Cone-Beam Computed Tomography (CBCT)-Guided Surgical Guide for Implant Placement Following Failed Endodontic...

Successful implant rehabilitation depends on accurate diagnosis, adequate preservation of the alveolar ridge, and precise implant positioning. Teeth with persistent periapical pathology following failed endodontic treatment often require extraction, making careful treatment planning essential to achieve predictable functional and esthetic outcomes. The use of cone-beam computed tomography (CBCT) and computer-designed surgical guides has improved the accuracy of implant placement while facilitating prosthetically driven treatment. We present the case of an American Society of Anesthesiologists (ASA) Physical Status I patient with no known drug allergies who presented with persistent pain and a chronic periapical infection associated with the mandibular left first molar after unsuccessful endodontic treatment and retreatment. The patient also reported significant dental anxiety, which was managed through comprehensive education and step-by-step explanation of every stage of treatment. Following initial pharmacological management, the tooth was atraumatically extracted, and alveolar ridge preservation was performed using particulate bovine bone graft and a resorbable collagen membrane. After four months of healing, CBCT was used to evaluate the regenerated ridge and fabricate a computer-guided surgical template. Implant placement was performed using the surgical guide, followed by a six-month osseointegration period. The restorative phase was completed using a digital workflow with an intraoral scan and scan body to fabricate the definitive implant-supported crown. Clinical and radiographic follow-up demonstrated successful osseointegration, healthy peri-implant tissues, restoration of function, and a satisfactory esthetic outcome. The patient reported complete resolution of symptoms and a positive treatment experience, with anxiety successfully controlled throughout the multidisciplinary treatment process. This case highlights the value of CBCT-based surgical guides, alveolar ridge preservation, and digital restorative workflows in achieving predictable implant rehabilitation after failed endodontic retreatment. It also emphasizes the importance of patient education and effective communication in reducing dental anxiety and improving treatment acceptance and overall clinical outcomes.