IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 18, Issue 1 Ser. 8 (January. 2019), PP 40-43 www.iosrjournals.org DOI: 10.9790/0853-1801084043 ww.iosrjournals.org 40 | Page Nonsurgical healing of large periapical lesion with nonsurgical root canal treatment and intracanal medicament of calcium hydroxide and chlorhexidine: a case report Dr. Pradnya V. Bansode 1 , Dr. Vaishali U. Bhalerao 2 Dr. Seema D. Pathak 3 , Dr. M. B. Wavdhane 4 , Dr. Hardik Rana 5 , Dr. Shilpa Rai 6 , 1 Professor & Head of the Department, Dept. of Conservative Dentistry & Endodontics, GDCH, Aurangabad, MUHS, Maharashtra, India 2 Postgraduate Student, Dept. of Conservative Dentistry & Endodontics, GDCH, Aurangabad, MUHS, Maharashtra, India 3 Professor, Dept. of Conservative Dentistry & Endodontics, GDCH, Aurangabad, MUHS, Maharashtra, India 4 Associate Professor, Dept. of Conservative Dentistry & Endodontics, GDCH, Aurangabad, MUHS, Maharashtra, India 5 Private Practitioner, Gujarat, India 6 Assisstant Professor, Dept. of Conservative Dentistry & Endodontics, GDCH, Aurangabad, MUHS, Maharashtra, India Corresponding Author: Dr. Vaishali U. Bhalerao Abstract: The present case report demonstrates the use of intracanal medicament of calcium hydroxide and 2% chlorhexidine for the treatment of nonsurgical healing of a large periapical lesion of a patient who was unable to report back for completion of treatment ; but despite of it showed healing of the lesion and tooth remaining largely asymptomatic even after 10 months of initiation of treatment. Keywords–calcium hydroxide, chlorhexidine, healing, non-surgical root canal treatment, periapical lesion, --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 30-12-2018 Date of acceptance: 15-01-2019 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Successful root canal therapy in cases of symptomatic teeth depends on the effective elimination of the focus of infection, efficacious cleaning shaping procedures, irrigation, intracanal medicament, and sealing of the root canal by three dimensional obturation and permanent restoration. With advances in the procedural and material aspects, use of a single appointment for completion of root canal therapy is preferred in most cases. But some cases still require placement of appropriate intracanal medicament for elimination of the bacteria and the biofilms. The materials that have been used conventionally as intracanal medicament include formocresol, camphorated monochlorophenol, calcium hydroxide, etc. Calcium hydroxide has since long been used as an effective interappointment medicament due to its effective antimicrobial activity and detoxification of bacterial lipopolysaccharides. [1] Chlorhexidine in its various concentrations and formulations has been used in dentistry as an effective antiplaque agent and its efficacy as a therapeutic adjunct in periodontics is well documented. [2][3][4][5][6][7] Since two decades its use as an endodontic irrigant and an intracanal medicament been proposed. [8][9][10] The present case report describes the effective use of calcium hydroxide with chlorhexidine as an intracanal medicament in the management of large periapical lesion associated with anterior teeth. II. CASE REPORT A 27-year-old male patient reported to the Department of Conservative Dentistry & Endodontics, Government Dental College and Hospital, Aurangabad in August 2017, with the chief complaint of pain in the upper front tooth for 4-5 days. The pain was of intermittent dull type and the patient could tolerate the pain, hence did not require any medication. The patient gave a history of trauma in the region of the front teeth in childhood at the age of 14 years. He also gave a contributory history of intraoral swelling associated with two upper front teeth 1 month back for which he had consulted a dental practitioner. He was prescribed medications after which the swelling subsided. On clinical examination, tooth no #21 & 22 showed brownish discoloration with no loss of coronal structure, suggestive of Ellis Class IV fracture of the tooth. There was no tenderness on vertical or horizontal