12th CONSEURO and the 25th National and 12th International SEOC Congress, April 3-5, 2025, Cordoba, Spain. Proceedings and Abstract

AimThis case report aims to describe the non-surgical endodontic retreatment and subsequent indirect overlay restoration of a mandibular first molar (tooth 4.6) presenting with symptomatic apical periodontitis following previous endodontic treatment. Case ReportA 56-year-old male patient presented to the Universitat Internacional de Catalunya clinic reporting "great pain when biting in the lower right molars".His medical history was non-contributory, with no known allergies, and he was classified as ASA I according to the American Society of Anesthesiologists.Clinical examination revealed pain upon percussion and palpation of the lower right first molar (tooth 4.6), with physiological mobility and periodontal probing depths, and no visible sinus tract.Pre-operative periapical radiography confirmed a previously endodontically treated tooth.Based on the American Association of Endodontists' criteria, the pulpal diagnosis was 'Previously treated tooth' and the periapical diagnosis was 'Symptomatic apical periodontitis'.The proposed treatment plan involved non-surgical endodontic retreatment followed by an indirect overlay restoration.During the retreatment, two canals were located.Gutta-percha was removed using a Reciproc M-file 25.08.Patency was established with a manual #10 Kfile.The mesial canal had a working length of 26 mm with an apical calibration of 40.02, while the distal canal measured 21 mm with an apical calibration of 55.02, both achieved with manual K-files.Prior to final obturation, a thorough irrigation protocol was performed sequentially: 4.25% sodium hypochlorite, followed by 10% citric acid, then another rinse with 4.25% sodium hypochlorite, and finally 96% alcohol. ResultsThe case was followed up for 6 months.The follow-up radiograph demonstrated healing of the periapical lesion.Clinically, the tooth remained asymptomatic, with no pain upon percussion or palpation, and maintained physiological mobility and periodontal probing depths. DiscussionThis case highlights the principles of minimally invasive dentistry (MID), prioritizing tooth structure preservation through non-surgical retreatment and direct/indirect restorative approaches.The choice of an indirect overlay restoration is consistent with modern restorative concepts.The observed healing of the periapical lesion and resolution of symptoms at 6 months aligns with successful outcomes reported for nonsurgical endodontic retreatments in the presence of periapical lesions ConclusionsThis case report demonstrates that non-surgical endodontic retreatment combined with an indirect overlay restoration can successfully manage symptomatic apical periodontitis in a previously treated mandibular molar, leading to periapical healing and complete symptom resolution within 6 months.This conservative interdisciplinary approach offers a predictable and effective option for the functional rehabilitation and preservation of compromised teeth. Endodontic management of tooth 4.5 through a bridge