Decompression of a large periapical lesion: a short treatment course

By Kehoe JC

Date: 07/1986
Journal: JOE

Summary:

-16 years old black female.

•Swelling :Extensive symptomatic nonfluctuant palatal swelling

•Past medical history was negative and oral temperature was 101.6 ºF. •Trauma at a younger age caused the right maxillary central incisor fracture .

•Intermittent palatal swelling and spontaneous drainage has been noted for 1 year.

•Radiographs: Large RL involving the apices of teeth #11,12,13.

•The central incisor did not respond to thermal or electrical pulp tests while the others did.

-Dx: Pulp necrosis with a symptomatic chronic apical periodontitis(Phoenix abscess).

Treatment:

-The maxillary central incisor was opened and suppurative exudate was released.

-WL, Instrumentation, temporized with unmedicated cotton pellet and cavit.

-Antibiotic therapy & Analgesics.

-1 week after the canal was obturated , vertical Incision 1 cm in length Mesial to the right central incisor in the area of root apex and perforation of the cortical bone.

-Drainage of 2 to 3 ml of purulent exudate, the lesion was aspirated and gently irrigated.

-A sterile plastic chuck was inserted through the perforation and the incision was sutured forming a snug collar around the plastic chuck.

-The suture and plastic chuck were removed after 10 days.

-Most highlighted Results: 

-No evidence of swelling and the patient had been asymptomatic since the second day after the decompression procedure.

-Progressive osseous repair shown in the postoperative radiographs.