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.

Dentinal Tubule Penetration of a Calcium Silicate-based Root Canal Sealer with Different Obturation Methods.

INTRODUCTION: The purpose of this study was to investigate the depths of penetration of a calcium silicate-based sealer in dentinal tubules by using 3 different obturation methods. METHODS: One hundred extracted human permanent anterior teeth were endodontically prepared and divided equally into 3 experimental groups and 1 control group as follows: CPoint single cone (CPSC), gutta-percha single cone (GPSC), gutta-percha vertical condensation (GPVC), all with a calcium silicate-based sealer and calcium indicator Fluo-3, and CPoint single cone with a calcium indicator Fluo-3 (CPF3) without sealer as the control. The roots of the teeth in each group were axially cross-sectioned, and the surfaces were examined under confocal laser scanning microscopy at ×10 and ×20 magnifications. The sealer penetration depths were measured at their maximum depths and at 4 circumferential depths (12, 3, 6, and 9 o'clock) by using fluorescence. RESULTS: Statistical analyses by using one-way analysis of variance and repeated measures analysis with linear mixed models showed no statistically significant difference among the mean maximum depth measurements (CPSC, 283.83 µm; GPSC, 318.66 µm; and GPVC, 313.03 µm; P = .7553) and among the average depths across all points (CPSC, 111.24 µm; GPSC, 135.38 µm; and GPVC, 126.62 µm; P = .5304) for the 3 experimental groups. CONCLUSIONS: The pressure derived from hygroscopic expansion of CPoint or warm vertical condensation did not enhance penetration depths of the calcium silicate-based sealer. Sealer penetration into the dentinal tubules occurred independent of the obturation technique.