Nonsurgical Management of a Large Periapical Lesion Following Instrument Retrieval From the Apical Third: A Case Report With a Three-Year Follow-Up

Instrument separation in the apical third of the tooth, which is associated with a large periapical lesion, presents an arduous task for the clinician. This case report presents nonsurgical endodontic management of a maxillary central incisor associated with a large periapical lesion and a separated instrument in the apical third of the root canal. A 28-year-old male patient presented with pain and labial swelling in the left maxillary central incisor region. Pulp sensibility testing showed no response. The radiograph revealed the presence of a separated instrument in the apical third of the root canal and periapical radiolucency. A diagnosis of previously initiated therapy with acute apical abscess was made. In the first visit, instrument retrieval was done using ProUltra Endo tips (Dentsply Sirona, York, Pennsylvania) under a dental operating microscope. In the subsequent visit, obturation was done as the patient was asymptomatic. The patient was recalled for follow-up at six, 12, 18, 24, and 36 months. Complete healing of the periapical tissues was evident on the radiograph, and the tooth remained functional for the entire follow-up period of three years. The successful outcome seen in this case shows that even large periapical lesions can be managed conservatively by nonsurgical endodontic treatment