Large Periradicular Lesion Research Articles

Non-surgical endodontic treatment of large periradicular lesion with paresthesia-case report

Non-surgical endodontic treatment of large periradicular lesion with paresthesia-case report

Endodontic treatment of type II dens invaginatus with a large periradicular lesion: A case report

Endodontic treatment of type II dens invaginatus with a large periradicular lesion: A case report

MAS (Mixture of Antibiotic and Steroid) paste – A novel drug combination in treating large periradicular lesions nonsurgically

MAS (Mixture of Antibiotic and Steroid) paste – A novel drug combination in treating large periradicular lesions nonsurgically - IDJSR- Print ISSN No: - 2394-708X Online ISSN No:- 2278-3784 Article DOI No:- 10.18231/j.idjsr.2019.018, International Dental Journal of Student's Research-Int Dent J Stud Res

Endodontic management of type II dens invaginatus with open apex and large periradicular lesion using the XP-endo Finisher: A case report

Dens invaginatus (DI) represents an endodontic challenge because of its complex root canal morphology. This case report presents the clinical management of a 22-year-old woman with type II DI in right maxillary lateral incisor with a painful swelling. Pulp testing revealed no response with the tooth. Type II DI with open apex and large periradicular lesion was seen on radiograph. The treatment was planned by using cone-beam computed tomography (CBCT) imaging. Canal treatment was completed in two appointments with the aid of a dental operating microscope. In the first appointment, the internal anatomy was modified using an ultrasonic tip, and chemo-mechanical preparation was performed using the XP-endo Finisher instrument and NaOCl; calcium hydroxide intracanal dressing was used for one month. In the second appointment, an apical plug of mineral trioxide aggregate (MTA) Repair HP was performed and the remaining pulp space was then filled with gutta-percha and AH Plus sealer using the continuous wave of condensation technique. At the fourteen-month reevaluation, the patient was asymptomatic, the tooth had remained functional, and radiographic and CBCT assessment showed significant osseous healing of the lesion. Successful non-surgical management of the present type II DI was achieved in the present case. The association of CBCT, dental operating microscope, XP-endo Finisher, NaOCl and MTA Repair HP were important for ensuring a predictable outcome. Key words:Cone beam computed tomography, dens invaginatus, MTA apexification, XP-endo Finisher.

Management of Dens Invaginatus Type II Associated with Immature Apex and Large Periradicular Lesion Using Platelet-rich Fibrin and Biodentine

Dens invaginatus (DI) poses peculiar challenges in endodontic treatment of teeth because of distortion of pulpal space. A case of Oehlers type II DI with open apex and large periapical lesion is reported. The case was managed using cone-beam computed tomography (CBCT), operating microscope, platelet-rich fibrin (PRF), and Biodentine. A 15-year-old male patient presented with palatal swelling. Pulp sensibility testing of right maxillary lateral incisor was negative. Intraoral periapical digital radiograph revealed an Oehlers type II DI with open apex and periapical radiolucency. A CBCT scan was performed to study the anatomy, determine the true extent of the periapical lesion, and form a treatment plan. A diagnosis of Oehlers type II DI with pulp necrosis and acute periapical abscess was made. Two-visit endodontic treatment was performed. In the first visit, the invaginated central mass was removed under operating microscope, chemo-mechanical preparation was done, and double antibiotic paste dressing was placed. In the second visit, the canal was sealed with apical matrices of PRF and Biodentine as filling material. The patient was asymptomatic and radiographs revealed continued healing of the osseous defect at follow-up visits. A CBCT scan at 30 months showed complete continuity of periodontal ligament space, healing of labial and palatal cortical plates, and formation of intercortical bone. The advances in endodontic armamentarium and technology, like CBCT and operating microscope, have made successful treatment of challenging cases possible. PRF and Biodentine as apical matrices and filling material, respectively, proved to be effective in the present case.

Nonsurgical endodontic management of maxillary lateral incisor with dens invaginatus and periradicular lesion

Dens invaginatus is a developmental malformation resulting from invagination of the tooth crown or root before calcification has occurred. It can range from a deep fissure or pit on the lingual surfaces of anterior teeth to an occlusal pit on the posterior teeth. This article presents a case of type II dens in dente in a 14-year-old female patient, where the invagination extends beyond the cementoenamel junction in maxillary lateral incisor with a large periradicular lesion. Usually, an anomaly such as dens invaginatus remains unnoticed by the patient until any clinical sign appears. Root canal treatment of such teeth with complex root canal anatomy can be difficult because infected pulpal tissues may remain in inaccessible areas of the canal. Hence, it is important to identify this anomaly and manage it as early as possible. In the present case, a nonsurgical root canal treatment of the invagination was performed. The treatment of invagination resulted in resolution of a substantial periradicular lesion.

Nonsurgical Endodontic Treatment Of A Large Periradicular Lesion

Nonsurgical Endodontic Treatment Of A Large Periradicular Lesion

Management of a Previously Treated, Calcified, and Dilacerated Maxillary Lateral Incisor: A Combined Nonsurgical/Surgical Approach Assisted by Cone-beam Computed Tomography

Teeth with calcified canals, dilacerated roots, and associated large periradicular lesions involving both cortical plates pose a challenge to dentists. In addition to the nonsurgical endodontic treatment, such teeth may require surgical intervention with concomitant use of bone grafting materials and barrier techniques. These techniques, when combined with the use of a host modulating agent such as platelet-rich fibrin (PRF), may improve the chances of success. A 26-year-old woman was referred for dental treatment with a recurrence of an intraoral sinus tract 2 months after periradicular surgery in the upper anterior region. Clinical and radiographic examinations revealed a calcified and perforated maxillary left lateral incisor with a severely dilacerated root as well as an associated large radiolucent lesion surrounding the roots of the maxillary left central and lateral incisors. A cone-beam computed tomographic scan of the anterior maxilla showed erosion of the labial and palatal cortical plates in the same region. A calcified canal in the lateral incisor was negotiated up to the straight line portion of the canal. Periradicular surgery with root-end resection was performed, and root-end filling was performed with mineral trioxide aggregate. The perforation present on the middle third of the labial surface of the root was repaired with mineral trioxide aggregate, and the canal was cleaned, shaped, and obturated. A PRF scaffold was prepared and used with a collagen membrane and a freeze-dried bone allograft. Follow-up visits after 3 months, 6 months, and 1 year revealed satisfactory clinical and radiographic healing. The combined use of nonsurgical and surgical modes of treatment cannot be overemphasized in this case. The use of PRF along with a bone graft and a barrier membrane may have enhanced the speed of healing and the resolution of periradicular radiolucency by enhancing bone regeneration.

Regression of large periapical lesion using calcium hydroxide therapy: a six-year follow-up case report

Periradicular lesions occur in non-vital teeth as the result of a chronic aggression by the presence of microorganisms into the root canal, which may appear as a radiolucent lesion in the radiographic exam; treatment varies according to surgical or nonsurgical methods. This case report describes the regression of a periradicular lesion using a nonsurgical endodontic treatment in association with intracanal calcium hydroxide-based medicament. After patient examination and radiographic analysis, a 13 mm (in maximum diameter) radiolucent lesion was observed in tooth number 12. The endodontic treatment was done and Calen-CMCP (S.S. White Artigos Dentários Ltda., Rio de Janeiro, RJ, Brazil) was placed into the root canal, which was changed after every two weeks during two months. It was observed a progressive centrifugal regression of the lesion after every renewing of the medicament. In addition, after six-year follow-up the tooth was still free of re-infection and bone tissue was completely regenerated. In conclusion, calcium hydroxide therapy can conservatively stimulate the regression of large periradicular lesions.

Nonsurgical Root Canal Therapy of Large Cystic Periapical Lesions Using Simple Aspiration and LSTR (Lesion Sterilization and Tissue Repair) Technique: Case Reports and Review

Introduction: This review and case report presents the treatment of two large cystic periapical lesions using simple aspiration technique for decompression and triple antibiotic paste for disinfection of the root canal system. Methods: A non-surgical approach was followed for the two large cystic periapical lesions. Simple aspiration irrigation technique along with lesion sterilization therapy with triple antibiotic paste was used without any surgical intervention. Results: Complete periapical healing of both the cyst like periapical lesions occurred without any surgical intervention. A 1 year follow-up radiograph showed complete healing of the lesion. Conclusion: Pathogenesis, histology, and molecular cell biology of inflammatory apical true cysts are not different from pocket cysts. Therefore, inflammatory apical true cysts might regress after nonsurgical root canal therapy by the mechanism of apoptosis or programmed cell death, similar to inflammatory pocket cysts. Non-surgical approach using a combination of Simple Aspiration technique and LSTR (lesion sterilization and tissue repair) technique was successful in healing large cyst-like periradicular lesions.

Treatment of a large periradicular defect using guided tissue regeneration: A case report of 2 years follow-up and surgical re-entry

Periradicular (PR) bone defects are common sequelae of chronic endodontic lesions. Sometimes, conventional root canal therapy is not adequate for complete resolution of the lesion. PR surgeries may be warranted in such selected cases. PR surgery provides a ready access for the removal of pathologic tissue from the periapical region, assisting in healing. Recently, the regeneration of the destroyed PR tissues has gained more attention rather than repair. In order to promote regeneration after apical surgery, the principle of guided tissue regeneration (GTR) has proved to be useful. This case presents the management of a large PR lesion in a 42-year-old male subject. The PR lesion associated with 21, 11 and 12 was treated using GTR membrane, fixated with titanium minipins. The case was followed up for 2 years radiographically, and a surgical re-entry confirmed the re-establishment of the lost labial plate. Thus, the principle of GTR may immensely improve the clinical outcome and prognosis of an endodontically involved tooth with a large PR defect.

Nonsurgical healing of large periradicular lesions using a triple antibiotic paste

The success of the endodontic treatment depends on the microbial suppression in the root canal and periapical region. The infection of the root canal system is considered to be a polymicrobial in nature. Because of the complexity of the root canal infection, it is unlikely that any single antibiotic could result in effective sterilization of the canal. Triple antibiotic paste (TAP) containing metronidazole, ciprofloxacin, and minocycline has been reported to be a successful regimen in controlling the root canal pathogen. Two case reports describe the nonsurgical endodontic treatment of teeth with large periradicular lesions. A triple antibiotic paste was used for 8 months, the follow-up radiograph of two cases showed progressive healing of periradicular lesion. The results of these cases 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 periradicular lesions.

Type III B dens invaginatus: Diagnostic and clinical considerations using 128-slice computed tomography

Endodontic therapy is successful only when thorough knowledge of root canal morphology is understood. Dens invaginatus is malformation of teeth resulting from invagination of tooth before biological mineralization occurs. It is clinically significant with an early pulpal involvement and chronic periapical lesion, which are often associated with this anomaly. The present case report describes a 13-year-old female patient who reported to our institution with complaint of pain and swelling in the right maxillary region. Intraoral examination revealed Ellis Type II fracture of right maxillary central incisor and normal appearing right maxillary lateral incisor. On radiographic examination right maxillary, lateral incisor roots are morphologically altered with an immature apex and a large periradicular lesion. Conventional radiographs help in the assessment of complex root morphology, but certain limitations pertaining to detail of complexity needs for the use of more advance imaging modalities. Complex anatomic variations can best be diagnosed with the use of computed tomography (CT). A combined endodontic and surgical treatment was performed followed by postobturation CT images which were reviewed as axial slices and in volume rendering multiplanar reconstruction. The scope of using spiral CT in the endodontic diagnosis and treatments is increasing as it provides better resolution than other methods.

The treatment of a maxillary lateral incisor with unusual morphology with long‐term follow‐up

To report the treatment of an unusual combination of one dens evaginatus and two dens invaginatus in a single tooth and its healing outcome after 10 years. The long-term outcome of a maxillary lateral incisor with dens evaginatus combined with two Oehlers type II dens invaginatus and a large periradicular lesion in an 11-year-old female treated endodontically and restoratively is described. The endodontic treatment included intracanal medication with calcium hydroxide and canal filling using a thermoplastic root canal filling technique. The crown was restored with conventional composite resin. During periodic clinical and radiographic follow-up, the patient remained symptom free, and the periradicular region was completely healed, meeting both aesthetic and functional expectations after 10 years. The co-occurrence of dens evaginatus and two dens invaginatus in the same tooth is an unusual finding that compromises aesthetics and predisposes the patient to dental pulp infection. The complex morphology observed in this case represented both endodontic and restorative challenges.

Non-surgical Endodontic Treatment for Dens Invaginatus Type III Using Cone Beam Computed Tomography and Dental Operating Microscope: A Case Report

Dens invaginatus is a morphological abnormality of the tooth in which the coronal tooth enamel and dentin fold inwards towards the pulp cavity. Dens invaginatus type III (Oehlers: 1957) is characterized by infolding of the enamel and dentin as far as the root apex. This report describes a case of surgical and non-surgical endodontic therapy for a maxillary lateral incisor with type III dens invaginatus, necrotic pulp, and an associated large periradicular lesion. The patient was a 16-year-old man. Periapical radiographs suggested the presence of an untreated area of invagination. Cone beam computed tomography (CBCT) was then used for three-dimensional observation of the morphological details of this area. The CBCT scans revealed invagination and its relationship with the pulp chamber. A dental operating microscope was used to access two primary root canals and the area of invagination. The root canals were then localized, negotiated, enlarged, and filled with calcium hydroxide. Two months later, the canal and invagination were obturated with core-based gutta-percha (FlexPoint Neo: FP core-carrier technique) and restored. Cone beam computed tomography and microscopic techniques allow even complicated cases of dens invaginatus to be diagnosed and treated using non-surgical root canal management.

Rapid endodontic management of type II dens invaginatus using an MTA plug: a case report

Dens invaginatus is an anomaly characterized by an infolding of enamel and dentin that can lead to caries and pulpal death while the tooth is still immature, and present difficulties with diagnosis and treatment. Generally such open apices are managed by long term apexifaction procedures. This article demonstrated rapid management of a maxillary lateral incisor having a type 2 dens invaginatus, necrotic pulp, open apex and very large periradicular lesion using calcium hydroxide for one week prior to placement of a mineral trioxide aggregate (MTA) plug. After setting of the MTA, the remaining canal space was obturated using a warm vertical gutta percha technique. At 6 months follow-up the patient was asymptomatic, the lesion had almost entirely resolved, and, the root was already completely surrounded by bone.

Repairing invasive cervical root resorption by glass ionomer cement combined with mineral trioxide aggregate

Cervical invasive root resorption is a type of external inflammatory root resorption that is relatively uncommon and aggressive, and leads to loss of tooth structure. A diagnosis of cervical invasive root resorption depends on careful routine clinical and radiographic examinations. This report describes the diagnosis and successful treatment of a 41-year-old male patient with invasive cervical root resorption at tooth #21. The distinctive feature was a large resorptive defect at the cervicopalatal aspect of the maxillary central incisor involving the root-canal space. A radiographic examination revealed a large periradicular lesion and severe periodontal damage around this tooth. The defect was surgically repaired using resin-reinforced glass ionomer cement (GIC) and mineral trioxide aggregate (MTA) to restore the coronal half and apical half of the resorption cavity, respectively. Thereafter, conventional root-canal treatment was performed. The 11-month recall revealed good healing of both the periodontal and periradicular conditions and no obvious clinical symptoms. This case provides a new treatment modality to repair defects of cervical invasive root resorption and promote the healing of periodontal defects.

Management of Dens Invaginatus Type III with Large Periradicular Lesion

This study describes a clinical case of type III dens invaginatus with an extensive periradicular lesion treated successfully. Dens invaginatus is a maldevelopment of the dental germ which occurs as a result of the invagination of the enamel organ. These cases may present difficulties with respect to its diagnosis and treatment because of canal morphology. The success of endodontic therapy requires a knowledge of dental anatomy and its anomalies. A 17-year-old female patient is reported presenting right maxillary lateral incisor (tooth no. 7) classified as type III dens invaginatus with necrotic pulp and presence of an extensive radiolucid lesion. Endodontic treatment was recommended for tooth. However, intracanal exudate was present, suggesting a resistant infection. Enucleation of the lesion was performed as a complementary approach. The root canal obturation was carried out by the gutta-percha thermoplastification technique with root canal sealer, followed by restoration of the tooth. Healing of the lesion with hard tissue formation was confirmed at follow-up. A combination of endodontic and surgical treatments were fundamental to the maintenance of the tooth. The treatment was considered successful. Root canal therapy of dens invaginatus should be based on a thorough clinical and radiographic evaluation. The knowledge of classification and anatomical variations of teeth with dens invaginatus are of great importance for correct treatment.

Dentinal Tubule Infection as the Cause of Recurrent Disease and Late Endodontic Treatment Failure: A Case Report

Introduction This article describes a case of recurrent post-treatment apical periodontitis and late failure after endodontic retreatment performed in a single visit. Methods The patient presented with a tooth exhibiting inadequate endodontic treatment and a large periradicular lesion that extended laterally to the root. Retreatment was performed in a single visit and involved chemomechanical preparation using 5.25% NaOCl as the irrigant and root canal obturation by Schilder’s vertical compaction technique. A large lateral canal was radiographically revealed after obturation. After 2 years, the lesion was no longer radiographically discernible, a condition that was confirmed 9 years after retreatment procedures. Nonetheless, after 12 years, radiographs revealed recurrent disease. Apical surgery was performed, and the root apex, including the area of the large lateral canal, was resected with care to maintain the lesion attached to it. The biopsy specimen was subjected to histopathologic and histobacteriologic analyses. Results Longitudinal sections of the apical root specimen revealed a heavy dentinal tubule infection surrounding the area of the lateral canal. Bacteria were not found in any other area of the specimen. No other possible reason for the inflammatory periradicular lesion, such as root fracture, coronal leakage, or foreign-body reaction, was evident. Conclusions A persistent intraradicular infection caused by bacteria located within dentinal tubules is the most reasonable explanation for resurgence of the apical periodontitis lesion. This case report stresses the importance of attaining proper disinfection of the root canal system for a predictable long-term outcome of the treatment.

Use of triple antibiotic paste in the treatment of large periradicular lesions

Microorganisms are the possible source of endodontic lesions. The polymicrobial infection makes the sterilization of the root canal difficult. The following case report describes the non-surgical endodontic treatment of teeth with a large periradicular lesion. First, an intracanal dressing of calcium hydroxide was given. Since the symptoms did not subside, the treatment protocol was changed. A triple antibiotic paste was used instead for 3 months. On follow up, teeth were clinically asymptomatic and radiographically showed healing of the periradicular lesion. The result of the case show that when most commonly-used medicaments fail in eliminating the symptoms, then a triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) can be used clinically in the treatment of teeth with large periradicular lesions.