Microsurgical Management of a Three-Rooted Maxillary Premolar: A Case Report

This case report details the management of a three-rooted maxillary first premolar presenting with symptomatic apical periodontitis after root canal has been done. An 18-year-old male patient experienced persistent pain localized around the treated tooth, despite a previous intervention six months ago. Clinical and radiographic evaluations revealed a complex three-canal system with a extruded material. Given the persistent symptoms and anatomical complexities, a combined approach of apicoectomy, surgical debridement and guided tissue regeneration was employed. No postoperative complications were observed and the 10-month follow-up confirmed satisfactory periapical healing and restoration of function. The treatment included the use of biocompatible materials and microsurgery techniques to enhance healing and structural integrity. This report highlights the importance of recognizing anatomical variations and discusses the effective integration of advanced surgical approaches and materials in managing complex endodontic cases. This case underscores the significance of recognizing rare anatomical variations and highlights the effective use of guided tissue regeneration and microsurgical techniques for successful endodontic outcomes. The follow-up demonstrated significant symptomatic relief and radiographic signs of healing, highlighting the effectiveness of the chosen management strategy.