Long-term follow-up of single-visit pulp revascularisation for the dens evaginatus and dens invaginatus: Cases report.

This article documents cases of single-visit pulp revascularisation for dens evaginatus and dens invaginatus, without using intracranial medicaments or antibiotics, aiming to provide a potentially applicable protocol for pulp revascularisation procedure in a single-visit. Two patients with chief complaints of pain and swelling visited a dental hospital. Radiographs revealed that the causative teeth had an open apex and periapical radiolucency, and the teeth were diagnosed as pulp necrosis and acute apical abscess or symptomatic apical periodontitis. For both cases, single-visit revascularisation was completed without intracanal medicaments or antibiotics. The patients were periodically recalled to evaluate periapical healing after treatment. The apical lesion healed, and the root dentin thickening was observed. The single-visit pulp revascularisation procedure without using specific intracanal medicaments can produce clinically favourable results for these dental anomalies.

Auricular suppurative perichondritis secondary to exclusive endoscopic ear surgery for tympanoplasty: A case report and literature review.

Endoscope is an innovative method for otologists in middle ear surgery. Many previous studies have confirmed the safety and efficiency of the endoscopic technique, as a reliable therapeutic option with very low complication rates, clearly supporting the use of endoscopy in ear surgery. Auricular suppurative perichondritis secondary to exclusive endoscopic ear surgery for tympanoplasty is an extremely rare type of those without any previously reported cases. In this report, we describe the course of auricular suppurative perichondritis of a 55-year-old woman. The patient was ultimately healed through surgical debridement and postoperative dressing with no evidence of recurrence at two months follow-up. There were no auricle deformity or external auditory canal stenosis with six months following-up.

Odontogenic Sinusitis: Current Concepts in Diagnosis and Treatment.

Odontogenic sinusitis is a unique cause of sinus disease that deserves special consideration. An astute clinician can elicit historical findings such as recent dental work, and symptoms such as unilateral facial pain and foul drainage, despite a relatively benign oral cavity examination. Otolaryngologists and dental professionals who care for these patients must be able to interpret imaging studies for dental disorder such as periapical abscesses and periodontal disease. Treatment is frequently some combination of antibiotic therapy, dental procedures, and endoscopic sinus surgery. More prospective studies are needed to determine the best approach to caring for this patient population.

Primary molar with chronic periapical abscess showing atypical presentation of simultaneous extraoral and intraoral sinus tract with multiple stomata.

Chronic periapical abscess drains through a sinus tract either intraorally or extraorally. However, intraoral drainage is more common than extraoral in both dentitions. Nevertheless, the simultaneous presentation of extraoral and intraoral sinus tract is very rarely reported in primary dentition. This case report discussed the management of a girl aged 7 years with a chronic periapical abscess of tooth no. 85 with both non-healing extraoral and intraoral sinus tract having multiple stomata. Non-vital pulpectomy using calcium hydroxide paste intracanal dressing was performed initially until 2 weeks without remarkable healing; then antibiotic dressing consisting of a mixture of ciprofloxacin, metronidazole and clindamycin was placed as an intracanal medicament for 1 week, which shows uneventful healing of both intraoral and extraoral sinus tract. This case report clearly indicates about how history, correct diagnosis and appropriate treatment of endodontic infection associated with sinus tract can be conservatively healed with endodontic treatment alone.

Mediastinitis as complication of odontogenic infection: A case report.

Odontogenic infections are one of the most common dental problems, which affect 80%-90% of the population. Untreated odontogenic infections can cause life-threatening complications such as necrotizing fasciitis, descending necrotizing mediastinitis, internal jugular vein thrombosis, cavernous sinus thrombosis, carotid artery pseudoaneurysm or rupture, and systemic inflammatory response syndrome. This report aims to present a mediastinitis case, in a 22-year-old healthy male patient, which originated from an odontogenic infection. The patient was hospitalized because of worsening general health status, despite the antibiotherapy. Computed tomography (CT) scan revealed that periapical abscess was spreading to the mediastinum through retropharyngeal space. The patient was successfully treated by IV antibiotherapy, transcervical drainage, and extraction of tooth.

El síndrome de Groves en el paciente endodóncico: implicaciones legales y para la práctica clínica / No disponible

El doctor J. E. Groves, psiquiatra estadounidense, en un artículo publicado en el New England Journal of Medicine en 1978, fue el primero en atreverse a plantear de forma sincera y abierta la existencia de pacientes a los que definió como "odiosos" o "indeseables" (hateful patient). El paciente endodóncico que padece el "síndrome de Groves" se caracteriza por provocar en el dentista sentimientos de contratransferencia tales como el odio, la aversión, el aborrecimiento, o, incluso, el recelo, el temor y el miedo, todo ello sin que el paciente pueda ser encuadrado en un cuadro psiquiátrico específico. En este artículo se analiza, desde un punto de vista muy personal, la epidemiología, etiología, formas clínicas, el diagnóstico diferencial y el manejo terapéutico de este síndrome cuando se presenta en pacientes que necesitan tratamiento endodóncico

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Knowledge and Practices of Family and Emergency Physicians in Managing Nontraumatic Dental Conditions: A Case-based Survey.

INTRODUCTION: Physicians are often patients' first point of contact for management of nontraumatic dental conditions (NTDCs). This study's aim was to evaluate the knowledge and practices of Ontario physicians in managing NTDCs, with a specific focus on antibiotic usage. METHODS: A Web-based survey featured 4 NTDC clinical scenarios: irreversible pulpitis, localized acute apical abscess with or without systemic involvement, and chronic apical abscess. The survey link was distributed to active Ontario family and emergency physicians. The sample group was asked questions about their management of and experience with NTDCs, and demographic and practice characteristics were collected. Descriptive and multivariate logistic regression analyses were undertaken (P ≤ .05). RESULTS: Sampled Ontario physicians tend to manage NTDCs in a manner that is not consistent with evidence-based care. For irreversible pulpitis and for localized acute apical abscess with or without systemic involvement, most physicians would prescribe an antibiotic (57.4%, 84.8%, and 96.3%, respectively), and 23.5% would prescribe an antibiotic for chronic apical abscess. Approximately half the sample (52.9%) felt discomfort in managing NTDCs, and 85.3% felt they were inadequately trained to manage NTDCs. CONCLUSION: Areas that present opportunities for improvement in the physician management of NTDCs were identified, including the incorporation of further NTDC training in medical curricula and continuing medical education courses, and development and dissemination of guidelines for physicians in managing NTDCs.

Ludwig Angina after First Aid Treatment: Possible Etiologies and Prevention-Case Report.

Ludwig angina is a life-threatening type of soft tissue cellulitis involving 3 compartments on the floor of the mouth including the submental, sublingual, and submandibular spaces bilaterally. Prevention, early recognition, and treatment of Ludwig angina are critical because this is a clinical diagnosis with unpredictable progression. This article describes a rare case of Ludwig angina that evolved from an odontogenic infection and the specific microbiology and clinical course and discusses possible etiologies and prevention.

Non-surgical endodontic management of immature permanent mandibular first molar: a 3 year follow-up.

BACKGROUND: Deep carious lesions in immature permanent molars with pulp necrosis pose a serious challenge to contemporary paedodontic practice. A further complex clinical scenario is an immature permanent molar with varying root formation in both roots. This case report demonstrates the successful management of an immature permanent mandibular first molar. CASE REPORT: An 8-year-old boy was referred for endodontic management of 36 by a general practitioner. After clinical and radiographic evaluation, a diagnosis of recurrent chronic periapical abscess with abrupt root closure in the mesial root and cessation of root closure in the distal root was made. Apexification was undertaken in three appointments. In the first appointment, under local analgesia and isolation, the mesial canals were prepared to size #F3 with rotary Protaper Universal and the distal canal was left unprepared. Both canals were irrigated with 5% sodium hypochlorite and calcium hydroxide intracanal medicament was placed. One week later, the mesial canals were obturated and a 4 mm white MTA apical plug was placed in the distal canal. Partial extrusion of the MTA was seen periapically. After 24 h, the hard-setting of the MTA plug was verified, remainder of the distal canal was obturated and core filling was placed followed by a preformed metal crown as an intermediate restoration. FOLLOW-UP: The patient was asymptomatic and showed resolution of the lesion, normal thickness of the PDL space with continuity of the lamina dura after 12 months. Extruded MTA was partially resorbed. Three years follow-up showed complete resorption of the extruded MTA and an intact lamina dura.

Cone-beam computed tomographic and histological investigation of regenerative endodontic procedure in an immature mandibular second premolar with chronic apical abscess.

AIM: The aim of the present study was to investigate the tissue generated after regenerative endodontic procedure (REP) in the root canal space of an immature mandibular second premolar with pulp necrosis and chronic apical abscess using cone-beam computed tomographic (CBCT) and histological methods. METHODS: REP was performed in an immature mandibular second premolar. At the 3-year follow up, CBCT scans were taken to evaluate the outcome of treatment. As the tooth was not restorable to function, it was extracted and processed for histological examination. RESULTS: CBCT showed a reduction in size of the periradicular radiolucency, with a marginal increase in root length. Apical closure and thickening of the root canal walls were apparent. Histologically, the root canal space was filled with minimally-inflamed fibrous connective tissue. Some cementum-like mineralized connective tissue was evident on the internal canal walls. The apical third showed cementum-like deposits at the apex and the outer canal walls, without dentin formation. CONCLUSIONS: The present study of a structurally-failed tooth with prior REP demonstrates that the tissue formed within the root canal space was fibrous connective tissue with cementum-like deposition in the canal space. No evidence of dentin- or pulp-like tissue was found.

Preferences of dentists and endodontists, in Saudi Arabia, on management of necrotic pulp with acute apical abscess.

BACKGROUND: This study aimed at investigating dental clinicians' preferences on management of necrotic pulp with acute apical abscess (NPAAA) cases. METHODS: Following an ethical approval and two pilot studies, an electronic survey was emailed to 400 general dental practitioners (GDPs) and 56 endodontists. The email explained the study's methods and assured that participants' identities and information given would remain anonymous and confidential. A reminder email was sent after eight weeks. Responses were collected and data were analyzed using the Chi-square test at p = 0.05. RESULTS: The majority of respondents (86.3%) would deal with NPAAA cases "differently" from vital-pulp ones (p < 0.001). More endodontists (40%) used two or three irrgants than GDPs (29.5%). Whilst the highest proportion of endodontists (29.7%) rarely prescribed antibiotics, the highest proportion of GDPs (26%) generally did so (p < 0.001). Whilst the highest proportion of GDPs (26.9%) over-instrumented the largest canal in the first visit, most endodontists (56.8%) performed complete cleaning & shaping (C&S) (p < 0.001). In cases of non-stopped exudates, whilst the highest proportions of endodontists would either let the patient wait till the exudates significantly reduce then continue their intended approach (40.5%) or insert ICMs and temporize the tooth (40.5%), the highest proportion of GDPs (30.8%) would insert only dry cotton pellet without temporizing the tooth (p = 0.002). Of those who would leave the tooth open if non-stopped exudates presents in the first visit, the majority (81.9%) would temporize the tooth if little exudates present after C&S (p < 0.001). CONCLUSIONS: Clinicians, especially GDPs, opted to treat teeth involved in NPAAA differently from those with vital-pulp, such as: were using different ICMs and irrigants, C&S to different apical size preparation. GDPs should improve their practice by implementing multi-irrigants protocol while C&S, limit prescribing antibiotics, perform complete debridement of the root canal system and not to leave the tooth open between visits. Clinicians, especially GDPs, relied on their own experiences in managing NPAA cases which necessitates scientific-based guidelines.

Complicated untreated apical periodontitis causing paraesthesia: A case report.

The purpose of this article was to report a case of untreated apical periodontitis resulting in severe late complications. A patient with an asymptomatic crowned root canal-treated mandibular molar revealing a radiographic substandard endodontic treatment and a slight periapical radiolucency was made aware of the treatment options and opted for no treatment. The lesion slightly increased in size after 6 years, but the tooth remained asymptomatic and endodontic retreatment was again refused. After 4 more years, the patient presented with an abscess and severe pain, complicated by paraesthesia of the left chin and lip. Radiographic examination revealed that the lesion had increased considerably to involve the mandibular canal. The treatment protocol included long-term intracanal medication with calcium hydroxide and follow-ups revealed complete resolution of the periapical radiolucency and the paraesthesia had completely subsided.

Facial Palsy Masquerading as an Acute Dental Abscess.

Facial nerve palsy has specific symptomology, but varied aetiology. Prompt and thorough assessment is required to ascertain if upper or lower motor neurone damage has occurred. This report discusses a 6-year-old female, presenting in the Emergency Department with unilateral facial weakness. Initially thought to be facial swelling relating to her carious dentition, clinical assessment from the maxillofacial team identified that the patient had a unilateral facial palsy, later diagnosed as Bell's palsy. Her delayed presentation was due to initial misdiagnoses in primary care. This case report aims to highlight its aetiology, clinical features and appropriate management. Clinical relevance: To make the general dental practitioner aware of different causes of facial paralysis, and to provide GDPs with an algorithm to follow in the presentation of a facial palsy in the primary care setting.

Treatment of mandibular osteomyelitis in two red-necked wallabies (Macropus rufogriseus) by means of intensive long-term parenteral drug administration and serial computed tomographic monitoring.

CASE DESCRIPTION 2 female red-necked wallabies (Macropus rufogriseus) were evaluated because of sudden-onset mandibular swelling, ptyalism, and hyporexia. CLINICAL FINDINGS Physical examination revealed a mandibular swelling with a fluctuant center in both wallabies. Hematologic analysis revealed leukocytosis with a mature neutrophilia and monocytosis in one wallaby (case 1) and a slight neutrophilia, hyperglobulinemia, and high serum alanine aminotransferase activity in the other (case 2). Cytologic examination of the swelling revealed a uniform population of gram-negative rods in case 1 and neutrophilic inflammation in case 2. Radiography revealed a soft tissue mandibular swelling with osteolucency around mandibular incisor roots in both wallabies. Computed tomography revealed changes consistent with chronic active mandibular osteomyelitis and reactive bone formation, but also sequestra formation not appreciable via radiography. TREATMENT AND OUTCOME Long-term antimicrobial treatment was initiated with clindamycin (17 to 21 mg/kg [7.7 to 9.5 mg/lb], IV, q 12 h for 40 to 55 days) and high-dose benzathine penicillin G (80,000 U/kg [36,364 U/lb], SC, q 12 h for 150 days). Serial CT was performed to evaluate response to treatment and resolution of disease. A CT scan 18 months after the initial evaluation revealed complete resolution of osteomyelitis and sequestra. CLINICAL RELEVANCE Advanced imaging and long-term treatment and management were integral to the successful outcome for these wallabies, given that the osseous changes visible on CT images were not visible on standard radiographs, guiding therapeutic decision-making. This report provides new therapeutic and diagnostic monitoring information to assist clinicians with similar cases.

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.

Second-generation Platelet Concentrate (Platelet-rich Fibrin) as a Scaffold in Regenerative Endodontics: A Case Series.

INTRODUCTION: The purpose of this case series was to report the clinical and radiographic results of a pulp regenerative procedure using platelet-rich fibrin (PRF), a second-generation platelet concentrate, in immature teeth with necrotic pulps. METHODS: Root canal revascularization using PRF was performed on 4 immature teeth with necrotic pulps. After access cavity preparation, the root canals were irrigated with low concentration sodium hypochlorite solution (1.5% sodium hypochlorite [20 mL/canal, 5 minutes]) and then irrigated with saline (20 mL/canal, 5 minutes). Equal proportions (167 mg) of ciprofloxacin, metronidazole, and cefaclor were mixed and diluted to a final concentration of 1 g/mL. Finally, the canal was sealed with 3-4 mm of a temporary restorative material, and patients were dismissed for 2 to 3 weeks. At the second appointment, 9 mL of the patient's whole blood was obtained and centrifuged to prepare a PRF clot. Canals were irrigated with 17% EDTA, and a sharp spreader was inserted beyond the apex. Then, the PRF clot was placed inside the root canals, and Biodentine (Septodont, Saint-Maur, France) was placed directly over the PRF. The teeth were restored permanently with glass ionomer cement and composite resin. RESULTS: Clinical examinations revealed that all cases were asymptomatic at the recall appointments at 1, 3, 6, 12, and 18 months. Radiographs revealed resolution of the periapical lesions, further root development, and apical closure in all cases. CONCLUSIONS: On the basis of the short-term results up to 12 months, PRF clots acted as successful scaffolds for the regeneration of pulpal contents in immature teeth with necrotic pulps.

Odontogenic Orofacial Infections.

Acute dental abscess is a frequent and sometimes underestimated disease of the oral cavity. The acute dental abscess usually occurs secondary to caries, trauma, or failed endodontic treatment. After the intact pulp chamber is opened, colonization of the root canals takes place with a variable set of anaerobic bacteria, which colonize the walls of the necrotic root canals forming a specialized mixed anaerobic biofilm. Asymptomatic necrosis is common. However, abscess formation occurs when these bacteria and their toxic products breach into the periapical tissues through the apical foramen and induce acute inflammation and pus formation. The main signs and symptoms of the acute dental abscess (often referred to as a periapical abscess or infection) are pain, swelling, erythema, and suppuration usually localized to the affected tooth, even if the abscess can eventually spread causing a severe odontogenic infection which is characterized by local and systemic involvement culminating in sepsis syndrome. The vast majority of dental abscesses respond to antibiotic treatment, however, in some patients surgical management of the infection may be indicated. In the present work, a retrospective analysis of the patients with dental orofacial infections referred to the Unit of Dentistry and Maxillofacial Surgery of the University of Verona from 1991 to 2011 has been performed.

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.

Diagnosis and Treatment of Odontogenic Cutaneous Sinus Tracts in an 11-Year-Old Boy: A Case Report.

Odontogenic cutaneous sinus tracts (OCSTs) are generally primarily misdiagnosed and inappropriately treated by virtue of their rarity and the absence of dental symptoms. Accurate diagnosis and treatment and the elimination of the source of infection can reduce the incidence of complications and relieve the pain of the patient.In this case report, we present the case of an 11-year-old patient with an apparent abscess but an unobvious draining sinus tract in his left cheek. Intraorally, a glass-ionomer-cement filling on the occlusal surface of the left mandibular first molar (tooth 36) was noted. Radiographic examination revealed a radiopaque mass inside the crown and pulp chamber and an irregular, radiolucent periapical lesion surrounding the distal root apex. He was diagnosed with an OCTS secondary to a periapical abscess of tooth 36. Precise root canal therapy (RCT) and chronic granuloma debridement was performed; 6 months later, the abscess and sinus had healed completely, and the periapical lesion had resolved.Odontogenic cutaneous sinus tracts are uncommon in the clinic. This case report reminds us of the significance of OCSTs and provides some implications for their diagnosis and treatment.