Deciphering Reparative Processes in the Inflamed Dental Pulp

Abstract

Research over several decades has increased our understanding of the nature of reparative and regenerative processes in the dental pulp, at both the cellular and molecular level. However, advances in scientific knowledge have not translated into novel clinical treatment strategies for caries-induced pulpitis. This narrative review explores the evidence regarding the ability of inflamed pulp tissue to heal and how this knowledge may be used therapeutically. A literature search and evidence analysis covering basic, translational and clinical pulp biology research was performed. The review focuses on (1) the regenerative and defense capabilities of the pulp during caries-induced inflammation; (2) the potential of novel biomaterials to harness the reparative and regenerative functions of the inflamed pulp; and (3) future perspectives and opportunities for conservative management of the inflamed pulp. Current conservative management strategies for pulpitis are limited by a combination of unreliable diagnostic tools and an outdated understanding of pulpal pathophysiological responses. This approach leads to the often unnecessary removal of the entire pulp. Consequently, there is a need for better diagnostic approaches and a focus on minimally-invasive treatments utilizing biologically-based regenerative materials and technologies.

Development of Rat Caries-Induced Pulpitis Model for Vital Pulp Therapy

“…The general wound-healing process is a highly programmed process that is involved in various cellular and molecular events. It includes hemostasis, inflammation, proliferation, and remodeling phases ( El karim et al 2021 ). In the present study, PCNA expression in moderate carious teeth indicated that the inflammatory and proliferative phases have overlapped during caries progression, and when DPC was performed, acute inflammation might have been triggered again due to pulp exposure ( Guo and DiPietro 2010 ; El karim et al 2021 ).…”

“…It includes hemostasis, inflammation, proliferation, and remodeling phases ( El karim et al 2021 ). In the present study, PCNA expression in moderate carious teeth indicated that the inflammatory and proliferative phases have overlapped during caries progression, and when DPC was performed, acute inflammation might have been triggered again due to pulp exposure ( Guo and DiPietro 2010 ; El karim et al 2021 ). As a result, the wound-healing process in carious teeth underwent a more complex process that is mainly affected by the surrounding environment (e.g., infection, immune regulation).…”

Regulation of caries‐induced pulp inflammation by NLRP3 inflammasome: A laboratory‐based investigation

“…It is known that acute inflammation is an important protective immune response during infections and is essential for healing of cariously inflamed pulp (Cooper et al, 2014 ; El Karim et al, 2021 ). However, chronic and excessive inflammation is a driver of host tissue injury seen in many severe infectious diseases, and it must therefore be carefully regulated for an optimal healing response.…”

“…In teeth with deep caries and exposed pulp, bacteria directly invade the dental pulp leading to irreversible pulpitis. The microflora in such lesions is mixed but dominated with Gram‐positive bacteria (Hahn et al, 1991 ; Love & Jenkinson, 2002 ; Zheng et al, 2019 ) that lead to the development of inflammatory and immune events in the dental pulp, the molecular and cellular determinants of which remain largely unknown (El Karim et al, 2021 ; Jontell et al, 1998 ). The NLRP3 inflammasome is expressed in the dental pulp (Song et al, 2012 ) and plays an important role in sterile pulp inflammation (Al Natour, Lundy, et al, 2021 ), but, its role in caries‐induced pulp inflammation is not fully understood.…”

Outcomes reporting in systematic reviews on vital pulp treatment: A scoping review for the development of a core outcome set

“…These treatments include a spectrum of modalities including indirect pulp capping, direct pulp capping and pulpotomy (partial or complete). Although not novel, VPT has recently emerged as a promising biologically based treatment due, in part, to advances made in the scientific field, including the introduction of bioactive hydraulic calcium silicate cements (Nair et al, 2008; Parirokh et al, 2018) as well as advances in pulp biology that have improved clinicians' understanding of the biological and reparative processes occurring in the injured dental pulp (Duncan, Cooper, & Smith, 2019; El Karim, Cooper, et al, 2021). Consequently, a plethora of clinical studies reporting on the outcome of VPT have been published over the last two decades and have demonstrated high success rates (Asgary et al, 2017; Bjørndal et al, 2017; Taha & Abdulkhader, 2018).…”