Root end resections play an important role in the success of periapical surgery. Beveling of the root end resections can vary significantly depending on the surgical technique, the root and canal morphology. The intention of this article was to clinically assess the root resections bevels and to estimate their relation to applied periapical surgeries. A prospective clinical study consisted of sixty periapical surgeries performed on teeth with chronic periapical lesions. Thirty periapical surgeries were performed in a conventional manner, while thirty were contemporary ultrasonic surgeries. Following the completion of strictly planned and performed intraoperative procedures, the resection bevels were assessed. To obtain the real bevel angles a compass was used. Root resections were significantly less beveled in all teeth operated with contemporary ultrasonic surgery, with mean values between 2.1° to 7.8°. The number of roots and their dilacerations didn't influence the root resection bevel. For comparison, root resections were significantly beveled in all conventionally operated teeth, with mean values of 46°. Due to the technical limitations of the conventional periapical surgery, mandibular premolars were exclusively operated with ultrasonic periapical surgery, with mean values of resection bevel not exceeding 20.7°. Significantly lesser resection bevel associated with ultrasonic periapical surgery contributes to root preservation and favorable surgical outcome.
Understanding the root anatomy and apical canal morphology of maxillary premolars is a key prerequisite for successful surgical and endodontic treatment. The aim of this study was to assess the root anatomy and apical canal morphology of maxillary first premolars. To achieve the set task, 30 maxillary first premolars were extracted. After thorough rinse visual assessment of root anatomy was made. Each root was transversally sectioned six millimeters from apex with a straight hand piece. The apical samples were decalcificated in 7.5% trichloroacetic acid, transversal sections were made, stored in 10% formalin then dyed in hematoxylin and eosin and numerated from I to VI. Apical canal morphology was evaluated with an optical microscope. Majority of maxillary first premolars had double roots (63.0%; n=19) that were mostly separated (50.0%; n=15) containing a single root canal. Minority had double roots that were fused (13.0%; n=4) with two root canals. Single root with almost equal occurrence of two, as well as variable root canal configuration were found in (30.0%; n=9). A very rare occurrence of maxillary first premolars with three roots (7.0%; n=2) was detected, two vestibular and one palatal, each containing a single canal configuration. Accessory lateral canals were detected in 20% of maxillary first premolars. Transversal communications were detected in maxillary premolars with one root and double fused roots (26.6%; n=8). A single apical foramen was detected in majority of maxillary first premolars (50.0%; n=15). Two apical foramina were detected in (33.4%; n=10), three in (10.0%; n=3) and four in (6.6%; n=2) maxillary premolars. Keywords: maxillary first premolar, root anatomy, apical canal morphology, decalcification, optical microscopy
Osteoid osteoma is an uncommon non odontogenic benign bone neoplasm that rarely occurs in the jaw bones.This article presents a rare case of osteoid osteoma in mandible mimicking a periapical inflammatory lesion. The patient reported without symptoms and in good general health. Intraorally, there was a swelling in the periapical region of the left mandibular first bicuspid. Vitality test was negative.Orthopantomography depicted a well defined unilocular periapical radiolucency incasing the apical third of the mandibular first bicuspid, with osteosclerotic rim on its distal prospect. Such clinical findings were appropriate for chronic periapical inflammatory lesion, so periapical surgery was scheduled.During surgery, apicoectomy was performed, the lesion removed and sent for histopathology. The result showed irregularly proliferated trabeculae with disrupted architecture and visible osteoid accumulations typical for osteoid osteoma. Periodic follow ups were scheduled. No recurrence was noted.Although rare, osteoid osteoma in mandible can mimic a periapical inflammatory lesion. Surgical removal and histology contributed to proper diagnostics. Complete surgical removal prevented recurrence.
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