ABSTRACT
Lesões periradiculares ocorrem em dentes não vitais como resultado de uma agressão crônica devido a presença de microrganismos dentro do canal radicular, as quais podem ser observadas como uma lesão radiolúcida durante o exame radiográfico; o tratamento varia de acordo com métodos cirúrgicos ou não-cirúrgicos. Este reporte de caso descreve a regressão de uma lesão periapical grande usando um tratamento endodôntico não-cirúrgico em associação com medicação intracanal à base de hidróxido de cálcio. Após exame do paciente e análise radiográfica, uma lesão radiolúcida com 13 mm (no maior diâmetro) foi observada no dente número 12. O tratamento endodôntico foi realizado e Calen-CMCP (S.S. White Artigos Dentários Ltda., Rio de Janeiro, RJ, Brazil) foi aplicado dentro do canal, o qual foi substituído por nova medicação a cada 2 semanas durante 2 meses. A lesão regrediu progressivamente a partir de cada troca de medicação. Além disso, após acompanhamento de 6 anos o dente permaneceu livre de infecção e o tecido ósseo foi completamente regenerado. Conclui-se que terapia à base de hidróxido de cálcio pode estimular de maneira conservadora a regressão de lesões periapicais grandes...
Periradicular lesions occur in non-vital teeth as the result of a chronic aggression by the presence of microorganisms into the root canal, which may appear as a radiolucent lesion in the radiographic exam; treatment varies according to surgical or nonsurgical methods. This case report describes the regression of a periradicular lesion using a nonsurgical endodontic treatment in association with intracanal calcium hydroxide-based medicament. After patient examination and radiographic analysis, a 13 mm (in maximum diameter) radiolucent lesion was observed in tooth number 12. The endodontic treatment was done and Calen-CMCP (S.S. White Artigos Dentários Ltda., Rio de Janeiro, RJ, Brazil) was placed into the root canal, which was changed after every two weeks during two months. It was observed a progressive centrifugal regression of the lesion after every renewing of the medicament. In addition, after six-year follow-up the tooth was still free of re-infection and bone tissue was completely regenerated. In conclusion, calcium hydroxide therapy can conservatively stimulate the regression of large periradicular lesions...
Subject(s)
Humans , Calcium Hydroxide , Periapical Periodontitis , Root Canal TherapyABSTRACT
OBJECTIVES: This study aimed to assess prospectively the clinical outcome of nonsurgical endodontic treatment and identify patient- and tooth-related factors, rather than treatment-related factors, that were the best predictors of this outcome. MATERIALS AND METHODS: The inception cohort comprised 441 teeth (320 patients) and 175 teeth (123 patients) were followed up for 1-2 years. Age, gender, presence of medical disease, number of canals, previous endodontic treatment, presence of sensitivity and pain, pulp vitality, swelling or sinus tract of pulpal origin on the gingiva, periapical radiolucency and tendency of unilateral bite on the affected tooth were recorded at treatment start. RESULTS: The outcome was classified on the basis of periapical radiolucency as healed or non healed. The overall healed rate in these cases, including nonsurgical retreatment, was 81.1%. Four tooth-related factors had a negative impact in the bivariate analysis: previous endodontic treatment, necrotic pulp, preoperative gingival swelling or sinus tract of pulpal origin, and preoperative periapical radiolucency. Stepwise logistic regression analysis including patient-, tooth-related factors and level of the root canal filling as a treatment-related factor showed that preoperative gingival lesion (odds ratio [OR]: 4.4; p = 0.005), preoperative periapical radiolucency (OR: 3.6; p = 0.011), and < or = 1-2 mm under root filling length (OR: 9.6; p = 0.012) were significant predictors of failure. CONCLUSIONS: A preoperative gingival lesion of pulpal origin can influence the outcome of nonsurgical endodontic treatment in addition to preoperative periapical radiolucency.