From: antonis
To: ROOTS
Sent: Friday, June 18, 2010 3:16 AM
Subject: [roots] self healing periradicular lesion or something else?

Hello rooters again from Greece. Here is a case to make us think a little bit more about what we really know.
Female patient with a clear medical history. Root canal treatments and prosthetic rehabilitation  at late 1996.
I saw the patient in February of  2006. she had two panorax (see attached files). Her exact words were ‘doctor
I think I need your help because I used to have a draining fistula on my left upper premolar. I was reffered
to your practice the summer of 2002 and it took me 4 years to come and visit you due to my dent phobia.’
After clinical examination I couldn’t find a draining fistula. On the upper premolar area. Then I noticed the
dates of the panorax and I was really surprised to see that I was looking them in the wrong chronological order.
The big lesion of the premolar in 2002 had almost healed in 2006. No surgery was performed   and no antibiotics
from 2002 till 2006. The patient told me that after 6 months from the first panorax the fistula disappeared.
Opinions welcome - Chaniotis Antonis





Hello Anthonis, Very interesting indeed. I think you're a very good endodontist  ;-) - Maarten

My opinion is that the immune system status of the patient plays much more important role than it was considered until
recently. As far as I am informed, there are a great number of dentists who use to fill root canals with formaline-resorcine
paste in Greece , too similarily to our situation in Bulgaria. I guess you often see teeth like the one on attached picture
which stayed for over 20 years without any clinical symptoms and without development of any PA lesion ! ( tooth is filled
with Russian red paste only ! No gutta at all )

I personally see at least 2 or 3 such teeth per week here on RXs done for treatment of other teeth.

That is why imho the shift must be towards methods/materials in endo which ensure best possible conditions for patient's
immune system to do its job. ( bioceramics for example ! J )

Parctice shows that in non complicated cases without peri-apical lesion "anything goes" as far as we mechanically and
chemically clean and shape the canals well enough.

In cases where there is peri-apical pathology everything matters and then everything which helps the body to fight
infection and pathosis matters. Application of  "biologically better" materials is to be recommended to achieve better
results in shortest possible time which to be maintained on long term, too.

From what I see on OPG, although there is a great "shrinkage" of the lesion peri-apical changes are still there and
probably cbCT will show bigger lesion borders than seen on plain RX. So, I would say that this tooth still needs
re-treatment. - Valeri Stefanov