Ultrasonic osteotomy and regeneration with A-PRF+ for periapical surgery of a mandibular molar with root cyst perforating the lingual osseous cortex: A case report.

Background: Periapical surgery is a complex dental procedure that remains a considerable challenge in clinical practice. The use of APRF+ membranes and piezoelectric osteotomy help to improve outcomes and increase the efficiency and speed of recovery.

Material And Methods: This case report describes a 20 years-old man with a periapical lesion which perforated the lingual cortex in a lower mandibular molar. A periapical surgery was performed with endoscope magnification and ultrasonic osteotomy. Apicectomy and retrograde cavities were performed using a piezoelectric scalpel and sealed using a bioceramic sealer. The osteolytic defect was filled with A-PRF+ membranes and the bone cortex was repositioned trough a micro-screw.

Results: The histological analysis concluded an inflammatory odontogenic cyst. The postoperative period was uneventful with pain and mild oedema until the fourth day. Short-term follow-up showed the beginnings of bone regeneration and correct healing of the surgery without periodontal defects. Two-year follow-up showed favorable results and regeneration of the bone defect.

Conclusions: Periapical surgery with magnification, ultrasonic osteotomy repositioning and application of A-PRF+ membranes as an adjuvant proved to be an effective approach for the regeneration of the osteolytic process, allowing the preservation of the tooth. Promising short and long-term results were shown for this case report. Periapical surgery, osteotomy, ultrasound, A-PRF+.