mohammad marvi

The patients with unusual symptoms present a diagnostic challenge for clinicians and may lead to misdiagnoses and inappropriate or unnecessary treatments. Endodontic diseases can present with a variety of symptoms, and it is possible for odontogenic pain to resemble non-odontogenic pain, which can complicate treatment due to the distinct management plans of the two conditions. This report details the successful management of vague pain, and popping sensations in the left maxilla triggered by cold exposure. Previous clinicians were unable to identify the pain's origin, leading to unnecessary treatments. A clinical examination, and cone-bea m computed tomography evaluation revealed the presence of a missed second mesiobuccal root canal. The canal was located using an operating microscope and ultrasonics. Non-surgical endodontic retreatment was completed in two visits, successfully. This report highlights the critical importance of identifying the diverse symptoms that may arise from endodontic origin, as these can complicate clinical diagnosis.

Statement of the Problem:

 One of the rare adverse effects in patients who take bisphosphonates is the osteonecrosis of the jaw in the oral cavity following any trauma such as tooth extraction.

The aim of this study is the histopathological evaluation of the jaw following intra-ligament anesthesia injection in Zoledronate-treated rats.

In this descriptive-experimental study, rats weighing 200-250 g were divided into 2 groups. The first group received a 0.6 mg/kg dose of zoledronate and the second group received normal saline. Five injections with a 28-day interval were performed. At the end of the injection, the animals were sacrificed. Then, five-micrometer histological slides were prepared from the first maxillary molars and the surrounding tissues. Hematoxylin and eosin staining was performed to evaluate osteonecrosis, infiltration of inflammatory cells, fibrosis, and root and bone resorption.

There was no difference between the macroscopic and clinical features in both groups and no evidence of osteonecrosis of the jaw was observed in the samples. From the histological point of view, all the samples had normal tissues and none of them showed any evidence of inflammation, tissue fibrosis, disorder, or pathological root resorption.

According to the histological findings, the periodontal ligament space, the bone adjacent to the roots, and the dental pulp conditions were similar in both groups. Osteonecrosis of the jaw did not develop in the rats that took bisphosphonates after intraligamental injection.

Enterococcus faecalis (E. faecalis) is the most commonly isolated microorganism from teeth with postoperative infection. Triple antibiotic paste (TAP) has the ability to eradicate microorganisms from the root canal system when used as an intracanal medicament. The aim of this study was to determine the minimum duration of application of TAP required for elimination of E. faecalis from the root canal system and its minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) in an ex-vivo model.
Root canals of 34 extracted human single canal teeth were inoculated with E. Faecalis after instrumentation, and then 4 g of TAP (ciprofloxacin, metronidazole and doxycycline) was mixed with 4.5 mL of saline and applied as intracanal medicament. The teeth were sectioned longitudinally and dentin chips were collected and evaluated to determine the count of bacterial colonies. Micro-dilution broth test was used to assess the MIC and MBC of TAP. Data were analyzed using SPSS version 22 via the Wilcoxon signed rank test.
After seven days of application of TAP as intracanal medicament, E. faecalis was eliminated from the dentinal tubules of the apical half of root canal up to 400 µ depth. The MIC and MBC of TAP in its original concentration were both found to be 16 µg/mL.
The original concentration of TAP was found to be 5×104 times its MIC. Considering the risk of coronal discoloration of teeth following the use of TAP, application of its lower concentrations is recommended.