Diagnosis and Treatment of Odontogenic Cutaneous Sinus Tracts in an 11-Year-Old Boy: A Case Report

Odontogenic cutaneous sinus tracts (OCSTs) are generally primarily misdiagnosed and inappropriately treated by virtue of their rarity and the absence of dental symptoms. Accurate diagnosis and treatment and the elimination of the source of infection can reduce the incidence of complications and relieve the pain of the patient.In this case report, we present the case of an 11-year-old patient with an apparent abscess but an unobvious draining sinus tract in his left cheek. Intraorally, a glass-ionomer-cement filling on the occlusal surface of the left mandibular first molar (tooth 36) was noted. Radiographic examination revealed a radiopaque mass inside the crown and pulp chamber and an irregular, radiolucent periapical lesion surrounding the distal root apex. He was diagnosed with an OCTS secondary to a periapical abscess of tooth 36. Precise root canal therapy (RCT) and chronic granuloma debridement was performed; 6 months later, the abscess and sinus had healed completely, and the periapical lesion had resolved.Odontogenic cutaneous sinus tracts are uncommon in the clinic. This case report reminds us of the significance of OCSTs and provides some implications for their diagnosis and treatment.

An unnoticed origin of fever: periapical tooth abscess. Three case reports and literature review

Dental infections may lead to severe local or systemic infections such as endocarditis, brain abscesses and mediastinitis. Fever may be the only symptom. We aim to highlight dental/odontogenic abscesses as the occult source of unexplained fever by reporting on three cases and reviewing the relevant literature. Early dental evaluation and referral of patients with persistent fever (even without any oral symptoms) to a dentist plays a critical role in preventing unnecessary, time-consuming and high-cost further diagnostic tests and invasive procedures. A simple panoramic dental radiography may suffice to establish the diagnosis.

The Use of Facial CT for the Evaluation of a Suspected Simple Dentoalveolar Abscess in the Emergency Department

INTRODUCTION

Facial computed tomography (CT) is often performed in the emergency department as a part of the diagnostic workup for patients presenting with the signs and symptoms of dentoalveolar abscess (DA). This investigation evaluated the diagnostic yield of the facial CT and its effects on management change in patients suspected of DA. Furthermore, we assessed secondary consequences of routine facial CT use in this population by using turn-around time (TAT), cost, and radiation exposure as the key parameters.

MATERIAL AND METHODS

We retrospectively reviewed records of suspected DA patients over a 5-year period, from June 2008 to June 2013. TAT was calculated for patients from the time the examination was ordered by the emergency department physician, to the time the report was finalized by the attending radiologist. Effective radiation dose for facial CT was calculated by multiplying dose length product by the standard conversion coefficient K (K = 0.0021 mSv/mGy x cm). CT cost was included for reference but was not analyzed extensively due to the lack of standardization of costs across the various institutions.

RESULTS

Our investigation consisted of 117 patients; 75 males of average age 41 (±12) years and 42 females of average age 44 (±17) years. Out of the total 117 patients that underwent CT for the suspicion of a simple DA, only a single individual (0.85%) underwent a management change. Mean TAT of facial CT was 110 (±63) minutes, and a median TAT was 87 (±71) minutes. Average effective radiation dose for a facial CT was 2.4 (±0.4) mSv. Approximate estimated cost of a contrast enhanced facial CT was $253 and non-contrast facial CT was $209.

CONCLUSION

Our study shows that routine use of facial CT has a very limited diagnostic value in the workup of simple DA and rarely results in management change. The overall impact on patient management is miniscule in the context of prolonged TAT, radiation exposure, and adding to the rising medical costs.

The value of cone beam CT in assessing and managing a dilated odontome of a maxillary canine

A case of an unusual anomaly in a maxillary canine is described. A deep enamel invagination resulted in pulpal necrosis, longstanding infection and development of an associated radicular cyst. Diagnostic X-ray imaging was invaluable in demonstrating the complex root anatomy of the dilated odontome. In particular, a cone beam CT scan helped in the formulation of an appropriate treatment plan. Clinical Relevance: Three-dimensional imaging using cone beam CT was valuable in this case to demonstrate the complicated anatomy of a rare dental anomaly, and to help plan treatment.

Aberration in the palatal root of the maxillary first molar

Thorough knowledge of root canal morphology is essential for the endodontic therapy. Variations in the root and root canal morphology, especially in multirooted teeth, are a constant challenge for diagnosis and management. The dentist needs to be familiar with the various root canal configurations and their variations for successful endodontic therapy. There are rare variations in canal number and configuration in maxillary molars, which could affect treatment outcome. Two lingual root structures are occasionally found on human permanent maxillary molars. One of these is the normal lingual root, which is always present, the other is a supernumerary structure which can be located either mesiolingually (radix mesiolingualis) or distolingually (radix distolingualis). The purpose of this paper is to review the literature and to demonstrate a case report which describes the successful non-surgical endodontic management of an unusual maxillary first molar with four separate roots and four canals.

Treatment of through-and-through bone lesion using autologous growth factors and xenogeneic bone graft: a case report

BACKGROUND

This pilot case study aimed at evaluating the possibility of achieving optimal hard and soft tissue regeneration using plasma rich in growth factors (PRGF) and anorganic bovine bone (ABB) for the surgical treatment of a large through-and-through periapical bone lesion.

CASE REPORT

Maxillary incisors of a patient with through-and-through periapical lesion of endodontic origin were treated using modern endodontic surgical technique with the adjunct of PRGF. The PRGF clot was positioned over the palatal side of the lesion while the remaining bone defect was grafted with PRGF and ABB. A collagen membrane embedded with plasma very rich in growth factors covered the graft. Post-operative pain and swelling were negligible, and soft tissue healing was very fast. One-year clinical and radiographic outcome showed complete healing and functionality.

DISCUSSION

The addition of PRGF to ABB could improve the regenerative process, reducing postoperative symptoms and resulting in a fast and predictable hard and soft tissue healing.

CBCT technology: endodontics and beyond, Part 2

There is a saying that knowledge is power. Without realizing it, 2-D imaging has created a large information gap due to its limitations as a technology resource. As dental professionals, we have relied on this technology while rarely questioning its validity or the quality of information it provided to us. With the advent of 3-D imaging, that information gap has been narrowed. CBCT imaging has stretched our boundaries, allowing for complete and accurate information in all 3 dimensions. This new knowledge is a most powerful force in dentistry that will dynamically change our ideas, diagnoses, and treatment options. It is the author's belief that the implementation of this technology will lead to new innovations and better care in all specialties of dentistry.

Panoramic radiographic examination: a survey of 271 edentulous patients

The aim of this study was to quantify the frequency of positive radiographic findings in edentulous arches. Panoramic radiographs from 271 patients who were edentulous in one or both arches were evaluated for the presence of retained root fragments, impacted teeth, foreign bodies, radiolucencies, radiopacities, mental foramina at or near the crest of the residual alveolar ridge, and maxillary sinus proximity to the crest of the residual alveolar ridge. One or more of these radiographic observations were found in 51.7% of the examined films. The most frequent finding (30.6%) was close approximation of the maxillary sinus to the crest of the ridge. These results underscore the importance of panoramic examination of edentulous patients in detecting potential problems before complete denture treatment. However, prescribing such an examination in patients seeking replacement dentures requires a thorough patient history and clinical examination.

Cone beam computed tomography radiation dose and image quality assessments

Diagnostic radiology has undergone profound changes in the last 30 years. New technologies are available to the dental field, cone beam computed tomography (CBCT) as one of the most important. CBCT is a catch-all term for a technology comprising a variety of machines differing in many respects: patient positioning, volume size (FOV), radiation quality, image capturing and reconstruction, image resolution and radiation dose. When new technology is introduced one must make sure that diagnostic accuracy is better or at least as good as the one it can be expected to replace. The CBCT brand tested was two versions of Accuitomo (Morita, Japan): 3D Accuitomo with an image intensifier as detector, FOV 3 cm x 4 cm and 3D Accuitomo FPD with a flat panel detector, FOVs 4 cm x 4 cm and 6 cm x 6 cm. The 3D Accuitomo was compared with intra-oral radiography for endodontic diagnosis in 35 patients with 46 teeth analyzed, of which 41 were endodontically treated. Three observers assessed the images by consensus. The result showed that CBCT imaging was superior with a higher number of teeth diagnosed with periapical lesions (42 vs 32 teeth). When evaluating 3D Accuitomo examinations in the posterior mandible in 30 patients, visibility of marginal bone crest and mandibular canal, important anatomic structures for implant planning, was high with good observer agreement among seven observers. Radiographic techniques have to be evaluated concerning radiation dose, which requires well-defined and easy-to-use methods. Two methods: CT dose index (CTDI), prevailing method for CT units, and dose-area product (DAP) were evaluated for calculating effective dose (E) for both units. An asymmetric dose distribution was revealed when a clinical situation was simulated. Hence, the CTDI method was not applicable for these units with small FOVs. Based on DAP values from 90 patient examinations effective dose was estimated for three diagnostic tasks: implant planning in posterior mandible and examinations of impacted lower third molars and retained upper cuspids. It varied between 11-77 microSv. Radiation dose should be evaluated together with image quality. Images of a skull phantom were obtained with both units varying tube voltage, tube current, degree of rotation and FOVs. Seven observers assessed subjective image quality using a six-point rating scale for two diagnostic tasks: periapical diagnosis and implant planning in the posterior part of the jaws. Intra-observer agreement was good and inter-observer agreement moderate. Periapical diagnosis was found to, regardless of jaw, require higher exposure parameters compared to implant planning. Implant planning in the lower jaw required higher exposure parameters compared to upper jaw. Substantial dose reduction could be made without loss of diagnostic information by using a rotation of 180 degrees, in particular implant planning in upper jaw. CBCT with small FOVs was found to be well-suited for periapical diagnosis and implant planning. The CTDI method is not applicable estimating effective dose for these units. Based on DAP values effective dose varied between 11-77 microSv (ICRP 60, 1991) in a retrospectively selected patient material. Adaptation of exposure parameters to diagnostic task can give substantial dose reduction.

Bilateral triplicated primary central incisors: clinical course and therapy

Uncommon developmental abnormalities such as fused or geminated teeth are of interest for the clinical problems associated with them. A rare case of fusion between maxillary primary central and lateral incisors and a supplemental incisor occurring bilaterally is presented. The patient was a 4-year-old Thai boy. Intraoral examination revealed an abscess and fistula in the region of the fused teeth as a result of periapical osteolysis. Access cavities were prepared as acute procedures. Because of the unpromising prognosis, surgical removal of the teeth was inevitable. For functional, esthetic, and phonetic rehabilitation, an acrylic denture was incorporated.

Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology

OBJECTIVE

To compare intraoral periapical radiography with 3D images for the diagnosis of periapical pathology.

STUDY DESIGN

Maxillary molars and premolars and mandibular molars with endodontic problems and examined with periapical radiographs and a 3D technique (3D Accuitomo) were retrospectively selected and evaluated by 3 oral radiologists. Numbers of roots and root canals, presence and location of periapical lesions, and their relation to neighboring structures were studied.

RESULTS

Among 46 teeth, both techniques demonstrated lesions in 32 teeth, and an additional 10 teeth were found in the Accuitomo images. As regards individual roots, 53 lesions were found in both techniques, and 33 more roots were found to have lesions in Accuitomo images. Artefacts were sometimes a problem in Accuitomo images. In 32 of the 46 cases, all observers agreed that additional clinically relevant information was obtained with Accuitomo images.

CONCLUSIONS

A high-resolution 3D technique can be of value for diagnosis of periapical problems.

Orbital abscess from an odontogenic infection

An orbital abscess is a rare but serious complication of an odontogenic infection, which can lead to loss of vision or worse. This paper presents a case of orbital abscess secondary to an infection from the upper molar teeth, which extended to the retobulbar and posterosuperior region of the orbit, close to the superior orbital fissure. The infection spreaded to the pterygopalatine and infratemporal fossa and then to the orbit via the inferior orbital fissure. This paper reviews the clinical presentation, differential diagnosis, route of spread, value of serial CT scanning, treatment and possible complications.

Effectiveness of dental computed tomography in diagnostic imaging of periradicular lesion of each root of a multirooted tooth: a case report

Radiography by use of the three-dimensional (3D) Accuitomo XYZ Slice View Tomograph (3DX), a device for compact computed tomography in dentistry, was performed as a new diagnostic imaging technique for a patient who needed endodontic therapy. The 3DX was used for examining and diagnosing the presence and expansion of periradicular lesions in each root of a multirooted tooth. High-resolution 3D images were observed and compared with those obtained by routine conventional radiography. It was difficult to diagnose the cause of clinical symptoms by general examinations including the usual intraoral radiography and panoramic radiography. The images obtained by the 3DX, however, clearly showed the apparent presence and expansion of a periradicular lesion in only one root of the multirooted tooth. The 3DX, a newly developed dental computed tomography, provides abundant new image information not attainable by either intraoral radiography or panoramic radiography, and its application for clinical use is very effective for examining and diagnosing regions of interest for endodontic therapy.

Three-dimensional visualization of a mandibular first molar with three distal roots using computer-aided rapid prototyping

Nonsurgical endodontic therapy of a right mandibular first molar with 3 distal roots was successfully performed with the aid of magnification. 3D data (DICOM format) of the tooth were obtained from a CT HighSpeed Advantage and a Denta Scan program produced by GE Medical Systems. The CT protocol used for this procedure involved a slit thickness of 1 mm. The 3D digital data obtained were fed into a visualization program (V-works; Cybermed Co) and then exported to the rapid prototyping machine for fabrication of the actual-sized tooth model. The material for the model-making process was starch. The 3D digital visualization and the computer-aided rapid prototyping (CARP) model clearly showed 3 separate distal roots (distobuccal, distolingual, and middle distal). The CARP technique seems to be a useful imaging technology to document unusual root anatomy in clinical dentistry.

A study of periapical lesions correlating the presence of a radiopaque lamina with histological findings

OBJECTIVE

To compare the presence or absence of a radiopaque lamina of 60 human periapical lesions with the histological findings from a case study in dental practice.

STUDY DESIGN

Paralleling radiographs were taken of 60 teeth with periapical radiolucencies. The periapical radiographs were scanned, and standardized images were evaluated on a computer screen for the presence or absence of a radiopaque lamina by 2 calibrated observers according to agreed criteria. The serially sectioned histological specimens were obtained from the extraction of 13 endodontically treated teeth and 27 nontreated teeth, as well as 20 post-treatment teeth with apical periodontitis removed during periapical surgical procedure; the specimens were classified according to agreed criteria. The findings of the 2 evaluations were compared.

RESULTS

Out of 57 electronic images that could be interpreted, 10 lesions had a radiopaque lamina, but of these only 3 were histologically diagnosed as cysts, while 7 were granulomas or abscesses. Out of 47 lesions without a radiopaque lamina, 40 were histologically diagnosed as granulomas or abscesses, while 7 were cysts.

CONCLUSIONS

The diagnosis of periapical lesions cannot be made on the basis of the presence or absence of a radiopaque lamina, but requires histological examination of serial sections.

Conventional and Surgical Endodontic Retreatment of A Maxillary First Molar: Unusual Anatomy

The prognosis for endodontic treatment in teeth exhibiting a complex anatomy is unfavorable if clinicians fail to recognize extra root canals. This case demonstrates the presence of a second canal in the disto-buccal root of a maxillary right first molar. Conventional retreatment followed by endodontic surgery was performed and a 1-year postoperative radiograph shows apparent periapical healing.

Endodontic Surgery Using 2 Different Magnification Devices: Preliminary Results of a Randomized Controlled Study

PURPOSE

The introduction of microsurgical instruments and magnification devices has brought advantages in root-end management and the application of root-end filling materials. The main purpose of this prospective clinical study was to monitor the outcome of ultrasonic root-end preparation using magnification loupes or an endoscope. Tooth location and the presence of post restoration were also examined as potentially affecting the outcome.

MATERIALS AND METHODS

Teeth treated surgically showed a periradicular lesion of strictly endodontic origin. A total of 59 patients were included in the study, according to specific selection criteria. Following the reflection of a full mucoperiosteal tissue flap, residual soft tissues were curetted, root ends were resected, and root-end cavities were prepared ultrasonically with a zirconium nitrate tip, and zinc oxide EBA-reinforced cement root-end fillings were placed. Thirty-two root-end management procedures were performed using magnification loupes and 39 using an endoscope. All cases followed for a period of 1 year were classified into 3 groups (success, uncertain healing, and failure) according to radiographic and clinical criteria.

RESULTS

Of the 71 teeth evaluated at 1-year follow-up, 67 teeth (92.95%) successfully healed, 3 teeth had uncertain healing, and 2 failed. In the group using endoscopy, 94.9% of successful healing was achieved, while for the other group, 90.6% was recorded. We found no statistically significant differences in treatment results related to the arch (P = .20), post restoration (P = .21), or type of magnification device (P = .08).

CONCLUSIONS

In the present study, adherence to a strict endodontic surgical protocol and the use of modern surgical endodontic procedures, together with visual magnifications, resulted in an overall high success rate.

The effects of periradicular inflamation and infection on a primary tooth and permanent successor

Primary teeth and the permanent successors must be understood as interdependent units, where each one of them interacts with and depends on each other. Pulpal inflammation/infection of a primary tooth and the spread of this condition over the periradicular tissues can lead to alterations in the dental germ of the permanent successor and to the surrounding structures if no therapy is done, i.e. endodontics or extraction. This work will present cases of permanent teeth that showed alteration in eruption and / or in development, as a consequence of inflammation / infection of the preceding primary teeth, such as: hypoplasia, morphological alteration on the dental crown or total arrest of. radicular formation. The teeth analysed in this study belong to patients who attended the Universidade Federal de Santa Catarina Children's Dentistry Clinic. The earlier these lesions are diagnosed, the less were the destructive effects and the consequences on the primary tooth/permanent germ unit.

Severe extrusion from an apical abscess: a case report

A 10-year-old boy presented with an acute apical abscess with extensive extrusion of a maxillary central incisor. The tooth, the maxillary right central incisor, had a history of trauma and subsequent apical abscesses. This article describes the presentation, management of the abscess and the subsequent results of treatment. The reasons for the extrusion and success of the treatment are discussed.

Non-surgical management of a chronic periapical lesion associated with traumatised maxillary central incisors: case report

A case is reported of a chronic periapical lesion involving maxillary central incisors with a history of traumatic injury eight years previously and subsequent development of a painful swelling that occasionally caused partial blockage of the nasal cavities. Retrograde surgery for removal of the suspected cystic lesion was scheduled. As a temporary measure before surgery, the necrotic pulp exudate was removed through standard endodontic access cavities prepared on the palatal surfaces of the crowns of the two central incisors, and a calcium hydroxide paste dressing material was placed inside the root canals up to the apices. The calcium hydroxide dressing was changed every four weeks and the case was followed up until healing of the periapical lesion occurred. The surgical procedure was postponed and finally cancelled when complete healing became evident in recall radiographs.

[Partsch's chronic granulomatous inflammation, the cutaneous manifestation of a dental cause]

Dentogenous inflammatory diseases can lead to typical dermatological facial symptoms with formation of cutaneous sinuses. Partsch's chronic granulomatous inflammation can result from conducted inflammation of a nonvital tooth via a chronic apical inflammation. In this rare disease, the granulomatous tissue perforates the bone, channels through the overlying skin, and drains via cutaneous or oral sinuses. A frequent localization of the cutaneous sinus is the skin inferior to the body of the mandible, and it is caused by an inflammation of the lower molars. Treatment consists of identifying the responsible teeth and eliminating the focus of infection. Chronically progressive periradicular granuloma and/or radicular cysts can be present with impressive dermatological symptoms. Therefore, X-ray examinations are necessary to exclude possible dentogenic causes in cases of badly healing processes of the face or neck.

Fractured dens evaginatus and unusual periapical radiolucency

Dens evaginatus (DE) is not uncommon. It can affect the premolars of people of oriental ethnicity, and it can lead to different clinical problems. This article describes the diagnosis and management of a patient presenting with a fractured tubercle of DE and an unusual buccal abscess in relation to periapical radiolucency extending around the mandibular second premolar and first molar.

Paresthesia of the mental nerve induced by periapical infection: a case report

Paresthesia can be a rare complication of infections of dental origin. This article presents a case of anesthesia/paresthesia caused by a periapical infection of the right mandibular second premolar. The sensory disturbance disappeared 2 weeks after conventional endodontic treatment associated with antibiotic therapy. Twelve months later, the tooth was still asymptomatic. The possible mechanisms responsible for paresthesia associated with periapical infection are discussed.

Lower lip numbness due to peri-radicular dental infection

Lower lip numbness has always been a sinister symptom. Much has been written about it being the sole symptom of pathological lesions and metastatic tumours in the mandible. It may also be a symptom of manifestations of certain systemic disorders. A case of lower lip numbness resulting from the compression of the mental nerve by a peri-radicular abscess is presented because of the unusual nature of this spread of infection.

The troublesome submerged tooth: a diagnostic dilemma

Facial swelling caused by a periapical abscess is commonly encountered by dental practitioners. It requires prompt treatment, usually by removal of the infective foci and administration of appropriate antibiotics. However, diagnosis can be difficult, and may be complicated by the presence of retained deciduous teeth. This case report demonstrates a diagnostic dilemma and highlights the importance of looking beyond the obvious.

Tooth root abscesses in New World camelids: 23 cases (1972-1994)

OBJECTIVE

To determine typical clinical and radiographic findings in a group of New World camelids with tooth root abscesses and to determine outcome after medical and surgical treatment.

DESIGN

Retrospective case series.

ANIMALS

23 llamas and alpacas with radiographic and clinical evidence of tooth root abscesses.

PROCEDURE

Disease history, signalment, physical and radiographic examination findings, bacteriologic culture results, treatment, and short-term and long-term outcome were retrieved from the medical records.

RESULTS

Local swelling was the most common clinical abnormality in camelids with tooth root abscesses. Mandibular molars were affected most commonly, and bacteriologic culture of samples from lesions often revealed facultative anaerobic bacteria. Antibiotic treatment for at least 30 days, surgical extraction of the affected tooth, and a root canal procedure were used successfully to treat tooth root abscesses.

CLINICAL IMPLICATIONS

Both surgical and medical treatment of tooth root abscesses may lead to successful resolution of clinical signs in New World camelids.

[Equipment and transducer-independent 3D ultrasound in the maxillofacial area]

AIM

The use of a new 3D ultrasound system should reduce the drawbacks of former 3D workstations (long image generation time, limited use due to the need for special 3D transducers), so that it is now applicable in daily clinical routine.

METHOD

An ultrasound 3D workstation was used based on a pentium PC platform, employing a magnetoelectronic position detection system for spatial reconstruction of conventional 2D B-scan image sequences.

RESULTS

Better assessment of topographico-anatomical spatial relationships was achieved when presenting pathological findings, especially in assessing lymph nodes and salivary stones. Pathological processes in the maxillofacial area occurring during a period of five months were visualised.

CONCLUSION

The method of 3D reconstruction of standard two-dimensional electronic scans, as presented here, is the first method of its kind enabling applicability in daily clinical routine thanks to rapid imaging. The images can be produced with any ultrasound unit or transducer. First clinical results in maxillofacial surgery clearly show improved diagnostic possibilities although there still room for an improvement of the image quality. The possibility of semi-automatic exact volumetry appears meaningful especially in the investigation of lymph nodes. Integration of colour duplex sonography will further enhance the diagnostic value of this method.

A bacteriologic aid in the differential diagnosis of periapical and periodontal abscesses

The aim of the present investigation was to determine whether spirochaetal count could help differentiate between periodontal and periapical abscesses. 23 draining abscesses were included, where 15 were diagnosed as periodontal and 8 as periapical, based on clinical and radiographic data. Exudate samples were collected aseptically and examined by both darkfield microscopy and Gram-stained smear. The results revealed a statistically high increase in spirochaetal count in periodontal abscesses compared to periapical ones. The obvious difference appeared adequate to differentiate both lesions and establish a rapid chairside diagnostic aid.

A survey of disease changes observed on dental panoramic tomographs taken of patients attending a periodontology clinic

Dental panoramic tomographs (DPTs) were taken consecutively of 500 patients referred to a specialist periodontal department by general dental practitioners in order to assist in the diagnosis of the severity of the periodontal disease. Analysis of these DPTs showed 316 (63.2%) of these patients to have some form of dental abnormality unrelated to periodontal disease. The DPT was shown to be a valuable screening technique for clinical practice.

The use of bone imaging to detect a periapical lesion of endodontic origin

This article reports the detection of a lesion of dental origin in the mandible of a 41-yr-old male patient during a routine bone scan used as a follow-up to cancer therapy. Unfortunately, more than 1 yr passed before the patient's signs and symptoms became severe enough for a definitive diagnosis to be made. A comprehensive dental examination is indicated for patients with positive bone scans in the area of the oral cavity. The use of bone imaging can be recommended to complement the dental examination of high risk patients with suspected metastasis or when all routine dental diagnostic measures are inconclusive.

[Radiographic and histological study of a case of apexification in a human molar]

A case of apexification in a lower right second molar is described. Radiographs demonstrate apical closure with a different morphological pattern from that of the lower left second molar. Following extraction, after 15 months, serial histologic sections show calcified tissue obturating the apical foramen, well adapted to the initial dentin and cementum walls. Inside some small areas containing connective tissue with capillaries can be observed. The histologic and radiographic observations indicate that apical closure occurs as a result of differentiation of periodontal apical cells.

A radiographic survey of periapical jawbone lesions

A radiographic survey of the jawbone adjacent to the teeth revealed a high incidence of bone pathosis in 889 randomly chosen patients. Jaw lesions, nearly all inflammatory, were present in every second person. Bone-destructive inflammatory processes (rarefying osteitis) were the most frequently encountered lesions, occurring in both the maxilla and the mandible. Bone-appositioning inflammatory processes (condensing osteitis), on the other hand, appeared mostly in the mandible, very often involving the first molar, thus indicating the differing biologic behavior of the two jawbones. Other bony manifestations in the mandible, such as enostosis and periapical cemental dysplasia, although relatively rare, also formed part of the picture. In light of the absence of related symptoms, the clinical significance of these widely prevalent periapical lesions has to be reconsidered.