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

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.

Nonsurgical Endodontik Retreatment of Maxillary First Premolar

DENTA ◽  
2017 ◽  
Vol 11 (1) ◽  
pp. 88
Author(s):  
Yongki Hadinata W ◽  
Karlina Samadi
Keyword(s):  
Root Canal ◽  
Radiographic Examination ◽  
Periapical Lesion ◽  
First Choice ◽  
Periapical Abscess ◽  
Dental Hospital ◽  
Conservative Dentistry ◽  
Previously Treated ◽  
Endodontic Retreatment

<p><strong><em>Background :</em></strong><em> There are some factors can cause endodontic failure such as inadequate in cleaning or shaping step, non hermetic obturation, or poor restoration, which can cause bacteria multiply. <strong>Purpose :</strong> To report the management of endodontic failure with nonsurgical treatment. <strong>Case :</strong> 46-year-old woman came to Airlangga Dental Hospital Conservative Dentistry Department to treat her upper right tooth which show symptomatic pain in the last 2 weeks. The tooth has been treated and crowned with porcelain fused to metal about 10 years ago. Clinical examination show the presence of fistula on premolar buccal gingiva, react to percussion.  Radiographic examination show not hermetic obturation in one root canal and radiolucency in the periapical area. The diagnosis for maxillary first premolar is previously treated tooth with chronic periapical abscess.. <strong>Treatment :</strong> Crown and post was removed from the tooth, and endodontic retreatment was done. Follow up 6 months after the retreatment show no reaction to percussion, and radiographic examination show no enlargement periapical lesion. <strong>Conclusion :</strong> Nonsurgical endodontic retreatment always become the first choice to resolve endodontic failure for previously treated tooth.</em></p><p><strong><em>Keywords :</em></strong><em> endodontic failure, maxillary first premolar, nonsurgical endodontic retreatment</em></p><p><strong><em>Correspondence:</em></strong><em> Yongki Hadinata W., drg. PPDGS Ilmu Konservasi Gigi Fakultas Kedokteran Gigi Universitas Airlangga, Surabaya. Jl. Mayjen. Prof. Dr. Moestopo No. 47, Surabaya.</em></p>

scholarly journals 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

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.

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

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.

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

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.

scholarly journals Identifikasi bakteri pada saluran akar gigi dengan diagnosis periodontitis apikalis kronis (Identification of bacteria in dental root canal diagnosed with chronic apicalis periodontitis)

2014 ◽  
Vol 13 (3) ◽  
pp. 182
Author(s):  
Yeyen Sutasmi ◽  
Nurhayati Natsir
Keyword(s):  
Root Canal ◽  
Anaerobic Bacteria ◽  
Apical Periodontitis ◽  
Root Canals ◽  
Different Types ◽  
Dental Hospital ◽  
Conservative Dentistry ◽  
Periapical Diseases ◽  
Identification Of Bacteria ◽  
Dominant Bacteria

Chronic apical periodontitis is one of common periapical diseases. Inflammation in the periapical tissue is caused bybacteria from the root canal necrotic. If the tooth is not treated, the infection can progress to periapical region causingchronic apical periodontitis. The variety of bacteria can be found in root canal with chronic apical periodontitis. Thisstudy aims to determine the type of bacteria in chronic apical periodontitis. Samples were obtained from fifteen patientswith teeth that have chronic apical periodontitis in the Department of Conservative Dentistry in Dental Hospital ofHasanuddin University. Bacteria collected from a sample specimen using paper points which were inserted into the rootcanal. Subsequent, bacterial specimens identified in the Medical Microbiology Laboratory of the Medical Faculty,Hasanuddin University. This study found seven different types of bacteria with varying percentages. Type of Grampositivefacultative anaerobic bacteria Streptococcus spp. is the most dominant bacteria found in the root canal withchronic apical periodontitis. This study concluded that the dominant bacteria in the root canals with chronic apical periodontitis were Streptococcus spp.

Application of High-Frequency Conduction for Persistent Apical Periodontitis: A Case Report

2021 ◽  
Vol 7 (4) ◽  
Author(s):  
Toshihiko Tominaga ◽  
◽  
Eiichiro Tada ◽  
Kazuki Takahira ◽  
Tsutomu Sugaya ◽  
...  
Keyword(s):  
Root Canal ◽  
High Frequency ◽  
Root Resorption ◽  
Root Surface ◽  
Apical Periodontitis ◽  
Root Canal Filling ◽  
Tissue Inflammation ◽  
External Root Resorption ◽  
Ultrasonic Irrigation

We report the case of a 39-year-old male with Persistent Apical Periodontitis (PAP) caused by infection in an uninstrumented area, wherein conventional chemical root canal treatment is not possible, which was sterilized via highfrequency conduction. He underwent root canal filling after multiple endodontic treatments for tooth #4. As symptoms recurred, he was referred to our department with the chief complaint of dull pain during mastication. Present symptoms were percussion pain of the tooth, buccal mucosa swelling at the apical portion, and grade 1 mobility. Radiography revealed inadequate root canal filling. A radiolucent image 5×6 mm in diameter and with an unclear boundary was observed around the apex. External root resorption was mainly observed in the apical foramen, with a crown root ratio of approximately 1:1. Using 6% sodium hypochlorite under dental microscopy, chemomechanical root canal preparation was performed. Passive ultrasonic irrigation and calcium hydroxide application were conducted three times; however, periapical tissue inflammation did not subside. Therefore, the patient was diagnosed with PAP, and the uninstrumented area was sterilized via high-frequency conduction. High-frequency currents were applied to the apex, root surface, and periapical lesion at 500 kHz and 90 V; periapical tissue inflammation resolved after 2 weeks. Subsequently, the root canal was filled. Follow-up radiography revealed a bone regeneration-like image at 2 months. Bone defects healed at 11 months. Although surgical endodontic therapy is conventionally performed in PAP patients, high-frequency conduction could be a minimally invasive nonsurgical endodontic treatment option for uninstrumented areas in PAP patients.

scholarly journals Management of non-vital anterior tooth with open apex by MTA apical plug -A case report.

2019 ◽  
Vol 9 (1) ◽  
pp. 42-45
Author(s):  
Fahd AA Karim ◽  
Kazi Hossain Mahmud ◽  
Asma Sultana ◽  
Shirin Sultana Chawdhari ◽  
Moktadir Hossain ◽  
...  
Keyword(s):  
Case Report ◽  
Clinical Examination ◽  
Root Canal ◽  
Radiographic Evaluation ◽  
Central Incisor ◽  
Maxillary Central Incisor ◽  
Anterior Teeth ◽  
The Right ◽  
Apical Area

A 15 year old boy was presented with pain in his upper anterior teeth. On clinical examination both the maxillary central incisor revealed slight discoloration and fracture of the crown. Radiographic evaluation revealed open apex of the left central incisor and apex of the right central incisor was fully developed. Apexification with MTA apical plug was carried out in left central incisor and conventional root canal treatment was done in right central incisor. In two months follow up both the tooth were clinically and radiographically asymptomatic and the healing of the apical area of the left central incisor was continued. These finding suggests that MTA can induce formation of apical barrier in the case of non-vital tooth with open apex. Update Dent. Coll. j: 2019; 9 (1): 42-45

scholarly journals Nonsurgical Retreatment of Lower Incisor with Apical Lesion

2014 ◽  
Vol 3 (2) ◽  
pp. 98-102
Author(s):  
Alberto Dagna
Keyword(s):  
Root Canal ◽  
Mineral Trioxide Aggregate ◽  
Canal System ◽  
Lower Incisor ◽  
Endodontic Surgery ◽  
Gutta Percha ◽  
First Choice ◽  
Root Canal System ◽  
The Right

ABSTRACT Orthograde retreatment is the first choice to manage an endodontic failure, because surgical approach not always eliminates from the root canal all those microorganisms that caused the failure. Endodontic surgery is commonly performed, when the root canal space is no longer accessible as a result of the presence coronal obstacles. But this case report demonstrates that the attempt to removal of prosthetic crown and post allows to create the right access and then to perform an adequate shaping, cleansing and sealing of the root canal system, even if the chronic periapical pathology induced an initial apical resorption. When the apical diameter is increased, perfect obturation with gutta-percha is not possible, and the apical sealing can be managed with mineral trioxide aggregate (MTA). Follow-up intraoral periapical radiograph at 20 months shows adequate repair of the periapical rarefaction. How to cite this article Dagna A, Saini R. Nonsurgical Retreatment of Lower Incisor with Apical Lesion. Int J Experiment Dent Sci 2014;3(2):98-102.

scholarly journals Apical Surgery: Therapeutic Option for Endodontic Failure

2018 ◽  
Vol 20 (3) ◽  
pp. 185
Author(s):  
Paulo Otávio Carmo Souza ◽  
Carolina Ferrari Piloni de Oliveira ◽  
Iussif Mamede-Neto ◽  
Amin De Macedo Mamede Sulaimen ◽  
Pedro Luís Alves de Lima ◽  
...  
Keyword(s):  
Root Canal ◽  
Therapeutic Option ◽  
Treatment Plan ◽  
Tomographic Images ◽  
Apical Surgery ◽  
Root Canal Retreatment ◽  
Periapical Granuloma ◽  
History Of ◽  
Endodontic Retreatment

AbstractThe aim of this study is present a surgical solution of the case of endodontic root canal failure caused by overfilling, with a history of endodontic retreatment and aesthetic rehabilitation with porcelain veneers. Patient C.F.P.L, 50 years old, female, was looking for treatment complaining of pain. Previous endodontic treatment was reported on tooth 11, and root canal retreatment after 6 months due to the persistence of painful symptomatology. Later, the patient carried out aesthetic rehabilitation with porcelain veneers, and approximately 6 months later the vitro pain related to the tooth 11 occurred again. Radiographic and tomographic images showed obturation of the root canal of the tooth 11 associated with diffuse hypodense area in the periapical region, with overextended endodontic material. The probable clinical diagnosis was symptomatic traumatic apical periodontitis, and apical surgery was proposed as treatment plan. After infiltrative anesthesia, a Newmann incision and split flap were performed, followed by osteotomy with micro-chisel and curettage of the lesion. An apicectomy was performed with Zecrya drill, followed by retro cavity with diamond ultrasonic tip and retrograde obturation with white MTA. After 2 years of follow-up bone neoformation and absence of symptomatology were observed, tooth in function and preservation of aesthetic rehabilitation harmony. Apical surgery is a therapeutic alternative with favorable prognosis for the treatment of endodontic failure, provided that it is correctly indicated and with a wellexecuted surgical protocol.Keywords: Apicectomy. Periapical Periodontitis. Periapical Granuloma. ResumoO objetivo deste estudo é apresentar a resolução cirúrgica de um caso de insucesso endodôntico ocasionado pela sobre obturação do canal radicular, com histórico de retratamento endodôntico e reabilitação estética com facetas cerâmicas. Paciente C.F.P.L, 50 anos, gênero feminino, procurou atendimento odontológico queixando-se de dor. Foi relatado tratamento endodôntico prévio no dente 11, e retratamento do canal radicular após 6 meses devido à persistência de sintomatologia dolorosa. Posteriormente, a paciente passou por reabilitação estética com facetas cerâmicas e, aproximadamente 6 meses após, houve o reaparecimento de dor espontânea relacionada ao dente 11. As imagens radiográficas e tomográficas revelaram obturação do canal radicular do dente 11 associado à área hipodensa difusa na região periapical, com extravasamento de material obturador. O diagnóstico clínico provável foi de periodontite apical sintomática traumática, e plano de tratamento proposto uma cirurgia parendodôntica. Posterior a anestesia infiltrativa, realizou-se incisão do tipo Newmann e retalho dividido, seguido de osteotomia com micro cinzel e curetagen da lesão. A apicectomia foi realizada com broca Zecrya, seguida da confecção da retrocavidade com ponta ultrassônica diamantada e obturação retrógrada com MTA branco. Após 2 anos de proservação foi observada neoformação óssea e ausência de sintomatologia, dente em função e preservação da harmonia da reabilitação estética. A cirurgia parendodôntica é uma alternativa terapêutica com prognóstico favorável para o tratamento do insucesso endodôntico, desde que corretamente indicada e com protocolo cirúrgico bem executado.Palavras-chave: Apicectomia. Periodontite Periapical. Granuloma Periapical.

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

2019 ◽  
Vol 9 (19) ◽  
pp. 3942 ◽  
Author(s):  
Paulo J. Palma ◽  
João Martins ◽  
Patrícia Diogo ◽  
Diana Sequeira ◽  
João Carlos Ramos ◽  
...  
Keyword(s):  
Root Development ◽  
Root Canal ◽  
Case Reports ◽  
Sinus Tract ◽  
Apical Periodontitis ◽  
Endodontic Treatment ◽  
Spontaneous Pain ◽  
Endodontic Infection ◽  
Apical Papilla

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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