ABSTRACT ÖZET

A hyperplastic pulpitis (pulp polyp) case was reported at the centre of a bridge abutment tooth associated with extensive caries and periapical radiolucency in a middle-aged female patient contrary to the fact that it usually develops in a large open cavity.

A 31-year-old-female patient had a bridge from 35 to 37 on her mandibular left side. She had discomfort in her mandibular left second molar.The bridge was removed. Radiographic and clinical evaluation reve-aled that a pulp polyp was associated with a radiolu-cent periapical involvement. Reddish cauliflower-like growth pulp was seen at the centre of her mandibular left second molar. Later, a root canal therapy was applied as treatment and the root canals were pre-pared with Profile rotary system and filled with gutta percha and AH26.

We report the diagnosis and treatment of a pulp polyp that proliferated under a bridge in a limited space, in contrast to the usual development in a large open cavity, and which was radiographically associ-ated with a radiolucent periapical involvement.

Genelde genç hastaların geniş, açık kaviteli dişlerinde gözlenen hiperplastik pulpitisin (pulpa polibi), peria-pikal radyolusensi gözlenen ve bir köprü ayağı olarak kullanılmakta olan orta yaşlı bir bayan hastanın dişin-de de geliştiğini gösteren bir olgudur.

31 yaşındaki hastanın alt çene sol ikinci küçük azıdan ikinci büyük azıya kadar uzanan köprüsü mevcuttu. Köprü ayağı olarak kullanılan sol alt ikinci büyük azı dişinde rahatsızlık hissi rapor edilmekteydi. Hastanın köprüsü çıkartıldı ve alışılmışın dışında, büyük karnı-bahar şeklindeki pulpa polibi alt çene sol ikinci büyük azı dişinin pulpa odasında görüldü. Radyografik ola-rak periapikal radyolusensi mevcuttu. Döner kanal genişletme aleti olan Profile ile kök kanalları şekillen-dirildi ve AH26 ve güta perka ile dolduruldu.

Genellikle geniş açık kaviteli dişlerde gelişmesine rağ-men, pulpa polibinin köprü ayağı olarak kullanılan bir dişte ve köprü altında sınırlı bir yüzeyde periapikal lezyon ile birlikte geliştiği gösterilmiş ve kök kanal tedavisi yapılmıştır.

Hacettepe Diş Hekimliği Fakültesi DergisiCilt: 32, Sayı: 1, Sayfa: 35-37, 2008

Hyperplastic Pulpitis Development in a Bridge Abutment Tooth

Köprü Ayağı olan bir Dişte GelişenHiperplastik Pulpitis

*Melahat GÖRDUYSUS DDS, PhD

*Hacettepe University Faculty of Dentistry Department of Endodontics

OLGU RAPORU (Case Report)

KEYWORDSAbutment, hyperplastic pulpitis, periapical involvement,

pulp polyp

ANAHTAR KELİMELERKöprü ayağı, hiperplastik pulpitis, periapikal

radyolusensi, pulpa polibi

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IntroDUctIon

Hyperplastic pulpitis is a type of irreversible chronic open pulpitis and occurs most often in young teeth with incompletely formed roots. It develops when carious pulp exposure creates a large open cavity. It is asymptomatic, except dur-ing mastication, when pressure of the food bolus may cause discomfort. Thermal and electrical sensitivity tests may elicit normal responses.1-4

Radiographic examination generally shows a large open cavity with direct access to the pulp chamber. This disorder is generally seen only in the teeth of children and young adults. The ap-pearance of this kind of polypoid tissue is clini-cally characteristic: a fleshy, reddish pulpal mass fills most of the pulp chamber or carious cavity. Pulp polyps are also seen in chronic wide cari-ous occlusal surfaces of a molar tooth where the antagonist tooth does not exist for a long time. Because of this, the hyperplastic pulp tissue ex-tends beyond the cavity of a tooth, and it may appear as if the gum tissue is growing into the cavity. When pulp involvement is extensive or long-standing, periapical radiography may re-veal an incipient chronic apical periodontitis3,5. Stabholtz et al.6 and Çalışkan1,2 reported that hyperplastic pulpitis associated with periapical involvement presented as radiolucencies or radi-opacities on radiographic examination.

The purpose of this case report is to report that a hyperplastic pulpitis associated with peri-apical radiolucency can develop in an abutment tooth under a bridge in middle aged people.

casE rEport

A 31-year-old-woman applied to the De-partment of Endodontics, Faculty of Dentistry, Hacettepe University with discomfort in her man-dibular left second molar. The patient had a bridge from 35 to 37 on her mandibular left side and she reported that the bridge was built 10 years ago. Radiographic evaluation revealed that hyperplas-tic pulpitis was associated with radiolucence peri-apical involvement (Fig. 1). First, the bridge was

removed and a reddish cauliflower-like growth of pulp polyp was seen at the centre of her mandibu-lar left second molar, which had been prepared to receive the bridge (Fig. 2). Later, root canal therapy was applied as treatment and the root ca-nals were prepared Profile rotary system and filled with gutta percha and AH26 (Fig. 3).

DIscUssIon

Chronic hyperplastic pulpitis develops when carious pulp exposure creates a large open cav-ity. This opening establishes a pathway for drain-age of the inflammatory exudate. When drainage is established, acute inflammation subsides and chronic inflammatory tissue proliferates through the opening inflammation created by the expo-sure to form a polyp. The polyp may cover most of what remains of the crown of the tooth, giv-ing the lesion the appearance of a fleshy mass. The management of this pulp polyp consists ei-ther of conservation of the tooth through end-odontic treatment or extaction of the tooth. The pulp polyp produces little or no pain; however, masticatory forces may produce irritation and bleeding7 . A hyperplastic response of the pulp to acute inflammation occurs in young teeth but has never been reported to have developed in the teeth of middle-aged patients8,9 .

FIGURE 1

Periapical radiograph showing the abutment tooth (mandibular left second molar) associated with radiolucent

periapical involvement before bridge removal

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In the case of hyperplastic pulpitis reported

here, the patient was a 31-year old middle-aged

person. Another interesting finding was that

there was an unusual pulp polyp development

under the bridge abutment which was much big-

ger than the normal. This may be attributed to

a big gap between the prepared tooth and the

bridge.

Our case has revealed findings similar to those of Stabholtz et al.6 and Çalışkan1,2, who demonstrated by radiographic evaluation that hyperplastic pulpitis was associated with radiolu-cence periapical involvement. Root canal thera-py treatment was successfully applied.

We believe that the case of hyperplastic pul-pitis reported here are rare. Contrary to develop-ing in a large open cavity, it prolifered under a bridge in a limited space.

acknowlEDgEmEnt

This case presentation was introduced as clin-ical poster in 13th Biennial Congress, European Society of Endodontology, 2007, ISTANBUL.

REFERENCES

1. Çalışkan MK. Success of pulpotomy in the management of hyperplastic pulpitis. Int Endod J 1993 ;26, 142-8.

2. Çalışkan MK. Pulpotomy of carious vital teeth with periapical involvement. Int Endod J 1995; 28, 172-6.

3. Grossman LI, Oliet S, Del Rio CE. Endodontic Practice, 11th edn. Philadelphia, USA:Lea & Febiger, 1988; pp. 70-71, 105.

4. Walton RE, Pashley DH, Dowden WE. Pulp pathosis. In: Ingle JI, Taintor FC, eds. Endodontics, 3rd edn. Philadelphia, USA:Lea & Febiger,1995, pp. 398- 402.

5. Smulson MH, Sieraski SM. Histophysiology and diseases of in dental pulp. In: Weine FS, ed. Endodontic Therapy, 4th edn. St. Louis, USA: CV Mosby, 1989; pp. 142-5.

6. Stabholz A, Shekter M, Schwartz Z. Condensing osteitis and chronic hyperplastic pulpitis in the same pulpally involved tooth. Quint Int 1982;2, 137-8.

7. Trowbridge HO. Histology of pulpal inflammation. In:Hargreaves KM, Goodis HE, 3 rd ed. Seltzer’s and Bender’s Dental Pulp, Quintessence, 2002; pp.227-245

8. Stanley HR. Pulp capping: conserving the dental pulp-can it be done; is it worth it? Oral Surg Oral Med and Oral Pathol 1989; 68, 628-39.

9. Seltzer S, Bender BI.The Dental Pulp: Biologic Considerations in Dental Procedures, 2nd edn. Philadelphia, USA: JB Lippincott Co.1976; pp.252-66,320.

FIGURE 2

Reddish cauliflower-like growth of pulp polyp seen after bridge removal

FIGURE 3

The radiographic appearance at the involving tooth immediately after root canal treatment

İLETİŞİM ADRESİ

Dr. Melahat GÖRDUYSUSHacettepe University Faculty of Dentistry Department of Endodontics 06100 Sıhhiye, Ankara/TÜRKİYE

Phone : +90 312 3052260 E-mail : mgorduysus@yahoo.com

Geliş Tarihi : 12.09.2007 Received Date : 12 September 2007 Kabul Tarihi : 21.02.2008 Accepted Date : 21 February 2008