根尖分叉引起的根尖周围囊肿的显微根尖手术:1例报告及文献复习。

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Liyun Bai, Na Hu, Qin Yang, Dongquan Pu, Xiaoqian Feng, Yiyun Yue, Weiwei Xiao, Rui Liu, Li Liu, Xia Zhou
{"title":"根尖分叉引起的根尖周围囊肿的显微根尖手术:1例报告及文献复习。","authors":"Liyun Bai, Na Hu, Qin Yang, Dongquan Pu, Xiaoqian Feng, Yiyun Yue, Weiwei Xiao, Rui Liu, Li Liu, Xia Zhou","doi":"10.1186/s13256-025-05234-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The destruction of tooth apical bone mainly comes from odontogenic apical cysts caused by pulp necrosis, chronic inflammation, or trauma. Some affected teeth can be cured by modern root canal treatment or non-surgical retreatment, but some affected teeth do not heal after treatment. Apical surgery should be considered when root canal therapy has failed, root canal retreatment through the crown channel is difficult, or true cysts are present. This article explores the use of microapical surgery to treat a periapical cyst caused by apical ramification, emphasizing a minimal surgical approach for this lesion.</p><p><strong>Case presentation: </strong>A 47-year-old female (Han nationality) presented with a chief complaint of recurrent buccal mucosal fistula in their maxillary posterior teeth for 1 year. Clinical examination revealed a porcelain-fused-metal crown of the maxilla of the left second premolar (tooth 25) and buccal mucosa fistula. X-ray assessment showed a high-density shadow in the root canal and low-density transmission from the root apex to the middle third of distal root surface. Microscopic apical surgery was performed under local anesthesia. The apical ramification was exposed and a root apex of 3 mm was cut off. Then the apical foramen of buccal root canal, palatal root canal, and apical ramification were filled retrogradely with mineral trioxide aggregate, and finally sewn up. Follow-up X-ray at postoperative 12 months and 24 months showed that the bone density of the root apex and distal root surface was higher compared with the values measured immediately after operation. There were no clinical symptoms, and normal mucosa.</p><p><strong>Conclusion: </strong>The patient presented with a recurrent buccal mucosal fistula in the maxillary left second premolar. Microscopic apical surgery was performed under local anesthesia. After minimally invasive surgery, apical resection, inverted preparation, and mineral trioxide aggregate treatment, at postoperative 24 months, the outcome was satisfactory, with recovered apical bone, normal mucosa, and no clinical symptoms. For periapical cysts, X-ray and cone-beam computed tomography images should be read carefully before the operation. The semicircular low-density transmission image around the apical sidewall indicates the apical ramification, and that root canal treatment or microapical surgery should be performed. The operating microscope enhances visibility and provides the surgeon with a better understanding of canal anatomy, a better surgical view, and the ability to undertake more complex but predictable apical resection techniques.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"19 1","pages":"249"},"PeriodicalIF":0.9000,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100992/pdf/","citationCount":"0","resultStr":"{\"title\":\"Microapical surgery of a periapical cyst caused by apical ramification: a case report and review of the literature.\",\"authors\":\"Liyun Bai, Na Hu, Qin Yang, Dongquan Pu, Xiaoqian Feng, Yiyun Yue, Weiwei Xiao, Rui Liu, Li Liu, Xia Zhou\",\"doi\":\"10.1186/s13256-025-05234-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The destruction of tooth apical bone mainly comes from odontogenic apical cysts caused by pulp necrosis, chronic inflammation, or trauma. Some affected teeth can be cured by modern root canal treatment or non-surgical retreatment, but some affected teeth do not heal after treatment. Apical surgery should be considered when root canal therapy has failed, root canal retreatment through the crown channel is difficult, or true cysts are present. This article explores the use of microapical surgery to treat a periapical cyst caused by apical ramification, emphasizing a minimal surgical approach for this lesion.</p><p><strong>Case presentation: </strong>A 47-year-old female (Han nationality) presented with a chief complaint of recurrent buccal mucosal fistula in their maxillary posterior teeth for 1 year. Clinical examination revealed a porcelain-fused-metal crown of the maxilla of the left second premolar (tooth 25) and buccal mucosa fistula. X-ray assessment showed a high-density shadow in the root canal and low-density transmission from the root apex to the middle third of distal root surface. Microscopic apical surgery was performed under local anesthesia. The apical ramification was exposed and a root apex of 3 mm was cut off. Then the apical foramen of buccal root canal, palatal root canal, and apical ramification were filled retrogradely with mineral trioxide aggregate, and finally sewn up. Follow-up X-ray at postoperative 12 months and 24 months showed that the bone density of the root apex and distal root surface was higher compared with the values measured immediately after operation. There were no clinical symptoms, and normal mucosa.</p><p><strong>Conclusion: </strong>The patient presented with a recurrent buccal mucosal fistula in the maxillary left second premolar. Microscopic apical surgery was performed under local anesthesia. After minimally invasive surgery, apical resection, inverted preparation, and mineral trioxide aggregate treatment, at postoperative 24 months, the outcome was satisfactory, with recovered apical bone, normal mucosa, and no clinical symptoms. For periapical cysts, X-ray and cone-beam computed tomography images should be read carefully before the operation. The semicircular low-density transmission image around the apical sidewall indicates the apical ramification, and that root canal treatment or microapical surgery should be performed. The operating microscope enhances visibility and provides the surgeon with a better understanding of canal anatomy, a better surgical view, and the ability to undertake more complex but predictable apical resection techniques.</p>\",\"PeriodicalId\":16236,\"journal\":{\"name\":\"Journal of Medical Case Reports\",\"volume\":\"19 1\",\"pages\":\"249\"},\"PeriodicalIF\":0.9000,\"publicationDate\":\"2025-05-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100992/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Medical Case Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1186/s13256-025-05234-x\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Medical Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s13256-025-05234-x","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

摘要

背景:牙根尖骨的破坏主要来自牙源性根尖囊肿,由牙髓坏死、慢性炎症或外伤引起。一些受影响的牙齿可以通过现代根管治疗或非手术再治疗治愈,但一些受影响的牙齿治疗后不愈合。当根管治疗失败,通过冠通道再根管治疗困难,或存在真囊肿时,应考虑进行根尖手术。这篇文章探讨了使用小根尖手术治疗根尖分叉引起的根尖周围囊肿,强调了对这种病变的最小手术方法。病例介绍:一名47岁汉族女性,以上颌后牙复发性口腔黏膜瘘1年为主诉。临床检查发现左第二前磨牙(第25齿)上颌骨有一烤瓷金属冠及颊黏膜瘘。x线检查显示根管内高密度阴影,根尖向远根面中间三分之一处低密度透射。显微根尖手术在局部麻醉下进行。露出根尖分枝,切断根尖3mm。然后用三氧化二矿骨料逆行填充颊根管根尖孔、腭根管根尖孔及根尖分枝,最后缝合。术后12个月和24个月随访x线显示,根尖和根远面骨密度高于术后即刻测量值。无临床症状,粘膜正常。结论:患者上颌左第二前磨牙口腔黏膜瘘复发。显微根尖手术在局部麻醉下进行。经微创手术、根尖切除、倒置准备、三氧化二矿骨料治疗,术后24个月疗效满意,根尖骨恢复,黏膜正常,无临床症状。对于根尖周围囊肿,术前应仔细阅读x线和锥束ct图像。根尖侧壁周围的半圆形低密度透射图像提示根尖分叉,需要进行根管治疗或根尖微手术。手术显微镜提高了可视性,为外科医生提供了对根管解剖的更好理解,更好的手术视野,以及进行更复杂但可预测的根尖切除技术的能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Microapical surgery of a periapical cyst caused by apical ramification: a case report and review of the literature.

Background: The destruction of tooth apical bone mainly comes from odontogenic apical cysts caused by pulp necrosis, chronic inflammation, or trauma. Some affected teeth can be cured by modern root canal treatment or non-surgical retreatment, but some affected teeth do not heal after treatment. Apical surgery should be considered when root canal therapy has failed, root canal retreatment through the crown channel is difficult, or true cysts are present. This article explores the use of microapical surgery to treat a periapical cyst caused by apical ramification, emphasizing a minimal surgical approach for this lesion.

Case presentation: A 47-year-old female (Han nationality) presented with a chief complaint of recurrent buccal mucosal fistula in their maxillary posterior teeth for 1 year. Clinical examination revealed a porcelain-fused-metal crown of the maxilla of the left second premolar (tooth 25) and buccal mucosa fistula. X-ray assessment showed a high-density shadow in the root canal and low-density transmission from the root apex to the middle third of distal root surface. Microscopic apical surgery was performed under local anesthesia. The apical ramification was exposed and a root apex of 3 mm was cut off. Then the apical foramen of buccal root canal, palatal root canal, and apical ramification were filled retrogradely with mineral trioxide aggregate, and finally sewn up. Follow-up X-ray at postoperative 12 months and 24 months showed that the bone density of the root apex and distal root surface was higher compared with the values measured immediately after operation. There were no clinical symptoms, and normal mucosa.

Conclusion: The patient presented with a recurrent buccal mucosal fistula in the maxillary left second premolar. Microscopic apical surgery was performed under local anesthesia. After minimally invasive surgery, apical resection, inverted preparation, and mineral trioxide aggregate treatment, at postoperative 24 months, the outcome was satisfactory, with recovered apical bone, normal mucosa, and no clinical symptoms. For periapical cysts, X-ray and cone-beam computed tomography images should be read carefully before the operation. The semicircular low-density transmission image around the apical sidewall indicates the apical ramification, and that root canal treatment or microapical surgery should be performed. The operating microscope enhances visibility and provides the surgeon with a better understanding of canal anatomy, a better surgical view, and the ability to undertake more complex but predictable apical resection techniques.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信