Multidisciplinary Management of Failed Endodontic Treatment in a Hypertensive Patient With Severe Dental Anxiety...

Failed endodontic treatment may result in persistent pain and tooth loss, requiring careful evaluation to determine the most appropriate treatment approach. In medically compromised patients with severe dental anxiety, successful management also depends on medical stabilization, individualized treatment planning, and interdisciplinary collaboration. A 56-year-old female with a medical history significant for hypertension and severe dental anxiety presented with intense pain associated with a previously endodontically treated mandibular left first molar (tooth #19). The patient's baseline blood pressure was 160/80 mmHg; however, during the initial dental evaluation, it increased to 180/140 mmHg, prompting postponement of treatment and immediate communication with her primary care physician. The patient was referred for medical stabilization before definitive dental care was undertaken. After medical clearance, comprehensive clinical and radiographic examinations, including cone beam computed tomography (CBCT), confirmed failed endodontic treatment with an unfavorable prognosis. Following discussion of all treatment options and shared decision-making, the patient elected extraction followed by delayed implant-supported rehabilitation. Atraumatic tooth extraction and alveolar ridge preservation were performed using a deproteinized bovine bone mineral xenograft covered with a resorbable collagen membrane. A delayed two-stage implant protocol was selected to allow maturation of the grafted site before implant placement. Three months later, CBCT-guided digital implant planning was used to determine optimal implant dimensions, and a 5 × 13 mm dental implant was successfully placed. Following successful osseointegration, the restorative phase was completed using a digital workflow with a scan body and a definitive implant-supported crown. During rehabilitation, malocclusion and dental crowding were identified, resulting in referral for interdisciplinary orthodontic treatment. At the one-year follow-up, the patient demonstrated successful implant function, favorable peri-implant tissue health, restored masticatory function, and high satisfaction with the overall treatment. This case highlights the importance of comprehensive medical assessment, physician consultation, patient-centered decision-making, delayed implant placement following ridge preservation, digital implant planning, and interdisciplinary collaboration in achieving safe and predictable outcomes in medically compromised patients presenting with severe dental anxiety and failed endodontic treatment.