LONG-TERM RADIOGRAPHIC FOLLOW UP OF ENDODONTICALLY TREATED TEETH ASSOCIATED WITH LARGE PERIAPICAL LESIONS: 2 CASE REPORTS

Abstract

The aim of this paper is to report the healing of two large periapical lesions following non-surgical root canal treatment. The first case was a mandibular right lateral with periapical lesion of endodontic origin in a 40 year-old female patient with extra oral fistula and swelling. In the second case, a mandibular right central incisor was affected in a 22 year-old male patient. The root canals were prepared and filled with calcium hydroxide as an intra-canal medicament. The patients were recalled for clinical evaluation at intervals of 3 weeks. Root canals obturations were performed with gutta–percha and AH Plus sealer. The clinical and radiographic examination after 1 year revealed complete repair. This report confirms that large periapical lesions can respond favourably to nonsurgical treatment

Keywords

• calcium hydroxide, endodontic therapy, periapical healing, periapical lesion

ENDODONTİK TEDAVİSİ YAPILMIŞ GENİŞ PERİAPİKAL LEZYONLU DİŞLERİN UZUN DÖNEM RADYOGRAFİK TAKİBİ: 2 OLGU SUNUMU

Abstract

Bu makalede cerrahi yaklaşım olmaksızın endodontik tedavi sonrası iki büyük periapikal lezyonlu vakanın iyileşme süreci radyografik değerlendirmeler ile birlikte verilmiştir. İlk olguda 40 yaşında bayan hastada ekstraoral fistül ve şişlikle seyreden sağ alt lateral diş kaynaklı geniş bir periapikal lezyon, ikinci olguda ise 22 yaşında erkek hastada sağ alt santral diş kaynaklı periapikal lezyon görülmektedir. Kök kanallarının preparasyonu yapıldıktan sonra kanallar kalsiyum hidroksit ile dolduruldu. Hastaların tekrar klinik değerlendirilmesi 3 haftalık periyotlarda yapıldı. Kök kanal dolgusu, AH Plus ve güta-perkayla bitirildi. 1 sene sonraki klinik ve radyografik muayenede tamamen iyileşme gözlendi. Bu olgu raporunda cerrahi müdahaleye gerek kalmadan başarılı bir şekilde yapılan endodontik tedaviler sonrasında geniş periapikal lezyonların iyileşebileceği anlatılmıştır.

Keywords

• Kalsiyum hidroksit, endodontik tedavi, periapikal iyileşme, periapikal lezyon

References

1. Sundqvist G. Taxonomy, pathogenicity of theroot canal flora. Oral Surg Oral Med Oral Pathol 1994; 78: 522–30.
2. Kvinnsland S, Kristiansen AB, Kvinsland I, Heyeraas KJ. Effect of experimental traumatic occlusion on periodontal and pulpal blood flow. Acta Odantol Scand 1992; 50: 211-9.
3. Wesselink PR. The accidental detection of apical periodontitis. Ned Tijdschr Tandheelkd 2011; 118: 205-8.
4. Çelik K, Belli S. Periapikal kistler ve kök kanal tedavisi ile ilişkileri. Türkiye Klinikleri J Dent Sci 2012; 18: 64-9.
5. Barbakow FH, Cleaton-Jones PE, Friedman D. Endodontic treatment of teeth with periapical radiolucent areas in a general dental practice. Oral Surg Oral Med Oral Pathol 1981; 51: 552–9.
6. Bhaskar SN. Periapical lesions-types, incidence, and clinical features. Oral Surg Oral Med Oral Pathol 1996; 21: 657–71.
7. Eversole LR. Clinical outline of oral pathology: diagnosis and treatment. 2nded. Philadelphia: Lea & Febiger; 1984. p.203–59.
8. Lin LM, Ricucci D, Lin J et al. Nonsurgical Root Canal Therapy of Large Cyst-like Inflammatory Periapical Lesions and Inflammatory Apical Cysts. J Endod 2009; 35: 607–15.

9. Milosevic A. Calcium hidroxide in restorative dentistry. J Dent 1991; 19: 3-13.
10. Foreman AC, Barnes IE. A review of calcium hydroxide. Int Endod J 1990; 23: 283-97.
11. Çelenk S, Ayna BE, Bolgül BS, Atakul F. Geniş Çaplı Periapikal Lezyonun Tedavisi (3 Yıllık Takip Çalışması):Olgu Sunumu. Turkiye Klinikleri J Dental Sci 2005; 11: 69-72.
12. Khayat BG, Byers MR, Taylor PE, Mecifi K, Kimberly CL. Response of nerve fibres to pulpal inflammation and periapical lesions in rat molars demonstrated by calcitonin gene-related peptide immunocytochemistry. J Endod 1988; 14: 577–87.
13. Öztan MD. Endodontic treatment of teeth associated with a large periapical lesion. Int Endod J. 2002; 35: 73-8.
14. Mirkoviç S, Tadiç A, Durdeviç Mirkoviç T, Levakov A. Comparative analysis of accuracy of diagnosis of chronic periapical lesions made by clinical and histopatological examination. Med Pregl 2012; 65: 277-80.
15. Riccitiello F, Stabile P, Amato M, Rengo S, D'Ambrosio C. The treatment of the large periradicular endodontic injury. Minerva Stomatol 2011; 60: 417-26.
16. Shah N. Nonsurgical management of periapical lesions: a prospective study. Oral Surg Oral Med Oral Pathol 1988; 66: 365-71.
17. Morse DR, Bhambhani SM. A dentist’s dilemma: nonsurgical endodontic therapy or periapical surgery for teeth with apparent pulpal pathosis and an associated periapical radiolucent lesion. Oral Surg Oral Med OralPathol 1990; 70: 333-40.
18. Paredes-Vieyra J, Enriquez FJ. Success Rate of Single- versus Two-visit Root Canal Treatment of Teeth with Apical Periodontitis: A Randomized Controlled Trial. J Endod 2012; 38: 1164-9.
19. Ağaçkıran E, Toptancı İR, Adıgüzel Ö. Total kron kaybı olan geniş periapikal lezyonlu maksiller santral kesici dişin çok seanslı endodontik tedavisi ve fiber post destekli kompozit rezin ile restorasyonu. 5 Yıllık Takip. Atatürk Üniv Diş Hek Fak Derg 2013; 23: 89-97.
20. Farhad A, Mohammadi Z. Calcium hydroxide: a review. Int Dent J 2005; 55: 293–301.
21. Soares JA, Leonardo MR, Tanomaru FM, Silva LAB, Ito IY. Effect of biomechanical preparation and calcium hydroxide pastes on the anti-sepsis of root canal systems in dogs. J Appl Oral Sci 2005; 13: 93-100.
22. Çalışkan MK. Prognosis of large cyst-like periapical lesions following nonsurgical root canal treatment: a clinical review. Int Endod J 2004; 37:408-16.
23. Çalışkan MK, Türkün M. Periapical repair and apical closure of a pulpless tooth using calcium hydroxide. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 84: 683-7.
24. Saatchi M. Healing of large periapical lesion: a non-surgical endodontic treatment approach. Aust Endod J 2007; 33: 136-40.