Nonsurgical treatment of extensive cyst‐like periapical lesion of endodontic origin

Abstract

Periapical lesions of endodontic origin may develop asymptomatically and become large. Proper biomechanical preparation followed by calcium hydroxide medication renewed periodically represents a nonsurgical approach to resolve extensive inflammatory periapical lesions.

Avaliação do metabolismo epitelial em cistos radiculares pela técnica de AgNORS

“…Alguns estudos têm apresentado índices de sucesso entre 85% e 95% de lesões radiograficamente compatíveis com CR que repararam, após o tratamento endodôntico do dente envolvido 4,7,16 . Biologicamente, há muitas hipóteses para explicar os mecanismos de reparo após a terapia endodôntica.…”

Favorable response of an extensive periapical lesion to root canal treatment

“…Therefore, effective neutralization and/or removal of infection from the root canal system would lead to nonsurgical resolution of the apical cystic lesions. Adequate biomechanical preparation with the aid of 5.25% NaClO is currently recommended for the above purpose, followed by placement of a calcium hydroxide root canal dressing (3,9,20). The favorable clinical, radiographic, and histological responses obtained with calcium hydroxide are attributed to the involvement of Ca 2+ and OH -in several cellular and molecular mechanisms leading to regeneration of periapical connective tissues (9).…”

“…The efficacy of calcium hydroxide, owing to its antiseptic, anti-exudative, and mineralizationinducing properties, depends on the sustained release of calcium and hydroxyl ions to the root canal system and periapical region (26). As they are progressively resorbed by the periapical fluids, regular renewal of the root canal dressing is fundamental in reducing the intensity of the periapical inflammatory process; transforming the inflammatory granulation tissue into reparative granulation tissue; and simultaneously inducing the differentiation of undifferentiated mesenchymal cells into reparative cells, e.g., fibroblasts, cementoblasts and osteoblasts (9,26). These are combined with the effect of the immunological system on the epithelial component of the supposedly cystic lesion (5,27,28).…”

“…Adequate biomechanical preparation with the aid of 5.25% NaClO is currently recommended for the above purpose, followed by placement of a calcium hydroxide root canal dressing (3,9,20). The favorable clinical, radiographic, and histological responses obtained with calcium hydroxide are attributed to the involvement of Ca 2+ and OH -in several cellular and molecular mechanisms leading to regeneration of periapical connective tissues (9). The benefits of calcium hydroxide include anti-inflammatory action through its hygroscopic properties, such as forming calcium-proteinate bridges and inhibiting the phospholipase; the neutralization of acidic products, such as hydrolases of clasts; activation of alkaline phosphatase; and antibacterial action (16)(17)(18)(19).…”

“…At this stage, the cortical plates of the alveolar process have a paper-like texture upon palpation; at a later stage, they may present fluctuation, and the mucosa may exhibit bluish discoloration (8). Radiographically, these plates display a round or elliptical contour, involve the apical third, and are delimited by a continuous radioopaque hard lamina (9).…”