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Dental Tribune United Kindom Edition

19Endo TribuneJuly 30 - August 5, 2012United Kingdom Edition Making Digital Dentistry Happen Objet Eden260V 3D Printer 3D Printing Solutions for Digital Dentistry • Print stone models, veneer try‑ins and delivery trays, surgical guides, denture try‑ins, orthodontic appliances and more • Produce parts faster with superior accuracy and resolution • Eliminate manual work and improve efficiency Find out how Objet 3D Printing can transform your dental business today. www.objetdental.com • dental@objet.com from the apical focus. There is no standard protocol for the length of time for which the tube should be left in. Some clinical cases, however, have reported five-week to 14-month-periods, with peri- odical reshaping if necessary. The literature offers evi- dence that the majority of these cyst-like lesions heal after conventional RCT over multiple appointments. Çal- iskan6 reported 74 per cent complete healing and 9.5per cent incomplete healing in an in vivo study of anterior teeth with large periapi- cal lesions ranging from seven to 18mm. The treat- ment combined long-term canal drainage with Ca(OH)2 dressing and non-surgical RCT. Several case reports7–9 have demonstrated that long- term decompression involving a tube combined with interim Ca(OH)2 dressing and RCT is also successful. Decompression is favoured because fewer visits are nec- essary compared with root- canal drainage. Furthermore, it is much more conservative, especially in comparison with surgical removal of the le- sion with the risk of damaging the nervous and vascular supply of adjacent teeth and other anatomical structures, such as the nose and maxil- lary sinus floor. Even if surgi- cal removal is still necessary later, the lesion will predict- ably have shrunk in size by such time and present less difficulty and less risk of dam- age to other teeth or vital structures. With complete informed consent, the patient may pre- fer more immediate therapy and select surgical enuclea- tion without delay in conjunc- tion with the conventional endodontic therapy of the re- sponsible tooth and usually the adjacent ones involved in the lesion. It is important to remember that microbes initially caused the lesion and continue to maintain the im- mune response and thus the apical periodontitis. The length of time re- quired for healing in these cases ranges from eight to 14 months.6 Follow-up on the process of healing should be done every six months for four years. There are also large periapical lesions of nonden- tal origin, such as non-dental cysts (e.g. naso - palatal cyst) and neoplastic entities. If there are doubts regarding the dental origin of the periapical lesion, the first choice of treat- ment is the surgical approach. This case has illustrated the healing of a large peri- apical lesion with a minimally invasive approach. However, every case requires an indi- vidual approach depending on the patient’s cooperation, preferences, availability and proximity to the surgery, as well as the dentist’s profes- sional training and technical skills. DT • Editorial note: A complete list of references is available from the publisher. About the author Dr Nuria Campo received her degree from the University of Barcelona in 1997. She is a self-trained endodon- tist. Dr Campo co-organised the Roots Summit IX in Barcelona. ncampob@ gmail.com www.microendodoncia. wordpress.com es-es.facebook.com/ microendodoncia ‘Decompression is favoured because fewer visits are nec- essary compared with root-canal drainage. Further- more, it is much more conservative’