Endodontic Microsurgery as a Primary Treatment for Pulp Canal Obliteration With Apical Periodontitis: Case Reports

Pulp canal obliteration (PCO), commonly following dental trauma, is characterized by progressive canal calcification and may be associated with pulp necrosis and apical periodontitis (AP). Conventional root canal treatment (RCT) may be technically unfeasible or associated with a high risk of iatrogenic complications. In the case reports, we explored endodontic microsurgery (EMS) as a primary treatment strategy for managing PCO with AP. Three patients (aged 30-46 years) presented with a history of dental trauma, severe canal calcification, and radiographic evidence of apical radiolucency, with or without associated bone loss. All cases were diagnosed using cone beam computed tomography (CBCT) and managed with EMS as the primary treatment approach, combined with iRoot BP Plus for apical sealing. Clinical symptoms, including gingival abscesses, resolved following treatment, and radiographic follow-up (up to 3 years) demonstrated resolution of periapical radiolucency and evidence of bone healing in all cases. Within the limitations of these case reports, primary EMS may represent a feasible alternative for selected cases of PCO with AP, allowing effective management of periapical pathology while avoiding the risks associated with attempting RCT in severely calcified canals.