IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 8 Ver. V (Aug. 2015), PP 105-108 www.iosrjournals.org DOI: 10.9790/0853-1485105108 www.iosrjournals.org 105 | Page Non- Surgical Management of Periapical Lesion Dr. Shikha Gupta 1 , Dr. Parimala Kulkarni 2 , Dr. Arpana Bansal 3 , Dr. Ankur Jain 3 . 1 (Post graduate student, Department of Pediatric and Preventive Dentistry, People’s Dental Academy, India) 2 (Professor and head, Department of Pediatric and Preventive Dentistry, People’s Dental Academy, India) 3 (Associate Professor, Department of Pediatric and Preventive Dentistry, People’s Dental Academy, India) Abstract: With dawn of era of minimal intervention in dentistry, surgical management of periapical lesions become controversial. Non-surgical or conservative management of periapical lesions not only cause less trauma to the tissues, but also promote faster and less eventful healing. This paper presents successful management of a periapical lesion in a 14 year old male child with calcium hydroxide paste in an oily vehicle with successful resolution of signs and symptoms both clinically and radiographically. Keywords: Calcium hydroxide, non surgical, Periapical lesions. I. Introduction The main goal of endodontic therapy is to completely eradicate or achieve a significant decrease in microbial flora of root canal system and to return the involved teeth to a state of health and function. Chemo- mechanical instrumentation alone is not completely sufficient or capable to disinfect the root canal system. 1 All inflammatory periapical lesions should be initially treated with conservative nonsurgical procedures. Surgical intervention is recommended only after nonsurgical techniques have failed. Surgical procedures have many drawbacks, which limit their use in the management of periapical lesions. Various studies have reported a success rate of up to 85% after endodontic treatment of teeth with periapical lesions. A high percentage of 94.4% of complete and partial healing of periapical lesions following nonsurgical endodontic therapy has also been reported 2 . Children specifically should be treated initially with nonsurgical approach, especially those causing least harm, both functionally and psychologically. Non-surgical techniques procedures for managing periapical lesions include like Active nonsurgical decompression technique, Aspiration and irrigation technique, Decompression technique Conservative root canal treatment without adjunctive therapy Aspiration through the root canal technique Method using calcium hydroxide Apexum procedure, Lesion sterilization and repair therapy. 3 Calcium hydroxide is used extensively as an intracanal medicament in endodontics for many years. It is used in various clinical situations such as to promote apexification, to repair perforation, to enhance healing of periapical lesions, to control root resorption, and to control exudation in teeth with persistent periapical inflammation. This paper presents a case report of non surgical management of a large periapical lesion in which Ca(OH) 2 was used as an intracanal medicament. II. Case Report A male patient 14 years of age, reported to the department of Pediatric and Preventive Dentistry of our institution with the chief complaint of swelling and intermittent pain in relation to upper front teeth. A history of accident 2 years back involving trauma to tooth was recorded. There was slight bearable pain since one year and swelling since 2-3days which has been increasing progressively. On oral examination, it was found that 11 was fractured (Ellis Class II fracture) and a small swelling was seen on the labial aspect of gingiva approx. On radiographic examination, a large radiolucency in the periapical area was seen in relation to 11 on the lateral aspect. Pulp vitality showed the tooth 11 to be non-vital and 12 and 21 to be vital. Only 11 was found tender on percussion. Root canal treatment was decided in 11. Access opening was done and abscess drained through the root canal. After thorough irrigation, tooth was sealed with a temporary restoration. In the following visit, the working length estimation and a thorough chemo-mechanical preparation was done using Ni-Ti K files. The root canals were irrigated with combination of sodium hypochlorite and sterile saline solution. The canals were dried with sterile paper points. Later, Metapex, a silicone oil-based calcium hydroxide paste containing 38% iodoform was placed in the root canal and pushed periapically. 3 months follow up did not show any noticeable healing of periapical region. On pulp vitality testing 12 was found to be non-vital. Root canal treatment was initiated thereby and access opening, working length determination and a thorough chemo-mechanical preparation was done. 2 months follow up revealed initiation of periapical healing in the area. The intracanal dressing was renewed at quarterly intervals. Regular follow ups