Apical surgery for treatment of persistent sinus tract caused by infected acessory canal

Apical surgery aims to treat periapical infections that endodontic treatment or retreatment has failure. This study aims to reporting 2 years and 8 months follow-up of a surgical retreatment of tooth 23 to solve a persistent sinus tract caused by a persistent root-infection of accessory canal. A 48-years-old male patient sought an endodontist due to a persistent sinus tract in the palatal portion of tooth 23, even after 2 previous endodontic retreatment. The radiographic and tomographic examinations demonstrated satisfactory endodontic treatment, absence of periapical lesion, over filling material, presence of fiberglass post on tooth 23. Also, fistula tract in the bone 5 mm from the apex associated with accessory canal were detected by tomography. The apical surgery was performed to treat and remove the persistent infection. The apicectomy and root-end preparation were performed. The root-end cavity was filled with Sealer 26 in dense consistency and apicoplasty was performed and the flat was sutured. The 2 years and 8 months follow-up of CBCT exam demonstrated a complete healing and the absence of sinus tract trajectory in the bone. In conclusion, the accurate diagnostic and surgical planning were utmost important to success.