Large Periapical Lesion Research Articles

Conservative approach in the management of large periapical lesion in a long standing trauma case: A case report

Pulpal and periradicular pathology is the common sequel following trauma to the teeth severe enough to cause displacement of tooth resulting in necrosis of pulp as a result of severing of neurovascular supply near apical constriction. This case report evidenced a conservative non-surgical endodontic management of a large periapical lesion in a 19-year-old young male induced due to traumatic injury to the face.

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

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

Outcome of Nonsurgical Root Canal Retreatment Procedures Obturated with Warm Gutta-percha Techniques: A Longitudinal Clinical Study

IntroductionTo evaluate the success rate of nonsurgical root canal retreatment at the 2–3-year follow-up and identify the possible prognostic factors. MethodsPatients who underwent root canal retreatment at a university dental clinic were contacted for clinical and radiographic follow-up. The retreatment outcomes in these cases were based on clinical signs, symptoms, and radiographic criteria. Inter- and intraexaminer concordances were calculated using Cohen's kappa coefficient. The retreatment outcome was dichotomized into success or failure according to strict and loose criteria. The radiographic success criteria consisted of complete resolution or absence of a periapical lesion (strict criteria) or a reduction in the size of an existing periapical lesion at recall (loose criteria). χ2 tests were used to evaluate possible variables associated with retreatment outcomes (age, sex, tooth type, location, contact points, periapical status, quality of previous and final root canal filling, previous and final restoration, number of visits, and complications). ResultsOverall, 129 teeth (113 patients) were included in the final evaluation. The success rate was 80.6% under strict criteria and 93% under loose criteria. Molars, teeth with an initially higher periapical index score, and teeth with >5 mm periapical radiolucency had a lower success rate according to the strict criteria model (P < .05). When the loose success criteria were used, teeth with larger (>5 mm) periapical lesions and those that had been perforated during retreatment showed a lower success rate (P < .05). ConclusionsThe present study demonstrated that nonsurgical root canal retreatment is a highly successful procedure after an observation period of 2–3 years. Treatment success is primarily affected by the presence of large periapical lesions.

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

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

A CBCT Healing Assessment of Nonsurgical Endodontic Management of Two Trauma-induced Large Periapical Lesions

A CBCT Healing Assessment of Nonsurgical Endodontic Management of Two Trauma-induced Large Periapical Lesions

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.

Endodontic Management of Four-Rooted Maxillary Second Molar with Large Periapical Lesion: A Case Report

Successful endodontic therapy requires a thorough understanding of root canal morphology and its variations. Commonly encountered morphological variations include the presence of extra roots, additional canals, lateral canals and deltas. The presence of periapical lesions in morphologically varied teeth may pose an additional clinical challenge affecting the long-term outcome of endodontic treatment. This case report demonstrates the successful endodontic treatment of four-rooted maxillary second molar with a large periapical lesion. Tooth #17 had a unique anatomy with two widely separated palatal roots, with two separate canals having different portals of exit. Successful healing of the periapical lesions was observed in an 8-month review.

Endodontic Treatment of Teeth with Large Periapical Lesions: Two Case Reports

Endodontic Treatment of Teeth with Large Periapical Lesions: Two Case Reports

Non-surgical Management of a Large Periapical Lesion: A Case Report

Periapical lesions develop as a sequela to pulpal diseases. The majority of inflammatory periapical lesions are initially treated with conservative non-surgical procedures. The success of root canal treatment is based on thorough cleaning, shaping and obturation of the root canal system. Calcium hydroxide and triple antibiotic paste (TAP) are recommended as intracanal medicaments due to its antibacterial properties. This case report describes the non-surgical management of a large cyst-like periapical lesion in relation to the maxillary lateral incisor of a 19-year-old male with the chief complaint of periodic swelling and pus drainage from the palatine region with a history of a traumatic accident in the same area. The present case highlights the use of calcium hydroxide and TAP as an interappointment endodontic dressing for non-surgical management of large periapical radiolucency, which resulted in favourable clinical and radiographic outcomes.

Cone-beam Computed Tomography Evaluation of Non-surgical management of a Large Periapical Lesion using Calcium hydroxide intracanal medicament: A 1-year follow-up case report

This case report aims to assess the healing of a large periapical lesion non-surgically using Calcium hydroxide (CH) with the aid of Cone Beam Computed Tomography (CBCT). A 28-year-old female patient presented with pain and swelling in the lower anterior teeth (31, 32, 41, 42) (Federation Dentaire Internationale (FDI) tooth notation system). Patient history and pre-operative radiographic examination revealed incomplete root canal treatment in relation to 31, 32, 41, 42 with periapical abscess. During the first visit, the access cavity was modified, followed by determination of the working length and biomechanical preparation. In the present case report, (CH) intracanal medicament(ICM) was placed in the canals for 2 weeks, and the process was repeated until the canals were dry. Once the canals were dry and the teeth became asymptomatic, obturation was performed. Permanent coronal seal was provided using composite restorative material. One year periodic follow-up was carried out to assess the healing of the periapical lesion, following which, post-operative healing was assessed with the help of CBCT- Periapical Index (CBCT-PAI) and was compared with the pre-operative CBCT-PAI. Regression of the lesion and formation of the trabecular pattern of the bone were noted. Intracanal medication with calcium hydroxide complemented the instrumentation with irrigation and optimal disinfection of the root canal system. In this case report, the use of CBCT as a diagnostic tool helped in the accurate measurement of periapical lesion size.

Quality of techniques used to assess clinical outcomes of regenerative endodontic treatment in necrotic mature teeth.

Data sources A preliminary, randomised, prospective, controlled clinical trial of patients managed with two regenerative endodontic procedures, revitalisation and a platelet-rich fibrin (PRF)-based technique, in the treatment of mature permanent teeth with necrotic pulps.Study selection Twenty patients with mature necrotic anterior teeth with large periapical lesions treated with the blood clot and a PRF-based techniques for revitalisation. Periradicular healing and pulp sensibility was assessed at 6 and 12 months after treatment.Results Significant periradicular radiographic healing and sensibility was reported at 6 and 12 months.

Giant apical cyst in anterior maxilla: A case report

Apical or periapical cysts are the most common type of cyst, affecting the local and systemic health of patients. This pathology can manifest as an inflammatory condition in periodontal tissues due to the stimulation and proliferation of the epithelial cell rests of Malassez and it can be identified in clinical visits and imaging exams of routine. Apical cysts do not cause facial pain and/or swelling and appear as a well-defined radiolucent region when analyzed radiographically. Differential diagnosis include dentigerous cyst, ameloblastoma, odontogenic keratocyst, and periapical cementoma. Only a histopathological analysis can provide a definite diagnosis. Several methods have been described to treat apical cysts, such as endodontic therapies, decompression, marsupialization and cystectomy. A healthy 60-year-old man looked the dental office and reported successful endodontic treatment in the upper central and lateral incisors teeth and a tomographic exam suggested the presence of the large periapical cystic lesions located in the anterior region of the maxillary. After complementary exams, the cystic lesion was enucleated without endodontic. Histopathological analysis confirmed the hypothetical diagnosis which had been observed in the imaging exam. The patient’s clinical follow-up showed good evolution with no clinical symptoms and bone healing was observed in the region of the lesion. It is essential for dentists to have knowledge about diagnostic methods and treatments to avoid adverse effects in healthy teeth or other structures present in the face. Disseminating information about an uncommon case to the scientific community may help achieving success in similar situations.

USAGE OF CHLORHEXIDINE AS A FINAL IRRIGANT IN ONE-VISIT ROOT CANAL TREATMENT IN COMPARISON WITH CONVENTIONAL TWO-VISIT ROOT CANAL TREATMENT IN MANDIBULAR MOLARS: A RANDOMIZED CLINICAL TRIAL

The effectiveness of 1-visit root canal treatment (RCT), especially for teeth with large periapical lesions, are still being debated. Although, the use of chlorhexidine (CHX) as a final irrigant have been recommended to provide an optimized approach in 1-visit RCT, there is limited knowledge about the outcome of 1-visit RCT using CHX as the final irrigant. The aim of this randomized clinical trial was to evaluate the healing of mandibular molar teeth with large periapical lesions after RCT that was completed in 1 visit using 2% CHX as a final irrigant, comparing the results with a conventional 2-visit RCT as a control group. This study is a prospective, parallel-designed, and single-blinded randomized clinical trial. One-hundred asymptomatic mandibular molar teeth with large periapical lesions were randomly assigned to 2 groups. All teeth were instrumented with Reciproc files with 2.5% sodium hypochloride (NaOCl) and 5% ethylenediaminetetraacetic acid (EDTA) as irrigants. In the intervention group, half of the teeth were treated in 1 visit, receiving an additional final rinse with 2% CHX before obturation; the other half of the teeth, however, were treated in 2 visits with calcium hydroxide (CH) dressings, in the control group. All root canals were obturated with Reciproc gutta-percha cones and AH Plus root canal sealer. All patients were recalled and investigated clinically and radiographically for 48 months. Periapical healing was evaluated statistically using the Mann-Whitney U test, followed by the Friedman and the Wilcoxon tests (α = 0.05). During the 48-month follow-up process, 86 teeth (44 in 1-visit and 42 in 2-visit group) were examined. There were no significant differences between the 2 groups regarding the radiographic healing rates (1-visit group 91% and 2-visit group 88%) (P > .05). In this study, 1-visit RCT using 2% CHX as final irrigant in asymptomatic mandibular molars with large periapical lesions produced favorable healing results, similar to 2-visit root canal treatment with calcium hydroxide.

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

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

Effect of Laser Bio stimulation and Bone Graft in Treatment of a Large Periapical Lesion – A CBCT Analysis

India accounts for 23% of global TB burden. Of these 38% are of Extra Pulmonary Tuberculosis. Lymph node TB is the most common EPTB, pleural effusion is second most common type of EPTB in India. The bacteriological confirmation to diagnose EPTB is more difficult due to its paucibacillary nature. This study aims assessing the comparison of ADA with Gene- Xpert MTB RIF in pleural fluid in the diagnosis of tubercular pleural effusion. Study was a cross-sectional study carried out at the Department of Respiratory Medicine and Department of Internal Medicine, Muzaffarnagar Medical College, and School of Medical Science and Research, Greater Noida, Gautam Budh Nagar, UP from January 2018 to March 2019. Paired and unpaired Student's t-test, Chi square test, P &lt; 0.05 was considered statistically significant; SPSS 18.0 software was used for analysis. The detection of MTB and rifampicin resistance using the Gene-Xpert MTB/RIF with pleural fluid ADA assay was assessed in 66 specimens. With ADA cut off as 40IU/L, 60 cases had an ADA &gt; 40IU/L and 6 cases had ADA &lt; 40IU/L. Pleural fluid Gene-Xpert detected MTb in 22 samples while in 44 samples MTB not detected. All pleural fluid MTb detected by Gene-Xpert were rifampicin sensitive. Gene-Xpert detected 2 tubercular pleural effusion in which ADA level was less than 40. Study shows that there was no statistically significance in diagnostic value between Gene- Xpert and ADA pleural fluid however Gene-Xpert MTB/RIF is useful method for rapid detection of MTB and Rifampicin resistance simultaneously. Estimation of ADA in pleural fluid is rapid inexpensive laboratory investigation where the diagnosis is uncertain. We found no significant connection between CBNAAT positivity and ADA level. In developing country lymphocyte predominant effusions with high ADA levels (&gt; 40 U/L) is better option but definitely combined use of ADA and Gene-Xpert is better than using individually for the diagnosis of Tubercular pleural effusion

Alternative Approach for the Management of Complete Crown Fracture with Periapical Lesion by Apicoectomy and Orthodontic Extrusion Using Removable Appliance

Trauma induced periapical lesions often require complex treatment, as conventional root canal therapy poses a high risk of failure due to apical transportation of infection. However, complete crown fractures with a fracture line close to the gingiva or extending subgingivally may require orthodontic extrusion to re-establish the biologic width thereby achieving aesthetic and functional restoration of the tooth. The purpose of this case report is to suggest an alternative treatment approach to achieve healing of periapical lesions and causing extrusion of the teeth by moving the fracture line above the supragingival level for final aesthetic and functional restoration. This case report discusses the management of an anterior tooth with long-standing subgingival fracture and large cyst-like periapical lesion using apicoectomy and orthodontic extrusion with a removable appliance.

Endodontic treatment of dens invaginatus with periapical lesion

Dens invaginatus or dens in dente represent anomaly of the developing tooth due to invagination of the enamel organinto the dental papilla. Dens invaginatus is usually diagnosed by standard radiological methods (RVG, OPG, and 3DCBCT).Clinical examination may reveal a mottled, dilated or conical shape of the crown. Endodontic treatment of dens invaginatuscan be difficult and complex due to the deviated anatomy. This report describes the successful endodontic treatmentof a maxillary lateral incisor that had dens invaginatus and a large periapical lesion. Clinical examination in a 30-year-oldpatient revealed an acute periapical abscess, and a dens invaginatus type II was diagnosed after radiography. Due to theexisting anatomy, endodontic treatment of the main canal was performed through two access cavities, which enabledchemo-mechanical treatment and access to all parts of the root canal. The canal of the invaginated tooth was treatedthrough the third access cavity.

Management of a Large Periapical Lesion Following Nonsurgical Retreatment and Low-level Laser Therapy: A Case Report

Tissue repair is an essential process that reestablishes tissue integrity and regular function. Nevertheless, different therapeutic factors and clinical conditions may interfere in this process of periapical healing. Long-term success of root canal treatment(RCT) is dependent on sufficient and appropriate cleaning and shaping of the root canal system along with 3 dimensional obturation. This article aims to report a non-surgical and orthograde endodontic retreatment of mandibular right central incisor with a large radicular cyst progression related to endodontic origin in a 51-year-old male. The signs (sinus tract) and symptoms ceased after treatment. Bone formation Complete healing of the periradicular lesion was observed at the two-year follow-up examination. The appropriate diagnosis of periradicular lesion and the treatment of root canal system allowed complete healing of large lesions without endodontic surgery.

Non-surgical management of a large periapical lesion using triple antibiotic paste: A case report

Root canal infection is considered to be a polymicrobial infection, consisting of both aerobic and anaerobic bacteria. Because of the complexity of the root canal infection, it is unlikely that any single antibiotic could result in effective sterilization of the canal. A combination of antibiotic drugs (metronidazole, ciprofloxacin, and minocycline/doxycycline in this case) is used to eliminate bacteria, which are possible sources of endodontic lesions. Case report describes the nonsurgical endodontic treatment of maxillary right central and lateral incisor with large periapical lesion. A triple antibiotic paste was used for 4 months at monthly interval. After 4 months, teeth was asymptomatic and was obturated. Complete periapical healing was observed at the 24-month recall. This report confirms that for treatment of a large periapical lesion it is not always necessary to do surgical treatment and even cyst-like periapical lesions heal following conservative endodontic therapy. The results of the case show that when most commonly used medicaments fail in eliminating the symptoms, then a triple antibiotic paste can be used clinically in the treatment of teeth with large periapical lesion.

Non-Surgical Management Of Dens Invaginatus With A Large Periapical Lesion With The Aid Of CBCT

Maxillary lateral incisors show a high incidence of anatomic variation Dens Invaginatus is a developmental anomaly of teeth characterized by infoldings of enamel, dentin and extend up to the apex. Such a condition is often associated with dental caries, pulpal and periodontal pathology. Root canal treatment of this abnormality is considered difficult due to the complex anatomy. This article discusses case report of a tooth with Dens Invaginatus with emphasis on correct diagnosis, treatment planning and nonsurgical healing with no extra intervention of a large periapical lesion associated with invaginated tooth.