Search

Purpose: To propose diffuse osteomyelitis as risk indicator for peri-implantitis following the loss of several dental implants in patients that present with highly sclerotic bone areas. Materials and Methods: A total of six "nightmare cases"--three of which were treated at the Department of Periodontology of the University Hospitals of the Catholic University Leuven and three of which were referred there for a second opinion--were retrospectively analyzed using radiographs obtained via contact with referring clinicians in order to fully reconstruct the treatment pathway and dental history for each of these patients. Results: All patients suffered from early implant failures and/or severe peri-implantitis with bone loss and crater formation up to the apical level, as well as the loss of all or nearly all implants. Re-examination of their preand postoperative CBCTs, in combination with several bone biopsies, confirmed the diagnosis of a diffuse sclerosing osteomyelitis in the treated area. Osteomyelitis could be linked to a longstanding history of chronic and/or therapyresistant periodontal/endodontic pathology. Conclusion: The current retrospective case series seems to suggest that diffuse osteomyelitis should be considered as a risk indicator for severe peri-implantitis. [ABSTRACT FROM AUTHOR]

Objective: To describe a case of breast carcinoma metastasis combined with pulpitis-like pain complaints in a mandibular molar. Although metastasis from distant sites to the mandible is unusual, it should be considered in the differential diagnosis of patients referred for endodontic treatment. Summary: A 54-year-old female with carcinoma of the breast was referred to the endodontic department for root canal treatment of tooth 47. After endodontic treatment, her pain disappeared, but periodontal problems persisted. Because hypoesthesia of the lip and chin, in combination with periodontal complaints, were noticed during follow-up appointments, a more aggressive process was suspected. Additional investigations with cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) revealed a metastasis in the mandibular molar area. Metastatic carcinomas may rarely mimic pulpal or periapical pathology. Failure to diagnose them may result in serious consequences for the patient. Patients with a history of malignancy and suffering from oral pain that is not completely resolved after therapy should undergo specific diagnostic tests to exclude a neoplastic aetiology for their symptoms. Interpretation: Follow-up of endodontic treatments is necessary to see if symptoms dissolve and to consider if the diagnosis should be modified. Endodontists are well qualified to detect oral metastases. Metastases from distant sites to the oral cavity are uncommon, but should be considered in the differential diagnosis. [ABSTRACT FROM AUTHOR]

This study aimed to assess the relationship between Schneiderian membrane thickening and periapical pathology in a retrospective analysis of Cone Beam Computed Tomography (CBCT) images. For this, 147 CBCT scans containing 258 sinuses and 1,181 teeth were assessed. Discontinuation of the lamina dura, widening of the periodontal ligament space, apical periodontitis (AP), and partly demineralized maxillary sinus floor associated with AP were considered periapical pathology. Maxillary sinus mucosal thickening (MSMT) was classified as odontogenic or non-odontogenic. An irregular band with a focal tooth associated thickening and local thickening related to a root were considered odontogenic types of MSMT. The relation between the imaging features of periapical pathology and the type and thickness of MSMT was determined by logistic regression and linear mixed model, respectively. In addition, linear regression and Mann Whitney test evaluated the relation and demineralization of the AP lesion towards the sinus floor (p≤0.05). The odds of having an odontogenic type of MSMT were significantly higher when a periapical pathology was present in the maxillary sinus. Eighty-two percent of AP partly demineralized towards the sinus floor were associated with an odontogenic MSMT. Both AP lesions partly demineralized towards the sinus floor and, with increased diameter, led to increased MSMT. In conclusion, there is an 82% risk of having an odontogenic type of MSMT with the presence of AP partly demineralized towards the sinus floor. More thickening of the maxillary sinus mucosa is seen with larger AP lesions and partial demineralization of the sinus floor.