GD557 - Periapical scar formation after apicoectomy using leukocyte- and platelet-rich fibrin as sole filling materials: a case report with 6-year follow-up-PDF Insrtuctional Page

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This case report describes a 53-year-old woman with a persistent periapical lesion on the maxillary left lateral incisor (tooth 10) that remained after two nonsurgical endodontic treatments. Because extraction was not desired, she underwent apicoectomy combined with open flap scaling and root planing. Leukocyte- and platelet-rich fibrin (L-PRF) membranes, prepared from the patient’s own blood, were used as the sole filling material for the bone defect.<br /><br />During surgery, the lesion was removed, the root apex was resected, the root surface was planed, and the defect was filled with L-PRF and blood clot without placing a retrograde filling. The patient received postoperative medications and had an uneventful early recovery. At 1 month, radiographs showed reduced radiolucency and early remineralization. Although long-term follow-up was initially lost, the patient was reassessed 6 years later and reported no symptoms or progression. Radiographs showed incomplete resolution of the lesion but clear mineralization and a periapical scar, indicating stable healing.<br /><br />The authors explain that incomplete healing after apical surgery can still be considered a clinical success when the tooth remains functional and asymptomatic. They note that L-PRF may support healing by releasing growth factors, promoting angiogenesis and bone repair, and providing antimicrobial and anti-inflammatory effects. The case suggests that apicoectomy with L-PRF can be a conservative alternative to extraction for persistent endodontic-periodontal lesions, allowing long-term tooth retention.

Keywords

apicoectomy

leukocyte-rich fibrin

platelet-rich fibrin

periapical lesion

maxillary lateral incisor

endodontic treatment

root planing

bone defect

periapical scar

tooth retention