Root canal treatment of an extensive periapical lesion

Chronic apical periodontitis (CAP) is one of the most common endodontic diagnosis caused by microbial infection within the root canal system of the affected tooth. Endodontic therapy is one of the possible treatment modalities for CAP, but the prognosis depends on numerous factors. The size of the periapical lesion is always singled out as one of the most significant, as its increase drastically decreases the degree of success of endodontic therapy. Certain periapex radiographic indices (PAI, CBCT-PAI, PESS) are used to evaluate the size and characteristics of the periapical lesion, as well as to monitor the outcome of the implemented therapy. A 30-year-old patient presented with pain caused by an acute exacerbation of CAP on tooth 37. Radiographic analysis revealed the presence of an extensive, diffuse radiolucency in the area of tooth 37. A complete endodontic procedure was performed. One year after, there were clear, radiographic signs of the reduction of the lesion. Findings of periapical radiographic indices indicated the success of therapy as well. The aim of this paper was to present, on one case from clinical practice, complete endodontic therapy protocol of an extensive periapical lesion with symptoms of exacerbation.