Clinical, radiological and histological diagnoses of periapical periodontitis spreading to the adjacent tooth: A case of endodontic failure

Luigi Cianconi, Manuele Mancini

Department of Restorative Dentistry and Endodontics, University of Rome “Tor Vergata”, Rome, Italy.

DOI: 10.4236/ojst.2013.35048                

Abstract

Aims: This article describes the apical infection in endodontically treated tooth 4.5 that spread to adjacent tooth 4.4. Case Report: A 52-year-old woman was referred for the presence of radiolucency extending from tooth 4.5 and mental foramen. Spontaneous symptoms were present. Tooth 4.5 showed poor-quality endodontics. The vitality of tooth 4.4 was negative, even though no mechanical trauma had been reported, nor was caries present. Both teeth were sensitive to percussion. Endodontic re-treatment of 4.5 and endodontic treatment of 4.4 were performed in a single visit. A large amount of endodontic sealer squeezed mesially from the root of tooth 4.5, where a partial horizontal root fracture was hypothesized. 6-, 12-, and 18-month radiographic follow-ups, by both periapical and cone-beam computed tomography (CBCT) analyses, showed incomplete osseous healing. CBCT excluded root fracture on 4.5. Local symptoms were still present. Clinical and radiological conditions led to extractions, and a cystic lesion was enucleated for histopathologic analyses. Histopathologic diagnosis was a periapical cyst. The supposed partial horizontal root fracture of 4.5 was actually a large lateral canal. Although the root canal treatments followed high standards in terms of quality, a persistent chronic infection developed histologically. The cystic lesion was one consistent reason for the unsuccessful healing of 4.5.

Keywords

Apical Periodontitis; Apicoectomy; Follow-Up; CBCT; Cyst; Lateral Canal

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Kakehashi, S., Stanley, H.R. and Fitzgerald, R.J. (1965) The effects of surgical exposures of dental pulps in germfree and conventional laboratory rats. Oral Surgery, Oral Medicine, Oral Pathology, 20, 340-349. doi:10.1016/0030-4220(65)90166-0
[2]	Sundqvist, G. (1976) Bacteriological studies of necrotic dental pulps. University of Umea, Umea.
[3]	Sjogren, U., Hagglund, B., Sundqvist, G. and Wing, K. (1990) Factors affecting the long-term results of endodontic treatment. Journal of Endodontics, 16, 498-504. doi:10.1016/S0099-2399(07)80180-4
[4]	Marquis, V.L., Dao, T., Farzaneh, M., Abitbol, S. and Friedman, S. (2006) Treatment outcome in endodontics: The Toronto study. Phase III: Initial treatment. Journal of Endodontics, 32, 299-306. doi:10.1016/j.joen.2005.10.050
[5]	McCall, J.O. and Wald, S.S. (1952) Clinical dental roentgenology. 3rd Edition, W.B. Saunders, Philadelphia.
[6]	Grossman, L.I. (1950) Root canal therapy. 3rd Edition, Lea & Febiger, Philadelphia.
[7]	Estrela, C., Bueno, M.R., Leles, C.R., et al. (2008) Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis. Journal of Endodontics, 34, 273-279. doi:10.1016/j.joen.2007.11.023
[8]	Nair, M.K. and Nair, U.P. (2007) Digital and advanced imaging in endodontics: A review. Journal of Endodontics, 33, 1-6. doi:10.1016/j.joen.2006.08.013
[9]	Simon, J. H. S., Enciso, R., Malfaz, J.M., et al. (2006) Differential diagnosis of large periapical lesions using cone beam computed tomography measurements and biopsy. Journal of Endodontics, 32, 833-837. doi:10.1016/j.joen.2006.03.008
[10]	Rosenberg, P.A., Frisbie, J., Lee, J., et al. (2010) Evaluation of pathologists (histopathology) and radiologists (cone beam computed tomography) differentiating radicular cysts from granulomas. Journal of Endodontics, 36, 423-428. doi:10.1016/j.joen.2009.11.005
[11]	Su, Y., Wang, C. and Ye, L. (2011) Healing rate and post-obturation pain of singleversus multiple-visitendodontic treatment for infectedrootcanals: A systematic review. Journal of Endodontics, 37, 125-132. doi:10.1016/j.joen.2010.09.005
[12]	Peters, E. and Lau, M. (2003) Histopathologic examination to confirm diagnosis of periapical lesions: A review. Journal of the Canadian Dental Association, 69, 598-600.
[13]	Newton, C.W. (1999) To biopsy or not [letter]. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 87, 642-643. doi:10.1016/S1079-2104(99)70177-0
[14]	Brooks, J.K., Ribera, M.J., Rogers, C.W., et al. (2005) Radiographic challenges: Report of 5 cases. New York State Dental Journal, 71, 48-50.
[15]	Siqueira Jr., J.F. (2011) Treatment of endodontic infections. Quintessence Publishing, London.
[16]	Ricucci, D. and Siqueira Jr., J.F. (2011) Recurrent apical periodontitis and late endodontic treatment failure related to coronal leakage: A case report. Journal of Endodontics, 37, 1171-1175. doi:10.1016/j.joen.2011.05.025
[17]	Ricucci, D. and Siqueira Jr., J.F. (2010) Biofilms and apical periodontitis: Study of prevalence and association with clinical and histopathologic findings. Journal of Endodontics, 36, 1277-1288. doi:10.1016/j.joen.2010.04.007
[18]	Peters, O.A., Schonenberger, K. and Laib, A. (2001) Effects of four Ni-Ti preparation techniques on root canal geometry assessed by micro computed tomography. International Endodontic Journal, 34, 221-230.
[19]	Love, R.M. and Jenkinson, H.F. (2002) Invasion of dentinal tubules by oral bacteria. Critical Reviews in Oral Biology & Medicine, 13, 171-183. doi:10.1177/154411130201300207
[20]	Peters, L.B., Wesselink, P.R. and Moorer, W.R. (1995) The fate and the role of bacteria left in root dentinal tubules. International Endodontic Journal, 28, 95-99. doi:10.1111/j.1365-2591.1995.tb00166.x
[21]	Siqueira, J.F. (2001) Aetiology of root canal treatment failure: Why well treated teeth can fail. International Endodontic Journal, 34, 1-10. doi:10.1046/j.1365-2591.2001.00396.x
[22]	Lin, L.M., Skribner, J.E. and Gaengler, P. (1992) Factors associated with endodontic treatment failures. Journal of Endodontics, 18, 625-627. doi:10.1016/S0099-2399(06)81335-X
[23]	Stashenko, P., Wang, C.-Y., Tani-Ishii, N. and Yu, S.M. (1994) Pathogenesis of induced rat periapical lesions. Oral Surgery, Oral Medicine, Oral Pathology, 78, 494-502. doi:10.1016/0030-4220(94)90044-2
[24]	Ricucci, D. and Siqueira Jr., J.F. (2008) Anatomic and microbiologic challenges to achieving success with endodontic treatment: A case report. Journal of Endodontics, 34, 1249-1254. doi:10.1016/j.joen.2008.07.002
[25]	Skaug, N. (1976) Intracystic fluid pressure in non-keratinizing jaw cysts. International Journal of Oral Surgery, 5, 59-65. doi:10.1016/S0300-9785(76)80049-X
[26]	Oka, S., Kubota, Y., Yamashiro, T., Ogata, S., Ninomiya, T., Ito, S., et al. (2005) Effects of positive pressure in odontogenic keratocysts. Journal of Dental Research, 84, 913-918. doi:10.1177/154405910508401008
[27]	Nair, P.N. (1998) New perspectives on radicular cysts: Do they heal? International Endodontic Journal, 31, 155-160. doi:10.1046/j.1365-2591.1998.00146.x