Complete Healing of a Large Periapical Lesion with Buccal Cortical Plate Perforation Using Single-visit Endodontics without Any Intracanal Medicament: A 2-year Follow-up Case Report

Large periapical lesions that involve perforation of the cortical plate are typically treated through multi-visit root canal therapy with the aid of intracanal medications or surgical endodontic. This document discusses how to successfully manage a large periapical lesion through a single appointment root canal therapy, without using any intracanal medications. A 41-year-old female present with swelling in the vestibule associated with tooth #24. The cone-beam computed tomography revealed a notable radiolucency around the apex, along with a perforation in the buccal cortical plate. The root canal treatment was successfully completed in one session using heated and ultrasonically activated 5.25% sodium hypochlorite, followed by obturation. At the 2-year follow-up, there was complete radiographic healing and bone regeneration, with the patient remaining asymptomatic. This case indicates that enhanced irrigation techniques may facilitate reliable healing of extensive periapical lesions without the need for any intracanal medications.