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Introduction: Secondary endodontic infections present intricate challenges in dental practice, necessitating effective retreatment strategies. The current systematic review aimed to critically evaluate the outcomes of single-visit versus multi-visit endodontic retreatment in patients with secondary endodontic infections. Materials and Methods: The current systematic review was registered in the Open Science Framework database and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Searches were conducted in PubMed/Medline, Scopus, and Web of Science databases for articles published until April 2023. The inclusion criteria for the current systematic review were clinical trials reporting the comparison of nonsurgical single-visit versus multiple-visit endodontic retreatments with predictive outcome. The Cochrane scale was used to assess the risk of bias. Results: Six studies were included in the systematic review. Four studies reported the incidence of postoperative pain, and two studies reported the periapical lesion healing after single- and multiple-visit endodontic retreatments with an 18- and 24-month follow-up. Three studies showed a low risk of bias, one study showed unclear risk of bias, and two studies showed a high risk of bias. Conclusion: Comparative analyses indicated that single-visit endodontic retreatment yielded comparable postoperative pain levels and healing outcomes as retreatment conducted over multiple visits. Notably, the utilization of intracanal medicaments such as calcium hydroxide and triple antibiotic paste demonstrates promise in mitigating postoperative pain subsequent to retreatment procedures.

Objective: This systematic review was aimed to assess the prevalence of apical periodontitis (AP) in Saudi Arabia, focusing on individual-level prevalence and the frequency of AP in endodontically versus untreated teeth. Methods: This review followed the PRISMA guidelines and involved searches in several databases, including PubMed-MEDLINE, Cochrane-CENTRAL, and EMBASE, without date restrictions until August 19th, 2023. Eligibility criteria encompassed studies using CBCT, panoramic, and periapical radiographs to diagnose AP in the Saudi population. The meta-analysis employed a random-effects model due to high heterogeneity among studies. Results: From 359 records, 13 studies were included, indicating a 40% prevalence of AP in individuals and a 6% prevalence across all teeth within the Saudi population. Root canal-treated teeth demonstrated a higher prevalence at 47%. The data revealed a substantial prevalence of AP compared to global averages, with first molars being the most affected. Studies showed moderate risk of bias and significant heterogeneity. Conclusion: The high occurrence of AP in Saudi Arabia, particularly in root-treated teeth, emphasizes the need for enhanced endodontic care and more accurate diagnostics. Urgent improvements in dental health policies and further research are essential to understand AP’s impact and improve oral health outcomes.

Introduction: In the rapidly evolving landscape of health care, artificial intelligence (AI) has emerged as a promising tool to enhance diagnostic accuracy across various medical disciplines. Within the realm of dentistry, one critical area of focus is endodontics, which involves the diagnosis and treatment of dental pulp diseases. This systematic review investigates the diagnostic precision of AI in contrast to dental experts when predicting endodontic outcomes. Materials and Methods: The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review was registered on the Open Science Framework database. A systematic search was performed of the literature on the application of AI versus dental experts in endodontics. The search was conducted on PubMed, Scopus, Web of Science, and OVID until December 2022. The QUADAS-2 tool was used to evaluate the risk of bias. Results: The initial search retrieved 972 records, of which eight articles were included in the study. The studies reported application of AI for working length determination, periapical lesions, pulp and tooth segmentation, apical periodontitis, vertical root fracture, and C-shaped canals. QUADAS-2 tool revealed a low risk of bias in five out of the eight included studies. Conclusion: AI models demonstrated a notable increase in accuracy and effectiveness in endodontic diagnosis and treatment planning. These results suggest that the integration of AI technology in endodontic diagnosis and treatment planning has immense potential to serve as a promising aid.

Aim of study. The aim of the present study was to assess the prevalence of periapical lesions in root-filled lateral teeth as well as the distribution of periapical lesions according to various factors that can influence the therapeutic outcome. Materials and method. The study group included 163 patients (gender: 58 males, 105 females; mean age 48.13 ± 14.708 yrs.) with at least 2-yrs. follow-up of 412 endodontically treated teeth. Following the radiographic assessment of the root and its periapical area, the root canal treatments were classified as adequate and poor, while the apical lesions was diagnosed on radiographic examen. The quality of coronal marginal sealing (poor, adequate) was assessed by radiographic examen. The distribution of apical lesion was assessed on socio-demographical parameters (gender, age groups), location (maxillary, mandibular), follow-up, quality of root canal filling, status of coronal marginal sealing, occlusal contacts, recurrent caries. Results. Periapical lesions prevalence in root-filled lateral teeth was as follows: gender (males- 47,3%; females- 50,2%); age groups (20-39 yrs.- 41,9%; 40-59 yrs.- 52,4%; ≥60 yrs.- 47,4%); follow-up (2-4 yrs.- 57,7%; 5-8 yrs.- 44,5%) (p=.010*); location (maxillary teeth- 46,1%; mandibular teeth- 54,5%). 58% of teeth with poor coronal marginal sealing, and 59% of teeth with poor root canal fillings were diagnosed with AP. Conclusions. Apical lesions were detected in 49.3% of the lateral root-filled teeth. Molars, poor root canals fillings, poor coronal marginal sealing, presence of recurrent caries were significantly associated with endodontic periapical lesions.

Aim of study. The aim of the present study was to assess the prevalence of periapical lesions in root-filled lateral teeth as well as the distribution of periapical lesions according to various factors that can influence the therapeutic outcome. Materials and method. The study group included 50 patients (gender: 12 males, 38 females; mean age 51.48 ± 13.218). A total number of 150 anterior root-filled teeth were evaluated at 2-8 yrs. post-treatment. Following the radiographic assessment of the root and its periapical area, the root-canals fillings were classified as adequate and poor. The status of periapical area was assessed on periapical radiographic images. The quality of coronal marginal sealing was assessed as poor or adequate by clinical and radiographic examen. The distribution of apical periodontitis was assessed according to socio-demographical parameters (gender, age groups), location (maxillary, mandibular), follow-up, quality of root canal filling, status of coronal marginal sealing, recurrent caries. Results. The global prevalence of apical periodontitis was 50,7%. The prevalence of apical periodontitis in root-filled anterior teeth was as follows: gender (males- 37,5%; females- 54,2%); age groups (20-39 yrs.- 30%; 40-59 yrs.- 52,9%; ≥60 yrs.- 57,1%); location (maxillary teeth- 42,4%; mandibular teeth- 81,3%). The prevalence of apical periodontitis was 70% in teeth with poor coronal marginal sealing, and 61,4% in teeth with poor root canal fillings. Conclusions. Apical periodontitis was detected in half of the anterior root-filled teeth. The rate of apical periodontitis was significantly increased in maxillary anterior teeth, poor root canals fillings, poor coronal marginal sealing, and root-filled teeth with the presence of recurrent caries.

Key Clinical Message: The main objective of root canal therapy is to locate all the canals, cleaning, and shaping, and obturation to obtain fluid tight seal and to heal the periapical lesion if present. The proper cleaning, shaping, and disinfection of the pulp chambers, as well as the filling of the canals, are critical to the efficacy of treatment with root canals. The success of an endodontically treated tooth is dependent on the accuracy of the diagnosis, disinfection, cleaning and shaping, obturation, and finally, the prosthetic rehabilitation management. Root canal therapy should provide a hermatic as well as fluid impenetrable seal which prevents the progression of periapical infection. There are two ways to treat such lesions: surgical and nonsurgical methods. If the root canal is cleaned, shaped, and sealed properly and adequately without the use of a surgical procedure, these lesions will recover during nonsurgical root canal therapy. This case series focuses primarily on the nonsurgical treatment of an enormous periapical lesion and provides evidence that these lesions respond well without surgery. [ABSTRACT FROM AUTHOR]

Key Clinical Message The main objective of root canal therapy is to locate all the canals, cleaning, and shaping, and obturation to obtain fluid tight seal and to heal the periapical lesion if present. Abstract The proper cleaning, shaping, and disinfection of the pulp chambers, as well as the filling of the canals, are critical to the efficacy of treatment with root canals. The success of an endodontically treated tooth is dependent on the accuracy of the diagnosis, disinfection, cleaning and shaping, obturation, and finally, the prosthetic rehabilitation management. Root canal therapy should provide a hermatic as well as fluid impenetrable seal which prevents the progression of periapical infection. There are two ways to treat such lesions: surgical and nonsurgical methods. If the root canal is cleaned, shaped, and sealed properly and adequately without the use of a surgical procedure, these lesions will recover during nonsurgical root canal therapy. This case series focuses primarily on the nonsurgical treatment of an enormous periapical lesion and provides evidence that these lesions respond well without surgery.

Abstract Background The aim of this study is to examine the survival rates of immediate implants placed in extraction sockets with chronic periapical pathology. Methods 69 patients and 124 immediate implants were included in the study. The patients included in the study were examined in 3 groups. Group 1: Patients who underwent tooth extraction with periapical pathology and immediate implant placement. Group 2: patients who underwent tooth extraction with periapical pathology, immediate implant placement and guided bone regeneration. Group 3: Patients who underwent tooth extraction with periapical pathology, sinus lift procedure and immediate implant placement. In statistical analysis, t-test and Anova analysis were used in the evaluation of quantitative data, cross-tables and chi-square (χ2) test were used in the evaluation of classified qualitative data. Statistical significance was determined as p

Florid cemento-osseous dysplasia (FCOD) is an uncommon fibro-osseous lesion that can affect the jaws. It involves the deposition of dense, acellular amorphous bone on a foundation of fibrous connective tissue, replacing normal cancellous bone. This condition often affects middle-aged women, with a mean age of 42. The lesion's epicenter is at the teeth apices and typically appears posterior to the canines. We present two cases of female patients, aged 49 and 26, who were both initially misdiagnosed with periapical infection and underwent root canal treatments while the lesions remained. Both patients visited our clinic. After careful history taking and clinical and radiographic examination, FCOD was diagnosed, and both patients were treated conservatively.

Introduction: The main cause for developing periapical lesions (PA) is the root canal infection. The mentioned causes may play a role in not controlling it but are not a “true” cause. Objective: To determine apical status and prevalence of endodontic treated tooth using radiograph assessment in relation to quality of root canal treatment and clinical factors among Saudi adults in the Eastern province. Patients and methods: This prospective case series study included 2161 patients who received root canal treatment (RCT) at Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia, between October 21, 2019 and April 22, 2020, after getting ethical approval from the Institutional Research Board (IRB). Saudi natives of either gender, age ≥ 18, with at least one fixed bridge or single dental crown evaluated on a clear, high-quality radiography image were recruited for the study. To determine the periapical state of root canal-filled teeth, the 'periapical index' (PAI) was used. All pertinent patient information was analyzed in SPSS verion-20 (IBM product, Chicago). Results: Out of 2161 cases, a PA lesion was present in 756 (35.0%). The prevalence of periapical lesions in endodontically treated teeth was 31.2%. PA lesion was associated with molar involvement (50.8% vs. 36.6%, p = 0.001), poor RCT quality (85.2% vs. 51.0%, p = 0.001), and smoking (13.6% vs. 10.5%, p = 0.028). According to logistic regression model, female gender, molar tooth, and poor RCT quality were more likely to expose PA lesion 1.5 times, 1.8 times, and 5 times, respectively. Conclusion: It is concluded that approximately 1/3rd of endodontically treated teeth are susceptible to the occurrence of periapical lesions in radiographic assessment, which are significantly associated with females, molars, and poor RCT quality, indicating a challenge for endodontists to improve their root canal assessment accuracy.

Aim: The aim of this study was to assess the prevalence of acute periapical lesions in patients with pSS. Methods: Integrated data of hospital patients was used. Data from the corresponding diagnosis codes for pSS and acute periapical abscess was retrieved by searching the appropriate query in the database. The patient population analyzed was mixed, presenting with different disease conditions including periapical abscesses without sinus. The different diagnoses were coded using the international coding systems ICD 10. Diagnosis was made by calibrated dentists in a hospital setting based on clinical examination and imaging data. Patients with ICD 10 diagnosis code of acute periapical abscess were recorded and the prevalence of acute periapical abscesses in patients with primary Sjögren syndrome were compared to the prevalence in the total hospital patient population. The odds ratio (OR) for the prevalence of acute periapical abscesses and its association with pSS were calculated with a 95% confidence interval and the statistical difference between the groups was assessed. Results: The odds ratio (OR) for the prevalence of acute apical abscesses and its association with pSS were calculated and analyzed statistically. The prevalence of periapical abscesses in patients with pSS was 1.87% as compared to 0.58% in the general patient population of the hospital. The OR was 3.11 and the difference was statistically significant (p

Background & objective: In current clinical dental practice radiographic imaging plays a major role in exploring the relationship between the maxillary sinus floor (MSF) and maxillary posterior teeth root apices, especially when there is an involvement of pathology in the periapical area that may lead to infectious, inflammatory or traumatic changes in the maxillary sinus (MS). It is also essential for exact implant placement, and therapeutic and surgical plans. The prevalence of different forms of anatomic relationship of the MSF to posterior root apices from one population to another is large. Hence the current research was conceived to evaluate the horizontal and vertical relationship forms of posterior root apices to the MSF in the Al-Qassim population of Saudi Arabia using Cone Beam Computed Tomography (CBCT). Materials and methods: To conduct the study, a total of 200 patients' data (100 male and 100 female) were taken from the archives. The linear distances of the root apices to the MSF were measured for maxillary posterior teeth. On cross-sectional CBCT images, the Kwak et al. criteria were used to assess the horizontal and vertical relationships between the root apices of maxillary posterior teeth and the MSF. Results: The mean distance between the apices of the maxillary second premolar ranged from 4.63 mm to 6.49 mm. The mean value of the distance between the apices of the posterior teeth and the MSF had a range of 0.68 ± 0.39 mm on the disto-buccal root (DBR) of the maxillary right second molar to 3.93 ± 1.26 mm on the palatal root (PR) of the maxillary left first molar. A similar result was observed in the maxillary second molar DBR in the male group (0.68 ± 1.17 mm) and the female group (0.69 ± 1.17 mm). The most frequently observed vertical relations were type 2 and type 2H horizontal relations. Conclusion: This study concludes that maxillary molar roots show greater proximity with the MSF when compared with premolars, and that the type 2 vertical and type 2H horizontal distribution suggests that the anatomy of each tooth and the maxillary sinus floor should be evaluated by CBCT prior to treatment planning.

Background. This retrospective study aimed to investigate the effect of various dental and maxillary sinus variables on maxillary sinus mucosal thickness (MT). The variables included periodontal bone loss (PBL), periapical status, dental restorations of posterior maxillary teeth, and the distance from the root apices to the sinus mucosa. Methods. Cone-beam computed tomography (CBCT) images of the maxillary sinuses (n=600) in 300 patients were examined. The sinus MT and the distance of the roots from maxillary sinuses were measured. Apical lesions of the roots, PBL, and situations of adjacent teeth were recorded. The relationships between these conditions and MT and characterization of MT were evaluated. The Kruskal–Wallis H test was used to compare groups due to the non-normal distribution of the data. The relationship between categorical variables was analyzed using chi-squared test. Results. There was a significant correlation between maxillary sinus MT and periapical lesions, PBL, and restorations (P

Periapical lesions regularly occur in untreated teeth, as well as in teeth that have already been subjected to endodontic treatment. There are various known factors that lead to effective endodontic treatment where the clinical symptoms disappear and the periapical lesion disappears or decreases in size. The risk of painful inflammation alongside a persistent periapical lesion is small, even if the periapical lesion has increased in size. The survival of a tooth with a periapical lesion that has undergone root canal treatment is 87% after 10 years. In cases where an endodontically treated tooth has to be extracted, a restorative problem is often the reason for extraction, while a persistent periapical lesion has a limited effect on tooth loss. There are insufficient data available on the effect of a periapical lesion on general health. [ABSTRACT FROM AUTHOR]

Risya Cilmiaty,1 Nirawati Pribadi,2 Mandojo Rukmo,2 Meircurius Dwi Condro Surboyo3 1Department of Oral Disease, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia; 2Department of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia; 3Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, IndonesiaCorrespondence: Nirawati PribadiDepartment of Conservative Dentistry, Faculty of Dental Medicine, Universitas Airlangga. Jalan Prof. Dr. Moestopo 47x, Surabaya 60132, IndonesiaTel +628123292481Email nirawati-p@fkg.unair.ac.idRisya CilmiatyDepartment of Oral Disease. Faculty of Medicine, Universitas Sebelas Maret, Jalan Ir. Sutami No. 36A, Kenthingan, Surakarta 57126, IndonesiaTel +6281227316161Email h_risya@yahoo.co.idBackground: Endodontic treatment on dental caries with dental granuloma on the periapical has the potential to flare. The symptoms of acute flare in dental granuloma are strongly related to the activation of macrophages that produce pro-inflammatory cytokine through nuclear factor kappa B (NFκB). However, the role of NFκB in dental granuloma has not been widely explained.Purpose: To compare NFκB expression in dental granuloma and dental nongranuloma in the periapical of dental caries.Methods: The periapical lesion of dental granuloma and dental nongranuloma was obtained from patients with dental caries who were subjected to tooth extraction. The periapical lesion was confirmed by periapical radiography and then differentiated by histological and immunohistochemistry by analyzing the NFκB expression.Results: Most dental granulomas were found in females (66.67%) between the ages 36 and 45 (61.11%). Dental granuloma showed higher NFκB expression compared to dental nongranuloma lesions in tooth caries (p=0.021).Conclusion: The dental granuloma tissue of dental caries showed an increase in NFκB expression. Understanding the role of NFκB might provide additional insights into the process of periapical lesion development.Keywords: dental granuloma, dental caries, NFκB expression, periapical lesion

Background/purpose: Periapical lesions of endodontic origin are often diagnosed based on the clinical and radiological presentations that may be different from the histological diagnoses. The purpose of this study was to assess the concordance between the clinical diagnosis of these lesions and the histopathological diagnoses and to analyze their clinical and pathological features. Materials and methods: Biopsies of periapical lesions of endodontic origin diagnosed in the histopathology laboratory between 2006 and 2017 were retrieved from the database and used to conduct this retrospective review. Clinical data were obtained, and tissue samples were re-evaluated. The overall agreement between the clinical and histological diagnoses was tested utilizing the Cohen kappa (k). Results: A total of 317 periapical biopsy specimens were included in this study which consisted of 137 periapical granulomas, 174 periapical cysts, and six periapical scars. Generally there was weak overall agreement between the clinical and histological diagnoses of periapical granuloma and periapical cysts (Cohen kappa, k = 0.059). Conclusion: The findings of this study indicate that clinical/radiographic examinations are not able to preoperatively determine whether a periapical lesion is a cyst or a granuloma and highlights the importance of developing a reliable nonsurgical diagnostic method to differentiate periapical lesions.

Background: Although periodontal disease is the most frequent reason for extraction in endodontically treated teeth, few studies have evaluated patients with Type 2 diabetes (T2D). In this study, we compared the success of endodontic treatment and the evolution of periapical lesion (PL) in patients with and without T2D. Materials and Methods: We performed a retrospective cohort including 58 patients who received endodontic treatment (31 with and 27 without T2D) 12 months before. Success of endodontic treatment, evolution of PL, and type of restoration were evaluated. Results: Treatment success was found in 16 (64%) and 23 (85%) patients with and without T2D, respectively (P = 0.07). Patients with diabetes had an increased failure to endodontic treatment risk (relative risk 1.68 [95% confidence interval 1.001–2.845]). The PL reduced or disappeared in 20 (74%) patients without and in 12 (48%) with T2D (P = 0.02). In patients with T2D, HbA1c levels were lower in those with successful treatment than in those with failure in treatment (6.23 ± 0.37 vs. 6.88 ± 0.34, P ≤ 0.001), respectively. Conclusion: Diabetes mellitus has a negative impact on the evolution of endodontic treatment and PL after 12-month follow-up, and it is related to metabolic control.

Introduction: The use of Bioceramic sealer in the obduration of the root canal system has been expected by many of the previous studies. However, the clinical outcome has not yet been established. Objective: To compare the effectiveness of bioceramic and calcium hydroxide based root canal sealer in treatment of non-vital permanent teeth with periapical lesion (Periapical periodontitis). Materials and Methods: A total 100 mature permanent anterior teeth were selected after clinical and radiological examination which had non-vital pulp with periapical lesion. Clinically pulp vitality test, palpation and percussion test was performed maintaining standard procedure. Following cavity preparation and biomechanical preparation, each canal was obturated either with bioceramic (Endosequence BC) or calcium hydroxide based sealer (Sealapex, Kerr). All participants were evaluated immediately after obturation, at 3 and 6 months for the assessment of change in size of periapical lesion, condition of periodontal ligament space, lamina dura and incidence of post-operative pain, swelling. Statistical analysis was performed using Chi- square(X2) test and t-test. A value of p

Background: A chronic apical abscess is defined as an inflammatory response to pulp infection and necrosis. It is identified by a step-wise onset, almost no discomfort, and the discontinuous release of pus through a related sinus tract. Radiographically, there are regular indications of bone destruction, such as radiolucency. The source of the infection in the root canal should be eradicated by root canal treatment. The main purpose of endodontic treatment is the finished debridement of the pulp tissue from the canal combined with the shaping and sufficient obstruction of the root canal system. This case report was written to show the proper management of a tooth with a chronic apical abscess and to reveal self-bone regeneration after treatment. Case Report: A 27-year-old woman complained of a cavity on her left lower back tooth, and she wanted it to be filled. There was a history of a fistula that appeared frequently in the gums near the decayed tooth. The radiographic examination showed that the caries had reached the pulp, along with a periapical lesion and bone destruction. The canals were prepared using a file instrument and irrigation with 5.25% sodium hypochlorite, 17% ethylenediaminetetraacetic acid, and 2% chlorhexidine gluconate. Calcium hydroxide paste was used as an intracanal medicament, and the canals were obturated using a continuous wave compaction technique. At the 4-month follow-up, healing of the periapical lesion and bone regeneration was evident. Conclusion: Adequate root canal treatment can result in the healing of periapical lesions and bone regeneration in chronic apical abscesses.

Background: Teeth with infected root canals, particularly those in which the infection has reached the periradicular tissues, require effective treatment interventions to save the tooth. Lesion sterilization concept (lesion sterilization and tissue repair [LSTR]) was successful in treating periapical polymicrobial infection, but this poses a risk of development of antimicrobial resistance. Aim: The present study evaluated and compared both clinically and radiographically the healing abilities of Propolis liquid (natural therapeutic agent)-mixed Endoflas powder with LSTR (allopathic combination) for the management of periapical lesions in primary molars. Materials and Methods: A total of 30 selected primary molars were randomly divided into two groups of 15 each: Group 1 – Propolis liquid-mixed Endoflas powder and Group 2 – LSTR (3Mix). Follow-up after 3, 6, and 12 months was done to evaluate progress in clinical and radiographic parameters. The obtained data were subjected to statistical analysis. McNemar's test was applied between the time points in each group. Comparison of Group 1 with Group 2 was done using Chi-square test. Results: At the end of 12th-month follow-up, the overall clinical and radiographic success rate for Group 1 was 100%, whereas for Group 2, it was 93% and 60%, respectively. The difference in the radiographic success rate between the two groups was statistically significant (P < 0.05). Conclusion: In the present study, Propolis liquid-mixed Endoflas powder combination has shown better results than LSTR. This novel combination of Propolis liquid-mixed Endoflas powder can, therefore, be considered as the material of choice for pulpectomy in deciduous molars with extensive involvement of pulp and periradicular tissues.

Introduction and aim: Nonendodontic lesions can be misdiagnosed as pathoses of endodontic origin. One of the most common nonodontogenic lesions of the oral cavity is the nasopalatine duct cyst, which is difficult to distinguish from periapical lesion. The aim of this case report is to familiarize readers with differential diagnosis of this disease. Case report: The patient who had suffered lateral luxation of tooth 11 aproximately 25 years ago presents with palatal abscess of premaxila. After non surgical retreatment of tooth 11 the symptoms disappeared, but the tooth become symptomatic two years after. After CBCT scan was taken the nasopalatine duct cyst was diagnosed and after surgical treatment histopathologically confirmed. Discussion: The possible predisposition factors, radiological signs and differential diagnosis is disccused. Conclusion: The understanding of anatomy, the use of appropriate diagnostic tests (including CBCT scan) to distinguish endodontic lesions from nonendodontitic pathoses are essential for accurate differential diagnosis and treatment.

ABSTRACT Jaw metastasis can be mistaken for inflammatory or infectious diseases. Then, they should be considered in the differential diagnosis of unknown jaw lesions. Study reported here involved metastasis of breast cancer in the mandible of a 45-year-old woman. The most important differential diagnostic was a reactive lesion in an unusual periapical location associated with a nonvital tooth. However, given patient’s medical history and because paresthesia and pain were observed a few days after pulpectomy, metastasis of breast cancer could not be ruled out. When bone scintigraphy suggested the metastasis of a malignant bone tumor, incisional biopsy was performed. Histopathologic examination and immunohistochemical reaction confirmed the diagnosis of metastasis of breastcancer, and chemotherapy was thus performed as well. Unfortunately, patient died 2 years after diagnosis. Dentists as well as general physicians should therefore consider presence of oral metastasis in cases involving atypical symptoms, especially in patients with known malignant disease.

Dens in dente is a developmental anomaly that predisposes the tooth to develop caries and pulp periapical pathologies. A chronic lesion can develop without any clinical symptoms of the pathology. The purpose of this case report is to describe the endodontic treatment of dens in dente associated with a periapical lesion using a mineral trioxide aggregate apical plug. [ABSTRACT FROM AUTHOR]

Purpose: To ducument a clinical and radiographical follow-up after root canal treatment of teeth with periapical lesions using an Er,Cr:YSGG hydrokinetic system laser (Waterlase). Materials and methods: YSGG laser applied at 20 Hz, 5.0 to 1.0 W with 30% to 90% air-water spray was used for complete root canal therapy in 2 patients bearing 3 teeth with periapical lesions. Radiographs were taken and percussion was tested after the filling procedure, at the end of the first week, and 3 months later. Results: According to the Coba et al classification, 3 of the teeth were nonsymptomatic to percussion in both controls; radiography showed that lesions healed completely. Conclusion: These results pointed out that YSGG laser can be used for complete root canal therapy both for incisors and molars, and healing fast and good. [ABSTRACT FROM AUTHOR]

Aim: To assess the 18-month success rate of root canal treatment with two integrated shaping and filling systems on upper central incisors with chronic periapical pathosis. Methodology: Sixty patients with an upper central incisors with a chronic periapical lesion smaller than 5 mm in diameter were randomly allocated to two treatment groups, which only differed in terms of canal shaping and filling protocol: G1 (n = 30), Revo-S/One Step Obturator; G2 (n = 30) GTX/GTX Obturator. The patients underwent clinical assessment at baseline and after 6, 12 and 18 months. Radiographic healing was scored according to a previously described scale by two independent examiners, who analysed the periapical radiographs taken at the recall visits. Intra- and inter-observer reliability was tested with Kappa statistics. The significance of the differences between the two groups and among time points with regard to clinical and radiographic data was evaluated with non-parametric tests (p

Aim: To evaluate the two-year success rate of primary root canal treatment performed with two integrated shaping and filling systems on upper central incisors with chronic periapical pathosis. Methodology: The trial enrolled 60 patients with an untreated maxillary central incisor presenting a chronic periapical lesion smaller than 5 mm in diameter, who were randomly assigned to two treatment groups: G1 (n = 30), Revo-S/One Step Obturator; G2 (n = 30) GTX/GTX Obturator. The patients underwent single-session root canal treatments by an experienced endodontist and were followed up for two years. The clinical evaluation entailed percussion and palpation tests. Two independent examiners rated the radiographic healing on the basis of a previously described scale. Comparability between groups in terms of baseline clinical parameters was tested with a Mann-Whitney test (age, apical gauging) and χ2 test (tenderness to percussion and palpation). The comparison of clinical data and radiographic healing scores between the groups and among time points was carried out with non-parametric statistical methods (p

Objective: The objective of this study was to determine the association between periapical health status with the quality of the root filling and was the coronal restoration and identify the predictors of periapical lesion. Subjects and Methods: It was conducted among 197 adult patients who visited Kuwait University. Periapical status was measured by periapical index. The presence or absence of periapical lesions was evaluated using panoramic radiographs. Statistical Analysis: Data were analyzed using the Statistical Package for Social Sciences. Chi-square tests were performed to assess associations between categorical variables. Results: Of the 4,841 teeth examined, 2.7% were root-filled (n = 130). Thirty-four percent of the root-filled teeth (n = 44), and 3% of the nonroot-filled teeth (n = 141 of 4711) exhibited periapical radiolucency. Of the root filled teeth, 49% were judged to be inadequate (n = 64) and 91% of the inadequate ones had short root filling (n = 58). The presence of periapical lesion was significantly predicted by inadequate coronal restoration, dental caries, periodontal bone loss, and the presence of post crown. Conclusion: This study demonstrated a large number of untreated teeth with periapical pathology. The quality of root fillings in this population appeared to be poor and was significantly associated with a high prevalence of apical periodontitis.

Introduction: Mechanical instrumentation and chemical irrigation alone is not considered enough to eliminate microorganisms in the deeper layer of root canal system. Therefore, antibacterial medicaments are required for complete disinfection of root canal dentin. Case Presentation: Triple antibiotic paste application (metronidazole, ciprofloxacin and minocycline) have demonstrated good clinical and radiographical results for treatment of presented traumatized teeth with periapical lesion. Conclusion: It confirms that conservative treatment should be first option for treatment of periapical lesion. Triple antibiotic paste has benefical effects for traumatized teeth with periapical lesion.

Parestezi yanma, karıncalanma, ağrı ve uyuşukluk gibi anormal hislerle tarif edilen duyusal bir rahatsızlıktır. Nadir görülen endodonti ile ilişkili parestezi genellikle büyüyen endodontik lezyonların mental sinire yaptığı lokal baskı ile ilişkilidir. Bu makalede; periapikal enfeksiyonun sebep olduğu mental sinirin geçici parestezisi gelişen bir olgunun, literatür bilgileri ışığında tartışılması amaçlandı. Elli yaşında erkek hastanın alt sağ birinci küçük azı dişten alt sağ dudak ortasına kadar hem ağız içi mukoza hem de yüz bölgesinde parestezi şikayeti bulunmaktaydı. Radyografik incelemede alt sağ birinci küçük azı dişinin apikal bölgesini çevreleyen radyolusent bir lezyon gözlendi. Parestezi endodontik tedavinin başlanmasından sonra 14 gün içinde tamamen çözüldü. Tam iyileşme periapikal cerrahi veya dişin çekimi yerine cerrahi olmayan kök kanal tedavisi ile elde edildi.

The aim of this work was to present a case report describing lower lip paresthesia following failed endodontic treatment and development of periapical lesion. A 42-year-old female presented difficulty in swallowing with pain in right mandibular second premolar and numbness in the right side of her lower lip. Radiographic examination revealed inadequate root canal and a large periapical lesion in the mental nerve area. The lesion appeared extending into the inferior alveolar canal causing irritation of inferior alveolar nerve and its mental branch. Following root canal retreatment, there was improvement of the clinical symptoms and gradual reduction in size of the lesion. A full resolution of symptoms was demonstrated 4 months after successful endodontic therapy. It was concluded that careful clinical and radiographic diagnosis followed by proper endodontic treatment proved to be successful in treating lower lip paresthesia occurred following failed root canal therapy.

Aim: To assess preliminarily the success rate of the root canal treatment with two integrated shaping and filling systems of upper central incisors with chronic periapical pathosis. Methodology: Sixty adult subjects with an untreated maxillary central incisor presenting a chronic periapical lesion smaller than 5 mm in diameter were recruited for the present study. The patients were randomly divided into two treatment groups: G1 (n = 30), Revo-S/One Step Obturator; G2 (n = 30) GTX/GTX Obturator. All root canal treatments were performed in a single session by the same operator. Sensitivity to palpation and percussion was registered at baseline and at the six-month recall. Radiographic healing was scored by two blind examiners according to a previously described scale. The absence of statistically significant differences in terms of baseline clinical parameters between the two groups was assessed by means of a Mann–Whitney test (age, apical gauging) and χ2 test (sensitivity to percussion and palpation). The radiographic scores attributed to the two groups were compared with a Mann–Whitney test, while a χ2 test served to compare the clinical data gathered after six months (p

Actinomycosis is a rare infection caused by filamentous Actinomyces, which form club-shaped filaments arranged in a radiating pattern and rarely infects jawbone. Due to its nonspecificity from its clinical features, it has been considered as a challenging diagnosis. This case report describes a case of periapical cyst which was diagnosed as actinomycosis based on histopathological examination. Periapical actinomycosis is one of the most important reasons for the failure of nonsurgical treatment. Clinically, if the periapical lesion is largely associated with weeping canals, surgical debridement of granulation tissue is mandatory. In this case, surgical intervention and adjunctive platelet rich fibrin with osseograft provided successful healing.

The cytokines affecting periapical bone lesions have been reviewed for current understanding of the mechanisms and mediators involved. Periapical bone lesions can result from dental disease that spreads into the root canal and expands to the surrounding periapical tissue. This will create periradicular tissue inflammation, where cells like monocytes, PMNs and lymphocytes regulate and are regulated by cytokines responsible for inflammation. Periapical bone resorption can be caused by inflammation, by cytokines including IL-1, MMP-8, GM-CSF. Meaning of level MMP-8s from root-canal exudates during endodontic treatment could be use as biochemical indicator of the inflammatory status of the periapical tissue. In addition, various cytokines such as TGF-β1, IL-6, IL-10 promote bone proliferation. The variance in cytokine receptor expressions may explain the selective recruitment in the inflitration of inflammatory cells at the local inflammation site. Cytokines, each having their own duty, are key mediators of periapical bone resorption bone resorption that still needs to be investigated in detail.

Traumatic injury of the teeth occurs frequently on anterior and posterior teeth. Pulp necrosis is often the frequent sequel of trauma and it will lead to development of periapical lesions in the presence of pathogenic microorganism. Two cases of periapical lesion reported here were caused by occlusal trauma. It is still controversial whether a case of large periapical lesion should be treated conventionally or surgically. This case was treated non surgically and it was proved that this kind of treatment could promote large apical healing successfully.

Dens invaginatus (DI) is a developmental anomaly that results from an infolding of the dental papilla during tooth development and simulates the appearance of a tooth within another tooth. It shows a wide spectrum of variations in morphology and usually affects the maxillary lateral incisors. This study presents an unusual case of an Oehlers′ Type I DI involving the bilateral mandibular first and second premolars, which presented as an incidental radiographic finding in the first premolars and was associated with a periapical lesion in the second premolars which was successfully treated using nonsurgical endodontics.

Periradicular (PR) bone defects are common sequelae of chronic endodontic lesions. Sometimes, conventional root canal therapy is not adequate for complete resolution of the lesion. PR surgeries may be warranted in such selected cases. PR surgery provides a ready access for the removal of pathologic tissue from the periapical region, assisting in healing. Recently, the regeneration of the destroyed PR tissues has gained more attention rather than repair. In order to promote regeneration after apical surgery, the principle of guided tissue regeneration (GTR) has proved to be useful. This case presents the management of a large PR lesion in a 42-year-old male subject. The PR lesion associated with 21, 11 and 12 was treated using GTR membrane, fixated with titanium minipins. The case was followed up for 2 years radiographically, and a surgical re-entry confirmed the re-establishment of the lost labial plate. Thus, the principle of GTR may immensely improve the clinical outcome and prognosis of an endodontically involved tooth with a large PR defect.