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PubMed2002

Effect of irrigating solution and calcium hydroxide root canal dressing on the repair of apical and periapical tissues of teeth with periapical lesion.

The objective of this study was to evaluate the apical and periapical repair after endodontic treatment of teeth with pulp necrosis and a chronic periapical lesion in dogs. Seventy-two root canals from four mongrel dogs were submitted to biomechanical preparation, using 5.25% sodium hypochlorite or 2% chlorhexidine digluconate as the irrigating solution. The root canals were subsequently either filled immediately with Sealapex, using active lateral gutta-percha condensation, or a calcium hydroxide root canal dressing was applied for 15 days before filling with Sealapex. After 210 days, the animals were killed by anesthetic overdose, and the obtained histological sections were stained with hematoxylin and eosin for optical microscopic analysis of apical and periapical repair. There was better histological repair in the groups with the root canal dressing (p < 0.05) than the groups with immediate obturation. Comparing the immediate obturation groups, irrigation with chlorhexidine solution resulted in better repair than sodium hypochlorite.

Animals↗
PubMed1992

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↗
PubMed2002

Calcium hydroxide root canal dressing. Histopathological evaluation of periapical repair at different time periods.

The objective of this study was to evaluate periapical and apical repair using calcium hydroxide root canal dressings for different lengths of times in teeth with induced chronic periapical lesions. A total of 61 root canals of maxillary and mandibular premolars from 4 dogs were used. After mechanical preparation of the root canals using the crown-down technique, and 5.25% NaOCl as irrigating solution, the apical foramen was enlarged in all cases. A calcium hydroxide root canal dressing was applied. The control group did not receive a root canal dressing. The animals were killed at 7, 15 or 30 days. After histological preparation, serial sections were stained with hematoxylin-eosin and Mallory's trichrome. The best histopathological results occurred at 15 and 30 days, and the worst results occurred at 7 days and in the control group.

Alveolar Bone Loss↗
PubMed1991

Surgical management of endodontic failures: indications and treatment results.

Two-hundred and twenty-four teeth with failures after conventional endodontic treatment were treated by periapical surgery by one surgeon and followed up for 1-8 years. Indications for surgery were: inaccessibility to the apical part of the root by a coronal approach due to posts, calcifications or procedural accidents. Cysts, a few acute cases and wide-open apices were also treated surgically. Healing was judged radiographically and classified into one of four healing groups: (1) complete healing, (2) incomplete healing (scar tissue); (3) uncertain healing, and (4) unsatisfactory healing. The grouping was performed separately by the oral surgeon and an endodontist. Deviating cases were then evaluated jointly, difficult cases and borderline cases were judged by an oral radiologist. Complete healing was observed for 76.6 per cent and incomplete healing (scar tissue) for 8.1 per cent of the teeth. The size of the latter group was strongly influenced by the number of cases with large preoperative rarefaction. A success/failure grouping of the material (success = complete and incomplete healing) revealed that 27 per cent of the retrofilled cases failed compared with 3.6 per cent in the orthograde group. The main conclusion is that retrofills should be avoided whenever possible.

Apicoectomy↗
PubMed2000

Radiographic periodontal attachment loss as an indicator of death risk in the elderly.

OBJECTIVES: Oral infections have been associated with serious systemic diseases and an increased risk of death. Our aims were to investigate whether radiographically-observed apical periodontitis lesions, carious teeth, periodontal attachment loss (horizontal bone loss, furcation lesions, number of teeth with infrabony periodontal pockets, the extent of infrabony periodontal pockets) and the sum of all these findings have any relationships with all-cause mortality within 4-year follow-up. MATERIAL AND METHODS: 292 community-dwelling elderly persons aged 76, 81 and 86 years. The number of deaths within 4 years was 54 (18.5%). In the dentate 169 subjects, of whom 32 (18.9%) deceased within 4 years, the mean number of teeth was 15.5 in men and 13.2 in women. The imaging method used was panoramic radiography supplemented by intraoral radiographs. RESULTS: 51% of the dentate subjects had infrabony pockets (mean 1.5, s.d. 2.2), and 40% had periapical periodontitis lesions (mean 1.0, s.d. 1.6). After controlling for age and gender, vertical bone loss judged as advanced infrabony pockets was associated with 4-year all-cause mortality (Odds ratio 2.2,1.0-4.7). Other associations were statistically insignificant. CONCLUSION: Periodontal attachment loss may indicate an increased risk of death in the elderly.

Aged↗
PubMed2005

A case of cutaneous odontogenic sinus.

Despite the fact that cutaneous sinus tracts of odontogenic origin are well documented, the condition is still commonly misdiagnosed, because chronic periapical periodontitis may be asymptomatic and is rarely open to the skin. A 75-year-old Japanese woman presented to our clinic with the chief complaint of a left cheek skin lesion with mild pain. Physical examination revealed a subcutaneous nodule covered with erythematous skin on her left buccal region. Cultures from the subcutaneous nodule grew Bacteroides species and Peptostreptococcus micros but did not yield acid-fast bacilli, fungi, or Actinomyces. Stains of smeared pus showed a considerable number of Gram-negative rods. The histopathological examination revealed a focal abscess formation in the lower dermis and subcutaneous tissue. Dental evaluation, including an orthopantogram, showed a radiolucent alveolar area at the left lower first molar apex, suggesting a periapical abscess. Antibiotic therapy for three weeks associated with surgical root canal therapy eliminated the subcutaneous nodule. A high degree of suspicion is required to correctly diagnose a lower facial lesion as being of odontogenic origin, and prompt dental evaluation should be considered.

Abscess↗
PubMed1998

[Dental foci. Role, treatment and prophylaxis in patients at risk].

A dental focus usually is a localized chronic infection that under certain circumstances may result in severe local or systemic disease. The most important dental foci are periodontitis, periapical lesions, advanced carious lesions, nonvital pulp, partially impacted teeth and root tips. Local effects of dental foci particularly are processes that may come to expression because of a compromised immunological defence, such as osteoradionecrosis. Systemic effects are mainly caused by transient bacteraemia which can occur spontaneously out of dental foci or after manipulations such as brushing, flossing and dental treatment. Well known examples are infectious endocarditis, fever during chemotherapy and hematogenous infections of total joint prostheses. For all patients at risk (a.o. endocarditis, endoprosthesis, chemotherapy, radiotherapy) it is important that dental foci are treated. Because in most patients the risk factors are present lifelong, a healthy dentition and a healthy periodontium are the best way of prevention.

Antibiotic Prophylaxis↗
PubMed1988

Upper anterior tooth mobility. Selected associations in untreated periodontitis.

The relationship between buccolingual tooth mobility (TM) and other clinical parameters was studied in 124 upper anterior teeth in 21 patients with untreated periodontitis. Periapical long-cone radiographs were available for 74 teeth in the same population. TM was measured with Mühlemann's macroperiodontometer. Probing depths, attachment levels and bleeding were measured with a constant force probe. Bone levels were estimated from radiographs. Presence of occlusal contact was noted in the intercuspal position and excursive movements of the mandible. Attachment levels showed the highest correlation with TM, and radiographically estimated bone support was the next highest. Results varied according to tooth type: the attachment level of the lateral incisors showed the highest correlation with TM, while probing depths and proximal bone support showed lower associations with TM in all cases. In this population, no association was detected between the presence of occlusal contact and TM, or between inflammation and TM. Multiple and partial correlation analysis indicated that probing attachment level was the most important correlate of tooth mobility.

Adult↗
PubMed2003

[Clinical evaluation and laboratory study of ultrasonic irrigation of the root canal].

OBJECTIVE: To assess the efficacy of ultrasonic irrigation of the root canal in vivo and in vitro. METHODS: Sixty anterior teeth or premolars with the diagnosis of periapical periodontitis were divided into two groups (syringe irrigation group, group S and ultrasonic irrigation group, group U) and were evaluated clinically. Sixty extracted teeth with single straight canals were selected. Forty of them were divided into two groups and were evaluated histologically. Another twenty teeth were divided into two groups and were evaluated by SEM. RESULTS: Clinically, the number of lateral canals obturated in group U was more than that in group S (P < 0.01). The incidence of pain during irrigation were 13.3% in group S, and 3.3% in group U (P > 0.05). Histologically, the amount of organic debris of the root canals in group U were significantly less than that in group S (P < 0.01). By SEM study, the number of visible open dentinal tubules in group U were significantly greater than that in group S (P < 0.05). CONCLUSION: Ultrasonic irrigation of the root canal will be a useful technique in root canal therapy.

Humans↗
PubMed1992

Tissue response following CO2 laser application in apical surgery: light microscopic assessment in dogs.

The potential advantages of CO2 laser in apical surgery have not been established histologically. Therefore, the long-term effects of CO2 laser on the apical and periapical tissues were examined histologically in dogs 6 months after apical surgery. Lased specimens and unlased controls showed periapical inflammatory and osteogenic reactions. Lased root surfaces revealed craters with a superficial charred layer closely associated with new cementum-like matrix. The subjacent dentin appeared tubule-free and eosinophilic. Lased bone trabeculae showed a charred layer with a deeper osteocyte-free zone. The charred layer was covered by new bone. Detached charred segments in the marrow space and periapical inflammatory infiltrate were intimately associated with multinucleated giant cells, some containing minute char particles. Such cells were absent from the root and trabecular char linings. In addition, the charred surfaces were free of hard tissue resorption. These results suggest that CO2 laser does not hinder healing when applied in apical surgery.

Alveolar Process↗
PubMed1998

Inflammation-associated lysyl oxidase protein expression in vivo, and modulation by FGF-2 plus IGF-1.

Lysyl oxidase is the extracellular enzyme that catalyzes oxidative deamination of peptidyl-lysine residues in elastin precursors, and lysine and hydroxylysine residues in collagen precursors to form peptidyl-aldehydes. These aldehydes then spontaneously condense to crosslink collagen and elastin and thereby allow the formation of a mature and functional extracellular matrix. In the present study, cryosections made from aseptic immune-induced periapical lesions experimentally generated in laboratory rats were examined by immunohistochemistry to investigate whether lysyl oxidase protein expression is altered in inflamed oral tissues. Periapical lesions are experimentally induced endodontic lesions of tooth roots. In addition, the effect of administration of a mixture of fibroblast growth factor (FGF)-2 and insulin-like growth factor (IGF)-1 into these lesions on lysyl oxidase expression was determined. Lysyl oxidase expression was found to be increased in non-mineralized connective tissue adjacent to inflamed lesions. Morphometric analyses indicated that maximum lysyl oxidase expression occurred at a discrete distance from the lesion not exceeding 350 microm from the inflammatory cells. Staining was associated with mesenchymal cells with a fibroblastic morphology. No lysyl oxidase staining was found near teeth where no lesion was induced. Application of a mixture of FGF-2 and IGF-1 resulted in a further twofold increase in lysyl oxidase expression. These results provide a new in vivo model to study lysyl oxidase regulation, and suggest that inflammatory cells may control lysyl oxidase expression in oral tissues, possibly by a mechanism involving secretion of cytokines and other factors, probably contributing to the regulation of extracellular matrix accumulation.

Animals↗
PubMed1987

Tissue response to retrograde root fillings in the ferret canine: a comparison of a glass ionomer cement and gutta-percha with sealer.

Tissue healing was compared after apicectomy and filling of ferret lower canines with glass ionomer (Ketacfil) or gutta-percha/sealer (Tubliseal). Both materials provoked an inflammatory response after 7 days, but the response to glass ionomer was less severe. The response after 28 days was different. Mild inflammation related to the gutta-percha was still present, but no inflammation was found in relation to the glass ionomer. Bone infill was quite advanced in all specimens at 28 days but was more complete in the glass ionomer specimens, with intimate contact between the bone and cement.

Animals↗
PubMed1992

Usage test of four endodontic sealers in Macaca fascicularis monkeys.

Root canals with vital pulps in four Macaca fascicularis monkeys were subjected to pulp extirpation and root filling with gutta-percha and sealer, either AH26, Endomethasone, Kloroperka N-phi, or ProcoSol. Observation periods were 1 and 6 months. The results of treatment were evaluated by radiographic analysis (periapical index scores) and by histopathologic assessment of the remaining pulp and periapical tissues. Sixty roots with acceptable termination (between 0.5 and 3 mm from apex) of the root fillings and adequate histopathologic specimens were available for analysis. These roots were equally distributed in each observation period group and among the four material groups. Radiography indicated periapical pathosis in 6 of the 60 roots--4 at 1 month and 2 at 6 months. Periapical inflammation was observed on histopathologic examination in 17 roots--11 after 1 month and 6 after 6 months. Histologic and radiographic assessment of periapical inflammation was significantly correlated (p less than 0.01, chi 2) at the 6-month observation period. No granuloma or cyst formation was evident on histologic examination. The magnitude of the inflammatory response appeared unrelated to the endodontic sealer used, and several inflammatory foci were not related to foreign bodies in the tissues. Bacteriologic sampling showed growth in thioglycollate broth cultures in 9 of the 60 roots, but the presence of cultivable bacteria by this technique was unrelated to inflammatory changes. Histologic demonstration of bacteria was positive in 4 roots, all of which were associated with inflammatory periapical reactions. The method applied in the present study did not provide a sensitive discrimination among endodontic materials of widely different chemical composition.

Administration, Topical↗
PubMed2005

Development and validation of a dental pain-screening questionnaire.

Dental pain, estimated to affect 12-40% of community-dwelling adults, is a symptom of a wide range of clinical conditions. A population screening instrument is needed to study their prevalence. This project aimed to develop a questionnaire for classifying a sample of dental pain patients into three groups of common dental pain conditions, i.e. Group 1 (Acute periapical periodontitis and Irreversible pulpitis), Group 2 (Reversible pulpitis and Dentine hypersensitivity) and Group 3 (Pericoronitis). Initial items were generated through a literature review, individual unstructured patient interviews and consultation with experts. Items generated were administered to a sample of dental pain patients for self-completion. Responses were subjected to a series of factor and discriminant analyses to identify questions capable of differentiating the sample into three groups, originally categorized by clinical diagnosis, with high classification rates. The selected items were administered to a further sample of dental pain patients to test for its sensitivity and specificity in classifying the sample into three groups against the gold standard of clinical diagnosis. The final 16-item Dental Pain Questionnaire (DePaQ) was capable of correctly classifying 89.7% of dental pain cases initially categorized by clinical diagnoses. The sensitivity of the questionnaire was 0.80-Group z1, 0.85-Group 2 and 0.59-Group 3. Specificity was 0.83-Group A1, 0.89-Group A2 and 0.90-Group 3. The DePaQ, which can easily be administered by non-clinical personnel, may be used to collect epidemiological data on common dental pain conditions, assess dental needs for a specified population, and triage of patients seeking treatment for dental pain.

Adolescent↗
PubMed1994

Pulpal and periapical tissue reactions after experimental pulpal exposure in rats.

The purpose of this study was to investigate histologically and histometrically the changes in pulpal and periapical tissues after pulpal exposure in rats. All animals received a pulpal exposure in the left mandibular first molar. Animals were killed at 1 to 56 days after pulpal exposure, and their mandibles were evaluated histologically and histometrically. Histologically, pulpal necrosis extended gradually from the upper part of the pulpal tissue to the apex, with inflammation starting in the periapical tissue at an early stage. As the periapical lesion developed, alveolar bone and cementum resorption was also found. Histometrically, the length of pulpal necrosis increased gradually from 1 to 28 days. The vertical length of the periapical lesion after 14 days was significantly increased, while the horizontal length and the overall area after 7 days were also significantly increased. The periapical lesion extended in a mesiodistal direction at first and then in a vertical direction before expansion ceased.

Animals↗
PubMed1994

Chronic pain associated with a foreign body left under the soft tissue flap during periapical surgery.

A case is reported of a patient who requested treatment for chronic pain of 7 yr duration. After several unsuccessful endodontic procedures, a cotton pellet was discovered under the soft tissue near the apex of the left maxillary cuspid. It was theorized that the cotton was left under the tissue flap during a previous apicoectomy procedure. After the cotton was removed the patient subsequentially reported that the pain was relieved.

Adult↗
PubMed1994

Interleukin 1-beta in symptomatic and asymptomatic human periradicular lesions.

Interleukin 1 beta (IL-1 beta) has been shown to be a potent mediator of bone resorption and has been implicated in resorption in periradicular lesions. In this study we compared the local concentrations of IL-1 beta in symptomatic and asymptomatic human periradicular lesions. Periradicular tissues from patients with symptomatic and asymptomatic lesions were obtained and stored at -70 degrees C. Pulpal tissues from unerupted third molars and chronically inflamed gingival tissues were also obtained and used as negative and positive controls, respectively. Tissue samples were homogenized, and supernatants were assayed for IL-1 beta by the enzyme-linked immunosorbant assay. Significantly higher levels of IL-1 beta were found in symptomatic and asymptomatic lesions and inflamed gingival tissues compared with uninflamed pulp tissues. There was a trend toward higher levels of IL-1 beta in symptomatic lesions compared with asymptomatic lesions, but the difference was not significant. The results suggest that IL-1 beta may play a significant role in the pathogenesis of human periradicular lesions.

Analysis of Variance↗