Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
Department of Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil.
Oral Dis. 2024 Mar;30(2):100-115. doi: 10.1111/odi.14267. Epub 2022 Jun 20.
This systematic review (PROSPERO CRD42021227711) evaluated the influence of diabetes mellitus (DM) on the response of the pulp tissue and in the pulp cells behaviour.
Searches in PubMed/MEDLINE, Embase, Web of Science and OpenGrey were performed until March 2022. Studies evaluating the effects of DM in the pulp tissue inflammation and in the cell behaviour were included, followed by risk of bias assessment (Methodological Index for Non-Randomized Studies and SYRCLE's RoB tools). The meta-analysis was unfeasible, and a narrative synthesis for each outcome was provided.
Of the 615 studies, 21 were eligible, mainly with in vivo analysis (16 studies). The pulp inflammation (10 studies) was analysed mainly by haematoxylin-eosin stain; DM increased pulp inflammation/degeneration in 9 studies, especially after dental procedures. The cell viability (5 studies) was analysed mostly using MTT assay; DM and glycating agents decreased cellular viability in 3 studies. DM reduced collagen in all of three studies. There were controversial results regarding mineralization; however, increased alkaline phosphatase was reported in three of four studies.
DM seems to increase inflammation/degeneration and mineralization in the pulp tissue while reducing cell proliferation. Further analyses in human pulp are important to provide stronger evidence.
本系统评价（PROSPERO CRD42021227711）评估了糖尿病（DM）对牙髓组织反应和牙髓细胞行为的影响。
检索 PubMed/MEDLINE、Embase、Web of Science 和 OpenGrey 数据库，检索时间截至 2022 年 3 月。纳入评估 DM 对牙髓组织炎症和细胞行为影响的研究，并进行偏倚风险评估（非随机研究方法学指数和 SYRCLE 的 RoB 工具）。Meta 分析不可行，因此针对每个结局提供了叙述性综合。
在 615 项研究中，有 21 项符合纳入标准，主要为体内分析（16 项研究）。牙髓炎症（10 项研究）主要通过苏木精-伊红染色进行分析；9 项研究表明 DM 增加了牙髓炎症/变性，尤其是在牙科操作后。细胞活力（5 项研究）主要通过 MTT 测定进行分析；3 项研究表明 DM 和糖基化剂降低了细胞活力。3 项研究均表明 DM 降低了胶原蛋白。关于矿化，结果存在争议；然而，4 项研究中的 3 项报告了碱性磷酸酶的增加。
DM 似乎增加了牙髓组织的炎症/变性和矿化，同时降低了细胞增殖。进一步对人牙髓进行分析对于提供更强有力的证据非常重要。
