Healing Of Periapical Lesions Research Articles

Resolvin D2-induced reparative dentin and pulp stem cells after pulpotomy in a rat model

IntroductionVital pulp therapy (VPT) is performed to preserve dental pulp. However, the biocompatibility of the existing materials is of concern. Therefore, novel materials that can induce pulp healing without adverse effects need to be developed. Resolvin D2 (RvD2), one of specialized pro-resolving mediators, can resolve inflammation and promote the healing of periapical lesions. Therefore, RvD2 may be suitable for use in VPT. In the present study, we evaluated the efficacy of RvD2 against VPT using in vivo and in vitro models. MethodsFirst molars of eight-week-old male Sprague–Dawley rats were used for pulpotomy. They were then divided into three treatment groups: RvD2, phosphate-buffered saline, and calcium hydroxide groups. Treatment results were assessed using radiological, histological, and immunohistochemical (GPR18, TNF-α, Ki67, VEGF, TGF-β, CD44, CD90, and TRPA1) analyses. Dental pulp-derived cells were treated with RvD2 in vitro and analyzed using cell-proliferation and cell-migration assays, real-time PCR (Gpr18, Tnf-α, Il-1β, Tgf-β, Vegf, Nanog, and Trpa1), ELISA (VEGF and TGF-β), immunocytochemistry (TRPA1), and flow cytometry (dental pulp stem cells: DPSCs). ResultsThe formation of calcified tissue in the pulp was observed in the RvD2 and calcium hydroxide groups. RvD2 inhibited inflammation in dental pulp cells. RvD2 promoted cell proliferation and migration and the expression of TGF-β and VEGF in vitro and in vivo. RvD2 increased the number of DPSCs. In addition, RvD2 suppressed TRPA1 expression as a pain receptor. ConclusionRvD2 induced the formation of reparative dentin, anti-inflammatory effects, and decreased pain, along with the proliferation of DPSCs via the expression of VEGF and TGF-β, on the pulp surface in pulpotomy models.

Resolvin D2-induced reparative dentin and pulp stem cells after pulpotomy in a rat model

IntroductionVital pulp therapy (VPT) is performed to preserve dental pulp. However, the biocompatibility of the existing materials is of concern. Therefore, novel materials that can induce pulp healing without adverse effects need to be developed. Resolvin D2 (RvD2), one of specialized pro-resolving mediators, can resolve inflammation and promote the healing of periapical lesions. Therefore, RvD2 may be suitable for use in VPT. In the present study, we evaluated the efficacy of RvD2 against VPT using in vivo and in vitro models. MethodsFirst molars of eight-week-old male Sprague–Dawley rats were used for pulpotomy. They were then divided into three treatment groups: RvD2, phosphate-buffered saline, and calcium hydroxide groups. Treatment results were assessed using radiological, histological, and immunohistochemical (GPR18, TNF-α, Ki67, VEGF, TGF-β, CD44, CD90, and TRPA1) analyses. Dental pulp-derived cells were treated with RvD2 in vitro and analyzed using cell-proliferation and cell-migration assays, real-time PCR (Gpr18, Tnf-α, Il-1β, Tgf-β, Vegf, Nanog, and Trpa1), ELISA (VEGF and TGF-β), immunocytochemistry (TRPA1), and flow cytometry (dental pulp stem cells: DPSCs). ResultsThe formation of calcified tissue in the pulp was observed in the RvD2 and calcium hydroxide groups. RvD2 inhibited inflammation in dental pulp cells. RvD2 promoted cell proliferation and migration and the expression of TGF-β and VEGF in vitro and in vivo. RvD2 increased the number of DPSCs. In addition, RvD2 suppressed TRPA1 expression as a pain receptor. ConclusionRvD2 induced the formation of reparative dentin, anti-inflammatory effects, and decreased pain, along with the proliferation of DPSCs via the expression of VEGF and TGF-β, on the pulp surface in pulpotomy models.

Healing of periapical lesion by non-surgical endodontic therapy: A case series

Trauma to the anterior teeth can lead to pulp necrosis and subsequent periapical lesions. Most of the cases remain undetected unless found in an IOPAR, the tooth gets discoloured or gets secondarily infected. In such cases, non-surgical endodontic therapy can be done as the first line of management with regular follow up. Surgical approach is indicated only if the non- surgical approach becomes a failure. A series of two cases with large periapical lesion following trauma to the maxillary anteriors were treated with multivisit non –surgical endodontic therapy. Inter-appointment dressings were given. Patients were recalled for evaluation of healing. Six months follow up radiographs showed healing of the lesion with significant increase in the radiopacity suggestive of bony healing. For the treatment of periapical lesions, non-surgical endodontic therapy should be considered as first line treatment option as it proves to be a more conservative approach.

The trend of radiographic healing after root canal treatment in teeth with apical periodontitis based on cone-beam computed tomography: A 4-year longitudinal study

ObjectivesThe aim of this study was to observe the radiographic healing of periapical lesions after root canal treatment via volumetric measurements based on cone-beam computed tomography (CBCT) over 4 years. MethodsIn total, 162 single-root teeth from patients with chronic periapical periodontitis who underwent primary root canal treatment were included in this retrospective study. Follow-up visits were scheduled at 1, 2, and 4 years after treatment. The volume of radiolucency at pretreatment and follow-up were measured, and the radiographic outcomes were classified into 4 categories: absence, reduction, uncertain or enlargement. Reduction or enlargement was considered when the volumetric change in radiolucency was 20 % or more. ResultsDuring the 4-year follow-up period, 128 teeth were reviewed at least once, including 3 extracted teeth. Of the remaining 125 teeth, the volume of radiolucency was reduced in 116 teeth (90.6 %), uncertain in 5, and enlarged in 4 teeth during 1 to 4 years after treatment. Among the 43 teeth with reduced radiolucency at 1 year after treatment, 42 (97.7 %) had continuing reduced lesions at 4 years. In the 2 teeth with enlarged radiolucency at 1 year, the volume of radiolucency doubled at 4 years. Cox regression analysis revealed that the preoperative radiolucency size was a risk factor for persistent periapical radiolucency. ConclusionsThe efficacy of root canal treatment for apical periodontitis was predictable. When the radiolucency changed by 20 % or more in volume on CBCT scans at 1 year after treatment, reversal of the radiographic healing tendency was rare. Clinical significanceThe volumetric changes in radiolucency on CBCT could reflect trends in the healing process and may foster early clinical decision-making.

Application of Inflammatory Vital Pulp Therapy in the Treatment of Apical Periodontitis in a deciduous Molar: A Case Report

Due to the distinct anatomical characteristics of deciduous teeth, they are particularly susceptible to apical periodontitis when afflicted by deep caries or other endodontic diseases. Conventional, root canal therapy (RCT) has served as the standard treatment protocol all the time by the most pediatric dentists. However, researchers try to find another possible alternative mothods because of its some drawbacks. Hence this report introduces a groundbreaking therapeutic modality - inflammatory vital pulp therapy (IVPT) - which has proven effective in treating apical periodontitis in a deciduous molar. The objective of this study was to assess the practicality and efficacy of IVPT in managing apical periodontitis in deciduous teeth. Through rigorous patient examination and evaluation, IVPT was adopted as the treatment plan, followed by meticulous long-term follow-up observations. The outcomes revealed remarkable clinical improvements, with the periapical lesion healing seamlessly without any complications. Notably, the development of the permanent tooth embryo remained undisturbed and progressed as expected. In summary, this study validates the efficacy of IVPT in treating apical periodontitis in deciduous teeth, opening a new avenue for the management of deciduous tooth diseases. The clinical utilization of this method is anticipated to enhance treatment experiences and prognostic outcomes for patients with deciduous tooth pathologies.

The impact of bone grafting with/without barrier membrane placement on the outcome of apical surgery: A systematic review and meta-analysis.

Regenerative techniques are increasingly being advocated in endodontic apical surgery (AS) to enhance the healing of periapical lesions. Various grafting and membrane materials are employed as adjuncts to modern AS. This systematic review aimed to answer the following PICO question: In patients with apical periodontitis (P) what is the impact of bone grafting with/without barrier membrane materials (I) compared with surgery without grafting materials (C) on the outcome of AS evaluated clinically and radiographically (O). A systematic search was conducted in four databases (Embase, Web of Science, PubMed and Cochrane Central Register of Controlled Trials) until 1 August 2023. Google Scholar was also manually searched. Studies with a prospective randomized design were included. Cochrane risk-of-bias (RoB) tool 2.0 assessed bias. Two independent reviewers performed the study selection, data extraction and appraisal of studies. Meta-analysis was performed using R3.5.1 software. From the identified 2582 studies, eight randomized clinical trials were included for meta-analysis. Two studies had low RoB, while six had some concerns. Analysis revealed significantly better outcomes when surgery involved bone regeneration techniques than conventional surgery (OR = 2.18, 95% CI: 1.32-4.31, p = .004). Subgroup analyses on individual grafts (OR = 0.22, 95% CI: -0.99 to 1.44, p = .720) (OR = -0.09, 95% CI: -1.42 to 1.23, p = .885) and membranes (OR = -1.09, 95% CI: -2.94 to 0.76, p = .247) and their combinations (OR = 0.03, 95% CI: -1.50 to 1.55, p = .970) did not yield any significant results. The type of membrane used did not significantly impact the outcome (OR = -1.09, 95% CI: -2.94 to 0.76, p = .247) nor did altering the combination of graft/membrane. This systematic review examined the effects of bone grafting with/without membrane placement on the outcome of AS. It highlights the potential advantages of regenerative techniques and the need for further research in this area. Based on current evidence, bone grafting with/without barrier membrane placement significantly improves healing after AS. Subgroup analysis of resorbable membranes or grafting did not significantly influence the outcome. The combination of membrane and graft was also not significant. Future well-designed, randomized controlled trials in this area are essential before these materials can be recommended for routine use to enhance healing outcomes in AS. PROSPERO (CRD42021255171).

Root to recovery: Successfully healing a large periapical lesion in the mandibular first molar: A case report

This case report presents the diagnosis, successful management, and healing of a large periapical lesion associated with the mandibular first molar teeth The patient's chief complaint was severe, intermittent pain in the lower right posterior region of the mouth, and radiographic examination revealed a substantial periapical radiolucency around the apices of the mandibular first molar. The treatment involved root canal therapy along with adjunctive procedures to promote healing of the periapical lesion. Follow-up radiographs demonstrated a significant reduction of the periapical lesion with complete resolution of symptoms.

Comparison of Clinical and Radiographic Healing of Periapical Lesions Using MTA or Conventional Filling Materials: Randomized Controlled Clinical Trial

Objectives The aim of this study was to compare the effect of MTA versus conventional filling materials on the healing of teeth with periapical lesions. Materials and methods Sixty-four teeth with periapical lesions of greater than 5 mm were divided into two groups; G1) MTA (ProRoot MTA; Dentsply Maillefer, Ballaigues, Switzerland) filling, G2) conventional filling materials (n = 32/group). In MTA group, the apical portion of the root canal was filled with ProRoot MTA and the middle and coronal thirds of the root canal were filled with injectable thermoplasticized gutta-percha system. Patients were followed for 15 months. The data were statistically analyzed with Mann-Whitney U and chi-square test (P = 0.05). Results With a follow-up rate of 89.06% of all patients for 15 months, favorable outcomes were obtained in 100% in ProRoot MTA and 83.3% in conventional technique. (P < 0.05). Conclusions ProRoot MTA showed better results compared to conventional filling materials in teeth with periapical radiolucency.

Allogeneic Bone Marrow Mesenchymal Stromal Cell Transplantation Induces Dentin Pulp Complex-like Formation in Immature Teeth with Pulp Necrosis and Apical Periodontitis

IntroductionDental pulp regeneration is challenging in endodontics. Cellular therapy is an alternative approach to induce dental pulp regeneration. Mesenchymal stromal cells (MSCs) have the capacity to induce dental pulp-like tissue formation. In this study, we evaluated the capacity of allogeneic bone marrow MSCs (BM-MSCs) to regenerate pulp following necrosis and apical periodontitis in children's permanent immature apex teeth. MethodsPatients aged 8 to 12 years with pulp necrosis and apical periodontitis were evaluated. The study included 15 teeth (13 incisors and 2 molars) from 14 patients (8 boys and 6 girls). Radiographic evaluation showed periapical radiolucency and immature apex teeth. There was no response to cold or electric pulp testing. The root canal of each tooth was cleaned, shaped, and Ca(OH)2 used as an interappointment medication. Cryopreserved allogeneic BM-MSCs were thawed, expanded, incorporated into preclotted platelet-rich plasma, and implanted into the tooth's pulp cavity. They were sealed with bioceramic cement and composite. Sensibility, apical foramen, calcium deposits within the root canal, and resolution of periapical lesions were evaluated in each tooth over the following 12 months. ResultsBased on 9 variables established for dental pulp-like tissue regeneration, all MSC-treated teeth showed evidence of successful regeneration. Clinical and radiographic evaluation of the treated teeth showed periapical lesion healing, sensitivity to cold and electricity, decreased width of the apical foramen, and mineralization within the canal space. ConclusionsTransplantation of allogeneic MSCs induces the formation of dental pulp-like tissue in permanent immature apex teeth with pulp necrosis and apical periodontitis. Implant of MSCs constitutes a potential therapy in regenerative endodontics in pediatric dentistry. Future studies incorporating a larger sample size may confirm these results.

The Effect of Lasers on the Healing of Periapical Lesion: A Systematic Review.

Introduction: Endodontic treatment of teeth with periapical lesions presents more clinical difficulty. Various lasers in several methods are used in endodontics, and most of them are utilized as an adjunctive protocol in order to reduce the bacterial load of the root canal system. Improved disinfection plays a crucial role in enhanced and accelerated healing of periapical lesions. This review aims to summarize studies assessing the effect of lasers on periapical lesion healing. Methods: PubMed/MEDLINE, Scopus, Embase, and Web of Science (ISI) online databases were searched, with no publication year or status restriction, for relevant articles on April 2023. Clinical studies evaluating the effect of laser application on the periapical lesion of patients using radiographic assessment were considered eligible for inclusion. Results: Eight studies were included after carefully screening the obtained articles, first by their title and abstract and then by their full texts. Diode (4), Er, Cr: YSGG (3), and Nd: YAG (1) lasers were used with output powers that varied from 0.75 to 2 watts. Photodynamic therapy was employed in two studies, and in other studies, the root canal system was directly irradiated. Irradiation of the root canal system was adjunctive to standard preparation in all studies. The healing of the teeth treated with lasers was not inferior to those conventionally treated. In all of the included studies, laser application outperformed the standard cleaning and shaping protocol; however, this improved or faster healing was not statistically significant in most studies. Conclusion: Lasers might expedite and improve the healing process of periapical lesions. Since lasers enhance the quality of cleaning of the root canal system, it is hard to point out the exact mechanism of it. Further investigations are needed to realize the effectiveness of this treatment modality and to discover the underlying biological concepts.

Perawatan saluran akar periodontitis apikalis kronis pada gigi insisivus lateral maksilaris kiri

Background: Root canal treatment is one of the modalities to treat periapical lesions. The success of root canal treatment in periapical lesions can be seen with the patient's chief complaint and the healing of periapical lesions as seen by the radiograph. Objective: This case report aims to demonstrate root canal treatment on a maxillary anterior tooth with periapical lesion. Case report: A 22-year-old female patient came with complaints of a maxillary anterior tooth that had throbbing pain several months ago, after having it filled by a previous dentist, and since then, it has never hurt again. Intra-oral examination of tooth 12 showed composite resin on the mesiopalatal surface. Radiographic findings showed that there was a round radiolucency in the periapical area with a diameter of 4 mm. Root canal treatment was performed based on the diagnosis of chronic apical periodontitis et causa necrotic pulp. Root canal treatment begins with the application of a rubber dam, opens the cavity, explores the root canal, and shapes the root canal. Biomechanical preparation was carried out using Protaper Hand Use with crown down technique, combined with 2.5% NaOCl irrigation. The first visit ends with the disinfection of the root canal using calcium hydroxide. Subsequent treatment was carried out with subjective and objective examination, removal of temporary filling, cleaning of calcium hydroxide, and final irrigation with 2.5% NaOCl, 17% EDTA, and 2% CHX. Obturation was achieved using the vertical condensation technique. The restoration was accomplished at the next visit using composite resin. Conclusion: Root canal treatment on teeth with chronic apical periodontitis was successfully carried out.

Effect of photodynamic therapy on the healing of periapical lesions after root canal retreatment: 1-year follow up randomized clinical trial

BackgroundThe aim of this randomized clinical trial was to evaluate the effects of photodynamic therapy (PDT) after traditional activated final irrigation protocol (ultrasonically activated irrigation, UAI) on periapical lesion healing after single–visit root canal retreatment. MethodsWe included 36 patients with asymptomatic chronic apical periodontitis with periapical lesions larger than 5 mm and teeth sensitive to percussion and palpation, who had previous root canal treatment. All patients who signed informed consent underwent cone-beam computed tomography (CBCT) to determine and calculate the preoperative volume of the periapical lesion. Patients were randomly distributed into two groups according to the final disinfection protocol: Group 1; UAI (NaOCl, EDTA, and NaOCl), Group 2; UAI + PDT. All patients underwent single-visit root canal retreatment using rotary instrumentation and standardized irrigation (3 %NaOCl) by the same endodontist. The root canals were filled with epoxy resin-based sealer and single-cone gutta-percha, followed by control radiography. After one year, a new CBCT scan of the teeth was performed to calculate the reduction in the initial periapical lesion as a measure of periapical healing. For the statistical analysis, the chi-square test variants, Fisher's exact test and the Fisher-Freeman-Halton test were used at the level of significance set at 5 %. ResultsThere were no significant differences between the groups in terms of age, sex, preoperative and postoperative lesion volume (p > 0.05), and reduction of periapical lesion volume (median, 86.98 % for UAI and 79.72 % for UAI+PDT) (p = 0.970). Additional use of PDT after UAI did not contribute to the healing of periapical lesions. ConclusionThe UAI and UAI+PDT protocols had equal effects on healing of periapical lesion.

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.

Limitations and Management of Dynamic Navigation System for Locating Calcified Canals Failure

Nonsurgical endodontic teeth treatment with severe pulp canal obliteration poses challenges, primarily locating canals. By combining 3-dimensional reconstruction and spatial location registration, the dynamic navigation technique uses an optical tracking system to guide the clinician to drill in real time according to the predesigned path until access to the canal is established. Several in vitro studies and case reports have shown that calcified canal location with dynamic navigation system (DNS) is more accurate and efficient, yet the technique has limitations. In 4 cases with 7 teeth, this work presents manipulation process and clinical outcomes of DNS helping in calcified canal location. We performed handpiece adaptation and elucidated the failure to locate the canals with DNS in 2 teeth, resulting in canal geometry alteration and canal path deviation. Subsequently, the more experienced endodontist located the canals by combining cone-beam computed tomographic imaging and dental operating microscopy. All patients were completely asymptomatic after treatment. At the 1-year follow-up visit, the bone healing of periapical lesions progressed well according to the periapical radiography or cone-beam computed tomographic imaging. These findings indicate that DNS is a promising technique for locating calcified canals; however, it needs to be refined before clinical use.

Treatment outcomes of regenerative endodontic procedures in nonvital mature permanent teeth: a retrospective study.

This retrospective study was undertaken to clinically and radiographically evaluate the long-term outcomes of regenerative endodontic procedures (REPs) for nonvital mature permanent teeth, to analyze predictors influencing treatment outcomes. Nonvital mature permanent teeth treated by REPs with a minimum follow-up period of 6 months were included from 2015 to 2017. Treatment outcomes were categorized as success and failure. The periapical status and lesion healing were assessed in terms of the periapical index (PAI) and the percentage changes in periapical radiolucency (PARL) area. The clinical and radiographic outcomes of REPs were assessed by Mann-Whitney test at different follow-up period. Kaplan-Meier curves and Univariate Cox regression analysis were conducted to assess the success and identify potential predictors affecting outcomes, respectively. A total of 37 mature teeth with an average follow-up of 4.3 years satisfied the criteria, and 89.2% of the teeth had a successful outcome. Significant differences in PAI scores were found between each period with respect to the baseline (p < .05). Among different periods, there was a significant difference between intervals of 3-6 months and 7-12 months (p = .039) and no significant difference between each interval of more than 12 months (p > .05). Eighty-seven percent of teeth with preoperative PARL presented completely healed. REPs significantly decreased the PARL area at the interval of 7-12 months compared to 3-6 months (p = .025), with no significant difference between each interval of more than 12 months (p > .05). No significant predictor was found for the success of outcome (p > .05). Thirteen teeth (35.1%) regained pulp sensibility, and 40.5% of the teeth exhibited intracanal calcification. Within the limitations of this study, REPs provided a high long-term success rate and promoted the resolution of PARL as a biologically-based alternative treatment option for nonvital mature teeth. REPs provide a high long-term success rate and promoted healing of apical periodontitis comparable with reported outcomes for root canal therapy of mature teeth.

The efficacy of concentrated growth factor and platelet-rich fibrin as scaffolds in regenerative endodontic treatment applied to immature permanent teeth: a retrospective study

BackgroundThe aim of this retrospective study was to compare the efficacy of concentrated growth factor (CGF) and platelet-rich fibrin (PRF) as scaffolds in regenerative endodontic therapy (RET).MethodsNecrotic immature permanent teeth treated with regenerative endodontic therapy during January 2018 to August 2022 were divided into the CGF and PRF groups according to the scaffold. The CGF and PRF groups included 7 and 6 teeth, respectively. The efficacy of regenerative endodontic therapy was analyzed based on the clinical and radiological outcomes at three different follow up periods: T1 (3–6 months), T2 (6–12 months) and T3 (12–24 months). Statistical analysis was performed using the independent T test, Mann-Whitney test and Fisher’s exact test at a significance level of 0.05.ResultsThe success rate of each stage in both groups was 100%. Through quantitative comparison of radiographic outcomes, there was no statistically significant difference between the two groups in terms of root development and periapical lesion healing at each stage, except that the increase rate of radiographic root area in PRF group in the T3 stage was above one in CGF group with statistically significance.ConclusionsBoth CGF and PRF had a similar clinical performance regarding resolution of clinical signs and symptoms, periapical lesion healing, and continued root development as scaffolds in RET. Further prospective studies with large samples for longer follow-up periods are needed.

Effect of Non-Setting Calcium Hydroxide on the Healing of Periapical Lesions: A Systematic Review

Summary: Periapical lesions, inflammatory reactions caused by bacterial infections in the periapical area of teeth, require effective treatment for optimal healing. Non-setting Ca (OH)2 has been utilized as a medicament in endodontic procedures to promote the healing of periapical lesions. This systematic review aims to evaluate the effect of non-setting calcium hydroxide on the healing of periapical lesions. Non-setting calcium hydroxide is commonly used in endodontic procedures for its antimicrobial and tissue-healing properties. Understanding its effectiveness in promoting periapical lesion healing is crucial for clinical decision-making and improving patient outcomes. A comprehensive literature search was conducted using electronic databases (PubMed, Embase, and Cochrane Library) to identify relevant studies published up to September 2021. The search strategy included keywords related to non-setting calcium hydroxide, periapical lesions, endodontic treatment, and healing. Both experimental and clinical studies assessing the effect of non- setting calcium hydroxide on periapical lesion healing were included. Data were extracted and assessed for quality and bias using appropriate tools. The initial search yielded a total of 378 articles, of which 12 studies met the inclusion criteria. The studies included in this review consisted of both in vitro and in vivo experimental models, as well as clinical trials. The outcomes assessed varied among the studies, including radiographic evaluation, histological analysis, and clinical examination. The majority of the included studies reported positive effects of non-setting calcium hydroxide on periapical lesion healing. These effects were attributed to its antimicrobial activity, promotion of tissue repair, and induction of mineralized tissue formation. Based on the available evidence, non-setting calcium hydroxide appears to have a beneficial effect on the healing of periapical lesions. However, due to the heterogeneity ...

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.

Healing of peri-apical lesions with calcium hydroxide medicament following apical enlargement: a case study

With public health orders restricting movement and changes to routine endodontic practice during the COVID-19 pandemic, many patients chose to wait, in the range of 12-18 months, before returning to complete their root canal treatment. This report describes several cases of non-vital and infected teeth that showed positive healing responses from having endodontic treatment using calcium hydroxide paste as an intracanal medicament and an apical enlargement technique to further reduce bacterial numbers. This indicates healing of peri-apical lesions may occur with a longer observation period. CPD/Clinical Relevance: Endodontic treatment for peri-apical infection may allow a patient time to decide upon treatment options.

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.