Microsurgical Endodontic Retreatment of a Mandibular First Molar with a recurrent Periapical Lesion

Abstract

Surgical endodontic retreatment is an established therapeutic approach for managing cases in which primary root canal treatment has failed. The use of high-magnification surgical microscopy has been shown to enhance procedural accuracy and improve treatment outcomes. This case report aims to present the clinical and radiographic results of surgical retreatment in a 43-year-old Thai female patient who presented with a persistent periapical infection associated with a previously treated mandibular first molar. The patient was referred for endodontic retreatment after reporting pain and tenderness during mastication on tooth 46, which had undergone root canal treatment and full-coverage restoration eight years earlier. The post, core, and crown restorations were in good condition with an intact margin. A periapical radiograph demonstrated an enlargement of the periapical radiolucency compared with a radiograph obtained four years prior, indicating failure of the primary endodontic treatment. After discussing treatment options, the patient elected to undergo surgical endodontic retreatment. The procedure was performed using modern endodontic microsurgical techniques under high magnification, including apicoectomy, and root-end filling with a bioceramic material. At the one-year follow-up, the patient remained asymptomatic, and radiographic examination demonstrated complete resolution of the periapical lesion.