Implant-Supported Rehabilitation Following Endodontic Failure in a Patient Classified as American Society of Anesthesiologists (ASA) Physical Status III With Chronic Post-Stroke Hemiplegia: A Multidisciplinary Dental Case Report

Patients with chronic neurological disabilities frequently present significant challenges in dental treatment due to functional limitations, impaired oral hygiene, and concerns regarding medical risk. These challenges often result in delayed care or refusal of treatment, particularly when surgical procedures and implant rehabilitation are required. This report describes the multidisciplinary dental management of a 76-year-old male patient classified as American Society of Anesthesiologists (ASA) Physical Status III with a history of ischemic cerebrovascular accident resulting in chronic right-sided hemiplegia, facial paralysis, wheelchair dependence, and reduced ability to perform oral hygiene independently. The patient presented on an emergency basis with severe pain associated with a previously endodontically treated maxillary right second premolar. Clinical and radiographic evaluation, including cone-beam computed tomography (CBCT), revealed persistent periapical infection consistent with endodontic failure. Given the patient's medical history, a comprehensive hospital-based medical evaluation and neurological clearance were obtained prior to treatment. The patient's poor oral hygiene status was addressed through caregiver-assisted oral hygiene instruction, professional dental cleaning, and infection control measures. Following medical approval, the affected tooth was extracted, and alveolar ridge preservation was performed using particulate bone graft material and a resorbable collagen membrane. After a six-month healing period, implant placement was completed using CBCT-guided treatment planning. Three months later, a definitive screw-retained implant-supported crown was fabricated using a digital workflow and successfully delivered. The patient experienced complete resolution of pain, restoration of masticatory function, and improvement in overall quality of life. This case highlights the importance of multidisciplinary dental management, advanced imaging, medical clearance, and caregiver involvement when treating medically stable ASA III patients with chronic post-stroke disabilities. The outcome observed in this carefully selected patient suggests that implant-supported rehabilitation may be successfully performed when appropriate individualized medical assessment, maintenance, and long-term oral hygiene support are available.