Asymptomatic apical periodontitis with cortical bone disruption in patient under continuous treatment with Isotretinoin: case report

Anarela Vassen BERNARDI, Jhenniffer SILVA, Patrícia RIBEIRO, Josiane de ALMEIDA, Marlowa CREMA, Patricia Maria Poli KOPPER

Introduction: Asymptomatic apical periodontitis (AAP) is characterized by inflammation and destruction of the periapical tissues and its progression leads to bone resorption, which may be aggravated by continuous use of Isotretinoin. The objective of this study was to report the resolution of AAP with mandibular cortical disruption in a patient under continuous treatment with isotretinoin (Roacutan®) and kickboxing practitioner, by conventional chemical-mechanical procedures and cone-bean computed tomography (CBCT) follow-up. Description: A 21-year-old Caucasoid individual, ASA I, under continuous use of isotretinoin and kickboxing practitioner sought dental care with moderate pain at the region of tooth #38. After clinical, radiographic and tomographic examination, the need for endodontic treatment of tooth #36 was verified. The CBCT showed an extensive and hypodense apical image between teeth #36 and #37, compatible with cystic bone lesion, with dimensions of 25.59 mm wide x 14.37 mm high x 8.40 mm deep. Apical resorption of the distal root, hypodense halo under a coronal restoration at #36, and rupture of the external buccal and lingual cortical bone were also observed. The endodontic treatment was performed in three sessions with the aid of a microscope and chemical-mechanical protocols, such as Easy Clean and photodynamic therapy. Result: Resolution of AAP was observed after follow-up for three years. Conclusion: Endodontic treatment allowed healing of an extensive periapical lesion, avoiding immediate parendodontic surgery and the continuous use of isotretinoin did not affect the AAP resolution.

Keywords: Periapical Periodontitis. Tomography, X-Ray Computed. Endodontics. Isotretinoin

How to cite: Bernardi AV, Silva J, Ribeiro P, Almeida J, Crema M, Kopper PMP. Asymptomatic apical periodontitis with cortical bone disruption in patient under continuous treatment with Isotretinoin: case report. Dental Press Endod. 2021 Sept-Dec;11(3):58-65.

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