Multidisciplinary approach for endodontic microsurgery combined with crown lengthening of tooth defects with apical lesion: a case series

BACKGROUND: Apical periodontitis in the anterior region is often accompanied by aesthetic defects, and its clinical management requires concurrent consideration of functional recovery and aesthetic rehabilitation. This report presents a rarely reported procedure combining endodontic microsurgery (EMS) and crown lengthening surgery (CLS) for anterior teeth with coronal defects and apical lesions. CASE PRESENTATION: This report presents two cases of residual crowns with apical periodontitis in the anterior region, for which a well-organized and coordinated multidisciplinary treatment protocol was implemented. Following detailed clinical assessment and meticulous treatment planning, a combination of EMS and CLS was performed simultaneously. EMS effectively controlled infection and promoted osseous healing, while CLS optimized the gingival contour and clinical crown length. More than six months after the combined surgery, the final prosthesis was delivered. The follow-up results for over one year confirmed that the affected teeth were clinically asymptomatic and exhibited incomplete healing radiographically in both cases, and also confirmed the stability of the crown lengthening surgery and restorative results. CONCLUSIONS: These cases demonstrate the advantages of EMS combined with CLS in treating complex affected teeth in the anterior aesthetic zone, eradicating infection, and facilitating rapid osseous healing. This approach may serve as a clinical reference for the preservation of similar complex anterior teeth in aesthetic zones.