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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 2  »  Endodontic treatment of teeth associated with a large periapical lesion
Endodontic treatment of teeth associated with a large periapical lesion
Report.



A 12-year-old male patient was referred to the Department of Endodontics in the Dental Faculty of Ankara University for treatment of mandibular left and right central and lateral incisor teeth. The patient stated that he was involved in a bicycle accident when he was 7 years old and had not seen a dentist, since he had no complaint. The patient’s history did not reveal whether the teeth were luxated, intruded or extruded. Until the age of 12, he sometimes had mild pain but no swelling in the mandibular anterior region. Clinical examination of soft tissues showed no signs of scarring or fistulae. None of these teeth were discoloured. Both the central and lateral incisors were slightly sensitive to percussion and palpation, but there was no mobility. Mandibular right and left lateral and right central incisor teeth failed to respond to electric pulp testing, whereas the mandibular left lateral incisor responded within normal limits.

Preoperative radiograph showing mandibular central and lateral incisors with large periapical lesion
Figure 1. Preoperative radiograph showing mandibular central and lateral incisors with large periapical lesion.

Follow-up 3 months after completion of endodontic treatment. Periapical radiograph shows healing of the periapical lesion
Figure 2. Follow-up 3 months after completion of endodontic treatment. Periapical radiograph shows healing of the periapical lesion.

Radiograph taken immediately after endodontic treatment
Figure 3. Radiograph taken immediately after endodontic treatment.

Periapical radiographs demonstrated a large radiolucent lesion around the apices of the mandibular incisors with a well-defined margin around the apex of the mandibular left lateral incisor (Fig. 1). This tooth gave a normal response to electric pulp tests.
Despite this positive sensitivity test, root canal treatment was initiated on all mandibular incisors. The mandibular left lateral incisor was anaesthetized and rubber dam applied. Following access cavity preparation, vital pulp tissue was extirpated and the working length was estimated as being 1 mm short of the radiographic apex. The canal was prepared with size 15–40 K-files using a step-back technique. The other three incisors that had necrotic pulp tissue were accessed and size 15 K-files were passed beyond the apical foramen. Copious, mucopurulent fluid was drained through the root canals. When drainage ceased, the canals were prepared 1 mm short of the radiographic apices with size 15–40 K-files using a step-back technique. Canals were irrigated copiously with 0.2% chlorhexidine gluconate. Calcium hydroxide powder (Merck, Darmstadt, Germany) was mixed with sterile

Radiograph taken at follow-up examination 6 months after completion of endodontic treatment. Healing of periapical lesion is evident
Figure 1. Radiograph taken at follow-up examination 6 months after completion of endodontic treatment. Healing of periapical lesion is evident.

Recall radiograph taken 1 year after completion of treatment
Figure 2. Recall radiograph taken 1 year after completion of treatment.

Radiographs showed that the radiolucent area was absent and that trabecular bone was forming. Clinical examination showed no sensitivity to percussion or palpation and the soft tissues were healthy. The next two radiographs at 6 months (Fig. 4) and 1 year (Fig. 5), revealed further bony healing.