Surgical Management of a Large Endodontic Periapical Lesion With Bone Putty and Platelet-Rich Fibrin: A Case Report With a Two-Year Volumetric Follow-Up.

The present case report evaluates the surgical management of a large periapical lesion with palatal perforation using platelet-rich fibrin (PRF) and bone putty material, with a two-year follow-up. A 15-year-old male presented with persistent swelling and pain in the right maxillary anterior region, having a history of trauma and recurrent swelling. Cone beam computed tomography (CBCT) imaging revealed a large periapical lesion extending from teeth #11 to #15 with a palatal breach. Initial non-surgical root canal treatment (RCT) failed due to persistent exudation from teeth #11, #12, and #13. This led to the decision for periradicular surgery involving cystic lesion enucleation, apicoectomy, retrofill with mineral trioxide aggregate (MTA), and placement of bone putty and PRF. Follow-up assessments, including volumetric analysis with ITK-SNAP software (www.itksnap.org), showed a 97% reduction in lesion volume, from 4055 to 132 cubic millimeters. The palatal perforation was successfully repaired, with no clinical symptoms reported. Substantial reduction in lesion size and successful repair of the perforation highlight the potential of this approach in complex surgical endodontic cases.