3D Comparative Evaluation of Healing Following Successful Management of Large Periapical Lesions of Endodontic Origin with Palatal Perforations-A Case Series with Three Years Follow-Up

Though periapical lesions with labial perforations have been adequately addressed in the endodontic surgical literature, the management of palatal perforations is rarely referred to. The evaluation of post-surgical healing for long has been quite subjective with 2D imaging; however with the availability of newer 3D software, volumetric analysis with numerical values has brought greater scientific accuracy in the evaluation of post-surgical healing. This case series has been written according to Preferred Reporting Items for Case Reports in Endodontics (PRICE) 2020 guidelines. Case description: After an appropriate diagnosis, root canal treatment was carried out as per protocol and on the day of surgery, lesion contents were completely removed palatal perforation was repaired with bone putty material acting as a scaffold and the enucleated cavity was filled with platelet-rich fibrin. Primary closure was done after repositioning the mucoperiosteal flap. Patients were kept under three years of follow-ups and were evaluated yearly using 3D software for CBCT analysis for a reduction in the size of the bone cavity post-surgically. Practical implications: The 3D evaluation of CBCT shows a significant volumetric reduction in the size of the bone cavity corroborating that, the exact placement and retention of bone putty material in the nasal/palatal perforations followed by filling the lesion with Platelet-Rich Fibrin (PRF) aids in faster and efficient healing of the large periapical lesion.