Endodontic failure affects the teeth and surrounding tissues. This is a case of a 62-year-old female with a chief complaint of pain and swelling occurring frequently in the upper left teeth for 6 months. The tooth was treated a year ago. Nonsurgical endodontic retreatment was carried out and observed for 4 months. The size of the lesion reduced significantly during the healing evaluation. This case report aimed to show the management of a non-surgery endodontic retreatment in periapical abscess using a rotary instrument.
Periapical Abscess

Cutaneous odontogenic sinuses are the most common cause of chronic draining sinus tracts on the face and neck. These lesions present as erythematous nodules with surrounding dimples, which intermittently drain purulent fluid. Although most patients do not have dental symptoms, careful questioning of a patient's past symptoms may help the clinician identify a dental etiology. A history of toothache in the affected area that resolves without dental intervention is useful information. Clinical and radiographic examination may reveal carious teeth with radiolucent areas. Elimination of the source of infection by endodontic treatment or tooth removal results in resolution of the sinus tract, typically within 2 weeks. Early precise diagnosis and appropriate dental treatment can circumvent unnecessary and ineffective antibiotic therapy or surgical treatment. We report a case of a cutaneous odontogenic sinus in the right cheek area.
Cheek ; Humans ; Neck ; Periapical Abscess ; Tooth ; Toothache

The most common cause of chronic cutaneous sinus tract in the face and neck is chronically draining dental infection. The diagnosis is easily confirmed by dental examination and dental roentgenogram of the involved area, but this disease is frequently misdiagnosed and incorrectly treated in dermatologic department. We report four cases of cutaneous sinus tract of dental origin. First patient had a painful nodule with chronically draining pus and a dimple on the left cheek. Second patient had a dimple with draining bloody fluid on the right chin. Third patient had a pea-sized papule with draining serous fluid on the left chin. Fourth patient had a fluctuant erythematous plaque with draining pus and a dimple on the left buccal area. In all four patients radiologic examination of the maxillary and mandibular regions demonstrated radioluency at the apex of tooth consistent with periapical abscess.
Cheek ; Chin ; Diagnosis ; Humans ; Neck ; Periapical Abscess ; Suppuration ; Tooth

As the dental pulp is encased with a rigid, noncompliant shell, changes in pulpal blood flow or vascular tissue pressure can have serious implication for the health of pulp. Numerous studies have demonstrated that orthodontic force application may influence both blood flow and cellular metabolism, leading degenerative and/or inflammatory responses in the dental pulp. The aim of this case report is to present a case about tooth with chronic periapical abscess which showed normal vital responses. Excessive orthodontic force is thought to be the prime cause of partial pulp necrosis. Owing to remaining vital tissue, wrong dianosis can be made, and tooth falsely diagnosed as vital may be left untreated, causing the necrotic tissue to destroy the supporting tissuses. Clinician should be able to utilize various diagnostic tools for the precise diagnosis, and be aware of the endodontic-orthodontic inter-relationship.
Dental Pulp ; Dental Pulp Necrosis ; Periapical Abscess ; Tooth

Cutaneous sinus tract of dental origin usually arises from chronic dental infection. Because many patients with these lesions do not have any complaints of oral symptoms, the lesions are often diagnosed incorrectly and overlooked. We report two cases of cutaneous sinus tract of dental origin. One case on nasolabial fold originated from the maxillary canine periapical abscess. Another case on the mandible originated from the mandibular 2nd premolar periapical abscess. Endodontic root canal therapy resulted in complete healing of the lesions in both cases. Early correct diagnosis and treatment of the lesions can prevent unnecessary and ineffective antibiotic therapy or surgical treatment.
Bicuspid ; Humans ; Mandible ; Nasolabial Fold ; Periapical Abscess ; Root Canal Therapy

Chronic Disease ; Cone-Beam Computed Tomography ; Humans ; Periapical Abscess ; pathology ; Periapical Granuloma ; pathology ; Periapical Periodontitis ; diagnostic imaging ; pathology ; Problem Solving ; Prognosis ; Radicular Cyst ; diagnostic imaging ; pathology

OBJECTIVES: Periapical lesions, including periapical cyst (PC), periapical granuloma (PG), and periapical abscess (PA), are frequently affected by chemical/physical damage during root canal treatment or severe bacterial infection, and thus, the differential diagnosis of periapical lesions may be difficult due to the presence of severe inflammatory reaction. The aim of this study was to make differential diagnosis among PC, PG, and PA under polarizing microscope. MATERIALS AND METHODS: The collagen birefringence patterns of 319 cases of PC (n = 122), PG (n = 158), and PA (n = 39) obtained using a polarizing microscope were compared. In addition, 6 cases of periodontal fibroma (PF) were used as positive controls. RESULTS: Collagen birefringence was condensed with a thick, linear band-like pattern in PC, but was short and irregularly scattered in PG, and scarce or absent in PA. PF showed intense collagen birefringence with a short, palisading pattern but no continuous band-like pattern. The linear band-like birefringence in PC was ascribed to pre-existing expansile tensile stress of the cyst wall. CONCLUSIONS: In this study all PCs (n = 122) were distinguishable from PGs and PAs by their characteristic birefringence, despite the absence of lining epithelium (n = 20). Therefore, the authors suggest that the presence of linear band-like collagen birefringence of the cyst wall aids the diagnostic differentiation of PC from PG and PA.
Bacterial Infections ; Birefringence* ; Collagen* ; Dental Pulp Cavity ; Diagnosis, Differential* ; Epithelium ; Fibroma ; Periapical Abscess ; Periapical Granuloma ; Radicular Cyst*

periapical lesions. A total of 130 periapical lesions which were obtained from biopsy and diagnosed histopathologically as periapical cyst, periapical abscess, and periapical granuloma at the Department of Dentistry in Hanyang University Hospital were throughly analysed according to the distribution and incidence of age, sex, location, and so on. The following results were obtained: 1. Out of 130 periapical lesions, 88 cases (67.7%) were periapical cysts, 30 cases (23.1%) were periapical abscesses, and 12 cases (9.2%) were periapical granulomas. 2. The periapical lesions occurred most frequently in the third decade, and followed by the fourth, fifth, sixth, and second decade. The periapical cysts occurred most frequently in the third decade (26.1%), the periapical granulomas in the fourth decade (33.3%) the periapical abscesses in the sixth decade (26.7%). 3. The periapical lesions were more frequent in men than in women with the ratio of men to women of 1.4 : 1. The ratio of men to women of periapical cysts was 1.6 : 1, that of periapical granulomas was 0.5 : 1, and that of periapical abscesses was 1.3 : 1.4. The periapical lesions were more frequent in maxilla than in mandible with the ratio of 1.2 : 1. The ratio of maxilla to mandible of periapical cysts was 1.5 : 1, that of periapical granulomas was 0.5 : 1, that of periapical abscesses was 1 : 1.5. The most commonly involved location of the periapical lesions was maxillary anterior teeth (40.8%), and followed by mandibular molars, mandibular premolars, and mandibular anterior teeth and maxillary molars. The most frequent location of the periapical cysts was maxillary anterior teeth (48.9%), that of periapical granulomas was mandibular molars (50.0%), that of periapical abscesses was mandibular molars (40.0%).]]>
Bicuspid ; Biopsy ; Dentistry ; Female ; Humans ; Incidence ; Male ; Mandible ; Maxilla ; Molar ; Periapical Abscess ; Periapical Granuloma ; Radicular Cyst ; Tooth

Cutaneous sinus tract of dental origin is a syndrome rather than a disease entity, and is composed of a periapical abscess, sinus tract and granulomatous skin change at the opening of the tract. The presence of an intermittently-draining, granulomatous lesion on the face or neck should alert clinicians to the necessity of a routine dental examination, including radiographic studies. Early correct diagnosis and appropriate dental treatment can prevent unnecessary and ineffective antibiotic therapy or surgical treatment. We report a case of a 68 year-old woman with a cutaneous sinus tract on the right nasolabial fold, secondary to infection of eight maxillary remnant teeth.
Aged ; Diagnosis ; Female ; Humans ; Nasolabial Fold ; Neck ; Periapical Abscess ; Skin ; Tooth

We report a case of a 77-year-old woman with a cutaneous sinus tract located on the right cheek secondary to a periapical abscess of the right maxillary first molar. The lesion was a nodule with surrounding dimple and drained purulent fluid. Previous topical and systemic treatment was temporarily effective. Radiologic examination of the maxillary and mandibular regions demonstrated diffuse radiolucency involving the apices of the right maxillary first molar, consistent with periapical abscesses. Removal of the involved teeth and curettage of the granulation tissue accompanied by antibiotic therapy resulted in the complete healing of the cheek lesion. In the presence of a single chronic suppurative or nodulocystic lesion of the face, it is always useful to perform a radiologic evaluation of the maxillary and mandibular regions to promptly exclude a possible odontogenic background.
Aged ; Cheek ; Curettage ; Female ; Granulation Tissue ; Humans ; Molar ; Periapical Abscess ; Skin* ; Tooth