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INTRODUCTION: A diagnosis of oral squamous cell carcinoma in adolescent patients is extremely rare. When an oral squamous cell carcinoma lesion arises near the teeth and/or periodontium, it can be easily misdiagnosed as an inflammatory condition of endodontic or periodontal origin. METHODS: This is a case report of an otherwise healthy 14-year-old patient who was referred for endodontic evaluation and treatment of a soft-tissue swelling in the anterior maxilla. RESULTS: The unexpected definitive diagnosis of invasive oral squamous cell carcinoma underscores the importance of proper diagnostic testing. CONCLUSIONS: Accurate interpretation of pulp testing results, periapical and cone beam computed tomography imaging, timely biopsy, and prompt definitive treatment are critical when a lesion of nonodontogenic origin is suspected.
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INTRODUCTION: Currently, there are no studies evaluating the impact of 3-dimensional (3D) printed models on endodontic surgical treatment planning. The aims of this study were: 1) to determine if 3D models could influence treatment planning; and 2) to assess the effect of 3D supported planning on operator confidence. MATERIALS: Endodontic practitioners (n = 25) were asked to analyze a preselected cone beam computed tomography (CBCT) scan of an endodontic surgical case and answer a questionnaire that elucidated their surgical approach. After 30 days, the same participants were asked to analyze the same CBCT scan. Additionally, participants were asked to study and to perform a mock osteotomy on a 3D printed model. The participants responded to the same questionnaire along with a new set of questions. Responses were statistically analyzed using chi square test followed by either logistic or ordered regression analysis. Adjustment for multiple comparison analysis was done using a Bonferroni correction. Statistical significance was set at ≤0.005. RESULTS: The availability of both the 3D printed model and the CBCT scan resulted in statistically significant differences in the participants' responses to their ability to detect bone landmarks, predict the location of osteotomy, and to determine the following: size of osteotomy, angle of instrumentation, involvement of critical structures in flap reflection and involvement of vital structures during curettage. In addition, the participants' confidence in performing surgery was found to be significantly higher. CONCLUSIONS: The availability of 3D printed models did not alter the participants' surgical approach but it significantly improved their confidence for endodontic microsurgery.
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Assistência Odontológica , Osteotomia , Humanos , Osteotomia/métodos , Tomografia Computadorizada de Feixe Cônico , Microcirurgia/métodos , Impressão TridimensionalRESUMO
BACKGROUND: Nowhere in the consideration of dental care involving endodontics does a patient become more vulnerable to potentially life-changing injuries than during a root canal procedure on the mandibular dentition that may invade and injure the neurovascular anatomy. CASE DESCRIPTION: The authors present a series of 5 cases wherein using calcium hydroxide as a disinfection strategy in endodontics caused serious neurologic injury to the treated patients. The mechanism in all cases was the inappropriate use of needle applications resulting in significant overfill into the inferior alveolar nerve space. Although calcium hydroxide has been recognized and used as a meaningful disinfectant in endodontic therapy for many years, the dangers and risks associated with a needle delivery technique are discussed and analyzed with recommendations based on current research to minimize risk. CONCLUSIONS AND PRACTICAL IMPLICATIONS: A literature search revealed that the 5 cases are not solitary cases; indeed, consequences of calcium hydroxide overfills have been described before. Therefore, a clinician initiating root canal therapy on a mandibular posterior tooth should always be mindful of the vital neurovascular anatomy, which commonly approximates the ends of these roots. Preoperative cone-beam computed tomographic imaging and the thoughtful delivery of medicaments in treatment can help the clinician manage close proximity to neural anatomy and avoid potential injuries.