Widening Of Periodontal Space Research Articles

A Life-Saving Early Diagnosis of Burkitt Lymphoma Involving both Jaws, Misdiagnosed as Pericoronitis

Purpose: Burkitt lymphoma (BL) is a highly aggressive and rare B-cell non-Hodgkin’s lymphoma. In this paper, a rare case of BL, involving both jaws, was presented. 
 
 Case Report: A 24-year-old male patient was referred to our clinic with the complaint of mandibular and maxillary swelling for two months. He was previously misdiagnosed with pericoronitis and had a history of right mandibular third molar tooth extraction, one-month prior. Intraoral examination showed swelling, ulceration, and spontaneous bleeding in both jaws. Radiographically, extensive osteolytic lesions, irregular periodontal space widening, loss of lamina dura, and peri-radicular radiolucencies were detected. Incisional biopsy was performed from both jaws and the final diagnosis was made as BL. 
 
 Conclusion: It is crucial to be aware of the clinical and radiological features of this disease by dentists and to consult the attending physician without delay.

Volumetric analysis of the periodontal microstructure under antiresorptive therapy: an experimental study in rabbits.

The objective of this study wasto volumetrically assess changes in the periodontal microstructure under antiresorptive therapy. Microtomographic scans from a total of 9 Dutch Belted rabbits having been randomly allocated to either the intravenous administration of amino-bisphosphonate (zoledronic acid) (Za) (n = 5) or a negative control group (nZa) (n = 4) were obtained at 10months following a repeated drug administration. A quantification of the periodontal space thickness (P.Th) of both maxillary and mandibular most posterior premolars, as well as of the 2nd molars was performed. Bone micromorphometry was assessed by means of bone volume per total volume (BV/TV), the bone mineral density (BMD), trabecular thickness (Tb.Th), trabecular number (Tb.N), bone surface (BS), and the specific bone surface (BS/BV). Za was associated with significantly higher P.Th (P = 0.010), which was most pronounced in the upper jaw. Bone micromorphometry revealed no significant differences among the two groups, i.e., Za and nZa, for all the investigated parameters. Volumetric analysis revealed that antiresorptive therapy was associated with periodontal space widening, whereas major effects on the bone micro-morphology could not be observed. A deep understanding of specific periodontal and alveolar bone alterations in patients under antiresorptive therapy might help to prevent the onset of medication-related osteonecrosis of the jaw.

Management of C-shaped canals using “Membrane-Barrier Technique”: A Case report

A 61-year old Chinese female was referred from a general private practitioner for persistent buccal abscess after completion of root canal treatment of tooth 37. On clinical examination, tooth 37 presented with a metal-ceramic crown (CMC) with 2mm of gingival recession noted at the buccal region. The overlying amalgam core was overhanging on distal and grade 2 mobility. The 37 CMC have no contact point at the distal. Tooth 37 was not tender to palpation but tender to percussion. No periodontal pocketing was detected. The periapical radiograph revealed a periapical radiolucent area associated end of its root. These 37 apices were resorbed, probably a result of the apical periodontitis there. Widening of periodontal space was noted with this 37. A diagnosis of chronic apical periodontitis with external resorption of root apices with a C-shaped canal was made for the tooth 37.Membrane barrier technique with MTA was used for obturation. A bonded amalgam core was placed in this tooth.

Head and neck radiotherapy-induced changes in dentomaxillofacial structures detected on panoramic radiographs: A systematic review.

PurposeThis study aimed to summarize the impact of neck and head radiation treatment on maxillofacial structures detected on panoramic radiographs.Materials and MethodsIn this systematic review, the authors searched PubMed Central, Embase, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar for original research studies up to February 2020 that included the following Medical Subject Headings keywords: words related to “radiotherapy” and synonyms combined with keywords related to “panoramic radiography” and “oral diagnosis” and synonyms. Only original studies in English that investigated the maxillofacial effects of radiotherapy via panoramic radiographs were included. The quality of the selected manuscripts was evaluated by assessing the risk of bias using Cochrane's ROBINS-I tool for non-randomized studies.ResultsThirty-three studies were eligible and included in this review. The main objectives pertained to the assessment of the effects of radiation on maxillofacial structures, including bone architecture alterations, periodontal space widening, teeth development abnormalities, osteoradionecrosis, and implant bone loss. The number of participants evaluated ranged from 8 to 176.ConclusionThe interaction between ionizing radiation and maxillofacial structures results in hazard to the tissues involved, particularly the bone tissue, periosteum, connective tissue of the mucosa, and endothelium. Hard tissue changes due to radiation therapy can be detected on panoramic radiographs.

Evaluation of Periodontal Space Widening in Patients with Antiresorptive Drug-related Osteonecrosis of the Jaws (ARONJ) on Panoramic Radiographs.

The purpose of this study was to evaluate a potential widening of the periodontal space as an initial measurable imaging criterium on panoramic radiographs in patients with the diagnosis of antiresorptive drug related osteonecrosis of the jaw (ARONJ). A retrospective analysis of panoramic radiographs of 16 patients (12 females and 4 males; mean age is 70.5 years, standard deviation is 14 years) was performed, over a period of 12 months with the diagnosis of ARONJ. Panoramic radiographs of 16 healthy patients (12 females and 4 males; mean age was 70.6 years, standard deviation was 13.8 years) without diagnosis of ARONJ served as controls. All images were taken with the same device and were evaluated by two experienced maxillofacial surgeons and one dentist. Compared to the control group, a mean widening of the periodontal space of 0.06 mm (confidence interval (CI)=0.05-0.17 mm) was found in the study group. However, this difference was not statistically significant. Although a very extensive and sophisticated interindividual comparison was performed to evaluate for slight changes of the periodontal space in patients with antiresorptive drug therapy, our results demonstrate that PDS widening is not a predictive parameter for ARONJ. Therefore, our results indicate that panoramic radiographs are not sufficient enough to allow assessment of stages and disease progress in ARONJ patients regarding to periodontal space widening.

Conduction of reparative dentin: A pulp protecting approach by indirect pulp capping in deep carious lesion with biodentine

This case report represents, the treatment of deep carious lesion in a male was done by using indirect pulp capping with biodentine. The clinical and radiological outcomes were evaluated. The patient was presented with mild to moderate sensitivity on thermal (cold) stimulation and discomfort associated with eating in the left mandibular first molar. The clinico–radiographical examination revealed a disto–occlusal carious lesion, very close to the pulp, absence of radiolucencies in the periapical region and no periodontal space widening. Pulp sensitivity was confirmed by thermal pulp vitality test. Indirect pulp capping treatment was performed with biodentine. Following 6 months of the treatment, the clinical symptoms were resolved and a calcific bridge was found at the dentin over the pulp and biodentine interface that was indicative the evidence of reparative dentin formation.

Odontogenic Myxoma of Mandible with Unusual (Sunburst) Appearance: A Rare Case Report

Odontogenic Myxoma of Mandible with Unusual (Sunburst) Appearance: A Rare Case Report

Pulp polyp - A periapical lesion: Radiographic observational study

Introduction: Pulp polyp (PP) is a chronic hyperplastic condition resulting in formation of granulation tissue and proliferative mass. The radiographic appearance of PP has innumerable presentations. Diagnosing and treatment planning of periapical lesions, heavily relies on the radiographic changes surrounding the root structures. Objective: To evaluate different radiographic periapical changes in clinically detected PP patients. Materials and Methods: Patients reporting to Department of Oral Medicine and Radiology and who were clinically diagnosed with PP by an oral diagnostician were subjected to radiographic examination. Digital intraoral periapical radiographs of 50 patients with PP were taken. Various periapical changes in the digital radiographs were recorded by a skilled oral radiologist. The data obtained was subjected to statistical analysis using SPSS ver 17.0 and P-value was set at <0.05 as significant. Result: Periapical changes like periodontal space widening (PDLW), loss of lamina dura, periapical abscess, periapical granuloma, hypercementosis, condensing osteitis and root resorption were noted. Periodontal space widening was seen in all patients (100%), loss of lamina dura was noted in 72%, periapical rarefying osteitis in 56%, condensing osteitis in 8%, hypercementosis, periapical granuloma, and root resorption were seen in 4% of PP patients. Majority of PP were asymptomatic (66%). Pulp polyp was commonly seen in mandibular first molar followed by mandibular second molar and maxillary first molar. Statistically significant difference was noticed between periapical changes in PP patients (P value <0.0001). All PP patients showed definite periapical changes suggesting it to be a periapical lesion. Conclusion: Pulp polyp is confined to the pulpal portion of the tooth which, may or may not cause changes in periapical region. The results of the present study showed that majority of the PP patients were associated with definite periapical changes. This observation suggests that clinically detected PP are radiographically associated with definite periapical changes suggesting it to be a periapical lesion.

Supplemental root in a mandibular first molar: a rarity.

Anatomic variations are common in human dentition. A clear understanding of these variations is very important for success of endodontic treatment. A dentist should be aware of these anatomic variations as this can affect the treatment outcome. A case of endodontic therapy is presented in which inability to locate an anatomically rare supplemental canal of a three rooted mandibular first molar resulted in treatment failure. A 21-year-old female reported with pain and swelling in relation to lower right first molar. An intra oral periapical radiograph revealed 3 roots; the first canal of the mesial root and a canal of one of the distal roots were found to be treated endodontically, which were infraobturated but the canal of the 2nd distal root had not been treated. The radiograph revealed periapical radiolucency and widening of periodontal space. Prior to starting the endodontic treatment the clinician must be aware of the anatomic variations in tooth pulp morphology and also the importance of preoperative radiographs cannot be underscored.

Direct Pulp Capping in Primary Molars with Enamel Matrix Derivative: Report of a Case

Enamel Matrix Derivative (EMD) is a rich amelogenin and amelin biomaterial that has been demonstrated to induce a reparative process similar to normal odontogenesis when placed in contact with pulp tissue. However its effects in pulp capping on primary teeth has not been previously reported. THE AIM of the present case report is to present the favorable clinical and radiographic findings of a primary molar treated with direct pulp capping (DPC) and using EMD as capping material in a 6-year-old girl. After 12 months, there was no sign or symptom indicative of treatment failure, such as pain, gingival swelling, sinus tract, sensitivity to percussion or palpation, abnormal mobility, widening of periodontal space, internal or external root resorption, or supporting bone or furcal area radiolucencies.

Periodontal space widening in patients with systemic sclerosis: a probable explanation

Periodontal space widening in patients with systemic sclerosis: a probable explanation