Management of the Sequelae of a Sport-Related Traumatic Dental Injury Using Ultrasound Examination in the Diagnosis and Follow-Up

Abstract

About a quarter of all oral pathologies involving the oral cavity and dental apparatus are traumatic injuries, and a substantial number of these cases are the result of sports injuries affecting adolescents and young adults. Here, we report the case of a 25-year-old healthy female referred to the department of Endodontics for the evaluation and management of teeth 1.2 and 1.1 because of a chronic apical abscess in an area involved in a sport-related dental trauma in the past. A multi-modular diagnostic assessment, comprising conventional periapical radiographs, CBCT imaging, ultrasound, and histopathologic examination, led to a final diagnosis of an apical granulomatous lesion connected to both teeth, and an associated sinus tract. During the follow-up period of three years, the patient was reviewed twice a year and showed progressive healing of the bone and absence of the sinus tract. The present report shows the challenges of diagnosing complications arising from past dental trauma. Furthermore, it is the first documented traumatic case where ultrasound examination was fruitfully used. Emphasis should be put on introducing diagnostic ultrasound for the management of both apical periodontitis and the related sinus tract.

Keywords: apical periodontitis; sport; traumatic dental injury; ultrasound examination.

Figure 1

Clinical examination showing coronal integrity of tooth 1.2, discoloration of teeth 1.1 and 2.1, and the stoma of a sinus tract located apically between teeth 1.1 and 1.2.

Figure 2

(a) Periapical radiograph depicting the presence of a previous root canal treatment on tooth 1.2 and a periapical radiolucency. (b) Periapical radiograph performed with insertion of a gutta-percha cone within the stoma to trace the sinus tract.

Figure 3

(a) B-mode ultrasound examination showing a sinus tract disrupting the vestibular bone, presenting as a dishomogeneous, hypoechoic pathway lined by echogenic and reinforced contours. (b) Power Doppler applied to the same area, showing an echogenic, solid lesion with poorly defined hyperechoic bone boundaries and internal blood vessels.

Figure 4

Root canal treatment. (a) Periapical radiograph after the first access to the root canal system. (b) Radiograph showing the calcium hydroxide temporary dressing within the canal after the first visit. (c) Periapical radiograph after obturation of the root canal system.

Figure 5

Three-month follow-up. (a) CBCT depicting the extent of the lesion and the extensive bone loss involving the periapical area of teeth 1.2 and 1.1. (b) Color Doppler examination showing the persistence of both the sinus tract and the inflammatory vascular signal within the lesion. (c) Clinical picture showing the persistence of the sinus tract.

Figure 6

(a) Intra-operative picture of the surgical endodontic treatment. (b) Post-operative periapical radiograph. (c) Clinical examination of the patient at one month after surgery showing the persistence of the stoma.

Figure 7

(a) Root canal treatment of tooth 1.1. (b) Clinical examination at one week after the root canal treatment, showing the disappearance of the stoma. (c) Ultrasound examination with the addition of the color Doppler showing the disappearance of the sinus tract and the vascular signal within the periapical lesion. (d) Post-operative periapical radiograph.

Figure 8

Follow-up at three years. (a) Post-operative CBCT performed at three years. (b) Clinical examination at three years revealing healthy soft tissues at the periapical area. (c) Periapical radiograph taken after three years postoperatively.