The periapical lesion of a tooth is often a challenging case once itcomes to save the tooth with periapical lesion or abscess.But in most ofthe cases we would be able to save the tooth with proper way of treatmentand follow ups.
It is an acute or chronic inflammatory response on or around the tip of thetooth or teeth due to trauma,decay or may be due to secondary dentalprocedures.
It may appear as a blister on the top of the gum usually where the root tipis located.patient may or may not experience the pain.some may not evenknow about the occurence of blister.if it is a chronic lesion the pain may benegligible, but in acute cases patient may report to the dentist with pain .
Here is a patient of us who has come with chronic lesion ,with pain due tosevere decay.Eventhough the lesion appeared to be big she was moreconcerned about the aesthetic aspect as it is a front teeth and she doesn’twant to remove the tooth..so her request was to somehow save the toothrather than extraction or any other alternate treatment options .
The prognosis of the tooth was not so good,taken initial diagnostic X ray.Started root canal treatment,opened the access and drainage of the canal
is facilitated.The access is kept open for 2 weeks with antibioticprophylaxis.
After 2 weeks, working length is taken and proper biomechanicalpreparation is done with lots of irrigation.Intracanal medicament such as
calcium hydroxide is placed till the apex to control the infection.Sinus tract
is traced with Gutta percha point .
Repeated the new calcium hydroxide dressing in every 2 weeks .Anoticable change in the regression of periapical lesion is noted along with the healing of sinus tract
After 2 months of proper BMP and placement of intracranal medicaments sinus iscompletely Unfortunately patient broke her tooth .but we planned to do post and core treatmentto save the tooth
Completion of obturation done with rotary endodontic files and post and core isplaced to reinforce the tooth crown structure. This series of xrays shows ,the progression of this case that how can a hugeabscess can be managed with proper treatment and follow ups without doingapicoectomy procedure.
Patient was happy with the outcome .Her pain was completely subsided.Within amonth of time did the crown preparation and delivered the zirconia crown..The toothwas restored both functionally and aesthetically.
This case is an example of how can we treat a tooth withhuge periapical lesion and fair prognosis with without doingapicoectomy.But still periapical lesions are often challenging totreat especially when it is chronic and huge.Also not all the casescannot be treated only with intracranal medicaments,some mayneed apicectomy also to control the infection post obturation.
Richardsons Face Hospitals has been one of the Best Face Hospitals in India, providing high-quality facial, dental, skin, and hair care since 2010. Our strength lies in delivering best treatment with best technology at affordable costs and treating our patients with respect, courtesy, and compassion.
