Endodontic Microsurgery In Maxillary Molar Using Buccal And Palatal Approach

This case report focused on endodontic microsurgery using buccal and palatal approaches in maxillary first molar. This case report focused on the right maxillary first molar of 60-year-old man who presented with the main complaint of swelling and pain for 6 months. Clinical examination revealed the right maxillary first molar (tooth #16) was tender on mild percussion, sinus tract was found in the palatal mucosa. Periapical radiography showed that tooth #16 had undergone root canal treatment and showed periapical radiolucency. Cone-beam computed tomography revealed periapical radiolucency surrounding the apex of the buccal and palatal roots, defect on the palatal plate. A diagnosis with chronic apical periodontitis in tooth #16 was established. During apical surgery, full-thickness flaps were raised on the buccal and palatal sides. An intact cortical plate on the buccal side and a bone defect on the palatal side were observed. After resecting a 3 mm root tip, root-end preparation and filling, the flaps were closed and postoperative radiography was performed. At 3- and 6-month follow-ups, tooth #16 was asymptomatic, percussion-negative, and had no mobility. Periapical radiographs showed healing of the periapical lesions. Endodontic microsurgery using buccal and palatal approaches represents an effective option for refractory periapical periodontitis of the maxillary molars following unsuccessful root canal therapy. The buccal and palatal approaches may be more suitable for microsurgery for apical periodontitis of the maxillary molars with buccal and palatal periapical lesions.