Endodontic Surgery Management of a Large Periradicular Actinomycosis Lesion

A 22-year-old female patient consulted the Odontology Department of the Mohammed V Military Hospital in Rabat, Morocco, for a recurrent abscess in relation to the left maxillary central incisor (#21). The dental history of the tooth began with necrosis following trauma a few years before. A conventional endodontic root canal treatment was performed, but several infectious episodes occurred, treated only with antibiotics. The radiographic examination showed an adequate root filling and a large apical lesion in Tooth #21. Tooth #21 was diagnosed as chronic apical periodontitis. After orthograde retreatment, clinical signs have not resolved, and the patient has consulted for a recurrent abscess. Given this atypical clinical situation, an extraradicular infection was suspected and the decision for endodontic surgery was made. The histopathological diagnosis revealed actinomycotic infection. The aim of this case report is to draw practitioners' attention to this rare infectious etiology, which does not respond to conventional endodontic treatment, and to expose the diagnostic and therapeutic approach required to treat apical actinomycosis.