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PubMed1993

Effect of sensory denervation on the response of rat molar pulp to exposure injury.

Sensory nerve fibers that contain calcitonin gene-related peptide (CGRP) have been shown previously to sprout into inflamed tissue surrounding sites of pulpal injury. The sprouting fibers contain increased CGRP immunoreactivity (IR), and neuropeptide levels increase in the surrounding pulp. We compared denervated and innervated first mandibular molars of rats to determine whether the absence of sensory nerve fibers affected tissue survival and healing after pulp exposure. Significant differences were seen between innervated and denervated teeth six days after occlusal exposure, with more extensive necrosis in the denervated teeth, and less survival of vascular pulp. When exposures were on the side of the crown, there was no significant difference between the innervated and denervated teeth. Both the innervated and denervated teeth had begun to make reparative dentin and osteodentin by six days after tooth injury. This study shows that teeth with sensory denervation had an accelerated loss of pulp tissue following occlusal exposure compared with innervated teeth with similar injury.

Animals↗
PubMedDate not supplied

Criteria for management of calcific metamorphosis: review with a case report.

Calcific metamorphosis is seen commonly in the dental pulp after traumatic tooth injuries and is characterized by deposition of hard tissue within the root canal space. Opinion differs among practitioners as to whether to treat these cases upon early detection of calcific metamorphosis or to observe them until symptoms or radiographic signs of pulpal necrosis are detected. In this article, the clinical, radiographic, and histopathologic appearance of calcific metamorphosis is described; a review of the literature is presented to address these issues in an attempt to establish sound rationale for treatment. Approximately 3.8% to 24% of traumatized teeth develop varying degrees of calcific metamorphosis. Studies indicate that of these, approximately 1% to 16% will develop pulpal necrosis. Most of the literature does not support endodontic intervention unless periradicular pathoses is detected or the involved tooth becomes syptomatic. It may be advisable to manage cases demonstrating calcific metamorphosis through observation and periodic examination. A report of a case where in non-surgical endodontic intervention was successfully carried out a patient suffering from calcific metamorphosis with periapical pathoses is also presented.

Adult↗
PubMed2003

A multicentre investigation into the role of structured histories for patients with tooth avulsion at their initial visit to a dental hospital.

A paper structured history (SH) is a sheet, which prompts or reminds the clinician to ask various important questions. The aim of this study was to examine avulsion cases with respect to the quality of clinical records. Hospitals studied used either a paper SH or had no specific structure in their recording of avulsion details, e.g. unstructured histories (USH). The most important prognostic items that should be recorded for avulsion cases at their first visit were identified by reviewing the literature. Clinical case records meeting strict inclusion criteria were retrospectively analyzed against 10 important prognostic items. Forty-seven patient records were identified in the SH group compared to 43 patient records in the USH group. Using chi-square and Fisher's exact tests, the SH group were significantly better at recording the following: accident details (P < 0.001), loss of consciousness (P < 0.001), other teeth or tooth injuries (P < 0.05), extra-alveolar mediums (P < 0.01), total extra-alveolar time (P < 0.001), antibiotics given at time of injury (P < 0.05) and apical maturity (P < 0.001). In all the dental hospitals selected, two-thirds of the case records were completed by junior dentists not in specialist training and the improvement in history when using an SH form was most pronounced in these groups. It is concluded, therefore, that an SH should be taken for cases ofavulsion as it was significantly better at collecting essential prognostic information.

Chi-Square Distribution↗
PubMed1995

Peripherally induced tremor and parkinsonism.

OBJECTIVE: Trauma to the peripheral nervous system is a well-recognized cause of dystonia and tremor, but peripherally induced parkinsonism has not previously been documented. We seek to characterize peripherally induced tremor and parkinsonism and propose possible mechanisms for this phenomenon. DESIGN: Review of records of patients evaluated in the Movement Disorders Clinic between 1977 and 1993. In addition to demographic and clinical information, the records were screened for any potential predisposing factors. PATIENTS: Twenty-eight patients in whom the onset of tremor, parkinsonism, or both was anatomically and temporally related to local injury. INTERVENTION: The type and site of injury were verified by history and examination of records whenever possible. Severity of tremor and parkinsonism was assessed by clinical rating scales. Three patients with tremor and parkinsonism had their striatal [18F]-fluorodopa uptake and raclopride binding measured with positron emission tomography. MAIN OUTCOME MEASURE: Response to conventional antitremor and antiparkinsonian medication was assessed by a clinical rating scale. RESULTS: Severe local injury preceded the onset of movement disorder by 47.5 +/- 74.7 days (mean +/- SD). The mean age at onset of movement disorder was 46.5 +/- 14.1 years. Tremor was present in all 28 patients, 11 of whom exhibited additional parkinsonian features. In 20 patients, the movement disorder spread beyond the original site. Possible predisposing factors were identified in 13 patients; nine had essential tremor or a family history of essential tremor. In addition to tremor, dystonia and myoclonus were evident in 13 and three patients, respectively. Reflex sympathetic dystrophy was present in six patients. Tremor did not improve with medications, and only seven patients with parkinsonism responded to therapy with levodopa. CONCLUSION: Central reorganization in response to peripheral injury may give rise to a motor disturbance, including tremor and parkinsonism.

Adult↗
PubMed2003

Pulpal regeneration after cavity preparation, with special reference to close spatio-relationships between odontoblasts and immunocompetent cells.

The regeneration process of the odontoblast cell layer incident to tooth injury, especially its relationship with immunocompetent cells in pulp healing, has not been fully understood. The purpose of the present study was to clarify this relationship between odontoblasts and immunocompetent cells in the process of pulp regeneration following cavity preparation in rat molars by immunocytochemistry for heat shock protein (Hsp) 25 as well as class II major histocompatibility complex (MHC) molecules. In untreated control teeth, intense Hsp 25-immunoreactivity was found in the cell bodies of odontoblasts and their processes within the predentin, whereas class II MHC-positive cells were predominantly located beneath the odontoblast cell layer. Cavity preparation caused the destruction of the odontoblast layer to form an edematous lesion and the shift of class II MHC-positive cells with the injured odontoblasts toward the pulp core at the affected site. Some damaged odontoblasts without apparent cytoplasmic processes, round in profile, retained the immunoreactivity for Hsp25, suggesting the survival of a part of the odontoblasts against artificial external stimuli. Twelve hours after cavity preparation, numerous class II MHC-positive cells appeared along the pulp-dentin border and extended their processes deep into the exposed dentinal tubules. By postoperative 72 hours, newly differentiated odontoblasts with Hsp 25-immunoreactivity were arranged at the pulp-dentin border, but the class II MHC-positive cells moved from the pulp-dentin border to the subodontoblastic layer. These findings indicate that the time course of changes in the expression of Hsp 25-immunoreactivity reflects the regeneration process of odontoblasts. The functional roles of Hsp 25-positive odontoblasts and immunocompetent cells such as class II MHC-positive cells in the process of pulp regeneration after cavity preparation are discussed in conjunction with our previous experimental data.

Animals↗
PubMed2006

Pulpal responses to cavity preparation in aged rat molars.

The dentin-pulp complex is capable of repair after tooth injuries including dental procedures. However, few data are available concerning aged changes in pulpal reactions to such injuries. The present study aimed to clarify the capability of defense in aged pulp by investigating the responses of odontoblasts and cells positive for class II major histocompatibility complex (MHC) to cavity preparation in aged rat molars (300-360 days) and by comparing the results with those in young adult rats (100 days). In untreated control teeth, immunoreactivity for intense heat-shock protein (HSP)-25 and nestin was found in odontoblasts, whereas class-II-MHC-positive cells were densely distributed in the periphery of the pulp. Cavity preparation caused two types of pulpal reactions based on the different extent of damage in the aged rats. In the case of severe damage, destruction of the odontoblast layer was conspicuous at the affected site. By 12 h after cavity preparation, numerous class-II-MHC-positive cells appeared along the pulp-dentin border but subsequently disappeared together with HSP-25-immunopositive cells, and finally newly differentiated odontoblast-like cells took the place of the degenerated odontoblasts and acquired immunoreactivity for HSP-25 and nestin by postoperative day 3. In the case of mild damage, no remarkable changes occurred in odontoblasts after operation, and some survived through the experimental stages. These findings indicate that aged pulp tissue still possesses a defense capacity, and that a variety of reactions can occur depending on the difference in the status of dentinal tubules and/or odontoblast processes in individuals.

Aging↗
PubMed1999

The distribution and ultrastructure of class II MHC-positive cells in human dental pulp.

The distribution and ultrastructure of class II major histocompatibility complex (MHC)-positive cells were investigated in human dental pulp, employing immunohistochemistry using an anti-human leukocyte antigen (HLA)-DR-monoclonal antibody. HLA-DR-immunopositive cells, appearing spindle-like or dendritic in profile, were densely distributed throughout the dental pulp. Under the electron microscope, these cells exhibited various sizes of vesicles containing clear or opaque contents, multivesicular bodies and characteristic fine tubulovesicular structures in their cytoplasm. Some reactive cells possessed coated pits and vesicles including electron-dense materials, indicating an active endocytosis. At the periphery of the pulp tissue, the HLA-DR-immunopositive cells were predominantly situated in the subodontoblastic layer, with some located in the odontoblast layer and/or predentin and extending their cytoplasmic processes into the dentinal tubules. Cell processes of these cells occasionally made contact with several odontoblast processes in the same way as the nerve fibers in the predentin. These cells never contained the typical phagosomes frequently observed in the HLA-DR-immunoreactive macrophages in the subodontoblastic layer and the pulp core. The results suggest that the HLA-DR-immunopositive cells in the odontoblast layer and/or predentin have some regulatory function on the odontoblasts under physiological conditions, in addition to their involvement in the initial defense reaction after tooth injury.

Cytoplasmic Granules↗
PubMed2001

Prevalence of dentofacial characteristics in a belgian orthodontic population.

The aim of this retrospective study was to provide quantitative information on the prevalence of dentofacial characteristics to find correlations between them and to determine the orthodontic treatment need in a Belgian orthodontic population. Data were acquired from 1,477 patients who had initial records made at the Department of Orthodontics, Katholieke Universiteit Leuven, Belgium between February 1983 and June 1997. The prevalence of Angle Class I, Class II div. 1, Class II div. 2 and Class III malocclusions was, respectively, 31%, 52%, 11% and 6%. The male-to-female ratio was 4:6. Spacing and trauma to teeth occurred more in males than in females. The prevalence of the following dentofacial characteristics was significantly different between the Angle classes: segmental crossbite; crossbite of one tooth; facial asymmetry; protral and lateral mandibular shift; horizontal and vertical growth patterns, impacted teeth; traumatised teeth; ectopically erupting canines; age at first records. No significant difference in the prevalence of the Angle classes between the sexes was found. Several clinically relevant correlations were found between the examined dentofacial characteristics. This Belgian orthodontic population from the Leuven region seems to be comparable to other orthodontic populations in Europe.

Adolescent↗
PubMed1982

Forced eruption: principles in periodontics and restorative dentistry.

Forced orthodontic eruption is based on an understanding of the normal dental unit. The relationships between tooth, attachment apparatus, gingival unit, and force and stress demand consideration when forced eruption is used to treat carious or traumatic destruction of clinical crowns, lateral root perforations, or isolated vertical periodontal defects. Factors that must be judged acceptable prior to the initiation of therapy are (1) esthetics, (2) clinical root length, (3) root proximity, (4) root morphology, (5) furcation location, (6) individual tooth position, (7) collective tooth position, and (8) the ability to restore teeth. A correct diagnosis is essential and must precede the choice of forced eruption as a clinical solution. Correctly chosen, force eruption allows the tooth to assist in the support of a multiunit restoration or maintain its individual integrity while contributing to esthetics, speech, and function.

Dental Caries↗
PubMed1975

Some unusual cases of apexification subsequent to trauma.

Three cases are reported in which apexification occurred without the benefit of endodontic treatment. These reports illustrate that immature teeth which are avulsed and replanted, dislocated and repositioned, or traumatized with pulp necrosis supervening, may progress to form complete apices without intracanal therapy. The value of using calcium hydroxide is not in question, but may not be as essential an aid to apical closure as was previously thought. In one case, the appearance of isolated apixes forming, deep in the bone after loss of very immature lateral incisors poses the question of whether this event does not occur more frequently after extraction of newly erupted or young impacted teeth.

Adolescent↗