• Restorative Dentistry and Endodontics
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• v.37 no.2
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• pp.123-126
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• 2012

It is often presumed that apical periodontitis follows total pulp necrosis, and consequently root canal treatment is commonly performed. Periapical lesion development is usually caused by bacteria and its byproduct which irritate pulp, develop pulpitis, and result in necrosis through an irreversible process. Afterwards, apical periodontitis occurs. This phenomenon is observed as an apical radiolucency in radiographic view. However, this unusual case presents a spontaneous healing of periapical lesion, which has developed without pulp necrosis in a vital tooth, through conservative treatment.

• The Journal of the Korean dental association
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• v.54 no.5
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• pp.365-373
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• 2016

Purpose: Cemental tear is a specific type of root surface fracture characterized by a complete separation of a cemental fragment along the cementodentinal junction or a partial split within the cementum along an incremental line. It is suggested to be a factor for periodontal or periapical tissue destruction. The aim of this study is to present a diagnosis and treatment of cemental tear associated with periapical lesion with root canal treatment and regenerative periodontal surgery. Treatments: A 60-year-old male who had a history of sports trauma on the mandibular right central incisor about 10 years ago presented with apical cemental tear. Clinical examination showed a slightly dark yellowish discoloration and sinus tract that was located on the apical labial mucosa. The mobility and percussion were also assessed on the diseased tooth and recorded as $Miller^{\circ}{\phi}s$ Class II and tenderness to percussion. The probing depth was within the normal limit (<3 mm). Radiographic examination revealed a radiolucent lesion at the apical area and extended to distal aspect of the tooth along the fragment of cemental tear. After root canal treatment, periapical surgery was performed. The bony defect was exposed and then the detached root fragment was removed. Apical root resection and retrograde filling with Mineral Trioxide Aggregate (MTA) were accomplished and the bony defect was filled with deproteinized bovine bone mineral (DBBM) and covered with biodegradable collagen membrane. Results: After 9-month follow-up, healing of the mandibular right central incisor was uneventful and no swelling, purulence or pain was revealed in the associated area. Probing pocket depth was favorably stable, and the tooth mobility was decreased to the Miller's Class I. Conclusions: Apical cemental tear associated periapical lesion could be successfully treated with removal of the detached cementum in combination with apical surgery and GTR procedure.

• Restorative Dentistry and Endodontics
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• v.19 no.2
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• pp.485-498
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• 1994

Porphyromonas endodontalis is a black-pigmented anaerobic Gram-negative rod which is associated with endodontal infections and this microorganism possesses a potential for pathogenicity. The purpose of this study was to compare the membrane components of Porphyromonas endodontalis and Porphyromonas gingivalis and to study the immune reaction patterns of Porphyromonas endodontalis with patients with periapical lesion. Porphyromonas endodontalis (ATCC 35406), Porphyromonas gingivals serotypea (381), serotype b(W50), serotype c(A7A1-28) were cultured in anaerobic condition. Rabbit antisera were prepared by intravenous injection of formalized whole cells and human sera were obtained from patients and dental students. Indirect immunofluorescence method was used to study on the cross reaction between Porphyromonas endodontalis and Porphyromonas gingivalis serotype a, b, c antigen. Total membrane protein profiles of Porphyromonas endodontalis antigen were studied by sodium dodecyl sulfate polyacrylamide gel electrophoresis and the reactivity of antigenic components of Porphyromonas endodontalis against sera of patients and rabbit anti-Porphyromonas endodontalis antisera were assessed by Immunoblotting method. The following results were obtained : 1. Antigens of Porphyromonas endodontalis has multiple antigenic components, and both patients with periapical lesion and normal healthy individual showed immune response to this. 2. Patients group and healthy individual group showed a diversity of immune reaction pattern but they showed immune response against 43kd protein. 3. Patients with periapical lesion showed more diverse immune response than healthy individual and in some patients, much more bands appeared to lower molecular weight protein. 4. According to indirect immunofluorescence and Immunoblotting study, Porphyromonas endodontalis did not share common antigen with Porphyromonas gingivalis serotype a, b, c.

• Restorative Dentistry and Endodontics
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• v.24 no.1
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• pp.212-221
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• 1999

The periapical response to injury is a complex interaction of inflammatory, immune, neural, vascular and synthetic activity. Nitric oxide(NO), synthesized by nitric oxide synthetase(NOS) from L-arginine, is becoming recognized as an important bio-regulatory molecule in a variety of tissue, but little is known about its possible role in periapical tissue. The purpose of this study was to investigate the expression of nitric oxide synthetase(NOS) in tooth follicle, periapical abscess, granuloma and cyst. The expression of NOS in periapical lesions was evaluated by immunohistochemical staining for $NOS_2$, and $NOS_3$. The immunoreactivity was evaluated by staining intensity, and inflammatory cell infiltration. Correlationship between the periapical lesion in immunoreractivity were statistically analyzed by SPSS. The degree of $NOS_2$ and $NOS_3$ expression in periapical abscess was higher than in any other periapical lesions, and stastically significant. The expression degree of $NOS_2$ and $NOS_3$ was not correlated with periapical abscess and granuloma, but expression of $NOS_2$ showed very significant in periapical cyst. The increased expression of $NOS_2$ and $NOS_3$ was correlated with inflammatory cell infiltration degree of the periapical cyst. These results suggested that NO should play an important role in progress and/or mediation of periapical lesions.

• Imaging Science in Dentistry
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• v.30 no.1
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• pp.49-54
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• 2000

Purpose : To compare the diagnostic performance of clinical and radiologic examination for the interproximal caries on intraoral periapical radiographs and to evaluate the value of periapical radiographs. Methods: One hundred seven dental patients were examined clinically, with a mouth mirror and an explorer, by a dentist at the department of oral medicine, and the presence or absence of interproximal caries lesion was recorded. The patients were prescribed one or more dental periapical radiographs. Radiographs were assessed for the presence of interproximal caries by three oral and maxillofacial radiologists independantly. Two thousand sixty interproximal surfaces were included in this study. The diagnostic accuracies of clinical and radiologic examinations for interproximal caries were calculated. To assess the degree of agreement between clinical and radiologic examinations, Cohen's coefficient of agreement was computed. Results: The specificity of clinical and radiologic examination was 0.991, 0.997 and the sensitivity was 0.279, 0.985 respectively. The diagnostic accuracy of radiologic examination was statistically significantly higher than that of clinical examination (P<0.05). Cohen's kappa value of clinical and radiologic examination was 0.335, 0.942 respectively. These results suggested that clinical examination show only fair agreement, whereas radiologic examination show perfect agreement. Conclusion: The diagnositic performance of the dental periapical radiographs on interproximal caries were higher than that of clinical examination, thus this study showed the validity of periapical radiographs for detecting interproximal caries lesion without bitewing radiograph.

• Restorative Dentistry and Endodontics
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• v.38 no.2
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• pp.90-92
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• 2013

Although periapical inflammatory lesions are usually resulted by infection in the root canal system, this rare case showed that a periapical lesion related to an infected tooth may cause pulpal necrosis in adjacent intact tooth, with no history or clinical signs of caries, disease, trauma or developmental anomaly. This case also suggests that the periapical lesion can be treated conservatively, without surgical intervention. Furthermore, this case highlights the importance of prompt treatment of apical periodontitis before the lesion becomes extensive as well as follows up of large lesions.

• Imaging Science in Dentistry
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• v.39 no.1
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• pp.41-49
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• 2009

Purpose: To detect the progression of experimentally induced periapical lesions on periapical radiograph and cone beam computed tomograph (CBCT) by quantitative analysis. Materials and Methods: After the removal of coronal pulps from premolars of two Beagle dogs, the root canals of premolars were exposed to oral environment during one week and then sealed for 70 days. Digital periapical radiographs and CBCTs were taken at baseline and every 7 days for 77 days after pulp exposure. We examined occurrence and areas of periapical bone resorption. Three comparative groups of CBCT radiographs were prepared by average projection of thin slabs with different bucco-lingual thicknesses (0.1, 3.0, and 8.0 mm) using a 3D visualization software. Radiographic densities were compensated by image normalization. Digital images were processed with mathematical morphology operations. The radiographic density and morphological features of periapical lesions were compared among three groups of CBCT in different time points. Results: In the CBCT group with 0.1 mm thickness, radiographic density (p<0.05) and trabecular bone area (p<0.01) were significantly decreased at the fifth week. However, in the CBCT groups with 3 mm and 8 mm thickness and periapical radiographs, none of densitometric and morphological features showed any significant differences in different time points. Radiographic density of periapical lesion showed increasing tendency at the eleventh week after pulp exposure. Conclusion: Radiographic detection of periapical lesions was possible at the fifth week after pulp contamination by quantitative method and was affected by buccolingual bone thickness.

• Restorative Dentistry and Endodontics
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• v.30 no.1
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• pp.66-71
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• 2005

Periapical cemental dysplasia(PCD) is a condition most commonly seen in the mandibular incisor region. Radiographically it passes through the three phases(osteolytic stage, intermediate stage, and mature stage). At osteolytic stage, the lesion is similar to features associated with granuloma or cyst that arise following pulpal necrosis. So, it is important to confirm the vitality of the pulp to diagnosis. In this case, it is difficult to confirm the vitality of involved tooth because the tooth was covered with PFG bridge. And it is unusual that the PCD lesion at mandibular incisors has occurred at first and the lesion of mandibular canine and mandibular premolar were occurred afterward.

• Journal of Dental Rehabilitation and Applied Science
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• v.37 no.2
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• pp.95-100
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• 2021

Calcium hydroxide has been widely used for root canal dressing material in endodontic treatment. This report describes that when the accurate diagnosis and proper nonsurgical endodontic retreatment is applied to periapical lesion with accidentally extruded calcium hydroxide paste, the lesion can be successfully treated. Overfilled calcium hydroxide can affect the healing process, so the overextension of calcium hydroxide agent should be avoided.

• Restorative Dentistry and Endodontics
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• v.1 no.1
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• pp.18-25
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• 1975

The author has experienced 8 cases of periapical lesion which were very closed to adjacent root tip. To avoid damage on neighboring nerve and blood supply polyvinyl tube was inserted through buccal window leaving a little pathological changes in involved area. The results are as follows: 1. The purpose to maintain adjacent tooth vitality was achieved by means of intubation in the lesion. 2. Swelling and pain after operation was rather lesser than routine apical surgery, because of drainage. 3. The total treatment period seems longer than that of routine apical amputation.