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KMID : 1035020140150010048
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Endodontics and Dental Rehabilitation
2014 Volume.15 No. 1 p.48 ~ p.48
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Peripheral tissues of mouth invade into the periapical lesion
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Kayoko KITAJIMA
Kyoko ARAI
Hanae IINO
Rie YAMADA
Masaru IGARASHI
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Abstract
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I. Clinical Case
25-year-old male was referred to endodontic clinic from pediatric clinic for treatment of maxillary left central incisor tooth which had periapical lesion with external root resorption. The tooth was replanted and performed endodontic treatment for luxation caused by traffic accident when the patient was 9 years old. External root resorption revealed at 24 years old. The root canal retreatment was started in the pediatric clinic, however the prognosis was not preferable because that external resorption expanded to the root canal and calcium hydroxide paste (CAL) was extended to the periapical tissues from perforation. The patient was referred to our clinic for the retreatment of this tooth. Finally a surgical endodontic procedure was chosen, the hard sinus duct was extirpated and periapical granulomatous tissue including CAL was eviscerated. The
retrofilling using MTA was applied to the root end cavity. Nine months later, the apical healing was confirmed and the prognosis was satisfactory.
II. Excision tissue examination
The excision tissue was fixed in 10% neutral formalin solution. Serial paraffin sections were stained with HE, Azan, Brown-Brenn and immunohistochemistry for laminin. The histological specimens showed thatmuscular tissues invaded into the periapical lesion.
III. Discussion
This is a remarkable case in the point that muscular tissues were included in the excision tissue. The muscular tissues are thought as a part of orbicularis oris. Extensive alveolar bone defect was caused by external root resorption and large periapical lesion, in consequence muscular tissues of orbicularis oris seemed to invade into extensive bone defect and attach tightly with periapical granulomatous tissues. CAL extruded into lesion lost the radiolucency after a few months, however the existence was confirmed on serial specimens histologically. It indicates that mass CAL extrusion influences apical tissue even after disappearance on radiograpy.
IV. Conclusion
In the tooth which has a large periapical lesion, peripheral tissue of mouth happened to invade into the large periapical lesion. In such a case, it was shown that a surgical endodontic procedure was successful and the tooth could be saved.
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KEYWORD
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