Healing Of Large Periapical Lesion Research Articles

Healing of Large Periapical Lesions with Non-Surgical Endodontic Treatment

Healing of Large Periapical Lesions with Non-Surgical Endodontic Treatment

Healing of large periapical lesion by Regenerative Endodontic procedure in immature and mature permanent teeth with/without collagen-hydroxyapatite scaffold: A Case report

Healing of large periapical lesion by Regenerative Endodontic procedure in immature and mature permanent teeth with/without collagen-hydroxyapatite scaffold: A Case report

Association between the irrigation-agitation techniques and Periapical Healing of large periapical lesions: a Randomized Controlled Trial

ObjectivesThe aim of this study was to evaluate the effects of manual dynamic activation (MDA), passive ultrasonic irrigation (PUI), and laser-activated irrigation (shock wave-enhanced emission photoacoustic streaming (SWEEPS)) on the periapical healing of large periapical lesions following nonsurgical root canal treatment.Materials and methodsA total of fifty-six systemically healthy patients with a mandibular single-rooted tooth with periapical lesions of endodontic origin and a periapical index score of 3 or higher were included in the study. Before the treatment procedures, lesion volumes were determined volumetrically using cone–beam computed tomography (CBCT). Patients were randomized into treatment (MDA, PUI, SWEEPS) and control groups (n = 14). Root canal treatment and irrigation procedures were performed by a calibrated postgraduate operator and completed at one visit. For routine follow-up, clinical and radiographic evaluations were performed by a blinded evaluator using periapical (PA) radiographs according to Molven’s criteria at 3, 6, and 9 months. At 12 months, lesion volumes were quantified volumetrically using CBCT (ITK-SNAP). The data were statistically analyzed with the Wilcoxon test. The significance level was set at p < 0.05.ResultsIn all groups, the mean lesion volume after treatment was significantly smaller than the mean volume before treatment (p = 0.001). Among the 56 teeth, 11 teeth were ‘totally healed’, and 39 teeth were ‘reduced’ on PA radiographs. No ‘enlargement’ was detected in any group. On CBCT, the lesion volume decreased in the following order: LAI-SWEEPS (86.9%) > PUI (85.4%) > MDA (80.4%) > control (74.5%), with no statistically significant difference (p > 0.05).ConclusionsDespite the limitations of the present study, although a greater percentage of healing was observed in the LAI-SWEEPS and PUI groups, irrigation procedures had no statistically significant effect on the healing of periapical lesions with a single root canal at the 12-month follow-up. On the other hand, the outcome may change in multirooted teeth with curved and complex root canal systems.Clinical relevanceIn the short term and in single-canal teeth, advanced irrigation agitation methods such as laser and ultrasonic did not make a difference in healing other than manual irrigation agitation.

Predictors of periapical bone healing associated with teeth having large periapical lesions following nonsurgical root canal treatment or retreatment: A cone beam computed tomography-based retrospective study.

Several factors influence the condition of the periapical tissues associated with root filled teeth. The primary objective of this study was to retrospectively evaluate the extent and speed of bone healing of large periapical lesions associated with nonsurgical root canal treatment or retreatment. The secondary objective was to analyse the relationship between the time to complete healing when analysed using cone beam computed tomography (CBCT) and other possible predictors that affect healing. Seventy-nine patients were treated during the years 2013-2020 with large periapical lesions of endodontic origin (10-15 mm) as observed on intraoral periapical radiographs (IOPAR) were included. IOPAR and CBCT were available before treatment and during the follow-up (IOPAR every 6 months and CBCT every 12 months). The volume of periapical lesions was calculated by OsiriX Lite software. Variables such as initial volume of the lesion, age, gender, type of treatment or type of root canal filling were compared to identify the differences between healed and unhealed lesions. Pearson's Chi-square test was used for categorical variables, the t-test for age and the Wilcoxon test for initial volume of the lesion. The association between time to healing and the variables was assessed using univariate analysis and multivariate analysis. The Wilcoxon test was used to observe the association of healing time with categorical variables and the correlation index was measured with the quantitative variables. Of the 79 cases analysed, 60 lesions (76%) were completely healed as verified by CBCT in a mean healing time of 19 months, of which 60% healed fully between 12 and 18 months. Increase in age of patient and larger initial volume of the lesion were associated with a significantly longer healing time (p < .001). Gender, filling material and type of treatment did not have a significant effect on the healing process (p > .05). Clinicians should be aware that periapical lesions in older patients and larger areas of bone loss take longer to heal. CBCT monitoring of large periapical lesions is critical and it can help clinicians in the decision-making process.

Healing of Large through-and-through Periapical Lesion 24 Managed by Non-Surgical Endodontic Treatment

The present case report demonstrates the nonsurgical endodontic treatment intervention of a large through-and-through periapical lesion in the anterior maxillary region of an 18-year-old female with a chief complaint of regular swelling and drainage of pus from the buccal and palatal areas of the maxillary anterior region of gingiva with no history of pain. The treatment includes thorough chemomechanical debridement, followed by complete endodontic therapy. The root canal was filled with calcium hydroxide for 2 weeks, followed by a bioceramic apical plug and obturation. Clinical and radiographic re-evaluations up to 2 years showed a total cure of periapical lesion. This case report shows that the conservative nonsurgical approach leads to the complete healing of large periapical lesions.

Resolution of Apical Periodontitis-induced Mental Nerve Paresthesia Through Nonsurgical Endodontic Retreatment: A Case Report

Paresthesia is a potential consequence of unsuccessful root canal treatment. Persistent infection resulting in apical periodontitis may enlarge sufficiently to involve the mental neurovascular bundle. The case presented in this report was referred for endodontic evaluation with a chief complaint of discomfort on mastication and persistent numbness of the lower left lip. Clinical and radiographic evaluation revealed incomplete primary endodontic treatment of the left mandibular second premolar with complex internal anatomy. The untreated root canal system resulted in the progression of apical periodontitis involving the left mental neurovascular bundle as confirmed by cone-beam computed tomography imaging. Nonsurgical root canal retreatment was performed over 2 visits. At the 3-year follow-up visit, the paresthesia had resolved with return of normal sensation. Nonsurgical endodontic retreatment may be sufficient to allow healing of large periapical lesions and resolve complications including paresthesia without the need for surgical intervention.

Non surgical management of a large periapical cyst like lesion using metapex, a three year followup - A case report

This case report describes the non - surgical management of a large periapical lesion using Metapex as a intracanal dressing and root canal therapy. Periapical lesions usually develop in non-vital teeth as a result of chronic aggression by the pathogenic microorganisms into the root canal which may appear as radiolucent in periapical radiographs. Treatment of such lesions usually varies from non-surgical and surgical means depending on the individual. In the era of minimally invasive, dentistry, non-surgical endodontic approach has been highly recommended in the periapical healing. This case report shows the healing of large periapical lesion using metapex as intracanal medicament at various time intervals followed by root canal therapy.

Iatrogenic Extrusion of Calcium Silicate Cements on Teeth Associated with Large Periapical Lesion: A Case Report with 12-Month Follow-up

Traumatic dental injuries can result in pulp necrosis and apical periodontitis, impairing root development. When this condition is left untreated, it causes inflammation in the tissues at the apex, which may lead to significant damage of the periapical alveolar bone. Tooth with open apex may have a risk of iatrogenic error of extrusion material during the stage of root canal obturation. Objective: This case report discussed the bone healing of large periapical lesion of an iatrogenic extrusion of calcium silicate cement in an open apex maxillary left central incisor. Case report: A 35-year-old female patient presented with a main complaint of a discoloured upper front tooth that was affecting with her appearance. Clinical examination showed her left maxillary central incisor was diagnosed with pulp necrosis and symptomatic apical periodontitis. Periapical radiograph revealed the tooth has an open apex and large periapical lesion. After chemomechanical disinfection, an apical plug was placed with bioceramic material. Periapical radiographs taken postoperatively demonstrated the extrusion of bioceramic material into the periapical lesion. After a year, the tooth does not exhibit any symptoms, and periapical radiographs showed that the periapical region has totally healed. Conclusion: Extruded bioceramic material has no detrimental impact on periapical tissue healing, as evidenced by 12-month follow-up observations.

English

Periapical surgery is the treatment of choice for a large periapical lesion with bone loss that occurs due to long standing untreated teeth affected by trauma, caries or in situations where there is an endodontic treatment failure. Failure of nonsurgical endodontic treatment may be due to peri radicular tissues incorporating with infections, foreign body response to filling materials, over instrumentation or over obturation which might have prevented complete periapical healing. We present here 2 case reports wherein, combination of platelet-rich fibrin (PRF) and the hydroxyapatite (HA) graft was used to achieve rapid healing of large periapical lesions, and the treatment outcome concluded that PRF and hydroxyapatite bone graft accelerated the wound healing and induced the rapid rate of bone formation, which was confirmed radiographically. Untreated non-vital teeth generally result in bone destruction in periapical region, which may occur due to the spread of infection following pulpal necrosis, trauma or failed endodontic treatment. Surgical intervention is essential when endodontic treatment has failed and retreatment is not possible. Periapical surgery, Apicoectomy or root end resection endodontic surgery is a safe and well documented treatment alternative when teeth with periapical pathosis are not responding to conventional endodontic treatment.1 Periapical surgery removes periapical pathosis resulting in optimal wound healing with regeneration of the bone and periodontal tissue.

SUCCESSFUL NON SURGICAL MANAGEMENT OF A LARGE PERIAPICAL LESION – TWO CASE REPORTS

Aim: The aim of these case reports is to emphasize the successful healing of large periapical lesions using non surgical endodontic treatment with advanced techniques Background: Periapical lesions of endodontic origin are common pathological conditions affecting the periradicular tissues. The primary objective of root canal treatment is to cure or prevent periradicular periodontitis and to retain natural teeth in function and aesthetics Case description: Two case reports of large periapical lesions are described here which have shown favourable clinical and radiographic outcome following non surgical endodontic therapy Conclusion: Size of a periapical lesion does not necessarily mandate surgical intervention always and has shown the potential to heal following conservative endodontic therapy. Assessment of healing of a large periapical lesion necessitates a long term follow up and has to be done periodically. Clinical significance: The article highlights that present day endodontic treatment has become predictable and highly successful due to the advancements in diagnostic imaging techniques, rotary instruments, irrigants , intracanal medicaments and obturation systems which has in turn led to the fall in root end surgeries

Healing of periapical lesion with mineral trioxide aggregate apexification

In the present study, the ability of mineral trioxide aggregate in the formation of apical plug for healing of large periapical lesion with open apex was assessed and evaluated the clinical outcome. Fifteen participants with periapical lesion at the upper anterior teeth with open apex were treated with mineral trioxide aggregate. The effect on healing of apical size was evaluated at 3, 6, and 12 months by radiological examinations in the form of periapical index criteria, diameter of the lesion size and the presence or absence of apical tissue barrier. The results found that neither pain nor any sinus was detected at 12 months. The mean size of the apical lesion was gradually reduced from 5.1 × 3.8 to 1.5 × 0.9 mm and mean PAI was reduced from 3.3 to 1.7 mm. The differences between mean size of periapical lesion at preoperative and 12 months observation period was also statistically significant (p&lt;0.05). The clinical success shown significant success rate of 93.3% analyzed with Z-test. In conclusion, tooth with open apex can be successfully treated with mineral trioxide aggregate apexification technique followed by root canal obturation.

Clinical and Radiographical Evaluation of the Healing of Large Periapical Lesions using Triple Antibiotic Paste, Photo Activated Disinfection and Calcium Hydroxide When used as Root Canal Disinfectant

Clinical and Radiographical Evaluation of the Healing of Large Periapical Lesions using Triple Antibiotic Paste, Photo Activated Disinfection and Calcium Hydroxide When used as Root Canal Disinfectant

A comparative clinical study to evaluate the healing of large periapical lesions using platelet-rich fibrin and hydroxyapatite

Aims: To evaluate and compare the effectiveness of periapical surgery using mineral trioxide aggregate (MTA) as a retrograde filling material with/without using hydroxyapatite or platelet-rich fibrin (PRF) in curetted periapical defect and to evaluate the patients clinically and radiographically at each recall visit. Subjects and Methods: The study was conducted on thirty patients having periapical radiolucency in maxillary anterior teeth. The selected teeth were divided into three groups: Group A, Group B, and Group C having 10 teeth each. All the teeth were treated with single visit root canal treatment. The periapical curettage along with apicoectomy was followed thereafter. In all the groups, root end cavity was prepared. In Group A, root end cavity was filled with MTA. In Group B, root end cavity was filled with MTA followed by placement of hydroxyapatite in the curetted periapical defect. In Group C, root end cavity was filled with MTA followed by placement of PRF in the curetted periapical defect. In all the three groups, patient recall visits were scheduled after 1, 3, 6, and 9 months time interval for clinical and radiological examination. Results: A significantly higher rate of healing was observed after 9 months in Group C (82.36%) followed by Group B (65.16%) and Group A (60.12%). Conclusions: Placement of root end filling material contributes greatly to the success of surgical treatment. To enhance the healing of periapical defect, use of host modulating agents such as PRF is preferred over grafts as these are autologous and contain growth factors that promote faster healing of periapical defects.

English

In this study, a patient with a large periapical lesion related to the maxillary left central incisor and two canalled lateral incisors was presented. A single visit non-surgical root canal treatment was performed for both teeth. A three-year follow-up radiograph revealed complete healing of the periapical lesion. This report confirms that the large size of a periapical lesion neither mandates surgical removal nor the placement of intra-canal dressing and that such a lesion can heal following a conservative single visit endodontic treatment. Furthermore, familiarity with the variations of root canal morphology is essential for successful endodontic treatment. Maxillary lateral incisors usually have a single canal; however, this case report describes endodontic treatment of maxillary lateral incisor with two buccopalatal root canals. Key words: Healing of large periapical lesion, single visit root canal treatment, two canalled maxillary lateral incisor.

Endodontic treatment of large periapical lesions: An alternative to surgery

Introduction: Non-surgical treatment with calcium hydroxide offers a high success rate in the healing of large periapical lesions. Case Series: We present the healing of large periapical lesions with conservative, non-surgical treatment in three young patients presenting large periapical lesions and diagnosed with chronic periapical periodontitis. Non-surgical endodontic treatment was carried out involving canal preparation, irrigation with 2.5% sodium hypochlorite, filling of the canal with 75% calcium hydroxide and 25% Kri-1 iodoform paste mixed with sterile saline solution, and sealing of the cavity with composite. The filling was replaced several times, after which endodontic treatment was finally carried out. Complete apical healing was observed in all cases. Conclusion: Non-surgical treatment as a first option allows us to avoid the trauma of surgery in young individuals.

Healing of Large Periapical Lesions by Non-surgical Approach - Case Reports

Introduction: Periapical lesions generally develop as a sequel to pulpal infection. When there is a large periapical tendency visible on the radiograph, clinicians tend to have a surgical approach towards treatment. However a nonsurgical approach with appropriate use of intracanal medicaments should be attempted to salvage teeth. This paper demonstrates healing of large periapical lesions in two cases by non – surgical Endodontic treatment Case Presentation: This report describes Endodontic treatment of a mandibular first molar and maxillary incisors. Calcium hydroxide in an aqueous vehicle was placed as intracanal medicament, the dressing changed every fifteen days for a period of three months. Continued follow ups demonstrated radiographic healing and the patients were asymptomatic. Conclusion: The case reports presented in this article showed healing of large periapical lesions following endodontic treatment. Isolation with rubber dam, thorough chemo mechanical debridement of the root canal space with use of calcium hydroxide as intracanal medicament is emphasized. Case Study Paul and Dube; BJMMR, 10(5): 1-6, 2015; Article no.BJMMR.18978 2

Non Surgical Management of Large Periapical Lesions of Endodontic Origin: A Case Series

ABSTRACT The success of root canal treatment is based on total elimination of root canal content, thorough cleaning, shaping and obturation of root canal system. Calcium hydroxide is recommended as intra-canal medicament because of its antibacterial properties, tissue dissolving ability, inhibition of tooth resorption and indication of tissue repair by hard tissue formation. The present case series highlights the use of calcium hydroxide as an inter appointment endodontic dressing for management of large periapical radiolucency and periodically reviewed. Thus the non surgical healing of large periapical lesions provided favourable clinical and radiographic response.

Clinical and radiographical evaluation of the healing of large periapical lesions using triple antibiotic paste, photo activated disinfection and calcium hydroxide when used as root canal disinfectant.

Objectives: To evaluate clinically and radio graphically, the healing following nonsurgical treatment of periapical lesions when Photo Activated Disinfection(PAD), triple antibiotic paste and calcium hydroxide was used as root canal disinfectant. Material and Methods: Sixty patients (20 for PAD, 20 for triple antibiotic paste, 20 for calcium hydroxide) with periapical lesions in the maxillary and mandibular anterior region were selected from the outpatient section of the Department of Conservative Dentistry & Endodontics, Govt. Dental College, Kozhikode to participate in this study. The patients were selected with a preoperative score of 4 or 5. There were no significant differences for the PAI Scores between the three groups at the start of the experiment .Intracanal disinfection was done in the three groups followed by obturation. The patients recalled at 3,6,12,18 months interval. Results: At 18 months follow up 15 % of cases failed in calcium hydroxide group,5% in triple antibiotic paste and no failure cases were seen in PAD group. Success criteria were divided into strict and loose, while the former had statistically significant p value the latter did not. Kruskal-Wallis Test showed an increased mean value for PDT and a significant change in p value. Bonferroni post hoc test was done to compare if there is any significant change between groups. Only significant change was found between calcium hydroxide and photoactivated disinfection . Conclusion: PAD was more effective intracanal disinfectant at 6,12 and 18 months. Key words:Calcium, hydroxide, photo activated disinfection, triple antibiotic paste, root canal disinfection

Healing of large periapical lesion: A non‐surgical endodontic treatment approach

A patient with a large periapical lesion around the apices of her mandibular incisors is presented. During the conservative non-surgical endodontic treatment, sodium hypochlorite was used for irrigation, and calcium hydroxide was used for the intra-canal dressing. Periapical healing was observed 1 month after obturation and continued in the 12-month recall. This report confirms that the large size of a periapical lesion does not mandate its surgical removal, and that even cyst-like periapical lesions heal following a conservative endodontic therapy.

Conservative Endodontic Management Of Teeth Associated With Extensive Periapical Pathology: Report Of Two Cases

Traditionally, long-term calcium hydroxide dressings have been recommended for the conservative management of large periapical lesions. However, calcium hydroxide therapy has some disadvantages such as variability of treatment time, difficulties with patient follow-up and prolonged treatment periods that increase the risk of root canal contamination via microleakage and crown fractures. This paper reports the healing of large periapical lesions following conservative non-surgical treatment with calcium hydroxide dressings.