Periapical surgery on maxillary incisors for the treatment of persistent apical periodontitis

Abstract

In cases of persistent apical periodontitis lesions in teeth submitted to endodontic retreatment, surgical intervention may be the only alternative capable of treating the periapical infection without condemning the tooth to extraction. A 28-year-old female patient sought care in a private office with the chief complaint of discomfort on palpation in the buccal mucosa of the anterior incisors and a history of two endodontic interventions performed (endodontic treatment and retreatment). On clinical examination, no clinical signs of inflammation such as edema, erythema and fistula were observed. The radiographic examination showed a radiolucent area involving the apices of teeth 21 and 22. For the establishment of adequate diagnosis and planning, a cone beam computed tomography (CBCT) exam was requested, whose images revealed a hypodense periapical area with preservation of buccal and palatal cortical bone. The treatment plan involved periapical surgery on both teeth which included curettage, apicoectomy, root-end preparation and filling, and placement of bovine bone graft. The anatomopathological diagnosis was periapical granuloma. Two-year radiographic follow-up demonstrates complete bone repair. The aim of this study was to describe a case report of periapical surgical intervention in anterior teeth with persistent apical periodontitis whose planning was based on a CBCT scan.

Keywords: Periapical periodontitis, Apicectomy, Cone-beam computed tomography