Cone beam computed tomography in the detection of reactional osteogenesis of the maxillary sinus: a case report.

This report describes a case of reactional osteogenesis associated with the residual roots of the maxillary left first molar (tooth 14) in a 42-year-old woman. During intraoral examination, an extensive carious lesion was observed in the residual roots of tooth 14. On the periapical radiograph, a radiolucent area with well-defined limits and regular shape was observed in association with these roots. The 3-dimensional cone beam computed tomographic evaluation revealed that the hyperdense mass was homogenous, not corticated, of defined limits, and irregular in shape and had the density of bone tissue. The mass was clearly associated with an inflammatory periapical lesion. In this clinical case, volumetric analysis established a diagnosis of reactional osteogenesis and facilitated removal of the focus of infection associated with its development. Three-dimensional examination of possible changes in the maxillary sinus is crucial when infectious processes are present in the posterior region of the maxilla.

Topical tetracycline in the treatment of a 7-year-old child with necrotizing ulcerative gingivitis: a case report.

A 7-year-old girl presented with necrotic gingival tissue manifesting as large ulcers in the labial and lingual gingival tissue along the region of the mandibular central incisors and right canine. The severe symptoms associated with the gingival lesions were an indication for the use of a topical tetracycline solution. The patient's parent was instructed to prepare the antibiotic solution by crushing a 250-mg tablet of tetracycline in 10 mL of distilled water. Initially, the patient was instructed to use the tetracycline solution 3 times daily for 7 days by swishing the solution around her mouth for 1 minute, expectorating the solution, and rinsing with water. After the first week, the lesions showed marked clinical improvement, and use of the antibiotic was prescribed for an additional 7 days. After 14 days of treatment, the patient presented with complete remission of the lesions. The results in the present case support the use of topical tetracycline as an effective treatment option for NUG.

20-year Follow-up of Recurrent Glandular Odontogenic Cyst Mimicking a Periapical Lesion.

Periapical lesions usually are caused by root canal infection; nevertheless, other pathologies may eventually involve the tooth apex, making the correct diagnosis more difficult. Glandular odontogenic cysts (GOCs) are uncommon and, despite their cystic nature, may present an aggressive behavior and a high recurrence rate. This report describes a recurrent GOC mimicking a periapical lesion that was followed up for 20 years. A 45-year-old woman described tooth discomfort for several years in the anterior region of the mandible that was not exacerbated during eating or occlusion. Clinical examination revealed no signs of swelling, redness, or inflammation in the gingival or surrounding soft tissue. Nevertheless, periapical radiography showed a well-defined large radiolucent lesion in the periapical region of teeth #22, #23, #24, and #25. The pulp test confirmed that all these teeth were vital. An incisional biopsy was performed, and with the histopathological diagnosis of an odontogenic cyst, the lesion was enucleated surgically. After recurrence, the extensive periapical multilocular lesions were again surgically removed. Based on the microscopic findings, the final diagnosis was GOC. One year later, there were no signs of recurrence. GOCs associated with the root apex may mimic periapical inflammatory diseases. Clinical, radiographic, and histopathological findings are essential for the diagnosis of inconclusive radiolucent findings in the periapical region. Biopsy specimens should be sent to a specialized oral pathology laboratory.