Sealing the End : Root End Surgery for a Persistent Periapical Pathosis : A Case Report

Surgical root canal therapy, or apicoectomy, is indicated when non surgical re-treatment is unsuccessful or impractical. The procedure involves resection of approximately 3 mm of the root apex, removal of periapical pathology, preparation of a root end cavity, and placement of a retrograde filling to establish a hermetic apical seal. Various root end filling materials, including amalgam, gutta-percha, zinc oxide-eugenol cements, glass ionomers, and bioceramics, have been employed; however, mineral trioxide aggregate (MTA) has emerged as the material of choice due to its superior sealing ability, biocompatibility, and capacity to promote regenerative healing. This case report presents a case of a 22-year-old male with a persistent periapical lesion associated with tooth 21. Following unsuccessful non surgical management, apicoectomy was performed with root end filling using MTA. Postoperative evaluation revealed uneventful healing, histopathological confirmation of periapical granuloma, and radiographic evidence of bone regeneration at 5 months. This case highlights the effectiveness of apicoectomy as a predictable treatment modality in managing refractory periapical pathology, with success rates exceeding 85–90% when combined with modern microsurgical techniques and biocompatible materials.