Abstract
OBJECTIVES: The aim of this study was to save endodontically failed teeth with periapical pathosis by surgery. Elimination of the periapical pathology and to evaluate the clinical and radiological efficiency of freeze dried bone allograft in bony defects. MATERIALS AND METHODS: Ten patients were included in this study with established periapical pathology with the need for periapical surgery after failed endodontic therapy. Surgery was decided after the cessation of acute symptoms. Patients on regular medications for known medical complications were excluded from the study. A full thickness flap or modified Leubke-ochsecnbein was raised depending upon the size and location of the lesion. Thorough periapical curettage was performed to remove the pathological tissue surrounding the apices and the root of the tooth. The graft material was mixed with patient's venous blood drawn earlier from a peripheral vein to make it more cohesive. The graft material mixed with blood was then carefully packed with light pressure into the defect. The flap was replaced. All the patients received broad spectrum antibiotics one day before and five days after surgery. The cases were followed up with clinical and radiological examination and were recalled at intervals of 1 month, 3 months and 5 months postoperatively to assess the condition of the periapical area. RESULTS: In all the ten cases at the end of 1st month postoperatively a well defined border separating the host bone from the graft material indicating simultaneous resorption of the graft. This resorption continued at 3 months follow up indicating continued graft resorption and also increasing radioopacity, haziness indicating bone regeneration. Eight of the ten patients could be evaluated at the end of fifth month and radiographs showed increase in radioopacity and reduction in size of periapical radiolucency as well as normal trabecular pattern of the bone. CONCLUSION: The results demonstrate successful use of FDBA in the treatment of osseous defects of periapical lesions associated with failed endodontically treated teeth.