Traumatic injury of anterior teeth is common and may lead to cyst over a period of time. Root perforation is contrived communication between root canal system and the supporting tissues of teeth or the oral cavity. Iatrogenic root perforation is a procedural mishap but quite an uncommon event, which may occur at any stage of root canal therapy, from access cavity preparation to post-space preparation, on any tooth. Perforations are reported to result in lower success rates. How they are managed can make the difference between retention and the loss of a tooth. It results in bacterial contamination, peri-radicular tissue injury, inflammation, and bone resorption. The purpose of this case report is to describe the endodontic retreatment and surgical management of a longstanding periapical lesion on maxillary central incisor, associated with perforation using mineral trioxide aggregate. MTA is bioactive material and shows good sealing activity for perforation repair and apical seal. For large periapical cyst healing PRF was used and Novabone putty was used for the healing of osseous defect.