Healing of a traumatic bone cyst after nonsurgical endodontic treatment

Idiopathic Bone Cavity: Clinicopathologic Features from a Case Series with Emphasis on Differential Diagnosis of Chronic Apical Periodontitis

INTRODUCTION

Idiopathic bone cavity (IBC) is an uncommon bone lesion that usually affects youngsters as an unilocular radiolucency with predilection for the posterior mandible. Because the lesion is frequently located in proximity to the adjacent teeth, chronic apical periodontitis is commonly included as a differential diagnosis. The aim of the present study was to analyze the clinical and radiologic features of a series of IBCs diagnosed in a single service.

METHODS

All cases diagnosed as IBC were retrieved from the files of an oral pathology laboratory, and the clinical and radiologic characteristics were described with a focus on the differential diagnosis with chronic apical periodontitis.

RESULTS

Thirty cases composed the final sample. The mean age of the affected patients was 22 years old; there was no sex predilection, and most lesions were located on the posterior (47%) and anterior (43%) mandible. Most lesions presented as unilocular radiolucencies (87%), and 90% were located in close association with the adjacent teeth. The associated teeth presented no endodontic involvement, and all proved to be vital.

CONCLUSIONS

IBC usually affects young patients as an unilocular radiolucency in close association with the adjacent teeth. Careful radiologic analysis and vitality tests of the adjacent teeth are essential to rule out chronic apical periodontitis, thus avoiding any unnecessary endodontic treatment.

Traumatic bone cyst of the mandible in a 10-year-old boy

Although rare, the presentation of mandibular cysts in children can be difficult for medical providers to recognize. We present a case of a 10-year-old boy who presented to our pediatric emergency department with a painful swelling of his chin on multiple occasions before the diagnosis of a traumatic mandibular bone cyst with superinfection was made. A review of the literature regarding the presentation and management of cystic lesions of the mandible in children is presented.

Simple Bone Cyst of the Jaws: Evaluation of Treatment Outcome by Review of 132 Cases

PURPOSE

To estimate the prognosis of simple bone cyst of the jaws.

SUBJECTS AND METHODS

We reviewed 132 of our own and published cases that received postoperative follow-up until healing or recurrence. The recurrence rate was obtained from treatment outcomes. The time to healing or recurrence was estimated from the distributions of the times of examinations that confirmed healing or recurrence.

RESULTS

Simple bone cyst lesions healed in 98 cases and recurred in 34 cases. The overall recurrence rate was 26%. The recurrence rate was 71% and 75% for cases with multiple cysts and cemento-osseous dysplasia, respectively. In most cases, healing or recurrence was confirmed within 3 years, 5 months of surgery. The maximum number of cases with healing and recurrence was observed 12 to 17 months and 2 to 2.5 years after surgery, respectively.

CONCLUSION

The recurrence rate was higher than rates reported previously. We recommend that postoperative examination be continued until complete healing is confirmed radiographically, particularly in cases with multiple lesions or cemento-osseous dysplasia. Healing or recurrence should be confirmed within 3 years of treatment.

Levels of Evidence for the Outcome of Nonsurgical Endodontic Treatment

The purpose of this systematic review was (a) to search for clinical articles pertaining to success and failure of nonsurgical root canal therapy, and (b) to assign levels of evidence to these studies. Electronic and manual searches were conducted to identify studies published between January 1966 and September 2004 with information on the success and failure of nonsurgical root canal therapy. Articles were reviewed and graded for strength of level of evidence (LOE) from one (highest level) to five (lowest level). This review resulted in the identification of 306 clinical studies related to this topic area. Six articles were randomized controlled trials (RCTs, LOE 1). This search also identified 12 low-quality RCTs (LOE 2), 14 cohort studies (LOE 2), five case-control and eight cross sectional studies (LOE 3), four low-quality cohort studies (LOE 4), and five low-quality case-control studies (LOE 4). The majority (73) of the often-quoted "success and failure" studies were case series (LOE 4). The rest of the articles were descriptive epidemiological studies (42), case reports (114), expert opinions (18), literature reviews (4), and one meta-analysis. Based on these findings, it appears that a few high-level studies have been published in the past four decades related to the success and failure of nonsurgical root canal therapy. The data generated by this search can be used in future studies to specifically answer questions and test hypotheses relevant to the outcome of nonsurgical root canal treatment.

Traumatic bone cyst: case report

The traumatic bone cyst is a lesion whose aetiology and pathogenesis have not been conclusively established. There are several theories and names for this lesion and various forms of management have been reported in the literature. This report outlines the clinical and radiographic findings associated with a case of a traumatic bone cyst. Laboratory investigations were also carried out and their findings are reported. This case was treated jointly by the endodontic and oral surgery departments of an institution and demonstrates the need for close follow-up from both departments. In particular, the endodontic aspects of monitoring the pulp status of teeth in the region of such a bone lesion are emphasised.

A dentist's dilemma: nonsurgical endodontic therapy or periapical surgery for teeth with apparent pulpal pathosis and an associated periapical radiolucent lesion

First presented is a brief review of nonsurgical versus surgical treatment of radicular cysts. This is followed by a consideration of the use of radiographs for differential diagnosis of periapical radiolucent lesions. Some of the nonendodontic local and systemic lesions that can occur periapically are then presented. Next examined are the fallibilities of pulp vitality testing methods. The need for histopathologic examination of periapical lesions is the subject of the next discussion. The dentist's dilemma is then examined: should teeth with apparent pulpal pathosis and an associated periapical radiolucent lesion have routine surgical treatment including biopsy or should they be treated nonsurgically and have periodic follow-ups? A possible resolution of this dilemma is the final consideration.