Mineral Trioxide Aggregate Obturation: A Review and Case Series

Mineral trioxide aggregate (MTA) has emerged as a reliable bioactive material with extended applications in endodontics that include the obturation of the root canal space. This article examines the literature supporting MTA as a canal filling material, suggests methods for its delivery and placement, and presents clinical cases that demonstrate its effectiveness in resolving apical periodontitis under a variety of circumstances. Case reports are presented documenting clinical outcomes after the application of MTA that include retreatment, obturation combined with root-end resection, apexification, internal resorption, dens in dente, and in conventional endodontic therapy. The review introduces clinicians to an alternative treatment strategy that might improve the healing outcomes for patients presenting with complex and challenging endodontic conditions.     

Endodontic Microsurgery of Mandibular Second Molars Using the Bony Lid Approach: A Case Series

Endodontic microsurgery is important for preservation of natural teeth with symptomatic apical periodontitis when conventional endodontic treatment is neither feasible nor effective. The thick buccal cortex, poor visibility, and potential neurovascular complications can make microsurgical procedures of mandibular second molars infeasible. With the aid of cone-beam computed tomography, the bony lid approach was applied in 10 cases of endodontic microsurgery of mandibular second molars at the VIP Center, Hangzhou Stomatology Hospital between 2019 and 2020. In all cases, the clinical and radiographic findings at the 24- or 36-month follow-up revealed complete healing of the periapical lesions. The bony lid technique contributed to precise root-end localization and helped avoid excessive postoperative pain or unfavorable healing that occurred in cases of excessive alveolar bone resection. Some clinical tips on preserving the cortical bone, obtaining precise access, and improving surgical efficiency have been proposed in this report.     

第一、二鳃弓综合征的临床因素探讨

目的 探讨第一、二鳃弓综合征的病因学、临床症状及治疗手段。方法 回顾性分析5例患者的临床资料及治疗情况。结果 根据病史及临床症状确诊,分期手术有效恢复了患者的面形。结论 本病病因尚不十分明确,诊断较容易,治疗以手术修复为主,分期进行,形态和功能并重。     

Variations of Palatal Canal Morphology in Maxillary Molars: A Case Series and Literature Review

A series of challenging cases with unusual canal anatomy in the palatal roots of maxillary first and second molars is presented. A review of the literature was done to elucidate the prevalence of anatomic variations in the palatal canal of maxillary first and second molars. An uncertain or indefinite radiographic appearance of the palatal canal, or eccentric deviation of the master cone or previous root canal filling was considered an indication of a bifurcated palatal canal. Five maxillary molars with a bifurcated palatal canal were identified. A MEDLINE database search was performed to identify studies on the palatal canal morphology of maxillary first and second molars. Data were categorized based on the methodology used in each study. The overall prevalence of anatomic variations in the palatal canal of maxillary first and second molars was less than 2%; however, anatomic variations occurred more frequently in certain ethnic groups, reaching up to 33% in maxillary first molars and up to 14% in maxillary second molars. This case series showed that even experienced endodontic clinicians can miss a bifurcated palatal canal if they are not aware of or overlook the hidden clues for these anatomic variations. The traditional assumption of an exclusively single-canal anatomy in palatal canals of maxillary molars needs to be changed, even though it is the most prevalent anatomy. The overall low percentage of more than 1 palatal canal in maxillary molars is disturbingly misleading, because in certain ethnic groups this prevalence can be considerably higher.     

Arthroscopic Management of Synovial Chondromatosis of the Temporomandibular Joint. Case Series and Systematic Review

Aim

Synovial chondromatosis (SC) is a benign condition that is characterized by the formation of cartilaginous nodules within the synovial tissue of a joint that may detach and form loose bodies inside the articular space. The purpose of this study is to evaluate the use of surgical arthroscopy for the treatment of SC of the temporomandibular joint (TMJ).

Materials and Methods

A series of six patients treated with arthroscopy (one patient requiring an open arthrotomy due to the size of the loose bodies) in our centre between 1997 and 2016 is presented and results are discussed. A systematic review of the literature of patients with SC treated with arthroscopy or arthroscopy-assisted open arthrotomy is also carried out.

Results

Pain, which was the main symptom in our patients, and maximum mouth opening both improved significantly after surgical treatment. Three of the patients were diagnosed with primary SC, and the other 3 had a previous diagnosis of internal derangement. None of the patients showed signs of relapse during the follow-up period.

Conclusions

Surgical arthroscopy is a minimally invasive procedure that allows the extraction of loose bodies and even partial synovectomy of the affected membrane with good results and without recurrence of the disease. This technique can be useful in cases of SC with loose bodies measuring less than 3 mm or without extra-articular extension.