Periapical Lesions: Current Modalities

Abstract

In cases with periapical lesions, there are two types of treatment modalities: noninvasive and invasive. The first one noninvasive is also known as nonsurgical or endodontic treatment. The second one – invasive method is surgical approach. In some cases, there is a need for combination of both aproaches. In everydays clinical treatment, the first choice is less invasive method and has better outcomes. Treatment of some periapical lesions (like cysts) are a theme of discussion and we do not have best option to treat them. The patient should make the definitive decision about the treatment. The doctor should inform him about the advantages and disadvantages of endodontic-noninvasive and surgical-invasive procedure. The therapeutic modalities for these pathologies are a wide range of treatment from endodontic treatment to different surgical options. We like to find out and present the best way about healing the periapical lesion. We wanted to know whenever surgical or non-surgical approach is better, and if using them might improve healing of those pathologies. The aim was clear and to reach it, we make an electronic search of medical and dental literature. We searched the following electronic databases: PubMed and Embase Ovid. Inclusion and exclusion criteria were used to reach the aim of this review study. We place restriction about language (only those articles that are written on English) and publication date (articles that are not older than 2010 year). We excluded duplicate article. We searched the references of the studies that we included for those review. We searched by hand the reference list of the studies and journals in the fields of endodontics and oral surgery. Every periapical lesion should firstly begin with good performed endodontic treatment. In some cases, there is a need for surgical approach of periapical pathologies because the endodontic treatment is not successful. Some cases might fail because of multipurpose factors such as: foreign body reaction, the size of the periapical lesion, biofilm, oral health and oral hygiene. A surgical approach is an option in cases when periapical lesion is large. Marsupialization might be the adequate option of treatment for those lesions in some cases. In cases with postoperative periapical lesion there is a need for surgical retrograde treatment. The procedure can be performed with hand endodontic instruments to make mechanical treatment of the root canal especially the part that is untreated. The advantages, disadvantages and modalities of treatment of periapical lesions are discussed in this review. According to these review there is no evidence that the first approach leads to better results compared to the second approach. This conclusion is based on electronic research of the literature database and clinical trials. There are several options for treatment to eliminate the clinical problems of periapical lesions but furder research is necessary. This review article is about the benefits of both approaches, and to determinate the best treatment modalities of cases with periapical pathologies, healing and postoperative quality of dental life.