Stumbling upon Palatogingival Groove: A Case Report

Palatogingival grooves (PGG) are developmental malformations infamous for precipitating endodontic-periodontal lesions. Pertaining to their discreet occurrence, variation in groove depth and funnel like shape, adherence of plaque and calculus is apparent thereby jeopardizing the periodontium and pulp. A case of palatogingival groove in maxillary left lateral incisor was diagnosed and managed with endodontic treatment followed by open flap debridement to seal the groove with biodentine and fill the defect with bone graft. On follow up, the periapical lesion and the periodontal pocket were successfully resolved.

Healing of periapical lesion after root canal treatment: A case report

Most of periapical lesions usually result from microbial infection with oral microorganisms originating from the degenerated pulp tissue. These lesions are commonly painless and incidentally found on routine radiographic examinations. Treating these cases using non-surgical root canal is the fruit of the innovative techniques, tools and root medicaments as well as the tendency toward minimally invasive treatment. The healing process of the infected area is conditioned by a proper diagnosis, a treatment that follows good clinical practice under aseptic environment including cleaning, shaping and root filing. The aim of the present clinical case report was to report non-surgical healing of a periapical lesion of endodontic origin associated with maxillary left central incisor, observed over a period of 2 years.

Factors Affecting the Outcome of Periapical Surgery; a Prospective Longitudinal Clinical Study

Wound healing following periapical surgery is influenced by age, gender, smoking, periapical lesion size, type of root-end filling, method of root-end cavity preparation and the use of microsurgical or conventional technique. This study aimed to evaluate the influence of various preoperative factors such as age, gender, smoking, preoperative pain, and preoperative periapical lesion size on the outcome of surgical endodontic treatment. A thorough history, examination, and investigation were performed to establish patient age, gender, smoking status, periapical lesion size, and the presence of preoperative pain. Forty patients aged between 15–57 years presented with persistent chronic apical periodontitis of single-rooted anterior teeth after conventional re-root canal treatment were enrolled for periapical surgery. Following periapical surgery, all patients were recalled for evaluation of periapical healing after 12 months based on clinical and periapical X-ray examination due to inaccessibility of an advanced imaging system (CBCT). Chi-squared and Fisher’s exact test were applied, which revealed a statistically significant association of periapical healing with age (p = 0.025), smoking (p = 0.029), and lesion size (p < 0.001). Although, the success of periapical healing was higher in males 78.6% (22/28) compared to females 58.3% (7/12) however, no statistically significant relationship was found between gender and healing (p = 0.254). Patient age, smoking status, and size of the preoperative lesion had a strong influence on periapical healing after surgical endodontic treatment.

Clinical Factors Affecting the Results of Regenerative Endodontic Procedure

This study retrospectively analyzed the effect of clinical factors on the outcomes of REP(regenerative endodontic procedure). Patients who received the REP using triple antibiotic paste due to trauma or fracture of dens evaginatus from February, 2011 to January, 2020 were included in the study. Finally, 57 teeth in 54 patients were selected. Investigated clinical factors were as follows: intentional bleeding, etiology, and root development stage. Treatment outcomes evaluated were as follows: improvement of subjective symptoms, changes in the periapical lesion, and the amounts of root development after REP. To compensate for differences in angulation and position between repeated radiographic examinations, images were aligned by Turboreg plugin. To evaluate the amounts of root development, apical diameter, root area, and root length were measured by ImageJ software. Among the aforementioned factors, intentional bleeding had no significant effect on treatment results. Regarding the etiology, the increase in the root area and the root length was significantly less in trauma cases than in dens evaginatus fracture cases. Considering root development stage, more immature teeth presented more increase in the root area.

Resolution of a large periapical lesion in an immature maxillary lateral incisor with the aid of triple antibiotic paste

Apexification procedures are frequently performed on immature permanent teeth with incomplete root formation, open apices and necrotic pulp status with or without periapical lesions in order to induce a calcific barrier prior to root canal therapy. The elimination and control of infection in the root canal space is critical to the success of these procedures. A healthy 21-year old male presented with pulpal necrosis, a large periapical lesion, incomplete root formation and an open apex on a maxillary right lateral incisor. Triple antibiotic paste was used to achieve antimicrobial control after traditional calcium hydroxide paste medicament failed to resolve the symptoms. Obturation was achieved using MTA and the conventional apexification technique. Excellent healing of the large periapical lesion was achieved without surgical intervention and the 4-year follow-up CBCT demonstrated complete bone fill of the lesion. Clinicians should be aware that alternative antimicrobial medicaments, such as triple antibiotic paste, may be beneficial in situations where conventional medicaments prove unsuccessful. The use of triple antibiotic paste may result in sufficient healing of the periapical lesion to justify placement of an MTA apical barrier without the need for surgical intervention

Introduction of nickel titanium rotary instruments to undergraduate students

Many studies address the quality of root canal treatments, but few refer to endodontics using rotatory techniques performed by novice operators. This study evaluated the performance of undergraduates in their first contact with rotary root canal instrumentation concerning the findings of the final periapical radiograph, and the post endodontic treatment pain. A longitudinal observational study was performed on periapical radiographs of 491 teeth from 450 patients submitted to root canal treatment by undergraduate students from 2015 to 2018. The analysis of the length of root canal filling followed the criteria: (i) acceptable, if periapical radiograph presents root filling ending 0 - 1 mm short of radiographic apex; (ii) over, if periapical radiograph presents root filling ending beyond the radiographic apex; and (iii) under, if periapical radiograph presents root filling ending > 1 mm short of radiographic apex. Evaluation of postendodontic treatment pain was categorized into either absence or presence of pain. Adequate length root canal filling was observed in 65.9% of the cases (324 teeth). Periapical lesions presence and dimensions did not interfere to the obturation quality. Statistical relation was found between the pulp condition and postendodontic treatment pain. The presence of pain was observed in 4.7% of the vital teeth and 0.3% of non-vital teeth. The presence of periapical lesion did not influence postoperative pain. Adequate length root canal filling was observed in most cases and NitTi rotary instrumentation had applicability in undergraduate programs, even with novice operators. Besides that, pulp condition had an effect on postendodontic pain.

A comparative clinical study of bioceramic and calcium hydroxide based root canal sealer in the treatment of non-vital permanent tooth with periapical lesion

Introduction: The use of Bioceramic sealer in the obduration of the root canal system has been expected by many of the previous studies. However, the clinical outcome has not yet been established. Objective: To compare the effectiveness of bioceramic and calcium hydroxide based root canal sealer in treatment of non-vital permanent teeth with periapical lesion (Periapical periodontitis). Materials and Methods: A total 100 mature permanent anterior teeth were selected after clinical and radiological examination which had non-vital pulp with periapical lesion. Clinically pulp vitality test, palpation and percussion test was performed maintaining standard procedure. Following cavity preparation and biomechanical preparation, each canal was obturated either with bioceramic (Endosequence BC) or calcium hydroxide based sealer (Sealapex, Kerr). All participants were evaluated immediately after obturation, at 3 and 6 months for the assessment of change in size of periapical lesion, condition of periodontal ligament space, lamina dura and incidence of post-operative pain, swelling. Statistical analysis was performed using Chi- square(X2) test and t-test. A value of p<0.05 was considered as statistically significant. Results: Bioceramic was more effective in reducing the lesion size than that of calcium hydroxide. At 6 months, the mean lesion size was reduced from 3.52±0.7 to 1.30±0.462 mm in Bioceramics and from 3.48±1.07 to 1.58± 0.498 mm in sealapex treated teeth.. Furthermore, 98% of bioceramic treated teeth and 94% of sealapex treated teeth showed absence of swelling. The differences between two groups were statistically significant (p<0.05). Conclusion: In this short period of study, Bioceramics based sealer seems to be more effective than calcium hydroxide based sealer in repair of periapical lesions of the nonvital teeth. Update Dent. Coll. j: 2021; 11(2): 26-31