Endo-perio lesions: diagnosis and interdisciplinary treatment options

AbstractAbout 50% of tooth loss is caused by either endodontic infection, periodontal disease or the combination of the two in the form on endo-perio lesions (EPL). Combined EPL develop due to the intimate anatomic and functional relation between endodontic and periodontal tissues. Both the pulp and periodontium share the same embryologic and anatomic origin. The various pathways connecting the two, added up to the extremely alike microorganisms in both illnesses’ etiology, create a complex condition in which interdisciplinary approach is required. Despite numerous decades of literature describing these lesions, they remain a continuous challenge for practitioners in both diagnosing and managing. The purpose of this article is to present a comprehensive review of various aspects of the combined EPL and to emphasize the importance of making a correct diagnosis and adopting the appropriate treatment method in the management of these challenging situations.

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Clinician-Patient Dialogue About Preventive Chronic Migraine Treatment

Journal of Primary Care & Community Health ◽

10.1177/2150132720959935 ◽

2020 ◽

Vol 11 ◽

pp. 215013272095993

Author(s):

Andrew M. Blumenfeld

Keyword(s):

Chronic Migraine ◽

Treatment Approach ◽

Treatment Options ◽

Correct Diagnosis ◽

Severe Form ◽

Migraine Treatment ◽

Appropriate Treatment ◽

The Individual ◽

Practical Recommendations

Many new medications for the treatment of migraine are now available on the market. In the current evolving migraine treatment landscape, an individualized treatment approach is needed. This review provides practical recommendations on how to obtain a correct diagnosis and then engage in a long-term partnership with patients with the most severe form of migraine: chronic migraine (CM). Given the need to effectively treat this complex neurological disease, clinicians in primary care, general neurologists, and headache specialists are at the forefront to ease the burden of this disease for their patients. This manuscript will review how to discuss the currently available treatment options to help control migraine attacks, manage expectations, and, together with the patient, determine the most effective and appropriate treatment. The goal is to create an environment where the clinician partners with the patient in shared decision-making to choose the most effective appropriate treatment for the individual patient.

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Jones Fractures in Sumo Wrestlers: Three Case Reports

Case Reports in Orthopedics ◽

10.1155/2019/9051327 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Takashi Hoshino ◽

Tomohiko Tateishi ◽

Tsuyoshi Nagase ◽

Arata Yuki ◽

Teruhiko Nakagawa ◽

...

Keyword(s):

Risk Factors ◽

Case Reports ◽

Treatment Options ◽

Treatment Compliance ◽

Treatment Method ◽

Delayed Union ◽

Duration Of Treatment ◽

Operative Case ◽

Appropriate Treatment ◽

And Training

Jones fractures sometimes occur in athletes and are known to have complications, such as nonunion, delayed union, and recurrence, even with treatment. We describe three cases of Jones fractures in sumo wrestlers with treatment-related difficulties. All patients discontinued treatment at their own discretion. The two conservative cases had nonunion or delayed union, and the operative case had a broken screw. However, all patients continued sumo wrestling, with little impact on their careers. The risk factors of Jones fractures in sumo wrestling may be heavy weight, and training or competition characteristics unique to sumo wrestling. In cases of a complete Jones fracture, operative treatment is most commonly selected, as the risk for nonunion or refractures is less than that for conservative treatment. However, in the case of sumo wrestlers, there are risks of infection and problems with treatment compliance. As taking a rest may result in a lowered rank, completing a sufficient duration of treatment is difficult. Treatment is difficult and controversial in sumo wrestlers; all three patients discontinued treatment of their own accord. These cases suggest that it is important to thoroughly inform sumo wrestlers of the treatment options, and to decide the most appropriate treatment method for each patient.

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Varying Outcomes among Patients with Large Angiomyolipomas according to the Treatment Method

Urologia Internationalis ◽

10.1159/000515990 ◽

2021 ◽

pp. 1-7

Author(s):

Myeong Chan Park ◽

Sejun Park ◽

Seong Cheol Kim ◽

Sungchan Park ◽

Kyung Hyun Moon ◽

...

Keyword(s):

Treatment Options ◽

Arterial Embolization ◽

Treatment Method ◽

Patient Demographics ◽

Appropriate Treatment ◽

Nephron Sparing ◽

The Mean ◽

Robotic Surgical System ◽

Surgical System ◽

Average Tumor Size

Purpose: This study aimed to evaluate the outcomes of large angiomyolipoma (AML) treatment by selective arterial embolization (SAE) versus nephron-sparing surgery (NSS) using a robotic surgical system. Materials and Methods: Between January 2011 and June 2018, we retrospectively reviewed 25 patients who underwent robot-assisted partial nephrectomy (RAPN) or SAE for large AMLs. Ten patients underwent RAPN, and 15 underwent SAE. Patient demographics, AML characteristics, and operative and postoperative clinical outcomes were recorded and analyzed. Outcomes were compared between patients who underwent RAPN and patients who underwent SAE. Specifically, changes in renal function and size were evaluated after the treatment. Results: The mean age of the patients was 52.9 years, and 22 of 25 patients were female. The mean maximum AML diameter on computed tomography was 8.9 cm, and 8 patients had multiple masses. Twenty-two of 25 patients had moderate to high RENAL complexity. Patients who underwent SAE had more symptoms (p = 0.018) and higher RENAL complexity scores (p = 0.013) on average. On average, tumor size decreased by 99% among RAPN patients and by 58% among SAE patients (p = 0.001). Although the mean pretreatment estimated glomerular filtration rate (eGFR) was higher among RAPN patients (99.8 vs. 80.0 mL/min/1.73 m2, p = 0.043), there were no significant changes in eGFR in either group after the treatment. One patient in the RAPN group experienced complications, but the postoperative ileus resolved without intervention. Conclusions: Both RAPN and SAE were effective and feasible treatment options for large AMLs. The AML characteristics and the condition of the patient might be important in determining the appropriate treatment method.

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Palato-gingival groove: A silent nidus. Recognition and an innovative management approach: A report of 3 cases

IP Indian Journal of Conservative and Endodontics ◽

10.18231/j.ijce.2021.026 ◽

2021 ◽

Vol 6 (2) ◽

pp. 114-119

Author(s):

Purushothama Rangaswamy ◽

Sri Harsha Tummala ◽

Samrat R Magarvalli ◽

Sujith Ramachandra ◽

Kavitha Govindappa ◽

...

Keyword(s):

Case Reports ◽

Treatment Options ◽

Interdisciplinary Approach ◽

Interdisciplinary Treatment ◽

Treatment Modalities ◽

Management Approach ◽

Root Region ◽

Barrier Membrane ◽

Anterior Teeth ◽

Early Diagnose

Developmental anomalies are one of the challenging clinical conditions to achieve successful treatment outcomes. Among these, Palatogingival groove [PGG] is a rare developmental anomaly usually found on the palatal aspect of maxillary anterior teeth. As self-cleansing is difficult in such patients, it can lead to serious localized periodontal lesion or can occur in combination with endodontic lesion. It is our sole responsibility being a specialist in the field of dentistry, to early diagnose and provide treatment for such conditions. On the basis of PGG extension to the pulp, it can be classified as simple or complex; accordingly, plethora of treatment options are available. Clinically taking interdisciplinary treatment modalities into consideration, curettage of the involved gingival tissues, elimination of the groove by grinding (saucerization), or by sealing with a Biocompatible material which might enhance the healing potential. Incase if the groove extends beyond the middle-third of the root, surgical flap debridement along with combined use of barrier membrane and alloplastic bone graft are recommended.This article represents a rare clinical case reports in management of PGG defect with an innovative conservative approach for simple, minimal groove extensive case and groove extension beyond 1/3 of the root region, treated with surgical multi-interdisciplinary approach.

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Primary molar with chronic periapical abscess showing atypical presentation of simultaneous extraoral and intraoral sinus tract with multiple stomata

BMJ Case Reports ◽

10.1136/bcr-2018-229039 ◽

2019 ◽

Vol 12 (9) ◽

pp. e229039 ◽

Cited By ~ 1

Author(s):

Abul Khair Mohammad Bashar ◽

Khaleda Akter ◽

Govind Kumar Chaudhary ◽

Asifur Rahman

Keyword(s):

Case Report ◽

Calcium Hydroxide ◽

Correct Diagnosis ◽

Simultaneous Presentation ◽

Sinus Tract ◽

Atypical Presentation ◽

Primary Molar ◽

Endodontic Infection ◽

Appropriate Treatment ◽

Periapical Abscess

Chronic periapical abscess drains through a sinus tract either intraorally or extraorally. However, intraoral drainage is more common than extraoral in both dentitions. Nevertheless, the simultaneous presentation of extraoral and intraoral sinus tract is very rarely reported in primary dentition. This case report discussed the management of a girl aged 7 years with a chronic periapical abscess of tooth no. 85 with both non-healing extraoral and intraoral sinus tract having multiple stomata. Non-vital pulpectomy using calcium hydroxide paste intracanal dressing was performed initially until 2 weeks without remarkable healing; then antibiotic dressing consisting of a mixture of ciprofloxacin, metronidazole and clindamycin was placed as an intracanal medicament for 1 week, which shows uneventful healing of both intraoral and extraoral sinus tract. This case report clearly indicates about how history, correct diagnosis and appropriate treatment of endodontic infection associated with sinus tract can be conservatively healed with endodontic treatment alone.

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Hopeless to hopeful: Management of an endo-perio lesion with an interdisciplinary approach

CODS Journal of Dentistry ◽

10.5005/cods-6-2-112 ◽

2014 ◽

Vol 6 (2) ◽

pp. 112-116

Author(s):

VT Pramod ◽

Shobhaprakash LNU ◽

S Sadiya

Keyword(s):

Case Report ◽

Bone Loss ◽

Periodontal Diseases ◽

Correct Diagnosis ◽

Interdisciplinary Approach ◽

Radiographic Examination ◽

Periodontal Tissues ◽

Diagnosis And Prognosis ◽

Furcation Involvement ◽

The Right

Abstract Endodontic–periodontal lesions pose challenge to the clinician as far as diagnosis and prognosis of the involved teeth are concerned. The pathways for the spread of bacteria between pulpal and periodontal tissues are controversial. Treatment and prognosis of endodontic–periodontal diseases vary and depend on the cause and the correct diagnosis of specific condition. This case report describes a successful treatment of a 44 year old male patient who reported with a chief compliant of pain in the right upper and lower tooth back region of the jaw since 20 days. Clinical examination revealed deep pockets and furcation involvement between maxillary right first and second molars. Radiographic examination showed bone loss and furcation involvement. Non-vital root resection with maxillary first molar was planned. Prior to root resection, root canal treatment was performed and then rehabilitated with full metal crown. How to cite this article Pramod VT, Shobhaprakash, Sadiya S. Hopeless to hopeful: Management of an endo-perio lesion with an interdisciplinary approach - A case report: CODS J Dent 2014;6;112-116

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Vascular decompression with videoendoscopy as a treatment for glossopharyngeal nerve neuralgia: clinical case and literature review

Russian journal of neurosurgery ◽

10.17650/1683-3295-2021-23-2-77-85 ◽

2021 ◽

Vol 23 (2) ◽

pp. 77-85

Author(s):

A. G. Vinokurov ◽

A. A. Kalinkin ◽

A. A. Bocharov ◽

O. N. Kalinkina ◽

S. M. Chupalenkov

Keyword(s):

Clinical Case ◽

Correct Diagnosis ◽

Pain Syndrome ◽

Treatment Method ◽

Glossopharyngeal Nerve ◽

Vagus Nerves ◽

Appropriate Treatment ◽

Clinical Center ◽

Low Incidence ◽

Vascular Decompression

The objective is to demonstrate the effectiveness of the vascular decompression with videoendoscopy in the treatment of classical glossopharyngeal nerve neuralgia by a clinical case and to summarize the literature data on this subject. Clinical case. In February 2020, a 56-year-old patient with a clinical picture of glossopharyngeal nerve neuralgia was admitted to the Research Clinical Center of Specialized Medical Care and Medical Technologies. The pain syndrome bothered about 3 years, constantly took carbamazepine at a dose of 1200 mg per day, amitriptyline 75 mg per day, clonazepam 2 mg per day without effect. After further examination and differential diagnosis of causal neuralgia of the glossopharyngeal nerve, a neurovascular conflict appeared between the glossopharyngeal nerve, the posterior inferior cerebellar and vertebral arteries. A good postoperative clinical result was obtained. An analysis of the available scientific literature on this problem is carried out.Results. After performing vascular decompression of the root of the glossopharyngeal and vagus nerves, pain completely regressed (BNI - I, VAS - 0). 6 months after surgery, there is no pain, the patient does not receive drug therapy. In the course of the analysis of available literature, the effectiveness of vascular decompression in the treatment of patients with classical neuralgia reaches 98 %.Conclusion. Given the low incidence of glossopharyngeal neuralgia, the correct diagnosis and the choice of an appropriate treatment method determine the outcome of the disease. The performed operation in the volume of vascular decompression of the glossopharyngeal nerve root with the use of videoendoscopy allowed to completely stop the pain syndrome.

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Candida albicans endocarditis involving a normal native aortic valve in an immunocompetent patient

BMJ Case Reports ◽

10.1136/bcr-2020-236902 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236902

Author(s):

Taha Sheikh ◽

Jeremy C Tomcho ◽

Mohammed T Awad ◽

Syeda Ramsha Zaidi

Keyword(s):

Candida Albicans ◽

Mortality Rate ◽

Aortic Valve ◽

High Mortality ◽

Treatment Options ◽

Immunocompetent Patient ◽

Fungal Endocarditis ◽

Appropriate Treatment ◽

Mechanical Valves ◽

Serious Infection

Fungal endocarditis, specifically from Candida species, is a rare but serious infection with a high mortality rate. Most cases occur in bioprosthetic or mechanical valves and are uncommon in native, structurally normal valves. When Candida endocarditis is detected and appropriate treatment is initiated earlier, there is an improvement in mortality. While the recommendation is usually to treat with a combination of surgery and antifungal medications, patient comorbidities may limit treatment options.

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The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

BMC Anesthesiology ◽

10.1186/s12871-021-01257-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Masayoshi Koike ◽

Mie Yoshimura ◽

Yasushi Mio ◽

Shoichi Uezono

Keyword(s):

Patient Safety ◽

Retrospective Study ◽

High Risk ◽

Treatment Plan ◽

Treatment Options ◽

High Risk Patients ◽

Appropriate Treatment ◽

Risk Patients ◽

Treatment Plans ◽

Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

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An intrasellar germinoma with normal tumor marker concentrations mimicking primary lymphocytic hypophysitis

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302013000700012 ◽

2013 ◽

Vol 57 (7) ◽

pp. 566-570 ◽

Cited By ~ 8

Author(s):

Mariana F. Guzzo ◽

Cristina B. Formiga Bueno ◽

Thiago T. Amancio ◽

Sergio Rosemberg ◽

Cleonice Bueno ◽

...

Keyword(s):

Clinical Laboratory ◽

Correct Diagnosis ◽

Careful Analysis ◽

Malignant Neoplasms ◽

Pituitary Hormone ◽

Appropriate Treatment ◽

Suprasellar Region ◽

Neoplastic Lesions ◽

Posterior Pituitary Hormone ◽

Pituitary Stalk Thickening

Intracranial germinomas (GE) are malignant neoplasms most commonly found in the suprasellar region, which may cause anterior and particularly posterior pituitary hormone deficits with central diabetes insipidus (DI). Differential diagnosis of pituitary stalk thickening includes granulomatous, inflammatory, infectious, and neoplastic lesions. Although careful analysis of clinical, laboratory, and imaging findings may facilitate the diagnosis, transsphenoidal biopsy is indicated to confirm the disease, as the correct diagnosis directs the appropriate treatment.

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