Reabsorción dentinaria interna coronaria: informe de un caso clínico / Coronary internal dentine resorption: report of a clinical case

Objetivo: La reabsorción dentinaria interna es un pro- ceso causado por la actividad odontoclástica asociada princi- palmente a la inflamación pulpar crónica y/o traumatismos, y se caracteriza por la pérdida progresiva de tejido dentinario y la posible invasión al cemento. El presente informe describe el diagnóstico y tratamiento de un molar inferior que presentó un cuadro sintomático de reabsorción dentinaria interna. Caso clínico: Un paciente de 38 años fue derivado a la consulta por presentar una zona de reabsorción interna en un segundo molar inferior. Durante el examen clínico y ra- diográfico se tomó una radiografía preoperatoria periapical con radiovisiógrafo en la que se observó la presencia de un área compatible con el diagnóstico de reabsorción dentinaria interna, el que fue posteriormente confirmado por medio de una tomografía computada de haz cónico. La imagen de la lesión se presentó como una zona radiolúcida deformante de bordes nítidos, localizada a nivel de la cámara pulpar. El tra- tamiento consistió en la extirpación de la pulpa coronaria y de la instrumentación, desinfección y obturación de los conduc- tos radiculares y la cavidad de acceso. En el control clínico y radiográfico realizado luego de 3 años se observó que el paciente estaba asintomático y las estructuras perirradiculares se encontraban dentro de los límites normales. La observación histológica del material removido de la cámara pulpar reveló la presencia de un tejido granulomatoso con numerosos vasos sanguíneos y escasos focos micro hemorrágicos. Hasta el momento, el tratamiento endodóntico es el pro- cedimiento indicado para el tratamiento de la reabsorción dentinaria interna. Se destaca la importancia de la tomografía computada de haz cónico para el diagnóstico y tratamiento temprano de las reabsorciones dentinarias internas a efectos de contar con un pronóstico favorable (AU)

Aim: Internal dentine resorption is aprocess caused by odontoclastic activity, mainly associated with chronic pulpal inflammation and/or trauma, and it'scharacterized by a pro- gressive loss of dentine tissue and the possible invasion of the cementum. This report describes the diagnosis and treatment of a lower molar that presented a symptomatic case of inter- nal dentine resorption. Clinical case: A 38-years old patient was referred to the office because of presenting an area of internal resorption in a lower second molar. During clinical and radiographic exam- ination, a periapical preoperative radiograph with radiovisio- graph was taken, in which the presence of an area compatible with the diagnosis of internal dentine resorption was observed, which was later confirmed by a cone-beam computed tomog- raphy.The image of the lesion was presented as a deforming radiolucent area with sharp edges, located at pulp chamber level. Treatment consisted of the removal of the coronary pulp and the instrumentation, disinfection and filling of the root ca- nals and the access cavity. In the clinical and radiographic control carried out 3 years after procedure, it was observed that the patient was asymptomatic and the periradicular struc- tures were within normal limits. The histological observation of the removed material from the pulp chamber revealed the presence of a granulomatous tissue with numerous blood ves- sels and scarce micro hemorrhagic focus. Until now, the endodontic treatment is the indicated pro- cedure to treat internal dentine resorption. It is necessary to highlight the importance of the cone-beam computerized to- mography for the early diagnosis and treatment of internal dentine resorptions in order to have a favorable outlook (AU)

Herpes Zoster and association with pulp necrosis and development of apical periodontitis - a review and presentation of two case reports.

The varicella zoster virus as an aetiological agent for endodontic disease is not a well-recognised entity despite several published case reports. While advances in DNA molecular analysis techniques (PCR) have contributed to the current understanding of the potential role of the varicella zoster virus in the initiation and progression of endodontic disease, a review indicates a need for ongoing research. Case reports are presented of two female patients with a history of herpes zoster who developed pulp necrosis, with one patient progressing to apical periodontitis. Both patients received non-surgical endodontic therapy, followed by intra-coronal bleaching in one of the patients due to tooth discolouration which developed during the prodromal and acute phases of the herpes zoster infection. Clinical and radiographic examinations at 23 and 22 years, respectively, showed the affected teeth to be retained in an asymptomatic and aesthetically satisfactory state with no radiographic evidence of apical pathosis.

Associations between Pain Severity, Clinical Findings, and Endodontic Disease: A Cross-Sectional Study.

INTRODUCTION: Thorough pain assessment and thermal and mechanical testing are the primary diagnostic tools used to assess the status of pulp and periapical tissues in teeth with potential endodontic pathology. This study evaluated predictors of acute odontogenic pain to better understand the relationship between endodontic pain, clinical testing, endodontic disease, and diagnoses. METHODS: Participants (N = 228) presenting with acute odontogenic pain underwent standardized clinical testing and reported their pain intensity. Univariate and multiple regression analyses were performed to evaluate the predictors of acute endodontic pain. Chi-square tests with Bonferroni adjustments were conducted to measure the frequency of endodontic diagnostic test findings and clinical observations in patients with different pulpal diagnoses. RESULTS: A negative response to cold stimulation on the causative tooth and percussion hypersensitivity on the healthy adjacent tooth were the strongest predictors of higher levels of acute endodontic pain. Percussion hypersensitivity on the healthy adjacent tooth was present in a quarter of the cohort and was reported with equal frequency in teeth diagnosed with irreversible pulpitis, necrotic pulp, and previously initiated/treated teeth. Although painful percussion on the causative tooth was more frequently reported in teeth diagnosed with necrotic pulp, painful palpation was more frequently reported on teeth diagnosed with previously initiated/treated teeth. CONCLUSIONS: Percussion hypersensitivity on the healthy adjacent tooth may reveal a lowered pain threshold and heightened pain sensitization. It is also possible that the 2 commonly performed mechanical sensory tests, percussion and palpation hypersensitivity, may detect different aspects of endodontic pathophysiology and pain processing.

Etiologic role of root canal infection in apical periodontitis and its relationship with clinical symptomatology.

Evidence shows the polymicrobial etiology of endodontic infections, in which bacteria and their products are the main agents for the development, progression, and dissemination of apical periodontitis. Microbial factors in necrotic root canals (e.g., endotoxin) may spread into apical tissue, evoking and supporting a chronic inflammatory load. Thus, apical periodontitis is the result of the complex interplay between microbial factors and host defense against invasion of periradicular tissues. This review of the literature aims to discuss the complex network between endodontic infectious content and host immune response in apical periodontitis. A better understanding of the relationship of microbial factors with clinical symptomatology is important to establish appropriate therapeutic procedures for a more predictable outcome of endodontic treatment.

Etiologic role of root canal infection in apical periodontitis and its relationship with clinical symptomatology

Abstract: Evidence shows the polymicrobial etiology of endodontic infections, in which bacteria and their products are the main agents for the development, progression, and dissemination of apical periodontitis. Microbial factors in necrotic root canals (e.g., endotoxin) may spread into apical tissue, evoking and supporting a chronic inflammatory load. Thus, apical periodontitis is the result of the complex interplay between microbial factors and host defense against invasion of periradicular tissues. This review of the literature aims to discuss the complex network between endodontic infectious content and host immune response in apical periodontitis. A better understanding of the relationship of microbial factors with clinical symptomatology is important to establish appropriate therapeutic procedures for a more predictable outcome of endodontic treatment.

Clinical radiological aspects of primary endodontic lesions with secondary periodontal involvement.

Damage of pulp tissue usually begins in the coronal pulp. Its mistreatment or its lack of on time detection determines the progressive inclusion of the whole endodontic space in its evolution, opening the way of its expansion in the surrounding tissues of the tooth, and on the marginal apical tissue. Aim. The goal of this study was to highlight that the primary endodontic lesions with secondary periodontal implication healed and bone repair was obtained due to a proper disinfection and an adequate sealing of the endodontic system. In primary endodontic lesion with secondary periodontal involvement, endodontic treatment is required in the first stage followed by specific periodontal treatment. The prognosis is good if an appropriate endodontic approach is chosen, depending on the stage of the periodontal disease and the treatment response. The identification of the etiological factors is the most important to establish the appropriate treatment. In all clinical cases selected in this article, the healing tendency was noticed after an adequate disinfection and sealing of the endodontic system.

Association between Systemic Diseases and Endodontic Outcome: A Systematic Review.

INTRODUCTION: To date, the relationships between systemic diseases and endodontic treatment outcomes remain poorly studied. Thus, the purpose of this systematic review was to evaluate the relationship between host-modifying factors and their association with endodontic outcomes. METHODS: Two reviewers independently conducted a comprehensive literature search. The MEDLINE, Embase, Cochrane, and PubMed databases were searched. In addition, the bibliographies and gray literature of all relevant articles and textbooks were manually searched. There was no disagreement between the 2 reviewers. RESULTS: Sixteen articles met the inclusion criteria with moderate to high risk of bias. There was no article with low risk of bias. Available scientific evidence remains inconclusive as to whether diabetes and/or cardiovascular disease(s) may be associated with endodontic outcomes. Human immunodeficiency virus and oral bisphosphonate did not appear to be associated with endodontic outcomes. CONCLUSIONS: Although additional well-designed longitudinal clinical studies are needed, the results of this systematic review suggest that some systemic diseases may be correlated with endodontic outcomes.

Extraoral cutaneous sinus tracts of dental origin in the paediatric patient. A report of three cases and a review of the literature.

BACKGROUND: An extraoral sinus of odontogenic origin within the face and neck region is normally the consequence of long-standing chronic infection due to caries, trauma or periodontal infection. There is little reported literature on the prevalence of extraoral cutaneous sinus lesions in the paediatric dental patient as presentation is often delayed resulting in misdiagnosis and consequential mismanagement. CASE REPORT: The cases discussed concentrate on the aetiology, history, presentation and diagnosis of extraoral sinus lesions that presented in children referred to the Child Dental Health Department at the University Dental Hospital of Manchester over a six-month period. CONCLUSIONS: The importance of correct diagnosis and treatment management of an extra oral cutaneous sinus in the paediatric patient only occurred when the child attended a specialist led paediatric dental clinic for consultation.

Detection of apical inflammatory root resorption associated with periapical lesion using different methods.

The aim of this study was to detect apical inflammatory root resorption (AIRR) associated with periapical lesion using cone beam computed tomography (CBCT) and scanning electronic microscopy (SEM). This clinical study evaluated AIRR in 88 root apexes, from 52 permanent teeth of 14 patients, extracted for different reasons. The patients were submitted to a clinical interview, review of dental/medical histories and clinical/imaging examinations for treatment planning. All selected teeth showed unrestorable condition because of the extensive coronal breakdown due to carious lesions, and root canal infection associated with periapical lesions. CBCT images were obtained from the patients with the aim of diagnosing the periapical diseases which showed complex or doubtful conditions. Two examiners assessed the presence or absence of AIRR. Apices were also analyzed under SEM. Chi-square test was used to compare the imaging methods for detection of AIRR. The level of statistical significance was set at 5%. AIRR associated with root canal infection and apical periodontitis was found in 61.4% of the cases studied by using SEM, and at least half of the cases by CBCT. The microscopic analysis remains as a reference standard against the imaging method to identify AIRR.

Understanding root resorption with diagnostic imaging.

This article presents the clinical, radiographic and histopathologic features of various types of tooth root resorption. Tooth resorption may occur in a tooth internally or externally with distinctively different treatment approaches for each type of resorption. Given that proper diagnosis of the type of resorption is important, the use of cone beam computed tomography (CBCT) and conventional 2-D intraoral images in evaluation of resorptive lesions is discussed.

The odontogenic-related microinflammation in patients with chronic kidney disease.

OBJECTIVES: This study estimated plasma levels of interleukin IL-1ß, IL-6, tumour necrosis factor-α (TNF-α), interferon-γ (INF-γ) in chronic kidney disease (CKD) patients with a single odontogenic pathology. MATERIAL AND METHODS: Forty-nine selected adult CKD patients with single odontogenic pathology based on clinical and X-ray examination: patients after proper root canal treatment, without periapical lesions (n = 12), with pulp necrosis (n = 7), with asymptomatic periapical lesions (n = 22), with periodontal disease (n = 8), and 14 with healthy teeth were enrolled. Patients with coexisting different dental pathologies and the evidence of other infection were excluded. In all patients plasma concentrations of CRP, IL-1ß, IL-6, TNF-α, and INF-γ were measured. RESULTS: Patients with periodontitis were characterized by increased concentrations of IL-6 and TNF-α. Those with pulp necrosis had significantly more frequently serum CRP level over 2 mg/L and presented significantly elevated IL-6, but decreased TNF-α concentration than in the subjects with healthy teeth. In patients with periapical lesions and patients after root canal therapy, the concentrations of cytokines did not indicate for the systemic inflammation. CONCLUSIONS: Periodontitis and pulp necrosis are important sources of systemic microinflammation in CKD patients. Plasma concentrations of IL-6 and TNF-α appear to be more sensitive markers of odontogenic inflammation in CKD patients than CRP.

Management of the single discoloured tooth. Part 1: Aetiology, prevention and minimally invasive restorative options.

UNLABELLED: The single discoloured tooth is commonly encountered in general practice. This is the first of two articles covering the broad range of management options for the single discoloured tooth. This first part outlines the common causes of discoloration and possible methods of prevention. Minimally invasive techniques are covered. Clinical procedures are outlined and clinical cases used to demonstrate outcomes that can be achieved. CLINICAL RELEVANCE: The single discoloured tooth is a commonly encountered clinical problem in general dental practice. A wide variety of management options exist and any one in particular may be most appropriate given the clinical scenario. It is therefore essential that general dental practitioners are familiar with the range of options that exist, as well as their indications, and consider adopting minimally invasive techniques in the first instance before moving to more invasive therapies.

An endodontic conundrum: the association between pulpal infection and periodontal disease.

This paper reviews the classification of periodontal-endodontic lesions and considers the pathways through which inflammatory lesions or bacteria may communicate between the pulp and the periodontium. Such communications have previously underpinned the classification of periodontal-endodontic lesions but a more up-to-date approach is to focus specifically on those lesions that originate concurrently as pulpal infection (and necrosis) and periodontal disease on the affected teeth. In doing so, both conventional periodontal and endodontic treatments are indicated for the affected teeth, although more complex management strategies may occasionally be indicated.

Resorption: part 1. Pathology, classification and aetiology.

This paper will explore the pathological process involved in dental resorption as well as its classifications and aetiology. The second subsequent paper will look at its diagnosis and management.

Comportamiento de algunas enfermedades pulpares como urgencias en pacientes de 15 y más años / Behavior of some pulpal diseases like emergencies in 15 year- old- patients and older

Introducción: la enfermedad pulpar es la respuesta de la pulpa en presencia de un irritante, la falta de tratamiento oportuno se traduce en urgencia estomatológica. Objetivo: determinar las enfermedades pulpares presentes en los pacientes objeto de estudio. Métodos: estudio de tipo descriptivo, transversal y prospectivo del comportamiento de algunas enfermedades pulpares como urgencias en pacientes mayores de 15 años de edad; consultorio estomatológico Robles 2 del ASIC El Gaitero, municipio Maracaibo, estado Zulia, Venezuela, enero - agosto 2007. De 2120 pacientes la muestra quedó integrada por 103. La información se obtuvo a través del interrogatorio y el examen clínico de los pacientes en el consultorio estomatológico. Se utilizaron los números absolutos y porcentajes.Resultados: las enfermedades pulpares afectaron al grupo entre 19-34 años (51.45 por ciento) y al sexo femenino (59.22 por ciento), fueron más frecuentes la necrosis pulpar (49.51por ciento) y la pulpitis inicial reversible (37.86 por ciento). Predominó el dolor severo (32.03 por ciento) y como causa se encontró la caries dental (41.74 por ciento). Conclusiones: la edad de 19–34 años y el sexo femenino fue la población afectada por enfermedades pulpares. La necrosis pulpar y la pulpitis inicial reversible fueron las más frecuentes, predominó el dolor severo, la causa principal fue la caries dental(AU)

Introduction: the pulpal disease is the answer of the pulp in the presence of an irritant, the lack of an oportune treatment is translated into the stomatological emergency. Objective: to determine the pulpal diseases in the patients object of study. Methods: a descriptive, transversal and prospective study of the behavior of some pulpar diseases like emergencies in patients older than 15 years; at the estomatological office Robles 2 of the ASIC El Gaitero in the municipality of Maracaibo, on Zulia state in Venezuela, since January - August 2007. From the 2120 patients the sample was integrated by 103. The information was obtained through the interview and the clinical examination of the patients in the stomatological office. There were used the absolute numbers and percentages. Results: the pulpal diseases affected the group between 19-34 years (51.45 percent) and the female sex (59.22 percent), there were more frequent the pulpal necrosis (49.51 percent) and the initial reversible pulpitis (37.86 percent). The acute pain prevailed (32.03 percent) and the cause found was the dental decay (41.74 percent). Conclusions: the age between 19 to 34 years and the feminine sex was the population affected by pulpal diseases. The pulpal necrosis and the reversible initial pulpitis were the most frequent conditions, the acute pain prevailed, the main cause was the dental decay(EU)

Association among oral health, apical periodontitis, CD14 polymorphisms, and coronary heart disease in middle-aged adults.

INTRODUCTION: There is evidence to suggest that an association exists between oral infections and coronary heart disease (CHD). Subjects presenting lesions of endodontic origin (LEOs) or pulpal inflammation had an increased risk of developing CHD. However, findings concerning systemic manifestations of apical periodontitis (AP) remain controversial. An association between CD14 gene polymorphisms and atherosclerosis-associated diseases has been shown, but there are no data regarding an association between CD14 polymorphism and AP. This study evaluated associations between clinical oral health status, CD14 polymorphisms, and CHD. METHODS: A case-controlled clinical trial was designed to compare middle-aged adults with acute myocardial infarction or unstable angina (n = 51) within 12 months of the acute event defined as first manifestation with healthy controls (n = 49). Participants were matched for age, sex, and socioeconomic status. Indicators of oral disease and compliance were evaluated. CD14 polymorphisms were analyzed by restriction fragment length polymorphism-polymerase chain reaction. RESULTS: CHD subjects had a higher prevalence of oral diseases and lower compliance to oral preventive strategies than healthy controls. Multivariate analysis showed a positive association between missing teeth (odds ratio [OR] = 1.37; 95% confidence interval [CI], 1.02-1.85), the number of LEOs (OR = 4.37; 95% CI, 1.69-11.28), chronic periodontitis (OR = 5.87; 95% CI, 1.17-29.4), and CHD. No statistically significant association emerged between the CD14 C(-260)T and the CD14 C(-159)T polymorphism, endodontic or periodontal disease, and CHD. CONCLUSIONS: Chronic oral diseases may increase the risk of CHD and may be an unconventional risk factor for CHD.

Concordance among different pain scales in patients with dental pain.

AIMS: To evaluate the concordance among different pain scales for evaluation of pain in toothache patients and to assess the influence of oral health on the quality of life of those patients. METHODS: Ninety-two patients seeking treatment for toothache were evaluated before and after treatment. At baseline and 1 week after the dental treatment, the patients were requested to fill out the Oral Health Impact Profile Inventory (OHIP-14) as well as the following pain scales: the visual analog scale (VAS), numeric scale (NS), verbal rating scale (VRS), and Faces Pain Scale-Revised (FPS-R). The data were analyzed by Pearson correlation, Student t test, and analysis of variance for repeated measurements, with a significance level of 5%. RESULTS: Patients were, on average, 34.4 years old. The sample was composed of 50 women and 42 men. Fifty-eight patients had dental pain of pulpal origin, and 34 had pain of periodontal origin. The mean OHIP score was 20.83 at baseline and 5.0 at 1 week after the completion of the dental treatment. The mean values of the scales at baseline were 50.7 mm, 56.7 mm, 52.2 mm, and 52.9 mm for the VAS, NS, VRS, and FPS-R, respectively. One week after the treatment, these values were 7.5 mm, 9.4 mm, 10.9 mm, and 8.7 mm. A positive correlation was detected between all four scales at baseline and also 1 week after the treatment (P < .05). At baseline, the NS was significantly different from the other scales. This difference, however, was not detected at the end of the trial. CONCLUSION: All scales were able to detect differences in the pain reported after dental treatment and may be valid and reliable for use in clinical dental practice. The NS, however, returns higher scores at baseline when assessing the pain.