Nonsurgical management of periapical lesions: a prospective study

A total of 93 cases comprising 132 teeth with signs and symptoms or radiographic evidence of periapical pathoses were treated endodontically and were followed up for a period of 2 years. Nonsurgical management was successful in 84.4% of the cases. Histopathologic examination of tissue specimens from cases in which treatment failed revealed that only 35.7% of the cases involved apical cysts, while the remaining 64.3% involved chronic inflammatory tissue. Interestingly, 50% of the failures were observed at or 1 year after completion of treatment, which stresses the need for long-term follow-up of treated endodontic cases. In this study, a successful outcome did not seem to be dependent on either the nature or the size of the lesion, even though it is true that treatment of larger lesions failed more frequently. There seems to be some individual immunologic response variation, which may influence the final outcome of the treatment. Gyromatic instruments were used in 44 of the 93 cases treated and were evaluated and compared with hand instruments in clinical situations. Gyromatic instruments were found to be more convenient and safer to use, since their use improved visibility and eliminated the risk of the instruments' falling into the throat and being aspirated. They exhibited good flexibility and could easily negotiate curved canals without breaking. Used judiciously, these would be efficient tools in the endodontist's armamentarium.