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VOLUME 13 , ISSUE 4 ( July-August, 2022 ) > List of Articles

ORIGINAL RESEARCH

Radiographical Assessment of Periapical Lesion Resolution Following Nonsurgical Root Canal Treatment with Different Irrigation Protocols and Intracanal Medicaments

Gaurav Patri, Surabhi Soumya, Prasanti Pradhan, Pratik Agrawal, S Lata

Keywords : Calcium hydroxide, Modified triple antibiotic paste, Periapical diseases, Photoactivated disinfection

Citation Information : Patri G, Soumya S, Pradhan P, Agrawal P, Lata S. Radiographical Assessment of Periapical Lesion Resolution Following Nonsurgical Root Canal Treatment with Different Irrigation Protocols and Intracanal Medicaments. World J Dent 2022; 13 (4):362-367.

DOI: 10.5005/jp-journals-10015-2060

License: CC BY-NC 4.0

Published Online: 18-06-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: To evaluate healing following nonsurgical treatment of periapical lesions using different intracanal medicaments and irrigation protocols. Materials and methods: Seventy-eight patients having periapical lesion were selected and randomly allocated into six equal groups based on the irrigation protocol followed and the intracanal medicament administered. The groups allocated were: positive pressure irrigation group (group I) and negative pressure irrigation group (group II). The subgroups were modified triple antibiotic paste (group Ia/IIa), photoactivated disinfection (group Ib/IIb), and calcium hydroxide (group Ic/IIc) subgroups. The patients were assessed radiographically based on the designated parameters at intervals of 3, 6, and 12 months. The data obtained were analyzed using one-way ANOVA with GPower software version 3.0. Kruskal Wallis test and Friedman test were used for intergroup comparison. An alpha level of 5% (p-value was <0.05) was considered significant. Results: Group II showed significantly better results than group I at 6 and 12 months (p = 0.042, 0.029). Group IIb showed the best healing at all time frames. Groups Ia and IIa showed better healing than group Ic and IIc at 6 and 12 months. Groups Ic & IIc showed the least amount of healing. Conclusion: The use of photoactivated disinfection (PAD) as an intracanal medicament and negative pressure irrigation for canal disinfection resulted in superior healing of periapical lesions. Clinical significance: Photoactivated disinfection resulted in superior canal disinfection followed by triple antibiotic paste and with negative pressure irrigation eventualized in better healing of periapical lesions. Calcium hydroxide was the least effective in canal disinfection and periapical lesion healing.


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  1. Borisova-Papancheva T, Svetlozarova S. Conservative management of periapical lesions of endodontic origin-a review of the different techniques. Scr Sci Med Dent 2018;4(2):7–14. DOI: 10.14748/ssmd.v4i2.5793
  2. Mutluay AT, Mutluay M. Management of large periapical lesion due to trauma using triple antibiotic paste. J oral maxillofac 2017;5(2):58–61. DOI: 10.4103/jomr.jomr_19_17
  3. Kumar T, Dhillon JS, Gill GS, et al. An in vitro comparison of the antimicrobial efficacy of positive pressure and negative pressure irrigation techniques in root canals infected with Enterococcus faecalis. J Conserv Dent 2018;21(4):438–442. DOI: 10.4103/JCD.JCD_328_17
  4. Berman LH, Hargreaves KM. Cohen's pathways of the pulp-12th edition. Elsevier 2020:854–1011.
  5. Sjögren U, Figdor D, Persson S, et al. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. Int Endod J 1997;30(5):297–306. DOI: 10.1046/j.1365-2591.1997.00092.x
  6. Jesus SF, Cohenca N, Romualdo PC, et al. Radiographic and immunohistochemical evaluation of root canal treatment using different irrigation systems. Braz Dent J 2019;30:123–32. DOI: 10.1590/0103-6440201901702
  7. Venumbaka NR, Baskaran P, Mungara J, et al. Comparative evaluation of endovac and conventional irrigating syringe on apical extrusion in primary molars. An in vitro Study. J Clin Pediatr Dent. 2018;42(5):355–360. DOI: 10.17796/1053-4625-42.5.6
  8. Cotti E, Schirru E, Acquas E, et al. An overview on biologic medications and their possible role in apical periodontitis. J Endod 2014;40(12):1902–1911. DOI: 10.1016/j.joen.2014.08.013
  9. Eslami LM, Vatanpour M, Aminzadeh N, et al. The comparison of intracanal medicaments, diode laser and photodynamic therapy on removing the biofilm of Enterococcus faecalis and Candida albicans in the root canal system (ex-vivo study). Photodiagnosis Photodyn Ther 2019;26:157–161. DOI: 10.1016/j.pdpdt.2019.01.033
  10. Windley W, Teixeira F, Levin L, et al. Disinfection of immature teeth with a triple antibiotic paste. J Endod 2005;31(6):439–443. DOI: 10.1097/01.don.0000148143.80283.ea
  11. Hoshino E, Kurihara-Ando N, Sato I, et al. In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J 1996;29(2):125–130. DOI: 10.1111/j.1365-2591.1996.tb01173.x
  12. Sato I, Ando-Kurihara N, Kota K, et al. Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ. Int Endod J 1996;29(2):118–124. DOI: 10.1111/j.1365-2591.1996.tb01172.x
  13. Parashar V, Khan SA, Singh P, et al. Effect of intracanal medicaments (modified triple antibiotic paste, calcium hydroxide, and aloe vera) on microhardness of root dentine: an in vitro study. J Contemp Dent Pract 2020;21(6):632–635. DOI: 10.5005/jp-journals-10024-2813
  14. Stubljar D, Jukic T, Ihan A. Does photo-activated photosensitizer really contribute to root canal antimicrobial treatment? Roum Arch Microbiol Immunol 2017;76(1):13–19.
  15. Mohan D, Maruthingal S, Indira R, et al. Photoactivated disinfection (PAD) of dental root canal system–an ex-vivo study. Saudi journal of biological sciences. 2016;23(1):122–127. DOI: 10.1016/j.sjbs.2015.01.013
  16. Johns DA, Varughese JM, Thomas K, et al. Clinical and radiographical evaluation of the healing of large periapical lesions using triple antibiotic paste, photo activated disinfection and calcium hydroxide when used as root canal disinfectant. J Clin Exp Dent 2014;6(3): e230–e236. DOI: 10.4317/jced.51324
  17. Ørstavik D, Kerekes K, Eriksen HM. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol 1986;2(1):20–34. DOI: 10.1111/j.1600-9657.1986.tb00119.x
  18. Weiger R, Rosendahl R, Löst C. Influence of calcium hydroxide intracanal dressings on the prognosis of teeth with endodontically induced periapical lesions. Int Endod J 2000;33(3):219–226. DOI: 10.1046/j.1365-2591.1999.00298.x
  19. Fernandes M, Ataide ID. Nonsurgical management of periapical lesions. J Conserv Dent 2010;13(4):240–245. DOI: 10.4103/0972-0707.73384
  20. Nielsen BA, Baumgartner JC. Comparison of the EndoVac system to needle irrigation of root canals. J Endod 2007;33(5):611–615. DOI: 10.1016/j.joen.2007.01.020
  21. Fish EW. Bone infection. J Am Dent Assoc 1939;26(5):691–712.
  22. Silva LA, Nelson-Filho P, Silva RA, et al. Revascularization and periapical repair after endodontic treatment using apical negative pressure irrigation versus conventional irrigation plus triantibiotic intracanal dressing in dogs’ teeth with apical periodontitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109(5):779–787. DOI: 10.1016/j.tripleo.2009.12.046
  23. Cohenca N, Silva LA, Silva RA, et al. Microbiological evaluation of different irrigation protocols on root canal disinfection in teeth with apical periodontitis: an in vivo study. Braz Dent J 2013;24:467–473. DOI: 10.1590/0103-6440201302179
  24. Cohenca N. Disinfection of root canal systems: the treatment of apical periodontitis. John Wiley & Sons 2014.
  25. White SC, Pharoah MJ. Oral radiology: principles and interpretation. St Louis, Mo: Mosby/Elsevier 2009;2009:32–43.
  26. Taneja S, Kumari M. Use of triple antibiotic paste in the treatment of large periradicular lesions. J Investig Clin Dent 2012;3(1):72–76. DOI: 10.1111/j.2041-1626.2011.00082.x
  27. Sharma A, Aggarwal N, Rastogi S, et al. Effectiveness of platelet-rich fibrin in the management of pain and delayed wound healing associated with established alveolar osteitis (dry socket). Eur J Dent 2017;11(4):508–513. DOI: 10.4103/ejd.ejd_346_16
  28. Karunakaran JV, Abraham CS, Karthik AK, et al. Successful nonsurgical management of periapical lesions of endodontic origin: a conservative orthograde approach. J Pharm Bioallied Sci 2017;9(1):S246–S251. DOI: 10.4103/jpbs.JPBS_100_17
  29. Sjögren U, Figdor D, Spångberg L, et al. The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing. Int Endod J 1991;24(3):119–125.
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