RESUMEN
Extrusion of root filling material had been shown to reduce the success of endodontic treatment. This case report describes the management of a patient who reported prolonged, persistent, and increasing pain on an upper root filled central incisor with extruded root filling material. A 28-year-old female patient came with the chief complaint of pain and tenderness on the upper left central incisor. The pain was mostly triggered by mastication. Upon examination and investigation, the tooth of concern was tooth 21 which was a root treated many years ago. It appeared to have tenderness on percussion and palpation. Non-surgical root canal retreatment was completed on tooth 21. However, the patient complained of the same pain while biting even after six months post-obturation. Therefore, endodontic microsurgery was performed to remove the root filling material that was extruded and to enucleate the granulomatous lesion around the periapical region of tooth 21. After enucleation, apical root end resection was performed. Postoperatively, the patient reported comfort and no pain and was able to resume her daily activities. At six months of review, the radiograph showed evidence of complete healing. This case report captured the importance of endodontic microsurgery as a viable treatment option where nonsurgical root canal retreatment failed to relieve the patient's symptoms.
RESUMEN
INTRODUCTION: The pulpal involvement, ulceration, fistula, and abscess (PUFA) index was developed to screen for the clinical consequences of untreated dental caries. The aim of this study was to compare the diagnostic accuracy of the PUFA index and the periapical index (PAI) in identifying pulpal and periapical diseases. METHODS: A cross-sectional study was conducted using consecutive sampling. Each participant went through screening using the PUFA index, orthopantomography assessment using PAI, and comprehensive clinical examination to derive pulpal and apical diagnoses. The outcomes were dichotomized. Reliability was estimated using the Cohen kappa coefficient. Sensitivity, specificity, and predictive values were calculated. The area under the receiver operating characteristic curve was compared using the chi-square test. RESULTS: A total of 165 participants were examined, 98.2% of whom had a decayed, missing, or filled tooth index >0. Of 4115 teeth assessed, 16.2% (n = 666) were diagnosed with pulpal disease and 7.9% (n = 325) with periapical disease. Interexaminer reliability for the PUFA index and PAI was 0.87 and 0.80, respectively. Intraexaminer reliability was 0.83 and 0.76 for the PUFA index and 0.75 and 0.72 for PAI. For pulpal diagnosis, the sensitivity of the PUFA index and PAI was 67.6% and 41.7%, respectively; the specificity of the PUFA index and PAI was 99.8% and 99.2%, respectively. For apical diagnosis, the sensitivity of the PUFA index and PAI was 87.7% and 75.4%, respectively; the specificity of the PUFA index and PAI was 95.4% and 98.4%, respectively. The PUFA index is statistically more accurate than PAI for pulpal diagnosis and apical diagnosis (P < .05). CONCLUSIONS: The PUFA index can be used in screening for pulpal and periapical diseases with some limitations.
