Necrotizing fasciitis as a complication of odontogenic infection: a review of management and case series.

BACKGROUND: The aims of the present study were to establish the incidence of head and neck necrotizing fasciitis (NF) in the Adelaide Oral and Maxillofacial Surgery Unit; review the current literature regarding the management of head and neck NF; and determine the evidence for the role of hyperbaric oxygen therapy in the management of NF. METHODS: A retrospective audit of all patients admitted to the Royal Adelaide Hospital Oral and Maxillofacial Surgery Unit 2006-2015 with severe odontogenic infections was carried out. Patient demographics were recorded and treatment details were collected and analysed. RESULTS: A total of 672 patients were admitted for management of severe odontogenic infections. Of these, three were identified as NF. One case was treated using hyperbaric oxygen as an adjunct to conventional surgical and medical management. Two cases were managed using aggressive surgical management alone. Two patients survived. The incidence of head and neck NF in South Australia is 48/100 000 infections per year. CONCLUSIONS: The first-line treatment of severe odontogenic infections remains conventional surgical and medical management; however, hyperbaric oxygen therapy may have an additional role in the management of NF and other rare severe infections in medically complex patients.

Regenerative Endodontic Treatment versus Apical Plug in Immature Teeth: Three-Year Follow-Up.

This report compares and evaluates the treatment outcomes of regenerative endodontic treatment and apical plug as two accepted treatment protocols in a pair of necrotic immature maxillary central incisors of a 12-year old female. The patient was referred complaining of a dull pain and swelling in her upper lip area. She had a history of trauma to the anterior maxilla two years earlier. Both teeth were clinically diagnosed with pulp necrosis and periapical radiographs revealed that separate periapical radiolucent lesions surrounded the immature apices of both teeth. The left and right incisors were treated with apical plug and regenerative endodontic treatment, respectively, using calcium-enriched mixture (CEM) cement. The patient was followed-up for three years. During this period, both teeth were clinically asymptomatic and showed complete radiographic healing of the periapical lesions. The right central incisor showed root development. No tooth discoloration was evident. Apexification by apical plug placement and pulp regeneration are both reliable treatments for immature non-vital teeth. In order to choose the right treatment the advantages of either technique should be weighed against its drawbacks. CEM cement can be successfully applied for both purposes. This biomaterial causes less discoloration of the tooth.

Treatment of a large cystlike inflammatory periapical lesion associated with mature necrotic teeth using regenerative endodontic therapy.

INTRODUCTION: Regenerative endodontic therapy is currently used to treat immature permanent teeth with necrotic pulp and/or apical periodontitis. However, mature teeth with necrotic pulp and apical periodontitis have also been treated using regenerative endodontic therapy. The treatment resulted in resolution of apical periodontitis, regression of clinical signs and symptoms but no apparent thickening of the canal walls, and/or continued root development. A recent study in an animal model showed that the tissues formed in the canals of mature teeth with apical periodontitis after regenerative endodontic therapy were cementumlike, bonelike, and periodontal ligament-like tissue with numerous blood vessels. These tissues are similar to the tissues observed in immature permanent teeth with apical periodontitis after regenerative endodontic therapy. METHODS: A 23-year-old woman had a history of traumatic injury to her upper anterior teeth when she was 8 years old. Subsequently, #8 developed pulp necrosis and an acute apical abscess and #7 symptomatic apical periodontitis. The apex of #8 was slightly open, and the apex of #7 was completely formed. Instead of nonsurgical root canal therapy, regenerative endodontic therapy was attempted, including complete chemomechanical debridement on #8 and #7. This was based on the premise that filling of disinfected root canals with the host's biological vital tissue might be better than filling with foreign materials. RESULTS: After regenerative endodontic therapy of #8 and #7, there was radiographic evidence of periapical osseous healing and regression of clinical signs and symptoms. The pulp cavity of #8 decreased in size, and the apex closed. The pulp cavity of #7 appeared to be obliterated by mineralized tissue. These indicated ingrowth of new vital tissue into the chemomechanically debrided canals. CONCLUSIONS: Regenerative endodontic therapy of mature teeth with apical periodontitis and apical abscess can result in the regression of clinical signs and/or symptoms and healing of apical periodontitis but no apparent thickening of the canal walls or continued root development. Filling of the disinfected canals with the host's vital tissue may be better than with foreign materials because vital tissue has innate and adaptive immune defense mechanisms.

Propolis and commonly used intracanal irrigants: comparative evaluation of antimicrobial potential.

UNLABELLED: The objective of endodontic therapy is not just simple cleaning and filling of root canals, but successful treatment requires the establishment of a sufficient level of disinfection. AIM: To evaluate, in vivo, the antimicrobial and inflammatory/irritant potential of Propolis against mixed endodontic aerobic and anaerobic bacteria. METHOD: An in vivo randomized controlled trial was conducted in a group of 60 children aged 6-12 years presenting with an acute apical abscess of the maxillary primary molars. Fifteen children each were divided randomly into four groups where irrigation during pulpectomy was performed using either 2% chlorhexidine, 4% calcium hydroxide or 4% Dimethyl Sulfoxide (DMSO) extract of propolis with normal saline as the control irrigant. Microbiological samples were taken from the disto-buccal root canal before initiating the pulpectomy as well as after 3 days later and for mixed aerobic and anaerobic bacterial cultures. RESULTS: In all the four groups, a significant decrease in mean aerobic colony forming units (cfu) count was seen. Maximum change in anaerobic cfu count was seen with 2% chlorhexidine. CONCLUSIONS: Chlorhexidine proved to be superior antimicrobial agent against both endodontic aerobes and anaerobes. Calcium hydroxide was found to be least effective.

Endodontic treatment of necrosed primary teeth using two different combinations of antibacterial drugs: an in vivo study.

AIM: This study was conducted to evaluate clinical and radiographic success of endodontic treatment of infected primary teeth using two combinations of antibacterial drugs consisting of ciprofloxacin, metronidazole, and minocycline in one group and ciprofloxacin, ornidazole, and minocycline in the other group. MATERIALS AND METHODS: The selected 40 teeth were randomly divided into two groups, viz. groups A and B with 20 teeth in each group. In Group A, antibacterial paste containing ciprofloxacin, metronidazole, and minocycline and in Group B, antibacterial paste containing ciprofloxacin, ornidazole, and minocycline mixed with propylene glycol were used. Medication cavities were filled with antibiotic pastes, depending on the groups followed by Glass Ionomer restorations and stainless steel crown placement. Clinical and radiographic evaluation was carried out at 3, 6, and 12 months intervals. RESULTS: Both the groups showed considerable clinical and radiographic success. There was no statistically significant difference between Group A and B. However, group B showed better results clinically and radiographically compared with group A. CONCLUSIONS: Both the antibacterial pastes, i.e., combination of ciprofloxacin, metronidazole, and minocycline and ciprofloxacin, ornidazole, and minocycline mixed with propylene glycol have shown good clinical and radiographic success in treating necrotic primary teeth.

Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial.

INTRODUCTION: Revascularization is a valuable treatment in immature necrotic teeth that allows the continuation of root development. In this article we describe successful revascularization treatment of 2 necrotic immature first mandibular molars. METHODS: The clinical and radiographic examinations showed extensive coronal caries, immature roots, and periapical radiolucencies in mandibular first molars of a 9-year-old boy and an 8-year-old girl. The exam findings suggested revascularization treatment in both cases, which was started with irrigation of the canals by using NaOCl 5.25% for 20 minutes, followed by 3 weeks of triple antibiotic (metronidazole, ciprofloxacin, and minocycline) paste dressing. Next, the antibiotic paste was removed, bleeding was induced in the canals, and calcium enriched mixture (CEM) cement was placed over blood clots. RESULTS: In radiographic and clinical follow-ups both cases were asymptomatic and functional, periapical radiolucencies were healed, and roots continued to develop. CONCLUSIONS: Revascularization is a realistic treatment in immature necrotic molars. In addition, placing CEM cement as a new endodontic biomaterial over the blood clot formed inside the canals provided good seal and favorable outcomes.

Utilidad de la terapia neural en sepsis de conductos radiculares 2008-2009: Policlínico Tipo III / Usefulness of neural therapy in sepsis of radicular ducts: 2008-2009: Policlinical tipo lll

Se realizó un estudio descriptivo-prospectivo en 50 pacientes, con diagnóstico confirmado de absceso alveolar agudo en dientes anteriores en el periodo comprendido de septiembre 2008 a marzo del 2009 a los cuales se le aplicó Terapia Neural con el objetivo de identificar la utilidad de la Terapia Neural en el tratamiento de la sepsis en conductos radiculares, se obtuvo la información a través de encuestas y cuestionarios realizados por el autor que incluyeron variables: sexos, edades, los números absolutos y las tasas como medidas se plasmaron en tablas, se observó como dato relevante que el 98 por ciento de los casos fue evaluados de bueno con solo 1 ó 2 sesiones de aplicación del neural terapéutico, arribando a la conclusión de que la Terapia Neural es más rápida y efectiva en el alivio del dolor, inflamación y secreción en conductos radiculares. Se recomienda difundir la aplicación y ventajas de dicho método con el fin de adquirir conocimientos más profundos y aplicarlos a cualquier desequilibrio en el organismo humano(AU)

It was performed a descriptive, prospective research in 50 patients with confirmed diagnosis of acute alveolar abscess in anterior teeth during the period from September 2007 to 2008, to whom there was applied neural therapy to prove its usefulness for the treatment of sepsis in radicular ducts. The information was gathered by means of surveys and questionnaires developed by the author who had included some variables like: sex, age, absolute numbers, and the rates were evidenced in tables. It was observed as a relevant data that the 98 percent of the cases were good with just one or two sections of the application of neural therapy, concluding that this therapy is faster and more effective to release pain, inflammation and secretion of radicular ducts(EU)

[Aplication of magnetostimulation in JPS system of chronic periapical tooth inflamation visible in the RTG picture]. / Zastosowanie magnetostymulacji w leczeniu przewleklych zapalen tkanek okolowierzcholkowych zeba widocznych w obrazie rentgenowskim.

PURPOSE: The aim of the work was to use the magneto-stimulation in JPS system as a therapy aiding the treatment of chronic inflammation of periapical tissues of a tooth and to evaluate its effectiveness in RTG in Digora 2.1 digital system and in conventional RTG. MATERIAL AND METHODS: The research was based on 62 teeth of 56 people (some treated for the first time). There was also a comparative group. In the work the magnetic field was used since the first day ofendodental treatment. Every patient had RTG done before and after the magnetostimula-tion. The qualitative and quantitative evaluations were done. The optical density both in the area of the osteolisis and in the laudable bone was presented in tables and graphs. The statistical analysis was also done. Conventional RTG was also used to evaluate the research. CONCLUSION: It was ascertained that magnetic field of low induction has a positive effect on the regeneration processes in chronic inflammations of periapical tissues of the tooth, visible in RTG.

Comprehensive therapy of a fusion between a mandibular lateral incisor and supernumerary tooth: case report.

The term fusion is used to define a developmental anomaly characterised by the union of two adjacent teeth. In the case reported here, clinical and radiographic examinations suggested a unilateral fusion between the mandibular left permanent incisor and a super-numerary tooth. Radiographs showed that the fused teeth had two distinct pulp chambers and canals. A diagnosis of chronic periapical abscess of the supernumerary tooth was made. Before root canal therapy, a periodontal surgical procedure was performed to section the central incisor and its fused supernumerary. Also, odontoplasty was performed on the roots, to establish an anatomy consistent with a normal central incisor. Later, the chronic apical abscess on the supernumerary tooth was instrumented chemo-mechanically, root canal filling was performed and an anterior composite resin restoration was placed. The patient was evaluated for one year after root canal therapy. The tooth was asymptomatic, not exhibiting any pathological root resorption or alveolar resorption, and the anterior composite restoration was intact. Instead of extracting the supernumerary tooth, the application of endodontic, periodontal, and restorative procedures proved to be an alternative treatment.

Uso de la magnetoterapia en la estomatología

Se aplicó la magnetoterapia a una muestra de 87 pacientes que acudieron al departamento de Estomatología del Hospital Docente Clínico-Quirúrgico "Arnaldo Milián Castro" de Villa Clara, algunas de estas enfermedades: periodontitis, absceso periapical crónico, movilidad por trauma, alveolitis, quistes radiculares, absceso perodontal con movilidad y reabsorción radicular externa. En todos los casos se procedió a utilizar el método de la magnetoterapia con el equipo cubano Magnetón, sin tratamiento medicamentoso, con el objetivo de probar su efectividad

Abscessos dentoalveolares agudos y su tratamiento con Hepar sulphur y Silicea terra / Acute dentoalveolar abscess and its treatment with Hepar sulphur and Silicea terra

Los abscesos dentoalveolares son una consecuencia de la infeccion pulpar. Se sabe que la enfermedad pulpar es una enfermedad muy comun en la consulta odontologica, practicamente un 70 porcento de los pacientes que acuden a consulta, presentan este problema. La infeccion localizada en esta area es comun y frecuentemente se convierte en un foco a partir del cual la infeccion se disemina a otras partes del organismo. La Terapeutica Homeopatica es de gran ayuda, por las caracteristicas tan especificas de esta forma de tratamiento; ademas el uso de estos medicamentos, evita problemas como el "sensibilizar" y provocar trastornos alergicos, que incluso pueden llegar el choque anafilactico

Abscessos dentoalveolares agudos y su tratamiento con Hepar sulphur y Silicea terra / Acute dentoalveolar abscess and its treatment with Hepar sulphur and Silicea terra

Los abscesos dentoalveolares son una consecuencia de la infeccion pulpar. Se sabe que la enfermedad pulpar es una enfermedad muy comun en la consulta odontologica, practicamente un 70% de los pacientes que acuden a consulta, presentan este problema. La infeccion localizada en esta area es comun y frecuentemente se convierte en un foco a partir del cual la infeccion se disemina a otras partes del organismo. La Terapeutica Homeopatica es de gran ayuda, por las caracteristicas tan especificas de esta forma de tratamiento; ademas el uso de estos medicamentos, evita problemas como el "sensibilizar" y provocar trastornos alergicos, que incluso pueden llegar el choque anafilactico

Tratamento homeopatico: 2 casos de abscesso dento alveolar agudo / Homeopathic treatment: 2 cases of acute dento alveolar abscess

The author describes two acute abcess dental socket acses with homeopathic drugs in association to the endodontic intervention. In bothcases the was confirmed in 48 hour; time was goined in relation to aclassic treatment. The terapy confirmed to be secure, efficient and with no colloteral effects

Tratamento homeopático: 2 casos de abscesso dentro alveolar agudo

The author describes two acute abcess dental socket acses with homeopathic drugs in association the endodontic intervention. In both cases the was confirmed in 48 hours; time was goined in relation to a classic treatment. The terapy confirmed to be secure, efficient andwith no colloteral effects