Endodontic treatment of an invaginated maxillary lateral incisor with a periradicular lesion and a healthy pulp

AIM: To report the healing of a periradicular lesion following nonsurgical root canal treatment of a dental invagination. SUMMARY: A case of dens invaginatus type 3 with a periradicular lesion and a healthy pulp is reported. Nonsurgical root canal treatment of the invagination was performed successfully and resolved an associated periradicular lesion. Despite the complex anatomy and a diagnosis of apical periodontitis, pulp health was retained after endodontic treatment of the invaginated canal. Clinical considerations and treatment are discussed and reported. KEY LEARNING POINTS: Dens invaginatus can present in a variety of forms, knowledge of which can usefully inform endodontic diagnosis and treatment. In certain cases, success can be achieved by treating the invagination alone. Pulp health may be preserved during and after treatment of an infected invagination.     

正畸治疗引起根吸收研究进展

根吸收是正畸治疗常见的并发症,它可发生于牙根的任何部位,但最常见于根尖部.本文就根吸收的临床表现、诊断、原因、周围组织变化进行综述,以供临床参考.     

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常规的正畸治疗会增大牙根吸收的风险,许多学者都在自己的临床观察中证实了这个现象的存在。Phillips[1]认为,在多数情况下,牙根吸收在临床上的表现并不明显,对于牙列的功能和寿命都没有影响。然而,在对牙齿进行长期观察之后发现,牙根有再吸收的现象出现,其冠根比     

正畸治疗前后牙根吸收的临床研究

目的 调查正畸治疗前后牙根吸收的临床特征。方法 随机选择至少经过十二个月固定正畸治疗,有清晰可辨的矫治前后全口曲面断层片的病例９６例,用根吸收分级评估法记录每人矫治前后全口牙齿根吸收情况,并统计分析。结果 （１）正畸治疗前８．６％的牙齿存在根吸收,治疗后４１．６％的牙齿有程度不等的根吸收;（２）治疗前的根吸收绝大部分为轻度,治疗后仍以轻度吸收为主,但也有部分中重度吸收;（３）治疗前的根吸收主要在上颌前牙区;治疗后根吸收上下颌没有显著性差异,但前牙明显高于后牙。结论（１）正畸后的根吸收较为常见;（２）大部分正畸过程中的牙根吸收是可接受的;（３）正畸治疗后有一部分牙齿（１．３％）出现重度根吸收,主要分布于上前牙,成为危害患者颜面美观及功能的隐患,应引起足够的重视。     

Root canal treatment of mandibular second premolar with four root canals: a case report

The importance of an accurate diagnosis of the morphology of the root canal system is a prerequisite for successful root canal treatment and has been emphasized throughout the literature. Root canal morphology of premolar teeth, either maxillary or mandibular, and the discrepancies between first and second premolars, have been investigated and reported. A case report is presented of the root canal treatment of a mandibular second premolar with four root canals. As far as the reviewed literature revealed, up to three root canals in mandibular premolars have been reported. No previous report of a similar case of four root canals in a mandibular premolar was found.     

3个根管的下颌第一前磨牙的根管治疗1例

3个根管的下颌第一前磨牙极其罕见,本文报道1例3个根管的下颌第一前磨牙的根管治疗,并着重探讨了根管探查和预备的要点。     

Use of triple antibiotic paste in the treatment of large periradicular lesions

Microorganisms are the possible source of endodontic lesions. The polymicrobial infection makes the sterilization of the root canal difficult. The following case report describes the non-surgical endodontic treatment of teeth with a large periradicular lesion. First, an intracanal dressing of calcium hydroxide was given. Since the symptoms did not subside, the treatment protocol was changed. A triple antibiotic paste was used instead for 3 months. On follow up, teeth were clinically asymptomatic and radiographically showed healing of the periradicular lesion. The result of the case show that when most commonly-used medicaments fail in eliminating the symptoms, then a triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) can be used clinically in the treatment of teeth with large periradicular lesions.     

The use of calcium sulphate in the surgical treatment of a 'through and through' periradicular lesion

AIM: This randomized, controlled, clinical study was designed to evaluate the adjunctive effect of calcium sulphate grafts on the surgical treatment of through and through periradicular lesions. METHODOLOGY: Twenty patients each with one tooth showing evidence radiologically of a periradicular lesion wider than 10 mm, with lack of both buccal and lingual cortical bony plates and an indication for surgery were selected for the study. Ten teeth were treated with apicectomy, root-end filling and grafting of the bone defect with calcium sulphate prior to suturing (test group). The other 10 teeth received the same surgical therapy but no grafting with calcium sulphate (control group). The outcome of the healing process was evaluated at 6 and 12 months radiographically following the criteria reported by Rud and Andreasen. RESULTS: At the six- and 12-month evaluation the test group had seven teeth with complete healing and two with incomplete healing, whilst the control group showed three teeth with complete healing, five with incomplete healing and one with unsatisfactory healing. One tooth in each group had to be extracted because of a vertical fracture that occurred during the follow-up period. CONCLUSIONS: The results of the study demonstrate that the addition of calcium sulphate as a bone graft during the conventional surgical treatment of through and through lesions improves the clinical outcome. Histological analysis is desirable to investigate the quality of tissues formed using the two surgical procedures.     

正畸治疗对根管治疗牙及对侧同名活髓牙根吸收影响的Meta分析

目的    分析正畸治疗对根管治疗牙及对侧同名活髓牙根吸收的影响。方法    计算机检索Cochrane Library、PubMed、Embase、Google Scholar、中国知网、万方等数据库,查找研究根管治疗牙经正畸治疗后牙根吸收情况的相关文献。应用Meta分析比较正畸治疗对根管治疗牙及对侧同名活髓牙根吸收的影响。结果    纳入了10篇相关文献。Meta分析结果发现,正畸治疗患者根管治疗牙根吸收情况与对侧同名活髓牙比较,差异无统计学意义（P > 0.05）。在男性正畸治疗患者中,根管治疗牙牙根吸收量小于对侧同名活髓牙,差异有统计学意义（P < 0.05）;而女性正畸治疗患者两侧牙根吸收量比较,差异无统计学意义（P > 0.05）。正畸治疗方式（拔牙矫治与非拔牙矫治）和牙位（前牙与后牙）对正畸治疗患者根管治疗牙及对侧同名活髓牙根吸收的影响比较,差异均无统计学意义（均P > 0.05）。结论    正畸治疗过程中移动根管治疗后的牙齿是一种相对安全的操作。     

Continued root formation of a pulpless permanent incisor following root canal treatment: a case report

AIM: To present a case of a pulpless permanent incisor that continued root formation following root canal treatment. SUMMARY: A healthy 8-year-old girl with a history of dental trauma resulting in a coronal fracture involving enamel, dentine and pulp was referred by her general dental practitioner for treatment and evaluation of tooth 21. The tooth had a necrotic pulp and periapical rarefaction was evident radiographically. The canal was prepared, dressed with Ca(OH)2 and then filled with a rolled gutta percha cone and Roth's root canal sealer. A radiograph exposed eight years post-treatment, showed evidence of continued apical formation. KEY LEARNING POINTS: *Teeth with necrotic pulps and periapical rarefaction may show evidence of continued apical formation after root canal treatment. *Hertwig's epithelial root sheath may be more resistant than expected to trauma and infection.     

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目的    评价上中切牙正畸治疗后根吸收状况,探讨影响根吸收的相关因素。方法    从大连大学附属口腔医院正畸科2名资深医生2007年5月至2009年12月所完成的正畸病例中,随机选择233例（男85例,女148例）。分为成人组90例,平均年龄（21.73 ± 3.68）岁;青少年组143例,平均年龄（13.37 ± 1.81）岁。通过分析治疗前后的头颅侧位片观察上中切牙牙根形态与长度变化,评价上中切牙根吸收状况。结果    233例患者中的13例上中切牙发生了不同程度的根吸收,根吸收发生率为5.58%。成人女性拔牙矫治组的上中切牙根吸收程度高于青少年女性拔牙矫治组,差异有统计学意义（P < 0.05）。青少年组中,女性拔牙矫治患者的根吸收程度较男性拔牙矫治患者明显,差异有统计学意义（P < 0.05）。而是否拔牙,其上中切牙根吸收程度差异无统计学意义（P > 0.05）。结论    女性拔牙矫治患者治疗后的上中切牙根吸收发生率较高。正畸根吸收原因复杂,治疗前应详细分析各种根吸收易发因素,以减小正畸根吸收的发生和程度,维持正畸牙齿的健康。     

Severe tooth loss after root damage caused by predrilled intermaxillary fixation screw: a case report

Intermaxillary fixation (IMF) with screws is routinely used as a conservative therapy or to obtain normal occlusion during the surgical procedure of open reduction and internal fixation for treating mandibular fractures. The risk of iatrogenic dental damage caused by interdental drilling is widely known. Several side effects are described, including loss of response to pulp sensibility testing, root fracture, and, loss of the tooth. This is a case report about a young man who had undergone temporary IMF treatment with a single proven root damage. The patient did not appear for follow‐up but he presented 5 years afterward with local purulent osteomyelitis concerning the affected and the adjacent teeth. Osteotomy and extraction of two premolars and one molar were necessary for rehabilitation. This case report illustrates the importance of careful use of predrilled IMF screws and the necessity of frequent follow‐ups in cases of proven tooth root damage due to IMF treatment.     

正畸治疗中牙根吸收的影响因素

牙根吸收是正畸治疗中的常见并发症，其直接影响治疗效果及牙齿的健康。正畸治疗诱导的牙根吸收是无法完全避免的，它的影响因素也非常复杂。控制牙根吸收，首先要了解其病因，本文将对牙根吸收的影响因素作一综述。     

根管治疗术在牙周牙髓联合病变治疗中的应用

目的：探讨根管治疗术在牙周牙髓联合病变治疗中的重要性。方法：对235例356个牙周病引起牙周牙髓联合病变的患牙进行分级并分成2组,实验组采用根管治疗术和牙周系统治疗的联合治疗,对照组只采用牙周系统治疗。观察治疗后1年的临床疗效。结果：治疗1年后,实验组临床疗效好于对照组,有显著性差异（P〈0．01）。结论：根管治疗术的应用在牙周病引起的牙周牙髓联合病变的治疗中具有重要意义。     

Root canal treatment of a mandibular canine with three root canals. Case report

The differing morphological manifestations of the root canal system have been the subject of research, and the incidence of various shapes of root canal systems has been classified. The present case describes the root canal treatment of a rare morphological pattern, namely a mandibular permanent canine with three root canals. No report of a similar case has been published previously.     

双根三根管上颌第一前磨牙根管治疗1例

上颌第一前磨牙三根管的发生率为0.5%~7.5%,目前国内报道的多为三根三根管型,尚未见双根三根管型的病例报告。本病例介绍1例双根三根管型上颌第一前磨牙的根管治疗。     

Root canal treatment in an unusual maxillary first molar: a case report

AIM: The aim of this clinical article is to describe the unusual anatomy that was detected in a maxillary first molar during routine endodontic treatment. SUMMARY: Success in root canal treatment is achieved after thorough cleaning and shaping followed by the complete obturation of the root canal system. Such treatment may be performed in root canal systems that do not comply with the normal anatomical features described in standard textbooks. The present case describes root canal treatment in a maxillary first molar with two roots and a type IV canal configuration in the buccal root. KEY LEARNING POINTS Careful examination of radiographs and the internal anatomy of teeth is essential. Root canal treatment is likely to fail if the entire system is not debrided and filled. Anatomic variations can occur in any tooth.