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Determination of Pulp Necrosis Based On Periapical
Determination of Pulp Necrosis Based On Periapical
Determination of Pulp Necrosis Based On Periapical
ABSTRACT
Introduction: Radiographic examination is needed to determine the diagnosis of pulp necrosis in addition
to a clinical examination. Visual observation was limited in seeing the colour change degree and hence an
effort taken by assessing the histogram value. The purpose of this study was to obtain the pulp chamber
histogram pattern which reveals its grey scale value, trend, intensity average, histogram variation, and
histograms maximum regional of interest (ROI) through digital periapical radiograph. Methods: This study
was a descriptive study of the total of nine pulp chamber periapical radiograph data samples. The sam-
ples were divided into three groups, the 1st group was the data taken prior to the tooth extraction, the 2nd
group was the data collected after the teeth extraction, and the 3rd group was the data of priorly pulpless
teeth. Results: There was a tendency of histogram graphic shifting to the left side, likely towards the
radiolucent area on ROI of the pulp at the apical region, whilst histopathologically, a massive infiltration
of a round PMN cells was found in the area. This finding supporteded the determination of pulp necrosis
diagnose. Conclusion: The tooth with a pulp necrosis showed a tendency that led to radiolucency on
periapical radiograph histogram, and histopathologic examination showed massive infiltration of a round
PMN cells, thus supported the pulp necrosis diagnose.
Corresponding author: Emy Khoironi, Department of Dental Radiology Faculty of Dentistry Univ Hang Tuah, Indonesia
Jl. Sekeloa Selatan No. 1 Bandung, West Java-Indonesia, Phone/Fax: +6222-2504985, Email:emykaha@gmail.com
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Padjadjaran Journal of Dentistry 2017;29(3):182-188.
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Determination of pulp necrosis based on periapical digital radiography histogram and pulp histopathology (Emy K et al.)
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Padjadjaran Journal of Dentistry 2017;29(3):182-188.
Table 1. The average of intensity, histogram variance, and maximum histogram prior to the tooth extraction
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Determination of pulp necrosis based on periapical digital radiography histogram and pulp histopathology (Emy K et al.)
variance the more variants, the more unpolluted The average of tooth pulp intensity before
the pulp content. it is pulled increasingly to the apical closer to
Maximum histogram of dental ROI before zero. Grossman said that the end result of pulp
revoked on the first ROI 0.3804 graph decreased decomposition is hydrogen sulphide, ammonia,
until the 5th ROI 0.3098, visible pattern of numbers fatty substance, ptomaine, water and carbon
decreased, meaning the first ROI of the apical part dioxide and further results are indol, skatol,
to the coronal of the pulp getting radiolucent. putrescine, and cadaverin.3 Yoon et al, states that
teeth after being pulled out with pulp from 0.2724 dry pulp tissue consists of 5.7 % calcium, 3.5%
down until the fourth ROI of 0.1931, the fifth ROI phosphorus, and 11.7% are nitrogen, increasingly
pattern rises then the sixth ROI down 0.2136 and to the more radiolucent apical, where in the
the tooth after unplugged without pulp between coronal portion contains more air so that the
0.2479 to 0.1723. pulp obtained ranged from density is lower than the apical region containing
0.0274 to 0.2136. histogram variance data does the end result of pulp decomposition.11
not vary much. The average intensity of each ROI on a
single tooth sample before being unplugged,
DISCUSSION unplugged with pulp and unplugged without pulp,
shows an average pattern of intensity patterns
Pulp inflammation causes the tissue to undergo increasingly coronal to radiolucent. This means
central disintegration thus forming a liquefaction the demineralisation process runs from coronal to
necrosis region due to a lack of collateral circulation apical or the process of necrosis goes from coronal
and a rigid dentin wall. This condition interferes to apical. The average ROI intensity in all tooth
with inflammatory drainage and increased tissue samples before removal compared to the teeth
pressure increases, resulting in uncontrolled that have been removed and the teeth removed
destruction until all pulp tissues are necrotic. and pulp is removed on each ROI as measured
The rate of progression of liquefaction from the apical part of the pulp approaching to
necrosis varies. Speed can be related to network the coronal down, meaning the coronal density
capability. The necrotizing region contains further decreases so that more radiolucent, pulp
irritants from tissue and microbial destruction, density in the region approximates the maximum
both anaerobic and aerobic. apical so that more radiopaque in this study is
Results of histopathological examination shown by the average number of ROI intensity on
of pulp tissue from three tooth samples, two the apical pulps higher approximation value.
cannot be examined because the sample is too The variance of the histogram of ROI in
small, marked with no visible colour difference one tooth sample was compared before it was
of fat and protein structure when given eosin revoked after it was removed with pulp and
hematoxylin staining. characterized by no visible tooth after unplugged without pulp, the data of
colour difference from fat and protein structures histogram variance did not vary much. Similarly,
when stained with hematoxylin-eosin. the comparison of the three samples, namely the
Carnerio et al in his study said the teeth have not been revoked, pulled out with
average grey scale can be used to look at pulp and unplugged without pulp not too varied.
caries remineralization, a smaller value for The maximum ROI histogram is the highest value in
demineralization. this study mentions the the one ROI that most often appears or how many
minimum histogram value lies on the grey scale of the most frequent intensities appear, from
50 and the highest histogram at number 200.9 the histogram graph, the higher the maximum
Merete et al in his study stated that the accumulated value of the histogram of the high value. These
increase in mineral deposits occurred in teeth varying values indicate the difference in the rate
with smaller pulp cavities compared with larger of the outcome of the pulp necrosis condition
pulp cavities in addition to composition factors of occurring on the pulp. This is related to the
pulps with different densities. As well as a barrier pathophysiological process of pulp necrosis.
factor from absorption of x-rays in the oral cavity Maximum comparison of the histogram of
than outside the oral cavity.10 ROI on one tooth sample before revoked at first ROI
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Padjadjaran Journal of Dentistry 2017;29(3):182-188.
((0.3804) shows highest peak pattern of histogram (commonly denoted by Z) is the number of protons
chart decreased until ROI to five (0.3098), meaning present in the atomic nucleus. The number of
the first ROI of the apical part towards coronal of protons is equal to the number of electrons in the
pulp increasingly to left that is more radiolucent. compound. The atomic number and the number
Teeth after being pulled out with pulp (0.2724) of electrons in the compounds are related to the
down to the fourth ROI (0.1931), meaning the first interaction of light on the object, in this study
ROI of the apical part to the coronal of the pulp is a pulp that has been necrosis with different
(ROI four) the radiolucent, meaning the density decomposition results.
progressively decreases to the coronal gear after The density is affected by the material
being unplugged without pulp from the first ROI or material, the physical characteristics of the
(0.6118) decreases until the ROI of six (0.3294) contrast material from the water of the effective
means the top of the graph (maximum value) atomic number (z) 7.42, density 1.0 gr/cm3; fat
of the histogram gascic the more the coronal to atomic number effective (z) 5.92, density 0.91;
the radiolucent Graph The maximum histogram air of effective atomic number (z) 7.64, density
of ROI of all tooth samples prior to repeal, 0.00129; calcium effective atomic number (z)
after being pulverized and after unplug pulse 20.0, density 1.55; effective atomic number (z)
measured from first ROI until ROI six shows the 7.46, density 1.0 gr/cm3; barium effective atomic
pattern approaching zero means the density is number (z) 56.0, density 3.5 gr/cm3; iodine
decreasing in the coronal section the comparison effective atomic number (z) 56.0, density 3.5 gr/
of all samples before removal, after unplug and cm3. According to the nature of the absorbs of
after pulling, the pattern shows more trend to the x-rays when the mass of the material is greater,
right ie more radiopak on the teeth after unplug the absorption power of the x-rays will also be
without pulp, this is due to formalin immersion greater,14 so that grayscale pulp necrosis is more
or the presence of formalin fluid on the tooth radiolucent.
after it is unplugged without pulp formalin fluid).
Water has a larger density of 1.0 compared to the CONCLUSION
air 0.000129, which means here that water or
liquids have more density or mass than gas or air. The tooth with a pulp necrosis showed a tendency
In accordance with the nature of absorption, the that led to radiolucency on periapical radiograph
lower the atomic number of an object the greater histogram, and histopathologic examination
the penetration of the X-ray and the greater the showed massive infiltration of a round PMN cells,
atomic number, the greater its absorption.12,13 So thus supported the pulp necrosis diagnose.
that radiographs result more radiopaque on the
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