Self healing periradicular lesion - Courtesy ROOTS
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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 betterresults 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