Large Periapical or Cystic Lesions in Association with Roots Having Open Apices Managed Nonsurgically Using 1-step Apexification Based on Platelet-rich Fibrin Matrix and Biodentine Apical Barrier: A Case Series

Abstract

Teeth having open apices in the absence of a natural apical constriction pose several challenges during conventional endodontic treatment, especially when establishing an apical seal. Treatment is further challenging when these teeth are associated with large periapical or cystic lesions having resulted in expansion and/or thinning of adjacent cortical plates. Although surgical intervention is commonly adopted in the management of such cases, a conservative treatment option offering equally good prognosis is always desirable. This case series describes 3 cases: a 39-year-old woman, a 45-year-old woman, and a 15-year-old boy having teeth with concomitant open apices and large periapical/cystic lesions managed conservatively by (1) following a strict intracanal disinfection protocol, (2) intracanal aspiration with digital decompression of associated swelling, and (3) 1-step apexification for closure of the root apex by placing a preliminary barrier of platelet-rich fibrin (PRF) and a secondary barrier of Biodentine (Septodont, Saint-Maur-des-Fossés, France). In all 3 cases, the treatment outcomes, both clinical and radiographic, were highly satisfactory. PRF and Biodentine collectively rendered an apical plug that proved to be a suitable alternative to commonly used mineral trioxide aggregate in 1-step apexification. Biodentine provides good interfacial adhesion and sealing with dentin attributed to its property of hydroxyapatite crystal deposition at the material-dentin interface. Also, because of its bioactivity, it likely promotes the conversion of adjacent PRF into a calcific barrier, thus reinforcing the apical seal. Additionally, host-modulating responses of PRF contribute in expediting the healing process. Reasonable osseous healing in the periapex could be appreciated as early as 3 months in all patients. The rapidity with which healing occurred may have been an incidental finding but definitely draws attention.

Non-surgical Management of Large Periapical Lesions with the Agreement Evaluation of the Methods

“…However, compared with calcium hydroxide the cost of these two treatment modalities are higher. The main advantage of these treatment modalities is A research [17] was carried out by Kunhappan (2016) to study about the use of MTA and triple antibiotic up radiographs shows the apical seal of MTA and the It has been proved that, even large periapical lesions can respond favorably to nonsurgical treatment with rich Fibrin in healing large periapical lesions The study has concluded a collective approach strategy involving 1-step apexification using PRF and Biodentine and supplemented with lesion decompression under a stringent disinfection protocol proved highly successful in enabling teeth with open apices and large periapical/cystic lesions to return to a state of health and function without surgical intervention [18].…”

“…Sarang et al [18] has used Biodentine and Platelet nonsurgically in their study. The follow MTA and Biodentine are more novel materials which are recommended to be used for successful apical closure in cases with large periapical lesions.…”

“…It has been proved that, even large periapical lesions can respond favorably to nonsurgical treatment with Sarang et al [18] has used Biodentine and Platelet-rich Fibrin in healing large periapical lesions nonsurgically in their study. The follow-up radiographs are given in the figure.…”

Estratégia de aproveitamento de dentes envolvidos por cistos em pacientes pediátricos

“…É necessária a ação de um agente inflamatório, por exemplo, capaz de estimular e determinar a proliferação desses remanescentes 10 . Tal condição é Revista de Iniciação Científica em Odontologia 2018;16(3):151-158. frequente nos maxilares, onde infecções e traumas são capazes de desencadear a resposta inflamatória 3,4,10,11 .…”

“…Os COs tendem a aumentar lentamente de tamanho, possivelmente em resposta ao aumento da pressão osmótica luminal. Genericamente estas lesões podem: ser assintomáticas, variar de milímetros a alguns centímetros e costumam causar deslocamento de estruturas adjacentes (como dentes, raízes e nervos) 4 . Radiograficamente costuma ser visível uma imagem radiolúcida, unilocular, de limites bem definidos e rodeada por uma margem de osso esclerótico 4,5,6 .…”