Use of biomaterials in periradicular surgery: a case report

This article reports a case of periradicular surgery in which biomaterials, such as mineral trioxide aggregate (MTA), human lyophilized bone, and calcium sulfate, were used. A 21-year-old female patient was referred to our endodontic clinic as a result of recurrent episodes of acute exacerbation of a chronic process involving the maxillary left lateral incisor. There was complete destruction of the buccal bone plate at the apical third, leaving this portion of the root exposed to the oral cavity. After conventional root canal therapy carried out under special tooth isolation conditions, apicoectomy was performed, and a root-end cavity was prepared and restored with MTA as a retrofilling material. Because of the exposure of the root-end resection to the mouth, osteoinductive and osteoconductive materials (human lyophilized bone and calcium sulfate, and calcium sulfate alone, respectively) were used, with the goals of modeling the lost bone structure, preventing invasion of the oral epithelium, and avoiding the occurrence of secondary infection. Two years after the periradicular surgery, there were no clinical or radiographic signs suggestive of treatment failure, but instead the patient's follow-up has shown that the case management has been successful as indicated by lesion regression and periodontal repair. On the basis of the review of literature and the clinical-radiographic outcomes hereby presented, it might be concluded that (1) large bone destructions caused by periradicular lesions might and should be filled with recognizably effective bone-replacing materials during regenerative tissue process. MTA, human lyophilized bone, and calcium sulfate seemed to have an important role in alveolar bone induction, remodeling, and repair. (2) Because of its characteristics of promoting excellent marginal sealing and stimulating osteoblastic adherence to the retrofilling surface, MTA has been considered as the retrofilling material of choice.