Successful Nonsurgical Resolution of a Large Periapical Lesion With Pre-Existing Sealer Extrusion and Adjacent...

The primary aim of root canal treatment is to eliminate intracanal infection, achieve an apical and coronal seal, and create conditions that allow repair of the periapical tissues. In root-filled teeth, persistent apical periodontitis may be associated with extensive periapical lesions, external inflammatory root resorption affecting the treated or adjacent teeth, and extrusion of endodontic materials. These complications may lead clinicians to consider surgical approaches. However, when canals are adequately cleaned, disinfected, and hermetically obturated, favorable healing may occur following nonsurgical retreatment alone. This case report describes the nonsurgical management of a large periapical lesion associated with a previously treated maxillary lateral incisor. The lesion was complicated by pre-existing sealer extrusion and by external apical inflammatory resorption of the adjacent maxillary central incisor. Repeated calcium hydroxide intracanal medication and obturation were performed, followed by functional coronal restoration. Ongoing radiographic healing and clinical stability were observed at 20 months of follow-up, supporting an orthograde, conservative approach in similar clinical situations.