Nonsurgical management of large periapical lesions: case reports and review of the literature.

The objectives of this article are to report 2 cases of nonsurgical endodontic treatment for the management of periapical lesions associated with large cortical bone perforations and review the literature on the clinical efficacy of nonsurgical endodontic treatment to draw insights from published case reports. Large, cyst-like periapical lesions in 2 patients were successfully treated with combined modalities of root canal treatment, antimicrobial therapy (calcium hydroxide and triple antibiotic paste [TAP]), and mineral trioxide aggregate (MTA) obturation of the canal space. In both cases, instrumentation was extended 1 mm beyond the apical foramen to facilitate drainage through the root canal, because it was assumed that the periapical lesion could be cystic. After instrumentation, TAP was placed within the canal space to aid in disinfection and healing of the dental, pulpal, and periapical conditions. In both patients, the teeth were asymptomatic and functional at follow-up examinations (case 1, 3 years; case 2, 30 months). Supporting the positive outcomes in the 2 clinical cases, the published literature suggests that the use of biocompatible materials such as MTA, which can promote the deposition of hydroxyapatite, has the potential to contribute to tissue regeneration and the healing of large periapical lesions.