Surgical Procedure to Optimize the Esthetic and Osseous Outcomes for Young Adults with Large Periradicular Defects: Two Case Reports.

Teeth exhibiting internal root resorption or those with persistent large periapical lesions after nonsurgical endodontic treatment are generally considered to have an unfavorable prognosis. Extraction of teeth with an unfavorable prognosis, followed by dental implant placement, has become an acceptable treatment option. However, implants are not indicated for young people with growing arches. Consequently, it is recommended that clinicians prioritize the preservation of natural dentition in younger patients and defer implant therapy until skeletal growth has ceased. In cases where tooth preservation is attempted despite severe periradicular defects, a surgical approach is often required to manage associated symptoms. However, modern periradicular surgery frequently leads to unesthetic complications such as conspicuous scar formation or gingival recession. The introduction of novel combined surgery-including guided tissue regeneration, deepithelialized free gingival graft, and coronally advanced flap-optimizes the clinical outcome, addressing both the functional and esthetic needs of the patient.