Abstract
Purpose: Osteogenesis imperfecta (OI) is a congenital disease which occurs in approximately one in 20,000 people. The dental characteristics of OI are dentinogenesis imperfecta and following root canal obliteration. We report a case of endodontic retreatment of an OI patient with good prognosis by using cone-beam computed tomography (CBCT) and a dental operating microscope on the mandibular central incisor with chronic apical periodontitis.
Case: A 12-year-old female with OI had teeth mobility and biting pain in her lower front teeth after eating a snack at the end of February 2020. Fixation of the lower front teeth and observation were performed at the pediatric dentistry department of Osaka University Dental Hospital. An apical lesion of #41 was observed after a few days, however, the tooth continued to be observed under fixation due to obliteration of the root canal and the difficulty of its treatment. She was referred to a conservative dentistry clinic in June 2020. From dental radiography and CBCT of #41, a radiolucent area at the apex and obliteration of the root canal from the incisal edge to the middle of the root were observed. Based on a diagnosis of chronic apical periodontitis, root canal treatment was performed on #41. However, although root canal treatment was performed under a microscope several times, the orifice of the root canal could not be found. To check the positional relationship between the searching point and the original root canal, the CBCT was retaken. The CBCT images showed that the searching point was off distally and lingually from the original one. After modification, the original canal was found and the root canal treatment was performed. In December 2020, all symptoms had disappeared. The root canal was obturated, and restored with composite resin after one month. At one year after the root canal obturation, the radiolucent area had disappeared and there were no clinical symptoms on #41.
Discussion and conclusion: Patients with OI often suffer from tooth crown fracture, and their dental management requires attention. In the present case, we obtained good healing through proper root canal treatment of the apical periodontitis of the OI patient, whose teeth are considered difficult to treat. Even in the extremely stenosed tooth, we could perform root canal treatment by CBCT imaging at the proper timing and by using a dental operating microscope.
