{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:29:43Z","timestamp":1786649383640,"version":"build-2736575974"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>Periapical lesions of endodontic origin are common pathological conditions affecting periradicular tissues. Microbial infection of pulpal tissues is primarily responsible for initiation and progression of apical periodontitis. The primary objective of endodontic therapy should be to restore involved teeth to a state of normalcy nonsurgically. Different nonsurgical management techniques, namely, conservative root canal therapy, decompression technique, method using calcium hydroxide, aspiration-irrigation technique, lesion sterilization and tissue repair therapy, active nonsurgical decompression technique, and the apexum procedure have been advocated. New techniques which use drug-loaded injectable scaffolds, simvastatin, and epigallocatechin-3-gallate have been tried. Surgical option should be considered when intra- or extra-radicular infections are persistent. Incidence of nonendodontic periapical lesions has also been reported. An accurate diagnosis of the periapical lesion whether it is of endodontic or nonendodontic origin has to be made. Surgical methods have many disadvantages, and hence should be considered as an option only in the case of failure of nonsurgical techniques. Assessment of healing of periapical lesions has to be done periodically which necessitates a long-term follow-up. Even large periapical lesions and retreatment cases where the lesion is of endodontic origin have been successfully managed nonsurgically with orthograde endodontic therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jpbs.jpbs_100_17","type":"journal-article","created":{"date-parts":[[2017,12,21]],"date-time":"2017-12-21T06:36:24Z","timestamp":1513838184000},"page":"S246-S251","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":26,"title":["Successful Nonsurgical Management of Periapical Lesions of Endodontic Origin"],"prefix":"10.4103","volume":"9","author":[{"given":"J. V.","family":"Karunakaran","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris Susan","family":"Abraham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Kaneesh","family":"Karthik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Jayaprakash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-49-20260427","first-page":"719","article-title":"Clinical, imagistic and histopathological study of chronic apical periodontitis","volume":"57","author":"Croitoru","year":"2016","journal-title":"Rom J Morphol Embryol"},{"key":"R2-49-20260427","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/j.joen.2007.02.006","article-title":"Proliferation of epithelial cell rests, formation of apical cysts, and regression of apical cysts after periapical wound healing","volume":"33","author":"Lin","year":"2007","journal-title":"J Endod"},{"key":"R3-49-20260427","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/j.joen.2016.04.021","article-title":"Management of cyst-like periapical lesions by orthograde decompression and long-term calcium hydroxide\/chlorhexidine intracanal dressing: A case series","volume":"42","author":"Santos Soares","year":"2016","journal-title":"J Endod"},{"key":"R4-49-20260427","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.joen.2009.02.012","article-title":"Nonsurgical root canal therapy of large cyst-like inflammatory periapical lesions and inflammatory apical cysts","volume":"35","author":"Lin","year":"2009","journal-title":"J Endod"},{"key":"R5-49-20260427","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1016\/0030-4220(86)90107-6","article-title":"Nonsurgical treatment of extraoral lesions caused by necrotic nonvital tooth","volume":"61","author":"Salamat","year":"1986","journal-title":"Oral Surg Oral Med Oral Pathol"},{"key":"R6-49-20260427","doi-asserted-by":"crossref","first-page":"133","DOI":"10.5005\/jp-journals-10005-1299","article-title":"Treatment of large periapical cyst like lesion: A noninvasive approach: A report of two cases","volume":"8","author":"Sood","year":"2015","journal-title":"Int J Clin Pediatr Dent"},{"key":"R7-49-20260427","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.tripleo.2005.03.038","article-title":"Epithelium and bacteria in periapical lesions","volume":"101","author":"Ricucci","year":"2006","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"R8-49-20260427","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1177\/0022034509359125","article-title":"Factors affecting wound healing","volume":"89","author":"Guo","year":"2010","journal-title":"J Dent Res"},{"key":"R9-49-20260427","doi-asserted-by":"crossref","first-page":"240","DOI":"10.4103\/0972-0707.73384","article-title":"Nonsurgical management of periapical lesions","volume":"13","author":"Fernandes","year":"2010","journal-title":"J Conserv Dent"},{"key":"R10-49-20260427","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.joen.2013.08.021","article-title":"Nonendodontic lesions misdiagnosed as apical periodontitis lesions: Series of case reports and review of literature","volume":"40","author":"Sirotheau Corr\u00eaa Pontes","year":"2014","journal-title":"J Endod"},{"key":"R11-49-20260427","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1007\/s00784-016-1997-7","article-title":"Retrospective analysis of nonendodontic periapical lesions misdiagnosed as endodontic apical periodontitis lesions in a population of Taiwanese patients","volume":"21","author":"Huang","year":"2017","journal-title":"Clin Oral Investig"},{"key":"R12-49-20260427","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1046\/j.1365-2591.2002.00455.x","article-title":"Endodontic treatment of teeth associated with a large periapical lesion","volume":"35","author":"Oztan","year":"2002","journal-title":"Int Endod J"},{"key":"R13-49-20260427","first-page":"587","article-title":"Imaging of a Stafne bone cavity: What MR adds and why a new name is needed","volume":"20","author":"Branstetter","year":"1999","journal-title":"AJNR Am J Neuroradiol"},{"key":"R14-49-20260427","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1067\/moe.2000.108803","article-title":"Periapical central giant cell granuloma: A potential endodontic misdiagnosis","volume":"90","author":"Dahlkemper","year":"2000","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"R15-49-20260427","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.ooe.2005.09.007","article-title":"Peripheral brown tumour of hyperparathyroidism in the oral cavity","volume":"42","author":"Sena Guimar\u00e3es","year":"2006","journal-title":"Oral Oncol Extra"},{"key":"R16-49-20260427","first-page":"2501","article-title":"Basal cell nevus syndrome: Guidelines for early detection","volume":"65","author":"Bitar","year":"2002","journal-title":"Am Fam Physician"},{"key":"R17-49-20260427","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/S1079-2104(98)90073-7","article-title":"The odontogenic keratocyst: A potential endodontic misdiagnosis","volume":"85","author":"Garlock","year":"1998","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"key":"R18-49-20260427","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1111\/j.1365-2591.2010.01719.x","article-title":"Non-surgical management of a large periapical lesion using a simple aspiration technique: A case report","volume":"43","author":"Fernandes","year":"2010","journal-title":"Int Endod J"},{"key":"R19-49-20260427","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1111\/j.1365-2591.2006.01109.x","article-title":"Nonsurgical treatment of extensive cyst-like periapical lesion of endodontic origin","volume":"39","author":"Soares","year":"2006","journal-title":"Int Endod J"},{"key":"R20-49-20260427","first-page":"115","article-title":"Healing of large periapical lesions following nonsurgical endodontic therapy: Case reports","volume":"25","author":"Al-Kandari","year":"1994","journal-title":"Quintessence Int"},{"key":"R21-49-20260427","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/0030-4220(72)90325-8","article-title":"Nonsurgical resolution of radicular cysts","volume":"34","author":"Bhaskar","year":"1972","journal-title":"Oral Surg Oral Med Oral Pathol"},{"key":"R22-49-20260427","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/0030-4220(72)90326-X","article-title":"A commentary on General Bhaskar's hypothesis","volume":"34","author":"Bender","year":"1972","journal-title":"Oral Surg Oral Med Oral Pathol"},{"key":"R23-49-20260427","doi-asserted-by":"crossref","first-page":"562","DOI":"10.4103\/0976-237X.194098","article-title":"Nonsurgical endodontic therapy along with minimal invasive treatment utilizing Bhasker's hypothesis for the management of infected radicular cystic lesion: A rare case report","volume":"7","author":"Salaria","year":"2016","journal-title":"Contemp Clin Dent"},{"key":"R24-49-20260427","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.ijpharm.2017.02.058","article-title":"Design of novel injectable in-situ forming scaffolds for non-surgical treatment of periapical lesions: In-vitro and in-vivo evaluation","volume":"521","author":"Shamma","year":"2017","journal-title":"Int J Pharm"},{"key":"R25-49-20260427","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.joen.2010.03.009","article-title":"Major histocompatibility complex Class II transactivator inhibits cysteine-rich 61 expression in osteoblastic cells and its implication in the pathogenesis of periapical lesions","volume":"36","author":"Lee","year":"2010","journal-title":"J Endod"},{"key":"R26-49-20260427","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.joen.2017.03.018","article-title":"MicroRNA-335-5p Plays Dual Roles in Periapical Lesions by Complex Regulation Pathways","volume":"43","author":"Yue","year":"2017","journal-title":"J Endod"},{"key":"R27-49-20260427","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.joen.2009.02.004","article-title":"Simvastatin as a novel strategy to alleviate periapical lesions","volume":"35","author":"Lin","year":"2009","journal-title":"J Endod"},{"key":"R28-49-20260427","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.joen.2012.12.014","article-title":"Simvastatin suppresses osteoblastic expression of Cyr61 and progression of apical periodontitis through enhancement of the transcription factor Forkhead\/winged helix box protein O3a","volume":"39","author":"Lin","year":"2013","journal-title":"J Endod"},{"key":"R29-49-20260427","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.joen.2008.11.015","article-title":"An extract of green tea, epigallocatechin-3-gallate, reduces periapical lesions by inhibiting cysteine-rich 61 expression in osteoblasts","volume":"35","author":"Lee","year":"2009","journal-title":"J Endod"},{"key":"R30-49-20260427","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1111\/iej.12196","article-title":"The role of IL-6 on apical periodontitis: A systematic review","volume":"47","author":"Azuma","year":"2014","journal-title":"Int Endod J"},{"key":"R31-49-20260427","first-page":"1","article-title":"The dependence of the results of pulp therapy on certain factors. An analytical study based on radiographic and clinical follow-up examinations","volume":"14","author":"Strindberg","year":"1956","journal-title":"Acta Odontol Scand"},{"key":"R32-49-20260427","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/j.1600-9657.1986.tb00119.x","article-title":"The periapical index: A scoring system for radiographic assessment of apical periodontitis","volume":"2","author":"Orstavik","year":"1986","journal-title":"Endod Dent Traumatol"},{"key":"R33-49-20260427","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.joen.2006.07.020","article-title":"Efficacy of ultrasound and color power Doppler as a monitoring tool in the healing of endodontic periapical lesions","volume":"33","author":"Rajendran","year":"2007","journal-title":"J Endod"}],"container-title":["Journal of Pharmacy and Bioallied Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01438291-201709001-00049","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:53:26Z","timestamp":1786647206000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01438291-201709001-00049"}},"subtitle":["A Conservative Orthograde Approach"],"short-title":[],"issued":{"date-parts":[[2017,11]]},"references-count":33,"journal-issue":{"issue":"Suppl 1","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.4103\/jpbs.jpbs_100_17","relation":{},"ISSN":["0976-4879"],"issn-type":[{"value":"0976-4879","type":"print"}],"subject":[],"published":{"date-parts":[[2017,11]]}}}