sodium-hypochlorite and Cutaneous-Fistula

Here, we report the diagnosis and treatment of an extraoral cutaneous sinus tract originating in a mandibular second molar with a C-shaped root canal system. The patient was referred to our department by a dermatologist after a series of unsuccessful treatments, including antibiotics. Diffuse radiolucency on a preoperative radiograph revealed that earlier root canal treatment had been only partially successful. Consequently, we performed retreatment of the root canal comprising removal of the former restoration and gutta-percha, cleaning and shaping, and passive irrigation with sodium hypochlorite. The patient responded well, and the cutaneous lesion completely resolved uneventfully within 1 month postoperatively. Preoperative recognition and thorough knowledge of the root canal anatomy and conventional methods of obturation are necessary in performing successful endodontic treatment.

Topics: Alveolar Process; Anatomic Variation; Bone Diseases, Infectious; Chronic Periodontitis; Cutaneous Fistula; Dental Fistula; Diagnosis, Differential; Gutta-Percha; Humans; Iatrogenic Disease; Male; Medical Errors; Molar; Periapical Abscess; Radiography, Dental; Retreatment; Root Canal Irrigants; Root Canal Therapy; Sodium Hypochlorite; Tooth Root; Treatment Failure; Young Adult

This paper describes the clinical courses of three cases with extra-oral sinus tract formation, from diagnosis and treatment to short-term follow-up and evaluation. All teeth involved had periradicular radiolucent areas noted on radiographic examination and extra-oral sinus tracts appearing on the chin with exudation and unpleasant aesthetic appearance. The adopted treatment protocol included treating the sinus tract surface simultaneously with the root canal therapy. After root canal shaping using 5.25% sodium hypochlorite solution, calcium hydroxide-based pastes associated with different vehicles were inserted into the root canal for 4 months, and were changed monthly. All the sinus tracts healed in 7 to 10 days. The apical lesions were completely repaired in a maximum period of 24 months. The treatment adopted provided a complete healing of the periapical lesions in a short follow-up period. Surgical repair of the cutaneous sinus tract was therefore unnecessary.

Topics: Adolescent; Adult; Calcium Hydroxide; Cutaneous Fistula; Dental Fistula; Female; Humans; Male; Periapical Abscess; Radiography; Root Canal Irrigants; Sodium Hypochlorite