Secondary hyperparathyroidism: a case report

A thorough diagnostic examination is essential before providing endodontic treatment. The sequence of diagnostic procedures must begin with a well-organized review of the medical history. In the early screening process, a health history that reveals a systemic disorder must be investigated further because it may have a significant impact on the dental diagnosis and ultimate endodontic treatment. There are a number of systemic diseases that can cause bone lesions throughout the body. Chronic renal failure is one disorder that may stimulate a secondary hyperparathyroidism that can cause a variety of bone lesions. In some instances these lesions appear in the periapical region of teeth and can lead to a misdiagnosis of a lesion of endodontic origin. The following case report of a patient referred for endodontic treatment demonstrates the importance of understanding the effects of end-stage renal disease on the dental structures.     

牙髓病与牙周病的内在联系

牙髓病与牙周病的鉴别诊断通常不是简单明了的,患牙同时罹患牙髓病损和牙周病损无疑大大增加疾病的诊断难度,需要通过诊断性检查收集大量临床数据来获得正确的诊断。当检查和治疗牙周牙髓联合病变或单个病变时,必须牢记成功的治疗基于正确的诊断。     

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??The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. Endodontic and periodontal lesions result from the close interrelationship of pulp tissue and the periodontium. The major pathways of communication between the two types of tissue are the apical foramina??lateral and accessory canals??and dentinal tubules. The differential diagnosis of endodontic and periodontal lesions is not always straightforward and requires clinical data accumulation from a number of diagnostic tests to obtain a correct diagnosis. When examining and treating the combined or individual lesion in endodontics and periodontics??the clinician must bear in mind that successful treatment depends on a correct diagnosis. Lesions with combined causes will require both endodontic and periodontal therapy??and endodontic therapy should usually be completed first.     

Bilateral buccal radicular groove in maxillary incisors: case report

AIM: To present the rare localization of a radicular groove on the buccal aspect of a tooth and to discuss the pathology and management of the concomitant endo-periodontal defect. SUMMARY: Bilateral buccal radicular grooves were found on the maxillary central incisors of a 60-year-old female Caucasian. One groove was associated with deep local pocketing resulting in pulp necrosis and the formation of a periodontal-endodontic lesion. After endodontic treatment of the affected tooth, periodontal surgery was performed during which an apicoectomy was carried out on the root-filled tooth. Both the buccal grooves were removed by grinding, the roots were planed with curettes and a guided-tissue regeneration technique applied using amelogenin (Emdogain, Biora, Sweden). Following a period of 2 years, re-examination showed excellent healing with the complete elimination of the periodontal pocket on both incisors and significant radiographic evidence of bone regeneration. KEY LEARNING POINTS: Deep radicular grooves can predispose to pulp necrosis and the establishment of combined periodontal-endodontic lesions. Evaluation of clinical signs and appropriate diagnostic tests are of paramount importance in order to prevent incorrect diagnosis and treatment. Endodontists must be capable of performing advanced periodontal regeneration techniques during endodontic surgery.     

牙周牙髓联合病变伴畸形根面沟治疗的临床疗效研究

目的:评价显微根管外科手术联合牙周治疗牙周牙髓联合病变伴畸形根面沟的治疗效果。方法:选择畸形根面沟致牙周牙髓联合病变的患牙11例,经显微根管治疗后,采用显微根管外科手术联合牙周治疗,分别记录患牙术前、术后6个月及术后1年牙周探诊深度(PD)、龈沟出血指数(SBI)、牙齿松动度(TM),并进行统计分析。所有患牙术后6个月及1年复查,通过临床检查和X线片评定根尖周病损愈合结果。结果:术后6月及术后1年分别与术前相比,PD、SBI及TM均明显降低(P<0.05);术后6月成功率为81.82%;术后1年成功率为90.91%。结论:显微根管外科手术联合牙周治疗是畸形根面沟致牙周牙髓联合病变的可行治疗方法。     

Guided tissue regeneration in the management of severe periodontal-endodontic lesions

Diagnosis of combined periodontal-endodontic lesions can prove difficult and frustrating. They are often characterised by extensive loss of periodontal attachment and alveolar bone, and their successful management depends on careful clinical evaluation, accurate diagnosis, and a structured approach to treatment planning for both the periodontic and endodontic components. Recent advances in regenerative periodontics have led to improved management of periodontal-endodontic lesions. This paper reviews the management of such lesions in light of these recent advances and illustrates this through reports of two patients who had severe periodontal involvement.     

Clinical repair of an osseous defect associated with a cemental tear: a case report

Cemental tears have been described as detachment of cementum caused by trauma or aging. They often result in severe periodontal lesions that may necessitate the extraction of the affected tooth. This case report describes the clinical resolution of a periodontal lesion associated with a cemental tear. A maxillary central incisor was subjected to endodontic treatment twice with no resolution of a deep distobuccal pocket and a palatal sinus tract from its apical region. The preoperative differential diagnosis for the condition present on the tooth included a vertical fracture and a combined periodontal-endodontic lesion. Surgical exploration of the area revealed a cemental tear on the apical third of the tooth. The cementum fragments were removed, root-end resection was performed, and the osseous lesion was treated with an osseous graft and guided tissue regeneration. Clinical examination of the area 1 year after surgery revealed resolution of both the prior pocket and sinus tract. Radiographic examination of the area showed increased radiopacity in the area of the original lesion, suggesting bone fill.     

The healing potential of periodontal-endodontic lesions

Osseous lesions involving the periodontium, and which are sometimes associated with discomfort and pathologic changes such as swelling or the development of a sinus tract, are not always due to periodontal disease. Thus, it is not uncommon to find a dentition with generally good periodontal health but with one tooth having a severe isolated bony periodontal defect. In other cases, periodontal treatment may result in a general improvement, except in relation to one tooth which does not respond to the therapy. Very often these cases are instances of combined periodontal-endodontic lesions, but which are solely of pulpal origin. This paper serves to help the dental practitioner recognise the disease process underlying the condition and appreciate its effective management with non-surgical root canal treatment.     

Interaction between endodontics and periodontics

Endodontic–periodontal lesions present challenges to the clinician regarding diagnosis, treatment planning and prognosis. Etiologic factors, such as bacteria and viruses, as well as contributing factors, such as trauma, root resorptions, perforations, cracks and dental malformations, play an important role in the development and progression of such lesions. Treatment and prognosis of endodontic–periodontal lesions vary, depending on the etiology, pathogenesis and correct diagnosis of each specific condition. This chapter will appraise the interrelationship between endodontic and periodontal lesions and provide biological and clinical evidence for diagnosis, prognosis and decision‐making in the treatment of these conditions.     

Periodontic-endodontic lesions: diagnostic and therapeutic indications

The presence of connections between periodontium and endodontium can lead to the diffusion of an infection from one apparatus to another. The involvement of both periodontium and endodontium is defined as Combined Periodontic-Endodontic lesions. This definition is not based on the initial etiology of the lesion and either the endodontic or periodontal lesion may be the cause or the result of the other or both may develop independently. The lesions must be correctly diagnosed for the best therapeutic approach. The diagnosis is based on clinical symptoms and radiographic analysis; clinical signs must show the presence of periodontal probing and pulpal necrosis. Radiographic examination can confirm the involvement of both periodontium and endodontium only if the lesion is present on the mesial and distal part of the diseased tooth; in the case of a palatal/lingual or vestibular lesion such evidence will not be detectable. The therapeutic approach is always based on an initial endodontic treatment followed, if needed, by the proper periodontal treatment.     

Therapeutic solution for a combined endo-periodontal lesion. Case report

The endo-periodontal lesion may lead to diagnostic and therapeutic difficulties in general dental practice. In the present case endo-periodontal inflammation of the lower left first molar caused the patient's complaints. The inflammation of periodontal and pulpal origin was separated although they simultaneously were present in the same time. Endo-periodontal lesion can be treated by endodontic and periodontal care and sometimes complemented by surgery. Scaling and polishing, as well as root planing were performed following the endodontic treatment of distal root, then the tooth was dissected and the mesial root was removed. Finally the remained distal part of molar was used as a bridge abutment. Combined endo-periodontal lesion can be cured with appropriate treatment as root filling, periodontal treatment, supplemented with tooth dissection.     

The endo‐perio lesion: a critical appraisal of the disease condition

Endodontic–periodontal lesions present challenges to the clinician as far as diagnosis and prognosis of the involved teeth are concerned. Etiologic factors such as bacteria, fungi, and viruses as well as various contributing factors such as trauma, root resorptions, perforations, and dental malformations play an important role in the development and progression of such lesions. Treatment and prognosis of endodontic–periodontal diseases vary and depend on the cause and the correct diagnosis of each specific condition. This article will appraise the interrelationship between endodontic and periodontal diseases and provide biological and clinical evidence of significance for diagnosis, prognosis, and decision‐making in the treatment of these conditions.     

Furcation lesion in a mandibular canine

Morphological changes can complicate dental treatment. This report presents a rare case of a furcation lesion in a mandibular canine with two roots. A 39-year-old man in general good health sought dental care for severe pain in his maxillary anterior teeth. The clinical examination showed localized swelling in the vestibular mucosa close to the mandibular left canine. Radiographic examination revealed two distinct roots and vertical bone resorption in the canine's mesial surface. Periodontal evaluation led to a diagnosis of periodontal abscess associated with furcation lesion. Despite the occurrence in an atypical location, the site of periodontal furcation received conventional therapy for initial decontamination, including tissue debridement and a combination of polyvinylpyrrolidone irrigation and antibiotics. To improve access, the decontamination was completed with surgical techniques and scaling and root planing. Early diagnosis of this rare morphological change helped to determine appropriate, timely treatment planning and optimal patient recovery.     

A Case Report of Non-Hodgkin Low-grade B-cell Mucosa-associated Lymphoid Tissue Lymphoma Presenting as a Suspected Endodontic Lesion

Extranodal mucosa-associated lymphoid tissue lymphoma is a rare oral disease. This case report describes a 71-year-old woman who presented for endodontic evaluation and treatment for swelling on the right posterior palatal. The case details the evaluation and diagnostic processes and treatment course. The case report draws attention to the importance of performing a biopsy, having proper sampling, and the additional steps sometimes required to arrive at a definitive diagnosis. This case report is the first to document a definitive low-grade B-cell mucosa-associated lymphoid tissue lymphoma mimicking endodontic pathology. The case shows the importance of proper examination, clinical imaging, and pathologic testing to arrive at a definitive diagnosis. It highlights that collaboration with other medical and dental specialties is essential for appropriate diagnosis and treatment and describes the “buttonhole” diagnostic strategy.     

牙周来源的牙周牙髓联合病变和牙周牙髓共存病变患牙牙周治疗时机的系统评价

目的 评估牙周来源的牙周牙髓联合病变以及真正联合病变（牙周病变和牙髓病变共存）患牙的牙周治疗时机,从而指导临床治疗。方法 在PubMed、EMbase、Cochrane、Web of Science、CNKI、CBM、万方数据库中搜索1980年至2017年3月间关于牙周牙髓联合病变治疗的相关文章,并对其进行分析。结果 最终纳入2篇随机对照研究、2篇前瞻性病例系列研究和8篇病例报告。所有研究病例均采用根管治疗和牙周非手术治疗或牙周手术治疗,且根管治疗是综合治疗的第一步;观察指标包括牙周探诊深度及附着丧失等。结论 对于牙周来源的牙周牙髓联合病变和真正的联合病变患牙,牙髓治疗和牙周非手术治疗间可能不需要观察期,但此结论还需大样本前瞻性随机对照临床研究来验证。     

A pilot study of treatment of periodontal-endodontic lesions

OBJECTIVE: A pilot study to evaluate a standardised treatment protocol for combined periodontal-endodontic lesions (involving staged endodontic and periodontal treatment). PARTICIPANTS: Nine patients with a diagnosis of a combined periodontal-endodontic lesion. METHODS: At baseline, root canal treatment (RCT) was performed by a standard protocol, and simple scaling/oral hygiene instruction provided. After one month, a standardised episode of non-surgical periodontal treatment was undertaken to address residual pocketing. Clinical measurements, including probing depths, attachment levels and bleeding on probing were recorded at baseline, month one and month three. Long-cone periapical radiographs taken using standardised projection geometry at baseline and month three were analysed for bone changes using digital subtraction radiography (DSR). RESULTS: During the study, one patient's affected tooth was extracted. From baseline to month three, there were statistically significant mean probing depth reductions (delta= 0.95mm, 95% CI= 0.20mm, 1.70mm; p= 0.02), mean attachment gains (delta= 1.13mm, 95% CI= 0.29mm, 1.96mm; p= 0.02) and reduction in mean bleeding on probing (delta= 29%, 95% CI= 10%, 49%; p= 0.01). DSR analysis revealed that between month 0 and month three, four teeth demonstrated bone gain, two teeth exhibited bone loss and two teeth showed no change. The mean bone change was in favour of bone gain but failed to achieve statistical significance (p>0.05). CONCLUSIONS: Within the limitations of this pilot study, treatment of periodontal-endodontic lesions by performing RCT prior to periodontal treatment was effective, resulting in improvements in clinical parameters together with alveolar bone gains in a majority of teeth.     

Management of the implant periapical lesion: a case report

The implant periapical lesion (IPL), a possible cause for implant failure, may occur from the presence of pre-existing microbial pathology such as endodontic/periodontal lesions. This case report presents a case history related to IPL, which was caused by a pre-existing endodontic lesion. In addition, other possible causes such as surgical trauma and the management strategies of IPL are suggested. For the treatment of the infected form of IPL, a sequential surgical therapy can be utilized. This includes surgical removal of the implant or implant apical region, thorough debridement of the infected lesion, systemic antibiotics, and/or guided bone regeneration. The implant therapy should be directed to minimize the occurrence or consequences of IPL by careful diagnosis, systematic treatment planning, and appropriate treatment procedures.     

Management of periodontitis associated with endodontically involved teeth: a case series

The pulp and the periodontal attachment are the two components that enable a tooth to function in the oral cavity. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. The function of the tooth is severely compromised when either one of these is involved in the disease process. Treatment of disease conditions involving both of these structures can be challenging and frequently requires combining both endodontic and periodontal treatment procedures. This article presents cases of periodontitis associated with endodontic lesions managed by both endodontic and periodontal therapy.     

140例牙周-牙髓联合病变的治疗效果分析

目的观察综合治疗牙周-牙髓联合病变的治疗效果。方法将140例160颗牙周-牙髓联合病变患牙分成3组,A组在进行根管治疗的同时行牙周治疗,B组在进行根管治疗后2～3个月再行牙周治疗,C组只进行根管治疗。观察治疗后1年的临床疗效。结果治疗1年后,A组的临床疗效好于B组,但差异没有显著性(P>0.05);A、B组临床疗效均好于C组,差异有显著性(P<0.05)。结论完善的根管治疗和及时的牙周系统治疗是牙周-牙髓联合病变治疗成功的有效手段,可以提高患牙的保存率。     

牙周牙髓病损预后的临床分析

目的 通过临床病例回顾分析牙周牙髓病损原发病因的诊断，治疗方案的选择对患牙预后的重要性。方法 选择31颗牙周牙髓病损患牙，临床详细检查，根据患牙的分类选择相应牙周，牙髓治疗方法，6－24个月评价临床愈合。结果 源于牙髓感染的牙周病损，牙周治疗需要量小，预后最好；源于牙周感染的牙髓病损，患牙预后取决于牙周病变程度，牙髓治疗未显著提高骨缺损的修复。评估牙周牙髓联合病变的预后，需监测阶段性治疗效果，牙周治疗需要量大。结论 牙周牙髓病损的临床需详细分析原发病因，选择优化治疗方案，监测阶段性治疗效果。