Journal of the Formosan Medical Association
Volume 108, Issue 10 , Pages 808-813, October 2009

Radicular Cyst With Actinomycotic Infection in an Upper Anterior Tooth

  • Shuei-Kuen Tseng

      Affiliations

    • Department of Dentistry, National Taiwan University Hospital and National Taiwan University Medical College, Taipei, Taiwan
    • Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
    • ,
  • Yi-Ling Tsai

      Affiliations

    • Department of Dentistry, National Taiwan University Hospital and National Taiwan University Medical College, Taipei, Taiwan
    • ,
  • Uei-Ming Li

      Affiliations

    • Department of Dentistry, National Taiwan University Hospital and National Taiwan University Medical College, Taipei, Taiwan
    • Department of Dentistry, Cardinal Tien Hospital, Taipei, Taiwan
    • ,
  • Jiiang-Huei Jeng

      Affiliations

    • Department of Dentistry, National Taiwan University Hospital and National Taiwan University Medical College, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Professor Jiiang-Huei Jeng, Department of Dentistry, National Taiwan University Hospital and National Taiwan University Medical College, 1 Chang-Te Street, Taipei, Taiwan

Received 2 October 2008; received in revised form 24 January 2009; accepted 4 February 2009.

Article Outline

Actinomycosis is an infection caused by filamentous, branching, Gram-positive anaerobic bacteria. It rarely infects the jawbone. This case report describes a patient with a left maxillary central incisor with an apical lesion and actinomycotic infection. A 23-year-old male patient underwent conventional root canal treatment of tooth 21, in a local dental clinic for about 1 year. However, percussion pain and a sinus tract that originated from tooth 21 were still present after treatment. Nonsurgical root canal treatment of tooth 21 was performed again but failed to relieve the symptoms. Therefore, apicoectomy and retrograde filling of the apical root canal with mineral trioxide aggregate were carried out. Periradicular bony defect was grafted by biocompatible material, and postoperative antibiotics (250 mg amoxicillin) were given three times daily for 5 days. Pathological examination of the removed periapical tissue showed a radicular cyst with actinomycosis. At the 9-month postoperative recall, the sinus tract had disappeared and radiographic examination showed healing of the apical lesion. Periradicular actinomycosis is one important reason for failure of nonsurgical endodontic treatment. Clinically, if the tooth shows a recurrent sinus tract and poor response to conventional root canal treatment combined with antibiotic control, apical actinomycotic infection should be highly suspected, and an alternative endodontic surgical approach is needed for successful treatment.

Key Words:  actinomycosis , apical surgery , periapical diseases , radicular cyst

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References 

  1. Rush JR , Sulte HR , Cohen DM , et al.   Course of infection and case outcome in individuals diagnosed with microbial colonies morphologically consistent with actinomycotic species . J Endod . 2002;28:613–618
  2. Acevedo F , Baudrand R , Letelier LM , et al.   Actinomycosis: a great pretender. Case reports of unusual presentations and a review of the literature . Int J Infect Dis . 2008;12:358–362
  3. Barnard D , Davies J , Figdor D . Susceptibility of Actinomyces israelii to antibiotics, sodium hypochlorite and calcium hydroxide . Int Endod J . 1996;29:320–326
  4. Wayman BE , Murata SM , Almeida RJ , et al.   A bacteriological and histological evaluation of 58 periapical lesions . J Endod . 1992;18:152–155
  5. Abou-Rass M , Bogen G . Microorganisms in closed periapical lesions . Int Endod J . 1998;31:39–47
  6. Freeman LR , Zimmermann EE , Ferrillo PJ . Conservative treatment of periapical actinomycosis . Oral Surg Oral Med Oral Pathol . 1981;51:205–208
  7. Happonen RP . Periapical actinomycosis: a follow-up study of 16 surgically treated cases . Endod Dent Traumatol . 1986;2:205–209

PII: S0929-6646(09)60409-5

doi:10.1016/S0929-6646(09)60409-5

Journal of the Formosan Medical Association
Volume 108, Issue 10 , Pages 808-813, October 2009

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