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 can lead to endodontic therapy failure. Overextended gutta-percha can also act as a periradicular tissue irritant. Large periapical lesions can be associated with such teeth. When using a nonsurgical approach, retrieval of overextended gutta-percha can prove to be a challenge. This case report describes the nonsurgical management of a large periapical lesion associated apical a tooth 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 at 1 year 3 months.