Resolution of a large periapical lesion in an immature maxillary lateral incisor with the aid of triple antibiotic paste

Apexification procedures are frequently performed on immature permanent teeth with incomplete root formation, open apices and necrotic pulp status with or without periapical lesions in order to induce a calcific barrier prior to root canal therapy. The elimination and control of infection in the root canal space is critical to the success of these procedures. A healthy 21-year old male presented with pulpal necrosis, a large periapical lesion, incomplete root formation and an open apex on a maxillary right lateral incisor. Triple antibiotic paste was used to achieve antimicrobial control after traditional calcium hydroxide paste medicament failed to resolve the symptoms. Obturation was achieved using MTA and the conventional apexification technique. Excellent healing of the large periapical lesion was achieved without surgical intervention and the 4-year follow-up CBCT demonstrated complete bone fill of the lesion. Clinicians should be aware that alternative antimicrobial medicaments, such as triple antibiotic paste, may be beneficial in situations where conventional medicaments prove unsuccessful. The use of triple antibiotic paste may result in sufficient healing of the periapical lesion to justify placement of an MTA apical barrier without the need for surgical intervention