Healing of periapical lesions

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Healing of periapical lesions

Periapical lesions are pathological conditions that occur at the apex of a tooth's root, often as a result of pulpal infection or necrosis. These lesions are typically identified through radiographic imaging and can manifest as periapical granulomas, periapical cysts, or periapical abscesses.

Etiology

The primary cause of periapical lesions is the infection of the dental pulp due to dental caries, trauma, or extensive dental restorations. The infection can lead to the formation of periapical periodontitis, which, if left untreated, can progress to a periapical lesion.

Diagnosis

Diagnosis of periapical lesions is primarily achieved through clinical examination and radiographic evaluation. Periapical radiographs and cone beam computed tomography (CBCT) are commonly used to assess the extent and nature of the lesion.

Treatment

The treatment of periapical lesions aims to eliminate the infection and promote healing. The primary treatment modalities include:

• Root canal therapy: This involves the removal of infected or necrotic pulp tissue, disinfection of the root canal system, and sealing of the canal to prevent reinfection.
• Endodontic surgery: In cases where root canal therapy is not sufficient, surgical intervention such as apicoectomy may be necessary to remove the infected tissue and the apex of the root.
• Extraction: In severe cases where the tooth cannot be saved, extraction may be the only viable option.

Healing Process

The healing of periapical lesions involves several stages:

1. **Inflammatory Phase**: Following treatment, an initial inflammatory response occurs, which is essential for the removal of necrotic tissue and pathogens. 2. **Proliferative Phase**: This phase is characterized by the proliferation of fibroblasts and the formation of granulation tissue. 3. **Maturation Phase**: The granulation tissue matures into fibrous tissue, and eventually, new bone formation occurs, leading to the resolution of the lesion.

Prognosis

The prognosis for healing of periapical lesions is generally favorable with appropriate treatment. Factors influencing the prognosis include the size of the lesion, the patient's immune response, and the quality of the endodontic treatment.

Prevention

Preventive measures include maintaining good oral hygiene, regular dental check-ups, and prompt treatment of dental caries and trauma to prevent the development of periapical lesions.

See Also

• Endodontics
• Periapical periodontitis
• Dental pulp
• Apicoectomy
• Root canal therapy