At the extraction appointment, the chronic periapical lesion is mechanically debrided with the 2mm Branemark twist drill. It is most important that the twist drill penetrate the superior sclerotic border of the bone lesion (Figure 2).This is aimed at reinstituting the microcirculation and removing necrotic bone and reducing attached biofilm established in the extraradicular infection

The radiographic presentation three months post extraction reveals bony regeneration reflecting improvement in bone quality and quantity. Radiographic digital density comparison shows a good increase in pixel density, a site with a developing trabecular pattern and a reduction in sclerotic demarcation of the former lesion (Figure 3).

Microbiological evidence suggests that the superior sclerotic demarcation of the lesion confines the microbial presence at the apex, and that the bone immediately superior to this will be negative culture or significantly reduced in numbers of species and counts. In the anterior maxilla bone quality increases with increasing proximity to the nasal cortex, meaning that there is a microbiological and biomechanical advantage in placing the fixture apex superior to the former sclerotic margin (Figure 4).