Apical periodontitis is an inflammatory condition of the tissues around the root apex, usually a consequence of untreated or incompletely treated pulp infection. In continuing education for medical staff, updating correct indications and technical protocols for pulp-apical treatment is crucial to conserve teeth and prevent spreading complications.

Overview of apical periodontitis and treatment indications

Apical periodontitis pathology can manifest in acute or chronic forms. For cases of teeth with pulp or periapical pathology, the core objective is to remove infected tissue and seal the root canal system. Specifically, techniques such as root canal treatment (endodontics) or more specialized apical procedures are indicated when teeth have irreversible pulpitis, pulp necrosis, or cases where teeth have undergone root canal treatment but have progressive periapical lesions.

Conversely, contraindications usually include teeth whose function cannot be restored, teeth with severe periodontal conditions leading to grade 3 mobility, or when the patient is in an acute systemic disease stage that does not allow invasive procedures.

Standard endodontic treatment technical protocol

A standard pulp-apical treatment process begins with patient preparation, including checking records, local examination, and performing a surgical safety checklist. The **anesthesia** process usually uses local infiltration or block anesthesia, depending on the location of the tooth being treated.

The technique is conducted through basic steps:

• Access opening: To expose the root canal system and determine working length.

• Cleaning and shaping: Using hand or rotary instruments combined with specialized irrigation solutions.

• Obturation: Sealing the root canal system with biocompatible materials.

• Restoration: Reconstructing the tooth crown to ensure chewing function and aesthetics for the patient.

Monitoring and handling treatment complications

During implementation, medical staff need to pay special attention to accidents such as pulp floor perforation, root canal wall perforation, or instrument breakage. Additionally, patients may experience extrusion of obturation material or irrigation solution beyond the apical region, causing pain.

Systemically, reactions such as anaphylactic shock or local anesthetic toxicity need immediate handling according to the Ministry of Health’s protocol. Post-treatment, evaluating results based on stable vital signs, no tooth sensitivity, and stable occlusion are important criteria to complete the record.

Conclusion and training orientation

Strict adherence to the technical protocol not only helps improve the success rate but also ensures maximum safety for the patient. Medical staff need to regularly cultivate skills in using diagnostic imaging means such as X-rays to closely monitor the healing of periapical lesions, thereby making timely indications for additional intervention.

Source of cited information: Ministry of Health (2025), “Technical Guidelines on Odonto-Stomatology – Volume 1”, issued with Decision No. 3634/QĐ-BYT dated May 24, 2025, of the Minister of Health.

MSc. Dr. Cao Thanh Hoa – Deputy Director of the Center for Support & Continuing Education