Management of a large periapical lesion using Biodentine™ as retrograde restoration with eighteen months evident follow up
A healthy 24-year-old male patient was reported to the Department of Conservative Dentistry and Endodontics with a chief complaint of broken, discolored tooth and swelling in the previously traumatized maxillary anterior region. The patient gave a history of fall and broken tooth 2 years ago. Medical history was noncontributory and clinical examination revealed a soft, fluctuant, and nontender swelling in the anterior region with fractured and discolored maxillary right central incisor []. Radiographic examination revealed well-defined radiolucency involving the coronally fractured and discolored maxillary right central incisor and lateral incisor.\nBoth the teeth presented a negative response to pulp testing and endodontic treatment for both the incisors were scheduled. The endodontic treatment procedures were conducted under magnification (loops × 2.5, Carl Zeiss, Germany). After teeth isolation the access cavities were prepared followed by shaping and cleaning and placement of intracanal medicament of calcium hydroxide (RC Cal, Prime Dental Products, India), which was renewed every 15 days for 3 months. Radiographic examination at 3 months proved no traits of healing and hence a periapical surgery was scheduled.\nThe teeth were then obturated using cold lateral condensation []. Raising a double vertical trapezoidal flap, a periapical surgery was performed and periapical pathosis was enucleated []. Maxillary right central and lateral incisors were apically resected 3 mm from the apex and retrograde cavity was prepared using ultrasonic tip. Biodentine™ was placed as retrograde restorative material of 3 mm thickness. The placement of the retrograde filling material was confirmed using a radiograph [] and the sutures were placed. Biopsy of enucleated lesion was sent for histopathologytests.\nThe patient was recalled after a week for suture removal. The patient was kept under symptomatic and radiographic observation for the purpose of postoperative evaluation of healing of the periapical intervention in intervals of 1, 3, 6, 12, and 18 months. Biopsy report confirmed the periapical pathology to be a periapical cyst. Periodic radiographic evaluation of the area of intervention showed progressive healing and 18 months follow-up X-ray showed complete bone formation and tooth was asymptomatic [Figures -]. The patient refused for an orthodontic treatment for correcting his misaligned teeth so the tooth was restored by an esthetic composite class IV restoration [].