RESUMO
BACKGROUND: Arsenic oxide compounds were traditionally used as devitalizing agents. Due to its toxicity, leakage of such compounds into the periodontium can cause gingival and osteo-necrosis. Their use is forbidden in Europe and the USA for decades, however, some dentists seem to still use it. CASE REPORT: We report the case of a 14-year-old girl referred to the paediatric dentistry department of Toulouse University hospital, France, presenting a bone necrosis following the use of an arsenic trioxide product to accelerate pulp necrosis. TREATMENT: The treatment included surgical removal of necrosis bone sequestrum, complete pulpectomy and an intermediate restoration of the tooth 27. FOLLOW-UP: After 1 week, the clinical conditions greatly improved. A restoration using a ceramic crown was performed after 2 months, and complete healing was observed after 1 year follow-up. CONCLUSION: Although arsenic trioxide is neither appropriate nor permitted for use in modern dentistry, especially in paediatric dentistry, some rare cases of arsenic-induced osteo-necrosis can still be encountered. A clearer message must be given to all dental practitioners against the use of arsenic trioxide in modern endodontic treatment.
Assuntos
Arsenicais/efeitos adversos , Necrose da Polpa Dentária/tratamento farmacológico , Osteonecrose/induzido quimicamente , Óxidos/efeitos adversos , Adolescente , Trióxido de Arsênio , Materiais Dentários/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Feminino , França , Doenças da Gengiva/induzido quimicamente , Humanos , Doenças Mandibulares/induzido quimicamente , Necrose/induzido quimicamente , Osteonecrose/diagnóstico por imagem , Osteonecrose/patologia , Osteonecrose/cirurgia , PulpectomiaRESUMO
The leakage of arsenic trioxide paste from tooth fillings has been associated with widespread necrosis of the supporting periodontal tissues. This report describes two cases of arsenic trioxide paste-induced gingival and localized alveolar bone necrosis in the mandible, following the use of arsenic trioxide paste as a pulp-devitalized agent. The first case was a 54-year-old female complaining of a painful white patch on the gingival tissue of the left mandibular second molar (tooth #37) after treatment by a private dentist. She underwent completely debridement of all necrotic soft tissue with physical saline irrigation. The gingival tissue was gradually replaced with vascular tissue and completely healed after 7 weeks. The second case was a 30-year-old female complaining of severe pain and continuous gingival bleeding from the right maxillary first bicuspid (tooth #14) following treatment by a private dentist. She finally accepted debridement of the sequestrum and necrotic alveolar bone with decortication to induce active bleeding. A partial thickness gingival flap was made to cover the wound. Four weeks later, the supporting tissues had completely healed. Arsenic trioxide paste is a cytotoxic agent and may cause harmful adverse effects on adjacent periodontium and supporting hard tissue if leakage occurs, or it is used carelessly. There is no indication for the use of arsenic trioxide paste in modern dental practice.
Assuntos
Processo Alveolar/efeitos dos fármacos , Arsenicais/efeitos adversos , Materiais Dentários/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Doenças da Gengiva/induzido quimicamente , Doenças Mandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , Óxidos/efeitos adversos , Adulto , Processo Alveolar/patologia , Trióxido de Arsênio , Desvitalização da Polpa Dentária/métodos , Feminino , Doenças da Gengiva/patologia , Humanos , Doenças Mandibulares/patologia , Pessoa de Meia-Idade , Necrose/induzido quimicamente , Osteonecrose/patologiaAssuntos
Processo Alveolar/efeitos dos fármacos , Arsenicais/efeitos adversos , Materiais Dentários/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Doenças da Gengiva/induzido quimicamente , Doenças Mandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , Óxidos/efeitos adversos , Feminino , HumanosAssuntos
Processo Alveolar/efeitos dos fármacos , Arsenicais/efeitos adversos , Materiais Dentários/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Doenças da Gengiva/induzido quimicamente , Doenças Mandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , Óxidos/efeitos adversos , Feminino , HumanosAssuntos
Arsênio/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Côndilo Mandibular , Doenças Mandibulares/etiologia , Osteomielite/etiologia , Adulto , Arsênio/uso terapêutico , Feminino , Humanos , Doenças Mandibulares/diagnóstico , Doenças Mandibulares/cirurgia , Osteomielite/diagnóstico , Osteomielite/cirurgia , Resultado do TratamentoAssuntos
Desvitalização da Polpa Dentária/instrumentação , Remoção de Dispositivo/métodos , Enteroscopia de Duplo Balão/métodos , Migração de Corpo Estranho/cirurgia , Jejuno , Agulhas , Desvitalização da Polpa Dentária/efeitos adversos , Diagnóstico Diferencial , Seguimentos , Migração de Corpo Estranho/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
AIM: To report that arsenical pastes are still employed in endodontics and to highlight the potentially serious consequences of their use. SUMMARY: Chemotherapeutic agents such as arsenic trioxide and paraformaldehyde were once commonly employed as pulp-necrotizing agents. Their cytotoxic effects are well recognized, and leakage from teeth has been associated with widespread necrosis of periodontal tissues and bone. This report describes two cases of severe bone necrosis affecting the mandible following the use of an arsenical paste. KEY LEARNING POINTS: Pulp-necrotizing agents such as arsenic trioxide can cause severe bone necrosis. Arsenical pastes have no place in contemporary dental practice. Dentists should employ appropriate local anaesthetic techniques for pulp extirpation instead of relying on toxic necrotizing agents.
Assuntos
Arsenicais/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Doenças Mandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , Óxidos/efeitos adversos , Adulto , Trióxido de Arsênio , Desvitalização da Polpa Dentária/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Desinfetantes de Equipamento Odontológico/efeitos adversos , Formaldeído/efeitos adversos , Osteonecrose/induzido quimicamente , Polímeros/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Desvitalização da Polpa Dentária/métodos , Humanos , Mucosa Bucal/efeitos dos fármacos , Necrose/induzido quimicamenteAssuntos
Arsenicais/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Doenças Maxilares/induzido quimicamente , Osteonecrose/induzido quimicamente , Óxidos/efeitos adversos , Irrigantes do Canal Radicular/efeitos adversos , Trióxido de Arsênio , Desvitalização da Polpa Dentária/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Paraformaldehyde is used both as a disinfectant and to devitalise inflamed pulps when local anaesthesia is ineffective. Despite the clinical benefits, paraformaldehyde is not confined to the pulp, but penetrates the dentine and is gradually released as formaldehyde. This case series describes the effects on periodontal and bone tissues of paraformaldehyde used as a devitalising or disinfectant agent.
Assuntos
Anti-Infecciosos Locais/efeitos adversos , Formaldeído/efeitos adversos , Doenças Maxilares/induzido quimicamente , Osteonecrose/induzido quimicamente , Polímeros/efeitos adversos , Irrigantes do Canal Radicular/efeitos adversos , Adulto , Desvitalização da Polpa Dentária/efeitos adversos , Desvitalização da Polpa Dentária/métodos , Feminino , Gengiva/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/efeitos dos fármacosAssuntos
Processo Alveolar/efeitos dos fármacos , Arsenicais/efeitos adversos , Implantação Dentária Endóssea/métodos , Desvitalização da Polpa Dentária/efeitos adversos , Osteonecrose/induzido quimicamente , Adulto , Processo Alveolar/patologia , Processo Alveolar/cirurgia , Implantes Dentários , Desvitalização da Polpa Dentária/métodos , Humanos , Arcada Parcialmente Edêntula/induzido quimicamente , Arcada Parcialmente Edêntula/patologia , Arcada Parcialmente Edêntula/reabilitação , Imageamento por Ressonância Magnética , Masculino , Necrose , Osteonecrose/patologia , Osteonecrose/cirurgia , Radiografia Panorâmica , Resultado do TratamentoRESUMO
AIM: To present a case of osteomyelitis that was caused by the use of arsenic trioxide during root canal treatment in a mandibular left first molar. SUMMARY: Arsenic was once in common use to devitalize inflammed pulp tissue before root canal treatment. Its prolonged application or leakage leads to toxic effects beyond the pulp tissue, and necrosis of periodontal tissues and supporting alveolar bone has been described. This report presents a case of osteomyelitis resulting from leakage of arsenic trioxide used in pulp devitalization. Sequestrectomy and excision of non-vital alveolar bone was performed to treat the severe tissue necrosis. KEY LEARNING POINTS: Agents containing arsenic are still employed by some clinicians and may be encountered when patients present with tissue destruction resulting from their use. Dental practitioners should be aware that arsenic paste may diffuse into periodontal tissues through apical, lateral or accessory canals, through perforations and around leaking restorations. Osteomyelitis caused by arsenic trioxide can be treated by a combination of pharmacotherapeutic and invasive surgical methods. Arsenic pastes have no place in endodontic practice.
Assuntos
Arsenicais/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Doenças Mandibulares/induzido quimicamente , Osteomielite/induzido quimicamente , Osteonecrose/induzido quimicamente , Óxidos/efeitos adversos , Irrigantes do Canal Radicular/efeitos adversos , Adolescente , Trióxido de Arsênio , Feminino , Humanos , Mandíbula , Dente MolarRESUMO
Historically, pulp-necrotizing agents were commonly used in endodontic treatments. They act quickly and devitalize the pulp within a few days. However, they are cytotoxic to gingiva and bone. If such an agent diffuses out of the cavity, it can readily cause widespread necrosis of gingiva and bone, which can lead to osteomyelitis of the jaws. Although the use of arsenic trioxide can cause severe damage to surrounding tissues, producing complications, it is still used in certain areas in the world. This article presents and discusses two cases of tissue necrosis and their surgical management. These cases showed severe alveolar bone loss in the maxilla, which affected the patients' quality of life and limited the restorative possibilities. As dentists, we should be aware of the hazardous effects of arsenic trioxide and should abandon its use. Because of its cytotoxicity, there is no justification for the use of arsenic trioxide in the modern dental practice.
Assuntos
Arsenicais/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Osteonecrose/induzido quimicamente , Óxidos/efeitos adversos , Adulto , Perda do Osso Alveolar/etiologia , Perda do Osso Alveolar/cirurgia , Trióxido de Arsênio , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Feminino , Humanos , Masculino , Doenças Maxilares/induzido quimicamente , Doenças Maxilares/cirurgia , Fístula Bucoantral/etiologia , Fístula Bucoantral/cirurgiaRESUMO
AIM: To report on an unusual case of gingival necrosis following the use of a paraformaldehyde-containing paste in root canal treatment. SUMMARY: Paraformaldehyde preparations are toxic to hard and soft tissues. In an era of effective local anaesthesia, toxic devitalizing preparations have few applications. However, in a mobile world population, severe tissue injury may occasionally be encountered after the use of paraformaldehyde or other toxic agents in some parts of the world. Dentists should avoid such preparations and be alert of the features and management of local toxicity if they encounter it in practice. KEY LEARNING POINTS: Paraformaldehyde-containing pastes have no application in contemporary dentistry. Dentists should avoid toxic preparations for pulp devitalization. Dentists should be aware of the features and management of tissue necrosis resulting from the use of toxic dressing materials.
Assuntos
Anti-Infecciosos Locais/efeitos adversos , Formaldeído/efeitos adversos , Doenças da Gengiva/induzido quimicamente , Polímeros/efeitos adversos , Irrigantes do Canal Radicular/efeitos adversos , Adulto , Desvitalização da Polpa Dentária/efeitos adversos , Desvitalização da Polpa Dentária/métodos , Feminino , Doenças da Gengiva/patologia , Humanos , NecroseAssuntos
Arsênio/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Doenças Mandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Feminino , Humanos , Nervo Mandibular/efeitos dos fármacos , Pessoa de Meia-Idade , Parestesia/induzido quimicamenteRESUMO
AIM: To describe some toxic effects of arsenic trioxide in the mouth, to condemn its continued use, and present a case in which a tooth was preserved despite significant bony destruction. SUMMARY: A case is presented in which severe alveolar bone necrosis resulted from leak-age of an arsenical devitalization paste into the periodontium. The tooth was root canal treated before root amputation, and restored with a cuspal coverage restoration. The tooth was observed to be symptomless and functional at the one-year follow-up. KEY LEARNING POINTS: * Arsenic and its compounds have no place in contemporary endodontics. * Dentists should protect their patients by avoiding the use of arsenic-containing materials and refusing to use products whose constituents are not known. * Localized bone necrosis may not require tooth extraction. Depending on the severity of the case, the tooth may be preserved by a combination of endodontic, periodontal,prosthodontic and maintenance therapies.
Assuntos
Processo Alveolar/efeitos dos fármacos , Intoxicação por Arsênico/etiologia , Arsenicais/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Osteonecrose/etiologia , Adolescente , Processo Alveolar/cirurgia , Feminino , Humanos , Doenças Mandibulares/etiologia , Doenças Mandibulares/cirurgia , Osteonecrose/cirurgia , Tratamento do Canal Radicular , Raiz Dentária/cirurgiaRESUMO
A paraformaldehyde preparation (Toxavit) was applied to an inflamed and symptomatic pulp of the mandibular right first molar (tooth #46), in a 30-year-old woman. Leakage from the product was responsible for marked necrosis of the gingiva and the alveolar cortical bone, which resulted in loss of the tooth.
Assuntos
Desvitalização da Polpa Dentária/efeitos adversos , Formaldeído/toxicidade , Doenças da Gengiva/induzido quimicamente , Doenças Mandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , Polímeros/toxicidade , Adulto , Feminino , Doenças da Gengiva/patologia , Humanos , Doenças Mandibulares/patologia , NecroseRESUMO
After a brief historical review of the use of arsenic in dental practice two cases of arsenical necrosis of the jaws, affecting the maxilla and mandible respectively, are reported. Both patients were treated conservatively over an extended period with excellent results. It is concluded that there is no justification, whatsoever, for the use of arsenic in modern dental practice and that, although prolonged, conservative treatment of chemical necrosis of the jaws is preferable to more radical treatment.
Assuntos
Arsenicais/efeitos adversos , Desvitalização da Polpa Dentária/efeitos adversos , Doenças Mandibulares/induzido quimicamente , Doenças Maxilares/induzido quimicamente , Osteonecrose/induzido quimicamente , Adulto , Terapia Combinada , Humanos , Masculino , Mandíbula/patologia , Doenças Mandibulares/patologia , Doenças Mandibulares/terapia , Maxila/patologia , Doenças Maxilares/patologia , Doenças Maxilares/terapia , Osteonecrose/patologia , Osteonecrose/terapia , Fatores de TempoRESUMO
One hundred and ninety-five teeth in 35 patients with periodontitis who had received both endodontic and periodontal treatment were evaluated 9 years after endodontic treatment and 8 years after periodontal treatment. Some 91.4% of cases were well maintained and 8.6% showed a deterioration in their periodontal condition. Twelve of the 195 teeth with endodontic treatment were lost, eight for periodontal reasons, three as a result of fracture and one because of caries, and the periodontal condition of 10 teeth had worsened. An apical lesion formed on one tooth. The results indicate that the risk of endodontic failure in this group of 195 teeth is very low, and that there is little risk of tooth loss for periodontal reasons, provided that the patients receive supportive periodontal treatment.
Assuntos
Desvitalização da Polpa Dentária/efeitos adversos , Doenças Periodontais/terapia , Tratamento do Canal Radicular , Perda de Dente/etiologia , Adulto , Idoso , Estudos de Avaliação como Assunto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Planejamento de Assistência ao Paciente , Doenças Periodontais/complicações , Prognóstico , Reoperação , Estudos Retrospectivos , Preparo de Canal Radicular , Tratamento do Canal Radicular/métodosRESUMO
Fifty--three teeth with pulpitis treated by pulp mummification and followed--up for fifteen years were examined. Of them, excellent result was achieved in 11 teeth (20.75%), good in 8 teeth (15.10%) and failure in 34 teeth (64.15%). Radiologically, 8 good cases were characterized by badly delineated periodontal ligament, increased periodontal ligament space in width, indistinct lamina dura and/or local increase in the density of bone; 34 failure cases were characterized by the radiolucent area or small lesion around apex with clear radiopaque line on the circumference of the area or local increase in the density of bone. These radiographs showed that chronic inflammations existed in periapex. Although further investigations are needed to identify the reasons leading to chronic inflammations, the results should be considered seriously when pulp mummification is upon selection.