In the present study, a conservative approach for removal of a fractured instrument located at the apical root area of maxillary left central incisor of a 35 years old male was performed and the clinical outcome was evaluated. On clinical examination, localized swelling associated with discharge of pus was seen near to the affected tooth. Furthermore, the tooth was restored with temporary filling and it was severely discolored. On radiographic examination, a radiolucent area around the apex was seen and there was a fractured instrument at the apex of the tooth. Tooth was then treated as nonsurgical endodontic technique and an attempt to remove the fractured instrument was undertaken. The results confirms that fractured instrument was successfully removed by using the File Braiding technique and after 3 months follow up, the tooth was asymptomatic and radiograph shows complete healing of the periapical lesion.DOI: http://dx.doi.org/10.3329/updcj.v2i1.13957 Update Dent. Coll. j: 2012; 2 (1): 25-30
Background: Extended endonasal solo endoscopic approach for the non-pituitary lesions of the sellar and suprasellar regions are not new in the field of neurosurgery. Following endoscopic surgical approach of the pituitary adenoma, endoscopic neurosurgeon is eager to develop the skill for non-pituitary sellar & suprasellar lesions. Common sellar & suprasellar lesions are pituitary adenoma, craniopharyngioma, tuberculumselle meningioma and suprasellar germinoma. Objective: Traditional transsphenoidal approach gives exposure to the pituitary fossa, whereas extended approach provides exposure to the optic nerve, chiasm, acom complex and basal frontal lobe ,mammillary body, mid brain and laterally to the cavernous sinuses. Material & method: From November 2007 to March 2012, 12 cases of done by extended endonasal solo endoscopic approach among 12 cases of craniopharyngiomas. Patient’s history, clinical findings, pre-operative and post-operative visual acuity, visual field and radiological data were collected and analyzed. All patients underwent solo endoscopic extended transsphenoidal approach with or without nasoseptal flap technique for closure. Most of the patients were given lumbar drain as a treatment for CSF leak. Result: All patients were of age group of 10 to 60 years. Male were 8 (66.67%), female were 4 (33.33%) in number. Gross total removals were done in 7 cases out of 12 (58.33%) craniopharyngiomas and subtotal removal done in 5 (41.67%) cases. Visual acuity and field of vision were improved in all cases of craniopharyngiomas. One case (8.33%) of craniopharyngioma had prolong period of unconsciousness probably from hypothalamic disturbance. CSF leak developed in 2 (16.67%) cases. Patients with craniopharyngioma were required thyroxin and cortisol for replacement. Permanent diabetes insipidus developed in 5 cases (41.67%). Three patients required permanent CSF diversion via a ventriculoperitoneal shunt after documentation of postoperative HCP. There was one case of chemical meningitis, and two cases confirmed bacterial infections. Craniopharyngioma can be successfully resected via a purely endoscopic, endonasal approach. Craniopharyngioma have a higher rate of perioperative hydrocephalus and postoperative CSF leak compared with other tumor types in the same area. Conclusion: Extended transsphenoidal approach is an excellent alternative of skull base approach for the removal of most of the craniopharyngioma.The endoscopic endonasal route provides a good exposure, especially of the sub-chiasmatic and retro-chiasmatic areas, as well as of the stalk– infundibulum axis and the third ventricle chamber. It gives better visualization, improved postoperative visual outcome for less manipulation and low complication then craniotomy. However CSF leak and diabetes insipidus is common known complications which have to be manage promptly and appropriately. Bangladesh Journal of Neuroscience 2013; Vol. 29 (2) : 108-114
This case report describes the Indirect Pulp Treatment (IPT) of deep carious lesion in a permanent molar with Ledemix. A 18 years old male patient reported discomfort associated with thermal stimulation on the mandibular right first permanent molar. Radiographically revealed a deep buccal carious lesion, very close to the pulp. periapical radiolucency and periodontal space thickening was absent. Pulp sensitivity was confirmed by thermal pulp vitality tests. Based on the main complaint and the clinical and radiographic examinations, the treatment plan was established to preserve pulp vitality. Clinical procedures consisted of removing the infected dentin and lining the caries-affected dentin with ledermix cement, the tooth was restored with composite cement. After 12 month followup, no clinical or radiographic pathological findings were found.
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