Search

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.

Aim: To assess the prevalence and to investigate the pathogenetic mechanisms of dental and periodontal lesions in children with X-linked hypophosphatemic rickets (XLH) examined at diagnosis or during treatment., Methods: Nine children with XLH (age 7.2 +/- 3.3 years) were enrolled in the study (at diagnosis, n = 2; during treatment with oral inorganic phosphate salts combined with 1,25-dihydroxyvitamin D3, n = 7). Oral examination was performed according to the evidence of carious and gingival lesions. Decayed or filled teeth (dft) index for primary teeth, and the decayed, missing, or filled teeth (DMFT) index for permanent teeth was assessed. All patients with a history of spontaneous dental abscesses underwent orthopantomography examination., Results: d/D ranged from 0 to 9 and f/F from 0 to 3. DMFT/dft index was 0 in the three youngest patients. One patient had enamel hypoplasia and two had enamel dyschromic alterations. Six out of nine patients (67%) had a history of spontaneous fistulae as a consequence of periapical abscesses occurring in the absence of dental decay or history of injury. In these patients, orthopantomographies showed enlarged pulp chambers associated with prominent pulp horns extending up to the dentino-enamel junction in both primary and permanent dentition., Conclusion: XLH patients show some peculiar dentinal abnormalities. Treatment prevents only in part dental and periodontal lesions. Genetic mechanisms have a main role in causing defective dentin mineralisation.

The recurrent spontaneous formation of abscesses affecting multiple noncarious primary as well as permanent teeth is the principle clinical dental feature in cases of hypophosphatemia, a condition inherited through the X chromosome. Patients often have high pulp horns, large pulp chambers and dentinal clefts. We report a case of hypophosphatemic vitamin D-resistant rickets in a patient who reported to our department on multiple occasions with spontaneous abscesses in relation to his primary teeth. The aim of this article is to review the features of this disorder and to discuss the risks and benefits of the treatment options suggested in the literature.

Objectives: To investigate the prevalence of dental sepsis in 5-year-old children in Scotland and the relationship between sepsis, treated and untreated decayed teeth, oral cleanliness (visible plaque on anterior teeth) and socio-economic deprivation., Subjects and Methods: Six thousand, nine hundred and ninety-four children of mean age 5.3 years were examined as part of a survey conducted under the Scottish Health Board's Dental Epidemiological Programme. The presence of dental sepsis was recorded, in addition to caries status, and presence of plaque. Postal code information was used to obtain a measure of material deprivation. Relationships between sepsis and its possible contributory factors were explored using stepwise logistic regression., Main Results: In the whole sample, 4.8% of children examined had dental sepsis, ranging from 2% in the most affluent areas to 11% in the most deprived. Children with sepsis had much higher caries experience (mean dmft 6.30) than those without sepsis (mean dmft 2.36). However, when these factors and the presence of plaque were entered into a logistic regression model to predict presence or absence of dental sepsis, the most important factor was not deprivation, but untreated decay., Conclusions: The proportion of children with sepsis increases markedly with caries experience. This disadvantage can be mitigated if more of the caries experience is treated. These findings would not support a policy of non-intervention for deciduous caries if oral sepsis is to be minimised.

Background: Maxillary sinusitis may develop from the extension of periodontal disease. In this case, reconstructed three-dimensional images from multidetector spiral computed tomographs were helpful in evaluating periodontal bony defects and their relationship with the maxillary sinus., Methods: A 42-year-old woman in good general health presented with a chronic deep periodontal pocket on the palatal and interproximal aspects of tooth #14. Probing depths of the tooth ranged from 2 to 9 mm, and it exhibited a Class 1 mobility. Radiographs revealed a close relationship between the root apex and the maxillary sinus. The patient's periodontal diagnosis was localized severe chronic periodontitis. Treatment of the tooth consisted of cause-related therapy, surgical exploration, and bone grafting. A very deep circumferential bony defect at the palatal root of tooth #14 was noted during surgery. After the operation, the wound healed without incidence, but 10 days later, a maxillary sinusitis and periapical abscess developed. To control the infection, an evaluation of sinus and alveolus using computed tomographs was performed, systemic antibiotics were prescribed, and endodontic treatment was initiated., Results: Two weeks after surgical treatment, the infection was relieved with the help of antibiotics and endodontic treatment. Bilateral bony communications between the maxillary sinus and periodontal bony defect of maxillary first molars were shown on three-dimensional computed tomographs. The digitally reconstructed images added valuable information for evaluating the periodontal defects., Conclusion: Three-dimensional images from spiral computed tomographs (CT) aided in evaluating and treating the close relationship between maxillary sinus disease and adjacent periodontal defects.

The term retrograde peri-implantitis has been commonly used to describe lesions in the periapical region of dental implants. There are very few reports on this condition, and the exact etiology and pathogenesis are subject to speculation. Management of retrograde peri-implantitis is even more scarcely discussed in the literature. The current article briefly reviews the literature on this subject and presents a case report of retrograde peri-implantitis. Special emphasis is placed on the management of the condition, and different strategies are critically evaluated. If the fixture is stable despite bone loss in the periapical region, it is suggested that surgical debridement be carried out with the use of a surface antiseptic like chlorhexidine. Also all possible efforts should be made to prevent damage to the implant surface. Bone loss due to this condition may be regenerated on the basis of the principle of guided bone regeneration.

Pyostomatitis vegetans (PV) is a rare benign chronic mucocutaneous pustular disorder of unknown etiology, though it is usually associated with chronic inflammatory disease of the bowel-particularly ulcerative colitis. At the oral level PV manifests as an exophytic lesion with an erythematous perimeter and a creamy-yellow surface presenting a friable covering membrane which easily disintegrates, giving rise to the development of small ulcers or superficial erosions. The histology shows epithelial acanthosis and superficial ulceration. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. The present study describes 2 cases of PV associated with ulcerative colitis. The differential diagnosis should be established with Neumann type pemphigus vegetans, since in both cases the lesions are clinically similar and the histology reveals an important eosinophil response, acanthosis, and the formation of intraepithelial miliary microabscesses. The treatment of PV focuses on control of the disease. In the event the orofacial lesions persist, topical oral drugs such as corticoids, with additional antibiotherapy, multivitamin complexes, and nutritional supplements, can be provided.

Root canal treatment techniques probably develop and change more frequently than any other area of dental practice and it can be hard for the busy general dental practitioner to keep up to date. The aim of this series of five papers is to give a thorough review of current teaching and practice. This will encompass the rationale of root canal treatment, guidance on the latest technical procedures for preparation and obturation of the entire root canal system, and consideration of how these principles may contribute to successful treatment. The series will address the following issues: diagnosis and treatment planning; root canal morphology and access; control of infection by effective isolation and anti-microbial agents; the philosophy of modern canal preparation techniques; single- or multi-visit treatment with relevant canal medication; obturation; diagnosis of failure and considerations in re-treatment. It is hoped that readers will be encouraged by the series to question their own techniques, audit their outcomes, and adopt new techniques only after careful reflection of the underlying principles involved.

"Lumpy jaw" of artiodactyls and macropods, although often considered a manifestation of actinomycosis, is actually an osteomyelitis, perhaps commencing with a dental root abscess or trauma to the jaw. Anaerobes may be cultured from the lesions, and vegetable matter may be impacted in them. It is a chronic disease and difficult to treat. Successful treatment may include draining the abscess, cleaning the cavity with saline and antibiotics, flushing with a combination of hydrogen peroxide-sodium hypochlorite and Betadine, and apicoectomy and endodontic filling when active inflammation has subsided.

Objective: To determine the durability and effectiveness of a black copper cement (BCC) and a conventional glass ionomer cement (GIC) when used to restore primary molars following partial caries removal (PCR) and to compare these results with conventional cavity preparation and restoration., Design: Split-mouth randomised controlled clinical trial., Setting: Department of Paediatric Dentistry, Dundee Dental Hospital, Dundee, 1998-1999., Subjects: Patients with previously unrestored, matched carious cavities in non-pulpally involved primary molars., Interventions: Three treatment groups: (1) Partial caries removal followed by lining with BCC and restoration with GIC (PCR:BCC); (2) Partial caries removal and restoration with GIC alone (PCR:GIC), and (3) Complete caries removal and conventional restoration (CR). Restoration durability and effectiveness was assessed both clinically and radiographically over 24 months.Main outcome measures Median survival time (MST) of restorations., Results: Forty-four patients (F: 31; M: 13), mean age 6.8 years (range: 3.7-9.5), had 120 restorations placed (PCR:GIC: 43; CR: 41; PCR:BCC: 36). Eighty-six molars (29 patients) (PCR:GIC: 30; CR: 29; PCR:BCC: 27) were reviewed at 24 months. The median survival times (MST) with 25% and 75% quartiles in parenthesis were as follows: PCR:BCC, MST = 24 months (6, 24); PCR:GIC, MST = 24 months (24, 24) and CR, MST = 24 months (24, 24). The MST for PCR:BCC restorations was significantly less than for PCR:GIC and CR restorations (W = 1163.5, P = 0.028 and W = 1081.0, P = 0.004 respectively)., Conclusion: There were no differences in the proportions of restorations lost between restoration types, although PCR:BCC restorations did have significantly more abscess/sinus formation over the 24-month study period.

Aim: To compare histological responses to zinc oxide-eugenol (ZOE) and calcium hydroxide (CH) pulpectomies in primary molar teeth with inflamed pulps., Study Design: This was an experimental study in 17 juvenile baboons (Papio ursinus)., Methods: Pulpitis was induced with fresh human carious dentine or Streptococcus mutans placed into occlusal cavities in 78 primary molars; after 14 days a pulpectomy was performed on the same primary molars with the two root fillings randomly allocated. The root canal openings were then covered with IRM and the cavity filled with 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 ZOE-treated versus CH-treated teeth were: no recognisable pulp 89% and 82%, internal root resorption 0% and 1%, external root resorption 11% and 24%, presence of bacteria 5% and 18%, periapical abscesses 24% and 52%., Statistics: Fisher's exact probability test showed a statistically significant higher prevalence of periapical abscesses in the CH-treated group (P=0.03, relative risk 2.2)., Conclusions: ZOE pulpectomy is preferred to CH for the treatment of infected pulps in primary molars.

This case report describes taurodontism in six molars of one patient. There were two mandibular second molars and four maxillary molars. All of them were hypertaurodont.

The X-linked hypophosphatemic rickets is a rare metabolic disorder characterized by low serum phosphate levels caused by a decreased renal tubular reabsorption of inorganic phosphates. The initial complaints are a delay in the development of walking caused by deformity of the legs. Oral findings include poorly mineralized dentin, enlarged pulp chambers and root canals, and periradicular abscesses in caries-free teeth. We present three patients from the same family with X-linked hypophosphatemic rickets showing bone and dental alterations.

A case is reported of a chronic periapical lesion involving maxillary central incisors with a history of traumatic injury eight years previously and subsequent development of a painful swelling that occasionally caused partial blockage of the nasal cavities. Retrograde surgery for removal of the suspected cystic lesion was scheduled. As a temporary measure before surgery, the necrotic pulp exudate was removed through standard endodontic access cavities prepared on the palatal surfaces of the crowns of the two central incisors, and a calcium hydroxide paste dressing material was placed inside the root canals up to the apices. The calcium hydroxide dressing was changed every four weeks and the case was followed up until healing of the periapical lesion occurred. The surgical procedure was postponed and finally cancelled when complete healing became evident in recall radiographs.

- A case of severe crown fracture and luxation in the upper permanent incisors of a 9-year-old boy is reported. The treatment of one of the injured teeth included apexification with calcium hydroxide and endodontic treatment with gutta-percha obturation. The other incisor was also treated with calcium hydroxide, but as there was no apical stop after 3 years of treatment, it was decided to use a new root-end filling material: mineral trioxide aggregate (MTA). At follow-up 12 months later, the tooth was asymptomatic and radiographically showed the initial repair of the radiolucent apical lesion.

The ultimate aim of endodontic treatment is to encourage the healing of apical periodontitis, or to prevent it from occurring if it was not present prior to treatment. Apical periodontitis is a general term used to describe an inflammatory response to irritation caused by the contents of a root canal system and it has several distinct forms. The most common is a granuloma but this can develop into other disease entities such as an abscess, a periapical pocket cyst or a true cyst, all of which present as radiolucencies. However, periapical radiolucencies may also be caused by extra-radicular infections, foreign body reactions and periapical scars, or they may be due to other tumours and cysts that have not originated from pulp disease. Practitioners must recognise and understand the different pathological entities and the dynamic interactions that occur in the periapical tissues in order to correctly diagnose and treat these conditions.

Dens evaginatus (DE) is not uncommon. It can affect the premolars of people of oriental ethnicity, and it can lead to different clinical problems. This article describes the diagnosis and management of a patient presenting with a fractured tubercle of DE and an unusual buccal abscess in relation to periapical radiolucency extending around the mandibular second premolar and first molar.

Dens evaginatus is a developmental dental anomaly predominantly affecting premolars in people of Mongolian origin. It is likely to become more prevalent in New Zealand due to the increase in immigration of Asians. The formation of dens evaginatus is postulated to be an abnormal evagination of the internal enamel epithelium and dental papilla into the stellate reticulum during morphodifferentiation. An important complication resulting from damage to the evagination is periapical abscess. When considering treatment options, the long-term prognosis of the tooth, its root length, the general alignment of the teeth, and overall arch length should be reviewed. Management options include composite resin placed at the base of the tubercle, excision of the tubercle followed by direct or indirect calcium-hydroxide pulp capping and composite-resin restoration, and apexification procedures followed by conventional endodontic therapy. Grinding of the intact tubercles of newly erupted evaginated premolars may contribute to secondary infection of the pulp, and is not recommended.

Aim: To describe the clinical management of an unusual dens invaginatus type 2., Summary: A case of dens invaginatus in a maxillary lateral incisor with a periapical lesion is reported. The patient presented with pain and localized swelling. Despite the complex anatomy and diagnosis of dens invaginatus, non-surgical root canal treatment was performed successfully., Key Learning Points: * Dens invaginatus may be presented in many forms, and the aetiology of this phenomenon is not fully understood. * Due to abnormal anatomical configuration, dens invaginatus presents technical difficulties in its clinical management. * Non-surgical root canal treatment can be performed successfully.

The purpose of this study was to investigate the effect of the addition of platelet-derived growth factor-BB and insulin-like growth factor-I to calcium hydroxide in the repair of apical perforations in dogs. Fifty-one premolar teeth of four beagle dogs were used. After developing periapical lesions root apices were artificially perforated. The teeth were divided into the three groups: group 1, the apical perforations were not sealed; group 2, the perforated areas were obturated with calcium hydroxide; and group 3, calcium hydroxide plus growth factors was applied to the sites of perforation. All canals were filled by a lateral condensation technique. Animals were killed 12 wk later, and sections were hematoxylin & eosin-stained and immunostained for osteonectin. The amount of inflammation was evaluated histomorphologically. The one-way ANOVA test demonstrated that the three groups were significantly different from one another. In group 3 there was no inflammatory reaction of apical tissue, and the connective tissue adjacent to the newly formed hard tissue was strongly immunostained for osteonectin. Most sections in group 1 showed no apical healing. Moderate healing was found in group 2. In conclusion the combination of platelet-derived growth factor-BB and insulin-like growth factor-I with calcium hydroxide improved healing of apical perforation in dogs.

The purpose of this study was to compare pulpal and periapical tissue reactions to electrosurgery versus formocresol pulpotomy techniques in the primary teeth of dogs. The study was conducted on 33 primary teeth of three mongrel dogs between the ages of one to three months. Each dog had three teeth treated by Formocresol Pulpotomy with Mechanical Coronal Pulp Removal (FC), three teeth treated by Electrosurgery Pulpotomy with Mechanical Coronal Pulp Removal (ES/MCPR), three teeth treated by Electrosurgery Pulpotomy with Electrosurgical Coronal Pulp Removal (ES/ECPR), and two teeth serving as untreated Controls. Dogs one, two and three were sacrificed performing the pulpotomies at two, four and six weeks, respectively. The pulp, periapical tissue and after surrounding bone were submitted to histological examination and the histological reaction was recorded. The results were fourteen out of 18 unfavorable and zero out of three favorable histological reactions occurred in the FC treated teeth. Six out of 18 unfavorable and one out of three favorable histological reactions occurred in the ES/MCPR treated teeth. Nine out of 18 unfavorable and two out of three favorable histological reactions occurred in the ES/ECPR treated teeth. One out of 18 unfavorable and zero out of three favorable histological reactions occurred in the untreated Control teeth. The conclusion of this study is that of the three experimental groups, the teeth treated by Electrosurgery Pulpotomy with either Mechanical or Electrosurgical Coronal Pulp Removal exhibited less histopathological reaction than the teeth treated by Formocresol Pulpotomy.

An unusual case is presented, underlying the rarity of the presence of two canals in a maxillary central incisor associated with macrodontia.

Objective: The multifunctional cytokine interleukin-6 (IL-6) has actions on multiple cell types, including promotion of the development of immune cells and osteoclasts. Periapical inflammation as the result of root canal infection is characterized by the accumulation of inflammatory cells and bone resorption. The effect of IL-6 on periapical lesion formation after pulpal infection is unknown. We sought to determine whether deletion of IL-6 affects periapical lesion formation after pulp exposure., Methods: Molar pulps of homozygous IL-6 knock-out mice (IL-6(-/-), strain B6, 129-Il6tm1Koe ) and wild-type mice (IL-6(+/+)) were exposed, and the mice were killed at 1, 2, 3, 5, and 8 weeks after the exposure. Mouse jaws were decalcified and prepared for histologic examination of periapical lesions., Results: The IL-6(-/-) mice developed larger periapical lesions more rapidly than did the IL-6(+/+) mice., Conclusions: IL-6 deletion promoted periapical lesion development.

The vitality of teeth adjacent to dental implants should be considered in the treatment planning of dental implants. Both the restorability of an endodontically treated tooth and the risk of infection of the adjacent implant are important factors in planning for success. Given the illustrated difficulties and difficulties associated with resolving periapical infections of teeth and implants, it is essential to define the vitality of teeth by careful pulp testing and to consider the integrity of existing questionable, endodontically treated teeth before implant treatment. The risk of periapical infection at teeth adjacent to implants must be minimized.

The ultimate aim of endodontic treatment is to encourage the healing of apical periodontitis, or to prevent it from occurring if it was not present prior to treatment. Apical periodontitis is a general term used to describe an inflammatory response to irritation caused by the contents of a root canal system and it has several distinct forms. The most common is a granuloma but this can develop into other disease entities such as an abscess, a periapical pocket cyst or a true cyst, all of which present as radiolucencies. However, periapical radiolucencies may also be caused by extra-radicular infections, foreign body reactions and periapical scars, or they may be due to other tumours and cysts that have not originated from pulp disease. Practitioners must recognize and understand the different pathological entities and the dynamic interactions that occur in the periapical tissues in order to correctly diagnose and treat these conditions.

The insertion of metal objects into intraoral and perioral sites is growing in popularity. However, there are numerous oral and dental complications associated with tongue piercing. Fifteen patients with tongue piercings (pierced in the body of the tongue, anterior to the lingual frenum) attending the dental office of the authors, with and without complaints, were clinically and radiographically examined. The most common dental problem registered was chipping of teeth. Furthermore, two cracked teeth and four teeth with cusp fractures were also seen. One case of selective dental abrasion was registered. Trauma to the lingual anterior gingiva was the most common gingival problem. A salivary flow stimulating effect was only reported by 2 of the 15 individuals. None of the patients complained of interference with speech, mastication and swallowing. One case of galvanic currents produced by the appliance was registered. On the basis of the registered data, we concluded that patients need to be better informed of the potential complications associated with tongue and oral piercings, and that the dental profession can serve this role.

A case of familial hypophosphatemic vitamin D-resistant rickets or X-linked hypophosphatemia (XLH) accompanied by specific systemic and dental findings is reported. A 15-year-old boy with XLH visited our facility complaining of a toothache in the left lower canine region. Two other family members of the patient, his younger sister and their mother, also had XLH, whereas the other 2 members, his younger brother and father, are healthy. Those with XLH show systemic signs of the disease, such as growth retardation, limb deformity, and spinal curvature disorders; however, these symptoms are more severe in the patient than in the others. The patient had multiple periodontal abscesses, but no evidence of dental caries, trauma, or periodontal disease on the corresponding teeth at the time of his oral examination. A radiographic examination showed root dysplasia and enlarged pulp chambers.A histologic examination of an extracted third molar showed marked globular dentin and an increased predentin width. The abscess was thought to be caused by pulpal infection, which came from bacterial invasion through enamel cracks and dentinal microcleavage of the teeth. The treatments provided in this case are discussed.

Luxation injuries to incisors, including intrusive displacement, occur with a high frequency in the primary dentition. Intrusion injuries are associated with damage to the pulpal and periodontal structures and possible fracture of the alveolar bone. The pulpal tissue of the intruded tooth sustains a severe shock during displacement, which may be reflected later by sequelae ranging from mild discoloration to pulpal necrosis and infection. Disintegration of pulpal tissue may result in periapical tissue inflammation, which in turn may induce developmental disturbances in the germ of the permanent successor tooth. Additionally, severe injury to the periodontal ligament during intrusion may lead to ankylosis of the primary incisor and consequently to delayed or ectopic eruption of its permanent successor. This article will review the possible sequelae affecting primary incisors following their intrusion.

The purpose of this paper is to present two case reports of dental trauma with middle-apical level root fractures and pulp necrosis. The treatment consisted of programmed applications of calcium hydroxide until a calcified barrier was formed at the fracture level. The technique presented here proved efficient in treating horizontal fractures at the middle and apical thirds of the root.

Aspirated exudate from 50 patients with oral abscesses were cultured and bacterial growth was assessed qualitatively and semi-quantitatively. Bacteria were recovered from all specimens. The mean number of species isolated per specimen was 3.6 Both facultative and obligate anaerobes were isolated from 39 (78%) specimens. The most commonly isolated facultative anaerobic species was Streptococcus virdans group, while pigmented gram negative bacilli were the most commonly isolated obligate anaerobes. Beta-hemolytic Streptococci of the "milleri" groups were recovered from 11 (22%) of the abscesses. Eight of those isolates were determined to carry Lancefield group F antigen, 2 group C, and 1 isolate was not groupable for any Lancefield antigen. These abscesses may be sequelae of oral infectious disease or trauma. Patients with oral abscesses infected with beta hemolytic Streptococci are apt to be male, and less than 35 years old. They are also likely to have a more rapid onset of infection and to require hospitalization for intensive treatment of a life threatening condition.

The periodontal tissues and the pulp-dentine complex form an intimate continuum through which pathological changes of either one may lead to infection of the other, and whose management can be fraught with diagnostic and therapeutic difficulty. The purpose of this review paper is to explain the nature of that relationship and to provide pointers which may assist in the diagnostic process and thus enable appropriate management from the outset. Traditional classifications of lesions affecting the periodontal-endodontic complex have caused confusion by attempting to form diagnoses which indicate the putative primary source of infection. We would suggest that the origin of the infection is irrelevant to the management process, and that what is important is whether either, or indeed both, of the tissues are viable or not. Successful therapy will only result from the establishment of an accurate diagnosis, and forming such a diagnosis requires a methodical multi-staged approach.

Oral health professionals are frequently asked to evaluate patients with routine odontogenic infections. These patients can sometimes present with systemic signs and symptoms, including fever, malaise, tachycardia, and dehydration. It is important for the astute clinician to understand the possible associated systemic diseases that may be contributing to odontogenic infections. We present here an interesting case of a pediatric patient with a routine canine space infection who exhibited classic clinical signs and symptoms of diabetic ketoacidosis.

For this survey, 92 vertically fractured endodontically treated teeth were evaluated clinically and radiographically before and after extraction. The maxillary second premolars (27.2%) and mesial roots of the mandibular molars (24%) were the most fractured teeth. In 67.4% of the teeth, a solitary buccal pocket was present; in 34.8%, a fistula frequently appeared closer to the gingival margin than to the apical area. A lateral radiolucency or a combination of lateral and periapical radiolucency was found in more than half of the cases. The general practitioners correctly diagnosed vertical root fracture in only one-third of the 92 fractured teeth in this survey.

A case of dentinal dysplasia type I is presented. This rare hereditary disturbance of dentine is characterized by short-rooted teeth with sharp conical apical constrictions, aberrant growth of dentine in the pulp chamber leading to reduced pulp space in permanent teeth and total pulpal obliteration in the primary dentition. Clinical, radiographic and histopathological material from a 7-year-old boy, showing the typical features of this disorder in which teeth are prematurely lost through periapical abscesses, cysts or spontaneous exfoliation, is described. A review of the theories of pathogenesis of this condition is included. Management of patients with dentinal dysplasia is difficult and a discussion of the shortcomings of various treatment strategies, including conventional endodontic therapy, periapical curettage and retrograde root filling, and a preventive regimen, are discussed. In this case, despite diagnosis being made at an early age and the provision of regular dental care, the patient is now losing teeth because of spontaneous abscess formation.

Aim: The aim of this study was to determine whether overinstrumentation followed by immediate overfilling could be a potential risk in the treatment of infected root canals., Methodology: Thirty-five human teeth with infected root canals were overinstrumented and overfilled approximately 45 min after their extraction. The experimental teeth were enlarged up to size 40 and the overinstrumentation and overfilling were checked with the aid of a magnifying glass. The specimens were fixed in glutaraldehyde plus sodium cacodylate solution and prepared for scanning electron microscope examination., Results: Bacteria were detected on the flute of the files and mostly at the root apices around the main foramen, remaining firmly attached to resorptive lacunae despite the fact that the apices had undergone great changes, including fracture or zipping. A control group consisting of 10 human teeth root canals containing vital pulps were also overinstrumented and overfilled. No bacteria were detected on the flutes of the files, at the apices or on the extruded master cone overfilling these samples., Conclusions: The high percentage of bacteria adhering to the resorptive lacunae or in the flutes of files used in overinstrumented human teeth with infected root canals carry a potential risk for postoperative pain, clinical discomfort and flare-ups. The hazards observed in these circumstances do not support the one-visit treatment of teeth having acute or chronic periapical abscesses.

Exudative macrophages are the most prevalent inflammatory cells during the entire pathogenetic process in experimentally induced rat periapical lesions. To clarify the significance of macrophages in the pathogenesis of periapical lesions, the way in which the phenotype of ED1 (a general marker for mononuclear phagocytes)-positive cells is modulated in actively expanding lesions was investigated, by immunoperoxidase staining with a panel of antibodies that recognize several activation-associated molecules on macrophages. Periapical lesions were induced experimentally by exposing the pulp in the lower first molars of Wistar rats. Active lesion expansion with morphological diversification of ED1-positive cells occurred between 14 and 28 days after the injury. Double immunoperoxidase staining revealed that ED1-positive cells coexpressing class II molecules of the major histocompatibility complex (MHC) molecules, inducible nitric oxide synthase (iNOS) and/or CD11a increased during the period of active lesion expansion. Increases of endothelial cells expressing intracellular adhesion molecule-1 and CD25 (interleukin-2 receptor)-expressing lymphocytes were also seen during the same period. Moreover, there existed two particular subpopulations of ED1 + cells in the established lesion at 28 days: (1) ED1++/class II MHC - /iNOS+ cells, located around the periapical abscess, and (2) ED1+/class II MHC+/ iNOS- cells with slender or dendritic morphology, distributed predominantly in the outer portion of the lesion where T lymphocytes were abundant. The first cell type could be a macrophage with potent phagocytic and antimicrobial actions, and the second might possess sufficient antigen-presenting capacity to cause the activation of T lymphocytes. It was concluded that macrophages, when activated, may participate in triggering lesion expansion. Functionally distinct subpopulations of macrophages may occupy different sites within the lesion where they can most effectively exert their specific functions.

A 12-year-old boy was referred with a discharging sinus tract related to the maxillary left lateral incisor, and with a non-vital maxillary left central incisor. The lateral incisor gave a positive response to sensitivity testing. The lesion did not heal after disinfection of the root canal of the central incisor, but healed subsequently after 'endodontic' treatment of an invagination in the lateral incisor. After 2 years the lateral incisor continued to give a positive response to sensitivity testing.