Surgical Management of Endodontic Failure and Dental Neglect: A Pediatric Case Report

The ultimate goal of an endodontic treatment is to eliminate infection, thoroughly clean and disinfect the root canal system, and prevent reinfection. Although endodontic procedures generally demonstrate high success rates, failures may still occur due to factors such as inadequate obturation or overextension of root-filling materials. Gutta-percha extrusion beyond the apex can lead to persistent inflammation and compromise the healing. This case report presents a 12-year-old girl with a two-month history of continuous pain and swelling in the maxillary anterior region. The patient had a history of dental trauma and previous root canal treatment and retreatment for tooth 21. Clinical and radiographic findings revealed periapical radiolucency with incomplete and over-extruded obturated material. An attempt to remove the extruded material using Hedstrom files under a Dental Operating Microscope (DOM) was unsuccessful, and persistent symptoms necessitated surgical intervention. This case presents the clinical challenges associated with an over-extended obturation and the limitations of nonsurgical retreatment in managing such conditions. Surgical endodontics, guided by American Association of Endodontists (AAE) protocols, can effectively manage persistent symptoms associated with over-extruded filling material. Timely intervention and adherence to clinical protocols are critical in ensuring successful long-term outcomes.