Asgary Saeed, Roghanizadeh Leyla
Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Case Rep Dent. 2021 Feb 25;2021:6619731. doi: 10.1155/2021/6619731. eCollection 2021.
Actinomycosis can be one of the causes of persistent periradicular lesions. This is the report of a patient who was first referred with complaint of pain in maxillary right incisors. A standard root canal therapy was carried out. Unluckily, the patient returned with recurrent symptoms; therefore, surgical endodontic retreatment was decided. While the large periradicular lesion was curetted, a whitish yellow granule-like material came out from the periapical area that was submitted for histopathological examination. The apices of both maxillary right incisors were resected. Root-end cavities were sealed with calcium-enriched mixture (CEM) cement. Finally, the remaining large defect was filled with natural bone substitutes. Since the histopathological diagnosis revealed actinomycotic infection, oral penicillin V was prescribed for four weeks. At two-year recall, the bone healing process was completed. Apical actinomycosis can cause therapy-resistant lesions. Root-end surgery employing CEM and bone substitutes might be an effective method to help bone healing in large periradicular lesions.
放线菌病可能是持续性根尖周病变的病因之一。本文报告了一名最初因右上颌切牙疼痛前来就诊的患者。进行了标准的根管治疗。不幸的是，患者症状复发；因此，决定进行牙髓外科再治疗。在刮除较大的根尖周病变时，从根尖区取出了灰白色颗粒状物质并送去做组织病理学检查。切除了右上颌两颗切牙的根尖。用富钙混合物（CEM）水门汀封闭根尖腔。最后，用天然骨替代物填充剩余的大缺损。由于组织病理学诊断显示为放线菌感染，遂开了四周的口服青霉素V。在两年的随访中，骨愈合过程完成。根尖放线菌病可导致治疗抵抗性病变。采用CEM和骨替代物的根尖手术可能是促进大根尖周病变骨愈合的有效方法。
