Conservative treatment of patients with periapical lesions associated with extraoral sinus tracts

Abstract

This paper describes the clinical courses of three cases with extra-oral sinus tract formation, from diagnosis and treatment to short-term follow-up and evaluation. All teeth involved had periradicular radiolucent areas noted on radiographic examination and extra-oral sinus tracts appearing on the chin with exudation and unpleasant aesthetic appearance. The adopted treatment protocol included treating the sinus tract surface simultaneously with the root canal therapy. After root canal shaping using 5.25% sodium hypochlorite solution, calcium hydroxide-based pastes associated with different vehicles were inserted into the root canal for 4 months, and were changed monthly. All the sinus tracts healed in 7 to 10 days. The apical lesions were completely repaired in a maximum period of 24 months. The treatment adopted provided a complete healing of the periapical lesions in a short follow-up period. Surgical repair of the cutaneous sinus tract was therefore unnecessary.

Extraoral tumor-like granuloma as a symptom of dental infection: A case report

“…[5,10] Infection in a tooth leads to a necrotic pulp and periapical infection may develop more acutely into an abscess (either submucosal or subcutaneous) or may take a more chronic course with development of a fistula (sinus tract) through which pus may drain. [6,7] In this case the symptoms are less severe and the disease course may be prolonged over many months. A dental fistula will often appear on the oral mucosa, and more uncommonly on the skin.…”

“…[1][2][3][4][5][6][7][8][9][10][11] Cutaneous fistulas may look like a tumor or granuloma and therefore can be mistaken initially for furuncle, bacterial infection of a sebaceous gland, carcinoma, pyogenic granuloma, congenital fistulae, tuberculosis or other granulomatous lesions. [1][2][3][4][5][6][7][8][9][10][11] It is important that the oral surgeon/dentist and physician interact in order to avoid unnecessary, ineffective or inappropriate treatment. Approximately half of the patients with cutaneous fistula are often misdiagnosed.…”

“…[8] The sinuses are most common seen in the submandibular and submental region. [2,5,7,9,10] Diagnosis of a dental origin includes medical history, clinical examination and radiographic examinations (panoramic radiographs, periapical radiographs and/or Cone Beam Tomography (CBT)). [9] The clinical findings of necrotic pulp can be verified by a negative electronic pulp test of the affected tooth.…”

Treatment of an extraoral cutaneous sinus tract with endodontic intervention: a case report

“…In advanced stages, radiographic analysis may reveal bone resorption. [5,6] In a clinical study, Gupta & Hasselgren [7] analyzed teeth in terms of dental periradicular inflammation and sinus tract formation. They indicated that; sinus tracts of endodontic origin are most commonly found in the intraoral region.…”

Diagnosis and treatment of odontogenic cutaneous sinus tracts of endodontic origin: A case report

“…Thus, the clinician should direct special attention to oral clinical conditions such as caries, deficient restorations and also periodontal conditions (Cantore et al 2002). As a tooth with a necrotic pulp can have a normal appearance or present only slight alterations in its color, radiographic analysis can be used to show bone loss in the apex of the infected tooth, contributing to the diagnosis (Soares et al 2007). In the clinical case described here, the radiographs clearly revealed furcal radiolucency associated with a suspected tooth that did not respond to pulp sensibility tests.…”