A critical analysis of research methods to study clinical molecular biomarkers in Endodontic research

Zehnder, Matthias; Belibasakis, Georgios N.

doi:10.1111/iej.13647

Cited by 14 publications

(14 citation statements)

References 74 publications

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“…Unfortunately, there is a lack of objective diagnostic tools in VPT with the reference standard, histological assessment, of no value for patients as it necessitates tooth extraction (Duncan, 2022). The development of objective, robust inflammatory (Ballal et al, 2021) or other biomarkers (Al‐Natour et al, 2021; Kearney et al, 2018; Rechenberg et al, 2016), which accurately reflect not only the level of inflammation in the pulp but also identifies the threshold between reversible and irreversible pulpitis, have long been considered a priority in endodontics (Zehnder & Belibasakis, 2022). In an ideal world, a small sample of pulpal blood, or another suitable analyte (dentinal fluid, gingival crevicular fluid), could be analysed in real time at chairside with a lateral flow antibody test and the results used to dictate tissue removal and subsequent treatment.…”

Section: Reviewmentioning

confidence: 99%

Factors that influence the outcome of pulpotomy in permanent teeth

et al. 2022

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The promotion of minimally invasive treatments focussed on the maintenance of pulp vitality has become a priority area in Endodontics. These vital pulp treatments (VPT) include partial and full pulpotomy, during which diseased coronal pulp tissue is removed prior to placement of a capping biomaterial and restoration. Traditionally, pulpotomies were confined to the treatment of carious primary and traumatized permanent teeth. However, these treatments have now been proposed as definitive solutions for cariously exposed permanent teeth with mild symptoms or even symptoms indicative of irreversible disease. Until recently, it was recommended that carious exposure of mature permanent teeth be managed by root canal treatment. The promotion of pulpotomy as an alternative treatment has opened up a wave of laboratory and clinical research aimed at improving therapies or evaluating clinical outcomes.In modern evidence-based endodontics, it is imperative that the outcomes of both partial and full pulpotomy are considered and important prognostic factors identified, so that improvements can be made to aid clinical decision-making and to direct new research. In this narrative review, the outcomes of partial and full pulpotomy are discussed, before analysis of patient, intraoperative and postoperative factors that influence the outcome of the pulpotomy procedure. The review highlights that although partial and full pulpotomy for the treatment of even pulpal disease are highly successful procedures, this is based on low-quality evidence with a lack of prospective, comparative trials investigating potential prognostic factors. Based on current evidence, it appears that age, gender, tooth type, root development and intraoperative pulpal haemorrhage do not impact significantly on pulpotomy outcome, whilst others such as caries depth, inflammatory status of the pulp, capping material, level of inflammatory pulpal-biomarkers and the final restoration integrity do. Other factors, including the influence of exposure type, periodontal condition, pulpal lavage, magnification, operator experience, isolation of the operating field and type of pulpotomy, require further experimental investigation before definitive conclusions can be made relating to the success of the pulpotomy procedure. Finally, there is not only a need for future well-designed prospective research addressing these issues but also

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Section: Reviewmentioning

confidence: 99%

Factors that influence the outcome of pulpotomy in permanent teeth

et al. 2022

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“…This generally requires exposure of the pulp; however, as the volume of analyte retrieved from dentinal fluid in unexposed cavities is likely to be too small for robust analysis (Rechenberg et al, 2016 ; Zehnder et al, 2011 ). Furthermore, although attractive, biomarker analysis from pulpal blood is fraught with technical, practical and scientific challenges, which have been extensively reviewed elsewhere in this series (Zehnder & Belibasakis, 2021 ).…”

Section: Reviewmentioning

confidence: 99%

Present status and future directions—Vital pulp treatment and pulp preservation strategies

Duncan

2022

Int Endodontic J

100

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Therapeutic strategies focussed on the pulp preservation, are important when managing vital teeth with deep caries and an exposed pulp. These vital pulp treatments (VPTs); however, are not new, with indirect and direct pulp capping procedures being described as a therapy for carious teeth for over a century. As a result of unpredictable outcomes, the traditional indications for VPT particularly when the pulp was exposed were limited to the treatment of immature teeth with incomplete root formation. Over the last 20 years, the advent of regenerative endodontics and the promotion of biologically based therapies aimed at reducing intervention have reinvigorated VPT with new waves of basic science and clinical research indicating a role for VPT not only in mature cariously affected teeth, but also in teeth with signs and symptoms indicative of irreversible pulpitis. Driven by new materials such as hydraulic calcium silicate cements, a better understanding of pulpal immunity and biology as well and improved tissue handling, VPT has been at the forefront of treatment recommendations made by global Cariology and Endodontic organizations.Care must be exercised, however, as key gaps in scientific knowledge remain alongside severe limitations in educational dissemination amongst dentists. Although research has highlighted that carious injury to the dentine-pulp complex stimulates a wide range of responses and that the interaction between infection, inflammation and repair will eventually impact on the outcome of pulpitis, our ability to accurately and objectively diagnose the true inflammatory state of the pulp remains poor. An overreliance on symptoms leaves clinicians with subjective, crude diagnostic tools by which to inform treatment planning and decision-making, which results in large variations in the treatments offered to patients. Not only is there an urgent need to develop preoperative and intraoperative diagnostic tools, but there is also a paucity of the high-quality comparative evidence required to answer the most important questions and justify treatment options. The aim of this review was to consider the current status of VPT and to discuss the principle problems that are hindering clinical acceptance of these techniques. Potential solutions and opportunities are offered to suggest ways that VPT may become a more consistently prescribed evidencedbased treatment in dental practice.How to cite this article: Duncan, H.F. ( 2022) Present status and future directions-Vital pulp treatment and pulp preservation strategies.

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“…We may hope that, in the not too distant future, user-friendly and accurate chairside methods for pulpal and periapical diagnosis may become generally available (19). However, extensive, and time-consuming translational research will be necessary to apply new knowledge from sterile laboratory studies to the development of reliable clinical methods for chair-side patient diagnosis.…”

Section: • 133 • #2 125mentioning

confidence: 99%

Future Directions in Endodontics

Virtej¹,

Wigsten²,

Ørstavik³

et al. 2023

Tidende

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Headlines Dental practitioners should have better communication with the patients about treatment goals and prognosis or refer to a specialist at the appropriate time without delays to achieve optimal treatment outcome. Research must not only concentrate on innovations which may interest stakeholders with short-term benefits but on randomized studies, to compare with existing materials, to prove their superiority in clinical outcomes. We need better knowledge to understand dental pain mechanisms, management of pain sensation, control and eradicate infection. Recruitment of students with outstanding performances by educational institutions in a competitive job market is a challenge that needs to be addressed. The cost of dental treatment, including endodontics, may call for increased third-party payment by government or private insurance schemes. By studying the cost-effectiveness of treatment, current systems may need to be reviewed.

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A critical analysis of research methods to study clinical molecular biomarkers in Endodontic research

Cited by 14 publications

References 74 publications

Factors that influence the outcome of pulpotomy in permanent teeth

Factors that influence the outcome of pulpotomy in permanent teeth

Present status and future directions—Vital pulp treatment and pulp preservation strategies

Future Directions in Endodontics

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