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Endo tips    Better Endo    Endo abstracts    Endo discussions

Self healing periradicular lesion - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are -
From: antonis
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

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