Modern Endodontic Surgery: A Case Report on Root Amputation & Apicoectomy of Maxillary Molar Using Guided Endodontics

Abstract

Endodontic surgery has significantly advanced with the incorporation of modern technologies such as guided endodontics, which has revolutionized the precision and predictability of surgical procedures like root amputation and apicoectomy. This case report describes the management of a complex case involving a maxillary first molar (tooth #26) with persistent periapical pathology despite prior conventional root canal therapy. The patient, a 30-year-old female, presented with symptoms of recurrent pain, swelling, and the presence of a periapical lesion with bony defect in the upper left maxillary region, which had not resolved following initial endodontic treatment.
A thorough diagnostic examination that included cone-beam computed tomography (CBCT) identified a significant periapical radiolucency involving the maxillary molar's distobuccal and palatal roots. The best course of action was found to be a combined technique comprising apicoectomy and root amputation due to the intricacy of the situation. Guided endodontics was used to improve surgical accuracy and reduce the likelihood of intraoperative complications. Using CBCT data, a 3D model of the tooth and surrounding anatomical components was created, and a surgical guide that was specifically tailored to the treatment was made to enable accurate navigation. The surgery involved the amputation of the affected roots at the furcation level, followed by apicoectomy of the remaining roots using ultrasonic instruments under magnification. The root-end cavities were subsequently filled with Biodentine to promote optimal healing. Postoperatively, the patient exhibited significant clinical and radiographic improvement, with complete resolution of symptoms and evidence of bone regeneration at the six-month follow-up.
This case emphasizes how important guided endodontics is to improving the success rates of difficult endodontic procedures. Clinicians can enhance patient outcomes, decrease the risk of iatrogenic injury, and gain more precision by utilizing modern imaging and navigation tools. The example emphasizes how crucial it is to incorporate contemporary surgical methods into the care of persistent periapical diseases, especially when all other therapeutic options have been exhausted.