Resolution of periapical radiolucency following pulpotomy

Abstract

There is evidence in the literature that some periapical lesions can be resolved by conservative management of the pulpal tissues rather than by traditional endodontic therapy (1-4). Moore (1) showed apparent resolution of periapical lesions radiographically in three of eight vital carious teeth after treatment by various direct and indirect capping techniques. Jordan et al. (2) treated 24 vital nonexposed teeth in 19 patients with gross caries and periapical radiolucencies by indirect pulp capping with fortified calcium hydroxide (Dycal; L. D. Caulk Co.) and zinc oxide cement. Eleven of the 24 teeth remained vital and showed resolution of the periapical radiolucency during observation times ranging from 11 months to 7 years. The remaining 13 teeth were either extracted or root filled. Recently, Foreman (3) reported some resolution of a periapical area in a second molar tooth following a calcium hydroxide (Calxyl; Exceldent Ltd., United Kingdom) pulpotomy and fortified zinc oxide dressing, and Russo et al. (4) showed reduction (2 teeth) or complete disappearance of abnormal radiolucency (28 teeth) in a group of 30 first permanent molars with carious pulp exposures and periapical radiolucencies after treatment by pulpotomy, corticosteroid-nitrofurazone dressing (48 h) followed by calcium hydroxide. The following case shows complete resolution of a periapical area 1 year following pulpotomy and dressing with a corticosteroid-antibiotic dressing material (Ledermix cement; Ledermix Pharmaceuticals, Wolfratshausen).