Marton Ildiko J
Department of Restorative Dentistry, Faculty of Dentistry, Medical and Health Science Center, University of Debrecen.
Fogorv Sz. 2007 Oct;100(5):200-9, 193-9.
In healthy condition, the periodontal space between the root surface and the alveolar bone is relatively poor in cells. In case of root canal infection however, large number of immune-inflammatory cells infiltrate the periapical region of the affected teeth. A major issue is if and to what extent microbial and host cells contribute to lesion formation and whether the local inflammation may impair general health. The question is important as it may fundamentally influence the therapeutic strategy in patients with apical periodontitis. The aim of this paper is to review the results of recent experimental and clinical observations that investigate the importance of cellular interactions in exerting protective and destructive effects in periapical inflammatory lesions. The majority of studies indicate that the lesion would not develop in the absence of permanent release of bacteria and their by-products from the infected root canal. On the other hand, the formation of the classical granulation tissue is dependent on the presence and proper function of host cells and regulatory molecules. The dynamic encounter of root canal microbiota and the local immune system prevents overwhelming bacterial infiltration of the periradicular space but it is also connected with degenerative changes, most importantly bone resorption, resulting ultimately in tooth loss. However, by the use of proper endodontic methods, the lesion can be successfully treated in the majority of cases. Remineralization of the lost hard tissue will occur or the lesion will transform into an inert periapical scar.
在健康状态下，牙根表面与牙槽骨之间的牙周间隙细胞相对较少。然而，在根管感染的情况下，大量免疫炎症细胞会浸润患牙的根尖区域。一个主要问题是微生物和宿主细胞是否以及在多大程度上促成病变形成，以及局部炎症是否会损害全身健康。这个问题很重要，因为它可能从根本上影响根尖周炎患者的治疗策略。本文的目的是综述近期实验和临床观察结果，这些观察研究了细胞相互作用在根尖周炎症病变中发挥保护和破坏作用的重要性。大多数研究表明，如果没有感染根管中细菌及其产物的持续释放，病变就不会发展。另一方面，典型肉芽组织的形成取决于宿主细胞和调节分子的存在及正常功能。根管微生物群与局部免疫系统的动态相互作用可防止细菌大量浸润根尖周间隙，但也与退行性变化有关，最重要的是骨吸收，最终导致牙齿脱落。然而，通过使用适当的牙髓治疗方法，在大多数情况下病变可以得到成功治疗。丢失的硬组织会发生再矿化，或者病变会转化为惰性根尖周瘢痕。
