(TC16) Management of Through-and-Through Lesions Using Bioactive Resorbable Membrane in Endodontic Microsurgery

Post-treatment endodontic disease is a challenging complication following root canal therapy. It is characterized by progressive destruction of periapical bone and surrounding periodontal apparatus. In cases of chronic periapical pathosis, extensive bone resorption affecting both buccal and lingual cortical plates can lead to the formation of through-and-through lesions. Traditional management of these lesions involves guided tissue regeneration (GTR) combined with endodontic microsurgery, using bone grafts and bioinert membranes as adjuncts. However, this conventional approach presents challenges, as it requires complex surgical techniques and yields unpredictable results, with success rates varying between 65% and 80%. These outcomes highlight the need for improved materials and techniques to enhance healing predictability. A bioactive material, dehydrated human amnion chorion membrane (dHACM), presents a promising alternative for tissue regeneration and healing in these cases. This bioactive material offers multiple therapeutic benefits, such as the recruitment of mesenchymal and hematopoietic stem cells through the release of growth factors and cytokines, as well as antimicrobial, anti-inflammatory, and immunomodulatory properties. Despite these advantages, the application of dHACM in GTR for through-and-through lesions remains unexplored. The purpose of this table clinic is to present the surgical procedures and treatment outcomes for managing through-and-through lesions using endodontic microsurgery combined with GTR and dHACM. Clinical cases will be presented to demonstrate the efficacy and potential benefits of this novel approach. With this knowledge, clinicians will be better able to manage extensive through-and-through lesions, potentially improving the predictability of endodontic microsurgery outcomes and enhancing long-term tooth preservation.