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Endoscope is an innovative method for otologists in middle ear surgery. Many previous studies have confirmed the safety and efficiency of the endoscopic technique, as a reliable therapeutic option with very low complication rates, clearly supporting the use of endoscopy in ear surgery. Auricular suppurative perichondritis secondary to exclusive endoscopic ear surgery for tympanoplasty is an extremely rare type of those without any previously reported cases. In this report, we describe the course of auricular suppurative perichondritis of a 55-year-old woman. The patient was ultimately healed through surgical debridement and postoperative dressing with no evidence of recurrence at two months follow-up. There were no auricle deformity or external auditory canal stenosis with six months following-up., (Copyright © 2020. Published by Elsevier Inc.)

Introduction: Odontogenic infections are fairly common in healthcare settings. However, late presentations such as Ludwig's angina, facial cellulitis, necrotizing cervical fasciitis (NCF), among others could lead to mortality. In view of suggestions that the occurrence of severe, near-fatal odontogenic infections is declining, this study set out to determine the incidence of such severe odontogenic infections over the past 5 years at the Korle-Bu Teaching Hospital, a major referral centre in Ghana., Methods: A retrospective review was done, involving all patients with severe odontogenic infection, thereby requiring admission, per stated criteria at the Department of Oral and Maxillofacial Surgery (Dental clinic), Korle-Bu Teaching Hospital, in the period between July 2012 and July 2017. The cumulative incidence for the respective years were then computed for the years of review., Results: A total of 243 patients were included in the study. This consisted of 121 males and 122 females, with an average age of 42.9 years (SD = 16.6), ranging from 18 months to 91 years. Incidence proportions for the years of the review were 8.2, 8.9, 17.7, 17.9 and 27.7 people per 1000 cases of tooth-related infections for the respective years. With a fatality rate of 5.8%, the incidence of odontogenic infections among patients attending the outpatient Dental clinic of the hospital is 40.3%, while that of dentoalveolar abscess is 6.2%. Ludwig's angina was the commonest (52%) form of presentation of spreading odontogenic infection., Conclusion: This study highlights the importance of persisting severe, near-fatal odontogenic infections in Ghana. Not only is there a need to assess the public, professional and institutional strategies to management, but for more evidence-based studies in our local setting to aid in management., Competing Interests: The authors declare no competing interests.

Hypophosphatemic rickets is a rare genetic disorder involving the regulation of fibroblast growth factor 23 (FGF23), a phosphaturic agent, clinically showing bowing of the legs, short stature and dentoalveolar abscesses. A 7-year-old boy, with previous hypochondroplasia diagnosis, was referred to our pediatric dentistry clinic presenting short stature, bone deformities and sinus tracts at deciduous teeth apex levels not related with trauma, restorations or dental caries. After deciduous teeth extraction, due to root resorption and mobility, light microscopy exhibited typical hypophosphatemic dentin, and micro-computed tomography revealed tubular clefts and porosities throughout the teeth. Laboratory tests confirmed the HR diagnosis, after which the treatment was initiated.

Aim: Opioid abuse/dependence (OAD) is an emerging public health crisis in the USA. The aim of the present study was to estimate the nationwide prevalence of OAD in those hospitalized due to periapical abscess in the USA., Methods: The Nationwide Inpatient Sample for 2012-2014 was used. All patients who were hospitalized due to periapical abscess were selected for analysis. In this cohort, OAD was identified and used as the outcome variable. A mix of patient and geographic factors were used as independent variables. The simultaneous association between outcome and independent variables was examined by a multivariable logistic regression model. Clustering of outcomes within hospitals was adjusted. Odds of OAD were computed for all independent variables., Results: During the study period, 30 040 patients were hospitalized due to periapical abscess; 1.5% of these had OAD. Those aged 18-29 years (odds ratio [OR] = 3.69, 95% confidence interval [CI] = 1.76-7.72, P < 0.01) and 30-44 years (OR = 3.19, 95% CI = 1.77-5.76, P < 0.01) were associated with higher odds for OAD compared to those aged 45-64 years. Blacks were associated with lower odds for OAD compared to whites (OR = 0.52, 95% CI = 0.28-0.95, P = 0.03). Those covered by Medicare (OR = 4.08, 95% CI = 1.458-11.44, P = 0.01), Medicaid (OR = 5.86, 95% CI = 2.22-15.47, P < 0.01), and those who were uninsured (OR = 3.68, 95% CI = 1.30-10.45, P = 0.01) were associated with higher odds for OAD compared to those covered by private insurance. The odds of OAD increased with comorbid burden (OR = 1.66, 95% CI = 1.50-1.84, P < 0.01)., Conclusions: High-risk groups that are likely to have OAD were identified among those hospitalized due to periapical abscess., (© 2018 John Wiley & Sons Australia, Ltd.)

Fungal infections in the intensive care unit are becoming a more common occurrence, especially in the care of the burn patient. Fungal infections in the critically burned patient, who by nature have a heightened inflammatory state and impaired immune response, have been found to carry a profound degree of morbidity and mortality. We present our experience in the care of severe thermal injuries; a series of patients with endodontic fungal infection which, as we found, pose a significant risk for the development of systemic infection and sepsis. Fungal periapical abscesses are a rare and, yet undescribed, potential source of systemic sepsis in the burn intensive care unit., (Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.)

Endodontic treatment of immature necrotic teeth is a real challenge. Recently, a biologically based treatment strategy, referred to as regeneration, has been introduced. Tissue regeneration requires the presence of stems cells, a scaffold, and growth factors. Endodontic regeneration may improve the prognosis of immature necrotic teeth by re-establishing the functional pulpal tissue and further development of the root. However, the tissue formed in the pulpal space may not be original pulp tissue, and in some cases, it may result in uncontrolled calcification of the pulp. This study reports a case of successful endodontic regeneration and compares this process with the normal development of the contralateral tooth. Finally, it discusses the nature of the tissue formed during endodontic regeneration., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Here, we report the diagnosis and treatment of an extraoral cutaneous sinus tract originating in a mandibular second molar with a C-shaped root canal system. The patient was referred to our department by a dermatologist after a series of unsuccessful treatments, including antibiotics. Diffuse radiolucency on a preoperative radiograph revealed that earlier root canal treatment had been only partially successful. Consequently, we performed retreatment of the root canal comprising removal of the former restoration and gutta-percha, cleaning and shaping, and passive irrigation with sodium hypochlorite. The patient responded well, and the cutaneous lesion completely resolved uneventfully within 1 month postoperatively. Preoperative recognition and thorough knowledge of the root canal anatomy and conventional methods of obturation are necessary in performing successful endodontic treatment.

Tooth surface loss (TSL), the non-carious loss of tooth tissue, is considered pathological if the teeth involved experience sensitivity and pain, are functionally compromised or they detract from the patient's appearance. TSL is a common clinical finding in many patient groups, although differences between the primary and permanent dentition contribute to TSL occurring at a faster rate and with worse outcomes in the primary dentition. This case report presents localized abrasion and associated apical periodontitis affecting a single primary tooth in a 2-year-old infant following the misuse of a babies' dummy clip whilst teething. Abrasion is rare in the primary dentition. CPD/CLINICAL RELEVANCE: This article highlights an unusual presentation of dental abrasion affecting the primary dentition caused by a previously unreported foreign object; abrasion in this case was a side-effect of soothing the discomfort of teething.

The widespread use of oral implants in recent years has resulted in various types of complications. One of those complications is the periapical implant lesion. Different factors have been proposed to play a role in the development and emergence of a periapical implant lesion. To date, there is no consensus on the etiology and therefore periapical lesions around dental implants are considered to have a multifactorial etiology. The diagnosis of an implant periapical lesion should be based on both clinical and radiological findings. Additionally, in order to apply the best treatment strategy the evolution of the lesion should be taken into account. The treatment of this kind of lesion, however, is still empiric. Data, primarily from case reports, seem to indicate that the removal of all granulation tissue is a first step to arrest the progression of the bone destruction. The removal of the apical part of the implant seems a valuable treatment strategy., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The Dai people, one of the ethnic minorities in China, have a population of 1,260,000. They have the same origin as one of the main ethnic groups of Laos and Thailand. Most of the Dai live in Yunnan province, which is located in the less-developed southwestern part of China. This study aimed to describe the oral health status of Dai preschool children in China and the factors that influence their oral health status., Methods: An oral health survey was performed between 2011 and 2012 to select Dai five-year-old children using multi-stage stratified sampling in Yunnan. Their dental caries experience was measured using the "dmft" index, and severe caries was assessed using the "pa" index, which is modified from the "pufa" index. Oral hygiene status was assessed using the visual plaque index (VPI). A questionnaire to study the children's socio-demographic background and oral health-related behaviours was completed by the children's parents., Results: A total of 833 children were examined. Their caries prevalence was 89% and 49% of the children had carious tooth with pulp involvement. The mean (SD) dmft score was 7.0 (5.3). Higher dmft scores were found among children who were girls, were currently bottle-fed, took daily sweet snacks, had higher VPI scores, and had visited a dentist within the last year., Conclusions: The caries prevalence and experience of the five-year-old Dai children in Yunnan, China was high, and almost half had severe caries. The caries experience was associated with gender, snack habits, dental visit habits, and oral hygiene status.

Introduction: True regeneration of the dental pulp-dentin complex in immature teeth with necrotic pulps has not been shown histologically. It is not known to what extent this true tissue regeneration is necessary to achieve clinically acceptable outcomes., Methods: This case report describes the treatment of a patient with an immature maxillary right central incisor with a history of impact trauma and enamel-dentin crown fracture. A diagnosis of pulp necrosis with acute apical abscess was established. A regenerative endodontic protocol that used a paste containing Augmentin for 5 weeks as an intracanal medicament was used., Results: Follow-ups at 9, 12, 17, and 31 months revealed complete osseous healing of the periapical lesion and formation of the root apex, but without increase in root length. Clinically, the tooth was functional, asymptomatic, and nonresponsive to pulp vitality tests. The crown discolored over time. On reentering the root canal, no tissues were observed under magnification inside the root canal space. The root canal treatment was completed with mineral trioxide aggregate obturation., Conclusions: Augmentin might be an acceptable choice for root canal disinfection in regenerative endodontic procedures. The protocol for regenerative endodontic treatment is not predictable for pulp-dentin regeneration. Formation of the root apex is possible without pulp regeneration., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: Data showed that among 5-year-old Chinese, 96.7% of cavitated primary teeth were left untreated. The study aimed to report on the course of cavitated primary teeth within the Chinese health-care system over a period of 3.5 years., Methods: Selection of high caries risk children for inclusion in a sealant comparison study was based on the presence of cavitated dentine lesions in their primary teeth. At the 6-month sealant evaluation point many of these cavitated dentine lesions had not been treated. This necessitated monitoring these cavitated teeth 6-monthly for those exfoliated, restored, with a cavity left open, having caused toothache (symptom) and having (or having had) an abscess or fistulae (symptom). Care-seeking instruction was given at every evaluation point. anova and t-test were used in analysing the data., Results: A total of 1012 cavitated primary teeth in 305 children (7.6 to 9.3 years old), were followed for 3.5 years. A total of 92.9% of cavitated primary teeth were left open, while 7.1% were restored at some stage during the observation period; 98.5% of restored teeth and 95.5% of cavitated teeth left open exfoliated and 93.9% of restored teeth and 81.5% of cavitated primary teeth left open exfoliated without any symptoms. Having (or having had) toothache was the symptom most frequently related to exfoliated restored teeth and to exfoliated cavitated teeth left open. Restored primary teeth survived statistically significantly longer than cavitated primary teeth left open: 1.99 ± 0.07 years and 1.68 ± 0.03 years, respectively., Conclusion: The large majority of cavitated primary teeth in this child population exfoliated without symptoms., (© 2013 FDI World Dental Federation.)

Dental implants have shown great success in recent years. However, in certain circumstances they can suffer from complications. It usually results from a combination of infection and host inflammatory responses or a lack thereof. This report documents an extra-oral cutaneous fistula associated with an osseointegrated dentoalveolar implant.

Introduction: A disintegrin and metalloproteinases (ADAMs) are a family of transmembrane proteins that share a common domain structure. However, little is known about the possible involvement of ADAM-8 and ADAM-17 in the development of periradicular lesions. Here we demonstrated the expression of ADAM-8 and ADAM-17 in rat periradicular lesions., Methods: We induced experimentally periradicular lesions in rats. The animals were killed at 0, 2, 4, 6, and 8 weeks after pulp exposure. The left molars underwent immunofluorescence analysis for both ADAMs and for neutrophil elastase, and right molars were used for reverse transcription-polymerase chain reaction analysis of ADAM-8 and ADAM-17. The areas of these lesions were measured histometrically, and the numbers of all antigen-positive cells in the periapical portion were counted per unit area., Results: The area of the periradicular lesions gradually expanded from 0 to 4 weeks, showing a large increase from week 2 to week 4. Both ADAM-8-positive and ADAM-17-positive cells gradually increased in number from 0 to 4 weeks and then decreased from 4 to 8 weeks. There were more ADAM-17-expressing cells than ADAM-8-expressing ones at all experimental periods except at 4 weeks. The highest expression of ADAM-8 mRNA was observed at 4 weeks, and there were significant differences between 0 and 2 weeks and between 4 and 6 weeks. The expression of ADAM-17 mRNA increased from 0 to 4 weeks and subsequently decreased from 4 to 8 weeks, with a significant difference between 4 and 6 weeks., Conclusions: Our results suggest that ADAM-8 and ADAM-17 may be related to the development of rat periradicular lesions., (Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this study was to evaluate clinical and radiological findings and the role of periapical infection and antecedent dental treatment of infected focus teeth in odontogenic maxillofacial abscesses requiring hospital care., Materials and Methods: In this retrospective cohort study, we evaluated medical records and panoramic radiographs during the hospital stay of patients (n = 60) admitted due to odontogenic maxillofacial infection originating from periapical periodontitis., Results: Twenty-three (38 %) patients had received endodontic treatment and ten (17 %) other acute dental treatment. Twenty-seven (45 %) had not visited the dentist in the near past. Median age of the patients was 45 (range 20-88) years and 60 % were males. Unfinished root canal treatment (RCT) was the major risk factor for hospitalisation in 16 (27 %) of the 60 cases (p = .0065). Completed RCT was the source only in 7 (12 %) of the 60 cases. Two of these RCTs were adequate and five inadequate., Conclusions: The initiation of inadequate or incomplete primary RCT of acute periapical periodontitis appears to open a risk window for locally invasive spread of infection with local abscess formation and systemic symptoms. Thereafter, the quality of the completed RCT appears to have minor impact. However, a considerable proportion of the patients had not received any dental treatment confirming the importance of good dental health. Thus, thorough canal debridement during the first session is essential for minimising the risk for spread of infection in addition to incision and drainage of the abscess. If this cannot be achieved, tooth extraction should be considered., Clinical Relevance: Incomplete or inadequate canal debridement and drainage of the abscess may increase the risk for spread of endodontic infection.

This article describes a unique case in which both internal and external inflammatory resorption and endodontic-periodontic lesions were present at the same time in the patient's left mandibular first molar. Based on clinical and radiographic findings, it was determined that the nature of this case was a pulpal infection-induced inflammatory resorption and furcation lesion. After root canal therapy, the furcation lesion and external inflammatory resorption were completely resolved. This case indicates that the correct diagnosis of the stimulating factor for tooth resorption and determination of the primary origin of endodontic-periodontic lesions are critical for clinical management and success., (Published 2011. This article is a U.S. Government work and is in the public domain in the USA.)

Little is known about the characteristics of cutaneous sinus tract (CST) of dental origin in children. 28 cases of CST of dental origin in children were evaluated. Age, sex, site of skin lesion, duration until diagnosis, teeth involved, etiology, treatment, and outcome were recorded. The last dental care visit was also recorded. The mean age was 10.25 years (range 4-16). The male to female ratio was 1:1.74. The mandibular-submandibular area was the most common site of skin lesions. The mandibular first molar was the most involved tooth, followed by the mandibular incisor. Caries was the most common etiology. The mean duration of lesions until correct diagnosis was 6.5 months (range 0.3-12 mos). The treatment was root canal therapy or extraction. After appropriate dental treatment, CSTs resolve rapidly. Surgical revision of the scars were indicated in eight (29%) patients, to provide better cosmetic results. In these patients, the duration of lesions were longer. Preventive dental care, as indicated by last dental care visit, was poor. CST in children is different from that in adults in terms of sites of skin lesions, duration of lesions, and involved tooth and similar to that in adults in terms of etiology and treatment modality. Early treatment of the dental infection may cause healing of the cutaneous lesion spontaneously, without a scar., (© 2012 Wiley Periodicals, Inc.)

Infantile Refsum disease (IRD) is a peroxisome biogenesis disorder (PBD), and is part of a larger group of diseases called leukodystrophies, which are inherited conditions that damage the white matter of the brain and affect motor movements. Multiple signs and symptoms of IRD begin in infancy and progress through early childhood, including hearing and visual impairment, intellectual and growth impairment, seizures, liver involvement, and orofacial and dental abnormalities. This paper presents a case history of a 12-year-old female patient with IRD who underwent dental rehabilitation in the operating room under general anesthesia and includes a 2-year follow-up. Medical, dental, and management considerations in the care of this child's condition are presented. This paper also discusses the importance of a multidisciplinary approach in the management of children with special needs., (© 2012 Special Care Dentistry Association and Wiley Periodicals, Inc.)

The aim of the present investigation was to assess the impact of dental caries prevalence and the consequences of untreated cavitated dentine lesions on quality of life of 6- and 7-year-old Brazilian children. A total of 826 schoolchildren were assessed using ICDAS and pufa (to score consequences of dental caries on soft tissues) indices. History of extraction and toothache was recorded. Oral health-related quality of life was assessed using the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). A multiple logistic regression model was used to analyze the relationship between the prevalence of dentine carious lesions, pufa, history of extraction and toothache with the B-ECOHIS scores. A total of 587 questionnaires were analyzed. The prevalence of cavitated dentine lesions and pufa was 74.8 and 26.2%, respectively. Some 21.8% of children reported toothache and 9.2% had had at least one tooth extraction. The chance (OR) for children with cavitated dentine lesions, pufa ≥1, history of extraction and toothache of having higher B-ECOHIS scores than those not affected was 1.90 (95% CI: 1.18-3.06), 6.26 (95% CI: 3.63-10.83), 6.87 (95% CI: 2.75-17.16) and 3.68 (95% CI: 2.12-6.39), respectively. Children's quality of life was negatively influenced by untreated cavitated dentine lesions and their consequences., (Copyright © 2012 S. Karger AG, Basel.)

Periradicular surgery aims to achieve complete wound healing and regeneration of the periodontal unit. Platelet-rich plasma (PRP) is a platelet concentrate that is widely used to promote tissue healing, and bone induction through its various growth factors has been used in this study. This case report describes the use of PRP unilaterally in a bilateral periapical lesion in the same patient. The site treated with PRP showed better healing than the untreated site. This was confirmed with computed tomography (CT) scan readings. It was hypothesized that PRP could promote tissue regeneration and alveolar bone repair.

Purpose: This study's purpose was to histologically evaluate the repair of rat tissue after pulpotomy and covering the pulp tissue with Copaifera langsdorffi oil resin, green propolis extract, fibrin sponge and iodoform-based paste., Methods: Pulpotomies were performed in the maxillary and mandibular first molars of 21 Wistar rats (84 total teeth). The access cavities were sealed with Coltosol, and histological evaluations were performed at 24 hours, 15 days, and 30 days postoperatively., Results: For all experimental periods and materials, an inflammatory response constituted predominantly by neutrophils was observed, being of milder intensity for the Copaifera langsdorffii oil-resin group and more severe for the fibrin sponge group, which exhibited periapical microabscesses. Necrosis was observed in all groups, and its extension increased with time, except for teeth protected with Copaifera langsdorffii oil-resin. Formation of a mineralized tissue barrier in the pulp exposure area occurred only in the Copaifera langsdorffii oil-resin group. Other findings, such as vascular congestion, edema, and hemorrhage, were observed in all cases., Conclusions: The inflammatory response was less severe, the area of pulp necrosis was smaller, and more frequent formation of a mineralized tissue barrier was noted after pulpotomy was performed with Copaifera langsdorffii oil-resin compared to the other materials tested.

Background: Leukemia is a fatal disease. The oral manifestations of the leukemias occur early in the course of the disease and these oral features can at times act as a diagnostic indicator. Saliva has been used as a diagnostic aid in a number of systemic diseases., Materials and Methods: In our study, samples of unstimulated saliva of 30 leukemia patients who were not on chemotherapy were collected and analyzed for salivary amylase and total protein. The oral manifestations and radiographic changes (OPG) were recorded. The correlation between the oral manifestations and the salivary components (salivary amylase and total protein) was assessed for prognostic significance., Results: In the present study when the mean values of salivary amylase (1280±754 U/ml) and total protein (647.2±320.7 mg%) were compared with that in control subjects. There was a statistically significant difference for amylase levels (P<.05). On intraoral examination the study subjects showed pallor, gingivitis, gingival enlargement, petechiae, and ecchymosis. On the OPG, the radiographic features included generalized rarefaction of bone (20%), thinning of lamina dura (3.4%), generalized alveolar crest bone resorption (30%), thinning of walls of alveolar crypts (6.7%), besides others, e.g., periapical abscess (10%)., Conclusions: The saliva of leukemic patients demonstrated obvious changes in composition. A rise in salivary amylase and total protein levels was evident, with the increase in amylase levels being statistically significant.

Aim: The aim of this study was to determine the incidence of dry socket, alveolar infection, and postoperative pain following the routine extraction of erupted teeth., Methods and Materials: Using a questionnaire, this prospective cross-sectional study evaluated 357 consecutive surgeries in which 473 erupted teeth were extracted by dental students under rigorous control of microbiologic contaminants during a 22-month period. The subject sample consisted of 210 (58.8%) male patients ranging in age from 11 to 79 years (mean 41 +/- 16.3). The most prevalent self-reported ethnicity was Caucasian (78.2%). The questionnaire consisted of 60 questions directed to the patient and to the dental student who performed the surgical procedure. The questionnaires were completed before and within seven days after the surgery to obtain outcomes data. Forty-five questionnaires were excluded due to lack of information, inconsistencies, or lack of contact with the patient; however, none had indications of alveolar infection or dry socket. The data were analyzed using descriptive statistics, chi-square tests (x(2)), and an odds ratio (OR) as appropriate at the critical level of significance, set at p<0.05 (x(2)) or p<0.01 (x(2), with the Monte Carlo simulation)., Results: The observed incidence was 0.6% (two cases each) for both alveolar infection and dry socket. Higher pain levels and pain persisting longer than two days were observed with more traumatic surgeries, or associated with postoperative complications. Smoking was found to be statistically associated with the development of postoperative complications., Conclusion: The incidence of alveolar infection, dry socket, and severe pain were very low for the routine extraction of erupted teeth. Severe pain that persists for more than two days can represent a sign of a postoperative complication such as dry socket., Clinical Significance: Dental extraction is part of the dentists' daily work and intercurrences like dry socket, infection, and pain can occur. This manuscript reports the incidence of these occurrences and search for its predisposing factors.

Actinomycosis has increasingly been recognized as a cause of persistent or recurrent periapical disease associated with endodontic therapy. After conventional root canal therapy of the lower left first and second molars, a 24-year-old woman presented with a persistent periapical lesion associated with one of the sinus tracts. The lesion was surgically removed, and actinomycosis was diagnosed on the basis of biopsy results. The clinical and histologic features of this rare condition are discussed.

The term "neonatal teeth" is applied to those teeth which erupt within the first 30 days of life. Case of a fifteen day old infant is presented here with a neonatal tooth that led to serious complications. An attempt has been made to highlight that these predeciduous teeth can sometimes lead to dangerous consequences about which the general dentist must be aware of and must take prompt action.

Oral habits that are performed daily, can be a factor in the progression of periodontal and/or endodontic diseases. The purpose of this clinical report was to describe the treatment of a wide periodontal lesion and 18-month follow-up of a 13-year-old male patient's permanent mandibular central incisor that was traumatized due to chronic pencil biting. The lesion was curreted surgically while the compromised mandibular central incisor was endodontically and periodontally treated. The interdisciplinary approach showed a successful clinical outcome, as the survival of the infected tooth and the recovery of the soft tissues and the alveolar bone could have been achieved.

Two patients presented with complaints of recurrent drainage of purulent exudate from sinus tracts, inflammation and pain after endodontic re-treatment of the maxillary left (Case 1) and right (Case 2) lateral incisors. The periapical lesions persisted after apical curettage, apicectomy and root-end filling with silver amalgam. Radiographic examination exposed the poor quality of the endodontic treatments and the silver amalgam root-end fillings, which were associated with periapical radiolucent areas in both teeth. The sinus tract persisted after root canal cleaning and shaping, followed by a calcium hydroxide root canal dressing. The root-end fillings were periapically dislodged with endodontic K-files, and showed progressive displacement by sinus tracts up to elimination in the oral cavity. Follow ups of 42 and 65 months post procedure revealed clinical disappearance of the symptoms, sinus tracts and exudates, and radiographs revealed that the repair process of the periapical radiolucent areas was quite advanced.

Sodium hypochlorite solution is toxic to vital tissues, causing severe effects if extruded during endodontic treatment. This paper presents a report on the tissue damage related to inadvertent extrusion of concentrated sodium hypochlorite solution during root canal treatment. A 65-year-old woman was referred with moderate pain, ecchymosis, and severe swelling of the right side of the face. These symptoms appeared immediately after a root canal treatment of the maxillary right canine, which had been started 21 hours earlier. It was diagnosed as air emphysema related to sodium hypochlorite solution extravasation during the endodontic treatment. To avoid this, an initial radiograph should be taken to determine the correct canal working length and confirm root canal integrity.

An unusual case of an endodontic-periodontal lesion in a 29-year-old man resulting from a habit of opening beer bottle (metal) caps using his mandibular left molar is reported. The patient had been a chronic alcoholic with several emotional problems and was unaware of the injurious nature of his habit. Thus, the importance of a detailed case history and assessment of psychosocial aspects for an accurate diagnosis of such conditions is highlighted.

Familial hypophosphatemic vitamin D-resistant rickets is a hereditary disease generally transmitted as an X-linked dominant trait and characterized by distinctive general clinical signs. Dental features include spontaneous dental abscesses that occur in the absence of a history of trauma or dental decay. The challenge for the dentist is to prevent and treat these lesions. This report describes the case of a young hypophosphatemic boy with abscesses. In this case, the application of fluid resin composites with a self-etching primer bonding system to all primary teeth prevented abscess formation for more than 1 year and thus avoided endodontic treatment or extraction. This constitutes a new approach to the prevention of spontaneous abscesses on primary teeth in children with familial hypophosphatemic rickets.

Aim: To determine the types of periapical lesions associated with root filled teeth with persistent periapical pathosis that required surgical treatment based on specific inclusion and exclusion criteria., Methodology: Periapical lesions from a consecutive clinical sample of 100 patients were examined histopathologically to determine a definitive diagnosis., Results: Females were more represented (n = 56), the average age was 46.5 years and there were no age differences between gender or lesion type. A diagnosis of periapical granuloma was the most common finding with a similar number present in females (n = 40) and males (n = 37). A cyst was present in 18% of the cases with a majority of females (n = 12) represented in the sample. Evidence of foreign material, with an appearance consistent with endodontic sealer materials, was seen in 25 periapical granulomas, two cysts and one scar. Two periapical scars were seen, one had a history of apicectomy and amalgam root-end filling while the other was associated with extruded root filling material., Conclusions: By using defined clinical inclusion and exclusion criteria a predictable clinical diagnosis of a persistent periapical lesion due to endodontic origin can be reliably made. Periapical granulomas and cysts were the most common periapical lesions of endodontic origin associated with persistent periapical pathosis with the overall incidence of periapical cysts similar to previous studies. The presence of endodontic material in a high proportion of periapical lesions suggests a cause-effect association with the inference that clinicians should employ canal preparation techniques that limit apical extrusion of material.

Root fractures are those that involve dentin, cementum, and the pulp. They occur more frequently in children than adults. This case report describes the treatment and 5-year follow-up of two maxillary central incisors with horizontal root fractures using mineral trioxide aggregate and the application of intracoronal bleaching of the discolored tooth.

A case is presented of a child from rural New Zealand with vitamin-D-resistant rickets. He underwent extensive treatment and is now partially dentate. The child may have received substantially different care if appropriate dental specialists had practised locally, although, in the long term, his outcome may not have been different. Early medical diagnosis of rickets and prompt preventive dental care may be useful in reducing spontaneous pulp death in either the primary or permanent dentitions.

Aim: To report the induction of apical root development by calcium hydroxide in teeth with pulp necrosis and periapical radiolucency., Summary: A 10-year-old male patient was admitted to the clinic complaining of an intense pain and oedema on the anterior facial region, compatible with an acute dentoalveolar abscess. There was a previous history of dental trauma; only tooth 11 was negative to pulp sensitivity tests. Radiographically, tooth 11 exhibited incomplete root formation, characterized by a wide root canal, thin and fragile dentinal walls, and an extensive, divergent foraminal opening associated with an apical radiolucency. The first appointment focused on urgent local and systemic treatment. Apexification treatment commenced at the second session after 7 days, by means of chemo-mechanical debridement throughout the entire root canal, using K-files and irrigation with a 2.5% sodium hypochlorite solution. Subsequently, a calcium hydroxide paste was applied and changed four times over 8 months, when radiographic examination revealed complete closure of the foraminal opening, resulting in resolution of the periapical radiolucency and associated with 5 mm of additional root development. The root canal was filled by thermomechanical compaction of gutta-percha and sealer. A 3-year follow-up revealed normal periapical tissues and the absence of symptoms., Key Learning Points: * In young patients, dental trauma may cause pulp necrosis and arrest of root formation. * Under certain circumstances, chemo-mechanical debridement, including the use of a calcium hydroxide paste, is a valid alternative to mineral trioxide aggregate and or surgery for root-end closure. * In teeth with incompletely formed roots associated with periapical lesions, calcium hydroxide can induce periapical repair through the closure of the foramen and apical root development.

Background: Vital pulpotomy is a single-stage procedure defined as the surgical amputation of the coronal portion of exposed vital pulp, usually as a means of preserving the vitality and function of the remaining radicular portion., Objectives: The aim of this study was to compare the clinical and radiographic success rates for electrosurgical vs formocresol pulpotomy in human primary molar teeth., Settings and Design: This was a prospective, randomized clinical trial., Materials and Methods: In this randomized clinical trial, pulpotomies were performed on 70 primary molars in children aged 5-10 years. The teeth were treated using either a conventional formocresol (35 teeth) or electrosurgical technique (35 teeth). Following the pulpotomy procedure, the teeth were evaluated for clinical and radiographic success for three, six and nine months. The teeth were evaluated for the presence of pain, abscess, fistula, mobility, internal and external resorption, and radiolucency., Statistical Analysis: The data were assessed with Fishers' Exact test., Results: After nine months of follow-up, the clinical and radiographic success rates were 96 and 84% respectively in the electrosurgical group and 100 and 96.8% respectively in the formocresol group. There was no statistically significant difference between the success rates in the two groups ( P > 0.05)., Conclusions: Our results showed the failure rates for electrosurgical pulpotomy to be equal to those for formocresol pulpotomy. Although electrosurgical pulpotomy is a nonpharmacological technique giving favorable results, it is still a preservative technique. Further studies using larger samples and longer evaluation periods are recommended.

Based on the case history of a 44-year-old female patient with a mandibular fracture, dental root injury from cutting off the apical blood supply after miniplate osteosynthesis is reported. The different types of dental injuries and complications are emphasized as well as the resulting therapeutic strategies.

The aim of this pilot study was to evaluate the clinical efficacy of mineral trioxide aggregate (MTA) as an apexification material when used in non-vital immature permanent incisors in children. Fifteen children with a mean age of 11.7 years and 17 non-vital permanent incisors were ajudged suitable for inclusion. Standard endodontic procedures were followed and an apical plug of 3-4 mm was created by using MTA after a calcium hydroxide intracanal dressing had been applied for at least 1 week. Final obturation was completed by using thermoplastisized Gutta-Percha (Obtura II) at least 1 week following MTA placement. Subjects were reviewed clinically and radiographically at 3-month intervals. Mean follow-up time for MTA was 12.53 months (+/-2.94 SD). Of the total of 17 teeth treated, MTA placement was considered to be adequate in 13 teeth. The procedure showed clinical success in 94.1% of the cases, radiographic success was found to be 76.5% and in further three cases (17.6%) the outcome was considered to be uncertain. This is one of the very few studies that have reported the out coming of MTA as an apexification material in children with non-vital teeth and incomplete root development. However, larger clinical studies are required to evaluate the long-term success of this procedure.

Lateral root perforation unnoticed during post-space preparation, and followed by post cementation, can subsequently be challenging to diagnose in the labio-lingual plane due to the two-dimensional nature of conventional radiography. This paper demonstrates the application of a recently developed three-dimensional imaging system, cone beam computed tomography, in the diagnosis of iatrogenic root perforation. A clinical case is reported where labial post perforation in a maxillary central incisor occurring 15 years previously presented with a sinus tract and radiolucent lesion. Non-surgical retreatment and perforation repair using mineral trioxide aggregate was performed with the aid of an operating microscope. The sinus tract resolved with radiographic evidence of healing at 1-year recall.

Purpose: The goal of this study was to evaluate retrospectively the efficacy of a treatment modality for a lesion at the apical portion of a nonmobile dental implant., Materials and Methods: All patients were treated with an intraoral treatment approach. A flap was elevated facial to the effected implant site, exposing the bone. A carbide bur was used to open a window in the bone. The bur was then used to cut the implant and completely remove the affected portion of the implant. The surgical site was then closed with interrupted vicryl sutures, and patients were prescribed., Results: Thirty-nine implants in 35 patients with a mean age of 58.3 years were identified clinically and radiographically with the presence of a periapical lesion. These 39 implants, which constituted 9.9% of implants (39 of 395) placed in these 35 patients, were consecutively treated using the intraoral apicoectomy procedure. Thirty-eight of the 39 implants (97.4%) treated with this technique remained stable and continued in function with no further complication. Follow-up time averaged 4.54 years; the longest follow-up time exceeded 15 years., Conclusion: Based upon the results of this retrospective study, lesions in the apical region of implants can be treated successfully using an intraoral apicoectomy procedure.

Unlabelled: Partial pulpotomy is an accepted treatment for traumatised incisor teeth with exposed pulps. Clinical studies in humans suggest that this may also be an acceptable technique for carious exposed pulps in molar teeth, but objective histological evidence to support this perception is lacking., Objective: To compare histological responses to complete or partial pulpotomies of inflamed pulps in immature baboon first permanent molar teeth., Methods: An experimental study in the baboon (Papio ursinus). Pulpitis was induced with fresh Streptococcus mutans placed into occlusal cavities with a small pulpal exposure in 34 first permanent molars of 9 juvenile baboons. After 14 days a pulpotomy, either complete or partial, was performed on the same molars in contra-lateral quadrants using calcium hydroxide covered with IRM and amalgam. After 90 days specimens were harvested and examined under the light microscope with the examiner blind to the treatment., Results: Reaction frequencies in the complete and partial pulpotomy teeth were: dentine bridges 9/16 and 10/16, viable pulp in root canals 10/16 and 13/18, peri-apical abscesses 3/13 and 4/13. Fisher's exact probability test showed no statistically significant rates between the groups., Conclusions: Complete or partial pulpotomy of inflamed pulps in immature baboon first permanent molars produced comparable reactions.

Gutta-percha (G) and sealer do not resist coronal leakage. In this study, the effect of orifice plugs using dentin-bonding/composite resin(C) or IRM on coronal leakage was evaluated in vivo. Sixty-one premolar roots in three beagle dogs were instrumented and filled with G and AH 26(S), or G alone. The coronal 2 mm was replaced with C or IRM, or left untreated. The access cavities were kept open for 8 months, the dogs were killed and the periapical regions of the roots were histologically examined. Periapical inflammation was observed in 89% of the group without plugs, but in those with plugs, the occurrence was decreased to 39% (C + G + S), 38% (IRM + G + S) and 58% (C + G), respectively. Furthermore, severe inflammation was observed in 50% of the former group but only 0 to 17% of the latter. The substantial reduction in apical periodontitis by the use of coronal plug underscores the clinical importance of providing an additional barrier to coronal leakage in comparison to that provided by gutta-percha and sealer alone.