Large Periapical Lesion Treatment Using Guided Tissue Regeneration: A Case Report

Abstract

Background: Intraradicular and/or extraradicular bacteria have been consistently associated with primary and post-treatment periapical lesions. Although the initial success rate for orthograde endodontic procedures is high, complications after treatment are common. If pathosis persists following a root canal procedure, it is advisable to consider endodontic retreatment as the primary treatment option. When a non-surgical root canal treatment fails or is insufficient to save the tooth, surgical intervention becomes necessary. The regeneration of large periapical defects can be quite challenging after periradicular surgery. In such cases, the proliferation of gingival connective tissue or the migration of oral epithelium into the defect can hinder the formation of normal trabecular bone. Guided Tissue Regeneration (GTR) can be used alongside endodontic retreatment to facilitate the restoration of hard tissue in cases involving large periapical lesions. 

Aim: The goal is to assess the impact of a resorbable collagen-based membrane and bone graft material following endodontic retreatment and cyst enucleation on the healing process of large periapical lesions. 

Methods: Clinical and radiographic evaluations led to a provisional diagnosis of a radicular cyst, which was later confirmed through biopsy. Root canal retreatment was undertaken, during which surgical treatment included apical resection without retrograde filling and enucleation of the cyst, followed by the placement of the bone graft and the resorbable membrane. 

Result: The combination of bone graft material and a resorbable barrier membrane alongside endodontic retreatment may have increased rapid bone regeneration in a large periapical lesion. 

Conclusion: In case of a large periapical lesion the use of a bone graft material and resorbable barrier membrane conjunct with endodontic treatment/retreatment is the effective method, which provides the regeneration of a large periapical lesion in the shortest possible time.

Keywords: GTR, periapical lesions, periradicular/periapical surgery, root canal therapy, endodontic retreatment.