Partial removal of gutta percha and the apical seal. Literature review and clinical recommendations.
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Biomedical subjects
Publications and source records attributed to M Tagger.
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The effects of vital root resection upon the remaining pulp were studied in twenty-six periodontally involved human molars. The pulp was extirpated 14 days after the intervention. Granulomatous tissue present in the pulp chamber protruded from the site of the exposure as a polyp in eleven cases. Mild chronic inflammatory changes were present in the coronalmost part of the radicular pulp. The apical pulp was not affected at this time interval.
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An investigation was designed to study the clinical and histological effects of delaying endodontic therapy for a period of 2 weeks without dressing of the exposed pulp, after vital intentional root amputation had been carried out on periodontally involved teeth. From the results obtained it was possible to conclude that: 1. Endodontics, prior to surgical root amputation, remains the treatment of choice. 2. When preoperative endodontics is not possible, the approach used in this study will provide good results without severe, adverse clinical or histological effects. 3. The altered periodontal condition and tooth form do not interfere with the performance of definitive endodontics 2 weeks after surgery. 4. Definitive preparation of the cut tooth surface at the time of root amputation facilitates maintenance of oral hygiene after removal of the periodontal dressings. 5. The high percentage of involvement of the distobuccal root of the first maxillary molar in periodontal situations requiring correction by root amputation, may be due to the anatomy of this root.
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Apical periodontal lesions were produced in the rat molar by exposing the pulp to the oral environment. The natural history of the undisturbed lesion was studied at time intervals ranging from 2 days to 1 year postoperatively. The earliest reactions were usually inflammatory infiltration at the apex. The severity of the lesions was related to the amount of vital pulp still present in the tooth rather than to the time lapse after exposure. After 1 month most pulps has undergone necrosis and the lesions about the apices which followed showed two main types of reaction. In the case of the suppurative reaction, pus drained along a root surface, destroying the periodontal ligament and interradicular bone until it emerged at the gingival sulcus. The sinus tract could become lined with oral epithelium. In the reparative type of reaction, suppuration was absent or minimal and the apices were surrounded by fibrous connective tissue. The fiber bundles occasionally formed a collagenous scar, but they were usually replaced by cementum and bone with a new periodontal ligament. The width of the periodontium was never restored to its normal dimensions. Secondary destruction of the teeth occurred by fracture of cusps followed by caries which started in the exposed pulp chamber. Despite the predominance of destructive factors, spontaneous repair indicated good healing potential of the apical periodontal tissues.
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Tetracycline hydrocholoride was administered to label reparative dentin in teeth indicated for extraction. Deep cavities or pulp capping performed on the teeth one of four months before extraction served as a stimulus for new dentin formation. Examination of undemineralized sections under ultraviolet light revealed fluorescent bands in the reparative dentin of most teeth. The technique can be safely used in studies of the effects of clinical procedures on the dentin and pulp of human teeth.