Conservative treatment of a radicular cyst in a 5-year-old child: A case report

The present report describes the management of a radicular cyst in a 5-year-old child. The treatment comprised extraction of the primary teeth involved followed by marsupialization. A removable appliance with a resin extension penetrating into the cystic cavity was used to help decompress the lesion. This treatment allowed rapid healing of the lesion and eruption of the permanent incisors without the need for orthodontic treatment.

Combined therapy with mineral trioxide aggregate, and guided tissue regeneration for a large radicular cyst: A 13-year follow-up

Biomaterials such as membrane barriers and/or bone grafts are often used to enhance periapical new bone formation. A combination of apical surgery and these biomaterials is one of the latest treatment options for avoiding tooth extraction. In case of periapical lesions, guided tissue regeneration (GTR) is attempted to improve the self-regenerative healing process by excluding undesired proliferation of the gingival connective tissue or migration of the oral epithelial cells into osseous defects. In many cases, GTR is necessary for achieving periodontal tissue healing. This report describes the healing process after surgery in a challenging case with a long-term followup. In this case report, endodontic surgery was followed by retrograde sealing with mineral trioxide aggregate (MTA) in the maxillary right central incisor and left lateral incisor. Apicectomy was performed in the maxillary left central incisor and a 1-mm filling was removed. The bone defect was filled with an anorganic bone graft and covered with a decalcified cortical osseous membrane. No intraoperative or postoperative complications were observed. After 13 years of follow-up, the patient showed no clinical signs or symptoms associated with the lesion and radiographic examination showed progressive resolution of radiolucency. In conclusion, the combination of apical surgery and regenerative techniques can successfully help the treatment of periapical lesions of endodontic origin and is suitable for the management of challenging cases.

Combined therapy with mineral trioxide aggregate, and guided tissue regeneration for a large radicular cyst: a 13-year follow-u

Biomaterials such as membrane barriers and/or bone grafts are often used to enhance periapical new bone formation. A combination of apical surgery and these biomaterials is one of the latest treatment options for avoiding tooth extraction. In case of periapical lesions, guided tissue regeneration (GTR) is attempted to improve the self-regenerative healing process by excluding undesired proliferation of the gingival connective tissue or migration of the oral epithelial cells into osseous defects. In many cases, GTR is necessary for achieving periodontal tissue healing. This report describes the healing process after surgery in a challenging case with a long-term followup. In this case report, endodontic surgery was followed by retrograde sealing with mineral trioxide aggregate (MTA) in the maxillary right central incisor and left lateral incisor. Apicectomy was performed in the maxillary left central incisor and a 1-mm filling was removed. The bone defect was filled with an anorganic bone graft and covered with a decalcified cortical osseous membrane. No intraoperative or postoperative complications were observed. After 13 years of follow-up, the patient showed no clinical signs or symptoms associated with the lesion and radiographic examination showed progressive resolution of radiolucency. In conclusion, the combination of apical surgery and regenerative techniques can successfully help the treatment of periapical lesions of endodontic origin and is suitable for the management of challenging cases

Lateral periodontal cyst: a case report and literature review

The lateral periodontal cyst is considered a developmental odontogenic cyst with unusual occurrence. In most cases it is preliminary diagnosed as a radiographic finding, presenting as well circumscribed or as a round or teardrop-shaped radiolucent area. Due to its location it can easily be misdiagnosed as a lesion of endodontic origin. Final diagnosis should be based on histopatological examination. The purpose of this paper is to report a classic case of lateral periodontal cyst located in the anterior region of mandible and to review the relevant literature which describes the clinical, radiological and histopathological features of lateral periodontal cysts. A 50 years female patient complained of an asymptomatic gingival swelling in the region between the left mandibular lateral incisor and canine. Radiographic examination revealed a well circumscribed radiolucency with approximately 0.5 cm diameter with a radiopaque margin between the roots of the left mandibular lateral incisor and canine. The adjacent teeth had vital pulp. A total enucleation of the lesion was performed, and intraoperative examination showed a single lesion with no communication between the cyst's cavity and the oral environment. Histological examination revealed that the lesion was lateral periodontal cyst of developmental origin. There was no recurrence or complications for 24 months follow-up. The lateral periodontal cyst can be considered in the differential diagnosis when a radioloucent lesion appears adjacent to the roots of vital teeth. The treatment of choice is surgical removal and subsequent histological evaluation to confirm the diagnosis. Relapses are infrequent.

Expressão imuno-histoquímica das proteínas IFN-γ e TGF-β1 em cistos radiculares e cistos dentígeros

Odontogenic cysts are pathologic cavities covered by odontogenic epithelium and filled by liquid, desquamated cells or other materials. The intraosseous lesions, such as radicular cyst and dentigerous cyst, present a potential of expansion capable of promoting the destruction of the surrounding osseous tissue. The mechanisms related to this process of expansion are the proliferation of cystic epithelium, the increase of the osmolarity of the cystic fluid and the synthesis of reabsorption factors such as IFN-γ and TGF-β1. The aim of this study was to evaluate and compare the immunohistochemical expression of IFN-γ and TGF-β1 between radicular cysts and dentigerous cysts in order to understand the role and behavior of these proteins in the expansion of these cysts. We selected 20 cases of radicular cyst and 20 cases of dentigerous cyst chosen from the files of UFRN s Laboratory of Oral Pathology. After analyzing the clinical data, the cases underwent the routine staining technique (HE) and immunohistochemistry for the appearance of IFN-γ and TGF-β1 in the epithelium and capsule of these cysts. The statistical analysis using the Mann-Whitney test revealed no statistically significant difference in immunoexpression of IFN-γ between the epithelium (p = 0.565) and capsules (p = 0.414) of radicular cysts and dentigerous cysts. Moreover, there was no statistically significant difference of immunoexpression of TGF-β1 between the epithelium (p = 0.620) and capsules (p = 0.056) of radicular cysts and dentigerous cysts. The Wilcoxon test revealed no statistically significant difference between IFN-γ and TGF-β1 imunoexpressions in the epithelium (p = 0.225) and capsules (p = 0.370) of radicular cysts. There was no statistically significant difference between IFN-γ and TGF-β1 imunoexpressions in the epithelium (p = 0.361) of dentigerous cysts. However, there was a statistically significant difference between IFN-γ and TGF-β1 immunoexpressions in the capsule (p = 0.001) of dentigerous cysts, being TGF-β1 the factor which presented the most significant immunoexpression. Given these results, we conclude that there was no difference in immunohistochemical expression of IFN-γ and TGF-β1 between radicular and dentigerous cysts and that TGF-β1 was more significant than the IFN-γ in the capsule of dentigerous cysts

Imunoexpressão do EGFR e da podoplanina em cistos radiculares e dentígeros

The radicular cysts (RCs) and dentigerous (DCs), despite having different etiologies, form a pathological cavity lined by epithelium, which grows due to the buildup of fluid inside, as the surrounding bone is reabsorbed and the epithelium will being induced to proliferate. The epithelial proliferation, which has been identified as one of the key processes in the growth of odontogenic cystic lesions, is influenced by growth factors such as EGFR (epidermal growth receptor factor) and podoplanin (PDPN), many of which may have its production stimulated mainly during inflammatory processes. The objective of this research was to evaluate and compare the immunohistochemical expression of EGFR and PDPN in 30 cases of RCs and 30 cases of DCs, semiquantitatively, in light microscopy, associating it with the degree of inflammation, cellular localization of immunostaining and with the immunostained epithelial layers. Data were statistically analyzed by Chi-square test and Fisher exact test, considering a significance level of 5 %. The results showed high immunoreactivity of both proteins in the lesions studied, only statistically significant difference was observed in immunostaining of PDPN (p=0.033), which proved higher in RCs. The other analyzed parameters showed no relevant significant differences. We conclude that, as EGFR and PDPN showed high immunoreactivity in cystic lesions analyzed, these proteins participate the pathogenesis of these lesions through the epithelial stimulation process, despite having different etiologies. Furthermore, it can infer that the higher immunostaining of PDNP in RCs that DCs showed no distinction indicator between the two lesions, regarding their etiologies, once this protein also showed a considerable expression in DCs, independent of the intensity of the inflammatory infiltrate

The challenges of treating a fused tooth

This paper describes and discusses the multidisciplinary treatment involving a permanent maxillary lateral incisor fused to a supernumerary tooth, both presenting pulp necrosis and periapical lesion. A 15-year-old male patient sought treatment complaining of pain, swelling and mobility on the maxillary right lateral incisor. After clinical and radiographic examination, root canal preparation was performed according to the crown-down technique and a calcium hydroxide dressing was placed for 15 days. The patient returned and the definitive endodontic filling was done with thermomechanical compaction of gutta-percha and sealer. After 18 months, clinical and radiographic examinations were carried out and no pain or swelling was reported. Two years after endodontic treatment, the patient returned for periodontal and cosmetic treatments. Nine months later, a cone-beam computed tomography (CBCT) revealed that the previously detected periodontal defect and periapical lesion were persistent. Apical endodontic surgery was indicated. The supernumerary tooth was removed, the communicating distal surface was filled and the surgical site received bioactive glass and demineralized bovine organic bone. The pathological tissue was submitted to histopathological examination and the diagnosis was periapical cyst. One year after the apical endodontic surgery, CBCT showed bone formation at maxillary lateral incisor apical area. Two years after the surgery, the restoration was replaced due to aesthetic reasons and periapical radiograph showed success after 5 years of treatment. A correct diagnosis and establishment of an adequate treatment plan resulted in a successful management of the case.

Estrogen deficiency-associated bone loss in the maxilla: A methodology to quantify the changes in the maxillary intra-radicular alveolar bone in an ovariectomized rat osteoporosis model

The effects of estrogen deficiency on bone characteristics are site-dependent, with the most commonly studied sites being appendicular long bones (proximal femur and tibia) and axial bones (vertebra). The effect on the maxillary and mandibular bones is still inconsistent and requires further investigation. This study was designed to evaluate bone quality in the posterior maxilla of ovariectomized rats in order to validate this site as an appropriate model to study the effect of osteoporotic changes. Methods: Forty-eight 3-month-old female Sprague-Dawley rats were randomly divided into two groups: an ovariectomized group (OVX, n=24) and Sham-operated group (SHAM, n=24). Six rats were randomly sacrificed from both groups at time points 8, 12, 16 and 20 weeks. The samples from tibia and maxilla were collected for Micro CT and histological analysis. For the maxilla, the volume of interest (VOI) area focused on the furcation areas of the first and second molar. Trabecular bone volume fraction (BV/TV, %), trabecular thickness (Tb.Th.), trabecular number (Tb.N.), trabecular separation (Tb.Sp.), and connectivity density (Conn.Dens) were analysed after Micro CT scanning. Results: At 8 weeks the indices BV/TV, Tb.Sp, Tb.N and Conn.Dens showed significant differences (P<0.05) between the OVX and SHAM groups in the tibia. Compared with the tibia, the maxilla developed osteoporosis at a later stage, with significant changes in maxillary bone density only occurring after 12 weeks. Compared with the SHAM group, both the first and second molars of the OVX group showed significantly decreased BV/TV values from 12 weeks, and these changes were sustained through 16 and 20 weeks. For Tb.Sp, there were significant increases in bone values for the OVX group compared with the SHAM group at 12, 16 and 20 weeks. Histological changes were highly consistent with Micro CT results. Conclusion: This study established a method to quantify the changes of intra-radicular alveolar bone in the posterior maxilla in an accepted rat osteoporosis model. The degree of the osteoporotic changes to trabecular bone architecture is site-dependent and at least 3 months are required for the osteoporotic effects to be apparent in the posterior maxilla following rat OVX.

Evaluación de tres sistemas de labranza (cero, mínima y convencional) sobre la pudrición radicular del frijol común (Phaseolus vulgaris L.) causada por Sclerotium rolfsii, su rendimiento y valoración económica

Con los objetivos de evaluar el efecto de los tres sistemas de labranza sobre el comportamiento de la enfermedad producida por Sclerotium rolfsii Sacc. y determinar cuál de los tres sistemas de labranza (cero, mínima y convencional) es económicamente más rentable para producir frijol, se llevó a efecto un estudio en la estación experimental La Compañía ubicada en el municipio de San Marcos, departamento de Carazo. El experimento fue establecido en época de primera (mayo-agosto) y postrera (septiembre -diciembre). El diseño utilizado fue bloques completos al azar (SCA) con tres tratamientos y cuatro repeticiones. Se tomaron datos sobre el número de plantas emergidas, incidencia de las enfermedades de la raíz, número de plantas a la cosecha, número de vainas por planta, peso de 1,000 semillas y también datos sobre los costos agrícolas de cada uno de los tratamientos y sus respectivos rendimientos. A los datos agronómicos se les realizó un análisis económico. Los resultados mostraron que en época de primera el mejor sistema de labranza para el cultivo del frijol, basándose en mejores rendimientos físicos y económicos resultó ser labranza mínima en comparación con labranza convencional; así mismo sucedió en postrera resultando ser, labranza mínima mejor que labranza cero Y convencional.

Determinación de la actividad radicular del Lima tahiti citrus aurantifolia (christm,) swing, mediante la variación de almacenamiento del agua del suelo, utilizando técnicas nucleares

Con el objetivo de determinar la actividad radicular y el patrón de distribución de las raíces activas del lima Tahití Citrus aurantifolia (Christm.) Swing., mediante la variación de almacenamiento de agua del suelo utilizando técnicas nucleares, se condujo un experimento en la finca San Bernardo, municipio de Masatepe, Departamento de Masaya. Se escogieron plantas de la misma edad, pureza varietal, características vegetativas uniformes y se establecieron en cada unidad experimental 4 tratamientos (50, 100, 150,200 cm de distancia del tronco), por 2 repeticiones para un total de 16 observaciones y se cubrió con plástico de polietileno negro en un área de 19.63 m2 que corresponde a un circulo de radio igual a 250 cm del tronco a cada árbol. En la época seca se tomaron lecturas, y la información obtenida y analizada permite concluir que en árboles de limón Tahití de 6 años de edad, y en las condiciones edafoclimáticas y de manejo del cultivo en que se llevó el experimento, presenta su actividad radicular directamente proporcional a las distancias horizontales del tronco del árbol, mediante el consumo total de agua en el volumen de suelo (O - 90 cm de profundidad), y a la vez directamente proporcional cada 30 cm de profundidad para un perfil de suelo de (O - 90 cm de profundidad), lo que indica presencia de un sistema radicular extenso y profundo.

Estudio de tratamientos en semilla de Teocintle anual de Nicaragua (Zea nicaraguensis Iltis y Benz) recolectada en diferentes momentos, comportamiento radicular en dos sustratos en etapa de crecimiento

El teocintle anual de Nicaragua (Zea nicaragüensis Iltis & Benz), es una especie silvestre endémica de Nicaragua, y pariente muy cercano del maíz, sus semillas presentan un alto porcentaje de latencia, por lo que los estudios fuera de su hábitat natural son escasos. Tomando en consideración esta limitante, en el área experimental del Programa Recursos Genéticos Nicaragüenses (REGEN) se estableció un estudio en laboratorio y canteros para identificar tratamientos que inhibieran en un mayor porcentaje la latencia de la semilla. El experimento se agrupó en dos fases: Fase I (ensayo de germinación), Fase II ensayo de la evaluación de los sustratos para medir el crecimiento del (sistema radicular). El diseño empleado para ambas fases fue un Diseño Completo al Azar (DCA) en un arreglo bifactorial con cuatro repeticiones. En la Fase I se evaluaron fechas de recolección de semillas (1991, 1992, 2005 y 2006), y tratamientos para inhibir latencia (ácido giberélico, un testigo, agua oxigenada al 20% y agua oxigenada al 50%. En la Fase II, se evaluó el período de recolección de semillas (1991-1992 y 2005-2006) y sustratos (50% arena + 50% tierra y 100% lombrihumus) sobre variables de crecimiento y del (sistema radicular). Se realizó un análisis de varianza (ANDEVA) y separación de medias por Duncan (a=0.05). El ANDEVA determinó efecto significativo en los factores evaluados e interacción para los dos ensayos. Los resultados obtenidos mostraron que en la Fase I el tratamiento agua oxigenada al 50% presentó un mayor número de semillas germinadas, y se encontró que las semillas de teocintle con un mayor período de envejecimiento mostraron los más altos valores de germinación. De igual manera, los pesos secos provenientes de los tallos de plantas jóvenes, así como las raíces de las mismas, presentaron los mayores valores promedios en peso.

Evaluación de pentacloronitrobenceno (PCNB) en el control de la pudrición radicular causada por Rhizoctonia solani kuhn en frijol común (Phaseolus vulgaris L.)

Este experimento fue conducido en La Compañía, Estación Experimental del Instituto Superior de Ciencias Agropecuarias (ISCA), ubicado en el departamento de Carazo, Nicaragua, Fue realizado en época de primera (junio a septiembre), 1987), con los siguientes objetivos: Determinar la dosis más adecuada de PCNB contra R solani en frijol. Evaluar el efecto de la mezcla de PCNB + Metalaxyl sobre el rendimiento del frijol. Determinar el porcentaje de pérdidas causadas por R. Solani en frijol. Seleccionar la mejor variedad de frijol en este experimento. Los resultados mostraron que la dosis de 6.81kg/ha de PCNB fue la mejor produciendo un rendimiento de 3. % más que el control y un 12% más que la mayor dosis de PCNB usada (11.36 kg/ha) la variedad Revolución 84 produjo el más alto rendimiento.