Ricucci Domenico, Siqueira José F
Private practice, Rome, Italy.
J Endod. 2008 Oct;34(10):1249-54. doi: 10.1016/j.joen.2008.07.002. Epub 2008 Aug 23.
This article describes a case of persistent apical periodontitis that required several nonsurgical and surgical approaches for resolution. A 28-year-old woman presented with a large symptomatic apical periodontitis lesion associated with the maxillary left lateral incisor that persisted in spite of previous nonsurgical and surgical endodontic treatment. Root canal retreatment was accomplished, but the lesion only showed a slight decrease in size after 18 months. Forty-six months after retreatment, the patient returned because of reemergence of symptoms. Radiographically, the lesion remained relatively unaltered. Periradicular resurgery was performed, and a biopsy specimen consisting of the lesion and the apical part of the root was collected for analysis. Radiographic and clinical reevaluation after 4 years revealed complete healing. Histopathologic and histobacteriologic observations demonstrated that the lesion was a cyst, and that the probable reason for failure was the occurrence of bacteria within dentinal tubules and in a lateral canal slightly coronal to the amalgam root-end filling. This case report clearly illustrates the difficulties imposed by anatomic complexities in attaining a disinfection level that is compatible with periradicular tissue healing.
本文描述了一例持续性根尖周炎病例，该病例需要多种非手术和手术方法来解决。一名28岁女性患者，上颌左侧侧切牙伴有一个有症状的大型根尖周炎病变，尽管之前进行了非手术和手术牙髓治疗，但该病变仍然存在。根管再治疗完成后，但18个月后病变大小仅略有减小。再治疗46个月后，患者因症状复发而复诊。影像学检查显示，病变相对未发生变化。进行了根尖周再手术，并采集了包含病变和根尖部分的活检标本进行分析。4年后的影像学和临床重新评估显示完全愈合。组织病理学和组织细菌学观察表明，该病变为囊肿，治疗失败的可能原因是牙本质小管内以及汞合金根充物稍冠方的侧支根管内存在细菌。本病例报告清楚地说明了解剖复杂性在达到与根尖周组织愈合相适应的消毒水平方面所带来的困难。
