Niavarzi Soheil, Noori Faranak, Aminsobhani Mohsen, Meraji Naghmeh
Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
Department of Endodontics, School of Dentistry, AJA University of Medical Sciences, Tehran, Iran.
Iran Endod J. 2021 Summer;16(3):205-209. doi: 10.22037/iej.v16i3.33750.
Large radicular lesions should be treated initially by orthograde root canal therapy. When the signs and symptoms of the infection ( persistent purulent drainage) do not resolve after this treatment, then surgical approaches should be considered. In the cases of large radicular cysts, total enucleation of the cyst can endanger adjacent structures and teeth. Therefore, decompression or marsupialization techniques are recommended in order to decrease the size of the lesion. In this case report, a 55-year-old woman with previously initiated therapy was referred to endodontic department for management of a sinus tract associated with tooth #7. Root canal treatment was performed and intracanal irrigant (5.25% sodium hypochlorite) activated using passive ultrasonic application, various intracanal medicament (calcium hydroxide, double antibiotic paste) was used in multiple sessions, but intracanal purulent drainage was not resolved After this, decompression was performed using needle cap to maintain the opening of the cyst and remained for three months. During this period the cavity was kept clean and rinsed by the patient with 0.2% chlorhexidine mouthwash. After three-year follow-up, radiographic examination revealed substantial osseous repair of the defect and clinical signs and symptoms were absent.
较大的根管病变应首先采用顺行根管治疗。若经此治疗后感染的体征和症状（持续脓性引流）仍未消除，则应考虑手术方法。对于较大的根管囊肿，囊肿的完全摘除可能会危及相邻结构和牙齿。因此，建议采用减压或袋形缝合术以减小病变大小。在本病例报告中，一名曾接受过治疗的55岁女性因与7号牙相关的窦道而被转诊至牙髓病科。进行了根管治疗，并使用被动超声应用激活根管内冲洗液（5.25%次氯酸钠），多次使用了各种根管内药物（氢氧化钙、双抗生素糊剂），但根管内脓性引流仍未消除。此后，使用针帽进行减压以保持囊肿开口，并持续了三个月。在此期间，患者用0.2%氯己定漱口水保持腔隙清洁并冲洗。经过三年随访，影像学检查显示缺损处有大量骨质修复，且临床体征和症状消失。
