title: Maxillary fungus ball: zinc-oxide endodontic materials as a risk factor.
abstract: The objective of this study was to demonstrate the correlation between endodontic treatment on maxillary teeth and fungus ball with inductively coupled plasma mass spectrometry measurement of zinc and other metals (barium, lead and copper) in fungus ball samples. Samples of normal maxillary mucosa were used as comparison. Metal concentration was also measured in several endodontic materials. A significant difference was found between the concentration of zinc and copper in fungus ball compared to normal mucosa. Metal distribution was more similar in fungus ball and in the endodontic materials tested than normal mucosa. The similar metal concentration in the endodontic materials and fungus ball suggests that endodontic materials play a role in the pathogenesis of fungus ball. Endodontic materials accidentally pushed into the maxillary sinus during endodontic treatments may play a crucial role. Dentists should be as careful as possible when treating maxillary teeth to avoid perforating the maxillary sinus floor; the use of zinc-free endodontic materials, as zinc is a metal that plays a pivotal role in fungus growth, should be encouraged.
authors.affiliation: Department of Otorhinolaryngology, University of Brescia, Italy;
authors.forename: P
authors.initials: P
authors.lastname: Nicolai
authors.affiliation: Department of Endodontology, Dental Clinic, University of Brescia, Italy;
authors.forename: M
authors.initials: M
authors.lastname: Mensi
authors.affiliation: Department of Endodontology, Dental Clinic, University of Brescia, Italy;
authors.forename: F
authors.initials: F
authors.lastname: Marsili
authors.affiliation: Department of Otorhinolaryngology, University of Brescia, Italy;
authors.forename: M
authors.initials: M
authors.lastname: Piccioni
authors.affiliation: Department of Endodontology, Dental Clinic, University of Brescia, Italy;
authors.forename: S
authors.initials: S
authors.lastname: Salgarello
authors.affiliation: Department of Occupational Medicine, University of Brescia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Gilberti
authors.affiliation: Department of Occupational Medicine, University of Brescia, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Apostoli
mesh_terms: D060487:Alternariosis / Q000139:chemically induced*; D001228:Aspergillosis / Q000139:chemically induced*; D006801:Humans; D011446:Prospective Studies; D012307:Risk Factors; D012387:Root Canal Filling Materials / Q000009:adverse effects*; D015034:Zinc Oxide / Q000009:adverse effects*
chemical_list: D012387:Root Canal Filling Materials; D015034:Zinc Oxide
keywords: Endodontic treatment; Inductively coupled plasma mass spectrometry; Maxillary fungus ball; Zinc-oxide materials