2012 Volume 55 Issue 1 Pages 60-65
There are many cases diagnosed in routine dental practice as persistent apical periodontitis with continuous and oppressive apical pain, occlusal pain, and pain on percussion. It is particularly difficult to diagnose persistent cases that are caused by apical fenestration with two-dimensional (2D) X-rays. Such cases are often treated in general dental offices as unexplained persistent apical periodontal disorders. This article reports cases referred to our Department for treatment that are caused by apical fenestration among those cases where general practitioners have made a diagnosis of either persistent apical periodontitis with continuous and oppressive apical pain, or strange sensations on percussion mainly in the anterior maxilla. We diagnosed and treated ten cases in which general practitioners had made a diagnosis of persistent apical periodontitis and had been referred to the Department of General Dentistry, Tokyo Dental College Suidobashi Hospital. Of the ten cases, seven cases were positively diagnosed preoperatively with CT images and three cases were diagnosed by palpation of the periapical gum in each affected tooth for an apicoectomy in a normal manner. The ten cases were then followed-up. In the majority of cases, lateral condensation was performed under clear vision using gutta-percha points and Finapec APC® immediately before the apicoectomy, rather than reverse canal filling. The maximum term of postoperative follow-up of four years showed a disappearance of discomfort, such as that of oppressive apical pain, for all ten cases. These results suggest that an apicoectomy as a therapeutic approach to persistent apical periodontitis due to apical fenestration is considered to be an effective option.
