Division of Endodontics, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts; Private Practice, Miami, Florida.
Division of Endodontics, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts.
J Endod. 2022 Sep;48(9):1178-1184. doi: 10.1016/j.joen.2022.06.010. Epub 2022 Jul 3.
Identifying the etiology and correct diagnoses for long-standing orofacial pain can be very challenging, especially in patients who have both odontogenic and nonodontogenic pain. This case report describes the successful management of a complex case of chronic orofacial pain in a patient with nonodontogenic chronic pain conditions and a maxillary molar tooth with persistent periapical pathology after endodontic treatment. The debilitating orofacial pain began after initial nonsurgical root canal treatment of the maxillary molar 3 years before presenting to our clinic. The initial clinical and radiographic assessment by our multidisciplinary team found that there were potentially both peripheral endodontic pathology and central pain mechanisms contributing to the long-standing pain. The diagnosis was shared with the patient's neurologist, who prescribed gabapentin, a centrally acting analgesic, and partial pain reduction was achieved. The odontogenic component of the orofacial pain was then addressed, by treating the persistent periapical infection and buccal bone fenestration of the roots of the maxillary molar. Treatments included both nonsurgical retreatment and surgical endodontic therapy (including root resection, root-end preparation, and retrofilling), and each significantly improved the patient's ongoing orofacial pain. After the successful endodontic treatments, the patient reported minimal pain and normal oral function. The case report highlights the importance of systematically treating endodontic pathology in a patient with long-standing orofacial pain, with both odontogenic and nonodontogenic components.
确定长期或面部疼痛的病因和正确诊断可能非常具有挑战性，尤其是在既有牙源性又有非牙源性疼痛的患者中。本病例报告描述了一例复杂的慢性面部疼痛患者的成功治疗，该患者患有非牙源性慢性疼痛病状，且在上颌磨牙接受根管治疗后仍有持续性根尖周病变。在向我们的诊所就诊前 3 年，该患者接受了上颌磨牙的初始非手术根管治疗后，开始出现这种使人虚弱的面部疼痛。我们的多学科团队进行的初始临床和影像学评估发现，长期疼痛可能既有外周牙髓病理学，也有中枢疼痛机制。我们与患者的神经科医生共享了诊断结果，神经科医生开了加巴喷丁，一种中枢作用的镇痛药，疼痛部分缓解。然后，通过治疗持续性根尖周感染和上颌磨牙颊侧骨开窗，解决了面部疼痛的牙源性成分。治疗包括非手术再治疗和手术根管治疗（包括根管切除、根管末端预备和逆行充填），每次治疗都显著改善了患者持续的面部疼痛。根管治疗成功后，患者报告疼痛轻微，口腔功能正常。本病例报告强调了在既有牙源性又有非牙源性成分的长期面部疼痛患者中，系统性治疗牙髓病理学的重要性。
