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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
Discussion - References.

The response to trauma can be varied. Some pulps remain apparently normal with no adverse effects, whereas others become necrotic. Necrotic pulps provide a good nutritional supply for pathogenic bacteria, which must be present for the development of a periapical lesion. In some cases periapical inflammation begins before the pulp is totally necrotic, and it is possible to have periapical radiolucency despite the presence of some vital tissue remaining in the root canal (Sundqvist 1976, Khayat et al . 1988). In the present case there was vital pulp tissue in the mandibular left lateral incisor despite the fact that there was a radiolucent lesion beyond the apex. Since this tooth was slightly sensitive to percussion and palpation, root canal treatment was initiated. The preoperative radiographic appearance of the mandibular left lateral incisor suggested the possibility of a second root. However, a further view at a different angle confirmed that the tooth had only one root.
Root canal treatment is based primarily on the removal of microbial infection from the complex root canal system. Irrigants aid in reducing the microbial flora of infected canals and if a tissue-solvent solution is used, can help to dissolve the necrotic tissue. Irrigating the canal system with chlorhexidine gluconate is an alternative to other irrigants (Jeansonne & White 1994, Ye ; ilsoy et al . 1995). Delany et al . (1982) tested chlorhexidine gluconate (0.2%) in a laboratory study using extracted teeth, and reported that it could be effective as an antibacterial agent when used as an endodontic irrigant. Kuruvilla & Kamath (1998) compared the antimicrobial efficacy of 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate. They reported that chlorhexidine gluconate was as effective, or possibly more effective in its antimicrobial activity than sodium hypochlorite. It has also been shown that chlorhexidinetreated root canals may be less susceptible to reinfection, which might be a clear advantage in the control of coronal leakage (Heling et al . 1992). However, chlorhexidine has none of the tissue-dissolving activity of sodium hypochlorite.
A calcium hydroxide-based paste was used as an antibacterial dressing and a calcium hydroxide containing sealer was used for permanent root canal obturation. Sjögren et al . (1991) found that the use of calcium hydroxide as a dressing for 1 week efficiently eliminates bacteria in the root canals. It has also been reported that treatment with calcium hydroxide resulted in a high frequency of periapical healing and some lesions, especially in young patients, were reduced or had completely disappeared only 1 or 3 months after treatment (Çalı ; kan & < en 1996, Çalı ; kan & Türkün 1997). Similarly, in the present case periapical healing appeared to be occurring 3 months after root canal obturation, and continued during the 12-month observation period. Radiographic signs such as density change within the lesion, trabecular reformation and lamina dura formation, especially around the apex of tooth 32, confirmed healing, particular when associated with the clinical finding that the teeth were asymptomatic and the soft tissues were healthy. It is difficult to determine with routine radiographic examination whether there is complete healing or whether decompression of the lesion reduced erosion of the cortical plates. More sophisticated techniques such as tomography and magnetic resonance may provide better intrabony imaging.


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