Cases reported "Periapical Diseases"

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1/47. apexification & apexogenesis.

    When there is pulpal involvement of permanent teeth with incompletely formed roots, techniques for the induction of apical closure should be completed before endodontic therapy is begun. apexification is a method of inducing a calcified barrier at the apex of a nonvital tooth with incomplete root formation. Apexogenesis refers to a vital pulp therapy procedure performed to encourage physiological development and formation of the root end.
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2/47. Deposition of calcified tissue around an overextended gutta-percha cone: case report.

    CASE REPORT: Root canal treatment was performed in a mandibular right second premolar with a periapical lesion and apical resorption. The root canal was prepared with K-files using the step-back technique and 3% NaOCl as an irrigant; during obturation gross overfilling of gutta-percha occurred. The tooth was permanently restored with a post and core along with a crown. Although healing of the periapical lesion occurred and the patient reported that he was symptom-free, the tooth was extracted after 4 years because of a subgingival root fracture. Following extraction the tooth was examined with SEM. The examination revealed the presence of newly formed calcified tissue at resorption sites on the root apex. This newly formed tissue extended from the surface of the root around the apex to the extruded gutta-percha cone to which it was well adapted, forming a bridge between the cone and the root.
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3/47. ameloblastoma--a diagnostic problem.

    A 50-year-old female was referred by her dental practitioner. She had a periapical radiolucency associated with the lower right second premolar tooth. The tooth was root treated and subsequently apicected. Tissue curetted at the time of surgery was shown to be a solid ameloblastoma which was managed initially by marginal excision. Histopathological examination of the resection specimen demonstrated tumour at the inferior margin. A segmental resection of the mandible with an immediate reconstruction using a free tissue transfer of the iliac crest was therefore performed. The case shows the need for vigilance in dealing with periapical pathology and underlines the importance of sending all tissue specimens for histopathological analysis.
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4/47. A suspected periradicular scar: treat or not?

    This paper presents an unusual case of a tooth with multiple adjacent endodontic problems. The diagnosis was complicated by a bony scar that untypically was located around the apex of one of the teeth.
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5/47. Reversible and irreversible painful pulpitides: diagnosis and treatment.

    The foregoing clinical evidence indicates that when pain is severe, or when mild to moderate pain is present with a previous history of pain in the aching tooth, with or without periapical radiolucency, the tooth is in the IRPP category. Treatment dictates endodontic therapy or extraction. On the other hand, when clinical evidence indicates that the pain is mild or moderate with no previous history of pain, normal pulp vitality, and there is no positive percussion sign, the pulp is in the RPP category. Treatment dictates indirect or direct pulp capping in teeth with or without periapical radiolucency. The success rate favours teeth with no periapical radiolucency, 98%; in teeth with periapical radiolucency the success rate is less favorable, 43%. Efforts should be made to maintain pulp vitality. Endodontic therapy can always be done, if in time the pulp develops necrosis.
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6/47. Apical healing of an endodontically treated tooth with a temporary restoration.

    A 35-yr-old, healthy male presented to the graduate endodontic clinic at indiana University School of dentistry for treatment of tooth #26. Two and one-half yr after treatment, the patient returned to the dental school for comprehensive treatment. The canal access opening had been restored with an intact interim restorative material restoration. The tooth was asymptomatic, and radiographic examination showed evidence of apical healing. In this article, a review of the literature concerning crown-down leakage is presented. A case report is given in which healing occurred after the tooth was restored with only an interim restorative material for an extended period of time.
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7/47. Periapical ameloblastoma--a case report.

    Ameloblastomas, although often benign, are locally aggressive odontogenic lesions. Presentation of this lesion as a pericoronal radiolucency associated with an impacted tooth is well documented. Presentation of this lesion as a solitary periapical radiolucency associated with a non-impacted tooth however, is rare. Periapical presentation of this lesion may confuse practitioners.
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8/47. Paradental cyst mimicking a radicular cyst on the adjacent tooth: case report and review of terminology.

    A distinctive form of paradental cyst can occur on the buccal and apical aspects of erupted mandibular molars. This cyst has peculiar clinical and radiographic features, although the microscopic findings are the same as those of odontogenic inflammatory cysts. Diagnostic and therapeutic problems can occur when this lesion is misinterpreted as a radicular cyst. The purpose of this paper is to present an additional case of a paradental cyst in the buccal and mesial aspects of a mandibular second molar involving the apical area of a mandibular first molar. The difficulty of diagnosis, treatment, and controversies regarding terminology are also discussed.
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9/47. Intentional replantation of endodontically treated teeth: an update.

    The IR technique is a clinically successful procedure, so long as the following conditions, as outlined by Niemczyk, are met: 1) Avoid any crushing or scraping contact with the root surface or socket; 2) Root surface must be continually hydrated with tissue culture media (e.g., HBSS); 3) tooth should be splinted, if indicated; and 4) Soft diet and hygiene instructions must be implemented and reinforced. The IR technique should not be considered a procedure of last resort. Rather, it should be used in situations where conventional apical surgery is difficult or places the patient at risk. The IR technique expands potential treatment alternatives and allows the patient to successfully retain his or her own tooth following treatment.
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10/47. Resolution of persistent periapical infection by endodontic surgery.

    AIM: To examine the surfaces of a root tip removed during surgical endodontic treatment for the presence of microorganisms. SUMMARY: The present clinical case illustrates an endodontic retreatment of a maxillary premolar tooth with a fistula and periapical reaction. The case was under treatment for 1 year, during which an intracanal medicament was replaced several times. As the lesion did not decrease and exudate was persistent through the fistula and root canal, root end resection with root end filling was performed. Microbiological samples were collected from the fistula, where propionibacterium acnes, a species associated with endodontic failures, was detected by appropriate anaerobic technique. The resected root apex was observed by scanning electron microscopy (SEM), which revealed cocci and fungal forms surrounding one of the foramina. After 12 months, the periapical lesion had reduced.
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