Assessing the efficacy of apicoectomy without retrograde filling in treating periapical inflammatory cysts

Objectives@#The necessity of retrograde filling after apicoectomy is controversial in cases of non-inflammatory cysts as opposed to bacteria-related periapical abscesses. This study aims to investigate whether the presence or absence of retrograde filling during apicoectomy has differential long-term prognostic implications between inflammatory and non-inflammatory cysts. @*Materials and Methods@#This retrospective study included patients who underwent tooth apicoectomy during jaw cyst enucleation between 2013 and 2022, and who underwent follow-up cone-beam computed tomography for at least 6 months. The prognosis of the tooth was evaluated during the follow-up period according to the cyst type, the presence or absence of retrograde filling, mandible or maxilla, and location. @*Results@#A total of 147 teeth was included in this study. All the operated teeth underwent preoperative root canal treatment by an endodontic specialist.Apicoectomy was performed for 119 inflammatory cysts and 28 non-inflammatory cysts. Retrograde filling was performed on 22 teeth with inflammatory cysts and 3 teeth with non-inflammatory cysts. All teeth survived the 3.5-year follow-up (range, 1.0-9.1 years). However, 1 tooth with an inflammatory cyst developed complications 1 year after surgery that required re-endodontic treatment. @*Conclusion@#The prognosis of a tooth treated by apicoectomy without retrograde filling during cyst enucleation is favorable, regardless of the cyst type.

Case series and technical report of nasal floor approach for mesiodens

Objectives@#This case series aims to introduce the nasal floor approach for extracting inverted mesiodens. @*Materials and Methods@#Through a retrospective chart review between January 2022 and February 2023, we included the mesiodens patients using nasal floor approach, and analysis the location of mesiodens from the anterior nasal spine (ANS), total operation time, and complications. @*Results@#Each mesiodens was located 10 to 12 mm from the ANS and was covered with a cortical layer of the nasal floor. All mesiodens were successfully extracted without exposing the adjacent incisors or nasopalatine nerve within 30 minutes from draping to postoperative dressing. @*Conclusion@#The nasal floor approach is an efficient extraction method that reduces bone removal and prevents anatomical damage while removing the mesiodens just below the nasal floor bone.

Is conservative treatment (enucleation using modified Carnoy’s solution) of odontogenic keratocyst in the maxilla good prognosis?

Odontogenic keratocysts (OKCs) located in the maxillae have rarely been reported in the literature. Standard treatment modalities for OKC range from marsupialization to marginal resection. However, most of the studies on OKC treatment have been related to mandibular OKCs. The anatomical structure and loose bone density of the maxillae and the empty space of the maxillary sinus could allow rapid growth of a lesion and the ability to tolerate tumor occupancy in the entire maxilla within a short period of time. Therefore, OKCs of the maxillae require more aggressive surgery, such as resection. As an alternative, this report introduces a modified Carnoy’s solution, a strong acid, as an adjuvant chemotherapy after cyst enucleation. This report describes the clinical outcomes of enucleation using a modified Carnoy’s solution in patients with large OKCs on the posterior maxillae. In three cases, application of a modified Carnoy’s solution had few side effects or morbidity. Each patient was followed for four to six years, and none showed any signs of recurrence. In conclusion, adjuvant treatment with a modified Carnoy’s solution can be considered a treatment option capable of reducing the recurrence rate of OKC in the maxillae.

Clinical Utility of Abdominal MDCT in Elderly Patients with Non-traumatic Acute Abdominal Pain

PURPOSE: The purposes of this study are to determine the degree of diagnostic consistency among the primary diagnosis in the emergency department (ED), abdominal multidetector computed tomography (MDCT) findings, and the final diagnosis at hospital discharge in elderly patients with non-traumatic acute abdominal pain; to describe common disease entities in these patients; and to determine the extent of agreement between management plans before and after abdominal MDCT. METHODS: We undertook the retrospective review of the charts of 109 patients, 65 years or older with non-traumatic acute abdominal pain. The measure of agreement between diagnostic phases and between planned and actual management was evaluated by Cohen's kappa statistic. RESULTS: Value of the kappa statistic for agreement between primary diagnosis in the ED and final diagnosis at hospital discharge and between MDCT findings and final diagnosis were 0.408 and 0.776, respectively. The most common MDCT findings were biliary disease (17.4%), ischemic bowel disease (16.5%) and malignancy (16.5%). At the time of final diagnosis at hospital discharge, the order of frequency was malignancy (16.5%), biliary disease (15.6%), and ischemic bowel disease (12.8%). The degree of agreement between before and after abdominal MDCT in management plans was 0.154. CONCLUSION: Abdominal MDCT can skew diagnosis and management plans significantly in elderly patients with nontraumatic acute abdominal pain.