Phillip Tomson - Academia.edu (original) (raw)

Papers by Phillip Tomson

Proliferative verrucous leukoplakia (PVL) is regarded as an aggressive form of oral leukoplakia. ... more Proliferative verrucous leukoplakia (PVL) is regarded as an aggressive form of oral leukoplakia. It often presents as a multifocal, persistent lesion (Ghazali et al, 2003) and classically exhibits a high morbidity and mortality rate (Silverman and Gorsky, 1997; Campisi et al, 2004). PVL is more commonly seen to affect the female population, with some authors quoting a male to female ratio of 1:4 (Silverman and Gorsky, 1997). The mean age at presentation is 62 years (Silverman and Gorsky, 1997; Campisi et al, 2004). The aetiology of PVL is unknown. It is a clinicopathological entity that tends to develop slowly and, as such, a wide phenotypic spectrum of disease is described. Some authors outline specific disease categories (Greer et al, 1999) including verrucous hyperplasia, with degrees of epithelial dysplasia and varying types of carcinoma, such as verrucous and oral squamous cell carcinoma. It is felt that the progressive nature of the lesion is inevitable and often irreversible ...

Dental Update, 2002

Thorough periodontal assessment is vital for diagnosis, treatment planning and monitoring the pro... more Thorough periodontal assessment is vital for diagnosis, treatment planning and monitoring the progression of periodontal disease. This is a report of a clinical audit that studied the periodontal assessment carried out at a large general dental practice in Shropshire, England. This audit was conducted over a 3-month period, analysing 700 patients for each audit cycle. A new protocol for periodontal assessment using the guidelines of the British Society of Periodontology was introduced. The results demonstrate a marked improvement in assessing the periodontal condition of patients in this general dental practice.

Http Www Libreriasaulamedica Com, 2006

British Dental Journal, 2006

Aim: To review the latest developments in the field of pulp biology, particularly those elements ... more Aim: To review the latest developments in the field of pulp biology, particularly those elements of specific interest to clinical dentists, whilst highlighting the importance of maintaining pulp vitality for conservative dentistry. Pulp biology is crucial to everyday practice in dentistry and the knowledge acquired, especially in the last five years on the pulp healing process, has highlighted simple but effective applications. However, difficulties in communication between biologists and clinicians, mostly due to the complexity of biology as a discipline, are a significant obstacle to therapeutic developments and their application on a larger scale. Methods: A literature review was undertaken on the current understanding of the biology of the dentine-pulp complex, especially in the context of conservative dentistry. Results: Novel biotechnological insights have recently been discovered, including the presence of stem cell-like cells within the tooth and their potential roles in rep...

British Dental Journal, 2021

This is the first article in a series reviewing the current literature surrounding the management... more This is the first article in a series reviewing the current literature surrounding the management of deep caries in permanent teeth. Approaches to caries management are continuing to evolve, with more conservative management increasingly favoured. This philosophy has never been more important than in managing the deep carious lesion. Evidence is emerging that the use of selective caries removal to reduce the risk of pulp exposure, in conjunction with calcium silicate cements, can be successful in maintaining pulp vitality, delaying the restorative cycle and prolonging the lifespan of the tooth. Non-selective caries removal is currently not recommended in the management of deep carious lesions. Selective caries removal should be considered ahead of a stepwise approach. Selective caries removal minimises the risk of pulp exposure and improves pulp survival in the short-to-medium term. Calcium silicate cements show potential in the management of deep caries.

Tissue Engineering Part B: Reviews, 2021

The recent discovery of mesenchymal stem cells within periapical lesions (PL-MSC) has presented n... more The recent discovery of mesenchymal stem cells within periapical lesions (PL-MSC) has presented novel opportunities for managing periradicular diseases in adult teeth by way of enhancing tissue regeneration. This discovery coincides with the current paradigm shift toward biologically driven treatment strategies in endodontics, which have typically been reserved for non-vital immature permanent teeth. One such approach that shows promise is utilizing local endogenous non-collagenous dentine extracellular matrix components (dECM) to recruit and upregulate the intrinsic regenerative capacity of PL-MSCs in situ. At picogram levels, these morphogens have demonstrated tremendous ability to enhance the cellular activities in in vitro and in vivo animal studies that would otherwise be necessary for periradicular regeneration. Briefly, these include proliferation, viability, migration, differentiation, and mineralization. Therefore, topical application of dECMs during ortho-or retrograde root canal treatment could potentially enhance and sustain the regenerative mechanisms within diseased periapical tissues that are responsible for attaining favorable clinical and radiographic outcomes. This would provide many advantages when compared with conventional antimicrobial-only therapies for apical periodontitis (AP), which do not directly stimulate healing and have had stagnant success rates over the past five decades despite significant advances in operative techniques. The aim of this narrative review was to present the novel concept of exploiting endogenous dECMs as clinical tools for treating AP in mature permanent teeth. A large scope of literature was summarized to discuss the issues associated with conventional treatment modalities; current knowledge surrounding PL-MSCs; composition of the dECM; inductive potentials of dECM morphogens in other odontogenic stem cell niches; how treatment protocols can be adapted to take advantage of dECMs and PL-MSCs; and finally, the challenges currently impeding successful clinical translation alongside directions for future research.

British Dental Journal, 2021

Vital pulp therapies (VPTs) aim to preserve the vitality of the pulp. The European Society of End... more Vital pulp therapies (VPTs) aim to preserve the vitality of the pulp. The European Society of Endodontology have begun a campaign to raise awareness on the efficacy of VPTs following on from the publication of their 2019 position statement, aimed at both specialists and general dental practitioners. This review examines the current evidence surrounding VPTs and provides a rational approach to the management of the exposed pulp with the aid of case studies. Success lies in accurate diagnosis and case selection, along with well-executed treatment and appropriate follow-up protocols. The introduction of calcium silicate cements has made these treatments more predictable. There is sufficient evidence to recommend calcium silicate cements ahead of calcium hydroxide for all vital pulp therapies, but consideration must be given to potential discolouration in material selection. The main driver for a decision between different vital pulp therapies is the visual appearance of the pulp and the ability to control haemorrhage. Following careful case selection, teeth receiving vital pulp therapies with calcium silicate cements have a good prognosis, equal to pulpectomy and root canal treatment, which still remains an option in the event of failure.

Scientific Reports, 2021

In root canal therapy, irrigating solutions are employed to eliminate the bacterial load and also... more In root canal therapy, irrigating solutions are employed to eliminate the bacterial load and also prepare dentin for sealer interaction. The aim of this research was to assess how irrigating solutions employed on their own or in sequence affected the tooth structure. The best way to prepare the tooth for obturation using hydraulic calcium silicate cement (HCSC) sealers and gutta-percha, thus guiding clinicians on a matched irrigation-obturation strategy for optimized root canal treatment was investigated. The effect of irrigating solutions on dentine was investigated by assessing changes in dentin microhardness, ultrastructure and mineral content, organic/inorganic matter, surface roughness and Young’s modulus. The interaction of four root canal sealers with the dentin was analysed by assessing the changes in microhardness of the dentin after sealer placement and also the sealer to dentin interface by scanning electron and confocal laser microscopy. The irrigating solutions damaged ...

Primary Dental Journal, 2016

Prevention or treatment of apical periodontitis is aimed at disinfecting the root canal system so... more Prevention or treatment of apical periodontitis is aimed at disinfecting the root canal system so that the periradicular tissues are not vulnerable to attack from microbiota within the tooth. This is achieved by a process of cleaning and shaping the root canal space. The fundamental principles underlying this process have not changed in decades. In contrast, the armamentarium available to the clinician continues to evolve rapidly. The use of specially designed nickel titanium (NiTi) files to create a glidepath allows the clinician to manage tight curved canals more predictably in situations which would otherwise have proved too difficult using conventional techniques. Other files, designed to shape the canal, have been developed using metallurgic principles which permit NiTi files to be more flexible and resistant to cyclic fatigue. These newer systems also require fewer instruments to prepare a canal and some, which have adopted a reciprocating (rotational) motion, may only require...

British Dental Journal, 2020

Where a licence is displayed above, please note the terms and conditions of the licence govern yo... more Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

International Endodontic Journal, 2020

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Dental Traumatology, 2019

Background/Aim: In addition to their anti-inflammatory and anti-osteoclastogenesis properties, ad... more Background/Aim: In addition to their anti-inflammatory and anti-osteoclastogenesis properties, adrenergic blockers may also have promising anti-resorptive effects that can prevent root resorption when teeth are replanted because of avulsion. The aim of this study was to investigate the effects of phentolamine (Ph) and propranolol (Pr) in gels on the repair process of late replanted rat incisors. A further aim was to evaluate the biocompatibility of both drugs to human periodontal ligament fibroblasts (HPDLFs). Material and methods: Forty-eight maxillary right incisors were extracted from male Wistar rats, stored in paper napkins for 60 minutes and randomly allocated to one of eight groups (n=6). The root canal, root surface and alveolus were treated with 0.75 µg/ml Ph gel (Ph0.75), 10 µg/ml Ph gel (Ph10), 100 µg/ml Ph gel (Ph100), 2.5 µg/ml Pr gel (Pr2.5), 10 µg/ml Pr gel (Pr10), 100 µg/ml Pr gel (Pr100), or sodium carboxymethylcellulose gel (CMC) before replantation. In the control group (CH), only the root canal was treated with calcium hydroxide paste. Thirty days following surgery, the animals were euthanized, and the right hemimaxilla was removed to perform micro-CT and histomorphometric analysis to determine osteoclastic activity. Ethanolic solutions of Ph10 and Pr10 were selected based on the in vivo study, and the viability of HPDLFs stimulated with lipopolysaccharide was determined by MTT assays. Results: The Micro-CT and histomorphometric analysis revealed no significant differences among the treatments (P > 0.05). The presence of active osteoclasts was significantly decreased in the Ph10 and Pr10 groups (P < 0.05). Ph10 and Pr10 produced statistically similar cell survival rates compared to the control group (P > 0.05). Conclusions: Ph10 2 and Pr10 significantly decreased osteoclastogenesis in delayed replanted rat teeth and were not cytotoxic towards HPDLFs.

http://isrctn.com/, 2019

A randomised controlled pilot study to determine the effect of irrigation techniques used to enha... more A randomised controlled pilot study to determine the effect of irrigation techniques used to enhance the release of endogenous signalling molecules from dentine matrix to treat apical periodontitis.

Journal of Dentistry, 2019

was reduced to 93.97% clinical and 88.39% radiographic success at 36 months follow-up. Results fr... more was reduced to 93.97% clinical and 88.39% radiographic success at 36 months follow-up. Results from the only comparative clinical trial showed pulpotomy to have comparable success to root canal treatment at 12, 24 and 60 month follow-up. Conclusions The evidence suggests high success for pulpotomy for teeth with signs and symptoms of irreversible pulpitis, however, results are based on heterogeneous studies with high risk of bias. Well-designed, adequately powered randomised controlled trials are required for evidence to change clinical practice. Clinical significance: Management of carious teeth with irreversible pulpitis is traditionally invasive, but emerging evidence suggests potentially successful treatment outcomes with less invasive therapies such as coronal pulpotomy

British Dental Journal, 2019

Highlights the regional inequalities that are present with the commissioning and provision of enh... more Highlights the regional inequalities that are present with the commissioning and provision of enhanced NHS endodontic services across England.

British Dental Journal, 2019

Discusses the advantages and limitations of the technique, in comparison with alternative approac... more Discusses the advantages and limitations of the technique, in comparison with alternative approaches.

Journal of Endodontics, 2019

Introduction: Neurotrophic factors play a significant role in the innervation of the pulp-dentin ... more Introduction: Neurotrophic factors play a significant role in the innervation of the pulp-dentin complex during and after organogenesis. There have been numerous bioactive molecules identified in the dentin extracellular matrix; however, the expression of neurotrophic factors in the dentin matrix and their biological activity are largely unknown. The purpose of this study was to characterize the relative expression of neurotrophic factors in human dentin matrix proteins (DMPs) and their effect on neurite outgrowth of trigeminal (TG) neurons. Methods: Dentin was powdered in liquid nitrogen from noncarious human third molar teeth. DMPs were solubilized through an EDTA extraction method, dialyzed, and lyophilized until use. The relative expression of nerve growth factor, brain-derived neurotrophic factor, glial cellÀline derived neurotrophic factor, neurotrophin 3, and neurotrophin 4/5 was determined by the enzyme-linked immunosorbent assay. Rat TG neurons were cultured and exposed to different concentrations of DMPs (1-10 5 ng/mL) or vehicle, and a quantitative neurite outgrowth assay was performed. Results: Human DMPs contained all of the tested neurotrophic factors, with glial cellÀline derived neurotrophic factor and neurotrophin 4/5 found at the highest levels. DMPs were able to promote the neurite outgrowth of rat TG neurons at an optimum concentration of 10-10 2 ng/mL, whereas the effect was partially inhibited at higher concentrations (>10 3 ng/mL). Conclusions: The human dentin extracellular matrix is a rich reservoir for neurotrophic factors that are key components for neuronal homeostasis, differentiation, and regeneration. These data suggest that neurotrophins in DMPs could play an important role as signaling molecules for the innervation of the pulp-dentin complex during the processes of tooth formation, repair, and regeneration.

Tissue Engineering Part A, 2018

In teeth with an injured pulp, dentin matrix orchestrates hard tissue repair through the release ... more In teeth with an injured pulp, dentin matrix orchestrates hard tissue repair through the release of dentin extracellular matrix components (dEMCs). dEMCs regulate the differentiation of resident mesenchymal stromal cells (MSCs), thereby affecting mineral deposition. Here, we show that low concentration solubilized dEMCs in osteogenic cultures of human umbilical cord mesenchymal stromal cells (UC-MSCs) and dental pulp stromal cells (DPSCs) enhanced mineral deposition, while adipose stromal cells (ASCs) were barely affected. Interestingly, UC-MSCs displayed significantly greater hydroxyapatite formation compared to DPSCs. UC-MSCs and DPSCs showed a dose-dependent viability and proliferation, whereas proliferation of ASCs remained unaffected. Qualitative analysis of the dEMCs-supplemented osteogenic cultures through scanning electron microscopy demonstrated differences in the architecture of the deposited mineralized structures. Large-sized mineral accretions upon a poorly organized collagen network was the prominent feature of UC-MSCs cultures, while mineral nodules interspersed throughout a collagen mesh were observed in the respective DPSCs cultures. The ability of dEMCs to induce mineralization varies between different human MSCs types in terms of total mineral formation and its architecture. Mineral formation by UC-MSCs exposed to low concentration dEMCs proved to be the most efficient and therefore could be considered as a promising combination for mineralized tissue engineering.

Proliferative verrucous leukoplakia (PVL) is regarded as an aggressive form of oral leukoplakia. ... more Proliferative verrucous leukoplakia (PVL) is regarded as an aggressive form of oral leukoplakia. It often presents as a multifocal, persistent lesion (Ghazali et al, 2003) and classically exhibits a high morbidity and mortality rate (Silverman and Gorsky, 1997; Campisi et al, 2004). PVL is more commonly seen to affect the female population, with some authors quoting a male to female ratio of 1:4 (Silverman and Gorsky, 1997). The mean age at presentation is 62 years (Silverman and Gorsky, 1997; Campisi et al, 2004). The aetiology of PVL is unknown. It is a clinicopathological entity that tends to develop slowly and, as such, a wide phenotypic spectrum of disease is described. Some authors outline specific disease categories (Greer et al, 1999) including verrucous hyperplasia, with degrees of epithelial dysplasia and varying types of carcinoma, such as verrucous and oral squamous cell carcinoma. It is felt that the progressive nature of the lesion is inevitable and often irreversible ...

Dental Update, 2002

Thorough periodontal assessment is vital for diagnosis, treatment planning and monitoring the pro... more Thorough periodontal assessment is vital for diagnosis, treatment planning and monitoring the progression of periodontal disease. This is a report of a clinical audit that studied the periodontal assessment carried out at a large general dental practice in Shropshire, England. This audit was conducted over a 3-month period, analysing 700 patients for each audit cycle. A new protocol for periodontal assessment using the guidelines of the British Society of Periodontology was introduced. The results demonstrate a marked improvement in assessing the periodontal condition of patients in this general dental practice.

Http Www Libreriasaulamedica Com, 2006

British Dental Journal, 2006

Aim: To review the latest developments in the field of pulp biology, particularly those elements ... more Aim: To review the latest developments in the field of pulp biology, particularly those elements of specific interest to clinical dentists, whilst highlighting the importance of maintaining pulp vitality for conservative dentistry. Pulp biology is crucial to everyday practice in dentistry and the knowledge acquired, especially in the last five years on the pulp healing process, has highlighted simple but effective applications. However, difficulties in communication between biologists and clinicians, mostly due to the complexity of biology as a discipline, are a significant obstacle to therapeutic developments and their application on a larger scale. Methods: A literature review was undertaken on the current understanding of the biology of the dentine-pulp complex, especially in the context of conservative dentistry. Results: Novel biotechnological insights have recently been discovered, including the presence of stem cell-like cells within the tooth and their potential roles in rep...

British Dental Journal, 2021

This is the first article in a series reviewing the current literature surrounding the management... more This is the first article in a series reviewing the current literature surrounding the management of deep caries in permanent teeth. Approaches to caries management are continuing to evolve, with more conservative management increasingly favoured. This philosophy has never been more important than in managing the deep carious lesion. Evidence is emerging that the use of selective caries removal to reduce the risk of pulp exposure, in conjunction with calcium silicate cements, can be successful in maintaining pulp vitality, delaying the restorative cycle and prolonging the lifespan of the tooth. Non-selective caries removal is currently not recommended in the management of deep carious lesions. Selective caries removal should be considered ahead of a stepwise approach. Selective caries removal minimises the risk of pulp exposure and improves pulp survival in the short-to-medium term. Calcium silicate cements show potential in the management of deep caries.

Tissue Engineering Part B: Reviews, 2021

The recent discovery of mesenchymal stem cells within periapical lesions (PL-MSC) has presented n... more The recent discovery of mesenchymal stem cells within periapical lesions (PL-MSC) has presented novel opportunities for managing periradicular diseases in adult teeth by way of enhancing tissue regeneration. This discovery coincides with the current paradigm shift toward biologically driven treatment strategies in endodontics, which have typically been reserved for non-vital immature permanent teeth. One such approach that shows promise is utilizing local endogenous non-collagenous dentine extracellular matrix components (dECM) to recruit and upregulate the intrinsic regenerative capacity of PL-MSCs in situ. At picogram levels, these morphogens have demonstrated tremendous ability to enhance the cellular activities in in vitro and in vivo animal studies that would otherwise be necessary for periradicular regeneration. Briefly, these include proliferation, viability, migration, differentiation, and mineralization. Therefore, topical application of dECMs during ortho-or retrograde root canal treatment could potentially enhance and sustain the regenerative mechanisms within diseased periapical tissues that are responsible for attaining favorable clinical and radiographic outcomes. This would provide many advantages when compared with conventional antimicrobial-only therapies for apical periodontitis (AP), which do not directly stimulate healing and have had stagnant success rates over the past five decades despite significant advances in operative techniques. The aim of this narrative review was to present the novel concept of exploiting endogenous dECMs as clinical tools for treating AP in mature permanent teeth. A large scope of literature was summarized to discuss the issues associated with conventional treatment modalities; current knowledge surrounding PL-MSCs; composition of the dECM; inductive potentials of dECM morphogens in other odontogenic stem cell niches; how treatment protocols can be adapted to take advantage of dECMs and PL-MSCs; and finally, the challenges currently impeding successful clinical translation alongside directions for future research.

British Dental Journal, 2021

Vital pulp therapies (VPTs) aim to preserve the vitality of the pulp. The European Society of End... more Vital pulp therapies (VPTs) aim to preserve the vitality of the pulp. The European Society of Endodontology have begun a campaign to raise awareness on the efficacy of VPTs following on from the publication of their 2019 position statement, aimed at both specialists and general dental practitioners. This review examines the current evidence surrounding VPTs and provides a rational approach to the management of the exposed pulp with the aid of case studies. Success lies in accurate diagnosis and case selection, along with well-executed treatment and appropriate follow-up protocols. The introduction of calcium silicate cements has made these treatments more predictable. There is sufficient evidence to recommend calcium silicate cements ahead of calcium hydroxide for all vital pulp therapies, but consideration must be given to potential discolouration in material selection. The main driver for a decision between different vital pulp therapies is the visual appearance of the pulp and the ability to control haemorrhage. Following careful case selection, teeth receiving vital pulp therapies with calcium silicate cements have a good prognosis, equal to pulpectomy and root canal treatment, which still remains an option in the event of failure.

Scientific Reports, 2021

In root canal therapy, irrigating solutions are employed to eliminate the bacterial load and also... more In root canal therapy, irrigating solutions are employed to eliminate the bacterial load and also prepare dentin for sealer interaction. The aim of this research was to assess how irrigating solutions employed on their own or in sequence affected the tooth structure. The best way to prepare the tooth for obturation using hydraulic calcium silicate cement (HCSC) sealers and gutta-percha, thus guiding clinicians on a matched irrigation-obturation strategy for optimized root canal treatment was investigated. The effect of irrigating solutions on dentine was investigated by assessing changes in dentin microhardness, ultrastructure and mineral content, organic/inorganic matter, surface roughness and Young’s modulus. The interaction of four root canal sealers with the dentin was analysed by assessing the changes in microhardness of the dentin after sealer placement and also the sealer to dentin interface by scanning electron and confocal laser microscopy. The irrigating solutions damaged ...

Primary Dental Journal, 2016

Prevention or treatment of apical periodontitis is aimed at disinfecting the root canal system so... more Prevention or treatment of apical periodontitis is aimed at disinfecting the root canal system so that the periradicular tissues are not vulnerable to attack from microbiota within the tooth. This is achieved by a process of cleaning and shaping the root canal space. The fundamental principles underlying this process have not changed in decades. In contrast, the armamentarium available to the clinician continues to evolve rapidly. The use of specially designed nickel titanium (NiTi) files to create a glidepath allows the clinician to manage tight curved canals more predictably in situations which would otherwise have proved too difficult using conventional techniques. Other files, designed to shape the canal, have been developed using metallurgic principles which permit NiTi files to be more flexible and resistant to cyclic fatigue. These newer systems also require fewer instruments to prepare a canal and some, which have adopted a reciprocating (rotational) motion, may only require...

British Dental Journal, 2020

Where a licence is displayed above, please note the terms and conditions of the licence govern yo... more Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

International Endodontic Journal, 2020

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Dental Traumatology, 2019

Background/Aim: In addition to their anti-inflammatory and anti-osteoclastogenesis properties, ad... more Background/Aim: In addition to their anti-inflammatory and anti-osteoclastogenesis properties, adrenergic blockers may also have promising anti-resorptive effects that can prevent root resorption when teeth are replanted because of avulsion. The aim of this study was to investigate the effects of phentolamine (Ph) and propranolol (Pr) in gels on the repair process of late replanted rat incisors. A further aim was to evaluate the biocompatibility of both drugs to human periodontal ligament fibroblasts (HPDLFs). Material and methods: Forty-eight maxillary right incisors were extracted from male Wistar rats, stored in paper napkins for 60 minutes and randomly allocated to one of eight groups (n=6). The root canal, root surface and alveolus were treated with 0.75 µg/ml Ph gel (Ph0.75), 10 µg/ml Ph gel (Ph10), 100 µg/ml Ph gel (Ph100), 2.5 µg/ml Pr gel (Pr2.5), 10 µg/ml Pr gel (Pr10), 100 µg/ml Pr gel (Pr100), or sodium carboxymethylcellulose gel (CMC) before replantation. In the control group (CH), only the root canal was treated with calcium hydroxide paste. Thirty days following surgery, the animals were euthanized, and the right hemimaxilla was removed to perform micro-CT and histomorphometric analysis to determine osteoclastic activity. Ethanolic solutions of Ph10 and Pr10 were selected based on the in vivo study, and the viability of HPDLFs stimulated with lipopolysaccharide was determined by MTT assays. Results: The Micro-CT and histomorphometric analysis revealed no significant differences among the treatments (P > 0.05). The presence of active osteoclasts was significantly decreased in the Ph10 and Pr10 groups (P < 0.05). Ph10 and Pr10 produced statistically similar cell survival rates compared to the control group (P > 0.05). Conclusions: Ph10 2 and Pr10 significantly decreased osteoclastogenesis in delayed replanted rat teeth and were not cytotoxic towards HPDLFs.

http://isrctn.com/, 2019

A randomised controlled pilot study to determine the effect of irrigation techniques used to enha... more A randomised controlled pilot study to determine the effect of irrigation techniques used to enhance the release of endogenous signalling molecules from dentine matrix to treat apical periodontitis.

Journal of Dentistry, 2019

was reduced to 93.97% clinical and 88.39% radiographic success at 36 months follow-up. Results fr... more was reduced to 93.97% clinical and 88.39% radiographic success at 36 months follow-up. Results from the only comparative clinical trial showed pulpotomy to have comparable success to root canal treatment at 12, 24 and 60 month follow-up. Conclusions The evidence suggests high success for pulpotomy for teeth with signs and symptoms of irreversible pulpitis, however, results are based on heterogeneous studies with high risk of bias. Well-designed, adequately powered randomised controlled trials are required for evidence to change clinical practice. Clinical significance: Management of carious teeth with irreversible pulpitis is traditionally invasive, but emerging evidence suggests potentially successful treatment outcomes with less invasive therapies such as coronal pulpotomy

British Dental Journal, 2019

Highlights the regional inequalities that are present with the commissioning and provision of enh... more Highlights the regional inequalities that are present with the commissioning and provision of enhanced NHS endodontic services across England.

British Dental Journal, 2019

Discusses the advantages and limitations of the technique, in comparison with alternative approac... more Discusses the advantages and limitations of the technique, in comparison with alternative approaches.

Journal of Endodontics, 2019

Introduction: Neurotrophic factors play a significant role in the innervation of the pulp-dentin ... more Introduction: Neurotrophic factors play a significant role in the innervation of the pulp-dentin complex during and after organogenesis. There have been numerous bioactive molecules identified in the dentin extracellular matrix; however, the expression of neurotrophic factors in the dentin matrix and their biological activity are largely unknown. The purpose of this study was to characterize the relative expression of neurotrophic factors in human dentin matrix proteins (DMPs) and their effect on neurite outgrowth of trigeminal (TG) neurons. Methods: Dentin was powdered in liquid nitrogen from noncarious human third molar teeth. DMPs were solubilized through an EDTA extraction method, dialyzed, and lyophilized until use. The relative expression of nerve growth factor, brain-derived neurotrophic factor, glial cellÀline derived neurotrophic factor, neurotrophin 3, and neurotrophin 4/5 was determined by the enzyme-linked immunosorbent assay. Rat TG neurons were cultured and exposed to different concentrations of DMPs (1-10 5 ng/mL) or vehicle, and a quantitative neurite outgrowth assay was performed. Results: Human DMPs contained all of the tested neurotrophic factors, with glial cellÀline derived neurotrophic factor and neurotrophin 4/5 found at the highest levels. DMPs were able to promote the neurite outgrowth of rat TG neurons at an optimum concentration of 10-10 2 ng/mL, whereas the effect was partially inhibited at higher concentrations (>10 3 ng/mL). Conclusions: The human dentin extracellular matrix is a rich reservoir for neurotrophic factors that are key components for neuronal homeostasis, differentiation, and regeneration. These data suggest that neurotrophins in DMPs could play an important role as signaling molecules for the innervation of the pulp-dentin complex during the processes of tooth formation, repair, and regeneration.

Tissue Engineering Part A, 2018

In teeth with an injured pulp, dentin matrix orchestrates hard tissue repair through the release ... more In teeth with an injured pulp, dentin matrix orchestrates hard tissue repair through the release of dentin extracellular matrix components (dEMCs). dEMCs regulate the differentiation of resident mesenchymal stromal cells (MSCs), thereby affecting mineral deposition. Here, we show that low concentration solubilized dEMCs in osteogenic cultures of human umbilical cord mesenchymal stromal cells (UC-MSCs) and dental pulp stromal cells (DPSCs) enhanced mineral deposition, while adipose stromal cells (ASCs) were barely affected. Interestingly, UC-MSCs displayed significantly greater hydroxyapatite formation compared to DPSCs. UC-MSCs and DPSCs showed a dose-dependent viability and proliferation, whereas proliferation of ASCs remained unaffected. Qualitative analysis of the dEMCs-supplemented osteogenic cultures through scanning electron microscopy demonstrated differences in the architecture of the deposited mineralized structures. Large-sized mineral accretions upon a poorly organized collagen network was the prominent feature of UC-MSCs cultures, while mineral nodules interspersed throughout a collagen mesh were observed in the respective DPSCs cultures. The ability of dEMCs to induce mineralization varies between different human MSCs types in terms of total mineral formation and its architecture. Mineral formation by UC-MSCs exposed to low concentration dEMCs proved to be the most efficient and therefore could be considered as a promising combination for mineralized tissue engineering.