Dental restoration / Observational data reanalysis
Read the patient-linked pulp analysis
Living-pulp records retain sensory and imaging discordance
This is an uncontrolled five-patient measured pattern, not a regeneration success rate. MRI signal is not blood flow, late responses stay at their later visit, and CBCT timing/unit conflicts remain unresolved.
# Living pulp: five linked patient records expose sensory and imaging discordance This is an executed reanalysis of all five patient/tooth columns in the [Nakashima et al. 2017 pilot](https://doi.org/10.1186/s13287-017-0506-5), not another review of stem-cell markers. Its 24-week records support a precise measured pattern: **patients 1, 3 and 5 had source-positive electric sensibility, a recorded apical MRI ratio and unambiguously absent periapical radiolucency**. That is 3/5 observed records, **not a regenerated-pulp success rate**. The [plan](analysis_plan.json) was frozen after source inspection. Prior goal documents required viable pulp and sensation but supplied no patient-level analysis of this pilot. Only this primary source was acquired; no second trial, contact, figure digitization or new experiment was needed. ## Keep patient, tooth and visit together Five patients aged 20–44 supplied one affected tooth each. Three dentists' EPT readings, repeated visits and MRI regions remain nested within those five people. All five have Table 4 EPT status, an apical MRI number and an X-ray symbol at 24 weeks. The source does not supply a screening/approach denominator or formal dropout flow. A late note about one patient cannot create a complete 36-week cohort. | Patient | First reported positive EPT | EPT at 12 / 24 weeks | Apical MRI ratio, 24 weeks | X-ray radiolucency, 24 weeks | CBCT lateral-mineralization flag, time not stated in Table 4 | | --- | --- | --- | ---: | --- | --- | | 1 | Day 6 | + / + | 0.8 | Absent | + | | 2 | After 36 weeks, exact day not supplied | − / − | 0.9 | Ambiguous −/+; prior lesion shrank, PDL widened | − | | 3 | Day 6 | + / + | 0.9 | Absent | − | | 4 | Day 28 | + / + | 0.7 | Present; PDL widening preceded it | + | | 5 | Day 14 | + / + | 0.9 | Absent | + | Enrollment EPT was positive in Table 1, before intervening pulpectomy. The narrative separately states that pre-transplant EPT was negative in all five. Those are different baselines, not contradictory values silently combined. The four positive 12-week patients remain positive at 24 weeks. Patient 2's late response is retained as **after 36 weeks**, without changing the earlier negative status or assigning an exact later observation day. The [patient extract](patient_records.json) retains all 36 nested device readings. Two onset readings are `80+`, preserved as right-censored values. Comparison-control teeth change across visits in patients 1, 3 and 4. No EPT reading is converted into a percentage of recovered sensation, nerve amount or pulp vitality, and no pooled control-normalized improvement is calculated. The source itself cautions against treating the numeric display as a validated vitality measure. ## MRI is an observed signal ratio, not blood flow The source methods reference canal-tissue signal to surrounding dentin in the same tooth, compared with normal pulp/dentin at the opposite site. The five published apical ratios average **0.84**, with median **0.9** and range **0.7–0.9**. These are continuous image-signal observations. A ratio near 1 is not a fraction of normal perfusion, histological identity or a noninferiority test. No healthy cutoff or MRI-positive classification is introduced. Patient 2 has an apical ratio of 0.9 while remaining EPT-negative through 24 weeks. Patient 4 has a positive EPT response and a ratio of 0.7 while developing periapical radiolucency after earlier PDL-space widening. These linked discordances survive the analysis. They prevent sensory response or MRI signal from standing in for the other outcomes. ## Exact bounds describe measured patterns All denominators remain the five enrolled patients; unknown is never replaced with absence. The bounds below describe this finite observed cohort, not sampling confidence or causal efficacy. | Explicitly timed pattern | Patient IDs meeting it | Count bounds | | --- | --- | ---: | | Source-positive EPT at both 12 and 24 weeks | 1, 3, 4, 5 | 4–4 / 5 | | At 24 weeks: MRI number available and periapical radiolucency absent | 1, 3, 5; patient 2 unresolved | 3–4 / 5 | | At 24 weeks: EPT-positive, MRI number available and radiolucency unambiguously absent | 1, 3, 5 | 3–3 / 5 | | At 24 weeks: EPT-positive with radiolucency present | 4 | 1–1 / 5 | “MRI number available” is explicitly a record-availability condition, not a physiological pass. Patient 2's ambiguous radiograph does not enlarge the third pattern's upper bound because that patient's 24-week EPT is negative. The CBCT row has no explicit visit and is excluded from these same-time patterns. Nor are the separate apical-obliteration and lateral-mineralization flags silently treated as the same structural endpoint. ## Pulp-space change and adverse findings remain visible The Results narrative supplies one internally consistent low-density-space volume pair: patient 1, **0.0143 to 0.0125 cm³**, at nominal 16→28 weeks. That is a **0.0018 cm³ / 12.59% decrease** in the source's CBCT-defined low-density space. It does not identify regenerated-tissue loss, native dentin, vascularization or mechanical benefit. Increasing mineralization can also constrain the remaining pulp space; no favorable threshold is selected here. For patient 4, the retrieved primary XML prints **0.0110 cm³ to 0.0081 m³**. Its Results, figure caption and Discussion also use inconsistent visit labels (16→28, 16→28/32 and 12→24 weeks). The unit and timing conflict remains unresolved: **no corrected or conditional volume change is calculated**. Patient 5 lacks the initial CBCT, so no volume change is invented. There is no cohort mean volume-change estimate. The source reports no transplantation-attributed laboratory/clinical events or postoperative pain through 24 weeks. That does not erase patient 4's radiographic deterioration or patient 2's residual/ambiguous findings, establish their cause, or prove long-term safety. Literal cell-culture karyotype entries are also retained separately rather than describing every preparation as unconditionally normal or inferring patient constitutional diagnoses. ## What this changes in the restoration work This source supplies real same-patient sensory/imaging follow-up and adverse discordance, whereas earlier work lacked living-pulp records. It does **not** directly measure blood flow or verify human pulp histology/innervation. It is a small, selected, uncontrolled pilot; opposite-tooth MRI references are not randomized untreated patients. No treatment effect or age effect is fitted. The next needed evidence is joint, time-stamped sensory response, directly qualified perfusion, preserved pulp-space/structural integrity and infection status on the same tooth, followed long enough to assess calcification and durability. Native pulp identity, dentin/enamel architecture, PDL/cementum/socket attachment, youthful gums and stable original tooth position remain separate required outcomes. The observed patterns here do not close that full contract. ## Reproduce and inspect ```text python -B studies/checklist-integration-2026-10-19/pulp/analyze_patient_endpoints.py python -B -m unittest discover -s tests -p test_checklist_integration_pulp.py -v ``` Default analysis and tests use the committed extract and standard library. `extract_nakashima.py` repeats table extraction from the ignored primary XML; analysis `--verify-cache` also verifies its actual byte hash. The source-specific module name avoids another study's extraction module during combined tests. [Results](derived/patient_endpoint_summary.json), [hash receipt](derived/analysis_receipt.json) and [actual fetch receipt index](source_receipts.json) are inspectable. The numerical/categorical observations are attributed to Nakashima, Iohara, Murakami and colleagues, *Stem Cell Research & Therapy* 8:61 (2017), under [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). The transcription, bounded calculations and interpretation are this reanalysis; original findings belong to the authors. Raw XML and genuine provenance stay ignored. No source figures, patient treatment steps, doses, preparation methods or wet-lab work are supplied. Docker workbench remains stopped.