Overfilling of calcium hydroxide-based paste Calcipex II produced a foreign body granuloma without acute inflammatory reaction.
A patient, a 62-year-old man, received endodontic treatment of the lower left canine complicated by apical overfilling of Calcipex II. At the second day after the root canal filling, the 14th day after placement of Calcipex II intracanal medication, he complained of a gingival swelling in the treated area. The incisional biopsy of the gingival swelling revealed a foreign body granuloma infiltrated with macrophages engulfing the fine Calcipex II granules but with polymorphonuclear leukocytes (PMNs). However, the gingival swelling was healed uneventfully, and the tooth was free of symptoms at 4 months' follow-up. This study first reports the Calcipex II-induced reaction in human periodontium. In the immunohistochemistry using antisera of lysozyme, CD31, CD68, interleukin-8 (IL-8), and poly(ADP-ribose) polymerase 1 (PARP-1), the granule-laden cells are positive for lysozyme, CD31, CD68, and PARP-1, but negative for IL-8. Thus, it is presumed that the granule-laden cells belong to the macrophages/monocytes rather than the PMNs, and that they gradually undergo the apoptotic processes. These data suggest that the canal dressing material, Calcipex II, is able to be widely dispersed into the periodontal tissues, primarily engulfed by macrophages, and resulted in the foreign body granuloma in the absence of acute inflammatory reaction.
Kim
Jin Woo
JW
Department of Conservative Dentistry, College of Dentistry, Kangnung National University, Gangneung, Korea.
Cho
Kyung Mo
KM
Park
Se Hee
SH
Song
Seung Gon
SG
Park
Mi Sun
MS
Jung
Hye Rim
HR
Song
Ji Yong
JY
Kim
Yeon Sook
YS
Lee
Suk Keun
SK
D002126:Calcium Hydroxide / Q000009:adverse effects*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications* / Q000209:etiology; D005882:Gingival Diseases / Q000209:etiology* / Q000473:pathology; D015745:Granuloma, Foreign-Body / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010485:Periapical Periodontitis / Q000628:therapy; D012388:Root Canal Irrigants / Q000009:adverse effects*; D012389:Root Canal Obturation
D012388:Root Canal Irrigants; C541436:calcipex II; D002126:Calcium Hydroxide