Chronic Odontogenic Infection Research Articles

THE ROLE OF ENDODONTICS IN THE TREATMENT OF CHRONIC ODONTOGENIC DISEASES IN PREPARATION FOR PROSTHETICS

Background. When planning orthopedic restoration of significantly destroyed teeth with signs of apical periodontitis, it is necessary to assess the complexity of root canal anatomy as one of the factors influencing successful endodontic dental treatment. Modern approaches in endodontics allow in most cases to achieve the restoration of bone tissue, as well as the elimination of the focus of chronic infection, which allows for subsequent orthopedic dental treatment in order to restore their function and increase the percentage of survival in the oral cavity.
 Purpose. Improving the efficiency of orthopedic restoration of teeth with chronic odontogenic infection.
 Materials and methods. 64 patients aged 18 to 45 were examined. All had clinical signs of failed endodontic treatment of the incisors in the upper and lower jaws with a dark, radiolucent focus in the apex region, as well as significant destruction of the crown requiring orthopedic restoration. The assessment of radiographic parameters was based on CBCT, and mobility was assessed clinically. The results were evaluated after 6, 12, and 24 months.
 Results. All patients showed different signs of restoration of the bone tissue after 6 and 12 months and complete restoration of the bone tissue 24 months after the treatment. No pathological tooth mobility was found 24 months after the end of treatment in 100% (primary endodontic treatment) and 97.5% (repeated endodontic treatment) of patients.
 Conclusion. The analysis of the anatomy of the root canals, and, accordingly, the complexity in biomechanical cleaning and washing of the root canals affects the decision to carry out treatment in one or two visits.

CHRONIC SUPPURATIVE OSTEOMYELITIS OF MANDIBULAR CONDYLE- A RARE CASE REPORT

Osteomyelitis is dened as inammation of the bone marrow with a tendency to progression and involves the adjacent cortical plates and periosteal tissues. It develops in the jaws after a chronic odontogenic infection or from other reasons such as trauma, incomplete management of fracture, following irradiation of the Mandible. It is more common in Mandible than maxilla. However, involvement of Mandibular condyle is very rare. Hereby we report a case of chronic suppurative osteomyelitis of condyle in a 16 years old female treated with course of antibiotics followed by Sequestrectomy, condylectomy and subsequent follow up.

Морфологические особенности строения корневых каналов премоляров и моляров верхней челюсти на основании конусно-лучевой компьютерной томографии

The key issue for dentists of all specialties is the fight against foci of chronic odontogenic infection. Much attention is paid to the introduction of operations that preserve teeth performed at an outpatient surgical appointment, but specialists rarely use them and often remove teeth. The purpose of the study is to determine the morphological features of the structure of the root canals of the premolars and molars of the upper jaw on the basis of cone-beam computed tomography of the jaws, to assess the quality of previously performed endodontic treatment and the frequency of destructive processes in the long-term follow-up. Materials and methods. Anatomical features of the structure of the premolars and molars of the upper jaw were retrospectively studied on the basis of cone-beam computed tomography data in 97 patients aged 26-71 years. 97 teeth (premolars and molars) of the upper jaw were examined in this number of patients. Depending on the belonging to the jaw segments, all the teeth of patients whose anatomical features of the root canals were analyzed, were divided into 4 groups: the first premolars – n=6; the second premolars – n=15; the first molars – n=54; the second molars – n=22. Results and discussion. The study of the morphology of the root canals of the first and second premolars of the upper jaw did not reveal statistically significant differences in the angle of inclination of the root canals, the number of roots and root canals. The analysis of the morphology of the root canals of the first and second molars of the upper jaw also found no significant differences in the angle of inclination of the root canals. At the same time, the share of unsatisfactory endodontic treatment in the analyzed groups of teeth was 82.5%. In addition, destructive bone processes in the periapical region were detected in all molars and premolars of the upper jaw, regardless of the quality of endodontic treatment. Conclusion. Each of the above results as well as all of them together, convincingly demonstrate: 1) insufficient effectiveness of the use of endodontic treatment alone in order to sanitize the foci of chronic odontogenic infection located in the apices of the roots of the molars and premolars of the upper jaw which is largely justified by the features of the anatomical structure of the latter; 2) the need to develop a system of differentiated use of surgical methods of treatment for the rehabilitation of foci of chronic odontogenic infection of the specified localization, taking into account the variant anatomy of the root canals of the premolars and molars of the upper jaw

Деструктивные поражения апикального периодонта: достижения фундаментальной и прикладной науки в современных подходах к решению проблемы

Destructive lesions of the periodontium are a serious professional challenge for dentists. Along with tooth loss, which requires expensive prosthetics, chronic odontogenic inflammation provokes transient bacteremia and disrupts the homeostasis of the body. This leads to an exacerbation of somatic diseases, the development of allergic reactions and atherosclerotic damage to the walls of blood vessels. Timely diagnosis and prognosis, adequate choice of treatment methods play a key role in providing care to patients with this pathology. Depending on the clinical situation, both conservative and surgical strategies can be successful. The aim of this review is systematization of the scientific facts, which were accumulated over the past 5–10 years and describing the existing regenerative surgical techniques and promising possibilities of conservative treatment of destructive apical periodontal lesions. CONCLUSION: The latest materials for tissue regeneration developed by scientists are promising in complicated clinical cases associated with a significant loss of the bone tissue and spread of the lesion to the neighboring anatomical structures (maxillary sinus, nasal cavity, etc.). However, with the development of ideas of a tooth as of a nanostructured organ, integration of nanoscale particles with antimicrobial properties into the composition of temporary and permanent filling materials, conservative treatment methods also possess great practical potential. A deeper understanding of pathophysiology and microbiology of pathological process of cyst formation creates methodological basis for development by dentists of the novel therapeutic methods of treatment of periapical lesions that are currently regarded as a “sentence” to the invasive intervention – cystectomy, resection of the root apex or removal of the causal tooth. Effective endodontics is the key to sparing and predictable elimination of foci of chronic odontogenic infection that deranges homeostasis of the whole organism. This is a promising field for synthesis of fundamental and clinical knowledge, for international scientific cooperation with the primary aim to improve the quality of Human life.

Decompression effects on bone healing in rat mandible osteomyelitis

Osteomyelitis (OM) of the jaw is usually caused by a chronic odontogenic infection. Decompression is the release the intraluminal pressure in the cystic cavity allowing gradual bone growth from the periphery. The aim of this study was to analyze the effectiveness of decompression in an OM jaw model. A 4-mm-diameter defect was made on mandibles of fourteen Sprague–Dawley rats and inoculated with S. aureus (20 μl of 1 × 107 CFU/ml) injection. Two weeks later, four groups were made as non-treatment (C1), only curettage (C2), curettage and decompression (E1), and curettage and decompression with normal saline irrigation (E2). After four weeks, each group was analyzed. Most micro-CT parameters, including bone mineral density [0.87 (± 0.08) g/cm3] with bone volume [0.73 (± 0.08) mm3] was higher in E2 group than that of C1 group (p = 0.04, p = 0.05, respectively). E2 group in histology showed the highest number of osteocytes than those of control groups, 91.00 (± 9.90) (p = 0.002). OPN were expressed strongly in the E1 (“5”: 76–100%) that those of other groups. Decompression drains induced advanced bone healing compared to that of curettage alone. Therefore, it could be recommended to use decompressive drain for enhancing the jaw OM management.

Групи ризику пацієнтів на стоматологічному прийомі з обтяженим алергологічним анамнезом

Local injectable anesthesia is widely used in modern dentistry. First of all, the purpose of anesthesia in the practice of the doctor is to relieve the patient’s emotional stress and eliminate pain during the procedure. According to the classical position of N. E. Vvedensky, local anesthetics affect the functional state of the nerve, changing its conductivity and excitability. With the help of questionnaires we conducted a survey of 65 patients aged 18 to 75 years who sought medical help at the regional dental center in Poltava. The results of a questionnaire of doctors on the use of local anesthetics in dental practice were also analyzed. With the help of laboratory methods of examination of oral fluid, a decrease in the rate of salivation, saliva pH, leukocyte migration rate was determined. The purpose of the survey was to identify the frequency of manifestations of various allergic reactions to drugs in patients. All patients were systematized by age and comorbidities, which further affected their distribution. The distribution of patients by risk groups (allergy history) allowed to assess the prevalence of allergic diseases depending on age and sex. Particular attention was paid to elderly and senile patients, as their condition is characterized by a decrease in compensatory and adaptive capabilities. Patients with somatic pathology and persons with multiple foci of chronic odontogenic infection should be classified as at risk for the development of allergic reactions to local anesthetics, which should be taken into account when performing local injection anesthesia on an outpatient basis. It should be remembered that concomitant pathology affects the choice of anesthetic and can determine the development of toxic reactions during local injection anesthesia in the head and neck. This category of patients requires dentists to take a more responsible approach to collecting medical history and taking preventive measures to prevent the development of allergic and toxic reactions to local anesthetics.

Characterizing disease manifestations and treatment outcomes among patients with orofacial granulomatosis in China

BackgroundRacial variation exists in the incidence of orofacial granulomatosis (OFG). The epidemiology and clinical characteristics of OFG in Asian countries are poorly described.ObjectiveTo describe the epidemiologic and clinical features of OFG in China from data collected on chronic odontogenic infection and studied in actual practice regarding the long-term outcome of OFG patients receiving different treatments.MethodsData on demographics, medical history, chronic odontogenic infection, and the extent of disease were collected, and long-term outcomes after the end of treatments were evaluated.ResultsOf the 165 OFG patients, 118 (71.5%; 95% CI 64.6%-78.5%) had a chronic odontogenic infection. There was a variety of difference between OFG with and without chronic odontogenic infection. Approximately 98.3% (95% confidence interval 94.8%-100%) of OFG patients with chronic odontogenic infection who received dental treatment showed a marked response, of whom 31 patients (53.4%; 95% confidence interval 40.2%-66.7%) had complete remission.LimitationsEndoscopic investigations were not performed for most of the patients, and more detailed data were not collected, which might have demonstrated additional systemic problems.ConclusionsOFG with chronic odontogenic infection is the major clinical pattern of OFG in China, which may be a subtype of OFG. Dental treatment should necessarily be the preferred first-line therapy for such patients.

Dental rehabilitation of total adentia at pensioners of the Ministry of defense and contingent attached to military medical organizations

Legal, economic and clinical aspects of treatment of military personnel, retired military personnel, as well as the attached contingent in the conditions of hospitals of the Ministry of defense are presented. The study is based on the results of studying the number of dental implants installed in patients from 2014 to 2019 based on the medical records and outpatient records of a dental patient in two specialized departments of multidisciplinary hospitals of the Ministry of defense of the Russian Federation. Primary medical records were studied, data on the sex and age of patients, the presence (absence) of opportunistic diseases used implant system, the installation of dental implants and their amount and frequency of soft tissue and osteoplastic operations (to increase the volume of the bone and soft tissues of the alveolar bone (part) jaws) and the Protocol of the temporary and permanent prosthesis. Based on the analysis, we describe the current possibilities of medical and diagnostic work and present various types of orthopedic structures on dental implants for the dental rehabilitation of the above-mentioned contingents with complete adentia of the jaws (including in cases where absolute indications require the removal of all teeth due to foci of chronic odontogenic infection or periodontitis). The methods of treatment of patients in cases of combination of adentia with varying degrees of atrophy of the alveolar processes (parts) of the jaws are analyzed in detail. Clinical examples of dental rehabilitation are shown both with and without the use of methods for increasing the volume of jaw bone tissue, using various modern protocols for fixing orthopedic structures on zygomatic and root dental implants, and the frequency of their use in military medical organizations of the Ministry of defense of the Russian Federation during the reporting period. Based on the presented results, it is shown that the military medical organizations of the Ministry of defense of the Russian Federation have a full range of opportunities to provide comprehensive dental care to patients with complete secondary adentia, even in the presence of extreme bone atrophy of the jaws.

COMPARATIVE CHARACTERISTICS OF THE STATE OF HARD DENTAL TISSUES IN DRUG-DEPENDENT PATIENTS WHO USE HEROIN, AND METHADONE AS REPLACEMENT THERAPY

According to the Federal service for drug control in Russia, currently, 8.5 million people take drugs, including marijuana-6.2 million, synthetic drugs-1.5 million, and heroin-800,000 people. According to foreign and domestic literature, the population's consumption of narcotic drugs is continuously growing, especially in the youth and adolescence: in the structure of drug addicts, 20% are patients aged 9-16 years, 60% - 17-30 years, 20% - 30 years and older. Besides, many authors note the fact that even in young people with short-term use of methadone sharply increases the intensity of dental caries with subsequent rapid loss of teeth. Since 2005, the WHO has included the drug methadone in the list of essential medicines for the treatment of opioid dependence. However, according to the latest literature, the negative effect of methadone on the body as a whole, and dental health is much more pronounced than when taking heroin. Changes in the oral cavity when taking heroin and methadone in the literature are not covered enough, so it is considered relevant to study dental pathology in this group of patients. This article presents the results of a comparative analysis of the adverse effects of heroin and methadone on the hard tissues of the teeth of drug-dependent patients. In patients taking heroin and methadone, there was a deterioration in dental status indicators. The main manifestations of taking narcotic drugs are the development of the carious process, inflammatory diseases of the oral cavity, violation of salivation, the formation and spread of chronic odontogenic infection. The negative effect of methadone is more pronounced in comparison with heroin due to the contact of the tablet form of the drug with the oral mucosa.

Age Peculiarities of the Pro-inflammatory Component of Cytokine Profile in Chronic Odontogenic Infection Affected by Polymorbid Pathology

Aim: This study aimed to study the features of pro-inflammatory component of the cytokine profile in chronic odontogenic infection affected by polymorbid pathology. Materials and Methods: The study included 251 people: 125 middle-aged people (40–49 years) and 126 elderly people (60–69 years). All the people included in the study were divided into groups: Group 1 - apparently healthy people (33 patients of middle age and 31 of elderly age); Group 2 - patients suffering from chronic apical periodontitis (CAP) in granulating form (31 middle-aged patients and 33 elderly age patients); Group 3 - patients with CAP and coronary heart disease (CHD) (30 patients of middle age and 32 of elderly age); and Group 4 - patients suffering from CAP, CHD, and type 2 diabetes (31 middle-aged patients and 33 elderly patients). In all patients of different ages, cytokine profile was studied in blood serum, oral fluid, and crevicular gingival fluid. Results: The level of tumor necrosis factor alpha (TNF-α) in the blood serum depends significantly on the presence of a combination of CAP and CHD, CAP, CHD, and type 2 diabetes. A significant increase in the level of TNF-α in the oral and gingival fluids was noted when associated with polymorbid background in people of both the age groups. In the isolated course of CAP in elderly patients, unlike middle-aged patients, there was a significant increase in the concentration of interleukin (IL)-1β in blood serum. The level of IL-6 in the oral and gingival fluids is indicative of the characteristics of the inflammatory immune response in patients with CAP. The serum levels of IL-8 in elderly people are significantly higher than in middle-aged people. The increase in polymorphism leads to a significant increase in the degree of IL main in terms of IL-8. Conclusion: Concentration of TNF-α in blood serum with CAP can serve as an integral measure of immune inflammation. The level of IL-1β in blood serum, oral fluid, and gingival fluid can be considered as an additional factor characterizing the pathological process in polymorbid pathology. The level of IL-6 in the oral and gingival fluids is indicative of the characteristics of inflammatory immune response in patients with CAP. The severity of proinflammatory reaction by concentration of IL-8 is age dependent with a tendency of significant increase in the transition from middle to elderly age

Сhronic odontogenic infection and septic endocarditis

Relevance of the research topic. One of the possible causes of septic endocarditis is chronic odontogenic infection. The danger of this pathology lies in the sudden and rapid development of septicemia and heart valve damage, leading to disability of patients and posing a threat to their lives. Purpose.The aim of the work is to draw the attention of practitioners to the need for preventive sanitation of the oral cavity in patients with chronic foci of odontogenic infection.Method and materials. The article is devoted to the description of clinical observation in a patient with the development of septic endocarditis caused by the pathogen Klebsiella, which was revealed during in-depth examination and treatment of foci of odontogenic infection.Results. The successful outcome of the disease was ensured by rapid diagnosis and adequate therapy. Summary. Pathological microflora in the periapical zones of the jaws in the form of odontogenic granulomas and radicular cysts can be the cause of severe forms of septic endocarditis. Timely surgical rehabilitation of such foci is an effective measure of prevention of life-threatening disease.

Morphofunctional Characteristic of Bone Tissue of Alveolar Processes (Parts) in Conditions of Chronic Odontogenic Infection

Assessment of the condition of the alveolar bone is important for the choice of treatment methods for many types of pathology of the dentoalveolar system. The aim of the study was to identify morphofunctional disorders and changes in the optical density of bone tissue of the alveolar process of the maxilla and the alveolar part of the mandible arising from the effects of chronic odontogenic foci of infection. Material and methods. Histological examination of the edges of the alveoli of the removed teeth was carried out in 40 patients with chronic forms of periodontitis. Bony fragments were removed on medical reasons for the prevention of postextraction pain. Decalcification was carried out in Trilon B solution, microtome tissue sections were stained with hematoxylin-eosin. The density of bone tissue was determined on the intraoral radiovisiograms of the removed teeth and intact teeth in 80 persons of the control group. Results. It is established that with chronic forms of periodontitis under the periosteum of the alveolar processes (parts), osteoclastic resorption occurs either in the plane of the bone or with the formation of gauchepic lacunae. The channels of the osteons and the folkman channels widen, and in their circles there are also foci of resorption. Appear pycnosis of osteocytes and extensive areas with empty and dilated osseous lacunae. In the zones of osteolysis, either connective or coarse-fibrous bone tissue is formed. The optical density of bone tissue in patients is significantly less than in individuals with intact teeth. Conclusions. Toxins from chronic odontogenic foci of infection activate the processes of bone resorption of the alveolar process (part) of the jaws and inhibit reparative osteogenesis. The resulting rarefaction of bone tissue leads to a decrease in its optical density.

MODERN ASPECTS OF ETIOLOGY AND PATHOGENESIS OF DISEASES OF PARODONT

The article is devoted to the review of the modern literary data regarding etiology and pathogenesis of diseases of parodont. Many general and local factors take part in development and progression of inflammatory diseases of parodont. Role of chronic odontogenic infection in development of somatic pathology is described in this article.

Chronic Suppurative Osteomyelitis of Mandible: A Case Report

Osteomyelitis is an inflammatory disease of the bone that usually begins as an infection of the medullary cavity, rapidly involves the haversian system, and quickly extends to the periosteum of the area. It develops in the jaws after a chronic odontogenic infection or for a variety of other reasons such as trauma, inadequate treatment of fracture, or irradiation to the mandible. When antimicrobial agents or drainage prove unsuccessful, acute osteomyelitis may become chronic. Conventional radiography, culture, bone biopsy, radioisotope bone scan, laser Doppler flowmetry, computed tomography, and magnetic resonance imaging are used for its diagnosis. We present a case of chronic suppurative osteomyelitis associated with a draining extraoral sinus, which was successfully treated with surgical debridement and stabilization with a 10-hole reconstruction plate and bicortical screws using AO principles.

Midline odontogenic infections: a continuing diagnostic problem

Cutaneous sinus tracts and facial swellings of odontogenic origin have been well documented in the literature. These lesions however continue to be incorrectly diagnosed resulting in inadequate and unnecessary treatment. This paper reports two cases of midline odontogenic infections presenting as skin lesions. Neither patient complained of dental problems, and intraoral examination failed to reveal pathology. Both had been treated over an 18-month period, undergoing multiple surgical procedures before the correct diagnosis was made. Lesions on the face can be the result of occult chronic odontogenic infection. Awareness of a possible dental cause, especially with facial lesions that recur after excision is essential. The use of vitality testing of the teeth and appropriate radiographs ensures the correct diagnosis should not be missed.

Draining skin lesions of dental origin: The path of spread of chronic odontogenic infection: L. B. Kaban. Plast Reconstr Surg 66:711–717 (Nobember), 1980

Draining skin lesions of dental origin: The path of spread of chronic odontogenic infection: L. B. Kaban. Plast Reconstr Surg 66:711–717 (Nobember), 1980