Apicoectomy after conventional endodontic treatment failure: case report

Resumo

Paraendodontic surgery is a safe and adequate
alternative when teeth are not responding to conventional treatment
and endodontic re-treatment. It must only be applied in specific
situations. Endodontic treatment failures can be related to:
extraradicular infections such as periapical actinomycosis; to foreign
body reactions that can be caused by endodontic material extrusion;
to endogenous cholesterol crystal accumulation in apical tissues; and
unresolved cystic lesion. Paraendodontic surgery comprehends a set
of procedures recommended in periapical diseases treatment, when
traditional endodontic therapy does not obtain favorable outcomes.
Objective: To report a clinical case where an apicoectomy was
indicated due to failure in conventional endodontic treatment.
Case report and Conclusion: Clinical case report of a tooth with
unsatisfying conventional endodontic treatment history, due to lack
of treatment in fourth root canal and an unsuccessful apicoectomy,
since the lesion and the fistula had persisted. It was chosen to retreat
tooth #26 and perform a new apicoectomy in the mesiobuccal root.
The treatment was successful due to absence of fistula and painful
symptoms and due to periapical bone repair.