☆ 4.7 Article

MMP-9 Levels and NaOCl Lavage in Randomized Trial on Direct Pulp Capping

JOURNAL OF DENTAL RESEARCH (2022)

Journal

JOURNAL OF DENTAL RESEARCH

Volume 101, Issue 4, Pages 414-419

Publisher

SAGE PUBLICATIONS INC

DOI: 10.1177/00220345211046874

Keywords

pulpitis; endodontics; biomarkers; caries treatment; matrix metalloproteinases; vital pulp treatment

Funding

Clinic of Conservative and Preventive Dentistry, University of Zurich

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Abstract

In this study, it was found that the levels of neutrophil gelatinase 9 (MMP-9)/total protein (TP) and NaOCl lavage significantly influenced pulp survival in cariously exposed and directly capped teeth, while mild preoperative discomfort did not have an impact.

Outcome expectations of direct pulp capping in carious teeth are obscured by a clinically unknown infiltration and breakdown of the dental pulp tissue. Histologic studies showed that this soft tissue breakdown is related to the innate immune system. We hypothesized 1) that a neutrophil biomarker could predict the outcome of direct pulp capping and 2) that using sodium hypochlorite (NaOCl) as a lavage solution to remove necrotized infected pulp tissue could improve it. In this randomized trial in mature posterior teeth causing no or mild discomfort with carious pulpal exposures, pulpal fluid was collected to assess neutrophil gelatinase (matrix metalloproteinase 9 [MMP-9]) per total protein (TP) levels as a predictive local biomarker. Subsequently, the dentin-pulp wound was randomly washed with a 2.5% NaOCl or a physiologic saline solution (1:1 allocation), capped with mineral trioxide aggregate, and the tooth was immediately restored with a resin-based composite restoration. Ninety-six patients were included, and 84 individuals could be followed up to treatment failure or clinically confirmed pulp survival after a minimum of 1 y. The entire data were fitted to a Cox proportional hazards model to assess the influence of the observational variables MMP-9/TP and discomfort with the randomized lavage treatment on pulp survival. The Kaplan-Meier pulp survival rates after 1 y were 55% for saline and 89% for NaOCl lavage. The inflammatory state of the pulp tissue as reflected by MMP-9/TP levels and NaOCl lavage had a highly significant (P < 0.001 and P = 0.004, respectively) impact on pulp survival, while mild preoperative discomfort did not. In conclusion, MMP-9/TP showed great promise as a predictive local biomarker, and NaOCl lavage considerably improved the survival time of cariously exposed and directly capped pulps.

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

Henry F. Duncan

Summary: Therapeutic strategies focused on pulp preservation are important in managing deep caries and exposed pulp in vital teeth. While vital pulp treatments (VPTs) have been used for over a century, recent advancements in regenerative endodontics and biologically based therapies have expanded the indications for VPT to include mature cariously affected teeth and teeth with irreversible pulpitis. However, gaps in scientific knowledge and limited educational dissemination among dentists pose challenges in accurately diagnosing the inflammatory state of the pulp and providing consistent treatment options. This review discusses the current status of VPT, identifies the major problems hindering its clinical acceptance, and offers potential solutions for making VPT a more consistently prescribed evidenced-based treatment in dental practice.

INTERNATIONAL ENDODONTIC JOURNAL (2022)