Healing of Extensive Through-and-Through Periradicular Lesion Using Apicoectomy Without Bone Grafting: A Case Report With 3-Year Recall

The pathogenic process of through-and-through lesions leads to erosion and loss of both cortical plates. Endodontic microsurgery (MS)with bone graft and membrane placement (guided tissue regeneration (GTR)) is the proposed treatment for such cases. This article is aimed at discussing an unusual treatment protocol for a large through-and-through lesion without the use of bone grafting or membrane. A 26-year-old Air Force pilot traveling at high altitudes presented to the Endodontic division for management of pain and swelling related to the upper left anterior lesion concerning Teeth #21, #22, and #23. Following a thorough clinical examination, medical history, and clinical and radiographic examination, the diagnosis of the presence of a through-and-through lesion related to previously treated teeth. The treatment plan included endodontic MS without the use of GTR due to his work nature. Over 3 years, routine follow-ups were essential for tracking the damaged area’s healing process, which ultimately resulted in full recovery. This case emphasizes how crucial it is to obtain a thorough history and use a multidisciplinary approach to diagnose and manage through-and-through lesions, achieving positive outcomes.