Interdisciplinary approach for treating a large through-and-through periapical defect using guided tissue...

Area of Science:

• Endodontology
• Regenerative Dentistry
• Oral Surgery

Background:

• Large through-and-through periapical lesions present significant diagnostic and management challenges.
• Uncontrolled infection and unpredictable bone healing can lead to unfavorable endodontic outcomes.
• Complete periapical tissue regeneration remains a complex clinical goal.

Observation:

• A case study involving a patient with a 15 × 15-mm through-and-through periapical lesion and persistent gingival swelling was presented.
• The lesion was associated with persistent gingival swelling, indicating ongoing inflammatory processes.
• Standard endodontic treatments were insufficient to resolve the condition.

Findings:

• Endodontic microsurgery combined with guided tissue regeneration (GTR) using a resorbable membrane and osseous substitute was performed.
• A 2-year postoperative radiograph demonstrated complete resolution of the periapical radiolucency.
• A 7-year clinical and radiographic follow-up confirmed the tooth remained asymptomatic with maintained long-term success.

Implications:

• This case highlights the efficacy of combining endodontic microsurgery with GTR for managing extensive periapical lesions.
• The findings suggest that this combined approach can achieve predictable and long-lasting regeneration of bone defects.
• Successful long-term outcomes are achievable even for large periapical lesions, improving patient prognosis.