Hyperplastic Pulpitis Research Articles

Pediatric Patient with Chronic Hyperplastic Pulpitis: Case Report and Pathology Overview

Pulp polyp (PP) is a type of irreversible pulpitis that occurs more frequently in young teeth, also referred to as chronic hyperplastic pulpitis or proliferative pulpitis, refers to a tissue condition characterized by excessive tissue growth in the pulp chamber. This process is often activated by an open cavity (traditionally induced by caries) and a chronic stimulus. This clinical case aimed to present a surgical traditional approach to extract a tooth diagnosed with a pulp pathology which is classified as a pulp polyp (PP) in a primary first molar. This article has been elaborated following the guidelines for case reports. A 7-year-old pediatric male patient with no systemic complications and no history of dental follow-up was referred to undergo care at the supervised internship clinic at the Maurício de Nassau University Center to assess his oral health condition in the year 2024 and to evaluate multiple caries lesions and sensitivity in some teeth. The patient didn’t show any painful symptoms or signs of secondary infection and did not respond positively to pulp tests. The extraction of unit 74 was performed with minor local anesthesia and atraumatic technique. The removal was successful and the child did not have any complications, the recovery went well, respectively. Pulp polyps can be treated by removing the pulp polyp followed by pulpectomy or root canal therapy, which removes the diseased pulp and seals the canals, or, in extreme situations, by teeth extraction.

The Management of Hyperplastic Pulpitis in Immature Permanent Molar Using Vital Pulp Therapy: A Case Report with 12 Months Follow‐Up

Hyperplastic pulpitis is an irreversible type of pulpitis that primarily affects young patients. It occurs when an inflamed pulp becomes exposed due to factors such as dental caries, dental trauma, or other causes. Root canal treatment is commonly employed to manage hyperplastic pulpitis. However, vital pulp therapy can be considered as a less invasive option. The main objective of this treatment is to preserve the vitality and functionality of the remaining pulp tissue. This case report discusses the potential management of hyperplastic pulpitis in an immature molar using vital pulp therapy instead of a full root canal treatment. The report includes clinical and radiographic follow‐up at six and twelve months.

Hyperplastic Pulpitis Management with Endocrown: A Case Report

Background: Pulp polyp (PP) or pulp hyperplasia is a type of irreversible pulpitis that occurs more frequently in young teeth. It is characterized by an exophytic proliferation of granulation tissue with a pinkish-red colour and fibrous consistency, usually asymptomatic. Case Presentation: Conservative approach for a PP in a young permanent lower molar using orthograde root canal treatment and subsequent endocrown placement with a 6-month follow-up. A detailed clinical history was carried out, as well as a radiographic study of the lesion, palpation and pulp sensitivity tests. The clinical diagnosis was pulp hyperplasia or PP, confirmed by histopathological analysis. Results: Treatment of this case required four appointments: surgical excision of the PP, cleaning and shaping of the root canal system, three-dimensional filling of the canals, cementation and adjustment of the endocrown, thereby achieving remission of symptoms and restitution of chewing function. Conclusion: Conservative treatment is a reproducible procedure that has shown satisfactory results in the lower first molar with the presence of a PP.

Postoperative Pain Following Root Canal Instrumentation Using ProTaper Next or Reciproc in Asymptomatic Molars: A Randomized Controlled Single-Blind Clinical Trial.

Aim: The development of postoperative pain following root canal instrumentation may impair patient’s comfort and undermine their trust in the dentist. This study assessed the effect of root canal instrumentation techniques (rotary (PTN; ProTaper Next®) and reciprocating (R; Reciproc®)) on the postoperative pain intensity (primary outcome) and tenderness on biting (secondary outcome) of patients’ asymptomatic molars. Methodology: This study protocol was registered with ReBec-WHO (U1111-1182-2800). From a pool of 112 patients evaluated for eligibility (healthy adults (≤18 years old)), with a single asymptomatic molar (maxillary or mandibular) indicated for root canal treatment, diagnosed with asymptomatic irreversible pulpitis (including chronic hyperplastic pulpitis), 75 were randomly allocated in similar proportions to receive the intervention (two-appointment root canal therapy) in either the PTN or R group. The allocated procedures were performed using standardized protocols. Participants (blinded to the instrumentation technique) rated their pain intensity at 6, 12 and 24 h and from day 2 to day 7 following the root canal instrumentation appointment using a VAS and an NRS; the ibuprofen tablets taken and the presence of tenderness on biting were recorded. The instrumentation time was registered. Univariate and multivariate statistics measured the effect of independent variables on the outcomes. Results: From the 75 patients allocated, 8 patients (4 from each group) were lost; in total, 33 patients were analyzed in the PTN group and 34 in the R group. The frequencies of postoperative pain (p > 0.05) and tenderness on biting (p > 0.05) were similar between groups. The medication intake (mean of 1.31 tablets) and the time of instrumentation (approximately 11 min) were similar between groups. Conclusion: ProTaper Next and Reciproc® caused a slight risk of tenderness on biting and contributed to similar self-reported postoperative pain (low intensity) up to 7 days following root canal shaping.

The Management of Transalevolar Surgery Teeth with Pulpal Polyps Condition

Background: The failure of intra-alveolar tooth extraction in cases of tooth extraction with complications is generally resolved by performing transalveolar tooth extraction. The open method of tooth extraction involves surgery by cutting the tooth or bone. Flap creation and partial removal of alveolar bone, refinement of alveolar bone, curettage, and suturing are the principles of this extraction method. The planning of the stages of the transalveolar extraction method must be made as carefully as possible to avoid complications of tooth extraction. Tooth extraction treatment in dental practice can be carried out due to various causes, including caries. Pulp polyps or also known as chronic hyperplastic pulpitis is another form of irreversible pulpitis in the chronically inflamed pulp so that the pulp tissue appears to the occlusal surface. Treatment in cases of pulp polyps varies widely depending on the remaining tooth crown wall. The usual treatments for polyps pulp patients are root canal treatment (RCT), pulpotomy to extraction. The transalveolar extraction method is performed by first taking a portion of the bone supporting the tooth. Objective: Knowing the treatment management of polyp pulp extraction with transalveolar surgery methods, indications and contraindications for transalveolar surgery and knowing the correct medical selection in cases of transalveolar surgical extraction of teeth with polyp pulp. Discussion: Chronic hyperplastic pulpitis or pulp polyp is a pathological condition that attacks vital pulp tissue so that it experiences a chronic inflammation as a defense response from the body to the pulp tissue against bacterial infection. The term use of the term chronic hyperplastic pulpitis occurs due to granulation of the pulp tissue covered with epithelial tissue due to chronic infection. The management of cases of pulp polyps for which restoration is no longer possible is to remove them. Extraction is the last step that can be done if restoration measures do not eliminate the source of infection. The transalveolar extraction procedure of the teeth located in the mandible is preceded by asepsis and anesthesia and removal of the polypoid tissue. Conclusion: In several cases of brittle teeth, extraction by intraalveolar method often failed so that it needs to be extracted by transalveolar method. Management of extraction with polyp pulp includes removal of the polypoid tissue first before extraction. The administration of medical therapy with the antibiotic amoxicillin 500 mg for 5 days, paracetamol for 5 days and dexamethasone for 3 days can control the patient's pain and help the healing process quickly.

Biodentine Pulpotomy as a Treatment Modality for Tooth with Chronic Hyperplastic Pulpitis – A Case Report

Biodentine Pulpotomy as a Treatment Modality for Tooth with Chronic Hyperplastic Pulpitis – A Case Report

Fourier Transform Infrared Imaging analysis of dental pulp inflammatory diseases

Fourier Transform Infrared microspectroscopy let characterize the macromolecular composition and distribution of tissues and cells, by studying the interaction between infrared radiation and matter. Therefore, we hypothesize to exploit this analytical tool in the analysis of inflamed pulps, to detect the different biochemical features related to various degrees of inflammation. IR maps of 13 irreversible and 12 hyperplastic pulpitis, together with 10 normal pulps, were acquired, compared with histological findings and submitted to multivariate (HCA, PCA, SIMCA) and statistical (one-way ANOVA) analysis. The fit of convoluted bands let calculate meaningful band area ratios (means±s.d., P<0.05). The infrared imaging analysis pin-pointed higher amounts of water and lower quantities of type I collagen in all inflamed pulps. Specific vibrational markers were defined for irreversible pulpitis (Lipids/Total Biomass, PhII/Total Biomass, CH2 /CH3 , and Ty/AII) and hyperplastic ones (OH/Total Biomass, Collagen/Total Biomass, and CH3 Collagen/Total Biomass). The study confirmed that FTIR microspectroscopy let discriminate tissues' biological features. The infrared imaging analysis evidenced, in inflamed pulps, alterations in tissues' structure and composition. Changes in lipid metabolism, increasing amounts of tyrosine, and the occurrence of phosphorylative processes were highlighted in irreversible pulpitis, while high amounts of water and low quantities of type I collagen were detected in hyperplastic samples.

Role of CD146 Enrichment in Purification of Stem Cells Derived from Dental Pulp Polyp.

Introduction:Hyperplastic pulpitis (pulp polyp) tissues contains cells with stem cell properties similar to that of the dental pulp stem cells (DPSCs). It has also been shown that CD146 enrichment can homogenize the cultures of DPSCs and enhance the colony forming potentials of their cultures. This study determines whether CD146 enrichment can help purifying the stem cells from heterogeneous cultures of the pulp polyp derived stem cells (PPSCs). Methods and Materials:Healthy dental pulps and pulp polyp tissues were enzymatically digested and the harvested single cells were sorted according to the presence of CD146 marker. The sorted cells were seeded directly for colony forming unit (CFU) assays of the negative and positive portions. Flowcytometric antigen panel and differentiation assays were used to see if these cells conform with mesenchymal stems cells (MSCs) definition. Differences between the between groups was assessed using independent t-test. The level of significance was set at 0.05. Results:Normal pulp tissue derived cells formed higher colonies (42.5±16.8 per 104 cells) than the pulp polyp (17.75±8.9 per 104 cells) (P=0.015). The CD146 positive portion of the polyp derived cells formed an average of 91.5±29.7 per 104 cells per CFU. On the other hand, CD146 negative portion did not show any colonies (P<0.001). Both resources showed cells with flowcytometric antigen panel and differentiation potentials conforming to MSC definition. Conclusion:The entire CFU of PPSCs were formed within CD146 enriched portion. It seems that CD146 enrichment may reduce the number of possible fibroblasts of the pulp polyps and may further homogenize the culture of the PPSCs.

Contribution of the Collagen-Binding Proteins of Streptococcus mutans to Bacterial Colonization of Inflamed Dental Pulp.

Streptococcus mutans is a major pathogen of dental caries. Collagen-binding proteins (CBPs) (approximately 120 kDa), termed Cnm and Cbm, are regarded as important cell surface antigens related to the adherence of S. mutans to collagenous tissue. Furthermore, CBP-positive S. mutans strains are associated with various systemic diseases involving bacteremia, such as infective endocarditis. Endodontic infection is considered to be an important cause of bacteremia, but little is known regarding the presence of S. mutans in dental pulp tissue. In the present study, the distribution and virulence of S. mutans in dental pulp tissues were investigated by focusing on CBPs. Adhesion and invasion properties of various S. mutans strains were analyzed using human dental pulp fibroblasts (HDPFs). CBP-positive strains had a significantly higher rate of adhesion to HDPFs compared with CBP-defective isogenic mutant strains (P<0.001). In addition, CBP-positive strains induced HDPF proliferation, which is a possible mechanism related to development of hyperplastic pulpitis. The distribution of S. mutans strains isolated from infected root canal specimens was then analyzed by PCR. We found that approximately 50% of the root canal specimens were positive for S. mutans. Approximately 20% of these strains were Cnm-positive, while no Cbm-positive strains were isolated. The Cnm-positive strains isolated from the specimens showed adhesion to HDPFs. Our results suggest that CBP-positive S. mutans strains exhibit high colonization in dental pulp. This could be a possible virulence factor for various systemic diseases.

Study on the possibility of pulp regeneration of different irreversible pulpitis

Objective To investigate the possibility of pulp regeneration of different irreversible pulpitis with absorbable gelatin sponge as the scaffold,and dental seed cells,induced molecules and MTA closed.Methods 150 patients with irreducible pulpitis,who were removed the crown infection pulp and retained the root living pulp,according to the visiting sequence,were randomly divided into two groups.The experimental group was given absorbable gelatin sponge as the scaffold and MTA closed.The control group was given calcium hydroxide coverage.The symptoms situation and pulp situation were observed.Results 6 months after surgery,the success rate of acute pulpitis and chronic closed pulpitis in the experimental group was 76.5％ and 47.0％,which were significantly higher than those of the control group (14.3 ％,8.8％) (P ＜ 0.01).In the experimental group,the success rate of chronic hyperplastic pulpitis and chronic ulcerative pulpitis was 33.0％ and 35.0％,which were higher than those of the control group(9.1％,6.0％),but the differences between the two groups were not statistically significant (P ＞ 0.05).Conclusion Pulp regeneration in vivo is possible with absorbable gelatin sponge as the scaffold and MTA,pulp regeneration of acute pulpitis and chronic closed pulpitis are more likely to induce. Key words: Absorbable gelatin sponge; Mineral trioxide aggregate; Pulp regeneration

Dental pulp polyps contain stem cells comparable to the normal dental pulps

Objectives: Few studies investigated the isolation of stem cells from pathologically injured dental tissues. The aim of this study was to assess the possibility of isolation of stem cells from pulp polyps (chronic hyperplastic pulpitis), a pathological tissue produced in an inflammatory proliferative response within a tooth. Study design: Pulp polyp tissues were enzymatically digested and the harvested single cells were cultured. Cultured cells underwent differentiation to adipocytes and osteoblasts as well as flowcytometric analysis for markers such as: CD90, CD73, CD105, CD45, and CD14. In addition we tried to compare other characteristics (including colonigenic efficacy, population doubling time and the cell surface antigen panels) of these cells to that of healthy dental pulp stem cells (DPSCs). Results: Cells isolated from pulp polyps displayed spindle shape morphology and differentiated into adipocytes and osteoblasts successfully. These cells expressed CD90, CD73, and CD105 while were negative for CD45, CD14. Number of colonies among 104 tissue cells was higher in the normal pulp tissue derived cells than the pulp polyps (P=0.016); but as polyp tissues are larger and contain more cells (P=0.004), the total number of the stem cell in a sample tissue was higher in polyps but not significantly (P=0.073). Conclusions: The cells isolated from pulp polyps fulfill minimal criteria needed for MSC definition; hence, it can be concluded that pulp polyps contain stem cells. Although pulp polyps are rare tissues in daily practice but when they are present, may serve as a possible new non-invasively acquired tissue resource of stem cells for affected patients. List of abbreviations: APC = allophycocyanin, BM = Bone Marrow, CFU-F = Colony Forming Unit Fibroblast, DPSC = Dental Pulp Stem Cell, FITC = fluorescein isothiocyanate, MNC = mononuclear cells, MSC = Multipotent Mesenchymal Stromal Cell, PE = Phycoerythrin, PerCP = Peridinin chlorophyll protein, PPSC = Pulp Polyp Stem Cell. Key words:Adult stem cell, chronic hyperplastic pulpitis, dental pulp stem cell, pulp polyp.

Delayed Partial Pulpotomy in a Midroot and Complicated Crown-root–fractured Permanent Incisor with Hyperplastic Pulpitis: A Case Report

Introduction The occurrence of multiple injuries of the same tooth is extremely rare. This case report describes the treatment in a midroot and complicated crown-root–fractured permanent incisor that remained untreated for 4 years after the accident. Methods The tooth was treated by delayed partial pulpotomy using calcium hydroxide. Results At the 3-year follow-up after treatment, the tooth was still vital and functional without any clinical and radiographic signs and symptoms. Conclusions A young permanent tooth with hyperplastic pulpitis caused by trauma has a great inherent defensive capacity to heal after delayed partial pulpotomy despite adverse conditions.

Partial Pulpotomy in a Permanent Molar with Hyperplastic Pulpitis: A Case Report

Partial pulpotomy is a pulp therapy in which a portion of damaged and inflamed coronal pulp tissue is removed surgically. A 22year-old female suffering from profound caries defect in her mandibular second molar was referred to our clinic. Tooth responded within normal limits to electrical pulp tests. No history of spontaneous pain, mobility or tenderness to percussion was noted. Radiographic examination revealed an enlargement towards the periodontal ligament of the tooth. It was diagnosed as hyperplastic pulpitis. A local anesthetic without vasoconstrictor was applied to the tooth. MTA was placed over the amputated pulp tissue and covered temporarily with zinc oxide–eugenol cement. The patient was re-called after 24 hours to asses if there was any sense of postoperative pain caused by the treated tooth. No postoperative sensitivity was noted. The temporary restoration was removed under aseptic conditions; MTA was then covered with glass ionomer cement. In the same appointment, the tooth was restored with resin composite. Examinations 1 year after the treatment revealed success with the observance of normal function, aesthetics with a vital pulp and healthy surrounding periodontal structures. MTA may be useful as a substitute for calcium hydroxide in pulpotomy procedures of permanent molars with hyperplastic pulpitis.

Histological evaluation of teeth with hyperplastic pulpitis caused by trauma or caries: case reports.

The purpose of this histological study was to examine teeth with hyperplastic pulpitis caused by trauma or caries. The pulp tissue of one young permanent incisor with a complicated crown-root fracture and a hyperplastic pulpitis, which had been contaminated with oral microflora for 40 days, and pulp polyps from four permanent first molars whose crowns were destroyed by extensive caries were prepared for standard histological examination. Histologically, normal pulp tissue organization was observed in the tooth with a complicated crown-root fracture in the cervical radicular region. Irregular calcification was seen in the coronal and radicular portion of the pulp in the four carious teeth with pulp polyps. Radicular pulp tissue in the middle and apical third of root canals beneath irregular calcification showed intensive fibrosis but was free from inflammatory cells. Hyperplastic pulpitis is a type of irreversible chronic open pulpitis. Young permanent teeth with hyperplastic pulpitis caused by trauma or caries have a great inherent defensive capacity to heal.

Histological evaluation of a tooth with hyperplastic pulpitis and periapical osteosclerosis

Histological evaluation of a tooth with hyperplastic pulpitis and periapical osteosclerosis

PR 2 Hyperplastic chronic pulpitis: Clinical and histopathological description in human teeth

PR 2 Hyperplastic chronic pulpitis: Clinical and histopathological description in human teeth

Neural changes in ulcerative and hyperplastic pulpitis: a transmission electron microscopic study.

The purpose of this study was to examine at ultrastructural level the neural changes in human apical pulps of teeth clinically diagnosed as having ulcerative or hyperplastic pulpitis. Seventeen specimens were prepared from six teeth with ulcerative or hyperplastic pulpitis and four specimens from two sound teeth. After routine procedures the specimens were examined under an electron microscope for changes in the structure of myelinated and unmyelinated nerve fibres. Although the teeth used in this study responded positively to vitality test, the results revealed that moderate to severe degenerative changes occurred in the nerve fibres of the apical pulps of the teeth showing these two diseases.

Success of pulpotomy in the management of hyperplastic pulpitis.

Hyperplastic pulpitis is a variety of chronic open pulpitis which is regarded as irreversible. This condition is usually treated by root canal treatment, unless coronal damage does not permit restoration, in which case extraction is indicated. In the present study, 24 permanent teeth of individuals, aged 10-22 years and diagnosed as hyperplastic pulpitis were treated by pulpotomy using an atraumatic surgical technique with calcium hydroxide alone. The treatment was successful in 22 teeth, according to the following criteria: absence of clinical symptoms, absence of any intraradicular or periradicular radiographic pathological changes, presence of dentine bridge detected by clinical examination and sometimes observed radiographically, and sensitivity to electrical stimulation. The follow-up examination ranged from 12 to 48 months. The high frequency of clinical healing in this study appears to justify recommending pulpotomy as the treatment regime in selected cases of chronic hyperplastic pulpitis.

2. Pathogenesis of pulpitis resulting from dental caries

Summary Demonstrable evidence suggests that the pattern of inflammation in the tooth affected by carious attack is determined by the permeability of dentin and the proximity of the carious lesion to the pulp. Accumulation of immunologically competent chronic inflammatory cells either accompanies or follows retrogressive changes in the odontoblast layer beneath the lesion. Deposition of collagen and proliferation of small vessels are also features of early inflam matory changes in the pulp. A transition from a chronic to an acute inflammatory reaction occurs as the lesion approximates the pulp or invades reparative dentin. Progressive accumulation of large numbers of neutrophils, presumably drawn by chemotactic influences, results in suppuration that may be diffuse or may become localized to form an abscess. Surface ulceration may develop as a result of chronic suppuration, which remains confined to the areas of the pulp beneath the carious lesion, and results in the creation of a space. In slow progressing lesions, continued formation of reparative dentin may be capable of preventing pulp exposure. Degeneration of the pulp occurs when the number of bacteria entering the pulp exceeds the ability of the blood vessels of the pulp to furnish a sufficient number of blood leukocytes to repel the bacteria. Hyperplastic pulpitis represents a proliferation of chronic inflammatory tissue in response to carious exposure to the young pulp.