Long-Term Results of Apical Periodontitis Treatment Using a Standardized Technique

Objectives: the purpose of this study was to assess the one-year outcome of multi-visit endodontic treatment of teeth with apical periodontitis using calcium hydroxide as the intracanal medicament. Methods: the material consisted of 40 teeth in 37 patients with radiographic signs of apical periodontitis had been referred to the Dental School of the Belarusian Medical University. The endodontic treatment was followed a standardized protocol with aseptic techniques including the use of rubber dam. The root canals were cleaned and shaped with hand instruments and 2.5% NaOCl and 17% EDTA solutions as irrigants. The canals were medicated for 7-14 days with a calcium hydroxide paste and were sealed with zinc oxide eugenol cement. At the second appointment, the canals were filled with laterally-condensed gutta percha and a sealer, and the teeth were restored. The measure of treatment outcome was absence (favourable) or presence (unfavourable) of radiographic and clinical signs of apical periodontitis, or loss of the tooth. Results: favourable outcomes of treatment were found in 32 (80%) of the teeth, and the outcome of five teeth (12.5%) was designated as being “uncertain but surviving” (no clinical signs of on-going periapical pathosis and the pre-operative periapical radiolucency had either remained the same size or had decreased in size). Unfavourable outcomes were noted in three teeth (7.5%) which had been extracted before the recall examination – one because it had a root fracture while the other two because the radiolucencies had increased in size and there were clinical signs of periapical abscesses. Conclusions: this study demonstrates that the standardized aseptic protocol of endodontic treatment using calcium hydroxide as an inter-appointment intracanal medicament for the management of infected canals with apical periodontitis is a procedure with a high rate of tooth retention.