Citation Information :
Salah KB, Mabrouk NA, Ziada S, Sahtout S. A CBCT Healing Assessment of Nonsurgical Endodontic Management of Two Trauma-induced Large Periapical Lesions. Cons Dent Endod J 2022; 7 (1):23-30.
Introduction: This case illustrates the healing of large trauma-induced periapical mandibular and maxillary pocket cysts in a 16-year-old female patient after a nonsurgical endodontic treatment. Dental pulp infection might be the result of tooth decay, trauma, and operative dental procedures. Pulp infection generally leads to the total pulpal necrosis. It stimulates the development of an immune response in the periapical region leading to the growth of periapical lesions with periapical bone resorption. Taking into account the crucial role of the microorganisms occupying the root canal in initiating and sustaining periradicular lesions, nonsurgical root canal treatment and proper infection control should be rule in the management of apical periodontitis. The outcome assessment of periapical lesions is based on clinical and radiographic criteria.
Conclusion: In the present case, the CBCT periapical index was used to control bone healing and concluded that the lesion is considered “healing in progress.” This case confirms that even large periapical lesions could respond favorably to a well-performed nonsurgical root canal treatment.
Stashenko P. Interrelationship of dental pulp and apical periodontitis. In: Hargreaves KM, Goodis HE, eds. Bender and Seltzer's dental pulp. Chicago: Quintessence Publishing; 2002:389–409.
Saatchi M. Healing of large periapical lesion: A non-surgical endodontic treatment approach. Aust Endod J 2007;33:136–140. DOI: 10.1111/j.1747-4477.2007.00061.x.
García CC, Sempere FV, Diago MP, et al. The post-endodontic periapical lesion: Histologic and etiopathogenic aspects. Med oral patol oral cir bucal 2007;12(8):E585–590. PMID: 18059244.
Fernandes M, de Ataide I. Nonsurgical management of periapical lesions. J conserv dent 2010;13(4):240–245. DOI: 10.4103/0972-0707.73384.
Zaleckiene V, Peciuliene V, Brukiene V, et al. Traumatic dental injuries: etiology, prevalence and possible outcomes. Stomatologija 2014;16:7–14. PMID: 24824054.
Nair PN. Apical periodontitis: A dynamic encounter between root canal infection and host response. Periodontology 2000 1997;13: 121–148. DOI: 10.1111/j.1600-0757.1997.tb00098.x.
Pitcher B, Alaqla A, Noujeim M, et al. Binary decision trees for preoperative periapical cyst screening using cone-beam computed tomography. J Endod 2017;43(3):383–388. DOI: 10.1016/j.joen.2016. 10.046.
Lalonde ER. A new rationale for the management of periapical granulomas and cysts: an evaluation of histopathological and radiographic findings. J Am Dent Assoc 1970;80(5):1056–1059. DOI: 10.14219/jada.archive.1970.0236.
Simon JHS, Enciso R, Malfaz JM, et al. Differential diagnosis of large periapical lesions using cone-beam computed tomography measurements and biopsy. J Endod 2006;32:833–837. DOI: 10.1016/j.joen.2006.03.008.
Misch CE. Bone character: second vital implant criterion. Dent Today 1988;7:39–40.
Diederichs CG, Engelke WG, Richter B, et al. Must radiation dose for CT of the maxilla and mandible be higher than that for conventional panoramic radiography? AJNR Am Soc Neuroradiol 1996;17(9): 1758-1760. PMCID: PMC8338279.
Lin LM, Huang GT, Rosenberg PA. Proliferation of epithelial cell rests, formation of apical cysts, and regression of apical cysts after periapical wound healing. J Endod 2007;33:908–916. DOI: 10.1016/j.joen.2007.02.006.
Tay FR, Gu LS, Schoeffel GJ, et al. Effect of vapor lock on root canal debridement by using a side-vented needle for positive-pressure irrigant delivery. J Endod 2010;36:745–750. DOI: 10.1016/j.joen.2009.11.022.
Siqueira JF, Rôças IN, Favieri A, et al. Chemomechanical reduction of the bacterial population in the root canal after instrumentation and irrigation with 1%, 2.5%, and 5.25% sodium hypochlorite. J Endod 2000;26:331–334. DOI: 10.1097/00004770-200006000-00006.
Karamifar K, Tondari A, Saghiri MA. Endodontic periapical lesion: An overview on the etiology, diagnosis and current treatment modalities. Eur Endod J 2020;5(2):54–67. DOI: 10.14744/eej.2020.42714.
Katebzadeh N, Sigurdsson A, Trope M. Radiographic evaluation of periapical healing after obturation of infected root canals: an in vivo study. Inter. Endod J 2000;33:60–66. DOI: 10.1046/j.1365-2591.2000.00301.x.
Shah N. Nonsurgical management of periapical lesions: A prospective study. Oral Surg Oral Med Oral Pathol 1988;66:365–371. DOI: 10.1016/0030-4220(88)90247-2.
Restrepo-Restrepo FA, Canas-Jimenez SJ, Romero-Albarracın RD, et al. Prognosis of root canal treatment in teeth with preoperative apical periodontitis: a study with cone-beam computed tomography and digital periapical radiography. Int Endod J 2019:52(11);1533–1546. DOI: 10.1111/iej.13168.
Metska ME, Parsa A, Aartman IH, et al. Volumetric changes in apical radiolucencies of endodontically treated teeth assessed by cone-beam computed tomography 1 year after orthograde retreatment. J Endod 2013;39:1504–1509. DOI: 10.1016/j.joen.2013.08.034.
Estrela C, Bueno MR, Azevedo BC, et al. A periapical index based on cone beam computed tomography. J Endod 2008;34(11):1325–1331. DOI: 10.1016/j.joen.2008.08.013.
Friedman S. Prognosis of initial endodontic therapy. Endodontic Topics 2002;2:59–88. DOI: 10.1034/j.1601-1546.2002.20105.x.
Zhang MM, Liang YH, Gao XJ, et al. Management of apical periodontitis: healing of post-treatment periapical lesions present 1 year after endodontic treatment. J Endod 2015;41(7):1020–1025. DOI: 10.1016/j.joen.2015.02.019.
