Endodontic Management of Apical Periodontitis in a Liver Transplant Candidate: A Case Report with CBCT-based Volumetric Monitoring
Natália Amanda Gomes
Endodontics Division, Department of Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba – SP, Brazil.
Mariana Pagliusi Justo
Endodontics Division, Department of Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba – SP, Brazil.
Henrique Timm Vieira
Department of Semiology and Clinics, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
Eloi Dezan Júnior
Endodontics Division, Department of Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba – SP, Brazil.
Luciano Tavares Angelo Cintra
Endodontics Division, Department of Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba – SP, Brazil.
Gustavo Sivieri-Araújo
Endodontics Division, Department of Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba – SP, Brazil.
João Eduardo Gomes-Filho
Endodontics Division, Department of Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba – SP, Brazil.
Carlos Roberto Emerenciano Bueno
Endodontics Division, Department of Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba – SP, Brazil.
Rogério Castilho Jacinto
*
Endodontics Division, Department of Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba – SP, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Background: Managing apical periodontitis in a liver transplant candidate requires close coordination because advanced cirrhosis, coagulation abnormalities, and metabolic comorbidities may complicate dental treatment.
Case Presentation: A 53-year-old man with alcohol-associated liver cirrhosis, type 2 diabetes mellitus, hypertension, and hypothyroidism was referred for elimination of oral infectious foci before transplantation. Teeth #14 and #21 were diagnosed with pulp necrosis and apical periodontitis, while tooth #22 had previously been treated and showed asymptomatic apical periodontitis. Following multidisciplinary assessment, nonsurgical root canal treatment was performed for teeth #14 and #21, and nonsurgical retreatment was performed for tooth #22. The protocol included chemomechanical preparation, sodium hypochlorite irrigation, calcium hydroxide intracanal medication, and adjunctive antimicrobial photodynamic therapy. Clinical status and periapical healing were assessed over 12 months using limited-field cone-beam computed tomography and manual volumetric segmentation.
Results: All treated teeth remained asymptomatic and functional. Periapical lesion volumes changed from 0.41 to 0.00 mm³ for tooth #14, 16.65 to 10.82 mm³ for tooth #21, and 8.17 to 1.18 mm³ for tooth #22, corresponding to reductions of 100.0%, 35.0%, and 85.6%, respectively. No treatment-related adverse events were observed.
Conclusion: This case demonstrates the clinical feasibility of coordinated nonsurgical endodontic care and CBCT-based volumetric monitoring in a medically complex liver transplant candidate. The findings are limited to a single case and do not establish the efficacy of adjunctive aPDT or the superiority of CBCT monitoring.
Keywords: Apical periodontitis, antimicrobial photodynamic therapy, cone-beam computed tomography, endodontic treatment, liver cirrhosis, liver transplantation, medically compromised patient, periapical healing, root canal retreatment, volumetric analysis