Treatment
Non-Surgical Root Canal Treatment
First-line treatment; achieves healing in 85–95% of granulomas and many cysts
- • Complete chemo-mechanical debridement of all canals
- • Copious NaOCl + EDTA irrigation
- • Long-term (3–4 week) calcium hydroxide dressing in large lesions to promote periapical healing
- • Dense three-dimensional obturation with warm gutta-percha
- • Radiographic review at 6 months, 1 year, 2 years post-treatment
- • Healing defined as: reduction in lesion size, development of corticated margin, or complete resolution
Non-Surgical Retreatment
For previously root-canal-treated teeth with persistent periapical lesion
- • Remove existing filling material (gutta-percha solvents + files)
- • Identify and treat missed canals with CBCT guidance
- • Remove intraradicular biofilm with ultrasonic agitation of irrigants
- • New calcium hydroxide dressing
- • Dense obturation; re-evaluate 1–2 years
Periapical Surgery (Apicoectomy)
Indicated for non-resolving lesions after 2+ years, suspected true cysts, or surgical access needed
- • Full-thickness mucoperiosteal flap elevation
- • Ostectomy to access root apex with carbide bur
- • Root-end resection (3mm), removing apical delta
- • Retrograde cavity preparation with ultrasonic tips
- • Root-end filling with MTA or bioceramic cement
- • Curettage and submission of lesion for histopathology
- • Flap repositioning and suture
- • Radiographic review at 1 and 2 years