As the dental pulp is encased with a rigid, noncompliant shell, changes in pulpal blood flow or vascular tissue pressure can have serious implication for the health of pulp. Numerous studies have demonstrated that orthodontic force application may influence both blood flow and cellular metabolism, leading degenerative and/or inflammatory responses in the dental pulp. The aim of this case report is to present a case about tooth with chronic periapical abscess which showed normal vital responses. Excessive orthodontic force is thought to be the prime cause of partial pulp necrosis. Owing to remaining vital tissue, wrong dianosis can be made, and tooth falsely diagnosed as vital may be left untreated, causing the necrotic tissue to destroy the supporting tissuses. Clinician should be able to utilize various diagnostic tools for the precise diagnosis, and be aware of the endodontic-orthodontic inter-relationship.
Dental Pulp ; Dental Pulp Necrosis ; Periapical Abscess ; Tooth

OBJECTIVEThis study aimed to explore the period of endodontic treatment and the effects of periodontal-endodontic treatment for advanced periodontitis.

METHODSA total of 180 patients with advanced periodontitis participated in this clinical multicenter study. The respondents were randomly divided into an endodontic combined treatment (experimental) group and a periodontal treatment alone (control) group; each group consisted of 90 teeth. The control group received periodontal therapy only. The experimental group received periodontal therapy and root-canal treatment, and then pulp status was recorded. The cases were followed up at 1, 3, 6, and 12 months after treatment.

RESULTSOut of 90 teeth in the test group, 22 teeth had completely necrotic pulps, 45 teeth had partial necrosis (coronal pulp necrosis or root pulp necrosis), and 23 had vital pulp. Differences between clinical parameters in the control and experimental groups were not significant (P>0.05) before treatment but were significant after three months (P<0.05).

CONCLUSIONSPulp treatment for teeth with advanced periodontitis and dull pulp vitality can control the development of inflammation and thus benefit the healing of periodontal tissue.

Paraformaldehyde has been used in the past as a pulpotomy agent. However, it has a severe cytotoxic effect and may cause alveolar bone necrosis. Depulpin, a devitalizing agent containing 49% paraformaldehyde, is no longer used frequently due to its severe side effects. In the two cases described in the present study, Depulpin was used as a devitalizing agent during root canal treatment. It caused a gradual loss of sensibility in adjacent teeth, gingival necrosis, and osteomyelitis. This case report demonstrates the serious side effects of using a paraformaldehyde-containing paste as a devitalizing agent for pulp, particularly mandibular bone necrosis.
Dental Pulp Cavity ; Necrosis* ; Osteomyelitis ; Pulpotomy ; Tooth

Although periapical inflammatory lesions are usually resulted by infection in the root canal system, this rare case showed that a periapical lesion related to an infected tooth may cause pulpal necrosis in adjacent intact tooth, with no history or clinical signs of caries, disease, trauma or developmental anomaly. This case also suggests that the periapical lesion can be treated conservatively, without surgical intervention. Furthermore, this case highlights the importance of prompt treatment of apical periodontitis before the lesion becomes extensive as well as follows up of large lesions.
Bicuspid ; Dental Pulp Cavity ; Dental Pulp Necrosis ; Necrosis ; Periapical Periodontitis ; Tooth

It is often presumed that apical periodontitis follows total pulp necrosis, and consequently root canal treatment is commonly performed. Periapical lesion development is usually caused by bacteria and its byproduct which irritate pulp, develop pulpitis, and result in necrosis through an irreversible process. Afterwards, apical periodontitis occurs. This phenomenon is observed as an apical radiolucency in radiographic view. However, this unusual case presents a spontaneous healing of periapical lesion, which has developed without pulp necrosis in a vital tooth, through conservative treatment.
Bacteria ; Dental Pulp Cavity ; Dental Pulp Necrosis ; Necrosis ; Neurogenic Inflammation ; Periapical Periodontitis ; Pulpitis ; Tooth

Pulpal and periapical diseases are the most prevalent dental conditions damaging the oral health of children in China. In view of China's national condition, the level of diagnosis and treatment for pulpal and periapical diseases of deciduous teeth is uneven and clinically there are inconsistent standards on the selection of operation methods for the endodontic treatment in deciduous teeth. Targeting these problems, the Society of Pediatric Dentistry, Chinese Stomatological Association organized experts from several famous universities and hospitals in China to carry out a panel discussion. The results of domestic and overseas researches and diagnosis and treatment experiences on dental pulp disease and periapical disease of deciduous teeth were also referred to. The present guideline was finally developed for the reference of dental clinicians.
Child ; Dental Care ; Dental Pulp ; Dental Pulp Necrosis ; Humans ; Periapical Diseases ; Tooth, Deciduous

Patients with diabetes mellitus show delayed wound healing and increased susceptibility to infection. Therefore, the effects of diabetes on pulpal and periodontal healing should be taken into consideration when treating diabetic dental traumatized patients. This case presents the treatment for dental traumatized 20 yr old female with uncontrolled type II diabetes. The traumatized upper central incisors had showed pulpal healing in early days. However, 7 mon after the trauma, the teeth had been diagnosed with pulp necrosis with apical abscess. Eventually, non surgical root canal treatment on the teeth had been performed.
Abscess ; Dental Pulp Cavity ; Dental Pulp Necrosis ; Diabetes Mellitus ; Female ; Humans ; Incisor ; Tooth ; Wound Healing

In order to examine the effects of advanced periodontitis on the dental pulps, 38 extracted human teeth were examined histologically. The 38 teeth had a positive or negative state in the electric pulp test(EPT). In addition, almost of the 38 teeth had a deep pocket and severe mobility, and floating state. A medical and dental history was elicited. The extracted teeth fixed in 10% neutral formalin solution. The general tissue processing method was followed. The tissue block including the teeth was prepared for optical microscopy using hema- toxillin-eosin staining. Among the 38 periodontally involved teeth, the dental pulps were respectively intact in 12(31%), and a pulp stone(or linear calcifications) was found in 18 teeeth(47%). In addition, 17 teeth(44%) had pulps exhibiting inflammatory reactions with varying intensities, such as hyperemia, pulp abscess, pulp necrosis. Among the 38 periodontally involved teeth, 37 teeth tested a positive to the EPT, and 7 teeth tested negative. The EPT positive 37 teeth had various histological features such as 7 normal pulp(18%), 17 pulp stone(44%), 1 hyperemia (2%), 9 pulpitis(23%), 5 root resorption(13%), 3 pulp abscess(7%), and 3 pulp necrosis(7%). In conclusion, it is suggested that in the EPT positive teeth, advanced periodontally involved teeth can cause inflammation of the dental pulp.
Abscess ; Dental Pulp Necrosis ; Dental Pulp* ; Formaldehyde ; Humans ; Hyperemia ; Inflammation ; Microscopy ; Periodontitis* ; Tooth

Dental trauma could be largely classified into three groups: Hard tissue injuries, pulp injuries and periodontal tissue injuries. Since pulp injuries are reported in tooth fracture, displacement and avulsion, it is commonly thought that pulp injuries were involved in almost every type of dental injuries. The sequelae of pulp tissue after dental injuries include pulp survival, pulp calcification and pulp necrosis. Dental trauma mostly occurs in 7-15 year-old children. The treatment and prognosis of dental trauma in children are more complicated than those in adults because of the developmental nature of the young permanent teeth. The evaluation of pulp damage and treatment after dental injuries in growing young permanent teeth are discussed in this paper.
Adult ; Child ; Dental Pulp ; Dental Pulp Necrosis ; Dentition, Permanent ; Humans ; Incisor ; Tooth Fractures

In the root fracture, pulp necrosis tends to involve only the coronal fragment, while the pulp in the apical fragment remains vital. The prognosis of endodontic treatment of the apical fragment is poor due to the possibility of overfilling of the space between the fragments and difficulty in removing necrotic tissue.In the present cases, endodontic treatment of the apical fragment of root fracture was performed. However, in reendodontic treatment, resistance was felt at the fracture site and access to the root canal in the apical fragment was difficult. Therefore, the calcium hydroxide was periodically exchanged only in the coronal fragment without further treatment in the apical fragment and the canal of the coronal fragment was finally filled with Gutta-percha.Regular observation revealed no radiologic complications in the apical fragment. In some cases, we can observe good healing pattern such as absorption of calcium hydroxide and pulp canal obliteration of apical fragment in the long term.
Absorption ; Calcium Hydroxide ; Dental Pulp Cavity ; Dental Pulp Necrosis ; Gutta-Percha ; Prognosis ; Tooth