Healing outcome in nonsurgical root canal treatment versus periapical surgery versus Intentional replantation for management of large periapical lesion of Endodontic origin.

Large periapical lesion (LPL) of endodontic origin are primarily caused by bacteria and their by-products emanating from the root canal system. These lesions are expected to heal if the source of infection (intracanal bacteria and bacterial-by products) is eradicated. Non-surgical root canal treatment (NSRCT) has a good success rate for management of LCPL. However, NSRCT may require multiple visits. Hence, in many cases surgical intervention may be required. Despite the advances in periapical surgeries, some cases of LPL cannot be managed surgically due to surrounding anatomical or neurovascular structures (e.g.; proximity to the mental nerve or maxillary sinus), or lack of accessibility (e.g.; thick buccal bone, endodontic-periodontal lesion, repair of a palatal radicular groove or extensive root perforation). Moreover, periapical surgery is an invasive procedure which takes long intraoperative time period with possibility of post-operative swelling and pain. Intentional replantation (IR) is defined as a deliberate extraction of tooth, following which the tooth undergoes inspection, endodontic manipulation and repair and is then replanted back into the same socket . Intentional replantation (IR) results in elimination of diseased tissue, removes apical

ramifications and provides a better quality of apical seal due to the improved access and ease of manipulation. IR addresses both intraradicular and extra-radicular infection. In this regard, it offers benefits of both non-surgical endodontic treatment and peri-apical surgery. It offers several advantages with reduced morbidity; less invasive; less technique-sensitive procedure that can potentially be done by general dental practitioners and is more cost-effective. Moreover, IR is done within 15-20 minutes, with very less postoperative complications. The aim of the study is to evaluate and compare the CBCT outcome of non-surgical root canal treatment with intentional replantation and periapical surgery performed for management of maxillary anterior large periapical lesion of endodontic origin.