[Immunological phenomena in pulpal-periapical lesions]

Based on an extensive review of the literature, the authors examine immunological reactions in pulpal and periapical lesions. Although it has been known for some time that bacterial infection causes this pathology, attention has been recently focused on immunological factors in the ambit of the phlogistic process. The present study examines the correlation between the latter and the type of extent of antigenic response, focusing attention on their important role in the phenomena of osteoclastic activation and inhibition of bone repair. From a physiological point of view there are few inflammatory cells in dental pulp, like macrophages and T lymphocytes. When the pulp comes into contact with the antigenic substance it activates a specific and aspecific immune response: the form through the activation of B and T lymphocytes, and the latter through the action of LPS, PMN and complement. An important role in the immune response is played by the cytokines which are able to regulate the intensity and duration of the immune response against potential pathogenic agents. It was initially thought that these were only produced by lymphocytes and as a result they were known as lymphokines. Later it was observed that other cell populations were also able to produce them. Phlogosis of the periapex starts before the pulp is fully necrotic. Tissue detritus and products of bacterial derivation escape through the numerous endoparadontal communication pathways and stimulate an inflammatory response by the vascular system of the parodontal ligament. The concomitant immune reaction occurs due to the tendency to block and restrict the inflammation to the radicular channels, thus preventing its diffusion.(ABSTRACT TRUNCATED AT 250 WORDS)