Anterior Periapikal Lezyonların Güncel Cerrahi Yönetimi: Vaka Serisi

Öz

Giriş: Kök kanal tedavisi şu anda periapikal hastalıkları tedavi etmek için en yaygın ve etkili yöntemdir ve %80'den fazla bir başarı oranına sahiptir. Ancak kök kanal sisteminin karmaşıklığı, ekstraradiküler bakteriyel biyofilmlerin oluşumu ve gerçek kistlerin oluşumu nedeniyle bazı periapikal hastalıklar cerrahi tedavi gerektirir. Endodontik tedavinin ardından iyileşme gözlenmeyen periapikal lezyonların tedavisi enfeksiyonun mümkün olan en iyi şekilde ortadan kaldırılmasına yol açacak apikal rezeksiyon, retrograt dolgu ve açık flep debridmanı gibi çeşitli cerrahi tedavi seçeneklerini içerir. Bu cerrahi tedaviler apikal bölgedeki kemik dolumu için greft materyalleri, trombositten zengin fibrin (PRF) gibi materyallerle desteklenebilmektedir. 

Olgu Sunumları: Çalışmamızda tüm vakalarda öncelikle endodontik tedavi uygulanmıştır. Endodontik tedaviyi takiben radyografik iyileşme gözlenmeyen maksiller anterior bölgede tek köklü apikal lezyona sahip 5 vaka lokal anestezi altında güncel yaklaşım olan submarjinal insizyon ile açık flep debridmanı ile tedavi edilmiştir. Bunlardan üçüne apikal rezeksiyon uygulanmış, kök ucu retrograt doldurulmuştur. İki vakada ise apikal rezeksiyonsuz ilgili bölge açık flep debridmanı uygulamıştır. Tüm kemik defektleri alloplastik greft materyali ve PRF uygulaması ile tedavi edilmiştir. Hastaların 6 aylık radyografik takibi sunulmaktadır. 

Sonuç: Endodontik tedavi, apikal lezyonların tedavisinde önemli ölçüde iyi performans gösterir; ancak endodontik tedaviye rağmen iyileşme gözlenmeyen apikal lezyon durumları detaylı tanı ve planlama gerektiren, klinisyenin üstesinden gelmesi zor olan durumlardır. Multidisipliner tedavi yaklaşımı gerektiren bu durumlarda açık flep debridmanı ile tedavi başarıyı ve radyografik kemik dolumunu artırmaktadır. Greftleme prosedürü, ilgili iyileşmeyi desteklemek ve prognozu iyileştirmek için ek fayda sağlar. Allogreft ve PRF ile uygulanan periapikal cerrahi, doğal

Anahtar Kelimeler

• Allogreft
• Debridman
• Periapikal hastalıklar
• Trombositten zengin fibrin

Current Surgical Management of Anterior Periapical Lesions: Case Series

Öz

Introduction: Root canal treatment is the most common and effective method of treating periapical diseases, with a high success rate. However, due to the complexity of the root canal system and the formation of extraradicular bacterial biofilms and true cysts, some cases require surgical treatment. If periapical lesions fail to heal after endodontic treatment, various surgical options are available to ensure the best possible eradication of the infection, including apical resection, retrograde filling and open flap debridement. These surgical treatments can be supplemented with graft materials and platelet-rich fibrin (PRF) to fill the bone in the apical region. 

Case reports: Five cases of single-rooted periapical lesions in the maxillary anterior region which showed no radiographic signs of healing following endodontic treatment were treated with open flap debridement under local anesthesia. Three of these cases underwent apical resection. In two cases, open flap debridement of the affected area was performed without apical resection. All bone defects were treated with alloplastic graft material and PRF application. The six-month radiographic follow-up of the patients is presented. 

Conclusion: Endodontic treatment is generally highly effective in treating apical lesions. However, periapical lesions that do not heal despite treatment are challenging for clinicians to manage, requiring detailed diagnosis and planning. In such cases, a multidisciplinary approach is necessary, and open flap debridement can increase the likelihood of success and bone fill. Performing periapical surgery with an allograft and PRF can successfully treat the lesion while preserving the natural tooth structure.

Anahtar Kelimeler

• Allografts
• Debridement
• Periapical diseases
• Platelet-rich fibrin

Destekleyen Kurum

This study received no financial support from any institution or organization.

Etik Beyan

Because this study did not use human or animal-derived sources, ethics committee approval was not obtained.

Teşekkür

We would like to thank our patients who agreed to participate in this case study and Prof. Dr. Hatice Reyhan EĞİLMEZ for her support in providing the histopathological images.

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