Resolution of Apical Periodontitis-induced Mental Nerve Paresthesia Through Nonsurgical Endodontic Retreatment: A Case Report.

Paresthesia is a potential consequence of unsuccessful root canal treatment. Persistent infection resulting in apical periodontitis may enlarge sufficiently to involve the mental neurovascular bundle. The case presented in this report was referred for endodontic evaluation with a chief complaint of discomfort on mastication and persistent numbness of the lower left lip. Clinical and radiographic evaluation revealed incomplete primary endodontic treatment of the left mandibular second premolar with complex internal anatomy. The untreated root canal system resulted in the progression of apical periodontitis involving the left mental neurovascular bundle as confirmed by cone-beam computed tomography imaging. Nonsurgical root canal retreatment was performed over 2 visits. At the 3-year follow-up visit, the paresthesia had resolved with return of normal sensation. Nonsurgical endodontic retreatment may be sufficient to allow healing of large periapical lesions and resolve complications including paresthesia without the need for surgical intervention.

Apexification of dens evaginatus in a mandibular premolar: A case report.

Key Clinical Message: Dens evaginatus is an uncommon dental anomaly presenting on mandibular premolar teeth. Affected teeth are difficult to diagnose and manage, and often demonstrate immature apices requiring complex endodontic treatment approaches. Abstract: Dens evaginatus (DE) is an uncommon anomaly affecting mandibular premolars, frequently requiring endodontic intervention. This report documents the treatment of an immature mandibular premolar presenting with DE. Early diagnosis and preventive strategies remain the preferred management for these anomalies, however endodontic approaches may be successfully applied to retain these teeth.

Root and canal morphology of maxillary second molars in a Black South African subpopulation using cone-beam computed tomography and two classifications.

This study investigated the root and canal morphology of maxillary second molars in a Black South African population using high-resolution cone-beam computed tomography. In total, 386 maxillary second molar teeth were evaluated and described according to the classifications of Vertucci (with the additions of Sert and Bayirli), as well as Ahmed et al. Root number, fusions and canal morphology were recorded. Relationships between morphology, sex and age were assessed using Fisher's exact test (p < 0.05). Maxillary second molars were predominantly three-rooted (96.1%), with root fusion observed in 14%. No relationships between sex, age and canal morphology were found. Additional canals were observed in 67.4% of mesiobuccal roots. The Ahmed et al. classification provided a better overall description of the morphology. In this population, maxillary second molar teeth exhibited a diversity of root and canal morphology. Complex variations may render endodontic management more difficult and increase the possibility of missed anatomy.

Assessment of the Prevalence of Radix Entomolaris and Distolingual Canal in Mandibular First Molars in 15 Countries: A Multinational Cross-sectional Study with Meta-analysis.

AIM: The aim of this study was two-folded: i) to assess the prevalence of Distolingual Canal (DLC) and Radix Entomolaris (RE) in Mandibular First Molars (M1Ms), using Cone Beam Computed Tomography (CBCT) images and ii) to assess the impact of sociodemographic factors on the prevalence of these conditions worldwide. METHODS: CBCT images were scanned retrospectively and the ones including bilateral M1Ms were included in the study. The evaluation was performed by 1 researcher in each country, trained with CBCT technology. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating axial sections from coronal to apical. The presence of DLC and RE in M1Ms (yes/no) was identified and recorded. RESULTS: Six thousand three hundred four CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries regarding the prevalence of both RE and DLC (P < .05). The prevalence of DLC ranged from 3% to 50%, and the overall prevalence was 22% (95% CI: 15%-29%). RE prevalence ranged from 0% to 12%, and the overall prevalence was 3% (95% CI: 2%-5%). There were no significant differences between left and right M1Ms or between genders for either DLC or RE (P > .05). CONCLUSION: The overall prevalence of RE and DLC in M1Ms was 3% and 22%. Additionally, both RE and DLC showed substantial bilaterally. These variations should be considered by endodontic clinicians during endodontic procedures in order to avoid potential complications.

Assessment of the Prevalence of Middle Mesial Canal in Mandibular First Molar: A Multinational Cross-sectional Study with Meta-analysis.

BACKGROUND: An additional canal found in the mandibular first molar (M1M) is the middle mesial canal (MMC), which is often missed during root canal treatment. In this study, the prevalence of MMC in M1M on cone-beam computed tomography (CBCT) images was evaluated in 15 countries, along with the effect of some demographic factors on its prevalence. METHODS: Deidentified CBCT images were scanned retrospectively, and the ones including bilateral M1Ms were included in the study. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating three planes (coronal, sagittal, and axial) after a 3-dimensional alignment of the long axis of the root(s). The presence of an MMC in M1Ms (yes/no) was identified and recorded. RESULTS: In total, 6304 CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries (P < .05). MMC prevalence ranged from 1% to 23%, and the overall prevalence was 7% (95% confidence interval [CI]: 5%-9%). No significant differences were found between the left and right M1M (odds ratio = 1.09, 95% CI: 0.93, 1.27; P > .05) or between genders (odds ratio= 1.07, 95% CI: 0.91, 1.27; P > .05). As for the age groups, no significant differences were found (P > .05). CONCLUSIONS: The prevalence of MMC varies by ethnicity, but it is generally estimated at 7% worldwide. Physicians must pay close attention to the presence of MMC in M1M, especially for opposite M1Ms, due to the prevalence of MMC being significantly bilateral.

Endodontic treatment of dentin dysplasia type I D.

Dentin dysplasia (DD) Type I is a developmental condition affecting dentin, inherited in an autosomal-dominant pattern or occurring due to a new mutation. Whilst the crowns of DD Type I affected teeth appear clinically normal, the roots are blunt and shortened. Pulp necrosis and periapical pathoses may be seen in the absence of obvious causes. Pulp stones and calcifications are frequently encountered. Endodontic management of DD may be challenging. A case of DD Type I, sub-classification d, in which spontaneous irreversible pulpitis developed on three mandibular incisors is documented. The case was managed by conventional endodontic treatment. Knowledge of this uncommon dental condition may assist dentists to adequately diagnose and manage these cases. Extraction should not be considered the first-line treatment option when sufficient root length is available to attempt endodontic treatment. Referral for medical evaluation is recommended to rule out systemic diseases which may mimic this condition.

Double Gemination or Fusion of a Permanent Mandibular Second Molar: A Case Report.

Gemination and fusion are developmental conditions affecting the shape of teeth in both primary and permanent dentition. A 12-year-old girl presented for clinical assessment and the examination revealed an unusually shaped mandibular right second molar with irreversible pulpitis. Correlation of the intraoral and radiological appearance of this tooth suggested a diagnosis of either double gemination or fusion. The favourable position of the developing third molar supported early extraction of the abnormal second molar. The present report documents the clinical and radiological presentation of a mandibular second molar with an unusual developmental alteration in shape. Well-timed extraction therapy and good communication may reduce the need for unnecessary, complex treatment.

Tongue-tied: a case of magnetic balls constricting the lingual frenum.

The health risks associated with aspiration and ingestion of foreign bodies in children are well known. The increased availability of magnetic toys have added to these risks. A 7-year-old girl presented at the Department of Maxillofacial and Oral Surgery at the University of Pretoria Oral and Dental Hospital with a complaint of pain under the tongue. Examination revealed that magnetic balls had been lodged on either side of the lingual frenum. The patient experienced pain and was unable to dislodge the magnets. This case report documents patient presentation and management and concludes with a brief discussion of potential complications associated with the oral intake of magnets. Though multiple cases documenting the complications associated with ingestion of magnets have been reported, reports of primary oral complications are scant. This case contributes to existing evidence for the dangers associated with high strength magnets used as toys by children.

Single-use of endodontic hand files: perceptions and practise.

BACKGROUND: The concept of single-use of endodontic files remains controversial in the published literature. The extent and attitudes concerning the single-use of endodontic hand files is currently unknown in many countries. AIM: The prevalence and perceptions regarding the single-use of endodontic files was investigated in this descriptive observational study. METHODS: A questionnaire regarding the perceptions and usage protocols of endodontic files was developed. Twenty-seven South African dental practices were included in this study. Participation was voluntary. RESULTS: None of the respondents reported single-use of endodontic hand files. Several decontamination methods were used by the respondents for reprocessing endodontic files. DISCUSSION: Financial constraints were reported as the primary reason for the reuse of endodontic files. As no standardised method of reprocessing these instruments exists for South Africa, written guidelines on this subject should be developed.

Allergic contact dermatitis from resin-modified glass ionomers.

Monomers in a variety of dental materials may cause allergic contact dermatitis. While resin materials have been implicated in the onset of this condition, there is a paucity of evidence linking the condition to the resin-modified glass ionomers (RMGIs). This report documents a rare case of a dentist who developed allergic contact dermatitis following exposure to a RMGI. Contact dermatitis occurred despite the use of latex gloves, which were worn during the procedure. Both the acute and chronic stages of the condition were clinically represented. Patch testing was conducted to confirm the diagnosis. A no-touch technique and the routine use of nitrile gloves were subsequently adopted, which resulted in an overall decrease of the condition. Dentists, auxiliary personnel, and students should be aware of the possibility of sensitization to, and the development of allergic contact dermatitis not only from conventional resin materials, but also from the RMGIs.