Healing beyond the apex: Nonsurgical management of a periapical lesion with esthetic rehabilitation using direct composite veneers

Discoloration of nonvital anterior teeth, often resulting from pulpal necrosis and associated periapical pathology, poses both functional and esthetic challenges. Conservative management that addresses both biological healing and esthetics is essential in such cases. A 45-year-old female presented with pain and discoloration in the maxillary anterior region. Clinical and radiographic examination revealed a nonvital, discolored tooth 11 with a large periapical lesion and initial periapical changes in tooth 12. Root canal treatment was performed on both teeth using HyFlex EDM files and ultrasonically activated irrigation protocol. Obturation was completed using a bioceramic sealer. Intracoronal bleaching of tooth 11 was attempted using sodium perborate and hydrogen peroxide, but minimal improvement in shade necessitated direct composite veneers for teeth 11 and 12. Tooth 13 was also veneered upon the patient's request. The patient was followed up at 3, 6, 9, and 12 months, with satisfactory clinical and radiographic outcomes. A combination of conservative endodontic treatment and minimally invasive esthetic rehabilitation can effectively manage nonvital, discolored anterior teeth, ensuring both functional success and patient satisfaction.