Does Apical Papilla Survive and Develop in Apical Periodontitis Presence after Regenerative Endodontic Procedures?

Regenerative endodontic procedures (REPs) have emerged as a treatment option for immature necrotic teeth to allow the reestablishment of a newly formed vital tissue and enable continued root development. The apical papilla stem cells (SCAPs) play an important role in physiologic root development and may also contribute to further root development during REPs. The goal of these case reports is to show evidence of the apical papilla survival and development, in human teeth with apical periodontitis, after REPs, with 5-year clinical and radiographic follow-up. In the first case, an 11-year-old girl with acute apical abscess of tooth 15 was referred for a REP. Treatment was performed with an intracanal medication followed by induction of a blood clot and a Mineral Trioxide Aggregate (MTA) cervical barrier. The 5-year follow-up showed an appreciable increase in root length as well as root canal thickness. In case 2, a 16-year-old girl was referred for endodontic treatment of tooth 21. The parents of the patient recalled a previous dental trauma (no specified on the patient records) on tooth 21 at age 7. The dental history reports a previous endodontic treatment failure and presence of a long-standing sinus tract. A mineralized tissue beyond the root apical portion could be seen at the preoperative X-ray. Nonsurgical root canal retreatment with an apical barrier was suggested as the treatment plan and accepted by the patient. After 2 weeks, the patient was recalled for a follow-up appointment presenting spontaneous pain, swelling, and sinus tract. Apical surgery was performed. Histopathological assessment of the apical root fragment collected showed the presence of dentin, cementum and pulp tissue, including odontoblasts. The 5-year follow-up depicted complete apical healing. The present case reports support survival and continued potential differentiation of the apical papilla after endodontic infection.

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Late endodontic treatment of a tooth with extrusive dislocation and invasive cervical resorption: a clinical case report

Research Society and Development ◽

10.33448/rsd-v10i12.20061 ◽

2021 ◽

Vol 10 (12) ◽

pp. e139101220061

Author(s):

Ana Paula Fernandes Ribeiro ◽

Julia Guerra de Andrade ◽

Heitor César Maia ◽

Caroline Loureiro ◽

Gladiston Willian Lobo Rodrigues ◽

...

Keyword(s):

Root Canal ◽

Clinical Case ◽

Glass Ionomer Cement ◽

Sinus Tract ◽

Endodontic Treatment ◽

Radiographic Examination ◽

Periapical Lesion ◽

Root Canal Filling ◽

Recurrent Sinus

This study aims to report the clinical case of a 16 years-old male patient, who attended a private office reporting that at an accident suffered at the age of 10 years-old, which caused extrusive dislocation in both teeth 11 and 21. At that time, the teeth were repositioned, without an adequate follow-up. Upon physical and radiographic examination, the following features were observed: presence of recurrent sinus tract on the vestibular surface, area of external cervical resorption, and a periapical lesion on tooth 21. Endodontic treatments (necropulpectomy) were performed on teeth 11 and 21, with the placement of a root canal dressing of calcium hydroxide and subsequent root canal filling. In addition, soft tissue flap folding was performed to treat the resorption area and to seal it with glass ionomer cement. A 7 months follow-up radiograph shows stabilization in the process of the tooth resorption and remission of the periapical lesion. In conclusion, the endodontic treatment with intracanal medication, and the sealing of the resorption area were successful to preserve the traumatized tooth. In addition, it is noteworthy that following up with the patient after the trauma episode is essential to monitor the pulp vitality of the tooth involved.

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Possibility of usage of a homeopathic remedy heparsulfuris in the therapy of endoperiodontal lesion

Stomatoloski glasnik Srbije ◽

10.2298/sgs0202053b ◽

2002 ◽

Vol 49 (1-2) ◽

pp. 53-56

Author(s):

Tatjana Brkanic ◽

Slavoljub Zivkovic

Keyword(s):

Clinical Practice ◽

Calcium Hydroxide ◽

Root Canal ◽

Apical Periodontitis ◽

Endodontic Treatment ◽

Root Canal Preparation ◽

Everyday Clinical Practice ◽

Homeopathic Remedy ◽

Periodontal Tissues

The aim of this paper was to, on the basis of everyday clinical practice analize the effect of a homeopathic remedy, as a complementary remedy in endodontic therapy of endoperiodontal lesions and chronic apical periodontitis and to radiologically check its effect on the flow and speed of reparation of damaged periodontal tissues. Endodontic therapy was done according to the usual protocol for the therapy of infectious canals with root canal preparation, medication with calcium hydroxide points and hermetic obturation with AH-26 paste. During endodontic treatment patients were taking homeophatic remedy Hepar sulfuris per os three times daily. The remedy stimulates the natural defences mechanism of the organism. Radiological follow up after three months period showed obvious reductiont of radiologic radiolucency in periapical region.

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Persistent Apical Periodontitis: Bacterial Taxonomic Analysis and Treatment Through Intentional Replantation

Journal of Dentistry and Oral Sciences ◽

10.37191/mapsci-2582-3736-2(3)-032 ◽

2020 ◽

Author(s):

Fernando Eduardo Coria-Valdiosera

Keyword(s):

Antibiotic Therapy ◽

Root Canal ◽

Resistance Mechanisms ◽

Apical Periodontitis ◽

Infectious Process ◽

Identification Of Bacteria ◽

The Right ◽

Apical Lesions ◽

Endodontic Retreatment

Introduction: The microorganisms own different resistance mechanisms that allow them to resist the chemo-mechanical cleanliness of root canal and antibiotic therapies causing the persistence of apical lesions. Methods: This clinical case describes a male patient diagnosed with pulp necrosis in the right lower central incisor due to trauma, which developed apical periodontitis manifesting itself extra orally. Root canal treatment along with antibiotic therapy was performed, but because the infectious process persisted, endodontic retreatment and a new antibiotic therapy were carried out, however, the clinical evolution was not favorable. For this reason, the intentional replantation was chosen as the outright treatment, performing apicectomy and curettage of the periapical lesion, from which the isolation and taxonomic study of microorganisms were carried out, with the respective antibiogram. Results: In the 10-day clinical follow-up, the extraoral infectious process disappeared almost completely and 6 months later, a complete repair of the bone tissue was observed on the tomography. Conclusion: A better understanding of the persistence of apical periodontitis was achieved by taxonomic identification of bacteria and the intentional replantation allowed to remove the apical biofilm gaining an excellent wound healing.

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Efficacy of Endodontic Treatment on the Persistence of Selected Endodontic Pathogens and on Radiographical Periapical Healing

Odovtos - International Journal of Dental Sciences ◽

10.15517/ijds.v17i2.22035 ◽

2015 ◽

Vol 17 (2) ◽

pp. 43

Author(s):

Rodolfo Zeledón DDS, Esp ◽

Carolina Ballestero DDS, Esp ◽

Erick Hernández DDS. Esp ◽

Tatiana Ramírez DDS, MSD ◽

Marianela Benavides DDS, Esp ◽

...

Keyword(s):

Positive Impact ◽

Fusobacterium Nucleatum ◽

Dental Students ◽

Apical Periodontitis ◽

Endodontic Treatment ◽

Root Canals ◽

Prevotella Nigrescens ◽

Infected Root

The objective of this clinical study was to evaluate by polymerase chain reaction (PCR) the antimicrobial efficacy and the outcome of an endodontic protocol treatment (EPT) performed by under-graduated dental students on infected root canals associated with periapical lesions. Fifty-six patients attending for treatment of pulp necrosis and apical periodontitis were included. A specific EPT approach was performed and DNA extracts were taken at the baseline (S1), after a disinfection-neutralization procedure (S2), post-chemomechanical preparation (S3) and after Intracanal medication (S4) for the presence of specific bacteria. The outcome of the EPT was assessed radiographically using the Periapical Index-system (PAI) after 18-month follow-up. An intergroup evaluation shows that when comparing S1 to S3, S1 to S4, S2 to S3, and S2 to S4, the presence of bacteria were significantly reduced (P < 0.05). Finally, S4 was not significantly reduced when compared with S3 (P > 0.05). The most prevalent species in their respect order were Actinomyces Israelii > Enterococcus Faecalis > Fusobacterium Nucleatum/Prevotella Nigrescens > Phorphyromonas Endodontalis. After the 18-month follow-up, the overall success rate of root canal – treated teeth was of 88% (PAI 1 or 2). This In Vivo study demonstrated that EPT significantly reduced the number of cases with positive results for the studied bacteria, showing a profound positive impact in the outcome of endodontic treatment of teeth diagnosed with Pulp Necrosis and Apical Periodontitis.

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Radiographic characteristics in the periapical healing post endodontic treatment in patients of the Autonomous University of Yucatan, School of Dentistry

Nova Scientia ◽

10.21640/ns.v10i21.1592 ◽

2018 ◽

Vol 10 (21) ◽

pp. 379-390

Author(s):

Oscar David Jurado Patrón ◽

Andrés Vargas López ◽

Elma María Vega Lizama ◽

Gabriel Alvarado Cárdenas ◽

María Eugenia López Villanueva ◽

...

Keyword(s):

Longitudinal Study ◽

Sinus Tract ◽

Complete Healing ◽

Endodontic Treatment ◽

Periapical Lesions ◽

Periapical Healing ◽

School Of Dentistry ◽

One Year ◽

Causes Of Failure

Introduction: The radiographic control of the root canal treatment can evaluate the healing of the periapical lesions. The objective of this study was to determinate the characteristics of the radiographic healing that was observed after one year, during follow-up sessions; so, the healing of the lesions according to the periapical pathology at the beginning of the treatment and the causes of failure of the endodontic treatments were recorded.Method: This is a prospective, observational, descriptive and longitudinal study, carried out in patients who attended control one year after endodontic treatment through the Periapical Index (PAI).Results: A total of 395 teeth of patients who underwent endodontic treatment one year prior to data collection, 87 presented radiogaphically observable periapical lesions; of these, 40 (45.97%) attended the control at one year. The frequency of cases in which some degree of radiographic healing was observed one year after treatment was 97.46%. The pathology with more cases of complete healing was periodontitis with sinus tract. In general, 84.61% of the cases decreased two levels in their PAI after one year. The 100% of the cases of failure presented vertical root fractures.Conclusion: The frequency of periapical healing after endodontic treatment is high. The main cause for the failure of the treatments documented in this study was the lack of coronal restoration that caused vertical fractures.

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Prevalence evaluation of apical periodontitis and its relationship with endodontic and restorative treatment in a community in Southern Brazil

Brazilian Dental Science ◽

10.14295/bds.2020.v23i1.1807 ◽

2020 ◽

Vol 23 (1) ◽

Author(s):

Julia Machado Saporiti ◽

Andressa Gomes ◽

Melissa Feres Damian ◽

Nadia De Souza Ferreira

Keyword(s):

Root Canal ◽

Apical Periodontitis ◽

Endodontic Treatment ◽

Endodontically Treated Teeth ◽

Chi Square ◽

Root Canal Filling ◽

Restorative Treatment ◽

Anterior Teeth ◽

Chi Square Test

Objective: The aim of this study was evaluate radiographically prevalence of apical periodontitis (AP) in endodontically treated teeth (ETT) and relate with demographic factors, quality of endodontic treatment and coronal restoration. Material and methods: Data were collected from dental records wich contained full-mouth radiographic series. In ETT, arch, dental group and presence of AP were evaluated. Quality of root canal filling, presence and quality of coronal restoration and type of restorative material were also collected. Data were evaluated using descriptive statistics and Chi-square Test. Results: Of 70 patients included in the final sample, the majority were female (54.3%) and age ranged from 13 to 77 years (47.14 ± 13.18). Of 1,333 teeth evaluated, 73 (5.4%) had endodontic treatment, being the majority maxillary (74%) and anterior teeth (52.1%). Of teeth without endodontic treatment, 320 (25.4%) had AP. Failure rate was high (52.8%) and quality of root canal filling and coronal restoration were considered inadequate in majority cases (58.3% and 47.7%, respectively). Dental group had a statistically significant relationship with presence of AP in ETT, being more frequent in anterior teeth (p = 0.019). Conclusion: It was concluded that prevalence of AP in ETT was high and dental group was the factor that most influenced prevalence of AP in ETT.KeywordsApical periodontitis; Radiography; Root canal filling.

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Healing of a tooth with an overinstrumented apex, extensive transportation and periapical lesion using a 5 mm calcium hydroxide apical plug: an 8-year follow-up report

Brazilian Dental Journal ◽

10.1590/s0103-64402012000500024 ◽

2012 ◽

Vol 23 (5) ◽

pp. 608-611

Author(s):

Ronaldo Araújo Souza ◽

Yara T. Corrêa Silva-Sousa ◽

Suely Colombo ◽

Maurício Lago ◽

Marco Antonio Hungaro Duarte ◽

...

Keyword(s):

Calcium Hydroxide ◽

Root Canal ◽

Apical Periodontitis ◽

Filling Material ◽

Root Canal Filling ◽

Apical Constriction ◽

Gutta Percha ◽

Open Apices ◽

Canal Transportation

Besides the risk of filling material extrusion throughout the apex, a satisfactory apical seal can be difficult to achieve in canals with open apices or iatrogenic enlargements of the apical constriction. These situations pose a challenge to root canal filling. This paper describes the root canal filling of a maxillary right canine with an overinstrumented apex, complete loss of the apical stop, extensive canal transportation and apical periodontitis. A 5 mm calcium hydroxide apical plug was placed before root canal filling. The plug was made by soaking paper points with saline, dipping the points in calcium hydroxide powder and then applying it to the apex several times, until a consistent apical plug was obtained. The canal was then irrigated with saline in order to remove any residual calcium hydroxide from the root canal walls, dried with paper points and obturated with an inverted #80 gutta-percha cone and zinc oxide-eugenol based sealer by the lateral condensation technique. An 8-year radiographic follow-up showed formation of mineralized tissue sealing the apical foramen, apical remodeling and no signs of apical periodontitis.

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Clinical features and endodontic treatment of two-rooted mandibular canines: Report of four cases

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1410592s ◽

2014 ◽

Vol 142 (9-10) ◽

pp. 592-596 ◽

Cited By ~ 2

Author(s):

Igor Stojanac ◽

Milica Premovic ◽

Milan Drobac ◽

Bojana Ramic ◽

Ljubomir Petrovic

Keyword(s):

Root Canal ◽

Case Reports ◽

Anatomical Variation ◽

Anatomical Variations ◽

Endodontic Treatment ◽

Careful Examination ◽

Root Canals ◽

Working Length ◽

Canal Systems ◽

Root Canal Morphology

Introduction. Predictable endodontic treatment depends on the dentist?s knowledge about root canal morphology and its possible anatomic variations. The majority of mandibular canines have one root and root canal, but 15% may have two canals and a smaller number may have two distinct roots. The following clinical reports describe endodontic treatment of mandibular canines with two roots and two root canals. Outline of Cases. Four clinical case reports are presented to exemplify anatomical variation in the human mandibular canine. Detailed analysis of the preoperative radiographs and careful examination of the pulp chamber floor detected the presence of two root canal orifices in all canines. Working length was determined with an electronic apex locator and biomechanical preparation was carried out by using engine driven BioRaCe Ni-Ti rotary instruments in a crown-down manner, followed by copious irrigation with 1% sodium hypochlorite. Definitive obturation was performed using cold lateral condensation with gutta-percha cones and Top Seal paste. The treatment outcome was evaluated using postoperative radiographs. Conclusion. Endodontists should be aware of anatomical variations of the treated teeth, and should never presume that canal systems are simple.

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Acute odontogenic maxillary sinusitis treated endodontically – two case reports and 15-day CBCT outcome

Brazilian Journal of Oral Sciences ◽

10.20396/bjos.v17i0.8654179 ◽

2018 ◽

Vol 17 ◽

pp. e181197

Author(s):

Lauter Eston Pelepenko Teixeira ◽

Marina Canali Lângaro ◽

Mateus Silveira Martins Hartmann

Keyword(s):

Soft Tissues ◽

Maxillary Sinusitis ◽

Case Reports ◽

Medical Intervention ◽

Endodontic Treatment ◽

Retreatment Case ◽

Maxillary Molar ◽

Long Term Follow Up ◽

Sinus Membrane

Patients presented acute recurrences from Otorhinolaryngology treatments with unilateral symptoms compatible with maxillary sinusitis with a dental origin (MSDO). Cone beam computed tomography (CBCT) showed sinus extensive membrane thickening that was not visible at periapical exam associated to the maxillary molar infection in both cases. Respiratory structures assessment was possible using a 6-inches field of view CBCT. Non-surgical endodontic treatment (case 1) performed and retreatment (case 2) showed a fast symptoms relief. Recall examination after 15 days revealed healthy soft tissues with normal periodontal probing and no dental mobility. In addition, 15-day CBCTs revealed initial maxillary sinus membrane recovery after the endodontic approaches in the reported cases. No additional medical intervention nor antibiotics administration were necessary in these MSDO cases management. Long-term follow-up in such cases is advisable to exclude other potential dental or respiratory issues. Diagnose and follow-up using CBCT presented significant sinus membrane thick reduction with no symptom’s recurrence after the endodontic treatment.

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Outcome of Root Canal Treatment of Necrotic Teeth with Apical Periodontitis Filled with a Bioceramic-Based Sealer

International Journal of Dentistry ◽

10.1155/2021/8816628 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Kawther Bel Haj Salah ◽

Sabra Jaâfoura ◽

Mahdi tlili ◽

Marwa Ben Ameur ◽

Saida Sahtout

Keyword(s):

Treatment Group ◽

Root Canal ◽

Apical Periodontitis ◽

Root Canal Treatment ◽

Inclusion Criteria ◽

Root Canal Filling ◽

Radiographic Findings ◽

Periapical Lesions ◽

Single Cone

Introduction. Apical periodontitis is among the most common pathologies in endodontics. The treatment of apical periodontitis has always been an important occupation in the modern practice of endodontics, and the failure has been associated with nonhermetic root canal filling. With that in mind, bioceramic-based sealers have been incorporated into endodontic practice. The purpose of this study was to evaluate the outcome of nonsurgical root canal treatment (RCT), using a single-cone and Bioroot RCS filling of necrotic teeth with apical periodontitis. Materials and Methods. This follow-up study included patients treated in the department of Restorative Dentistry and Endodontics in the Dental Clinic of Monastir, from January 2018 to December 2019. The study intended to include all adult patients presenting a symptomatic or asymptomatic apical periodontitis. Once the diagnosis was performed, the patients were divided into two groups: a one-session treatment group and a two-session treatment group. All cases were obtured with BioRoot using a single-cone technique with a minimum of a 6-month recall. At 6-month follow-ups, teeth were classified as healed, healing (success), or not healed (failure), based on clinical and radiographic findings. Results. Twelve patients met the inclusion criteria, six patients per group. Seven patients returned for follow-ups. At 6-month follow-ups, the overall success rate was 100%, with 57.1% determined to be “healed” and 42.8% determined to be “healing.” All the PAI scores decreased compared to the baseline situation. Conclusion. The results obtained showed the contribution of BioRoot RCS in the healing of periapical lesions. Accordingly, bioceramic-based sealers seem to optimize the prognosis of root canal treatments.

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