Clinical study of dens evaginatus cases with pulpal involvement

The objective of the present study was to investigate the incidence, clinical findings, diagnosis and treatment of evaginated teeth with pulpal involvement. Five hundred and three cases requiring endodontically treated premolars were studied at Kaohsiung Medical College Hospital. We observed 23 (4.6%) evaginated teeth with pulpal involvement out of the 503 samples studied here. Of the 23 teeth, mandibular second premolars comprise the largest portion. Clinically, all tubercles of pulpally involved evaginated teeth had been worn down by attrition and all these teeth showed negative response in vitality tests. The study indicated that 17 cases had sinus tracts, 1 tooth had discoloration in crown portion, 1 case had facial asymmetry and 6 teeth had a painful history. Radiographs confirmed that 21 cases had apical or lateral rarefaction, 1 tooth had thickened periodontal ligament and 8 teeth had incomplete root formation. Clinical diagnosis included pulp necrosis (23 cases), acute apical periodontitis (3 cases), chronic apical periodontitis (4 cases), suppurative apical periodontitis (17 cases)and Garrer' osteomyelitis (1 case). After the treatment, 13 teeth showed satisfactory results. The treatment on 2 teeth was failed, 1 tooth had root fracture and 7 teeth had loss of follow-up. We conclude that the evaginated teeth can hence be preserved even if they are pulplly infected and have an incomplete root apex.

[The management of sinus tracts of dental origin]

The purpose of this study was to evaluate the results of conservative endodontic therapy of 86 fistulous cases of dental origin at the Department of Conservative Dentistry, Kaohsiung Medical College Hospital. Approximately 60% (52/86) endodontically treated teeth, with a minimum recall period of 6 months, were evaluated for success or failure. The results are as follows: (1) The overall success rate was 82.7% (43/52) fistulous cases. There was no significant statistical difference between male and female patients. (2) There was a better success rate with cases over a 2-year recall period than with cases under a 2-year recall period, but there was no significant statistical difference between these two groups. (3) Cases with periapical pathosis less than 5 mm in diameter, had a better success rate than those with periapical pathosis larger than 5 mm in diameter, but there was no significant statistical difference between these two groups. (4) There was a 79.1% (34/43) success rate in non-surgically treated cases, and a 66.7% success rate (6/9, excluding three successfully retreated cases which had been originally treated with a non-surgical technique) in surgically treated cases.

Dilaceration of a central incisor with iatrogenic root perforation--a case report

Dilacerated tooth is caused by disruption of the follicle of the developing tooth secondary to traumatic injury of its deciduous predecessor. This case presented a dilacerated permanent maxillary incisor which was perforated in root canal at buccal side by general practitioner and treated successfully by conservative endodontic therapy.

[Sinus tracts of dental origin. A clinical study. Part I]

Chronic draining sinus tracts on the oral mucosa or the skin of the face frequently have dental pathosis. The purpose of this study was to investigate the incidence and the distribution of age, sex, opening, and tooth position of sinus tract cases with dental origin. A total of 678 teeth requiring endodontic treatment and having periapical pathosis at the Department of Conservative Dentistry, Kaohsiung Medical College Hospital, were studied. There were 86 (12.7%) teeth associated with sinus tracts, among these 47 (16.3%, 47/288) were from males and 39 (10.0%, 39/390) were from females. Of the openings of the sinus tracts, 70 were on the facial, 2 were on the palatal, 1 was on the distal, 4 were on the lingual, 2 were on both facial and lingual surfaces of teeth, and 7 were extraorally. The sinus tracts occurred more frequently in the mandibular than maxillary teeth. The maximum number of 34 cases (39.5%, 34/86) were from the 21-30 years of age group. In addition, we also found that the teeth with periapical lesions of larger than 5 mm in diameter are more frequently associated with sinus tracts than those teeth with lesions of smaller than 5 mm in diameter.