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Case Reports
. 2022 Jan-Feb;33(1):112-118.
doi: 10.1590/0103-6440202204818.

Management of periapical lesion with persistent exsudate

[Article in Portuguese]
Sérgio André Quaresma  1 , Rui Pereira da Costa  2   1 , Beatriz Batalha  1 , Maria Carlos Real Dias Quaresma  1 , Fabiane Carneiro Lopes  2 , Jardel Francisco Mazzi-Chaves  2 , Antônio Ginjeira  1 , Manoel Damião de Sousa-Neto  2
Affiliations
Case Reports

Management of periapical lesion with persistent exsudate

[Article in Portuguese]
Sérgio André Quaresma et al. Braz Dent J. 2022 Jan-Feb.

Abstract
in English, Portuguese

This case describes the treatment and follow-up of a mandibular molar in an 18-year-old female with a periapical cyst. Thus, it becomes important to know which options should we take when faced with a clinical situation that we cannot resolve through conventional methods, and which techniques and approaches we have to achieve treatment success. This case showed the treatment plan and follow-up, by the use of CBCT images, from a previously treated mandibular molar with a large periapical abscess and cystic lesion, in which, the first treatment plan approach was to make the endodontic retreatment. During the chemo-mechanical preparation the presence of permanent intracanal purulent exudate made it impossible to dry the canals, impeding obturation of the root canal system. Due to this clinical situation, a surgical approach was performed with the intention of reduce this permanent exudate and to execute a decompression technique. Clinical findings, periapical radiographs and cone beam computed tomographic, indicated almost complete resolution of the radiolucency, after a one-year follow-up.

Este relato de caso descreve o tratamento e acompanhamento de um molar inferior em uma jovem de 18 anos com cisto periapical. Assim, torna-se importante saber quais opções devemos tomar diante de uma situação clínica que não podemos resolver pelos métodos convencionais, e quais técnicas e abordagens temos para alcançar o sucesso do tratamento. Este caso mostrou o plano de tratamento e acompanhamento, por meio de imagens de tomografia computadorizada de feixe cônico (TCFC), de um molar inferior previamente tratado com grande abscesso periapical e lesão cística, no qual, a primeira abordagem do plano de tratamento foi fazer o retratamento endodôntico. Durante o preparo químico-mecânico a presença de exsudato purulento intracanal permanente impossibilitou a secagem dos canais, impedindo a obturação do sistema de canais radiculares. Devido a essa situação clínica, foi realizada abordagem cirúrgica com a intenção de reduzir esse exsudato permanente e executar uma técnica de descompressão. Após um ano de acompanhamento, os achados clínicos e radiográficos indicaram processo de reparo.

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Conflict of interest statement

The authors have stated explicitly that there are no conflicts of interest in connection with this article

Figures

Figure 1
Figure 1. (A) Periapical radiograph with the previous treatment. (B), (C) and (D) Cross section of cone-beam computed tomographic images showing extensive lesion involving the interproximal, buccal, and lingual surfaces.
Figure 2
Figure 2. A. Flap with the hole made in the bone for drainage and tube placement. B. Decompression tube sutured to the surrounding soft tissues.
Figure 3
Figure 3. (A) Photograph showing the perforation near the mesio-lingual canal. (B) Photograph showing the placement of MTA at the perforation, using the MTA gun. (C) Immediate post-operative periapical radiograph with MTA obturation sealing the perforation. (D) Periapical radiograph with the cone-fit probe. (E) Periapical radiograph with the cone-fit probe.
Figure 4
Figure 4. (A) Interproximal, (B) lingual and (C) buccal surfaces of one-year post-operative cone beam tomography showing almost complete resolution of radiolucent lesion.
See this image and copyright information in PMC

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