Long Term Histological Response of Hemisectioned Exposed Primary pulps. An in vivo Study

The aim of this study was to analyze the pulp behavior 17 hemisectioned primary second mandibular molars, exposed into the oral environment. The mesial crown and root portions were extracted after 8 months and analyzed histologically. Results: The cardinal signs such as pain, sensitivity and necrosis were not found in any of these teeth with the exception of one case which had a previous restoration. The formation of pulp polyps, pulp calcifications and pulp obliteration were seen as a normal physio-pathological response. Conclusions:Exposed pulps, reacted forming pulp polyps and in a similar fashion to exfoliating primary teeth but in an accelerated manner.

dental pulp, primary teeth, hemisection, physiology, pulp polyps, pulp calcification, pulp stones

1. Miura M, Gronthos S, Zhao M, Lu B, Fisher LW, Robey PG, Shi S. SHED: stem cells from human exfoliated deciduous teeth. Proc Natl Acad Sci, 100: 5807–12, 2003.

2. Arora V, Arora P, Munshi AK. Banking Stem Cells from Human Exfo-liated Deciduous Teeth (SHED): Saving for the Future. J Clin Ped Dent, 33(4): 289–94, 2009.

3. Kopel H, Considerations for the direct pulp capping procedure in pri-mary teeth: a review of the literature. J Dent Child, 59: 141–9, 1992.

4. Huth KC, Paschos E, Hajek-al-Khatar N, Hollweck R, Crispin A,Hickel R et al, Effectiveness of 4 pulpotomy techniques-Random-ized controlled trial. J Dent Res, 84: 1144–118, 2005.

5. Milnes AR. Persuasive evidence that formocresol use in pediatric den-tistry is safe. J Can Dent Assoc, 72, 247–248, 2006.

6. Nogara Borges de Menezes JV, Takamori ER, Borro Bijella MFT, Granjeiro JM, In vitro toxicity of MTA Compared with other Primary Teeth. J Clin Ped Dent, 33: 217–222, 2008.

7. Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod, 16, 498–504. 1990

8. Grossman LI. Endodontic practice - 10th edition, Lea and Febriger, 297, 1982.

9. Prasanna Neelakantan and Subbarao CV. An analysis of the antimicro-bial activity of ten root canal sealers—A duration based in vitro evalu-ation. J Clin Ped Dent, 33(2):117–22, 2008.

10. Ferraz Cerqueira DF, Volpi Mello-Moura AC, Santos EM, Guedes-Pinto, AC. Cytotoxicity, histopathological, microbiological and clinical aspects of an endodontic iodoform-based paste used in pediatric den-tistry: A Review. J Clin Ped Dent, 32(2), 102–110, 2007.

11. Marchi JJ, De Araujo FB, et al. Indirect pulp capping in the primary dentition: a 4 year follow-up study. J Clin Pediatr Dent, 31: 68–71, 2006.

12. Bjorndal, LT, Larsen et al. A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment inter-vals. Caries Res, 31–6: 411–7, 1997.

13. Farooq NS, Coll, JA, et al. Success rates of formocresol pulpotomy and indirect pulp therapy in the treatment of deep dentinal caries in primary teeth. Pediatr Dent, 22: 278–86, 2000.

14. Casagrande L, Westphalen Bento L, Ossok Rerin S, de Resende Lucas E, Martini Dalpian, D, Borba de Araujo F. In vivo outcomes of Indirect Pulp Treatment using a Self-etching Primer versus Calcium Hydroxide over the Demineralized Dentin in Primary Molars. J Clin Ped Dent, 33: 133–136, 2008.

15. Subramaniam P, Konde S, Mathew S and Sugnani S. Mineral Trioxide Aggregate as Pulp Capping Agent for Primary Teeth Pulpotomy: 2 Year Follow Up Study. J Clin Ped Dent, 33(4): 307–10, 2009.

16. Sabbarini J, Mounir M, Dean J. Histological evaluation of enamel matrix derivative as a pulpotomy agent in primary teeth. Pediatr Dent, 29: 475–9, 2007.

17. Ishizaki NT, Matsumoto K, KimuraY, Wang X, Yamashita. Histopatho-logical study of dental pulp tissue capped with Enamel Matrix Deriva-tive. J Endod, 29(3): 176–9, 2003.

18. Garrocho-Rangel A, Flores H, Silva-Herzog D, Rosales-Ibañez R, Pozos-Guillen AJ. Direct Pulp Capping in Primary Molars with Enamel Matrix Derivative: Report of a Case. J Clin Ped Dent; 34-1, 2009.

19. Haskel EW and Harold RS Vital hemisection of a mandibular second molar. A case report. JADA, 102: 503–06, 1981.

20. Binns WH and Escobar A. Defects in permanent teeth following pulp exposure of primary teeth., J Dent Child, 37: 4–14, 1967.

21. Abdelhamied YS, Regressive changes of the dental pulp complex in retained primary molars with congenitally missing successor teeth. J Clin Ped Dent, 22: 63–67, 1997.

22. Morse DR. Age-related changes of the dental pulp complex and their relationship to systemic aging Oral Surg, 72: 721–745, 1991.

23. Cvek M. A clinical report on partial pulpotomy and capping with cal-cium hydroxide in permanent incisors with complicated crown frac-ture. J Endod. 4: 232–7, 1978.

24. Valencia R, Saadia M, Grinberg G. Controlled slicing in the manage-ment of congenitally missing second premolars. Am J Orthod Dentofac Orthop, 125: 537–43, 2004.

25. Ten Cate AR. Histología Oral; Desarollo, estructura y función 2ª ed Cap. 3 Estructura de los tejidos bucales pág 65-69 (1968).

26. JohnsenDC, Karlsson UL. Electron microscopy quantitations of feline primary and permanent incisor inervation. Arch oral Biol, 19, 671–674, 1974.

27. Pashley DH, Walton RE and Slavkin HC. Histology and physiology of the dental pulp Chapter 2. From http://dentistry.tums.ac.ir/Files/lib/My%20Web%20sites/Endo%20(E)/docs/ch02.pdf

28. Edwall L, Kindlova M. The effect of sympathetic nerve stimulation on the rate of disappearance of tracers from various oral tissues. Acta Odont Scand, 29: 387–391, 1971.

29. Fulton RS. Electron and light microscopic study of pulp polyps http://iadr.confex.com/iadr/2002SanDiego/techprogram/abstract_ 6582.htm

30. Freitas P, Novaretti CP, Rodini, CO, Batista AC, Lara VS. Mast cells and lymphocyte subsets in pulps from healthy and carious human teeth. Oral Surg, Oral Med, Oral Path, Oral Rad, & Endodon, 103(5): e95–e102, 2007.

31. Shaffer W, Hine M, Levy B and Tomich C. Tratado de Patología Bucal. 4º edición. Interamericana S.A. México. Cap 8, 1988.

32. Boyle PE. Kronfeld´s Histopathology of the teeth and their surround-ing structures. 4th ed. Philadelphia. Lea & Febiger, 75–107, 1955.