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Galler KM, Weber M, Korkmaz Y, Widbiller M, Feuerer M. Inflammatory Response Mechanisms of the Dentine-Pulp Complex and the Periapical Tissues. Int J Mol Sci 2021; 22:ijms22031480. [PMID: 33540711 PMCID: PMC7867227 DOI: 10.3390/ijms22031480] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 02/08/2023] Open
Abstract
The macroscopic and microscopic anatomy of the oral cavity is complex and unique in the human body. Soft-tissue structures are in close interaction with mineralized bone, but also dentine, cementum and enamel of our teeth. These are exposed to intense mechanical and chemical stress as well as to dense microbiologic colonization. Teeth are susceptible to damage, most commonly to caries, where microorganisms from the oral cavity degrade the mineralized tissues of enamel and dentine and invade the soft connective tissue at the core, the dental pulp. However, the pulp is well-equipped to sense and fend off bacteria and their products and mounts various and intricate defense mechanisms. The front rank is formed by a layer of odontoblasts, which line the pulp chamber towards the dentine. These highly specialized cells not only form mineralized tissue but exert important functions as barrier cells. They recognize pathogens early in the process, secrete antibacterial compounds and neutralize bacterial toxins, initiate the immune response and alert other key players of the host defense. As bacteria get closer to the pulp, additional cell types of the pulp, including fibroblasts, stem and immune cells, but also vascular and neuronal networks, contribute with a variety of distinct defense mechanisms, and inflammatory response mechanisms are critical for tissue homeostasis. Still, without therapeutic intervention, a deep carious lesion may lead to tissue necrosis, which allows bacteria to populate the root canal system and invade the periradicular bone via the apical foramen at the root tip. The periodontal tissues and alveolar bone react to the insult with an inflammatory response, most commonly by the formation of an apical granuloma. Healing can occur after pathogen removal, which is achieved by disinfection and obturation of the pulp space by root canal treatment. This review highlights the various mechanisms of pathogen recognition and defense of dental pulp cells and periradicular tissues, explains the different cell types involved in the immune response and discusses the mechanisms of healing and repair, pointing out the close links between inflammation and regeneration as well as between inflammation and potential malignant transformation.
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Affiliation(s)
- Kerstin M. Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93093 Regensburg, Germany;
- Correspondence:
| | - Manuel Weber
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Yüksel Korkmaz
- Department of Periodontology and Operative Dentistry, University of Mainz, 55131 Mainz, Germany;
| | - Matthias Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93093 Regensburg, Germany;
| | - Markus Feuerer
- Department for Immunology, University Hospital Regensburg, 93053 Regensburg, Germany;
- Regensburg Center for Interventional Immunology (RCI), University Hospital Regensburg, 93053 Regensburg, Germany
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D'addazio G, Artese L, Piccirilli M, Perfetti G. Role of matrix metalloproteinases in radicular cysts and periapical granulomas. Minerva Stomatol 2014; 63:411-420. [PMID: 25503342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The aim of the present study was to evaluate the expression and distribution of different classes of matrix metalloproteinases (MMPs) in radicular cysts and periapical granulomas. METHODS Twenty consecutive specimens of radicular cysts and 20 of periapical granulomas were selected. Expression of MMP-2, -9, -8, -13, -3 was immunohistochemically evaluated. The intensity of expression of the MMPs was evaluated using a semi-quantitative analysis: low = +; intermediate = ++; high = +++. RESULTS Positive expression of MMPs was present with different distribution. MMP-9 expressed differently in the lesions. Indeed, in periapical granulomas low expression was found in endothelial cells and fibroblasts, whilst high intensities were only detected in inflammatory cells. On the contrary, in radicular cysts the high intensities were mainly present in keratinocytes and fibroblasts. MMP-8 was mainly expressed in inflammatory cells of periapical granulomas. MMP-2 and -3 presented a low intensity of expression in both groups. MMP-13 showed a variable pattern of distribution in the different cell types of the two different lesions. CONCLUSION The present investigation supports the role of MMPs in the inflammatory process leading to the development of radicular cysts and periapical granulomas. The results of the present study suggested that the increased enlargement of radicular cysts, compared to periapical granulomas, might be related to a higher expression of MMP-9. On the other hands, the higher intensity of expression of MMP-8 in periapical granulomas could be related to an active inflammatory process. MMP-8 could play an important role in the inflammation processes during the development of periapical lesions.
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Affiliation(s)
- G D'addazio
- Department of Medical, Oral and Biotechnological Sciences University of Chieti‑Pescara, Italy -
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Kovác J, Kovác D. [Histopathology and etiopathogenesis of chronic apical periodontitis--periapical granuloma]. Epidemiol Mikrobiol Imunol 2011; 60:77-86. [PMID: 21838176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Periapical lesions are among the most frequently diagnosed apical odontogenic pathologies in human teeth. The condition is generally described as apical periodontitis. Apical periodontitis is a sequel to endodontic infection and manifests itself as the host defense response to microbial challenge emanating from the root canal system to the periapical tissue. It is viewed as a dynamic encounter between microbial factors and host defenses at the interface between infected radicular pulp and periodontal ligament that results in local inflammation, resorption of hard tissues, destruction of other periapical tissues, and eventual formation of various histopathological categories of apical periodontitis, commonly referred to as periapical lesions. There are also factors located within the inflamed periapical tissue that can interfere with post-treatment healing of the lesion. The purpose of this article is to provide a comprehensive overview of the etiopathogenesis of apical periodontitis and causes of failed endodontic treatment. This study presents a histopathological analysis through optical microscopy of periapical lesions, commonly referred to as solid dental or periapical granuloma.
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Affiliation(s)
- J Kovác
- Klinika stomatológie a maxilofaciálnej chirurgie LFUK a OULSA Bratislava, Slovenská republika.
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Sasaki H, Balto K, Kawashima N, Eastcott J, Hoshino K, Akira S, Stashenko P. Gamma interferon (IFN-gamma) and IFN-gamma-inducing cytokines interleukin-12 (IL-12) and IL-18 do not augment infection-stimulated bone resorption in vivo. Clin Diagn Lab Immunol 2004; 11:106-10. [PMID: 14715554 PMCID: PMC321357 DOI: 10.1128/cdli.11.1.106-110.2004] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Periapical granulomas are induced by bacterial infection of the dental pulp and result in destruction of the surrounding alveolar bone. In previous studies we have reported that the bone resorption in this model is primarily mediated by macrophage-expressed interleukin-1 (IL-1). The expression and activity of IL-1 is in turn modulated by a network of Th1 and Th2 regulatory cytokines. In the present study, the functional roles of the Th1 cytokine gamma interferon (IFN-gamma) and IFN-gamma-inducing cytokines IL-12 and IL-18 were determined in a murine model of periapical bone destruction. IL-12-/-, IL-18-/-, and IFN-gamma-/- mice were subjected to surgical pulp exposure and infection with a mixture of four endodontic pathogens, and bone destruction was determined by microcomputed tomography on day 21. The results indicated that all IL-12-/-, IL-18-/-, and IFN-gamma-/- mice had similar infection-stimulated bone resorption in vivo as wild-type control mice. Mice infused with recombinant IL-12 also had resorption similar to controls. IFN-gamma-/- mice exhibited significant elevations in IL-6, IL-10, IL-12, and tumor necrosis factor alpha in lesions compared to wild-type mice, but these modulations had no net effect on IL-1alpha levels. Recombinant IL-12, IL-18, and IFN-gamma individually failed to consistently modulate macrophage IL-1alpha production in vitro. We conclude that, at least individually, endogenous IL-12, IL-18, and IFN-gamma do not have a significant effect on the pathogenesis of infection-stimulated bone resorption in vivo, suggesting possible functional redundancy in proinflammatory pathways.
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Affiliation(s)
- Hajime Sasaki
- Department of Cytokine Biology, The Forsyth Institute, Boston, Massachusetts, USA
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5
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Abstract
The ultimate aim of endodontic treatment is to encourage the healing of apical periodontitis, or to prevent it from occurring if it was not present prior to treatment. Apical periodontitis is a general term used to describe an inflammatory response to irritation caused by the contents of a root canal system and it has several distinct forms. The most common is a granuloma but this can develop into other disease entities such as an abscess, a periapical pocket cyst or a true cyst, all of which present as radiolucencies. However, periapical radiolucencies may also be caused by extra-radicular infections, foreign body reactions and periapical scars, or they may be due to other tumours and cysts that have not originated from pulp disease. Practitioners must recognise and understand the different pathological entities and the dynamic interactions that occur in the periapical tissues in order to correctly diagnose and treat these conditions.
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Affiliation(s)
- Paul V Abbott
- Oral Health Centre of WA, University of WA, Nedlands, WA, 6009
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6
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Wong K. Exarticulation and reimplantation utilizing guided tissue regeneration: a case report. Quintessence Int 2002; 33:101-9. [PMID: 11890024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The extraction and reimplantation of teeth is a technique that has been practiced for many years, resulting in successful retention of teeth for up to 30 years. Although evidence confirming the advantages of this technique is limited, clinical observations and histologic examinations have revealed some important factors that are prerequisites for success: limitation of the time the tooth is exposed to the extraoral environment and preservation of vital periodontal tissue attachments on root surfaces. The latter goal can be achieved by gentle, atraumatic removal of the tooth from its socket, and hence the term exarticulation and reimplantation is more representative of the technique. In the present case report, a maxillary lateral incisor with a developmental defect was treated by exarticulation and reimplantation and application of calcium sulfate. Exarticulation and reimplantation seems to be a useful clinical procedure, but controlled studies are required to confirm its efficacy.
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Affiliation(s)
- Kevan Wong
- Hard Tissue Research Unit, University College, London, England.
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Huang GT, Do M, Wingard M, Park JS, Chugal N. Effect of interleukin-6 deficiency on the formation of periapical lesions after pulp exposure in mice. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 92:83-8. [PMID: 11458250 DOI: 10.1067/moe.2001.115025] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The multifunctional cytokine interleukin-6 (IL-6) has actions on multiple cell types, including promotion of the development of immune cells and osteoclasts. Periapical inflammation as the result of root canal infection is characterized by the accumulation of inflammatory cells and bone resorption. The effect of IL-6 on periapical lesion formation after pulpal infection is unknown. We sought to determine whether deletion of IL-6 affects periapical lesion formation after pulp exposure. METHODS Molar pulps of homozygous IL-6 knock-out mice (IL-6(-/-), strain B6, 129-Il6tm1Koe ) and wild-type mice (IL-6(+/+)) were exposed, and the mice were killed at 1, 2, 3, 5, and 8 weeks after the exposure. Mouse jaws were decalcified and prepared for histologic examination of periapical lesions. RESULTS The IL-6(-/-) mice developed larger periapical lesions more rapidly than did the IL-6(+/+) mice. CONCLUSIONS IL-6 deletion promoted periapical lesion development.
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Affiliation(s)
- G T Huang
- Division of Associated Clinical Specialties, Section of Endodontics, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA.
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8
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Abstract
Osteomyelitis of jaws caused by infection with Mycobacterium tuberculosis is uncommon, especially in children. We present a case of tuberculous osteomyelitis in a young child. Its clinical presentation, with features similar to a dento-alveolar abscess, underline the importance of considering it in the differential diagnosis of jaw lesions. We discuss of the diagnostic techniques, management and preventive measures, and stress the importance of history taking during clinical examination.
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Affiliation(s)
- A P Bhatt
- Department of Oral Pathology, Yenepoya Dental College, Rajiv Gandhi University, Karnataka, India
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9
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Ayangco L, Sheridan PJ. Development and treatment of retrograde peri-implantitis involving a site with a history of failed endodontic and apicoectomy procedures: a series of reports. Int J Oral Maxillofac Implants 2001; 16:412-7. [PMID: 11432661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
Osseointegrated implants provide predictable restorative support for crowns, restorations, prosthesis abutments, and removable dentures. Their widespread use in recent years has produced different types of complications. Retrograde peri-implantitis, a lesion occurring at the periapical area of an osseointegrated implant, has recently been described. This paper presents a series of reports describing the occurrence and management of retrograde peri-implantitis involving implants replacing teeth with histories of failed endodontic and apicoectomy procedures.
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Affiliation(s)
- L Ayangco
- Department of Dental Specialities, Mayo Clinic, Rochester, Minnesota 55905, USA
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10
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Koh ET. Mineral trioxide aggregate (MTA) as a root end filling material in apical surgery--a case report. Singapore Dent J 2000; 23:72-8. [PMID: 11699369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Many root end filling materials for apical surgeries have been identified either for scientific evaluation or clinical usage but none meets the requirements of an ideal root end filling material. Recently a new cement, Mineral Trioxide Aggregate (MTA) was researched as a potential root end filling material and showed promising results. This paper reports the significant findings of research done on MTA as a root end filling material and presents a clinical case where apical surgery was performed using MTA as retrograde filling.
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Affiliation(s)
- E T Koh
- ET Koh Dental Surgery, 290 Orchard Road, #09-15 Paragon, Singapore 238859
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11
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12
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Abbott PV. The periapical space--a dynamic interface. Ann R Australas Coll Dent Surg 2000; 15:223-34. [PMID: 11709943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The ultimate aim of endodontic treatment is to encourage the healing of apical periodontitis, or to prevent it from occurring if it was not present prior to treatment. Apical periodontitis is a general term used to describe an inflammatory response to irritation caused by the contents of a root canal system and it has several distinct forms. The most common is a granuloma but this can develop into other disease entities such as an abscess, a periapical pocket cyst or a true cyst, all of which present as radiolucencies. However, periapical radiolucencies may also be caused by extra-radicular infections, foreign body reactions and periapical scars, or they may be due to other tumours and cysts that have not originated from pulp disease. Practitioners must recognize and understand the different pathological entities and the dynamic interactions that occur in the periapical tissues in order to correctly diagnose and treat these conditions.
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Affiliation(s)
- P V Abbott
- School of Dental Science, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne
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13
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Abstract
This case report describes the replacement of a failed subperiosteal implant with a tripodal design in a 60-year-old woman. The patient had been given the option of an augmentation using an autogenous iliac crest graft with subsequent insertion of endosteal implants or of replacing the failed implant with another of more sophisticated design. The latter, a more conservative approach, was selected for both economic and quality-of-life issues.
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14
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Bhat SS, Jayakrishnan A, Rao BH, Kudva S. Peripheral giant cell granuloma--a case report. J Indian Soc Pedod Prev Dent 1999; 17:93-6. [PMID: 10863498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Peripheral giant cell granuloma is a lesion arising mainly from the connective tissue of gingiva or periosteum of alveolar ridge. A case of peripheral giant cell granuloma involving a deciduous molar and the succedaneous tooth is reported. The lesion was large and interfered with occlusion. Surgical excision of the lesion along with the deciduous first molar was done. The underlying permanent first premolar was also involved, and had to be removed. The importance of an adequate salivary flow and maintenance of oral hygiene in the prevention of such lesions is stressed.
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Affiliation(s)
- S S Bhat
- Department of Pedodontics, Yenepoya Dental College, Karnataka
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15
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Rapisarda E, Bonaccorso A, Tripi T. [The role of cell adhesion molecules in the formation of periapical granulomas]. Minerva Stomatol 1998; 47:509-17. [PMID: 9866964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Cell adhesion molecules (CAMs) are cell surface proteins involved in the binding of cells, usually leukocytes, to each other, to endothelial cells, or to extracellular matrix. Specific signals produced in response to wounding and infection control the expression and activation of certain of these adhesion molecules. The interactions and responses then initiated by binding of these CAMs to their receptors/ligands play important roles in the mediation of the inflammatory and immune reactions that consult one line of the body's defense against these insults. Most of the CAMs characterized so far fall into three general families of proteins: the immunoglobulin (Ig) superfamily, the integrin family, or the selectine family. Recent studies have indicated that selectins (E,L,P) are implicated in cell trafficking, an important aspect of inflammation-related process. Regulation of white blood cell trafficking from the blood vascular compartment to regions of pathogenic exposure is one of the most important functions of the immune system. The distinct phases of leukocyte migration include: rolling, activation, firm adhesion, transendothelial migration and subendothelial migration. The selectins have been implicated in the first step of this cascade. An inflammatory response is first evoked in the pulpal tissue in an attempt to neutralize the injurious agent and to dispose of damaged tissue and cells. The pulpal vessels dilate and blood flow to the tooth increases. At the same time, permeability of the vessels increases allowing leakage of fluid and leukocytes into the tissue.
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Affiliation(s)
- E Rapisarda
- Cattedra di Odontoiatria Conservatrice, Università degli Studi, Catania
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16
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Lindskog S, Pierce AM, Blomlöf L. Chlorhexidine as a root canal medicament for treating inflammatory lesions in the periodontal space. Endod Dent Traumatol 1998; 14:186-90. [PMID: 9796483 DOI: 10.1111/j.1600-9657.1998.tb00835.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The purpose of the present study was to investigate the therapeutic effect of intra-canal application of chlorhexidine on inflammatory root resorption. Dental pulps from monkey incisors were infected and resealed prior to extraction of the teeth. Root dentin was mechanically exposed and the teeth were replanted under aseptic conditions. After 4 weeks, the experimental teeth were dressed with chlorhexidine gel and resealed. Animals were sacrificed 4 weeks later, and their jaws prepared for histologic examination. Results showed that both marginal and apical periodontal inflammation and resorption were reduced in the chlorhexidine-treated teeth. It was concluded that the use of intra-canal chlorhexidine may be a useful adjunct in the treatment of inflammatory root resorption, but further human trials need to be undertaken before its clinical use can be recommended.
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Affiliation(s)
- S Lindskog
- Department of Basic Oral Sciences, School of Dentistry, Karolinska Institute, Stockholm, Sweden
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17
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Leong R, Seng GF. Epulis granulomatosa: extraction sequellae. Gen Dent 1998; 46:252-5. [PMID: 9693538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Epulis granulomatosa is a post-surgical lesion emanating from an extraction socket. It can be misdiagnosed with lesions of similar appearance, for example, foreign body or pyogenic granulomas, or as a herniation of the maxillary sinus. Based on clinical appearance and microscopic description, granulomas all appear to represent essentially the same lesion. However, pathonomonically, the epulis granulomatosa emanates only from an extraction socket; the other granulomas can be found anywhere in the body.
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Affiliation(s)
- R Leong
- University Dental Center, Stratford, NJ, USA
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18
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Abstract
The aim of the present study was to describe the periodontal tissue that formed after GTR when different resorbable barriers were applied to degree III furcation defects. The study was performed in 5 foxhound dogs. The 2nd and 4th premolars in both sides of the mandible were extracted. Degree III furcation defects were produced in the 3rd mandibular premolars. 5 weeks later, GTR therapy using a barrier composed by a polylactide-glycolide copolymer was performed on one quadrant (group A). In the contralateral quadrant, a barrier made of polylactide and citric acid ester (group B) was used. The dogs were sacrificed 6 months after reconstructive therapy. Tissue blocks containing the experimental teeth were excised, demineralised in EDTA and embedded in paraffin. Serial sections were cut in the mesio-distal plane and parallel with the long axis of the roots. The microtome was set at 7 microm. The sections were stained in hematoxyline and eosin. From each biopsy, 3 sections representing the central part of the furcation were selected for light microscopic examination. In the healed furcation sites, descriptive histological analysis and histomorphometric measurements of the newly formed tissues were performed. In both groups the root surface of the healed furcation defects was covered by a cellular, extrinsic-intrinsic fibers type cementum. The composition of the newly formed periodontal ligament was similar in both groups. The proportions of bone, bone marrow and periodontal ligament, however, were substantially larger in group A than in group B. In Group B, an area in the previous furcation defect was consistently occupied by a granuloma. It is suggested that the presence of the granuloma in the healed furcation defect prevented bone regrowth.
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Affiliation(s)
- M G Araújo
- Department of Periodontology, Faculty of Odontology, Göteborg University, Sweden
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19
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Abou-Rass M, Bogen G. Microorganisms in closed periapical lesions. Int Endod J 1998; 31:39-47. [PMID: 9823127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The purpose of this study was to investigate the microorganisms of strictly selected closed periapical lesions associated with both refractory endodontic therapy and pulpal calcification. Definitive criteria were established that assured complete clinical isolation of the periapical lesion from the oral and periodontal environment. A total of 13 criteria-referenced lesions were selected from 70 patients with endodontic surgical indications. A well controlled culturing method was used in all cases and samples were taken by one clinician at three separate sites during each surgery. Samples taken at the surgical window and within the body of the lesion served as controls, whilst a third sample was taken at the apex. In all 13 cases, samples taken from the apex yielded microorganisms comprising 63.6% obligate anaerobes and 36.4% facultative anaerobes. Prevalence of the isolated species was 31.8% for Actinomyces sp., 22.7% Propionibacterium sp., 18.2% Streptococcus sp., 13.6% Staphlyococcus sp., 4.6% Porphyromonas gingivalis, 4.6% Peptostreptococcus micros and 4.6% Gram-negative enterics. The results of this investigation indicate that closed periapical lesions associated with calcified teeth or those resistant to root canal treatment harbour bacteria. The inability to eradicate all root canal microorganisms during root canal treatment, along with anatomical factors, may allow further bacterial colonization of the root apex and surrounding periapical tissues, and consequently prevent healing.
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Affiliation(s)
- M Abou-Rass
- Department of Endodontics, University of Southern California, School of Dentistry, Los Angeles 90089-0641, USA
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Sauveur G, Sobel M, Boucher Y. Surgical treatment of a lateroradicular lesion on an invaginated lateral incisor (dens in dente). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83:703-6. [PMID: 9195627 DOI: 10.1016/s1079-2104(97)90323-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The complex anatomy of invaginated teeth makes their endodontic treatment difficult. The case described here reports the successful management of an invaginated tooth presenting with a lateroradicular lesion. After the root was surgically exposed and the radicular defect was cleaned, gutta percha was sealed with a zinc oxide eugenol cement, heat-compacted under 5 degrees, and then cold-burnished. The osseous cavity was filled with Biocorail. Radiographs at 1 month and 5 years show periapical healing with osseous formation. This procedure, resulting in minimal loss of hard tissues, permitted retention of the tooth.
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Affiliation(s)
- G Sauveur
- Department of Restorative Dentistry and Endodontics, Université Paris, France
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21
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Abstract
Periapical bone destruction is an important pathogenic sequela of pulpal infection. Recent findings from this laboratory have demonstrated that most bone-resorbing activity in extracts of rat periapical lesions can be neutralized by an anti-interleukin (IL)-1 alpha antiserum. To further clarify pathogenic mechanisms, bone-resorptive cytokine messenger RNA (mRNA) expression was analyzed in developing rat periapical lesions. The molar teeth of 20 Sprague-Dawley rats were surgically exposed and left open to permit infection from the oral environment. Total cell RNA was isolated from periapical granuloma tissue obtained on days 3, 7, 15 and 30 after exposure. mRNA for IL-1 alpha, IL-1 beta and tumor necrosis factor alpha (TNF-alpha) was amplified by reverse transcription polymerase chain reaction, and levels were approximated by comparison to the parallel amplification of the housekeeping gene glyceraldehyde phosphate dehydrogenase. IL-1 alpha and TNF-alpha mRNA were both highly expressed beginning on day 7, increased on day 15, and declined somewhat on day 30. In contrast, IL-1 beta mRNA was expressed at much lower levels, but with similar kinetics. The kinetics of steady state IL-1 alpha and TNF-alpha mRNA levels were confirmed using the quantitative RNase protection assay, whereas IL-1 beta mRNA could not be detected by this technique. IL-1 alpha mRNA-expressing cells were identified using in situ hybridization and included infiltrating macrophages, as well as resident fibroblasts, endothelial cells and osteoclasts. These results demonstrate that the IL-1 alpha and TNF-alpha genes are highly expressed in developing periapical lesions in the rat and confirm previous studies at the protein level in this model.
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Affiliation(s)
- C Y Wang
- Department of Cytokine Biology, Forsyth Dental Center, Boston, Massachusetts 02115, USA
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22
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Unkel JH, Nieusma GE, Todd MJ, Fenton SJ. Pediatric facial fistula. Pediatr Emerg Care 1997; 13:21-3. [PMID: 9061730 DOI: 10.1097/00006565-199702000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J H Unkel
- Department of Pediatric Dentistry, University of Tennessee College of Dentistry, Memphis 38263, USA
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Abstract
Histological analysis of human leprosy periapical granulomas was conducted to study the histological responses to Mycobacterium leprae. Many Langhans-type giant cells and epithelioid cell tubercles were observed, although M. leprae were not detected in leprosy periapical granulomas. Although numerous T- and B-cells were infiltrated in leprosy periapical granuloma, the T-/B-cell ratio of leprosy is not changed to that of periapical granulomas isolated from normal patients. These findings suggested that human leprosy periapical granulomas develop as a result of immunological responses to M. leprae.
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Affiliation(s)
- N Tani-Ishii
- Department of Endodontics, Kanagawa Dental College, Japan
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24
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Granchi D, Stea S, Ciapetti G, Cavedagna D, Stea S, Pizzoferrato A. Endodontic cements induce alterations in the cell cycle of in vitro cultured osteoblasts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 79:359-66. [PMID: 7621013 DOI: 10.1016/s1079-2104(05)80230-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The effects of endodontic cements on the cell cycle of MG63 osteoblasts cultured in vitro have been examined. Three groups of compounds were tested. Group I encompassed zinc oxide- and eugenol-based cements (Tubliseal, Argoseal, N2), group II consisted of cements with a phenol group other than eugenol (AH26, Forfenan, Methode R/R), and group III included CaOH-based cements (Biocalex, Endocalex). The cell cycle of MG63 cells was analyzed by flow cytometry; the DNA content was evaluated by means of the propidium iodide uptake method, whereas the proportion of cells in the S phase was defined by the incorporation of bromodeoxyuridine later revealed by a specific antibody. The results showed that some root canal sealers could hamper the periapex healing processes by inhibiting the cell proliferation through a selective action on different phases of the cell cycle.
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Affiliation(s)
- D Granchi
- Laboratory for Biocompatibility Research on Implant Materials, Istituti Ortopedici Rizzoli, Bologna, Italy
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25
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Olmez S, Uzamis M, Er N. Dens invaginatus of a mandibular central incisor: surgical endodontic treatment. J Clin Pediatr Dent 1995; 20:53-6. [PMID: 8634198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Dens invaginatus is a developmental malformation that mostly affects maxillary lateral teeth and mandibular teeth are rarely affected. In this paper a mandibular central incisor with a dens invaginatus is identified as requiring both endodontic and surgical treatment is presented. At one year recall appointment satisfactory clinical and radiographic healing was evident. This case demonstrates that also periapical surgery should be performed in some cases with dens invaginatus for resolution of periapical tissues.
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Affiliation(s)
- S Olmez
- Department of Paedondontics, Faculty of Dentistry, University of Hacettepe, Ankara, Turkey
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26
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Affiliation(s)
- S Amar
- Department of Periodontology, Eastman Dental Center, Rochester, New York, USA
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27
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Abstract
Multiple mechanisms are involved in the pathologic changes associated with formation of acute and chronic periradicular lesions. Mechanical injury to the periradicular tissues can cause activation of several pathways of inflammation and release of nonspecific mediators. Continuous irritation of periradicular tissues can cause activation of several pathways of inflammation and release of nonspecific mediators. Continuous egress of antigens from a pathologically involved root canal can also result in one or a combination of the various types of immunologic reactions. A number of these reactions participate in the destruction of periradicular tissues. Because of complex interactions between the various components of these systems, the dominance of any one pathway or substance may be difficult to establish.
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Affiliation(s)
- M Torabinejad
- School of Dentistry, Department of Endodontics, Loma Linda University, Calif
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28
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Matsuo T, Ebisu S, Nakanishi T, Yonemura K, Harada Y, Okada H. Interleukin-1 alpha and interleukin-1 beta periapical exudates of infected root canals: correlations with the clinical findings of the involved teeth. J Endod 1994; 20:432-5. [PMID: 7996112 DOI: 10.1016/s0099-2399(06)80032-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study quantified the concentrations of interleukin-1 alpha (IL-1 alpha) and interleukin-1 beta (IL-1 beta) in the periapical exudates obtained from 69 single-rooted teeth using enzyme-linked immunosorbent assays, and examined their correlation with clinical findings of the involved teeth. Changes in the levels of these factors during root canal treatment were also investigated. The average levels of IL-1 beta (6.57 ng/ml) in periapical exudates were twice that of IL-1 alpha (3.25 ng/ml). The exudates containing pus showed significantly higher IL-1 alpha levels than those from the canals without pus (p < 0.01). The exudates from the canals with small radiolucent areas contained significantly higher IL-1 alpha levels than those from the canals with large radiolucent areas (p < 0.05). The tendency for there to be an increase in the levels of IL-1 alpha and a decrease in the levels of IL-1 beta was observed following root canal treatment. These observations suggest that IL-1 alpha and IL-1 beta are involved in the immunopathogenesis of periapical lesions and that IL-1 alpha and IL-1 beta may play different roles in the healing process of periapical lesions during root canal treatment.
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Affiliation(s)
- T Matsuo
- Department of Conservative Dentistry, Tokushima University School of Dentistry, Japan
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29
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Elkins DA, Torabinejad M, Schmidt RE, Rossi JJ, Kettering JD. Polymerase chain reaction detection of human immunodeficiency virus DNA in human periradicular lesions. J Endod 1994; 20:386-8. [PMID: 7996105 DOI: 10.1016/s0099-2399(06)80296-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Human immunodeficiency virus (HIV) has been previously reported to be present in the dental pulp of a patient with AIDS. The present report investigated the feasibility of polymerase chain reaction (PCR) amplification to detect the HIV proviral DNA in cells from periradicular lesions from an HIV-positive patient. The standard PCR amplification with 30 cycles and the nested PCR consisting of two 25-cycle amplifications were used. Samples from each reaction were separated by nondenaturing polyacrylamide gel electrophoresis and stained with ethidium bromide for visualization. Gels were electroblotted to nylon membranes, which were then fixed, denatured, and dried. Membranes were hybridized to specific radioactive oligonucleotide probes and placed next to Kodak XAR film for visualization of the HIV-specific bands. No evidence of HIV-specific reaction was observed in cells (negative control) or in two periradicular lesions from two HIV-negative patients. The ethidium bromide strains revealed that PCR amplification of DNA extracts from two lesions from the HIV-positive patient yielded PCR bands (with both primer pairs) which corresponded to HIV-specific bands of the expected size.
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Affiliation(s)
- D A Elkins
- Department of Microbiology, School of Medicine, Loma Linda University, California
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30
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Chattopadhyay A. The granulomatous response and oral cavity. Indian J Dent Res 1994; 5:15-8. [PMID: 9495146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The granulomatous response is a phylogenetically primitive specialized immunological reaction of the body to wall off an irritant, ingest and remove it, characterised by a localized collection of epithelioid cells, macrophages and lymphocytes. The cells forming the granuloma, its mechanism of formation and types of granuloma have been discussed. A classification of granulomatous diseases of the oral cavity based on etiology has been suggested.
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Affiliation(s)
- A Chattopadhyay
- Department of Oral Pathology, S.D.M. College of Dental Sciences, Dharwad
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31
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Marton IJ, Balla G, Hegedus C, Redi P, Szilagyi Z, Karmazsin L, Kiss C. The role of reactive oxygen intermediates in the pathogenesis of chronic apical periodontitis. Oral Microbiol Immunol 1993; 8:254-7. [PMID: 8247615 DOI: 10.1111/j.1399-302x.1993.tb00570.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The level of malondialdehyde, a stable end product of lipid peroxidation induced by reactive oxygen intermediates and the activity of two potent antioxidant enzymes, superoxide dismutase and glutathione peroxidase, was investigated in tissue homogenates of 22 surgical periapical granuloma specimens. Malondialdehyde levels were significantly higher and glutathione peroxidase activity was significantly lower in periapical granuloma samples than in healthy gingival tissue homogenates, which were used as controls. The activity of superoxide dismutase was similar in periapical granuloma and in control samples. Our results indicate an altered balance between the production and the elimination of toxic oxygen metabolites in chronic apical periodontitis. We hypothesize that reactive oxygen intermediates, which are being produced by activated phagocytic cells abundantly present in periapical granulomas, can contribute to periapical tissue injury and bone loss in this disease.
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Affiliation(s)
- I J Marton
- Department of Stomatology, Medical University of Debrecen, Hungary
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32
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Abstract
A case is reported of a 15 mm paper point found in the periapical area of a maxillary right central incisor during endodontic surgery for an unresolved periapical radiolucency. The paper point had been present for between five and nine years. Histopathological examination showed the presence of chronically inflamed fibrous connective tissue with a number of foreign body giant cells and focal collections of chronic inflammatory cells. SEM comparison of the specimen with a similarly treated fresh paper point showed no indication of degradation of the paper point by host defense cells.
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Affiliation(s)
- C M Sedgley
- Royal Dental Hospital, School of Dental Science, University of Melbourne, Australia
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33
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Abstract
Biopsy reports from 150 periradicular tissue specimens obtained from teeth refractory to nonsurgical endodontic therapy were reviewed. The specimens were submitted by postdoctoral dental students in the Department of Endodontics, and the biopsy reports were prepared by oral pathologists at the University of Texas Health Science Center at San Antonio. The study found that 59.3% of the periradicular lesions were granulomas, 22% cysts, 12% scars, and 6.7% other pathoses. The majority (56%) of endodontically treated cases which failed to heal were recognized within 2 yr after the completion of therapy. The most common location for surgical retreatment was the anterior maxilla, followed by the posterior maxilla, the posterior mandible, and the anterior mandible. The periapical granuloma was the predominant pathosis at each location.
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Affiliation(s)
- W K Nobuhara
- Department of Endodontics, University of Texas Health Science Center, San Antonio 78284
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34
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Pringle GA, Daley TD, Veinot LA, Wysocki GP. Langerhans' cell histiocytosis in association with periapical granulomas and cysts. Oral Surg Oral Med Oral Pathol 1992; 74:186-92. [PMID: 1508527 DOI: 10.1016/0030-4220(92)90381-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This report describes a series of six cases of inflammatory periapical disease with small aggregates of Langerhans cells as a minor component. Immunohistochemical findings confirm that the cells are phenotypically related to Langerhans cells. Aggregates of these cells are not normally found in radicular cysts or periapical granulomas and have been interpreted to represent chronic localized Langerhans' cells histiocytosis. Whether these lesions, which arise within the context of chronic inflammatory periapical disease, represent incipient eosinophilic granulomas or are a more benign, minimally destructive form of Langerhans' cell histiocytosis is unknown. Clinical follow-up suggests that these lesions remain localized and that curettage is adequate treatment.
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Affiliation(s)
- G A Pringle
- Department of Pathology, University of Western Ontario, London, Canada
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35
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Koppang HS, Koppang R, Stolen SO. Identification of common foreign material in postendodontic granulomas and cysts. J Dent Assoc S Afr 1992; 47:210-6. [PMID: 1401421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The present investigation was undertaken to identify commonly occurring foreign material in postendodontic periapical granulomas and cysts. 29 biopsies from such lesions with observed foreign material were routinely processed, stained with H&E, von Kossa and Calcofluor White and investigated by light, polarization and fluorescence microscopy. Applying back-scattered SEM images, the foreign material was subjected to energy dispersive X-ray analysis. 4 groups of foreign material were observed: 1. Black/brownish fragments and yellow/brown granules containing Au, Ag, Cu, Hg, Sn and Zn compatible with amalgam. 2. Fine black/brown/yellow granules compatible with endodontic sealer components revealing Ag, Ba, Bi, Cu, S, Ti and Zn. 3. Basophilic fragments compatible with Ca salts from Ca(OH), extruded periapically and containing Ca and P. 4. Elongated/rounded/oval/kidney-shaped, colourless to slightly basophilic, birefringent structures revealing C and O and with a slit-like central canal and a bright, pale-blue fluorescence specific for cellulose.
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36
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Abstract
The presence and kinetics of bone-resorbing activity in periapical lesions were studied with a rat model system. Lesions were found to expand most rapidly between induction on day 0 and day 15 ("active phase"), with enlargement occurring at a slower rate thereafter (days 20 and 30, "chronic phase"), as assessed by measurement of magnified radiographs and automated image analysis. Pooled extracts of periapical tissues obtained on day 15 contained significant levels of bone-resorbing activity, as determined by 45Ca release from pre-labeled fetal rat long bones. Normal rat dental pulp and periodontal ligament contained no activity. In two kinetic experiments, highest levels of bone-resorbing activity were detected in tissues on days 10 (10.4% and 11.6% specific 45Ca release/mg/mL) and 15 (8.9%). Activity declined thereafter on day 20 (4.4% and 6.1%) to near baseline levels by day 30 (1.4% and 3.3%). Identical levels of resorbing activity were found in the presence or absence of polymyxin-B, an inhibitor of bacterial lipopolysaccharide. These findings demonstrate that bone-resorbing activity is temporarily related to periapical bone destruction and suggest that this model may be useful for studies of mediators that are involved in the pathogenesis of inflammatory bone resorption.
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Affiliation(s)
- C Y Wang
- Department of Immunology, Forsyth Dental Center, Boston, Massachusetts 02115
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37
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Gallini G, Merlini C, Martelossi L, Benetti C. [Inflammatory odontogenic lesions of the jaws]. Dent Cadmos 1991; 59:80-4, 87-90, 93-5. [PMID: 2070926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The apical granuloma, the periapical abcess and the radicular cyst are the most frequent between the inflammatory odontogenic lesions of the jaws. These three lesions are caused by the necrosis of the pulp but are very different between each other from an histological point of view and they can correspond to different stages of the same pathological process considering the fact that from a granuloma can arise a periapical abcess or a radicular cyst and from a radicular cyst and abcess can originate. About these three pathological processes we discuss in this article the clinical, radiographical, ethiological, microscopical features, we suggest the treatment and the differential diagnosis.
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38
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Márton I, Kiss C, Szabó T. [The role of acute phase proteins in the pathogenesis of chronic periapical granuloma]. Fogorv Sz 1990; 83:235-9. [PMID: 1698164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Alpha-1-antitrypsin, alpha-2-macroglobulin, C-reactive protein, haptoglobin and complement component C 3 concentrations and oxidase activity of ceruloplasmin were studied in sera of 36 patients with chronic periapical granuloma before and after surgical treatment. Mean serum concentrations of the investigated proteins were slightly elevated at diagnosis, with the exception of haptoglobin. Alpha-1-antitrypsin and ceruloplasmin levels decreased significantly 7 days after apicectomy, the four other proteins were unchanged at this sampling time. Each investigated protein decreased significantly 3 months after apicectomy. This is the first longitudinal study of "acute-phase proteins" in chronic periapical granuloma. The results suggest that inflammatory reactions contribute to the maintenance of chronic periapical lesion.
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Affiliation(s)
- I Márton
- Debreceni Orvostudományi Egyetem Stomatologiai Klinika
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39
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Morand MA. [The causes of post-endodontic failure: a descriptive analysis of a population of 198 cases of surgical retreatment]. J Can Dent Assoc 1990; 56:491-6. [PMID: 2369701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this article, a statistical analysis describes 198 cases of post-endodontic failures referred from private practitioners for surgical retreatments. Biopsies of these lesions showed that 68.18 per cent of them were identified as apical granulomas, 3.5 per cent as cysts, 16.16 per cent as epitheliated granulomas and 12.12 per cent as "other" cases. The two main groups of causes associated with these failures are: technical errors (55.05 per cent of the cases) and procedural mistakes (17.68 per cent).
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Affiliation(s)
- M A Morand
- Section en Endodontie, Université Laval, Québec, QC
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40
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Maquin M, Laurent-Maquin D, Svoboda JM. [After pulpectomy--dento-periodontal adaptation]. Real Clin 1990; 1:169-83. [PMID: 2135778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Recovery after an endodontic treatment can only be assessed clinically, on the basis of symptomatological and radiographic data, for lack of histo-clinical correlations. An anatomicopathological examination of damaged tissues pinpoints the anatomical obstacles and tissular modifications apt to undermine the success of root canal work. The aim of endodontic treatment is to maintain or reinstate an environment conducive to healing through the use of a non-traumatic endodontic technique, followed by functional rehabilitation of the dental organ in its periodontia structures.
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Affiliation(s)
- M Maquin
- Faculté de Chirurgie Dentaire, Reims, France
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41
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Hernández Vallejo G, García MD, López A, Mendieta C, Moskow BS. Unusual periodontal findings in an AIDS patient with Burkitt's lymphoma. A case report. J Periodontol 1989; 60:723-7. [PMID: 2614637 DOI: 10.1902/jop.1989.60.12.723] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This report deals with a case of AIDS-related Burkitt's lymphoma in which some of the earliest findings were dental and periodontal in nature. The patient presented initially with painless and extremely loose teeth accompanied by progressive paresthesia of the lower jaw. Unique radiographic findings included extensive periodontal ligament space widening and bulbous, granuloma-like lesions about the apices of the teeth. These findings were associated with progressive tumor infiltration of the mandible and do not appear to be related to other reports of aggressive periodontitis associated with impaired immunologic functions in AIDS patients.
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Affiliation(s)
- G Hernández Vallejo
- Department of Oral Medicine and Maxillo-Facial Surgery, Escuela de Estomatología, Ciudad Universitaria, Madrid, Spain
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42
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Drouin RD, Mascrès C. [Granuloma or cyst? The unknown chronic periapical lesion]. J Dent Que 1989; 26:547-51. [PMID: 2639162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The periapical lesions, granuloma and cyst, are being dealt with in modern scientific articles. The ethiology, whether it be infectious, traumatic, physical or chemical, is reviewed and mention is made of the fact that pulpal necrosis or gangrene is a prerequisite for these chronic proliferous lesions. According to epidemiological studies, the granuloma is observed more often than the cyst and the cyst more often in the upper jaw bone. Furthermore, certain teeth show a particular susceptibility to one or the other of these lesions. An x-ray is not sufficient to assure the appropriate clinical diagnosis. Electrophoresis and histopathology does, however, allow one to do the same. Acting as an immunological entity, the granuloma is less of an immunological irritation than a local defense protective barrier.
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43
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Koppang HS, Koppang R, Solheim T, Aarnes H, Stølen SO. Cellulose fibers from endodontic paper points as an etiological factor in postendodontic periapical granulomas and cysts. J Endod 1989; 15:369-72. [PMID: 2637329 DOI: 10.1016/s0099-2399(89)80075-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Histological sections of eight periapical granulomas and cysts developing after conventional endodontic therapy and displaying faintly hematoxylinophilic, birefringent foreign bodies were investigated by light and polarization microscopy, scanning electron microscopy, energy-dispersive X-ray, and chemical analysis. In addition to a variably dense mononuclear infiltrate, the granulomas and cysts revealed varying amounts of giant cells associated with the birefringent foreign bodies. These structures were identified as cellulose fibers, most probably originating from endodontic paper points, which in our opinion can be held responsible for the initiation and perpetuation of chronic postendodontic periapical lesions.
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44
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Kalusokoma K, Duchateau J, Mayer R, Dourov N. [Immunopathologic mechanisms associated with granulomas and odontogenic cysts: a general review]. Bull Group Int Rech Sci Stomatol Odontol 1989; 32:73-8. [PMID: 2670007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The authors make a general survey of the immunopathological mechanisms involved in odontogenic cysts and granulomas. The dental pulp and the sound periapical tissues contain neither inflammatory nor immunoglobin-producing cells. Dental decay associated with bacterial aggression of the dental pulp and periapical tissues might induce a nonspecific inflammation which subsequently becomes more specific. Immunoglobulins are present in fluid aspirates from odontogenic cysts and granulomas. Several investigations have pointed out nonspecific inflammatory mediators (including the C3 complement components), T lymphocytes (helpers and suppressors), B lymphocytes, protein S-100 + cells (Langerhans cells). The presence of immunoglobulins, immunocompetent cells and C3 complement components confirms that all constituents of both humoral and cell-mediated immunological reactions might play an essential role in the pathogenesis of osteolysis.
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45
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Zmener O, Dominguez FV. [Detection of silver in a periapical granuloma: report of a case]. Rev Esp Endodoncia 1986; 4:95-9. [PMID: 3474720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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46
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Harmati S, Márton I. [Immunoglobulin levels in chronic periapical changes]. Fogorv Sz 1985; 78:161-5. [PMID: 3860408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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47
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Rixecker H, Tetsch P. [Apical osteitis and herpes zoster in the 3rd branch of the trigeminal nerve. A case history]. Dtsch Z Mund Kiefer Gesichtschir 1985; 9:38-42. [PMID: 3858038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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48
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McCalla RE. Intentional replantation: a 'viable' alternative to extraction or retreatment. J Tenn Dent Assoc 1985; 65:26-8. [PMID: 3856080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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49
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Honda M, Sakamoto T, Uno K, Naka S. [Granular inflammation produced by a rubber impression material]. Shikai Tenbo 1984; 64:965-8. [PMID: 6396886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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50
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