Question: In an endodontically treated tooth, is there still an enzymatic response?
Alright, here is a question for my research colleagues that have more knowledge then I ever will. We know that there are active MMP’s, cysteine cathepsins, and other enzymes present in the vital tooth that responds to acid attack (carious or acid etching from our restorative processes). But in an endodontically treated tooth, is there still an enzymatic response? And if so, is it the same or muted in comparison?
Salvatore Sauro: Nice question John Comisi!!!!!!
John Comisi: Its very scary what my mind thinks about.
Umer Daood: John Comisi thats very logical to think . You see, for sure the high MMP levels detected within root canals of necrotic teeth did reduce after end therapy. Such as use of calcium hydroxide. But there has not been any real effort to look the levels after the end treatment. But for sure i know they are reduced , but to suggest muting them i am really not sure. Remember, MMP activity also owes a lot to inflammatory activity within the root canals too. There is a misbalance in the normal redox due to the oxidative stress cells are going through , due to the inflammatory disorder and necrosis i mentioned earlier. But I agree with you, this needs to be looked in, in particular to a particular type of material that is being used in the canals. Martin et al talk about extrusion of MMps along with debris with use of EDTA. But I dunno man, sounds inconclusive and old, as the paper came way back.
Umer Daood: The more you know about them, the more you hate them, the MMPs that is
Richard Downs: Porcine hormone levels also affect MMP levels in teeth I have read. Non vital teeth would not naturally remove them.
Umer Daood: True Richard. Therefore I was compelled to use the word reduced. The pro-enzymes are bound to stay in within the dentine inherently.
John Comisi: So, if I am understanding this correctly, we will always have to deal with the potential for enzymatic breakdown and need to find methods and biomaterials that will help shift the balance of power.
Umer Daood: Spot on John Comisi
Umer Daood: a pretreatment or an adhesive that may therapeutically leach out something for a long period of time or that which stays immobile within the hybrid layer
Dave Pierson: John, looking forward to expanding the learning experience in this important and evolving field.Thanks for including me
John Comisi: Your welcome Dave Pierson. This is an outstanding group!
Richard Downs: I have written a long article that is not published in a dental journal that reflects on this subject. It relates the various forms of toxins produced in gingival tissues as well and endodontic articles. It you would like I will copy the entire literature review and my conclusions in this comment section but it will take up allot of space.
Salvatore Sauro: Please write a brief message and the upload it as PDF file. Thanks for your support
Umer Daood: Richard you can make it as a separate post
Richard Downs: OK