Karunakaran J V, Abraham Chris Susan, Karthik A Kaneesh, Jayaprakash N
Department of Conservative Dentistry, JKK Nataraja Dental College, Komarapalayam, Namakkal, Tamil Nadu, India.
Department of Oral and Maxillofacial Surgery, JKK Nataraja Dental College, Komarapalayam, Namakkal, Tamil Nadu, India.
J Pharm Bioallied Sci. 2017 Nov;9(Suppl 1):S246-S251. doi: 10.4103/jpbs.JPBS_100_17.
Periapical lesions of endodontic origin are common pathological conditions affecting periradicular tissues. Microbial infection of pulpal tissues is primarily responsible for initiation and progression of apical periodontitis. The primary objective of endodontic therapy should be to restore involved teeth to a state of normalcy nonsurgically. Different nonsurgical management techniques, namely, conservative root canal therapy, decompression technique, method using calcium hydroxide, aspiration-irrigation technique, lesion sterilization and tissue repair therapy, active nonsurgical decompression technique, and the apexum procedure have been advocated. New techniques which use drug-loaded injectable scaffolds, simvastatin, and epigallocatechin-3-gallate have been tried. Surgical option should be considered when intra- or extra-radicular infections are persistent. Incidence of nonendodontic periapical lesions has also been reported. An accurate diagnosis of the periapical lesion whether it is of endodontic or nonendodontic origin has to be made. Surgical methods have many disadvantages, and hence should be considered as an option only in the case of failure of nonsurgical techniques. Assessment of healing of periapical lesions has to be done periodically which necessitates a long-term follow-up. Even large periapical lesions and retreatment cases where the lesion is of endodontic origin have been successfully managed nonsurgically with orthograde endodontic therapy.
牙髓源性根尖周病变是影响根尖周组织的常见病理状况。牙髓组织的微生物感染是根尖周炎发生和发展的主要原因。牙髓治疗的主要目标应是通过非手术方法使患牙恢复到正常状态。人们提倡采用不同的非手术治疗技术，即保守根管治疗、减压技术、使用氢氧化钙的方法、抽吸冲洗技术、病变消毒和组织修复治疗、主动非手术减压技术以及根尖诱导成形术。已尝试使用载药可注射支架、辛伐他汀和表没食子儿茶素-3-没食子酸酯等新技术。当根管内或根管外感染持续存在时，应考虑手术治疗。也有非牙髓性根尖周病变的发病率报道。必须对根尖周病变进行准确诊断，确定其是牙髓源性还是非牙髓源性。手术方法有许多缺点，因此仅在非手术技术失败的情况下才应将其视为一种选择。必须定期评估根尖周病变的愈合情况，这需要长期随访。即使是大型根尖周病变以及病变为牙髓源性的再治疗病例，通过顺行性牙髓治疗也已成功地进行了非手术治疗。
