Trattamento chirurgico di una cisti odontogena gigante associata a terzo molare inferiore incluso,follow-up a 2 anni

Objectives

The aim of this case report is to describe the surgical approach to a large keratocystic odontogenic tumor associated with impacted lower third molar. The considerable size of the cyst and its adjacency to noble anatomical structures make the surgery more complex.

Materials and methods

The authors present a case of large keratocystic odontogenic tumor associated with impacted third molar, located in the right mandibular ramus.Cystectomy intervention with vestibular access was selected in order to preserve surrounding healthy tissues and to extract, at the same time, the impacted tooth. Histological analysis had previously allowed the initial diagnosis of keratocystic odontogenic tumor.

Results

Postoperative radiograph, performed 2 years after the cystectomy intervention, showed complete bone regeneration. Neither neurological complications, nor cyst recurrence occurred.

Conclusions

The presented surgical intervention allowed the cyst removal without any damage to surrounding anatomical structures.     

10-Year Follow-up of Calcifying Odontogenic Cyst in the Periapical Region of Vital Maxillary Central Incisor

Introduction

Radiographic images may lead to misinterpretations of lesions of endodontic and nonendodontic origin. This report describes a case of a 10-year follow-up of a calcifying odontogenic cyst (COC) in the periapical region of a vital maxillary central incisor in a 9-year-old boy.

Methods

The patient revealed a history of a swelling in the periapical area of tooth #9. The patient denied any dental trauma or history of pain. Clinical examination revealed no mobility, but there was discrete discomfort when horizontal pressure was applied. Pulp vitality was present in all maxillary anterior teeth. Radiographs revealed an oval radiolucent lesion in the periapical region of maxillary central incisor. The therapeutic option was enucleation of the periapical lesion and histologic examination of the specimen. Microscopic findings suggested the diagnosis of a COC.

Results

At a follow-up visit 10 years after surgery, panoramic and periapical radiographs showed new bone formation; the patient did not have any pain, and pulp vitality was maintained in all teeth in this area.

Conclusions

A COC should be part of the differential diagnosis of other jaw lesions, such as apical periodontitis. The definitive diagnosis of a COC can only be made after microscopic evaluation of the specimen. The follow-up is a helpful reference because it confirms the survival of pulp tissue and no recurrence of the COC.     

Effect of F68, F127, and P85 Pluronic Block Copolymers on Odontogenic Differentiation of Human Tooth Germ Stem Cells

Introduction

The major challenge in dental pulp engineering is to make a successful combination of stem cells and biomaterials with the aim of providing the differentiation of stem cells into odontogenic cell types. Among biomaterials, some types of pluronics have been reported to increase bone formation of stem cells. The effect of these pluronics on odontogenic differentiation has not been addressed yet. This study aimed to examine the effect of pluronics F68, F127, and P85 on odontogenic differentiation of stem cells derived from third molar tooth germs of young adults.

Methods

Human tooth germ stem cells (hTGSCs) were induced to differentiate into odontogenic cells in the presence of different concentrations of pluronics. Differentiation efficiency was assessed by quantitative real-time polymerase chain reaction for determining expression messenger RNA levels and by immunocytostaining for determining the protein expression of odontogenic markers (ie, dentin sialoprotein, dentin matrix protein 1, bone morphogenic protein 2, bone morphogenic protein 7) by measuring alkaline phosphatase enzyme activity and lastly by von Kossa staining for determining mineralization.

Results

The results revealed for the first time that F68 has a great potential to boost odontogenic differentiation of hTGSCs. P85 was found to reduce cell viability during differentiation. F127 was nontoxic to hTGSCs but did not have any effect on differentiation.

Conclusions

The positive effect of F68 on odontogenic differentiation might enable more efficient pulp regeneration. Yet, the exact mechanism of how F68 alters the differentiation pattern of hTGSCs remains to be investigated in the future studies.     

Chirurgia estrattiva e riabilitazione implantoprotesica di paziente con inclusioni dentarie multiple secondarie ad anchilosi

Objectives

The aim of this work is to present a case of multiple tooth inclusions caused by tooth ankylosis and treated by tooth extractions and implant-supported rehabilitation.

Materials and methods

The present case report is about a twenty year old male patient who came to our observation complaining of severe pain in the left mandible. He was not a smoker and was in good general health. Clinical examination and panoramic radiograph showed a rare case of multiple tooth inclusions, namely of 3.6, 3.7 and 3.8. Tooth 3.6 was also affected by destructive caries responsible for the patient's pain. As it was impossible to recover the bone included teeth, it was decided to extract hopeless teeth and to regenerate bone defect using platelet-rich fibrin (PRF) membrane and titanium mesh.

Results and conclusions

9 months after surgery, the titanium mesh was removed and two implants were inserted in the regenerated bone. The proposed clinical solution made the case treatment possible in a short time, without the use of biomaterials.     

Autogenous Premolar Transplantation into Artificial Socket in Maxillary Lateral Incisor Site

Introduction

Autogenous transplantation of a natural tooth to another site has significant advantages over dental implants, particularly in cases of agenesis, accidental tooth loss, or poor prognosis for the maintenance of tooth function.

Methods

This report describes a case of autogenous premolar transplantation into an artificial socket in the site of a missing maxillary lateral incisor in a 13-year-old girl. Clinical examination and radiography revealed tooth agenesis (#4, #10, #13, and #20) and microdontia (#7). The occlusion and skeletal maxillomandibular relations were normal.

Results

Tooth #29 was chosen for transplantation into the site of tooth #10 because of its size, stage of root formation, and possible closure of the spaces created by agenesis.

Conclusions

Autogenous transplantation is a feasible alternative to dental implants in cases of tooth agenesis or tooth loss because of trauma. Autotransplantation was indicated in this case because it ensures the natural (facial) growth of the alveolar process and preserves the function of periodontal tissues. A multidisciplinary approach (ie, combining techniques from different dental specialties) was important for treatment success. Clinical and radiographic follow-up confirmed that the transplanted premolar was esthetically comparable with the lateral incisor and that root development and pulp canal obliteration were complete.     

Orthokeratinized Odontogenic Cysts Presenting as a Periapical Lesion: Report of a Case and Literature Review

Introduction

Inflammatory cysts, granulomas, abscesses, and fibrous scars represent most periapical radiolucencies. However, other less common lesions, such as orthokeratinized odontogenic cysts (OOCs), can be found at this region, and they deserve to be discussed because the prognosis for an OOC is different from that expected for the ordinary inflammatory periapical diseases.

Methods

An interesting case of OOC associated with a nonvital tooth in a 40-year-old woman is described. After a previous clinical diagnosis of a radicular cyst, the tooth was extracted, and the lesion was enucleated and submitted to microscopy examination.

Results

Because of the detection of an orthokeratinized epithelium lining, a diagnosis of OOC was concluded. After 2 years of periodic follow-up, no signs of recurrence were detected.

Conclusions

The presence of keratin in radicular lesions must be carefully evaluated to eliminate the diagnosis of lesions with more aggressive behavior, such as an OOC or even a keratocystic odontogenic tumor. Hence, histopathologic examination is mandatory to confirm the type of lesion and to differentiate other pathologic conditions, therefore establishing patients' prognoses precisely.     

Exposure to a continuous low dose of tetrachlorodibenzo-p-dioxin impairs the development of the tooth root in lactational rats and alters the function of apical papilla-derived stem cells

Objectives

Ubiquitous environmental pollutants such as 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) cause abnormalities in reproduction and development. TCDD inhibits the development of teeth, and its effects depend on its dose and the developmental stage of the tooth. Our aim here was to investigate the effect of lower doses of TCDD on the development of the tooth root in vivo and in vitro.

Design

We observed tooth root development in lactational rats exposed to continuous low doses of TCDD starting on postnatal day 6 using Mico-CT analyses and histopathological examinations. And then the characteristics of stem cells derived from the apical papilla (SCAPs) were evaluated and compared with SCAPs induced by lower doses of TCDD both in vitro and in vivo.

Results

The results of experiments showed that rat pups exposed to low dose TCDD at prenatal stage developed, dentine hypoplasia, and hypomineralization. Further, TCDD impaired the functions of SCAPs in vivo by inhibiting cell proliferation and osteogenic and odontogenic differentiation. The impairment of SCAPs after TCDD exposure was accompanied by increased expression of AHR, down-regulation of the expression of Runx2, and alkaline phosphatase, suggesting that the AHR pathway mediated the effects of TCDD.

Conclusion

These results provide the first insights into the toxicity of TCDD, which adversely affects the development of the tooth root through indirectly altering the function of SCAPs.     

Histologic and Histobacteriologic Observations of Failed Revascularization/Revitalization Therapy: A Case Report

Introduction

Mechanical debridement plays an important role in eliminating intracanal bacteria, such as biofilm on the canal walls and bacteria in the dentinal tubules. Mechanical debridement is not recommended for root canal disinfection in revascularization/revitalization therapy. Here we report a failed revascularization/revitalization case, which could be due to inadequate root canal disinfection without mechanical removal of biofilm and bacteria in dentinal tubules.

Methods

A 6-year-old boy had a traumatic injury to tooth #9, which was avulsed and replanted within 40 minutes. The tooth subsequently developed a local swelling in the periapical area. The patient was referred to the Postgraduate Endodontic Clinic for revascularization/revitalization therapy on tooth #9. The treated tooth remained asymptomatic for 16 months and then developed pain and local periapical swelling. The oral surgeon extracted the revascularized/revitalized tooth. On request, the extracted tooth was processed for histologic and histobacteriologic examination.

Results

The tissue in the canal was completely destroyed. Most bacteria were observed in the apical portion and not in the coronal portion of the canal and formed biofilm on the canal walls and penetrated into the dentinal tubules.

Conclusions

On the basis of histobacteriologic observations, the failure of revascularized/revitalized tooth could be due to inadequate root canal disinfection without mechanical debridement. It may be important to perform mechanical debridement as part of the revascularization/revitalization therapy to disrupt the biofilm on the canal walls and remove bacteria in the dentinal tubules because revascularization/revitalization therapy is able to increase thickening of the canal walls.     

Peripheral GABAA receptor activation modulates rat tongue afferent mechanical sensitivity

Objectives

The expression of GABA_A receptors and the effects of GABAA receptor agonists on the response properties of tongue afferent fibres were investigated in female rats to determine if peripheral GABA receptors might be a target of topical benzodiazepines when used for pain relief in burning mouth syndrome patients.

Design

Nerve fibres in tongue sections from six female rats were identified using protein gene product 9.5, and the co-expression of the γ subunit of GABAA receptor and substance P assessed in the nerve fibres. In vivo extracellular recordings of trigeminal ganglion neurons that innervate the tongue were undertaken in 27 anesthetised female rats and their responses to mechanical and thermal stimulation characterised before and after topical application of GABA, the GABA_A receptor selective agonist muscimol or vehicle control.

Results

The vast majority of tongue nerve fibres examined (95%) expressed the γ subunit of GABA_A receptor. Bath application of muscimol, but not GABA, significantly increased the mechanical thresholds of tongue afferent fibres compared to vehicle, but only after the tongue had been heated with 60 °C water.

Conclusions

GABA_A receptors are present on tongue nerve fibres and their activation alters the mechanical sensitivity these fibres. These findings suggest that topical application of benzodiazepines to the oral mucosa may decrease pain in burning mouth syndrome through a local action on peripheral GABA_A receptors.     

Effect of Preoperative Acetaminophen/Hydrocodone on the Efficacy of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective,Randomized, Double-blind,Placebo-controlled Study

Introduction

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of the administration of the combination acetaminophen/hydrocodone on the anesthetic success of mandibular posterior teeth in patients experiencing symptomatic irreversible pulpitis.

Methods

One hundred emergency patients in moderate to severe pain diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, identical capsules of either a combination dose of 1000 mg acetaminophen/10 mg hydrocodone or placebo 60 minutes before the administration of a conventional inferior alveolar nerve (IAN) block. Endodontic access was begun 15 minutes after completion of the block, and all patients used for data analysis had profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) on pulpal access or instrumentation.

Results

The success rate for the IAN block was 32% for the combination dose of 1000 mg acetaminophen/10 hydrocodone and 28% for the placebo dose, with no statistically significant difference between the 2 groups (P = .662).

Conclusions

A combination dose of 1000 mg acetaminophen/10 mg hydrocodone given 60 minutes before the administration of the IAN block did not result in a statistically significant increase in anesthetic success for mandibular posterior teeth in patients experiencing symptomatic irreversible pulpitis.     

Effect of Thermal Stresses on the Mechanism of Tooth Pain

Introduction

Daily hot and cold thermal loadings on teeth may result in structural deformation, mechanical stress, and pain signaling. The aim of this study was to compare the adverse effects of hot and cold beverages on an intact tooth and, then, to provide physical evidence to support the hydrodynamic theory of tooth pain sensation mechanism.

Methods

Three-dimensional finite element analysis was performed on a premolar model subjected to hot and cold thermal loadings. Elapsed times for heat diffusion and stress detection at the pulp-dentin junction were calculated as measures of the pain sensation.

Results

Extreme tensile stress within the enamel resulted in damage in cold loadings. Also, extreme values of stress at the pulpal wall occurred 21.6 seconds earlier than extreme temperatures in hot and cold loadings.

Conclusions

The intact tooth was remarkably vulnerable to cold loading. Earlier changes in mechanical stress rather than temperature at the pulp-dentin junction indicate that the dental pain caused by hot or cold beverages may be based on the hydrodynamic theory.     

Diagnosi,trattamento e follow-up delle lesioni trigeminali del cavo orale

Objectives

Oral surgery complications, specifically nerve lesions, are more and more frequent due to the wide spread of implantology.

Materials and methods

Surgical timing is pivotal. Surgical treatment should be promptly performed in case of either ascertained lesion or pain. The authors present their procedural protocol for lingual nerve and inferior alveolar nerve lesions.

Results

Results of the presented protocol are satisfactory with a functional recovery of approximately 80%.

Conclusions

Regeneration process, prognosis and treatment of nerve lesions are still hardly known by specialists. A systematic approach allows both patients and physicians to keep unconcerned by unprofessional opinions that are unsupported by actual scientific evidence.     

Changes in the spatial distribution of sclerostin in the osteocytic lacuno-canalicular system in alveolar bone due to orthodontic forces,as detected on multimodal confocal fluorescence imaging analyses

Objective

Mechanical loading on the bone is sensed by osteocytes. Sclerostin is a molecule secreted by osteocytes that is downregulated by mechanical loading; therefore, its expression level is a potent sensor that indicates the spatial transduction of biomechanical properties in bone. This study applied macroconfocal microscopy to observe the spatial response of alveolar bone to orthodontic forces after immunofluorescence using anti-sclerostin antibodies.

Design

Orthodontic tooth movement with the Ni–Ti closed-coil spring was applied between the upper bilateral incisors and the left first molar of mice. Four days after this application, the animals were subjected to multimodal confocal fluorescence imaging analyses.

Results

Obvious downregulation of sclerotin in the osteocytic lacuna-canalicular system (LCS) was observed specifically in tensile sites of alveolar bone. Confocal-based three-dimensional fluorescence morphometry further quantitatively demonstrated that the distribution and expression of sclerostin in the tensile sites was significantly reduced compared to that observed in the corresponding control sites. Interestingly, the levels of sclerotin signals in the compression sites were significantly higher than those observed in the control sites, although the distribution of sclerotin was not significantly different.

Conclusions

Our observations suggest that spatial changes in the level and distribution of sclerostin in the alveolar LCS trigger successive bone remodelling due to orthodontic tooth movement. The multimodal confocal imaging analyses applied in this work will enhance comprehensive understanding regarding the spatial regulation of molecules of interest from the tissue to the cellular level.     

A rare case report and appraisal of the literature on spontaneous tooth exfoliation associated with trigeminal herpes zoster

Background

Reports of post herpetic maxillofacial complications have been very rarely documented in the literature that includes periapical lesions, calcified and devitalized pulps, resorption of roots, osteonecrosis, and spontaneous exfoliation of teeth. The atypical feature of the case of concern to the dental surgeon is the rare complication of spontaneous tooth exfoliation following herpes zoster.

Case report

This case reports a male patient of age 47 years who reported to the Department of Periodontology with the chief complaint of mobility in the left upper central incisor. Patient history revealed herpes zoster infection that began 11 days earlier along with underlying diabetes mellitus condition. We hereby report a known diabetic patient with history of herpes zoster infection who presented with rare complication of spontaneous tooth exfoliation involving the maxillary division of the trigeminal nerve.

Discussion

Limited number of cases has been reported in the literature regarding spontaneous teeth exfoliation secondary to herpes zoster. The exact pathogenesis regarding the spontaneous exfoliation of teeth in herpes zoster patient is still controversial. Thus, an oral health care provider should be aware of this rare complication while managing a case of tooth mobility with the previous history of herpes zoster of trigeminal nerve.

     

Degree of Patient Pain,Complications, and Satisfaction after Root Canal Treatment or a Single Implant: A Preliminary Prospective Investigation

Introduction

Dentists often face the choice between tooth retention with root canal treatment and tooth replacement with implant treatment. To date, there has not been a prospective clinical trial directly comparing nonsurgical root canal treatment and single delayed implant therapy with regard to the degree of preoperative and postoperative pain, complications, and patient satisfaction.

Methods

Twenty-four patients had initial nonsurgical root canal treatment, and another 24 had single implant treatment in healed sites. Questionnaires were given at pretreatment, 7 days, 3 months, 6 months, and 12 months.

Results

All patients completed the 12-month follow-up period. No significant difference in pain, complications, or overall satisfaction was noted between the 2 groups at any of the time points (P > .05). However, there were differences within each group between the time points. There was more pain at pretreatment for root canal treatment and 7-day post-treatment point for single implant treatment than any other time point. For complications, more were reported at the 7-day post-treatment point than any other time point for both groups. With overall satisfaction, there was no difference from any time point for either group.

Conclusions

The results of this study suggest that patients perceive both treatments with high degrees of satisfaction with minimal pain and discomfort. Differences were found at different time points of treatment and were related to the nature of the treatment itself. This information is useful to help patients with treatment decisions.     

Examining the Sensitivity and Specificity of 2 Screening Instruments: Odontogenic or Temporomandibular Disorder Pain?

Introduction

Two groups of patients with orofacial pains that are clinically important to distinguish from each other are patients with odontogenic pain and temporomandibular disorder (TMD) pain. The aim of this study was to determine the sensitivity and specificity of 2 screening instruments in distinguishing between patients with these types of pain.

8-Year Follow-up of Central Giant Cell Lesion Mimicking Apical Periodontitis

Introduction

Lesions of nonendodontic origin may mimic apical periodontitis. Central giant cell lesions (CGCLs) are aggressive or nonaggressive benign idiopathic intraosseous lesions of the jaw. This report describes a case of a CGCL in the periapical region of teeth #21–#26 of a 17-year-old female who sought orthodontic care because of a change in the position of tooth #23.

Methods

Clinical examination revealed mild facial asymmetry caused by increased volume in the mental region and cortical bone expansion but no cortical disruption. A panoramic radiograph showed a well-defined radiolucent osteolytic lesion involving teeth #21–#26. The cortical bone was not affected, and there was no root resorption. Incisional biopsy was performed, and the diagnosis was a CGCL. The lesion was enucleated surgically. CGCLs should be included in the differential diagnosis of jaw lesions that mimic apical periodontitis.

Results

The patient subsequently underwent orthodontic treatment successfully.

Conclusions

The 8-year clinical and radiographic follow-up confirmed lesion remission, no recurrence, and pulp vitality of all teeth.     

Treatment of a Hypertaurodontic Maxillary Second Molar in a Patient with 10 Taurodonts: A Case Report

Introduction

Taurodontism is an aberration in tooth morphology characterized by vertically enlarged pulp chambers, apical displacement of pulp floors, and short roots. So far in the literature, no more than 8 taurodonts have been reported in 1 patient. The aim of this case report was to describe the endodontic management of a hypertaurodont maxillary second molar and to present a rare case with 10 taurodonts in a black man with a biometric analysis using cone-beam computed tomographic imaging.

Methods

An 18 year-old black man was referred to the postgraduate endodontic clinic for emergency treatment. The patient's medical history was noncontributory. Tooth #2 had lingering pain in response to the cold test and was positive to both percussion and palpation. Radiographic examination showed the characteristics of taurodontism and periapical radiolucency around the root apices of tooth #2. Tooth #2 was diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. The tooth was endodontically treated in 2 appointments. A panoramic radiograph showed multiple taurodontism. At the follow-up, a cone-beam computed tomographic scan was taken to further evaluate and diagnose taurodontism. Ten molars showed taurodontism including 7 hypertaurodonts, 2 mesotaurodonts, and a hypotaurodont. High variations of root canal anatomy were observed among taurodonts including maxillary and mandibular hypertaurodonts with C-shape canals.

Conclusions

The present case describes 10 taurodonts in a patient with no specific syndromes and endodontic treatment of a hypertaurodont maxillary second molar. Cone-beam computed tomographic imaging may be useful in the evaluation and management of the anatomic complexity of roots and root canals of taurodonts.     

Prevalence of dentine hypersensitivity and study of associated factors: A European population-based cross-sectional study

Objectives

Dentine hypersensitivity (DH) manifests as a transient but arresting oral pain. The incidence is thought to be rising, particularly in young adults, due to increases in consumption of healthy, yet erosive, diets. This study aimed to assess the prevalence of DH and relative importance of risk factors, in 18–35 year old Europeans.

Methods

In 2011, 3187 adults were enrolled from general dental practices in France, Spain, Italy, United Kingdom, Finland, Latvia and Estonia. DH was clinically evaluated by cold air tooth stimulation, patient pain rating (yes/no), accompanied by investigator pain rating (Schiff 0–3). Erosive toothwear (BEWE index 0–3) and gingival recession (mm) were recorded. Patients completed a questionnaire regarding the nature of their DH, erosive dietary intake and toothbrushing habits.

Results

41.9% of patients reported pain on tooth stimulation and 56.8% scored ≥1 on Schiff scale for at least one tooth. Clinical elicited sensitivity was closely related to Schiff score and to a lesser degree, questionnaire reported sensitivity (26.8%), possibly reflecting the transient nature of the pain, alongside good coping mechanisms. Significant associations were found between clinically elicited DH and erosive toothwear and gingival recession. The questionnaire showed marked associations between DH and risk factors including heartburn/acid reflux, vomiting, sleeping medications, energy drinks, smoking and acid dietary intake.

Conclusion

Overall, the prevalence of DH was high compared to many published findings, with a strong, progressive relationship between DH and erosive toothwear, which is important to recognise for patient preventive therapies and clinical management of DH pain.