Effect of Severe Periodontitis on Pulp: A Histopathological Study

Abstract

This study examines the histopathological changes in pulp tissue of teeth in periodontitis patients with deep pockets but no root damage. The study includes 68 teeth from 33 individuals diagnosed with stage 3 and 4 periodontitis (degree B and C) through clinical examination, periodontal assessment, and periapical radiography. The BRD criteria (Bacterial Invasion, Regenerative Parameters, and Degenerative Parameters) were used to evaluate sections (5μm). Participant demographics and histological parameters were expressed as percentages. Median periodontal values were presented, and Pearson's Correlation was analyzed. The study compared periodontal parameters with pulp histopathological data using a significance threshold of P<0.05. Of the patients who underwent extractions, 19 were female and 15 were male, with a mean age of 49.12±7.17 years (ranging from 18 to 65 years). All teeth had a mobility degree of three. There were 33 incisors and 35 single-rooted premolars. Degenerative parameters were observed in 95.6% of teeth, while regenerative parameters were observed in 47%.Bacterial invasion was observed in 5% of teeth. The study results suggest a relationship between pulp degeneration and the severity of periodontal disease. Pulp sensitivity had a moderately positive correlation with the severity of periodontal disease. A significant correlation was found between Clinical Attachment Level (CAL), which indicates the severity of periodontal destruction, and pulpal inflammation (rho=0.384 and P<0.05). Within the limits of this study, advanced periodontal disease has both regenerative and degenerative effects on the pulp. Therefore, when diagnosing and planning treatment for patients with advanced periodontitis, it is important to consider the presence of endodontic-periodontal lesions. It is also important to note that changes in the pulp of still vital teeth due to periodontal destruction can have an impact on the outcomes of periodontal treatment.

Keywords

• periodontitis
• pulp
• histopathology
• calcification
• pulp degeneration

Şiddetli Periodontitisin Pulpa Üzerine Etkisi: Bir Histopatolojik Çalışma

Abstract

Bu çalışmanın amacı periodontitis hastalarında, kök hasarı bulunmayan ancak tüm yüzeylerinde derin periodontal cebi bulunan dişlerde, pulpa dokusundaki olası histopatolojik değişiklikleri incelemektir. Bu çalışmaya, klinik muayene, periodontal değerlendirme ve periapikal radyografi sonuçlarına dayanarak, evre 3 ve evre 4 periodontitis ile derece B ve C tanısı konulan 33 bireyin periodontal yıkıma bağlı olarak çekilmiş 68 dişi dahil edildi. Her birinden bukko/lingual yönde alınan 5μm'lik kesitlerdeki pulpa alanları, Bakteriyel invazyon, Rejeneratif parametreler ve Dejeneratif parametreler (BRD) kriterlerine göre histopatolojik olarak değerlendirildi. Dişlerin ait olduğu bireylerin yaş, cinsiyet, histolojik parametrelerin dağılımları sayı ve yüzde olarak ifade edildi. Periodontal parametreler, medyan (aralık) değerleri olarak sunuldu. Periodontal parametreler ile pulpa histopatolojik verileri arasındaki korelasyonlar Pearson Korelasyonu ile incelendi. P<0,05 anlamlılık sınırı olarak kabul edildi. Çekimlerin yapıldığı hastaların 19’u kadın, 15’i erkek iken, katılımcıların yaş ortalaması 49,12±7,17 (18-65 yaş) idi. Tüm dişlerin mobilite derecesi üçtü. Dişlerin 33’ü kesici, 35’i tek köklü premolardı. Dişlerin %95,6’sında dejeneratif parametrelere rastlanırken, %47’sinde rejeneratif parametreler izlendi. Dişlerin 5’inde (%7,4) bakteriyel invazyon izlendi. Çalışmamızın sonuçları, pulpa dejenerasyonunun, periodontal hastalığın şiddeti ile ilişkili olduğunu göstermektedir. Pulpa duyarlılığı, KAS ile orta derecede pozitif bir ilişkiye sahipti (rho=0,269 ve P<0,05). Periodontal yıkımın şiddetini gösteren KAS ile pulpal enflamasyon arasında anlamlı korelasyon tespit edildi (rho=0,384 ve P<0,05). Bu çalışmanın sınırları dahilinde ileri periodontal hastalık pulpa üzerinde rejeneratif ve dejeneratif etkilere sahiptir. Bu nedenle, ileri periodontitisi olan hastalarda tanı ve tedavi planlamasında endodontik-periodontal lezyonlar dikkate alınmalıdır. Henüz vital olan dişlerin pulpasında periodontal yıkım nedeniyle oluşabilecek değişiklikler, periodontal tedavi sonuçlarını da etkileyebilir.

Keywords

• periodontitis
• pulpa
• histopatoloji
• kalsifikasyon
• pulpa dejenerasyonu

Ethical Statement

Bu çalışmanın araştırma protokolü, Süleyman Demirel Üniversitesi Tıp Fakültesi Araştırmalar Etik Kurulu tarafından onaylanmıştır (25.02.2021, 06/120).

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