Non-Surgical Management of Mandibular Molar with Multiple Intra-oral Sinus Tracts: A Case Report

Rare case of extrapulmonary tuberculosis masquerading as an intraoral sinus in association with a nonhealing extraction socket in a teenage girl-"A case report with Review of literature"

Tuberculosis (TB) is a serious infectious disease with significant mortality and most commonly affects the pulmonary system and rarely the oral cavity. Because oral tuberculosis is a rare disease, it is often overlooked in the differential diagnosis of oral lesions. Despite the recent decline in the incidence of tuberculosis, it remains a highly contagious and serious public health problem, thus requiring early diagnosis and rapid intervention. Extrapulmonary tuberculosis (EPTB) is defined as any bacteriologically confirmed or clinically diagnosed case of tuberculosis (TB). A 17-year-old girl reported at the outpatient Department of Dentistry with the chief complaint of a swelling at the backside of mouth along with pus discharge. She noticed these symptoms approximately one month after the extraction of the left mandibular first molar. The patient was referred to the Department of Pulmonary Medicine for further investigation and treatment. Subsequently, diagnosis of EPOTB was reached on the basis of the histopathological findings and the previous personal as well as family history. Drastic improvement was observed in the general condition and a complete resolution of the oral lesion after four weeks of ATT and the patient was completely free of all the symptoms after six months of follow-up period. This case demonstrated the importance of oral manifestation of oral tuberculosis for dentist who may be the first healthcare provider to encounter a variety of oral lesions.

Single-visit endodontic treatment of mature teeth with chronic apical abscesses using mineral trioxide aggregate cement: a randomized clinical trial

BACKGROUND

Mature teeth with chronic apical abscesses characterized by intermittent discharge of pus through an associated sinus tract. This communication between oral mucosa and periapical inflammation is challenging for the sealing ability of root canal obturation material. Therefore, the study aim was to compare the outcomes of endodontic treatment using mineral trioxide aggregate (MTA) cement to the conventional gutta-percha cone and root canal sealer as an obturation material in mature teeth with chronic apical abscesses.

METHODS

Mature teeth with chronic apical abscesses referred to our clinic for root canal treatment between 2010 and 2012 were treated in a single visit and distributed among treatment (T) and control (C) groups using a predetermined randomization block (TCTC). After chemo-mechanical preparation, teeth in group T received MTA cement mixed in a 0.26 water to powder ratio, and teeth group C received gutta-percha and root canal sealer using the warm vertical technique. The treatment outcomes were defined as obturation length, periapical healing, resorption of extruded material, and survival rate at least 2.5 years after treatment. Three endodontists blinded to the type of obturation material documented treatment outcomes. Statistical analysis at P < 0.05 was conducted to measure difference between the groups.

RESULTS

Thirty-six teeth were treated between 2010 and 2012, and 32 teeth were evaluated in 2015. Complete periapical healing was observed in 87.5 % of MTA-treated teeth and 75.0 % of gutta-percha-treated teeth. Adequate obturation length was reported in 50.0 % of MTA-treated and 37.5 % of gutta-percha-treated teeth. Complete resorption of extruded material was evident in 83.3 % MTA-treated teeth and 100.0 % gutta-percha-treated teeth. The survival rate of MTA-treated teeth was 100 % at 3, and 5 years, while the survival rate of gutta-percha-treated teeth was 83.3 % at 3, and 5 years. There was no significant difference between the groups in term of periapical healing, survival rate, obturation length, or resorption of extruded material.

CONCLUSIONS

The outcomes of single-visit endodontic treatment of mature teeth with chronic apical abscesses using MTA cement were better, but not statistically significant, compared to conventional treatment.

TRIAL REGISTRATION

ISRCTN15285974 . Registered retrospectively 23 June 2015.