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2.
Am J Emerg Med ; 35(5): 808.e5-808.e7, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27988253

RESUMO

An odontogenic cutaneous sinus tract (OCST) is a rare extraoral sinus tract related to a chronic draining dental infection, typically apical periodontitis. OCST usually presents as an erythematous and non-tender nodule and often requires endodontic treatment for resolution of the sinus tract. If there is disruption of the mandibular cortex, it may be difficult to differentiate an OCST from a non-odontogenic malignant mass in patients without dental symptoms. This report describes a rare case of OCST presenting as a left cheek mass in a 21-year-old man which was initially diagnosed in the emergency department.


Assuntos
Bochecha/patologia , Fístula Cutânea/patologia , Fístula Dentária/patologia , Mandíbula/patologia , Periodontite/complicações , Fístula Cutânea/terapia , Fístula Dentária/terapia , Drenagem , Humanos , Masculino , Mandíbula/cirurgia , Periodontite/patologia , Tratamento do Canal Radicular , Resultado do Tratamento , Adulto Jovem
3.
Bull Tokyo Dent Coll ; 57(3): 183-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27665696

RESUMO

Here, we report the diagnosis and treatment of an extraoral cutaneous sinus tract originating in a mandibular second molar with a C-shaped root canal system. The patient was referred to our department by a dermatologist after a series of unsuccessful treatments, including antibiotics. Diffuse radiolucency on a preoperative radiograph revealed that earlier root canal treatment had been only partially successful. Consequently, we performed retreatment of the root canal comprising removal of the former restoration and gutta-percha, cleaning and shaping, and passive irrigation with sodium hypochlorite. The patient responded well, and the cutaneous lesion completely resolved uneventfully within 1 month postoperatively. Preoperative recognition and thorough knowledge of the root canal anatomy and conventional methods of obturation are necessary in performing successful endodontic treatment.


Assuntos
Variação Anatômica , Doenças Ósseas Infecciosas/etiologia , Doenças Ósseas Infecciosas/patologia , Doenças Ósseas Infecciosas/terapia , Periodontite Crônica/complicações , Periodontite Crônica/etiologia , Fístula Cutânea/diagnóstico , Fístula Cutânea/etiologia , Fístula Cutânea/patologia , Fístula Cutânea/terapia , Fístula Dentária/diagnóstico , Fístula Dentária/etiologia , Fístula Dentária/patologia , Fístula Dentária/terapia , Erros Médicos/efeitos adversos , Abscesso Periapical/complicações , Abscesso Periapical/etiologia , Tratamento do Canal Radicular/efeitos adversos , Tratamento do Canal Radicular/métodos , Raiz Dentária/anatomia & histologia , Processo Alveolar/patologia , Doenças Ósseas Infecciosas/diagnóstico , Diagnóstico Diferencial , Guta-Percha/uso terapêutico , Humanos , Doença Iatrogênica , Masculino , Dente Molar/diagnóstico por imagem , Dente Molar/patologia , Radiografia Dentária , Retratamento , Irrigantes do Canal Radicular/uso terapêutico , Tratamento do Canal Radicular/instrumentação , Hipoclorito de Sódio/uso terapêutico , Raiz Dentária/diagnóstico por imagem , Falha de Tratamento , Adulto Jovem
4.
Ugeskr Laeger ; 177(47): V12140674, 2015 Nov 16.
Artigo em Dinamarquês | MEDLINE | ID: mdl-26616832

RESUMO

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.


Assuntos
Fístula Cutânea/diagnóstico , Fístula Dentária/diagnóstico , Fístula Cutânea/diagnóstico por imagem , Fístula Cutânea/patologia , Fístula Cutânea/cirurgia , Fístula Dentária/diagnóstico por imagem , Fístula Dentária/patologia , Fístula Dentária/cirurgia , Infecção Focal Dentária/diagnóstico , Infecção Focal Dentária/diagnóstico por imagem , Infecção Focal Dentária/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Tratamento do Canal Radicular
5.
Int J Dermatol ; 54(1): 50-5, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24134798

RESUMO

BACKGROUND: Odontogenic cutaneous fistulas arise as a sequel of bacterial invasion of the dental pulp, become necrotic, and infection spreads into the periradicular area resulting in dissection and breakthrough to form sinus tracts that drain towards the skin. The objective of this study was to investigate the clinical and epidemiologic characteristics of patients diagnosed with odontogenic cutaneous fistulas. METHODS: A retrospective study was done between January 2001 and December 2011. Cases were included with a clinical and radiological diagnosis of odontogenic cutaneous fistulas. The variables investigated were frequency, gender, age, localization, morphology, time of evolution, and referral clinical diagnosis. Data were analyzed using descriptive statistical methods. RESULTS: During an 11-year period, 75 cases were found. Female gender predominated with 53% of the cases, and the mean age was 45 ± 26 years. The most frequent location was the mandible angle, in 36% of the cases, and the most common morphology was a nodule, in 52%. The mean time of evolution was 8 ± 11 months. The referral clinical diagnosis was odontogenic cutaneous fistulas in 51% of the cases. CONCLUSIONS: Our results are similar to those previously published-the diagnosis was suspected in only half of the cases. We consider it important that odontogenic cutaneous fistulas be included among the differential diagnosis of cutaneous facial lesions to avoid delaying appropriate treatment.


Assuntos
Fístula Cutânea/patologia , Fístula Dentária/patologia , Dente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Fístula Cutânea/epidemiologia , Fístula Dentária/epidemiologia , Face , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
7.
J Endod ; 40(9): 1400-3, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25043329

RESUMO

INTRODUCTION: Interleukin (IL)-17 expression has been detected in apical periodontitis lesions, but its role in the disease process remains unclear. The present study compared the expression of IL-17 in periradicular cysts and granulomas and evaluated the association of this cytokine with clinical and radiographic findings. METHODS: Apical periodontitis lesions (18 cysts and 20 granulomas) were obtained from 38 patients subjected to periradicular surgery. Some clinical, radiographic, and cone-beam computed tomographic features were recorded. Silanized slides containing paraffin sections were used for the immunohistochemical reactions using anti-IL-17 antibody. Image analysis was performed using an optical microscope, and each sample was divided into 5 high-power fields, which were evaluated for the expression of IL-17 in the epithelium and connective tissues. Results were evaluated for correlations with the lesion size and the occurrence of symptoms and sinus tract. RESULTS: Expression of IL-17 was significantly higher in cysts than in granulomas (P = .02). Among the periradicular cysts, a thin epithelium showed significantly increased labeling for IL-17 when compared with a hyperplastic epithelium (P = .003). IL-17 expression was usually associated with focal accumulations of polymorphonuclear leukocytes. No association of IL-17 expression with symptoms, sinus tract, or lesion size was observed (P > .05). CONCLUSIONS: The present study reinforces the notion that IL-17 may take part in the pathogenesis of apical periodontitis lesions. A role in the exacerbation of chronic inflammation and cyst formation is suspected. Further studies are required to shed light on the specific functions of IL-17 in periradicular inflammatory processes.


Assuntos
Interleucina-17/análise , Periodontite Periapical/imunologia , Adulto , Tomografia Computadorizada de Feixe Cônico/métodos , Tecido Conjuntivo/imunologia , Tecido Conjuntivo/patologia , Fístula Dentária/imunologia , Fístula Dentária/patologia , Epitélio/imunologia , Epitélio/patologia , Feminino , Humanos , Hiperplasia , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Neutrófilos/imunologia , Neutrófilos/patologia , Granuloma Periapical/diagnóstico por imagem , Granuloma Periapical/imunologia , Granuloma Periapical/patologia , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/patologia , Cisto Radicular/diagnóstico por imagem , Cisto Radicular/imunologia , Cisto Radicular/patologia
8.
Int Endod J ; 47(12): 1185-91, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24697494

RESUMO

AIM: To report a case in which a submental cutaneous sinus tract resulted from apical periodontitis associated with a mandibular second molar. SUMMARY: A 53-year-old man presented with a chronic cutaneous sinus tract in the submental region, which had previously been misdiagnosed as a thyroglossal fistula. The origin of the sinus tract was shown by sinus tract angiography to be the left mandibular second molar (tooth 37), which had apical periodontitis. The sinus tract healed after extraction of the tooth and partial excision of the lesion from an extraoral approach. Histological examination confirmed that the tract was lined with granulation tissue and not with epithelial tissue. A submental sinus tract drainage pathway was observed. Prompt dental evaluation, especially of all mandibular teeth, should be considered when assessing cases of submental cutaneous sinus tracts. KEY LEARNING POINTS: An odontogenic origin should be part of the differential diagnosis for orofacial skin lesions. Cutaneous sinus tracts of mandibular molar origin are complex and thus a comprehensive examination should be stressed. It is necessary to examine all mandibular teeth in cases of odontogenic submental cutaneous sinus tracts. Sinus tract angiography can be used to identify the sinus tract pathway and to confirm the associated teeth. The treatment of an odontogenic cutaneous sinus tract requires the elimination of the source of infection.


Assuntos
Fístula Cutânea/patologia , Fístula Dentária/patologia , Dente Molar/diagnóstico por imagem , Fístula Cutânea/diagnóstico , Fístula Dentária/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia
9.
J Endod ; 40(4): 476-83, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24666895

RESUMO

INTRODUCTION: This article reports on the morphologic features and the frequency of ciliated epithelium in apical cysts and discusses its origin. METHODS: The study material consisted of 167 human apical periodontitis lesions obtained consecutively from patients presenting for treatment during a period of 12 years in a dental practice operated by one of the authors. All of the lesions were obtained still attached to the root apices of teeth with untreated (93 lesions) or treated canals (74 lesions). The former were obtained by extraction and the latter by extraction or apical surgery. Specimens were processed for histopathologic and histobacteriologic analyses. Lesions were classified, and the type of epithelium, if present, was recorded. RESULTS: Of the lesions analyzed, 49 (29%) were diagnosed as cysts. Of these, 26 (53%) were found in untreated teeth, and 23 (47%) related to root canal-treated teeth. Ciliated columnar epithelium was observed partially or completely lining the cyst wall in 4 cysts, and all of them occurred in untreated maxillary molars. Three of these lesions were categorized as pocket cysts, and the other was a true cyst. CONCLUSIONS: Ciliated columnar epithelium-lined cysts corresponded to approximately 2% of the apical periodontitis lesions and 8% of the cysts of endodontic origin in the population studied. This epithelium is highly likely to have a sinus origin in the majority of cases. However, the possibility of prosoplasia or upgraded differentiation into ciliated epithelium from the typical cystic lining squamous epithelium may also be considered.


Assuntos
Periodontite Periapical/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biofilmes , Diferenciação Celular , Cílios/patologia , Fístula Dentária/microbiologia , Fístula Dentária/patologia , Células Epiteliais/patologia , Epitélio/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Periapical/microbiologia , Abscesso Periapical/patologia , Granuloma Periapical/patologia , Cisto Radicular/patologia , Ápice Dentário/patologia , Dente não Vital/patologia , Adulto Jovem
10.
J Endod ; 40(2): 199-203, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24461404

RESUMO

INTRODUCTION: Cysts and periapical granulomas are inflammatory reactions that develop in response to periapical infection by microbial species in dental root canal. It is known that toll-like receptors (TLRs) are pathogen recognition molecules and that galectins are lectins that can be associated with the inflammatory process, stimulating or inhibiting the immune system. The objective of this study was to evaluate the in situ expression of TLRs and galectins in radicular cysts and periapical granulomas. METHODS: We analyzed 62 cases (30 radicular cysts, 27 periapical granulomas, and 5 control cases). Indirect immunohistochemistry was used to evaluate the expression of TLRs (TRL-2 and TLR-4) and galectins (Gal-3 and Gal-9). RESULTS: The expression of Gal-3 and Gal-9 was significantly higher in periapical granulomas and radicular cysts than in the control group. Similarly, both Gal-3 and Gal-9 were expressed significantly more in periapical granulomas than in radicular cysts. The expression of TLR-2 was significantly higher in periapical granulomas and radicular cysts than in the control group, and it was also significantly higher in radicular cysts with sinus tract than in the cases without sinus tract. Furthermore, the expression of TLR-4 was significantly higher in the cases of periapical granulomas with sinus tract than in the cases without sinus tract. CONCLUSIONS: Gal-3/Gal-9 and TLR-2/TLR-4 expression in the periapical granulomas and radicular cysts is associated with reactive periapical inflammation. Pathobiology of periapical disease is a very complex interplay of many bioactive molecules involved in immunoinflammatory responses. Up-regulation of these bioactive molecules might be an important modulator of inflammatory periapical lesions.


Assuntos
Galectina 3/análise , Galectinas/análise , Granuloma Periapical/metabolismo , Periodontite Periapical/metabolismo , Cisto Radicular/metabolismo , Receptor 2 Toll-Like/análise , Receptor 4 Toll-Like/análise , Biópsia/métodos , Proteínas Sanguíneas , Fístula Dentária/imunologia , Fístula Dentária/metabolismo , Fístula Dentária/patologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Granuloma Periapical/imunologia , Granuloma Periapical/patologia , Periodontite Periapical/imunologia , Periodontite Periapical/patologia , Cisto Radicular/imunologia , Cisto Radicular/patologia
11.
Adv Med Sci ; 58(2): 442-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23793065

RESUMO

PURPOSE: The purpose of this study was to evaluate the prevalence and experience of clinical consequences of untreated dental caries in primary dentition in 5 and 7 year-old children from north-east Poland and to find whether there is a correlation between dmft and pufa indices. MATERIAL/METHODS: Two hundred fifteen children aged 5 and 7 years living in the Podlaskie region were examined in the course of the Polish National Oral Health Survey 2011. Caries prevalence and experience in primary dentition was evaluated according to WHO criteria (dmft index). The clinical consequences of untreated dental caries were assessed by pufa index. RESULTS: The dmft index was 5.56 ± 4.45 in 5-years-old children and 6.69 ± 3.14 in 7-years-olds. The prevalence/experience of pufa index was 43.4%/2.20 ± 3.43 and 72.4%/2.44 ± 2.22, respectively. Children living in rural areas presented a worse dental condition. A statistical analysis revealed a strong relation between dmft and pufa in both age groups. CONCLUSION: The present study revealed negligence in the dental treatment of children from north-east Poland resulting in the high prevalence and experience of the pufa index in primary dentition. This index is a valuable measurement tool to record the clinical consequences of untreated dental caries.


Assuntos
Cárie Dentária/epidemiologia , Fístula Dentária/epidemiologia , Saúde Bucal/estatística & dados numéricos , Úlceras Orais/epidemiologia , Índice de Gravidade de Doença , Criança , Pré-Escolar , Cárie Dentária/patologia , Fístula Dentária/patologia , Cavidade Pulpar/patologia , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Úlceras Orais/patologia , Polônia/epidemiologia , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , Dente Decíduo/patologia
12.
Rev. Asoc. Odontol. Argent ; 100(4): 47-53, dic. 2012. ilus
Artigo em Espanhol | LILACS | ID: lil-684956

RESUMO

La fístula dentoalveolar se desarrolla como una ruta de drenaje desde una lesión inflamatoria periapical, siguiendo el camino de menor resistencia, a través de hueso, periostio y mucosa. Puede salir a través de cualquier punto de la mucosa bucal o aún por la piel. Algunos profesionales están convencidos de que la presencia de una fístula indica una lesión seria que requiere cirugía apical e incluso la exodoncia. Sin embargo, su tratamiento tiene buen pronóstico, siendo la indicación correcta una adecuada terapia endodóntica no quirúrgica.


Assuntos
Humanos , Fístula Dentária/etiologia , Fístula Dentária/patologia , Periodontite Periapical/complicações , Fístula Dentária/microbiologia , Infecções Bacterianas/microbiologia , Prognóstico , Tratamento do Canal Radicular/métodos
13.
Rev. Asoc. Odontol. Argent ; 100(4): 47-53, dic. 2012. ilus
Artigo em Espanhol | BINACIS | ID: bin-128649

RESUMO

La fístula dentoalveolar se desarrolla como una ruta de drenaje desde una lesión inflamatoria periapical, siguiendo el camino de menor resistencia, a través de hueso, periostio y mucosa. Puede salir a través de cualquier punto de la mucosa bucal o aún por la piel. Algunos profesionales están convencidos de que la presencia de una fístula indica una lesión seria que requiere cirugía apical e incluso la exodoncia. Sin embargo, su tratamiento tiene buen pronóstico, siendo la indicación correcta una adecuada terapia endodóntica no quirúrgica.(AU)


Assuntos
Humanos , Fístula Dentária/etiologia , Fístula Dentária/patologia , Periodontite Periapical/complicações , Tratamento do Canal Radicular/métodos , Prognóstico , Infecções Bacterianas/microbiologia , Fístula Dentária/microbiologia
14.
Ned Tijdschr Tandheelkd ; 118(6): 330-3, 2011 Jun.
Artigo em Holandês | MEDLINE | ID: mdl-21761797

RESUMO

Hardly any data are available on the clinical consequences of untreated severe caries, because there is no method to quantify the prevalence of oral conditions resulting from untreated caries. In the Philippines, an index was developed which records for (the location of) each tooth whether caries has reached the dental pulp, whether ulceration is present in the surrounding soft tissues due to sharp edges of fragments of a tooth lost due to caries, or whether a fistula or abscess is present. By adding the index to the existing Decayed Missing Filled Tooth index, insight is provided on the extent and the consequences of untreated caries and research may be carried out on its possible impact on the general health and wellbeing of national populations.


Assuntos
Cárie Dentária/classificação , Cárie Dentária/patologia , Doenças Dentárias/classificação , Doenças Dentárias/patologia , Criança , Índice CPO , Cárie Dentária/epidemiologia , Fístula Dentária/classificação , Fístula Dentária/epidemiologia , Fístula Dentária/patologia , Doenças da Polpa Dentária/classificação , Doenças da Polpa Dentária/epidemiologia , Doenças da Polpa Dentária/patologia , Exposição da Polpa Dentária/classificação , Exposição da Polpa Dentária/epidemiologia , Exposição da Polpa Dentária/patologia , Humanos , Mucosa Bucal/lesões , Úlceras Orais/classificação , Úlceras Orais/epidemiologia , Úlceras Orais/patologia , Abscesso Periodontal/classificação , Abscesso Periodontal/epidemiologia , Abscesso Periodontal/patologia , Índice de Gravidade de Doença , Doenças Dentárias/epidemiologia , Dente Decíduo/patologia
15.
Int Endod J ; 44(7): 583-609, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21366626

RESUMO

AIM: To investigate the probability of and factors influencing periapical status of teeth following primary (1°RCTx) or secondary (2°RCTx) root canal treatment. METHODOLOGY: This prospective study involved annual clinical and radiographic follow-up of 1°RCTx (1170 roots, 702 teeth and 534 patients) or 2°RCTx (1314 roots, 750 teeth and 559 patients) carried out by Endodontic postgraduate students for 2-4 (50%) years. Pre-, intra- and postoperative data were collected prospectively on customized forms. The proportion of roots with complete periapical healing was estimated, and prognostic factors were investigated using multiple logistic regression models. Clustering effects within patients were adjusted in all models using robust standard error. RESULTS: proportion of roots with complete periapical healing after 1°RCTx (83%; 95% CI: 81%, 85%) or 2°RCTx (80%; 95% CI: 78%, 82%) were similar. Eleven prognostic factors were identified. The conditions that were found to improve periapical healing significantly were: the preoperative absence of a periapical lesion (P = 0.003); in presence of a periapical lesion, the smaller its size (P ≤ 0.001), the better the treatment prognosis; the absence of a preoperative sinus tract (P = 0.001); achievement of patency at the canal terminus (P = 0.001); extension of canal cleaning as close as possible to its apical terminus (P = 0.001); the use of ethylene-diamine-tetra-acetic acid (EDTA) solution as a penultimate wash followed by final rinse with NaOCl solution in 2°RCTx cases (P = 0.002); abstaining from using 2% chlorexidine as an adjunct irrigant to NaOCl solution (P = 0.01); absence of tooth/root perforation (P = 0.06); absence of interappointment flare-up (pain or swelling) (P =0.002); absence of root-filling extrusion (P ≤ 0.001); and presence of a satisfactory coronal restoration (P ≤ 0.001). CONCLUSIONS: Success based on periapical health associated with roots following 1°RCTx (83%) or 2°RCTx (80%) was similar, with 10 factors having a common effect on both, whilst the 11th factor 'EDTA as an additional irrigant' had different effects on the two treatments.


Assuntos
Doenças Periapicais/terapia , Tratamento do Canal Radicular/métodos , Adulto , Quelantes/uso terapêutico , Clorexidina , Estudos de Coortes , Contraindicações , Fístula Dentária/patologia , Cavidade Pulpar/lesões , Cavidade Pulpar/patologia , Ácido Edético/uso terapêutico , Feminino , Seguimentos , Guta-Percha/uso terapêutico , Humanos , Masculino , Doenças Periapicais/diagnóstico por imagem , Tecido Periapical/diagnóstico por imagem , Tecido Periapical/patologia , Técnica para Retentor Intrarradicular , Prognóstico , Estudos Prospectivos , Radiografia , Retratamento , Materiais Restauradores do Canal Radicular/uso terapêutico , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/instrumentação , Preparo de Canal Radicular/métodos , Hipoclorito de Sódio/uso terapêutico , Ápice Dentário/patologia , Odontalgia/prevenção & controle , Resultado do Tratamento , Cicatrização/fisiologia , Cimento de Óxido de Zinco e Eugenol/uso terapêutico
16.
Int Endod J ; 44(6): 574-82, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21342210

RESUMO

AIM: To present the successful endodontic and periodontal management of a two rooted maxillary lateral incisor tooth with a complex radicular lingual groove and severe periodontal destruction using spiral computed tomography as a diagnostic aid. SUMMARY: A 30-year-old male patient presented with a chief complaint of mobility and discharge of pus in an upper front tooth. Clinical examination revealed a sinus tract on the labial gingival surface and a 10-mm-deep periodontal pocket associated with maxillary left lateral incisor tooth. On the lingual side, a groove emerging from cingulum, continuing mesioapically down the lingual aspect of tooth was found. Intraoral periapical radiographs demonstrated a lateral periodontal defect around the mesial aspect and a diffuse radiolucency at the apex of maxillary left lateral incisor tooth. The sinus tract was traced with gutta-percha to the maxillary left lateral incisor that showed an accessory root surrounded by a large radiolucent area. A spiral computed tomographic scan for better understanding of the complicated root canal morphology of the tooth was performed. Based on the clinical, radiographic and spiral computed tomographic findings, a diagnosis of an endo-perio lesion in tooth 22 was made. Management consisted of conventional root canal treatment, radiculoplasty, root resection of accessory root and surgical curettage of the periodontal defect. Follow-up with radiographic examination at 3 months and 1 year was performed. At 1-year recall, the patient was asymptomatic, there was no evidence of the sinus tract and a 3-mm nonbleeding pocket was present in relation to tooth 22. Progression of hard tissue healing was observed in the periapical radiograph taken 1 year postoperatively. KEY LEARNING POINTS: The key to achieving favourable results in this particular type of developmental anomaly is accurate diagnosis and treatment planning. The health of the periapical osseous tissues appears to be the provital factor for tooth retention. A favourable outcome can only be achieved with a comprehensive treatment approach that effectively manages all local factors that are contributing to the disease process.


Assuntos
Fístula Dentária/terapia , Cavidade Pulpar/anormalidades , Incisivo/anormalidades , Doenças Periapicais/terapia , Bolsa Periodontal/terapia , Tratamento do Canal Radicular/métodos , Adulto , Fístula Dentária/complicações , Fístula Dentária/diagnóstico por imagem , Fístula Dentária/patologia , Cavidade Pulpar/patologia , Humanos , Incisivo/patologia , Masculino , Maxila , Doenças Periapicais/complicações , Doenças Periapicais/diagnóstico por imagem , Doenças Periapicais/patologia , Bolsa Periodontal/complicações , Bolsa Periodontal/diagnóstico por imagem , Bolsa Periodontal/patologia , Tomografia Computadorizada Espiral , Raiz Dentária/anormalidades , Resultado do Tratamento
18.
Dent Traumatol ; 25(6): 620-625, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19917027

RESUMO

Pulp canal obliteration (PCO) is a sequela of tooth trauma. The dental clinician faced with this condition has to make a difficult decision. The aim of this study was to evaluate the clinical signs and symptoms associated with teeth with PCO and to assess the status of the periapical tissues using the periapical index (PAI) as an aid in making a treatment decision. The study included teeth diagnosed with PCO in patients with a history of traumatic injury to the involved teeth. Histories of associated signs and symptoms including pain, swelling and drainage from a sinus tract were elicited. Tooth color, sensibility to electric pulp testing, mobility and percussion tenderness were recorded. The periapical status was assessed using the PAI. Two hundred and seventy-six teeth were diagnosed with PCO. One hundred and fifty-seven (56.9%) and 119 (43.1%) demonstrated partial or total PCO, respectively. Yellow discoloration presented most frequently, occurring in 186 (67.4%) teeth. Sixty-two (33.3%) of these had developed periapical lesions and reacted negatively to sensibility testing. Fifty-seven (30.7%) of these teeth presented radiographically with a normal periapical appearance and reacted normally to sensibility testing, whereas 67 (36.0%) presented with small changes in the periapical bone pattern and reacted in the high normal range to sensibility testing. Teeth with PAI scores < or =2 presented with occasional spontaneous pain. Teeth with PAI scores > or =3 presented with clinical symptoms and signs ranging from pain on percussion to spontaneous pain, and slight swelling to sinus tract drainage. Based on the findings of this study, endodontic treatment should be initiated in teeth with tenderness to percussion, PAI scores > or =3 and a negative response to sensibility testing.


Assuntos
Calcificações da Polpa Dentária/diagnóstico por imagem , Calcificações da Polpa Dentária/patologia , Tomada de Decisões , Fístula Dentária/etiologia , Fístula Dentária/patologia , Calcificações da Polpa Dentária/etiologia , Calcificações da Polpa Dentária/terapia , Necrose da Polpa Dentária/etiologia , Necrose da Polpa Dentária/patologia , Teste da Polpa Dentária , Humanos , Tecido Periapical/diagnóstico por imagem , Tecido Periapical/patologia , Radiografia , Tratamento do Canal Radicular , Descoloração de Dente/etiologia , Descoloração de Dente/patologia , Traumatismos Dentários/complicações , Odontalgia/etiologia
19.
J Oral Maxillofac Surg ; 67(11): 2332-6, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19837299

RESUMO

PURPOSE: The sinus and fistulous tracts in the head and neck region often pose a challenge to the surgeon, and are usually misdiagnosed, resulting in treatment failure. MATERIALS AND METHODS: This study included 117 patients who presented to the Department of Dental and Maxillofacial Surgery, Department of General Surgery, and Department of Dermatology of the Sheri-Kashmir Institute of Medical Sciences Medical College (Srinagar, India) over a period of 7 years. All 117 patients were analyzed using clinical methods, radiologic studies, and laboratory investigations. RESULTS: The mean age of patients was 30 years, with a male-to-female ratio of 3:2. A dental origin was noticed in 55% of these tracts, followed by tracts originating from infected implants or bone grafts (20%) and chronic osteomyelitis (11%). Eighty percent of these tracts had a mandibular origin (and from the anterior part) (53%). Maxillary tracts arose mostly from the posterior part of the bone (70%). The commonest presenting symptom was discharge from a nonhealing wound. Anterior mandibular tracts were straight and short (84%), whereas posterior mandibular tracts were mostly long and curved (75%). Misdiagnosed and mismanaged sinuses and fistulas were mostly of odontogenic origin (70%). Radiologic studies were the most useful diagnostic tools in tracts related to dental pathology, infected implants/bone grafts, and chronic osteomyelitis. Proper treatment of basic pathology was followed by complete healing in 96% of patients. CONCLUSION: All patients with sinus or fistulous tracts in the head and neck region should be properly assessed and evaluated for proper diagnosis and treatment, to prevent the recurrence and chronicity of these lesions.


Assuntos
Fístula Dentária/cirurgia , Fístula/cirurgia , Osteomielite/complicações , Infecções Relacionadas à Prótese/complicações , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Fístula Dentária/etiologia , Fístula Dentária/patologia , Ossos Faciais/patologia , Ossos Faciais/cirurgia , Feminino , Fístula/etiologia , Fístula/patologia , Seguimentos , Cabeça/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Osteomielite/patologia , Infecções Relacionadas à Prótese/patologia , Resultado do Tratamento , Adulto Jovem
20.
Braz Dent J ; 20(3): 249-53, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19784473

RESUMO

Hymenoptera order includes bees, which have a stinging apparatus at the tail capable of delivering venom to the affected tissues. Myocardial infarction, acute renal failure, Necrotizing fasciitis, fatal infection and hemifacial asymmetry, are some of the unusual reactions reported following hymenoptera stings. This paper reports a case of bee sting in the right floor of the nose that mimicked an odontogenic infection affecting the upper lip, canine space and nasal cavity such as in cases of infection secondary to pulpal or periodontal pathology of the anterior teeth. After a thorough clinical and radiographic examination, odontogenic infection was discarded and the diagnosis of floor of the nose mucosal lysis and lip abscess secondary to a bee sting was made. This case was successfully managed with adequate incision, drainage and antibiotics without any further complication. There are several reports of unusual reactions following hymenoptera stings. However, just a few of them referred to infections of local reactions and none of them related to the anatomic location affected in the patient of the present case. Early diagnosis and treatment prevented infection dissemination and the likelihood of tissue necrosis as in previously reported cases of Necrotizing fasciitis.


Assuntos
Abscesso/patologia , Fístula Dentária/patologia , Mordeduras e Picadas de Insetos/complicações , Doenças Labiais/patologia , Mucosa Nasal/patologia , Abscesso/etiologia , Abscesso/terapia , Adulto , Animais , Venenos de Abelha/efeitos adversos , Abelhas , Desbridamento , Fístula Dentária/etiologia , Fístula Dentária/terapia , Diagnóstico Diferencial , Drenagem , Humanos , Doenças Labiais/etiologia , Doenças Labiais/terapia , Masculino , Doenças Dentárias/patologia , Resultado do Tratamento
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