Periradicular regenerative surgery in a maxillary central incisor: 7-year results including cone-beam computed...

A case of a symptomatic maxillary central incisor that underwent periradicular regenerative surgery with a successful long-term clinical and radiographic outcome is presented.

A 52-year old woman was referred to the Endodontology Clinic, UCL Eastman Dental Institute and Hospital, London, UK, in 2004 for swelling and discoloration of the maxillary right central incisor. There was a history of trauma 21 years previously. The tooth was endodontically treated 5 years before the referral. At presentation, there was diffuse facial swelling/erythema and a periodontal probing depth of 11 mm on the midfacial surface with bleeding on probing and purulent exudate. Endodontic retreatment was completed along with subgingival debridement. Reassessment at 6 weeks showed persistent purulent exudate and a probing depth up to 13 mm facially. Periradicular surgery was performed for the purposes of surgical exploration, apical resection and root-end filling with mineral trioxide aggregate, and guided tissue regeneration using a bone xenograft and collagen membrane. Histopathology confirmed the presence of a radicular cyst.

Clinical and radiographic evaluation, including cone-beam computed tomographic imaging, at 7 years postoperatively showed a probing depth up to 3 mm and hard tissue formation apically, interproximally, and partly facially on the root surface.

In this case of a combined endodontic-periodontic lesion in a maxillary central incisor, regenerative periradicular surgery led to the resolution of the defect, significant attachment gain, and a stable clinical and radiographic outcome after 7 years of follow-up.