Long-term success of endodontic treatment is dependent on adequate and appropriate cleaning and shaping of the root canal along with proper and correct obturation of the entire prepared space. This article aims to report an exceptional non-surgical and orthograde endodontic treatment of maxillary right central incisor with an extensive radiolucent LESION in a 17-year-old male. Six and 20-month follow-ups showed significant changes, including bone formation and PERIAPICAL healing within the LESION. The patient was asymptomatic. After 20 months, complete radiographic and clinical healing of the PERIAPICAL LESION was observed.

Background and Aim: Chronic dental PERIAPICAL LESIONs resulted from chronic inflammatory response to the PERIAPICAL tissues. Since T-helper (CD4+Y) cells are the prominent cells in these LESIONs, so the aim of this study was to determine the correlation between the concentration of IL-4 and IL-12 (most important cytokines for differentiation of T helper 2 and T helper 1 cells, respectively), and the diameter of chronic PERIAPICAL LESIONs. Materials & Methods: Thirty-eight chronic PERIAPICAL LESIONs were collected which 18 PERIAPICAL LESIONs had diameter of ≥5 millimeter (case group) and 20 PERIAPICAL LESIONs had the diameter less than 5 millimeter (control group). Tissue samples were cultured for 72 hours, then ELISA (Enzyme linked immuno-sorbent Assay) was used for determining the concentration of IL-4 and IL-12 in supernatant fluids. Mann-whitney U and Spearman correlation tests were used to analyze the data. Results: IL-4 and IL-12 were found in all of samples. There was no significant difference between case and control groups regarding the concentration of IL-4, IL-12 and IL-4/IL-12. The only significant correlation was between IL-4 and IL-6 concentration without any regard to the diameter of LESIONs (P less than 0.001)  (Spearman correlation coefficient= 0.593). Conclusion: It is concluded that in chronic PERIAPICAL LESIONs, probably T helper 1 and T helper 2 cells participate in active phases of inflammation and tissue damage equally. This could be resulted from mixed population of bacteria in these LESIONs.

Introduction: The study aimed to correlate the PERIAPICAL Index (PAI), obtained by way of PERIAPICAL radiographs, with the volume of chronic PERIAPICAL LESION, obtained through conebeam computed tomography (CBCT), in the permanent teeth. Methods and Materials: Radiographs and CBCT images were selected from 35 single-rooted permanent teeth, with fully formed apices, with a diagnosis of pulp necrosis and chronic apical periodontitis that was radiographically visible. Two independent raters evaluated the radiographs on two separate occasions and classified the PERIAPICAL LESIONs in accordance with Ø rstavik’ s PAI. The PERIAPICAL LESION volume was calculated in the CBCT images. The correlation between the PAI and the LESION volume was calculated using Spearman’ s correlation test. Results: There was a positive, moderate correlation between the PAI and the volume (rs=0. 596; P<0. 001) where rs 2 is equal to 0. 355, showing that only 35% of the PAI variation was dependent upon the variation in PERIAPICAL LESION volume. Conclusion: The radiographic evaluation of the PERIAPICAL LESION does not reflect the LESION’ s volumetric characteristics as the volume had a moderate effect on the choice of PAI score.

Pulp and PERIAPICAL diseases are directly or indirectly caused by oral bacteria and various bacteria species play role in root canal infection. The purpose of this study was to investigate bacterial flora in the apical third of teeth with PERIAPICAL LESION.Forthy teeth with PERIAPICAL LESION from 40 patients, extracted. Five mm of the apex of each teeth was cut under anerobic condition using sterile bur. The content of root canals were transferred to two blood agar cultures including an aerobic and anerobic (Hydrogen 5%, CO2 10% Nitrogen 85%) condition using sterile files.Ten intact teeth extracted dueto orthdontic treatments as control group. After the formation of colonies, the types of bacterial species were recognized according to morphologic properties of cultured colonies, gram staining technique and using microscope and biochemical tests.The results showed that 126 bacteria belonging to 17 different species were isolated 62 bacteria from 126 bacteria were obligate anerobic and the sum of obligate and factitive anerobic bacteria were 118 in number (94%). Almost all the specimens (39 out of 40) showed bacterial growth and at least one anerobic bacterium species was detected in each of them. This confirms that the root canal infections are caused by various species. Sterptococcus species were the most common strain, bacteroid species which the peptococcous were the most common.At least 26 specimens (95% of all spescimens) had a strain of bacteroid in root canal infection.Based on the results of this study, bacteria play a very important role in root canal intection and our study indicated that anerobic bacteria had the most efficacy.

Introduction: The success of root canal treated teeth with PERIAPICAL LESIONs was addressed in several studies. However, in some cases, such as traumatic occlusion, these LESIONs may remain stable. On the other hand, the effect of traumatic occlusion in development of pulp and PERIAPICAL diseases is not known thoroughly.Case Report: The article reports the remaining of PERIAPICAL LESION after appropriate endodontic treatment and surgery in a 17-year-old patient. However, the patient symptoms improved after removal of premature contacts and PERIAPICAL LESION healed.Conclusion: Elimination of premature contacts during treatment can be one of the influential factors in treatment outcomes.

The treatment of necrotic permanent teeth with immature apices is a daunting challenge. Apexification has been traditionally used to treat immature permanent teeth with lost pulp vitality. This technique promotes the formation of an apical barrier to close the open apex so that filling materials can be confined to the root canal. The authors present a case report of the successful treatment of a traumatized tooth with an open apex that was weakened due to a long-standing infection and thin dentin walls. In this case, we first used a triple antibiotic to disinfect the canal and then placed a calcium-enriched mixture (CEM) cement plug. Follow-up evaluations were performed 15 months after treatment. The CEM-cement appears to be a valid material to obtain periradicular healing in teeth with open apices and necrotic pulps.