Management Of Periapical Lesions Research Articles

Nonsurgical Management of Periapical Lesions of Mandibular First Molar - Case Report

Periapical lesions develop from non-vital teeth. In teeth with non-hermetic root canal filling, the presence of microleakage bacteria will invade the root canal and reach the periradicular area and cause inflammation so that it develops into periapical lesions as a form of failure of root canal treatment. Periapical lesions should be treated with a non-surgical endodontic procedure with a fair success rate. The purpose of this case report was to evaluate conventional endodontics as non-surgical management of teeth with a periapical lesion in previously treated teeth.
 Case: A 25-year-old female patient came to a private practice with a complaint of cavity in her lower left molar. One month ago, she had a throbbing tooth pain for which she took analgesic medication. The tooth was treated by root canal treatment about 6 years ago. The patient had no history of systemic disease.
 Case Management: Occlusal Adjustment, non-vital root canal treatment, the core build-up (fibre reinforced composite) and full coverage direct composite restoration.
 Conclusion: Adequate root canal treatment affects the success of endodontic treatment, in this case, there was very good progress in healing of the periapical lesion.
 Periapical lesions develop from non-vital teeth. In teeth with non-hermetic root canal filling, the presence of microleakage bacteria will invade the root canal and reach the periradicular area and cause inflammation so that it develops into periapical lesions as a form of failure of root canal treatment. Periapical tissue develops in response to microbial assumption and their by-products that infiltrate the periradicular tissues and activate the host's immune reaction. A dynamic encounter between the host's immune response and microbial infective factors at the interface of the periodontal membrane and infected pulpal tissue results in various periapical lesions.[1,2,3]
 Periapical lesions should be treated with a non-surgical endodontic procedure with a fair success rate. Microbial elimination or minimization from the pulp system using efficient chemo mechanical preparation can lead to a successful treatment.[1,4,5] The aim of this case report is to evaluate conventional endodontics as non-surgical management of teeth with a periapical lesion.

Management of periapical lesion with persistent exsudate

This case describes the treatment and follow-up of a mandibular molar in an 18-year-old female with a periapical cyst. Thus, it becomes important to know which options should we take when faced with a clinical situation that we cannot resolve through conventional methods, and which techniques and approaches we have to achieve treatment success. This case showed the treatment plan and follow-up, by the use of CBCT images, from a previously treated mandibular molar with a large periapical abscess and cystic lesion, in which, the first treatment plan approach was to make the endodontic retreatment. During the chemo-mechanical preparation the presence of permanent intracanal purulent exudate made it impossible to dry the canals, impeding obturation of the root canal system. Due to this clinical situation, a surgical approach was performed with the intention of reduce this permanent exudate and to execute a decompression technique. Clinical findings, periapical radiographs and cone beam computed tomographic, indicated almost complete resolution of the radiolucency, after a one-year follow-up.

Management of periapical lesion using platelet-rich fibrin as a grafting material

Management of periapical lesion using platelet-rich fibrin as a grafting material

The role of cone-beam computed tomography in evaluation of an extensive radicular cyst of the maxilla

Radicular cyst is the second most common odontogenic cyst. Most of these lesions involve the apex of offending tooth and appear as well-defined radiolucencies. When asymptomatic, a cyst can acquire a large size, even extending into anatomic cavities. The present case reports an extensive radicular cyst extending into the maxillary sinus that could have been easily mistaken for just a displaced tooth. Conventional radiographs show two-dimensional images of three-dimensional objects. Cone-beam computed tomography provides undistorted three-dimensional information of hard tissues, gives adequate spatial resolution, and recently seen as an expansion in diagnosis and management of periapical lesions. Prompt diagnosis and treatment of radicular cyst were successful with endodontic treatment and surgical management.

Platelet-rich fibrin in the management of periapical lesions: A case series

Platelet rich Fibrin is a rich concentrate of various growth factors which exhibit properties such as cell migration, cell attachment ,cell proliferation, and cell differentiation .These properties allow for the enhancement of the regenerative process and hence the use of the PRF has been increasing in the field of Dentistry.In this case report we have described the use of two cases of periapical leions wherein the PRF has been used along with bone grafts as a regenerative material.

Triple antibiotic paste versus propolis: A clinical quest for the reliable treatment of periapical lesions in primary molars

Background: Teeth with infected root canals, particularly those in which the infection has reached the periradicular tissues, require effective treatment interventions to save the tooth. Lesion sterilization concept (lesion sterilization and tissue repair [LSTR]) was successful in treating periapical polymicrobial infection, but this poses a risk of development of antimicrobial resistance. Aim: The present study evaluated and compared both clinically and radiographically the healing abilities of Propolis liquid (natural therapeutic agent)-mixed Endoflas powder with LSTR (allopathic combination) for the management of periapical lesions in primary molars. Materials and Methods: A total of 30 selected primary molars were randomly divided into two groups of 15 each: Group 1 – Propolis liquid-mixed Endoflas powder and Group 2 – LSTR (3Mix). Follow-up after 3, 6, and 12 months was done to evaluate progress in clinical and radiographic parameters. The obtained data were subjected to statistical analysis. McNemar's test was applied between the time points in each group. Comparison of Group 1 with Group 2 was done using Chi-square test. Results: At the end of 12th-month follow-up, the overall clinical and radiographic success rate for Group 1 was 100%, whereas for Group 2, it was 93% and 60%, respectively. The difference in the radiographic success rate between the two groups was statistically significant (P Conclusion: In the present study, Propolis liquid-mixed Endoflas powder combination has shown better results than LSTR. This novel combination of Propolis liquid-mixed Endoflas powder can, therefore, be considered as the material of choice for pulpectomy in deciduous molars with extensive involvement of pulp and periradicular tissues.

Nonsurgical Management of Periapical Lesion with External Root Resorption Followed by Orthodontic Treatment in Maxillary Lateral Incisor

The aim of this case report is to discuss the radiological outcome of a nonsurgical management of periapical lesion with external resorption followed by orthodontic treatment of the maxillary lateral incisor. A 33-year-old female reported with missing tooth in the maxillary anterior region as a result of surgical extraction of maxillary left canine tooth. Patient was referred for intentional root canal treatment in 22 followed by fixed prosthesis. The radiograph revealed external resorption in 21 and 22. After preparation of the access cavity, the necrotic pulp was removed and the canal irrigated using 5.25% sodium hypochlorite solution. The canal was then dried and packed with calcium hydroxide for 6 weeks. After removal of calcium hydroxide, canal was disinfected, dried and four millimetres of MTA orthograde filling was carried out. After 24 hrs, root canal was obturated with back fill using system B. At 1-3-6, month recall, the tooth was asymptomatic with no pain on percussion or palpation. Radiographic examination demonstrated continued thickening of root canal walls, root lengthening and apical closure.

Increased Expression of Glutaminase in Osteoblasts Promotes Macrophage Recruitment in Periapical Lesions

IntroductionRecently, we have shown that tissue hypoxia stimulates the progression of periapical lesions by up-regulating glycolysis-dependent apoptosis of osteoblasts. Other facets of hypoxia-induced metabolic reprogramming in disease pathogenesis require further investigation. In this study, we examined the connection between hypoxia-augmented glutamine catabolism in osteoblasts and the development of periapical lesions. MethodsPrimary human osteoblasts were cultured under hypoxia. The expression of glutaminase 1 (GLS1) was examined using Western blot analysis. The production of glutamate was measured by colorimetric assay. Knockdown of GLS1 was performed with small interfering RNA technology. C-C motif chemokine ligand 2 (CCL2) secretion and chemotaxis of J774 macrophages were examined by enzyme-linked immunosorbent assay and transwell migration assay, respectively. In a rat model of induced periapical lesions, the relations between disease progression and osteoblastic expression of GLS1 or macrophage recruitment were studied. ResultsHypoxia enhanced GLS1 expression and subsequent glutamate production in osteoblasts. Glutamate induced chemoattraction of macrophages by osteoblasts through up-regulation of CCL2 synthesis. Hypoxia promoted CCL2 secretion and macrophage recruitment through augmentation of glutaminolysis. Knockdown of GLS1 abolished hypoxia-induced effects. In rat periapical lesions, progressive bone resorption was significantly related to elevated GLS1 expression in osteoblasts and increased macrophage recruitment. ConclusionsIn addition to the rise in glycolytic activity, the progression of periapical lesions is also associated with enhanced glutamine catabolism in osteoblasts. GLS1 may be a potential therapeutic target in the management of periapical lesions.

Nonsurgical removal of separated gutta percha and granulation tissue from the periapical area using an aspiration irrigation technique

Pulpal diseases progress to periapical lesions. The incidence of cysts and granulomas within periapical lesions are 55% and 70.07%, respectively. It is accepted that all inflammatory periapical lesions should be initially treated with conservative nonsurgical procedures. Studies have reported a success rate of up to 85% after endodontic treatment of teeth with periapical lesions. The various options for the removal of obturating material are K-files or H-files, gutta percha solvent, combination of paper points and gutta percha solvent, rotary instruments, retreatment files, heat transfer devices, heat carrier tips, ultrasonic tips and soft tissue laser. In the present case, we removed the gutta percha using K-files and H-files. The various methods of removing detached gutta percha are K-files and H-files, heat carrier tips or periapical surgery. Various methods can be used in the nonsurgical management of periapical lesions: The conservative root canal treatment, decompression technique, active nonsurgical decompression technique, aspiration-irrigation technique, calcium hydroxide methods, lesion sterilization and repair therapy and the apexum procedure. In the present case, we removed the gutta percha using K-files and H-files and we followed the aspiration-irrigation technique as a line of management. This case report describes an aspiration-irrigation technique achieved through the root canal space, which might hasten osseous regeneration, thereby eliminating the need for periapical surgery.

Management of periapical lesion using autologous growth factors and osteoinductive bone with guided tissue regeneration - A case report

Management of periapical lesion using autologous growth factors and osteoinductive bone with guided tissue regeneration - A case report

The management of periapical lesions in endodontically treated teeth

When root canal therapy is done according to accepted clinical principles and under aseptic conditions, the success rate is generally high. However, it has also been reported that 16% to 64.5% of endodontically treated teeth are associated with periapical radiolucent lesions. There are great variations among clinicians when suggesting treatment of these failed endodontic cases. This article will discuss factors influencing treatment decisions on these particular cases, and the pros and cons of nonsurgical retreatment versus surgical retreatment. The advancement of modern endodontic microsurgery will also be discussed.

Advanced radiographic techniques for the detection of lesions in bone

Radiographs in endodontics are of importance for the study and management of periapical lesions. With the development of advanced systems in traditional radiology, new and more accurate imaging techniques are constantly under investigation. Computerized tomography, magnetic resonance and real‐time echotomography have been introduced in recent years to the field of endodontics: they may have advantages over conventional techniques for the amount of detailed information they can provide on specific cases. This paper reviews these new imaging techniques with respect to their possible role in the diagnosis and management of periapical lesions.

Prescribing endodontic retreatment: towards a theory of dentist behaviour.

The large variations observed in dentists' management of periapical lesions in endodontically treated teeth suggest that disease concepts used in clinical practice should be investigated. In the present study it was hypothesized that dentists regard various periapical conditions as different stages on a health continuum. Variations could then be regarded as the result of the individuals selection of differing cut-off points for prescribing retreatment. The hypothesized decision-making model was tested using dental students in Amsterdam (Holland), Gothenburg (Sweden) and Pavia (Italy). The students were shown six simulated cases among which the quality of root filling seal and presence of post and crown were systematically varied. For each case, management of five periapical conditions was assessed. Five options were offered: no therapy, wait-and-see, nonsurgical retreatment, surgical retreatment, and extraction. For each examiner and case a 'retreatment preference score (RPS)' was established. The investigation showed large interindividual variations in RPS. A statistically significant higher mean RPS was seen among students in Pavia compared with students in Amsterdam and Gothenburg. Among all observers and cases it was found that if retreatment was proposed for a certain size of lesion, retreatment was subsequently selected for all larger lesions. The experiment gave evidence in support of the proposed hypothesis. The data also suggest that the choice of retreatment criterion is affected by values, costs of retreatment and technical quality of the original treatment.