Healing Of Lesions Research Articles

Tooth vitality and periapical healing: is Biodentine at par with MTA in regenerative endodontics?

The study is a prospective, double-blinded randomised control trial that compares the mineral trioxide aggregate (MTA) and Biodentine as the pulp space barrier material after induction of a periapical blood clot by over-instrumentation for endodontic regeneration in single-rooted mature permanent anterior tooth (closed apex) with apical periodontitis (periapical pathology of more than 3 mm) and having necrosed pulp. A total of 36 patients were included in the study and after randomisation were allocated equally to both the groups out of which 31 patients returned for follow-up over an 18-month period. The treatment protocol consisted of two separate appointments. At the first appointment, a standardised and custom-made radiographic guide was prepared for each patient to ensure uniformity and repeatability of the radiographs at subsequent follow-up visits. This was followed by access to the pulp chamber and biomechanical preparation of the single canal up to master apical file size. The irrigant used in each case was 1.5% sodium hypochlorite and also calcium hydroxide intracanal medicament was placed during this visit. The interval between the two appointments was not fixed and depended on the patient's symptoms following the first visit; however, the maximum allowable time frame was set at 3 weeks. During the second visit after irrigation with 17% ethylenediaminetetraacetic acid (EDTA) over instrumentation was done to induce bleeding that was allowed to fill the canal. The clot was stabilised by collagen plug and the pulp space sealer (either MTA or Biodentine) was placed below the cementoenamel junction following which composite restoration was done. The radiographs were taken before the treatment, after both the appointments and at 6, 9, 12 and 18 months subsequently by a single experienced examiner. Pre-operatively, a periapical index score (PAI) was given to each case and the sensibility test was performed at 6, 12, 18 months postoperatively using an electric pulp tester (EPT). Participants were recruited from the Department of Endodontics outpatient clinic. The patients were aged between 10-35 years and had no systemic conditions. For inclusion in the study, participants were required to have mature anterior tooth (single root canal) with closed apex associated with apical periodontitis and necrotic pulp having periapical radiolucency of more than 3 mm on the radiograph. Patients suffering from periodontitis (ensured by periodontal probing) and those having developmental anomalies of the teeth were excluded from the study. The normalcy of the data was assessed by Shapiro-Wilk test. Continuous data was analysed by Mann Whitney U test and the categorical data was analysed by Chi-square test and Fisher's exact test. With the level of significance set at 0.05. Firstly, the author presented the overall healing of the periapical lesion from Fisher's exact test, which showed that after 18 months, out of 31 patients, 21 cases (67.7%) had completely healed and 10 cases (32.3%) showed signs of healing and no case remained unhealed. The difference between the Biodentine and MTA was non-significant as derived from the Chi-square test for comparison of postoperative lesion sizes score at 18 months postoperatively. Secondly, based on EPT, the author presented the regain of tooth sensibility from Fisher's exact test which shows that out of 31 cases, 22 (71%) showed a positive response to EPT and 9 cases (29%) showed no response. Again, the difference between Biodentine and MTA was non-significant. Both Biodentine and MTA when used as pulp space barrier in regenerative endodontic procedures showed promising results. In both groups significant reduction in the size of periapical radiolucency was noted along with resolution of patient's symptoms. There was also significant regain in the tooth sensibility postoperatively. As there was no significant difference between the two in the treatment outcomes, both of these biomaterials can be used to treat apical periodontitis in mature permanent tooth as an alternative to conventional endodontic treatment in which the vitality of tooth is lost.

Photodynamic Therapy Mediated by Curcumin and Blue Light for Recurrent Herpes Labialis: A Case Report.

This study is the first to use photodynamic therapy (PDT) mediated by curcumin and blue light for the treatment of recurrent herpes labialis. According to our study, PDT effectively accelerated lesion healing and reduced its recurrence. PDT may represent a promising, safe, and cost-effective treatment option for this challenging disease.

The efficiency of single-session photobiomodulation on healing of periapical bone lesions using CBCT: a randomized clinical trial

As photobiomodulation is growing in the dental field the aim of this prospective, two-arm clinical trial was to assess the radiographic changes for chronic periapical bone lesions related to mandibular molars after primary root canal therapy with or without applying Diode laser on soft tissue. The samples were randomly divided into a Laser group and a mock laser (ML) group. Preoperative CBCT images were compared 12 months later with postoperative CBCT to gauge the changes in the volume of the bony lesion by two observers. The kappa coefficient was calculated to assess the intra-observer agreement. Data were presented as median, mean, and standard deviation (SD) values. For parametric data (age), a Student’s t-test was used. Qualitative data (Gender) was presented as frequencies and percentages and then analyzed by Chi-square test. The Wilcoxon signed-rank test was used to compare CBCT measurements pre- and post-treatment. The significance level was set at P ≤ 0.05. The collected data in this study showed that there was no statistically significant difference between median volumes of the periapical lesion in the Laser and ML groups (P-value = 0.564, Effect size = 0.237) and (P-value = 0.452, Effect size = 0.310), respectively while, there was a statistically significant decrease in the volume of periapical lesion post-treatment within each group (P-value < 0.001). The size of the periapical bony lesion decreased significantly after conventional endodontic treatment whether Laser was applied or not. The study protocol was enrolled as NCT04311905 at www.clinicaltrials.gov database on (17/03/2020) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASURecID091703).

A Multicentre Evaluation of a Ceramide-Containing Hydrating Cream-to-Foam Cleanser and Facial Moisturizing Lotion for Improving Topical Treatment Tolerability in Facial Acne.

Acne vulgaris (AV) is a common skin condition that can cause substantial psychosocial impact. Treatments of AV target clearing and prevention of lesions and reducing scarring and dyspigmentation. Numerous medications are used to target one or more of the pathogenetic factors contributing to AV. The irritative potential of acne products and their tolerability are important aspects that may affect patient adherence to therapies. Adjunctive skincare products offer several benefits to acne-prone skin, by reducing redness, inflammation, and discomfort and improving skin texture. In addition, complementing AV prescription interventions reduces the time to healing of lesions, the extent of scarring, and the number and severity of breakouts. This multicentre, open-label, single-cohort study evaluated the use of ceramide-containing hydrating cream-to-foam cleanser and facial moisturizing lotion for improving topical treatment tolerability and adherence in facial acne. Combining a proper skincare regimen with acne treatments may help decrease their irritating potential and support the skin barrier, which can improve treatment adherence and ultimately, treatment outcomes.

Nanotechnological Advances in Burn Wound Care: Silver Sulfadiazine-Loaded Nanosuspension-Based Chitosan-Incorporated Nanogel for Partial Thickness Burns.

Burn lesions damage the skin's outermost defensive layer, allowing pathogenic microbes including Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli to infiltrate. Silver sulfadiazine (SSD) is an effective antibacterial agent approved by U.S. Food and Drug Administration (US-FDA) and is considered as the gold standard for burn wound treatment. Despite the high degree of efficacy of SSD in burn wound management, it possesses some drawbacks, such as poor solubility, low topical bioavailability and skin irritations. The present study endeavors to develop nanosuspension based SSD nanogel for improving the deliverability of SSD and its therapeutic outcomes for the management of partial thickness burn. The SSD nanosuspension was formulated employing controlled nanoprecipitation approach using various surfactants. The formulation was optimized utilizing one-factor-at-a-time approach and to fetch the optimized formulation of 134.6 nm size. The optimized nanosuspension was incorporated into chitosan gel that offer superior drug release potential, and also offered better spreadability (5.21 ± 0.38 g) and extrudability (152.27 ± 0.22 gm) that represents the easy application over the skin and extrusion of gel from the tube. The formulation was well tolerated as shown by skin irritation study and offered a superior burn lesion healing characteristics vis-à-vis the marketed product, even at a lower concentration. Hence, the formulation offers a huge potential in enhancing the clinical outcomes of SSD, especially in the management of partial thickness burn. The developed system with the above mentioned outcomes could be a promising delivery system for partial thickness burn wound management.

Gene Therapy and Diabetes: A Narrative Review of Recent Advances and the Role of Multidisciplinary Healthcare Teams.

Introduction: Gene therapy has emerged as a promising frontier in the management of diabetes, offering innovative approaches to address both type 1 and type 2 diabetes. This narrative review examines the advancements in gene therapy applications, focusing on both animal and human studies, and includes a total of 11 studies in adherence to PRISMA guidelines. These studies utilize various viral vectors, such as adeno-associated virus (AAV) and lentivirus, to deliver genes that regulate insulin production and enhance angiogenesis. This review aims to synthesize recent advancements in gene therapy for both type 1 and type 2 diabetes and its complications, and to explore the evolving role of pharmacists in this emerging field. Methods: A comprehensive search was conducted to identify relevant studies on gene therapy for diabetes. Databases such as PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Google Scholar were queried using keywords such as "Diabetes", "gene therapy", "Type 1 diabetes", and "Type 2 diabetes". Both animal and human studies were included to provide a broad perspective on the advancements in this field. Results: Animal model studies have shown promising results, including sustained insulin production, improved glucose homeostasis, and enhanced wound healing. Human studies, though fewer in number, have reported significant advancements. Patients with diabetic neuropathy treated with plasmid VEGF and recombinant adeno-associated virus (rAAV) showed improvements in neuropathic symptoms and glycemic control. Other studies involving intramuscular injections of VM202 and bicistronic VEGF165/HGF plasmid have reported pain reduction, improved healing of ischemic lesions, and increased angiogenesis. Conclusions: Despite these encouraging results, limitations such as small sample sizes, short follow-up periods, and the necessity for more extensive clinical trials persist. Diabetes is a metabolic syndrome that requires the collaboration of a multidisciplinary team to assist in several aspects of implementing successful gene therapy. Several healthcare providers and policy makers may play a crucial role in patient education, counseling, and the management of gene therapy treatments.

D-mannose promotes diabetic wound healing through inhibiting advanced glycation end products formation in keratinocytes

BackgroundDiabetic chronic foot ulcers pose a significant therapeutic challenge around the world, resulting in adverse effects and complications in patients. D-mannose is enriched in cirtus peel and exerts beneficial effects among various diseases, especially against inflammation-related disorders.MethodsHere, we examined the potential effect of D-mannose during wound healing process in streptozotocin (STZ)-induced diabetes mice in vivo and by culturing keratinocytes under high glucose condition in vitro. The skin lesion healing was recorded in photos and evaluated by histochemical staining. What’s more, the advanced glycation end products (AGEs) concentration in blood and mice skin was quantified. Apoptotic cells were assessed by flow cytometry and Western blotting. Inflammatory cytokines and cellular differential gene expression levels were measured by real-time PCR. The expression of the AMPK/Nrf2/HO-1 signaling-related molecules was determined by Western blotting.ResultsWe first found that topical supplementation of D-mannose remarkably improved skin wound healing in diabetes mice. Furthermore, both in vivo and in vitro experiments demonstrated that D-mannose reduced the AGEs generation. Mechanistically, D-mannose inhibited AGEs, then upregulated AMPK/Nrf2/HO-1 signaling in the context of high glucose to maintain keratinocyte normal functions, which positively influenced macrophage and fibroblast to accelerate diabetic wound healing. Noteworthily, these protective effects of D-mannose were abolished by the pretreatment with inhibitors of AGEs or AMPK.ConclusionAs far as we know, this is the first study exploring the protective role of D-mannose on diabetic wound healing via topical supplementation. We find that D-mannose protects keratinocytes from high glucose stimulation via inhibition of AGEs formation as well as orchestrates inflammatory microenvironment in diabetic wounded skin, suggesting its supplementation as a potential therapy to promote refractory wound healing in diabetic patients.

Cutaneous ulceration in dermatomyositis : Case reports with positive anti-NXP-2/anti-TIF1-gamma antibody status

Painful ulcerations developed in a33-year-old woman with anti-NXP-2-positive dermatomyositis in the facial and trunk areas and a 67-year-old woman with TIF1-gamma-positive dermatomyositis on the hands, while undergoing systemic therapy with azathioprine or low-dose methylprednisolone and cyclic administration of intravenous immunoglobulins (IVIG), respectively. In the laboratory workup, the anti-MDA‑5 antibody status remained negative and the creatine kinase (CK) normal in both patients, while histopathological examinations were nonspecific. Intensive topical class4 corticosteroid therapy and continuation of the immunosuppressive or immunomodulating therapy led to healing of the ulcerative skin lesions. This report aims to raise awareness of the rare occurrence of cutaneous ulceration in anti-NXP-2- or anti-TIF1-gamma-positive dermatomyositis, as ulcerations may be associated with a severe disease course. In both of our patient cases, it is exclusively adermal manifestation without other complications.

Treatment of severe flares in Crohn's disease and ulcerative colitis

In chronic inflammatory bowel diseases (IBD), severe flares are characterized by intense inflammatory activity and ahigh disease burden for patients. Treatment addresses both short-term goals (e.g., symptom reduction, prevention of complications) and long-term goals (sustained clinical steroid-free remission and healing of inflammatory lesions, known as "mucosal healing"). To present evidence-based, targeted diagnostics and stepwise treatment of severe flares in Crohn's disease (CD) and ulcerative colitis (UC), in order to prevent complications, including mortality, and to achieve rapid remission. Selective literature review, including German and European guidelines for the treatment of severe flares. After ruling out complications (e.g., infections, strictures, abscesses, toxic megacolon), based on astructured assessment of disease severity, intravenous steroid therapy is indicated in severe acute flares for both CD and UC, which should lead to improvement within the first 72 h. If no improvement occurs, medical therapy must be intensified. Various therapeutics, including biologics targeting tumor necrosis factor (TNF)-α, α4ß7 integrins, interleukin (IL)-12/23 or IL-23, as well as Janus kinase (JAK) inhibitors, sphingosine 1‑phosphate receptor (S1PR) modulators, and calcineurin inhibitors, are available today, but there is no clear algorithm preferring one drug for CD or UC. Instead, treatment should be selected based on approvals, the patient's medical history, prior treatment, risk profile, and potential complications. Surgical options must always be considered as part of close interdisciplinary care.

A Case of Euglycemic Diabetic Ketoacidosis in a Patient with Diabetic Foot Syndrome.

Euglycemic Diabetic ketoacidosis (E-DKA) is a life-threatening emergency characterized by ketonemia and metabolic acidosis in presence of relatively normal glycemic values. In recent years it has been associated with some predisposing conditions including sodium-glucose transporter 2 inhibitors (SGLT2-i) therapy, widely used in high-risk cardiovascular patients. We report the case of a 78-year-old diabetic woman treated with dapagliflozin, affected by critical limb threatening ischemia and septic osteoarthritis of interphalangeal joint of first right toe. At admission blood exams allowed diagnosis of E-DKA associated to acute kidney failure. The occurrence of the condition was probably due to foot infection acting on a trigger on a SGLT2-i predisposition. We treated the patient according to guidelines' indications achieving the resolution of the metabolic derangement. After the control of acute condition and return of metabolic parameters within the normal range, the patient underwent revascularization procedure and surgical debridement eventually obtaining complete healing of foot lesion.

Optimizations of Placenta Extracellular Matrix-Loaded Silk Fibroin/Alginate 3D-Printed Scaffolds Structurally and Functionally for Bone Tissue Engineering.

Recent interest has been focused on extracellular matrix (ECM)-based scaffolds totreat critical-sized bone injuries. In this study, urea was used to decellularize and solubilize human placenta tissue. Then, different concentrations of ECM were composited with 8% alginate (Alg) and 12% silk fibroin (SF) for printing in order to produce a natural 3D construct that resembled bone tissue. The physical and biological features of the printed structures were evaluated entirely in vitro. Finally, a rat model was employed to examine the optimal 3D printed scaffold (5% ECM) as a bone transplant for the healing of cranial bone lesions. The present investigation demonstrated that decellularizing placental tissue fragments led to efficient removal of cell debris. In addition, a remarkable improvement in the printed scaffolds' mechanical and biological properties was observed by increasing the ECM concentration. The histology studies and real-time PCR results demonstrated the acceleration of bone regeneration in the bone lesions treated with 5%ECM-SF/Alg at 4 and 8 weeks after implantation. Overall, these results proved that the placental ECM-printed scaffolds could potentially construct biomimetic grafts to reconstruct significant bone defects and now promise to proceed with clinical studies.

Comparative evaluation of three accidentally extruded sealers in periapical healing – An evidence – based study

Abstract Background: The present study aimed to evaluate the periapical healing of root canal treatment after accidental extrusion and rate of resorption of three different base endodontic sealers. Materials and Methods: Seventy-five patients with single visit root canal treated teeth with accidental extrusion of sealer were selected based on inclusion and exclusion criteria and were allocated into three equal groups based on different base endodontic sealers used during obturation; Grossman, Sealapex™, and Seal-pex. Radiographic evaluation was done to assess periapical healing and rate of resorption at baseline, 1, 3, and 6 months. Statistical analysis was done using one-way repeated measured analysis of variance. Results: At the end of 6 months in Group 1 (Grossman), healing was rated as unchanged in 0 patients (0%), reduced in 0 patients (0%), almost absent in 2 patients (8%) and absent in 23 patients (92%). In Group 2 (sealapex), healing was rated as unchanged in 1 patient (4%), reduced in 6 patients (24%), almost absent in 6 patients (24%), and absent in 12 patients (48%). In Group 3 (seal-pex), healing was rated as unchanged in 2 patients (8%), reduced in 10 patients (40%), almost absent in 6 patients (24%) and absent in 7 patients (28%). Conclusions: Sealapex™ has shown better periapical lesion healing compared to Grossman Sealer and Seal-pex and Grossman Sealer had shown faster rate of resorption compared to Sealapex™ and seal-pex™.

Research Progress on the Use of Cotton-Moxibustion in the Treatment of Skin Diseases

Cotton-moxibustion, also referred to as "thin cotton moxibustion," is a form of direct moxibustion that utilizes heat to eliminate excess heat and dispel stagnant fire, providing therapeutic benefits. It is primarily employed in the treatment of skin conditions, particularly in alleviating symptoms such as itching and pain, and promoting the healing of skin lesions. The procedure is straightforward and well-accepted by patients. This paper reviews recent literature on the application of cotton-moxibustion in treating skin diseases, aiming to standardize its practice and broaden its clinical use. Furthermore, it underscores the importance of preserving traditional principles while fostering innovation to better understand the mechanisms underlying cotton-moxibustion therapy.

Diagnostic Dilemmas: Anatomical Masquerades in Dental Radiographs – A Sri Lankan Perspicacity &amp;nbsp;

Dental radiographs are an essential component in routine dental practice. They serve multiple purposes such as aiding in the diagnosis, and exclusion of disease monitoring the progression or healing of lesions and observing the natural development of the dentition. Furthermore, they play a considerable role in medico-legal documentation. Dental radiographs are usually taken within the dental clinic and are not routinely reported by the radiologists. Instead, dental surgeons themselves use them for diagnostic purposes.Intra Oral Periapical radiographs, Upper Standard Occlusal radiographs, and Dental Panoramic Tomographs are frequently taken in dental practice despite their inherent limitations. Although there are better imaging techniques propitious in clinical practice, increased radiation exposure and higher cost, make them less utilized as a primary tool in day-to-day practice. Therefore, it is imperative to have a better knowledge of natural structures that are superimposed in dental radiographs. Instituting other investigations with thorough clinical assessment is highly recommended in doubtful cases.This mini review presents a series of radiographs where normal anatomical counterparts simulate pathology in them. All the presented cases were taken in Sri Lanka under the purview of the authors.

Evaluation of the Effects of MTA Apexification and Regenerative Endodontic Therapy on Lesion Healing using Fractal Analysis: A Retrospective Study.

A comparison between mineral trioxide aggregate (MTA) apexification and regenerative endodontic therapy (RET) in immature permanent teeth is pivotal for optimising treatment outcomes and enhancing clinical decision-making. Understanding the efficacy, limitations and long-term implications of each approach is essential for achieving predictable, successful outcomes when managing immature teeth with necrotic pulps. The aim of this retrospective study was to compare the changes in the periapical bone using fractal dimension (FD) on the periapical radiographs of patients who underwent apexification and RET. The lesion area was evaluated using fractal analysis on periapical radiographs obtained before and one year after treatment with the ImageJ program. Additionally, periapical status was classified using the periapical index (PAI). The significance level was set at 0.05. In the present study, we found that the changes in FD and PAI over a one-year observation period were independent of the specific root canal treatment technique used. According to the fractal analysis, neither MTA apexification nor RET with tripleantibiotic paste is superior for immature teeth with pulp necrosis resulting from dental trauma.

Comparative Efficacy of Conventional Versus Diode Laser Assisted Root Canal Treatment in Reduction of Postoperative Pain and Healing of Periapical Lesion: A Randomized Controlled Clinical Trial

ABSTRACT Background: Laser assisted root canal treatment has emerged as a promising adjunct to conventional randomized controlled trials (RCTs). Material and method: To evaluate the same, we observed 90 patients (98 roots) with chronic periapical lesions; they were randomized into two groups (n = 45): diode laser and control. The level of pain was measured before and at 6, 12, 24, 48, and 72 hours after treatment using a visual analog scale. Cone beam computed tomography images were obtained before and 6 months after treatment to assess the healing of periapical lesions based on their apicocoronal, mesiodistal, and buccolingual diameters. Result and conclusion: It was observed that root canal disinfection by diode laser significantly decreased the postendodontic pain and resulted in a higher success rate in lesion resolution.

CLINICAL APPLICATIONS OF MINERAL TRIOXIDE AGGREGATE IN ENDODONTICS: A CASE SERIES

In recent years, mineral trioxide aggregate (MTA) has been used extensively in endodontic treatment applications and satisfactory results have been obtained. This case series aims to describe the recovery of patients with the nonsurgical endodontic management of different endodontic cases using MTA. Case Report: Case 1. A 72-year-old female patient presented with cold and sweet sensitivity. A reversible pulpitis diagnosis was made, and direct pulp capping with MTA was performed. A 12-month follow-up showed positive clinical outcomes. Case 2. A 16-year-old female patient presented with prolonged throbbing pain and a history of episodic severe pain. Diagnosed with irreversible pulpitis and an immature apex, apexification was performed using MTA. A 14-month follow-up revealed successful healing. Case 3. A 14- year-old male patient presented with a broken tooth, intermittent swelling, and pain. Diagnosed with chronic apical periodontitis, root canal treatment was conducted on tooth 21, while regenerative endodontic treatment was applied to tooth 22. A 15-month follow-up showed lesion healing. Conclusion: These cases suggest that MTA may be a substitute material for the treatment of endodontic problems (vital and necrotic conditions); however, more clinical studies with larger sample size and longer follow-ups are needed.

Skin infections caused by Mycobacterium chelonae: Underestimated, especially in immunocompromised patients

AbstractMycobacterium chelonae infections are rare but significant in immunocompromised patients, often leading to delayed diagnosis due to a specific clinical signs and the difficulty to culture and identify the causative agent with conventional laboratory techniques. We report a case series of five patients presenting with cutaneous infection due to M. chelonae. An extensive review of the literature was accomplished to provide summary data on the clinical presentation, diagnostic methods and treatment options for these infections. Four out of five patients were receiving immunosuppressive treatments. All patients presented after a prolonged history of painful lesions on the extremities. Sampling and definitive diagnosis implied repeated tissue biopsies and a combination of mycobacterial tests. All patients received a combination of antibiotics comprising a macrolide and achieved complete healing of the skin lesions after 4–12 months. Our case report aims to increase awareness of skin infections caused by M. chelonae and emphasises the importance of early implementation of mycobacterial cultures in the diagnosis of painful ulcerations on the extremities that do not improve to standard systemic antibiotics.

Influence of photobiomodulation and radiofrequency on the healing of pressure lesions in mice.

The objective of this study was to ascertain the impact of photobiomodulation and radiofrequency on the healing of pressure injuries in mice. A total of 70 animals were randomly assigned to seven experimental groups. A pressure injury was induced in the dorsal region of the mice by the application of two magnets. The photobiomodulation treatment was administered at a dosage of 3.6J per session. In the radiofrequency group, the treatment time was four minutes and the power was 22 watts. The analyses included the lesion area, infrared thermography, and the collection of material for cytokine, histological, and histochemical analyses following euthanasia. In the macroscopic analyses, the 660nm photobiomodulation group demonstrated superior outcomes in comparison to the control group. With regard to the microscopic analyses, the greatest difference between the groups was observed when TNF-α was evaluated in the photobiomodulation group. It can be observed that the groups irradiated by electrophysical means (i.e., a combination of radiofrequency with PBM 830nm-660nm) exhibited a positive influence on the repair process, with the greatest impact observed in the group irradiated by a combination of radiofrequency and 660nm photobiomodulation.

Nonsurgical Endodontic Retreatment of a Cystic Apical Lesion Associated with Root Resorption: A Promising Approach

This case report highlights the successful management of a cystic apical lesion associated with root resorption through nonsurgical endodontic retreatment, utilizing calcium-enriched mixture (CEM) cement as an obturating biomaterial. A 35-year-old woman presented with mild discomfort in the mandibular right first molar (#46), with radiographic evidence of a well-defined radiolucent lesion at the apex of the mesial root. The tooth had a history of previous failed endodontic treatment with poor root canal obturation, indicating internal root resorption. Nonsurgical endodontic retreatment was performed, and the canals were filled/sealed with CEM cement. Follow-up radiographs showed a gradual reduction in the size of the cystic lesion. At 54 months, complete bone healing of the cystic apical lesion was evident. This case report provides clinical evidence supporting the potential efficacy of nonsurgical endodontic retreatment using CEM cement in managing certain cystic apical lesions, offering a promising alternative to traditional surgical enucleation, even in cases with inflammatory root resorption. Further research is needed to validate the long-term efficacy of this approach in larger patient populations.