Refractory apical periodontitis associated with a calculus-like deposit at the root apex

Received 11 February 2010; accepted 20 April 2010.

In this case report, we describe a refractory case in which a calculus-like deposit was found at the apical root surfaces of two adjacent teeth. This case involved a 45-year-old male with a sinus tract at the labial mucosa of the maxillary left central incisor, which did not heal after conventional root canal treatment of the maxillary left lateral incisor. Periradicular radiolucencies and unusual radio-opacities were noted on the root surfaces of the vital maxillary left central incisor and prior endodontically treated lateral incisor. Subsequent surgery found calculus-like particles at the root surface of both teeth. A pathology examination revealed calculus-like particles scattered in the granulomatous tissue. A test cavity confirmed pulp necrosis of the maxillary central incisor, and endodontic treatment was performed 1 year after surgery. At the 20-month recall, the size of the periapical radiolucency had decreased. The presence of calculus-like particles at the root surfaces was noted and may have possibly contributed towards the etiology of root canal treatment failure.

Key Words: apical periodontitis , biofilm , calculus , extraradicular infection

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Article Outline

• Abstract

• References

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References

1. 1 Tronstad L , Barnett F , Riso K , Slots J . Extraradicular endodontic infections . Endod Dent Traumatol . 1987;3:86–90 . MEDLINE

2. 2 Sunde PT , Olsen I , Debelian GJ , Tronstad L . Microbiota of periapical lesions refractory to endodontic therapy . J Endod . 2002;28:304–310 . Abstract | Full Text | Full-Text PDF (1299 KB) | CrossRef

3. 3 Noiri Y , Ehara A , Kawahara T , Takemura N , Ebisu S . Participation of bacterial biofilms in refractory and chronic periapical periodontitis . J Endod . 2002;28:679–683 . Abstract | Full Text | Full-Text PDF (1458 KB) | CrossRef

4. 4 White DJ . Dental calculus: recent insights into occurrence, formation, prevention, removal and oral health effects of supragingival and subgingival deposits . Eur J Oral Sci . 1997;105:508–522 . MEDLINE | CrossRef

5. 5 Ramachandran Nair PN . Light and electron microscopic studies of root canal flora and periapical lesions . J Endod . 1987;13:29–39 . Abstract | Full-Text PDF (6060 KB) | CrossRef

6. 6 Tronstad L , Sunde PT . The evolving new understanding of endodontic infections . Endod Topics . 2003;6:57–77 .

7. 7 Harn WM , Chen YH , Yuan K , Chung CH , Huang PH . Calculus-like deposit at apex of tooth with refractory apical periodontitis . Endod Dent Traumatol . 1998;14:237–240 . MEDLINE

8. 8 Ricucci D , Martorano M , Bate AL , Pascon EA . Calculus-like deposit on the apical external root surface of teeth with post-treatment apical periodontitis: report of two cases . Int Endod J . 2005;38:262–271 . MEDLINE | CrossRef

9. 9 Souchay A , Pouezat JA , Menanteau J . Mineralization of Streptococcus mutans in vitro: an ultrastructural study . Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 1995;79:311–320 . Abstract | Full-Text PDF (7126 KB) | CrossRef

a Department of Dentistry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

b Graduate School of Dental Science, National Defense Medical Center, Taipei, Taiwan

c Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan

d School of Dentistry, National Yang-Ming University, Taipei, Taiwan

Corresponding author. Department of Stomatology, Taipei Veterans General Hospital, 201, Shih-Pai Road, Section 2, Taipei 11221, Taiwan

PII: S1991-7902(10)60015-3

doi:10.1016/S1991-7902(10)60015-3

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