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  1. Maqbool M, Syed NH, Rossi-Fedele G, Shatriah I, Noorani TY
    Odontology, 2023 Jul;111(3):531-540.
    PMID: 36309897 DOI: 10.1007/s10266-022-00762-0
    MicroRNAs (miRNAs) are short, 19-23 nucleotide non-coding RNA molecules that regulate gene expression by silencing or degrading the target mRNA gene. Since their discovery in the nineties of the last century, they have emerged as key inflammatory regulators. Inflammation induces the synthesis of various miRNAs that modulate the expression of multiple molecules involved in orchestrating the inflammatory response. This review aims to provide an insight into the role of miRNAs as potential biomarkers, mediators, and potential therapeutic targets of dental pulp inflammation. A literature search was conducted using the keywords; biogenesis of microRNA, human dental pulp cells, pulpitis, and inflammation in PubMed and Scopus index databases for all the published articles dealing with the role of miRNAs in pulp inflammation in the last 10 years. According to the literature, there is a clear correlation between miRNAs and several physiological events, as well as their role as mediators of innate immune response and inflammation in dental pulp cells. Our narrative review stipulates that numerous miRNAs play a key role in modulating inflammation, delaying or enhancing cell repair, cell differentiation, and survival in dental pulp diseases. However, further studies are required for the validation of miRNAs as reliable biomarkers in dental pulp pathology and their targeted therapy.
    Matched MeSH terms: Dental Pulp/metabolism
  2. Ahmed HMA, El-Karim I, Duncan HF, Krastl G, Galler K
    Clin Oral Investig, 2023 Nov;27(11):6357-6369.
    PMID: 37870593 DOI: 10.1007/s00784-023-05284-9
    OBJECTIVES: This review aims to discuss the implications of anatomy of the root, pulp chamber, and canals on pulpotomy and revitalization procedures (RPs) as treatment alternatives to root canal treatment procedures.

    METHODS: This narrative review was undertaken to address two main questions - why remove vital pulp tissue in teeth with complex canal anatomy when it can be preserved? And why replace the necrotic pulp in teeth with mature roots with a synthetic material when we can revitalize? This review also aims to discuss anatomical challenges with pulpotomy and revitalization procedures.

    RESULTS: Maintaining the vitality of the pulp via partial or full pulpotomy procedures avoids the multiple potential challenges faced by clinicians during root canal treatment. However, carrying out pulpotomy procedures requires a meticulous understanding of the pulp chamber anatomy, which varies from tooth to tooth. Literature shows an increased interest in the application of RPs in teeth with mature roots; however, to date, the relation between the complexity of the root canal system and outcomes of RPs in necrotic multi-rooted teeth with mature roots is unclear and requires further robust comparative research and long-term follow-up.

    CONCLUSIONS: Whenever indicated, pulpotomy procedures are viable treatment options for vital teeth with mature roots; however, comparative, adequately powered studies with long-term follow-up are needed as a priority in this area. RPs show promising outcomes for necrotic teeth with mature roots that warrant more evidence in different tooth types with long-term follow-ups.  CLINICAL RELEVANCE: Clinicians should be aware of the pulp chamber anatomy, which is subject to morphological changes by age or as a defensive mechanism against microbial irritation, before practicing partial and full pulpotomy procedures. RP is a promising treatment option for teeth with immature roots, but more evidence is needed for its applications in teeth with mature roots. A universal consensus and considerably more robust evidence are needed for the standardization of RPs in teeth with mature roots.

    Matched MeSH terms: Dental Pulp; Dental Pulp Cavity*; Dental Pulp Necrosis/therapy
  3. Safura, A.B.
    Malaysian Dental Journal, 2008;29(1):31-33.
    MyJurnal
    The assessment of pulp vitality is a crucial diagnostic procedure in the practice of endodontics. Dentists should establish their treatment decisions based on good sound information and in the best interests of the patients. Therefore, a definite diagnosis must be established with comprehensive investigation and records before any treatment is carried out1. Since the dental pulp is enclosed in an opaque tooth, the assessment of tooth vitality is undertaken indirectly by: looking for clinical or radiological evidence of pulp necrosis or apical periodontitis; investigating nerve conduction; or examining the blood flow. (Copied from article).
    Matched MeSH terms: Dental Pulp; Dental Pulp Necrosis; Dental Pulp Test
  4. Arslan H, Ahmed HMA, Şahin Y, Doğanay Yıldız E, Gündoğdu EC, Güven Y, et al.
    J Endod, 2019 Jul;45(7):863-872.
    PMID: 31155298 DOI: 10.1016/j.joen.2019.04.005
    INTRODUCTION: This preliminary study compared clinical and radiographic outcomes of regenerative endodontic procedures (REPs) with that of conventional root canal treatment (CRCT) in necrotic mature teeth with periapical radiolucencies.

    METHODS: Fifty-six mature necrotic teeth with large periapical radiolucencies were distributed into 2 groups: group 1, REPs and group 2, CRCT (n = 28/group). Clinical and radiographic follow-up assessments were undertaken up to 12 months. Statistical analysis was performed using the independent samples t test and the chi-square test, and the level of significance was set at P = .05.

    RESULTS: With a follow-up rate of about 73.4% of the total patients for 12 months, favorable clinical and radiographic outcomes were found in 92.3% and 80% in REPs and CRCT groups, respectively, and the difference was not statistically significant (P > .05). Half of the teeth treated with REPs responded to the electric pulp test.

    CONCLUSIONS: Regenerative endodontic procedures have the potential to be used as a treatment option for mature teeth with large periapical radiolucencies.

    Matched MeSH terms: Dental Pulp
  5. Salas H, Torres J, Pauro J, Ahmed HMA
    Int Endod J, 2021 Jan;54(1):147-149.
    PMID: 33351981 DOI: 10.1111/iej.13439
    Matched MeSH terms: Dental Pulp Cavity*
  6. Neelakantan P, Ahmed HMA, Chang JWW, Nabhan MS, Wei X, Cheung GSP, et al.
    Aust Endod J, 2019 Dec;45(3):407-413.
    PMID: 30520194 DOI: 10.1111/aej.12333
    This systematic review assessed the effect of different root canal instrumentation systems on endotoxin reduction from the root canal system. The literature search was conducted in two electronic databases (PubMed and Scopus) using specific key words. The search strategy followed the PRISMA guidelines. Qualitative synthesis and quantitative synthesis of the data were performed and data interpretation was done based on the guidelines in the Cochrane Handbook. The risk of bias was assessed using Cochrane criteria. The initial search yielded 600 citations, of which three papers met the criteria for inclusion in this review. Studies showed a significant reduction in endotoxin following rotary and reciprocating instrumentation, with no significant differences between them. The meta-analysis showed no statistical significant difference between reciprocation and rotary files (P > 0.05). In conclusion, the instrumentation techniques compared in this review decrease endotoxin content from root canals, with no significant difference between them.
    Matched MeSH terms: Dental Pulp Cavity*
  7. Karobari MI, Noorani TY, Halim MS, Dummer PMH, Ahmed HMA
    Int Endod J, 2019 Jun;52(6):917-919.
    PMID: 31074504 DOI: 10.1111/iej.13106
    Matched MeSH terms: Dental Pulp Cavity*
  8. Ahmed HMA, Keleş A, Wolf TG, Rossi-Fedele G, Dummer PMH
    Eur Endod J, 2024 Jan 01;9(1):1-7.
    PMID: 37990574 DOI: 10.14744/eej.2023.82713
    Matched MeSH terms: Dental Pulp Cavity*
  9. Kaur G, Thomas AR, Samson RS, Varghese E, Ponraj RR, Nagraj SK, et al.
    BMC Oral Health, 2024 May 04;24(1):532.
    PMID: 38704529 DOI: 10.1186/s12903-024-04259-w
    BACKGROUND: Successful endodontic treatment needs accurate determination of working length (WL). Electronic apex locators (EALs) were presented as an alternative to radiographic methods; and since then, they have evolved and gained popularity in the determination of WL. However, there is insufficient evidence on the post-operative pain, adequacy, and accuracy of EALs in determining WL.

    OBJECTIVE: The systematic review and meta-analysis aims to gather evidence regarding the effectiveness of EALs for WL determination when compared to different imaging techniques along with postoperative pain associated with WL determination, the number of radiographs taken during the procedure, the time taken, and the adverse effects.

    METHODS: For the review, clinical studies with cross-over and parallel-arm randomized controlled trials (RCTs) were searched in seven electronic databases, followed by cross-referencing of the selected studies and related research synthesis. Risk of bias (RoB) assessment was carried out with Cochrane's RoB tool and a random-effects model was used. The meta-analysis was performed with the RevMan software 5.4.1.

    RESULTS: Eleven eligible RCTs were incorporated into the review and eight RCTs into the meta-analysis, of which five had high RoB and the remaining six had unclear RoB. Following meta-analysis, no significant difference in postoperative pain was found among the EAL and radiograph groups (SMD 0.00, CI .29 to .28, 354 participants; P value = 0.98). Radiograph group showed better WL accuracy (SMD 0.55, CI .11 to .99, 254 participants; P value = 0.02), while the EAL group had 10% better WL adequacy (RR 1.10, CI 1.03-1.18, 573 participants; P value = 0.006).

    CONCLUSION: We found very low-certainty evidence to support the efficacy of different types of EAL compared to radiography for the outcomes tested. We were unable to reach any conclusions about the superiority of any type of EAL. Well-planned RCTs need to be conducted by standardizing the outcomes and outcome measurement methods.

    Matched MeSH terms: Dental Pulp Cavity/anatomy & histology
  10. Taha NA, Ali MM, Abidin IZ, Khader YS
    J Dent, 2024 Dec;151:105408.
    PMID: 39442480 DOI: 10.1016/j.jdent.2024.105408
    OBJECTIVES: To compare pulpal survival and treatment needs following selective and total caries removal in mature permanent teeth.

    METHODS: The design was a parallel double blind, randomized clinical trial. Mature teeth with caries radiographically extending ≥ 2/3 of dentine and without spontaneous pulpitis were included. Teeth were allocated to either selective (SCR) or total caries removal (TCR) using block randomization technique. In the SCR group, caries removal to firm dentine was followed by placement of Biodentine and composite restoration. In TCR group caries removal was to hard dentine; with immediate management by vital pulp therapy (VPT) using Biodentine in case of pulp exposure. Preoperative pain levels were recorded. Teeth were followed up after 6 and 12 months. Data were analyzed using Chi square test and regression analysis.

    RESULTS: 124 teeth with a diagnosis of reversible pulpitis were treated (63 in SCR, 61 in TCR). 17/ 61 teeth (28%) in the TCR had pulp exposure, managed by VPT and were successful at recall. Pulp survival was significantly higher in TCR compared to SCR at 6 months (100 % vs 93.65%, p =0.04 respectively) and at 12 months (98.4% vs 82.5, P= 0.003 respectively). Multivariate analysis revealed the type of procedure (SCR vs TCR) and the preoperative pain levels (above or below 5/10) as significant prognostic factors. The odds of failure increased significantly for teeth treated with SCR (OR 27.6, 3.6-212.4, p=0.001) and if preoperative pain levels were ≥5/10 (OR 0.2, 0.04-0.8, P=0.024).

    CONCLUSION: Selective caries removal for deep carious lesions in mature teeth failed to reveal overt pulp exposures in more than one quarter of cases and led to significantly lower pulp survival over one year, when compared with complete caries removal and immediate VPT.

    CLINICAL SIGNIFICANCE: In deep carious lesions of mature permeant teeth with revrsible pulpitis, total caries removal to hard dentine is recommended for a predictable pulp survival.

    CLINICAL TRIAL REGISTRATION: This trial was registered at CliniclTrials.gov (NCT05144711).

    Matched MeSH terms: Dental Pulp*; Dental Pulp Capping/methods; Dental Pulp Exposure/therapy
  11. Daud S, Nambiar P, Hossain MZ, Rahman MR, Bakri MM
    Gerodontology, 2016 Sep;33(3):315-21.
    PMID: 25266855 DOI: 10.1111/ger.12154
    OBJECTIVES: The aim of this study was to determine the changes in cell density and morphology of selected cells of the ageing human dental pulp.

    BACKGROUND: Changes in cell density and morphology of dental pulp cells over time may affect their capability to respond to tooth injury.

    MATERIALS AND METHODS: One hundred thirty-one extracted teeth were obtained from individuals between the ages of 6 and 80 years. The apical 1/3 of the root region was removed from all teeth prior to routine processing for producing histological slides. The histology slides were used to study the changes in cell density and morphology of selected pulp cells; odontoblasts, subodontoblasts and fibroblasts in the crown and root regions of the dental pulp. Student's t-test and one-way anova were used for statistical analyses.

    RESULTS: In all age groups, the cell density for all types of cells was found to be higher in the crown than in the root (p 

    Matched MeSH terms: Dental Pulp/cytology*; Dental Pulp/pathology*
  12. Islam R, Toida Y, Chen F, Tanaka T, Inoue S, Kitamura T, et al.
    Int Endod J, 2021 Oct;54(10):1902-1914.
    PMID: 34096634 DOI: 10.1111/iej.13587
    AIM: To evaluate the dental pulp response to a novel mineral trioxide aggregate containing phosphorylated pullulan (MTAPPL) in rats after direct pulp capping.

    METHODS: Ninety-six cavities were prepared in the maxillary first molars of 56 male Wistar rats. The dental pulps were intentionally exposed and randomly divided into four groups according to the application of pulp capping materials: MTAPPL; phosphorylated pullulan (PPL); a conventional MTA (Nex-Cem MTA, NCMTA; positive control); and Super-Bond (SB; negative control). All cavities were restored with SB and observed for pulpal responses at 1-, 3-, 7- and 28-day intervals using a histological scoring system. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U-test with Bonferroni's correction, and the level of significance was set at 0.05. DMP1 and CD34 antigen were used to evaluate odontoblast differentiation and pulpal vascularization, respectively.

    RESULTS: On day 1, mild inflammatory cells were present in MTAPPL and NCMTA groups; fewer inflammatory cells were present in the PPL, whereas SB was associated with a mild-to-moderate inflammatory response. A significant difference was observed between PPL and SB (p  .05). SB exhibited incomplete mineralized tissue barriers, significantly different from NCMTA, MTAPPL and PPL (p 

    Matched MeSH terms: Dental Pulp; Dental Pulp Capping*
  13. Seow LL, Toh CG, Wilson NH
    J Dent, 2015 Jan;43(1):126-32.
    PMID: 25448436 DOI: 10.1016/j.jdent.2014.10.001
    OBJECTIVES: The aim of this study was to investigate the recovery of cuspal stiffness and fracture resistance in endodontically treated maxillary premolars restored with bonded ceramic inlays and onlays of various designs.
    METHODS: Seventy intact premolars were selected for this study; six cavity designs were investigated: (i) mesio-occlusal-distal (MOD) inlay (I), (ii) MOD inlay with palatal cusp coverage (IPC), (iii) MOD onlay (O), (iv) MOD inlay with pulp chamber extension (IPE), (v) MOD inlay with palatal cusp coverage and pulp chamber extension (IPCPE), and (vi) MOD onlay with pulp chamber extension (OPE). Intact teeth acted as control. Strain gauges were attached to the buccal and palatal surfaces of the teeth to measure cuspal stiffness under static loading. All specimens were eventually subjected to compressive load to failure. Cuspal stiffness and fracture resistance data were analyzed using ANOVA and Tukey test.
    RESULTS: The I and IPE restorations restored cuspal stiffness to 75% of the sound tooth value. The O and OPE restored teeth had stiffness values greater than that of a sound tooth. The I, IPC, O, IPE, IPCPE and OPE restored teeth demonstrated fracture strength values of 938N±113 N (s.d.), 1073N±176 N and 1317N±219 N, 893N±129 N, 1062N±153 N and 1347N±191 N respectively.
    CONCLUSIONS: Within the limitations of this study, it was concluded that the all-ceramic onlay or inlay with palatal cusp coverage provided best biomechanical advantage in restoring an endodontically treated maxillary premolar tooth.
    CLINICAL SIGNIFICANCE: The onlay approach which is more conservative compared to full coverage restoration is considered an appropriate approach to the restoration of endodontically treated maxillary premolars. The addition of a pulpal extension to the all-ceramic restorations, apart from being technically challenging, was not found to offer any biomechanical advantage to the restored teeth.
    KEYWORDS: Endodontically treated teeth; Fracture strengths; Inlay; Onlay; Pulp chamber extension; Strains
    Matched MeSH terms: Dental Pulp; Dental Pulp Cavity
  14. Ahmed HM, Al Rayes MH, Saini D
    J Conserv Dent, 2012 Jan;15(1):77-9.
    PMID: 22368341 DOI: 10.4103/0972-0707.92612
    Crown fractures are common detrimental consequences of dental traumatic injuries. Early management of such cases is mandatory in order to prevent subsequent pathological changes that could further complicate the treatment. Pulp necrosis, chronic and cystic apical periodontitis can be the fate if these teeth are left untreated. Despite these serious complications, root canal treatment followed by apical surgery is considered a valid treatment option when such cases become complicated with large periapical lesions. However, whether a retrograde filling is essential to be placed or not is still a matter of debate. This case report discusses the orthograde endodontic management, the surgical approach and the clinical outcomes of longstanding crown fractured teeth with large cyst-like periapical lesions with and without retrograde filling.
    Matched MeSH terms: Dental Pulp Cavity; Dental Pulp Necrosis
  15. Kundabala, M., Shetty, Neeta, Parolia, Abhishek
    Malaysian Dental Journal, 2010;31(2):94-0.
    MyJurnal
    Tissue regeneration is a rapidly growing field providing a beacon of hope in the field of restorative and endodontics. Root canal treatment involves the removal of pulp tissue and replacement by an inorganic materials where as regenerative endodontics deals with replacement with healthy pulp to revitalize the teeth .Research in the field of tissue engineering and material science have lead to significant progress but still is plague with lots of drawbacks and failures, hence it is still not being adapted as routine clinical procedures .The purpose of this article is to review the advances made in regenerative endodontics and the future scopes.
    Matched MeSH terms: Dental Pulp; Dental Pulp Cavity
  16. Aws Hashim Al-Kadhim, Normaliza AB Malik, Azlan Jaafar, Zainul Ahmad Rajion
    MyJurnal
    Introduction: A few studies investigated the numerous potential endodontic uses of CBCT, including the
    examination of root canal morphology and presumed that CBCT was effective for the initial identification of
    such morphology; moreover CBCT is a reliable method for the detection of the MB2 canal when compared
    with the gold standard of physical sectioning of the specimen. The aim of this study was to identify the root
    and canal morphology of the maxillary first molars among Malaysians analysed by cone-beam computed
    tomography (CBCT) images.

    Materials and Methods: Maxillary first (n = 421) molars from Malaysian patients
    (n = 241) of Malay, Chinese and Indians inceptions were examined by two Endodontists using in vivo CBCT
    methods. The number and configuration of roots, the number of root canals, and the canal configuration
    according to Vertucci’s classification were determined.

    Results: Single roots were not found in maxillary
    first molars. The incidence of fused roots was 1.995% in the first molars between mesiobuccal and
    distobuccal roots. In (421) 3-rooted maxillary first molars, additional canals were found in 45.6% of the
    mesiobuccal (MB) roots and 0% of the distobuccal (DB) roots. Bilateral symmetry of the MB roots was found
    in 82.36% of the first molar. Only one tooth was found to have pulp stone inside the pulp chamber.

    Conclusions: The root and canal configuration of a Malaysian population showed different features from
    those of other populations. CBCT scans can enhance the understanding of root canal anatomy, with the
    potential of improving the outcome of endodontic treatment.
    Matched MeSH terms: Dental Pulp Calcification; Dental Pulp Cavity
  17. Ahmed HMA, Neelakantan P, Dummer PMH
    Int Endod J, 2018 Feb;51(2):164-176.
    PMID: 28635100 DOI: 10.1111/iej.12800
    Thorough knowledge of anatomical complexities of the root canal system has a direct impact on the effectiveness of canal preparation and filling, and is an essential prerequisite for successful root canal treatment. A wide range of complex variations in root canal anatomy exists, including root canal configuration type, developmental anomalies and minor canal morphology such as accessory canals and apical deltas. Accessory canals and apical deltas have been associated with pulp disease, primary canal infection, canal reinfection and post-treatment disease. The current definitions of accessory canal anatomy are not standardized and potentially confusing. Given their role in endodontic disease and their impact on treatment outcomes, there is a need to have a simple classification of their anatomy to provide an accurate description of their position and path from the canal to the external surface of the root. The purpose of this article is to introduce a new system for classifying accessory canal morphology for use in research, clinical practice and training.
    Matched MeSH terms: Dental Pulp Cavity/anatomy & histology*
  18. Soh JA, Sheriff SO, Ramar NA, Pulikkotil SJ, Nagendrababu V, Neelakantan P, et al.
    Aust Endod J, 2019 Aug;45(2):171-176.
    PMID: 30230109 DOI: 10.1111/aej.12303
    In endodontic infections, inflammatory mediators such as cytokines are released, recruited and retained until the infection is eradicated. Root canal therapy is performed to prevent the spread of infection. The aim of this study was to investigate the effects of root canal debridement (cleaning and shaping) on periapical inflammation by measuring the levels of inflammatory cytokines, Interleukin-8 (IL-8) and Interleukin-10 (IL-10). The study includes twenty patients with pulp necrosis and asymptomatic apical periodontitis. Periradicular sample was collected using paper points before and after root canal debridement. Cytokine levels were determined by Sandwich Enzyme-Linked Immunosorbent Assay (ELISA). Data were analysed using paired t-test (PASW Statistics 18) (P = 0.05). All samples showed the presence of IL-8 and IL-10 prior to root canal debridement. Significantly reduced levels (P < 0.05) of IL-8 and IL-10 were detected after root canal debridement. In conclusion, root canal debridement significantly decreased the levels of the tested pro- and anti-inflammatory cytokine in the periradicular interstitial fluid.
    Matched MeSH terms: Dental Pulp Cavity*
  19. Mohd Ariffin S, Dalzell O, Hardiman R, Manton DJ, Parashos P, Rajan S
    Eur Arch Paediatr Dent, 2020 Aug;21(4):519-525.
    PMID: 32100200 DOI: 10.1007/s40368-020-00515-z
    AIM: Successful endodontic treatment of primary teeth requires comprehensive knowledge and understanding of root canal morphology. The purpose of this study was to investigate the root canal configurations of primary maxillary second molars using micro-computed tomography.

    METHODS: Extracted human primary maxillary second molars (n = 57) were scanned using micro-computed tomography and reconstructed to produce three-dimensional models. Each root canal system was analysed qualitatively according to Vertucci's classification.

    RESULTS: 22.8% (n = 13) of the sample presented with the fusion of the disto-buccal and palatal roots; of these, Type V was the most prevalent classification. For teeth with three separate roots (n = 44), the most common root canal type was Type 1 for the palatal canal (100%) and disto-buccal canal (77.3%) and Type V for the mesio-buccal canal (36.4%). Overall, 7% (n = 4) of mesio-buccal canals were 'unclassifiable'.

    CONCLUSION: The root canal systems of primary maxillary second molars were not only complex but had a range of configurations that may contribute to unfavourable clinical outcomes after endodontic treatment.

    Matched MeSH terms: Dental Pulp Cavity*
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