Single-step integrated minimally invasive static-guided microsurgery for file retrieval from the periapex of...

Traditional endodontic surgery has often faced challenges, particularly in locating and removing broken file fragments within the surgical site near the periapex. A 55-year-old woman presented with pain in her lower left molar, and radiographs showed a fractured file extending beyond the apex of tooth #36. Initial attempts to retrieve the fragment using the braiding technique were unsuccessful after a second instrument separation, prompting the choice of guided microsurgical intervention. Utilizing cone-beam computed tomography and intraoral scans, a surgical template was designed and fabricated to enable precise osteotomy and root-end resection with file retrieval. The procedure included root canal treatment, with the distal canal filled with mineral trioxide aggregate before surgery. This single-step, novel, minimally invasive, guided microsurgery involved guided ostectomy and root-end resection, leading to successful retrieval of the file fragments. The treatment resulted in symptom resolution and uneventful healing.