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.     

Long-term follow-up implant site development in the submerged mandibular primary second molars: a case report

Treatment of ankylosed and submerged primary molars without permanent successors is challenging, as normal vertical dentoalveolar growth is compromised. Thus, grafting techniques and distraction osteogenesis are performed for ridge augmentation before implant restoration. However, these techniques are invasive with limited success. Another treatment for implant site development is noninvasive forced eruption. This case report describes long-term follow-up of alveolar ridge augmentation in the submerged mandibular primary second molars using subluxation and orthodontic forced eruption for implant site development. A 19-year old female had Class II molar relationships, upper anterior crowding with large overjet, missing four second premolars and submerged mandibular primary second molars with inadequate vertical development of alveolar bone. For the vertical alveolar bone alterations in the mandible, forced eruption with subluxation of ankylosed lower primary second molars was applied. Treatment outcome was evaluated over 5 years with stable occlusion, healthy periodontal tissues, and successful radiographic results.     

Endodontic treatment of dens invaginatus with a periradicular lesion: case report

A left maxillary lateral incisor with Type III dens invaginatus with a periradicular lesion was treated non-surgically. Pulp involvement and periapical abscess subsequent to contamination through the invagination space were observed. The signs (sinus tract) and symptoms ceased after treatment. Complete healing of the periradicular lesion was observed at the one-year follow-up examination.     

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.     

Micro-structured calcium phosphate ceramic for donor site repair after harvesting chin bone for grafting alveolar clefts in children

ObjectivesThe purpose of this study was to evaluate the use of synthetic bone graft material as a filling material at the mandibular symphysis donor site of autologous bone in children.Materials and methodsA blinded patient group comprised 20 patients with unilateral (UCLP) or bilateral (BCLP) cleft of lip and palate, all with an indication for alveolar cleft repair. The study took the form of a prospective randomized clinical trial. We used lateral cephalograms for the measurement of the symphyseal donor area defect both peroperatively and at 12 months postoperatively. The data obtained were digitalized and the treatment outcome expressed in numbers. Comparisons with a previous study were made. Histology of biopsies and CT scans were used for visualising bone formation.ResultsThis study demonstrates that the micro-structured, resorbable calcium phosphate ceramic provides good regeneration properties for the repair of a critical size bony defect in children. One year postoperatively, the measurements taken from lateral cephalograms show that there is scarcely any visible residual defect. Histological investigations of the bone biopsies show solid, induced bone formation and almost complete resorption of the micro-structured calcium phosphate.ConclusionsThe findings of this study (novel in children) indicate that micro-structured resorbable calcium phosphate is an excellent alternative to autologous bone. The digital findings showed a restored donor site defect significantly indicating the efficacy (i.e. osteoconductivity and resorbability) of this bone substitute. The biopsy histology demonstrated the overall presence of newly formed vital bone and the resorption of the bone substitute. Its use for grafting the alveolar cleft is currently researched and it may become the new standard.Clinical relevanceAs co-morbidity and prolonged operation time at the donor operation site are inherent to the alveolar cleft repair procedure, the use of the described bone substitute is winning progress.     

Endodontic treatment of a maxillary canine with type 3 dens invaginatus and large periradicular lesion: a case report

Dens invaginatus type 3 is an anomaly characterized by an infolding of enamel and dentin that can extend up to the root apex and might present difficulties with respect to its diagnosis and treatment because of canal morphology. This article describes an unusual case of the maxillary canine having a type 3 dens invaginatus, necrotic pulp, and an associated large periradicular lesion treated by conventional root canal therapy. After gaining access to the pulp chamber, the primary canal and the invagination were localized, negotiated, enlarged, and filled with calcium hydroxide. Three weeks later the canal and the invagination were obturated with gutta-percha and restored. At 24-month recall satisfactory bone healing had occurred.     

Endodontic treatment of a large cyst-like periradicular lesion using a combination of antibiotic drugs: a case report

This case report describes the endodontic treatment of a large cyst-like periradicular lesion using a combination of antibiotic drugs. A 15-yr-old boy with a large cyst-like lesion from the apices of his teeth 29 to 31. Conservative root canal treatment was performed (tooth #30). During treatment procedure, 2.5% sodium hypochlorite solution was used for irrigation and a combination of antibiotic drugs was used for the intracanal dressing. Periapical healing was observed 3-month after initial treatment and continued at the 7-month review.     

Orthograde retreatment failure with extruded MTA apical plug in a large periradicular lesion followed by surgical intervention: case report

Absence of periapical healing after orthograde retreatment using an apical plug with mineral trioxide aggregate (MTA) can require surgical intervention. A patient with a root-filled maxillary central incisor with chronic apical periodontitis and sinus tract was referred for endodontic retreatment. Excessive apical enlargement was verified, indicating an MTA apical plug placement; however, an unintentional extrusion of MTA occurred during this step. The root canal was filled with gutta-percha and sealer, and periodic recalls were scheduled. The sinus tract was observed after six months and the lesion remained unaltered, although the extruded MTA had resorbed; therefore, an apicoectomy and retrograde root-end filling with MTA were performed. Absence of sinus tract, normal clinical aspect, and complete repair of the lesion were observed at the two-year follow-up.     

Root canal treatment of a periradicular lesion caused by unintentional root damage after orthodontic miniscrew placement: a case report

AIM: To present the successful endodontic management of a maxillary lateral incisor tooth with a periradicular lesion caused by unintentional root damage after orthodontic miniscrew placement. SUMMARY: A 22-year-old female was diagnosed with a skeletal Class II, Division 2 malocclusion with Class II molar and canine relationships on both sides. The treatment plan included distalization of the maxillary first molars bilaterally followed by full fixed appliance therapy. For the maxillary molar distalization, an appliance in conjunction with a miniscrew anchorage system was designed. Two months later, the patient came to the clinic with complaints of pain in the maxillary right lateral incisor region. On intraoral examination, intraoral sinus tracts were detected in the maxillary right buccal sulcus and palate. A large radiolucent lesion with a well-defined margin around the root of the maxillary right lateral incisor was seen. Root canal treatment was performed on the maxillary right lateral incisor tooth. The root canal was filled with gutta-percha and AH Plus sealer, using a lateral compaction technique. The final restoration of the tooth was completed using composite, and the tooth was reviewed after 10 months. The tooth was asymptomatic and radiographically showed repair of the lesion. Healing was achieved without any need for further endodontic or surgical intervention. Key learning points ? This case illustrates the need to take care with miniscrews when performing orthodontic treatment, especially when the miniscrews are in close proximity to root apices. ? The periradicular lesion as a result of miniscrew damage was successfully treated with root canal treatment.     

Potential efficacy of GTR and autogenous bone graft for autotransplantation to recipient sites with osseous defects: evaluation by re-entry procedure

Abstract –  This clinical study aimed to evaluate the effectiveness of guided tissue regeneration (GTR) or autogenous bone graft for autotransplantation to recipient sites with an osseous defect, based on a substantial assessment of bone regeneration using a re-entry procedure. Three cases of autotransplantation of a wisdom tooth to the position of first molar, in which moderate to extensive bone loss at the buccal alveolar plate was observed, were studied. Each tooth was transplanted with no additional treatment, or in conjunction with GTR or autogenous bone graft. Four to 20 months after surgery, a re-entry procedure was performed to visually examine healing. When GTR membrane coverage or bone graft was used, previously absent alveolar bony plates regenerated and the initially exposed roots were covered with newly formed bone, while no bone formation was observed in the case without any additional procedure. These results demonstrate that both GTR and autogenous bone graft are beneficial for obtaining bone regeneration in autotransplantation to defective recipient sites, contributing to retaining space and excluding the contact of gingival connective tissue with periodontal ligaments.     

Benign lymphoepithelial lesion with large cysts: case report

A case of benign lymphoepithelial lesion with two large cysts and many foci of duct dilatation is reported. Clinical features, except for absence of dry eyes, indicated the case was Sjogren's syndrome. The cysts were found in the left parotid gland of a 60-yr-old woman and were surgically removed. The size of each cyst was 20 mm in diameter and one of them was located in the lymph node. Because of the HLA-DR expression by the epithelium, the cysts are considered to have formed as a result of duct dilatation due to autoimmune response. As for one cyst, it is also possible that the pre-existing lymphoepithelial cyst might be involved in the autoimmune phenomenon because of its relation to the lymph node.     

Intra-alveolar surgical uprighting of impacted teeth: a case report

Abstract Although orthodontic repositioning of impacted teeth is widely used, the treatment has its limitations. Autotransplantation or intra-alveolar surgical repositioning of teeth is an alternative therapy that may be used in selected cases of desperate impactions, when orthodontic extrusion is unsuccessful or when orthodontic treatment is rejected by the patient. A case report is presented to stress both the indications and limitations of a modified technique of intra-alveolar surgical uprighting of impacted teeth.     

Effect of unintentionally extruded mineral trioxide aggregate in treatment of root perforation with periradicular lesion: a case report

This case report describes the effect of unintentionally extruded mineral trioxide aggregate (MTA) into periradicular lesions on the prognosis of periradicular healing in maxillary right molar with periradicular lesion. A 39-year-old male patient with a periradicular lesion from the root perforation of his maxillary right first molar was referred to our Department. A root canal retreatment was performed and the root perforation was filled with MTA. During this procedure, an unintentionally extrusion of MTA into the periradicular lesion occurred. At follow-up, the tooth was asymptomatic and at radiography a repair of the lesion was evident. No endodontic surgical treatment was necessary. In this case the healing was possible despite the extrusion of the MTA. This might be due to the biologic properties of the MTA.     

Autotransplantation of a supplemental premolar: a case report

In this article, we describe the autotransplantation of a supplemental premolar to replace an extracted first permanent molar in a 12-year-old boy. Although the end results are not ideal due to the small size of the donor tooth, the esthetics and function of the dental arch are partly restored using a natural tooth rather than a prosthesis. This case report illustrates the usefulness of autotransplantation as a viable treatment option in children with missing permanent teeth.     

Cementoblastoma related to a primary tooth: a case report

Cementoblastomas are benign lesions of the odontogenic ectomesenchyme that rarely occur related to the primary dentition, especially on the left side of the mandible. This study describes a case of a true cementoblastoma related to the left second primary mandibular molar in a 7-year-old child (the largest one seen in the left side of the mandible). Additionally, the radiographic and histologic findings of the lesion are described in details.     

Autotransplantation: a viable treatment option for adolescent patients with significantly compromised teeth

Autotransplantation is the technique of transplanting embedded, impacted or erupted teeth from one site into another in the same individual. Despite current scientific evidence indicating that autotransplantation has favourable long‐term survival rates, autotransplantation is still not generally regarded as mainstream practice outside of Scandinavian countries. Successful autotransplantation can offer many advantages in a growing patient, including a normally functioning periodontium, proprioception and preservation of alveolar bone volume. In the event that the autotransplantation eventually fails, the bone and soft tissue conditions would still be likely to be favourable for subsequent implant treatment. This review article will identify and discuss the factors that influence case selection, the ideal timing for autotransplantation and the critical determinants for achieving a successful outcome. The limitations of the technique and alternative treatment options will also be discussed. It is hoped that through greater awareness and recognition by the dental profession, autotransplantation will become another viable treatment option in the management of compromised teeth in patients with significant remaining growth potential.     

Traumatic bone cyst: case report

Abstract The traumatic bone cyst is a lesion whose aetiology and pathogenesis have not been conclusively established. There are several theories and names for this lesion and various forms of management have been reported in the literature. This report outlines the clinical and radiographic findings associated with a case of a traumatic bone cyst. Laboratory investigations were also carried out and their findings are reported. This case was treated jointly by the endodontic and oral surgery departments of an institution and demonstrates the need for close follow-up from both departments. In particular, the endodontic aspects of monitoring the pulp status of teeth in the region of such a bone lesion are emphasised.