Integrated Endodontic–Surgical Treatment of a Large Periapical Lesion and Apical Third Root Fracture with Displaced Root Tip

Horizontal root fractures are uncommon traumatic dental injuries, comprising 1.2%–7% of cases, most often affecting the anterior maxillary region. The prognosis is influenced by fracture location, mobility, pulp vitality, and periapical pathology, with apical third fractures usually having a favorable prognosis but may require intervention when complicated by necrosis, resorption, or fragment displacement. Advanced imaging techniques like cone beam computed tomography are critical in identifying fractured fragment position and extension of the lesion. When conventional endodontic management is insufficient, surgical removal of fractured root fragments combined with periapical curettage and regenerative techniques such as bone grafting and guided tissue regeneration may improve healing. This case report presents a rare apical third root fracture with apical fragment migration and a large periapical lesion, successfully managed by an integrated endodontic–surgical approach.