Construction of a predictive model for the transition from irreversible pulpitis to periodontal-involved disease

Irreversible pulpitis can develop into pulp necrosis, causing apical periodontitis (AP). The progression of apical periodontitis is always accompanied by periodontal disease. Many similar inflammatory response pathways are involved in both apical periodontitis (AP) and periodontal disease. The infiltration of specific immune cells and the activation of immune responses are thought to play important roles in the transition from irreversible pulpitis to AP and periodontal-related diseases. This study explored immune response characteristics during the transformation of pulpitis to periodontal disease. The study also constructed a predictive model by combining known clinical and imaging indicators related to this transformation. Gene expression data related to irreversible pulpitis, apical periodontitis, and periodontal disease were extracted from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were compared and identified. KEGG (Kyoto Encyclopedia of Genes and Genomes) enrichment analysis was performed to identify immune-related pathways. Key gene signatures were screened, and a retrospective research strategy was used to collect 80 samples from patients with irreversible pulpitis. Information about pulp sensation test indicators, caries depth, root canal curvature, and inflammation indices of the patients were combined, and a logistic regression model of clinical periodontal disease was created. Receiver-operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the model. Five genes were identified as common gene signatures during the transition from pulpitis to apical periodontitis and periodontal-involved disease. Following regression and ROC analyses revealed the expression of four genes, and the electric pulp test (EPT) value formed a predictive model with the best specificity and sensitivity in predicting the occurrence of apical periodontitis. A prognostic model was constructed and evaluated for predicting the transition from pulpitis to periodontal disease.