Fig. 1

A 28 yers old patient was referred to me due to repeated abscesses on tooth 2.2

Fig. 2

The patient had a sinus tract on 2.2.

The referring dentist asked to make a root canal treatment on tooth 2.1 (negative response to pulp sensitivity test, negative response to electric test) and specification of tooth 2.2

Fig. 3

The pre operative CBCT showed the width of the lesion and the size of the apex

Fig. 4

The access cavity on tooth 2.2 was corrected

Fig. 5

The temporary root canal filling material was removed

Fig. 6

The intra and post operative X-ray show the removal of the canal dressing and the apical plug with MTA.

Fig. 7

72 hours later the MTA hardening was checked and the root canal therapy was finished.

Fig. 8

In a following appointment the root canal treatment of tooth 2.1 was done

Fig. 9

1 month later the patient still had a sinus tract on tooth 2.2 and in the time between the initial therapy and the recall she had multiple abscessed

Fig. 10

It was decided to treat both incisors with a surgical approach. After raising a flap and removing the lesion, methylene bue helped identifying the anatomy.

Fig. 11

Both apices were resected

Fig. 12

After the retro-preparation, a root end filling material was positioned.

Fig. 13

The material set was checked before finishing the therapy

Video of the procedure

Fig. 14

Post operative X-ray

Fig. 15

4 months follow up

Fig. 16

9 months follow up

Fig. 17

2 years follow up

Fig. 18

4 years follow up


A careful analysis of the reasons for failure of the initial treatment help the clinician picking the correct solution for each endodontic case.


Azim AA, Albanyan H, Azim KA, Piasecki L. The Buffalo study: Outcome and associated predictors in endodontic microsurgery- a cohort study. Int Endod J. 2021;54(3):301-18.

Curtis DM, VanderWeele RA, Ray JJ, Wealleans JA. Clinician-centered Outcomes Assessment of Retreatment and Endodontic Microsurgery Using Cone-beam Computed Tomographic Volumetric Analysis. J Endod. 2018;44(8):1251-6.

Eskandar RF, Al-Habib MA, Barayan MA, Edrees HY. Outcomes of endodontic microsurgery using different calcium silicate–based retrograde filling materials: a cohort retrospective cone-beam computed tomographic analysis. BMC Oral Health. 2023;23(1):70.