Treatment of large periapical lesions using cannulization through the involved teeth

Pioneering Periapical Healing: The Novel Synergy of Mineral Trioxide Aggregate and Injectable Platelet-Rich Fibrin

This case report presents a novel non-surgical approach for managing a substantial periapical lesion associated with tooth 12 using a combination of injectable platelet-rich fibrin (i-PRF) and mineral trioxide aggregate (MTA). A 28-year-old male patient presented with pus discharge and intermittent swelling following a history of dental trauma. Clinical and radiographic assessments confirmed a large periapical cyst associated with tooth 12. The treatment involved root canal therapy with calcium hydroxide medication, leading to symptom relief. Subsequently, i-PRF combined with MTA was used as a regenerative material for periapical healing. Follow-up examinations at three, six, and nine months showed complete resolution of symptoms and radiographic evidence of lesion healing. This innovative technique demonstrates the potential of i-PRF and MTA synergy in the non-surgical management of periapical lesions, avoiding the risks associated with surgical interventions and promoting effective tissue healing.

Endodontic Periapical Lesion: An Overview on the Etiology, Diagnosis and Current Treatment Modalities

Nonsurgical and surgical endodontic treatments have a high success rate in the treatment and prevention of apical periodontitis when carried out according to standard and accepted clinical principles. Nevertheless, endodontic periapical lesions remain in some cases, and further treatment should be considered when apical periodontitis persists. Although several treatment modalities have been proposed for endodontically treated teeth with persistent apical periodontitis, there is a need for less invasive methods with more predictable outcomes. The advantages and shortcomings of existing approaches for the diagnosis and treatment of endodontic periradicular lesions are discussed in this review.

Design of novel injectable in-situ forming scaffolds for non-surgical treatment of periapical lesions: In-vitro and in-vivo evaluation

Periapical lesions are considered one of the common pathological conditions affecting alveolar bone. The primary focus of this study was to investigate the effectiveness of formulating an injectable in-situ forming scaffold-loaded with risedronate (bone resorption inhibitor) and with lornoxicam (anti-inflammatory drug) for the non-surgical treatment of periapical lesions. The scaffolds were prepared using solvent-induced phase inversion technique. Two insoluble copolymers were investigated namely; PLGA (ester-terminal) and PLGA-A (acid-terminal), additionally, SAIB was added as a high viscosity water-insoluble carrier. The addition of porogenic agents like hydrolyzed collagen was also investigated. The prepared scaffolds were characterized by analyzing their in-vitro release, DSC and rheological properties, besides their morphological properties. The results showed that the scaffolds prepared using 30% (w/v) PLGA or combined PLGA: SAIB (1:1, w/w) with total polymer concentration of 30% (w/v) possessed the most sustained drug release profile. Selected scaffolds were tested for their therapeutic effect to study the effect of porogenic agent, anti-inflammatory drug and risedronate in periapical lesions induced in dogs' teeth. Results declared that the selected scaffolds succeeded in improving the inflammation and enhancing the formation of new bony regions confirming the success of the prepared scaffolds as an innovative approach in the treatment of bone defects.

Management of large preiapical lesion with the combination of second generation platelet extract and hydroxyapatite bone graft: a report of three cases

The pulp tissue necrosis and extensive periodontal diseases leads to the development of the inflammatory periapical lesion which causes a local response of bone around the apex of the tooth. Depends upon the nature of wound and available biological growth factors the outcome will be either regeneration or repair. Being a rich source of growth factors, platelet rich fibrin (PRF) posses many advantages in bone regeneration. The purpose of this case report is to present an attempt to evaluate the healing potential of the combination of PRF and Hydroxyapatite bone graft as opposed to using these materials alone. A periapical endodontic surgery was performed on three patients with a large periapical inflammatory lesion and a large bony defect. The defect was then filled with a combination of PRF and Hydroxyapatite bone graft crystals. Clinical examination exhibited uneventful wound healing. The HA crystals have been replaced by new bone radiographically at the end of two years in Case 1 and Case 2, Case 3 were followed upto one year. On the basis of our cases outcome, we conclude the use of PRF in combination with HA crystals might have accelerate the bone regeneration.

Platelet-Rich Fibrin with β-Tricalcium Phosphate-A Noval Approach for Bone Augmentation in Chronic Periapical Lesion: A Case Report

Introduction. This paper describes a case of bone augmentation with combination of Platelet-Rich Fibrin (PRF) and β-TCP for treatment of chronic periapical cyst. The case was followed for 12 months. Methods. Patient presented with chronic periapical lesion in maxillary anterior teeth with history of trauma 8 years back. Radiographically, a periapical cyst was seen in relation to maxillary left central and lateral incisors. Conventional endodontic treatment was started. Since it was not successful, apical surgery was performed. Bone augmentation was done using PRF in combination with β-TCP bone graft to achieve faster healing of the periapical region. Regular followups at 3, 6, 9, and 12 months were done. Results. Healing was uneventful. Follow-up examinations revealed progressive, significant, and predictable clinical and radiographic bone regeneration/healing without any clinical symptoms. Conclusions. Combined use of PRF and β-TCP for bone augmentation in treatment of periapical defects is a potential treatment alternative for faster healing than using these biomaterials alone.

Nonsurgical management of periapical lesions

Periapical lesions develop as sequelae to pulp disease. They often occur without any episode of acute pain and are discovered on routine radiographic examination. The incidence of cysts within periapical lesions varies between 6 and 55%. The occurrence of periapical granulomas ranges between 9.3 and 87.1%, and of abscesses between 28.7 and 70.07%. It is accepted that all inflammatory periapical lesions should be initially treated with conservative nonsurgical procedures. Studies have reported a success rate of up to 85% after endodontic treatment of teeth with periapical lesions. A review of literature was performed by using electronic and hand searching methods for the nonsurgical management of periapical lesions. Various methods can be used in the nonsurgical management of periapical lesions: the conservative root canal treatment, decompression technique, active nonsurgical decompression technique, aspiration-irrigation technique, method using calcium hydroxide, Lesion Sterilization and Repair Therapy, and the Apexum procedure. Monitoring the healing of periapical lesions is essential through periodic follow-up examinations.

Management of infected radicular cyst by surgical decompression

Treatment of maxillary incisor with an associated cystic lesion by conventional endodontic therapy combined with decompression is reported. Although small cystic lesions frequently heal simply with endodontic therapy, larger lesions may need additional treatment. In some cases, when surgical enucleation is elected, there is a chance for inadvertent injury to adjacent teeth or structures even though periapical surgery has a role in endodontics. Therefore a more conservative approach of decompression and a workable protocol for this was attempted with success and is presented here.

Treatment of large periapical lesions by inserting a drainage tube into the root canal

Long-term drainage and depressurization is performed by inserting a stainless steel tube into the root canal of teeth with persisting periapical exudation. This article presents 2 cases of large periapical lesions showing a complete healing of bone after the drainage tube procedure. The tube allows lasting drainage, relieves the pressure and modifies the local apical environment so the host defense mechanism can exert repair process.

A 2-day decompression: a case report of a maxillary first molar

A case report of a maxillary first molar is presented in which a drainage tube from a decompression procedure was removed 2 days following placement. The oral surgeon who removed the tube scheduled the patient for surgical enucleation of the large periapical lesion. The surgical appointment was subsequently cancelled and routine endodontic follow-up showed continued osseous repair at 3, 6, and 12 months. The decompression of a large periapical lesion is a conservative alternative to surgical enucleation.

A dentist's dilemma: nonsurgical endodontic therapy or periapical surgery for teeth with apparent pulpal pathosis and an associated periapical radiolucent lesion

First presented is a brief review of nonsurgical versus surgical treatment of radicular cysts. This is followed by a consideration of the use of radiographs for differential diagnosis of periapical radiolucent lesions. Some of the nonendodontic local and systemic lesions that can occur periapically are then presented. Next examined are the fallibilities of pulp vitality testing methods. The need for histopathologic examination of periapical lesions is the subject of the next discussion. The dentist's dilemma is then examined: should teeth with apparent pulpal pathosis and an associated periapical radiolucent lesion have routine surgical treatment including biopsy or should they be treated nonsurgically and have periodic follow-ups? A possible resolution of this dilemma is the final consideration.

Decompression of a large periapical lesion utilizing an improved drainage device

A decompression device constructed of plastic intravenous tubing attached to an acrylic base and ligated into position with orthodontic ligature wire was used to successfully reduce a large periapical lesion in the anterior mandible. Guidelines for this treatment approach are presented.