The Use of a Novel <scp>3D</scp> Printed Surgical Decompression Device to Induce Healing of Large Periapical Lesions: A Case Report

The development of periapical pathology is influenced by a variety of factors including local microbiology and pathophysiology. In large lesions, lone orthograde endodontic treatment is often insufficient in promoting healing of the periapical tissues and therefore is followed by apical surgery to reduce inflammation. While traditional surgical treatments often involve enucleation for cystic lesions, decompression techniques have shown to provide a less invasive alternative when combined with non-surgical and/or surgical endodontic treatment. The case presented here is a 21-year-old male with a large periapical lesion involving a root canal-treated right maxillary central incisor and nasopalatine canal; extending from the maxillary right lateral incisor to the maxillary left central incisor and having perforated buccal and lingual cortical plates. Clinically, the patient reported an associated fluctuant, non-tender buccal swelling. CBCT confirmed a well-condensed root canal filling; hence, it was decided to first treat the lesion conservatively using only the surgical decompression technique. Following a discussion about treatment options, the patient consented to surgical decompression. CBCT imaging alongside digital software was used to fabricate a customised decompression device that was sutured in situ for 4 weeks. Nine months following the removal of the device, CBCT showed evidence of osseous deposition, with a significant reduction of the periapical radiolucency and separation from the nasopalatine canal, thus portraying the use of decompression in its own right as a treatment option. Surgical decompression is not a novel technique, and the literature describes the use of various dental equipment such as suction tubing, needle hub, or dental dam material to facilitate decompression of a lesion. These devices have, however, shown to cause irritation, discomfort, and instability and are therefore not always effective in inducing healing. This case report describes the use of a novel digital workflow to fabricate a customised decompression device in the management of a large periapical lesion. The reduction of intra-cystic pressure alongside active irrigation reduced inflammatory compounds, contributing to a reduction in the lesion size and promoting osseous healing.