Large Periapical Lesion Research Articles

Conservative Management Of A Large Periapical Lesion: Triumph And Tragedy

AbstractTeeth that become devitalised before the completion of root maturation present many clinical challenges. These include the lack of an apical constriction, thin root walls that are prone to fracture and the presence of an associated large periapical lesion. The following case describes the treatment of such a case and its unfortunate outcome due to iatrogenic crown fracture.

The guided tissue regeneration principle in endodontic surgery: one‐year postoperative results of large periapical lesions

Twenty patients with large endodontic lesions, which failed to respond to conventional endodontic therapy, were selected for this study. The lesions had a radiographic diameter of at least 10 mm, were removed by periradicular surgery, before retrofilling the apices with either super EBA or dessicated zinc oxide-eugenol. In 10 test sites large e-PTFE membranes (Gortex) were placed to cover the lesions, while at the control sites the lesions were not covered before resuturing. Radio-graphic analysis of the lesions at 3, 6, 9 and 12 months revealed that lesions covered with the membranes healed quicker than the control lesions, and that the quality and quantity of the regenerated bone was superior when membranes were used. Results of the study indicate that guided tissue regeneration (GTR) principles can be effectively applied to the healing of large periapical lesions, especially in through-and-through lesions.

Root end isolation for retrograde fillings

Isolation and moisture control of the root end of a tooth with a large periapical lesion is normally accomplished with the aid of bone wax, cotton pellets, or sterile gauze saturated with a suitable hemostatic agent. An alternative procedure, a simple and effective rubber dam technique, is presented demonstrating isolation of an apex before reverse filling.

Surgical fenestration of large periapical lesions

The decompression technique utilizing tubing for the treatment of large periapical lesions has been widely used with success. However, unobtainable biopsies and patient noncompliance are among the disadvantages that are of concern. An alternative approach is presented, whereby a surgical procedure is performed involving only partial removal of tissue from the lesion. The advantages of this procedure are discussed.

A 2-day decompression: A case report of a maxillary first molar

A case report of a maxillary first molar is presented in which a drainage tube from a decompression procedure was removed 2 days following placement. The oral surgeon who removed the tube scheduled the patient for surgical enucleation of the large periapical lesion. The surgical appointment was subsequently cancelled and routine endodontic follow-up showed continued osseous repair at 3, 6, and 12 months. The decompression of a large periapical lesion is a conservative alternative to surgical enucleation.

Inflammatory resorption caused by an adjacent necrotic tooth

A case history is presented with a large periapical lesion and a perforating resorption defect on a cuspid. Endodontic therapy was performed, presuming that the necrotic cuspid caused the inflammatory response. No radiographic healing was evident 18 months after endodontic therapy. Considerable healing was demonstrated 6 months later, following the extraction of an adjacent tooth with prior root canal therapy. It was concluded that the failing root canal therapy of the extracted tooth was the primary factor leading to the inflammatory lesion, the resorptive perforation of the adjacent tooth, and its pulpal necrosis. It has not been reported prior that inflammatory resorption can result from the pulpal necrosis of an adjacent tooth.

Decompression of a large periapical lesion utilizing an improved drainage device

A decompression device constructed of plastic intravenous tubing attached to an acrylic base and ligated into position with orthodontic ligature wire was used to successfully reduce a large periapical lesion in the anterior mandible. Guidelines for this treatment approach are presented.

Decompression of a large periapical lesion: A short treatment course

Conservative reduction of a large periapical lesion was accomplished by early root canal obturation and unintentional interruption of the drainage/lavage regime within 10 days of a decompression procedure. Uneventful healing followed and osseous repair was almost complete within 1 yr. Conservative reduction of a large periapical lesion was accomplished by early root canal obturation and unintentional interruption of the drainage/lavage regime within 10 days of a decompression procedure. Uneventful healing followed and osseous repair was almost complete within 1 yr.

Treatment of large periapical lesions using cannulization through the involved teeth

A method for the nonsurgical treatment of teeth with persistent large periapical lesions is presented. Two clinical cases in which the technique was used successfully are also presented. A method for the nonsurgical treatment of teeth with persistent large periapical lesions is presented. Two clinical cases in which the technique was used successfully are also presented.

Quantitation of circulating immune complexes, immunoglobulins G and M, and C3 complement component in patients with large periapical lesions

The serum concentrations of circulating immune complexes, immunoglobulins G and M, and the C3 complement component of thirty patients with one to three large periapical lesions were measured and compared with those of patients with no periapical lesions. The results indicate that there is no statistical difference between the two groups, and it appears that chronic periapical lesions cannot act as a focus to cause systemic diseases via immune complexes.

Decompression of large periapical cystic lesions

The removal of extensive periapical cystic lesions by surgical enucleation frequently causes postsurgical sequelae, such as devitalization of adjacent teeth, patient apprehension and discomfort, loss of bony support and, on occasion, paresthesia. An alternative approach is presented, whereby a tube is inserted into the cystic cavity. This tube is then periodically reduced in length as the lesion heals.

Conservative reduction of large periapical lesions

T he clinician is often confronted with the problem of treating an extensive periapical lesion which may be cystic as a result of pulpal pathosis. Surgical management by curettement and/or apical resection has usually been the accepted procedure for such lesions. However, in cases in which extensive periapical lesions are visualized on the roentgenograms, a surgical approach can create complications by injuring the vitality of the adjacent teeth and may possibly cause an anatomic deformity. The purpose of this article is (1) to question the need for surgical treatment of the extensive periapical lesion and (2) to present a method of treating the lesion with minimal surgical intervention and injury to any of the related structures in cases of extensive regions of rarefaction.

Treatment of Large Periapical Lesions by an Indwelling Tube

Treatment of Large Periapical Lesions by an Indwelling Tube