Barani Merita, Aliu Xhevdet, Ajeti Nexhmije, Asllani Lumturije
University for Business and Technology, Faculty of Dentistry, Pristina, Kosovo.
Saudi Dent J. 2023 Jul;35(5):540-546. doi: 10.1016/j.sdentj.2023.05.003. Epub 2023 May 10.
This study aimed to analyse the presence of pulpitis using different techniques and compare the findings of the various examination methods.
A total of 108 patients were enrolled and randomly divided into two groups: 56 patients whose pulp samples were sent for histopathological analysis and 52 patients whose samples were sent for microbiological analysis. All participants underwent endodontic procedures, with clinical evaluation and assessment using periapical radiography. Bacteria were isolated and identified using agar culture and VITEK 2 identification cards.
Histopathology confirmed chronic pulpitis in 33 samples (58.9%) and acute pulpitis in 23 samples (41.1 %). For chronic pulpitis, the histopathological diagnosis agreed with the clinical evaluation diagnosis in 65.2% of cases, and a similar percentage of agreement was observed for acute pulpitis. Chronic pulpitis was observed in 34.8% of patients on clinical examination; however, according to histopathology, these cases were acute. Dilated blood vessels were detected in 56.5% of patients with acute pulpitis and 15.2% of patients with chronic pulpitis. Neutrophilic leucocytes were observed in 43.5% of patients with acute pulpitis and 69.7% of patients with chronic pulpitis. Lymphocytes were observed in 17.4% of acute pulpitis samples but zero chronic pulpitis samples. Microbiological analysis identified gram-positive bacilli in 22 samples, gram-positive cocci in 51 samples, and fungi in 2 samples. Acute pulpitis was typically found to be associated with anaerobic , aerobic , and , whereas chronic pulpitis was more often associated with two facultative anaerobes, and .
Comparison of clinical, radiographic, and histological examination techniquesrevealed several notable discrepancies. Radiographic imaging only suggested the presence of pulpal pathologies; therefore, histopathological analysis of the pulp material was still ultimately required to verify the clinical diagnosis and exclude other pathologies. Although histopathology remains the gold standard for assessing pulpal disease, performing additional examinations may provide the most comprehensive, and perhaps the most effective, approach.
本研究旨在运用不同技术分析牙髓炎的存在情况，并比较各种检查方法的结果。
共纳入108例患者，随机分为两组：56例患者的牙髓样本送去进行组织病理学分析，52例患者的样本送去进行微生物学分析。所有参与者均接受了牙髓治疗程序，并通过根尖片进行临床评估。使用琼脂培养和VITEK 2鉴定卡分离和鉴定细菌。
组织病理学证实33个样本（58.9%）为慢性牙髓炎，23个样本（41.1%）为急性牙髓炎。对于慢性牙髓炎，组织病理学诊断与临床评估诊断在65.2%的病例中一致，急性牙髓炎的一致率相似。临床检查中34.8%的患者被观察到慢性牙髓炎；然而，根据组织病理学，这些病例为急性。在43.5%的急性牙髓炎患者和69.7%的慢性牙髓炎患者中观察到中性粒细胞。在17.4%的急性牙髓炎样本中观察到淋巴细胞，但慢性牙髓炎样本中为零。微生物学分析在22个样本中鉴定出革兰氏阳性杆菌，51个样本中鉴定出革兰氏阳性球菌，2个样本中鉴定出真菌。急性牙髓炎通常与厌氧菌、需氧菌和 有关，而慢性牙髓炎更常与两种兼性厌氧菌 和 有关。
临床、影像学和组织学检查技术的比较显示出一些显著差异。影像学检查仅提示牙髓病变的存在；因此，最终仍需要对牙髓材料进行组织病理学分析以验证临床诊断并排除其他病变。尽管组织病理学仍然是评估牙髓疾病的金标准，但进行额外检查可能提供最全面、也许也是最有效的方法。
