The success of endodontic surgery depends on the removal of all necrotic tissue and complete sealing of the entire root canal system. For many years, the traditional approach with surgical burs and amalgam for root-end filling has been a common procedure. However, examination of failed clinical cases revealed that it could not be predictable to locate, clean, and fill all the complex apical ramifications with traditional surgical techniques. Microendosurgery is the most recent step in the evolution of periradicular surgery, applying modern ultrasonic preparation, biocompatible retro filling materials, and incorporating microsurgical instruments, high-power magnification and illumination. It has been reported that microendosurgery produces predictable outcomes in the healing of lesions of endodontic origin compare to traditional techniques. In this review, the current concepts, techniques, instruments and materials of microendosurgery will be presented.
In the Department of Oral and Maxillofacial Surgery, Gunma University Hospital, relatively large radicular cysts extending over 3 or more teeth are treated with a combination of complete excision, endodontic microsurgery and Er: YAG laser irradiation, whereby favorable outcomes have been achieved. The purpose of this report is to describe our surgical procedure and discuss the therapeutic outcomes. Patients between December 2008 and December 2014 with radicular cysts pathologically extending over 3 or more teeth, who were followed up for 1 year or longer, participated in this study.
A 45-year-old man was referred to our hospital because of limitation of mandibular movement. He was given a diagnosis of hyperplasia of the mandibular coronoid process and masticatory muscle tendonaponeurosis hyperplasia. Bilateral coronoidectomy and aponeurectomy of the masseter muscles were performed via an oral approach. Posterior open bite was noted 3 days after the operation. Magnetic resonance imaging of both temporal mandibular joints showed displacement of the left condyle as well as joint effusion at the posterosuperior joint space. A splint and pumping manipulation were applied, and the patient was given a nonsteroidal anti-inflammatory drug. The left posterior open bite nearly completely improved with no negative impact on the patient’s quality of life 1 year 9 months after the operation.
We report a case of an ectopic third molar in the left maxillary sinus associated with surrounding bone formation. A 31-year-old woman visited our hospital because of headache and discomfort in the left buccal region. Imaging findings revealed an impacted tooth in the left maxillary sinus and radiographic opacity with bone formation around the tooth. The lesion was clinically diagnosed as a benign tumor in the left maxillary sinus, and surgery was performed with the patient under general anesthesia. Examination of the resected specimens revealed a third molar surrounded by globules of pale yellow fatty marrow in thin sheets of bone. Histopathologically, the lesion was diagnosed as a third molar erupting ectopically in the maxillary sinus. During growth and development, bone including the germ of the third molar mostly likely became detached from the bone around the maxillary sinus, and this fragment was displaced to the maxillary sinus, where additional bone was formed. In our experience, such a case is extremely rare. Our findings also suggested that an isolated bone fragment in the maxillary sinus probably caused the lesion.
Dermoid cyst and epidermoid cyst usually arise as midline swellings in the floor of the mouth. We report a rare case of epidermoid cyst that arose in the left side of the root of the tongue. A 47-year-old man was referred to our department because of a painless mass in the left lateral aspect of the root of the tongue. Clinical examination showed an exophytic mass measuring 6 × 4 mm near the left lingual tonsil. Excisional biopsy was performed with the patient under local anesthesia. Histopathologically, the mass was diagnosed as an epidermoid cyst. No recurrence has occurred as of 1 year after excision.
We report a case of extensive bisphosphonate-related osteonecrosis of the jaw (BRONJ) associated with a mandibular fracture, which improved after treatment with teriparatide and surgical therapy. An 83-year-old woman was referred to our hospital because of swelling of the submandibular region. At presentation, clinical examination revealed swelling of the right submandibular region and discharge of pus. A computed tomographic (CT) scan confirmed osteolytic changes and a fracture of the mandible. Three months after bone curettage, fixation with a titanic plate, and treatment with teriparatide, new bone formation was observed. Five months after this therapy, the fractured segment had completely healed. Teriparatide may contribute to the improvement of BRONJ.
Nevoid basal cell carcinoma syndrome (NBCCS) is a condition characterized by findings such as a keratocystic odontogenic tumor (KCOT), basal cell carcinoma, and small pits on the palms or the soles of the feet. The responsible gene is PTCH1. In this paper, we report on a parent and child with NBCCS in whom we resected the KCOT and confirmed a PTCH1 genetic mutation. Case 1 developed in a 14-year-old boy, and case 2 was in a 32-year-old woman, the mother of the boy of case 1. Both patients underwent multiple maxillary tumorectomies, and a histopathological diagnosis of KCOT was obtained. Genetic analysis confirmed the presence of a frameshift mutation in the PTCH1 gene in both the parent and the child. Even with the diagnostic criteria of Kimonis et al, a diagnosis of NBCCS was reached. Many similar cases of NBCCS are encountered in dentistry and oral and maxillofacial surgery, and the dentist is considered to play an important role in diagnosis, treatment, and explanation of the condition. Moreover, because some symptoms emerge with advancing age, PTCH1 genetic analysis should be proactively performed to achieve an early diagnosis.