A Novel Protocol For Bone Healing In Periapical Defects Using Prf With Antibiotic-Infused Collagen: A Case Report

Abstract

Periapical pathology resulting from pulpal necrosis can lead to extensive bone destruction, particularly in cases involving through-and-through defects affecting both buccal and lingual cortical plates. This case report presents a novel approach combining advanced platelet-rich fibrin (A-PRF) and an antibiotic-loaded collagen graft (Enzomac CM) for the surgical management of a large periapical lesion. A 22-year-old female patient with a history of dental trauma presented with a non-vital maxillary lateral incisor and a radiographically diagnosed periapical cyst extending across multiple teeth. A combined endodontic and surgical approach was adopted, including root canal treatment, lesion enucleation, apicectomy, and graft placement. The graft material, composed of PRF and Enzomac CM granules containing collagen, mupirocin, and metronidazole, was used to fill the bony cavity. Postoperative CBCT evaluations at six months and one year revealed significant reduction in lesion size and satisfactory bone regeneration. This case highlights the therapeutic potential of combining PRF with a medicated collagen scaffold to enhance periapical healing, especially in complex defects where soft tissue ingrowth can impede osteogenesis.