title: Biological Markers for Pulpal Inflammation: A Systematic Review.
abstract: OBJECTIVE
  Pulpitis is mainly caused by an opportunistic infection of the pulp space with commensal oral microorganisms. Depending on the state of inflammation, different treatment regimes are currently advocated. Predictable vital pulp therapy depends on accurate determination of the pulpal status that will allow repair to occur. The role of several players of the host response in pulpitis is well documented: cytokines, proteases, inflammatory mediators, growth factors, antimicrobial peptides and others contribute to pulpal defense mechanisms; these factors may serve as biomarkers that indicate the status of the pulp. Therefore, the aim of this systematic review was to evaluate the presence of biomarkers in pulpitis.
  
  
  METHODS
  The electronic databases of MEDLINE, EMBASE, Scopus and other sources were searched for English and non-English articles published through February 2015. Two independent reviewers extracted information regarding study design, tissue or analyte used, outcome measures, results and conclusions for each article. The quality of the included studies was assessed using a modification of the Newcastle-Ottawa-Scale.
  
  
  CONCLUSIONS
  From the initial 847 publications evaluated, a total of 57 articles were included in this review. In general, irreversible pulpitis was associated with different expression of various biomarkers compared to normal controls. These biomarkers were significantly expressed not only in pulp tissue, but also in gingival crevicular fluid that can be collected non-invasively, and in dentin fluid that can be analyzed without extirpating the entire pulpal tissue. Such data may then be used to accurately differentiate diseased from healthy pulp tissue. The interplay of pulpal biomarkers and their potential use for a more accurate and biologically based diagnostic tool in endodontics is envisaged.
authors.affiliation: Department of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zürich, Zürich, Switzerland.
authors.forename: Dan-Krister
authors.identifier: http://orcid.org/0000-0002-7509-764X
authors.initials: DK
authors.lastname: Rechenberg
authors.affiliation: Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, United States of America.
authors.forename: Johnah C
authors.initials: JC
authors.lastname: Galicia
authors.affiliation: Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California, United States of America.
authors.forename: Ove A
authors.initials: OA
authors.lastname: Peters
mesh_terms: D023181:Antimicrobial Cationic Peptides / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism*; D016207:Cytokines / Q000378:metabolism; D016208:Databases, Factual; D003782:Dental Pulp / Q000378:metabolism* / Q000473:pathology; D004798:Enzymes / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000378:metabolism* / Q000473:pathology; D007962:Leukocytes / Q000166:cytology / Q000276:immunology / Q000378:metabolism; D010447:Peptide Hydrolases / Q000378:metabolism
chemical_list: D023181:Antimicrobial Cationic Peptides; D015415:Biomarkers; D016207:Cytokines; D004798:Enzymes; D010447:Peptide Hydrolases