Pulp Inflammation Diagnosis from Clinical to Inflammatory Mediators: A Systematic Review

doi:10.1016/j.joen.2017.02.009

Journal of Endodontics

Volume 43, Issue 7, July 2017, Pages 1033-1051

https://doi.org/10.1016/j.joen.2017.02.009 Get rights and content

Highlights

•
Clinical evaluation does not accurately diagnose pulp inflammation severity.
•
Biomarker quantification may aid in the distinction between reversible and irreversible pulpitis.
•
IL-8, MMP-9, TNF-α, and RAGE expression increased in the inflamed dental pulp.

Abstract

Introduction

Similar to other tissues, the dental pulp mounts an inflammatory reaction as a way to eliminate pathogens and stimulate repair. Pulp inflammation is prerequisite for dentin pulp complex repair and regeneration; otherwise, chronic disease or pulp necrosis occurs. Evaluation of pulp inflammation severity is necessary to predict the clinical success of maintaining pulp vitality. Clinical limitations to evaluating in situ inflammatory status are well-described. A molecular approach that aids clinical distinction between reversible and irreversible pulpitis could improve the success rate of vital pulp therapy. The aim of this article is to review inflammatory mediator expression in the context of clinical diagnosis.

Methods

We searched PubMed and Cochrane databases for articles published between 1970 and December 2016. Only published studies of inflammatory mediator expression related to clinical diagnosis were eligible for inclusion and analysis.

Results

Thirty-two articles were analyzed. Two molecular approaches were described by study methods, protein expression analysis and gene expression analysis. Our review indicates that interleukin-8, matrix metalloproteinase 9, tumor necrosis factor-α, and receptor for advanced glycation end products expression increase at both the gene and protein levels during inflammation.

Conclusions

Clinical irreversible pulpitis is related to specific levels of inflammatory mediator expression. The difference in expression between reversible and irreversible disease is both quantitative and qualitative. On the basis of our analysis, in situ quantification of inflammatory mediators may aid in the clinical distinction between reversible and irreversible pulpitis.

Section snippets

Methods

We performed a literature review of expression of any inflammatory mediators related to clinical diagnosis to create a list of potential expression patterns. This systematic review was conducted by using Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA) guideline principles (24). The flow diagram of included records is shown in Figure 1. The focused question was proposed by using principle of Population, the Intervention (or exposure), the appropriate Control or

Selected Studies

This review included 32 articles (Table 1, Table 2). The analysis showed that authors used methods of messenger RNA or protein quantification of inflammatory mediators during inflammation; 28 addressed protein expression profiles 30, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 2 addressed gene expression profiles 71, 72, and 2 addressed both molecular and gene expression 73, 74.

Sampling Methods

Sampling involved tooth extraction in 24 articles 30,

Discussion

The main limitation of this study is the lack of quality studies. Furthermore, the variability in study methods and sample sizes are secondary limitations that preclude meta-analysis.

The results of this systematic review suggest that the gene and protein expression of IL-8, TNF-α, MMP-9, and RAGE increase inside pulp samples of teeth clinically diagnosed with irreversible symptomatic pulpitis.

IL-8 is produced by several pulpal cells including macrophages, lymphocytes, fibroblasts, and

Conclusion and Perspectives

Because dental pain descriptions are subjective, clinical diagnosis alone is unreliable to accurately determine pulp inflammation severity and pulp tissue ability to respond to endodontic procedures. As a result, pulp vital therapy is usually performed following empirical decision-making criteria. The need for new pulp diagnostic tools is increasingly evident. Molecular-based strategies are promising and may be relevant to determine appropriate clinical indications for vital pulp therapy and to