Assessment of intraoral biomarkers as an indicator of dental pulp inflammation in primary teeth – A systematic review and meta-analysis

Diagnosis of dental pulp inflammation in primary teeth traditionally relies on patient history, clinical examination, and radiographic findings. However, intraoral biomarkers offer an objective approach for assessing the degree of inflammation, potentially improving the accuracy of treatment planning and prognosis in pediatric endodontics. This systematic review and meta-analysis aimed to evaluate intraoral biomarkers indicative of dental pulp inflammation in primary teeth and to compare their diagnostic performance with conventional clinical methods. The review protocol was registered in PROSPERO (CRD420251002230). Electronic databases—PubMed, Scopus, Embase, and Web of Science—were searched comprehensively, yielding 57 relevant studies. After screening abstracts and removing duplicates, 20 studies were included for full-text review and qualitative synthesis. The findings indicated that specific biomarkers, including inflammatory cytokines and neuropeptides, show promising diagnostic value in determining the inflammatory status of dental pulp. Biomarkers were found to correlate significantly with histopathological findings, suggesting their potential utility in distinguishing between reversible and irreversible pulp inflammation. In conclusion, intraoral biomarkers can serve as valuable diagnostic tools for pulp inflammation in primary teeth. Further randomized clinical trials are needed to establish standardized biomarker thresholds for clinical application, facilitating a shift from subjective symptom-based diagnosis to objective, evidence-based pulp assessment.