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Nonsurgical management of periapical lesions

Surgically treated periapical lesions show enhanced healing kinetics compared with those treated nonsurgically.[ Surgical removal of the periapical, chronically inflamed tissue allows a fresh blood clot to form, thereby converting a chronic inflammatory lesion into a new granulation tissue, where healing might proceed much faster.[64,65] The Apexum procedure uses two sequential rotary devices, the Apexum NiTi Ablator and Apexum PGA Ablator (Apexum Ltd, Or Yehuda, Israel), designed to extend beyond the apex and mince the periapical tissues on rotation in a low-speed handpiece, followed by washing out the minced tissue. A clinical trial reported significantly faster periapical healing in the Apexum-treated group (95%) than in the conventional root canal treatment group (39%) at six months, with significantly less postoperative discomfort or pain. However, whether the procedure was able to remove all the periapical inflammatory tissue was beyond the scope of the study conducted. Further studies regarding this procedure are in progress.