Endodontic treatment of a large periapical cyst with the aid of antimicrobial photodynamic therapy - Case report

Amjad Abu Hasna,Carlos Henrique Ferrari,Cláudio Antonio Talge Carvalho

doi:10.14295/bds.2019.v22i4.1745

Amjad Abu Hasna, Carlos Henrique Ferrari + Show 1 more

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https://doi.org/10.14295/bds.2019.v22i4.1745

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Abstract

Introduction: Periapical cysts, especially those of great extension, represent a challenge for endodontics, since they are not repaired with traditional treatment. The aim of this case report was to evaluate the effectivity of antimicrobial photodynamic therapy “aPDT” when associated with calcium hydroxide Ca(OH)2 in treating such cysts. Case report: A 40-year-old female patient complained of bulging in the upper anterior region of the mouth. The clinical examination showed an extensive swollen periodontal area, painful with digital palpation, with a negative response to thermal tests on teeth 11 and 21. After traditional treatment, the canals of 11 and 21 were filled with photosensitizer methylene blue 0.005% pre irradiation time (PIT) of 5 minutes and irradiation by low power diode laser with visible red wavelength (660 nm) during 2 minutes without intervals, using an optical fiber delivering system with a helical movement from apical to cervical. Then the canal were filled with Ca(OH)2 paste for 45 days being changed each 15 days, and repeating the radiation. Results: After 45 days, the patient already had a bulging remission, with painless resistance to apical pressure in the region and signs of bone repair at the radiographic examination, and total absence of signs or symptoms. Conclusion: the association of aPDT with Ca(OH)2 paste is effective in treating of periapical lesions of great extension and avoid surgical treatment.Keywords: Antimicrobial; Calcium hydroxide; Diode Laser; Periapical cysts; Photodynamic Therapy; Root canal treatment.

Highlights

Periapical cysts, especially those of great extension, represent a challenge for endodontics, due to the ineffectiveness of traditional root canal treatment (RCT) in such cases
This doubt and uncertainty in the effectivity of Ca(OH)2 as intracanal medication, promoted a lot of studies to investigate a complementary techniques that could be used in addition to Ca(OH)2, like antimicrobial photodynamic therapy “aPDT”, which showed to be effective in association with an interappointment dressing with Ca(OH)2, even more it stimulated repair [9]
After six months the patient was recalled for control radiographic exams (Figure 4). This case report aimed to mention the success achieved by the association of aPDT as a complementary technique that collaborate in microorganism reduction in the root canal system with the Ca(OH)2 paste the wide used intracanal medication

Summary

Introduction

Periapical cysts, especially those of great extension, represent a challenge for endodontics, due to the ineffectiveness of traditional root canal treatment (RCT) in such cases. In another study, Ca(OH)2 paste showed to be effective in root canal disinfection, and over E.faecalis and C.albicana [8].

Results

Conclusion