Chronic Apical Abscess Research Articles

Successful Regenerative Endodontic Therapy of a Dens Evaginatus Mandibular Second Premolar with an Acute Apical Abscess and Extensive Periapical Bone Loss: A Case Report.

Regenerative endodontics is a rapidly growing field within dentistry that aims to replace damaged tooth structures and cells of the pulp-dentin complex. This case report presents the successful management of an immature permanent second mandibular premolar with an acute apical abscess and extensive apical bone loss caused by a dens evaginatus. This tooth was unexpectedly treated with long-term calcium hydroxide (Ca(OH)2) that was replenished several times over 6 months. During the treatment process, this tooth became reinflamed developing a chronic apical abscess after resolution of the initial acute apical abscess, which resulted in the replacement and prolonged use of Ca(OH)2. The final regenerative procedures were completed using a bioceramic fast set putty placed directly over the blood clot and an occlusal composite restoration. At the 6-month follow-up, the patient was asymptomatic with a fully healed radiographic lesion, new periodontal ligament, and the apex closed with thickening of the mesial and distal aspects of the root. At the 15-month follow-up, the patient remained asymptomatic with continued evidence of radiographic development of the apical aspect of this tooth, displaying root end closure and thickening. This is a unique case report of the management of a complex infection process in an immature tooth with regenerative techniques with repeated and long-term use of Ca(OH)2. This novel report provides dental practitioners with a new potential protocol for the management of these immature cases with advanced periapical infections that require extensive disinfection to have successful outcomes.

Orthodontic movement after regenerative endodontic procedure in mature permanent tooth associated with dens invaginatus: a case report with 4-year follow-up

BackgroundRegenerative endodontic procedures (REPs) are innovative treatments aimed at restoring damaged dental structures. However, the effect of orthodontic movement on REP-treated teeth is not well understood and may have significant long-term consequences. This study aimed to evaluate the impact of orthodontic movement on a mature permanent tooth associated with dens invaginatus that has undergone a regenerative endodontic procedure (REP).Case presentationThis report describes the case of a 13-year-old healthy male who presented with pulp necrosis and a chronic apical abscess (tooth number 2.2). Following REP according to the American Association of Endodontists' guidelines, the patient began non-extraction orthodontic treatment with fixed appliances after a 9-month healing period, which lasted 17 months in the upper arch. Subsequent follow-ups at 24, 36 and 48 months post-REP revealed an asymptomatic state with minimal cervical discoloration and diminished cold sensitivity. Radiographic analyses revealed periapical healing, mild apical remodeling on tooth 2.2, and moderate apical remodeling on other maxillary incisors. The treated tooth displayed a positive response to both REP and orthodontic treatment, yet further research is required to determine the long-term effects of orthodontics on REP-treated teeth.ConclusionOrthodontic movement following REPs in mature permanent teeth is feasible and do not seem to prone teeth to orthodontic tooth resorption. Our experience indicates that a 9-month healing period allows successful orthodontic outcomes following REPs. Nonetheless, the predictability of outcomes and the ideal healing period before orthodontic movement is initiated remain to be established.

Bone Regeneration on Chronic Apical Abscess After Root Canal Treatment

Chronic Apical Abscess is explained as an inflammatory reaction to pulp infection and necrosis. It is characterized by intermittent discharge of pus through an intraoral sinus tract and usually associated with little or no discomfort. On radiograph examination showed radiolucency as signs of periapical bone destruction. Root canal treatment can elimination bacteria as source of the infection in root canal system. Purpose: these two case report aims to present the management of chronic apical abscess with bone destruction in periapical area. Case report: (1) A 21-years-old female came to complained of a lack of self-confidence due to her upper-front tooth was broken about 8 years ago. Clinical examination showed no discomfort on percussion test, negative on palpation and vitality test. Periapical radiography showed a radiolucent with clear but indistinct boundaries, oval in shape with a diameter of approximately 4 mm. (2) A 20-years-old male complained that his front teeth were broken and discoloured. This complaint had been felt for a long time about 7 years ago. The patient had felt spontaneous pain in the tooth that was hit during the accident for a week. Currently, the tooth is no longer painful. There is no swelling in the gum area where the tooth has changed colour. Radiological examination showed bone damage with a periapical radiolucent appearance with diffuse oval borders with a diameter of 5-6 mm. The diagnosis of these two cases were pulp necrosis with chronic apical abscess. Root canal treatment were performed to elimination bacteria of source infection. First case was restoration using composite resin crown with fiber post intracanal restoration and the second case was restoration using direct restoration. Conclusion: proper root canal treatment resulting bone regeneration and periapical lesions healing in chronic apical abscess cases.

Combined Endodontic and Surgical Management of a Maxillary Lateral Incisor with Type 3 of Dens Invaginatus

Dens invaginatus (DI) is a developmental anomaly characterized by invagination of the enamel organ into the dental papilla before calcification of the dental tissues. The etiology of this phenomenon has been related either to focal growth retardation or focal growth stimulation, or localized external pressure in certain areas of the tooth bud. In this case of upper lateral incisor showing type 3 dense invaginatus and diagnose as necrotic pulp with chronic apical abscess and treated by nonsurgical root canal treatment during follow up patient comlaing of recurrent swelling associated with treated tooth so we did surgical approach has been employed to resolve patient chief complaint. A follow up of one year is also presented to show healing.

Identification of root canal microbiota profiles of periapical tissue diseases using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

ObjectivesThe purpose of this study was to identify microorganisms isolated from various periapical tissue diseases using Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF-MS) and classify them via an unsupervised machine learning approach. MethodsA total of 150 patients with various apical conditions and teeth in need of endodontic retreatment were divided into five groups, including Retreatment, Acute Apical Abscess, Chronic Apical Abscess, Acute Apical Periodontitis, and Chronic Apical Periodontitis. Samples were collected from root canals using paper points after agitating with a #10 K file then microorganisms were identified using MALDI-TOF-MS. Data were analyzed using a hierarchical clustering method. Quadruple clusters and dendrograms were formed according to similarities and dissimilarities. ResultsA total of 80 species were identified representative of six different phyla. The most similar microorganism species identified were: ''Enterococcus faecalis'' between 21 and 23-year-old female cases in Retreatment group; ''Lactobacillus rhamnosus'' between 20 and 18-year-old male cases in Symptomatic Apical Abscess cases; ''Lactobacillus paracasei'' between 26 and 40-year-old male cases in Asymptomatic Apical Abscess cases; ''Enterococcus faecalis'' between 48 and 50-year-old female cases in Symptomatic Apical Periodontitis cases; ''Lactobacillus rhamnosus'' between 48 and 60-year-old male cases in Asymptomatic Apical Periodontitis cases. ConclusionsMALDI-TOF MS can be considered a fast and high-throughput screening technique for microbial species identification in endodontics. Thus, it will provide valuable data for future research designs regarding periapical tissue diseases. As the MALDI-TOF MS database expands and comprehensive data becomes available, the relationship between microbial profiles and disease progression will become increasingly apparent.

Genetic polymorphism of interleukins 6 and 17 correlated with apical periodontitis: A Cross-sectional study.

Interleukins 6 and 17 act in bone resorption in the presence of infections of endodontic origin for host defense. Genetic polymorphisms may be associated with increased bone loss, represented by areas of large periapical lesions. This study aimed to verify the frequency of interleukin 6 and 17 gene polymorphism in patients with asymptomatic apical periodontitis or chronic apical abscess and to verify the existence of correlations between periapical lesion area with age, gender, and presence of the polymorphism, in the studied population, in the state of Pernambuco. A population consisting of thirty diagnosed individuals was included. The area of the lesions was measured in mm². Genomic DNA was extracted and genotyping was performed by Polymerase Chain Reaction Restriction Fragment Length Polymorphism for interleukin 6 (rs 1800795) and interleukin 17 (rs 2275913). Fisher's exact, chi-square, and odds ratio tests were used. A logistic regression analysis was also performed using sex, age, and the presence of polymorphism as covariates, in addition to linear regression to test the relationship between age and lesion area. All tests used a significance level of 0.05% (p ≤0.05%). There was no statistical significance in the occurrence of large areas of periapical lesions correlated with age, sex, and diagnosis, nor in the distribution of alleles in the polymorphism of interleukins 6 and 17 in the studied groups. The frequency of homozygous and heterozygous polymorphism was high. The polymorphism of these interleukins is not correlated with the increase in the areas of asymptomatic periapical inflammatory lesions.

Knowledge Regarding Prescription of Antibiotic for Endodontic Treatment among House Officers of Multan

OBJECTIVE: To evaluate the knowledge regarding the prescription of antibiotic for treatment of endodontic disease and errors made by the house officers at Multan Dental College. Since the discovery of antibiotics, they have been in use broadly for the treatment of odontogenic infections. Prescription is a dynamic, customized clinical process, which is set owing to the necessities of patient & the acquaintance of the practitioner. METHODOLOGY: This survey-based study was conducted among 40 house officers working at Multan Dental College. A survey form was designed, about the pattern of antibiotics prescription and the situations for which they were recommended by the House officers. RESULTS: The medication of choice was mostly Amoxicillin + clavulanic acid (52.6%) and Amoxicillin alone (47.3%). The most incidence of antibiotic prescription was reported for acute abscess of periapical area of the tooth (62.8%) and patient having fever with malaise (62%). Chronic apical abscess with sinus tract (58%). Overall, 12% of part takers were used to suggest p antibiotics for root canal treatment. CONCLUSION: We conclude that here is deficiency of information & knowledge for the proper indication, kind, and antibiotics dose. Different educational activity like symposium or lectures should be practiced to teach the practitioner to prescribe antibiotics. Curriculum & syllabus should offer great emphasis on prescribing. KEYWORDS: Antibiotics, Endodontics, Prescription, prophylaxis, Root canal treatment (RCT)

Management of Bilateral Foreign Objects in Immature Permanent Maxillary Central Incisors: A Case Report

AbstractTraumatic dental injuries are more commonly seen in children and it often results in a complicated crown fracture. This case is unique as foreign objects in the form of hand-sewing needles were accidentally lodged bilaterally in both maxillary central incisors. A 13-year-old patient was referred to the Dental Clinics at the College of Dentistry, Jazan University with a complaint of broken needles in her front teeth and a history of trauma 3 years ago. Although the patient had the habit of using a hand-sewing needle to remove the lodged food particles from the open pulp chamber, she was not able to recollect the incidence of needle separations. Radiographic examination revealed radiopaque objects in the middle third of the right maxillary central incisor (#11) and in the apical third of the left maxillary central incisor (#21). Tooth #11 was clinically diagnosed as pulp necrosis with chronic apical abscess and tooth #21 as pulp necrosis with asymptomatic apical periodontitis. The micro tweezer from the broken instrument removal kit (Zumax Medical Co.,Ltd., Jiangsu, China) was used to retrieve the separated needle pieces under the operating microscope. The open apices were managed by the formation of mineral trioxide aggregate apical plug, and the procedure of root reinforcement was achieved by bonded resin cement and fiber resin posts. Finally, teeth were restored with dual cure core build-up composite material and direct composite veneers. Recommendations are made to treat complicated crown fractures, especially in children on priority to minimize the risk of foreign object impaction.

Endodontic management of two-rooted maxillary central incisor using cone-beam computed tomography: A case report and literature review

Morphological variations of the pulpal chamber are considered a challenge and may affect successful treatment or prognosis. Maxillary central incisors usually present one canal system and one root. In this report, a 47-year-old Saudi male patient presented with symptomatic permanent maxillary left central incisor with two roots associated with draining sinus tract and buccal groove. The tooth was not mobile but was tender to percussion and palpation. The periapical radiograph demonstrated apical radiolucency of the two-rooted central incisors. The endodontic diagnosis was pulpal necrosis with chronic apical abscess. With aid of periapical radiographs and cone-beam computed tomography evaluation, successful nonsurgical root canal treatment was achieved at 1-year follow-up. Careful preoperative clinical and radiographic examinations to identify any anatomical variations are crucial for appropriate management and successful outcome.

Radiographic evaluation of preoperative periapical status in teeth with apical abscess

Background: The presence of preoperative periapical lesion is a significant prognostic factor that influences the outcome of endodontic treatment. Radiographic evaluation of periapical status is important for diagnosis, treatment, and prognosis of periapical lesion. Objectives: To radiographically compare and evaluate the preoperative periapical status using periapical index (PAI) in teeth with acute and chronic apical abscess. Methods: An analytical cross-sectional study was conducted in Chitwan Medical College, between 2022 February to 2022 May using nonprobability convenience sampling technique. Forty-eight periapical radiographs with a diagnosis of apical abscess {24 acute apical abscess (AAA) = Group 1; 24 chronic apical abscess (CAA) = Group 2)} were included for evaluation. Four observers (Three endodontists and one oral radiologist) evaluated the periapical status on radiographs and scored them according to PAI scoring system. Statistical analysis was done using the Mann-Whitney U test and SPSS v.22. Results: The most common PAI score for teeth in Group 1 was three (13, 54.20%) with mean PAI score = 3.21 and in Group 2 the score was four (13, 54.20%) with mean PAI score = 3.79. Analysis of PAI scores found significant differences (p = 0.009, p <0.05) between groups. The distribution of PAI varied according to apical diagnosis (p <0.05). Intraobserver and Interobserver agreement values demonstrated good self-agreement and interobserver agreement. Conclusion: Teeth with CAA were more likely to have higher PAI scores and therefore, periapical radiograph and PAI scoring system can be used effectively for the evaluation of preoperative periapical status in teeth with apical abscess.

Histologic and Electron Microscopic Characterization of a Human Immature Permanent Premolar with Chronic Apical Abscess 16 Years after Regenerative Endodontic Procedures

Previous studies have reported successful clinical outcomes after regenerative endodontic procedures (REPs) for immature permanent teeth with pulpal infection. However, it remains unclear whether the procedures promote true regeneration or repair. This case report describes the histologic and electron microscopic characteristics of a human immature permanent premolar with a chronic apical abscess that was treated with an REP. Tooth #20 of a 9-year-old girl underwent an REP. At the 6-year follow-up, the patient was asymptomatic, and closure of the apex and thickening of the dentinal walls were observed. However, 16 years after the procedure, apical periodontitis recurred, necessitating apical surgery. The resected root fragments were obtained during the surgery and analyzed using micro–computed tomography, light microscopy, and scanning electron microscopy. Distinct dentinal tubules and interglobular dentin were observed in the regenerated hard tissue. Cementum-like tissue and a root canal were also observed in the apical fragment. The regenerated root tissue in this case exhibited a structure similar to the native root structure. Therefore, we believe that cell-free REPs possess regenerative potential for teeth diagnosed with pulp necrosis and chronic apical abscess.

The Epidemiology of Dental Pathologies in Elderly Patients Admitted to a Tertiary Level Hospital in Oradea, NW Romania: A 5-Year Retrospective Study.

Oral diseases can affect the quality of life of all individuals, including elderly people. In elderly people, the associated general diseases can increase the risk of dental pathologies or can impact their treatment. The main aim of this study was to identify elderly patients with dental pathology out of the total number of patients admitted to the Department of Oral and Maxillofacial Surgery at a tertiary-level hospital in North-Western Romania. Another aim was to describe the characteristics of the patients included in this study, as well as to analyze data from patients with dental pathologies. In this retrospective study, the medical records of patients admitted to the Department of Oral and Maxillofacial Surgery at the Bihor County Emergency Hospital between 2016 and 2020 were analyzed, with a focus on patients aged 65 years or more. After applying the exclusion criteria, 721 patients were kept in the study, of which 316 (43.8%) had at least one dental pathology. Most elderly patients with dental pathologies were admitted in 2018 (n = 89). The most common associated systemic diseases were arterial hypertension (n = 268) and ischemic heart disease (n = 233), while the most common dental pathologies were pulpitis (n = 185), chronic apical periodontitis (n = 61) and abscesses (n = 35). Most patients were either healed or had an improved condition at the time of discharge. The great number of dental pathologies, as well as the diversity in dental pathologies, underline the necessity for better preventive programs aimed not only at children, adolescents or young people but at the elderly population as well.

Single-visit regenerative endodontic procedure of necrotic immature lower permanent molar with acute apical abscess

Regenerative endodontic procedures (REPs) of immature teeth with necrotic pulp and apical pathosis focus on passive chemomechanical debridement and usually require multiple visits to enhance the antibacterial effect by placing intracanal medications. However, different case reports showed a favorable clinical and radiographic outcome in single-visit REPs of necrotic immature teeth with symptomatic apical periodontitis or chronic apical abscess. To the best of our knowledge, there are no published reports of single-visit REPs on cases with acute apical abscess. Therefore, this case report aimed to present a successful REP performed in a single visit for immature lower molar with necrotic pulp and acute apical abscess. A 9-year-old female patient referred for the management of the lower right molar (#46), with the chief complaint of localized moderate pain with cold drinks in the lower right molar for 1 week. The extraoral clinical examination revealed no significant findings. Intraorally, tooth #46 revealed a deep occlusal caries, with normal response to palpation, mild pain on percussion, and moderate pain to the cold test. The radiographic examination showed deep occlusal caries approaching the pulp, and periapical radiolucency related to the distal root. It was diagnosed as symptomatic irreversible pulpitis with symptomatic apical periodontitis. After accessing the pulp chamber, the radicular pulp on the mesial root was vital, while necrotic in the distal root. Therefore, vital pulp therapy was done for the mesial root, and REPs initiated for the distal root with intracanal medicament placement. However, the patient failed to show up in the scheduled visit to complete the treatment. The father refused to bring her as she was asymptomatic, and he was afraid of the COVID-19 pandemic situation. One month later, she presented to the clinic with pain and facial swelling in the lower right area of her face. Clinical examination revealed extra- and intraoral swelling related to tooth #46 (i.e., acute apical abscess) with severe pain on palpation and percussion. The patient’s parents insist to finish the treatment or extract the tooth on the same visit. Hence, a single-visit REP was done. After 20 months, clinical and radiographic examinations showed that the tooth became asymptomatic, responded to sensibility tests, and the periapical pathosis healed. It was concluded that regenerative endodontic treatment can be done in single visit in cases with acute apical abscess. It should be considered in cases of poor complaint, difficulty in accessing dental care, or pandemic curfew.

Pulp tissue regeneration in the treatment of immature premolars accompanied by infection: A case report

Background: Young permanent teeth are one of the challenges in performing endodontic treatment. Revascularization is a good yet simple treatment option for pulp tissue regeneration to stimulate periapical lesion healing, continue root growth and restore pulp tissue function. Purpose: This case report describes management of pulp tissue regeneration in teeth with infection. Case: Female, 16 years old, came complaining of pain in the left lower back tooth accompanied by recurrent swelling. Radiograph showed an open apex with apical lesion on tooth 35. The diagnosis was pulpal necrosis accompanied by a chronic apical abscess. Case management: The treatment plan was revascularization and direct composite restoration. After accessing the cavity, the teeth were prepared, irrigated, and medicated with TAP, which was repeated for 2 visits. On the next visit, after the root canal was cleaned, over instrumentation was performed for bleeding and Collaplug was placed over the blood clot, covered with MTA, and composite resin for coronal sealing. Follow up was carried out for up to 9 months and was asymptomatic. Radiographs show healing of the lesion accompanied by closure of the root canal. Conclusion: Regenerative endodontics has been shown the successful in stimulating root canal closure to treat immature teeth

Clinical Approach of Extensive Periapical Lesion with Periradicular Regenerative Surgery: A Case Report with 7 Year Follow Up

The aim of this study is to report a case of two maxillary incisors with chronic apical abscess and through-and-through lesion submitted to periradicular regenerative surgery, with clinical follow-ups and evaluation through cone-beam computerized tomography for 7 years. In the presentation, there was a persistent sinus tract in the palate and sensibility to touch at the apical region of the central and left lateral maxillary incisors. The initial tomography revealed the presence of an extensive radiolucent area in the apical third of the referred teeth, with loss of the buccal and palatal cortic es. For the treatment, a periradicular regenerative surgery was performed, an association of endodontic surgery with Guided Tissue Regeneration technique, using bovine bone xenograft and bioabsorbable membrane. The clinical and radiographic evaluations, including cone-beam computerized tomography, at seven years postoperatively, showed absence of symptomatology and sinus tract, probing depth within normal standards and apical bone neoformation.

Inhibitory Effect of Medicament Camphorated Parachlorophenol to Bacteria in Chronic Apical Abscess

Chronic apical abscesses are triggered by bacteria belonging to the Staphylococcus and Streptococcus genus. The use of adequate endodontic treatments and materials is essential for long-term performance treatment. Camphorated parachlorophenol has high antibacterial activity, evaporating continuously and diffusing throughout the root canals. This study aims to determine the inhibitory effect of camphorated parachlorophenol on Staphylococcus and Streptococcus in a chronic apical abscess. This experimental study using the well-diffusion test and the Davis and Stout inhibitory zone classification. Six Staphylococcus and one Streptococcus isolated from the apical abscess root canal are used in this study. The 50% and 75% camphorated parachlorophenol with chlorhexidine gluconate 2% as a positive control and Dimethyl sulfoxide (DMSO) as a negative control were test the sensitivity of bacteria Staphylococcus cohnii, Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus, Staphylococcus warneri and Streptococcus salivarius. The inhibitory zone diameter was calculated for each concentration and bacteria. Staphylococcus and Streptococcus genus were found to be 100 percent highly susceptible to camphorated parachlorophenol, while Staphylococcus genus were 50 percent and 75 percent extremely susceptible. The inhibitory zone of camphorated parachlorophenol 50 percent was slightly higher than the inhibitor zone of camphorated parachlorophenol 75 percent. The highest significant ratios of camphorated parachlorophenol 50 percent and 75 percent inhibitory zone were found in Staphylococcus hominis, Staphylococcus warneri, and Staphylocccus saprophyticus. Antibacterials in chemical compounds affect bacteria through three mechanisms: damaging cell membranes containing lipids, modifying proteins, or modifying DNA. In conclusion, camphorated parachlorophenol as a medicament has an inhibitory effect to Staphylococcus and Streptococcus genus. Staphylococcus epidermidis, Staphylococcus warneri, Staphlyococcus saprofiticus, Staphlococcus haemoliticus, Staphlyococcus cohnii, Staphlyococcus hominis, and Streptococcus salivarius were highly susceptible to camphorated parachlorophenol 50% and 75%.

THE ANTIBIOTICS SENSITIVITY TEST ON STAPHYLOCOCCUS AND STREPTOCOCCUS FROM CHRONIC APICAL ABSCESS

Background: Prophylactic antibiotics are required as part of root canal therapy for patient with chronic apical abscess. Streptococcus and Staphylococcus are the most common bacteria found in root canals with chronic apical abscess. Resistance to amoxicillin, clindamycin and vancomycin has been increasing year after year, necessitating the use of a sensitivity test. The goal of this research was to determine the sensitivity of Streptococcus and Staphylococcus from root canals with chronic apical abscess to amoxicillin, clindamycin, and vancomycin to make scientific antibiotic selections. Method: Six isolates of Staphylococcus and one Streptococcus from root canals with chronic apical abscess were identified by Remel RapID and tested to 10 g amoxicillin, 2 g clindamycin, and 30 g vancomycin using Kirby-Bauer disk-diffusion sensitivity test. The diameter inhibition zone was measured and interpreted according to the CLSI (Clinical and Laboratory Standards Institute) standard. Result: Three of six Staphylococcus are resistant, one of six are intermediate, and two are sensitive to amoxicillin. While the Streptococcus is sensitive to amoxicillin. In contrast, all Staphylococcus and the Streptococcus are resistant to clindamycin. Whilst four of six Staphylococcus are resistant, two are intermediate, and the Streptococcus is resistant to vancomycin. Conclusion: Staphylococcus sensitivity to amoxicillin and vancomycin are diverse even though resistant to clindamycin. In comparison, the Streptococcus sensitivity to clindamycin and vancomycin is resistant but sensitive to amoxicillin.

Apexification with apical plug in immature permanent maxillary incisor teeth: case report

This article describes about the apexification of open apex with apical plug in immature permanent maxillary incisor teeth. A 12-year-old girl came to the Dental Hospital Hasanuddin University with a complaint of cavities in her upper front teeth. The teeth were filled one year ago, and it fell out about six months later. The right upper tooth had been swollen and sore a few days be-fore. There is a history of colliding at the age of 8 years. Radiographic examination showed a wide root canal on tooth 11 and an open apex with radiolucency in the apical area on teeth 11 and 21. So the diagnosis of these teeth was chronic apical abscess and asymptomatic apical periodontitis, respectively. After performing open access, the root canal was prepared using conventional cir-cumferential techniques, then dressing using calcium hydroxide was given for 2 weeks. Next, the apical plug procedure was per-formed using MTA. The patient showed no complaints of pain after treatment, and the size of the radiolucency image in the pe-riapical area of ​​the tooth was reduced. So, it is concluded that apexification treatment with apical plug is one of the effective treatment methods to overcome the problem of open apex in immature permanent teeth.
 Keywords: apexification, apical plug, mineral trioxide aggregate, open apex

Management of iatrogenic root perforation with grade II furcation involvement through guided tissue regeneration technique: A case with comprehensive review of clinical literature

The aim of this case report was to describe a successful repair of a long-standing furcal and coronal root perforation with grade II furcation involvement in the mesiolingual canal of a lower first molar. A 41-year-old male patient reported with the chief complaint of mild intermittent pain and pus discharge from mandibular left first molar for 1 year. Upon clinical and radiographic examination, a pulpal diagnosis of previously initiated therapy with root perforation was made. In addition, the tooth had a periapical diagnosis of chronic apical abscess, as well as a primary endodontic and secondary periodontal lesion with grade II furcation involvement. Root canal treatment and surgical repair of the perforation and furcation involvement with Mineral Trioxide Aggregate and bone graft was done. Recall examination after 2 years showed no evidence of periodontal breakdown. The patient was asymptomatic, and favorable bone regeneration and periodontal healing were seen on the radiograph. A literature review was also conducted to assess the factors affecting the prognosis of perforation repair in molars. Long-standing cervical root and furcal perforations readily lead to persistent endo-perio lesions and have been found to have the worst prognosis. A biocompatible sealing of the perforation site along with periodontal regeneration effectively enhances the longevity of such teeth. Though there are very few case reports that advocated the use of guided tissue regeneration for periodontal regeneration, nevertheless it has proven to be a reliable technique to improve the prognosis for crestal level and furcal root perforations.

Penatalaksanaan Perawatan Saluran Akar pada Gigi dengan Lesi Abfraksi : Laporan Kasus

Background: Pulp and periapical disease may also result from the presence of a cervical cavity reaching the pulp chamber as an abfraction lesion. Abfraction causes the dentinal tubules to be exposed so that it becomes a pathway for microorganisms to enter the pulp. Root canal treatment in cases with abfraction lesions requires special management, so that contamination does not occur during treatment due to the exposed cervical part. Objective: Discusses the management of root canal treatment in teeth with abfractional lesions that penetrate the pulp chamber. Case Management: A 53-year-old male patient came RSGM Unand because he wanted to be treated for a cavity in his right lower posterior tooth and had a sudden throbbing pain. Based on the results of subjective, objective and preoperative radiographs, tooth 45 was diagnosed with pulp necrosis with chronic apical abscess. Pulp and periapical disease of tooth 45 was probably caused by the entry of microorganisms through the abfraction lesion that reached the pulp chamber. Temporary coronal seal of the abfraction cavity and access occlusal cavity is necessary to prevent the entry of microorganisms during root canal treatment procedures. The final restoration is a direct composite resin using a fiber-reinforced composite (FRC). Conclusion: The management of root canal treatment in this case of abfraction lesion showed success as indicated by the absence of subjective complaints, objective examination showed negative results, and periapical lesions showed healing seen on periapical radiographs.