(PR85) Decompression of Large Periapical Lesion Using Penrose Drain: A Case Report

Abstract: Treatment of large endodontic periapical lesions can be very challenging. Surgical debridement and apicoectomy can be limited due to multiple factors, such as the proximity of critical anatomical structures and the risk of the devitalizing adjacent teeth. Multiple techniques have been utilized for decompression in such situations. Penrose drains are inert, soft, radiopaque, and economical; importantly, they cause little foreign body reaction. Here, we report a case of decompression using Penrose drain in a large periapical lesion with no response to non-surgical endodontic retreatment. A 56-year-old male patient presented with a non-healed periapical lesion after endodontic retreatment of tooth #10. Cone-beam computed tomography (CBCT) scanning revealed that the through-and-through periapical lesion perforated into not only the buccal/palatal plates but also the floor of the nasal cavity. Decompression was elected for treatment. A ¼’’ Penrose drain was placed into the cystic lumen after aspiration and saline irrigation using 18G needles. The drain was fixed with sutures and removed in 4 weeks. Patient was monitored for 1, 6, 10, 18, and 30 months. Patient remained asymptomatic , and teeth #9 and #11 responded to cold tests at each follow-up appointment. No swelling or sinus tract developed. CBCT scanning at 30-month follow-up showed dramatic bone regeneration in the periapical area of tooth #10 three-dimensionally. Intact palatal plate and nasal floor were re-established. This report demonstrates that the placement of Penrose drain after aspiration and irrigation can be a simple and inexpensive alternative approach to manage large periapical lesions with an endodontic origin.