Histologic Features of External Cervical Resorption Affecting Impacted Maxillary Canines: A Report of 2 Cases.

Reports on the histopathologic features of external cervical resorption (ECR) in unerupted teeth are scarce. This article reports on 2 maxillary impacted canines from different patients that showed ECR lesions and were surgically removed and histologically evaluated. Case 1 showed symptoms associated with oral communication of the dental follicle and pulpal exposure. Radiographs and cone-beam computed tomographic imaging showed that resorption affected a large part of the root and the crown. Case 2 was asymptomatic, and the resorption cavity was restricted to the tooth crown. Both teeth were extracted and subjected to histologic processing and analysis. In case number 1, the coronal pulp was necrotic and infected, showing areas of exposure to the resorption channels. The apical pulp was vital and uninflamed. The pulp space was surrounded by a continuous pericanalar resorption-resistant sheet. Part of the resorbed area of dentin was occupied by inflamed granulation tissue. More apically, a network of trabecular bone was present in the resorbed area. In case number 2, the pulp around the resorbed area was uninflamed and vital. A large fraction of the lost dentin was replaced by trabecular bone, closely adapted to the irregularly resorbed dentin surface, and no inflammatory cells. Our findings indicate that impacted teeth with ECR may remain asymptomatic until associated with infection. Histologic features of resorption in impacted teeth were similar to those in erupted teeth. In the case associated with infection, the resorbed area was occupied by inflamed tissue and newly formed bone. In the case with no infection, the resorption area was filled with bone undergoing a remodeling process.

Surgical management of a lateral lesion refractory to root canal retreatment caused by an extraradicular calculus. A case report.

This article describes the management of a root canal-treated maxillary central incisor displaying a radiographic lateral radiolucency and a sinus tract that persisted irrespective of root canal retreatment following high standards. Endodontic microsurgery was indicated and curettage of the pathologic tissue revealed a calculus-like material attached to the outer root surface around the exit of a large lateral canal. A non-conventional approach was chosen: No root-end resection was conducted. Instead, the calculus was removed and the apical surface was scaled and smoothed, conserving the apical structure. Retrocavities were prepared in both lateral and apical foramens and filled with a bioceramic material. Follow-up examination showed optimal soft tissue healing. One-year follow-up of radiographs revealed healing of the lateral lesion. The lesion was diagnosed as a cyst, with an infected lumen. An exuberant calculus-like material attached to the external root surface was the most likely cause of the recalcitrant lateral periradicular lesion.

Unusual Lesion Caused by Food Displacement Into the Oral Mucosa, Mimicking a Sinus Tract.

This article reports an unusual case of foreign body lesion on the oral mucosa. A 61-year-old man, with no previous traumatic episode, presented with a small swelling resembling a sinus tract on the mucosa in the anterior mandible, adjacent to the left central and lateral incisors. Because of a discrete drainage of serous/purulent exudate, the clinician initially suspected endodontic involvement; however, the adjacent teeth were caries-free, responded positively to pulp tests, and the periapical tissues were radiographically normal. Exploration of the lesion opening under an operating microscope revealed a small seed associated with a dark filamentous structure; both were removed and processed for histologic examination. The seed was from a fig, and was germinating under the mucosa conditions. Bacterial colonization of the vegetable structures and polymorphonuclear leukocyte accumulations were histologically observed. The mucosa healed completely and uneventfully over the following weeks.

Unusual Location of Dens Invaginatus Causing a Difficult-to-Diagnose Pulpal Involvement.

This article reports on an unusual case of dens invaginatus in a maxillary third molar that was causing severe symptoms of irreversible pulpitis. This malformation was not clinically or radiographically identified, and the occurrence of referred pain made the early identification of the responsible tooth difficult. Determination of the tooth that was the source of symptoms was only possible after an observation period and fast aggravation of the pathologic process to cause pulp necrosis and extreme tenderness to percussion. The diagnosis of dens invaginatus was made only after extraction and sectioning. Histopathologic and histobacteriologic features of this case are illustrated.