Dental Tribune United Kindom Edition

July 30 - August 5, 201218 Endo Tribune United Kingdom Edition plastic cannula was inserted into the lesion, obtaining purulent drainage. Thereafter, the cannula was prepared and sutured to the mucosa (Figs 8 & 9), and the patient was in- structed to irrigate through the lumen of the cannula with 3ml of 0.12 per cent chlorhex- idine on a daily basis for four weeks (Fig 10), consistent with the protocol described by Brøndum and Jensen.5 3Two months after the last visit, complete drying of the canal space was achieved but, owing to the extent of the le- sion, it was decided to replace and maintain the Ca(OH)2 for two months in order to deter- mine whether this would ef- fect healing as evidenced in the pattern of the lesion. 4 Two months later, heal- ing appeared to be underway (Fig 11a) and the canal was dry. The root-canal filling was performed with gutta-per- cha and AH Plus (DENTSPLY DeTrey) and composite were placed to seal the access (Fig 11b). The patient was recalled at eight months and was asymp- tomatic and there was no swelling or abscess at either the palatal or buccal surfac- es. Normal pulpal responses have been maintained in teeth #7 to 11 since. Healing of the lesion still appeared to be in progress, owing to the reduction in the size of the lesion. The trabec- ular pattern at the borders of the lesion had been restored (Fig. 11c) and the perio dontal ligament around tooth #9 was almost fully recovered (Fig. 12). We plan to recall this pa- tient on a yearly basis until the lesion is fully healed. Discussion The management of large periapical lesions is the sub- ject of prolonged debate. The treatment options range from RCT or NSRCT with long-term Ca(OH)2 therapy to various surgical interventions, in- cluding marsupialisation, de- compression with a tube and surgical removal of the lesion. These treatment options can also be combined. Long-term drainage is im- portant in the conservative management of these large le- sions. One method is to drain through the canal on a daily basis until the canal becomes dry. This could last for be- tween 15 days and one month. At each visit, debridement, drying and closing of the ac- cess cavity are mandatory. Another method of drainage is decompression with a tube page 17DTß Fig 7 Remains of buccal encapsulated tissue Fig 8 Modified print tip used as cannula ‘Long-term drainage is important in the conservative management of these large lesions. One method is to drain through the canal on a daily basis until the canal becomes dry’ Fig 9 Sutured plastic cannula Fig 10 Flat-tipped needle with Luer-Lok syringe for irrigation Fig 11a After five months of interim medi- cation, healing appeared to be underway. Fig 11b Root-canal filling and coronal sealing Fig 11c Eight-month recall periapical radiograph Fig. 12 Eight-month recall panoramic radiograph