Destructive lesions of apical periodontitis: achievements of fundamental and applied science in modern approaches to solving the problem

Destructive lesions of the periodontium are a serious professional challenge for dentists. Along with tooth loss, which requires expensive prosthetics, chronic odontogenic inflammation provokes transient bacteremia and disrupts the homeostasis of the body. This leads to an exacerbation of somatic diseases, the development of allergic reactions and atherosclerotic damage to the walls of blood vessels. Timely diagnosis and prognosis, adequate choice of treatment methods play a key role in providing care to patients with this pathology. Depending on the clinical situation, both conservative and surgical strategies can be successful. The aim of this review is systematization of the scientific facts, which were accumulated over the past 5–10 years and describing the existing regenerative surgical techniques and promising possibilities of conservative treatment of destructive apical periodontal lesions. CONCLUSION: The latest materials for tissue regeneration developed by scientists are promising in complicated clinical cases associated with a significant loss of the bone tissue and spread of the lesion to the neighboring anatomical structures (maxillary sinus, nasal cavity, etc.). However, with the development of ideas of a tooth as of a nanostructured organ, integration of nanoscale particles with antimicrobial properties into the composition of temporary and permanent filling materials, conservative treatment methods also possess great practical potential. A deeper understanding of pathophysiology and microbiology of pathological process of cyst formation creates methodological basis for development by dentists of the novel therapeutic methods of treatment of periapical lesions that are currently regarded as a “sentence” to the invasive intervention — cystectomy, resection of the root apex or removal of the causal tooth. Effective endodontics is the key to sparing and predictable elimination of foci of chronic odontogenic infection that deranges homeostasis of the whole organism. This is a promising field for synthesis of fundamental and clinical knowledge, for international scientific cooperation with the primary aim to improve the quality of Human life.