Surgical and Regenerative Treatment of a Periapical Cyst After Endodontic Reintervention: A Case Report

Abstract

This case report aims to demonstrate the relevance of periapical surgical technique in the resolution of persistent endodontic pathologies and the use of autogenous graft combined with L-PRF membranes to enhance tissue regeneration. A 42-year-old female patient, treated at the School of Dentistry of UFAM, presented with spontaneous pain as the chief complaint. Clinical and radiographic evaluation revealed an acute periapical abscess and a radiolucent image suggestive of a periapical cyst. The initial approach consisted of an endodontic retreatment using a hybrid instrumentation technique and irrigation with 2.5% sodium hypochlorite, followed by obturation with gutta-percha cones and AH Plus® sealer. Subsequently, a periapical surgery was performed with enucleation of the cystic lesion, and the sample was sent for histopathological analysis. Retrograde filling was carried out using Bio-C Sealer Repair®. For bone reconstruction, an autogenous graft from the mandibular ramus was used, combined with leukocyte- and platelet-rich fibrin (L-PRF) membranes. The patient received postoperative care instructions and was followed clinically and radiographically at six- to twelve-month intervals to monitor healing and bone regeneration. The surgical and regenerative treatment adopted proved effective in managing persistent endodontic infection, resulting in satisfactory tissue recovery and a favorable prognosis. Keywords: endodontics, acute periapical abscess, periapical surgery, endodontic retreatment.

Keywords: endodontics, acute periapical abscess, periapical surgery, endodontic retreatment.