Periodontite apical persistente: etiologia, diagnóstico e tratamento

Abstract

Even with all the advances in Endodontics over time, it remains a challenging task to establish the etiology and diagnosis of the changes that involve the pulp and peri-apex. Through a literature review, the present study aims to study the etiology, diagnosis, and some treatment options for persistent apical periodontitis (PAP). Even when cleaning and filling the channels correctly, it is possible that periapical periodontitis persists in the form of an asymptomatic radiolucency, giving rise to PAP. This can present several etiologic factors, being the main factor associated with the persistence of microorganisms in the root canal system (RCS). However, although some causes are well known to the endodontist, the development of PAP seems to be somewhat unpredictable in endodontic practice. Therefore, it is extremely important for dentists to know how to diagnose and know the existing techniques for the treatment of this pathology. And for that, the endodontist must always be up-to-date on the options of imaging tests available, knowing how to indicate and interpret them very well, since in some cases of PAP a cone beam computed tomography is indispensable. It is well documented that the persistence of microorganisms in the RCS has been shown to be the main cause for the failure of endodontic treatment and the appearance of PAP. For this reason, the chemical and mechanical disinfection of the RCS must always be performed very well, as well as the filling of the channels, since another weight factor that can be attributed to the appearance of PAP is the presence of irritating agents in the periapex, such as extrusion of filling materials and accumulation of cholesterol crystals. For the treatment of PAP, the options currently available are: endodontic retreatment and / or periapical surgery with the attribution of other methods such as photodynamic therapy, laser and pulp revascularization.