Komabayashi Takashi, Jiang Jin, Zhu Qiang
Department of Endodontics, Texas A&M Health Science Center, Baylor College of Dentistry, Dallas, TX 75246, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Jun;111(6):e15-20. doi: 10.1016/j.tripleo.2011.01.008. Epub 2011 Mar 31.
This case report describes apical infection on tooth number 24 that spread to adjacent teeth, resulting in devitalized teeth numbers 23 and 25. The 25-year-old Caucasian female patient was referred to the endodontic resident clinic because of uncontrolled apical infection. Root-end surgery and root-end filling of teeth numbers 23, 24, and 25 were performed. The histopathological diagnosis was a periapical cyst; however, the clinical surgical finding of a purulence-filled bone cavity also revealed a periapical abscess. After root-end surgery and regenerative therapy using Mineral Trioxide Aggregate, Bio-Oss xenograft material, and Bio-Gide resorbable collagen membrane, the patient had no symptoms. Radiographs showed the apical lesion had healed satisfactorily at the 6-month, 1-year, and 2-year follow-ups. The clinical implication of this rare case suggests the importance of standard endodontic diagnostic procedures for pulpal and apical diagnosis, prevention of apical periodontitis exacerbation by reducing bacterial factors, and the effectiveness of healing large bone defects using regenerative materials.
本病例报告描述了24号牙的根尖感染扩散至相邻牙齿，导致23号和25号牙牙髓坏死。一名25岁的白种女性患者因根尖感染无法控制被转诊至牙髓科住院诊所。对23、24和25号牙进行了根尖手术和根尖充填。组织病理学诊断为根尖囊肿；然而，临床手术发现充满脓液的骨腔也提示存在根尖脓肿。在根尖手术后，使用三氧化矿物凝聚体、Bio - Oss异种骨移植材料和Bio - Gide可吸收胶原膜进行再生治疗后，患者无症状。X线片显示在6个月、1年和2年的随访中根尖病变愈合良好。该罕见病例的临床意义表明，牙髓和根尖诊断的标准牙髓病诊断程序很重要，通过减少细菌因素预防根尖周炎加重，以及使用再生材料治愈大的骨缺损有效。
