Dastgir Ramtin, Sohrabi Maryam
Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
Case Rep Dent. 2022 Jun 6;2022:7323268. doi: 10.1155/2022/7323268. eCollection 2022.
Periapical actinomycosis, which is reckoned as a subgroup of cervicofacial actinomycosis, is an uncommon, more indolent, less invasive, and limited type of actinomycosis infection. However, it can be considerably underreported due to the low number of periapical surgical specimens that are submitted for histopathological analysis after excision of the lesion with the preliminary diagnosis of typical periapical infections. It is believed that during root canal treatment, the organisms are displaced from the oral cavity into the periapical regions as a result of failure to establish aseptic techniques which can further result in actinomycosis infections and, in rare instances, lead to more severe events and can even be life-threatening. . We intend to report a case of periapical actinomycosis in a 34-year-old female who presented with the chief complaint of pain and slight mobility of the mandibular right second premolar and first molar with no significant issues in the patient's medical history. Initial orthopantomography revealed a uniloculated, radiolucent lesion engulfing the apices of the aforementioned teeth. An incisional biopsy was then obtained which revealed fragments of fibroconnective tissue including few crushed bone particles severely infiltrated by acute inflammatory cells and some foamy macrophages. The suppurative exudate focally surrounds colonies of filamentous bacteria as round basophilic masses with radial configuration resembling "sulfur granules." Surgical approach consisted of curettage accompanied with peripheral ostectomy and cautious burnishing of the two involved tooth roots.
This case report emphasizes the importance of aseptic techniques during endodontic and more invasive treatments, as they can cause penetration of Actinomyces into the periapical region which in some cases can lead to more serious complications and even life-threatening situations.
根尖放线菌病被认为是颈面部放线菌病的一个亚组，是一种罕见、进展较缓慢、侵袭性较小且局限的放线菌感染类型。然而，由于在初步诊断为典型根尖感染并切除病变后，提交进行组织病理学分析的根尖手术标本数量较少，其实际发病率可能被严重低估。据信，在根管治疗过程中，由于未能建立无菌技术，微生物会从口腔进入根尖区域，进而导致放线菌感染，在极少数情况下，会引发更严重的事件，甚至危及生命。我们打算报告一例34岁女性的根尖放线菌病病例，该患者的主要症状为下颌右第二前磨牙和第一磨牙疼痛及轻度松动，其病史无重大问题。最初的曲面断层片显示一个单房性、透射性病变，累及上述牙齿的根尖。随后进行了切开活检，结果显示纤维结缔组织碎片，包括少量被急性炎症细胞严重浸润的碎骨颗粒和一些泡沫巨噬细胞。脓性渗出物局部围绕丝状细菌菌落，呈圆形嗜碱性团块，具有放射状结构，类似“硫磺颗粒”。手术方法包括刮除术、周边骨切除术以及对两颗受累牙根进行谨慎的抛光。
本病例报告强调了在牙髓治疗及更具侵入性的治疗过程中无菌技术的重要性，因为这些操作可能导致放线菌侵入根尖区域，在某些情况下会引发更严重的并发症，甚至危及生命。
