Endodontic Management of a Tooth with Severe External Root Resorption using Injected Non-setting Calcium Hydroxide Paste: A Case Report

External Root Resorption (ERR) is a pathological condition that can lead to tooth loss if not diagnosed and treated correctly. Calcium Hydroxide Ca(OH)2 is an intracanal medicament, which is used in cases of teeth with pulp necrosis, peri-radicular lesions and ERR. This paper describes the endodontic management of a tooth with severe ERR using injected non-setting Ca(OH)2 paste. A 28-year-old patient was referred for endodontic evaluation of tooth 47, which presented an extensive composite resin restoration and was negative to cold test. Panoramic and periapical radiographs revealed the presence of a filled pulp chamber, calcified root canals, ERR on the mesial and distal roots, and apical periodontitis in the mesial and distal roots. The diagnosis of asymptomatic apical periodontitis and severe ERR was established, and conventional root canal treatment combined with non-setting Ca(OH)2dressing was chosen. After five months, no more discharge from the root canal was observed, and a decrease in the size of the periapical lesion and arrest of ERR was detected. The root canal was filled, and the patient was referred for restoration. At the 6-months follow-up, radiographic examination evidenced periapical repair and containment of the ERR process. Chemomechanical root preparation in association with a non-setting Ca(OH)2 dressing protocol allows positive outcomes during the management of severe ERR associated with pulp necrosis and periapical inflammation.

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Effects of Contemporary Irrigant Activation Schemes and Subsequent Placement of an Interim Dressing on Bacterial Presence and Activity in Root Canals Associated with Asymptomatic Apical Periodontitis

Journal of Clinical Medicine ◽

10.3390/jcm9030854 ◽

2020 ◽

Vol 9 (3) ◽

pp. 854 ◽

Cited By ~ 7

Author(s):

Alexandre P. L. Carvalho ◽

Laura C. L. Nardello ◽

Fernanda S. Fernandes ◽

Fernanda P. Bruno ◽

Luiza R. Paz ◽

...

Keyword(s):

Calcium Hydroxide ◽

Root Canal ◽

Quantitative Polymerase Chain Reaction ◽

Apical Periodontitis ◽

Universal Primers ◽

Rrna Gene ◽

Root Canal Preparation ◽

Root Canals ◽

Mechanical Preparation ◽

Root Canal Disinfection

New tools for activating endodontic irrigants have evolved, yet their impact on root canal disinfection, in comparison to the passive placing of an inter-visit medication, have not yet been fully elucidated. The use of DNA- and rRNA-based methods may cast some new light on this issue, as they allow a comparison to be made between microbial presence and activity. Therefore, the aim of this single-arm intervention trial is to evaluate the antibacterial effect of endodontic procedures using both molecular methods. Root canal samples were obtained from 20 patients with asymptomatic apical periodontitis after each treatment step: access cavity, chemo-mechanical preparation, adjunctive procedures (XP-endo Finisher file and passive ultrasonic irrigation), calcium hydroxide medication, and 2nd-visit root canal preparation. DNA and cDNA from the samples were subjected to quantitative polymerase chain reaction with universal primers for the bacterial 16S rRNA gene. Chemo-mechanical preparation promoted a drastic reduction in bacterial levels and activity, whereas the adjunctive procedures did not make a significant contribution to further disinfection. At the 2nd visit, bacteria were active after the use of calcium hydroxide medication; however, they were significantly reduced after a 2nd-visit preparation. Consequently, the lowest bacterial levels were found at the end of the treatment. This clinical trial, which used an rRNA and rDNA combined approach, confirmed previous studies showing that root canal preparation represents the main strategy for root canal disinfection.

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In Vivo Study of Calcium Hydroxide Endodontic Treatment in Chronic Apical Periodontitis

ARS Medica Tomitana ◽

10.2478/arsm-2018-0034 ◽

2018 ◽

Vol 24 (4) ◽

pp. 164-167

Author(s):

Gheorghiu Irina-Maria ◽

Mitran Loredana ◽

M. Mitran ◽

Temelcea Anca-Nicoleta ◽

Scarlatesc Sanziana ◽

...

Keyword(s):

Antimicrobial Activity ◽

Calcium Hydroxide ◽

Root Canal ◽

Essential Role ◽

Apical Periodontitis ◽

Endodontic Treatment ◽

Microbial Load ◽

Root Canals

Abstract The aim of this study was to evaluate the in vivo efficiency of endodontic treatment with calcium hydroxide in chronic apical periodontitis by determining the microbial load from the endodontic space in different stages of treatment. The microbiological determinations that have been made have led to the conclusion that calcium hydroxide possesses a redoubltable antimicrobial activity, but only with the condition of long-lasting contact with the root canals. Another important result is the essential role of the rigorous biomechanical treatment of the root canals, intracanal medication with calcium hydroxide is addresses mostly to microorganisms located in root canal ramifications.

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Nonsurgical Endodontic Retreatment of Advanced Inflammatory External Root Resorption Using Mineral Trioxide Aggregate Obturation

Case Reports in Dentistry ◽

10.1155/2012/624792 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Shivani Utneja ◽

Gaurav Garg ◽

Shipra Arora ◽

Sangeeta Talwar

Keyword(s):

Root Canal ◽

Root Resorption ◽

Clinical Symptoms ◽

Mineral Trioxide Aggregate ◽

Radiographic Examination ◽

Apical Region ◽

Central Incisor ◽

Root Canal Filling ◽

Maxillary Central Incisor ◽

External Root Resorption

Inflammatory external root resorption is one of the major complications after traumatic dental injury. In this case report, we describe treatment of a maxillary central incisor affected by severe, perforating external root resorption. An 18-year-old patient presented with a previously traumatized, root-filled maxillary central incisor associated with pain and sinus tract. Radiographic examination revealed periradicular lesion involving pathologic resorption of the apical region of the root and lateral root surface both mesially and distally. After removal of the root canal filling, the tooth was disinfected with intracanal triple antibiotic paste for 2 weeks. The antibiotic dressing was then removed, and the entire root canal was filled with mineral trioxide aggregate. The endodontic access cavity was restored with composite resin. After 18 months, significant osseous healing of the periradicular region and lateral periodontium had occurred with arrest of external root resorption, and no clinical symptoms were apparent.

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SELECTION OF OBTURATIONS MATERIALS IN PULPECTOMY TREATMENT OF DECIDUOUS TEETH

Interdental Jurnal Kedokteran Gigi (IJKG) ◽

10.46862/interdental.v17i2.1426 ◽

2021 ◽

Vol 17 (2) ◽

pp. 63-68

Author(s):

Bambang Tri Hartomo ◽

Laksmita Tanjung ◽

Mahindra Awwaludin Romdlon ◽

Fitri Diah Oktadewi

Keyword(s):

Zinc Oxide ◽

Calcium Hydroxide ◽

Root Canal ◽

Treatment Plan ◽

Deciduous Teeth ◽

Radiographic Examination ◽

Pulp Tissue ◽

Root Canals ◽

Left Posterior ◽

Selection Of

Introduction: Pulpectomy is the procedure of taking the entire pulp tissue from all the roots and corona of a tooth. There are several materials for obturation / root canal fillers in deciduous teeth, namely zinc oxide eugenol (ZOE), calcium hydroxide and iodoform paste a mixture of calcium hydroxide. A 6 year old boy patient came to RSGM with his parents seeking for treatment a tooth with a large cavity in the upper left posterior region and had been pain before. Intraoral examination revealed deep caries in the occlusal tooth 65 which reaching the pulp, percussion (-), palpation (-), mobility (-), vitality (-). Radiographic examination of tooth 65 showed a radiolucent image that had reached the pulp and the root canals had not yet undergone resorption. The diagnosis of this case was pulp necrosis at tooth 65. Case management: The treatment plan to be carried out was non-vital pulpectomy on tooth 65 and used technique non-vital pulpectomy because the tooth had already necrosis. Discussion: The filler used is ZOE. The reason for choosing this material was because it was indications for the use of ZOE material for teeth with necrosis. Conclussion: ZOE has anti-inflammatory and analgesic properties that can reduce pain

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

Journal of Dentistry & Oral Disorders ◽

10.26420/jdentoraldisord.2021.1168 ◽

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.

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Management of Traumatic Inflammatory External Root Resorption

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v15i1.22238 ◽

2019 ◽

Vol 15 (1) ◽

pp. 71-74

Author(s):

Shikha Bantawa ◽

Navin Agrawal ◽

Mannu Vikram ◽

Vimmi Singh ◽

Ashok Ayer ◽

...

Keyword(s):

Root Canal ◽

Root Resorption ◽

Clinical Symptoms ◽

Mineral Trioxide Aggregate ◽

Radiographic Examination ◽

Apical Region ◽

Dental Tissue ◽

Root Canal Filling ◽

Gutta Percha ◽

External Root Resorption

Inflammatory external root resorption is one of the major complications after traumatic dental injury. It is characterized by the loss of mineralized dental tissue which may, ultimately, result in loss of the tooth. However, with appropriate treatment, prognosis for these teeth may be greatly improved, by preventing or arresting resorption. This is a case report of an 18-year-old male patient presented with root canal treated maxillary central incisors associated with pain; with history of trauma. Radiographic examination revealed periradicular lesion and associated pathologic resorption of the apical region of the root with respect to 11 and calcification of the root canal with inadequate obturation with respect to 21. After removal of the root canal filling, 11 was disinfected with intracanal double antibiotic paste. After 2 weeks, antibiotic dressing was removed, and apical third was sealed with mineral trioxide aggregate (MTA). Canal was obturated with custom-fit gutta-percha and accessory cones with AH plus sealer and restoration was done with composite resin. Retreatment was also done with respect to 21 and obturated with custom-fit gutta-percha. Both teeth were restored with E-max crown. No clinical symptoms were apparent, significant osseous healing of the periradicular region was observed with arrest of external root resorption with respect to 11 and no periapical changes were apparent with respect to 21 on subsequent follow-up.

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Disinfection and outcome of root canal treatment using single-file or multifile systems and Ca(OH)2 medication

Brazilian Dental Journal ◽

10.1590/0103-6440202003245 ◽

2020 ◽

Vol 31 (5) ◽

pp. 493-498

Author(s):

Mônica A. S. Neves ◽

José C. Provenzano ◽

Simone C. L. Fonseca ◽

Renata C. V. Rodrigues ◽

Lucio S. Gonçalves ◽

...

Keyword(s):

Success Rate ◽

Calcium Hydroxide ◽

Root Canal ◽

Apical Periodontitis ◽

Antibacterial Effects ◽

Bacterial Reduction ◽

Root Canals ◽

Single File ◽

Polymerase Chain ◽

Clinical Study Reports

Abstract This clinical study reports on the antibacterial effects and outcome of endodontic treatment using either a single-file or a multifile system, associated with calcium hydroxide interappointment medication. The root canals of single-rooted teeth with apical periodontitis were treated by using either Reciproc or BioRaCe instrument systems, 2.5% NaOCl irrigation, and calcium hydroxide medication. Bacteriological samples taken before preparation and immediately before obturation were evaluated for total bacterial counts by quantitative real-time polymerase chain reaction (qPCR). Patients were followed up and the treatment outcome was assessed by clinical and radiographic criteria. Decreasing lesions were classified as success in a lenient criterion or failure in a rigid one. Bacteria were detected in all initial samples (47 cases) and were significantly reduced after treatment in both groups (p<0.001). In the Reciproc and BioRaCe groups, 7/25 (28%) and 11/22 (50%) root canals yielded negative qPCR results before obturation, respectively (p>0.05). Quantitative bacterial reduction was similar between groups (p>0.05). The success rate in the BioRaCe group was 95.5% and 77% in the loose and rigid criterion, respectively. In the Reciproc group, corresponding figures were 88% and 76%. Differences in outcome were not significant (p>0.05). No diseased case showed negative qPCR results for bacteria. A difference of >1 Log10 counts was observed between healed and diseased cases. Root canal treatments of teeth with apical periodontitis using a single-file or a multifile system for preparation, associated with NaOCl irrigation and calcium hydroxide interappointment medication, showed similar antibacterial effectiveness and success rate.

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Alveólise decorrente de traumatismo dentário: relato de caso

Revista da Faculdade de Odontologia de Porto Alegre ◽

10.22456/2177-0018.103603 ◽

2020 ◽

Vol 61 (2) ◽

pp. 136-141

Author(s):

Maria Arianna Lima Ribeiro ◽

Kamila Nogueira Borges da Costa ◽

Tacíria Machado Bezerra ◽

Meire Coelho Ferreira

Keyword(s):

Dental Caries ◽

Clinical Examination ◽

Root Resorption ◽

Pathological Condition ◽

Dental Trauma ◽

Radiographic Examination ◽

Early Care ◽

Chronic Infections ◽

External Root Resorption ◽

Root Exposure

The alveolysis is a pathological condition classified as partial or total dehiscence (the root exposure is partial or total and involves the marginal bone) and apical fenestration (the root exposure doesn’t involve the marginal bone). Usually occurs by vestibular and in the anterior region of the maxilla. It’s commonly associated with chronic infections provoked by dental caries and dental trauma. This study aims to report a clinical alveolysis case in a previous traumatized deciduous tooth of a 4 years old child. Clinical examination noticed aveolysis apical fenestration type associated to partial dehiscence (tooth 51) and presence of mobility. In the radiographic examination it was found thickening of the pericementary space and external root resorption. The indicated treatment was extraction of the affected tooth and the use of maintainer of space. Based on the reported case, it is concluded that early care and the control of traumatized and decayed teeth are essential for the prevention of alveolysis.

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Antibacterial effect of root canal preparation and calcium hydroxide paste (Calen) intracanal dressing in primary teeth with apical periodontitis

Journal of Applied Oral Science ◽

10.1590/s1678-77572005000400007 ◽

2005 ◽

Vol 13 (4) ◽

pp. 351-355 ◽

Cited By ~ 12

Author(s):

Gisele Faria ◽

Paulo Nelson-Filho ◽

Aldevina Campos de Freitas ◽

Sada Assed ◽

Izabel Yoko Ito

Keyword(s):

Calcium Hydroxide ◽

Root Canal ◽

Primary Teeth ◽

Antibacterial Effect ◽

Apical Periodontitis ◽

Wilcoxon Test ◽

Microbial Culture ◽

Root Canal Preparation ◽

Root Canals ◽

Mechanical Preparation

The aim of this study was to evaluate the antibacterial action of root canal mechanical preparation using 2.5% sodium hypochlorite as the irrigating solution and a calcium hydroxide paste as the antibacterial intracanal dressing in human primary teeth root canals with pulp necrosis and apical periodontitis by means of microbial culture. A total of 26 root canals of human primary teeth with pulp necrosis and apical periodontitis were used. Samples were collected before, 72h after biomechanical treatment and 72h after removal of the intracanal dressing. Comparison by Wilcoxon test showed that root canal mechanical preparation effectively eliminated all microorganisms in 20% of the root canals, and the intracanal dressing in 62.5%; however, the cumulative action of biomechanical treatment and intracanal dressing eliminated the microorganisms of 70% of the root canals (p<0.001). Isolated root canal mechanical preparation presented poorer microbiological results that those obtained with root canal mechanical preparation and the use of an intracanal dressing indicating the necessity of topical application of an intracanal medication between sessions in primary teeth with pulp necrosis and apical periodontitis.

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Portland Cement Use in Dental Root Perforations: A Long Term Followup

Case Reports in Dentistry ◽

10.1155/2014/637693 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Álvaro Henrique Borges ◽

Matheus Coelho Bandeca ◽

Mateus Rodrigues Tonetto ◽

Luis Augusto Faitaroni ◽

Elibel Reginna de Siqueira Carvalho ◽

...

Keyword(s):

Portland Cement ◽

Calcium Hydroxide ◽

Root Canal ◽

Clinical Signs ◽

Signs And Symptoms ◽

Clinical Aspects ◽

Iatrogenic Perforation ◽

Root Canals ◽

First Case ◽

Clinical Signs And Symptoms

Root canal and furcal perforations are causes of endodontic therapy failure and different materials that stimulate tissue mineralization have been proposed for perforation treatment. In the first case, a patient presented tooth 46 with unsatisfactory endodontic treatment and a periapical radiographic lesion. A radiolucent area compatible with a perforating internal resorption cavity was found in the mesial root. The granulation tissue was removed, and root canals were prepared. The intracanal medication was composed of calcium hydroxide and the perforation cavity was filled with Portland cement. The 11-year followup showed radiographic repair of the tissue adjacent to the perforation and absence of clinical signs and symptoms or periapical lesion. In the second case, a patient presented with edema on the buccal surface of tooth 46. The examination showed a radiolucent area in the furcation region compatible with an iatrogenic perforation cavity. The mesial root canals were calcified, and only the distal root canal was prepared. The cavity was filled with a calcium hydroxide-based paste and the distal root canal was obturated. In sequence, the perforation cavity was filled with Portland cement. The 9-year followup showed the tooth in masticatory function with radiographic and clinical aspects compatible with normality.

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