Endodontic-surgical-orthodontic management of maxillary central incisor with root dilaceration and large apical periodontitis using leukocyte and platelet-rich fibrin

Abstract

Teeth with root dilaceration represents a challenge in clinical practice when an intervention is needed, especially in cases requiring a multidisciplinary approach to resolve the issue. Aim: This report describes the root dilaceration of a maxillary central incisor with severe apical periodontitis, involving a 4-year follow-up of endodontic surgical-orthodontic management using leukocyte and platelet-rich fibrin (L-PRF). Methods: The planning process included treating the root canal and the central maxillary incisor affected by distoangular root dilaceration, by using orthodontic repositioning of the neighboring tooth, and an endodontic and periapical surgical approach. The operative procedure used cone-beam computed tomography (CBCT) scans of the left maxillary central incisor, taken prior to orthodontic tooth movement maxillary lateral incisor. Orthodontic treatment was performed after the endodontic treatment, and followed by surgical management with periapical lesion curettage, apicoectomy, retro-preparation, retro-filling and grafting with L-PRF, resulting in a successful conclusion. Conclusion: The four-year clinical follow-up showed complete alignment of the maxillary lateral incisor and signs of periapical healing based on CBCT images.