Retreatment + Endodontic Microsurgery – Tooth 26

A 67-year-old female (ASA II, controlled hypertension) was referred for retreatment of tooth 26. The patient reported a previous apical surgery in the same area years earlier. Radiographic and CBCT evaluation revealed a periapical lesion centered on the mesiobuccal root, associated with a previously resected apex and an untreated MB2 canal. The lesion measured approximately 5×4×5 mm and was classified CBCT-PAI 5+D (cortical bone destruction, according to Estrella, J Endod 2008). Diagnosis: acute apical periodontitis of endodontic origin due to persistent intraradicular infection (missed MB2 + prior apical resection without adequate canal disinfection). Orthograde retreatment was performed (unfilling, mechanical & manual shaping, NaOCl 3%, sonic activation, obturation with gutta-percha and bioceramic sealer). Despite this, the patient developed an abscess two…