| ObjectiveThe aim was to explore the relationship between the prognosis of vital pulp therapy of symptomatic irreversible pulpitis caused by caries and the clinical indexes,as well as the microbial characteristics of deep caries through a 3-month follow up.MethodsTwenty-six cases of symptomatic irreversible pulpitis caused by caries were collected from the Department of Endodontics,School of Stomatology,Tianjin Medical University.On the basis of the American Association of Endodontists and the clinical examinations,the diagnosis was made.After examinations,the patient was informed of the condition of the teeth,the treatment methods and risks,and the informed consent was signed.Depended on pulp exposure condition,three types of vital pulp therapy were operated: indirect pulp capping(IPC),direct pulp capping(DPC),and pulpotomy(PPT).The deepest layer decay was collected and sequenced by 16 S rDNA,the color/texture of the decay were recorded.Mineral Trioxide Aggregate was placed.After glass ionomer was sealed for a week,permanent resin filling was performed.All patients were followed up for 3 months,and divided into success group and failure group.The correlation between the clinical indexes and the prognosis was analyzed,and the optimal subset regression model was built.The receiver operating characteristic curve(ROC)was used to validate the model.16 S rDNA sequencing was used to detect the species and quantity of microbiome,α and β diversity analysis was applied to analyze the microbial abundance and the difference of microbial distribution,and Linear discriminant analysis effect size analysis(LEfSe)was used to explore whether there was differential microbiome between two groups.ResultsIn the twenty-six teeth,there were 23 samples in S group and 3 samples in F group.There was no correlation between the prognosis and age,sex,dental arch,tooth type,carious surfaces,cold/heat stimulus pain intensity,cold/heat stimulus lingering pain time,spontaneous pain,spontaneous pain intensity,night pain,percussion pain and the D-value of electric pulp test.The prognosis was related to the color/texture of the decay and the way of vital pulp therapy.The area under the ROC curve that verified the optimal subset regression model was 0.993.The 16 S rDNA sequencing showed that 853 OTUs was obtained.The dominant phylum was mainly Firmicutes,Proteobacteria,Actinobacteria,and Bacteroidetes.At genus level,the relative abundance of Lactobacillus was the highest.In α diversity analysis,species richness differed between the 26 samples.β diversity analysis found that the distribution of microbiome in F group was similar with those in S group.The LEfSe analysis showed that the differential microbiome was Bacteroidete between two groups,and there was no differential species at the genus.Conclusions1.There was no correlation between the prognosis and demographic characteristics as well as clinical indexes.The prognosis was related to the color/texture of the decay and the way of vital pulp therapy.These three characteristics have a good ability to distinguish the success and failure of the vital pulp therapy of symptomatic irreversible pulpitis.2.The microorganisms in the deep caries possessed rich diversity,and the dominant bacteria was mainly Lactobacillus,which may be one of the pathogenic microbiome of irreversible pulpitis.There was no difference in microbial composition between two groups.The relative abundance of Bacteroidetes may be one of the factors that affect the prognosis of vital pulp therapy of irreversible pulpitis.3.The prognosis of vital pulp therapy of irreversible pulpitis was influenced by the color/texture of the decay and the way of vital pulp therapy.On the other hand,the relative abundance of Bacteroides was also relative.4.In view of the limitations of this study,vital pulp therapy has a good short-term effect for symptomatic irreversible pulpitis caused by caries of mature permanent teeth,which may be another option in addition to root canal therapy. |
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