Cutaneous odontogenic sinus: an inflammatory mimicker of squamous cell carcinoma and epidermal cysts.

An odontogenic cutaneous sinus tract (OCST) of dental origin is an uncommon and frequently misdiagnosed lesion that is caused by chronic periodontitis. Given that OCSTs often lack symptoms, are located on the lower face, and can have notable variations in clinical appearance, they can be mistaken for more common dermatologic diagnoses such as squamous cell carcinomas (SCCs) and cysts. We present 2 patients with OCSTs who were referred for cutaneous surgery for a rendered diagnosis of an SCC and epidermal cyst. A proper diagnosis was rendered after a high index of suspicion, and clinicopathologic correlation led to additional testing and eventual referral to oral surgery for an OCST.

Esthetic improvement of a cutaneous sinus tract of odontogenic origin.

A cutaneous sinus tract of dental origin is relatively uncommon and may easily be misdiagnosed because of its unusual occurrence and absence of dental symptoms. Extraoral drainage depends on the location of the affected tooth as well as on specific factors such as the virulence of the microorganism, resistance of the patient's body, and the relationship between anatomy and muscle facial attachments.

Pilonidal sinus of the chin: mistreated as a dental fistula.

Pilonidal sinus is a chronic inflammatory condition associated with penetration of hair particles into the skin. It is rare in the chin area and, to our knowledge, there is only one such reported case. A 56-year-old man was previously admitted to a private clinic, with a hard mass on his anterior buccal sulcus. Three of the patient's teeth were extracted as the swelling was thought to be associated with a dental infection. Because the fistula did not resolve, the patient was referred to our department. Following radiological and clinical examinations, the hard mass was reached intraorally and hair shafts were seen inside it. The area was closed primarily after cleaning the inflammatory tissues and the hairs. The recovery period was uneventful. In this case report, we present a pilonidal sinus encountered in the chin area, the wrong treatment initially given to the patient and the subsequent treatment carried out by us.

[Cutaneous sinus tract due to an asymptomatic dental infection]. / Fisteldannelse i huden som følge af enubehandlet asymptomatisk tandinfektion.

Pyogenic cutaneous lesions of the cervicofacial region may have a variety of causes but one possibility that should be considered is a cutaneous sinus tract (CST) of dental origin. Correct diagnosis is based on a high index of suspicion and radiologic evidence of a dental pathology. Patients with odontogenic CST should be referred to a dentist and the treatment consists of either endodontic therapy or extraction of the involved tooth. We present a case report with misdiagnosis of CST of dental origin.

Odontogenic cutaneous sinus tract associated with a mandibular second molar having a rare distolingual root: a case report.

INTRODUCTION: Odontogenic cutaneous sinus tracts are often misdiagnosed as lesions of non-odontogenic origin, leading to the treatment of patients with unnecessary and ineffective therapies. Sinus tracts of endodontic origin usually respond well to endodontic therapy. However, root canal treatment of mandibular molars with aberrant canal anatomy can be diagnostically and technically challenging. Herein we present a patient with a cutaneous odontogenic sinus tract in the right submandibular area. CASE REPORT: A 23-year-old Chinese female patient presented with a cutaneous odontogenic sinus tract that was initially misdiagnosed as a sebaceous cyst. The patient had undergone surgical excision and traditional Chinese medical therapy before endodontic consultation. With the aid of cone beam computed tomography (CBCT), it was confirmed that the causative factor of the cutaneous odontogenic sinus tract was chronic periapical periodontitis of the right mandibular second molar, which had a rare and curved distolingual root. The resolution of the sinus tract and apical healing was accomplished following nonsurgical root canal treatment. CONCLUSION: A dental aetiology must be included in the differential diagnosis of cutaneous sinus tracts in the neck and face. Elimination of odontogenic cutaneous sinus tract infection by endodontic therapy results in resolution of the sinus tract without surgical excision or systemic antibiotic therapy. This case report also indicates that CBCT imaging is useful for identifying the tooth involved, ascertaining the extent of surrounding bone destruction and accurately managing the aberrant canal morphology.

Active implant peri-apical lesion: a case report treated via guided bone regeneration with a 5-year clinical and radiographic follow-up.

Implant peri-apical lesion (IPL) is a periapical lesion, usually asymptomatic, in which the coronal portion of the implant achieves a normal bone to implant interface. A case of IPL following immediate implant placement and treated with guided bone regeneration (GBR) principles is described. Five-year clinical and radiographic follow-up with cone-beam assessment showed complete healing of the bone. GBR principles applied to IPL could completely solve the lesion.

Odontogenic cutaneous draining sinus.

The aim of the present article was to discuss an unusual case report of the odontogenic cutaneous sinus with emphasis on diagnosis and treatment. The causative factor in this case was diagnosed intraoperatively due to infected follicular space in absence of any sign and symptoms. Timely diagnosis of the case could have prevented significant morbidity due to mistreatment medically and surgically with eventual recurrence.

Needle subcision: a conservative treatment for facial dimpling after elimination of odontogenic infection source: a technical note.

AIM: Extraoral skin fistula after resolution of odontogenic infection often resolves spontaneously, but in some cases, facial dimpling occur which needs revision surgery. This article evaluates the result of needle subcision for treatment of this condition, with or without dermal filler injection. METHODS: Five patients with facial dimpling that was remained after elimination of odontogenic infection origin were evaluated. Subcision alone was used in four patients, and needle subcision followed by dermal filler was done in a patient. RESULTS: Facial dimpling in the chin (a case), mandibular lower border (two cases) as well as cheek skin (two cases) were treated by this method. All patients were satisfied with the cosmetic results. Six month after surgery, treatment outcomes were stable. CONCLUSION: Needle subcision is a simple and conservative method for correction of facial dimpling after elimination of odontogenic infection source.

Transcervical removal of an impacted third molar: an uncommon indication.

This article presents a case of and reviews the literature involving the extraoral approach for surgical removal of an ectopic mandibular third molar tooth. Case reports describing extraction of the mandibular third molar using the extraoral approach are very limited. This article describes an unusual case of an impacted, infected, ectopic right mandibular third molar that was positioned at the inferior border and had caused an extraoral draining sinus. Furthermore, the roots were intimately involved with the inferior alveolar nerve (IAN) and had perforated the buccal cortex of the mandible. Surgical removal using a transcervical submandibular approach was deemed necessary to try to preserve the IAN and avoid fracture of the mandible in this 74-year-old patient.

Facial cutaneous sinuses of dental origin - a diagnostic challenge.

It is common for practitioners to misdiagnose the cause of facial cutaneous sinus tracts, failing to recognise that many have an odontogenic cause. Chronic infection around the apex of a dental root can drain to the mouth or less commonly to the skin via a sinus tract. Dental symptoms are not always present and this confuses the clinical picture further. Failure to identify an odontogenic cause may result in unnecessary and ineffective treatment. Elimination of dental infection via tooth extraction or root canal treatment leads to resolution of the cutaneous sinus. We present a series of cutaneous draining sinuses of dental origin that resolved rapidly following dental treatment and hope to highlight the importance of including odontogenic infection in the differential diagnosis of such a lesion in the head and neck.

The use of diffuse laser photonic energy and indocyanine green photosensitiser as an adjunct to periodontal therapy.

Light-activated chemical therapy - generally known as photodynamic therapy (PDT) - has been developed within medicine, to allow the use of an applied agent (photosensitiser) that could be activated using laser photonic energy, leading to the destruction of target cellular structures. In clinical dentistry, PDT has been utilised within a wide scope of topical application in endodontic, periodontal and oral epithelial pathology where specifically, anti-bacterial action may prove useful. Underlying the complex and multi-factorial aetiology, periodontal disease remains of essentially-bacterial origin and anti-bacterial PDT (aPDT) has been investigated as an adjunctive to other periodontal treatment therapies. Of several topically-applied photosensitisers, one agent, indocyanine green, may be activated using a diode laser wavelength (810 nm) that is commonly-available in clinical dental practice, to provide generalised bacteriocidal effect. Unlike antibiotics and antibacterial mouthwashes, the mode of action appears to be nonspecific to bacterial species and is linked to cell death through a process of oxidative stress. Additionally, indocyanine green has otherwise low toxicity to non-target host tissue and dental restorative materials. This paper explores the background to this therapy, its position within the broader delivery of periodontal treatment and the specific application of indocyanine green in clinical dental practice.

Guided bone regeneration in the treatment of fenestration osseous defect.

This article presents a case with a fenestration defect which was treated by placing a resorbable barrier alone. In the case presented, the osseous defect was a natural space maker with the wall of the defect providing sufficient support to prevent collapse of the membrane into the space. So the use of membrane alone is the preferred treatment. Resorbable collagen membrane was placed in order to avoid a second surgical procedure to remove the nonresorbable membrane. The membrane was positioned by placing a resorbable sling suture such that it covered the defective site adequately. Postsurgical healing of the defect was evaluated 1 month after the surgery and it was satisfactory. Thus guided bone regeneration of the fenestration defect is a reliable treatment procedure.

Platelet-rich fibrin in treatment of periapical lesions: a novel therapeutic option.

In the present case of a 35-year old patient, platelet-rich fibrin, which is an autologous platelet concentrate, was used to fill the osseous defect following surgery. The case was assessed both clinically and radiographically for a period of 9 months.

Endodontic and surgical treatment of root damage caused by orthodontic miniscrew placement.

INTRODUCTION: Miniscrews are being increasingly used for anchorage control in orthodontics. Despite the concern over root damage caused by miniscrews, there are few reports of precise clinical evaluations and appropriate management of that damage. In the case presented herein, the root damage caused by the placement of miniscrews was repaired by root canal treatment and surgical intervention. METHODS: A 44-year-old man received orthodontic treatment for intrusion of the left maxillary first molar with a miniscrew anchorage system. During that treatment, the miniscrews had fallen out and had to be reinserted more than 6 times in the same area. Two years later, the patient complained of a spontaneous pain in the maxillary left molar region. Although the patient received root canal treatment, intraoral sinus tracts could still be detected, and the patient's discomfort persisted. Periradicular surgery revealed that the persistent infection was related to root surface damage caused by orthodontic miniscrew placement. Healing was achieved by a combination of root canal treatment and surgical intervention. RESULTS: Scanning electron microscopy of the damaged distobuccal root apex revealed a mature biofilm consisting of a network of matrix that contained mostly rod-like and spherical bacteria. At a 12-month recall checkup, the patient was free of pain. A repeat periapical radiograph revealed reduction of the pretreatment radiolucent lesion. CONCLUSIONS: More careful planning of miniscrew placement is necessary to lessen the danger of root damage. Furthermore, a precise evaluation of both root and pulpal damage and careful consideration of the choice of optimal treatment modality are needed.

Layered socket Grafting using an anorganic bovine bone mineral-collagen composite.

Following tooth extraction, socket grafts are commonly used to prevent incomplete healing and to optimize the bony site for implant placement (1). Many particulate, composite, and putty-like bone grafting materials either with or without a membrane have been used as socket grafts. This article introduces the layered socket grafting technique for socket grafting without the use of a membrane or primary closure. This technique uses a particulate anorganic bone mineral to graft the apices of sockets and then a composite material consisting of anorganic bovine bone mineral and collagen for the superior or crestal one-third of a socket or defect. When grafting sockets, the technique is fast and does not require the use of releasing flaps or primary closure and can also be used to manage large periapical defects.

Inflammatory implant periapical lesion prior to osseointegration: a case series study.

PURPOSE: To report 20 cases with implant periapical pathology diagnosed during the osseointegration phase, evaluating retrospectively the efficacy of the treatment with implant periapical surgery. MATERIALS AND METHODS: A retrospective chart review was conducted of all patients in whom implant periapical surgery was performed between 1996 and 2010. The criteria for diagnosing implant periapical pathology and, accordingly, performing implant periapical surgery were: (1) acute pain during the osseointegration period (8 weeks after implant placement) located in the area of the affected implant or presence of mucous fistula in relation with the implant apex; (2) absence of implant mobility; (3) non-dull percussion of nonsubmerged implants; and (4) presence or absence of implant periapical radiolucency. RESULTS: Twenty-two implants were diagnosed with periapical pathology in 20 patients (13 women and 7 men) with a mean age of 54.3 years (range, 32 to 70 years) and were consecutively treated by a surgical approach. In 19 implants, the diagnosis was acute apical peri-implantitis (nonsuppurated in 7 cases and suppurated in 12), as based on the symptoms and radiographic sign, and in 3 cases it was subacute apical peri-implantitis, as based on the presence of a fistula. After a minimum follow-up of 1 year, 20 implants remained functional, with no clinical or radiologic alterations; the survival rate of the treated implants was 91%. CONCLUSION: The early diagnosis of inflammatory implant periapical lesions during the osseintegration phase, and their prompt surgical treatment, led to a survival rate of the treated implants of 91%.

Clinical outcome in periradicular surgery: effect of patient- and tooth-related factors--a multicenter study.

OBJECTIVE: To evaluate the effect of patient- and tooth-related factors on the outcome of apical surgery in a multicenter study. METHOD AND MATERIALS: A total of 281 teeth in 255 patients undergoing periradicular surgery were investigated clinically and radiographically 6 to 12 months postoperatively. RESULTS: The overall success rate was 88.0%. Sex was a significant (P = .024) predictor, with a success rate of 89.8% in females and 84.0% in males. The success rate was significantly higher in patients 31 to 40 years of age. The treatment of premolars resulted in a significantly higher success rate (91.9%) than the treatment of anterior teeth (86.1%, P = .042) and molars (86.4 %, P = .026). The loss of the buccal bone plate and the extension of apical osteolysis to the furcation area in molars resulted in a considerably lower success rate. Lesion size, preoperative pain, tenderness to percussion, fistula, and resurgery were significant factors. CONCLUSION: There are several factors influencing the success rate of apical surgery that must be taken into account when considering apical surgery as a treatment alternative.

Pulp revascularization in an immature necrotic tooth: a case report.

Immature permanent teeth damaged by caries or trauma can present a challenge to dentistry. Currently, triple antibiotic paste (TAP) containing ciprofloxacin, metronidazole, and minocycline is used to attempt revascularization in necrotic immature teeth. Therefore, the purpose of this report was to present a case of pulp revascularization in an immature necrotic tooth. An 8-year-old male presented with trauma to the permanent maxillary left and right central incisors. Upon clinical and radiographic examination, the left central incisor was deemed necrotic. Revascularization therapy was performed over multiple visits. At 11 months follow-up, healing of the periapical area and apexogenesis were found to be complete. With an increasing breadth of clinical evidence and practitioner acceptance, regenerative techniques may become a standard technique in treating immature necrotic permanent teeth.