Factors Affecting the Outcome of Periapical Surgery; a Prospective Longitudinal Clinical Study

Wound healing following periapical surgery is influenced by age, gender, smoking, periapical lesion size, type of root-end filling, method of root-end cavity preparation and the use of microsurgical or conventional technique. This study aimed to evaluate the influence of various preoperative factors such as age, gender, smoking, preoperative pain, and preoperative periapical lesion size on the outcome of surgical endodontic treatment. A thorough history, examination, and investigation were performed to establish patient age, gender, smoking status, periapical lesion size, and the presence of preoperative pain. Forty patients aged between 15–57 years presented with persistent chronic apical periodontitis of single-rooted anterior teeth after conventional re-root canal treatment were enrolled for periapical surgery. Following periapical surgery, all patients were recalled for evaluation of periapical healing after 12 months based on clinical and periapical X-ray examination due to inaccessibility of an advanced imaging system (CBCT). Chi-squared and Fisher’s exact test were applied, which revealed a statistically significant association of periapical healing with age (p = 0.025), smoking (p = 0.029), and lesion size (p < 0.001). Although, the success of periapical healing was higher in males 78.6% (22/28) compared to females 58.3% (7/12) however, no statistically significant relationship was found between gender and healing (p = 0.254). Patient age, smoking status, and size of the preoperative lesion had a strong influence on periapical healing after surgical endodontic treatment.

Regenerative endodontic treatment performed with platelet-rich plasma presents better periapical healing than only induced blot clot: a systematic review

This study comprehensively reviewed two different treatments for regenerative endodontic: platelet-rich plasma and induced blot clot, in regarding to periapical healing. Two investigators performed a systematic review. MEDLINE/PubMed, Cochrane Library and Scopus supplied relevant data from studies published until December 2020 to answer the PICO question. Primary outcome was periapical healing. Eight randomized clinical trials fulfilled eligibility criteria. Primary outcome indicated that platelet-rich plasma results in similar or better periapical healing compared to blot clot group. The reported failures were related to blot clot group due to incomplete radiographic parameters, pain and reinfection; however, few cases of unsuccess were reported to platelet-rich plasma group. Only two studies observed better results to blot clot group in relation to increase of radiographic area and partial pulp canal obliteration. This review showed that procedures using platelet-rich plasma were successful in treating permanent teeth with root development.

Non-Surgical Management of Iatrogenic Extrusion of Calcium Hydroxide Based Intracanal Medicament in Clinical Endodontics – A Case Report

Calcium hydroxide is used as an intracanal medicament in endodontics as it reduces intracanal microbial load and exudate discharge from infected teeth. Reports have shown that extrusion of calcium hydroxide periapically leads to an increased incidence of swelling, delayed periapical healing, nerve paraesthesia and other complications. Teeth with immature apex or those undergoing apical resorption are prone to higher chances of periapical medicament extrusion, especially under high pressure delivery systems. This case report discusses nonsurgical management of periapically extruded non-setting calcium hydroxide by an innovative technique which is less invasive and comfortable both for the clinician and the patient. Calcium hydroxide is widely used as an intracanal medicament for the treatment of pulpal and periapical diseases.1 The intracanal placement of calcium hydroxide can be done with a lentulospiral or a syringe-based delivery system.2 If extruded periapically, there is an increased incidence of swelling, delayed periapical healing, nerve paraesthesia and other complications.3 Case reports in the past have suggested surgical management of periapically extruded calcium hydroxide. The purpose of this case report is to discuss an orthograde nonsurgical management of periapically extruded calcium hydroxide based intracanal medicament containing barium sulphate during endodontic treatment.

Comparative Evaluation of Postoperative Pain and Periapical Healing After Root Canal Treatment Using Three Different Base Endodontic Sealers – A Randomized Control Clinical Trial

Backgroundː Endodontic Sealers come in direct contact with periapical tissue through the apical foramen and lateral canals, influencing the postoperative pain and periapical healing. The aim of the present study was to evaluate and compare postoperative pain and periapical healing after root canal treatment using different base endodontic sealers.Methodsː Primary root canal treatment was initiated in 63 patients diagnosed with necrotic pulp and apical periodontitis, followed by which the endodontic sealers used for obturation were selected based on the random allocation of the participants to the following groups; Tubli-Seal, AH Plus and BioRoot RCS. Postoperative pain was recorded by using 100 mm visual analog scale at 24 h, 48 h, 72 h and 7 d after obturation. Digital periapical radiographic evaluation was done to assess rate of periapical healing at baseline, 1, 3 and 6 months. Statistical analysis was done using Kruskal Wallis test and one-way ANOVA and p-value of less than 0.05 was considered as significance level.Resultsː Significant reduction was seen in the size of periapical lesions in all the study groups at 3 and 6 months (p ˂ 0.05). The mean difference in the size of periapical lesions for BioRoot RCS was 4.05, 10.22, for AH Plus was 2 3.86, 9.80 and Tubli-Seal were 6.27, 13.41 at 3 months and 6 months respectively. The mean pain scores at 24 h for Tubli-Seal, AH Plus, BioRoot RCS were 17.94 ± 11.35, 11.57 ± 11.18 and 4.73 ± 7.72. At 48 h were 5.26 ± 9.04, 1.57 ± 3.74 and 1.57 ± 3.74 respectively. The mean pain score at 72 h for Tubli-Seal was 2.63 ± 7.33 whereas none of the patients had reported pain in AH Plus and BioRoot RCS group. None of the patients had pain 7 d after treatment.Conclusionsː BioRoot RCS showed less postoperative pain compared to AH Plus and Tubli-Seal. BioRoot RCS showed better periapical healing compared to AH Plus and Tubliseal at 3- and 6-months interval respectively.Trial Registration: Registration of this trial was done prospectively in Clinical trials registry – India (CTRI) with registration number (CTRI/2018/10/015919) dated 08/10/2018.

Metaloproteinases da matriz: papel no desenvolvimento das lesões periapicais e modulação após tratamento endodôntico

Introduction: Apical periodontitis represents a local immune response directed against the progression of microorganisms from the dental pulp to the apical foramen and periapical tissues, which results in bone and dental resorption. The aim of this review is to describe the expression of this group of proteases in apical periodontitis and its modulation during the periapical healing phase following root canal treatment. Literature review: The pathogenesis of apical periodontitis involves degradation of several extracellular matrix components. Matrix metalloproteinases (MMPs) are expressed in response to specific stimuli by resident cells of connective tissue during tissue remodeling and by inflammatory cells that arrive into the surrounding tissues during inflammatory events. MMPs have been reported in apical periodontitis, either experimentally induced or obtained from humans and there is evidence that these enzymes show diff erent expression patterns in granulomas and periapical cysts. Root canal therapy is important for the reduction of periapical inflammation as well as the synthesis of MMPs, especially when using a calcium hydroxide-based dressing. Conclusion: Apical periodontitis show high expression of matrix metalloproteinases and root canal treatment results in less expression of MMPs when compared to untreated apical periodontitis.