Clinicopathological study of radicular cysts with actinomycosis.

BACKGROUND/PURPOSE: Actinomycosis is sometimes associated with a radicular cyst (RC). This retrospective study evaluated the clinical and histopathological features of 6 RCs with actinomycosis (AM/RCs). MATERIALS AND METHODS: The demographic data and clinicopathological features of 6 AM/RCs were collected and analyzed. RESULTS: The 6 AM/RCs were taken from 2 male and 4 female patients, and 3 were found in the maxilla and the other 3 in the mandible. The involved teeth included maxillary or mandibular incisors (2 cases) and maxillary or mandibular first and second molars (4 cases). The most common symptom was pain (5 cases) and the more frequent signs were sinus tract and pus discharge (4 cases). Microscopically, the actinomycotic colony presented as a mass with filamentous bacteria arranging in a sun-ray pattern at the periphery. The mean actinomycotic colony number was 7.7 ±â€¯6.6 colonies per slide. Due to the severe inflammation in all 6 AM/RCs, the stratified squamous epithelial lining was completely abolished in 2 cases and partially destroyed in 4 cases with the residual epithelial lining varying from approximately 10%-50%. CONCLUSION: Our results indicate that pain is the most common symptom and sinus tract and pus discharge are the two frequent signs of our 6 AM/RCs. The stratified squamous epithelial lining was either completely abolished (2 cases) or partially destroyed (4 cases) in 6 AM/RCs. Thus, if the endodontically-treated tooth shows a recurrent sinus tract and poor response to repeated conventional root canal treatments, periradicular actinomycotic infection should be highly suspected.

Impact of diabetes mellitus, hypertension, and coronary artery disease on tooth extraction after nonsurgical endodontic treatment.

INTRODUCTION: Limited prospective data are available on the long-term prognosis of teeth receiving nonsurgical root canal treatment (NSRCT) in patients with systemic diseases including diabetes mellitus (DM), hypertension (HT), and coronary artery disease (CAD). This prospective study aimed to elucidate the impact of systemic diseases on the risk of tooth extraction after NSRCT. METHODS: A total of 49,334 NSRCT teeth were randomly selected from databank in October 2003 and were followed for 2 years for tooth extraction after NSRCT. Cox proportional hazards model was used to estimate the risk of tooth extraction after NSRCT. RESULTS: Of the 49,334 teeth, 1592 (3.2%) were extracted during the 2-year follow-up period, yielding a 2-year tooth retention rate of 96.8%. We found that DM (hazard ratio [HR], 1.79), HT (HR, 1.75), and CAD (HR, 1.70) were significant risk factors for tooth extraction after NSRCT (all P values <.0001) in univariate Cox proportional analyses. After adjustment for age, gender, and tooth type in multivariate analyses, DM (HR, 1.29) and HT (HR, 1.18) remained as independent risk factors (both P values <.05). Simultaneous possession of 2 diseases of DM, HT, and CAD was a significant and robust predictor for an increased long-term risk of tooth extraction after NSRCT (P for trend <.001). CONCLUSIONS: An increased risk of tooth extraction after NSRCT is significantly associated with DM, HT, and CAD individually. Moreover, the constellation of systemic disease burden also manifests the importance in addition to other potential confounders.

Histology of Irreversible pulpitis premolars treated with mineral trioxide aggregate pulpotomy.

Studies show that human permanent teeth with carious pulpal exposures can result in a high clinical success rate when treated with pulpotomy and direct pulp capping with mineral trioxide aggregate (MTA pulpotomy). In this case report, a 19-year-old female patient with a second premolar with irreversible pulpitis and symptomatic apical periodontitis was treated with MTA pulpotomy. Follow-up electric pulp tests showed viability of the tooth at three and 10 months. Ten months after the initial treatment, the tooth was extracted for orthodontic reasons and processed for histological examination. Microscopically, the pulpal wound treated with MTA was free from inflammation and covered with a thin layer of reparative dentin. The authors conclude that, when caries and bacterial contamination can be removed from the dentin-pulp complex, the inflamed but vital pulp of a permanent tooth may have a chance to return to a healthy, functional status after MTA pulpotomy.

Regenerative endodontic treatment for necrotic immature permanent teeth.

This retrospective study included 23 necrotic immature permanent teeth treated for either short-term (treatment period <3 months) or long-term (treatment period >3 months) using conservative endodontic procedures with 2.5% NaOCl irrigations without instrumentation but with Ca(OH)(2) paste medication. For seven teeth treated short-term, the gutta-percha points were filled onto an artificial barrier of mineral trioxide aggregate (MTA). For 16 teeth treated long-term, the gutta-percha points, amalgam, or MTA were filled onto the Ca(OH)(2)-induced hard tissue barrier in the root canal. We found that all apical lesions showed complete regression in 3 to 21 (mean, 8) months after initial treatment. All necrotic immature permanent teeth achieved a nearly normal root development 10 to 29 (mean, 16) months after initial treatment. We conclude that immature permanent teeth with pulp necrosis and apical pathosis can still achieve continued root development after proper short-term or long-term regenerative endodontic treatment procedures.

Five-year follow-up study of tooth extraction after nonsurgical endodontic treatment in a large population in Taiwan.

BACKGROUND/PURPOSE: Nonsurgical retreatment, apical surgery and tooth extraction are three major untoward events following nonsurgical root canal treatment (NSRCT). The purpose of this study was to assess untoward events and total tooth extraction after NSRCT in a large population of dental patients in Taiwan. METHODS: A total of 1,588,217 teeth treated with NSRCT in Taiwan in 2000 were analyzed for the first untoward event and total tooth extraction over a 5-year follow-up period. RESULTS: The first untoward event occurred in 192,488 (12.1%) teeth within the first 5 years posttreatment. Nonsurgical retreatment was performed on 69,273 (36.0%) of these teeth, 4741 (2.5%) received apical surgery, and 118,474 (61.5%) were extracted. In addition, 1,463,312 (92.1%) teeth treated with NSRCT were retained in the oral cavity, and 124,905 (7.9%), including 24,499 (19.6%) anterior teeth, 33,356 (26.7%) premolars, and 67,050 (53.7%) molars were extracted within the 5 years of follow-up. Of these 124,905 teeth, 5869 (4.7%) were extracted after nonsurgical retreatment, 562 (0.4%) after apical surgery, and 118,474 (94.9%) after the first untoward events. There were significantly more molars (54.5% vs. 43.3%) and significantly fewer anterior teeth (19.0% vs. 27.5%) extracted in private clinics than in hospitals (p<0.001). The overall tooth extraction rate was significantly greater in hospitals (10.0%) than in private clinics (7.7%, p<0.001). However, tooth extraction procedures were almost evenly distributed over the 5-year follow-up period, with the annual incidence being close to 20%. The overall mean tooth extraction time was significantly greater in private clinics (2.52+/-1.43 years) than in hospitals (2.29+/-1.50 years, p<0.001). CONCLUSION: We conclude that tooth extraction (61.5%) is the most common of the three untoward events, and approximately 95% of tooth extractions are performed at the time of the first untoward event. NSRCT is still a valuable dental procedure in Taiwan because of the high rate (92.1%) of tooth retention after 5 years of follow-up.

First untoward events and reasons for tooth extraction after nonsurgical endodontic treatment in Taiwan.

In this study, 857 teeth having undergone nonsurgical root canal treatment (NSRCT) in Taiwan in 2000 were evaluated during a 5-year follow-up period for first untoward events and reasons for tooth extractions. First untoward events occurred in 83 (9.7%) teeth during this follow-up period, and nonsurgical retreatment was performed for 20 (24.1%), 4 (4.8%) received apical surgery, and 59 (71.1%) were extracted. By the end of this 5-year follow-up period a total of 64 (7.5%) teeth had been extracted. There were 65 reasons for tooth extraction given by the 56 performing dentists who responded to the extraction reason questionnaires; 6 (10.7%) were attributed to endodontically related diseases, 15 (26.8%) to periodontal diseases, 26 (46.4%) to large decay or unrestorable tooth, and 18 (32.1%) to tooth fracture. The conclusion was that 7.5% of the NSRCT teeth were extracted by the end of the 5-year follow-up period, and only 10.7% of these teeth were extracted as a result of endodontically related diseases.

An epidemiologic study of tooth retention after nonsurgical endodontic treatment in a large population in Taiwan.

In this study, tooth retention and untoward events were assessed over a 5-year follow-up period for 1,557,547 teeth receiving nonsurgical root canal treatment (NSRCT) in Taiwan in 1998. We found that 1,446,199 (92.9%) of teeth receiving NSRCT were retained in the oral cavity 5 years after treatment and that a total of 111,348 (7.1%) of the studied teeth were extracted. Untoward events occurred in 159,680 (10.3%) teeth during the 5-year follow-up period. Of this small subpopulation, nonsurgical retreatment was performed for 50,587 teeth (31.7%), apical surgery was performed on 4,502 (2.8%) teeth, and extractions were performed on 104,591 (65.5%) teeth. Approximately 40% of the nonsurgical retreatments and 81% of the apical surgeries occurred in the first follow-up year. However, the yearly incidence of tooth extractions was nearly even within the 5-year study period. We conclude that NSRCT is a valuable dental procedure because of the high rate (92.9%) of tooth retention 5 years after NSRCTs in Taiwan.

Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis: a paradigm shift.

Four clinical cases of immature teeth that developed periradicular periodontitis or abscess underwent a conservative treatment approach, i.e. without canal instrumentation. Instead, only copious 2.5% NaOCl irrigation was performed. All cases presented herein developed mature apices after 7 months to 5 years after the initial treatment without complications, although narrowing canal space was observed. Our clinical observations support a shifting paradigm toward a conservative approach by providing a favorable environment for tissue regeneration. The mechanism of this continued development and formation of the root end is discussed.