Treatment outcomes of periapical lesions in permanent incisors treated with calcium hydroxide

Abstract

Introduction: There remains debate over the optimal initial treatment of periapical lesions that are the hallmark of chronic apical periodontitis. Calcium hydroxide may be a cost-effective initial non-surgical treatment for these lesions. The aim of this study was to evaluate the short-term treatment outcome of periapical lesions treated with calcium hydroxide both clinically and radiographically. Methods: Patients with periapical lesions having Periapical Index (PAI) ≥ 3 and horizontal diameter ≤ 5mm were invited to participate in this study. A standardized treatment incorporating calcium hydroxide paste was applied followed subsequently by obturation with gutta-percha and endomethasone cement. Clinical response was determined by the presence or absence of symptoms before and at 3 and 6 months after therapy. Radiological evidence of healing was determined at both 3 and 6 months according to three predefined categories (‘healed’, ‘healing’ and ‘not healed’) based on changes in the PAI determined by a blinded assessor. Results: Twenty-seven patients with thirty-six permanent incisors with periapical lesions were included in the study. Nine patients with ten treated lesions were lost to follow up. Clinical symptoms improved significantly after treatment with calcium hydroxide. With radiological assessments, there was a large decline in the percentage graded as ‘not healed’ at 6 months post therapy (from 100% at baseline to 19.2% at 6 months). The proportion of lesions rated as ‘healed’ and ‘healing’ at 6 months was 46.2% and 34.6%, respectively. Conclusion: Calcium hydroxide treatment appears to be effective at facilitating the healing of periapical lesions associated with chronic periodontitis.