Importance of anatomic variables in endodontic treatment outcomes: case report

Abstract Surgical endodontic treatment was performed after a large periradicular lesion failed to resolve following nonsurgical intervention. The subsequent periradicular surgery resulted in healing with scar formation. Assessment of the resected root apex revealed a complex anatomy. The ramifications of these anatomical findings and the periradicular tissue response in healing are discussed relative to prognosis and ultimate treatment outcomes.     

Nonsurgical endodontic treatment of dens invaginatus with large periradicular lesion: a case report

The endodontic treatment of teeth with severe Type 3 dens invaginatus, characterized by an infolding of enamel and dentin, extending deep into the pulp cavity near the root apex, may be complicated and challenging. Because of the bizarre root canal anatomy and widely open apex, a combination of nonsurgical and surgical endodontic treatment or extraction is the most common choice of therapy. This article describes a nonsurgical endodontic treatment of a tooth with severe Type 3 dens invaginatus and an associated large periradicular lesion. After complete removal of the invaginated central mass of hard tissue and long-term calcium hydroxide treatment, nonsurgical endodontic treatment was performed. Complete healing of the periradicular lesion was observed at 25-month and 74-month follow-up examinations.     

Anatomic and microbiologic challenges to achieving success with endodontic treatment: a case report

This article describes a case of persistent apical periodontitis that required several nonsurgical and surgical approaches for resolution. A 28-year-old woman presented with a large symptomatic apical periodontitis lesion associated with the maxillary left lateral incisor that persisted in spite of previous nonsurgical and surgical endodontic treatment. Root canal retreatment was accomplished, but the lesion only showed a slight decrease in size after 18 months. Forty-six months after retreatment, the patient returned because of reemergence of symptoms. Radiographically, the lesion remained relatively unaltered. Periradicular resurgery was performed, and a biopsy specimen consisting of the lesion and the apical part of the root was collected for analysis. Radiographic and clinical reevaluation after 4 years revealed complete healing. Histopathologic and histobacteriologic observations demonstrated that the lesion was a cyst, and that the probable reason for failure was the occurrence of bacteria within dentinal tubules and in a lateral canal slightly coronal to the amalgam root-end filling. This case report clearly illustrates the difficulties imposed by anatomic complexities in attaining a disinfection level that is compatible with periradicular tissue healing.     

Conservative treatment of obstructive sleep apnea: a case report

Conservative treatment of obstructive sleep apnea includes weight loss, changes in sleep posture, drug therapy, nasal continuous positive airway pressure and placement of an intraoral prosthesis. This article describes the success achieved in a case treated with conservative therapy, that is, intraoral prosthesis. A mandibular advancement prosthesis was fabricated for a 35-year-old male patient suffering from obstructive sleep apnea. The prosthesis was fabricated at a raised vertical dimension, with the central area open for the air passage. This advanced mandibular position enhanced the patency of the oropharynx. The prosthesis showed better results in the treatment. There was significant improvement in the apneic episodes and daytime sleepiness after wearing the prosthesis.     

An unusual treatment with sagittal split osteotomy: report of a case involving an odontoma

Sagittal split osteotomy is one of the most commonly performed surgical techniques in the world and has been modified by many authors. The efficacy of this operation has been studied by many groups. When performing this surgery, there should be adequate contact of wide, cancellous bone surfaces, which guarantees excellent and rapid bony union in the desired position. In the present article, treatment of mandibular prognathism with open bite by sagittal split osteotomy with an odontoma in the third molar area is presented.     

Embolia cutis medicamentosa (Nicolau syndrome) after endodontic treatment: a case report

Introduction

Embolia cutis medicamentosa (Nicolau syndrome) is a rare iatrogenic event of tissue necrosis after intramuscular or intraarticular application of cristalloid suspensions. Clinically, it presents as a livid discoloration of the skin, local pain, and signs of inflammation.

Methods

This article presents the first case of Nicolau syndrome after the endodontic application of calcium hydroxide paste into the distal root canal of tooth 18. The patient presented to the Department for Maxillofacial Surgery and hospitalized for several days.

Results

The application of calcium hydroxide paste led to a thrombosis of the inferior alveolar artery and various branches of the maxillary artery. A definite necrosis of the left-side infraorbital skin area and concomitant hypaesthesia of the infraorbital nerve and of the mental nerve were observed.

Conclusions

Calcium hydroxide paste is appropriate for the medicamentous treatment of root canals, but is not suitable to stanch bleeding from periapical arteries.     

Conventional and surgical endodontic treatment of a maxillary first molar with unusual anatomy--a case report

AIM: To describe conventional and surgical endodontic treatment of a maxillary left first molar with two canals on the distobuccal root and to discuss the treatment outcome. SUMMARY: According to the literature, the presence of a second canal on the distobuccal root of a maxillary first molar is rare. This anatomical anomaly might lead to an unfavourable outcome if clinicians fail to identify and treat it properly. The following case report describes conventional and surgical endodontic treatment of a maxillary left first molar with two canals on the distobuccal root. Key learning points ? Anatomical variations of the root canal system are a challenge for clinicians during root canal retreatment. ? The principles and techniques of endodontic microsurgery are of utmost importance in clinical practice, and clinicians should be aware of them.     

上颌侧切牙年轻恒牙牙中牙伴根尖周炎的牙髓血运重建治疗1例

牙内陷是由牙发育时期成釉器过度卷叠或局部过度增殖,深入到牙乳头中而导致的牙齿形态异常,因其复杂的解剖结构,给常规的牙髓治疗带来困难和挑战。牙中牙的牙髓治疗为牙内陷最复杂的一种情况,本文报道1例上颌侧切牙年轻恒牙牙中牙伴根尖周炎的牙髓血运重建治疗的病例,结合锥形束CT的辅助诊断,对其治疗及预后进行评估。随访2年,牙根继续发育,根尖周炎症消失。本病例为年轻恒牙牙中牙的牙髓病及根尖周病提供了新的治疗策略。     

Nonsurgical endodontic treatment of dens invaginatus in a mandibular premolar with large periradicular lesion: a case report

This case report describes the treatment of a dens invaginatus in a mandibular premolar with large periradicular lesion. A nonsurgical endodontic treatment was performed to tooth #28. During the treatment procedure, calcium hydroxide and a triple antibiotic paste were separately used for intracanal dressing. The apical third of the canal was obturated with mineral trioxide aggregate (MTA), and the remaining canal space was obturated with gutta-percha and AH 26 root canal sealer, using a lateral condensation technique. At follow-up examination after 1 year, the tooth was asymptomatic and radiographically showed repair of the lesion. Healing was achieved without any need for further endodontic surgical intervention.     

Nonsurgical endodontic retreatment of geminated teeth: a case report

The purpose of this case presentation is to describe nonsurgical retreatment of anterior teeth with gemination. A 21-year-old male patient was referred for endodontic treatment of his maxillary left lateral incisor. In the clinical examination, a large crown was observed in the left maxillary incisor region when compared with the right maxillary lateral incisor. In the present case, a tooth gemination of a maxillary lateral incisor has been described. A periapical radiograph showed that the tooth had partially separated two crowns having a single root and one root canal, but the access cavity of the distal crown had not been opened, and the root canal had been obturated with single cone technique. Nonsurgical endodontic retreatment was decided for geminated lateral incisor. At the 6-month follow-up, the tooth was asymptomatic and there was no radiolucency around the apical region.