Effect of Severe Periodontitis on Pulp: A Histopathological Study

Öz

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.

Anahtar Kelimeler

• periodontitis
• pulp
• histopathology
• calcification
• pulp degeneration

Şiddetli Periodontitisin Pulpa Üzerine Etkisi: Bir Histopatolojik Çalışma

Öz

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.

Anahtar Kelimeler

• periodontitis
• pulpa
• histopatoloji
• kalsifikasyon
• pulpa dejenerasyonu

Etik Beyan

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

Kaynakça

1. [1] Papapanou, PN, Sanz, M, Buduneli N, Dietrich T, Feres M, Fine DH, Flemmig T, ve ark. 2018. Periodontitis: Consensus report of Workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of of Periodontoloji, 89(1), 173–182.
2. [2] Mazur B, Massler M. (1964). Influence of periodontal disease of the dental pulp. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 17, 592–603.
3. [3] Bender IB, Seltzer S. (1972). The effect of periodontal disease on the pulp. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 33, 458–74.
4. [4] Czarnecki RT, Schilder H. (1979). A histological evaluation of the human pulp in teeth with varying degrees of periodontal disease. Jounal of Endodontics, 5(8), 242-53.
5. [5] Torabinejad M, Kiger RD. (1985). A histologic evaluation of dental pulp tissue of a patient with periodontal disease. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology, 59(2), 198–200.
6. [6] Adriaens PA, De Boever JA, Loesche WJ. (1988). Bacterial invasion in root cementum and radicular dentin of periodontally diseased teeth in humans. A reservoir of periodontopathic bacteria. Journal of Periodontolology, 59(4), 222–30.
7. [7] Seltzer S, Bender IB, Ziontz M. (1963). The interrelationship of pulp and periodontal disease. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 1, 1474-90.
8. [8] Mandi FA. (1972). Histological study of the pulp changes caused by periodontal disease. International Endodontic Journal, 6(4), 80-3.

9. [9] Langeland, K. (1987). Tissue response to dental caries. Endodontics and Dental Traumatology, 59(4), 222–30.
10. [10] Sheykhrezaee MS, Eshghyar N, Khoshkhounejad AA, Khoshkhounejad M. (2007). Evaluation of histopathologic changes of dental pulp in advanced periodontal diseases. Acta Medica Iranica, 45(1), 51-7.
11. [11] Gautam S, Galgali SR, Sheethal HS, Priya NS. (2017). Pulpal changes associated with advanced periodontal disease: A histopathological study. Journal of Oral and Maxillofacial Pathology, 59(4):222–30.
12. [12] Terlemez A, Alan R, Gezgin O. (2018). Evaluation of the Periodontal Disease Effect on Pulp. Journal of Endodontics, 44(1), 111-114.
13. [13] Hattler AB, Snyder DE, Listgarten MA, Kemp W. (1977). The lack of pulpal pathosis in rice rats with the periodontal syndrome. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 44(6), 939-48
14. [14] Bergenholtz G, Lindhe J. (1978). Effect of experimentally induced marginal periodontitis and periodontal scaling on the dental pulp. Journal of Clinical Periodontology, 5(1), 59-73.
15. [15] Gomes BP, Pinheiro ET, Gadê-Neto CR, Sousa EL, Ferraz CC, Zaia AA, Teixeira FB, Souza-Filho FJ. (2004). Microbiological examination of infected dental root canals. Oral Microbiology and Immunology, 19(2);71-6.
16. [16] Zöllner A, Gaengler P. (2000). Pulp reactions to different preparation techniques on teeth exhibiting periodontal disease. Journal of Oral Rehabilitation, 27(2), 93-102.
17. [17] Rotstein I. (2017). Interaction between endodontics and periodontics. Periodontology 2000, 74(1), 11–39.
18. [18] Neves VCQ, Toledo BEC, Camargo GACG, Souza AA, Zuza EP. (2017). Determination of the Influence of CP on Pulp Sensibility by Means of Electric and Thermal Cold Testing. Journal of Endodontics, 43(11), 1802-1805.
19. [19] Zehnder M, Gold SI, Hasselgren G. (2002). Pathologic interactions in pulpal and periodontal tissue. Journal of Clinical Periodontology, 29(8), 663–71.
20. [20] Zuza EP, Carrareto AL, Lia RC, Pires JR, de Toledo BEC. (2012). Histopathological features of dental pulp in teeth with different levels of CP severity. International Scholarly Research Notices: Dentistry, 2012, 271350.
21. [21] Jansson LE, Ehnevid H.1998. The influence of endodontic infection on periodontal status in mandibular molars. Jounal of Periodontol, 6(12), 1392-6.
22. [22] Vongsavan N1, Matthews B. (1991). The permeability of cat dentine in vivo and in vitro. Archives of Oral Biology 36(9), 641-6.
23. [23] Pashley DH, Matthews WG. (1993). The effects of outward forced convective flow on inward diffusion in human dentine in vitro. Archives of Oral Biology, 38(7), 577-82.
24. [24] Fatemi K, Disfani R, Zare R, Moeintaghavi A, Ali SA, Boostani HR. (2012). Influence of moderate to severe CP on dental pulp. Journal of Indian Society of Periodontology, 16(4), 558‑61.
25. [25] Kipioti A, Nakou M, Legakis N, Mitsis F. (1984). Microbiological findings of infected root canals and adjacent periodontal pockets in teeth with advanced periodontitis. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 58(2), 213–20.
26. [26] Kobayashi T, Hayashi A, Yoshikawa R, Okuda K, Hara K. (1990). The microbial flora from root canals and periodontal pockets of non-vital teeth associated with advanced periodontitis. International Endodontic Journal, 23(2), 100–6.