Modern endodontic medication in chronic osteodestructive apical periodontitis

Abstract

Background. Chronic osteodestructive apical periodontitis is a frequently encountered condition in endodontic practice, characterized by progressive periapical bone destruction resulting from persistent root canal system infection. The organization of the endodontic microbiota as a three-dimensional polymicrobial biofilm, extending into complex anatomical structures such as isthmuses, lateral canals, and dentinal tubules, explains the increased resistance to conventional treatment and the maintenance of chronic periapical inflammation. Objective of the study: To evaluate the effectiveness of modern endodontic medication in the management of chronic osteodestructive apical periodontitis by analyzing the impact of chemomechanical decontamination associated with activated irrigation and calcium hydroxide–based intracanal medication on infection control and periapical healing processes. Material and methods. This observational descriptive study included adult patients clinically and radiographically diagnosed with osteodestructive periapical lesions. The therapeutic protocol consisted of reciprocating mechanical preparation, sequential irrigation with sodium hypochlorite at concentrations of 5– 10% with ultrasonic activation, use of 17% EDTA, application of calcium hydroxide intracanal medication, and three-dimensional obturation using modern thermoplastic techniques in association with appropriate sealers. Clinical and radiological follow-up was performed for up to 24 months. Results. Most cases demonstrated resolution of clinical symptoms and progressive reduction of periapical radiolucency, with restoration of trabecular bone architecture at later follow-up stages. Faster healing was observed in cases treated using comprehensive activated irrigation protocols and adequate intracanal medication. Conclusions. The application of an integrated therapeutic protocol aimed at effective biofilm control and prevention of reinfection allows the achievement of stable and predictable periapical healing in the medium and long term.