Histopathological Investigation of Dental Pulp Reactions Related to apical periodontitis

Abstract

Background:
Apical periodontitis is a common inflammatory disorder primarily caused by microbial invasion of the dental pulp, leading to subsequent periapical tissue changes. The histopathological assessment of pulpal reactions can provide critical insights into the progression and extent of inflammation associated with apical lesions.

Materials and Methods:
This study was conducted on 30 freshly extracted human teeth indicated for extraction due to advanced carious lesions and signs of apical periodontitis. The samples were fixed in 10% buffered formalin, decalcified in 10% formic acid, embedded in paraffin, and sectioned at 5 μm thickness. Hematoxylin and eosin (H&E) staining was performed to evaluate pulpal changes. Histological parameters assessed included degree of inflammation, pulp necrosis, presence of calcifications, and fibrosis. Descriptive and inferential statistics were applied using SPSS software (version 25.0).

Results:
Out of 30 samples, 23 (76.7%) exhibited chronic inflammatory cell infiltration, 19 (63.3%) showed partial or complete pulp necrosis, 12 (40%) demonstrated dystrophic calcifications, and 9 (30%) revealed fibrotic changes. Severe inflammation was more frequently associated with apical granulomas than cystic lesions (p < 0.05). Calcifications were predominantly seen in older patients.

Conclusion:
The dental pulp undergoes significant degenerative and inflammatory changes in response to apical periodontitis, with varying degrees of necrosis, fibrosis, and calcification. Histopathological evaluation aids in understanding the pathophysiological alterations and supports the clinical diagnosis of pulpal-periapical diseases.