C-reactive protein and serum amyloid A in a canine model of chronic apical periodontitis.

Increased levels of systemic inflammatory markers have been observed in patients with chronic dental diseases, such as marginal periodontitis. A canine model was used to determine if a systemic inflammatory response was evident during chronic apical periodontitis (CAP). Dental pulps in 10 dogs were exposed and infected with dental plaque to induce CAP. Blood samples were drawn preoperatively and postinfection when CAP was seen radiographically. In three of the 10 dogs, an intravenous challenge of Porphyromonas gingivalis A7436 was given subsequent to the development of CAP. An ELISA assay was used to measure the levels of C-reactive protein (CRP) and serum amyloid A (SAA) as markers of systemic inflammation. During CAP the levels of CRP and SAA were not statistically different from the preoperative values as determined by the Friedman test (p < 0.05). One dog, which had an unplanned trauma-induced laceration of the paw 2 days before blood sampling, showed a 40-fold increase in CRP. The 3 dogs challenged by intravenous P. gingivalis A7436 showed elevated levels of CRP, consistent with an acute phase response. These data demonstrate that the canine model provides a useful means for studying the systemic effects of apical periodontitis, and show that CAP is not associated with elevated CRP or SAA.

Success of an alternative for interim management of irreversible pulpitis.

BACKGROUND: Extraction and endodontic therapy are treatment options for irreversible pulpitis. Extraction often is chosen for financial reasons. The authors conducted a study to investigate an alternative interim therapy. METHODS: The authors recruited patients (N = 73) with irreversible pulpitis and whose teeth were restorable but who opted for extraction owing to financial reasons. After undergoing pulpotomy, the teeth were restored by random assignment with one of two intermediate restorative materials: Caulk IRM (Dentsply Caulk, Milford, Del.) (Group I, n = 38) or an IRM base with glass ionomer core (Fuji IX GP, GC America, Alsip, Ill.) (Group II, n = 35). The authors monitored the teeth over six and 12 months for pain, integrity of restoration and radiographic periapical status by densitometric analysis. RESULTS: By six months, 10 percent of subjects remaining in the study (Group I, n = 27; Group II, n = 25) reported pain; by 12 months, 22 percent (Group I, n = 22; Group II, n = 18) reported pain. A two-tailed Fisher exact test showed no significant difference (P > or = .05) between groups at either time interval. No apical radiographic change was noted in 49 percent of teeth at six months (Group I, n = 18; Group II, n = 19) and 42 percent at 12 months (Group I, n = 16; Group II, n = 15). Chi2 analysis demonstrated no significant differences (P > or = .05) between groups. Seven of 22 restorations in Group I and four of 18 in Group II required repair at 12 months with no statistical difference (chi2 analysis, P > or = .05). CONCLUSIONS: The interim treatment of eugenol pulpotomy using either restorative material reliably prevented pain for six months. For longer periods, both restorations may require repair. CLINICAL IMPLICATIONS: This option should preserve the integrity of the arch and extend the use of the tooth while the patient finds the means to finance complete endodontic treatment.