Healing Large Periapical Lesions Using Metapex—Report of a Case Series

Objective: To evaluate the clinical and radiographic effectiveness of Metapex as an intracanal medicament in the nonsurgical management of large periapical lesions. Methods: Three female patients (ages 44-55) presented to the Dental Department of Sanjeevan Hospital, Delhi, with extensive periapical radiolucencies associated with teeth 15, 26 and 46. Each case underwent thorough chemo mechanical debridement followed by placement of Metapex, a silicone-oil-based paste containing calcium hydroxide, 38% iodoform, and barium sulfate into the prepared canals. Systemic antibiotics were prescribed initially. Metapex dressings were refreshed at regular intervals over a period of four to five months. Patients were assessed for pain, swelling, and inter-appointment discomfort, and radiographic healing was monitored at 3-week, 2.5-month, and 5-month follow-ups. Results: All three patients reported complete resolution of pain and soft-tissue swelling without any inter- appointment discomfort. Serial periapical radiographs demonstrated progressive reduction in lesion size, with full trabecular bone regeneration observed by 2.5 months in the first case and by five months in the remaining cases. No adverse reactions or procedural complications were noted. Conclusion: Metapex, used as an intracanal dressing following conventional root canal therapy, facilitated predictable healing of large periapical lesions in this case series. Its combined antimicrobial action, biocompatibility, and radiopacity support its role as a first-line adjunct in conservative endodontic protocols for extensive periapical pathology. Keywords: Metapex, Intracanal medicament, Periapical lesion, Non-surgical endodontic treatment, Calcium hydroxide.