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

Clinical, radiographic and histological findings of seven teeth from two California sea lions (Zalophus californianus) housed under professional care

Seven teeth extracted from two adult California sea lions (Zalophus californianus) due to pulp exposure and/or to gain access to the mandibular canine teeth were histologically evaluated, and the findings were compared with clinical and radiographic findings. Three teeth were diagnosed with pulp exposure, and two of these showed no radiographic signs of endodontic disease and were histologically vital with prominent coronal pulpitis and a pulp polyp. Another tooth with pulp exposure was showing clinical and radiographic signs of endodontic disease and was histologically confirmed with pulp necrosis. A discoloured incisor tooth was showing radiographic signs of endodontic disease and was also histologically non-vital. Two clinically and radiographically healthy mandibular first premolar teeth and one second incisor tooth had no evidence of pulpitis or pulp necrosis but had pulp canal obliteration. Regular clinical and radiographic follow-up for 5 months to 3 years after the procedures confirmed uneventful healing of the extraction sites, despite initial flap's dehiscence. Although extractions of affected teeth in California sea lions are considered the most practical and beneficial therapy, these are associated with the risks of extensive trauma and anaesthesia and the need to perform these surgical procedures on-site under variable conditions. As California sea lions can be trained to allow conscious dental radiographic re-checks, monitoring teeth with clinical signs of pulp polyp formation and without radiographic signs of endodontic disease warrant further evaluation/reconsideration from previous recommendations. Endodontic treatment of abscessed teeth in California sea lions is reportedly unsuccessful and is discouraged. However, vital pulpectomy could be an alternative treatment to extraction in teeth with pulp polyps as it was found to be highly successful in humans, but the possibility of endodontic failure and need for further treatments should be weighted in the treatment choice.

Radiological and Histopathological Features of Internal Tooth Resorption

BACKGROUND

Internal root resorption is an endodontic disease characterized by progressive resorption of dentin from the inside of the pulp chamber. It is a comparatively rare finding in the permanent dentition, and the underlying pathology is not fully understood.

CASE REPORT

A 45-year-old patient was referred to our Department for the evaluation of the lower right canine and the upper left wisdom tooth. Pulp sensitivity tests, cone-beam tomography, and magnetic resonance imaging were used to determine the extent of lesions of the affected teeth. The teeth were subsequently extracted due the extent of the lesions. The same was the case for the upper right canine, which developed a severe internal resorption 10 months later. Micro-computed tomography of the extracted teeth revealed that all lesions had a well-defined border with no evidence of sclerosis or hypomineralization. Pulp stones were evident inside the pulp chamber. Ground sectioning of the upper right canine revealed pulp necrosis and an acute infection that had gradually moved in the apical direction. Large multi-nucleated resorbing cells were found on the dentin surface. Importantly, the apical half of the pulp exhibited comparatively normal tissue without substantial inflammatory changes. Decalcified histology of the upper left wisdom tooth demonstrated a completely different histopathological appearance characterized by chronically inflamed granulation tissue with pseudoepitheliomatous hyperplasia and massive bacterial colonization.

CONCLUSION

Our analyses demonstrate that internal root resorption is a multifaceted dental disease with considerable variability in the rate of the underlying inflammatory changes. Oral surgeons should take this into consideration when evaluating the need for extraction of teeth with internal root resorption.

Replantation of two avulsed teeth after 1 h of storage in adverse extraoral dry conditions: A thought-provoking outcome after a 15-month follow-up

This article reports a clinical case of an 8-year-old boy who sustained avulsion of the maxillary right central incisor and the maxillary left lateral incisor. The avulsed teeth were kept in adverse extraoral dry conditions for 1 h from the moment of trauma until their replantation. The prognosis of tooth replantation is dependent on multiple factors such as methods of teeth storage in vitro, endodontic intervention, extra-oral time, and type of retention employed. The main reasons for root resorption in this case may be the extra-oral time, the initial replantation, or the delayed endodontic treatment.

Impact of root canal preparation performed by ProTaper Next or Reciproc on the quality of life of patients: a randomized clinical trial

AIM

To compare the impact of the two different root canal preparation systems on the quality of life of patients and correlate postoperative pain with the impact on quality of life.

METHODOLOGY

A randomized clinical trial was conducted with 58 patients allocated into two groups based on the root canal preparation system employed: ProTaper Next (PN) or Reciproc (R). Data collection involved the administration of a questionnaire addressing demographic and clinical characteristics, the OHIP-14 (quality of life) and a visual analog scale (pain). The latter two were the outcomes of interest and were administered in the first 24 h after root canal treatment. The data were submitted to descriptive analysis, bivariate analysis, Poisson univariate and multiple regression, and Spearman's correlation test, with a 5% significance level.

RESULTS

A greater frequency of impact after treatment was found for the items 'uncomfortable to eat food' and 'felt self-conscious'. No significant difference between groups was found regarding the severity of impact for total OHIP-14 score or any of the domain scores.

CONCLUSIONS

The two root canal preparation systems exerted a similar impact on quality of life. Postoperative pain was correlated with impact on quality of life, affecting chewing function, self-consciousness and stress. Thus, it is important for dentists to provide care capable of preventing or treating the negative consequences of such therapy.

Microbiological Aspects and Inflammatory Response of Pulp Tissue in Traumatic Dental Lesions

Traumatic dental lesions are more frequently found in the pediatric population, with a major involvement, in 80% of the cases, of the superior central incisors. The exposure of the dental pulp leads to major morphological changes in dental tissue, such as discolouring, acute pulp inflammation, chronic inflammation and necrosis. This article reviews the various studies published on the different types of inflammatory response of the pulp tissue following traumatic events, from the microbiological and histological point of view of various techniques.

Vital Pulp Therapy of a Mature Molar with Concurrent Hyperplastic Pulpitis, Internal Root Resorption and Periradicular Periodontitis: A Case Report

Vital pulp therapy (VPT) of permanent mature teeth is continuously ascertaining to be a more reliable endodontic treatment. The purpose of this case report was to describe successful VPT of a mature mandibular left first molar with concurrent hyperplastic pulpitis, internal root resorption and periradicular periodontitis in a 35-year-old male patient. After complete caries removal and access cavity preparation, the dental pulp was removed from the coronal third of the roots. To protect the remaining pulp, calcium-enriched mixture (CEM) cement was placed and adapted into the cavities; the tooth was then restored with amalgam. Six months after VPT, radiographic examination showed evidence of periradicular healing. Clinically, the tooth was functional without signs and symptoms of infection/inflammation. The successful outcome of this case suggests that diseased dental pulp (i.e. irreversible pulpitis) has the potential to heal after pulp protection with CEM biocement.

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.

Pulp polyp in traumatized primary teeth--a case-control study

AIM

To assess clinical characteristics and other factors associated with the occurrence of pulp polyp in traumatized primary teeth as well to evaluate the impact of pulp polyp occurrence on clinical decision-making after traumatic injuries.

MATERIAL AND METHODS

This study was divided into three phases. First, occurrence and clinical characteristics of pulp polyp were assessed followed by a descriptive analysis and categorical tests of association. Secondly, a case-control design was used, and the occurrence of pulp polyp was set as the outcome. In third phase, the occurrence of pulp polyp after fracture with pulp exposure was investigated as a variable possibly associated with clinical decision-making (dental extraction/endodontic treatment). Logistic regression analyses were used, and odds ratios and 95% confidence interval (OR; 95% CI) were calculated in second and third phases.

RESULTS

Occurrence of pulp polyp in traumatized primary teeth was of 2.3%. Hyperplastic tissue color and proliferation size were not associated with the time to seek treatment after injury (P > 0.05). Children up to 2 years of age had more chance of having pulp polyp in comparison with older children (3.15; 1.15-8.64). Teeth with crown-root fracture had more chance of dental extraction in the therapeutic approach than the teeth with only crown fracture (4.36; 1.10-17.32). Presence of pulp polyp was not associated with the treatment carried out.

CONCLUSIONS

Occurrence of pulp polyp in traumatized primary teeth is not frequent and is associated with the age when traumatic dental injury occurs but does not interfere directly with the therapeutic approach.

The relationship of pulp polyp with the presence and concentration of immunoglobulin E, histamine, interleukin-4 and interleukin-12

The aim of this study was to evaluate the relationship between pulp polyp formation and immunoglobulin E (IgE), histamine and interleukin-4 (IL-4) as the most important mediators which are involved in allergy. Thirty-two samples including 16 pulp polyps and 16 normal pulps were gathered. After homogenising the pulpal tissue samples, enzyme-linked immunosorbent assay (ELISA) techniques were used to assess the concentration of IgE, histamine, IL-4 and IL-12. The two groups showed statistically significant differences in terms of both the concentration and presence of IgE, histamine and IL-4 (P < 0.001); both presence and concentration of IgE, histamine and IL-4 were higher in pulp polyps than in normal pulps. There is not any significant difference between case and control groups regarding IL-12. The results of this study give rise to the possibility of type I hypersensitivity reaction being involved in pulp polyp's pathogenesis.

Minor traumatic injuries to the permanent dentition

Treatment of traumatized teeth generally occurs in two phases: short-term emergency treatment and stabilization followed by endodontic management and review. These authors recently reviewed the endodontic considerations in the treatment of traumatized permanent anterior teeth, and in this article review the early management of traumatized permanent teeth. Preoperative assessment and emergency management are emphasized, as is the treatment of immature teeth for which continued development of the root system must be encouraged. Factors influencing long-term prognosis are discussed and the influence of various management strategies evaluated.

The endodontic management of traumatized permanent anterior teeth: a review

Despite the many journal articles and reviews that have been published regarding the treatment of trauma to teeth, the endodontic management of these injuries is often still not fully understood. The purpose of this review is to establish clear and up-to-date guidelines for practitioners who are faced with treating dental injuries on a day-to-day basis, based on an assessment of current available scientific information relating to the endodontic management of these injuries. Treatment is discussed under the headings: infractions, uncomplicated crown fractures, complicated crown fractures, crown-root fractures, root fractures, luxation injuries, avulsion, root resorption, pulp canal obliteration and open-apex teeth. Emphasis is placed on the treatment of traumatized immature teeth where maintenance of pulp blood supply is important to encourage continued development of the root system. Only the treatment of traumatized permanent anterior teeth is reviewed. Information contained in this article is based on a review of the literature on dental trauma which involved a MEDLINE search using the key words "dental trauma" and the individual topics listed above. The guidelines produced by the International Association of Dental Traumatology, the American Academy of Pediatric Dentistry and the American Association of Endodontists were also reviewed and the recommendations contained in this paper are in concert with the major recommendations of these bodies.

Exposed human pulp caused by trauma and/or caries in primary dentition: a histological evaluation

The aim of this study was to compare the pulpal reactions after exposure due to trauma and/or caries and to suggest the appropriate treatment options for the management of pulp, in the light of the histological findings in the primary teeth. Fifteen primary maxillary incisors with pulpal exposure were examined with light microscope in a blind study. After the histological evaluation, teeth were divided into three groups for the etiological factors due to the exposure according to the patient's files: trauma group, caries group and caries and trauma group. The inflammatory infiltration was diminished from the pulp chamber towards the apical third of the root canal in all of the examined teeth. Teeth in the trauma group presented fewer inflammatory cells in the root canal in comparison with other groups. It was concluded that the teeth with traumatic pulp exposure were considered as more likely to respond positively to pulpotomy technique. Pulpectomy or extraction seemed to be indicated for the decayed or decayed and traumatically injured teeth.