Abstract

The dentition has been suspect as an unfavorable influence in the healing potential of the jaws. Today, many surgical procedures are based on the supposition that teeth should be avoided, endodontically treated, or removed from the sphere of tissue infliction. On the other hand, and abundant blood supply and osteogenic capability have been recognized as favorable factors in repair.

An extra oral removal of an osteoid osteoma from the body of the mandible of a thirty-year-old female resulted in vital apicoectomies of her molar teeth as well as the removal of the medullary blood supply. An uneventful course of healing and periapical remodeling stimulated interest in an experiment which provided tissues for histological studies. A search of the literature revealed no in formation pertaining to non-treated vital apicoectomies. There was only suggestive information pertaining to centripetal blood flow potentials in the mandible. Five miniature pigs underwent similar procedures which are referred to as vital apical cortical marginal ostectomies. It was hypothesized that under normal surgical conditions, there would be healing resulting in vital dental pulps, remodeling of the apical hard and soft tissues, and recontouring of the bone under the functional influence of the masticatory apparatus. Care was taken to provide strict operating room protocol for a sterile technic. As in the human patient, intermaxillary fixation was not utilized. Four of the animals remained available for study and were sacrificed after a six month interval.

Gross findings revealed a general regeneration of bone In the surgical defect with no evidence of purulent exudates. On two of the animals, microscopic studies revealed pulp chambers occupied by vital tissues vascularized with arterioles, precluding healing by granulation tissue. Although these stromas consisted of a loose myxomatious connective tissue, there were essentially no other recognizable micromorphological characteristics ordinarily associated with the true pulp. A reparative mineralization (osteocementum) resembling pig cementum and also similar to human osteodentlne was observed In many pulpal wall areas, and many pulpal areas were associated with active blast cells. There was periapical remodeling. Indicating repair In the area ordinarily thought to be most vulnerable to toxic destruction. There was no evidence of regenerated nerve tissue. The roots of the teeth In the remaining two animals were Involved with further Injuries, but there was a tendency toward repair manifested by periapical remodeling with cementum and Sharpey's fibers and regeneration of bone In the surgical defect.

Apparently the same phenomenon observed In the mandible of the pig model and of the patient may occur In the maxilla. Inference to this was drawn from the successful removal of the blood and nerve supply plus the apices of the buccal roots of a molar tooth In a young male for a large Juvenile nasopharyngeal angloflbroma.

The experiment demonstrated a healing phenomenon heretofore - the ability of a tooth to maintain a vital pseudopulp following a complete vital apicoectomy. The pulpal metamorphosis having occurred without benefit of a medullary blood supply served to emphasize the healing potential following a central injury to the pulp. This repair together with the regenerated supporting bone served to reveal the collateral potential of the periodontium.

The results of this experiment suggest that the current concept pertaining to the role of blood supply and bacteria upon the surgically inflicted tooth and supporting structures be re-evaluated to accommodate possible variables.

The miniature pigs had a high degree of masticatory activity and a deficiency for postoperative cooperation. It would be reasonable to expect human repair to be associated with less superimposed trauma and inflammation, and therefore, to be less eventful. The potentials for human application of the vital apical cortical marginal ostectomy as a selective alternative to a mandibular or maxillary excision causing discontinuity of the jaws or to root canal therapy, and the possible applications to surgical orthodontics are intriguing and warrant further research.

Department

Dentistry

School

Graduate School

First Advisor

I. I. Rappaport

Second Advisor

Bernard C. Byrd

Third Advisor

Elmer E. Kelln

Degree Name

Master of Science (MS)

Degree Level

M.S.

Year Degree Awarded

1970

Date (Title Page)

8-1970

Language

English

Library of Congress/MESH Subject Headings

Surgery, Oral

Type

Thesis

Page Count

x; 108

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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