MMP-9 Levels and NaOCl Lavage in Randomized Trial on Direct Pulp Capping.
MMP-9 Levels and NaOCl Lavage in Randomized Trial on Direct Pulp Capping.
复制标题
DOI：
10.1177/00220345211046874
复制
发表时间：
2022-04
影响因子：
7.6
通讯作者：
Zehnder M
中科院分区：
文献类型：
--
作者：
Ballal NV;Duncan HF;Wiedemeier DB;Rai N;Jalan P;Bhat V;Belle VS;Zehnder M
临床上未知的牙髓组织浸润和破裂使龋齿直接盖髓的预期结果模糊不清。组织学研究表明，这种软组织破坏与先天免疫系统有关。我们假设1）中性粒细胞生物标志物可以预测直接盖髓的结果，2）使用次氯酸钠（NaOCl）作为灌洗溶液去除坏死的感染牙髓组织可以改善它。在这项随机试验中，成熟的后牙没有或轻微不适的龋齿牙髓暴露，收集牙髓液以评估中性粒细胞明胶酶（基质金属蛋白酶9 [MMP-9]）/总蛋白（TP）水平作为预测性局部生物标志物。随后，牙本质-牙髓伤口随机用2.5%NaOCl或生理盐水溶液（1：1分配）冲洗，用矿物三氧化物聚合物覆盖，并立即用树脂基复合材料修复。96例患者入选，84例患者随访至治疗失败或至少1年后临床确认牙髓存活。将全部数据拟合到考克斯比例风险模型，以评估观察变量MMP-9/TP和随机灌洗治疗对牙髓存活的不适的影响。1年后的Kaplan-Meier牙髓存活率为55%，盐水和89%的NaOCl灌洗。由MMP-9/TP水平和NaOCl灌洗反映的牙髓组织的炎症状态对牙髓存活具有高度显著的影响（分别为P < 0.001和P = 0.004），而轻度术前不适则没有影响。总之，MMP-9/TP显示出作为预测性局部生物标志物的巨大前景，NaOCl灌洗显著改善了龋暴露和直接盖髓的存活时间。
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.
登录
查看更多内容
影响因子：
6.7
作者：
Meyle, Joerg;Dommisch, Henrik;Herzberg, Mark
通讯作者：
Herzberg, Mark
DOI：
10.4103/0972-0707.212243
发表时间：
2017-03-01
期刊：
Journal of conservative dentistry : JCD
影响因子：
--
作者：
Hegde, Swaroop;Sowmya, B;Dinesh, K
通讯作者：
Dinesh, K
影响因子：
4.2
作者：
Matsuo, T;Nakanishi, T;Ebisu, S
通讯作者：
Ebisu, S
DOI：
10.14219/jada.archive.1970.0293
发表时间：
1970-01-01
影响因子：
3.9
作者：
HASLER, JF;MITCHELL, DF
通讯作者：
MITCHELL, DF
影响因子：
4.3
作者：
Heikkinen, Anna Maria;Nwhator, Solomon O.;Sorsa, Timo
通讯作者：
Sorsa, Timo