GCF NLRP3 as a Biomarker for Assessing Endodontic Treatment Outcomes in Symptomatic Irreversible Pulpitis: A...

Biomarker-based evaluation of endodontic outcomes offers an objective alternative to traditional clinical assessments. The human nucleotide-binding domain, leucine-rich repeat, and pyrin domain-containing-3 (NLRP3) inflammasome is emerging as a potential indicator in inflammatory dental conditions. The aim was to correlate changes in pain levels with gingival crevicular fluid (GCF) levels of the NLRP3 inflammasome in patients with symptomatic irreversible pulpitis (SIP), before and after nonsurgical endodontic treatment.

This nonrandomized matched comparative study included 15 SIP patients (45 teeth: involved, adjacent, and contralateral) and 15 healthy controls (15 teeth). GCF samples were analyzed via enzyme-linked immunosorbent assay. Pain was assessed using the Heft Parker visual analog scale (HP-VAS). Data were analyzed using linear mixed models, the Wilcoxon signed-rank test, and the Spearman correlation.

Baseline GCF-NLRP3 levels were significantly higher in SIP-affected teeth (4.33 ± 0.98 ng/mL) than in controls (1.34 ± 0.45 ng/mL; P < 0.001). A significant difference was observed between involved and contralateral teeth (mean difference = 2.96; 95% CI = 2.28-3.65). Post-treatment levels in both involved and adjacent teeth decreased (P < 0.05). HP-VAS scores also showed a significant reduction (median difference: 69; P < 0.001). The reduction in the NLRP3 inflammasome activity was significantly correlated with pain reduction, with P value (<0.001) after the treatment (r = 0.686; 95% CI = 0.22-0.91).

GCF-NLRP3 levels can serve as a reliable biomarker for evaluating endodontic treatment outcomes in SIP, reflecting both local inflammation and patient-reported pain. Integrating GCF-NLRP3 monitoring may enhance the diagnostic accuracy and inform treatment planning. Future studies should assess longitudinal trends and therapeutic thresholds. GCF-NLRP3 could be a promising biomarker for assessing the outcome of endodontic treatment. This finding opens up new possibilities for improving the efficacy of endodontic procedures and, ultimately, patient care.

The clinical study was registered under the clinical trial registry-India www.ctri.nic.in (CTRI/2023/07/055526) on July 24, 2023. The supporting document can be produced through requisition mail to the corresponding author.