International Journal of Clinical Case Reports 2016, Vol.6, No.22, 1-8
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Figure 10
Showing removed infected, necrosed bone with a continuous apico-marginal defect being seen along with buccal wall with
dehiscence and 3 mm of root resected for apicoectomy with 3 mm gutta percha removed from the apex with the help of a heated
probe
PRF preparation: Blood sample of the patient was drawn in 10 mL test tubes without an anti-coagulant and
centrifuged immediately. Blood was centrifuged using a tabletop centrifuge (REMY Laboratories, Chennai,
Tamilnadu, India) for 12 min at 3000 rpm. The resultant product consisted of the following three layers
(Figure11):
• the upper layer of acellular PPP (platelet-poor plasma);
• PRF clot in the middle;
• Red blood cells at the bottom.
Figure 11
Showing blood sample of the patient being drawn in 10 mL test tubes without an anti-coagulant for centrifugation
Platelet rich fibrin was then separated by cutting with a sterile surgical scissor and collected using a dappen dish.
(
Figure 12
) PRF clot was placed inside the periapical defect. (
Figure 13
) A demineralised bone matrix (DBM)
xenograft was then placed over the peri-apical defect and also, the entire root length devoid of bone. (
Figure 14
) A
Collagen membrane was finally placed over the defect. The Collagen membrane was cut according to requirement
and then placed over the defect using 4-0 vicryl resorbable suture. (
Figure 15
) The flap was sutured with 3-0 black
braided silk. (
Figure 16
) A perio pack was then mixed and placed over the sutured area so that the repositioned
flap be immobile till healing ensued. (
Figure 17
) Immediate post-operative radiograph (IOPAR) was advised.
(
Figure 18
) Antibiotics and analgesics were prescribed for one week. After 15 days, the pack was removed. The
sutures were removed and the healing was found to be uneventful. The crown preparation with 11 was done
(
Figure 19
) and elastomeric impression was recorded. (
Figure 20
) All Ceramic Emax crown was fabricated and
cemented. (
Figure 21
) The patient was asked for regular follow-up visits and the 12 months post-operative
radiograph was taken which revealed apparent bone fill with resolution of the osseous defect. (
Figure 22
) Clinical
