The Dilemma Of Management Of Cystic Lesions; An Uncertain Way Forward: A Case Report.

Periapical diseases ranges from mild granulomatous lesions to large cystic ones, with the treatments corresponding to their respective pre-operative diagnoses. However, the determination of cause of periapical radiolucency is impossible on pre-operative clinical and radiographic examinations. We present a case highlighting the difficulties encountered in treating a periapical cyst using the current evidence in literature. It demonstrates the uncertainty involved in treating such lesions, owing to the impossible nature of determining the histopathological nature of the cyst, i.e., being either true cysts or pocket cysts. This case includes orthograde re-treatment; decompression of the cystic lesion, followed by peri-apical surgery of two teeth over a course of three years; and the uncertain outcomes encountered after each phase of the treatment.

Factors associated with postoperative signs and symptoms in teeth with periapical lesion: a longitudinal study.

This study aimed to evaluate the association of the variables age, gender, arch position, tooth length, root canal amplitude, and periapical lesion size with the occurrence of postoperative signs and symptoms (pain, tenderness, and edema) and the use of postoperative analgesics following root canal treatment with foraminal enlargement in single-rooted teeth with apical periodontitis. This prospective longitudinal study included 105 patients requiring root canal treatment of maxillary or mandibular single-rooted teeth with periapical lesion. After root canal treatment in a single session, pain intensity and tenderness were recorded daily for 7 days and on days 14 and 30. Edema was evaluated by two independent evaluators within 48 h, 72 h, and 7 days after treatment. Ordinal and logistic regressions were performed (p < 0.05). Female gender (beta = 1.02; p < 0.01), mandibular teeth (beta = 25.50; p < 0.01), medium root canal amplitude (beta = 0.93; p = 0.03), and edema (beta = 1.88; p < 0.01) were associated with increased postoperative pain and tenderness, while the use of analgesics (beta = -1.82; p < 0.01) and time in days (beta = -0.23; p < 0.01) were associated with a decrease in these signs and symptoms. Edema was considered a risk factor for analgesic requirement (Odds Ratio [OR] = 61.46; p < 0.01). Factors such as gender, arch position, and root canal amplitude were associated with postoperative signs and symptoms. The use of analgesics was more required in edema and was associated with decreased pain.

Lesiones perirradiculares persistentes: revisión narrativa / Persistent periradicular lesions: a narrative review

La persistencia de lesiones perirradiculares luego del tra- tamiento endodóntico es un problema que requiere del clínico un conocimiento cabal de la histofisiología y de la histopato- logía del sistema de conductos radiculares del tejido pulpar y de los tejidos perirradiculares (periodonto y hueso); además de considerar siempre la posible existencia de enfermedades sistémicas que también pueden actuar como factores de in- fluencia. La presencia de bacterias remanentes a posteriori del tratamiento es considerada como una de las causas principales y más frecuentes para la perpetuación de las lesiones perirra- diculares. Sin embargo, existen otros factores causales, como la existencia de conductos laterales o accesorios infectados y no tratados, la reabsorción dentinaria interna, intercomunica- ciones, cul-de-sacs o istmos; que representan áreas de difícil acceso durante la instrumentación e irrigación. Cuando la cau- sa original se localiza en la zona perirradicular, como en los casos de actinomicosis, reacciones a cuerpo extraño, cristales de colesterol (CRCo) y granulomas o quistes con alto conte- nido de CRCo, la indicación más adecuada es el retratamiento y la cirugía periapical como complemento (AU)

The persistence of periradicular lesions after endodontic treatment is a problem that requires the doctor to have a thor- ough knowledge of the histophysiology and histopathology of the root canal system, the pulp tissue and periradicular tis- sues (periodontium and bone); as well as always considering the possible existence of systemic alterations that can also be influencing factors. Persisting bacteria within the root canal system after treatment is one of the major and most frequent causes for the perpetuation of periradicular lesions. Howev- er, there are other possible causal factors such as the exist- ence of untreated lateral or accessory canals, internal dentin resorption, intercommunications, cul-de-sacs or isthmuses; areas that represent a difficulty in access during instrumen- tation and irrigation. If the original cause is located in the periradicular area, in cases like actinomycosis, foreign-body reactions, cholesterol crystals (CRCo) and granulomas or cysts with high content of CRCo, retreatment coupled with periapical surgery is the best approach to treatment (AU)

Endodontic Microsurgery of Posterior Teeth with the Assistance of Dynamic Navigation Technology: A Report of Three Cases.

When nonsurgical endodontic treatment fails, surgical treatment is an alternative approach for treating periapical disease. However, endodontic microsurgery (EMS), particularly in anatomically challenging areas, such as the posterior teeth, is a skill-sensitive task that can present a unique set of challenges for the surgeon. In recent years, digital guidance technology has been applied more frequently in dentistry. Dynamic navigation (DN) is a pioneering technology that uses an optical positioning device controlled by a sophisticated computerized interface and dedicated three-dimensional surgical path planning software program. This technique has also recently been introduced in the field of EMS to improve accuracy and avoid related complications. This case report presents a novel approach to DN-assisted EMS and describes its application in posterior teeth. After undergoing DN-assisted EMS, all patients were completely asymptomatic at the follow-up visit. Radiographic examinations performed immediately and 3-9 months after EMS revealed that the root resection was performed accurately without complications. The DN technique has been proven to be a feasible, predictable, and time-saving system for assisting EMS in cases requiring treatment in anatomically challenging areas, such as in the posterior teeth.

Evaluation of YouTube videos for patients' education on periradicular surgery.

The aim of this study was to evaluate the content of periradicular surgery-related YouTube videos available for patients' education. YouTube search was made for videos related to periradicular surgery using specific terms. After exclusions, 42 videos were selected, viewed and assessed by two independent observers. The videos were assessed in terms of duration, days since upload, country of upload, number of views, likes and dislikes, authorship source, viewing rate and interaction index. To grade the content of videos about periradicular surgery, a usefulness score was created with 10 elements based mainly on the American Association of Endodontists guidelines. Each element was given a score of 0 or 1. SPSS software (SPSS Inc, Chicago, IL, USA) was used to analyze data at a 95% confidence level. An inter-evaluator reliability analysis for the scoring system was performed using the Kappa statistic. The videos received an average of 35103.9 views (range: 9-652378) with an average duration of 338.71 seconds (range: 42-2081), respectively. Most videos were provided by individuals (57%). Half of the videos were posted by authors from the United States. The inter-evaluator reliability for usefulness scoring was 94.5%. No video covered the 10 scoring elements completely, presenting very low usefulness scores (mean: 3.2; range: 1-7). The most discussed elements were supporting media (100%) and steps of the procedure (90.5%) followed by indications and contraindications (45.2%) and symptoms (31%). None of the included videos discussed the procedure's cost or prognosis. In terms of usefulness score, no significant difference was detected between different sources of upload (chi-square test, P > 0.05). Information on periradicular surgery in YouTube videos is not comprehensive and patients should not rely on YouTube as the only source of information. Dental professionals should enrich the content of YouTube with good quality videos by providing full and evidence-based information that will positively affect patients' attitudes and satisfaction.

Is periapical surgery follow-up with only two-dimensional radiographs reliable? A retrospective cohort type sensitivity study / ¿El seguimiento de la cirugía periapical se realiza únicamente con radiografías bidimensionales confiable? Un estudio retrospectivo de sensibilidad de tipo cohorte

Background: Two-dimensional (2D) radiographic techniques are commonly used for assessing lesion prognosisafter endodontic surgery. The present retrospective cohort study analyzes the sensitivity and ability of differentradiographic techniques in obtaining area and volume measurements of periapical lesions.Material and Methods: Preoperative and follow-up (6-48 months) periapical and panoramic radiographs (indextest) and cone-beam computed tomography (CBCT) images (reference standard) were selected from an endodonticmicrosurgery database. Sensitivity was analyzed independently by two examiners. The areas of the 2D radio-graphic images and CBCT volumes were studied using Itk-Snap software and Romexis viewer.Results: The sample comprised 105 patients and 105 teeth, with a mean follow-up of 21 months (range 6-48). Preop-eratively, CBCT detected all the periapical areas, periapical radiography detected 67, and panoramic radiographydetected 60. Postoperatively, of the 52 cases in which CBCT detected remains of the periapical area, periapical ra-diography detected 22, and panoramic radiography detected 17. The measurements of the areas obtained by the 2Dmethods, and the volumes obtained by CBCT, had to be transformed into linear measures for comparison purpos-es. The measurements were found to be significantly different in both the preoperative and the follow-up images. Conclusions: Periapical radiography showed greater sensitivity than panoramic radiography, both preoperatively andat follow-up. The lesions measured with CBCT were larger, with significant differences than as evidenced by theperiapical and panoramic radiographs.(AU)

Conservative approach in a patient with multiple radiolucent periapical lesions using endodontics and surgery

Case report of a 43- year old male patient with multiple periapical radiolucent lesions caused by endodontic failure in teeth supporting a metalloceramic prosthetic rehabilitation, who came to the clinic to assess the possibility of keeping his teeth. After clinical and radiological examination with periapical x-rays and cone beam computer tomography (CBCT), we decided to use a combined endodontic-surgical approach. Clinical evolution was favourable, and the radiographic and tomographic controls showed complete healing of the periapical radiolucent lesions. Endodontic retreatment combined with periapical microsurgery are effective tools for conservative treatment of teeth with periapical lesions caused by endodontic failures. (AU)

Radiographic Assessment of Bone Healing Using Cone-beam Computed Tomographic Scans 1 and 5 Years after Apical Surgery.

INTRODUCTION: The objective of this long-term study was to evaluate radiographic healing in cone-beam computed tomographic (CBCT) scans taken 1 and 5 years after apical surgery. METHODS: In the context of a prospective clinical study, postsurgical CBCT scans were taken 1 and 5 years after apical surgery. Three calibrated observers independently assessed buccolingual CBCT images oriented along the longitudinal axis of the treated roots. Radiographic periapical healing was categorized as "fully, partially, or not healed" for each of the following study parameters: the resection plane, the cortical plate, the apical area, and the overall bone healing. The analysis included the interobserver agreement (Fleiss kappa values), the comparison of 5- and 1-year ratings, and the changes of healing categories from 1-5 years (McNemar-Bowker tests). Data were analyzed statistically for the detection of significant differences. RESULTS: CBCT images of 41 teeth (in 41 patients) with 47 treated roots were evaluated. At 5 years, all studied parameters had higher rates of fully healed cases compared with the rate at 1 year. The resection plane and apical area parameters each were judged in 72.3% as fully healed at 5 years, whereas the cortical plate and overall bone healing parameters showed clearly lower fully healed rates (42.6% and 38.3%, respectively). Fully healed cases at 1 year remained so at 5 years in 87.5%-100% depending on the study parameter. CONCLUSIONS: This 5-year CBCT follow-up study of apical surgery showed a marked improvement of radiographic healing from 1-5 years but to a varying degree regarding the different study parameters. Although new hard tissue formation at the resection plane and within the former apical defect was advanced in most cases at 5 years, the reestablishment of the cortical bone plate clearly lagged behind.

Tratamiento de la periodontitis apical persistente: cirugía periapical versus retratamiento endodóncico no quirúrgico / Treatment of persistent apical periodontitis: periapical surgery versus nonsurgical retreatment

Se denomina Periodontitis Apical Crónica Persistente (PACP) al proceso inflamatorio periapical que se desarrolla o persiste tras el tratamiento de conductos. Las opciones terapéuticas en el tratamiento de la PACP, cuando el diente puede conservarse, son el retratamiento de conductos por vía ortógrada o la cirugía periapical, e incluso puede ser necesaria una combinación de ambos tratamientos. El objetivo de este trabajo ha sido buscar respuesta a la siguiente pregunta: ¿En un paciente con un diente al que se le ha realizado tratamiento endodóncico que ha fracasado y sufre periodontitis apical crónica persistente (PACP), se obtiene mayor tasa de curación del proceso inflamatorio periapical mediante el retratamiento por vía ortógrada o con la cirugía periapical? La búsqueda realizada proporcionó 7 artículos: 3 ensayos clínicos aleatorios, 3 revisiones sistemáticas y 1 revisión no sistemática. La evidencia científica disponible sugiere que no existen diferencias significativas en las tasas de éxito a largo plazo del retratamiento endodóncico por vía ortógrada y la cirugía periapical, en casos de periodontitis apical crónica persistente tras el tratamiento endodóncico. El retratamiento endodóncico por vía ortógrada obtiene mejores resultados a largo plazo, mientras que la cirugía periapical tiene una tasa de curación más rápida. El retratamiento ortógrado conlleva un mejor postoperatorio para el paciente, mientras que la cirugía periapical implica una mayor necesidad de trata-miento analgésico y antiinflamatorio en los primeros 7 días

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Periapical Microsurgery: A 4-dimensional Analysis of Healing Patterns.

INTRODUCTION: Currently, the success of periapical microsurgery is determined by the restoration of the lamina dura and the elimination of symptoms. However, inadequate site preservation may prevent later implant placement. Although not possible before, the advent of cone-beam computed tomographic imaging and computer-aided registration allows for indirect and accurate 3-dimensional analysis of the surgical site over time. This study analyzed the volumetric healing pattern of the buccal plate after periapical microsurgery, with a specific focus on the buccolingual thickness of bone and the regression of the surface contour of the cortical plate. METHODS: Thirty-seven patients were scheduled for follow-up at least 1 year after periapical microsurgery (median = 25 months, total range = 12-31 months). Volumetric healing was analyzed by converting preoperative and postoperative cone-beam computed tomographic images into digital 3-dimensional models. The models were then registered to be able to analyze the changes in volume over time. Analysis was completed using Geomagic software (3D Systems, Rock Hill, SC), which allowed for registration of the volumes, calculation of volume change, and calculation of the margin of error. RESULTS: Twelve cases qualified for volumetric analysis. The median volumetric reduction of the cortical plate was -24.9 mm3 (interquartile range = -8.94 to -67 mm3), with an average linear error of 0.7 mm. This corresponded to an average loss in buccolingual dimension of 0.1-0.25 mm. Regression of the cortical plate was within the margin of error in all cases. CONCLUSIONS: After periapical microsurgery, and in the absence of grafting materials or membranes, healing occurs with little to no regression of the buccal cortical plate.

Periapical Healing in Single-visit Endodontics under General Anesthesia in Special Needs Patients.

INTRODUCTION: The aim of this study was to determine the prognostic factors of periapical healing of teeth after single-visit nonsurgical endodontic treatment under general anesthesia in special needs patients. METHODS: This retrospective study collected 448 teeth from 241 patients (mean age = 27.4 years, standard deviation = 13.9 years). A total of 271 teeth (60.5%) with clinical and radiographic follow-up records longer than 12 months (mean [standard deviation] = 56.1 [27.9]) were included in the outcome analysis. Demographic, systemic, and dental information about the cases were compared between the healed and nonhealed groups using the Pearson chi-square test. Factors contributing to periapical healing were determined with multivariate logistic regression analysis. RESULTS: Complete periapical healing without clinical signs was observed in 221 teeth (81.5%), uncertain healing with decreased size of the periapical lesion was shown in 43 teeth (15.9%), and no reduction in lesion size was observed in 7 cases (2.6%). In the multivariate analysis, diet type, oral hygiene maintenance, pulp vitality, and root filling length were detected as contributing factors for complete resolution of periapical lesions (P < .05). CONCLUSIONS: Successful outcomes of single-visit endodontic treatment under general anesthesia were shown in special needs patients. The prognoses were influenced by the clinical circumstances of the patients and the preoperative conditions of their teeth.

Aluminum Chloride versus Electrocauterization in Periapical Surgery: A Randomized Controlled Trial.

INTRODUCTION: The aim of this study was to evaluate the efficacy of 2 hemostatic agents in periapical surgery and its relationship with patient- and tooth-dependent variables. METHODS: A prospective study was designed with 2 randomized parallel groups established according to the hemostatic agent used: aluminum chloride or electrocauterization. The surgeon and 2 independent blinded observers examined the initial and final bleeding and recorded it as 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding), or 2 (complete hemorrhage control). The following patient- and tooth-dependent variables were collected: sex, age, smoking habit, plaque index, and position. RESULTS: Sixty patients with a periapical lesion in the esthetic zone were enrolled in this study and divided into 2 groups of 30 patients. In the aluminum chloride group, complete hemorrhage control was achieved in 24 patients, and in the electrocauterization group, it was achieved in 18 patients (P < .05). A relationship between sex and the effectiveness of hemostasis was found; a female patient increases the possibility of achieving complete hemorrhage control. CONCLUSIONS: Hemorrhage control was better in the aluminum chloride group than in the electrocauterization group as well as in female patients compared with male patients.

Influence of Hemostatic Agents in the Prognosis of Periapical Surgery: A Randomized Study of Epinephrine versus Aluminum Chloride.

INTRODUCTION: Several variables have been associated with a better prognosis of periapical surgery. The aim of this study was to evaluate the influence of 2 hemostatic agents on the prognosis of periapical surgery at 12 months. METHODS: A prospective study was designed with 2 randomized parallel groups established depending on the hemostatic agent used: epinephrine or aluminum chloride. The analysis of the hemorrhage control was recorded as 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding persisted after application of the material), or 2 (complete hemorrhage control). At 12 months, periapical lesion healing was determined clinically and radiologically as success, improvement, or failure. RESULTS: Ninety-five patients (67 women and 28 men) with periapical lesions involving a single tooth were enrolled in this study; in 45 teeth, epinephrine was used and in 50 teeth aluminum chloride. In the epinephrine group, 28 teeth were classified as successes, 10 as improvements, and 7 as failures. In the aluminum chloride group, 34 teeth were classified as successes, 11 as improvements, and 5 as failures. No statistically significant difference was found. CONCLUSIONS: The present study found no association between the use of epinephrine or aluminum chloride as hemostatic agents on the prognosis of periapical surgery. The efficacy of hemostatic agents at the time of surgery showed no relationship with the healing outcome.

Clinician-centered Outcomes Assessment of Retreatment and Endodontic Microsurgery Using Cone-beam Computed Tomographic Volumetric Analysis.

INTRODUCTION: Outcomes assessment of retreatment and endodontic microsurgery (EMS) are traditionally based on clinical findings and radiographs. The purpose of this study was to assess the volumetric change of periapical radiolucencies (PARLs) by cone-beam computed tomographic (CBCT)-based analysis in retreatment and EMS cases. METHODS: For 68 retreatment and 57 EMS cases, preoperative and recall clinical data, periapical (PA) radiographs, and CBCT imaging were retrospectively obtained. Specialized software was used by 2 board-certified endodontists for volumetric analysis of PARLs. For EMS and retreatment, clinical outcomes were determined by combining clinical data with CBCT-generated volumetric analysis (PA radiographs not used). Additionally, comparisons of percent volume reduction for EMS and retreatment were performed. Examiner interpretations of outcomes assessment using PA radiography and CBCT imaging were compared. RESULTS: In teeth with or without a preoperative PARL, EMS resulted in a statistically significant difference in complete healing (49/57 [86.0%]) versus retreatment (28/68 [41.2%], P < .0001). EMS resulted in a statistically significant difference in combined complete healing and reductive healing (54/57 [94.7%]) versus retreatment (56/68 [82.4%], P < .05). Of 46 recalls in which CBCT imaging detected a PARL, PA radiography detected 30 (a 35% false-negative rate). Of the 79 recall studies in which CBCT imaging did not detect a PARL, PA radiography did detect PARL in 13 (a 16.5% false-positive rate). CONCLUSIONS: In this CBCT and clinical data-based outcomes assessment, EMS resulted in a greater mean volumetric reduction and a higher healing rate compared with retreatment. Postoperative CBCT imaging is more sensitive and specific than PA radiography in assessing PARL and has demonstrable usefulness in outcomes assessment.

Root-end surgery with leucocyte- and platelet-rich fibrin and an occlusive membrane: a randomized controlled clinical trial on patients' quality of life.

OBJECTIVES: The aim of this study was to investigate the impact of the adjunct of leukocyte- and platelet-rich fibrin (LPRF) to root-end surgery (RES) on the patients' quality of life during the first week post RES. MATERIALS AND METHODS: Patients in need of RES were recruited for an open randomized controlled clinical trial (RCT) with a 2 × 2 factorial design. They were randomly allocated to the test (+LPRF) and control (-LPRF) group. Each group was subsequently divided into two strata: with or without an occlusive membrane (Bio-Gide®, Geistlich Biomaterials, Switzerland; BG). After RES, the patients completed daily for 1 week a visual analog pain scale (VAS) and a 5-point Likert-type scale questionnaire concerning activity impairment, occurrence of symptoms, and medication use. RESULTS: Fifty patients were included, equally divided between the test and control group. Only one patient in the "-LPRF+BG-group" had to take additional antibiotics due to a persistent jaw swelling. There was no evidence (p ≤ 0.05) for a difference between the test and control group in VAS, occurrence of pain symptoms, impairment of daily activities, and medication use, over the 7 days and daily during the 7 days post RES. CONCLUSIONS: There was no statistical significant evidence for improvement of patients' quality of life during the first week post RES with LPRF in comparison with RES without LPRF. CLINICAL RELEVANCE: Although LPRF seems to be an inexpensive and autologous agent to reduce pain and swelling post RES, this RCT does not provide a statistical significant evidence for that.

Retrospective evaluation of healing of periapical lesions after unintentional extrusion of mineral trioxide aggregate.

BACKGROUND: During the apexification procedure for teeth with open apices, mineral trioxide aggregate (MTA) may be unintentionally extruded. The aim of the present study was the retrospective evaluation of the healing of periapical lesions in permanent incisor teeth with open apices after the unintentional extrusion of MTA. METHODS: The clinical and radiographic records of 55 maxillary permanent central teeth treated by MTA apexification were evaluated. Filled teeth with unintentionally extruded MTA were selected as group 1 (n = 21), whereas the teeth with no MTA extrusion were selected as group 2 (n = 34). For each tooth, the clinical and radiographic records from a 3-year follow-up were investigated. RESULTS: Complete healing (CH) was observed in 19 teeth (90.4%) in group 1, whereas the same type of healing was observed in all 34 teeth (100%) in group 2 (p>0.05). At the 6-month follow-up appointment, 25 teeth (73.5%) showed CH in group 2, whereas 15 teeth (71.4%) showed CH at the 1-year follow-up in group 1 (p<0.001). At the end of the 3-year follow-up period, the amount of MTA extrusion was reduced in 17 teeth (85%) (p<0.05), whereas it was almost absent in 2 teeth (10%). CONCLUSIONS: The unintentional extrusion of MTA does not prevent the healing of periapical lesions, but may be a delaying factor for periapical healing.

Guided Modern Endodontic Surgery: A Novel Approach for Guided Osteotomy and Root Resection.

INTRODUCTION: Continuous improvements in techniques, instruments, and materials have established modern endodontic microsurgery as a state-of-the-art treatment method. The purpose of this approach was to introduce a new surgical endodontic technique by using a three-dimensional printed template for guided osteotomy and root resection. METHODS: A 38-year-old patient was diagnosed with periapical lesions of teeth #3 and #4 and extruded gutta-percha material. Three-dimensional radiographic and optical scan files were imported into surgical planning software designed for guided implant surgery. Within the adapted software program the periapical lesions and the extruded gutta-percha were visualized and marked. With the aid of virtually positioned surgical pins and piezoelectric instruments, the osteotomy size, the apical resection level, and the bevel angle were defined before treatment. Three-dimensional surgical templates for each tooth were designed within the software program for a guided treatment approach. RESULTS: This approach comprised the treatment of periapical lesions of teeth #3 and #4 with root-end fillings and the detection and complete removal of the extruded gutta-percha material without perforation of sinus membrane. There were no postoperative complications, and clinical and radiologic assessments verified complete healing of the teeth. CONCLUSIONS: The guided microsurgical endodontic treatment presented appears to be a viable technique that allows for predefined osteotomies and root resections.

Does root canal treatment in necrotic pulp or retreatment cases with periapical lesions require anaesthesia? An in vivo clinical study.

AIM: To examine whether local anaesthesia is required for treating teeth with necrotic pulps (TNP) and retreatment cases (RCs) associated with periapical lesions. METHODOLOGY: Root canal treatment was performed in TNP and RCs without the administration of local anaesthesia. Patients were assured that if they experienced pain, local anaesthesia would be provided. Eighty canals, 40 TNP and 40 RCs, were included in the study. Two length measurements were performed: one using an electronic apex locator (EAL), which was defined as the electronic length (EL), and the second, the length at which the patient first reported that a size 15 file was touching the periapical tissues, which was defined as the periodontal length (PL). The difference between these two measurements (Δ = PL - EL) was the parameter studied. Statistical analysis was conducted using two-way anova and paired t-tests. Working length (WL) was defined in this study as being 0.5 mm short of the EL. RESULTS: EL was shorter than PL in 96% of cases. The mean difference between measurements was 0.78 (±0.11) mm in the TNP group and 0.63 (±0.15) mm in the RC group; the difference was not significant. The distances between the WL and PL were thus 1.28 and 1.13 mm, respectively. In none of the 80 canals did the patient experience any pain, either during the measurements or during the instrumentation procedures. CONCLUSIONS: When EALs are used, local anaesthesia may not be required for root canal treatment in teeth with necrotic pulps and retreatment cases associated with periapical lesions.

Platelet Rich Fibrin in Management of Complex Endoperio Cases.

Endo-perio lesions have been a dilemma to the dental practitioner. Both tissues share the same anatomical origin. Sometimes exact etiological passage of disease process cannot be traced; nevertheless traditional and newer treatment modalities must be employed to ensure best treatment possibilities. Patient reported with pain and pus exudates in upper left anterior region. Past dental history revealed no history of trauma. Initial examination revealed draining sinus with respect to 22. However, no Caries and pockets could be detected. Tooth was nonresponsive to vitality test. Patient symptoms did not relieve even two months after completion of RCT. Apical surgery was planned. Apicectomy was done and osseous defect was filled with PRF coagulum. Patient was followed up every three months and showed complete resolution of all symptoms. Radiographs showed complete resolution of osseous defect in nine months. PRF can be used to enhance bone augmentation in treatment of periapical defects as a potential treatment alternative for faster healing.

Guía de práctica clínica cirugía periapical, indicaciones y técnica quirúrgica / Periapical surgery clinical practice guide, indications and surgical technique

Esta GPC en Cirugía periapical tiene como objetivos proporcionar recomendaciones basadas en la evidencia científica, con la finalidad de mejorar la calidad asistencial y unificar los criterios de actuación en relación a las indicaciones y técnicas de aplicación en Cirugía Periapical de los profesionales sanitarios en el ámbito de la Odontología.