Single-Visit Endodontic Treatment with Photodynamic Therapy in Chronic Periapical Abscess: A Case Report

Abstract

In teeth with pulp necrosis, microorganisms form complex biofilms along the root canal walls and colonize deep into the dentinal tubules. This infection is essential for the development of periapical abscesses, granulomas, and cysts. Biomechanical preparation represents the basis of endodontic treatment; however, the anatomical complexity of the root canal system facilitates the survival of microorganisms even after this debridement and shaping phase, regardless of the use of devices, instruments, antiseptics, and disinfectants. Therefore, photodynamic therapy (PDT) has been used as an alternative to intracanal medication to improve antisepsis, reduce chair time, and minimize postoperative pain. This study aimed to report a clinical case of endodontic treatment of tooth 32 with a chronic periapical abscess, performed in a single session, using PDT as an adjunct to root canal antisepsis. A 46-year-old female patient presented to the UFVJM Dental Clinic with complaints of gingival bleeding and edema in the region of her lower anterior teeth. Clinical and radiographic examinations revealed the presence of a fistula associated with a radiolucent periapical lesion in tooth 32, leading to the diagnosis of chronic periapical abscess. The proposed treatment included biomechanical preparation and an alternating irrigation protocol, followed by photodynamic therapy (PDT) and root canal obturation. At the six-month follow-up appointment, the patient was asymptomatic. Clinically, the gingival bleeding had decreased, without a fistula, and radiographically, the periapical lesion had reduced in size. It is therefore concluded that the use of PDT resulted in satisfactory healing of periapical tissue and effective control of postoperative pain.