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Periapical innervation of the ferret canine and the local retrograde neural changes after pulpectomy.

The amputation of the dental pulp severs a population of axons that are predominantly in the A delta and C fiber size range and are principally involved in nociception. Local periapical neuromas, if they are formed after pulpectomy, may be the sites of spontaneous nervous activity that may, in some circumstances, be involved in the genesis of chronic pain. The periapical tissues from the mandibular canines of four ferrets were examined 3 months after pulpectomies. Silver-stained paraffin sections were examined in three dimensions at the light microscope level. Ultrathin sections were examined at the electron microscope level. Compared with contralateral and independent controls, the principal changes were the loss of the periodontal plexus around the root apex, the extension of damage well below the apical foramen, and the persistence of inflammation 12 weeks postoperatively. While a somewhat disorderly mass of nerve fibers develops subapically, the arrangement has only some of the features usually associated with neuromas.

Animals↗

Tissue reactions following apical plugging of the root canal with dentin chips in monkey teeth subjected to pulpectomy.

The tissue reaction following apical plugging of the root canal with dentin chips in monkey teeth subjected to pulpectomy was studied. The reaction was characterized by formation of a cementum-like tissue onto the chips, often walling off the root canal as well as accessory and lateral canals. Twenty-two of twenty-four teeth were rated as successful 95 days after pulpectomy. In the control groups, in which apical plugging of the canal with dentin chips was not attempted, ten of twenty-one teeth were rated as successful at this observation time. In six of the ten successfully treated teeth in these groups a dentin chip plug had been made, although care had been taken to avoid this. It is suggested that a plug of dentin chips is well tolerated by the tissues and may present an effective barrier in the apical part of the root canal, facilitating the accomplishment of a well-condensed, tightly sealing root filling.

Animals↗

Incidence of periapical lesions and clinical symptoms after pulpectomy--a clinical and radiographic evaluation of 1- versus 2-session treatment.

OBJECTIVE: Outcome of pulpectomy in 2 treatment sessions with calcium hydroxide as an intracanal dressing was compared to a procedure comprising instrumentation and root-filling in 1 session. STUDY DESIGN: Subjects with a vital pulp condition (N = 256) were recruited to a randomized clinical trial. Outcome parameters included radiographic signs of apical periodontitis and painful symptoms at clinical follow-ups 1 week and 1-3 years after treatment. RESULTS: Of 244 subjects available for final recall, 17 presented with periapical radiolucency. Lesions were evenly distributed among the 2 treatment groups. Postoperative pain recorded 1 week after permanent filling was significantly associated with overfilling (P = .001), with no difference between treatment groups. There was no association with presence of overfilling and radiographic lesion at end point of recall. CONCLUSIONS: Study confirms that pulpectomy may be carried out at a high rate of success if due attention is given to aseptic operating procedures, proper instrumentation and filling. Under these conditions an interappointment dressing with calcium hydroxide does not seem to influence outcome.

Adolescent↗

Periapical neural changes after pulpectomy.

Pulpectomy and pulpal necrosis result in severance of the nerves that supply the pulp as well as loss of their target organ. Inflammatory changes commonly extend into the periapical region to involve those nerves. The neural response to pulpal loss combined with periapical inflammation is a derangement of the periodontal plexus normally located in the center of the periodontal space around the apical third of the root; the result is the formation of a disorganized group of sprouting and branching axons that have some features in common with neuromas. The inflammatory and neural responses continue for at least a year even when pulpectomy is followed by canal debridement and obturation. Then the responses are reduced but not eliminated by steroids. Root canal therapy with techniques that do not leave residual inflammation still results in increased periapical innervation; the increase seems to be an organized addition to the normal periradicular plexus.

Animals↗

A clinical study on the effects of pulsed Nd:YAG laser irradiation at root canals immediately after pulpectomy and shaping.

OBJECTIVE: The effects of pulsed Nd:YAG laser irradiation for the treatment of root canals immediately after pulpectomy and shaping with regard to improvement of symptoms were evaluated clinically. SUMMARY BACKGROUND DATA: The effects of pulsed Nd:YAG laser irradiation for the treatment of root canals were experimentally investigated using an animal model, but not under clinical conditions. MATERIALS AND METHODS: Thirty-eight teeth from 29 patients were diagnosed as normal or irreversible pulpitis were used. After extirpation of pulp and shaping using a step-back technique and cleansing with 5% sodium hypochlorite (NaOCl) and 3% hydrogen peroxide (H2O2), laser irradiation was applied at 1 W and 15 pps for 1 second in 23 teeth (laser-treated group). Root canals were then obturated with gutta-percha points and sealer by the lateral condensation method. The condition of the obturations was confirmed radiographically. The control teeth were treated in the same way, but without laser irradiation. Occurrence of spontaneous pain was recorded 1 day after treatment and occurrence of percussion pain was recorded 1, 2, and 3 weeks after treatment. RESULTS: Effective ratio, which was the ratio of the number of "none" teeth to total teeth number in the laser-treated group, was higher than that in the control group, but there was no significant difference between 2 groups with regard to spontaneous and percussion pain (p > 0.05). CONCLUSION: These results suggest that the clinical application of pulsed Nd:YAG laser might be advantageous for the one-visit treatment of root canals immediately after pulpectomy shaping and to reduce postoperative pain.

Adolescent↗

The effect of pulpectomy on the longitudinal distribution of nerve fibres in the periodontal ligament of the ferret.

The innervation density of the periodontal ligament was measured at a series of levels around the mandibular canines of 6 ferrets, in 5 of the which the pulp of one of each of these pairs of teeth had been removed 3 months earlier. In control (unoperated) teeth the density of innervation was greatest in the apical third and lowest in the coronal third. The pattern around the pulpectomized teeth was similar. There was no statistically significant difference between density values for control and operated teeth. Pulpectomy thus does not affect the incidence or distribution pattern of nerves in the periodontal ligament.

Animals↗

Comparison of calcium hydroxide and zinc oxide and eugenol pulpectomies in primary teeth of dogs.

The purpose of this investigation was to compare calcium hydroxide with zinc oxide and eugenol (ZOE) as root canal obturants in the pulpectomy procedure for irreversibly inflamed primary pulps of dogs. Clinical, radiographic, and histologic comparisons of calcium hydroxide and ZOE root canal filling materials were made in forty-two primary premolars of seven mongrel puppies. When the animals were 6 weeks of age, the pulps of all samples teeth were extirpated and the canals left open to the oral environment. The root canals were assigned to calcium hydroxide, ZOE, and control groups, instrumented, and filled 2 weeks later. The animals were killed 1 day, 1 week, 4 weeks, and 12 weeks after filling. Statistical analysis of all categories for comparison at 4 weeks indicated that calcium hydroxide gave significantly more favorable results than ZOE. Canals treated with calcium hydroxide exhibited less inflammation, less resorption, and more hard-tissue apposition than ZOE-treated and control groups.

Animals↗

Systemic distribution of 14C-labeled formaldehyde applied in the root canal following pulpectomy.

The systemic distribution of 14C-labeled formaldehyde which had been placed in the root canals of the canines of cats following pulpectomies was studied using liquid scintillation counting and wholebody autoradiographic technique. Radioactive 14C which had been placed in the canals was found in the plasma 30 min after the root canal procedure. The recovery of systemic 14C radioactivity increased with time. In addition, it seemed that approximately 3% of the dose placed in the teeth was excreted in the urine within 36 h. Whole-body autoradiograms indicated extensive concentration of 14C radioactivity in tissues other than those analyzed with the liquid scintillation technique.

Animals↗

Recidivous offence in sadistic homosexual pedophile with karyotype 48, XXXY after testicular pulpectomy. A case report.

The case of recidivous sexual offender with genetically caused mental retardation and primary hypogonadism (Klinefelter's syndrome with karyotype 48, XXXY) is described. He was examined after sadistic abuse of a boy aged 13 that he had committed 19 years after performed testicular pulpectomy. Plasmatic level of testosterone was found 4x higher than mean level in men after orchidectomy. Histological examination of residual scrotal tissues proved that the source of androgens were hyperplastic nodules of extratesticular Leydig cells.

Biopsy↗

A comparison of pain levels during pulpectomy, extractions, and restorative procedures.

Most previous studies on pain in endodontics have focused on pain that occurs after root canal therapy. Very few studies have compared pain during the root canal procedure with pain occurring during other dental procedures. In the present study, 250 patients were queried following dental procedures regarding their pain levels prior to treatment and their pain levels during the treatment procedure. Of the total number of patients, 150 had a pulpectomy, 50 patients had a single extraction, and 50 patients had a single restoration. These patients reported significantly more pain during extractions than during root canal therapy. Ninety-two percent of patients undergoing root canal therapy reported that pain during the procedure was less than or much less than anticipated. Eighty-three percent of the patients undergoing root canal therapy experienced less pain during the treatment procedure than they experienced prior to the treatment.

Adolescent↗

Human pulpectomy: incidence of postoperative pain using two different intracanal dressings.

A clinical study using vital maxillary central incisors was performed to evaluate the incidence of postoperative pain after pulpectomy and dressing with a corticosteroid-antibiotic preparation or a calcium-hydroxide paste. Sixty teeth from 45 patients were prepared and dressed on the first visit and re-evaluated 7 days later. No difference was observed in the incidence of postoperative pain between the two groups.

Adolescent↗

Periapical innervation of the ferret canine one year after pulpectomy.

Previous studies have shown that, following removal of the dental pulp and its replacement with a filling material, the nerves in the periapical region proliferate within an area of chronic inflammation. This study examined these responses in the ferret in more detail, both quantitatively and in three dimensions, 12 months after pulpectomy which was followed by obturation with gutta percha and zinc oxide and eugenol sealer. The results were compared with the responses after three months. The basic patterns, in terms of both inflammation and neural proliferation, were similar at the two time periods. Both the sizes of the inflammatory lesions and the degree of neural proliferation were lower at 12 months than at three, although the differences were not significantly different in the small number of specimens examined. Bacterial stains failed to show bacteria either in the apical root canal delta or in the periapical area. It is possible that the persistent inflammation was due to the irritant nature of the obturating materials used but not due to the original tissue damage, since extraction sites, by comparison, healed very quickly. Apparently, following endodontic treatment, chronic periapical inflammation and concomitant neural proliferation can continue for long periods.

Animals↗

Surgical repair of tusk injury (pulpectomy) in an adult, male forest elephant (Loxodonta cyclotis).

A 15-year-old male forest elephant housed in a zoo sustained a fracture of the right tusk that was 10 cm inside the cheek pouch, thus exposing the tusk canal. Treatment of the cavity by packing, topical application of antibiotics, and administration of various antiseptic preparations failed; however, the tusk grew. To treat the infected, growing tusks's root canal or pulp, surgery--comparable to a pulpectomy in man--was performed with successful results.

Animals↗

Labial pulpectomy access followed by esthetic composite resin restoration for nonvital maxillary deciduous incisors.

A 3-year-old girl had a darkened and symptomatic maxillary right deciduous central incisor. This report describes the rationale and technique for a labial pulpectomy access opening and subsequent composite resin restoration. This innovative approach for the pulpal treatment of these deciduous incosors not only improves the access for instruments and direct visualization for the operator but also greatly improves the appearance of the dark teeth without complete coverage. Two other clinical applications of this labial approach should also be mentioned. First, anterior stainless steel crowns can be made esthetically pleasing by placing labial resin facings in the crown. Second, access for pulpotomy procedures can be improved with use of a labioincisal approach after the incisal reduction step in the preparation of deciduous incisors for complete coverage.

Child, Preschool↗

Pulpectomies in primary incisors using three delivery systems: an in vitro study.

This in vitro study assessed the quality of pulpectomies in primary incisors using three filling systems: syringe with plastic needle syringe with metal needle, and lentulo spiral. Preoperative radiographs of sixty extracted primary incisors were taken, canals were prepared and obturated Postoperative radiographs taken in two directions were evaluated by two independent evaluators blinded to the technique used. Filling quality was determined by analyzing radiopacity, presence of voids and amount of material in the canal After statistical analysis, this study showed that NaviTip system offered a more desirable filling quality than lentulo and Vitapex syringe techniques

Alloys↗

[Pulpectomy. Why? When?].

There are many circumstances under which the condition of the pulp calls for root canal work, due to the real or potential risk of pain, infection, inflammation or functional difficulties (acute, irreversible pulpitis, chronic pulpitic conditions, necrosis and its consequences, etc.). Other circumstances exist in which injury to the pulp is not necessarily irreversible: initial pulpitis, iatrogenic fracture of the pulp, traumatisms, dystrophic deteriorations. The high success rate for endodontic therapy could argue for elimination of impaired or necrose-prone pulp. In fact, however, unsuccessful pulpectomies often lead to loss of the dental organ and successful endodontic treatment severely weakens the whole tooth structure and often implies prosthetic restoration, with the consequent increase in tissular loss. In order to preserve pulp and crown tissues, pulpal vitality should be protected in all cases where such conservative efforts do not worsen the prognosis for maintaining the tooth on its arch or jeopardize a planned restoration. Solutions are presented for various types of situations, according to the risks encountered.

Contraindications↗

[Consequences of pulpectomy followed by canal obturation on the renewal of periodontal ligament in the baboon (Papio papio)].

Endodontic root filling following pulpectomy in Baboons was shown to induce diphasic consequences at the level of the periodontal ligament according to the time of the observation. Initially the specific activity of previously incorporated 3H Glycine decreased and the weight of extractible ligament increased at the same time. Later on, the turnover slowed down and, unexpectedly, the weight of the extractible ligament decreased. This could be explained since the periodotal ligament was shown to exhibit a transient inflammatory reaction followed initially by a tissue accretion and progressively by a partial amputation of the ligament volume compensated by an excess of bone deposit on the surface of the alveolar bone socket.

Animals↗