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Case Reports in Dentistry 2023. This case report discusses the multi-disciplinary approach and long-term follow-up of a 66-year-old male who suffered a combined endodontic-periodontal lesion (EPL)....
. This case report discusses the multi-disciplinary approach and long-term follow-up of a 66-year-old male who suffered a combined endodontic-periodontal lesion (EPL). As EPL is uncommon in daily practice and dentists' knowledge and awareness of EPL is quite low, this case becomes of high interest and value to document and research. The objective of this study is to present the diagnosis, multi-disciplinary approach, and long-term follow-up of compromised teeth with EPL. It highlights the importance of the identification and elimination of all causative factors as well as the correct treatment sequence to achieve a predictable outcome. The patient was referred to the periodontist after multiple unsuccessful attempts by his previous dentist. He complained of recurrent dull pain and abscess on his upper left tooth (tooth #26) that had been present for the past three years. A diagnosis of combined EPL was obtained after thorough anamnesis, clinical evaluation, and radiographic examination. The clinician identified several predisposing factors, such as plaque, trauma from occlusion, and excessive force on tooth #26 due to incorrect denture design. Treatment involved multiple dental specialties. At the periodontist, the patient underwent scaling, root planning, and removal of overhanging part of the restoration. At the endodontist, root canal treatment (RCT) was completed. Two months after RCT, a periodontal regenerative procedure was done. The defect was filled with a combination of allograft/alloplastic bone graft and covered with a barrier membrane. Upon healing, the prosthodontist did the final restoration of fiber post with a metal crown on tooth #26 and constructed a new denture with a periodontal-friendly design. A follow-up at five months and four years showed excellent results. The patient was symptom-free, and tooth #26 showed no periodontal inflammation. Radiographic examination showed a good bone fill at the defect. Supportive periodontal therapy should be emphasized to achieve the long-term success of EPL.
PubMed: 36726694
DOI: 10.1155/2023/3024231 -
Case Reports in Dentistry 2023Auto-transplantation is a procedure that replaces traumatized or congenitally missing teeth. While most auto-transplanted teeth are successfully integrated into...
Auto-transplantation is a procedure that replaces traumatized or congenitally missing teeth. While most auto-transplanted teeth are successfully integrated into recipient sites, the donor tooth may develop apical periodontitis, causing early failure. In the present case report, the periodontic resident performed the procedure on a 15-year-old male by selecting donor teeth #4 and #13 and transplanting them at recipient sites #29 and #20, respectively. After 6 weeks, the patient was referred to the endodontic resident for evaluation of tooth #20 due to symptom development. While one auto-transplanted tooth (donor tooth #4, recipient site #29) was successfully integrated, the other (donor tooth #13, recipient site #20) was unsuccessful: the patient was diagnosed with pulp necrosis and a chronic apical abscess. Because of the patient's age, collaboration among periodontic, endodontic, and orthodontic residents/specialists informed the clinical decision to pursue non-surgical root canal treatment (NSRCT) rather than extraction. The canal was cleaned and shaped to a size #80 using copious irrigation of 2.5% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA) via the EndoVac Negative Pressure Irrigation system. The tooth was dried with paper points, and then calcium hydroxide was mixed with 2.5% NaOCl and placed with an amalgam carrier 2 mm from the radiographic apex. The tooth was next temporized with Teflon tape and Fuji TRIAGE. Four weeks later, after confirming the patient was asymptomatic and tooth mobility had decreased, the canal was obturated using EndoSequence Bioceramic Root Repair Material Fast Set Putty in 2 mm incremental layers to achieve a three-dimensional fill and create an apical plug to prevent gutta-percha extrusion, then backfilled in incremental layers of gutta-percha to the cementoenamel junction (CEJ). At the 8-month follow-up, the patient was asymptomatic, and the periodontal ligament (PDL) had no signs of periapical pathology. When teeth undergoing auto-transplantation procedures develop apical periodontitis, NSRCT can be implemented.
PubMed: 37305807
DOI: 10.1155/2023/9389760 -
Journal of Indian Society of... 2023An escalation in cases of rhinomaxillary mucormycosis among post-COVID patients is being reported. However, there is limited information about periodontal features in...
BACKGROUND
An escalation in cases of rhinomaxillary mucormycosis among post-COVID patients is being reported. However, there is limited information about periodontal features in mucormycosis cases. This study explored the periodontal signs and symptoms among post-COVID mucormycosis individuals.
MATERIALS AND METHODS
This cross-sectional study was carried out with a total of 25 post-COVID mucormycosis patients attending tertiary care public teaching hospital. Clinical and radiographic assessments were done.
RESULTS
An elevation in mean probing pocket depth (PPD) up to 6.21 ± 2.7 mm was noted. Nearly 16%-40% of patients had Miller's Grade III mobility in the affected site. Forty-four per cent had localized single or multiple abscess, 40% had palatal swelling, 32% had necrosis of soft tissue and bone exposure, and 52% had maxillary dentoalveolar segmental mobility in the affected site. Radiographic examination revealed varying stages of interdental bone loss.
CONCLUSION
The present study observed an increase in mobility and mean PPD which did not commiserate with interdental bone loss in the affected maxillary region.
PubMed: 37593554
DOI: 10.4103/jisp.jisp_429_22 -
Infection and Immunity Mar 2024Oral streptococci, key players in oral biofilm formation, are implicated in oral dysbiosis and various clinical conditions, including dental caries, gingivitis,...
Oral streptococci, key players in oral biofilm formation, are implicated in oral dysbiosis and various clinical conditions, including dental caries, gingivitis, periodontal disease, and oral cancer. Specifically, is associated with esophageal, gastric, and pharyngeal cancers, while is linked to oral cancer. However, no study has investigated the mechanistic links between these species and cancer-related inflammatory responses. As an initial step, we probed the innate immune response triggered by and in RAW264.7 macrophages. These bacteria exerted time- and dose-dependent effects on macrophage morphology without affecting cell viability. Compared with untreated macrophages, macrophages infected with exhibited a robust proinflammatory response characterized by significantly increased levels of inflammatory cytokines and mediators, including TNF, IL-6, IL-1β, NOS2, and COX2, accompanied by enhanced NF-κB activation. In contrast, -infected macrophages failed to elicit a robust inflammatory response. Seahorse Xfe96 analysis revealed an increased extracellular acidification rate in macrophages infected with compared with . At the 24-h time point, the presence of led to reduced extracellular itaconate, while triggered increased itaconate levels, highlighting distinct metabolic profiles in macrophages during infection in contrast to aconitate decarboxylase expression observed at the 6-h time point. This initial investigation highlights how and , two Gram-positive bacteria from the same genus, can prompt distinct immune responses and metabolic shifts in macrophages during infection.IMPORTANCEThe surge in head and neck cancer cases among individuals devoid of typical risk factors such as Human Papilloma Virus (HPV) infection and tobacco and alcohol use sparks an argumentative discussion around the emerging role of oral microbiota as a novel risk factor in oral squamous cell carcinoma (OSCC). While substantial research has dissected the gut microbiome's influence on physiology, the oral microbiome, notably oral streptococci, has been underappreciated during mucosal immunopathogenesis. , a viridans streptococci group, has been linked to abscess formation and an elevated presence in esophageal cancer and OSCC. The current study aims to probe the innate immune response to compared with the early colonizer as an important first step toward understanding the impact of distinct oral species on the host immune response, which is an understudied determinant of OSCC development and progression.
Topics: Humans; Streptococcus anginosus; Carcinoma, Squamous Cell; Mouth Neoplasms; Dental Caries; Streptococcus; Macrophages; Succinates
PubMed: 38289109
DOI: 10.1128/iai.00536-23 -
Turkish Journal of Pharmaceutical... Sep 2021Periodontal treatment focuses on the thorough removal of specific periodontal pathogens, mainly anaerobic Gram-negative bacteria, by mechanical scaling and root...
OBJECTIVES
Periodontal treatment focuses on the thorough removal of specific periodontal pathogens, mainly anaerobic Gram-negative bacteria, by mechanical scaling and root planning. In case the periodontal abscess is detected after treatment, a high dose of antimicrobial agents is commonly applied via oral administration. However, this approach increases the risk of antibiotic resistance and systemic side effects and decreases efficacy. To overcome the aforementioned issues, this study focused on the development of thermosensitive hydrogel to deliver the antibiotic drug metronidazole (MTZ) directly and locally to the oral infection site.
MATERIALS AND METHODS
The thermosensitive hydrogels were prepared by blending 28% w/v Pluronic F127 with various concentrations of methylcellulose (MC) and silk fibroin (SF). The gel properties, such as sol-gel transition time, viscosity, and gel strength, were investigated. The drug dissolution profiles, together with their theoretical models and gel dissolution characteristics, were also determined.
RESULTS
All hydrogel formulations exhibited sol-gel transitions at 37°C within 1 min. An increase in MC content proportionally increased the viscosity but decreased the gel strength of the hydrogel. By contrast, the SF content did not significantly affect the viscosity but increased the gel strength of the hydrogel. The thermosensitive hydrogels also showed prolonged MTZ release characteristics for 10 days in phosphate-buffered saline (PBS) at pH 6.6, which followed the Higuchi diffusion model. Moreover, MTZ-thermosensitive hydrogel exhibited delayed dissolution in PBS at 37°C for more than 9 days.
CONCLUSION
MTZ-thermosensitive hydrogels could be considered a prospective local oral drug delivery system to achieve efficient sustained release and improve the drug pharmacological properties in periodontitis treatment.
PubMed: 34496558
DOI: 10.4274/tjps.galenos.2020.09623 -
Journal of Advanced Pharmaceutical... Nov 2022Among several treatment modalities done in dental clinics, dental extractions are the most frequently carried out treatment. Tooth extraction is indicated in cases such...
Among several treatment modalities done in dental clinics, dental extractions are the most frequently carried out treatment. Tooth extraction is indicated in cases such as chronic periodontal disease, abscess, root caries, root stumps, fractured teeth, and failed root canal treatments with the persistence of periapical cysts or granulomas, impacted teeth, or to facilitate orthodontic or prosthodontic rehabilitation. The consequence of routine tooth extraction could lead to dentoalveolar diseases, which cause tooth loss. The various complications of surgical procedures are delayed wound healing, postoperative bleeding, remnant bony spicules, and nerve paresthesia. This study aimed to assess the impact of nonsurgical tooth extraction on the quality of life of patients. Institutional patient data from January 2021 to April 2021 were analyzed, in which 2000 patients who had undergone extractions at our dental institution were included in our study. The data evaluating the patients' quality-of-life postextraction were recorded. It included speech variation, social interaction, postoperative pain, sleep impairment, and inability to work. Data obtained were statistically analyzed using SPSS, and results were obtained. Most men (49%) experienced an inability to work compared to women (25%). 38% of females had moderate-to-severe pain, whereas males (21%) had only mild pain. 21% of males are isolated socially due to feeling sick, whereas 20% of females are isolated socially due to pain. Speech was affected more postextraction. Most of the patients could not go to work for 1-3 days following the removal of the tooth. Most of the patients were pleased with the procedure, with their symptoms disappearing after the procedure, and were not worried about dental extractions.
PubMed: 36643114
DOI: 10.4103/japtr.japtr_361_22 -
Journal of Periodontal & Implant Science Dec 2023No evidence exists regarding the advantages of periodontal regeneration treatment for furcation defects using soft block bone substitutes. Therefore, this randomized...
PURPOSE
No evidence exists regarding the advantages of periodontal regeneration treatment for furcation defects using soft block bone substitutes. Therefore, this randomized controlled trial aimed to assess the clinical and radiographic outcomes of regenerative therapy using porcine-derived soft block bone substitutes (DPBM-C, test group) compared with porcine-derived particulate bone substitutes (DPBM, control group) for the treatment of severe class II furcation defects in the mandibular molar regions.
METHODS
Thirty-five enrolled patients (test group, n=17; control group, n=18) were available for a 12-month follow-up assessment. Clinical (probing pocket depth [PPD] and clinical attachment level [CAL]) and radiographic (vertical furcation defect; VFD) parameters were evaluated at baseline and 6 and 12 months after regenerative treatment. Early postoperative discomfort (severity and duration of pain and swelling) and wound healing outcomes (dehiscence, suppuration, abscess formation, and swelling) were also assessed 2 weeks after surgery.
RESULTS
For both treatment modalities, significant improvements in PPD, CAL, and VFD were found in the test group (PPD reduction of 4.1±3.0 mm, CAL gain of 4.4±2.9 mm, and VFD reduction of 4.1±2.5 mm) and control group (PPD reduction of 2.7±2.0 mm, CAL gain of 2.0±2.8 mm, and VFD reduction of 2.4±2.5 mm) 12 months after the regenerative treatment of furcation defects (<0.05). However, no statistically significant differences were found in any of the measured clinical and radiographic parameters, and no significant differences were observed in any early postoperative discomfort and wound healing outcomes between the 2 groups.
CONCLUSIONS
Similar to DPBM, DPBM-C showed favorable clinical and radiographic outcomes for periodontal regeneration of severe class II furcation defects in a 12-month follow-up period.
TRIAL REGISTRATION
Clinical Research Information Service Identifier: KCT0007305.
PubMed: 37154106
DOI: 10.5051/jpis.2203660183 -
Cureus Jul 2022is a strict anaerobe that is indigenous to the human oral cavity, where it coexists with more than 500 other species. It is associated with paranasal sinus,...
is a strict anaerobe that is indigenous to the human oral cavity, where it coexists with more than 500 other species. It is associated with paranasal sinus, odontogenic, and pulmonary infections. In literature, cases of are rare. Here we report a case of a patient with multiple brain abscesses caused by . This case report looks to assist clinicians in determining the true etiology of this organism, which can change patient management based on the current literature review and similar case studies.
PubMed: 35989742
DOI: 10.7759/cureus.26989 -
BMC Oral Health Nov 2019There are conflicting opinions about the contribution of malocclusions to the development of dental caries and periodontal disease. This study's aim was to determine the...
BACKGROUND
There are conflicting opinions about the contribution of malocclusions to the development of dental caries and periodontal disease. This study's aim was to determine the association between specific malocclusion traits, caries, oral hygiene and periodontal health for children 6 to 12 years old.
METHODS
The study was a household survey. The presence of malocclusion traits was assessed in 495 participants. The caries status and severity were assessed with the decayed, missing, and filled teeth (dmft/DMFT) index and the pulpal involvement, ulceration, fistula and abscess (pufa/PUFA) index. The Simplified Oral Hygiene Index (OHI-S) and Gingival Index (GI) were used to assess periodontal health. The association between malocclusion traits, the presence of caries, poor oral hygiene, and poor gingival health were determined with chi square and logistic regression analyses. Statistical significance was inferred at p < 0.05.
RESULTS
Seventy-four (14.9%) study participants had caries, with mean (SD) dmft/DMFT scores of 0.27 (0.82) and 0.07 (0.39), respectively, and mean (SD) pufa/PUFA index scores of 0.09 (0.43) and 0.02 (0.20), respectively. The mean (SD) OHI-S score was 1.56 (0.74) and mean (SD) GI score was 0.90 (0.43). Dental Aesthetic Index scores ranged from 13 to 48 with a mean (SD) score of 20.7 (4.57). Significantly greater proportions of participants with crowding (p = 0.026) and buccal crossbite (p = 0.009) had caries. Significantly more children with increased overjet (p = 0.003) and anterior open bite (p = 0.008) had moderate to severe gingivitis. Poor oral hygiene (OR: 1.83; CI: 1.05-3.18 p = 0.033), crowding (OR: 1.97; CI: 1.01-3.49; p = 0.021) and buccal crossbite (OR: 6.57; CI: 1.51-28.51 p = 0.012) significantly increased the odds of having caries. Poor oral hygiene (p < 0.001), increased overjet (p = 0.003), and anterior open bite (p = 0.014) were the only significant traits associated with gingivitis.
CONCLUSIONS
Crowding and buccal cross bite were associated with caries, whereas increased overjet and anterior open bite were associated with gingivitis. These findings justify the recommendation of orthodontic treatment to improve oral health.
Topics: Child; Cross-Sectional Studies; DMF Index; Dental Caries; Female; Humans; Male; Malocclusion; Nigeria; Oral Hygiene; Prevalence
PubMed: 31775712
DOI: 10.1186/s12903-019-0959-2 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Feb 2023Palatal radicular groove is a developmental malformation of maxillary incisors, lateral incisors in particular, which often causes periodontal destruction. This paper... (Review)
Review
Palatal radicular groove is a developmental malformation of maxillary incisors, lateral incisors in particular, which often causes periodontal destruction. This paper reports a case of combined periodontal-endodontic lesions induced by palatal radicular groove, which was initially misdiagnosed as a simple periapical cyst. After root canal therapy and periapical cyst curettage, the course of disease was prolonged, resulting in the absence of buccal and maxillary bone plates in the affected tooth area. After the etiology was determined, the affected tooth was extracted and guide bone tissue regeneration was performed at the same time, followed by implantation and restoration at the later stage, leading to clinical cure. The palatal radicular groove is highly occult, and the clinical symptoms are not typical. If the abscess of the maxillary lateral incisor occurs repeatedly, and the abscess of the maxillary lateral incisor has not been cured after periodontal and root canal treatment, cone-beam computed tomographic and periodontal flap surgery should be considered.
Topics: Humans; Incisor; Radicular Cyst; Abscess; Tooth Root; Root Canal Therapy; Maxilla; Cysts
PubMed: 36999478
DOI: 10.11817/j.issn.1672-7347.2023.220104