Symptomatic apical periodontitis (SAP) is indicative of inflammation of the periodontal ligament. It may or may not be accompanied by radiographic changes and may occur with vital or necrotic pulpal diagnosis. Purpose of this study was to analyze clinical and radiographic presentations of SAP in a retrospective electronic dental chart and digital radiograph review utilizing the endodontic diagnostic template note of predoctoral dental school patients presenting with SAP. The aim was to determine prevalence of periapical radiolucencies (PARLs) in SAP, association of SAP to pulpal diagnosis, and define associated radiographic changes. Most prevalent pulpal diagnosis with SAP was symptomatic irreversible pulpitis (44%). A tooth presenting with SAP was more likely to have an intact lamina dura, but presented with a PARL 38% of the time. When a PARL was present the most common pulpal diagnosis was pulp necrosis however, 24.5% of teeth presented with a vital pulp diagnosis and lesions <2mm.

Syftet med denna masterstudie var att jämföra den smärtlindrande effekten av fullständig utrensning och desinfektion av rotkanalsystemet med enbart utrymning av pulpakavum, utan instrumentering av rotkanalerna, som akutbehandling hos tänder med symtomatisk apikal parodontit. Materialet utgjordes av 16 patienter insamlade på Tandvårdshögskolans jourmottagning. Patienter med svullnad och allmänpåverkan exkluderades. Patienterna valdes slumpmässigt ut till att genomgå någon av behandlingarna. Den preoperativa smärtnivån och ev. analgetikaintag registrerades. Tre till fem dagar efter utförd behandling kontaktades patienterna per telefon och fick då gradera sin postoperativa smärtnivå samt analgetika- och/eller antibiotikaintag. Resultatet visade att 100% av patienterna som behandlades med fullständig utrensning erhöll tillfredställande smärtlindring jämfört med 71% av de patienter som behandlades med enbart utrymning av pulpakavum. Skillnaden var inte statistiskt signifikant. 44% av patienterna som behandlades med fullständig utrensning hade tagit smärtstillande postoperativt medan 29% av patienterna i utrymningsgruppen hade gjort det. Skillnaden var inte signifikant. Ingen av patienterna oavsett behandling hade tagit antibiotika efter behandlingen. Ingen skillnad förelåg i andelen patienter som blev tillräckligt smärtlindrade mellan fullständig utrensning och enbart utrymning av pulpakavum hos tänder med symtomatisk apikal parodontit. Det var inte heller någon skillnad i smärtsänkning mellan de två behandlingarna. / The aim was to compare the pain relieving effect of complete chemo mechanical disinfection of the root canal system with removal of necrotic tissue in the pulp chamber without instrumentation of the root canals as emergency treatment in teeth with symptomatic apical periodontitis. The material consisted of 16 patients collected at the emergency clinic at Malmö University. Patients with swelling and/or systemic involvement were excluded. The patients were randomized to either treatment. The preoperative pain level and intake of analgesics was registered. Three till 5 days postoperatively the patients were contacted and asked to grade the current pain level and intake of analgesics and/or antibiotics. The results showed that 100% of the patients treated with complete chemo mechanical disinfection of the root canal system obtained satisfying pain relief compared to 71% for patients treated with removal of necrotic tissue in the pulp chamber. 44% of the patients treated with chemo mechanical disinfection of the root canal system had some kind of analgesics postoperatively compared to 29% for those treated with removal of necrotic tissue in the pulp chamber. No patients in either group reported use of antibiotics postoperatively. The conclusion was that both complete chemo mechanical disinfection and removal of necrotic tissue implied a significant pain relief as emergency treatment in teeth with symptomatic apical periodontitis. There was no difference between the two treatments concerning the number of patients who obtained sufficient pain relief or in pain relieving effect.