Terapijski efekti eritropoetina u direktnom prekrivanju inflamirane zubne pulpe

Abstract

Uvod Direktno prekrivanje predstavlja postavljanje određenih materijala na mesto eksponiranja pulpe kako bi se održao njen vitalitet. Stopa uspeha terapije značajno se umanjuje ako se sprovodi na prethodno inflamiranoj zubnoj pulpi. Eritropoetin (EPO) je glavni stimulator eritropoeze, ali postojeća saznanja ukazuju da može ostvariti različite povoljne efekte u reparaciji oštećenih tkiva. Cilj Ispitivanje ekspresije eritropoetina i eritropoetinskog receptora u eksponiranoj i direktno prekrivenoj pulpi i ispitivanje efekata eritropoetina na inflamaciju i reparatornu dentinogenezu u terapiji direktnim prekrivanjem inflamirane zubne pulpe. Materijal i metode Indukovana je inflamacija eksponiranjem pulpe prvih maksilarnih molara pacova na 48 sati, a zatim direktno prekrivanje primenom rhEPO, Ca(OH)2, MTA ili MTA+rhEPO. Kao kontrole korišćene su eksponirana neprekrivena (EC) i zdrava zubna pulpa (HC). Sprovedene su imunohistohemijska, histološka, PCR i spektrofotometrijska analiza. Dobijeni podaci su obrađeni statistički. Rezultati EC grupa imala je najvišu ekspresiju EPO-R, dok je prekrivanje primenom Ca(OH)2 ili MTA dovelo do povećanja ekspresije EPO. Direktno prekrivanje umanjilo je ekspresiju proinflamatornih citokina i povećalo ekspresiju imunoregulatornih citokina u odnosu na EC grupu. Primena MTA+rhEPO dovela je do povećanja ekspresije markera odontoblaste aktivnosti u odnosu na EC grupu. Primena preparata koji sadrže rhEPO umanjila je vrednosti prooksidativnih parametara u odnosu na EC grupu. Zaključak ERO i ERO-R eksprimirani su u eksponiranoj i direktno prekrivenoj zubnoj pulpi. EPO može biti pogodan za primenu u terapiji direktnim prekrivanjem pulpe jer umanjuje stepen inflamacije i stimuliše reparatornu dentinogenezu, ostvarujući efekat sličan uobičajeno korišćenim materijalima.

Introduction Direct pulp capping presents placing of certain materials on exposure site in order to preserve its vitality. The success rate of this therapy is significantly reduced if it is performed on previously inflamed dental pulp. Erythropoietin (EPO) is the main stimulator of erythropoiesis, but the existing literature indicates that it could have various beneficial effects on repair of damaged tissues. Aim To investigate the expression of erythropoietin and erythropoietin receptor in pulp exposure and direct pulp capping and to investigate the effects of erythropoietin on inflammation and reparative dentinogenesis in direct capping of inflamed dental pulp. Material and methods Pulp inflammation was induced by exposing the pulp of rats’ maxillary first molars for 48 h, followed by capping using rhEPO, Ca(OH)2, MTA or MTA+rhEPO. Noncapped exposed pulp (EC) and healthy pulp (HC) were used as controls. Immunohistochemical, histological, PCR and spectrophotometric analysis were performed. Acquired data was analyzed statistically. Results EC group had the highest expression of EPO-R, while capping with Ca(OH)2 or MTA led to increased EPO expression. Direct pulp capping decreased the expression of proinflammatory and increased the expression of immunoregulatory cytokines compared to EC group. Capping with MTA+rhEPO led to increased expression of odontoblast activity markers compared to EC group. Capping with the rhEPO-containing materials reduced the values of pro-oxidative parameters compared to EC group. Conclusion EPO and EPO-R are expressed in exposed and capped dental pulp. EPO can be suitable for direct pulp capping because it reduces the degree of inflammation and stimulates the reparative dentinogenesis, having similar effects to commonly used materials.