Forum for Clinical and Surgical Oral Pathology

Case BBOPF 09-6

Dr. Harvey Kessler (Baylor College of Dentistry, Dallas, Texas. USA) is requesting your opinion. Please send your comments in the window located below the images. This case will be posted from August 19 to August 26, 2009. A summary of the responses will be posted in BBOP.

History

The patient is a 45 yo WF. She had a tooth treated endodontically that was severely decayed. Some time after the RCT, the tooth "fell out" (patient's description, according to the reconstructed history obtained by the oral surgeon that submitted the specimen). The patient went back to the general dentist, who, according to the patient, stuffed the socket area with some type of "cotton material" (again, the patient's description). She had pain and swelling in the area and went to see a different DDS, who opened the socket area and "dug out" the previously packed material and "sewed it up." The patient continued to have pain and swelling in the area, and the second DDS referred her to the OMFS, who proceeded to do a more definitive curettage of the area.

Histologic exam revealed mostly inflamed granulation tissue but there were fragments of tissue containing an obvious foreign material with minimal surrounding inflammation and only occasional giant cell response. The case was signed out descriptively and is really not much of a big deal except for the academic interest in what the foreign material might be. It had a relatively uniform triangular shape and none of us recognized it as anything specific that we've seen previously. It didn't resemble the typical cotton fibers we've seen before. It somewhat resembles gelfoam sponge, but that usually stains a bright pink-red color and this material didn't really pick up much stain at all. IT DID NOT POLARIZE (everyone tried but all agreed that it didn't light up at all!) as cotton would be expected to. We are interested if anyone recognizes what this material might be for our future reference. (Apologies about the 10x image--it is a little out of focus)

Harvey P. Kessler
Professor
Department of Diagnostic Sciences
Baylor College of Dentistry
3302 Gaston Avenue
Dallas, Texas 75246

Images

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Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (Web Administrator, University at Buffalo School of Dental Medicine).