Specialized pro-resolving lipid mediators in endodontics: a narrative review

Abstract

Endodontics is the branch of dentistry concerned with the morphology, physiology, and pathology of the human dental pulp and periradicular tissues. Human dental pulp is a highly dynamic tissue equipped with a network of resident immunocompetent cells that play major roles in the defense against pathogens and during tissue injury. However, the efficiency of these mechanisms during dental pulp inflammation (pulpitis) varies due to anatomical and physiological restrictions. Uncontrolled, excessive, or unresolved inflammation can lead to pulp tissue necrosis and subsequent bone infections called apical periodontitis. In most cases, pulpitis treatment consists of total pulp removal. Although this strategy has a good success rate, this treatment has some drawbacks (lack of defense mechanisms, loss of healing capacities, incomplete formation of the root in young patients). In a sizeable number of clinical situations, the decision to perform pulp extirpation and endodontic treatment is justifiable by the lack of therapeutic tools that could otherwise limit the immune/inflammatory process. In the past few decades, many studies have demonstrated that the resolution of acute inflammation is necessary to avoid the development of chronic inflammation and to promote repair or regeneration. This active process is orchestrated by Specialized Pro-resolving lipid Mediators (SPMs), including lipoxins, resolvins, protectins and maresins. Interestingly, SPMs do not have direct anti-inflammatory effects by inhibiting or directly blocking this process but can actively reduce neutrophil infiltration into inflamed tissues, enhance efferocytosis and bacterial phagocytosis by monocytes and macrophages and simultaneously inhibit inflammatory cytokine production. Experimental clinical application of SPMs has shown promising result in a wide range of inflammatory diseases, such as renal fibrosis, cerebral ischemia, marginal periodontitis, and cancer; the potential of SPMs in endodontic therapy has recently been explored. In this review, our objective was to analyze the involvement and potential use of SPMs in endodontic therapies with an emphasis on SPM delivery systems to effectively administer SPMs into the dental pulp space.

Wnt4 prevents apoptosis and inflammation of dental pulp cells induced by LPS by inhibiting the IKK/NF‑κB pathway

“…Pulpitis is a physiological response to bacterial infections, physical and chemical injuries (22). Bacterial invasion triggers immune reactions to initiate pulpitis (23). Pulpitis may continuously develop into pulp necrosis, periapical periodontitis and severe infections (24).…”

Recent Advances in Apical Periodontitis Treatment: A Narrative Review

“…The inflammatory process in periapical tissue is primarily caused by the infiltration of bacterial substances from infected teeth. In the absence of treatment, persistent bacterial infection causes chronic inflammation, eventually promoting the destruction of periapical tissue (bone resorption) [ 43 , 89 ]. With successful root canal treatment, SPMs, including RVs, protectins, maresins, and lipoxins, may play a key role in the resolution of acute inflammation, which occurs after the vascular and cellular phases [ 89 , 90 ].…”

“…In the absence of treatment, persistent bacterial infection causes chronic inflammation, eventually promoting the destruction of periapical tissue (bone resorption) [ 43 , 89 ]. With successful root canal treatment, SPMs, including RVs, protectins, maresins, and lipoxins, may play a key role in the resolution of acute inflammation, which occurs after the vascular and cellular phases [ 89 , 90 ]. Bacterial invasion activates the migration and chemotaxis of polymorphonuclear neutrophils to the site of injury by inducing chemotactic signals involving LTB4 [ 90 , 91 ].…”

Analysis of circRNAs profile in TNF-α treated DPSC

“…Currently, drilling or filling are utilized for reversible pulpitis treatment, whereas root canal and crown or extraction are applied for inrreversible pulpitis [ 5 ]. Nevertheless, these treatments may lead to post-operative discomforts, injuries on the periodontium due to micro-leakages from the tooth crown, and vertical root breakage as treated teeth are more fragile than non-treated teeth [ 6 , 7 ]. Hence, it is expedient to discover a new technique to mitigate the scourge of pulpitis.…”