PMC6362495_01
Preoperative clinical and surgical procedure and radiographic images: IOPA and CBCT images (Case Report 1). (a) Pre-op clinical photograph showing discoloured 11 with chipping of the incisal edge of the crown. (b) Preoperative IOPA showing the periapical lesion involving the apices of 11 and 12 and extending to the mesial margin of 13. (c) Complete curettage of the lesion and apicectomy done in 12. (d) Retrograde preparation and filling with MTA in 11 and 12. (e) CGF fibrin block placed in the bony cavity. (f) CGF membrane placed to cover the bone defect. (g) Pre-op CBCT image showing the lesion measurement in the coronal slice. (h) Post-op CBCT image showing the lesion measurement in the coronal slice. (i) Pre-op CBCT image showing the lesion measurement in sagittal slice corresponding to 12. (j) Post-op CBCT image showing the lesion measurement in sagittal slice corresponding to 12. (k) Pre-op CBCT image showing the lesion measurement in sagittal slice corresponding to 11. (l) Post-op CBCT image showing the lesion measurement in sagittal slice corresponding to 11.
CRID2019-7046203.001.jpg
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fig1
Intraoral clinical examination revealed a slightly discoloured 11 and chipping of the incisal edge with no presenting symptoms (Figure 1(a)). On radiographic examination (VistaScan Mini, UK), extensive periapical radiolucency involving the roots of 11 and 12 and an open apex of 11 was revealed (Figure 1(b)). The preoperative measurements of the lesion as seen in CBCT in different planes can be seen in Figures 1(g), 1(i), 1(k). A bony window was created and thorough curettage was done (Figure 1(c)). Switzerland) in 11 and 12. Subsequently, retrograde filling was done with Mineral Trioxide Aggregate (MTA Angelus  Brazil) (Figure 1(d)). The CGF layer is then placed in a condensing disc and compressed to convert to CGF membrane. (Figures 1(e), 1(f)). The postoperative CBCT at 1-year follow-up showed satisfactory healing with evident reduction in lesion size as shown in Figures 1(h), 1(j), 1(l), and the patient was asymptomatic at all the recall periods, suggesting a successful treatment outcome.
PMC6362495_02
Preoperative clinical and surgical procedure and radiographic images: IOPA and CBCT images (Case Report 2). (a) Pre-op clinical photograph shows discoloured 31. (b) Preoperative IOPA showing the periapical lesion involving the apices of 11 and 12 and extending to the mesial margin of 13. (c) Complete curettage of the lesion. (d) Apicectomy done and MTA retrograde filling given in 31 and 41. (e) CGF fibrin-rich block placed in the bony defect. (f) CGF membrane placed before suturing of the flap. (g) Pre-op CBCT image showing the lesion measurement in the coronal slice. (h) Post-op CBCT image showing the lesion measurement in coronal slice. (i) Pre-op CBCT image showing the lesion measurement in sagittal slice corresponding to 41. (j) Post-op CBCT image showing the lesion measurement in sagittal slice corresponding to 41. (k) Pre-op CBCT image showing the lesion measurement in sagittal slice corresponding to 31. (l) Post-op CBCT image showing the lesion measurement in sagittal slice corresponding to 31.
CRID2019-7046203.002.jpg
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fig2
On clinical examination, 31 was discoloured with mild swelling on the labial aspect (Figure 2(a)). Radiographic examination revealed a well-obturated 31 and 41 with large periapical radiolucency (Figure 2(b)). The CBCT-PAI score was 5D (Figures 2(g), 2(i), 2(k)). The surgical site was flushed with sterile saline after thorough curettage of the lesion (Figure 2(c)). Following which, apicectomy and retrograde MTA filling were done (Figure 2(d)). The CGF preparation was similar as described in Case Report 1, and the prepared CGF was placed inside the surgical site and covered with CGF membrane (Figures 2(e), 2(f)). Follow-up CBCT at 1 year revealed complete healing with complete bone repair, evidently seen in coronal and sagittal views (Figures 2(h), 2(j), 2(l)).