Mohamed Fawzy Mansour

Background: Congenital Insensitivity to Pain and Anhidrosis (CIPA) is a rare autosomal recessive disorder characterized by congenital analgesia, anhidrosis, and multisystem involvement affecting the musculoskeletal, cutaneous, oral, and para-oral structures. This case report describes the oral phenotype and multidisciplinary clinical management of a child with CIPA. Case Description: A 9-year-old boy presented with poor oral hygiene, multiple severely damaged teeth, masticatory difficulty, limited mouth opening, impaired bolus control, and para-oral traumatic injuries. Medical and orthopedic history indicated recurrent painless fractures, self-inflicted injuries, cutaneous scarring, and recurrent hyperpyrexia. Oral self-injury associated with CIPA was suspected and supported by the Nociception Assessment Test and Minor’s Iodine–Starch Test. Although the clinical findings were suggestive of CIPA, the diagnosis remained presumptive due to the absence of confirmatory molecular or histopathological testing. Management: A wearable wireless continuous temperature-monitoring device was prescribed to assist in tracking hyperpyrexia associated with CIPA (RHA-CIPA). A conservative, staged, multidisciplinary treatment was planned rather than full-mouth extraction, emphasizing prevention of dental sepsis and mitigation of future self-injury. Dental procedures were performed under local anesthesia to manage discomfort related to tactile hyperesthesia. To reduce nocturnal biting and oral trauma, a hard acrylic occlusal protector was fabricated using an intraoral scanner and a 3D-printed cast. The patient was followed for 12 months. Outcomes: At the 12-month follow-up, clinical improvement was observed, with particularly notable gains in cheek elasticity and soft tissue resilience. Conclusions: This case highlights the considerable challenges involved in the interdisciplinary management of children with CIPA, including oral self-injury prevention, limited mouth opening, and the necessity of close coordination with medical specialties. These findings are descriptive observations of a single case and do not establish efficacy or generalizability of any intervention.

Aim: to evaluate the healing rate of periapical lesions following application of different intra-canal medicament such; Calcium hydroxide, Simvastatin and Epigallocatechin-3-gallate. Materials and methods: Thirty patients with periapical lesions size less than 200 mm2 were selected; Perioperative CBCT images to verify lesion size and position were taken as base line data. The teeth were accessed, and after the working length determination all canals were prepared with ProTaper next files system till (X3, X4, X5) according to the initial canal size. The patients were randomly assorted into 3 groups with 10 patients in each, according to the intra-canal medicaments; group 1: using Calcium hydroxide (control group), group 2: using Simvastatin, and group 3: using Epigallocatechin-3-gallate. All medications were applied for 2 weeks then washed out completely before complete obturation of root canals. The patients were recalled at 3, 6, 12 and 18 months for clinical and radiographic evaluation. Results: 29 out of 30 study cases exhibited no clinical signs or symptoms. Regardless the medication type, CBCT evaluation of those cases revealed signs of decreasing the lesion size by time elapsing ranges from partial to complete healing. no significant differences between the study groups were detected. Conclusion: Conventional root canal treatment should be the first conservative line for management of periapical lesion. Intra-canal medicaments enhanced the periapical lesions healing. Both Epigallocatechin- 3-gallate and Simvastatin were reported to be good alternatives for Calcium hydroxide.