Non-surgical Management of a Large Endodontic Lesion Using Diode Laser-Assisted Decompression and Photobiomodulation Therapy: A Case Report

Management of Large Radicular Lesions Using Decompression: A Case Series and Review of the Literature

Pulpal tissue necrosis transforms the pulpal chamber into an unprotected environment. This environment becomes susceptible to colonization by numerous microorganisms that inhabit the oral cavity. Periapical lesions are formed as a result of the immunologic host response to bacteria or its products. These periapical lesions cannot be differentially diagnosed as either radicular cysts or apical granulomas based on radiographic evidence alone. The exact mechanism by which periapical cysts heal is also not clearly understood. In these case reports, root canal treatment proved successful in promoting the healing of large periapical lesions. This confirms that periapical lesions can respond favorably to nonsurgical treatment.

This case report describes the non-surgical management of a large cyst-like periapical lesion in the mandible of a 16-year-old female with the chief complaint of periodic swelling and pus drainage from the mandibular anterior region gingivae with no history of pain and traumatic accident in this area. Both mandibular central incisors had extensive caries. Root canals of both mandibular central incisors were filled with calcium hydroxide. After 10 days, endodontic therapy was carried out on both teeth. Clinical and radiographic re-evaluations at 3 and 12 months revealed progressing bone healing. This case report shows that appropriate diagnosis in combination with root canal treatment as a conservative non-surgical approach can lead to complete healing of large lesions without invasive treatments.

AimThis report describes an atypical mandibular canine with a single boomerang-shaped root and root canal system with a large periapical lesion managed by root canal treatment. MethodsThe chief complaint of a 16-year-old male was acute pain and an abnormal sensation in the right mandibular canine (tooth #27). The clinical examination revealed that tooth #27 had an unusual coronal morphology. The buccal aspect of the tooth resembled that of a normal canine but was significantly broader than expected. On the lingual aspect of the crown; however, there was an unusual cusp-like structure with ridges that was slightly less prominent than the buccal incisal tip. The intraoral periapical radiographs revealed a complex root with an obvious cow horn-shaped canal mesially and distally, but with the suggestion of a root structure joining the mesial and distal extensions. A large periapical lesion was present. Computed tomography revealed the presence of a single root and canal system shaped like a boomerang. Root canal treatment was performed and the patient was followed-up for 9 years. ResultsFollowing root canal treatment, the patient had no symptoms, no mobility, no periodontal pockets, or root resorption. At 9 years, the cone beam computed tomography images confirmed that satisfactory healing of the periapical tissues had occurred. ConclusionThe mandibular right canine had a unique boomerang-shaped root and canal system. Effective shaping and cleaning of the complex canal shape plus thermoplastic root filling aided the successful healing of the periapical lesion.

The aim of this paper is to present two case reports of pulp necrosis and radiolucent periapical lesions, which were treated without surgical treatment. The first was a mandibular molar with periapical lesion of endodontic origin extending towards the furcation in a 20-year-old woman, and the second affected a maxillary right lateral incisor with a large periapical lesion in a 22-year-old woman. The endodontic treatments were carried out in two sessions, with crown-down instrumentation, irrigation with 2.5% sodium hypochlorite and intracanal medication with calcium hydroxide paste. After 30 days, the root canals were filled with gutta-percha and Sealapex sealer by the lateral condensation technique. The clinical and radiographic examination after 1 year revealed complete repair. The appropriate diagnosis of lesions of endodontic origin and the treatment and obturation of the infected canals allowed complete repair of these large radiolucent periapical lesions without surgical treatment.

Background : In most cases of large periapical radiolucent lesions of pulpal origin, we often encounter a dilemmatic situation, such as whether to either treat these cases endodontically or surgically. Development of techniques, instruments and root medicaments as well as the tendency toward minimally invasive treatment, all support dentists to treat those cases using the minimal invasive principle (i.e. endodontically instead of surgically). Purpose : The purpose of this paper is to report and discuss the managing of periapical lesions by endodontic no invasive treatment. Case management : The patient with large periapical lesions were treated with noninvasive endodontic treatment. After 6 months, patients in this report were asymptomatic and radiolucencies had disappeared. When the root canal treatment is done according to accepted clinical principles and under aseptic condition, including cleaning, shaping, abturating as well as proper diagnosis, the healing process of the infected area will occur. Conclusion : Some lesions, however, may not be treated conservatively and may require surgical treatment for total elimination of the lesions.

Introduction Periapical lesions develop as a result of microorganisms from necrotic pulp tissue or retained foreign bodies in the periapical tissue, leading to acute or chronic inflammation. It has been proven that the majority of inflammatory periapical lesions can be effectively treated using nonsurgical endodontic management. However, the selection between surgical and nonsurgical endodontic treatment for managing large periapical lesions remains a controversial issue. This report aims to reveal the effectiveness of nonsurgical, minimally invasive endodontic treatment for large periapical lesions in conjunction with lesion decompression and aspiration. Case Presentation This article presents three cases with large periapical lesions related to severe bone destruction with different causes that were managed with nonsurgical endodontic treatment, involving multiple visits for intracanal medication with calcium hydroxide. In all three cases, the long-term clinical assessments and CBCT scans consistently showed complete healing. The follow-up period ranged from 24 to 48 months. Conclusion The successful results demonstrated the efficacy of nonsurgical endodontic management, which is a minimally invasive approach when addressing large inflammatory periapical lesions with diverse causes.

Background and Objectives: Periapical cystic lesions are a pathology frequently addressed to endodontic specialists. Although their therapy is still not standardized, the treatment should be as conservative as possible and by endodontic means, as they are lesions of endodontic origin. The present case report describes two cases of upper central incisors with large cyst-like periapical lesions, and their one-year follow up. Materials and Methods: Endodontic orthograde treatment was performed under copious irrigation with sodium hypochlorite, in association with calcium hydroxide as an intra-canal medication for both teeth. Root canal filling was achieved in a separate appointment using the continuous wave of condensation technique. A decompression procedure was used in association with endodontic therapy in the second case to reduce the pressure inside the cystic lesion and to allow its drainage, and only because the root canal could not be dried three weeks after medication. Initial cone beam computed tomography (CBCT) investigations, as well as at the one-year follow up, were used to compare the evolution of the lesion. Results: Both cases had a favorable outcome. New bone formation in the periapical region and complete resolution of the lesion was observed at the one-year control in the first case. In the second case, although the lesion was still not completely healed at 12 months, a significant reduction in its size could be observed, showing active signs of healing. Conclusions: Endodontic treatment is the first choice option in the management of teeth with pulpal necrosis and large periapical cystic-like lesions. Decompression is the only surgical procedure recommended when the canals cannot be dried and obturated. Large surgical interventions are unnecessary in cases where endodontic treatment can be performed.

Nonsurgical endodontic treatments in molar teeth with large periapical lesions in children: 2-year follow-up

Use of EndoVac System for Aspiration of Exudates from a Large Periapical Lesion: A Case Report

To report a case of conservative nonsurgical management of periapical lesions. Small periapical lesions of endodontic origin usually heal by conventional endodontic therapy alone. Larger periapical lesions presumed to be cystic may require additional treatment protocols to aid in regression. Conservative nonsurgical management of such lesions eliminates the possible complications of surgery and has wider patient compliance and acceptance. A periapical cystic lesion associated with maxillary central incisor and lateral incisor was treated conservatively using buccal aspiration decompression followed by conventional endodontic therapy employing calcium hydroxide iodoform paste as intracanal medicament is reported. The treatment was successful as evidenced by relief of symptoms and radiographic evaluation. Large periapical cyst-like lesions can resolve by nonsurgical endodontic therapy employing calcium hydroxide intracanal interappointment medicament.

Crown fractures are common detrimental consequences of dental traumatic injuries. Early management of such cases is mandatory in order to prevent subsequent pathological changes that could further complicate the treatment. Pulp necrosis, chronic and cystic apical periodontitis can be the fate if these teeth are left untreated. Despite these serious complications, root canal treatment followed by apical surgery is considered a valid treatment option when such cases become complicated with large periapical lesions. However, whether a retrograde filling is essential to be placed or not is still a matter of debate. This case report discusses the orthograde endodontic management, the surgical approach and the clinical outcomes of longstanding crown fractured teeth with large cyst-like periapical lesions with and without retrograde filling.

A case report to describe the use of a novel 3D printed surgical decompression device to induce healing of large periapical lesions. The development of periapical pathology is influenced by a variety of factors including local microbiology and pathophysiology. In large lesions, lone orthograde endodontic treatment is often insufficient in promoting healing of the periapical tissues and therefore is followed by apical surgery to reduce inflammation. While traditional surgical treatments often involve enucleation for cystic lesions, decompression techniques have shown to provide a less invasive alternative when combined with non-surgical and/or surgical endodontic treatment. The case presented here is a 21-year-old male with a large periapical lesion involving a root canal-treated right maxillary central incisor and nasopalatine canal; extending from the maxillary right lateral incisor to the maxillary left central incisor and having perforated buccal and lingual cortical plates. Clinically, the patient reported an associated fluctuant, non-tender buccal swelling. CBCT confirmed a well-condensed root canal filling; hence, it was decided to first treat the lesion conservatively using only the surgical decompression technique. Following a discussion about treatment options, the patient consented to surgical decompression. CBCT imaging alongside digital software was used to fabricate a customised decompression device that was sutured insitu for 4 weeks. Nine months following the removal of the device, CBCT showed evidence of osseous deposition, with a significant reduction of the periapical radiolucency and separation from the nasopalatine canal, thus portraying the use of decompression in its own right as a treatment option. Surgical decompression is not a novel technique, and the literature describes the use of various dental equipment such as suction tubing, needle hub, or dental dam material to facilitate decompression of a lesion. These devices have, however, shown to cause irritation, discomfort, and instability and are therefore not always effective in inducing healing. This case report describes the use of a novel digital workflow to fabricate a customised decompression device in the management of a large periapical lesion. The reduction of intra-cystic pressure alongside active irrigation reduced inflammatory compounds, contributing to a reduction in the lesion size and promoting osseous healing.

Background Diode laser (DL) can be used in endodontics both for its bactericidal effect inside the root canal system (RCS) and for photobiomodulation therapy (PBMT) to accelerate the repair of periradicular bone tissue. Clinical CasesThis work presents two cases of pulp necrosis/asymptomatic apical periodontitis (AAP) that were treated with 940-nm DL, administered both to disinfect the root canal and to apply PBMT to the periradicular tissues. The cases were analysed by Cone-Beam Computed Tomography (CBCT). DiscussionDL has become widely accepted due to its high antimicrobial effectiveness and its ability to accelerate the repair of large apical lesions by biostimulation. Nevertheless, differences of opinion persist within the scientific community due to the lack of standardized endodontic protocols. Conclusions The application of 940-nm DL, both for disinfection of the RCS and for PBMT, is an effective treatment in non-vital teeth with large periapical lesions. In both cases reported, bone neoformation were found at the 6-month check-up. Key words:Low-level laser therapy, photobiomodulation therapy, diode laser, endodontics.

Objectives:To evaluate the treatment outcome of large periapical cystic lesions treated by combining two novel, conservative approaches, “SealBio” and “Surgical Fenestration”.Materials and Methods:Five cases (4M:1F, age range 14-38 years, mean age 24.5 years) of large periapical cystic lesions, diagnosed on clinical and radiographic examination, were included in the study. After informed consent, endodontic treatment was initiated; chemo-mechanical preparation and intra-canal dressing of calcium hydroxide was given. At the next sitting after one week, further disinfection root canals was done by “apical clearing”, “apical foramen widening” and irrigation. A cotton pellet was kept in the access cavity. After local anaesthesia, full thickness muco-periosteal flap was reflected and the thinned out bone was removed with bone rongers, a small piece of cystic lining was excised and the cystic cavity was copiously flushed with Betadine solution. The remaining cystic lining was gently curetted and the flap was sutured back. “SealBio” was performed after gentle irrigation with saline and intentional over instrumentation. A calcium sulphate based cement was pushed in the cervical third of the canal and the access opening was sealed with glass ionomer cement. Patient was prescribed antibiotics and anti-inflammatory drugs for 5 days and sutures were removed after 7 days. Patients were followed up clinically and radiographically at regular intervals.Conclusions:In this pilot study, treatment outcome after combined technique of “SealBio” and “Surgical fenestration” was found to be highly effective in healing of large periapical cystic lesions. It was simple to perform and very conservative treatment; it required minimal bone removal, obviated the need for complete cyst enucleation, apicectomy and retrograde filling.