Diagnostic Biomarkers to Correlate Molecular Changes and Inflammatory Cascade in the Dental Pulp.
Condition: Vital Pulp Therapy
Study type: Interventional

Summary: 
      This study aimed to evaluate the molecular changes that occur within the pulp tissue during
      inflammation and its correlation with vital pulp therapy with its different treatment
      modalities (Direct pulp capping, Partial Pulpotomy and Complete Pulpotomy).
    

Detailed description: 
      The diagnosis of irreversible pulpitis was based only on the clinical signs and symptoms
      which does not always match that of the histological changes of the pulp tissues. So, it is
      more appropriate to diagnose the pulp according to the molecular changes taking place
      throughout the pulp tissues. Different studies have been conducted to study the molecular
      changes that take place in the inflamed pulp, Including a study that was conducted by
      Rechenberg et al in 2014 which states different locations to obtain samples for these
      molecules. The best of which was the dental pulp blood sample. Many studies stated the way to
      obtain a blood sample from the pulp and how to prepare and test it to evaluate the levels and
      concentrations of different inflammatory molecules. Many studies were also conducted to study
      the different changes and accurateness of measurement of different molecules.

      The pulp inflammation occurs in a low compliance environment of dentinal walls. So, During
      acute inflammatory reaction, Vasodilatation occurs along with increased capillary
      permeability, Which leads to increase in the pulp interstitial fluid pressure which creates
      more pressure on blood vessels and this prevents beneficial blood flow, which decreases the
      ability of the pulp to defend itself from bacterial attacks causing tissue necrosis. This
      necrotic tissue is colonized by bacterial tissues.

      In the literature, one of the novel treatment modalities for irrevesible inflammation of the
      pulp is partial removal of the inflammed pulp tissue according to clinical sign (bleeding
      control), The pulp tissue is removed partially until reaching complete coronal pulp removal
      or complete pulpectomy until hemostasis is obtained after 10 minutes of moist cotton pellet
      application.So, The normal pulp is preserved.

      In 2019, Ricucci et al conducted a systematic review for treatment of deep carious lesions
      with pulp exposure. With treatment modalities ranging from direct pulp capping, partial
      pulpotomy, complete pulpotomy and pulpectomy. Based only on clinical signs of normal
      appearance of the pulp tissue under magnification with dental operating microscope and
      bleeding control within 10 minutes with a moist cotton pellet.
    

Intervention name(s): Pulp therapy; Cytokines level in pulpal blood.
Intervention type(s): Procedure; Diagnostic Test
Intervention description(s): partial or complete removal of inflamed pulp tissue; Measuring the concentration of IL-8 and MMP-9 in the dental pulp during inflammation.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Partial Pulpotomy; Cytokines; Direct Pulp Capping