Loo Ai Leen Shu Jen, Cen Rong, Wang Junwen, Wu Zhaoming, Duncan Henry Fergus, Lee Angeline Hui Cheng, Zhang Chengfei
Endodontics, Restorative Dental Sciences, Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, Hong Kong.
Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, the University of Hong Kong, Hong Kong SAR, Hong Kong.
Int Endod J. 2025 Oct;58(10):1565-1581. doi: 10.1111/iej.14275. Epub 2025 Jun 26.
To evaluate the association of inflammatory mediators with clinical signs and symptoms and their spatial distribution in teeth with pulpitis.
Fifty permanent teeth from adults with clinical diagnoses of normal pulp (n = 17), reversible pulpitis (n = 13) and symptomatic/asymptomatic irreversible pulpitis (n = 20), were recruited. Two pulp blood samples from each tooth, one at the pulp exposure site (coronal blood) and one at the orifice level (radicular blood), were collected and analysed using multiplex immunoassay. The expression of 52 inflammatory mediators was analysed to compare regional variations within teeth, between groups and amongst teeth with pulpitis regrouped by symptom severity. Statistical comparisons were made using paired comparison tests at p < 0.05.
TGFα and FGF-2 were significantly downregulated in teeth with reversible and irreversible pulpitis compared with healthy controls (p < 0.05). IL-1β was significantly upregulated in the radicular blood of teeth with irreversible pulpitis compared with reversible pulpitis (p < 0.05). Higher concentrations of inflammatory markers were found in the coronal blood of reversibly inflamed teeth, whilst irreversibly inflamed teeth exhibited elevated fractalkine and IL-2 in radicular regions (p < 0.05). The spatial distribution of biomarkers in teeth with pulpitis after regrouping by symptom severity demonstrated increased IL-22 in coronal blood and IL-13 in radicular blood in symptomatic teeth (p < 0.001, p < 0.05). Radicular blood of teeth with mild symptomatic pulpitis showed significantly increased levels of IL-17A but decreased concentrations of TGFα and MMP-2 compared to asymptomatic teeth (p < 0.05). Teeth with severe symptomatic pulpitis exhibited significantly higher levels of IL-1α and TGFα in coronal blood compared with asymptomatic irreversible pulpitis (p < 0.05). Symptomatic teeth generally exhibited more pronounced coronal inflammatory mediator expression.
IL-1β is a promising biomarker for distinguishing between reversible and irreversible pulpitis. TGFα and FGF-2 demonstrate significant potential as diagnostic biomarkers in discriminating between states of pulpitis and health. IL-1α, IL-13, IL-17A, IL-22, TGFα and MMP2 also showed potential to differentiate between teeth with symptomatic and asymptomatic irreversible pulpitis. Both classification systems used revealed distinct inflammatory mediator patterns, which were found to be correlated with symptom severity, particularly in the coronal region.
评估炎症介质与牙髓炎患牙临床体征和症状及其空间分布的相关性。
招募了50颗来自临床诊断为正常牙髓（n = 17）、可复性牙髓炎（n = 13）以及有症状/无症状不可复性牙髓炎（n = 20）的成年人恒牙。从每颗牙齿采集两份牙髓血样本，一份在牙髓暴露部位（冠部血液），一份在根尖孔水平（根部血液），并使用多重免疫测定法进行分析。分析52种炎症介质的表达，以比较牙齿内部、组间以及根据症状严重程度重新分组的牙髓炎患牙之间的区域差异。使用p < 0.05的配对比较检验进行统计学比较。
与健康对照组相比，可复性和不可复性牙髓炎患牙中的转化生长因子α（TGFα）和成纤维细胞生长因子2（FGF - 2）显著下调（p < 0.05）。与可复性牙髓炎相比，不可复性牙髓炎患牙根尖血液中的白细胞介素1β（IL - 1β）显著上调（p < 0.05）。在可复性炎症牙齿的冠部血液中发现了更高浓度的炎症标志物，而不可复性炎症牙齿在根尖区域表现出趋化因子和白细胞介素2升高（p < 0.05）。根据症状严重程度重新分组后，牙髓炎患牙中生物标志物的空间分布显示，有症状牙齿的冠部血液中白细胞介素22增加，根尖血液中白细胞介素13增加（p < 0.001，p < 0.05）。与无症状牙齿相比，轻度症状性牙髓炎患牙根尖血液中白细胞介素17A水平显著升高，但转化生长因子α和基质金属蛋白酶2（MMP - 2）浓度降低（p < 0.05）。与无症状不可复性牙髓炎相比，重度症状性牙髓炎患牙冠部血液中白细胞介素1α和转化生长因子α水平显著更高（p < 0.05）。有症状的牙齿通常表现出更明显的冠部炎症介质表达。
白细胞介素1β是区分可复性和不可复性牙髓炎的有前景的生物标志物。转化生长因子α和成纤维细胞生长因子2在区分牙髓炎状态与健康状态方面具有作为诊断生物标志物的显著潜力。白细胞介素1α、白细胞介素13、白细胞介素17A、白细胞介素22、转化生长因子α和基质金属蛋白酶2在区分有症状和无症状不可复性牙髓炎患牙方面也显示出潜力。所使用的两种分类系统均揭示了不同的炎症介质模式，这些模式与症状严重程度相关，特别是在冠部区域。
