Regenerative endodontic procedure combined with apical surgery of a necrotic permanent incisor with extensive periapical lesion using plasma rich in growth factors (PRGF): A Case report with 6 years post-op evaluation using CBCT.

BACKGROUND: The aim of this case report is to describe the step-by step and outcomes of a treatment approach which simultaneously combines a Regenerative Endodontic Procedure (REP) and apical surgery using PRGF as treatment of a post-traumatic necrotic permanent central incisor with extensive periapical lesion and undeveloped apex in a 16 years-old patient. CASE DESCRIPTION: A 16 years-old patient with an extensive periapical lesion in the maxillary central incisor was treated with a combination of REP and periapical surgery in the same visit. A Bi- antibiotic paste (BAP) was used to priorly disinfect the canal, which was posteriorly sealed with MTA placed over a PRGF clot at the same time that the periapical lesion was surgically debrided, removed and grafted, The radiographic and CBCT follow-up results showed a complete healing of the radiolucent lesion, which was replaced with bone-like tissue in two years and well preserved until six years later. PRACTICAL IMPLICATIONS: A combined approach of a Regenerative Endodontic Procedure and apical surgery using PRGF may be a good treatment modality in cases of extensive periapical lesions in necrotic teeth with open apexes. PRGF has shown to act as an ideal autologous matrix because it is stable, provides growth factors and bioactive molecules, and stimulates collagen production, angiogenesis, and cell differentiation. Key words:Regenerative endodontic procedure, open apex necrotic tooth, periodontal apical lesion, growth factors, apical surgery.

Reparación de una perforación iatrogénica en el tercio cervical de un incisivo central superior: a propósito de un caso / No disponible

Se describe el caso clínico de una paciente mujer de 35 años que presenta necrosis pulpar con periodontitis apical aguda de 1.1 con una perforación iatrogénica asociada, localizada en la pared vestibular del tercio cervical de la raíz, observándose la emergencia de la lima por la encía vestibular. El sondaje es regular de 3 mm. El plan de tratamiento consiste en la limpieza y conformación del conducto y el sellado del defecto de la perforación con MTA (ProRootMTA®) a través de la cavidad de acceso. Se describe detalladamente la secuencia de tratamiento así como la evolución a los 2,6 y 9 meses (AU)

We describe the case of a 35 year old woman patient who presents pulp necrosis with acute apical periodontitis of 1.1 with an associated iatrogenic perforation, located at the buccal Wall in the cervical third of the root, showing the emergence of the file on the buccal gingiva. The probing is regular 3mm. The treatment plan consists in cleaning and the canal and sealing the perforation defect with MTA (ProRootMTA®) through the access cavity. It describes in detail the sequence of treatment as well as the evolution at 2, 6 and 9 months (AU)