demeclocycline and Dental-Fistula

To investigate the use of 3D plastic models, printed from cone beam computed tomography (CBCT) data, for accurate diagnosis and conservative treatment of a complex case of dens invaginatus.. A chronic apical abscess with a draining sinus tract was diagnosed during the treatment planning stage of orthodontic therapy. Radiographic examination revealed a large radiolucent area associated with an invaginated right maxillary central incisor, which was found to contain a vital pulp. The affected tooth was strategic in the dental arch. Conventional periapical radiographs provided only partial information about the invagination and its relationship with the main root canal and with the periapical tissues. A limited-volume CBCT scan of the maxilla did not show evidence of communication between the infected invagination and the pulp in the main root canal, which could explain the pulp vitality. A novel method was adopted to allow for instrumentation, disinfection and filling of the invagination, without compromising the vitality of the pulp in the complex root canal system. The CBCT data were used to produce precise 3D plastic models of the tooth. These models facilitated the treatment planning process and the trial of treatment approaches. This approach allowed the vitality of the pulp to be maintained in the complex root canal space of the main root canal whilst enabling the healing of the periapical tissues.. Even when extensive periapical pathosis is associated with a tooth with type III dens invaginatus, pulp sensibility tests should be performed. CBCT is a diagnostic tool that may allow for the management of such teeth with complex anatomy. 3D printed plastic models may be a valuable aid in the process of assessing and planning effective treatment modalities and practicing them ex vivo before actually performing the clinical procedure. Unconventional technological approaches may be required for detailed treatment planning of complex cases of dens invaginatus.

Topics: Adolescent; Aluminum Compounds; Anti-Bacterial Agents; Calcium Compounds; Computer-Aided Design; Cone-Beam Computed Tomography; Demeclocycline; Dens in Dente; Dental Fistula; Dental Pulp Cavity; Drug Combinations; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Incisor; Models, Dental; Oxides; Patient Care Planning; Periapical Abscess; Plastics; Radiography, Bitewing; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Preparation; Root Canal Therapy; Silicates; Triamcinolone Acetonide

In the age group between 6 and 12 years, trauma to the upper incisors happens frequently. In the case of avulsion, a replantation is the state-of-the-art treatment; however, it may lead to several complications, particularly if suitable posttraumatic management is not carried out. External cervical resorptions as well as apical granuloma and cysts due to microbial contamination of the root canal are common complications. In the presented trauma case, a conservative approach was chosen to treat a large cystic lesion combined with cervical and apical resorptions. After initial placement of Ledermix and calcium hydroxide into the root canal, a marsupialization with the temporary insertion of an obturator was performed. The gradual reduction led to a fast recovery of the bony defect and a root canal filling was placed. The 2-year follow-up showed an improved condition. All adjacent teeth remained vital during the course of the treatment.

Topics: Adolescent; Aluminum Compounds; Anti-Inflammatory Agents; Calcium Compounds; Calcium Hydroxide; Demeclocycline; Dental Fistula; Drug Combinations; Female; Follow-Up Studies; Gutta-Percha; Humans; Incisor; Oxides; Radicular Cyst; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Therapy; Root Resorption; Silicates; Tooth Apex; Tooth Avulsion; Tooth Cervix; Triamcinolone Acetonide; Wound Healing