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Dental India Newsletter dated  2nd October 2005... Choice of 22000 dentists
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This week
Amalgam bond - Question & Answer
Root canal therapy of an acute cystic apical periodontitis - Part 4 - Part 1 - Part 2 -Part 3
A Case Study:  courtesy DougR - ROOTS
Dentigerous Cysts Presenting As Head And Neck Infections
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The opinions and photographs within this newsletters are not ours. Authors have been credited for the individual posts where they are.

Question: I am really becoming confused about the names of certain products? It's irritating because it seems like once I figure out which product it is I like, the company changes the name. Why?

Col Charlton: You are certainly correct about the frequency with which the brand names of dental materials can change. Here are a few examples: Vitrabond (3M ESPE) was changed to Vitrebond, Fuji Duet Cement (GC America) was changed to Fuji Plus, and Vitremer Luting Cement (3M ESPE) was changed to RelyX. Some changes are made for legal reasons, while others occur in order to associate a product with a larger product line. While some names change completely, others are only modified, which can also cause confusion. For example, Dyract was changed Dyract AP, Compoglass to Compoglass F, Photac-Fil to Photac-Fil Quick, and Fuji II LC to Fuji II LC Improved. Most often these changes are made to indicate a purported improvement that the manufacturer has made to the original version of the product. The bottom line is that too many products have names that are too similar and the frequency with which product names are modified or completely changed adds to the confusion. There isn't a lot that we as individuals can do to prevent name changes other than let the manufacturers know that the practice can cause confusion. The hybrid resin/glass-ionomer products represent some of the most rapidly materials in dentistry, so they seem to be prone to name changes.

Root canal therapy of an acute cystic apical periodontitis

9. Xray confirmation of the gauging procedure. The obturation was performed using an adhesive procedure. Guttapercha cones were replaced by Resilon (Resilon Research), the sealer beeing a dual cured Methacrylat RealSeal-SybronEndo) and the adhesion process was enhenced by the use of a 6th genaration bonding (SybronEndo). The adhesive root canal obturation procedure will be topic of a future column.


10. Direct view of themaster cones in place. Note the orange filter to avoid premature polymerisation of the sealer by the Xenon light of the microscope. The condensation procedure applied used rotary files and was performed ad modum “thermomechanical”. The mentione condensation procedure will be topic of a future column.

To be continued......

A Case Study:  courtesy DougR - ROOTS

Twenty-eight y.o. F saw dentist for endo #31 two weeks ago; presumably vital at that time. Diagnosis is NEVER mentioned in the referral, a sore point with the endodudes...At any rate, there was, fortunately, relatively straight line access to the file lodged in the ML canal. It was screwed in so I wound up blasting through all but the apical 3 mm which then wound out. Good joss all around. Schilder, KS-EWT, WV, orifices closed with FUJI II GIC. DougR   Click here for images

Dentigerous Cysts Presenting As Head And Neck Infections

Otolaryngologists Joseph L. Smith, II MD and Robert M. Kellman MD will present the findings of their research into dental cysts at the 109th Annual Meeting of the American Academy of Otolaryngology next week. Here's a sneak preview of their findings

Dentigerous cysts, or those arising from teeth, are benign, associated with the crowns of permanent teeth, usually involving impacted, unerupted teeth. In 75 percent of all cases, they are located in the mandible. The mandibular third molar and maxillary canine are involved most frequently. Dentigerous cysts are the second most common odontogenic cysts after those related to the roots of the teeth. They usually present in the second or third decade of life and are rarely seen in childhood. Dentigerous cysts are usually solitary, with multiple cysts reported on occasion in association with syndromes such as mucopolysaccharidosis and basal cell nevus syndrome.

Typically, dentigerous cysts are painless, considered sterile, but may cause facial swelling and delayed tooth eruption. However, head and neck specialists have recently encountered several cases of dentigerous cysts presenting as recurrent head and neck infections or as a deep neck space abscess. A literature review revealed three cases of submasseteric abscess caused by dentigerous cysts and one case of superior orbital fissure syndrome caused by an infected maxillary dentigerous cyst, all reported in the dental literature.

As this is an ill-defined presentation for these cysts and is underreported, especially in the otolaryngologic literature, the otolaryngologists undertook an extensive chart review spanning thirty years in an effort to better delineate this unusual presentation. Their findings are available in the study, ‘Dentigerous Cysts Presenting as Head and Neck Infections’ by Joseph L. Smith, II MD, and Robert M. Kellman MD, both from the Department of Otolaryngology and Communication Sciences, Upstate Medical University, Syracuse, NY.

A retrospective chart review from 1975 to 2004 was conducted at a tertiary care center. All charts with an admitting diagnosis of head and neck infection, deep neck space infection (including submasseteric space abscess, retropharyngeal space abscess, and parapharyngeal space abscess) were reviewed. Charts of patients with a diagnosis of dentigerous cyst were reviewed as well. Of the 327 charts reviewed, seven patients were identified who had dentigerous cysts that presented as head and neck infections. From these seven charts, information was obtained. The researchers recorded the patient's age, abscess/infection site, cyst site, presenting white blood cell (WBC) count, culture results, medical and surgical treatment, and length of hospital stay. These results were then compared to previously reported data for these cysts.

Of the 327 charts of patients with head and neck infections reviewed, seven cases were identified in which a dentigerous cyst was the underlying etiology, for an incidence of 2.1 percent. The average age for these patients was 46 years with the range spanning from 29 to 65. The most common infection was located in the buccal space. Of these seven cases, six had had previous infections at the same location. The most common cyst site was the ramus of the mandible with the cyst involving an unerupted third molar. All of these cysts were diagnosed by computed tomography (CT) scanning. The average white blood count (WBC) on presentation was 12.0 x 103 with a range of 4.3 x 103 to 23.9 x 103. The most common definitive management of the cysts was enucleation, or removal without structure. For the one case with an extensive abscess associated with it, incision and drainage of the abscess was the first procedure with subsequent enucleation of the cyst once the infection had resolved. All patients were treated with antibiotics prior to surgery. Only one patient required multiple surgical procedures due to recurrence of the cyst. The average length of hospital stay was six days with a range of one to 29 days; the median length of stay was four days. Cultures taken grew H. influenzae, S. pyogenes, and oral flora.

Head and neck infections are not the most common presentation of dentigerous cysts. However, the researchers found that 2.1 percent of head and neck infections serious enough to warrant hospital admission at their institution were due to dentigerous cysts, which is more frequent than expected. Therefore, dentigerous cysts need to be considered as a possible underlying cause when treating head and neck infections.

They therefore recommend that unless there is an obvious source of infection, a CT scan should be part of the work up of recurrent head and neck infections as well as those that are serious enough to warrant hospital admission. If a cyst is revealed on radiological imaging, initial treatment is aimed at resolving the infection. Antibiotic coverage should be broad enough to cover typical head and neck infections; coverage can be adjusted as needed based on culture results. Definitive treatment of the cyst should follow resolution of the infection. Since these cysts can reoccur, patients should be followed with annual radiologic studies. For surveillance, panorex or plain films are adequate. Patients with head and neck infections are often referred to otolaryngologists. It is therefore important to be familiar with dentigerous cysts as a possible etiology of these infections.

Wanted immediately - Full time female dentist for Multispeciality Dental Office at Andheri, Mumbai. Contact Dr Anil Arora or call 022 26744509 / 26743641

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