RESUMO
INTRODUCTION: Histologic studies of teeth from animal models of revascularization/revitalization are available; however, specimens from human studies are lacking. The nature of tissues formed in the canal of human revascularized/revitalized teeth was not well established. METHODS: An immature mandibular premolar with infected necrotic pulp and a chronic apical abscess was treated with revascularization/revitalization procedures. At both the 18-month and 2-year follow-up visits, radiographic examination showed complete resolution of the periapical lesion, narrowing of the root apex without root lengthening, and minimal thickening of the canal walls. The revascularized/revitalized tooth was removed because of orthodontic treatment and processed for histologic examination. RESULTS: The large canal space of revascularized/revitalized tooth was not empty and filled with fibrous connective tissue. The apical closure was caused by cementum deposition without dentin. Some cementum-like tissue was formed on the canal dentin walls. Inflammatory cells were observed in the coronal and middle third of revascularized/revitalized tissue. CONCLUSIONS: In the present case, the tissue formed in the canal of a human revascularized/revitalized tooth was soft connective tissue similar to that in the periodontal ligament and cementum-like or bone-like hard tissue, which is comparable with the histology observed in the canals of teeth from animal models of revascularization/revitalization.
Assuntos
Apexificação/métodos , Dente Pré-Molar/patologia , Abscesso Periapical/terapia , Compostos de Alumínio/uso terapêutico , Antibacterianos/administração & dosagem , Coagulação Sanguínea/fisiologia , Calcificação Fisiológica/fisiologia , Compostos de Cálcio/uso terapêutico , Cementogênese/fisiologia , Criança , Ciprofloxacina/administração & dosagem , Tecido Conjuntivo/patologia , Fístula Dentária/terapia , Cavidade Pulpar/patologia , Necrose da Polpa Dentária/terapia , Dentina/patologia , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Metilmetacrilatos/uso terapêutico , Metronidazol/administração & dosagem , Minociclina/administração & dosagem , Óxidos/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Silicatos/uso terapêutico , Ápice Dentário/patologia , Cimento de Óxido de Zinco e Eugenol/uso terapêuticoRESUMO
AIM: This work describes the retreatment of an unusual case of dens invaginatus with gutta-percha overfilling at the gingival mucosa and chronic apical periodontitis in a 34-year-old woman. Initial periapical radiograph showed the presence of type II dens invaginatus with poor quality obturation, root perforation and chronic apical periodontitis of tooth 22. BACKGROUND: Dens invaginatus is a tooth malformation caused by infolding of the dental papilla during tooth development. This anomaly has been associated with increased prevalence of pulpal and periapical diseases. CASE DESCRIPTION: Conventional endodontic retreatment was performed using rotary files and calcium hydroxide paste as intracanal dressing. After 7 days, root canal was filled with guttapercha points and Sealapex® sealer. Obturation was radiographically followed and, after 3 years, absence of fistula and periapical radiolucency was observed, thus conventional endodontic therapy proved to be successful. CONCLUSION: Conventional endodontic retreatment of type II dens invaginatus has been successful for a 3-year period, showing a better treatment alternative. CLINICAL SIGNIFICANCE: Conservative endodontic retreatment of dens invaginatus should be considered to promote periapical healing with complete reconstitution of bone and periodontal ligament regeneration without signs of recurrence over a period of 3 years. Moreover, it preserves the entire tooth.
Assuntos
Dens in Dente/terapia , Corpos Estranhos/etiologia , Gengiva/patologia , Guta-Percha/efeitos adversos , Periodontite Periapical/etiologia , Materiais Restauradores do Canal Radicular/efeitos adversos , Tratamento do Canal Radicular/efeitos adversos , Adulto , Doença Crônica , Fístula Dentária/etiologia , Fístula Dentária/terapia , Feminino , Seguimentos , Corpos Estranhos/terapia , Humanos , Incisivo/anormalidades , Periodontite Periapical/terapia , Radiografia Interproximal , Retratamento , Preparo de Canal Radicular/instrumentação , Preparo de Canal Radicular/métodos , Raiz Dentária/lesõesRESUMO
OBJECTIVE: To compare via a split-mouth randomized clinical trial the efficacy of 1% chlorhexidine gel, calcium hydroxide/camphorated paramonochlorophenol (Callen PMCC), and a one-visit endodontic treatment against mutans streptococci and anaerobic bacteria found in primary molars with necrotic pulps and to assess clinical success rates after 12 months. METHOD AND MATERIALS: Pre- and posttreatment intracanal samples were collected from 37 teeth (from 21 children) for analysis of the number of mutans streptococci and anaerobic bacteria. Clinical and radiographic criteria were analyzed to determine treatment outcome. RESULTS: Chlorhexidine gel significantly reduced mutans streptococci levels (P = .010), whereas Callen PMCC significantly reduced the levels of anaerobic bacteria (P = .002). No differences in the reduction of mutans streptococci (P = .187) and anaerobes (P = .564) were observed between groups. The clinical success rates were 85.71% (Callen PMCC), 78.57% (chlorexidine gel), and 77.77% (one-visit treatment). CONCLUSION: Teeth treated with Callen PMCC presented the highest clinical success rate. The 1% chlorhexidine gel, as well as calcium hydroxide/camphorated paramonochlorophenol, presented limited efficacy in reducing bacteria from necrotic primary root canals.
Assuntos
Anti-Infecciosos Locais/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Cânfora/uso terapêutico , Clorexidina/uso terapêutico , Clorofenóis/uso terapêutico , Necrose da Polpa Dentária/terapia , Dente Molar/microbiologia , Irrigantes do Canal Radicular/uso terapêutico , Dente Decíduo/microbiologia , Bactérias Anaeróbias/efeitos dos fármacos , Carga Bacteriana/efeitos dos fármacos , Criança , Pré-Escolar , Coroas , Fístula Dentária/terapia , Cavidade Pulpar/microbiologia , Necrose da Polpa Dentária/microbiologia , Combinação de Medicamentos , Seguimentos , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Humanos , Abscesso Periodontal/terapia , Materiais Restauradores do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Tratamento do Canal Radicular/métodos , Streptococcus mutans/efeitos dos fármacos , Resultado do TratamentoRESUMO
Dens invaginatus is a developmental abnormality that alters dental morphology; as a result, treating this condition is a challenge for endodontic practices. This article describes how a combination of nonsurgical and surgical therapies was utilized to treat a maxillary central incisor with Type III dens invaginatus and vital pulp. The treatment plan included using computed tomography (CT) for a detailed analysis of the dental anatomy and periapical area, endodontic and surgical procedures, and a 4-year follow-up period that included periodic clinical and radiographic examinations. The follow-up examinations revealed a regression of the apical lesion and no other signs or symptoms. Based on the present case report, the authors concluded that this combination of surgical and nonsurgical approaches was effective and that CT is a valuable auxiliary tool for the study of dental anatomy.
Assuntos
Dens in Dente/terapia , Fístula Dentária/diagnóstico por imagem , Incisivo/anormalidades , Periodontite Periapical/diagnóstico por imagem , Tratamento do Canal Radicular/métodos , Criança , Dens in Dente/diagnóstico por imagem , Fístula Dentária/terapia , Humanos , Incisivo/diagnóstico por imagem , Masculino , Periodontite Periapical/terapia , Tomografia Computadorizada por Raios X/métodosRESUMO
Root-end resected teeth with persistent apical periodontitis are usually retreated surgically or a combination of non-surgical and surgical retreatment is employed. However, patients are sometimes unwilling to be subjected to a second surgical procedure. The apical barrier technique that is used for apical closure of immature teeth with necrotic pulps may be an alternative to non-surgically retreat a failed apicoectomy. Mineral trioxide aggregate (MTA) has become the material of choice in such cases because of its excellent biocompatibility, sealing ability and osseoinductive properties. This case report describes the non-surgical retreatment of a failed apicoectomy with no attempt at retrofilling of a maxillary central incisor. White MTA was used to induce apical closure of the wide resected apical area. Four-year follow-up examination revealed an asymptomatic, fully functional tooth with a satisfactory healing of the apical lesion. White MTA apical barrier may constitute a reliable and efficient technique to non-surgically retreat teeth with failed root-end resection. The predictability of such a treatment is of great benefit for the patient who is unwilling to be submitted to a second surgical procedure.
Assuntos
Compostos de Alumínio , Apexificação/métodos , Apicectomia , Compostos de Cálcio , Fístula Dentária/terapia , Óxidos , Periodontite Periapical/terapia , Materiais Restauradores do Canal Radicular , Silicatos , Ápice Dentário/cirurgia , Adulto , Combinação de Medicamentos , Humanos , Incisivo/cirurgia , Masculino , Retratamento , Falha de TratamentoRESUMO
Endodontic treatment of teeth with perforating internal root resorption represents a clinical challenge. In most cases, extraction of the tooth and subsequent replacement with an osseointegrated implant is indicated. Presented herein is a case report of a maxillary lateral incisor with advanced perforating internal root resorption in the middle third of the root and the presence of a sinus tract. Mineral Trioxide Aggregate (MTA) was used with the aid of a surgical microscope in order to fill the resorption area after conventional root canal therapy of the apical segment. At the follow-up after 11 years and 8 months, the patient was clinically asymptomatic and the sinus tract had disappeared. The radiographic examination and computerized tomography indicated periodontal bone repair.
Assuntos
Materiais Restauradores do Canal Radicular/uso terapêutico , Reabsorção da Raiz/terapia , Adulto , Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Fístula Dentária/terapia , Combinação de Medicamentos , Feminino , Humanos , Incisivo/patologia , Maxila , Óxidos/uso terapêutico , Retratamento , Tratamento do Canal Radicular/métodos , Reabsorção da Raiz/patologia , Silicatos/uso terapêutico , Dente não Vital/patologiaRESUMO
Root-end resected teeth with persistent apical periodontitis are usually retreated surgically or a combination of non-surgical and surgical retreatment is employed. However, patients are sometimes unwilling to be subjected to a second surgical procedure. The apical barrier technique that is used for apical closure of immature teeth with necrotic pulps may be an alternative to non-surgically retreat a failed apicoectomy. Mineral trioxide aggregate (MTA) has become the material of choice in such cases because of its excellent biocompatibility, sealing ability and osseoinductive properties. This case report describes the non-surgical retreatment of a failed apicoectomy with no attempt at retrofilling of a maxillary central incisor. White MTA was used to induce apical closure of the wide resected apical area. Four-year follow-up examination revealed an asymptomatic, fully functional tooth with a satisfactory healing of the apical lesion. White MTA apical barrier may constitute a reliable and efficient technique to non-surgically retreat teeth with failed root-end resection. The predictability of such a treatment is of great benefit for the patient who is unwilling to be submitted to a second surgical procedure.
Dentes com periodontite persistente após apicectomia são comumente tratados cirurgicamente ou pela combinação de cirurgia e tratamento não-cirúrgico. Porém, alguns pacientes não aceitam se submeter a um segundo procedimento cirúrgico. A técnica da barreira apical, utilizada para fechamento apical de dentes com ápice aberto com necrose pulpar, pode ser uma alternativa não-cirúrgica para retratamento de casos de apicectomia mal sucedida. O agregado de trióxido mineral (MTA) tornou-se o material de escolha para estes casos devido a sua excelente biocompatibilidade, capacidade de selamento e propriedades osseoindutivas. O relato de caso aqui apresentado descreve o retratamento não-cirúrgico de uma apicectomia mal sucedida, sem retrobturação, de um incisivo central superior. Foi utilizado o MTA branco para induzir o fechamento apical da ampla área de ressecção radicular. O exame de acompanhamento quatro anos após o tratamento mostrou um dente assintomático e totalmente funcional com reparo satisfatório da lesão apical. A barreira apical com MTA branco pode ser uma técnica segura e eficaz para o retratamento não-cirúrgico de dentes com apicectomia mal sucedida. A previsibilidade de tal tratamento é um grande benefício para o paciente que não deseja ser submetido a um novo procedimento cirúrgico.
Assuntos
Adulto , Humanos , Masculino , Compostos de Alumínio , Apicectomia , Apexificação/métodos , Compostos de Cálcio , Fístula Dentária/terapia , Óxidos , Periodontite Periapical/terapia , Materiais Restauradores do Canal Radicular , Silicatos , Ápice Dentário/cirurgia , Combinação de Medicamentos , Incisivo/cirurgia , Retratamento , Falha de TratamentoRESUMO
Absence of periapical healing after orthograde retreatment using an apical plug with mineral trioxide aggregate (MTA) can require surgical intervention. A patient with a root-filled maxillary central incisor with chronic apical periodontitis and sinus tract was referred for endodontic retreatment. Excessive apical enlargement was verified, indicating an MTA apical plug placement; however, an unintentional extrusion of MTA occurred during this step. The root canal was filled with gutta-percha and sealer, and periodic recalls were scheduled. The sinus tract was observed after six months and the lesion remained unaltered, although the extruded MTA had resorbed; therefore, an apicoectomy and retrograde root-end filling with MTA were performed. Absence of sinus tract, normal clinical aspect, and complete repair of the lesion were observed at the two-year follow-up.
Assuntos
Compostos de Alumínio/efeitos adversos , Compostos de Cálcio/efeitos adversos , Corpos Estranhos/etiologia , Óxidos/efeitos adversos , Periodontite Periapical/cirurgia , Materiais Restauradores do Canal Radicular/efeitos adversos , Tratamento do Canal Radicular/efeitos adversos , Silicatos/efeitos adversos , Ápice Dentário/patologia , Adulto , Compostos de Alumínio/uso terapêutico , Apicectomia/métodos , Bismuto/uso terapêutico , Compostos de Cálcio/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Fístula Dentária/cirurgia , Fístula Dentária/terapia , Combinação de Medicamentos , Feminino , Seguimentos , Corpos Estranhos/cirurgia , Guta-Percha/uso terapêutico , Humanos , Incisivo/patologia , Óxidos/uso terapêutico , Periodontite Periapical/terapia , Piezocirurgia/métodos , Retratamento , Obturação Retrógrada/métodos , Materiais Restauradores do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Silicatos/uso terapêutico , Dente não Vital/cirurgia , Dente não Vital/terapia , Falha de TratamentoRESUMO
AIM: To present the case of a maxillary left lateral incisor with Oehlers' type III dens invaginatus in which cone beam computed tomography (CBCT) was used as an adjunctive resource in the diagnosis as well as in the planning and 2-year follow-up of the nonsurgical/surgical treatment. SUMMARY: The tooth had two root canals: a primary (main) canal with vital pulp that appeared to be closed apically and an invaginated canal that was necrotic, wide-open at the portal of exit and associated with a large chronic periapical lesion extending to the apex of the maxillary left central incisor. Radiographic tracking of a sinus tract in the labial gingiva of the affected tooth with a gutta-percha point revealed its origin to be the invagination. The CBCT scans revealed that the periapical radiolucency was significantly larger than seen radiographically as well as an increased thickness of the buccal cortical plate. Conventional root canal treatment of the primary canal was undertaken. As nonsurgical access to the invaginated canal was not possible, endodontic surgery was performed for curettage of the lesion, root-end cavity preparation using ultrasonic tips and root canal filling with white mineral trioxide aggregate (MTA). CBCT scanning after 17 months and clinical and radiographic follow-up after 24 months revealed complete periapical repair and absence of symptoms. KEY LEARNING POINTS: The combination of nonsurgical and surgical treatments produced periapical repair in a tooth with type III dens invaginatus with two root canals. CBCT may aid the diagnosis as well as the management plan and follow-up of teeth with this developmental anomaly.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Dens in Dente/diagnóstico por imagem , Incisivo/anormalidades , Planejamento de Assistência ao Paciente , Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Criança , Dens in Dente/terapia , Fístula Dentária/diagnóstico por imagem , Fístula Dentária/terapia , Cavidade Pulpar/anormalidades , Cavidade Pulpar/diagnóstico por imagem , Necrose da Polpa Dentária/diagnóstico por imagem , Necrose da Polpa Dentária/terapia , Combinação de Medicamentos , Seguimentos , Humanos , Incisivo/diagnóstico por imagem , Masculino , Óxidos/uso terapêutico , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/terapia , Obturação Retrógrada/métodos , Materiais Restauradores do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Tratamento do Canal Radicular/métodos , Silicatos/uso terapêuticoRESUMO
INTRODUCTION: Procedural accidents have a negative effect on healing and might contribute to the persistence of infections in inaccessible apical areas, requiring surgical intervention. This report describes a case of persistent apical periodontitis of a lower left first molar associated with the sinus tract and a periapical lesion that required nonsurgical endodontic retreatment and apical surgery for resolution. METHODS: The tooth had received endodontic treatment 3 years ago and had to be retreated using the crown-down technique with chemical auxiliary substance (2% chlorhexidine gel), foramen patency, and enlargement and was filled in a single appointment. The occlusal access cavity was immediately restored with composite resin. After 1 month, it could be observed that the sinus tract persisted and, radiographically, the lesion remained unaltered. Therefore, endodontic microsurgery was indicated. Apical microsurgery was performed under magnification with the use of a dental operating microscope including apicectomy, root end with ultrasound, and sealing with mineral trioxide aggregate. A microbiological sample was collected from the apical lesion. The resected distal root apex was observed by scanning electron microscopy. RESULTS: The following species were detected: Actinomyces naeslundii and Actinomyces meyeri, Propionibacterium propionicum, Clostridium botullinum, Parvimonas micra, and Bacteroides ureolyticus; scanning electron microscopic analysis revealed bacterial biofilm surrounding the apical foramen and external radicular surface. Gutta-percha overfilling at the apex because of a zip caused during initial endodontic treatment could be observed. A 6-month follow-up showed apparent radiographic periapical healing, which progressed after 24 months. CONCLUSION: Gram-positive anaerobic bacteria and extraradicular biofilm seem to participate in the maintenance of persistent periapical pathology, and endodontic retreatment followed by periapical microsurgery proved to be a successful alternative in the resolution of persistent extraradicular infections.
Assuntos
Apicectomia/métodos , Biofilmes , Periodontite Periapical/microbiologia , Dente não Vital/terapia , Actinomyces/isolamento & purificação , Adulto , Compostos de Alumínio/uso terapêutico , Doenças Assintomáticas , Bacteroides/isolamento & purificação , Compostos de Cálcio/uso terapêutico , Clostridium botulinum/isolamento & purificação , Fístula Dentária/terapia , Combinação de Medicamentos , Feminino , Seguimentos , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Microscopia Eletrônica de Varredura , Microcirurgia/métodos , Óxidos/uso terapêutico , Peptostreptococcus/isolamento & purificação , Periodontite Periapical/cirurgia , Piezocirurgia/métodos , Propionibacterium/isolamento & purificação , Retratamento , Obturação Retrógrada/métodos , Materiais Restauradores do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodos , Silicatos/uso terapêutico , Ápice Dentário/microbiologia , Ápice Dentário/patologiaRESUMO
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 TratamentoRESUMO
Dens invaginatus (DI), commonly known as dens in dente, is a developmental malformation of teeth that most commonly affects permanent maxillary incisor teeth. DI can present in a variety of forms, knowledge of which can usefully help in endodontic diagnosis and treatment. This article reports on an unusual case of DI type III with a periradicular lesion in a mandibular lateral incisor. Non-surgical endodontic treatment was performed and resolution of the periradicular lesion was observed at 1 year follow-up. Clinical considerations and treatment are discussed and reported.
Assuntos
Dens in Dente/classificação , Incisivo/anormalidades , Doenças Periapicais/terapia , Tratamento do Canal Radicular/métodos , Adulto , Dens in Dente/terapia , Fístula Dentária/terapia , Necrose da Polpa Dentária/terapia , Seguimentos , Humanos , Masculino , Mandíbula , Materiais Restauradores do Canal Radicular/uso terapêutico , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/métodosRESUMO
AIM: To describe three cases of extraoral sinus tracts, related to infected teeth, which were initially misdiagnosed as skin lesions and inappropriately treated. SUMMARY: The extraoral sinus tracts were initially misdiagnosed as skin lesions. Dermatological surgery was performed and antibiotics prescribed but the lesions did not resolve. Then, a dental cause was sought, and identified. Endodontic intervention resulted in resolution of the problem, confirming the initial misdiagnosis. KEY LEARNING POINTS: Dermatologists and other medical practitioners should be aware that dental extraoral sinus tracts can be confused with skin lesions. A dental aetiology, as part of a differential diagnosis, should be kept in mind with oro-facial skin lesions. If an extraoral sinus tract is of endodontic origin, then elimination of infection through effective endodontic treatment will lead to resolution of the sinus tract. Early correct diagnosis can prevent unnecessary and ineffective antibiotic therapy and/or surgical intervention.
Assuntos
Fístula Cutânea/etiologia , Fístula Dentária/etiologia , Doenças da Polpa Dentária/complicações , Dermatoses Faciais/etiologia , Adolescente , Adulto , Fístula Cutânea/diagnóstico , Fístula Cutânea/terapia , Fístula Dentária/diagnóstico , Fístula Dentária/terapia , Doenças da Polpa Dentária/diagnóstico , Doenças da Polpa Dentária/terapia , Necrose da Polpa Dentária/complicações , Necrose da Polpa Dentária/diagnóstico , Diagnóstico Diferencial , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/terapia , Feminino , Seguimentos , Humanos , Masculino , Periodontite Periapical/diagnóstico , Periodontite Periapical/etiologia , Tratamento do Canal Radicular , Resultado do TratamentoRESUMO
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.
A ordem das himenópteras inclui abelhas, que possuem um ferrão na cauda capaz de de injetar veneno nos tecidos afetados. Fasciite necrosante, infecção fatal e assimetria hemifacial são algumas das reações incomuns relatadas após picada de himenópteras. Este estudo relata um caso de picada de abelha no assoalho da narina direita que simulou uma infecção odontogênica atingindo o lábio superior, o espaço canino e a cavidade nasal, como observado nos casos de infecção secundária após patologia pulpar ou periodontal dos dentes anteriores. Após completo exame clínico e radiográfico, foi descartada a hipótese de infecção odontogênica e foi estabelecido o diagnóstico de lise da mucosa do assoalho da narina e abscesso do lábio, após picada de abelha. Este caso foi tratado com sucesso com adequada incisão, drenagem e administração de antibióticos, sem outras complicações. Há vários relatos de reações incomuns resultantes de picada de himenópteras, porém poucos são relativos a infecções locais e nenhum se refere à localização anatômica afetada no paciente do caso aqui relatado. Diagnóstico e tratamento precoces preveniram a disseminação da infecção e a possibilidade de necrose tecidual, como já relatado em casos de fasciite necrosante.
Assuntos
Adulto , Animais , Humanos , Masculino , Abscesso/patologia , Fístula Dentária/patologia , Mordeduras e Picadas de Insetos/complicações , Doenças Labiais/patologia , Mucosa Nasal/patologia , Abscesso/etiologia , Abscesso/terapia , Abelhas , Venenos de Abelha/efeitos adversos , Desbridamento , Diagnóstico Diferencial , Drenagem , Fístula Dentária/etiologia , Fístula Dentária/terapia , Doenças Labiais/etiologia , Doenças Labiais/terapia , Resultado do Tratamento , Doenças Dentárias/patologiaRESUMO
Dens invaginatus is a rare malformation of the teeth resulting from the invagination of the tooth crown before biological mineralization occurs. In most cases, the thin or incomplete enamel lining of the invagination cannot prevent the entry of bacteria into the pulp, which leads to pulp necrosis with an eventual periapical inflammatory response. The treatment options include preventive sealing or filling of the invagination, root canal treatment, endodontic apical surgery and extraction. The root canal treatment of such teeth is often complicated because of their anatomical complexity. This case describes a successful non-surgical endodontic treatment of a maxillary lateral incisor with type 2 dens invaginatus with a large periradicular lesion. At follow-up examinations after 6 and 12-months, the tooth was asymptomatic and the healed lesion was evident radiographically
Assuntos
Dens in Dente/terapia , Fístula Dentária/terapia , Cavidade Pulpar/anormalidades , Incisivo/anormalidades , Tratamento do Canal Radicular/métodos , Adolescente , Dens in Dente/complicações , Dens in Dente/patologia , Fístula Dentária/complicações , Cavidade Pulpar/patologia , Cavidade Pulpar/cirurgia , Necrose da Polpa Dentária/etiologia , Necrose da Polpa Dentária/cirurgia , Humanos , Incisivo/cirurgia , Masculino , Maxila , Raiz Dentária/anormalidades , Raiz Dentária/patologia , Resultado do TratamentoRESUMO
Las reabsorciones cervicales son entidades patológicas de etiología no pulpar, ocasionadas por procesos inflamatorios tardíos a nivel cervical del cemento radicular, lo que hace complicado su diagnóstico. En el presente trabajo se presenta el manejo de dos casos clínicos de reabsorciones radiculares cervicales
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Fístula Dentária/etiologia , Fístula Dentária/terapia , Cimentos de Ionômeros de Vidro , Obturação do Canal Radicular/métodos , Raiz Dentária/métodos , Tratamento do Canal RadicularRESUMO
This research sought to evaluate periapical repair in 28 traumatized deciduous teeth that had suffered endodontic intervention due to the presence of internal or external inflammatory resorption or replacement root resorption. After obtaining endodontic access, work length and biomechanical preparation, the root canals were filled with calcium hydroxide and propylene glycol under the form of a dense slurry, during 12 months. Replacement of the intracanal dressing was performed when monthly radiographic examinations showed its absence. After 12 months the teeth were obturated with zinc oxide and eugenol cement. Halting of the inflammatory and replacement root resorption (64.3%; n = 28) occurred 9 months after the use of calcium hydroxide dressings, in a total of 18 successful cases. Fisher's test was applied to relate success with the type of trauma, work length time, child's age and pulpal condition. The test did not present statistical significance (P < 0.05). However, in the qualitative analysis, failure was observed in those cases (35.7%) where replacement resorption was already present at the moment of treatment (up to two-thirds) associated with severe trauma cases. The authors concluded that endodontic treatment must be initiated at an early stage, and must be coincident with the radiographic signs of resorption. Success of the treatment is directly related to the seriousness of the sequelae at the moment of the first examination or the endodontic treatment.
Assuntos
Tratamento do Canal Radicular/métodos , Traumatismos Dentários/complicações , Traumatismos Dentários/terapia , Pré-Escolar , Protocolos Clínicos , Fístula Dentária/etiologia , Fístula Dentária/terapia , Necrose da Polpa Dentária/etiologia , Necrose da Polpa Dentária/terapia , Falha de Restauração Dentária , Diagnóstico Precoce , Seguimentos , Humanos , Pulpectomia , Reabsorção da Raiz/etiologia , Reabsorção da Raiz/terapia , Fatores de Tempo , Descoloração de Dente/etiologia , Mobilidade Dentária/etiologia , Mobilidade Dentária/terapia , Dente DecíduoRESUMO
A report of Garre's osteomyelitis of the mandible associated with a fistula is presented. Elimination of pulpal periapical infection through endodontic therapy was shown to be an effective treatment. The total bone healing was observed one year later.