Bone-like tissue growth in the root canal of immature permanent teeth after traumatic injuries

Histological analysis for pulp mineralisation after severe intrusive luxation of immature molars in rats

BACKGROUND/AIM

Pulp mineralisation is a survival process that may occur in the pulp of immature teeth following trauma. However, the mechanism of this process remains unclear. The aim of this study was to evaluate the histological manifestations of pulp mineralisation after intrusion in immature molars of rats.

MATERIALS AND METHODS

Three-week-old male Sprague-Dawley rats were subjected to intrusive luxation of the right maxillary second molar by an impact force from a striking instrument through a metal force transfer rod. The left maxillary second molar of each rat was used as a control. The control and injured maxillae were collected at 3, 7, 10, 14, and 30 days after trauma (n = 15 per time group) and evaluated using haematoxylin and eosin staining and immunohistochemistry. Independent two-tailed Student's t-test was used for statistical comparison of the immunoreactive area.

RESULTS

Pulp atrophy and mineralisation were observed in 30%-40% of the animals, and no pulp necrosis occurred. Ten days after trauma, pulp mineralisation, with osteoid tissue rather than reparative dentin, formed around the newly vascularised areas in the coronal pulp. CD90-immunoreactive cells were observed in the sub-odontoblastic multicellular layer in control molars, whereas the number of these cells was decreased in the traumatised teeth. CD105 localised in cells around the pulp osteoid tissue of the traumatised teeth, whereas in control teeth, it was only expressed in the vascular endothelial cells of capillaries in the odontoblastic or sub-odontoblastic layers. In specimens with pulp atrophy at 3-10 days after trauma, hypoxia inducible factor expression and CD11b-immunoreactive inflammatory cells increased.

CONCLUSIONS

Following intrusive luxation of immature teeth without crown fractures in rats, no pulp necrosis occurred. Instead, pulp atrophy and osteogenesis around neovascularisation with activated CD105-immunoreactive cells were observed in the coronal pulp microenvironment characterised by hypoxia and inflammation.

Ingrowth of Mineralized Tissue into the Root Canal of Immature Permanent Teeth after a Traumatic Injury: A Report of 3 Cases

The aim of this case series was to describe the endodontic management of 3 immature permanent teeth that sustained traumatic injuries and subsequently presented with complete ingrowth of mineralized tissue into the canal space. Ingrowth of bone/mineralized tissue into the canal has been considered a poor long-term outcome with an inherent risk of ankylosis. In cases 1 and 2, no endodontic treatment was undertaken, except for emergency management requiring splinting. The cases were followed for 36 and 23 months, respectively. No ankylosis was evident over the review period, and normal teeth eruption was apparent. In case 1, the tooth was treated orthodontically and was responsive to pulp sensibility testing. In both cases, there was an appearance of an internal periodontal ligament-like space on the inner root wall of the canal. In case 3, 2 years postinjury, pulp necrosis and apical periodontitis occurred, and the tooth was managed with regenerative endodontic treatment consistent with the European Society of Endodontology and the American Association of Endodontists guidelines/recommendations for a regenerative procedure. The case was followed for 8 years after regenerative endodontic treatment. No ankylosis was noted with normal eruption of the teeth. The tooth was responsive to pulp sensibility testing despite the ingrowth of mineralized tissue, which was confirmed clinically.

Reparative bone-like tissue formation in the tooth of a systemic sclerosis patient

AIM

To report a case of reparative bone-like tissue formation in the tooth of a patient with systemic sclerosis.

SUMMARY

A 58-year-old Japanese female patient with systemic sclerosis was referred because of tooth fracture. Cone beam computerized tomography (CBCT) revealed multiple root resorption and the unclear transition from alveolar bone to root profile. A sample from a fractured tooth was analysed histologically. Haematoxylin and eosin-stained sections revealed the irregular replacement of pulp and dentine by bone-like tissue. Calcinosis was noted in various parts of the body and a histological analysis identified it as dystrophic calcification on sclerosed fibrous connective tissue. Bite force and the occlusal area were markedly weaker than the means for female of the same age.

KEY LEARNING POINTS

CBCT may be more useful than dental radiography for diagnosing multiple root resorption in systemic sclerosis patients. When systemic sclerosis patients have calcinosis, their root status must be examined carefully. When root resorption is present in systemic sclerosis patients, reparative bone-like tissue formation in teeth needs to be taken into account prior to the initiation of dental treatment.

A Case Series: The Orthodontic Management of Central Incisors with Horizontal Root Fractures

This case series illustrates the successful orthodontic management of previously root-fractured central incisors. Orthodontic treatment was carried out to correct the underlying malocclusion, remove traumatic occlusal forces and to provide a suitable occlusion for future restorative treatment should the root-fractured teeth be lost in the future. Clinical relevance: Dental trauma occurs commonly; having affected 10% of orthodontic patients. All practitioners should be able to discuss the possibility of orthodontic treatment with patients who have had previous trauma to their front teeth.

Bone-like material growth in a replanted immature central incisor following avulsion

BACKGROUND

Avulsion is one of the most complicated types of trauma to the teeth. After replantation of an avulsed immature tooth, numerous pulpo-dentinal responses may occur.

CASE REPORT

This study reports a case of a seven-and-a-half-year-old boy in whom an immature maxillary permanent central incisor was replanted following avulsion due to a fall from a tree, and a bone-like growth was observed in the pulp chamber 6 months after the trauma, with a thin radiolucent line on the inner surface of the dentinal walls. The bone-like structure eventually filled the pulp chamber of the tooth.

FOLLOW-UP

The tooth was followed up 4 years after the replantation with no evidence of pathology.

CONCLUSION

This case demonstrates an immature avulsed tooth which did not present positive vital signs, but still maintains the potential of survival, and endodontic intervention may not be required. Instead, follow-up visits are recommended as long as there are no pathologic signs, especially in teeth with questionable prognosis.

Pulpal sequelae after trauma to anterior teeth among adult Nigerian dental patients

Background

Epidemiological studies show that about 11.6% to 33.0% of all boys and about 3.6% to 19.3% of all girls suffer dental trauma of varying severity before the age of 12 years. Moderate injuries to the periodontium such as concussion and subluxation are usually associated with relatively minor symptoms and hence may go unnoticed by the patient or the dentist, if consulted. Patients with these kinds of injuries present years after a traumatic accident most of the time with a single discoloured tooth. This study sets out to document the incidence of various posttraumatic sequelae of discoloured anterior teeth among adult Nigerian dental patients.

Methods

One hundred and sixty eight (168) traumatized discoloured anterior teeth in 165 patients were studied. Teeth with root canal treatment were excluded from the study. Partial obliteration was recorded when the pulp chamber or root canal was not discernible or reduced in size on radiographs, total obliteration was recorded when pulp chamber and root canal were not discernible. A retrospective diagnosis of concussion was made from patient's history of trauma to the tooth without abnormal loosening, while subluxation was made from patient's history of trauma to the tooth with abnormal loosening.

Results

Of the 168 traumatized discoloured anterior teeth, 47.6% and 31.6% had partial and total obliteration of the pulp canal spaces respectively, 20.8% had pulpal necrosis. Concussion and subluxation injuries resulted more in obliteration of the pulp canal space, while fracture of the teeth resulted in more pulpal necrosis (p < 0.001). Injuries sustained during the 1^st and 2^nd decade of life resulted more in obliteration of the pulp canal space, while injuries sustained in the 3^rd decade resulted in more pulpal necrosis.

Conclusion

Calcific metamorphosis developed more in teeth with concussion and subluxation injuries. Pulpal necrosis occurred more often in traumatized teeth including fractures.

Teeth: malignant neoplasms in the dental pulp?

Common pathologies of the dental pulp differentiate between acute and chronic inflammatory states caused by caries or dental trauma. Inflammations of the dental pulp as a result of neoplastic alterations are generally considered non-existent. In fact, using the search phrase "dental pulp" combined with "sarcoma", "carcinoma", or "neoplasms" in PubMed when using the MeSH search mode yielded no reports on primary malignant neoplasms. However, a hand search yields clinical reports on pulpal tumours that were published over a century ago. In this Essay, the results of a hand search in historic published work are presented. Furthermore, deductive reflections are done on general tumour pathogenesis with respect to specific anatomical prerequisites of the dental pulp. Because of the restricted space in a tooth, tumour expansion will probably lead to the formation of irritation dentine by secondary odontoblasts and, subsequently, to a haemorrhage infarct of the pulp. One hypothesis states that a purported neoplasm of the dental pulp leads to a chronic appositive pulpitis and-sooner or later-will be treated likewise by root-canal treatment or extraction. Further research, including stem-cell studies, is recommended.