Diagnosis and treatment of resistant periapical pathoses at the maxillary anterior region
a case report
DOI:
https://doi.org/10.5935/2525-5711.20160027Keywords:
Diagnosis, Oral, Periapical Granuloma, Magnetic Resonance ImagingAbstract
The objective of this study was to report a clinical case of periapical pathosis at the maxillary anterior region which was resistant to conventional endodontic treatment and discuss the contribution of the magnetic resonance imaging (MRI) to the diagnostic process. Female patient aged 43 years old was referred to specialised dental care following unsuccessful endodontic treatment of tooth #11, which had been carried out after presumptive diagnosis of granuloma or root cyst. For a better evaluation, periapical radiography, cone beam computed tomography and MRI exam were all indicated. By means of these exams, one could observe the presence of another lesion at the region of tooth #13, which was suggestive of residual cyst. On MRI scan, the T2WI of the lesions showed hypersignal areas compatible to inflammatory process. Surgery excision of the lesions and apicoectomy of tooth #11 were the treatments chosen, including further referral for histopathological exam. Final diagnosis of both lesions was non-specific inflammatory process or dental granuloma. Clinical-radiographic control showed area of new bone formation, thus evidencing bone repair process. One can conclude that the diagnosis and treatment of periapical pathoses may be challenging and that MRI contributed by providing important information on the nature and content of these lesions.
References
Schulz M, von Arx T, Altermatt HJ, Bosshardt D. Histology of periapical lesions obtained during apical surgery. J Endod. 2009;35(5):634-42. doi:10.1016/j.joen.2009.01.024.
Nair PNR, Pajarola G, Schroeder HE. Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:93e102.
Ferreira LGV, Rosin FCP, Corrêa L. Analysis of Interleukin 17A in periapical abscess and granuloma lesions. Brazilian oral research. 2016;30(1).
Nair PNR. Pathogenesis of apical periodontitis and the causes of endodontic failures. Critical Reviews in Oral Biology & Medicine. 2004;15(6), 348-381.
Guo J, Simon JH, Sedghizadeh P, Soliman ON, Chapman T, Enciso R. Evaluation of the reliability and accuracy of using cone-beam computed tomography for diagnosing periapical cysts from granulomas. Journal of endodontics. 2013;39(12), 1485-1490.
Barbizam JV, Fariniuk LF, Marchesan MA, Pecora JD, Sousa-Neto MD. Effectiveness of manual and rotary instrumentation techniques for cleaning flattened root canals. J Endod 2002;28:365-6.
Song M, Kim HC, Lee W, Kim E. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. Journal of endodontics. 2011;37(11), 1516-1519.
De Cleen MJ, Schuurs AH, Wesselink PR, Wu MK. Periapical status and prevalence of endodontic treatment in an adult Dutch population. Int Endod J 1993;26:112-9.
Schulz M, von Arx T, Altermatt HJ, Bosshardt D. Histology of periapical lesions obtained during apical surgery. J Endod. 2009;35(5):634-42. doi:10.1016/j.joen.2009.01.024
Kuştarcı, A., Köşger, H. H., & Er, K. (2014). Nonsurgical endodontic treatment of a large cyst-like periradicular lesion. Journal of Dental Sciences, 9(4), 420-421.
Srinivasan K, Seith A, Gadodia A, Sharma R, Kumar A, Roychoudhury A, Bhutia O. Evaluation of the Inferior Alveolar Canal for Cysts and Tumors of the Mandible-Comparison of Multidetector Computed Tomography and 3-Dimensional Volume Interpolated Breath-Hold Examination Magnetic Resonance Sequence With Curved Multiplanar Reformatted Reconstructions. Journal of Oral and Maxillofacial Surgery. 2012;70(10), 2327-2332.
