Bacteria and their virulence factors play important role in the induction of pulpal and periradicular diseases. Biofilms are the main etiological factors in the pulp and periodontium inflammation. In cases of vital pulp tissues and associated periodontal disease, the bacteria from periodontal pockets are the primary source of infection to the dental pulp through pathways of infection (i.e., dentinal tubules, lateral canals, apical foramen, etc). Consequently, the hosts' immune system releases a range of inflammatory mediators, contributing to both destructive and reparative processes. Epigenetic mechanisms have been shown to be highly involved in orchestrating inflammatory diseases including periodontitis, pulpitis, and apical periodontitis. The objectives of this clinical research are threefold and include: a) to compare the gene expression profile related to inflammation in periodontal samples of sound, unrestored teeth and those with vital pulp and associated periodontal disease; b) to compare the gene expression profile before and after root canal treatment procedures in teeth with vital pulps and associated periodontal disease; and c) to compare the inflammatory pattern and gene promoter methylation status in sound teeth and those with vital pulp and associated periodontal disease after root canal treatment procedures. Ten periodontal samples from unrestored, sound teeth, 10 periodontal samples before endodontic treatment (baseline) and 10 periodontal samples after endodontic procedures (30 days after intracanal medication) will be selected for this study. Reverse transcriptionquantitative polymerase chain reaction (qRTPCR) using SYBR-green uorescence quantication system in a Step-One real-time PCR will be performed as well as bisulphite modification and gene-specific qRT-PCR evaluation of methylation status of selected inflammatory genes. The results obtained will be statistically analysed using SPSS for WINDOWS, version 19.0 (SPSS Inc, Chicago, IL, USA). Significance levels will be set at 5% (P < 0.05).
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