Influence of different endodontic methods of treatment upon the process of apical closure of immature pulpless human teeth and the structure of the newly formed calcified tissue in apical opening.

A description is given of the pathohistological structure of the calcified tissue in the apical opening of four extracted immature pulpless human teeth treated by various endodontic methods. It is concluded that in the tooth treated by mortal extirpation there was neither histological healing nor any tendency for further apex formation. In both the tooth where vital extirpation was performed and in one of the teeth treated as apical periodontitis, the apices were formed from conglomerates of different calcified tissues, identical to the tissue which was formed under comparable conditions in experimental dogs. In the fourth human tooth also treated as apical periodontitis after treatment the apical opening closed with irregular dentine tissue. In this study consideration was given to the problem of the origin of the odontoblasts which co-exist with the hard destructive process present in some pulpless teeth. It is concluded that in the case presented in this study the irregular dentine was formed by the same odontoblasts which took part in the process of normal odontogenesis. This fact, should be respected in the course of endodontic treatment of immature pulpless teeth.

Periodontal cell migration into the apical pulp during the repair process after pulpectomy in immature teeth: an autoradiographic study.

The migration of dental papilla cells into the periodontium during the process of root development may occur as part of the process involved in the formation of the periodontal tissues. The question posed is whether such cells under pathological conditions could retromigrate from periodontium into dental pulp and together with other apical pulp cells of immature teeth, take part in the production of additional dental tissue, e.g. 1) the tertiary/dentine under deep carious lesion where odontoblasts had been destroyed 2) the dentine bridge on an amputation wound and 3) calcified tissue which closes an apex during the apexification process in immature teeth. The migration of periodontal cells locally marked by H3 thymidine immediately after partial pulpectomy in immature dog's teeth was analysed at observation periods of 2, 24 and 50 h and also without H3 thymidine labelling of periodontal cells 8 weeks after pulpectomy. The marked cells were found in the early observation periods after pulpectomy just in the places where the hard tissues were formed in the later observation period of 8 weeks. They were found in large numbers just around the coagulated necrotic foci. The finding supports the assumption that firm necrotic masses are a very important stimulative factor in the reparation process in pulp and periodontium. The experiment also corroborated the existence of periodontal cell retromigration into apical dental papilla of immature teeth. Future research should assess the possible role of the pathological condition in the determination of undifferentiated odontogenic ectomesenchymal periodontal cells into odontoblasts.

Bacteria and pulpal reactions under silicate cement restorations.

Silicate cement was inserted in deep unlined cavities in 70 human teeth; 35 cavities were cleaned with an antibacterial cleanser, and the other 35 cavities in the contralateral teeth were treated with water spray only. In all teeth, invasion of bacteria from the tooth surface was prevented with a surface seal. Histologic examinations after 4 weeks revealed bacterial growth on dentinal walls in 9 of the uncleaned and in 2 cleaned cavities. Only in these 11 teeth was an inflammatory reaction seen in the pulp. Under eight cavities without bacterial growth and with silicate cement placed directly on an exposed pulp, no serious injury and no inflammatory reactions were observed. It was concluded that silicate cement per se does not seriously irritate the pulp. Infection of cavity walls should be avoided, not only by removing grinding debris and antibacterial cleansing, but also by use of a liner to prevent invasion of bacteria from the surface of the tooth.