搜索结果：Australian endodontic journal : the journal of the Australian Society of Endodontology Inc

BACKGROUND: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3-level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence-based recommendations for the management of patients presenting with pulpal and apical disease. AIM: To develop an S3-level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. METHODS: This S3-level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert-based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. RESULTS: The S3-level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re-evaluations during and after treatment is stressed. CONCLUSION: The first S3-level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available.

Endodontic treatment entails the removal of pulpal tissue, the filing and contouring of root canals, the obturation of the root canal space, and the placement of a permanent replacement for the tooth. The extent to which a person appreciates the essential possibilities of life is defined as quality of life. Oral disorders, including diseaserelated symptoms, can have a substantial influence on people's daily life. As a result, there has been a significant interest in determining the degree to which individual oral disorders impose a weight of illness on afflicted communities and the usefulness of health services in alleviating that burden in recent years. Patient reports of oral health-related quality of life have only lately begun to supplement the limited professional assessment based solely on clinical data. This allows for the creation of treatment regimens that are more closely customized to the preferences and demands of the patients. The purpose of this research is to review the available information about the quality of life and satisfaction outcomes of endodontic treatment. The ability to compare endodontic treatment results to those of other dental and medical procedures, as well as undertake health economic studies, makes determining the impact of endodontic treatment on health-related quality of life appealing. Dental treatment has a substantial impact on overall happiness and quality of life. Treatment with endodontics increases one's quality of life. By stressing the broader personal and societal repercussions of oral diseases and disorders, quality of life instruments and dental satisfaction scores can be used to bring dentistry into line with contemporary ideas of health care.

BACKGROUND: The aim of this cross-sectional observational analytical study was to assess the accuracy and consistency of responses provided by Google Gemini (GG), a free-access high-performance multimodal large language model, to questions related to the European Society of Endodontology position statement on the management of traumatized permanent teeth (MTPT). MATERIALS AND METHODS: Three academic endodontists developed a set of 99 yes/no questions covering all areas of the MTPT. Nine general dentists and 22 endodontic specialists evaluated these questions for clarity and comprehension through an iterative process. Two academic dental trauma experts categorized the knowledge required to answer each question into three levels. The three academic endodontists submitted the 99 questions to the GG, resulting in 297 responses, which were then assessed for accuracy and consistency. Accuracy was evaluated using the Wald binomial method, while the consistency of GG responses was assessed using the kappa-Fleiss coefficient with a confidence interval of 95%. A 5% significance level chi-squared test was used to evaluate the influence of question level of knowledge on accuracy and consistency. RESULTS: The responses generated by Gemini showed an overall moderate accuracy of 80.81%, with no significant differences found between the responses of the academic endodontists. Overall, high consistency (95.96%) was demonstrated, with no significant differences between GG responses across the three accounts. The analysis also revealed no correlation between question level of knowledge and accuracy or consistency, with no significant differences. CONCLUSIONS: The results of this study could significantly impact the potential use of Gemini as a free-access source of information for clinicians in the MTPT.

The main goal of root canal treatment (RCT) is to eradicate or essentially diminish the microbial population within the root canal system and to prevent reinfection by a proper chemo-mechanical preparation and hermetic final obturation of the root canal space. The aim of this study was to assess the quality of the root canal filling and the number of visits needed for completing RCT by operators with different experience, including dentistry students (4th and 5th year), general dental practitioners (GDPs), and endodontists. Data from medical records of 798 patients were analyzed, obtaining 900 teeth and 1773 obturated canals according to the inclusion and exclusion criteria. A similar number of teeth was assessed in each group in terms of density and length of root canal filling and number of visits. The larger number of visits and the lower quality of treatment was observed for 4th year students than for other groups (p < 0.05); in contrast, the endodontists needed the lowest number of visits to complete RCT and more often overfilled teeth than other operator groups (p < 0.05). Interestingly, no statistical difference in quality of root canal filling was noted between 5th year students, GPDs and endodontists. The treatment of lower teeth demanded statistically more visits than that of upper teeth (p < 0.05). The results of the study emphasize that most of the root canal filling performed by operators was considered adequate, regardless of tooth type, files used and number of visits.

OBJECTIVES: This study aimed to compare the effects of three irrigation activation systems (IAS) on postoperative pain (PP) in activating three final irrigants: sodium hypochlorite 5.25%, ethylenediaminetetraacetic acid 17%, and chlorhexidine 2%. MATERIALS AND METHODS: This parallel randomized clinical trial included referred patients with asymptomatic large-sized apical lesion incisors. A standard method was followed in the canal cleaning and shaping for all included patients in the study. Then, the patients were randomly assigned (1:1 allocation) into three groups: G1 (n = 20) with passive ultrasonic irrigation activation; G2 (n = 20) with XP-Endo Finisher file activation; and G3 (n = 20) with diode laser (810 nm) activation. PP was estimated in all groups using a visual analog scale after 1, 3, 7, and 14 days of treatment. Comparisons between the groups were made using the Kruskal-Wallis test, whereas the Mann-Whitney U test was used in the pairwise comparisons. RESULTS: Sixty patients were followed-up in this trial. There were significant differences between the groups in terms of PP After 1, 3, and 7 days of treatment (p = 0.002, p = 0.017, and p = 0.006, respectively). On the first day of treatment, G3 showed the lowest PP compared with G1 and G2 (p = 0.007 and p = 0.001, respectively). On the third day of treatment, G3 showed less PP compared with G2 (p = 0.005). On the seventh day of treatment, G2 showed the highest PP compared with G1 and G3 (p = 0.012 and p = 0.003, respectively). CONCLUSIONS: The XP-Endo Finisher file caused the highest PP level especially in the next day and 3 days of the treatment, whereas the diode laser had the lowest PP level during the first week of treatment. It is noteworthy that PP disappeared completely after 2 weeks of treatment with all three IASs. TRIAL REGISTRATION: The trial was registered in the ISRCTN registry (Trial ID: SRCTN99457940).

BACKGROUND: Preoperative pulpal status may influence the outcomes of root canal treatment (RCTx) according to various measures used. OBJECTIVES: To compare the effectiveness of RCTx of teeth with a vital pulp versus a necrotic pulp, using a range of clinical and patient-related outcomes proposed for the development of S3-level clinical practice guidelines. METHODS: A search was conducted in the PubMed-MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until 29 March 2022. Clinical studies published in the English language comparing the stipulated outcomes of RCTx of teeth with vital versus necrotic pulp were included. The Newcastle-Ottawa Scale was adapted to assess study quality. Effects of pulpal status were estimated and expressed as risk ratio (RR) using fixed- and random-effect meta-analyses. The quality of evidence was assessed through the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: Twenty-eight studies published between 1961 and 2021 were included. Five studies have investigated the "tooth survival" outcome, four reported pulpal status was not a significant predictor, consistent with meta-analysis findings (RR: 1.00; 95% CI: 1.00, 1.00; n = 3). Seven studies reported pulpal status had no significant influence on postoperative pain, regardless of duration after treatment. Sixteen studies have analysed "periapical health," and 11 revealed pulpal status had no significant influence. Meta-analyses revealed the influence was not significant if preoperative periapical radiolucency was absent (RR: 0.95; 95% CI: 0.90, 1.00; n = 9) but significant if it was present (RR: 1.12; 95% CI: 1.05, 1.19; n = 11). Most studies were classified as "some concerns" (n = 17) to "low" (n = 9) risk of bias RoB. DISCUSSION: Evidence is limited and only available for three outcomes when comparing the effectiveness of RCTx in permanent teeth with vital pulp versus pulp necrosis. Nevertheless, the quality of available evidence was moderate to high. The "periapical health" data heterogeneity could be explained by preoperative radiolucency, thus RCTx was found more effective for prevention than the resolution of apical periodontitis. CONCLUSIONS: There was no significant difference in the "tooth survival," "postoperative pain" and "evidence of apical radiolucency" outcomes of RCTx in teeth with vital or necrotic pulps. REGISTRATION: PROSPERO database (CRD42021260280).

Observational studies are non-interventional studies that establish the prevalence and incidence of conditions or diseases in populations or analyse the relationship between health status and other variables. They also facilitate the development of specific research questions for future randomized trials or to answer important scientific questions when trials are not possible to carry out. This article outlines the previously documented consensus-based approach by which the Preferred Reporting items for Observational studies in Endodontics (PROBE) 2023 guidelines were developed. A steering committee of nine members was formed, including the project leaders (PD, VN). The steering committee developed an initial checklist by combining and adapting items from the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as adding several new items specifically for the specialty of Endodontics. The steering committee then established a PROBE Delphi Group (PDG) and a PROBE Online Meeting Group (POMG) to obtain expert input and feedback on the preliminary draft checklist. The PDG members participated in an online Delphi process to reach consensus on the clarity and suitability of the items present in the PROBE checklist. The POMG then held detailed discussions on the PROBE checklist generated through the online Delphi process. This online meeting was held via the Zoom platform on 7th October 2022. Following this meeting, the steering committee revised the PROBE checklist, which was piloted by several authors when preparing a manuscript describing an observational study for publication. The PROBE 2023 checklist consists of 11 sections and 58 items. Authors are now encouraged to adopt the PROBE 2023 guidelines, which will improve the overall reporting quality of observational studies in Endodontics. The PROBE 2023 checklist is freely available and can be downloaded from the PRIDE website (https://pride-endodonticguidelines.org/probe/).

Several papers have been published to illustrate the effectiveness of mineral trioxide aggregate (MTA) as a pulpotomy medicament. Most of these reports do not offer a critical assessment on the data quality. Therefore, this review evaluated whether the currently available evidence is of an appropriate quality to support the long-term effectiveness of MTA as a pulpotomy medicament in primary molars using a standardized assessment criterion. A comprehensive literature search of human clinical outcome studies, which employed MTA as a pulpotomy medicament in primary teeth, was conducted using the MEDLINE database. Two independent observers rated these articles using the standardized assessment criteria. Furthermore, based on the initial sample mentioned in the individual studies and the sample included for the final analysis, the drop-out rates were calculated. Twenty-two studies were included for quality assessment with an excellent interobserver agreement. None of the 22 studies obtained grade A, four studies attained grade B1, five were graded B2 and 13 received grade C. Based on the assessment criteria employed, there was no evidence that MTA was better than present materials and techniques as a pulpotomy medicament. Furthermore, given the low quality of data, it is highly desirable to establish standard requisites for conducting and reporting on pulp therapy studies in primary teeth so as to benefit both researchers and clinicians to produce high-quality studies that are comparable and to prevent the misuse of clinical material and resources.

BACKGROUND: To analyse via life cycle analysis (LCA) the global resource use and environmental output of the endodontic procedure. METHODOLOGY: An LCA was conducted to measure the life cycle of a standard/routine two-visit RCT. The LCA was conducted according to the International Organization of Standardization guidelines; ISO 14040:2006. All clinical elements of an endodontic treatment (RCT) were input into OpenLCA software using process and flows from the ecoinvent database. Travel to and from the dental clinic was not included. Environmental outputs included abiotic depletion, acidification, freshwater ecotoxicity/eutrophication, human toxicity, cancer/non cancer effects, ionizing radiation, global warming, marine eutrophication, ozone depletion, photochemical ozone formation and terrestrial eutrophication. RESULTS: An RCT procedure contributes 4.9 kg of carbon dioxide equivalent (CO2 eq) emissions. This is the equivalent of a 30 km drive in a small car. The main 5 contributors were dental clothing followed by surface disinfection (isopropanol), disposable bib (paper and plastic), single-use stainless steel instruments and electricity use. Although this LCA has illustrated the effect endodontic treatment has on the environment, there are a number of limitations that may influence the validity of the results. CONCLUSIONS: The endodontic team need to consider how they can reduce the environmental burden of endodontic care. One immediate area of focus might be to consider alternatives to isopropyl alcohol, and look at paper, single use instrument and electricity use. Longer term, research into environmentally-friendly medicaments should continue to investigate the replacement of current cytotoxic gold standards with possible natural alternatives. Minimally invasive regenerative endodontics techniques designed to stimulate repair or regeneration of damaged pulp tissue may also be one way of improving the environmental impact of an RCT.

BACKGROUND: The aim of this retrospective study was to compare the efficacy of concentrated growth factor (CGF) and platelet-rich fibrin (PRF) as scaffolds in regenerative endodontic therapy (RET). METHODS: Necrotic immature permanent teeth treated with regenerative endodontic therapy during January 2018 to August 2022 were divided into the CGF and PRF groups according to the scaffold. The CGF and PRF groups included 7 and 6 teeth, respectively. The efficacy of regenerative endodontic therapy was analyzed based on the clinical and radiological outcomes at three different follow up periods: T1 (3-6 months), T2 (6-12 months) and T3 (12-24 months). Statistical analysis was performed using the independent T test, Mann-Whitney test and Fisher's exact test at a significance level of 0.05. RESULTS: The success rate of each stage in both groups was 100%. Through quantitative comparison of radiographic outcomes, there was no statistically significant difference between the two groups in terms of root development and periapical lesion healing at each stage, except that the increase rate of radiographic root area in PRF group in the T3 stage was above one in CGF group with statistically significance. CONCLUSIONS: Both CGF and PRF had a similar clinical performance regarding resolution of clinical signs and symptoms, periapical lesion healing, and continued root development as scaffolds in RET. Further prospective studies with large samples for longer follow-up periods are needed.

The neo-Gramscian scholarship locates the agency of common sense in the reproduction of the hegemonic world order but under-theorises the underpinnings for dissimilar subaltern responses to common sense. This article draws on insights from Gramsci and anti-colonial thinkers to unpack three analytical categories for investigating subaltern consent and dissent in hegemonic orders. These analytical categories offer a tripartite framework which maintains the central theoretical argument that the key underlying rationale why some subaltern social groups consent to the hegemonic order while others dissent from the same order could be found in the subaltern past experience, (non)commitment to alternative ideologies and level of socio-political consciousness. Essentially, the article contributes to the theoretical discussion of the re/unmaking of hegemony and demonstrates how neo-Gramscian analysts could further reconnect with Gramsci and engage the postcolonial literature to enhance our understanding of the continuity and disruption of hegemonic orders in the world periphery.

BACKGROUND: Limited evidence is available regarding the superior clinical properties of bioceramic sealers comparted with traditional standard sealers. OBJECTIVES: This review aimed to answer the following research questions: 'In healthy patients requiring a root canal treatment (P), what is the efficacy of premixed bioceramic sealers (I) compared with traditional root canal epoxy resin-based sealers (C) in terms of survival, success rates (PICO1) sealer extrusion and resorption (PICO2) post-obturation pain (PICO3) (O)?' METHODS: Authors independently searched three electronic databases: PubMed (including MEDLINE), Web of Science, Embase and Scopus up to 31 October 2023. This was accompanied by both grey literature and manual search. Detailed selection criteria were applied, namely mature permanent teeth requiring root canal treatment, premixed bioceramic sealer with gutta-percha as an intervention group, a standard filling technique as control group and full-text available in English. A random-effect meta-analysis was used to synthesize the body of evidence regarding the use of bioceramic sealers in root canal treatment and their impact on post-obturation pain. Effect sizes were represented as relative risks on a logarithmic scale for binary outcomes and as mean differences for continuous outcomes. RESULTS: A total of 941 articles were identified. Fifteen Comparative clinical studies were finally included. Eleven were randomized clinical trials, and four were prospective clinical trials with control group. The follow-up of these studies was not greater than 2 years. No publication bias was observed in any study. No significant differences were observed between the two groups in terms of survival and success rates. A small non-significant lower risk of extrusion was observed for bioceramics. A small, non-significantly lower post-operative-pain within 24-h was observed when bioceramics were used. DISCUSSION: The majority of current evidence shows inconsistencies in reporting and is of short-term duration. Robust prospective long-term trials are needed in this area to better support future recommendations. CONCLUSION: This systematic review is the first to analyse several clinical outcomes using premixed sealers. Included studies differed in terms of clinical protocol and operator expertise, but reported a similar outcome when comparing bioceramic versus standard sealers. Tooth survival, treatment outcome, post-operative pain and periapical extrusion were similar and presented no significant differences between the two sealer types. REGISTRATION: PROSPERO database (CRD42023449151).

The anatomical and clinical significance of the maxillary sinus in relation to conventional and surgical endodontic therapy is considered. The discussion includes a review on the development, anatomy and physiology of the maxillary sinus, the diagnostic evaluation of the sinus and the differential diagnosis of sinusitis. Endodontic implications of the maxillary sinus include extension of periapical infections into the sinus, the introduction of endodontic instruments and materials beyond the apices of teeth in close proximity to the sinus and the risks and complications associated with endodontic surgery.

Taurodontism can be defined as a change in tooth shape caused by the failure of Hertwig's epithelial sheath diaphragm to invaginate at the proper horizontal level. An enlarged pulp chamber, apical displacement of the pulpal floor, and no constriction at the level of the cementoenamel junction are the characteristic features. Although permanent molar teeth are most commonly affected, this change can also be seen in both the permanent and deciduous dentition, unilaterally or bilaterally, and in any combination of teeth or quadrants. Whilst it appears most frequently as an isolated anomaly, its association with several syndromes and abnormalities has also been reported. The literature on taurodontism in the context of endodontics up to March 2007 was reviewed using PubMed, MEDLINE and Cumulative Index to Nursing & Allied Health Literature. Despite the clinical challenges in endodontic therapy, taurodontism has received little attention from clinicians. In performing root canal treatment on such teeth, one should appreciate the complexity of the root canal system, canal obliteration and configuration, and the potential for additional root canal systems. Careful exploration of the grooves between all orifices particularly with magnification, use of ultrasonic irrigation; and a modified filling technique are of particular use.

BACKGROUND: The development of endodontic instruments has rapidly advanced, but their impact on endodontic outcome parameters remains unclear. OBJECTIVES: This systematic review aimed to answer the following PICOT questions: In patients with apical periodontitis (P) what is the effectiveness of root canal instrumentation ([Q1] performed with contemporary techniques [I] in comparison with 'traditional' techniques [C]] and ([Q2] performed with contemporary engine-driven NiTi instruments [I] compared with other types of contemporary engine-driven NiTi instruments [with different design and/or technology] [C]) in terms of clinical and patient-related outcomes (O)? METHODS: After PROSPERO protocol registration, a literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Central Register of Controlled Trials. Grey literature and major journal contents were examined. Two independent reviewers performed the study selection, data extraction and appraisal of included studies. A quantitative meta-analysis was considered, and statistical heterogeneity and overall quality of evidence were assessed. RESULTS: = 0%) but low quality of evidence. DISCUSSION: Albeit a few studies fulfilled eligible criteria, no study had a low risk of bias. Compelling evidence indicating significantly different outcome rates using different endodontic instruments when treating teeth with apical periodontitis is lacking. CONCLUSIONS: In terms of healing, the results of the meta-analysis determined the higher effectiveness of root canal instrumentation performed with contemporary techniques in comparison with conventional stainless steel instruments in patients with apical periodontitis followed for a minimum of 1 year with low quality of evidence. No differences could be demonstrated between preparations with traditional stainless steel and contemporary NiTi instruments for other clinical and patient-related outcomes. REGISTRATION: PROSPERO (CRD42021274642).

The purpose of this study is to evaluate the biocompatibility and cytotoxicity of Total Fill (FKG Dentaire SA, Switzerland) and compare it with white MTA and Biodentine. The biocompatibility of Total Fill (FKG Dentaire SA, Switzerland) was tested in comparison with (Tulsa Dental, Tulsa, OK) and Biodentine (Septodont, Saint Maur des Fosses, France) bioceramic materials. Cytotoxicity was investigated in terms of cell proliferation throughout the MTT assay, cell viability using FDA/PI test on MG63 pre-osteoblasts cell line for 24h, 48h and 72h. SEM micrographs have been used to describe the morphology of the cells seeded on the different ceramics. The alkaline phosphatase activity (ALP) was measured using the QUANTI-Blue method for experimental and control groups. As control the cells were seeded at the Tissue Culture Plastic (TCP). All the experiments were performed in triplicate in 3 independed runs and statistically analysed using 2-way ANOVA. MTT assay results showed a major rate of proliferation, after 72h of seeding of the MG63 cells on the Total Fill sealing material than MTA and Biodentin. These results were in accordance with those obtained by the FDA/PI double staining and the SEM micrographs. All tested sealing materials performed an optimal biocompatibility, although Total Fill prevailed due to the characteristics of its solid state. In particular Total Fill presented an improved consistency which allowed the cells to populate the entire mass of the material, maintaining their viability.

The objective of this study was to evaluate the effect of Er:YAG laser irrigation on the push-out bond strength of fiber posts to the root dentine. Sixty extracted human mandibular first premolars were collected and decoronated. The residual roots received endodontic treatment. The treated roots were randomly divided into three groups according to different irrigation protocols: group LAI (Er:YAG laser-activated irrigation), group PUI (passive ultrasonic irrigation, positive control), and group CSI (conventional syringe irrigation, negative control) (n = 20). Each group was divided into two subgroups, either total-etching modes or self-etching modes (n = 10). After fiber post restoration, all roots were sectioned into seven 1.0-mm-thick slices. The slices received a push-out test by a universal test machine. The resin tag on the segments' bonding interfaces was observed by scanning electron microscope. There were significant differences in the effects of the irrigation method, bonding modes, and root regions on the push-out bond strength among the groups (p < 0.05). The specimens with Er:YAG laser-activated irrigation and self-etching mode showed significantly the highest bonding strength (p < 0.001). The lengths and densities of resin tags in group PUI or group LAI with self-etching modes were longer than those in group CSI with total-etching modes. The laser-activated irrigation with self-etching modes improved the bond strength of fiber post to root dentine compared to the passive ultrasonic irrigation or conventional syringe irrigation with total or self-etching modes.

BACKGROUND: ) are commonly used during root canal treatment. Evaluation of their effectiveness regarding clinical and patient-related outcomes requires further understanding. OBJECTIVES: To assess the effectiveness of root canal irrigation and dressing for the treatment of teeth with apical periodontitis (AP). METHODS: A search was conducted in the PubMed-MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until July 2021. Eligibility criteria followed the a priori formulated Population, Intervention, Comparator, Outcomes, Timing, and Study design (PICOTS) framework. Clinical studies restricted to English language were included. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess the quality of included studies. Meta-analyses were performed using the fixed-effect model to obtain Risk Ratio (RR) and 95% Confidence Interval (CI), with sensitivity analysis. Overall quality of evidence of meta-analyses was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool. RESULTS: = 0). RoB of included studies was moderate to low. DISCUSSION: for the treatment of AP may not be beneficial. There is scarce or no evidence fulfilling the proposed PICOTS regarding irrigants and dressings. CONCLUSIONS: Reduction of AP is comparable after irrigation with 1% and 5% NaOCl, whereas postoperative pain at 7 days for the irrigants assessed is similar. REGISTRATION: PROSPERO database CRD42021260271.

AIM: To create an irreversible pulpitis gene signature from microarray data of healthy and inflamed dental pulps, followed by a bioinformatics approach using connectivity mapping to identify therapeutic compounds that could potentially treat pulpitis. METHODOLOGY: The Gene Expression Omnibus (GEO) database, an international public repository of genomics data sets, was searched for human microarray datasets assessing pulpitis. An irreversible pulpitis gene expression signature was generated by differential expression analysis. The statistically significant connectivity map (ssCMap) method was used to identify compounds with a highly correlating gene expression pattern. qPCR was used to validate novel pulpitis genes. An ex vivo pulpitis model was used to test the effects of the compounds identified, and the level of inflammatory cytokines was measured with qPCR, ELISA and multiplex array. Means were compared using the t-test or ANOVA with the level of significance set at p ≤ .05. RESULTS: Pulpitis gene signatures were created using differential gene expression analysis at cutoff points p = .0001 and .000018. Top upregulated genes were selected as potential pulpitis biomarkers. Among these, IL8, IL6 and MMP9 were previously identified as pulpitis biomarkers. Novel upregulated genes, chemokine (C-C motif) ligand 21 (CCL21), metallothionein 1H (MT1H) and aquaporin 9 (AQP9) were validated in the pulp tissue of teeth clinically diagnosed with irreversible pulpitis using qPCR. ssCMap analysis identified fluvastatin (Statin) and dequalinium chloride (Quaternary ammonium) as compounds with the strongest correlation to the gene signatures (p = .0001). Fluvastatin reduced IL8, IL6, CCL21, AQP9 (p < .001) and MMP9 (p < .05) in the ex vivo pulpitis model, while dequalinium chloride reduced AQP9 (p < .001) but had no significant effect on the other biomarkers. CONCLUSIONS: AQP9, MT1H and CCL21 were identified and validated as novel biomarkers for pulpitis. Fluvastatin and dequalinium chloride identified by the ssCMap as potential therapeutics for pulpitis reduced selected pulpitis biomarkers in an ex vivo pulpitis model. In vivo testing of these licenced drugs is warranted.