The Treatment of Persistent Apical Periodontitis Caused by Apical Fenestration

DOI 14 References
  • FURUSAWA Masahiro
    Department of Clinical Oral Health Science, Division of General Dentistry, Tokyo Dental College:Division of Oral Health Sciences, Department of Health Sciences, Saitama Prefectural University
  • KONNO Michiyo
    Department of Clinical Oral Health Science, Division of General Dentistry, Tokyo Dental College
  • KURUSHIMA Yukina
    Department of Clinical Oral Health Science, Division of General Dentistry, Tokyo Dental College
  • YANAGIDA Hiroko
    Department of Clinical Oral Health Science, Division of General Dentistry, Tokyo Dental College
  • OOTA Kei
    Department of Clinical Oral Health Science, Division of General Dentistry, Tokyo Dental College
  • IDA Atsushi
    Department of Clinical Oral Health Science, Division of General Dentistry, Tokyo Dental College
  • HAYAKAWA Hiroki
    Department of Clinical Oral Health Science, Division of General Dentistry, Tokyo Dental College
  • HOSOKAWA Souhei
    Department of Clinical Oral Health Science, Division of General Dentistry, Tokyo Dental College:Division of Oral Health Sciences, Department of Health Sciences, Saitama Prefectural University
  • YOSHIDA Takashi
    Department of Clinical Oral Health Science, Division of General Dentistry, Tokyo Dental College:Division of Oral Health Sciences, Department of Health Sciences, Saitama Prefectural University
  • ARIIZUMI Yuugo
    Department of Dental Hygiene, University of Shizuoka, Junior College
  • KOUNO Masayuki
    Department of Clinical Oral Health Science, Division of General Dentistry, Tokyo Dental College

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Other Title
  • フェネストレーションが原因で難治性根尖性歯周炎と診断された症例に対する処置

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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.

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