1/7. Unhealed extraction sites mimicking TMJ pain. A case of unhealed extraction sites in the mandible is described, including clinical, radiographic, and biopsy findings. The subject was treated for TMJ disease in the past but still had related signs and symptoms and facial pain. ( info) |
| This article presents the case of a 46-year-old vegetarian who had a painful dry socket in the left third molar areas. Since the patient's general appraisal was anaemic, investigations for haematological status, folic acid and vitamin B12 were performed. The results revealed that the patient was severely iron deficient and slightly vitamin B12 deficient. ( info) |
3/7. tooth exfoliation and necrosis of the crestal bone caused by the use of formocresol. A 68-year-old woman received a formocresol pulpectomy of the right lower lateral incisor. The temporary restoration was lost within hours. The next day, the patient suffered continuous pain, the gingiva sloughed, and the alveolar bone was exposed. Four days after treatment, the patient complained of moderate pain. Six days after the pulpectomy, the tooth spontaneously exfoliated. At this time she was referred to our hospital. The clinical diagnosis was chronic alveolitis. Treatment consisted of irrigation of the area. Three weeks after the pulpectomy, the dull pain had subsided, but the alveolar bone of the area showed increased mobility. Five weeks after the pulpectomy, the mobility of the alveolar bone was more significant and a sequestrectomy was performed with the patient under local anesthesia. The sequestrum of necrotic bone was approximately 10 x 5 x 5 mm in size. The patient has been symptom-free for 2 years since the sequestrectomy. ( info) |
4/7. IMZ implants placed into extraction sockets in association with membrane therapy (Gengiflex) and porous hydroxyapatite: a case report. A buccal plate destroyed by the inflammatory process as a result of a longitudinal root fracture was completely restored by the combined use of an IMZ implant placed in the alveolus of the fractured maxillary central incisor and the principles of guided tissue regeneration. A Gengiflex membrane was used to cover the implant, and porous hydroxyapatite was used as grafting material. At the 6-month reentry, the defect around the implant was completely filled by mineralized tissue. ( info) |
| Chronic osteomyelitis is a devastating disease of unknown etiology. The primary cause is usually thought to be microbiological. The diagnosis of osteomyelitis of the mandible is arduous, particularly in the early stages, and this disease is almost always difficult to cure. Clinical symptoms, radiographic changes and histologic findings are characteristic of this disease. Treatment modalities have been directed toward eradicating microbes and improving circulation, in the early stages. In the case presented, surgical debridement and IV antibiotics were the treatment of choice. The bone biopsy histopathology report in this case, revealed normal bone, which was inconsistent with chronic osteomyelitis. This article delves into the literature providing history and current research trends in the diagnosis, treatment and follow up care for chronic osteomyelitis. ( info) |
6/7. Skeletal lesions in palmar-plantar pustulosis. In four women low-grade spondylitis-arthritis-osteitis coincided with palmar-plantar pustulosis. Both conditions are believed to be aseptic and part of a common immuno-defect reaction. ( info) |
7/7. Exogenous estrogen may exacerbate thrombophilia, impair bone healing and contribute to development of chronic facial pain. A 32 year old white female, in apparently good health, failed to respond to conservative wound care for alveolar osteitis after a routine mandibular first molar extraction. curettage and biopsy of necrotic alveolar bone from the #30 socket escalated her pain such that hospitalization was necessary for pain management with intravenous morphine. Twelve months prior to admission she had been placed on exogenous estrogen (Premarin, 0.625 mg/day) after a partial oophorectomy. While hospitalized, she was found to have resistance to activated protein c (APCR). Premarin was discontinued. After discharge, weekly changes of an antibiotic impregnated dressing allowed for progressive regeneration of bone and epithelium with gradual reduction in her pain. She was found to be heterozygous for the mutant factor v Leiden, a heritable factor for increased tendency to form thrombi, so-called thrombophilia. We speculate that the exogenous estrogen administration exacerbated the thrombophilia associated with the factor v Leiden mutation by compounding the patient's resistance to activated protein c thereby contributing to her development of osteonecrosis and severe alveolar neuralgia. ( info) |