Endodontic Microsurgery with Orthodontic Treatment in a Mandibular Left Molar with Symptomatic Apical Periodontitis

Endodontic microsurgery has reduced the degree of treatment trauma compared with traditional apical surgery and further increased the success rate of natural teeth retention. However, when root apices of the mandibular posterior teeth are far from the buccal cortical bone surface or near to the inferior alveolar nerve, the operational difficulty of endodontic microsurgery increased greatly. Orthodontic treatments may be helpful to decrease the difficulties. In this case, the roots of a highly calcified mandibular molar diagnosed as previously initiated, symptomatic apical periodontitis were moved initially buccally by orthodontic treatment in 2 months. Then, endodontic microsurgery was completed. The tooth remained asymptomatic and functional with a radiographically healing periapical lesion at the 4-, 12-, and 24-month follow-ups.