Pulpal Pathosis Research Articles

Obturarea canalelor laterale la premolarul secund maxilar – prezentare a două cazuri clinice

The lateral canals are communication pathways between the main endodontic canal and the periodontal space. In case of pulpal pathosis, it is very important to seal the main canal together with lateral and accessory canals, because that means a premise for the rapid healing of apical pe­rio­dontitis. Endodontic obturation method of warm ver­ti­cal condensation most commonly seals the lateral and ac­ces­sory canals as well. The radiographic examination can show the presence and the correct filling of these little ra­mi­fi­ca­tions.

Challenges Assessment in Endodontics Among Undergraduate Students.

Objective To explore perceptions of undergraduate dental students regarding difficulties faced during endodontic procedures. Methods An e-questionnaire was sent to 57 fourth-year and 45 fifth-year dental students. It comprised questions regarding demographic data and difficulties faced during different steps of the endodontic treatment. The responses were recorded on a 5-point Likert scale. During dichotomization, responses where one and two were chosen were considered yes whereas responses where three, four, and five were chosen were considered no. The sample size (SS) calculated using the Qualtrics SS calculator was 89. Data were analyzed using SPSS version 20. Frequencies and percentages were calculated. A p-value of less than 0.05 was considered significant. The chi-square test was applied for comparison based on the students' academic year and genders. Results Ninety students responded with an 88.2% response rate. Most students reported not facing any difficulty in differentiating healthy pulp and periapex from conditions of pulp pathosis (78.9%) and periapical pathosis (75.6%). Most males found access opening and de-roofing of the pulp chamber (35.6%) and working length determination (31.1%) difficult. Females reported having difficulty mostly in mesial and distal shift radiograph techniques (55.6%) and access openings (51.1%). No statistical difference was found based on an academic year or gender except in the use of mesial and distal shift techniques for radiograph acquisition Conclusion Assessing difficulties encountered by students during endodontic therapy can aid in the development of teaching strategies for preclinical and clinical instruction. Mesial and distal shift techniques, access cavity preparation, and working length determination are areas requiring more focus in the training process.

Differential Responses of Human Dental Pulp Stromal Cells to Bioceramic Materials: A Comparative In Vitro Study

The aim of this study was to compare the effects of white MTA-Angelus (wMTA), Biodentine® (Biodentine) and TotalFill® BC Root Repair MaterialTM putty (TotalFill) on human dental pulp stromal cells (hDPSCs) in vitro. hDPSCs were isolated from third molars of healthy young adults. Material elutes at different concentrations were prepared. Cells were exposed to the eluates for 1, 3, and 7 days. Cell proliferation was evaluated using 3-(4,5-dimethyl-thiazoyl)-2, 5-diphenyl-tetrazolium bromide assay. The expression of alkaline phosphatase (ALP), osteoprotegerin (OPG), osteocalcin (OC), collagen1A (Col1A), runt-related transcription factor 2 (RUNX2), vascular endothelial growth factor-A (VEGF-A), fibroblast growth factor-1 (FGF-1), interleukin 6 (IL6), tumor necrosis factor alpha (TNFα), and interleukin-1-beta (IL1β) was determined by reverse transcription-polymerase chain reaction (RT-PCR). VEGF-A protein levels and ALP activity were quantified in the culture supernatant. Data were analyzed by two-way analysis of variance (ANOVA). p values <0.05 were considered statistically significant. hDPSC proliferation was decreased in a dose-related manner for all materials on day 3. The same effect was observed with wMTA and TotalFill on day 7. RT-PCR showed that Biodentine increased the expression of the osteogenic markers ALP, OPG, and OC. TotalFill decreased the ALP expression and activity, enhanced the production of angiogenic VEGF-A, and downregulated the inflammatory IL6 on day 7. Although the tested materials are used interchangeably in vital pulp therapy, the findings showed varied hDPSC responses. Biodentine did not affect cell proliferation and increased the expression of osteo-/odontogenic markers compared to wMTA and TotalFill, whereas TotalFill decreased cell proliferation and exhibited enhanced angiogenic and anti-inflammatory effects over time. The clinical significance of the results needs further investigation in an attempt to provide recommendations on the selection of bioceramic pulp capping material under different scenarios of pulpal pathosis.

Management of an endo-perio lesion: A multidisciplinary approach

The presence of pulpal pathosis and inflammatory periodontal disease concomitantly can complicate diagnosis and treatment planning of any tooth. It requires a combined treatment approach involving endodontic, periodontic and prosthodontic intervention. Often, the periodontal and prosthodontic aspects are neglected by the clinicians after successful endodontic treatment resulting in failure. The present case report describes a multidisciplinary approach for the treatment of a tooth that presented with an endo-perio lesion; using non-surgical root canal treatment and periodontal regenerative surgery (non-incised papillae surgical approach, {NIPSA} long with GTR membrane and an alloplastic bone graft) which were then followed by the placement of a conservative tooth coverage restoration (endocrown). A significant gain in clinical attachment level was seen 6 months postoperatively. Radiographically also a significant amount of bone fill was observed.

Methods of obturation

After irreversible pulpal pathosis, obturation of a root canal should result in a full closure from the coronal to the apical aspect, limiting the entrance of microorganisms and fluid and therefore eliminating the root system as a source of infection and inflammation to the apical periodontium. According to current studies, the goal of obturation is to achieve not only a fluid-tight but also an airtight closure of the root canal. For obturation, semi-solid filler materials like gutta-percha have been employed in combination with sealants for many years. Poor obturation, according to Dow and Ingle, is the root cause of endodontic treatment failure. Ingle and Beveridge (1961) found that incomplete root canal obliteration accounts for roughly 58.65 percent of root canal failures in a research done at the University of Washington on the success and failures in endodontics. As a result, several obturation procedures have been developed over time. Every approach has its own set of benefits and drawbacks. As a result, the obturation procedure differs from instance to case.

The Location and Incidence of Patent Accessory Pulpal Canals in Permanent Molars with Periodontal Lesion by Using Micro-Computed Tomography

Objective: In this study, the event of patent accessory pulpal canals situated in periodontal pockets has been resolved to utilize the micro-CT method. Methods: Fifty-seven extracted permanent human teeth were utilized to examine the commonness, location, and diameter of the patent accessory canals that are opening outside toward the periodontal pocket by utilizing micro-CT and high-resolution desktop. Results: Through 57 molars 6 (10.25%) were accessible with patent accessory, canals inside furcation area, of root, 49 (85%) were accessible with patent accessory canals inside the mesial and distal buccal root, and 28 (49.1%) were accessible with patent accessory, canals inside the palatal/lingual root. A measurably critical variety was found alongside the nearness of patent accessory trench in various roots and pocket depth at a similar region of the nearness waterway just as the nearness of these canals and connection misfortune in this region. Conclusions: Progression of periodontal pocket might be responsible for opening accessory canal and cause pulp pathosis, making successful periodontal therapy difficult.

Pulpal Disease Arising from Medication-related Osteonecrosis of the Jaw: A Case Report

Although bisphosphonates are widely used to treat conditions such as osteoporosis, they may cause osteonecrosis of the jaw. We treated a patient with no history of tooth extraction or other surgical treatment who developed medication-related osteonecrosis of the jaw (MRONJ) with secondary pulpal disease. A 79-year-old woman presented with purulent discharge from the gum at the incisor region. She had been using bisphosphonates for 9 years. Tooth #6 had undertaken root canal treatment at a general practice. All teeth other than tooth #6 reacted to electric pulp testing. Computed tomographic imaging revealed signs suggestive of necrotic bone, and MRONJ was diagnosed. Teeth #7 and #8, which had initially exhibited vital reactions, also subsequently ceased to react to thermal and electric pulp testing. Root canal treatment was performed on teeth #6–8, and their condition was monitored. Computed tomographic imaging at 9 months after the first presentation revealed that the bone defect had greatly enlarged with separation of the necrotic bone; therefore, excision of the necrotic bone and curettage were performed in the department of oral and maxillofacial surgery. The loss of pulp reaction in teeth that had exhibited a vital reaction at the first presentation was considered to indicate that teeth #6–8 had developed dental pulp pathosis as a result of MRONJ.

Genetic and Epigenetic Characterization of Pulpal and Periapical Inflammation.

Pulpal and periapical diseases affect a large segment of the population. The role of microbial infections and host effector molecules in these diseases is well established. However, the interaction between host genes and environmental factors in disease susceptibility and progression is less well understood. Studies of genetic polymorphisms in disease relevant genes have suggested that individual predisposition may contribute to susceptibility to pulpal and periapical diseases. Other studies have explored the contribution of epigenetic mechanisms to these diseases. Ongoing research expands the spectrum of non-coding RNAs in pulpal disease to include viral microRNAs as well. This review summarizes recent advances in the genetic and epigenetic characterization of pulpal and periapical disease, with special emphasis on recent data that address the pathogenesis of irreversible pulpal pathosis and apical periodontitis. Specifically, proinflammatory and anti-inflammatory gene expression and gene polymorphism, as well as recent data on DNA methylation and microRNAs are reviewed. Improved understanding of these mechanisms may aid in disease prevention as well as in improved treatment outcomes.

Success of Coronal Pulpotomy in Permanent Teeth with Irreversible Pulpitis: An Evidence-based Review.

Vital pulp therapies have been used in primary teeth and immature permanent teeth. However, with the advent of new bioactive material, the paradigm is shifting toward permanent teeth with mature apices of roots. There are many prospective and retrospective studies, randomized controlled trials, and systematic reviews that report coronal pulpotomy with bioactive material in permanent teeth with pulpal pathosis proved to be as successful as root canal therapy (RCT). Coronal pulpotomy is cost-effective, not very technical demanding like root canal therapy and less time consuming for both the dentists and patients. This treatment can be offered to the patient as an alternative to endodontic therapy.The objective of this study is to review the literature related to the clinical outcome of coronal pulpotomy in permanent teeth with mature apex and having pulpal pathosis. This evidence-based review will facilitate clinical decision making in situations to choose coronal pulpotomy over root canal therapy in mature permanent teeth with irreversible pulpitis.

Evaginacija i invaginacija zuba - prikaz dva slučaja

Introduction: Developmental disturbances of teeth at the stage of morpho-differentiation have been related to abnormalities associated with changes in the tooth shape and size. Dens evaginatus and dens invaginatus are the developmental variations of the human dentition. Dens evaginatus, a rare anomaly characterized by the presence of a tubercle on the occlusal surface of teeth is seen to occur due to abnormal proliferation and folding of the inner enamel epithelium and part of the dental papilla into the stellate reticulum of the enamel organ; whereas, dens invaginatus is seen to occur due to infolding of the enamel and dentine into the pulp cavity and sometimes extending to the root apex. Case report: We report cases with bilateral dens evaginatus in mandibular second premolars and dens invaginatus in maxillary lateral incisor. Conclusion: Such developmental anomalies of teeth deserve clinical importance, as high chances of early pulpal pathosis.

Inflammatory response of the human tooth pulp tissue to dental caries

Introduction: Dental caries is a chronic infectious disease resultingfrom the penetration of oral bacteria into tooth hard tissues.Microorganisms subsequently trigger inflammatory responsesin the dental pulp and the stem cells provide a source of cells toreplace the damaged cells and facilitate repair. These events canlead to pulp healing if the infection is not too severe and treatedin a short time. Remaining pulpal pathosis in severe form withouttreatment induces permanent loss of normal tissue due to limitedrepair capacities in response to large damage. The importanceof the depth of inflammation has been underestimated in pulpalhealing. The purpose of this study is to investigate the pulp tissueresponse to dental caries and to find out the association of differentdistributions of the inflammatory characteristics among a differentdepth of dental caries. Materials and Methods: Pulp tissue sampleswere collected from 118 extracted teeth from the Privet dental clinicsand dental health centers in Duhok government, from April/ 2016 toAugust/ 2017 (16 months period). Each section prepared and stainedwith hematoxylin and Eosin (H&amp;E). Inflammatory infiltration, fibrosis, calcification, and necrosis were the main features that have beenexamined histopathologically and assessed with the presence of dentalcaries at a different depth. Results and Discussion: Inflammatoryfeatures were identified in 88 of the samples examined. Inflammatory infiltration and fibrosis were the most frequent features amongthe deep caries teeth compared to the shallow caries teeth. Single andgroup of calcification were observed in 57 samples, most of them (48samples) were in deep caries sections. Conclusion: the histopathological observations of pulp tissue in response to caries process provideuseful information for the clinical aspect and how to decide and selectthe best strategy in the treatment of dental caries at a different depthto preserve the pulp tissue vitality for a longer time, and strength ofthe tooth hard tissue will maintain.

Pulp pathosis associated with ancient Maya dental inlays

ObjectiveThe ancient Maya used to practice dental inlays as part of the cultural traditions. Most of those inlays remain in place after more than one thousand years. The purpose of this paper is to investigate the incidence of pulp pathosis associated with ancient Maya dental inlays to assess the impact that such common practice had on the population’s oral health. DesignWe scored 193 anterior inlaid teeth from 107 pre-Hispanic Maya dentitions studied at three archaeological storage facilities (Universidad Autonoma de Yucatan, Harvard University, Atlas of Guatemala Project). Two hundred eleven untreated frontal teeth of pre-Hispanic Mayan collections were used as controls. We performed macroscopic, radiographic and microscopic analyses to assess the frequency of caries, pulp calcifications, internal root resorption (IRR), and periapical lesions (PALs). ResultsIn the inlaid teeth, the frequencies of pulp calcifications, IRR, caries and PALs were 59.8%, 2.2%, 18.5% and 19.2%, respectively. Compared with untreated teeth, inlaid specimens exhibited greater susceptibility to caries, pulp calcifications, IRR and PALs than untreated teeth (pulp calcifications: 44.5%, IRR: 0%, caries: 1.4%, and PAL: 1.9%). Age-at-death did not have any significant influence on susceptibility to pulp calcifications, IRR, caries or PALs. ConclusionsWe noted relatively low pulp irritation and a low frequency of carious infections, IRR and PALs in Mayan inlaid teeth. However, these levels exceeded the frequencies of untreated teeth from the same area and time period. We follow that the cements used by the pre-Hispanic Maya to fix the inlays into their sockets provided excellent sealing characteristics on average.

Effective anaesthesia of the acutely inflamed pulp: part 1. The acutely inflamed pulp.

Achieving profound pulpal anaesthesia in a mandibular molar diagnosed with irreversible pulpitis can be argued to be the most testing of dental anaesthetic challenges. This can be attributed to the technical complexities of conventional techniques and the presence of pulp pathosis. Reasons for why the latter influences the ability to attain pulpal anaesthesia is not yet fully understood, but its frequent occurrence is well documented. In light of overcoming this it has become common practice to prescribe antibiotics, refer onto secondary care or to even commence treatment without appropriately anaesthetising the tooth. Therefore, this two part series aims to help practitioners attain clinically acceptable pulpal anaesthesia in the most testing of scenarios; the acutely inflamed mandibular molar. They should then be able to apply these same principles to other teeth presenting with similar symptoms. This section outlines the clinical presentation and pathophysiology associated with an acutely inflamed pulp, defines what it is to attain pulpal anaesthesia and critically analyses theories as to why these teeth are up to eight times more difficult to anaesthetise than their healthy counterparts.

Immunocompetent cell level as a diagnostic reference for pulpal pathosis of primary teeth

ObjectiveThe present study was designed to measure changes in the level of immunocompetent cells as healthy pulp becomes inflamed in order to evaluate the use of CD4+/CD8+ and B/CD3+ lymphocyte ratios as a diagnostic reference for pulpal pathosis in primary teeth pulp. DesignBased on clinical and radiographic examinations, 113 carious and non-carious primary teeth were grouped as healthy teeth, teeth with reversible pulpitis and teeth with irreversible pulpitis. Following dental extraction, pulp samples were collected from all teeth, and 81 of the samples were found to be suitable for flow-cytometric analysis of lymphocyte subset. Kolmogorov–Smirnov's test, One-way ANOVA and Tukey's Post Hoc tests were used for statistical analysis. ResultsStatistical analysis revealed no increases in the mean percentages of T, B and CD4+ lymphocytes in inflamed pulp when compared to healthy pulp. However, both CD8+ and NK cell numbers decreased in line with progressive inflammation. Whereas the CD4+/CD8+ ratios increased in accordance with the severity of pulpitis, B/T ratios remained unaffected. ConclusionsImmunocompetent cell levels did not change in line with progressive inflammation; therefore, the use of CD4+/CD8+ and B/CD3+ lymphocyte ratios cannot be used as a diagnostic reference for pulpal pathosis in primary teeth.

Pulp pathosis and its diagnosis

Pulp pathosis and its diagnosis

Syndesmocorono-radicular tooth: An endo-perio challenge

Syndesmocorono-radicular tooth consist of palatoradicular groove that represents anomalous morphology and is the predisposing factor for developing localized chronic periodontitis and pulpal necrosis. This clinical report discusses diagnosis and endodontic-periodontal treatment of maxillary central incisor with palatoradicular groove that begins in the central fossa, crosses cingulum and extends a variable distance onto the root. Both endodontic and periodontal surgical therapy is required for treatment of pulpal pathosis, correction of osseous defect, pocket elimination and groove correction depending on the extent and depth of the radicular groove.Clinical Relevance to Interdisciplinary DentistryEndodontic failure may occur due to communication of palatal groove with pulp cavity. Such anomaly often predisposes to periodontal defects, severe bone destruction or combined endodontic-periodontal lesions. Interdisciplinary treatment modalities used in the present case reports emphasizes on the team approach management consisting of both endodontist and periodontist.

Pulp pathosis in inlayed teeth of the ancient Mayas: a microcomputed tomography study

To evaluate three-dimensionally, using microcomputed tomography (μCT), the anatomical relationship between the cavity prepared to hold the inlay stone and the pulp chamber in the teeth of the ancient Maya. Six well-preserved teeth from Maya corpses found in an archaeological site in Guatemala (approximately 1600 year old) were selected and scanned using a high-resolution μCT system (SkyScan 1174v2; SkyScan N.V., Kontich, Belgium). The sample comprised six maxillary teeth: two canines, one premolar, two central incisors and one lateral incisor. All teeth had one or two inlay stones on the buccal surface of the crown. Each specimen was scanned at an isotropic resolution of 22.5 μm, a rotational step of 0.70°, a rotational angle of 180° and a 3.1-s exposure time, using a 1-mm-thick aluminium filter. Images of each specimen were reconstructed from apex to the crown with dedicated software (NRecon v1.6.1.5) in approximately 450 slices. CTan v1.11 and CTVol v2.1 were used for three-dimensional visualization and qualitative analysis of the external and internal anatomy of the teeth. The tooth modification in all samples was classified as type E1 (one stone on the buccal surface of the crown) or E2 (two stones on the buccal surface of the crown). In the canine teeth, the cavities created to insert the inlay stone did not reach the pulp chamber. Conversely, in the maxillary incisors, the cavities clearly perforated the pulp chamber resulting in massive internal inflammatory resorption or partial calcification of the pulp cavity. In the premolar tooth, a small perforation of the pulp chamber under the buccal cusp, without morphological alteration of the intraradicular dentine, was observed. Microcomputed tomography analysis of teeth of the ancient Maya civilization showed that the inlay cavities cut reached the pulp chamber in the maxillary incisors and premolar teeth, with the potential to cause pulp and periapical disease.

ZOE Paste Pulpectomies Outcome in Primary Teeth: A Systematic Review

To perform a systematic review in which the clinical research question for primary teeth with irreversible pulpal pathosis was "how pulpectomies with zinc oxide eugenol (ZOE) paste performed compared to other materials in their clinical and radiographic outcomes after twelve months or more follow-up period. A literature survey of the electronic database (1950-2010) used the Medical Subject Headings and free text terms. Forty three references were retrieved and inclusion criteria were applied; 15 articles remained for full-text evaluation. From these, two were selected for data extraction regarding quality characteristics and results. Selected studies showed moderate or high risk of bias. The overall success of pulpectomy was 80.0% (Calcicur), 60.0% (Sealapex) and varied from 85.0% to 100.0% (ZOE) and 89.0% to 100.0% (Vitapex). Solely Calcicur presented success rate significantly lower when compared to ZOE and Vitapex. These pastes lead to overfilled canals and particles of extruded ZOE were still evident even after the evaluation period. Resorption of Vitapex, Calcicur and Sealapex within the root canal was also reported. In primary teeth with irreversible pulpal changes ZOE pulpectomies yielded similar outcome than Vitapex and Sealapex, although there was no agreement with regard to filling materials' resorption.

A First Study on the Usefulness of Matrix Metalloproteinase 9 from Dentinal Fluid to Indicate Pulp Inflammation

Introduction Pulpal diagnostics might be improved by using molecular markers found in dentinal fluid. In the current pilot study, we tested whether matrix metallopeptidase 9 (MMP-9) levels in dentinal fluid were detectable and differed between pulps from symptomatic teeth diagnosed with irreversible pulpitis and healthy counterparts. Methods Thirty-one patients participated; 19 were diagnosed with irreversible pulpitis, and 12 were in need of replacement of a filling close to the pulp space in a clinically healthy tooth. Dentinal fluid was collected during a period of 2 minutes from dentin cavities by using folded polyvinylidene difluoride (PVDF) membranes, which were then transferred to microcentrifugation tubes containing physiologic saline solution. Total MMP-9 levels in these solutions were assessed by using a human MMP-9 fluorescent assay, detection limit 0.25 ng/mL. MMP-9 levels between groups were compared by using Mann-Whitney U test (alpha <0.05). Results Three specimens from the symptomatic teeth were not included because coronal pulps proved to be necrotic on access. Dentinal fluid samples from symptomatic teeth had significantly higher MMP-9 levels than those from clinically healthy counterparts ( P < .05). However, merely 7 of the 16 pulpitis samples contained detectable levels of MMP-9. None of the clinically healthy control specimens contained any detectable amounts of MMP-9. Conclusions With a sensitive assay, it was possible to detect an enzyme linked with pulp tissue destruction (MMP-9) in dentinal fluid. However, the collection method needs to be improved to provide predictable fluid yields. Longitudinal studies should be performed to assess the predictive value of molecular markers in dentinal fluid on pulpal pathosis.

Turner′s hypoplasia and non-vitality: A case report of sequelae in permanent tooth

Hypoplasia is the result of disruption in the process of enamel matrix formation, which in turn causes defect in quality and thickness of enamel. Four cases of Turner's hypoplastic teeth with a previous history of trauma/infection in their primary predecessors at the age of 2-3 years have been reported. These hypoplastic teeth had turned non-vital without any carious insult, cavitation or further trauma. This article thereby stresses the importance of early detection of enamel hypoplasia and proper management at the earliest possible stage to enable an efficient prevention from clinically non-evident microbial invasion in the dentinal tubules and concomitant pulp pathosis.