ENDODONTICS
Cite this article:
Perlea P, Nistor CC.
Healing of Periapical
Periodontitis – Cone Beam
Computed Tomography
Visualization – Case
Report.
Stoma Edu J. 2014;1(2):
98-101.
HEALING OF PERIAPICAL
PERIODONTITIS – CONE BEAM
COMPUTED TOMOGRAPHY
VISUALIZATION – CASE REPORT
Paula Perleaa*,
Coralia Cristina Nistorb
Department of Endodontology, Faculty of Dental
Medicine, “Carol Davila” University of Medicine and
Pharmacy, Bucharest, Romania
a. MD, PhD, Specialist in endodontics, Senior Lecturer
b. MD, Specialist in endodontics, Senior Lecturer
Abstract
Aim: The clinical case highlights the outcome of a large periapical periodontitis using
radiograph compared with Cone Beam Computed Tomography (CBCT).
Summary: Periapical periodontitis is one of the most frequent reasons for endodontic
treatments. The outcome of the endodontic procedures can be assessed either
by radiographs or Cone Beam Computed Tomography (CBCT). The periapical
radiolucency can increase, decrease or resolve over a period of time. CBCT, as
compared to periapical (PA) radiographs shows higher accuracy in detecting the
real extend of periapical lesions, facilitating the visualization of the outcome of the
treatment.
Key learning points:
Even larger periapical periodontitis can be treated in a single visit.
No medication or surgical procedures are needed for a positive outcome of
endodontic treatment of periapical lesions.
Radiographs provide limited information about the healing of periapical pathosis.
Radiographs do not detect smaller periapical radiolucency.
CBCT shows more accurate detection of apical periodontitis.
Keyword: periapical periodontitis, radiograph, CBCT, endodontics, outcome
Introduction
The presence of bacteria in the root canal system and the marginal leakage of the tooth
restoration with penetrating caries lead to persistent periapical periodontitis. Medication
beyond the apex has no effect, because chronical lesions are considered sterile (1). Surgical
elimination of the lesion might be an alternative. The first choice in periapical periodontitis
should be the orthograde treatment. The purpose of this procedure is to eliminate the
infected content of the endodontic system and to seal it with a proper root canal filling.
Correct treatment leads to a reduction or complete healing of the periapical lesion. The
outcome of an endodontic treatment can be visualized using periapical (PA) radiographs
or Cone Beam Computed Tomography (CBCT).
Our clinical case highlights the healing of periapical periodontitis after a single-visit
treatment revealed on a CBCT compared with PA radiograph.
Clinical Case
Received: 19 November 2014
Accepted: 28 December 2014
* Corresponding author:
Senior Lecturer Paula Perlea, MD, PhD,
57 Levantica Str, District 3,
RO-031402 Bucharest, Romania.
Tel: +40744 377 011, Fax: +40213468888,
e-mail: [email protected]
98
A 51 year old patient was referred to our endodontic department for endodontic treatment
of tooth 47. The clinical examination revealed a large caries penetrating into the pulp chamber.
The tooth was slightly positive to percussion and the vitally test showed negative response. No
swelling or draining sinus could be detected. There was no periodontal probing more than 3
mm. The initial periapical radiograph showed a radiolucency due to infection noted around
both the mesial and distal roots of tooth 47 (Fig. 1). Rubber dam was placed and the alterate
dentine was removed. The coronal walls were reconstructed using glass ionomer cement.
STOMA.EDUJ (2014) 1 (2)