Endodontic treatment of necrotic teeth with periapical lesion
29/09/2024
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A 31-year-old patient came to my attention due to pain when chewing and swelling in the vestibular area of the left maxillary incisors 2.1-2.2, as well as discoloration on tooth 2.1. His dental history indicated that he had experienced trauma at the age of 10 years.
A cold vitality test and an electric pulp test (DIGITEST III Parkell) were performed on teeth 2.1-2.2, with negative results.
The percussion test was performed, showing increased sensitivity on teeth 2.1-2.2, and circumferential periodontal probing, which appeared to be physiological.
Radiological examination revealed bone loss and a radiolucent area between teeth 2.1 and 2.2. 4-5
Fig. 1
The diagnosis of necrosis in teeth 2.1 and 2.2 was confirmed, and treatment for both teeth was performed in a single session.
Nickel-titanium (NiTi) rotary files with a progressive taper were used to efficiently shape the large apices of tooth 2.1, ensuring effective management while minimizing damage to the dental structure.
Irrigations with 5.25% sodium hypochlorite were activated to improve apical root canal cleaning. 6
The obturation of the root canal was performed using the Warm Vertical Condensation technique.
Bioceramic materials improve root canal treatment in large apices by forming a strong seal, reducing microleakage, and promoting healing. Their biocompatibility and stability make them ideal for better long-term outcomes.7-8-9
Fig. 2
After covering the root canal filling with glass ionomer cement, applied over the gutta-percha and below the level of the amelo-cemental junction, the ready-to-use gel (active ingredient: 35% hydrogen peroxide - Opalescence® Endo) was applied directly into the devitalized tooth. The procedure was repeated 5 days later before the definitive filling with resin composite.
The last photo represents the chromatic control carried out during the removal of the whitener and the filling of the cavity access.
Follow-up checks will be conducted at 3, 6, and 12 months, followed by annual evaluations.
Fig. 3
A reduction in the lesion can be observed at 3 months, confirmed through radiographic evaluation. Follow-up will continue to monitor the healing process and assess the long-term success of the treatment.
Fig. 4
About the author:
Specialization in Oral Surgery at the Vita-Salute San Raffaele University, Milan. Post Graduate: Reconstructive surgery of periodontal and peri-implant tissues, course director Prof. Massimo de Sanctis, periodontology department of Vita-Salute San Raffaele University. Collaboration with Dr. Fabio Gorni and Partners at Milano Face Institute and with Professor Tiziano Testori at the Lake Como Institute.
Conclusions
The dental pulp can respond to traumatic injuries with serious outcomes like pulp necrosis and root canal infections, potentially leading to apical periodontitis. A personalized approach is crucial for large apices, focusing on the tooth's anatomy and surrounding tissue to ensure effective cleaning while minimizing risks.
Success in endodontic treatment depends on the shape and cleanliness of the root canal, as proper shaping allows effective penetration of irrigants. Efficient shaping with appropriate instruments is essential for thorough cleaning and disinfection.
9
Bibliography
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