Surgical Management of an Open Apex with Platelet-Rich Fibrin and Hydroxyapatite Bone Graft – A Case Report

Abstract

Periapical surgery is the treatment of choice for a large periapical lesion with bone loss that occurs due to long standing untreated teeth affected by trauma, caries or in situations where there is an endodontic treatment failure. Failure of nonsurgical endodontic treatment may be due to peri radicular tissues incorporating with infections, foreign body response to filling materials, over instrumentation or over obturation which might have prevented complete periapical healing. We present here 2 case reports wherein, combination of platelet-rich fibrin (PRF) and the hydroxyapatite (HA) graft was used to achieve rapid healing of large periapical lesions, and the treatment outcome concluded that PRF and hydroxyapatite bone graft accelerated the wound healing and induced the rapid rate of bone formation, which was confirmed radiographically. Untreated non-vital teeth generally result in bone destruction in periapical region, which may occur due to the spread of infection following pulpal necrosis, trauma or failed endodontic treatment. Surgical intervention is essential when endodontic treatment has failed and retreatment is not possible. Periapical surgery, Apicoectomy or root end resection endodontic surgery is a safe and well documented treatment alternative when teeth with periapical pathosis are not responding to conventional endodontic treatment.1 Periapical surgery removes periapical pathosis resulting in optimal wound healing with regeneration of the bone and periodontal tissue.