Division of Endodontology and Operative Dentistry
Staff
Key words: endodontics, materials, standards, hydraulic cements
PURE profile
Key words: vital pulp therapy, regeneration, endodontics
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Key words: clinical research, biomarkers, periapical disease
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Key words: molar incisor hypomineralisation, dental disease, public health, dental caries
PURE profile
Research within the Division
The research undertaken by the Division of Endodontology and Operative Dentistry is underpinned by understanding the disease processes leading to loss of mineral tissues and their replacement and the management of the dental pulp. Dental caries is still one of the main causes of loss of dental hard tissues. Collaborative work is being undertaken with the Division of Oral Surgery, Medicine, Pathology, Biology, Radiology to understand the disease process, and imaging in collaboration with our partners at Isis Neutron Imaging. The clinical perspective on the society guidance on full or partial caries removal is a focus of our research. Furthermore, research is being undertaken by looking into demineralisation of teeth with molar- incisor hypomineralisation.
The research undertaken pertaining to pulp and periapical disease aims to better understand the molecular processes that lead to injury of the pulpal and periradicular tissues during disease and subsequently regenerative processes leading to healing in order to identify opportunities to improve diagnostics and treatments for patients with endodontic disease. This work has led to the characterisation of periradicular tissue fluid-derived biomarkers in patients with apical periodontitis providing potential prognostic profiles for predictable treatment outcomes. Molecular analysis of material induced healing by hydraulic calcium silicate cements of the pulpal tissues has shown local release of matrix-bound growth factors induces tissue repair-associated processes such as cell proliferation, differentiation, angiogenesis, chemotaxis and mineralisation. Further work has shown therapeutic irrigation protocols can be utilised during conventional root canal therapy that enable bioavailability of dentine extracellular matrix components and their positive regenerative effects on periapical lesion-derived mesenchymal stem cells. This suggests a whole new approach and strategy for managing periradicular disease.
Research is also undertaken to develop more biologically driven treatment strategies for common pulp and periradicular diseases, a field that provides exciting opportunities to harness developments in regenerative medicine. More specifically, it explores the therapeutic potentials of dentine extracellular matrix components for the treatment of apical periodontitis and the identification of diagnostic and prognostic biomarkers for this disease.
The clinical translatory aspect is also shown on the research undertaken on hydraulic cements. The world leading research on hydraulic cements used as endodontic materials has led to the development and understanding of the chemistry of these materials and their specific use. This research has led to the discovery of the interaction of the hydraulic cements with tooth structure, blood and the endodontic environment which could be translated in development of protocols for specific clinical procedures. The understanding has been achieved by lab-based testing using simulated clinical procedures but also by testing materials retrieved from failed cases.
The interactions of dental materials with the clinical environment have also led to the discovery of the aetiology and mitigating factors of tooth discolouration related to the use of bismuth oxide with sodium hypochlorite used in clinical endodontic procedures. This work has been undertaken in partnership with Diamond Light Source. It has led to changes in clinical protocols and also the elimination of bismuth oxide from dental materials.
Other work being undertaken by the division and which has received funding by the Medical Research Council is the development of standards for testing hydraulic cements in dentistry where the material interactions effecting the material properties will be assessed. Our staff are also involved in the Adult Oral Health Survey and research into the admissions process for dentistry.
Clinical to lab translation showing a failed root cnal treatement with the root-end filling material retrieved and assessed in the laboratory for chemical and morphological changes - https://pubmed.ncbi.nlm.nih.gov/26786381/.
Microstructural changes on hydrauli ccalcium silicate cement used for vital pulp therapy exposed to different environments when testing solubility showing the need to develop standards for materials used in vital pulp therapy - https://pubmed.ncbi.nlm.nih.gov/38876829/.
Investigating bismuth oxide microstructure with changes in contact with sodium hypochlorite leading to tooth discolouration (Clinical photo courtesy of Dr Philip Tomson) - https://pubmed.ncbi.nlm.nih.gov/33176336/.
Clinical study undertaken to show the management of apical periodontitis using alternative biologically focused methods.