Healing Of Periapical Lesions Research Articles

Healing of Periapical Lesion in Teeth Obturated with Different Techniques and Lengths (Radiographic Assessment)

Aim: The purpose of this study was to assess healing of periapical lesion in either symptomatic or asymptomatic cases after obturation with different obturation techniques: cold lateral compaction and single cone obturation techniques at different apical extensions; 1 mm &2mm. Materials and Methods: A total of eighty patients were divided into two main groups; symptomatic or asymptomatic (n=40) then each group was subdivided into two subgroups (n=20) according to the obturation technique; subgroup a: Cold lateral compaction technique and subgroup b: single cone obturation technique. Further, each subgroup was divided into two divisions (n=10) depending on whether the apical extent; 1 or 2 mm from radiographic apex. All cases were prepared and obturated. CBCT scans were taken preoperatively, at 3, 6, and nine months and volume of the lesion was calculated to determine the treatment outcome. Data were then gathered, tabulated and statistically analyzed. Results: At 1mm, no significant difference between mean % changes in lesion volume after using lateral compaction or single cone techniques either asymptomatic or symptomatic along the evaluation periods while at 2mm lateral compaction technique showed higher mean % decrease in lesion volume than single cone technique after 3, 6 as well as 9 months. In both groups, using lateral compaction technique, no significant difference was recorded at 1 or 2 mm apical extension of filling while in single cone, at 1mm apical extension revealed higher decrease in lesion volume than 2mm Conclusions: Radiographic success rate of the single cone obturation technique was comparable with those of the lateral compaction obturation technique in root canal treatment of teeth with periapical lesions in short term evaluations at 1mm apical extension.

Resolvin D2 Induces Resolution of Periapical Inflammation and Promotes Healing of Periapical Lesions in Rat Periapical Periodontitis.

Periapical periodontitis results from pulpal infection leading to pulpal necrosis and resorption of periapical bone. The current treatment is root canal therapy, which attempts to eliminate infection and necrotic tissue. But, in some cases periapical inflammation doesn't resolve even after treatment. Resolvins belongs to a large family of specialized pro-resolving lipid mediators that actively resolves inflammation signaling via specific receptors. Resolvin D2 (RvD2), a metabolite of docosahexaenoic acid (DHA), was tested as an intracanal medicament in rats in vivo. Mechanism was evaluated in rat primary dental pulp cells (DPCs) in vitro. The results demonstrate that RvD2 reduces inflammatory cell infiltrate, periapical lesion size, and fosters pulp like tissue regeneration and healing of periapical lesion. RvD2 enhanced expression of its receptor, GPR18, dentin matrix acidic phosphoprotein 1 (DMP1) and mineralization in vivo and in vitro. Moreover, RvD2 induces phosphorylation of Stat3 transcription factor in dental pulp cells. We conclude that intracanal treatment with RvD2 resolves inflammation and promoting calcification around root apex and healing of periapical bone lesions. The data suggest that RvD2 induces active resolution of inflammation with pulp-like tissue regeneration after root canal infection and thus maybe suitable for treating periapical lesions.

LSTR 3mix-MP Important Efficacy Particularly Antibacterial and Periapical Lesions during Conservative Treatment in the Dentistry like RCT and Others Endodontics Management: Case Studies

Local sterilization and tissue repair which generally termed as LSTR, brings a radicular change in the field of conservative dentistry. Efficacy against antibacterial environment and non-surgical healing of periapical lesions much better than calcium hydroxide. LSTR 3Mix-MP, Using an antibacterial drug combination, therapy is a novel caries, pulpal treatment of primary tooth and root canal treatment. LSTR 3Mix-MP aims to eliminate causative bacteria from lesions and after sterilization, the host’s natural tissue recovery process usually the lesions are repaired or resolved. LSTR 3Mix MP where TAP (triple antibiotics paste) such as: Metronidazole, Ciprofloxacin, Minocycline and Vehicle MP Macrogol/polyethylene glycol and propylene glycol used to prepare. TAP has great antibacterial efficacy particularly against enterococci which remains after successful root canal treatment, effective eradication of the causative microorganisms during root canal treatment procedures. Residual infection in Root canal therapy has always been an area of interdermind or vague for a treating dental surgeon. Lesion sterilization and tissue repair (LSTR) therapy is a non-surgical or non-conventional endodontic treatment procedure that involves non-instrumentation or minimal instrumentation followed by placement of a triple antibiotic paste in a medication along with Macrogol and Propylene glycol.

Correction to: Influence of foraminal enlargement on the healing of periapical lesions in rat molars.

Figures 2 and 3 in the published version of this article contained a mistake. CCP and DCP should have been FEG and NFEG. Correct figures are presented here.

Bone regeneration on chronic apical abscess after root canal treatment on left mandibular first molar: A case report

Background: A chronic apical abscess is defined as an inflammatory response to pulp infection and necrosis. It is identified by a step-wise onset, almost no discomfort, and the discontinuous release of pus through a related sinus tract. Radiographically, there are regular indications of bone destruction, such as radiolucency. The source of the infection in the root canal should be eradicated by root canal treatment. The main purpose of endodontic treatment is the finished debridement of the pulp tissue from the canal combined with the shaping and sufficient obstruction of the root canal system. This case report was written to show the proper management of a tooth with a chronic apical abscess and to reveal self-bone regeneration after treatment. Case Report: A 27-year-old woman complained of a cavity on her left lower back tooth, and she wanted it to be filled. There was a history of a fistula that appeared frequently in the gums near the decayed tooth. The radiographic examination showed that the caries had reached the pulp, along with a periapical lesion and bone destruction. The canals were prepared using a file instrument and irrigation with 5.25% sodium hypochlorite, 17% ethylenediaminetetraacetic acid, and 2% chlorhexidine gluconate. Calcium hydroxide paste was used as an intracanal medicament, and the canals were obturated using a continuous wave compaction technique. At the 4-month follow-up, healing of the periapical lesion and bone regeneration was evident. Conclusion: Adequate root canal treatment can result in the healing of periapical lesions and bone regeneration in chronic apical abscesses.

Nonsurgical healing of periapical lesion using single cone with bioceramic sealer

An important goal of root canal treatment is to properly seal the canal system after cleaning and shaping. However, irregularities such as fins, isthmuses, and lateral canals are often present can pose challenge to clinician during obturation. The importance of three-dimensional obturation of the root canal system cannot be overstated, with the ability to achieve this goal primarily dependent on the quality of canal cleaning and shaping as well as clinical skill. Other factors that influence the ultimate success or failure of each case include the materials used and how they are used. Root canal sealer not only helps to enhance impervious seal but can also act as lubricant and can flow to lateral and accessory canals. This case report states the importance of bioceramic-based sealers in nonsurgical healing of periapical lesion.

Influence of foraminal enlargement on the healing of periapical lesions in rat molars.

The aim of this study was to evaluate the influence of foraminal enlargement on the healing of induced apical periodontitis in a rat model. Periapical lesions were bilaterally induced in mandibular first molars of 24 Wistar rats, through root canals exposure to the oral environment during 3weeks. Endodontic treatment was performed in the mesial canal of right molars, which were separated into two experimental groups (n = 12/group). The foraminal enlargement group (FEG) received instrumentation in the entire root canal length, including the cemental canal, while in the non-foraminal enlargement group (NFEG), instrumentation was carried out 1mm short of the apical foramen. Root canals were filled with gutta-percha and AH Plus sealer, in the same visit, 1mm short of the apical foramen in both experimental groups. Left molars were not treated and served as a baseline control group. The animals were killed after 4weeks, and their hemi-mandibles were prepared for radiographic and histological analysis. Data were analyzed by Student's t test and ANOVA. Only FEG presented lower areas of periapical radiolucency compared to the control (p < .05). Both FEG and NFEG allowed decreased inflammation intensity (p < .0001 and p < .01) and higher scores of cementum neoformation when compared to non-treated samples (p < .0001). FEG was more effective than NFEG in promoting biological seal, i.e., apical closure with cementum (p < .01). FEG, but not NFEG, showed lower scores of root resorption than the control. Foraminal enlargement during root canal preparation improved periapical healing in rat molars. Foraminal enlargement has been suggested to improve disinfection at the apical portion of root canals. This procedure may favor the healing of chronic periapical lesions.

Effectiveness of triple antibiotic paste as an intra-canal medication for the root canal treatment of non-vital teeth with apical periodontitis: A systematic review

Background: This is a systematic review to assess and provide a pooled effect estimate, if possible, for the effects of triple antibiotic paste as an intra-canal medication for root canal treatment of mature permanent non-vital teeth with apical periodontitis. This review will assess post-operative pain, flare-up incidence, and clinical and radiographic healing. Methods: Nine electronic databases (Pubmed, CENTRAL, VHL, Scopus, EBSCOhost, Web of Science, Trip, OpenGrey, Proquest) were searched along with two major clinical trial registries. Conference proceedings, reference lists and citations of the included studies were also searched. A total of 537 records were identified and 392 were obtained after duplicate removal. Six records were identified after screening and three studies were included after full text eligibility assessment. Results: Three comparators were reported in the included studies: calcium hydroxide paste, 2% chlorhexidine gel and ledermix paste. There was no statistically significant difference between triple antibiotic paste and calcium hydroxide regarding postoperative pain, and clinical and radiographic healing of periapical lesions. There was no difference between triple antibiotic paste and chlorhexidine regarding flare-up incidence. However, triple antibiotic paste reduced the level of post-operative pain more than ledermix, which was statistically significant. Conclusions: The evidence is still insufficient surrounding the use of triple antibiotic paste; therefore more clinical investigations with high levels of evidence and rigorous methodologies are needed.

Platelet-Rich Plasma and Platelet-Rich Fibrin Can Induce Apical Closure More Frequently Than Blood-Clot Revascularization for the Regeneration of Immature Permanent Teeth: A Meta-Analysis of Clinical Efficacy.

The purpose of this review was to compare the clinical efficacy of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), vs. blood clot revascularization (BCR) for the regeneration of immature permanent teeth. A survey of the literature identified 222 cases of immature permanent teeth which had been given PRP, PRF or BCR regeneration treatment with at least a year-long follow-up in 12 different articles. A meta-analysis of the 222 immature permanent teeth after 1 year, were compared to assess the ability of PRP, PRF, and BCR to accomplish apical closure, a periapical lesion healing response, root lengthening, and dentinal wall thickening. The mean success rate for apical closure or reduction after 1 year was: PRP (85.1%) PRF (85.2%), and BCR (58.8%). The mean success rate for root lengthening after 1 year was: BCR (64.1%), PRP (64.2%), and PRF (74.1%). The periapical lesion healing response was 88.9% for BCR, 100% for PRP, and 100% for PRF. Dentinal wall thickening was 100% for BCR, 100% for PRP, and 100% for PRF. Apical closure occurred more frequently following PRP and PRF than with BCR (Fischer test, P < 0.0011), for all the other effects the PRP, PRF, and BCR treatments were similarly effective (Fischer tests, P > 0.05). In conclusion, the fractured or decayed immature permanent teeth of children and young adults aged 6 years to 28 which have a restorable crown, but thin dentinal walls may be regenerated by using a revascularization procedure which draws blood and stem cells into a disinfected root canal space. Although BCR is most common revascularization method, apical closure may occur more frequently if PRF and PRP are used instead of BCR for the regeneration of immature permanent teeth. The proper use of regenerative procedures can be very successful at the disinfection of bacteria from the periapical region of immature permanent teeth, which helps to heal localized lesions, and avoid the need for complex apical surgery, in addition to regenerating tissues to strengthen the structure of immature teeth, to help prevent tooth fracture and tooth loss.

Advances in root canal filling materials used in primary teeth

Root canal treatment of primary teeth is the most common treatment method for pulpitis and periapical periodontitis in pediatric dentistry. Effective root canal treatment could prevent the teeth from occurring of periapical infection or promote the healing of periapical lesions of teeth with periodontitis for preserving the decayed tooth, preventing early loss of primary teeth and inducing the formation of normal permanent dentition. The material selection for root canal filling is one of the most important factors influencing the treatment outcome of root canal treatment. So far, there has been various root canal filling materials used in clinic. This paper summarized the characteristics and clinical applications of currently used root canal filling materials in treatment of primary teeth.

The efficacy of platelet-rich fibrin as a scaffold in regenerative endodontic treatment: a retrospective controlled cohort study

BackgroundBlood Clot (BC) or platelet concentrates have been used as scaffold in regenerative endodontic treatment (RET). The aim of this retrospective study was to compare the performance of platelet-rich fibrin (PRF) with BC in inducing root development and periapical lesion healing after tooth revascularization.MethodsFive patients receiving RET using PRF as a scaffold were matched 1:1 to a previous cohort of 5 patients who underwent tooth revascularization by provoking periapical bleeding. Clinical signs and symptoms were examined at follow-ups. Periapical lesion healing and root development were monitored radiographically. The resolution of clinical signs and symptoms as well as periapical radiolucency was observed in all patients (100%).ResultsRoot elongation, dentinal wall thickening and apex closure were found in most cases (80% in both groups). There was no significant difference between the groups in terms of clinical sign resolution, root development and periapical healing.ConclusionsWithin the limits of this study, PRF achieved comparable outcomes to BC in terms of clinical sign and symptom resolution, periapical lesion healing and continued root development in RET.

Influence of Hemostatic Agents in the Prognosis of Periapical Surgery: A Randomized Study of Epinephrine versus Aluminum Chloride

IntroductionSeveral variables have been associated with a better prognosis of periapical surgery. The aim of this study was to evaluate the influence of 2 hemostatic agents on the prognosis of periapical surgery at 12 months. MethodsA prospective study was designed with 2 randomized parallel groups established depending on the hemostatic agent used: epinephrine or aluminum chloride. The analysis of the hemorrhage control was recorded as 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding persisted after application of the material), or 2 (complete hemorrhage control). At 12 months, periapical lesion healing was determined clinically and radiologically as success, improvement, or failure. ResultsNinety-five patients (67 women and 28 men) with periapical lesions involving a single tooth were enrolled in this study; in 45 teeth, epinephrine was used and in 50 teeth aluminum chloride. In the epinephrine group, 28 teeth were classified as successes, 10 as improvements, and 7 as failures. In the aluminum chloride group, 34 teeth were classified as successes, 11 as improvements, and 5 as failures. No statistically significant difference was found. ConclusionsThe present study found no association between the use of epinephrine or aluminum chloride as hemostatic agents on the prognosis of periapical surgery. The efficacy of hemostatic agents at the time of surgery showed no relationship with the healing outcome.

Outcome of 940-nm diode laser-assisted endodontic treatment of teeth with apical periodontitis: a retrospective study of clinical cases

The aim of this retrospective study of clinical cases was to compare outcomes of laser-assisted endodontic treatment/retreatment using 940-nm diode laser and EDTA versus conventional use of NaOCl and EDTA or citric acid with or without Ca(OH)2 intersessions in teeth with apical periodontitis. Database of medical documentation in a private practice was screened for root canal treatments done during 2014–2017. Then all files of cases with apical periodontitis (N = 46) were taken for retrospective evaluation and divided into two groups: group 1—940-nm diode laser-assisted endodontic treatments/retreatments (N = 24); group 2—conventional treatments/retreatments (N = 22). The outcome measure was radiographic change in apical bone density, using the periapical index (PAI). Unrelated specialist endodontist was asked to give PAI scores for radiographs done before treatment and after treatment—short- and long-term follow-up or both if present. All available data was assessed for statistical evaluation. No statistically significant difference of PAI score between groups before treatment (p = 0.943) and after long-term follow-up (p = 0.22) was found. Both groups exhibited a statistically significant decrease in PAI scores in short-term and in long-term follow-up evaluation (p < 0.001). With laser group having first follow-up evaluation significantly earlier (p < 0.001) with significantly lower PAI score (p = 0.002) than conventional. Significantly more treatments in laser group were done without any chemical antibacterial substances (NaOCl, Ca(OH)2 or antibiotics), while in conventional, at least one was always used. Results of this study suggests that 940-nm diode laser-assisted endodontic protocol is a reliable alternative to conventional treatment, allowing a decrease of chemical irrigation solutions, intracanal medication, and systemic antibiotic use and initiating faster healing of periapical lesion. However, to have stronger evidence, well designed randomised clinical trial studies are needed with larger sample size.

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.

Healing of Periapical Lesions after Endodontic Treatment with the GentleWave Procedure: A Prospective Multicenter Clinical Study

IntroductionThis report includes outcomes for a group of patients with significant periapical lesions who were treated and evaluated in two single-arm, multicenter, prospective, nonsignificant risk clinical studies. MethodsForty-five teeth were from 45 patients who met the inclusion criteria and consented for the clinical studies and were diagnosed with periapical lesions with periapical index score ≥3. Patients were treated with a standardized treatment protocol including instrumentation to an apical diameter of #20 without orifice enlargement, the GentleWave Procedure, and warm vertical obturation. Clinical signs and radiographic assessments were evaluated at 12 months to assess healing. Success was classified as healing or healed and accounted for the cumulative success rate of healing. Statistical analyses were performed by using Fisher exact test, Pearson correlation, and multivariate logistic regression analyses. ResultsAt 12 months, 44 of 45 teeth (97.8%) were evaluated. The cumulative success rate for the GentleWave Procedure was 97.7%. Forty-three of 44 teeth were completely functional; all teeth had complete resolution for measured indices of mobility, soft tissue lesions, sinus tract, and furcation involvement. No patients experienced moderate or severe pain at 2, 7, and 14 days after procedure. Although only 1 patient was unsuccessful and the presence of clinical symptoms and type of periradicular diagnosis at 12 months were correlated with an unsuccessful outcome, the analyses were limited by the sample size. ConclusionsIn this case series analysis, treatment of sizable periapical lesions with the GentleWave Procedure resulted in a success rate of 97.7% at 12-month re-evaluation.

Revitalization Teeth: A Prospective Case Series

In addition to caries, dental trauma is one of the most common causes of damage to permanent teeth and pulp. Pulp necrosis or damage to Hertwig’s epithelial root sheath (HERS) leads to arrested tooth root development in immature teeth. Pulp necrosis can be treated by revitalization, a biology-based treatment alternative to apexification. Induction of a blood clot inside the root canal can lead to healing of periapical lesions and increased root length and thickness. Traumatic impact as the cause of pulp necrosis may affect the treatment outcome negatively, depending on the severity of damage to HERS. Revitalization procedures in four teeth with pulp necrosis following dental trauma were performed using a standardized treatment protocol. Three teeth were dislocated, the fourth tooth was avulsed. Each patient exhibited at least two clinical signs of pulp necrosis as well as radiographic evidence of apical periodontitis. X-rays were taken using individualized film holders (IFH) to reliably assess the treatment outcome. Revitalization treatment was performed without instrumentation of the canal walls, but disinfection with sodium hypochlorite and intracanal dressing with triple antibiotic paste (TAP) for three weeks. Provocation of bleeding was induced in a second visit, the blood clot was covered with collagen followed by calcium silicate cement, and teeth were sealed with resin composite. Clinical and radiographic follow-ups were performed after 1, 3, 6 and 12 months. An increase of root length and thickness was evident in the three teeth with dislocation injuries. In one case, formation of mineralized tissue below the calcium silicate cement was observed. The tooth which had been avulsed and replanted showed resorption of the apical root area. The observations made in this study support the assumption that a separation of HERS and the cells that form pulp and dentin during tooth root development may negatively affect the outcome after a standardized revitalization procedure. The consistent implementation of standardized treatment protocols and the use of IFH are helpful receiving a reliable treatment outcome.

Insufficient evidence for the association between diabetes mellitus and healing of periapical lesions

Insufficient evidence for the association between diabetes mellitus and healing of periapical lesions

No clinical quantifiable benefits between non-surgical and surgical endodontic treatment.

Data sourcesThe authors searched the following electronic databases: the Cochrane Oral Health Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline Ovid and Embase Ovid. The US National Registry of Clinical Trials (ClinicalTrials.gov) and the World Health Organisation (WHO) International Clinical Trials Registry Platform were searched for ongoing trials. There were no restrictions regarding language and publication date. The authors hand-searched the reference lists of the studies retrieved and key journals in the field of endodontics.Study selectionRandomised controlled trials (RCTs) involving people with periapical pathosis including comparison of surgical versus non-surgical treatment or different types of surgery. Outcome measures were healing of the periapical lesion assessed after one-year follow-up or longer, postoperative pain and discomfort and adverse effects such as tooth loss, mobility, soft tissue recession, abscess, infection, neurological damage or loss of root sealing material evaluated through radiographs.Data extraction and synthesisTwo review authors independently extracted data from the included studies and assessed their risk of bias. Study authors were contacted to obtain missing information. The authors combined results of trials assessing comparable outcomes using the fixed-effect model, with risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, and 95% confidence intervals (CIs) and they used generic inverse variance for split-mouth studies.ResultsThe review included 20 RCTs. Two trials at high risk of bias assessed surgery versus a non-surgical approach: root-end resection with root-end filling versus root canal retreatment. The other 18 trials evaluated different surgical protocols.There was no clear evidence of superiority in the surgical or non-surgical approach for healing at one-year follow-up (RR 1.15, 95% CI 0.97 to 1.35; two RCTs, 126 participants) or at four- or ten-year follow-up (one RCT, 82 to 95 participants), although the evidence is very low quality. More participants in the surgically treated group reported pain in the first week after treatment (RR 3.34, 95% CI 2.05 to 5.43; one RCT, 87 participants; low quality evidence).In terms of surgical protocols, there was some inconclusive evidence that ultrasonic devices for root-end preparation may improve healing one year after retreatment, when compared with the traditional bur (RR 1.14, 95%CI 1.00 to 1.30; one RCT, 290 participants; low quality evidence). There was evidence of better healing when root-ends were filled with MTA than when they were treated by smoothing of orthograde GP root filling, after one-year follow-up (RR 1.60, 95% CI 1.14 to 2.24; one RCT, 46 participants; low quality evidence).There was no evidence that using CBCT rather than radiography for preoperative evaluation was advantageous for healing (RR 1.02, 95% CI 0.70 to 1.47; one RCT, 39 participants; very low quality evidence), nor that any magnification device affected healing more than any other (loupes versus endoscope at one year: RR 1.05, 95% CI 0.92 to 1.20; microscope versus endoscope at two years: RR 1.01, 95% CI 0.89 to 1.15; one RCT, 70 participants, low quality evidence). There was no evidence that antibiotic prophylaxis reduced incidence of postoperative infection (RR 0.49, 95% CI 0.09 to 2.64; one RCT, 250 participants; low quality evidence).There was some evidence that using a papilla base incision (PBI) may be beneficial for preservation of the interdental papilla compared with complete papilla mobilisation (one RCT (split-mouth), 12 participants/24 sites; very low quality evidence). There was no evidence of less pain in the PBI group at day one post surgery (one RCT, 38 participants; very low quality evidence).There was evidence that adjunctive use of a gel of plasma rich in growth factors reduced postoperative pain compared with no grafting (measured on visual analogue scale: one day postoperative MD -51.60 mm, 95% CI -63.43 to -39.77; one RCT, 36 participants; low quality evidence). There was no evidence that use of low energy level laser therapy (LLLT) prevented postoperative pain (very low quality evidence).ConclusionsAvailable evidence does not provide clinicians with reliable guidelines for treating periapical lesions. Further research is necessary to understand the effects of surgical versus non-surgical approaches, as well as to determine which surgical procedures provide the best results for periapical lesion healing and postoperative quality of life. Future studies should use standardised techniques and success criteria, with precisely-defined outcomes and the participant as the unit of analysis.

Comparision of Healing of Periapical Lesion with Different Intracanal Medicament Using Mineral Trioxide Aggregate as Apical Barrier

Comparision of Healing of Periapical Lesion with Different Intracanal Medicament Using Mineral Trioxide Aggregate as Apical Barrier

A two-year report of a comparative randomized controlled trial on the treatment of upper central incisors with periapical lesions

AimTo evaluate the two-year success rate of primary root canal treatment performed with two integrated shaping and filling systems on upper central incisors with chronic periapical pathosis. MethodologyThe trial enrolled 60 patients with an untreated maxillary central incisor presenting a chronic periapical lesion smaller than 5mm in diameter, who were randomly assigned to two treatment groups: G1 (n=30), Revo-S/One Step Obturator; G2 (n=30) GTX/GTX Obturator. The patients underwent single-session root canal treatments by an experienced endodontist and were followed up for two years. The clinical evaluation entailed percussion and palpation tests. Two independent examiners rated the radiographic healing on the basis of a previously described scale. Comparability between groups in terms of baseline clinical parameters was tested with a Mann-Whitney test (age, apical gauging) and χ2 test (tenderness to percussion and palpation). The comparison of clinical data and radiographic healing scores between the groups and among time points was carried out with non-parametric statistical methods (p<0.05). ResultsThe two groups were comparable in terms of baseline clinical parameters. All patients were available for the re-evaluation after two years. Only one patient per group was positive to the clinical tests at the final recall. An improvement of radiographic healing scores along the follow-up period was observed. After two years, the lesions were scored as totally healed, partially healed and not healed in 93.3%, 3.3% and 3.3% of cases in G1 and in 93.3%, 0% and 6.7% of cases in G2, without pointing out statistically significant differences between groups. ConclusionsBoth the two tested integrated shaping and filling systems proved to be effective for the treatment of upper central incisors with periapical pathosis. When monitoring the healing of periapical lesions, follow-up times longer than one year may be required to observe complete healing.