Surgical Management of a Large Periapical Lesion - A Two Year Follow Up

ABSTRACT

A successful endodontic therapy depends on resolution of all the clinical signs and symptoms with complete periapical repair or regeneration. Sometimes conventional root canal therapy fails because of which we have to resort to periapical surgery.1 Periapical surgery removes the pathological tissue and leads to healing of the periapical lesion.2,3 Periapical surgery accounts for 3 % - 10 % in endodontic practice.4Platelet‐Rich Fibrin (PRF) is a platelet concentrate with specific composition, three‐dimensional architecture, and has characteristics with all the constituents of a blood sample to favour wound healing.5 PRF contains numerous growth factors such as platelet-derived growth factor (PDGF), transforming growth factor β1 (TGF β1), insulin-like growth factor (IGF) and exhibits numerous properties such as cell migration, cell attachment, cell proliferation, and differentiation6 facilitating the regenerative process of human body by utilizing the patient’s own blood is a novel concept in dentistry. These blood clots initiate the process of healing and regeneration of the hard and soft tissues.7,8PRF is like an interpositional biomaterial. It accelerates wound healing due to growth factor release. It is an easy and cost-effective way to obtain high concentrations of growth factors for tissue healing and regeneration.5 Any periapical lesion is a type of response of the bone around the apex of tooth that develops due to pulpal necrosis or extensive periodontal disease. Following endodontic treatment, repair or regeneration can occur depending on the microenvironmental causes. This case report exemplifies the use of platelet rich fibrin (PRF) and bone graft for the management of a large periapical lesion. Following endodontic treatment, periapical endodontic surgery was performed on a 41 year old male patient having a swelling in the buccal region of lower front teeth with a large defect evidenced radiographically. The surgical defect after curettage was filled with PRF, bone graft and guided tissue membrane and sutured. PRF along with bone graft accelerated the wound healing and induced bone formation.