Figure 3 - uploaded by Michele Bolan
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(A,B)Macroscopic aspect of the lesion. (C) Histological section of lesion (chronic abscess) stained by HE technique. Original magnification X66. Immunohistochemical staining for CD20+ cells (D,E,F), CD45RO+ cells (G), (F,G) CD68+ cells (H,I). Original magnification X33, X66, X132, X132, X33, X66 respectively.
Source publication
The periapical lesion is the result of a local inflammatory reaction caused by bacteria and its products present on the root canal. The interaction between inflammatory cells and bacteria elicit both specific and non-specific immune responses.
Due to the lack of studies evaluating the role of the immune system in periapical lesions of primary teeth...
Citations
... Macrophages [3,4], regulatory T lymphocytes (Tregs) [5], cytotoxic T lymphocytes [3], mast cells [6,7,8], and dendritic cells [9], among others, are present in periapical lesions of permanent teeth. However, the literature in this regard for the primary dentition is scarce [2,10,11]. ...
... Immunohistochemical studies evaluating periapical lesions in human primary teeth have been scarce. Bolan et al. [10] evaluated the presence of T and B lymphocytes and macrophages in periapical lesions, in general granulomas, epithelialized granulomas, acute abscesses, and chronic abscesses, of primary teeth and concluded that the humoral and cell-mediated immune response are important in these lesions. In a recent study by our research group [11] on the polarization of M1 and M2 macrophages in radicular cysts of human primary and permanent teeth, evaluated using immunohistochemistry, no signi cant difference was observed. ...
Objectives
To quantify mast cells, mature and immature plasmacytoid dendritic cells, mature and immature Tregs, cytotoxic T lymphocytes, and B lymphocytes, and hBD-3 expression in radicular cysts of primary and permanent teeth and to evaluate the relationship between radiographic lesion size and the intensity of hBD-3 staining.
Material and Methods
19 radicular cysts of primary teeth and 17 of permanent teeth were subjected to immunohistochemical analysis for quantification of immune and inflammatory response cells and for evaluation of hBD-3 and its relationship with the radiographic lesion size. The results were analyzed using D'Agostino & Pearson, Mann–Whitney, t-test, Kruskal–Wallis and Dunn's post-test, at 5% significance level.
Results
All the evaluated cell types were detected in all radicular cysts. Cysts of primary teeth showed higher expression of plasmacytoid dendritic cells (mature and immature), B lymphocytes, and T lymphocytes (p < 0.05), whereas those in permanent teeth showed higher expression of T lymphocytes, immature plasmacytoid dendritic cells, cytotoxic T lymphocytes, and B lymphocytes (p < 0.05). hBD-3 was expressed in primary teeth similarly in the capsule and epithelium (p > 0.05), whereas in permanent teeth the expression was higher in the capsule (p < 0.05). In primary teeth, hBD-3 expression in small lesions was higher than in large lesions (p < 0.05).
Conclusion
Immature plasmacytoid dendritic cells were the predominant cells in radicular cysts in primary teeth whereas T lymphocytes were more abundant in permanent teeth. hBD-3 was expressed in the epithelium/capsule in both primary and permanent teeth. In primary teeth, a direct relationship was observed between hBD-3 expression and radicular cyst size.
Clinical Relevance
The present study should provide a better understanding of radicular cysts, which would be useful for devising targeted treatment techniques and immunologically active materials for endodontic use.
... For a long time, bacterial infection in the dental pulp was considered to be the cause of periapical periodontitis [3]. However, humoural and cell-mediated immune reactions are also reported to be involved in the periradicular inflammatory processes in primary teeth [4]. In recent years, studies on chronic arthritis and periodontitis have suggested that multiple cytokines produced by both inflammatory and non-inflammatory host cells are involved in the mediation of bone resorption [5,6]. ...
Background:
Interleukin 1 (IL-1) is involved in bone resorption. However, the role of IL-1 in periapical lesions characterized by periapical bone destruction in primary teeth has not yet been fully elucidated. This study aimed to detect the distribution and expression of IL-1 in periapical lesions in primary teeth and assess the relationship between the cytokines and the degree of inflammatory cell infiltration.
Methods:
A total of 106 chronic periapical lesions in primary teeth were harvested. Haematoxylin and eosin (H&E) staining was used to determine the histological type and the inflammatory cell infiltration grade (mild, moderate, and severe), and immunohistochemistry and enzyme-linked immunosorbent assay (ELISA) were used to detect the distribution and expression of IL-1α and IL-1β.
Results:
Of the 106 chronic periapical lesion samples, there were 85 cases of periapical granuloma, accounting for 80.19% of the total samples, and 21 cases of radicular cysts, accounting for 19.81%; no cases of abscess were detected. Immunohistochemistry results showed that both IL-1α and IL-1β were expressed in periapical granulomas and cysts. ELISA results showed that IL-1α and IL-1β levels were higher in the periapical granuloma group than in the radicular cyst and normal control groups (P < 0.05). In the periapical granuloma group, IL-1α and IL-1β were detected at higher levels in the severe inflammatory cell infiltration subgroup than in the mild-inflammatory cell infiltration subgroup (P < 0.05), and IL-1β expression was also higher in the moderate inflammatory cell infiltration subgroup than in the mild inflammatory cell infiltration subgroup (P < 0.01). A significant positive correlation was observed between the protein expression levels of IL-1α and IL-1β and the inflammation grade in periapical granulomas from primary teeth (P < 0.05).
Conclusion:
Expression levels of the cytokines IL-1α and IL-1β in periapical granulomas from primary teeth increased with increasing inflammatory severity and appeared to be a contributing factor to the progression of periapical lesions.
... [25] Sometimes, agglomerations of bacteria detach from the bacterial biofilm, thus resulting in the so-called planktonic bacteria that can cause distant infections. [46] Despite the danger this infection can cause both locally [6][7][8][9][10][11][12]14,47] and to the child patient's general health, [15,16] some dental practitioners working with children still use protocols for endodontic treatment of primary teeth without biomechanical preparation. Consequently, the infection control depends on antiseptic substances only. ...
The aim was to assess the characteristics and outcomes of infections affecting the structures of carious primary molars.
Forty primary molars were used and classified according to the following clinical situation: With profound caries lesion, with bone loss at the furcation region, with perforation of the pulp chamber floor, and residual roots. The teeth were demineralized, cut, and stained with both haematoxylin-eosin and Brown and Brenn staining techniques. Assessment was performed using optical microscopy.
Statistical analysis of the data by means of the Chi-square test suggests that there was a significant relationship (P<0.001) between the intensity and localization of infection and the level of destruction of dental structures. A significant difference was also observed in the intensity and localization of infection between the groups regarding crown, furca, and root (P<0.001).
More intense and profound the infection, more severe is the dental destruction. The groups of residual roots showed the most severe bacterial infection compared to other groups.
Objectives
The objective of this study is to evaluate the potential factors that could influence the long-term survival of primary molars after pulpectomy with Vitapex.
Materials and Methods
A total of 212 primary molars underwent pulpectomy at the Department of Pediatric Dentistry from January 2018 to December 2020 were analyzed in this retrospective study. Kaplan-Meier analyses were utilized to evaluate time until failure. Multivariate Cox regression analysis was conducted to evaluate the clinical factors associated with failures.
Results
The survival rate was 86.8% at 12 months, declining to 49.5% at 24 months, and further decreasing to 3.3% at 48 months. In the multivariate Cox regression analysis, children aged 5 to 7 had a hazard ratio of 2.10 (P = 0.003), while those aged 7 or older had a significantly higher hazard ratio of 4.40 (P < 0.001) compared to children under 5 years old. Primary molars with a mucosal fistula have a 2.61 times (P = 0.004) higher risk of failure compared to those without this condition .
Conclusions
The age at initial treatment and the presence of a mucosal fistula before treatment are crucial factors for predicting the outcomes of Vitapex pulpectomy in primary molars and assessing the likelihood of treatment failure.
Clinical relevance
The apical seal and the extent of apical infection before treatment significantly impact survival rates following pulpectomy of primary molars. Evaluating these variables is crucial for evidence-based clinical decisions.
Background:
To retrospectively investigate the success rate of primary-molar pulpectomy performed under general anaesthesia and the potential risk factors that affect the 24-month success rate.
Methods:
The case data and two-year follow-up records of children (aged 3-6 years) who received pulpectomy in primary molars performed under general anaesthesia were reviewed and assessed. Potential risk factors included age, gender, decayed-missing-filled teeth, endodontic diagnosis, tooth location, and postobturation sealing of the pulp chamber floor with MTA. With a two-year follow-up period, the outcomes of all the primary molars were classified into success and failure. Survival analysis was used to assess the outcomes. The Kaplan-Meier method was used to analyse the success rate. Univariate and multivariate Cox proportional hazards regression models were used to evaluate the potential risk factors associated with the overall survival of primary molars.
Results:
A total of 410 teeth from 163 children (88 boys and 75 girls) were included in this study. The overall two-year success rate was 66.1% for all primary molars. The mean overall survival time for this study was 22.1 (95% CI, 21.73‒22.48) months. Multivariate Cox regression analysis demonstrated that endodontic diagnosis (irreversible pulpitis or periapical periodontitis), tooth location (maxillary or mandibular primary molar), and postobturation sealing of the pulp chamber floor (MTA or no-MTA) were significant risk factors for overall survival in this study (P < .05). The differences in success rates were not statistically significant in terms of age, gender, and decayed-missing-filled teeth (P > .05).
Conclusions:
When compared to teeth diagnosed with irreversible pulpitis, those with periapical periodontitis failed more frequently. Postobturation sealing of the pulp chamber floor with MTA improved the success rate of pulpectomy in primary molars, especially when the inflammation did not spread to the periradicular area.
Aim
To characterize plasma cell subsets in chronic periapical lesions affecting permanent and primary teeth.
Methodology
Only chronic periapical lesions without root canal treatment were selected. Twenty‐one radicular cysts and 7 periapical granulomas affecting permanent teeth and 19 radicular cysts and 4 periapical granulomas affecting primary teeth were assessed for immunoglobulin (Ig) light chain (kappa and lambda), Ig heavy chain (IgG, IgG4, IgA, IgM, and IgD), as well as plasma cell IHC markers (MUM1/IRF4, EMA, and CD138). The data acquired were analyzed by Student’s t test, Mann–Whitney U, Friedman test followed by Dunn's multiple comparison test and Spearman’s rank correlation.
Results
All cases were polyclonal (having similar kappa/lambda light chain ratio). IgG was most abundant compared to other Ig heavy chains (all, p<0.001); like Ig light chains, but unlike IgA, there was greater expression of IgG in the primary compared to the permanent dentition, for both radicular cyst (p<0.001) and periapical granuloma (p=0.53). Notably, IgG4 expression was greater in the permanent than the primary dentition, for both radicular cyst (p<0.05) and periapical granuloma (p=0.65). IgM and IgD expression was scarce and variable, whereas plasma cell populations were detected efficiently through EMA, CD138, and MUM1/IRF4 markers, the latter being more sensitive in both dentitions.
Conclusions
There were slight variations in the Ig light and heavy chain profiles in chronic periapical lesions when comparing the permanent and primary dentitions. The ability of IgG4+ plasma cell infiltration to modulate inflammatory responses in chronic periapical lesions arising from permanent as opposed to primary teeth should be considered in future studies.
Aim:
To quantify M1 and M2 macrophages in radicular cysts of permanent (n = 14 cases) and primary teeth (n = 15 cases).
Methodology:
All patients who attended the School of Dentistry Ribeirão Preto, University of São Paulo with primary teeth or permanent molars that were scheduled for extraction and fulfilled the inclusion criteria: absence of pain; presence/absence of fistulae; extensive coronal destruction due to caries lesions without possibility of restoration; pulp necrosis; radiographically visible apical periodontitis; and no previous treatment, were selected. The radicular cysts were removed and subsequently submitted to histopathologic analysis in order to classify the type of inflammatory infiltrate. In addition, CD68 (M1+, M2+) and CD163 (M1-, M2+) markers were quantified through an immunohistochemistry analysis. The data acquired were submitted to a Mann-Whitney test, with a 5% significance level.
Results:
The patients had a mean age of 38.6 years and 5.9 years for cysts associated with permanent and primary teeth, respectively. In the histopathological analysis, no significant difference (P = 0.87) was found between radicular cysts in primary and permanent teeth regarding the intensity of the chronic inflammatory infiltrate. A significantly greater prevalence of M2 macrophages (P < 0.05) was observed in the lesions of both permanent and primary teeth, even though both M1 and M2 macrophages were detected. No significant difference (P > 0.05) was found for M1 and M2 macrophages associated with the cysts of primary and permanent teeth.
Conclusion:
M1 and M2 macrophages were present in radicular cysts associated with primary and permanent teeth, with a greater quantity of M2 cells. The immunophenotypic quantification of M1 and M2 macrophage polarization in radicular cysts associated with primary and permanent teeth were similar.
