Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis

TLDR

Periapical lesions that do not heal despite careful bacteriological monitoring may be caused by bacteria establishing outside the root canal, rendering them inaccessible to conventional endodontic treatment. After eliminating bacteria anaerobically before root filling, 79 periapical lesions were followed for 2–5 years, with most healing or shrinking, while only five showed little change—two still contained Actinomyces or Arachnid and one had dentin chips.

Abstract

Abstract Using a careful anaerobic bacteriological technique, bacteria were shown to be eliminated from infected root canals before the endodontic treatment was finished by root filling. Healing of the periapical lesions of the teeth was followed for 2–5 yr. The majority of the 79 lesions healed completely or decreased in size in such a way that they could be expected to heal. In 5 cases there was no or only an insignificant decrease in the size of the lesions. Two of these lesions were shown to contain bacteria of the species Actinomyces or Arachnid. In another case there were dentin chips in the periapical tissue. Periapical lesions which fail to heal in spite of careful bacteriological monitoring of the endodontic treatment may in some cases be due to an establishment of the bacteria outside the root canal in the periapical tissue. In these sites, the bacteria are inaccessible to conventional endodontic treatment.