Cone-beam Computed Tomography Evaluation of Non-surgical management of a Large Periapical Lesion using Calcium hydroxide intracanal medicament: A 1-year follow-up case report

Abstract

This case report aims to assess the healing of a large periapical lesion non-surgically using Calcium hydroxide (CH) with the aid of Cone Beam Computed Tomography (CBCT). A 28-year-old female patient presented with pain and swelling in the lower anterior teeth (31, 32, 41, 42) (Federation Dentaire Internationale (FDI) tooth notation system). Patient history and pre-operative radiographic examination revealed incomplete root canal treatment in relation to 31, 32, 41, 42 with periapical abscess. During the first visit, the access cavity was modified, followed by determination of the working length and biomechanical preparation. In the present case report, (CH) intracanal medicament(ICM) was placed in the canals for 2 weeks, and the process was repeated until the canals were dry. Once the canals were dry and the teeth became asymptomatic, obturation was performed. Permanent coronal seal was provided using composite restorative material. One year periodic follow-up was carried out to assess the healing of the periapical lesion, following which, post-operative healing was assessed with the help of CBCT- Periapical Index (CBCT-PAI) and was compared with the pre-operative CBCT-PAI. Regression of the lesion and formation of the trabecular pattern of the bone were noted. Intracanal medication with calcium hydroxide complemented the instrumentation with irrigation and optimal disinfection of the root canal system. In this case report, the use of CBCT as a diagnostic tool helped in the accurate measurement of periapical lesion size.