Evaluation of healing criteria for success after periapical surgery

INTRODUCTION: In periapical surgery, the absence of standardization between different studies makes it difficult to compare the outcomes. OBJECTIVE: To compare the healing classification of different authors and evaluate the prognostic criteria of periapical surgery at 12 months. MATERIAL AND METHODS: 278 patients (101 men and 177 women) with a mean age of 38.1 years (range 11 to 77) treated with periapical surgery using the ultrasound technique and a 2.6x magnifying glass, and silver amalgam as root-end filling material were included in the study. Evolution was analyzed using the clinical criteria of Mikkonen et al., 1983; radiographic criteria of Rud et al., 1972; the overall combined clinical and radiographic criteria of von Arx and Kurt, 1999; and the Friedman (2005) concept of functional tooth at 12 months of surgery. RESULTS: After 12 months, 87.2% clinical success was obtained according to the Mikkonen et al., 1983 criteria; 73.9% complete radiographic healing using Rud et al. criteria; 62.1% overall success, following the clinical and radiographic parameters of von Arx and Kurt, and 91.9% of teeth were functional. The von Arx and Kurt criteria was found to be the most reliable. CONCLUSION: Overall evolution according to von Arx and Kurt agreed most closely with the other scales.

Pulp and periodontal healing of laterally luxated permanent teeth: results after 4 years

AIM: To evaluate the pulp and periodontal healing of laterally luxated permanent teeth. MATERIAL AND METHODS: Patients presenting with lateral luxation of permanent teeth during 2001-2002 were enrolled in this clinical study. Laterally luxated teeth were repositioned and splinted with a TTS/composite resin splint for 4 weeks. Immediate (prophylactic) root-canal treatment was performed in severely luxated teeth with radiographically closed apices. All patients received tetracycline for 10 days. Re-examinations were performed after 1, 2, 3, 6, 12 and 48 months. RESULTS: All 47 laterally luxated permanent teeth that could be followed over the entire study period survived. In 10 teeth (21.3%), a prophylactic root-canal treatment was performed within 2 weeks following injury. The remaining 37 teeth showed the following characteristics at the 4-year re-examination: 19 teeth (51.4%) had pulp survival (no clinical or radiographic signs or symptoms), nine teeth (24.3%) presented with pulp canal calcification, and pulp necrosis was seen in another nine teeth (24.3%), within the first year after trauma. None of the teeth with a radiographically open apex at the time of lateral luxation showed complications. External root resorption was only seen in one tooth. CONCLUSIONS: Laterally luxated permanent teeth with incomplete root formation have a good prognosis, with all teeth surviving in this study. The most frequent complication was pulp necrosis that was only seen in teeth with closed apices.

Ultra-high-resolution dual-source CT for forensic dental visualization-discrimination of ceramic and composite fillings

Dental identification is the most valuable method to identify human remains in single cases with major postmortem alterations as well as in mass casualties because of its practicability and demanding reliability. Computed tomography (CT) has been investigated as a supportive tool for forensic identification and has proven to be valuable. It can also scan the dentition of a deceased within minutes. In the present study, we investigated currently used restorative materials using ultra-high-resolution dual-source CT and the extended CT scale for the purpose of a color-encoded, in scale, and artifact-free visualization in 3D volume rendering. In 122 human molars, 220 cavities with 2-, 3-, 4- and 5-mm diameter were prepared. With presently used filling materials (different composites, temporary filling materials, ceramic, and liner), these cavities were restored in six teeth for each material and cavity size (exception amalgam n = 1). The teeth were CT scanned and images reconstructed using an extended CT scale. Filling materials were analyzed in terms of resulting Hounsfield units (HU) and filling size representation within the images. Varying restorative materials showed distinctively differing radiopacities allowing for CT-data-based discrimination. Particularly, ceramic and composite fillings could be differentiated. The HU values were used to generate an updated volume-rendering preset for postmortem extended CT scale data of the dentition to easily visualize the position of restorations, the shape (in scale), and the material used which is color encoded in 3D. The results provide the scientific background for the application of 3D volume rendering to visualize the human dentition for forensic identification purposes.

Mayflower, Renova Basin, and South Boulder Creek Areas

In Montana at the turn of the century a great many men sought the riches buried in the earth's crust. Prospectors fanning out from Butte and other early Montana mining areas located veins at the Mayflower, Renova, and Gold Hill areas.

RFID Transponders : Link between information and material flows. How reliable are identification procedures?

Along with the growing complexity of logistic chains the demand for transparency of informations has increased. The use of intelligent RFID-Technology offers the possibility to optimize and control all capacities in use, since it enables the identification and tracking of goods alongside the entire supply chain. Every single product can be located at any given time and a multitude of current and historical data can be transferred. The interaction of the flow of material and the flow of information between the various process steps can be optimized by using RFID-Technology since it guarantees that all required data is available at the right time and at the right place. The local accessibility and convertibility of data allows a flexible, decentralised control of logistic systems. As additional advantages of RFID-Components can be considered that they are individually writable and that their identification can be achieved over considerable distances even if there is no intervisibility between tag and reader. The use of RFID-Transponder opens up new potentials regarding process security, reduction of logistic costs or availability of products. These advantages depend on reliability of the identification processes. The undisputed potentials that are made accessible by the use of RFID-Elements can only be beneficial when the informations that are decentralised and attached to goods and loading equipment can be reliably retrieved at the required points. The communication between tag and reader can be influenced by different materials such as metal, that can disturbed or complicate the radio contact. The communications reliability is subject of various tests and experiments that analyse the effects of different filling materials as well as different alignments of tags on the loading equipment.

Comparative antibacterial efficacies of hydrodynamic and ultrasonic irrigation systems in vitro

INTRODUCTION To ensure root canal treatment success, endodontic microbiota should be efficiently reduced. The in vitro bactericidal effects of a hydrodynamic system and a passive ultrasonic irrigation system were compared. METHODS Single-rooted extracted teeth (n = 250) were contaminated with suspensions of Enterococcus faecalis ATCC 29212, mixed aerobic cultures, or mixed anaerobic cultures. First, the antibacterial effects of the hydrodynamic system (RinsEndo), a passive ultrasonic irrigation system (Piezo smart), and manual rinsing with 0.9% NaCl (the control) were compared. Colony-forming units were counted. Second, the 2 systems were used with 1.5% sodium hypochlorite (NaOCl) alone or NaOCl + 0.2% chlorhexidine (CHX). The colony-forming units in the treated and untreated roots were determined during a period of 5 days. RESULTS Both irrigation systems reduced bacterial numbers more effectively than manual rinsing (P < .001). With NaCl, ultrasonic activated irrigation reduced bacterial counts significantly better than hydrodynamic irrigation (P = .042). The NaOCl + CHX combination was more effective than NaOCl alone for both systems (P < .001), but hydrodynamic irrigation was more effective with NaOCl + CHX than the passive ultrasonic irrigation system. CONCLUSIONS Both irrigation systems, when combined with NaOCl + CHX, removed bacteria from root canals.

The impact of loupes and microscopes on vision in endodontics.

AIM To report on an intraradicular visual test in a simulated clinical setting under different optical conditions. METHODOLOGY Miniaturized visual tests with E-optotypes (bar distance from 0.01 to 0.05 mm) were fixed inside the root canal system of an extracted maxillary molar at different locations: at the orifice, a depth of 5 mm and the apex. The tooth was mounted in a phantom head for a simulated clinical setting. Unaided vision was compared with Galilean loupes (2.5× magnification) with integrated light source and an operating microscope (6× magnification). The influence of the dentists' age within two groups was evaluated: <40 years (n = 9) and ≥40 years (n = 15). RESULTS Some younger dentists were able to identify the E-optotypes at the orifice, but otherwise, natural vision did not reveal any measurable result. With Galilean loupes, the younger dentists <40 years could see a 0.05 mm structure at the root canal orifice, in contrast to the older group ≥40 years. Only the microscope allowed the observation of structures inside the root canal, independent of age. CONCLUSION Unaided vision and Galilean loupes with an integrated light source could not provide any measurable vision inside the root canal, but younger dentists <40 years could detect with Galilean loupes a canal orifice corresponding to the tip of the smallest endodontic instruments. Dentists over 40 years of age were dependent on the microscope to inspect the root canal system.

The Perceived Prognosis of Endodontic Treatment and Implant Therapy Among Dental Practitioners

Little data concerning the perceived success of implant therapy in comparison with endodontic treatment exists. While the criteria used to measure the outcome of each modality are not the same, it is not clear if this is appreciated by practicing dentists. The purpose of the study was to evaluate the perceived outcome of implant therapy in comparison to endodontic treatment. A 23 question Web-based survey was distributed to 648 dentists who matriculated from the University of Connecticut School Of Dental Medicine over the past 30 years. The response rate was 47%. Sixty-seven percent of respondents were general dentists. Forty-nine percent of respondents did not know different criteria exist in the literature and are used to evaluate implant and root canal treatment. Fifty-four percent of dentists felt the prognosis of implant therapy was the same as or better than endodontic treatment of teeth with vital pulps. Thirty percent of responders thought root canal treatment of teeth with necrotic pulp was superior to implants and only 16% thought retreatment was preferable. Treatment planning for implant placement vs. retreatment of a restorable tooth was 46% and 32%, respectively. A third of the respondents felt that the role of endodontics will decline in the future. Dentists’ primary source of information regarding implant therapy was continuing education; however, their primary source of information regarding endodontic treatment was their dental program. Dentists felt the prognosis of implant therapy was as good or superior to endodontic treatment of teeth with vital, necrotic or previously treated pulps.

Pilot study assessment of indoor air quality in two dental settings: Particulate matter and volatile organic compounds

Objective: To assess the indoor environment of two different types of dental practices regarding VOCs, PM2.5, and ultrafine particulate concentrations and examine the relationship between specific dental activities and contaminant levels. Method: The indoor environments of two selected dental settings (private practice and community health center) will were assessed in regards to VOCs, PM 2.5, and ultrafine particulate concentrations, as well as other indoor air quality parameters (CO2, CO, temperature, and relative humidity). The sampling duration was four working days for each dental practice. Continuous monitoring and integrated sampling methods were used and number of occupants, frequency, type, and duration of dental procedures or activities recorded. Measurements were compared to indoor air quality standards and guidelines. Results: The private practice had higher CO2, CO, and most VOC concentrations than the community health center, but the community health center had higher PM2.5 and ultrafine PM concentrations. Concentrations of p-dichlorobenzene and PM2.5 exceeded some guidelines. Outdoor concentrations greatly influenced the indoor concentration. There were no significant differences in contaminant levels between the operatory and general area. Indoor concentrations during the working period were not always consistently higher than during the nonworking period. Peaks in particulate matter concentration occurred during root canal and composite procedures.^

Restauración de incisivo inferior fracturado mediante procedimientos de invasión mínima : reporte de un caso clínico

La odontología está inmersa en un nuevo paradigma: no se puede pensar en ninguna técnica restauradora sin que participen fenómenos de adhesión. El desarrollo de pernos de fibra de vidrio, sumado a los procedimientos de restauraciones adhesivas puede utilizarse como uno de los tantos recursos de la odontología de invasión mínima. Los pernos de fibra de vidrio ofrecen varias ventajas: comportamiento anisótropo, módulo de elasticidad bajo, buena resistencia mecánica, el lecho que aloja al perno de fibra requiere de una mínima preparación y se cementan con cementos adhesivos con carga, permitiendo de esta manera obtener una superficie homogénea que se interpone entre el perno de fibra y los tejidos dentales, conectándolo a los tejidos del conducto y sustituyendo mecánicamente la dentina. El caso clínico que se reporta se presentó para su resolución en la Clínica Integrada III F. O. UNCuyo durante el año lectivo 2009. El paciente presentaba una fractura amelodentinaria desde hacía cuatro años, con compromiso de la vitalidad y un proceso periapical. Durante los procedimientos endodónticos se realizó una perforación de la pared del conducto que se selló mediante la colocación de hidróxido de calcio y la obturación del mismo con conos de gutapercha. Se efectuó el seguimiento clínico y radiográfico del caso en donde se constató la reparación del proceso apical y luego se procedió a la restauración del elemento dentario con resinas compuestas con la ayuda de un poste de fibra de vidrio cementado con cemento resinoso. Dadas las características del tratamiento endodóntico realizado, se decidió dejar más porción del cono de gutapercha a pesar de lo aconsejado por numerosos autores, ya que de esta manera se aseguró el sellado de la perforación radicular para evitar de esta manera la nanofiltración hacia el interior del elemento dentario.

Evaluación de la profundidad de la fisuración superficial descendente en pavimentos asfálticos mediante técnicas de ultrasonidos. Validación teórico-práctica y modelos

La fisuración iniciada en la superficie de los pavimentos asfálticos constituye uno de los más frecuentes e importantes modos de deterioro que tienen lugar en los firmes bituminosos, como han demostrado los estudios teóricos y experimentales llevados a cabo en la última década. Sin embargo, este mecanismo de fallo no ha sido considerado por los métodos tradicionales de diseño de estos firmes. El concepto de firmes de larga duración se fundamenta en un adecuado seguimiento del proceso de avance en profundidad de estos deterioros y la intervención en el momento más apropiado para conseguir mantenerlos confinados como fisuras de profundidad parcial en la capa superficial más fácilmente accesible y reparable, de manera que pueda prolongarse la durabilidad y funcionalidad del firme y reducir los costes generalizados de su ciclo de vida. Por lo tanto, para la selección de la estrategia óptima de conservación de los firmes resulta esencial disponer de metodologías que posibiliten la identificación precisa in situ de la fisuración descendente, su seguimiento y control, y que además permitan una determinación fiable y con alto rendimiento de su profundidad y extensión. En esta Tesis Doctoral se presentan los resultados obtenidos mediante la investigación sistemática de laboratorio e in situ llevada a cabo para la obtención de datos sobre fisuración descendente en firmes asfálticos y para el estudio de procedimientos de evaluación de la profundidad de este tipo de fisuras empleando técnicas de ultrasonidos. Dichos resultados han permitido comprobar que la metodología no destructiva propuesta, de rápida ejecución, bajo coste y sencilla implementación (principalmente empleada hasta el momento en estructuras metálicas y de hormigón, debido a las dificultades que introduce la naturaleza viscoelástica de los materiales bituminosos) puede ser aplicada con suficiente fiabilidad y repetibilidad sobre firmes asfálticos. Las medidas resultan asimismo independientes del espesor total del firme. Además, permite resolver algunos de los inconvenientes frecuentes que presentan otros métodos de diagnóstico de las fisuras de pavimentos, tales como la extracción de testigos (sistema destructivo, de alto coste y prolongados tiempos de interrupción del tráfico) o algunas otras técnicas no destructivas como las basadas en medidas de deflexiones o el georradar, las cuales no resultan suficientemente precisas para la investigación de fisuras superficiales. Para ello se han realizado varias campañas de ensayos sobre probetas de laboratorio en las que se han estudiado diferentes condiciones empíricas como, por ejemplo, distintos tipos de mezclas bituminosas en caliente (AC, SMA y PA), espesores de firme y adherencias entre capas, temperaturas, texturas superficiales, materiales de relleno y agua en el interior de las grietas, posición de los sensores y un amplio rango de posibles profundidades de fisura. Los métodos empleados se basan en la realización de varias medidas de velocidad o de tiempo de transmisión del pulso ultrasónico sobre una única cara o superficie accesible del material, de manera que resulte posible obtener un coeficiente de transmisión de la señal (mediciones relativas o autocompensadas). Las mediciones se han realizado a bajas frecuencias de excitación mediante dos equipos de ultrasonidos diferentes dotados, en un caso, de transductores de contacto puntual seco (DPC) y siendo en el otro instrumento de contacto plano a través de un material especialmente seleccionado para el acoplamiento (CPC). Ello ha permitido superar algunos de los tradicionales inconvenientes que presenta el uso de los transductores convencionales y no precisar preparación previa de las superficies. La técnica de autocalibración empleada elimina los errores sistemáticos y la necesidad de una calibración local previa, demostrando el potencial de esta tecnología. Los resultados experimentales han sido comparados con modelos teóricos simplificados que simulan la propagación de las ondas ultrasónicas en estos materiales bituminosos fisurados, los cuales han sido deducidos previamente mediante un planteamiento analítico y han permitido la correcta interpretación de dichos datos empíricos. Posteriormente, estos modelos se han calibrado mediante los resultados de laboratorio, proporcionándose sus expresiones matemáticas generalizadas y gráficas para su uso rutinario en las aplicaciones prácticas. Mediante los ensayos con ultrasonidos efectuados en campañas llevadas a cabo in situ, acompañados de la extracción de testigos del firme, se han podido evaluar los modelos propuestos. El máximo error relativo promedio en la estimación de la profundidad de las fisuras al aplicar dichos modelos no ha superado el 13%, con un nivel de confianza del 95%, en el conjunto de todos los ensayos realizados. La comprobación in situ de los modelos ha permitido establecer los criterios y las necesarias recomendaciones para su utilización sobre firmes en servicio. La experiencia obtenida posibilita la integración de esta metodología entre las técnicas de auscultación para la gestión de su conservación. Abstract Surface-initiated cracking of asphalt pavements constitutes one of the most frequent and important types of distress that occur in flexible bituminous pavements, as clearly has been demonstrated in the technical and experimental studies done over the past decade. However, this failure mechanism has not been taken into consideration for traditional methods of flexible pavement design. The concept of long-lasting pavements is based on adequate monitoring of the depth and extent of these deteriorations and on intervention at the most appropriate moment so as to contain them in the surface layer in the form of easily-accessible and repairable partial-depth topdown cracks, thereby prolonging the durability and serviceability of the pavement and reducing the overall cost of its life cycle. Therefore, to select the optimal maintenance strategy for perpetual pavements, it becomes essential to have access to methodologies that enable precise on-site identification, monitoring and control of top-down propagated cracks and that also permit a reliable, high-performance determination of the extent and depth of cracking. This PhD Thesis presents the results of systematic laboratory and in situ research carried out to obtain information about top-down cracking in asphalt pavements and to study methods of depth evaluation of this type of cracking using ultrasonic techniques. These results have demonstrated that the proposed non-destructive methodology –cost-effective, fast and easy-to-implement– (mainly used to date for concrete and metal structures, due to the difficulties caused by the viscoelastic nature of bituminous materials) can be applied with sufficient reliability and repeatability to asphalt pavements. Measurements are also independent of the asphalt thickness. Furthermore, it resolves some of the common inconveniences presented by other methods used to evaluate pavement cracking, such as core extraction (a destructive and expensive procedure that requires prolonged traffic interruptions) and other non-destructive techniques, such as those based on deflection measurements or ground-penetrating radar, which are not sufficiently precise to measure surface cracks. To obtain these results, extensive tests were performed on laboratory specimens. Different empirical conditions were studied, such as various types of hot bituminous mixtures (AC, SMA and PA), differing thicknesses of asphalt and adhesions between layers, varied temperatures, surface textures, filling materials and water within the crack, different sensor positions, as well as an ample range of possible crack depths. The methods employed in the study are based on a series of measurements of ultrasonic pulse velocities or transmission times over a single accessible side or surface of the material that make it possible to obtain a signal transmission coefficient (relative or auto-calibrated readings). Measurements were taken at low frequencies by two short-pulse ultrasonic devices: one equipped with dry point contact transducers (DPC) and the other with flat contact transducers that require a specially-selected coupling material (CPC). In this way, some of the traditional inconveniences presented by the use of conventional transducers were overcome and a prior preparation of the surfaces was not required. The auto-compensating technique eliminated systematic errors and the need for previous local calibration, demonstrating the potential for this technology. The experimental results have been compared with simplified theoretical models that simulate ultrasonic wave propagation in cracked bituminous materials, which had been previously deduced using an analytical approach and have permitted the correct interpretation of the aforementioned empirical results. These models were subsequently calibrated using the laboratory results, providing generalized mathematical expressions and graphics for routine use in practical applications. Through a series of on-site ultrasound test campaigns, accompanied by asphalt core extraction, it was possible to evaluate the proposed models, with differences between predicted crack depths and those measured in situ lower than 13% (with a confidence level of 95%). Thereby, the criteria and the necessary recommendations for their implementation on in-service asphalt pavements have been established. The experience obtained through this study makes it possible to integrate this methodology into the evaluation techniques for pavement management systems.

Absorción acústica a incidencia normal de espumas de aluminio

En este artículo se presentan los primeros resultados de absorción acústica a incidencia normal de espumas de aluminio fabricadas mediante una técnica pulvimetalúrgica. El interés de estas espumas radica en que en ellas se combinan interesantes propiedades acústicas y mecánicas. Se estudian espumas de aluminio de distinta morfología superficial conseguida variando el tipo de precursor y usando materiales de relleno durante el proceso de espumación. Se muestra un estudio comparativo de las espumas fabricadas mediante esta técnica con las espumas comerciales ALPORAS. Las espumas de menor densidad presentan una absorción acústica comparable a la de las comerciales ALPORAS. ABSTRACT. In this paper, the first experimental data of acoustic absorption at normal incidence in aluminum foams generated by a metallurgic technique are presented. The interest of this kind of structures is due to the combination of mechanical and acoustic properties. By changing the precursor type or using filling materials during the foaming process, we have obtained aluminum foams with different surface morphologies. A comparative study between foams fabricated using this technique and ALPORAS commercial aluminum foams is shown. The foams which present the lower density show an acoustic absorption comparable to the ALPORAS commercial ones.

Análise biomecânica de resistência à fratura em dentes caninos artificiais de cães, com restauração metálica fundida e retentores intrarradiculares retos e curvos com núcleo - Estudo comparativo com análise por elementos finitos

Os cães, por fatores diversos, acabam por apresentar dentes fraturados com ou sem exposição de polpa. Estas fraturas basicamente são identificadas como fraturas recuperáveis não complicadas, recuperáveis complicadas ou irrecuperáveis. As fraturas recuperáveis (localizadas apenas no esmalte e dentina) são tratadas com dentística restauradora. As recuperáveis complicadas (com lesões em esmalte, dentina e exposição do canal radicular) passam por tratamento endodôntico, podendo ser seguidas de restaurações metálicas. Os dentes mais comumente acometidos são os dentes caninos, superiores ou inferiores. Este trabalho em dentes artificiais simulando considerável destruição de sua porção coronal objetivou testar, após a adaptação da restauração metálica fundida, a resistência às fraturas no dente canino. Os dentes artificiais foram padronizados com uma técnica de replicação de raízes artificiais em molde de resina acrílica quimicamente ativada. Oitenta réplicas iguais de resina composta fotopolimerizável, padronizadas em tamanho e forma, foram construídas a partir desta técnica. Antes da reconstrução protética, aplicou-se o tratamento endodôntico, desobturação, preparo do canal radicular e moldagem. Proteticamente, um pino intrarradicular reto e outro curvo, ambos com núcleo para sustentar a coroa metálica fundida foram cimentados na porção coronal de cada raiz-réplica. Os núcleos e coroa metálica foram ambos ferulados ou estojados. Avaliou-se os dois tipos de restauração com pino intrarradicular curvos ou retos cimentados com cimento de fosfato de zinco ou resinoso para identificar o melhor conjunto restaurador. Os testes de resistência biomecânica de 80 raízes-réplicas foram divididos em 4 grupos com 20 corpos de prova para cada um dos grupos. Grupo 1: das raízes-réplicas com pino intrarradicular curvo cimentados com cimento resinoso. Grupo 2: das raízes-réplicas com pino intrarradicular curvo cimentados com cimento de fosfato de zinco. Grupo 3: das raízes-réplicas com pino intrarradicular reto cimentados com cimento resinoso. Grupo 4: das raízes-réplicas com pino intrarradicular reto cimentados com cimento de fosfato de zinco. Estes grupos foram submetidos a teste de força com pré-carga de 1,5 N, com velocidade de avanço constante de 0,05 mm por minuto em ponto pré- determinado (mésio-lateral vestibularizada) até ocorrência de fratura do conjunto ou parte dele em uma Máquina Universal Kratos. Com a avaliação biomecânica e estudo estatístico de Kruskall-Wallis, identificou-se que os dados obtidos não seguiram distribuição normal. Esta diferença mostrou-se com o p<0,05 na interpretação do teste. No caso de dados não paramétricos o post-hoc do Kruskal-Wallis foi o teste de U de Mann-Withney. Paralelamente, um estudo com análise de elementos finitos comparou os resultados obtidos. Não houve diferença significativa sobre o tipo de cimento utilizado ou que favorecesse o uso do pino reto ou do pino curvo, recaindo a escolha para o operador decidir de acordo com a melhor indicação para cada caso clínico

Conservative endodontic management of teeth associated with extensive periapical pathology: report of two cases

Traditionally, long-term calcium hydroxide dressings have been recommended for the conservative management of large periapical lesions. However, calcium hydroxide therapy has some disadvantages such as variability of treatment time, difficulties with patient follow-up and prolonged treatment periods that increase the risk of root canal contamination via microleakage and crown fractures. This paper reports the healing of large periapical lesions following conservative non-surgical treatment with calcium hydroxide dressings.