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PubMed1977

Correlation of scanning electron microscope and light microscope findings in uninflamed and pathologically involved human pulps.

The use of the scanning electron microscope has been investigated as a modality for pulpal diagnosis. Findings in ten normal, inflamed, and necrotic human pulps were correlated with light microscope findings. Inflammatory cell identification by SEM was found to be difficult. The inflammatory cells, especially lymphocytes, appeared in varying forms in SEM. Polymorphonuclear leukocytes and macrophages had similar surface structure. Degenerative changes of cells and fibers and dystrophic mineralizations were graphically depicted by SEM.

Abscess↗
PubMed1977

Microscopic study of the pulps of human teeth following vital root resection.

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.

Adult↗
PubMed1994

Unusual pattern of pulp canal obliteration following luxation injury.

Pulp canal obliteration can occur as a result of tooth injury. A case report is presented in which a 6-yr-old patient developed partial pulp canal obliteration of a maxillary central incisor 9 months after luxation injury. The mineralization created unusual canal morphology which presented some difficulty in endodontic treatment of the tooth.

Child↗
PubMed1995

Microcomputed tomography: an advanced system for detailed endodontic research.

This study evaluated the value of microcomputed tomography (MCT) for use in endodontic research. Four periodontally involved highly calcified maxillary first molars were extracted and then scanned for evaluation by a MCT system. The teeth were then instrumented, and 2 of the 4 obturated before rescanning for comparison evaluation. Several capabilities of the MCT to advance endodontic research significantly were observed: the ability of the MCT to present accurately the external and internal morphologies of the tooth without tooth destruction; the possibility of showing changes over time in surface areas and volumes of tissues; the ability to assess area and volume changes after instrumentation or obturation; and the capability of evaluating canal transportation following instrumentation or instrumentation and obturation. The tremendous potential of this scientific tool was discussed.

Dental Pulp Calcification↗
PubMed1996

Incidence of pulp necrosis subsequent to pulp canal obliteration from trauma of permanent incisors.

Little long-term data are available on the frequency by which pulp canal obliteration (PCO) subsequent to trauma leads to pulp necrosis (PN). In this study, 82 concussed, subluxated, extruded, laterally luxated, and intruded permanent incisors presenting with PCO were followed for a period of 7 to 22 yr (mean 16 yr). At final clinical examination, 51% of the observed teeth responded normally to electric pulp testing (EPT). An additional 40% of the teeth although not responding to EPT were clinically and radiographically within normal limits. Yellow discoloration was a frequent finding. During the observation period, periapical bone lesions suggesting PN developed in seven teeth (8.5%). Twenty-yr pulp survival rate was 84%, as determined from life-table calculations. There was no higher frequency of PN in obliterated teeth subjected to caries, new trauma, orthodontic treatment, or complete crown coverage than intact teeth. Although the incidence of PN in teeth displaying PCO seems to increase over the course of time, prophylactic endodontic intervention on a routine basis does not seem justified.

Chi-Square Distribution↗
PubMed1996

Characteristics and effects of calcified degenerative zones on the formation of hard tissue barriers in amputated canine dental pulp.

The purpose of this research was to study under undecalcified conditions the presence, ultrastructural features, and contributions of the degenerative zone beneath the necrotic zone and whether it had effects on the formation of reparative dentin in canine incisors and premolars. The research was conducted over a period of 14 days after experimental pulpotomy using calcium hydroxide as a pulp-capping agent. On the first day following pulp exposure and capping with calcium hydroxide, electron-dense spherical bodies were observed under the necrotic zone. Energy dispersive X-ray point analysis confirmed that these electron-dense deposits contained calcium and phosphorus. By the third day, varying amounts of minute von Kossa-positive granules could be observed light-microscopically between the two zones of necrosis and underlying vital pulp tissue. Migration and proliferation of pulpal cells, most probably mesenchymal cells, were observed adjacent to the von Kossa-positive zone. The ultrastructure of the von Kossa-positive zone consisted of degenerated cells, electron-dense spherical bodies, and electron-dense shortened dilating fibrils. By the seventh day, short cylindrical-shaped cells collected at the coronal end of the vital pulp tissue. By the fourteenth day, the specimens having a uniform von Kossa-positive zone exhibited rapid differentiation of odontoblasts and tubular dentin formation. In contrast, only some specimens having an irregular von Kossa-positive zone exhibited osteodentin formation and the beginning of odontoblast differentiation beneath the osteodentin. These findings suggest that this calcified degenerative zone has an important effect on the reparative process of pulp tissue after pulpotomy.

Animals↗
PubMed1993

Repair process of external root resorption subsequent to palatal expansion treatment.

The repair process of external root resorption (ERR) and the role of retention mechanics in enhancing ERR repair were studied on eight Macaca fascicularis monkeys that were divided equally into short- and long-term groups. Six monkeys received palatal expansion appliances, and two received sham appliances. The short-term group received active treatment. The long-term group received additional retention (4 months) and relapse (2 months) treatment periods with biweekly injections of individual vital dye per phase, i.e., procion red H-8B and violet H-3R (80 mg/kg B.W.), respectively. Histomorphologic examinations included scanning electron microscopy, light, and ultraviolet microscopy. The short-term group demonstrated penetrated resorption with pulp exposure at sites with initial deficiency of the protecting odontoblastic layer (apical zone, nutrition canal). The long-term group showed two forms of ERR repair: (1) Nonfunctional retarded repair cementum, comprised of overlapped incremental lines and deprived of extrinsic fibers, was delineated in severe pulp exposure. The pulp/dentin complex showed intense incorporation of procion dye in the dentinal tubuli, conceivably related to a defense response in the form of sclerotic dentin. (2) Functional rapid repair cementum, comprised of discriminated incremental lines mainly of mixed cellular cementum, with a consistent pattern of five sequential phases: the lag phase (14 to 28 days), the incipient phase (14 days), the peak phase (14 to 28 days), the steady phase (42 to 56 days) and the retreating phase (70 days). Sharpey's fibers at functional ERR sites were scarce, never emerging from the dentinocemental junction, and not developing into principal fibers. The pulp/dentin complex showed an increase in pulp stones but no formation of tertiary dentin. The apical area responded by hypercementosis in the form of apical occlusion and a displaced pulp canal. The application of a fixed retention device is recommended in light of accelerated apposition of repair cementum during the retention period. However, increased formation of Sharpey's fibers during the relapse period might suggest a restricted duration in splinting therapy.

Animals↗
PubMed2000

Bone-like tissue growth in the root canal of immature permanent teeth after traumatic injuries.

Following a severe traumatic incident to permanent immature teeth, the growth of calcified tissue in the pulp space may occasionally occur. This calcified tissue may be diffuse or in intimate contact with the dentine. It has been suggested that a wide open apex, severe damage to the root sheath, and the absence of infection are only some of the predisposing factors leading to this metaplasia of pulp tissue into bone-like tissue. Five cases are described.

Adolescent↗
PubMed2002

Clinical and epidemiological study of traumatic root fractures.

The aim of this work was to study the prevalence and clinical presentation of root fractures in a series of patients with dental trauma. Treatment strategies were classified and outcomes after a 6-month period presented. The study population comprised 76 patients (between the ages of 2 and 55 years) with 93 root fractures in their teeth (18 primary, 75 permanent). Data were collected following the taking of a detailed clinical history, objective clinical examination and photographic and radiological investigation. Since most of the primary teeth were extracted, only cases with root fracture of permanent teeth were followed-up: in all, 24 patients with 31 teeth with root fractures. The prevalence of root fractures in permanent teeth was 7.7% of all injuries, while in primary teeth it was 3.8%. The most frequently involved teeth were the maxillary incisors with a percentage of 75% in permanent teeth. Moreover, 40% of root fractures in permanent teeth were associated with fracture of the alveolar bone and of the soft tissues and in 45% of cases, the adjacent teeth were also injured. The results of this study reaffirm the necessity for scrupulous diagnosis of teeth after a traumatic injury. Adjacent teeth and those in the opposing arch should not be ignored. Treatment is multidisciplinary, requiring surgical, orthodontic, operative and prosthetic compliance. Periodic check-up is essential.

Adolescent↗
PubMed2003

Clinical outcomes for permanent incisor luxations in a pediatric population. II. Extrusions.

A longitudinal outcome study was undertaken to identify variables that significantly influenced outcomes for extruded permanent maxillary incisors of children and adolescents. Clinical and radiographic data was available for 35 patients (18 males, 17 females) representing 55 incisors. Mean age at the time of injury was 10.6 years (range: 7.1-17.8 years). Mean time elapsed to follow up was 1320 days (range: 423-2887 days). Survival analysis was used to identify variables significantly related to the prognosis of these teeth. The loss of an incisor following extrusion was uncommon as only one tooth (1/55) required extraction. There was no statistically significant difference in survival between severely extruded teeth and avulsions that had been stored in physiological media (P > 0.10). Pulp necrosis (PN) was the most common complication following injury (43%) and it most often occurred during the first year. Although not statistically significant, a trend towards increased PN was found with more severely extruded teeth (P = 0.20, relative risk = 2.08). Pulp canal obliteration (PCO) was the second most common outcome (35%). The degree of extrusion was proven to be significantly associated with the development of PCO (P = 0.03, relative risk = 0.33). Root resorption was an uncommon outcome (3/55). This study represents the first outcome data on extrusions to permanent maxillary incisors in an exclusively pediatric population.

Adolescent↗
PubMed2003

Clinical outcomes for permanent incisor luxations in a pediatric population. III. Lateral luxations.

A longitudinal outcome study was designed to identify variables that influenced tooth survival as well as pulpal and periodontal outcomes of laterally luxated permanent maxillary incisors of children and adolescents. All cases were treated between June 1988 and June 1998 in a teaching hospital clinic. Clinical and radiographic data were collected for 42 patients (26 males, 16 females) that represented 58 permanent maxillary incisors. Mean age at the time of injury was 11.4 years (range: 6.3-17.8 years). Mean follow-up time was 1460 days (range: 183-3905 days). In the entire sample (n = 58), no incisors required extraction. Survival analysis and logistic regression were used to identify variables significantly related to the survival and healing outcomes of these incisors. Pulp necrosis (PN) (40%) and pulp canal obliteration (PCO) (40%) were common healing complications. Proportional hazards (Cox) regression showed that PN develops within the first year. Logistic regression demonstrated that root development (P = 0.3, PN; P = 0.8, PCO) and extent of lateral luxation (P = 0.5, PN; P = 0.9, PCO) were not significantly related to PN and PCO. This study provides the first report of incisor survival in children and adolescents following lateral luxation injuries.

Adolescent↗
PubMed2000

Primary molar pulp therapy--histological evaluation of failure.

OBJECTIVES: Qualitative comparison of the clinical, radiographic and histological outcomes in a small sample of cariously exposed primary molars, extracted after unsuccessful pulp treatment by two vital pulpotomy methods. SUBJECTS AND METHODS: The primary molars were extracted, because of treatment failure, during a longitudinal clinical investigation of the relative efficacy of 20% Buckley's Formocresol versus calcium hydroxide powder as pulp dressings in vital pulp therapy (in press). Fifty-two child patients were sequentially enrolled in the longitudinal clinical investigation, 26 boys and 26 girls. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). Coronal pulp amputation was prescribed only in teeth with vital, cariously-exposed pulp tissue. All cases were reviewed using predefined clinical and radiological criteria. Seventy-nine cariously-exposed primary molars required vital pulp therapy. Forty-four teeth were included in group F and 35 in group C. Five per cent (n = 2) of teeth in group F and 11 per cent of teeth (n = 4) in group C were terminated from the trial due to clinical and/or radiographic failure. Of the six teeth extracted, five were sufficiently intact to be retained for histological evaluation. RESULTS: Post-extraction radiographs taken before specimen preparation showed reactionary dentine barrier (bridge) formation in teeth treated with calcium hydroxide. However, the narrowing of root canals, indicative of appositional reactionary dentine deposition, was seen in both groups (F and C). Histological examination confirmed these findings and revealed that pus cells were evident in all specimens examined. There was also histological evidence of resorption of reactionary dentine within the root canal and that forming the calcified barrier (dentine bridge). CONCLUSION: The clinical and radiographic outcomes for the five teeth correlate well with the reported findings from decalcified histological section. Although numbers are small, the histological findings may indicate possible reasons for treatment failure. There are few reports of this sort in the literature of this under-researched treatment modality.

Calcium Hydroxide↗