Endodontic Division, Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, Brazil.
Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland.
J Endod. 2021 Feb;47(2):327-334. doi: 10.1016/j.joen.2020.10.004. Epub 2020 Oct 14.
This case report describes the resolution of a 20-year misdiagnosed nasal sinus tract after root canal therapy with multiple sessions of calcium hydroxide (Ca[OH]) intracanal medication. Clinical evaluation, including diagnostic testing and sinus tract tracing, was performed followed by a cone-beam computed tomographic scan and 3-dimensional reconstruction of the apical lesion. Bacteria and endotoxin analyses were performed from the nasal sinus tract and paired root canal infection before (s1) and after instrumentation (s2) and after 7 (s3), 14 (s4), and 21 (s5) days of Ca(OH) medication. The bacteria analysis was performed using the checkerboard DNA-DNA hybridization method and endotoxin quantified by the limulus amebocyte lysate method. A similar microbiota profile was found in the sinus tract and paired root canal infection. No target bacterial species were detected in the root canal at s2, s3, and s5. In contrast, Actinomyces israellii and Eubacterium nodatum were detected at s4. Differences in bacterial detection were found between s1 × s2, s3 × s4, and s4 × s5 (all P < .05). Endotoxin was detected in the root canal at all sampling times. Differences in the levels of endotoxin were found between s1 × s2, s2 × s3, and s3 × s4 (all P < .05).The bacterial analysis revealed similar microbiota profiles present in the nasal sinus tract and paired root canal infection with the participation of a wide variety of gram-positive and -negative species. Additionally, root canal therapy with multiple sessions of Ca(OH) intracanal medication for 21 days was effective in disinfecting the root canal system and resolving the nasal sinus tract.
本病例报告描述了一例根管治疗后 20 年误诊的鼻窦窦道，经过多次氢氧化钙（Ca[OH]）根管内药物治疗后得到解决。进行了临床评估，包括诊断性测试和窦道追踪，随后进行了锥形束计算机断层扫描和根尖病变的三维重建。对鼻窦窦道和配对根管感染进行了细菌和内毒素分析，在器械预备前后（s1）和预备后 7 天（s3）、14 天（s4）和 21 天（s5）进行了 Ca（OH）药物治疗。使用棋盘式 DNA-DNA 杂交法进行细菌分析，使用鲎变形细胞溶解物法定量内毒素。在窦道和配对根管感染中发现了相似的微生物群谱。在 s2、s3 和 s5 时，在根管中未检测到目标细菌种。相比之下，在 s4 时检测到放线菌和真杆菌。在 s1 × s2、s3 × s4 和 s4 × s5 之间发现了细菌检测的差异（均 P <.05）。在所有采样时间均在根管中检测到内毒素。在 s1 × s2、s2 × s3 和 s3 × s4 之间发现了内毒素水平的差异（均 P <.05）。细菌分析显示，鼻窦窦道和配对根管感染中存在相似的微生物群谱，涉及多种革兰氏阳性和阴性种。此外，根管治疗后多次使用 Ca（OH）根管内药物治疗 21 天，有效消毒根管系统并解决了鼻窦窦道。
