Nonsurgical management of a large periapical lesion using aspiration in combination with a triple antibiotic paste and calcium hydroxide

Persistent microorganisms in the root canal are known to cause endodontic treatments failure. Overextended gutta-percha can also act as a periradicular tissue irritant, leading to large periapical lesions. Retrieval of overextended gutta-percha with a nonsurgical approach can prove to be a challenge. This case describes the nonsurgical management of a large periapical lesion associated with overextended gutta-percha. Retrieval of gutta-percha was attempted but the overextended portion could not be removed. Aspiration of the purulent exudate was done through the root canal followed by use of a triple antibiotic paste. After 2 weeks the antibiotic paste was replaced with calcium hydroxide, to enhance the osseous regeneration. The periapical lesion showed a considerable amount of periapical healing after 15 months. The results of this case demonstrate that aspiration in conjunction with the triple antibiotic paste and calcium hydroxide may possibly be used in managing large periapical lesions associated with overextend gutta-percha.