APICAL MICROSURGERY IN THE MANAGEMENT OF SYMPTOMATIC APICAL PERIODONTITIS OF TOOTH 2.2 AFTER ORTHOGRADE RETREATMENT: A CLINICAL CASE

Background: Apical periodontitis is a host-mediated inflammatory disease of periradicular tissues initiated and sustained by microbial infection of the root canal system. Persistent apical periodontitis following technically adequate orthograde retreatment remains a significant biological and clinical challenge.Although contemporary endodontic therapy demonstrates high long-term success rates, post-treatment apical periodontitis continues to present a clinically relevant problem. Objective: This report describes the diagnostic rationale, microsurgical management, and 12-month cone-beam computed tomography (CBCT) outcome of a maxillary lateral incisor presenting with recurrent symptoms after retreatment. Materials and Methods:A 23-year-old male presented with pain on biting two months after nonsurgical retreatment of tooth 2.2. Clinical examination and CBCT imaging demonstrated homogeneous root canal obturation and a localized 3-mm periapical radiolucency with preserved cortical integrity. Apical microsurgery was performed under magnification, including flap elevation, conservative osteotomy, resection of 2.5 mm of the apical root segment, ultrasonic retrograde cavity preparation (3 mm), and retrograde filling with mineral trioxide aggregate (MTA). Clinical and CBCT follow-up was conducted at 12 months. Results:Postoperative healing was uneventful. At 12 months, the patient was asymptomatic, and CBCT imaging demonstrated complete resolution of the periapical lesion with restoration of normal trabecular architecture. Conclusion: Apical microsurgery is a predictable, biologically rational, and minimally invasive treatment modality for persistent symptomatic apical periodontitis following technically adequate orthograde retreatment. Careful case selection, CBCT-guided diagnosis, and adherence to contemporary microsurgical principles enable preservation of natural dentition with favorable clinical and radiographic outcomes.