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PubMed1977

Immunologic aspects of pulpal-periapical diseases. A review.

The relationship of immunologic concepts to endodontic diseases is discussed. Immunologic mechanisms are considered, including antigens, haptens, antibodies, and cell-mediated responses. Studies of immunologic manifestations in endodontic diseases are given. These include (1) localization of plasma proteins in inflammed human dental pulp, (2) introduction of microbes into animal root canals, (3) introduction of non-microbial antigens into animal root canals, (4) introduction of root canal antigens into human beings, (5) introduction of root canal antigens into animals, (6) studies of "focal" infection, (7) examination of serum antibodies, (8) examination of periapical lesions, and (9) a cell-mediated study. Next, immunologic concepts related to periapical pathosis are considered. Finally, preventive and treatment concepts are reviewed.

Animals↗
PubMed1978

Histologic identification of mast cells in human dental pulp.

Previous investigators who attempted to identify mast cells in the dental pulp have used demineralizing or tooth-splitting procedures to obtain their tissue samples. However, Eda and Langeland15 found that the fluorescence of mast cells is destroyed by acid demineralizing agents. On the other hand, tooth splitting may damage the pulp by crushing it with forceps, or cutting and heating it with burs, stones, or discs. In the present study, we used the extirpated pulps from teeth in which endodontic access openings were made by means of high-speed rotary instruments with water spray. Metachromatic staining methods failed to demonstrate mast cells in any of the non-inflamed pulp specimens. Two of the inflamed pulp specimens revealed numerous mast cells which appeared intact and well preserved with no evidence of degranulation. As to the distribution of the mast cells, there was no correlation with the number and types of other inflammatory cells observed. Although several cells present in the specimens examined were suggestive of mast cells, only those cells that revealed definitive metachromasia were included in this study.

Cytoplasmic Granules↗
PubMed1979

Analysis of the use of Dycal with gutta-percha points as an endodontic filling technique.

The use of Dycal combined with gutta-percha cones as a permanent root canal filling material was analyzed. The following experiments were performed: 1. In vitro microscopic analysis of Dycal's adaptation in the dentin wall--gutta-percha cone interphase. 2. Study of the duration period of alkalinity. 3. Clinical and radiograhic posttreatment, inspection and evaluation, and follow-up. The results obtained in these studies showed: 1. There was correct adaptation and adherence of the material. 2. The alkalinity persisted up to 8 months after mixing. 3. There was clinically good postoperative tolerance. 4. Clinical and radiographic success was found in 90 percent of the cases in the treatment of normal vital pulps, vital inflamed pulps, and pulpless teeth with or without areas.

Calcium Hydroxide↗
PubMed1979

Wound healing following curettement of bifurcation abscesses of human primary molars.

Forty-five abscessed human mandibular primary molars with bifurcation radiolucency were subjected to a two-stage formocresol treatment of the pulp chamber. On the first appointment, an elliptical patch of buccal mucosa was removed. Bony defects varied from 2 mm. to more than 4 mm. in diameter. Periapical radiographs were used to record changes in bone development. Punch biopsy specimens were taken from the bifurcation area of some subjects from 2 weeks up to a year after surgical curettement. Biopsied tissue was studied by electron and light microscopy to examine wound healing of the bifurcation, revealing an early proliferation of fibroblasts with extracellular collagen fibers. Some of the fibroblasts exhibited an extensive network of rough endoplasmic reticulum, scattered free ribosomes, mitochondria, and other organelles which are normally observed in healthy fibroblasts. Histologic and clinical evaluation support the treatment tested for retention of previously abscessed primary molars.

Bacteria↗
PubMed1980

Occurrence of microorganisms at different levels of the pulp. Contribution to endodontic techniques.

Microorganisms were absent in the remaining pulp stumps of twenty teeth which had been exposed to caries and contaminated at the pulpal chamber level. We have demonstrated that microorganisms are not carried to the deepest areas of the pulp when the basic procedure is strict antisepsis applied to the living pulp stump. A sterile and living pulp stump wound contributes to an adequate biologic sealing of the apical foramen. Of all the isolated microorganisms, the alpha hemolytic Streptococcus was most frequently found in all examined cases, in pure or mixed cultures, demonstrating once again he prodominance of that type of microorganism when pulpal injury occurs.

Dental Caries↗
PubMed1980

Pulpectomy: immediate root canal filling with calcium hydroxide. Concept and procedures.

From the clinical aspect the endodontic treatment is divided into two groups: (1) teeth with pulp vitality (biopulpectomy) and (2) pulpless teeth (necropulpectomy). The authors point out the necessity of knowing the clinical pathologic conditions and the macroscopic aspect of the dental pulp before endodontic treatment. They describe the clinical procedures that must be performed in cases when the tooth presents pulp vitality (biopulpectomy), emphasizing (1) the necessity of a field of operation in an aseptic condition; (2) the necessity of a noninjuring instrumentation; (3) the use of cytophylactic substances and not cytotoxic substances; and (4) the use of a root canal--filling technique that respects the limits of the pulp stump, employing calcium hydroxide, a substance that maintains its vitality and induces and accelerates the apical closure by hard-tissue deposition.

Calcium Hydroxide↗
PubMed1980

Pulpal response to MPC for capping exposures.

This study has shown that pulp capping of traumatic exposures with Dycal will stimulate dentine formation, with complete bridging adjacent to the material in seven out of eight teeth 1 month later. The success rate at 3 months was similar, with regular dentine being formed under the initial irregular dentine barrier. Dentine bridging was not found 3 months after pulp capping with MPC, although some reparative dentine had been formed. The coronal pulp was usually partially necrotic and inflamed, although the extent of each was not related. Large amounts of MPC were found in the pulp at some distance from the exposure but were not necessarily associated with inflammation or necrosis. In view of the lack of bridge formation and the presence of inflammation and necrosis, these results do not support the manufacturer's claim that MPC is an effect preparation for capping exposed pulps. This study underlines the importance of biologic testing of new materials prior to commercial distribution, for what may appear similar may not produce the same therapeutic effect.

Animals↗
PubMed1980

The pulpal response to ZOE with stock eugenol versus ZOE with purified eugenol.

Sixty-nine rat mandibular molars were exposed surgically, and the pulpal response to ZOE with a purified form of eugenol versus ZOE with stock eugenol was investigated. Evaluation and analysis of the control and experimental specimens at 1, 3, 7 and 21 days indicated that there were no differences in the amount of inflammation observed between the two groups. Thus, it may be inferred from the results of this study that the impurities found in stock eugenol are not of clinical significance.

Animals↗
PubMed1981

Capping of monkey pulps with Dycal and a Ca-eugenol cement.

Capping of 120 teeth in four monkeys was performed with Dycal or with a calcium-eugenol cement. The observation periods were 8 days or 90 days. The monkeys were killed, and the teeth were examined histologically. After 8 days, the pulp-tissue reactions were basically the same in the two groups. The tissue adjacent to the exposure site was characterized by varying amounts of necrotic tissue, inflammatory cells, and extravasated erythrocytes. Capping material and dentin chips were displaced into the pulp tissue. Particles from the capping materials were found in vessels, macrophages, and foreign body cells. After 90 days, more hard-tissue formation occurred in the Dycal group than in the Ca-eugenol cement group. The hard tissue was formed by either fibroblasts or the original odontoblasts.

Animals↗
PubMed1984

Intracanal use of a corticosteroid solution as an endodontic anodyne.

In fifty consecutive clinical patients with endodontically involved teeth that responded with vital pulp test readings, a corticosteroid solution and a saline placebo were alternately used as an intracanal anodyne. The patients subjectively rated their pain on a scale of 0 to 100 as "none," "mild," "moderate," and "severe" (0 = none, 1 to 33 = mild, 34 to 66 = moderate, 67 and above = severe). The ratings were done before the first treatment and then at 24, 48, and 72 hours after treatment. Corticosteroid-treated and placebo-treated cases were not significantly different in terms of type of teeth treated, clinical pulpal diagnosis, and preoperative patient evaluation of pain. The results showed a decreased subjective report of pain for the corticosteroid cases as compared to the controls through the three posttreatment time periods (p less than 0.10). A statistically significant decreased incidence of pain was reported for the corticosteroid cases as compared to the control at the 24-hour time period (p less than 0.05). No clinical indication of infection was noted in either the corticosteroid or saline control cases.

Dexamethasone↗
PubMed1984

Identification of bacteria in immunopathologic mechanisms of human dental pulp.

Serial frozen sections from human dental pulp were used for the identification of oral bacteria in immunopathologic mechanisms. Sera raised against Actinomyces viscosus, A. naeslundii, Bacteroides gingivalis, and B. melaninogenicus ss. intermedius, commercial sera against human immunoglobulins, complement, and monoclonal antibodies against human T cells were used in a double-staining immunofluorescence technique. Sections of dental pulp from normal teeth showed no penetration of bacteria or bacterial antigens and no signs of inflammation. A unique aspect of the present study was the demonstration that penetrating bacteria and bacterial antigens in the pulp of involved teeth were always associated with antibodies and frequently also with complement. A. viscosus has been found most frequently in complement-fixing immune complexes followed by B. gingivalis. A. naeslundii and B. melaninogenicus ss. intermedius were found only in complexes with antibodies. The involvement of plasma cells and T cells was also demonstrated. In the dental pulps of diseased teeth, cytotoxic and Arthus type immunopathologic reactions occurred.

Actinomyces↗
PubMed1985

The effect of radiation on the response of dental pulp to operative and endodontic procedures: an experimental study.

Thirty-six 56-day-old male Sprague-Dawley albino rats served as two groups of experimental animals. Group 1 was irradiated with 400 rads delivered as total-body radiation from a cesium source. Group 2 served as the control group and was not irradiated. Three weeks later, the dental microscope was used to facilitate various dental procedures in both groups of animals (cavity preparation filled with zinc oxide-eugenol, pulp exposure capped with zinc oxide-eugenol, and pulp exposure left open). Two animals for each procedure from Groups 1 and 2 were killed at time intervals of 2, 4, and 8 weeks. The results showed that (1) radiation at this dose resulted in a depression of the normal response of the dental pulp to the trauma and infection induced by pulpal exposure, (2) there were no pathologic changes in the untreated molars of the irradiated animals, and (3) the use of the dental microscope greatly facilitated cavity preparation in the molars of rats.

Animals↗
PubMed1985

A pilot study of the clinical problem of regionally anesthetizing the pulp of an acutely inflamed mandibular molar.

The diplomates of the American Association of Endodontists were surveyed regarding difficulties in regionally anesthetizing acutely painful mandibular molar teeth. Frequently patients developed evidence of adequate regional block anesthesia but experienced pain when the dentist attempted access. A pilot projection was undertaken to determine if a scientific basis existed for this problem. With the animal under general anesthesia, the mandibular nerve of a cat was isolated and then regionally blocked. A stimulating electrode was implanted in a cuspid tooth and a receiving electrode in the cortex of the brain. When a state of inflammation was created in the tooth in the presence of a regional block, there was an increasing cortical response to this stimulation. It was concluded that the pilot project offered a realistic technique for the study of this clinical entity.

Acute Disease↗
PubMed1986

Acute pulpal-alveolar cellulitis syndrome. IV. Exacerbations during endodontic treatment: a clinical study of specific microbial isolates and their etiologic role. Part 1.

A statement has been made by Sundqvist that it has not been possible to isolate the specific bacteria that is responsible for acute exacerbations during endodontic treatment of existing periapical inflammation. This clinical study presents specific microbial isolates from 34 intact nonvital teeth involved with acute cellulitis exacerbations during endodontic therapy. No obligate anaerobes were isolated. Forty-seven aerobic and facultative microbes were isolated. Streptococci, primarily facultative, were the major group of microbes isolated (80%); alpha hemolytic streptococci and the group D enterococcus were predominant as mixed and pure culture specimens. Gram-negative microbes as strict aerobic and facultative microbes were also reported as specific isolates. The biological role of anaerobes were discussed in primary pulpal-periapical infections. The alteration of the tissue oxidation-reduction potential, (Eh) is proposed as an etiologic factor in cellulitis exacerbations during endodontic treatment. This is further substantiated in the Part 2 report. Attention is drawn to the pathogenic potential of streptococci and other microbes isolated in this study.

Acute Disease↗
PubMed1986

Acute pulpal-alveolar cellulitis syndrome. IV. Clinical parameters, demographics, and affirmation of a traditional etiologic theory. Part 2.

The Part 1 report revealed the microbiologic etiology and introduced the oxidation-reduction potential (Eh) as a major factor in acute cellulitis exacerbations during endodontic therapy. Facultative streptococci were the predominant group of microbes specifically isolated. This Part 2 study revealed a 9.5% incidence of cellulitis exacerbations in patients during endodontic treatment of 168 primarily intact nonvital teeth. These teeth were usually asymptomatic, manifesting radiographic periapical lesions without fistulous tracts and necrotic canals. This category of pulpal periapical inflammation is virtually the only type of tooth that is predisposed to cellulitis exacerbations. A frequency distribution of the 34 permanent teeth studied revealed a spectrum of mandibular and maxillary molars, premolars, and anterior teeth involved with the exacerbations. Sex and age did not appear to be factors. Further clinical evidence is cited, which support the concept of altering the tissue oxidation-reduction potential as the prime etiologic factor in favoring the growth of aerobic microbial pathogens.

Acute Disease↗
PubMed1986

Incompletely fractured teeth--a survey of endodontists.

By means of questionnaires, 303 endodontists were asked about their experiences in the diagnosis and treatment of incompletely fractured teeth. The present article discloses the results relative to which teeth are most likely to fracture, which predisposing factors involve higher or lower risk, how endodontists prefer to treat root-fractured teeth, and the success rate they have had with them. The endodontists also reported the frequency of endodontic treatment failures attributable to root fractures. These results are discussed with respect to the potential implications for clinical dental practice.

Humans↗