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PubMed2000

Intra-oral storage phosphor and conventional radiography in the assessment of alveolar bone structures.

OBJECTIVES: To compare storage phosphor (SP) with conventional film radiography for accuracy of linear measurements of the marginal alveolar bone and visibility of anatomical structures. METHODS: Linear measurements were made in paired SP and conventional images of dried human mandibles with a metal pin fixed 10 mm below the alveolar crest. One observer measured the distance from the alveolar crest to the reference point on the radiographs. The difference between the measured and the true distance was calculated. Two observers rated the visibility of bony structures (periodontal ligament space, periapical bone tissue, alveolar crest) in 51 paired digital and conventional images of 21 patients on a 3-point scale. Overall agreement and Kappa index were calculated. RESULTS: Accuracy of linear measurements was higher in digital radiography (mean difference 0.17 mm) than in conventional radiography (mean difference 0.59 mm). Overall, the two observers rated visibility higher in conventional radiographs. The Kappa indices for the periodontal ligament space and periapical bone indicated fair to almost perfect agreement (kappa = 0.38 and 0.5; kappa = 0.39 and 0.84) while for the alveolar crest there was only poor or moderate agreement (kappa = 0.2 and 0.5). CONCLUSIONS: The small differences in linear measurements indicate that the Digora system is suitable for clinical assessment of periodontal and peri-implant bone loss. The visibility of dental structures depends as much on the individual features assessed, as the radiographic system.

Alveolar Process↗
PubMed1991

[Alternative solutions for postoperative pain in teeth with necrotic pulp].

Both the literature and clinical experience have verified that necrotic root canals, with or without periapical lesion, display a confusing response to the various tests for pulp vitality. As suggested by clinical and histopathological research studies, these lesions are due to a defense reaction from the periapical connective tissue, in response to bacterial infections which alter host tissues. Diminishing the frequency of postoperative pain in endodontic treatment is currently a leading concern, and this study aimed to evaluate the different variables involved in root canal therapy, so as to recommend the most suitable approach, without losing sight of the main goal at hand: a successful endodontic treatment. The present study was performed on 200 necrotic root canals, using frontal teeth, upper and lower premolars and molars, both with straight or curved canals. Avoiding damage to the periapical regions, the study concluded, is of prime importance in lowering the frequency of postoperatory pain. Also, the presence of periapical pain is vitally important in the appearance of postoperatory pain, and it is in such cases that cleansing must be adopted as a routine clinical procedure.

Adult↗
PubMed1993

The role of reactive oxygen intermediates in the pathogenesis of chronic apical periodontitis.

The level of malondialdehyde, a stable end product of lipid peroxidation induced by reactive oxygen intermediates and the activity of two potent antioxidant enzymes, superoxide dismutase and glutathione peroxidase, was investigated in tissue homogenates of 22 surgical periapical granuloma specimens. Malondialdehyde levels were significantly higher and glutathione peroxidase activity was significantly lower in periapical granuloma samples than in healthy gingival tissue homogenates, which were used as controls. The activity of superoxide dismutase was similar in periapical granuloma and in control samples. Our results indicate an altered balance between the production and the elimination of toxic oxygen metabolites in chronic apical periodontitis. We hypothesize that reactive oxygen intermediates, which are being produced by activated phagocytic cells abundantly present in periapical granulomas, can contribute to periapical tissue injury and bone loss in this disease.

Adult↗
PubMed2004

Identification of gammadeltaT lymphocytes in human periapical lesions.

Endodontic (root canal) therapy is required when the pulp of a tooth becomes necrotic due to a bacterial infection or trauma. A proportion of patients who receive endodontic therapy subsequently have periapical (around the tooth root) lesions detected by radiolucency. Currently, there are no means to identify susceptible patients. Although tissue from periapical lesions has been described as inflammatory, inflammatory cell types and their functions have been poorly characterized. For example, T lymphocytes were identified using pan specific anti-CD3 mAb, which recognizes both alphabeta and gammadeltaT cells. Using the current model of gammadeltaT cells as immunoregulatory cells; gammadeltaT cells can mediate protective or destructive milieus. We postulated that patients who have a periapical lesion, as identified by radiographic bone loss, mount a gammadeltaT cell response. We collected specimens removed by surgery from both periapical lesions and other oral tissues, generated total RNA and performed reverse-transcriptase polymerase chain reaction to identify rearranged delta genes. Results were confirmed with semi-nested polymerase chain reaction. In addition, we demonstrate that these lesions contain a population of CD3+ cells that are alphabetaT cell receptor negative, implying that these cells are gammadeltaT cells. Here we show that 36/37 of periapical lesions and only 2/11 of other lesions contain gammadeltaT cells (P<0.0001). Vdelta2+ T cells were the most common subtype identified (30/36) in these samples. This is the first report in the literature of the presence of gammadeltaT cells in human periapical lesions.

Adult↗
PubMed2001

Presence of interleukin-4-producing cells for human bone regeneration after application of guided tissue regeneration membranes.

To study the process of bone regeneration we examined three samples of periapical regenerative tissue obtained from two patients under a guided tissue regeneration treatment in endodontic surgery by the immunohistochemical and enzyme histochemical methods. The regenerative tissue consisted of a large number of fibroblast-like cells and a small number of mononuclear cells. Fibroblast-like cells stained positively for alkaline phosphatase and osteopontin, whereas mononuclear cells stained positively for CD4. Interleukin-4-producing cells could be detected in adjacent sections. However, interferon-y-producing cells could not be detected. These findings suggest that interleukin-4-producing cells may be one of the elements associated with success in the human bone regeneration process in vivo.

Adult↗
PubMed1991

Wound healing in the tissues of the periodontium following periradicular surgery. I. The incisional wound.

Periradicular surgical procedures were performed on rhesus monkeys and the wound healing responses of the tissues of the periodontium were evaluated by light microscopy. This article, Part I of the investigation, reports the mucoperiosteal tissue wound healing responses to incisional wounds of the triangular and submarginal rectangular flap designs. Little difference was found in the temporal and qualitative healing responses to incisional wounds of the two flap designs. However, the submarginal rectangular design showed less predictable results, with a greater intersample variation of wound healing responses in the earlier postsurgical evaluation periods. Vital connective tissue and epithelium, although not visible clinically, remain attached to the root surfaces following reflection of flaps which include an intrasulcular incision. Preservation of these root-attached tissues prevented apical epithelial down-growth along the root surfaces and loss of soft tissue attachment levels. Vitality of root-attached tissues was preserved by preventing dehydration, avoiding curettement of root surfaces, and using a flap reflection technique which eliminates reflective forces in the intrasulcular incisional wound site.

Animals↗
PubMed2004

Conventional and digital radiographic methods in the detection of simulated external root resorptions: a comparative study.

OBJECTIVES: The purpose of this study was to evaluate and to compare the efficacy of a conventional and a digital radiographic method in diagnosing simulated external root resorption cavities. METHODS: Human dry mandibles containing teeth were covered with bovine muscle slices in order to simulate the soft tissues. Nine teeth from each dental group were investigated. Three periapical radiographs of each tooth were taken in an orthoradial, mesioradial and distoradial aspect using conventional film (Insight Kodak F-speed; Eastman Kodak, Rochester, NY) and a digital sensor (DRS Gnatus System; Gnatus, Ribeirao Preto, Brasil). The teeth were extracted using a forceps and had 0.7 mm and 1.0 mm deep cavities prepared on their vestibular, mesial and distal surfaces at the cervical, middle and apical thirds. Following preparation, each tooth was replaced in its alveolus and new radiographs were taken. Three dental professionals, an endodontist, a radiologist and a general practioner, evaluated the images. RESULTS: A larger number of cavities (P<0.05) were detected by the digital method when compared with the conventional method, for all depths of lesions. CONCLUSIONS: The results of this study suggest that the digital radiographic method is more sensitive than conventional radiography to detect simulated external root resorption cavities.

Animals↗
PubMed2002

Periapical lesions accidentally filled with calcium hydroxide.

AIM: To evaluate the effect of accidental and voluminous calcium hydroxide overextensions into periradicular lesions and tissues on the prognosis of periapical healing. SUMMARY: Eleven cases with periapical lesions and voluminous calcium hydroxide overextension are presented. Despite literature reports on the deleterious effects of calcium hydroxide extension in the periapical area, none of the endodontic treatments failed and surgical intervention was not indicated. KEY LEARNING POINTS: Extensive extrusion of calcium hydroxide into the periapical tissues does not appear to comprise periapical healing. Despite this finding, the deliberate extrusion of dental materials into the apical tissues is not advocated.

Accidents↗
PubMed2000

CD45/isotypes expression in the immune cells of human periapical lesions.

Expression of some leukocyte antigens (including CD45) and its isoforms (CD2, CD4, CD5, CD6, CD7, and CD8) was examined in the human periapical granulation tissue samples in the present study. The majority of the infiltrating cells expressed heavy molecular-weight isoforms of the CD45 antigen. Expression of CD2, CD5, CD6, and CD7 antigens was also detected, implying significant roles for these antigens in the immune reaction taking place in periapical lesions. This suggests that the immune response taking place at the periapical region is predominantly cellular and the humoral responses to antigenic challenge are conducted mainly by regional lymph nodes.

Antibody Formation↗
PubMed1990

[Histopathological studies of periodontal tissue reactions following apical plugging with autogenous dentin chips].

After treating the infected canals, we investigated to determine the influence of autogenous dentin chips accidentally applied as filling in the root apexes. Materials were 15 mandibular premolars and molars obtained from healthy, mature dogs. According to standard procedures, after pulp extirpation, canals were temporarily filled with sandarac cotton pellets and left otherwise untreated for 4 weeks. At this time, the degree of infection was ascertained. After root-canal enlargement, root canals were filled with No. 55 gutta-percha points; and a sealer (Neotriozinc Paste, AH26, or Sealapex) was applied. The animals were sacrificed at the conclusion of either a short term (2 weeks) or a long term (16 weeks), and histological studies were performed. Conclusions In short-term specimens, no formation of new hard tissue was observed at the apical dentino-cemental junction; and inflammatory changes in the periapical soft tissue were remarkable. In long-term specimens, hard-tissue formation had resulted in apical closure in 6 out of 8 instances; and periapical inflammatory changes had decreased. Relations between dentin-chip density and histopathological conditions were as follows: In most of the specimens that were evaluated as good, dentin chips were very densely applied. Insufficient numbers of dentin chips produced poor results. In other words, dense applications of dentin chips result in good prognoses. Consequently, when root-canal enlargement has been adequately performed, application of dentin chips to the apex of infected canals stimulates hard-tissue formation resulting in biological apical closure. In infected canals, however, the degree to which dentin chips are infected can be a major factor.

Animals↗
PubMed1994

Bacteria invading periapical cementum.

The aim of this study was to determine whether microorganisms invade periapical cementum of human teeth from the adjacent periapical lesions. We therefore attempted to isolate microorganisms from periapical cementum through the adoption of standard anaerobic procedures for obligate anaerobes. Samples of cementum were taken from 10 amputated tooth roots at the time of apicoectomy. From two of these samples, bacteria were recovered after anaerobic incubation, but no bacteria were recovered after aerobic incubation of the same samples. Of a total of eight isolates from the cementum, seven were obligate anaerobes and one was aerotolerant. The obligate anaerobes isolated were assigned to the genera Prevotella, Peptostreptococcus, Eubacterium, and Fusobacterium. The aerotolerant anaerobe was Campylobacter. From this, we conclude that bacteria can successfully invade cementum via periapical periodontal tissue, and that such bacteria may play a significant role in chronic periapical pathosis.

Actinomyces↗
PubMed2001

Rationale for the application of the GTR principle using a barrier membrane in endodontic surgery: a proposal of classification and literature review.

Periradicular surgery has become an established treatment option in endodontic surgery. The major objective of this surgery is to obtain periradicular tissue regeneration, including the formation of a new attachment apparatus, by exclusion of any potentially noxious agent within the physical confines of the affected root. However, in a substantial number of cases, the endodontic lesion has a concomitant marginal periodontal lesion that may complicate the healing success. In periodontology, the guided tissue regeneration (GTR) principle using a barrier membrane has been extensively studied and successfully used, and thus may become an adjunct in endodontic surgery. This article presents a classification system of endodontic and periodontal lesions with respect to the application of the membrane technique and reviews the pertinent literature based upon this classification system.

Alveolar Bone Loss↗