A number of diagnostic and management challenges exist for achieving complete regeneration of large through and through periapical lesions. An unfavorable endodontic outcome may occur as a result of uncontrolled infection or unpredictable bone healing. The presence of an apicomarginal defect is also one of the reasons for the failure of endodontic treatment. The best treatment option to treat an apicomarginal defect is to perform endodontic surgery using Guided Tissue Regeneration (GTR) membranes. A few recent studies have reported favorable outcome for treatment of apicomarginal and through & through defects using GTR. CBCT imaging provides clinicians with a clear view of the anatomic relationship between root apices and neighboring structures, such as the mandibular canal, mental foramen, and maxillary sinus it also suggests where access osteotomies can be performed enabling minimally invasive surgery. This article presents a case with a large through and through periapical lesion and apicomarginal defects. Endodontic microsurgery and guided tissue regeneration were performed using a resorbable membrane. Preoperative and one year post-operative CBCT were compared for healing of lesion. 1 year post-operative CBCT showed more than 90% healing of periapical lesion and significant healing of apico-marginal lesion.
Key words: Through & through lesion, apico-marginal lesion, CBCT, microsurgery, guided tissue regeneration, bio-resorbable membrane.
Received: 14 October 2018 Revised: 27 October 2018 Accepted: 28 October 2018
Corresponding author: Dr. Pragnesh D Parmar, MDS, Department of Conservative Dentistry & Endodontics, Post Graduate Institute of Dental Sciences (PGIDS), Rohtak(Haryana), India
This article may be cited as: Parmar PD, Kaur R, Singh N. Surgical management of combined apico-marginal and through & through peri-radicular lesion with GTR using bio-resorbable membrane, microscope and cone beam computed tomography: A Case Report. J Adv Med Dent Scie Res 2018;6(11):42-47.