RESUMO
Evidence shows the polymicrobial etiology of endodontic infections, in which bacteria and their products are the main agents for the development, progression, and dissemination of apical periodontitis. Microbial factors in necrotic root canals (e.g., endotoxin) may spread into apical tissue, evoking and supporting a chronic inflammatory load. Thus, apical periodontitis is the result of the complex interplay between microbial factors and host defense against invasion of periradicular tissues. This review of the literature aims to discuss the complex network between endodontic infectious content and host immune response in apical periodontitis. A better understanding of the relationship of microbial factors with clinical symptomatology is important to establish appropriate therapeutic procedures for a more predictable outcome of endodontic treatment.
Assuntos
Cavidade Pulpar/microbiologia , Doenças da Polpa Dentária/complicações , Doenças da Polpa Dentária/microbiologia , Periodontite Periapical/microbiologia , Infecções Bacterianas/complicações , Infecções Bacterianas/microbiologia , Citocinas/análise , Citocinas/fisiologia , Cavidade Pulpar/patologia , Doenças da Polpa Dentária/patologia , Endotoxinas/fisiologia , Humanos , Lipopolissacarídeos/fisiologia , Metaloproteinases da Matriz/análise , Metaloproteinases da Matriz/fisiologia , Periodontite Periapical/patologiaRESUMO
Pulp canal obliteration (PCO) is a frequent finding associated with pulpal revascularization after luxation injuries of young permanent teeth. The underlying mechanisms of PCO are still unclear, and no experimental scientific evidence is available, except the results of a single histopathological study. The lack of sound knowledge concerning this process gives rise to controversies, including the most suitable denomination. More than a mere semantic question, the denomination is an important issue, because it reflects the nature of this process, and directly impacts the treatment plan decision. The hypothesis that accelerated dentin deposition is related to the loss of neural control over odontoblastic secretory activity is well accepted, but demands further supportive studies. PCO is seen radiographically as a rapid narrowing of pulp canal space, whereas common clinical features are yellow crown discoloration and a lower or non-response to sensibility tests. Late development of pulp necrosis and periapical disease are rare complications after PCO, rendering prophylactic endodontic intervention useless. Indeed, yellowish or gray crown discoloration may pose a challenge to clinicians, and may demand endodontic intervention to help restore aesthetics. This literature review was conducted to discuss currently available information concerning PCO after traumatic dental injuries (TDI), and was gathered according to three topics: I) physiopathology of PCO after TDI; II) frequency and predictors of pulpal healing induced by PCO; and III) clinical findings related to PCO. Review articles, original studies and case reports were included aiming to support clinical decisions during the follow-up of teeth with PCO, and highlight future research strategies.
Assuntos
Cavidade Pulpar/lesões , Doenças da Polpa Dentária/etiologia , Dentição Permanente , Avulsão Dentária/complicações , Fraturas dos Dentes/complicações , Cavidade Pulpar/diagnóstico por imagem , Cavidade Pulpar/patologia , Doenças da Polpa Dentária/patologia , Humanos , Radiografia Dentária , Avulsão Dentária/diagnóstico por imagem , Avulsão Dentária/patologia , Coroa do Dente/patologia , Descoloração de Dente/etiologia , Fraturas dos Dentes/diagnóstico por imagem , Fraturas dos Dentes/patologiaRESUMO
Abstract: Pulp canal obliteration (PCO) is a frequent finding associated with pulpal revascularization after luxation injuries of young permanent teeth. The underlying mechanisms of PCO are still unclear, and no experimental scientific evidence is available, except the results of a single histopathological study. The lack of sound knowledge concerning this process gives rise to controversies, including the most suitable denomination. More than a mere semantic question, the denomination is an important issue, because it reflects the nature of this process, and directly impacts the treatment plan decision. The hypothesis that accelerated dentin deposition is related to the loss of neural control over odontoblastic secretory activity is well accepted, but demands further supportive studies. PCO is seen radiographically as a rapid narrowing of pulp canal space, whereas common clinical features are yellow crown discoloration and a lower or non-response to sensibility tests. Late development of pulp necrosis and periapical disease are rare complications after PCO, rendering prophylactic endodontic intervention useless. Indeed, yellowish or gray crown discoloration may pose a challenge to clinicians, and may demand endodontic intervention to help restore aesthetics. This literature review was conducted to discuss currently available information concerning PCO after traumatic dental injuries (TDI), and was gathered according to three topics: I) physiopathology of PCO after TDI; II) frequency and predictors of pulpal healing induced by PCO; and III) clinical findings related to PCO. Review articles, original studies and case reports were included aiming to support clinical decisions during the follow-up of teeth with PCO, and highlight future research strategies.
Assuntos
Humanos , Fraturas dos Dentes/complicações , Avulsão Dentária/complicações , Dentição Permanente , Cavidade Pulpar/lesões , Doenças da Polpa Dentária/etiologia , Descoloração de Dente/etiologia , Fraturas dos Dentes/patologia , Fraturas dos Dentes/diagnóstico por imagem , Avulsão Dentária/patologia , Avulsão Dentária/diagnóstico por imagem , Radiografia Dentária , Coroa do Dente/patologia , Cavidade Pulpar/patologia , Cavidade Pulpar/diagnóstico por imagem , Doenças da Polpa Dentária/patologiaRESUMO
Abstract: Evidence shows the polymicrobial etiology of endodontic infections, in which bacteria and their products are the main agents for the development, progression, and dissemination of apical periodontitis. Microbial factors in necrotic root canals (e.g., endotoxin) may spread into apical tissue, evoking and supporting a chronic inflammatory load. Thus, apical periodontitis is the result of the complex interplay between microbial factors and host defense against invasion of periradicular tissues. This review of the literature aims to discuss the complex network between endodontic infectious content and host immune response in apical periodontitis. A better understanding of the relationship of microbial factors with clinical symptomatology is important to establish appropriate therapeutic procedures for a more predictable outcome of endodontic treatment.
Assuntos
Humanos , Periodontite Periapical/microbiologia , Cavidade Pulpar/microbiologia , Doenças da Polpa Dentária/complicações , Doenças da Polpa Dentária/microbiologia , Periodontite Periapical/patologia , Infecções Bacterianas/complicações , Infecções Bacterianas/microbiologia , Lipopolissacarídeos/fisiologia , Citocinas/análise , Citocinas/fisiologia , Metaloproteinases da Matriz/análise , Metaloproteinases da Matriz/fisiologia , Cavidade Pulpar/patologia , Doenças da Polpa Dentária/patologia , Endotoxinas/fisiologiaRESUMO
INTRODUCTION: Recently, case reports have shown that immature teeth diagnosed with necrotic pulp and periapical periodontitis can be repaired through a regenerative endodontic procedure. True regeneration depends on the presence of stem cells in the remaining vital tissues. The aim of this study was to evaluate the histologic condition of the pulp tissue, root apical papilla, and periapical tissues after inducing endodontic infection in immature rat teeth for different periods. METHODS: This study evaluated 18 first upper rat molars (36 roots). Periapical lesions were induced and were confirmed radiographically, and the animals were divided into 3 groups according to the days of pulp exposure for endodontic infection induction: 30, 60, and 90 days. Histologic analysis was performed in 5 different areas (ie, cervical, middle, and apical root canal thirds; the apical papilla; and the periapex surrounding the apical papilla). RESULTS: At 30 days, one third of the specimens still showed vital but intensely inflamed pulp tissue in the apical third and vital apical papilla with varying degrees of inflammation. After 60 days, the results were similar with respect to the apical pulp tissue and apical papilla. Completely necrotic pulp tissue in the space canal and vital apical papilla were observed in about 67% of the cases after 90 days. CONCLUSIONS: Vital pulp tissue was observed in the apical third until 60 days and in the vital apical papilla until 90 days of infection in a rat model.
Assuntos
Cavidade Pulpar/patologia , Doenças da Polpa Dentária/patologia , Polpa Dentária/patologia , Dente Molar/patologia , Tecido Periapical/patologia , Ápice Dentário/patologia , Animais , Exposição da Polpa Dentária/patologia , Necrose da Polpa Dentária/patologia , Leucócitos Mononucleares/patologia , Masculino , Neutrófilos/patologia , Doenças Periapicais/patologia , Pulpite/patologia , Radiografia Interproximal , Ratos , Ratos Wistar , Fatores de TempoRESUMO
Teniendo en cuenta el desconocimiento existente sobre las bases morfofisiopatológicas que caracterizan la respuesta inflamatoria aguda pulpar; conocimiento este que resulta imprescindible para tomar decisiones según se trate de enfermedades pulpares reversibles o irreversibles, tratables o intratables, tejidos para el recubrimiento y su conservación o pulpas que deben ser extraídas, se decidió describir las mencionadas bases en el presente artículo, con la finalidad de que se reflexione acerca de ello y se debatan los aspectos de mayor interés en relación con el tema.
Given the lack of knowledge on morphophysiopathological bases characterizing pulpar acute inflammatory response, which becomes essential knowledge to make decisions depending on reversible or irreversible and treatable or untreatable pulpar diseases, tissues for covering and preservation or pulps to be extracted, it was decided to describe the bases mentioned in this article in order to reflect on this and to discuss the aspects of greatest significance in relation to the topic.