Single and multiple session endodontic treatment of teeth with periapical diseases: a case report

摘要

This case report aimed to compare the quality of the apical repair obtained in teeth with visible periapical lesions on radiography, treated either in single or in multiple sessions. The treatment was administered to a patient bearer of chronic periapical lesions in the apexes of teeth 41, 31 and 32. Teeth 41 and 32 received endodontic treatment in a single session, whereas 31 received Calen, an intracanal medication, for a fortnight before the final filling. Preservation x rays were then taken. The patient returned for the last time, 1 year and 4 months after completion of treatment. He was asymptomatic and the complete remission of radiotransparent images in the apexes of the teeth treated was observed, suggesting clinical and radiographic success of the endodontic treatment reported. Introduction Endodontics has been submitted to the most varied concepts and philosophies which characterize different stages of its development. Despite significant advances, many aspects and procedures in endodontics are still in discussion among the professionals, demanding a larger amount of research to be settled (1). The endodontic treatment of teeth with periapical lesion in a single session is one of such controversial themes. The success of the endodontic treatment is directly related to the control of the endodontic infection. In the situations of pulp vitality, the endodontic treatment in a single session is ideal if there is time for the accomplishment of the procedure. This treatment modality is based on the fact that the canal is free from bacteria. Since the aseptic chain has been maintained by the professional, there is no reason for not finishing the procedure in the same session (2).In the case of necrotized teeth with visible periapical lesions on a radiograph, the biomechanical preparation and the immediate filling of the root canal raise doubts over the quality of the canal sanitation due to the diffuse nature of the infection through the isthmuses, dentinal tubules, secondary and accessory canals, apical cementoclasts and spots of apical cementary reabsorption (3;4;5), Possibly, some reports of refractory periapical lesions or many cases of partially repaired radiotransparent areas are consequences of such remaining infection. Soares and Cesar (2001) (6) have assessed the incidence of postoperative pain and periapical repair, following the endodontic treatment in a single session in patient bearers of necrotized pulp associated with radiotransparent periapical lesions. After a twelve-month period, the endodontic treatment in a single session proved to be clinically successful in one hundred per cent of the cases, but radiographic success lagged far behind. However, the endodontic literature reports cases of treatment of teeth with necrotized pulp and periapical diseases in a single session and sometimes within a relatively short period (7;8;9;10;11), which had a good outcome. For example, Soares et al. (2005) (12) presented two clinical cases of teeth presenting with great periapical chronic lesions which were treated in a single session with clinical and radiographic success. Some authors have claimed that the success of the treatment is based on the proper use of the irrigant, on the professional's anatomical knowledge, and mainly, on the technical ability of such professional in carrying out an effective biomechanical instrumentation and a suitable three-dimensional filling.Therefore, the aim of this case report is to show an interesting case focusing on the discussion of the quality of periapical repair in endodontic treatment performed in single and multiple sessions. Case Report The patient, a Caucasian female, 20 years old, came to the dental public health service provided by the municipality of Limoeiro, Pernambuco, Brazil with a complaint of intense pain to vertical percussion in teeth 41, 31, and 32. The teeth had been restored for nearly 10 years prior to the date of the beginning of the treatment. Following the