Therapeutics of periapical inflammatory lesions of endodontic origin
Introduction :
Conservative treatment of a tooth affected by a periapical lesion is an intervention allowing the definitive, surgical and medicinal removal of the infectious and necrotic focus; it allows the healing of the desmodont and the alveolar bone, as well as the cementum closure of the apex.
-Goals:
The goal of treating a dead tooth is:
-To remove necrotic tissue and substances released by damaged tissues in the root canal
-to remove the infection
-to hermetically close the channel to bacteria
-save a functional tooth in a healthy periodontium.
Apical periodontitis that is refractory to conservative endodontic treatment can be cured by surgical-endodontic treatment involving curettage of the apical granulation tissue.
Treatment of chronic periapical periodontitis:
Treatment of granulomatous periapical periodontitis:
Two attitudes are possible: either conservative treatment or surgical treatment.
A)-conservative treatment:
Endodontic treatment: initially, and as a general rule, granulomas are likely to disappear through endodontic treatment (trimming, disinfection and root canal filling).
In a second step there is monitoring of the granulomatous lesion:
– clinical monitoring: because a warming in the form of a phoenix abscess may appear in the days following canal disinfection. Drainage must therefore be carried out and general treatment is prescribed.
Radiological monitoring: after at least 6 to 12 months, the disappearance of the periapical radiolucent lesion is frequent with reconstitution of the periapical alveolar framework of the neocementum replacing the resorbed hard tissues; the ligament space resumes its usual radiographic appearance.
B)-surgical treatment:
Indications: Canals inaccessible via the coronal route, Perforated roots, External resorptions, calcification of root anchorage, impossible to dismantle.
-contraindications: General condition of the patient Incompetence of the practitioner Anatomical particularities
Treatment of chronic cystic periapical periodontitis :
The treatment is the same as for granuloma, namely endodontic treatment and surgical treatment. Another treatment can also be considered:
Enucleation.
Therapeutics of periapical inflammatory lesions of endodontic origin
Treatment of chronic periapical periodontitis with condensing osteitis : caused by chronic pulpitis inflammation, and maintained by low but long-term irritation (poly microtrauma, bruxism). Therefore, simple endodontic treatment and removal of the exogenous causal factor can lead to healing of this lesion.
6-12 months radio check, the desmodontal space returns to normal appearance
Treatment of chronic periapical periodontitis with fistula : endodontic treatment remains the treatment of choice, the fistula will regress and disappear with healing after a few months.
Therapeutics of periapical inflammatory lesions of endodontic origin
Treatment of acute periapical periodontitis:
Treatment of primary periapical periodontitis:
If acute primary apical periodontitis is a complication of an endodontic infection: treatment consists of creating an access cavity, root canal trimming and disinfecting the canals as much as possible.
Calcium hydroxide medication is started, and the coronary cavity is sealed with a temporary filling.
The tooth is then placed under occlusion.
If simple apical periodontitis is a post-operative consequence of conservative treatment or intra-ligamentous anesthesia, the tooth is placed under occlusion.
It is then important to check for the absence of contact during lateral movements.
Treatment of primary acute apical abscess and Phoenix abscess:
The only way to relieve the patient is therefore to allow the evacuation of this pus:
Emergency treatment:
Intracanal route : a file is placed in the canal and used beyond the foramen. The pus can then gradually drain back up into the canal; abundant irrigation is continued as long as a flow is perceptible; the tooth is left open for 48 hours.
Therapeutics of periapical inflammatory lesions of endodontic origin
By incision : if intracanal drainage cannot be obtained and a gingival abscess is present and collected, drainage is obtained by incision of the abscess; after anesthesia of the mucous membranes, a clean incision up to bone contact is made with a number 11 scalpel blade; the incision allows drainage. In this case, the tooth can be closed on the same day as the draining incision.
If no abscess is present (or not collected) and intraductal drainage cannot be obtained:
The tooth is left open for 24 to 48 hours.
A prescription of antibiotics is recommended (amoxicillin and metronidazole) for 7 days and mouthwashes are also prescribed to cause the abscess to collect.
The patient must be seen again as soon as possible to try to obtain drainage again and close the tooth.
Routine treatment:
The endodontic system is cleaned and disinfected. An intracanal medication based on calcium hydroxide is put in place. The tooth is temporarily filled and placed in sub-occlusion.
The endodontic treatment is carried out during a 3rd session.
Conclusion :
Treatment of periapical lesions is a very common procedure. However, since it involves the body’s deep reactions, it must be carried out with great caution because it can cause very serious infectious complications.
Among all the therapeutic procedures currently proposed, it seems that the evolution is increasingly towards more biological than mechanical formulas, towards more specific than blind disinfection and therefore towards non-surgical medical therapy.
Sensitive teeth react to hot, cold or sweet.
Sensitive teeth react to hot, cold or sweet.
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Impacted teeth can cause pain and require intervention.
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Fractured teeth can be repaired with modern techniques.
A balanced diet promotes healthy teeth and gums.