Aim To investigate the correlation between the concentration of active‐matrix metalloproteinases‐9 (aMMP‐9) in pulpal blood and the outcome of pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis (SIP). Methodology Forty permanent molar teeth with a clinical diagnosis of SIP and normal apical tissues with periapical index (PAI) score ≤ 2 and ten permanent teeth (8 molars and two premolars) with a diagnosis of normal pulp that required root canal treatment for prosthetic reasons from patients between the ages of 15–35 years were recruited. All clinical procedures were performed under local anaesthesia and rubber dam isolation. After access opening, the coronal pulp tissue was amputated up to the canal orifice. A 100 μL volume of the pulpal blood was collected using a micropipette and transported to the laboratory. Sodium hypochlorite (2.5 %) was used as a haemostatic agent, and mineral trioxide aggregate (MTA) was used as the pulp capping material. The tooth was restored with composite at the same visit. Teeth with normal pulps were treated with single‐visit root canal treatment. Patients with pulpotomy were recalled at 6 and 12 months. Outcome assessment of teeth with pulpotomy was carried out at 12 months and was categorized as success (asymptomatic patients with PAI score ≤ 2) or failure (symptomatic patients or PAI score ≥ 3). Quantification of aMMP‐9 in pulpal blood was achieved using a fluorometric assay. The following statistical analyses were performed to assess the data: t‐test, Fisher's exact test, kappa coefficient, non‐parametric test, Wilcoxon rank‐sum test, Spearman rank correlation test and receiver operating characteristic curve (ROC). Result The success rate of pulpotomy was 88 % at 12‐months. There was a significant difference between the median concentrations of aMMP‐9 in pulpal blood of teeth with normal pulps (52 (12–96) ng mL−1:) and SIP (193.3 (25.8–607.7) ng mL−1:) (P = 0.0003) and successful (132.3 (25.8–548.3) ng mL−1:) and failed cases (512.4 (334.8–607.7 ng mL−1:) (P = 0.0015) of MTA pulpotomy. A significant association was established between aMMP‐9 concentration and outcome of pulpotomy. The area under the receiver operating characteristics curve (0.9484, 95%CI) suggested excellent discriminatory power of aMMP‐9 concentration in pulpal blood to predict the pulpotomy outcome. Conclusion The pulpal blood concentration of aMMP‐9 was significantly associated with the outcome of pulpotomy in teeth with symptomatic irreversible pulpitis, where it may be used as a potential prognostic biomarker.

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Purpose Medial pivot (MP) total knee arthroplasty (TKA) aims to restore native knee kinematics due to highly conforming medial tibio-femoral articulation with survival comparable to contemporary knee designs. Posterior stabilized (PS) TKAs use cam-post mechanism to restore native femoral rollback. However, there is conlicting evidence regarding the reported patient satisfaction with MP TKA designs when compared to PS TKAs. The primary aim of this study is to compare the patient satisfaction between MP and PS TKA and the secondary aim is to establish potential reasons behind any diferences in the outcomes noted between these two design philosophies. Methods In this IRB-approved single surgeon, single centre prospective RCT, 53 patients (mean age 62 years, 42 women) with comparable bilateral end-stage knee arthritis undergoing simultaneous bilateral TKA were randomized to receive MP TKA in one knee and PS TKA in the contralateral knee. At 4 years post-surgery, all patients were assessed using Knee Society Score (KSS)-Satisfaction and -Expectation scores, and Oxford Knee Score (OKS). In addition, all the patients underwent standardized radiological and in vivo kinematic assessment. Results Patients were more satisied with the MP TKA as compared to PS TKA: mean KSS-Satisfaction [34.5 ± 3.05 in MP and 31.7 ± 3.16 in PS TKAs (p < 0.0001)] and mean KSS-Expectation scores [12.5 ± 1.39 in MP TKAs and 11.2 ± 1.41 in PS TKAs (p < 0.0001)]. No signiicant diference was noted in any other clinical outcomes. The in vivo kinematics of MP TKAs was signiicantly better than those of PS TKAs. Conclusion MP TKAs provide superior patient satisfaction and patient expectations as compared to PS TKA. This may be related to better replication of natural knee kinematics with MP TKA. Level of evidence I.

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