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Degradation of a silver point in association with endodontic infection.

This paper describes an unusual clinical report of degradation of an endodontic silver point within the root canal of a lower right first premolar. Its apical portion was found to be degrading and at one stage a small portion became separated from its main body and was displaced apically. The tooth, despite past apical surgery, displayed signs of endodontic failure. Conventional retreatment and removal of the silver point improved the endodontic problems associated with this tooth. The silver point was analysed using both scanning electron microscopy and x-ray microanalyses. These tests revealed that the silver point had deteriorated significantly with a surface coating of a silver-chloride salt. Microleakage with infection and galvanic reaction are possible hypotheses as to the reason for the degradation of the silver point. Although other reports have demonstrated corrosion of silver points, this method of presentation appears unique.

Biodegradation, Environmental↗

Black-pigmented anaerobic rods in closed periapical lesions.

AIM: This study determined the frequency of Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia and Prevotella nigrescens in 20 closed periapical lesions associated with symptomatic and asymptomatic refractory endodontic disease. METHODOLOGY: To deliniate possible oral sources of P. endodontalis, the presence of the organism was assessed in selected subgingival sites and saliva in the same study patients. Periapical samples were obtained by paper points during surgical endodontic procedures using methods designed to minimize contamination by non-endodontic microorganisms. Subgingival plaque samples were obtained by paper points from three periodontal pockets and from the pocket of the tooth associated with the closed periapical lesion. Unstimulated saliva was collected from the surface of the soft palate. Bacterial identification was performed using a species-specific polymerase chain reaction (PCR) detection method. RESULTS: P. endodontalis was not identified in any periapical lesion, even though subgingival samples from eight patients (40%) revealed the P. endodontalis-specific amplicon. P. gingivalis occurred in one periapical lesion that was associated with moderate pain. P. nigrescens, P. endodontalis and P. intermedia were not detected in any periapical lesion studied. CONCLUSIONS: Black-pigmented anaerobic rods appear to be infrequent inhabitants of the closed periapical lesion.

DNA, Bacterial↗

Non-surgical root canal treatment of dens invaginatus type 2 in a maxillary lateral incisor.

AIM: To describe the clinical management of an unusual dens invaginatus type 2. SUMMARY: A case of dens invaginatus in a maxillary lateral incisor with a periapical lesion is reported. The patient presented with pain and localized swelling. Despite the complex anatomy and diagnosis of dens invaginatus, non-surgical root canal treatment was performed successfully. Key learning points Dens invaginatus may be presented in many forms, and the aetiology of this phenomenon is not fully understood. Due to abnormal anatomical configuration, dens invaginatus presents technical difficulties in its clinical management. Non-surgical root canal treatment can be performed successfully.

Calcium Hydroxide↗

Endodontic and periodontal treatments of a geminated mandibular first premolar.

AIM: To describe a rare case of gemination involving a mandibular first premolar. SUMMARY: The complex morphology of geminated teeth renders their endodontic and periodontal management difficult. Root canal and periodontal treatments were performed on a geminated mandibular first premolar with three canals. Clinical examination showed two separated crowns with united roots. Radiographically, two distinct pulp chambers with two joined and a third independent canal were seen. Conventional root canal treatment resulted in complete healing of the apical lesion. However, the occurrence of a vertical fracture led to the extraction of the mesial segment. At the follow-up visit, the distal segment was clinically healthy and continued to satisfy functional demands.

Adult↗

Peri-radicular inflammation related to dens invaginatus treated without damaging the dental pulp: a case report.

A 12-year-old boy was referred with a discharging sinus tract related to the maxillary left lateral incisor, and with a non-vital maxillary left central incisor. The lateral incisor gave a positive response to sensitivity testing. The lesion did not heal after disinfection of the root canal of the central incisor, but healed subsequently after 'endodontic' treatment of an invagination in the lateral incisor. After 2 years the lateral incisor continued to give a positive response to sensitivity testing.

Child↗

[Benign diseases of the mandible in MRI].

Diseases of the mandible affect the soft tissues aside from the osseous manifestation. This can be shown clearly and in great detail by magnetic resonance imaging (MRI). MRI is the gold standard in the diagnostic evaluation of any internal derangement of the temporomandibular joint. Dental MRI requires high resolution techniques and in some cases also intravenous administration of contrast material. These techniques allow delineation of the neurovascular bundle. In the past few years new indications were formulated, for example, the evaluation of the integrity of the inferior alveolar nerve in trauma and in radicular cysts. New quantitative methods now enable insights into the pathophysiology. The objective of this review is to communicate accepted indications for MRI of the mandible and to present innovative applications.

Contrast Media↗

[Equipment and transducer-independent 3D ultrasound in the maxillofacial area].

AIM: The use of a new 3D ultrasound system should reduce the drawbacks of former 3D workstations (long image generation time, limited use due to the need for special 3D transducers), so that it is now applicable in daily clinical routine. METHOD: An ultrasound 3D workstation was used based on a pentium PC platform, employing a magnetoelectronic position detection system for spatial reconstruction of conventional 2D B-scan image sequences. RESULTS: Better assessment of topographico-anatomical spatial relationships was achieved when presenting pathological findings, especially in assessing lymph nodes and salivary stones. Pathological processes in the maxillofacial area occurring during a period of five months were visualised. CONCLUSION: The method of 3D reconstruction of standard two-dimensional electronic scans, as presented here, is the first method of its kind enabling applicability in daily clinical routine thanks to rapid imaging. The images can be produced with any ultrasound unit or transducer. First clinical results in maxillofacial surgery clearly show improved diagnostic possibilities although there still room for an improvement of the image quality. The possibility of semi-automatic exact volumetry appears meaningful especially in the investigation of lymph nodes. Integration of colour duplex sonography will further enhance the diagnostic value of this method.

Humans↗

[Special anesthesiological aspects in patients with Niikawa-Kuroki ("Kabuki Make-Up") syndrome].

The Niikawa-Kuroki ("Kabuki Make-up") syndrome (NKS) is a rare disease with a characteristic array of multiple congenital anomalies. The syndrome is characterised by distinct craniofacial dysmorphias, moderate mental retardation, skeletal abnormalities, cardiovascular and urogenital disorders, growth retardation and skeletal muscle abnormalities. The inheritance of NKS is not completely clear. However, the available data are compatible with an autosomal dominant mutation with variable expressivity. There is no specific treatment for NKS. The patients require intensive support for the development of their mental and physical capabilities. Furthermore, therapy includes operative correction of the multiple anomalies. The risk of anaesthesia is increased in these patients because of a possible difficult airway, cardiovascular and urogenital diseases, and abnormalities of the skeletal muscles. Special problems associated with the anaesthetic management in patients with NKS are discussed in this case report.

Abnormalities, Multiple↗

Bacteriologic features and antimicrobial susceptibility in isolates from orofacial odontogenic infections.

OBJECTIVE: The aim of this study was to obtain information for an effective antimicrobial therapy against orofacial odontogenic infections; such information was obtained from recent bacteriologic features and antimicrobial susceptibility data. STUDY DESIGN: The bacteriology and antimicrobial susceptibility of major pathogens in 163 patients with orofacial odontogenic infections to 7 antibiotics was examined. RESULTS: Mixed infection of strict anaerobes with facultative anaerobes (especially viridans streptococci) was observed most often in dentoalveolar infections, periodontitis, and pericoronitis. Penicillin (penicillin G) was effective against almost all pathogens, although it did not work well against beta-lactamase-positive Prevotella. Cefmetazole was effective against all test pathogens. Erythromycin was ineffective against viridans streptococci and most Fusobacterium. Clindamycin exerted a strong antimicrobial activity on anaerobes. Minocycline was effective against almost all the test pathogens. The antimicrobial activity of levofloxacin against viridans streptococci was not strong. CONCLUSIONS: An antibiotic that carries out antimicrobial activity against both viridans streptococci and oral anaerobes should be suitable for treatment of dentoalveolar infection, periodontitis, and pericoronitis. Penicillin remains effective as an antimicrobial against most major pathogens in orofacial odontogenic infections. Cefmetazole, clindamycin, and minocycline may be effective against most pathogens, including penicillin-unsusceptible bacteria.

Anti-Bacterial Agents↗

Paresthesia of the mental nerve induced by periapical infection: a case report.

Paresthesia can be a rare complication of infections of dental origin. This article presents a case of anesthesia/paresthesia caused by a periapical infection of the right mandibular second premolar. The sensory disturbance disappeared 2 weeks after conventional endodontic treatment associated with antibiotic therapy. Twelve months later, the tooth was still asymptomatic. The possible mechanisms responsible for paresthesia associated with periapical infection are discussed.

Chin↗