Wound healing of apical tissues after root canal therapy: a long-term clinical, radiographic, and histopathologic observation study
Wound healing of apical tissues after root canal therapy: a long-term clinical, radiographic, and histopathologic observation study
复制标题
DOI：
10.1016/j.tripleo.2009.05.028
复制
发表时间：
2009-10-01
期刊：
影响因子：
--
通讯作者：
Spangberg, Larz S. W.
中科院分区：
文献类型：
--
作者：
Ricucci, Domenico;Lin, Louis M.;Spangberg, Larz S. W.
目标。这项研究的目的是评估51颗经过长期观察的人牙齿的牙髓愈合过程和牙本质-牙骨质复合体，并将组织学观察与传统的根尖周放射学发现相关联。标本取自77颗被认为是不可修复的治疗牙，在随访时没有证据表明根尖周骨损伤。经过严格的X线片评价，选出51例被3名独立评价者评定为正常根尖周情况的病例。采用连续切片对标本进行组织学评价。在大多数病例中，观察到完全愈合，剩余的根尖组织或牙周组织碎片没有急性或慢性炎症过程的迹象。部分病例根管组织呈中度炎症。牙骨质导致根管狭窄是大多数病例的常见表现，但未观察到根管完全闭合。碎屑与坏死组织和封闭剂颗粒混合在一起是牙髓残端的常见发现。几乎所有病例的牙根冠部均有细菌存在，但仅有1例牙根冠部和根尖部有细菌存在。经过适当处理的牙齿的根尖组织没有根尖周围改变的迹象，只有很少有明显的炎症。当组织发炎时，微生物的原因总是可以证明的。尽管几乎所有病例的冠部都有微生物存在，但根尖组织很少受到影响。《口腔外科》《口腔医学》《口腔病理学》《口腔放射学》2009；108：609-621)
Objective. The purpose of this study was to evaluate the pulp healing process and the dentin-cementum complex in 51 endodontically treated human teeth after long observation periods and to correlate histologic observations with conventional periapical radiographic findings.Study design. Specimens were obtained from the extraction of 77 treated teeth, which were deemed to be unrestorable, with no evidence of periapical bone lesion at the follow-up. After stringent evaluation of the radiographs, 51 cases that 3 independent evaluators assessed as having normal periapical conditions were selected. The specimens were histologically evaluated using serial sections.Results. In the majority of the cases, complete healing was observed, with no signs of acute or chronic inflammatory processes in the remaining apical tissue or periodontal tissue fragments. Some cases showed moderate inflammation in the root canal tissue. Narrowing of the apical root canal by cementum was a common finding in most cases, but total closure was not observed. Debris intermixed with necrotic tissue and sealer particles was a common finding in the pulp stump. Bacteria were present in the coronal portion of the root in almost all cases, but in only 1 case could bacteria be demonstrated in the coronal and apical portions of the root.Conclusions. Apical tissue of properly treated teeth with no signs of periapical changes is only rarely significantly inflamed. When the tissue is inflamed, microbial causes can always be demonstrated. Despite the presence of microorganisms coronally in nearly all cases, apical tissue is seldom affected. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 609-621)