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One of the most frequent pathologies of jaw bone is a bacteria-induced inflammation at the apices of teeth with subsequent bone resorption that typically presents as a radiolucency in radiographs. Usually, corresponding clinical and radiographic findings correlate and allow for an accurate diagnosis. However, occasionally an unexpected and completely different diagnosis presents as documented in this case report. In a 55-year-old female patient, a radicular cyst was suspected in her right maxillary bone. The treatment plan included a cystectomy as well as apical surgery of the adjacent and root-canal filled teeth 15 and 16. However, the intraoperative finding absolutely did not fit a radicular cyst but rather a mucous retention cyst, as could be confirmed subsequently by histopathology. The diagnosis of a mucous retention cyst within the jaw bone is extraordinary and as such has never been described before in the literature.

Inflammation-related pathologies such as apical periodontitis or radicular cysts are frequent lesions of the jawbones. Typically, a radiolucency is present that is not always distinguishable from other pathologies. A surgical approach would allow for tissue harvesting with further histopathologic processing. However, in the present case report of a cystic and large tunnelling lesion in the anterior maxilla, a conservative treatment with diagnostic needle aspiration and subsequent root-canal therapy was chosen. The long-term follow-up (eight years) including cone-beam computed tomography demonstrates a complete healing of the former bone defect with reestablishment of the vestibular and palatal cortices as well as absence of pain and other clinical symptoms.

The objective of apical surgery is to retain teeth with persistent apical pathosis following orthograde root canal treatment if endodontic non-surgical revision is difficult or associated with risks, or is even declined by the patient. Since the most frequent cause of recurrent apical disease is bacterial reinfection from the (remaining) root canal system, the bacteria-tight root-end filling is the most important step in apical surgery. In the early 1990s, mineral trioxide aggregate (MTA) was developed at the Loma Linda University in California/USA. Preclinical studies clearly showed that MTA has a high sealing capability, a good material stability and an excellent biocompatbility. Multiple experimental studies in animals highlighted the mild tissue reactions observed adjacent to this material. Furthermore, histological analysis of the periapical regions demonstrated a frequent deposition of new cementum not only onto the resection plane (cut dentinal surface), but also directly onto MTA. For these reasons, MTA is considered a bioactive material. In 1997 MTA was cleared for clinical use in patients. Multiple prospective clinical and randomized studies have documented high and constant success rates of MTA-treated teeth in apical surgery. A recently published longitudinal study showed that MTA-treated teeth remained stable over five years; hence the high healed rates documented after one year are maintained during long-term observation.

Periapical surgery is required when periradicular pathosis associated with endodontically treated teeth cannot be resolved by nonsurgical root canal therapy (retreatment), or when retreatment was unsuccessful, not feasible or contraindicated. Endodontic failures can occur when irritants remain within the confines of the root canal, or when an extraradicular infection cannot be eradicated by orthograde root canal treatment. Foreign-body reponses towards filling materials, towards cholesterol crystals or radicular cysts might prevent complete periapical healing. Following enhanced microsurgical techniques in the last years the success rates of apical surgery have improved considerably. The aim of the current case report is to describe the therapeutical approach to a persistent periapical lesion and its histologic examination.

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.

Dentogenous inflammatory diseases can lead to typical dermatological facial symptoms with formation of cutaneous sinuses. Partsch's chronic granulomatous inflammation can result from conducted inflammation of a nonvital tooth via a chronic apical inflammation. In this rare disease, the granulomatous tissue perforates the bone, channels through the overlying skin, and drains via cutaneous or oral sinuses. A frequent localization of the cutaneous sinus is the skin inferior to the body of the mandible, and it is caused by an inflammation of the lower molars. Treatment consists of identifying the responsible teeth and eliminating the focus of infection. Chronically progressive periradicular granuloma and/or radicular cysts can be present with impressive dermatological symptoms. Therefore, X-ray examinations are necessary to exclude possible dentogenic causes in cases of badly healing processes of the face or neck.

In a clinical trial over a period of two years 50 cavities were filled up with an ionomeric porous micro implant (V-Os)* as bone replacement material after apicectomy and excision of cysts. Primary healing was found in 43 cases. 3 months after the operation 44 of 46 examined cases showed no pathological signs. In two cases the material had to be removed. 2 years after the operation 35 cases should be examined, in one case there was a fistula, the other cases showed no pathological signs. The comparison of the individual reproducible X-ray pictures after 3, 6, 12 and 24 months shows a bone regeneration next to the implanted micro implant.

Demineralized bone matrix has been tested in a clinical study concerning the filling of bone defects in the surgical stomatology. It is reported on the clinical results and the X-ray evaluation of the replacement of bones by demineralized bone matrix. Fifty two implantations in the maxilla and mandible of 51 patients were carried out to be able to evaluate the efficacy of demineralized bone matrix.

A woman is described in whom an infected radicular cyst of the mandible resulted in a cervical phlegmon with abscess formation and spreading into the superior mediastinum.

The complicated anatomy of the masticatory system with its coordinated functional elements offers a multitude of noxae for atypical neuralgias. More specifically, affections of the pulp, apical periodontopathies with cyst formation, impacted teeth, aggressive osteopathies and malignant growth come into consideration. In addition, dysfunctional unions must be borne in mind. The styloid syndrome also deserves attention. Because of this causal complex the discovery of other puzzling painful conditions needs dental investigation.

The good results were confirmed in a follow-up examination of 23 patients two to six months after surgery. No signs of disturbed wound healing and/or inadequate organization of the clot could be observed catamnestically, clinically, and roentgenologically. The late infections often observed after implantation of Gelastypt S (with Surfen) did not develop after use of Gelastypt M 1/2. This preparation therefore may be recommended without restriction.

The plaque inhibitor chlorhexidine digluconate was used for intra- and transcanal irrigation in the endodontic treatment triad for periapical lesions (circumscribed, diffuse, fistulating, cystic, suspected cystic lesions). 50 patients were followed up by clinical and standardized radiologic studies. In another 18 patients microbiologic criteria were also used. 16 root canals showed pretreatment infection with mixed aerobic and anaerobic organisms. Mechanical preparation of the root canals with or without extension of the foramen and triple irrigation with 0.5% chlorhexidine digluconate produced clinical relief of symptoms (49 pts.), sterility (14 of 18 pts.) and reduction of the size of periapical lesions (12 pts.). At a mean follow-up of 24 months 30 patients have so far shown complete restitution of periapical bone.

The difficulties in the differential diagnosis of jaw cysts are demonstrated by 10 selected case studies. Panorama radiographies are basic for radiodiagnosis. Supplementary radiographs, including CT, are often necessary. In general, the final diagnosis can be given after synopsis of clinical, radiographic and patho-histological findings.

In a 22 year-old female patient affected with focal dermal hypoplasia, multiple apocrine nevi occurred in the sternal region; these nevi may be part of the syndrome. Roentgenograms of the long bones revealed marked longitudinal striations. This anomaly represents a characteristic and hitherto underestimated feature of the syndrome.

The present study involves 23 patients with 25 cysts whose conditions were assessed postoperatively by means of clinical and radiological criteria. The radicular and follicular cysts were most frequently located in the anterior region of the upper jaw. With 17.4% of the total number of bone cysts, the percentage of cysts on juvenile permanent teeth is relatively low. Teeth that did not respond to irritants were the most frequent complication in the operating area. Nevertheless, the clinical and radiological findings tell against the non-vitality of these teeth.