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Case report of an internal granuloma investigated by light and scanning electron microscopy.

Gassmann G, Arnold WH - Head Face Med (2015)

Bottom Line: Clinically the upper right medial incisor appeared discoloured darkly not showing the typical pink spot.Without any force the coronal part of the right medial incisor could be removed manually and the root was extracted using a periostal extractor.As it was not suitable to leave the patient with a missing tooth in the front the wound was sutured and as a temporary solution the tooth was reconstructed with composite intraorally and fixed to the neighbour teeth adhesively.

View Article: PubMed Central - PubMed

Affiliation: PraxisHochschule Cologne, Dental Hygiene and Preventive Management, Köln, Germany. g.gassmann@praxishochschule.de.

ABSTRACT
There is no doubt that the main reason for an internal grauloma is a traumatic event. The trauma may be physical or chemical as in the case of caries or coronal pulpectomy. In most of the cases it is diagnosed by hazard or, when in case of fracture or mobility, extraction is the only therapy to be performed. If diagnosed in time root canal treatment may be adequate.In the presented case no single specific event could be determined being the cause of this large internal granuloma extending from the coronal third of the root canal to the whole crown just leaving an eggshell of enamel that fractured and mimicked mobility of the whole tooth to the patient finally causing him to attend the clinic. As the patient presented severe aggressive periodontitis and mobility of all teeth it first was assumed that periodontitis was the ethiological reason in this case. Due to secondary trauma the front teeth were labially positioned thus probably being exposed to traumatic insults more frequently. Clinically the upper right medial incisor appeared discoloured darkly not showing the typical pink spot. Without any force the coronal part of the right medial incisor could be removed manually and the root was extracted using a periostal extractor. As it was not suitable to leave the patient with a missing tooth in the front the wound was sutured and as a temporary solution the tooth was reconstructed with composite intraorally and fixed to the neighbour teeth adhesively. The histopathology of the internal granuloma and the crown was investigated.

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Clinical state of tooth 11 prior to treatment. The tooth shows discoloration
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Fig1: Clinical state of tooth 11 prior to treatment. The tooth shows discoloration

Mentions: In the case presented here, no single specific event could be identified as being the cause of this large internal granuloma. It extended from the coronal third of the root canal into the whole crown, just leaving an eggshell of enamel that fractured within the gingival attachment border. Thus, mobility of the whole tooth was mimicked to the patient perception, finally causing him to attend the clinic. Because the 23-year-old patient presented with a severe generalized aggressive periodontitis, showing mobility in all of his teeth, this diagnosis was assumed to be the etiological reason. Due to secondary trauma, the front teeth were positioned labially, thus probably being exposed to traumatic insults more frequently. Clinically, the upper right medial incisor appeared discolored darkly, and not showing the typical pink spot (Fig. 1.).Fig. 1


Case report of an internal granuloma investigated by light and scanning electron microscopy.

Gassmann G, Arnold WH - Head Face Med (2015)

Clinical state of tooth 11 prior to treatment. The tooth shows discoloration
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4465001&req=5

Fig1: Clinical state of tooth 11 prior to treatment. The tooth shows discoloration
Mentions: In the case presented here, no single specific event could be identified as being the cause of this large internal granuloma. It extended from the coronal third of the root canal into the whole crown, just leaving an eggshell of enamel that fractured within the gingival attachment border. Thus, mobility of the whole tooth was mimicked to the patient perception, finally causing him to attend the clinic. Because the 23-year-old patient presented with a severe generalized aggressive periodontitis, showing mobility in all of his teeth, this diagnosis was assumed to be the etiological reason. Due to secondary trauma, the front teeth were positioned labially, thus probably being exposed to traumatic insults more frequently. Clinically, the upper right medial incisor appeared discolored darkly, and not showing the typical pink spot (Fig. 1.).Fig. 1

Bottom Line: Clinically the upper right medial incisor appeared discoloured darkly not showing the typical pink spot.Without any force the coronal part of the right medial incisor could be removed manually and the root was extracted using a periostal extractor.As it was not suitable to leave the patient with a missing tooth in the front the wound was sutured and as a temporary solution the tooth was reconstructed with composite intraorally and fixed to the neighbour teeth adhesively.

View Article: PubMed Central - PubMed

Affiliation: PraxisHochschule Cologne, Dental Hygiene and Preventive Management, Köln, Germany. g.gassmann@praxishochschule.de.

ABSTRACT
There is no doubt that the main reason for an internal grauloma is a traumatic event. The trauma may be physical or chemical as in the case of caries or coronal pulpectomy. In most of the cases it is diagnosed by hazard or, when in case of fracture or mobility, extraction is the only therapy to be performed. If diagnosed in time root canal treatment may be adequate.In the presented case no single specific event could be determined being the cause of this large internal granuloma extending from the coronal third of the root canal to the whole crown just leaving an eggshell of enamel that fractured and mimicked mobility of the whole tooth to the patient finally causing him to attend the clinic. As the patient presented severe aggressive periodontitis and mobility of all teeth it first was assumed that periodontitis was the ethiological reason in this case. Due to secondary trauma the front teeth were labially positioned thus probably being exposed to traumatic insults more frequently. Clinically the upper right medial incisor appeared discoloured darkly not showing the typical pink spot. Without any force the coronal part of the right medial incisor could be removed manually and the root was extracted using a periostal extractor. As it was not suitable to leave the patient with a missing tooth in the front the wound was sutured and as a temporary solution the tooth was reconstructed with composite intraorally and fixed to the neighbour teeth adhesively. The histopathology of the internal granuloma and the crown was investigated.

Show MeSH
Related in: MedlinePlus