Healing of a Large ¡®Cyst-like¡¯ Periapical Lesion by Nonsurgical RCT
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(Kang Soon-Mi) - Yonsei University Department of Conservative Dentistry
ÀÌÂù¿µ(Lee Chan-Young) - Yonsei University Department of Conservative Dentistry
Abstract
I. Objective
To suggest the possibility of healing of a large ¡®cyst-like¡¯ periapical lesion by non-surgical RCT anddiscuss the mechanism of healing.
II. Case presentation
A 57 year old male came to the department of conservative dentistry at Yonsei university dental hospital whose chief complaint was pus discharge from his upper anterior teeth, especially on #22. He had started root canal therapy on #21 and 22 at a local clinic 3 weeks ago before visiting us. The size of lesion was 33mm x 33mm, which was roughly measured on the panoramic view and he had a sinus tract on the upper anterior gingiva. He was diagnosed of previously initiated therapy and chronic apical abscess on #21, 22 and referred to the department of oral and maxillofacial surgery (OMFS) to evaluatepossibility of a radicular cyst. The treatment plan of the OMFS was cyst enucleation of the lesion under general anesthesia but the patient refused the surgery for the fear of surgical procedure and did not comeback for five months until gingival swelling and active pus discharge was recurred from his upper anterior teeth. Thus, we inevitably changed the treatment plan to non-surgical root canal therapy(NSRCT) instead of doing surgery and resumed root canal therapy. We have just done canal irrigation with saline and NaOCl and used Ca(OH)2 (Metapaste) as an intracanal medicament for three months due to continuous cystic fluid and exudate from #21 and #22. The size of lesion has been getting smaller with Metapastewithin a root canal of #21 and #22 for about six months. The root canals were obturated when he did not show any sign of symptom. We have recalled him once or twice a year for four years and he has had no discomfort and symptom ever since NSRCT was finished on #21 and #22.
III. Discussion
It has been controversial issue that recovery of a large ¡®cyst-like¡¯ lesion by NSRCT alone is sufficient and surgical procedure is not necessary because apical true cysts are considerd to be self-sustaining. According to Louis M. Lin, apical true cysts could delay but not preventperiapical wound healing after nonsurgical root canal therapy, whose mechanism of healing is apoptosis by reducing inflammation through NSRCT.
IV. Conclusion
Although there has been no direct evidence so far, a large cyst-like lesion can regress or heal by non-surgical root canal therapy alone and non-surgical root canal treatment using calcium hydroxide could be an alternative treatment to apical surgery.In addition, patients should be informed about longer period of treatment and long-term follow up is necessary.
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KMID :
1035020140150010026
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