Conservative management of lateral canal biofilm-related persistent intraoral sinus and other complications in traumatized, immature incisors: A case report with 30 months’ follow-up

Divya S Sharma¹ image, Zeba Ambreen2 image

Highlights

Lateral canals can retain bacteria even after cleaning the main canal, thus causing persistent or recurrent intraoral sinus. Disinfecting the entire root canal systemis crucial to prevent endodontic failure.

This case report suggests re-evaluating diagnosis and treatment steps for cases with persistent intraoral sinus and long-standing periradicular pathology in traumatized teeth.

This report emphasizes the need to clean lateral canals and introduces a new technique using a custom viscous dressing that penetrates lateral canals, enhancing endodontic therapy.

Abstract

Conservative or regenerative endodontic treatments are the preferred approaches for managing traumatized (vital or necrotic) immature permanent teeth in growing patients. Diagnosing pulp vitality preoperatively using sensitivity tests can be challenging, especially if multiple teeth are traumatized, potentially leading to the failure of the chosen endodontic treatment. Unexpected complications, such as persistent intraoral sinus related to the lateral canal (often not visible on conventional radiographs) and delayed periradicular bone healing, may also arise. This case report presents the successful conservative management of three traumatized incisors with such complications. A novel intracanal dressing method was used to treat a persistent intraoral sinus related to the lateral canal in the permanent maxillary left central incisor, which was unresponsive to traditional dressing materials and methods, thereby avoiding surgery or extraction. Additionally, delayed bone healing in response to revascularization treatment in the permanent maxillary right central incisor, and the initially involved vital permanent maxillary right lateral incisor, was addressed with re-revascularization and root canal treatment, respectively. This article discusses tailored management strategies and possible reasons for associated complications in traumatized teeth. It emphasizes the importance of high-quality radiographic images, pulp vitality tests based on blood oxygenation, understanding the presence of biofilm in lateral canals, modified dressing methods, appropriate dressing vehicles, and the necessity of patience in treating traumatic dental injuries.

Keywords: Biofilm; Conservative Management; Pediatric Dentistry; Root Canal Medicaments; Teeth Injuries

Author Affiliations

  1. Professor, Department of Pediatric and Preventive Dentistry, Aligarh Muslim University, India (Correspondence:drdivyassharma@gmail.com)
  2. Junior Resident, Department of Pediatric and Preventive Dentistry, Aligarh Muslim University, India
  1. Artaza L, F Campello A, Soimu G, Alves FRF, Rôças IN, Siqueira JF Jr. Clinical and radiographic outcome of the root canal treatment of infected teeth with associated sinus tract: A retrospective study. Aust Endod J 2021;47:599-607
  2. Ricucci D, Siqueira JF Jr. Fate of the tissue in lateral canals and apical ramifications in response to pathologic conditions and treatment procedures. J Endod 2010;36:1-15
  3. Ahmed HM, Hashem AA. Accessory roots and root canals in human anterior teeth: a review and clinical considerations. Int Endod J 2016;49:724-736
  4. Sharma R, Cheema RK. Healing of recurrent sinus tract after retrograde endodontic treatment of an associated lateral canal. Endodontology. 2016;28:179-182
  5. Nagendrababu V, Chong BS, McCabe P, Shah PK, Priya E, Jayaraman J et al. PRICE 2020 guidelines for reporting case reports in Endodontics: a consensus-based development. Int Endod J 2020;53:619-626
  6. Verma R, Sharma DS, Pathak AK. Antibacterial Efficacy of Pastes Against E Faecalis in Primary Root Dentin: A Confocal Microscope Study. J Clin Pediatr Dent 2015;39:247-254
  7. Chen MY, Chen KL, Chen CA, Tayebaty F, Rosenberg PA, Lin LM. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J 2012;45:294-305
  8. Mathew VB, Madhusudhana K, Sivakumar N, Venugopal T, Reddy RK. Anti-microbial efficiency of silver diamine fluoride as an endodontic medicament – An ex vivo study. Contemp Clin Dent 2012;3:262-274
  9. Shah N, Logani A, Bhaskar U, Aggarwal V. Efficacy of revascularization to induce apexification/apexogensis in infected, nonvital, immature teeth: a pilot clinical study. J Endod. 2008;34:919-925
  10. Handal T, Caugant DA, Olsen I, Sunde PT. Bacterial diversity in persistent periapical lesions on root-filled teeth. J Oral Microbiol 2009;21:1-10
  11. Chaudhari Dv, Shashikiran N, Maurya A, Gugwad S, Gaonkar N, Taur S, Hadakar S. Comparative Evaluation of Antimicrobial Efficacy of Sodium Hypochlorite, Silver Diamine Fluoride Fluoride, Chitosan and Bioactive Glass Nanoparticles as Root Canal Irrigants against the Bacterial Strain of Enterococcus Faecalis-An In Vitro Study. J Clin Diagn Res 20201;14:22-26
  12. Maru V, Padawe D, Naik S, Takate V, Sarjerao Dighe K, Mali S. Assessment of Bacterial Load Using 3.8% SDF as an Irrigant in Pulpectomized Primary Molars: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15:47-51
  13. Briseño-Marroquín B, Ismael Y, Callaway A, Tennert C, Wolf TG. Antibacterial effect of silver diamine fluoride and potassium iodide against E. faecalis, A. naeslundii and P. micra. BMC Oral Health 2021;21:1-7
  14. Minavi B, Youssefi A, Quock R, Letra A, Silva R, Kirkpatrick TC, Tribble G, van der Hoeven R. Evaluating the substantivity of silver diamine fluoride in a dentin model. Clin Exp Dent Res 2021;7:628-633
  15. Moheb, Hesham; Zakeer, Samira1; Hassan, Hayam Y. Effect of different intracanal medicaments on eradication of Enterococcus faecalis biofilm – Ex vivo study. Saudi Endod J 2023;13:254-262
  16. Pallotta RC, Machado ME, Reis NS, Martins GH, Nabeshima CK. Tissue inflammatory response to implantation of calcium hydroxide and iodoform in the back of rats. Revista Odonto Ciência 2010;25:59-64
  17. Sharma DS, Chauhan SP, Kulkarni VK, Bhusari C, Verma R. Accidental periapical extrusion of non-setting calcium hydroxide: unusual bone response and management. J Indian Soc Pedod Prev Dent 2014;32:63-67
  18. Kuga MC, Tanomaru-Filho M, Faria G, Só MV, Galletti T, Bavello JR. Calcium hydroxide intracanal dressing removal with different rotary instruments and irrigating solutions: a scanning electron microscopy study. Braz Dent J 2010;21:310-314
  19. Nair PN. On the causes of persistent apical periodontitis: a review. Int Endod J 2006;39:249-281
  20. Manoharan L, Brundin M, Rakhimova O, Chávez de Paz L, Romani Vestman N. New Insights into the Microbial Profiles of Infected Root Canals in Traumatized Teeth. J Clin Med 2020;9:3877

 

Article Info

Contemp Pediatr Dent 2024:5(1):43-52

Received: 27 January 2024

Accepted: 21 March 2024

Online First: 01 April 2024

DOI: 10.51463/cpd.2024.2

223 views

Full Text

Attachments

Attachments

File Downloads
pdf CPD_2024_2 573

How to Cite 

				
					Divya S Sharma, Zeba Ambreen. Conservative management of lateral canal biofilm-related persistent intraoral sinus and other complications in traumatized, immature incisors: A case report with 30 months’ follow-up. Contemp Pediatr Dent 2024:5(1):43-52.

Related Articles

Share Article

Under a Creative Commons license
Tagged , ,