kaplan, Tuna Kaplan
Restor Dent Endod 2021;46(3):e34.   Published online June 8, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e34
AbstractAbstract PDFPubReaderePub
Objectives

This study aimed to assess the presence of pulp stones through an examination of cone beam computed tomography images and correlate their prevalence with age, sex, dental arch and side, tooth type, and restoration type and depth.

Materials and Methods

Cone beam computed tomography images obtained from 673 patients and archival data on 11,494 teeth were evaluated. The associations of pulp stones with age, sex, dental arch and side, tooth type, and restoration type and depth were noted. All the measurements were subjected to a χ2 test and one sample χ2 test (p < 0.05).

Results

In the study group, 163 (24.2%) patients and 379 (3.3%) teeth had at least one pulp stone. The pulp stone frequency in those aged 30–39 years was significantly greater than in those aged 18–29 and ≥ 60 years, and the frequency was higher in females than in males (p < 0.05). The highest prevalence of pulp stones was found in maxillary dental arches and molar teeth (p < 0.05). Pulp stones were significantly more common in medium-depth restorations (p < 0.05).

Conclusions

Maxillary molar teeth, medium-depth restorations, individuals aged 30–39 years and females had a greater percentage of pulp stones.

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Cryopreservation of mesenchymal stem cells derived from dental pulp: a systematic review
Sabrina Moreira Paes, Yasmine Mendes Pupo, Bruno Cavalini Cavenago, Thiago Fonseca-Silva, Carolina Carvalho de Oliveira Santos
Restor Dent Endod 2021;46(2):e26.   Published online April 29, 2021
DOI: https://doi.org/10.5395/rde.2021.46.e26
AbstractAbstract PDFPubReaderePub
Objectives

The aim of the present systematic review was to investigate the cryopreservation process of dental pulp mesenchymal stromal cells and whether cryopreservation is effective in promoting cell viability and recovery.

Materials and Methods

This systematic review was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the research question was determined using the population, exposure, comparison, and outcomes strategy. Electronic searches were conducted in the PubMed, Cochrane Library, Science Direct, LILACS, and SciELO databases and in the gray literature (dissertations and thesis databases and Google Scholar) for relevant articles published up to March 2019. Clinical trial studies performed with dental pulp of human permanent or primary teeth, containing concrete information regarding the cryopreservation stages, and with cryopreservation performed for a period of at least 1 week were included in this study.

Results

The search strategy resulted in the retrieval of 185 publications. After the application of the eligibility criteria, 21 articles were selected for a qualitative analysis.

Conclusions

The cryopreservation process must be carried out in 6 stages: tooth disinfection, pulp extraction, cell isolation, cell proliferation, cryopreservation, and thawing. In addition, it can be inferred that the use of dimethyl sulfoxide, programmable freezing, and storage in liquid nitrogen are associated with a high rate of cell viability after thawing and a high rate of cell proliferation in both primary and permanent teeth.

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Reference values for pulp oxygen saturation as a diagnostic tool in endodontics: a systematic review and meta-analysis
Paula Lambert, Sergio Augusto Quevedo Miguens, Caroline Solda, Juliana Tomaz Sganzerla, Leandro Azambuja Reichert, Carlos Estrela, Fernando Branco Barletta
Restor Dent Endod 2020;45(4):e48.   Published online October 5, 2020
DOI: https://doi.org/10.5395/rde.2020.45.e48
AbstractAbstract PDFPubReaderePub
Objectives

This systematic review aimed to identify mean oxygen saturation values (SpO2) using pulse oximetry in permanent maxillary anterior teeth.

Materials and Methods

The MEDLINE, Scientific Electronic Library Online, Cochrane Central Register of Controlled Trials, EMBASE, and Literatura Latino Americana em Ciências da Saúde electronic databases were searched. Combinations and variations of “oximetry” AND “dental pulp test” were used as search terms. Studies reporting means and standard deviations of SpO2 values were included. Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Heterogeneity was assessed using the I2 statistic, and all analyses were performed using R software. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa scale.

Results

Of the 251 studies identified, 19 met the eligibility criteria and were included (total sample, 4,541 teeth). In the meta-analysis, the mean SpO2 values were 84.94% (95% confidence interval [CI], 84.85%–85.04%) for the central incisors, 89.29% (95% CI, 89.22%–89.35%) for the lateral incisors, and 89.20% (95% CI, 89.05%–89.34%) for the canines. The studies were predominantly low-quality due to the high risk of bias associated with the index test, unclear risk regarding patient selection, and concerns about outcome assessment.

Conclusions

Although most studies were low-quality, the oxygen saturation levels in normal pulp could be established (minimum saturation, 77.52%). Despite the risk of bias of the included studies, the reference values reported herein are clinically relevant for assessments of changes in pulp status.

Trial Registration

International Prospective Register of Systematic Reviews Identifier: CRD42018085598

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Bioactivity of endodontic biomaterials on dental pulp stem cells through dentin
Bahar Javid, Narges Panahandeh, Hassan Torabzadeh, Hamid Nazarian, Ardavan Parhizkar, Saeed Asgary
Restor Dent Endod 2020;45(1):e3.   Published online November 4, 2019
DOI: https://doi.org/10.5395/rde.2020.45.e3
AbstractAbstract PDFPubReaderePub
Objectives

This study investigated the indirect effect of calcium-enriched mixture (CEM) cement and mineral trioxide aggregate (MTA), as 2 calcium silicate-based hydraulic cements, on human dental pulp stem cells (hDPSCs) through different dentin thicknesses.

Materials and Methods

Two-chamber setups were designed to simulate indirect pulp capping (IPC). Human molars were sectioned to obtain 0.1-, 0.3-, and 0.5-mm-thick dentin discs, which were placed between the 2 chambers to simulate an IPC procedure. Then, MTA and CEM were applied on one side of the discs, while hDPSCs were cultured on the other side. After 2 weeks of incubation, the cells were removed, and cell proliferation, morphology, and attachment to the discs were evaluated under scanning electron microscopy (SEM). Energy-dispersive X-ray (EDXA) spectroscopy was performed for elemental analysis. Alkaline phosphatase (ALP) activity was assessed quantitatively. The data were analyzed using the Kruskal-Wallis and Mann-Whitney tests.

Results

SEM micrographs revealed elongated cells, collagen fibers, and calcified nucleations in all samples. EDXA verified that the calcified nucleations consisted of calcium phosphate. The largest calcifications were seen in the 0.1-mm-thick dentin subgroups. There was no significant difference in ALP activity across the CEM subgroups; however, ALP activity was significantly lower in the 0.1-mm-thick dentin subgroup than in the other MTA subgroups (p < 0.05).

Conclusions

The employed capping biomaterials exerted biological activity on hDPSCs, as shown by cell proliferation, morphology, and attachment and calcific precipitations, through 0.1- to 0.5-mm-thick layers of dentin. In IPC, the bioactivity of these endodontic biomaterials is probably beneficial.

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Case Report
A case report of multiple bilateral dens invaginatus in maxillary anteriors
Shin Hye Chung, You-Jeong Hwang, Sung-Yeop You, Young-Hye Hwang, Soram Oh
Restor Dent Endod 2019;44(4):e39.   Published online October 21, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e39
AbstractAbstract PDFPubReaderePub

The present report presents a case of dens invaginatus (DI) in a patient with 4 maxillary incisors. A 24-year-old female complained of swelling of the maxillary left anterior region and discoloration of the maxillary left anterior tooth. The maxillary left lateral incisor (tooth #22) showed pulp necrosis and a chronic apical abscess, and a periapical X-ray demonstrated DI on bilateral maxillary central and lateral incisors. All teeth responded to a vitality test, except tooth #22. The anatomic form of tooth #22 was similar to that of tooth #12, and both teeth had lingual pits. In addition, panoramic and periapical X-rays demonstrated root canal calcification, such as pulp stones, in the maxillary canines, first and second premolars, and the mandibular incisors, canines, and first premolars bilaterally. The patient underwent root canal treatment of tooth #22 and non-vital tooth bleaching. After a temporary filling material was removed, the invaginated mass was removed using ultrasonic tips under an operating microscope. The working length was established, and the root canal was enlarged up to #50 apical size and obturated with gutta-percha and AH 26 sealer using the continuous wave of condensation technique. Finally, non-vital bleaching was performed, and the access cavity was filled with composite resin.

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Research Articles
Development of a mouse model for pulp-dentin complex regeneration research: a preliminary study
Sunil Kim, Sukjoon Lee, Han-Sung Jung, Sun-Young Kim, Euiseong Kim
Restor Dent Endod 2019;44(2):e20.   Published online May 7, 2019
DOI: https://doi.org/10.5395/rde.2019.44.e20
AbstractAbstract PDFPubReaderePub
Objectives

To achieve pulp-dentin complex regeneration with tissue engineering, treatment efficacies and safeties should be evaluated using in vivo orthotopic transplantation in a sufficient number of animals. Mice have been a species of choice in which to study stem cell biology in mammals. However, most pulp-dentin complex regeneration studies have used large animals because the mouse tooth is too small. The purpose of this study was to demonstrate the utility of the mouse tooth as a transplantation model for pulp-dentin complex regeneration research.

Materials and Methods

Experiments were performed using 7-week-old male Institute of Cancer Research (ICR) mice; a total of 35 mice had their pulp exposed, and 5 mice each were sacrificed at 1, 2, 4, 7, 9, 12 and 14 days after pulp exposure. After decalcification in 5% ethylenediaminetetraacetic acid, the samples were embedded and cut with a microtome and then stained with hematoxylin and eosin. Slides were observed under a high-magnification light microscope.

Results

Until 1 week postoperatively, the tissue below the pulp chamber orifice appeared normal. The remaining coronal portion of the pulp tissue was inflammatory and necrotic. After 1 week postoperatively, inflammation and necrosis were apparent in the root canals inferior to the orifices. The specimens obtained after experimental day 14 showed necrosis of all tissue in the root canals.

Conclusions

This study could provide opportunities for researchers performing in vivo orthotopic transplantation experiments with mice.

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Effects of the exposure site on histological pulpal responses after direct capping with 2 calcium-silicate based cements in a rat model
Panruethai Trongkij, Supachai Sutimuntanakul, Puangwan Lapthanasupkul, Chitpol Chaimanakarn, Rebecca Wong, Danuchit Banomyong
Restor Dent Endod 2018;43(4):e36.   Published online August 22, 2018
DOI: https://doi.org/10.5395/rde.2018.43.e36
AbstractAbstract PDFPubReaderePub
Objectives

Direct pulp capping is a treatment for mechanically exposed pulp in which a biocompatible capping material is used to preserve pulpal vitality. Biocompatibility tests in animal studies have used a variety of experimental protocols, particularly with regard to the exposure site. In this study, pulp exposure on the occlusal and mesial surfaces of molar teeth was investigated in a rat model.

Materials and Methods

A total of 58 maxillary first molars of Wistar rats were used. Forty molars were mechanically exposed and randomly assigned according to 3 factors: 1) the exposure site (occlusal or mesial), 2) the pulp-capping material (ProRoot White MTA or Bio-MA), and 3) 2 follow-up periods (1 day or 7 days) (n = 5 each). The pulp of 6 intact molars served as negative controls. The pulp of 12 molars was exposed without a capping material (n = 3 per exposure site for each period) and served as positive controls. Inflammatory cell infiltration and reparative dentin formation were histologically evaluated at 1 and 7 days using grading scores.

Results

At 1 day, localized mild inflammation was detected in most teeth in all experimental groups. At 7 days, continuous/discontinuous calcified bridges were formed at exposure sites with no or few inflammatory cells. No significant differences in pulpal response according to the exposure site or calcium-silicate cement were observed.

Conclusions

The location of the exposure site had no effect on rat pulpal healing. However, mesial exposures could be performed easily, with more consistent results. The pulpal responses were not significantly different between the 2 capping materials.

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In vivo assessment of accuracy of Propex II, Root ZX II, and radiographic measurements for location of the major foramen
Fernanda Garcia Tampelini, Marcelo Santos Coelho, Marcos de Azevêdo Rios, Carlos Eduardo Fontana, Daniel Guimarães Pedro Rocha, Sergio Luiz Pinheiro, Carlos Eduardo da Silveira Bueno
Restor Dent Endod 2017;42(3):200-205.   Published online May 16, 2017
DOI: https://doi.org/10.5395/rde.2017.42.3.200
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this in vivo study was to assess the accuracy of 2 third-generation electronic apex locators (EALs), Propex II (Dentsply Maillefer) and Root ZX II (J. Morita), and radiographic technique for locating the major foramen (MF).

Materials and Methods

Thirty-two premolars with single canals that required extraction were included. Following anesthesia, access, and initial canal preparation with size 10 and 15 K-flex files and SX and S1 rotary ProTaper files, the canals were irrigated with 2.5% sodium hypochlorite. The length of the root canal was verified 3 times for each tooth using the 2 apex locators and once using the radiographic technique. Teeth were extracted and the actual WL was determined using size 15 K-files under a × 25 magnification. The Biostat 4.0 program (AnalystSoft Inc.) was used for comparing the direct measurements with those obtained using radiographic technique and the apex locators. Pearson's correlation analysis and analysis of variance (ANOVA) were used for statistical analyses.

Results

The measurements obtained using the visual method exhibited the strongest correlation with Root ZX II (r = 0.94), followed by Propex II (r = 0.90) and Ingle's technique (r = 0.81; p < 0.001). Descriptive statistics using ANOVA (Tukey's post hoc test) revealed significant differences between the radiographic measurements and both EALs measurements (p < 0.05).

Conclusions

Both EALs presented similar accuracy that was higher than that of the radiographic measurements obtained with Ingle's technique. Our results suggest that the use of these EALs for MF location is more accurate than the use of radiographic measurements.

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In vitro characterization of human dental pulp stem cells isolated by three different methods
Ji-Hyun Jang, Hyeon-Woo Lee, Kyu Min Cho, Hee-Woong Shin, Mo Kwan Kang, Sang Hyuk Park, Euiseong Kim
Restor Dent Endod 2016;41(4):283-295.   Published online October 12, 2016
DOI: https://doi.org/10.5395/rde.2016.41.4.283
AbstractAbstract PDFPubReaderePub
Objectives

In this study, we characterized human dental pulp cells (HDPCs) obtained by different culture methods to establish the most suitable methodology for dental tissue engineering and regenerative endodontic applications.

Materials and Methods

HDPCs were isolated by the outgrowth method (HDPCs-OG), the enzymatic digestion method (collagenase/dispase/trypsin, HDPCs-ED), or the combination of both methods (HDPCs-Combined). The expression of mesenchymal stem cell markers (CD105, CD90, and CD73) was investigated. In vitro differentiation capacities of HDPCs into adipogenic, osteogenic, and chondrogenic lineages were compared. Differentiation markers were analyzed by quantitative reverse-transcription polymerase chain reaction (RT-PCR) and western blotting.

Results

Our data indicated that whole HDPCs-ED, HPDCs-OG, and HDPCs-Combined could be differentiated into adipogenic, chrondrogenic, and osteogenic cell types. However, we found that the methods for isolating and culturing HDPCs influence the differentiation capacities of cells. HDPCs-OG and HDPCs-ED were preferably differentiated into adipogenic and osteogenic cells, respectively. Differentiation markers shown by RT-PCR and western blotting analysis were mostly upregulated in the treated groups compared with the control groups.

Conclusions

Our findings confirmed that cell populations formed by two different culture methods and the combined culture method exhibited different properties. The results of this study could provide an insight into regenerative endodontic treatment using HDPCs.

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Involvement of TRPA1 in the cinnamaldehyde-induced pulpal blood flow change in the feline dental pulp
Dokyung Kim, Moon-Hwan Lee, Sung Kyo Kim
Restor Dent Endod 2016;41(3):202-209.   Published online July 29, 2016
DOI: https://doi.org/10.5395/rde.2016.41.3.202
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to investigate the involvement of TRPA1 in the cinnamaldehyde-induced pulpal blood flow (PBF) change in the feline dental pulp.

Materials and Methods

Mandibles of eight cats were immobilized and PBF was monitored with a laser Doppler flowmetry at the mandibular canine tooth. To evaluate the effect of cinnamaldehyde on PBF, cinnamaldehyde was injected into the pulp through the lingual artery at a constant rate for 60 seconds. As a control, a mixture of 70% ethanol and 30% dimethyl sulfoxide (DMSO, vehicle) was used. To evaluate the involvement of transient receptor potential ankyrin 1 (TRPA1) in PBF change, AP18, a specific TRPA1 antagonist, was applied into the pulp through the Class V dentinal cavity followed by cinnamaldehyde-administration 3 minutes later. The paired variables of experimental data were statistically analyzed using paired t-test. A p value of less than 0.05 was considered as statistically significant.

Results

Administration of cinnamaldehyde (0.5 mg/kg, intra-arterial [i.a.]) induced significant increases in PBF (p < 0.05). While administration of a TRPA1 antagonist, AP18 (2.5 - 3.0 mM, into the dentinal cavity [i.c.]) caused insignificant change of PBF (p > 0.05), administration of cinnamaldehyde (0.5 mg/kg, i.a.) following the application of AP18 (2.5 - 3.0 mM, i.c.) resulted in an attenuation of PBF increase from the control level (p < 0.05). As a result, a TRPA1 antagonist, AP18 effectively inhibited the vasodilative effect of cinnamaldehyde (p < 0.05).

Conclusions

The result of the present study provided a functional evidence that TRPA1 is involved in the mechanism of cinnamaldehyde-induced vasodilation in the feline dental pulp.

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Antioxidant therapy enhances pulpal healing in bleached teeth
Adriano Fonseca Lima, Marcelo Rocha Marques, Diana Gabriela Soares, Josimeri Hebling, Giselle Maria Marchi, Carlos Alberto de Souza Costa
Restor Dent Endod 2016;41(1):44-54.   Published online February 1, 2016
DOI: https://doi.org/10.5395/rde.2016.41.1.44
AbstractAbstract PDFPubReaderePub
Objectives

The purpose of this study was to evaluate the histopathological effects of an antioxidant therapy on the pulp tissue of rat teeth exposed to a bleaching gel with 35% hydrogen peroxide.

Materials and Methods

Forty rats were subjected to oral ingestion by gavage of distilled water (DW) or ascorbic acid (AA) 90 min before the bleaching therapy. For the bleaching treatment, the agent was applied twice for 5 min each to buccal surfaces of the first right mandibular molars. Then, the animals were sacrificed at 6 hr, 24 hr, 3 day, or 7 day post-bleaching, and the teeth were processed for microscopic evaluation of the pulp tissue.

Results

At 6 hr, the pulp tissue showed moderate inflammatory reactions in all teeth of both groups. In the DW and AA groups, 100% and 80% of teeth exhibited pulp tissue with significant necrosis and intense tissue disorganization, respectively. At 24 hr, the AA-treated group demonstrated a greater regenerative capability than the DW group, with less intense inflammatory reaction and new odontoblast layer formation in 60% of the teeth. For up to the 7 day period, the areas of pulpal necrosis were replaced by viable connective tissue, and the dentin was underlined by differentiated odontoblast-like cells in most teeth of both groups.

Conclusions

A slight reduction in initial pulpal damage during post-bleaching was promoted by AA therapy. However, the pulp tissue of AA-treated animals featured faster regenerative potential over time.

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Effect of dentin treatment on proliferation and differentiation of human dental pulp stem cells
Minjeong Park, Nan-Sim Pang, Il-Young Jung
Restor Dent Endod 2015;40(4):290-298.   Published online September 23, 2015
DOI: https://doi.org/10.5395/rde.2015.40.4.290
AbstractAbstract PDFPubReaderePub
Objectives

Sodium hypochlorite (NaOCl) is an excellent bactericidal agent, but it is detrimental to stem cell survival, whereas intracanal medicaments such as calcium hydroxide (Ca[OH]2) promote the survival and proliferation of stem cells. This study evaluated the effect of sequential NaOCl and Ca[OH]2 application on the attachment and differentiation of dental pulp stem cells (DPSCs).

Materials and Methods

DPSCs were obtained from human third molars. All dentin specimens were treated with 5.25% NaOCl for 30 min. DPSCs were seeded on the dentin specimens and processed with additional 1 mg/mL Ca[OH]2, 17% ethylenediaminetetraacetic acid (EDTA) treatment, file instrumentation, or a combination of these methods. After 7 day of culture, we examined DPSC morphology using scanning electron microscopy and determined the cell survival rate with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. We measured cell adhesion gene expression levels after 4 day of culture and odontogenic differentiation gene expression levels after 4 wk using quantitative real-time polymerase chain reaction.

Results

DPSCs did not attach to the dentin in the NaOCl-treated group. The gene expression levels of fibronectin-1 and secreted phosphoprotein-1 gene in both the Ca[OH]2- and the EDTA-treated groups were significantly higher than those in the other groups. All Ca[OH]2-treated groups showed higher expression levels of dentin matrix protein-1 than that of the control. The dentin sialophosphoprotein level was significantly higher in the groups treated with both Ca[OH]2 and EDTA.

Conclusions

The application of Ca[OH]2 and additional treatment such as EDTA or instrumentation promoted the attachment and differentiation of DPSCs after NaOCl treatment.

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Changes in SIRT gene expression during odontoblastic differentiation of human dental pulp cells
Young-Eun Jang, Su-Hee Go, Bin-Na Lee, Hoon-Sang Chang, In-Nam Hwang, Won-Mann Oh, Yun-Chan Hwang
Restor Dent Endod 2015;40(3):223-228.   Published online July 15, 2015
DOI: https://doi.org/10.5395/rde.2015.40.3.223
AbstractAbstract PDFPubReaderePub
Objectives

The aim of this study was to investigate the expression of 7 different sirtuin genes (SIRT1-SIRT7) in human dental pulp cells (HDPCs), and to determine the role of SIRTs in the odontoblastic differentiation potential of HDPCs.

Materials and Methods

HDPCs were isolated from freshly extracted third molar teeth of healthy patients and cultulred in odontoblastic differentiation inducing media. Osteocalcin (OCN) and dentin sialophosphoprotein (DSPP) expression was analyzed to evaluate the odontoblastic differentiation of HDPCs by reverse transcription-polymerase chain reaction (RT-PCR), while alizarin red staining was used for the mineralization assay. To investigate the expression of SIRTs during odontoblastic differentiation of HDPCs, real time PCR was also performed with RT-PCR.

Results

During the culture of HDPCs in the differentiation inducing media, OCN, and DSPP mRNA expressions were increased. Mineralized nodule formation was also increased in the 14 days culture. All seven SIRT genes were expressed during the odontogenic induction period. SIRT4 expression was increased in a time-dependent manner.

Conclusions

Our study identified the expression of seven different SIRT genes in HDPCs, and revealed that SIRT4 could exert an influence on the odontoblast differentiation process. Further studies are needed to determine the effects of other SIRTs on the odontogenic potential of HDPCs.

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Review Article
Epigenetics: general characteristics and implications for oral health
Ji-Yun Seo, Yoon-Jung Park, Young-Ah Yi, Ji-Yun Hwang, In-Bog Lee, Byeong-Hoon Cho, Ho-Hyun Son, Deog-Gyu Seo
Restor Dent Endod 2015;40(1):14-22.   Published online November 13, 2014
DOI: https://doi.org/10.5395/rde.2015.40.1.14
AbstractAbstract PDFPubReaderePub

Genetic information such as DNA sequences has been limited to fully explain mechanisms of gene regulation and disease process. Epigenetic mechanisms, which include DNA methylation, histone modification and non-coding RNAs, can regulate gene expression and affect progression of disease. Although studies focused on epigenetics are being actively investigated in the field of medicine and biology, epigenetics in dental research is at the early stages. However, studies on epigenetics in dentistry deserve attention because epigenetic mechanisms play important roles in gene expression during tooth development and may affect oral diseases. In addition, understanding of epigenetic alteration is important for developing new therapeutic methods. This review article aims to outline the general features of epigenetic mechanisms and describe its future implications in the field of dentistry.

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Case Report
Necrosis of intact premolar caused by an adjacent apical infection: a case report
Saeed Asgary, Laleh Alim Marvasti
Restor Dent Endod 2013;38(2):90-92.   Published online May 28, 2013
DOI: https://doi.org/10.5395/rde.2013.38.2.90
AbstractAbstract PDFPubReaderePub

Although periapical inflammatory lesions are usually resulted by infection in the root canal system, this rare case showed that a periapical lesion related to an infected tooth may cause pulpal necrosis in adjacent intact tooth, with no history or clinical signs of caries, disease, trauma or developmental anomaly. This case also suggests that the periapical lesion can be treated conservatively, without surgical intervention. Furthermore, this case highlights the importance of prompt treatment of apical periodontitis before the lesion becomes extensive as well as follows up of large lesions.

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Research Articles
Analysis of gene expression during odontogenic differentiation of cultured human dental pulp cells
Min-Seock Seo, Kyung-Gyun Hwang, Hyongbum Kim, Seung-Ho Baek
Restor Dent Endod 2012;37(3):142-148.   Published online August 29, 2012
DOI: https://doi.org/10.5395/rde.2012.37.3.142
AbstractAbstract PDFPubReaderePub
Objectives

We analyzed gene-expression profiles after 14 day odontogenic induction of human dental pulp cells (DPCs) using a DNA microarray and sought candidate genes possibly associated with mineralization.

Materials and Methods

Induced human dental pulp cells were obtained by culturing DPCs in odontogenic induction medium (OM) for 14 day. Cells exposed to normal culture medium were used as controls. Total RNA was extracted from cells and analyzed by microarray analysis and the key results were confirmed selectively by reverse-transcriptase polymerase chain reaction (RT-PCR). We also performed a gene set enrichment analysis (GSEA) of the microarray data.

Results

Six hundred and five genes among the 47,320 probes on the BeadChip differed by a factor of more than two-fold in the induced cells. Of these, 217 genes were upregulated, and 388 were down-regulated. GSEA revealed that in the induced cells, genes implicated in Apoptosis and Signaling by wingless MMTV integration (Wnt) were significantly upregulated.

Conclusions

Genes implicated in Apoptosis and Signaling by Wnt are highly connected to the differentiation of dental pulp cells into odontoblast.

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Morphological evaluation during in vitro chondrogenesis of dental pulp stromal cells
Choo-Ryung Chung, Ha-Na Kim, Yeul Park, Min-Jeong Kim, Young-Ju Oh, Su-Jung Shin, Yoon-Jeong Choi, Kyung-Ho Kim
Restor Dent Endod 2012;37(1):34-40.   Published online March 2, 2012
DOI: https://doi.org/10.5395/rde.2012.37.1.34
AbstractAbstract PDFPubReaderePub
Objectives

The aim was to confirm the stem cell-like properties of the dental pulp stromal cells and to evaluate the morphologic changes during in vitro chondrogenesis.

Materials and Methods

Stromal cells were outgrown from the dental pulp tissue of the premolars. Surface markers were investigated and cell proliferation rate was compared to other mesenchymal stem cells. Multipotency of the pulp cells was confirmed by inducing osteogenesis, adipogenesis and chondrogenesis. The morphologic changes in the chondrogenic pellet during the 21 day of induction were evaluated under light microscope and transmission electron microscope. TUNEL assay was used to evaluate apoptosis within the chondrogenic pellets.

Results

Pulp cells were CD90, 105 positive and CD31, 34 negative. They showed similar proliferation rate to other stem cells. Pulp cells differentiated to osteogenic, adipogenic and chondrogenic tissues. During chondrogenesis, 3-dimensional pellet was created with multi-layers, hypertrophic chondrocyte-like cells and cartilage-like extracellular matrix. However, cell morphology became irregular and apoptotic cells were increased after 7 day of chondrogenic induction.

Conclusions

Pulp cells indicated mesenchymal stem cell-like characteristics. During the in vitro chondrogenesis, cellular activity was superior during the earlier phase (within 7 day) of differentiation.

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Basic Researchs
Histology of dental pulp healing after tooth replantation in rats
Eun-Jin Go, Han-Seong Jung, Eui-Seong Kim, Il-Young Jung, Seung-Jong Lee
J Korean Acad Conserv Dent 2010;35(4):273-284.   Published online July 31, 2010
DOI: https://doi.org/10.5395/JKACD.2010.35.4.273
AbstractAbstract PDFPubReaderePub

The objective of this study was to observe the histology of dental pulp healing after tooth replantation in rats. The maxillary right first molars of 4-week-old rat were extracted, and then the teeth were repositioned in the original socket. At 3 days after replantation, there was localized inflammatory reaction. But, pulp revasculization and healing had already begun in the root area. At 5 days after replantation, odontoblast-like cells were observed. Tertiary dentin deposition was observed beneath the pulp-dentin border from 1 week after replantation. And tertiary dentin was increased at 2 weeks after replantation. The presence of odontoblast-like cells and the formation of tertiary dentin were continued to 4 weeks after replantation. At 4 weeks after replantation, the deposition of bone-like tissues and cementum-like tissues was observed. This results show that there is a possibility of pulp healing after tooth replantation in rats and the mineralization of tooth can progress. The mineralization of tooth after replantation was initially occurred by the deposition of tertiary dentin, but as time passed, the deposition of bone-like tissues and cementum-like tissues was begun and increased.

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Gene expression profiling in human dental pulp cells treated with mineral trioxide aggregate
Yong-Beom Kim, Won-Jun Shon, WooCheol Lee, Kee-Yeon Kum, Seung-Ho Baek, Kwang-Shik Bae
J Korean Acad Conserv Dent 2010;35(3):152-163.   Published online May 31, 2010
DOI: https://doi.org/10.5395/JKACD.2010.35.3.152
AbstractAbstract PDFPubReaderePub

This study investigated the changes in gene expression when mineral trioxide aggregate (MTA) was applied in vitro to human dental pulp cells (HDPCs). MTA in a teflon tube (diameter 10 mm, height 2 mm) was applied to HDPCs. Empty tube-applied HDPCs were used as negative control. For microarray analysis, total RNA was extracted at 6, 24, and 72 hrs after MTA application. The results were confirmed selectively by performing reverse transcriptase polymerase chain reaction for genes that showed changes of more than two-fold or less than half. Of the 24,546 genes, 109 genes were up-regulated greater than two-fold (e.g., FOSB, THBS1, BHLHB2, EDN1, IL11, FN1, COL10A1, and TUFT1) and 69 genes were down-regulated below 50% (e.g., SMAD6 and DCN). These results suggest that MTA, rather than being a bio-inert material, may have potential to affect the proliferation and differentiation of pulp cells in various ways.

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Original Articles
The comparison of gene expression from human dental pulp cells and periodontal ligament cells
Hyoun So, Sang-Hyuk Park, Gi-Woon Choi
J Korean Acad Conserv Dent 2009;34(5):430-441.   Published online September 30, 2009
DOI: https://doi.org/10.5395/JKACD.2009.34.5.430
AbstractAbstract PDFPubReaderePub

The purpose of this study was to characterize functional distinction between human dental pulp cells(PC) and periodontal ligament cells(PDLC) using cDNA microarray assay and to confirm the results of the microarray assay using RT-PCR. 3 genes out of 51 genes which were found to be more expressed(>2 fold) in PC were selected, and 3 genes out of 19 genes which were found to be more expressed(>2 fold) in PDLC were selected for RT-PCR as well.

According to this study, the results were as follows:

1. From the microarray assay, 51 genes were more expressed (2 fold) from PC than PDLC.

2. RT-PCR confirmed that ITGA4 and TGF β2 were more expressed in PC than in PDLC.

3. From the microarray assay, 19 genes were more expressed (2 fold) from PDLC than PC.

4. RT-PCR confirmed that LUM, WISP1, and MMP1 were more expressed in PDLC than in PC.

From the present study, different expression of the genes between the PC and PDLC were characterized to show the genes which play an important role in dentinogenesis were more expressed from PC than PDLC, while the genes which were related with collagen synthesis were more expressed from PDLC than PC.

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Expression of P2X3 and its colocalization with trpv1 in the human dental pulp
Young Kyung Kim, Sung Kyo Kim
J Korean Acad Conserv Dent 2007;32(6):514-521.   Published online November 30, 2007
DOI: https://doi.org/10.5395/JKACD.2007.32.6.514
AbstractAbstract PDFPubReaderePub

The purinoreceptor, P2X3 is a ligand-gated cation channel activated by extracellular ATP. It has been reported that ATP can be released during inflammation and tissue damage, which in turn may activate P2X3 receptors to initiate nociceptive signals. However, little is known about the contribution of P2X3 to the dental pain during pulpal inflammation. Therefore, the purpose of this study was to investigate the expression of P2X3 and its colocalization with TRPV1 to understand the mechanism of pain transmission through P2X3 in the human dental pulp with double labeling immunofluorescence method.

In the human dental pulp, intense P2X3 immunoreactivity was observed throughout the coronal and radicular pulp. Of all P2X3-positive fibers examined, 79.4% coexpressed TRPV1.

This result suggests that P2X3 along with TRPV1 may be involved in the transmission of pain and potentiation of noxious stimuli during pulpal inflammation.

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REGULATION OF PULPAL MICROCIRCULATION BY CALCITONIN GENE-RELATED PEPTIDE
Sung-Kyo Kim, Young-Kyung Kim, Myoung-Uk Jin
J Korean Acad Conserv Dent 2005;30(6):470-476.   Published online January 14, 2005
DOI: https://doi.org/10.5395/JKACD.2005.30.6.470
AbstractAbstract PDFPubReaderePub
Abstract

The purpose of this study was to investigate the function of calcitonin gene-related peptide (CGRP) in regulatory mechanism of pulpal microcirculation with the aim of elucidating neurogenic inflammation.

Experiments were performed on twelve cats under general anesthesia. CGRP was administered through the femoral vein to see the systemic influence and through the external carotid artery to see the local effect. Sympathetic nerve to the dental pulp was stimulated electrically and pulpal blood flow (PBF) was measured with a laser Doppler flowmeter on the canine teeth to the drug administration. The paired variables of control and experimental data were compared by paired t-test and differences with p < 0.05 were considered statistically significant.

Systemic administration of CGRP (0.3 μg/kg) exerted decreases in systemic blood pressure and caused changes in PBF with an initial increase followed by decrease and a more marked second increase and decrease.

Close intra-arterial (i.a.) injection of CGRP (0.03 μ/kg) resulted in slight PBF increase. The effect of CGRP resulted in no significant increase in PBF in the presence of CGRP8-37.

The electrical stimulation of the sympathetic nerve alone resulted in PBF decreases. The i.a. administration of CGRP following the electrical stimulation of the sympathetic nerve compensated the decreased PBF. Therefore, CGRP effectively blocked the sympathetic nerve stimulation-induced PBF decrease.

Results of the present study have provided evidences that even though the local vasodilatory function of CGRP are weak, CGRP is effectively involved in blocking the vasoconstriction caused by sympathetic nerve stimulation in the feline dental pulp.

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Nitric oxide and dental pulp
Young-Kyung Kim, Sung-Kyo Kim
J Korean Acad Conserv Dent 2002;27(5):543-551.   Published online September 30, 2002
DOI: https://doi.org/10.5395/JKACD.2002.27.5.543
AbstractAbstract PDFPubReaderePub

Nitric oxide (NO) is a small molecule (mol. wt. 30 Da) and oxidative free radical. It is uncharged and can therefore diffuse freely within and between cells across membrane. Such characteristics make it a biologically important messenger in physiologic processes such as neurotransmission and the control of vascular tone. NO is also highly toxic and is known to acts as a mediator of cytotoxicity during host defense.

NO is synthesized by nitric oxide synthase (NOS) through L-arginine/nitric oxide pathway which is a dioxygenation process. NO synthesis involves several participants, three co-substrates, five electrons, five co-factors and two prosthetic groups.

Under normal condition, low levels of NO are synthesized by type I and III NOS for a short period of time and mediates many physiologic processes. Under condition of oxidant stress, high levels of NO are synthesized by type II NOS and inhibits a variety of metabolic processes and can also cause direct damage to DNA. Such interaction result in cytostasis, energy depletion and ultimately cell death. NO has the potential to interact with a variety of intercellular targets producing diverse array of metabolic effects.

It is known that NO is involved in hemodynamic regulation, neurogenic inflammation, re-innervation, management of dentin hypersensitivity on teeth. Under basal condition of pulpal blood flow, NO provides constant vasodilator tone acting against sympathetic vasoconstriction. Substance P, a well known vasodilator, was reported to be mediated partly by NO, while calcitonin-gene related peptide has provided no evidence of its relation with NO.

This review describes the roles of NO in dental pulp in addition to the known general roles of it.

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