Association between pulp and periapical disease with type 2 diabetes: A bidirectional Mendelian randomization.

AIM: This current Mendelian randomization (MR) study aims to comprehensively explore the potential bidirectional link between pulp and periapical disease (PAP) with type 2 diabetes mellitus (T2DM). METHODOLOGY: Summary level data of European-based population genome-wide association studies (GWASs) were employed to undertake this MR study. With the selection of single nucleotide polymorphisms (SNPs) as the instrumental variable, the radial inverse-variance weighted (radial IVW) method with modified second-order weights was applied as the primary method. Additionally, a range of sensitivity analyses were conducted to investigate pleiotropy. Results from different sources of outcome were pooled by meta-analysis with the fixed model. RESULTS: The results of this MR analysis did not suggest a significant impact of pulp and periapical disease on type 2 diabetes (combined OR = 1.04, 95% CI: 1.00-1.07, p = .033) and vice versa (OR = 1.04, 95% CI: 0.96-1.14, p = .329). No significant pleiotropy was detected in the final model after the removal of outliers, demonstrating the reliability of the results in our primary analysis. CONCLUSIONS: With the limitations inherent in the present MR study, there is no significant evidence in either direction to suggest a causal association between pulp and periapical disease and type 2 diabetes mellitus.

Imipramine treatment reverses depressive- and anxiety-like behaviors, normalize adrenocorticotropic hormone, and reduces interleukin-1ß in the brain of rats subjected to experimental periapical lesion.

BACKGROUND: A periodontal lesion is a consequence of chronic inflammatory processes, itself triggered by a bacterial infection of the pulpal and endodontic microenvironment. Evidence suggests that periodontal lesion induction could alter inflammatory cytokines leading to behavior changes. These effects in the context of anxiety and depressive behavior have been not full investigated. We aimed to observe anxiety- and depressive-like behavioral in rodent subjected to periapical dental lesions. METHODS: Pro-inflammatory cytokines levels also were investigated in the frontal cortex and hippocampus. Parameters related to hypothalamic-pituitary-adrenal (HPA) axis activation also were evaluated. Wistar rats were divided in groups: control/saline; control/imipramine; periapical lesion/saline; and periapical lesion/imipramine. Three weeks after induction of the periapical dental lesion, they were subjected to behavioral tests. RESULTS: In the periapical lesion group was demonstrated anhedonic behavior and depressive-like behavior. In the elevated plus-maze test the periapical lesion group had an increase in the number of entries and spent more time in the closed arms. Imipramine treatment was able to reverse depressive- and anxiety-like behaviors. In the hippocampus and frontal cortex tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), IL-6, and serum adrenocorticotropic hormone (ACTH) levels were higher in the periapical lesion group. However, rats treated with imipramine had lower IL-1ß and ACTH levels. CONCLUSIONS: Our results revealed depressive- and anxiety-like behaviors following induction of a specific dental lesion. These effects could be associated to higher levels of brain pro-inflammatory cytokines and HPA axis changes. Antidepressants treatments could be an alternative to treat comorbidities associated to periodontal lesions.

Large Periapical or Cystic Lesions in Association with Roots Having Open Apices Managed Nonsurgically Using 1-step Apexification Based on Platelet-rich Fibrin Matrix and Biodentine Apical Barrier: A Case Series.

Teeth having open apices in the absence of a natural apical constriction pose several challenges during conventional endodontic treatment, especially when establishing an apical seal. Treatment is further challenging when these teeth are associated with large periapical or cystic lesions having resulted in expansion and/or thinning of adjacent cortical plates. Although surgical intervention is commonly adopted in the management of such cases, a conservative treatment option offering equally good prognosis is always desirable. This case series describes 3 cases: a 39-year-old woman, a 45-year-old woman, and a 15-year-old boy having teeth with concomitant open apices and large periapical/cystic lesions managed conservatively by (1) following a strict intracanal disinfection protocol, (2) intracanal aspiration with digital decompression of associated swelling, and (3) 1-step apexification for closure of the root apex by placing a preliminary barrier of platelet-rich fibrin (PRF) and a secondary barrier of Biodentine (Septodont, Saint-Maur-des-Fossés, France). In all 3 cases, the treatment outcomes, both clinical and radiographic, were highly satisfactory. PRF and Biodentine collectively rendered an apical plug that proved to be a suitable alternative to commonly used mineral trioxide aggregate in 1-step apexification. Biodentine provides good interfacial adhesion and sealing with dentin attributed to its property of hydroxyapatite crystal deposition at the material-dentin interface. Also, because of its bioactivity, it likely promotes the conversion of adjacent PRF into a calcific barrier, thus reinforcing the apical seal. Additionally, host-modulating responses of PRF contribute in expediting the healing process. Reasonable osseous healing in the periapex could be appreciated as early as 3 months in all patients. The rapidity with which healing occurred may have been an incidental finding but definitely draws attention.

Actinomycosis is not Frequent in the Periapex But is a Persistent Lesion.

Periapical actinomycosis caused by a gram-positive anaerobic pathogen characterizes a typical extra-radicular infection. This study determined the frequency and correlated the content of bacteria colonies with the of periapical actinomycosis size. The study comprised a total of 218 periapical lesions (PL) (cysts, granulomas or abscess). The specimens embedded in paraffin were sliced into 4-µm sections and stained with hematoxylin-eosin, Gram, Periodic Acid-Schiff (PAS) and Grocott's stain. The presence of bacterial colonies composed of filamentous structures labeled with the histochemical stains were described as Actinomyces, and for each case, the bacterial colonies were counted and measured. The correlation between the number and size of bacterial colonies and the size of PL was tested using Pearson's adjusted correlation coefficient. From 218 PL, bacterial colonies were identified in 64 biopsies. Seven cases (0.3%) fulfill the criteria for diagnosis of periapical actinomycosis. All of cases were therapy-resistant and did not showed periapical repair after 12 months of follow-up. Periapical surgery or dental extraction was performed. The correlation test indicated no correlation between the number of bacterial colonies and the lesion size (p=0.752, r=-0.148). However, a larger bacterial colony size generally resulted in a larger periapical lesion (P=0.000, r=0.657). The frequency of periapical actinomycosis was low, and this lesion should be included in the differential diagnosis of PL. The size of the Actinomyces colonies seemed to contribute to increase the size of the periapical lesion.

Actinomycosis is not Frequent in the Periapex But is a Persistent Lesion

Abstract Periapical actinomycosis caused by a gram-positive anaerobic pathogen characterizes a typical extra-radicular infection. This study determined the frequency and correlated the content of bacteria colonies with the of periapical actinomycosis size. The study comprised a total of 218 periapical lesions (PL) (cysts, granulomas or abscess). The specimens embedded in paraffin were sliced into 4-µm sections and stained with hematoxylin-eosin, Gram, Periodic Acid-Schiff (PAS) and Grocott's stain. The presence of bacterial colonies composed of filamentous structures labeled with the histochemical stains were described as Actinomyces, and for each case, the bacterial colonies were counted and measured. The correlation between the number and size of bacterial colonies and the size of PL was tested using Pearson's adjusted correlation coefficient. From 218 PL, bacterial colonies were identified in 64 biopsies. Seven cases (0.3%) fulfill the criteria for diagnosis of periapical actinomycosis. All of cases were therapy-resistant and did not showed periapical repair after 12 months of follow-up. Periapical surgery or dental extraction was performed. The correlation test indicated no correlation between the number of bacterial colonies and the lesion size (p=0.752, r=-0.148). However, a larger bacterial colony size generally resulted in a larger periapical lesion (P=0.000, r=0.657). The frequency of periapical actinomycosis was low, and this lesion should be included in the differential diagnosis of PL. The size of the Actinomyces colonies seemed to contribute to increase the size of the periapical lesion.

Resumo A actinomicose periapical causada por um patógeno anaeróbio Gram positivo caracteriza uma infecção extra-radicular típica. Esse estudo determinou a frequência e correlacionou o conteúdo das colônias bacterianas com o tamanho das actinomicoses periapicais. O estudo compreendeu um total de 218 lesões periapicais (LPs) (cistos, granulomas ou abscessos). Os espécimes embebidos em parafina foram cortados em secções de 4-µm e corados com hematoxilina-eosina, Gram, ácido periódico de Schiff (PAS) e coloração de Grocott. A presença de colônias bacterianas compostas por estruturas filamentosas marcadas com os corantes histoquímicos foram descritas como Actinomyces, e para cada caso, as colônias bacterianas foram contadas e mensuradas. A correlação entre o número e tamanho das colônias bacterianas e o tamanho das LPs foi testado usando o coeficiente de correlação ajustado de Pearson. De 218 LPs, colônias bacterianas foram identificadas em 64 biópsias. Sete casos (0,3%) preencheram os critérios para o diagnóstico de actinomicose periapical. Todos os casos foram resistentes à terapia e não mostraram reparo periapical após 12 meses de acompanhamento. Cirurgia periapical ou extração dental foi realizada. O teste de correlação indicou nenhuma correlação entre o número de colônias bacterianas e o tamanho da lesão (p=0.752, r=-0.148). Entretanto, uma maior colônia bacteriana geralmente resultou em uma maior lesão periapical (p=0.000, r=0.657). A frequência de actinomicose periapical foi baixa e esta lesão deve ser incluída no diagnóstico diferencial das LPs. O tamanho das colônias de Actinomyces pareceu contribuir para o aumento no tamanho da lesão periapical.

[Odontogenic cutaneous fistula: a diagnostic challenge]. / Fístula cutánea odontogénica: un reto diagnóstico.

Odontogenic cutaneous fistula (OCF) is the result of an abnormal canalization originating from chronic periapical infection. It represents a diagnostic challenge, as it is frequently misdiagnosed as dermatological lesion. There is a broad differential diagnosis, including pyogenic granuloma, cutaneous tuberculosis or congenital malformations, among others. We report the case of a 46-year-old man diagnosed with OCF who presented a rapid improvement after extraction of the affected dental pieces and fistulectomy. We consider knowledge of this pathology to be important in order to avoid unnecessary delays in diagnosis and proper treatment. Key words. Cutaneous fistula. DIAGNOSIS: Orthopantomography.

Management of Dens Invaginatus Type II Associated with Immature Apex and Large Periradicular Lesion Using Platelet-rich Fibrin and Biodentine.

Dens invaginatus (DI) poses peculiar challenges in endodontic treatment of teeth because of distortion of pulpal space. A case of Oehlers type II DI with open apex and large periapical lesion is reported. The case was managed using cone-beam computed tomography (CBCT), operating microscope, platelet-rich fibrin (PRF), and Biodentine. A 15-year-old male patient presented with palatal swelling. Pulp sensibility testing of right maxillary lateral incisor was negative. Intraoral periapical digital radiograph revealed an Oehlers type II DI with open apex and periapical radiolucency. A CBCT scan was performed to study the anatomy, determine the true extent of the periapical lesion, and form a treatment plan. A diagnosis of Oehlers type II DI with pulp necrosis and acute periapical abscess was made. Two-visit endodontic treatment was performed. In the first visit, the invaginated central mass was removed under operating microscope, chemo-mechanical preparation was done, and double antibiotic paste dressing was placed. In the second visit, the canal was sealed with apical matrices of PRF and Biodentine as filling material. The patient was asymptomatic and radiographs revealed continued healing of the osseous defect at follow-up visits. A CBCT scan at 30 months showed complete continuity of periodontal ligament space, healing of labial and palatal cortical plates, and formation of intercortical bone. The advances in endodontic armamentarium and technology, like CBCT and operating microscope, have made successful treatment of challenging cases possible. PRF and Biodentine as apical matrices and filling material, respectively, proved to be effective in the present case.

Maxillary and Mandibular Non-Hodgkin Lymphoma with Concurrent Periapical Endodontic Disease: Diagnosis and Management.

Extranodal non-Hodgkin lymphoma (NHL) in the oral region can present similarly to diseases of odontogenic origin. The objective of this report was to describe a rare case of maxillary and mandibular NHL that presented similarly to and concurrently with lesions of odontogenic origin.A unique case of extranodal NHL, which presented at the apices of maxillary and mandibular teeth in conjunction with lesions of odontogenic origin in a 68-year-old white man, is described. The patient sought care because of a lesion in the right maxillary paranasal region that caused him paresthesia. Radiographically, periapical radiolucencies were present along teeth #5-8, #23 and 24, and #30 and 31. Biopsies of the right maxillary and anterior mandibular lesions were completed and led to a diagnosis of NHL at the apices of teeth #5-8 extending to the hard palate and granulation tissue at the apices of teeth #23 and 24. Two years later, the patient returned because of pressure and sensitivity associated with teeth #30 and 31. Vestibular swelling was noted clinically, and a multilocular periapical radiolucency was present radiographically. Via endodontic therapy and a positron emission tomographic scan, the lesion associated with teeth #30 and 31 was determined to be of both odontogenic and nonodontogenic origin because it possessed both a sinus tract associated with tooth #30 and NHL. Lesions of odontogenic and nonodontogenic origin possess diagnostic and treatment challenges because they may present similarly and/or concurrently. Thoughtful and conservative management of odontogenic lesions with associated NHL is imperative. Interprofessional collaboration and communication among providers must be thorough and clear to properly coordinate care and prevent delays in diagnosis and treatment when these entities occur together.

A case series of trigeminal nerve injuries caused by periapical lesions of mandibular teeth.

Aims Periapical lesions have been implicated in mandibular trigeminal sensory neuropathy. This study aimed to report on a case series of consecutive patients presenting with mandibular division trigeminal nerve injuries (TNI) caused by periapical lesions. Common presenting characteristics and possible strategies for management were also investigated.Materials and methods A retrospective study of 22 patients with TNI caused by periapical lesions. Data were extracted from patient records and analysed using Microsoft Excel and SPSS. Factors associated with TNI resolution were assessed using Student's t-Tests and one-way Analysis of Variance (ANOVA), where P <0.05 indicated statistical significance.Results Twenty-one patients had inferior alveolar nerve injuries (IANI) and one had a lingual nerve injury (LNI). The most commonly affected teeth were the first molars (11 patients; 50%). TNI symptoms included numbness, pain and/or paraesthesia. IANI resolved completely among five patients within a mean time of 4.7 months (range 1.5-12 months). Patients who showed complete resolution had the affected teeth extracted or primary endodontic treatment with antibiotics.Conclusions Patients with TNI caused by periapical lesions can suffer significantly from combined numbness, pain and paraesthesia. Resolution of these injuries may be maximised upon early diagnosis and treatment of the periapical lesion by tooth extraction or primary endodontic treatment.

Expression of hypoxia-induced semaphorin 7A correlates with the severity of inflammation and osteoclastogenesis in experimentally induced periapical lesions.

OBJECTIVE: While hypoxia and inflammation are intimately linked, the effects of inflammatory hypoxia on the pathogenesis of periapical lesions remain largely unknown. The aim of this study was to examine hypoxia during the progression of experimentally induced rat periapical lesions, and to derive correlations between hypoxia-induced Semaphorin 7A (Sema7a) expression, severity of inflammation, and osteoclastogenesis in the lesions. DESIGN: Periapical lesions were developed after mandibular first molar pulp exposure in forty Sprague-Dawley rats. The animals were randomly divided into four groups and sacrificed at 0, 7, 14, and 28days after pulpal exposure. The bilateral mandibles containing the first molar were obtained and routinely prepared for histological, immunohistochemical, enzyme histochemical analyses and quantitative polymerase chain reaction detecting Sema7a mRNA expression. Data were analysed by one-way analysis of variance and the Pearson's correlation and linear tendency test. RESULTS: Periapical tissues become hypoxic during the development of experimentally induced periapical lesions, with steadily increasing numbers of HIF-1α-positive cells that positively correlate with the expression of Sema7a mRNA in the lesions. Furthermore, significant positive correlates were derived for the expression of Sema7a and the degree of inflammatory infiltration and osteoclast number, respectively. CONCLUSIONS: Hypoxia-induced Sema7a participates in the pathogenesis of periapical lesions, providing a novel therapeutic target for the treatment of this inflammatory disease in the future.

Preexisting Periapical Inflammatory Condition Exacerbates Tooth Extraction-induced Bisphosphonate-related Osteonecrosis of the Jaw Lesions in Mice.

INTRODUCTION: Surgical interventions such as tooth extraction increase the chances of developing osteonecrosis of the jaw in patients receiving bisphosphonates (BPs) for the treatment of bone-related diseases. Tooth extraction is often performed to eliminate preexisting pathological inflammatory conditions that make the tooth unsalvageable; however, the role of such conditions on bisphosphonate-related osteonecrosis of the jaw (BRONJ) development after tooth extraction is not clearly defined. Here, we examined the effects of periapical periodontitis on tooth extraction-induced BRONJ development in mice. METHODS: Periapical periodontitis was induced by exposing the pulp of the maxillary first molar for 3 weeks in C57/BL6 mice that were intravenously administered with BPs. The same tooth was extracted, and after an 3 additional weeks, the mice were harvested for histologic, histomorphometric, and histochemical staining analyses. RESULTS: Pulp exposure induced periapical radiolucency as shown by increased inflammatory cells, tartrate-resistant acid phosphatase-positive osteoclasts, and bone resorption. When BPs were administered, pulp exposure did not induce apical bone resorption despite the presence of inflammatory cells and tartrate-resistant acid phosphatase-positive osteoclasts. Although tooth extraction alone induced BRONJ lesions, pulp exposure further increased tooth extraction-induced BRONJ development as shown by the presence of more bone necrosis. CONCLUSIONS: Our study demonstrates that a preexisting pathological inflammatory condition such as periapical periodontitis is a predisposing factor that may exacerbate BRONJ development after tooth extraction. Our study further provides a clinical implication wherein periapical periodontitis should be controlled before performing tooth extraction in BP users in order to reduce the risk of developing BRONJ.

Influence of Size and Volume of Periapical Lesions on the Outcome of Endodontic Microsurgery: 3-Dimensional Analysis Using Cone-beam Computed Tomography.

INTRODUCTION: The purpose of this study was to examine the size, volume, and other parameters of preoperative periapical lesions measured from cone-beam computed tomographic (CBCT) images as potential prognostic factors in endodontic microsurgery. METHODS: A clinical database was searched for patients who had received endodontic microsurgery with preoperative CBCT examination between March 2010 and December 2014. The CBCT images were analyzed with the OnDemand3D software program (Cybermed, Seoul, South Korea). The mesiodistal (Lx), apicocoronal (Ly), and buccolingual (Lz) diameter and the volume (V) of the periapical lesions, destruction of the cortical bone, and height of the buccal bone plate (Lb) were measured independently by 2 examiners. The outcome was classified as a success or failure based on the clinical and radiographic evaluation at least 1 year after the operation. Univariate analyses using the chi-square or Fisher exact test were performed to show the correlation of the outcomes with variables to identify the potential predisposing factors. Multivariate analysis using a logistic regression model was performed with the associated variables. RESULTS: Ninety-five cases were evaluated after a period of at least 1 year, and 2 were extracted before the 1-year follow-up. The interexaminer agreements were excellent for the linear and volume measurement of the preoperative periapical lesion. A lesion volume above 50 mm(3) was found to be a significant negative predictor in the univariate analysis (P = .028) and the logistic regression model (P = .038). CONCLUSIONS: Within the limitations of this study, the volume of the preoperative periapical lesion had a significant effect on the outcome of endodontic microsurgery. It is suggested that further studies on endodontic microsurgery should be performed and that quantitative measurements using CBCT imaging may be useful for the analyses.

Fístula cutánea: un caso clínico / Cutaneous fistula: a clinical case

Objetivo: diagnosticar y tratar la presencia de una fístula cutánea. Caso clínico: un paciente de sexo masculino, de 9 años de edad, consultó por una lesión cutánea en la zona mandibular del lado izquierdo. Concusiones: una fístula cutánea requiere un diagnóstico diferencial preciso, a fin de determinar su etiología y planificar el procedimiento endodóntico correcto. Como consecuencia de una mortificación pulpar, la presencia de bacterias dentro del conducto radicular puede generar una periodontitis perirradicular crónica de origen endodóntico.

External root resorption during orthodontic treatment in root-filled teeth and contralateral teeth with vital pulp: A clinical study of contributing factors.

INTRODUCTION: There is a lack of research to support the belief that root canal treatment can be considered for stopping or decreasing external apical root resorption (EARR). There is conflicting evidence as to whether root-filled teeth are more or less likely to experience EARR after orthodontic treatment. The purpose of this study was to compare the degree of EARR of root-filled teeth with that of contralateral teeth with vital pulp after fixed orthodontic treatment. METHODS: The study sample consisted of 35 patients aged 25.23 ± 4.92 years who had at least 1 root-filled tooth before orthodontic treatment. Digital panoramic radiographs of each patient taken before and after orthodontic treatment were used to measure the EARR. The Student t test for matched pairs and the Pearson correlation analysis were applied. RESULTS: The mean EARR values were 0.22 (0.14, 0.35) for root-filled teeth and 0.87 (0.59, 1.31) for contralateral teeth with vital pulp, indicating significantly less EARR for root-filled teeth compared with the contralateral teeth with vital pulp after orthodontic treatment. EARR was influenced by the patient's age, treatment duration, treatment type, and periapical pathosis, but not by tooth type and sex. CONCLUSIONS: Root-filled teeth appear to be associated with significantly less EARR than are contralateral teeth with vital pulp. This study suggests that the possible complication of EARR in root-filled teeth may not be an important consideration in orthodontic treatment planning, and root canal treatment can be considered for stopping or decreasing EARR when severe EARR occurs during orthodontic treatment.

Apical root-end filling with tricalcium silicate-based cement in a patient with diabetes mellitus: A case report.

Introduction: The material used for root-end filling has to be biocompatible with adjacent periapical tissue and to stimulate its regenerative processes. Tricalcium silicate cement (TSC), as a new dental material, shows good sealing properties with dentin, high compression strengths and better marginal adaptation than commonly used root-end filling materials. Although optimal postoperative healing of periapical tissues is mainly influenced by characteristics of end-root material used, it could sometimes be affected by the influence of systemic diseases, such as diabetes mellitus (DM). Case report: We presented apical healing of the upper central incisor, retrofilled with TSC, in a diabetic patient (type 2 DM) with peripheral neuropathy. Standard root-end resection of upper central incisor was accompanied by retropreparation using ultrasonic retrotips to the depth of 3 mm and retrofilling with TSC. Post-operatively, the surgical wound healed uneventfully. However, the patient reported undefined dull pain in the operated area that could possibly be attributed to undiagnosed intraoral diabetic peripheral neuropathy, what was evaluated clinically. Conclusion: Although TSC presents a suitable material for apical root-end filling in the treatment of chronic periradicular lesions a possible presence of systemic diseases, like type 2 DM, has to be considered in the treatment outcome estimation.

Periimplantitis apical - presentación de serie de 11 casos clínicos / Apical peri-implantitis: a presentation of a series of 11 clinical cases

Objetivos. Evaluar el protocolo quirúrgico y discutir los posibles factores predisponentes de la periimplantitis apical. Material y método. En el presente trabajo, se planteó un estudio descriptivo retrospectivo analizando una serie de 11 casos clínicos de periimplantitis apical diagnosticados y tratados en el ámbito del Hospital de La Princesa (Madrid) y la Clínica Universidad de Navarra (Pamplona) entre 2002 y 2013. Los pacientes sintomáticos fueron tratados mediante legrado de la zona con o sin relleno. Resultados. Se analizaron un número total de 11 casos de periimplantitis apical (4 asintomáticos y 7 con síntomas). La clínica observada fue parecida a la enfermedad dentaria periapical y el tiempo transcurrido hasta el diagnóstico fue variable, inferior a los 3 años. Se observó resolución completa del problema en 6 de los 7 casos tratados con legrado de la zona periapical del implante. En el caso restante se procedió a la explantación del implante afecto. En los casos asintomáticos no se realizó ningún tipo de tratamiento quirúrgico, presentando una tendencia autolimitada. Conclusión. La periimplantitis apical es una enfermedad que puede complicar el tratamiento implantológico. La cirugía conservadora ha tenido resultados satisfactorios en los casos sintomáticos (AU)

Objectives. The purpose of this study was to evaluate the surgical protocol and discuss possible predisposing factors of apical peri-implantitis. Material and methods. A retrospective study was performed by analyzing a series of cases involving 11 patients, all of whom where diagnosed with, and treated for, apical peri-implantitis at La Princesa Hospital in Madrid and at Navarre University Clinic in Pamplona, Spain, between 2002 and 2013. Symptomatic patients were treated with curettage of the area, which was, in some cases, combined with bone regeneration techniques. Results. A total of 11 cases of apical periimplantitis were included (4 asymptomatic and 7 symptomatic). The symptoms observed were similar to dental periapical pathology, and the period of time elapsed until the patients were diagnosed with API was variable, but was less than 3 years. Complete resolution of the pathology was observed in 6 of the 7 patients treated with curettage of the periapical implant area. In the remaining case the affected implant was removed. No surgical treatment was used in asymptomatic cases, as they were self-limiting. Conclusion. Apical periimplantitis is a condition which may complicate the dental implant treatment. Conservative surgical treatment has shown satisfactory results in symptomatic patients (AU)

Splinted Porcelain Laminate Veneers With a Natural Tooth Pontic: A Provisional Approach for Conservative and Esthetic Treatment of a Challenging Case.

Esthetic rehabilitation of discolored anterior teeth is always a great challenge, especially in the presence of pathology. Fortunately, conservative management in the esthetic zone has become more feasible in compromised cases because of the development of restorative materials and advances in dental adhesives. This report presents a complicated case of a patient with tetracycline-related discoloration, multiple root resorption, and a periapical lesion. Treatment was conservative and used a natural tooth pontic and splinted porcelain laminate veneers.

Etiology and clinical characteristics of symptomatic unilateral maxillary sinusitis: A review of 174 cases.

The purpose of the study was to analyze the causative pathology associated with symptomatic unilateral maxillary sinusitis requiring surgical treatment. A retrospective review of all patients that have been treated surgically for unilateral symptomatic maxillary sinusitis between 2006 and 2013 at a single institution was performed. Demographic, anamnesis, clinical, radiological, microbiological and histological data were gathered and analyzed. The patients were allocated into groups depending on the underlying cause of the disease. Descriptive and inferential statistics were computed (level of significance: p ≤ 0.05). The study sample was composed of 174 patients (72 female; 102 male) with a mean age of 52.7 years (SD 16.9). Most cases (130; 75%) were triggered by odontogenic pathology following dentoalveolar surgical interventions (83/130 patients; 64%). Other etiological factors for odontogenic unilateral sinusitis were periapical (23/130 cases; 18%) and periodontal pathology (13/130 cases; 10%). Rhinogenic factors for sinusitis were detected in 13 patients (7.5%) and dental implant-associated unilateral maxillary sinusitis was diagnosed in nine patients (5.2%). Four patients (2.3%) had undergone previous sinus augmentation surgery. A leading cause for the sinus infection could not be identified in 18 patients (10%) who all had a history of midfacial surgery. Medication-related osteonecrosis of the jaw (8) and squamous cell carcinoma (2) were incidental findings. There were no differences in the clinical appearance of the disease with respect to its etiology. Odontogenic causes for maxillary sinusitis must be considered especially in unilateral cases. Maxillary dental implants may induce symptomatic unilateral maxillary sinusitis.

Metástasis cutánea facial de angiosarcoma de mama / Facial skin metastasis of a breast angiosarcoma

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