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Histological evaluationof teethwith

Histological evaluationof teethwith

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02/02/2013

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CASE REPORT
Histologicalevaluationofteethwithhyperplasticpulpitiscausedbytraumaorcaries:casereports
M. K. C
¸
als
¸
kan
1
, F. O«ztop
2
& G. C
¸
als
¸
kan
3
1
Department of Endodontology, School of Dentistry, Ege University,
2
Department ofPathology, Faculty of Medicine, Ege University,
3
Dental Health and Oral Hygiene Centre,Alsancak, I˙zmir, Tu¨rkiye
Abstract
C
¸
als
¸
kan MK, O«ztop F, C
¸
als
¸
kan G.
Histological evaluation of teeth with hyperplastic pulpitis causedby trauma or caries: case reports.
International Endodontic Journal 
,
36
, 64^70, 2003.
Aim
The purpose of this histological study was to examine teeth with hyperplasticpulpitis caused by trauma or caries.
Summary
The pulp tissue of one young permanent incisor with a complicated crown-root fracture and a hyperplastic pulpitis, which had been contaminated with oralmicroflora for 40 days, and pulp polyps from four permanent first molars whose crownswere destroyed by extensive caries were prepared for standard histological examination.Histologically, normal pulp tissue organization was observed in the tooth with acomplicated crown-root fracture in the cervical radicular region. Irregular calcificationwas seen in the coronal and radicular portion of the pulp in the four carious teeth withpulp polyps. Radicular pulp tissue in the middle and apical third of root canals beneathirregular calcification showed intensive fibrosis but was free from inflammatory cells.
Key learning points
Hyperplastic pulpitis is a type of irreversible chronic open pulpitis.
Youngpermanentteethwithhyperplasticpulpitiscausedbytraumaorcarieshaveagreatinherent defensive capacity to heal.
Keywords: caries, histologic evaluation, hyperplastic pulpitis, trauma
Received 17 January 2002; accepted 12 July 2002 
Introduction
Hyperplastic pulpitis is a type of irreversible chronic open pulpitis that occurs usually inyoung teeth where the pulp has been exposed by caries or trauma. It is asymptomatic,exceptduringmastication,whenpressureofthefoodbolusmaycausediscomfort.Thermal
Correspondence: Mehmet Kemal C
¸
alıs
¸
kan, Ege U¨niversitesi, Dis
¸
Hekimlig˘i Faku¨ltesi, Endodonti Bilim Dalı,Bornova Kampu¨su¨35100, I˙zmir, TU¨RKI˙YE (Tel.:
þ
90 232 3880328; fax:
þ
90 232 3880325;e-mail: calıskan@dishekimligi.ege.edu.tr).
64
International Endodontic Journal,
36
, 64^70, 2003
ß
2003 Blackwell Publishing Ltd
 
andelectricalsensitivitytestsmayelicitnormalresponses.Sometimes,itmaybeconfusedwithproliferatinggingivaltissue.Radiographsgenerallyshowalargeopencavitywithdirectaccess to the pulp chamber (Walton
et al 
. 1985, Grossman
et al 
. 1988, Smulson & Sieraski1989, C
¸
al
ı
s
¸
kan 1993; 1995).Histopathologically, a blood clot,
brin and in
ammatory cells may be present at the pulpsurface immediately after traumatic or carious pulp exposure, due to tissue trauma andmicrobial irritation. If treatment is delayed, the pulp may develop a proliferative (hyper-plastic) pulpitis (Brannstro
¨
m 1982). The surface of the polyp usually shows epithelializationand even para-keratinization depending upon the age of the polyp. The tissue in the pulpchamber is often transformed into granulation tissue, which projects from the pulp into thecarious lesion. There may be
brosis and calci
c degeneration in some areas of the coronalpulp, whilst the radicular pulp tissue may be healthy or contain few chronic in
ammatorycells (Walton
et al 
. 1985, Grossman
et al 
. 1988, Smulson & Sieraski 1989, C
¸
al
ı
s
¸
kan
et al 
.1997). However, no histological report of human pulp reaction to exposure, after compli-cated crown fracture has been published in the literature and there are only two experi-mental histological studies in monkeys on this subject. In these studies, pulpal changeswere characterized by a proliferative response, invariably associated with only super
cialin
ammationextendingnotmorethan2 mmfromtheexposuresiteafter7 days(Cvek
etal 
.1982, Heide & Mjor 1983).The depth of pulp in
ammation is a critical factor for pulp healing after pulpotomy (Cvek1994) because calcium hydroxide has no bene
cial effect on the healing of in
amed pulp(Tronstad & Mjor 1972). Depending on the size of the exposure, time elapsed after injuryand type of pulp exposure (cariously or traumatically), different levels of pulpal amputationhave been recommended, i.e. partial or cervical (Stanley 1989, Cvek 1994).The purpose of this study was to examine the histological changes in a complicatedcrown-root fractured tooth with hyperplastic pulpitis which had been previously contami-nated by the oral micro
ora and in four teeth with pulp polyps whose crowns had beencompletely destroyed by caries.
Materials and method
The report describes
ve teeth with hyperplastic pulpitis, in patients ranging in age from10 to 20 years, who presented at the Dental Clinic of Ege University, I
˙
zmir, Turkey forexamination and treatment. Clinical examination of one case revealed hyperplasticpulp tissue growing from a traumatic exposure site in a left maxillary central incisor,40 days afteranuntreated crown-rootfracture (Fig. 1a).Theother four teeth, all permanentmandibular
rst molars, had pulp polyps after complete coronal destruction by caries(Fig. 2a).Patients and/or parents stated that carious lesions had appeared in the molars severalyears before, but they had not previously received any treatment. The teeth responding toelectrical pulp testing were not mobile or tender to percussion, and gave no history ofspontaneous prolonged pain. Internal resorption or periradicular pathological changes werenot observed on radiographs (Fig. 1b). Whilst three of the carious teeth with pulp polypsshowed normal, mature roots, the fourth case showed short root formation withoutradiographic signs of periapical involvement (Fig. 2b). These carious teeth had been seenby an orthodontist who had recommended extraction. The patient with the complicatedcrown-rootfracturewasadvisedtoundergoorthodonticorsurgicalextrusionandrootcanaltreatment followed by a post, core and crown, but preferred extraction.The teeth were extracted and
xed in 10% neutral buffered formalin, decalci
ed in 1 Nnitric acid and embedded in paraf
n wax. Sections of 5
6
m
m were cut in a buccal
lingualplane and stained with haematoxylin and eosin for nuclear differantiation, Weigert von
ß
2003 Blackwell Publishing Ltd International Endodontic Journal,
36
, 64^70, 2003
65
 
Figure 1
(a) Lacerated gingival tissue and hyperplastic pulp tissue around the site of the maxillary left centralincisor in a case with complicated crown-root fracture untreated for 40 days after accident. The polyp iscovered by plaque. (b) Radiographic view of same tooth. (c) There is granulation tissue of pulp through theexposure (H&E stain:
Â
32). (d) Laminated matrix on the surface of the proliferated pulp tissue (H&Estain:
Â
100). (e) Chronic pulp in
ammation was found just beneath the exposure site (H&E stain:
Â
170).(f)CervicalradicularpulptissuebeneaththeregionshowninFig. 1(e)demonstratingnormaltissueorganizationwith odontoblastic layer and dilated functioning blood vessel (H&E stain:
Â
170).
66
International Endodontic Journal,
36
, 64^70, 2003
ß
2003 Blackwell Publishing Ltd

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