Apicoectomy on a maxillary molar

Microsurgery, specifically surgical endodontics, is a solution when conservative endodontic treatment fails. In this case, a conservative endodontic treatment had been performed, followed by a re-treatment by the referring dentist. A crown had been placed, which the patient did not wish to replace. Clinically, the crown had marginal discrepancies, but there was no sign of decay, and its retention could be considered. Similarly, in the first upper molar (#16), there was a fistula leading to the mesial root, although no clinical pocket was observed. Radiographically, the endodontic treatment appeared acceptable, with a potential shift in the mesial root. A cone-beam computed tomography (CBCT) scan was requested from the patient, which revealed the following: a large periapical lesion on the mesial buccal root with extension to the distal root, in contact with the maxillary sinus membrane, and no periapical lesion on the palatal root.

The presence of displacement and the absence of any lesion on the palatal root led to the decision for a surgical approach. During the surgery, a crack or fracture in the mesial buccal root was ruled out, and the apical displacement of the root canal in the same root was confirmed. Initially, the granulomatous tissue was removed, and an apicoectomy was performed on the mesial buccal root. An inverted preparation was then done using ultrasound, and the preparation was checked both microscopically and through a retroalveolar X-ray.

The cavity was then filled with bioceramic material (BC putty), and an apicoectomy was performed on the distal root. After thorough examination with the optical microscope, the integrity of the filling was confirmed. The flap was sutured, and a final radiograph was taken. A few days later, the sutures were removed, and healing was evaluated.