[Dental pulp devitalization].
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Uninfected necrotic tissue, such as that which follows a myocardial or cerebral infarct, is capable of inducing an inflammatory reaction. Eventually, the infarct is organized by granulation tissue. Why then, does uninfected devitalized pulp tissue, such as in traumatized teeth, not cause periradicular inflammation and does not become organized by granulation tissue? Four beagle dogs were used in this experiment. A total of 48 teeth, which included 24 maxillary and 24 mandibular incisors, were aseptically devitalized, leaving residual pulp tissues in the root canals, and equally divided into two groups. Group A (24 uninfected): A sterile cotton pellet was placed deep into the canal orifice before the pulp chamber and access opening were closed with a layer of zinc-oxide eugenol cement followed by glass ionomer cement. Group B (24 infected): The teeth were left open to the oral cavity for 7 days and then closed with a cotton pellet and zinc-oxide eugenol and glass ionomer cement. The animals were sacrificed one year after the experiment and prepared for histological examination of periradicular tissue responses to uninfected and infected devitalized pulp tissues. The results indicate that uninfected devitalized pulp tissues did not continuously release inflammatory mediators and cause persistent periradicular inflammation over a period of one year. However, infected devitalized pulp tissues induced various degrees of periradicular inflammation. Only the apical few millimeters of uninfected devitalized pulp tissue in the root canals were organized by granulation tissue from vital periodontal ligament tissue.
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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.
An evaluation of Gram's method of staining of 601 nonvital dental pulps was performed. It gave positive results in 60.1% of the cases, the most frequent finding was gram-positive cocci. Preoperative x-ray status correlated significantly with the staining results but the size of the radiolucency did not. Previously treated teeth gave less positive staining results than other teeth. There was an obvious correlation between presence of bacteria and various complications (p < 0.001), but no differences were noted between the combinations of bacteria. The teeth that were the most resistant to complications seemed to be the lower canines. The staining results did not correlate with sex, systemic diseases, or preoperative symptoms. We believe that Gram's method of staining is a useful, rapid aid in root canal therapy, especially in complicated cases.
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