Successful nonsurgical management of large periapical lesion – a case report

Katarzyna Olczak


This article presents a case where an extensive inflammatory change in the periapical tissues was successfully treated by conservative root canal treatment. A patient was referred to a specialist endodontic clinic for apicoectomy of tooth 22. Despite the presence of extensive changes in the bone, it was chosen not to perform resection and instead to perform conservative root canal treatment to decompress the cyst through the root canal. The treatment was successful, as confirmed over an 8-year observation period. Cone beam computed tomography (CBCT) was used to diagnose the lesions and monitor the healing process. A CBCT scan performed after the treatment indicated that sealer had been introduced beyond the anatomical opening; however, this did not disturb the healing of the periapical tissue. This case is an example confirming the value of limiting the hasty use of endo-surgical or surgical treatment.


nonsurgical management; periapical lesion; root canal treatment; tomography

Full Text:



Ramachandran Nair PN, Pajarola G, Schroeder HE. Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81(1):93-102.

Schulz M, von Arx T, Altermatt HJ, Bosshardt D. Histology of periapical lesions obtained during apical surgery. J Endod 2009;35(5):634-42.

Natkin E, Oswald RJ, Carnes LI. The relationship of lesion size to diagnosis, incidence, and treatment of periapical cysts and granulomas. Oral Surg Oral Med Oral Pathol 1984;57(1):82-94.

Sood N, Maheshwari N, Gothi R, Sood N. Treatment of large periapical cyst like lesion: a noninvasive approach: a report of two cases. Int J Clin Pediatr Dent 2015;8(2):133-7.

Nair MK, Nair UP. Digital and advanced imaging in endodontics: a review. J Endod 2007;33(1):1-6.

Olczak K, Pawlicka H. Mineral trioxide aggregate in treatment of permanent teeth with open apex and endo-perio lesions. A case report. Eur J Paediatr Dent 2015;16(4):287-9.

Estrela C, Bueno MR, Azevedo BC, Azevedo JR, Pécora JD. A new periapical index based on cone beam computed tomography. J Endod 2008;34(11):1325-31.

Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J 2007;40(10):818-30.

Sroczyk-Jaszczyńska M, Kołecki J, Lipski M, Puciło M, Wilk G, Falkowski A, et al. A study of the symmetry of roots and root canal morphology in mandibular anterior teeth using cone-beam computed tomographic imaging in a Polish population. Folia Morphol (Warsz) 2020;79(4):835-44. doi: 10.5603/FM.a2019.0128.

Olczak K, Pawlicka H, Szymański W. Root form and canal anatomy of maxillary first premolars: a cone-beam computed tomography study. Odontology 2022;110(2):365-75.

Calişkan MK. Prognosis of large cyst-like periapical lesions following nonsurgical root canal treatment: a clinical review. Int Endod J 2004;37(6):408-16.

European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J 2006;39(12):921-30.

Paredes-Vieyra J, Enriquez FJ. Success rate of single- versus two-visit root canal treatment of teeth with apical periodontitis: a randomized controlled trial. J Endod 2012;38(9):1164-9.

Lofthag-Hansen S, Huumonen S, Gröndahl K, Gröndahl HG. Limited cone--beam CT and intraoral radiography for the diagnosis of periapical pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(1):114-9.

Velvart P, Hecker H, Tillinger G. Detection of the apical lesion and the mandibular canal in conventional radiography and computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92(6):682-8.

Rigolone M, Pasqualini D, Bianchi L, Berutti E, Bianchi SD. Vestibular surgical access to the palatine root of the superior first molar: “low-dose cone-beam” CT analysis of the pathway and its anatomic variations. J Endod 2003;29(11):773-5.

Simon JH, Enciso R, Malfaz JM, Roges R, Bailey-Perry M, Patel A. Differential diagnosis of large periapical lesions using cone-beam computed tomography measurements and biopsy. J Endod 2006;32(9):833-7.

Hannig C, Dullin C, Hülsmann M, Heidrich G. Three-dimensional, non--destructive visualization of vertical root fractures using flat panel volume detector computer tomography: an ex vivo in vitro case report. Int Endod J 2005;38(12):904-13.

Nakata K, Naitoh M, Izumi M, Inamoto K, Ariji E, Nakamura H. Effectiveness of dental computed tomography in diagnostic imaging of periradicular lesion of each root of a multirooted tooth: a case report. J Endod 2006;32(6):583-7.

Patel S, Dawood A. The use of cone beam computed tomography in the management of external cervical resorption lesions. Int Endod J 2007;40(9):730-7.

Fernandes M, De Ataide I. Non-surgical management of a large periapical lesion using a simple aspiration technique: a case report. Int Endod J 2010;43(6):536-42.

Shah N. Nonsurgical management of periapical lesions: a prospective study. Oral Surg Oral Med Oral Pathol 1988;66(3):365-71.

Loushine RJ, Weller RN, Bellizzi R, Kulild JC. A 2-day decompression: a case report of a maxillary first molar. J Endod 1991;17(2):85-7.

Martin SA. Conventional endodontic therapy of upper central incisor combined with cyst decompression: a case report. J Endod 2007;33(6):753-7.

Mejia JL, Donado JE, Basrani B. Active nonsurgical decompression of large periapical lesions – 3 case reports. J Can Dent Assoc 2004;70(10):691-4.

Calişkan MK, Türkün M. Periapical repair and apical closure of a pulpless tooth using calcium hydroxide. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84(6):683-7.

Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol 1992;8(2):45-55.

Ghose LJ, Baghdady VS, Hikmat YM. Apexification of immature apices of pulpless permanent anterior teeth with calcium hydroxide. J Endod 1987;13(6):285-90.


Copyright (c) 2022 Katarzyna Olczak

License URL: