Dental Pulp Ch16
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Dental pulp and periodontium are connected in three ways:
1. Exposed dentinal tubules
2. Smaller portals of exit
3. the apical foramen
Number of dentinal tubules varies from approx ______mm2 at the CDJ to _______mm2 at the pulpal end.
Cervical area of the root the number of dentinal tubules is about _____mm2
Dentinal exposure at the CEJ occurs in about __% of the teeth in general and in __% of anterior teeth in particular.
It is estimated that __-__% of all teeth have ancillary canal systems, and the majority are found in the _______.
- apical third of root
De Deus reported what?
17% of teeth presented multiple canal systems in the apical third
about 9% middle third
2% coronal third
Kirkham reported what?
1000 teeth studied with perio disease
2% of ancillary canals assoc. with perio pocket
Incidence of accessory canals?
connect to periodontium with connective tissue and vasculature
How can periodontal disease be degenerative on the pulp, findings of pulp?
Increase in calcification
Kakehashi, Moller, and Korzen?
all three found that microorganisms key to pulpal and periradicular infections
What did Jansson find?
Denuded dentin had 20% more epithelium downgrowth in necrotic canals, augments periodontal disease, deeper pocketing around necrotic teeth
Jansson in 3 year retrospective study findings?
Patients with endondontic treatment failures had 3 times greater marginal bone loss, assoc with more attachment loss in furcation
Change of microbiota in root canal over time, from what to what?
Proteolytic to anaerobic
Where are spirochetes usually found?
What spirochete species are usually found in root canals?
T denticola and T maltophilum
What is the main virulence factor of maltophilum?
its rotating flagella
isolated in patients with rapidly progessing periodontitis
Bacteria without cell walls named?
Prevalence of fungi in untreated root canals and in previously treated canals?
- highest incidence at 55%
C albicans has been detected in __% of infected root canals.
Name some factors affecting colonization of root canals by fungi
certain IC meds
local or systemic abx
Previous unsuccessful endo
poor asepsis during tx
__% of patients with adult periodontitis also harbor subgingival fungi
presence in root canal directly assoc with presence in mouth
Human CMV was observed in __% of period pockets and __% of gingival tissues.
EBV Type I observed in __% period pockets and in __% of gingival tissues
Biofilm microcolonies are composed of __% cells embedded in __% matrix material.
convective flow, water channels carry bulk fluid
Describe foreign body reaction microscopically?
giant cells surrounding foreign material in a chronic inflammatory infiltrate.
Mechanical or surgical removal is tx
What is an epitheliated granuloma?
rests of Malassez that begin making epithelium attempting to wall off irritants, all surrounded by chronic inflammation
What is a bay cyst?
Chronic inflammatory lesion in which an epithelial lining surrounds lumen that has DIRECT communication with apical foramen
a true cyst does not communicate, meaing needs surgery, only 10%
What did Valderhaug find?
No cyst formation until tooth was 6 months necrotic
Incidence of cholesterol clefts?
How are the cholesterol crystals formed?
released by dieing blood cells from stagnant BVs, by lymphocytes, plasma cells, plasma lipids, dieing macrophages
What are russel bodies, incidence?
spherical accumulations, esinophilic substance within or near plasma cells and other lymphoid cells
caused by production of excess amts of secretroy protein
What are rushton hyaline bodies? Incidence?
keratinous or blood origin, secreted by odontogenic epithelium, degenerated blood cells
What are charcot-leyden crystals?
Naturally occuring hexagonal pyramidal crsytals
intracellular granules of eosinophils and basophils
activated macrophages may have role
What did Madison and Wilcox find?
root canals exposed to environment allowed coronal leakage
What did Ray and Trope find?
Defective restoration and good endo had a high incidence of failure
AR and GE 9% failure
PR and PE 82% failure
What did Saunders and Saunders find?
Packing excess GP and sealer over the floor of pulp chamber did not provide a better seal
Long-term prognosis of endo treatment review of lit factors:
- 1. post prep/cement RDI
- 2. heated plugger use for post space
- 3. min of 3mm material beneath post
- 4. irrigate post space/ dressing
- 5. leak-proof restoration ASAP
- 6. Retx if coronal seal broken >3 months
Root fracture splinting?
flexible splinting up to 12 weeks. RCT not necessary until vitality testing shows otherwise
Extrusive luxation treatment?
repositioning and splinting for 2 to 3 weeks
Lateral luxation with bone fragment movement, time of splinting?
up to 8 weeks
Metallic sound, open apex may reerupt
closed apex, initiate RCT
Prognosis of perforation factors?
depends on location and size
degree of perio damage
time of dx and tx
sealing ability and biocomp of material used
Pathogens found in CAP and Chronic adult periodontitis
Why are biofilms hard to cultivate using standard methods?
Prolonged starvation induces loss of culitvability
Presence of viruses in pulp was reported by who with what virus?
AIDS, Glick 1989
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