Pulpoperiapical disease: diagnosis and healing. A clinical endodontic study.
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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.
Response of induced periapical lesions in monkeys to a conventional endodontic technique was investigated at varying periods ranging from 15 to 365 days after treatment. The findings indicate that response to treatment is influenced by the extent of the root canal filling, the time lapse between treatment and death, and the presence or absence of bacteria in the apical portion of the canal.
A case of multiple bilateral dens in dente of the maxillary anterior region with associated multiple periapical lesions of the maxilla is reported. Examination demonstrated the condition known as dens in dente to be present in all six maxillary anterior teeth. Also noted was a large palatal swelling which was confirmed to be an infected maxillary radicular cyst. The multiplicity, severity, and consequences of the dens in dente as reported in this case may indicate prophylactic restorative therapy.
Dequalinium compounds are known as chemotherapeutic and bactericidal agents. They are used in various areas of medicine and oral medicine for combating cases of mixed infections. Until now, results of basic research studies have been published whose objective was to examine the suitability of dequalinium preparations as cleansing agents and intracanal dressings for endodontic use. This article presents for the first time a number of selected cases from a clinical research study in which widespread periapical lesions revealed before the start of treatment were treated with a preparation whose active ingredient was dequalinium acetate. The results of treatment and follow-up are given. These case reports show that healing of the periapical lesions occurs relatively quickly and is generally completed within a period of 9 months.
A total of 93 cases comprising 132 teeth with signs and symptoms or radiographic evidence of periapical pathoses were treated endodontically and were followed up for a period of 2 years. Nonsurgical management was successful in 84.4% of the cases. Histopathologic examination of tissue specimens from cases in which treatment failed revealed that only 35.7% of the cases involved apical cysts, while the remaining 64.3% involved chronic inflammatory tissue. Interestingly, 50% of the failures were observed at or 1 year after completion of treatment, which stresses the need for long-term follow-up of treated endodontic cases. In this study, a successful outcome did not seem to be dependent on either the nature or the size of the lesion, even though it is true that treatment of larger lesions failed more frequently. There seems to be some individual immunologic response variation, which may influence the final outcome of the treatment. Gyromatic instruments were used in 44 of the 93 cases treated and were evaluated and compared with hand instruments in clinical situations. Gyromatic instruments were found to be more convenient and safer to use, since their use improved visibility and eliminated the risk of the instruments' falling into the throat and being aspirated. They exhibited good flexibility and could easily negotiate curved canals without breaking. Used judiciously, these would be efficient tools in the endodontist's armamentarium.
Multiple mechanisms are involved in the pathologic changes associated with formation of acute and chronic periradicular lesions. Mechanical injury to the periradicular tissues can cause activation of several pathways of inflammation and release of nonspecific mediators. Continuous irritation of periradicular tissues can cause activation of several pathways of inflammation and release of nonspecific mediators. Continuous egress of antigens from a pathologically involved root canal can also result in one or a combination of the various types of immunologic reactions. A number of these reactions participate in the destruction of periradicular tissues. Because of complex interactions between the various components of these systems, the dominance of any one pathway or substance may be difficult to establish.
We investigated the effect of methotrexate-induced neutropenia on periapical lesions in rats. Periapical lesions were prepared in all animals by pulpal exposure. The animals were injected with methotrexate three times a week 4 weeks before or after the pulpal exposure. The periapical lesion of each animal was examined histologically, histometrically, and immunohistochemically. The total leukocyte count and neutrophil count in the peripheral blood decreased after the injection. The methotrexate-induced neutropenia elicited after pulpal exposure did not change the status of the periapical lesion, whereas the neutropenia before the exposure inhibited the development of the lesion. Moreover, the neutropenia before pulpal exposure resulted in an inhibition of infiltration of neutrophils into the lesion.
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BACKGROUND: Valvular heart disease predisposing to endocarditis and requiring prosthetic valve implantation is common among the elderly. Spontaneous bacteremias associated with acute or chronic oral/odontogenic infections may represent a far greater cumulative risk for the development of endocarditis than do occasional health care procedures administered in a professional setting. METHODS: To determine the oral disease burden in patients undergoing mechanical or bioprosthetic heart valve implantation, we performed a comprehensive clinical and radiographic regional examination on 156 consecutive patients, with emphasis on identifying acute and chronic oral/odontogenic infections and conditions. RESULTS: The mean number of remaining teeth in the cohort was 19.32; of these, 1.07 were carious, involving a mean number of 2.51 tooth surfaces. In addition, 15.38% of the patients had evidence of acute or chronic periapical abscesses, and 43.6% of the patients had moderate to advanced periodontitis. CONCLUSIONS: In view of the substantial morbidity and mortality associated with prosthetic valve endocarditis and based upon the high incidence of dental disease identified in patients undergoing valvular operations, routine preoperative dental assessment should be deemed a "medical necessity" by third-party payors. Appropriate therapeutic intervention should be initiated whenever possible before valve implantation.
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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.
This study quantified the concentrations of interleukin-1 alpha (IL-1 alpha) and interleukin-1 beta (IL-1 beta) in the periapical exudates obtained from 69 single-rooted teeth using enzyme-linked immunosorbent assays, and examined their correlation with clinical findings of the involved teeth. Changes in the levels of these factors during root canal treatment were also investigated. The average levels of IL-1 beta (6.57 ng/ml) in periapical exudates were twice that of IL-1 alpha (3.25 ng/ml). The exudates containing pus showed significantly higher IL-1 alpha levels than those from the canals without pus (p < 0.01). The exudates from the canals with small radiolucent areas contained significantly higher IL-1 alpha levels than those from the canals with large radiolucent areas (p < 0.05). The tendency for there to be an increase in the levels of IL-1 alpha and a decrease in the levels of IL-1 beta was observed following root canal treatment. These observations suggest that IL-1 alpha and IL-1 beta are involved in the immunopathogenesis of periapical lesions and that IL-1 alpha and IL-1 beta may play different roles in the healing process of periapical lesions during root canal treatment.
This article presents an alternative one-visit treatment to conventional apexification. Time, patient compliance, and multiple office visits are required to complete an apexification successfully. In the technique described, the root canal system is instrumented and filled followed by immediate periradicular manipulation and apical repair with Super-EBA cement. Cases presented in this pilot study have a recall period ranging from 5 to 14 months. It is our contention that the results of this technique are highly predictable, with the added advantage that unsalvageable situations (e.g., vertical root fracture) can be assessed right away. In both instances, the patient will receive the precise prognostic assessment and treatment. Thus, patients are returned to their restorative dentists with minimal delay.
The effect of traumatic occlusion on periapical lesions in rats was investigated histologically and histometrically. Rats were divided equally into groups A to D. Rats in group A received no treatment; in group B, rats received pulpal exposure of the left mandibular first molar; in group C, a resin plate was cemented onto the occlusal surface of the corresponding maxillary molar; and in group D, the molar pulp was exposed and the resin plate was installed. At 1 and 2 wk, compression of the periodontal ligament and inflammation were less in group D than in group B. Lesions in the periapical periodontal ligament at 1, 2, and 4 wk in group D were significantly smaller than those in group B. This study suggests that traumatic occlusion delayed the enlargement of the periapical lesions in rats.
Severe pain and/or swelling following a root canal treatment appointment are serious sequelae. Information varies or is incomplete as to the incidence of these conditions and related factors. In this study, data were collected at root canal treatment appointments on demographics, pulp/periapical diagnoses, presenting symptoms, treatment procedures, and number of appointments. Patients that then experienced a flare-up (a severe problem requiring an unscheduled visit and treatment) had the correlating factors examined. Statistical determinations were by chi-square analysis with significance at 0.05 or less. Nine hundred forty-six visits resulted in an incidence of 3.17% flare-ups. Flare-ups were positively correlated with more severe presenting symptoms, pulp necrosis with painful apical pathosis, and patients on analgesics. Fewer flare-ups occurred in undergraduate patients and following obturation procedures. There was no correlation between patient demographics or systemic conditions, number of appointments, treatment procedures, or taking antibiotics.
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