PMC7433950_01
Preoperative clinical and surgical procedure. Preoperative clinical photograph showing drifted 43, 44, 45 (a). Flap elevation and cystic enucleation, apicoectomy, and retrograde filling (b). Placement of concentrated growth factor cystic space (c). Placement of sticky bone (d). Placement of concentrated growth factor membrane (e). Sutures placed (f)
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F1
Intraoral clinical examination revealed pathological migration of 43 with no debilitating symptoms [Figure 1a]. Full-thickness mucoperiosteal flap was elevated with two vertical incisions, complete curettage was carried out, followed by apicectomy and retrograde filling with MTA in 43, 44, 45 [Figure 1b]. Later, the surgical site was prepared for the placement of a combination of CGF with osseograft followed by CGF membrane [Figure 1c and d]. The fibrin gel accommodating the CGF was separated from the red blood cells, dispensed onto a metal storage box, compressed using a metal cover to procure the CGF membrane which was effectively used as a substitute for GTR [Figure 1e]. Piscataway, USA) [Figure 1f]. Postoperative instructions were given to the patient, following which medications were prescribed.
Preoperative radiographic images-intraoral periapical and cone-beam computed tomography images. Preoperative intraoral periapical showing periapical lesion involving the apices of 43, 44, 45 (a). Postoperative intraoral periapical showing healing (b). Preoperative cone-beam computed tomography image showing the extent of lesion in cross-sectional slice (c). Postoperative cone-beam computed tomography image showing the extent of lesion in cross-sectional slice (d). Preoperative cone-beam computed tomography showing the lesion in tangential slice (e). Postoperative cone-beam computed tomography showing the lesion in tangential slice (f). Preoperative cone-beam computed tomography showing the lesion in axial section (g). Postoperative cone-beam computed tomography showing the lesion in axial section (h)
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F2
On radiographic examination (VistaScan Mini, UK), periapical radiolucency was evident in 43, 44, 45 [Figure 2a]. The preoperative measurements of the lesion extent were viewed in different planes; the tangential section measured 14.39 mm x 9.42 mm; cross-sectional measured 14.77 mm x 8.46 mm and axial section measured 12.14 mm x 6.52 mm [Figure 2c-g]. Obturation was carried out in 43, 44, 45 [Figure 2b]. No adverse events were reported, at 1 year follow-up, intraoral periapical radiograph [Figure 3], and CBCT revealed a thorough healing at 43, 44, 45 region with bone regeneration at the defective site [Figure 2d, f and h].
1 and 2 years' follow radiographs showing 90% healing of the periapical lesion
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F3
No adverse events were reported, at 1 year follow-up, intraoral periapical radiograph [Figure 3], and CBCT revealed a thorough healing at 43, 44, 45 region with bone regeneration at the defective site [Figure 2d, f and h].
Preoperative and postoperative volume calculations to delineate the lesion from healthy bone. (a and b) Preoperative and postoperative volume calculations, respectively
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F4
Pre- and post-operative volume calculations were 1.0798 cm3 and 0.2265 cm3, respectively [Figure 4a and b].