Equine dental disease part 4: a long-term study of 400 cases: apical infections of cheek teeth

Of 400 horses referred because of equine dental disease, 162 suffered from primary apical infections of their cheek teeth (CT), including 92 with maxillary CT infections and 70 with mandibular CT infections. Maxillary swellings and sinus tracts were more common (82 and 26% incidence, respectively) with infections of the rostral 3 maxillary CT, than with infections of the caudal 3 maxillary CT (39 and 5% incidence, respectively). Nasal discharge was more commonly present with caudal (95%) than rostral (23%) maxillary CT infections. Mandibular CT apical infections commonly had mandibular swellings (91%) and mandibular sinus tracts (59%) and these infections were closely related to eruption of the affected CT. A variety of treatments, including medical treatment, apical curettage, repulsion and oral extraction of affected teeth were utilised in these cases, with oral extraction appearing to be most satisfactory. Infections of caudal maxillary CT with a secondary paranasal sinusitis were most refractory to treatment, with a complete response to the initial treatment achieved in just 33% of these cases. Most other cases responded fully to their initial treatment. The long-term response to treatment was good in most cases.

Diagnosis and surgical treatment of periapical infection of the third mandibular molar in five horses

Diagnosis and treatment of periapical infection of the third mandibular molar in 5 horses was assessed. In 4 of 5 horses, there was a recent history of dental work performed. Diagnosis required multiple imaging techniques. Radiography revealed evidence of periapical bone lysis or tooth root lysis of the third mandibular molar in 3 of 5 horses. Sonographic examination was effective in identifying abscesses within the masseter muscle and defects of the lateral cortex of the mandible in 4 of 5 horses. Nuclear scintigraphy was diagnostic in 1 of 2 horses examined. All horses were treated by repulsion of the affected tooth. The surgical approach involved elevating the masseter muscle from the caudal portion of the mandible. This approach provided excellent access to the affected tooth with minimal postoperative complications. All incisions healed with good cosmetic results.

[Diagnostic and therapeutic concepts of canine fossa abscess. Evaluation of a multicenter study of 55 German-speaking departments of oromaxillofacial surgery]

A possible complication of fossa canina infections is reactive thrombosis of the vena angularis, which can lead to cavernous sinus phlebothrombosis. According to the literature there are different opinions about the treatment protocol of fossa canina abscesses. Therefore a multicentre study was undertaken in which 55 departments of oral surgery were interviewed using a standardized questionnaire about their procedures. The basis of diagnosis consists of clinical examination (100%), antibiogram (77.1%) and radiography (97.1%). A total of 28.6% use additional imaging procedures. Sonography is used by 20.0% and is found to be helpful in the diagnosis of vena angularis thrombosis. The painful palpation of the medial angle of the eye is of major diagnostic importance (100%) although anatomic variations of the vena angularis have to be considered. Extraoral incisions are not used in most cases (25.7% in exceptional cases) as well as ligations of the vena angularis in case of thrombosis (8.6% in exceptional cases). There is an agreement in the use of antibiotics (elective administration in 14.3%, obligatory administration in 85.7%); 77.1% don't use heparin to treat thrombosis of the vena angularis. In heparin therapy risks such as bleeding complications and thrombocytopenia have to be considered.

[Treatment of deep neck infections]

BACKGROUND

The incidence of deep neck space infections has been significantly reduced by modern antibiotic therapy. These infections are relatively rare and yet the life-threatening complications merit special consideration by head and neck surgeons.

PATIENTS

Seven cases of deep neck space infections as a consequence of purulent pharyngitis (3), peritonsillar abscess (2), retropharyngeal (1), and odontogenic (1) abscess are presented. Despite antibiotic therapy according to antibiogram all patients showed an increase in complaints with persisting febrile temperatures and rising inflammation parameters. Surgical intervention became necessary. In two cases the infection spread into the mediastinum.

RESULTS

All patients were completely cured by means of early surgical intervention including extensive drainage of the primary focus, deep neck spaces and mediastinum, accompanied by intravenous antibiotic therapy. Tracheotomy was performed on one patient with increasing dyspnea. All patients had an uneventful recovery without major postoperative complications.

CONCLUSIONS

The clinical course of the disease must be observed particularly closely even after starting antibiotic therapy and identification of the infectious focus. Antibiotic therapy may in some cases cover clinical symptoms. However, in the presence of abscess formation or necrotizing infections, antibiotics can prove to be ineffective. The optimum time for surgery is difficult to determine. Complete drainage of the neck spaces down to the mediastinum is a safe procedure to save the patients' life. This shortens the duration of the disease and prevents complications. The most common problems in the management of deep neck space infections are discussed.

Clinical and histologic evaluation of an active "implant periapical lesion": a case report

A new entity called "implant periapical lesion" has recently been described. This lesion could be the result of, for example, bone overheating, implant overloading, presence of a preexisting infection or residual root fragments and foreign bodies in the bone, contamination of the implant, or implant placement in an infected maxillary sinus. This case report describes a titanium implant that was placed in the maxillary premolar region. A fenestration involving the middle portion of the implant was present. After 7 months, the apical portion of the implant showed radiolucency. This lesion rapidly increased in size and a vestibular fistula appeared. A systemic course of antibiotics was not successful, and the implant was then removed. The histologic examination showed the presence of necrotic bone inside the antirotational hole of the implant. The etiology of the implant failure in this instance could possibly be related to bone overheating associated with an excessive tightening of the implant and compression of the bone chips inside the apical hole, producing subsequent necrosis.

Alveolar osteitis (dry socket) in a dog: a case report

Following extraction of a maxillary left first molar tooth in an eight year-old retriever, the dog re-presented five days later because of oral pain, which did not respond to analgesic therapy. The extraction site contained a foul-smelling fluid, but did not contain a clot or granulation tissue. Alveolar osteitis (dry socket) was diagnosed. The alveolus was curetted and flushed, and the dog was given cefalexine and prednisolone. The alveolus was filling with healthy granulation tissue one week later and the dog was no longer in pain.

A combined approach for treatment of developmental groove associated periodontal defect. A case report

Developmental grooves are not rare and often appear on maxillary lateral incisors. This may represent a challenge and sometimes tooth extraction is inevitable. This case report describes a combined technique of regenerative and antimicrobial/root conditioning used to treat a maxillary lateral incisor in a 32-year-old woman. Tooth #10 presented a periodontal probing depth of 8 mm below the cingulum, associated with a developmental groove. The tooth was vital. After initial preparation, a palatal mini-flap was raised, granulation tissue was eliminated by means of ultrasonic bactericidal curettage and radicoloplasty performed. The surface was then treated for 3 minutes with tetracycline-HCl solution (100mg/ml), and the defect filled with sterile, medical grade, calcium sulfate. Clinical measurements were retaken at 6, 12, and 18 months. The results indicated a reduction of probing depth to 2 mm, reestablishment of the lamina dura, and radiographical evidence of bone growth. This combined treatment allowed the tooth to be saved, the palatal surgical approach did not alter the esthetics of the area, and its simplicity is recommended.

Intentional replantation: a case report and review of the literature

Through a case report and a review of the literature, the indications and contraindications for intentional replantation are discussed. The current procedures and techniques for this seldom used modality are presented.

Gingival overgrowth with valproic acid: a case report

A case of a nine-year-old epileptic girl with severe gingival overgrowth who had been taking valproic acid since two months of age is presented. A review of the literature and possible mechanisms for drug-induced gingival overgrowth is outlined.

Endodontic treatment in three cases of dens invaginatus

Three cases of dens invaginated teeth with periapical lesions are presented in this article. In the first case the maxillary canine was treated with conventional endodontic treatment. The second and third cases, in mandibular and maxillary central incisors respectively, were treated surgically. Six months postoperatively all cases appeared radiographically to be improved.

Surgical treatment of a periradicular lesion on an invaginated maxillary lateral incisor (dens in dente)

The complex anatomy of invaginated teeth make their root canal treatment difficult. Moreover, this treatment may compromise the future of the tooth if it is destined to support a post-retained coronal restoration. This case reports the successful surgical root canal treatment of an invaginated tooth using a retrograde filling with gutta-percha. After surgical exposure of the root-end and cleaning of the root canal, the gutta-percha was compacted in the root canal which had been coated previously with a zinc oxide-eugenol cement. The gutta-percha was then cold-burnished. Periapical radiographic examination after 1, 2, 3, 6 and 12 months showed periapical healing with osseous formation. This procedure, resulting in minimal loss of hard tissues, permitted subsequent restoration of the tooth.

[Special anesthesiological aspects in patients with Niikawa-Kuroki ("Kabuki Make-Up") syndrome]

The Niikawa-Kuroki ("Kabuki Make-up") syndrome (NKS) is a rare disease with a characteristic array of multiple congenital anomalies. The syndrome is characterised by distinct craniofacial dysmorphias, moderate mental retardation, skeletal abnormalities, cardiovascular and urogenital disorders, growth retardation and skeletal muscle abnormalities. The inheritance of NKS is not completely clear. However, the available data are compatible with an autosomal dominant mutation with variable expressivity. There is no specific treatment for NKS. The patients require intensive support for the development of their mental and physical capabilities. Furthermore, therapy includes operative correction of the multiple anomalies. The risk of anaesthesia is increased in these patients because of a possible difficult airway, cardiovascular and urogenital diseases, and abnormalities of the skeletal muscles. Special problems associated with the anaesthetic management in patients with NKS are discussed in this case report.

Reasons for apicectomies. A retrospective study

A retrospective study was carried out to evaluate the clinical factors involved in deciding to perform apicectomies. Five hundred and seventeen teeth from 392 patients (211 women and 181 men) that had undergone apicectomy during the period from September, 1990 to December, 1992 were assessed using the patients' clinical records. The information recorded included the source of referral, the quality of preoperative root canal filling, the size of periradicular lesion, the type of the lesion (for biopsed lesions), the type of coronal and radicular restorations, and the different factors that influenced the decision to perform an apicectomy for each tooth. These factors were classified into technical and biological, and when they occurred together they were classified as combined. The decisions to perform apicectomies most commonly involved combined technical and biological factors. Biological factors alone only amounted to 35% of the total. Technical factors alone amounted to only 3% of the total. When all factors were considered, biological factors constituted 60%, whilst technical factors constituted 40%, of the total. The most common biological factors were persistent symptoms (54%), and continuing presence of a periradicular lesion (44%). The most common technical factors were post crown (60%) and crowned teeth without posts (31%). This study emphasised the need for a high standard of conventional root canal treatment in order to avoid surgical treatment.

Abscess formation around the apex of a maxillary root form implant: clinical and microscopical aspects. A case report

This case report describes the occurrence of an abscess in the periapical area of a root form maxillary titanium implant, with a radiolucent appearance and purulent discharge. The removal of the infected periapical tissues was carried out but the clinical symptoms of infection persisted, an attempt at guided tissue regeneration with a freeze-dried dura mater membrane notwithstanding, and it was necessary to remove the implant. The microscopical examination showed that it was possible to observe nonviable bone tissue, with absence of bone cells and areas of bone resorption in the apical portion of the implant. These microscopical features were compatible with an acute localized suppurative osteomyelitis.

Immediate implants placed into infected sites: a clinical report

Placement of immediate implants is a routine clinical procedure. However, certain clinical conditions, especially the presence of infected sites, are considered to be contraindications for the immediate implant. Based on clinical experience, it is proposed that if certain preoperative and postoperative steps are carefully followed and meticulous debridement of the alveolus is done during the surgical procedure, immediate implants can be successfully placed into chronically infected sites. The advantages of this procedure are discussed.

Importance of anatomic variables in endodontic treatment outcomes: case report

Surgical endodontic treatment was performed after a large periradicular lesion failed to resolve following nonsurgical intervention. The subsequent periradicular surgery resulted in healing with scar formation. Assessment of the resected root apex revealed a complex anatomy. The ramifications of these anatomical findings and the periradicular tissue response in healing are discussed relative to prognosis and ultimate treatment outcomes.

An approach to some dilemmas and complications of office oral surgery

This article reviews an eclectic collection of problems. There is no particular reason why any one of them was chosen other than that they are more likely to occur in the course of practice than some other complications such as an oro-antral fistula or trauma to the lingual nerve or tissue emphysema. These latter and some other predicaments were discussed in the course of the talks given by the author at the 28th Australian Dental Congress in March 1995. The problems discussed in this paper are: 1. Dentoalveolar abscess anaesthesia. 2. Inability to obtain effective anaesthesia. The complications: 1. Post-extraction haemorrhage. 2. Syncope. 3. Postoperative infection.

Maxillary nerve block: a case report and review of the intraoral technique

Maxillary nerve blockade is not commonly used by general practitioners due to a lack of experience with the techniques involved and the fear of iatrogenic damage. Nevertheless, it represents an excellent method of producing profound anesthesia in the maxilla, with definite indications in selected instances. The anatomy and techniques associated with the maxillary block, as well as the indications, contraindications and complications are reviewed, and the use of the greater palatine foramen approach to treat a patient with a facial abscess is described.