From this article you will learn:
In the video you can see how, when opening a tooth with acute purulent periodontitis, pus begins to emerge from the mouth of one of the root canals.
Chronic periodontitis is most often the outcome acute process, however, in some cases it can develop independently (especially with weak immunity). Chronic periodontitis occurs, as a rule, asymptomatically, or with slight pain when biting on the causative tooth.
Severe symptoms appear only during exacerbation of a chronic process, which can be triggered by hypothermia of the body, decreased immunity after suffering from acute respiratory viral infection. There are 3 forms of chronic periodontitis...
Characterized by the fact that periodontal fibers ( ligamentous apparatus of the tooth, which connects the tooth to the bone) are gradually replaced by connective fibrous tissue. Chronic fibrous periodontitis is extremely sparse in symptoms, and painful sensations may be completely absent.
Chronic granulomatous periodontitis is characterized by the formation of something like a purulent sac at the apex of the root. Depending on the size of this formation, it is customary to distinguish the following 3 types of this form of periodontitis: granuloma, cystogranuloma and radicular cyst. They have the same structure, are filled with pus, and differ only in size...
Granuloma and cyst on x-ray –
On an x-ray –
in the area of the apex of the tooth root, a darkening with clear, even, rounded contours is determined. This darkening indicates that bone tissue has resolved in this area. The even, clear contours of such darkening indicate that the formation (cystogranuloma or cyst) has a dense capsule that is not connected to the surrounding bone tissue.
What causes growth? –
the growth of these formations and their transformation into each other occurs due to a constant increase in the amount of pus inside the formation, which leads to an increase in the pressure of the formation on the surrounding bone tissue. The bone is dissolved under pressure. As a result, education occupies a new space, and then everything starts all over again. As the granuloma grows, it turns into cystogranuloma, and the latter –
into a cyst.
Symptoms of granulomatous periodontitis –
This form of periodontitis, in terms of the nature of its course, occupies an intermediate place between the sluggish fibrous form of periodontitis and the aggressive course of granulating periodontitis. At the beginning of its development, chronic granulomatous periodontitis has very poor symptoms, and biting on a tooth or tapping on it does not always cause pain.
What does cystogranuloma look like at the root apex? extracted tooth: video
Long-existing chronic foci of inflammation in the periodontium are prone to periodic exacerbations. This will be manifested by the appearance of acute pain, swelling of the gums, and swelling of the soft tissues of the face. Exacerbation of the chronic process can lead to:
Sources:
1. Higher prof. The author's education in therapeutic dentistry,
2. Based on personal experience work as a dentist,
3. National Library of Medicine (USA),
4. “Therapeutic dentistry: Textbook” (Borovsky E.),
5. "Practical" therapeutic dentistry"(Nikolaev A.).
The periodontium is a thin connective tissue layer that is located between the alveolus and the tooth root. It is entrusted with several important functions: holding the tooth in the alveolus, uniformly distributing the chewing load, protecting the surrounding soft tissues from “attacks” of harmful agents, and also ensuring normal metabolism inside the tooth.
Inflammation of the periodontium is called periodontitis. The inflammatory process can occur in acute and chronic form, be fibrous, granulating or granulomatous. Granulomatous periodontitis (hereinafter referred to as GP) in dentistry is understood as chronic inflammation of the periodontium, accompanied by the formation of granulomas near both apexes of the tooth. Granulomas, in turn, are connective tissue structures that separate healthy tissue from foci of the inflammatory process.
HP is practically asymptomatic, inflammation develops in a limited area - dental granuloma, and is maintained pathogenic bacteria, living in the root canal of the “affected” unit. Chronic granulomatous periodontitis, due to its “silent” course, poses a greater danger to patients than, for example, the granulating form of inflammation. This is due to the fact that granulomas tend to degenerate into cysts, and these formations often displace healthy dental bone tissue and lead to adentia.
The main factor contributing to the development of HP is chronic inflammatory processes affecting soft tissues oral cavity. As a rule, the presence of such is the result of untreated caries or advanced pulpitis. It happens that HP is preceded by direct trauma to the maxillofacial area of the skull or bad habit gnaw with teeth hard objects. An incorrectly fitted crown or incorrectly placed braces can also lead to the development of inflammation.
Periodontal inflammation can occur in fibrous, granulating and granulomatous forms
Important! Exacerbation of HP in a number of clinical cases It happens allergic reaction on certain medications (including in case of non-compliance with the dosage of the drug).
Risk factors:
Depending on the shape of the connective tissue structures in chronic HP, dentistry distinguishes several of its morphological varieties. So, inflammatory process It begins when the periodontium becomes denser and a granuloma is formed. Bacteria, leukocytes, and fibrous inclusions “settle” in its cavity. It is noteworthy that granulomas can be localized both at the root and at the apex of the tooth, as well as in the bifurcation zone. The size of such connective tissue formation, as a rule, reaches 5 mm.
Further proliferation of microbes in the inflammatory focus leads to the formation of cystogranulomas. The inner surface of such structures is lined with mucous membrane and has increased level pH. This, in turn, leads to the fact that in the affected area the processes of destruction bone tissue begin to dominate the processes of synthesis of new cells. Cystogranuloma can grow up to 1 cm in diameter.
The next stage in the development of chronic granulomatous periodontitis is considered to be a cyst. It is a cavity that is externally formed by cells connective tissue, and from the inside it has a mucous membrane. The latter actively produces a secretion, which, in contact with the bone tissue of the tooth, provokes its deformation with subsequent destruction.
The formation and increase in size of granulomas does not cause any discomfort in patients. The rate of development and intensity of the inflammatory process depends on the characteristics immune system patient. In some cases, patients may complain about fillings falling out, discoloration of the “damaged” tooth, or pain in it under chewing load. Such symptoms accompany the period of exacerbation of HP or the stage of transition of cystogranulomas to cysts.
GP is treated as conservative methods, so surgically(resection of the apex of the tooth root is performed or the “affected” unit is completely removed)
One of the most unpleasant features of the course of HP is high risk relapse. An exacerbation is characterized by all the classic symptoms of acute periodontitis:
Anamnesis, examination of the oral cavity, instrumental and laboratory tests– all these methods are used by the dentist to confirm the appropriate diagnosis. Patients with HP may complain of increased sensitivity affected tooth or pain in it. However, this problem may disappear over time, either without medical intervention or after dental treatment.
During the examination, an “affected” unit of discolored color is discovered, usually with a filling or crown, or a large carious lesion. When probing the dental canal as such, there is no pain or discomfort, but an unpleasant sensation appears from the cavity. putrid smell. Percussion is painless; slight hyperemia or swelling may be present near the root of the tooth. Main diagnostic method with GP is an x-ray. The granuloma in the picture is a round shadow; it can be adjacent to the root or form a kind of “cap” around it.
As the inflammatory process progresses, the areas of absence of bone tissue become increasingly clearer (they have characteristic smooth edges). Chronic HP is differentiated:
Treatment of granulomatous periodontitis is individual and depends on several factors:
Conservative healing methods indicated for patients with high performance restoration of bone tissue cells (osteoblasts) with small granulomas, consisting mainly of epithelium. Therapy is carried out in this way: pre-cleaned and disinfected antiseptic solutions root canals are processed with a special drug complex action.
Its high acidity ensures the death of pathogenic microorganisms; subsequently, the restored neutral environment is most favorable for the formation of new ones bone cells. Contains calcium hydroxide of this medicine“is responsible” for restoring the structure of affected osteoblasts, and iodoform provides its bactericidal properties.
Regular visits to the dentist and timely treatment any inflammatory processes in the oral cavity - the main measures to prevent periodontitis
HP with large granulomas is treated exclusively surgically - such patients undergo resection of the apex of the tooth root or the affected unit is completely removed. Resection is a surgical intervention that consists of several successive stages:
If left untreated, HP can lead to partial or complete edentia. If there are symptoms of exacerbation of HP, the patient is given an x-ray; if the tooth can be saved, anti-inflammatory therapy is carried out (purulent exudate is released, antibiotics are prescribed). Next, the same therapeutic measures are taken as with conventional GP.
With timely and competent drug treatment The granulomatous form of periodontitis gradually turns into fibrous and does not require further therapeutic measures. After the measures taken, the patient may experience pain, swelling, or swelling of the gums for some time - this is a normal phenomenon associated with the body’s reaction to dental intervention.
IN postoperative period mandatory conditions speedy recovery are:
Six months after conservative treatment or surgical intervention, patients with HP need to visit the dentist and have a control x-ray. Home preventative measure to prevent HP - regular visits to the dentist and timely treatment of any inflammatory diseases oral cavity.
So, chronic HP is an inflammatory lesion of the periodontium, accompanied by the formation of granulomas. The disease is usually asymptomatic and “makes itself known” only during periods of exacerbation. GP is treated with conservative methods and surgery (depending on the degree of prevalence pathological process, characteristics of the body and age of the patient).
This is one of its main differences from, in which the destruction zone is not clearly encapsulated and can quickly increase.
In terms of danger, granulomatous periodontitis is located between fibrous and granulating. The first is the most stable and safe, the second is the most dynamic and destructive.
Granulomatous periodontitis can be a consequence of a granular process or develops independently. As already noted, the main feature of the granulomatous process is that the area of inflammation is enclosed in a fibrous capsule with a dense wall. This prevents the spread of infection from the diseased tooth to other organs and tissues. There is a kind of balance between the pathogenic microflora concentrated in and the immune system.
At the location of the granuloma, the bone tissue of the tooth or alveoli is usually destroyed to one degree or another. This is clearly visible on. The focus of destruction has a clearly defined oval or round shape. A compacted rim forms around it - the result of osteosclerosis.
Chronic granulomatous periodontitis sooner or later leads to the destruction of the cementum of the root and dental crown, and their gradual replacement by club-shaped deposits crowning the apex of the tooth. In appearance, the granuloma is similar to an oval or round sac with a dense, smooth shell, which is firmly attached to the roots.
Forms of periodontal inflammation differ in the phase in which they are (remission or exacerbation), as well as the shape and size of the lesion (cystogranuloma or). The difference is this: 
During remission, granulomatous inflammation occurs in a latent form and does not bother the patient, who sees no reason to see a doctor. In the absence of complications, which are relatively rare, granulomatous periodontitis is often
The photo shows that on x-ray the granuloma looks like a ball
discovered by chance due to another disease. Fistulas, as a rule, do not form.
During exacerbations, granulomatous periodontitis resembles or aggravated granulating periodontitis. Appears severe pain, swelling of adjacent tissues occurs, it is noted that intoxication of the body increases.
When pressing on a diseased tooth, a cyst is created. high blood pressure, which can lead to disruption of the integrity of the capsule, release of pus into the underlying tissue and spread of infection.
In the chronic course of the disease in remission between protective forces the body and the infection localized in the cyst, there is a relative balance, which is disrupted during an exacerbation.
The latter can occur when the destructive process is activated due to decreased immunity. In this case, the bone structures may melt under the influence of the contents of the cyst, and the capsule may rupture and infection of neighboring tissues with pus.
If there is a complication, the size of the hilar cyst and the zone of destruction can be so significant that there is a danger of a jaw fracture even with minor trauma.
Diagnosis is based on the clinic and hardware diagnostic data.
When interviewing the patient and conducting an initial examination, the presence of pain, its nature and time of onset are established. A symptom that speaks in favor of granulomatous periodontitis is increased pain when biting. Examination of a diseased tooth allows you to determine a change in its color, presence, and hyperemia.
If a cyst is present, a slight bulge may be palpable on the surface of the jaw. Probing for granulomatous periodontitis is painless, the reaction to heat and cold can be both positive and negative. Questioning the patient about the time of occurrence of discomfort or pain allows us to establish whether the destructive process is acute or chronic.
The main hardware method for diagnosing periodontitis is. She is able to answer almost all questions. In the granulomatous form of the disease, the radiograph shows a shading zone with a round configuration with clear outlines in the apex zone.
X-ray is the most informative method for differential diagnosis. The focus of destruction in granular periodontitis does not have a clearly defined contour, and in fibrous periodontitis only the expansion of the periodontium is recorded.
It is characterized by large zones of destruction, which are located outside the apex zone. and x-rays show no changes in the periodontium at all.
Diagnostics is indeed a very important stage of the entire treatment complex:
Treatment of granulomatous periodontitis depends on the type and size of the granuloma, the condition of the dental canals (passable or not), as well as the patient’s immune system. If the destruction of bone structures is not critical, and the body resists inflammation well, conservative treatment is carried out.
An effective drug with a bactericidal and regenerating effect is one with a pH of 12.5. Within a day, it destroys 90% of pathogenic microflora and stimulates the formation of osteoblasts, from which osteocytes (normal bone tissue) are subsequently formed.
The first action during an exacerbation is to block the pain. Then the exudate is drained from the cyst or granuloma and prescribed. Further therapy is determined by the form of granulation formation - granuloma, cystogranuloma or cyst.
If impossible conservative therapy produced surgical treatment, consisting in partial or complete removal tooth Usually it is performed as a tooth-preserving operation. Access to it is made from the gum (a window is cut in the alveolar plate). The affected root tip is cut off, and the resulting space is filled with material that regenerates bone tissue.
If the size of the granuloma is such that removal of more than 1/3 of the root is required, resection is abandoned and the tooth is removed completely.
The consequences of granulomatous periodontitis primarily depend on the timeliness of visiting a doctor and the correctness of treatment.
With proper conservative treatment of the disease at the stage of granuloma or cystogranuloma, inflammation turns into fibrous form and stops bothering the patient. The tooth is preserved as a functional unit.
If you see a doctor too late and the granuloma has developed into a cyst, the tooth must be removed. In the worst case, the cyst spreads to the roots of neighboring teeth, which, depending on the extent of the damage, will require appropriate treatment.
The best prevention is to visit the dentist every six months. It is recommended to do this even if your teeth do not bother you. The dentist will detect the disease at the very early stages, if necessary, will refer you for an x-ray.
Measures that prevent the development of periodontitis include:
As for the latter, the best food for maintaining teeth in healthy condition are hard vegetables and fruits that provide a significant and uniform load on the dental apparatus.
Periodontitis is an inflammation of the tissues located between the tooth and the surrounding bone. There can be several reasons for periodontitis:
Infection. Can be acute or chronic. Most often, inflammation is caused by streptococcus; other oral microflora may also be involved. Infection can enter the periodontal tissues from the root canal (pulpitis) or from the gum pocket (periodontitis). Periodontitis can also be classified as infectious as a complication of influenza and other infections and the transfer of inflammation from other organs (for example, maxillary sinus, bones).
Injury. Acute injury is a consequence of a blow, bruise, excessive load while eating. Chronic injury is a consequence of less intense, but constantly repeated overload of the periodontium. The cause may be bad or professional habits (thread biting), chewing pressure overload during partial absence teeth, incorrectly applied filling, malocclusion.
Potent medications. Most often develops with improper treatment pulpitis. Medicines that most often lead to periodontitis are arsenic paste, resorcinol, formalin, phenol. Also contribute to periodontal irritation foreign bodies, extended beyond the apex of the tooth root (cement, gutta-percha pins). Drug-induced periodontitis can also include manifestations of allergies to medications (for example, antibiotics).
By clinical course Periodontitis is divided into:
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It begins with mild, localized pain in a specific tooth. Can be unpleasant biting on a tooth, percussion (tapping) is sensitive in the vertical direction. The gums are not changed, painless, there are no changes on the radiograph. When inflammation passes into the purulent stage, the pain becomes tearing, unbearable, and throbbing. It is difficult to indicate the causative tooth; the pain radiates (spreads along the branches of the nerves) to the ear, eye, and other teeth.
Biting on a tooth is sharply painful, percussion painful in all directions. Since the tooth pulp (nerves and blood vessels) has died, pain from hot and cold does not occur. The patient has a feeling of an “overgrown” tooth - due to swelling, the tooth is the first to close with the teeth of the other jaw, it seems to be extended. The gums in the area of the tooth are red and swollen, there may be swelling along the transitional fold (the place where the gums meet the cheek). The tooth may become mobile. Pus can find its way into the oral cavity, into the sinus, under the skin, in which case the pain subsides, but signs of complications appear ( abscess, phlegmon, periostitis, sinusitis).
Lymph nodes(submandibular) enlarged and painful. There may be general manifestations - increased temperature, changes in leukemia, increased ESR. On an x-ray, acute purulent periodontitis will appear as a blurred bone pattern in the tooth area. Acute periodontitis can last from several days to a month.
The most “harmless” variant of the disease. May be a consequence of pulpitis or acute periodontitis, as well as the result of treatment of other chronic forms periodontitis. It is usually not manifested clinically. There may be awkwardness 
biting, itching sensation. The gums are not changed, painless. The diagnosis is made on the basis of an x-ray, which shows expansion periodontal fissure in the area of the tooth apex. The bone tissue and cementum of the tooth root are not destroyed.
It manifests itself as a feeling of awkwardness, heaviness, swelling in the tooth, and mild pain in it. Biting on a tooth may be unpleasant, but there may be no complaints at all. A fistula periodically appears on the gum, from which pus is released. The radiograph reveals a focus of rarefaction of bone tissue with unclear boundaries. The disease often worsens, but due to the fact that the infection comes out through the fistula, it usually does not cause significant manifestations or pain, and responds quite well to treatment.
Outside of an exacerbation, it most often does not manifest itself in any way; occasionally, a fistula, hyperemia and swelling of the mucous membrane over the tooth may occur. X-ray signs - a focus of bone tissue loss with clear boundaries. The size can be different (up to 0.5 cm - granuloma, 0.5-0.8 cm - cystogranuloma, more than 0.8 cm – radicular cyst). 
The granuloma is surrounded by a fibrous capsule and may be lined with epithelium inside.
Fibrous periodontitis worsens less often. Clinical picture similar to acute periodontitis, and radiological data – with chronic periodontitis (only the picture is more blurred). From common manifestations there may be an increase in temperature, headache, changes in the blood.
For quality treatment it is necessary to make a correct diagnosis. You cannot do without radiography; it plays an important role in making a diagnosis. The cause of the disease must be eliminated. To do this, it is necessary to normalize the bite when the teeth are overloaded, stop contact with medicinal substance which caused the damage. For infectious periodontitis, it is necessary to treat in 3 areas - antibacterial, anti-inflammatory, osteotropic (bone-forming) therapy.
In practice it looks like this.
If the complaints have decreased at the next visit, the tooth canals can be filled using temporal medicinal paste
, which promotes bone formation at the lesion site. Most often these are calcium-based preparations, often with the addition of iodine.
Tooth closes up temporary filling, the medicine is in it long time(from a week to six months, depending on the severity of the changes). If the medication is left on for a long time, repeat x-rays are taken periodically to monitor the progress. Subsequently, the tooth filled with permanent material according to the generally accepted method, and the crown part of the tooth is restored with a filling or crown.
General treatment consists of prescribing antibiotics, anti-inflammatory therapy, hyposensitizing and painkillers. Rinsing the mouth with warm soda solution is prescribed.
In some cases, conservative surgical treatment of periodontitis is indicated. Its purpose is to preserve part of the tooth while removing other parts. It could be tooth root apex resection(the most common method) – the tip of a single-rooted tooth is removed along with the pathological focus. There is also coronoradicular separation(separation of the tooth vertically into two coated halves common crown), g emission of the tooth(the tooth is divided into 2 halves, one is left, the other is removed along with the root), root amputation (only the affected root is removed, the entire crown is left). These methods are rarely used and are only suitable for multi-rooted teeth.
If other treatment methods are ineffective, periodontitis is treated surgically (radically) - by removing the tooth.
A long-term inflammatory process in the area of the apex of the tooth root can occur in different ways. In one case, it is monotonous and does not create anything fundamentally new. But sometimes a completely new structure develops around the source of inflammation, which has its own structure and stages of formation. This happens with granulomatous periodontitis.
If the focus of chronic inflammation is active and supported by microflora rapidly developing in the root canal, and the body is able to build a barrier to isolate this focus, then a granuloma appears.
At the stage of formation, granuloma is a connective tissue barrier formed from periodontal tissue. It is designed to isolate the source of infection, reduce the absorption and spread of waste products and decay of microbes.
Therefore, unlike granulating periodontitis, in which the destruction process is more active, granulomatous periodontitis proceeds calmer and more purposefully. Depending on the stage of development, several forms of postapical cavity formations are distinguished.
At the start of the inflammatory process, the periodontal tissue thickens with the growth of connective tissue. Since the cellular and toxic effects from the root canal are constant, the process of proliferation (formation) is also continuous.
In the constant struggle between creation and destruction, a cavity connective tissue formation is born, filled with granulations, fibrous elements, living and dead microbes, as well as cells responsible for the body’s immune response.
Cystogranuloma is the next stage in the development of simple granuloma. The periodontium always contains epithelial cells, similar in structure to the epithelium of the oral mucosa.
They begin to actively develop, becoming involved in the formation of a cyst and forming an internal mucous lining. At the site of inflammation, an acidic environment is formed, which inhibits osteoblasts (cells that form bone tissue) and activates osteoclasts (cells that destroy bone tissue).
If with granuloma the destruction zone did not exceed 5 mm in diameter, then normal sizes cystogranulomas are already 5-8mm and up to a centimeter.
A cyst is a complete, fully formed cavity formation formed by a connective tissue capsule with internal mucous tissue.
The secret produced inner layer, creates a slight constant excess pressure that is transmitted to the surrounding bone tissue and also contributes to its destruction.
Cholesterol crystals gradually precipitate in the liquid contents of the cyst, visible in the exudate when the cyst is opened or during outflow through the fistula; this is important feature in differential diagnosis.
The formation and formation of granuloma can be completely asymptomatic, unnoticeable to humans.
The growth rate depends on the activity of the main inflammatory focus and the body's resistance and can vary significantly from a complete stop to a rapid increase in size.
In the case when the granuloma (or rather, already a cyst) is not located strictly in the apex area, but is shifted to the side, a small bulge may be palpated on the surface of the jaw. Complaints and other symptoms appear during exacerbation of chronic granulomatous periodontitis.
Diagnosis of chronic granulating periodontitis is simple and complex at the same time. The difficulty lies in paying attention to a specific tooth at all.
If it is discolored, if it has a significant defect that is painless on probing and other signs of chronic periodontitis, then it is not difficult to suspect the formation of a granuloma.
And if the tooth has a sound filling and does not manifest itself in any negative way, then no one diagnoses it. Why, if everything is already calm? As a result, the inflammatory process has a significant period of time for cyst formation.
Radiography in dentistry refers to additional methods examination of the patient, however chronic inflammation periodontal exactly x-ray allows you to reliably identify and characterize the type of pathology.
With granulomatous periodontitis, a rounded area of shading is formed in the area of the root apex. This defect can either touch the root or be located at the top of the root. As the size increases, the lack of bone structure in the cavity itself, which has clear, even contours.
About problems with differential diagnosis you can only talk until the x-ray appears; As soon as the picture is taken, all questions are usually removed.
At fibrous periodontitis There is only a uniform expansion of the periodontium, and with granulating, a clearly defined focus is not formed. Caries and pulpitis do not lead to changes in the periodontium at all. Osteomyelitis gives a significant size of the destruction zone, different in location relative to the teeth.
Treatment of chronic granulomatous periodontitis is long-term and depends on:
If the granuloma has small sizes, its structure has insufficient or missing components epithelial tissue If the root canals are well passable and the patient’s body has a high activity of bone tissue restoration, then conservative treatment can give a positive result.
The essence of the treatment is that after expansion and antiseptic treatment of the root canals, a drug is removed from the apex of the root, which:
Such drugs include Metapex. The drug has a pH of 12.5, which causes the death of microflora up to 90% within 24 hours. Neutralization acidic environment at the site of inflammation stimulates the activity of osteoblasts.
Calcium hydroxide promotes the destruction of the capsule, calcium goes to restore the bone structure. The iodoform included in the composition significantly enhances bactericidal effect drug.
Metapex is easily introduced into the root canals, does not cause aggravations and does not harden (the canals are very easily unfilled).
Surgical treatment usually involves resection of the root apex.
The operation is indicated for a significant size of the granuloma, however, if more than a third of the root is subject to resection, preference is given to tooth extraction.
Stages of the operation:
Photo: Result of root apex resection
One of the dangers of chronic granulomatous periodontitis (as well as granulating periodontitis) is the high likelihood of exacerbation.
During exacerbation, pain occurs, which intensifies significantly when touching the tooth. Swelling in the gum area increases very quickly, often with the formation (or resumption of activity) of a fistula. Nearest lymph nodes enlarge and become painful.
It is most reliable to diagnose an exacerbation of a granulomatous process using an x-ray.
If a decision is made to save a tooth, first of all, it should be removed acute symptoms(pain, swelling, etc.), for which it is necessary to ensure the outflow of exudate and prescribe antibacterial therapy. Further treatment according to standard scheme for granulomatous periodontitis.
In case of successful conservative treatment, the disease transforms into fibrous and further treatment does not require.
Resection of the root apex provides a higher percentage of cure, however, due to the undesirability of additional trauma, it is used only if there are indications for this operation.
Without treatment, there are two possible outcomes:
Timely detection of granulomas – best prevention appearance of cysts. That is why you should contact your dentist at least twice a year, and not only when the problem becomes obvious even to a non-specialist.
