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Acute pulpal-alveolar cellulitis syndrome V. Apical closure of immature teeth by infection control: case report and a possible microbial-immunologic etiology. Part 1.

Das with Matusow and Goodall previously noted the rapid clinical apexogenesis of nonvital immature permanent teeth that are involved with an acute endodontic cellulitis. This apexogenesis was achieved by control of infection and by nonspecific intracanal medication without the use of calcium hydroxide. The case report confirms the clinical observations. The experimental canine endodontic cellulitis in a Cebus primate was induced as an immunologic pulp infection with a facultative Streptococcus species. The noted epithelial proliferation and organization into lacelike strands and bilaminar loops, similar to Hertwig's epithelial root sheath in root development, appear to be immunologic and genetic in origin, with an acceleration of the root maturation process.

Animals

Long-term effects of segmental alveolar osteotomy.

The long-term effects of segmental alveolar osteotomy are reviewed. Thirteen patients attended a follow-up appointment between 5 and 9 years after operation and investigations related to the teeth, their supporting structures and the osteotomy bone cuts. The teeth involved in the osteotomies which gave a vital response after 1 year with ethyl chloride all maintained this response in the long term and about half the number of the teeth not responding at 3 years had recovered this response after 5 years or more. The incidence of periodontal pocketing, non-vital teeth and tooth mobility was low. There was radiographic evidence of the osteotomy bone cuts in more than half of the cases in the long term, although clinically, union had occurred in all cases. The occlusion was stable in all except one class II div. 2 case, which had been treated by lower segmental osteotomy only, where relapse had occurred.

Adolescent

Pulp changes after anterior mandibular subapical osteotomy in a primate model.

Subapical osteotomy of the anterior mandible was carried out on 10 adult Macaca Irus monkeys with and without open bite. Teeth were extracted at 8 weeks, 12 weeks, 24 weeks and 1 year after surgery and the pulps examined histologically. No normal pulps were found. Progressive fibrosis and calcification was noted in all teeth. Patent pulp blood vessels were found up to 24 weeks after surgery. Pulp damage to teeth distal to the osteotomy site was found in 50% of cases. Control teeth extracted from the opposing jaw at the same intervals were all found to have normal pulps.

Animals

The microbial flora from root canals and periodontal pockets of non-vital teeth associated with advanced periodontitis.

Microflora from root canals and periodontal pockets of periodontally affected teeth were compared in order to elucidate the as yet unknown relationship between pulpal and periodontal disease. Caries-free teeth affected with advanced periodontitis and diagnosed as clinically dead by electric pulp testing were selected. The root canals and periodontal pockets were sampled, and the bacterial flora examined by both culture and interference microscopy. The results indicated that the aerobe/anaerobe ratio in the periodontal pocket was 0.23, while it was 0.0022 in the root canal, the large predominance of obligate anaerobes reflecting the anaerobic environment found in the root canal. Morphological classification obtained from interference microscopy showed similar proportions of morphotypes in the two sites. Results of anaerobic culture demonstrated a significantly higher rate of detection of facultative Streptococcus bacteria in the periodontal pocket than in the root canal. The predominant bacterial species common to both regions were Streptococcus, Peptostreptococcus, Eubacterium, Bacteroides, and Fusobacterium for obligate anaerobes. As for facultative anaerobes, Actinomyces and Streptococcus were detected predominantly in the periodontal pocket. The occurrence of micro-organisms common to both sites in this study suggests that the periodontal pocket may be a possible source of root canal infections.

Actinomyces

Non-Hodgkin's lymphoma disguised as odontogenic pain.

A patient was treated for infraorbital swelling, nonvital teeth and a periapical lesion. Suspected malignancy, confirmed with an early biopsy, resulted in diagnosis of non-Hodgkin's lymphoma.

Dental Pulp Devitalization