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Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 51-53

Nonsurgical management of a large periapical lesion in the anterior mandibular region of a patient with a deep traumatic overbite: A 3-year follow-up

1 Department of Restorative Dentistry, Izmir Katip Çelebi University, Izmir, Turkey
2 Department of Endodontics, Izmir Katip Çelebi University, Izmir, Turkey

Date of Web Publication20-Mar-2014

Correspondence Address:
Hakan Arslan
Department of Endodontics, Izmir Katip Çelebi University, Izmir - 35620
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2321-4619.129079

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The aim of this case report is to describe the management of a large periapical lesion in a patient without a trauma history, but with a deep traumatic overbite. The large periapical lesion in the region of the mandibular anterior teeth was detected in a routine radiographic examination. The patient was asymptomatic, and teeth 33, 32, 31, 41, and 42 failed to respond to thermal and electric testing. Nonsurgical endodontic treatment was performed on these teeth. Follow-up at 6 months, 1 year, and 2 years indicated that the radiolucency was reduced. Finally, follow-up at 3 years revealed that the large periapical lesion had disappeared.

Keywords: Deep bite, occlusal trauma, periapical lesion

How to cite this article:
Yasa B, Arslan H. Nonsurgical management of a large periapical lesion in the anterior mandibular region of a patient with a deep traumatic overbite: A 3-year follow-up. J Res Dent 2014;2:51-3

How to cite this URL:
Yasa B, Arslan H. Nonsurgical management of a large periapical lesion in the anterior mandibular region of a patient with a deep traumatic overbite: A 3-year follow-up. J Res Dent [serial online] 2014 [cited 2020 Dec 1];2:51-3. Available from: http://www.jresdent.org/text.asp?2014/2/1/51/129079

  Introduction Top

Apical periodontitis can be caused by microbes and their toxins and noxious metabolic byproducts, chemical agents, mechanical irritation, foreign bodies, and trauma. [1] Research has shown that occlusal trauma is responsible for the pathology and the risk of pulpal and periradicular diseases. [2] In particular, occlusal trauma caused by a deep overbite can result in periradicular lesions. [3]

Unless a patient visits a dentist due to discomfort or acute pain, such lesions are typically diagnosed by the dentist during a routine radiographic examination. [4] Treatment options of large periapical lesions include nonsurgical root canal treatment, apical surgery, or extraction. Initially, nonsurgical root canal treatment is attempted to control large periapical lesions. When such treatment fails to resolve the periradicular pathosis, additional treatment options, including surgery, should be considered. [5] The aim of this case report is to describe the nonsurgical management of a large periapical lesion in the anterior mandibular region of a patient with a deep traumatic overbite during a 3-year follow-up.

  Case Report Top

A 30-year-old male patient was referred to the clinic of the Faculty of Dentistry for dental control. He had no systemic disease. A panoramic radiograph revealed a large periapical lesion in the anterior mandibular region [Figure 1]a. There was no swelling, and extraoral and intraoral fistulas were not observed. The patient did not recall any trauma associated with this region, but a deep overbite attracted our attention. On clinical examination, the patient did not report any pain during palpation of the labial mucosa or percussion of the mandibular anterior teeth. Vitality tests were performed using both electric and cold tests, and teeth 33, 32, 31, 41, and 42 failed to respond to the thermal and electric testing. Periodontal examination revealed no loss of periodontal attachment and no mobility.
Figure 1: (a) Pretreatment appearance of the periapical lesion and appearance (b) shortly after treatment, (c) 6 months later, (d) 1 year later, (e) 2 years later, and (f) 3 years later. Note the disappearance of the periapical lesion

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After obtaining the approval of the patient, nonsurgical endodontic therapy of the nonvital teeth was planned. The access cavities were prepared under a rubber dam, the working lengths were determined with an electronic apex locator (Propex; Dentsply-Maillefer, Ballaigues, Switzerland), and canal preparation was conducted using ProTaper® Universal rotary files (Dentsply Maillefer). There was slight drainage from the root canals. Irrigation with 2.5% sodium hypochlorite (NaOCl) was performed between each instrument change. The final rinse was performed using 17% ethylenediaminetetraacetic acid (EDTA) and 2.5% NaOCl, both for 1 min. Calcium hydroxide paste was placed into the canals with lentulo filler. The teeth were temporarily restored with Cavit (ESPE Dental AG, Seefeld, Germany). Clinical evaluation performed after 7 days revealed that the teeth were asymptomatic, and there was no drainage. The root canals were filled with gutta-percha and AH Plus sealer® (Dentsply DeTrey, Konstanz, Germany) using cold lateral compaction [Figure 1]b. The patient was recalled at 6 months [Figure 1]c, 1 year [Figure 1]d, 2 years [Figure 1]e, and 3 years [Figure 1]f. The follow-up showed that the radiolucency had decreased. After 3 years, the patient exhibited healthy dental structures and the radiolucent periapical lesion had disappeared [Figure 1]f.

  Discussion Top

Radiographic signs that indicate healing include a density change within the lesion, trabecular reformation, and lamina dura formation, particularly when they are associated with the clinical findings of an asymptomatic tooth and healthy soft tissue. [6] Caliskan [7] observed healing within 2 years of treatment in approximately 70% of patients with periapical lesions. Other authors [8],[9] have reported the complete disappearance of periapical lesions within 1-12 months after treatment. In the present paper, we observed radiographically periapical healing 6 months after the treatment and complete healing after 3 years, with no recurrence. The prolonged time to complete healing could be due to the deep overbite causing trauma, which can affect the healing time.

Trauma from occlusion is discussed in the current literature. Nasry and Barclay [3] demonstrated periodontal lesions associated with a deep traumatic overbite. According to the researchers, the manner in which the roots of teeth are orientated in relation to the forces to which they are exposed may have an effect on the periodontal health of the teeth. Axially inclined forces are better tolerated than nonaxially inclined forces because the effect of excessive forces can be exaggerated when teeth are badly aligned. [3] Shi et al. [2] evaluated the relationship between occlusal trauma and pulpal and periodontal tissues in a rat model. They proved that occlusal trauma is responsible for the pathology and the pathogeny of pulpitis and periapical periodontitis. In the present study, a deep overbite was determined in the patient's occlusion. The overbite probably caused the periapical lesion because there were no caries, restorations, or other potential contributing factors.

  Conclusion Top

This case report described a large periradicular lesion, which was likely due to a deep overbite, and its treatment. Although the healing period was prolonged, the lesion had healed successfully after 3 years.

  References Top

1.Hargreaves KM, Cohen S. Cohen's pathways of the pulp. St. Louis: Mosby Elsevier; 2011. p. 81-3.  Back to cited text no. 1
2.Shi Y, Wang J, Cao C. The effect of artificial traumatic occlusion on the pulp and periodontium in rat molars. Zhonghua Kou Qiang Yi Xue Za Zhi 1997;32:212-4.  Back to cited text no. 2
3.Nasry HA, Barclay SC. Periodontal lesions associated with deep traumatic overbite. Br Dent J 2006;200:557-61.  Back to cited text no. 3
4.Barbakow FH, Cleaton-Jones PE, Friedman D. Endodontic treatment of teeth with periapical radiolucent areas in a general dental practice. Oral Surg Oral Med Oral Pathol 1981;51:552-9.  Back to cited text no. 4
5.Hoen MM, LaBounty GL, Strittmatter EJ. Conservative treatment of persistent periradicular lesions using aspiration and irrigation. J Endod 1990;16:182-6.  Back to cited text no. 5
6.Saatchi M. Healing of large periapical lesion: A non-surgical endodontic treatment approach. Aust Endod J 2007;33:136-40.  Back to cited text no. 6
7.Caliºkan MK. Prognosis of large cyst-like periapical lesions following nonsurgical root canal treatment: A clinical review. Int Endod J 2004;37:408-16.  Back to cited text no. 7
8.Caliºkan MK, Türkün M. Periapical repair and apical closure of a pulpless tooth using calcium hydroxide. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:683-7.  Back to cited text no. 8
9.Sjögren U, Figdor D, Spångberg L, Sundqvist G. The antimicrobial effect of calcium hydroxide as a short-term intracanal dressing. Int Endod J 1991;24:119-25.  Back to cited text no. 9


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