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Healing of peri-apical lesions with calcium hydroxide medicament following apical enlargement: a case study Thai Yeng Dental Update 2024 50:2, 707-709.
With public health orders restricting movement and changes to routine endodontic practice during the COVID-19 pandemic, many patients chose to wait, in the range of 12-18 months, before returning to complete their root canal treatment. This report describes several cases of non-vital and infected teeth that showed positive healing responses from having endodontic treatment using calcium hydroxide paste as an intracanal medicament and an apical enlargement technique to further reduce bacterial numbers. This indicates healing of peri-apical lesions may occur with a longer observation period.
CPD/Clinical Relevance: Endodontic treatment for peri-apical infection may allow a patient time to decide upon treatment options.
Article
Bacteria are essential for the development of apical periodontitis.1·2 Local factors, such as access to nutrients, positive and negative bacterial interactions, the redox potential and the host's defence system, influence the fate of bacteria that have entered the root canal space.3 In the management of apical periodontitis, the main antibacterial phase of endodontic treatment is attributed to chemomechanical instrumentation.4,5,6 Bacteria in areas such as isthmuses, ramifications, deltas, irregularities, and dentinal tubules may be unaffected by root canal treatment procedures.7,8
When root canal treatment is performed adequately, healing of the peri-apical lesion usually occurs, with gradual reduction and resolution of the radiolucency observed on subsequent examination.9,10 If an interappointment dressing is used, calcium hydroxide remains the best medicament available to inhibit the growth of intracanal bacteria before obturation.11 However, studies have shown that complete bacterial eradication is not achievable after chemomechanical debridement, even with the use of an intracanal medicament.11,12 Hence, further approaches need to be considered to maximize root canal disinfection.
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