Endodontic Periapical Lesion: An Overview on Etiology, Diagnosis and Current Treatment Modalities

Abstract

Nonsurgical and surgical endodontic treatments have a high success rate in the treatment and prevention of apical periodontitis when carried out according to standard and accepted clinical principles. Nevertheless, endodontic periapical lesions remain in some cases, and further treatment should be considered when apical periodontitis persists. Although several treatment modalities have been proposed for endodontically treated teeth with persistent apical periodontitis, there is a need for less invasive methods with more predictable outcomes. The advantages and shortcomings of existing approaches for the diagnosis and treatment of endodontic periradicular lesions are discussed in this review.

German Dentists’ Preferences for the Treatment of Apical Periodontitis: A Cross-Sectional Survey

“…For example, almost half of the respondents in CS1 and CS2 ( Table 3 and Table 4 ) have surprisingly ranked the treatment option “tooth retention using apicoectomy followed by a coronal restauration” as “(very) appropriate” although this option is not indicated scientifically until primary RCT has failed [ 47 ]. Such lack of consensus has already been reported for teeth with AP and previous RCT and endorses the described claims of subjective and inconsistent treatment recommendations [ 48 , 49 ]. Previously reported factors disturbing the adoption of modern and evidence-based dental technology and science in decision making, such as psychosocial and behavioral factors, as well as a complex interplay of perceived benefits might provide an explanation of this observation [ 50 , 51 ].…”

iRoot SP Promotes Osteo/Odontogenesis of Bone Marrow Mesenchymal Stem Cells via Activation of NF-κB and MAPK Signaling Pathways

“…The pulp tissue of teeth can be affected by trauma, dental caries, and anatomic variation, leading to clinical cases of pulpitis and periapical periodontitis [ 1 ]. Root canal treatment (RCT) is effective for removing infected dentin and pulp, promoting recovery from inflammation and preventing reinfection of the tooth's root and crown [ 2 ]. The purpose of a root canal filling is to form a complete 3D filling.…”

Conservative Approach in the Management of Large Periapical Cyst-Like Lesions. A Report of Two Cases

“…Several treatment methods have been described in the management of large periapical cystic lesions of endodontic origin, such as endodontic therapy with or without calcium hydroxide medication, and surgical procedures such as decompression [ 6 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], marsupialization [ 19 , 27 , 28 , 29 ], and cystectomy [ 19 , 30 ]; decompression being the least invasive surgical treatment.…”

“…Radicular cysts are the most common odontogenic cystic lesions of inflammatory origin involving both the maxillary and the mandibular alveolar bone [ 1 , 2 , 3 , 4 , 5 ]. It is thought that the formation of a radicular cyst is determined by the proliferation and/or degeneration of the epithelial rest cells of Malassez, stimulated by an inflammatory process originating in the pulpal necrosis of a non-vital tooth [ 5 , 6 ]. The majority of apical cysts are asymptomatic and may develop insidiously, being accidently discovered on a routine X-ray control as a large periapical radiolucency involving the apex of one or more teeth [ 2 ].…”

“…The majority of apical cysts are asymptomatic and may develop insidiously, being accidently discovered on a routine X-ray control as a large periapical radiolucency involving the apex of one or more teeth [ 2 ]. A more precise diagnosis is achieved by histopathological examination, with the confirmation of the lesion as a granuloma or cyst [ 6 , 7 ]. Although conventional radiographic methods cannot be used for a certain diagnosis of periapical cysts, it is considered that round or oval, well-circumscribed radiolucent images of a larger size around the apex of a tooth are cystic lesions [ 8 , 9 , 10 ].…”