ABSTRACT
In cases where endodontic treatment is unsuccessful, endodontic retreatment is usually the first option for clinical management. However, it is possible for periapical infection to persist. Eventually, these apical infections reach inaccessible locations, requiring surgical intervention. Female patient, elderly, diabetic, without other comorbidities and allergies, presented a persistent circumscribed and well-defined periapical bone defect around the root apex of the left maxillary lateral incisor (#22), with disruption of the buccal and palatal bone plates, with no signs of regression after six months of endodontic retreatment. The objective of this paper was to demonstrate the stages of endodontic surgery − apicoectomy of an upper left lateral incisor, with bone graft and collagen membrane, both of bovine origin, as well as six months’ postoperative follow-up. It can be concluded that endodontic surgery performed with bovine bone graft and collagen membrane showed therapeutic success, considering a six-month follow-up period. Periodic clinical and radiographic follow-ups are strongly recommended for the assessment of endodontic surgery success.
Indexing terms
Apicoectomy; Bone transplantation; Membranes, artificial
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Note: 1: 3D Reconstruction - Cone Beam Computed Tomography, illustrating periapical bone defect in the region of left maxillary lateral incisor (#22). 2: Final periapical X-Ray after endodontic retreatment of left maxillary lateral incisor (#22). Satisfactory appearance of root canal filling and circumscribed periapical bone rarefaction – (#22). 3: Sagittal section of CBCT, highlighting periapical bone defect in left maxillary lateral incisor (#22). 4: Xenogenic bone graft and resorbable collagen membrane was used in this case.
Note: 5: Initial aspect after semilunar incision and tissue divulsion. Note the apical bone defect and root apex of left maxillary lateral incisor (#22). 6: Aspect after osteotomy of sclerotic margins of the periapical bone defect around left maxillary lateral incisor (#22).
Note: 7: Surgical site appearance after removal of the root apex of left maxillary lateral incisor (#22) (Apicoectomy). Still without curettage. 8: Resorbable collagen membrane and bone graft, both of bovine origin, properly installed. Covering the surgical site with resorbable collagen membrane, of bovine origin, after bone graft insertion. 9: Suturing performed with 07 (seven) simple interrupted suture using 4-0 Nylon thread.
Note: 10: Periapical X-ray seven days after the procedure. 11: Periapical X-ray six months after the procedure.