scholarly journals Abordagem endodôntica não cirúrgica em extensa lesão periapical: relato de caso

2020 ◽  
Vol 9 (6) ◽  
pp. 513-516
Author(s):  
Mailon Cury Carneiro ◽  
Fernanda Angelio Da Costa ◽  
Paula Gabriela Vieira Chicora ◽  
Marcos Sergio Endo ◽  
Vanessa Cristina Veltrini

O objetivo deste trabalho é relatar um caso clínico de uma extensa lesão periapical em maxila, tratada somente por uma abordagem endodôntica não cirúrgica, com expressivo reparo periapical. Paciente do sexo feminino, 52 anos, compareceu à clínica odontológica, com a queixa principal de “cisto crescendo na boca”. Os dentes 13, 14 e 15 apresentavam-se sem vitalidade pulpar. Os exames radiográficos mostraram duas áreas radiolúcidas, uniloculares, envolvendo os ápices dos dentes 13 e 15, ambos sem sinais de intervenção endodôntica. As áreas eram sugestivas de granuloma periapical e cisto periapical inflamatório, respectivamente. Realizou-se tratamento endodôntico dos dentes 13, 14 e 15. Após 11 meses, notou-se regressão significativa da rarefação óssea periapical, não sendo necessária qualquer intervenção cirúrgica. A paciente continuará em proservação até a remissão completa da lesão. O preparo químico-mecânico, associado ao emprego de medicação intracanal, pode ser suficiente para o reparo de lesões periapicais extensas. Sugere-se que o tratamento conservador seja sempre a primeira opção em casos semelhantes, de forma a se evitar cirurgias parendodônticas invasivas desnecessárias. Descritores: Endodontia; Cisto Radicular; Tratamento Conservador. Referências Hammouti J, Chhoul H, Ramdi H. Non-surgical management of large periapical cyst like lesion: case report and litterature review. J Oral Heal Dent Sci. 2019;3(1):1–7. Mitra A, Adhikari C. Management of large periapical lesions by non surgical endodontic approach - two case reports. 2017;2(5):97–104. Al Khasawnah Q, Hassan F, Malhan D, Engelhardt M, Daghma DES, Obidat D, et al. Nonsurgical clinical management of periapical lesions using calcium hydroxide-iodoform-silicon-oil paste. Biomed Res Int. 2018;2018:1-8. Schulz M, von Arx T, Altermatt HJ, Bosshardt D. Histology of periapical lesions obtained during apical surgery. 2009;35(5):634-42. Ramachandran Nair PN, Pajarola G, Schroeder HE. Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81(1):93-102. Gutmann JL, Baumgartner JC, Gluskin AH, Hartwell GR, Walton RE. Identify and define all diagnostic terms for periapical/periradicular health and disease states. JOE. 2009;35(12):1658-74. Antoh M, Hasegawa H, Kawakami T, Kage T, Chino T, Eda S. Hyperkeratosis and atypical proliferation appearing in the lining epithelium of a radicular cyst. Report of a case. J Cranio-Maxillo-Facial Surg. 1983;21(5):210-13. Natkin E, Oswald RJ, Carries LI. The relationship of lesion size to diagnosis, incidence, and treatment of periapical cysts and granulomas. Oral Surg. 1984;57(1):82-94. Rathod DM, Mulay SA. Non-surgical treatment of large periapical lesion using various formulations of calcium hydroxide & nd: yag laser. Int J Curr Res. 2017;9(8):56668-72. Rosenberg PA, Frisbie J, Lee J, Lee K, Frommer H, Kottal S, et al. Evaluation of pathologists (histopathology) and radiologists (cone beam computed tomography) differentiating radicular cysts from granulomas. J Endod. 2010;36(3):423-28. Sant’ana Filho M, Rados PV. Lesões apicais. In: Silveira JOL, Beltrão GC. Exodontia. 1Porto Alegre: Missau; 1998. cap. 22, p. 275-85. Sood N, Maheshwari N, Gothi R, Sood N. Treatment of large periapical cyst like lesion: a noninvasive approach: a report of two cases. Int J Clin Pediatr Dent. 2015;8(2):133-37. Singh U, Nagpal R, Sinha D, Tuhin, Tyagi N. Iodoform based calcium hydroxide paste (metapex):an aid for the healing of chronic periapical lesion. J Adv Res Biol Sci. 2013;6(1):63-7. Dandotikar D, Peddi R, Lakhani B, Lata K, Mathur A, Chowdary UK. Nonsurgical management of a periapical cyst: a case report. J Int Oral Health. 2013;5(3):79-84. Calişkan MK. Prognosis of large cyst-like periapical lesions following nonsurgical root canal treatment: a clinical review. Int Endod J. 2004;37(6):408-16.  Kanmaz F, Altunbaş D, Zan R, Akpınar KE. Nonsurgical endodontic treatment of a large periradicular lesion. Turk Endod J. 2017;2(1):21–4. Öztan MD. Endodontic treatment of teeth associated with a large periapical lesion. Int Endod J. 2002;35(1):73–8. Barroso JAY, Uchimura JYT, Endo MS, Pavan NNO, Queiroz AF. Avaliação in vitro da influência da lima patência na manutenção do comprimento de trabalho. Rev Odontol UNESP. 2017;46(2):72-6. Madhusudhana K, Surada R, Kumar CS, Lavanya A. Non-surgical management of a large periapical lesion: a case report. Ann Essences Dent. 2017;9(2):22-5. Soares J, Santos S, Silveira F, Nunes E. Nonsurgical treatment of extensive cyst-like periapical lesion of endodontic origin. Int Endod J. 2006;39(7):566-75. Mohammadi Z, Shalavi S, Yazdizadeh M. Antimicrobial activity of calcium hydroxide in endodontics: a review. Chonnam Med J. 2013;48(3):133-40. Estrela C, Bammann LL, Pimenta FC, Pécora JD. Control of microorganisms in vitro by calcium hydroxide pastes. Int Endod J. 2001;34(5):341-45. Soares JA, Brito-Júnior M, Silveira FF, Nunes E, Santos SMC. Favorable response of an extensive periapical lesion to root canal treatment. J Oral Sci. 2008;50(1):107-11.

2020 ◽  
Vol 2 ◽  
pp. 120-123
Author(s):  
Munish Singla ◽  
Iyana Garg ◽  
Vandana Goyal ◽  
Harleen Kaur ◽  
Litik Mittal

Sterilization of root canal space is foremost for the success of the endodontic treatment which is usually carried out with intracanal irrigants and medicaments. Triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) is used to achieve sterilization and healing of periradicular area. In the present case report, the triple antibiotic paste was used for non-surgical management of periapical lesion for 3 weeks. After 3 weeks, the tooth became asymptomatic that was then obturated. Hence, it is confirmed that conventional root canal treatment, along with intracanal medicaments (triple antibiotic paste), can non-surgically manage the periapical lesions and further promotes healing.


2015 ◽  
Vol 18 (1) ◽  
pp. 17 ◽  
Author(s):  
Cari Maristela Pieper ◽  
Eliseu Aldrighi Münchow ◽  
Evandro Piva

<span>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.</span>


2021 ◽  
Vol 33 (3) ◽  
pp. 262
Author(s):  
Diatri Nariratih ◽  
Hendra Dian Adhita Dharsono

ABSTRAKPendahuluan: Penatalaksanaan kasus penyakit pulpa yang disertai dengan lesi periapikal dapat dilakukan dengan perawatan saluran akar tanpa intervensi bedah. Preparasi biomekanis pada perawatan endodontik non-bedah dapat mengeliminasi bakteri dari saluran akar dan mencegah terjadinya infeksi berulang setelah dilakukannya obturasi. Kompleksitas anatomi menyebabkan keterbatasan preparasi biomekanis saluran akar, sehingga perawatan dapat mengalami kegagalan. Variasi anatomi saluran akar pada gigi molar pertama rahang atas umumnya terdapat pada bagian palatal akar mesiobukal yang disebut sebagai saluran akar mesiobukal kedua dengan insidensi 94%. Saluran akar mesiobukal kedua berukuran lebih sempit dan dangkal dibandingkan saluran akar mesiobukal pertama, sehingga dibutuhkan beberapa metode untuk menentukan lokasi orifis tersebut. Tujuan laporan kasus ini adalah membahas mengenai penatalaksanaan non-bedah gigi pasca perawatan endodontik parsial yang disertai dengan lesi periapikal. Laporan kasus: Pasien perempuan berusia 28 tahun datang dengan keluhan gigi belakang kiri atas sakit berdenyut sejak 1 bulan, gigi tersebut pernah dirawat saluran akarnya beberapa tahun sebelumnya. Pemeriksaan klinis menunjukkan terdapat tambalan permanen pada gigi 26. Pemeriksaan radiografis menunjukkan adanya gambaran radiopak pada email mesio-oklusal hingga mencapai dasar kamar pulpa, pelebaran ligamen periodontal, terputusnya lamina dura, serta lesi periapikal pada akar mesial dan palatal. Preparasi akses dilakukan pada gigi 26, dilanjutkan dengan penentuan lokasi orifis mesiobukal kedua. Empat saluran akar dipreparasi menggunakan instrumen rotary nickel titanium dengan teknik crown down dan dilakukan obturasi teknik kondensasi lateral. Restorasi definitif berupa mahkota penuh porselen. Simpulan: Lesi periapikal sembuh setelah dilakukan preparasi pada saluran akar mesiobukal kedua sehingga pengetahuan mengenai anatomi dan variasi internal saluran akar gigi sangat penting dalam keberhasilan perawatan endodontik non-bedah.Kata kunci: Perawatan endodontik non-bedah; previously initiated therapy; lesi periapical; mesiobukal kedua  ABSTRACTIntroduction: The management of pulp disease cases accompanied by periapical lesions can be done by root canal treatment without surgical intervention. Biomechanical preparations for non-surgical endodontic treatment can eliminate bacteria from the root canal and prevent re-infection after obturation. However, the complexity of the anatomy limits the biomechanical preparation of the root canal so that treatment can fail. Anatomical variations of the root canal in the maxillary first molars are generally found in the palatal part of the mesiobuccal root, which is the second mesiobuccal root canal with an incidence of 94%. The second mesiobuccal root canal is narrower and shallower than the first mesiobuccal root canal, so several methods are needed to determine the location of the orifice. The purpose of this case report was to discuss the non-surgical management of teeth after partial endodontic treatment accompanied by periapical lesions. Case report: A 28-year-old female patient complained of throbbing pain in the left upper back tooth for one month. The tooth had had its root canal treated several years before. Clinical examination revealed permanent fillings on tooth 26. Radiographic examination showed the radiopaque appearance of mesio-occlusal enamel to the floor of the pulp chamber, widening of the periodontal ligament, rupture of the lamina dura, and periapical lesions of the mesial and palatal roots. Access preparation was performed on tooth 26, followed by the determination of the location of the second mesiobuccal orifice. Four root canals were prepared using a rotary nickel titanium instrument with a crown down technique and obturation with lateral condensation technique. The definitive restoration is a full porcelain crown. Conclusions: Periapical lesions healed after preparation of the second mesiobuccal root canal. This result proves that knowledge of the anatomy and internal variations of the root canal is fundamental in the success of non-surgical endodontic treatment.Keywords: Non-surgical endodontic treatment; previously initiated therapy; periapical lesions; second mesiobuccal canal


2012 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Badi Soerachman ◽  
Moch. Richata Fadil ◽  
Endang Sukartini ◽  
Milly Armilia

Abnormalities of the teeth that have had periapical endodontic treatment generally due to recurrent infections of root canal. Infection of the root canal is caused by leakage due to poor quality of coronal restoration and iatrogenicfactors. Root canal treatment of the tooth with periapical cyst generally do conventionally. Medication materialsused for healing of periapical lesions is calcium hydroxide, since it has properties not irritating, alkaline pH andantibacterial capabilities, so it is a biological stimulator for the formation of hard tissue in the area of damage andis expected to accelerate the healing process. It was reported the case of a 23-year-old student came to the Dentalclinic of Conservation Specialist RSGM Sekeloa with complaints lower right back teeth has restored with amalgam,no pain, but less comfortable when chewing. The results obtained after treatment with calcium hydroxide andmedikamen gutta percha filling with resin-based root canal cement. Approximately 4 months later, the periapicalradiolucent area had thinned. So it was concluded that conventional endodontic treatment proved to heal periapicallesions including cysts, as long as the treatment is taken adequately.


2020 ◽  
Vol 8 (2) ◽  
pp. 90-100
Author(s):  
Ratu Amelia ◽  
Deli M

The main goal of endodontic treatment is to remove the entire microbial flora from the root canal system and promote periapical healing. Microorganisms that settle in the root system play an important role in the development and persistence of periapical lesions. Necrotic canals provide a very favorable environment for the growth of microorganisms in the root canal system. Thus, elimination of these bacteria is essential for apical and periapical healing after endodontic treatment. This case report discusses the endodontic treatment using calcium hydroxide in a necrotic pulp with chronic periapical abscess.


2021 ◽  
Vol 10 (30) ◽  
pp. 2331-2333
Author(s):  
Shelly Sharma ◽  
Anshul Arora ◽  
Mandeep S. Grewal ◽  
Mamta Singla ◽  
Lakshita Singh

In-depth knowledge of the root canal system is a major prerequisite for successful endodontic treatment.1 The major aim of endodontic treatment is the eradication of infection and prevention of reinfection in canal. However endodontic treatment may fail because of incomplete knowledge about the anatomical variation of root canals. Most of the times the canal remains untreated because of the inability of the dentist to recognize its presence. For good prognosis of the root canal treatment, proper exploration, complete debridement, biomechanical preparation, and filling of root canal system must be done. Therefore, a dentist must be familiar with all the various possible canal configurations.2 Many times, failure of endodontic treatment may occur because the morphological variation of the tooth unfavourably affects the treatment. Pulpal inflammation can occur as a result of many factors like dental caries or trauma which causes tissue necrosis. Periapical tissue eradication develops in response to microbial accumulation and infiltration of their by-products in the periradicular tissues and activates host's immune reaction.3 The following case report presents the non-surgical management of mandibular central and lateral incisors, with each having two separate canals which join together to form a single canal just before exiting the apical foramen. Before starting root canal treatment, a careful radiographic examination should be done to detect the morphological variations in root canal anatomy. This paper describes two clinical cases of mandibular incisors with or without periapical lesion having two canals.


2013 ◽  
Vol 5 (2) ◽  
pp. 3-5
Author(s):  
R.S. Bassvanna ◽  
Chitra Gohil

ABSTRACT Management of non vital teeth with open apices isa challenge to the dental practitioners. In this clinical scenario, it is difficult to maintain the obturating material confine within the root canal without encroaching into periapical area. These kinds of cases cannot be managed by conventional endodontic treatment, and treatment of such cases with calcium hydroxide may take longer time for apical closure. But with this new material called BIODENTINE (Septodont) same treatment can be done in single visit with predictable result. Hence this case report present the use ofbiodentine to form an apical plug in open apex followed by complete root canal obturation using thermoplasticized guttapercha.


2020 ◽  
Vol 10 (2) ◽  
pp. 10-13
Author(s):  
Md Abdul Hannan Sheikh ◽  
Eyad Al Khalifa ◽  
Mozammal Hossain ◽  
Md Faruk Hossain ◽  
Nazneen Karim ◽  
...  

In this study, 120 teeth having periradicular pathosis were treated with single visit root canal treatment and then obturated with either calcium hydroxide containing sealer or mineral trioxide aggregate based sealer. The healing of periradicular pathosis was examined at 3, 6, and 12 months by clinical and radiological evaluation. Collected data were analyzed with standard statistical methods by using SPSS version- 20. The results showed that at 3 and 6 months, the differences between calcium hydroxide containing sealer or mineral trioxide aggregate based sealer were not statistically significant. However, the healing capability of periapical radiolucency at 12 months between two groups was statistically significant (P=0.03). The final outcome of the clinical and radiological investigation showed successful results of 96.6% and 98.1% in calcium hydroxide and mineral trioxide aggregate group, respectively. In conclusion, both calcium hydroxide and mineral trioxide aggregate based sealers are almost equally effective in single visit root canal therapy for the management of periradicular pathosis. Update Dent. Coll. j: 2020; 10 (2): 10-13


2018 ◽  
Vol 42 (2) ◽  
pp. 146-149
Author(s):  
Fadi Said ◽  
Moti Moskovitz

Objectives: The aim of the present study was to assess the effect of calcium hydroxide as a root canal dressing material on dentin microtensile fracture strength in human primary teeth in vitro. Study design: Thirty primary anterior teeth with root canals packed with calcium hydroxide were divided into groups of ten and immersed in saline at room temperature for 7, 30 and 90 days. Ten teeth with root canals filled with sterile saline were the control group. Microtensile fracture strength was measured in Mechanical tester Lloyd testing machine. Results: There was a significant difference (P &lt; 0.05) between the fracture strength of the calcium hydroxide-filled teeth after 90 days (19.1 MPa) compared with the control (35.8 MPa). Dentin microtensile fracture strength of the calcium hydroxide-filled teeth decreased at an average of 0.142 MPa per day. Conclusion: Calcium hydroxide placed in root canals for an extended time had a significantly negative effect on root strength. Long-term success of root canal treatment in primary anterior teeth is estimated as 65% with most of the failures result from trauma recurrence. Clinical Relevance: Our results stress the need to evaluate the pros and cons of root canal treatment compared to extractions of non-vital primary incisors.


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