Endodontic Microsurgery for Post-Treatment Apical Periodontitis: A Case Report

Persistent post-treatment apical periodontitis may remain after root canal treatment when microbial control is incomplete or orthograde retreatment is impractical. This four-case series describes endodontic microsurgery performed with magnification, root-end resection, ultrasonic retro-preparation, and calcium silicate-based retrograde materials, and places the cases in the context of a focused narrative review. Preoperative cone-beam computed tomography was used for surgical planning. The cases involved symptomatic or suppurative lesions in previously treated teeth for which existing crowns, posts, or prior retreatment limited further orthograde management. At 4–6 months, all patients were clinically asymptomatic and the available periapical radiographs showed early favorable healing. No standardized postoperative pain scores were collected. A focused narrative search of PubMed/MEDLINE, Crossref metadata, and journal websites identified nine recent case reports or small series (26 patients/cases) published from 2022 through August 2026. The reports included conventional, guided, navigated, and bone-lid approaches, together with case-based microbiologic and histologic findings; reported clinical outcomes were generally favorable but heterogeneous. The cases in this report are distinct from the 2023 case published by Soesilo et al.; no text or figures from that report were reused. Because this is a small uncontrolled series with short follow-up and nonstandardized outcome assessment, the findings are preliminary. Endodontic microsurgery can be considered a tooth-preserving option in carefully selected cases when nonsurgical retreatment is not feasible, but longer prospective follow-up with standardized clinical and radiographic outcomes is required