Pulp and Periodontium Pathological Changes PDF

The pathological changes in the pulp and periodontium Dr. Herczegh Anna PhD Helyreállító Fogászati és Endodonciai Klinika The pulp What is the role of the pulp? Dentin health maintainer and restorer Provides the teeth sensitivity, circulation Composition 75% wate...

The pathological changes in the pulp and periodontium Dr. Herczegh Anna PhD Helyreállító Fogászati és Endodonciai Klinika The pulp What is the role of the pulp? Dentin health maintainer and restorer Provides the teeth sensitivity, circulation Composition 75% water 25% organic and water-soluble inorganic substances Connective tissue that fills the root canal and pulp chamber Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor The pulp Pulp matrix III, I, V type collagen fibers (III: gives flexibility, I: provides the tensile strength, V: characteristics to mesenchymal tissue Base: proteoglycan It has high water absorption and ion binding capacity Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor The pulp Blood supply Artery and vein, alveolar superior, inferior branches Organizing into artelioli and venules Toward the surface it forms a capillary network Maintaining odontoblasts Regulation of liquid level Excess interstitial fluid drained through the lymphatic system Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor The pulp Innervation N. trigeminal (sensory fibers) Gl. Cervical superior sensory fibers A-beta axon (small amount) palpation, pressure A- delta axon (2,000 / tooth) leads the sharp localized pain C axon (300 / tooth) leads the dull diffuse pain rises from thermal, mechanical and chemical stimuli a fiber network forming under odontoblasts layer some of the fibers reach the dentinal tubules Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor The causes of pathological changes in the pulp Irritations 1. Mechanical dental preparation made with insufficient cooling, high restorative, orthodontic treatment, improper scaling and curettage 2.Chemical alcohol, hydrogen peroxide, pulp base or its lack, too long time acidizing, inappropriate acid washing Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor The causes of pathological changes in the pulp Bacterial From the crown (caries) From the side canals (periapical space) From apex (retrograde) Inflamation can be endodontic periodontal 0 mixed E.fm Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  The pathological changes in the pulp What marks it? Discomfort pain bighele Patient side: Discomfort, pain, big hole in the tooth Dentist side: Extensive caries, tooth discoloration, patient complaints Dis comfort bighole intheteeth pain Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor The pathological changes in the pulp irritation → tissue inflammation starts process is reversible or irreversible the symptoms vary with the progression In pulp tissue: acute or chronic inflammation, partial or complete necrosis Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor The pathological changes in the pulp Reversible pulpitis Irreversible pulpitis Hyperplastic pulpitis (pulp polyp) Pulp necrosis Pulp calcification Internal resorption Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  Reverzible pulpitis Etiology caries dental procedures (mechanical, chemical) cervical erosion, high abrasion Symptom cold, warm, salty, sweet stimuli occur the pain, well be localize run off after removal of the stimulus Process pulp tissue damage is reversible inflamation affects only the pulp tissue exudate is draining (Starling hypothesis) anteriovenosus anastomozy Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Reverzible pulpitis Sensitivity test Cold + (stronger than test tooth) Warm – Percussion – Rtg It does not give X-ray image, it may indicate the depth of caries Treatment avoid irritating factors deep caries supply if necessary, pulp capping Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  Irreverzible Pulpitis Etiology the persistence of inflammation caries reaches the pulp, the effect of their toxins dental preparation, trauma Symptom spontaneous, radiant, unlocalized pain lying position (!) Process pain depends on the nature of inflammation or degree of necrosis Acute inflammation: intense, excruciating, unbearable spontaneous pain, throbbing in the lying position (due to vascular causes), cold stimulation intensifies the pain Chronic inflammation: pain decreases, throbbing, dull (inflammation turns into necrosis), cold sensitivity ↓ warm ↑ in proportion to the extent of necrosis (bacterial infection derives gas) With an open pulp chamber pain is uncertain Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Irreverzible pulpitis Sensitivity test Pain after termination of stimulus Cold + Warm -/+ depends from the necrotic part Percussion – ( + if it reaches the periodontitis) Rtg No rtg sign In advanced form the periodontal ligaments widened Treatment root canal treatment: one seat in case serous (acute) cases, two seat in case purulent (chronic) or if medicine is necessary! Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Hyperplastic pulpitis Etiology Proliferative form of irreversible pulpitis (mainly in childhood, wide pulp chamber) Symptom No symptom (exudate draining) Or symptoms of irreversible pulpitis Clinical appearance Livid red formula is overgrown into carious cavity (must be isolated from gingiva!!!) Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Hyperplastic pulpitis Sensitivity test Response to stimulus similar to the intact tooth Rtg No rtg sign Histology granulation tissue Treatment Pulpotomia, if the apex is still open Root canal treatment (blood cause problem) Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Pulp necrosis Etiology Irreversible pulpitis trauma Incorrect orthodontic treatment Symptoms usually asymptomatic warm cause pain (in case of a closed cavity → gas of bacteria percussion can cause pain Process veins, lymph vessels are compressed circulation stops necrosis Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Pulp necrosis Clinical appearance Gray teeth discoloration Sensitivity test cold– warm + Percussion – , if it leads to the periapical space+ Rtg No rtg sign Treatment Root canal treatment (one or two sites → infected or not) Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Inside resorption Etiology inflammation of the pulp (pulpitis chronica or granulomatosa clausa, Palazzi's granuloma) immune cells in the granulation tissue and dentinoclasts break down the inside dentin Symptom asymptomatic purple patch on the crown Process Progressive Clinical appearance pink discoloration Sensitivity test response similar to the intact tooth in general, it will retain their vitality Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Inside resorption Rtg Radiolucens laesio inside the root Treatment Rootcanal treatment ( rapidly) Warm gutta-percha technique, MTA Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Pulp calcificatio Etiology Advancing age Persistent stimuli (eg. caries) calcification Secondary dentin formation →the cavity system narrows At the end of the root cement apposition → foramen apical narrowing reduction in amount of blood flow →arteriosclerotic changes The number→ of cellular elements is decreasing → collagen bundles can be detected → pulp fibrosis number of blood vessels and nerves decreasing → dentin permeability↓ Symptom Asymptomatic Process Progressive Clinical appearance the crown may be discolored ( yellowish) Sensitivity test No response for stimuli or reduced Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Pulp calcificatio Rtg pulp chamber and root canal narrowing, obstruction pulp stones calcification metamorphosis Treatment If it is necessery rootcanal treatment Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  Differencial diagnosis Dentin sensitivity The pain is similar to reversible pulpitis But the pain is caused by a hydrostatic pressure difference in the dentin which is mechanically irritates the nerve endings Irreversible pulpitis need to be allocated from periapical inflammation in case of apical periodontitis there is axial percussion sensitivity in case of periapical abscess there is fistula the apical processes in general there are also x-ray findings Sinusitis thermal and electrical pain stimuli can not elicit in tooth typical symptoms of sinusitis are present: pain when you drive forward the head and pressure cause pain in the front wall of the maxilla Unlocalizable pain separation from: jaw, neuralgic pain, otitis media, osteomyelitis, inflammation of the parotid Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Periodontal diseases Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Acute apical periodontitis Etiology Pulp necrosis Pulp inflammation reach the periapical tissue Endodontic procedure Paradontal process Symptoms Intense pain bite on it or touch to biting inflammation→edema fluid → pressure on the nerve Elongation (feeling) Process Depends from virulence and exposure time Stronger infection than the body’s defenses→ intense acute inflammation Increased edema fluid → pain Untreated case→abcessus Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Acute apical periodontitis Sensitivity test Cold – Warm can be+ Palpation: the tooth can be movable Percussion: Intense pain Do not use it !!! Rtg Negative Root membrane gap widening ( after10-12 days) Positive, after chronic inflammation : resorption bone defense Treatment Reduce occlusion Root canal treatment ( open???? close?????) 2 sites Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  Chronic apical periodontitis Etiology Permanent presence of moderate virulence bacteria Untreated pulp necrosis Incomplete rootcanal treatment (dead space) Periodontitis apicalis acuta Symptom Discomfort for biting Process Chronical inflammation → reabsorption of lamina dura and spongiest asymptomatic or mild discomfort Sensitivity test Cold- , electrical stimulus- Warm: can be + ( closed tooth) Palpation, Percussion: can cause sensitivity Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Chronic apical periodontitis Rtg Destruction of periapical tissues Histology Granulomatic tissue + macrophag, histiocyta plasma cell Cyst: eosinophil fluid multilayered epithelium, connective tissue,, granulomatic cells Treatment Rootcanal treatment (1 or 2 sites) Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  Acute apical abscess Etiology Flare-up of a chronic process - the body reacts severely to irritativ factors from necrotized pulp. It rarely develops from an acute process. Symptoms Pain, systemic manifestation (fever, malaise, leukocytosis) Process Inflammation leads to abscess → melts or spreads diffusely in the periapical space. Sensitivity test No response to heat and electrical stimuli Palpation The tooth may become loose, swelling Percussion Intense pain, forbidden to use it Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Abscessus apicalis acuta Rtg Thickened ,widened root membrane gap, then a picture typical of chronic apical periodontitis. Histology Abscess PMN leukocyte Granulomatous tissue Purulent exudate Treatment Drainage Rootcanal treatment (Closing in 2 sessions?????) Antibiotic Oral surgeon Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  Chronic apical abscess (periodontitis apicalis suppurativa) Etiology abscess formation after pulp necrosis or periodontitis apicalis chronica Symptoms fistula → drainage → no pain Process Chronic apical abscess →fistula, parulis Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  Chronic apical abscess (periodontitis apicalis suppurativa) Sensitivity test no response to heat and electrical stimuli Rtg Similar to chronic apical periodontitis Histology Similar to chronic apical periodontitis + fistula Treatment Rootcanal treatment (1 site) Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Condensing osteitis Etiology Inflammation spreads into the root membrane gap Pulp necrosis or irreversible pulpitis cause it Persistent minor infection, mild toxin effect →local defense mechanism reduces inflammation Symptom Asymptomatic, discomfort Process Inflammation → Increased osteoblast activity → hyperossification Sensitivity test - Percussion - Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Condensing osteitis Rtg Irregular, diffuse, concentric radiopaque bone around the root apex, hyperossificacio It most often develops around the roots of lower molar teeth. Histology Irregular bone structure Treatment Rootcanal treatment Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor Differencial diagnosis Anatomical formulas: canalis mandibulae, foramen mentale, sinus maxillaris, foramen incisivum, Benign lesions that do not originate from the periodontium: cementoma, monostaticus fibroticus dysplasia, traumatic bone cyst, ameloblastoma, central hemangioma Malignant lesions not originating from the dental pulp: chondrosarcoma, myeloma Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  Dr. Herczegh Anna PhD Department of Restorative Dentistry and Endodontics associate professor  Thank you for your attention! Dr. Herczegh Anna PhD