Becerra Patricia, Ricucci Domenico, Loghin Simona, Gibbs Jennifer L, Lin Louis M
Department of Endodontics, Faculty of Dentistry, University Santo Tomás in Bogotá, Bogotá, Colombia.
Private Practice, Cetraro, Italy.
J Endod. 2014 Jan;40(1):133-9. doi: 10.1016/j.joen.2013.07.017. Epub 2013 Aug 31.
Histologic studies of teeth from animal models of revascularization/revitalization are available; however, specimens from human studies are lacking. The nature of tissues formed in the canal of human revascularized/revitalized teeth was not well established.
An immature mandibular premolar with infected necrotic pulp and a chronic apical abscess was treated with revascularization/revitalization procedures. At both the 18-month and 2-year follow-up visits, radiographic examination showed complete resolution of the periapical lesion, narrowing of the root apex without root lengthening, and minimal thickening of the canal walls. The revascularized/revitalized tooth was removed because of orthodontic treatment and processed for histologic examination.
The large canal space of revascularized/revitalized tooth was not empty and filled with fibrous connective tissue. The apical closure was caused by cementum deposition without dentin. Some cementum-like tissue was formed on the canal dentin walls. Inflammatory cells were observed in the coronal and middle third of revascularized/revitalized tissue.
In the present case, the tissue formed in the canal of a human revascularized/revitalized tooth was soft connective tissue similar to that in the periodontal ligament and cementum-like or bone-like hard tissue, which is comparable with the histology observed in the canals of teeth from animal models of revascularization/revitalization.
目前已有关于牙髓血管再生/牙髓复活动物模型牙齿的组织学研究；然而，缺乏人体研究的标本。人类牙髓血管再生/复活牙齿根管内形成的组织性质尚未明确。
对一颗患有感染性坏死牙髓和慢性根尖脓肿的未成熟下颌前磨牙进行牙髓血管再生/复活治疗。在18个月和2年的随访中，影像学检查显示根尖病变完全消退，根尖变窄但无根延长，根管壁增厚轻微。因正畸治疗拔除该牙髓血管再生/复活牙齿并进行组织学检查。
牙髓血管再生/复活牙齿的大根管空间并非空的，而是充满纤维结缔组织。根尖封闭是由无牙本质的牙骨质沉积引起的。在根管牙本质壁上形成了一些类牙骨质组织。在牙髓血管再生/复活组织的冠部和中三分之一处观察到炎症细胞。
在本病例中，人类牙髓血管再生/复活牙齿根管内形成的组织是类似于牙周膜的软结缔组织以及类牙骨质或类骨硬组织，这与牙髓血管再生/复活动物模型牙齿根管内观察到的组织学情况相当。
