Background: Vital pulp therapy (VPT) is a cornerstone of minimally invasive dentistry and aims to preserve pulp vitality whenever clinically feasible. Teeth with vital pulp show better long-term survival than endodontically treated teeth. However, the success of VPT procedures-such as indirect or direct pulp capping, partial pulpotomy, and full pulpotomy-critically depends on an accurate assessment of the extent and severity of pulpal inflammation. Current diagnostic classifications are mainly based on patient-reported symptoms and sensibility tests, which do not reliably reflect the underlying inflammatory status of the pulp tissue. This diagnostic uncertainty contributes to inappropriate treatment selection, early therapeutic failures, and wide variability in clinical practice. Rationale: Pulpal inflammation is a dynamic and spatially heterogeneous biological process that progresses from localized to diffuse tissue involvement. Clinical studies have demonstrated discrepancies between clinical diagnosis and the actual histological and molecular status of the pulp. A new diagnostic classification (Endolight) has been proposed to better guide VPT indications by distinguishing different stages of pulpal inflammation, but it has not yet been validated against in situ biological analyses of human pulp tissue. Moreover, the identification of molecular and protein biomarkers associated with inflammatory severity could support the development of more accurate diagnostic and prognostic tools for endodontic decision-making. Objectives: The primary objective of this study is to characterize the immune and inflammatory response of human dental pulp at the tissue, transcriptomic, and proteomic levels using biological samples obtained during routine dental care. Secondary objectives are to assess the concordance between clinical diagnostic categories-particularly those of the Endolight classification-and pulpal inflammatory profiles, and to explore associations between inflammatory profiles and patient-related or tooth-related factors. Methods: This is a prospective, monocentric observational study conducted at the Department of Dental Medicine of Pitié-Salpêtrière Hospital. Pulp tissue samples and whole pulp-containing teeth are collected as operative waste during routine endodontic treatments or tooth extractions. Samples are pseudonymized and processed according to the planned analyses. Transcriptomic profiling is performed using RNA sequencing, with validation by RT-qPCR, in situ hybridization and RNAscope. Protein expression and activity are assessed using proteomic approaches, ELISA assays, and immunohistochemical or immunofluorescence analyses. Clinical, demographic, and dental data are collected from medical records using a secured electronic case report form. Outcomes: Primary outcomes include the identification and characterization of inflammatory gene and protein expression profiles in human dental pulp. Secondary outcomes include the concordance between clinical diagnoses and biological inflammatory profiles, as well as the identification of molecular biomarkers potentially relevant for guiding VPT indications. Expected impact: By improving the biological characterization of pulpal inflammation and its relationship with clinical diagnosis, this study aims to support more precise, biology-driven decision-making in vital pulp therapy and the management of endodontic emergencies.
Age range
18 Years
Sex
ALL
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Gene expression levels in inflamed dental pulp tissues
Timeframe: At the time of pulp tissue collection (baseline)
Marjolaine GOSSET, Dental surgeon, Professor