Herniation of an antral polyp through an oroantral fistula.

This paper reports a case of herniation of an antral polyp through an oroantral fistula, appearing as a polypoid lesion of the alveolar ridge. The patient was a 24-year-old female, and her upper molar had been extracted two months previously. The lesion was asymptomatic, and was a soft tissue mass, red in color and nontender to palpation, involving the alveolar ridge in the maxillary molar area. Review of the literature yielded only a few other such cases.     

Resolution of an active peri-implantitis in a chronic steroid user by bone augmentation with PepGen P-15 and a barrier membrane

Dental implant treatment can be complicated with infection. A list of possible causes includes overheating during the osteotomy, bacterial contamination from an adjacent tooth, residual bacteria from the infected tooth that previously occupied the site, bone microfractures from overloading or loading too soon, and residual space left around the implant after it is seated. Most treatments entail surgical debridement of the lesion and chemical detoxification of the apical or exposed portion of the implant surface with citric acid, tetracycline, or chlorhexidine gluconate as well as guided tissue regenerative or guided bone regenerative procedures. This article describes the case of an active labiolateral peri-implantitis from a previous infectious site at tooth 12 in a patient who was a chronic steroid user. The patient was treated with surgical debridement and no implant surface detoxification and regenerative procedures with xenograft of PepGen P-15 and an absorbable collagen membrane. The patient was advised to discontinue steroid therapy. This resulted in resolution of the associated signs and symptoms of infection and new bone formation in the radiograph. The negative effect of corticosteroids on calcium metabolism and bone regeneration is discussed. The potential implications of steroid use for implant dentistry are critically appraised, and guidelines are proposed for pre- and postoperative management that may assist in the successful implant-supported rehabilitation of this patient category.     

Odontogenic keratocyst clinically mimicking an eruption cyst: report of a case

This article describes a case of odontogenic keratocyst (OKC) in a 1 year and 7 month old girl who presented such a lesion mimicking an eruption cyst. To date, only one well-documented OKC occurring in a patient under 5 years old has been reported and it was thought to be associated with nevoid basal cell carcinoma syndrome (NBCCS). In our OKC case, the cyst was totally enucleated. No evidence of recurrence and NBCCS was found after a 4-year follow-up. The development of involving tooth in a growing child and the histogenesis of OKC are discussed in this article.     

Inflammatory resorption caused by an adjacent necrotic tooth

A case history is presented with a large periapical lesion and a perforating resorption defect on a cuspid. Endodontic therapy was performed, presuming that the necrotic cuspid caused the inflammatory response. No radiographic healing was evident 18 months after endodontic therapy. Considerable healing was demonstrated 6 months later, following the extraction of an adjacent tooth with prior root canal therapy. It was concluded that the failing root canal therapy of the extracted tooth was the primary factor leading to the inflammatory lesion, the resorptive perforation of the adjacent tooth, and its pulpal necrosis. It has not been reported prior that inflammatory resorption can result from the pulpal necrosis of an adjacent tooth.     

Mandibular intraosseous lipoma

A case has been presented of an intra-alveolar lipoma occurring in the mandible and involving an impacted third molar in a 51-year-old white man. The lesion was asymptomatic. Treatment consisted of surgical removal of the impacted tooth and the lipoid tissue.     

MRI of nasoalveolar cyst: case report

Nasoalveolar cyst is a rare nonodontogenic cyst arising in the nasoalar region of the face. In this case, a 39-year-old female had a nontender, fluctuant, soft, round, and bluish lesion in the right anterior gingiva of the right maxilla. Panoramic and magnetic resonance imaging examinatioins were performed. No abnormality was evident on the radiograph. The lesion was hypointense signal intensity on T1-weighted images and hyperintense on T2-weighted images. On sagittal T2-weighted images, a septum could be seen within the lesion. After injection of contrast medium and acquisition of T1-weighted images, enhancement was not observed in the lesion, but was evident at the periphery. The lesion did not enhance with contrast on T1-weighted images, but the periphery was enhanced. The lesion was surgically excised. Histopathologic examination showed the lesion to be a nasoalveolar cyst.     

Classification and Clinical Management of Retrograde Peri-implantitis Associated with Apical Periodontitis: A Proposed Classification System and Case Report

Biological complications involving dental implants include peri-implant diseases such as peri-implant mucositis and peri-implantitis. The latter presents with progressive bone loss from the alveolar crest in a coronal apical direction. However, a separate disease entity termed retrograde peri-implantitis (RPI), which presents with progressive bone loss at the periapex of the implant, also exists and may be of particular interest to endodontists because it typically presents with periapical pathology of both the implant and adjacent tooth or at a site that previously housed an endodontically treated tooth. The reported prevalence of retrograde peri-implantitis is 0.26%, which is much lower than the prevalence of marginal peri-implantitis; however, its incidence increases to 7.8% when teeth adjacent to the implant exhibit an endodontic infection. It is positively correlated with a shorter distance between the implant and the adjacent tooth and a shorter time elapsed from the endodontically treated adjacent tooth to implant placement. This case report describes a patient diagnosed with an RPI lesion (RPI) associated with an adjacent endodontically treated tooth with a persistent periapical radiolucent lesion. The diagnosis, possible etiology, and management of the RPI lesion is thoroughly reported including follow-up visits showing complete resolution after subsequent periodontal and endodontic therapy. Endodontic evaluation of teeth adjacent to the implant site should be performed for primary prevention of RPI. Proper classification of RPI will aid in determining the course of treatment; class 1 and 2 cases require endodontic therapy of the involved teeth for healing to occur.     

Pseudoaneurysm of the facial artery after the injection of local anesthetics

Generally, a true aneurysm is a dilatation of the vessel wall, whereas a pseudoaneurysm (PA) is a weakening or rent in a vessel wall, with contained rupture into the surrounding tissues. In the face, PAs of the facial artery are an extremely rare development after penetrating or blunt trauma. A 31-year-old woman presented with nontender, palpable, and firm lump that had been steadily increasing in size over a 4-week period. Examination confirmed a firm and spherical swelling in the left mandibular area, which was nonpulsatile. The patient presented with a mass on the upper part of her left chin 6 months after the injection of local anesthetics for dental treatment. After the procedure, a hematoma developed over the injection site, and it was treated with local ice. This case is unique in that the lesion seen using computed tomography and ultrasonography scanning had an unusual presentation. Ultrasonography revealed thrombi within the tumor, and color Doppler examination showed blood moving in the perivascular mass. During the operation via intraoral incision, a lesion was found as a dilation of the muscular branch of the facial artery. The facial artery was exposed, isolated, and tied off with a 2-0 white silk ligature. Histopathologic analysis determined that the content of the fragile cystic lesion was an organized thrombus and hematoma. As with any penetrating facial injury, local anesthetics can damage vessels and produce a PA. Therefore, we present a rare case of false facial artery aneurysm with no associated risk factors, which was nonpulsatile on presentation.     

左上侧切牙Ⅲ型牙内陷牙髓及牙周联合治疗1例

本文报告1例因牙齿根面畸形导致严重根尖病变及牙周破坏的牙周牙髓联合病变的左上侧切牙,瘘道长期不愈,腭侧窄而深牙周袋,严重根尖病变及牙槽骨垂直吸收。通过显微根管治疗、根尖手术、引导牙周组织再生术治疗,实现了控制根尖及牙周感染,达到了保留患牙的目的。     

左上侧切牙Ⅲ型牙内陷牙髓及牙周联合治疗1例

本文报告1例因牙齿根面畸形导致严重根尖病变及牙周破坏的牙周牙髓联合病变的左上侧切牙,瘘道长期不愈,腭侧窄而深牙周袋,严重根尖病变及牙槽骨垂直吸收。通过显微根管治疗、根尖手术、引导牙周组织再生术治疗,实现了控制根尖及牙周感染,达到了保留患牙的目的。     

Transplantation of displaced and dilacerated anterior teeth

Abstract— The therapy of dilacerated permanent anterior teeth usually involves surgically removing the tooth. Subsequently, or-thodontic methods for closing the space or keeping it open are preferred until the patient reaches an age when definitive im-plantological or prosthetic treatments may be used. Anterior tooth transplantation should be considered as an alternative to surgically extracting the tooth. This study describes a period of investigation covering 3 years during which neither replacement resorption nor inflammatory resorption was diagnosed in the five transplanted teeth. The clinical tooth mobility was similar to that of the adjacent teeth. In spite of the vertical loss of bone shown radiographi-cally no pathologically enlarged pockets or recessions have been found. It is not yet possible to make any comments on the prognosis for the long term.     

Lipoma of the parotid gland

This case report describes a lipoma that appeared as a parotid gland tumor. The lipoma is an asymptomatic, slow-growing, nontender mass. This lesion is rare at this site and exhibits no unique clinical features. There is no reliable method of establishing a preoperative diagnosis; therefore, the lesion should be included as a rare possibility in the differential diagnosis of tumors involving the parotid gland. The treatment of choice is surgical excision, and recurrence is rare.     

The challenges of treating a fused tooth

This paper describes and discusses the multidisciplinary treatment involving a permanent maxillary lateral incisor fused to a supernumerary tooth, both presenting pulp necrosis and periapical lesion. A 15-year-old male patient sought treatment complaining of pain, swelling and mobility on the maxillary right lateral incisor. After clinical and radiographic examination, root canal preparation was performed according to the crown-down technique and a calcium hydroxide dressing was placed for 15 days. The patient returned and the definitive endodontic filling was done with thermomechanical compaction of gutta-percha and sealer. After 18 months, clinical and radiographic examinations were carried out and no pain or swelling was reported. Two years after endodontic treatment, the patient returned for periodontal and cosmetic treatments. Nine months later, a cone-beam computed tomography (CBCT) revealed that the previously detected periodontal defect and periapical lesion were persistent. Apical endodontic surgery was indicated. The supernumerary tooth was removed, the communicating distal surface was filled and the surgical site received bioactive glass and demineralized bovine organic bone. The pathological tissue was submitted to histopathological examination and the diagnosis was periapical cyst. One year after the apical endodontic surgery, CBCT showed bone formation at maxillary lateral incisor apical area. Two years after the surgery, the restoration was replaced due to aesthetic reasons and periapical radiograph showed success after 5 years of treatment. A correct diagnosis and establishment of an adequate treatment plan resulted in a successful management of the case.     

Pre-Eruptive Intracoronal Resorption (PEIR): A Case Report

Pre-Eruptive Intracoronal Resorption (PEIR) is a rare yet significant phenomenon in which an abnormal, well-circumscribed, radiolucent area develops in the tooth prior to eruption. This case report outlines the treatment of a 12 year old Hispanic female who was referred for endodontic evaluation of tooth #31 and subsequently diagnosed with PEIR.The patient’s chief complaint was recorded as “spontaneous pain” in the lower right quadrant of her jaw. Clinical examination revealed a partially erupted tooth #31 with no visible decay. Radiographic examination, including a cone beam computed tomography scan, led to the detection of a radiolucent area surrounding the pulp chamber on the mesial aspect of tooth #31. Radiographically, the enamel appeared intact with no signs of perforation. Based on the clinical and radiographic evaluation, tooth #31 was determined to have PEIR, with the pulpal and periapical diagnosis of “Symptomatic Irreversible Pulpitis” and “Normal Apical Tissue,” respectively.The Orthodontic consultation obtained for this patient recommended that tooth #31 be maintained at least until tooth #32 appeared in the oral cavity and could be used as a replacement. Therefore, a treatment plan involving vital pulp therapy and gingivectomy was selected. During the procedure, granulation tissue was excavated and sent for histological evaluation, which concluded the presence of “granulation tissue with acute and chronic inflammation”. No caries were detected.Following the procedure, the tooth was found to be asymptomatic with continued root development. A positive response to Electric Pulp Test was achieved after 3.5 years of follow up.     

The resolution of a periradicular lesion involving an implant

Published reports claim that implants can fail from endodontic pathosis involving teeth adjacent to an implant, from preexisting bacteria in an extraction site that had a history of a tooth having a periradicular lesion, and even from an asymptomatic endodontically treated tooth with no clinical or radiographic evidence of pathosis. This report considers the support offered for an endodontic connection to implant failure, and it presents a case that conflicts with the premise that endodontic involvement causes implant failure. The diagnosis and treatment of a radiolucent lesion associated with an implant is described. Although initially interpreted as indicating a failing implant, the etiology of the radiolucency was a necrotic pulp in a maxillary lateral incisor with resorption. Nonsurgical endodontic treatment that combined Ca(OH)2 for interim treatment and mineral trioxide aggregate for final obturation completely resolved the periradicular lesion abutting the implant and successfully retained both the implant and the resorbed lateral incisor.     

Bone regeneration after surgical repositioning of impacted mandibular second molars: a case report

Abstract  – A case is presented where the mesially impacted mandibular second molar teeth were surgically uprighted in an 11-year-old female patient. Bone regeneration is shown in the areas occupied by the impacted second molars with maturation of bone and cortication of the crest of the alveolar bone. The probing depths are also normal with no residual bony defects. This healing was achieved with no bone grafting procedure, emphasizing two important factors: to prevent/minimize any trauma to the tissues at the site of elevation and uprighting of the tooth (i.e. maintaining viable periodontal ligament cells and minimal cementum damage); and to obtain primary closure whilst allowing the tissue in the mesial defect to reorganize against the scaffold of bone. However, the procedure on the one side was complicated with necrosis and infection of the pulp space with external inflammatory root resorption. Endodontic therapy of this tooth proved to be successful with periradicular healing radiographically and re-establishment of the lamina dura. At the 3-year follow-up, the endodontically treated tooth showed no clinical and radiographic signs of pathology. The left second mandibular molar had no pulpal or periodontal postsurgical complications, which may be attributed to apparently more open apices allowing for pulp revascularization after manipulation at the time of surgery. This report illustrates unassisted wound healing that occurs in the area of uprighting with complete reconstitution of periodontal anatomy without additional regenerative procedures to augment bone.     

Root resorption associated with an impacted mesiodens: a surgical and endodontic approach to treatment

Abstract –  This article describes a case of root resorption of a maxillary non-vital immature incisor associated with an impacted and angulated mesiodens. The impacted tooth was surgically removed and the compromised incisor was subsequently endodontically treated. Over a period of 27 months the tooth was medicated with repeated applications of calcium hydroxide. Radiographically after 18 months, an incomplete hard tissue barrier was observed with full apical closure at the conclusion of 27 months of treatment. Once the patient was comfortable after surgical removal of the mesiodens, the tooth was asymptomatic and remained so for the duration of the treatment and after definitive restorative work had been completed.     

Peripheral osteoma bilateral of the mandible without association with Gardner syndrome

Periosteal osteoma is a rare benign pathologic lesion in the jaws and the mandible is the anatomic region most frequently involved. Elective treatment consists of surgical excision. The aim of this report was to report a rare case of bilateral periosteal osteoma involving the mandible--a painless, firm, and well-circumscribed lesion, with more bony prominence on the left than on the right side. The patient had no history of facial trauma or systemic changes that could intervene with the progression of the lesion. It was diagnosed as a periosteal osteoma, and surgical excision was performed. No recurrence after 4 years of follow-up was demonstrated. Surgical excision of the periosteal osteoma was demonstrated to be a useful technical strategy that simplifies and accelerates the surgical procedures and probably contributes to establish harmony of the jaws. Periodical clinical and radiographic follow-ups after surgery are advised.     

20-year Follow-up of Recurrent Glandular Odontogenic Cyst Mimicking a Periapical Lesion

Periapical lesions usually are caused by root canal infection; nevertheless, other pathologies may eventually involve the tooth apex, making the correct diagnosis more difficult. Glandular odontogenic cysts (GOCs) are uncommon and, despite their cystic nature, may present an aggressive behavior and a high recurrence rate. This report describes a recurrent GOC mimicking a periapical lesion that was followed up for 20 years. A 45-year-old woman described tooth discomfort for several years in the anterior region of the mandible that was not exacerbated during eating or occlusion. Clinical examination revealed no signs of swelling, redness, or inflammation in the gingival or surrounding soft tissue. Nevertheless, periapical radiography showed a well-defined large radiolucent lesion in the periapical region of teeth #22, #23, #24, and #25. The pulp test confirmed that all these teeth were vital. An incisional biopsy was performed, and with the histopathological diagnosis of an odontogenic cyst, the lesion was enucleated surgically. After recurrence, the extensive periapical multilocular lesions were again surgically removed. Based on the microscopic findings, the final diagnosis was GOC. One year later, there were no signs of recurrence. GOCs associated with the root apex may mimic periapical inflammatory diseases. Clinical, radiographic, and histopathological findings are essential for the diagnosis of inconclusive radiolucent findings in the periapical region. Biopsy specimens should be sent to a specialized oral pathology laboratory.     

Rapidly progressive acute periodontal infection in a patient with acute leukemia

The clinical course of an adult patient with acute lymphocytic leukemia and localized, rapidly progressive periodontal disease in a setting of marrow regeneration is described. Initial presentation of this condition was consistent with herpes simplex virus infection involving the gingiva; however, more extensive evaluation including radiographs, cultures and biopsy revealed necrotic tissue, nonspecific bacterial growth and acute gingival inflammation, with no evidence of viral infection. While most acute oral infections in chemotherapy patients occur during the development of marrow aplasia, this lesion initially developed late during the marrow recovery phase. The characteristics of this lesion are compared with those occurring in noncancer patients with rapidly progressive periodontitis and who have genetically governed neutrophil and/or lymphocyte defects.